Hiv and Aids
By: Dr A Benjamin
Published by WSIC EBooks Ltd.
Copyright October 3, 2011 by WSIC Ebooks Ltd.
Smashwords Edition
Smashwords Edition, License Notes
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INTRODUCTION
Many people are dying because of lack of knowledge. Thirty year ago the world witnessed the arrival of the most devastating and unexplained viral infection that was initially associated with homosexual men in the developed world and later found with heterosexuals in both developed and developing world. It was a wakeup call for many people like Scientists, Doctors, politicians and those who cared to know and do something. In 1983 the virus HIV was isolated and the full epidemiology of the syndrome emerged and the world began to know more about the type of virus, geographical spread and so on. Who can get the disease and who cannot?
Looking around the world during these thirty years, I believed many work had be carried out, more people are knowledgeable but some had passed on due to lack of knowledge. Why is this virus still spreading despite of this awareness? The answer is obvious- inadequate knowledge and this is what this book is trying to point out and correct things so that people can live well through adequate knowledge, correct positive attitude and good practices of the knowledge.
Many unanswered questions were answered people are more knowledgeable than thirty year ago but things are still happening in a bizarre fashion to many who still believe HIV and AIDS is not real and some said this infection is not for them because they carefully select their partners. What a shame? The infection does not show on the face.
PART ONE
KNOWN FACTS ABOUT HIV AND AIDS
This part is to refresh our memory about what we should remember on HIV and AIDS
WE KNOW THAT:
HIV is a virus that destroys the body’s immune system.
HIV transmission can be prevented.
HIV can be passed from one person to another.
There is no cure for HIV infection, but treatment exists to help people live healthily with HIV for many years.
We have rights and responsibilities concerning HIV.
What is HIV?
Human immunodeficiency virus, or HIV, is the virus that causes AIDS. It attacks the body’s immune system. By weakening the body’s defenses against disease, HIV makes the body vulnerable to a number of potentially life-threatening infection and cancer. HIV is infectious, which means it can be transmitted from one person to another.
How is HIV transmitted?
HIV is transmitted through:
Unprotected sexual contact, primarily through unprotected vaginal or anal intercourse with someone living with HIV. Worldwide, sexual intercourse is the leading mode of HIV transmission. Oral sex is very unlikely to result in the transmission of HIV, but risk increase if the mouth or genitals have cuts and/or sores;
Exposure to infected blood. The most efficient means of HIV transmission is the introduction of HIV-infected blood into bloodstream, particularly through transfusion of infected blood. Most blood-to-blood transmission now occurs as a result of multiple use of contaminated injection equipment during injecting drug use. Use of improperly sterilized syringes and other medical equipment in health-care settings can also result in HIV transmission. The WHO required all medical institutions to take all the necessary precautions and use only new or sterilized equipment. People are unlikely to become infected this way if using facilities approved by WHO, Extra precautions should be taken, however, when using medical facilities not approved by WHO, as the WHO cannot ensure the safety of blood supplies or injection equipment obtained elsewhere. It is always a good idea to avoid direct exposure to another person’s blood – to avoid not only HIV but also hepatitis and other blood-borne infections;
Transmission from mother living with HIV to her child, during delivery, or as result of breastfeeding.
Are you sure that these are the only ways that HIV can be transmitted?
Yes. HIV is the most carefully studied virus in history. Overwhelming evidence indicates that you cannot become infected or infect others in any of the following ways:
Shaking hands, hugging or kissing
Coughing or sneezing
Coming in to contact with saliva
Using a public telephone
Visiting a hospital
Opening a door
Sharing food or sharing eating or drinking
Sharing toothbrushes
Using drinking fountain
Using toilet or showers
Using swimming pools
Being beating by a mosquito or any insect
Working, socializing or living side by side with people living with HIV
Is HIV preventable?
Yes. HIV infection is preventable. As people of a country in the UN system, we are entitled to information on HIV prevention, access to male and female condoms, and referrals to sources of counseling and testing.
If HIV infection is preventable, why is the HIV epidemic still progressing?
Changing sexual or other risk behaviors is not easy. Factor such as emotions, perceived risk, knowledge and attitudes, social influence, norms, power dynamics religion, cultural practices and socioeconomic status all influence the individual’s behavior.
What is AIDS?
If left untreated, HIV will almost always deplete the immune system, leaving the body vulnerable to one or more life-threatening diseases that normally do not affect healthy people. This stage of HIV infection is called AIDS, or acquired immunodeficiency syndrome. The more the immune system has been damaged, the greater the risk of death from opportunistic infections (infection that take advantage of weaknesses in the immune defenses).
Experts agreed on the term AIDS in the early 1980s, before the discovery of HIV, to describe the new syndrome of profound immune suppression. Today, AIDS is understood as the latter stage of a prolonged or a continuous HIV infection and disease.
Without treatment, HIV generally takes 8 to 10 years to progress to AIDS. A few weeks or months after infection a person may experience a ‘flu-like illness’ that is the person is becoming sero-converted and then feel well again. The interval between initial infection and appearance of symptoms indicating advanced HIV-related disease (AIDS) varies from person to person. However, it appears to be shorter for those persons infected through blood transmission and children.
What treatment exists for HIV infection and their impacts?
Several different types of medicines exist to treat HIV infection. These medicines attack various aspects of the process by which the virus replicates itself. Because HIV quickly mutates to become resistant to any single drugs, patients must take a combination of medicines to achieve maximum suppression of HIV.
The combination of medicines is known as antiretroviral therapy; some people use the term ARV (antiretroviral) treatment. Antiretroviral medications or drugs are used to treat children and adults infected with HIV, to prevent transmission of HIV from mother to child, and as a preventive therapy after exposure to HIV infection (also called post-exposure prophylaxis). Starting antiretroviral therapy early in the cause of HIV infection in infants and children has also led to significant positive changes in the survival of children living with HIV.
Antiretroviral therapy changes the natural course of HIV infection, significantly extending the period between initial infection and the development of symptoms. To achieve this, it is important to diagnose HIV infection before AIDS symptoms develop, in order to initial therapy at most effective point before the immune system is damaged. However, patients who start on therapy even after be diagnosed with AIDS often receive major and long-lasting health benefits.
Although antiretroviral therapy is effective is slowing the progression of HIV-related disease and can prolong one’s life to a normal life expectancy, it is not a cure, and a person may still develop AIDS one day. Antiretroviral therapy should not be disputed and needs to be taken for life. Any exception to this should be carried out in consultation with a specialized medical doctor on a case-by-case basis. In addition to treatments for HIV infection itself, therapies exist to prevent and/or treat many HIV-related opportunistic infections.
Live’, provides details information about how you can protect your health, whether or not you are living with HIV. If you are living with HIV, please note that it is helpful to become aware of the variety of existing treatment before you get treatment. Each treatment needs to be adapted to your personal situation. It is helpful for you to become educated partner with your medical doctor when discussing what kind of antiretroviral therapy would be best for you.
The global effect of antiretroviral therapy
Antiretroviral therapy generally leads to significant improvements in the health and well-being of people living with HIV. The number of people receiving antiretroviral drugs in low- and middle-income countries has increased tenfold in only five years, reaching almost four million people by the end of 2008. In addition, the number of AIDS-related deaths has started to decline, partly as a result of improved access to treatment.
The impact of antiretroviral drugs on the management of HIV has been startling. Improvements in health are significantly more marked and enduring than those that were anticipated when combination antiretroviral therapy first emerged in the mid-1990s.
The availability of antiretroviral therapy
It is important to keep in mind that antiretroviral drugs are still expensive for most people. The majority of the world’s infected individuals do not have access to medications and treatments for HIV. According to the most recent available data, from 2007, an estimated 9.7 million people living with HIV in low-and middle-income countries urgently need life-saving antiretroviral medication. Only three million of these people, however, were estimated to have access to the appropriate medicines, leaving 6.7 million without.
How do I know if I have HIV?
The only way to know if you are living with HIV is by being tested. Antibodies to HIV can be detected through a simple test that is available in most places around the world.
What happens in the body when HIV infection occurs?
HIV infects white blood cells, which are body’s immune system. A strong immune system is needed to fight off a range of infections. When a person is infected with HIV, the virus infects cells and over time, the immune system becomes progressively less able to fight off disease.
Soon after HIV infection occurs, the body’s immune system mounts an attack against the virus by means of specialized killer cells and antibodies that usually succeed in temporarily lowering the amount of virus in the blood. But HIV still remains active, continuing to infect and kill vital cells of the immune system. HIV also establishes reservoirs within the body that the body that cannot be destroyed by available overwhelming the body’s ability to fight off disease.
Is HIV infection always fatal?
HIV infection is not necessarily fatal. Today, there are treatments that can greatly slow the progression of HIV infection and allow people living with the virus to remain healthy and productive for many years. Without treatment, however, HIV infection almost invariably leads to AIDS, which almost leads to death.
I hear that HIV is not visible and that you cannot feel it either.
So how can I tell if I have HIV, if some else has it?
It is impossible to tell if someone has the virus just by looking at or talking to the person. The only way for someone to know his or her status is by getting tested 3-6 months after any possible exposure. Even the test result is negative; if there has been a recent exposure it should be repeated three month later. Today, because tests are more precise, it is possible for some tests to detect the antibodies earlier on. It is important to get tested for your own well-being and well-being of others, as well as to know the ways to prevent infection and to encourage others to do the same.
Are women more vulnerable to HIV infection than men?
Yes. Approximately half of the people living with HIV are women. The highest HIV prevalence found among women is in countries where the epidemic has become generalized; women living with HIV have mainly become infected in heterosexual relationships and often in a marriage context. A number of biological, social, cultural and economic factors contribute to women’s vulnerability to HIV.
Biological factor: the female genital tract has a greater exposed surface area than the male genital tract; therefore, women may be prone to greater risk of .infection with every exposure. Younger women are even more vulnerable to HIV infection due to immaturity of the opening of the womb.
Economic disempowerment: pressure to provide income for themselves or their families leads some women to engage in ‘transactional’ sex men who give them money, school fees or gifts in exchange for sex. In some regions this is particularly true for younger women who engage in sex with older men. Women who are economically dependent may not be able to insist on condom use.
Migrant husbands: women, especially those in rural areas, are infected by their husbands who work away from home for long periods, for example, as miners, truckers or soldiers, and who engage in unprotected sex while away. These men may become infected with HIV and, upon returning home, can transmit it to their wives.
Child marriage: it is still common in many part of the world for young girls to marry before they are 18 years old. Most often, they marry older, sexually experienced men who may already be infected with HIV and transmit it their young wives.
Violence: one in three women worldwide will be raped, beaten, coerced in to sex, or otherwise abused in her lifetime. Sexual violence increases the risk of infection as it can damage the virginal wall, allowing infected semen to come into direct contact with underlying tissue. Coerced sex can also deny women the ability to insist on condom use.
Is HIV a serious problem in the region where I live and work?
Yes, HIV is a serious problem everywhere. Despite declines in new HIV infections in some countries and regions, the AIDS epidemic is far from over and the numbers of new HIV infections are rising in many countries. In sub-Saharan Africa, the most affected region, women account for up 61% of infections and HIV remains the leading cause of death. Most of the epidemics in the Caribbean’s appear to have stabilized, while a few declined in urban areas. In Asia, HIV prevalence is highest South-East Asia, with variation in epidemic trends between countries. In the Eastern Europe, Central Asia, Middle East and North Africa regions, injecting drug use is a major means of HIV transmission. Latin America’s epidemic remains generally stable but stigma and discrimination hamper the achievement of universal access to HIV prevention, treatment, care and support. Based on the most recent available information, AIDS-related illness is the sixth most common cause of death in the world.
Is it safe for an uninfected person to work with people who are living with HIV, and vice versa?
Yes. HIV cannot be transmitted as a result of casual contact. It is perfectly safe to work with people living with HIV or with whose HIV has progress to AIDS. UN personnel policies strictly prohibit discrimination against personnel living with HIV. The united nation HIV/AIDS Personnel policy ensure a safe workplace while protecting the dignity and human rights of all personnel. The important of a fair, equitable and non-discriminatory workplace is addressed in general.
Is it safe to hire people living with HIV to work in homes or offices?
Yes. As HIV can only be transmitted through unprotected sex and blood transfusion or use of contaminated injection equipment or from mother to child, there is no reason why a person living with HIV should feel that they are unemployable in someone home. Remember that HIV cannot be transmitted through hugging, kissing, playing with your children, using a common toilet, sharing drinking or eating utensils, preparing food for your family or other household work.
UN policy is very clear that HIV should not be a factor in recruitment or determining employment anywhere. Screening for HIV is not mandatory for employment and no one living with HIV is required to disclose his or her status. The International Labour Organization (ILO) encourages this standard also for all employers worldwide. UN personnel who hire people to work in their homes should also follow the policy. The UN recommends that all personnel working in UN staff member’s home have access to prevention, as well as care and treatment, services. If your home is also a workplace please make information about HIV readily available to employees that you hire either directly or through local organizations. You can share what you household employees and encourage them to get tested and learn more about HIV.
How can I support colleagues who are living with HIV?
By treating all your colleagues, regardless of their status, as you would want to treated-with dignity, respect and professionalism.
What might we expect for the future with regards to HIV reach?
Vaccine: at present an effective HIV vaccine is not available. Despite the fact that many research projects are underway and experts are working hard to develop a vaccine for HIV, it is likely to be a long time before one is available for widespread use. While there has been major progress in learning about possible approaches to a vaccine against HIV, developing an effective vaccine presents enormous challenges.
Microbicides: also sometimes referred to as antiviral gel, microbicides are intended to protect against sexually transmitted infections, including HIV. Some product would be for vaginal sex and some for anal sex. Some product may be contraceptive, while others would not be. Some may include antiretroviral drugs, while other that is being tested does not. Different formulations such as gels, cream, films, vaginal rings or suppositories are being tested. At present, an effective microbicide is not available. It is important to support the development of microbicides in global HIV prevention research, as they represent a potential method of protection that does require a partner’s cooperation.
Pre-exposure prophylaxis (PrEP): clinical trials are currently planned or under way to look at the efficacy of pre-exposure prophylaxis, an unproven strategy in which HIV-negative people could take an antiretroviral medicine, or a combination of medicines, on a regular basis with the aim of reducing their risk of acquiring HIV. At present, an effective pre-exposure prophylaxis is not available.
In the meantime, male and female condom use, male circumcision, and other existing HIV prevention strategies offer the only feasible measures for avoiding HIV transmission. There is no cure for AIDS in sight, but if people living with HIV seek professional care and appropriate treatment, they can enjoy improved health, wealth and well-being for many years.
Protect yourself and others
MAKE HEALTHY DECISIONS
TO PROTECT YOURSELF, YOUR FAMILY AND FRIENDS, YOU SHOULD:
Prepare in advance to protect yourself from HIV
Know your HIV status by going for voluntary counseling and testing
Seek treatment at once if you a sexually transmitted infection
Avoid penetrative sex or use condom correctly and consistently every time have sex, unless you know for certain you and your partner(s) are not infected with HIV
Use only new needles and syringes
Take the necessary precautions if you are living with HIV and want to have a baby
Talk about HIV prevention with your partner(s). Children and colleagues
Isn’t HIV prevention a simple matter of avoiding exposure to the virus, especially since there are only a limited number of ways that HIV can be transmitted?
It is true that HIV is not particularly easy to transmit and that infection can be averted. But the primary mode of HIV transmission-sexual intercourse-involves intimate and established personnel behaviors of that are often difficult to change and maintain in the long run.
Effective prevention relies on several proven principles.
Accurate Information. Avoiding acquiring the virus and avoiding transmitting it to others requires that all of us know how HIV is –and is not-transmitted. This book, along with many more information provides the basic fact about HIV, as well as information about sources for more detailed information. In addition, you are required to participate in a learning session on HIV (if you have not already) in which you have the opportunity to get answers to any questions you might have.
Personal Plan. If you are not living with HIV, it is useful to think in advance about ways you might come in to contact with the virus and you can plan to avoid exposure to it. If you are living with HIV, your personal protection plans as to how to protect yourself and protect others, as a new infection can cause additional health issues you should avoid. Because everyone is unique, you need to tailor your prevention plan to personal circumstances. For some of us, especially women in heterosexual relationship, our prevention plan may need to take account of interpersonal power dynamics that can some time make it difficult for us to protect ourselves. As this chapter explains, we all have the right to essential means of prevention, including access to information, male and female condoms, first-aid kits, new syringes and sterilized equipment for medical care, and safe blood supplies.
Communication. ”IT TAKES TWO TO TANGLE” Because it takes at least two people for HIV transmission to occur sexually, it is important that we all talk about HIV prevention-with our partner(s), our families, our colleagues and our health-care providers. All of us in any form of employment should be ready to discuss HIV prevention and provide referrals to community-based HIV- related counseling.
Reinforcement. HIV prevention involves more than just information. Because changing behaviors that increase the risk of HIV transmission and maintaining those positive changes over time can some time be difficult, we must be motivated to used effective HIV prevention methods and develop the skills needed to remain safe. The emergence in recent years of effective treatments for HIV has causes some people to become complacent about the risk of transmission. Because HIV prevention is life-long undertaking, the WHO, United Nations HIV/AIDS Personnel Policy, ALL NATIONAL AND INTERNATIONAL HIV/AIDS AGENCIES SHOULD CONTINUE TO provide for an ongoing HIV prevention efforts that allow prevention message to be reinforced over time.
SEXUAL TRANSMISSION
How can I avoid sexual transmission of HIV?
Abstain from sex: the safest way to avoid being exposed to HIV infection sexually is to abstain from having penetrative sex. This can mean delaying sexual initiation or, once sexually active, refraining from having penetrative sex.
Be faithful with another HIV-negative partner: some of us may be in relationship where we can discuss the need either to be mutually faithful (if both partner know they are HIV –negative) or to practice safer sex within or outside of the relationship (avoiding penetrative sex, for example, a significant proportion of women living with HIV were given by their husbands/partners, whom they trusted and to whom they were sexually faithful..
Engage only in non –penetrative sex: another prevention approach is engage only in non-penetrative sex. Oral sex present an extremely low risk of transmission, although the is likely to be greater if ejaculate is taken into the mouth during penile oral sex if there are genital sores on the partner receiving oral sex, and if the mouth has cut and/or sores.
CONDOM USE: How effective are condoms at preventing HIV transmission?
When correctly and consistently used, the male latex condom and female condom are the most effective available tools to reduce the sexual transmission of HIV and other sexually transmitted infection for people having sexual intercourse. Condoms are a very safe means of contraception.
Condoms are most likely to fail when they are not used as directed. Opening a condom packet with your teeth, a knife or scissors, for example, can cause the condom to puncture or tear. It is important to use condom from the beginning of a sexual act, rather than immediately before ejaculation, to prevent exposure to potentially infectious pre-ejaculate or vaginal fluids. The more often you use condoms, the easier it will be and the more comfortable it will feel for you and your partner. Because sexual intercourse is often unplanned, it is good idea always have a condom with you.
Condoms that are out of date, poorly manufactured, or in appropriately stored at high temperature especially susceptible to breakage. Oil-based produce (such as hand lotion or petroleum jelly) will damage male latex condom, so use only water-based lubricants with latex a condom. Condoms do occasionally slip or break.
If you have a steady partner, discuss how you as a couple intend to avoid the risk of HIV transmission. Ideally, a couple’s decision to use a male or female condom results from a process of negotiation. The couple discusses the benefit of using a condom, addresses any concerns or resistance, and agrees on mutually satisfactory approach. Sometimes one member of couple may lack the power to negotiate condom use. Many women, for example, report having difficulty asking their husbands or partners to use a condom. Therefore, it is important that men advocate for consistent condom use among their (male) peers, become proactive model for their sons, nephews, etc, and advocate for condom use in their communities. It is important that we act accordingly when it comes to our own lives and those we come into contact with professionally and socially.
How to use a male condom
First, always check the expiry date on the package. Don’t use expired condom.
Handle condoms gently. Open the package carefully, but avoid scissors, a knife or teeth.
Remove the condom from the package, being particularly careful if you are wearing rings and / or have long or jagged fingernails so as not to rip the condom.
Check that you have the condom with the correct side facing up, so that it can be easily rolled down. If you accidentally put the condom on upside down, you need to throw it away and used a new one to avoid transferring any pre-ejaculatory fluid (semen) to your partner.
Pinch the air from the tip of the condom (this makes room for the semen and is key to avoiding breakage) and place the condom on the end of the penis. Some people like to put one or two drops of water-based lubricant inside the tip of the condom to increase sensitivity.
Carefully roll the condom down over the ERECT penis until it is completely unrolled and / or the entire penis is covered. Ensure that there is no air in condom (the tip of the condom should be ‘slack’ or ‘empty- looking’). If additional lubricant is desired, lubricate the outside of the condom using water –based lubricant.
Put on the condom before any penile contact is made with vagina or anus. (As far as infection is concerned, any unprotected penetration increases risk.)
Wear the condom from the beginning of penetration through the climax to withdrawal after sexual relations, while the penis is still hard.
Once the sexual act has ended, remove the condom by holding the base on the condom and sliding it off, being very careful not to allow semen leak onto your hands.
Wrap the used condom and depose of it in an appropriate manner – for example, in a rubbish bin. Never flush a condom down the toilet, as it will block the plumbing system! Think of the 3 Bs’: Bin, Burn or Bury.
Always use one condom per sexual act.
Is there a female condom?
Yes. Whereas the male condom placed on the penis, the female condom is positioned inside the vagina. The female condom is a loose –fitting sheath, made of either nitrile or polyurethane, with a flexible ring at either end. The inner ring at the closed end of the female condom is positioned inside vagina while the out ring at open end of the condom covers the area around the opening of the vagina. The female condom can be inserted up to the eight hours before sex, including immediately before sex. Bout oil-based and water-based lubricant can be used with the female condom.
The most commonly available female condom is the FC2 made of nitrile polymer, synthetic latex. FC2 has the same physical design, specifications, safety and efficacy profile as the earlier female condom and was developed to make female condom more available, as nitrile polymer is less expensive than polyurethane. The nitrile polymer is also more comfortable material and more users – friendly. The female condom will not be damaged by high temperature or humidity, while the male condom can be. The use of female condom is idea for those allergic to latex. Note that the female condom is intended for vagina intercourse and as not been clinically tested for use in anal intercourse.
Use of the female condom is increasing, with studies showing that it is acceptable to both male and female partners. Like the male condom, the female condoms prevent HIV transmission by helping avoid exposure to semen or vagina fluids. The female condom is more expensive than the male condom and is not as readily available for purchase in many parts of the world, although UN system organizations are encouraged to make them available to personnel at low or cost.
How to use a female condom
Always check the expiry date on the packet; if the date marked has passed, the condom should not be used. The female condom comes pre-lubricated with a non spermicidal silicone-based lubricant. While the female condom is still in the unopened packet, spread the lubrication around with your finger by squeezing or rubbing the packet to ensure even coverage. Tear open the packet carefully with clean hands, and avoid the use of sharp object.
The female condom (pictured) has a ring each end. Pinch the inner ring (at the closed end of the condom) with your thumb and middle finger so that it becomes long and narrow in order for you to insert it, a bit like one dose with a diaphragm.
You should find a comfortable position for inserting, such as squatting or sitting with one leg raised or lying down. Next insert the female condom into the vaginal opening should be relaxed.
Then, Place your finger inside the female condom and push the inner ring as far as it will go up into the vaginal, ensuring that the pouch does not get twisted during insertion. The inner ring should be at the cervix, and the outer ring (at the open end of the condom) should remain on the outside of the vaginal, covering part of the external genitalia. The female condom will line the inside of the vaginal, whose natural sharp, along with the inner ring which sits against the cervix when inserted properly, holds the condom in place.
It is now safe to have penetrative sex. Note that the man’s penis need no to be fully erect for penetration with used of female condom. Be sure that the penis goes inside the female condom in order that the surface of the genitals of the male and female are protected. You are not protected if the penis goes between the outside of the female condom and the wall of vagina.
After sexual intercourse, squeeze and twist the outer ring gently pull the condom out to remove (you don’t have to remove it immediately after the act).