HIV/AIDS Prevention Strategies: Informing the Public and Identifying Priorities

Social Implications of Medical Issues Human Immunodeficiency Virus Infection and Its Deadly Effects

Over the past few decades Human immunodeficiency virus (HIV) infection & Acquired immunodeficiency syndrome (AIDS) prevention strategies has focused on helping high risk individuals including individuals uninfected with HIV. The responsibility of National programs is to inform the public regarding prevention strategies, identify priorities, plan, and implement disease prevention strategies. It’s common knowledge all over the world that HIV infection is the leading cause of death. “Human immunodeficiency virus HIV and AIDS remain the leading causes of illness and death in the United States. As of December 2004, an estimated 944,306 persons had received a diagnosis of AIDS, and of these 529,113 (56%) had died” (Center for Disease Control, 2010). Approximately 40,000 new cases of HIV infection occur each year and 40 million people worldwide are now living with HIV” (Falvo, 2010, pg. 318).

Everyone knows, or should be aware that there’s no way to restore their damaged immune system, and no cure for HIV, nor for AIDS. Advances in medical systems today have shown improved life expectancy. “Since 1995, the number of deaths from AIDS in the United States has declined so significantly that HIV/AIDS is no longer treated as a terminal illness but rather as a chronic condition to be managed” (Falvo, 2010, pg. 18). “A virus is an infectious organism that cannot grow or reproduce outside living cells. To survive, it must enter a living cell and use the reproductive capacity of that cell for its own replication. Consequently, when a virus enters a cell, it instructs the cell to reproduce the virus” (Falvo, 2010, pg. 313). Normally the body recognizes these as foreign, this is how a healthy immune system is suppose to work, as I remember from anatomy and physiology, then will destroy the foreign cells.

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Some will remain dormant, sometimes for long periods of time, and without causing problems, but still will remain in our body with other cells and can replicate at any time. “HIV infection is caused by a retrovirus called HIV. A retrovirus uses a complicated process called reverse transcription to reproduce itself. This process uses a viral enzyme called reverse transcriptase to integrate the virus’s genetic material into the other cells. HIV essentially takes over these cells—primarily the CD4 cells to produce more HIV.

They multiply extremely rapidly and some errors caused by this rapid generation of ells are not corrected, so there are constant mutations of the virus. Some of the cells containing the virus burst, releasing HIV directly into the blood stream. Consequently, there can be both infected cells and virus in the blood traveling to other sites” (Falvo, 2010, pg. 313). This rapid generation of cells explain why some patients who may have been somewhat stable, then they rapidly deteriorate or their medications do not seem to work anymore.

The symptoms of HIV and AIDS vary depending on the phase of the infection. “Early infection—when first infected with HIV, you may have no signs or symptoms at all, although it’s more common to develop a brief flu-like illness two to four weeks after becoming infected. Signs and symptoms may include:

• Fever
• Headache
• Sore throat
• Swollen lymph glands
• Rash

Even if you don’t have symptoms, you’re still able to transmit the virus to others. Once the virus enters your body, your immune system also comes under attack.

The virus multiplies in your lymph nodes and slowly begins to destroy your helper T cells (CD4 lymphocytes) ---the white blood cells that coordinate your entire immune system” (Mayo clinic, 2010). In my opinion, this phase is when most HIV is transmitted, sexually people don’t know they have it, they are engaging in unprotected sex and it’s just too late. This among others is a priority needed regarding informing public awareness. “Later infection—you may remain symptom-free for eight or nine years or more.

As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic symptoms such as:

• Swollen lymph nodes-often one of the first signs of HIV infection
• Diarrhea
• Weight loss
• Fever
• Cough & Shortness of Breath

This phase is scary in itself; it could be a multitude of conditions, an individual wouldn’t know, depending on their lifestyle, probably have a clue that they have aides. I do not think any of our physicians would guess HIV infection either.

Thinking back, I have taken care of a few HIV patients, and if I didn’t already know they had the infection, I don’t think I could have guessed it! But they do have a dark circles around their eyes, deathly look, and very pale. A number of the signs and symptoms are just what you would guess for the flu, or respiratory infection. Just think for so many years, they are carrying the virus, and not knowing! “During the last phase of HIV—which occurs ten or more years after the initial infection, more serious symptoms begin to appear, infection may then meet the official definition of AIDS.

In 1993 the CDC redefined AIDS to mean the presence of HIV infection as shown by a positive HIV antibody test plus at least one of the following:

• The development of an opportunistic infection-an infection that occurs when your immune system is impaired. Such as Pneumocystis carinii pneumonia (PCP).

By the time AIDS develops your immune system has been severely damaged, making you susceptible to opportunistic infections. The signs and symptoms of some of these infections may include:

1. Soaking night sweats Shaking chills or fever higher than 100 F for several weeks
2. Dry cough and Shortness of Breath
3. Chronic diarrhea, Headaches
4. Persistent white spots or unusual lesions on your tongue or in your mouth
5. Blurred or distorted vision,
6. Weight loss

You may also begin to experience signs and symptoms of later stages HIV infection itself, such as:

• Persistent, unexplained fatigue
• Soaking night sweats
• Shaking chills or fever higher than 100F for several weeks
• Chronic diarrhea, persistent headaches

Everyone should get tested especially if they are engaging in high risk behavior, like IV drug use, unprotected sex. Every community should also make their people knowledgeable about services available to them. High-risk individuals also need to know these test are private and not released to anyone else, including the federal government, employers, insurance companies and family members, unless of course the individual gives permission or consent to do so as stated by the Mayo Clinic. There are several ways to become infected with HIV:

1. Sexual Transmission: Vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body.
2. Infected blood: Since 1985, American hospitals and blood banks have screened the blood supply for HIV antibodies.
3. Needle sharing: Needles and syringes contaminated with infected blood. Sharing intravenous drug paraphernalia puts individuals at high risk
4. Accidental Needle sticks: HIV-positive people and health care workers through needle sticks are low. Experts put the risk at far less than 1%.
5. Mother to child: Each year nearly 600,000 infants are infected with HIV, either during pregnancy or delivery or through breastfeeding. If women receive treatment during pregnancy, the risk to their babies is significantly reduced. “In the U. S. most pregnant women are prescreened for HIV, and antiviral drugs are given. Not so in developing nations, where women seldom know there status, and treatment is limited or nonexistent. When medications aren’t available, Caesarean section is recommended instead of vaginal delivery. Other options, such as vaginal disinfection, haven’t proven effective” (Mayo clinic, 2010).

Other sources of transmission can be sexual devices that are not washed or covered with a condom. The virus also can be present in vaginal tears or the rectum, which places the person at greater risk of developing HIV. Needle users also should be informed that some communities have a needle exchange program where they can trade used needles and syringes for new ones. Most individuals diagnosed with HIV/AIDS use a test to predict their prognosis called viral load. This measures the amount of virus in the blood, of course the lower the load the better their prognosis. The Centers for Disease Control and Prevention (CDC) encourages adolescents and adults ages 13 to 64 as a part of their routine medical care for these ages. Yearly testing should be done. Several tests can be done, including ELISA, and Western Blot tests. ELISA looks for antibodies to the virus in a sample of your blood. If the test is positive, meaning you have the antibodies to HIV, they would repeat the test, and then do the western blot test, which checks for HIV proteins, combining the two tests confirms the diagnosis” (Mayo clinic, 2010).

There are home tests in which you mail in a drop of your blood, and call a toll free number to receive the results in three to seven business days. This test is marketed by Home Access Health, is as accurate as a clinical test, and if positive, they are all retested. We all know, there is no cure for HIV, nor for AIDS, which was first identified sometime in the 80’s. Since that time a number of drugs have been developed to treat both HIV, and AIDS. The other problem, and a big one, with this condition, is the secondary infections that come along with HIV/AIDS. According to current guidelines, treatment should focus on achieving the maximum suppression of symptoms for as long as possible. This aggressive approach is known as highly active anti-retroviral therapy (HAART). The aim of HAART is to reduce the amount of virus in your blood to very low or even nondetectable levels, although this doesn’t mean the virus is gone. This is usually accomplished by three or more drugs. The first anti-retroviral drugs developed: Nucleoside analogue reverse transcriptase inhibitors (NRTI’s).

They inhibit the replication of the HIV enzyme called reverse transcriptase. They include zidovudine (Retrovir), Iamivudine (Epivir), didanosine (Videx). A newer drug emtricitabine (Emtriva), which must be used in combination with at least two other AIDS medications, treats both HIV and hepatitis B” (Mayo clinic, 2010). Treatment should be also aimed at quality of life in my opinion, as most of these drugs cause a number of side effects, including the most common nausea, and diarrhea. Another drug, the Protease inhibitor, which interrupts HIV replication at a later stage in the life cycle by interfering with an enzyme known as HIV protease. It causes HIV particles in your body to become structurally disorganized and noninfectious. Protease inhibitors are usually prescribed with other medications to help avoid drug resistance. “A clinical trial with a Chemokine co-receptor inhibitors (CCR5 antagonists) make up a new class of drugs used to treat a type of HIV infection called CCR5-tropic HIV-1.

The only drug in this class—maraviroc (Selzentry) was used in this trial , approximately twice as many people with CCR5-tropic HIV-1 infection who received maraviroc had undetectable viral loads after 24 weeks as did those who received more standard therapy in the control groups. The side effects of maraviroc may include liver and cardiovascular problems, as well as cough, fever, upper respiratory infections, rash and abdominal pain. “The President’s Emergency Plan for AIDS Relief (PEPFAR) is the most recent international social program instituted by the U. S. Government to combat HIV/AIDS.

Since its inception in 2003, this foreign policy initiative has dedicated $63 billion for HIV/AIDS prevention and treatment in foreign countries. Despite PEPFAR’s many accomplishments, it continues to promote controversial prevention strategies” (Barney, Buckingham, Friedrich, Johnson, Robinson, Sar, 2010, p. 9). The most important thing to remember, and to be able to implement is to get individuals, and doctors to coordinate HIV testing into routine medical care. The CDC has initiated several strategies for prevention:

Strategy 1: Incorporate HIV Testing as a Routine Part of Care in Traditional Medical Settings

CDC will issue recommendations strongly encouraging all health care providers to include HIV testing, when indicated, as part of routine medical care, like other routine medical tests by:

Promoting removal of real and perceived barriers to routine testing, including “de-coupling” HIV tests in the medical setting from extensive, pre-test prevention counseling. In some jurisdictions, statutory requirements, e. g. for pretest counseling, can serve as barriers to testing. Working with professional medical associations and others to promote adoption of the recommendations. CDC will work with public and private payors to promote appropriate reimbursement incentives.

Strategy 2: Implement New Models for Diagnosing HIV Infections Outside Medical Settings

1. Encouraging the use of HIV rapid test—Some persons do not have access to traditional medical settings
2. Funding pilot projects in 2003, aimed at identifying the most effective models for HIV diagnosis and referral for medical and preventive care which CDC grantees can employ outside traditional medical settings

Strategy 3: Prevent New Infections by Working with People Diagnosed with HIV and their partners

CDC will promote preventive and treatment services within and outside traditional settings by:

1. Working with HRSA to reach those who have been diagnosed with HIV but who are not receiving treatment and care
2. Conducting demonstration projects through health departments to provide prevention case management and counseling to people living with HIV.
3. Standardizing procedures for prevention interventions and evaluation activities to ensure that such measures are appropriate and effective.
4. Ensuring that requirements related to partner notification in grant guidelines are fully met. Piloting new approaches to partner notification, including rapid HIV testing for partners and using peers to conduct appropriate partner notification, prevention counseling, and referral.

Strategy 4: Further Decrease Mother-to-Child HIV Transmission

1. Treatment of pregnant women and their infants can substantially reduce the number of babies born with HIV infection.
2. Promote screening of every pregnant woman for HIV, using the “opt-out” approach. Make prenatal HIV screening a routine part of medical care.
3. Promote screening of newborns whose mothers HIV status is not known (Center for Disease Control, 2010).

Historically, HIV and AIDS have been treated differently from other diseases or conditions. Since the last decade or so, it has changed, as far as how it is viewed medically. No longer is AIDS viewed as a deadly condition, rather it’s more looked at as a chronic, long term condition, that is treated like other diseases, we treat the symptoms, and the secondary infections. The problem with AIDS/HIV is the public doesn’t have the knowledge that the medical community has, and will probably never understand, or believe the real ways of contracting the infection. We as health care professionals need to continue to inform the public regarding prevention, and encourage more public awareness of the need to be tested before it is too late.

References:

1. Barney, R. , Buckingham, S. , Friedrich, J. , Johnson, L. , Robinson, M. , Sar. , B. (2010, Mar). The President’s Emergency Plan for AIDS Relief (PEPFAR): A Social Work Ethical Analysis and Recommendations. Journal of Sociology & Social Welfare. 37(1), 9-22.
2. Retrieved from Ebscohost database. Bashook, P. , Linsk, N. , Jacob, B. , Aguado, P. (2010, Feb). Outcomes of Aids Education And Training Center HIV/Aids Skill-Building Workshops on Provider Practices. Aids Education and Prevention. 22 (1), 49. Retrieved from ProQuest database. Center for Disease Control. (2010).
3. A Career with the CDC Global Aids Program. Retrieved from http://www. cdc. gov/globalAIDS/johs. html Falvo, D. (2009).
4. Medical & Psychosocial Aspects of Chronic Illness & Disability. Boston: Jones & Bartlett. HIV/AIDS: ALL. (2010). Retrieved from http://www. mayoclinic. com References Insert References Here.

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