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Siyayinqoba Beat It! 2005 Episode 4 –

Substance Abuse & Adherence

There are many different substances out there, and they have two things in common; they make it more likely for us to have unsafe sex and get infected or re-infected with HIV. Drugs also make it harder for HIV positive people to adhere to ARVs once they’ve progressed to stage 4 of the disease. In this episode of Siyayinqoba Beat It!, support group member Zack Smit was the youth guest. Zack shared his experiences as someone recovering from substance abuse and living openly with HIV with the viewers.

Jason Wessenaar: Dimachaeri {Venda} [Hello] and we welcome to the Siyayinqoba Beat It! Support Group. My name is 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 leadership in the fight against HIV/AIDS to dental health. U-Siyayinqoba wuhlelo lwakho lokuphila kangcono ne-HIV. {isiZulu} [Siyayinqoba is your guide to better living with HIV. If you are living with HIV] or you have a friend, a family member or a partner who is HIV positive this program is for you. This week we are talking about the impact of substance abuse on HIV /AIDS. There are many different substances out there, and they have two things in common; they make it more likely for us to have unsafe sex and get infected or re-infected. They make it harder for us to adhere to ARVs. Our youth guest today is our very own Zack Smit. Zack will share his experiences as someone recovering from substance abuse and living openly with HIV. Siyayinqoba went to party with Zac to see how he is doing, let’s check this out.

Choosing Adherence over drug abuse

Cape Town, Western Cape

Zack Smit: I’m Zack and I am 24 years old. I found out seven years ago. I donated blood and that was my way getting my results. I was, I think, too scared to actually go and have an HIV test.

Dr Biersteker (Robbie Nurock Day Hospital): Zack. Hi, come in. How are you?

Zack Smit: I’m fine thanks and yourself?

Dr Biersteker (Robbie Nurock Day Hospital): Can we just count your pills today?

Zack Smit: Ja, uhm the one that was, those pills are in that …

Dr Biersteker (Robbie Nurock Day Hospital): That’s ok, can you remember missing any?

Zack Smit: No

Dr Biersteker (Robbie Nurock Day Hospital): Not at all? Ok.

Onscreen text: Your pills will be counted to see if you have missed any doses.

Zack Smit: The CD4 count was 88 and the viruses were 78 000.

Dr Biersteker (Robbie Nurock Day Hospital): 78000 viruses per ml of blood. Adherence is terribly important because the virus can change or mutate for you easily and if you don’t have drug levels in your blood that are high all the time that’s when the virus can learn to work against antiretrovirals, and they can stop working for you. Tell me about other things you’ve been taking.

Zack Smit: Nothing.

Dr Biersteker (Robbie Nurock Day Hospital): Specifically in terms of substances.

Zack Smit: Substances, nothing. I haven’t been doing drugs. I’m quite proud of myself, honestly. Alcohol either.

Dr Biersteker (Robbie Nurock Day Hospital): You’re clean.

Zack Smit: Ja.

Dr Biersteker (Robbie Nurock Day Hospital): Well, we always tell our patients. Most of the substance abuse that we see is alcohol, it’s very common. And we tell our patients there are two reasons: We know that the antiretrovirals can be toxic to your liver, and we know that alcohol is toxic to your liver, so we don’t have to add two toxic things to the liver. You know we want the liver to be healthy.

Zack Smit: I would go up very irresponsibly, have unprotected sex, take drugs to the point that I wouldn’t wake up. You lose track of the days. My whole life was one big party, and it became, like, a health hazard. My first drug ever, I started off with heroine. And in a matter of a week, I was almost addicted. It was carrying on like that for about three months, and then I started doing normal rock and cocaine, and ecstasy. And that was about it. And it didn’t end. It just carried on and on and on and I ruined my life. When I started ARVs, it wasn’t very easy. The clinic didn’t want to give me the medication at first. They held it back. And they were convinced that I wasn’t going to take it. And I helped them realize that I’m going to and like: “Please give it to me, I’m sick.” Anyway, so at that point my cell count was very low. My CD4 count was 84, 88 or something like that; I can’t really remember, and I had a viral load that was something like 78 000. I’m going clubbing, having a few drinks and socialize. I know how to control when I drink and if I do use substance abuse, I know how to control it. I don’t get totally like wasted. I can basically have fun just knowing that tomorrow morning at nine o’clock again, I have to take my medication once again.

Dr Biersteker (Robbie Nurock Day Hospital): I think Zack has been coping absolutely amazingly since he started ARVs. I was very hesitant to start him, but in fact Zack has managed incredibly well.

Zack Smit: Being HIV actually opened doors for me. It has also made me more wiser, more mature and by coming out it’s exactly the same as being gay. Coming out of the closet is a major, major achievement.

Support Group

Jason Wessenaar: Zack what were your experiences of abusing drugs and how did it affect you adhering to your medication?

Zack Smit: Ok, well there would be many events where I would go out and have a good time. Many other times it wouldn’t be necessarily at a club it would be a, what they call, the male steam bath, ok. I found that when I was using drugs I became less aware of what I was doing. You loose track of time as I said, you just don’t think. There were three or four cases where I was unsafe while using drugs. I do believe very strongly that the drugs do affect your responsibility as well.

Primrose Mathabatha: Zack, what made you to stop using drugs and start adhering to treatment.

Zack Smit: Well, the fact that I wasn’t adhering to my treatment became a issue. If you are constantly on a total new different wavelength when using drugs, you never adhere to your medication and that’s a fact. So I look at it now from this way it’s either or, its not in between. I do my medication or I do my drugs, and I mess my life up totally.

Lihle Dlamini: How hard or how easy was it for you to stop abusing drugs?

Zack Smit: I don’t have an addictive personality. That’s one of my very fortunate points, but it’s not easy. There are still times that I wanna go out, and all my friends, they all use drugs. So I really feel awkward when visiting them, and they don’t respect the way that I am now. And they would use it in front of me, making it more difficult for me to say: “What do I do now? Do I have a line, or don’t I have a line?” You feel very uncomfortable and you don’t know now if this for definite, am I really stopping or am just gonna have a bit of a binge go through the whole weekend again. I think, when you actually like, you reach a point where you say: “This is enough.” Whatever you take being in my case your last pill, that I had taken one ecstasy pill and that was the last pill that I took and I felt really ill from one pill. I think that was my body telling me: “Hey, you know, sorry I’m not gonna handle it anymore.” After that I decided to stop and it’s been now two months.

Jason Wessenaar: This is maybe a personal or maybe a difficult question but you say you don’t have an addictive personality. Is it really about personality or the effects that drugs have on you? That they need to have that drug.

Zack Smit: There’s a positive of taking drugs, especially the drugs that I took, and there’s a negative. The positive is that you can stay up for five days. The negative is that one day you’re gonna have to stop, and the five days are gonna be up, and there’s not gonna be any more money, and there’s not gonna be any more drugs. And therefore you’re gonna suffer depression, you’re gonna suffer pain, your body goes into total agony. In my case, I’d rather live like this now where I feel more healthier, and I’m gaining weight and my skin’s clearing up. I’m feeling much more positive about life. I’m not depressed anymore, I don’t suffer all those negatives. So I’d rather stay on the positive frame of mind then to have to worry about if I go out tonight and I do this tomorrow what’s gonna happen. Then you start getting all this anxiety issues and depression and who wants that. So I made a good decision by saying, no I don’t.

Jason Wessenaar: Re bua hape ka substance abuse le HIV ha re kgutla mabenkeleng. {Sesotho} [We talk more about substance abuse and HIV after the break.] Stay with us.

Jason Wessenaar: Mmuhi re ya ho amohela hape mona mo Siyayinqoba Beat It! Support Group. {Sesotho} [Welcome back to Siyayinqoba Beat It! Support Group] – the program for everyone infected and affected by HIV. The Siyayinqoba team visited Gordon in Katlehong. Gordon started on ARVs but had problems because of his drinking. Let’s see what we can learn from Gordon’s story.

Choosing Adherence over drug abuse

Katlehong, Gauteng

Gordon Mthembu: Ngihlala nje always ngisetshwaleni, yonke lento yenzeke after ngiqeda uluza umsebenzi. Then ngaba ngumuntu ohleli nje is’khathi esiningi ngisetshwaleni from Monday to Monday, tindlela ebengiyiphila leyo. Nga-diagnoswa ngo-1998. Into mhlambe engeza ngiyotesta ukuthi bekunalento yogula njalo nje, ngoba bengithi kancane kancane nje ngiyagula kwaze kwafika la kungcono ukuthi ngiyotestama beqeda ukungi diagnosa angizange ngiwa accepte ama-results wami. All along bengiloko ngi ngala ukuthi I’m HIV positive. Kuze kwafik is’khathi la uthola ukuthi sengiba weak and sengiqala nalezinto lezi ezinje nge-peripheral neuropathy then ngaba nama-seizures uthola ukuthi sengiba ne this constant issues. Kwasho ukuthi kufanele ngibuyele futhi e-Jo’burg Gen then kulatafile yase-Jo’burg Gen ngathola ukuthi bathatha i-CD4 count yam, beseyehle kakhulu i-CD4 count yam, mhlambe yehla yaze yafike ku-37, kwase kufanele ngithathe ama-ARVs. Ama-ARVs ngiqale uwathatha last year ngo-September. Ngithe ngikwama-ARVs still bengisaphuza full time. Ngathi ngokwenza lama-test ngathola ukuthi ngine-problem ye-liver. Then kwaba yilapho ngibona ukuthi ngine-problem e-serious {isiZulu} [I used to drink all the time. It all started when I lost my job. That’s when I started drinking all the time, from Monday to Monday. That’s how I was living my life .I was diagnosed in 1998 .The reason I went for a test is because I wasn’t feeling well. I would get sick all the time and that’s when I decided to go for a test. After my diagnoses, I didn’t want to accept my results. All along I was denying that I’m HIV positive. Until I started getting weak and I had peripheral neuropathy. I also suffered seizures, so I had these constant issues. I had to go back to Johannesburg General Hospital. They took my CD4 cell count and it had gone down a lot. I think it had gone down to 37. And then I had to start taking ARVs. I started taking ARVs last year in September. Even if I was on ARVs I was still drinking, full time. When I did my tests, I found out that I had a problem with my liver. That’s when I realized that I had a serious problem.

Pinkie Nocwezo (Helen Joseph Hospital, Gauteng): Kunjani namhlanje? {isiZulu} How are things today?

Gordon Mthembu: Ngizizwa ngendlela e-right. {isiZulu} Everything is going well.

Pinkie Nocwezo: Ugcine nini ukwenza i-CD4 count? {isiZulu} When last did you check your CD4 cell count?

Gordon Mthembu: Ngigqibele ngo-April. {isiZulu} The last time I checked was in April.

Pinkie Nocwezo: Beyisithini ke? {isiZulu} And where is it standing?

Gordon Mthembu: Inoba {isiXhosa} the last time I checked it was 450.

Pinkie Nocwezo: Ndifundisa abantu ngama-ARVs ukuthi athathwa kanjani lama-ARVs and ukuthi kubalulekile ukuthi uwathathe ngexesha and akumelanga umixe notywala because ingakwenzela ama-problems. Most yamapilisi a-metabolizwa kwi-liver and then ne-aclohol iba ne-liver. So uzophinde uze nini for i-viral load ne-CD4? {isiXhosa} [I teach people about ARVs. I tell people how to take ARVs, and that it’s important to take them at the right times. That you must not mix ARVs with alcohol because you may have problems. Most of the pills metabolise in the liver and then alcohol also affects the liver. When are you checking your viral load and CD4 cell count again?]

Gordon Mthembu: Fanele ngibuyele ngo-October futhi. {isiZulu} I’m going to do it in October.

Pinkie Nocwezo: Singajabula uma ingabuya ithi undetectable. {isiZulu} I’ll be happy if your viral load is undetectable.

Gordon Mthembu: Yinto nam engi hopayo ukuthi yenzeke because ikakhulu ngifuna utshwala ngibuyeke all together. {isiZulu} I hope so too because I wish to stop drinking completely.

Pinkie Nocwezo: I’m proud of Gordon because now amapilisi seyewaphuza right, sekangubaba womtwana omuhle and uya-progressa a lot. Yonke into yakhe ihamba sharp, nama-viral load ache at least seyehla ngendlela e-right. {isiZulu} I’m proud of Gordon because he takes his medication correctly. He’s a father to a beautiful daughter and he’s progressing very well. Everything is going right and his viral load is dropping a lot.

Gordon Mthembu: Anginaluva ukuthi ngisazobuyela ngendlela ebengiphuza ngayo before. Iyilento ye-choice yokuthi if ngibuyela kufanele ngibe clear ukuthi ngizomisa ama-doses ekufanele ngiwathathe and then leyo nto leyo ingaze ingikhozele i-drug resistance. And if ngizobane drug resistance kufanele ngiba aware yokuthi yini ezokwenzeka nge-life yami. {isiZulu} [I don’t think I’ll drink as much as before. It will be by choice if I go back to drinking, but I know that I may miss my doses. That can lead to me having drug resistance. And if I’m resistant to medication, I must be aware of what is going to happen with my life] So it’s either you choose life or you choose death.

Support Group

Jason Wessenaar: What is the impact of alcohol abuse and drug abuse uma u-HIV positive? {isiZulu} [when you are HIV positive?]

Ricardo Moses: My experience with abusing of alcohol was the time when I was diagnosed. I did drink as the gentleman said Mondays to Mondays as well. And I did drink brandy, whiskey you can name it. At the end of the day I was diagnosed with abdominal problems, where I almost died. And I also realised through that, that alcohol is not gonna be the way. And through that I stopped abusing alcohol, stopped drinking and followed a healthy lifestyle.

Jason Wessenaar: Your drinking, did it affect your sex life with your wife at all? What impact did it have?

Ricardo Moses: Ja, definitely, because on that point my wife was feeling like she’s not part of me. We was far away from each other because I was the party type of guy, I want to keep it away from her, but on the one hand she knew that she was HIV positive, but she was waiting for me to disclose. I didn’t want to disclose on that point. So, that’s why I’m totally against drug. I don’t associate with my friends group, if I see they are using drugs I will pull me away from that group, because I don’t associate, because I don’t want to go back in drugs.

Busisiwe Maqungo: I never drink, I never do i-drugs and I never did i-drugs, but my partner was doing drugs whom I was with when we found out that we were HIV positive. Generally I knew into yokuba ii-drugs zihleli zirongo kakde emntwini so zizobarongo worse xa e-HIV positive. And I persuaded him uba makayeke but he never stopped instead things became worse. And kengoku yaba ne-impact especially na kum because we also had a child, ndandine income encinci, he wasn’t working and I was the provider apha endlini. Eyona nto yayiphinde ibebuhlungu kuyo yonke lonto is that kengoku he became abusive kum. He was so abusive, it’s when I got ezi scars nezinye ke ezilapha emzimbheni, awunozibona ke. And nokufa kwakhe he shot himself, zange abulawe yingculaza, he shot himself but sasohlukene ngoko and I hear that before shooting himself waye high. {isiXhosa} [Generally I knew that drugs were wrong and it gets worse when you’re HIV positive. I persuaded him to stop, but he never stopped. Instead, things became worse. It had a huge impact on me because we also had a child. I had a small income and he wasn’t working and I was the provider at home. The most difficult part of it was that he became abusive to me. He was so abusive and that’s where I got these scars and a lot more scars on my body. He died by shooting himself. He wasn’t killed by HIV. He shot himself, but our relationship had already ended. I heard that before shooting himself, he was high.]

Lihle Dlamini: I think what you are saying Busi is true because I also had a cousin who was abusing alcohol and he also was on TB medication, because it’s not only amaARVs and it also can be TB medication. Because nayo i-metaboliza esibindini and umchamo wakhe ended up ubangathi a-reddish asoba ngathi une-jaundice. {isiZulu} Alcohol gets metabolised in the liver. And that’s why you have to take ama weekends off. He would say: “Ok, I’m not taking TB medication on weekends so I can drink.” That time is when the liver is supposed to recover but he was over-working the liver. And he ended up having i-liver damage. His urine was becoming red and he developed jaundice. And after that he died. And I think he could’ve saved his life. I think we should stress how important it is to stop abusing drugs and alcohol as well. It’s not very easy to stop immediately. It takes time but at least steady but surely try and minimize it, and eventually stop.

Jason Wessenaar: We talk more about substance abuse and HIV after this short break.

Jason Wessenaar: Welcome back to Siyayinqoba Beat It! Support Group – the program for everyone infected and affected by HIV. If somebody is abusing alcohol or drugs they are putting themselves at risk .Or the likelihood of them having unprotected sex are higher. Also if somebody is living with HIV and they’re abusing alcohol and drugs it affects their immune system. But then thirdly is that the chances of not being adherent to ARVs are quite high if you’re abusing alcohol and drugs. But then, what are we saying? Are we saying people should not drink at all or are we saying they should limit, how must they drink?

Busisiwe Maqungo: Mabavele bayeke ngoba abkwazi nje ukusela, bekungekho wrongo uthatha i-shot eyi-1 udiniwe uvela emsebenzini, take one shot ye-brandy wenze umsebenzi wakho uqhubekeke. Thina into esifuna uyenza uba uthi xa ubuya emsebenzini ngoLwesihlanu, ubize i-case lonke le-beer nebhotile yebranti uyibeke apha, hayike mntaka tata uyawtsho kuse. {isiXhosa} I think people should stop completely. Drinking wouldn’t be bad if you took one shot after work. You take one shot of brandy and you continue with your work, but what we do is, take a whole case of beer and a bottle of brandy, sit down and drink the whole night.

Vuyani Jacobs: When I tested for HIV I became quite alcoholic I would say. I drank everyday that was when I was still working at the bank. But definitely when I started taking ARVs I was quite ill so I did not drink alcohol for a long time. But feeling better made me drink again. When I started drinking antiretroviral drugs and taking alcohol at the same time, it became quite problematic because I would want to throw up in the morning, and that’s the time I have to drink my medication, and I cannot skip that. And should I then drink it and vomit at the same time? That does not work. It’s like the same thing as not taking it correctly. But I didn’t drink like I used to drink. I started to enjoy a lot of other things that you don’t enjoy when you’re drinking alcohol. If you’re going to drink from Friday, Saturday, Sunday, when will the last time that you’ve ever seen a cinema? I engage in social drinking sometimes of course, because I go to a shebeen and I go to a club, because I miss my friends and I live my lifestyle. But I still take out responsibility on how much I drink or how much I engage in alcohol drinking.

Jason Wessenaar: Ke ya lebong Zack {Sesotho} [Thanks to Zack] the support group nani babukeli emakhaya {isiXhosa} [and the viewers at home.] This week we learned that substance abuse whether use or abuse of alcohol or drugs are a real problem for three reasons:

1. You are most likely to have unprotected sex if you are under the influence of drugs and alcohol.

2. Substance abuse compromises your immune system and makes you more vulnerable to illnesses. Substance abuse is likely to make you miss your ARV doses, causing you to become resistant to medication.

3. If you have problems with substance abuse, get help. You can quit and get your life back.

Jason Wessenaar: We hope that you have enjoyed the show and are feeling the Siyayinqoba Spirit that together we can Beat It! If you have any questions please contact us on the numbers below. Join us again next week in the Siyayinqoba Beat It! Support Group. Till then, stay healthy and stay positive.

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