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Chapter 9 - HIV and AIDS AND THE LAW

Introduction

Everybody has heard about HIV and AIDS. It is one of the most widely talked about illnesses in history and has become a pandemic of massive proportions particularly in Southern Africa. There are many untrue stories about AIDS and this causes people who are living with the disease to live with fear, prejudice and discrimination. It is important that people understand what HIV and AIDS are and how to prevent the disease from spreading but it is also important that we look at ways of undoing the prejudice that has built up around the disease.

Facts and statistics about HIV and AIDs

HIV/AIDS is one of the biggest challenges we face in South Africa. The incidence of HIV/AIDS is rising rapidly in this country and over 5.4 million people are already HIV-positive (2006 figures). This is the largest number of individuals living with the virus in a single country.

• Thousands of people are becoming ill and dying every week and more and more children are being orphaned. As more people have become ill, the impact of AIDS has been felt in almost all communities.

The research to measure how common HIV/AIDS infection is in South Africa is done among pregnant women who visit state health clinics. The infection rates quoted below for each province are for these women. The national HIV infection rate among pregnant women attending state health clinics in 2006 was 28.3%. These statistics apply mostly to young women who are sexually active. Many of the men who are partners to these women will also be HIV positive. From these figures the estimate is that about 19% of all South African adults are infected with the virus.

The infection rate amongst pregnant women in 2006 was as follows:

(Source: South African Department of Health)

South Africa HIV estimates for 2007

(Source: Statssa.gov.za)

By the end of 2007 an estimated one million people will have died of Aids in South Africa and more than a million children will have become orphans as a result of Aids. Almost one thousand people die every day.

The estimated adult HIV-prevalence rates (the proportion of adults who are infected with HIV) for 2007 are as follows:

Women 15–49 - 20,4%
Women 20–64 - 18,1 %
Men 20–64 - 17.7%
Adults 20–64 - 17,9%

The total HIV prevalence rate has been estimatedat 11% in 2007 with an estimated 5,4 million people who are HIV-positive. Most of the people who are dying from AIDS are women between the ages of 18 and 40 and men between the ages of 30 and 50. This means that the most vulnerable groups are women of child-rearing and working age and men in their working years. This will badly affect our society as a whole.

For 2007, life expectancy, which was 60 years in 1990 had decreased to 48 years for men and 52 years for females. This means that around 50% of people living in South Africa will not live to the age of 60 years.

What are HIV and AIDS?

HIV stands for the Human Immune Deficiency Virus. This virus attacks the immune system which is the body's defence against disease. HIV can live in our bodies for years without us looking or feeling sick in any way. Most people with HIV feel healthy and are able to work and live healthy lives for many years. It is only when a person develops an AIDS-related illness that he or she becomes very ill.

AIDS is caused by HIV. AIDS stands for Acquired Immune Deficiency Syndrome. It is the name given to a group of serious illnesses that are caused by your body being unable to fight infections. People with HIV or AIDS are more likely to get some diseases and infections because their immune system cannot fight them off.

The different stages of HIV

There are four stages of the HIV disease:

Stage 1: Primary HIV infection

After an early feeling of sore throat, swollen glands, headache, muscle aches or similar flu-like symptoms, you will return to feeling completely well. This stage may last several years during which the person might have no HIV-related illnesses

Stage 2: The asymptomatic or "silent" stage

If you have the primary HIV illness you can feel very well for many years without showing any major symptoms. A person with HIV who lives a healthy lifestyle by eating healthy foods, taking exercise, food supplements and antiretroviral treatment (ART) when necessary, can remain in stage 1 or 2 of the illness for many years living a normal life.

Where the person does not live healthily and/or fails to take ART treatment, he or she will begin to develop minor illnesses in stage 2. Ear infections, frequent flu and skin problems are common at this stage.

Stage 3: Early HIV symptomatic disease

Gradually, after many years, the person’s immune system starts to break down and the CD4+ cell count drops lower and lower. (The strength of a person’s immune system is calculated by their CD4+cell count). Some people will begin to show mild symptoms of HIV disease, for example, shingles, swollen lymph glands, occasional fevers, mild skin irritations and rashes, fungal skin and nail infections, mouth ulcers, chest infections and weight loss.

Stage 4: Medium-stage HIV symptomatic disease

This is the stage when the CD 4+ cell count gets very low and people use ART treatment to boost their immune systems. In stage four, the person has illnesses due to a very weak immune system. These may include PCP, pneumonia, chronic diarrhoea, toxoplasmosis and meningitis. It is at this stage that a person is said to “have AIDS.” A person is also said to “have AIDS” if their CD4 count (white blood cells) goes under 200.

How do you get HIV?

There are only three ways to get HIV/AIDS:

1.Unprotected sex (sex without a condom),
2.Contact between your blood and infected blood or body fluids, and
3. Mother-to-child transmission.

1. Unprotected sex.

This is the most common way that people get HIV/AIDS. If you have sex with an HIV positive person and there is direct contact between the penis and vagina or anus, you can easily get infected. The virus lives in the fluids inside the penis and vagina and can easily enter your bloodstream. Using condoms properly is the only protection against this kind of infection.

You cannot get AIDS from kissing someone on the lips, hugging, sharing food and drink or using the same bath or toilet as someone who is HIV positive. (Deep kissing or French kissing can pass on HIV if you have sores in your mouth).

2. Contact with infected blood.

If you have an open wound and it is exposed to the blood of an HIV positive person, you can be infected. This contact could be through using the same needles for drugs or unsafe instruments used for circumcision. It is possible to get HIV if you use the same razor blade or tooth brush as an HIV-positive person if there are any traces of blood on the implement. While you could easily contract HIV from a blood transfusion if the blood is contaminated, all blood in SA is tested for safety. Medical workers can get it from accidentally pricking themselves with needles they have used to inject HIV positive people.

3. Mother to child transmission.

HIV positive mothers can pass the infection to their babies. An estimated 15-30 % of mothers with HIV will transmit the infection during either pregnancy or during childbirth. This happens because of the contact with blood. Another 10-20 % will pass the HIV to the baby through breast milk. A medicine called Nevirapine (antiretroviral treatment) can make it half as likely that a mother will transmit the virus to her child in the womb or during childbirth. If the mother has been taking the full cocktail of antiretrovirals the risk is reduced even more. Using formula instead of breast-feeding can ensure that the baby is not infected through breast milk.

Who is most at risk of contracting HIV?

Anyone can get HIV, but some people are more vulnerable because they do not have the power to say no to unprotected sex or because of their risky lifestyles. The groups who are most vulnerable and have the highest infection rates are:

• Young women between 15 and 30 years old - many of the women in this age group are in unequal relationships where they cannot refuse unsafe sex or are exposed to sexual violence.
• Sexually active men and women who have more than one partner. Although polygamy (having more than one wife) is a custom followed only by some men, many others have a wife and a girlfriend or casual sexual partners. They may get the virus from a casual partner and pass it on to their wife.
• Migrant and mine workers who are separated from their families for most of the year and many of them have sex with sex workers.
• Transport workers who travel a lot and many of them use the services of sex workers.
• Sex workers who are exposed to many partners and are sometimes powerless to insist on safe sex.
• Drug users who share needles – one person who is HIV positive can infect a group of people who share the same needle unless it is sterilised in between usage. Many drug addicts also become sex workers to pay for their drugs.
• People who practice anal sex – the anus can easily be injured during sex because it has no natural lubrication (wetness) and the virus can be passed on unless a condom is used. Women who have anal sex, gay men and other men who have sex with men (for example prisoners), are vulnerable to this form of transmission.

Young women are the most vulnerable because they are often powerless to say no to unprotected sex with an HIV positive partner. They have the highest infection rate of all in South Africa. They are also the most common victims of rape and sexual abuse. Young girls who are virgins are also at risk because of the myth that a person can be cured of HIV or AIDS by having sex with a virgin. This is completely untrue and is just an excuse for child abuse.

It is easier for women to get infected by HIV than men. The virus can easily enter the bloodstream through the vagina. When the vagina is not lubricated (wet), it can be injured during sex and infection happens more easily. Rape and practices like dry sex (where herbs and other materials are used to keep the vagina dry) contribute to the rapid spread of HIV and AIDS among women.

Men and women who have other sexually transmitted diseases (such as syphilis or gonorrhoea) are also more vulnerable because they often have open sores on their private parts.

How can you treat HIV and AIDS?

You can find out whether you are HIV positive by having a free blood test at any clinic or hospital. The results will only be given to you. If you are positive, you should tell your sexual partner so that he or she can also be tested and you should only practice safe sex by using a condom.

There is no cure for HIV, but there are many ways to help people living with HIV to strengthen their immune systems for example:

• by treating the opportunistic infections that are caused by HIV so that people can live longer, for example, by giving people antibiotics to fight diseases;
• by following a healthy diet, exercising and living in a clean and healthy environment;
• by providing counselling and emotional support to the person and his or her family;
• treating people with anti-retroviral drugs.

There are medications that can help to fight the illnesses like pneumonia and stomach infections that easily kill people with AIDS. These infections are called opportunistic infections. Many of the medicines used to fight opportunistic infections are available at clinics and the government is working to get more affordable medicines to people who need them.

Anti-retroviral treatment (ART), when taken properly, can greatly reduce the level of HIV in the body, reduce susceptibility to HIV/AIDS illness and extend the person’s life, sometimes for many years. ART prevents the virus from reproducing and helps prevent further damage to the body. Many people find that, after taking ART for a few months, the level of the virus in their blood is so low that it cannot be detected.

ART cannot, however, repair damage to organs and systems to the body that the virus has already made. Once a person goes on ART, they must accept that they will have to keep taking the medication for many years to come and quite probably for the rest of their lives.

How do HIV and AIDS impact on individuals and society?

The impact on people living with HIV/AIDS

Finding out that you are HIV-positive can be a big shock in itself and can lead to further emotional and physical suffering. There is a lot of ignorance and prejudice about HIV and AIDS and it is often seen as a “death sentence”. Most people are terrified when they are first diagnosed. Some respond by feeling that their lives are over and become very depressed. Many people cannot accept the diagnosis and deny that they are positive to their families and to themselves. Others react with anger and refuse to be responsible and practice safe sex. Many people feel ashamed of their HIV status and think that they will be rejected by their partners and family, or that their communities will isolate them if they are open about being HIV positive.

It takes courage to face this disease and a lot of support is needed to fight it. People with HIV/AIDS can live long and productive lives if they get emotional support, strengthen their immune systems, get proper medical treatment and take good care of their health.

The vast majority of people who are HIV positive do not know it. In South Africa only 15% - 20% of people who are positive have been tested. The people who do not know may be spreading the disease by having unprotected sex. Many of them only realise they are HIV positive when they develop AIDS and get seriously ill.

The impact on families and children

The burden of care falls mostly on the families and children of those who are ill. Often they have already lost a breadwinner and the few resources they have left are not enough to provide care for the ill person and food for the family. Families also suffer the daily stress of looking after someone who is ill and, in many cases, facing death. Many children, especially older female children, have to leave school to look after ill parents.

Children who are orphaned are often deprived of parental care and financial support. More and more orphans are living in child-headed families where no-one is earning an income. Many of them leave school and have no hope of ever getting a decent education or job. These children who grow up without any support or guidance from adults may become our biggest problem in the future. They are more likely to become street children or turn to sex work or crime as a way of surviving.

Older female relatives, mostly grandmothers, are the most likely to take in orphans. Many of them survive on pensions and already live in dire poverty. When their children die and they become responsible for grandchildren, they get a huge extra financial burden and at the same time they lose the financial support they may have received from their children.

Poverty, the economy and HIV/AIDS

People who carry the heaviest burden as a result of HIV and AIDS are the poor. AIDS increases poverty and families are the first to feel the economic effects of having members of the family who have HIV and/or AIDS. Families lose income if an earner is sick. Often another family member stays at home to look after the sick person and further income is lost. Families have also increased costs as they have to spend money on caring for the sick or paying for funerals.

Government spending will also be affected since more and more of the taxes will have to be spent on health care and welfare. Our welfare system may not be able to cope with the number of orphans who need grants. Our health system is already strained to provide basic health care for all diseases and in parts of KwaZulu Natal and Gauteng almost half of hospital beds are taken by people who are ill from AIDS. If government spends more on health and welfare, less money will be available for providing basic services or for spending on development.

In addition, very poor people usually cannot afford the basic requirements for a healthy lifestyle - such as healthy food, a clean environment and clean water. They also cannot afford the costs of basic health care such as transport to clinics or hospitals and vitamin supplements.

So, it is clear that poverty cannot cause HIV or AIDS, but poor people are more at risk of HIV infection and of developing the disease more quickly.

Most of the people who are dying are between the ages of 20 and 45 – an age when most people are workers and parents. This has serious consequences for our economy and the development of the country.

Breaking the silence around HIV/AIDS

Although HIV and AIDS have become very common it is still surrounded by silence. People are ashamed to speak about being infected and many see it as a scandal when it happens in their families. People living with HIV or AIDS are exposed to daily prejudice born out of ignorance and fear. Fear leads to discrimination and victimisation against those living with HIV or AIDS. People have been taught to believe that only gays, prostitutes, people who sleep around and drug users get infected with HIV. They think if you are not one of 'these', you are safe. This makes it easy for some people to discriminate against others and blame them for the disease, while not protecting themselves. And because people fear the discrimination they will face if others know that they are HIV positive, they are afraid to go for an HIV test or to be open about their HIV status.

There are myths around HIV/AIDS and they lead to people seeing it as a scandal that should be kept secret. Many people see those with HIV/AIDS as people who are somehow to blame because they were promiscuous or homosexual. AIDS is seen by some people as a plague that you can catch just from being with someone who is HIV positive. In some communities people with HIV or AIDS have been chased out or attacked. This underlines the great importance of widespread community education efforts because the ignorance and prejudice around HIV/AIDS can be almost as destructive as the disease itself. In some countries AIDS activists have adopted the slogan “Fight AIDS NOT People with AIDS.” (See Running an HIV/AIDS awareness campaign)

In countries where the infection rate has gone down, this only happened after so many people became ill that no-one could pretend it was not happening. Everyone started fearing that they would be next. We cannot afford to wait that long and must find ways of bringing HIV and AIDS into the open.

The challenge for us is to make people fear getting the disease without them turning against those who are already HIV positive. This means that we have to make it easier for people to be open, to go for tests and to seek care. We have to treat it as an illness and not a scandal that has to be kept secret. We must work to ensure respect for and observance of rights and freedoms for people with HIV/AIDS, as well as the avoidance of HIV/AIDS-related discrimination and stigma.

We have to create an environment where communities become more caring towards people living with HIV/AIDS and orphans and we all take responsibility for education around prevention. Although AIDS is a terrible disease that can destroy families and communities, we should never forget that it is also a preventable disease. We can also protect ourselves against becoming infected by the virus.