Test Results - Anna

Today, I am going to the laboratory to pick up the test results for Clive Alaena and Naledi. Our tests are to evaluate the strength of an infected system. It is usual to use tests for CD4 count and “viral load” to evaluate the progress of HIV once this has been diagnosed. CD4 is the type of white blood cell, or lymphocyte, which diminishes fastest in the body when it is infected with HIV, but other types are also damaged, and the ratio of different types of lymphocytes is an indication of overall strength of the immune system. We are testing for in the blood for total no of lymphocytes (all types); total no of CD4 lymphocytes, for mitochondrial depolarisation, for cytotoxicity; and for liver function. We are also testing the rate of apoptosis (cell death) of the lymphocytes. This testing is expensive. The mechanism by which the HIV virus causes the death of other cells is interesting. Contrary to what one might assume, it isn’t cells that have been infected with the virus which principally die. Infected cells produce more virions - viral cells - and these cause other, healthy cells to die. It is as if they send out “die! commit suicide!” messages. So the rate of overall cell death accelerates. It is the rate of that cell death, or “apoptosis” which leading scientists now recognise as the best indicator or disease progression. And still, it is not conventional to test for the rate of apoptosis. Some of the researchers here in KZN are amongst the top scientists researching onto this area, and we are working with them.

Results have been promised for days, but I haven‘t yet got them. I am told that I will get them when I visit the lab.

This lab is one of the biggest in SA. There are sister labs through South Africa and in other African countries. They process tests for many powerful multinational companies, work closely with the government, and have state of the art technology. The building is lovely: well-designed in brick and glass and surrounded by greenery. Leading researchers into HIV share the premises. However, our results are not there. I am frustrated. Why have I been promised them? Why tell me that they were ready when they are not? I am told that the blood samples went directly to the scientist was to analyse the blood, but no-one can confirm that he actually did the work. He is a busy man. I have visions of them sitting on his desk, whilst he lectures PhD students, unaware that that they are deteriorating. Some of our tests have to be done within three hours of bloods being taken, so there is not much room for mistakes. I leave, shocked. I want those results. I want to see what our baseline is. It is great that Clive Alaena Naledi and Tumelo are feeling so much better. In Tumelo’s case I think we have made the difference between life and imminent death, and in Naledi’s case, between a weary, gradually deteriorating life, and worry for children, and a strong healthy life in which she sees herelf going forward. Clive would have done OK on his ARVs, sleeping in the afternoons but not in pain, and Alaena would probably have gone on glowing. That is great, and I want to be able to SHOW what has changed.

HIV Testing in South Africa

A little more about testing, generally. Here, there is a great resistance to being tested for the presence of HIV. People do not want to know their status. There have been some thorough testing programmes, for example, the programme in KZN a few years ago which showed that 40% of women who were about to give birth were HIV+. There have been extensive programs on volunteers - I read one study on 32,000 self-selected volunteers in various workplaces which showed an 11% overall infection rate - 17% in blacks. Counselling is often not very good, and there is a great heaviness around a diagnosis, rather than a sense that this is a manageable illness, as it should be now, given the availability of anti-retroviral drugs. A diagnosis is a curse. Not many feel as Clive does, that HIV presented him with a great opportunity to reevaluate his life, to learn and become more. I admire that man. One of the great things about this trip has been the opportunity to get close to others. We have taken on a big task. Clive has embraced a far greater role than I could ever have hoped for. Clive and Alaena and Naledi are great to film because they are prepared to talk openly about their experiences. Clive, is well-known for his work with HIV+ people. But I did not expect him to work tirelessly from before dawn each day contacting people individually to tell them of his experiences. I really do feel very blessed. I love this group, and its integrity.