You may be able to reduce your risk of cervical cancer by:

Not starting to have sex early (before age 20).
Remembering that, if you choose to have sex, the only truly safe sex partner is one who doesn't have an STI and has only ever had sex with you.
Limiting the number of sex partners you have may also help.
Using latex condoms (rubbers) may help prevent the spread of HPV and other STIs.
Using a spermicide (sperm-killer) that contains nonoxynol-9 along with condoms may increase this protection. But using condoms is not 100% effective in protecting you. For example, HPV can be on the scrotum, thigh and other places not covered by condoms.
Not smoking may also help reduce your risk of cervical cancer.

Shade, sunglasses, clothing and hats provide the best protection – applying sunscreen becomes necessary on those parts of the body that remain exposed, like the face and hands. Sunscreen should never be used to prolong the duration of sun exposure.

Limit time in the midday sun. The sun's UV rays are the strongest two hours each side of the solar noon, so you should limit exposure to the sun during these hours.


Watch the UV Index - where it is available. This important resource helps you plan your outdoor activities in ways that prevent overexposure to the sun's rays. While you should always take precautions against overexposure, take special care to adopt sun safety practices when the UV Index predicts exposure levels of moderate or above.


Use shade wisely. Seek shade when UV rays are the most intense, but keep in mind that shade structures such as trees, umbrellas or canopies do not offer complete sun protection. Remember the shadow rule: "Watch your shadow – short shadow, seek shade!"


Wear protective clothing. A hat with a wide brim offers good sun protection for your eyes, ears, face, and the back of your neck. Sunglasses that provide 99 to 100 per cent UVA and UVB protection will greatly reduce eye damage from sun exposure. Tightly woven, loose fitting clothes will provide additional protection from the sun.


Use sunscreen. Apply a broad-spectrum sunscreen of SPF 15+ liberally and re-apply every two hours, or after working, swimming, playing or exercising outdoors.


Avoid sunlamps and tanning parlours. Sunbeds damage the skin and unprotected eyes and so are best avoided entirely. WHO recommends that no one under 18 use a tanning bed.


Protect children. Children are generally more susceptible to environmental hazards than adults. During outdoor activities, they should be protected from high UV exposure as above, and babies should always remain in the shade.

A mental or behavioural disorder is characterized by a disturbance in thinking, mood, or behaviour, which is out of keeping with cultural beliefs and norms. In most cases the symptoms are associated with distress and interference with personal functions.

Mental disorders produce symptoms that sufferers or those close to them notice. These may include:

physical symptoms (e.g. aches and sleep disturbance)
emotional symptoms (e.g. feeling sad, scared, or anxious)
cognitive symptoms (e.g. difficulty thinking clearly, abnormal beliefs, memory disturbance)
behavioural symptoms (e.g. behaving in an aggressive manner, inability to perform routine daily functions, excessive use of substances)
perceptual symptoms (e.g. seeing or hearing things that others cannot).
Specific early signs vary from disorder to disorder. People who experience one or more of the symptoms listed above are encouraged to seek professional help if the symptoms persist, cause significant distress, or interfere with tasks of day-to-day living.

Examples of mental disorders include depression, substance abuse, schizophrenia, mental retardation, childhood autism, and dementia. They can occur in men and women of any age and in all races and ethnic groups. Although the causes of many mental disorders are not fully understood, they are thought to be influenced by a combination of biological, psychological, and social factors such as stressful life events, a difficult family background, brain diseases, heredity or genes, and medical problems. In most cases mental disorders can be diagnosed and treated effectively.

The four most common STIs that Canadians get each year are:

chlamydia - a bacterial infection
gonorrhea - also a bacterium
Human Papilloma Virus (HPV), which causes genital warts
Herpes Simplex Virus (HSV), which causes genital herpes.

According to WHO estimates, over 17 million people died of a cardiovascular disease such as heart attack or stroke in 2005. Contrary to popular belief, over 80% of these deaths occured in low and middle income countries, and men and women were equally affected.

The good news, however, is that 80% of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to success. These three simple measures will not only dramatically reduce the chance of a heart attack or stroke, but will also help prevent most type 2 diabetes and chronic respiratory disorders, and certain types of cancer.

Eat a healthy diet: A balanced diet is crucial to a healthy heart and vascular system: including plenty of fruit and vegetables, whole grains, lean meat, fish and pulses, and restricted salt and sugar intake.

Take regular physical activity: At least thirty minutes of regular physical activity every day helps to maintain cardiovascular fitness; at least 60 minutes on most days helps to maintain healthy weight.

Avoid tobacco use: Tobacco is very harmful to health, whether cigarettes, cigars, pipes, or chew tobacco. Exposure to second-hand tobacco smoke is also dangerous. The good news is that risk of heart attack and stroke starts to drop immediately after a person stops using tobacco products, and can drop by as much as half after one year.

To be successful in reducing risks, people need supportive environments, such as easily-available and affordable healthy food choices, walking and cycling paths, and smoke-free public spaces. This is especially true for children and people living in poverty, who often cannot choose the environment in which they live, their diet and their passive exposure to tobacco smoke. Governments, with the support of civil society and the private sector, have a crucial role to play in creating supportive environments for all people.

High blood pressure or hypertension means high pressure (tension) in the arteries. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the body. High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase blood pressure. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called "pre–hypertension", and a blood pressure of 140/90 or above is considered high.

The top number, the systolic blood pressure, corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. The bottom number, the diastolic pressure, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed.

An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage). These complications of hypertension are often referred to as end–organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure. For that reason, the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications.

It was previously thought that rises in diastolic blood pressure were a more important risk factor than systolic elevations, but it is now known that in people 50 years or older systolic hypertension represents a greater risk.

The main risk factors for cervical cancer are related to sexual practices. Much of this risk seems to be related to diseases that can be passed by having sex. These sexually transmitted infections (STIs) may affect your cells in a way that makes them more likely to undergo changes that can lead to cancer. These diseases include HPV, herpes, gonorrhea, and chlamydia. HPV seems to be very closely connected with these changes.

It is the nicotine in cigarettes that stains the fingers and teeth yellow. Nicotine is absorbed through the skin and the mucosal lining of the mouth and nose. It is also absorbed when you inhale smoke into your lungs.

Cigarette smoking produces a rapid distribution of nicotine to the brain. Nicotine is absorbed both through the skin lining of the mouth and nose and by inhaling smoke into the lungs. Drug levels peak within 10 seconds of inhalation. The acute effects of nicotine dissipate in a few minutes, making it necessary to smoke frequently throughout the day to maintain the drug's pleasurable effects and prevent withdrawal. A typical smoker will take 10 puffs on a cigarette over the 5-minute period that a cigarette is lit. Therefore, a person who smokes about 1-1/2 packs (30 cigarettes) a day, gets 300 "hits" of nicotine to the brain each day. These factors contribute considerably to nicotine's highly addictive nature.

Cigar and pipe smokers, on the other hand, typically do not inhale smoke, so nicotine is absorbed more slowly through the mucosal membranes of their mouths. The nicotine in smokeless tobacco is absorbed the same way.

Many people see drug abuse and addiction as strictly a social problem. They tend to characterize people who take drugs as morally weak or as having criminal tendencies. They believe that drug abusers and addicts should be able to stop taking drugs if only they were willing to change their behavior.

These common myths have stereotyped and stigmatized not only those with drug problems, but also their families, their communities, and the professionals who work with them. Drug abuse and addiction represent a major public health problem, one that affects many people from all walks of life, a problem that has wide-ranging social consequences.

Addiction does begin with drug abuse when an individual makes a conscious choice to use drugs, but addiction is not just "a lot of drug use." Recent scientific research provides overwhelming evidence that not only do drugs interfere with normal brain functioning creating powerful feelings of pleasure, but they also have long-term effects on brain metabolism and activity.

At some point during drug use, changes occur in the brain that can turn drug abuse into addiction, a chronic, relapsing illness. Those addicted to drugs suffer from a compulsive drug craving and usage and cannot quit by themselves. Treatment is necessary to end this compulsive behavior.

A number of approaches are used in contemporary treatment programs to help patients deal with these cravings and possibly avoid drug relapse. Addiction is clearly treatable. Through treatment that is tailored to individual needs, patients can learn to control their condition and live relatively normal lives.

Treatment can have a profound effect not only on drug abusers, but on their families, friends, and society as a whole by significantly improving social and psychological functioning, decreasing drug-related crime and violence, and reducing the spread of some important diseases such as HIV/AIDS. Effective treatment can also dramatically reduce the costs to society of drug abuse.

Understanding drug abuse also helps in understanding how to prevent use in the first place. Research has shown that comprehensive prevention programs involving the family, schools, communities, and the media are effective in reducing drug abuse. It is necessary to keep sending the message that it is better to not start at all than to enter rehabilitation if addiction occurs.

A tremendous opportunity exists to effectively change the ways in which the public understands drug abuse and addiction. Overcoming misconceptions and replacing ideology with scientific knowledge is the best hope for bridging the "great disconnect" -- the gap between the public perception and and the scientific facts about drug abuse and addiction.

Emergency services – public or private?
Emergency services, including ambulance services, are run by provincial health departments. The South African Health Services of the South African National Defence Force also plays a key role in emergencies and disasters.

Motor vehicle accident and trauma rates are high in South Africa, and our state emergency services are overstretched. In recent years, private "rapid response" emergency services have sprung up to fill the much-needed gap.

If it's your first Pap test, you may want to ask the doctor or nurse to explain the different steps involved before the test. Don't be afraid to ask questions throughout the test or express any concerns; you have the right to be an active participant in your health care. It may help to ask a friend who has had a Pap test about her experience or have someone you trust come with you for the test.

Pap tests shouldn't hurt, but they can be uncomfortable. Some women will feel discomfort if their vaginal muscles aren't relaxed. Taking long, slow breaths may help relax these muscles.

If you're uncomfortable having a Pap test because of your cultural beliefs, a history of sexual abuse, or for any other reason, it may help to talk to your doctor about your concerns. You may want to consider seeking a doctor who is sensitive to your cultural background or aware of issues related to sexual abuse or other concerns you may have. Some women also feel more comfortable having a female doctor or nurse do the test.

Injuries cause 5 million deaths every year. They are also a leading cause of demand for medical care and rehabilitation services. People of all ages are affected, but some groups are more at risk. For example, for people between the ages of 5 and 44 years, six of the ten leading causes of death are injury-related. The burden of injuries also falls disproportionately on the poor - over 90% of injury-related deaths occur in low-income and middle-income countries and even poor people in wealthier countries suffer much higher rates of injury. Poorer people are at higher risk of injury because they often live, work, travel and go to school in unsafe environments. They also benefit less from prevention efforts, and have less access to high-quality treatment and rehabilitation services.

Injuries can be prevented. There is clear, scientific evidence that injury-related deaths can be avoided and the effect of injury mitigated. In high-income countries, injury-related deaths among children under the age of 15 years were reduced by half between 1970 and 1995. This reduction is attributed to a combination of research, development of data collection systems, the introduction of specific prevention measures such as improvements in the local environment, legislation, public education, product safety, and improvements in the level and quality of emergency care.

To prevent so-called "accidental" injuries (known as unintentional injuries) proven and promising measures include the use of motor cycle helmets, seat-belts and child restraints; separating pedestrians from vehicles; controls on speeding and on drink driving; use of safer stoves for cooking; child resistant containers for poison; and barriers separating children from hazards such as water.

For violence-related injuries (known as intentional injuries), examples of proven prevention strategies include home visitation by professional nurses and social workers; parent training on child development, non-violent discipline and problem-solving skills; pre-school enrichment programmes to give young children an educational head start; life skills training; reducing alcohol availability through taxation, pricing and the enforcement of liquor licencing laws; restricting access to firearms; and multi-media campaigns to promote non-violent social norms. For all types of injuries measures to improve the efficiency of emergency care will assist in reducing the risk of death, the time for recovery and the level of long-term impairment.

Not all suicides can be prevented, but a majority can. There are a number of measures that can be taken at community and national levels to reduce the risk, including:

reducing access to the means of suicide (e.g. pesticides, medication, guns);
treating people with mental disorders (particularly those with depression, alcoholism, and schizophrenia);
following-up people who made suicide attempts;
responsible media reporting;
training primary health care workers.
At a more personal level, it is important to know that only a small number of suicides happen without warning. Most people who kill themselves give definite warnings of their intentions. Therefore, all threats of self-harm should be taken seriously. In addition, a majority of people who attempt suicide are ambivalent and not entirely intent on dying.

Many suicides occur in a period of improvement when the person has the energy and the will to turn despairing thoughts into destructive action. However, a once-suicidal person is not necessarily always at risk: suicidal thoughts may return but they are not permanent and in some people they may never return.

In the year 2000, an estimated 877 000 people died by committing suicide. This represents one death every 40 seconds. Worldwide, suicide ranks among the three leading causes of death among those aged 15-44 years.

Private hospitals and clinics can be found in most urban areas:

Not all government jobs are advertised in the media. Some jobs are just advertised internally.

National and provincial government positions advertised internally appear in the Public Service Vacancy Circular. The Eastern Cape Department of Health advertises its internal vacancies online.

More senior positions, that is those in the senior management service (SMS), must be advertised nationally, according to regulations applicable to the public service. You can find out more about the SMS by reading the SMS handbook.

How to apply for a government job
The first step in applying for an advertised government job is to fill in the government job application form, called form Z83. You can download this form, or get it from any government office.

This form needs to be completed for all government jobs at both national and provincial level. Applications for employment are usually not accepted without a completed Z83 form.

To fill the form in properly, you will need to have the advertisement for the job in front of you for the correct details, such as the reference number for the job, the position name and the department which advertised the job, to be filled in on "Part A" of the form.

After completing the form, you should attach your CV. You may be asked to supply certified copies of any certificates or degrees you have mentioned in your CV or on the form. Submit your job application (Z83 form, CV, and copies of certificates) to the place listed in the advertisement before the closing date.

Do not send any more information or documents after the closing date as they will not be taken into consideration. Positions are usually advertised for about a month before being closed.

What to expect after applying for a government job

After the closing date, all the applications will be considered and certain applicants selected (short-listed) for an interview. Those who are selected for an interview will be telephoned to set an interview date.

A selection committee or panel conducts the interviews. According to the public service regulations, the committee must consist of at least three government employees at the same or higher grading level as the job advertised. The selection committee will recommend a candidate after all the interviews are completed.

The selection committee must record the reasons for its recommendation. This recommendation can be approved or rejected by the person with executive responsibility for appointments, which in a provincial department is the MEC concerned. Reasons must be given where the recommendation is rejected.

All appointments for more than a year's contract are subject to a period of probation.

Yes. Abortion was made legal in South Africa with the implementation of the Choice on Termination of Pregnancy Act of 1996. Although 45 449 abortions were performed in state hospitals and clinics in 2001, there is still significant resistance to abortion, based on cultural or religious grounds. Most abortions are administered to girls under the age of 18, which points to the need for more education on safe sex for young people.

The Eastern Cape Department of Health invites applications from suitable and qualified persons whose dream has always been to pursue a career in medicine.

CRITERIA FOR SELECTION OF RSA STUDENTS TO STUDY MEDICINE IN CUBA

1. Those applicants who have difficulties in gaining acceptance into South African medical universities are invited to apply. Application will be based on gaining representation in the profession, based on those groups who are least represented in the medical fraternity in terms of race, gender and socio-economic status.

2. Applicants should have Matric (Grade 12) exemption with a good pass rate in English, Mathematics, Physics and Biology.

3. Applicants will be recruited from predominantly rural areas from disadvantaged backgrounds within the province, and must be committed to work in the most underprivileged communities of the province.

4. Applicants must show potential to undertake and successfully complete a medical degree. They will be identified by selection panels and this will include an assessment of their social and coping skills.

5. Applicants should be not be older than 25 years of age.

6. Successful candidates must be committed to undertake bridging courses that will include a basic Spanish language course and an orientation of the South African environment upon their return, before they are deployed in the province.

7. Successful candidates will be requested to sign a contract with the Eastern Cape Department of Health to work in a public hospital and will be deployed where they are most needed.
PROCEDURE

1. Application forms will be available from District and Local Service Area Offices from 26 June 2007.

2. The following documents must be submitted with the application forms -:
• A certified copy of the Identity Document.
• A certified copy of their Grade 12 Certificate or transcript of their results.
• Proof of income.
• A recommendation letter from the School Principal of the last school attended.
• A recommendation letter from a Community/Religious Leader confirming their residence and general conduct.
• A certified copy of the death certificates where one or both parents have died.

3. Short listed candidates will be invited to attend the second phase of selection at district level.

4. Final selection will be conducted at Head Office.

5. Applicants are advised to provide all relevant contact details.

6. The closing date for all applications is 13 July 2007.

For more information call the nearest Health District/LSA Office or the Manager of the nearest Hospital or Community Health Centre.

In addition contact Head Office at the following numbers -:
040 609 5067, 040 609 4936 and 040 609 4934 or alternatively
Mr. Mjoli: 083 3780 146, Mr. Hloma: 083 3781 426 Ms Papu: 083 3781 470

healers, and there is a growing recognition of their value to society. Traditional healers, or sangomas, use a combination of plant and animal products for their medicinal potions, known as muti. They also incorporate a spiritual element into the healing process and perform a variety of functions for those who visit them, including doctor, counsellor, priest and psychiatrist. Traditional healers divine with symbols such as bones and other artefacts through which ancestors communicate problems and solutions for their patients.

Attempts are now being made to create more harmony between Western and traditional medicinal practices, which have tended to view each other with suspicion. Research is being conducted on the use of traditional medicines in curing malaria and tuberculosis.

It is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health.

A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. And it needs to provide services that are responsive and financially fair, while treating people decently.

A Pap smear is a simple test that can help prevent cancer of the cervix. Pap smear testing saves lives. If women had regular pap tests, 90% of cancer of the cervix would be prevented. During a Pap smear, your doctor takes a sample of cells from your cervix to be tested. The cervix is the part of your uterus (womb) where blood flows through when you have a menstrual period.

To take the sample, your doctor will gently put a special instrument called a speculum into your vagina. This helps open your vagina so the doctor can see your cervix and a sample can be taken. Your doctor may gently clean your cervix with a cotton swab and then collect a sample of cells from your cervix with a small brush, a tiny spatula or a cotton swab. This sample is put on a glass slide and sent to a laboratory to be checked This exam only takes a few minutes. It is very important to stay relaxed to help make it more comfortable for you.

The Pap test is named after the doctor who invented it, Dr. Papanicolaou. It involves taking a sample of cells from your cervix, which is the narrow entrance to the uterus, at the top of your vagina. The test checks for any changes in these cells. Abnormal cells may be a sign that cervical cancer might develop later. If they're detected early, these abnormal cells can be effectively treated before they develop into cancer. The test can also detect infections in the cervix, including yeast infections, infection with the human papillomavirus (HPV) or herpes virus.

Generally, 'being fertile' means that you can become pregnant and carry the pregnancy to term within one year of trying to become pregnant (having sex frequently without using birth control).
Even if you're not trying to get pregnant, you can be pretty sure you're fertile if:

your cycles are regular (between 26 to 35 days long and about the same length each month)
you're in general good health
your periods aren't too heavy, light or painful
you don't have any known medical conditions that could interfere with your fertility (e.g. blocked or missing fallopian tubes, endometriosis, etc.)
you're not taking any medications or drugs that can interfere with your fertility.

The national department of health has implemented the Expanded Programme on Immunisation (EPI(SA)) as one of the cornerstones of its health care policy. South Africa follows the World Health Organisation's recommended immunisation schedule, where infants are routinely vaccinated against nine major childhood diseases including tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, measles, haemophilus influenza type B (Hib) and Hepatitis B.

National immunisation awareness campaigns are held periodically, usually coinciding with Child Health Week (August 6-12). The state spends around R80-million a year on vaccinations for children.

You should have your first Pap smear when you start having sex or by the time you reach age 18. Keep having Pap smears throughout your life, even after you've gone through menopause.

HIV slowly damages a person’s immune system. The immune system is the part of the body that fights germs. These germs make us sick.

With a damaged immune system, the body is not properly protected
against germs. This is why people living with HIV can get sick more easily and more often.

If you have any of the following signs of sickness, get treatment straight away:


Chest pain and coughing that doesn’t go away


Night sweats and fever


Loss of weight and a runny tummy


Painful swallowing and sores in or around the mouth


Bad headaches

If your immune system stays strong, you will get sick less often.

There are ways to help keep your immune system strong and prevent sickness:


Get medicines to prevent common sicknesses.


Eat healthy food. Ask your health worker for ideas.


Exercise regularly.


Don’t drink alcohol or use tobacco.


Keep your house and yourself clean.


Wash your hands after using the toilet and before eating.


Wash all your vegetables in clean water.


Cook meat and chicken well.


Don’t share things that are used on the body, like toothbrushes, razors and needles.


Get treated straight away if you do get sick.


Always use a condom when you have sex. This will protect you from getting infected with HIV again. It will also protect your partner.


Sexually Transmitted Infections (STIs)

A Sexually Transmitted Infection (STI) is a sickness that is passed from one person to another during sex. STIs are very common. The prevention and treatment of STIs are key strategies in the fight against AIDS because the presence of STIs magnifies the risk of HIV transmission during unprotected sex tenfold. According to WHO estimates, over 300 million people are infected each year with an STI.

For some STIs there are signs that are easy to see.

Other STIs are not always easy to see. STIs are usually much harder to identify in women.

If you have any signs of STIs, you should go and see a health worker or doctor. Most STIs can be cured relatively easily with antibiotic treatment. You may be given pills or injections. It is very important that the treatment is taken properly. It is important that your sexual partner also gets treatment. Remember that the treatment available at public health clinics is of high quality, and
will not cost you anything.

These are some of the signs of STIs:


Pus or smelly fluids coming out of the penis or vagina


Blisters, sores or warts on the vagina, penis or anus


Pain in the lower stomach


Pain or burning when passing urine


Itching or redness around the vagina or penis


Pain when having sex


Pain in the testicles


Smelly fluids, e.g., Pus


Unusual swelling in the groin

You can protect yourself from STIs by using a condom every time you have sex. Quality condoms are available from local clinics and hospitals at no cost.

STIs cause sores or weaken the skin of the penis or vagina. This makes it easier for HIV to enter the body.

People with an STI are also more likely to get HIV if they don’t go for treatment.

How are HIV and AIDS diagnosed?

An HIV blood test can be done at some clinics, or by a doctor, or at an AIDS Training, Information and Counselling Centre (ATICC) in most cities.

You cannot be forced to have an HIV test. It is your choice. Whether you have HIV or not, having an HIV test gives you the power to plan for a healthy future.


Why should I test for HIV?

It takes many years for the signs of HIV to show up. Many of us could be infected with HIV without knowing it. If you have ever had sex, you could be infected with HIV. The only way to know if you have HIV is to have an HIV test. To do an HIV test, a health worker will take some of your blood and check it for signs of HIV.

If you test HIV positive:


You are infected with HIV.


You can still look after yourself and enjoy a healthy life for longer.


You can avoid infecting someone else.


You can get medicine to prevent common sicknesses.


You can get anti-HIV medicines.


You can use a condom to protect your partner and yourself.

If you test HIV negative:


You are not infected with HIV.


You can plan to stay HIV negative.


You can have safer sex and use a condom to stay negative.


You can tell your sexual partner/s and they can also test for HIV.

If you had sex without a condom recently, wait three months then test again.

Whether you have HIV or not, having an HIV test gives you the power to plan for a healthy future.


What are your rights?


Counselling – get the right information about having the test and what to do after it.


Consent – no one can give you an HIV test unless you agree to it.


Confidentiality – no one may tell anyone the results of your test without your permission.


How reliable is HIV testing?

HIV testing is very reliable, through either antibody tests or tests for the virus itself. Testing for the presence of infections often uses the detection of antibodies that the human body produces in response to the presence of a pathogen. These antibodies are specific to a given pathogen: they match each other. Diagnosis of infection using antibody testing is one of the best-established concepts in medicine.

Examples include the diagnosis of viral hepatitis, rubella, and many
other infectious diseases. Antibody testing for these diseases has never been questioned. HIV antibody tests exceed the performance criteria of most other infectious disease tests in both sensitivity and specificity. Recent HIV antibody tests have sensitivity and specificity in excess of 98% and are therefore extremely reliable.

Progress in the methods used for testing has also made it possible to detect viral genetic material, antigens and the HIV virus itself in body fluids and cells. While not widely used for routine testing due to high cost and requirements in laboratory equipment, these direct testing techniques have confirmed the validity of the antibody tests.

HIV is transmitted through unprotected sexual intercourse with an infected partner. HIV can also be transmitted through infected blood or blood products, such as blood transfusions, or by the sharing of contaminated needles.

Further HIV can be transmitted from a mother to her unborn child. This is called Mother to Child Transmission (MTCT) and it not only occurs before birth, but also during delivery, or through breast-feeding.

HIV cannot be transmitted through casual contact like shaking hands, sharing cups or hugging.

Can I get infected through oral sex?
There is a low risk that infection can occur during oral sex.

Can I be infected if my partner does not ejaculate in me?
Yes. During intercourse both partners may experience bleeding which could result in the transmission of the virus. The virus is also present in pre-cum (fluid that comes out before ejaculation) which could result in infection.

Can I get infected through: Hugging, using the same bathroom, sharing utensils and swimming pools?
No. The virus cannot be transmitted through casual contact.

Mosquito Bites?
No. Mosquitoes have different body temperatures to humans.

Because the virus cannot live for long outside the human body and because there is so little blood passing through, the virus quickly dies off.

Kissing?
HIV is present in saliva (spit). However, no-one has ever become infected from kissing alone.

Do contraceptives prevent transmission?
The only contraceptives that prevent transmission of HIV are male and female condoms. Other contraceptives, for example, oral contraceptives (the pill), the loop, and the injection prevent pregnancy but not HIV transmission. The only way to prevent HIV infection is to abstain from having sex.

While HIV and AIDS doesn't discriminate at all, people still do. And women are at high risk of contracting HIV in countries – like ours – where they still do not have the power to choose when and where they have sex. Here is an extract from a fact sheet prepared by the WHO (World Health Organisation) exploring the vulnerability of women to HIV and AIDS because of their poor financial situations.

The right to choose is most violated in those places where women exchange sex for survival as a way of life. We are not talking about prostitution, but rather a basic social and economic arrangement between the sexes that results on the one hand from poverty affecting men and women, and on the other hand, from male control over women’s lives in a context of poverty. For example, in many instances the male is the breadwinner and brings the money home. If his wife or partner does not do as he asks, he can use his status as breadwinner to withhold money from her.

By and large, most men - however poor - can choose when, with whom and with what protection (if any) to have sex. Most women cannot. A Minister of Health of one of the Southern African countries recently declared that women should have a right to sexuality which does not endanger their lives.

The major issues
* Lack of control over own sexuality and sexual relationships (see above).
* Poor reproductive and sexual health, leading to serious morbidity and mortality. Rates of infection in young (15-19) women are between 5 and 6 times higher than in young men (recent studies in various African populations).
* Neglect of health needs, nutrition, medical care etc. Women’s access to care and support for HIV and AIDS is much delayed (if it arrives at all) and limited. Family resources are nearly always devoted to caring for the husband or children. Women, even when infected themselves, are the ones who provide all the care.
* Clinical management based on research on men. A module on clinical management of HIV and AIDS in women needs to be designed and implemented.
* All forms of coerced sex – from violent rape to cultural/economic obligations to have sex when it is not really wanted, increases risk of microlesions and therefore of STIs/HIV infection.
* Harmful cultural practices: From genital mutilation to practices such as "dry" sex.
* Stigma and discrimination in relation to AIDS (and all STIss): Discrimination is far stronger against women who risk violence, abandonment, neglect (of health and material needs), destitution, ostracism from family and community. Furthermore, women are often blamed for spread of disease, even though the majority have been infected by only partner/husband.
* Adolescents: Access to education for prevention, (in and out of school and through media campaigns), condoms, and reproductive health services before and after they are sexually active.
* Promotion and protection of adolescent reproductive rights (particularly girls). Obstacles in terms of laws and policies, health service provision, cultural attitudes and expectations of girls and boys’ sexual behaviour, cultural practices, and educational and employment opportunities.
* Sexual abuse: There is now evidence that this is an underestimated mode of transmission of HIV infection in children (even very small children). Adult men seek ever-younger female partners (younger than 15 years of age) in order to avoid HIV infection, or if already infected, in order to be "cured". Apparently, there is a (false) belief among some men that sex with a virgin will cure AIDS.
* Disclosure of status, partner notification, confidentiality. These are all more difficult issues for women than for men for the reasons discussed above - negative consequences and the fact that women have usually been infected by their only partner/husband.

Because telling people is more difficult for a woman, women’s access to care and support is further decreased. Protection for women when they disclose status must be assured.

The WHO has worked intensively with UNAIDS on issues of disclosure and confidentiality. HSI produced a question and answer document that will be published shortly.

By Introduction to HIV/AIDS Vaccines

What is a vaccine?

A vaccine is a substance that stimulates an immune response that can either prevent an infection or create resistance to an infection.

What are the benefits of a vaccine?

Individual Benefit
This refers the protection an individual person gains against a particular disease through vaccination. This is the most readily understood benefit of vaccines.

Public Health Benefit

This refers the protection a community gains against a particular disease through mass vaccination by creating “Herd Immunity”.
Herd Immunity is the concept of decreased infection among susceptible individuals as a result of vaccination among household or community contacts.Or simply put, if enough people in a community are vaccinated, there are fewer opportunities for an infectious disease to be transmitted, thus lowering the risk of infection for people who have not been vaccinated.

What are the different types of vaccines?

Live-attenuated
This type of vaccine is made of live pathogen (or disease causing agent) that has been put through a chemical or physical process to weaken it so it is unable to cause disease.
Examples of live-attenuated vaccines are:
Measles
Mumps
Rubella

Whole killed


This type of vaccine is made of whole pathogen that has been put through a chemical or physical process to kill it so it is unable to cause disease.
Examples of whole killed vaccine are:
Influenza
Rabies

But these methods of developing vaccines are not being pursued for AIDS.Instead, scientists are working to develop a recombinant vaccine for AIDS. Also, because HIV is so highly mutating, there is concern it might be able to mutate out of attenuation and cause disease.

AIDS vaccines are recombinant vaccines, using genetically engineered components of HIV to eliminate any risk of HIV infection from the vaccine.
Recombinant
This type of vaccine is composed of man-made pieces of antigen. By using genetic engineering, scientists create copies of pieces of HIV. Because actual, whole HIV is never used, there is no risk of getting HIV from the vaccine.

Therapeutic AIDS vaccines
Therapeutic AIDS vaccines are designed for people who are infect with HIV. This is basically a form of immune-based therapy, using a person’s immune system to control the HIV in their body.

Preventative AIDS vaccines
Preventative AIDS vaccines are designed for people who are not infected with HIV. Preventative AIDS vaccines are designed to stimulate the production of antibodies or the production of infection fighting white blood cells, including helper T-cells (CD4) and cytotoxic T-lymphocytes (CTL).
Some antibodies are able to attach to HIV, blocking the virus from attaching to cells and infecting them. Antibodies can also alert other parts of the immune system to eliminate the HIV before it can infect cells.

white blood cells would seek out and kill cells in the body already infected with HIV and kill them before the virus can complete its replication cycle and spread to other cells.

HIV infection can be prevented by:


saying "no" to sex


staying faithful to your sexual partner q using a condom every time you have sex


asking your health worker about HIV-risks when you are pregnant


preventing direct contact with blood by using gloves, plastic bags or other barriers

There is no cure for AIDS, but many people infected with HIV live long healthy lives.

They do this by taking care of their health, keeping fit, getting treatment when they are sick, eating correct foods, reducing stress and practicing safer sex.

Prevention is the first line of defence against AIDS, and the correct and consistent use of condoms is a mainstay of HIV prevention approaches. Condom use to prevent HIV is most effective when it is part of a broader safer sexual behavior package that includes sexual abstinence, non-penetrative sexual practices, and reduced numbers of sexual partners.

But many people, especially young people and young girls, do not have sufficient information about the importance of using condoms, nor are there sufficient supplies of condoms. Cost is also a major issue. UNAIDS continues to make the promotion and availability of condoms, including the female condom, a key priority.


Condoms and safer sex

The condom can be used to prevent pregnancy and sexually transmitted infections (STIs), like HIV. They give the best protection if they are used correctly when you have sex. Share the responsibility of using condoms with your partner.

When you are ready to have sex:


Open the condom pack carefully so that the condom is not damaged. Check the expiry date.


Check that the condom will roll onto the penis correctly. The penis must be erect, and the foreskin pulled back.


Roll the condom down to the base of the penis.

Squeeze the tip of the condom to make sure there is no air in it.


Make sure that the condom stays on during sex.


It is important to remove the penis immediately after you have ejaculated (cum), otherwise fluid might leak out. Hold the base of the condom and pull the penis out of the vagina.


Slide the condom off the penis. Tie a knot in it to prevent the fluid leaking out, and throw it away.

Do not use petroleum jelly or oils such as baby oil. These can weaken the condom and cause it to break. Ask a health worker what
to use.

High quality condoms are available at no cost at government clinics, hospitals, organisations in the community and in some workplaces. You can also buy condoms at low cost at shops and pharmacies.

Always carry condoms with you, and use a condom every time you have sex.

Speak to your health worker if you want to know how to use a condom, or if you are having problems using condoms. You can also ask about female condoms.

Store condoms in a cool place. Heat and strong sunlight can damage them.

If you have any questions about HIV and AIDS, you can phone the free 24-hour AIDS Helpline at 0800 012 322. There are other
leaflets in this series that give more information about HIV, AIDS and STIs.


1 Why is condom promotion and distribution absolutely essential in
limiting the spread of HIV and AIDS?

The vast majority of HIV infections are sexually transmitted. There are only four ways to prevent sexual transmission of HIV. These are: (1) abstinence, (2) monogamous relations with an uninfected partner, (3) non-penetrative sex, and (4) consistent and correct use of male or female condoms.

Studies consistently show that in every population above the age of sexual debut there are many people who are either unable or unwilling to practise abstinence, monogamy and non-penetrative sex. This leaves condoms for protecting these people and their
partners.

2 Are condoms really effective in preventing HIV transmission?

Quality-assured condoms are the only products currently available to protect against sexual infection by HIV and other sexually transmitted infections (STIs).

When used properly, condoms are a proven and effective means for preventing HIV infection in women and men.

Based on research between discordant couples (one HIV-negative and one HIVpositive), condoms have been found to be 90% effective. The vast majority of condom failures result not from leakage or permeability of the latex material, but from improper use, breakage, or slippage.

It is important to emphasize that an effectiveness of 90% for condoms does not mean HIV transmission will take place in 10% of sexual acts in which condoms are used. This means that each time a person has sex using a condom, he or she reduces their risk to acquire HIV by 90%.

3 What about other STIs?

The data are less complete for other STIs, but enough evidence exists to make condoms the recommended strategy for preventing gonorrhoea, chlamydia, trichomoniasis, and syphilis. Studies to establish reliably the effectiveness of condoms against specific STIs are difficult to conduct in a scientifically rigorous and ethical manner, but a number of studies are underway and more are
planned. Studies have already proven the effectiveness of condoms in preventing gonorrhoea in men.

4 Is there any evidence that condom use is effective in reducing HIV infections in generalized epidemics?

More data is now emerging that demonstrates the effectiveness of condoms in preventing HIV transmission in generalized epidemics. A study from South Africa, soon to be published in the journal “AIDS”, finds that when enough young men use condoms consistently, there is a clear protective effect for both the individual
and the population at large.

5 Can HIV pass through a condom?

Condoms provide an impermeable barrier to viruses and to sperm barrier that indeed blocks the passage of organisms much smaller than the HIV virus.

Condoms are required to undergo demanding tests, including tests for holes, before they are distributed or sold. If any holes or perforations are found, the condoms are discarded.

6 Don't condoms often "fail" during intercourse?

The evidence from valid studies conducted by reputable and reliable organizations is overwhelmingly that condoms provide effective protection from sexually transmitted HIV infection and other STIs, as well as unwanted pregnancy.

Condom "failure" occurs on the rare occasion that a person contracts an infection or becomes pregnant despite the use of a condom. Such "failure" is very infrequent and is usually associated with condom breakage or slippage. Most slippage and breakage of condoms are caused by incorrect use, though there is an increased likelihood of breakage if the condom is past its expiry date or has
been exposed to excessive heat. If condoms are to prevent HIV and STIs, they must be used correctly and consistently. Occasional use provides no more than occasional protection.

7 Do condoms lead to increased promiscuity?

No, condoms do not lead to increased promiscuity. Since the early 1990s, extensive research has shown that education about sexuality and access to condoms do not lead young people to begin having sex, or to have more partners. In fact, condoms, when distributed with educational materials as part of a comprehensive prevention package, have been shown to significantly lower sexual risk and activity, both among those already sexually active and those who
are not.

8 What is the “ABC” prevention approach?

Just as combination treatment attacks HIV at different phases of virus replication, combination prevention includes various safer sex behaviour strategies that informed individuals who are in a position to decide for themselves can choose at different times in their lives to reduce their risk of exposing themselves or others to HIV (Global HIV Prevention Working Group, 2003). These are often referred to
as the ABCs of combination prevention:


A means abstinence—not engaging in sexual intercourse or delaying sexual initiation. Whether abstinence occurs by delaying sexual debut or by adopting a period of abstinence at a later stage, access to information and education about alternative safer sexual practices is critical to avoid HIV infection when sexual activity begins or is resumed.


B means being safer—by being faithful to one’s partner or reducing the number of sexual partners. The lifetime number of sexual partners is a very important predictor of HIV infection. Thus, having fewer sexual partners reduces the risk of HIV exposure. However, strategies to promote faithfulness among couples do not necessarily lead to lower incidence of HIV unless neither partner
has HIV infec-tion and both are consistently faithful.


C means correct and consistent condom use—condoms reduce the risk of HIV transmission for sexually active young people, couples in which one person is HIV-positive, sex workers and their clients, and anyone engaging in sexual activity with partners who may have been at risk of HIV expo-sure. Research has found that if people do not have access to condoms, other prevention strategies
lose much of their potential effectiveness.

A, B, and C interventions can be adapted and combined in a balanced approach that will vary by cultural context, the population addressed and the stage of the epidemic.

9 Are condoms enough?

No. It is essential that all people, including young people and women and girls, have access to the information, education and life skills that enable them to have safe and responsible sexual relations and negotiate safer sex, including condom use. This is especially important with regard to changing harmful gender norms that make men less likely to use condoms, and make women and girls less able to insist on their use.

10 What makes someone use a condom?

Knowledge about HIV/AIDS, easy accessibility and affordability, and social support to do so. Increasing condom accessibility and availability also increases condom use. In Brazil, there was a massive increase in the uptake of condoms when prices came down in the early 1990s.

However, almost everywhere, sexually active young people (especially young women) are denied accurate information about condoms. Researchers in Kenya report that 54% of young
people do not believe that condoms protect against HIV infection.

11 What are the most effective ways for women to protect
themselves against HIV infection during sexual intercourse?

Besides mutual fidelity between uninfected partners, correct use of a condom "from start to finish" continues to be the single most effective means for women and men to protect themselves from HIV infection through sexual intercourse.

However, because of their social and cultural situations, women are often unable to insist on condom use by their male partners. This should be countered by the promotion of the following:


Sexual health education, sexual responsibility and gender sensitivity for men/boys


Negotiating and life-skills for women/girls


Economic, social and political equality for women/girls


Promotion and widespread distribution of female condoms


Urgent development and distribution of microbicides.


Microbicides

1 What are microbicides?

Microbicides are chemical substances that kill viruses and bacteria when applied vaginally or rectally before sexual intercourse.

Microbicides are a form of "chemical condom" that can be self-administered and that can protect both partners from HIV infection during sexual intercourse.

Applied inside the vagina or rectum in the form of gel, cream, suppository or film, a microbicide for HIV would prevent infection with HIV and, possibly, other sexually transmitted infections. If
spermicidal, it might also be useful for birth control. The ideal product would be odourless and colourless, and therefore undetectable to partners.

2 How would microbicides benefit women and others who cannot
negotiate safe sex?

As a form of "chemical condom" that can be self-administered and might be undetectable to partners, microbicides could increase the options for women, men, and sex workers who find it difficult or impossible to persuade their spouses or other sex partners to use a condom. Microbicides have been shown to be acceptable to women.

An estimated 56 new microbicide products are in various stages of development. It is difficult to say how long it will be before an effective product is available on the world market.

Women who seldom or never use condoms would reduce their overall risk of infection if an effective microbicide were available to them at low cost.

There are three stages of HIV

1. You are HIV positive and you feel healthy
At this stage, it means your immune system is strong and your CD4 count is high. You do not need anti-retroviral treatment (ART).

If you are a parent, prepare your children by telling them about HIV. Make sure they will be well taken of if you became ill or if you die. Get support to help you deal with this.

2. You are HIV positive and start to get sick
At this stage, your immune system is starting to get weak. Ask your health worker to do a CD4 blood test. This will tell you if you need to take ART.

Most illnesses that you get when you are HIV positive can be treated. But you must be careful because some of the illnesses are very serious. It is important to visit a clinic or health worker to treat any illnesses you may have.

3. You are HIV positive and you are very sick with AIDS
At this stage, you get very sick very often, or you do not get better. It means that your immune system is very weak. You should get treatment for the illnesses that you have. You should now start taking ART as well.

Often people who go on treatment are very sick and cannot take care of themselves. If you are taking care of a sick person, and they are given ART, make sure you understand all about it.

AIDS is a disease that affects millions of South Africans. It is caused by a virus called HIV that slowly weakens a person's ability to fight off other diseases. We have a very important system in our bodies called the immune system.

The immune system protects the body against germs and diseases. It also heals the body after sickness or injury. HIV infects cells of the immune system (mainly CD4 cells) . When the HIV virus gets into a person’s body, it slowly breaks down the immune system.

This means that the body cannot fight sickness anymore. It also cannot heal itself. The HIV virus increases in number more and more, making your body weaker and weaker. When the HIV virus has weakened the person’s immune system, the person has AIDS. It can take many years before a person who is HIV positive gets sick with AIDS.

Most people who are infected with HIV do not know they are infected, and you cannot tell if a person is infected just by looking at them.

It takes many years for the signs of HIV infection to show up. This is usually when a person becomes ill from other diseases. People who have AIDS get many different sicknesses. They lose weight, and get diarrhoea, sores in the mouth, coughs, pneumonia, brain and nerve diseases, swellings, fevers and sores.

Some of these diseases, namely those that are strongly associated with severe immunodeficiency, are called "opportunistic infections", because they take advantage of a weakened immune system.These sicknesses take a long time to get better, or they come back again and again. People who have AIDS can die from one of these sicknesses.

How is HIV spread ?

HIV is spread from one person to another:


by having unprotected sex with an infected person


through contact with infected blood


from an infected mother to her unborn or newborn baby (but only some babies born to infected mothers become infected with HIV).

Sex

The most common way for the HIV virus to be passed on is when a person has unprotected sex (sex without a condom) with someone who already has the HIV virus.The type of sexual practice affects the risk of transmission.

Anal intercourse carries a greater risk than vaginal intercourse for the receptive partner.

Children can get the HIV virus from an HIV-positive adult who has sexually abused or raped them.

Transmission via Blood and Blood Products

Transfer of contaminated blood from one person to another through :

The HIV virus can pass from one person who has it to another person if they share blades, needles and syringes that are not sterilised.

The HIV virus can also be passed on if they both have a cut or an open wound and their blood gets mixed.


Sick people are given extra blood through a blood transfusion

Pregnancy and breastfeeding

HIV can be transmitted from a mother to her unborn child. This is called Mother to Child Transmission (MTCT). A pregnant woman who has the HIV virus can pass it on to her baby when she is pregnant, gives birth, or breastfeeds. About 1 in every 3 babies born to HIV-positive mothers will get the virus


A woman is more likely to pass the HIV virus if she is sick with AIDS when she become pregnant or if she gets the HIV virus while she is pregnant.The risk of transmission varies between 15% and 30% among infants who are not breastfed. Breastfeeding increases the risk of transmission by 10-15%.


How HIV cannot be transmitted

You cannot be infected with HIV in other ways. For example, if a person with HIV coughs, he/she cannot pass on the virus. If you hug or touch a person with HIV you cannot get HIV, or or through casual contact like shaking hands, sharing cups or hugging.

The virus is not transmitted through air or water

Can I get infected through oral sex?

There is a small chance that HIV can be transmitted through oral sex, especially if a person has abrasions in the mouth or gum disease.

Can I be infected if my partner does not ejaculate in me?

Yes. During intercourse both partners may experience bleeding which could result in the transmission of the virus. The virus is also present in pre-cum (fluid that comes out before ejaculation) which could result in infection.

Can I get infected through: Hugging, using the same bathroom, sharing utensils and swimming pools?

No. The virus cannot be transmitted through casual contact.

Mosquito Bites?No. Mosquitoes have different body temperatures to humans. Because the virus cannot live for long outside the human body and because there is so little blood passing through, the virus quickly dies off.

Kissing?

HIV is present in saliva (spit). However, no-one has ever become infected from kissing alone.

Do contraceptives prevent transmission?

The only contraceptives that prevent transmission of HIV are male and female condoms. Other contraceptives, for example, oral contraceptives (the pill), the loop, and the injection prevent pregnancy but not HIV transmission. The only way to prevent HIV infection is to abstain from having sex.

How long after HIV infection do people develop signs of AIDS?

The majority of people infected with HIV, if not treated, develop signs of AIDS within eight to 10 years. Symptoms of AIDS generally appear when the numbers of CD4 white blood cells (critical in mounting immune responses) decreases to 200 per mm3 of blood.

About five to 10% of HIV-positive individuals develop AIDS symptoms very rapidly during the first years of infection, and about the same proportion remain infected with HIV for 15 years or more without progressing to AIDS. But on average, AIDS symptoms develop approximately eight to 10 years after initial HIV infection in people who do not receive ARV therapy.

What is the course of HIV infection?

HIV infection typically follows the following course:

Primary acute infection with a characteristic clinical picture

Prolonged period without obvious, visible symptoms—although laboratory studies can demonstrate continuous disease progression; and

Severe immunodeficiency resulting in secondary opportunistic infections and tumours which act as the major causes of death in AIDS patients.

The spectrum of opportunistic infections may differ in different geographical locations, depending on the prevalence of certain pathogens (parasites, fungi, bacteria and viruses) to which immuno-compromised individuals may be exposed.

STIs or sexually transmitted infections can be spread in several ways.

STIs are usually spread through sex because the bacteria or viruses travel in semen, vaginal fluids, and blood. Saliva (or spit) can spread some STIs if you have a tiny cut in or around your mouth.

STIs can be spread through direct contact with an infected area.

Infected blood on needles and syringes can spread certain STIs.

Infected women can pass some STIs to their babies during pregnancy, at childbirth or during breastfeeding.

You can catch some STIs more than once. And, you can have more than one STI at a time.

If you are HIV positive and have another of the sexually transmitted infections, you increase your chances of GIVING HIV to your partner.

If you don't have HIV but have another sexually transmitted infection, you increase your chances of GETTING HIV from an HIV positive partner.

Many STIs are easily treated, but all can be dangerous if ignored.

To reduce the possibility of spreading STIs or reinfection, sexually activity should be postponed until treatment has been completed.

For some STIs, like HIV, there is no cure to date.

You can get an STI from having sex with someone who is infected regardless of age, background, or sexual orientation.

You have a chance of catching a sexually transmitted infection if:

you have unprotected oral, vaginal or anal sex (without using a condom or if the condom breaks) with a person who may have an infection
your partner has, or has had, a sexually transmitted infection
you have a new sex partner
you or your partner had or is having sex with others
you have sex under the influence of alcohol or drugs
you share needles or equipment for drugs, body piercing, tattoos, or sex toys or your partner does.
If you have taken chances such as having sex without using a condom, please see a doctor or visit a public health clinic, and ask for an STI check-up. Your health is important, and so is the health of your partner. Remember that some STIs may not cause symptoms.

Malaria is an infectious disease that is transmitted through mosquito bites. Malaria is caused by parasites in blood, namely plasmodium. There are two main kinds of malaria, Plasmodium falciparum and Plasmodium vivax. The former is a severe type that may kill patients whereas the latter is mild but chronic.



2. What are common signs and symptoms of malaria?

The initial symptoms are malaise (not feeling well), low grade fever, body pain or cold like symptoms followed by intermittent high fever.

High fever

Headache

Nausea

Vomiting

Pale and yellowish skin.



3. When do the symptoms start after mosquito bite?

Generally, the symptoms start approximately 10 to 14 days after the biting of an infective mosquito. However, there are some types of malaria that the symptoms may start one to two or several months after mosquito biting.



4. Where is malaria transmitted?

There is great variety of malaria in epidemiology in the South-East Asia Region. Malaria transmission exists in cities (urban malaria) in India and other South- East Asia countries, in forests and foothill areas in Thailand, Myanmar and Bangladesh, in sea coast areas in Indonesia, etc.



5. How to prevent malaria?

There are three main ways to prevent malaria:

a) Prevent mosquitoes from biting people:

sleep under mosquito nets (ordinary or insecticide-treated)

screen all windows and doors in the house or, at least, in rooms where people sleep;

apply mosquito repellents to the skin; and

use mosquito coils.

b) Control mosquito breeding:

eliminate places where mosquitoes can lay eggs;

reclaim land by filling and draining;

introduce special fish that eat mosquito larvae; and

put special insecticides in the water to kill mosquito larvae.

c) Kill adult mosquitoes

spray rooms with insecticides before going to bed; and

participate in activities carried out by the health services, such as spraying the inside walls of houses with insecticides that kill mosquitoes.



Preventing mosquito bite

Mosquito nets: A mosquito net provides good protection from mosquito bites. Malaria-transmitting mosquitoes usually bite from sunset to sunrise, so a mosquito net can prevent children and adults from mosquito bites while they sleep. Mosquito nets treated with special insecticide provide better protection. Make sure that mosquito nets are used correctly, and are in good condition.

Screening: A mosquito net only provides protection to those while sleeping under it. But screening a whole house can protect everyone living in it, because screening can prevent mosquitoes from entering the house. All windows and doors must be screened. All screens must be properly maintained to ensure that mosquitoes cannot enter.

Repellents: Repellents are chemicals that are applied to the skin to keep mosquitoes away. They are readily available at chemists and pharmacies in all countries. They are effective when people are not using mosquito nets or are outside the house.

Mosquito coils: The smoke from mosquito coils keeps mosquitoes away, and may even kill them. They are useful when sitting outdoors, or in rooms that do not have screens.



6. Where do mosquitoes breed ?

Malaria mosquitoes may breed in:

fresh or brackish water (slightly salty) water, especially if it is stagnant or slow- flowing;

open streams with very slow-flowing water aling their banks;

pools of water left after the rains or as a result of poor water management;

swamps, rice fields, and reservoirs;

small ponds, pools, borrow-pits, canals, and ditches with stagnant water, in and around villages;

animal hoof-prints filled with water;

cisterns (water tanks) for storage of water, and

anything that may collect water – plant pots, old car tyres, etc.

mosquitoes usually “operate” within a 2-kilometre radius.



7. How to control mosquito breeding ?

Communities and individuals can reduce mosquito breeding by:

using sand to fill in pools, ponds, borrow-pits, etc.;

removing discarded containers that might collect water;

covering cisterns (water tanks) with mosquito nets or lids;

clearing away vegetation and other matter from the banks of stream so that water flows speedily;

repairing leaks, preventing spillage of water, improving drainage.

If, in spite if all preventive measures, someone gets malaria it is important to know the symptoms so that timely medical advice and treatment can be sought.



8. How to recognize malaria ?

Symptoms of malaria

One of the first symptoms is fiver accompanied with chill, rigor and followed by sweating. These symptoms recur at regular intervals (daily, 48 or 72 hours).

If the person has had these symptoms, then it could be malaria. See the doctor or the health worker as soon as possible.

The danger signs of severe malaria are:

changes in behaviour (convulsions; unconsciousness; drowsiness; confusion; inability to walk, sit, speak, or recognize relatives);

repeated vomiting, inability to retain oral medication, inability to eat or drink;

passage of small quantities of urine or no urine, or passage of dark urine;

severe diarrhoea;

unexplained heavy bleeding from nose, gums or other sotes;

high fever (above 39˚ C);

severe dehydration (loose skin and sunken eyes);

anemia; and

the whites of the eyes turning yellow.



9. What to do when someone has malaria?



When someone has ANY of the above symptoms, it is possible the patient has severe malaria. The patient’s life could be in danger. Urgent treatment is needed at a clinic or hospital to save the patient’s life. Do not waste any time in seeking good medical advice.

Remember, malaria is dangerous. But it is preventable through a multi-sectoral effort to address and control the problem by individuals, community, media and their sectors.



10.What is the role of the community and the individual ?

While governments and NGOs can do a lot to control malaria, other sectors, such as the media, organized groups, communities and individuals, can play a more critical role in addressing the problem:

Governments must combat malaria through effective strategies and programmes. They must mount vast IEC campaigns to educate people about malaria, its spread and control. They can spray insecticides; and they can control mosquito breeding by reclaiming land and filling drains. They can anticipate and be prepared for epidemics.

NGOs can support governments in all of the above activities by disseminating information, and exercising vigilance to ensure that all precautions are taken.

Media can play its part by highlighting the dangers of malaria and the simple means to prevent it.

Communities and individuals can make sure they keep their surroundings safe by eliminating breeding grounds and stagnant water. They can keep their families safe by understanding how, malaria is spread. They can help by recognizing the signs and symptoms and facilitating early diagnosis and treatment .They can adopt the simple practices within their reach to avoid malaria and contain its spread.



11.Is it recommended that pregnant women take chloroquine prophylaxis?

Malaria chemoprophylaxis is not contraindicated in pregnancy. These drugs are usually well tolerated for pregnant women and children. However, due to prevalence of Cholroquine and SP resistance in most countries of the SEA Region, these drugs would not guarantee full protection. Therefore, personal protection is strongly recommended.



12.Does the drug cause any side effects?

Yes, but very rare. It may cause stomach upset, itching.

These services are available at state hospitals, but waiting lists are often very long, depending on the problem or medical procedure needed. If you have medical aid cover it may be easier to go to a private hospital.

Criteria for selection of RSA students to study medicine in Cuba

1. Students who have difficulties in gaining access into South African medical universities because they do not have even the money to apply. It should be based on gaining representativity in the profession, based on those groups who are least represented in the medical fraternity in terms of race, gender and socio-economic status. Most students cannot afford the required fees for them to enrol in tertiary institutions nor have access to such information.

2. Students should have Matric (Grade 12) exemption with a good pass in English, Mathematics, Physics and Biology. The admission policy in certain tertiary institutions which is based on academic performance tends to exclude those students coming from disadvantaged backgrounds. If a student passes with a D in higher grade from a school which has no resources at all gives an indication that if the student was placed in a well resourced school he/she would have excelled.

3. Students have to be from rural areas within the province, from disadvantaged background and should be committed to work in the most underserved communities of the province. The majority of people in this province live in rural areas and the majority of hospitals are in rural areas yet, they lack access to health facilities as most South African educated doctors are not prepared to work there. Most of the facilities are manned by medical doctors from other countries.

4. Students should show potential to undertake and successfully complete a Medical Degree. This should be identified by the selection panels and should include an assessment of social and coping skills.

5. Students should be not more than 25 years of age. The target is the young people. The majority of them is between 18 and 22 years.

6. Students should commit themselves to undertake bridging courses: basic Spanish language course and orientation to South African environment upon their return before their deployment in the province. During the first year they study Spanish. On completion of four years they come back to South Africa to acclimatize themselves with the South African conditions and be distributed in various medical schools. On completion of their studies they graduate from Cuba in a South African university.

7. Students should sign a contract with the Eastern Cape Department of Health to work in the public hospital and be deployed where they are most needed. Their contracts are linked to communities they come from.

Apart from the normal interview, it was explained to candidates that they have to undergo full medical examination which included amongst other things the HIV and hepatitis B tests.

Yes. The amount will depend on how much you earn and on how many dependants you have, according to the hospital rating scale.

At the low end of the scale - that is, if you are unemployed - you will be expected to pay R39 as an outpatient. This will cover your consultation, medication and possible blood or other tests. A pensioner will pay only R13 for the same service. If you are unemployed and need to be admitted, you will pay R194 for up to 30 days.

The maximum a state hospital will charge, if you're at the top end of the income scale, is R55 for a consultation. However, you will be charged additional amounts for medication and tests. For a stay in hospital, a top-end patient (including those on medical aid) will pay R484.90 per day, excluding medicine and theatre costs.

The government is trying to guide patients away from hospitals to its public clinics and community health care centres - where free primary health care services are available. However, patients on medical aids will be charged.

There is no national medical insurance scheme in South Africa. Private medical schemes, regulated by the Medical Schemes Act, offer group membership or individual cover. Contributions to group schemes are usually split between the employer and employee. Medical aid costs are rapidly rising, partly because of the increase in the price of drugs, medical equipment and doctors' fees.

The government wants to introduce a social insurance policy requiring all employees to have health insurance. Medical schemes, fearing that an influx of low-income earners into their schemes will place an enormous financial burden on them, are lobbying for a subsidised national health scheme.

Most medical schemes provide a variety of choices for the consumer - from a basic hospital plan to full medical cover. Belonging to a medical aid is becoming increasingly costly and members often have to pay additional expenses. Doctors bills and some private hospital costs often exceed the scale of benefits, or the amount that the medical aid is prepared pay.

Medical aids also place ceilings on various categories of medical expenses - for example, R5,000 per year for dentistry for the family - and if these are exceeded, the member is liable for payment. Some medical aids, like Discovery Health, are encouraging their members to follow healthy lifestyles with a point system that rewards them with benefits for regular exercise, medical check-ups and other practices that reduce illness.

Pharmacists may only prescribe up to Schedule 3 drugs, which do not include antibiotics. They may issue oral contraceptives, insulin, thyroid and heart medications and some pain killers, for example.

Pharmacists are trained to give basic medical advice to cut down on wastage from unnecessary visits to the doctor. However, a pharmacist should advise when a visit to the doctor is necessary.

The BCG vaccine prevents severe forms of TB in children, such as TB meningitis. It would be expected that BCG would have the same effect in preventing severe forms of TB in children, even if they were exposed to XDR-TB, but it may be less effective in preventing pulmonary TB in adults, the commonest and most infectious form of TB. The effect of BCG against XDR-TB would therefore likely be very limited. New vaccines are urgently needed, and WHO and members of the Stop TB Partnership are actively working on new vaccines.

Yes, in some cases. Several countries with good TB control programmes have shown that cure is possible for up to 30% of affected people. But successful outcomes also depend greatly on the extent of the drug resistance, the severity of the disease and whether the patient’s immune system is compromised. It is vital that clinicians caring for TB patients are aware of the possibility of drug resistance and have access to laboratories that can provide early and accurate diagnosis so that effective treatment is provided as soon as possible. Effective treatment requires that all six classes of second-line drugs are available to clinicians who have special expertise in treating such cases.

The majority of healthy people with normal immunity may never become ill with TB, unless they are heavily exposed to infectious cases who are not treated or who have been on treatment for less than about one week. Even then, 90% of people infected with TB bacteria never develop TB disease. This applies to XDR-TB as well as to “ordinary” TB. People with HIV infection, however, in close contact with a TB patient, are more likely to catch TB and fall ill. The TB patients whom they meet should be encouraged to follow good cough hygiene, for example, covering their mouths with a handkerchief when they cough, or even, in the early stages of treatment, using a surgical mask, especially in closed environments with poor ventilation. The risk of becoming infected with TB is very low outdoors in the open air. Overall, the chances of being infected with XDR-TB are even lower than with ordinary TB because cases of XDR-TB are still very rare.

The most important thing is for a patient to continue taking all their treatment exactly as prescribed. No doses should be missed, but this is especially important if the course of treatment is meant to be taken every other day: so-called “intermittent treatment”. Above all, the treatment should be taken right through to the end. If a patient finds that side-effects are a problem, for example, the tablets make them feel sick, they should inform their clinician or nurse, because often there is a very simple solution. If they need to go away for any reason, patients should make sure they have enough tablets with them for the duration of the trip.

We do not know at the moment, but XDR-TB is rare. However, WHO estimates that there were almost half a million cases of MDR-TB worldwide in 2004, and MDR-TB usually has to occur before XDR-TB arises. We also know that findings from the only global study carried out so far showed that in some places perhaps as many as 19% of MDR-TB cases were in fact XDR-TB, but this is likely to be uncommon. Wherever second-line drugs to treat MDR-TB are being misused, the possibility of XDR-TB exists. Research is being carried out urgently to find out more.

Countries can prevent XDR-TB by ensuring that the work of their national TB control programmes, and all practitioners working with people with TB, is carried out according to the International Standards for TB Care. These emphasize providing proper diagnosis and treatment to all TB patients, including those with drug-resistant TB; assuring regular, timely supplies of all anti-TB drugs; proper management of anti-TB drugs and providing support to patients to maximize adherence to prescribed regimens; caring for XDR-TB cases in a centre with proper ventilation, and minimizing contact with other patients, particularly those with HIV, especially in the early stages before treatment has had a chance to reduce the infectiousness.

Symptoms of XDR-TB are no different from ordinary or drug-susceptible TB: a cough with thick, cloudy mucus (or sputum), sometimes with blood, for more than 2 weeks; fever, chills, and night sweats; fatigue and muscle weakness; weight loss; and in some cases shortness of breath and chest pain. If you have these symptoms, it does not mean you have XDR-TB, but it does mean you must go and see a doctor for a check-up. If you are already a patient with TB and you are taking treatment , if after a few weeks of treatment at least some of these symptoms are not improving, you should inform your clinician or nurse.

People who are ill with pulmonary TB (i.e. TB of the lungs, the site most commonly affected) are often infectious and can spread the disease by coughing, or sneezing, or simply talking, as this propels TB bacteria into the air. A person needs only to breathe in a small number of these germs to become infected (although only a small proportion of people will become infected with TB disease). Sometimes the bacteria are already drug resistant if they come from a person who already has drug-resistant TB. A second way of developing MDR-TB or XDR-TB is when a patient’s own TB develops resistance. This can occur when anti-TB drugs are misused or mismanaged. This happens when TB control programmes are poorly managed, for example when patients are not properly supported to complete their full course of treatment; when health-care providers prescribe the wrong treatment, or the wrong dose, or for too short a period of time; when the supply of drugs to the clinics dispensing drugs is erratic; or when the drugs are of poor quality.

There is probably no difference between the speed of transmission of XDR-TB and any other forms of TB. The spread of TB bacteria depends on factors such as the number and concentration of infectious people in any one place together with the presence of people with a higher risk of being infected (such as those with HIV/AIDS). The risk of becoming infected increases the longer the time that a previously uninfected person spends in the same room as the infectious case. The risk of spread increases where there is a high concentration of TB bacteria, such as can occur in closed environments like overcrowded houses, hospitals or prisons. The risk will be further increased if ventilation is poor. The risk of spread will be reduced and eventually eliminated if infectious patients receive proper treatment.

This depends on the patient’s access to health-care services. If TB bacteria are found in the sputum, the diagnosis of TB can be made in a day or two, but this finding will not be able to distinguish between drug-susceptible and drug-resistant TB. To evaluate drug susceptibility, the bacteria need to be cultivated and tested in a suitable laboratory. Final diagnosis in this way for TB, and especially for XDR-TB, may take from 6 to 16 weeks. To reduce the time needed for diagnosis, new tools for rapid TB diagnosis are urgently needed.

XDR-TB has been found in every region of the world, though it is still very rare. People who are at most risk, if they do come into contact with someone with XDR-TB, are those with reduced immunity to infectious diseases, such as those with HIV infection or other medical conditions that can weaken a person's immunity. It is also advised that such people should avoid high-risk areas where there are no infection control measures in place. Air travel itself carries only very minimal risks of infection with TB of any kind. Travellers with concerns about visiting countries with XDR-TB, or other health risks, should seek advice from their doctor, national authorities, or trusted travel web sites such as www.who.int/topics/travel

TB is one of the most common infections in people living with HIV/AIDS – because so many people are already infected with TB bacteria (see No. 1 above). In places where XDR-TB is most common, people living with HIV are at greater risk of becoming infected with XDR-TB, compared with people without HIV, because of their weakened immunity. If there are a lot of HIV-infected people in these places, then there will be a strong link between XDR-TB and HIV. Fortunately, in most of the places with high rates of HIV, XDR-TB is not widespread. For this reason, the majority of people with HIV who develop TB will have drug-susceptible or ordinary TB, and can be treated with standard first-line anti-TB drugs (see No. 1 above). For those with HIV infection, treatment with antiretroviral drugs will likely reduce the risk of becoming infected with XDR-TB, just as it does with ordinary TB.

MDR-TB, or multidrug-resistant TB, is a specific form of drug-resistant TB. It occurs when the TB bacteria are resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.
XDR-TB is TB that is resistant to any fluoroquinolone, and at least one of three injectable second-line drugs (capreomycin, kanamycin, and amikacin), in addition to MDR-TB. This definition of XDR-TB was agreed by the WHO Global Task Force on XDR-TB in October 2006.

First, WHO is ensuring that the health authorities responsible for TB control receive accurate information about XDR-TB. Second, WHO is emphasizing that good TB control prevents the emergence of drug resistance in the first place, and that the proper treatment of MDR-TB prevents the emergence of XDR-TB. This is completely in line with the new Stop TB Strategy launched in March 2006. Third, WHO is disseminating MDR-TB guidelines for national TB control programme managers published in May 2006 to help countries establish effective programmes to combat drug-resistant TB. Fourth, the WHO Stop TB and HIV departments are coordinating an international response through a WHO Global Task Force on XDR-TB which met for the first time in October 2006. Latest information and regular updates on XDR-TB, and related TB issues, will be published on the WHO Stop TB web site at www.who.int/tb and on the Stop TB Partnership web site at www.stoptb.org

XDR-TB is the abbreviation for extensively drug-resistant tuberculosis (TB). One in three people in the world is infected with dormant TB germs (i.e. TB bacteria). Only when the bacteria become active do people become ill with TB. Bacteria become active as a result of anything that can reduce the person’s immunity, such as HIV, advancing age, or some medical conditions. TB can usually be treated with a course of four standard, or first-line, anti-TB drugs. If these drugs are misused or mismanaged, multidrug-resistant TB (MDR-TB) can develop. MDR-TB takes longer to treat with second-line drugs, which are more expensive and have more side-effects. XDR-TB can develop when these second-line drugs are also misused or mismanaged and therefore also become ineffective. Because XDR-TB is resistant to first- and second-line drugs, treatment options are seriously limited. It is therefore vital that TB control is managed properly.

To protect health-care workers who may come into contact with infectious TB patients, appropriate and strict infection control measures must be implemented in health-care facilities at all times. Health care workers are also encouraged to make sure they are aware of their HIV status so that they can avoid putting themselves at risk of exposure.

Anyone who has been in contact with someone known, or suspected of having, XDR-TB should consult their doctor or a local TB clinic and be screened to see if they have TB. This is most important if the person has any symptoms of TB (see No. 13 above). If they have a cough, they will be asked to provide a sample of sputum, which will be tested for evidence of TB. Several other tests will be performed in the clinic, including a skin test and a chest radiograph. If TB is found, treatment will be started with the drugs to which the person’s TB is most likely to respond. If there is any evidence of infection with TB bacteria but without TB disease, preventive treatment may be given (the choice of drugs will depend upon the known drug resistance pattern) or the person may simply be asked to attend regularly for a check up.

For some years we have seen isolated cases of very highly resistant TB around the world that we would today call XDR-TB. All the drugs used against TB have been around for a long time. If they are not used carefully, then resistance can develop. It is only recently as we carry out regular surveys of drug resistance in more and more countries, and with improvements in laboratory capacity, that these cases are being reported in greater numbers. This has led to the problem being more closely examined and given a name.