Radio Series: South Sudan Safari

Programme 4: Special Interview with Professor James Hakim on the ABC of HIV/AIDS

Chris: Welcome to South Sudan Safari. I am Chris Olet.
Christine Dario: And I am Christine Dario. In this second special interview of South Sudan Safari, we would like first, to apologise for the noises in the back ground, nevertheless, the message is audible and quite important, so we hope you listen.

Chris: And the message is from Professor James Hakim, a South Sudanese HIV/AIDS specialist and a lecturer at the University of Zimbabwe. Jacob Akol of South Sudan Safari met up with him recently in Juba and asked him to walk us through the ABC of HIV and AIDS. Is it important to know the difference between the two, Professor Hakim?

Prof. Hakim: It is indeed important to make a distinction between HIV/AIDS .HIV is an abbreviation which stands for Human Immunodeficiency Virus. And as that abbreviation says, it is a virus. So that is the name of the virus which may eventually lead to AIDS. But let us agree that HIV is simply the name of the virus.

Jacob Akol: Where is it found normally, does it exist in itself and can you find it anywhere, the HIV?

Prof. James Hakim: HIV does not exist in the environment freely, it's not in the soil or water or food like any other germ that we know about. HIV resides in people; it's in the blood stream and various tissues of the body.

Jacob Akol: Does it mean that it exists in everybody or anybody?

Prof. James Hakim: No, it does not exist in everybody, obviously you need to be infected and if you are infected, then it takes hold and stays in your body.

Jacob Akol: What is AIDS then?

Prof. James Hakim: Now, if you have acquired HIV infection, that means you have the virus now transmitted into your body. After some time it begins to destroy your capacity to fight various types of infections and you begin to have diseases which generally will not affect a healthy person. These are called opportunistic infections. You may also get certain cancers and when these conditions take their toll on your body, you begin to lose weight without any obvious reason. Despite eating, you continue losing weight and people then refer to what you have as the Acquired Immunodeficiency Syndrome, which is AIDS.

Jacob Akol: Can AIDS exist without HIV?

Prof. James Hakim: As I just described, you need to have HIV introduced into your body and its only then that your immunity begins to get destroyed and that would be followed by the various conditions which are referred to as AIDS. So you do need to have HIV before you come down with AIDS.

Jacob Akol: Now, we just mentioned that people lose weight and generally it seems to have been the way in Africa that when you find somebody who is malnourished and who is looking weak, people assume that he is suffering from AIDS. How do you guard against this kind of diagnosis that is not medical?

Prof. James Hakim: AIDS was the term coined before the discovery of HIV, so in the early 80s when people were losing weight, it became clear to scientists that there was a pattern of a disease that make people loss weight and the term AIDS was coined around that time. But when in1984 the HIV virus was identified, the link between HIV/AIDS became very clear. Hence nowadays we do not go around making the diagnoses of AIDS without showing that somebody has the HIV virus because there are many other conditions that can make somebody lose weight, including even starvation and many other diseases that exist in our environment. Therefore, one needs to be very clear before labeling somebody who is losing weight as having AIDS.

Jacob Akol: How do you diagnose, what are the methods used to find out whether a person is HIV positive?

Prof. James Hakim: In 1985, it became possible to identify infection with HIV through a number of tests and those tests usually pick up antibodies; those are soldiers of the immune system which the body builds once it has been infected. So the main way of identifying HIV is through tests that pick up those antibodies and it’s important for people to appreciate that whilst in the beginning the tests were laborious, expensive and would take a number of days before somebody is aware that they are positive or negative, nowadays there are rapid tests which can be done within 20 minutes to 30 minutes.

Jacob Akol: When a person is diagnosed as being HIV positive, how long does it take before AIDS actually sets in?

Prof. James Hakim: HIV is a disease that is very different from many other diseases that we know like malaria. If, for example, you are bitten by a mosquito now, within a week or a couple of weeks you come down with clinical malaria; you have fever, you become very sick. HIV has different phases. If say, you acquire HIV today, you will be fine, maybe and to a very small extent, you may develop a general illness; you feel little bit feverish and you may get a little bit of headache. However that usually goes away and then HIV settles in your body and eats away at your immune system and you will only get minor conditions for several years, which can go on for up to 8 to 10 years. So it's a disease that eats away at the systems of the body very slowly but eventually you reach a stage when your immunity can no longer control the virus and all these diseases that I mentioned earlier on begin to take the better of you.

Jacob Akol: How should patients take the news that they are HIV positive?
             
Prof. James Hakim: Many people have this fear that HIV is a death sentence. I would presume if you were told you were HIV positive in the 80s or early 70s, that wouldn't be the case because there was no way you could control the disease, but in this day and age, there are ways through the use of drugs; antiretroviral drugs to control the virus. I am saying to control the virus and not to cure the individual because up to date it is not possible to cure anybody with HIV or AIDS. The virus hides in various parts of the body and the drug will not reach those hiding places and from time to time if there is no drug, the virus comes out and begins to cause damage to the whole body.

Jacob Akol: Any green light at the end of the tunnel, cure and treatment, and all that?

Prof. James Hakim: There is tremendous research going on. In fact, if we look at all diseases historically and any disease that exist at the moment, a single disease, HIV is the one that scientists have probably put the greatest energy, time and money into trying to discover ways of treating it and eradicating  it from an individual. Unfortunately, up to date there is no cure and as I said we can only control the virus by taking antiretroviral drugs in a very consistent way.
Jacob Akol: The amount of money that is going into research for HIV, the amount of money that is being spent on drugs to try to treat the  AIDS or HIV, have generated some sort of controversies on whether this money should be spent on what is actually the biggest killer in Africa, that is malaria. I don't know whether this question should be left to a social scientist or should a doctor indulge in answering this question?

Prof. James Hakim: No, I think it's a significant question that people in the health arena should also address. The truth is that one must look at the burden of disease in totality. Yes, there is malaria, there is HIV, and there is tuberculosis and many other diseases like the Sudan losiolaises and so on. One must address them because they all cause human suffering.  The amount of money going into HIV is relevant in my thinking, one can debate on how much should go into the other diseases, but I think that the correct approach in terms of allocation of money is being made as far as HIV and AIDS is concerned.

Jacob Akol: Was President Thabo Mbeki misunderstood in 2000 because he was raising these questions of poverty and whether so much money should be spent on AIDS while there are other diseases such as malnutrition as well?

Prof. James Hakim: Statements made by world leaders who occupy important positions, where their opinion matter and every word is taken seriously, are obviously people who must make statements in a very clear manner so that they are not misunderstood. I think the world was greatly divided over what president Thabo Mbeki meant when he said that the actual cause of AIDS is poverty rather than emphasising the fact that HIV and poverty are interlinked in many ways and therefore even though scientifically HIV is indeed the cause of AIDS, poverty plays such an important role that we must also address when you are addressing HIV AIDS.

Jacob Akol: Are people with HIV infectious?

Prof. James Hakim: Yes, people with HIV can transmit the infection, and there are a number of ways that infections are transmitted. The commonest and the most important in the African region and especially in the sub-Saharan Africa, is through sex between a man and a woman; so if one person is infected it is possible for the other one to get infected. There are other ways that infection can occur; one which is extremely important is infection from a pregnant woman to her baby which can occur either when the baby is still in the womb or during birth or can occur through breast milk when the mother is breastfeeding the child.

Jacob Akol: Transmission through infected blood as well as mother-child transmission are the other channels of transmission. How can these be mitigated: what is the best way of guarding against mothers passing on the disease or the HIV to their children and how can blood be guarded against injecting/infecting people with it?

Prof. James Hakim: Yes I think you have touched on a very important route of transmission which involves blood in general. If for example, you get pricked by a needle that has pricked an infected person, then that infection will be transmitted into your body. This is common especially in health care settings and hence a nurse, a mid wife or a doctor who deals with sharp objects must guard against transmission of infection through this route.
We also know of course that blood transfusion is a life saver, especially for accident victims or those undergoing an operation and need to have additional blood. Now, if that blood is not carefully screened for HIV plus other infections, you could unintentionally infect somebody .It’s also possible during scarification and we know that scarification or the creation of marks to identify different ethnic communities is very common in our environment and if you use a needle or you use a blade that is contaminated, you could transmit an infection from one individual to the next. Hence, all these are extremely important areas to guard against.
But to come to your second question about preventing the transmission of HIV from mother to child, there have been many different ways that have been devised. However, one that probably is universally accepted by many authorities and the one that the World Health Organinization (WHO) emphasises on is the use of antiretroviral drugs which can be administered during delivery or before delivery. Both the mother and the new born infant should be given that antiretroviral drug. Additionally, as I have mentioned, breast milk can also transmit the disease. Now, that is a very sensitive subject because in many environments, if you deny a child breast milk, there is a question of stigma, but much more medically they could suffer from water-borne diseases because of the use of contaminated water for mixing infant formula and so on.
So the recommendation, which is fully endorsed by the WHO, is that in a society where you must breast feed for both social and health reasons, breastfeeding must be comprehensively done. This can be say up to about 6 months and the child should not be fed on additional water, porridge or juices. After the 6 months, you then wean the child fairly rapidly and then you change them over to other foods.

Jacob Akol: Can HIV or AIDS be transmitted through casual association with people who have got it like hand shaking, hugging or something like that?

Prof. James Hakim: I think that is extremely important and that is probably one area where at the beginning of the epidemic, there was a lot of confusion and people begun to shun relatives and friends who have HIV and that created stigma and discrimination. There have been many evaluation studies done and clearly casual contact like shaking hands, hugging are non sex contacts which do not result into any transmission of HIV infection.

Jacob Akol: 10 years back, the predictions for Africa were very grave indeed; millions were supposed to die of HIV, has this fear passed by or are we still having a very dark future ahead of us for our young people?

Prof. James Hakim: One can look at this from two angles. HIV affects close to 22.5 million people in sub-Saharan Africa and about 33 million globally. The figures do vary a little because most of these are really estimates, I know at some point people gave figures as high as 40 million, but these are currently the UNAIDS’s figures. With 22.5 million people affected with HIV in Africa, it is indeed a very grave situation. The number of deaths is increasing rapidly and currently we have about 2.1 million deaths in sub Saharan Africa, but that….

Jacob Akol: That's a year?

Prof. James Hakim: In a year, 2.1 million per year.  Fortunately, the introduction of antiretroviral drugs in the African environment (this was of course introduced in the west from the mid 90s but its only from 2000-2001 that anti therapy became available to many Africans in the public sector), brought a ray of hope and its now possible for infected people to live longer.

Jacob Akol: Before I ask you the last question, what would be your view on what is supposed to be leadership's conspiracy of silence; sometimes if somebody related to them is HIV positive they will not actually come out openly to admit that this is happening, it doesn't only happen to the poor, it doesn't only happen to people who are not in political power, and that it can happen to everybody?

Prof. James Hakim: That is very important; we must accept that HIV affects everybody regardless of their status in society. We have had high profile people like the former president of Zambia, Kenneth Kaunda, whose son died of HIV and he came out. Not only did he come out publicly, but he also took up HIV as a personal area of interest and has been heard in several fora advocating for issues related to the disease. This has received remarkable results in Zambia’s campaign against HIV/AIDS.

Jacob Akol: Regarding that, would you recommend that to our leaders?

Prof. James Hakim: Yes indeed. I think another obvious example that has been quoted by many different quotas is the role of leadership in Uganda where President Yoweri Museveni has been a champion in this area; he has taken this on as a personal fight and this has been extremely positive for Uganda. Therefore, I would encourage strong leadership in this fight. It is unfortunate that only a few presidents are spearheading these campaigns yet leadership at all levels is required to take on the fight against HIV and destigmatise. This will create awareness amongst the citizenry as people will get to appreciate that the infection could affect anybody and somebody who is not infected is not a lesser human being than any other.

Jacob Akol: Any particular point you would like to add?      

Prof. James Hakim: Well, I think the issue of prevention is extremely important even though we now have treatment available and the treatment if used in the right way, can result into very positive outcomes. We still must prevent the disease as much as possible and there are many different strategies that have been used for prevention but I will just mention a few.
First, I think everybody needs to be informed. I think if you are informed and you are aware of what HIV and  AIDS is and how it is transmitted and the fact that you don't have to be either a very rich or poor  person to get it.
Secondly, since most infections in sub-Saharan Africa and in South Sudan occur in an environment where it is a man and a woman engages in sex, then obviously there is need for the two to be faithful to each other, without engaging in sex with multiple partners. Abstinence for the unmarried should also be upheld until marriage. In many parts of Africa, girls are married early to older people and HIV is then transmitted through that inter generational relationship. Girls are often disempowered and end up engaging in commercial sex or transactional sex to get gifts, money and so on. So you find girls who are 16 or 17 years old engaging in sex and this contributes to the high infection rates among young girls.
Moreover, there is need to convey the right messages that help in prevention of this disease. This is especially important among youth organizations and in schools, where abstinence can be preached. There should also be enhanced campaigns to promote the use of condoms since it has been found to be a very effective tool in preventing transmission of the virus.
I have already talked about how to prevent transmission to infants by use of antiretroviral drugs and also how exclusive breast feeding works. Those are also important ways of preventing HIV/AIDS transmission. There are others which are still under experimentation including vaccination; in fact, vaccination would be the greatest preventive tool just like we know about its value in fighting diseases like measles, polio and so on. Unfortunately, up to date there is no vaccine that can succeed in preventing HIV/AIDS transmission. There are other specific types of gel which women can apply to try and prevent the virus from getting into them. Once again these are still not available in the market.

Christine Dario: Professor James Hakim talking to Jacob Akol in our second special interview of the series for South Sudan Safari.
Chris: Until next time then, it is goodbye from me Chris Olet.
Christine Dario: And it is goodbye from me Christine Dario.

Christine and Chris: Goodbye.

Chris: The programme was produced by Jacob Akol, assisted by Silvanos Batali and Clement Luchio Lomornana. South Sudan Safari is a radio series of Gurtong Trust Peace and Media Project. The series is funded by the Norwegian Ministry of Foreign Affairs, through the Norwegian Peoples' Aid.

Posted: 07/11/2008