Table of contents

Introduction and dedication

Chapter 1: New beginnings “the first day of
your new life”
Chapter 2: HIV & Me
Chapter 3: How HIV makes me feel
Chapter 4: HIV, Sex & Me
Chapter 5: Treatment and side effects
Chapter 6: AIDS the final chapter
 INTRODUCTION

I have always been passionate about helping

people. My goal from a child has been to serve
and be an instrument for the greater good of
people. I have dedicated my life to teaching
prevention and educating my patients. In so
doing, contribute to improving health literacy in
Belize. All my patients are important, and my
HIV patients hold a special place in my heart for
they are the strongest in my eyes: to live and
survive in a hateful society, that is tabooed and
discriminatory. I have come to realize that this
behaviour has also contributed to the
continued spreading of this disease, for many
are still not properly informed, others are still not taking proper precautions. I
have watched many dear to me engage in risky behaviours and continue with
the “it can’t happen to me” mentality and in so doing, some have sat in my
office staring at a positive rapid strip. However, in a changing society HIV
positive patients are not only those that have participated in risky behaviours
but also those born from HIV mothers and are now adults. This book is written
particularly for my patients. I have compiled some of the answers to questions
that you aren’t quite ready to ask yet, or haven’t thought of yet or just things I
think you should know. After reading this book you wouldn’t have gained great
knowledge, but hopefully it makes you feel better prepared, have a better
understanding of what you need to do, as well as the goals you want to
achieve. Nothing needs to be placed on hold, you are still the same person and
you are entitled to everything this world has to offer you. They sky is the limit.
Have a great read.
Chapter 1: NEW BEGININGS – “The first day of your
new life”
"So there are many commercials and slogans all around you. They've slowly managed to work
on your thoughts and have finally convinced you to go in and get your HIV test done. The wait
was nerve wrecking and the minutes excruciating, two lines finally appear and you are
POSITIVE. WHAT NOW???"

Getting a positive result can submerge you into an ocean of emotions. The feeling of being
overwhelmed with the news is a normal first response for many. So many questions: who gave
it to me? When did I get this? How did this happen to me? Then there are the feelings of
anger, guilt, shame, remorse and the list goes on. At this point it is important for you to know
HIV IS NOT A LIFE SENTENCE. HIV is a manageable disease and treatment is readily available for
all those who are infected free of charge. The first step is going to see a doctor or health care
provider even if you don't really want to, or if you feel that you are ok and not sick. It already
happened and now you need to take control of what happens next. Medical Doctors and Health
Care Providers will provide you with an initial assessment or what we call a baseline evaluation.
This evaluation is done on your first visit after you’ve learned of your positive status.

What is a Baseline evaluation? It is an initial assessment where you receive counselling, a

physical examination, lab tests and a chest x-ray. These steps are done to determine how much
of the virus you have in your body and also to determine how much of it has affected your body
to this point. This is done to determine the aggressiveness of treatment in efforts to prevent
HIV advancement to AIDS. During this visit you may start with questions in your head: Will I
eventually get AIDS? Does this mean I have AIDS? Am I going to die? How much time do I have?
What can I do now? Do I tell my Partner? All these questions and more are normal to feel and
are ok to ask.

CD4 count is a very important part of testing. CD4 cells are the soldiers of your immune system.
HIV destroys these cells, breaking down your defence and makes you susceptible to other
infections. This is important to know because HIV does not kill people, other infections do.
Most people die from complications to a broken immune system and coinfections.
Antiretroviral treatment (ART) prevent HIV from destroying cells. Treatment aims at giving your
CD4 cells a chance and help keep your system intact. Having a CD4 count of below 200cell/mm³
increases your NEED to start treatment. Measuring your CD4 levels is also important because it
allows us to see the effectiveness of your treatment.

Viral load is another test that is used to determine exactly how much virus is in the blood.
Remember the virus multiplies at a rapid rate. The main goal and objective as health care
providers is to have a person's viral load 'undetectable'. Meaning that the count is so low the
measurement done by the machines at the laboratory flags it as below 20. THIS IS AWESOME!
That should be your main goal from now on. MISSION OBJECTIVE: Become undetectable.

Other tests done during baseline evaluation

Your doctor may also screen or test you for sexually transmitted infections (STI). Having a
coinfection with one or more STI can cause your progression with HIV to accelerate at a faster
pace and may increase the risk of transmission to others. Detecting and getting other infections
out of the way allows your body to properly function with your treatment regime and may
improve your immune response to therapy.

When do you start treatment?

Persons should only start treatment when they are mentally prepared and understand that
treatment is for the rest of their lives. It is recommended by guidelines to start treatment as
soon as possible but if you are not mentally prepared for the road ahead you do more harm
than good in starting a treatment regime and quitting. The government of Belize provides ARTS
free of charge to any and every one that has been infected by this virus. It is not sold in
pharmacies, but instead is offered and made readily available to you every month for free. The
treatment regime is a tough one and you will always find yourself taking a cocktail of
medications daily. Sometimes you will grow tired and weary of taking them because they are
not easy to stomach, they are often times bitter and are rather large.

Drug resistance
The reason why there are so many pills to take is because the HIV virus form resistance when
exposed to only one anti-viral medication (this is also known as monotherapy), so in an effort to
attack the virus and not form resistance more than one antiretroviral medication is given.
However, IF you abruptly skip a day or stop taking your medications for a while you create what
is called drug resistant strains of HIV. This reduces the effectivity of your treatment because
drug resistant strains of HIV no longer respond to treatment and therefore your medications
can become ineffective. The problem with drug resistance in Belize is that antiretroviral
medications are expensive and we have a limited amount of combinations offered. Most of the
time it is difficult to know which anti-retroviral medications you are resistant to. The only true
way to know is by testing and these tests are not offered in Belize. This leads to doctors
changing your regimen completely and if you do the same thing with these new medications
you create a super-resistant strain of HIV and might end up living in Belize and not respond to
the treatment readily available to you due to induced resistance, provoked by your own
negligence. Taking your medications daily as prescribed by your doctor is the only way to
reduce the risks of drug resistance.

Cross resistance
Because HIV medications are classed or categorized by drugs and how they operate, it is
possible to be resistant to a drug that you have never been exposed to, if they are in the same
group or class as the specific one that your body is resistant to. This makes your options smaller
if you start developing resistance to a drug - considering all that I have mentioned previously
concerning the availability of antiretroviral that are being used in the country at the moment.
IMPORTANT to remember that we do not offer a wide variety of treatment options. Hence
being resistant to a particular drug may limit and reduce your treatment options greatly.

Chapter 2: HIV & Me

Living with HIV can be challenging, the start of your treatment, dealing with the side effects, dealing
with discrimination, stigma and the list goes on. Honestly there is a lot going on both physically and
emotionally. In this chapter we will talk about the more common physical changes to expect.

Physical changes

Lipohypertrophy is the abnormal accumulation of fat. When this fat is distributed around organs it is
known as visceral fat. This can cause the appearance of an enlarged abdomen or during an examination
can cause an abdomen to feel firm. In men, an increase in adipose tissue can cause men to develop the
appearance of breast, this is known as gynecomastia. Fat may also deposit to the upper back and the
neck, this characteristic is also referred to as the buffalo hump. Person with HIV may also detect round
lumps under the skin, these are known as lipomas.

Lipoatrophy is abnormal loss of fat in certain parts of the body. Most common place of lipoatrophy can
be observed as reduced fat in the face along the cheeks, temple and eye socket. Fats are also reduced
in the arms, leg and buttocks. The loss of fat to these areas may make your veins appear bulging,
however, this is only due to the fact that you now have less adipose or fatty tissue. Each person’s body
reacts differently to the virus, although it has been noted that women tend to build up fats and men
tend to lose fat.

It is important to maintain a healthy diet and adhere to your medication because lack of one or both
can contribute to weight loss and alter your physical image or appearance. This change can be drastic
and rapid and may then lead to depression, low self-esteem and a tendency to become socially isolated
for fear of discrimination or rejection.

Metabolic changes

Lipodystrophy as mentioned previously causes abnormal amounts of fats in the blood! This includes
both triglycerides and cholesterol. Having large amount of fats in the blood also known as
dyslipidaemia increase your risk of stroke and heart disease. Having elevated triglycerides may affect
your pancreas. This can then affect insulin production which if there is a restriction in insulin
production or elevated levels of glucose may then lead to type 2 Diabetes (secondary to your new
baseline disease).

Increase lactic acid in the blood may lead to lactic acidosis. This can cause you to feel tired, fatigued,
with reduced appetite, nausea, vomiting, abdominal cramps and also weight loss. Other signs or life-
threatening symptoms would be jaundice (yellow eyes), muscle weakness or tiredness, fast breathing
and elevated pulse. IF YOU ARE EXPERIENCING ANY OF THESE SIGNS SEEK A PROFESSIONAL.

Wasting syndrome
 Despite the fact that most persons living with HIV no longer “waste” while being compliant to
treatment, a small few still experience it. This is why it is important to explain to your doctor if you
experience any changes in fat distribution or changes in your body weight.

What is wasting syndrome?

HIV related wasting syndrome is as a consequence of the abnormal metabolic changes that your body
is experiencing, which alters your body’s ability to process protein, fats and carbohydrates. This
alteration then results in:

 Weight loss of more than 10% of total body weight. It generally occurs with diarrhoeas or
weakness that can last up to 30 days, as well as fever that is not related to an infection.
 Reduce physical endurance or stamina
 Lean muscle tone
 Reduced or no appetite

How can you prevent yourself from getting wasting syndrome?

1. Healthy diet: Be sure to incorporate plenty of fats and protein in your diet. This is to prevent loss
of muscle mass. In order to achieve this you may want to add:

 peanut butter
 legumes (dried beans and peas)
 cheese
 eggs
 instant breakfast drinks
 milkshakes
 sauces

2. Apart from eating right you also want to start doing exercise. Be sure to exercise regularly and if
possible progressive strength building and resistance training for your muscles.
3. Adherence to treatment: as previously mentioned the most important treatment for wasting
syndrome is effective treatment of HIV with antiretroviral medications. Be sure to be consistent
with your treatment and always explain to your doctor if you are experiencing any form of side
effects apart from the ones already explained to you by your doctor. Do not stop treatment on
your own without an alternative because creating resistant HIV strains are difficult to treat.

LUNGS AND HEART

Other changes in your body may involve Respiratory and Cardiovascular complications. Without
treatment persons living with HIV become vulnerable and more susceptible to infections such as
Tuberculosis, pneumonia and a disease called pneumocystis carinii pneumonia (PCP). This is a condition
that result in cough, difficulty to breath and fever. Living with HIV also increase your risk of developing
pulmonary arterial hypertension. A type of high blood pressure that affects the arteries of the lungs,
causing strain to the heart.
DIGESTIVE

Candidiasis is a fungal infection commonly seen in patients that suffer from HIV. Observed as a white
growth; It is seen frequently in the mouth and on the tongue, but may also affect the esophageal tract.
Leukoplakia is another infection, it is described as a white/gray hairy-like growth noted to the tongue
and the inner cheek of HIV patients. These infections may make it difficult at times to eat and to
swallow. The consumption of contaminated food and water may result at times in a parasitic intestinal
infection known as cryptosporidiosis. This infection generally affects the bile ducts and intestines.
Cryptosporidiosis is capable of affecting people whose immune system is intact, however it is a chronic
problem for persons living with HIV and AIDS making diarrhea a very common ailment.

RENAL SYSTEM

HIV related nephropathy is caused by an inflammation of the filters in the kidneys. When the kidneys
become affected they are unable to filter the blood properly and as a result are unable to remove toxins
from the blood in an efficient and effective manner.

CENTRAL NERVOUS SYSTEM

Advanced HIV infections are capable of damaging nerves (neuropathy). It creates small holes in the
conducting sheaths of the peripheral nerve fibers and when this occurs you begin to experience pain,
weakness and difficulty to walk, this is referred to as vacuolar myelopathy. HIV associated dementia or
AIDS dementia complex are disorders that affect cognitive functions, this mean that you may experience
difficulty thinking, remembering and understanding. This complex disorder is generally seen in younger
persons as opposed to chronic non-HIV related dementia that affects the elderly. Toxoplasma
encephalitis is an infection that is causes by a parasite, it increases the risk of inflammation to the spinal
cord and the brain; symptoms include confusion, headaches and seizures.

SKIN

The skin is the largest organ of the human body, with a weakened immune system it would be hard not
to observe it being affected. Persons with HIV are more vulnerable to herpes infections and are likely to
have relapses and outbreaks around the mouth and genitals. They are also at risk for shingles, as well as
a viral skin infection called Molluscum contagiosium. Persons may also develop an infection called
Prurugio nodularis which is a common skin disease described as a crusty lump on the skin with severe
itching.
Chapter 3: How HIV makes me feel
The diagnosis of HIV creates a considerable amount of stress psychologically. The uncertainty about
your life - quality and length of life, the effects of opportunistic infections and the response of society
towards your illness are great concerns that most people are often challenged with. While there is NO
way of predicting how a person may react to the news of a positive test, there are frequent emotions
that are normal.

1. SHOCK:
As in any life-threatening news, the reaction of shock is normal. You may feel struck silent,
numb, confused, in despair and in some cases people move from silent to tears to laughter or
visa/versa.

2. DENIAL:
Some people respond to the news of a positive result by denying its truth. Initial denial reduces
the amount of stress you may feel in the moment; however, if this goes on for a long period it
may hinder behavioural changes and the need to start treatment. All of which are essential in
learning to cope with this disease and prevent transmission to others and also preventing
yourself from being infected with another strain of this virus.

3. ANGER:
Some people become angry with the outcome of their results and may begin to engage in
destructive behaviours. This may also result in reckless behaviours that can lead to substance
abuse and negligence in taking treatment. Anger can be viewed as just an irritable mood or
outbursts that are at times triggered by trivial issues. Be reminded that anger can be directed
inward as a basic form of self-blame or can be displayed in self- destructive behaviours.

4. FEAR:
Upon receiving the news of a positive result a person may be over-whelmed with fear. The fear
of death is a normal concern, more-over the thoughts of dying alone might be consuming. The
fear of desertion, the thought of leaving family and children uncared for, disability, the loss of
bodily or mental functions and most importantly the loss of confidentiality and of privacy.

5. ISOLATION:
After hearing the news, you may have a strong urge to withdraw from social contacts. This
feeling of isolation can be attributed to your fear of abandonment once friends and relatives
learn about your status. The natural mentality and our human nature tells us, “Everyone is going
to abandon me if they find out, so it’s best I stick to myself!” While it is important to understand
that you wanting to be alone is a normal sentiment, ‘NO MAN IS AN ISLAND”, you need a
support system if you are going to start living. While it may be your own personal choice to
withdraw or keep the secret of your diagnosis to yourself – it is healthy to have someone to talk
 to (someone you trust). Evidence has proven that social support greatly improves treatment
outcome and quality of life.

6. LOSS:
A positive HIV status can automatically give you a sense of loss. Makes you want to give up,
forget about all your ambitions, your goals, and just gives you a feeling of defeat. ALL is NOT
lost, pick yourself up and dust off those feelings. Today the opportunities and availability of
treatment and care by far exceeds those of 10 years ago. You can still embrace a long and
healthy future and still achieve ALL your goals!

7. GUILT:
Usually after learning about being infected, grief and guilt often follow. The guilt of possibly
infecting your partner or child (if you had contracted the virus from promiscuity or found out
during pregnancy). Other times a sense of guilt is felt when you contemplate on all the times
you consented to unprotected sexual intercourse or engaged in reckless sexual behaviours at
parties and clubs. The guilt of having a habit that led to drug use and sharing of needles and
probably the guilt of all the sadness and disruption in the lives of your love ones the news might
cause.

8. DEPRESSION:
The knowledge of now being infected with a virus that requires a life time of medications,
needles and lab tests can result in a feeling of being helpless or powerless. This is a feeling that
is not experienced initially but after being subjected to repeated medical examinations and
needle pricks it may lead to one feeling depressed due to loss of personal control or privacy. In
like manner, the impression of not being able to procreate, or of have kids might also lead to a
feeling of depression. (Please know that this is not the end, with proper support and treatment,
having a HIV negative child IS POSSIBLE.)

9. LOW SELF-ESTEEM:
There is no doubt that your level of self-esteem drops a notch or two after learning about your
new status. The thought of how people perceive you after they find out, the fear of rejection by
friends, relatives, neighbours – just people on a whole. Preconceived thoughts of rejection, loss
of social status and confidence can quickly lead to feelings of reduced self-worth. Also the
physical changes that your body may be subjected to such as ‘wasting syndrome’ and loss of
physical strength may strongly support reduced self-worth.

10. SUICIDAL THOUGHTS, PLANS AND ACTIONS:

Sometimes people are unable to cope with thoughts of rejection and are unable to deal with the
overwhelming feelings of finding out they are now HIV positive - This may lead to wanting to
take one’s own life. Suicide may be viewed as a way of saving yourself from further ‘disgrace’,
shame or having to deal with rejection or the gossips around. Please know that suicide is NOT
the answer; while the thought is common, thoughts of suicide are NEVER normal in any
situation. It is important to speak to someone about your affliction and let your feelings out.
Keeping emotions bottled up and your infection a secret can lead to additional stress and is
 never a good thing. Instead, EDUCATE YOURSELF, learn all you can about your infection and
start living.

Chapter 4: HIV, Sex & Me

Persons living with HIV want the same things every other person wants and craves: Love, affection and
also to continue to be able to enjoy an experience the pleasures and satisfaction that sex offers. After
all, it’s just a disease and we are still very much human. Sex and relationships are essential aspects of
every adult life.

While there are many reactions towards sexual health after a recent diagnosis, you may feel the need
to be drastic and in your mind decide to be single and ‘never’ have sex again! Although that feeling is
ok and a normal one, the decision of isolation and celibacy should not be made solely on the fear of
transmitting the virus to loved ones and others. Instead it should be a decision made with great
thought; should you decide to remain celibate it should be a choice made and influenced only by you
after feeding yourself with all the right information. Considering permanent celibacy is very drastic,
instead a temporary time frame of celibacy is understood as you gather information about your new
status and educate yourself on how to better protect yourself and others. Please be mindful that this
initial reaction is normal. These feelings arise from being anxious about passing HIV to others, you may
no longer feel desirable or think that no one will want to have sex with you after finding out about your
status.

Having HIV can make you look at yourself differently and view sex in a negative light. The thought of
having to tell your past, present or future lover that you are infected can cause some level of anxiety.
You will need to firstly make that decision of telling none, some or all your sexual partners. Some
people tend to choose to have relationships and sex only with other people that are HIV positive as
well, thinking that this way no one gets hurt. This action is often triggered by thinking that no one will
understand you better than someone else that is going through the same thing, or justifying your
actions by saying at least this way no one else will get infected. You may feel also that by dating or
having a sexual relationship with another infected person you no longer need to use protection, since
you both share the same infection. This is a common misconception and yes while dating someone that
is infected with HIV may understand you or get you better than anyone else, it does not justify you not
using a condom to protect yourself. This is considered risky behaviour. Remember, although the other
person might be infected, having unprotected sex with them leaves you vulnerable to contracting
another strain of the same virus. YES! You can get HIV again and again! Because the virus mutates there
are various strains of HIV that exists including drug resistant strains. It is important to know that the
mutated strains of HIV that develop while a person is taking HIV medications can lead to drug-resistant
strains of HIV. But this is not the only concern, being exposed to various strains or constantly exposing
yourself to the virus can increase your viral load, and have negative impacts on your health. As your
CD4 declines due to this invasion, your ability to fight of diseases go down with it making it easier to get
sick and makes it more difficult for you to get over something as simple as a ‘flu’. Making healthy
decisions should include you using protection at all times, not only for others but for yourself.
 HIV, Sex & the Law

Let’s be real about it, no one asks to get infected by HIV, but people are infected on a daily basis. While
there exist cases such as transmission from mother to child during pregnancy and others through blood
transfusion with tainted blood, the same is also true that sometimes it is by our own negligence and
actions that we become infected. However, there still exist some people that are infected through an
act of vengeance, bad mind or unknowingly by a partner that is or was just as clueless. This is why
raising awareness and doing a status check is very important. When it comes to the law however, there
exists something called a criminalization code for HIV in the world. Please know: If you know you are
HIV positive, and you have sex without a condom without telling your sexual partner about your HIV
status, and your partner acquires HIV as a result, it is possible you could have legal action taken against
you. Belize’s Criminal Code, enacted in 2000, includes an HIV specific law criminalizing “deliberate” or
“reckless” HIV exposure or transmission with a maximum prison sentence of ten years. It defines these
acts as having vaginal, oral or anal intercourse that “is capable of transmitting bodily fluids” without
disclosure of known HIV-positive status. There are no data on the number of prosecutions or
convictions in this moment and the national HIV program headed by the ministry of health has
expressed to me that there is a notion to repeal this code but until then be mindful of your actions for
they can lead to legal implications. Also I would like to insist that even in the event such code is
annulled, that in your mind you still carry on as if it exists because if by chance you go to another
country and infect another through reckless or deliberate means you can be challenged legally through
their laws. Here are some guidelines to avoid court action, there is usually no case if:

 You didn’t know you have HIV or

 You told your partner you are HIV positive and
 You took reasonable steps to avoid passing HIV on to your partner

Now, while it is true that sex often happens in the heat of the moment, it may lead you to feel that
there is no opportunity to mention that you have HIV. You may also find that your partner initiates sex
without using a condom. Think in advance about how you would respond to these situations. Don’t
assume, just because your partner doesn’t want to talk about HIV or is willing or even eager to have sex
without a condom, that he or she is also living with HIV. Many times HIV-negative persons and people
who do not know their status - expect people living with HIV to tell them before they have sex. Having
this in mind they will then assume that, because there has been no mention of HIV and they have had
sex without using a condom, their partner is also HIV negative. This is not a fair judgement because just
as people living with HIV have a responsibility to look after their own health and not to pass on HIV,
HIV-negative persons and people who don’t know their HIV status have a responsibility to look after
their own health and to protect themselves from HIV. But, in the eyes of the law, the balance of
responsibility is weighed more towards people with HIV. Like I mentioned earlier, this code is pending
repeal in Belize or at least the notion has been suggested, but until then its best you practice safe
habits and always be mindful of protecting yourself. IF you make efforts to live a healthy lifestyle and
live to protect yourself you won’t ever have to worry about a criminalization code or legal actions taken
against you.

Relationship with an HIV-Negative person

Maintaining or starting a relationship with a partner that is HIV negative is what healthcare professionals
refer to as ‘serodifferent’ or ‘serodiscordant’. Being HIV positive does not hinder you from engaging in
relationships with persons of a negative status. By educating yourself you will come to understand that
having an undetectable HIV viral load and if you are on treatment you are less likely to pass on HIV.
Talking to your partner about sex and being HIV positive can be a struggle and sometimes a topic that is
difficult to face. It is recommended that you both educate yourself so that you fully understand the risks
and the best ways of preventing transmission. Condoms when used properly are very effective in
preventing transmission, however it is only as effective as the user. It is well known that persons do not
use condoms every time they engage in sexual activities and most individuals whether seronegative or
seropositive can attest to that. Your guidance counsellor will encourage you to be consistent with your
treatment and condom use, this is the recipe for a healthy life and will as a result allow you to have a
healthy sexual life. Feel free to consult your healthcare provider about your feelings and doubts, ask all
the questions you need whenever you go to your doctor or see your guidance counsellor.

HIV & Anal sex

Anal sex without a condom is one of the highest risk and activity for transmission of HIV as well as other
sexually transmitted infections. Being on HIV treatment with an undetectable viral load or correctly
using condoms each time you have sex can prevent this. The chances of a man passing HIV during anal
sex is greatest when he is the active, or ‘insertive’ partner. The risk is particularly high if you have a high
viral load or if you have an untreated sexually transmitted infection, since these can cause inflammation
or damage to tissue in the genital area. If you ejaculate inside your partner or if you have sex that causes
tissue damage you may also be at risk for transmission of the virus. The use of ‘uppers ‘or pills
(recreational drug used by young adults) during sex significantly increases the chance of the receptive
partner acquiring HIV, this is due to increase blood flow to tissue in the rectum.

HIV & Pregnancy

If you are HIV positive and wish to have children at present or in the near future I am here to tell you
that having a child that is HIV negative is possible! You may be wondering how a woman can become
pregnant if you are trying to be precautious and have been using condoms. Well working closely with
your doctor in an effort to get your viral load ‘undetectable’ is the first step. Couples, where one person
has HIV and the other does not and are trying to have a baby would then be advised to have sex without
a condom only on days when the woman is ovulating and at her most fertile as a way of minimising any
risk if one or both of you are concerned about the risks. It is also important that if the mother is HIV
positive that she tries to prevent pregnancy until her viral load is undetectable and that she maintains
on her antiretroviral treatment during her pregnancy. These will reduce greatly the risk of transmission
to her unborn child. While it is NOT an obligation to have a c-section due to being HIV positive it has
been a wide practice country wide as a preventative method. A lot of HIV mothers after having a child
have been advised by doctors to have their tubes tied. THIS IS NOT AN OBLIGATION and it is your right
to decide whether or not you want to be sterile. Adhering to your treatment and keeping your viral load
undetectable can allow you to have more than one child and the possibility of transmitting to them
considered very low. After birth it’s important to know that your breastmilk do contain the virus, when
you are on your treatment and your viral load is undetectable the risk is relatively low, however you
should only breastfeed if advised to do so. Breastfeeding your child places them at risk of contracting
the virus after you have already went through the extent of prevention throughout the pregnancy.
You’ve come too far to fail now. This should always be in your mind, as you will feel pressured at times
especially in the maternity ward with the other mothers who will be seen breastfeeding. You may feel as
if they are wondering about you and why you haven’t breastfed, do not feel pressured, you are doing
what is best for your child. Most of the time our mind is our greatest enemy, stop thinking the worst of
what others think of you, say something like, ‘I have no milk’ or ‘my nipples aren’t apt’ there are many
ways to boycott the question of why you haven’t breastfed.

Chapter 5: Treatment & side effects

Starting your new treatment regime can be a bit nerve wrecking, the whole concept of your new status
and not to mention the heap load of medications you were just given by your doctor to take. It’s easy to
become disheartened by the quantity of the treatment; your future might even seem a bit dim at this
point when you start contemplating how you would mask the idea of why you are on so many pills! All
these thoughts are normal, and a lot of patients try to express to family and friends that its ‘vitamins’, I
am not implying in this book that this is what you should say, besides…who takes that many vitamins?!
But indeed it has been used and you will definitely not be the first.

As you already read in the previous chapters, the decision of starting your antiretroviral treatment is
very important. After you have conditioned in your mind that you will be taking treatment daily for the
rest of your life and have dedicated to do so, your will to continue might be a bit shaken during your first
days of actually taking the treatment. Most ARV therapy have the tendency to make you feel extremely
sick upon initiation; however, the good news is that the sensation most of the time fades and your body
adapts. IF in the event your nausea and vomiting does not subside after two weeks it is probably best
you take that issue up with your doctor. Here in Belize there are limited combinations of therapy, so in
an effort to risk you abruptly quitting, medical officers observe you during the first few weeks to
evaluate your feelings while taking this new treatment. Very rarely do they switch treatment regimes,
because remember the risk of you creating a new resistant strain of HIV is always a concern. As a result,
IF the side effects are over bearing then a switch is made, IF the effects are minimal your doctor would
then add medications to help you through it. (for example: if nausea and vomiting are your biggest issue
– which in MOST cases it will be, your doctor would treat you with an antiemetic to reduce the sensation
of nausea and stop you from throwing up every time you take your medication) This method, works for
most people and there is a high chance it will work for you as well.

At present there are more than 20 antiretroviral drugs approved to treat HIV. These medications are not
cures for the virus but works by reducing the amount of virus in your body, and prevents it from
completely destroying your immune system. Your doctor will always provide a combination of these
drugs for you to take, this is called antiretroviral therapy. The act of taking your medication the way your
doctor prescribed them is called ‘adherence’. As most drugs, there is always the possibility of
experiencing side effects. These side effects can be divided in to short-termed or long-termed effects as
should be explained by your personal doctor.

Common short termed side effects often include:

  Tiredness
 Nausea (upset stomach)
 Vomiting
 Diarrhoea
 Headaches
 Fever
 Muscle pain
 Dry mouth
 dizziness

Long termed side effects are:

 kidney failure
 hepatotoxicity
 heart disease
 diabetes and insulin resistance
 Hyperlipidemia (increase fats in blood)
 Lipodystophy
 Osteoporosis
 Phychiatric effects (suicidal thoughts, insomnia, depression)

Just as in taking any medication there will always exist the desired result as well as the unwanted side-
effects. This is important to communicate with your doctor just as much as it is important for you to
participate in having your regular medical check-ups. Your physical examination and general blood
works are essential, especially when attempting to prevent the long term effects as mentioned above.
Be mindful that your treatment is for the rest of your life and as such having a regular routine when it
comes to seeing your doctor may keep some of these effects at bay.

When it comes to taking your medication make sure that you are open and honest with your health care
provider, be consistent with your scheduled time for taking each pills and talk to your doctor about
which treatment can be taken with food. Feel free to question your pharmacist about what foods are
better to take along with your ARTs and which you should avoid. Health care providers and the
pharmacists are here for you, feel comfortable having a rapport with them and ALWAYS ASK
QUESTIONS!

Chapter 6: AIDS ‘the final chapter’

There are many classifications that exists when addressing the stages of HIV and AIDS, however doctors
have defined a classification of 3 important phases of this disease.
 1. Acute stage infection: 2-4 weeks after becoming infected a person may develop ‘flu-like’
symptoms, persons would describe it as the worst flu ever! This would often include symptoms
such as fever, swollen lymph glands, sore throat, rash, muscle aches and headache. This is
considered the acute retroviral syndrome (ARS) also known as the Primary HIV infection. It is
important to know that in this phase HIV multiplies very rapidly throughout the body and your
risk of transmitting the infection is high.

2. Clinical Latency / Asymptomatic HIV infection: The virus is established within the body, there
may not be any signs or symptoms in this phase. The virus is still multiplying but at a moderate
rate, your risk of transmitting the infection is still possible despite not having symptoms. The
lifespan of a person in this chronic phase has been estimated as 10 years before developing
AIDS, however there are certain factors that may influence your body and speed up your
progression to the end stage infection – AIDS, if not on treatment.

3. AIDS: The immune system is severely damaged and leaves you vulnerable to infections called
opportunistic infections. These are infections that are caused or provoked by viruses, bacteria
and fungi that would not have affected the body if your immune system was intact. Having a
CD4 count of below 200 cell/mm3 in blood along with the presence of one or more
opportunistic diseases is criteria for the diagnosis of AIDS. However it is important to note that
you are considered to have AIDS regardless of your cd4 count if you have one or more
opportunistic infections present. Without treatment a person living with AIDS has an estimated
lifespan of approximately 3 years.

People tend to use the terms “HIV & AIDS” together or interchangeably as if they are both the same. The
truth is, they are different diagnoses despite being used to describe ONE particular disease. HIV is the
short term used to address the human immune deficiency virus; its function is to attack the CD4 cells in
your body whose responsibility is to defend against infections. This virus, IF left untreated can lead to a
condition/syndrome called AIDS – Acquired Immune Deficiency Syndrome, considered the most
advanced stage of an HIV infection. AIDS develops in a person after the Human immunodeficiency virus
has completely attacked and stripped the immune system to the point where it is no longer capable of
defence. This complex condition results in a collection of signs and symptoms that may vary from person
to person. Because each person is different, physicians use a certain set of guidelines to determine
whether you are HIV positive without AIDS or whether you have completely travelled through all stages
and now have full blown AIDS.

The diagnosis of having AIDS is indeed a complicated one but the criteria remains as follows:

1. Having a CD4 count of equal or less than 200 – Your CD4 count is a guide to evaluate how well
your immune system is functioning. For this reason you doctor has been encouraging you to do
regular CD4 counts and viral load tests, so that he or she may have an idea of how well your
immune system has been recovering while on treatment. Any person living with a positive
diagnosis of HIV with a CD4 count of less than 200 cells is considered to have AIDS. (NOTE – a
 person without an HIV infection would have levels of CD4 ranging from 500-1,500 and is
considered normal.)

2. Opportunistic infections – The presence of opportunistic infections are considered those

diseases provoked by the presence of viruses, fungi or bacteria that would not make a person
who has a fully functioning immune system sick.

Factors that affect disease progression

Not everyone that has HIV progresses to AIDS and there are reasons for this. A person can live decades
with HIV and not move on to the end stage infection. While antiretroviral therapy slows down the
progression of the infection there exist other factors, these include:

 Age: being young compared to elderly upon infection plays an important role in how your body
responds to the infection and its progression. This can be attributed to the condition of your
immune system at the time of infections. Being older can result in faster progression of HIV.
 Health: As with age, your health upon initial infection can be key to the progression of HIV. If
you have other diseases or infections that greatly affects your immune system at the time of
initial exposure this may allow you to progress a lot quicker due to a compromised immune
system.
 Timeline: The amount of time passed from initial infection to the point in time where you are
actually diagnosed is of great importance in preventing progression. The longer the time
between diagnosis and treatment the faster the progression.
 Lifestyle: Having a compromised immune system is already a setback for you. Not having
enough sleep, not eating properly or balanced, engaging in reckless behaviours such as sexual
promiscuity, alcoholism and smoking are all factors that keep your immune system weak,
deprives recovery and facilitates a faster progression rate to AIDS.
 Medication: It is very important that you take your medications as prescribed by your doctor
and on time. Failure to do so can result in developing resistance to treatment and creation of a
resistant strain of the virus. This is very difficult to control and many times require changing of
your therapy regime. In Belize combination therapy does not exist in a wide variety as do other
countries, becoming resistant to the treatment offered within the country does you more bad
than good and can allow you to progress to AIDS due to treatment being ineffective.

How can you slow down the progression of HIV?

Person that have been diagnosed with HIV need to understand 2 important concepts.

1. You have a weakened immune system due to HIV.

2. You have a virus rapidly multiplying within you.

By understanding these two factors you will be able to make better choices and decisions that greatly
influence your lifestyle. Steps to delay the progression of HIV include:

 Medications: Taking your medication as prescribed by your doctor and being consistent is very
crucial to this infection. Your antiretroviral medications work by inhibiting the multiplication of
 this virus and reduce the destruction done to your cells. This helps you to achieve a lower viral
load and increases your CD4 count, making you strong by reducing damage to your immune
system.
 Follow up: Make an effort to visit your doctor regularly, be sure to explain how you feel while
taking treatment (if you have just started). Be on time for your blood tests and to pick up your
re-fills.
 Lifestyle: Always eat balanced meals, get enough rest, hydrate and be sure to exercise. Try to
minimize stress levels, and as much as it depends on you make every effort to have protection
when engaging in sexual activities. This is not only to reduce transmission but also to prevent
you from re-infection and exposure to other strains of the virus and protection from other
infections that can easily become a super-infection or opportunistic infection.

The End
That’s it, you have completed reading this book! Like I said, upon completion you would not have gain
great knowledge, but I do hope you learned a lot about your new life and that this helps you to have a
better footing on where to begin. I know that the road ahead is a long one, but be comforted that I am
here for you. It’s ok to have a preference when it comes to locating a particular health care facility and
also normal to want to see a particular doctor. I have had patients ask for me by name. That is fine,
however do not limit yourselves to one or feel like there is no one else you can talk to. We are all here to
help you and guide you. Never be shy to reach out, always ask questions and take care of you!!