IGNOU BSW Solved Assignments 2011 BSWE 005 Introduction to HIV/AIDS Course Code: BSWE 005 Total marks:

: 100 Note: i) Answer all the five questions. ii) All questions carry equal marks. iii) Answer to question No. 1 and 2 should not exceed 600 words each. 1. Discuss the epidemiology of HIV in India. 20 Or Describe the mode of HIV transmission through sexual activities. 20 Solution: Epidemiology of HIV in India: In India there is an estimated 2-5 million people infected with HIV in India today. The most rapid and well-documented spread of infection has occurred in Bombay and the State of Tamilnadu.In Bombay, HIV prevalence has reached 50% in sex workers, 36% in STD patients, and 2.5% in women seen in antenatal clinics. The infection affects both urban and rural areas. In Bombay, seroprevalence rose from 2-3% in patients seen in STD clinics in 1990 to 36% in 1994 and in rural areas 3-4% of some populations have an STD. In India, there are an estimated 1-2 million cases of tuberculosis every year. TB is the most prevalent form of POI (opportunistic infection) in over 60% of AIDS cases. In Bombay alone, 10% of the patients with TB are HIVpositive. Despite being home to the world's third-largest population suffering from HIV/AIDS, the AIDS prevalence rate in India is lower than in many other countries. In 2007, India's AIDS prevalence rate stood at approximately 0.30%the 89th highest in the world. The spread of HIV in India is primarily restricted to the southern and north-eastern regions of the country and India has also been praised for its extensive anti-AIDS campaign.[6] The US$2.5 billion National AIDS Control Plan III was set up by India in 2007 and received support from UNAIDS[7] The main factors which have contributed to India's large HIV-infected population are extensive labor migration and low literacy levels in certain rural areas resulting in lack of awareness and gender disparity.[8] The Government of India has also raised concerns about the role of intravenous drug use and prostitution in spreading AIDS, especially in north-east India and certain urban pockets.[8] A recent study published in the British medical journal "The Lancet" in (2006) reported an approximately 30% decline in HIV infections among young women aged 15 to 24 years attending prenatal clinics in selected southern states of India from 2000 to 2004 where the epidemic is thought to be concentrated. The authors cautiously attribute observed declines to increased condom use by men who visit commercial sex workers and cite several pieces of corroborating evidence. Some efforts have been made to tailor educational literature to those with low literacy levels, mainly through local libraries as this is the most readily accessible locus of information for interested parties Increased awareness regarding the disease and citizen's related rights is in line with the Universal Declaration on Human Rights.

HIV statistics, 2007 Antenatal clinic HIV prevalence 2007 (%)[10] 1.00 0.25 0.50 0.50 0.75 0.75 0.60 0.25 0.25 0.25 STD clinic HIV prevalence 2007 (%) [11] 17.20 2.40 8.40 11.62 4.08 7.13 3.42 8.00 5.20 0.42 IDU HIV prevalence 2007 (%)[12] 3.71 ... 2.00 24.40 17.90 7.53 1.91 16.80 10.10 8.64 MSM HIV prevalence 2007 (%)[13] 17.04 8.40 17.60 11.80 16.4 ... ... 6.60 11.73 3.60 Female sex worker HIV prevalence 2007 (%)[14] 9.74 6.53 5.30 17.91 13.07 7.20 8.91 4.68 3.15 0.40

State Andhra Pradesh Gujarat Karnataka Maharashtra Manipur Mizoram Nagaland Tamil Nadu Delhi Chandigarh

Some areas report an HIV prevalence rate of zero in antenatal clinics. This does not necessarily mean HIV is absent from the area, as some states report the presence of the virus at STD clinics and amongst injecting drug users. In some states and territories the average antenatal HIV prevalence is based on reports from only a small number of clinics. The genetic strains of HIV which have been uncovered in India have a different origin from those present in Thailand. Also, both HIV-1 and HIV-2 have been detected in India. In a 1991-93 study of clients of a sexually transmitted disease clinic in Bombay, it was found that seroprevalence of HIV in 241 clients was 39%, the 78.5% positive for HIV-1, 6.5% for HIV-2, and 15% for both. Distribution was even for males and females, reflecting heterosexual transmission. HIV-2 has also been detected in other parts of India, and HIV-1 is spreading throughout the country. HIV in children is a sequelae to blood transfusion. The prevalence of HIV in areas where IV drug use is rampant is increasing rapidly and is spreading to the general population. Genetic analysis revealed that the most closely related genetic sequence to the Indian HIV-1 from Bombay occurs in a strain of the virus from South Africa. One subtype of HIV-2 and several subtypes of HIV-1 have been found, with HIV-1 subtype C and HIV-2 subtype A the most frequently encountered. An examination of phylogenetic trees shows the relationships among these different strains. The close genetic relationship between isolates of HIV-1 and HIV2 from patients in different parts of the country reflects the recent introduction of these strains. Thus, India is an ideal site for studying the efficacy of a vaccine designed specifically for a population of highly similar strains (the high similarity among HIV-2 isolates is unique in India). Since HIV-2 strains are diverging at a rate of 1% per year, any such research would have to occur soon. ======================================================

2. Explain the concept of life skills education in the context of HIV/AIDS. 20 Or Discuss some of the common STDs and their treatment. 20 Solution: Some of the common STDs and their treatment Sexually transmitted diseases (STDs) are those that are mostly spread through sexual activities. One partner transfers the disease to his or her partner as a result of sexual contact, including vaginal sex, anal sex or oral sex. While most STDs may only be transmitted through sexual intercourse, they are still common because many people do not know how to avoid or prevent them, much less treat them. Those who test positive for STD have to advise their partners to be tested too. The most common but curable STD is chlamydia, which usually affects the urethra of the penis in men and the cervix in women. One of the reasons why this disease is prevalent is because half of those who are infected have no symptoms. Prescription antibiotics are used to treat chlamydia for a period of one to two weeks. Gonorrhea is another common STD that is caused by bacteria. Like chlamydia, many of those who have gonorrhea are unaware that they are infected because they have no symptoms. Treatment is also through antibiotics. The problem is that new strains of the bacteria that cause this STD have become resistant to certain drugs. Moreover, gonorrhea in the throat is more difficult to treat. In the past, the treatment of uncomplicated gonorrhea was fairly simple. A single injection of penicillin cured almost every infected person. Unfortunately, there are new strains of gonorrhea that have become resistant to various antibiotics, including penicillins, and are therefore more difficult to treat. Fortunately, gonorrhea can still be treated by other injectable or oral medications.Uncomplicated gonococcal infections of the cervix, urethra, and rectum, are usually treated by a single injection of ceftriaxone intramuscularly or by 400mg of cefixime (Suprax) in a single oral dose. For uncomplicated gonococcal infections of the pharynx, the recommended treatment is 125 mg of ceftriaxone in a single IM dose.Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, and rectum are 2 g of spectinomycin in nonpregnant women (not available in the United States) in a single IM dose or single doses of cephalosporins (ceftizoxime, 500 mg IM; or cefoxitin, 2 g IM, administered with probenecid (Benemid), 1 g orally; or cefotaxime, 500 mg IM). Treatment should always include medication that will treat chlamydia [for example, azithromycin (Zithromax, Zmax) or doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others)] as well as gonorrhea, because gonorrhea and chlamydia frequently exist together in the same person. The sexual partners of women who have had either gonorrhea or chlamydia must receive treatment for both infections since their partners may be infected as well. Treating the partners also prevents reinfection of the woman. Women suffering from PID require more aggressive treatment that is effective against the bacteria that cause gonorrhea as well as against other organisms. These women often require intravenous administration of antibiotics.It is important to note that doxycycline, one of the recommended drugs for treatment of PID, is not recommended for use in pregnant women.Gonorrhea is one of the easier STDs to prevent

because the bacterium that causes the infection can survive only under certain conditions. The use of condoms protects against gonorrhea infection. Since the organism can live in the throat, condoms should be used during oral-genital contact as well. Syphilis is another common and well-known STD that is primarily transmitted through the sores that appear on the genital area, the anus and the mouth. It should be noted that because the sores may be located in areas that are not covered by a condom, condoms will not completely eliminate the possibility of the transmission of this disease. These sores or chancres are painless and small and may heal by themselves. However, this does not mean that syphilis is no longer present. Treatment of syphilis is primarily through parenteral penicillin. Trichomoniasis is the most prevalent STD in young women who are sexually active. The problem is that this disease is usually mistaken as bacterial vaginosis or a yeast infection because of the similarity of the symptoms. The treatment of this STD is a single dose of metronidazole. Other common STDs are pubic lice, scabies, human papillomavirus, HIV and herpes. Vaccines are available that protect against some viral STIs, such as Hepatitis A, Hepatitis B, Herpes simplex vaccine (both Herpevac and ImmunoVex), and some types of HPV. Vaccination before initiation of sexual contact is advised to assure maximal protection. High risk exposure such as that which occurs in rape cases may be treated prophylacticly using antibiotic combinations such as azithromycin, cefixime, and metronidazole. An option for treating partners of patients (index cases) diagnosed with chlamydia or gonorrhea is patient-delivered partner therapy (PDT or PDPT), which is the clinical practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner. ====================================================== 3. Answer any two of the following in about 300 words each: i) Critically analyze the ethical issues involved with mother to child transmission of HIV. 10 Solution: Optional ====================================================== ii) Describe the initiatives taken by Government of India for the control and prevention of HIV/AIDS. 10 Solution: The initiatives taken by Government of India for the control and prevention of HIV/AIDS are as follow: Integrated Counseling and Testing Centres (ICTC) About 70% of HIV infected are not aware about their status and there is need to extend access to the counseling and testing facilities and increase demand generation. The ICTCs have been

established at medical colleges, district hospitals, sub-district level hospitals and few community health centres and it is proposed to further extend the services to all the CHCs and 24 hours PHCs in the country. Prevention of Parent to Child Transmission All the ICTCs centres are now providing counseling and testing services to pregnant women. Hospitals with large number of ANCs & institutional deliveries provide an ICTC in the Obstretics & Gynaecology department. The programme aims at increasing the proportion of women counselled and tested, specially in category A&B districts and the coverage of HIV positive women with Nevirapine to 70% in the next year. The high dropout rates need to be addressed and awareness levels and demand for services improved. Sexually Transmitted Infections (STI) The number of STI clinics being supported by NACO has increased from 815 in 2005 to 895 in 2007. The reported number of patients treated for STI in 2005 was over 16.7 lakh, in 2006, 20.2 lakh and in 2007, it has increased to 25.9 lakh. The baseline survey carried out in 2001 indicated that at any given time 6% of the adult population had symptoms of STI. There is, thus, very large gap between the estimated number of STI patients and those reported to have sought treatment in government health facilities. During 2006, NACO and RCH division jointly released a manual on management of STIs, so as to strengthen the services in the government health facilities and also to involve the physicians working in the private sector. Joint training material has also been developed. A package for involvement of private physicians in the Category A&B districts has been developed. Medicines are under procurement in coloured cartons for each STI syndrome to facilitate the management of STI in the peripheral health facilities. Care and Support Government of India announced a policy cum programme commitment for providing free ART with effect from 1st April, 2004. Antiretroviral treatment (ART) is a combination of at least 3 ARV drugs that is given to HIV infected individuals once they reach a stage of advanced immuno-suppression. At present there are 174 ART centres in the country. More than 1.46 lakh patients are receiving free ART at these centres (May, 2008). In addition nearly 35,000 patients are receiving ART in private and NGO sector. Second line ARV drugs are being provided free of cost at Mumbai and Chennai from 2008. A total of 159 community care centres have also been established in high prevalence states to enable People Living with HIV/AIDS (PLHA) to get used to ART, to provide Counseling & follow-up advice on drug adherence, management of opportunistic infections and Nutrition Counseling, to provide pre-ART care for those PLHA who are not yet on ART through outreach and home-based services. To reduce inconvenience and indirect expenditures of patients, 46 drug dispensing centres have been established linked to the ART centre. These link centres will require the patients to go to the ART centres only 2 times instead of 12 as at present. Second line treatment has been introduced on a pilot basis in 2 centres and 42 persons are being treated. National Paediatric AIDS Initiative In order to provide comprehensive Care & Support (including ART) to children infected and affected by HIV, NACO has launched National Paediatric AIDS Initiative on 30th November, 2006. For this initiative NACO, along with the Indian Academy of Paediatrics (IAP), UNICEF,

WHO and Clinton Foundation, has developed guidelines for paediatric ART. ARV drugs in paediatric formulations are available at all ART centres. Number of children receiving ART increased from 1800 before October 2006 to 9925 in May 2008. 32,500 are reported and being monitored. Other activities under this initiative include establishment of seven Regional Paediatric Centres, free CD4 monitoring, free DNA PCR test for children up to 18 months, liquid formulations for babies weighing less than 5 kg, diagnosis and treatment of opportunistic infections and micro nutrient supplementation. The initiative also includes training of paediatricians and counsellors, establishing laboratories for diagnosis, introduction of Dried Blood Support system to transport dried blood samples. Care and Support for CLHA (Children Living with HIV/AIDS) orphans and vulnerable children forms an integral part of NACP III. Condom Promotion Condom programme is central to HIV/AIDS prevention at the intervention level. The use of condoms is promoted as a protection against STIs and HIV/AIDS in addition, to Family Planning. Condom use is promoted and condoms provided at all ICTCS and ART centres and also the STI clinics. In 2006, 1250 million condoms were supplied free, 604 million were distributed through social marketing while 389 million through commercial marketing. 11025 Condom Vending Machines have been installed and another 11000 are in the process of being installed. 3.5 billion condoms are targeted to be distributed through 3 million outlets during NACP-III. Information, Education and Communication activities (IEC) NACO is working on a communication strategy which is a shift from awareness generation to bringing about behaviour change. NACO has focused on reduction of stigma and discrimination, promotion of services viz., counseling & testing, ART, routinisation of condom use and blood safety. Special emphasis has been given to youth and women who are more vulnerable to HIV infection. A cadre of village level Link workers are going to be set up in A & B category districts for focused interventions of BCC. Intensive IEC among general populations has resulted in increasing awareness of HIV/AIDS among rural populations to about 75% (BSS 2006). Under the adolescent education program, over 1,14,345 high schools have been covered with HIV/AIDS and life skill education programs. The Red Ribbon Express launched on 1.12.2007 has traversed over 180 stations and 27,000 kms. It has drawn huge crowds at all the stations. MainstreamingIn order to reiterate the Government's multi-sectoral response to prevent the spread of HIV and to facilitate a strong multi-sectoral response to combat it effectively, a National Council on AIDS (NCA) has been constituted, under the chairmanship of Hon'ble Prime Minister with representation of 33 ministries and departments. Private sector, civil society organisation, PLHA networks and government departments would all play crucial role in prevention, care, support, treatment and service delivery. ====================================================== iii) Briefly discuss the need for workplace policy on HIV/AIDS. 10 Solution: Need for workplace policy on HIV/AIDS Avoid Non-Discrimination

HIV/AIDS Workplace Policy to provide a work environment for its employees that is free from harassment and/or discrimination. Colleagues who engage in acts of harassment and/or discrimination are subject to corrective action that may include termination of employment. Accordingly, colleague situations related to HIV and AIDS are governed by the following Principles: * HIV/AIDS Workplace Policy will not and does not discriminate against colleagues or applicants having, perceived as having, living with or otherwise affected by HIV or AIDS. * HIV/AIDS Workplace Policy treats HIV/AIDS the same as other illnesses in terms of all of our employee policies and benefits, including health and life insurance, disability benefits and leaves of absence. HIV Testing, Confidentiality and Disclosure * HIV/AIDS Workplace Policy encourages routine, confidential, voluntary testing and counseling as part of its education and awareness programs. * HIV and AIDS are treated confidentially as medical conditions, in accordance with applicable laws and HIV/AIDS Workplace Policy policies. * HIV/AIDS Workplace Policy does not require colleagues, their dependents, job applicants or other third parties to undergo HIV testing as a condition of employment or receipt of benefits. Promoting a Safe Work Environment HIV/AIDS Workplace Policy is committed to providing a work environment that protects colleague health and safety. This commitment recognizes that HIV/ AIDS cannot be transmitted through casual contact. Employees who know the facts about HIV infection and AIDS are less likely to react negatively or inappropriately to a colleague's illness. Therefore, HIV/AIDS Workplace Policy 's global sites are expected to manage the risk of HIV infection in the workplace through: * Appropriate training, awareness, and education on the use of infection control measures in the workplace; * Provision of appropriate equipment and materials to protect colleagues from the risk of exposure to HIV in the performance of their work; * Appropriate HIV/AIDS information included in occupational health and first aid training. Create Education and Awareness HIV/AIDS Workplace Policy is concerned about the wellness of our colleagues and their families. Company-provided benefits and programs have an important role in preserving the dignity of those colleagues infected with or affected by HIV/AIDS. They serve to help them maintain normal and productive lives. The Company will provide, either directly or through third parties, an integrated education and awareness program focusing on prevention. Such programs, to be determined by global workplace sites, could include: Access to Treatment and Care Colleagues who test positive for HIV can be productive for a long time if they receive the right treatment and medical support. While recognizing that health care delivery systems differ by country or local jurisdiction, HIV/AIDS Workplace Policy believes that its employees should

have access to treatment, including, where available, treatment regimens requiring anti-retroviral and anti-infective. In the absence of the availability of and access to external programs for which its employees may be eligible (e.g., through government-sponsored health insurance or other state-sponsored programs and opportunities for treatment and care), HIV/AIDS Workplace Policy will ensure access to anti-retroviral therapy as follows: HIV/AIDS Workplace Policy will provide any HIV/AIDS Workplace Policy medicines, other medications approved and available for sale in the country, and other treatments according to the local standard of care including medically necessary and appropriate tests. ====================================================== iv) Discuss the implications of HIV/AIDS for the community. 10 Solution: Optional ======================================================

4. Answer any four of the following in about 150 words each: i) Discuss the myths and misconceptions related to transmission of HIV/AIDS. 5 Solution: HIV/AIDS myths and misconceptions about HIV transmission There have been many misconceptions and widespread myths over the years as to how HIV is transmitted. Unfortunately, these misconceptions and myths have often led to unfounded fears, stigma against people living with HIV/AIDS, unnecessary and punitive restrictions, and discriminatory practices. These misconceptions and myths also may have diverted attention from the actual routes of HIV transmission and, as a consequence, may have increased the likelihood that some people would not follow established HIV prevention guidelines. +-HIV/AIDS Myth: "HIV can be transmitted through casual contact" Truth: Diverse studies have shown that HIV is not transmitted through casual, everyday contact, such as shaking hands or sharing eating utensils, even when people are living in close quarters (SFAF, n.d.). +-HIV/AIDS Myth: "HIV can be transmitted through insect bites" Truth: Studies conducted by the US Centers for Disease Control and Prevention (CDC) and others have shown no evidence of HIV transmission through bloodsucking or biting insects, including mosquitoes, flies, ticks, and fleas, perhaps because HIV cannot live and replicate in insects' bodies (CDC, 2003). +-HIV/AIDS Myth: "In the United States, donating blood or receiving donated blood is risky" Truth: According to the American Association of Blood Banks, many safeguards on our national blood supply help ensure safe blood for patients. When people volunteer to donate blood, they

must answer a number of questions about their health and risk factors for disease. Only people with a clean bill of health are permitted to donate. Blood is drawn with sterilized needles that are used only once. The blood from each donor is type-tested and then subjected to nine separate screening tests that check for evidence of infection with HIV, hepatitis, syphilis, and other diseases (American Association of Blood Banks, n.d.; SFAF, n.d.). +-HIV/AIDS Myth: "Pets and other animals can carry HIV and transmit it to people" Truth: Humans are the only animals that can harbor HIV. Some animals do carry viruses similar to HIV that cause immune deficiency in their own species. For examples, cats can get FIV (feline immunodeficiency virus) and some monkeys can get SIV (simian immunodeficiency virus). However, FIV and SIV cannot be transmitted to people, nor can people transmit HIV to their pets. An exception to this rule is chimpanzees that have been infected with HIV for research purposes. Contact with their blood could infect the researchers who work with them (SFAF, n.d.). +-HIV/AIDS Myth: "HIV can be transmitted through contact with saliva, tears, or sweat" Truth: HIV can be transmitted only when a sufficient amount of HIV enters the body. Saliva, tears, sweat, and urine either contain no HIV or contain quantities too small to result in infection (SFAF, n.d.). To date, contact with saliva, tears, or sweat has never been shown to result in transmission of HIV (CDC, 2003). The only time these body fluids would pose a risk is if they had blood in them. ====================================================== ii) Briefly describe the issues pertaining to HIV testing of specific groups. 5 Solution: Optional ====================================================== iii) Enumerate the basic rights of persons living with HIV/AIDS. 5 Solution: People living with HIV infection and AIDS should have the same basic rights and responsibilities as those which apply to all citizens of the country. 1) Liberty, autonomy, security of the person and freedom of movement: * People with HIV or AIDS have the same rights to liberty and autonomy, security of the person and to freedom of movement as the rest of the population. * No restrictions should be placed on the free movement of HIV-infected people, and they may not be segregated, isolated or quarantined in prisons, schools, hospitals or elsewhere merely because of their HIV-positive status. * People with HIV infection or AIDS are entitled to maintain personal autonomy (i.e. the right to make their own decisions) about any matter that affects marriage and child-bearing - although counselling about the consequences of their decisions should be provided.

2) HIV Testing (a) When may a person be tested for HIV * No person may be tested for HIV infection without his or her free and informed consent (except in the case of anonymous epidemiological screening programmes undertaken by authorised agencies such as the national, provincial or local health authorities.) * In all other cases such as HIV testing for research purposes or when a persons blood will be screened because he or she is a blood donor the informed consent of the individual is legally required. * Where an existing blood sample is available, and an emergency situation necessitates testing the source patients blood (e.g. when a health care worker has been put at risk because of an accident such as a needlestick injury), HIV testing may be undertaken without informed consent - but only after informing the source patient that the test will be performed and after assuring him or her that privacy and absolute confidentiality will be maintained. * If an existing blood sample is not available for testing in an emergency situation, the patient must give his or her informed consent for blood to be drawn for the HIV test to be done. * Routine testing of a person for HIV infection for the perceived purpose of protecting a health care professional from infection is impermissible - regardless of consent. * Proxy consent for an HIV test may be given where an individual is unable to give consent. Proxy consent is consent by a person legally entitled to grant consent on the behalf of another individual. For example, a parent or guardian of a child below the age of consent to medical treatment may give proxy consent to HIV testing of the child. (b) Informed consent, pre- and post-HIV test counselling * Informed consent, which includes pre-HIV test counselling, is compulsory before HIV testing may be carried out. * Informed consent means that the person has been made aware of, and understands, the implications of the test. * The person should be free to make his or her own decision about whether to be tested or not, and may in no way be coerced or forced into being tested. * Pre-test counselling should occur before an HIV test is undertaken. It should take the form of a confidential dialogue between the client and a suitable, qualified person where relevant information is given and consent obtained. * Post-test HIV counselling should take place as part of the process of informing an individual of an HIV test result. * Anonymous and confidential HIV antibody testing with pre- and post-HIV test counselling should be available to all. Persons who test HIV positive should have access to continuing support and health services. . 3. Confidentiality and privacy: People with HIV infection and AIDS have the right to confidentiality and privacy about their health and HIV status. * Health care professionals are ethically and legally required to keep all information about clients or patients confidential. * Information about a persons HIV status may not be disclosed to anybody without that persons fully informed consent.

* After death, the HIV status of the deceased person may not be disclosed to anybody without the consent of his or her family or partner except when required by law. ====================================================== iv) Explain substance abuse and its effects. 5 Solution: Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts. The terms have a huge range of definitions related to taking a psychoactive drug or performance enhancing drug for a nontherapeutic or non-medical effect. All of these definitions imply a negative judgment of the drug use in question (compare with the term responsible drug use for alternative views). Some of the drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines, cocaine, methaqualone, and opioids. Use of these drugs may lead to criminal penalty in addition to possible physical, social, and psychological harm, both strongly depending on local jurisdiction. Other definitions of drug abuse fall into four main categories: public health definitions, mass communication and vernacular usage, medical definitions, and political and criminal justice definitions. Drug abuse makes central nervous system (CNS) effects, which produce changes in mood, levels of awareness or perceptions and sensations. Most of these drugs also alter systems other than the CNS. Some of these are often thought of as being abused. Some drugs appear to be more likely to lead to uncontrolled use than others. Traditionally, new pharmacotherapies are quickly adopted in primary care settings, however; drugs for substance abuse treatment have faced many barriers. Naltrexone, a drug originally marketed under the name "ReVia," and now marketed in intramuscular formulation as "Vivitrol" or in oral formulation as a generic, is a medication approved for the treatment of alcohol dependence. This drug has reached very few patients. This may be due to a number of factors, including resistance by Addiction Medicine specialists and lack of resources.The ability to recognize the signs of drug use or the symptoms of drug use in family members by parents and spouses has been affected significantly by the emergence of home drug test technology which helps identify recent use of common street and prescription drugs with near lab quality accuracy ====================================================== v) Explain the term Palliative care. 5 Solution: Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. Nonhospice palliative care is not dependent on prognosis and is offered in conjunction with curative and all other appropriate forms of medical treatment.

In the United States, a distinction is made between general palliative care and hospice care, which delivers palliative care to those at the end of life; the two aspects of care share a similar philosophy but differ in their payment systems and location of services. Elsewhere, for example in the United Kingdom and Canada, this distinction is not operative: in addition to specialized hospices, non-hospice-based palliative care teams provide care to those with life-limiting illness at any stage of disease ====================================================== vi) List the laws which are useful to enforce the rights of PLHAS. 5 Solution: Optional ====================================================== 5. Write short notes on any five of the following in about 100 words each: i) Window period 4

Solution: Optional ================================================================ ii) ELISA 4

Solution: Enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is a biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample. The ELISA has been used as a diagnostic tool in medicine and plant pathology, as well as a quality-control check in various industries. In simple terms, in ELISA, an unknown amount of antigen is affixed to a surface, and then a specific antibody is applied over the surface so that it can bind to the antigen. This antibody is linked to an enzyme, and in the final step a substance is added that the enzyme can convert to some detectable signal, most commonly a colour change in a chemical substrate. Performing an ELISA involves at least one antibody with specificity for a particular antigen. The sample with an unknown amount of antigen is immobilized on a solid support (usually a polystyrene microtiter plate) either non-specifically (via adsorption to the surface) or specifically (via capture by another antibody specific to the same antigen, in a "sandwich" ELISA). After the antigen is immobilized, the detection antibody is added, forming a complex with the antigen. The detection antibody can be covalently linked to an enzyme, or can itself be detected by a secondary antibody that is linked to an enzyme through bioconjugation. Between each step, the plate is typically washed with a mild detergent solution to remove any proteins or antibodies that are not specifically bound. After the final wash step, the plate is developed by adding an enzymatic substrate to produce a visible signal, which indicates the quantity of antigen in the sample.

Traditional ELISA typically involves chromogenic reporters and substrates that produce some kind of observable color change to indicate the presence of antigen or analyte. Newer ELISAlike techniques utilize fluorogenic, electrochemiluminescent, and real-time PCR reporters to create quantifiable signals. These new reporters can have various advantages including higher sensitivities and multiplexing.[1][2] In technical terms, newer assays of this type are not strictly ELISAs, as they are not "enzyme-linked" but are instead linked to some non-enzymatic reporter. However, given that the general principles in these assays are largely similar, they are often grouped in the same category as ELISAs. ================================================================ iii) List out skills useful for helping professionals 4

Solution: ================================================================ iv) Wasting Syndrome 4 Solution: AIDS wasting is the involuntary loss of more than 10% of body weight, plus more than 30 days of either diarrhea, or weakness and fever. Wasting is linked to disease progression and death. Losing just 5% of body weight can have the same negative effects. Wasting is still a problem for people with AIDS, even people whose HIV is controlled by medications. Part of the weight lost during wasting is fat. More important is the loss of muscle mass. This is also called lean body mass, or body cell mass. Lean body mass can be measured by bioelectrical impedance analysis (BIA) or by a full body x-ray (DEXA) scan. These are simple, painless office procedures. AIDS wasting and lipodystrophy can both cause some body shape changes. See Fact Sheet 553 for more information on lipodystrophy. Wasting is the loss of muscle. Lipodystrophy can cause a loss of fat under the skin. Wasting is not the same as fat loss caused by lipodystrophy. However, wasting in women can start with a loss of fat. WHAT CAUSES AIDS WASTING? Several factors contribute to AIDS wasting: * Low food intake: Low appetite is common with HIV. Also, some AIDS drugs have to be taken with an empty stomach, or with a meal. It can be difficult for some people with AIDS to eat when theyre hungry. Drug side effects such as nausea, changes in the sense of taste, or tingling around the mouth also decrease appetite. Opportunistic infections in the mouth or throat can make it painful to eat. Infections in the gut can make people feel full after eating just a little food. Finally, lack of money or energy may make it difficult to shop for food or prepare meals. * Poor nutrient absorption: Healthy people absorb nutrients through the small intestine. In HIV disease, several infections (including parasites) can interfere with this process. HIV may directly

affect the intestinal lining and reduce nutrient absorption. Diarrhea causes loss of calories and nutrients. * Altered metabolism: Food processing and protein building are affected by HIV disease. Even before any symptoms show up, you need more energy. This might be caused by the increased activity of the immune system. People with HIV need more calories just to maintain their body weight. ================================================================

v) Syphilis 4 Solution: Syphilis is a sexually transmitted disease caused by the spirochetal bacteria Treponema pallidum subspecies pallidum. The primary route of transmission of syphilis is through sexual contact however it may also be transmitted from mother to fetus during pregnancy or at birth resulting in congenital syphilis.The signs and symptoms of syphilis vary depending on which of the four stages it presents in (primary, secondary, latent, and tertiary). The primary stage typically presents with a single chancre, secondary syphilis with a diffuse rash, latent with little to no symptoms, and tertiary with gummas, neurological, or cardiac symptoms. Diagnosis is usually via blood tests. It can be effectively treated with antibiotics, specifically intramuscular penicillin G. Syphilis is believed to have infected 12 million people worldwide in 1999 with greater than 90% of cases in the developing world. Rates of infection have increased during the 2000s in many countries. ================================================================ vi) Narcotics 4 Solution: The term narcotic (pronounced /nrktk/) originally referred medically to any psychoactive compound with sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin. The term is, today, imprecisely defined and typically has negative connotations.[1] When used in a legal context in the US, a narcotic drug is simply one that is totally prohibited, or one that is used in violation of strict governmental regulation, such as PCP or marijuana. From a pharmacological standpoint it is not a useful term. Some people define narcotics as substances that bind at opioid receptors (cellular membrane proteins activated by substances like heroin or morphine) while others refer to any illicit substance as a narcotic. From a legal perspective, narcotic refers to opium, opium derivatives, and their semi-synthetic substitutes.[7] Though in U.S. law, due to its numbing properties, cocaine is also considered a narcotic. ==================================================================== vii) Role of social worker in dealing with HIV/AIDS patients 4 Solution: Optional ================================================================

viii) Law of Torts Solution: A tort, in common law jurisdictions, is a wrong that involves a breach of a civil duty owed to someone else. It is differentiated from criminal wrongdoing, which involves a breach of a duty owed to society. Though many acts are both torts and crimes, only the state may prosecute a crime, whereas any party who has been injured may bring a lawsuit for tort. One who commits a tortious act is called a tortfeasor. The equivalent of tort in civil law jurisdictions is delict. A person who suffers a tortious injury is entitled to receive "damages", usually monetary compensation, from the person or people responsible or liable for those injuries. Tort law defines what is a legal injury and, therefore, whether a person may be held liable for an injury they have caused. Legal injuries are not limited to physical injuries but may also include emotional, economic, or reputational injuries as well as violations of privacy, property, or constitutional rights. Tort cases therefore comprise such varied topics as auto accidents, false imprisonment, defamation, product liability (for defective consumer products), copyright infringement, and environmental pollution (toxic torts), among many others. In much of the common law world, the most prominent tort liability is negligence. If the injured party can prove that the person believed to have caused the injury acted negligently (or without taking reasonable care to avoid injuring others), tort law will allow compensation. However, tort law also recognizes intentional torts, where a person has intentionally acted in a way that harms another, and "strict liability," which allows recovery under certain circumstances without negligence ==================================================================== ==================================================================== ===============THE END============================================