Activity Card 4 - ViiV Healthcare

POSITIVE ACTION AT WORK
ldkjkRed dkjZokbZ
INDIA
Hkkjr
ACTIVITY CARD 4 HIV TESTS AND TREATMENT
xfrfof/k dkMZ 4 ,pvkbZoh ijh{k.k vkSj bykt
OBJECTIVES:
mn~ns';
after the session co-workers should
l= ds ckn lgdfeZ;ksa dks fuEu esa l{ke gksuk pkfg,
1 Understand that HIV tests identify antibodies
2 Know the importance of pre- and post-test counselling
3 Have information on local testing centres
4 Know the different stages of HIV illness and AIDS
5 Understand the importance of adherence in ART
ACTIVITY 1-(30-40 minutes) VOLUNTARY
COUNSELLING AND HIV TESTING (VCT)
1- le>uk fd ,pvkbZoh ijh{k.k ,aVhckWMh dh igpku dj ysrs gSa
2- ijh{k.k ds iwoZ vkSj ckn esa ijke'kZ ds egRo dks le>uk
k3-LFkkuh; ijh{k.k dsanzksa ds ckjs esa lwpuk
4- ,pvkbZoh vkSj ,M~l ds fofHkUu pj.kksa dks tkuuk
5- ,vkjVh ls tqM+s jgus ds egRo dksle>uk
xfrfof/k 1 ¼30&40 feuV½ LoSfPNd ijke'kZ vkSaj ,pvkbZoh ijh{k.k
¼ohlhVh½
Why would we want to know our HIV status?
ge viuh ,pvkbZoh voLFkk ds ckjs esa D;ksa tkuuk pkgsaxs\
Remind the group that the only way to be sure someone is
infected with HIV is to test them for the antibodies we
produce to HIV when infected – we cannot tell by looking at
someone or making and external examination. Ask the
group to think of as many advantages to knowing your HIV
status as possible – ask them to do this ingroups of three
people. Allow five minutes and then ask each group in turn
for one of their ideas until all the ideas have been shared
and written up on your flipchart.Your list may look something
like this, divided into the two different test results:
lewg dks ;kn fnyk,a fd dksbZ ,pvkbZoh ls ladzfer gS ;k ugha] ;g
lqfuf'pr djus dk bdykSrk rjhdk ;gh gS fd mldk ijh{k.k djok;k
tk,& ckgj ls ns[k dj ugha crk;k tk ldrkA lewg ls iwNs fd og
,pvkbZoh voLFkk dk Kku gksus ds vf/kd ls vf/kd Qk;ns fxuk,&
rhu ds lewg esa mUgsa ,slk djus ds fy, dgsaA ikap feuV dk le; nsa
fQj izR;sd lewg ls mlds fopkj iwNsa tc rd fd lkjs fopkjksa dks
vki fQ~yipkVZ ij fy[k u MkysaA vkidh lwph dqN ,sls fn[ksxh] nks
fHkUu ijh{k.k urhtksa esa foHkkftr%
If you know you are positive:
;fn vki tkurs gSa fd vki ikWft+fVo gSa%
?
You can seek medical advice and treatment
?
You can take better care of your health
?
You can be sure not to pass on the virus
?
You can seek the support of HIV counsellors (why?)
?
You can focus on your health instead of worrying about it
?
vki fpfdRld dh lykg vkSj mipkj ys ldrs gSa
?
vki vius LokLF; dk csgrj /;ku ns ldrs gSa
?
vki ;g r; dj ldrs gSa fd ok;jl fdlh vkZSj rd lapkfjr u gks
?
vki ,pvkbZoh ijke'kZnkrk dk lg;ksx ys ldrs gSa ¼D;ksa½
?
vius LokLF; ds ckjs esa fpark djus dh ctk; ml ij /;ku ns ldrs
If you know you are negative:
?
You can make sure you stay HIV negative
?
As an HIV negative couple you can rely on monogamy,
not condoms
?
You can start a family
If you do not have all of these you may want to suggest the
ideas that were omitted. The next step is to acknowledge
that people do not come forward for testing for many
reasons. Ask the same groups to list these: peoples’ fears
of taking the HIV test and of the possibly problematic
consequences of a positive result. Again, list them after
five minutes:
Fears and problems
?
I might get infected at the clinic
?
They may make a mistake with my results
?
I might be seen going for the test
?
If I tested positive I do not know what I would do
?
There is no-one I could tell – this would be my burden
?
I could not afford treatment – I would know
I was going to die
?
People would find out – then I would be
discriminated against:
- at home
- at work
- in the wider community
;fn vki tkurs gSa fd vki usxsfVo gSa %
?
vki lqfuf'pr dj ldrs gSa fd vki usxsfVo gh cus jgsa
?
,pvkbZoh usxsfVo tksM+s ds rkSj ij vki daMkse dh ctk; ,d&nwljs
ds izfr oQknkj cus jgs ldrs gSa
?
vki ifjokj dh 'kq#vkr dj ldrs gSa
;fn vkids ikl ;s lkjs lq>ko ugah gSa] rks vki dqN ,sls lq>ko nsuk
ilan djsaxs tks NksM+ fn, x, FksA vxyk dne ;g Lohdkj djus dk
gS fd yksx dbZ dkj.kksa ls ijh{k.k ds fy, vkxs ugha vkrsA mUgha
lewgksa dks bu dkj.kksa dks ntZ djus dks dgsa % ijh{k.k djokus esa
yksxksa dk Hk; vkSj ikWft+fVo urhtk vkus dh laHkkouk ds ifj.kkeA
ikap feuV ckn bUgsa lwphc) djsaA
Hk; vkSj fnDdrsa
?
fDyfud esa gh dgha ladzfer u gks tk,a
?
os esjs urhtksa ds ekeys esa xyrh dj ldrs gSa
?
dksbZ ijh{k.k ds fy, tkrs gq, ns[k ldrk gS
?
;fn eSa ikWft+fVo ik;k x;k rks irk ugha eSa D;k d:axk
?
eSa fdls crkÅaxk& ;g esjs Åij cks> cu tk,xk
?
bykt dk [kpZ ugha mBk ikÅaxk& lg tkurs gq, fd esjh ekSr
gksuk r; gS
?
yksx irk yxk gh ysaxs & fQj esjs lkFk bu LFkkuksa ij HksnHkko
fd;k tk,xk %
?
&?kj ij
?
&dke ij
?
&O;kid lewnk; esa
Do the benefits outweigh the fears or problems?
You now have lists of both benefits and problems. The benefits
may depend on local access: to reliable, confidential testing with
counselling; to post-test counselling and psychological support; to
medical services; to treatment for opportunistic infections; to
antiretroviral treatment (ART). You need to know the reality of
these access questions before you run this session. Even in places
where ART is not available or is unaffordable, there are health
benefits to knowing one’s HIV status, and there can always be
benefits in terms of personal responsibility and behaviour change
as long as counselling and/or other support is available. But
remember the HIV test does not tell you how long you have been
infected, when you may become ill, or which opportunistic
infections or AIDS-related illnesses you may succumb to: further
tests would be required to determine how soon you should start
treatment with antiretroviral drugs (ARVs) where they are
available.You will explain the “window period” in this explanation of
HIV testing:
How do HIV tests work?
There are several kinds of HIV test in use – some use a
blood sample, some use saliva. They all seek to identify the
antibodies to HIV – these are easier to find than HIV itself.
Point out: the antibodies are present in detectable levels in
saliva, but remember HIV itself does not occur at dangerous
levels in saliva. The results of blood tests usually take longer
than saliva tests: blood test results can take weeks while
saliva tests can be ready the same day. When someone
becomes infected with HIV it takes the body a little time
to produce antibodies to HIV – this time can vary from a few
days to many months. This period is called the “window
period” and an HIV test during that time that gives a negative
result would need confirming by a second, later test –
probably two months later. This can be an anxious time, but
the first test is useful in showing if one is already infected or if
this might be a new infection.
Tell the group their options for HIV testing: research a list of
clinics offering HIV testing, and try to recommend the ones
that are both free and offer counselling (especially post-test
counselling). Explain that counselling is an important
component of HIV testing – individuals need the chance to
consider all the points raised above before deciding they will
take the test; both positive and negative results need to be
discussed as both have implications.
D;k blds Qk;ns Hk; vkSj fnDdrksa ij Hkkjh gSa\
vc vkids ikl Qk;nksa vkSj fnDdrksa nksuksa dh lwph gSA Qk;ns fuEu
ij fuHkZj djsaxs % LFkkuh; Lrj ij ekStwn Hkjkslsean vkSj xksiuh;
ijh{k.k] ijh{k.k ds ckn ijke'kZ vkSj euksoSKkfud lgkjk] fpfdRlk
lsokvksa rd igqap] voljoknh ladze.kksa ds bykt rd igqap vkSj
,aVh&jsVªkso;jy byktA bl l= dks pykus ls igys vkidks igqap
laca/kh bu lokyksa dh okLrfodrk ds tkuuk iM+sxkA ;gka rd fd
ftu LFkkuksa ij ,vkjVh miyC/k ugah gS] ogka Hkh viuh ,pvkbZoh
voLFkk ds ckjs es tkuuk ykHkdkjh gks ldrk gS] futh ftEesnkjh vkSj
vkpj.k esa cnyko ds ut+fj;s ls tc rd fd ijke'kZ vkSj vU;
lg;ksx miyC/k gksAysfdu ;kn j[ksa fd ,pvkbZoh ijh{k.k vkidks ;g
ugha crkrk fd fdrusyacs le; ls vki ladzfer gSa] vki dc chekj
iM+saxs];k dkSu ls voljoknh ladze.k ;k ,M~l laca/kh chekjh dh pisV
esa vki vk tk,axs % ijh{k.k dh t+:je blfy, gS fd vki r; dj
ldsa fd ,vkjoh ls mipkj fdruh tYn 'kq: djuk gS] tgka os
,pvkbZoh ijh{k.k dSls dke djrs gSa\
,pvkbZoh ijh{k.k dbZ fdLe dk gksrk gS& dqN esa [kwu ds uewus dk
bLrseky fd;k tkrk gS vkSj dqN esa ykj ls gh ijh{k.k fd;k tkrk
gSA bu lHkh esa ,pvkbZoh dh ,aVhckWMht+ dk irk yxk;k tkrk gS&
,pvkbZoh dk irk yxkus ls T;knk vklku budk irk yxkuk gSA bl
ckr dks fo'ks"k rkSj ij js[kkafdr djsa fd ykj esa ,aVhckWMh i;kZIr ek=k
esa ekStwn gksrs gSa] ysfdu ,pvkbZoh [kqn ykj esa [krjukd Lrjksa ij
ugha ik;k tkrk gSA [kwu dh tkap dk urhtk vkus esa dbZ fnu yx
ldrs gSa tcfd ykj ijh{k.k dk ifj.kke mlh fnu vk ldrk gSA
,pvkbZoh ds ladze.k ds ckn fdlh ds 'kjhj esa ,aVhckWMh iSnk gksus esa
oDr yxrk gS tks dqN fnuksa ls dqN eghuksa rd dk gks ldrk gSA
blh vof/k dks ^foaMks ihfj;M* dgrs gSa vkSj blnkSjku fd, x,
,pvkbZoh ijh{k.k esa ;fn udkjkRed ifj.kke vkrs gSa rks iqf"V ds fy,
nksckjk ijh{k.k djokuk iM+rk gS tks nks eghus ckn djok;k tkrk gSA
;g le; mRrstuk esa chrrk gS] ysfdu igyk ijh{k.k ;g crkus ds
fy, i;kZIr gksrk gS fd dksbZ igyh ckj ladzfer gqvk gS ;k ladze.k
igys ls gh gSA
lewg dks crk,a fd muds ikl ,pvkbZoh ijh{k.k ds dkSu ls fodYi
ekStwn gSa% ijh{k.k lsok,a nsus okys fDyfudksa dh lwph cuk,a] vkSJ muds
uke izLrkfor djsa tgka fu'kqYd ijh{k.k vkSj ijke'kZ fn;k tkrk gSA
foLrkj ls crk,a fd ijke'kZ ijh{k.k dk ,d vfuok;Z vax gS&
O;fDr;ksa dks ijh{k.k laca/kh QSlyk ysus ls igys mi;qZDr lHkh fcanqvksa
ij fopkj djus dk ekSdk feyuk pkfg,( ikWft+fVo vkSj usxsfVo nksuksa
ACTIVITY 2-(25-30 minutes) ANTIRETROVIRAL
TREATMENT (ART)
xfrfof/k 2 & ¼25&30 feuV½ ,aVh jsVªksok;jy mipkj
Use the Positive Action at Work powerpoint
presentation or use the slides as overheads
or flipchart posters:
ldkjkRed dkjZokbZ dk ikojIokbaV ;k LykbM ;k fQ~yipkVZ iksLVj
bLrseky djsa
HIV treatment, 1
,pvkbZoh mipkj
Together, the cells of the immune system act as a
barrier that protects us from infections.
izfrjks/kh ra= dh dksf'kdk,a fey dj ,d lkFk <ky dk dke djrh gSa
tks gesa ladze.kksa ls cpkrk gSA
Slide 1
The immune system in our bodies gives us vital
protection from infections – like a wall that keeps these
illnesses at bay, or surrounds them until we can kill them
off. We might feel quite ill while our immune system is
battling an infection, but that is because it is hard work
for the glands that produce the cells and antibodies
required.
LykbM 1
gekjs 'kjhj dk izfrjks/kh ra= gesa ladze.kksa ls Hkkjh lqj{kk nsrk gS& ,d
nhokj dh rjg tks bu chekfj;ksa dks fdukjs ij j[krk gS tc rd fd
os lekIr u gks tk,aA ge Hkys gh vLoLFk lk eglwl dj ldrs gksa]
ysfdu izfrjks/k ra= yxkrkj ,d ladze.k ds f[kykQ yM+kbZ esa yxk
jgrk gS] D;ksafd ,slk djus esa dksf'kdk iSNk djus okys XySaM vkSj
,aVhckWMh dks dkQh e'kDdr djuh gksrh gSA
HIV is a virus that damages the cells of the
immune system, like a demolition man
,pvkbZoh ,d ,slk ok;jl gS tks izfrjks/kh ra= dh dksf'kdkvksa dks
uqdlku igqapkrk gSA
Slide 2
The reason HIV is so deadly is that it targets the
cells of our immune system.
LykbM 2
,pvkbZoh blfy, bruk ?kkrd gS D;ksafd og gekjs izfrjks/kh ra= dh
dksf'kdkvksa dks y{; cukrk gSA
Once someone is infected, HIV can enter the
cells of the immune system
,d ckj dksbZ ladzfer gks tk, rks ,pvkbZoh izfrjks/k ra= esa izos'k dj
tkrk gSA
Slide 3
When you are infected with HIV, the virus enters
some of the most important cells of the immune
system.
LykbM 3
tc vki ,pvkbZoh ls ladzfer gks tkrs gSa] rks ok;jl izfrjks/kjh ra=
dh dqN egRoiw.kZ dksf'kdkvksa esa izos'k dj tkrk gSA
HIV uses the cells to make copies of itself
,pvkbZoh bu dksf'kdkvksa dk bLrseky dj viuh vuqd`fr;ka x<+ ysrk
gSA
Slide 4
The virus uses the cells’ material to build copies of
itself.
LykbM 4
ok;jl dksf'kdkvksa dh lkexzh dk bLrseky dj viuh vuqd`fr;ka x<+
ysrk gSA
HIV continues to copy itself, using the immune
cell to do so
,pvkbZoh viuh vuqd`fr;ka x<+uk tkjh j[krk gS] ftlesa og izfrjks/kh
dksf'kdkvksa dk bLrseky djrk gSA
Slide 5
HIV reproduces very quickly, one of the reasons it
mutates easily – the result of tiny mistakes in the
copying process.
LykbM 5
,pvkbZoh viuk nksckjk mRiknu cgqr tYnh dj ysrk gS] tks mlds
rsth ls QSyus dh ,d otg gS& vuqd`frdj.k dh izfdz;k esa vkbZ
NksVh xyfr;ksa dk ifj.kkeA
Once it has used up and destroyed that cell, the
new HIV disperses to other immune cells
,d ckj mDr dksf'kdk dks bLrseky dj lekIr dj nsus ds ckn u;k
,pvkbZoh vU; izfrjks/kh dksf'kdkvksa esa QSy tkrk gSA
LykbM 6
viuh vuqd`fr cukrs oDr ,pvkbZoh us ftl dksf'kdk ij dCtk fd;k
Fkk] mldkbLrseky dj u"V dj nsrk gS vkSj dCts ds fy, ubZ
dksf'kdkvksa dh ryk'k esa yx tkrk gSA
The process begins all over again, damaging more ;g izfdz;k pyrh jgrh gS] vf/kd ls vf/kd dksf'kdkvksa dk uk'k gksrk
and more cells, creating more and more virus, until jgrk gS] T;knk ls T;knk ok;jl iSnk gksrs gSa tc rd fd izfrjks/k ra=
cqjs rjhds ls det+ksj ugha gks tkrkA
the immune system is severely weakend.
Slide 6
In copying itself HIV uses and destroys the cell it
occupied and seeks out new cells to invade.
Slide 7
This process sounds rapid, but it can take many
years for the immune system to be severely
weakened: all the time HIV is attacking it, the
immune system is producing new cells to try to
control it. And HIV cells are dying all the time – but
as they die more and more are produced to
replace them. Eventually the immune system will
be so weak that it cannot fight off other infections –
some of these lead to AIDS-defining illness.
LykbM 7
yxrk gS fd ;g izfdz;k rst gS] ysfdu izfrjks/k ra= dks det+ksj gksus
esa dbZ lky yx tkrs gSa% gj oDr ,pvkbZoh geyk cksyrk gS] izfrjks/k
ra= mls fu;af=r djus ds fy, ubZ dksf'kdk,a iSnk djrk gSA
,pvkbZoh dksf'kdk,a ejrh jgrh gSa ysfdu muls T;knk iSnk gks tkrh
gSaA vkf[kjdkj izfrjks/k ra= bruk det+ksj gks tkrk gS fd og vU;
ladze.kksa ls ugha yM+ ikrk& ftuesa ls dqN ,M~l dh chekjh dkj.k
curs gSaA
Anti-retroviral treatment - with drug that control
HIV - stops HIV copying itself and invading
cells, but does not kill it.
,aVh jsVªksok;jy mipkj & ,pvkbZoh dks fu;af=r djus okyh nokvksa
ds lkFk& ,pvkbZoh dks viuh vuqd`fr;ka cukus ls jksdrk gS ysfdu
ok;jl dks ekj ugha ikrkA
Slide 8
ARVs – antiretroviral drugs – have been developed
to interrupt this process. Usually three different
ARVs are taken in combination – we call this
Combination Therapy. Once they stop HIV
reproducing, the amount of HIV in the body can be
reduced to very low levels indeed.
LykbM 8
,vkjoh&,aVh jsVªksok;jy nok,a bl izfdz;k esa n[ky nsus ds fy, cukbZ
xbZ gSaA vke rkSj ij rhu ,vkjoh fefJr fy, tkrs gSa& bUgsage feJ.k
mipkj dgrs gSaA ,d ckj os ,pvkbZoh dks iSnk gksus ls jksdrs gSa] rks
'kjhj esa ,pvkbZoh ds Lrj dks dkQh fuEu Lrjksa ij yk;k tk ldrk
gSA
With HIV locked away, the immune system can
rebuild itself and function as it used to
.d ckj ,pvkbZoh ij yxke dlus ds ckn izfrjks/k ra= [kqn dks
nksckjk fufeZr dj igys dh rjg dke djuk 'kq: dj ldrk gSA
Slide 9
As long as ARV treatment continues, HIV
reproduction is slowed down so there is very little
HIV present in the blood and other body fluids..
The immune system can recover – often very
quickly – and even someone who was seriously ill
can see their health return to normal. But someone
on ART can still infect others with HIV and should
observe good prevention practices like condom
use.
LykbM 9
tc rd ,vkjoh mipkj tkjh jgrk gS] ,pvkbZoh dk iztuu de gks
tkrk gS vkSj [kwu o 'kjhj ds vU; nzO;ksa esa ,pvkbZoh dh cgqr de
la[;kjg tkrh gSA izfrjks/k ra= cgqr tYnh cgky gks tkrk gS& vkSj
;gka rd fd chekj O;fDr Hkh lkekU; voLFkk esa vk tkrk gSA ysfdu
,vkjVh ij th jgk dksbZ O;fDr vc Hkh nwljs dks ,pvkbZoh ls ladzfer
dj ldrk gS blfy, mls daMkse tSls csgrj lqj{kkRed mik; viukus
pkfg,A
If ARV treatment stops - even for a short time- the
HIV can start to copy itself again. This time the
new HIV may be drug-resistant.
;fn dqN de le; ds fy, Hkh ,vkjoh mipkj dks jksd fn;k x;k]
rks ,pvkbZoh nksckjk viuh izfr;ka cukuk pkyw dj nsxkA bl ckj ;g
u;k ,pvkbZoh nok izfrjks/kh gks ldrk gSA
Slide 10
But if treatment stops, HIV is given the chance to
reproduce as rapidly as it did before and return to
previous levels. This time it may be resistant to the
drugs that were used – one of its many mutations
will be able to resist the way one or more of the
drugs attacks it. So resuming the exact same
treatment may not work – a new combination of
drugs must be found, and that is not always easy.
LykbM 10
But if ARVs are taken regularly they will enable the
immune system to recover, and the person who
was previously ill or susceptible to Opportunistic
infections should enjoy good health.
;fn ,vkjoh dks fu;fer fy;k x;k rks og izfrjks/k ra= dks cgky
djus esa l{ke cuk,xk] vkSj tks O;fDr igys ls chekj Fkk ;k
voljoknh ladze.kksa ds izfr laosnu'khy Fkk] og vPNs LokLF; dk
vkuan mBk ldrk gSA
Slide 11
Most people who take ARV therapy recover well,
but they have to adhere strictly to the treatment,
taking their pills at the right times everyday. Some
people experience side effects, especially when
starting the treatment, but these can usually be
treated or alleviated.We do not know how long
ARVs can be effective, but we hope they at least
give many extra years of healthy life, perhaps even
a normal life span.
LykbM 11
,vkjoh mipkj ysus okys dbZ yksx Bhd gks tkrs gSa ysfdu mUgsa
dM+kbZ ls bykt dk ikyu djuk pkfg,] le; ij xksfy;ka jkst+
ysuh pkfg,A dqN yksxksa ij nokvksa dk izHkko gksrk gS] [kkldj rc
tc bykt 'kq: fd;k tkrk gS] ysfdu bUgsa nwj fd;k tk ldrk gSA
ge ugha tkurs fd ,vkjoh dc rd izHkkoh jgrs gSa] ysfdu bruh
mEehn gS fd os de ls de dqN o"kksZa dk vfrfjDr LoLFk thou
iznku dj nsrs gSa] laHko gS ,d lkekU; thoudky HkhA
?
HIV infection can not be cured but it can be
?
,pvkbZoh ladze.k dk bykt ugha fd;k tk ldrk gS] ysfdu dkcw
controlled.
?
HIV treatment - ARVs - must be taken regularly
and can not be stopped.
?
With ARV treatment some people living with
HIV or AIDS can enjoy many additional years of
good health
esa fd;k tk ldrk gSA
?
,pvkbZoh mipkj ds rgr ,vkjoh fu;fer yh tkuh pkfg,A
?
,vkjoh ,ipkj djok dj ,pvkbZoh ;k ,M~l ds lkFk th jgs
O;fDr LoLFk thou ds dqN vkSj o"kksZa dk vkuan ys ldrs gSaA
Slide 12
So, to recap: we can control HIV infection but not
cure it; successful ART requires strict adherence;
with ART people can recover their health and lead
normal lives.
LykbM 12
rks] ,d ckj fQj ;kn djsa% ge ,pvkbZoh ladze.k dks fu;af=r dj
ldrsgSaysfdu bykt ugha dj ldrs( dke;kc ,vkjVh ls fu;fer
tqM+s jguk iM+rk gS( ,vkjVh ds lkFk yksx lsgr cgky dj lkekU;
thou xqt+kj ldrs gSaA
mipkj #d tkus ij ,pvkbZoh dks iwoZ Lrjksa ij vkus dk ,d ekSdk
fey tkrk gSA bl ckj og mu nokvksa ds izfr izfrjks/kh gks tkrk gS
ftudk igys bLrseky fd;k x;k gS& og vc [kqn ij geyk djus
okyh nokvksa dk lkeuk djus esa l{ke gks tkrk gSA blfy, ogh
mipkj dke ugha djsxk& nokvksa dk ,d u;k feJ.k ysuk gksxk tks
fd ges'kk bruk vklku ugha gksrkA
Conclude the session with a short opportunity
for questions.
You should have answers ready for some of these:
?
Is ARV therapy available to me in this area?
Where can I get it ? Is it free?
?
Does our employer provide ART, or subsidise it
in any way?
?
If so, how does one access this?
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