HIV? Me? No, I am married (18)

“Doctor, please tell my husband what is going on.” Nma put her hands together under her chin and sighed.

I stared back at her confused for a moment.

Could it be that she hadn’t told him her status? Was she seriously expecting me to do this? First her daughter, now her husband. How many more family members was I expected to break this news to?

I felt a bit panicky at the thought of Nma bringing an endless line up of sons, daughters, uncles and aunties, in short a whole clan of people for me to speak to.

Nma had come back to see me with her husband a week after I’d seen her with her daughter. I was glad they had come together. I immediately recognised Dike, though we hadn’t met for nearly a year. He looked much older than I remembered but still had that distinguished look about him. Perhaps a few more grey hairs than last time.

“This is my husband, Dike,” Nma spoke once they sat down.
I had nodded at him and smiled. I wasn’t sure how much he had disclosed to Nma. Had he told her his status? He nodded back at me, his face blank. Maybe he didn’t recognise me.

“Nma,” I started trying to gather my thoughts. “I…”

“What is going on, doctor,” Dike snapped. “My wife has been losing weight, she is always tired, I have found her crying on several occasions for no reason…is she at meno…meno…whatever you women experience when you are older?”

What! I screamed inside. If it hadn’t been such a serious situation, I was sure I’d have burst out laughing. Instead, my mind went into a tail spin. What game was Dike playing??

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HIV? Me? No, I am married! (16)

I stood up when he did, our eyes clashing. For once I was grateful for my
height because he was really tall and imposing. I wasn’t going to be
intimidated, however.

“Please do the right thing. Tell her your status so she can get tested’.”

He maintained his defiant stance for a moment.

“And if I don’t?”

“I owe you a duty of confidentiality as my patient so she will not hear it from
me without your permission. But be aware that its a legal offence to
deliberately engage in activity that will get another person infected with
HIV.”
HIV, SEXUAL HEALTH
He lowered his gaze. I could see he was reconsidering so I pushed on.

“Remember it’s not a death sentence, HIV can be treated even though there is no
cure. If she is positive, you can both receive treatment and support each other.
If she is negative, then you can take steps to protect her like making sure you
always use condoms during sex.”

He sighed heavily, rubbing his hand across his forehead. I felt a twinge of
compassion for him.

“Okay” he said at last, raising his eyes. I smiled at him.

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HIV? Me? No, I am married! (15)

HIV, SEXUAL HEALTHDike looked up finally.

“I couldn’t tell her. She will be furious to learn I have been with other women.”

”We are talking about a serious infection, Dike. If she doesn’t get tested, she cannot benefit from treatment if she needs it. If she is tested and she is negative, then she can protect herself and not have to get HIV as well.”

”I can’t” he said with a note of finality.

I felt myself getting angry. How selfish! All he could worry about was losing face before his wife.

”But what of her health?” I demanded.

He picked up his keys off the table – his usual way of signalling that he was finished with me.

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Talking Sex in the Afrocarribean Community.

Afrocarribean health event, sexual healthRobert Gordon University (RGU) recently hosted a conference to highlight sexual health amongst the Afro-Caribbean diaspora. Several delegates attended the free event at the university’s Riverside East building on Saturday, April 19.

Sponsored by NHS Grampian Sexual Health and Blood Borne Virus MCN and African Health Project Waverley Care, the conference boasted an impressive line-up of keynote speakers.

Conference convener Dr Adaeze Ifezulike is GP Clinical Lead for Sexual health and Blood borne Viruses in NHS Grampian and author of the Amazon Bestseller book “Understanding Contraception.” She said: “The Afro-Caribbean community make an invaluable contribution to the energy sector, NHS, educational sector and indeed all areas of UK business and yet continues to lag behind in sexual health issues with high abortion rates as well as HIV/AIDS and Hepatitis B infections. “This is completely unacceptable and one of our objectives at this conference was to mobilise both the healthcare and Afro-Caribbean communities to take steps to improve our sexual wellbeing.”

Dr Winifred Eboh, a senior lecturer at Robert Gordon University, helped to organise the event and gave her own presentation entitled: “Cultural misconceptions that affect sexual behaviour and risk taking.” Dr Eboh said: “We’re very proud to have hosted the conference here at RGU and add our support to this cause. We have received great feedback from delegates who said they found it interesting and informative, and enjoyed the interactive nature of the event which allowed detailed discussions. “Sexual health and wellbeing amongst the Afro-Caribbean diaspora is a very important topic and we hope the event has helped to raise awareness of the work being done to address a number of issues in this area.”

Afrocarribean Health event, sexual health Other speakers on the day included Dr Emmanuel Okpo, Consultant Public Health Physician at NHS Grampian, Dr Daniella Brawley, Consultant in Sexual Health at NHS Grampian and Katai Kasengele from Waverley Care. Dr Okpo reviewed the state of sexual health (unplanned pregnancy / abortion / HIV and Hepatitis B/C) in the black community in the UK and Dr Brawley’s presentation helped to put the side effects of contraception into perspective with the treatment of blood borne viruses. Katai Kasengele showcased the work of African health projects and support available for Africans living with HIV.

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HIV? Me? No, I am married! (13)

  “It’s okay,” I hurried to reassure her. ”Noooo,” she screamed. ”Mum, tell me that’s not true.” ”Its true.” ”How could that be?” Aka asked at us both, bewildered, ”….does it mean…Daddy?” She stopped in confusion.

”I really don’t know,” Nma answered her unspoken question. ”What’s going to happen now?” Aka started crying.

”I know it’s a shock,” I said gently. ”But things have changed a lot and HIV is no longer the death sentence it used to be.With treatment, many people live normal lives with HIV.”

”Everybody will find out and we will be ostracised,” said Aka. It appeared she hadn’t heard a word I’d said.HIV, Black women health

”No one needs to find out,” Nma spoke sharply to her daughter. ”You are not to tell a soul, promise me.”

”But Mum..!’ ”Promise me NOW!”

”OKAY, OKAY!”

”I only wanted you to know because I have no one else to tell,” Nma’s voice broke and she sobbed quietly.

It was as if seeing her mum cry sobered Aka. Wiping her own tears, she tentatively reached out to Nma and gave her a hug. ”Its okay, Mum,” she whispered.

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HIV? Me? No, I am married! (12)

HIV, Black women.”You knew all this while,” I had exclaimed.

”I bought an HIV testing kit off the internet and the result came back positive.”

”When was this?”

”About a month ago.”

”I see.” But I didn’t see at all.

”So why were you reluctant for me to do the test?” I asked, remembering how he had flared up when I mentioned testing for HIV.

”I don’t know,” he shrugged. He put his head in his hands and sighed heavily. We were both silent for a moment.

”We need to do another test to confirm and check your viral load. The viral load tells us how many of the HIV viruses are circulating in your system and helps us decide if you need to start treatment now or wait a bit.”

”Okay.” He rubbed his fingers across his eyes. I noticed for the first time some gray strands of hair at his temples.

”And your wife…”

He looked up. ”What about her?”

”She needs to be tested as well.”

He sighed again heavily.

Click here to download Dr Adaeze’s special report on Optimising sexual intimacy.

Click here to learn about the Afrocarribean health event on the 19th of April 2014

HIV? Me? No, I am married! (11)

Black couple

Dike returned for his blood test result a week later. He’d called the receptionist for his result but, due to our surgery policy, this could not be given over the phone and he had been asked to make an appointment to see a doctor.

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”How is work?” I asked when he sat down. He looked the picture of prosperity with his well-cut brown suit and an expensive tie to match. “I must get my husband one of those ties for his birthday,” I thought as my mind strayed momentarily.

”It’s going very well. I have just been promoted and my company is sending me to Angola for a few weeks.”

“Lucky him,” I thought and wondered how I ended up becoming a doctor and not an engineer in a wealthy oil company. All expense paid travel, luxurious homes… I had to discipline my mind to stay in the clinic and not drift off to Abu Dhabi.

”Oh, that’s lovely! Congratulations!” I was genuinely pleased for him.

”Thanks. So about the test…?”

”Well, I’m sorry, I don’t have good news for you.”I paused. 

It seemed that all I had done today was give out bad news to patients. There was the man with lung cancer, the lady whose wrist had broken after a minor fall, the lady who’d been barren for 12 years and had forgotten about childbearing only to find out she is pregnant and wouldn’t hear of keeping the baby. She was still trying to work out why the pregnancy was bad news for her. Oh well!

”Yes?”he asked.

”One of the viral tests was positive.”

We talked for a while. And long after Dike left I sat stunned and unable to move on to my next patient. How could this be? Had I really heard him correctly…?

 

Click here for information on the Afrocarribean Health Event this spring.

Click here to download my free article “6 Keys to Outstanding Sexual Intimacy.”

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Condoms – do they fail or do you? (3)

”Which one of you is taking up the responsibility to ensure you always have condoms available ?” I asked.
(If you havent met Amina and Baako, you can meet them here and here)

”It’s a woman’s job, isnt it?” Baako shrugged.

”What makes it a woman’s job to provide contraception?” I was curious.

”Ask him, please!!” Amina said irritated.

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Sexual Wellbeing Network

”I will wear it if it’s available but don’t expect me to go into a shop to buy condoms.”

”Really! How do you think I look when I go to ask for condoms? What do you think the shopkeeper is thinking of this woman who has not only bought some spinach but also a box of condoms?? Eh?”

”That you have sex…” Baako teased.

Amina shook her head in despair.

”Well, the surgery has some free condoms in the toilet if you want to pick up some on your way out,” I offered, smiling.

Should you feel awkward when you go into a store to buy condoms?
Does your doctor’s clinic stock free condoms? Should they?

My Contraception failed me!!

A dear friend called me on phone a few days ago. We had talked about contraception in the past and after the birth of her last child she had started using a new method of contraception like any responsible person who didn’t want an unplanned pregnancy.

So I was stunned when she said she had done a pregnancy test and found out she was pregnant despite her contraception.

I know none of the methods are 100% effective (try abstinence or hysterectomy if you must have 100%) but it’s always a huge surprise to me when I meet someone who is the <1% person who will get pregnant despite using an effective method that does not depend on user expertise.
Methods like coils, implants and injections just do the job without any help from you but, very occasionally, they fail.

I could feel her distress and confusion.

What had gone wrong??
She did as she was told and yet….

How do you counsel such a person? What can you say to make it right?

Nothing really except to empathise and crosscheck that they had indeed done everything the right way.

Ensure they attended their three monthly injections on time… check.
They could feel their coil threads after each period and it hadn’t been pulled out with the tampon… check.
The implant can be felt in their arm… check.
The pills were taken regularly, they hadn’t had diarrhoea or vomited and lost the tablet… check.
They used the condom consistently and correctly… check.

So what next?
At this point I let each person go and talk to their spouse and decide on what to do. Only they can make the decision. Whatever decision they arrive at, my role is to support and not judge.

Sexual Wellbeing Network

Sexual Wellbeing Network

And I explain again carefully to the next person how to use a method properly while in my heart hoping and praying that they are not the <1% who the method will fail.

Have you ever been failed by your contraception? What went wrong in your case? And what helped to make things right?

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