'I used to be beautiful': Progress in management of HIVAids

Prof Omu Anzala Director of the Kenya AIDS Vaccine Initiative.

One of my memories of the HIV pandemic in Kenya, whose treatment is now widely available in Kenya, is of my cousin who contracted HIV. She was the belle of the village, as they say, and there was never a shortage of men pursuing her. This being the early 90s, she dreamt of a Prince Charming who would whisk her away to the big city. She did, eventually, marry; I thought the husband was charming, but they remained in the rural areas.

In those days, it was only after you heard of an unexpected death that you would be triggered to conduct an HIV test. My cousin's husband died, and she tested positive. There was a free anti-retroviral programme run by PEPFAR for which we managed to get her enrolled.

These were the early days of people living with HIV and the combination drug therapy 3TC was just being rolled out. Patients till then had to endure multiple drugs with severe adverse side effects - the effects from patient to patient. And some symptoms were a result of the co-morbidities or better yet, infections that a person became more susceptible to as a result of a weakened immune system.

It is also important that you understand that while I am a medical doctor, I ventured into medical research earlier on in my career with minimal clinical practice.

Therefore, my cousin's request when I once visited took me by surprise. I can still hear her raspy voice when she says, "Help me, my friend, I don't want to live anymore." Naturally, I encouraged her to keep on taking the anti-retroviral and assured her that there will be better drugs to come - researchers were working day and night.

True enough, HIV management has come a long way. Decades ago, we wouldn't have imagined at-home testing kits; pre-exposure prophylaxis from pills to vaginal rings, and patients living with undetectable viral loads. In recent times, FDA has approved Long-acting anti-retroviral therapy in the form of intramuscular injection given every six months.

My cousin has since died and, in the end, she had her way. She simply refused to take her ARVs and I can recall what she said to me, "Look at me now, I am nothing but sick and bones. I used to be beautiful. I don't want to live anymore."