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Fresh Start L E A R N . A C T. S U P P O R T

WORLD AIDS DAY 2013 GETTING TO ZERO ZERO NEW HIV INFECTIONS ZERO DISCRIMINATION ZERO AIDS RELATED DEATHS

HIV-POSITIVE WOMEN & BREASTFEEDING Pamela Morrison, IBCLC

MASSAGE THERAPIST & HIV/AIDS RINALDA, FHT, IRMT

HIV & YOUTH Hadassah Hector


Editor’s Outlook T

oday, December 1st is commemorated as World AIDS Day by all countries across the globe. The theme chosen for this year is “Shared Responsibility: Strengthening Results for an AIDS-Free Generation”. The commemoration of this day is an opportunity to unite in the response against HIV/AIDS, show our support for people living with HIV/AIDS and to remember people who died from this epidemic. Everyone has a right to live a full and productive life with dignity. No one should be discriminated against because of their HIV status. A people-centered approach requires collaboration with partners, local and international NGOs, community-based organizations, volunteer organizations, networks of people living with HIV/AIDS, and national HIV/AIDS programs for those affected and infected. Our HIV/AIDS Awareness Supplement is part of Fresh Start's commitment to Whole Health. OMO™ and Best Start™ encourage you to help promote an AIDS-free generation through education, policy, support and compassion. Learn. Act. Support World Aids Day 2013 Adepeju Oyesanya, MPA, CLE Editor in Chief

Contact Info Best Start™ #9 Hamilton Street Woodbrook, Trinidad, W.I. Tel: 1.868.741.8907 Email:info@omobeststart.com Web:www.omobeststart.com Facebook: OMO and Best Start

Please note: The material and information in this publication are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a health care professional before implementing changes to your diet,exercise or routine or before adding or stopping new modalities. Nothing contained in this publication should be constructed as an endorsement by Best Start™. 2013 Best Start. All rights reserved. Reproduction of this publication, in whole or part, is forbidden without permission of the publisher. Volume 3, December 2013.


It’s Everybody’s Business

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OCCUPATIONAL

THERAPISTS STRATEGIES FOR HIV/ THOSE

WITH

AIDS

HIV/AIDS is a serious medical condition that affects men, women and children. Occupational Therapists, OTs, are specialists who help people of all ages to live their life to the fullest through environmental adaptaby Rona Silverstein, OTR/L tion, and teaching new skills for persons suffering from various physical or mental conditions. With a diagnosis of HIV/AIDS, men, women and children live with compromised health and can benefit from strategies that are often recommended by their medical team, including occupational therapists. Occupational therapists will choose the best approach for a person’s treatment. It may be restorative (to restore lost skills) or compensatory (compensate for lost skills.) The following are some real life examples: • If a person is weakened due to prolonged bed rest, such as what occurs when someone is hospitalized, a restorative approach is provided to strengthen and improve activity tolerance. Sitting up in a chair and doing seated tasks can improve a person’s stamina. The expected outcome is improved activity tolerance to regain those temporarily lost skills. • If a person has increased physical needs due to mobility issues, then compensation for these challenges needs to take place. Performing daily tasks can be done seated instead of standing. Cleaning can be done seated as well. If in a wheelchair, clothes can be put in dresser drawers instead of hanging in the closet for easier access. Men and women with HIV/AIDS often have different concerns and priorities. These can be cultural and attention is always paid to the patient’s priorities. Occupational therapists treat both the physical and the mental health issues associated with HIV/AIDS. As with any other illness or disease, coping strategies and emphasis on identifying concerns and problems are often addressed within the occupational therapy treatment session.

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• Energy conservation technique: reduce large chores into smaller ones, take rest breaks, delegate if living with others who can help and pace activity far enough apart to allow for rest and recovery. • Sitting in a supported position with feet supported, hips at 90 degrees. • Use a cane, walker or wheelchair if needed. • Use good foot care to protect your skin. • Relaxation techniques for pain management and anxiety. • Use safe techniques when running bath water. • Cognitive strategies: write things down. • Develop a routine and structure your day. • Develop healthy coping strategies. • Find and maintain a support system. Children most often contract HIV/AIDS in and around childbirth. Their experiences due to their age are somewhat different than adults. The areas that an occupational therapist would look at include: • Physical needs of a growing infant and child • Neurological concerns • Developmental issues • Mental health concerns In addition, occupational therapy looks at a child’s age, appropriate self-care, skills and levels of independence. Examples of this may be dressing, grooming and toileting. Often, OTs may suggest environmental modifications or adaptive equipment to make these tasks easier. For children of all stages and ages with an HIV/AIDS diagnosis, similar to any child with illness or disease, their primary occupation is playing and interacting with their caregivers. Occupational therapists look at a child’s functional performance in these play tasks. Occupational therapists may: • Educate parents on how to help their baby or child • Facilitate movement to help a child reach, crawl, and move • Help a child learn to follow 2 or 3 step instructions • Help a child cope with disappointment • Help a distracted child by reducing environmental noise • Build skills for sharing, taking turns and playing with other children • Help a child develop the ability to use toys and play and be creative with them

In conclusion, men, women and children who are diagnosed with HIV/AIDS have occupational therapy needs that are both unique to the condition but also similar to other conditions. Occupational therapists are members of the medical team that can assist an individual in restoring lost skills, improving function, and/or learning other ways to perform the task. Each person is an individual and each course of treatment is customized. By working to have the best quality of life possible, the support of others (friends, family and medical team members) is important and vital. **Credit to the AOTA (American Occupational Therapy Association) and the CAOT (Canadian Association of Occupational Therapists) for providing resources for this article. For further information, contact them at www.aota.com and www.caot.ca. Rona Silverstein has been an occupational therapist for over 20 years. Rona is a graduate of Wayne State University in Detroit, MI and has practiced in the United States including UCLA in Los Angeles, CA.  Currently, Rona is a school-based therapist working for PediaStaff and is in the public school system in Chicago, IL's northwest suburbs.  Rona has raised 3 children and considers them her greatest accomplishment.

Breastfeeding

Think

The following is a list of frequently recommended strategies that seek to assist the adult with HIV/AIDS.

Class Offerings Woodbrook Learning Sessions

partnering with parents for better outcomes 9 Hamilton Street, Woodbrook (1st right after One Woodbrook Place)

www.omobeststart.com | email: info@omobeststart.com OMO and Best Start | 868.741.8907

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CONTEXTUAL

CONSIDERATIONS OF BREASTFEEDING WITHIN HIV-POSITIVE

MOTHERS IN T&T

Breastfeeding is supported worldwide as the best nutrition for babies but much discussion surrounds breastfeeding for HIV-positive mothers. We believe in fluid conversations that are based on evidence and best practice guidelines with an understanding that culture, resources and information affect decisions. In Trinidad and Tobago the Ministry of Health’s policy supports formula feeding of babies born to HIV-positive mothers. Formula is provided free of charge and breastfeeding is actively discouraged. This policy was put in place before it was known with certainty that when a mother’s viral load is so low as to be described by laboratory results as “undetectable”, the risk of transmitting HIV by breastfeeding is 0-1%. During pregnancy, today’s generation of HIV-positive mothers in Trinidad and Tobago may wish to have a frank and informed discussion with their health care providers about their specific circumstances. Would they be willing and likely to continue follow up visits for mother and baby should they embark on breastfeeding? What does exclusive breastfeeding entail? Would secrecy of the mother’s HIV status, due to stigma, place efforts of exclusive breastfeeding at risk? How does the risk change once weaning begins? How reliable will the supply of ART medication be? Breastfeeding with HIV is considered safe if baby receives only breast milk for the first six months and the breastfeeding mother’s viral load is known to be undetectable. Exclusive breastfeeding for the first six months of baby’s life requires the active support of others such as grandparents and partners. All involved must understand and support mother’s need to continue her medication and to have her viral load monitored. A mother with a young baby and family may need support simply to get to her medical appointments on time. And with many relatives openly opposing exclusive breastfeeding, viewing it as “tiresome and unnecessary,” a commitment to exclusive breastfeeding would be a critical ingredient. Mothers would also want to know why the risk of HIV transmission has not been found to be zero consistently. What factors cause a small percentage of babies whose mothers are on ART while breastfeeding, to become infected anyway? And if these factors can be identified, can our Ministry of Health create a policy which when followed will reduce the risk to zero?

Fresh Start Editorial Board 6 FRESH START


by Pamela Morrison, IBCLC Photography by Best Start™

WHAT HIV POSITIVEWANT TO WOMEN KNOWABOUT BREASTFEEDING

The tiny Human Immunodeficiency Virus, or HIV, is passed during the most intimate and important moments of women’s lives, during love-making, while giving birth to their babies, and during breastfeeding. Without preventive drugs, approximately 30% of their babies will become infected.1 Of interest, the risk of the baby becoming infected is twice as high during the 24 hours surrounding birth as it is during 24 months of breastfeeding. If left untreated, HIV leads to the deadly group of diseases known as the Acquired Immunodeficiency Syndrome, or AIDS. Yet in recent years, development of drugs to treat or prevent HIV, known as antiretroviral therapy (ART) can halt the spread of HIV within the body, transforming HIV from a lethal infection to just another chronic disease, like diabetes. ART’s effectiveness can be monitored by tests that show the declining levels of virus (or viral load) over weeks and months to the point that the virus becomes virtually “undetectable”. Treatment also allows the immune system to recover its efficiency. This means that HIV-positive women who are careful to take their prescribed ART can now expect to enjoy a normal life-span.2 Equally as important, an undetectable viral load means that the HIV-positive individual’s infectivity, (that is the ability to infect others through the exchange of body fluids during sex, pregnancy, birth and breastfeeding), becomes so low that the risk is said by some experts to be NIL.3 In times gone by, before the availability of effective ART, HIV-positive women were urged not to have sex, not to become pregnant and not to give birth to their babies in the normal way, but by Caesarean section (C-section), in order 8 FRESH START

to avoid exposing the baby to the virus in the birth canal. And, for nearly three decades, they have received the clear message that on no account should they breastfeed. However, while it was known that formula-fed babies could be saved from HIV in breast milk, a higher number died from the more common infections associated with formula feeding such as pneumonia, diarrhoea or malnutrition.4 News of these developments has caused today’s HIVpositive women to start asking questions. Can they have babies without passing on the virus during pregnancy? Can they give birth naturally, instead of having to have a Csection? Current policy on prevention of mother-to-child transmission of HIV in Trinidad & Tobago prohibits breastfeeding,5 but health outcomes for formula-fed babies are unknown. Might breastfeeding with ART be safer? In 2010, 1.6% of pregnant women (205 expectant mothers) in Trinidad and Tobago tested HIV-positive,6 but only 80% of them received medications during pregnancy to help prevent infection of their babies. By 2015, it is estimated that 184 more HIV-positive mothers will give birth and altogether nearly 250 children will be infected with HIV. Some HIV-positive mothers say they have always wanted to breastfeed because it just feels right. Others who live in areas where breastfeeding is the normal way to feed babies fear that bottle-feeding may be associated with a positive HIV status, which will lead to stigma, ostracism and violence. Still others may not have safe water supplies, or enough money to buy the 40 kg of powdered formula it will take to feed one bottle-fed baby for the first year or life.


Early ART Ideally, all expectant mothers should be offered HIV testing early in pregnancy. The World Health Organization recommends that all pregnant mothers diagnosed as HIV-positive start ART immediately and that treatment should continue for life.7 Women have the best chance of lowering their viral load to undetectable levels by the baby’s due date if they receive ART for at least 13 weeks before the birth.8 The British HIV Association recommends that a decision regarding how the baby should be delivered (vaginal birth or Csection) should be made after review of viral load results at 36 weeks of pregnancy. For women with a viral load of less than 50 copies per millilitre, and if there are no other problems, a planned vaginal delivery is recommended.9 The importance of exclusive breastfeeding Outside the context of HIV, mother’s milk provides perfect nutrition for babies’ growing bodies and brains,10 11 and protection from infection and allergy. The highest protection occurs when babies are exclusively breastfed during the first six months of life. This means that the baby receives no other foods or drinks except breast milk. For HIV-positive mothers, the importance of exclusive breastfeeding posing a greatly reduced risk was first documented in 1999,12 and subsequently confirmed in 200513 Even when mothers received no ART, exclusive breastfeeding reduced the risk to babies by 75% compared to those who received other foods and liquids. Feeding other foods and drinks too early may damage the baby’s gut, allowing virus in the breast milk to enter the baby’s bloodstream.14 Antiretroviral therapy and exclusive breastfeeding However, the best results have been achieved when HIVpositive mothers receive effective ART and when they exclusively breastfeed for the first six months. Since 2007, no fewer than eight separate studies reveal that the risk of their babies becoming infected during breastfeeding can be reduced to 0-1%. 15 16 17 18 19 20 21 22 Continued partial breastfeeding with the addition of other foods and liquids, as recommended for babies outside the context of HIV, resulted in an extremely low risk of transmission up to 12 months.21 23 24 Prevention of mother to child transmission requires that mothers take prescribed ART without missing any doses for at least 13 weeks prior to delivery. 25 Women on ART for less than 4 weeks have a 5-fold increased risk. In some studies, the only cases of mother-to-child transmission during breastfeeding have occurred when the mother stops taking her medication altogether, or when she has received it for too short a time before giving birth.20 24

Revised HIV and infant feeding recommendations These findings caused the World Health Organization to issue revised HIV and infant feeding recommendations in 2009 26 confirming for the first time the safety of breastfeeding with ART. In 2012 WHO further recommended that HIVpositive women should receive ART on diagnosis, to be continued for life.27 So exclusive breastfeeding with ART is now recommended to 6 months, with continued breastfeeding and appropriate weaning foods to 12 months.28 This revision frees health workers from having to recommend unsafe formula-feeding. It also enables HIV-positive mothers to avoid the stigma surrounding bottle-feeding.29 Most importantly, the new recommendations ensure that the greatest number of HIV-exposed babies will not only survive, but thrive. In 2011 the British HIV Association recognized 30 that an HIV-positive woman already receiving ART, with a repeated undetectable viral load at delivery may, after careful consideration, choose to breastfeed. In this case they recommend: • Continuing maternal triple ART and short-term infant prophylaxis • Exclusive breastfeeding for 6 months • Frequent follow-up • Careful monitoring to ensure that mothers take ART until 1 week after weaning, • Monthly checks on maternal viral load and infant HIV status. In January 2013, the American Academy of Pediatrics (AAP) published similar guidance 31 allowing that an HIVinfected woman receiving effective ART with repeatedly undetectable viral loads may choose to breastfeed. The AAP recommends consultation with a pediatric expert to minimize postpartum transmission risk including: • exclusive breastfeeding, • careful monitoring of maternal viral load, • adherence to maternal ART • prompt treatment of clinical mastitis • monitoring of infant HIV infection status throughout lactation, at 4-6 weeks and later at 3-6 months after weaning.

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Many countries in the Caribbean and other regions report a significant loss to follow up of mothers and infants after delivery, with approximately half the infants not being brought back for HIV testing. This may be related to stigma and more research is required to determine the reasons why the mothers do not bring their infants back and whether they continue with the postnatal medication.6,32 Conclusion Never before has there been so much hope that HIV-positive women can lead as normal and happy a life as other women. The benefits of the new regimen indicate that virtual elimination of transmission through birth and breastfeeding to less than 2% can be attained for mothers adhering to treatment regimens. Much work still needs to be done to reduce the post natal loss to follow up and ensure all HIV exposed infants are tested and the mothers are supported in adhering to lifetime ART. We ask all medical practitioners and HIVpositive mothers to have open conversations on breastfeeding, full compliance with ART medication and diligence to testing of mothers and babies as we move toward zero transmission. Pamela Morrison is an IBCLC, International Board Certified Lactation Consultant. Having certified in 1990 as the first IBCLC in Zimbabwe, a country with extremely high HIV-prevalence, Pamela Morrison worked in private practice and served as a member of the Zimbabwe National Multi-sectoral Breastfeeding Committee, as a BFHI trainer and assessor, and assisted with development of national Code legislation and HIV and breastfeeding policy. In 2002 she was invited to Trinidad to present on HIV and Breastfeeding at the 25th Anniversary Conference of The Informative Breastfeeding Service (TIBS). After emigrating to England she served as Co-Coordinator of the WABA Task Force on Breastfeeding and HIV from 2005 to 2009. She recently completed writing the WABA 2012 publication, International Policy on HIV and Breastfeeding: a Comprehensive Resource, available at www.hivbreastfeeding.org.

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Summary of strategies to prevent mother-to-child transmission of HIV All expectant mothers should receive an HIV test early in pregnancy. All mothers who test HIV-positive should be under the care of a doctor to receive appropriate and effective medical treatment and advice during pregnancy and breastfeeding. WHO recommends that HIV-positive mothers receive appropriate antiretroviral therapy (ART) from the time of a positive test, and that ART should be continued for life. The least risk of HIV transmission through breastfeeding will be achieved if the HIV-positive mother: • receives ART for at least 13 weeks before delivery and until at least 1 week after all breastfeeding ends • takes medical advice about any antiretroviral prophylaxis for her baby after birth (usually given for 4 – 6 weeks) • meticulously takes her ART throughout pregnancy and breastfeeding • receives regular monitoring to achieve an undetectable viral load • exclusively breastfeeds for the first 6 months of her baby's life • partially breastfeeds with appropriate nutrient-dense complementary feeding after 6 months • follows very gradual weaning • receives prompt treatment for any breast and nipple problems • has her baby's HIV status monitored regularly; at 6 weeks after birth, at 6 months and 3-6 months after breastfeeding ends.


1De Cock KM, Fowler MG, Mercier E, De Vincenzi I, Saba J, Hoff E, Alnwick DJ, Rogers M, Shaffer N, Prevention of mother-to-child HIV transmission in resource-poor countries; translation research into policy and practice. JAMA 2000;283:1175-1182

15Palombi, L., M.C. Marazzi, A. Voetberg, and N.A. Magid. Treatment

2Rodger AJ et al. Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population. AIDS 27: 973-979, doi: 10.1097/QAD.0b013e32835cae9c, 2013.

16Kilewo, C., K. Karlsson, A. Massawe, et al. Prevention of mother-to-child transmission of HIV-1 through breast-feeding by treating infants prophylactically with lamivudine in Dar es Salaam, Tanzania: the Mitra Study. Journal of Acquired Immune Deficiency Syndrome 2008;48(3): 315–23.

3Vernazza P et al. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des médecins suisses 89 (5), 2008.

17Kilewo, C., K. Karlsson, M. Ngarina, et al. Prevention of mother to child

4World Alliance for Breastfeeding Action (WABA), International Policy on HIV and Breastfeeding: a Comprehensive Resource, released 3 December 2012, see http://www.hivbreastfeeding.org and http://www.waba.org.my/whatwedo/hcp/ihiv.htm#kit. 5Trinidad & Tobago Ministry of Health, Prevention of Mother-to-Child Transmission (PMTCT) of HIV Policy, August 2010 available at http://hiv.opm.gov.tt/site_media/media/filer_public/2013/01/21/prevention_o f_mother_to_child_transmission_policy.pdf (accessed 7 October 2013) 6Trinidad & Tobago, Global AIDS Response, Country Progress Report, Jan 2010 – Dec 2011, submitted 30 Mar 2012 available at http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogress reports/2012countries/ce_TT_Narrative_Report%5b1%5d.pdf (accessed 7 October 2013) 7 WHO 2013, 15 facts on HIV treatment scale-up and new WHO ARV guidelines 2013, available at http://www.who.int/hiv/pub/guidelines/arv2013/15facts/en/index.html 8 Chibwesha CJ, Giganti MJ, Putta N, et al. Optimal Time on HAART for

acceleration program and the experience of the DREAM program in prevention of mother-to-child transmission of HIV. AIDS 2007; 21(Suppl 4): S65–71

transmission of HIV-1 through breastfeeding by treating mothers with triple antiretroviral therapy in Dar es Salaam, Tanzania: the Mitra Plus study. Journal of Acquired Immune Deficiency Syndrome 2009;52(3): 406–16. 18Marazzi, M.C., K. Nielsen-Saines, P.E. Buonomi, et al. Increased infant human immunodeficiency virus-type one free survival at one year of age in sub-Saharan Africa with maternal use of Highly Active Antiretroviral Therapy during breast-feeding. Pediatric Infectious Disease Journal 2009;28: 483–487. 19Peltier, C.A., G.F. Ndayisaba, P. Lepage, et al. Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to child transmission in Rwanda. AIDS 2009;23: 2415–23. 20Shapiro RL, Hughes MD, Ogwu A, Kitch D, Lockman S, Moffat C, et al. Antiretroviral regimens in pregnancy and breastfeeding in Botswana. N Engl J Med 2010; 362:2282–2294. 21Homsy J, Moore D, Barasa A, Were W, Likicho C, Waiswa B, et al. Breastfeeding, mother-to-child HIV transmission, and mortality among infants born to HIV-infected women on highly active antiretroviral therapy in rural Uganda. J Acquir Immune Defic Syndr 2010; 53:28–35. 22Thomas TK, Masaba R, Borkowf CB, Ndivo R, Zeh C, Misore A, et al.

Syndr. 2011;58(2):224-8. doi: 10.1097/QAI.0b013e318229147e

Triple-Antiretroviral Prophylaxis to Prevent Mother-To-Child HIV Transmission through Breastfeeding-The Kisumu Breastfeeding Study, Kenya: A Clinical Trial. Plos Medicine 2011. Mar;8(3) e1001015.

9 British HIV Association guidelines for the management of HIV infection in

23Kuhn L, Sinkala M, Kankasa C, Semrau K, Kasonde P, Scott N, Mwiya

pregnant women 2012, available at http://www.bhiva.org/documents/Guidelines/Pregnancy/2012/hiv1030_6. pdf

M, Cheswa V, Walter J, Wei-Yann T, Aldrovandi GM, and Thea DM. High Uptake of Exclusive Breastfeeding and Reduced Early Post-Natal HIV Transmission. PLoS ONE Dec 2007; 2(12): e1363. doi:10.1371/journal.pone.0001363

Prevention of Mother-to-Child Transmission of HIV. J Acquir Immune Defic

10 American Academy of Pediatrics, Breastfeeding and the use of Human Milk, Policy Statement, Pediatrics; originally published online February 27, 2012;DOI: 10.1542/peds.2011-3552 available at http://pediatrics.aappublications.org/content/early/2012/02/22/peds.20113552.full.pdf+html 11 WHO Collaborative Study Team. On the role of breastfeeding on the prevention of infant mortality, effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 2000; 355:451-55. 12 Coutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM. Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. South African Vitamin A Study Group. Lancet. 1999 Aug 7;354(9177):471-6. 13 Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, Moulton LH, Ward BJ, the ZVITAMBO study group and Humphrey JH. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS 2005, 19:699–708. 14 Smith MM and Kuhn L, Exclusive breast-feeding: does it have the potential to reduce breast-feeding transmission of HIV-1?. Nutrition Reviews 2000;58(11):333-340.

24Ngoma M, Raha A, Elong A, Pilon R, Mwansa J, Mutale W, Yee K, Chisele S, Wu S, Chandawe M, Mumba S and Silverman MS (citation) Interim Results of HIV Transmission Rates Using a Lopinavir/ritonavir based regimen and the New WHO Breast Feeding Guidelines for PMTCT of HIV International Congress of Antimicrobial Agents and Chemotherapy (ICAAC) Chicago Il, Sep19,2011. H1-1153, available at http://www.icaac.org/index.php/component/content/article/9newsroom/169-preliminary-results-of-hiv-transmission-rates-using-a-lopina virritonavir-lpvr-aluvia-based-regimen-and-the-new-who-breast-feeding-gui delines-for-pmtct-of-hiv25Chibwesha CJ, Giganti MJ, Putta N, et al. Optimal Time on HAART for Prevention of Mother-to-Child Transmission of HIV. J Acquir Immune Defic Syndr. 2011;58(2):224-8. doi:10.1097/QAI.0b013e318229147e 26WHO 2009, Rapid advice: revised WHO principles and recommendations on infant feeding in the context of HIV, available at http://whqlibdoc.who.int/publications/2009/9789241598873_eng.pdf 27WHO 2012, Programmatic update; Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants, Executive Summary April 2012, available at http://whqlibdoc.who.int/hq/2012/WHO_HIV_2012.8_eng.pdf

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28WHO Guidelines on HIV and infant feeding. 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence, ISBN 978 92 4 159953 5 available at http://www.who.int/child_adolescent_health/documents/9789241599535/en /index.html 29WHO Consensus Statement 2006, HIV and Infant Feeding Technical Consultation Held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV Infections in Pregnant Women, Mothers and their Infants, Geneva, October 25-27, 2006, available at http://www.who.int/maternal_child_adolescent/documents/pdfs/who_hiv_inf ant_feeding_technical_consultation.pdf 30Taylor GP, Anderson J, Clayden P, Gazzard BG, Fortin J, Kennedy J, et al. British HIV Association and Children’s HIV Association position statement on infant feeding in the UK. HIV Med 2011; 12:389–393, text available at http://www.bhiva.org/documents/Publications/InfantFeeding10.pdf 31American Academy of Pediatrics, Infant Feeding and Transmission of Human Immunodeficiency Virus in the United States, Committee on Pediatric AIDS, Pediatrics, originally published online January 28, 2013, DOI:10.1542/peds.2012-3543, Pediatrics 2013;131:391–396 available at http://pediatrics.aappublications.org/content/early/2013/01/23/peds.20123543 32Global Report: UNAIDS report on the global AIDS epidemic 2013. available at   http://www.unaids.org/en/media/unaids/contentassets/documents/epidemi ology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf  

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YOUTH HIV/AIDS by Hadassah Hector

DONATE MONEY FOR LIFE SAVING MEDICATION AND MEDICAL NEEDS. HADASSAH HECTOR IS A YOUNG PERSON MAKING A CHANGE IN T&T HER MESSAGE ISBELOW World HIV/AIDS Day was declared December 1st which is also my 20th birthday. For my birthday this year, I decided to devote my birthday and the rest of the month of December to this cause. Every year I plan to host a drive to raise funds that will all go towards one of the many problems that arise from this disease. This year I have chosen to do a Medicine Drive for a single mother of three living here in Trinidad whose health is severely deteriorated due to complications and symptoms associated with HIV/AIDS. For the sake of confidentiality the person's identity will not be disclosed.  My birthday wish this year is to raise funds that will assist this person in her time of need. You can help by donating $20 TTD toward this cause, during the month of December. Your donations will help make my birthday wish come true. You can call me at 1-868-397-0445 or email me at hadassahhector@gmail.com for information on how you can donate.  Persons outside of Trinidad can send donations via wire transfer and simply inbox me with the information. Learn more on Facebook at ‘First Annual Christmas HIV/AIDS Drive.’ FRESH START 13


My Experience as a MassageTherapist Treating Patients with HIV/AIDs by Rinalda, FHT, IRMT Photography by Best Start™

When I think of HIV/AIDS, red ribbons and African faces flashing across the television screen come to mind.    Words like retroviral, cocktails, discrimination, safe sex, latex condoms, get tested, etc. are some of the words I recall, never is the word ‘friend’ associated with the disease.  Yet I have had a few friends who suffered and died from an AIDS-related condition. The most prevalent and distressing symptoms of HIV/AIDS are weight loss, anorexia, fatigue, nausea, vomiting, anxiety, depression, cough, fever, and dyspnoea, which may evolve into another medical condition from which the patient dies.   Stress tends to impair logical thinking and can make a controllable problem seem like a catastrophe.  The soothing effects of massage provides a safe space in which the client can soothe their mind and consider constructive ways of approaching and handling their situation.  Quite often there are many difficult decisions to be made and discussion does not come easy, as everything can seem to be a big swirl of chaos that challenges the client to the point where they feel unable to cope.  In the case of one particular female client, this had resulted in an abrupt ending of the massage therapy treatments.  She had much to say, but did not know where to start, and opted for shutting me out.  Though I did not understand what she was going through at the time, I never gave up on her.  An assessment of the client helps in creating specific treatment plans for massage therapy, but I was unaware of my client’s condition because a client generally has no obligation to disclose their medical conditions, and she may have been fearful of the discrimination that often follows disclosure.  Eventually she opened up to me and treatment resumed.  She explained how difficult it was to receive the bad news of being HIV positive, and listening to the counsellor explain her treatment options.  I was asked to participate in broaching the subject to her loved ones, and as she had anticipated, it provoked a crisis.  Emotions were raw, both for her and her children.  During the discussion, she was able to do most of the communicating, addressing end-of-life issues which led to her mother being assigned power of attorney for health care and custody of her children after her passing. 14 FRESH START


Massage therapy is also very effective in pain management by activating endorphins and stimulating the parasympathetic nervous system. The HIV/AIDS disease and its treatment are associated with significantly painful syndromes causing morbidity, decline in function, and decreased quality of life.   Essential oils can have potent emotional effects and are ideal mood changers. Some oils uplift the spirits while others relax or calm.  Their therapeutic value includes antidepressant, aphrodisiac, antiseptic and antiviral effects.  Hence, the same oil can produce different effects depending upon the emotional state of the individual at the time.  Apart from wellness treatments like aromatherapy massage, clients can be encouraged to seek out nutrition programms and learn basic hygiene and treatment for common skin infection, which may easily occur.  As Massage Therapists, it is important to for us to remember that our psychological and emotional support are important elements of treatment and can further strengthen our role in helping to clear up misunderstandings about HIV/AIDS.  HIV/AIDS cannot be spread through any social or affectionate touching which does not involve the exchange of bodily fluids.  Kissing is a very low risk activity.  Sharing the same bedding is perfectly safe.  Both HIV-positive and negative people can share meals together with no risk whatsoever.  Also we need to recognize that HIV/AIDS clients can hope for many things other than the cure of their illness.  For example, they can hope for good control of their symptoms, so they can spend meaningful time with family and friends, heal troubled relationships, or create a legacy.  We can help clients to refocus on more attainable goals, thereby reinstating hope into what may be perceived as a hopeless situation.  Massage therapy does help to improve quality of life for people living with HIV/AIDS, particularly in combination with other stress-management techniques such as Yoga and Meditation. Massage therapy standards of practice require that Therapists adhere to general contraindications and special care should be taken to ensure that the client does not feel stigmatized during a massage therapy treatment by treating him/her with respect. Read more about Rinalda’s experience in Fresh Start’s Dec. 2013 Whole Health issue.

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A Family of Companies Working to Support Healthy Families & Communities

We provide breastfeeding information and support: • • • • • • • • •

Workplace Lactation Wellness Programs Health Research Policy Development Speaking Engagements Prenatal/Working Women Classes etc. Health Promotion Materials Breastfeeding Supplies Newborns to Toddlers

Clothing, Books & More Breastmilk the WonderFood

OMO and Best Start | info@omobeststart.com | 868.741.8907

Fresh Start By Best Start WORLD AIDS DAY 2013  

Our HIV/AIDS Awareness Supplement is part of Fresh Start's commitment to Whole Health. OMO™ and Best Start™ encourage you to help promote an...

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