Health professionals such as physiotherapists and speech and occupational therapists are increasingly playing critical roles in the survival of HIV-infected patients, particularly children.
Elelwani Ramugondo of the University of Cape Town’s occupational therapy department said the need for the therapeutic treatment of youngsters with HIV had spiked so dramatically that she started a paediatric HIV treatment group to train therapists to work with them.
“Antiretroviral drugs (ARVs) let people infected with HIV live longer. But because they live longer there is more time for HIV to cause HIV-related disabilities, particularly in children,” Ramugondo said.
“ARVs seem to target HIV in the physical body very well, but not … in the central nervous system. Because this is a virus that specifically attacks the neurological system, you find many central nervous system conditions such as serious developmental delays, cerebral palsy and stunting in children with HIV.”
According to physiotherapist Sue Statham of Stellenbosch University, children with HIV are also more likely to suffer strokes than those who are not infected.
“They become paralysed, usually on the one side of their bodies. I also see many young adults between the age of 25 and 40 with HIV who have had strokes — they are having strokes at a much younger age than before HIV became endemic.”
Strokes in HIV patients are often the result of tuberculosis (TB) of the brain. More than three-quarters of them are often co-infected with TB.
In the rural Eastern Cape, as many as one-quarter of speech therapist Stephanie Benn’s patients at Zithulele Hospital are infected with HIV. The most common problem she deals with is hearing loss.
“ARVs can be toxic to the ears, resulting in hearing loss in the inner ear. But it’s often a matter of weighing up saving someone’s life as opposed to his or her hearing, and the choice is obvious,” she said.
Even worse are the effects of HIV on the middle ear. As many as half of Benn’s patients with middle-ear infections also have HIV.
“It’s a common opportunistic infection [an illness as a result of a compromised immune system] in people with HIV and causes a type of hearing loss that is very difficult to treat because the severity of the hearing loss fluctuates — it becomes milder when the infection lessens and worse when the infection deteriorates. This makes it very hard to adjust a hearing aid, because the settings need to be changed all the time,” Benn said.
About one in five people with HIV develop dysphasia — a decreased ability to talk as well as understand others — as a result of the virus’s attack on the brain. HIV-infected children also often find it hard to swallow food because they regularly develop oral thrush.
Therapists help HIV patients and their families to function despite these disabilities.
“A physiotherapist will help a patient with stroke-related paralysis to walk as much as is possible again and figure out ways to bath and go to the toilet,” Statham said. “We also assist patients with HIV-related pneumonia to keep their lungs clear and become mobile again.”
Physiotherapy is very important to HIV patients
Statham said the positive impact of physiotherapy on HIV patients could not be underestimated. “When we help a cancer patient to be functional, the patient often dies shortly thereafter. But in the case of patients with HIV who are on ARVs, the therapy changes the rest of their lives.”
Exercise classes and massage have also been shown to help to increase CD4 counts — a measure of the strength of the immune system — and improve the quality of life of these patients.
Ramugondo said HIV-infected mothers and their children had “complex relationships” that frequently resulted in developmental delays. “The mother often feels guilty for infecting the child and suffers from depression, because she has to deal with the virus and the daily stigma. Her partner might not even know that she’s infected. As a result, she may not play freely with her child and could see the child as a totally sick being without expecting much from it. Occupational therapists help to reorientate that relationship. If a child is not encouraged to play, it might as well not eat. It’s extremely important for development.”
Occupational therapist Shannon Morgan gives “hope therapy” to HIV patients with low CD4 counts at Zithulele Hospital. “These patients mostly just want to die. They stay in hospital for long periods of time and feel very ill and weak. We work on their psyches, because the body of someone who is sad and depressed takes longer to heal. We do beading and sewing with them and things like helping the female patients to paint their nails. They learn to produce things … and it has amazing consequences for their health.”
However, the public sector remains badly understaffed in terms of therapists. “In the Western Cape I’m only aware of three new physiotherapy positions for this year, but there will be 120 new graduates at the end of the year,” Statham said.
In terms of salaries, therapists earn less than half of what other allied health professionals such as pharmacists and clinical psychologists make. And they also have more limited career prospects.
Therapists are able to complete “advanced therapy” degrees — but in South Africa this does not translate into better pay because no specialist therapist positions exist.
Benn said: “We become therapists because we love what we do; it’s not about the money. I’m still young, though it will be really hard to look after a family with my salary when I’m older. Out of necessity, that results in many of us looking for employment where our salaries are higher — in the private sector, overseas, or we move into other careers.”
Mia Malan works for the Discovery Health Journalism Centre at Rhodes University
Therapists don’t score on salaries
- The entry salary for physiotherapists and speech and occupational therapists after three to four years of study and one year of community service is R15 481 a month.
- A chief therapist earns R22 800 a month.
- The most a therapist in the public sector can earn at the moment is R24 410 a month.
- The entry salary for a clinical psychologist after completing a master’s degree, a one-year internship and one year’s community service is R34 895 a month.
- The entry salary for a pharmacist after completing four years of study, a one-year internship and one year’s community service is R33 917 a month.
- The entry salary for a doctor after completing five years of study, a two-year internship and one year of community service is R39 051 a month (without commuted overtime and rural allowances, if they qualify for it).
Source: Workforce Management, health department