We are studying four drugs. These drugs are the four most commonly used by women with epilepsy who are pregnant. They are carbamazepine (Tegretol or Carbatrol), phenytoin (Dilantin or Phenytek), valproate (Depakote or Depakene), and lamotrigine (Lamictal). There are generic versions of several of these, in addition to the brand names here. Phenytoin is the oldest of the four—it's been around for over 70 years. Carbamazepine also has been around for quite a while, and it's the one most commonly prescribed for pregnant women with epilepsy. Of the new drugs, lamotrigine is the one that's used most often by pregnant women.
We have a few reports of pregnancies with other new antiepileptic drugs, but the number is not as high as for the other four drugs so we haven't added those. If we try to look at every drug and there aren't many people taking some of them, we won't have much information when we get done. When the sample size is so small, we can't make good conclusions. We'd like to expand the study in the future and put in additional new drugs, but right now other new drugs are not being used at the same rates. They may be used a lot, but not so much in women who are pregnant.
Deciding to get pregnant is possibly one of the most exciting and most monumental decisions a woman can make. Although you may not realize it, it takes a lot more to getting pregnant than you may think. A lot of planning goes into pregnancy such as how should you take care of your body during pregnancy and what can you do to prepare? Have you heard that you should be taking folic acid before pregnancy and special vitamin pills once you become pregnant? Some doctors are now even recommending that you take these good multivitamins before you decide to become pregnant. Do you know that it is best to quite smoking and drinking at least three months before becoming pregnant in order to give your body enough time to cleanse itself of all the toxins? Are you worried that even if you do succeed in getting pregnant you will be lost as to what you should do next?
Babies born to mothers with diabetes do not arrive into this world with the condition. However, if the mother did not control the diabetes before and during her pregnancy, the baby very likely will develop low blood sugar and will have to be monitored very closely after birth to ensure his or her body is making insulin adjustments properly.
One of the frequent effects on babies born to diabetic mothers is their large size at birth. These babies are more likely to become obese and eventually develop Type 2 diabetes later in life. It is imperative they develop excellent lifestyle habits of good diet and exercise to lessen the chance of this occurrence.
Diabetes is a condition in which the body is unable to convert the sugars and starches it takes in as food into energy. The pancreas either produces too little insulin or it is unable to utilize the insulin it does make in order to convert the sugars and starches into energy. The result is the collection of the surplus sugar in the blood and the release of some of the sugar through the urine. The extra sugar in the blood system causes damage to organs such as the heart, eyes and kidneys, if it remains in the body too long.
In developed countries, children can be tested soon after birth (sometimes within 48 hours) using polymerase chain reaction (PCR) tests and other specialist techniques. Where this technology is available, the longest a mother will have to wait for an accurate result is usually around six weeks.
In resource-poor countries, where PCR testing is generally unaffordable or unavailable, a mother may have to wait up to 18 months after giving birth before antibody tests (which are used in adults, and are more commonly available) can be used to accurately diagnose her child. During this time the antenatal clinic, where the mother was probably diagnosed, is likely to lose contact with her.
In some resource-poor countries, ‘dried blood spot’ testing has been introduced in recent years. This is where a small sample of blood is taken from a child, dropped onto paper, and sent to a laboratory where it can be tested. Since these samples do not need to be refrigerated and are easy to transport, they can potentially be sent miles away to places where PCR is available. This means that even children living in resource-poor areas can be tested relatively quickly. However, dried blood spot testing can be expensive and it can take a long time for test results to return. There's also evidence that when the drug nevirapine is used to prevent mother-to-child transmission of HIV, dried blood spot testing doesn't always detect HIV in the first few days of the child's life.
I am a 42 year old Italian guy from Staten Island NY. I have been living with this disease for 10 years going on 11. I was diagnosed in 1996 and from 1996-2000 I was in so much denial I ran the streets as I had before smoking crack and just wanting to get high and higher, because I thought if I was going to die , I was going to die happy and high.
So I thought. After 4 years I saw I was still here and healthy , so to speak. I decided to get help for my addiction and get educated about HIV/AIDS. I am happy and yes even proud to say that I have been clean from the drug of my choice for 6 going on 7 years and have been an HIV/AIDS Outreach Worker, Educator and Test Counselor for the same number of years and still am. I have also been a member of many groups within the government of New York: HIV/AIDS Planning Council, Advisory Group to the Planning Council, HIV/AIDS Advocate, Human and Civil Rights Advocate. I have found my passion and knowing now that it is not a death sentence, just a change of life, I can go out and spread the word that, "WE CAN LIVE" and live a very happy, productive life.
I have been addicted to crack for 12 years and lost everything: my job, my partner after 8 years, my home but mostly myself. I am back now with alot of thanks to many, but mostly to myself because it was me who willing and chose to get the truth and I did. I will persevere in this fight to educate and fight for the rights of HIV/AIDS people and all people who are treated unjustly........ I have never been more content and happy than now.
Anthony J Raiola
Hi my name is Russell a white 20 year old male. What am about to write is a true story about me finding out that I have HIV (Some events have been left out and some names changed), and the truth of what am going though now and back when I found out…
So lets travel back a two weeks ago, I woke up like every other day, the date Sunday the 31st of Aug 2008, it’s the day that will go down in history for being the start of the worst week in my life, but at the same time a new scary beginning. A beginning that I had of read about when I was 16 years old, A STI that around 1100 people in Western Australia live with every day, that we know of. This is how I became that 1101 person.
Here I am getting up out of bed and getting ready for my day the sun was shining the cats where trying to get outside like they do every morning, the time was around 9am. Today was abit different and for me it felt different maybe cos I knew i was about to get tested for HIV, and all the other STI’s who knew all I knew is I had this wierd feeling that something was not right. My closes mate at the time Smith said “I am sure it will be ok.” Just the day before. Smith and I where great close friends some thought that we where an item but we weren’t. Smith and I went back just a few months but for some reason unknown to us we felt like we knew each other for a life time.
I headed out to go to RPH (Royal Perth Hospital) arund 10am I had my appointment at 11am, To get to the city I have to catch the 421 bus and the Striling Train into the city, all the way I was thinking to myself that all I have to do is turn away and go back home and no one would be the wiser. However I had to do it. I had not had a blood test for close to a year and something in me said that I needed to find out if I had anything. All the way sitting on the bus and train I was trying to take my mind off the feeling that I am about to have a test that could change my life. To take my mind off it I started listening to my iPod and one song kept playing and playing. For some reason all I wanted to do was listen to this one song that reminded me of living in foster care and growing up in over 30 different foster homes, going to 20 plus schools, being belted, raped and neally killed. The song Secrets by Anastacia hearing the kids at the start and end of the song made me feel safe while the words stuck out in my mind like my life in a song. Never being able to be a child always having to think fast on my feet, not worrying what some one would say or do to me as long as they did not do it to my sisters or older brother.
Before long I am there waiting in the waiting room to see the Doctor, he was the doctor that three days from now would ring me up and tell me to come in. He asked me when was the last time I had a HIV test I said around a year or maybe more. He looked at his records and it showed that I have not been tested since late 2006, He said that they will do a full STI test which ment anal, mouth, and cock swaps to test for any other STI’s and a blood test to see if I had HIV.
I went from the doctors office into the nurses room standing beside me a young 20 something year old lady who was about to take my blood, I said to her “I might scream, I hate needles.” She replied “Oh there is nothing to be worried about, ill be soft.” Yeah I heard that from many people in the past from other Doctors to the first guy I had sex with.
Before long it was all over and was told that I should be notifided by Wednesday. The day continues on, heading home all I can think about is that what if the test comes back POZ what will I do then, What will my life be like? Will I crash, will I be able to carry on? Oh and the big question was will I still have the strength to keep working on my own business, or will I give up and get a 9 to 5 job?
Tuesday was not that easy I stayed in bed slept for most of the day, I rang Smith at around 10am and just talked he kept saying it will be ok. Being the friend that he is. But deep down I knew something was going to come up and eat me alive.
Wednesday morning comes, I get a phone call around 9am from the Doctor asking me “Hi Russell I need to see you. Can you come in as soon as possible thanks.” I left for RPH straight way did not know what I was going to be told. At first I was thinking HIV then maybe some other STI I was so confussed I just did not know what to do. I got there around 10:30am and went straight in, it was like they where waiting for me ready to take my soul and toss it out the 4th story. I went into his office and I sat down, then I hear “Russell am sorry to say but the test for HIV is positive.” I frooze for a few seconds and just looked amazed. What felt like a life time of silance was around 30 seconds. I said “I was thinking it might come back that way.” I cant believe that I said that really the first words out of my mouth was I thought it might come back that way. What a dick nob.
We talked for about 30min about the T count and how they have to do more testing. That day was going to be a hard one, for what I thought was going to be a 20 min visit soon turned out to being a full day there from 10:30am till 5pm when I was able to get up and go home. It was like a bad dream getting tossed from department to department, getting 9 tubes of blood out and being told that it is a very very rare thing for them to be wrong about this. Still they tested it and the wait was on till Friday when I would finialy find out if I was the next person in WA for that matter in the World to have HIV.
While waiting for the test I had to get back to work working on organzising the Mr. G competitions (This name has been changed in this story to protect the competition.) I had to organize the Melbourne, and Sydney rounds that where coming up search for the hottest male in Australia. The Melbourne rounds that are coming up in a few weeks was my most concerend about event. I took my worry about my health and placed my worry on my business. I need this to be the hottest competition in Australia, I want to show people that not all guys are alike. We're not the way the media likes to show us.
So I kept going working as hard as I have every worked in my life. I called my mate Smith and told him that I was HIV poz and he just froozed hung up the phone and did not return any of my calls, sadly to this day I have no idea what he is doing or if he is ok.
Friday come so fast went in to the doctors and the Dcotor called me in, sat me down and said “Yeah the test come back poz.” I left there feeling down, sad and all alone, who do I tell, who can I tell, who can I trust?
Sitting down writing this is the hardest thing I have had to do today. Realizing that I have HIV well that has not hit me just yet. I told a true friend of mine just two days ago he went to have sex and unlike normal where he would just have bareback sex, he told me he put on that condom and is now going to get himself and his partner tested. He went on to say He would not be able to be me, in the way that I am staying strong and following my future, there is NO WAY that am going to let this little bug kill me. I want to help inform people young and old that its better to have safe sex and get tested every 3 months, other wise they risk ending up like me HIV POZ!!!
During my pregnancy I found out I was HIV+ and it was a day just before Christmas. I went to my doctor for a check up knowing that I had done an HIV test. I didnt expect the results that day but even though the doctor told me he had my results I was not bothered at all because in my mind I was sure I was negative. The doctor went to take my results as my fiance and I were sitting down waiting. He came back and I could see my fiance panicking as he is the one more emotional than I. the doctor set down as he opened my file and read the results to us. You are HIV+, he said. I didnt say anything in shock as my mind just stopped working at all. My God, I said. My doctor continued to speak and giving us advice and telling my fiance to go test as well. He told me about my CD4 count and viral load of which I didnt even hear what he was saying at the time.
My doctor gave a prescription of is called TRIOMUNE 30, it was a very good medicine he said as it was just introduced and was a combination of the HIV meds. As I said it was just a day before Christmas and you can just imagine the mood everyone is in. I was going driving home that day as I like spending my holidays with my family. I am a kind of person that when I find out about something disturbing I switch off and not even feel hurt over it but when it hits me it really does. I got home and we were all happy to be together as we are a only girls at home (5 girls) and my mother is a single parent which I met only in 2004 Dec, 22 yrs at the time. When I first saw my mother she was really struggling and poor with 3kids as my old sister and I were brought up by my dad. Saying anything to my mother would destroy her as she has a soft heart and all of them basically at home are very fragile compared to me.
I didnt want to spoil the holidays for them really and I was the bread winner at home and still am as I said when I found my mom she was really struggling. The night before Christmas I watched all of them busy up and down preparing for Christmas. Cooking, baking and all that and remember that I was still pregnant at the time therefore they just told me to sit there and relax because we were up and down after my doctors appointment buying everything needed. I remember sitting in the lounge alone whist they were playing gospel music so loud. At home we are all Christians and God comes first. As they were busy in the kitchen I just sat there and listened to the music playing, oh God tears started falling from my eyes as I really thought of this deeply this time, what it meant for my unborn baby, what it meant for my future. I cried, really cried because since I had been told the news I had not responded anyhow. Unfortunately my mom saw me and she asked what is wrong now baby. I couldnt say anything but cry. My sisters came as well and my big sister who understood me better than all of them came as well. She said to them no ma dont worry I know she is only crying because she is in worship because of the songs that they were playing. I couldnt stop crying really and my mom started crying as well, it started to be a very sad moment for us now. Just imagine if they cry only because they saw me cry how much more if they had known what was going within me.
I started taking meds to prevent my baby from getting infected and now she is a beautiful 3mnths old and I am so crazy about her. Eventually my fiance went for a test this year as well and he was HIV+ as I knew already because I knew he gave me that disease as I was a very careful in my past relationships. The good thing is that both our CD4 counts are still fine. Mine is 451 and his 351 but my worry is that I was recently tested for TB and it was positive and now I am on treatment and my fiance is. They gave pills for my baby as well to prevent me from giving it to her. My big worry is that I am a smoker and its very hard for me to stop as I am used into and I tried stopping but I always fail. My fiance smokes as well and this is not good for both of us mostly I with TB I know. My life is just a mess at he moment and with every puff I take I think of my baby and I value her and I grew without my mother and I worry that by smoking I am taking the opportunity of leaving a longer life with my kid. She is my princess and I do everything for her hence I got to stop smoking.
Besides all this I know God is my strength I am not only strong because I can do it but because God gives me strength and He sustains me. He is looking after my baby and he is a God of possibilities and He surpasses all circumstance.
To you all out there please take care of yourselves and know that Greater is God than any disease out there, be strong all the time and know that even the person next door might be living with HIV but you dont know as she doesnt know about you, therefore dont feel sorry for yourself. Live your life and be strong. Be healthy.
Although injecting drug users constitute a risk group in themselves, there is also an overlap between drug addiction and those involved in sex work. Individuals who fall into both categories are therefore particularly vulnerable to HIV and are perhaps doubly stigmatised. The link between substance abuse and sex work is hard to pinpoint though there are a variety of factors that are common to both including homelessness, unstable family lives, socio-economic deprivation, disrupted schooling, local authority care and coOne study of UK cities found 63% of people who sold sex outdoors did so mainly to pay for drugs. Heroin was the most commonly used drug, with 78% having used it, and just under half the sample had injected drugs in the previous month.30 UNAIDS believes that the spread of HIV in several North African and Middle Eastern countries is being facilitated by a combination of injecting drug use and sex work with one third of IDUs having paid for or sold sex. In Syria 53% of drug users have sold sex, with 40% of these saying they had never used condoms.31 One study of Sichuan province, China, reported similar rates, around 56%, of female IDUs who sell sex.32
IDUs who are sex workers put themselves at risk and also facilitate the transmission of HIV between population groups. Looking at the spread of HIV among the two risk groups in Jakarta, Indonesia, the Commission on AIDS in Asia found that infection levels began to increase within commercial sex networks only after the epidemic among injecting drug users had reached significant levels.33Sexual risk behaviour related to drug use should not just be considered within the bounds of sex work. While the impact of drugs on sexual behaviour may vary by drug, length of use, sexual identity, and other factors, there are a number of effects related to drug use that could influence unsafe sexual behaviour. HIV transmission may be facilitated among drug users and their sexual partners if the user is sexually stimulated or disinhibited by drugs.
Injecting drugs for purposes not prescribed by a doctor is illegal worldwide, and the criminalisation of drug use and possession can hinder attempts to engage IDUs with available HIV services. There have been documented incidences of Ukrainian police arresting and beating IDUs near needle exchanges for possessing used and sterile syringes.20 Police in Thailand have reportedly acted similarly despite possession of syringes being legal in the country.21 It is estimated that 40% of countries have laws that interfere with their ability to reach injecting drug users.22
IDUs who find themselves on the wrong side of the law and in confrontation with the police may be mistrustful of the authorities in general and hesitate to seek treatment or take advantage of prevention initiatives in the first place. Following a major drug operation by Vancouver police in the Downtown Eastside district, in which there were reported cases of unnecessary force and illegal search and seizure, the number of sterile syringes provided nightly by a local needle exchange program dropped by a third.
There are several possible reasons as to why drugs are injected rather than taken in other forms. The UNDP HIV and Development Programme suggests these include the availability of drugs that can be injected, linked to production locations and trafficking routes; that it is a cheaper and more rapidly acting method; the sharing of knowledge about such techniques that comes from migrating drug users; and so none of the drug becomes lost in smoke, especially when drug control efforts reduce its availability.7
The UNDP estimates that the most common change in drug consumption patterns is the move from the smoking of opium to the injecting of heroin and other drugs as a result of law enforcement.8 Populations in developing nations have become more exposed to new methods of drug taking, including injecting, as refinement of drugs into injectable forms has been forced from more developed nations and closer to production areas.
In Pakistan, for example, the last 10 to 15 years has seen a shift from the inhalation and smoking of heroin, to the injecting of heroin and synthetic drugs. Injectors of heroin are an ever growing proportion of total heroin users rising from less than 2 percent in 1993 to 15 percent in 2000 to more than a quarter in 2007. This is largely attributed to aggessive drug control measures that have reduced supply, boosted the cost, and made injecting a more economically viable method of consumption.9
One HIV-positive IDU in Pakistan described the scarcity and growing cost of heroin as the primary reason for switching from inhaling to injecting:
People take drugs, both legal and illegal, for a variety of reasons that will differ from person to person and from drug to drug. Individuals may enjoy the sense of detachment or euphoria that drugs create, their relaxing or energy-inducing properties, the heightened alertness or sensitivity they produce, and their medicinal qualities. Peer pressure or habit may be other reasons, and if they are chemically dependent, addicts will feel they cannot operate without them. These reasons will depend on an individual’s own background and socio-economic circumstances.
Drugs can be taken in a variety of ways including drinking, smoking, snorting and rubbing, but it is the injection of drugs that creates the biggest risk of HIV transmission.
According to British guidelines, HIV testing should be offered at GUM clinics as part of routine STD screening, regardless of symptoms of disease or risk factors of infection. The guidelines state that everybody taking an HIV test should have a pre-test discussion, and be offered counselling if requested, or if there is a high risk of a positive result.28
The number of people being tested for HIV and other STDs at GUM clinics (where the majority of people are tested for HIV) has risen in recent years. Almost half of sexual health screens in 2003 included an HIV test; this proportion increased to two-thirds for England, Wales and Northern Ireland in 2006. Overall, around 800,000 had an HIV test in a GUM clinic in England, Wales and Northern Ireland in 2007HIV prevention in the UK currently includes measures to educate people about HIV/AIDS and how it is passed on so that they can take measures to protect themselves (by using condoms for example); encourage harm reduction measures for drug users (such as needle exchange programmes); and promote HIV testing.
It is widely felt by those working in HIV/AIDS organizations and the healthcare sector that HIV prevention in the UK needs to be stepped up and improved as the number of new infections continues to rise as the level of knowledge of the virus falls.
Although AIDS gets less attention from the media in the UK than it did during the early history of the UK AIDS epidemic, it’s far from a problem of the past. In fact, the epidemic has expanded, with the annual rate of new HIV diagnoses more than doubling between 1999 and 2003, and peaking in 2007.2
HIV prevalence in the UK is relatively low and currently stands at 0.2% of the population3. Statistics show that at the end of 2007 there were an estimated 77,400 people living with HIV in the UK, of whom approximately 20,700 were unaware of their infection. An estimated 7,734 people were newly diagnosed with HIV in the UK in 2007.4
Relatively low numbers of people in the UK have died from AIDS in recent years thanks to the availability of HAART (Highly Active Antiretroviral Therapy), which dramatically increases the life expectancy of people living with HIV. In 2007, around 540 HIV-infected persons died, compared to 1,726 in 1995, when antiretroviral treatment for HIV/AIDS was not available. The majority of AIDS related deaths occurred because people were diagnosed late and therefore did not start treatment early enough. In 2007, an estimated 31% of newly diagnosed, HIV-infected adults were diagnosed late.5
Although HIV is often perceived to be a ‘gay’ problem, infections acquired through heterosexual sex account for the largest number of HIV diagnoses in the UK. The majority of people who acquired HIV heterosexually were infected overseas but only became aware of their status after being tested in the UK. In terms of HIV infections actually occurring within the UK, gay men (and other men who have sex with men) accounted for two thirds of new cases.6
Despite the rising numbers of new HIV infections in the UK, public knowledge of HIV and AIDS appears to have declined. While 91% of people in the UK knew that HIV was transmitted through unprotected heterosexual sex in 2000, by 2007 this figure had fallen to 79%7.
Many UK HIV/AIDS organisations are calling for improved sexual health services. The Terrence Higgins Trust, for example, released a 2007 report stating that sexual health services in England remain woefully under prioritised and under funded. It claims that despite the government’s promise of an extra £300 million for sexual health services across the United Kingdom to modernise clinics and reduce waiting times, many GUM (Genitourinary Medicine) clinics remain cramped, out-of-date and understaffed
Due largely to their close geographic locations, the Caribbean is usually grouped with Latin America in discussions about HIV and AIDS, but the epidemics in these regions are very different. Even within the Caribbean, each country faces a unique situation. The diversity of the region – which is apparent in terms of politics, languages spoken, geographic location and wealth – is reflected in the significantly different ways that countries are affected.
At one extreme, the Bahamas has the highest HIV prevalence in the entire western hemisphere (3%); at the other, Cuba has one of the lowest (0.1%). Haiti (2.2%), Trinidad and Tobago (1.5%) and Jamaica (1.6%) are all heavily affected, while Puerto Rico is the only Caribbean country apart from Cuba where it is thought that less than 1% of the population is living with HIV. 2 Other factors, such as AIDS mortality rates and transmission patterns, also vary across countries and areas. 3 See our Caribbean statistics page for more data.
Recent developments have given cause for optimism, with an overall stabilisation in the region. A small number of countries in the Caribbean have even shown signs of a decline in prevalence. In the Dominican Republic prevalence fell from 1% in 2002 to 0.8% in 2007. HIV infection levels have also decreased in Haiti, which has been partly attributed to an increase in condom use and changes in sexual behaviour. 4 However, HIV surveillance in the Caribbean is generally considered inadequate, so these reported trends are only vague indicators. Both HIV prevalence and AIDS cases are thought to be widely underestimated in the region. 5
Reflecting global patterns, heterosexual sex is now the main route of transmission throughout the region, and it has been established that women and young people are particularly vulnerable. 6 Little is known about the role that sex between men plays in the region’s epidemics – it has been estimated that men who have sex with men account for 12% of infections, but it is thought that the actual proportion is higher than this, since the rampant homophobia that exists throughout the region has led to denial and under-reporting.7
Despite differences between countries, the spread of HIV in the Caribbean has taken place against a common background of poverty, gender inequalities and a high degree of HIV-related stigma. Migration between islands and countries is common, contributing to the spread of HIV and blurring the boundaries between different national epidemics. 8 Additionally, poor availability of HIV and AIDS data makes it difficult to gain a clear picture of each country’s situation.
With many women who are HIV-positive still not receiving drugs that could prevent them passing HIV to their babies, HIV infections are alarmingly common amongst children in South Africa. According to UNAIDS, there were around 280,000 children aged below 15 living with HIV in South Africa in 2007.27
Children who are living with HIV are highly vulnerable to illness and death unless they are provided with paediatric antiretroviral treatment. Unfortunately there is still a shortage of such treatment in South Africa. The AIDS Law Project, an NGO based in Johannesburg, estimated that 50,000 children in South Africa were in need of antiretroviral drugs at the beginning of 2006, but that only around 10,000 were receiving them.28 UNAIDS estimates that at the end of 2005, children accounted for 8% of those receiving antiretroviral drugs in South Africa.29
As well as many children being infected with HIV in South Africa, many more are suffering from the loss of their parents and family members from AIDS. UNAIDS estimated that there were 1.4 million South African children orphaned by AIDS in 2007, compared to 780,000 in 2003.30 Once orphaned, these children are more likely to face poverty, poor health and a lack of access to education.
Although HIV prevention campaigns usually encourage people to use condoms and have fewer sexual partners, women and girls in South Africa are often unable to negotiate safer sex and are frequently involved with men who have several sexual partners. They are also particularly vulnerable to sexual abuse and rape, and are economically and socially subordinate to men. Police reports suggest that in 2004-2005 there were at least 55,114 cases of rape in South Africa 23, although the actual figure is undoubtedly higher than this since the majority of cases go unreported. In a 2006 study of 1,370 South African men, nearly one fifth revealed that they had raped a woman.24 Rape plays a significant role in the high prevalence of HIV among women in South Africa.
Women often face more severe discrimination than men if they are known to be HIV-positive. This can lead to physical abuse and the loss of economic stability if their partners leave them. Since antenatal testing gives them a greater chance of being identified as HIV-positive, women are sometimes branded as ‘spreaders’ of infection.
The government has acknowledged that many women face ‘triple oppression’ in South African society – oppression on the grounds of race, class and gender – and has been making efforts to address this problem, through education and skills development schemes.25 In September 2007 rape laws were strengthened to stop judges and magistrates taking into account factors such as a rape victim's sexual history, their apparent lack of physical injury, or the relationship between the victim and the perpetrator, when deciding on the length of the perpetrator's sentence.HIV voluntary counselling and testing (VCT) should be an important part of any country’s response to AIDS. The number of VCT sites in South Africa has increased significantly in recent years, with 4,172 operational by November 2006. Despite this progress, there are concerns about the quality of VCT services in some areas. Reports suggest that counsellors are not always adequately trained, may lack medical knowledge about HIV, and are often overworked.14
Another problem is that women seem to be accessing testing more readily than men in South Africa. Researchers believe that this is due to fears amongst men that their HIV-positive status will be disclosed through testing, and that stigmatisation will follow. Surveys have also suggested that some men see no value in knowing their HIV status, viewing such knowledge as a burden.15
South Africa’s national HIV treatment programme has been the topic of much debate. The South African government was initially hesitant about providing antiretroviral treatment to HIV-positive people, and only started to supply the drugs in 2004 – years after many other nations had begun to do so – following pressure from activists. Even since 2004, the distribution of antiretroviral drugs has been relatively slow, with only around 28% of people in need receiving treatment at the end of 2007.13
The government was also initially reluctant to provide drugs that could prevent HIV-positive mothers from passing HIV on to their babies, and has been accused of not making enough effort to get these drugs to women that need them.
The slow provision of treatment has been linked to unconventional views about HIV and AIDS amongst the government. Alongside President Mbeki’s questioning of whether HIV really causes AIDS, his health minister Manto Tshabalala-Msimang caused controversy by promoting nutrition rather than antiretroviral drugs as a means of treating HIV. These views attracted widespread criticism, both within South Africa and amongst the international community.
See our AIDS in South Africa: treatment, transmission and the government page for a full account of the issues surrounding antiretroviral drug provision, misinformation, and mother-to-child transmission of HIV in South Africa.
South Africa has had a turbulent past, and this history is relevant to the explosive spread of HIV in the country.
1980s - In 1985, a State of Emergency was declared in South Africa that would last for five years. This was a result of riots and unrest that had arisen in response to Apartheid, the system of racial segregation that had been in place since the 1950s. Apartheid prohibited mixed-race marriages and sex between different ethnic groups, and categorised separate areas in which different races lived. In the same year, the government set up the country’s first AIDS Advisory Group in response to the increasingly apparent presence of HIV amongst South Africans. The first recorded case of AIDS in South Africa was diagnosed in 1982, and although initially HIV infections seemed mainly to be occurring amongst gay men, by 1985 it was clear that other sectors of society were also affected. Towards the end of the decade, as the abolition of Apartheid began, an increasing amount of attention was paid to the AIDS crisis.
1990 - The first national antenatal survey to test for HIV found that 0.8% of pregnant women were HIV-positive.9 It was estimated that there were between 74,000 and 120,000 people in South Africa living with HIV. Antenatal surveys have subsequently been carried out annually.
1991 - The number of diagnosed heterosexually transmitted HIV infections equalled the number transmitted through sex between men. Since this point, heterosexually acquired infections have dominated the epidemic. Several AIDS information, training and counselling centres were established during the year.
1992 - The government’s first significant response to AIDS came when Nelson Mandela addressed the newly formed National AIDS Convention of South Africa (NACOSA). The purpose of NACOSA was to begin developing a national strategy to cope with AIDS. The free National AIDS Helpline was founded.
1993 - The National Health Department reported that the number of recorded HIV infections had increased by 60% in the previous two years and the number was expected to double in 1993. The HIV prevalence rate among pregnant women was 4.3%.
1994 - The Minister for Health accepted the basis of the NACOSA strategy as the foundation of the government's AIDS plan. There was criticism that the plan, however well intended, was poorly thought-out and disorganised. The South African organisation Soul City was formed, with the aim of developing media productions to educate people about health issues, including HIV/AIDS.
1995 - The International Conference for People Living with HIV and AIDS was held in South Africa, the first time that the annual conference had been held in Africa. The then Deputy President Thabo Mbeki, acknowledged the seriousness of the epidemic, and the South African Ministry of Health announced that some 850,000 people - 2.1% of the total population - were believed to be HIV-positive.10
1996 - The HIV prevalence rate among pregnant women was 12.2%.
1997 - The HIV prevalence rate among pregnant women was 17.0%. A national review of South Africa's AIDS response to the epidemic found that there was a lack of political leadership.
1998 - The pressure group Treatment Action Campaign (TAC) was founded, to campaign for the rights of people living with HIV, and to demand access to HIV treatment in South Africa for all those who were in need of it. Deputy President Thabo Mbeki launched the Partnership Against AIDS, admitting that 1,500 HIV infections were occurring every day.
1999 - The HIV prevalence rate among pregnant women was 22.4%.
2000 - The Department of Health outlined a five-year plan to combat AIDS, HIV and STIs.11 A National AIDS Council was set up to oversee these developments. At the International AIDS Conference in Durban, the new South African President Thabo Mbeki made a speech that avoided reference to HIV and instead focused on the problem of poverty, fuelling suspicions that he saw poverty, rather than HIV, as the main cause of AIDS. President Mbeki consulted a number of ‘dissident’ scientists who rejected the link between HIV and AIDS.
2001 - The HIV prevalence rate among pregnant women was 24.8%.
2002 - South Africa's High Court ordered the government to make the drug nevirapine available to pregnant women to help prevent mother to child transmission of HIV. Despite international drug companies offering free or cheap antiretroviral drugs,12 the Health Ministry, led by Manto Tshabalala-Msimang, remained hesitant about providing treatment for people living with HIV.
2003 - In November, the government finally approved a plan to make antiretroviral treatment publicly available. The HIV prevalence rate among pregnant women was 27.9%.
2004 - The South African government’s treatment program began to take effect in Gauteng in March, followed shortly afterwards by other provinces.
2005 - At least one service point for AIDS related care and treatment had been established in all of the 53 districts in the country by March, meeting the government’s 2003 target. However, it was clear that the number of people receiving antiretroviral drugs was well behind initial targets. The HIV prevalence rate among pregnant women was 30.2%.
2006 – Jacob Zuma, the Former South African Deputy-President, went on trial for allegedly raping an HIV-positive woman. He argued that she had consented to sex and was eventually found not guilty, but attracted controversy when he stated that he had showered after sex in the belief that this would reduce his chances of becoming infected with HIV. Criticism of the government’s response to AIDS heightened, with UN special envoy Stephen Lewis attacking the government as ‘obtuse and negligent’ at the International AIDS Conference in Toronto. At the end of the year, the government announced a draft framework to tackle AIDS and pledged to improve antiretroviral drug access. Civil society groups claimed that this marked a turning point in the government’s response.
2008 – President Mbeki resigned in September 2008 after losing the support of his party. Kgalema Motlanthe took over as interim president and appointed Barbara Hogan as health minister in place of Manto Tshabalala-Msimang. AIDS activists welcomed the changes, anticipating greater government commitment to the AIDS response.
Having sex does not usually hurt, though first time sex may be a bit uncomfortable for a woman because her hymen (a thin layer of skin that partially covers the entrance to the vagina) may be stretched or torn. This may cause a little bleeding, but it does not usually last long. Sex is not usually painful for a man.
After the first time, sex should become more comfortable. The vagina is very stretchy and will usually accommodate a penis (even a large one) with ease. However, a woman may experience pain when having sexual intercourse if her vagina does not produce enough natural lubrication. Extra vaginal fluids are usually produced when a woman becomes sexually excited to allow the penis to enter the vagina easily. If a woman is tense or rushing when she has sex, her vagina may not become moist enough to allow the penis to move in and out smoothly. Stress can also cause the muscles in the vagina to involuntarily tense up, making penetration difficult and painful. The best way to ensure pain free sex is for both partners to relax and take their time.
Extra lubrication might also help, and can be bought from many chemists and some supermarkets. When using a condom, it is very important that a water-based lubricant (like KY jelly) is used, as oil-based lubricants like Vaseline can cause the condom to disintegrate.
It depends what you mean by having sex. Sexual intercourse is sometimes called making love or having sex. The most common definition of sexual intercourse is an act that involves a man putting his erect penis inside a woman's vagina. Sexual intercourse might also be used to refer to sex acts between two men or between two women.
Sexual intercourse between a man and a woman starts with them both getting sexually excited. This is sometimes referred to as foreplay, and might involve kissing and cuddling, touching each other and other sexual activities. Foreplay is important as it means a woman's vagina begins to get moist and a man gets an erection. If the woman's vagina does not get moist enough, then having sexual intercourse could be difficult or painful for her.
If a man and woman are having sexual intercourse, then using a contraceptive properly, every time, will prevent the woman becoming pregnant. There is more information on the contraceptive page.
If two people have sex (sexual intercourse) and one of them has a sexually transmitted disease (STD) then they could pass it on to the other person. Using a condom is the best way to prevent any infection from being passed from one person to the other.
If a couple are going to use a condom for protection against pregnancy or infections, they should put it on the man's penis as soon as he gets an erection. Some men say they worry about using condoms in case they lose their erection or have difficulty putting the condom on. You could get some condoms and practice beforehand. Condoms come with instructions in words and pictures which show exactly how to use them.
After the condom is on, the man or woman can guide his penis into her vagina. The couple then move their bodies so that his penis moves up and down inside her vagina. This usually rubs the penis and makes the man sexually excited so that he has an orgasm. The movement might also rub the woman's clitoris (or sensitive areas inside her vagina) so she can have an orgasm. But this depends on the position the couple are in when they have sexual intercourse.
A major constraint is the high cost of ARVs, as both first- and second-line drugs are still unaffordable to most governments. Cheaper generic drugs are now produced by a number of pharmaceutical manufacturers in Asia, and together with the increasing availability of lower-cost branded ARVs, it’s hoped that this will make it easier for governments to obtain and distribute the drugs. Yet even where drugs are available, the poor state of healthcare in many Asian countries, particularly a shortage of trained doctors, is hindering governments' abilities to organise life-long treatment programmes for millions of people living with HIV
Asia has been the base for some extremely successful large-scale HIV prevention programmes. Well-funded, politically supported campaigns in Thailand and Cambodia have led to significant declines in HIV-infection levels, and HIV prevention aimed at sex workers and their clients has played a large role in these achievements. The Indian state of Tamil Nadu is another area where HIV prevention has had a substantial impact. Here high-profile public campaigns discouraged risky sexual behaviour, made condoms more widely available, and provided STI testing and treatment for people who needed them. These efforts resulted in a large decline in risky sex.15
Successes such as these prove that interventions can change the course of Asia's AIDS epidemics. As HIV infection rates continue to grow however, it's clear that more needs to be done. The groups most at risk of becoming infected – sex workers, IDUs, and MSM – are all too often being neglected. For instance, although injecting drug use is one of the most common HIV transmission routes in Asia, it is estimated that less than one in ten IDUs in the region have access to prevention services.16 Similarly men who have sex with men are overlooked and poorly monitored by most governments, even though it is firmly established that this group play a significant role in some countries’ epidemics.17
Due to the stigma that often surrounds those groups most at risk of HIV infection, coverage of HIV testing and counselling services in South-East Asia remains very low. An estimated 0.1% of the adult population in the region received testing and counselling in 2005.18
Progression is being made in China though where free HIV testing has been made available at more than 3000 sites in all 31 provinces of the country.
Testing services in India have also been expanded recently with about 3600 testing centres now open to the public.19
Despite efforts being made across the region, more still needs to be done to make testing available to those most at risk.
The coverage of prevention of mother-to-child transmission (PMTCT) services is also very low in Asia. In South-East Asia, less than 5% of pregnant women are offered HIV counselling and testing.20 Across East, South and South-East Asia, the proportion of HIV-infected pregnant women receiving ARVs is just 5%.21
See our HIV prevention around the world page for more about efforts to stem the spread of HIV in Asia and other parts of the world.
In the early to mid-1980s, while other parts of the world were beginning to deal with serious HIV & AIDS epidemics, Asia remained relatively unaffected by this newly discovered health problem. By the early 1990s, however, AIDS epidemics had emerged in several Asian countries, and by the end of that decade, HIV was spreading rapidly in many areas of the continent.
Today, HIV/AIDS is a growing problem in every region of Asia. East Asia has been identified by UNAIDS as one of the areas of the world where ‘the most striking increases’ in the numbers of people living with HIV have occurred in recent years (along with Eastern Europe and Central Asia).1 Although national HIV prevalence rates in Asia appear to be relatively low (particularly in comparison with sub-Saharan Africa), the populations of some Asian countries are so vast that these low percentages actually represent very large numbers of people living with HIV. The latest statistics compiled by UNAIDS suggest that at the end of 2007, 5 million people were living with HIV in Asia.2
Various factors make Asia vulnerable to the spread of HIV, including poverty, inequality, unequal status of women, stigma, cultural myths about sex and high levels of migration.3 4 Some experts predict that Asia may eventually overtake Africa as the part of the world with the highest number of HIV-infected people. Others, however, argue that Asia’s epidemics are on a different trajectory to those found in Africa, as HIV infection in Asia is still largely occurring among members of ‘high-risk groups’, unlike Africa where HIV and AIDS are widespread amongst all sections of some countries’ populations.5
Although its useful to understand the overall impact that AIDS is having on the Asian region as a whole, there is no single ‘Asian epidemic’; each country in the region faces a different situation.
Thailand once led the way in world HIV prevention, with a series of successful campaigns that helped to reduce the national HIV prevalence. However, in the new millennium there were signs of complacency; prevention programmes received just 8% of the national HIV/AIDS budget in 2000, and by 2001 the level of domestic funding for HIV prevention was half of what it had been in 1997.36 In 2006, UNAIDS reported that Thailand’s government had reduced its HIV prevention budget by two-thirds.37
There were concerns that the declining focus on prevention was putting the public at risk. Reports suggested that condom use had decreased and the rate of STI transmission had risen.38 39 Without new prevention campaigns, there was a risk that safe sex messages would be forgotten and a new generation of young people would grow up ignorant of the risks that they face.
In September 2006 following a military coup, a new Thai government was installed. In light of the concerns about a resurgence of the epidemic, the new government decided to increase HIV/AIDS prevention efforts. In 2007 a three-year strategic plan was announced which would focus on those most at risk of HIV infection and difficult-to-reach groups.40
| Thailand Statistics31 | |
|---|---|
| Estimated total population, 2008 | 65,493,000 |
| Estimated number of people living with HIV, end 2007 | 610,000 |
| Adults (15+) | 600,000 |
| Women (15+) | 250,000 |
| Children (0-15) | 14,000 |
| Estimated adult HIV prevalence | 1.4% |
| Estimated number of AIDS deaths in 2007 | 31,000 |
At the same time, public awareness of the issue was increasing. The case of Cha-on Suesom, a factory worker who became infected with HIV following a blood transfusion, was widely broadcast through the media after he agreed to allow his story and identity to be publicised in 1987. He became well known after appearing on TV shows and in national newspapers, allowing the public to appreciate the human side of the epidemic. Cha-on and his wife had both been fired from their jobs as a result of his HIV-positive status, and the injustice of this situation helped to increase public sympathy for people living with HIV. 6
Between 1988 and 1989, the HIV prevalence among injecting drug users rose dramatically, from virtually zero to 40%. The prevalence among sex workers also increased, with studies in Chang Mai, northern Thailand, suggesting that 44% of sex workers were infected with HIV.7 The rising level of infection among sex workers led to subsequent waves of the epidemic among the male clients of sex workers, their wives and partners, and their children.8
The prevailing view was still that HIV and AIDS had come from abroad and were mostly confined to a few individuals in high-risk groups. It was still not generally recognised that the epidemic would spread more widely. One government official insisted that the situation was under control, and stated that:
“The general public need not be alarmed. Thai-to-Thai transmission is not in evidence.”9
Some members of Thailand’s parliament proposed that all foreigners should be required to pass an HIV test before being admitted to the country.10 In keeping with the view that the threat was limited, the government only spent $180,000 on HIV prevention in 1988.11
One of the main barriers to effective HIV prevention is that the majority of people infected with HIV in China are not aware of their positive status. HIV testing is important so that those found to be infected with the virus can seek treatment and take measures to prevent transmission to others. Little over a quarter of those questioned in a 2008 survey knew where they could get tested.74
Until recently people in China were only tested for HIV through voluntary counselling and testing (VCT) schemes. Although these VCT sites still exist, in 2004 the government launched a national programme of ‘active testing’ to seek out certain high-risk groups. Under the new policy, community health leaders initiate outreach schemes to invite members of the targeted groups to be tested. The new policy was launched in Yunnan province in 2004 and found that of the 424,000 people targeted, only 1.3% refused the test. 13,486 people (3.2%) were found to be HIV positive.
Although the Chinese government consider outreach ‘active testing’ to be successful for the increased number of people identified as HIV positive (in Yunnan the number of people found to have HIV was equivalent to the total number identified through voluntary testing in the previous 18 years) some experts have voiced concern over the human rights of those being tested. There is unease that ‘active testing’ may be placing community protection over individual rights. The tests may not be entirely voluntary due to the significant social pressure to be tested. Additionally social marketing campaigns promoting HIV awareness and addressing misconceptions are often used in place of individual pre- and post test counselling75.
Routine testing (whereby people are tested as part of an annual medical check up) has also been introduced in institutional settings such as prisons and government offices76. This method of HIV testing has also provoked criticism as individuals consent to health examinations that include an HIV test, rather than directly agreeing to the test itself77.
In the first seven months of 2008, China conducted random HIV tests on some 756,000 travellers at border crossings. HIV positive foreigners are generally barred from entering China, though it is expected that this ban may be lifted in 200978.
The AIDS epidemic in China consists of several different sub-epidemics that often overlap and intersect with each other. High prevalence groups in China include injecting drugs users, men who have sex with men, former plasma donors, commercial sex workers and migrant workers. UNAIDS predicts that amongst these sub-populations, there are an estimated 30–50 million people who are at risk of exposure to HIV23.
Although it is customary to associate HIV/AIDS in China with these high-risk groups, boundaries are becoming increasingly blurred as the virus finds its way into the general population, and sex becomes the dominant transmission route24.
In 2007 there were a reported 937,000 registered injecting drug users in China27, although unofficial estimates put the number closer to three or four million.
A zero tolerance attitude to drug use meant that the government was slow to implement HIV prevention and control measures for IDUs. Prevention activities tended to focus on posters outlining the harmful effects of drug use, or concentrated on reducing supply and demand.
In the late 1990s the Chinese government began to show a change in attitude towards preventing HIV transmission among injecting drug users28.
A pilot began in Guangdong in 2000. After initial positive results showed that participants were almost three times less likely to have shared needles in the past month, the programme was scaled up to approximately 92 sites in high prevalence regions29. China now has more drug replacement clinics and needle social marketing programmes than any other country in Asia30.
Further interventions for IDUs were also explored and in 2004 a methadone maintenance treatment programme was piloted. The programme found that the rates of heroin use, intravenous injection and crime related to drug use decreased in the pilot areas31. By September 2006 there were 307 methadone clinics in China, covering two thirds of the country's provinces.
By late 1994 it was clear that the reported AIDS cases amongst IDUs in Yunnan had signalled the beginning of an epidemic amongst drug users. National figures for HIV infection were growing quickly – in 1996 the Minister of Health, Chen Min-Zhang, put the number of infections at between 50,000 and 100,00012 - and new cases were being reported in more regions. By 1998, HIV infections had been reported in all 31 provinces, autonomous regions and municipalities, with drug users accounting for 60-70% of reported infections13.
The sharp increase in AIDS cases in China in the 1990s was also attributed to a large number of people infected through blood donation, which was widely reported by the western press, as well as transmission through heterosexual sex, which increased steadily to represent 7% of all HIV infections14.
There was a notable shift in government response to the epidemic in the new millennium. On World AIDS Day 2001, stories and testimonials of those infected with HIV alongside a television drama about AIDS reflected a far greater willingness to discuss the emerging epidemicIn 2003, the Health Minister’s change in attitude was evident, it is widely felt that the 2003 SARS epidemic prompted the change as it demonstrated to the government the impact public health could have on social and economic stability. He described the fight against AIDS as a "long-term war" and, as well as showing a new willingness to accept overseas assistance, requested that China’s AIDS budget of US$12.5 million be doubled.17.
On World AIDS Day 2003, Wen Jiabao became the first Chinese premier to shake hands with an HIV-positive person
China’s first AIDS case was reported in Beijing in 19856. In the following five years a small number of further cases were reported among foreigners and Chinese, who were infected overseas or by imported blood products7.
During the early stages of the AIDS epidemic the Health Ministry concentrated its prevention efforts on the risk of infection from abroad. In 1986 it announced that it planned to test all foreign students for AIDS who had been in the country for more than a year, and students entering China would require a certificate from their country of origin testifying that they were not infected with HIV8. Although a National Programme for AIDS Prevention and Control was set up in 1987, the Public Health Authorities reported that AIDS would not become established as homosexuality and "abnormal" sexuality - thought to be the main causes of the spread of HIV - were a "limited" problem
Although voluntary testing is officially supported in India, some states have tried to implement policies that would force people to be tested for HIV against their will. In Goa, the state government recently planned to make HIV tests compulsory before marriage, and in Punjab it has been proposed that all people wishing to obtain or retain a driver’s license should be tested for HIV. 44 Neither of these plans has come to pass, but they have concerned activists, who argue that HIV testing should never be imposed on people against their wishes.
Unfortunately, cases of people being tested without their consent or knowledge are common in Indian hospitals. In one 2002 study, it was suggested that over 95% of patients listed for surgical procedures are tested against their will, often resulting in their surgery being cancelled. 45 Hospital staff and health professionals, much like the rest of the Indian population, are often unaware of the facts about HIV. This leads to unnecessary fears and, in some cases, causes them to stigmatise HIV positive people and discriminate against them, including testing them without consent.
