HIV/AIDS
by Jimmy Henderson


Q 1. What is Hiv and Aids?

 HIV = Human Imunno Deficiency Virus (discovered in 1984) (germs)

 AIDS = Acquired Immuno –Deficiency syndrome (first described in 1981)
(syndrome- a name given to a group of symptoms )

 HI virus belongs to a family of viruses called the Retrovirus

 Infects the CD+ 4 cells which control the human immune system (see transparency).

 The immune system is the bodies natural defences against infections and disease.

 It comprises of the skin, (outer protection), white blood cells, antibodies and macrophages –scavenger cells)

 The HIV invades, enters and multiplies within these CD+ 4 cells and destroys them.(see transparency)

 By invading these cells, the HIV infects and eventually destroys the entire body's natural immune system, which is the system which helps our body to fight infection.

 When the immune system is weakened by the HIV, the body is no longer able to defend itself and is open to opportunistic infections such as flu, tuberculosis (T.B.), pneumonia and cancers.

 The amount of HIV in the body (viral load) can be controlled to a degree by means of special medications called Anti-retrovirals and the immune system can be strengthened by natural means such as exercise and diet.

 The infected person can therefore live for many years after infection, provided he
or she has the correct medication and can maintain a strong immune system.
There are people living with HIV for over 15 years.

 However, without intervention , HIV infection can worsen into the severe form of immunological weakness known as Aids. (Acute Immune-Deficiency Syndrome)

 We will deal with the symptoms and progression of AIDS a little later.
Q .2 How is HIV transmitted?

 HIV is transmitted with the transfer of body fluids, mostly blood and blood products and semen.
 It is not transmitted through the air by coughing or touching

Specific ways of becoming infected

 Unprotected sexual intercourse
 Penetrative vaginal, oral or anal sex without a condom.
 75 85% of HIV infection is as the result of unprotected sexual intercourse.
 The HIV enters the walls of the genitals through small cuts and scrapes.
 Gets into the bloodstream.
 Mother to child transmission
 25 35% of all infants born to Hiv+ mothers become infected.
 This type of transmission accounts for 90% of the global infection of infants and children.
 Children who develop HIV usually contract it during childbirth in the uterus from the placenta (blood and scrapes) or from the breast milk (blood product).
 Drug abuse
 The sharing of Hiv infected injection needles and blades accounts for between 5 and 10 % of all adult infections.
 It is also advisable NOT to share razors or toothbrushes because of the possible presence of blood on them.

 Blood transfusions or direct contact with infected blood (open wounds)
 Infected blood or blood products accounts for 3 5% of all global adult infections.
 If blood from the wound of an HIV + person enters your skin (sores, cuts scrapes)
 South Africa has introduced routine screening of donated blood for HIV.

Q3 What are the real risk factors ?

 High risk sexual behaviours (prostitutes, multiple partners, casual sex)
 Drug users -sharing of infected needles and syringes.
 Women are more at risk because of the relatively large amount of semen transmitted from the man during intercourse.
 HIV is also more likely to be transmitted through intercourse when one or both partners have a sexually transmitted disease (STDS) such as syphilis due to sores, tiny cuts or scrapes.
 HIV can also be passed on between persons through open wounds.
 It is therefore important that emergency workers use rubber gloves when working with injured and bleeding patients.


Q 4 What are the Myths surrounding HIV?

You cannot get HIV from kissing under normal circumstances
 Kissing is regarded as safe, provided there is no blood in the mouths due to cuts.
 There is a very slim chance of HIV being transmitted by saliva or insect bites as the amount of infectious particles in saliva and bites is too low for a "loading dose".
 Saliva also contains proteins which may neutralise the virus to an extent.

You cannot get HIV from touching an HIV + person.
 It is therefore quite safe to associate with and care for persons with HIV/Aids as long as you do not come into direct contact with infected blood and you have an open wound (the skin protects you).
 It cannot be spread by a toilet seat, shaking hands, hugging or touching or using the same towels, cups or utensils
 Blood or semen is not infectious if out of the body for a while.
 The HIV loses its effectivity if outside the human body even for a short period and does therefore not appear to be transmitted by social or casual non sexual contact.
Washing does not protect you
 You are not safe from HIV if you wash after sex. It is transmitted internally
through the genitals.
Having sex with a virgin will not protect you or cure AIDS.
 There is no known cure for AIDS at this time. It can only be controlled with medication.

Q.5 How can we prevent infection?

 The best long term strategy is education, knowing your status, and applying the governments A-B-C method.

 A = Abstinence
Having a lifestyle which includes abstaining from sex.

 B = Be faithful to a single partner (Be open and honest)
(don’t sleep around)
 C = Condomise
All persons , especially women, should be educated in their right to say
NO or demand the use of a condom, even within marriage.

(demonstrate male and female condom)

Q. 6 What are the Symptoms of HIV infection?

 It is possible to have HIV and NOT show any visible signs of illness.
 Symptoms can take months and even years to develop.
 The symptoms could also belong to other illnesses (TB, Flu etc)
 The HIV test is the only way to really know if you are infected.
 There is a "window period" of up to three months before the HIV may be positively detected in the body (HIV antibodies) (see transparency)
 This delay can result in a person not being aware that they have contracted the HIV until symptoms appear.
 This is why it is so important to get tested early and regularly.
 A significant number of individuals can, however, produce antibodies within one to two weeks after infection and produce an illness similar to glandular fever
 The estimated incubation period of the virus varies from 5 months to 10 years.
 During this time the virus gradually destroys the CD + 4 cells and the bodies immune system and symptoms begin to appear.
 The gradual loss of the immune system is measured by the CD + 4 count (see transparency)
 As the viral load increases, the CD + 4 count will drop. (see transparency)
 One can live for many years with HIV with the proper treatment.
 However, the overwhelming majority of people infected with HIV do eventually develop Aids.
 Aids will eventually lead to death.
 How long this takes will vary from person to person. It is important therefore for high risk individuals to have themselves tested regularly in order to obtain treatment as soon as possible.

Q.7 What is AIDS ?

 Doctors have a list of so called "Aids defining conditions".
 These are serious medical conditions such as severe respiratory infections, coughing, diarrhoea, bowel infections, weakness, weight loss, nausea, vomiting, brain infections (mental deterioration), cancers, and visible skin infections.
 When the CD+ 4 count of an HIV+ person drops to below 200 and he /she develops these Stage 5 illnesses (see transparency), they are said to have AIDS.
 This is said to be the last stage (5) of HIV ( see transparency)
 The lower the count, the more advanced the disease (see transparency)
 Eventually death results from sicknesses such as TB and pneumonia to which the body now has no defence (6 months -2 years).

Q.8 What is VCT ? ( Voluntary testing and counselling)

 In terms of the Labour regulations and Basic Conditions of Employment Act, companies have an obligation to provide support to workers with HIV and AIDS.
 Many companies have clinics on site and Wellness programmes in place to support those with HIV/AIDS
 If not, they should provide arrangements for workers to get to test centres or preferably tested on site by companies who are registered to do this.
 These clinics can also provide testing for HIV
 A worker cannot be forced to go for an HIV test (it is voluntary) (informed consent)
 Prior to the test, the worker must be offered counselling. (To prepare them psychologically and emotionally) (Pre-test counselling)

THE HIV TEST
 The test can only be performed by a registered professional, nurse, sister etc.
 The test is very quick and involves only taking a drop of blood and placing it on the test strip (see transparency on Rapid Test)
 The blood will reveal the presence of HIV antibodies (sero-conversion)
 If the results are negative, the person will be tested later in a few months (Window Period)
 If the tests are positive, more blood will be taken to ensure that the rapid test was correct.
 The sister / nurse is obliged by law to keep the results confidential.
 The results can only be released to a third party with the workers written permission.
 Counselling must be made available to the worker following the test results (Post-Test counselling)

Q.9 What treatment is available?

 HIV cannot be cured as yet but its effects can be controlled with certain types of medication.
 The type of medication is based on the results of a Viral load test.(how much HIV)

Types of medication
 Anti-retrovirals which work against a retrovirus. Prevent it replicating.
 Drugs involved include AZT, ddl , ddC and 3TC.
 Usually these medicines are combined for the best effect ("cocktails").
 Different strains of HIV require different combinations.
 The medication AZT reduces the risk of infection by 79% (pregnant women)
 HIV mutates easily and can form different strains, making it difficult to develop a really effective vaccine.
 Tests can be conducted every 3 6 months to determine how well the patient is responding to treatment.
 Remember HIV+ persons can be cured of most associated conditions such as TB, pneumonia and infections, although NOT of HIV itself
 Persons with HIV can go on to lead normal productive lives for many years (15 years)
 Others in an advanced stage of full blown Aids have substantially less chance of long term survival .
 This is why it is so important to know your status and get treatment early.
 Other medications
 Other types of medications are available to treat the effects of Hiv or Aids.
 To keep the immune system as healthy as possible (Vit.boosters, B12 injections etc) .
 Other drugs work to prevent or treat the opportunistic infections or symptoms, such as loss of appetite, weight loss, nausea etc.
 HIV symptoms differ from person to person and some type of medications work better on some patients.
 Others may develop a tolerance for certain medications and may have to change regularly.
 Aids medication is normally costly, but at present some pharmaceutical manufacturers are prepared to supply certain drugs free of charge to clinics and provincial hospitals.
Diet
 It is believed that a special diet, exercise and a reduction of stress can slow down the onset of AIDS.

Q. 10 What is the best way to care for people with HIV/Aids?

 Home or community care of the Aids patient is part of the official management plan of the Dept. of Health, due to lack of resources, overcrowding at state hospitals and the high cost of hospitalisation and treatment (medications).
 Use of out-patients and clinics.
 Home care -from a social viewpoint of family emotional support and care, this also makes the most sense.
 Wellness programmes at companies
 Usually involves sister/nurse at company
 VCT testing and counselling facilities.
 EAP counsellors.
 Monitoring HIV + workers who are on the program.
 Assist with monitoring of CD+ 4 count, transport to clinic, seek free medication for workers
 Provide guidelines on diet and booster medications.
 May provide anti-retrovirals if registered to do so.
 Follow-up on families and needs.
 The psychological and social needs of a person with Aids is similar to those of persons with other life threatening diseases such as cancer, heart disease etc.
 They need to be shown love, understanding, re assurance and support.

Q. 11 Why do I need to know my status?

 Reasons : Why people do not wish to know status
Fear of death –denial (better not to know) (less painful)
Fear of rejection - It is a fact that many people do fear contact
with a HIV + person and can reject him or her.
Fear of victimisation at work – This cannot really happen in terms
of the Constitution (no discrimination) and the Labour
Relations Act (unfair labour practices).
 Confidentiality
At present it is NOT compulsory for a victim to declare their status
Or for medical practitioners to report cases of HIV/ Aids
(Company clinic sisters usually only supply statistics to management)
Health care workers or managers can get into legal problems if they breach
confidentiality.
The worker has to give written permission for their status to be made known.

 Reasons why should know status.
 Can access the company wellness programmes and gain assistance.
 Can get medication early on and prolong their life
 Can reduce the spread of HIV to partners by taking extra precautions
 It is also difficult to plan help to victims of HIV when accurate figures and the geographic spread are not known.




Information Sources:
Information supplied by the Dental faculty of the University of the W. Cape , the Dept. of Health (KZ Natal), Bristo Myers Squibb, Glaxo Welcome and the SA Medical Research Council. Transparencies supplied by kind permission of Aunde (SA ) Ltd.