HIV/AIDS Prevention Education As A Means of Prevention

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1 HIV/AIDS Prevention Education As A Means of Prevention My name is Gustavo Alejos. I m a registered nurse which means that I have a Bachelor of Science Degree in Nursing. I am currently employed as a Nurse Manger for the faith based corporation Methodist Healthcare Ministries. My company is privately owned and operated, founded for the sole purpose of serving the poor. I am responsible for the day to day operation of 2 small Family Practice Clinics that targets their services specifically towards the segment of our city s population that has no funding for healthcare. My experience in HIV / AIDS comes from time spent operating a mobile clinic focused on a strategy known as Early Intervention. The philosophy was early diagnosis through early testing of high-risk populations. Our clinic had 3 sites located in strategic areas throughout San Antonio (Texas), areas where many people of high-risk groups were said to live. If patients tested sero-positive for HIV, early, moderately aggressive treatment and management of immunodeficiency conditions was prescribed. Patients who tested sero-negative were offered counseling to identify highrisk behaviors, receive information on how to make better decisions and how to use methods to minimize their risk thereby reducing the risk of infection. Once patients progressed to AIDS (CDC definition is a CD4+T cell count below 200, normal = > 1000) they were referred to the County Infectious Disease Out-patient Clinic for Secondary and Tertiary care. Much more

2 aggressive forms of treatment were available there. The prognosis at that time (late 1980s to early 1990s) was poor. Many infected patients died within six (6) to twenty-four (24) months from positive sero conversion. Basic Principles: Agent: HIV Human Immunodeficiency Virus that causes Acquired Immune Deficiency Syndrome. Modes of Transmission: Most commonly transmitted by engaging in unprotected sexual practices with infected partner(s). Other known ways of transmitting HIV include, invasive contact with infected blood, sharing needles among intravenous drug users, and passing the virus to unborn/newborn children from HIV infected mothers (i.e. birth canal, and breast milk). Risk: All who are sexually active engaging in high-risk behaviors. No age, ethnicity, gender, or socioeconomic category exempt form risk. Even prenatal and neonatal risk exists, from possible transmission during pregnancy / childbirth. (Approximately one quarter to one third of pregnant women will pass the infection to their babies.) High Risk practices: Ways the HIV can enter the body. Unprotected sexual contact with an infected partner. ( Wet sex with no barrier)

3 Sharing of needles used to inject illicit substances among users. Small amounts of blood containing HIV left in the syringe barrel can be reinjected from user to user thereby transmitting the virus. Having sexual contact with someone whose HIV status is unknown. It is impossible to tell whether a person is infected or not just by looking at them. HIV can enter the body through lining of the vagina, vulva, penis, or mouth, during sex. Having a sexually transmitted disease such as syphilis, genital herpes, chlamydial infection, gonorrhea, or bacterial vaginosis appears to make people more susceptible to HIV infection during sex with infected partners. Symptoms of HIV infection: Many people are asymptomatic when they first become infected with HIV. Some people however, have a flu-like illness within a month or two after exposure to the virus. Symptoms may include: Fever Headache Tiredness Enlarged lymph nodes These symptoms usually disappear in a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

4 Persistent or severe symptoms may not appear for ten years or more, or within two years in children born with HIV infection. This period of asymptomatic infection is highly individual. Some people may begin to have symptoms within a few months, while others may be symptom free for more than ten years. However during this period HIV is actively multiplying, infecting and killing cells of the immune system, specifically T4 cells. At the beginning HIV disables or destroys these cells without causing symptoms. As the immune system weakens a variety of complications begin to overwhelm the body. For many people the first sign of infection are large lymph nodes that last for more than three months. Other symptoms often experienced months to years before the onset of AIDS include: Lack of energy Weight loss Frequent fevers and or sweats Persistent or frequent yeast infections (oral or vaginal) Persistent rashes or flaky skin Pelvic inflammatory disease in women that does not respond to treatment Short- term memory loss Frequent and severe herpes infections Genital or anal sores Shingles (Herpes Zoster) Children may be sick a lot or grow slowly

5 These symptoms may appear separately and seem vague to primary care physicians who may not be aware of what is presenting. This group of symptoms is sometimes referred to as AIDS Related Complex or ARC. The presence of these symptoms also signifies a progression to more advanced stages of infection also known as AIDS. Diagnosis: Due to the varied presentation of the asymptomatic stage of HIV infection, infection is often difficult to diagnose. Physicians and other healthcare professionals must rely on serological testing to confirm HIV infection. The most accepted form of testing is through the ELISA method with a second test the Western Blot for confirmation. These tests detect and confirm the presence of antibodies to HIV. HIV antibodies do not reach detectable levels in the blood for one to three months following infection. It may take up to six months for sufficient antibodies to be produced before they can be detected by these standard tests. People suspected of exposure to HIV should get tested within 6 weeks to 12 months after possible exposure to the virus. Early testing is important in order to help patients get care and discuss treatment options with their physicians. Early testing also alerts HIV infected people to avoid high-risk practices that could spread the virus to others. Counseling for people being tested is highly recommended due to the fear, and anxiety often associated with testing. Regardless of test results (positive or negative) counseling is also an opportunity to discuss high-risk practices, and how to minimize if not prevent risk.

6 Patients who test negative for HIV but are still considered at high risk may be counseled to repeat testing at a later date when antibodies to HIV are more likely to develop. Early intervention with any disease is often considered the Gold Standard for treatment. This minimizes the negative impact of a disease entity. With HIV infection, Early Intervention is critical, because early treatment can assist in helping to minimize the impact of HIV infection on the patient s immune system. Early treatment is also important and is directed towards prevent or minimizing certain opportunistic infections for which the patient is now susceptible. Treatment: When HIV/ AIDS first surfaced, there were no medications to fight the immune deficiency and few treatments were available for the opportunistic infections that resulted. During the last ten years research has developed medications to fight both HIV and its associated infections and cancers. The first medications developed were known as reverse transcriptase inhibitors, which interrupt early stage viral replication. These drugs may slow the spread of HIV and delay the start of opportunistic infections. This class includes: Nucleoside Analogs (RTI) Zidovudine or AZT Zalcitabine or ddc Dideoxyinsine or ddl Stavudine or d4t

7 Lamivudine or 3TC Abcavir or ziagen Tenofovir or viread Non - Nucleoside Reverse Transcriptase Inhibitors (NNRTI) Delvaridine or Rescriptor Nevirapine or Viramune Efravirenz or Sustiva NNRTIs can be prescribed in combination with other antiretroviral medications. A second class of medications used to treat HIV/ AIDS infection is called protease inhibitors. They interrupt virus replication at a later step in its life cycle. Protease Inhibitors Ritonavir or Norvir Saquinavir orinvirase Indinavir or Crixivan Amprenivir or Agenerase Nelfinavir or Viracept Lopinavir or Kaletra

8 HIV can become resistant to any of these medications. Healthcare providers must use a combination of drug therapy to effectively suppress the virus. When RT inhibitors are used in combination with protease inhibitors the treatment is referred to as highly active antiretroviral therapy or HAART, which can be used for people who are newly infected as well as those who have advanced to AIDS. HAART has been shown to reduce the amount of virus in the blood to nearly undetectable levels. However, research has demonstrated that HIV remains present in hiding places such as the lymph nodes, brain, testes and retina despite treatment. HAART is credited with greatly improving the health of people with HIV/AIDS, and has also proved to be a major factor in reducing the number of deaths from HIV/AIDS. Despite its beneficial effects, HAART has been associated with side effects that can potentially be severe. Some antiretrovirals, may cause a decrease in red or white blood cells, pancreatitis, painful nerve damage, and even death. Experts recommend that all patients on antiretroviral therapy be followed routinely and carefully monitored. The most common side effects seen with protease inhibitor use include nausea, diarrhea and other gastrointestinal symptoms. Protease inhibitors may also react adversely with other medications resulting in serious side effects.

9 There are several medications used to treat opportunistic infections common to HIV infected people. These include: Foscarnet and gancyclovir for cytomegalovirus (CMV) eye infections. Fluconazole to treat yeast and other fungal infections Trimethoprim / sulfamethoxazole or pentanmidine to treat Pneumocystis carinii pneumonia (PCP). Prevention Studies of families of HIV infected people have clearly shown that HIV cannot be spread through casual contact such as sharing of food utensils, towels, and bedding, swimming pools, telephones or toilet seats. No evidence has been found to show that HIV is spread through sweat, tears, urine or feces. HIV has not been seen to be spread by biting insects such as mosquitoes or bed bugs. Although HIV has been found in saliva there is no evidence that the virus is spread through contact with saliva. Research reveals that saliva has natural properties that limit the power of HIV to infect. Studies of people infected with HIV have found no evidence that HIV is spread to others through saliva by kissing. However, it is not known whether so- called deep kissing involving the exchange of large amounts of saliva or unprotected oral intercourse increase the risk of infection.

10 Health professionals must recognize that the only way to prevent infection by HIV is to avoid practices that may put a person at risk for infection. Having unprotected sex and sharing needles are widely known methods of placing anyone at risk for infection. Many infected people have no symptoms, so there is no way of knowing whether a person is infected unless they have repeatedly tested negative for the virus and have not engaged in any high risk practices. There is no such thing as SAFE SEX. Using a barrier method such as a condom can reduce the risk, ( Safer Sex ) but no barrier methods exist that can offer a 100% guarantee of protection from infection. There is a practice known as abstinence (refusing to engage in sexual activity) that works extremely well. Once considered antiquated, and extremely unpopular, it is beginning to gain strength and momentum as a way to avoid risk not only for HIV but also for exposure to all types of STDs. Education/ Prevention Education for all populations with respect to illicit drugs, use of alcohol while engaging in sexual activity, knowing what risks are present, and the social, financial and legal consequences of being sexually active is extremely important. As people confront their own personal decisions, coupled with social/ peer pressure these are all points to consider. Education can help everyone make informed choices in this life-changing part of their lives. Each person, especially our young people, must evolve to a position where they can feel comfortable and supported to make the

11 decision that refraining from early, or any unprotected or protected sexual activity (abstinence) is a positive life choice not only for a strong self esteem, self honor, but what also could be an important life saving decision as well. Potential local factors In the United States it is well known that freedom of choice has its price. All choices can come with potential consequences. When HIV/AIDS first surfaced with the first United States reported cases in 1981, it was seen as a problem for only certain populations possibly related to poor or even abnormal choices, namely homosexuals and intravenous drug users. Those groups being seen as disposable by lawmakers led to a philosophy of complacency, low priority, even punishment for poor choices by those in power. The failure to take action that could have contained what eventually became an epidemic was a grave error that has ended up costing millions of lives, many of whom have never been associated with those populations in question. The economic impact, which is in the billions by now, is all due to the fact that the potential of the illness was vastly under estimated. The perception that HIV /AIDS would never surface in the good population, has consequences even today. Monies are still reluctantly allocated, prejudice still exists, and ignorance abounds. The HIV/ AIDS issue affects all of us as a collective world. Together we must work to unite in combat against this agent that threatens to devastate our most precious resource, our people. We must commit to working together to

12 educate ALL in risk reduction, making informed choices, promoting abstinence and monogamy, as well as finding new methods to find better therapies for those infected. Personally I don t hope for a vaccine, as this could be considered a step backwards as far as choice and risk as concerned. While we have made major advances with the help of cooperative world efforts, assistance still eludes many. Infection rates once on the decline are rising again with our young as the most at risk population. HIV/ AIDS have made a dramatic run at the population once thought of as the safe people and their children. HIV is again on the rise even in the at risk groups, who by their own education efforts, once brought the epidemic to a virtual stand still for those groups. It was the actions of those high-risk groups that helped the mainstream groups recognize the severity of the potential problem. Our own research has made a once feared condition into just another chronic illness that with proper medication can be managed for a longer life than ever thought possible for a person afflicted with HIV/AIDS. The potential for a devastating epidemic exists in all societies where open freedom is a newer practice. The world often looks to the West as a mirror of where freedom can take a society. It is easy to ignore the potential pitfalls when searching for greener pastures. Less control is an open door for illicit practices that can lead to devastation in certain areas of what was once a more protected society. The illegal drug trade, sex industry proliferation all in the name of profit can potentially become a portal for infection by this silent hidden plague. Once HIV/ Aids have

13 gotten a strong hold it is very difficult to get control of again. Since there is no known cure, and sexual activity is part of normal human behavior, the potential impact is awesome. It can become the pollution of a society. A fatal disease passed through what is considered normal human behavior is a potentially society devastating event. Much like Pandora s box once opened and the problem let out - that problem will forever change anything that was before. Link that with ignorance, prejudice and lack of resources and that makes for a lethal combination in any society. The primary tools of importance continue to be education and the societal acceptance of abstinence as a method to eliminate risk. It is my sincere hope you that all of you here today will understand and recognize the gravity and enormity of the threshold that lies before you. And with that understanding use your knowledge and influence to work on multiple levels towards containing what can potentially become a major national health issue. God bless you all and thank you for the honor and privilege of being able to serve you on such an important issue. REFERENCES HIV Infection and AIDS: An Overview (2003) on the Internet at

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