Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
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New Vision (Kampala) - December 12, 2006
Sarah
Dear Sarah,
I commend you for your concern about preventing further spread of HIV infection among young girls. It is true young girls are more vulnerable to HIV infection than their male counter parts mainly because of risky sexual behaviour and tendencies. They engage in intergenerational sex (sex with partners much older than themselves), transactional sex (sex in exchange for some favour or gift), commercial sex (sex as a means of earning an income) and some are forced into difficult situations ending up in sex for survival. In many cases, the girls engage in sex without HIV-testing or knowledge of a partner's HIV status, and with inconsistent condom use.
Coupled with the culture of submission to men, inculcated in a girl's early life and little or no communication about sex, then the result is more girls getting infected with HIV. Unless the factors that increase the vulnerability of young girls to HIV infection are well understood, as well as the need for behaviour change, then high infection rates among young girls will continue to be a problem.
Other factors that have predisposed young girls to the risk of HIV infection are early marriages, rape and other forms of sexual abuse to which young girls are often subjected. While it is important for girls to develop life skills and learn to be assertive, it is also the responsibility of every adult to do everything possible to protect the girl-child from any form of abuse that would, in any way, put her at risk of HIV infection. We should push for universal and compulsory primary and post primary education for all children but especially the girls.
The longer these children are kept at school, the less vulnerable they will be. This is because they are kept busy at school, often delaying their first sexual encounter. They can also learn negotiation skills as they mature.
Can ARVs affect someone's manhood?
Dear doctor, My husband has been on ARVs for about three years now and has generally improved, with no serious illnesses. This was after he was put on second line drugs (Combivir and Kaletra) because he failed to improve on Triomune. We are concerned because he has started developing breasts like a young girl! He is apprehensive and fears he might become impotent. Do ARVs affect someone's manhood? Please assist us because now he fears taking the drugs.
Amina
Dear Amina,
Thank you for this important question on the side effects of some ARVs. As I have mentioned before in this column, all drugs, ARVs inclusive have side effects. It is important therefore, that before anyone starts taking ARVs, he or she must undergo comprehensive Antiretroviral therapy (ART) counseling, during which, all possible side effects are discussed. The patient is therefore, not shocked or stops taking the drugs unnecessarily due to certain side effects.
Your husband being on second line drugs makes this more important because, if he fails on this regimen due to poor adherence, he has nothing else to fall back to. The condition you describe where men develop breasts is called gynaecomastia and the drug Kaletra sometimes causes it. Kaletra also causes diabetes and wasting of fat on the face and the body extremities. People sometimes develop fat pads on trunk and neck - the so-called "Buffalo hump".
These alterations in body fat redistribution can be highly distressing to people living with HIV/AIDS as they experience marked changes in their appearance. The changes may threaten the anonymity of HIV-positive persons and may contribute to poor adherence or discontinuation of ART, despite having their viral load adequately suppressed.
It is important that your husband gets a medical check-up including one for diabetes and fat levels in his blood. Your doctor should be able to advise you on where you can have these tests done.
Lastly, your husband will not become feminine or impotent, he seems to fear. ARVs have not yet been known to cause this. He should continue taking ARVs. He should also continue getting counseling and support because the breast enlargement is self-limiting but certainly not life ûthreatening.
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Send your question on HIV to Health Editor, The New Vision. P. O. Box 9815, Kampala or health&beauty@newvision.co.ug
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