❤️ Know Your HIV Status, Protect Your Future | Dr. David Nyarieko

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[00:00:00]If I get in tested today and I'm found positive that I've been infected, what will I do? Does it mean my life has come to an end? And we they have so many other questions. The hardest part of counseling someone is when somebody uh has been tested, he he or she came in knowing that he cannot turn to be positive. And then you get that person turning to be >> positive.

[00:00:33]>> So it is advisable that once someone gets into a relationship they have to know the status of >> Yeah, that is true. They have to get the status. They they have to know their status and they must go together. This one we must put it right.

[00:00:51]Welcome to Nanjo Adventist Mission Hospital where quality health care is delivered with compassion, professionalism and respect for every life. Good evening everyone and welcome back to our 21st century live talk # lifebilters and today we dive into a conversation that touches lives, emotions, fear, courage and hope. I am your host Kulkid Kumboka.

[00:01:22]Uh we'll be discussing HIV testing and counseling not just as a medical process but as a journey of strength, awareness and support. Um many people struggle silently because of fear, stigma and lack of information and today's discussion aims to break that silence.

[00:01:42]Joining me is a special guest who works directly in HIV testing and counseling, helping people face some of the most emotional moments in their lives. Uh stay with us as we learn, reflect, and discover how hard times help people rise above fear and uncertainity. Welcome Dr. Welcome.

[00:02:05]>> You can tell us more about yourself.

[00:02:08]>> Uh good evening. I'm Davido working uh in uh CCC clinic dealing with HIV counseling and testing.

[00:02:21]Thank you.

[00:02:22]>> Welcome. Uh Dr. I'd love to ask what inspired you to get into HIV testing and counseling?

[00:02:31]uh what inspired me to venture into this HIV testing and counseling was that uh as I grew up I I I was hearing about I I I I was concerned about the health of our community and our friends and our family members.

[00:02:51]>> Um when I grew up and uh I came to a point that uh after school I I had to choose something to do. Yes, >> I had to choose and uh I chose into entering into counseling helping people with psychological counseling in combination with HIV testing.

[00:03:12]>> Okay. You're talking about psychological counseling. Tell us more about psychological counseling.

[00:03:17]>> Psych psychological counseling is is all about u it's all about mental issues.

[00:03:23]>> Yes. This is where we support patients and clients uh mentally on uh issues to do with life issues now with in because I work with the KCC clinic, HIV clinic then we support them handling uh and accepting results after testing >> either both ne negative or positive results.

[00:03:47]>> Okay.

[00:03:48]>> Yeah. So what does a normal day in work look like?

[00:03:52]>> Yeah, the normal day is uh it's it's it's tight. Um uh normally we we we report to our work >> uh normally in the morning >> and we wait for clients to come.

[00:04:08]>> Yes. And these clients we are ever ready to offer services doing with the HIV testing and counseling. And um uh because we are facility based services then uh we expect clients as they come we introduce them to the offer services that we are offering >> and those that accept to get these services we we offer them these services to them and uh these services are offered for free and um normally we we offer these services both genders and uh but limited to some age groups because uh anything to do with below 15 years we must get a consent from the parent >> below 15 years >> below 15 years anybody that is above 15 15 and above we get a consent from that person then we continue to offer those services. So if someone is 15 years and above comes to hospital complaining about some issues and uh you think they're related to HIV, you advise that person to test or how does it happen?

[00:05:21]Because uh not 90% of people don't just walk into hospital and say I want to be tested for HIV. How do you get these clients?

[00:05:31]>> Now normally we have uh stages. We have entry points the SDP in in full we are calling them service delivery point. The first service delivery point is at triage and at triage is where we do screening and while screening of course we document.

[00:05:50]>> Uh then we have questions that we ask clients and these questions can help helps us to identify whether that person is eligible for testing or not. And if we find that person eligible for testing then we advise that person to be tested maybe before before seeing the uh the clinician or proceeding or others suggest that they get treatment first and then they come for the services.

[00:06:20]>> Okay. So during screening are you able to realize that this person is infected or how does it happen?

[00:06:29]>> Uh-huh. you you can you cannot tell whether somebody's infected >> while screening.

[00:06:37]>> Um why? because uh uh uh the the the symptoms the symptoms the symptoms of HIV they come because of uh uh because of their immunity has been compromised >> and uh there are no more symptoms like cough uh we have uh we have rashes and then we we just give an option we sell the services so that we the any person that is coming to the facility not to miss those services.

[00:07:11]>> Okay.

[00:07:11]>> Yes.

[00:07:12]>> So the rashes do they come in the whole body or >> No, it depends.

[00:07:18]>> Mhm.

[00:07:19]>> A a patient might come or a client uh with a oral fl >> in the in the tongue >> and then uh it's one of the signs they affect people that have been already been affected infected with HIV. But remember that we are saying doesn't mean that you are infected.

[00:07:40]>> It's just part of the symptom. Those are the few symptoms that accompany that that are found with a person that that a person with who has been infected presents with.

[00:07:52]>> Uhhuh. What's the biggest misconception people have about HIV testing?

[00:07:58]>> Myths and misconception.

[00:08:00]>> Yes. we have um uh I think this normally depends on the surrounding and the community >> uh because um like in this region >> you find that there's a region that people tend to think they have they have been bewitched >> depending on where that person comes from >> and um others think HIV or any people are infected with HIV when they have sexual contact.

[00:08:33]>> But uh as we know HIV uh pe a person cannot be infected with HIV only because he or she has part has has been has had that >> a positive sexual partner >> partner.

[00:08:51]>> Okay.

[00:08:51]>> Yeah. And uh we find out that uh most young people in Kenya or generally all all age groups most people fear testing for HIV. What might be these reasons as to why these people fear testing?

[00:09:09]>> Um now the the the the the platform or the background of HIV in the community is that when you are tested and you found HIV you are dead. Mhm.

[00:09:21]>> People interpret that that person who has been infected with HIV must die.

[00:09:28]>> Must die.

[00:09:28]>> That that instill fear into people or individuals not to test for HIV.

[00:09:35]>> Mhm.

[00:09:36]>> Yeah. And we have others that think that you better live with HIV without knowing than get going to be tested. Get tested and know that you had HIV. I think I'm one of those people.

[00:09:52]It's better to live with HIV without knowing than knowing you have it.

[00:09:58]>> There's that fear that comes with >> Yeah, that is natural. It means that you are a human being. If you are you can fear but again uh the good thing we have information that people don't don't know >> or they are not informed and this is number one probably if you are tested today you are you get that there is and you are infected with HIV >> at that given point you are infected >> the HIV is when that HIV IV has been your immunity has been compromised that is where it it moves from HIV and it becomes HIV AIDS.

[00:10:45]>> So AIDS is more dangerous than HIV.

[00:10:48]>> AIDS is an advanced stage of HIV.

[00:10:51]>> All right.

[00:10:52]>> Yeah.

[00:10:53]>> So what emotions do people show before testing for HIV?

[00:10:57]>> Uh people Okay. By creation people naturally people react differently in different cases and different scenarios.

[00:11:09]>> But most most people especially the youth they come like they they come with a lot of fear. They fear a lot because they don't know what they expect. They don't know whether they are infected or not. And at that given point you find them somebody thinking about if I get in tested today and I'm found positive that I've been infected what will I do does it mean my life has come to an end we they have so many other questions but this when you are you come to the services we have uh several processes that we take you through number one we have a pre-cancelling session these sessions number one the pre-ancelling session is to prepare you. We give you information why to test for HIV and the modes of transmission of HIV and the interpretation of results and in case you turn positive then we we we we give you information that you can live without you can live with HIV HIV testing HIV positive is not a death sentence. So during pre-ancelling what information do you give to these clients?

[00:12:27]>> We number one we have uh the importance of testing for HIV and number two uh we talk about the prevention of HIV. Number three, we talk about the the results, the interpretation of HIV and we talk about how we get the sample and which commodities the commodities that we use to for testing for HIV and then the time frame after after getting the sample, how long will we wait for so that we can interpret the results and probably we normally ask the clients how how they feel. Are they still ready or are they still ready to test for HIV? At that given point, if the client stop says no, then we stop. We terminate the session.

[00:13:19]>> So, a session can be terminated at the pre-ancelling stage.

[00:13:24]>> Very true. Before we get to the mode of transmission, >> if that client always the client is always late, >> if a client comes and at a certain point in the middle of the session, that client declines and says stop. I don't want that. I've changed my mind. We give that room because he's is a test that you need a consent for you to test. It >> is a volunteer.

[00:13:50]>> Is that voluntary testing?

[00:13:52]>> Okay.

[00:13:53]Um have you ever met someone who completely changed after counseling? You've already done the precancelling.

[00:14:01]You've done you've told them about these mode of transmissions and everything.

[00:14:05]Now someone who completely changed after that counseling. Yeah, we have very few cases of course because okay a client may change but very few but this totally relies on the precancelling session. If the pre-cancelling was done successfully then very few uh decline after getting tested and uh those few that get tested and they decline we also give them room we accept that you know it is a it's a new thing and a decision and a new results that has been given to that client. So we give room for that client to think and we we go back to we revisit the pre-cancelling session and we address the importance of taking drugs.

[00:14:59]Do you once you've cancelled this patient and they've decided to to decline the offer now, do you do a followup on these patients later because maybe the signs are very clear and this person has hasn't been tested like do you do a followup on these patients maybe because in any facility once you get there you have to give information on your address maybe phone numbers and all that. Do you do a followup? No, very true. We normally do the followup because every session that we start we are we we we are we purpose to complete >> with it is a client centered session that we are focusing on helping that client not anybody else. It's not about me as a service provider it's about the client. So we normally do some followup and uh we normally do that under the cover of confidentiality.

[00:16:02]>> We normally observe confidentiality because it is a results to that client not to everybody. So as we follow uh as we do some followup to ensure that this client has been helped uh get support and we normally even do some followup if we get that that client is declining he or she is declining because of maybe he comes within the surrounding maybe he knows one of the staffs we've seen we normally advise that client it is always uh there's that room always for referral we can refer to another's facility or advice or give give information uh to visit any other facility that is giving the same facility for the purposes of helping that client.

[00:16:49]>> Oh, that's nice. Um I'm just curious to know how do you handle these people once you know that this person is infected.

[00:16:56]It's it's humanly that to know that yeah these people are there and uh how do you handle them once you meet them out here you as a doctor because if I know someone is infected I'll tend to there are this misconceptions we we had even once you were little this person you know you do not want to share your items with this person how do you handle them now that you know a number of a lot of people and how do you deal with it to to avoid telling the community that this person is infected. I was testing this person. How do you handle it?

[00:17:33]>> Um we are just service provider.

[00:17:37]>> Mhm.

[00:17:38]>> And our services stops within the facility our services anything to share with client about his or her health that we separate. We move somewhere aside then we talk because we observe confidentiality. So we make we we these are our friends that come to this facility. So when we meet meet outside there we meet as friends not as a client and a and as a doctor. So that is where we we normally observe confidentiality and um then the main thing we we we do as we offer these services we let we let the our clients to understand that when we meet outside there we are friends and there is nothing we can discuss outside there unless he or she wants to ask me anything then we might move just aside from the crowd then We share because it is official and confidentiality. Those are our friends. We hug them. We greet them. We talk about and that is a that is public place. We talk about the public thing life and some not about health.

[00:18:57]>> So what is the hardest part of counseling someone?

[00:19:01]>> The hardest part of counseling someone is when somebody uh has been tested.

[00:19:10]He he or she came in knowing that he cannot turn to be positive and then you get that person turning to be >> positive. Go through this that when some a client come and that person is tested and that person turns to be positive.

[00:19:28]Nowadays we use three commodities unlike some other days we were using two. Now nowadays we use three. If client A comes and is tested and turns positive with using commodity number one, we repeat with the we use the second commodity one step. Then after one step turning positive, we use the third commod commodity known as first response. And if the third commodity will give two line that means confirmation that the the two gave the right the right uh results then we record that into into our system that that client is positive.

[00:20:13]We do not stop there. What will happens normally we use a national algorithm from the government and the national government states that if the first tester I've tested that person with the three commodities and the three commodities are given the same results concordance results that both are giving positive results. We refer to that client to the second tester for the process we we named we name as retesting session by the second tester. The second tester will repeat the same with the three commodities that is the national algorithm. If the client will be tested with the first commodity by the second tester, then the second test the result is positive then the second tester will go to the the second commodity one step.

[00:21:05]If that turns to be positive and then go to the third commodity which is the first response and thanks to be positive that is when we say now it is a confirmed positive and that at that given point that client is referred to care and treatment and that is about drugs.

[00:21:25]>> Oh so that goes to the other side of >> it goes to the other side of drugs that is by he or she will be attended by the clinician.

[00:21:34]>> All right. So you've talked about uh testing using three commodities for the first time and again for the second time. So all those processes are they done in a day?

[00:21:45]>> Yes, they they are done in fact nonstop.

[00:21:50]When we are doing pre-casting >> I think that that that is where we can get it right that when we are doing pre-ancelling we also mention the commodities that we use.

[00:22:01]>> Okay. When we are talking about the interpretation of results, if the commodity number one trend screen turns to be positive, then we are going to go to the next test commodity that is first one step. Then if one step gives a positive result, we go to the third commodity that is first response. But again we have to understand that is on a positive results. But if it is a a client that has come that client is tested and that client's commodity number one that is twin screen turn to be negative the process of testing stops at that given point and we give we have information important information that we give to all clients that have turned to negative.

[00:22:47]>> Number one uh safe sex practices. Number two, of course, we we mention use of condoms.

[00:22:56]And then number three, we we we ensure that there's a uh if that person is in a relationship, we advise or give information about uh partner testing or cop of testing.

[00:23:10]>> So you advise the person to get their partners tested.

[00:23:14]>> Yeah. We give them information. They they either come with a partner to be tested or go somewhere where they can get these services and get get tested together as a couple. Why? Because at times people are are in a relationship but you find one turning positive and the other turning negative that is a discordant couple.

[00:23:36]>> Okay. So we have questions on young people also. uh in your facil in your facility do we have young people testing enough?

[00:23:46]>> Yeah.

[00:23:47]>> Today >> yeah we have enough. You see we are surrounded by young people environment.

[00:23:54]>> We have the we have a university within.

[00:23:58]We have the kip within. We have those that are going KMTC. We have a college here.

[00:24:07]Uh we have a college here. And then so we they come they come and we they get tested after taking through the the pre-esting those process they accept we test them and we support them.

[00:24:22]>> That is nice having all these people around you. So at least you're getting these clients in abundance each day.

[00:24:30]>> Yeah. Yeah. Of course. But again what we what I must mention is that uh it's not every day the number cannot be equal every day but we have some days that like the weekends they come a lot a lot of them uh sometimes we have u and they have really supported us these young men because we have others that come and then when we test them we give them information so that they can get their colleague their friends getting the same information and then that is what we call uh that gives us a room to test the social network of the that youth.

[00:25:14]>> So you spread awareness through these young people who come here.

[00:25:17]>> Correct.

[00:25:18]>> Yeah. We have another question where what mistakes are common among youths concerning HIV?

[00:25:24]>> Wow. We have uh several mistakes that uh uh uh that our youths uh are affecting our youth uh nowadays.

[00:25:36]>> Mhm.

[00:25:37]>> Number one uh we have youths that don't believe that still HIV is existing.

[00:25:47]>> Mhm. Another thing we have another other youths that uh uh that uh that thinks that if you have sex with someone once you cannot get HIV.

[00:26:02]>> Mhm. And we we have other youths that uh uh that that they fall into a relationship minus knowing the uh status of their partners or their their >> So it is advisable that once someone gets into a relationship they have to know the status of >> Yeah, that is true. They have to get the status. They they have to know their status and they must go together. This one we must put it right. Why? Because you find somebody's having a relationship and uh this person is in Ky and someone is in Nairobi.

[00:26:44]>> So they they maybe communicate in a phone and they say go get tested then take a snapshot then >> let me see the result.

[00:26:55]>> Let me the results. This is tricky. This is tricky. The right way to do it is to go together, visit a facility that is offering these services, get tested as you are seated there and you you have a service provider there. Service provider will give you proper information that will support both of you in that relationship as you are moving on and that will give you room as a partner to see the other person's partner.

[00:27:23]Remember, but it is it must be consented. M >> because if you are partner again that is trick when we are counseling youths they they come to our room we are getting them they getting these services and at the end of the the end of the session when we want to interpret the results one says I don't want the other party to see my results we terminate >> the whole process >> the whole process and we don't give either the results >> and why will that happen if they both decided to visit the facility.

[00:28:00]>> Uh human beings we normally say that um human beings can change and we have room for that especially clients they have their rights. Mhm.

[00:28:14]>> So these rights of their the clients if if that person reaches a point and says no that is his right or her right that is we stop at that given point.

[00:28:29]>> So we we can attest to the question that trust in relationships can be a barrier to testing.

[00:28:37]>> Very true. Trust is a barrier.

[00:28:42]>> Okay. Uh how do couples react when asked to test together? Maybe we came from home. We are a couple. We've come we visited your facility and uh maybe one of us was sick and that is the person we want to be tested. Now have you tried when you tried talking to these people like they should all of them test they should do the test together. How do these couples react possibly?

[00:29:10]>> Wow. different different couples they react differently.

[00:29:17]Um we have scenarios that you get yes one of them was sick they came to the facility for the purposes of getting treatment but upon reaching the facility we have done screening maybe they are together there then uh you see we sell what other what's our services and maybe one of them wants to be tested both of them to be tested and the other doesn't want to be tested Then at that given point you can see it it al somehow they there is pull and pull and push but again we give them room with give them room with uh we give them information the importance of testing together and uh why they should see the other the the spouse's results and um uh when they should tests. As a couple, we give them information. But again, sometimes you find that uh we have couples that come to the facility, they come purposes for the for testing.

[00:30:31]>> But you find that uh you find that upon doing uh pre-ancelling testing, you find that one couple did not want to test.

[00:30:41]Maybe he she he was forced to be tested because of in some questions in life in infidelity. Right?

[00:30:52]>> So at that given point we also give them information. Uh we tell them the importance of testing together but we give room to the other party to accept to to consent so that we can test.

[00:31:08]Otherwise if that person declines again as we said earlier we terminate that session but again at times we terminate and you find the other party who wanted to be tested goes on to test wants to test and uh probably he or she wants that the partner to sit in the session.

[00:31:28]>> Mhm.

[00:31:28]>> Normally we it's not it's not right.

[00:31:32]>> It's not right. We we we we advise that uh the only one the the the the person that wants to test to be in the room, get the services, then we give results to to that person.

[00:31:46]Of course he he or she looks at the results and then we allow that person he or she is a grownup he can share he can tell the partner about the results how was the outcome >> and uh how should this partners communicate about HIV testing maybe one partner feels that yeah they should go for this testing but this person lacks a platform to talk to the partner that I feel that we should do this HIV testing How should these partners communicate?

[00:32:19]>> Uh that totally depends on uh uh how they communicate naturally normally in a relationship.

[00:32:28]>> You see if there's there are things that you don't share, you have never shared with your partner, >> it becomes difficult for you to start sharing. But uh if one one of the partner can can get that can be bold enough and start that uh conversation, what is expected is the one that is starting that conversation should be polite enough should not uh should consider not to coers the other party as sharing >> uh so that he can he can uh he or she can put it as a suggestion. question if they can get go test together but not tell somebody in the house we must go test tomorrow that one is not allowed >> so they can give it as a as a suggestion so the other party thinks about it >> yeah you give room that person thinks about it and uh if that person g says yes then you come >> for testing or you you visit the the center that is giving these services.

[00:33:40]>> Okay. We have stigma as a big problem in the society.

[00:33:45]>> Can you talk about it?

[00:33:47]>> Stigma.

[00:33:49]Wow. Especially when we are talking about stigma.

[00:33:54]Especially from way I see it and my observation stigma. Stigma when it come to percentage men have more stigma than ladies. Mhm.

[00:34:08]>> Uh-huh. They like u you see it depends totally in what is in your mind. We have people that think if I go for testing service provider will see me as a somebody is moving up and down everywhere.

[00:34:26]>> You see >> it's true.

[00:34:27]>> Yes. So from that judgment alone somebody tends to be like feels it's not okay for me to go. it's not right for me to go for for testing. But um uh and again people stigma comes in again uh upon people thinking that if I turn positive the outcome positivity outcome what will people say I did to be infected? How will the community see me as a as a husband or as a wife automatically? They they also think to an extent that the community will know that they they are positive.

[00:35:16]So they that one I know it is something that is adding and contributing so much when it come to stigma.

[00:35:24]>> How how can we handle this? How can these people handle that situation?

[00:35:31]>> Wow. Handling that situation about stigma. It's only about understanding.

[00:35:37]Get get to visit a a center that is offering HIV even if you are not going to uh to be tested.

[00:35:47]>> Ask get more information about HIV. If you get more information about HIV and you become informed enough then I know stigma will will not be there. But if you fear or you are not like uh if again if you want if you must get information about HIV visit centers that are offering these services and visit a service provider who knows about HIV. Not everybody. Somebody that knows about HIV will give you information that will support you in terms of getting tested to HIV and again and how to live with HIV because there is life after turning positive.

[00:36:35]>> So how does the society treat people after a positive result? That is where we find that uh someone has tested positive and maybe needed someone to talk to. they've talked to someone out there in the society and now these people do this now these people who've tested positive normally they come back maybe after they've been treated badly and they talk to you about it >> give us more information >> wow when it comes to our community uh it is true that some handle they treat people that are that they have known that they're HIV positive differently but uh as I said earlier it totally depends on the information you have but um that is why we as service provider we are fear to confidentiality so much and we give while testing