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Tasp effective

19/08/2013 06:17:00 BY Phumlani Matse

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Stigmatising people with debilitating communicable disease is an age-old practice. Sociologists like Emile Durkheim and Erving Goffman say that has always been a form of social protection.

In Biblical times, lepers were forced to wear distinctive clothing, live on the fringes of communities, publicly declare they were unclean and ring bells to announce their presence as they approached non-lepers.

Today, the methods of stigma and discrimination may have changed, but people living with HIV and AIDS have to endure isolation of a different kind, as a recent report by Swaziland National Network of People Living with HIV/AIDS (SWANNEPA) reveals that self- blame and guilt are the most common forms of stigma among the afflicted. The report adds that apart from feeling inferior, people have to deal with stigma and discrimination from their own families and from the communities they live, work and go to school in.

In a bid to address the scourge of stigma in Swaziland, the Ministry of Health and other partners have launched an interesting new initiative. They are calling it Treatment as Prevention (TasP) approach. It is based on putting anyone who has tested HIV positive on anti-retroviral treatment, irrespective of their CD4. Previously, only people living with HIV with a CD4 count of less than 350 were put on treatment. This was later raised to 500, but even that still proved a barrier to universal access.

The introduction of TasP follows research the Ministry of Health conducted on discordant couples in Swaziland. According to Senior Medical Officer, National ART Coordinator at Swaziland National AIDS Programme (SNAP) Dr Veleleni Okello, results from the research proved that there was less transmission that occurred among the matched couples who were put on treatment immediately after testing HIV positive.

“When calculations were made following the research, protection of people who adhered to treatment who had HIV negative partners was around 96 per cent,” she said.
Dr Okello explained that the research findings need to be understood in the context of other factors like poverty and hunger that make adherence hard for people on the lower rungs of the socio-economic ladder, who live with HIV. “Poor people do not have the money to go to the hospital when they are required to and that makes it difficult for them to adhere to treatment,” the doctor said.

Dr Okello added that these factors prompted the Ministry of Health to extend ART to pregnant women and people living with HIV, no matter what their CD count was. As programmes go, TasP is still in its pilot stage. If it shows positive outcomes, it could be rolled out more broadly.

Therapy

That may be the ultimate goal, but Dr Okello admits that as things stand, there are not enough personnel available to handle the numbers of people who need ART and other HIV services, including specialised laboratories. Furthermore, government does not have the money to procure the drugs that would be required to put everyone who is HIV positive in Swaziland on anti-retroviral therapy.

Availability of drugs may be one thing, but whether people who have tested positive accept their status and start treatment is another question altogether, given the levels of stigma attached to the condition of being HIV positive. When it comes right down to it, accepting to start treatment is not mandatory—one that government, through the Ministry of Health can enforce. Ultimately, starting ART and adhering religiously to the treatment regime is a matter of individual choice.
The programme to put pregnant women with HIV on ART was launched in February this year and is expected to run for one year. It is being piloted in a handful of sites in Shiselweni and Manzini. Research is also being carried out in clinics around Nhlangano where pregnant women who test HIV positive are immediately put on ART. It will also look at issues to do with resistance among patients. Similar clinical research will be done in selected clinics in the Hhohho region, though this is yet to start, according to the Ministry of Health.

Previously, women were put under the other Prevention of Mother to Child programme, where they were given Naverapine to protect their babies from HIV infection. This study would be done over a period of one year. The approach would be also looking at issues of resistance among the patients.

All in all, TasP is expected to reduce HIV transmission on a broad national scale. Dr Okello said there is proof that HIV transmission has reduced from what it was in 2010. She said with pregnant mothers who died due to HIV complicated illnesses when giving birth, numbers have drastically declined from 580 000 in 2008 to 300 000. “This is evidence enough that the TasP approach is working,” she said.

The Swaziland National Network of People Living with HIV/AIDS (SWANNEPHA) in Swaziland has thrown its support behind the TasP programme. National Director, Thembi Nkambule says the approach presents an opportunity of boosting the adherence to treatment and people would be willing to take treatment due to the good result of having an undetectable viral load. “People will feel much acceptable in that way,” said Nkambule.

Nkambule said this approach would assist Sero- Discordant couples by means of choice when they want to have babies as the HIV positive partner would have an undetected viral load and thus no transmission would happen. “In this way they are able to engage in the normal way of making babies,” said Nkambule. Above all, Nkambule said the TasP would boost the self esteem of People Living With HIV/AIDS in the way they would view themselves on what it means to have an undetected viral load. “It means you have been adherent to your treatment, it means you are in good health,” said Nkambule. She said what most people living with HIV struggled with was the internal stigma, blame and guilt issue, which would be addressed through such an approach and they would be able to view themselves in a way that they are also normal like others who are HIV negative.

“If the PLHIV knows and understands that by adhering to treatment they reduce the chances of passing on the virus to their sexual partner. The element of self-stigma may be reduced,” she said.