| Pill to prevent HIV infection still underused

From gritty neighbourhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularise a pill that has proven highly effective in preventing HIV but which – in their view – remains woefully underused.

Marketed in the United States as Truvada, and sometimes available abroad in generic versions, the pill has been shown to reduce the risk of getting HIV from sex by more than 90% if taken daily. Yet worldwide, only about a dozen countries have aggressive, government-backed programmes to promote the pill.

In the US, there are problems related to Truvada’s high cost, lingering scepticism among some doctors and low usage rates among black gays and bisexuals who have the highest rates of HIV infection.

Pill should be essential

“Truvada works,” said James Krellenstein, a New York-based activist. “We have to start thinking of it not as a luxury but as an essential public health component of this nation’s response to HIV.”

A few large US cities are promoting Truvada, often with sexually charged ads. In New York, “Bare It All” was among the slogans urging gay men to consult their doctors. The Los Angeles LGBT Center – using what it called “raw, real language” – launched a campaign to increase use among young Latino and black gay men and transgender women.

“We’ve got the tools to not only end the fear of HIV, but to end it as an epidemic,” said the centre’s chief of staff, Darrel Cummings. “Those at risk have to know about the tools, though, and they need honest information about them.”

More people using Truvada

In New York, roughly 30% of gay and bisexual men are using Truvada now, up dramatically from a few years ago, according to Dr Demetre Daskalakis, a deputy commissioner of the city’s health department.

However, Daskalakis said use among young black and Hispanic men – who account for a majority of new HIV diagnoses – lags behind. To address that, the city is making Truvada readily available in some clinics in or near heavily black and Hispanic neighbourhoods.

“We like to go to the root of the problem,” said Daskalakis, who personally posed for the “Bare It All” campaign.

According to the US Centers for Disease Control and Prevention, Truvada would be appropriate for about 1.2 million people in the US – including sex workers and roughly 25% of gay men. Gilead Scientific, Truvada’s California-based manufacturer, says there are only about 145 000 active prescriptions for HIV prevention use.

Under federal guidelines, prime candidates for preventive use of Truvada include some gay and bisexual men with multiple sexual partners, and anyone who does not have HIV but has an ongoing sexual relationship with someone who has the virus.

Efforts to promote Truvada

Abroad, a few government health agencies – including those in France, Norway, Belgium, Kenya, South Africa, Brazil and some Canadian provinces – have launched major efforts to promote preventive use of Truvada or generic alternatives, providing it for free or a nominal charge. In Britain, health officials in Scotland and England recently took steps to provide the medication directly through government-funded programmes, though in England it’s in the form of a trial limited to 10 000 people.

Truvada was launched in 2004, initially used in combination with other drugs as the basic treatment for people who have HIV, the virus that causes Aids. It is primarily spread through sex.

Cost a concern

Controversy arose in 2012 when the US Food and Drug Administration approved Truvada to reduce the risk of getting HIV in the first place, for what’s called pre-exposure prophylaxis, or PrEP. It blocks the virus from making copies and taking hold. Critics warned that many gay men wouldn’t heed Truvada’s once-a-day schedule and complained of its high cost – roughly $1 500 (±R18 600) a month.

Gilead offers a payment assistance plan to people without insurance that covers the full cost. Some cities and a few states – including Illinois, Massachusetts and Washington – also help cover costs. Activists have pressed Gilead to make its copay programme more generous in light of its profits from Truvada.

“There’s no reason it has to cost so much,” said Krellenstein.

Gilead spokesman Ryan McKeel, in an email, said the company is reviewing the copay programme.

“Like those in the advocacy community, we are committed to expanding access to Truvada for PrEP to as many people as possible,” he wrote.

In June, the FDA approved a generic version of Truvada, which is likely to push the price down, but it won’t be available in the US for a few years.

To use or not to use?

The Truvada debate has taken many twists, as exemplified by the varying stances of the Los Angeles-based AIDS Healthcare Foundation – a leading HIV/Aids service provider. In 2012, the group unsuccessfully petitioned the FDA to delay or deny approval of Truvada for preventive use. The foundation’s president, Michael Weinstein, belittled Truvada as “a party drug” and warned it would increase the spread of sexually transmitted infections by encouraging men to engage in sex without condoms.

But last year, the foundation, while still sceptical about some Truvada-related policies, urged Gilead to cut its price to make it more available.

“We have no dispute about its ability to prevent HIV transmission,” said spokesman Ged Kenslea. He noted that the organisation’s 40 pharmacies across the US handle many Truvada prescriptions.

And in South Africa?

In 2016, Health-e News reported that the National Health Department was expected to announce that sex workers in South Africa would be eligible to use Truvada as a preventative measure. This announcement was expected to make South Africa one of the first countries in the world to bring the latest HIV prevention science to those who need it most.

In 2017 it was reported that Truvada was now available for university students and served as a trial to show the National Health Department whether there is a high demand for this pill.

Image credit: iStock | How to get a grip on that first-day-of-school anxiety

Children around South Africa are set to start another academic year – the beginning of a new chapter in their lives.

It is also a major milestone for those parents who will be sending their children to “big school” for the first time.

A major event like this may stir up feelings of fear, uncertainty and angst in parents and children.

Cape Town educational psychologist, Dr Yusuf Lalkhen, says that anxiety is your body’s way of communicating that a situation is making you feel unsafe or stressed.

An old feeling?

Many children who are starting grade one are already familiar with being away from parents, grandparents or guardians. 

Lalkhen says that many children are placed at daycare centres or creches when they’re three or four years old, and then pre-school when they’re five or six.

What helps with first-day jitters is if the child is attending the same school as an older sibling.

Despite these factors, there is still some anxiety for children and parents on the first day of grade one.

A new feeling?

Lalkhen says: “For children, it is about entering a larger world than they’re used to and making new friends. On the part of the parents it is the realisation that their children will be entering the world of ‘formal education’, filled with expectations, obligations and responsibilities.

“They worry about whether their child will connect with their teacher or get along with their classmates or perform according to the school’s expectations.”

Parents should be careful about being over-protective and projecting their feelings of fear and angst onto their children.

“Children look to parents for information on how to interpret and respond to new and sometimes ambiguous situations. Therefore, if a parent appears consistently anxious and fearful about a situation, children may interpret that situation or environment as unsafe.

“Parents who are anxious may transmit that anxiety to their children, but this is not necessarily inevitable. Most anxious parents learn to manage their anxiety and to present a calm and confident demeanor to their children,” says Lalkhen.

Varying degrees of anxiety

Lalkhen adds that there are varying degrees of anxiety that can range from mild, moderate, severe to a state of panic.

“Mild anxiety is fairly common and occasionally, it can help you focus and orientate yourself. Once you’ve done so, the anxiety dissipates.

“Moderate anxiety, in a parent, for example, may be centred around the child’s teacher – is she kind, warm and a good match for my child? Meeting the teacher could alleviate the anxiety.

“Severe anxiety is experienced when you perceive a situation to be such that your ability to focus and resolve the problem is severely impaired.

“The most disruptive and challenging form of anxiety is at panic level, where it overwhelms a person’s capacity to function adequately. One should be concerned should you experience the last two levels of anxiety,” said Lalkhen.

Assistant Professor in Paediatrics at Harvard, Dr Claire McCarthy, published a few tips to help parents and children make the transition a little smoother.

Keep talking

McCarthy says that parents and children should have been talking about school for a while. Talking about how children will get ready in the morning, how they will get to school and how they will learn new things at school and meet new friends while they’re at school.

Parents should also let their children know who will be there to collect them, once their school day is done, and what the remainder of the day will look like.

Include them in the planning

When planning for school, include your child. When shopping for their school uniform, besides the fact that they need to try it on for size, make them feel good about how they look in their uniform and teach them about taking care of their uniforms.

The same goes for stationery shopping and finding all the books they’ll need, along with shopping for their lunch groceries and making healthy choices about what they’ll be eating during the day.

Create structure

Get your children into a routine – even though they may hate the thought of it and hate going through the same schedule day-in and day-out; they will thank you for it… eventually.

Lalkhen says that structure and routine creates an environment which is conducive to minimising anxiety.

“Structure and routine provides children with a sense of predictability, familiarity and security. If this is the nature of the home environment, it becomes easier for a child to make the transition to another environment where these features are present.

“Not only do these children respond well to structure and routine, but they often find ways to create that structure and routing to manage themselves better.”

Image credit: iStock

NEXT ON HEALTH24X | 7 terrifying diseases you could have without knowing it

Conditions such as fever or pain are clear signs that there is something wrong with your body. Whether serious or not, physical symptoms tell us when we’re sick, prompting us to seek rapid diagnosis and treatment. 

But what if you’re harbouring a disease without realising it? It is not as farfetched as it may sound. Here are seven illnesses you could be suffering from without showing any symptoms:

1. Heart disease

There are several diseases linked to the heart. Heart disease can be hereditary, but it’s also something that can develop over time because of factors like unhealthy habits and ageing. Heart disease can be fatal, but it’s unfortunately not always easy to spot. Symptoms can be atypical and not severe enough to signify a problem. By the time a person experiences serious symptoms, the heart could already be significantly damaged.

Be vigilant: Have regular cholesterol and blood-pressure checks to identify any possible risk factors that could cause heart disease. Have a clear understanding of your family’s medical history and mention to your doctor if heart disease runs in your family.

2. Colorectal cancer

Colorectal cancer (cancer of the colon) is difficult to detect with a colonoscopy. It can take several years for an abnormal polyp in the digestive system to develop into cancer. According to, the survival rate for colon cancer is 90%, but only about four out of 10 colorectal cancers are found in time. When cancer has spread, survival rates are much lower. Symptoms usually start to manifest when the cancer has already spread. By then it may be too late for effective treatment.

Be vigilant: A healthy diet, weight and exercise can significantly lower your risk for colon cancer. Do not hesitate to contact your doctor when you experience a random change in appetite, bowel movements or any type of digestive problems.

woman visiting her doctor

3. Glaucoma

Glaucoma is a disorder where pressure builds up behind the eye. This can eventually lead to partial or complete loss of sight in the eye. It’s important to detect glaucoma early to avoid loss of sight. It has no symptoms or very subtle symptoms. The progression is so gradual that you may not recognise the progressive patchy loss of your peripheral field of vision. The central part of the vision is not affected until very late. Damage almost always goes unnoticed until it is too late.

Be vigilant: You can only detect glaucoma through regular eye tests. You should have your eyes tested regularly for glaucoma especially if you have a family member with glaucoma, if you have bad vision, or if you have had an injury to your eyes.

4. Huntington’s disease

Huntington’s disease is a genetic disorder that causes the degeneration of nerve cells in the brain. This disease can be present without any symptoms, but by the time symptoms appear, it develops quite rapidly.  In some cases, symptoms can start before the age of twenty in the form of learning disabilities and psychological problems. Huntington’s disease can be hard to diagnose.

Be vigilant: Prenatal testing is possible if you have any family member suffering from the disease and you are worried about the status of your unknown baby. To make a diagnosis, a doctor will also take a full medical and family history and do a clinical examination, involving physical and neurological evaluation.

Those who are at risk but do not yet have symptoms may choose to be genetically tested. Because there is no cure, and because such tests cannot predict the onset or severity of the disease, this decision should be carefully considered. 

5. Hypertension

Hypertension is not a disease as such, but a condition that can lead to illnesses such as heart disease and stroke. People are often unaware that they have high blood pressure and symptoms can be minimal. There is a reason why hypertension is often called “the silent killer”. High blood pressure develops over time.

Be vigilant: Have your blood pressure checked regularly. You can improve high blood pressure by making changes to your lifestyle.

6. Deep vein thrombosis

Deep vein thrombosis (also called pulmonary embolism or DVT) occurs when a clot forms in the deep, larger, lower veins of the legs. This condition occurs when the blood pools in your legs or if your blood is prone to clotting. About half of the people who experience DVT have no symptoms until the clot forms and interrupts circulation, which can be fatal.

Be vigilant: Look out for persistent pain and swelling in one leg and be vigilant when you are going through long periods of inactivity, such as long-haul flights or bed rest after an operation.

7. Chlamydia

This sexually transmitted disease is one of the most common STDs and can present without symptoms for a while – in fact, 80% of women with chlamydia are unaware that they have it. If it’s so common and can go unnoticed, why is it serious? The answer is that untreated chlamydia can cause a host of health complications including infertility, reactive arthritis and pelvic inflammatory disease (PID).

Be vigilant: Don’t have unprotected sex and get tested for chlamydia regularly, as chlamydia can be asymptomatic, especially in women. 

Image credits: iStock

NEXT ON HEALTH24X | Want to look younger? Facial stretching can help

Do you try to improve your appearance with the help of products with miracle-ingredients?

There might however be another cheaper, more effective way to look your best – and scientists are investigating if facial “yoga” could be the new fountain of youth.

A new, small study suggests that it might be the case.

An exercise regime for the face

Investigators asked 27 middle-aged women (between 40 and 65) to embark on a 20-week facial exercise regimen. For the first half of the study, the women were asked to perform 32 specific facial exercises daily, for about a half hour in total. For the remainder of the study period, the exercise regimen was performed every other day.

Two dermatologists then compared photographs taken before the study began with photographs taken both halfway through, and again at the end.

The study results 

By the study’s end, participants appeared to have turned back the clock by an average of nearly three years.

“The scientists looking at appearance changes found that the upper and lower cheeks were full after the study,” explained study author Dr Murad Alam. He’s vice chair in the department of dermatology at the Northwestern University Feinberg School of Medicine in Chicago.

“Patients themselves found even greater benefits, and noticed that 18 of the 20 areas and features of the face that were studied got better over the course of the study,” Alam said.

“In general,” he added, “the appearance benefit was that the contour of the face became smoother, fuller and firmer.”

Facial stretching combats loss of elasticity 

The investigators noted that skin elasticity tends to loosen over time, and fat “pads” located between the muscle and skin thin out.

The exercise experiment set out to combat that.

Participants first underwent two 90-minute training sessions.

Each exercise was one minute in duration, and included such movement-to-hold positions as smiling without showing teeth; pursing the lips; and smiling while forcing the cheek muscles upwards.

Before the study, age appearance was pegged at 50.8 years old, on average. Midway through the programme that dropped to 49.6 years, finishing at 48.1 years by the end of the 20 weeks.

That said, not all the women stuck to the programme, with 11 dropping out before the study ended.

But a survey of those who stuck with it suggested a high rate of satisfaction with the regimen and results.

The findings were published in the journal JAMA Dermatology. Alam noted that none of the researchers had a financial interest in the facial yoga exercise programme.

As for whether men or perhaps younger women might achieve a similar benefit, Alam said, “We would expect to see an effect. But until we study it we won’t know if it is a little more or a little less.”

Not enough for eternal youth

Still, exercise alone may not be enough “to replace the tried-and-tested methods of improving facial appearance” that can be achieved with fillers, lasers and the like, Alam acknowledged. Instead, exercises might best serve to enhance such interventions, he said.

Meanwhile, Dr Steve Xu, who also teaches dermatology at Northwestern University but was not involved in the study, cautioned that the study was small and 11 of the 27 patients dropped out.

“That’s something to keep in mind,” he said.

Facial muscles do play a role

But Xu praised the study design while suggesting that facial exercise “makes a lot of intuitive sense”.

Why? “Facial aging is so much more than just seeing more wrinkles on the face,” said Xu. “It’s a complex process, and includes thinning of the upper layers of the skin, loss of collagen and elastin in the deeper layers of the skin, and loss of fat and muscle.

“Oftentimes,” Xu continued, “it’s the loss of the fat and muscle that really adds years to a person’s face. High cheekbones is a large component of an attractive face. When we age, this definition fades, leading the cheeks to lose their fullness pulling the face inward and downward. This then leads to the jaw becoming less defined as well.

“Strengthening facial muscles through exercise makes a lot of sense in helping reverse some of those changes, by allowing the muscles of the face to get bigger and provide more fullness to the overlying skin,” he said

Image credit: iStock