Novia Condell, Contributor
A SUPPORTIVE ENVIRONMENT, where persons living with HIV/AIDS can disclose their HIV-positive status without fear of stigmatisation and discrimination can significantly improve their state of mind and their ability to better deal with the effects of HIV/AIDS.
The larger public has the responsibility of providing support for persons living with HIV/AIDS (PLWHA). Failure to do so will continue to drive the epidemic underground.
While social support for PLWHA is important, it is not the only factor that preserves health in the face of a weakened immune system. Treatments including prophylaxis (medicines to prevent and treat opportunistic infections) and antiretroviral therapy also contribute to maintaining wellness.
Antiretroviral therapy (ARV), a combination of three powerful medicines, is one of the essential tools in managing the disease. These medications can reduce the amount of the human immunodeficiency virus in a person's blood. They can improve individual longevity and quality of life. They are not a cure for the disease.
However, not all persons who are diagnosed HIV positive should immediately begin antiretroviral treatment. One of the major criteria for commencing ARV treatment is a diagnosis of AIDS, which occurs an average of 8-10 years after being infected with the virus.
Director of Treatment and Care in the National HIV/STI Control Programme, Dr. Kevin Harvey, says it is extremely important that persons living with the condition are aware that these drugs must be taken under the supervision of a qualified, specially trained physician. If not, the results can be damaging.
"A physician should only prescribe antiretroviral treatment once they know at what stage of HIV/AIDS the person is."
He said that it was more critical for persons at the AIDS stage of the disease to be put on ARV medication. Dr. Harvey noted that adhering to a healthy diet and leading a healthy lifestyle could aid in preserving the health of an HIV-positive person.
He also notes that support from family and friends is as important to maintaining health as access to medication.
"One of the most essential parts of management of HIV is creating a supportive environment for PLWHA. De-stigmatisation and ending acts of discrimination will make it easier for PLWHA to access healthcare and have a better quality of life."
According to Dr. Harvey, the ability to live a normal life and maintain relationships with friends and family can stave off depression. Any form of emotional stress can hamper a PLWHA's ability to properly care for him or herself.
At present, the Ministry of Health does not provide ARV treatment to persons with HIV/AIDS. This is due to the high cost of the treatment.
Costs
In February 2002, the Ministry with WHO/PAHO and UNAIDS led negotiations with international drug companies to reduce the cost of ARV treatments by 90 per cent. Since then, the number of persons accessing ARVs on their own or with the help of family members has been growing.
However, the majority of PLWHA being treated in the public sector are from lower socio economic backgrounds. For them, even with the reduced price, the drugs are difficult or impossible to access.
Dr. Harvey points out that Government is fully committed to providing comprehensive treatment and care for PLWHAs, including ARVs.
"We are working on it. Our aim is that by the end of the year, ARVs will be available on a limited basis through the public sector. It must be clear that in many countries much richer than ours, they are unable to provide ARV treatments to their PLWHAs."
In Jamaica, an estimated 22,000 persons are infected with HIV/AIDS. Of this number approximately 4000 are at AIDS stage where access to ARV treatment is most critical. It would cost the Government approximately half a billion dollars per year to provide just ARVs to these persons.
Immediate plans for the provision of ARVs include HIV positive women who have participated in the Ministry of Health's Prevention of Mother to Child Transmission programme (PMTCT).
"HIV-positive pregnant women who have participated in the PMTCT programme are high on our priority list," says Dr. Harvey. "Once an infected woman gives birth to an uninfected child then we must focus on improving her chances of being able to care for that child."
In addition the Ministry will continue to provide prophylaxis to prevent infection for health care workers who have been accidentally exposed to the virus, such as through needle stick injuries.
Prophylaxis to prevent and treat opportunistic infections in PLWHAs is currently provided through the public health services. In 2002, it cost the public sector $19.5 million to treat opportunistic infections and hospitalise 600 PLWHA.
Anyone who is put on anti-retroviral treatment must be able to afford to take these medicines for the duration of their lives. Quitting the treatment will cause the body to replicate the virus at an accelerated rate and speed up a PLWHA's death.
Dr. Harvey believes that it is of utmost importance for infected people to be properly counselled on caring for themselves in the absence of ARV treatment. This includes, avoiding cigarette smoking, excessive alcohol intake and drug use.
Consistent condom use to prevent re-infection and transmission to the partner is also important to staying healthy. Members of the general public must realise the importance of allowing PLWHA to live normal lives without the fear of having their rights unfairly taken away.
People living with HIV/AIDS can access services and treatment for opportunistic infections as well as nutritional counselling and support at any public health facility.
