First reactions – (On being Diagnosed HIV+) – Living positively with HIV.

By Alan Brand, 01 December 2015 (Article for World AIDS Day 2015)

People react in many different ways when they hear that they have HIV. You might carry on as if nothing has happened, you may search out lots of information, or you might find it difficult to accept the news.

You may blame yourself. But HIV does not infect people because they ‘deserve it’ – having HIV does not mean you are a wicked, immoral or stupid person.

Most people get HIV from a sexual partner. You might not have known about HIV at the time, or not thought you were at risk, or you might have decided not to worry about it for once. All these are very normal, human things to do.

You may blame someone else. If you think you know who passed HIV on to you, you may understandably feel angry with them.

But they may not realise that they have HIV. Very often, HIV is passed on by people who have only had it for a few months themselves, usually without knowing.

Or they may have known and not told you. Perhaps things would be better if they had done. But many people are afraid of telling others, because they feel ashamed, or are worried about being rejected. It’s not easy to tell. We’ll look at how to tell other people later. 

Keeping an eye on your health

You can’t tell from someone’s physical appearance, if they have HIV or not. And you can’t always know how good their health is. But blood tests can show how HIV is affecting your health. Whether or not you are taking treatment, it’s important to have some tests done regularly.

One important test is called a CD4 count and is a measure of the strength of your immune system. A low CD4 count means that HIV is damaging your immune system. A higher CD4 count shows that your immune system is stronger. Another test is called a viral load. It’s a measure of the amount of HIV in a sample of blood. If you are taking treatment, the viral load test shows how well your treatment is working – the lower it is the better.

Have these tests done every 4 to 5 months. They will help you and your doctor make decisions about your health and treatment.

Quick guide to test results:

CD4 counts (An important monitor to determine when to embark on treatment as it measures the strength of your immune health)

·         Between 500 and 1200 = usual for people who do not have HIV

·         Above 350 = HIV treatment is not usually recommended

·         Below 350 = HIV treatment is recommended

·         Below 200 = There is a higher risk of illness and infections, so HIV treatment is recommended

Your doctor may give your CD4 results as a percentage

·         Above 29% = similar to CD4 count of above 500

·         Below 14% = similar to a CD4 count of below 200

Viral Load (An important monitor to determine how well your ARV treatment is working as it measures the amount of HIV in a sample of blood)

·         Between 100,000 and 1 million = High

·         Between 10,000 = for people with HIV not on treatment, this is low

·         Below 50 = known as an “undetectable” viral load. The aim of HIV treatment is to have an undetectable viral load also known as viral suppression.

IMPORTANT POINTS:

·         CD4 and Viral load tests give essential information about the effects HIV is having on your immune health and hence your bodies response to infections and illness.

·         The aim of HIV treatment is to have a very low (or undetectable) viral load and a high CD4

·         When the CD4 count is low, the viral load is usually high. This situation is not good.

·         When the CD4 count is high, the viral load is usually low. This is much better.

·         If your CD4 count has dropped to 350 or below, it is recommended that you start ARV treatment.

·         The result of treatment should be that the CD4 is going up, and the viral load is going right down to undetectable levels.

HIV treatment

HIV treatment involves taking tablets (ARV’s) once or twice a day. ARV treatment stops the virus from reproducing and reduces the amount of HIV inside your body. If there is less HIV, there is less damage to your immune system, and you are less likely to get ill.

And if there is less HIV in your body fluids, you are less likely to pass on HIV (for example to a sexual partner, or to your unborn child during pregnancy).

The aim of HIV treatment is to have an ‘undetectable’ viral load – this means there is only a tiny amount of HIV in the body. ARV treatment is not a cure – they cannot totally wipe out HIV from your body.

HIV treatment helps you stay well by reducing the amount of HIV in the body. All ant-HIV drugs (ARV) try to prevent HIV infecting new cells. But different types of drugs do this in different ways. A combination of two to three different types of drugs provides a powerful attack on HIV. The aim of treatment is an “undetectable viral load” – very low levels of HIV in the blood.

Should I take HIV treatment?

Not everybody with HIV chooses to take anti-HIV drugs straightaway. Treatment will usually be recommended:

·         if your CD4 count is below 350,

·         if HIV is making you ill,

·         if you have another health condition such as hepatitis or TB,

·         if you are pregnant, or

·         if you want to take it in order to reduce the risk of passing HIV on to a sexual partner.

N.B: By knowing your status early you will give yourself enough time to find out about your options and make the right decisions in time.

Taking drugs on time

HIV treatment only works well if it is taken exactly as prescribed.

This is often called ‘adherence’, and it means taking the drugs:

·         at the right times,

·         at the right dose, and

·         following any advice about food and drink.

The nurses, pharmacists and doctors at your clinic can help you with this. You may need to develop a routine that helps you remember to take the drugs at the same time each day.

If you sometimes forget to take your pills, the drugs you are taking may stop working properly. If this happens you would need to change your treatment.

KEY POINTS ON ADHERANCE:

·         It is essential to take all your doses of HIV treatment at the right times and in the right amounts.

·         Taking anti-HIV (ARV’s) drugs regularly will mean that there is always enough of the drug in your body. This will keep HIV under control.

·         Not taking ARV’s as prescribed can result in HIV becoming resistant to the drug treatment choice you are on and can result in HIV being harder to treat in the future.

Looking after your health

As for anyone else, taking care of your health involves more than popping pills.

It will also help if you can:

·         Getting sufficient rest and sleep is important so that you can wind down and strengthen your immune system.

·         Eating a balanced diet to maintain a healthy weight gives you energy and ensures that you get the nutrients your body needs.

·         Get some exercise, which is good for the heart, lungs, circulation and mobility.

·         Give up smoking, if you are a smoker.

·         Talk to people and seek support (isolation and stress are bad for your health too).

As well as improving your physical health, all these things are good for your feelings and emotional wellbeing. For example, exercise can make you feel more relaxed and energised.

During difficult times, you may find that you use more alcohol or drugs. They may help you to forget, or to stop thinking about things. While they may offer temporary relief, relying on them is likely to make your feelings harder to deal with in the long run. Too much drink or drug use usually brings its own problems.

Seven ways to look after your health:

1.     Eat a balanced healthy diet

2.     Get some exercise

3.     If you are a smoker consider giving up smoking

4.     Get enough rest and sleep

5.     Talk to people and get a support for example: join a support group.

6.     Attending your clinic appointments and have regular blood tests.

7.     Take anti-HIV (ARV) drugs, if your blood tests show that you need to. 

Why are women at higher risk of contracting HIV?

Women’s Day Awareness Article

2015

By Alan Brand - Positively Alive - 09 August 2015

In this fact sheet we review specific biological factors in women that make it more or less likely that HIV can be sexually transmitted.

Fast Facts

•          It is estimated that 12.2% of the South African population (6.4 million persons) are HIV positive. This is 1.2 million more People Living with HIV than in 2008 (10.6%, or 5.2 million). The main route of HIV transmission is through heterosexual sex.
•         HIV prevalence in young women 20 - 24 is at 17.4% which is three times higher than in men of the same age, 5.1%. Within the 25 - 29 year age group HIV prevalence amongst women is 28.4% whilst in men of the same age group it is 17.3%.
•         Only 43.5 per cent of male youth (aged 15-24 years) and 40.6 per cent of females of the same age group can correctly identify ways to prevent sexual transmission of HIV and reject major misconceptions about HIV transmission.
•         Women (especially young women and girls) face increased risks of HIV infection, these calls for more effective enabling interventions. Risk-enhancing factors include alcohol abuse, violence against women and socioeconomic insecurity there are many people accessing ARVs which has a huge impact on available domestic resources.

Before we explore why genetically women are more at risk of HIV transmission, lets first look at some important basic information on HIV transmission in general.

How does HIV infection occur?

For infection to occur two things must happen.

·         The virus must find a way to enter your bloodstream.

·         The virus must “take a hold” (find a T/cell with a CD4 and CCR5 receptor which the virus needs to enter the body’s cells) 

Think of it with the word SAD

S = Sufficient quantities of the virus

A = Access into the body

D = Duration

There must be sufficient quantity of the virus to infect you, and it must enter your body in an efficient manner, and their needs to be enough time for this to happen.

There are only three ways in which this can happen:

·         Unprotected sexual acts with an infected person

·         Through infected blood e.g. in sharing needles

·         Prenatally from mother to child during pregnancy or at birth, and through breast milk.

Body fluids!

Body fluids can be divided into those, which contain sufficient quantities of the virus to be infectious. These are:

Blood (100% if HIV Viral load present)

Semen (75% if HIV Viral load present)

Vaginal secretions (50% if HIV Viral load present)

Breast milk (Low but still possible with prolonged breast feeding if HIV Viral load present)

For transmission of HIV to happen, body fluids infected with the virus must pass from the already infected person into the bloodstream of another. HIV can do this through contact with the thin linings of various openings in the body and openings in the skin. These linings contain concentrations of the cells to which HIV attaches to enter the body. The sexual organs of both men and women have such linings.

This is why unprotected sexual acts are the most common route for HIV transmission. The chance of transmission is greatly increased if the lining or skin is inflamed or damaged, for example when another sexually transmitted disease is present.

On the other hand there are other body fluids, which do not contain sufficient quantities of the virus to be infectious.  These are:

Saliva

Sweat

Tears

Urine

How do you get HIV?

• Infection through sexual practices.
• Semen / vaginal fluid coming into contact with the thin linings of various openings in the body and openings in the skin.
• Infection through blood. (Blood products)
• Intravenous drug users.
• Blood transfusions. (Since 1985 all blood is tested for HIV)
• Needles, ear piercing, razor blades, dental tools, (unsterilized)
• Infection from mother to child.
• Across the placenta: - during pregnancy.
• During birth:  damaged lining/skin
• Breast milk:

So why are women at greater risk of HIV?

The risk of transmitting HIV from men to women is much higher than from women to men. This is in part because of the much larger surface area of the vagina and cervix compared to the areas of the penis where transmission can happen (foreskin, urethra and small tears on the head of the penis).

Women are exposed to considerable amounts of seminal fluid during sex, if ejaculation occurs.

The vagina is particularly vulnerable to invasion by bacteria, viruses and other germs. It is an ideal place for bacteria to grow, as it is warm and moist. It also provides an easy entrance into the body.

Women with low levels of the hormone oestrogen may be at increased risk for transmission of HIV because low oestrogen levels directly affect the vaginal wall, making it thinner so HIV can more easily pass through the wall.

How does HIV get into the body through the female genital tract?

The vagina has various defence mechanisms against infection. These help to protect a potential foetus developing in the uterus.

The walls of the vagina are made up of mucous membrane that is thicker than the mucous membrane in other places where HIV transmission often happens, such as the rectum or cervix.  The walls of the vagina have ten to twelve overlapping layers of epithelial cells, which create a strong barrier against germs such as viruses and bacteria.

The vagina is also home to a number of “friendly” bacteria species (for example, Lactobacilli) which are thought to give some protection against less friendly bacteria (for example, Gardnerella vaginalis) as well as viruses that might infect the body.

It used to be thought that HIV can only get through the walls of the vagina through small tears or sores in the mucous membrane. Recent research suggests that HIV can pass between or through healthy cells. This means that HIV can still infect women even if the vaginal mucous membranes are healthy and intact.

Unlike the vagina, the mucous membranes lining the cervix and uterine walls have only a very thin layer of cells (often just one layer thick) and so it is much easier for viruses like HIV to cross into the body through the cervix and possibly the uterus.

Because the cervix acts as a barrier to protect a potential foetus, it is home to a large number of immune cells. Many of those immune cells are CD4+ cells, which are the cells that HIV is most able to infect.

What about sexually transmitted infections?

Women are at more risk for sexually transmitted infections (STIs) than men. In addition, women often have fewer obvious symptoms, and therefore don’t get treatment until the infection has been present for a long time. 

Having an STI increases the risk of HIV transmission in several ways:

•         All STIs cause inflammation of the mucous membrane. Inflammation is the body’s immune response to an infection or irritation. When the mucous membrane is inflamed, a large number of immune cells come to the area to fight the infection.
•         Many of those immune cells will be CD4+ cells or other immune cells that are involved in HIV transmission. In addition, when cells are fighting off an infection, they become activated. Activated CD4+ cells are more easily infected by HIV.
•         Some STIs also cause open lesions or sores, which offer an easy way for the virus to get into the body and cause an infection.

Why are women at higher risk of being affected by HIV?

·         Some women may be unaware of their male partner’s risk factors for HIV (such as injection drug use or having sex with other men) and may not use condoms.

     

      The risk of getting HIV during vaginal sex without a condom or other protection such as PrEP is much higher for women than it is for men, and anal sex without a condom or PrEP is riskier for women than vaginal sex without a condom or PrEP.

·         

      Women may be afraid that their partner will leave them or even physically abuse them if they try to talk about condom use.

·         

      Some sexually transmitted diseases (STDs), such as gonorrhoea and syphilis, greatly increase the likelihood of getting or spreading HIV.

·         

      Women who have been sexually abused may be more likely than women with no abuse history to engage in sexual behaviours like exchanging sex for drugs, having multiple partners, or having sex with a partner who is physically abusive when asked to use a condom.

·         

      Some HIV infections among women are due to injection drug and other substance use—either directly (sharing drug injection equipment contaminated with HIV) or indirectly (engaging in high-risk behaviours while under the influence of drugs or alcohol).

What is “SAFER SEX”?

“Safer Sex” Means: - Sexual practices, which involve the use of condoms for penetrative anal or vaginal sex, and the use of many different forms of experiencing sexual pleasure without placing people at risk of HIV transmission.

Always talk to your regular or potential sexual partner about safe sex.

Alan Brand

Employee Wellness Consultant and Specialist HIV and Employee Wellness Training Provider

www.positivelyalive.co.za