Understanding AIDS in Africa

Population Diagnosed with HIV

    Often we speak of HIV and AIDS together but it is important to distinguish between the two. HIV and AIDS are not the same thing although HIV does cause AIDS.

HIV stands for human immunodeficiency virus: 'Human' because it only infects human beings; 'Immunodeficiency' because it attacks and destroys the body’s immune system; and 'Virus', because it shares characteristics with other viruses that are not common to living cells. A person living with HIV is often times not aware they are infected and can look healthy and live a normal life for many years. Because the virus breaks down the immune system slowly, that person then becomes a transmitter of the virus without being aware that he or she is spreading the virus to others. HIV causes AIDS when the virus has broken down the immune system to the point where the body becomes susceptible to opportunistic infections.

AIDS stands for Acquired Immune Deficiency Syndrome. The most common opportunistic infections in the South African context are TB and other lung infections such as pneumonia. In the province of Mpumalanga, the official HIV rate is about 35% of the adult population but our experience tells the percentage is higher.

How is HIV Contracted/Transmitted?
HIV is transmitted through bodily fluids. HIV is most highly concentrated in blood, semen, and vaginal fluids. Because of this, the most common form of transmission is through sex, although it can also be transmitted through needle sharing and from mother to child during birth or through breast feeding.  In South Africa, HIV has been transmitted primarily through heterosexual relationships, and women have been most vulnerable. Women account for nearly 70% of all infections. HIV is also present in sweat, tears, saliva, urine and feces but in such low amounts that there is very low to no risk of transmission from these fluids. HIV is very fragile outside the human body and quickly degrades. HIV cannot be contracted through coughing or sneezing, through sharing a glass of water, from a toilet seat, from shaking hands, or sharing food. There has never been a reported case of HIV infection through the environment or from an insect bite.

How does HIV break down the immune system?
In very simple terms, HIV attaches itself to a host cell and uses that cell to replicate itself. The cell that HIV attaches itself to is part of the immune system called the T-helper cell, also called the CD4 cell. This particular cell gives orders to the rest of the immune system to fight infection. HIV takes over the CD4 cell and uses it as a factory to make more HIV. In this way, HIV slowly takes over and incapacitates the body’s immune system.

What factors complicate HIV/AIDS in rural South African communities?
There are many complex factors but many are rooted in poverty. Poverty has created desperation which has made women especially vulnerable. There is pressure to provide for children that has caused some to turn to sex work. Some young orphan girls also use sex for food as a means of survival. There are myths, such as sex with a virgin will cure AIDS. Rape is widespread and often not reported. There is societal pressure to prove that a woman can have children at an early age. Women are also looked upon as possessions of men, and women often have no power in their sexual relationships with their partners. Then there is the issue of stigma associated with being HIV positive; families will reject another HIV positive family member. The community, even the church, will sometimes reject an infected person. An infected person is often looked upon as cursed or bewitched and then there is an accompanied fear of association with that person. Because of these stigmas, many people will not be open about their status. In most cases people do not even want to know their status and fear being tested. 

What are the treatment options in South Africa? And what is the ARV availability in this area?
ARV stands for Antiretroviral and it is a group of medications that slow down the reproduction of the virus in the body. It is not a cure but it does prolong life. ARV treatment was not really an option in South Africa until 2004 and in our area until late 2005. Initially the government was resistant to offering ARV treatment, and there has been much controversy about this. Currently the government has revised it's view on ARV treatment and the situation has improved greatly. Recent UNAIDS statistics show that 1,000 people die everyday in South Africa of an AIDS-related illness.

The following are the steps that need to be taken to qualify for free ARV treatment: You must first go to your local clinic and be tested for HIV. If the test is positive, then your CD4 count will be measured. If your CD4 count is bellow 200, your local clinic will refer you to a specialized AIDS clinic. The AIDS Clinic will then assess liver function to see if ARV treatment can be started. A complication in getting treatment is that many people do not have the money for transportation or are not physically capable of getting to the clinic. Many people in this area who are HIV positive also test positive for TB. If that is the case, they must first start on a course of TB treatment before they can begin ARV treatment. Complications for those on ARVs and TB treatment are that the medications themselves can have severe side effects. ARVs must be taken twice a day, everyday, at the same time, for life. They must also be taken with food. In many cases, people do not have food and if you try to take ARV’s without food, you can become very ill.

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