Taking advantage of mixed messages
Living with AIDS # 229

KHOPOTSO: Tessa Michael is a former social worker from the Charles Hurwitz TB Hospital in Diepkloof, Soweto. These days she runs a private consultancy service in Johannesburg, advising companies on how to handle HIV in the workplace and counselling infected people. She says a big part of her work is to advise clients on what treatment to take to keep healthy and when they fall sick. She recommends a treatment regimen comprising of nutrition and vitamin supplements, minus antiretrovirals.

TESSA MICHAEL: There’€™s a big gap in terms of identifying your status and then actually going on to ARVs. The government’€™s policy is currently that you do not go on to ARVs until your CD4 (count) is 200 or below, or unless if you are constantly getting sick. I prefer people to really look after their health the moment they are identified as being HIV positive and move into a health regimen that will support them so that they never need to get to a state where their CD4 (count) has fallen so low that they have to get on to ARVs.

KHOPOTSO: She goes on.

TESSA MICHAEL: I agree with you that if people are identified as being HIV positive and if you have a massive viral load and your CD4 (count) is low that, at that point, it might be necessary to go on to ARVs in combination with good supplements and, obviously, good nutrition. The problem is that remaining on your ARVs over a long period you eventually reach a point where your body cannot tolerate such massive doses of something that is so powerful. It affects things like the liver, the brain, the kidneys.

KHOPOTSO: Michael might well have a point. At the end of the recent World Health Organisation Consultation meeting on Nutrition and HIV/AIDS in Africa, participating countries, including South Africa, adopted a policy statement. It acknowledges that ‘€œlong term use of ARVs can be associated with metabolic complications, such as cardiovascular disease, diabetes and bone related problems’€. However, it goes on to say that ‘€œthe value of ARV therapy far outweighs the risks and the metabolic complications need to be adequately managed’€. But Michael will not be moved from advising her clients to take only multivitamins as treatment for their HIV and AIDS infection.

TESSA MICHAEL: I would especially recommend an amino-acid called Lysine’€¦ I would recommend selenium’€¦ And you really should be on a good vitamin. Your B complex vitamins all help your red blood (cells). If your red blood (cells) are in good condition, that means you’€™re taking enough oxygen to feed the whole body. For your body to be healthy you need sufficient oxygen in the body.

KHOPOTSO: The good role multivitamins play in the management of HIV and AIDS cannot be over-emphasised. But it becomes a great concern when people are told to never go on antiretrovirals, especially when their health status requires that they should start this form of treatment. Collen tested HIV positive in 1997. He looks and feels fit as a fiddle. Yet his CD4 cell count is slowly on the downward slope, and has now plunged to below the critical 200 mark. That clinically means that he is no longer HIV positive, but now has AIDS.

COLLEN: Last year November, it was 300+’€¦ This year, round about January, it was 255. Now it’€™s 198.

KHOPOTSO: Collen has been doing his CD4 count tests at the Helen Joseph Hospital in Johannesburg, and was due for antiretroviral therapy. But he was discouraged from it and offered multi-vitamin supplements as an option.

COLLEN: Actually, yes’€¦ the first week of August I was going to be starting my ARVs, but Tessa came up with supplements and nutrition. And I thought it’€™s better if I can try them out and see how they will do because, quite honestly, I look very well, and I look very healthy, and I feel healthy.

KHOPOTSO: Collen admits that the constant free fall of his CD4 cell count is worrisome. But he still won’€™t go on to antiretrovirals.

COLLEN: I’€™ve got a friend of mine that has been on that. There’€™s a couple of side-effects that happened to him’€¦ He’€™s recently had a fit. So, I told myself ‘€˜if that can happen and he’€™s on the medication, what will happen to me?’€™ Then, I said, ‘€˜no, I won’€™t go on it’€™.

KHOPOTSO: Coupled with what he has heard from Tessa, Collen is, quite understandably, scared. But perhaps he should be told that only 10 percent of people develop serious side-effects from antiretroviral medication and most side-effects can be managed effectively. Without the true facts and with plenty of confusing messages, including from policy-makers, many HIV infected South Africans are scared and confused about what to do about their infection. Government’€™s HIV and AIDS Care and Treatment Plan has antiretroviral drugs as its primary intervention, in combination with vitamin supplements and certain traditional medicines. South Africans living with HIV should be offered all these and be given proper information about ARVs by trained health workers.                                    

E-mail Khopotso Bodibe

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