The other side of sex

Written by Dr Sindi Van Zyl
Wednesday, 08 February 2012 14:41

A lot of progress has been made in South Africa regarding public awareness around the human immunodeficiency virus (HIV) pandemic. The HIV counselling and testing campaign launched by the National Department of Health in April 2010 was a great success. According to President Jacob Zuma’s 2011 World AIDS Day speech, more than 13 million people had been tested for HIV. Furthermore, he stated that from January 2010 to September 2011, the number of public health facilities initiating patients on antiretroviral (ARV) treatment had increased from 495 to 2 948. In addition, the number of nurses accredited to initiate and provide treatment went up from 290 to 10 542. This makes me especially proud because of my involvement with the training of these nurses.

But as an HIV doctor I see people die needless deaths simply because they did not test for HIV. This is a serious problem within certain pockets of our society and drives my passion to save people’s lives.
 

There are three blind spots to highlight when it comes to the diagnosis and treatment of HIV: the elderly and HIV, racial stereotyping and HIV, and the closest to my heart – pregnancy and HIV.
 

THE ELDERLY
 
 

October 2010 saw me working in Orange Farm on the outskirts of Johannesburg, in one of the smallest clinics I had ever seen. Though small, this clinic was progressive and had embarked on a roll-out of life-saving ARV therapy. One late afternoon an elderly woman walked into the consultation room. The reason for her visit was to collect her blood pressure medication. As any doctor would, I went through her file. She was 77 years old, and her blood pressure was well controlled. I started asking her general medical questions about her health. During our consultation, a young lady walked in. After hearing that she was the granddaughter and making sure that the elderly woman was comfortable, I continued with my routine questioning. I enquired whether or not she had ever been tested for HIV. This question sparked the rage of the granddaughter and quickly deteriorated into a full-on confrontation. I called the most senior nurse clinician into the consultation room, and she made it clear that I was performing my basic duties as a medical officer and that no patient examination is complete without offering an HIV test.
 

Her granddaughter’s indignant stance was borne by a belief that my suggesting her grandmother be tested for HIV was an insult. She declared, “Her husband died 10 years ago. So what are you trying to say about her?” In the absence of her granddaughter, I once again offered the elderly woman the test, to which she agreed. I dispensed her medication, referred her to the counselling room and then left the clinic. I asked the nurse to call me as soon as the results were available. An hour later my phone rang. The results were positive.
 

The elderly woman took the news well. She also made it clear that she was not going to tell anyone about her status. Lastly, she asked the nurse to thank me for offering her the test. Her CD4 blood had been taken for testing, (CD4 cells are a type of white blood cell that fights infection and their count indicates the stage of HIV or AIDS in a patient) and when the results came back, they showed that she qualified for ARV therapy. Sadly we never saw her again.

I am confident that we are going to screen more elderly patients in 2012. “Provider initiated counselling and testing” is the latest buzz phrase. Every patient who is seen by a healthcare professional will be offered an HIV test in the consultation room. This is regardless of the presenting complaint. If the patient agrees, the test is performed immediately. Our organisation is currently working closely with the Department of Health and training healthcare workers in Soweto and the surrounding areas.
 

RACIAL STEREOTYPING
 

Part of my job involves training and mentoring nurse clinicians on how to manage patients how are on ARV treatment. It is always exciting when a new group has to be trained because of all the different questions they ask. One of the hardest questions to answer is the inevitable question on race and HIV. “Why is it that HIV only affects black people?”
 

Fortunately, I have worked at Steve Biko Academic and Helen Joseph hospitals, Lenasia South Clinic and for the last few years in Soweto. I have seen patients from all walks of life who are HIV-positive. I always reassure the nurse clinicians that HIV knows no colour. And to walk around with such a blind spot is very dangerous.
 

The truth remains though that the face of HIV is black. We’ve all seen the typical images of a poverty-stricken rural black woman surrounded by malnourished children. Yes, the demographics are that 79.4 percent of the country is black. So the majority of HIV-infected people in our country are going to be black – all else being equal. But other groups are not unaffected. However, those groups access healthcare in the private sector, and as a result those statistics are not readily available.
 

One of the biggest lessons that I learnt was at one of the academic hospitals in Gauteng. An eight-year old Muslim boy had been admitted with fever and swollen glands. From the mother’s dress code you could see that they were conservative Muslims. The senior registrar was at his wits’ ends after running a battery of tests and coming up without a diagnosis. During the grand ward round, the consultant casually enquired if anyone had asked the mother if we could test her son for HIV. The silence was deafening. Post-ward-round chores were performed, the mother was referred for counselling, and her son was tested. I was as sceptical as any naïve medical intern would have been. The results came back positive. That consultant taught the team an invaluable lesson that day. No assumptions were to be made – ever.
 

One of the ways to address this blind spot would be to have the HIV statistics from the private sector made available to the Department of Health. It would give us a clearer picture of where we stand and how we can save more lives.
 

PREGNANCY
 

South Africa has one of the best prevention-of-mother-to-child-transmission (PMTCT) programmes on the continent.

My biggest passion is to make sure that as many pregnant HIV-positive women as possible access what the programme has to offer. All women who seek basic antenatal care in the public sector are offered an HIV test, and the uptake is good. The women who test positive have a CD4 blood test done. They are started on either short-course or lifelong ARV treatment, depending on whether the CD4 count is above or below 350. The sole aim of the PMTCT programme is to ensure that we end up with a healthy mother and a healthy HIV-free baby. This is not the case in the private sector. HIV testing in pregnancy is not offered as routine basic antenatal care, which leaves women vulnerable.
 

This is a great tragedy because the PMTCT interventions work. Women take ARV treatment during pregnancy to decrease the chances of their babies being infected with the virus. Mothers now have the option of breastfeeding their infants, provided that they do so exclusively. These are the wonderful advances that have been made in science to ensure that HIV-positive mothers are able to give birth to HIV-free babies. But if you do not know your status, you cannot be part of this programme.
 

Being HIV-positive and pregnant comes with its own risk factors. A few years ago an acquaintance of mine called. At eight months pregnant she had developed a skin rash that I immediately recognised as herpes zoster, or shingles. I didn’t broach the subject of an HIV test. She was in the care of a prominent obstetrician, and I assumed that she had been screened thoroughly. She delivered a month later by Caesarean section, developed post-partum complications and died. If her status had been known, she would have been treated differently and would probably not have died.

Making people aware of blind spots saves lives.
 

I am optimistic because of the changes that I have witnessed in people’s lives. The attitude around HIV is changing as more people become educated. More people are choosing life over death by confronting HIV head-on instead of ignoring it. This positive attitude is spilling over into society as a whole and gaining momentum.


On 1 December 2011, two South African celebrities – Lesego Motsepe and Koyo Bala – disclosed their HIV-positive statuses. There was a social-media frenzy, which I was very happy about. This is because the stigma of secrecy is being broken. And once again it brings the message home.

HIV can happen to anybody. No blind spots.
 

Sexy but safe tips
 

• Being HIV-positive should not limit or curb your sex drive. Sex can be had as often as you want (and physically can). The important thing is for you to have protected sex. No compromise!
• Get intimate
• Being intimate does not always mean penetrative sex. Giving each other a massages, kissing, cuddling and mutual masturbation are all ways that can keep the fire burning.
• Go down!
• Oral sex is safe and fun for both males and females! However, using condoms is vital, as risks do become higher in the presence of sexually transmitted infections, open sores or lesions in the mouth or genital area and bleeding gums.
• Using flavoured condoms can add spice to a relationship. For performing safe oral sex on a woman, you can make a dental dam, which covers the clitoris and the entrance to the vagina. Read more about how to make a dental dam with a condom here: http://std.about.com/od/oralsextips/ig/make-a-dental-dam/
• Sex toys
• Sex toys (vibrators and dildos) can bring a new element to your sex life. Just never share sex toys. Have a separate collection for each partner, and cover them with condoms each time.

Dr Sindisiwe van Zyl graduated from the University of Pretoria in 2005. She decided to do her internship at Chris Hani Baragwanath Hospital and she has been working in Soweto ever since. Sindi is currently working for an HIV NPO as a medical officer.

She is very passionate about Primary Healthcare and patients’ rights. She is also dedicated to ensuring that PMTCT – Prevention-of-Mother-to-Child-Transmission strategies are rolled out timeously in all Soweto clinics. Her hobbies include mall trawling, reading, cooking and surfing the Internet. She is a self-confessed Twitterholic