HIV isn’t spread through casual contact with other people,
such as hugging, sharing cutlery or shaking hands – the virus simply doesn’t
survive long outside of the body. It’s also not spread through sweat, tears,
vomit, faeces or urine.
The virus is spread by means of direct contact with an
infected person’s semen, vaginal fluid, blood or breast milk. HIV is most
commonly spread through unprotect vaginal, anal and oral sex. It’s also often
spread by people who inject drugs (and who use the same needles as an infected
Start by following these steps to reduce your risk of
your HIV status. If you don’t get tested, you won’t know if
you’re HIV positive or not. During the
first three months of infection (the ‘window period’), it’s hard to pick up the
virus in the body. That’s why testing every six months is the best way to be
• Know your partner’s HIV status. You and your partner should both get tested
before you have sex for the first time. You can’t rely on being this person’s
only sexual partner. People are sometimes reluctant to disclose their sexual
• Never have sex without a condom. You simply have to make this a rule if you
want to reduce your chances of becoming HIV positive. Make sure you know how to
use a condom correctly.
• Practise safe sex. Kissing, erotic massage and mutual
masturbation are all examples of safer sex activities. You can’t get HIV from
doing these things. Oral sex without a condom or dental dam isn’t recommended,
but it’s still safer than having unprotected sex.
• Be faithful. Don’t sleep around. If you and your
partner have both been tested, you’re both HIV negative and you’re faithful to
one another, you can’t get HIV from sexual contact. Experts recommend that you
have two HIV tests six months apart when neither of you has had any new sexual
partners in between. It’s the only way to be sure.
• Avoid having sex. This isn’t easy for most people, but it’s the
one way of making absolutely sure that you don’t become HIV positive as a
result of sexual contact. If you’re still a virgin, try to delay your sexual
• Stay away from drugs. If you’re unable to do this, make sure
you use clean needles and equipment and that you don’t share needles with other
drug users. Note that one of the consequences of drug use is also that being
high can make you forget about the rules of safe sex.
• Avoid blood contact. If you’re helping a bleeding person, avoid
getting any of their blood into any sores or cuts you may have on your skin.
Also protect your eyes and mouth. There should be gloves in all first-aid kits
– use them.
• Transmission in pregnancy. If you’re pregnant and don’t know your HIV
status, get tested. If you’re HIV-positive, taking antiretroviral treatment
(ART) during your pregnancy and when you deliver the baby will greatly reduce
the chances of transmitting HIV to your baby.
• Consider circumcision. This procedure, in which the foreskin of the
penis is removed, has been shown to reduce the risk of HIV transmission from
women to men.
• Take action if you’ve been exposed to HIV. Post-exposure prophylaxis (PEP) means
taking antiretroviral treatment after you’ve been exposed to HIV. It must be
taken within 72 hours of exposure and reduces your chances of becoming HIV-positive.
PEP is often given to people who work in a medical environment (after a
needle-prick incident) and to those who have been sexually assaulted or shared
drug needles. PEP must be taken for 28 days and has some side effects, such as
nausea. Note that it’s not a substitute for normal HIV preventative measures.
• Consider pre-exposure prophalaxis (PrEP). This means taking medication to prevent HIV
infection if you’re at high risk of getting infected. In South Africa, a drug
named Truvada (a combination of
emtricitabine and tenofovir) is proving to be particularly useful among
sex workers. If you’re using PrEP, it’s important to take the drugs exactly as
prescribed and to use other preventative measures (e.g. condoms) if you can.
Treatment as prevention (TasP)
These days, there’s also much focus on treatment as prevention (TasP). This
refers to HIV prevention methods and programmes
that use antiretroviral treatment (ART) to decrease the risk of HIV
Experts now know that if an HIV-positive person’s viral
load is so suppressed that it’s undetectable, they’re unlikely to pass the
virus on to others. So, for example, if an HIV-positive woman who has an
undetectable viral load has sex with her HIV-negative partner, she’s unlikely
to pass on the disease. If this woman falls pregnant, she’s also unlikely to
transmit the virus to her child.
Two recent studies conducted
among heterosexual couples demonstrated that HIV-positive people who are on ART
are about 20 times less likely to transmit the virus to their HIV-negative
partners than people who are not using the medication.
Preventing opportunistic infections
Preventative treatment for opportunistic infections covers primary prevention
(preventing illness before it occurs) and secondary prevention (preventing a
disease that you’ve had in the past from coming back).
HIV-positive people contract an opportunistic infection, both the infection and
the HIV become harder to treat because of drug interactions. Healthcare
professionals wouldn’t, for instance, treat TB and AIDS at the same time
because of the drug load.
reason, it’s extremely important that you live a healthy lifestyle to give your
body a fighting chance against HIV. It’s also crucial that you follow steps to
reduce your risk of exposure to opportunistic infections.
children and adults who have started to show signs of disease (or who have a
CD4 count of less than 350), should take an antibiotic called co-trimoxazole
continuously. This prevents Pneumocystis jerovici pneumonia (PJP), the most
common opportunistic infection in people who are HIV positive. Adults and
children who have had TB, or who have contact with people with TB (especially
at home), should also take anti-TB medication.
should receive their routine vaccinations but, if they already have AIDS, they
shouldn’t get the vaccine against TB. Extra vaccinations may be recommended in
both adults and children.
Other ways to prevent opportunistic
- Washing your
- Using hand
sanitiser after touching gym equipment or other surfaces in public spaces.
- Avoiding raw
or undercooked meals. Wash and cook all your foods.
- Steering clear
of people who are ill, as they might infect you.
all cooking implements and surfaces.
- Practising safe
- Not cleaning
cat litter trays or picking up dog faeces without using gloves.
How to prevent the progression to AIDS
Generally speaking, if
you’re HIV-positive, there could come a time when your body’s immune system
becomes so weak that you can no longer fight off opportunistic infections. This
is when HIV progresses to AIDS, or Acquired Immune Deficiency Syndrome.
The good news
is that, as long as you take your antiretroviral treatment (ART) daily and maintain a
healthy lifestyle, you’re unlikely to progress to the AIDS stage of the
disease. The treatment can
halt the progress of the disease and allow your immune system to rebuild itself.
AIDS as such
isn’t a disease – it merely describes the stage when HIV has progressed to such
an extent that the body’s CD4 count drops below 200. ART can raise the CD4 count again to above
500. It’s essential that you follow your doctor’s instructions on taking these
drugs, as they can and do save lives. Also have your CD4 count checked
Preventative treatment for opportunistic infections
Preventative treatment for opportunistic infections covers primary prevention (i.e.
preventing illness before it occurs) and secondary prevention (i.e. preventing
a disease that a person has already had from coming back).
(CTX) preventative therapy, for example, provides protection against
opportunistic infections such as Pneumocystis jerovici pneumonia, toxoplasmosis,
malaria and other bacterial infections. This fixed-dose combination of two
antimicrobial drugs (sulfamethoxazole and trimethoprim) has been shown to
reduce hospitalisations and death.
treatment is a cost-effective, well-tolerated intervention for people living
with HIV/AIDS, and is therefore widely prescribed for adults (including
pregnant women) with severe or advanced HIV and/or with a CD4 count of 350 or
Prophylaxis refers to the prevention or protective treatment of disease. In the
context of HIV, post-exposure prophylaxis (PEP) refers to antiretroviral
treatment that’s given to someone to help prevent HIV infection after being
exposed to the virus.
Healthcare workers who are accidentally exposed to HIV
through, for example, a needle-prick accident, should start taking ART (usually
AZT and 3TC) as soon as possible after the incident and preferably within 24
hours. The drugs must be taken for 28 days.
From analysing thousands of accidental exposures in
healthcare workers, it’s been calculated that even though the risk of getting
HIV infection from such an accident is quite low (0.3% of cases), taking ART
reduces the risk of infection by about 80%.
South African Government now also funds ART in the context of rape and women
who have been raped should start ART as soon as possible. Note that PEP may be
difficult to obtain outside of large hospitals. Get in touch with a rape centre
in your area or ask the local police to point you to a facility where you’ll be
doctor or clinic nurse will assess your risk of HIV infection before starting
treatment with PEP. Remember that it’s best to start PEP within 24 hours, but certainly within