KHOPOTSO: It was a long time before antiretroviral therapy would be available in South Africa’€™s public health sector. Only a few could afford it. And in 2001 doctors knew very little about the medicine, particularly its safety and how to administer it. Selinah Mashinini can attest to this.    

SELINAH MASHININI: I started to take ARVs, actually, it was 2001. The doctor prescribed me two regimens’€¦ I was taking Hydrea and Videx, then. End of 2001, I began to develop resistance to my medication. Then, they said I must stop it because it was not working at all’€¦ It was very hectic for me because my skin changed and I lost my hair’€¦ I was so scared and I didn’€™t know what to do.      

KHOPOTSO: This mother of two from Alexandra township, north of Johannesburg, resolved to seek a second opinion on these medicines that were supposed to improve her health status.

SELINAH MASHININI: The mistake that the previous doctor did ‘€“ he prescribed two combinations ‘€“ only Hydrea and Videx’€¦ That doctor was supposed to prescribe three regimens.            

KHOPOTSO: Helen Struthers, a researcher on adherence to AIDS medicine at the Perinatal HIV Research Unit supports this view, and speculates even further on the cause of why Mashinini might have developed resistance. This develops when there is not enough medication in the body to stop the HI virus from multiplying in such a way that it changes its form over a while so that the medicine will no longer be able to suppress the new virus that has developed.        

HELEN STRUTHERS: Selinah was on dual therapy, which, we know now is not as effective as triple therapy. And, either, it was because she was only on dual therapy or because she wasn’€™t entirely adherent to her medication that resistance could have developed. We know that even if people are 95% adherent to their medication, 80% of those people will develop resistance over a period of time.        

KHOPOTSO:  According to Dr Francois Venter, a specialist physician on HIV and AIDS, Mashinini could have been placed on the two-drug regimen because it was the cheapest option available at the time. He added that Hydrea ceased to be widely in use some four or five years ago, due to its toxic qualities and harmful side-effects. The other medicine she took, Videx, also known as ddI is still in use, however.  

Following this episode of complications with her initial regimen, a new treatment programme comprising three drugs was recommended for Mashinini. But the high costs involved denied her the opportunity to replace her treatment. During that year, 2002 ‘€“ 2003, her health continued to deteriorate.

SELINAH MASHININI: Hey, my condition was very bad because I was having many, many different types of disease now. My lower abdominal (area) was very painful’€¦ It was about the bladder now. They didn’€™t manage to perform the operation because my CD 4 count was low. Then they said, at least, if I can be on ARVs again. If my CD 4 count will go up, then, they think they can do the operation.  

KHOPOTSO: Through donations, she tried antiretrovirals the second time around and they proved to be working.

SELINAH MASHININI: My CD 4 count was 76 in 2003 when I started the ARVs again. Then, in the middle of 2004 my CD 4 count rose up to 293. Then, they started to perform the operation ‘€“ it was September 2004. After the operation, at least, my health improved, then. Now my CD 4 count is 611’€¦ Even now I’€™m gaining my hair again and my skin is okay now.

KHOPOTSO: I can see you have beautiful hair. It’€™s actually difficult to believe that you lost your hair. It’€™s re-grown completely.

SELINAH MASHININI: It’€™s because ARVs are working well if the doctors have prescribed the right regimen for a person. If they don’€™t prescribe the right medication it will do damage to a person’€™s health.

KHOPOTSO: But, according, to Helen Struthers that should not be the end of the road.      

HELEN STRUTHERS: As people develop resistance, which happens fairly frequently when people are on medication’€¦ people then can move on to another regimen. There are other drugs that can be used to suppress the resistant virus.

KHOPOTSO: In the next ‘€œLiving with AIDS’€ feature, Selinah Mashinini speaks to us about the challenges of being on ARVs again, adhering to the treatment and making a success of it.