KHOPOTSO: It was just after lunchtime on Tuesday when I fetched Goitsemang from his place of work in Parktown, Johannesburg. I asked him his expectations before we met the doctor.      

GOITSEMANG: I just hope that the doctor will be able to give me more information ‘€“ not only myself, but as well as my family ‘€“ as to what steps to take in terms of ensuring that my sister, Dibuseng, lives a fruitful and very much enjoyable life’€¦ Most of the questions are actually based around nutrition because it’€™s very much important for her as well as the family to know what kind of food-stuffs and what kind of medicines as well, if there are any, to take in terms of making sure that the progression of the virus does not get worse’€¦ I’€™m actually feeling very much confident’€¦ I believe that the advice that I will be able to get from him is going to be very much beneficial.

KHOPOTSO: It was after official consulting hours when we arrived at Dr David Spencer’€™s rooms at the Linksfield Medical Centre, in Orange Grove. It was quiet and empty. Dr Spencer was expecting us and was keen to hear from Goitsemang.    

 Dr SPENCER: I’€™d like to know whether this young man’€™s sister is ill with HIV, or is just living, with HIV. There’€™s a difference between the two. Many, many people are living with HIV and getting on with their lives quite well. But a time comes in most people’€™s lives when the immune system is weakened by it, and as a result they develop various diseases and then we say that they are no longer just living with HIV, but that they now are sick with it. And so, I’€™d want to know if this young woman is sick with HIV.

KHOPOTSO: Goitsemang, quickly filled the doctor in.

GOITSEMANG: She has lost weight. I’€™m not sure whether she’€™s living with it or sick with it.

KHOPOTSO: So, what does that mean, doctor?

Dr SPENCER: What that means is that one has moved already to a phase of being sick with HIV. When we start losing weight it implies already that the virus has done substantial amount of damage to our bodies, either because of the virus itself, or because of other infections that we pick up because our immune system is so weak. So, it does really say to me, hey, this young person needs help.

KHOPOTSO: Dr Spencer went on to explain to Goitsemang what kind of help Dibuseng would need, based on a three-point intervention method.      

Dr SPENCER: I think the first level is meeting with this young woman and finding out what, physically, is wrong’€¦ If I was her doctor I’€™d want to interview her’€¦ I’€™d want to examine her, and maybe, if necessary, do special things like a chest X-ray or look at various secretions: urine, stool and sputum to see if there was a germ or some bug that requires treatment’€¦ There’€™s an opportunity now for horrible bugs, like TB and so on, to get into this body’€¦ I want to identify what that process is that’€™s making her lose weight, stop it and get her well.

The second thing that I would want to then do is that I’€™d want to identify the stage of her HIV infection. What stage is she at? Does she need treatment now for that HIV virus? We have excellent drugs’€¦ that can now reverse the whole HIV process. It cannot cure, but it can undoubtedly reverse this HIV infection’€¦

And the third thing that I would want to do with this young person is I would want to look at her as a whole human being with emotional needs, with needs of a spiritual nature. Who am I? Why has this happened to me? The whole question of guilt and shame and doubt. And I would want to address the broader issues of who she is in our society, in our community because I’€™d want her to build up confidence enough to get back into society and get on with life.

KHOPOTSO: In the next feature, Dr Spencer urges Goitsemang to convince his sister to urgently find a doctor who treats and understands HIV and offers advice to the family about how best to support her.

E-mail Khopotso Bodibe