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Beat It! 1999 Episode 3

What is mother-to-child-transmission? How is the virus passed on to the baby? What are HIV positive pregnant women’s options? These are some of the questions that the Beat It! Team answered in this the third episode of the 1999 series.

Sipho Nhlapo: Hi I’m Sipho Nhlapo welcome back to Beat It! – your guide to better living with HIV and AIDS. I am HIV positive and so is my co-presenter here.

Mercy Makhalemele: Sanibonani Bakithi igama lami ngingu [Hi everyone my name is] Mercy Makhalemele I have been living with HIV for the past six years. Beat It! is a programme which will bring you reliable information that will help you to live a better life with HIV.

Sipho Nhlapo: Njengamanje sime amagcekeni wase [Right now we are standing outside the premises] of Chris Hani Baragwanath Hospital. In this week’s programme we zoom in on how pregnant women transmit the virus to their babies.

Mercy Makhalemele: Uyazi Sipho, [You know Sipho] this is a topic close to my heart since I lost a baby girl who was born HIV positive. The Beat It! team visited Chris Hani Baragwanath Hospital in Soweto right here and also spoke to doctors in Cape Town. They filed this report.

Special Report - Prevention-of-mother-to-child-transmission

Narrator: Every woman is at risk of catching the HIV virus. Country wide one in every four pregnant women using antenatal clinics is infected with HIV.

Elizabeth Chidonza: I gladly went for the test and then only to find out that the results were HIV positive.

Joy Shezi: Emva kokuthi bangitshele, baqeda nje ukungitshela ngacollapsa, ngaquleka, kwaba yi-two hours ngiqulekile. {IsiZulu} [After they told me when they finished telling me I collapsed. I fainted for two hours.]

Prof. James McIntyre (Co-Director of the Perinatal HIV Unit, Chris Hani Baragwanath Hospital): I think again there is a perception of a very core risk group of women who have HIV. And I think the worst thing is ordinary women if you like, average women who are coming through infected.

Narrator: If these women do not receive any help, they stand 30% chance of transmitting the virus to their babies. But how do mothers infect their babies.

Prof. Greg Hussey (Head of Paediatric Infectious Diseases at UCT): Most children get HIV infection from their mother while they are still unborn in the womb. A few children do contract HIV trough accidental exposure to blood and blood products or through sexual abuse. But the major way that they get is through their mothers.

Sister Isaacs: You can choose to have a child when you are HIV and AIDS positive or not but you must be aware that it impact negatively on your health.

Prof. Greg Hussey: Not all children born to mothers who are HIV positive will become truly infected with the virus. We estimate that probably 30% of this infant will become truly infected.

Elizabeth Chidonza: I had a feeling just psychological thinking that obviously if I’m positive obviously the baby would be positive, so I asked my gynea if I could have an abortion because I didn’t want the child born positive and suffer because then I had a bit of information of how people suffer, people who’ve got HIV and AIDS.

Sister Isaacs: In South Africa the law has passed which give mothers the legal right to decide whether they want to continue with pregnancy or whether they want termination of pregnancy and it is every health professional’s responsibility to see or counsel clients and refer for TPO (Termination of) of pregnancy because that is the client’s legal right.

Prof. James McIntyre: Some of them will become ill in the first year of life, what we call rapid progressors they go very quickly and those are probably children who were infected very early in pregnancy and some of the other only started to get ill on the later stage, maybe five years, six years and are quiet well. The most common kind of illnesses that we seeing are pneumonia, diarrhoea, and gastro intestine upsets: infections that most children get but which become more severe in the infected children.

Sibongile Mkhize: So, nje ezinyangeni, enyangeni eyodwa bekegula kathathu, so bengingekhe ukwazi ukuyithenga, mhlambe beyingaka ku-five hundred rand. {IsiZulu} [So in months, in one month he will get sick three times, so I could not afford it, I think it was R500.]

Narrator: Elizabeth eventually continued with her pregnancy but she was in for a hard time. Sometimes Bernies will be in and out of the hospital.

Elizabeth Chidonza: I must be honest I did loss hope, when she fell very ill, when she was three months old, when she went splashy and she had diarrhoea, she just went weak and I thought that was the end she’s; dying.

Narrator: Elizabeth also had to deal with her husband’s attitude.

Elizabeth Chidonza: He didn’t want to accept this HIV thing, he said it must be some traditional stuff that affecting the child maybe there is some ancestral spirit that is making her sickly. He asked if he should rather go to his father and seek some help, some traditional help. We went all the way to Zimbabwe with the sick child in the car we drove from Cape Town to Harare. One traditional doctor even pulled out something like a snake from her navel and showed us that you come from Cape Town near the sea, somebody has been fidgeting with your child, which I don’t believe that was true but the way he did it looked so true. I did believe because the child did get well anyway.

Narrator: Bernies was finally taken to hospital were her diarrhoea was successfully treated; other women have been less fortunate.

Sibongile Mkhize: Ushone ngo-1998 eseneminyaka engu-eight. Kakhulu, kakhulu kwangiphatha kabuhlungu ukushona kwakhe ngoba bekakhulile, sesixoxa indaba sihlale phantsi sobabili kube nokutile esikusherayo sobalili nami naye. {IsiZulu} [He passed away in 1998, he was eight years old. There was… the most painfully thing when he passed because he was grown, we used to sit and talk, me and him and share something.]

Narrator: In the meantime neither traditional healers nor conventional doctors have come up with the miracle cure of HIV. With the new medicines HIV/AIDS can be treated making it a chronic disease is like diabetes and asthma but these medicines are very expensive. However it has been shown that the drug called AZT could prevent the transmission of the virus from mothers to the babies.

Prof. Greg Hussey: In the American and French they gave the women AZT from about fourteen weeks of pregnancy, initially they gave it by mouth and in labour they gave it by injection, after delivery they gave AZT to the baby by mouth for about six weeks. They had a control group by women who got no treatment at all and when they looked at the rate of transmission they found that the women who got AZT the rate of transmission was reduced quit dramatically by the order of about 67 to 70%.

Narrator: To achieve these results medicines costing about R4000 per woman is needed supported by sophisticated healthcare procedures. Doctors searched for cheaper and simpler ways of administering AZT to pregnant woman.

Prof. Greg Hussey: The American study was done about six years ago and this was followed by the Thai study which was the study to look at a cheaper and easier way to administer AZT. And in this study AZT was given for the last four weeks of pregnancy to the mother and also during labour and the babies were not breast fed but the babies were not given AZT in this study. And they found in this study transmission rate was reduced by 50%.

Narrator: The cost of the medicine needed per woman and to achieve Thai results amounts to only R400. More recently studies similar to the Thai one has been done in Tanzania, Uganda and South Africa. Here researchers gave women AZT together with another drug called 3TC, although women in this study breast fed the mother-to-child-transmission was still reduced by 50%.

Joy Shezi: Ingane yami ikhona njena kodwa soloko bayitesta ina-three months yatholakala i-negative, baphinda futhi ena-nine months bathola ukuthi isolokho I negative, baphinda futhi asononyaka bathola solokho inegathivu. {IsiZulu} [My child is alive…She was tested when she was 3 months old and again at 9 months and 1 year, she is still negative.]

Prof. James McIntyre: I’ve had a research unit at Chris Hani Baragwanath; we’ve been involved in a very large trial given AZT and 3TC to pregnant woman to look at affected…. on transmission. We now have a limited access programme with some drug which has be supplied by UNAIDS and we are negotiating for a larger pilot project because what is so very obvious that, it doesn’t matter if we were to fly a drug in here tomorrow we need to have a lot of other things in place like testing and counselling, like proper supply systems in order to take it wider and we would now like to move to that step with a large pilot project that will provide drugs for about 5000 women.

Narrator: So far the government has refused to pay for AZT for pregnant women because it says it can not afford it. Researchers are now looking at giving less AZT to women and it looks like short course of AZT can still bring down mother to child transmission to about 37%. The cost of this treatment will be even less than R400.

Seabelo Kgarosi: I do not know how much the drugs cost if I had to pay for them. But then even if I knew I would have money to pay for them.

Narrator: In the meantime the study done in Uganda which compared AZT and Nevirapine showed promising results. While AZT cost R400 and the amount of Nevirapine used per woman in the Uganda trials cost only R40.

Prof. Greg Hussey: The Ugandan study found out that the mothers who were given Nevirapine they actually in fact had much lower transmission rate on the mothers who were given AZT. On the orders like 12% compared to 22 % in the mothers who got AZT. Showing a dramatic effect. I think the advantage of Nevirapine is that is a single dose.

Narrator: A similar trial comparing the effectiveness of AZT given together with 3TC with Nevirapine is currently under way in South Africa.

Dr Paul Duminy (Investigator in the Nevirapine – AZT trial): Our trial started in March 1999 and they should be running for ten months after that.

Narrator: But Dr Duminy warns that it is vital to run well controlled trial before dispensing drugs to people.

Dr Paul Duminy: It would be very, very irresponsible of the medical profession to use any drugs that are not specifically tested and haven’t been proven to work.

Sibongile Mkhize: Mangi bongele abomama abakhulelwe sebengakwazi ukuyithola iAZT. [I am glad for those mothers who are pregnant and can get AZT.]

Narrator: Bernies health has improved considerably since she has been enrolled on a drug trial at the beginning of this year.

Elizabeth Chidonza: The observation since she’s been on the drugs, the observation I’m seeing is that she hardly falling ill, she not getting any fevers like temperatures, high temperatures, she hardly gets diarrhoea, she is very hyper active.

Narrator: It’s a R1000 a month, Elizabeth will not be able to pay for her daughters medicine herself. However if AZT would have been available when Elizabeth was pregnant, Bernie would not be ill in the first place. The government is aware of the studies undertaken with AZT.

Prof. James Mcintyre: I suspect that the real bottom line is cost and the health services in provinces, they are in a lot of strain and this is perhaps not seen just as a priority, I think it’s just a perception you have to challenge. One child out of every ten born today is going to die of HIV. Now why is this not an emergency? If a cholera epidemic came sweeping through the townships surrounding Durban and started killing one person in ten, there will be all sorts of …… mobilized to stop it but somehow for HIV we don’t have that sense of emergency. There is almost a fatalism attached to it that says it will happen anyway, there is nothing we can do.

Narrator: AZT and Nevirapine will prevent the majority of babies for being infected by the virus. Research shows that it is cheaper to prevent HIV in babies than treating the disease. Will the government implement this programme? Will the drug companies lower their profits; make AIDS drugs like AZT and Nevirapine affordable? These questions remain to be answered.

Treatment Literacy

Faghmeda Miller: Hello doctor, a lot of people think that HIV and AIDS are the same thing, like one of my friends told me when her family discovered that she was HIV positive, they all come to the house because they wanted to discuss her funeral arrangements and that they thought she had AIDS. So what is the difference between HIV and AIDS really?

Dr Steve Andrews: Faghmeda there is a big difference between HIV and AIDS. HIV is the virus or the germ that infects the body. It does so by coming in contact with the infected body fluids and primarily this is sexual contact. This means practically having sex with a person who is HIV positive puts you at risk of becoming HIV positive yourself. Other ways of becoming in contact with infected fluids is for example by sharing needles as a drug user. There are however some fluids that are not infectious, for example tears and salvia. Studies have shown that infectious fluids really are sexual fluids such as semen and blood.

Faghmeda Miller: How is that possible that one virus can affect your whole system?

Dr Steve Andrews: Once HIV enters the body it lives in and multiples in the cells of the immune system. These cells which are called T cells sometimes CD4 cells, are the ones which normally takes care of you. Just like in an army you have cells that do the job and have cells that give orders. These are the cells that give the orders, the General cells if you were. HIV over long period of time, this can take many years robs the body of its General cells, the body becomes weaker and weaker and then eventually the body can’t defend itself against other invaders. It’s important to realise that the majority of these sicknesses though, things like tuberculosis, some forms of pneumonia, various skin diseases and things such as oral thrush are treatable.

Faghmeda Miller: I know that lots of people that are HIV positive they believe that uhm; this is not treatable at all.

Dr Steve Andrews: Faghmeda it’s important to distinguish the treatment of HIV itself and the treatment of illnesses that HIV causes, for now we are going to be talking about the illnesses that HIV causes and a little bit later addressing the issues of the treatment of HIV itself. It is important to diagnose and treat all illnesses, they crop up in terms of keeping somebody healthy, if you are HIV positive and you do develop an illness it’s important to consult your doctor rapidly in order for you to obtain treatment for that illness.

Faghmeda Miller: I know for lot of HIV positive patients that go to the doctor basically government hospitals feels that they don’t get a proper treatment at all. So what can they do to ensure that they are treated properly?

Dr Steve Andrews: Faghmeda this is why it’s so important for people with HIV to know about their illness and to take charge of it. If you feel that you are adequately for illnesses that are really treatable then you should feel that you have the right to ask questions of the doctor who is treating you and to get a proper treatment. There is a medical reason for this as well because illness that are badly treated result in your immune system being less able to fight of the HIV.

Faghmeda Miller: Why can’t we do something about the HIV virus itself?

Dr Steve Andrews: There are medications available that directly treat HIV. What’s important about these is that they do not take away and kill the illness but they keep it under control very much in the same way as illnesses such as diabetes are kept under control by medication.

Faghmeda Miller: If there are medicines available to treat us HIV, why are they so, why people don’t know about it, why is that so?

Dr Steve Andrews: A lot of people haven’t heard of them and a lot of people are not taking them for a large number of reasons but the main problem is money. These medications are very expensive and most people can’t afford them.

Faghmeda Miller: For a South African you know, what will the medicine actually cost if I should go forward and say I would like to get a proper treatment here.

Dr Steve Andrews: The cost of medication differs from person to person and there are a lot of factors that will determine what will cost but the cost of the drugs could be anything from R500 to R4000 per person per month.

Faghmeda Miller: What would you say to someone who is HIV positive, how should they deal with this situation.

Dr Steve Andrews: Faghmeda I will remind the people that this is your illness, it is something that you need to learn as much as possible about and you need to take control and see your doctor rapidly when you feel sick.

Faghmeda Miller: Thank you very much Doctor, but next I would like to ask you about AIDS itself?

Dr Steve Andrews: Sure.

Food for life

Marc Lottering: Mum I’m always telling you, never ever go to the wedding excepting food, you know in fact they should get Luanne and Adeline to do the catering for them. Daai sal vir jou ’n health buffet wees ne. [That'll be a health buffet for you,] but wait the programme is starting I will call you later. Ja, thank you bye.

Adeline Mangcu: Hello everybody welcome again.

Luanne Epstein: Many viewers are gluing in on a balanced diet, it seems lot of people are still quite confused about the concept but it is really not that difficult, you just have to remember about the three different food groups.

Adeline Mangcu: I hope you still remember them.

Luanne Epstein: The energy foods: brown bread, brown pasta, samp, rice, honey, bali and oats.

Adeline Mangcu: The building foods are chicken, meat, plain yoghurt with the AB on top, beans, lentils and eggs.

Luanne Epstein: And the protective foods: our fruits and vegetables which are just filled with all the vitamins and minerals.

Adeline Mangcu: This week we are going to show you that making a balanced meal is a lot easier and less expensive than you thought, so get ready for the food fest.

Luanne Epstein: Are you ready Adeline?

Adeline Mangcu: I’m ready Luanne. Well here we go.

Marc Lottering: 19, 95, 14, 50 where is Trevor Manual when you need him.

Adeline Mangcu: We’ve cooked for different tastes and different budgets. Let’s start where we start the day. Breakfast: here we have this plate which has the three basic food groups. We have the egg which is your building foods, and then we have the toast which is the energy foods: brown toast and the tomato and the oranges are our protective foods. Alternatively you could have a bowl of cereal, the cereal itself is your energy food and the milk is your building foods and the oranges your protective foods. Now this meal cost R1.10, this 80 cents.

Luanne Epstein: A meal that’s good for vegetarians and dead cheap is this samp and beans. Samp is your energy foods, beans are your building food and the carrots and spinach protectors, this meal cost 80 cents.

Adeline Mangcu: Here is another meal this is quite easy to make, you also again have three basic food groups. You have your brown rice which is your energy foods and then you have your pilchards which are your building foods and this salad is our protective foods and this cost R1, 40.

Luanne Epstein: A meal that is good if you feeling lazy is this baked potato which is your energy food the cheese is your building food and salad is your protective food, it all cost about R1.00.

Adeline Mangcu: If you have many mouths to feed the soup is always the winner, here you have your energy foods, bali, peas and lentils as your building foods and celery, carrots, turnips and onions as protective food this cost only R1.00.

Luanne Epstein: Our final meal is the Sunday spread here we have potatoes as our energy food, chicken as our building food, mixed vegetables, beetroot salad and squash is our protective foods, this meal is a little but more pricey at R5.00.

Adeline Mangcu: ...the end of the day isn’t it Luanne?

Luanne Epstein: … recipes using the three food groups. We hope you enjoyed yourself.

Adeline Mangcu: In the mean time we will try these recipes out. Goodbye everybody.

Marc Lottering: All that food for two people, healthy diet?

Red Noose and positive person awards

Marc Lottering: Hello, hello this is Marc Lottering again with this week’s riveting red noose and positive person award. Now this week the red noose goes to all the members of the Pharmaceutical Manufactures Association involved in making HIV drugs, companies like Glaxo Wellcome , Brystol Myers, Pfizer and all the others; you know who you are, for not excepting that health comes before profits and to block our government from importing drugs at the cheapest world market. And how is that for free enterprise and how is this for the neck accessory to get the message. Now the positive person award this week goes to every researcher, doctor, nurse and counsellor who is working on the pilot projects and drug trials at Chris Hani Baragwanath Hospital in Johannesburg and Hlabisa, Prince Edward Hospital in Durban and Khayelitsha Cape Town and too all others that we might have left out to try and counter the transmission of HIV virus from mothers to children, to all of you out there we say keep up the good work we are rooting for you and the heart is for you. Oh Oh Oh before I go a very special note to Doctor Manto Tshabalala-Msimang our Minister of Health and to all others who work at the Department of Health in Pretoria, please make a note in your diaries we must remember to set a price with which we’ll be able to afford AZT to pregnant mothers so that we can close the deal with Glaxo on this one. Don’t forget, read my Cape Flats lips, it’s hard to miss: “Set the price.” Come on now we know you can do it.

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