Treatment brings hope to 170 AIDS patients
GUM clinic plans nationwide programme
By Samantha Alleyne
Stabroek News
June 9, 2003
Some 170 AIDS patients are receiving free anti-retroviral treatment which if properly taken can allow them to live healthy and productive lives.
The drugs are produced locally by the New Guyana Pharmaceutical Corporation and are made available through the Ministry of Health at the Genito-Urinary Medicine clinic (GUM) in the Georgetown Hospital compound.
The anti-retroviral (ARV) drugs offered at the clinic are stavudine (stavimune), one capsule two times daily; lamivudine (lavimune), one capsule two times daily; and nivirapine (nerahiv), one capsule daily.
In an interview with Stabroek News, Director of the clinic, Dr Michael Ali, reported that patients have been responding well to the treatment and some “who have been on their death bed were given a second chance and are now up and well and some even back at their jobs.”
A previous concern that the pills were all the same colour is to be corrected and Ali said the next batch would be colour-coded.
The clinic began to treat patients in April 2002 and now has 170 persons on its roll.
While most of the patients are from Georgetown, others are from the East Coast, East Bank, Corentyne, Skeldon, New Amsterdam, Charity and Linden.
Depending on where they are in their treatment the clinic would see the patients at different intervals, some every two weeks others monthly or every two months.
“If they are stable we don’t need to see them every month, they would just be returning for check ups. I must say that the response to treatment has been excellent. The drugs are effective, they are generics. I have no question about the quality.”
According to Ali when they initially began treatment patients did not flood the clinic as was expected.
“But I think within a couple weeks, recently, I think we are having more and more people.... I noticed more and more patients coming in and we are going to have to find a way to deal with that in terms of our staffing and resources.”
Dr Ali said the next step is to decentralise the treatment programme. “To have treatment programmes in New Amsterdam, Linden, Suddie and maybe West Demerara and that will help us to have more patients accessing treatment and will reduce the load here at the clinic.”
He said decentralisating the treatment programme should also include “getting into the private sector.”
A workshop was held last year for doctors in outlying regions on how to administer the treatment.
He said later this month there would be a refresher course.
“Here we have in Guyana, care that can be compared with many countries in the world and even better than some. And just in Berbice we have that which is among the worst. So we have to work on that.... because these drugs they work and they can make such a difference that people can return to productive lives, they can take care of their families, they don’t have to die.”
In relation to the drugs being provided by doctors in the private sector, Ali said that he had one major concern with those medical practitioners:
“My very major concern is that.... in terms of managing HIV, worldwide mono-therapy is not being used, that is using a single ARV drug, double therapy or dual therapy is not being used, it is not acceptable. What is proper is using triple therapy. Any patient who goes on ARV must be on three drugs, at the right doses and they must comply by using the treatment and whether it is twice a day or three times a day, they must be using it all the time.”
Ali stressed that patients could not use the drugs for a month or two weeks and then stop, “for as long as they live they have to use it...”
He said that his concern was that in the private settings there were patients placed on mono-therapy or on just two drugs.
“That is not acceptable... and it will also allow for the emergence of resistant strains of the virus. Considering the fact that this is a poor country, we only have five ARVs that are being locally produced, that are available to patients free of cost. If patients should start receiving treatment improperly and they develop resistance to these drugs then there would be no option for them down the line.”
Patients who might develop a resistant strain could also transmit this to other patients.
“It means that it can be a detriment to the entire [HIV/AIDS] population. I think physicians should desist from doing this. Anybody who is treating patients should not be doing that. If you are treating patients it is either you do it properly or you do not treat at all.”
Ali said some patients received drugs from overseas and they might receive a supply only for a short time and did not know when the next supply was arriving.
“Patients also need to understand that when they go on these drugs, you have to be on them all the time it is not a case where you use it for a couple of mornings and you get better and you stop using it.”
The protocol at the clinic is that only persons who have full-blown AIDS (Acquired Immune Deficiency Syndrome) will be placed on the treatment.
“Only patients that are symptomatic that are showing up symptoms of AIDS, then we would place them on treatment.”
The director noted that there were many patients who were HIV (Human Immuno-deficiency Virus)-infected and they were looking as healthy and normal as anybody else. He added that only when one started developing symptoms of AIDS did a person develop opportunist infections.
But not all persons who have full-blown AIDS and visit the clinic are placed on treatment.
Dr Ali explains: “Firstly they have to satisfy us that they can adhere to the treatment. Adherence is a big issue because of resistance. The HIV virus multiplies so quickly that resistant strains can emerge quickly too. If patients do not satisfy us in their ability to adhere to the treatment in the sense of taking their medications in the morning and in the evening........ There will be some on the streets, some who may be mentally impaired and for some other reasons, maybe drug addicted or something.”
He added that no doctor at the clinic was withholding treatment since their desire was to see as many patients on therapy as possible.
However, they do not want to jeopardise their programme by placing patients on treatment who were not going to adhere to it.
He said there were just a few patients they were not satisfied with, while others had opted not to go on the treatment.
When the treatment first became available, Ali said that at first there was a scare and some persons were not keen on being treated because of negative publicity.
“There was this scare and patients were reluctant.... Now HIV positive people are just coming, having seen what the ARV has done for others.”
Ali said that they were confident that once the treatment started and people actually saw evidence of its effectiveness they would want to be treated.
“We are not saying that every patient who went on the drugs survives, there are some who went on too late and they are so sick that even though we tried we could not salvage them.”
In terms of educating patients on the drugs themselves and possible side effects, Ali explained that no patient was placed on ARVs on their first visit. Initially their history would be taken and they would be examined and they would have to undergo some laboratory testing.
“Then we counsel them on the ARVs, the importance of adhering to the treatment and on clinic visits and the fact that you would have to be doing laboratory tests every time you come for the first four months. Also we tell them they have to take blood tests regularly.”
To make it easier, Ali has developed a handout which he gives to prospective patients informing them of their rights; who goes on treatment; what is the procedure; the laboratory investigation; what the capsules are; what they look like; what are some of the minor side effects; and what are some of the serious side effects.
The handout for the patient states that the start-up treatment lasts for two weeks after which they return to the clinic and would experience some side effects such as headaches, upset stomach, abdominal pain and diarrhoea.
The handout warns that serious side effects such as fever, redness to the eyes, sore throat and muscle or joint pain should be seen by a doctor right away.
The patients are urged to take their treatment correctly and to keep their appointment dates or visit two to three days before their treatment finishes so they would not be left without medication. A balanced diet is also very important.
Ali said that in anticipation of the expansion of the treatment programme there were two other full-time doctors and one who worked twice a week.
“So any day you would have three doctors working with patients.”
He noted that the clinic did not only deal with HIV/AIDS patients but other patients who might be infected with sexually transmitted diseases or those who might just want counselling.
There are only two rooms at the clinic equipped to examine patients and they are working on equipping the third.
Dr Ali encourages people who just suspect that they are HIV positive to visit the clinic and get tested.
“The main thing I want to get across is that HIV, it is not a death sentence, it is not... Treatment is available, the treatment works, you can be sick but you don’t have to die. Come in, but come early, we would treat you and we want people to come in here... You have kids, think about those children you want to live for. Go on treatment and you are going to be so happy.”
He added that everything at the clinic was free of cost and while there might be some horror stories it was not so bad and he had encouraged his staff to be as professional as possible.
As for confidentiality Ali said, “Guyana is a small country. Are you going to allow that to get in the way of your life?”
He pointed out that the confidentiality problem did not only lie with the clinic but it could be somebody who might pass and see someone at the clinic and tell someone else.
“I understand, but it is not because of the GUM clinic. It is because of the whole issue of stigma and discrimination that this disease carries with it worldwide. I think one of the best things we can do to de-stigmatise the disease is where treatment is concerned. Because when people see you doing well they would realise it is not so bad.”
