Description

 
• AIDS (Acquired Immunodeficiency Syndrome) is caused by HIV (the Human Immunodeficiency Virus).  
• HIV is mainly transmitted through sexual intercourse.  
• Once a person is infected, the virus remains in the body for life.  
• One can be HIV positive and feel completely well for many years. When a pregnant woman is infected, there is a one in three chance of her baby becoming infected if no steps are taken to prevent this.  
• All people infected with HIV will eventually get AIDS.  
• AIDS is a fatal illness.  
• There is no drug that can cure HIV infection, but there are drugs that can control the virus and delay the onset of AIDS.  
• There is no preventative HIV vaccine available at the moment, however research is ongoing to find one.

The Acquired Immune Deficiency Syndrome (AIDS) is caused by infection with the Human Immunodeficiency Virus (HIV). HIV attacks and gradually destroys the immune system, which protects the body against infections.

AIDS develops during the last stages of HIV infection. AIDS is not a single illness, but the whole clinical picture (a syndrome) that occurs when the immune system fails entirely. A person with a failing immune system is susceptible to a variety of infections that are very unlikely to occur in people with healthy immune systems. These are called opportunistic infections because they take advantage of the body’s weakened immune system. Certain types of cancers also occur when the immune system fails.

It may take years for a person’s immune system to deteriorate to such an extent that the person becomes ill and a diagnosis of AIDS is made. During this time (which can last as long as 15 years or possibly even longer), a person may look and feel perfectly well. This explains why so many people are unaware that they are infected with HIV. However, even though they feel healthy, they can still transmit the virus to others.

More than 90% of people living with HIV are in developing countries, with sub-Saharan Africa accounting for two thirds of all the HIV-infected people in the world. Unlike Western countries, where HIV has initially affected predominantly homosexual men, in Africa and developing countries HIV is usually spread by sex between men and women (heterosexual sex).

Research into HIV/AIDS is ongoing and new information is emerging rapidly. There are drugs that can dramatically slow down the disease in an infected person. These drugs need to be taken in various combinations in order to be effective and so treatment is generally quite expensive. Also, individuals on the drugs must be monitored by medical personnel trained in the use of antiretroviral therapy because these drugs can potentially cause serious side effects if not taken correctly and if the individual is not monitored properly. However, there is no cure for AIDS. There is also currently no preventative vaccine against HIV infection. At this time the only effective strategy for controlling the spread of HIV is prevention through individual behaviour change, spreading the correct information about preventing HIV infection and the use of condoms and other safe sex measures. Other measures, which should be taken by a country’s health system, are screening of blood products and the prevention of infection of patients through contaminated medical equipment. Mother to child infection can be reduced by a short course of an anti-HIV drug given to the mother and new-born baby at the time of delivery. (See “treatment”)
Cause
According to researchers, two viruses cause AIDS, namely HIV-1 and HIV-2. HIV-1 is the predominant virus in most parts of the world, whereas HIV-2 is most commonly found in West Africa. These viruses belong to a family called the retroviruses. They are unique viruses in that they are able to insert their genetic material into the genetic material (DNA) of cells of the person that they have infected. In this way they are able to persistently infect a person for the rest of that person’s life.

To understand how the virus eventually causes AIDS, see the section “Course of the disease”.

For detailed discussion of evidence that HIV causes AIDS, go to http://www.niaid.nih.gov/factsheets/evidhiv.htm

Viruses that are very closely related to HIV are found in other primates (apes and monkeys). These viruses are called Simian Immunodeficiency Viruses (SIV). HIV-2 is genetically almost indistinguishable from the SIV found in sooty mangabeys. A very close genetic relative of HIV-1 has been found in chimpanzees. Therefore most scientists accept that the human immunodeficiency viruses are recently derived from these primate viruses. The earliest blood sample found to contain HIV dates from 1959; this sample was collected in central Africa.

Based on molecular technology and the use of large computer programmes, scientists have been able to trace back the genetic origins of HIV-1 and HIV-2 and roughly pinpoint the time when these viruses first appeared in humans. The current theory is that sometime between 1930-1940 there was a “species-jump” of certain SIV’s into human populations, probably through the practise of slaughtering, preparing and consuming of “bush meat” from monkeys in parts of Central and West Africa.

HIV is not as contagious as is often believed. The virus does not survive long outside the body and can only be transmitted through the direct exchange of certain body fluids such as blood, semen and vaginal fluid. The virus can gain access to the body at its moist surfaces (“mucous membranes”) during sex, or through direct injection into the blood stream. Sex is the major mode of transmission of HIV worldwide.

HIV can be transferred from one person to another (transmitted) through:

 
• Unprotected vaginal or anal intercourse with an infected person  
• A mother’s infection passing to her child during pregnancy, birth or breastfeeding (called vertical transmission) - the risk of HIV passing from mother to child is approximately 30%  
• Injection with contaminated needles, which may occur when intravenous drug users share needles, or when health care workers are involved in needleprick accidents  
• Use of contaminated surgical instruments, for example during traditional circumcision  
• Blood transfusion with infected blood  
• Contact of a mucous-membrane surface with infected blood or body fluid, for example with a splash in the eye (Note that the virus cannot penetrate undamaged skin.)

If a person is exposed to HIV in one of the above ways, infection is not inevitable. The likelihood of transmission of HIV is determined by factors such as the concentration of HIV present in the body fluids. For example, although HIV has been detected in saliva, the concentration is thought to be too low for HIV to be transmitted through deep/wet kissing since it would require the exchange of almost one litre of saliva between individuals before there would be sufficient virus available for possible transmission. Additionally, a digestive protein in human saliva tends to inactivate the virus.

The risk of HIV transmission also depends on the stage of infection the HIV-positive sexual partner is in. Virus concentrations in blood and body fluids are highest when a person has very recently been infected with HIV, or otherwise very late in the disease, when AIDS has developed. Very early after infection the virus can multiply rapidly as the immune system has not had time to respond and fight back, and late in the disease the virus can multiply rapidly because it has destroyed the immune system altogether. However, it is important to note that once a person is infected with HIV, their blood, semen or vaginal fluids are always infectious, for the rest of their lives.

Vulnerability to HIV infection through sexual contact is increased if a person has sores on the genitals, mouth or around the anus/rectum. These sores can be caused by rough intercourse, other sexually transmitted diseases (STDs), gum disease or overuse of spermicides.

In heterosexual sex, women are more vulnerable to HIV infection because of the large mucous-membrane surface area of the vagina compared to that of the urethra (penile opening). Therefore, in regions where heterosexual sex is the main way HIV is transmitted (as in South Africa), approximately four women are infected for every three men that are infected.

Men who are circumcised may have a slightly lower risk of being infected with HIV.

Fortunately, people can take action to reduce their risk of infection. For example, a person who uses a condom every time he or she has sex is at far lower risk of infection than someone who has unprotected sex.

The following outlines common sexual behaviours according to relative risk:
Very low risk

 
• Kissing (if no blood is exchanged through cuts or sores)  
• Touching (such as stroking, hugging or massage)  
• Masturbation (including mutual masturbation)  
• Oral sex on a man with a condom  
• Oral sex on a woman with a barrier method (such as plastic wrap, dental dam or a condom cut open)

Low risk

 
• Wet/deep kissing (when sores or gum disease, and therefore blood, are present)  
• Oral sex  
• Vaginal sex with a male or female condom  
• Anal sex with a male or female condom

High risk

 
• Anal intercourse without a condom  
• Vaginal sex without a condom

How HIV is not transmitted
Unfortunately, there are still many myths around HIV. A person cannot be infected through:

 
• Mosquito bites  
• Urine or sweat  
• Public toilets, saunas, showers or swimming pools  
• Sharing towels, linen or clothing  
• Going to school with, socialising or working with HIV-positive people  
• Sharing cutlery or crockery  
• Sneezes or coughs  
• Touching, hugging or dry kissing a person with HIV  
• (Sexual) contact with animals, since HIV is strictly a human virus and is not carried by animals

In South Africa, blood donated for transfusions or blood products is screened for antibodies to HIV and for the presence of one of the viral proteins. Any contaminated blood is discarded. The probability of HIV infection via blood transfusion in this country is therefore extremely low, but can still occur because the tests used do not detect very early HIV infection in a donor. (See “the window period” in the section on HIV tests.)
Symptoms
The majority of people will have some symptoms about three weeks after they have been infected with HIV. These symptoms are similar to those of glandular fever:

 
• Fever and night sweats  
• Aching muscles and tiredness  
• Sore throat  
• Swollen glands  
• Diarrhoea  
• Skin rash and ulceration of the inside surface of the mouth and genitals  
• Headache, sore eyes and sensitivity to light

These early symptoms are called the HIV seroconversion illness. This is because the illness coincides with the start of the production of antibodies to the virus. (Antibodies are blood proteins made by the immune system that recognise and attach to organisms invading the body.) Consequently, seroconversion from HIV antibody negative to HIV antibody positive follows; these are the antibodies detected with HIV tests. The seroconversion illness is brief, lasting a week or two.

Thereafter most people remain symptom-free for a long time, on average ten years. Then symptoms associated with the advance of HIV disease, roughly in order of appearance, may include:

 
• Unexplained weight loss (more than 10% of body weight)  
• Swelling of glands in the neck, armpit or groin  
• Easy bruising  
• Recurring and unusual skin rashes, often itchy  
• A thick, white coating of the tongue or mouth (oral thrush) or vagina (vaginal thrush) which is severe and recurs  
• Ongoing vaginal discharge and pain in the lower abdomen  
• Sinus fullness and drainage  
• Recurrent herpes  
• Shingles  
• Persistent sore throat  
• Recurring fevers lasting more than 10 days without an obvious cause  
• Night sweats or chills  
• Persistent cough and/or shortness of breath  
• Persistent severe diarrhoea (longer than a month)  
• Changes in vision  
• Pain, loss of control and strength of muscles, paralysis  
• Discoloured or purplish growths on the skin or inside the mouth or nose  
• Difficulty with concentration, inability to perform mental tasks that have been done in the past, confusion, personality change

Symptoms are slightly different in children. Common symptoms include:

 
• Persistent oral thrush  
• Recurrent bacterial infections, such as ear infections  
• Recurrent gastro-enteritis  
• Swollen salivary glands (parotitis)  
• Swollen lymph nodes in the neck, armpits or groin  
• Enlargement of the liver and spleen  
• Failure to grow or reach normal points in development at the right time (such as talking, walking)

Prevalence
Estimates published in the annual “UNAIDS Report on the Global HIV/AIDS Epidemic” in 2002 estimate that more than 40 million adults and children were infected with HIV around the world in 2001. Africa south of the Sahara desert accounts for 28 million of these adults and children. A recent study by the Human Sciences Research Council (HSRC) which was published in December 2002 estimated that 11.4% of South Africans (4.5 million people) are currently living with HIV/AIDS. Also this study clearly demonstrated that young women in South Africa in the age group 25-29 are more at risk for HIV infection.

This data is also supported by the annual Department of Health Ante-natal clinic (ANC) surveys that showed about 24.8% of pregnant women were HIV positive in 2001. This in turn indicates that many thousands of babies would have been infected by their mothers in South Africa during 1999 to 2001. By the end of 2003, it is estimated that there were 1 100 000 AIDS orphans (mother or both parents lost to AIDS) under 15 years of age in South Africa. During 2003, 370 000 people died of AIDS in South Africa.

See “Epidemic Update” at http://www.UNAIDS.org

Course of the disease
The disease is best understood as a continuum from initial infection to terminal illness.

During sexual transmission, the virus penetrates the thin, moist surface of the vagina, urethra or rectum of another person during sex. Special protective white cells called macrophages usually patrol just beneath these surfaces and usually protect against invading organisms. Unfortunately, HIV is able to infect these exact defender cells or macrophages, which then carry the virus into the blood circulation.

Once in the blood, the virus has access to another type of white cell, called a T-helper lymphocyte. HIV gets into these cells by attaching to a specific protein on their surface, known as CD4 (so these cells are also called CD4 cells). T-helper lymphocytes circulate in the blood, but most of them are found in the lymph glands, where they stimulate other cells of the immune system to go into action.

In addition to the CD4 receptor, another co-receptor is required for the HIV virus to enter the CD4 cell successfully. The co-receptors are called CCR5 and CXCR4 and are also protein markers on the surface of these types of cells. Certain people have genetically defective CCR5 receptors that make them relatively resistant to HIV infection. CCR5 defects are common in Northern European populations but unfortunately are not common in South Africans.

HIV multiplies best inside T-helper lymphocytes and the infected lymphocytes eventually deteriorate and die, releasing more viruses to infect new lymphocytes.

The virus takes about two weeks to start multiplying efficiently in the body. At about three weeks after infection the immune system will recognise the “invasion” and start to produce antibodies to HIV. The battle between the virus and the immune response causes the symptoms of the seroconversion illness when antibodies are produced. Amazingly, the immune system will get the upper hand at this stage and limit multiplication of the virus, so that symptoms resolve in a week or two. Thereafter most people will have partial control over the virus with no symptoms of HIV infection for several years, 10 on average.

However, the virus hides out in an individual’s lymphocytes and slowly but surely evades the control measures of the immune system, mostly because it is genetically changeable and therefore keeps presenting a new appearance to the immune system which cannot keep up with the virus. All this time T-helper cells are not functioning properly or are destroyed whenever the virus multiplies. Initially the body is able to replace the T-helper cells as fast as they are destroyed and there is no significant effect on their numbers. However, after several years the body’s ability to replace the T-lymphocytes begins to fall off. T-helper cells play a crucial part in the proper functioning of the immune system and the depletion of these cells drastically reduces the effectiveness of the immune system.

AIDS is first diagnosed when an HIV-positive person gets a characteristic opportunistic infection or an AIDS-related tumour. Very common opportunistic infections in AIDS are Pneumocystis carinii pneumonia (PCP) now known as Pneumocystis jerovici pneumonia and tuberculosis (TB), which can even occur in sites in the body outside the lungs, bones or gut. The common tumours in AIDS are Kaposi’s sarcoma, usually visible in the skin, and certain tumours of the lymph glands (lymphoma). Infection of the brain by HIV itself or other viruses and certain types of parasites, can cause dementia and stroke-like problems.

Some people progress to AIDS quickly within two years, whereas others remain symptom-free for 15 years or more. This latter group of people are known as “long-term non-progressors” and scientists are very interested in what advantage they have for withstanding HIV. In developing countries, where people may be malnourished and have many other illnesses to contend with as well, HIV disease tends to progress to AIDS more quickly than the 10-year average for people living in the better circumstances of the developing world.
Risk factors
The following people are most at risk of HIV infection:

 
• People who have unprotected vaginal or anal sex  
• People who have sex with many partners, thereby increasing the chance that they will encounter a partner who is HIV infected  
• People who share needles (for example for intravenous drug use, tattooing or body piercing)  
• Babies of mothers who are HIV infected  
• People who have another STD, especially STDs that cause open sores or ulcers such as herpes, chancroid or syphilis  
• Haemophiliacs and other people who frequently receive blood products (this risk is now very much diminished, but there are still countries where blood is not adequately screened)  
• Health care workers, where precautions are neglected or fail (for example through not wearing gloves or accidental needle injuries)

When to call a health professional
A health care professional should be seen if:

 
• You have been at risk of HIV infection (for example through unprotected sex, rape or sharing of needles). Anti-HIV drugs taken within hours or days of exposure to HIV can decrease the risk of contracting the virus.  
• Your sexual partners engage in high-risk behaviour or are known to be HIV positive  
• You are pregnant or plan to have a child  
• Any of the symptoms listed above are present  
• An HIV-positive person develops shortness of breath, convulsions, weakness in a limb or one side of the body, or loses consciousness (they should receive emergency care)

Visit preparation
Before being tested for HIV, it is best to seek counselling. All clinics and doctors should insist on pre- and post-test counselling to help patients deal with the psychological stress and anxiety they are likely to experience while waiting for results or when they have to deal with the consequences of a positive result. Pre- and post-test counselling for HIV testing is a requirement by law in South Africa. Avoid sexual contact with others while waiting for test results.

Diagnosis
Diagnostic testing can only be done with your consent. Pre-employment testing is now illegal in South Africa. Testing by life insurance companies is still often required, but can only be done if the client gives consent.

Ordinary HIV tests do not detect the virus, but rather the specific antibodies that are produced by the immune system in response to HIV infection. Antibodies are produced from about three weeks after infection and usually become detectable by enzyme liked immunosorbent assay or ELISA testing by four to six weeks after infection. This four- to six-week period between infection and a positive test is called the window period. In some people the window period is longer; it may take up to three months for an antibody test to become positive after they have been infected, but this is unusual. People who think that they might have been exposed to infection are therefore usually asked to wait at least four weeks before having the HIV test. Also, even if the first test is negative (i.e., no antibodies detected), a follow-up test should be done three months after the suspected exposure.

The most widely used and best antibody test is called an ELISA test (ELISA is short for Enzyme-Linked Immunosorbent Assay). ELISA tests have to be done in a laboratory. If a positive result is obtained on an ELISA test, the laboratory will confirm the result by testing with at least one different type of ELISA test. As an additional check, a second blood specimen is usually taken from the person for repeat testing.

Testing can also be done with a rapid HIV test which can be carried out by any health care professional immediately on-site in a clinic. Two different rapid tests should be used to confirm a diagnosis of HIV infection. The advantage of rapid testing is that an HIV result is available within 30 minutes.

This sort of HIV testing is very accurate. Very rarely false positives occur due to antibodies that cross-react in the testing system, but these occur less frequently with the new generation tests.

Currently, home HIV tests are being sold in some chemists. Most health care professionals and the Department of Health are not in favour of this practice. One reason is that the quality of the test cannot be regulated, so that there may be a greater risk of false positive or negative results. Also, a person testing themselves or someone else, will probably not have the information or psychological support that is gained through pre- and post-test counselling.

HIV testing in babies:
In babies less than 18 months old, the mother’s antibodies in the baby’s blood can interfere with the HIV antibody test. Therefore, to test whether a baby is infected with HIV, it is necessary to detect the virus itself. This is commonly done with a PCR test.

Once a person has tested positive for HIV, a thorough medical examination should be done to evaluate their present state of health. As other STDs and TB are often present in someone who is HIV positive, additional screening tests for these diseases should be done, so that they can be treated straight away.

There are tests to monitor how advanced a person’s HIV disease is. A CD4 cell count indicates what reserves of T-helper lymphocytes the person has and therefore the remaining strength of their immune system. A normal CD4 count is 800 or more cells per microlitre of blood. HIV-infected people in the early stages of the disease have a count of 200 to 500 cells per microlitre and in late phases a count lower than 200. A viral load test measures the amount of virus in the blood, which shows how rapidly HIV is multiplying and therefore how quickly the disease is likely to progress. The viral load test is also very useful for showing how the virus is responding to antiretroviral drug treatment.

Treatment
Home

 
• Discuss your HIV status with your partner(s). While this may be difficult to do, it is important that they be tested so that they can also be treated if necessary. In addition, they in turn may be unknowingly putting others at risk of HIV.  
• Protect your partner(s) from HIV by practising safer sex.  
• Stay healthy to maintain a strong immune system: eat a healthy, balanced diet, get enough rest and exercise, and avoid cigarettes and alcohol.

Medication
Anti-retroviral drugs slow down the rate at which the virus multiplies. Even though these drugs cannot completely eliminate the virus, by slowing down its multiplication they can prolong the symptom-free period of the disease. The presence of symptoms of HIV disease, the CD4 count and viral load tests are all used to decide when to start anti-retroviral drugs. Even if there are no symptoms, according to international guidelines that are revised every year, a CD4 count lower than 250 or a viral load higher than 50 000 would indicate the need for drug treatment. These guidelines also give information on which drugs are suitable to start therapy with and how to monitor individuals on these drugs.

It is believed that it is not best to start treatment too early so as to avoid the possibility of viral resistance developing to certain important groups of drugs and to minimise the drug side effects to an individual.

Anti-retroviral drugs include:

 
• Nucleoside reverse transcriptase inhibitors (NRTIs) such as zidovudine (AZT) and lamivudine (3TC)  
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as nevirapine  
• Protease inhibitors (PIs) such as indinavir

The two groups of reverse transcriptase inhibitors handicap (inhibit) the viral enzyme that allows the virus to repeatedly copy itself into the DNA of T-helper lymphocytes.

The protease inhibitors handicap the viral enzyme that allows young viruses to mature to the state in which they can infect new cells.

In the best circumstances a person is given a combination of these drugs. This is because the drugs assist each other against the virus, so it takes longer for the virus to become resistant to any one drug. Ultimately a person’s virus becomes resistant to these drugs so that they are no longer effective, in the same way that insects become resistant to a pesticide and bacteria become resistant to a frequently used antibiotic.

These drugs are very expensive and laboratory monitoring while on the drugs can also be costly. If you do not have medical aid, and private health care, you can now obtain treatment through certain government hospitals and clinics. However, these government treatment centres are not yet up and running in all areas. Instead, there may be a non-governmental organisation (NGO) free treatment programme in your region.

You may have the opportunity to participate in a drug trial, usually at a large hospital. In a drug trial new drugs or new combinations of drugs are tried out on a group of patients. These trials are closely monitored to ensure that those participating benefit from the drugs, and are not harmed or exploited.

HIV drugs and mother to child transmission (MTCT)
Pregnant women who are HIV positive can reduce the risk of infecting their babies by using anti-retroviral drugs during pregnancy and labour. In addition, the baby may be given an anti-retroviral drug for a few weeks after birth to counteract exposure to the virus during labour. There are different drugs and treatment approaches that can be used in this situation, but the most world-wide experience has been obtained with the drug AZT, and more recently, nevirapine. Infection of babies can be reduced by approximately 50% by using a short course of either of these drugs. A planned caesarean section will also reduce the risk of HIV being transmitted to the baby, as most infections occur during labour itself.

New data from studies conducted in Soweto, South Africa, using only one dose of drug (nevirapine) to the mother during labour and one dose of nevirapine to the infant after delivery has shown to decrease transmission by almost 60%. This is a very easy and short schedule that can easily be implemented in this country to prevent mother to child transmission of HIV. One concern about the use of nevirapine for PMTCT (preventing mother to child transmission) is that the virus in both mother and child may develop resistance to the drug, and then it is not suitable for use if they should need treatment.

Babies can be infected through breastfeeding, so most specialists strongly recommend that mothers who are HIV positive should only bottle feed their babies. If pure bottle feeding is not an option, then pure breastfeeding is recommended, and mixed feeding (breast and bottle) should be avoided. It is believed that mixed feeding may actually increase the chance of HIV transmission through the mother’s milk. The recently implemented Department of Health MTCT programme in South Africa provides a dose of nevirapine for a mother and her infant as well as a supply of formula milk at a subsidised cost. Most antenatal clinics in the country also have a “training” programme to show mothers how to use this milk properly. So although the benefits of breast milk are unfortunately lost in these infants, receiving formula or bottle milk at least ensures they are not exposed to HIV.

MTCT is a very complex problem. If you are HIV positive and pregnant you would need to discuss the issues at length with a health care professional knowledgeable in the area.

Health care workers who are accidentally exposed to HIV through, for example, a needleprick accident should start one or more anti-retroviral drugs (usually AZT and 3TC) as soon as possible after the incident and preferably within 72 hours. The drugs are usually taken for one month. From analysing thousands of such accidental exposures to health care workers, it has been calculated that even though the risk of getting HIV infection from such an accident is quite low (0.3% of cases), taking anti-retroviral drugs reduces the risk of infection by about 80%.

Women who have been raped should also start anti-retroviral drugs as soon as possible. Most specialists believe that this is highly likely to reduce the risk of HIV infection, just as the drugs reduce infections after needleprick accidents and reduces transmission of HIV from a mother to her newborn baby. Recently some experimental work in monkeys and data from rape clinics have confirmed this theory, and showed that the drugs must be taken early (definitely before 72 hours, and preferably within 36 hours) to be effective.

The South African government now funds anti-retroviral drugs in the context of rape. However, this treatment may be difficult to obtain outside of large hospitals. There are special rape centres where treatment is available, and the police in your area should be able to help.

Preventative treatment for opportunistic infections
Preventative treatment for opportunistic infections covers primary prevention (preventing illness before it occurs) and secondary prevention (preventing a disease that a person has already had from coming back).

Children should receive their routine vaccinations, but if they already have AIDS, they should not get the vaccine against TB. Extra vaccinations may be recommended in both adults and children. All children, as well as adults who have started to show the signs of HIV disease, should take an antibiotic called co-trimoxazole continuously. This antibiotic prevents Pneumocystis jerovici pneumonia. Adults or children who have had TB or who have contact with people with TB (especially at home) should take anti-TB drugs as well.

Boosting the immune system
A third aspect of treatment focuses on boosting the immune system. In general one should take care of one’s health and immune system. In addition, get treatment for any infections early on before they become too serious. Recently, researchers at the University of Stellenbosch have developed a drug called Moducare, which is made from the African potato plant. Moducare has been shown to boost the immune system and may help, along with other measures, to slow down HIV disease.

Follow-up
Follow-up treatment and examinations will include regular visits to a doctor to monitor the progress of HIV disease, to diagnose and treat other infections and to keep up to date with new treatments.

Regular dental examinations are necessary, because people with HIV have a higher rate of mouth problems, including gum disease.

Other
HIV-positive people often have to deal with being treated differently by others (discrimination) or even shunned because they carry an infectious disease that is transferred by sex. There is also the anxiety about the threat of illness and death. It may therefore be important to get emotional support from a psychologist or a support group.

It may happen that, when it is known that people have HIV, their colleagues do not want to work with them or their employer will want to fire them. Information on legal and human rights for people living with HIV/AIDS may be obtained from an AIDS service organisation.

Prevention
How to protect yourself from getting HIV:

 
• Reduce the number of sexual partners.  
• Always practice safer sex:       o Use condoms from start to finish during anal or vaginal sex. Male latex condoms as well as female condoms provide protection against infection.       o Always use male condoms when performing oral sex on a man.       o For oral sex on a woman, cover the vaginal area with plastic wrap (cling wrap), a condom cut open or dental dams.       o Never use oil-based lubricants with male condoms.       o Engage in non-penetrative sex practices such as kissing, massaging, hugging, touching, body rubbing and masturbation.       o Avoid alcohol and drugs, which can impair judgement and motivation to practice safer sex.  
• Do not share needles/syringes when using intravenous drugs - preferably don’t use recreational or illegal drugs at all!  
• Make sure all medical and surgical instruments, including those used for tattooing, body piercing or circumcision, are completely sterilised before re-use or are safely discarded.  
• Be tested regularly and get treatment for other STDs (women and men with open sores from herpes, syphilis or chancroid are more susceptible to HIV than other people).