March 6, 2015

March 6, 2015
Primary HIV Infection
Part 2

Welcome to another day in my life. Today is Friday and we have almost made it through another work week. I hope you are having a beary safe and great week so far. Many thanks to all of you for your wonderful caring emails and notes of love and support during my illness.

Yesterday, I started blogging about primary HIV infection which I would like to continue today talking about applications and recommendations based on my blog yesterday.

Applications and recommendations

Developed countries have already implemented routine screening of viral load levels, and protocols exist for detecting and treating PHI. However, in developing countries – where viral load testing is not routine in the public health sector – different strategies are required to apply these developments.

It is inevitable that debate will ensue regarding the increased availability of equipment and trained personnel to conduct routine viral load testing, not only for those living with HIV, but also for those who test negative and are suspected of being in the PHI stage of infection.

Our primary initial objective should be to engage health care workers, and inform such personnel of the nature and details of both viral load fluctuations and PHI. Apart from the treatment and management of symptoms, health care workers need to be informed of the implications for transmission of HIV, and begin conscious screening for PHI, provide risk-reduction advice and referrals, as well as provide accurate information regarding various health and lifestyle practices that impact viral load levels. Guidelines in this regard need to be urgently developed.

In preparation of the inevitable technological and medical applications of viral load monitoring, HIV/AIDS health educators need to broaden their curricula to include germ theory, primary health care, the dynamic relationship between TH1 and TH2 immune systems, and the nature of viral activity. It is no longer adequate to merely deliver simplistic – and inaccurate – information about HIV transmission to the public.

HIV/AIDS educators would also be advised to ‘mainstream’ HIV education to include primary health prevention methods, as these would reduce the number and severity of co-infections that cause viral load spikes, which in turn increase probabilities of HIV transmission.

In the absence of widespread viral load technology, interim public messaging needs to be developed so that the public may benefit from this increase in knowledge. For example, it is a simple biological fact that viral loads will spike when a person living with HIV has some other illness. Therefore, messaging concerning taking precautions – such as abstaining from sex and wearing condoms – when you are ill would be appropriate.

There is also an urgent need to various sectors involved in social development and service delivery to become aware of the impact that their services have upon aggregated viral load activity in communities, due to issues such as the state of a community’s primary health, and access to health services.

The private sector – especially those involved in food supplies – need to become aware of the impact that specific nutritional elements (e.g., selenium) have upon HIV transmission. Government subsidies of suppliers needs to be linked to both the quantity and quality of fortification of foods.

It is also evident that research needs to be conducted to ascertain the precise extent of the impact of PHI in HIV transmission in Southern Africa.

It is apparent that there is already a range of practical steps that can be implemented to integrate the new paradigm into existing HIV transmission reduction methods, without throwing ABC out of the window. Neither the biological or behavioural paradigms are article of faith: They are methods to achieve an objective. We merely need to revise and integrate the old and the new strategies, keeping our collective eyes firmly on the ultimate goal: Zero HIV transmission.

Hope you have a beary safe and great Friday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab