The Sunday Mail
THERE have been many instances where people testify that they were healed at their churches. They claim that through faith they received their healing. I cannot doubt their faith and the healing part but what these people claim to be healing could be undetectable viral loads.
The country has achieved success in that people on anti-retroviral therapy (ART) now live longer. There is a 90 percent survival rate on those initiated on ART. With less people now bed ridden, the focus changes as more people are now able to work and stay healthy.
With correct adherence to ART and depending on the efficacy of the medicine used, the virus can become undetectable after a year or two. The first public figure to have announced that their viral load was undetectable a decade ago was former basketball star Magic Earvin Johnson. He had been on ART and adhered to his regimen. In a few years, the virus ‘‘disappeared’’. This means that when he took an HIV test it came out negative.
“Earvin is doing very well,’’ Drs David Ho and Michael Mellman said in a statement more than a decade ago.
“However, we must emphasise that ‘undetectable’ doesn’t equal ‘absent’.’ It would be premature and incorrect to say Earvin is ‘virus-free’.’’
The doctors added, “We are very pleased he has adhered to his daily drug regimen and that is reflected in his good health.’’ However, Johnson’s wife, Cookie, believed otherwise.
“The Lord has definitely healed Earvin,’’ the basketball star’s wife said in an interview with Ebony magazine. “Doctors think it’s the medicine. We claim it is in the name of Jesus.’
“I honestly feel that the Lord is going to heal him and that we are going to live together forever and have more children and be happy,’’ Mrs Johnson said.
The Zimbabwean story runs on a similar script as Government started the free ART programme in 2004. A decade later, the majority of people who went on ARVs in that year are still alive and healthy.
One such person is Miss Shingirayi Matogo who tested HIV positive in 1986. By 1996 she was constantly sick. By 2000 she was in bad shape but held on to life through the support given by Lynde Francis at The Centre.
“I lost my baby in the 90s. She had been ill since birth from 1986 and then there was no medication. In 2000, I got to know Lynde Francis who ran an organisation called The Centre. She offered psycho-social support and that way we met regularly as people living with the virus and gave each other support,” said Miss Matogo. Miss Matogo was lucky to be among the first group to be initiated on ART in 2004. She has religiously taken her medication for the past decade and today, she is as fit as a fiddle. She went on to explain that this was a result of the ART success which suppressed the virus to minimal undetectable levels. However, she does not claim to be HIV negative.
“If I take an HIV test today, it comes out negative, but I am not. This is due to the depressed viral load which is now undetectable,” she explained.
Thousands of HIV patients have also seen their infections recede to undetectable levels after taking drug “cocktails’’ containing protease inhibitors.
Unfortunately, a patient with an undetectable viral load can still infect others. Even if the virus is undetected in blood or semen, it can still be present in other areas such as the intestines.
Mrs Judith Mutangirwa, a development practitioner working for an international medical organisation, commenting on her own capacity, said she too was disturbed with claims by some people to have been healed of HIV.
“I was shocked at one church service when it was time for testimonies. A middle-aged man got to the podium and narrated how he had been taking ARVs for the past three years. He said that six weeks ago his doctor asked him to take a viral load test and the result was ‘undetectable’ meaning he no longer had the virus. He said he had stopped taking ARVs as he no longer have the virus. He testified ‘I no longer have the virus, I am healed. Praise be to God!’ as the congregation broke into song, dance and great ululation — celebrating the miracle healing. “I looked down to control my emotions. I felt like grabbing the microphone to correct the misconception. I thought of Hosea — people perish because of lack of knowledge. The whole congregation of nearly 500 people took home that inaccurate message,” said Mrs Mutangirwa.
There is need to explain what viral load is. The Zimbabwe Guidelines on anti-retro-viral-therapy (2013) defines HIV viral load testing as the ‘gold standard’ for monitoring an individual’s response to ART and says it should be done routinely once a year.
With proper adherence, the viral load usually falls to undetectable levels.
Mrs Mutangirwa explained that viral loads have a cut-off point and a limit to detection. “All viral load tests have a cut-off point below which they can’t reliably detect HIV. This is called the limit of detection. For example, in Zimbabwe any viral load below 100 copies/millilitre is undetectable, but this does not mean an individual no longer has HIV. The level is too low to be detected. That is the reason why anyone testing HIV negative for the first time is asked to come for a retest after six weeks. That time is called the window period where the virus was undetectable. If one has a new infection it then shows after six weeks or so,” she said.
“Viral load only measures levels of HIV in the blood which may be different to viral load in other parts of the body e.g. genital fluids, gut or lymph nodes,” she explained. Mrs Mutangirwa said the country needs to strengthen patient education as provision of ART alone was not the panacea to managing HIV.
“Health care workers need to take time to explain procedures done on their clients to empower them on why they are done. Staff shortages are appreciated, but there is need to give quality care,” Mrs Mutangirwa added.
“Church leadership needs to be capacitated so that they provide good counsel to their congregates and encourage those on ART and other chronic conditions to take their medicines properly. God will take care of his people while they take their medicines,” she said.
Reverend Phumzile Mabizela, the executive director for International Network of Religious Leaders — Lay and Ordained Living with or Personally Affected with HIV, castigated churches who called on their congregates to stop taking medication. “Medication is a gift from God.
It is rather irresponsible to encourage people to stop taking medication for chronic illnesses. Medication is part of the healing process that God avails to us. Most of these leaders surprisingly take their diabetes and high blood pressure medication in private,” said Rev Mabizela.
“We must challenge church leaders who understand the importance of the healing discourse within their churches to speak out against such destructive teaching.” Defaulting is now a major challenge as moving patients onto second line medication in the case of HIV medicines is very expensive.
First line medicines cost between US$10 to US$15 depending on the type but for the second line medication, the cost is ten times more. Government has 660 000 people on the assisted ARVs programme with the same number waiting to be initiated. With more people now defaulting, this puts a strain on the Government free ART programme. National Aids Council monitoring and evaluation director Mr Amon Mpofu said 4 683 women were on second line ARVs. He said although the number of people resistant to ARVs had decreased from 8 739 to 8 560 in the last quarter of 2012, the statistics for children and women were increasing.
“For the first quarter of 2013, there were 608 children, 4 683 women and 3 269 men who were resistant to ARVs. The number has, however, gone down to 8 560 in total,” he said.
National Aids Council Chairman Mr David Mutambara added his voice, saying that due to ART success the trend of undetectable viral loads was now very common. “When you look at it from a strategic focus it is a natural progression of the response that the Government has taken.
Because of the success we have had in getting people on ARVs, the focus changes and false security tends to take over. We now need to respond to this change as NAC and have messages that are current and speak directly that an undetectable viral load is not a negative case,” said Mr Mutambara.
A Harare doctor speaking on condition of anonymity said not only is it expensive for a patient to be moved on to second line medication, it is also life threatening.
“It is risky, drug resistance occurs even to the second line because one would have defaulted. The ART medicines are cocktail drugs and any failure is hard to rectify. Defaulting makes one prone to a host of opportunistic infections which are difficult to treat and at times failure to respond to medication results in death,” said the doctor.
For any chronic condition, sticking to what the doctor prescribed is the best.
