DR. ANNE CHIMOYI: Demystifying the misconceptions on HIV/AIDS

Kindly introduce yourself to us
I am Dr Anne Chimoyi, a medical practitioner, HIV specialist and public health officer. Also, a researcher and national mentor in care and treatment of HIV/ AIDs. I am part of an adolescent project that works with HIV positive adolescents under Baylor Uganda.

AIDS is an issue more especially in our country. Is it a matter of morality or something else ? What’s the best remedy for preventing the spread of HIV/AIDS?
HIV is a multifaceted disease. So many factors contribute to its spread; lack of knowledge, cultural practices, myths and misconceptions, irresponsible sexual behaviour, stigma to the infected, poor health seeking behaviour, lack of proper policies etc. Tackling this scourge needs a multidimensional approach because it is never just one thing and its not always white and black.

Why are we not getting a cure for HIV and AIDS? After all these years, we still don’t have a cure. Why?
By nature, viral infections don’t primarily have a cure but the body has a way in which it fights the disease. Think of diseases like the flu (viral common cold), ebola, hepatitisB, rabies, measles etc. We have no cure for these diseases.

However, with HIV the virus is among the group of viruses that mutate very fast because it takes up the hosts DNA to live. Therefore, destroying it means destroying the host cells leading to no cure. But treatment is available.

HIV/AIDS is regarded not only as a medical but also a social problem. Thus, this stigma and discrimination doesn’t only affect the patient but also the family. How can we go about it?
HIV is more of a social problem than a medical problem. Once we sought out the social part the medical part is quite easy. The only way is to talk about the disease, dangers of discrimination, make policies, counsel the infected and affected. It is about a lifestyle change.

When applying for work or visa to some countries a health check is required. If one is HIV positive, he is denied access. Can the applicant file a case against the embassy or employer? Or the country has the right to do so ?
Yes, I am aware that there are some countries that don’t allow entry if one is HIV positive. It is their right to do so because it is their country’s policy. Therefore, it is upon a person to know which country they are getting into. Also, the international law does not allow countries to discriminate against HIV positive people.

Why do they tell us to always go and be tested?
Testing is good for one to know their status. Also, to know the next action and plan to make for the future. If positive, one can start medication and live positively. If negative, one can live responsibily to keep the status negative.

Should employers, churches, countries and our neighbours demand that we test and share the results with them? Do they have this right?
They do not have any right to demand for your HIV test results.

Are the HIV test results confidential?
Yes they are confidential. As a health worker I cannot give the results to your spouse or any one without your consent.

Do we have to tell people our positive status? Or, we can keep shut about it?
You don’t have to tell anyone. But we encourage people to disclose to someone who is close to them for social support. People who are socially supported have better outcomes because they take their drugs openly and on time and when things get tough. Those not supported have the stigma, poor adherence and finally die untimely.

If one tests positive, are ARVS freely given?
Yes ARVs are free.

Can one be HIV positive and not have any symptoms at all? Like can you be HIV positive and not lose any weight at all? Or, are people able to look at others and know their status, just by looking at them?
Yes one can have the virus and look absolutely normal for years! HIV positive people rarely look sick. Taking a HIV test is the only sure way to the truth about one’s status.

Why is there a stigma to the disease and not the others? Why does this come with shame?
I believe this stigma stems from the mode of transmission and possibly the way HIV wastes one’s body when they have AIDS. It is traumatising to people.

Nowadays there’s no stigmatization but the don’t care attitude of the infected. Is it true?
No. Stigmatization is very rife even now. Positive living is a strategy of kicking out stigmatization. There are 2 types of stigma;
1. Self stigma
2. Stigma from society

Self stigma is worse. It’s the reason people decide to spread the disease to others indiscriminately because they haven’t accepted it. If someone keeps infecting others maliciously that’s part of stigma.

What is self stigma?
Self stigma is basically the feeling of a person not accepting his or her HIV status thus does not live positively.

What are the markers of self stigma?
Some of the markers may include; depression, refusal to take drugs, lack of disclosure, tendency to want to spread the virus etc

And, how can self stigma be resolved?
It’s resolved through counselling.

HIV/AIDs is an issue but people say cancer is worse than it. Kindly enlighten us on this?
I think people look at it in terms of prognosis. A diagnosis of HIV has a better prognosis than a diagnosis of cancer. Also, HIV treatment is available and highly effective no matter the stage one is at which may not be the case with cancer.

Would you also say that we are not also lowering the infection rates? Or are we lowering?
The infection rates have lowered significantly within the last 20 years. Of course every decade we have new challenges but we have been able to overcome that with new effective treatments and other social issues like stigma addressed.

Who decides on which kind of medicines patients will have in Uganda or Africa? Or medicines coming in from outside?
World Health Organisation recommends the drugs to be used in particular situations. Then the state comes in with policies especially on the costs. Thirdly, the donors also decide what we get. Cost of the drugs is a determining factor for the stakeholders.

Is there a HIV vaccine?
Yes, there is one underway on trial. It is quite elusive since the virus mutates into different viruses. The virus in person A and virus from person B is never the same even if they got it from the same person. Though, we hope to get the vaccine soon.

Why is there no medication for the lactating infected mothers to prolong their breastfeeding to at least one year rather than just 6 months breastfeeding?
I think the WHO policy actually allows breastfeeding upto 1 year. (I am not sure on the practice in Kenya.)This is because the ARVs are highly effective in that if the viral load is undetectable you can breastfeed your child till 1 year. Those who are stopped may be because their viral load is still high and detectable.

Why do the ARVs react to bodies of the infected making them grow bigger or do I say making them fat?
Those are side effects of the drugs and we can’t do much about it. However newer drugs have come up and we have done away with those side effects.

Shed more light on how blood group O- people can just be carriers of the virus ?
This is not true. Carriers are very few. A very negligible number. Carriers depend on a surface antigen on the cell whose chemical property usually allows the virus to enter the cell and not to destroy it. Their antibody test will show negative HIV status but the DNA PCR test will show positive HIV status.

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Apparently there is one a day tablet which directly deals with the cells. It does not have adverse effects to other body organs. Is there hope for this kind of drug getting to Africa?
Yes, in Uganda we have one a day tablet that was rolled out 4 years ago mainly for pregnant mothers and women. Currently, men have also been included.

Researchers around the world are also working on a once in a lifetime jab. Those infected will have only this jab and they carry the virus but can not infect others neither do they need to take ARVs again in their lifetime. Is there hope for this reaching us in Africa?
We have heard of the jab. It is still being researched on and is at the final stages of trials. However, it will be a monthly jab in place of the ARVs.

Tell us more about the new ARV drug?
We have a new regimen whose trail name is Gammora. It is potent. It has less side effects. It is cost effective to countries. It won’t be given to women who are in their reproductive age but to those on menopausal stage, men, those who have stopped giving birth and those who don’t want children because it has effects on the foetus.

How comes the septrin size in CCC differs in size from the normal septrin?
Septrin size in Kenya is designed to fit the donors specification. The septrin provided in CC clinics or ARV patients is big in size thus cannot be stolen or passed to community pharmacy
Its dosage; For adults is 960mg twice what is bought in the pharmacy for adults in any bacteria in infections. For Children is 480mg.

However, size dose not matter but the strength of the tablet.

There is a lady living positively for almost 25 years. She has three negative children. The drugs she uses have a side effect of fat redistribution. Is there a better drug than this?
The drugs she is taking most likely are of the second line. If she is taking more than three pills per day probably she is on the second line. It is hard to change the drugs for her. She has to go through some tests to make sure that the virus she has will not be resistant to the drugs to be given. Doctors are hesitant to change unless there is a very big reason for the change. The drug with less side effects available.

How do discordant couples work out their marriage considering that one is HIV positive and the other one is negative?
Once someone is on ARVs (highly effective drugs) and is adherent there are undetectable levels of the virus hence the transmission of the virus is low. They can continually use condoms. When the time to get pregnant comes they can do it naturally, through sex. We put into consideration that the viral load is undetectable and when the lady ovulates, sex takes place and we expect a baby. It is a meticulous planned process. We have cut mother to child HIV transmission rate by 70% in Uganda.

What advice would you give those that are living positively?
Keep living positively and spread the message of positivity. Get rid of stigma. Own your status. The more you own your status the easier it is to manage the condition.

What advice would you give those that are negative, sexually active but wouldn’t want to get infected?
Test every partner. Use condoms correctly and consistently. Be faithful to one partner.

If you sleep with an infected person once, do you get infected that one time?
The chances are not at 100%. There are so many factors that can facilitate the spread of the virus during that one encounter; preexisting sexually transmitted infection, wounds on the genitalia, active bleeding, rough sex, dry sex, a person with high viral load and one who has just got infected. However, the chance is there.

Once positive, do you remain positive? What’s the rumour that some people use drugs to suppress the virus hence the test turns negative?
Once positive YOU REMAIN POSITIVE! Antibody tests can turn negative because the body isn’t producing any more antibodies since the virus has been effectively suppressed but a DNA PCR test will be positive. For such people please tell them to do a DNA PCR test.