February 19, 2009

A Turning of the Tide?

I want to be very cautious about how I phrase this but in the last two months in the clinic we’ve noticed a definite uptick in the number of HIV tests we perform. If we keep up January’s pace, we’ll do far more this year than in any recent year.

As I’ve noted before, it can sometimes be like pulling teeth to get someone to agree to an HIV test. People are just too afraid and would rather not know than know. But knowing your status is the first step towards getting help and is a crucial part of getting the HIV epidemic under control.

I don’t have any good explanations for this sudden surge in tests but it is gratifying. A young woman I know very well came in for a test and was negative. It was really wonderful to see the joy on her face and hear her exclamation of delight - “I am HIV negative,” she shouted for all the clinic to hear. I’ve made a point of telling her and others like her that now they need to tell their friends and especially boyfriends to come do the same thing.

At the same time as we’ve had more self-referred patients for tests, there’s been a steady stream of people who show up too weak to walk, vomiting, with diarrhoea, in pain, gaunt, and emaciated. In many cases, they’ve had HIV tests in the past but have not regularly had their CD4 count checked to keep tabs on the progress of the disease. It is inexpressibly disheartening to see someone who is so sick and could have been helped long ago if only he or she had taken the time to visit the clinic.

One woman came in this morning who had tested positive several years ago and had never had a CD4 count done. The last time she visited our clinic was a little more than two years ago when she had been encouraged to come back the next day for a CD4 count. (We can’t do counts every day for a variety of reasons too complex to explain here.) She continued to live in Itipini but she had never returned to the clinic. Today she came in, supported by a friend, not looking too thin but weak and labouring hard. None of these was her chief complaint, however. What made her return to the clinic was her painful feet. Jenny took the blood for a CD4 count but we still have to wait a week for the results and then - if everything goes well - it’ll be another month of appointments before she can get ARVs. Will she still be alive then? I hope so. We’re dancing along the edge of the cliff with someone like her. I like high stakes as much as anyone but not when those stakes are someone’s life. Remember Nosisi? Her story is emblazoned in my memory and I want to avoid anymore like her.

Ironically, today’s patient lives with Nobathembu, a woman I’ve written much about before, who is now on ARVs but not before she nearly died of AIDS. Nobathembu spoke passionately at our World AIDS Day celebration last December on the importance of knowing your status and having a CD4 count done regularly. Evidentially, that message didn’t make it to her friend.