Outline For HIV / AIDS

Case in point: Between 1981 and June 30, 1995 there were 476,899 adult, adolescent and pediatric cases of AIDS reported in the United States. In Florida, between 1981 and August 31, 1995, there were 49,860 reported cases. Occasionally, adult and adolescent cases are reported as one category, and pediatric cases as another. Sometimes, the number of reported cases represents only the preceding full calendar year. Occasionally, many will represent year-to-date data. Case ratios are usually reported as the number of cases per 100,000 people. Case ratios are used to proportionately compare populations with a lot of reported cases against populations with few reported cases. For example: there were 14,550 cumulative cases of AIDS reported in Dade county (Miami) from 1981 through May 31, 1995. This is a case rate of 962.4 AIDS cases per 100,000 people. There were 551 cumulative cases of AIDS reported in Escambia County (Pensacola) from 1981 through May 31, 1995, for a case rate of 238.7 AIDS cases per 100,000 people. And, there were 9 cases of AIDS reported in Washington County, Florida, from 1981 through May 31, 1995, for a case rate of 67.1 AIDS cases per 100,000 people. This example presents a comparison of case ratios between a large, medium, and small population area.

The likelihood of acquiring HIV from a blood transfusion in the U.S. is currently remote. At the beginning of the epidemic, some people contracted the virus through infected blood in the nation’s blood supply. Subsequently, safeguards were implemented and the risk of getting an HIV contaminated transfusion has diminished significantly, being now estimated at two in one million units of blood. As time has gone on, testing procedures have improved notably. Nonetheless, testing cannot entirely remove the chance of infected blood. If someone donates blood or plasma soon after they are infected, current tests may not always detect the existence of the virus.

There is no vaccine for HIV, nor a cure for AIDS. However, there are several medications are now available to help treat the symptoms of AIDS and permit patients to live more comfortably. None of these medications can exclude a person from becoming infected with HIV, nor can they cure AIDS. On the other hand, people can take an active role in the prevention of HIV infection by understanding the facts and following the guidelines.

You can aid in the battle against HIV and AIDS by becoming a volunteer. Volunteers are always needed, to answer AIDS hotlines and help educate others about HIV and AIDS. They can assist people living with AIDS by shopping for them or bringing meals to their homes. They can help generate funds to combat this epidemic. Contact your local AIDS service organization or the Red Cross chapter to find out how you can help. People with HIV and AIDS need love and compassion. Most people who are living with AIDS are often sick and under a lot of stress, and would benefit from support and care.

Be a role model for others. Show your support and caring for people who are infected with HIV and for those who are living with AIDS. Keep in mind that you cannot get AIDS from being a friend.

1) The AIDS epidemic has already resulted in the deaths of approximately 11.7 million people worldwide and will ultimately cause the deaths of the estimated 30.6 million men, women, and children around the globe still living with this disease. Roughly 6 million people were newly infected with HIV in 1997 (nearly 16,000 people each day).

2) AIDS (acquired immunodeficiency syndrome) results from the late stage of infection with HIV (human immunodeficiency virus). The onset of AIDS can take up to 10 or more years, and new drug therapies can delay the progression of the disease into AIDS even longer. A person infected with HIV may look and feel healthy for many years, but can still transmit the virus to others, which is why testing is so important.

3) HIV is transmitted through the exchange of any HIV infected body fluids. Transfer may occur during all stages of the disease. The HIV virus is found in the following fluids: blood, semen (and pre-ejaculated fluid), vaginal secretions, and breast milk. HIV does not survive long outside the body and therefore can only be transmitted when any of the above body fluids from an infected individual enters an uninfected individual.

4) HIV most frequently is transmitted sexually. The only way you can be completely sure to prevent the sexual transmission of HIV is by abstaining from all sexual contact. How can you have sex and still significantly reduce your risk of contracting HIV? By correctly using a latex condom from start to finish, every time you have vaginal or anal intercourse, and with each act of oral sex on a man. Be aware that HIV can be transmitted through oral sex. Use a dental dam or a condom cut open while performing each act of oral sex with a woman. Bear in mind that all semen, even pre-ejaculated fluid, can carry the HIV virus. Engage in safer sex practices that involve no penetration, (such as kissing, massaging, hugging, touching, body rubbing, and masturbation).

5) It is important to know that all blood, organs, and tissues used during transfusions or surgeries have been tested for HIV. Medical professionals immediately and carefully dispose of all contaminated products. All medical and surgical instruments, including those used for tattooing and body piercing, must be completely sterilized or discarded properly after each use in order to prevent HIV transmission. For information on HIV/AIDS in the work place or referrals to organizations that handle the proper disposal of medical instruments call the CDC National HIV/AIDS Hotline at 1-800-342-AIDS.

6) Anonymous HIV testing is the only form of HIV testing that is not name based. If you receive a test from an anonymous testing center, no one but you will know the results of your test. Currently, 40 states plus the District of Columbia and Puerto Rico offer anonymous testing.

7) You do not get HIV from donating blood, from mosquito bites or bites from other bugs, from the urine, sweat, or sneezes of an infected person, nor from public restrooms, saunas, showers or pools. You also do not get HIV from being friends with a person who has HIV/AIDS, touching, hugging, or dry kissing a person with HIV, sharing towels or clothing, or sharing eating utensils.

8) Young adults (under age 25) are quickly becoming the most at risk age group, now accounting for an estimated 50% of all new HIV infections in the United States. Teenagers and young people here and around the world need to take an active role in changing the course of the HIV/AIDS epidemic by adjusting their behaviors and attitudes toward the disease.

9) Discriminating against people who are infected with HIV/AIDS, or anyone thought to be at risk of infection, violates individual human rights and endangers public health. Every person infected with and affected by HIV/AIDS deserves compassion and support, regardless of the circumstances surrounding their infection. Education is crucial in getting this message out.

10) You can help stop the spread of HIV by getting involved in community efforts. World AIDS Day is a special event held every year to focus attention on this urgent challenge that affects all of us. It is marked around the world by thousands of different events designed to increase awareness and to express compassion and solidarity.

You can learn more facts about HIV and AIDS by ordering the American Red Cross HIV/AIDS Facts Book.

Barrier protection, personal cleanliness, and proper disinfection are the three "precautions" that make up the meaning of "Universal Precautions." All three methods must be used to be completely effective

Barrier Protection - Puts a shield between you and your clients.

Personal Cleanliness - Includes washing your hands, keeping your work area clean, etc.

Disinfection – Refers to removing germs from your tools, equipment, and work area.

Hands should be washed before and after client contact, and washed immediately if hands become contaminated with blood or other body fluids. Hands should also be washed after removing gloves.

Gloves should be worn whenever there is a possibility of contact with body fluids.

Masks should be worn whenever there is a possibility of splashing or splattering of body fluids.

Both clients and beauty professionals should wear smocks if soiling of clothing or splashing on exposed skin is likely.

To minimize the risks for exchange of body fluids during resuscitation procedures, pocket masks or mechanical ventilation devices should be readily available where these procedures are likely to be needed.

Spills of blood or blood-contaminated body fluids should be cleaned up using a solution of household bleach and water in a 1 to 100 parts solution for smooth surfaces, and 1 to 10 parts solution for porous surfaces. Diluted bleach solutions should be no more than 24 hours old.

Beauty professionals, who have open lesions, dermatitis, or other skin irritations, should not participate in direct client contact and services and should never handle contaminated equipment or supplies, such as towels, smocks, capes, or even used cotton strips.

Sharp objects such as shears, razors, nippers, and needles pose the greatest risk for exposure. Contaminated needles and other disposable objects should be discarded into a puncture-resistant "sharps" container designed for this purpose. Contaminated reusable objects, such as shears, etc., should be disinfected by using 70% alcohol to wipe implements with a cutting edge. Another approved method of disinfection is to clean, and then soak in a 1 to 1000 parts solution of an EPA registered quaternary ammonium compound (Quats) for 10 minutes. The EPA has also listed "Lysol" as a killer of HIV. It can be used right out of the bottle to wipe your instruments. Chlorine bleach is very inexpensive, easy to use, and also effective in killing most germs.

Tuberculosis infection is determined by a significant reaction to the Mantoux skin test, even when there are no symptoms of tuberculosis and no TB organisms are found in the sputum (the expectorated material that is coughed up from the respiratory tree). The disease itself is characterized by the appearance of symptoms, the presence of organisms in the sputum, as well as a significant reaction to a Mantoux skin test.

In order to spread the TB germs, a person must have TB disease. Having TB infection is not enough to spread the germ. Tuberculosis may last for a lifetime as an infection, never developing into the disease. The symptoms of TB disease include a low-grade fever, night sweats, fatigue, weight loss, and a persistent cough. Some people may not have obvious symptoms.

Most people infected with the germ that causes TB never develop active TB. If active TB does develop, it can occur anytime from 2 months after infection to many years later. The risk of active disease lessens as time passes. A person with TB disease may remain contagious until he/she has been on appropriate treatment for several weeks. However, a person with TB infection, but not disease, cannot spread the infection to others, since there are no TB germs in the sputum.

Because HIV infection weakens the immune system, someone with TB infection and HIV infection has a very high risk of getting TB disease. HIV infection, when it occurs in tandem with TB infection, without treatment, can work together to shorten the life of an infected person. Other medical risk factors, which increase the chance of developing TB disease, include diabetes mellitus, prolonged corticosteroid therapy, Immuno-suppressive therapy, cancer, silicosis, as well as being 10 percent or more below ideal body weight.

If TB infection has occurred, treatment should be sought. It should be noted that TB is one of the few diseases related to HIV infection that is easily prevented and cured with medication. People that are immune-compromised are currently being treated with drug combinations containing three and four different drugs simultaneously. Conversely, in addition to spreading the disease to others, an untreated person will become severely ill or die.

The most important way to stop the spread of tuberculosis is to cover the mouth and nose when coughing, and to take all the TB medication exactly as prescribed by the physician. Some strains of TB have the ability to grow and multiply even in the presence of certain drugs that would normally kill them. People who have been exposed to a case of drug-resistant TB (MDR-TB), especially if they are immune-compromised, are at the risk for developing MDR-TB. Other people who may develop drug-resistant tuberculosis include TB patients who have failed to take anti-tuberculosis medications as prescribed, TB patients who have been prescribed an ineffective treatment plan, and people who have been treated previously for TB. For patients with disease due to drug-resistant organisms, expert consultation from a specialist in treating drug-resistant TB should be obtained. Patients with drug-resistant disease should be treated with a minimum of two or three drugs to which their organisms are susceptible.

It is currently unknown whether preventive therapy can effectively prevent the development of active TB disease in people who are infected with MDR-TB strains. Nevertheless, recommendations concerning preventive therapy for people who have been infected with MDR-TB are being developed by the Centers for Disease Control (CDC). The most important ways to stop the spread of MDR-TB remain the same¾ to cover the mouth and nose when coughing, and to seek adequate treatment. It is also essential that health officials directly oversee the administration of TB medications to people who, due to mental illness or incapacity, are unable to follow the prescribed regimens themselves.

Usually, the first evidence of an infestation is the itching or scratching in the area of the body where the lice feed. Scratching at the back of the head or around the ears should lead to an examination for head louse eggs (nits) on the hair. Itching around the genital area should lead to an examination for crab lice or their eggs. Scratching can be sufficiently intense to result in secondary bacterial infection in these areas. It may take as long as 2 to 3 weeks or longer for a person to notice the intense itching associated with this infestation. Pediculosis can be spread as long as lice or eggs remain alive on the infested person or clothing.

Medicated shampoos or cream rinses containing lindane or pyrethrin are used to kill lice. Products containing pyrethrin are available over-the-counter, but those containing lindane are available only through a physician's prescription. Lindane is not recommended for infants, young children, and pregnant or lactating women. Re-treatment after 7 to 10 days is recommended to assure that no eggs have survived. Nit combs are available to help remove nits from hair. Dose and duration of shampoo treatment should be followed according to label instructions.

Physical contact with infested individuals and their belongings, especially clothing, headgear, combs, and bedding, should be avoided. Health education on the life history of lice, proper treatment, and the importance of laundering clothing and bedding in hot water (140°F for 20 minutes), or dry cleaning to destroy lice and eggs, is extremely valuable. In addition, regular inspection of children, especially of children in schools, institutions, and summer camps, is crucial in detecting infestation.

Ringworm of the scalp usually begins as a small pimple, which becomes larger in size, leaving scaly patches of temporary baldness. Infected hairs become brittle and break off easily. Occasionally, yellowish cup-like, crusty areas are seen. With ringworm of the nails, the affected nails become thicker, discolored, and brittle, or they will become chalky and disintegrate. Ringworm of the body appears as flat, spreading, ring-shaped areas. The edge is reddish and may be both dry and scaly, or moist and crusted. As it spreads, the center area clears and appears normal. Ringworm of the foot appears as a scaling or cracking of the skin, especially between the toes.

The incubation period is unknown for most of these agents, however, ringworm of the scalp is usually seen 10 to 14 days after contact, and ringworm of the body is seen 4 to 10 days after initial contact. Since so many species of fungus can cause ringworm, infection with one species will not make a person immune to future infections.

Your doctor may prescribe fungicidal tablets to swallow, or powders that can be applied directly to the affected areas. Griseofulvin is an oral medication, commonly prescribed for treatment of fungal infections of the skin, scalp, and nails where topical therapy has failed or is considered inappropriate.

Towels, hats, and clothing of the infected individual should not be shared with others. Young children who are infected should minimize close contact with other children until they are effectively treated. When multiple cases occur, seek advice from your local health department.

The first sign of syphilis is generally one or more painless sores that become visible at the site of initial contact. It might be accompanied by swollen glands, which develop within a week after the appearance of the first sore. The sore will persist for 1 to 5 weeks and will vanish by itself, even if no medical care is obtained. Roughly 6 weeks after the sore first appears, a person will enter the second stage of the disease. The most likely symptom during this stage is a rash, which might appear on any part of the body: trunk, arms, legs, palms, soles, etc. Other, more generalized symptoms include fatigue, swollen glands, fever, headaches, loss of appetite, and sore throat. These symptoms will last 2 to 6 weeks and will disappear with or without medical care. After the second stage of the disease, the only way syphilis can be detected is through a blood test, although secondary symptoms might sporadically occur again. Persons having syphilis for over four years may suffer from illness in the skin, bones, central nervous system, and heart, and may experience a reduced life expectancy, impaired health, and limited occupational efficiency.

How soon do symptoms appear? Symptoms can emerge from 10 to 90 days after an individual becomes infected, though usually within 3 to 4 weeks. Symptoms often go unnoticed or are thought to be minor abrasions or heat rash, thus treatment is not sought.

When and for how long is a person able to spread syphilis? Syphilis is considered to be contagious for a duration of up to 2 years, perhaps more. The extent of communicability depends on the existence of infectious lesions (sores) which may or may not be visible. There is no natural immunity to syphilis and prior infection lends no defense to the patient. Syphilis is treated with penicillin or tetracycline. The amount of medication a patient must take and treatment depends on the stage of syphilis. Expectant women with a history of allergic reaction to penicillin should undergo penicillin desensitization, followed by appropriate penicillin therapy.

Untreated syphilis can lead to destruction of soft tissue and bone, heart failure, insanity, blindness, and a variety of other conditions, which may be mild to incapacitating. More important, a pregnant woman with untreated syphilis will transmit the disease to her unborn child, which may result in death or deformity of the child. Physicians and hospitals are required to test pregnant women for syphilis at prenatal visits. Tests of newborns or their mothers are required at the time of delivery. There are a number of ways to prevent the spread of syphilis:

• Limit your number of sex partners.
• Use a condom.
• Carefully wash genitals after sexual relations.
• If you think you are infected, avoid any sexual contact and visit your local STD clinic, a hospital, or your doctor.
• Notify all sexual contacts immediately so they can obtain examination and treatment.
• All pregnant women should receive at least one prenatal blood test for syphilis.

The Centers for Disease Control/ www.cdc.gov

Pub Med./ www.ncbi.nlm.nih.gov/PubMed/

Calgary Regional Health Authority
http://www.crha-health.ab.ca/clin/sac/glossary.htm