KHOPOTSO: At the time of her diagnosis with HIV three months ago, Goitsemang’€™s sister, Dibuseng, had lost a considerable amount of weight. According to Dr David Spencer, an Infectious Diseases Physician at a private practice in Johannesburg, Dibuseng might have been infected a long while ago. This underlines the importance of early testing for HIV, which can help one deal with a positive result more appropriately and efficiently. Dr David Spencer’€™s advice to Goitsemang:

Dr SPENCER : ‘€œNo wasting time now’€¦ Get to grips with the situation. No putting your head in the sand like an ostrich. But hey, say, to this young woman we wanna help you. And get her in touch with a competent doctor, physician, GP, whatever, who knows what they’€™re doing and get her onto the medication that’€™s gonna help stop her losing weight, and uncover the underlying process ‘€“ whether it’€™s TB’€¦ chronic diarrhoea or tummy infections. Then secondly, get the virus under control.

KHOPOTSO: He further explained why the loss of weight is such a significant aspect in the HIV and AIDS equation.

Dr SPENCER: A critical definition of AIDS is a loss of 10 percent body weight or more. Say, if you’€™re a 70kg man and you’€™ve lost 7 or more kg’€™s ‘€“ you’€™ve lost 10 percent ‘€“ so, you’€™re down at 63 or 62, then you can say, hey, by definition this is AIDS’€¦ And I would say if your sister’€™s lost 10 percent of her body weight, then I wouldn’€™t just say, aag, this is depression or she’€™s unhappy. It could be’€¦ But I would try and find out – is there TB here, is there an underlying process that actually needs to be stopped.

KHOPOTSO: In light of this, Goitsemang had some questions to ask the doctor.

GOITSEMANG: In terms of nutrition, what kind of foodstuffs should she use?

Dr SPENCER: Goitsemang, my brief answer to that is that a balanced, healthy diet is required. And when I talk about a balanced, healthy diet I’€™m talking about protein, carbohydrates, fats, minerals and vitamins’€¦ But they don’€™t have a primary role. And so, I need, one, to identify what’€™s making my patients ill and get rid of that. And secondly, I need to get to the virus and stop that virus from growing. We can’€™t cure it’€¦ But we do have excellent anti-viral drugs’€¦ that will prevent that virus from continuing to damage my immune system. So, the bottom line is to put my patients onto those things. And then after that look at these broader aspects of diet, of immune boosters, of why is my patient ‘€“ why have they got themselves into this mess in the first place and how can I help them make their decisions about their lives in future and to kindalike, walk the road well, in future.

GOITSEMANG : What is the role of the family in terms of counselling’€¦ helping her to get on her feet?

Dr SPENCER : The family is there to grow me as a human being and say, hey, my sweetheart, you made a mistake. You’€™re infected, but we love you’€¦ And that is what the human heart in this disease, HIV, has to hear. Otherwise, they are gonna give up. And when the time comes for taking drugs everyday of your life and feeling nauseated with the drugs, or having to have blood tests done every three-four months and just the sheer fatigue’€¦ that’€™s when you need the family around you. Not just when the diagnosis is made, but for the whole trip’€¦ for the next ten, twenty years.  

KHOPOTSO: Dr Spencer, talking to Goitsemang. I asked the doctor if there is hope for Goitsemang’€™s sister, Dibuseng.

Dr SPENCER: I think there is. I truly do. I do think that if this young lady can be convinced that this is not the end of the road’€¦ I have no doubt that provided this person within her spirit, within who she is as a human being, can be convinced, can hear the right message, then the drugs ‘€“ if she needs them ‘€“ will work. She will take them reliably. She’€™ll get on with her life and make something of it.

KHOPOTSO: Dibuseng is fortunate that her family is prepared to help her and that they can afford the cost of anti-retrovirals when she needs them. But many other people’€™s hopes are pinned on the pending decision by Cabinet as to when the medication will become available in the public health sector. As we left the doctor’€™s rooms, Goitsemang reflected on Dr Spencer’€™s advice.

GOITSEMANG:  The doctor talked about confidence. I’€™ll definitely have to talk confidence into her and to encourage her that this is not the end of the world. Obviously, that needs a lot of work to do in terms of convincing her. I will go down and talk to her as well as meet with the family because they have been very much supportive. Absolutely, I think the advice was very much fruitful.

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