"WE SUPPORT BECAUSE WE UNDERSTAND"

Description of AIDS and its Cause:
Acquired Immune Deficiency Syndrome (AIDS) is a disease caused by the Human Immunodeficiency Virus (HIV).

The virus which causes AIDS primarily attacks white blood cells called T-4 helper cells that are part of the body's internal defense against disease. The virus may also affect the central nervous system.

An infected person's immune system responds by developing antibodies to fight off the virus. The body's ability to produce disease-fighting antibodies eventually becomes limited in HIV-infected persons as the virus reproduces and destroys the body's T-4 helper cells.

Clinical Manifestation:
HIV infection may lead to diseases and illnesses which can take many forms. The problems associated with HIV infection range from the complete absence of symptoms (asymptomatic), to mild illness, to debilitating neurological disorders, to conditions which can lead to death.

"HIV disease" is new terminology being used to cover the whole spectrum from infection with HIV on through to the diagnosis of AIDS.

More than 3.5 million persons globally are believed to be infected with the causative virus (HIV). For every person who has been diagnosed with AIDS there may be as many as ten persons who have HIV disease.

These persons may have no signs of illness and may be unaware that they are infected. (All persons who are infected with the virus are capable of transmitting the virus to others through sexual activity in which there is an exchange of infected semen, vaginal fluid or blood, and by sharing contaminated needles and works.)

The incubation period before any symptoms of HIV disease appear varies significantly from person to person. Some develop symptoms within six months to two years of exposure. Many others, however, may be infected for as many as seven years or more and shown no signs of illness. Research is being done to determine why some infected people become fatally ill while others have milder symptoms or remain symptom-free.

Symptoms of HIV disease include:
loss of appetite
weight loss
tiredness
fever
night sweats
swollen lymph glands
skin rashes
diarrhea
tiredness
poor resistance to infection
About 8.3% 1 of HIV-infected people in the United States have been diagnosed with AIDS to date.

The condition called AIDS represents a syndrome of late- stage diseases in which the immune system is unable to fight off viruses, bacteria, protozoa, and fungi resulting in infections and diseases which frequently lead to death.

The symptoms that individuals with HIV develop are related to the opportunistic diseases that take advantage of the body's greatly diminished ability to fight off illness. These symptoms are usually persistent, difficult to treat, and progressively debilitating. AIDS symptoms may include:

Other opportunistic diseases include tuberculosis, certain non-Hodgkin's lymphomas and unusually severe infections with yeast, cytomegalovirus, herpesvirus, disseminated histoplasmosis, bronchial or pulmonary candidiasis and parasites such as Toxoplasma or Cryptosporidia.

Neurological involvement occurs in many, perhaps a majority of, people with AIDS as the disease progresses. "AIDS dementia (AD), also called HIV encephalopathy . . . may include auditory, visual, and other sensory disturbances, muscular dysfunction, gross personality changes, memory and judgment impairments and/or a severe loss of intellectual, social or occupational abilities. The most common cause of AD is believed to be direct involvement of the brain by HIV." 2

Transmission
Unlike flu or measles, HIV is not transmitted through the air; it must get into the bloodstream to cause infection. For this reason, HIV positive people don't pose a risk to others through any form of casual contact. There is no evidence that AIDS is transmitted through coughing, sneezing, food preparation, drinking fountains, toilet seats, mosquitoes, being around an infected person on a daily basis, or donating blood.

HIV is carried in blood, semen, vaginal secretions, breast milk and other body fluids 3 of an infected person. It is transmitted from one person to another by three routes:

through sexual intercourse including vaginal intercourse, oral intercourse, and anal intercourse (male to female; female to male; male to male; female to female);
through blood-to-blood exposure to infected blood, and
from infected women to their infants before, during or shortly after birth.
Transmission through blood-to-blood exposure to infected blood occurs in persons sharing contaminated needles, syringes, and works during intravenous (IV) drug use. Small, even invisible, particles of infected blood can remain in one's drug paraphernalia and can be injected into the bloodstream of the next user.

The risk of HIV transmission through blood transfusions and the transfusion of blood products has been almost eliminated since all U.S. blood banks began testing donated blood for antibodies to HIV in April 1985. There may be some risk to receiving blood if it was too early for the virus to show up when donor blood was tested. There is no risk of HIV infection from donating blood. Blood collection centers use new transfusion equipment for each donor. Persons concerned about transfusions can seek the advice of physicians about alternative ways to assure having virus free blood available.

Determining if One is Infected with HIV
You cannot tell if a person is infected with HIV simply by looking at him or her. HIV infection can be determined only through a blood test in which a small quantity of blood is drawn and tested. Persons who are infected with the virus usually develop antibodies to the virus within three to six months after infection. 4 The ELISA test is the antibody test one usually hears about. It stands for Enzyme-Linked Immunosorbent Assay and is the test used at clinics, hospitals, counseling and testing centers. The test looks for the presence of antibodies that one's blood might have developed to fight the virus if one has been infected. If the ELISA test indicates that antibodies are present, confirmatory tests are run.

Who should be counseled and tested?
You should be counseled and tested if, since 1978:
you have had any sexually transmitted disease or have shared needles for injecting drugs;
if you are a man who has had sex with men;
if you are the sexual partner of a person who is an IV drug user;
if you are the female sex partner of a man who has had sex with men;
if you received blood transfusions or blood products prior to 1986;
if you are a woman who has engaged in risk behavior (IV drug use or sex with a person who might be infected with the virus) and you plan to have a baby or become pregnant.
If you believe you have reason to be concerned about your HIV status.
Why should one be tested? Out of concern for one's self and others, and to protect oneself and others from unnecessary contact with the virus. Persons who are already infected must take responsibility not to transmit the virus to others and to protect themselves from reinfection.

Persons who know they are infected should voluntary contact those to whom they might have transmitted the virus (or let a health official make the contact) so these individuals can take necessary precautions, seek counseling, testing and medical attention.

Women who are at risk of having been infected need to know their HIV status in order to seek care for themselves and as they make decisions regarding pregnancy and child birth. In addition, therapeutic agents such as AZT are being used successfully with HIV infected individuals to help protect them against developing HIV related illnesses and to decrease the severity of illness if and when it occurs. Early medical intervention and treatment are very important.

"Early medical intervention for HIV infection and HIV related illness can alter the natural history of infection by:
increasing the duration of wellness;
decreasing hospital stays and costs; and
transforming the disease into a chronic illness that may be controlled for most persons by regular medical supervision.
HIV positivity (infection) should be linked to medical care, health information, counseling and support for HIV infected individuals, their families and significant others." 5

HIV Testing and Privacy. There are two ways in which the results of HIV antibody tests are kept "private". If the test is confidential, the results will be available to a limited number of medical personnel. Persons who are contemplating confidential testing should inquire ahead of time about who will know the test results, under what conditions and how the information will be stored.

Persons who want their test results to be even more private should seek anonymous testing. With anonymous testing, a person's test results cannot be traced to him or her. In most cases, all information and results are numbered, and the person tested is the only one who knows the number that has been assigned. Public health departments and community based AIDS service organizations can provide information about where to go for confidential or anonymous testing.

Incidence
Since the initial recognition of AIDS in 1981, it has become a global pandemic with as many as 10 million people infected with HIV worldwide. From 1981 - 1986 over 38,000 Americans were diagnosed with AIDS. Since then the number of cases has more than tripled to a total of 124,987. 6

There is a broad spectrum of opinion about the extent of HIV infection in the heterosexual population in the United States. Overall, the Committee on the National Strategy for AIDS (of the Institute of Medicine: National Academy of Sciences) concludes that over the next 5 to 10 years there will be substantially more HIV infection in the heterosexual population and that these cases will occur predominantly among those who are also at greatest risk for other sexually transmitted diseases and drug use.

Major Risk Factors

Persons at increased risk for being infected with HIV include:
present or past IV drug users
sex partners of IV drug users
sex partners of infected persons
persons who received blood-clotting factor, blood transfusions or blood products prior to 1986
children born to infected mothers
The Use of Alcohol by Persons with HIV Infection

Persons with HIV disease are urged to abstain from the use of alcohol. Alcohol has immune-suppressant properties which further impede the ability of the body's immune system to function effectively. Alcohol also impairs judgment and affects one's ability to protect oneself and others against virus transmission.

Caring for a Person with HIV
In most instances, persons with HIV disease can be cared for at home by family and friends. Home care training is available through most community based AIDS service organizations as well as through local Red Cross Chapters, Volunteer Nurse Associations, and Hospice Care programs. Home hospice care is chosen by many persons in the final weeks or months of life. Personal care and HIV infection control can be understood and administered effectively by prospective care providers, volunteers and loved ones.

Health professionals and infection control specialists are available to train community center workers, day care providers, foster and adoptive parents, teachers, classroom workers and other service providers regarding infection precautions and how to handle, care for and dispose of bodily fluids which might be infectious.

Psycho-Social and Treatement Needs of People with AIDS. 7
The best treatment builds on the person's past coping abilities, capitalizes on strengths, maintains hope, shows continued human care and concern. At the time of diagnosis and throughout the course of treatment, persons living with AIDS should be given up-to-date information about AIDS, its causes, modes of transmission, treatments available, and sources of care and social support. Suicidal thoughts and plans should be discussed openly to allow persons to ventilate feelings of despair. Assessing the seriousness of suicidal intent and the need for intervention is also important. Feelings about homosexuality/bisexuality, drug-taking habits, guilt that one might have infected others, and anger over discrimination and stigmatization should be listened to and explored with attitudes of openness and appreciation for what the person is feeling. Intravenous drug users should be given full assistance in finding treatment.

Persons with progressive disease should also be urged to express their feelings about being ill and encouraged to talk about their fears, anger and sadness. They should be treated with utmost concern and compassion and assured that everything will be done to provide continuity of care and relief from distress.

For persons who are afraid of being abandoned, frequent visits from friends, family, clergy and health care workers should be arranged. Support groups for persons with HIV infection and AIDS, as well as for their care providers and loved ones are critically important.

Experience has shown that support groups should be open-ended, allowing people with AIDS to attend intermittently if they choose. Support groups can help persons dismiss untrue notions about AIDS, and realize that although they have every reason to feel sad, frightened, and angry, they can still control their attitudes, make their own decisions, manage their lives and seek assistance when necessary. Support groups encourage persons to participate actively in their own treatment, contribute to treatment decisions, and augment medical procedures with attention to diet, spiritual growth, adequate rest, exercise, and relaxation.

Referral for mental health evaluation and therapy should be made if a person has symptoms of anxiety or depression which threaten to become disabling or to interfere with one's overall treatment regime. Persons with AIDS should be made aware of local and regional community based AIDS organizations and the assistance and support they have to offer. Home care programs need to be established in every community to assure 24-hour attention and monitoring of symptoms and their associated pain, nausea, and labored breathing.

Concerns over death should be discussed and persons with AIDS should have religious and spiritual support available; should receive help to secure benefits and financial assistance, to obtain legal help in preparing a will, and to prepare written medical directives about their care during terminal stages, notification of clergy and family, and funeral arrangements. Persons who are rapidly losing mental acuity should be encouraged to appoint a legally recognized guardian as soon as possible.

Prevention
There is no vaccine against AIDS or any treatment so far that can reverse the damage done by HIV to the immune system. People can and must learn how to protect themselves and their loved ones from HIV infection. 8 Following are some basic elements of AIDS information related to prevention. These elements can be adapted to varying degrees of specificity.

Schools and other important community institutions, such as religious organizations, families, and voluntary organizations can adapt the presentation of this information to fit within their value systems while providing scientifically sound, accurate and frank information. Within this framework, individuals should be given information to help them develop responsible life-affirming / health-affirming behaviors which will protect themselves and their contacts from virus transmission.

The specific wording and style of presentation, once developed, should be pretested to ensure effectiveness. All materials and presentations should be made available in the primary language of the individuals being addressed. Seek expert advice, consultation, and creative assistance from health care providers, religious counselors and health educators. The following information is adapted from materials distributed by the federal Centers for Disease Control and the New York Department of Health for use in developing an AIDS prevention education session.

Things Individuals in All Groups Need to Know
Current information on the seriousness of the disease.

How the causative virus (HIV) is spread.
HIV has been shown to be spread from an infected person to an uninfected person by:

sexual contact in which there is an exchange of infected bodily fluid -- semen, vaginal secretions, blood -- (through penis/vagina, penis/rectum, mouth/rectum, mouth/genital contact)
sharing needles or works used in injecting drugs
an infected woman to her fetus or newly born baby
transfusion or injection of infectious blood or blood fractions.

An individual can be infected with the virus that causes AIDS without having symptoms of HIV infection or appearing ill. Infected individuals who are asymptomatic can transmit the infection to others. Once infected, a person is presumed infected for life, but actual symptoms may not appear for many years.

A single exposure to HIV may result in infection.

How the virus is known NOT to be spread.

There is no evidence that the virus is spread through casual social contact (shaking hands, social kissing, coughing, sneezing; mosquitoes; sharing swimming pools, bed linens, eating utensils, office equipment; being next to or served by an infected person). There is no reason to avoid an infected person in ordinary social contact.

It is not spread by the process of giving blood; new transfusion equipment is used for each blood donor.
It is not spread by sexual intercourse between individuals who have maintained a sexual relationship exclusively with each other, assuming that they have not been infected through contaminated blood, blood factors, IV drug use or a previous sexual partner.

How to prevent infection
Infection through sexual contact can be avoided by practicing abstinence or having a mutually faithful monogamous relationship with no known risk factors in either partner. Young people, and people of all ages, can stay safe from AIDS by not having sex. Youth need to know that it is alright to say no to sex.
In addition to the risk of HIV infection, there are other good reasons to postpone sex, including the risk of gonorrhea, syphilis, and herpes, and unplanned pregnancies. Youth need to be taught that sex is good; that it need not be equated with illness and death.
Do not use IV drugs; do not share needles or works. Youth and others need to know it is alright to say no to all drugs.

If already sexually active:
Until you ask a lot of questions about his or her past sexual experience and drug use, don't have sex.
The more people one has sex with, the greater the chances of becoming infected so avoid sex with multiple partners.

With infected partners or partners whose HIV status is unknown, using a condom and lubricant containing nonoxynol-9 from start to finish during sex will help reduce the risk of HIV infected fluids entering the body. Condoms must be used properly with every encounter. They are not fullproof, but can and must be used to reduce the risk of virus transmission.

Youth who choose to be sexually active must be fully informed about precautions they must take to help reduce the risk of virus transmission for themselves and their sexual partners. They must have access to condoms and information about the proper use of condoms, as well as access to quality health care designed to meet their special medical and psycho-social needs.

The chance of blood or semen entering the bloodstream is very high during anal sex, since it can cause tearing of delicate tissues, so avoid anal sex.
Drugs and alcohol can impair immune system functioning and lead to doing things one wouldn't do drug-free, so don't drink alcohol or use drugs of any kind.

If there is suspicion of infection.
Abstain from sexual intercourse.

Seek counseling and HIV antibody testing to be sure of infection status. Be aware that weeks to months may elapse from the time of infection to the time that antibodies to the virus appear in the blood. During this time persons may be infectious even though they may have tested negative.
Obtain counseling and testing if pregnancy is being considered.

How to get more information about AIDS
Call a local or regional AIDS hotline number or HASHMI HUMAN RESOURCES DEVELOPMENT SOCIETY(AIDS Wing) Telephone No..... or

visit us on www.hashmi.com

Call a personal physician, health department, or an AIDS community service organization.

Information which will emphasize the seriousness of the HIV epidemic, yet reduce inappropriate fear.
AIDS is a global crisis requiring everyone's attention.
If people change their behaviors, the spread of HIV can be reduced.
Blood for transfusions in the United States is screened for antibodies to HIV and is now essentially safe, but some risks cannot be eliminated.
Everyone who engages in high-risk behaviors is at risk.

Research and Treatment
Though researchers are working to develop a vaccine, the task is difficult because HIV can alter its form in the human body. There is no cure for AIDS at this time, nor is there any treatment that can reverse the damage that has been done to the immune system. A number of therapeutic agents including AZT, DDI, and ganciclovir are showing promise, some for their potential to curb the ability of the virus to reproduce itself inside human cells. These agents continue to be tested to learn more about their toxic effects and whether lower dosages can be used with comparable benefit and fewer side effects.