Thorn in flesh for discordant couples

medical terms, the latter is called Code 1 and the negative is Code 0.
This is occurring more often and one wonders how one could be negative despite having unprotected intercourse for many years.
Scientists are looking into this to find out what makes the other a resistor.
The religious could attribute this to divine intervention which could be.
Cases of discordant couples are baffling, but on the increase.
This Catch-22 situation is a reality in some homes today and the New Start Centre is interested in such couples.
couples in this predicament are thus invited to any of their centres for investigations.
A report by NAC said in more than one in four couples, either one or both partners are HIV-positive.
According to statistics from the National Aids Council, 14,7 percent of couples were concordant positive, that is both male and female.
A further 13,3 percent of couples are discordant with 8,1 percent being male and 5,2 percent female.
A large number of 72,1 percent were concordant, both males and females.
Now how does one part ensure that they remain negative in the event that the above has occurred.
All centres testing for HIV have fully trained personnel and pre- and post-counselling sessions are offered.
In the event that this scenario unfolds, a session for both is held and safe sex is discussed.
“Safe sex” and how is that possible.
Safe sex is when the condom is used correctly and consistently as required.
Besides condom-use, discordant couples need to use other methods of family planning to ensure they do not have unwanted pregnancies.
A woman can thus have an implant, use the depo (injection) and still take a further step to using condoms.
Today, with the female condom enforcing use can be easier as she takes the step on her own.
For a couple that is discordant it was found out that when one part was on ARVs the chances of passing the virus were reduced.
A study taken in seven African countries followed up on 3 400 couples and found out that the chance of passing the virus when on ART are minimal.
Dr Deborah Donnell of the Fred Hutchinson Cancer Research Centre in Seattle taking the study said ARVs reduced the transmission rate.
Over a period of three years, 103 previously uninfected people became infected.
Of these 102 infections occurred before the infected partner had started ART. Of the group only one was infected by a partner on ART.
“Only one happened when the partner was on antiretroviral therapy,” said Dr Donnell.
“That amounts to a finall reduction of 92 percent when on ARVs,” she said.
“. . . it is likely that ART is going to reduce the risk of HIV transmission,” said Dr Donnell.
The tests showed whether or not newly-infected partners were infected by the current partner or by someone else.
Unfortunately, we have not moved to have such sophisticated equipment to see where infection occurred as yet.
So couples in such unions are required to use the precautionary measures and also see that ART is adhered to.
The uninfected partner, the onus lies on you to remain so.
The infected partner knows fully well that any cross infections will not do one any good so they are more likely to take protection seriously.
My concern here comes with the caution now taken by the Code 1 partner to protect oneself, would it not have been good had one taken such measures in the first place to make sure they had remained negative?
It appears Code 1 partners are more inclined to use protection for fear of cross infections.
It is just an observation that has not been substantiated by any survey as yet.
How then can the couple be said to be having a safe encounter say that they now require to have a child?
A doctor speaking on condition of anonymity said there is nothing like safe sex, but rather just being lucky.
HIV negative partners are at very high risk of HIV infection from their HIV positive partners, in the everyday living.
The idea that they practice safe sex is not feasible as we know that there are times they need to have children and thus discard use of protection.
“There is nothing like safe sex, one is just lucky and a couple is best advised to be under medical attention in case they want to try for a baby,” he said recently.
He dismissed the notion that one can avoid deep penetration as fluids carry the virus and could even infect without the so called penetration.
He further added that only after the viral load is not detectable can a doctor recommend that the couple tries for a baby.
“It is very tricky, being poor we rely on CD4 counts but the correct manner would be to have a viral load test done, this way when it is undectable will there be a small or nil chance of passing the virus, but the risk is still there,” he said.
“The virus is a very clever thing, it keeps mutating and I believe it has existed longer than recorded because there are cases long back which presented in the same way only that scientists did not understand what was happening,” he added.
“A CD4 count may give a false variation because it can go down due to other conditions, for example cancer,” he said.
“The best parameter to use is a viral load because it is conclusive,” the doctor added.
He therefore said that such unproved theories like taking a shower after an encounter was nonsensical as the virus has an affinity (liking) for penetrating in the prepuce – cells found around uncircumcised male organs. Men who are not circumcised have a high infective rate.
He pointed out that the male partner in such a union was advised to undergo circumcision as this was found out to reduce the rate of infection by 60 percent.
The doctor pointed out just as what happened with the dinosaurs that disappeared due to climate change, this HIV issue was really not new, its only that science has awakened.
“Just like smallpox which was vaccinated, the last case was reported in 1969 in Ethiopia and today it has been eradicated, we may get to that stage with HIV,” he gave hope.
Now that the HIV virus is found in the vaginal secretions, in the semenal fluid and in blood so there was no way unprotected sex could be deemed “safe” under the circumstances.
In some instances, couples interviewed said they just did not feel comfortable using latex and therefore risked getting infection.
“Who knows, I may already be infected only that my system is stronger and keeps it suppressed that the virus is not detectable,” said one of the males in such a union.
This transmission mode which occurs with one knowing can be termed “friendly fire infection” and remains very dangerous to the response in curtailing the spread of HIV.
A couple trying to have another baby once said they only had unprotected encounters during ovulatory period when the woman was more fertile and was more likely to conceive.
Fertility period, DIY self insemination and sperm washing were some of the methods propagated in a small survey I carried out.
The fertility period would entail a couple having unprotected sex when the woman is believed to be fertile.
The viral load must also be low and this can be achieved if one is on ART.
A high CD4 count means that the viral load is getting down and this cuts down on the risk infection factor.
It is not a certain way of not transmitting but it cuts the percentage by a wide margin as compared to a discordant couple that has non on ART.
It was once reported in Uganda in the late 90s that in a finding that left science baffled a group of sex workers had been found to have been HIV negative despite the fact that they were indulging in unprotected sex.
Tests carried out on these women wanted to determine what made them resist the virus.
Could it be that they had something in them that wipes and kills the virus the moment it entered their bodies.
Acting like a fly swat? No conclusive report was issued but such people do exist.
A man in my neighbourhood lost his wife in 1992 after she had full blown Aids.
He was never tested in the first ten years as he assumed that he was positive.
It was only in 2007 when a friend convinced him that he was as fit as a fiddle and should get tested that he agreed.
The man was shocked, he tested HIV negative and had never been on ART.
He ponders now on settling down again but fears that people will label him a carrier, a term which was used when someone lost a partner due to an Aids related illness and did not seem to be infected themselves.
Such people are advised to take their new partner for a test before tying the knot and going to bed.
With a discordant couple trying for a child there comes a risk that the child must be protected from the mother.
Comprehensive family planning, maternal health and HIV services for women living with HIV are critical if the rate of mother to child transmission is to go down by 2015 as envisaged.
They as mothers carry the baby and have to be protected against passing the virus to the unborn child.
These are being taken care of through the prevention from mother to child transmission programmes (PMTCT) nationwide.
There have been reports of a HIV negative partner standing by the positive partner but in most instances marriages have been dissolved.
One woman who is in such a union says she loves her husband but is not getting tired of his inferiority complex.
“We can not agree even on a simple issue and when I point out that he is wrong he shifts the focus to his status.
“It is not fair anything argue on he ends up shifting the blame, ‘What could I do I am positive’, which really is not the matter, I have nursed him in bad times and will be there as I vowed before,” she said in Harare.
Another man writing said that his wife did not like to use condoms.
He feared getting infected but the wife insisted on “friendly fire” arguing that the husband was resistant hence there was no need for protection.
Sure such a person needs counselling and should see that there is no benefit in having both parents Code 1.
A woman who had a husband taking ART secretly took the tablets to the clinic to ask what they were for.
She was told that her husband was on ART.
She fainted, the nurses had not anticipated this, the husband had been on ARVs. When the woman regained consciousness, she explained the situation.
There are many more out there, mean and only protecting themselves at the expense of their partners even in matrimony.
Disclosure is therefore the stepping stone in any union even when discordant, some unions have stood the test.
May you get understanding in all you endeavour to get.
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