Question: My sister has just started using Antiretroviral drugs and I am concerned because I think I will have to start on them soon myself. She told me that her Counsellor said that everybody who takes these drugs always have to use condoms. Why?

Answer: What your sister told you is true. If you do not always use a condom correctly, you stand the chance of developing drug resistant strains of HIV. This means that the drugs will not work anymore against the virus.

The viral load will increase and the CD4 cells (white cells) which is our immune system, will start to drop. This situation will lead to a drug resistant strain and the virus will manage to produce more of itself. If this happened, the drugs would be ineffective.

The resistant strain would then become stronger and multiply in the body. Resistance to one drug (because of not using condoms) could also prevent other classes of drugs from working.

If you do not commit yourself to use condoms consistently and correctly, you could infect those people, with whom you have unprotected penetrative sex, with this drug resistant strain of the virus. That means that those people whom you may have infected, will not be able to take those drugs at the time that they are ready to do so, even though they have not taken ARVs before, because they started out with drug resistant strains.

When someone is ready to start ARV therapy, it is necessary for that person to go to the ARV clinic to see the doctor, who after assessment will decide whether the person's health warrants Antiretroviral therapy. The doctor will then refer the person to the Counsellor.

The Counsellor will spend time with that person in private and explain everything concerning the ARV drugs, such as, adherence, diet, living a positive lifestyle etc. The Counsellor will also answer all questions that the client may have concerning ARV therapy.

It will also be necessary, thereafter, for the person to attend groups sessions as advised by the Counsellor. This does not mean that you will be required to discuss your personal issues in the presence of other people, but it enables you to learn about many issues around ARVs in a safe environment.

Following the group sessions, there will also be other individual (face to face) counselling opportunities with the Counsellor, where personal issues and difficulties regarding ARVs may be discussed in private.

In between these various sessions, a client is free to contact the Counsellor should problems arise, whether those problems have to do with such issues as condom use or anything else related to ARVs.

Whether you are ready to be started on ARV drugs, or not, it is necessary for you to be committed to the consistent use of condoms. Your decision to do so will not only benefit society but equally importantly, it will protect you from getting resistant strains of the virus now and in the future.