3
Why and When should Women
begin taking Antiretroviral Medicines?
Without treatment, nearly all HIV positive women will experience a gradual
weakening of the immune system and over time, will develop AIDS. You
should seek information and regular medical care to determine if, and
when, you should start taking ARV medicines. Research has shown that
ARV medicines work just as well in women as in men.
Step 1: Take the first step in ART — get tested and
share your status with a friend for support.
page 1
Emma (25) talks to Anna (31)
Being HIV
positive does not
mean you are
going to die soon.
It is good that
you know. You
can do
something about
it. Have you not
heard about the
medicines that
fight HIV?
After my husband’s death,
I suspected that I might
be HIV positive. I was too
scared to take the test.
A friend helped me have
the courage to go for a
test. I have just tested
HIV positive and I am very
worried that I will soon
die leaving my children still
very young.
You have already taken the
first step- getting tested. The
next step is for you to go for
further tests that measure how
much virus there is in your body
and how strong your immune
system is. These are called viral
load and CD4 count tests. They
will determine if you need to
start on the medicines.
ARV medicines you
mean? I have
heard about them
on the radio and
when I got tested.
How do I start on
the medicines?
Why do I need to have
these tests first?
Because not
everyone who is
HIV positive needs
to start on
treatment
immediately.
page 2
You are not a nurse, how
do you know all these things?
My sister is on treatment
and she tells me everything.
I used to accompany her to
the laboratories to have the
tests done. She even used
to ask me to go with her to
the clinic for check up. Do
you want to talk to her about
starting treatment?
That sounds like a
good idea. I will think
about it and let you
know.
PLEASE REMEMBER
- You must first be tested to see if you are HIV positive before you start taking any ARV
medicines.
- If you are HIV positive, you need to have a medical check up to determine if you need
to begin taking ARV medicines.
- It is good for you to have a friend or relative whom you trust to tell about your status,
so that they support you. There are many other women who are taking ARV medicines
and would be happy to talk to you and support you while you make your choices.
- If you begin to take ARV medicines you can live longer and prevent your children from
becoming orphans.
- Finding out all the facts about ARV medicines does not mean you must begin taking
them immediately.
- Talk about it with your friends and family.
page 3
Step 2: Get correct information about starting Antiretroviral
Treatment
Nester (18) talks to Vicky (18)
After going for VCT
one afternoon, my
whole life changed. As
a young girl, do you
think there is any hope
for me after what has
happened?
Remember what your
counsellor said. Of course
there is a lot of hope.You
can live to see yourself
graduate. I know of a
number of people living with
HIV in this country who
have been on treatment
for years and they continue
to live healthy lives.
Maybe you need
to go back to a
health centre and
ask them where
you should go for
the treatment.
I don’t remember anything my counsellor
told me since I was in shock. How do
I start the treatment? I have no idea
of where to go for the treatment
and how to go about getting started.
page 4
How do you think
they will react
to having such
a young person
like me being
positive? Seeing
young girls of 18
being positive,
might not be
what they are
used to.
I do not think that
they will judge you.
You do not even
have to tell them
how you got
infected unless you
want to.
I do not enjoy repeating
my story to people.
As a matter of fact, the
uncle who infected me left
some medicines, which he
was taking before he died.
So we have the same virus.
Can I not just go ahead
and take over his
medicines? I think we have
the same blood type as
well since he is my mother’s
brother.
I really do not feel like
going back to the health
centre. Is there no other
place with the information?
Our college clinic is
definitely out.
No, you should never
take over someone
else’s medicines even
if you have the same
symptoms and are
blood related. You need
to have the doctor
examine you first to
see which ones are
most suitable for you
and your body.
What about going to those organisations
that usually display HIV and AIDS material
at public gatherings like agricultural
shows and trade fairs?
page 5
AIDS Service
Organisations?
Yes.
OK, I think I will be
more comfortable going
to people that
specialise in that area.
I think they will be in
a better position to
understand my
situation. I also think
that they know more
about how one can
start taking ARV
medicines. I really want
to start on them and
finish my degree.
I like the way you
are so positive and
determined now.
Do you want me to
come with you
tomorrow after
class?
PLEASE REMEMBER
- As a young HIV positive woman, when you begin taking ART you can live a longer
and healthier life. You can continue your education, get married, have children , and
achieve your life goals and ambitions.
- Never take over someone else’s ARV medicines, even if you have similar symptoms
and are blood related. Go and be examined by a doctor to determine if you need to
start on ARV medicines and which medicines best suit your body.
- Never share your ARV medicines with anyone even if they have similar symptoms and
are related to you.
- Never begin taking ART without discussing it with a doctor, and unless your doctor
prescribes it for you.
- Always consult your doctor or counsellor if you have questions and are not sure about
something related to your HIV status or ARV medicines.
Step 3: Disclosure
You will need someone or some people within your circle
of friends or family to support and encourage you. It is
therefore very important for you to tell someone – a family
member or a friend, about your HIV status, as well as the
page 6
treatment that you are on. Telling someone about your
status is called “disclosing.” To get appropriate and
adequate support from family members and caregivers,
you need to disclose your status to people whom you trust.
Why do you need to disclose your status?
- Disclosing can help you to accept your status and reduce the stress of coping
on your own: “a problem shared can be a problem halved.”
- After you have disclosed, you will not need to hide that you are taking ARV
medicines, and you will be better able to adhere.
- Disclosing can help you access the medical services, care and support that
you need.
- Disclosing can help you protect yourself and others, such as negotiating for
safer sex.
- Once you have disclosed you may influence others to avoid infection.
- People may suspect your HIV status particularly if you are showing symptoms
of AIDS. Disclosing can stop the rumours.
- As more people disclose their HIV status, it will help reduce the stigma,
discrimination and denial around HIV and AIDS. This will reduce transmission
of new infections in your community.
Step 4: Special issues to think about – Pregnant women
that took ARV medicines for PMTCT can still start on ART
Rose (28) talking to Violet (29)
page 7
In a queue at an antenatal clinic - After some greetings
Ah, Amai Sofi, what are
you doing here?
Why should I not be here? Sofi
is now 2 years old and she
needs someone to play with!
I am happy that you are
here. This is my first time
coming here and I would
like to ask some private
questions before I talk
to the nurses. Is it all
right if I ask you? I am
really scared of nurses
and I do not know how
they will react to my
situation.
Yes sure.
What situation
is it?
Yes, they test pregnant
women. They tell you the
results in that room with
a closed door. There is
a special counsellor in
there. She is very nice.
She talks to you before
the test and after the
test as well. I talked to
her a lot and we became
friends. She comes to
our meetings at the
support group.
page 8
You see, I am
worried about
something. I have
not talked to anyone
about it. Do they
test for HIV at this
clinic?
I am worried about
having a baby who is
always going to be sick.
Do not be worried. Is Sofi
a sick baby? I took Nevirapine.
I was on the Prevention of
Mother-to-Child Transmission
(PMTCT) programme.
It worked for me. Sofi was
born HIV negative.
That is what I want also.
I am very worried about
passing the virus to my
baby.
page 9
These days, most
mothers are getting
Nevirapine and it
really works. The last
time the counsellor
came to our support
group meeting, she
told us about
pregnant women
starting ART.
Ah, can you start
taking those
medicines while
you are
pregnant? Are
they not too
strong for the
baby inside you?
Yes you can. You just need to be tested to
check if you need to start yet. Let us go
inside and ask the counsellor for more
information about it.
PLEASE REMEMBER
- If you are pregnant, you can start on ART after your doctor has determined which
medicines are best for you.
- If you fall pregnant while taking ARV medicines, continue taking the medicines but
inform your doctor of the pregnancy.
- Even if you have taken some ARV medicines at some point in your life, such as in a
short course to prevent mother-to-child transmission of HIV, you can still start on ART
after your baby is born.
- Pregnant or breast feeding women living with AIDS become a lot weaker if they do
not start on ARV medicines.
Step 5: You can take ART even if you took ARV medicines
for Post Exposure Prophylaxis (PEP).
Molly talks to Viola
Were you also
raped?
page 10
I also took ARV medicines
like you for PEP.
I am sorry to hear
that you went through
such a horrible
experience. Did the
PEP work?
No I was not raped
but a needle pricked
me as I was putting
up a drip on a
patient in an
ambulance. The
patient was known
to be HIV positive
so I immediately
started PEP.
page 11
Oh yes it did. I have tested HIV negative
twice after I finished the course. The
PEP course was for a whole month and
I was tested for HIV three months after
finishing the course. And you, did you
ever test negative after the PEP course?
Yes I did test HIV
negative. Do you
think if I had
tested HIV positive
I could have begun
ART after taking
PEP?
Yes one can start taking
ARV medicines even after
taking some for PEP.
See a doctor who will
determine when you need
to start on ART .
PLEASE REMEMBER
- You can take ARV medicines even if you have been on PEP before
- Inform your doctor or pharmacist about any other herbs or therapies that you
might be taking
- Ask your doctor if you are worried about drug resistance
- It is a good idea to know your HIV status before beginning PEP
- PEP should be taken within 72 hours of being exposed to HIV (If you are
raped) but it is best that it be taken within the first 24 hours if possible
- You should not rely on PEP access if you are having unprotected sex or sharing
drug-injection needles
- As soon as you think an accident may have put you at risk of HIV infection,
you need to report it to your nearest health centre and be directed to where
you can access PEP.
page 12
Step 6: Thinking about yourself: As mothers, sisters, wives
and aunts, women and girls must think of themselves as
important – have self worth
Gladys (35) talking to Martha (36)
Yes my husband has been
taking the ARV medicines for
a while and he is really
improving. I am happy that
the medicines are working.
What about you? Are you
thinking of starting the
medicines as well?
My main worry right now is my child and my
husband. If they do have any medicines at the
clinic, I would rather they give them to my
husband and my child first before me.
My husband has to go
back to work and
provide for us. My child
has to live this time.
My in-laws will think
that I bewitched this
child again after what
was said when my first
one died. How can I
live without a child in
this home?
Are you saying that your husband is
more important than you are? Are you
not the one who looks after everyone,
who takes care of the house and your
vegetable garden and poultry?
You need to think of
yourself as well my
dear. You need to be
well to look after them.
Go and be checked to
see if you need to start
ARV medicines yet.
Step 7: Managing side-effects
page 13
Lerato is an executive
secretary working in
Gaborone, Botswana
I am 25 and I feel
that I am at the peak
of my carrier. I live in
a very comfortable
apartment in the city
and I am otherwise
happy. I have been
on ARV medicines
for the past 3 years
and I have
experienced some
ups and downs.
My health has improved a lot lately but I
have not had a baby of my own
and I really want to have one. Before I
started on ARV medicines, I had an
operation on my abdomen. I had a lot of
pain under my umbilicus and the doctor
said I had a boil inside me because of what
he said was Pelvic Inflammatory Disease
(PID). I was informed that one of my tubes
is blocked so I really have to rely on just the
one clear tube to fall pregnant.
I have been trying for a baby for some time.
My doctors told me that I am fit enough
to safely carry pregnancy and deliver a baby,
but I am not getting pregnant. Although
I have been to many doctors, none of
them has carried out extensive tests to
find out why I am not getting pregnant.
Each time that I miss a period, I go to a
doctor who tells me that I have irregular
periods because of how HIV affects my
hormones. I suspect that HIV makes people
infertile. When I started taking ARV
medicines, I was referred to a support
group from where I got a buddy. She told
me that she has also been trying for a
baby for a while and we have two friends
of ours who are also trying to get pregnant
without much success.
I have been doing well on my treatment
though I changed three times before
settling on my current combination. My
first combination had AZT, which made
me have severe anemia and then my
periods used to be heavy so I really had
serious blood problems. I nearly got a
blood transfusion. I was moved to
another combination. Nevirapine in the
new combination made me have a bad
rash all over my body and I changed
again. I have no problems with my
current combination, which I take
morning and evening so does not even
interfere with my work hours at all. I
am glad that I began taking ARV
medicines and look forward to having
a baby one day soon.
PLEASE REMEMBER
- As a woman, you are very important to your family so you must think of ways to
remain alive and healthy for as long as is possible.
- It does not matter what other people think, say or call you in your family or
community, you still deserve to live a full life.
- Get ART if your doctor says you need it. Stay strong and healthy.