Angolan Men Hide Their HIV Status From Their Spouses

Maria Antónia* began to wonder about her husband's frequent trips to neighbouring South Africa, especially when he was away for 15 days without contacting her on one occasion.

She decided to investigate whether he was going to South Africa to see another woman, but discovered that he was going to get antiretroviral (ARV) medication because he was HIV positive.

Miguel André's wife died in 2001, officially from typhoid fever, but before she died she told her child's godmother that she had AIDS. She never found the courage to tell her husband, but the news spread and soon everyone in Benguela, a coastal town in central Angola, was talking about it. André was the last to find out that his wife had been HIV positive.

Stories like these are repeated time and again in Angola, but fear of a partner's reaction, fear of being abandoned, fear of discrimination, even fear of shame, are just some of the reasons that prevent people living with HIV from telling those dear to them.

Many only discover the HIV status of their partners after they have died, and then learn that they are also infected, but it is often hard to know who infected whom, or how. An estimated 2.5 percent of Angola's 16 million people are living with HIV/AIDS.

To tell or not to tell?

The debate in Angola about the role of healthcare workers in disclosing the HIV status of their patients has been heated. On the one hand there are those who believe that health workers should do their utmost to find the spouses of patients living with HIV, as was once the case with syphilis, and there should be compulsory notification. Others say doctor-patient confidentiality should be preserved at all costs.

António Coelho, executive secretary of the Network of AIDS Service Organisations (known by the Portuguese acronym Anaso), feels there should not be mandatory notification of spouses, but rather awareness-raising to enable HIV-positive patients to tell their partners.

He stressed that by law "infected persons have the duty to inform those people with whom they have or intend to have sexual relations about their serological status."

But Catarina Saldanha, executive secretary of Mwenho, an association of HIV-positive women, believes that doctors should inform their patients' spouses.

Saldanha, who is HIV positive, told IRIN/PlusNews this was to protect the partners of people living with HIV, because the network of sexual relations is often not restricted to spouses, but extends to previous partners and extra-spousal relations.

She said some doctors in Angola were already doing this: they told patients that they could continue treatment only if their spouse or partner also came to the next appointment.

The country's network of people living with HIV/AIDS is calling for a compromise. "First, the doctor should exhaust every possibility of changing the infected person's behaviour. If this doesn't work, the doctor should make his position clear regarding intentional infection - that it is a crime punishable by law," said Noé Mateus, the network's executive secretary.

"But confidentiality can and should be discarded as soon as the physician realises that the infected person's behaviour places his or her spouse or others at risk of becoming infected."

The mysterious cassette tape

UNAIDS official Roberto Campos said confidentiality should be maintained in all instances, without exception. "People have to have the sovereignty to reveal their serological status to whomever they wish. They and they alone have this right, under any and all circumstances."

Campos stressed that because of the extremely high levels of stigma still associated with HIV/AIDS, doctors could place patients at risk of being publicly condemned by revealing their seropositivity. "Health professionals must be competent enough to give patients all the information they need to make the decision," he added.

António Feijó, the director of Hospital Esperança ("Hope" in Portuguese), a healthcare facility for HIV patients in the capital, Luanda, said doctors should encourage their patients to tell. "Notifying a patient's spouse about his or her serological status cannot be decided in an arbitrary manner ... It's immoral to treat one of them and leave the other's life at risk."

When she was 17, Suzana* married her first boyfriend. After 25 years of marriage her husband died in her arms, but she only learned that he had died of an AIDS-related illness when, during the funeral, she heard a cassette tape on which he confessed to being HIV-positive.

Her husband had given the cassette to a nephew, who thought it contained his wishes regarding his estate and it would therefore be appropriate to play the tape at the funeral.

With clearer rules covering confidentiality and HIV, the final message left by Suzana's husband could have been a message of love, or even about his estate, rather than a painful confession of his positive status.

* Not their real names

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Some 20 Million Condoms Recalled In South Africa

South Africa's health department said Tuesday it has recalled 20 million potentially defective condoms approved by an official accused of taking bribes from a manufacturer.

Unsafe sex is especially risky in South Africa, which has one of the world's highest HIV infection rates with an estimated 12 percent of its 47 million people infected with the virus.

There are up to 1,000 AIDS-related deaths in South Africa every day and free condom distribution is a crucial part of the government's efforts to combat the spread of the epidemic.

"An official of the South African Bureau of Standards (SABS), has put millions of people at risk by illegally passing millions of condoms, which had not met the quality assurance requirements," said health department spokesman Sibani Mngadi.

Mngadi said even though only a batch of 7 million condoms was affected, the department decided to recall all 20 million condoms supplied by the manufacturer since last year, and will no longer be dealing with that company.

The SABS official accused of taking bribes and two directors of the manufacturing company have been arrested and are out on bail, said the spokesman. They will be appearing in a Pretoria court on September 10 to face charges of corruption and fraud.

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LEGAL ACTION

The condoms did not meet several standard tests for strength, pressure and lubrication, said Mngadi.

The SABS Web site alerted the public, saying the faulty condoms were distributed by brand names including Ultramour, Randy Rat and Positions.

SABS said it had instructed Latex Surgical Products (LSP) to recall the condoms and that it would take legal action against the manufacturer.

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The Health Department is also recalling condoms produced by LSP from its national HIV/AIDS supply chain.

LSP was not immediately available to comment.

Besides a struggling health-care system characterized by a lack of doctors and nurses, many of whom have left the country for better pay abroad, the fight against AIDS has been hampered by conflicting messages from senior government officials.

Researchers, scientists and health-care workers said in a conference in South Africa in June that they were encouraged by the government's fresh approach to the crisis and improved weapons to protect those most at risk of infection.

But fresh controversy over the government's AIDS policies has erupted.

President Thabo Mbeki sacked Deputy Health Minister Nozizwe Madlala-Routledge this month for insubordination, sparking an outcry from AIDS activists who strongly backed her policies and critics who say she was fired for political reasons.

Madlala-Routledge had clashed with Health Minister Manto Tshabalala-Msimang, dubbed "Dr Beetroot," who had horrified

AIDS activists with her advocacy of garlic, lemon and African potatoes over conventional anti-retroviral drugs.

The health department said it does not know how many of the defective condoms have been used, and it is urging the public to return them.

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The Bitter Side Of Blood Transfusion

For weeks now, Kanat Alseidov has been sitting only a few feet from the doctor who is on trial for prescribing a blood transfusion for his 2-year-old son, who had pneumonia.

Two months after receiving the transfusion, Alseidov's son, a ruddy, playful boy named Baurzhan who plays constantly with his twin sister, tested positive for HIV, the virus that causes AIDS.

"I couldn't understand why the doctor said my son needed a blood transfusion or he would get worse," Alseidov said.

Baurzhan's exposure to HIV was only the beginning of an epidemic that has engulfed Shymkent, an industrial, car-choked city along the Uzbekistan border. Since last summer, 93 children who were treated at a children's hospital in Shymkent have tested positive for HIV.

And as the trial has progressed, a possible reason why the doctor prescribed a blood transfusion to treat pneumonia has become increasingly clear: The parents of HIV-infected children in Shymkent allege that doctors charged each patient $20 for 415 cubic centimeters, or 14 ounces, of blood, splitting the proceeds with the local blood bank. A profit of as much as $10 on every transfusion may not sound like much, but it is a considerable amount in a country where doctors' salaries begin at $175 a month.

Many doctors and patients in Russia and Eastern Europe, Central Asia and parts of China and India believe that infusions of fresh blood can fortify a healthy body and remedy diseases that are not blood related, Western doctors with extensive experience in the region say. While pervasive corruption encourages many unnecessary transfusions, patients also frequently demand transfusions, which they associate with modern health care.

As a result, Western health experts say, local doctors prescribe tens of millions of unnecessary transfusions throughout the developing world, putting people at heightened risk of contracting AIDS or other diseases transmitted in the blood.

"It's dumb medicine," Max Essex, chairman of the Harvard AIDS initiative and professor at the Harvard School of Public Health in Boston, said in a telephone interview. He said that a measure taken in the United States in the late 1980s, "even after HIV blood tests were available was to drastically cut down the number of blood transfusions given."

"In that region of Asia," he said, "there has been a tremendous expansion of the HIV epidemic. Even if they were doing the state of the art testing there is big danger in overusing blood transfusions."

All of these factors seem to have converged on the children of Shymkent. One 8-month-old boy received 25 unnecessary blood transfusions, according to court documents. The boy's transfusion regime was halted only last summer when he was diagnosed with HIV.

The situation in Shymkent raises echoes of another noteworthy legal case involving the spread of HIV through tainted blood: Five Bulgarian nurses and a Palestinian doctor have twice been sentenced to death in Libya after being judged guilty of infecting more than 400 children. The case has dragged on for nearly eight years.

Speaking about the transfusions in Shymkent, Michael Favorov, an epidemiologist and Central Asia program director for the Centers for Disease Control and Prevention, based in Atlanta, said simply: "It's insane."

Favorov headed an extensive medical investigation by the agency, which identified transfusions of tainted blood as the source of the Shymkent outbreak. "This kid needed no blood," he said, referring to Baurzhan Alseidov.

Kanat Alseidov, the father, said that doctors had told him that no family member could provide the blood, so he went to a private blood bank. He said he had been told at the blood bank that the doctor would receive half the $20 price for the blood.

"Our hospitals are like a factory line," Alseidov said. "The doctors sometimes take not even $10 but they make their money from volume."

Doctors say that their low wages force them to search for ways to generate additional revenue. "Salaries are very low and even increases don't make a difference because of inflation," said Amangeldy Shopaer, deputy chief physician at the Shymkent Infectious Diseases Hospital, where the infected children have received treatment.

Families of the infected say government neglect has compounded their predicament. They say health officials have refused to regulate blood banks or police doctors who routinely prescribed blood transfusions to make a profit. "It's not popular to blame the government but the evidence is clear," said Alseidov, the father of the child who originally had pneumonia. "Veins are not garbage bins."

Families of HIV-infected children are often forced to move to seek anonymity after being ostracized by friends and neighbors. More than half the fathers of HIV-positive children have left their families, according to members of the families attending the trial.

Despite the detailed study by the U.S. agency, Shopaer maintained that the cause for the outbreak remained "not concretely known" and defended the practice of ordering blood transfusions for illnesses unrelated to the blood, including pneumonia. "In some cases it is required. It depends on what kind of pneumonia."

Frequent blood transfusions put people in developing countries especially at risk because of galloping rates of HIV infection.

The biggest HIV epidemic in the region is in neighboring Uzbekistan, which straddles major drug-trafficking routes and where the number of reported HIV cases has more than doubled since 2001 to 31,000, according to the World Health Organization. Kazakhstan may have three times its officially stated number of 7,000 HIV cases, according to the most recent statistics compiled by Unicef.

The Kazakhstan government has responded to the outbreak by firing the health minister and breaking ground on a planned pediatric AIDS facility in downtown Shymkent.

Small outbreaks continue to haunt the developing world, however, especially the former Soviet Union, where corruption in the medical system is rampant and belief in the remedial powers of new blood runs deep. Russia alone has reported more than 200 outbreaks of HIV associated with unnecessary blood transfusions.

"We have been screaming and yelling since 2002, but there is limited funding to address the problems," Favorov said, adding: "Unfortunately before you see the thunderstorm" nobody wants to open an umbrella.

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