Disclaimer: This post is in no way meant to stigmatize. HIV is manageable with proper medication and lifestyle changes. Prevention of HIV acquisition is important. Discordant couples are encouraged on early testing and proper precautions such as PreP to protect one another. Do not stigmatize!
This post is also not targeting my Muslim community. This applies to all ; including sexually active dating couples.
One afternoon, as I was washing my new set of hangers on the balcony, I put on you-tube on auto play and was enjoying my favorite Bongo Music (yes I buy my stainless steel clothes-hangers from jua kali and wash them to remove the dust ; why spend 70 shillings on a weak supermarket hanger when I can get a better stronger option from the fabricators at only Kshs.10 a piece). In between the music, I somehow found myself on a You-Tube Tanzanian Online Channel where a favourite female artist from a popular Bongo group was being interviewed. She was discussing matters sexuality and she went on and on about how she has HIV rapid testing kits in her house and would test any new catch on the spot before engaging in sexual activity. I was shell-shocked ; I got goose bumps imagining how many young girls look up-to her, would listen to the interview and do the same thing she seemed to be validating. I wondered if she knew that the window period for HIV is approximately 90 days; rapid-test would be negative yet there is
highest virus replication and highest chance of transmitting to others. A person who has caught the virus within this period would test negative and still be able to transmit it. This is trading on very dangerous grounds, albeit out of ignorance and misinformation. I wondered whether BASATA the Tanzanian moral-police knew that such kind information was being disseminated; instead on focusing on banning songs, these are some of the things they should look out for, otherwise they risk putting generations upon generations at risk.
This reminded me of a dear friend. She got into the mess of a hurried Nikkah as per our religion rules (Nikkah is marriage-vows/ wedding).A quick arranged marriage was conducted correctly as per Islamic rules; courtship is highly forbidden.
A rapid HIV testing was done in a nearby VCT and both parties tested negative. A repeat after 3 months was never done because Nikkah should be a hurried affair; no time to wait for 3 months to lapse. Do you blame the Sheikh for being ignorant on the need of a repeat test before he can officiate a Nikkah , or do you blame the parties involved in the wedding , or the medic who conducted the test for not insisting and emphasizing on with-holding any unprotected sexual activity or wedding
before a repeat test is done . Again, what if a repeat test is done correctly but one of the parties cheats in between the 90 day window-period; it’s an endless cycle.
I’m told of a Sheikh in Nairobi who insists on a 4th Generation test and re-testing if needed preferably from KEMRI. This is more reliable and has a shorter window period for one to get tested. Within a few weeks, the test gives reliable accurate results. I’m told he insists on testing from KEMRI which is the main government institution on matters laboratory, research and policy formulation. This is commendable. I however need to meet him in person to confirm this.
Where I come from in Machakos, of all the weddings I have attended; I have never heard of a wedding being delayed due to confirmatory tests. It is mostly one VCT rapid test and the wedding is officiated. This is very scary and dangerous. Experts need to meet with sheikhs and the community in general to educate them.
Another one of my close friends
almost got into a similar mess. First of all, her wedding was planned within a record 1 month of meeting the guy .A repeat VCT testing was never done so she took a real gamble on her life but she pulled through. 8 months into marriage, her husband started cheating with different women. It was a period of intense stress. Another humble, noble woman in her late twenties being put at risk big-time. She caught her husband severally engaging in risky activities. This is when the reality for a possible risk of infection hit her. She informed her people and a meeting quickly assembled. They were asked to go to VCT and the fact that both tests were negative at that moment was being used as a basis for them to reconcile. This was hardly a week after the man had been caught in a very high risk activity. Sadly there was a sheikh in this meeting too; ignorance is real. The negative testing was being used as evidence that all was well. Luckily she somehow communicated to a knowledgeable person and she was advised on the importance of re-testing or doing more advanced testing. She is well and safe– but sadly the marriage never lasted.
There are different types of HIV Testing with different window periods.
Window period is the period between acquisition of the HIV virus and appearance of detectable antibodies to the virus. It varies from person to person and is also different depending on the type of testing done. It takes time for the body to form sufficient antibodies to the virus that can be detected on the different tests.
Another type of testing checks for the virus DNA/RNA or antigen proteins produced by the virus- these have a much shorter period for detection,
Types of HIV testing can be generally divided into Rapid and Standard HIV testing.
The Self-Testing home kits and the rapid tests (mostly done in our VCTs) test for antibodies whose formation in sufficient amounts varies from person to person. The window period for these tests is up-to 3 months or even longer in a few people. If one tests negative on a rapid test, a repeat testing is usually recommended after 3 months. A positive rapid test must be subjected to another confirmatory test to rule out false positive results.
ELISA is a more accurate antibody testing. ELISA stands for Enzyme-Linked Immunosorbent Assay. ELISA testing is very sensitive and can give false-positive results. The window period is up-to 3 months depending on the ELISA generation. ELISA is available in major hospitals and labs in Kenya.
There are modern HIV testing called 4th Generation Tests that test for both the antibody and the virus itself (antigen) in various combinations. These have a shorter window period of up-to 4 weeks. A repeat testing is recommended after the 4-week window period has lapsed. These tests are available in Kenya in most big towns in private laboratories.
The PCR or the Nucleic Acid Amplification Tests (NAAT) test for the HIV virus RNA or DNA. This is the first test to be positive after HIV infection.
It can show infection as early as 10 days after exposure and as late as 30 days. It however has a higher rate of false-positive results which is a major concern and need to be ruled out. These test for the actual viral load.
HIV antigen tests look for actual proteins produced by the HIV Virus . These tests turn positive as early as 18 days after exposure and as late as 4 weeks .
I hope this post is helpful. I am in no-way opposed to hurried weddings as per our religion. Religion must however be taken into context with current times. This is of particular importance during this period just before Ramadhan where rushed arranged weddings are the norm.
Stay safe!
Dr. K