Frequently Asked Questions

1. What is HIV and AIDS?
   

   HIV
   HIV (Human Immunedeficiency Virus)is a virus, and just like so many other viruses, it thrives, multiplies and survives in a human body. Once inside the human body, HIV attacks the defense mechanism called the immune system. The immune system helps the body to defend itself against diseases like Tuberculosis (TB), influenza and many other diseases. In other words, the immune system acts like the soldiers of the body providing it with necessary protection. HIV is dangerous because it targets these soldiers to render the body defenseless and weak. People infected with HIV can live for a long time. While most live for about ten years, there are others who have lived for more than twenty years. These are the people who have used medication, practiced safe sexand tested for HIV at an earlier stage.
   
   AIDS
   AIDS (Acquired ImmuneDeficiency Syndrome)is a condition that results from HIV infection. Once HIV has eaten away the immune system, or the soldiers of the body, the body becomes vulnerable. The ability to fight other diseases vanishes. TB, flu, pneumonia and many other diseases now take the opportunity to attack. Once the person is in this stage, he is said to be suffering from AIDS. AIDS then, is an accumulation of many diseases once the body is rendered defenseless by HIV.

2. What is VCT?
   

   VCT is the confidential procedure that is followed when you decide (on a voluntary basis) to take an HIV test. As the result of the test can be life changing, it is important that you are properly counselled before you take the test.
   
   Step One – Pre-test Counselling
   You will be assigned a code number- you will not be required to give your name. During the pre-test counselling session, which lasts between 20-45 minutes, you will be told about the test and HIV disease. Ways to cope with a positive diagnosis will be discussed. You will be able to ask questions.
   
   Step Two - Testing
   If you agree to take the test, you will be asked to sign a consent form. You must then supply a small sample of blood from a finger prick, or a saliva sample. Most hospitals and clinics use a rapid HIV test, which means that the results will be available within 20 minutes. If this test is not available an Elisa test will be done, which requires a larger blood sample from your arm. It also needs to be sent away to a laboratory. You will be told when to return for your results, which can take up to two weeks.
   
   Step Three – Results and Post-test Counselling
   Your results will be given during a post-test counselling session. The health professionals and counsellors who conduct and discuss the test with you must, by law, keep the results strictly confidential. You decide whether to tell your family and friends if you are HIV-positive. Children over 14 years of age do not need permission from a parent or guardian to have an HIV test. Children under the age of 14 do require permission, although in emergency situations, such as after a rape when a HIV test is required, a doctor can authorize a test.
   
   

3. Where can I get VCT?
   
   • The majority (90+%) of government health facilities (hospitals and clinics) now provide a free VCT service, and the aim if for 100% coverage. All government HIV service points offer VCT.
   • Many Non-Profit Organisations (NPOs), such as Touching Nations, loveLife Youth Centres and the Planned Parenthood Association of South Africa (PPASA) Youth Centres provide a free VCT service.
   • Large corporates generally offer free VCT to their employees.
   • Private doctors and hospitals. Private laboratories will not do an HIV test without a doctor’s referral, and will only give the results to the referring doctor. This is because the doctor needs to provide pre- and post-test counselling. The person will be charged for this service. Medical Aids generally cover the cost of VCT.
   • Mobile VCT facilities. For instance, New Start, run by the Society for Family Health, provides a mobile VCT service. The organisation pitches its hallmark blue tents in poor and under-serviced areas. Touching Nations recently acquired tents to offer a similar service on the Cape Flats. This free and convenient VCT facility is aimed at people who do not usually visit clinics or travel to the city centres (see directory for further information)
   • The AIDS helpline on 0800 012 322 can provide information about the nearest VCT centre for any person wanting an HIV test. Any questions a person may have about the VCT process will also be answered.
4. What results doesn't the test show?
   
   • How a person was infected.
   • Who the person got the infection from.
   • When the person first became infected.
   • If a person has AIDS - different kinds of blood tests need to be done
5. What are the benefits of getting tested?
   

   If you test negative, you will be able to make sure that you do not put yourself at risk in future by adjusting your sexual lifestyle and practices.
   
   If you are worried that you may be HIV-positive because you have practised unsafe sex it is important that you take a test. If you are negative you can put your mind at rest and start making sure you do not put yourself at risk in future. If you test positive you can start to actively manage your health and also make sure that you do not infect any of your future partners.
   
   There is good evidence to support the fact that most people who test positive immediately modify their behaviour and therefore reduce the risk of infection for others. Testing negative also tends to encourage people to adopt safer sexual practices in the future.

6. What are the stages of the HIV & AIDS Infection?
   

   HIV disease progresses at different speeds in different people. A higher number of viruses in the blood, or viral load, causes more rapid damage to the immune system, including the very important CD4 cells. As the CD4 count drops other infections can start entering the body. A person infected with HIV goes through the four stages described below. Some people pass through the stages rapidly (under six years), while others take well over 10 years. This is why it is important for people to live healthily by eating well and not smoking or drinking alcohol to help their immune systems remain strong for as long as possible. It is also important for them to practise safe sex so they don’t expose themselves to more viruses.
   
   Stage 1: A person with Stage 1 HIV disease usually still looks and feels well. Swollen glands in the neck and groin are quite common in this stage, and if they become large and/or painful a doctor should be consulted. Roughly half of people who become infected experience an illness similar to glandular fever 4-6 weeks after being exposed to the virus. The rest do not have any symptoms, but after this period it becomes possible to test for the presence of the virus with an HIV test.
   
   Stage 2: As the CD4 count starts to drop a person may start to develop minor illnesses, such as skin rashes and diarrhoea.
   
   Stage 3: As the disease progresses a person will start to suffer from thrush, and a variety of other diseases. Weight loss and diarrhoea can also become a problem.
   
   Stage 4: During this stage, because of a very weakened immune function (CD4 count below 200), a person can develop many different serious illnesses such as pneumonia and certain types of cancer. Weight loss and problems such as diarrhoea and oral thrush become more pronounced. This is the stage of AIDS and once a person has reached this stage he or she can only survive for 1-2 years without treatment.

7. I am infected with HIV & AIDS. When can I start ART?
   

   People who are infected with HIV should begin ART when the disease has progressed to the point where either of the following happens:
   
   1. The CD4 cell count falls below 200 cells/mm3 or
   2. The patient develops profound weight loss and/or one of the life-threatening opportunistic infections that are associated with Stage 4 of HIV disease, such as pneumonia (note that tuberculosis is not a criterion for initiating ART unless the CD4 cell count is below 200).

8. Who can access ART?
   

   People cannot attend an ART centre directly to access treatment. They first need to be monitored and assessed by their local health facility. Once they qualify for treatment they will be sent to the nearest ART centre with a referral letter containing the details of their CD4 counts and medical history. They will then be given an appointment to see whether they are suitable candidates for treatment. (Note that people accessing general HIV medical care in a facility which also provides ART, such as a large hospital, must also go through the same process requiring a referral letter and appointment. This is to ensure that all patients get equal access to ART.)
   
   At the appointment new laboratory tests will be done and people will be assessed to see whether they still fulfil the medical criteria for treatment. They will also be assessed to see whether they also fulfil the following psychosocial criteria: Reliability (for example if the person has attended three or more scheduled visits to an HIV clinic). Compliance. People must be prepared to take their tablets every day exactly as instructed. If they think they are not ready to take them every day they should not start treatment as this will lead to viral resistance, which makes the virus much more difficult to control.
   
   No active alcohol or other substance abuse.
   
   No untreated active depression.
   
   Safe Sex. People must be prepared to use male or female condoms every time they have sex. Women will also need to take the contraceptive pill or injection to prevent unplanned pregnancies.
   
   Disclosure. It is strongly recommended that patients have already disclosed their HIV status to at least one friend or family member, or have joined an HIV support group.
   
   Insight. People need to demonstrate insight into the consequences of HIV infection and understand how ART works and the commitment required for treatment to be successful.
   
   Ability to regularly attend the ART centre (transport may need to be arranged for patients in rural areas or for those living far from the treatment site). Contactability. People must be easily contactable for follow-up and treatment support.
   
   NOTE In order to qualify for ART in South Africa it is not necessary to have an ID document or be a South African citizen. Access to health care is guaranteed by the constitution for everyone, not just those with citizenship or residence papers. All a person needs is a fixed address to enable follow-up.

9. If ART is indicated, what next?
   

   If ART is indicated, treatment will only start once the patient does the following: Attends a series of courses about ART. This initiation programme includes information on nutrition, how to live positively, the basics of HIV and AIDS, opportunistic infections, and how to take antiretroviral medicines properly. The programme runs over several weeks.
   
   Tells at least one family member or friend about the treatment programme so that this person can help make sure the medication is taken as instructed. Most programmes advise the patient to bring this person with them to attend the preparation courses.
   
   As soon as treatment starts the patient will be required to visit the clinic or hospital regularly. This may be on a weekly basis in the beginning, but will then stretch to every three or six months. Blood samples will be taken at every visit so that tests can be done to ensure the ART is keeping HIV disease under control. Many non-profit organisations offer treatment support for people starting ART. Specially trained people offer support and help to make sure people take their medicines properly.
   
   Once people start taking ART they will usually start to feel better quickly. If other infections are present, such as TB, which are also being treated, then it may take longer for the person to start feeling better. ART needs to be continued for the rest of a person’s life.

10. While on ART is it advisable to fall pregnant?
    

    In order to avoid pregnancy while on ART it is recommended that women use the contraceptive injection as well as condoms every time they have sex. The contraceptive pill may not provide reliable protection when taken with antiretroviral drugs. If a woman receiving ART wants to conceive she must tell her doctor so that she can be given antiretroviral drugs that will not harm the developing baby.

11. If my viral load becomes undetectable does that mean I am cured?
    

    No. It just means the treatment is working very well at keeping the virus totally under control. (ART is considered successful if the viral load drops below 400 copies/ml)

12. Can I still pass the virus on to someone else when I am on ART?
    

    Yes. You must continue to practise safe sex at all times as you can still pass on the virus. It is also possible for you to get infected by another different strain of the HIV virus, which might be resistant to the antiretroviral medicines you are taking.

13. What is antiretroviral (ARV) resistance?
    

    This means that the ARV drugs are no longer effective at keeping the virus under control. This may happen if you have been re-infected with a resistant strain of virus. It can also develop if you do not take your medicines every day as instructed. Even missing only one dose every two weeks can lead to viral resistance. Resistance can also develop if you previously started ART and then stopped for a period. Once you start ART it is important to continue taking it for the rest of your life.

14. Is ART dangerous? What are the side effects?
    

    ART is not dangerous; it is a life-saving treatment. However ARV drugs, like all medicines, can have side effects. Common side effects include: nausea, vomiting, headaches, tiredness, stomach pains, diarrhea, numbness in the legs, and skin rashes. These symptoms are usually mild and disappear after a while. If they persist or become serious, you must tell your doctor. Sometimes the drugs need to be changed.

15. What are the benefits of providing ART?
    

    The first and foremost benefit is that ART is life saving. This not only benefits the individual concerned but also society as a whole for the following reasons:
    
    The lives of many breadwinners are prolonged, enabling them to continue providing and caring for their families.
    
    Families can stay together, which reduces the emotional and psychological stress of the disease. The elderly are not left to cope with the burden of caring for their sick children and grandchildren.
    
    The cost of providing disability, childcare and foster grants, care for orphans and vulnerable children, care for people living with AIDS, and hospitalisation costs is dramatically reduced.
    
    The workforce remains productive, reducing the costs of absenteeism, illness and death, and the training of new staff.

16. When do I go for testing
    
    • If you are sexually active (or have been within the last 10 years) and:
    • You have had unsafe sex with multiple partners
    • You do not know the HIV status of your partner
    • You are not sure if your partner is faithful
    • You have been the victim of sexual abuse
    • You have contracted a sexually-transmitted infection (STI) within the last 10 years
    • You or your partner have used intravenous drugs and shared needles within the last 10 years
    • If people are to come forward for testing there must be advantages. One of the most powerful reasons to get tested is the knowledge that there is appropriate support and treatment available if the test is positive. In both developed and developing countries as soon as antiretroviral treatment (ART) becomes widely available more people start to come forward for testing.
17. I am infected with the virus. What are my rights in my place of work?
    
    • You do not have to tell your employer if you are HIV Positive
    • You cannot be fired from work if you are HIV Positive (even if you are too ill to perform your functions or duties)
    • If you, as an HIV positive person, become ill you have the same right to sick leave as other workers.
    • People who are HIV positive have the right to work for as long as they are able enough to do so.
    • An employer is not allowed to disclose the HIV status of any employee without their permission to do so.
    • An employer cannot force you to have an HIV test.
18. I am about to go to the HIV & AIDS test. I’ll like to know what my rights are?
    
    • You do not have to tell your employer if you are HIV Positive
    • Your HIV status has to remain confidential unless you have given permission to reveal your status
    • You have the right to be treated with dignity
    • You cannot be forced to take an HIV test or have any ARV treatment
    • You have the right to access healthcare services