Dr Pillay encourages HIV screening and COVID-19 vaccination
General practitioner Dr Unben Pillay says the COVID-19 pandemic has caused a dramatic drop in the number of people being screened for HIV and accessing HIV treatment, and we must reverse this trend. He also strongly encourages people who live with HIV to be vaccinated against COVID-19.
"For people who live with HIV, contracting COVID-19 comes with the risk of serious illness."
Get vaccinated for COVID-19. This is Dr Unben Pillay's emphatic message to his HIV-positive patients.
Dr Pillay is a general practitioner (GP) with a special interest in HIV. Based in Midrand, Gauteng, his practice has been treating HIV-positive patients for more than 20 years.
"I see a lot of patients who live with HIV and who are hesitant to be vaccinated against COVID-19 because of all the fake news about the vaccines," says Dr Pillay. "Because patients trust their doctors, we have an important role to play in making sure they have proper knowledge. For people who live with HIV, contracting COVID-19 comes with the risk of serious illness. We're not always certain what's going to happen with the next wave of infection, and we need to make sure our patients are better protected."
HIV patients default on their treatment during the pandemic
Before the COVID-19 pandemic began, Dr Pillay says most of his practice's HIV-positive patients were virally supressed and keeping up with their treatment plans. The practice would keep in touch with patients to make sure they took their treatment and to find out how they were doing. "COVID-19 changed that. We lost track of a lot of patients. Many patients stopped taking their medicine and that's been a really big challenge," says Dr Pillay. He mentions that, according to South African medical schemes, between 15% and 20% of HIV-positive people stopped taking their treatment during the pandemic. Many people stopped going to their doctors and pharmacists because of the hard lockdown or the fear of contracting COVID-19, or because of loss of income. "When COVID-19 came along, we lost our ability to see and counsel our patients. It's not just about patients being able to collect repeat scripts - we can email those to them. It's about contact with their doctor to see how they've been doing and if there are any issues we've missed," says Dr Pillay.
HIV screening should be part of routine medical check-ups
The number of people getting screened for HIV also dropped during the pandemic, especially during South Africa's first Alert Level 5 hard lockdown.
Dr Pillay recalls how difficult it was to convince patients to be tested for HIV when he first started treating the disease more than 20 years ago, because the stigma around HIV was so much worse than it is now.
He believes that all patients should be tested for HIV when they visit their GP as part of routine screening, whether they've been tested before or not.
Dr Pillay has made a point of making HIV screening easy for his patients. His practice has an on-site laboratory where they can get their blood drawn. "We've found that our patients' compliance is better because we have free VCT and ELISA tests easily available," says Dr Pillay. "This also means we can pick up complications, compliance issues and drug resistance faster."
(VCT is voluntary counselling and testing for HIV, which allows people to have HIV and AIDS counselling so they can make an informed decision about being tested for HIV. The ELISA, or enzyme-linked immunosorbent assay test, is usually the first one used to detect HIV infection with HIV.)
HIV is a chronic illness
Dr Pillay is grateful for the advancements that have been made in medicine since he first started treating HIV-positive patients.
"All those years ago, the patients we saw were really sick. There was nothing we could do for them because we didn't have access to medicine," the doctor recalls. There weren't many doctors treating HIV back then and the medicine that was available had many unpleasant and often long-term side effects.
"Today we treat HIV like any chronic disease in our practice. We manage it as we would manage diabetes or hypertension. We don't have an HIV clinic day and we don't put HIV-positive patients on any special programmes, because that just adds to the stigma around them," he says.
"We don't treat the disease. We treat the person."
Treating HIV as you would treat any other chronic disease helps take away any stigma faced by HIV-positive patients. Dr Pillay also explains that HIV, like other chronic illnesses, is complex to manage.
He counsels his HIV-positive patients and their families and manages co-morbidities (other medical conditions) and lifestyle diseases that they have developed since contracting HIV. "We don't treat the disease. We treat the person," he says.
Collaboration with Discovery Health improves outcomes for HIV-positive patients
Dr Pillay works closely with Discovery Health Medical Scheme's HIV Care Programme's case managers to help his HIV-positive patients who are members of Discovery Health Medical Scheme to stick to their treatment.
"I may speak to a case manager because a patient has decided to stop taking medicine," he says. "Or sometimes a case manager tells us a patient hasn't collected their medicine for three months. There is no way I would have known that without their insight. It really helps us when they give us information that we wouldn't necessarily have had at our fingertips."
"Between us, we will then look at the best options available to us to get a patient back on treatment. It is a team effort and I think that's why we get such good results in our patients," Dr Pillay explains. He says that the HIV Care Programme team have also referred patients to him who haven't yet been put on treatment or are struggling with their HIV treatment for some reason.
The HIV Care Programme helps HIV-positive individuals to get clinically sound and cost-effective treatment. The programme gives a patient and their Premier Plus GP access to various tools to monitor and manage their condition. Cases are dealt with individually and with complete confidentiality.
Find out more about the Discovery Health Medical Scheme HIV Care Programme