This document provides information about HIV/AIDS and tuberculosis (TB) in South Africa to enhance nursing students' experience at service sites. It discusses transmission, symptoms, diagnosis and treatment of HIV/AIDS and TB. South Africa has the most HIV infections worldwide, especially among young women. TB is highly associated with HIV and a leading cause of death for those infected. The document recommends precautions to prevent transmission and encourages interaction with communities while dismissing stigmas.

1. AIDS & Tuberculosis in
South Africa
John C. Foster & Haleigh Powell
Nursing Teaching Project
UNRS 410 – Community Health Nursing

2. Our Goal
• To enhance your service site experience by providing information related to
HIV/AIDS and Tuberculosis that includes:
• Protection from transmission
• Effects on the community where service sites will take place
• We aim to dismiss any myths or social stigmas related to HIV/AIDS or TB
that would prevent the API students from fully interacting with their service
site community

3. HIV/AIDS
• Zoonotic virus which origin is in primate hosts in Africa
• Discovered in the 1980s through an increased prevalence of rare and serious
diseases
• Infects cells that mediate immune response
• CD4 cells and T cells
• Starts with an acute syndrome which progresses to AIDS
• Three stages of progression

4. HIV: Transmission
• Routes of Transmission
• Sexual contact, IV drug use, percutaneous/mucocutaneous contact (needle stick, open
wound, eyes/mouth), blood transfusion, mother-child
• Infectious fluids:
• Blood, sexual fluids, tissue fluids (wound secretions, embryonic fluid, etc.), and breast
milk
• Safe fluids:
• Sweat, tears, saliva, sputum, urine, stool

5. HIV/AIDS: Symptoms
• Stage One: Acute Infection Stage
• “Acute Retroviral Syndrome’ 2-4 weeks following exposure: rash, fatigue, fever, muscle
and joint aches/pain
• Stage Two: Clinical Latency Stage
• No HIV-related symptoms; lasts an average of 10 years for those not receiving ART
• Stage Three: AIDS
• CD4 cells <200 (normal 500-1600); opportunistic infections; without treatment 3 year
survival, without treatment and opportunistic infection 1 year survival

6. HIV/AIDS: Diagnosis and Treatment
• Diagnosis through several types of testing:
• Antibody tests: blood, oral fluid, or urine; Western blot test to confirm a positive result
• Antigen tests: blood; can detect HIV infection early on (1-3 weeks after infection)
• PCR test: blood; used for babies born to HIV+ mothers (2-3 weeks after infection)
• Antiretroviral Treatment (ART)
• Usually prescribed 3 different medications from 2 different classes (each class acts
differently on the virus)
• Controls amount of virus in the body and protects the immune system

7. HIV/AIDS: South Africa
• 5.6 million South Africans infected with HIV (17.3% of population)
• Country with the most people living with HIV in the world
• Main affected population: males and females aged 20-39
• Young women at high risk
• Violence against women
• Premature deaths rose 39% to 75% in 2000-2010
• 2.5 million children orphaned due to AIDS deaths in 2012
• Social stigma

8. HIV/AIDS: Myths
• You can get HIV from being around those who are HIV+
• Breathing same air, touching shared objects, hugging/kissing/shaking hands will not
transmit the virus
• You can get HIV from mosquitoes
• The lives of those who get infected with HIV are “over”
• You are free from risk if you are straight and are not an intravenous drug user
• 16% of men and 78% of women become HIV+ through heterosexual contact
• Those who are receiving treatment cannot spread the virus
• No matter how low a person’s viral count is, they are still considered infectious

9. Tuberculosis (TB)
• A disease caused by the bacteria Mycobacterium tuberculosis
• Most common sites of infection
• Lungs
• Lymph Nodes
• One third of the world’s population is infected
• Caused 1.3 million deaths worldwide in 2012
• Commonly associated with malnourished, impoverished, & immunosuppressed populations

10. TB: Transmission
• Pulmonary Tuberculosis is spread when airborne droplets are inhaled by an
uninfected person
• Transmission occurs when an infected person in close contact with another
• Coughs
• Sneezes
• Mycobacterium enters the lung and the bacteria are either:
• Destroyed by the immune system and become dormant
• Persist, multiply, and cause an active case of TB

11. TB: Active & Latent Symptoms
• 5% of individuals initially infected will develop active pulmonary TB
• Common symptoms include
• Chronic cough, night sweats, weight loss, & fatigue
• 95% of individuals develop the latent form of the infection
• No symptoms present because the bacteria is dormant
• 10% of healthy individuals with latent TB may develop an active case later in life

12. TB: Diagnosis & Treatment
• TB is diagnosed in the presence of:
• Positive Tuberculin Skin Test
• Chest x-ray revealing a tubercle
• IVGRA blood test for immunocompromised
• Treatment of tuberculosis consists of
• 6 to 9 months of antibiotic treatment
• Additional antibiotics and increased treatment time if the TB is drug resistant

13. TB: South Africa
• 88,000 South African TB & HIV related deaths in 2012
• Decreased access to healthcare and a lack of knowledge to seek treatment present
barriers to eradicating TB
• TB is highly associated with HIV/AIDS
• Up to 80% of TB clients are HIV positive
• 5.6 million South Africans infected with HIV
• HIV suppresses the immune system making it difficult to fight TB bacteria
• TB is the leading killer of people with HIV, causing 25% of deaths

14. Preventing Exposure at Service Sites
• HIV/AIDS
• Avoid contact with blood and other infectious fluids while at service sites
• If contact with infectious fluids:
• Mouth/eyes: rinse thoroughly with running water
• Percutaneous: encourage bleeding by squeezing under running water, and covering with
waterproof dressing
• Report immediately if contact is suspected or known
• Service site supervisor and call Janet (or Quinton/Roxy if she’s unavailable)
• Tuberculosis
• Remove yourself from a small enclosed room if your client is coughing violently or reports an active
case of TB

15. Service Site Encouragement
• Do not let a diagnosis come between you and loving the people of South
Africa
• Physical touch within the guidelines we provided is safe & extremely valuable
for the men and women you will be serving
• HIV/AIDS and social constraints/stigmas
• Matthew 8:3 – Jesus touches the leper
• Personal Ethembeni story

16. Quiz
• Describe the symptoms of a client with TB:
• Chronic cough, night sweats, weight loss, & fatigue
• True or False: An individual who shows no symptoms of TB after two
months does not have TB
• False. Latent TB could progress to active TB many years later.

17. Quiz
• What are some of the body fluids that can transmit HIV?
• Blood, sexual fluids, tissue fluids, and breast milk
• True or False: Someone previously diagnosed as HIV+ but hasn’t had
symptoms for years is not infectious
• False
• What stage of HIV/AIDS is this called?
• Clinical latency stage

18. References
• Aids.gov. (2013). Stages of HIV infection. Retrieved from http://aids.gov/ hiv-aids-basics/
just-diagnosed-with-hiv-aids/hiv-in-your-body/stages-of-hiv/
• AVERT. (2012). HIV & AIDS in South Africa. Retrieved from
http://www.avert.org/hiv-aids-south-africa.htm
• Copstead, L.C., & Banasik, J.L. (2010). Pathophysiology. (4th ed.). St. Louis, MI:
Elsevier
• Johnson, K. (2012). The Top 10 Myths and Misconceptions about HIV and AIDS.
Retrieved from http://www.webmd.com/hiv-aids/top-10-myths-misconceptions-about-
hiv-aids

19. References
• Stanhope, M., & Lancaster, J. (2012). Public Health Nursing: Population-Centered Health
Care in the Community. (8th ed.). Maryland Heights, MI: Elsevier
• UNAIDS. (2012). South Africa: HIV and AIDS estimates. Retrieved from
http://www.unaids.org/en/regionscountries/countries/southafrica/
• World Health Organization (2012). South Africa Tuberculosis Profile. Received from:
https://extranet.who.int/sree/Reports?op=Replet&name=/WHO_HQ_Reports/
G2/PROD/EXT/TBCountryProfile&ISO2=ZA&outtype=html
• World Health Organization (2013). Tuberculosis Fact Sheet. Received from:
http://www.who.int/mediacentre/factsheets/fs104/en/