Natural Family Planning Method:CycleBeads

I am excited to share withyou thish tool that is a natual family planning method. CycleBeads are a tool that you can use to make planning pregnancy natural and easy. CycleBeads are made up of a series of color-coded beads which enables you to track your cycle and know if you are on a fertile day.

To use CycleBeads you simply move a ring over the series of color-coded beads that represent the days of her cycle. The color of the beads lets you know whether you are on a day when you’re likely to be fertile or not. The one medical criterion for using CycleBeads is that a you should have cycles between 26 and 32 days long.

How They Work
standa2CycleBeads are a color-coded string of beads that represent a typical menstrual cycle. Each bead represents a day of the cycle and the color helps you to determine if are likely to be fertile that day.

The day you start your period you put the rubber ring on the red bead. Each day you move the ring one bead, always in the direction of the arrow. When the ring is on the red bead or a dark bead, there is very low likelihood of pregnancy, so you can have intercourse on these days without getting pregnant. When the ring is on a white bead – Days 8 through 19 – there is a high likelihood of getting pregnant if you have unprotected intercourse.

Please note, the Standard Days Method, on which CycleBeads are based, works best for women with regular menstrual cycles that are between 26 and 32 days long. Women with cycles outside this range should use a different method of family planning.

The Research Behind CycleBeads
CycleBeads are based on a natural method of family planning called the Standard Days Method. This method was developed by the Institute for Reproductive Health at Georgetown University.

The Standard Days Method is based on physiological evidence that the woman’s fertile phase starts five days prior to ovulation and lasts through the day of ovulation. This fertile phase is related to the life span of the sperm, which can remain viable in the woman’s reproductive tract for approximately five days, and to the fact that the ovum can be fertilized for up to 24 hours.

The probability of pregnancy increases from 4% five days before ovulation to almost 30% just before ovulation, and decreases again to 8% on the day of ovulation. The probability of pregnancy is then virtually zero for the rest of the cycle.

Q. How do I use CycleBeads?
A. CycleBeads are a visual tool that help a woman with regular cycles between 26 and 32 days long to keep track of the days of her cycle and know when she is likely to get pregnant if she has unprotected intercourse. They are a string of 32 color-coded beads, with each bead representing a day of a woman’s menstrual cycle. They have a black rubber ring that the woman moves one bead each day in the direction of the arrow. When the woman starts her period, she puts the ring on the first bead, which is red. She continues moving the ring one bead each day of her cycle. When the ring is on a dark bead, she is on a day in her cycle when she can have intercourse without getting pregnant. But when she in on a day represented by the white beads, she may be fertile and could get pregnant if she has unprotected intercourse.

beads

Q. Can I use CycleBeads to help me get pregnant?
A. Yes you can. No research has been conducted to date to see exactly how effective the Standard Days Method is in helping a couple who wants to get pregnant, but because CycleBeads identify the fertile days, using CycleBeads can be an important first step in trying to get pregnant. This is because when they are using CycleBeads,

1. a woman and her partner can see on which days she is fertile, and they can have intercourse on those days; and
2. keeping track of the number of days in her cycle gives a woman information about her cycle that she can share with her doctor and thereby make appropriate choices to help her conceive.

Of course, there are women who are not ovulating, or have some other biological issue that makes it difficult for them to conceive. Or the man may not be fertile. While CycleBeads will not directly help them to conceive, it can be useful in helping them to at least establish the woman’s potentially fertile days and her cycle lengths.

Q. What is the Standard Days Method?
A. The Standard Days Method is a new, simple method of family planning that was developed by the Institute for Reproductive Health at Georgetown University. The Institute developed a computer model, based on data from the World Health Organization, and determined that women who usually have menstrual cycles between 26 and 32 days long are potentially fertile – or able to get pregnant – on days 8 through 19 of their cycles. So the Standard Days Method identifies a fixed set of days in each menstrual cycle as the days when a woman can get pregnant if she has unprotected intercourse. If the woman doesn’t want to get pregnant, she and her partner avoid unprotected intercourse on days 8 through 19 of her cycle. The Institute has tested the Standard Days Method in a clinical trial with about 500 women in 3 countries – Bolivia, Peru and the Philippines. They found that women were able to use the method correctly, and when they did use it correctly, it was more than 95% effective. That is, out of 100 women using the method for 1 year, fewer than 5 would get pregnant.

Q. How is this different from the rhythm method?
A. Actually, it’s very different. The rhythm method involves having exact information about the last 6 menstrual cycles and every month making complex calculations – adding and subtracting – to figure out which days in the current cycle you’re likely to get pregnant. And the rhythm method has never actually been tested in a well-designed efficacy study. The Standard Days Method on which CycleBeads are based, is simple – it doesn’t involve any calculations, and it is the same every cycle. It has also been tested in a well-designed effectiveness trial, with excellent results.

Q. Can I use the Standard Days Method without using CycleBeads?
A. Yes you can. CycleBeads have been found to be an efficient, easy-to-use tool for helping women keep track of their cycles and know which days are fertile and which are not. However, a woman could simply keep track of her cycle on a calendar and count the days, starting with her period so that she would know when she was in her fertile window – Days 8 through 19 of her cycle – and could get pregnant. She would also need to be sure that her cycles were regularly between 26 and 32 days so that this fertile window is accurate for her.

Q. Why do women choose to use CycleBeads?
A. The most common answer we hear is that women want to use them because they are based on a method that is natural, effective, and has no side effects. Many women want an easy to use family planning method that is natural – that doesn’t involve hormones or surgical procedures. Some women are concerned about side effects with other methods, others don’t want to do anything that might impair their future ability to get pregnant. Some women want to use it for religious reasons. And others want a method that helps them involve their partners instead of one that is only the woman’s responsibility.

Q. If I’m only fertile for a few days of my cycle, why is the “fertile window” 12 days long?
A. The research on which CycleBeads are based identifies the fertile window – the time during which most women could get pregnant – as days 8 through 19 of the menstrual cycle. While it is true that a woman can get pregnant during only a few days of her cycle, these days may not be at the same time from one cycle to the next. The “fertile window” identified is 12 days long because it takes into account both the days around ovulation and the possible changes in the actual timing of ovulation from one cycle to the next.

Q. Will CycleBeads protect me from sexually transmitted diseases (STDs)?
A. No. Like most other family planning methods except condoms, the Standard Days Method on which CycleBeads are based does not protect people from STDs. If you think you are at risk of an STD, you should consult your doctor immediately to find out how you can protect yourself.

Who can use CycleBeads?

Q. Can anyone use CycleBeads?
A. No. The Standard Days Method, on which CycleBeads are based, works very well for women who usually have menstrual cycles between 26 and 32 days long. Women who often have cycles shorter than 26 days or longer than 32 days are not good candidates for this method. Also, women who would not be able to avoid unprotected intercourse on the days they might get pregnant are not likely to be successful using this method. So, like any method of family planning, it isn’t for everyone.

Q. How can I determine if my cycle length is between 26 and 32 days?
A. A woman does not need a record of her previous cycles, but we ask a woman to answer a few questions that will help her or her provider to know whether or not she is in this range. These questions include:

* Do my periods usually come about when I expect them?
* When did my last period start?
* When do I think my next period will start?
* How many days are there between the day my last period started and the day I think my next period will start?

If you can tell by answering these questions that your cycles are likely to be between 26 and 32 days long, you can use CycleBeads. If you are still not sure, it would be a good idea for you to use the CycleBeads or a calendar for two or three cycles just to keep track of your cycle lengths. But you should not rely on this as a way to prevent pregnancy until you are sure your cycles are usually between 26 and 32 days long.

Q. How many women have cycle lengths that are between 26 and 32 days long?
A. According to data from the World Health Organization, about 80% of cycles are between 26 and 32 days long and most women have most of their cycles within this range.

Q. Can I use CycleBeads if I just stopped taking the pill?
A. Yes, if your cycles were 26-32 days long before you started taking pills. If you are still taking pills and want to use CycleBeads, you should finish taking the pills for this current cycle. Then, on the first day of your next period, you can begin using the method. If you have already stopped taking pills, you should wait until your next period starts before you start using the method.

Q. Can I use CycleBeads if I just stopped taking an injectable form of birth control?
A. It depends. First, you must have had regular cycles between 26 and 32 days long before you started using the injection. If you have taken a 1-month injectable recently and you had cycles in this range before you started using the injectable, you can use CycleBeads as soon as you have your next period. However, if you have taken a three-month injectable, it may be a while before your cycles return to normal. You’ll need to wait until three months have passed since you got your last injection and then wait until you have a cycle that is between 26 and 32 days long.

Q. Can I use CycleBeads if I just stopped using an IUD?
A. Yes, as long as during the time you were using the IUD your cycles were between 26 and 32 days long. Once the IUD is taken out, you can start using CycleBeads on the first day of your next period.

Q. Can I use CycleBeads if I am breastfeeding?
A. That depends. Wait until you have had 4 menstrual periods since your baby was born. After you have had 4 periods, if your last cycle was between 26 and 32 days long, you can start using CycleBeads on the first day of your next period.

Q. Can I use CycleBeads if I am close to menopause?
A. Yes, as long as your cycles are between 26 and 32 days long. However, as you approach menopause, your cycles may become irregular – either shorter or longer. When this happens, CycleBeads will not work for you.

How to use CycleBeads.

Q. What is the darker bead for?
A. The darker bead on the CycleBeads is to help a woman know if her cycle is shorter than 26 days. CycleBeads are most appropriate for women who have cycles between 26 and 32 days long. If a woman starts her period before she puts the band on the dark bead, she has had a cycle that is shorter than 26 days. If that happens more than once in one year, then she should consider another alternative to meet her family planning needs.

Q. What if I’m using CycleBeads and I start my period before I get to the darker bead?
A. If you start your period before you get to the darker bead that means you have had a cycle that is less than 26 days long. CycleBeads work best for women who usually have cycles between 26 and 32 days long. If you have more than one cycle less than 26 days long in a 12-month period, CycleBeads will not work well for you and you should use another alternative to meet your family planning needs.

Q. What if I’m using CycleBeads and I start my period before I finish all the beads?
A. This is what will happen most of the time. As soon as you start your period, just skip over any remaining beads and put the ring on the red bead. Then continue moving the ring one bead per day.

Q. What if I’m using CycleBeads and I get to the last bead, but I still haven’t started my period?
A. If you move the ring to the last bead and you don’t start your period by the next day that means you are having a cycle that is more than 32 days long. CycleBeads work best for women who usually have cycles between 26 and 32 days long. If you have more than one cycle that is more than 32 days long in a 12-month period, CycleBeads will not work well for you and you should use another alternative. If you move the ring to the last bead and you don’t start your period within a week, you should consult your doctor.

Q. What should I do if I forget to move the ring?
A. It is best to always mark the day that you start your period on a calendar. If you know the date you started your period this cycle, you can go to your calendar and count the days between that date and today. Then count the same number of beads on the CycleBeads, beginning with the red bead. Just move the ring to the correct bead and continue moving the ring every day. If you are unable to determine what day you started your cycle, wait until your next period to begin using CycleBeads.

Q. If I start my period late at night or early in the morning, what should I do about moving the ring?
A. You should move the ring to the red bead on the day that you start your period. If you know that you started your period anytime before midnight, move the ring to the red bead that day. The next morning (or whenever you normally move the ring) you should move it to the following bead. If you started your period during the night and are not sure what time it started, move the ring to the red bead when you wake up and consider that day to be Day 1 of your menstrual cycle. You will then move the ring the following day.

Q. What if I bleed a little in the middle of my cycle?
A. If you bleed any time except when you are having your period, you should check with your health provider. But for many women, a small amount of bleeding around the time they ovulate is normal. Bleeding in the middle of the cycle should not affect use of the CycleBeads.

Q. Can’t I get pregnant any time during my cycle?
A. No, actually research shows that there are a small number of days during which a woman is likely to get pregnant – a few days before she ovulates and the day she ovulates. But these days may not be at the same time every cycle because a woman doesn’t always ovulate at the same time. Studies conducted by the Institute for Reproductive Health have shown that the “fertile window” – days when a woman could get pregnant – is Days 8 through 19 of their menstrual cycles for most women. This “fertile window” takes into account the days around ovulation as well as the fact that the day of ovulation is not the same every cycle.

Q. How is my menstrual cycle different from my period?
A. A woman’s menstrual cycle is not the same thing as her period. A period is just the days when a woman is actually having menstrual bleeding. Her cycle is the whole time from the beginning of one period until the beginning of the next period. A woman’s menstrual cycle begins the first day of her period. It ends just before she starts her next period. So the first day of her period is Day 1 of her cycle. By counting each day, beginning with Day 1, and continuing every day until she starts her next period, a woman can know how long her cycle is. CycleBeads help a woman to keep track of the days of her menstrual cycle.

Q. What is ovulation?
A. Ovulation is the release of an egg by the woman’s ovary. In almost every menstrual cycle, the woman’s ovary releases an egg. There are thousands of eggs inside the woman’s ovaries. The natural chemicals in her body trigger the development of one of these eggs every cycle. When the egg is ready to be fertilized, it comes out of the ovary and travels down the woman’s tubes to her uterus. If the man’s sperm has fertilized it, the egg can attach itself to the uterus and the woman is pregnant.

PAP SMEAR

Overview
A Pap smear (also called a Pap test) is a screening procedure for cervical cancer. It tests for the presence of precancerous or cancerous cells on the cervix, the opening of the uterus. It’s named after the western doctor who determined that this was a useful way to detect signs of cervical cancer, Georgios Papanikolaou. During the procedure, cells from your cervix are gently scraped away and then examined for abnormal growth.

Part 2 of 6: Uses

Reasons for Getting a Pap Smear
The human papillomavirus (HPV) is a virus that causes warts. There are over 100 different types of HPV. There are 40 that are sexually transmitted. The primary causes of cervical cancer are HPV types 16 and 18. Even though a Pap smear doesn’t test for HPV, it identifies cellular changes caused by the virus. By detecting cervical cancer cells early with a Pap smear, treatment can start before it spreads and becomes a bigger problem.

You can get HPV from sex with men or women. All sexually active women are at risk for contracting HPV and should get a Pap smear at least every three years.

The test doesn’t detect other sexually transmitted diseases. It can occasionally detect cell growth that indicates other cancers, but it shouldn’t be relied on for that purpose.

Part 3 of 6: Candidates

Who Needs a Pap Smear?
Generally, you should start getting regular Pap smears at age 21.

If you are HIV-positive or have a weakened immune system from chemotherapy or an organ transplant, you may need more frequent tests because of a higher risk of infections and cancer.

If you’re over 30 and have had three normal Pap tests in a row, ask your doctor about having one every five years if the test is combined with an HPV screening. Women over the age of 65 with a history of normal Pap test results may be able to stop having Pap smears in the future.

You should still get regular Pap smears even if you’re in a monogamous relationship. That’s because the HPV virus can be dormant for years, and then suddenly become active.

Part 4 of 6: Preparation
Preparation for a Pap Smear
You can schedule a Pap smear with your annual gynaecological examination or request a separate appointment with your gynaecologist.

If you’ll be menstruating on the day of your Pap smear, your doctor may want to reschedule the test, since results could be less accurate. Try to avoid having sexual intercourse, douching, or using spermicidal products the day before your test because these may interfere with your results.

Since Pap smears go more smoothly if your body is relaxed, it’s important to stay calm and take deep breaths during the procedure.

Part 5 of 6: Procedure

Pap Smear Procedure
The bad news is Pap smears can be a bit uncomfortable and they are risks.

During the procedure, you’ll lie on your back on an examination table with your legs spread and your feet resting in supports called stirrups. Your doctor will slowly insert a device called a speculum into your vagina to keep the vaginal walls open and provide access to the cervix. Then your doctor will scrape a small sample of cells from your cervix using a tool called a spatula. Most women feel a slight push and irritation during the brief scraping.

The sample of cells from your cervix will be preserved and sent to a lab to be tested for the presence of abnormal cells.

After the test, you might feel mild discomfort from the scraping, or a bit of cramping. You could also experience very light vaginal bleeding immediately following the test. Tell your doctor if discomfort or bleeding continues after the day of the test.

Part 6 of 6: Results
Results of a Pap Smear
There are two possible results from a Pap smear: normal or abnormal.

If the test results are abnormal, this doesn’t mean you have cancer. It simply means that there are abnormal cells on your cervix, some of which could be precancerous. Depending on what the test results show, your doctor may recommend increasing the frequency of your Pap smears, or getting a closer look at your cervical tissue with a procedure called colposcopy. This exam uses light and magnification to see vaginal and cervical tissues more clearly. In some cases, your doctor may also take a sample of your cervical tissue in a biopsy.

Pap tests are very accurate and regular Pap screenings reduce cervical cancer rates and mortality by 80 percent. Like a lot of medical testing, it’s not pleasant, and the discomfort isn’t a good thing. The other thing is that you have to go see the gynaecologist from time to time because you will the moping the water whilst the tap is open. Once the water floods again, you need to mop (do pap smear). As always, the western fraternity deals with the symptoms of a disorder and not the root cause thereby offering a temporal solution aka generic medication.

ARV:ODEFSEY.

ODEFSEY
(rilpivirine + emtricitabine + tenofovir alafenamide)

WHAT IS ODEFSEY?
Odefsey is a tablet that contains three antiretroviral drugs (ARVs) used to fight HIV: rilpivirine (Edurant), emtricitabine (Emtriva), and tenofovir alafenamide (TAF). Odefsey is manufactured by Gilead and Janssen. It is the second single tablet regimen that includes TAF, a new version of tenofovir that has lower bone and kidney risks.
The drugs in Odefsey are a non-nucleoside reverse transcriptase inhibitor (rilpivirine) and two nucleoside analog reverse transcriptase inhibitors, or nukes (emtricitabine and tenofovir). These drugs block the reverse transcriptase enzyme. This enzyme changes HIV’s genetic material (RNA) into the form of DNA. This has to occur before HIV’s genetic code gets inserted into an infected cell’s own genetic codes.

WHO SHOULD TAKE ODEFSEY?
Odefsey was approved in March 2016 as an antiretroviral treatment for people 12 or older with HIV infection who have not already taken antiviral drugs and whose viral load is below 100,000. Odefsey is also approved as a replacement for stable antiretroviral therapy (ART) in people who have had undetectable viral loads for more than 6 months and never experienced failure of past ART.
While there are no absolute rules about when to start ART, treatment is now recommended for all people living with HIV, independent of your CD4 count. You and your health care provider should consider your viral load, any symptoms you are having, and your attitude about taking ART.
If you take Odefsey, you can reduce your viral load to extremely low levels, and increase your CD4 cell counts. This should mean staying healthier longer.
Odefsey provides three drugs in one pill. It can be more convenient to use Odefsey than some other combinations of drugs. This could mean fewer missed doses and better control of HIV. Odefsey can be an effective regimen of ARVs in one pill.

WHO SHOULD NOT TAKE ODEFSEY?
Odefsey should not be used by people who have virus with resistance to the any of the three anti-HIV medications it contains. Odefsey is not recommended for people less than 12 years of age.
Odefsey is a fixed-dose combination. Dosages of the individual components cannot be adjusted. Patients who have severe kidney disease, or severe liver disease, should not use Odefsey.

WHAT ABOUT DRUG RESISTANCE?
Many new copies of HIV are mutations. They are slightly different from the original virus. Some mutations can keep multiplying even when you are taking an ARV. When this happens, the drug will stop working. This is called “developing resistance” to the drug.
Sometimes, if your virus develops resistance to one drug, it will also have resistance to other ARVs. This is called “cross-resistance.”
Resistance can develop quickly. It is very important to take ARVs according to instructions, on schedule, and not to skip or reduce doses.

HOW IS ODEFSEY TAKEN?
Odefsey is taken by mouth as a tablet. The normal adult dose is one tablet, once a day. Odefsey should be taken with a meal. Each tablet includes 25 milligrams (mg) of rilpivirine, 200 mg of emtricitabine, and 25 mg of tenofovir alfafenamide.
Don’t change your dose or stop taking Odefsey without talking to your healthcare provider.

WHAT ARE THE SIDE EFFECTS?
When you start any ART, you may have temporary side effects such as headaches, or a general sense of feeling ill. These side effects usually get better or disappear over time.
Odefsey is usually very well tolerated. The most common side effects of Odefsey are the same as with the drugs it contains: rilpivirine can cause depression, trouble sleeping and headache. Emtricitabine, and tenofovir can cause nausea. Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

If you have had hepatitis B or C, your liver function tests may increase significantly. Your healthcare provider should monitor your liver health before and during treatment with Odefsey.

HOW DOES ODEFSEY REACT WITH OTHER DRUGS?
Odefsey can interact with other drugs or supplements you are taking. These interactions can change the amount of each drug in your bloodstream and cause an under- or overdose. New interactions are constantly being identified. Make sure that your health care provider knows about ALL drugs and supplements you are taking.
Drugs to avoid include some antacids. Drugs to watch out for include other ARVs, drugs to treat tuberculosis for lowering stomach acid (such as omeprazole), erectile dysfunction (such as Viagra), for heart rhythm (antiarrhythmics), and for migraine headaches. Interactions are also possible with several antihistamines (allergy medications), sedatives, drugs to lower cholesterol, and anti-fungal drugs.
The herb St. John's Wort lowers the blood levels of some HIV medications. Do not take it with Odefsey.

FACTS ABOUT HIV/AIDS

What does undetectable viral load mean?

When you test positive for HIV, you will be offered treatment and the drugs are called Antiretroviral (ARV). Typically, if your HIV medication is working, and you take them exactly as prescribed, your viral load should reach undetectable levels within 3-6 months after you begin treatment.

There has been a lot of confusion over the issue of viral load and testing positive for HIV. I will try to explain this so that it becomes clear to everyone and should help people to stay safe and not let ignorance kill us.

Viral load is only tested in those that are HIV positive because they have the virus so checking the amount of the load is important in monitoring their treatment.

The term “viral load” refers to the amount of HIV in a sample of your blood. When your viral load is high, you have more HIV in your body, and that means your immune system is not fighting HIV as well.

A viral load test is a lab test that measures the number of HIV virus particles in a milliliter of your blood. These particles are called “copies.” A viral load test helps provide information on your health status and how well antiretroviral therapy (ART – treatment with HIV medicines) is controlling the virus. ART can’t cure HIV, but it can help you live a longer, healthier life and reduce your risk of HIV transmission.

The goal of ART is to move your viral load down, ideally to undetectable levels. In general, your viral load will be declared “undetectable” if it is under 40 to 75 copies in a sample of your blood. The exact number depends on the lab that analyzes your test.

Having an “undetectable” viral load doesn’t mean that the virus is completely gone from your body, just that it is below what a lab test can find. You still have HIV and you are still HIV positive and need to stay on ART to remain healthy.If one is HIV negative, then they do not have the virus in their body and there is no need to check the viral load because it will be ZERO.

If my viral load is undetectable, does that mean I am cured?

No, “undetectable” does not mean you are cured or that the virus is gone from your body. It means that the virus is below the level that a lab test can find. You still have HIV and need to stay on ART to remain healthy.

Can I infect anyone with undetectable viral load?

Having an undetectable viral load greatly lowers your chance of transmitting the virus to your sexual partner who is HIV-negative. However, even when your viral load is undetectable, HIV can still exist in semen, vaginal and rectal fluids, breast milk, and other bodily fluids. For this reason, you should continue to take steps to prevent HIV transmission. So, the answer is; yes you can infect other people even if your viral load is “undetectable”. Remember “undetectable ” means that the virus is below the level that a lab test can find, i. e. below 40-75 copies in a sample of blood. This explains why a person with undetectable viral load can have unprotected sex with different partners and not all of them will be infected. This practice is wrong and the advice is that an HIV positive person should have protected sex regardless of the level of viral load.

HIV DRUG RESISTANCE

WHAT IS RESISTANCE?
HIV is “resistant” to a drug if it keeps multiplying rapidly while you are taking the drug. Changes (mutations) in the virus cause resistance.
HIV mutates almost every time a new copy is made. Not every mutation causes resistance. The “wild type” virus is the most common form of HIV. Anything different from the wild type is considered a mutation.
An antiretroviral drug (ARV) won’t control a virus that is resistant to it. It can “escape” from the drug. If you keep taking the drug, the resistant virus will multiply the fastest. This is called “selective pressure.”
If you stop taking medications, there is no selective pressure. The wild type virus will multiply the fastest. Although tests may not detect any drug resistance, it might come back if you re-start the same drugs.
Resistance testing helps health care providers make better treatment decisions for their patients.

HOW DOES RESISTANCE DEVELOP?
HIV usually becomes resistant when it is not totally controlled by drugs someone is taking. However, more people are getting infected with HIV that is already resistant to one or more ARVs.
The more that HIV multiplies, the more mutations show up. These mutations happen by accident. The virus doesn’t “figure out” which mutations will resist medications.
Just one mutation can make HIV resistant to some drugs. This is true for 3TC (Epivir) and the non-nucleoside reverse transcriptase inhibitors (NNRTIs). However, HIV has to go through a series of mutations to develop resistance to other drugs, including most protease inhibitors.
The best way to prevent resistance is to control HIV by taking strong ARVs. If you miss doses of your medications, HIV will multiply more easily. More mutations will occur. Some of them could cause resistance.
If you have to stop taking any ARV, talk to your health care provider. You may have to stop some drugs sooner than others. If you stop taking drugs while the virus is under control, you should be able to use them again.

TYPES OF RESISTANCE
There are three types of resistance:
Clinical resistance: HIV multiplies rapidly in your body even though you’re taking ARVs.
Phenotypic resistance: HIV multiplies in a test tube when ARVs are added.
Genotypic resistance: The genetic code of HIV has mutations that are linked to drug resistance. 
Clinical resistance shows up as a higher viral load, lower CD4 count, or opportunistic infections. Laboratory tests can measure phenotypic and genotypic resistance.

PHENOTYPIC TESTING
A sample of HIV is grown in the laboratory. A dose of one ARV is added. The growth rate of the HIV is compared to the rate of wild type virus. If the sample grows more than normal, it is resistant to the medication.
Phenotypic resistance is reported as “fold” resistance. If the test sample grows twenty times as much as normal, it has “20-fold resistance.” Phenotypic testing is the preferred method for people with known or suspected resistance, especially to protease inhibitors.
Phenotypic tests cost about $800. It used to take over a month to get the results. New phenotypic tests are somewhat quicker.

GENOTYPIC TESTING
The genetic code of the sample virus is compared to the wild type. The code is a long chain of molecules called nucleotides. Each group of three nucleotides, called a “codon,” defines a particular amino acid used to build a new virus.
Mutations are described by a combination of letters and numbers, for example K103N. The first letter (K) is the code for the amino acid in the wild type virus. The number (103) identifies the position of the codon. The second letter (N) is the code for the “changed” amino acid in the mutant sample.
Genotypic testing costs about $250. Results come back in about two weeks. Genotypic testing is the preferred method for people having problems with their first or second treatment regimen.

VIRTUAL PHENOTYPE
This test is really a method of interpreting genotypic test results. First, genotypic testing is done on the sample. Phenotypic test results for other virus samples with a similar genotypic pattern are taken from a database. These matched samples tell you how the virus is likely to behave. The virtual phenotype is faster and less expensive than a phenotypic test.

CROSS-RESISTANCE
Sometimes a mutant version of HIV is resistant to more than one drug. When this happens, the drugs are called “cross-resistant.” For example, most HIV that is resistant to nevirapine (Viramune) is also resistant to efavirenz (Sustiva). This means that nevirapine and efavirenz are cross-resistant.
Cross-resistance is important when you change medications. You need to choose new drugs that are not cross-resistant to drugs you’ve already taken.
We do not totally understand cross-resistance. However, many drugs are at least partly cross-resistant. As HIV develops more mutations, it gets harder to control. Take every dose of your ARVs according to instructions. This reduces the risk of resistance and cross-resistance. It saves the most options for changing medications in the future.

PROBLEMS WITH  RESISTANCE TESTING
Resistance tests are not available everywhere. They are expensive. However, they are becoming more common, faster, and cheaper.
The tests aren’t good at detecting “minority” mutations (less than 20% of the virus population). Also, they work better when the viral load is higher. If your viral load is very low, the tests might not work. Tests usually cannot be run if the patient’s viral load is less than 500 to 1,000 copies per ml.
Test results can be difficult to understand. Drugs that should work according to the tests sometimes don’t work, and vice versa. Sometimes genotypic and phenotypic tests give conflicting results for the same patient. Some mutations can “reverse” or reduce resistance to some medications.
Recent research suggests that a genotypic resistance test should be done for every patient before they start taking ARVs. This saves money by avoiding putting someone on ARVs that will not work for them.

CD4 and viral load

CD4 and viral load… Which one should you focus on? Both!  says Otieno.

Your CD4 count is a good overview of how well your immune system is working and how much damage HIV has done to it. Viral Load (VL) will show you how active the HI Virus is in your body.

It’s really important to get a number of readings of both, over the course of a year or two, rather than making a decisions based on any single test result. Results change constantly, so it’s best to get several tests and see how they compare over time. A CD4 count below 200 is an immediate cause for worry because you have a much higher risk of developing an opportunistic infections (OI’s).

CD4 Cell Count  - CD4 cells are the immune system’s leaders, issuing commands to nearly every other cell. For people living with HIV, CD4 counts are the No. 1 sign of how strong or weak the immune system is. Most experts recommend CD4 measurements every three to six months—more often if they’re lower or changing quickly. Low CD4 counts are a sign that the HIV is in need of treatment. HIV may cause other numbers (e.g. neutrophil counts) to fall as well, which may call for treatment. Talk to your healthcare provider about your options.

HIV Viral Load measures how much HIVirus is in your blood. This information will help you and your healthcare provider make decisions about starting HIV treatment (ARV’s) and will show whether the medications are working or not. Fewer than 50 copies of HIV per mL—about a teaspoon of blood—will show as “undetectable”. Results can range from undetectable up to millions of copies per mL

When should you have a viral load test done? If you can, at the same time as you get your CD4 counts done—typically every 6 months or more frequently, based upon your health care providers recommendation. —then between you, you can monitor your HIV infection and see if any change in treatment are needed. A sudden or dramatic change in viral load may call for an immediate repeat test.

An undetectable result doesn’t mean the virus has left your body, but rather indicates the success of your treatment and less chance of the disease getting worse. If you are on HAART (Highly Active Antiretroviral Treatment/ ARV’s—a potent combo of HIV-fighting drugs), an undetectable viral load is considered the ultimate prize and shows that your treatment is working.

If you’ve just started treatment, this could take several months— another test in two or three months will tell for sure. Even if the viral load is considered undetectable, it may occasionally bounce up to small but measurable amounts. Continual, detectable viral load, while you’re on HAART/ARV’s, is cause for concern, as it signals that your treatment isn’t controlling the virus. You and your healthcare provider need to talk about switching treatment.

HOW DOES DRUG USE RELATE TO HIV?

HOW DOES DRUG USE RELATE TO HIV?
Injection drug and alcohol use are a major factor in the spread of HIV infection. Outside of Africa, injection drug use now accounts for 1 in 3 new HIV infections. Shared equipment for using drugs can carry HIV and hepatitis viruses, and drug and alcohol use is linked with unsafe sexual activity.
Drug and alcohol use can also be dangerous for people who are taking antiretroviral medications (ARVs). Drug users are less likely to be adherent to their medications, and street drugs may have dangerous interactions with ARVs. Drug and alcohol treatment to stop drug use can lower your risk of HIV infection.

INJECTION AND INFECTION
HIV infection spreads easily when people share equipment to inject drugs. Sharing equipment also spreads hepatitis B, hepatitis C, and other serious diseases.
Infected blood can be drawn up into a syringe and then get injected along with the drug by the next user of the syringe. This is the easiest way to transmit HIV during drug use because infected blood goes directly into someone’s bloodstream. Even small amounts of blood on your hands, cookers, filters, tourniquets, or in rinse water can be enough to infect another user.
To reduce the risk of HIV and hepatitis infection, never share any equipment used with drugs, and keep washing your hands. Carefully clean your cookers and the site you will use for injection.
A recent study showed that HIV can survive in a used syringe for at least 4 weeks. If you have to re-use equipment, you can reduce the risk of infection by cleaning it between users. If possible, re-use your own syringe. It still should be cleaned because bacteria can grow in it.
The most effective way to clean a syringe is to use water first, then bleach and a final water rinse. Try to get all blood out of the syringe by shaking vigorously for 30 seconds. Use cold water because hot water can make the blood form clots. To kill most HIV and hepatitis C virus, leave bleach in the syringe for two full minutes. Cleaning does not always kill HIV or hepatitis. Always use a new syringe if possible.

ACCESS TO CLEAN NEEDLES
Access to clean needles and syringes reduces the spread of HIV and viral hepatitis. In some states, adults can purchase new syringes in pharmacies without a prescription. Some communities have started needle exchange programs to give free, clean syringes to people so they won’t need to share.
Programs that provide easier access to new syringes are controversial because some people think they promote drug use. However, research on needle exchange shows that this is not true. Rates of HIV infection go down where there are needle exchange programs, and more drug users sign up for treatment programs.
The North American Syringe Exchange Network has a web page listing several needle exchange programs at http://www.nasen.org/

DRUG USE AND UNSAFE SEX
For a lot of people, drugs and sex go together. Drug users might trade sex for drugs or for money to buy drugs. Some people connect having unsafe sex with their drug use. Research shows that sexual behavior is the main HIV risk factor for injection drug users.
Drug use, including methamphetamine or alcohol, increases the chance that people will not protect themselves during sexual activity. Someone who is trading sex for drugs might find it difficult to set limits on what they are willing to do. Drug and alcohol use may reduce condom use and safer sex practices.
Often, substance users have multiple sexual partners. This increases their risk of becoming infected with HIV or another sexually transmitted disease. Also, substance users may have an increased risk of carrying sexually transmitted diseases. This can increase their risk of becoming infected with HIV, or of transmitting HIV infection.

MEDICATIONS AND DRUGS
It is very important to take every dose of ARVs. People who are not adherent (miss doses) are more likely to have higher levels of HIV in their blood, and to develop resistance to ARV medications. Drug use is linked with poor adherence, which can lead to treatment failure and disease worsening.

Some street drugs interact with ARVs. The liver breaks down some medications used to fight HIV, especially the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors. It also breaks down some recreational drugs, including alcohol. When drugs and medications are both “in line” to use the liver, they might both be processed much more slowly. This can lead to a serious overdose of the medication or of the recreational drug.
An overdose of a medication can cause serious side effects. An overdose of a recreational drug can be deadly. At least one death of a person with HIV has been blamed on mixing a protease inhibitor with the recreational drug Ecstasy.
Some ARVs can change the amount of methadone in the bloodstream. It may be necessary to adjust the dosage of methadone in some cases. See the fact sheets for each of the medications you are taking, and discuss your HIV medications with your methadone counselor and your HIV health care provider.

THE BOTTOM LINE
Drug use is a major cause of new HIV infections. Shared equipment can spread HIV, hepatitis, and other diseases. Alcohol and drug use, even when just used recreationally, contribute to unsafe sexual activities and an increase in sexually transmitted infections.
To protect yourself from infection, never re-use any equipment for using drugs. Even if you re-use your own syringes, clean them thoroughly between times. Cleaning is only partly effective.
In some communities, new syringes can be bought without a prescription. Also, needle exchange programs in some areas provide free, new syringes. These programs reduce the rate of new HIV infections.
Drug use can lead to missed doses of ARVs. This increases the chances of treatment failure and resistance to medications.
Mixing recreational drugs and ARVs can be dangerous. Drug interactions can cause serious side effects or dangerous overdoses.

TODAY IS FATHER'S DAY AND I WANT TO TALK ABOUT PROSTATE CANCER

It’s important to their sex life, yet few men know anything about their prostate or what can go wrong with it. The prostate is a small gland in the pelvis found only in men. About the size of a walnut, it is located between the penis and the bladder. It surrounds the urethra, the tube that carries urine from the bladder to the penis. The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen.

Causes of prostate cancer
These figures are a cause for concern but we need to look at the causes of prostate cancer. The causes of prostate cancer are largely unknown. However, a number of things can increase one’s risk of developing the condition. The chances of developing prostate cancer increase as one gets older. Most cases develop in men aged 50 or older. For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in men of Asian descent.
Men who have first degree male relatives (such as a father or brother) affected by prostate cancer are at slightly increased risk as well. It is thought that lycopene-rich foods are best in protecting one from the disease. Lycopene is an antioxidant that is commonly found in fruits and vegetables that are red in colour like tomatoes, watermelon and guavas. Chillis of all sorts are also lycopene powerhouses.

Diagnosing Prostate cancer

There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you. The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate (known as a digital rectal examination or DRE) and a biopsy (taking a piece of the prostate and testing it for cancer). The blood test, known as a prostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer.

What is PSA?

PSA is made by the prostate gland and some of it will leak into the bloodstream depending on age and the health of the prostate. A raised PSA may mean that one has prostate cancer. However other conditions which are not cancer do cause raised PSA such as enlargement of the prostate, urinary infection and prostatitis. This test has problems in that 2 out 3 people with raised PSA will not have prostate cancer and the test can miss prostate cancer.
PSA test is sensitive to a lot of things hence the need to follow the instructions carefully otherwise one will get high levels due to not following the right procedure of testing. One should not have PSA testing if they have urinary infection, has ejaculated in the last 48hrs, exercised heavily in the last 48hrs , had a prostate biopsy in the last 6 weeks or had a digital rectal (anal) examination in the previous week.

What should one look for in order to see a doctor about this prostate cancer?

Prostate cancer usually develops slowly, so there may be no signs resulting in one having it for many years without knowing. Symptoms often only become apparent when one’s prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis). When this happens, one may notice things like an increased need to urinate, straining while urinating and a feeling that the bladder has not fully emptied. However, these signs do not mean one has prostate cancer. It is more likely they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement).
Because of the problems highlighted above men in UK are not routinely offered PSA tests to screen for prostate cancer as results can be unreliable. However PSA testing is offered on an individual basis after a full discussion with your doctor. A lot of research is currently taking place to come up with evidence based screening that is also safe because raised PSA levels also cannot tell a doctor whether a man has life threatening prostate cancer or not ( the one that can kill you and the one that won’t.). This means that a raised PSA can lead to unnecessary tests and treatment.

What is the take away home message about prostate cancer?

I have tried to present the facts to you and I apologise if l have confused some of you but the “take away home” message to my fellow African men is that prostate cancer is on the rise but rare below 45 years of age. If your father or brother was diagnosed with prostate cancer then you are at high risk of developing it. I suggest that if you have family history of prostate cancer and you are above 45 years then you must see your doctor to discuss screening options available regardless of whether you have symptoms or not.
Your doctor should be able to clearly discuss with you the advantages and disadvantages of the tests allowing you to make an informed decision about your situation. If you do not have family history of cancer and have symptoms such as constant urge to rush to the toilet to pass urine, passing urine more often than usual, especially at night and difficulty in passing urine then you should see your doctor for further tests. If you do not have family history and do not have symptoms either, but you are now worried after reading this article, l suggest that you also see your own doctor for further discussions.
If you are found to have prostate cancer, how then is it treated one may ask.
For many men with prostate cancer, treatment is not immediately necessary. If the cancer is at an early stage and not causing symptoms, a policy of “watchful waiting” or “active surveillance” may be adopted. This involves carefully monitoring your condition. Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy. Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms.
Sadly some people are being diagnosed at a later stage when cancer has already spread. In these situations the relatives and doctors can feel hopeless but having worked in a hospice myself, I feel passionate about end of life care that we are delivering to our loved ones in their last days on this earth. No one should be allowed to die in pain.
We may not be able to cure the cancer but we should guarantee to relieve pain and I know that it can be done. Family members need to work with doctors and pharmacists to get the best pain killers. There is need for education to both doctors and the public about the safe use of strong pain killers . This will make sure that people with cancer can die with dignity and pain free.