WOMEN IN THE WORLD OF WORK

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CHAPTER 3 HIV AND AIDS: A THEORETICAL OVERVIEW

 INTRODUCTION

Much is known about the virus that causes AIDS, the ways in which it is transmitted, about the acute symptoms and the impact on the society. In addition, the statistical picture of HIV and AIDS at both national and international level is clear. This chapter aims to illustrate the basics of HIV and AIDS.

DEFINITION OF HIV AND AIDS

Acquired Immuno Deficiency Syndrome (AIDS) was first recognised in 1981 as a distinct medical condition by the Centre for Disease Control (CDC). A person infected with HIV is diagnosed with AIDS when the body’s immune system breaks down and certain conditions or illnesses occur. HIV is a virus that attacks the body’s immune system.
A person infected with HIV may not initially show any symptoms, but eventually, without effective treatment, the immune system will become very weak and the person will no longer be able to fight the illnesses. The Centre for Disease Control and Prevention (CDC) defines a person who has AIDS as being infected with HIV and having less than 200 CD4 cells per cubic millimetre of blood accompanied by health problems common in people with AIDS, which are called opportunistic infections (CDC, 2006). Healthy adults have CD4 and T cell counts of 1,000 or more.
HIV destroys white blood cells named the CD4+ T-lymphocytes, which are important to the body’s immune system. When these cells are weakened or lost, the body becomes weak and is left vulnerable to opportunistic infections. The death of these blood cells is a consequence of the infection with HIV (National Research Foundation (NRF), 1986: 6). Opportunistic infections are illnesses that are caused by organisms that do not ordinarily cause disease in a person with a healthy immune system, such as tuberculosis, pneumocystis carinii pneumonia, cervical cancers, herpes zoster, lymphoma and others (World AIDS Day Website…, 2007).
The Human Immuno-deficiency Virus (HIV) causes the acquired immuno-deficiency syndrome AIDS. There are different types and strains of HIV. Most people have the HIV- 1 strain (type). A person can become infected with more than one strain. HIV attacks the body’s immune system (natural defence system against disease) by destroying one type of blood cell (CD4 cells) that helps the body fight against and destroy germs.
CD4 cells belong to a group of blood cells called T-cells that also help the body fight disease. In the body, HIV enters these cells, replicates, and kills the healthy cells and leaves the body vulnerable against germs. When HIV overpowers enough CD4 cells or causes serious infections that do not normally make a healthy person sick, a person is then confirmed to have AIDS. The progression from HIV to AIDS is different from person to person, meaning some people live for 15 years or more with HIV without it developing into AIDS, while others develop AIDS faster. The exact explanation for progression from early HIV to AIDS is unknown. A number of factors are involved, including genetic susceptibility, co-infection with other viruses, age, and probably the resistance of HIV to anti-HIV drugs (Essex & Kanki, 1989:3).

HOW IS HIV TRANSMITTED?

HIV is transmitted through contact with certain body fluids or tissue of persons infected with the virus. HIV travels in the blood, semen, vaginal fluids, and breast milk of an infected person. The virus is transmitted through sexual contact (unprotected vaginal, anal and oral), by needle sharing, from mother to child during pregnancy, birth or after birth, through blood transfusion, tissue or organ donation.
The virus enters the body and attaches itself to host cells, which is known as the CD4 cells (or T-helper cells). The T-helper cells are the prime targets of HIV. In order for the person to be infected, the virus has to enter the body and attach itself to the CD4 cells. The process of the HIV infection and killing of the T4 cells is the process that starts the infection. The infection begins as a protein on the viral envelope that attaches itself tightly to a protein known as CD4. The virus then merges with the T4 cell and transcribes its RNA genome into the double-strand DNA. The viral DNA becomes incorporated into the genetic material in the cell’s nucleus and directs the products of new viral RNA and viral proteins, which combine to form new virus particles. These particles bud from the cell membrane and infect other cells. Finally, the viral protein circulates in the blood of people with HIV and makes the immune system weak  (Redfield & Burke 1989: 3).
AIDS has become a social disease that can be defined as a social disease with its transmission related to certain identifiable forms of social behaviour, such as sex. The emphasis is also on behaviour change as the only way to prevent the spread of AIDS in the current event of absence of a medical cure. The two identifiable options to address behaviour, in the opinion of Jobson (2002:3), are reducing the number of sexual  partners and increasing the use of condoms. Pool (1997:83) suggests that an understanding of the social, cultural, and economic contexts of the behaviour concerned is as important. He further adds that the relationship between knowledge and general causal models is essential, noting the following:

• Sexual behaviour and related attitudes.
• Knowledge and perceptions of
• Local aetiologies and treatment-seeking
• Social organisations, customs and
• Underlying socio-economic factors.
• Coping with AIDS and its

There are symptoms and signs that identify a person who is HIV infected. During the first stage of HIV infection, the person is ‘asymptomatic’. Asymptomatic means the person shows no symptoms of being infected. In this case, the only way to know if the person is infected is through a blood test. The second stage is called the symptomatic stage. The symptoms associated with this stage are fatigue, fever, swollen lymph glands, chronic diarrhoea, meningitis, and weight loss. HIV may also result in symptoms such as neurological damage, and of the neurological complications, dementia is among the most severe and disabling (CDC, 1993: 2). Sometimes the presence of neurological complications may mimic psychological problems, posing difficulties in diagnosis. Women experience vagina yeast infections. This stage may last for several years, but it also may progress to severe, advanced illness in a matter of weeks or months. Through the introduction of drug therapy, the length of time can be extended before the person becomes seriously ill. The most advanced stage of HIV infection is the AIDS phase. This is the stage when the infected person has severe immune-suppression (less than 200 CD4 count).

STAGES OF HIV

The following description is a summary of the training manual developed by the researcher for the purpose of HIV training that is offered to various workplaces through consultation process. The manual is in a presentation format and the content was gathered from various research from newspapers and Internet sources, seminar and conference papers and interactions with experts in the field of HIV and AIDS over the past years.

Stage 1: HIV Infection

This stage comprises the first 6-12 weeks after acquiring the HIV-infection, until the body’s initial immune response develops enough antibodies to reduce the amount of  HIV in the body. During this period, people are highly infectious and the virus can then easily be passed on to others.
At this stage some people may develop a flu-like illness, called ‘sero-conversion illness’. This occurs around the time the HIV antibody test converts from negative to positive, i.e. when the body has developed sufficient antibodies to be able to detect them with a blood test. It is probably caused by the activation of the immune system. Sero- conversion illness may present as follows:

• Fever, headache, malaise (general feeling of illness)
• Enlarged lymph nodes (glands of the immune system in the neck and groin)
• Skin rash
• Painful muscles and joints
• Sore throat

These symptoms usually disappear within a week to a month and are often mistaken for a simple cold or flu.
The period prior to sero-conversion is known as the ‘window period’. During this period, antibodies are not detectable and a blood test may return a false negative result. This phase lasts two to twenty-four weeks after infection and most HIV tests will show negative results in this phase, although the person is already infected. This is a very dangerous period because people are infectious and are easily able to spread the virus, even though blood tests show that they are ‘negative’ (CDC, 2004).
Once antibodies are detected, the blood test result is positive and sero-conversion is said to have taken place. During sero-conversion, the antibody levels are very high. Levels drop much lower thereafter. Once the symptoms related to the sero-conversion illness disappear, the infected person may remain symptom-free and well for many years.

Stage 2: Asymptomatic Or Silent Phase

During this stage, an HIV positive person enters an asymptomatic phase, during which time he or she remains clinically healthy. This stage can last anything from three to seven years – sometimes up to 10 years. Although the infection is silent, the virus is continues its onslaught on the immune system, which is slowly deteriorating.
During this phase, the only indication that a person is infected with HIV would be by a positive HIV test. The person remains infective throughout this stage. This stage is associated with a CD4 cell count of 500 – 800 cells/mm³ (CDC, 1993:4).
Most of the patients in this phase of the disease are unaware of their HIV infection and continue with their lives as normal. Those who become aware of their status, usually from screening during pregnancy, testing for blood donation or testing for insurance purposes, have to make a major social adjustment. A positive diagnosis usually causes an acute (sudden onset) emotional crisis for the person (and his/her family) and often results in depression. Psychological support in the form of counselling is often necessary.

Stage 3: Minor Symptomatic Phase

As the CD4 cell count reduces, a variety of minor complications begin to surface because of the weakened immune system. (Stage 3, characterised by minor symptoms, and stage 4, characterised by more serious symptoms are often discussed as one stage).
One of the first such symptoms experienced by many people infected with HIV, is lymph nodes (glands) that remain enlarged for more than three months, also called persistent lymphadenopathy (Crewe & Orkin, 1992).
Other symptoms often experienced months to years before the onset of AIDS include:

• A lack of energy
• Weight loss
• Frequent fevers and sweats
• Persistent or frequent yeast/thrush infections (oral or vaginal)
• Persistent skin rashes, dry and itchy skin
• Pelvic inflammatory disease that does not respond to treatment
• Short-term memory loss
• Children may have delayed development or ‘failure to thrive’
• Fungal nail infections
• Recurrent mouth ulcers
• Recurrent throat infections
• Shingles (herpes Zoster)

SUMMARY
CHAPTER 1 GENERAL ORIENTATION
1.1 INTRODUCTION
1.1.1 The Role of EAP
1.1.2 HIV and AIDS
1.2 MOTIVATION
1.3 PROBLEM FORMULATION
1.4 GOALS AND OBJECTIVES
1.4.1 Goals
1.4.2 Objectives
1.5 RESEARCH QUESTION
1.6 RESEARCH APPROACH
1.7 TYPE OF RESEARCH
1.8 RESEARCH DESIGN
1.9 RESEARCH PROCEDURE AND STRATEGY
1.9.1 Data Collection
1.9.2 Data Analysis
1.10 PILOT STUDY
1.10.1 Pilot Test Of Questionnaire
1.10.2 Literature Study
1.10.3 Consultation With Experts
1.10.4 Feasibility Of The Study
1.11 DESCRIPTION OF THE RESEARCH POPULATION
1.11.1 Description Of Population
1.11.1.1 Population: Qualitative Study
1.11.1.2 Population: Quantitative Study
1.11.2 Sample
1.11.2.1 Sample Qualitative Study
1.11.2.2 Sample Quantitative Study
1.11.3 Sampling Strategy
1.11.3.1 Sampling Strategy: Qualitative Study
1.11.3.2 Sampling Strategy: Quantitative Study
1.12 ETHICAL ISSUES
1.12.1 Confidentiality And Anonymity
1.12.2 Debriefing of Respondents
1.13 DEFINITION OF CONCEPTS
1.13.1 HIV and AIDS
1.13.2 Employee Assistance Programme
1.13.3 Employee Assistance Programme Practitioner
1.13.4 Occupational Social Work
1.14 LIMITATIONS OF THE STUDY
1.15 CONTENT OF THE RESEARCH REPORT
CHAPTER 2  WOMEN IN THE WORLD OF WORK 
2.1 INTRODUCTION
2.2 WOMEN’S ROLES
2.3 CHANGES IN THE WORKPLACE
2.4 DEVELOPMENT OF WOMEN
2.5 CHANGING STRUCTURE OF THE FAMILY
2.6 EDUCATIONAL IMPROVEMENTS
2.7 FEMINISM
2.8 WOMEN’S HEALTH
2.9 SUMMARY
CHAPTER 3 HIV AND AIDS: A THEORETICAL OVERVIEW
3.1 INTRODUCTION
3.2 DEFINITION OF HIV AND AIDS
3.3 HOW IS HIV TRANSMITTED?
3.4 STAGES OF HIV
3.4.1 Stage 1: HIV Infection
3.4.2 Stage 2: Asymptomatic Or Silent Phase
3.4.3 Stage 3: Minor Symptomatic Phase
3.4.4 Stage 4: Symptomatic HIV-Disease.
3.4.5 Stage 5: Full-Blown AIDS
3.5 THE INTERNATIONAL EPIDEMIOLOGY OF AIDS
3.6 THE SOUTH AFRICAN TRENDS ON AIDS
3.7 SUMMARY
CHAPTER 4 GENDER AND HIV AND AIDS
4.1 INTRODUCTION
4.2 GENDER PERSPECTIVE ON WOMEN AND HIV AND AIDS
4.3 THE UNITED NATION’S ROLE
4.4 SUMMARY.
CHAPTER 5  HIV AND AIDS IN THE WORKPLACE 
5.1 INTRODUCTION
5.2 THE PREVALENCE OF HIV AND AIDS IN THE WORKPLACE
5.3 THE IMPACT OF HIV AND AIDS IN THE WORKPLACE
5.4 SOUTH AFRICAN BUSINESS RESPONSE TO HIV AND AIDS
5.5 SUMMARY
CHAPTER 6 DIFFICULTIES EXPERIENCED BY HIV AND AIDS INFECTED AND AFFECTED WOMEN IN THE WORKPLACE
6.1 INTRODUCTION
6.2 THE EFFECT OF HIV AND AIDS ON SOUTH AFRICAN WOMEN
6.3 THE DIFFICULTIES EXPERIENCED BY HIV AND AIDS FEMALE CAREGIVERS
6.4 THE STIGMATISATION OF HIV INFECTED AND AFFECTED WOMEN
6.5 THE EMOTIONAL PAIN OF WOMEN WITH HIV AND AIDS
6.6 SUMMARY
CHAPTER 7  THE ROLE OF EAP IN THE WORKPLACE 
7.1 INTRODUCTION
7.2 EMPLOYEE ASSISTANCE PROGRAMME (EAP)
7.3 HISTORICAL PERSPECTIVE OF EAP
7.4 REASONS FOR IMPLEMENTING EAP
7.5 THE TROUBLED EMPLOYEE
7.6 MODELS OF EAP
7.7 SUCCESS OF THE EAP
7.8 SUMMARY
CHAPTER 8 THE ROLE OF EAP IN ADRESSING ISSUES OF HIV AND AIDS INFECTED AND AFFECTED WOMEN IN THE WORKPLACE
8.1 INTRODUCTION
8.2 HIV AND AIDS PROGRAMME
8.3 HIV AND AIDS COUNSELLING IN THE CONTEXT OF EAP
8.4 SKILLS FOR COUNSELLORS HELPING PEOPLE AFFECTED BY HIV AND AIDS
8.5 SPIRITUAL COPING MECHANISM FOR WOMEN WITH HIV AND AIDS
8.6 PHYSCHOSOCIAL IMPACT OF HIV AND AIDS ON COUNSELLORS
8.7 SUMMARY
CHAPTER 9  EMPIRICAL RESULTS ON THE ROLE OF THE EAP IN ADDRESSING THE DIFFICULTIES EXPERIENCED BY WORKING WOMEN RESULTING FROM THE IMPACT OF HIV AND AIDS
9.1 INTRODUCTION
9.2 RESEARCH PROCEDURE
9.3 PRESENTATION OF EMPIRICAL DATA
CHAPTER 10  SUMMARY AND RECOMMENDATIONS 
10.1 INTRODUCTION
10.2 RESEARCH OBJECTIVES
10.3 LITERATURE REVIEW
10.4 QUALITATIVE STUDY
10.5 QUANTITATIVE STUDY
10.6 RECOMMENDATIONS
10.7 GOALS AND OBJECTIVES
10.8 CLOSING REMARKS
REFERENCES
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