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Siyayinqoba Beat It! 2005 Episode 25 -

Prophylactics & Vaccines to prevent infections

In this episode of Siyayinqoba Beat It! we looked at what prophylatics to prevent opportunistic infections are available and what the possibilities are of an HIV vaccine being developed.

Jason Wessenaar: Kgotsong re ya le amohela mona ho Siyayinqoba Beat It! Support Group. [Hello and welcome to the Siyayinqoba Beat It! Support Group.] My name Jason. In the Siyayinqoba support group we are all living positively with HIV. Each week we get together to talk about issues that affects our lives with HIV from sex and the positive person to disclosure. uSiyayinqoba nguhlelo lwako lokhuphila kangcono ne HIV/AIDS. Uma uphila ne gciwane le HIV [Siyayinqoba is your guide to better living with HIV/AIDS. If you are living with HIV] or you have a partner, a friend or member of the family who is HIV positive this programme is for you. Today we are discussing prophylactics and vaccinations. Prophylaxis means to prevent and that is what prophylactics and vaccines do they prevent illness. Antiretrovirals can be used to prevent mother-to-child-transmission of HIV. They can also be used to prevent infection after rape or needle stick injuries to healthcare workers. But what other preventable methods are there that we should know about especially when we start antiretrovirals. With us to discuss this issue is Ullah Mothibi. Doctor Mothibi is from the HIV Unit in the Western Cape Department of Health. Welcome Doctor Mothibi. But first the Siyayinqoba team went with Busi and Vathiswa to visit their doctor in Site B in Khayelitsha to find out more about prophylactic medication. Let’s go. {Sesotho}

TB vaccination/prophylaxis

Khayelitsha, Western Cape

Dr Giles van Cutsem (Doctors Without Borders): Hi, do you know what hepatitis B is? Not at all? Hepatitis B is a virus just like HIV that gets transmitted through sexual relationships, through blood, actually a little bit like HIV but it transmits more easily than HIV.

Busisiwe Maqungo: According to the results do I need to take a vaccine?

Dr Giles van Cutsem: One if you have antibodies for hepatitis B. Antibodies; it’s your own immune system that shows that you have been exposed to hepatitis B and your body has made your body to combat that hepatitis. So if you have antibodies it means you don’t have to be vaccinated because you have already made your own protection against hepatitis B. If you don’t have antibodies at all then it means that you have not been exposed to hepatitis B and then the vaccination will be useful to prevent you from getting the disease. You have not being exposed, so you still can be vaccinated.

Vathiswa Kamkam: Okay, Giles as you know that I’m HIV positive and I also heard about the INH which is one of the prophylaxis for iTB.

Dr Giles van Cutsem: The national protocol says that all HIV positive people who do not have TB or who had not had TB for the last two years and who are not on ARV should be offered INH prophylaxis.

Vathiswa Kamkam: I have done the TB test and my results came negative.

Dr Giles van Cutsem: If taken INH you will kill the TB that is sleeping in your lungs and you prevent it to get out when your CD4 count is dropping. If you take six months of INH and then you don’t take INH for six months and for a year and somebody who is living in the same house as you has TB and is coughing you can get TB. So it is not a definitive to protect you from TB.

Vathiswa Kamkam: If I am on ARVs what will this INH do to me and also if I’m not on ARVs will it affect my CD4 count or my viral load.

Dr Giles van Cutsem: The INH itself will not affect your CD4 count and the viral load, but preventing TB, it does not have an effect on your CD4 and viral load because for the worse thing for your CD4 and viral load is to have TB. For example your CD4 is 500 and you have a pretty low viral load and you get TB your CD4 count drops and your viral load goes up to the sky, so by preventing TB you are maintaining for a longer time a good CD4 and quite low viral load.

Sister Nomfusi Mlanjeni: I-vaccine i-BCG ikhusela abatwana bangabi nayo i-TB meningitis okanye i-forms ze-TB ezinzima, ithatha ixesha phambi kokuba isebenze, about six to ten weeks. Kubo bonke abomama be-PMTCT asikaboni nto ebangela ukuba kube khona into, if umtwana unikwe i-BCG vaccine. So kubalulekile ukuba omama nxa benzima bahambe ikliniki, i-antenatal kliniki. Okwesibini kubalulekile ukuba abantu xa bebeleka, bayo belekela esibhedlele, kulapho bazakubonwa ukuba mabanikwe i-BCG omama abanabantwana. {IsiXhosa} [BCG vaccine protects babies from getting TB meningitis or other forms of TB that are hard to treat. It takes a while before it can work, about six to ten weeks. In all mothers who have gone through the PMTCT programme, we haven’t had any problem from babies who were given the BCG vaccine. It’s very important for pregnant women to visit antenatal clinics regularly. Secondly, it’s important for women to give birth at hospital. That’s where they will find out if their babies must get the BCG vaccine.]

Support Group

Jason Wessenaar: Dr Mothibi, ke eng Hepatitis B,ene e etsang mmeleng wa motho ene hobaneng hole bohlokwa hore re e thibelle hore re sa i fumana? {Sesotho} [Dr Mothibi, what is hepatitis B, what does it do in the human body and why is it important to prevent it?]

Dr Ullah Mothibi: Hepatitis B ke bohloko bo bakiwang ke virus ifana negciwane leHIV. Ene ka mokgwa o motho o kgonang go thola Hepatitis B go tshwana fela le HIV. O e thola ka bohloko ba thobalano ha o robe tse le motho o naleng Hepatitis B, kampo ka di needle stick injury ha o hlabiwa ke nale ya motho o naleng Hepatitis B madi a gage a kene mo mading a gagwe o be le yona.So ha ole infected ka Hepatitis B batho ba tla bona ha e santse e qala initially oba le nausea, ha o batle ho ja loss of appetite oba le fever. Ka mora beke tse pedi tse tharo, obe le jaundice mahlo a be yellow. So tseo ke tsone di features tsa Hepatitis B. Ka nako engwe o be le abdominal pain [especially on the right side] so ke yona Hepatitis B.Batho ba bangata he Hepatitis B [their own bodies can deal with it] e fele he. [Hepatitis B is a disease caused by a virus that is similar to HIV]. And the way you contract hepatitis B is the same as for HIV. You can get it through sexual contact with someone who has hepatitis B or through a needle stick injury where you come into contact with blood infected with hepatitis B. So once you are infected with hepatitis B the early symptoms are nausea, loss of appetite and fever. After a week or two, you develop jaundice; your eyes become yellow. So those are the symptoms of hepatitis. Sometimes you experience abdominal pain especially on the right side. So that is hepatitis B. When most people get hepatitis B their own bodies can deal with it and it goes away.] But in some people the bodies are not able to deal with it ba be le chronic Hepatitis ke hore Hepatitis entse e tswelela ka mo mmeleng wa bona.Ka mora le mo tse ka lo ba be le liver failure. [and they develop chronic hepatitis which stays in their system. After a few years they have a liver failure.] There is no cure once ole infected ka Hepatitis B [you are infected with hepatitis B] because once ingenile emzimbeni wakho ingenelele kwi cells zesibindini sakho ihlale nawo just like HIV. [the virus enters your body, it goes straight to your liver and it stays in your liver cells.] It can be controlled, once you infected ngayo [with it] we can control it, zikhona idrugs kuthwa iantivirals [with drugs called antivirals]. But the point of hepatitis B is not to get it, so stop your self from getting it. So those two are very similar hepatitis B and HIV. {Sesotho}

Jason Wessenaar: We will talk more about what more we can do about preventing diseases after this break.

Jason Wessenaar: Mmuhi re ya ho amohela hape mona ho Siyayinqoba Beat It! support group {Sesotho} [Welcome back to the Siyayinqoba Beat It! Support Group] – the programme for everyone infected and affected by HIV. We are talking about prophylaxis, vaccines and HIV.

Busisiwe Maqungo: Ndifuna ukuqonda ukuba iguaranteed ukuba abatwana mabagcitywa ukuzalwa nxa omama babasa kwi appointment zamo ekliniki bazayifumana. Omama abaninsi we don’t even ask ukuba masi explanelwe ngugqirha ukuba yintoni le? {IsiXhosa} [Is it guaranteed that if babies are taken for vaccinations at the clinic, that they are given the hepatitis B vaccine? Is it amongst the injection, because most mothers don’t even ask for an explanation from the doctor?]

Dr Ullah Mothibi: Hepatitis B is amongst those, so there is quite a few that the children get, I agree with you Busi sometimes when omama baya ekliniki {IsiZulu} [mothers go to clinic] we don’t take the time to explain to say this is BCG now and this is what it will do, this is Hepatitis B this is what will do but viral Hepatitis and Hepatitis B is amongst.

Busisiwe Maqungo: And polio drops?

Dr Ullah Mothibi: Yes and the polio drop.

Jason Wessenaar: So ha o kile wa ba le Hepatitis B, o ka thola vaccination? [If you’ve Hepatitis B before can you still get the vaccination?] Or how do you know that you need the vaccination if like o kile wa ba na le yona, and then ya fela acute Hepatitis B. [if you’ve had it before and it was an acute Hepatitis B.] {Sesotho}

Dr Ullah Mothibi: If o kile wa ba le Hepatitis [or most infections]if o kile wa ba le infection mmele wa hao o kgona ho bopa tse re di bitsang di antibodies. Antibodies ke di thibedi mmeleng wa hao. Hore nako e ngwe ha o kopana le infection e o, la o e thola e ba mild kampo ha o sa e thola. So if u kile wa ba le infection ya Hepatitis B a o ya ko tliniking {Sesotho} [If you’ve had Hepatitis or most infections if you’ve had an infection, your body will have antibodies for that infection. Antibodies are the protectors of your body. So that next time you get that infection, it won’t be as severe or you won’t get it all. If you’ve had Hepatitis B and you go to the clinic, bazakuthatha igazi balitsala nxa babona ukuthi unazo iantibodies zeHepatitis B bazawuthi you don’t need ivaccine. [they’ll do a blood test and if you have antibodies for Hepatitis, they tell you that]. However kulezo [in those] antibodies there is a certain amount which is enough to protect you so they will even measures the amount of antibody. Makungabe le antibody ayilingananga [If the antibodies are not enough] then they will give you a booster. Okay, so that you can have enough antibody to prevent further infections.

Ricardo Moses: Ek het voorheen het ek gegaan vir INH prophylaxis. Die medical staff daar het geweier om INH prophylaxis te gee. Hoekom ek gegaan het; die rede hoekom ek gegaan het was omdat ek werk met pasiente wat TB het deur opvoeding in die kliniek en hulle het geweier om vir my die INH prophylaxis te gee. Hulle het vir my gesê dit is nie nodig nie. Wat is die rede daarvoor? {Afrikaans} [I went for an INH prophylaxis. The medical staff refused to give me an INH prophylaxis. The reason I went was because I work amongst TB patients through education at the clinic, and they refused to give me INH prophylaxis. They said it was not necessary. What was the reason for that?]

Dr Ullah Mothibi: INH prophylaxis is baie belangrik vir mense wat HIV positive is; vernaam daardie mense wat saam met siek patiente werk. Maar hoe dit gaan jy kan nie net in dokter of in die suster se kantoor loop nie en se: “Ek soek INH prophylaxis.” Daar is n proses. So jy gaan daar en jy se vir hulle: “Ek soek INH prophylaxis, die is die rede.” Nou voor hulle jou die prophalaxis gee, dan moet hulle eers uit vind of jy nie TB het nie. As hulle uit vind jy het nie die TB tekens nie, en die hoes die slym wat jy hulle gegee het as dit negatief is, dit het nie tering nie, en jy het nie tering in die twee jare gehad nie dan kan hulle jou die INH prophylaxis gee. {Afrikaans} [INH prophylaxis is very important for people who are HIV positive, especially those who work with sick patients. But how it works is that you can’t simply walk into a doctor’s or nurse’s office and demand INH prophylaxis. There is a process. So you go there and tell them I want INH prophylaxis, and this is the reason. Before they give you the prophylaxis they first need to find out if you have TB. If they find out you don’t have TB symptoms, and your sputum test is negative, it doesn’t contain TB, and you didn’t have TB in the past two years, then they can give you the INH prophylaxis.]

Vuyani Jacobs: Dokter, jy praat lekker Afrikaans. Maar ek wil net weet, ek wil net een vrae vra. Sal jy vir my sê, dit is belangrik dat elke mens wat HIV positive is gaan toets of hy of daai virus in ons is en wat gaan gebeur as ek nie dit toets nie of wat kan gebeur? {Afrikaans} [Doctor, you speak Afrikaans well. But I would just like to ask you one question. Can you tell me is it important as an HIV positive person to test for the virus, and what can happen if I don’t?]

Dr Ullah Mothibi: Ek kyk Hepatitis B en HIV met die selfde oë want al twee is sexually transmitted infections. Jy moet gaan toets {Afrikaans} [I see Hepatitis B and HIV as being very similar because both are sexually transmitted infections. You must go for a test] and after that then you will know. As die tyd kom +laat jy HIV medisyne kry die antiretrovirals, daar is een van die drugs wat aan HIV werk wat ook aan die Hepatitis B werk. [When the time for you to start HIV medication comes, one of the drugs for HIV also works on Hepatitis B.] So you will be killing two birds with one stone; of them not all of them; one of them is effective against Hepatitis B okay, and then I just want to stress this point that is why it’s important even if we are HIV positive now we must make sure that we don’t get Hepatitis B on top and the way to get that is, well vaccination. The most important one is safe sex.

Lihle Dlamini: If ngiyile ngayo testa for hepatitis B ngatholakala ukuthi nginayo [If I go for a Hepatitis B test and result are positive] or I had it and it’s gone does my partner ukuze ayo [have to go to] check for Hepatitis as well because uyewasho [you said that] before ukuthi [because] it is sexual transmitted. And okunye ingifuna ukubuza ukuthi ukungabe ngiya eclinic yami ekhona elokishini ngizoyithola yini ivaccine or is it only [at] kuma district hospital? {IsiZulu} [Another thing I want to know is if I go to my local clinic will I get the vaccine there?]

Dr Ullah Mothibi: It will be a good idea for your ipartner yako nayo [partner as well] to go and test the same as HIV test. If you have had it, kusho ukuthi mhlambe ukuthi unayo. [it’s possible that your partner has also contracted it]. And ivaccine iyatholakala [the vaccine is available] and the, but as we have said some of our health centers may not know about it. So thina we know, so it is also our duty to go an educate some of the health workers who don’t know. Especially amakliniki amancane, amanurse akhona mhlambe abayazi ukuthi ikhona le Hepatitis B vaccine okay nut thina siyayazi so its up to us ukuthi siye emakliniki siyoyicela levaccine ikhona igovernment iyayikhipha le vaccine so please sifuna ukuyithola and the its up to them ukuba baye amadoropini bayoyithatha ukuzokwazi ukuyinika umphakathi. {IsiZulu} [in the smaller clinics, the nurse might not know that there is a vaccine for Hepatitis B. But we know and so it’s up to us to go to the clinics and ask for it because it is available. The government provides it for those who need it and it’s up them to go to the district hospital and get it for you.]

Lihle Dlamini: How often should I have vaccine?

Dr Ullah Mothibi: With a vaccine kanye nje empilweni yakho [only once in your life].

Prudence Mabele: Ke mang o testileng Hepatitis B ko rona mo? And then ne ke batla gape ho botsa ko wena. Batho ba HIV positive ka mariha ba ba very exposed to di cold dintho tse kaofela. Ntho e ke batlang go e botse ke gore, why is it, gore di vaccine tseo sometimes di go etsa o kule obe le flu pele di sebetsa hantle. {Sesotho} [Who of you have tested? And then I want to ask you something. Most HIV positive people are exposed to flu in winter. What I want to know is why is it that the vaccine makes you sick before it becomes effective?]

Dr Ullah Mothibi: Flu vaccine is good for everyone, because flu is so common almost all of us get flu. Every year I think I get it two to three times a year; so it’s good if you. If you can access flu vaccine, go and get it. I’m saying access because you need to pay, it’s not free form the government and the flu vaccine you need to get before the flu. So let’s say the flu season starts in May then you should have it by March. Otherwise before you get the flu you have already got it and what they normal do, a lot of the vaccines not only the flu vaccine after you get the vaccine then you turn to be a little bit under the weather that is not necessary that the vaccine is bad or the vaccine is actually giving you the infection but it’s just your body now reacting to the vaccine.

Jason Wessenaar: So it’s important when you’re traveling and you get a malaria vaccine to tell the doctor that you are HIV positive as well so they must be able to give you what is good for you especially if you are on ARVs.

Dr Ullah Mothibi: In fact not only when you are traveling but any time uyobona ugqirha {IsiXhosa} [you go to a doctor] and you are on any kind of medication. People only talk about ARVs but any kind of medication if you are already taking medication you need to see a health worker for something else, you have to alert them and say I am taking these tablets okay so that they know what they can give you which is not going to interact with your tablet or atleast they can look at your tablet and make sure that whatever they give you is going to be okay for you. So it is important whether you are HIV positive or not.

Jason Wessenaar: Ha re kgutla mabenkeleng {Sesotho} [After the break] we talk more for HIV vaccine. Don’t go away.

Jason Wessenaar: It will take a few more years before an effective vaccine is developed but what are the major obstacles. Siyayinqoba spoke to Professor Williams from UCT (University of Cape Town) and Doctor Mayaphi from University of Wits on the challenges of developing HIV vaccine.

Challenges of developing an HIV vaccine

Cape Town, Western Cape

Dr Simnikiwe Mayaphi: Amavaccine lana idlela asebenza ngawo ayenza umzimba ukuthi uyenze abasotsha amaningi against HIV. So that umzimba mawuhlangana ne HIV [The vaccines are meant to increase the number of soldier cells in order to fight against the HIV. So that when the body comes into contact with the HIV] at a later stage after vaccination; should be able to recognise HIV and protect our bodies against it.

Prof. Carolyn Williamson: HIV has been around for over ten years now, in fact over 20 years and every year we are getting closer and closer towards developing an effective vaccine but in HIV it’s a very slow process.

Dr Simnikiwe Mayaphi: Once ama-vaccine afike kuma-human clinical trials, they have to go through ku-phase 1 to phase 4. Ku-phase 1 kulapho sibheka khona ukuthi ama-vaccine a-safe na. {IsiZulu} [Once the vaccines reach the human clinical trials they have to go through phase 1 to phase 4. In phase 1, we check if the vaccines are safe, okay.]

Prof. Carolyn Williamson: HIV is an incredibly clever virus. It’s out to manipulate us in every move in your body is hiding in your cells and is hard to get rid of it. You know once you have HIV infection it’s for life. So develop an infective vaccine you got to completely block HIV replication and that’s a very difficult thing to do. And that’s what other vaccines haven’t achieved, because it’s not necessary with other viral infections. So, essentially the nature of the virus makes this a very big challenge.

Dr Simnikiwe Mayaphi: Once sa-satisfied nge-information esiyithola ku-phase 1 we move to phase 2. Ku-phase 2 sisabheke ukuthi ingaba zi-safe na ezi-vaccines but in a larger group of people [Once we are satisfied with the response we get in phase 1 we move to phase 2, we check if the vaccine is safe but in a larger group of people] and still not forgetting the immune responses to see if the vaccines are effective. Ku-phase 3 kulapho sibheka ukuthi ama-vaccine angaba ayasebenza na a-effective na against i-HIV. [In phase 3, we check if the vaccines are effective enough against the HIV.] And if they pass phase 3 then researchers apply for licenses in order to make vaccines available to everyone. Manje siseku-phase 1, sinama-trials azayo azongena ku-phase 2 and onke ama-trials esiwenzayo now siwenza kubantu aba-HIV negative. {IsiZulu} [Currently we are in phase 1, but we are moving towards trials for phase 2 and at the moment all the trials are conducted with HIV negative] people because these are vaccines which are meant to be preventative.]

Jason Wessenaar: Doctor how far are we in getting an effective vaccination against HIV in South Africa?

Dr Ullah Mothibi: Jason, re santse re le sebaka pele re ba le effective vaccine. {Sesotho} [Jason, there is still a long way to go before we get an effective vaccine.] Maybe ten years lets hope maybe six years you know we hope that it is sooner rather than very late.

Vuyani Jacobs: Even in the scenario having exposure prophylaxis takes a lot of mental challenge for the three months for the counselling and everything takes a lot of energy from me even as a person living openly with HIV who knows his status with my partner who might be HIV negative or who I think is HIV negative, so having a vaccine will make it easier for us to have comfortable sexually relationship that can take away the guilt of us that we are getting every now and again. The challenges that we get but yet we do say that at the moment while its not there, safe sex, condom use is a primary importance, very very important we cannot take away the condom.

Dr Ullah Mothibi: If you look at lots of these infectious diseases almost all of them are preventable, they are preventable disease and measures of preventing them are very easy. You start with yourself, the common hygiene and then going form there as you are saying we need to have improved living conditions and once we have that then its easy to control a lot of transmittable diseases.

Jason Wessenaar: Re ya leboha Dr Ulla, the support group le lona ba bohedi mahaeng. Bekeng e na re ithutile hore ho nale dintho tse ngata tse re tla dietsang ho thibela mafu. Etsa bo nnete ba hore o fumana di vaccination tsa hao kaofela ha holo ha holo di vaccination tsa Hepatitis B, haeba o motho ya etsang thobalano. Etsa bo nnete ba hore o fumana flu shot mariha a mang le a mang hore o thibele feberu. Bana le masea ba tlamehile ho fumana BCG vaccination ho re ba thibele lefuba. Haeba CD4 count ya hao ke 200 kapa e ka tlase ho 200 mme ha o so qale ho nka di ARVs, kopa ngaka ya hao e hofe Bactrim hore o thibele pneumonia.Hlokomela ka matla hore metsi a o a nwang a bolokehile mme le tikoloho e o phelang ho yona e hlwekile. Re tshepa hore le thabetse le nanewo la rona la kajeno. {Sesotho} [Thank you Dr Mothibi, the support group and the viewers at home. This week we have learnt that there are lots of things we can do to prevent infections. Make sure you get all your vaccinations especially for Hepatities B, if you are sexually active. Make sure that you get a flu shot every winter to prevent flu. Children need to get a BCG vaccination to prevent TB. If your CD4 count is 200 or below 200 and you are not on ARVs yet ask your doctor for Bactrim to prevent pneumonia. Make sure you drink clean water maintain hygienic living conditions. We hope that you have enjoyed the show] and that you are feeling the Siyayinqoba Spirit that together we can beat HIV. E ba le rona bekeng e tlang ho Siyayinqoba Beat It! support group. [Join us again next week] in the Siyayinqoba Beat It! Support Group. If you have any comments, views or questions about the show please contact us on P.O. Box 62, Muizenburg, Cape Town, 7950 or go log on to our website, www.beatit.co.za or you can mail us on info@beatit.co.za. Join as again next week in the Siyayinqoba Beat It! Support Group. Until then, stay health and stay positive. {Sesotho}

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