Almost no child should be born HIV-positive. We now have the knowledge and wherewithal to prevent this unnecessary tragedy. It does not make any sense  - from the suffering that an HIV-positive baby has to endure to the cost to the government of providing life-long treatment – not to pull out all the stops to prevent mother to child transmission from taking place.

 

The following topics are covered in this section:

• Importance of PMTCT
  
• How HIV disease is passed from mother to baby
• What is the PMTCT programme?
• Antiretroviral treatment for pregnant mothers
• National implementation of the PMTCT programme
• Effectiveness of national PMTCT programmes

 

This section provides information on the following:

• What are VCT and HCT?
• What if your test is negative?
• What if your test is positive?
• What the HIV test cannot show
• Where to get an HIV test
• Benefits of getting tested
• The government's HCT Campaign
• When to go for testing
• HIV testing and your rights
  

Should you stop drinking alcohol when you test HIV-positive?

There is no evidence that moderate drinking harms people with HIV. For most HIV-positive people, enjoying a beer or a glass of wine a few times a week should not cause health problems. So if you test positive for HIV, you do not have to cut out alcohol from your life altogether. However, there is an exception to this: if an HIV-positive person has hepatitis or high levels of blood fats, he or she may have to stop drinking alcohol, or keep alcohol consumption to an absolute minimum.

• Heavy alcohol use negatively affects the immune system and may slow down recovery from HIV-related infections
• A study has shown that HIV-positive people who are heavy drinkers are four times more likely to have a high amount of HIV in their bodies than HIV-positive people who are moderate drinkers

• Alcohol may cause antiretroviral medicines (ARVs) to work less effectively. This is because both alcohol and medicines are processed by the liver
• Drinking too much alcohol makes the liver less healthy and therefore less able to process ARVs. Effective use of ARVs is important if a person with HIV is to stay healthy
• Some ARVs cause an increase in blood fats, and this can be made worse by heavy drinking. An increase in blood fat levels raises the risk of heart attack and pancreatitis (a condition that can be fatal and involves the inflammation of the pancreas, an organ which produces essential hormones)
• People whose livers have been damaged by drinking too much alcohol, especially those who have hepatitis, are more likely to experience ARV side effects
• Alcohol can react badly with certain medicines (e.g.rifampicin, rifabutin, metronidazole) so it is always good to ask a pharmacist or health worker if it is safe to drink alcohol with any new medicines that are prescribed
• Heavy drinking can cause vomiting. If an HIV-positive person vomits within an hour of taking anti-HIV drugs, or any other medicine, then he or she should retake the dose

 

This section contains information about the following:

• Human rights and the spread of HIV disease
• Human rights for people living with HIV and AIDS 
• Health and medical rights
• Rights in the workplace
• Women and HIV
• Rights of children and youth
• Rights of lesbians and gay men
• Rights of prisoners
• Social security and HIV
  
• NPOs working in the field of rights and HIV
• How does South Africa measure up?

Multiple concurrent partners and inter-generational sex – the two main drivers of the HIV epidemic?

In much of Africa the cultural norm is to be in relationships with more than one partner at a time (concurrent partners) in what has been termed a ‘net’ of sexual partners. This  could be a polygamous marriage in which a man has several wives; a marriage in which one or both of the married partners has additional sexual partners; or a sexual relationship in which either or both partners have other concurrent sexual partners. The last two scenarios may also involve stable long-term arrangements which means that condoms are less likely to be used. In the West the more common pattern is to have sex in ‘strings’ or one after the other. So a man or woman could have many more sexual partners over the same period of time but the more traditional pattern is to have sex with one partner at a time, or serially rather than concurrently.

 

HIV replicates faster through nets than strings. This is because the risk of transmission is dependent on the stage of HIV infection. The acute phase is when you have just been infected with HIV but do not yet test positive (the so-called window phase). During this stage, before your immune system learns how to fight the virus, the level of HIV in your blood and sexual fluids is at its highest - higher even than during the final phase of AIDS. This stage, which usually lasts  about three months, is therefore associated with the highest risk of passing the infection onto your partner. A person in this stage who has several concurrent sexual partners will put them all at risk during unprotected sex. As many of these partners may also have multiple concurrent partners, these will all be drawn into the HIV net. HIV is therefore able to spread very quickly throughout this ever-increasing, never-ending net of connected people. On the other hand, people who traditionally have sex in strings will usually only put one person at risk during the period that they are most infectious. This reduces the potential for HIV to spread.

 

A survey by the HSRC suggests that multiple partners and inter-generational sex (typically younger women having sex with older men, often referred to as sugar daddies as they have the means to give the younger girls a good time and expensive presents) are common behaviours in South Africa and important epidemic drivers. The survey showed that 30.8% of males and 6.0% of females in the 15-24 age group have multiple partners.  This percentage drops by approximately half in both 25-49 age groups but remains significant.

 

Inter-generational sex is a common pattern with 27.6% of 15-19 year old females having sex with someone who is at least 5 years older compared with 1.5% of males in the same age group. Worryingly, the percentage in females has increased quite dramatically from 18.5% in 2005. Inter-generational sex ensures that the HIV net ensnares the newly sexually active youth.  If people only had sex within their own age group (intra-generational sex), the epidemic would eventually die out as the members of that generation all died. Inter-generational sex therefore guarantees the continuation of the epidemic. This behaviour pattern needs to be aggressively addressed through appropriate interventions if South Africa is to have any hope of limiting the recruitment of the younger generation into the HIV net.

 

The age prevalence figures (total numbers of HIV-infected in each group) tell this story quite graphically with young females having much higher prevalence rates than their contemporary males (4x in the 20-24 age group). By 30-34 years, the prevalence rates start to converge and then in the 40-44 age group the male rates peak and exceed the female rates. One can therefore see clear evidence of the HIV loop between older men and younger women, and how a new generation of youth become exposed to HIV.

 

 

Several trials in South Africa, Uganda, and Kenya have conclusively demonstrated that male circumcision is over 60% effective in reducing the risk of acquiring HIV in HIV-negative circumcised men. It does not reduce the risk to the partner if the circumcised man is HIV-positive. Other countries in southern Africa have already begun rolling out mass male circumcision programmes, which UNAIDS estimates will avert one infection for every 5-15 circumcisions and therefore substantially reduce the incidence of new infections.

 

South Africa has agreed to roll out free circumcisions nationally in 2011 once it has finalised a policy and trained sufficient staff (UNAIDS estimates that around 35% South African men are already circumcised). Francois Venter, clinical director of the Reproductive Health Research Unit in Johannesburg and chairman of the Southern African HIV Clinician's Society says:

 

 

However, male circumcision is not a magic bullet for HIV prevention (it only reduces the risk for the circumcised male, it does not prevent HIV) and, to form part of a successful prevention strategy, needs to be combined with counselling sessions and general education campaigns to promote safe sex. The government may struggle to finance a national male circumcision programme, but international donors have proved willing to fund this quick, effective, inexpensive and safe intervention.