/ 24 January 2014

Private sector lags in HIV testing

Robotics technician Ché Makanjee squints at his computer, concentrating so hard on writing up the report about the diagnostic robot he has just tested that he hardly notices the other people in the laboratory as he types at a whirlwind pace. "Tested 80 live samples," he mumbles as he hits the letters on the keyboard. 

He hears the sharp sound of glass connecting with metal and everything in front of him turns red. He hears a gasp to the left and turns his head. The blonde-haired woman, also a robotics technician, stands still, a look of panic on her face as her glove-clad hands hover in front of her gaping mouth. 

Makanjee looks back in front of him and only then realises the flash of red now covering his desk, computer, hands, arms, jeans and shoes is blood. The blood the diagnostic robots were using in the test run. Blood infected with HIV. 

The vial had slipped through the woman's hands as she was placing the cap on to seal it. She has no blood on her but looks so horrified that Makanjee feels compelled to reassure her: "Don't worry! It's okay – we'll just wash it off."  But in his mind the 26-year-old, at the beginning of his career, wonders whether there are any small cuts on his arms or hands through which the virus could enter his system.

The pair rush to the basin and  he cleans his hands and arms with a special disinfectant designed to kill live organisms – similar to what doctors use to wash their hands before surgery. 

It is only when the safety officer from the Johannesburg-based laboratory at which he consults comes to talk to him that he starts to feel a sense of panic overwhelming him. Could he be infected with HIV?

First step: get tested
The in-house safety officer recommends that Makanjee get an HIV test as soon as possible. If he was negative he could take drugs, termed post-exposure prophylaxis (PEP), within 72 hours to prevent infection. If the test was positive it meant he had already been infected and should consult with a doctor about his future treatment. 

But Sindi van Zyl, an HIV clinician from the Anova Health Institute, said Makanjee was at such a small risk of infection, "because the blood was not exposed to any of his mucous membranes" and he had no visible cuts on his skin, that PEP may not have been recommended. 

The incident happened just before World Aids Day last year, December 1, and he thought it would be the easiest time of year to get tested. 

Makanjee expected there to be testing drives everywhere he went. But walking and driving around some of the middle-class northern suburbs of Johannesburg, where he spends much of his time, it seemed like any other Sunday. Prominent chain-store pharmacies he visited, such as Clicks in Rosebank, for example, did not even have nurses on duty, never mind a fully fledged HIV testing drive. "How can nobody care about HIV testing on World Aids Day?" he asked.

World Aids Day: where was the private sector? 
Marlin McKay, a Roodepoort-based doctor in private practice with a special interest in HIV, said he also didn't see any private sector initiatives on World Aids Day. "There definitely should have been testing drives initiated by the private-sector – we're missing thousands of people who would have loved and appreciated the convenience of stepping into a private pharmacy, for instance, to get tested on World Aids Day," he said. 

Section27 head Mark Heywood said "the private sector is not playing a big enough role" and he attributes this waning interest to "the fact that political pressure for an across-the-board response to HIV has gone". He said that as the panic around the disease began to recede, as it shifted from a deadly condition to a chronic one, so did the response from business.

On Monday December 2, Makanjee went to another Clicks branch on Malibongwe Drive in Randburg. Again, no nurse was on duty. He was referred to another of their Randburg stores, in the Brightwater Commons Shopping Centre, where he was told to make a booking over the internet or phone for an HIV test. The soonest available slot was in four days' time. 

Clicks offered free HIV tests during the health department's nationwide testing campaign, that ran from early 2010 to the middle of 2011, but spokesperson Susann Caminada said they do not do a "specific testing drive any more as we offer HIV screening and counselling [costing R155] throughout the year, not only on World Aids Day". She said that Clicks was "sorry" to hear about Makanjee's negative experience and "will investigate the case further".

A surprising hero
"Luckily, that afternoon I had to go to Charlotte Maxeke [Academic Hospital] because we're working on a project in one of the labs there and I saw a little sign on my left that said 'clinic'. I thought 'let me go and see if I can get a test', and it was actually really nice," he said.

As a person privileged enough to have medical aid and who had never been to, and had little knowledge of, public health facilities – except from largely negative reports in the media – Makanjee was more than a little surprised by this "pleasant" experience.

"There were quite a lot of people waiting to be tested, but the whole process went very quickly. The nurse who did the pre-test counselling was friendly and well informed – you could tell all the staff had been well trained for this." 

The entire process took less than half an hour and included pre- and post-test counselling, blood pressure and sugar level checks, a haemoglobin test (to check for anaemia) and the HIV test itself. It was also free. 

Private GPs and HIV: "inadequate"
McKay said: "A lot of middle-class people have this negative perception about the public health sector, but I think as far as HIV is concerned the government has, for the most part, proved themselves to be very qualified and professional." He said that in his experience, many private GPs are "inadequate" in their treatment of patients with HIV. 

"I do a lot of HIV talks and just listening to some of the questions from the GPs scares me."

If his HIV patients can no longer afford private healthcare, McKay said he "feels more than comfortable" referring them to government facilities. An HIV clinician at Charlotte Maxeke, Francois Venter, said he didn't see any private-sector initiatives on World Aids Day, "but to be fair, I wasn't looking". Venter, who conducts research through the Wits Reproductive Health and HIV Institute, said many people believe HIV is a "poor person's disease". But according to the Joint United Nations Programme on HIV and Aids, there are more than six million people living with HIV in South Africa and Venter said that an estimated 300 000 of these use private healthcare. "And this estimate is conservative."

But, Venter said, in both the private and public health sectors "some places are fantastic and some are not". And although the public sector's success is "partially" linked to its HIV services, "I see some excellent ICU and other services in some state facilities." 

It's been over six weeks since the incident in the laboratory and time for Makanjee to go for his second HIV test. It can take up to six weeks for the body to produce antibodies that can be picked up by the test. "I'll definitely be going back to Charlotte Maxeke," he said with a smile.