HIV / Aids

HIV Testing

Gay men have a high risk profile of contracting HIV due to sexual behavior involved. All people, not only gay men, should go for an HIV test at least every 6 months. If you were exposed to risky behavior e.g. engaged in unprotected anal sex or the condom broke, then you should immediately consult your doctor. Usually a rapid test is used as screening method. The rapid test is used to screen for antibodies of the HI Virus.  The following can be expected during an HIV test:

• Pre-test counselling:
  • Personal questions may be asked, but this is only to help prepare you adequately and effectively.
  • You will be asked questions about HIV to test your knowledge on the subject.
  • Your current risk profile will be developed e.g. use of condoms, partners turn-over.
  • Health education will be provided on how to reduce your risks.
  • The HIV test will be explained to you.
  • Your available support system and general stress management will be assessed.
  • You will then be requested to sign a consent form in order to carry out the test.
• Performing of HIV test:
  • Pricking of finger for a rapid test and/or;
  • Drawing of a blood sample to be sent to a laboratory.
• Post-test counselling
  • If you test positive, a confirmation blood sample will be drawn.
  • If you test positive, ongoing support will be made available.
  • If you test negative, a follow up test is arranged and you are encouraged to follow safer sex precautions.

What is HIV?

HIV is an acronym that stands for:

• Human:  infection is limited to humans only
• Immunodeficiency:  attacks and causes damage to the immune system
• Virus:  the smallest and most complex infectious agent known

What are the different strains?

• HIV Type 1:  Most common worldwide, including South Africa.
• HIV Type 2:  Found mostly in West Africa. This is generally regarded as being less easily transmitted and the period between initial infection and illness is considered longer.

How is HIV transmitted?

HIV can be transmitted by:

• Sexual intercourse;
• Exchanging body fluids;
• Blood transfusion or blood products;
• Sharing of injecting equipment such as needles or body piercing;
• Transmission from mother to child.

HIV can NOT be transmitted by:

• Coughing or sneezing;
• Insect bites like mosquitoes;
• Touching or hugging;
• Water or food;
• Kissing and sharing toothbrush;
• Public baths and toilets.

The Link between STIs and HIV

If STI’s are present, a client is more susceptible to contracting HIV due to the presence of other bacteria. The presence of STIs are also a clear indication of unprotected sex taking place, making the individual vulnerable to contracting HIV.

The Link between Substance Abuse and HIV Transmission

• Drug use is a major factor in the spread of HIV infection. Shared equipment for injecting drugs can carry HIV and hepatitis. Drug use is generally linked with unsafe sexual activity.
• 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.
• 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.
• 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 use can reduce a person's commitment to use condoms and practice safer sex.
• 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.

What are the clinical features of HIV?

Early symptoms

Many people will not have experience any symptoms when they first become infected with HIV. They may, however, experience flu-like symptoms within a month or two after exposure to the virus. This illness may include:

• Fever
• Headache
• Tiredness
• Enlarged lymph nodes (glands related to the immune system, easily felt in the neck and groin)
• These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

Later symptoms

Generally, more persistent or severe symptoms may not appear for up to 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. This period of asymptomatic (no symptoms) infection varies greatly between each person. Some people may begin to experience symptoms within a few months, while others may be symptom-free for more than 10 years.

Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The virus can also hide within infected cells and be inactive. The most obvious effect of HIV infection is a decline in the number of CD4 positive T (CD4+) cells found in the blood-the immune system's key infection fighters. The virus slowly disables or destroys these cells without causing symptoms.

As the immune system becomes more debilitated, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes, or swollen glands that may be enlarged for more than 3 months. Other symptoms often experienced months to years before the onset of AIDS include:

• Lack of energy;
• Weight loss;
• Frequent fevers and sweats;
• Persistent or frequent yeast infections (oral or vaginal);
• Persistent skin rashes or flaky skin;
• Short-term memory loss;
• Some people develop frequent and severe herpes infections that cause mouth, genital, or anal sores, or a painful nerve disease called shingles.

How is HIV managed?

• Promotion of health and the strengthening of the immune system;
• Rest, exercise and a healthy diet;
• Avoidance or reduction in drug, alcohol and smoking use
  • Drug, alcohol and smoking lower the immune system
• Avoidance of other people with illnesses or infection
  • A client suffering from HIV already has a low immune system.  Being exposed to illnesses can increase their risk of contracting other complicating infections.
• Routine visits to the doctor or clinic
  • Minimum 6 monthly check-up
• Monitoring of CD4 count and Viral load count
• General examination to obtain optimal health
• Be careful of pets in the home
  • Pets can make you feel psychologically and physically better, BUT
  • Refrain from cleaning cat litter boxes, dog litter and fish tanks. Serious infections can be transmitted through pet excrement.
• Ensure safety in your sexual life
  • Protect sex partners from infection
  • Protect yourself from re-infection (the more you get of the HIV virus, the faster the virus progress)
• Stress management and positive living
  • Stress has a very negative effect on the immune system.
  • Increased stress often causes a decrease in the number of CD4 cells.

How is HIV prevented?

• Abstinence
• Be faithful
• Condomise, correct condom use
• Don’t share needles and syringes
• Treatment after risky exposure
• HIV testing of both parties in a new relationship.

What is AIDS?

The acronym - AIDS - stands for:

• Acquired:  implies that you get it from an external source
• Immune:  meaning that one is protected from certain infections
• Deficiency:  depleted, impaired functioning, weakening
• Syndrome:  constellation of symptoms, signs or diseases

What are the clinical features of AIDS?

• Drop in CD4 and T-cells and with progressive symptoms of HIV disease.
• Drop in workload and household chores due to severe malaise.
• The development of various cancers, especially those caused by viruses such as Kaposi’s sarcoma and cervical cancers. Kaposi’s sarcoma in light-skinned people is round brown, reddish or purple spots that develop on the skin or in the mouth.  In dark-skinned clients the spots are more pigmented.
• The development of cancers of the immune system known as lymphomas (more aggressive to treat in clients with AIDS).
• Persistent coughing and shortness of breath.
• Difficult and painful swallowing.
• Seizures and lack of coordination.
• Mental symptoms such as confusion and forgetfulness.
• Persistent fever.
• Severe and persistent diarrhea.
• Vision loss.
• Nausea, vomiting, abdominal cramps and muscle cramps.
• Weight loss and extreme fatigue.
• Severe headaches.
• Coma.

For some, they may experience phases of intense life-threatening illness followed by phases in which they function normally.

How is AIDS managed?

• ARV’s (given when CD4 <200, viral load high)
• Healthy lifestyle:
  • Balanced diet, food enriched with Selenium.
  • Daily supplements.
  • Mild-moderate exercise and enough rest.
  • Protect yourself from getting cold – a reduction in body temperature will cause a further drop in immune system, thus making it ideal for opportunistic infections to develop.
  • Treatment of opportunistic diseases.

What are opportunistic infections?

Opportunistic infections are infections that enter the body due to a compromised immune system.  The common opportunistic infections in AIDS are:

• Tuberculosis (TB);
• STI’s;
• Septicemia;
• Pneumonia;
• Recurrent fungal infection of the skin and Oral Candida;
• Unexplained fever;
• Meningitis;
• Frequent diarrhea resulting in weight loss;
• Skin diseases and other diseases such as cancers.