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Microbicide, Solution To Female HIV Infection?

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Since the Human Immune Virus and the Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic became known in Nigeria in the mid eighties, no illness has caused more commotion and separated families and friends alike.

From being a rumour initially, it became a cruel reality which raised so much pandemonium that how it is transmitted from person to person became more horrifying and confusing almost by the day.

However, from the mid eighties to now, so much water had passed under the bridge. Form being regarded as the most dreaded diseases, which had no cure, HIV/AIDS is now manageable.

In fact, research has proved that an infected person can live a normal life like every other person. All it requires is awareness in the part of the infected person.

In spite of this encouraging development, however, research has also shown that the virus is still spreading and fastly too, for various reasons, which include the fact that people, mostly out of fear of being discriminated upon, prefer to keep their infection to themselves, or refuse to know their status.

Research has alo showed that majority of those infected are women, thus raising questions regarding why it is so.

It did not take long for researchers to reason that perharps this will not be far from the fact that women seem to be the most vulnerable when it comes to adopting preventive measures during heterosexual intercourse.

This is because the presumed efficacy  of such preventive measures as abstinence, use of condoms and being faithful to a partner could not stop more women from being infected. Hence the decision to come up with a preventive measure strictly to be controlled by women.

In the words of Dr. Orikomaba Korifama Obunge, consultant clinical microbiologist and Head of Medical Microbiology department, University of Port Harcourt Teaching Hospital (UPTH) ‘‘a lot of them (women) are still being infected, not because their partners are a little bit more adventurous, and the ability of them negotiating for the use of preventive measures such as condoms is not working much as it should.

‘‘The issue is that, can we not provide a preventive measure that is controlled by the women, that is capable of forming a barrier during heterosexual intercourse?’’

It is the search for this measure, according to Dr Obunge, that resulted in the emergence of  a concept of a microbiocide by a group of researchers and activities, which also include Dr Obunge.

According to a recent UNAIDS estimates, in 2009 more than 33 million people were living with HIV and approximately 2.5 million people were newly infected.

The estimates also showed that worldwide, nearly half of all individuals living with HIV are now women, who acquired the virus largely by heterosexual exposure.

Further more, many women, because  of limited economic options and gender inequality, cannot reliably negotiate sexual encounters, leaving them vulnerable to unwanted pregnancies and sexually transmitted infections (STIs), including HIV.

Thus, with clinical deployment of safe and effective HIV Vaccine still likely to be years away, topical microbicide formulations that are applied vaginally or rectally are receiving increasing attention as another strategy for HIV prevention.

The microbicide is a product in the form of a gel which could be infected intraveinously with the sole objective of preventing the transmission of the virus during heterosexual intercourse to the woman.

According to the researchers, a review of preclinical and clinical research on the development of microbicides formulated to prevent vaginal HIV transmission yielded 118 studies globally.

Presently, mathematical modeling has shown that if there is such a preventive measure that is workable, then millions of new infections could be prevented and it would be an encouragement for donor agencies to start working on it. Hence the emergence of research on microbicides.

In the words of Dr. Alan Stone of the Medical Research Council in the United Kingdom, ‘‘the development of an effective microbicide is a global priority of the highest order… The question is not whether the microbicide approach will prevent HIV infection but, rather, what proportion of HIV infections it will prevent.’’

Towards coming up with such a microbicide, two research organizations, FHI and Vera Halpen using collaborators in various countries embarked on research for the purpose. In Nigeria the collaborators were Dr. Orikomaba Korifama Obunge and Dr F.S.Ogusola of the university of Lagos.

The research went through the first and second phases, which are smaller studies that look at safety at does and at efficacy before this third phase which entailed randomized clinical/controlled trails on large groups of participants to look at the efficacy of the microbicide.

The products of the investigation were 6% Sodium Cellulose Sulphate (CS), which is a gel that was tested as a possible topical microbicide, but in 2007 was found to be  in effective. Researchers thought that CS could potentially block HIV infection (and possibly others STIs) by creating a barrier between the virus and the woman’s cells in the vagina which the virus targets for infection. This would make it more difficult for the virus to enter the woman’s cell.

The other products of investigation are vaginal gel, single use applicator, and 3.5ml of gel.

According to the researchers, the study design at this phase III entailed randomized placebo controlled trail, in which a total of 2160 women at high risk of HIV/STI were in Lagos while the other half were in Port Harcourt.

The placebo is not the treatment being tested, but looks exactly like the treatment. For topical microbicides trails, the control group received a gel that looked and was used the same day as the gel given to the intervention group, except that it did not contain the microbicide.

Placebos are used in blinded clinical trails so that participants for twelve months, while tests were carried out for HIV, gonnorhoea and Chlamydia at baseline and at each monthly follow up visits.

A summary of the research showed that the duration of the study was 12 months of participants recruitment, 12 months of product used for each participants and 26 total months in the fields including screening and close-down, while the primary objective of the study was to determine the effectiveness of CS gel in preventing male-female vaginal transmission of HIV infection among women of high risk.

The primary endpoint is the incidence of HIV-1 and HIV-2 infection as determined by detection of HIV antibodies from all Mucosal Transudate (OMT) specimens, while the secondary objective is to determine the effectiveness of CS gel in preventing malae-female  transmission of gonnorrhoea and chlamydial infection among women at high risk.

The secondary end point is the incidence of the genital gonorrhea or chlamydial infections as determined by DNA probe technology from self-administered vaginal swabs .

At the end of the study, it was found that the CS gel (this microbicide) did not protect against HIV and canot be used, “there were more infection in CS group compared to the placebo group from other studies outside Nigeria resulting in the stoppage of the study on CS3, and the preventive measure (HIV risk reduction messages works)”

It was thus agreed that community/scientist rapport must recognize that community involvement is an essential component in microbicide trail; that the approach to such involvement must consider the local setting (community politics and environment) that the relationship is a dynamic one.

Others are that it is clear the development of a topical microbicide to prevent the sexual transmission of HIV is scientifically, ethically and culturally complicated; and that in spite of these the benefit in lives protected may far exceed those risks seen and, as yet, unforeseen.

The implication of the foregoing is as encouraging as it is dreadful. Encouraging  because by this and other researches carried out, all in pursuit of a solution to the HIV/AIDS pandemic show that there is a relentless quest to get a solution .

However, the situation looks dreadful considering that such solution seem to have remained evasive and hence almost impossible to come by.

This, therefore, is an indicator that a lot of work still needs to be done to thoroughly put the transmission of HIV under check, particularly as it concerns the most vulnerable groups.

Such areas that require more job to be done include community sensitization/involvement, capacity building programmes for various stakeholders, including families.

The question that should thus be on every bodies mind is “which way forward in HIV prevention.”

 

Sogbeba Dokubo

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Establish More Psychiatric Facilities, Expert Urges Govt

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The Executive Secretary, Association of Resident Doctors, Federal Neuro-Psychiatric Hospital, Yaba, Dr Michael Osingun, has urged the governments at all levels to establish more psychiatric hospitals in Nigeria.
Osingun made the call in an interview with newsmen yesterday in Lagos.
He also decried “the poor state of the few existing psychiatric hospitals in the country”, saying that most states in the country did not have a functional psychiatric hospital.
He said the establishment of more psychiatric hospitals was necessary due to the increasing cases of mental illness which seemed to overwhelm available mental health facilities.
The psychiatrist attributed the rising cases of mental illness to drug abuse, stress, economic downturn, unemployment, inadequate finances, depression and effects of the COVID-19 pandemic.
According to him, mental health services are barely accessible outside the state capitals, adding that there is also an urgent need to establish mental healthcare facilities at the grassroots level.
He noted that most mental health cases happened in rural communities where there were no mental healthcare facilities/psychiatric hospitals.
“That is why people will resort to taking the victims to prayer houses where the situation will be allowed to get complicated,” he said.
Osingun said there were only about 10 psychiatric hospitals across the country adding that more should be established while existing facilities should be equipped with adequate human and material resources.
“Mental health needs to be given the seriousness it deserves by government, individuals and non-governmental organisations.
“Let the government subsidise the treatment of mental illness, establish more psychiatric hospitals to enable more mental patients to access treatment.
“This will go a long way to increase access to mental healthcare and prevent mental cases from degenerating and making them difficult to treat or manage,” he said.
The psychiatrist said that the devastating effects of insurgent attacks, insecurity, economic hardships and other crises across the country had left several people in need of psychiatric evaluation.
He explained that although victims of those crises were often affected psychologically, little or no attention was given to providing them with health care to serve their needs.
He identified lack of political support, inadequate management, over-burdened health services and resistance from policymakers and health workers as some of the factors affecting the development of a good mental healthcare system in Nigeria.
He, therefore, urged the governments at all levels to prioritise the welfare of the citizens by ensuring that the basic necessities of life were made available and affordable.
“Mental health is as important as physical health. Mental health is the base of all health. For one to have health, he/she must be mentally stable. So, there’s no health without mental health.
“But you find out that agencies of government and international organisations focus more on catering for the physical needs of the people rather than mental needs,” Osingun said.
He also alleged that although Nigeria had a mental health policy the policy was not being implemented adding that such a policy should be reviewed and implemented.

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‘Family Planning Reduces Maternal Death By 30%’

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The Association for the Advancement of Family Planning in Nigeria, says family planning has the potential of reducing maternal death by 30 per cent.
Chairman, Technical Management Committee of the association, Dr Ejike Oji, stated this in an interview with newsmen in Abuja yesterday.
Oji explained that family planning was the greatest fundamental investment for mothers and children.
“If you are able to space your children, you as a mother will be healthier and the children will be healthier too.
“The frequency of visiting hospitals will reduce and if you are working class person, you will have enough time for productivity,” he said.
Oji, who reiterated the importance of family planning for families, said it was available in all primary health centres.
According to him, family planning services are free and have been made available by primary health centres provision fund.
“In each of the primary health centres in the rural areas, there is a family planning service which is free.
“Unless the community or rural area has no primary health centre, then family planning service may not be available,” Oji said.
The medical practitioner called on women to avail themselves of services of family planning for a secured future.
According to reports, Nigeria’s Contraceptives Prevalence Rate is 12 per cent according to the 2018 National Demographic and Health Survey.

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Six Effective Home Remedies For Low Blood Pressure

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Many people do not know that low blood pressure is dangerous, perhaps more fatal than high blood pressure. An optimal blood pressure reading is less than 120mm Hg and above 80 mm Hg.  The first number indicates the systolic pressure or the pressure in the arteries when the heart beats and fills them with blood. The second number represents the diastolic pressure which is the pressure in the arteries when the heart rests between beats. Low blood pressure or hypotension may cause inadequate blood flow to the heart, brain, and other vital organs. A sudden drop in blood pressure often occurs when someone suddenly rises from a lying down or sitting position. This is called postural hypo-tension and may cause light-headedness and dizziness. There are some home remedies for low blood pressure that you can employ in order to deal with the symptoms of erratic blood pressure. But if you’ve been feeling the following symptoms for a while, consult your doctor and get your blood pressure measured: fatigue, light-headedness, dizziness, nausea, clammy skin, loss of consciousness, blurry vision.
Once your doctor confirms that your blood pressure is low, follow his advice and take medication if required. A healthy low blood pressure diet is important for low blood pressure treatment. Along with that, here’s more homely help. Your diet plays a crucial role in maintaining your blood pressure.
. Eat small portions frequently: Healthy snacking sessions in-between the major meals of the day to avoid long gaps. Eating small portions several times of the day helps in preventing the sudden drop in blood pressure that one may experience after meals. So, if you are eating three full meals a day, it would be better to rather have them distributed in to five small meals a day. This one’s a great home remedy for also people who have diabetes.
. Have adequate salt: Excess salt is bad, but on the other hand it is required by your body in moderate quantities. According to the World Health Organisation, your daily diet must contain at one teaspoon of added salt besides what you derive from natural fruits and vegetables. In summers or if you exercise daily, keep some lime water with a pinch of salt handy. Salt works like an instant pick-me-up. Make sure you do not have too much salt too that may lead to problems like water retention along with high blood pressure.
. Drink more fluids: Drink at least two to three litres of water every day. Besides this, include drinks like coconut water, in your low blood pressure diet. These will give you the necessary electrolytes required to maintain the fluids in your body. Dehydration is a common cause of low blood pressure. Pomegranate juice is rich in antioxidants called polyphenols and may help you lower your blood pressure. One of the best ways to fight dehydration is water; so, do not forget to load up on enough water for the day.
. Caffeine helps: Caffeinated beverages like tea or coffee may help boost your blood pressure temporarily.  When your blood pressure dips suddenly, a cup of coffee or tea can get your circulation going. It causes short, but dramatic increase in your blood pressure. Although nobody knows why this happens, it is believed to help you improve your blood pressure.
. Scent Leaves:  “A home remedy from our granny’s treasure trove. Chew five to six tulsi leaves every morning,” suggests Dr Rupali. Tulsi leaves have high levels of potassium, magnesium and vitamin c which can help in regulating your blood pressure. It is also loaded with an antioxidant called Eugenol which keeps the blood pressure under control and lowers cholesterol levels.
. Almond Milk: Soak 5 to 6 almonds overnight, peel them in the morning, make a paste and boil them into a drink. Drink this every day to prevent your blood pressure from falling. There is no cholesterol or saturated fat in almond milk. In fact, it is rich in healthy fats like Omega-3 fatty acids. Include this milk in your low blood pressure diet; basically, you can add it to your cereals, smoothies, et and enjoy the goodness of the almond milk.

By: Kevin Nengia
Adapted from NDTV Food online

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