HIV Testing in Papua New Guinea, AIDS Testing, Human Immunodeficiency Virus Testing

Question 1. What is HIV and AIDS?

HIV is the abbreviation used for the human immunodeficiency virus. HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease. HIV attacks the body's immune system. The infection-fighting cells of the immune system are called CD4 cells or T-helper cells a subset of lymphocytes. Months to years after a person is infected with HIV, the virus destroys the CD4 cells. When the CD4 cells are destroyed, the immune system can no longer defend the body against infections and cancers.

 HIV infection becomes AIDS when you lose your ability to fight off serious infections or tumours. Various infections called opportunistic infections develop. They are called opportunistic because they take advantage of the weakened immune system. These infections would not normally cause severe or fatal health problems. However, when you have AIDS, the infections and tumours are serious and can be fatal.

 Question 2. What is the status of HIV/AIDS in Papua New Guinea?

According to 2013 UNAIDS/WHO report, PNG has the highest incidence of HIV in the Pacific region. It is estimated that 0.6-0.7% of the adult population, approximately 34-37,000 people, are now living with HIV in PNG. Heterosexual transmission is the predominant means of infection. While approximately equal numbers of men and women are currently affected, young women and older men are disproportionately affected. Significant HIV prevalence rates are found both in large urban areas, such as Port Moresby, and in rural pockets, typically around high risk settings including transport routes, mining and logging sites. Close to 50% of HIV cases occur between ages of 15-49 years. If not controlled HIV/AIDS epidemic will impact on the future of PNG, including reduced life expectancy, workforce depletion, increased health expenditure and reduced economic growth. The latest (2013) statistics from WHO for PNG is;

¨ Estimated 28,000-36,000 people are living with HIV/AIDS in PNG

¨ HIV prevalence has remained the same from 2005 to 2013 (0.5-0.7%)

¨ Death rate is about 3% of HIV cases which is lower than that of Fiji

¨ HIV diagnostic centres have increased from 100 to over 300 between 2005 to 2013

The overall impression for HIV in PNG is the progress of HIV has been halted in the last 10 years but we need to do more to reduce yearly rates of HIV infection.

 Question 3. How does HIV infection Occur?

HIV is not spread through the air, in food, or by casual social contact such as shaking hands or hugging. It is not transmitted through mosquito bite. The virus is passed on only when the blood or sexual secretions enter another person's body.

It can also be  transmitted from infected mother through breast feeding and vaginal birth. Spread of the virus can occur during such activities as:

Sex (most):- unprotected sexual activity, promiscuity, homosexuals, sex with someone other than your fixed partner

Needle injury: needle stick injury, IV drug use, sharing needles, blood entry through cuts on skin

Blood Transfusion:  rare now with screening

Mother to Child: Pregnancy, Vaginal Birth & ? Breast feeding

 Question 4. What are the symptoms?

It is important to note that HIV infected person can remain asymptomatic and remain well and health for many months to years. For those who develop problems, symptoms are those of opportunistic diseases that attack the body because of a weakened immune system:

General Complaints:

Fever that lasts from a few days to longer than a month, loss of appetite or weight- especially loss of more than 10% of body weight, nausea and vomiting, fatigue, headache, prolonged swelling of the lymph nodes, night sweats, muscle & joints pains and sore throat and enlarged lymph glands

Skin Problems:

small flat-raised rash, loss of hair (alopecia), abscesses, herpes infection (cold sore), shingles (HZV), plantar warts, penile candidiasis (grille), vagina candidiasis (red, itchy, mucous discharge), fungal infections, urticaria/hive (wide spread) and skin peeling off (desquamation)

Gastrointestinal/Abdominal Problems: 

Chronic diarrhoea (>1month), nausea and vomiting, sore tongue or gums, ulcers of mouth, itchiness around anus, enlarged spleen/liver

Respiratory/Lung Problems:

Pneumonia, TB, chronic cough, breathless, sinusitis

CNS/Nerve Problems: headache, numbness, tingling, confused, brain  infection, nerve pain, poor memory and vision loss

Cancer: Kaposi's sarcoma

 Question 5. Can I Request Test Myself without Doctors Referral?

Although some will centres will provide testing to general public without health worker or doctor’s referral, we strongly recommend pre-test interviews and counselling with your doctor or someone who has expertise on HIV. Many HIV positive patients have felt devastated with unexpected positive result mainly due to lack of pre-test counselling to address issues such as nature of HIV, myths of transmission and treatment, fears and anxieties, pitfalls of tests, how to cope with illness, availability of support services, confidentiality, legal issues etc.

 Question 6. How is it diagnosed?

In Papua New guinea, the first test done is usually ELISA or rapid kit test from a blood sample. If this test is positive, another more specific blood test, usually the Western blot test, is done to confirm the results. If you are tested in smaller clinics or rural hospitals, your test is referred to central laboratory located in the Port Moresby General Hospital for confirmation. Once your positive HIV test results is confirmed, your results will be confidentially send back to your doctor or clinic. You must arrange for follow-up with you local doctor. Your health care provider or doctor will ask about your medical history and symptoms and will examine you. The medical history and physical exam includes discussing your history of sexual practices and sexually transmitted diseases. Your health care provider will also ask about any history of drug abuse. You will have some lab tests. Comparing the results of the physical exam and these first lab tests with results weeks or months from now can help your health care provider diagnose new symptoms you may have in the future. It can also help your provider know how well your medicines are working.

You may be screened for certain infections, such as tuberculosis (TB), syphilis, and hepatitis B. These infections can worsen rapidly when you have HIV. They also pose a serious risk to others.

HIV-positive women should have a Pap test according to the schedule recommended by their health care provider (usually every 6 to 12 months).

Question 7. Is there any benefit in Early diagnosis?

The benefit of early diagnosis has become more impressive since the discovery that HIV is not a latent infection throughout most of its course. Soon after initial infection, explosive replication (multiplication) of HIV occurs, which is brought under control by our immune system in 6-8 weeks. Over time as many as 10 billion new viruses are produced and up to 2 billion CD4 cells are destroyed and replaced daily in the battle to control virus replication.  If the virus is not treated at this stage, CD4 cells eventually become depleted and our immune systems ability to fight infection is finally exhausted. Hence, if your HIV infection is diagnosed at the stage where CD4 number are adequate, you will give your body opportunity to fight HIV infection and multiplication. 

 Question 8. How is it treated?

Upon confirmation of positive HIV screening test, you will be referred to centre for HIV treatment. The treatment given will depend on further assessment by your doctor and assessment of risks associated with  use of specific combinations of anti-retroviral/HIV drugs and availability of drugs locally. Your  treatment will depend on local protocol but may include:

-Antiviral medicines, such as zidovudine (also called ZDV or AZT), didanosine (ddI), and lamivudine (3TC), and other protease inhibitors

-Lab tests every few weeks to see how well your immune system is working, to measure the amount of HIV in your blood, and to screen for infections or other medical problems

-Regular dental exams because people who are HIV positive often have mouth problems, including gum disease

-Preventive treatment for such diseases as:, Pneumocystis carinii pneumonia (PCP), tuberculosis, toxoplasmosis (be sure to avoid raw meat and cat litter boxes), tetanus, hepatitis B, pneumococcal infections, influenza

-Specific Treatments for infections and tumours as they develop.

 Your health care provider will probably recommend starting treatment with antiviral drugs and anti-pneumonia drugs if you are having symptoms of HIV infection (AIDS).

In many developed countries that do monitor CD4 cells and viral DNA load, treatment is recommended even without symptoms  if:

Your CD4 cell count is know how well the immune system is working. (CD4 cells are a type of white blood cell.) You should have this lab test every 4 to 6 months. The old recommendation was to start ART when  the following condition applied (1) patient was symptomatic ,(2) CD4 count dropped below 350 cells per cubic millimeter (3), viral load  was > 30,000 copies per milliliter (mL) when using the branched DNA test or  >55,000 copies/mL when using the RT-PCR test. New recommendation (April 2012) is to start ART immediately unless patient can not take medicines for some reason. The CD4 cell count is cheaper and used for monitoring response. The viral load test measures the amount of HIV in your blood.

 Antiviral medicines can slow the progress of the disease, but they are not a cure. Many new drug treatments and combinations are being prescribed or studied.

Vision problems are often an early sign of opportunistic infection in HIV-positive individuals. Tell your health care provider promptly about any eye symptoms, especially if you keep having blurry vision or a loss of vision.

Getting care in an office or clinic that specialises in HIV patients is perhaps the most important aspect of your treatment. This approach ensures that you are treated expertly. Other advantages include:

Up-to-date medical care will be available to you.

Treatment of the medical and social aspects of your illness will be brought together.

You will have help in finding resources (medical, social, financial).

 Question 9. I am HIV positive but I have no symptoms. Why is that?

Initially, you may experience no symptoms or only have mild cold symptoms because your CD4 count is normal. If your CD4 count drops, you are unable to withstand effects of opportunistic infections and may develop AIDS.  The full effects of AIDS may not appear until 5 to 10 years after you are first infected with HIV. Although AIDS is a fatal disease, life expectancy has increased as new treatments are developed.

 Question 10. How can I take care of myself?

If you are in a high-risk group but have not tested positive for HIV, see your health care provider regularly. He or she will examine you for signs of HIV-associated infections and will recommend how often your blood should be tested for HIV infection.

If you are HIV positive:

Discuss your treatment with your health care provider.

See your provider on a regular schedule to keep up to date on new treatments.

Contact a local AIDS support network. Your provider should be able to help you find one.

Call or see your health care provider if:

¨ You have new or persistent symptoms.

¨ You notice a change in body function that concerns you.

¨ You are having side effects from your medicine

 Question 11. How can I prevent HIV infection?

To prevent becoming infected, ask any new sexual partner about his or her sexual history. Be careful to practice safe sex, use latex or polyurethane condoms, and seek HIV testing.  If you are HIV positive, you can help prevent spreading the virus if you:

Practice safe sex: Do not share sexual secretions or blood in any way. Carefully use latex or polyurethane condoms for every oral, vaginal, or anal sexual activity.

Ask sexual partners to be tested for HIV.

Tell your health care providers that you are HIV positive. (Discuss any concerns you may have about confidentiality with your health care provider.)

In addition:

Do not share needles for drug use, tattooing, or body piercing.

Do not donate blood, plasma, or semen.

Do not plan to donate organs, such as corneas. (If you were previously planning to donate organs, have that statement removed from your driver's license.)

To avoid passing HIV to a baby, women should talk to their health care providers before becoming pregnant.

 Antiretroviral drugs may be used to prevent HIV infection if you have been exposed to HIV through sexual intercourse, sexual assault, injection drug use, or an accident. The treatment must be started no more than 72 hours after a high-risk exposure to someone known to be HIV-infected. The treatment lasts 28 days. This preventive treatment is not recommended for people who are often at risk of exposure to HIV, like those who have HIV-infected sex partners and rarely use condoms, or injection drug users who often share equipment.

Question 12. Why is my test negative when I know I have HIV?