1.1 HIV&AIDS
Human Immune system
The immune system is our duty to protect us from any disease that every day we are attacked from outside. One very important element in the immune system are CD4 cells, a type of white blood cells. Therefore, the health of the immune system can be assessed by measuring the number of CD4 cells. In normal people , CD4 cell count ranged between 500 and 1,500.
Antibodies are proteins made by the immune system when a foreign object found in the human body. Together with parts of the body's immune system, antibodies work to destroy the cause of the disease, namely bacteria, fungi, viruses, and parasites.Our immune system makes antibodies that vary according to the germs that resisted.There are specific antibodies for any disease.
HIV
HIV stands for human immunodeficiency virus. This particular virus was discovered in the mid 1980s and belongs to a group of viruses called ‘retroviruses’. The virus is only transmitted between humans.
HIV attacks the immune system and gradually causes damage. HIV enters the CD4 cell, 'hijack' the cell, and then making 'factory' that makes billions of copies of the virus. When the process is completed, copies of HIV that leave the cell and into the other CD4 cells. Cells that become damaged or die abandoned. If these cells are destroyed, the immune system loses its ability to protect our body against disease. This situation makes us prone to various diseases.
The longer you are infected with HIV, a growing number of CD4 cells were killed, bringing the total number of cells is becoming increasingly low. With fewer and fewer CD4 cells, the ability of the immune system to protect us from infection is also lower. This can mean that a person infected with HIV is at risk of developing some serious infections and cancers that a healthy immune system can fight off.
There are no symptoms or signs of infection for most people infected with HIV since the first years after infection. Immediately after infection, some people experience symptoms similar to flu symptoms for several weeks. The disease is called primary HIV infection or acute. Moreover there is no sign of HIV infection.But the virus persists in the body and replicates itself all the time.
The characteristics of the virus are as follows:
n Abound in blood, genital fluids and breast milk, a very small amount of virus found in saliva, tears, vomit, feces and urine,not in sweat;
n Multiplication in human’s body;
n Attacks human’s immune system;
n No cure for HIV;
n Can spread only between humans.
AIDS
AIDS stands for acquired immune deficiency syndrome. AIDS is the name used to describe a combination of potentially life-threatening infections and cancers, which can develop when someone’s immune system has been damaged by HIV.
Getting HIV infection causes the immune system becomes weaker. This situation will make people vulnerable to several types of disease which may not affect people with healthy immune systems. The disease is referred to as opportunistic infections . Opportunistic infections including fungi in the mouth, a rare type of cancer, and certain diseases of the eye, skin and nervous system.
AIDS is defined as:
- CD4 cell count below 200 and / or
- occurrence of one or more of certain opportunistic infections
several opportunistic infections are:
- TB (tuberculosis), in pulmonary or extrapulmonary;
- PCP , a kind of lung infection ;
- CMV (cytomegalovirus), an infection that usually affects the eyes ;
- Candidiasis , a fungal infection in the mouth or vagina .
What is the difference between HIV and AIDS
A person who is infected with HIV can remain healthy for years without any physical signs or symptoms of infection. People who are infected but without symptoms is ' HIV positive 'or have' asymptomatic HIV disease’.
If symptoms begin to appear, people have called 'symptomatic HIV infection' or 'advanced HIV disease’. At this stage the person is more likely to develop opportunistic infections. 'AIDS' is the definition given to HIV-infected persons who entered the stage of severe infections.
Figure 1 stage of infection
1.2 HIV transmission
How is HIV transmitted
Found in HIV-infected person's blood (including menstrual blood), breast milk, semen and vaginal fluids.
- During sex without a condom, HIV can be transmitted from blood, semen or vaginal fluids of infected person directly into the blood stream of another person, or through mucous membranes (mucosa) in the vagina, penis, anus or mouth.
- HIV can be transmitted through transfusion of blood containing HIV; current blood donors should be screened by the Indonesian Red Cross (PMI), so the risk of HIV infection through blood transfusion should be low, although not zero.
- HIV can be transmitted through a syringe (eg used in turn by injecting drug users), through a medical act, or by piercing needles used for tattoos, if the tool contains the blood of people infected with HIV.
- HIV can be transmitted to infants during pregnancy, birth, and breastfeeding. If there is no intervention, approximately one third of babies born to mothers with HIV will be infected.
Rather difficult infectious HIV, and every time there was no infectious risk events involving people infected with HIV. For example, although very different, the average will occur only one transmission of HIV from infected men to uninfected women to have sex 500 times in the vagina. But the transmission once it can happen the first time.
The risk of HIV transmission through anal sex than are higher, and transmission through sharing needles higher. The risk of transmission from oral sex is lower, but still there.
How is HIV not transmitted
HIV can only live inside the human body that lived and only lasted a few hours outside the body.
- HIV can not be transmitted through saliva, tears, vomit, feces and urine, although a very small amount of virus found in this fluid. HIV is not found in sweat.
- HIV can not penetrate intact skin and is not spread through contact with infected people, or something used by someone infected with HIV; mutual use of the furniture to eat or drink, or use of toilet or bathing water alternately.
- Nursing a person with HIV does not carry risks if precautions followed as safely dispose of syringes and close the wound.
- HIV is not transmitted through the bite of mosquitoes or other blood-sucking insects. Most insects do not carry blood from one person to another when they bite humans. Malaria parasite enters the bloodstream in the saliva of mosquitoes, not his.
Figure 2 shows us transmission of HIV in the world and United States
1.3 HIV prevention
After we know how HIV can be transmitted, we should know how to prevent ourselves and others from HIV.
High-risk behaviors
The meaning is doing something that carries a high risk of infection to themselves or others. We usually do not know who is infected with HIV and who are not so high-risk activities including the following:
- sex with entering the vagina, anus or mouth without a condom. Men with HIV can infect either the male partner during sex and women through unprotected anal
- using hypodermic needles and syringes (insul), or tools that are not sterile medical action, which may be contaminated by the blood of others, either to himself or others
- receiving infected blood transfusions
Safer sex is any sex that is not associated with semen, vaginal fluids and blood entering another person's body or touching broken skin, for example:
- sexual activity without penetration - by stimulating the genitals us or our partners (masturbation), sex thigh, massage or kiss
- use a condom with water based lubricants (eg KY Jelly or Silk lubricant, from start to finish during sexual intercourse through vaginal or anal
- risks of oral sex (oral contact with genitals male or female) was lower than intercourse with vaginal or anal penetration without a condom
- not having sex (abstinence) is safe
Harm reduction of drug use
Harm reduction are actions taken to reduce the risk of transmission through drug use. The rationale is:
- Let's not do drugs at all. But if drug use can not be avoided:
- Let's not use drugs by injection (including the use of methadone maintenance treatment programs / PTRM). But if the use by injecting can not be avoided:
- Should we always use new needles every time you inject. But if not available a new syringe:
- Let's not use needles - just our own taking one's own needle. But if have to use needles:
- Clean needles and syringes with bleach before being used by others.
1.4 HIV testing
How do we know if we get HIV? As for newly infected people, approximately 2-3 weeks after infection, some people experience fever, headache, muscle and joint pain, abdominal pain, lymph node swelling, or rash on the skin for a week or two. These symptoms usually disappear without treatment. Most people feel this flu. Some people experience no symptoms whatsoever. So we can’t just tell by these symptoms if we ge HIV or not. if there is a possibility you recently exposed to HIV and you want to make sure, only HIV testing can tell you.
VCT
HIV testing is not just for testing. We have the principle of VCT(Voluntary,Conseling and Testing).
(1) Voluntary
nobody can force you to do an HIV test,only yourself want to do that.
(2) Counseling
we should be given counseling before and after HIV testing. HIV testing should not be done without full informed consent from the concerned. There will be counselors from Peer Support Groups in the hospital where we can get HIV testing.
(3) Testing
- HIV test found antibodies to HIV in the blood made by the immune system response to infection by the virus.
- Virus load test can show the amount of virus in our blood ,but not widely available in
Indonesia - CD4 test can show CD4 cells count which reflects the health of our immue system. If the CD4 count falls below 200, we should take antiretroviral drugs (ARVs).
When we mention of HIV testing, it means testing antibodies in the blood. Virus load test and CD4 test are much more expensive. If the result is HIV positive, it means we are infected with HIV. But if the result is HIV negative or non-reactive, it really means you are not infected? Not always, because maybe you are in window period.
Window period
Figure 3 Antibody Levels, T Cell Counts, and HIV Concentration
Fig1.3 shows us change of antibody levels,T Cell Counts and HIV concentration after infected with HIV. We can see it will take time for our body to reponse to HIV and produce measurable antibodies. An interval of three weeks to six months between the time of HIV infection and the production of measurable antibodies to HIV is ‘window period’. During this period, antibody tests may give false negative results but maybe you have been infected with HIV. So you must do another test after three months.
The vast majority of people (97%) have detectable antibodies by three months after HIV infection; a six-month window is extremely rare with modern antibody testing. During the window period, the virus multiplies in one’s body and an infected person can transmit HIV to others more easily.
Where can we do HIV testing?
Not all hospitals provide HIV testing service. If we don’t know which hospitals provide such service, we can get information from HIV/AIDS institutions such as NAC(national aids commission) or local peer support groups and from Internet.
1.5 HIV treatment
After HIV testing,if we get HIV positive,what should we do? It just means there is a kind of virus in our body and our body will produce antibodies to fight with HIV infection. It does’t mean an end of our life and we have no hope. We must be very sad of the fact, but we should’t give up, we still have future and long way to go.
Antiretroviral therapy
We used to hear AIDS referred to as' the disease that there is no cure. " This is the wrong term! Most opportunistic infections can be treated, even prevented, with a drug that is not too expensive and widely available. And now there are more sophisticated drugs, which can slow the activity of HIV to infect cells that are still healthy. These drugs are called antiretroviral drugs or ARVs.
To treat HIV, can not use one type of these drugs alone; that this therapy can be effective for long periods of time, we must use a combination of three antiretroviral drugs of different kinds. This therapy is called highly active antiretroviral therapy or HAART.
ART was very expensive, but is now available free to all people in some countries with fully subsidized by the government, through a number of hospitals designated as referral hospitals ARVs. Currently there are at least one referral hospital in each province.
ART is only successful if used in obedience, in accordance with the schedule, usually twice a day, every day. If you forgot a dose, effectiveness of therapy will quickly disappear. Because HIV persists in the body, and without the drug will begin to multiply again, it must be taken for a lifetime. But there is hope in a few years, we just have to take medication once a day, and then (maybe 15 years from now?) will form a single injection once a month.
Some people experience side effects when taking antiretroviral therapy, especially in the first weeks of use. It is important antiretroviral therapy supervised by a physician experienced with this therapy.
Although we are on antiretroviral therapy, and although the amount of virus in our blood becomes very low (below the level that can be measured), we can still transmit HIV to others through our risky behavior.
Alternative therapies
Adjunctive therapy or traditional therapy is often referred to therapy without chemical drugs. The goal of this therapy is to improve the quality of life, and keep yourself to stay healthy. This therapy can also complement antiretroviral therapy, mainly to avoid side effects. Can also be an option if we do not want or can not obtain treatment.
Which includes among other adjunctive therapy is the use of traditional herbs, plants, herbs, nutrients in food regulation, and the use of vitamin and mineral supplements.
Also included in this therapy, yoga, acupuncture, massage, reflexology, sports, and music. Psychological therapy, spiritual or religious, and emotional can also help. Included here among others, counseling, peer support, and meditation.
What we need to do by ourselves?
(1) Learn about HIV and its treatment
Patients must be empowered to know about the infection, how it works and its treatment. Take advantage of the information contained on website to learn and find the latest information. Use question and answer forum anonymously to seek answers to questions about health and HIV-related treatment. Follow the peer group support (peer support group is established as a organization for all people living with HIV / AIDS and affected by HIV / AIDS ,eg family, partner or companion to other people with HIV, regardless of sex, race, religion, creed, educational and economic backgrounds, and sexual orientation) for local people living with HIV.
But we must realize that the science of HIV is growing very fast, and often correct information two years ago is no longer valid today. See the date the information was published, and when it is expired, try to find a more up to date. And take a very cautious attitude about the information obtained from the Internet;
(2) Be a friend of your doctor
With it checked regularly (preferably at least every six months), we can continue to find our state of health. Through blood tests (TLC, and CD4 if possible), and examination by a physician, we can see the extent to which HIV affects the immune system.
Doctor gives advice on care for us, but we ourselves who decide to follow or not. The more our knowledge about HIV and its treatment, the better we prepare to discuss with the doctor and to take decisions. In terms of living with HIV, be a knowledgeable partner who work for our own doctors.
A good relationship between doctor and patient is essential. The important thing is trust. We need to feel comfortable and supported when it comes to our health issues with doctors. Tell your doctor if any other medicines, including herbal remedies, which we drink. Ask about medication or treatment that is given to us. If we do not feel comfortable and confident in our doctors, it is okay to find another doctor. If you feel the need to hear the opinion of another doctor or specialist to meet with, discuss with your doctor and ask his help to arrange this.
(3) The most important is Motivation
The most important thing is that we should have motivation to live with HIV. We should prepare ourselves for fighting with HIV in our lifetime. If you want, you can share your feelings with someone who can be trusted:families,friends or others. After telling other people, some people get a positive reaction and beneficial, but there is also a disappointment or worse than that. Fortunately, there are many local peer support groups where we can share our feelings with others who are also living with HIV and also get some adivice and guidance. Anyway, yourself should have confidence and be optimistic about life. That’s very important in your treatment.
We are not alone
There are many people and institutions that care about PLWHA. Global organisations such as UNAIDS, Globe Fund provide fund and other support for HIV prevention and treatment all over the world. In each country, there will be NAC, national and local NGOs,Peer Support Groups that can provide services to PLWHA. You can learn more about these institutions on Internet.