Your rights to antiretroviral treatment

2010-08-02 00:00

THE severity of HIV infection is measured by testing a person’s CD4 count. The HIV weakens the body’s ability to fight infection. The CD4 count is the level of the body’s infection- fighting soldiers. The higher the level, the healthier the person. Conversely, the lower the level, the more vulnerable the person is to other opportunistic infections, which, if untreated, ultimately kill.

The World Health Organisation (WHO) recommends that every- one who has a CD4 count of below 350 should receive anti-retroviral therapy (ART). In South Africa, ART treatment is generally only given to people with CD4 counts of 200 or less. However, the government has now made some exceptions to this policy. There are three circumstances in which people with CD4 counts above 200 are entitled to receive ART free from the government.

Firstly, all HIV-positive babies of less than one year old must be given ART, regardless of their CD4 count. You have the right to insist on this for your baby. Studies have proved that babies who are given ART in the first year of life have a much better chance of survival that those who are given ART at a later stage.

Secondly, all people who are co-infected with HIV and tuberculosis (TB) must be given ART at a CD4 count of below 350. The earlier that you receive treatment the better, because you will better be able to resist opportunistic infections. The government has promised that the HIV and TB health services will be integrated, which will mean that medication for both diseases will be available at the same clinic.

Thirdly, all HIV-positive pregnant women with CD4 counts below 350 must be given prevention of mother-to-child transmission treatment (PMTCT) immediately. If the CD4 count is above 350, women must be given PMTCT treatment from the 14th week of pregnancy. Past practice was for women only to be given PMTCT from the 28th week of pregnancy, and some clinics still turn women away until they are in their 28th week of pregnancy. You have the right to insist that you be tested so that you can access the treatment to which you are entitled.

This is an important positive development for South Africa, but we need to ensure that these changes are actually implemented in our communities. The government must deliver on its promises. Tragically, there is much evidence to show that official government policy is often not actually implemented — especially in under-resourced rural communities.

We also need to continue to urge the government to comply with the WHO recommendation that all people with a CD4 count of lower than 350 receive ART.

People who only receive ART at levels of 200 or below are at risk of suffering permanent disability, even if their CD4 count improves after the ART. For example, Aids dementia (also known as HIV encephalopathy, or hive) occurs in two out of every 10 people who develop Aids, which often happens at around a CD4 count of 200. The lower the CD4 count before ART is received, the smaller the chance of any significant recovery. Aids dementia progresses from stage one to four. At stage one, a person suffers relatively mild difficulty with mental tasks, such as remembering things or following a detailed set of instructions. At stage four the person cannot control their bodily functions, and can hardly communicate at all. If you suspect that you have Aids dementia you should insist on being tested at a clinic. If dementia is diagnosed you should request ART treatment regardless of your CD4 count, as the dementia can be stopped from getting worse, and can sometimes even be reversed. • Nicci Whitear-Nel is a senior lecturer at the University of KwaZulu-Natal, Pietermaritzburg.

• The Pietermaritzburg campus of the Law Faculty of the University of KwaZulu-Natal is celebrating its centenary this year. As part of its centenary celebrations, legal academics from the Pietermaritzburg campus will be publishing a series of articles on current legal developments and other interesting topics, in The Witness.

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