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HIV and benefits of disclosure

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By Catherine Murombedzi

WE have heard many tales of couples married for years where the other partner is not informed of medication taken by the spouse.
This is usually the case under conditions that carry a stigma.
In the 1990s, when HIV and AIDS wreaked havoc in communities, it was viewed as a disease for those with loose morals.
That tag has not been erased; no wonder the secrecy when one tests HIV positive.
Conditions like hypertension, diabetes mellitus, cancer and many others are disclosed without difficulty while HIV remains shrouded in secrecy.
With HIV, there is fear of losing a partner hence one ends up taking medication secretly.
The medication is either kept at work, in the car or even hidden under the bed.
For women who have kept the condition secret, the medication is buried in the mealie-meal pack or even in the laundry basket.
Why all the trouble of risking health by so doing?
The footpath from Harare Central Hospital, (and I guess many other hospitals) is littered with containers used to store anti-retroviral tablets (ARVs).
The tablets are meant to be kept in the containers where the conditions are conducive.
However, they are repacked in paracetamol sachets.
When one has a life condition, medication must be taken at a set time.
Where one takes medication in secret, there is a danger of not keeping the time.
One ends up defaulting, with negative health risks.
Nursing mothers are urged to disclose their HIV status if they are to stop infecting their babies.
Babies are infected either in the womb, at birth or when breast-feeding.
Pregnant and nursing mothers are therefore urged to disclose their status to their spouses if they are to stop primary infection from mother to child.
Dr Agnes Mahomva, country director of the Elizabeth Glaser Paediatric Foundation (EGPAF), said stigma led to some women keeping their status a secret.
She said the secrecy could be due to stigma and fear of how one breaks the news.
Dr Mahomva said the way to overcome this was for partners to get tested together.
This barrier could only be overcome if husbands accompanied their wives to ante-natal clinics and get tested together.
Mother-to-child transmission proved to be the second most common cause of HIV infection, Dr Mahomva informed journalists in Nyanga during a workshop.
“It is imperative that husbands accompany their wives to antenatal clinic,” she said.
“Pregnancy needs spousal support and we find that couples who call together have less difficulty in accepting any diagnosis that would result in blood tests.
“We therefore urge husbands to be part of the ‘prevention of HIV from mother to child programme’.
“No baby should be born with the HIV virus today.
“Stopping vertical transmission is therefore possible.
“A baby born by an HIV positive mother is at risk of getting infected when in the womb, at birth and during breastfeeding,” she said.
Dr Mahomva said there was no fear at all of infecting the baby if a mother enrolled at ante natal clinic at 12 weeks, as highly effective medication is now available.
Said Dr Mahomva: “We put the mother on Highly Active Antiretroviral Therapy (HAART) to cut off infection risk.
So pregnant mothers are advised to book for ante-natal clinic early so that they are tested for HIV and other infections.
It is possible to give birth to an HIV negative baby.”
The EGPAF works in conjunction with the Ministry of Health and Child Care nationwide offering Prevention of Mother To Child Transmission (PMTCT) services.
Less than five percent of babies in Zimbabwe are now born HIV positive.
However, the country is striving to have no baby born HIV infected.
In 2015, Cuba eliminated the mother-to-child transmission and Zimbabwe is following closely.
This writer has established that the state of HIV disclosure in rural areas is more open as compared to urban areas.
Disclosure in rural communities is better managed at a community level, through well-knit people living in the same geographical area.
People hailing from the same village know who suffers from asthma, diabetes mellitus, hypertension and any chronic condition.
So, for such a community, disclosing HIV status is not a big deal as they usually talk of their health concerns at the water point (well or borehole), while drinking beer at the shops or when herding cattle.
Urban folks are not so open about their health status.
It could be due to a more ‘individualistic living’ in towns.
Rural folks are more enlightened on HIV issues since stigma and discrimination barriers were long dissolved.
For example, this writer’s rural community in Kakora, Chiweshe, Mashonaland Central, is a beacon where People Living with HIV (PLHIV) meet under the baobab tree every month for updates and support.
They help new people integrate into the group.
Joseph Nhadzi, a family man, is open about his status and has helped his counterparts.
“As a community in Kakora, we are beyond diagnosis,” he said. “We help each other manage our health.
“We have a livelihoods project where we pool resources and buy chickens or goats.
“We find that people prefer to work in their own time and framework, so we provide the money and know-how to them. “When we meet, we do not talk of health issues only, we also tackle economic issues.
“A good economy builds a healthy family.”
Nhadzi stressed on time management.
He said they came up with a timetable for medication collection.
“We find people from the same neighbourhood in queues at hospitals and clinics, yet they are healthy and only need refills,” he said.
“One sees a nurse only when ill or on routine.
“We therefore have formed club refill groups and members take turns to visit the clinic on behalf of the group, with one person collecting the medication for the rest.
“When back from clinic, we meet under the baobab tree for collection and moral support.
“We also discuss family issues, adherence and check if any member has a problem.
“We are one big family.”
Nhadzi said in some families where four or more people are on medication, they form a family ART refill group, rather than a community one.
However, he feels that engaging at community level is always better.
Children on ART, said Nhadzi, are not excluded from groups since they need moral support.
“We have children in our groups and cater for children’s special needs,” he said.
“Children are growing up and need to be seen at the hospital so they have a follow-up schedule where ART is adjusted accordingly as they grow.
“So, the member visiting the clinic may take the child along, or better still, have the parent collect on behalf of the group.”
With communities now managing time effectively and reducing congestion at clinics, we find that ART refill groups are a novel way to be recommended to other communities living in the hard-to-reach areas.
This is only possible when medication is not taken in secret.
Stigma has no place in a community with active refill groups.

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