HIV disclosure - church family

HIV was first known to be a killer disease. Arguably that's the reason why it's still scary to most people because of how it was introduced to the world - a deadly pandemic. Fear was immediately attached to HIV making people, world over afraid of getting it. Even decades later, there are still people who are frightened to the bone about HIV. Just the word scares many off.

The sad truth is everyone globally it's either you are affected or infected by HIV and that's a good enough reason for people to let the guard down a bit. In a WhatsApp conversation I had with a follower from Pretoria, we spoke about fasting vs ARV. After sharing with her my expert opinion, I ask this follower to pray about it coupled with talking to a youth pastor from church. Just by the response, I later realised that, the religious sector in Southern Africa still has a discriminatory stereotype against people living with HIV.

Shockingly, church leaders and congregates wear the adulterous spectacle owing to the believe that HIV is one of the-so-called incurable deadly disease that God sent as punishment to the world for sinning. I am disgusted by this attitude honestly.

Back to the agenda of this blogspot, allow me to share the steps one should take when disclosing their HIV status to someone in church esp the pastor. Please note, from the extensive research I did, I managed to combine points to come up with this.

GENERAL GUIDELINES

Here are some things to think about when you’re considering telling someone that you’re HIV-positive:

• Know why you want to tell them. What do you want from them?
• Anticipate their reaction. What’s the best you can hope for? The worst you might have to deal with?
• Prepare by informing yourself about HIV disease. You may want to leave articles or a hotline phone number for the person you tell.
• Get support. Talk it over with someone you trust, and come up with a plan.
• Accept the reaction. You can’t control how others will deal with your news.

All that matters at the end of the day is that, you become a free bird once you share with your church family.

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CD4 count vs VIRAL load

Ever wondered what CD4 count is? or what is it with numbers when it comes to HIV? 

They say doctors use two key tests to assess the strength of your immune system - a CD4 cell count and a viral load test. HIV damages your immune system even though you may look and feel well. That’s why new guidelines recommend that everyone with HIV starts treatment whatever their CD4 count.

Viral load explained

The viral load test shows how active HIV is in your body.

The test for viral load measures how many particles of HIV are circulating in the blood. The results are given as the number of ‘copies’ of HIV per millilitre of blood - for example 200 copies/ml. Your viral load test results can fluctuate a lot if you’re not taking HIV treatment. Looking at the trend over a number of months may be more useful than comparing two test results.

A high viral load will usually – but not always – mean a low CD4 count. Knowing what is going on with your immune system can help you make decisions about lifestyle and treatment.

What’s happening inside you after infection?

When you first get HIV, your body starts to produce antibodies to fight it off.

You may feel ill for a while at this stage. This is often called 'seroconversion illness' because it coincides with the time that blood (‘sero’) tests for antibodies to HIV become (‘conversion’) positive.

Once seroconversion has taken place, you may stay well for a number of years without treatment. But there will be some signs of damage being done to your immune system.

As you can see on the graphic above, you will also be infectious during this period, even though you may not be aware you have HIV. That’s why it is so important to get diagnosed early, so you can start treatment as soon as possible – before too much damage has been done to your immune system.

The strength of your immune system can be detected by laboratory tests. Doctors will use two key tests at your regular clinic appointments - a CD4 cell count and a viral load test.

What is the CD4 cell count?

This test gives a rough indication of the strength of your immune system.

A normal CD4 cell count in an HIV-negative man is between 400 and 1600 per cubic millimetre of blood (but doctors normally just give a figure, e.g. 500). CD4 cell counts in HIV-negative women tend to be a little higher, between 500 and 1700.

Soon after infection with HIV, your CD4 cell count probably dropped sharply, before stabilising at around 500 to 600. Even while you are well and have no obvious symptoms of HIV, millions of CD4 cells are infected by HIV and lost every day, and millions more are produced to replace them. General illness can also have an impact on your CD4 count, which may subsequently rise again.

Without treatment, an HIV-positive person’s CD4 cell count will fall over time (see the graphic above).

Starting treatment – new guidelines

UNAIDS treatment guidelines have been changed to say that anyone with HIV who is ready to commit to treatment should start regardless of their CD4 count. This reflects the findings of the START study.

START found that people who waited to start treatment until their CD4 count dropped to 350 (which is when people were previously advised to start) had a much higher chance of developing AIDS-related illnesses such as cancers.

Starting treatment also reduces the chances that you will pass on HIV.

HIV criminalisation - increases transmission 2

Last week I touched on the reasons why criminalisation of HIV is disadvantageous to women. Today, I will just wrap up on how criminalisation of HIV causes more harm than good.

6. Women are more likely to be prosecuted:
Since women are more likely to know their HIV status, they are also more likely to be prosecuted for HIV exposure and transmission, since knowledge of one’s HIV positive status is often a necessary element for prosecution. At the same time, women are least likely to have access to legal services and, thus, a fair trial. The burden of proof and the biased application of the law further increase women’s risks of being charged, prosecuted and found ‘guilty’ of HIV exposure or transmission.

7. Some women might be prosecuted for mother-to-child transmission:
Some laws criminalizing HIV transmission or exposure are drafted broadly enough to include transmission during pregnancy or breastfeeding. For millions of women, living with HIV – but often denied access to family planning, reproductive health services, or medicines that prevent perinatal transmission of HIV – this effectively makes pregnancy, intended or not, a criminal offense. Further, it is increasingly recognized that in many middle and low-income settings, breastfeeding is the best option for child survival and well-being, despite the possibility of HIV transmission. There are many more effective ways to prevent perinatal transmission of HIV, beginning with supporting the rights of all women to make informed decisions about pregnancy and providing them with sexual and reproductive information and services; preventing HIV in women and girls in the first place; preventing unwanted pregnancies among all women; and providing effective medication and healthcare services to prevent perinatal transmission for HIV positive women, who wish to have children, or who are pregnant.

8. Women will be more vulnerable to HIV transmission:
Existing barriers limiting women’s access to information, resources and services, including gender inequalities and inequities, will be compounded by the fear of prosecution for HIV exposure or transmission. The gendered access to health information and services, combined with the fear of being criminalized for exposing or transmitting HIV to someone, will place women in an even lesser position of power to negotiate conditions of sex, as negotiating condom use may be perceived as ‘proof’ of knowledge of an HIV positive diagnosis.

9. The most ‘vulnerable and marginalized’ women will be most affected:
‘Vulnerable and marginalized’ women, such as women in same-sex relationships, and women sex workers and drug users, often lack adequate access to HIV prevention, testing, treatment, care, and support services, primarily as a result of their existing ‘criminalized’ status. The criminalization of HIV exposure and transmission is likely to further stigmatize already ‘criminalized’ women and to constitute yet another barrier to healthcare and other services by posing a threat of double prosecution – prosecution for engaging in ‘criminal behavior’ and for HIV exposure or transmission.

10. Human rights responses to HIV are most effective:
Now, more than ever, greater attention to human rights is needed in the response to the global HIV epidemic. Criminalizing HIV exposure and transmission compromises human rights, undermines public health initiatives, and increases especially women’s risks and vulnerabilities.

HIV criminalisation - increases transmission

Its 2016!! Great. But how is the year going to be as far as HIV is concerned. There are things I am still worried about and I feel, this is the year to deal with such. There are laws in most parts of Southern Africa especially in Zimbabwe that still criminalise HIV transmission and exposure.

In Zimbabwe, criminalisation of HIV is known as willful or deliberate transmission of HIV. In the Zimbabwean law, willful transmission is defined as the failure to disclose one's status or take precautions for preventing the transmission of HIV. The law is used to prosecute people for transmitting HIV or exposing others to HIV.

 Picture taken from: www.hivjustice.net

The call to apply criminal law to HIV exposure and transmission is often driven by a well-intentioned wish to protect women, and to respond to serious concerns about the ongoing rapid spread of HIV in many countries, coupled with the perceived failure of existing HIV prevention.

This law is a deliberate way of fanning discrimination, here is why.

1. Women will be deterred from accessing HIV prevention, treatment, and care services, including HIV testing:

Many women fear violence and rejection associated with disclosure and an HIV + diagnosis. The criminalisation of HIV transmission or exposure may generate additional obstacles to healthcare for women. Prevailing stigma, discrimination and other violations of rights, including the lack of assured confidentiality, already pose a barrier to HIV prevention and testing services.

2. Women are more likely to be blamed for HIV transmission:

Women are often the first to know their HIV positive status; particularly as governments move towards provider-initiated HIV testing and counseling in pre-natal settings. Thus, women are more likely to be blamed by health staff, by their intimate partners, their partners’ families, and their communities for ‘bringing HIV into the home.

3. Women will be at greater risk of HIV-related violence and abuse:

While violence increases women’s risks of HIV transmission, women’s HIV-positive diagnosis also increases the risks of violence. The fear of violence deters women from disclosing their HIV status. Research indicates that young positive women are ten times more likely to experience violence and abuse, than their HIV negative counterparts. There are also increasing reports of women being killed by their partners for ‘bringing HIV into the family’.

4. Criminalization of HIV exposure or transmission does not protect women from coercion or violence:

Sexual violence and rape, including marital rape, place women worldwide at risk of HIV transmission. Laws against sexual violence, where they exist, are often poorly enforced. Similarly, government policies and guidelines that call for providing sexual violence survivors with necessary medical treatment, including emergency contraception to prevent pregnancy and post-exposure prophylaxis to prevent contracting HIV, are often not implemented.

5. Women’s rights to make informed sexual and reproductive choices will be further compromised:

The patriarchal context of society undermines the power of many women to make informed choices, including sexual and reproductive choices. As a result, women are often not in a position to negotiate the conditions of sex, including whether or not to engage in sex, as well as to negotiate condom use. Women also often have limited access to sexual and reproductive health and rights information to inform their choices, and to access non-discriminatory and unbiased sexual and reproductive healthcare services.

While these concerns are legitimate and must be urgently addressed, closer analysis reveals that criminalisation does not prevent new HIV transmissions or reduce women’s vulnerabilities to HIV. In fact, criminalisation harms women, rather than assists them, while negatively impacting on both public health needs and human rights protections.