ARVs are safe when taken as prescribed by a qualified and experienced health professional and carefully monitored. There has been a lot of media coverage of statements by the Minister of Health, other government spokespeople and so-called AIDS denialists that ARVs are toxic and have harmful side-effects. All drugs are toxic and may have side effects but doctors prescribe them because the benefit to the patient (in this case a longer, healthier life) outweighs the side-effects. In the case of other life-threatening illnesses, such as cancer, asthma, hypertension and diabetes, medication may have to be taken for life and may have serious side effects but it is left to doctors and their patients to decide whether to take the treatment and how to manage the side effects. When patients on ARVs suffer side effects, their doctors can change the combination of drugs they are taking.
Nearly all people exposed to HIV develop antibodies to the virus in the first three months following infection. There are blood tests that detect the antibodies and test that detect the virus in the blood.
UNAIDS says that diagnosis of infection using antibody testing is ‘one of the best-established concepts in medicine. Examples include the diagnosis of viral hepatitis, rubella, and many other infectious diseases. Antibody testing for these diseases has never been questioned. HIV antibody tests exceed the performance criteria of most other infectious disease tests… Recent HIV antibody tests have sensitivity and specificity in excess of 98%.’
For detailed information on diagnostic tests for HIV and their reliability, go to the World Health Organisation website.
Estimates of the numbers of people infected with HIV and dying of AIDS are based on surveys and models. Most people in South Africa do not know their HIV status. Therefore, researchers and statisticians use the prevalence of HIV among groups whose status is known (such as pregnant women attending antenatal classes) to work out the likely prevalence rate in the general population. They also ‘project’ how many people are likely to become infected and die in future, based on what is already known about infection and mortality rates.
The statistics vary depending on the ‘models’ used to make the calculations. For example, some models assume that people will gradually change their behaviour and that treatment will become more widely available; others assume that prevention and treatment efforts will be less effective.
Some people say the estimates of the numbers of people infected and dying in South Africa are wildly exaggerated. However, the projections made by the South African Department of Health are similar to those of the Actuarial Society of South Africa’s ASSA2002 model and the findings of the Human Science Research Council in a 2002 community survey. The community groups that AFSA supports are all reporting increasing numbers of people becoming sick and dying from AIDS-related illnesses, with disastrous consequences for thousands of households. Their experience paints the same picture as the statistics – that even if there is uncertainty about exact numbers, South Africa is facing a health and developmental crisis on a massive scale that requires everyone to take urgent action.
People with medical aid cover can get access to treatment for HIV/AIDS including antiretroviral (ARV) therapy, as part of their minimum benefits. People without medical aid can get treatment privately through a doctor or hospital but the cost of antiretroviral drugs is still very high. Those in need of treatment can start treatment straight away as part of the Test and Treat method. Currently, over 4.2 million people are receiving ART from either the state or the private sector in South Africa. It is estimated that this reflects only 20% of the people thought to need ART. There is at least one public health facility in every health district rolling out the treatment programme. The National AIDS Helpline (toll-free on 08 000 123 22) can provide details of the nearest treatment site.
HIV destroys blood cells called CD4+ T cells, which are crucial to the normal function of the human immune system. Studies of thousands of people have revealed that most people infected with HIV carry the virus for years before enough damage is done to the immune system for AIDS to develop. Tests have shown a strong connection between the amount of HIV in the blood and the decline in CD4+ T cells and the development of AIDS.
How many people are already infected with HIV? Globally the number of people living with the virus reached 33.4 million in 2008. Sub-Saharan Africa is home to about 67% of all people living with HIV and accounts for almost 72% of AIDS deaths globally.
South Africa ranks in the top five highest HIV prevalence countries in the world, with 17.5% of the population estimated to be infected. South Africa has the highest number of people infected globally, estimated at around 5.3 million. This includes 220 000 HIV positive children under the age of 15 years in 2008 (UNAIDS 2009). The UNAIDS 2009 Global Report Epidemic Update estimated that in 2008, 310 000 people died from AIDS in South Africa. In 2009, there were almost 2 million children orphaned by HIV/AIDS.
South Africa is regarded as having the most severe HIV epidemic in the world.
Source: UNAIDS, AIDS Epidemic Update; November 2009
Without treatment, it was estimated that about half the people with HIV would develop AIDS within 10 years. Advances in drug therapies and other medical treatments have dramatically increased the time between HIV infection and the development of AIDS. As with other diseases, early detection of infection allows for more options for treatment and preventative health care.
Some people say traditional remedies are as effective as ARVs. The South African government supports the use of traditional medicines but only where their safety and effectiveness have been proven. ARVs have been proven to prolong the lives and well-being of people with HIV/AIDS. Several traditional remedies and nutritional supplements are reported to strengthen the immune system, improve health status and prevent opportunistic infections. However, some traditional medicines can interfere with the action of ARVs so people should only take or vary any combination of medicines under medical advice.
Yes. The United Nations AIDS agency (UNAIDS) says the evidence that HIV is the underlying cause of AIDS is ‘irrefutable’. HIV was isolated and identified as the source of what came to be defined as AIDS in 1983/84. The process for isolating the virus and linking it to AIDS followed standard, systematic, scientific steps, similar to investigations into other viral diseases such as polio, measles and smallpox.
There is no cure for AIDS. Scientific research is producing new information about the virus and disease progression all the time but no one can predict when a cure will be found.
There are several teams of scientists working on vaccines in different parts of the world. The results of some of the studies, including the South African Antiretroviral Vaccine Initiative (SAARVI) are very promising but it will be several years before a vaccine is likely to be available.
HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS – Acquired Immune Deficiency Syndrome.
People with HIV are infected with the virus. The virus may be passed from one person to another when infected body fluids – blood, semen, or vaginal secretions – come in contact with an uninfected person’s broken skin or mucous membranes. Pregnant women with HIV can pass the virus to their babies during pregnancy, birth, and breastfeeding.
Most people who are infected with HIV develop AIDS. As their immune systems become weaker and weaker, they become sick with opportunistic infections, such as tuberculosis.
If people with HIV/AIDS have a healthy diet and lifestyle, and receive medical treatment, including antiretroviral therapy, they can enjoy productive lives for many years. In the developing world, however, most people who are HIV positive do not know they have the virus, do not have access to nutritious food or ARV treatment, and die of illnesses that would not be fatal to people with a strong immune system.
If you are living with HIV, it is very important to have a nutritious diet, to get regular exercise, rest and relaxation, to avoid harmful substances such as alcohol, to avoid behaviour that increases the risk of reinfection, and to seek prompt treatment for any opportunistic infections. It is also important to protect your mental and emotional health – the support of family, friends, colleagues, other people living with HIV/AIDS and health practitioners will help to do this. Once your immune system becomes weak, it may be necessary to take anti-retroviral therapy to fight the virus and protect your body against opportunistic infections.
There are several subtypes of HIV that are prevalent in different parts of the world. The earliest known case of any type of HIV in a human was from a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of Congo. The virus has existed in the United States since the mid-to-late 1970s. The first two official AIDS deaths in South Africa were recorded in 1982.
In 1999, an international team of researchers reported that a subspecies of chimpanzee, native to west equatorial Africa, was the original source of the virus. They believe that it passed to humans when hunters became exposed to infected blood
Anyone who is exposed to the virus can become infected. However, the risk of the transmission of HIV through sex is higher if there is anal penetration, cuts or sores on the genitals, sexually transmitted infections are present, the vagina is immature, the woman is menstruating, the man is uncircumcised, and/or if the HIV-positive person is newly infected or in the late stages of infection.
In Africa, women are more vulnerable to infection than boys and men, and are being infected at an earlier age. On average there are three women infected with HIV for every two men who are infected. The difference is greatest in the 15-24 age group, where three young women for every one young man are infected.