-or face upsurge in drug-resistant cases
WORKING IN a health care setting, or having access to a reservoir of life-saving anti-HIV drugs does not automatically qualify a health care worker to introduce anyone to antiretroviral drugs, or at anytime dispense such medication to another without the advice or direction of a doctor or clinician qualified to dispense such treatments. What people need to know is that, if not taken in accordance with strict universal guidelines, the same anti-HIV drugs that can give a person living with HIV/AIDS (PLHIV) ‘a new lease on life’ can really ‘mess a person up’.  This can be so to the extent that a person would eventually be forced to stand aside and see other PLHIV benefit from the medication – look and feel really good, whilst they, without special intervention, can embark on a downward spiral.
There’s an adage which says:  “To whom much is given, (from that person) much is expected.”  Therefore, as a National Press Foundation (NFP) J-2-J Fellow trained at the expense of the International AIDS Society (IAS) in Health and Science Reporting, and having benefited from extensive training in HIV/AIDS by the Caribbean Clinical and Analytical Society (CCAS) as well as the UNDP, I think I have to live up to expectations.

Beware the ‘quacks’
It is against this background that I sound a warning to readers, and moreso PLHIV and their caregivers, that not just anyone wearing white or working in a health care setting can introduce a person to, prescribe, or dispense HIV medication.
Similarly, even with the much touted pre-exposure prophylaxis (PrEP) or ‘Treatment as Prevention’, one cannot arbitrarily cause another to embark on the use of the one-pill-a-day (Truvada) in an effort to prevent contracting HIV.
Ever since the news hit mainstream media that the Gilead pharmaceutical company was moving towards proposing for approval from the FDA for the use of Truvada as a pre-exposure prophylaxis of HIV, there has been a hype; and some persons, being not keen to engage in behavioural change or condom use, have seen the use of PrEP as a good option for prevention of HIV transmission.  The subject was widely ventilated at the International AIDS Conference in 2011, but there appears to have been mixed reaction.
On December 16 last, the US Centers for Disease Control and Prevention (CDC) reported that Gilead Sciences Inc. announced it had asked US regulators to approve its once-daily pill, Truvada (emtricitabine/tenofovir) as the world’s first drug to prevent HIV infection. Gilead, it said, had sold Truvada for years as an HIV treatment, and the new application sought to extend Food and Drug Administration (FDA) approval to cover pre-exposure prophylaxis.  (More updates at a later date).
Truvada, approved by the FDA in 2004 for the treatment of HIV-1 infection, is currently the most-prescribed antiretroviral treatment in the United States.  It is also being used, along with two other drugs, in the treatment of PLHIV locally.  Studies so far have shown that when taken consistently, the drug may provide up to 73% protection from contracting the virus, but more guidance is awaited.

Don’t play with ARVs
Let me reiterate that taking anti-HIV medication is serious business, and unless dispensed and taken in accordance with those strict international guidelines, the same medication that is working wonders for PLHIV, bringing about immune reconstitution, can cause drug resistance and create more problems for the user later on, if used irresponsibly.
Quite recently, I cringed on learning that a PLHIV who happens to be a health care provider, and who should know better, had taken a decision to introduce antiretroviral (ARV or anti-HIV) drugs to another person without observing even the minimal ethical requirements.  The PLHIV took a decision, it is said, to have commenced treatment of a relative whom he felt was greatly ‘at risk’ of contracting HIV because of his sexual preferences and lifestyle.  He claimed to have been acting as a Good Samaritan and in the best interest of the relative, whom he felt needed to be protected from HIV, so he shared the drugs.
But as bad as that is, he also committed the following other public health breaches:

* Did not insist and ensure that the young man embarked on any Voluntary Counselling and Testing (VCT) programme prior to having him use the medication. In other words, they by-passed getting him tested for the virus, but started him on the treatment.

* The PLHIV did not involve a doctor in this very vital decision concerning a person’s future health.

* The subject was very likely not properly counselled in preparation for the uptake of ARV medication and the consequences of failing to comply with treatment adherence.

Even a person who has tested positive for HIV and needs treatment is not allowed to share a supply of medication that was prescribed for another. Both persons run the risk of ending up with inadequate supplies, and that can lead to drug resistance.

Developing drug resistance
The next question is: How does person A, offering to share his medication with Person B, know that person B is not already infected, and that with a resistant strain of the virus?  This could have come about through having unprotected sex with a sex partner who had a resistant strain of the virus.  That could have happened to the sex partner simply because of non-adherence to the guidelines for drug use.  He or she might have failed to take the treatment exactly as prescribed by his/her doctor, and skipped taking medication when he/she was supposed to take it.
This is a very real and equally frightening scenario. What happens here is that, when a person tests positive for HIV, the doctor will run certain tests on him/her, and if he/she has been found to be infected with the common HIV-1 wild-type virus, he/she would be placed on first line treatment.
However, for the person who has contracted a resistant strain of the virus from a sex partner, another class of medication is necessary for him/her, since the virus would have mutated and changed form.  Very likely, he/she will be recommended for second-line treatment, which is not easy to access and is also more costly.  I am advised that our National AIDS Programme has available second-line treatment.
It is very possible for a person, being exposed to HIV for the first time, to start out with a resistant strain of the virus.  In that case, it would be an exercise in futility to place him/her of first-line treatment, since it would not work for him/her.
That explains why it was bad in practise for our ‘Good Samaritan PLHIV’ to share his medication with his relative.
If, on the other hand, the PLHIV was thinking of sharing his one-a-day pill with his relative to prevent him contracting HIV, he is still culpable, because the man has not been tested, and so his status could not be determined.

Test before being treated
In concluding, readers are urged to let good sense prevail, and to resist the temptation to try getting involved in any short cuts to treatment for HIV, either because of shame or fear of the stigma associated with persons knowing that the reader might be HIV-positive. It’s your life, take it into your hand and take the decision to get tested.  It’s the only way you can know for sure what is your status.
And for those persons guilty of ‘quacking’ on vulnerable or gullible others, be urged to desist from this practice, for it borders on lunacy and is tantamount to criminality.