HIV / Aids

What is HIV?

HIV is an acronym that stands for:

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

What are the different strains?

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

Within the different strains there are also different Clades. This is important when it comes to things like vaccines as it is unlikely that a vaccine will prevent infection for all types and Clades. In Southern Africa the most common Clade is C, and most of the vaccine development is being done on this Clade.

HIV can be transmitted by:

• Sexual intercourse; vaginal and anal [see: A-Z of W2W Sex]
• Exchanging body fluids; semen, vaginal fluid, blood and breast milk
• Blood transfusion or blood products;
• Sharing of injecting equipment such as needles or body piercing;
• Transmission from mother to child.

HIV can NOT be transmitted by:

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

For HIV to be transmitted the infected body fluids has to get into the blood stream of the other person – this can happen through cuts and tears in the skin and the mucous membranes.
 

If Sexually Transmitted Infections [STI’s] are present, a person is more susceptible to contracting HIV due to the presence of other bacteria and lesions or sores that provide a perfect entry point. The presence of STIs are also a clear indication of unprotected sex taking place, making the individual vulnerable to contracting HIV.

It is important to note two things:

1. WSW do get STI’s and
2. STI’s in women often go unnoticed and undiagnosed.

It is important that we know the signs of different STI’s and go to our doctor or clinic if we think we may have a STI.

• Drug use is a major factor in the spread of HIV infection. Shared equipment for injecting drugs can carry HIV and hepatitis. Drug use is generally linked with unsafe sexual activity.
• Infected blood can be drawn up into a syringe and then get injected along with the drug by the next user of the syringe. This is the easiest way to transmit HIV during drug use because infected blood goes directly into someone's bloodstream.
• For a lot of people, drugs and sex go together. Drug users might trade sex for drugs or for money to buy drugs. Some people connect having unsafe sex with their drug use.
• Drug use, including methamphetamine or alcohol, increases the chance that people will not protect themselves during sexual activity. Someone who is trading sex for drugs might find it difficult to set limits on what they are willing to do. Drug use can reduce a person's commitment to use condoms and practice safer sex.
• Drug use can lead to missed doses of ARVs. This increases the chances of treatment failure and resistance to medications.
• Mixing recreational drugs and ARVs can be dangerous. Drug interactions can cause serious side effects or dangerous overdoses.
• The lives of WSW are generally under researched and we don’t have a clear and accurate picture of substance abuse in our communities. What we do know anecdotally is that some WSW do engage in recreational drugs and some women may also have addiction issues. We need to understand what the implications of this are for HIV and AIDS.

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

• Fever
• Headache
• Tiredness
• Enlarged lymph nodes (glands related to the immune system, easily felt in the neck and groin)

These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

IT IS IMPORTANT TO NOTE THAT THESE ARE GENERAL SYMPTOMS FOR MANY ILLNESSES AND ARE NOT ONLY AN INDICATION OF HIV INFECTION. THE ONLY WAY TO KNOW IF YOU ARE INFECTED OR NOT IS THROUGH HIV TESTING.

Later symptoms
Generally, more persistent or severe symptoms may not appear for between 5 - 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. This period of asymptomatic (no symptoms) infection varies greatly between each person and is an indication of how healthy your immune system is. Some people may begin to experience symptoms within a few months, while others may be symptom-free for more than 10 years.

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

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

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

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

We all know the messages of abstaining, being faithful and condomising but what does that mean for WSW?
Abstinence i.e., not having sex is obviously going to reduce our chances of getting HIV but it is not going to be a popular choice for many women. After all, we are sexual beings and have wants, needs and desires.

Being faithful to one partner is also an option and some of us may choose this approach. Obviously it is not enough just for us to be faithful, our partner also needs to be faithful and that is more difficult to control. We need to work at having an open and honest relationship so issues of fidelity can be discussed.
Safer sex is good practice to minimize the risk of sexual transmission. Barriers such as dental dams (OUT’s silk-e’s) are important to use. It is also important that we don’t share sex toys. More about safer sex when we describe the different things we do!!
 
We can also:

• Not share needles and syringes
• Seek treatment after risky exposure, that is take some form of post-exposure prophylaxis (PEP) if we have been exposed to the virus (PEP is available at the OUT clinic)

HIV testing of both parties in a new relationship, bearing in mind that a follow up test should be done after 6 months as you or her may initially be in the window period.

The acronym - AIDS - stands for:

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

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

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

• Tuberculosis (TB);
• STI’s;
• Septicemia;
• Pneumonia;
• Recurrent fungal infection of the skin and Oral Candida;
• Unexplained fever;
• Meningitis;
• Frequent diarrhea resulting in weight loss;
• Skin diseases and other diseases such as cancers.
• Some women may experience phases of intense life-threatening illness followed by phases in which they feel healthy.

It is important that women living with HIV and AIDS have a balanced and healthy lifestyle; this includes:

• Healthy lifestyle:
  • Balanced diet, food enriched with Selenium e.g., brazil nuts, wheat germ, brewer’s yeast, kidneys, liver, tuna, other oily fish, shellfish, sunflower seeds, lentils and cashew nuts.
  • Daily supplements, of vitamin A (preformedvitamin A and beta carotene), multivitamins (vitamins B, C,and E) http://content.nejm.org/cgi/content/full/351/1/23
  • Exercise
  • Sufficient rest.
  • Protection from cold – a reduction in body temperature will cause a further drop in immune system, thus making it ideal for opportunistic infections to develop.
  • Regular health checks. It is important to have a good relationship with your health provider
  • Early, and sometimes aggressive of treatment of opportunistic diseases.
• Ante-retrovirals (ARV’s) are a drug that counters or acts against a retrovirus, usually understood to be HIV or a substance or drug that stops or suppresses the activity of retroviruses such as HIV. A person should start on ARV’s when her CD4 count is around 200, and the viral load high. There is constant research carried out about treatment and it is important to keep up to date with the latest information. The following websites can help.
  
  •  HIV Treatment Literacy Toolkit for women. www.safaids.net/?q=node/20
  • www.thebody.com
  • www.tac.org.za

Different ARV’s may have different side effects, some of which are specific to women. One specific side-effect is changes in body shape which can have a serious impact on body image.
Lesbian, bisexual and other women who have sex with women (WSW) may be at greater risk for certain cancers due to certain behaviors and social factors. Breast cancer and uterine cancer may be associated with nulliparity, the state of not having given birth. Some evidence suggests that uterine/endometrial cancer and ovarian cancer are more prevalent among women who have never used oral contraception (the pill).