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