Definitions

What is HIV?

In 1985, scientists discovered the human immunodeficiency virus (HIV).  HIV is a virus that is transmitted from person to another through the exchange of body fluids such as:

• blood,
• semen,
•  breast milk
• vaginal secretions. 

As well as through direct contact with the Mucous Membrane such as:

• mouth
• nose
• eyes
• penis
• anus

Sexual (anal, oral and vaginal) contact is the most common way to spread HIV AIDS, but it can also be transmitted by:

• sharing needles when injecting drugs,
• blood transfusions
• pregnancy
• during childbirth
• breastfeeding. 

As HIV AIDS reproduces, it damages the body's immune system and the body becomes susceptible to illness and infection.  Acquiring one of these infections means a person is diagnosed with AIDS.

A person can be infected for years without having AIDS.  Having HIV infection does not mean you have AIDS.  HIV and AIDS are not the same thing.

HIV cannot be transmitted through casual contact. Personal contact in the workplace is casual.

You cannot get HIV by any of the following activities:

• patting a co-worker on the back;
• sharing equipment;
• sharing restrooms;
• shaking hands;
• hugging;
• coughing;
• sneezing;
• using the same drinking fountain;
• using the same telephone;
• eating together.

Research shows that family members of people with HIV/AIDS have not been infected with the virus through normal household contact. Even people who have bathed or slept in the same bed with AIDS patients have not become infected.

Why is it important for you to understand what HIV/AIDS is?

By understanding the HIV virus, the chance of living a healthier, longer life increases.  In the beginning of the epidemic, an AIDS diagnosis signaled death would soon follow.  But today, thanks to the development of HIV medications, people are no longer dying from AIDS they are living with the HIV virus.  To live a productive, healthy life with HIV, one must learn as much as possible about the disease

How Does the HIV Virus Multiply?

Once inside the body the virus attacks specialized immune system cells known as CD4 cells. The HIV virus attaches to these cells and infects them by injecting HIV proteins (DNA and RNA) into the cell. The new HIV virus then infects other CD4 cells as the cycle repeats itself.

This figure illustrates how the HIV Virus attacks the immune system cells

How Does the HIV Virus Harm the Body?                                

As the HIV virus reproduces, the CD4 cells are damaged, becoming unable to fight infections.  As this process continues, the body's immune system weakens and the infected person becomes susceptible to a score of different infections, all capable of making the person sick and in extreme cases can lead to death.

Stages of HIV to Full Blown AIDS
Primary Infection (or Acute Infection)

Primary HIV infection is the first stage of HIV disease, typically lasting only a week or two, when the virus first establishes itself in the body. Some researchers use the term acute HIV infection to describe the period of time between when a person is first infected with HIV and when antibodies(proteins made by the immune system in response to infection) against the virus are produced by the body (usually 6 to 12 weeks) and can be detected by an HIV test.

Up to 70% of people newly infected with HIV will experience some "flu-like" symptoms during this stage. These symptoms, which usually last no more than several days, might include fevers, chills, night sweats, and rashes. Afterward, the infected person returns to feeling and looking completely well. The remaining percentage of people either do not experience symptoms of acute infection or have symptoms so mild that they may not notice them.

Given the general character of these symptoms, they can easily have causes other than HIV, such as a flu infection. For example, if you had some risk for HIV infection a few days ago and are now experiencing flu-like symptoms, it is possible that HIV is responsible for the symptoms, but it is also possible that you have some other viral infection instead. If you believe you may have been exposed to HIV, you may want to consider calling an AIDS hotline to discuss whether you were in a situation that put you at risk for HIV infection and whether you should take an HIV test.

During acute HIV infection, the virus makes its way to the lymph nodes, a process which is believed to take three to five days. Then HIV actively replicates (makes copies of itself) and releases new virus particles into the bloodstream. This burst of rapid HIV replication usually lasts about two months. People at this stage often have a very high HIV "viral load" (amount of virus in the body). However, people with acute HIV infection usually will not test positive for HIV antibodies, since it takes the body approximately one to three months to produce antibodies against HIV.

Some individuals who fear they have recently been exposed to HIV may be curious about PCR and RNA viral load testing, which test directly for the virus itself rather than for antibodies and can therefore be used during the acute infection stage. Viral load testing is generally used by physicians to track the progression of HIV disease in the body -- thus helping HIV positive patients make choices about appropriate treatment strategies. Most people concerned about their HIV status do not need viral load testing. The antibody test is the cheapest, easiest, and overall most reliable way for individuals to learn their HIV status. That said, individuals who have been exposed to HIV recently and experience symptoms consistent with acute HIV infection can request a viral load test from their doctor. This test may help identify HIV infection during the "window period" before HIV antibodies have developed, though an antibody test will ultimately be needed to confirm the viral load test result.

Some doctors are treating newly infected people (those in the acute stage of HIV infection) with a combination of anti-HIV drugs. Scientists disagree about whether anti-HIV treatment is useful during primary HIV infection. While some researchers are optimistic about the impact of very early anti-HIV treatment, they are also concerned about drug side effects, long-term effects on the body, and the possibility of developing drug-resistant virus if people use powerful anti-HIV drugs before they become ill due to HIV disease. You should consult with your doctor to make the most informed choice about when to start taking anti-HIV medications.

Seroconversion

This term refers to the time when an HIV positive person's immune system responds to the infection by producing antibodies to the virus. Most people develop antibodies within three months after infection, and some can take up to six months.

If an antibody test is done before seroconversion is complete, it may give a "false negative" result because sufficient antibodies have not yet been developed by the body. A three-month window period between infection and production of antibodies is normal for most of the population. Very, very rarely (i.e., in only a few cases ever), a person may take six months to produce antibodies. To be certain of your HIV status, take an HIV antibody test three months or longer after you were exposed to the virus. For even greater certainty, get tested again six months after the exposure occurred.

The Asymptomatic Stage

After the acute stage of HIV infection, people infected with HIV continue to look and feel completely well for long periods, usually for many years. During this time, the only indication that you are infected with HIV is that you will test positive on standard (antibody) HIV tests and you may have swollen lymph glands.

This means that you look and feel healthy but can infect other people through unprotected sex or through needle sharing -- especially if you have not been tested and do not know that you are infected.

Even though an infected person may appear perfectly healthy, HIV is still very active and is continuing to weaken the immune system during this stage. In some individuals, the virus appears to slowly damage the immune system over a number of years. In most people, however, a faster decline of the immune system occurs at some point, and the virus rapidly replicates. This damage can be seen in blood tests before any actual symptoms are experienced.

HIV positive people should seek medical care and begin monitoring their immune systems as soon as possible after receiving a positive test result. Periodic immune monitoring tests, such as CD4 count and viral load tests, can give you and your doctor a better picture of your immune health and disease progression, and can help you make smart choices about treatment.

Seeking early care for HIV disease can give people better chances of survival and improved quality of life. People with HIV are encouraged to see a doctor regularly, even if they feel fine at the moment, because the virus could be already damaging the immune system. Early and regular care enables HIV positive individuals and their medical care providers to take control of their treatment before symptoms appear.

Early- and Medium-Stage HIV Symptomatic Disease

When the immune system is compromised by HIV infection, many people begin to experience some mild HIV disease symptoms, such as skin rashes, fatigue, night sweats, slight weight loss, mouth ulcers, and fungal skin and nail infections. Most, though not all, will experience mild symptoms such as these before developing more serious illnesses. Although one's prognosis varies greatly depending on a number of factors, it is generally believed that it takes five to seven years for the first mild symptoms to appear. These symptoms mark the early and medium stages of HIV symptomatic disease.

As the disease progresses, some individuals may become quite ill even if they have not yet been diagnosed with AIDS, the late stage of HIV disease. Typical problems include chronic oral or vaginal thrush (a fungal rash or spots), recurrent herpes blisters on the mouth (cold sores) or genitals, ongoing fevers, persistent diarrhea, and significant weight loss.

These symptoms are not necessarily specific to HIV or the development of AIDS. However, they should be of concern to people who have tested positive for HIV. Usually, symptoms occur when the virus has already caused considerable damage to the immune system. For that reason, people with HIV should not wait until symptoms appear to get medical treatment. Also, people with high risk for HIV infection should not wait to for symptoms to appear before getting tested.

Late-Stage HIV Disease (AIDS)

When immune system damage is more severe, HIV positive individuals may experience opportunistic infections (called "opportunistic" because they are caused by organisms which do not ordinarily induce illness in people with normal immune systems, but take the opportunity to flourish in people with compromised immune systems). Some of the most common opportunistic infections includePneumocystis carinii pneumonia (PCP), Mycobacterium avium complex (MAC) disease, cytomegalovirus(CMV), toxoplasmosis, and candidiasis.

According to the Centers for Disease Control and Prevention (CDC), an AIDS diagnosis can be given to an HIV positive person who has a CD4 count of less 200/mm3 or a history of an "AIDS-defining illness" (such as one of the opportunistic infections mentioned above). For more information on what defines AIDS, including a complete list of AIDS-defining illnesses, see "Mortality Trends" from the Winter 2005 BETA.

It is important to note that this definition of AIDS may apply to HIV positive individuals who have never experienced symptoms of HIV disease.

Receiving an AIDS diagnosis does not necessarily mean that the diagnosed person will die soon; some people have lived for many years after their diagnosis. This is even more the case today with the availability of highly active antiretroviral therapy (HAART), which has helped extend the lives of thousands of people living with HIV and AIDS. In addition, many opportunistic infections can be prevented or treated successfully. This has substantially increased the longevity and quality of life of people living with HIV/AIDS.

Does everyone who has HIV eventually develop AIDS? We don't know for certain. Studies show that the majority of untreated people do eventually become ill from HIV. However, with regular medical care and other positive lifestyle factors, such as emotional support, many long-term survivors have been living with HIV/AIDS for upwards of two decades. As existing treatments are used earlier in the course of HIV disease and new treatments are developed, it has become possible to further postpone, and perhaps even prevent, illness.

What Can Be Done to Stop the HIV Virus?

While there is no cure for HIV, medications are now available that diminish the virus's ability to reproduce.  This in turn helps the immune system stay healthy and able to fight infection.  Keep in mind that these medications can't rid the body entirely of HIV and people can still infect others while on medications.

There is no risk of transmission from:

·         saliva, sweat, tears, urine,

·         respiratory droplets, handshaking, swimming-pool water, communal bath

·         water, toilets, food or drinking water

Symptoms of AIDS

The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems.  Most of these conditions are infections caused by that which are normally controlled by the elements of the immune system that HIV damages, such as:

• bacteria
• viruses
•  fungi 
• parasites 

Opportunistic infections are common in people with AIDS^.   These infections affect nearly every organ system.

People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas.  Additionally, people with AIDS often have systemic symptoms of infection like:

• fevers,
• sweats (particularly at night),
• swollen glands,
• chills,
• weakness, and
• weight loss.

The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the person lives.

Illnesses that are identified with STDs or STIs are as follows:

• Chlamydia
• Gonorrhea
• Genital Herpes
• Genital Warts
• Syphilis
• Trichomonas
• Bacterial Vaginosis
• Scabies and Crabs
• HIV/AIDS

The reason why HIV is still spreading is because:

·         People are uneducated about HIV/AIDS and how it is transmitted

·         People are afraid to speak up when they think they might have it

·         People still have unprotected sex

·         People are unfaithful to each other

·         Poverty

·         Not being able to get help (clinic or health center)

·         Unequal relationships between men and woman

Unequal relationships between men and woman

In most communities, woman are expected to agree to their male partners’ demands and decisions.  It is hard for women in these situations to say what they want or do not want.

For example, a woman who knows that her partner has other girlfriends may still not be able to ask him to use a condom.  Or a woman may be afraid that her partner will abuse her if she talks about safe sex.

Poverty

Although poverty may make people more vulnerable to HIV and AIDS, poverty does not cause the disease.  Poverty means that people often have to leave home to find work in other places.  When people move around, they look for new friends and sometimes seek comforting. 

If people worked in the same place all the time, they would find it easier to keep to one partner.  This would mean that HIV and AIDs would not be spread so fast.

Poor women often struggle to find work.  Sometimes they have to exchange sex for food or money.  These women may not be able to insist that their clients wear condoms.  When these things happen, HIV and AIDS can are spread quickly.

Poor access to health services

Some people have to travel long distances to get to the clinic.  Or they may not be able to afford to go to the clinic, and so they may leave a sexually transmitted infection untreated.  Having an untreated STI can make it easier for a person to get HIV. 

In addition, staff at busy and overcrowded clinics may not have the time to give their patients the information they need about HIV and AIDS.  These patients may not be able to get this information from anywhere else.  Free condoms are supplied at clinics.  If the clinics are far away, it can be difficult for some people to get the condoms they need.

Illiteracy

Many people who cannot read or write manage their lives very well.  But they may not be able to get the information they need to protect themselves against HIV and AIDS.

Unsafe sex

There are many reasons why HIV is spreading to fast.  The main reason is that many people have unsafe sex (sex without a condom).

How can you prevent HIV or STDs from spreading?

• You can choose not to have sex at all.  If you do not have sex, you are unlikely to get the HIV germ.
• If you do have sex, always have protected sex.  Protected sex means that you always use a condom when having sex.
• Only have sex with one partner who you know does not have the HIV germ.  The only way to know this is for both of you to be tested for HIV.  You and your partner must be faithful to each other after have been tested.
• If you work with blood always wear gloves.
• Clean workplaces with bleach
• Do not share needles
• Always assume that other people you do not know have HIV/AIDS and use precaution when dealing with them where it comes to getting in touch with their bodily fluids or blood.

Mother and Child Transmissions

Woman who are HIV positive and pregnant

Woman who are HIV positive and pregnant can pass the HIV to their babies.  This can be very hard to cope with, especially if you only find out you are HIV positive when you are already pregnant.  Women who know that they are HIV positive should think carefully before they decide to have a baby because:

• One out of every three babies born to HIV positive mothers will get HIV if the mother and baby do not take nevirapine to stop this from happening.
• Babies who have the HIV germ get sick often.  They usually die when they are very small.
• If you are HIV positive and pregnant, you may get sick with AIDS more quickly.

If you are HIV positive and pregnant, you have the right to terminate the pregnancy.  If you chose to do this it is better to have it done early in the pregnancy.  An abortion can be done until a woman is 20 weeks pregnant.

As a HIV positive mother you must live a healthy lifestyle and be careful during your pregnancy so that your baby has the maximum chance of not getting HIV.

Nevirapine is a medicine that lowers the chance of passing HIV to your baby.  Your baby must also been given a small amount of Nevirapine within 3 days of birth.  Babies take it in syrup form so it is easy for them to swallow.  The law says that you and your baby should be treated with Nevirapine if you are HIV positive.  Ask the health worker about this.

If you are HIV negative and pregnant you should take precautionary methods not get HIV while you are pregnant by:

• Not having unprotected sex – use a condom at all times
• Not having sex with different partners

Your baby can get HIV through:

• Pregnancy
• Birth
• Breastfeeding

Most babies do not live over 8 years who are HIV positive, most die before they are two years old.

Most babies who are HIV positive get sick often.  Some of the illnesses will be easy to treat with medicine.  A baby who is HIV positive will usually need to go to the clinic or doctor more often than other babies.  Babies who are HIV positive may have some of the following problems

• Not put on any weight
• Not grow and develop normally
• Get diarrhea a lot
• Get pneumonia or TB

It is very painful for parents to see their small baby getting sick so often.  It can make them feel helpless and afraid.  If your baby is sick, get support.

Breast-feeding and HIV and AIDS

Breast milk is the best food for new babies.  It gives them all the goodness they need until they are about six months old.  But if you are HIV positive and you breast-feed your baby, there is a chance that you will pass on HIV to your baby during breast-feeding.  Here are some things you can do to protect your baby:

• You can squeeze milk from your breasts and boil it well.  This will kill HIV and make the milk safe for your baby to drink.
• You can also give your baby milk formula if you can afford it.