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CONTENTS
TABLE OF CONTENTS
PAGE
GLOSSARY OF HIV/AIDS TERMS AND ACRONYMS
3
WHAT YOU WILL GET FROM THIS WORKSHOP
4
1. WHAT IS HIV
5
1.1.
HIV and AIDS
5
1.2.
The Immune System
6
1.3.
How HIV Infects the Body
6
1.4.
Stages and Symptoms
7
1.5.
History: HIV/AIDS Time line
9
1.6.
Statistics
11
2. IMPACT OF HIV/AIDS
12
2.1.
Economic Impact of HIV/AIDS on the Workplace
12
2.2.
What is the Risk of HIV/AIDS for your Organisation?
13
3. WHAT CAUSES INFECTION
14
3.1.
Requirements for HIV Infection to Occur
14
3.2.
What Causes Infection
14
3.3.
Other Possible Risks
16
3.4.
Sexually Transmitted Infections
18
3.5.
Vulnerability of Women
19
3.6.
What is Your Risk
20
4. PREVENTION
21
4.1.
ABC Option
21
4.2.
Post Exposure Prophylaxis
23
4.3.
Preventing Mother-To-Child Transmission
23
4.4.
Drugs and Alcohol
23
4.5.
Prevention of Occupational Injuries
23
5. FINDING OUT YOUR STATUS
25
5.1.
Different Methods of Testing
25
5.2.
Window Period
26
5.3.
Workplace Surveys
26
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6. LIVING WITH HIV/AIDS
27
6.1.
Body
27
6.2.
Mind
29
6.3.
Spirit
30
7. SUPPORTING PEOPLE WITH HIV/AIDS
31
7.1.
How to be an Emotional Supporter
31
7.2.
Support Groups
31
7.3.
Peer Education
32
8. LAWS THAT PROTECT PEOPLE LIVING WITH HIV/AIDS
33
8.1.
Labour Relations Act (No. 66 of 1995)
33
8.2.
Employment Equity Act (No. 55 of 1998)
33
8.3.
Basic Conditions of Employment Act (No. 75 of 1997)
33
8.4.
Promotion of Equality and Prevention of Unfair Discrimination (No. 4 of 2000) 33
8.5.
Occupational Health and Safety Act (No. 85 of 1993)
33
8.6.
Compensation for Occupational Injuries and Diseases Act (No. 130 of 1993)
33
9. ORGANISATION-BASED HIV/AIDS INTERVENTION
34
9.1.
Design and Implementation of an HIV/AIDS Intervention
34
9.2.
Medical Aid
36
10.
RESOURCES
37
10.1.
Contact Numbers for Resources regarding HIV/AIDS
37
10.2.
List of HIV/AIDS Educational Material
40
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2
GLOSSARY
GLOSSARY OF HIV/AIDS TERMS AND ACRONYMS
ACQUIRED: Something you get that is not your own. In the case of AIDS you get the HIV virus
from the blood or body fluids of somebody else.
AIDS: (Acquired Immunodeficiency Syndrome)
ANTIBODY: A cell developed by the immune system of the body to fight against a virus, germ or
something unknown in the body.
ANTIGEN: any intruder molecule in the body, like bacteria or viruses.
ART (anti-retroviral treatment): Medicine that stops retroviruses from making a person sick.
BACTERIA: A very small bug (too small too see) that makes you ill. It is easier to fight bacteria
than it is to fight a Virus. (see VIRUS)
DEFICIENCY: When something is missing or not present. HIV takes away the body’s immune
system and that is why we say the body has a immune ‘deficiency’ (see IMMUNE).
EXPOSURE: When a person has come into contact with HIV, they have been ‘exposed’ to it.
HIV (Human Immunodeficiency Virus): (see IMMUNO, DEFICIENCY, and VIRUS)
HIV-POSITIVE: A person who has been infected with the HI-Virus is said to be HIV-positive.
IMMUNE: A system in the blood of a human that fights against infection and sickness.
IMMUNODEFICIENCY: (see IMMUNE and DEFICIENCY)
MTCT (Mother-to-child transmission): When a HIV-positive mother passes HIV on to her baby.
OPPORTUNISTIC INFECTIONS: A whole range of signs, symptoms and illnesses that are
associated with AIDS because they get easy access to the body because HIV has broken down
the immune system. As a whole these sicknesses are referred to as opportunistic infections or
opportunistic diseases.
PEP (Post-exposure Prophylaxis): Medicine taken by a person after they have been exposed to
HIV to prevent becoming infected.
PID (Pelvic Inflammatory Disease): A disease that gives you chronic pelvic pain, life-threatening
pregnancy, infertility, and abscesses in the pelvis.
RETROVIRUS: A rare type of virus. HIV is a retrovirus.
STI (Sexually Transmitted Infection): Sickness a person gets from having sex with a person who is
infected with a STI virus of bacteria. The virus or bacteria is passed from your sex partner’s body
to your own body. There are different types of STI’s with different symptoms.
SYNDROME: A collection of signs and symptoms or illnesses. AIDS is a syndrome because a
whole range of illnesses is associated with the disease.
TRANSMISSION: When HIV is passed from one person to another.
VIRUS: A very small bug (too small to see) that infects the body, causes a breakdown in the
immune system and leaves the person vulnerable to opportunistic infections.
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OUTCOMES
WHAT YOU WILL GET FROM THIS WORKSHOP
1. How it can be of value to you personally

Increase your understanding of what HIV and AIDS are and how the disease works

Give you an indication of the latest global and local statistics of the disease

Help you realise the impact of the disease on individuals, families, communities and society
as a whole

Enable you to identify what causes infection and calculate your own risk

Help you identify ways of preventing HIV infection and how to live responsibly

Inform you on methods of testing and where to go for tests

Give you an overview of antiretroviral drugs
2. How it can be of value to your organisation

Help you realize the economic impact of HIV/AIDS on your organisation

Calculate the risk of HIV/AIDS to your organization

Enable you to support HIV-infected employees effectively

Give you an overview of legislation and legal implications related to HIV/AIDS

Give you an indication of how to design and implement an HIV/AIDS policy in your
organization
3. How you can help others

Enable you to relay the message and informally educate others on HIV/AIDS

Help you support people infected with and affected by HIV/AIDS

Help you reduce the stigma of HIV/AIDS in your sphere of influence

Equip you to encourage others to find out their status

Enable you to refer infected individuals to appropriate support structures
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WHAT IS HIV
1. WHAT IS HIV
1.1. HIV and AIDS
HIV is the acronym for ‘Human Immunodeficiency Virus’, a virus that was first identified in 1983 by
a group of French scientists. The HI-Virus does not infect any other species although it is
speculated that the disease originated from the Simian Monkey. HIV is classified in a virus group
called lentiviruses, which typically develop over a long period of time and cause immunodeficiency.
Immunodeficiency refers to the inability of the body to fight off infections.
AIDS is the acronym for ‘Acquired Immunodeficiency Syndrome’. The HI-Virus is not spread
passively and requires activity from you – it is acquired through action. ‘Syndrome’ refers not only
to one illness, but a collection of diseases called ‘opportunistic infections’.
Notes: ____________________________________ ______________________________
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“A virus is a piece of nucleic acid surrounded by bad news.”
M.B.A. Oldstone: Viruses, Plagues and History
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WHAT IS HIV
1.2. The Immune System
White blood cells (Leukocytes) are the main component of the Immune System (the skin and
mucous membranes are the other components). Leukocytes can be divided into Antigen
Presenting Cells and Lymphocytes.

THE TRANSLATOR – Antigen Presenting Cell
Antigen Presenting Cells break dying cells or antigens up into Epitopes. Epitopes are antigen
building blocks and are classified into Major Histocompatibility Complex Class 1 and Class 2 cells
(MHC 1 and MHC 2 cells). All cells belonging to the body have a MHC 1 cell on their surface. The
antigen presenting cells present the Epitopes to T-cells to ‘read’ and to identify which cells should
be destroyed. Macrophages, Monocytes and Dendritic Cells are all Antigen Presenting Cells.

THE WARRIOR – B-Cells
Lyphocytes are subdivided into B-Cells and T-Cells, which are both formed in bone marrow. BCells produce Antibodies that circulate the blood looking for foreign Antigens (Antigens without the
MHC 1 epitope are classified as being foreign) and if found the B-Cell latches on to it and destroys
the intruder.

THE CONSULTANT – T-Helper Lymphocytes
There are three types of T-Cells: Helper Cells, Cytotoxic Cells and Natural Killer Cells. The
Helper Cells have a protein on their surface called the CD4 cell. The CD4 cell has a receptor,
called the CCR5 receptor that binds to antigens. The binding between the CD4 cells and antigens
stimulates the release of cytokines (messenger chemicals), which send a signal to Dendritic Cells,
Macrophages and B-cells, which then stimulates antibody production and destroys the intruder.
Cytotoxic Cells need to be activated by Cytokine and kill the antigen on contact. Natural Killer
Cells do not need a cytokine before reacting, but are activated when MHC-1 molecules are not on
the surface of the antigen (when the antigen is foreign to the body). The MHC-1 molecule binds to
a CD8 cell on the surface of the Natural Killer Cell. If there is no MHC-1 molecule to bind with, the
Natural Killer cell kills the antigen on contact.

THE INTRUDER - HIV
The Human Immunodeficiency Virus (HIV) is an antigen and binds to the CCR5 receptor of the
CD4 cell. HIV prevents the CD4 cell from secreting cytokines and even though a foreign antigen is
identified, no kill-and-destroy response is signalled. The HI-Virus thus has ample time to infiltrate
the Helper Cell, use its RNA to replicate and then to destroy the Helper Cell – weakening the
immune system. The HI-Virus has no MCH-1 molecule on its surface and is destroyed by the
Natural Killer Cells, but after being in the body while the HI-Virus mutates and can then attach to
CD8 on the surface of the Killer Cell. This attachment keeps the Natural Killer Cell from destroying
the HIV and the Virus prevails.
1.3. How HIV Infects the Body
The HI-Virus enters the body through an open sore, abrasion or broken skin – even if
microscopically small. Once inside the body the HI-Virus (which is an Antigen) binds to the CD4
cell of the Helper T-cell with the help of the CCR5 receptor. The HI-Virus prevents the Helper Tcell from signalling the immune response and no kill-and-destroy action is initiated. The Virus has
 Free To Grow POSITIVE LIVING August 2004
6
WHAT IS HIV
ample time to infiltrate the Helper T-cell and use its RNA to replicate and multiply. After replication
the virus destroys the Helper T-cell, thereby weakening the immune system and limiting the body’s
ability to fight off diseases.
Initially Natural Killer cells can identify and destroy the HI-Virus without the activation signal from
the Helper T-cell, but with every replication the Virus mutates and becomes less detectable to the
Killer cells. This way the HI-Virus slowly infiltrates and wear down the body’s immune system to a
point where infected individuals no longer have any resistance against the opportunistic infections
that characterise AIDS.
1.4. Stages and Symptoms
A whole range of signs, symptoms and illnesses are associated with HIV/AIDS because your
immune system is too weak to defend your body against invading viruses, bacteria, germs or
foreign cells. The illnesses associated with HIV/AIDS are referred to as opportunistic infections or
opportunistic diseases and no symptom is limited to only one stage of the disease, because each
person’s immune system reacts differently under attack. The World Health Organisation (WHO)
identifies 4 different stages spanning across HIV infection and progression of the disease:

Stage 1 – Primary HIV Infection
After infection you usually experience a short flu-like illness also called seroconversion illness.
Seroconversion illness can be identified by a sore throat, fever and/or rash, but only up to 20
percent of people have symptoms serious enough to consult a doctor. The first stage usually
lasts up to a few weeks and during this time an antibody test will not yet be positive. This is
because of the window period (which lasts up to six months) where the body has not produced
enough HIV-antibodies to show up in a HIV test. The WHO performance scale classifies you
as stage 1 when you can continue normal activity and no symptoms can be identified.

Stage 2 – Asymptomatic Stage
During this stage you are infected, but healthy and relatively free of symptoms. Some
symptoms that might occur include weight loss and swollen glands, called PGL (persistent
generalized lymphadenopathy). HIV is very active in your lymph nodes during this stage and
large amounts of the virus are produced. This stage can last from 3 up to ten years. The WHO
performance scale classifies you as stage 2 when some symptoms are present, but you can
continue normal activity.

Stage 3 – Symptomatic HIV Infection
In this chronic illness stage you experience symptoms like serious weight loss (less than 10
percent of your body weight), unexplained chronic diarrhea (for shorter than a month),
unexplained prolonged fever (intermittent or constant) for shorter than 1 month, drenching night
sweats, a dry cough and shortness of breath, memory loss, depression, chronic fatigue, yeast
infection (especially in women) and swollen lymph glands in your armpits, neck and or groin.
The WHO performance scale classifies you as stage 3 when you are seriously ill, but bedridden
for less than 50 percent of the day during the preceding month.
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WHAT IS HIV

Stage 4 – Progression of HIV to AIDS
During this stage your immune system gets more and more damaged and illnesses become
more severe. You will be diagnosed with AIDS when you develop specific infections, cancers
or mental disorders as a result of the weakening immune system. These infections include HIV
wasting syndrome (weight loss of more than 10 percent of your body weight), unexplained
chronic diarrhea for more than 1 month, chronic weakness and fever for more than a month,
pneumonia, tuberculosis, and disabling cognitive and or motor dysfunction interfering with daily
living. About 50 percent of people with HIV develop AIDS within 8 years after infection. This
stage usually lasts about 2 years. The WHO performance scale classifies you as stage 4 when
you are seriously ill and bedridden for more than 50 percent of the day during the preceding
month.
Figure 1: The Progression of HIV/AIDS
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WHAT IS HIV
1.5. History: HIV/AIDS Time line
1981: An American drug technician wrote a scientific report after noting a high number of requests
for the drug used to treat Pneumocystis carinii pneumonia (PCP) amongst gay men in Los
Angeles. Later in the year the first cases of PCP appeared in drug addicts.
1982: The syndrome was called GRID (Gay-Related Immune Deficiency), but renamed because it
did not just affect gay men. It was named Acquired Immune Deficiency Syndrome, or AIDS. By this
time, the disease had been reported in 14 nations worldwide.
1983: Two Aids epidemics were reported in Europe and the first Australian death from AIDS was
recorded in Melbourne. By now, AIDS had been reported in 33 countries.
1985: The first international conference on AIDS was held in Atlanta. By the end of the year, AIDS
had been reported in 51 countries.
1986: The World Health Organisation (WHO) launched its global AIDS strategy.
1987: A total of 62811 cases of AIDS were reported from 127 countries.
1988: A world summit of ministers of health was held in London to discuss a common AIDS
strategy. The WHO's Global Program on AIDS instituted World AIDS Day as an annual event on
December 1 each year.
1990: By December, over 307 000 AIDS cases had been reported to the WHO, but the actual
number was estimated to be closer to a million.
1991: The red ribbon was launched as an international symbol of AIDS awareness.
1995: The WHO’s global program on AIDS was closed and replaced by UNAIDS (Joint United
Nations Program on HIV/AIDS).
1996: UNAIDS reported that the number of new HIV infections declined in many countries due to
safer sex practices.
1997: UNAIDS reported that the HIV epidemic was far worse than thought. It was estimated that
2.3-million people had died of AIDS, 50 percent more than in 1996.
1998: UNAIDS estimated that a further 5.8-million people had become infected with HIV, half of
them under the age of 25. It was also estimated that 70% of all new infections and 80% of all
deaths were occurring in Sub-Saharan Africa.
1999: According to the annual World Health Report, AIDS had become the fourth biggest killer
worldwide. By then, 33-million people were living with HIV/AIDS.
2000: AIDS deaths totalled 3-million. Of these, 2.4-million deaths occurred in Africa.
2001: United Nations general assembly convenes the first ever special session on AIDS ‘UNGASS’.
2002: The global fund to fight AIDS, Tuberculosis, and Malaria begins operations and approves the
first round of grants.
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2003: President George W. Bush announces PEPFAR, the president’s emergency plan for AIDS
relief. South African government announces comprehensive roll-out plan for fighting HIV/AIDS and
a budget of R12 billion to support the plan for the next five years.
2004: Fifteenth Annual AIDS conference held in Bangkok in July. Second Annual African AIDS
Conference held in Cape Town to discuss the social issues relating to HIV/AIDS.
(The Sunday Times & www.kff.org/hivaids/timeline/)
Notes: ____________________________________ ______________________________
________________________________________________________________________
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The catastrophic damage that the HI-Virus can cause to the immune
system can leave the body prey to infections of the lungs, skin, nervous
and digestive system and a variety of cancers.
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WHAT IS HIV
1.6. Statistics

Global Estimates of HIV/AIDS Epidemic at the end of 2001:
(UNAIDS, Global AIDS Report, 2002)

South African Prevalence Statistics as per province, 2002
Provincial Prevalence
16.0%
14.1%
14.7%
14.9%
14.0%
11.7%
12.0%
9.8%
10.0%
11.4%
10.7%
10.3%
8.4%
8.0%
6.6%
6.0%
4.0%
2.0%
A
SO
U
TH
AF
R
IC
St
at
e
Fr
ee
au
te
ng
G
ap
e
aZ
ul
uNa
ta
l
M
pu
m
al
an
ga
C
Kw
W
es
t
W
es
te
rn
or
th
N
Li
m
po
po
ap
e
C
or
th
er
n
N
Ea
st
er
n
C
ap
e
0.0%
(Nelson Mandela Foundation/HSRC, South African Mass Media Household Survey, 2002)
 Free To Grow POSITIVE LIVING August 2004
11
IMPACT
2. IMPACT OF HIV/AIDS
2.1. Economic Impact of HIV/AIDS on the Workplace
DIRECT COSTS
Benefits package
 Organisation-run health-clinics
 Medical aid/health insurance
 Disability insurance
 Pension fund
 Death benefit/life insurance
payout
 Funeral expenses
 Subsidized loans
INDIRECT COSTS
Absenteeism
 Sick leave
 Other leave taken by sick
employees
 Bereavement and funeral
leave
 Leave to care for dependants
with AIDS
SYSTEMIC COSTS
Loss of workplace cohesion
 Reduction in morale,
motivation, and concentration
 Disruption of schedules and
work teams or units
 Breakdown of workforce
discipline (slacking,
unauthorized absences, theft,
etc.)
Recruitment
 Recruiting expenses
(advertising, interviewing, etc.)
 Cost of having positions
vacant (profit the employee
would have produced)
Morbidity on the job
 Reduced performance due to
HIV/AIDS sickness on the job
Workforce performance and
experience
 Reduction in average level of
skill, performance, institutional
memory, and experience of
workforce.
Training
 Pre-employment education
and training costs
 In-service and on-the-job
training costs
 Salary while new employee
comes up to speed
Management resources
 Managers’ time and effort for
responding to workforce
impacts, planning prevention
and care programs, etc.
 Legal and human resource
staff time for HIV-related
policy development and
problem solving
HIV/AIDS programs
 Direct costs of prevention
programs (materials, staff,
etc.)
 Time employees spend in
prevention programs
 Studies, surveys and other
planning activities
(Whiteside, A. & Sunter, C. (2000). AIDS: The Challenge for South Africa. Human & Rosseau
Tafelberg, Kaapstad.)
Notes: ____________________________________ ______________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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IMPACT
2.2. What is the Risk of HIV/AIDS for your Organisation?
Answer each question by ticking Yes or No.
YES
NO
1. Are most of the workers in your organisation aged between 25 and 45?
2. Are workers of your organisation living in single sex quarters?
3. Are the workers of your organisation migrant (travel across the country or
world on a regular basis)?
4. Are there crucial workers in the production process?
5. Does the organisation find it difficult to find replacements for semi-skilled
workers?
6. Does the organisation find it difficult to find replacements for skilled
workers?
7. Is there a shortage of recreational activities available to employees (i.e.
community or sport centres)?
8. Are alcohol and drug use common?
9. Are there risky environments in the surrounding community?
10. Will the epidemic affect the markets for your goods?
TOTAL
(Add up all the crosses you have in the Yes and No columns respectively)
RISK FACTOR
(Multiply the total of the Yes column by 10)
(Adapted from the American Social Health Society)
%
-
The Risk Factor gives you an indication of how much more your organisation are at risk than the
average risk factor.
Please note that the organisation can lower its risk factor by implementing an HIV/AIDS policy,
which includes a specifications regarding allowances for sick leave and compassionate leave. The
organisation also needs to determine how HIV/AIDS will affect benefits like medical aid, pension,
disability and group life insurance.
“HIV/AIDS is undoubtedly a bottom-line issue for business, as it impacts
on production costs and consumer markets.”
Leighton McDonald, spokesman for SABCOHA
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WHAT CAUSES INFECTION
3. WHAT CAUSES INFECTION
3.1. Requirements for HIV Infection to Occur
For HIV infection to occur one of the individuals involved in the (possible) transmission
circumstance must be infected with HIV. Further you must be exposed to pre-cum, semen, vaginal
secretions, blood, or breast milk; AND the virus must get directly into your bloodstream through
some fresh cut, open sore, or abrasion; AND the virus must be transmitted from one person to the
other very quickly. The concentration of the HI-Virus in the pre-cum, semen, vaginal secretions,
blood, or breast milk also determines whether you will be infected. Blood contains the highest
concentration of the virus and a small amount of blood is enough to infect you. After blood, semen
has the highest concentration of the HI-Virus, followed by vaginal fluids and breast milk. A larger
amount of these fluids is needed for HIV transmission to occur. Body fluids with a very low
concentration of the HI-Virus include saliva, tears, sweat, faeces, and urine.
HIV is very fragile and many common substances, including hot water, soap, bleach and alcohol,
destroy it on contact. When HIV is exposed to air it dries out quickly and the virus is destroyed.
3.2. What Causes Infection

Infected Blood
The use of contaminated blood or blood products is the most effective way of transmitting the
virus as it introduces the virus directly into the bloodstream. All blood used for blood
transfusions are screened with an HIV antibody test before it is used. Due to this reason, the
probability of infection through blood transfusion in South Africa is very low. However, because
of the window period (when you are infected but the antibodies are not detectable) the risk of
infection cannot be eliminated entirely.
HIV can survive for several days in the small amount of blood that remains in an infection
needle after use. Drug users who share needles have a high risk of infection, because this
small amount of infected blood is injected directly into the blood stream.

Mother-to-Child Transmission (MTCT)
If a woman is HIV-positive the chances that her infant will be infected is estimated to be 30
percent if she remains untreated. Transmission from mother to baby can happen during
pregnancy, during birth or when breast-feeding.
A women is more likely to pass the virus to her unborn baby if she became infected just before
or during her pregnancy; she has a high viral load or a low CD4 count; she shows symptoms of
AIDS; she has an asymptomatic HIV disease; or if she has a vitamin A deficiency due to
malnutrition.
Transmission can occur during delivery due to a lengthy labour, rupture of membranes by
health care workers, or an instrumental delivery. Studies indicate that transmission can be
reduced to less than 2 percent if a caesarian section (c-section) is performed prior to labor
combined with the use of antiretroviral treatment during the last trimester of pregnancy. Using
antiretroviral treatment during the later stages of pregnancy and delivery reduces the probability
of a pregnant mother passing the HI-Virus to her infant to between 5 and 8 percent.
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14
Approximately 5 percent of MTCT occurs via breast milk and when a mother breastfeeds she
increases the chance that her infant can be infected by 15 percent. Breast milk contains
varying concentrations of the virus depending on the viral load of the mother. The infant
consumes vast quantities of breast milk and because of its small body weight and newly
forming immune system, there is a high risk of HIV infection. If a HIV-positive mother cannot
access formula for feeding her infant, she should rather breastfeed than mix-feed since the
latter increases chances of infection.

Unprotected Sex
Up to ninety percent of HIV infections occur through unprotected sex. If you keep the
requirements for HIV infection (as discussed in section 3.1) in mind, you can determine the
infection risk of a sexual practice. Remember that even though sores, abrasions or broken skin
is a prerequisite for the HI-Virus to enter you body, these cuts or sores are often
microscopically small – too small to be seen with the naked eye, but big enough for the virus to
find entry to the blood stream. Varying sizes of sores and abrasions are a natural result of the
friction that occurs during sex.
Deep or open-mouthed kissing: Deep or open-mouthed kissing is a low risk activity in terms
of HIV transmission. HIV is only present in saliva in very minute concentrations, but if you or
your partner has blood in your mouth you should avoid kissing until the bleeding stops.
Fingering: Inserting a finger into someone’s anus or vagina would only be an HIV risk if your
finger has cuts or sores on it and if there is direct contact with HIV infected blood, pre-cum,
vaginal fluids or semen from the receiving partner.
Oral Sex: The risk of HIV transmission through the throat, gums and oral membranes are
lower than through genital or anal membranes. There is a moderate risk of HIV infection if precum, semen or vaginal fluid got into any cuts, sores or receding gums you might have in your
mouth. The risk of infection can be increased if there is menstrual blood involved or a sexually
transmitted infection (STI) present.
Extracting the penis before ejaculation: Research suggest that high concentrations of HIV
can be detected in pre-cum and as a result it is difficult to judge whether HIV is present in
sufficient quantities for infection to occur even though no semen is transferred from one partner
to the other.
Lesbian sex: Women-to-women sex has a relatively low risk, but cases have been reported
where women have been infected through lesbian sex or the sharing of sex toys.
Anal intercourse: Unprotected anal intercourse carries a higher HIV infection risk than most
other forms of sexual activities. The lining of the rectum has fewer cells than that of the vagina
and is more easily damaged or torn (which can cause bleeding) during intercourse. In the case
of tearing, the HI-Virus can easily be transferred from sexual fluids directly into the
bloodstream. During anal intercourse the risk of infection is higher for the receptive partner
than what it is for the insertive partner.
“After sexual transmission, the next most important cause of HIV infection
in South Africa is mother-to-child transmission (MTCT).”
Alan Whiteside and Clem Sunter, 2000
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15
WHAT CAUSES INFECTION
Table 1: Risk of HIV infection
ACTIVITY
BODY FLUIDS INVOLVED
RISK OF HIV INFECTION
Holding hands
None
None
Social kissing
None
None
Deep kissing
Saliva – Blood
Low – Moderate
You would have to swallow seven litres of
saliva in order for the virus to be transmitted in
this way! Bleeding gums and sores in the
mouth increase the chances of infection from
blood.
Masturbation
Vaginal fluid / Semen
None
Thigh sex
Vaginal fluid / Semen
Low
Mutual masturbation
Vaginal fluid / Semen
Low
Oral sex
Saliva / Vaginal fluid / Semen /
Blood
Vaginal sex
Vaginal fluid / Semen / Blood
Anal sex
Semen / Blood
High: 1/60 for women
High: 1/90 for men
Needle prick / Blood
from HIV+ person if
you have a cut
Blood
High: 1/250
Blood Transfusion
Blood
Low: 1/100 000
Due to testing in the window period
Low to High
The virus can enter the blood stream through
bleeding gums, mouth sores or abrasions in
the throat.
High: 1/250 for women
High: 1/350 for men
3.3. Other Possible Risks
Visiting the doctor or dentist: Transmission of HIV in a health care setting is extremely rare. All
heath care professionals are required to follow infection control procedures when caring for any
patient.
Blood splashes into eye: Research suggests that the risk of HIV infection in this way is
extremely small. A very small number of people (usually in a healthcare setting) have become
infected with HIV as a result of blood that splashed into their eyes.
Donor semen: Donor semen is checked for HIV antibodies when the semen is collected. The
semen is then frozen and the donor is required to come back after six months for a second HIV
test, to confirm the initial HIV screening. The semen is not used before the procedure in
completed.
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WHAT CAUSES INFECTION
Biting: Infection with HIV in this way is unusual. There have been a couple of documented cases
where HIV transmission resulted from biting, but in these cases severe tissue tearing and damage
were reported in addition to the presence of blood.
Household settings: HIV is not transmitted through everyday social contact. Although HIV
transmission from one family member in a household to another in the same household is
theoretically possible, it occurs very seldom and documented cases are rare.
Tattooing, piercing, acupuncture, electrolysis and shaving: Where a needle or razor is used
on more than one person there is a theoretical risk of HIV transmission because of the possibility of
infected blood on the instrument. However, the risk can be reduced or eliminated through routine
sterilization procedures.
Contact sports: The possibility of HIV transmission through open, bleeding wounds in contact
sports has been recognized, but are low. Those who participate in contact sports like boxing,
wrestling and rugby where blood and open wounds are often part of the game, have a higher risk
where bleeding is not managed effectively.
Contact with saliva, tears, sweat, faeces or urine: Transmission can only occur when a
sufficient amount of HV enters the bloodstream, through cuts or mucous membranes. These body
fluids contain HIV in a quantity too small to result in transmission.
Insect bites: Mosquitoes, flies, ticks, fleas, bees or wasps do not transmit HIV. If a bloodsucking
insect bites someone with HIV the virus dies almost instantly in the insect’s stomach as it digests
the blood. HIV can only live in human cells.
Casual contact, sharing dishes or food: HIV is not transmitted through casual, every day
contact. Since HIV is not transmitted by a small amount of saliva, it is impossible be infected by
sharing a glass, a fork, a sandwich or fruit.
Swimming pools and jacuzzi’s: The chemicals used in swimming pools and jacuzzi’s will
instantly kill any HIV, if the hot water hadn’t killed it already.
Pets: The HI-Virus cannot live in the bloodstream of animals and is a specific human virus.
Notes: ____________________________________ ______________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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17
WHAT CAUSES INFECTION
3.4. Sexually Transmitted Infections
Sexually transmitted infections (STIs) are infections that are usually passed on from an infected
person to an uninfected person through sexual contact, including oral, vaginal and anal sex. Some
STIs are also transmitted through other means than sexual contact, for instance HIV and Syphilis
that can be transmitted through contaminated blood.
There are over 20 different kinds of STIs. Here are some examples:
EFFECTS
COMMENTS
Discharge Diseases
HIV/AIDS
Gonorrhea
Chlamydia
Hepatitis B
Fatal, incurable
Causes Pelvic Inflammatory Disease
(PID), chronic pain, infertility, lifethreatening pregnancy and arthritis.
Causes PID, chronic pain, infertility, and
problems during pregnancy.
Causes liver disease and cancer.
Estimated 40 million worldwide by the year
2000.
1.3 Million new cases per year. Some
strains are resistant to treatment.
Over 4 million new cases each year.
300 000 new cases each year.
Genital Ulcer Diseases
Genital Herpes
Genital Warts
Syphilis
Painful blisters around sex organs,
produces fever, enlarged lymph glands,
flu-like symptoms.
Warts on the inside and outside of vagina,
on tip of penis, testicles and around the
anus.
Leads to blindness, heart disease,
nervous disorders, insanity, tumours and
death.
Almost 500 000 new cases reported each
year. INCURABLE.
About 30% of people have the HP-Virus that
causes genital warts.
Over 100 000 reported cases per year.
Most STIs (except HIV and Herpes) can be effectively treated and cured. It is vital to start with
treatment as soon as possible and to complete the entire course of medication prescribed to you.
Treatment is available for free or really affordable prices at public health institutions.
A person with an STI is 20 times more likely to be infected with HIV. Genital sores cause breaks in
the skin that allow HIV to enter the body more easily and in the case of discharges the number of
white blood cells in the genital area increase, making it easier to get infected.
A person with a Sexually Transmitted Infection is 20 times more
likely to be infected with HIV than one without an infection.
3.5.
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WHAT CAUSES INFECTION
3.5. Vulnerability of Women
Women are more vulnerable to HIV infection than men. This is due to the following factors:

Physical Issues
The inside of a woman’s vagina is a natural incubator for HIV and is a much larger area than a
man’s penis. The vaginal wall is prone to sores and abrasions during sex and the amount of
exposed vaginal tissue increases the woman’s risk of HIV infection.
After ejaculation, semen remains in the vagina while the man extracts his penis. The viral load
in semen is higher than in vaginal fluid and the extended period of exposure to semen
increases the woman’s risk of infection. Several opportunistic infections occur with greater
frequency in women than in men.

Young Women
Young women are particularly at risk because they are physiologically immature and more
prone to trauma (sores and abrasions) during sexual encounters. Risk of infection is
especially high for young women when they have relations with older sexually experienced
men who are more likely to be HIV-positive. It is very unlikely for a young girl to be able to
negotiate safe sex in these inherently unequal relationships, and research paints a picture of
frighteningly high levels of coercive sex.

Rape and Violence
Where force is used in sex, abrasions and cuts are more likely, thus making it easier for the HIVirus to enter the bloodstream. Without immediate treatment up to 40 percent of rapes could
result in HIV infection. It is clear that violence against women is fuelling the HIV/AIDS
epidemic.

Education and Economic
In more impoverished areas women are the ones to be removed from school when the family
faces hard times, they are therefore more likely to be illiterate and the least likely to have
marketable skills. In other instances, women are expected to stay at home and look after the
households and they do not get the opportunity to develop professionally. This leads to an
economic dependence on their husbands or partners, which in turn weakens their position in
society. The woman who can muster the courage to leave her husband often ends up in a
difficult financial position. This can force her to turn to commercial sex for survival, which
increases her risk of HIV infection.
“Up to 80 percent of women who are HIV-positive and in long-term relationships
acquired the virus from their partners. This is in a society where a man having
multiple sex partners is the accepted norm. Ironically marriage is one of the
greatest risk factors for women today.”
UNAIDS, HIV prevention news update 2002
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WHAT CAUSES INFECTION
3.6. What is Your Risk
The risk assessment chart below can be used to calculate your risk of HIV infection for the last 12
months. (Please note that even though you might not have been sexually active in the past 12
months, if you were sexually active before your risk of infection might be higher than what is
portrayed in this assessment.) Calculating your risk can help you decide whether you should:
o
o
Take an HIV test
Take extra precautions to protect yourself when having sex
o Take extra precautions to protect your spouse or sexual partner(s) and family
No.
How to score the points
1.
Start with a score of 0
2.
If your age is between 11 and 15, add 5 points
3.
If your age is between 16 and 25, add 7 points
4.
If your age is 25 or older, add 6 points
5.
6.
7.
8.
9.
10.
Score
Total
0
Add 3 points for every sexual partner that you have had in the last year (e.g.
3 partners = 9)
Subtract 1 point for each partner that you knew for at least 6 months before
you had sex with him or her
Subtract 1 point for each partner that you discussed STIs with, and the risk
of you both getting them
Subtract 3 points if you do or would use a condom with every sexual
partner. You can subtract 2 points if you only use a condom sometimes
Subtract 2 points if you can recognise the signs and symptoms of STIs and
would go for treatment immediately after identifying one
If you have been in a mutually faithful relationship for 5 years or more,
subtract 3 points
TOTAL SCORE
(Adapted from the American Social Health Society)
Your estimated risk:
A score of 0 to 5
A score of 6 to 10
A score of 11 and above
=
=
=
low risk
moderate risk
high risk
“Change is a door that has to be opened from the inside.”
French proverb
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4. PREVENTION
4.1. ABC Option
There are different ways of protecting yourself or at least reduce the likelihood an HIV infection
through sexual transmission. These prevention methods are often referred to as the ‘ABC’
approach to prevention:



A – ABSTAIN until married or in a long-term committed relationship
B – BE FAITHFUL in marriage and long term committed relationships
C – USE CONDOMS consistently and correctly if neither A not B is followed
The ABC approach target and balance abstaining from sexual activity, mutual monogamy and
condom use according to the needs of different at-risk populations and specific circumstances
confronting a particular individual. You must choose the way of protection that is most appropriate
for your lifestyle.
Education in the prevention of HIV is fundamentally about communication, healthy choices,
responsible behaviors and self-awareness. The only way to slow and ultimately stop HIV/AIDS is
by educating people about risk and risk reduction. Any intervention that stresses either condom
use or abstinence only misses the mark and is unlikely to significantly slow the pandemic. Studies
have shown that the comprehensive ABC approach to HIV prevention is far more successful in
reducing risky behaviours. Such an intervention has been implemented in Uganda with great
success.

Abstinence
Practicing abstinence means not to have sex. The safest sex is definitely no sex. Abstinence
takes discipline and goes hand in hand with skills in goal setting, decision-making, relationship
development and communication. This option is not appealing to everybody, but is especially
advisable to young people who can delay their first sexual relationship as long as possible or
those who are not in a steady relationship.
If total abstinence is not possible, you can still abstain from having penetrative sex by resorting
to a safer sexual activity. You will not be infected if your penis, mouth, vagina or rectum does
not touch anyone else’s penis, vagina, mouth or rectum. Safe activities include kissing, erotic
massage, masturbation or mutual masturbation.

Be Faithful
For those adults to whom abstaining is not an option, sex within the boundaries of a mutually
faithful relationship is a more likely mode of protection against HIV infection. Many people
engage in sexual activity without first establishing a committed relationship that allows for trust
and open communication. As a safety measure, you and your partner should discuss your
sexual history, any previous STI exposures, current or previous intravenous drug use, and your
current health status before engaging in unprotected penetrative sex. Having sex in a
monogamous, faithful relationship is safe if both of you are HIV-negative, you both only have
sex with each other, and neither of you gets exposed to HIV through drug use or other
activities.
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21

Condom use
For some, neither abstinence, nor being faithful is an option and using condoms are the only
way of protecting yourself against HIV infection. Either the male or the female can wear a
condom during sex to protect both parties from HIV infection. (Not all individuals, cultures
and/or religious groups are open and willing to maintain the use of condoms as a method of
prevention. These individuals or groups should stick to the A and B options of HIV prevention.)
Condoms are made of latex or polyurethane and come in a variety of shapes, sizes, flavors and
textures to make sex more enjoyable. The latex condom is the only form of protection, which
can stop HIV transmission, the transmission of STI’s and prevent pregnancy. Some condoms
are lubricated with a silicone or water-based substance to make it easier to put the condom on
and make use more comfortable. Some lubricated condoms are available with Spermacide
(Nonoxynol 9) added, which provide additional protection against pregnancy if some semen
happens to leak out. Some people have an allergic reaction to Spermacide that causes small
sores on the penis that can increases the risk of HIV infection. It is important not to use an oilbased lubricant with condoms, as this damages the latex and cause tearing.
When used consistently and correctly, a condom is between 69 and 90 percent effective in
preventing you against a HIV infection. Consistent condom use refers to using a condom every
time you have sexual intercourse. It is important to never use the same condom twice.
Condoms are affected by heat and light and must be stored properly. Do not use a condom
stored in your back pocket, wallet or the glove compartment of your car.
The female condom is a polyurethane sheath or pouch, closed at the one end and about 17cm
in length, which can be worn by a woman during sex. At each end of the condom there is a
flexible ring. To insert the condom into the vagina the ring around the closed end of the
condom is shaped into a figure 8 and then inserted in much the same way as a tampon. The
inner ring will ensure than the condom stay in place during sex. The outer ring at the open end
of the sheath stays outside the vulva at the entrance to the vagina. The outer ring acts as a
guide during penetration and it also stops the sheath from bunching up inside the vagina.
The female condom should not be used at the same time as a latex male condom because the
friction between the condoms may cause the condoms to break.
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PREVENTION
4.2. Post Exposure Prophylaxis
Post Exposure Prophylaxis (PEP) is a dose of antiretroviral therapy that is designed to reduce the
possibility of infection after an accidental exposure to the HI-Virus. PEP usually consists of the
drugs AZD (Zidovudine), 3TC (Lamivudine) and Crixivan (Indinavir). The treatment approach
varies according to the level of risk of infection and the level of risk is related to the type of
exposure to the virus. In order for the treatment to be effective it must be taken within 72 hours of
exposure (preferably within 2 to 3 hours after exposure) for a period of 28 days. The
administration of PEP following exposure usually reduces the chance of HIV by between 79 and 81
percent.
The South African government provides PEP to individuals involved in occupational accidents (i.e.
needle stick injury of health care workers) and rape survivors. In order to access the government
funded PEP you must first report the case (accident or rape) to the police where you will be
required to write out a statement. The police will then refer you to a doctor who will do some tests.
Only once the tests have been completed PEP will be prescribed and administered. For all other
cases of exposure you will be required to visit your private physician for PEP and in these cases
the cost of PEP will be for your own account.
In case of a possible exposure to the HI-Virus it is recommended that you go for a HIV antibody
test 6 weeks after the incident and then again at 3 months and 6 months to determine your HIVstatus and whether sero-conversion takes place. Alternatively you can go for an HIV PCR test 10
days after exposure to determine whether HIV infection has occurred. (See section 5.1 for more
information on testing.)
4.3. Preventing Mother-To-Child Transmission
Risk of infection can be reduced to less than 15 percent if the mother uses antiretroviral treatment
during the last trimester of her pregnancy. In South Africa, mothers are treated with AZT or
Nevirapine during the pregnancy and infants are given a dose of Nevirapine syrup just after birth to
protect the babies from HIV infection.
4.4. Drugs and Alcohol
Drugs (if users do not share needles) and alcohol do not cause HIV, but bad judgment calls when
you are high or intoxicated can increase your risk of infection. For instance, when you are high or
intoxicated you might be more likely to throw caution to the wind and have unprotected sex. Part
of prevention is to use drugs and alcohol responsibly.
4.5. Prevention of Occupational Injuries
There is no known risk of contracting HIV from working in a normal group setting. However,
transmission is possible in, for example, factories where employees can get cuts from sharp
utensils or equipment. The best policy is to treat all workplace incidents as if there is an HIV risk.
The law requires that one first aid worker must be appointed for every 50 employees working at the
organization. For the prevention of HIV transmission, first aid workers should use protective gloves
at all times when assisting a patient and use special mouthpieces for mouth-to-mouth
resuscitation. It is also advisable to keep bleach in the first aid kit for cleaning up after accidents.
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PREVENTION
If an occupational injury occurs and an employee fears the risk of HIV infection, the employer must:







Report the workplace accident
Send the employee for an HIV test immediately to determine HIV status before the accident
Know that if the test is positive that infection occurred before the accident
Ask the individual who could be the source of infection to go for a HIV test
Get an affidavit if the source employee refuses to have an HIV test
Help employee at risk to get access tot PEP
Ask the employee to re-test after 6 to 12 weeks to see if he/she sero-converts.
If it is proven that an employee contracted HIV from a workplace accident, the onus is on the
employer to assist the employee in applying for workman’s compensation.
Notes: ____________________________________ ______________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
 Free To Grow POSITIVE LIVING August 2004
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FINDING OUT YOUR STATUS
5. FINDING OUT YOUR STATUS
5.1. Different Methods of Testing

Rapid Tests
Rapid tests are hand-held, easy to use tests that can be used for on-site testing. Results take
between 20 to 30 minutes to return. The Abbot Determined test may test positive for HIV,
malaria, pregnancy, flu or liver disease. If there is a positive result, a Gaifar test will be done.
If the Gaifar is negative, you are HIV negative, but if tested positive, an Elisa test will be done
and sent to a laboratory to confirm the results.

Antibody Test (testing for antibodies and not the HIV Virus)
The ELISA test is the most popular and commonly used antibody test. It is adequate to make
a HIV diagnosis. It tests for antibodies that are found in serum, which has been separated from
red blood cells. The ELISA test will pick up the antibodies 6 weeks after infection (i.e. after the
window period) and it takes one to two weeks to analyze. It is widely available, is reasonably
cheap and is excellent for screening purposes, as it is also highly sensitive. In 0.5% – 2% of
cases, the ELISA test gives false positive reactions because of its great sensitivity. Because of
this, a second test is normally required when the result of the test is positive. This may not be
necessary when there are other indicators of HIV infection such as obvious signs and
symptoms of AIDS or a low CD4 count. Elisa tests are also available for rapid ‘bedside’ testing
(tests that do not need a laboratory, but that can be done in a doctor’s/sister’s consultation
room or clinic). As a rapid test the ELISA is reasonably reliable, but, in case of a positive result,
a second test should be done through a laboratory.

Testing for the actual HIV virus
These tests can detect the HIV virus in the blood. It is usually not necessary to make an HIV
diagnosis, but is useful when testing small babies, when it is necessary to know the HIV status
very early (i.e. within the window period), in special circumstances (after rape) and when
antibody tests have been inconclusive. These tests are expensive and are not suitable for
screening purposes.
The P24 Antigen test is more likely to be positive around sero-conversion and in the more
advanced stages of the disease. It is more likely to give a false positive test (people who are
negative, but show up positive) in the very early phase of infection.
PCR Antigen Detection (also known as the ‘three week test’) is an extremely sophisticated
method, which can detect very small numbers of HI-Virus in the blood soon after infection. The
virus usually becomes detectable 3-4 weeks after exposure and the test may be positive some
time before antibodies are found. This test will remain positive for the duration of the illness. In
further sophistication, the assay is used to quantify the amount of virus in the blood to help in
management and drug therapy of infection with HIV. It is still very expensive and limited to only
a few laboratories.
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FINDING OUT YOUR STATUS
5.2. Window Period
After being infected with HIV immune system takes 3 to 12 weeks to produce HIV antibodies. If
you go for a rapid or antibody test during this period, the test will be falsely negative. That is why it
is always advisable to go for a second test 3 to 6 months after exposure to the virus. The 3 to 12
weeks after infection is known as the window period.
5.3. Workplace Surveys
HIV surveys will assist companies in establishing the magnitude of the HIV epidemic in the
workplace. A proper HIV survey should provide the following information:




The number of employees who are HIV positive
The percentage of employees who are HIV positive
The number of employees infected in pre-determined demographic groups
(e.g. age, job category, gender, divisions in the organisation etc.)
Recommendations for managing the epidemic
When doing an HIV survey in the workplace it is important that:




Participation must be voluntary and in agreement with organised labour
Qualified health specialists with training in epidemiology and bio statistics are used to
conduct the survey
Legal and ethical principals are adhered to
The survey forms part of a comprehensive HIV/AIDS prevention programme
Notes: ____________________________________ ______________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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LIVING WITH HIV
6. LIVING WITH HIV/AIDS
You can look at HIV/AIDS from two angles: living with HIV/AIDS or dying from HIV/AIDS.
HIV/AIDS cannot be cured, but it can be managed like a chronic disease and even with HIV you
can still have quality of life for years. The only prerequisite to attain and maintain quality of life is to
ensure that you have a healthy body, a healthy mind and a strong spirit.
6.1. Body

Anti-retroviral Drugs (ARV’s)
On 19 November 2003 the Cabinet announced that ARV treatment would be available in every
health district within a year and every local municipality within 5 years. Antiretroviral drugs
inhibit the growth and replication of HIV at various stages of its life cycle and for lifelong
treatment three different ARV drugs must be taken together. This is called combination
treatment or HAART. There are three classes of ARV drugs and a combination must be found
that accommodates with your physiology and has the minimal side effects. The three classes
of ARVs include:
Nucleoside analogue reverse transcriptase inhibitors (NRTI’s): NRTI’s were the first
antiretroviral drugs to be developed. They inhibit the replication of an HIV enzyme called
reverse transcriptase. They include zidovudine (Retrovir, AZT), lamivudine, didanosine (Videx),
zalcitabine (Hivid), stavudine (Zerit) and abacavir (Ziagen).
Protease inhibitors (PI’s): PI’s interrupt HIV replication at a later stage in its life cycle by
interfering with an enzyme known as HIV protease. This causes HIV particles in your body to
become structurally disorganized and noninfectious. Among these drugs are saquinavir
(Fortovase), ritonavir (Norvir), indinavir (Crixivan), nelfinavir (Viracept), amprenavir
(Agenerase) and lopinavir (Kaletra).
Non-nucleoside reverse transcriptase inhibitors (NNRTI’s): These drugs bind directly to
the enzyme, reverse transcriptase. Three NNRTIs are approved for clinical use: nevirapine
(Viramune), delavirdine (Rescriptor) and efavirenz (Sustiva).

Nutrition
Although your dietary intake cannot cure HIV/AIDS, it can influence the progression from HIV
to AIDS. Serious deficiencies of protein, energy, vitamins and minerals decrease the proper
functioning of the immune system. Malnutrition that exists before you become infected with
HIV weakens the immune system and makes you more susceptible to infections, including
HIV.
Most people living with HIV/AIDS suffer from anorexia, diarrhoea, nausea, and/or vomiting. All
of these symptoms put an enormous strain on the body’s reserves of energy, protein and
micronutrients. Malnutrition is often caused by HIV/AIDS and is also called ‘Slim Disease’
because patients literally tend to waste away. Many of the anti-retroviral drugs can also cause
nausea, anorexia and vomiting, which interfere with food intake.
A healthy diet comprises of eating regular meals, including energy foods like starches to
supply your body with the energy it needs to function optimally. Eat garlic often and drink
lemon juice and olive oil regularly, but in moderate amounts. Vitamins and minerals should be
taken regularly and include calcium, magnesium, selenium, zinc, vitamin A, C, B2, B6, B12
 Free To Grow POSITIVE LIVING August 2004
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LIVING WITH HIV
and folic acid. Avoid sugar, spicy and fried foods, coffee, red meat, peanuts, leftovers,
unwashed or undercooked food.

Fitness and Exercise
Here are some of the benefits of keeping fit:
o
o
More white blood cells are released into the blood stream to help you fight infection
Increases the release of endorphins, which are chemicals produced by the brain that help
you fight pain
o Improves your blood circulation and helps your blood carry more oxygen
o Removes toxins (poisons) through your sweat glands
o Improves sleep
o Relieves depression and stress
o Makes you feel healthy and alive
o Improves your attention to nutrition. Good eating habits and exercise go hand in hand
o Increases your appetite
o Improves your appearance and increases your motivation for living
o Increases the activity of T-cells and B-cells produced by the immune system.
Some useful web-site addresses on how to keep the body fit:
www.primusweb.com/fitnessporter
www.justwalk.com
www.justmove.com
www.50plus.org
www.thefitnessportal.com
If you have HIV/AIDS it is important that you take an active role in every treatment
decision. You and your doctor should discuss the different treatment options so
that you can make an informed decision.
 Free To Grow POSITIVE LIVING August 2004
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LIVING WITH HIV
6.2. Mind
Having a positive mental attitude and sufficient knowledge is the key to living with HIV/AIDS. A
positive attitude and fighting spirit can give people with HIV a longer, better quality of life. See the
article written by such an attitude warrior below:
I’M STILL STANDING
“A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every
difficulty.”
Sir Winston Churchill
AIDS entered my world on 10 March 1983.
On my 22nd birthday I received the results and it confirmed that something was seriously wrong
with my body. I had a CD4 cell count of 362. I was told that I had six months to live, and then told
to go home.
In the early days, HIV took many different paths and none of them had signposts to guide me. My
journey has taken me to the highest levels of joy and the depths of sadness.
I started out life full of innocence and joy, with only instinct as my guide. As I grew up and life
started with its lessons, fear entered. So I faced my fears head-on and slayed those dragons, one
by one. With this, came courage – the courage to dare to be who God intended me to be, to live
my truth and fulfil my purpose. I am grateful for the lessons HIV has taught me because without it,
I would not be the person I am today.
The lessons I have learned are to hold onto hope. If we lose hope we lose our dreams and
ourselves. Dreams are essential because they make the impossible possible. I have also learned
that without faith in myself, others and in God, the lessons of HIV are wasted. The most important
lesson is about LOVE - without it we are nothing.
Today, on the 13th March, I celebrate the 20th anniversary of my diagnosis with HIV/AIDS. It also
happens to be my 42nd birthday.
I look at the future and am excited at all the possibilities, opportunities and lessons the next 20
years will bring. If HIV were a race between fear and myself with life as the prize, I can honestly
say that I have won. By the grace of God I go.”
Written by David Patient
“I never have bad days – only good ones and excellent ones.”
Lance Armstrong, world biking champion and survivor of cancer
 Free To Grow POSITIVE LIVING August 2004
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LIVING WITH HIV
6.3. Spirit
Even life threatening disease cannot destroy the human spirit. The fruit of unconditional love,
thankfulness, friendliness, patience and kindness, bring about a peace, joy and purpose that drive
away darkness and bring life to a very darkened disease. It is no surprise that people who are
HIV-positive often become interested in pursuing the strengthening of their spirit, especially when
the mind and body are under assault of the HI-Virus.
The spirit works in close conjunction with the mind and your quality of thought determines your
state of health. Don’t deny your suffering. Facing death can make you stronger, wiser and more
understanding. It can help you focus on what is really important: family, helping others and living
life to the fullest.
The saying “prayer heals“ is true - even if healing is not physical it certainly seems to heal
emotionally. People who pray seem to be better able to deal with what life gives them. The key
seems to be not to ask that AIDS be taken away, but to ask for health and quality of life.
Remember, you are still alive. Focus on what is good and positive every day and say thank you.
Small and big things are important. Focus on the good things in life, appreciate them and value
them.
7.
“Considering the international AIDS crisis, I’ve found that taking a
prayer-based approach to the problem can bring healing to my own
thinking that will ultimately help bring healing to the disease itself.”
Ron Ballard
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SUPPORTING PEOPLE WITH HIV/AIDS
7. SUPPORTING PEOPLE WITH HIV/AIDS
7.1. How to be an Emotional Supporter
In a society where people living with HIV/AIDS are often stigmatised, discriminated against and
ostracised, HIV-positive individuals are in dire need of emotional support. The most important
characteristics of an emotional supporter are respect, trust and understanding of which respect is
the foundation to good relationships.
Respect is an attitude that portrays the belief that every person is unique, is a worthy being and is
competent to decide what he or she really wants from life. You show respect by refraining from
judgement or looking down on someone, but accepting the person irrespective of their values,
beliefs, culture or behaviour. You show someone understanding by trying to walk in his or her
shoes and by making time to support and to listen to that person. Trust is formed when you treat
what a person shares with you as confidential. When someone opens up to you they make
themselves vulnerable. If you exploit that vulnerability it will break trust.
7.2. Support Groups
Support groups can help both those infected with and those affected by HIV/AIDS to cope better
with the disease. Support groups are structures where people meet on a regular basis to talk
about their difficulties or simply to relax and enjoy each other’s organisation.
Family, friends and/or neighbours can all form part of your informal support structures when they
care for those who are sick or need emotional support, whereas formal support groups are often
run by a health professional. Both these structures have the same characteristics that make them
successful:
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
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Group members trust each other
Members trust their leaders (if the group has formal leaders)
Members feel free of discrimination and blame
Personal information shared is not discussed outside the boundaries of the group
Access the appropriate information about the disease or issue being discussed
Group members show respect to each other (not only words)
Group members share interests and/or life experiences
The group addresses the specific needs and expectations of each group member
Group members get the opportunity to give and receive
Group members listen and are listened to
The key to successful support groups is action, rather than words. What you do, not what you say,
creates long-lasting networks of support.
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SUPPORTING PEOPLE WITH HIV/AIDS
7.3. Peer Education
Peer Education is one of the most widely used strategies to address the HIV/AIDS pandemic and
typically involves training and supporting members of a specific group to effect change among
members of the same group. Peer Education can be used to bring about a change in knowledge,
attitudes, beliefs and behaviours of individuals and it may also create change on a group or
societal level by modifying norms and stimulating collective action that in turn can contribute to
change in policies and programs regarding a specific issue.
Peers are usually individuals of equal standing with the target group and are usually volunteers
that assist in the education relating to a specific topic – in this case HIV/AIDS. When peers are of
the same social standing and volunteers members of the target group seem more willing to listen
and more receptive to messages on HIV/AIDS.
The role and responsibilities of an HIV/AIDS Peer Educator can be summarized as follow:

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Educate peers on HIV and STI’s in one-on-one and small group sessions
Assist peers to access condoms and voluntary counseling and testing (VCT)
Support people living with HIV/AIDS in their effort to live positively
Teach pees to negotiate safer sex
Teach peers to do personal risk assessment
Teach peers about home care for people living with HIV/AIDS
Distribute educational materials
Provide referrals to health care facilities
Participate in HIV outreach awareness and other public events
Train other peers
Different methods of peer counseling can be used like storytelling, interactive drama, computer
simulation games, slides and videos, but the most important tool or characteristic that a peer
educator can use is the building of truly supportive relationships.
Notes: ____________________________________ ______________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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RIGHTS AND RESPONSIBILITIES
8. LAWS THAT PROTECT PEOPLE LIVING WITH HIV/AIDS
8.1. Labour Relations Act (No. 66 of 1995)
Protects employees against unfair dismissal. If an employee is dismissed just because he/she has
HIV/AIDS this dismissal is based on discrimination and is Automatically Unfair. The employer can
be taken to the CCMA or Labour Court and be forced to re-employ the employee or give him/her
compensation stipulated by the Court. Dismissal is fair only if it is based on the wrongful conduct
of an employee or if an employee can no longer do his/her work properly. Where employees can
no longer do their work an employer should first investigate what the extent of the employee’s
capability to do their job is and what alternatives are available apart from dismissal. These
alternatives can include extended sick leave without pay, adapted duties and possible means of
accommodating the employee’s disability. An employee no longer able to work must be provided
with an incapacity hearing before they can be dismissed.
8.2. Employment Equity Act (No. 55 of 1998)
This Act ensures that all employees are treated equally and that there is no discrimination in the
workplace. The Act promotes equal opportunity by eliminating unfair discrimination and prohibits
unfair discrimination (directly or indirectly) against an employee on the grounds of their HIV status.
The Employment Equity Act also prohibits medical testing to determine the HIV status of an
employee, except in limited circumstances. Testing can only be done if the Labour Court agrees to
it. Employees may not be forced to answer questions on their HIV status. It is not unfair
discrimination to exclude an HIV-positive person (when hiring them) if it is essential that an
employee must not be HIV-positive in that job. The employer must be able to prove to the Labour
Court that HIV-negative status is essential to that job. The ‘Code of Good Practice on Key Aspects
of HIV/AIDS and Employment’ is part of the Employment Equity Act and gives employers guidelines
to implement the requirements of the Act.
8.3. Basic Conditions of Employment Act (No. 75 of 1997)
This Act sets standards for employers on how many hours an employee may work in a week and
how much leave they are allowed to have. Employees are allowed to take a total of six weeks
paid sick leave every 3 years and employees with HIV/AIDS can take this leave just like any other
employee in the organisation. Sick employees can ask employers to have more sick leave for less
pay.
8.4. Promotion of Equality and Prevention of Unfair Discrimination (No. 4 of 2000)
The Promotion of Equality and Prevention of Unfair Discrimination Act also sees to it that there is no
unfair discrimination in the workplace, especially with things like insurance. This means that an
employee with HIV/AIDS must be treated in exactly the same way as all the other employees in the
organisation in all matters.
8.5. Occupational Health and Safety Act (No. 85 of 1993)
An employer is obliged to ensure that the risk of occupational exposure to HIV is minimized as far
as is reasonably possible.
8.6. Compensation for Occupational Injuries and Diseases Act (No. 130 of 1993)
If an employee is exposed to infected blood or body fluids as a result of a workplace accident and
is infected with HIV, he or she may apply for benefits in terms of Section 22(1) of the Act.
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ORGANISATION-BASED HIV INTERVENTION
9. ORGANISATION-BASED HIV/AIDS INTERVENTION
9.1. Design and Implementation of an HIV/AIDS Intervention
The following twelve steps can be used as a guideline for the design and implementation of an HIV
intervention:

Step 1 - Management Meeting
Management meets and appoints an HIV/AIDS campaign leader to take responsibility to
promote HIV/AIDS as an important and strategic consideration for the organisation. Any
person in the organisation can play this role, but the more influential the better. Management
should also start discussing a budget for an HIV/AIDS intervention.

Step 2 – Awareness Campaign
The key to success in an HIV/AIDS intervention is to involve all interest groups in the
organisation and this is achieved through communication. Communicate the organisation’s
intention to launch a HIV/AIDS intervention, share the aim of the intervention and ask
employees to volunteer for a committee that will initiate and manage the intervention.
The HIV/AIDS Committee is responsible for initiating and implementing the intervention,
gathering information through assessments, writing and promoting an HIV/AIDS workplace
policy and overseeing the implementation of the strategy. It is important for the committee to
be highly visible in order to stimulate interest and gain acceptance from employees. Duties of
the committee members and time allocated to serve on the committee should be clearly defined
so that clear boundaries are drawn between the work and committee responsibilities of
employees.

Step 3 – Train the Committee
The HIV/AIDS committee should be educated in HIV/AIDS principles and thoroughly
understand HIV/AIDS as a strategic issue.

Step 4 – Review Legislation
The following acts, read in conjunction with the Constitution of South Africa are relevant:
o
o
o
o
o
o
o
Employment Equity Act, No. 55 of 1998
[Especially Section 6(1)]
Labour Relations Act, No. 66 of 1995
[Especially Section 8 and Section 187(1)]
Occupational Health and Safety Act, No. 85 of 1993
[Especially Section 8(1)]
Compensation for Occupational Injuries and Diseases Act, No. 130 of 1993
[Especially Section 22(1)]
Basic Conditions of Employment Act, No.75 of 1997
Medical Schemes Act, No.131 of 1998
[Especially Section 24(2)(e) and Section 67(1)(9)]
Promotion of Equality and Prevention of Unfair Discrimination Act (Act 4 of 2000)
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ORGANISATION-BASED HIV-INTERVENTION
These Acts, as well as the Code of Good Practice for HIV/AIDS, No.R1298 of 2000 should be
taken into account when developing, implementing or reviewing any workplace policies or
interventions.

Step 5 – Brainstorm Organisation Policy
By this time the committee will most probably be quite fired up and stimulated and a
brainstorming session might be beneficial. At the brainstorming session the committee can
start talking about organisation policy and principles with regard to HIV/AIDS and how it will be
managed.

Step 6 – Assess the Organisation
The following aspects should be assessed in the organisation:
o
o
o
o
o
o

What existing HIV/AIDS programs are being run in the organisation?
What services and interventions are available in the close community?
What is the prevalence and incidence of HIV in the organisation? (This could possibly be
measured by facilitating voluntary counselling and testing in the organisation with the help
of a clinic in the community. Employees could be asked permission to use anonymous
statistics of prevalence and incidence after testing.)
How aware are employees of HIV/AIDS? (A knowledge survey can be used to measure
this.)
What is the attitude of employees in regards to HIV/AIDS?
What are the occupational health and safety risks in regards to HIV/AIDS in the
organisation?
Step 7 – Calculate Financial Impact
Calculate financial impact of HIV/AIDS in the organisation and review the budget agreed upon
in Step 1.

Step 8 – Share the Findings
Share findings with the rest of the organisation.

Step 9 – Write an HIV/AIDS Policy
Write a HIV/AIDS policy covering areas such as legal requirements, ambient attitudes within
the organisation, key role players, and protection of rights and creation of duties. It is essential
that after completion the policy be promoted within the organisation.

Step 10 – Devise an HIV/AIDS Strategy
It is important not to confuse policy and strategy. The strategy outlines plans for the
intervention, where a policy describes an organisation’s stance on HIV/AIDS. Strategies
include defined actions and related costs. In this step the HIV/AIDS committee decides which
actions are going to be included in the organisation specific HIV/AIDS intervention.
 Free To Grow POSITIVE LIVING August 2004
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ORGANISATION-BASED HIV INTERVENTION
Actions can include, but are not limited to:
o Education, prevention and awareness programs
o Support groups for HIV+ individuals
o Ensure the avoidance of discrimination
o Ongoing voluntary counselling and testing
o Treatment e.g. provision of antiretrovirals
It is important to focus on awareness and de-stigmatisation in the intervention and take both
prevention and care into account.
In this step the budget for the HIV/AIDS intervention should also be finalized.

Step 11 – Implement the Strategy
The ultimate success of an HIV/AIDS intervention depends on the ability to implement the
plans.

Step 12 – Review and Adjust
Review and adjust the policy, strategy and functioning of the HIV/AIDS Committee at specified
intervals to suit the changing needs of the organisation.
9.2. Medical Aid
According to the Medical Schemes Act, a registered medical aid scheme may not unfairly
discriminate against its members on health grounds and regulations may be stipulated that all
schemes must offer a minimum level of benefits to their members. In other words, registered
medical schemes must provide minimum benefits to al members and people living with HIV/AIDS
cannot be excluded from a medical aid scheme on the grounds of their HIV status.
Notes: ____________________________________ ______________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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 Free To Grow POSITIVE LIVING August 2004
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RESOURCES
10.
RESOURCES
10.1. Contact Numbers for Resources regarding HIV/AIDS
NATIONAL AIDS HELPLINE
Provides 24-hour toll-free information on any issue regarding HIV/AIDS.
0800 0123 22
AIDS LAW PROJECT
Provides legal advice on any issue regarding HIV/AIDS.
(011) 717 8600
ATICC
(AIDS Training Information and Counselling Centre)
Provides free HIV testing and counselling to all.
Cape Town
Bloemfontein
Durban
Johannesburg (Hillbrow)
Johannesburg (Baragwanath)
Nelspruit
Pietermaritzburg
Port Elizabeth
Pretoria
Mamelodi
Queenstown
Qwa-qwa
(021) 797 3327
(015) 405 8544
(031) 300 3104
(011) 725 6711/2
(011) 933 4361/9340
(013) 759 2167
(033) 395 1612
(041) 506 1415
(012) 308 8743
(012) 308 5570
(045) 838 2233
(058) 713 2573
CCMA
(Commission for Conciliation, Mediation and Arbitration).
Handles HIV/AIDS related legal cases from the workplace
Head Office
Cape Town
Port Elizabeth
Bloemfontein
Johannesburg
Durban
Witbank
Klerksdorp
Kimberley
Pietersburg
(011) 377 6650
(021) 469 0111
(041) 586 4466
(051) 505 4400
(011) 377 6600
(031) 306 5454
(013) 656 2800
(018) 462 3137
(053) 831 6780
(015) 297 5010
See next page…
 Free To Grow POSITIVE LIVING August 2004
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LIFE LINE
Provides free telephone counselling, face-to-face counselling, referrals
and information.
Durban
East London
Elsies River
Free State
Gugulethu
Johannesburg
Khayelitsha
Mafikeng
Mdantsane
Mohlakeng
Port Elizabeth
Pretoria
Western Cape
West Rand
KwaZulu-Natal
(031) 312 2323
(043) 722 2000
(021) 932 0352
(057) 352 2212
(021) 637 3009
(011) 728 1347
(021) 361 5855
(0183) 814 263
(043) 760 1730
(011) 414 3056
(041) 585 5581
(012) 342 2222
(021) 461 1111
(011) 953 4111
(035) 753 3333
LABOUR COURT
For HIV/AIDS related court cases in the workplace (also see CCMA)
(011) 403 4893
LAWCO
(Labour and AIDS in the Workplace Consultants)
Advises on and drafts AIDS policies in the workplace.
(012) 342 1774
EASTERN CAPE
House of Resurrection
East London AIDS Training, Information and Counselling Centre
Port Elizabeth AIDS Training, Information and Counselling Centre
Queenstown AIDS Training, Information and Counselling Centre
(041) 481 1515
(043) 705 2968
(041) 506 1486
(0458) 38 2233
FREE STATE
Bloemfontein AIDS Training, Information and Counselling Centre
Bloemfontein Hospice
(051) 405 8544
(051) 447 7281
GAUTENG
Community AIDS Response
Cotlands Sancuary
National Association of People Living with HIV and AIDS
AIDS Education and Training
Soweto Hospice
Sparrow Ministries
Sungardens Hospice
The Community AIDS Information and Support Centre
AIDS Consortium
Mamelodi AIDS Training, Information and Counselling Centre
Hope Worldwide
(011) 728 0218
(011) 683 7200
(011) 872 0975
(011) 726 1495
(011) 982 5835
(011) 763 1466
(012) 348 1934
(011) 725 6711
(011) 403 0265
(012) 308 5570
(011) 984 4422
KWAZULU-NATAL
Philanjalo Care and Support
South Coast Hospice
Durban AIDS Training, Information and Counselling Centre
Pietermaritzburg AIDS Training, Information and Counselling Centre
(033) 493 0004
(039) 682 3031
(031) 300 3104
(033) 395 1612
 Free To Grow POSITIVE LIVING August 2004
38
MPUMALANGA
Nelspruit AIDS Training, Information and Counselling Centre
(013) 759 2167
NOTHERN PROVINCE
Pietersburg AIDS Training, Information and Counselling Centre
(015) 290 2363
NORTH WEST
Lifeline
(018) 462 7838
WESTERN CAPE
Joy for Life
Wolanani
Western Province AIDS Training, Information and Counselling Centre
(021) 423 7413
(021) 43 7385
(021) 797 3327
 Free To Grow POSITIVE LIVING August 2004
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RESOURCES
10.2. List of HIV/AIDS Educational Material
Title:
Need to know’s: HIV/AIDS
Author(s):
Connoly S. (2003)
Description: This series of books provide information that does not patronize, over-simplify or
judge, but examines social phenomena that are difficult or harmful to the HIV/AIDS epidemic. Each
book traces the history, prevalence and consequences of such phenomena and offers ways of
finding help for those involved or affected.
Title:
The complete story of HIV/AIDS
Author(s):
Visagie C.J. (1999)
Description: HIV and AIDS have reached epidemic proportions in southern Africa. Although
there is no cure or vaccination at present, correct information can protect sexually active people
and prevent the spread of the virus. This book is a comprehensive guide to HIV and AIDS. It could
save your life and those of your loved ones.
Title:
AIDS: the challenge for South Africa
Author(s):
Whiteside A. and Sunter C. (2000)
Description: On the issue of HIV/AIDS, the majority of South Africans can be divided into two
broad categories: those who bury their heads in the sand and deny that the epidemic exists, and
those who believe that it exists but that they cannot do anything about it. In this book the authors
offer a third view which is shared by a small number of people active in the HIV/AIDS field: there is
an epidemic but there are plenty of things we can do to prevent it spreading further and to
ameliorate the impact of increasing sickness and death among those already infected. The book
covers the likely origin of HIV/AIDS; the current situation in the world and in Africa; why it has hit us
so badly in South Africa; and the possible demographic, economic and social consequences for
our society over the next twenty years. Along the way, the authors dispose of many myths
associated with the epidemic. Finally, the authors recommend a grassroots approach made up of
many small initiatives, pursued on as wide a front as possible, to overcome the epidemic and
soften its impact. The message of the book is that we can beat HIV/AIDS, but we must all in our
own way take appropriate action now.
For a more comprehensive list of HIV/AIDS books, please visit www.kalahari.net or www.amazon.com

Other HIV/AIDS Material
o
o
o

Soul City: Television, Radio and Printed Material. (011) 643 5852 or
[email protected]
Ed-Unique AIDS Posters. Contact: Stella Heuer (043) 722 4228 or
[email protected]
“The Silent Enemy” (Video). Clem Sunter.
Websites
o
o
o
o
o
o
AIDS Education Global Information System: www.aegis.co.za
International Labour Organisation and HIV/AIDS: www.ilo.org/aids
Redribbon – A portal on HIV/AIDS: www.redribbon.co.za
Soul City: www.soulcity.org.za
The Body – An AIDS and HIV Information Resource: www.thebody.com
UNAIDS – Joint United Nations Program on HIV/AIDS: www.unaids.org
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