Wall of Life

March 6, 2014

Young people are the hope of tomorrow!

At Jeevan Sahara Kendra we are thrilled that since August 2013, our staff have facilitated two adolescent groups.  The first one was called “Character Formation” and was for young people aged 11-14.  The second group focussed on “Life Skills” and was for youth 15-20 years old.  Meeting on public holidays, the young people had 15 wonderful sessions where they explored the changes that they are going through and worked on understanding making healthy choices in their lives and relationships.

At the end of this first batch of young people, we wanted to do something special – and we did!  Thanks to our dear friends Ilaisa and Shubhra, we had an amazing time on the 27th of February 2014 when 22 young people came together to paint a “Wall of Life” outside the Jeevan Sahara Kendra.

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The work to prepare this started a month before with Ilaisa and Shubhra conceptualising the wall and getting the materials together.

We then had the basic primer and white paint applied and Ilaisa spent almost a week sketching the basic design, which the young people would paint.

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When the big day came, we had lots of happy volunteers – 22 youth showed up – and more came during the day, but we did not have enough brushes and paints for those who wanted to join later.

???????????????????????????????What a joy to see happy hands at work!   Over the course of the day, the white wall took colour as the young artists got to painting.

Our budding Leonardos (or M.F. Hussains) did not want to let go of their paint brushes.  It was with quite a lot of effort that the youth had to be persuaded to come in for lunch!

finished wall with JSK entranceThe final result is wonderful.  The entrance to the Jeevan Sahara Kendra now sports a beautiful mural called “God’s Love Express” where the cheery engine pulls 6 ‘carriages’ which each have a message of hope and life on them.

faithfulness 1Why don’t you come and see the art these young people have created for yourself?  Here is one of the panels – a carriage which shares the message of how faithfulness in marriage can prevent HIV from spreading.

ART panelWe are glad to be able to have a medium which pitches life-giving messages to passers-by.  Here is one about the fact that free Anti-Retroviral medications are available to help people with HIV live and not die…

At the end of the day – we want people to know that everyone is very special – and very valuable.  The last message is thus:god loves all

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Baby cured of HIV! What does it mean for treatment now?

March 13, 2013

ImageThis month we have heard some exciting news: a newborn in the US who was shown to have HIV was treated with a full strength combination of HIV drugs for 1.5 years.  Then her mother took her away for 5 months – discontinuing the treatment.  When the mother brought the toddler back she was found to have no virus in her – and no anti-bodies targetting the virus.  The first hard evidence of a cure for HIV in a child!

This is wonderful news, because it shows again a ‘proof of concept’ that a cure for HIV is possible.

For most people with HIV who are on the life-saving Anti-Retroviral Therapy (ART) medications – the medicines effectively kill all the virus in their circulating blood supply.   But the virus manages to ‘hide’ in an ‘dormant’ form in some of the body’s own CD4 cells.  These ‘latent’ CD4 cells are not affected by the ART medications.

So if a person with HIV stops the ART medication – what happens is that the HIV genetic material in the latent resevoir cells get ‘turned on’ and start producing new HIV virions because there is no ART in the person’s blood to prevent them from multiplying.

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In the case of the little girl – researchers think that the immediate starting of ART meant that the ART medications wiped out all the HIV in the girl’s blood – and prevented the formation of the latent viral reservoir.

So what does this mean for us?

We are thrilled to see that early and aggressive treatment in this little girl seems to have stopped HIV from ‘getting a foothold’ – and that this girl now does not need to take the ART medicine life-long!  We would expect to see changes in HIV treatment for HIV infected new-borns where they are immediately put on treatment after birth.

By God’s grace very few new-borns are now HIV positive because mothers are being treated with ART and so the chance of transmission from mother to child has gone down from about 30% to less than 5% (if all the treatments are taken correctly).    But the hope is now that even for the 5% who are born with HIV despite treatment to mother – they can be cured!   This will obviously mean more research and careful planning – so we will not expect new protocols very soon – but probably within a year or two we should see new ways forward.

What about for adults?  Sadly most adults are infected with HIV without themselves knowing they have the disease.  Usually by the time a person starts on ART the virus has done its damage and will have set up an impressive array of latent reservoir cells.

Does this mean there is no hope?  No it does not.  Because the current set of research is to try and work to get medication that can attack the latent reservoir and thus achieve a ‘functional cure.’

Here is one current model which is being researched.  It is based on an experimental drug called Prostatin.  Prostatin is known to activate the HIV reservoir cells.  So this is what they hope will happen:

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The idea is that by giving prostatin – along with existing ART – the latent reservoir cells will become active and so open themselves up to attack by the ART.   If this works – then it should be possible to rid the body of latent reservoir cells and at some point in time stop the ART.  And not have HIV show up again!

There is still a long way to go along this road – studies need to be done on how toxic prostatin is (and other drugs like it), how effectively they cause the cells to express themselves, how quickly they work, what doses are needed etc. etc.

We are not close to a cure.  But the real possibility of a cure is starting to come into view.

As Winston Churchill said after the Battle of Britain: “This is not the end.  This is not even the beginning of the end.  This is perhaps the end of the beginning.”

Lets keep praying for our medical research community.  We need to see God inspire them to new treatment breakthroughs.  And we all want to see a functional cure as soon as possible!

In the mean time – it is vital that every person with HIV – young and old – who is on treatment with ART – should continue to take it.  We must not stop the medications until we have the rock-solid proof of a functional cure.  And by taking the medicines faithfully – we trust and hope that each person currently living with HIV and on ART – will see the day when they can stop taking their meds!

But till that day finally comes – keep on the ART medications!  Don’t give up! Don’t stop!


Take your meds!

August 8, 2012

Anti-retroviral Therapy (ART) medicines are the life-line to living with HIV! 

At the recent International Conference on HIV in Washington DC (USA) it was said that a person with HIV in Uganda who is 35 years old now – and has a CD4 count of higher than 100  –  and starts on ART and takes it faithfully is now expected to live for more than 35 years!

That means that taking ART regularly can allow you to live just as long as you would expect to live if you did not have HIV.  This is great news!  And we are not talking about living in the ‘advanced western countries’ – the Uganda estimate is for a country with a health system and standard-of-life situation similar to what we have in India! 

But did you notice that in the second paragraph we highlighted 4 words: and takes it faithfully!  If I have HIV and I do not take the medicine very, very, very regularly…. well, then it just won’t work!  

This is what we call ‘Adherence’.

What does ‘adherence’ mean? 

It means being able to take the medicines you have been prescribed completely!

All the drugs – at the right dosages – at the right time – and in the right way!

No missing doses!

If I have HIV and I take my meds properly – then the amazing immune system God has given me can be rebuilt.   My body can fight off all the other diseases that are trying to bring me down.

But if I do not take the medicines properly – well – then the medicines will stop working.   Period.

There are other sicknesses like diabetes – where if I miss some meds then I can compensate by increasing my doses later.  HIV does not work that way.  If I miss my meds – then I am giving the virus a free ride to become resistant to the meds. 

Take a look at these pictures.  They illustrate what happens in the body of a person with HIV who is taking their ART meds twice a day.

If the person taking ART is regular – taking their medicines at the same time each day and not missing a dose, then this is what takes place:

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After a person takes their morning dose at 8 AM, the level of the drugs in the blood increases till about 2 PM, after which they start to drop.  But they never go down to ‘zero’ because at 8 PM, the next dose is taken and the level of drugs increases again.  The pattern is repeated the next day.

The most important aspect is this – by regular taking of ART at the right time each day, the level of drugs in the blood never drops below the ‘Threshold of Viral suppression’ (shown in the picture in yellow).  This means there is always enough drug available to suppress the HIV.  You suppress the HIV – and it can’t reproduce!

That is why good adherence to ART medication should result in the person with HIV having no detectable HIV in their blood!  

That’s great news!  It means that the bodies CD4 cells are then able to replenish themselves – and the overall immune function can improve – leading to a restored immune system!  And we are seeing this happening over and over again.  People on ART who are taking their meds properly – are getting so, so much better.  Are able to work again.  Are living to see their children getting married!  Amazing stuff!

But all of this depends on taking the medicines in the right way – faithfully!

Here is what happens if the ART meds are not taken regularly.

In this case, the person took a dose at around noon – and then the next dose the next day at about 5 AM.

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As you see in the picture above, from 8 AM to noon there are no ART drugs circulating in the person’s blood at all – because they have not taken their meds. Even when around noon they take their dose of ART – it still takes about an hour for it to come to a level where it will suppress the HIV virus.  

So from about 2 PM the ART is now able to suppress the HIV virus – the levels increase till about 6 PM, when they start decreasing again.  Around 12 AM the levels of ART dip below the minimum threshold needed to suppress HIV.  From now on the HIV can multiply again.  And the next dose is only taken at 5 AM, which means another hour or two before the minimum threshold is reached.

So what does the HIV do in a person on ART who is not taking his or her meds regularly?  It does this:

As you can see – whenever there are no ART drugs circulating in the blood – the HIV is reproducing.    More HIV means more attacks on the CD4 cells.

And even more importantly – when the ART drug is present in sub-optimal levels – the HIV that is reproducing at that time can become drug resistant.

This is why some people who are being treated on ART experience drug failure.  They have opened up doors for the virus to keep reproducing even though they are taking ART meds.   Sadly – some of them allow their HIV to become resistant to the ART meds.

The shocking thing is this – even people who think that they are taking their meds regularly may be opening up the gates for HIV to reproduce.

Take a look at this chart.

What you see is the percentage of people with ‘undetectable viral loads’ (which is what good ART should achieve – as against how regularly they take their ART meds:

If you see the first column you can see that 80% of people who are taking their ART over 95% of the time – achieve an ‘undetectable viral load.’

But here is the shocker – even people who are 90-95% adherent – only half of them achieve an ‘undetectable viral load.’

And for people who are less regular … well the figures show that most of them won’t reach the goal of suppressing their HIV.

So what does this mean?

My dear friend – if you are reading this and you have HIV – please do take your ART faithfully!

It is such a gift to be able to have these meds!  They can take you well into old age.  You can become old – just like all your friends and relatives who do not have HIV expect to get old.  But they will only work if you take them very, very, very regularly.

You have to achieve an adherence rate of over 95%.  That means that if you are taking your meds morning and evening – you have to miss less than 3 doses in 3 months!

Remember – the key to your long life is in your hands.  Those ART tablets are a gift from God.  Take them.  Regularly.  We want to see you live.  And we all want to see you live long and healthily!

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If you are reading this and you have a friend or relative who is HIV positive – please do encourage them to take their meds.  It is often a challenge to take the meds regularly.  No one likes to take pills – and that too life-long!  But if your loved-one does take their meds – and takes them regularly – then they can have a long life!

Your part in encouraging and helping out your loved one is vital.  

Be there for them.  Keep positively talking about the need to take the meds.  Pray with them.  Find out when their next ART appointment is.  Offer to go along with them to the doctor.  Tell them how valuable they are.   Show them you care by being with them through the thick and the thin of things!

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We all need each other.  ART meds are a great gift from God – but are not always easy to take.   But once we start on them, we have got to keep taking them.  If we take them regularly… then we can live looooooong!

Don’t stop!  Keep taking your meds!  And make sure you take your meds faithfully! 

We want to see you old!

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Note:  Much of this post was taken from “Adherence and ART” the excellent powerpoint presentation put together by the Harvard Medical School HIV Initiative in Vietnam.  This can be downloaded by clicking: here

Steps into life

June 2, 2010

Six years ago we came across a boy.  He was 11 years old.  His parents had died of HIV.  His grandmother was looking after him.

Tarun (not his real name) was also HIV positive.

When we first met him, he kept falling sick.  He had TB.  His skin was infected.  He kept falling sick – with his grandmother bringing him to the clinic every 2 weeks or so with some sickness or other.

We then started him on Anti-Retroviral Therapy.  This was well before the government was providing the medications.  We bought the meds from the market and subsidised the medications – with a small monthly contribution coming from the boy’s family.

Today Tarun is 17 years old.  He has finished his class 10.  He is working at a part time job.  He is growing young man.

It all seemed so impossible then.  But we have seen how 5 years of ART have benefitted a boy who we thought may die in 2005.

By God’s grace our government has opened up ART centres in many parts of the country.  To get these medications free of cost is a great blessing.  Spend a moment to thank God for the Government health system.

Tarun has been receiving his medications from the local ART centre now for the past 3 years.  Your taxpayer money and mine help support this life-saving intervention.  Lets make sure it gets used though.

Get the word out that ART medications are available free for those who need them.  Encourage friends and family members with HIV to get tested and treated.  If you are affected yourself – then take a deep breath – and make a big step towards life.  Go and see what can be done.

There is always hope.  Step into life. Lets move forward!