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BURDEN OF ANXIETY: Story of HIV patients’ fear of COVID-19

Many Human Immunodeficiency Virus (HIV) positive patients appear to be avoiding hospitals for fear of contracting the deadly coronavirus (COVID-19) disease. However, these fears and anxieties have been dispelled by health workers, who, according to this report by ISIOMA MADIKE, have said that COVID-19 poses no greater risks for those of them that are properly medicated

Many Human Immunodeficiency Virus (HIV) positive patients may have come from damaged social-economic environments, making them very vulnerable to additional disease burden. This may be the reason why the advent of coronavirus (COVID- 19 has somewhat instigated fear in them; fear of the unknown.

While the biggest thing they’re fearful of is the isolation, they often feel depressed and anxious of what their future might be. Though medical experts have said COVID-19 poses no greater risks for HIV/AIDS patients who are properly medicated, the social anxiety and probable stigmatization, no doubt, is exacerbating existing issues for them.

Today, many of them are evading the hospitals for fear of contracting this new deadly disease. While those living with HIV express this fear as they believe to be among the high risk groups because of their often compromised immunity, for other people, the ‘fear of the unknown’ stops them also from going to test their HIV status at the hospitals. Grace, who lives in the neighbourhood of Ikotun, Lagos State, is one of those who nurse this fear.

She has been living with HIV since 2011, when she walked into a clinic and her HIV status was disclosed to her. Although Grace has been living healthy ever since her status was revealed to her, the recent fear, according to her, is induced by the advent of COVID-19 disease.

The Anti-Retroviral (ART) drugs, which she religiously takes, had suppressed the virus and boosted her immune system, and had helped her to live positively since 2011. But the fear of severe complications from COVID-19, if contracted, has been palpable. She said: “For now, I’m fine, but each time we go for our drugs, our caregivers keep reminding us to be extremely careful not to contract coronavirus because of our compromised immunity.

They remind us every time that we are among the high risk groups. Again, no one knows what will likely happen in the near future because the drugs we take come from abroad, mainly from India.

We just hope we’ll continue to get supplies of those drugs. Without the drugs, we are all dead, whether COVID-19 or not.” Like Grace, Josephina (surname withheld), has been in a similar dilemma ever since the outbreak of Coronavirus disease. She has been living in fear, not knowing what would happen next, should India and other nations stop supplying Nigeria with the much needed ART drugs.

“Look at what is happening already with the procurement of the COVID-19 vaccines; Nigeria cannot even get its foot on the ground, talk less of the ART drugs that are meant primarily for the poor.

“India is also battling seriously with this coronavirus disease; we just hope they won’t concentrate more with finding solutions to the current pandemic at the expense of those of us with this double wahala of HIV.

As it is now, we can only hope on God for His mercies, and for our existence,” Josephina lamented. Veronica, another HIV patient, however, had an opportunity to speak to someone she described as an “amazing” senior health worker, who helped calmed her down.

She, like others afflicted with HIV, had been worried since coronavirus crawled into the country in February 2020. But, last week, she felt somehow relieved after seeing a medical consultant over her worries and smiled for the first time in months. On the day of her appointment, her blood, she said, was erratic as to be expected, as she waited for the informed explanation on her fears, fingers crossed, and she was anxious. What I had expected, she added, was the anxiety and panic attacks; the nightmares I had and the lack of concentration.

“But the doctor gave another perspective and that became the tonic I needed to calm my nerves. “He said failure to take antiretroviral drugs can only weaken the immune systems of people with HIV. When the immune system is that weak, according to him, every disease that comes to the body is going to infect the body. So, you have frequent diarrheas, weight loss, diseases like cryptococcal meningitis and tuberculosis.”

“These, he said, are very common opportunistic infections. He said when properly treated, HIV-positive patients are at no greater risk of contracting COVID- 19, but that most patients are suffering from isolation and further stigmatisation during this time,” Veronica recounted. Regarding HIV, the doctor, according to Veronica, said, “It’s extremely important that patients take their medicine so they stay virally-suppressed and keep their immune systems healthy.

“As long as they’re virally-suppressed, as long as their immune systems are healthy, their risks are no greater than somebody that is HIVnegative. I try to educate them, because there’s a lot of fear in the community that because of HIV they’re going to be at extremely higher risk of getting the COVID-19.”

She added: “After this, it took awhile for me to calm down about it and I’m not usually an anxious person. These were totally new experiences to me and I was finding it tough. Combined with fatigue and continued stomach bugs I experienced, I felt like I was falling apart.

“I’m not saying all these to cause worry; I’m saying all these because if I’d known to expect of this, it wouldn’t have been so hard. Jumping hurdles is easier if you can see them. It’s been a week now and for the first time I’m actually feeling okay, relaxed. “Obviously, I still worry about things, particularly the future.

I never felt so mortal before and my long-term health still concerns me, but I feel okay, at least for now.” For 31-year-old Nkechi, who for seven years has been living with HIV, it ited hospital. First, the fear today is palpable, she said.

“Stores have sold out of obvious items like hand sanitizer and less obvious items like toilet paper. People are afraid of the virus, and a lack of communication from government officials exacerbates the anxiety.

“We usually have monthly meetings where we sit together, share ideas, and encourage one another; people share their success stories. Each story is very different. Some tell a tale of people struggling with the debilitating effects of HIV and the fear of an early death.

“Other stories are much more positive. Thanks to a breakthrough in the delivery of antiretroviral medicines, individuals are not only beating HIV, they now have renewed hope for the future, for themselves and for their families.

“But, due to the fact that people are now afraid of Coronavirus, we have not been meeting. Before now, when we also go for drug pick up, the health workers often have counselling sessions with us.

“But all these have changed and this has further created fear in the minds of those of us living with HIV; many of us even avoid hospitals for fear of being infected with the new disease that could bring about additional burden for us,” Nkechi added. Kayode’s story is different.

As someone who has experienced COVID- 19 firsthand, Kayode understands well how it feels to be infected with the coronavirus when you already have HIV. That is why he advises his peers to follow personal hygiene and observe social distancing to stay away from danger. But even if they do get infected with it, it does not necessarily mean that they will get severely ill. He said: “If you are living with HIV, you probably have enough willpower to cope with the feeling of anxiety that may come with COVID-19.

“Stay positive and hold on to any thought that can motivate you. A lot of people, including HIV sufferers,are getting this virus and doing okay. Keep taking your anti-retroviral therapy pills, drink a lot of liquid and eat well.” He was not in the age group that is at risk of having severe COVID-19.

But, unfortunately, he did become very sick and eventually needed hospital treatment. Lying in bed in an intensive care ward, she even remembered asking himself “I’m I going to die?” As anxiety and uncertainty enveloped him for the first time, his parents had to disclose his HIV status to him. Kayode recalled this is exactly the same question he asked two years ago when his parents chose to keep his HIV-positive status secret.

They chose not to disclose his HIVstatus to him until he turned 18 as they did not know how well he would be able to cope with the diagnosis as a young child. When they finally decided to have a conversation about it, he was already going through a spell of depression, having learnt about his condition at a clinic where he had been treated several months before that. “I knew nothing about HIV back then. At the clinic, I heard people say that it was a fatal disease.

I was very depressed but told no one about it. I waited for my mum and dad to explain it to me. I was angry with my parents for not telling me about my illness and stopped taking my pills,” he said.

It took a while for him to bounce back. One of the first steps towards recovery was his visit to the hospital for children and families affected by HIV in Lagos. There, Kayode learned what HIV really was, and met other HIV-positive teenagers. He started going to the centre regularly, attended training courses and made a lot of new friends.

“At the centre I met with a psychologist, who helped me a lot to understand my condition. He was the one who convinced me that it was not the end,” he recalled. Starting with his classmates, Kayode shared his new knowledge, skills and disclosed much to the pride of his peers. “I really wanted everyone to know the truth about this disease and to understand that people with HIV are just like them, not some bad people and that they should not be stigmatised. With time, Kayode grew passionate about raising awareness about HIV and helping others suffering from it.

Now he works alongside other volunteers to help HIV-positive adolescents and their parents to understand the virus better and learn how to live with it. The Director-General of the Nigerian Institute of Medical Research (NIMR), Professor Babatunde Lawal Salako, while reacting to fears in some quarters, especially for those who are living with HIV as per the sustainability of the anti-retroviral drugs, said his institute has been given patients three months’ supply.

He said: “I think there is enough supply for most patients within the country now, and hopefully we will continue to get supplies irrespective of the COVID-19 pandemic. I believe that all over the world, the HIV drugs will continue to be manufactured and distributed to countries where they are needed.” When reminded that most of the HIV drugs are coming from India.

The clinician, who is reputed to have been involved in a number of clinical trials on drug development, reassures that India will be willing to continue to supply HIV drugs to the country in spite of what’s happening now. “I imagine so, even though I’m not the one in charge, and I can’t speak for them.

“But I imagined that that should happen because they belong to a special group of people that must necessarily continue to take their drugs because that condition may make infection by COVID-19 worse, especially if they are not taking their drugs.

“So, I think the government and development partners will ensure that those drugs flow and supply continues. “I also think vitamin C 1000 could be helpful to this group of people. It’s such a common drug that it will be useful if taken appropriately as prescribed to boost immunity. But, the problem is that HIV is attacking immunity.

“So, it may not be as effective for those living with the virus as against those without the virus. This is because the virus is still in the system. What the HIV drugs do is to help reduce the viral load and bring up the CD4 count or simply put, boost the immunity so that the patient can function maximally. “For such people, vitamin C will take a slow pace. However, that does not mean that it can’t work on those with the virus only that it will take a longer time unlike those without it.

I believe that HIV positive people are at higher risk and so, I would sincerely advise those in that group bracket to observe strictly the stipulated guidelines from the Nigerian Centre for Disease Control (NCDC) and the world health bodies. “It pays them more to do that; to be preventive rather than allow COVID- 19 infection.

So, things like facemask, social distancing, and avoiding crowds are compulsory for them. This is because they have the tendency to succumb easily to the infection because of their compromised immunity.

“Aside that, hand washing for now should also be a routine for them, and of course the use of hand sanitizer. More importantly, they should try to avoid public transport as much as they can. If they do that, they will be fine. “However, if they notice any little changes in their health system, like sneezing often, coughing and fever, they should quickly get in touch with their doctors because that is very important.

If they neglect that, it could be catastrophic for them and of course, they should continue to take their antiretroviral drugs and stay safe.” Another Professor of Veterinary Medicine and Clinical Virology at the Michael Okpara University of Agriculture, Umudike, Abia State, Maduike Ezeibe, has also advised people living with HIV, to, as a matter of compulsion, keep to the protocols to avoid being infected while taking any medicine that works against all viruses or against RNA.

He said both HIV and COVID-19 are RNA viruses (positively charged). “That is what makes the MSAMS unique. Its mechanism is inhibition of electrical charges and every virus has either positive changes or negative charges.

Both COVID-19 and HIV/ AIDS are caused by viruses and every virus has either positive electrical charges or the negative charges. “Aluminum-Magnesium silicate (AMS), a WHO approved medicine is made of Nanoparticles that have both positive ends and negative ends. All this information is in literature for anybody to confirm.

“The medicinal synthetic AMS (MSAMS) is a formulation of Aluminum silicate and Magnesium silicate (also WHO-approved medicines). So, it is a medicine for both diseases and what the world needs is an effective medicine, not vaccines. “The problem is that the big countries want every good thing to come from them. They use some of us to suppress inventions that are not theirs. “To answer your question, all patients of HIV/AIDS or of COVID-19 should be treated with the MSAMS.

The National Assembly should investigate all that is going on between the Federal Ministry of Health, the PTF on COVID-19 and May & Barker. “If Nigeria frees herself from being manipulated by foreign interestgroups and gives the MSAMS due certification, COVID-19 pandemic could become a blessing to the country and to the whole of Africa.” Dr. Doyin Odubanjo, a public Health Physician, agrees that there is hope for HIV patients, especially if they keep up with their drugs.

“The challenge with HIV is that it attacks the immunity of the person infected, and that immunity is needed to fight off other diseases including COVID-19. But the anti-retroviral drugs taken by HIV patients help to ensure they are not overwhelmed by the virus. “So, they just need to make sure they keep to their therapy, and take all precautions as for COVID-19 too,” Odubanjo recommended.

The Lagos State Commissioner for Health, Prof. Akin Abayomi, had warned that coronavirus causes upper respiratory infection with flu-like symptoms such as stuffy nose, cough and sore throat.

“The virus could be transmitted through coughing and sneezing and the touching of contaminated handles or surfaces,” he had said. However, COVID-19 affects different people in different ways. Most infected people will, according to experts, develop mild to moderate illness and recover without hospitalisation.

The most common symptoms they say are: fever, dry cough and tiredness, while less common symptoms include aches and pains, sore throat, diarrhea, conjunctivitis, headache, loss of taste or smell, and a rash on skin, or discolouration of fingers or toes. Coronavirus disease began in China with a group of severe pneumonia cases, later identified to be caused by the severe acute respiratory syndrome coronavirus 2 in December 2019.

Thailand reported the first COVID-19 case outside of China on January 13, 2020, while Africa reported its first case in Egypt on February 14, 2020. Nigeria, however, reported its index case of COVID-19 on February 27, 2020. Today, virtually, all countries in the world are affected, with over five million cases reported globally.

The disease is associated with typical and atypical signs and symptoms, mimicking other common illnesses, especially malaria fever. The country is now said to be in the phase of widespread community transmission as almost all the states have reported confirmed cases.

The pandemic has shown a wide range of case-fatality rate (CFR) globally; this is assumed to be related to the demographics, existing health systems and probably other unidentified factors.

There has been a steady increase in the burden caused by the disease in Nigeria with a relatively stable CFR, which is said to be lower than the global CFR. Health systems have responded with the guidelines for prevention, management, and surveillance of the disease, while effort is being put in place to find a vaccine and a specific therapy for the cure of the disease. The pandemic has had a severe effect on health systems globally, including an unintended disruption in the service delivery of other diseases.

It is said to have the potential to disrupt the weak health system in Nigeria significantly. As such, a combination of nonpharmaceutical preventive measures that are cost-effective has been advocated in some quarters to be scaled up to prevent it from further debilitating the existing weak health system.

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