Defaulters!

I recently read an article about an organisation coming to the rescue of Karonga District Hospital by providing ARVs.

The article said Karonga registered 4 000 ARV defaulters—up from 2 000 the previous year.

I am near Karonga at the moment, writing this article on a sunny beach resort, but before coming here I went off the main road and down a dusty beaten track deep into the hills near Nyika. I saw many people and villages and I thought to myself: if someone here is in need of ARVs, how do they access them? How do they get tested? Where do they get tested? How do they find transport? Money for transport?

No wonder they default. When your priority is food at the end of the day, why spend K1 000 on transport fare?

In another article in The Daily Times, Karonga district health officer Dr Charles Sungani said: “The contributing factors are stigma and discrimination, high migration rate, failing to disclose to spouses for women on prevention of mother-to-child transmission (PMTCT) and religious beliefs while others just stop for reasons best known to themselves.”

Defaulting from life saving treatment is very risky—it can lead to resistance to ARVs later on and importantly shorted life span and death from opportunistic infections and Aids.

Knowing the contributing factors is a fantastic step in developing interventions that support people with HIV to adhere to treatment.

HIV lifecycle

There are several steps in the HIV life cycle:

1. Free virus circulates in the bloodstream.
2. HIV attaches to a cell.
3. HIV empties its contents into the cell.
4. The HIV genetic material (RNA) is used by the reverse transcriptase enzyme to build HIV DNA.
5. The HIV DNA is inserted into the cell’s chromosome by the HIV integrase enzyme. This establishes the HIV infection in the cell.
6. When the infected cell reproduces, it activates the HIV DNA, which makes the raw material for new HIV viruses.
7. Packets of material for a new virus come together.
8. The immature virus pushes out of the infected cell in a process called “budding.”
9. The immature virus breaks free of the infected cell.
10. The new virus matures: raw materials are cut by the protease enzyme and assembled into a functioning virus.—www.aidsinfonet.org