The HIV viral load blog

Jan-Olof Morfeldt in Memoriam

It is with great sadness that I learned of the recent death of Jan Olof Morfeldt. Jan Olof, an HIV doctor, started Noaks Ark (Noah's Ark) back in 1985 along with a number of colleagues. The organization has been an outstanding combatant in the fight to try and stop the spread of HIV in Sweden and continues to provide much needed assistance to those already infected.

Jan Olof was passionate, compassionate and an inspiration. His enthusiasm and great sense of humor will be sorely missed. Our thoughts are with his family, friends, colleagues at Noaks Ark and the many that he has brought help and hope to throughout the years.

Photo: Elisabeth Ohlson Wallin

Watch How HIV Works

Do you know what Reverse Transcriptase (RT) is? For one thing, measuring it is what makes our ExaVir HIV viral load test unique. But unless you have a medical background, it’s hard to get your head around RT. That’s why I’m so happy someone sent me this YouTube video. It’s a bit thick on technical-speak but the animation is fantastic and the role of RT very well depicted.

RT is the perfect marker for measuring HIV viral load because a retrovirus, like HIV, requires a functional RT in order to be infectious. This means that by measuring RT activity we can accurately measure viral load regardless of subtype. If you have any other videos related to RT or HIV viral load please let me know.

Global Triage - Food First or HIV First?

The global rise in food prices is triggering a crisis in many poorer countries. In many donor circles this has raised the question of whether money earmarked for HIV treatment and prevention should now be diverted to address food shortages as part of our HIV programs as Dr. Ramon Soto suggested at AIDS 2008.  It's got me wondering where the boundary between HIV treatment and general health and welfare issues lies.

Should it be the responsibility of organizations working against HIV to devote their funding, which doesn’t reach far enough as it is, to try and solve other societal issues they encounter in the fight against HIV? Or should it be the responsibility of other relief organizations or the local governments themselves?

In the parts of the world suffering most from HIV, organizations are already struggling to provide universal access to ARVs, viral load and CD4 monitoring as well as prevention. The money is never enough to help everyone as it is. Spreading those funds even further to include food support could undermine the progress made thus far.

 On the other hand, the food crisis is fundamentally undermining the effect of those people who do receive HIV treatment. Rising food prices are not only affecting the health of people living with HIV, it is changing the priorities and behavior of people in general. More and more individuals living with HIV are going to have to decide between buying medicine or buying food. The ones who do buy medicine at the expense of their nutrition won’t be getting the full benefit of treatment anyway since their immune systems will already be so weak.

For me, this is a real chicken and egg situation. Both sides of the argument have ugly downsides. So any solution will be the lesser of two evils I suppose. It’s determining which is the lesser that has me stumped. What do you think?

THE DONOR DILEMMA

Millions of lives have been saved thanks to the generous donations of people and organizations around the world to fight HIV. Their efforts are making a difference in the war on HIV and AIDS.  Sadly, according to a recent report by the Center for Global Development, (CGD) many of these well-intentioned organizations are inadvertently undermining the very healthcare systems they are trying to aid.

The study focused on HIV initiatives in Mozambique, Uganda and Zambia. It reveals that in those three countries, because of the process requirements that come with the money; the programs initiated by major donors create a burden on already shaky healthcare infrastructures.

By specifying how the treatment is to be administered, the fund provider creates a treatment process for HIV that is separate from the rest of the healthcare system. Having another separate process to learn and run creates new complexity and burdens on already over-burdened systems.

Then there are the staffing issues. Instead of adding new workers for the HIV programs, they usually train existing staff in HIV/AIDS treatment and give them extra money for doing so. Since workers in the AIDS programs get paid more, it draws health and administrative workers away from other (generally already under-staffed) areas.

According to the report all this strengthens the nation’s ability to treat HIV, but weakens its overall ability to treat all other health issues — which are numerous.

I think the report did a good job at documenting the problem, but I was disappointed that it did not investigate or suggest a solution. It would be easy to conclude from the study that perhaps the money should just be handed over to the local health ministry.

The reason many HIV fund providers no longer do that is because they tried that approach and found it didn’t work. Other donors who support a sector approach through ministries get so bogged down with bureaucracy and politics that in many cases nothing happened and if it did, it simply took too long.

Generally, the American donor organizations favor the approach outlined in the report, although many do actually give directly to ministries as well. This results in fast action, but as the report says, can create other obstacles, i.e. sustainability issues and shortage of workforce in other areas.

One thing the CGD paper did not mention is the effort that donors are making to shore up local healthcare infrastructures. I think it’s important to mention that most donors do realize these problems exist and are trying to improve the situation. The World Bank used a whopping 40% of its HIV money for bolstering local infrastructures, and the new PEPFAR plan includes a program to train 140,000 health care workers.

Science recently addressed many of these issues in an investigation of how HIV funding is being used titled ‘HIV/AIDS: Follow the Money.’ In the feature, they call for the whole system to be re-thought and point out that many are questioning if all this money for HIV is only made possible by sacrificing treatment for other diseases.

The article also points out that many countries with poor infrastructures miss out on funding because donors realize much of the money will go to waste if they give it to them. The major contributors will not give more money to a country if they feel that country cannot handle it.  In most countries, that maximum capacity doesn’t provide enough money to treat everyone. So simply going around local health infrastructures is clearly not the way to make universal access a reality.

HIV is a long-term problem and clearly the current way of doing things is a short-term solution.  It’s fantastic that these programs have saved so many lives. It’s a shame the only way they can achieve these results is by circumnavigating the health ministries.  The bottom line is that millions are in need right now and they cannot afford to wait for efficient health care systems to develop. But develop they must. 

It is not the donors’ responsibility, but that of the governments who run the health ministries.

AIDS slang speaks volumes

You can learn a lot about the perception of HIV by looking at the words people use to talk about it. I’ve just found this list of HIV slang from plusnews.org.  The terms come from some of the African countries hardest hit by the HIV pandemic.

The outlook for a person who contracts HIV in Africa is improving, but as these terms reveal the perception on the streets is rather bleak. Many of the slang phrases are also quite clever, like ‘Five and three’ (because eight sounds like AIDS). Let us know if you have any terms to add to the list and we’ll pass them on to plusnews.  

Angola (Portuguese)
Pisar pisar na min - Contracting HIV is like having "stepped on a landmine"
Bichinho - "Little bug" (the virus)

Kenya (Kikuyu, spoken mainly in central Kenya)
kagunyo - "The worm" (euphemism for HIV)

Nigeria (Hausa, spoken mainly in the north)
Kabari Salama aalaiku - Literally translates as "Excuse me, grave" (reference to AIDS)
Tewo Zamani - Translates as the “sickness of this generation” (another reference to AIDS)

Nigeria (Igbo, spoken mainly in the east)
Ato nai ise - "Five and three" (5 + 3 = 8, and "eight" sounds like "AIDS")
Oria Obiri na aja ocha - "Sickness that ends in death" (euphemism for AIDS)

Nigeria (Yoruba, spoken mainly in the west)
Eedi - "Curse"
Arun ti ogbogun - "Sickness without cure"

Nigeria (Pidgin, the unofficial lingua franca)
He don carry - "He carries the virus"

Nigeria (English)
HIV - He Intends Victory (acronym of HIV and a phrase popular among born-again Christians)

South Africa (IsiXhosa and IsiZulu)
Udlala ilotto - "Playing the lotto" /ubambe ilotto - "won the lotto" (said of someone suspected of being HIV positive; Lotto is the national lottery)
Unyathele icable - Contracting HIV is like "stepping on a live wire"

South Africa (English)
House in Vereeniging - (Acronym of HIV; "bought a house in Vereeniging", a town about 50km south of Johannesburg, refers to someone suspected of being HIV positive)
Driving a "Z3"/ "having three kids"/ the "three letters" - All refer to the three letters in the HIV acronym
Tracker - If you are suspected of being HIV positive people say God is tracking you, like the popular southern African service that tracks and recovers stolen vehicles

Tanzania (KiSwahili)
amesimamia msumari - "Standing on a nail"; euphemism for being skinny, or being small enough to fit on a nail's head, referring to AIDS-related weight loss
kukanyaga miwaya - Contracting HIV is like "stepping on a live wire"
mdudu - "The bug" (refers to HIV)

Uganda (English)
Slim - Euphemism for HIV/AIDS as a result of the associated weight loss; less popular since the advent of ARVs

Uganda (Luganda, spoken mainly in the central region)
Okugwa mubatemu - You have been waylaid by thugs (contracted HIV)

Zambia (Nyanja, spoken mainly in the east and the capital, Lusaka)
Kanayaka - "It has lit up" (refers to a positive reaction from an HIV test)
Ka-onde-onde - "Thing that makes you thinner and thinner" (HIV)

Zambia (Bemba, spoken mainly in the north and Lusaka)
Bamalwele ya akashishi - "Those that suffer from the germ" (HIV-positive people)
Kaleza - "Razor blade" (Refers to a person being thin as a result of AIDS-related weight loss)

Zimbabwe (Shona)
Ari pachirongwa - "He/she is on a (treatment) programme"
Akarohwa nematsoti - "He/she has been beaten by thieves"
Mukondas - Abbreviation of "mukondombera" (epidemic)
Ari kumwa mangai - "He/she is drinking mangai" (mangai is boiled corn seeds, which represent antiretroviral (ARV) drugs)
Akabatwa - "He/she was caught" (received a positive diagnosis)
Zvirwere zvemazuvano - "The current diseases" (the HIV epidemic)
Akatsika banana - "He/she has stepped on a banana and slipped" (someone who has tested positive and therefore will "fall" or die as a result)
Shuramatongo - "A bad omen for relatives"

Zimbabwe (English)
Red card - Like a football player being sent off, life is over
Go slow - Taken to mean that he/she is now progressing slowly towards death
TB2 - Refers to high rates of HIV and TB co-infection (used to denote AIDS)
RVR - Slang for ARVs, adapted from Mitsubishi's RVR sports utility vehicle
John the Baptist - When someone has TB or HIV, he/she is said to have been baptised by "John the Baptist", who has come to announce the coming of AIDS
FTT - "Failure to thrive" (adapted from the medical phrase, now used to describe HIV-positive children)
Boarding pass - Implies that HIV is a boarding pass to death
Departure lounge - An HIV-infected person is in the departure lounge awaiting death

Photo courtesy of General Idea, Toronto