Questions on HIV Sero-Discordant Couples

I was fortunate to be invited as speaker for the SHIP online course for HIV treatment hub staff in Mindanao and NCR, to enlighten them about prevention of mother to child transmission of HIV infection.  However, the COVID-19 prevented me from giving my lecture live so here is my contribution to the cases discussed, as these are scenarios we encounter often.

For serodiscordant couples, they can still enjoy sexual relationships without HIV transmission thru:

1. Correct and consistent condom use reduces the risk of HIV transmission, but the risk is not zero.

2. ARV adherence reduces the HIV viral load down to undetectable. If undetectable = untransmissible. This means the risk of transmitting HIV to the HIV negative partner is very very low, but still the risk is not zero.

3. The HIV negative partner can take PrEP or pre-exposure prophylaxis. He/she takes ARV to reduce the risk of HIV transmission.

In reality, the only expression of love that is 100% free of risk of HIV transmission is abstinence.

Still, with our ARVs effective in reducing the HIV viral load, it is possible for serodiscordant couples to have unprotected penetrative sexual intercourse without transmitting the infection to their partners.

If the couple wishes to get pregnant, it would be best to learn about the woman's fertile period using the symptothermal method (calendar method, basal body temperature and cervical mucus method combined).  The couple should have unprotected penetrative sexual intercourse every other day during the woman's fertile period. This reduces the exposure of the HIV negative partner to risk of HIV transmission and allows for greater chances of getting pregnant.

If the pregnant patient is PLHIV, no need to do HIV testing.  We just request for baseline prenatal labs and screen for opportunistic infections.  We request also for CD4 count and viral load.  We usually deliver by cesarean section as this has been proven by research to significantly reduce risk of HIV transmission to the newborn. Any hospital capable of delivering a pregnant patient via cesarean section is equipped to deliver PLHIVs so long as standard precaution is observed to protect the healthcare worker.  If we go back to the modes of transmission, then there is very little chance of the healthcare worker getting HIV via occupational transmission.

The PLHIV mother needs to weigh the benefits and risks of exclusive breastfeeding versus exclusive replacement feeding, but we do not recommend mixed feeding for the HIV-exposed newborn.

If the viral load near term is <1,000 then the patient may opt to deliver vaginally and even breastfeed with very low risk of HIV transmission to the newborn.  The risk, however, is not zero.

For the HIV-negative pregnant partner of a PLHIV, HIV testing may be done as early as the first prenatal visit.  HIV testing may be done every trimester if there is a continuing risk for HIV transmission.  Otherwise, routine prenatal care should be provided for the pregnant patient and indications for cesarean delivery will follow the usual clinical practice guidelines.

As HIV treatment staff, we can help prenant PLHIVs by referring them as early as possible to OBGYNs for prenatal care so that complications can be identified early, ARVs can be initiated as early as 14 weeks and continued for life, those already on ARV can be assured that it is safe to continue taking their ARVs, to connect these PLHIV mothers to appropriate suport groups, as well as to celebrate their pregnancies not as problems to address but as gifts from God.

Life goes on with HIV, basta naka ARV!

Panic and Anxiety brought about by 2019 Novel Corona virus

With the deluge of shared text messages and forwarded videos and infographics, fake news has the propensity to pop up on my cellphone and social media newsfeed.  People walking in the streets are all wearing face masks.  Everyone seems in a panic to procure their own face mask, because all suppliers are out of stock.  This 2019 novel corona virus has caused panic and anxiety and it's all we talk about especially when one confirmed case quarantined in Manila allegedly travelled to Cebu and Dumaguete before she was confined in Manila.  What really do we know about this virus?

My professional advice:  wait and watch out for the official advisories from the DOH, the top authority in the country for health.

How can we regulate sharing of fake news that cause public to panic? Always recommend to get news and evidence-based information from credible sources. 

When DUTY calls

This week I responded to a call of duty, to take over as officer in charge of two high ranking officials who had to go on leave for medical reasons.  This was the pile of paperwork I had to sift through everyday.  Not complaining about my arthritis and my long signature, I did what I was expected to do.  Considering the fact that I could not step down as training officer, I began to delegate my work and tried not to care so much whether they were done how I wanted things to be done, or whether they were done at all.  I had to let go.  Sometimes, done is better than perfect.

On top of work that was given to me, I also did work that I assigned to myself.  PAKIKIALAM is insinuating yourself where you may or may not have any business getting involved in.  It may a good thing or a bad thing.  It's good because you care enough to get involved with someone else.  However, it may be bad, especially when your achievements make other people look bad.

Meetings were held and policies and guidelines were laid out.  Next on the things to do would be implementation of all that planning.

It hurts me though when people misunderstand the things you do, to the point of taking measures against you.  It hurts most deeply when it involves people you love.

We were asked to describe how this photo reflects our teaching.  For me, the waters may be unpredictable: sometimes tranquil but often turbulent and chaotic.  Both learner and teacher ride the banca together to enter the mouth of the cave where we both will discover and learn together all the unknowns.  Where there is darkness, we will bring our light so that all who see it will be illuminated by its guiding light.