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Beat It! 2000 Episode 4

In this Beat It! episode we met Queenie Qiza who had words of encouragement for everyone living with HIV/AIDS. Queenie went on to assist the viewers to better understand what we can learn from viral load and CD4 test results and why they are necessary. Queenie’s results were not encouraging. Dr Hermann Reuter gave sound and practical advice about nutrition for People Living with HIV/AIDS. He encouraged HIV positive people to eat as often and as much as they can to counter the weight loss that accompanies the late stages of HIV infection.

Mercy Makhalemele: Dumelang, ko lapheng. [Hello viewers at home.] Welcome to this edition of Beat It! Dumela [Hello] Paddy {Sesotho}

Paddy Nhlapo: Dumela [Hello] Mercy, how have you been since last time? {Sesotho}

Mercy Makhalemele: Well, I’ve stopped my antiretroviral AIDS medicine trial that I was on so I am wondering what’s happening to my viral load, you know the amount of virus that’s actually swimming around in my body.

Paddy Nhlapo: We are in luck, because this week we investigate the role of viral load measurement and CD4 testing in proper management of HIV disease.

Mercy Makhalemele: Okay, so it’s off to the laboratory again this week. After that we are going to our support group, where we will be sharing some information that I think you will be finding very interesting.

Paddy Nhlapo: Let’s say hello to Queenie Qiza. Queenie’s been a National Association of People Living with AIDS volunteer for years, and was one of the first women to declare her HIV status in Gugs, you know Gugulethu, and has been a vital support for others. Let’s watch her blow your mind.

Profile - Queenie Qiza

Queenie Qiza: Ndingu Queen mna, ndingu-Nozibonela Qiza. Nda zalwela apha eKapa ngo 1957, ndina 43 years, this year. Kule yadi ndihlala kuyo yi-four room le, lendlu enkulu le. Ndibe ne-shacks eziyi-seven e-back. Abantu abakhoyo bayi-28. Nale ndawo ndihlala kuyo ayikho-right for mna. Because yabona if imvula iyanetha, ayangena lamanzi. Ayangena lamanzi adade apha phakhathi. Ndilale nabo ibhendini, kuyabanda. Ndihlala apha kulendawo since 1989. Since from 1989 ndahlala ndazohlelwa yile-HIV/AIDS ngo-1997, nge-23 zaka-May ngo-97. Ndatsalwa igazi e-Conradie Hospital wathi ugqirha mandihambe ndibuye after a week. Andizange ndifumane i-counselling, qha yena wandixelela ukuthi uzonditsala igazi. Okay ndihambe, ndabuya after leyo week ugqirha uyoyika undixelela, wabala i-note wandithumela kwi-social worker. I-social worker xa ndifikayo pha, into yokuqala wandibuza ukuba ndinayo i-boyfriend na? Wandichazela ukuthi into i-HIV ndiyayazi na? Ndathi hayi andiyi-understandi. Wandichazela nge-STD, wazongena kwi-HIV. Wathi i-HIV yilanto asiyo-diseases yi-virus nje. Uyandicela ukuba ndingayifaki kakhulu enqondweni. Xa ndigoduka, ndize nge-train ndisuka eConradie, njengoba ndikhwelwe itrain nje andiva niks. Ndiyababona abantu bethetha ngemilomo, ndibona nje imilomo andiva niks, ndiyacinga lento apha etreynini heyi abantwana, ndizabathini, umam’am ndizamthini and umdala. {isiXhosa} [I am Queenie Nozibonela Qiza. I was born here in Cape Town in 1957. And the conditions I live in are not right for me, because when it rains the water leaks through the roof. I cuddle with my kids on the bed because it’s cold. I’ve lived in this shack since 1989. I contracted HIV/AIDS in 1997. I was diagnosed on 23 May 1997. They took blood at Conradie Hospital. The doctor told me to go home and come back in a week’s time. I did not get counselling before they took blood. I think the doctor was reluctant to tell me. He wrote a note and sent me to a social worker. The social worker asked me if I had a boyfriend. She asked me if I knew anything about HIV and I said no. Then she explained, starting with STD’s and got to HIV. She said HIV is not the disease, just the virus. She told me not to think about it too much. I took the train home from Conradie. As I’m sitting in the train, I could see people talking but I couldn’t hear a word. I’m thinking about this, about my children and my mother, who is old.]

Queenie’s Daughter: We have to just accept it because it won’t change, and just be supportive.

Queenie Qiza: Ndinenye i-friend yam, hayi naye ke ungumntu ogulayo ziiswekile ne-high blood. Sihlale ngamacebiso andincebise, athi Queen fanele sithi, sithi ngoluhlobo. Ngamanye amaxesha ahlale acinge, athi hayi Queenie uyakhumbula thina ngoku,besingayi khumbuli ngesihleli neepakhethi zeepilisi sizisela ngoku by this time. Sasisoloko sizibona ziselwa ngoomama bethu , ngoku sithi ngoku, omama bethu bamkile. Ndithi hayi ayikho enye indlela mfondini, xa ifikile, i-fikile. Ndivuka ekuseni ngamanye amaxesha, ndithathe a walk ndijikeleze ndizeso, ndiphinde ndingene ngapha. Ndithi ukugqiba kwam uku-wokha ndize apha endlini, Ndikline, ndipheke, ndivase i-washing, yonke lonto leyo. Ndingumntu othanda ukuklina ke mna ke. Ndiphinde ndithi since ndikulemeko ndikuyo, njengoba umsebenzi unqabile kangaka, bendinqwenela nam ndifumane umsebenzi, ndisebenze, qha ndibethwa yilemeko ndikuyo. Nomnye umntu odla ngondincedisa ke, ngabantu baka-TAC. {isiXhosa} [I have a friend who has diabetes and high blood pressure. She advises me. She said: do you remember when we were young, we never thought we’d sit with packets of pills by this time. We used to see our mothers taking tablets. Our mothers are gone now. Not it is our turn. Hey, if it’s your turn, it’s your turn. I sometimes wake up in the morning and take a walk right around the block. And then after that I clean, cook and do the washing and all that. I like cleaning the house. Being the person that I am, I would like to get a job but my condition prevents me from finding employment. People who usually help me are from Treatment Action Campaign.]

Queenie Qiza: Abahlali, ndingathi kulo lonke ilizwe, niqine, nibe-supportive, nibe-active, ni-acte njengam, njeng’ba ndi-acta and ninonke ndiyanithanda nani abafana nam, niphile nibe live, ningatyhafi, niqhubekeke nge-life yenu, nisoyika, phumani out. {isiXhosa} [I’d like to say to the community: Be strong, be supportive, be active, like me. I love all those who are HIV positive like me. Live on, and don’t be discouraged. Continue with your lives. Do not be afraid. Enjoy your life. ]

Special Report - Viral Load and CD4 testing.

Mercy Makhalemele: Apart from doing an HIV antibody test, you can also test the virus itself. And consequently, calculate the amount of the virus in the blood of an infected person. This is known as the viral load test. Your body produces soldier cells called CD4 cells, which can keep the virus under control for many years. But eventually HIV kills off these CD4 cells, and you start getting the many diseases collectively called AIDS. In order to manage these diseases effectively, you need to know what the balance is between the viral load and the CD4 cell count. Queenie Qiza underwent these procedures and will receive her results today.

Dr Steve Andrews: What we need to talk about is what is happening with your HIV now. Have you ever had a test done of your viral load or your CD4 before?

Queenie Qiza: Only at Groote Schuur.

Dr Steve Andrews: And what did they say?

Queenie Qiza: It was after a month from my blood test and they found out that my CD4 count is 252, but the thing I didn’t hear is my viral load.

Dr Steve Andrews: Okay. Did he tell you what it means?

Queenie Qiza: No he didn’t.

Dr Steve Andrews: A CD4 count is just another way of measuring how strong your body is. What we say is when the CD4 count falls below 200, that your body is no longer strong enough to fight for itself.

Prof. Estrelita Janse van Rensburg (Head of Medical Virology, Tygerberg): HIV specifically targets CD4 lymphocytes. So those are the cells that they infect, they’ve got specific receptors to attach to these cells, and viruses can only replicate once they inside these cells. What we see here is part of our immune system. This is CD4 lymphocyte which is important in fighting infections like HIV. You can see that this cell is infected by the virus, and there’s a virus, and there’s a virus particle busy popping out of this infected cell, and there on the outside there is actually two viral particles that’s already been released. And it’s the release of these viral particles that damages the lymphocyte, and causes it to die.

Dr Steve Andrews: HIV is like being a train on a track, or a taxi on a road. And you’re heading along that road towards a ravine where there is a bridge. And the bridge has collapsed, and the taxi driver doesn’t know it, and that bridge, that bridge is AIDS. Okay? Once you get over there, the taxi or the train is gonna fall into that ravine and that is the place where your body is so weak that it can’t defend itself any more, and you start getting other infections.

Prof. Estrelita Janse van Rensburg (Head of Medical Virology, Tygerberg): This is the effect of HIV. It actually clumps together many different cells and you have this big, abnormal cell. And when the virus then replicates inside the cell, many more viruses are produced and they are released form the cell, and as soon as the viruses are released from the cell, they will actually kill the cell in the process. And the new viral particles which are formed, will then go to new CD4 cells, and infect them. And they’ve actually determined that, in the body, one billion new viral particles are produced per day.

Mercy Makhalemele: After you’ve been infected with the virus, HIV gradually takes over and destroys your immune system by attacking and killing your CD4 cells. Without effective treatment it takes the virus about eight or more years to weaken your immune system so much that your body has virtually no resistance against illnesses. This is the stage we call AIDS.

Prof. Estrelita Janse van Rensburg (Head of Medical Virology, Tygerberg): Gradually, as the virus replicates in your body over a period of years, your CD4 count will decrease, and your viral load will increase steadily. This is in patients that’s not on any treatment.

Dr Steve Andrews: You know earlier in the week we did tests for your CD4 and viral loads, and I was going to give you the results today.

Prof. Estrelita Janse van Rensburg (Head of Medical Virology, Tygerberg): We have our scientist here, Tracey, and she’s busy doing a HIV culture, and if I can show you. This is a normal flask that we use for HIV cultures. We have suspended lymphocytes in this medium, and this is what is used to support the cells, because it’s living cells, they’re not dead. And we look at the culture, and we look at the abnormal lymphocyte forms that appear.

Mercy Makhalemele: Like the one that you showed?

Prof. Estrelita Janse van Rensburg (Head of Medical Virology, Tygerberg): The ones that I showed on the slide.

Tracey: We increase the amount of RNA to detectable levels, which we then detect on the nuclisense reader, and that then converts the number of copies of RNA, per milliliter of serum.

Prof. Estrelita Janse van Rensburg (Head of Medical Virology, Tygerberg): Now that’s also called the viral load assay. And that actually determines the number of genetic material that’s in RNA of the virus, copies per milliliter of blood, so we can actually quantify how many viruses circulate in the bloodstream of that infected patient. And that’s usually used for people that’s on treatment for HIV.

Dr Steve Andrews: Your CD4 count is 108 cells. Okay, which is, as discussed, below 200, so it’s low. Okay, so you are very close to falling into that ravine which we call AIDS. Your viral load is 360 000 which is very high.

Queenie Qiza: I will ask you this question; can you put back my CD4 count to over 200?

Dr Steve Andrews: That question I can’t answer for you. Certainly, if your chest has got TB in it, your CD4 count will go up with TB treatment. Then, we must get into a treatment with vitamins, with eating well, with picking up weight so you take care of yourself. We need to get you onto treatment that will deal with this HIV. Now, if we were in another part of the world, if we were in the United States, or in Britain, then it would be easy to get these drugs. But in South Africa, the government does not provide them, so we’re going to have to find some way to get you onto these medicines.

Queenie Qiza: Uh, okay Steve, but the one thing I know myself, I’m strong. Everything, I believe in God.

Dr Steve Andrews: I know you do, you need to keep strong.

Queenie Qiza: I will survive, I will survive.

Mercy Makhalemele: You are watching Beat it! – this is your guide to better living with HIV and AIDS. At least I know now how viral load is measured. Really, doctors ought to be able to measure CD4 and viral load to properly advise their patients.

Paddy Nhlapo: But as we see, it’s a question of patent rights again. This time, Roche, who own the test kits, making access to these tests expensive, once more.

Mercy Makhalemele: Coming up, we are off to the Support Group where Dr Herman is talking to us about the crucial subject of nutrition and HIV.

Support Group - Nutrition

Marius Thomas: Hello everybody, and a special welcome to Dr Herman again; Themba. Last week we talked about early treatment. And what we’re gonna focus on. I think today, is to look at nutrition, because we keep hearing about nutrition, good food. How does it work for us?

Paddy Nhlapo: All I know is that: One, I should no longer cook or eat food that is cooked with fish oil. Instead, I should use olive oil. And the food that I eat should have lots of garlic and ginger, and that I shouldn’t overcook food.

Dr Hermann Reuter: A problem with nutrition and HIV is that often we have consulted the nutritionists, and the nutritionists are focusing basically on nutrition often to tell people to lose weight, that is where the money in nutrition lies. And advice like Paddy got, to rather eat olive oil than cooking oil, fish oil, sunflower oil, is based on that, because if you want to lose weight, olive oil is much better. But in case of people who want to gain weight, I advise people: “If you eat a plate of porridge, take a spoon of fish oil and mix it into it.” As your stomach is trying to digest the porridge, the oils are there to maintain an energy level so that your body doesn’t use up the protein.

Adeline Mangcu: Right through the day I make myself something called amarhewu, don’t know what English word there is for it. But, okay, it’s a drink made from mealie meal, and if I take a lot of apple cider vinegar, then somehow I don’t really need to go for candida treatment and I don’t know how that works, but apparently it does work

Dr Hermann Reuter: Usually, it’s easier to digest something that has been fermented, that is sour, like Amarhewu that is sour milk, like Amasi is easier to digest than fresh milk. But I think you must look, each one has to see for themselves what can they digest and what can they not digest. Some people have got problems eating fats, they get diarrhoea from it, and I think it’s normal that you just cut down on the fats.

Mercy Makhalemele: I started eating raw beetroot, without cooking it, which I grew up, my mum used to cook beetroot, so I don’t cook beetroot any more now when I eat, it’s something I’ve taught myself through many other people.

Busisiwe Maqungo: What about kengoku esi uzawuzitya because imbhiza ephekwayo apha inye and ababantu abazungakutyi ukutya beqhele ukutya kuba kuthiwe hayi u-Busisiwe ngoku unegciwane, kufuneka engayityanga into ethile, ngoku nabo kufuneka betshintshile, ayizukwenzeka ngolohlobo. {IsiXhosa} [What about the things you are supposed to eat? We eat from one pot at home. We can’t change what we eat just because of me.]

Dr Hermann Reuter: They advise you to eat it raw ’cause there’s more vitamins in it, but it’s better to eat a lot of well-cooked cabbage, than a little raw cabbage. So I think eat what your family is eating.

Antoinette Fouché: En ek het eenkeer met ’n dokter gesels en hy’t gesê: “Moenie so concerned wees oor drie hoof malle nie, maar ‘even’ as jy die tyd kan kry om iets te eet en daar’s kos wat by jou verby gaan, ‘if it goes there, grab it’ en eet tussen in.” {Afrikaans} [I spoke to a doctor once and he told me not to be so concerned about eating three meals a day. Rather eat whenever food is available. If it goes there, grab it and eat in-between meals.]

Dr Hermann Reuter: The virus itself, and all the infections you get with HIV, they take up energy. So you always have to have enough food in your body. I think the most important point is to eat as often as possible during the day. Even if it’s very small, a slice of bread, if it’s a biscuit, if it’s a king pie, if it’s an apple, if it’s banana but try throughout the day have some kind of the food. Because just having a bit in your body is just as good.

Paddy Nhlapo: So I want to know specifically here, specifically here that food. Does food make you fat and I think if that might be the case then, when we start thinking we have to eat a lot so that we don’t think.

Dr Hermann Reuter: With HIV, we lose the muscle, we don’t lose the fat. Somebody can look well-fed, but in the meantime below that fat level the muscles are getting smaller and smaller. Instead of breaking down fats, your body starts breaking down protein, it starts breaking down your muscles. And so, if you skip on your meal, your muscles will go down. Medically, we talk about lean body mass. So some people are saying the first line in treating HIV is actually to maintain your lean body mass.

Marius Thomas: Ek kom van ‘n agtergrond van vleis en brood af, so dit is wat jy nou meer groot geword het sien, maar dan hoor jy nou jy moet gesond eet. {Afrikaans} [I’m from a background of eating meat and bread. That’s what you grew up with, but then you hear that you must eat healthy.]

Adeline Mangcu: I am very sorry, as much as I should be able to afford red meat, it’s expensive. So the aunty uMaNdlamini, sells liver, sheep’s liver, ox liver, ox spleen thing, and intestines, tripe that is basic. If they’ve ever seen the way we wash that tripe, we wash it over and over. So I don’t see why we shouldn’t eat it, but then we get people saying there might be little goggas there. For god’s sakes, there’s little goggas in the lettuce.

Dr Hermann Reuter: Towards the end of the disease, we start losing weight, and we show symptoms of wasting. We see in Xhosa it is called isifo ungawulayo. You see, if you chop a piece of wood, it becomes smaller and smaller until it dies, and the same with HIV. Our body loses weight. Normally, we talk about HIV virus going into the CD4 cells, but we know that is also goes into about 30 other cells. One of them being the cells that line the intestines, and with the virus being there, they swell, so the intestines can’t really absorb food as well if the virus is inside those cells, so it means that you have to take in more food to actually be able to absorb enough.

Busisiwe Maqungo: Kulento ibisele ithethiwe ngoogxa bam u-Marius, uba mhlawumbi omnye umntu uzongakwazi uku-afforda athini athini. {IsiXhosa} [I’m responding to what Marius just said. Some of us can not afford to buy these healthy foods.]

Dr Hermann Reuter: Eat what you enjoy eating, what you’ve used to be eating over centuries you’re eating mngqusho {IsiXhosa} [samp and beans], so you should continue it.

Adeline Mangcu: Yes sir.

Dr Hermann Reuter: You ate well with meat and bread, eat meat and bread but also when you’re on your own, try to get fruit.

Mkhanyiseli Mpalali: Mina ndinegxaki ngakuzo because kufumaniseka uba akukhonto endiyikhethayo, zonke ziyandilungela ndiyazitya and akubikho nto erongo endiyi-experiyensayo. {IsiXhosa} [I have a problem with this healthy stuff. I eat everything and I have not experienced any problem.]

Dr Hermann Reuter: I think one of the main causes of poor nutrition in South Africa amongst both people with HIV/AIDS and people without is the use of alcohol because alcohol its got enough sugars in it to keep you from eating. And although I was saying is important to get enough sugars, the sugars in alcohol it doesn’t have any vitamins, proteins, they don’t have any nutritional value and usually with the other sugars that you eat or bread, or fruit, or milk they’ve got other nutritional values were as in alcohol it’s only the sugar, you don’t eat anything else and you waste.

Sindiswa Godwana: Hayi nam ndingomnye ombulelayo u-Dr Herman kwezizinto seyezichazile ngoba mhla ndafunyaniswa into yoba ndi-HIV, kwaye kwathiwa ungayisebenzisi i-yoghurt, ungawasebenzisi amasi, ndazibuza ukuba njani? Ngoku umphokoqo ndiwuthanda kangaka, ndazixelele into yoba hayi ndizowatya maan amasi. Hayi ndahlala ndawatya amasi nomphokoqo, azindenzi nto. I-yoghurt ndizifumanise into yoba umzimbha wam uyayifuna kodwa kuba kuthiwe mandingayityi, ndingayityi i-yoghurt. Oko ndizibambe umzimba, so sendizixelele inoba banintsi abanye abantu okuthiwayo kubo suyitya into ethile, umntu ahlala angayityi, umntu ongafani nam ke, oyihambelayo lento uyaqonda, ahlale kuthiwa mandingayityi into ethile, angaqhubekeki abuze. Sendisithi ndiyabulela. {IsiXhosa} [I want to thank Dr Herman for sharing his knowledge with us. When I was diagnosed, I was told not to eat yoghurt or amasi and I ask myself why. So I ate amasi because my body craved it. I crave yoghurt, but I’ve been holding myself back. There are others like me who’ve been told to eat certain foods, who don’t have my advantage of enquiring about HIV. I appreciate this session.]

Paddy Nhlapo: Wow, so eat, eat, eat. To keep up that lean body mass, that’s Dr Herman’s advice, and it makes sense to me. What do you think?

Mercy Makhalemele: It’s the first time I’ve ever heard a doctor’s advice which is so easy to follow.

Red Ribbon and Red Noose Awards

Paddy Nhlapo: Time for that Red Ribbon and Red Noose again. This week, it’s my pleasure to give the Noose to all the doctors who profit out of AIDS, because they are on an HIV/AIDS gravy train driven by the pharmaceutical companies and pathology laboratories; doctors fail to speak out about high drug prices, the high cost of laboratory services, because of this. So this week’s Noose goes to all the doctors who have lost their independence and become vessels of the pharmaceutical company.

Mercy Makhalemele: Moving into better things, I am happy to present this week’s Red Ribbon award to Dr Eric Goemaere and all the Medecins Sans Frontieres people; that’s doctors without borders working in Khayelitsha programme. They are a group of dedicated healthcare workers who believe in equal access to medical care. They respond to disasters and medical emergencies around the world. Recently they decided to respond to the HIV/AIDS emergency in Africa. They are campaigning for pharmaceutical companies to drop their prices of antiretroviral AIDS medicine so it’s Red Ribbon for MSF.

Paddy Nhlapo: Thanks for watching, we hope you enjoyed the programme. We really value your feedback so please contact us at the numbers on your screen with your comments and suggestions. Until next week at half past twelve, remember together we can Beat It!

Mercy Makhalemele: Beat It!

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