New Vision (Kampala) - October 21, 2007
Irene Nabusoba and Harriette Onyalla

Without doubt, everyday, someone gets infected and with the national HIV prevalence in Uganda at seven people, the risk is high. But because of lack of protective gear, health workers and policemen are at higher risk.

Quite often, these people have been infected with HIV while on duty - the reason HIV-positive mothers are reportedly being shunned during delivery and road carnage victims abandoned by the road to bleed to death.

During a 2002 study carried out at Mulago Hospital, Kampala, physicians reported that occupational exposure to HIV infection occurs at least four times every year.

For Sera Nabudere, she had just been injecting a patient when she tripped over the patients bag of that was lying on the floor. She fell and the needle sunk into her thumb.

Nabudere was trying to work fast so that she could attend to other patients who had been waiting on the bench for hours. Hope of helping crying children, adults coughing or shuffling restlessly and the long line, all faded as she saw herself die.

At 31, the mother of two had injected countless patients with expertise in her seven years of medical practice. "It was terrible. It was a general ward, but the thought of acquiring HIV was shattering.

It was like throwing away all my years of responsible living. How would I tell my husband? My children were still young, I could not believe it was happening to me," she says.

When Nabudere had the accident, Rose, her workmate pulled the needle out and rushed her to the doctor, but unfortunately, there was not much he could do. This was in 1992 when there were no drugs to prevent infection.

Dr. Stephen Watiti, the clinic manager at Mildmay Centre, an AIDS care facility in Kajjansi on Entebbe Road, says there is a way out if a person gets exposed to HIV ('immunisation against immediate HIV exposure').

He says HIV post exposure prophylaxis is when a person who is HIV-negative has been exposed to HIV and is given antiretroviral drugs to prevent infection.

The drug is usually given in case of rape, accidents, cuts and other occupational hazards. Infection can also occur if one gets into contact with body fluids like semen, blood and saliva.

Watiti says the antiretroviral therapy administered in these cases prevents HIV from entering the cells. "When the virus gets into the body, it could take about 24 hours to attach itself to the cells. HIV post exposure prophylaxis is the process of preventing this attachment.

"But the antiretroviral drugs (ARVs) have to be taken within 24 hours from exposure and it should be done under medical supervision.

In difficult circumstances, the drug can be given after 24 hours, but not exceeding 72 hours from the time of contact," Watiti says.

Dr. Tonny Asonyu says: "Each body cell has a receptor or doorway. However, the AIDS virus is particularly interested in the CD4 receptor. When the virus attaches itself to this receptor, it changes itself to look like our body cells.

"The virus then joins the process of our body cell multiplication. Our body cells are renewed everyday - that is why we grow.

"However, when HIV enters our cells and turns itself to look like them, instead of our cells multiplying, it is the HIV that multiplies. In the process, our old cells are not replaced. That is why the CD4 cell counts start to drop.

"The HIV post exposure prophylaxis prevents the virus from attaching itself onto the cells. The antiretroviral drugs that the person at risk of HIV infection takes, form a protective coating around the body cells so that HIV cannot reach them," he says.

Asonyu says the anti-retroviral drugs have to be taken for at least 28 days in either two or three-drug therapies depending on whether the feared infection was low or high risk.

Low-risk infection is when the exposure is through a needle prick, a slight cut, when body fluids come into contact with your skin, or when the person feared to be carrying the infection does not have symptoms of AIDS.

High-risk exposure is when there is serious bleeding or when the object like a razor or needle has blood on it.

This also occurs in instances where one has been involved in a road accident or in the labour ward, but most of all, in the case of rape.

The person who is now at risk of HIV infection should then take an HIV test to ascertain whether they were free from infection in the first place.

"It must be done pretty fast. The source of the feared infection can be tested later, but we just assume the person is HIV-positive, especially where it is difficult to find that person like in the case of rape. The antiretroviral therapy should begin immediately," he says.

Asonyu advises that when one is exposed to HIV through an existing wound, a prick, cut or any external contact with body fluids, the person should immediately wash the affected area with a mixture of water and a disinfectant like jik.

In the absence of a disinfectant, ordinary soap should be used.

"If the person takes the ARVs when they were infected before the exposure, it may cause drug resistance making it difficult for the ARVs to work when the person needs them," he says.

"Rape victims can benefit from the procedure. Unfortunately, most cases are reported late. Most people do not want to talk about it or take too long grieving and forget about seeking medical attention," Watiti says.

What is the cost of antiretroviral post exposure prophylaxis?

Dr. Elizabeth Madraa, the manager of the AIDS Control Programme, Ministry of Health, says every government health unit offering voluntary counselling and testing services, as well as antiretroviral therapy should be able to provide HIV post exposure prophylaxis free of charge.

She says they are working on a post exposure prophylaxis policy and Uganda has already adopted the World Health Organisation guidelines, which provide that every health worker should have the required set of ARVs for prophylaxis in case of any eventuality.

But she warns that there may be issues of implementing the guidelines, which require health workers to wear aprons, gloves and use closed methods for drawing blood using vacutainers. It also requires for a health worker with an open wound to dress it before carrying out any procedure.

"This is a serious matter because someone who got infected at work can sue. But policy making is a process, we have a draft policy, but enacting it into law may take a long time," she says.

Does the service increase risky behaviour?

Although more people are becoming aware of prophylaxis, the US government department of health website, www.dh.gov, says research has shown that this knowledge had not resulted into people getting involved in risky sexual behaviour.

Unfortunately, many people who had received antiretroviral post exposure prophylaxis sought another dose, meaning that they did not adopt means to keep out of situations that expose them to HIV infection.

"We have no facts on that, but one time a girl called me saying she had succumbed to her boss' advances and had unprotected sex with him while on a trip. She wanted to know what she could do.

This was a complex situation, but our work as medical people is to provide treatment and care. So I advised her to come over to the clinic or find a nearby hospital where she could be attended to," Watiti explains.

What if one feigns rape?

"We just take your word because we know people hardly lie about such things that involve legal follow-up," the site reveals. However, Watiti advises that in case of rape, the victim should rush for HIV post exposure prophylaxis before going to the Police.

The most effective method of preventing HIV infection is preventing exposure to the virus.

For drug abusers, apart from the damaging health effects, use of injection-drugs exposes them to HIV infection, especially because they are administered under the influence of drugs.

For health workers, consistent use of sterile equipment is the way to go. Do not try to return a used needle to its cap.

And, it boils down to ABC for the rest of us.

Abstinence, sticking to one sexual partner and not allowing your blood to boil so much that you throw away the condom.

Remember, consistent and correct condom use. ABC, it is as mundane as that, but it could turn out a lifesaver.

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