By Catherine Murombedzi

A DECADE ago, urging people to get tested for HIV and AIDS was met with raised eyebrows and stiff resistance.
“What next after I test HIV positive?” was the question.
Treatment was not readily available and the demand for treatment outweighed supply.
There was a waiting period before one was put on anti-retroviral therapy (ART).
A series of tests was a requirement to start ART.
A CD4 count was necessary.
This was a test to find out the blood cell count.
Everyone has red and white blood cells.
The white cells are the defence mechanism or in simple terms, the ‘soldiers’.
The number of ‘soldiers’ determined if one was to start treatment. If the ‘soldiers’ were below 500 in the count, that meant one was prone to opportunistic infections like tuberculosis (TB), pneumonia, skin rashes and a host of other diseases.
Thus, 500 and below was the threshold for a person to commence ART globally.
However, in Zimbabwe, with 70 percent reliance on donor funding, even a person with a CD4 count of 300 was delayed commencing treatment since there was a waiting list.
People in need were to get priority as opposed to someone not ill.
With the HIV pandemic being dynamic, the World Health Organisation (WHO) saw it fit to commence a person on ART before that person got ill.
This finding was named ‘Test and treat (TT).’
The TT programme has been touted as a modern way to curb stigma in the HIV response.
In 2015, WHO gave new treatment guidelines stating that when one tested for HIV and was found to be positive, the person was to be commenced on treatment immediately.
Test and treat has its benefits outweighing delayed initiation for any HIV positive person.
With TT, everyone eligible to commence taking the life-long medication, regardless of the CD4 count, which used to be the bar to initiation.
Therefore, the CD4 count is no longer used as a measure to start treatment in the revised 2015 guidelines.
ART is lifelong. Can someone not ill adhere to taking medication for life?
That now depends on an individual understanding of the condition.
Note well: There currently is no cure for the HIV virus, but only treatment to suppress the virus to undetectable levels, leaving one able to live a near normal life.
ARVs have given a new lease of life to people living with HIV. Defaulting, therefore, remains high in anyone taking life-long medication.
Counselling is an integral part for anyone taking life-long medication.
People commenced on ART bemoan pill burden.
If it is difficult to take antibiotics for a prescribed week, what more when it is for life?
Mostly, people being commenced on ART today have not been very ill.
This number is making the defaulters’ register grow.
Annah Sango, a youth peer educator keen on advocacy and literacy in the HIV and AIDS arena, said she is worried by the growing list of youths now on second line treatment after defaulting.
Said Sango at a recent Meaningful Involvement of People Living with AIDS (MIPA) in Gweru early this year: “I have been seeing youths aged 24 and less on second line treatment and I am disturbed.
“What is the future and where will they be at age 35.
“If they fail second line treatment at that age, that calls for third line treatment and being the final call to treatment, my heart bleeds.
“Let’s get back to the drawing board and let’s think outside the box.
“Where are the youths getting it wrong?”
Sango pointed out that counselling must be vibrant, the same way it was 10 years ago where people collecting medication went through counselling sessions.
“Back in the days, counselling was part of medication restocking,” she said.
“There was always literacy counselling carried out in such a refreshing manner.
“No matter how many times one heard the message, one looked forward to the group counselling sessions which were not mandatory, but available.
“This was a reminder and wake up call for anyone who would get into a slumber just because they felt healthy and fit again.”
Another issue posing challenges is self-testing.
Although self-testing has been touted to fight stigma, for locals, it could spell doom.
One self-test, get a positive result; is the person likely to go out to get counselling?
Say they do visit their doctor, are they in a position to meet fellow people on ART?
Medically speaking, doctors do not reveal the health status of patients, that is private and confidential.
Sango attended the 73 UN High Level Meeting in New York where she represented the youths while supporting the First Lady Amai Auxillia Mnangagwa’s initiative to end HIV and AIDS dubbed ‘Free to Shine’.