Question 5 (Practical Tasks)
The Concept of the Elisa Test and the implications it has on the window period and the
use of vaccinations.
The ELISA antibody test, which stands for Enzyme-Linked Immuno-Absorbent is also known as
EIA (Enzyme Immuno-Assay) was the first HIV test to be widely used across the world to detect
an HIV Infection. The HIV antibody tests are the most appropriate test for routine diagnosis of
HIV among adults. The tests are inexpensive and very accurate and is one of the most common
tests used to test for HIV in South Africa.
When a person is infected with HIV, their body responds by producing special proteins that fight
infection, called antibodies. An HIV antibody test looks for these antibodies in blood, saliva, or
urine. If antibodies to HIV are detected, it means a person has been infected with HIV.
There are only two exceptions that has found to be true facts; Babies born to HIV infected
mothers retain their mother's antibodies for up to 18 months, which means they may test positive
on an HIV antibody test, even if they are actually HIV negative. Normally babies who are born
to HIV positive mothers receive a PCR test after birth; and some people who have taken part in
HIV vaccine trials may have HIV antibodies even if they are not infected with the virus.
Most people develop detectable HIV antibodies within 6 to 12 weeks of infection. It has been
found in some very rare cases, that it can take up to 6 months to be detected and there are
nearly always very particular reasons for antibodies developing so late for instance the person
might be suffering from other auto-immune disorders. It is exceedingly unlikely that someone
would take longer than 6 months to develop antibodies.
What is a Window period?
The Window Period is a term used to describe the period of time between HIV infection and the
production of antibodies. During this time, an antibody test may give a False Negative result,
which means the test, will be negative, even though a person is infected with HIV. To avoid false
negative results, antibody tests are recommended three months after potential exposure to HIV
infection.
A negative test at three months will almost always mean a person is not infected with HIV. If an
individual’s test is still negative at six months, and they have not been at risk of HIV infection in
the meantime, it means they are not infected with HIV. It is very important to note that if a person
is infected with HIV, they can still transmit the virus to others during the window period.
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The importance of pre and posttest counselling and the personal implications of HIV
testing for an individual
It is of utmost importance to conduct Counselling before as well as after an HIV test. The
emotional wellbeing of an individual needs to be established and when conducting the
counselling such important and critical information about HIV will be provide to the person. The
counselling itself should not just be about HIV itself but also about the testing process and what
the various outcome implications can be for the person.
The counselling services may not be available in all health care facilities, many testing sites do
offer these services. If you would like access to pre-test and post-test counselling, be sure to
inquire about the availability of these services at your chosen test site. If they do not have them
readily available, the staff may be able to direct you to alternate service providers who does offer
the services.
Pre-HIV test counselling is extremely important. It should not only be seen as a preparation for
the HIV test, but as a golden opportunity to educate people about HIV/Aids and safer sex.
Remember that this may be the one and only time that you will see the client because he or she
might decide not to be tested, or not to come back for the test results after all. The purpose of
pre-test counselling is further to find out why you want to be tested, the nature and extent of
your previous and present high-risk behaviour, and the steps that need to be taken to prevent
you from becoming infected or from transmitting HIV infection.
Counselling after testing will depend on the outcome of the test - which may be a negative result,
a positive result, or an inconclusive result. The counsellor should always ask the client if he or
she is prepared to receive the results. In the case of the rapid HIV antibody test - where the
results are available within minutes - ask the client if he/she is ready to receive the results
immediately. Some clients need time to prepare for the results.
Informed consent
The decision to be tested can only be made by the client and their informed consent must be
obtained prior to testing. Consenting to medical testing or treatment has two elements:
information and permission. Before an HIV test can be done, the client must understand the
nature of the test, and he/she must also give verbal or written permission to be tested. A client
may never be misled or deceived into consenting to an HIV test.
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According to the law, health care professionals may not do an HIV test on a person unless he
or she clearly understands what the purpose of the test is, what advantages or disadvantages
testing may hold for him or her as client, why the health care professional wants this information,
what influence the result of such a test will have on his or her treatment, and how his or her
medical protocol will be altered by this information.
The stages of the HIV - from infection with to full-blown AIDS and death.
The Four Stages of HIV/AIDS, also be known as:

Stage 1: Primary HIV Infection

Stage 2: Asymptomatic HIV

Stage 3: Symptomatic HIV

Stage 4: Acquired Immune Deficiency Syndrome (AIDS)
Stage 1: Infected: The period following the initial HIV infection is called the window period. This
is the period between infection with the virus and when HIV antibodies develop in the
bloodstream. At this stage there is no way of detecting HIV infection in the body. Seroconversion
refers to the period of time during which the body is producing HIV antibodies, trying to protect
itself against the virus. Many people experience flu-like symptoms and swollen lymph nodes –
this is a highly infectious stage.
Stage 2: HIV Well: After sero-converting, many people usually experience a symptom-free
period or asymptomatic period. For many years, people with HIV look and feel well. Although
the person with HIV is experiencing no symptoms, the virus is still replicating inside the body
and weakening the immune system. This stage can last anything from three to twelve years.
The average time is six years. During this stage, infected people need counselling, support and
a healthy lifestyle. This is the most dangerous stage because unless they have an HIV test, they
will not know that they are infected. In this way they can spread the virus without knowing it.
Stage 3: HIV ill: HIV slowly weakens the immune system. Between five and eight years after
infection, people start getting sick. They usually begin to lose weight and their bodies become
weak. The early signs of HIV related illnesses are:

Weight loss

Swelling in the neck, behind the ear, under the arm and in the groin

Sores on the lips or genitals which do not heal
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
A white rash inside the mouth or on the genitals

Signs of TB – coughing, sweating, and losing weight

Painful sores or rashes

Fevers and sweating at night

Diarrhea that does not stop
Stage 4: AIDS: After this period, severe immune cell loss leads to the symptomatic period, in
which the body experiences the symptoms associated with AIDS. This is the final stage and is
referred to as AIDS sickness. On average it takes a person 18 months between getting very ill
with AIDS and dying. People with AIDS need special care and medicine. There is often a need
to go to the hospital. People with AIDS usually suffer from serious diseases like TB, pneumonia,
or certain types of cancer. They become very ill with these diseases, and they eventually die. It
usually takes about eight years between the times people are first infected with the HI Virus to
when they die of AIDS (www.unaids.org).
Later signs of AIDS are:

TB and pneumonia

Thrush (a fungal infection of the mouth or vagina)

Re-occurring shingles and skin rashes and lesions

Various cancers

Meningitis

Weight loss of more than 10%
What are the chances of a person surviving with AIDS - latest views on medication and
the cost of Drugs
To be infected with HIV is in some instance a lifelong disease, these days it is considered that
people with HIV and AIDS are living longer, if they conduct a healthier lifestyle and with the new
and effective treatments available the disease is treated and managed more like a Chronic
illness as to a death sentence. Since the introduction of the newly developed HIV medications
treatment regiments, statistics have shown that fewer people are dying of AIDS and people are
now living long, productive lives despite their HIV infection.
Unfortunately, what has become a challenge and especially with African countries is the cost of
HIV medications, it is sometimes seen as the only obstacle for people to step forward in getting
therapy. While this hurdle has been negotiated in the western world, some of the world's hardest
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hit areas still can't afford to properly treat their citizens with HIV medications. As of late,
governments, advocacy groups and even drug manufacturers are making HIV medications more
affordable for those who can't afford them. The government is spending billions and billions of
Rands to provide medication to people living with HIV/AIDS.
South Africa has the largest Antiretroviral therapy programme in the world, but it also has the
world’s largest epidemic, and access to treatment is low. According to the latest World Health
Organisations guidelines of 2010, an estimated 55 percent of people who needed ARVS was
receiving treatment for HIV, at the end of 2010. Over the last 10 years, the country has been
making progress towards its goal of 80 percent coverage. By mid-2011, it was announced that
the number of people on antiretroviral treatment had increased significantly from 923,000 in
February 2010 to 1.4 million in May 2011.
The state of HIV treatment in South Africa can only be seen in the context of years of doubting
the effectiveness of treatment at the highest levels of government, and the initial delay and slow
pace of delivering a public ARV programme. The initial cost the government spend on tender
prices during 2010 stood at a cost more than R8.8 billion to treat people with antiretroviral.
Following this massive reduction in the price of antiretroviral drugs, the government can now
treat twice as many people as before.
Understanding HIV/AIDS and behaviour that carry a risk of contracting HIV/AIDS
A person that contracts an HIV infection can at most relay it to the result of human behavior, and
at best to ensure that rate of infections grows less. Such has been the aim of awareness
campaigns and educational life skills programmes have inevitably been to broadcast that change
in behaviour. As this change in lifestyle has long been understood as essential to curbing the
spread of infection. In all cases where national epidemics have been reversed, broad-based
behavior changes were central to success. For example, Acts such as sexual behaviour can
range between more, or less risky
Low Risk or No Risk Behaviors: Kissing, dancing, hugging, body rubbing (outer course) and
massage are no-risk behaviors for contracting HIV; mutual masturbation if there are no cuts on
the hand, penis or vagina is very low risk. But individuals should at all times not just be guarded
against HIV but should be aware that STIs (Sexually Transmitted Infections) such as Herpes
or Genital Warts can be transmitted by body-to-body contact, without intercourse.
Moderate Risk Behaviors
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Oral sex on a man is a higher risk than oral on a woman which is considered as moderately
risky behavior. The risk is increased when there are open sores in the mouth, on the penis or
vagina. Flossing and rigorous brushing before oral sex can cause small cuts in the gums,
increasing the risk; mouthwash is an alternative. If there is body fluids present, oral sex is high
risk behavior. Using condoms on penis or dental dam on vagina can make oral sex a safe
behavior. Oral sex on anus is very low risk for HIV, but like all unprotected oral sex, has some
risk for STIs; using a dental dam reduces this risk.
High Risk Behaviors
Unprotected vaginal and anal sex and oral sex with ejaculate (cum) or vaginal blood are high risk
behaviors as is using and sharing un-sterilized injection drug needles. HIV infected mother breast
feeding is also high-risk behavior for mother to child transmission.
Other factors that can influence your behaviour
Having a perception that you can't get HIV or that your partner does not look like someone who
can have HIV can increase your likelihood of participating in unprotected sex. Being high on drugs
and alcohol can increase the chance that you will do something that you would not do sober and
increase the incidence of unprotected and unplanned intercourse.
Avoid contracting or spreading HIV/AIDS and how behaviour can reduce the risk of
infection.
Always using condoms for vaginal intercourse also prevents unplanned pregnancy. Make use
of PReP if you and your partner has not undergone testing before your first time of having
planned intercourse. Be Proud that you take control of decision regarding your body and your
safety. Taking responsibility for your own actions can decrease your chance of becoming
infected with HIV or an STD.
Becoming educated about HIV and understanding how it is transmitted is the most important
way to prevent the spread of HIV. It is essential to make informed decisions about the level of
risk they are willing to take, based on what is realistic for them. Using a Condom and not sharing
needles is one of the most effective ways for people to protect themselves from HIV and other
Sexually Transmitted Diseases (STDs). Even though abstinence is not a realistic option for
everyone, it should be practiced at best possible in situation where you do not know the person.
When abstinence is not an option, the proper use of barrier protection such as latex or
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polyurethane condom (male or female) with a water-based lubricant is the next best thing for
vaginal or anal sex.
When working within a health care environment or coming across an incident where blood or
body fluids are exposed, be stringent about taking all necessary precautions.; Although this is a
rare way of contracting HIV, avoid coming into contact with other people's blood. Your health
comes first. If you ever need a transplant, know where organs come from. whether it be organs
or other body parts, like cells, it would be safer to know where they come from. Try to get organs,
such as kidneys, from a family member. Other transplants, such as cell transplants, can also be
taken from willing family and friends. Know that there is no way to avoid it entirely and there is
no cure. So the only way is to not have sex at all unless you are positive the significant other
does not have this STD or any other STD of the sort.
Prevention is always better than cure. This principle holds a phenomenal significance when it
comes to HIV/AIDS. AIDS is one such disease that does not have any permanent cure. Available
PReP treatment options are only effective in reducing the symptoms associated with the disease.
In such scenario, it is important to have adequate protection so that you do not get the infection.
Situations that have a potential to spread HIV/AIDS in the workplace
HIV infections is mostly contracted through the blood of an infected person into another person's
bloodstream. HIV has been found in several body fluids, including blood, semen and vaginal
secretions. Small amounts of the virus have been detected in saliva, tears and breast milk. HIV
is also acquired through vaginal or anal intercourse, direct injection of contaminated blood or
blood products, or by using contaminated needles.
HIV is not spread through the air like cold or covid viruses. You cannot "catch" HIV like the
common cold or flu. The virus is not transmitted in social situations, such as at work or by sharing
food or water, through contact with saliva or tears or using the same utensils and toilet as an HIV
Infected person. No evidence exists that HIV can be transmitted through insects, such as
mosquitoes. It's important to keep in mind that there is no medical evidence that HIV can be
spread by casual contact with someone with HIV infection.
Low Risk Situations: Most occupational groups are not at risk of becoming infected with HIV
through exposures at work. There is no evidence that HIV is transmitted through touching or
caring for patients or clients (unless direct contact with blood or body fluids is involved); from
cutlery, glasses, food, or dishes, swimming pools, drinking fountains, coughing or sneezing, or
toilet seats.
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Medium Risk Situations: The risk associated with broken skin or mucous membrane
transmission is believed to be lower than that associated with needle-sticks. Workers who have
contact with blood and body fluids are potentially at risk and should take the same type of
precautions as are used for other blood borne pathogens, such as Hepatitis B or C.
Workers at risk of exposure in their field of work include:

Health care workers, including those involved in patient care and support services such
as laundry, housekeeping, and materials handling

Laboratory workers

Emergency response personnel, including paramedics, ambulance attendants, police,
and firefighters

Institutional workers in group homes and psychiatric facilities

Correctional officers

Morgue attendants

Dental workers.
High Risk Situations: Occupational transmission of HIV can happen in several ways. The most
effective way for HIV to enter the body is through a needle-stick if that needle has been used by
someone with HIV infection. Studies indicate that the risk of developing HIV infection is about 0.4
per cent (or about one chance in 250) after a needle-stick with a needle from a known HIV-infected
person. An open wound, cut or skin that is not intact, such as skin that is chapped, weeping or
skin that has rashes, can allow infected fluid to enter the body. Finally, if infected fluids touch
mucous membranes such as the eyes, nose or mouth, these surfaces can absorb the fluid and
transmit the virus.
Behaviour and activities that carry a low risk of infection
HIV is NOT spread through the environment; it is a very fragile blood-borne virus. HIV-infected
persons do not pose a threat to coworkers or clients during casual, day-to-day activities and
contacts. So, you cannot be infected with HIV through:

Handshakes

Hugs or casual touching

Close working conditions

Telephones, office equipment, or furniture

Sinks, toilets, or showers

Dishes, utensils, or food
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
Sneezing or coughing

Air

Water

Insects
Most of the behaviors that pass HIV from one person to another do not occur in the workplace.
The only way that most people in the average workplace could be exposed to HIV would be if
they had an open wound and someone else’s infected blood entered their body through that
broken skin. It is vital that workers recognize that all blood and body fluids they come in contact
with are potentially infectious, and not just with HIV!
Treatment options available to a person with HIV/AIDS locally in South Africa
Antiretroviral drugs (ARVs) are currently the primary method for treating HIV. These drugs inhibit
either of the two enzymes that are essential for HIV replication, namely, reverse transcriptase and
protease. Newer drugs target other areas of the virus' lifecycle but are not yet readily available in
our region. Although antiretroviral treatment is not a cure for HIV/AIDS, it can significantly prolong
and improve the lives of HIV-infected people. ARVs slow down the production of HIV and give the
body a chance to build up its CD4 cell count which, in turn, helps the body fight against
opportunistic infections.
Types of Antiretrovirals
There are more than 20 approved antiretroviral drugs but not all are licensed or available in every
country. Antiretroviral treatment is usually prescribed as a combination of two or three different
types of drugs to combat different processes during HIV replication. Taking two or more
antiretroviral drugs at a time is called combination therapy.
Taking a combination of three or more anti-HIV drugs is sometimes referred to as Highly Active
Antiretroviral Therapy (HAART). If only one drug was taken, HIV would quickly become resistant
to it and the drug would stop working. Taking two or more antiretrovirals at the same time vastly
reduces the rate at which resistance would develop, making treatment more effective in the long
term. The three main types of drugs available are listed below:
Antiretroviral Drug
Action
Generic Examples
(abbr)
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Nucleoside
Prevents healthy T-cells from becoming
zidovudine (AZT)
Analogue Reverse
infected with HIV by preventing the
lamivudine (3TC)
Transcriptase
conversion of viral RNA into viral DNA.
stavudine (d4T)
Non-nucleoside
Prevents healthy T-cells from becoming
nevirapine (NVP)
Reverse
infected with HIV by interfering with the
efavirenz (EFV)
Transcriptase
reverse transcriptase enzyme which the HIV
delavirdine
Inhibitors (NNRTI)
uses to convert viral RNA to viral DNA.
(DLV)
Protease Inhibitor
Prevents infected T-cells from producing new
ritonavir (RTV)
copies of the virus by blocking the protease
indinavir (IDV)
enzyme which helps produce new copies of
lopinavir
the virus.
(LPV)
Inhibitor (NRTI)
There are two groups of HAART ARV drugs that the government uses in South Africa. Health
workers call these groups ‘regimens”. These are the names of the drugs in the two regimens:
Group 1 or Regimen 1
Group 2 or Regimen 2
(for those whose HIV resists Regimen 1)

3TC or Lamivudine

AZT or Zidovudine

d4T or Stavudine

ddl or Didanosine

Efavirenz (or Nevirapine, which is safe for

Lopinavir with Rittonavir
women who may want to fall pregnant)
ARVs have different names, depending on which Drug Company makes them. The names given
on this page are the generic names of the contents of the drugs. Other kinds of drugs also use
different names for the same thing. For example, paracetamol is sold by different drug companies
as Panado, Painamol, Tylenol, or Dolorol.
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