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Posted: 09 Jul 2011 06:10 PM PDT

The increasing prominence of HIV transmission through the sexual route have prompted calls for more strategies to prevent it.

THE auditorium at Hospital Sungai Buloh, Selangor, that was packed to the aisles during the hospital's International AIDS Memorial Day celebration in May was, to its head of infectious disease unit Dr Christopher Lee, one of the most rewarding changes he has seen in his career as an infectious disease physician.

"The hall can accommodate about 250 to 280 people, but we packed in about 300. About a third of them are healthcare workers, and the rest of them are from NGOs and the (HIV) positive community," he says.

"Many of those from the positive community have only participated in an event like this for the first time. Most are surprised at the support they receive."

It was certainly a far cry from the early days when the first case of AIDS was reported in Malaysia back in 1986.

Then, there was little doctors could do for those who were diagnosed, and people were dying every day from the disease.

Today, people who have lived on for years with the disease present in the auditorium are walking examples of how information, treatment and support have made a once fatal disease the chronic disease it is now.

"But a lot more has changed. The picture of HIV and AIDS is very different today than it is in the 80's and early 90's," says Dr Lee.

From a disease that affects predominantly injecting drug users, HIV and AIDS is now starting to affect more people who engage in unprotected or risky sexual behaviours.

And while Health Ministry figures show a decrease in the number of new infections in men for the past decade, the number of new infections in women have been on a slow but steady increase.

"Nationwide, the percentage of new infections due to sexual transmission (48.5%) overtook injecting drug use (47.6%) for the first time, so we need to look at it a little bit more," says Dr Lee.

From drug abuse to sexual transmission

It may be the first time sexual transmission has taken over as the most important risk factor of HIV transmission, but statistics have shown a fluctuating but increasing trend amidst the decrease in new infections caused by injecting drug use over the past decade.

In 2003, injecting drug use was found to be responsible for 4,796 new infections. In 2010, that figure went down 30% to 1,737 cases.

Instead, for the same period of time, new cases that are traced back to sexual transmission have increased slightly from 1,493 new cases in 2004 to 1,773 new cases in 2010.

So, while the total number of new infections has slowly dropped since year 2002, the percentage of people getting infected through sexual (which includes homosexual, bisexual, and heterosexual) contact has increased.

These statistics reflect the reality on the ground, as people who are involved in the treatment and support work for HIV and AIDS like Kuala Lumpur AIDS Support Society (KLASS) vice president Nick Heow and Dr Lee have already noticed the trend.

"Over the past few years, we have been seeing a trend in our hospital peer support group and also in KLASS: people who are newly diagnosed are getting younger, and many of them have gotten it through unprotected sex," says Heow.

Although KLASS's main objective is still to provide information and support to PLHIVs, they have started a roadshow last year around Peninsular Malaysia to talk to secondary school students about HIV and sex.

"In every session, we give the students a manual with information about the virus and invite them to participate in games and discussions about the disease," says Heow.

"There are a lot of funny questions about sex, of course, but there were also a lot of questions about how the disease is transmitted too. Many of them have heard about HIV, but if you ask them for details, they might not know much," he elaborates.

What Nick and those who run the roadshows found, is that students from big cities like Kuala Lumpur appeared to know more about the subject compared to students from smaller towns like Teluk Intan or Kuantan.

"We realise that it is the students from smaller towns who needed more information about the virus and safer sex. However, they tend to ask very practical questions, like where can they get treatment if they contract the virus," says Heow.

However, information alone may not be enough. Without the realisation that HIV can affect them, people may not take active steps to protect themselves.

"I think while the school education system educates students about HIV, the problem is that most of them do not personalise it. They may think that someone else, like a drug addict, will get it," says Dr Lee. "Personalising the message has always been a problem."

The questions he thinks students and the general public should ask are self-reflective.

Some of the examples are, "Can I get HIV? How can I get it? Now that you are in form 5, what happens when you graduate? What happens when you are in a relationship? Can you have sex? If you have sex, can you get HIV?"

"The answer is that it is possible, depending on who your partner is," says Dr Lee.

"After that, if you ask yourself how you can pass on the virus to someone else, maybe it will occur to you that you can pass the virus on to your girlfriend if you had sex.

"And if you have only had sex with a girlfriend you've known for a year, you might also realise that you do not really know whether she was exposed or not," he explains.

Harm reduction

While HIV prevention efforts in the country to date have been more focused on preventing injecting drug users from sharing the virus amongst themselves when they share needles, the increasing relevance of sexual transmission calls for a revision of prevention strategies that has to be put in place.

"The government has invested a lot of money into harm reduction programmes, like the needle exchange programmes and drug substitution therapy, and it has been showing positive results. But what about sexual transmission?" asks Hisham Hussein, chairman of the PT Foundation, a community-based, voluntary organisation that works with communities most affected by HIV in Kuala Lumpur.

"With drugs, abstinence is the best. But the authorities eventually realised that it is next to impossible to get all injecting drug users to abstain. So, they gave them clean syringes to reduce HIV transmission, because it is the next best thing to do," says Hisham.

"With sex, it is similar. You can't really stop people from having sex. So, why can't we (work out a similar programme) with condoms?" he says.

The challenge is that sex, and condom distribution is still considered taboo subjects in the country.

Says Malaysian AIDS Council president Tan Sri Mohd Zaman Khan, "We are increasing our efforts to educate the general public about the sexual transmission of HIV, particularly among women. However, the trouble is we still have people who don't want to talk about it."

Even the distribution of free condoms can be challenging. "Although it is probably the best way to protect oneself from HIV transmission through sex, condom distribution is often viewed as a move that encourages people to have sex," says Mohd Zaman.

"The public needs to understand that this is not our intention. What we are trying to do is prevent people from getting infected, and encouraging people to use condoms can help us do that."

The way forward

In view of the changing trends of the way HIV is transmitted, strategies that are designed to deal with the situation is needed.

"We cannot go about business as usual, because when the epidemic changes, our interventions must also change," says Dr Lee.

While harm reduction programmes should be continued, it is also equally important to educate the community about safer sex, says Mohd Zaman.

"This is not limited to sex workers, or men who have sex with men (MSN) or the transgender population only. Everyone should be educated."

To address sexually transmitted HIV, the Health Ministry is taking a holistic approach, says Deputy Director General of Health (Public Health) Dr Lokman Hakim Sulaiman.

"Through partners, the ministry also focuses on increasing awareness, encouraging partner counseling and partner notification, conducting contact tracing and testing, encouraging voluntary testing, scaling up pre-marital screening and enhancing antenatal screening.

As for condom distribution, Dr Lokman says it is already part of the Needle Syringe Exchange Program, which is accessible at any of the Health Ministry's facilities and participating NGO sites.

With regards to condom use, Dr Lokman questions whether the issue is affordability (as a condom costs about RM1.00) or a reluctance to use condoms. "We have to be clear on this, and that is why the ministry is emphasising on creating awareness and advocacy with partner organisations."

Currently the Health Ministry is also developing a new strategic plan to reduce the risk and spread of HIV infection, improve the quality of life of PLHIVs and reduce the social and economic impact of HIV and AIDS on the individual, family and society.

"While acknowledging that the sexual route is getting important as the source of infection, we must not relax our focus on injecting drug users who still form a significant proportion of cases. The ministry is giving equal importance to both routes of infection," he explains.

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Fat livers

Posted: 09 Jul 2011 06:09 PM PDT

Fatty liver disease can have far reaching consequences.

DID you know that the liver is the largest internal organ of the human body? One of the major functions of the liver is to remove toxic and waste materials from the body.

As blood flows through the liver, waste materials are filtered through the liver and removed. Other than purifying the blood, the liver also synthesises bile juice for the digestion of fat.

The liver also acts as storage for energy, vitamins and minerals, and produces important blood clotting factors as well as regulates blood sugar and cholesterol levels.

It is therefore very important for us to ensure that the liver is healthy and performing at an optimum level.

There is a common condition which can adversely affect the liver silently, and this condirtion is known as fatty liver. It is estimated that 17% of Malaysian's are affected by this condition.

What is fatty liver?

A healthy liver usually consists of 2% to 5% fat. If fat in the liver accumulates to over 5% of liver weight, this is known as fatty liver. When fat exceeds 10% of liver weight, the fat cells can damage liver cells.

A fatty liver can develop in three stages:

1. Simple fatty liver – The liver progressively accumulates fat, and this is early liver damage. This condition is known as non-alcoholic fatty liver disease (NAFLD). Most people have no symptoms at this stage and the liver is not enlarged.

2. Inflammation of liver cells (Non-alcoholic steatohepatitis) – Excessive fat causes inflammation and eventually damages liver cells. Dead liver cells will form scar tissue.

3. Hardening of the liver (cirrhosis) – Excessive scarring causes hardening of the liver, and liver fails to perform properly.

The risks factors for developing fatty liver include the following:

● High blood sugar levels – Consistently having high blood sugar (in diabetes) levels affects liver function. Statistics show that 88% of type 2 diabetics develop fatty liver.

● Being overweight or obese – A person is overweight when his body mass index (BMI) is between 23 and 27.4, and it has been found that about 37.4% of NAFLD patients are overweight. As high as 80% of obese patients have NAFLD.

● High cholesterol levels – About 63% of NAFLD patients also have high cholesterol.

● Alcohol drinkers – Statistics indicate that 90% to 100% of heavy alcohol drinkers develop fatty liver disease.

Keeping your liver healthy

The potential health problems that can be caused by fatty liver should not be take lightly. Fortunately, there are many ways to keep your liver healthy. Here are some tips:

● Increase consumption of low glycaemic index foods – This will help to avoid rapid increases in blood sugar. Examples include fruit, whole meal bread, oats and soba noodles.

● Low fat diet – Fat should not exceed 20% of our total daily calorie intake. A high fat diet can increase cholesterol levels and increase the risk of developing a fatty liver.

● High fibre diet – Increase intake of fresh fruits and vegetables, oats and grains. This can help to reduce blood sugar and cholesterol levels.

● Regular exercise – Maintain moderate exercise for at least 30 minutes at least three times a week. This is the most effective way to maintain healthy body weight.

● Weight loss – In overweight and obese individuals, reducing weight will help to reduce the overall risk of developing a fatty liver.

● Nutritional supplements – Supplements which contain polyunsaturated fatty acids, which are also known as essential phospholipids (EPL), are vital nutrients which can support the liver. The liver cell is protected by a cell membrane and EPL is a major component of cell membranes. Therefore, when liver cells are inflamed, EPL is lost, causing the loss of cell structure, function and eventually death. Replenishing EPL has been shown to have protective and regenerative effects on liver cells.

As the liver is such an important organ, take charge of your liver today. Liver cells are the only internal organ that can regenerate, as long as there are enough healthy cells; it's never too late to protect your liver.

References:

1. Amarapurkar, D.N et al. Journal of Gastroenterology and Hepatolgy 2007; 22:788 – 793

2. Falck-Ytter et al. Hepatology 2006

3. Malik, A et al. Journal of Digestive Diseases 2007

4. Preiss, D et al. Clinical Science 2008

This article is courtesy of sanofi-aventis. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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The detox way

Posted: 09 Jul 2011 06:09 PM PDT

Safe ways to cleanse the body of toxins.

YOU would be amazed at the amount of toxins that enters our bodies every day. We only have to open our windows to have exhaust fumes and cigarette smoke blacken our lungs.

Caffeine, saturated fats and all sorts of preservatives are almost unavoidable in our food these days. Furthermore, who knows what other types of chemicals we may be inhaling from normal household items or processes at our workplace.

You can't see these toxins working in your body, but they do cause harm, nonetheless. The build-up of such toxins can lead to sluggishness and fatigue, and make you fall ill easily, or have headaches, skin and digestive problems.

Detoxification of the body, or simply "detox", is a popular trend, especially among the health-conscious. There are many detox services and therapies being touted in the market, ranging from the basic to the extreme. But how do you know what works, and what is safe for your health?

In this article, I will discuss some safe detox strategies that you can do for yourself at home.

Falling ill due to toxins

Our body actually has a good mechanism for getting rid of wastes and toxins from the body. This function is controlled primarily by the kidneys and the liver.

The kidneys filter out extra fluid and waste from the blood, and pass them through to the bladder to be removed by urination.

The liver filters the blood coming from the digestive tract, as well as detoxifies chemicals and metabolises drugs.

However, imagine if you just keep pumping your body with toxins – you smoke a pack of cigarettes a day, drink five cups of coffee or five cans of beer a day, eat mostly simple sugars, and do not get any antioxidants, vitamins or minerals.

Your liver and kidneys will have to work extra hard to remove all these toxins, but very soon, these organs will become worn out and function poorly. When these organs don't function properly, it will have an effect on your whole body and overall health.

This is when you start to feel yourself "declining" – you may not experience anything truly dramatic, but little things will start to plague you, like having no energy, a slow metabolism, or just feeling mentally drained. You may also notice more frequent headaches, digestive problems, aches and pains, or skin problems.

Just like a clogged drain or system, you need to get rid of the wastes from your body, and clean the "insides" every so often. Your body also needs to rest so that it is able to heal from the onslaught of chemicals and toxins that it has received.

Quite simply, that is what detox is about – cleansing your system and getting a fresh start so that your body's organs and systems can go back to doing what they do best.

Detox diets

A lot of people think that detoxification is about fasting or starving themselves. But food can be great detoxifiers as well, while giving you a boost of good nutrients and antioxidants. The important thing is choosing the right food for your detox.

You need plenty of fresh fruits and vegetables, as these contain vitamins, minerals, fibre and antioxidants that boost your immune system. For example, the secret behind grapefruit is that it contains a powerful antioxidant called narigenin that helps reprogramme your liver to melt excess fat, instead of storing it.

Garlic is another cleansing food that helps boost the ability of your white blood cells to fight the effects of toxins in your body. You may notice a difference by just taking three cloves of fresh garlic per day. If you dislike the smell of garlic, you can get odourless aged garlic supplements at the health store.

You can also get fibre from brown rice and other wholegrain foods.

Another misconception is that protein, especially meat protein, is bad for detox. This is not true, and in fact, you need protein for energy, building muscles, and to stimulate the enzymes that break down toxins in the body.

However, make sure that you cut out the fat in your protein, so choose lean beef or lamb, skinless chicken, and plenty of fresh fish. Ideally, your food choices should be organic, so that you consume less pesticides and chemicals usually used in agriculture.

You should eat these foods as part of a healthy, balanced diet. Too often, people detox by eating only one food item a day, but that will not give them the nutrients they need. What you should do is have a variety of foods every day, but in small portions so that you do not overeat.

Water is absolutely key in a detox diet! Drink at least two litres of water every day so that you can flush out the wastes in your body.

You don't need to buy expensive mineral or spring water, or special detox drinks; just drink plain (boiled) tap water. Avoid coffee and sweetened drinks, as these introduce more toxins back into your body. Tea, especially green tea, drunk without sugar, is also good for your system.

Detox-ing your life

There is little evidence that extreme detox programmes like fasting or colon cleansing with supplements or irrigation is safe. It worries me when people undergo these programmes without proper medical advice, choosing instead to trust friends or beauty centres who may not be fully aware of the possible risks of such procedures.

Instead, why not look at what you can detox in your daily life? By doing this, you are ensuring that you can stay toxin-free over the long term, rather than just a one-off effort.

You have to reduce the toxin load in your life – basically, cut down or get rid of alcohol, coffee, cigarettes, refined sugars and saturated fats. As much as possible, try to use natural household products, such as cleaners, cosmetics and personal healthcare products (such as your shampoo, deodorant and toothpaste).

Stress also creates toxins in your body, because when stress hormones are produced in large amounts over a protracted period, they produce toxic by-products and slow down the action of detoxification enzymes in the liver.

So slow down, take a serious look at what aspects of your life are stressing you out, and think of ways to change these. It can be done, even though many people think that they cannot escape stress.

Finally, you might not have thought this, but exercise is the best way to detox.

You just cannot escape it – taking detox supplements or doing any sort of detox diet without exercising will not work.

Certain types of exercise are believed to be especially beneficial for cleansing, such as yoga and qigong, because of the traditional breathing and meditative techniques that they employ.

Do you think that you will feel any difference after detoxing your diet and life? You certainly will, because you have been "unclogged", so to speak. Your body systems will work more efficiently and the nutrients from your food can nourish your organs, muscles and brain much faster.

All this will translate into more energy, better health, fewer illnesses, feeling more revitalised, refreshed and, yes, even fewer mood swings!

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Kredit: www.thestar.com.my

Ahad, 10 Julai 2011

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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