• What is HIV infection?
• Prevention and awareness
• Stages of HIV infection
• What is antiretroviral therapy?
• Who should take antiretroviral therapy?
• Antiretroviral therapy in children

HIV or the human immunodeficiency virus, causes HIV infection. Once a person becomes infected with this virus he/she is infected for life. In the long term HIV causes AIDS (The Acquired immunodeficiency syndrome). AIDS may only develop after many years of being infected with HIV.

The HIV is passed from person to person in body fluids. The most likely way to catch the virus is through being exposed to an infected person's sexual fluids during sex. One in every six to eight people in South Africa is HIV positive. You do not need to have many sexual partners, nor do you need to have sex often to catch HIV.

HIV may also be passed by blood or from an infected mother to her baby during pregnancy, birth or breast-feeding. It is NOT passed by kissing, sharing plates or forks, or using the same toilet.

Prevention and awareness remains the cornerstone of the Department of Health's approach to dealing with HIV/Aids. This is based on the ABCs - Abstain, Be mutually faithful, and Consistently Use Condoms:

• Abstain from Sex - This is the only guaranteed protection from HIV infection.
• Be mutually faithful - Always have sex with the same person. This person also must not have sex with anyone else and not have been infected with HIV or other Sexually Transmitted Infections.
• Consistently Use Condoms - Use them every time you have sexual intercourse and use them correctly.

Your body has an immune system that defends your body and keeps you well. HIV attacks and kills the "soldiers" in the immune system (called CD4 cells). Without these CD4 cells your body is unable to defend itself from germs.

It takes the HIV many years (between 3 and 20) to damage all the CD4 cells so it is a long while before there are too few to defend your body. There are many years after infection when a person can remain well.

Stage 1: During this time the "soldiers" are still relatively strong. A person with stage 1 HIV usually looks and feels well. Glands causing swellings in the neck or groin are common- these show that the immune system is fighting the HIV.
Stage 2: As the CD4 count becomes lower minor illnesses may develop, such as skin rashes or diarrhoea. People with Stage 2 infection may lose some weight.
Stage 3: Tuberculosis is a common stage 3 illness in the Western Cape. People with stage 3 illness may see thrush in their mouths. More weight loss or diarrhoea may occur in stage 3. Other infections, like pneumonia, may occur. People with stage 3 illness need to take a medicine called co-trimoxazole, which helps to prevent chest infections and diarrhoea, every day.
Stage 4: An HIV infected person with Stage 4 illness is at risk of developing opportunistic infections. These are infections, which only happen in people with very weak immune systems (CD4 count less than 200 cells/mm3). Once one of these illnesses occurs, the person is said to have AIDS.

Many of the illnesses that HIV infected people develop are treatable, particularly when diagnosed early. Some others can be prevented. It is very important that HIV infected people go to see their nurse or doctor if they become unwell, to get problems treated as soon as possible.

Antiretrovirals are medicines given to people with HIV to suppress the virus in their blood. THEY ARE NOT A CURE FOR HIV/AIDS. They lower the level of the virus in the blood. This allows the immune system to recover (the CD4 count may increase). People taking antiretrovirals may find that their appetite improves, they pick up weight and problems they had, such as diarrhoea or skin rashes, clear up.

If antiretrovirals are taken reliably and correctly, the medicines can reduce the virus to a level in the blood when it can no longer be measured (undetectable).

People who are infected with HIV do not need antiretroviral treatment while their immune system is still strong (Stages 1, 2 and 3). Antiretroviral treatment is only needed once the immune system has become weak. Antiretroviral treatment should be considered if an HIV infected adult has a CD4 count <200 cells, or has developed a serious (stage 4) illness.

Antiretroviral medicines will not work effectively if they are not taken reliably. People considering antiretroviral therapy must be prepared to take tablets every day, twice a day. People with substance abuse problems, eg drinking alcohol excessively, find it very difficult to take medicines reliably every day. Substance abuse problems need to be dealt with before starting antiretroviral medicines.

Children who are infected with HIV only require antiretroviral treatment if their immune systems have become weak. Many infected children live healthily for a number of years before requiring antiretroviral treatment.

Children require antiretroviral treatment if they have become ill with HIV related illnesses, or if they have a low CD4 percentage.

Antiretroviral medicines (ARVs) form part of the care of HIV infected people. HIV positive people can live healthily for many years before they reach the point where they require treatment with ARVs. It is very important that people living with HIV attend their primary health care facility for regular follow up. People living with HIV should go to their primary health care facility promptly if they become unwell.

If an HIV-infected person notices any of the following problems, it is important that they visit their primary health care facility for a check-up:

• Ongoing cough (>2 weeks)
• Marked loss of weight (a few kilograms)
• Ongoing night sweating (> 2 weeks)
• Loose stools or diarrhoea for more than 2 weeks
• Severe headaches or depression
• Any other symptoms that worry them

Antiretroviral therapy is available at designated sites throughout the province. HIV infected people who require antiretroviral therapy may access antiretroviral treatment by referral from their primary care facility. All primary care facilities in the province can refer clients for antiretroviral therapy at antiretroviral sites.

First-time visitors to the clinic/secondary or tertiary hospital will be asked to fill out a form and a folder will be opened. Bring your ID book. A referral letter from the clinic is required when visiting a hospital. Also hospitals will ask for your most recent payslip/income assessment (IRP5). Bring your hospital card if previously registered at the hospital.

• Aids Training, Information and Counselling Centre (ATICC): tel 021 797 3327; fax 797 3356
• National Association of People Living with HIV/Aids (Napwa): tel 021 424 1106
• Treatment Action Campaign (TAC): tel 021 788 3507, fax 021 788 3726
• Aids Law Project (ALP): tel 011 356 4100, fax 011 339 4311