The Lifespring Foundation (Africa)
UK Registered Charity 1112363
UK Base: The Old Rectory, Singleton, West Sussex PO18 0HF
Telephone No: ++44 01243 818181
HIV stands for Human Immunodeficiency Virus
HIV is the virus that causes AIDS by attacking the body’s immune system
What is an immune system?
A person’s blood is divided up into red and white blood cells. These white blood cells are the parts of your body that fight and protect against disease & it is these that keep us healthy. So when a disease or infection enters our body normally these white blood cells will surround it and kill it, keeping us healthy.
When the immune system is damaged then the body is not able to keep the disease and illnesses away.
When someone gets HIV then this virus enters the body and attacks the white blood cell soldiers and so when other illnesses enter our white blood cells are not able to fight the illness off properly.
What happens when HIV enters the body?
The surface of the HIV cell is shaped so that it fits onto a very specific type of white blood cell. These white blood cells are called CD4 cells. So when HIV is said to be attacking the immune system it latches on to these CD4 cells and attacks them. HIV is a tiny virus that attacks and infects these cells. HIV enters these CD4 cells and makes them think that they are not CD4 cells anymore, and so they cannot do their job protecting the body anymore.
What is AIDS?
AIDS stands for Acquired Immune Deficiency Syndrome
Acquired – means a disease you get during your lifetime as opposed to one you are born with
Immune Deficiency – means a weakness in the body’s immune system
Syndrome – means a group of particular health problems that make up a disease
AIDS occurs when the body is no longer able to fight off infection because of damage sone to the immune system by HIV
How & when does HIV become AIDS?
A person may have HIV from anywhere from 4 years to over 15 years before it turns into AIDS. There are many different factors that affect the amount of time that a person could carry HIV before it turns into full blown AIDS.
• Access to and quality of health care for opportunistic infections
• Lifestyle (chance of re-infection)
Without treatment the rate of progression from HIV to AIDS varies from person to person.
• Rapid progressors take 4-10 years
• Average progressors take 10+ years
• Slow progressors take 15+ years
As more HIV id produced in a person’s body the higher the person’s “viral load”, a term used to describe the amount of HIV in a person’s body. As this viral load increases the CD4 count (the number of white CD4 blood cells in the body) decreases.
The amount of CD4 cells in a person’s blood is used to test for AIDS. If a person has a count less than 200 then they are said to have AIDS.
What happens in a person’s body in the stages between HIV & AIDS?
Initial Infection: When first infected with HIV, people may experience flu-like symptoms. This happens as the body recognises that HIV has entered the body and so the body produces antibodies to fight it off. People will not notice this, it may only be years later when they get really ill that they realise that this was when it started.
Window Period: It takes approximately 2-6 weeks for the body to make antibodies. This is when the body tests positive for HIV. The window period can last for up to 6 months though, during which time the person may still be testing negative for HIV even though they have the virus.
Asymptomatic HIV (Asymptomatic = no symptoms): A person may live like this, testing positive for HIV but showing no symptoms or illness of the disease for 10-15 years or more.
HIV & AIDS illness: After this period, the person will begin to show signs and symptoms of the disease as the immune system has been severely weakened and cannot cope with opportunistic infections (OIs are different infections that take advantage of when HIV damages the immune system, for example TB, meningitis, pneumonia, diarrhoeal diseases etc). With most of these infections people who have a healthy immune system are not infected when they are exposed to them but when the immune system is compromised by HIV then these infections are able to overtake the body’s defences with potentially fatal results dependant on available treatment.
Ways that HIV CAN be transmitted
• Sexual – through unprotected sexual intercourse (most frequent form of transmission)
• Blood transmission – through needles, open wounds or sharing blood in any way with another person. If you have an open cut or wound cover it and be careful. A person who is bleeding can only infect you if you have an open wound or cut yourself. If their blood or pus just gets on your skin then you will not be infected, unless your own skin is cut.
• Mother to child transmission – HIV can cross while the child is in the womb, during labour when the child can swallow a lot of amniotic fluid and blood and through breastfeeding.
Ways that HIV CANNOT be transmitted
• Social contact – hugging, kissing, shaking hands, coughing, sneezing, sweat, tears
• Sharing – toilet seats, food utensils or drinking cups, clothes, bathing water
• Insects – Mosquitoes, lice, bed bugs, other insects
When are people most infectious?
In the very early stages people are very infectious, although this stage is difficult because symptoms may be mild and the virus totally undetectable.
People are least infectious in the Asymptomatic stage when there are HIV antibodies that are active in the blood system - although they are still infectious!
When the immune system later begins to fail and AIDS takes over the body, the person is extremely infectious again.
How can the transmission of HIV be prevented?
• Abstinence and faithfulness. If two people marry as virgins and remain faithful to each other
• Condoms – If people are going to have sexual activity outside of a faithful marriage, then it is vital that they use condoms every time they partake in any form of sexual activity.
• Wearing gloves or covering open wounds or cuts – this will help prevent transmission should your wound come into contact with blood from another person who has HIV/AIDS
Can HIV/AIDS be cured?
HIV/AIDS cannot be cured. It can, however, be treated with Antiretroviral drugs (ARVs). These are medications that slow or block the replication of HIV and help boost the body’s ability to fight the HIV infection, and help prolong a person’s life.
Symptoms suggestive of HIV infection
• Acute or chronic cough
• Oral thrush
• Chronic diarrhoea
• Genital sores
• Mental illness
• Trouble breathing
• Skin rashes
• Weight loss
• Skin problem- sores on the skin
• Damage to the nervous system
• Chronic headaches
• Severe stomach pains
These are the infections or sicknesses that attack the body when it is weak. Some examples are TB, malaria & pneumonia. TB (tuberculosis) is the commonest cause of death from AIDS in Africa)
As HIV attacks the CD4 cells the person’s immune system becomes weaker and weaker. This means that they can no longer fight off the germs that can make them sick. The germs take advantage of the weak immune system, or too few soldier cells and that is why they are called “opportunistic”.
How can opportunistic infections be avoided?
Opportunistic infections can be avoided with good basic hygiene for example
• Bathing using soap and water everyday
• Wearing shoes to avoid injuries which may lead to infections
• Brushing your teeth after eating
• Washing your hands with soap and water after going to the toilet & before eating
• Boiling your water
• Cleaning after animals
• Sleeping under a treated mosquito net
All of these things make picking up some of the germs that cause OIs less likely. This means that a person with HIV can stay stronger and healthier for longer.
Many infections can be prevented by taking medications called “prophylaxis”, which means preventative. Most OIs (including TB) can be cured and many can be prevented. The sooner people start treatment the better. For example, Septrin is a medicine that helps prevent a very serious type of pneumonia called PCP. If a person’s CD4 count is low then they can take Septrin everyday to try to prevent this.
Anti Retroviral Therapy
What is ART?
Antiretroviral Therapy is the term used to describe the treatment of HIV & AIDS. It involves more than just taking the ARV drugs. It is also about understanding HIV & AIDS, preparing for and adhering to an ARV drug regime, good nutrition, support & caring for the care-givers.
ART prolongs and improves quality of life for people with HIV, reduces the amount of HIV in their body, increases the CD4 count, boosts the immune system and reduces the amount of OIs.
ART also increases the awareness of HIV & AIDS in the community. It reduces some of the stigma and discrimination by proving that HIV can be a manageable illness.
What are antiretroviral drugs? ARVs
ARVs are drugs that help to reduce the amount of HIV in the blood stream. They do not cure HIV but they can help keep a person staying well for longer.
They work by slowing down the speed at which HIV attacks the immune system. They slow down the rate at which HIV reproduces, and increases the number of CD4 white blood cells. Once somebody starts taking ARV drugs their immune system should become stronger and the body should be able to fight infections better. The HIV will not disappear but will be sleeping in the person’s body. Although ARVs can make a person feel better the HIV is still there and they can still infect other people.
Once a person starts taking ARV drugs they must take them regularly at the right times for the rest of their life. If the ARV drugs are working well then the viral load should reduce within 6 to 12 weeks. If a person stops then the HIV will multiply rapidly in the person’s blood.
Adherence involves taking all the drugs in the right amount and at the right time every single day, eating and drinking the right things and knowing about the interactions that can take place between ARVs and other medications. For ARVs to be successful people need to achieve at least 95% adherence. This means taking their ARVs exactly as prescribed 95% of the time.
Stopping and restarting or missing tablets stops ARVs from working well and the person can develop drug resistance. This means that the drug does not work for them anymore. Because of this adherence is the most important factor in the success of ART.
It is important that there is somebody to help the person living with HIV AIDS to take their medication correctly. There are different reasons that people find it hard to adhere to their drug regime.
• If they get a lot of side effects from the medication
• If they start to feel well and start thinking that they do not need them anymore
• If they suffer from depression
• If they drink too much alcohol and forget
• If they vomit up the pills
• If they don’t know about the importance of adherence
• If they have difficulty obtaining the pills & run out
If the person develops drug resistance to ARVs then the person has developed a type of HIV which cannot be attacked by one or more of the ARV drugs. The ARVs stop working and the CD4 soldier cells cannot defend the immune system against HIV anymore.
Good nutrition while taking ARVs is absolutely vital. The way that the ARVs combine with food inside the body affects how well they work inside the body. Remembering that a good diet helps to boost the immune system, therefore the healthier the food, the healthier the body will be.
These usually go away once a person gets used to them, although this could take 4-6 weeks or even longer. Feeling tired, diarrhoea, having a headache, dry mouth or skin rash, tingling or pain in the hands or feet, nausea & vomiting, bad dreams, depression.
Knowing when to start ART is extremely important. If it is started too early then there is a risk that the drug may cause toxicity and that the patient develops a resistance early. If it is started too late, however, a patient may not respond very well. A person who is diagnosed with HIV does not necessarily need treatment straight away.
Before somebody starts ART it is so important that they understand that this is a life long treatment. People with HIV/AIDS who are not committed to this will do more damage to themselves than if they are not on these drugs.
Stigma refers to negative thoughts others have about a person they see as different to what they consider normal.
Reasons for HIV related stigma include:
• Fear – HIV/ AIDS is life threatening & people are scared of contracting it
• Ignorance – many people do not have enough access to information about HIV and how it is transmitted. This leads to fear.
• Prejudice – because of how HIV is often contracted (such as promiscuity, homosexuality, drug use, or unfaithfulness) this can lead other people to be unfairly judgmental.
This is when a person is treated unfairly because of their HIV status.
This can be:
• Giving a person living with HIV/AIDS different cups, plates, spoons etc, leaving them like an outsider. There is no risk of getting HIV from eating & drinking together.
• Keeping a family member with HIV or AIDS hidden away because the family is ashamed of what others might think.
• People avoiding or rejecting a person with AIDS even if this is a family member or friend.
Stigma is a huge problem & can prevent people from going to the clinic for treatment where they could be receiving life saving treatment. It prevents people from telling their partners (thus infecting them) & their family & friends who could be an invaluable source of support if people are properly educated.
It is important to educate the community and to encourage others in having a loving attitude to those with HIV or AIDS – they are suffering & it is important that they are made to feel supported & loved by those around them. It is important that those living with HIV are supported to live positively and with dignity.