Money Sense Follow up session - Fasset
TABLE OF CONTENTS PAGE
GLOSSARY OF HIV/AIDS TERMS AND ACRONYMS 3
WHAT YOU WILL GET FROM THIS WORKSHOP 4
1. WHAT IS HIV 5
1.1. HIV and AIDS 5
1.2. The Immune System 6
1.3. How HIV Infects the Body 6
1.4. Stages and Symptoms 7
1.5. History: HIV/AIDS Time line 9
1.6. Statistics 11
2. IMPACT OF HIV/AIDS 12
2.1. Economic Impact of HIV/AIDS on the Workplace 12
2.2. What is the Risk of HIV/AIDS for your Organisation? 13
3. WHAT CAUSES INFECTION 14
3.1. Requirements for HIV Infection to Occur 14
3.2. What Causes Infection 14
3.3. Other Possible Risks 16
3.4. Sexually Transmitted Infections 18
3.5. Vulnerability of Women 19
3.6. What is Your Risk 20
4. PREVENTION 21
4.1. ABC Option 21
4.2. Post Exposure Prophylaxis 23
4.3. Preventing Mother-To-Child Transmission 23
4.4. Drugs and Alcohol 23
4.5. Prevention of Occupational Injuries 23
5. FINDING OUT YOUR STATUS 25
5.1. Different Methods of Testing 25
5.2. Window Period 26
5.3. Workplace Surveys 26
6. LIVING WITH HIV/AIDS 27
6.1. Body 27
6.2. Mind 29
6.3. Spirit 30
7. SUPPORTING PEOPLE WITH HIV/AIDS 31
7.1. How to be an Emotional Supporter 31
7.2. Support Groups 31
7.3. Peer Education 32
8. LAWS THAT PROTECT PEOPLE LIVING WITH HIV/AIDS 33
8.1. Labour Relations Act (No. 66 of 1995) 33
8.2. Employment Equity Act (No. 55 of 1998) 33
8.3. Basic Conditions of Employment Act (No. 75 of 1997) 33
8.4. Promotion of Equality and Prevention of Unfair Discrimination (No. 4 of 2000) 33
8.5. Occupational Health and Safety Act (No. 85 of 1993) 33
8.6. Compensation for Occupational Injuries and Diseases Act (No. 130 of 1993) 33
9. ORGANISATION-BASED HIV/AIDS INTERVENTION 34
9.1. Design and Implementation of an HIV/AIDS Intervention 34
9.2. Medical Aid 36
10. RESOURCES 37
10.1. Contact Numbers for Resources regarding HIV/AIDS 37
10.2. List of HIV/AIDS Educational Material 40
GLOSSARY OF HIV/AIDS TERMS AND ACRONYMS
ACQUIRED: Something you get that is not your own. In the case of AIDS you get the HIV virus from the blood or body fluids of somebody else.
AIDS: (Acquired Immunodeficiency Syndrome)
ANTIBODY: A cell developed by the immune system of the body to fight against a virus, germ or something unknown in the body.
ANTIGEN: any intruder molecule in the body, like bacteria or viruses.
ART (anti-retroviral treatment): Medicine that stops retroviruses from making a person sick.
BACTERIA: A very small bug (too small too see) that makes you ill. It is easier to fight bacteria than it is to fight a Virus. (see VIRUS)
DEFICIENCY: When something is missing or not present. HIV takes away the body’s immune system and that is why we say the body has a immune ‘deficiency’ (see IMMUNE).
EXPOSURE: When a person has come into contact with HIV, they have been ‘exposed’ to it.
HIV (Human Immunodeficiency Virus): (see IMMUNO, DEFICIENCY, and VIRUS)
HIV-POSITIVE: A person who has been infected with the HI-Virus is said to be HIV-positive.
IMMUNE: A system in the blood of a human that fights against infection and sickness.
IMMUNODEFICIENCY: (see IMMUNE and DEFICIENCY)
MTCT (Mother-to-child transmission): When a HIV-positive mother passes HIV on to her baby.
OPPORTUNISTIC INFECTIONS: A whole range of signs, symptoms and illnesses that are associated with AIDS because they get easy access to the body because HIV has broken down the immune system. As a whole these sicknesses are referred to as opportunistic infections or opportunistic diseases.
PEP (Post-exposure Prophylaxis): Medicine taken by a person after they have been exposed to HIV to prevent becoming infected.
PID (Pelvic Inflammatory Disease): A disease that gives you chronic pelvic pain, life-threatening pregnancy, infertility, and abscesses in the pelvis.
RETROVIRUS: A rare type of virus. HIV is a retrovirus.
STI (Sexually Transmitted Infection): Sickness a person gets from having sex with a person who is infected with a STI virus of bacteria. The virus or bacteria is passed from your sex partner’s body to your own body. There are different types of STI’s with different symptoms.
SYNDROME: A collection of signs and symptoms or illnesses. AIDS is a syndrome because a whole range of illnesses is associated with the disease.
TRANSMISSION: When HIV is passed from one person to another.
VIRUS: A very small bug (too small to see) that infects the body, causes a breakdown in the immune system and leaves the person vulnerable to opportunistic infections.
WHAT YOU WILL GET FROM THIS WORKSHOP
1. How it can be of value to you personally
• Increase your understanding of what HIV and AIDS are and how the disease works
• Give you an indication of the latest global and local statistics of the disease
• Help you realise the impact of the disease on individuals, families, communities and society as a whole
• Enable you to identify what causes infection and calculate your own risk
• Help you identify ways of preventing HIV infection and how to live responsibly
• Inform you on methods of testing and where to go for tests
• Give you an overview of antiretroviral drugs
2. How it can be of value to your organisation
• Help you realize the economic impact of HIV/AIDS on your organisation
• Calculate the risk of HIV/AIDS to your organization
• Enable you to support HIV-infected employees effectively
• Give you an overview of legislation and legal implications related to HIV/AIDS
• Give you an indication of how to design and implement an HIV/AIDS policy in your organization
3. How you can help others
• Enable you to relay the message and informally educate others on HIV/AIDS
• Help you support people infected with and affected by HIV/AIDS
• Help you reduce the stigma of HIV/AIDS in your sphere of influence
• Equip you to encourage others to find out their status
• Enable you to refer infected individuals to appropriate support structures
WHAT IS HIV
5 HIV and AIDS
HIV is the acronym for ‘Human Immunodeficiency Virus’, a virus that was first identified in 1983 by a group of French scientists. The HI-Virus does not infect any other species although it is speculated that the disease originated from the Simian Monkey. HIV is classified in a virus group called lentiviruses, which typically develop over a long period of time and cause immunodeficiency. Immunodeficiency refers to the inability of the body to fight off infections.
AIDS is the acronym for ‘Acquired Immunodeficiency Syndrome’. The HI-Virus is not spread passively and requires activity from you – it is acquired through action. ‘Syndrome’ refers not only to one illness, but a collection of diseases called ‘opportunistic infections’.
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6 The Immune System
White blood cells (Leukocytes) are the main component of the Immune System (the skin and mucous membranes are the other components). Leukocytes can be divided into Antigen Presenting Cells and Lymphocytes.
THE TRANSLATOR – Antigen Presenting Cell
Antigen Presenting Cells break dying cells or antigens up into Epitopes. Epitopes are antigen building blocks and are classified into Major Histocompatibility Complex Class 1 and Class 2 cells (MHC 1 and MHC 2 cells). All cells belonging to the body have a MHC 1 cell on their surface. The antigen presenting cells present the Epitopes to T-cells to ‘read’ and to identify which cells should be destroyed. Macrophages, Monocytes and Dendritic Cells are all Antigen Presenting Cells.
THE WARRIOR – B-Cells
Lyphocytes are subdivided into B-Cells and T-Cells, which are both formed in bone marrow. B-Cells produce Antibodies that circulate the blood looking for foreign Antigens (Antigens without the MHC 1 epitope are classified as being foreign) and if found the B-Cell latches on to it and destroys the intruder.
THE CONSULTANT – T-Helper Lymphocytes
There are three types of T-Cells: Helper Cells, Cytotoxic Cells and Natural Killer Cells. The Helper Cells have a protein on their surface called the CD4 cell. The CD4 cell has a receptor, called the CCR5 receptor that binds to antigens. The binding between the CD4 cells and antigens stimulates the release of cytokines (messenger chemicals), which send a signal to Dendritic Cells, Macrophages and B-cells, which then stimulates antibody production and destroys the intruder.
Cytotoxic Cells need to be activated by Cytokine and kill the antigen on contact. Natural Killer Cells do not need a cytokine before reacting, but are activated when MHC-1 molecules are not on the surface of the antigen (when the antigen is foreign to the body). The MHC-1 molecule binds to a CD8 cell on the surface of the Natural Killer Cell. If there is no MHC-1 molecule to bind with, the Natural Killer cell kills the antigen on contact.
THE INTRUDER - HIV
The Human Immunodeficiency Virus (HIV) is an antigen and binds to the CCR5 receptor of the CD4 cell. HIV prevents the CD4 cell from secreting cytokines and even though a foreign antigen is identified, no kill-and-destroy response is signalled. The HI-Virus thus has ample time to infiltrate the Helper Cell, use its RNA to replicate and then to destroy the Helper Cell – weakening the immune system. The HI-Virus has no MCH-1 molecule on its surface and is destroyed by the Natural Killer Cells, but after being in the body while the HI-Virus mutates and can then attach to CD8 on the surface of the Killer Cell. This attachment keeps the Natural Killer Cell from destroying the HIV and the Virus prevails.
7 How HIV Infects the Body
The HI-Virus enters the body through an open sore, abrasion or broken skin – even if microscopically small. Once inside the body the HI-Virus (which is an Antigen) binds to the CD4 cell of the Helper T-cell with the help of the CCR5 receptor. The HI-Virus prevents the Helper T-cell from signalling the immune response and no kill-and-destroy action is initiated. The Virus has ample time to infiltrate the Helper T-cell and use its RNA to replicate and multiply. After replication the virus destroys the Helper T-cell, thereby weakening the immune system and limiting the body’s ability to fight off diseases.
Initially Natural Killer cells can identify and destroy the HI-Virus without the activation signal from the Helper T-cell, but with every replication the Virus mutates and becomes less detectable to the Killer cells. This way the HI-Virus slowly infiltrates and wear down the body’s immune system to a point where infected individuals no longer have any resistance against the opportunistic infections that characterise AIDS.
9 Stages and Symptoms
A whole range of signs, symptoms and illnesses are associated with HIV/AIDS because your immune system is too weak to defend your body against invading viruses, bacteria, germs or foreign cells. The illnesses associated with HIV/AIDS are referred to as opportunistic infections or opportunistic diseases and no symptom is limited to only one stage of the disease, because each person’s immune system reacts differently under attack. The World Health Organisation (WHO) identifies 4 different stages spanning across HIV infection and progression of the disease:
• Stage 1 – Primary HIV Infection
After infection you usually experience a short flu-like illness also called seroconversion illness. Seroconversion illness can be identified by a sore throat, fever and/or rash, but only up to 20 percent of people have symptoms serious enough to consult a doctor. The first stage usually lasts up to a few weeks and during this time an antibody test will not yet be positive. This is because of the window period (which lasts up to six months) where the body has not produced enough HIV-antibodies to show up in a HIV test. The WHO performance scale classifies you as stage 1 when you can continue normal activity and no symptoms can be identified.
• Stage 2 – Asymptomatic Stage
During this stage you are infected, but healthy and relatively free of symptoms. Some symptoms that might occur include weight loss and swollen glands, called PGL (persistent generalized lymphadenopathy). HIV is very active in your lymph nodes during this stage and large amounts of the virus are produced. This stage can last from 3 up to ten years. The WHO performance scale classifies you as stage 2 when some symptoms are present, but you can continue normal activity.
• Stage 3 – Symptomatic HIV Infection
In this chronic illness stage you experience symptoms like serious weight loss (less than 10 percent of your body weight), unexplained chronic diarrhea (for shorter than a month), unexplained prolonged fever (intermittent or constant) for shorter than 1 month, drenching night sweats, a dry cough and shortness of breath, memory loss, depression, chronic fatigue, yeast infection (especially in women) and swollen lymph glands in your armpits, neck and or groin. The WHO performance scale classifies you as stage 3 when you are seriously ill, but bedridden for less than 50 percent of the day during the preceding month.
• Stage 4 – Progression of HIV to AIDS
During this stage your immune system gets more and more damaged and illnesses become more severe. You will be diagnosed with AIDS when you develop specific infections, cancers or mental disorders as a result of the weakening immune system. These infections include HIV wasting syndrome (weight loss of more than 10 percent of your body weight), unexplained chronic diarrhea for more than 1 month, chronic weakness and fever for more than a month, pneumonia, tuberculosis, and disabling cognitive and or motor dysfunction interfering with daily living. About 50 percent of people with HIV develop AIDS within 8 years after infection. This stage usually lasts about 2 years. The WHO performance scale classifies you as stage 4 when you are seriously ill and bedridden for more than 50 percent of the day during the preceding month.
Figure 1: The Progression of HIV/AIDS
2 History: HIV/AIDS Time line
1981: An American drug technician wrote a scientific report after noting a high number of requests for the drug used to treat Pneumocystis carinii pneumonia (PCP) amongst gay men in Los Angeles. Later in the year the first cases of PCP appeared in drug addicts.
1982: The syndrome was called GRID (Gay-Related Immune Deficiency), but renamed because it did not just affect gay men. It was named Acquired Immune Deficiency Syndrome, or AIDS. By this time, the disease had been reported in 14 nations worldwide.
1983: Two Aids epidemics were reported in Europe and the first Australian death from AIDS was recorded in Melbourne. By now, AIDS had been reported in 33 countries.
1985: The first international conference on AIDS was held in Atlanta. By the end of the year, AIDS had been reported in 51 countries.
1986: The World Health Organisation (WHO) launched its global AIDS strategy.
1987: A total of 62811 cases of AIDS were reported from 127 countries.
1988: A world summit of ministers of health was held in London to discuss a common AIDS strategy. The WHO's Global Program on AIDS instituted World AIDS Day as an annual event on December 1 each year.
1990: By December, over 307 000 AIDS cases had been reported to the WHO, but the actual number was estimated to be closer to a million.
1991: The red ribbon was launched as an international symbol of AIDS awareness.
1995: The WHO’s global program on AIDS was closed and replaced by UNAIDS (Joint United Nations Program on HIV/AIDS).
1996: UNAIDS reported that the number of new HIV infections declined in many countries due to safer sex practices.
1997: UNAIDS reported that the HIV epidemic was far worse than thought. It was estimated that 2.3-million people had died of AIDS, 50 percent more than in 1996.
1998: UNAIDS estimated that a further 5.8-million people had become infected with HIV, half of them under the age of 25. It was also estimated that 70% of all new infections and 80% of all deaths were occurring in Sub-Saharan Africa.
1999: According to the annual World Health Report, AIDS had become the fourth biggest killer worldwide. By then, 33-million people were living with HIV/AIDS.
2000: AIDS deaths totalled 3-million. Of these, 2.4-million deaths occurred in Africa.
2001: United Nations general assembly convenes the first ever special session on AIDS - ‘UNGASS’.
2002: The global fund to fight AIDS, Tuberculosis, and Malaria begins operations and approves the first round of grants.
2003: President George W. Bush announces PEPFAR, the president’s emergency plan for AIDS relief. South African government announces comprehensive roll-out plan for fighting HIV/AIDS and a budget of R12 billion to support the plan for the next five years.
2004: Fifteenth Annual AIDS conference held in Bangkok in July. Second Annual African AIDS Conference held in Cape Town to discuss the social issues relating to HIV/AIDS.
(The Sunday Times & hivaids/timeline/)
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4 Statistics
• Global Estimates of HIV/AIDS Epidemic at the end of 2001:
(UNAIDS, Global AIDS Report, 2002)
• South African Prevalence Statistics as per province, 2002
[pic]
(Nelson Mandela Foundation/HSRC, South African Mass Media Household Survey, 2002)
IMPACT OF HIV/AIDS
6 Economic Impact of HIV/AIDS on the Workplace
|Direct costs |Indirect costs |Systemic costs |
|Benefits package |Absenteeism |Loss of workplace cohesion |
|Organisation-run health-clinics |Sick leave |Reduction in morale, motivation, and |
|Medical aid/health insurance |Other leave taken by sick employees |concentration |
|Disability insurance |Bereavement and funeral leave |Disruption of schedules and work teams or units |
|Pension fund |Leave to care for dependants with AIDS |Breakdown of workforce discipline (slacking, |
|Death benefit/life insurance payout | |unauthorized absences, theft, etc.) |
|Funeral expenses | | |
|Subsidized loans |Morbidity on the job |Workforce performance and experience |
| |Reduced performance due to HIV/AIDS sickness on |Reduction in average level of skill, |
|Recruitment |the job |performance, institutional memory, and |
|Recruiting expenses (advertising, interviewing, | |experience of workforce. |
|etc.) | | |
|Cost of having positions vacant (profit the | | |
|employee would have produced) |Management resources | |
| |Managers’ time and effort for responding to | |
|Training |workforce impacts, planning prevention and care | |
|Pre-employment education and training costs |programs, etc. | |
|In-service and on-the-job training costs |Legal and human resource staff time for | |
|Salary while new employee comes up to speed |HIV-related policy development and problem | |
| |solving | |
|HIV/AIDS programs | | |
|Direct costs of prevention programs (materials, | | |
|staff, etc.) | | |
|Time employees spend in prevention programs | | |
|Studies, surveys and other planning activities | | |
(Whiteside, A. & Sunter, C. (2000). AIDS: The Challenge for South Africa. Human & Rosseau Tafelberg, Kaapstad.)
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7 What is the Risk of HIV/AIDS for your Organisation?
Answer each question by ticking Yes or No.
| |YES |NO |
|Are most of the workers in your organisation aged between 25 and 45? | | |
|Are workers of your organisation living in single sex quarters? | | |
|Are the workers of your organisation migrant (travel across the country or world on a regular basis)? | | |
|Are there crucial workers in the production process? | | |
|Does the organisation find it difficult to find replacements for semi-skilled workers? | | |
|Does the organisation find it difficult to find replacements for skilled workers? | | |
|Is there a shortage of recreational activities available to employees (i.e. community or sport centres)? | | |
|Are alcohol and drug use common? | | |
|Are there risky environments in the surrounding community? | | |
|10. Will the epidemic affect the markets for your goods? | | |
|TOTAL | | |
|(Add up all the crosses you have in the Yes and No columns respectively) | | |
|RISK FACTOR |% |- |
|(Multiply the total of the Yes column by 10) | | |
(Adapted from the American Social Health Society)
The Risk Factor gives you an indication of how much more your organisation are at risk than the average risk factor.
Please note that the organisation can lower its risk factor by implementing an HIV/AIDS policy, which includes a specifications regarding allowances for sick leave and compassionate leave. The organisation also needs to determine how HIV/AIDS will affect benefits like medical aid, pension, disability and group life insurance.
WHAT CAUSES INFECTION
10 Requirements for HIV Infection to Occur
For HIV infection to occur one of the individuals involved in the (possible) transmission circumstance must be infected with HIV. Further you must be exposed to pre-cum, semen, vaginal secretions, blood, or breast milk; AND the virus must get directly into your bloodstream through some fresh cut, open sore, or abrasion; AND the virus must be transmitted from one person to the other very quickly. The concentration of the HI-Virus in the pre-cum, semen, vaginal secretions, blood, or breast milk also determines whether you will be infected. Blood contains the highest concentration of the virus and a small amount of blood is enough to infect you. After blood, semen has the highest concentration of the HI-Virus, followed by vaginal fluids and breast milk. A larger amount of these fluids is needed for HIV transmission to occur. Body fluids with a very low concentration of the HI-Virus include saliva, tears, sweat, faeces, and urine.
HIV is very fragile and many common substances, including hot water, soap, bleach and alcohol, destroy it on contact. When HIV is exposed to air it dries out quickly and the virus is destroyed.
11 What Causes Infection
• Infected Blood
The use of contaminated blood or blood products is the most effective way of transmitting the virus as it introduces the virus directly into the bloodstream. All blood used for blood transfusions are screened with an HIV antibody test before it is used. Due to this reason, the probability of infection through blood transfusion in South Africa is very low. However, because of the window period (when you are infected but the antibodies are not detectable) the risk of infection cannot be eliminated entirely.
HIV can survive for several days in the small amount of blood that remains in an infection needle after use. Drug users who share needles have a high risk of infection, because this small amount of infected blood is injected directly into the blood stream.
• Mother-to-Child Transmission (MTCT)
If a woman is HIV-positive the chances that her infant will be infected is estimated to be 30 percent if she remains untreated. Transmission from mother to baby can happen during pregnancy, during birth or when breast-feeding.
A women is more likely to pass the virus to her unborn baby if she became infected just before or during her pregnancy; she has a high viral load or a low CD4 count; she shows symptoms of AIDS; she has an asymptomatic HIV disease; or if she has a vitamin A deficiency due to malnutrition.
Transmission can occur during delivery due to a lengthy labour, rupture of membranes by health care workers, or an instrumental delivery. Studies indicate that transmission can be reduced to less than 2 percent if a caesarian section (c-section) is performed prior to labor combined with the use of antiretroviral treatment during the last trimester of pregnancy. Using antiretroviral treatment during the later stages of pregnancy and delivery reduces the probability of a pregnant mother passing the HI-Virus to her infant to between 5 and 8 percent.
Approximately 5 percent of MTCT occurs via breast milk and when a mother breastfeeds she increases the chance that her infant can be infected by 15 percent. Breast milk contains varying concentrations of the virus depending on the viral load of the mother. The infant consumes vast quantities of breast milk and because of its small body weight and newly forming immune system, there is a high risk of HIV infection. If a HIV-positive mother cannot access formula for feeding her infant, she should rather breastfeed than mix-feed since the latter increases chances of infection.
• Unprotected Sex
Up to ninety percent of HIV infections occur through unprotected sex. If you keep the requirements for HIV infection (as discussed in section 3.1) in mind, you can determine the infection risk of a sexual practice. Remember that even though sores, abrasions or broken skin is a prerequisite for the HI-Virus to enter you body, these cuts or sores are often microscopically small – too small to be seen with the naked eye, but big enough for the virus to find entry to the blood stream. Varying sizes of sores and abrasions are a natural result of the friction that occurs during sex.
Deep or open-mouthed kissing: Deep or open-mouthed kissing is a low risk activity in terms of HIV transmission. HIV is only present in saliva in very minute concentrations, but if you or your partner has blood in your mouth you should avoid kissing until the bleeding stops.
Fingering: Inserting a finger into someone’s anus or vagina would only be an HIV risk if your finger has cuts or sores on it and if there is direct contact with HIV infected blood, pre-cum, vaginal fluids or semen from the receiving partner.
Oral Sex: The risk of HIV transmission through the throat, gums and oral membranes are lower than through genital or anal membranes. There is a moderate risk of HIV infection if pre-cum, semen or vaginal fluid got into any cuts, sores or receding gums you might have in your mouth. The risk of infection can be increased if there is menstrual blood involved or a sexually transmitted infection (STI) present.
Extracting the penis before ejaculation: Research suggest that high concentrations of HIV can be detected in pre-cum and as a result it is difficult to judge whether HIV is present in sufficient quantities for infection to occur even though no semen is transferred from one partner to the other.
Lesbian sex: Women-to-women sex has a relatively low risk, but cases have been reported where women have been infected through lesbian sex or the sharing of sex toys.
Anal intercourse: Unprotected anal intercourse carries a higher HIV infection risk than most other forms of sexual activities. The lining of the rectum has fewer cells than that of the vagina and is more easily damaged or torn (which can cause bleeding) during intercourse. In the case of tearing, the HI-Virus can easily be transferred from sexual fluids directly into the bloodstream. During anal intercourse the risk of infection is higher for the receptive partner than what it is for the insertive partner.
Table 1: Risk of HIV infection
|ACTIVITY |BODY FLUIDS INVOLVED |RISK OF HIV INFECTION |
|Holding hands |None |None |
|Social kissing |None |None |
|Deep kissing |Saliva – Blood |Low – Moderate |
| | |You would have to swallow seven litres of saliva in order for |
| | |the virus to be transmitted in this way! Bleeding gums and |
| | |sores in the mouth increase the chances of infection from blood.|
|Masturbation |Vaginal fluid / Semen |None |
|Thigh sex |Vaginal fluid / Semen |Low |
|Mutual masturbation |Vaginal fluid / Semen |Low |
|Oral sex |Saliva / Vaginal fluid / Semen / Blood |Low to High |
| | |The virus can enter the blood stream through bleeding gums, |
| | |mouth sores or abrasions in the throat. |
|Vaginal sex |Vaginal fluid / Semen / Blood |High: 1/250 for women |
| | |High: 1/350 for men |
|Anal sex |Semen / Blood |High: 1/60 for women |
| | |High: 1/90 for men |
|Needle prick / Blood from HIV+ |Blood |High: 1/250 |
|person if you have a cut | | |
|Blood Transfusion |Blood |Low: 1/100 000 |
| | |Due to testing in the window period |
12 Other Possible Risks
Visiting the doctor or dentist: Transmission of HIV in a health care setting is extremely rare. All heath care professionals are required to follow infection control procedures when caring for any patient.
Blood splashes into eye: Research suggests that the risk of HIV infection in this way is extremely small. A very small number of people (usually in a healthcare setting) have become infected with HIV as a result of blood that splashed into their eyes.
Donor semen: Donor semen is checked for HIV antibodies when the semen is collected. The semen is then frozen and the donor is required to come back after six months for a second HIV test, to confirm the initial HIV screening. The semen is not used before the procedure in completed.
Biting: Infection with HIV in this way is unusual. There have been a couple of documented cases where HIV transmission resulted from biting, but in these cases severe tissue tearing and damage were reported in addition to the presence of blood.
Household settings: HIV is not transmitted through everyday social contact. Although HIV transmission from one family member in a household to another in the same household is theoretically possible, it occurs very seldom and documented cases are rare.
Tattooing, piercing, acupuncture, electrolysis and shaving: Where a needle or razor is used on more than one person there is a theoretical risk of HIV transmission because of the possibility of infected blood on the instrument. However, the risk can be reduced or eliminated through routine sterilization procedures.
Contact sports: The possibility of HIV transmission through open, bleeding wounds in contact sports has been recognized, but are low. Those who participate in contact sports like boxing, wrestling and rugby where blood and open wounds are often part of the game, have a higher risk where bleeding is not managed effectively.
Contact with saliva, tears, sweat, faeces or urine: Transmission can only occur when a sufficient amount of HV enters the bloodstream, through cuts or mucous membranes. These body fluids contain HIV in a quantity too small to result in transmission.
Insect bites: Mosquitoes, flies, ticks, fleas, bees or wasps do not transmit HIV. If a bloodsucking insect bites someone with HIV the virus dies almost instantly in the insect’s stomach as it digests the blood. HIV can only live in human cells.
Casual contact, sharing dishes or food: HIV is not transmitted through casual, every day contact. Since HIV is not transmitted by a small amount of saliva, it is impossible be infected by sharing a glass, a fork, a sandwich or fruit.
Swimming pools and jacuzzi’s: The chemicals used in swimming pools and jacuzzi’s will instantly kill any HIV, if the hot water hadn’t killed it already.
Pets: The HI-Virus cannot live in the bloodstream of animals and is a specific human virus.
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13 Sexually Transmitted Infections
Sexually transmitted infections (STIs) are infections that are usually passed on from an infected person to an uninfected person through sexual contact, including oral, vaginal and anal sex. Some STIs are also transmitted through other means than sexual contact, for instance HIV and Syphilis that can be transmitted through contaminated blood.
There are over 20 different kinds of STIs. Here are some examples:
| |EFFECTS |COMMENTS |
|Discharge Diseases |
|HIV/AIDS |Fatal, incurable |Estimated 40 million worldwide by the year 2000. |
|Gonorrhea |Causes Pelvic Inflammatory Disease (PID), chronic pain, |1.3 Million new cases per year. Some strains are resistant to|
| |infertility, life-threatening pregnancy and arthritis. |treatment. |
|Chlamydia |Causes PID, chronic pain, infertility, and problems during|Over 4 million new cases each year. |
| |pregnancy. | |
|Hepatitis B |Causes liver disease and cancer. |300 000 new cases each year. |
|Genital Ulcer Diseases |
|Genital Herpes |Painful blisters around sex organs, produces fever, |Almost 500 000 new cases reported each year. INCURABLE. |
| |enlarged lymph glands, flu-like symptoms. | |
|Genital Warts |Warts on the inside and outside of vagina, on tip of |About 30% of people have the HP-Virus that causes genital |
| |penis, testicles and around the anus. |warts. |
|Syphilis |Leads to blindness, heart disease, nervous disorders, |Over 100 000 reported cases per year. |
| |insanity, tumours and death. | |
Most STIs (except HIV and Herpes) can be effectively treated and cured. It is vital to start with treatment as soon as possible and to complete the entire course of medication prescribed to you. Treatment is available for free or really affordable prices at public health institutions.
A person with an STI is 20 times more likely to be infected with HIV. Genital sores cause breaks in the skin that allow HIV to enter the body more easily and in the case of discharges the number of white blood cells in the genital area increase, making it easier to get infected.
14 Vulnerability of Women
Women are more vulnerable to HIV infection than men. This is due to the following factors:
• Physical Issues
The inside of a woman’s vagina is a natural incubator for HIV and is a much larger area than a man’s penis. The vaginal wall is prone to sores and abrasions during sex and the amount of exposed vaginal tissue increases the woman’s risk of HIV infection.
After ejaculation, semen remains in the vagina while the man extracts his penis. The viral load in semen is higher than in vaginal fluid and the extended period of exposure to semen increases the woman’s risk of infection. Several opportunistic infections occur with greater frequency in women than in men.
• Young Women
Young women are particularly at risk because they are physiologically immature and more prone to trauma (sores and abrasions) during sexual encounters. Risk of infection is especially high for young women when they have relations with older sexually experienced men who are more likely to be HIV-positive. It is very unlikely for a young girl to be able to negotiate safe sex in these inherently unequal relationships, and research paints a picture of frighteningly high levels of coercive sex.
• Rape and Violence
Where force is used in sex, abrasions and cuts are more likely, thus making it easier for the HI-Virus to enter the bloodstream. Without immediate treatment up to 40 percent of rapes could result in HIV infection. It is clear that violence against women is fuelling the HIV/AIDS epidemic.
• Education and Economic
In more impoverished areas women are the ones to be removed from school when the family faces hard times, they are therefore more likely to be illiterate and the least likely to have marketable skills. In other instances, women are expected to stay at home and look after the households and they do not get the opportunity to develop professionally. This leads to an economic dependence on their husbands or partners, which in turn weakens their position in society. The woman who can muster the courage to leave her husband often ends up in a difficult financial position. This can force her to turn to commercial sex for survival, which increases her risk of HIV infection.
15 What is Your Risk
The risk assessment chart below can be used to calculate your risk of HIV infection for the last 12 months. (Please note that even though you might not have been sexually active in the past 12 months, if you were sexually active before your risk of infection might be higher than what is portrayed in this assessment.) Calculating your risk can help you decide whether you should:
o Take an HIV test
o Take extra precautions to protect yourself when having sex
o Take extra precautions to protect your spouse or sexual partner(s) and family
|No. |How to score the points |Score |Total |
|1. |Start with a score of 0 |0 | |
|2. |If your age is between 11 and 15, add 5 points | | |
|3. |If your age is between 16 and 25, add 7 points | | |
|4. |If your age is 25 or older, add 6 points | | |
|5. |Add 3 points for every sexual partner that you have had in the last year (e.g. 3 partners = 9) | | |
|6. |Subtract 1 point for each partner that you knew for at least 6 months before you had sex with him or | | |
| |her | | |
|7. |Subtract 1 point for each partner that you discussed STIs with, and the risk of you both getting them | | |
|8. |Subtract 3 points if you do or would use a condom with every sexual partner. You can subtract 2 points| | |
| |if you only use a condom sometimes | | |
|9. |Subtract 2 points if you can recognise the signs and symptoms of STIs and would go for treatment | | |
| |immediately after identifying one | | |
|10. |If you have been in a mutually faithful relationship for 5 years or more, subtract 3 points | | |
| |TOTAL SCORE | | |
(Adapted from the American Social Health Society)
Your estimated risk:
A score of 0 to 5 = low risk
A score of 6 to 10 = moderate risk
A score of 11 and above = high risk
PREVENTION
17 ABC Option
There are different ways of protecting yourself or at least reduce the likelihood an HIV infection through sexual transmission. These prevention methods are often referred to as the ‘ABC’ approach to prevention:
• A – ABSTAIN until married or in a long-term committed relationship
• B – BE FAITHFUL in marriage and long term committed relationships
• C – USE CONDOMS consistently and correctly if neither A not B is followed
The ABC approach target and balance abstaining from sexual activity, mutual monogamy and condom use according to the needs of different at-risk populations and specific circumstances confronting a particular individual. You must choose the way of protection that is most appropriate for your lifestyle.
Education in the prevention of HIV is fundamentally about communication, healthy choices, responsible behaviors and self-awareness. The only way to slow and ultimately stop HIV/AIDS is by educating people about risk and risk reduction. Any intervention that stresses either condom use or abstinence only misses the mark and is unlikely to significantly slow the pandemic. Studies have shown that the comprehensive ABC approach to HIV prevention is far more successful in reducing risky behaviours. Such an intervention has been implemented in Uganda with great success.
• Abstinence
Practicing abstinence means not to have sex. The safest sex is definitely no sex. Abstinence takes discipline and goes hand in hand with skills in goal setting, decision-making, relationship development and communication. This option is not appealing to everybody, but is especially advisable to young people who can delay their first sexual relationship as long as possible or those who are not in a steady relationship.
If total abstinence is not possible, you can still abstain from having penetrative sex by resorting to a safer sexual activity. You will not be infected if your penis, mouth, vagina or rectum does not touch anyone else’s penis, vagina, mouth or rectum. Safe activities include kissing, erotic massage, masturbation or mutual masturbation.
• Be Faithful
For those adults to whom abstaining is not an option, sex within the boundaries of a mutually faithful relationship is a more likely mode of protection against HIV infection. Many people engage in sexual activity without first establishing a committed relationship that allows for trust and open communication. As a safety measure, you and your partner should discuss your sexual history, any previous STI exposures, current or previous intravenous drug use, and your current health status before engaging in unprotected penetrative sex. Having sex in a monogamous, faithful relationship is safe if both of you are HIV-negative, you both only have sex with each other, and neither of you gets exposed to HIV through drug use or other activities.
• Condom use
For some, neither abstinence, nor being faithful is an option and using condoms are the only way of protecting yourself against HIV infection. Either the male or the female can wear a condom during sex to protect both parties from HIV infection. (Not all individuals, cultures and/or religious groups are open and willing to maintain the use of condoms as a method of prevention. These individuals or groups should stick to the A and B options of HIV prevention.)
Condoms are made of latex or polyurethane and come in a variety of shapes, sizes, flavors and textures to make sex more enjoyable. The latex condom is the only form of protection, which can stop HIV transmission, the transmission of STI’s and prevent pregnancy. Some condoms are lubricated with a silicone or water-based substance to make it easier to put the condom on and make use more comfortable. Some lubricated condoms are available with Spermacide (Nonoxynol 9) added, which provide additional protection against pregnancy if some semen happens to leak out. Some people have an allergic reaction to Spermacide that causes small sores on the penis that can increases the risk of HIV infection. It is important not to use an oil-based lubricant with condoms, as this damages the latex and cause tearing.
When used consistently and correctly, a condom is between 69 and 90 percent effective in preventing you against a HIV infection. Consistent condom use refers to using a condom every time you have sexual intercourse. It is important to never use the same condom twice. Condoms are affected by heat and light and must be stored properly. Do not use a condom stored in your back pocket, wallet or the glove compartment of your car.
The female condom is a polyurethane sheath or pouch, closed at the one end and about 17cm in length, which can be worn by a woman during sex. At each end of the condom there is a flexible ring. To insert the condom into the vagina the ring around the closed end of the condom is shaped into a figure 8 and then inserted in much the same way as a tampon. The inner ring will ensure than the condom stay in place during sex. The outer ring at the open end of the sheath stays outside the vulva at the entrance to the vagina. The outer ring acts as a guide during penetration and it also stops the sheath from bunching up inside the vagina.
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The female condom should not be used at the same time as a latex male condom because the friction between the condoms may cause the condoms to break.
18 Post Exposure Prophylaxis
Post Exposure Prophylaxis (PEP) is a dose of antiretroviral therapy that is designed to reduce the possibility of infection after an accidental exposure to the HI-Virus. PEP usually consists of the drugs AZD (Zidovudine), 3TC (Lamivudine) and Crixivan (Indinavir). The treatment approach varies according to the level of risk of infection and the level of risk is related to the type of exposure to the virus. In order for the treatment to be effective it must be taken within 72 hours of exposure (preferably within 2 to 3 hours after exposure) for a period of 28 days. The administration of PEP following exposure usually reduces the chance of HIV by between 79 and 81 percent.
The South African government provides PEP to individuals involved in occupational accidents (i.e. needle stick injury of health care workers) and rape survivors. In order to access the government funded PEP you must first report the case (accident or rape) to the police where you will be required to write out a statement. The police will then refer you to a doctor who will do some tests. Only once the tests have been completed PEP will be prescribed and administered. For all other cases of exposure you will be required to visit your private physician for PEP and in these cases the cost of PEP will be for your own account.
In case of a possible exposure to the HI-Virus it is recommended that you go for a HIV antibody test 6 weeks after the incident and then again at 3 months and 6 months to determine your HIV-status and whether sero-conversion takes place. Alternatively you can go for an HIV PCR test 10 days after exposure to determine whether HIV infection has occurred. (See section 5.1 for more information on testing.)
20 Preventing Mother-To-Child Transmission
Risk of infection can be reduced to less than 15 percent if the mother uses antiretroviral treatment during the last trimester of her pregnancy. In South Africa, mothers are treated with AZT or Nevirapine during the pregnancy and infants are given a dose of Nevirapine syrup just after birth to protect the babies from HIV infection.
21 Drugs and Alcohol
Drugs (if users do not share needles) and alcohol do not cause HIV, but bad judgment calls when you are high or intoxicated can increase your risk of infection. For instance, when you are high or intoxicated you might be more likely to throw caution to the wind and have unprotected sex. Part of prevention is to use drugs and alcohol responsibly.
22 Prevention of Occupational Injuries
There is no known risk of contracting HIV from working in a normal group setting. However, transmission is possible in, for example, factories where employees can get cuts from sharp utensils or equipment. The best policy is to treat all workplace incidents as if there is an HIV risk. The law requires that one first aid worker must be appointed for every 50 employees working at the organization. For the prevention of HIV transmission, first aid workers should use protective gloves at all times when assisting a patient and use special mouthpieces for mouth-to-mouth resuscitation. It is also advisable to keep bleach in the first aid kit for cleaning up after accidents.
If an occupational injury occurs and an employee fears the risk of HIV infection, the employer must:
• Report the workplace accident
• Send the employee for an HIV test immediately to determine HIV status before the accident
• Know that if the test is positive that infection occurred before the accident
• Ask the individual who could be the source of infection to go for a HIV test
• Get an affidavit if the source employee refuses to have an HIV test
• Help employee at risk to get access tot PEP
• Ask the employee to re-test after 6 to 12 weeks to see if he/she sero-converts.
If it is proven that an employee contracted HIV from a workplace accident, the onus is on the employer to assist the employee in applying for workman’s compensation.
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FINDING OUT YOUR STATUS
31 Different Methods of Testing
• Rapid Tests
Rapid tests are hand-held, easy to use tests that can be used for on-site testing. Results take between 20 to 30 minutes to return. The Abbot Determined test may test positive for HIV, malaria, pregnancy, flu or liver disease. If there is a positive result, a Gaifar test will be done. If the Gaifar is negative, you are HIV negative, but if tested positive, an Elisa test will be done and sent to a laboratory to confirm the results.
• Antibody Test (testing for antibodies and not the HIV Virus)
The ELISA test is the most popular and commonly used antibody test. It is adequate to make a HIV diagnosis. It tests for antibodies that are found in serum, which has been separated from red blood cells. The ELISA test will pick up the antibodies 6 weeks after infection (i.e. after the window period) and it takes one to two weeks to analyze. It is widely available, is reasonably cheap and is excellent for screening purposes, as it is also highly sensitive. In 0.5% – 2% of cases, the ELISA test gives false positive reactions because of its great sensitivity. Because of this, a second test is normally required when the result of the test is positive. This may not be necessary when there are other indicators of HIV infection such as obvious signs and symptoms of AIDS or a low CD4 count. Elisa tests are also available for rapid ‘bedside’ testing (tests that do not need a laboratory, but that can be done in a doctor’s/sister’s consultation room or clinic). As a rapid test the ELISA is reasonably reliable, but, in case of a positive result, a second test should be done through a laboratory.
• Testing for the actual HIV virus
These tests can detect the HIV virus in the blood. It is usually not necessary to make an HIV diagnosis, but is useful when testing small babies, when it is necessary to know the HIV status very early (i.e. within the window period), in special circumstances (after rape) and when antibody tests have been inconclusive. These tests are expensive and are not suitable for screening purposes.
The P24 Antigen test is more likely to be positive around sero-conversion and in the more advanced stages of the disease. It is more likely to give a false positive test (people who are negative, but show up positive) in the very early phase of infection.
PCR Antigen Detection (also known as the ‘three week test’) is an extremely sophisticated method, which can detect very small numbers of HI-Virus in the blood soon after infection. The virus usually becomes detectable 3-4 weeks after exposure and the test may be positive some time before antibodies are found. This test will remain positive for the duration of the illness. In further sophistication, the assay is used to quantify the amount of virus in the blood to help in management and drug therapy of infection with HIV. It is still very expensive and limited to only a few laboratories.
33 Window Period
After being infected with HIV immune system takes 3 to 12 weeks to produce HIV antibodies. If you go for a rapid or antibody test during this period, the test will be falsely negative. That is why it is always advisable to go for a second test 3 to 6 months after exposure to the virus. The 3 to 12 weeks after infection is known as the window period.
34 Workplace Surveys
HIV surveys will assist companies in establishing the magnitude of the HIV epidemic in the workplace. A proper HIV survey should provide the following information:
• The number of employees who are HIV positive
• The percentage of employees who are HIV positive
• The number of employees infected in pre-determined demographic groups
(e.g. age, job category, gender, divisions in the organisation etc.)
• Recommendations for managing the epidemic
When doing an HIV survey in the workplace it is important that:
• Participation must be voluntary and in agreement with organised labour
• Qualified health specialists with training in epidemiology and bio statistics are used to conduct the survey
• Legal and ethical principals are adhered to
• The survey forms part of a comprehensive HIV/AIDS prevention programme
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LIVING WITH HIV/AIDS
You can look at HIV/AIDS from two angles: living with HIV/AIDS or dying from HIV/AIDS. HIV/AIDS cannot be cured, but it can be managed like a chronic disease and even with HIV you can still have quality of life for years. The only prerequisite to attain and maintain quality of life is to ensure that you have a healthy body, a healthy mind and a strong spirit.
36 Body
Anti-retroviral Drugs (ARV’s)
On 19 November 2003 the Cabinet announced that ARV treatment would be available in every health district within a year and every local municipality within 5 years. Antiretroviral drugs inhibit the growth and replication of HIV at various stages of its life cycle and for lifelong treatment three different ARV drugs must be taken together. This is called combination treatment or HAART. There are three classes of ARV drugs and a combination must be found that accommodates with your physiology and has the minimal side effects. The three classes of ARVs include:
Nucleoside analogue reverse transcriptase inhibitors (NRTI’s): NRTI’s were the first antiretroviral drugs to be developed. They inhibit the replication of an HIV enzyme called reverse transcriptase. They include zidovudine (Retrovir, AZT), lamivudine, didanosine (Videx), zalcitabine (Hivid), stavudine (Zerit) and abacavir (Ziagen).
Protease inhibitors (PI’s): PI’s interrupt HIV replication at a later stage in its life cycle by interfering with an enzyme known as HIV protease. This causes HIV particles in your body to become structurally disorganized and noninfectious. Among these drugs are saquinavir (Fortovase), ritonavir (Norvir), indinavir (Crixivan), nelfinavir (Viracept), amprenavir (Agenerase) and lopinavir (Kaletra).
Non-nucleoside reverse transcriptase inhibitors (NNRTI’s): These drugs bind directly to the enzyme, reverse transcriptase. Three NNRTIs are approved for clinical use: nevirapine (Viramune), delavirdine (Rescriptor) and efavirenz (Sustiva).
Nutrition
Although your dietary intake cannot cure HIV/AIDS, it can influence the progression from HIV to AIDS. Serious deficiencies of protein, energy, vitamins and minerals decrease the proper functioning of the immune system. Malnutrition that exists before you become infected with HIV weakens the immune system and makes you more susceptible to infections, including HIV.
Most people living with HIV/AIDS suffer from anorexia, diarrhoea, nausea, and/or vomiting. All of these symptoms put an enormous strain on the body’s reserves of energy, protein and micronutrients. Malnutrition is often caused by HIV/AIDS and is also called ‘Slim Disease’ because patients literally tend to waste away. Many of the anti-retroviral drugs can also cause nausea, anorexia and vomiting, which interfere with food intake.
A healthy diet comprises of eating regular meals, including energy foods like starches to supply your body with the energy it needs to function optimally. Eat garlic often and drink lemon juice and olive oil regularly, but in moderate amounts. Vitamins and minerals should be taken regularly and include calcium, magnesium, selenium, zinc, vitamin A, C, B2, B6, B12 and folic acid. Avoid sugar, spicy and fried foods, coffee, red meat, peanuts, leftovers, unwashed or undercooked food.
Fitness and Exercise
Here are some of the benefits of keeping fit:
o More white blood cells are released into the blood stream to help you fight infection
o Increases the release of endorphins, which are chemicals produced by the brain that help you fight pain
o Improves your blood circulation and helps your blood carry more oxygen
o Removes toxins (poisons) through your sweat glands
o Improves sleep
o Relieves depression and stress
o Makes you feel healthy and alive
o Improves your attention to nutrition. Good eating habits and exercise go hand in hand
o Increases your appetite
o Improves your appearance and increases your motivation for living
o Increases the activity of T-cells and B-cells produced by the immune system.
Some useful web-site addresses on how to keep the body fit:
fitnessporter
38 Mind
Having a positive mental attitude and sufficient knowledge is the key to living with HIV/AIDS. A positive attitude and fighting spirit can give people with HIV a longer, better quality of life. See the article written by such an attitude warrior below:
I’M STILL STANDING
“A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.”
Sir Winston Churchill
AIDS entered my world on 10 March 1983.
On my 22nd birthday I received the results and it confirmed that something was seriously wrong with my body. I had a CD4 cell count of 362. I was told that I had six months to live, and then told to go home.
In the early days, HIV took many different paths and none of them had signposts to guide me. My journey has taken me to the highest levels of joy and the depths of sadness.
I started out life full of innocence and joy, with only instinct as my guide. As I grew up and life started with its lessons, fear entered. So I faced my fears head-on and slayed those dragons, one by one. With this, came courage – the courage to dare to be who God intended me to be, to live my truth and fulfil my purpose. I am grateful for the lessons HIV has taught me because without it, I would not be the person I am today.
The lessons I have learned are to hold onto hope. If we lose hope we lose our dreams and ourselves. Dreams are essential because they make the impossible possible. I have also learned that without faith in myself, others and in God, the lessons of HIV are wasted. The most important lesson is about LOVE - without it we are nothing.
Today, on the 13th March, I celebrate the 20th anniversary of my diagnosis with HIV/AIDS. It also happens to be my 42nd birthday.
I look at the future and am excited at all the possibilities, opportunities and lessons the next 20 years will bring. If HIV were a race between fear and myself with life as the prize, I can honestly say that I have won. By the grace of God I go.”
Written by David Patient
39 Spirit
Even life threatening disease cannot destroy the human spirit. The fruit of unconditional love, thankfulness, friendliness, patience and kindness, bring about a peace, joy and purpose that drive away darkness and bring life to a very darkened disease. It is no surprise that people who are HIV-positive often become interested in pursuing the strengthening of their spirit, especially when the mind and body are under assault of the HI-Virus.
The spirit works in close conjunction with the mind and your quality of thought determines your state of health. Don’t deny your suffering. Facing death can make you stronger, wiser and more understanding. It can help you focus on what is really important: family, helping others and living life to the fullest.
The saying “prayer heals“ is true - even if healing is not physical it certainly seems to heal emotionally. People who pray seem to be better able to deal with what life gives them. The key seems to be not to ask that AIDS be taken away, but to ask for health and quality of life.
Remember, you are still alive. Focus on what is good and positive every day and say thank you. Small and big things are important. Focus on the good things in life, appreciate them and value them.
SUPPORTING PEOPLE WITH HIV/AIDS
41 How to be an Emotional Supporter
In a society where people living with HIV/AIDS are often stigmatised, discriminated against and ostracised, HIV-positive individuals are in dire need of emotional support. The most important characteristics of an emotional supporter are respect, trust and understanding of which respect is the foundation to good relationships.
Respect is an attitude that portrays the belief that every person is unique, is a worthy being and is competent to decide what he or she really wants from life. You show respect by refraining from judgement or looking down on someone, but accepting the person irrespective of their values, beliefs, culture or behaviour. You show someone understanding by trying to walk in his or her shoes and by making time to support and to listen to that person. Trust is formed when you treat what a person shares with you as confidential. When someone opens up to you they make themselves vulnerable. If you exploit that vulnerability it will break trust.
42 Support Groups
Support groups can help both those infected with and those affected by HIV/AIDS to cope better with the disease. Support groups are structures where people meet on a regular basis to talk about their difficulties or simply to relax and enjoy each other’s organisation.
Family, friends and/or neighbours can all form part of your informal support structures when they care for those who are sick or need emotional support, whereas formal support groups are often run by a health professional. Both these structures have the same characteristics that make them successful:
• Group members trust each other
• Members trust their leaders (if the group has formal leaders)
• Members feel free of discrimination and blame
• Personal information shared is not discussed outside the boundaries of the group
• Access the appropriate information about the disease or issue being discussed
• Group members show respect to each other (not only words)
• Group members share interests and/or life experiences
• The group addresses the specific needs and expectations of each group member
• Group members get the opportunity to give and receive
• Group members listen and are listened to
The key to successful support groups is action, rather than words. What you do, not what you say, creates long-lasting networks of support.
45 Peer Education
Peer Education is one of the most widely used strategies to address the HIV/AIDS pandemic and typically involves training and supporting members of a specific group to effect change among members of the same group. Peer Education can be used to bring about a change in knowledge, attitudes, beliefs and behaviours of individuals and it may also create change on a group or societal level by modifying norms and stimulating collective action that in turn can contribute to change in policies and programs regarding a specific issue.
Peers are usually individuals of equal standing with the target group and are usually volunteers that assist in the education relating to a specific topic – in this case HIV/AIDS. When peers are of the same social standing and volunteers members of the target group seem more willing to listen and more receptive to messages on HIV/AIDS.
The role and responsibilities of an HIV/AIDS Peer Educator can be summarized as follow:
• Educate peers on HIV and STI’s in one-on-one and small group sessions
• Assist peers to access condoms and voluntary counseling and testing (VCT)
• Support people living with HIV/AIDS in their effort to live positively
• Teach pees to negotiate safer sex
• Teach peers to do personal risk assessment
• Teach peers about home care for people living with HIV/AIDS
• Distribute educational materials
• Provide referrals to health care facilities
• Participate in HIV outreach awareness and other public events
• Train other peers
Different methods of peer counseling can be used like storytelling, interactive drama, computer simulation games, slides and videos, but the most important tool or characteristic that a peer educator can use is the building of truly supportive relationships.
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LAWS THAT PROTECT PEOPLE LIVING WITH HIV/AIDS
48 Labour Relations Act (No. 66 of 1995)
Protects employees against unfair dismissal. If an employee is dismissed just because he/she has HIV/AIDS this dismissal is based on discrimination and is Automatically Unfair. The employer can be taken to the CCMA or Labour Court and be forced to re-employ the employee or give him/her compensation stipulated by the Court. Dismissal is fair only if it is based on the wrongful conduct of an employee or if an employee can no longer do his/her work properly. Where employees can no longer do their work an employer should first investigate what the extent of the employee’s capability to do their job is and what alternatives are available apart from dismissal. These alternatives can include extended sick leave without pay, adapted duties and possible means of accommodating the employee’s disability. An employee no longer able to work must be provided with an incapacity hearing before they can be dismissed.
49 Employment Equity Act (No. 55 of 1998)
This Act ensures that all employees are treated equally and that there is no discrimination in the workplace. The Act promotes equal opportunity by eliminating unfair discrimination and prohibits unfair discrimination (directly or indirectly) against an employee on the grounds of their HIV status. The Employment Equity Act also prohibits medical testing to determine the HIV status of an employee, except in limited circumstances. Testing can only be done if the Labour Court agrees to it. Employees may not be forced to answer questions on their HIV status. It is not unfair discrimination to exclude an HIV-positive person (when hiring them) if it is essential that an employee must not be HIV-positive in that job. The employer must be able to prove to the Labour Court that HIV-negative status is essential to that job. The ‘Code of Good Practice on Key Aspects of HIV/AIDS and Employment’ is part of the Employment Equity Act and gives employers guidelines to implement the requirements of the Act.
50 Basic Conditions of Employment Act (No. 75 of 1997)
This Act sets standards for employers on how many hours an employee may work in a week and how much leave they are allowed to have. Employees are allowed to take a total of six weeks paid sick leave every 3 years and employees with HIV/AIDS can take this leave just like any other employee in the organisation. Sick employees can ask employers to have more sick leave for less pay.
51 Promotion of Equality and Prevention of Unfair Discrimination (No. 4 of 2000)
The Promotion of Equality and Prevention of Unfair Discrimination Act also sees to it that there is no unfair discrimination in the workplace, especially with things like insurance. This means that an employee with HIV/AIDS must be treated in exactly the same way as all the other employees in the organisation in all matters.
52 Occupational Health and Safety Act (No. 85 of 1993)
An employer is obliged to ensure that the risk of occupational exposure to HIV is minimized as far as is reasonably possible.
55 Compensation for Occupational Injuries and Diseases Act (No. 130 of 1993)
If an employee is exposed to infected blood or body fluids as a result of a workplace accident and is infected with HIV, he or she may apply for benefits in terms of Section 22(1) of the Act.
ORGANISATION-BASED HIV/AIDS INTERVENTION
58 Design and Implementation of an HIV/AIDS Intervention
The following twelve steps can be used as a guideline for the design and implementation of an HIV intervention:
Step 1 - Management Meeting
Management meets and appoints an HIV/AIDS campaign leader to take responsibility to promote HIV/AIDS as an important and strategic consideration for the organisation. Any person in the organisation can play this role, but the more influential the better. Management should also start discussing a budget for an HIV/AIDS intervention.
Step 2 – Awareness Campaign
The key to success in an HIV/AIDS intervention is to involve all interest groups in the organisation and this is achieved through communication. Communicate the organisation’s intention to launch a HIV/AIDS intervention, share the aim of the intervention and ask employees to volunteer for a committee that will initiate and manage the intervention.
The HIV/AIDS Committee is responsible for initiating and implementing the intervention, gathering information through assessments, writing and promoting an HIV/AIDS workplace policy and overseeing the implementation of the strategy. It is important for the committee to be highly visible in order to stimulate interest and gain acceptance from employees. Duties of the committee members and time allocated to serve on the committee should be clearly defined so that clear boundaries are drawn between the work and committee responsibilities of employees.
Step 3 – Train the Committee
The HIV/AIDS committee should be educated in HIV/AIDS principles and thoroughly understand HIV/AIDS as a strategic issue.
Step 4 – Review Legislation
The following acts, read in conjunction with the Constitution of South Africa are relevant:
o Employment Equity Act, No. 55 of 1998
[Especially Section 6(1)]
o Labour Relations Act, No. 66 of 1995
[Especially Section 8 and Section 187(1)]
o Occupational Health and Safety Act, No. 85 of 1993
[Especially Section 8(1)]
o Compensation for Occupational Injuries and Diseases Act, No. 130 of 1993
[Especially Section 22(1)]
o Basic Conditions of Employment Act, No.75 of 1997
o Medical Schemes Act, No.131 of 1998
[Especially Section 24(2)(e) and Section 67(1)(9)]
o Promotion of Equality and Prevention of Unfair Discrimination Act (Act 4 of 2000)
These Acts, as well as the Code of Good Practice for HIV/AIDS, No.R1298 of 2000 should be taken into account when developing, implementing or reviewing any workplace policies or interventions.
Step 5 – Brainstorm Organisation Policy
By this time the committee will most probably be quite fired up and stimulated and a brainstorming session might be beneficial. At the brainstorming session the committee can start talking about organisation policy and principles with regard to HIV/AIDS and how it will be managed.
Step 6 – Assess the Organisation
The following aspects should be assessed in the organisation:
o What existing HIV/AIDS programs are being run in the organisation?
o What services and interventions are available in the close community?
o What is the prevalence and incidence of HIV in the organisation? (This could possibly be measured by facilitating voluntary counselling and testing in the organisation with the help of a clinic in the community. Employees could be asked permission to use anonymous statistics of prevalence and incidence after testing.)
o How aware are employees of HIV/AIDS? (A knowledge survey can be used to measure this.)
o What is the attitude of employees in regards to HIV/AIDS?
o What are the occupational health and safety risks in regards to HIV/AIDS in the organisation?
Step 7 – Calculate Financial Impact
Calculate financial impact of HIV/AIDS in the organisation and review the budget agreed upon in Step 1.
Step 8 – Share the Findings
Share findings with the rest of the organisation.
Step 9 – Write an HIV/AIDS Policy
Write a HIV/AIDS policy covering areas such as legal requirements, ambient attitudes within the organisation, key role players, and protection of rights and creation of duties. It is essential that after completion the policy be promoted within the organisation.
Step 10 – Devise an HIV/AIDS Strategy
It is important not to confuse policy and strategy. The strategy outlines plans for the intervention, where a policy describes an organisation’s stance on HIV/AIDS. Strategies include defined actions and related costs. In this step the HIV/AIDS committee decides which actions are going to be included in the organisation specific HIV/AIDS intervention.
Actions can include, but are not limited to:
o Education, prevention and awareness programs
o Support groups for HIV+ individuals
o Ensure the avoidance of discrimination
o Ongoing voluntary counselling and testing
o Treatment e.g. provision of antiretrovirals
It is important to focus on awareness and de-stigmatisation in the intervention and take both prevention and care into account.
In this step the budget for the HIV/AIDS intervention should also be finalized.
Step 11 – Implement the Strategy
The ultimate success of an HIV/AIDS intervention depends on the ability to implement the plans.
Step 12 – Review and Adjust
Review and adjust the policy, strategy and functioning of the HIV/AIDS Committee at specified intervals to suit the changing needs of the organisation.
59 Medical Aid
According to the Medical Schemes Act, a registered medical aid scheme may not unfairly discriminate against its members on health grounds and regulations may be stipulated that all schemes must offer a minimum level of benefits to their members. In other words, registered medical schemes must provide minimum benefits to al members and people living with HIV/AIDS cannot be excluded from a medical aid scheme on the grounds of their HIV status.
Notes: ____________________________________ ______________________________
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RESOURCES
64 Contact Numbers for Resources regarding HIV/AIDS
|NATIONAL AIDS HELPLINE |0800 0123 22 |
|Provides 24-hour toll-free information on any issue regarding HIV/AIDS. | |
|AIDS LAW PROJECT |(011) 717 8600 |
|Provides legal advice on any issue regarding HIV/AIDS. | |
|ATICC | |
|(AIDS Training Information and Counselling Centre) | |
|Provides free HIV testing and counselling to all. | |
|Cape Town |(021) 797 3327 |
|Bloemfontein |(015) 405 8544 |
|Durban |(031) 300 3104 |
|Johannesburg (Hillbrow) |(011) 725 6711/2 |
|Johannesburg (Baragwanath) |(011) 933 4361/9340 |
|Nelspruit |(013) 759 2167 |
|Pietermaritzburg |(033) 395 1612 |
|Port Elizabeth |(041) 506 1415 |
|Pretoria |(012) 308 8743 |
|Mamelodi |(012) 308 5570 |
|Queenstown |(045) 838 2233 |
|Qwa-qwa |(058) 713 2573 |
|CCMA | |
|(Commission for Conciliation, Mediation and Arbitration). | |
|Handles HIV/AIDS related legal cases from the workplace | |
|Head Office |(011) 377 6650 |
|Cape Town |(021) 469 0111 |
|Port Elizabeth |(041) 586 4466 |
|Bloemfontein |(051) 505 4400 |
|Johannesburg |(011) 377 6600 |
|Durban |(031) 306 5454 |
|Witbank |(013) 656 2800 |
|Klerksdorp |(018) 462 3137 |
|Kimberley |(053) 831 6780 |
|Pietersburg |(015) 297 5010 |
|LIFE LINE | |
|Provides free telephone counselling, face-to-face counselling, referrals and information. | |
|Durban | |
|East London |(031) 312 2323 |
|Elsies River |(043) 722 2000 |
|Free State |(021) 932 0352 |
|Gugulethu |(057) 352 2212 |
|Johannesburg |(021) 637 3009 |
|Khayelitsha |(011) 728 1347 |
|Mafikeng |(021) 361 5855 |
|Mdantsane |(0183) 814 263 |
|Mohlakeng |(043) 760 1730 |
|Port Elizabeth |(011) 414 3056 |
|Pretoria |(041) 585 5581 |
|Western Cape |(012) 342 2222 |
|West Rand |(021) 461 1111 |
|KwaZulu-Natal |(011) 953 4111 |
| |(035) 753 3333 |
|LABOUR COURT |(011) 403 4893 |
|For HIV/AIDS related court cases in the workplace (also see CCMA) | |
|LAWCO |(012) 342 1774 |
|(Labour and AIDS in the Workplace Consultants) | |
|Advises on and drafts AIDS policies in the workplace. | |
|EASTERN CAPE | |
|House of Resurrection |(041) 481 1515 |
|East London AIDS Training, Information and Counselling Centre |(043) 705 2968 |
|Port Elizabeth AIDS Training, Information and Counselling Centre |(041) 506 1486 |
|Queenstown AIDS Training, Information and Counselling Centre |(0458) 38 2233 |
|FREE STATE | |
|Bloemfontein AIDS Training, Information and Counselling Centre |(051) 405 8544 |
|Bloemfontein Hospice |(051) 447 7281 |
|GAUTENG | |
|Community AIDS Response |(011) 728 0218 |
|Cotlands Sancuary |(011) 683 7200 |
|National Association of People Living with HIV and AIDS |(011) 872 0975 |
|AIDS Education and Training |(011) 726 1495 |
|Soweto Hospice |(011) 982 5835 |
|Sparrow Ministries |(011) 763 1466 |
|Sungardens Hospice |(012) 348 1934 |
|The Community AIDS Information and Support Centre |(011) 725 6711 |
|AIDS Consortium |(011) 403 0265 |
|Mamelodi AIDS Training, Information and Counselling Centre |(012) 308 5570 |
|Hope Worldwide |(011) 984 4422 |
|KWAZULU-NATAL | |
|Philanjalo Care and Support |(033) 493 0004 |
|South Coast Hospice |(039) 682 3031 |
|Durban AIDS Training, Information and Counselling Centre |(031) 300 3104 |
|Pietermaritzburg AIDS Training, Information and Counselling Centre |(033) 395 1612 |
|MPUMALANGA | |
|Nelspruit AIDS Training, Information and Counselling Centre |(013) 759 2167 |
|NOTHERN PROVINCE | |
|Pietersburg AIDS Training, Information and Counselling Centre |(015) 290 2363 |
|NORTH WEST | |
|Lifeline |(018) 462 7838 |
|WESTERN CAPE | |
|Joy for Life |(021) 423 7413 |
|Wolanani |(021) 43 7385 |
|Western Province AIDS Training, Information and Counselling Centre |(021) 797 3327 |
65 List of HIV/AIDS Educational Material
Title: Need to know’s: HIV/AIDS
Author(s): Connoly S. (2003)
Description: This series of books provide information that does not patronize, over-simplify or judge, but examines social phenomena that are difficult or harmful to the HIV/AIDS epidemic. Each book traces the history, prevalence and consequences of such phenomena and offers ways of finding help for those involved or affected.
Title: The complete story of HIV/AIDS
Author(s): Visagie C.J. (1999)
Description: HIV and AIDS have reached epidemic proportions in southern Africa. Although there is no cure or vaccination at present, correct information can protect sexually active people and prevent the spread of the virus. This book is a comprehensive guide to HIV and AIDS. It could save your life and those of your loved ones.
Title: AIDS: the challenge for South Africa
Author(s): Whiteside A. and Sunter C. (2000)
Description: On the issue of HIV/AIDS, the majority of South Africans can be divided into two broad categories: those who bury their heads in the sand and deny that the epidemic exists, and those who believe that it exists but that they cannot do anything about it. In this book the authors offer a third view which is shared by a small number of people active in the HIV/AIDS field: there is an epidemic but there are plenty of things we can do to prevent it spreading further and to ameliorate the impact of increasing sickness and death among those already infected. The book covers the likely origin of HIV/AIDS; the current situation in the world and in Africa; why it has hit us so badly in South Africa; and the possible demographic, economic and social consequences for our society over the next twenty years. Along the way, the authors dispose of many myths associated with the epidemic. Finally, the authors recommend a grassroots approach made up of many small initiatives, pursued on as wide a front as possible, to overcome the epidemic and soften its impact. The message of the book is that we can beat HIV/AIDS, but we must all in our own way take appropriate action now.
For a more comprehensive list of HIV/AIDS books, please visit or
• Other HIV/AIDS Material
o Soul City: Television, Radio and Printed Material. (011) 643 5852 or soulcity@.za
o Ed-Unique AIDS Posters. Contact: Stella Heuer (043) 722 4228 or stellaheuer@freemail.absa.co.za
o “The Silent Enemy” (Video). Clem Sunter.
• Websites
o AIDS Education Global Information System: aegis.co.za
o International Labour Organisation and HIV/AIDS: aids
o Redribbon – A portal on HIV/AIDS: redribbon.co.za
o Soul City: .za
o The Body – An AIDS and HIV Information Resource:
o UNAIDS – Joint United Nations Program on HIV/AIDS:
-----------------------
CONTENTS
If you have HIV/AIDS it is important that you take an active role in every treatment decision. You and your doctor should discuss the different treatment options so that you can make an informed decision.
See next page…
FINDING OUT YOUR STATUS
[pic]
LIVING WITH HIV
LIVING WITH HIV
IMPACT
WHAT IS HIV
WHAT IS HIV
FINDING OUT YOUR STATUS
PREVENTION
WHAT CAUSES INFECTION
A person with a Sexually Transmitted Infection is 20 times more likely to be infected with HIV than one without an infection.
WHAT IS HIV
The catastrophic damage that the HI-Virus can cause to the immune system can leave the body prey to infections of the lungs, skin, nervous and digestive system and a variety of cancers.
WHAT IS HIV
WHAT IS HIV
OUTCOMES
PREVENTION
“Up to 80 percent of women who are HIV-positive and in long-term relationships acquired the virus from their partners. This is in a society where a man having multiple sex partners is the accepted norm. Ironically marriage is one of the greatest risk factors for women today.”
UNAIDS, HIV prevention news update 2002
“Change is a door that has to be opened from the inside.”
French proverb
WHAT CAUSES INFECTION
WHAT CAUSES INFECTION
WHAT CAUSES INFECTION
“After sexual transmission, the next most important cause of HIV infection in South Africa is mother-to-child transmission (MTCT).”
Alan Whiteside and Clem Sunter, 2000
“HIV/AIDS is undoubtedly a bottom-line issue for business, as it impacts on production costs and consumer markets.”
Leighton McDonald, spokesman for SABCOHA
“A virus is a piece of nucleic acid surrounded by bad news.”
M.B.A. Oldstone: Viruses, Plagues and History
IMPACT
WHAT CAUSES INFECTION
WHAT IS HIV
GLOSSARY
Copyright
Free to Grow is the copyright owner of this learner manual. Fasset may use the learner
manual to further its aims within the broader community in which it operates.
“I never have bad days – only good ones and excellent ones.”
Lance Armstrong, world biking champion and survivor of cancer
LIVING WITH HIV
“Considering the international AIDS crisis, I’ve found that taking a prayer-based approach to the problem can bring healing to my own thinking that will ultimately help bring healing to the disease itself.”
Ron Ballard
LIVING WITH HIV
SUPPORTING PEOPLE WITH HIV/AIDS
RIGHTS AND RESPONSIBILITIES
ORGANISATION-BASED HIV INTERVENTION
ORGANISATION-BASED HIV INTERVENTION
ORGANISATION-BASED HIV-INTERVENTION
RESOURCES
RESOURCES
WHAT CAUSES INFECTION
WHAT CAUSES INFECTION
SUPPORTING PEOPLE WITH HIV/AIDS
ORGANISATION-BASED HIV INTERVENTION
................
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