This section is designed to help you:

- review basic facts about HIV and AIDS; and
- understand the challenges of people living with HIV/AIDS.

The basic facts about HIV and AIDS

What is AIDS?

AIDS is the name of a disease which is caused by a virus that breaks down the body’s immune system and leads to fatal infections and some forms of cancer.

A-I-D-S stands for:	Acquired........ something you get rather than you are born with
	Immune......... resistance or protection from diseases
	Deficiency...... absence of protective power
	Syndrome...... a variety of symptoms rather than one single disease

What causes AIDS?

HIV is the virus that causes AIDS.

H-I-V stands for:	Human
	Immunodeficiency
	Virus

When HIV enters the body through semen, blood or vaginal secretions, it damages the immune system that normally protects us from infections.

Where does HIV come from?

This is a question often asked. Although various people have speculated on the geographical origin of the virus, it is unlikely that we will ever know where it came from. It is certain, however, that it is not man-made. We know that viruses can sometimes change from being harmless to harmful. This could have happened to HIV before the virus spread rapidly and before the AIDS epidemic started.

How does HIV weaken the immune system?

Our immune system contains white cells in the bloodstream and lymph nodes, which can recognize foreign substances or germs entering our bodies and can kill them, and remember them if they enter the body again.

When the Human Immunodeficiency Virus attacks our immune system, it starts to destroy our white cells. HIV can stay in the body for some time without making us ill. But, eventually, as more and more of these white cells are destroyed, the body is unable to fight off the many germs that live in and around our bodies all the time. And in time, as the immune system becomes weaker and weaker, infections take hold and the body cannot fight them.

What are the symptoms of HIV infection?

People who have been infected with HIV become seropositive or HIV-positive. Except for a generally mild illness (fever, sore throat, rash, swollen glands) that about 70 per cent of people experience a few weeks after initial infection with the virus, most HIV-infected people have no symptoms for a long time. They may look and feel perfectly healthy and be unaware that they are infected.

Increasingly, the virus destroys the immune system to such an extent that the infected person may become ill. AIDS is the end stage of infection with HIV, characterized by a range of symptoms.

Major signs are: Loss of weight greater than 10 per cent of body weight Fever for longer than one month Chronic diarrhoea for longer than one month Persistent, severe tiredness (fatigue) Minor signs are: Persistent cough for longer than one month Profuse sweating at night Itchy skin rashes Mouth ulcers Oral thrush (a fungal infection in the mouth and throat) Herpes infection Swollen glands

These symptoms are also common features of many other diseases as well, so don’t forget that HIV infection can only be confirmed by a blood test! (See page 22: How can you find out if you have become infected with HIV?)

As the infection progresses, the infected person becomes susceptible to a number of so-called opportunistic infections: infections that rarely occur in people whose immune systems are normal and that take advantage of the weakened immune system of the person with AIDS. Tuberculosis (TB) is an example of an opportunistic infection frequently seen in patients with AIDS. In countries with severe HIV epidemics, the number of patients with TB has risen dramatically. (See also: Section 5, Activities with youth groups, Fact sheet: Tuberculosis.)

In a late stage of HIV infection, the virus may also attack the nervous system and cause mental confusion and poor coordination of the body.

The person with AIDS may recover from some of these illnesses. The periods when the person is seriously and distressingly ill may alternate with long periods of feeling well. The length of time between becoming infected with HIV and getting sick varies. Up to 60 per cent of the infected will develop AIDS within 12 to 13 years after being infected. As long as there is no vaccine or no cure available, HIV-infected people will, in the long run, die as a result of their damaged immune system.

How does a person become infected with HIV?

It has been proven that HIV passes from an infected person to another person in three ways:

through unprotected sexual intercourse with someone who has HIV; through blood, blood products or transplanted organs which contain the virus; or from an HIV-infected mother to her child during pregnancy, childbirth or through breastfeeding.

During unprotected sexual contact with an infected person, HIV can enter a person's bloodstream through the vagina, penis or anus.

Figure

AIDS is thus a sexually transmitted disease (STD).

For more information on STD: see Section 5, Activities with youth groups, Fact sheet: Sexually transmitted diseases, p. 74.

It is important to know that the risk of infection is greater if either partner has another sexually transmitted disease, such as syphilis or herpes where a sore or lesion is present. This is because semen or vaginal secretions of an HIV-infected person can come into contact with open sores or ulcers on or near the genitals of the partner and it is easier for the virus to pass into the other person's body.

Infection through contact with blood

In areas where donated blood is not screened for HIV, receiving a transfusion is a potential risk for contracting the virus: infected blood will transmit HIV directly into the bloodstream of the recipient. The chance of passing the virus this way is high.

Worldwide efforts are being made to ensure that blood for transfusions is tested for HIV and that blood products used by people with haemophilia are heat-treated to inactivate the virus.

In addition, recruitment of voluntary, non-remunerated, regular blood donors is encouraged and guidelines are developed for pre-donation counselling in blood transfusion services. Similarly, potential sperm and organ donors are increasingly tested for HIV.

Figure

Sharing syringes and needles (which contain infected blood) can pass HIV.

When they inject their drug, intravenous drug users draw blood up into the needle and syringe; so sharing needles becomes a very risky activity and has caused many cases of HIV infection.

Any used needle and syringe which has not been properly sterilized can carry the virus from an infected person to the next user of the needle. It does not matter what the syringe contains. The risk is from the blood in the needle and the syringe. Therefore needles and syringes used by injecting drug users or used for medical treatment need to be sterilized or used only once.

HIV can be passed on from one person to another through infected blood left on instruments used in activities which draw blood such as male and female circumcision, tattooing, acupuncture, traditional scarification, cutting of uvula or tonsils, and ear piercing. Tools used for any procedure that cuts the skin should be properly sterilized before each use.

Figure

Although the risks are very small, sharing toothbrushes and razors should be avoided.

Transmission from mother to child

An HIV-positive mother can pass the virus to her child during pregnancy, labour and delivery or through breastfeeding.

The overall risk of mother-to-child transmission of HIV is about 15 to 25 per cent among seropositive women who do not breastfeed, and between 25 to 45 per cent among women who breastfeed.

The risk of transmission is increased if the mother has recently been infected or is already ill with AIDS.

Research now shows that breastfeeding accounts for an estimated one-third of all HIV infections of infants. On the other hand, it is recognized that breastfeeding is normally the best way to feed infants. Breast milk contains many substances that protect an infant's health and breastfeeding delays the return of a woman's fertility.

Therefore, the dilemma between the choice of breastfeeding and the risk of HIV infection for the baby is not only a personal concern for many women, but also one of public health importance.

The overall objective should be to prevent HIV transmission through breastfeeding while continuing to promote and support breastfeeding for uninfected women and women whose HIV status is not known. If a mother is infected with HIV and can afford replacement feeding, it may be preferable not to breastfeed. However, it is important to weigh the risks. Are the risks from replacement feeding (illness and perhaps death from unhygienic preparation, use of contaminated water, etc.) less than the potential risk of HIV transmission through infected breast milk? If not, there is no advantage in replacement feeding.

Figure

An HIV-positive woman who is considering pregnancy should seek information and advice from a trained counsellor or health-care worker about the possible risks involved in pregnancy.

HIV CANNOT be passed from one person to another in the following kinds of contact:

Wearing someone else's clothes or using articles belonging to them that they have touched (for example, towels, bedding, toilet articles). Living with or sleeping in the same room as a person with HIV/AIDS. Hugging or playing with a baby or a child who has HIV/AIDS. Caring for children when the adult is HIV-positive. Swimming in a swimming pool, river or waterhole with a person or people with HIV/AIDS. Travelling on crowded buses with a person or people with HIV/AIDS. A person with HIV/AIDS coughing or sneezing on you. Sharing food, cups and plates with a person with HIV/AIDS. Caring for someone who has developed AIDS when basic good hygiene is observed. Giving first aid when good safety practices are followed (see Appendix V: Guidelines for AIDS and first aid). Donating blood if you are not HIV-positive.

Why don’t mosquitoes spread HIV?

There is clear evidence from epidemiological surveys and laboratory observations that HIV is not transmitted by mosquitoes or any other biting insects.

If you are not convinced, remember that almost no cases of AIDS occur in children aged from 5 to 12, although children of this age are often bitten by mosquitoes. (HIV infections in children are mainly caused by blood transfusions and sometimes by sexual abuse. Very young infants can also be infected by HIV-positive mothers during pregnancy, childbirth, and through breastfeeding.)

Can kissing pass on HIV?

Kissing can only carry a risk if there is an exchange of blood from an HIV-positive person to his or her partner. Bleeding might occur because of damage caused to the skin or mucous membranes around the mouth. Saliva, tears or sweat do not contain HIV in a sufficient quantity to be infectious.

HIV is not spread by:

Insects

Caring for someone with AIDS

Toilet seats

Shaking hands

Sharing belongings

Touching and hugging

Who can get HIV/AIDS?

Figure

Anyone, male or female, young or old, from any country or any religion can acquire HIV. HIV and AIDS are not limited to certain groups of people, sexual preferences, or jobs.

How many people are infected with HIV?*

As of December 1999, according to estimates of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), the number of people living with HIV has grown to 33.6 million.

Since the start of the epidemic about 20 years ago, HIV has infected almost 50 million people.

The cumulative number of deaths due to HIV/AIDS is nearly 16.3 million.

Figure

This map shows the regional distribution of adults and children estimated to be living with HIV/AIDS as of December 1999.

About 95 per cent of all HIV-infected people now live in the developing world.

Women represent 45 per cent of all people over 15 years of age living with HIV/AIDS. The number of children under the age of 15 living with HIV is 1.2 million. By the end of 1999, the epidemic had already created more than 11 million orphans: children who had lost their mothers or both their parents to AIDS before the age of 15.

How many young people are infected?*

Young people aged 15 to 24 account for roughly half of all new HIV infections.

About 7,000 young people aged 10 to 24 are infected with HIV every day, that is five young people every minute.

Every year, about 1.7 million young people in Africa are infected with HIV.

Almost 700,000 young people are infected with HIV every year in Asia and the Pacific.

The characteristics of the epidemic among young people differ by region: Africa and Asia, for example, show more transmission through heterosexual contact; Latin America through homosexual and bisexual contacts; and Eastern Europe through drug injection.

How can you protect yourself from becoming infected with HIV?

To avoid infection through sexual contact:

You could choose not to have sex. Abstinence is the safest of all!

You could choose to have sexual contact with a faithful partner only and be faithful to him/her.

Figure

Unless you and your partner have been tested HIV-negative, be sure that you or your partner:

haven’t engaged in unprotected sex with someone else;
haven’t received HIV-infected blood; and
haven’t used intravenous drugs.

Or you could choose safer sex.

What does safer sex mean? Safer sex includes any sexual activity which provides protection against the risk of infection:

Avoiding penetration and contact with semen or vaginal secretions is one way to lower the risk of infection.

If either you or your partner might be HIV-positive, there are many sexual activities for you to consider which do not involve penetration such as caressing or massaging any part of the body. Also safe are masturbation (provided that sexual secretions do not come into contact with exposed mucous membrane or with cuts or sores on the partner’s skin) and kissing that does not involve exchange of blood. n Another way to reduce the risk of infection is through the use of condoms.

A male condom is a close-fitting latex cover, which fits over the penis during sexual intercourse.

A female condom is a transparent sheath, which is inserted into the vagina. Condoms prevent contact with high-risk body fluids – blood, semen, and vaginal secretions. For this reason they are also useful as a protection against many STD and pregnancy. Condoms make sex safer, but not 100 per cent safe. However, if condoms are used correctly, they significantly reduce the risk of infection with HIV and other STD.

For more details on the male and the female condom and for instructions on how to use them, see Appendix IV: Condoms and safer sex.

Remember: if you have sex with several partners, you increase the risk of becoming infected with each partner you have. However, it is not just a question of how many partners you have. Even just one act of unprotected intercourse (sexwithout a condom) with a person who is infected with HIV could result in your becoming infected.

Although it is not always easy, talking openly about these topics with your partner is very important. Don’t forget it may not only help you create a healthier sexual relationship – but also save your life!

Figure

To avoid infection through contact with blood

If you live and work in a country where blood is not always tested for HIV or in a situation where you are not sure whether needles and other instruments that draw blood are systematically sterilized, then you should take the following precautions:

You can lower your risk of needing a blood transfusion by avoiding situations which could lead to major accidents. If you are riding a motorcycle, for example, wear a helmet and keep to a reasonable speed. Don’t drink and drive: drinking alcohol and driving greatly increases your chances of having an accident. Avoid driving in the dark if road conditions make this dangerous.

If you need medication and an injection is recommended, ask whether the medication can be taken in another form, such as pills. You can make sure that needles and syringes used for any kind of injection are either new or have been properly sterilized. Be sure that any knife, razor or other instrument used in a process that draws blood have been thoroughly cleaned and sterilized.

How to sterilize instruments:

Immersing instruments in a weak solution of one part ordinary household bleach to ten parts water (1:10) for 30 minutes or boiling them in water for 20 minutes may sterilize them. (Note that in some countries the bleach is not very strong and you will need to use more bleach per parts of water.)

If you are giving first aid to a patient who is bleeding, make sure you follow good hygiene. For detailed information, see Appendix V: Guidelines for AIDS and first aid.

Intravenous drug users should always use sterile injecting equipment and avoid borrowing other people’s needles or syringes. The final goal, of course, is to stop people from taking drugs!

Figure

Remember The safest sexual course of all is abstinence. Also safe are sexual practices that involve no penetration such as caressing, kissing, massaging and masturbation. Use condoms and use them correctly. Limit your sexual contacts to a faithful partner only. Avoid using drugs or alcohol: they can keep you from thinking clearly and can push you to make unwise decisions.e If you use needles, syringes or other instruments that pierce the skin, make surethey are sterile. Never share injection-needles and syringes. Make sure blood is tested before transfusion. Make sure the equipment for blood donation or blood transfusion is sterile.

How can you find out if you have become infected with HIV?

The only way to find out if you are infected with HIV is to have a blood test.

How does the test work?

When germs enter our body, white blood cells in our blood react by producing chemical substances called antibodies.

When HIV enters the body, antibodies are formed but they cannot kill the virus. They do, however, indicate that the virus is present. Therefore, the presence or absence of antibodies in the bloodstream is the basis for the HIV test. A sample of blood has to be taken and analysed. When antibodies are found, we say the blood is HIV-positive or seropositive.

Beware of the window period!

HIV antibodies usually take between two and three months to appear in the bloodstream. This period is called the window period. It means that when a test is done in this period, an infected person will test negative, even if he/she has the virus and is infectious! So if a person’s behaviour has been risky in the three months before the test, and the result is negative, he or she should have another test three months later.

But it is important to remember that the HIV test is not a test for AIDS. We do not know exactly how long it takes for an individual with HIV to become ill with AIDS. What we do know is that the people whose blood contains antibodies can infect others through their blood, through semen (in men), through vaginal fluid (in women) and through breast milk.

What should you think about before taking the HIV test?

Before deciding to have an HIV antibody test, it is important to consider what effect the result of the test will have on your behaviour and your life. For example, if your test is positive, how will you manage, knowing you have an infection for which there is no known cure? Will it help you reduce the possibility of passing on the infection to others?

Whatever you decide, you should make sure you can discuss with the health-care worker providing the test what the result of the test means. This is called pre-test counselling. The health staff will help you to think about the advantages and disadvantages of taking the test in your culture and environment.

Even before taking the test, you should think about who you can talk to if your test is positive. To avoid unnecessary rejection and prejudice, you should only tell the result to people you can trust. Make sure that confidentiality is guaranteed in the centre where you take the test.

If you decide not to take the test or your test has a negative result, you should still make sure you always practice safer sex. Everyone who intends to have sexual intercourse must think about their level of risk and act responsibly with partners. Safer sex needs to become the way to show you care.

What should you do if the HIV test is positive?

Finding out that you are HIV-positive will be distressful and will come as a shock to many. Try to find someone you can trust and who you can talk to easily. You may know of someone who is also HIV-positive with whom you can discuss your fears. Whoever you choose, he or she should be sympathetic and willing to listen. Don’t sit and go over all your worries and fears by yourself. Try to talk with someone as often as you feel you need to.

Remember that HIV cannot be passed on by casual contact. It is perfectly safe to cuddle and care for your children and partner, to share cooking and household utensils and lead a normal life. In sexual relationships, you need to adapt your behaviour: practise safer sex by not letting your partner come into contact with your semen if you are a man or vaginal fluids if you are a woman. Furthermore, do not donate blood and do not share needles or syringes.

Can HIV infection and AIDS be treated?

There is no vaccine today that protects people from the HIV virus and no cure once a person has been infected.

However, new and more effective therapies for treating HIV/AIDS continue to be developed: the so-called combination therapies. These new therapies, a combination of several drugs, have led to a longer life expectancy of infected people and have raised the possibility that HIV/AIDS could probably become a chronic infection.

But there is a reverse side of the medal: the new therapies are extremely expensive and, therefore, out of reach of the vast majority of infected people in developing countries. In addition, these therapies require a rigorous and difficult daily dosage (20 tablets and more are to be taken at certain times during the day) and often have unpleasant side effects.

Living with HIV/AIDS

How does HIV/AIDS affect people’s lives?

How people deal with the news of a life-threatening infection such as HIV/AIDS will depend on the culture and environment they were brought up in and their life experiences. How they manage their illness will depend not only on their own attitudes, but also on the reactions of their friends, family, community, co-workers and employers. If people with HIV feel safe and protected and have support from those around them, it may be easier for them to come to terms with their illness and to help others with the disease. On the other hand, if people with HIV are isolated and live in fear, they may have little reason to take care of themselves and may possibly get ill sooner. Remember that people who are infected and are carriers of HIV live many years before becoming sick and they are infectious to others. If these persons are rejected and not supported they will not care for others and could behave irresponsibly.

The following case studies describe the effect HIV/AIDS has had on the lives of a few people from different parts of the world.

Rita and Bob are 19 years old and work in the same factory. They fell in love with each other six months ago and started a relationship. Both are very popular and had lots of boyfriends and girlfriends before their relationship started.

Recently, Bob was not feeling well and went to see a doctor. The doctor decided to have a blood test done. The result of this test was very disturbing: Bob is infected with HIV, the virus that causes AIDS. A counsellor at the local clinic helps him to overcome his initial shock. He also discusses the possibility that his girlfriend Rita may be infected. And, indeed, a blood test shows that she is infected too.

Although they have been faithful to each other since they started their relationship, they realize one or both of them must have become infected before their relationship began. Rita’s and Bob’s lives change. Rita’s family is very upset and frightened about contracting the virus from her. Her mother doesn’t want to share any plates and never hugs her, even when Rita feels very sad. Bob has told a friend in his soccer team that he is seropositive. Soon after, he is thrown out of the team because his former mates are scared that they will get AIDS from playing with him. Rita and Bob were thinking about marriage and having children. Now this seems all very unrealistic...

Pablo is 20. He has just found out that his father has AIDS and he is frightened. He doesn’t know how his mother will cope if his father dies and he is worried his sister might lose her job if people find out at work. He keeps wondering why this terrible thing should happen in his family when none of them has ever been bad. He decides to tell the one person he trusts, his fiancée. She is very angry and frightened and leaves him. He goes to visit his father in hospital, but the ward is locked and the doctors are unhelpful. Eventually he manages to get into the ward. His father is very ill and says how frightened he is of dying alone. He has fever and diarrhoea but there are few nurses willing to work on the ward, so he is not very often given care. When Pablo’s father dies, he tells his family and friends his father died abroad. Pablo is very sad. He has no grave to visit and feels lonely and isolated.

Anne found out that she was HIV-positive when she took her baby to the doctor because he was losing weight. The doctor was worried and took some blood from the baby to test it for HIV. The test turned out to be positive, and so the doctor tested Anne too. Anne’s test was also positive. Some time afterwards Anne became ill with AIDS. Her family and friends responded to the news with disbelief and shock. Some people disappeared from her life. Sometimes she felt that she was already dead. But then she joined a group of people living with AIDS and there she found acceptance and compassion. However, Anne was careful not to talk about her condition outside the AIDS group because she knew that many people were frightened and misinformed about the disease. One day, a friend of hers visited and started complaining how fed up he was with all the fuss about AIDS. He said it didn’t affect his life – he didn’t know anybody with the disease. He thought all the news was exaggerated. Of course, Anne knew why her friend didn’t think he knew anybody with AIDS: no one with AIDS would tell him for fear of his reaction.

These examples describe only a few of the many ways in which people are affected by HIV/AIDS.

Why do HIV/AIDS and STD affect girls and women more than boys and men?

In many societies, men control women in all aspects of relationships. This traditional gender role may prevent women from taking measures to protect themselves. For example, if a woman buys condoms she may be accused of infidelity. However, many HIV-infected women have been infected by their (unfaithful) husbands. With lack of negotiating power, they have often been unable to insist on safer sex.

With low levels of education many young girls and women have a poor understanding of their bodies, the mechanisms of HIV/STD transmission and their level of risk in unprotected sex.

Another important source of vulnerability to HIV is violence against girls and women. Domestic workers, for example, are often sexually abused by their employers. But rape is still underreported as, ironically, women themselves are blamed for it.

The traffic of girls and women to be sold into prostitution is increasing worldwide. In Asia, girls from poor rural areas are promised a job in the city but instead are sold to a brothel.

Female sex workers are often blamed for the spread of HIV. But it is important to realize that, with lower levels of education than men and less access to employment, selling sex is, for some women, the only way they can survive. And when people blame sex workers for the spread of HIV, they ignore the role played by the customer. For example, clients often are unwilling to use condoms, despite the risk of infection.

The demand for sexual services is sometimes promoted by cultural attitudes. In some countries, for example, young men are encouraged to have their first sexual experience with a prostitute.

Women are also physiologically more vulnerable to HIV infection. There are multiple causes: intercourse at a premature age, genital mutilation and rough sex are practices that cause trauma and increase the risk of STD infections. Researchers estimate that the risk for women of being infected with HIV is at least twice that of men!

As the traditional ‘care-givers’ in the family, women carry the main burden of caring for their AIDS-affected relatives. With the devastating impact of the epidemic on households and the increasing number of orphans, it falls to elderly women and young girls to look after the family.

How can we help someone with HIV/AIDS?

First, try to picture yourself as HIV-infected. How would you like to be treated? Having HIV or AIDS can make you feel very isolated and lonely. People who are not afraid and still care for you are a great help.

People with HIV/AIDS and their families should not have to fear discrimination from individuals or from their community. Having HIV/AIDS should not exclude you from the same provision of services and care as any other person well or ill.

You can help someone with HIV/AIDS by behaving in exactly the same way you would with anyone else. Hugging or talking to someone does not spread the virus from one person to another.

There are also community projects that you and your youth group can carry out to help educate people about HIV/AIDS and to offer care and support for people with AIDS, their friends and their families. Section 6 of this manual gives you many ideas for community projects and describes how to organize them.