Finding out
Doctors and midwives are trained to counsel and you will need time to recover and compose yourself in the consulting rooms before given the chance to ask a few questions.

Don't feel guilty if you lose your cool or sit dumbfounded and in denial; it happens. Give yourself time to think clearly before making any rash decisions: eg rushing over to your partner, gatecrashing his boardroom meeting and shouting out the news to the entire company.

This is an action situation however, and you have to get yourself together sooner rather than later. Blood tests can be taken to determine the viral count (these tests are expensive if done privately) and the white blood cell (CD4) count (this is quite easy and relatively inexpensive).

These numbers are very important because they may influence your treatment, if and how the virus affects your baby, and the type of birth you need to prepare for.

High viral count = high risk to your baby
Low viral count = minimal risk to your baby
High white blood cell count = good personal immunity
Low white blood cell count = poor personal immunity

Your health
It is essential that a couple be counselled together because you will need to change your sexual behaviour. Counselling may be difficult initially, but it will certainly open up communication barriers. When your partner has been tested, you need to understand how not to re-infect one another.

Any infections that you may have need attention. You also need to be alert to "opportunistic" infections like flu, thrush or gastro that can quickly multiply into a whole host of infections that take twice as long to heal when you are HIV-positive.

It is also wise to avoid "people traffic" areas (like shopping malls on public holidays) where there are a whole lot of invisible air-borne infections – particularly when you're not feeling well.

Lifestyle changes means doing all the good stuff to keep your body healthy: eat healthily, quit smoking, recreational drugs and drinking alcohol.

You need to exercise, get out in the fresh air, eat fresh fruit and vegetables and have a positive outlook in life. This is easier said than done, but getting your status out into the open may clear more obstacles than you realise. You may be pleasantly surprised by the support you get from family, colleagues and friends.

Anti-retrovirals are recommended only when the virus takes control and practically destroys the immune system. This is because they can have serious side effects and are unable to destroy the virus; they simply keep it under control while the body's natural immune system gets a chance to recover and increase the number of circulating white blood cells.

When anti-retroviral medication is recommended (usually the HAART regime) it has been shown to decrease transmission of the virus to the baby. Research shows that women with a vitamin A deficiency have been shown to be more at risk for transmitting the virus and, although taking a supplement did not necessarily show a decrease in viral transmission, it did play a role in decreasing the number of premature births.

Premature babies are at risk for a higher transmission of the virus.

Feeding your baby
The risk of giving the virus to the baby through breastfeeding is increased from 14% to 29% when the mother is in the advancing stages of Aids and when she has a vitamin A deficiency.

The risks of transmission are highest in the earliest months of breastfeeding, but the longer a mother breastfeeds, the greater is the risk to her baby – so mothers in a high risk category are advised not to breastfeed for longer than six months. Other factors that make transmission more likely include cracked nipples or a breast abscess, oral thrush in the baby and mixed feeding (breast and formula feeding).

Mixed feeding has been ruled out as a no-no when a mother is HIV-positive because any food or liquid other than breastmilk causes a breakdown in the beneficial properties of the breastmilk, increasing the risk of your baby contracting HIV.

Both the Department of Health and support groups like the Breastfeeding Forum and La Leché League encourage breastfeeding, despite HIV. They recommend pasteurising breastmilk by heating expressed breastmilk in a sterilised glass bottle placed in boiled water poured into a 1 litre pot for at least 10 minutes.

In this way, the virus is destroyed without interfering with the good qualities of breastmilk. The more we understand HIV, the better we can take pro-active measures to outsmart this clever virus.

The first important step is to acknowledge its existence, and the second is to be informed and responsible, ensuring the best possible health for all moms and their babies.

Finding help
Aids Law Project www.alp.org.za (011) 717 8600
Treatment Action Campaign www.tac.org.za (021) 788 3507.
The Aids Consortium www.ac.org.za (021) 403 0265.
Dept of Health www.doh.gov.za (012) 312 0774/5.