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INTRODUCTION
Human
immunodeficiency
virus
infection / acquired
immunodeficiency syndrome (HIV/AIDS) is a disease of the
human immune system caused by the human immunodeficiency
virus (HIV). During the initial infection a person may experience a brief
period of influenza-like illness. This is typically followed by a prolonged
period without symptoms. As the illness progresses it interferes more
and more with the immune system, making people much more likely to
get infections, including opportunistic infections, and tumors that do not
usually affect people with working immune systems.
DEFINITION
Acquired immune deficiency syndrome (AIDS) is an infectious disease
caused by the human immunodeficiency virus (HIV). There are two
variants of the HIV virus, HIV-1 and HIV-2, both of which ultimately cause
AIDS.
-www.medical-dictionary.thefreedictionary.com
During the course of the HIV infection, most people experience a gradual
decline in the number of CD4+ T cells, although some individuals may
have abrupt and dramatic drops in their counts.
The symptoms of an HIV infection may resemble other medical
conditions. Always consult your doctor for a diagnosis.
TRANSMISSION
i. Sexual Contact
HIV is spread most commonly by sexual contact with an infected
partner. The virus enters the body through the lining of the vagina,
vulva, penis, rectum, or mouth during sexual activity.
ii.
Blood Contamination
HIV may also be spread through contact with infected blood. However,
due to the screening of blood for evidence of HIV infection, the risk of
acquiring HIV from blood transfusions is extremely low.
iii.
Needles
Mother-infant
HIV also can be spread to babies born to, or breastfed by, mothers
infected with the virus.
v.
Saliva
Sweat
Tears
Casual contact, such as sharing food utensils, towels, and bedding
Swimming pools
Telephones
Toilet seats
Biting insects (such as mosquitoes)
DIAGNOSIS
Early HIV infection often causes no symptoms, and must be detected by
testing a person's blood for the presence of antibodies--disease-fighting
proteins-- to HIV. These HIV antibodies generally do not reach levels high
enough to detect by standard blood tests until one to three months
following infection, and may take as long as six months. People exposed
to HIV should be tested for HIV infection as soon as they are likely to
develop antibodies to the virus.
When a person is highly likely to be infected with HIV and yet antibody
tests are negative, a test for the presence of HIV itself in the blood is
used. Repeat antibody testing at a later date, when antibodies to HIV are
more likely to have developed, is often recommended.
Many people are surprised when they learn that they have been infected
with HIV. Some people feel overwhelmed by the changes that they will
There are many things you can do to deal with the emotional aspects of
having HIV. What follows are some of the most common feelings
associated with a diagnosis of HIV and suggestions on how to cope with
these feelings. You may experience some, all, or none of these feelings,
and you may experience them at different times.
i.
Denial
People who find out that they are HIV positive often deal with the news
by denying that it is true. You may believe that the HIV test was not
accurate or that there was a mix-up with the result, even after
confirmatory testing shows that it is a true positive. This is a natural and
normal first reaction.
At first, this denial may even be helpful, because it can give you time to
get used to the idea of infection. However, if not dealt with, denial can
be dangerous; you may fail to take certain precautions or reach out for
the necessary help and medical support.
It is important that you talk out your feelings with your doctor, a
therapist, or someone you trust. It is important to do this so that you can
begin to receive the care and support you need.
ii.
Anger
iii.
Sadness or depression
It is also normal to feel sad when you learn you have HIV. If, over time,
you find that the sadness doesn't go away or is getting worse, talk with
your doctor or someone else you trust. You may be depressed.
Symptoms of depression can include the following, especially if they last
for more than 2 weeks:
Feeling sad, anxious, irritable, or hopeless
Gaining or losing weight
Sleeping more or less than usual
Moving slower than usual or finding it hard to sit still
Losing interest in the things you usually enjoy
Feeling tired all the time
Feeling worthless or guilty
Having a hard time concentrating
Thinking about death or giving up
Persistent loss of libido or interest in sex
If the mood swings or depression get very severe, or if ever think about
suicide, call your doctor right away. Your doctor can help you.
Finding the right treatment for depression takes time; so does recovery.
If you think you may be depressed, don't lose hope. Instead, talk to your
health care provider and seek help for depression.
iv.
Fear and anxiety may be caused by not knowing what to expect after
you've been diagnosed with HIV, or by not knowing how others will treat
you if they find out you have HIV. You also may be afraid of telling
people--friends, family members, and others--that you are HIV positive.
Fear can make your heart beat faster or make it hard for you to sleep.
Anxiety also can make you feel nervous or agitated. Fear and anxiety
might make you sweat, feel dizzy, or feel short of breath.
Ways to control your feelings of fear and anxiety include the following:
Learn as much as you can about HIV. HIV infection is now a very
treatable disease and most HIV-infected people can live long, healthy
lives if they seek medical care and take good care of themselves.
Current HIV medications can be very well tolerated and in general do
not lead to the body changes that were seen with older treatments.
Have your questions answered by your doctor.
Talk with your friends, family members, and health care providers.
Join a support group.
Help others who are in the same situation, such as by volunteering at
an HIV service organization. This may empower you and lessen your
feelings of fear.
Talk to your doctor about medicines for anxiety if the feelings don't
lessen with time or if they get worse.
v.
Stress
If you are HIV infected, you and your loved ones constantly have to deal
with stress. Stress is unique and personal to each of us. When stress
does occur, it is important to recognize the fact and deal with it. Some
ways to handle stress are discussed below. As you gain more
understanding about how stress affects you, you will come up with your
own ideas for coping with stress.
Try physical activity. When you are nervous, angry, or upset, try
exercise or some other kind of physical activity. Walking, yoga, and
gardening are just some of the activities you might try to release your
tension.
Take care of yourself. Be sure you get enough rest and eat well. If you
are irritable from lack of sleep or if you are not eating right, you will
have less energy to deal with stressful situations. If stress keeps you
from sleeping, you should ask your doctor for help.
Talk about it. It helps to talk to someone about your concerns and
worries. You can talk to a friend, family member, counselor, or health
care provider.
Let it out. A good cry can bring relief to your anxiety, and it might even
prevent a headache or other physical problem. Taking some deep
breaths also releases tension.
vi.
AIDS dementia
HIV/AIDS and some medications for treating HIV may affect your brain.
When HIV itself infects the brain, it can cause a condition known asAIDS
Dementia Complex (ADC). Symptoms can include the following:
Forgetfulness
Confusion
Difficulty paying attention
Slurred speech
Sudden shifts in mood or behaviour
Muscle weakness
Clumsiness
Coping tips
It is completely normal to have an emotional reaction upon learning that
you are infected with HIV, such as anxiety, anger, or depression. These
feelings do not last forever. As noted above, there are many things that
you can do to help take care of your emotional needs. Here are just a
few ideas:
Talk about your feelings with your doctor, friends, family members, or
other supportive people.
Try to find activities that relieve your stress, such as exercise or
hobbies.
Try to get enough sleep each night to help you feel rested.
Learn relaxation methods such as meditation, yoga, or deep breathing.
Limit the amount of caffeine, nicotine, alcohol, and recreational drugs
you use.
Eat small, healthy meals throughout the day.
Join a support group.
There are many kinds of support groups that provide a place where you
can talk about your feelings, help others, and get the latest information
about HIV/AIDS. Check with your health care provider for a listing of local
support groups.
More specific ways to care for your emotional well-being include various
forms of therapy and medication. Used alone or in combination, these
may be helpful in dealing with the feelings you are experiencing.
Therapy can help you better express your feelings and find ways to cope
with your emotions. Medicines that may be able to help with anxiety and
depression are also available.
You should always talk with your doctor about your options. There are
many ways to care for your emotional health, but treatments must be
carefully chosen by your physician based on your specific circumstances
and needs.
The most important thing to remember is that you are not alone; there
are support systems in place to help you, including doctors,
psychiatrists, family members, friends, support groups, and other
services.
PSYCHOLOGICAL TREATMENTS
Often drug therapies for mental health problems work better if used
along with special kinds of psychological therapy. Examples include
psychotherapy, and cognitive behavioural therapy (CBT), both of which
usually involve a short course of sessions with a psychotherapist or
psychologist.
HIV COUNSELING
Counseling in HIV and AIDS has become a core element in a holistic
model of health care, in which psychological issues are recognised as
integral to patient management.
One to one prevention counseling has a particular contribution in that it
enables frank discussion of sensitive aspects of a patient's lifesuch
discussion may be hampered in other settings by the patient's concern
for confidentiality or anxiety about a judgmental response. Also, when
patients know that they have HIV infection or disease, they may suffer
great psychosocial and psychological stresses through a fear of rejection,
social stigma, disease progression, and the uncertainties associated with
future management of HIV. Good clinical management requires that such
issues be managed with consistency and professionalism, and
counseling can both minimise morbidity and reduce its occurrence. All
counselors in this field should have formal counseling training and
receive regular clinical supervision as part of adherence to good
standards of clinical practice.
b) Support
Individual, relationship, and family counseling to prevent and reduce
psychological morbidity associated with HIV infection.
Knowing whether you have HIV infection would alert you to your
need to seek medical care to prevent or delay life- threatening
illness. Your test result (positive or negative) would also help your
doctor determine the cause and best treatment of the various
illnesses you may have now or in the future. For example, if you are
HIV-positive, tuberculosis (TB) and syphilis are treated differently
than if you are HIV- negative.
If you find out you are infected, knowing your result would help
you protect your sex partner(s) from infection and illness. If they are
not infected, you can avoid infecting them.
Knowing your result would help you assess the safety of having a
child.
Knowing your result, even if you are infected (positive test result)
may be less stressful for some people than the anxiety of thinking
you might be infected but not knowing. If your result indicates you
are not infected (negative), you can take action to be sure you don't
become infected in the future.
test results. Most counseling and testing centers follow one of two
policies:
If you have been to a particular place for health care before for
other reasons, you may feel more comfortable with the staff that will
counsel and offer testing.
Counseling
You should be given materials to read before you enter a group or
private session with a counselor or doctor. He or she might ask why you
want to be tested. Your counselor should also ask about your behaviour
and that of your sex partner(s). This will help your counselor and you to
determine whether testing is appropriate for you. If testing is
appropriate, your counselor or doctor should:
If these questions are not covered, or if you have any other questions,
ask them. You should come prepared with questions that have been on
your mind. Also ask your doctor or counselor how you will be told of the
test result. If your test result is negative, the post-test counselor will talk
to you about how to avoid behaviours that will put you at risk.
Informed Consent
You have the right to refuse any medical procedure, to be fully informed
about it, and to agree to it. You should be asked to read a statement
saying that you have been informed about the HIV-antibody testing
procedure, you understand it, and you consent to have it done.
Your counselor should tell you your result and, regardless of whether it is
positive or negative, how to protect your health and the health of others.
He or she will review methods to prevent the spread of HIV.
If your result is negative, your counselor may discuss retesting if, during
the 6 months before your test, you engaged in any behaviours that
might have infected you. You may be infected but your body may not yet
have produced enough antibodies for the test to detect. Since it takes
time for your body to develop antibodies, you may need to be retested.
If your test is positive, your counselor will tell you what this means for
you. Any questions you have should be answered and your counselor will
refer you for follow-up health care, support services, or further
counseling. Your counselor will also talk to you about telling your sex
and/or drug-using partner(s).
PREVENTION COUNSELING
Prevention counseling should be offered and encouraged in all healthcare facilities that serve patients at high risk (e.g., STD clinics), because
these facilities routinely elicit information about the behaviours that
place persons at high risk for HIV. Prevention counseling need not be
explicitly linked to HIV testing. However, some patients might be more
likely to think about HIV and consider their risk-related behaviour when
undergoing an HIV test. HIV testing presents an excellent opportunity to
provide or arrange for prevention counseling to assist with behaviour
changes that can reduce risk for acquiring HIV infection.
Instructions
1. Educate yourself about the HIV and AIDS virus. It is important that
you are informed about various treatment options that you can
discuss with your patient. Take the time to think about what your
patient will be feeling before you talk to them. There are many
emotions that revolve around a positive HIV result.
2. Educate your patient about the virus. Discuss various drug-andtreatment options with your patient. Encourage them to take
charge of their health and stay up-to-date about the various
available treatments. Make sure they know that being diagnosed
with HIV is not an immediate death sentence. Many people live
completely normal lives for more than 10 years after being
diagnosed.
5. If your patient has not told their friends or family about having HIV,
help them come up with a way to tell them. The family needs to
know, the drug-using friends and the sexual partner(s) of your
patient need to know as well. Let your patients ask questions and
take the time to answer them.
MANAGEMENT
There is currently no cure or effective HIV vaccine. Treatment consists of
high active antiretroviral therapy (HAART) which slows progression of the
disease and as of 2010 more than 6.6 million people were taking them in
low and middle income countries. Treatment also includes preventative
and active treatment of opportunistic infections.
PREVENTION
Individuals can reduce the risk of HIV infection by limiting exposure to
risk factors. Key approaches for HIV prevention, which are often used in
combination, include:
1. Male and female condom use
Correct and consistent use of male and female condoms during vaginal
or anal penetration can protect against the spread of sexually
transmitted infections, including HIV. Evidence shows that male latex
condoms have an 85% or greater protective effect against the sexual
transmission of HIV and other sexually transmitted infections (STIs).
2. Testing and counseling for HIV and STIs
Testing for HIV and other STIs is strongly advised for all people exposed
to any of the risk factors so that they can learn of their own infection
status and access necessary prevention and treatment services without
delay. WHO also recommends offering testing for partners or couples.
3. Voluntary medical male circumcision
Medical male circumcision, when safely provided by well-trained health
professionals, reduces the risk of heterosexually acquired HIV infection in
men by approximately 60%. This is a key intervention in generalized
epidemic settings with high HIV prevalence and low male circumcision
rates.
Every person who is HIV positive must work with his doctor to determine
a treatment plan that is tailored specifically to him. HIV carriers may
require a mixture of the three medications listed above and each case is
unique in determining treatment, particularly when side effects and
other risks are taken into consideration. Alternative therapies, such as
chiropractics, are also available in treating those with HIV. In addition to
medication and alternative therapy treatment, a person with HIV should
try to maintain a healthy lifestyle through diet and exercise.
Be honest with your doctor about any other medical conditions you
have or have had, no matter how minor they may seem, as this can
affect your treatment, says Stovell. These conditions include
everything from cancer, diabetes and high cholesterol to mental
health disorders and substance abuse.
Visit your doctor for blood tests to determine your viral load and
CD-4 counts (also known as T-cell counts). According to Smith,
these numbers will give you a clear picture of the state of your
health, including how much damage has been done to your organs
and immune system and the likelihood of transmitting the virus to a
partner. Your doctor will repeat these tests at regular intervals.
Make certain your doctor also runs tests to see if you are carrying a
strain of HIV that may be resistant to certain medications, which is
a very common occurrence, says Smith. "Twenty percent of HIVinfected people in California alone have a resistance to at least one
type of HIV medication, so it's extremely important to weed out
ineffective medications at the get-go," he says.
Learn constantly about HIV and AIDS and what you can do to stay
healthy. Stovell agrees, "knowledge is power and new research on
the disease comes out all the time. The more you are on top of
these developments, the more you can take advantage of beneficial
new treatments and breakthroughs."