The difference a decade makes

The 17th March 1995 was a Friday. In the UK it was ‘Red Nose Day’ and it was the day one of the Kray twins died. These facts are etched in my memory because it was the day I stuck an HIV contaminated needle into my finger. I remember almost everything about that day from the feeling of horror at the first sight of blood on my finger to the look on the face of my girlfriend when I told her later that evening. It was a Wednesday three months later when the consultant told me that the HIV test was negative. The details are a blur but I can still remember the sleepless night beforehand and the feeling of utter relief at the news.

It was only a week ago but already I’ve forgotten the date. Sixty patients had finished collecting a month’s supply of anti-retrovirals at the isolated rural clinic when a staff member saw her chance to grab a quiet word. She said she knew deep down that she had HIV and neither of us was surprised when the point of care test result was positive. It was at that moment that the needle slipped in my hand and stuck into my finger. As I had done more than a decade before I squeezed blood from my finger but my reaction couldn’t have been more different. With no occupational health service within 100 miles and a recent negative HIV test under my belt I simply put into action the plan I had rehearsed for this moment. I walked calmly to the pharmacy assistant and asked for a dose of anti-retrovirals. I then just returned to the newly diagnosed woman to offer her post-test counselling. I had no worries for the remainder of the day except the wave of medication-induced nausea that swept over me later that evening.

The important difference between the two events of course is the availability of anti-retrovirals. In 1995 I had yet to enter medical school and to many people, including myself, HIV infection meant an automatic death sentence. The knowledge that the chance of infection was only around 1 in 300 did nothing to alleviate the terror I felt. The image of Tom Hanks wasting away in the film Philadelphia was only too real to me as I was working as the phlebotomist on a ward where I regularly witnessed people in the last stages of AIDS. I had no idea, I’m not even sure if the experts new, what was on the horizon.

The figures are debatable but my chances of being infected this time are probably less than my yearly risk of dying in a car crash in South Africa. I also feel comfortable that should the worst happen I could still at least look forward to watching my own grandchildren grow up at the end of a productive life. With the rollout of anti-retrovirals gathering pace, at last many South Africans with HIV can expect the same. The hope is that should I be writing a similar post in a decade’s time the big news will be of the huge increase in the numbers accessing treatment rather than the fact that effective treatment exists at all.