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Christopher

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SUSTAINABLE LIVING WITH HIV:

 

FROM ASSESSMENT TO ADHERENCE

 

 

 

INTRODUCTION

               

 While the topic of sustainability is usually thought of as something that applies to the extrinsic world in the form of economics, the environment, or governmental and social issues, sustainability is just as applicable to the individual on the intrinsic level. Achieving and maintaining good health is just as much an evolving and relentless process, especially for those who may have or do have HIV (human immunodeficiency virus). The purpose of this document is to describe the general process of HIV contraction, assessment of HIV risks, testing for HIV, and the paradigm shifts that must take place in order for one with the virus to live sustainably.

Also provided are resources for organizations in the Las Vegas area that can more directly guide a person at risk or who has contracted the virus with medical assistance and means of funding for that assistance. Because of the disproportionately and almost epidemically high risk in the LGBT community (Lesbian Gay Bisexual and Transgender), those resources are predominantly focused towards the LGBT demographic but are not exclusive to that portion of society.

The goal of this document is to give valuable information to people who have recently received HIV, people who think themselves at risk, or people who know somebody applicable to either of those two conditions. This document is NOT a resource for any person whose HIV status has developed into AIDS, and anybody with AIDS reading this should seek direct medical attention if he/she has not done so. The purpose of living sustainably with HIV is to either prevent or at least severely delay HIVs transition into AIDS.

 

The five phases in the process of having and dealing with an HIV risk are: 

 

1) having an encounter

2) assessing Risk

3) getting Tested

4) responding to the test's results

5) living sustainably with HIV

 

 

 

1 – The Encounter

               

 The encounter in which one contracts, or is at risk of contracting, HIV is the initial phase of this process. There are many conditions under which one may contract HIV, some of which are voluntary actions and some of which are involuntary, meaning that some people make decisions that put them at risk despite their awareness of those risks and others are not necessarily aware of those risks or are not cooperative in the process (such as victims of rape, who should always have a full STD test as soon as possible after it occurs).

 

 

 

The sharing of needles, whether for medical use or drug abuse, is one of the three most common means by which the virus is transmitted. Pregnant women with HIV who transmit the virus to their children are also very common. The third most common, and to some the most notorious, means of transmission is sexual. These three means of transmission all abide by the same fundamental rules of infection (as stated by Aid for Aids of Nevada 2008):

 

    1. The virus must be present in the person
    2. The virus must have means by which to get into the bloodstream
    3. There must be enough of the virus in the bodily fluid for transmission

The kind of fluid that the virus is concentrated in is also a factor. Fluids such as saliva are very hostile to HIV and thusly have a very low risk of transmission, but blood makes an excellent host fluid for the virus.

 

 

 

2 - Risk assessment after an encounter

                After having what one might consider an encounter with the virus, the second phase of this process is to assess one’s risk and look for testing sites. People who feel themselves at risk of HIV infection have several factors that they must consider. These factors vary depending on the reason that the person might have for believing that he/she could have been infected. Though there is some cross-over between risk assessments for a person who shares needles and a person who has unprotected sex, there are also some exclusive issues to consider (especially for sexual encounters).

               

IF THE ENOUNTER WAS SEXUAL

  • Ø  Was the other person confirmed to have HIV?
  • Ø  Was the sex unprotected? If so, were fluids actually from either person during penetration?
  • Ø  Were there any open sores or cuts on the body or inside the mouth of the person?
  • Ø  What were the fluids that were released (i.e. ejaculatory, “pre-cum”, blood, saliva, etc.)?
  • Ø  Is there a way to contact the person?

 

 

IF THE ENCOUNTER WAS DRUG RELATED 

 

  • Ø  Were drugs shared or purchased and consumed separately?
  • Ø  In what form were the drugs taken (injection, snorted, smoked, huffed, etc.)?
  • Ø  If consumed via injection, was a needle shared?
  • Ø  If a needle was shared, was that needle cleaned in any way?

 

(This information was partially obtained from Aid for Aids of Nevada 2008)

 

 

 

PREGNANT WOMEN WITH HIV

In The Canadian Aids Society’s book HIV Transmission: Guidelines for Assessment (2004) it is stated that women with HIV who bear children and do not use anti-retroviral drugs have a 20%-30% chance of infecting fetuses, while mothers who use medications, such as Zidovudine or Nevirapine, during their pregnancy, compounded with immediate treatment of the child after birth, only have a 2%-3% chance of transmitting the virus to their children.

Women who are HIV positive are not instructed to avoid pregnancy, but rather to discuss their pregnancies with an obstetrician in order to ensure the safest birth possible.

 

  

 

The following figure, obtained from U.S. Centers for Disease Control and Prevention (1999) shows the numbers of pregnant women in 13 states across the country who have discussed HIV testing with their doctors as well as those who have actually tested for HIV in the year 1997. The figure shows that even though at least more than half of the pregnant women in these states have discussed testing with a medical professional, in some states none of those women have ever actually gotten tested.

 

 

 

3 – HIV testing after an assessment

                After careful consideration of the aforementioned factors of risk for infection, the person at risk should immediately get tested. This is the third phase of the process of dealing with HIV risks and possible infection. Local health departments, various community centers, clinics, and private doctors are all professional, sterile, and (most often) fast places for testing. It is very important, for the sake of the individual and those not infected with the virus, that all behaviors leading up to the risk (i.e. sexual activity, drug use, blood interactions, etc.) be discontinued so as not to put the uninfected at any risk.

 

 

3 MOST COMMON FORMS OF TESTING (provided by AFAN 2008)

 

Elisa - the initial test performed

 

1. Blood is drawn in a sterile environment and sent for laboratory testing.

2. The blood is sent to a laboratory where the antibodies specific to HIV are  paired with an enzyme that catalyzes their activity.

3. If the target antibodies appear in the blood sample, the material will change color as a reaction to the enzyme.

 

 

Western Blot

  1. As with the Elisa test, blood is drawn and sent to a laboratory for testing. 
  2. The blood is placed on a test strip laced with proteins that of a specific atomic weight matching those of HIV. 
  3. A serum is added to the strip, and if antibodies are present, the strip will cause the strip to “light up” (Virusmyth). 

  

 

Orasure

  1. Saliva is gathered with a cotton swab and sent to a lab for testing. 
  2. That saliva is put through the Elisa testing  

 

 

 

 

 

4 – Testing Positive

               

     For a person who tests negative, the process ends at the third phase; however, if a person tests positive, there are several steps that should be taken before even beginning treatment.

 

 

NOTIFYING PEOPLE ABOUT BEING HIV POSITIVE

                If a person tests positive, it is imperative that he/she notify all previous partners (in sex, intravenous drug use, blood exposure, etc.) of their potential risk of HIV infection. If that person’s work involves any kind of exposure to blood, wounds, medical equipment, or other means of contamination, that person must notify his/her work of recent infection. The most difficult step in this process of discovering one’s HIV positive status may be notifying the family, and this is often the final notification for many. In some cases, a person is, for various reasons, estranged from family and does not notify them, and so there is no truly right or truly wrong way to handle the issue. Regardless of whether or not family is ever made aware of the person’s HIV status, they should never be at risk of exposure. People who have tested positive for HIV may also enlist the help of a partner counsel and referral service (PCRS), which works with the client to notify past partners about his/her current status (San Francisco Aids Foundation 2010).

 

 

IT IS ILLEGAL TO HAVE SEX OR PERFORM ANY OTHER ACTIVITY THAT MAY RESULT IN AN EXPOSURE RISK WITHOUT NOTIFICATION OF ONE’S HIV

  

POSITIVE STATUS

 

CREATING A SUPPORT SYSTEM OF FRIENDS AND FAMILY

                Having a support system of people the newly positive person can trust is vital to his/her sustainable living. Should the person experience any sudden corrosion of the body or immune system as a result of drugs or perpetuation of the virus, there must be family members or friends who can be contacted and relied upon to ensure that the person receives medical attention and judiciously takes his/her medications. Additionally, the support system will be beneficial to the emotional stability of the newly infected, and that person’s emotional stability will significantly affect the strength of the immune system. Excessive and unvented stresses can cause a kind of exhaustion that the person may not even be aware of.

 

PRELIMINARY MEDICAL ASSESSMENTS

                Before beginning any regimen of medications, a preliminary medical assessment of the person’s immune system must be performed in order to create the most accurate and successful combination of medications possible in combating the virus.

  •         A T-cell count must be administered (a count of the white blood cells present in the blood, which create the antibodies that fight infections)
  •         Vaccines must be administered for any diseases to which the person has not already been vaccinated, and expired vaccines must be renewed to help prevent future infections.
  •         Initial antiviral treatments are prescribed and combined with protease inhibitors (medications which prevent the HIV virus from producing the enzymes that allow it to reproduce effectively)
  •         Regular checkups are scheduled (Aids Treatment Data Network 2006). These checkups serve several purposes:
    •    to monitor the success of medication combination and to change medications or dosages as needed
    •    to monitor the T-cell count of the patient
    •    to monitor the patient’s viral load (the degree of expansion of the HIV virus within the body)
    •    to address any issues the patient may have with changes in his/her body and questions that arise pertaining to conduct and/or lifestyle adjustments
    •    to assess and reassess dietary and exercise regimens in accordance with the severity of the virus and the state of the patient

 

5 -  Living a sustainable life

                HIV is no longer the guarantee of a short life that it once was in the 1980s and 1990s. It is very possible to live a long, fulfilling, and sustainable life with the HIV virus, but there is also a lifestyle paradigm that must be strictly followed in order to ensure that sustainability. The fifth phase of dealing with an HIV risk is learning to live a productive, safe life with HIV.

 

ADHERENCE

                Once a regimen of medications is given to the person, he/she must be very attentive towards taking the proper doses at the prescribed times. Medications work best when there is a consistent amount of the medication at all times in the blood stream. This consistency is referred to as steady state concentration. Adherence is maintaining a steady state concentration of medications, which means taking all medications in the proper form and at the proper time. Missing a dose can give the virus the opportunity to mutate and become resistant to future dosages. Contrarily, overcompensating for missed doses by doubling up on medications can poison the body via an unmanageable toxicity in the bloodstream from the drugs taken.

 

FROM ASSESSMENT TO ADHERENCE

                The process of HIV education, assessment, testing, and treatment is, in its entirety, vital to the sustainability of both people with the HIV virus and to those without it. An understanding of the virus helps prevent those with a positive status from infecting others. It gives those who have had risks the knowledge and opportunities necessary to test themselves and refrain from lifestyle modalities that may harm others. Also, the earlier a person can discover his/her status, the better the chances of preventing the virus from gaining ground on the body’s immune system and developing into AIDS. Sustainability of the body begins with the recognition of a risk and continues through the process of adherence to a lifestyle regimen that combats the Human Immunodeficiency Virus as adamantly as possible.

 

Glossary of terms

 

adherence – maintaining  a steady state concentration by taking medications at the exact times and in the exact dosages prescribed

 

AIDS – acquired immune deficiency syndrome

 

Anti-retroviral Drugs –generic term for drugs used to combat HIV and other retroviruses

 

HIV – human immunodeficiency virus

 

LGBT – Lesbian, Gay, Bisexual, and Transgender

 

protease inhibitors – medications that prevent the HIV virus from reproducing effectively by affecting its ability to protease the enzymes necessary for reproduction

 

STD – sexually transmitted disease

 

steady state concentration – a consistent equilibrium of HIV combating medications in the bloodstream

 

T-cell count – a count of the white blood cell concentration in the blood

 

 

Additional resources

 

Local Associations and Information

www.afanlv.org

www.sinsitysisters.org

www.thecenterlv.org

http://www.studentlife.unlv.edu/shc/

http://www.southernnevadahealthdistrict.org/

 

 

Other sources

http://www.aegis.com/factshts/network/simple/protease.html

http://www.sfaf.org/aids101/if_positive.html

http://www.nlm.nih.gov/medlineplus/ency/article/003332.htm

http://www.cdnaids.ca/web/repguide.nsf/Pages/cas-rep-0307

 

 

 

 

References

 

Aid for Aids of Nevada. (2008). HIV 101. Retrieved from http://www.afanlv.org/#8a

Asia Society. (2003). [Picture of an anonymous hand holding a syringe filled with intravenous recreation

drugs]. In Iran, a New Fight Against AIDS. Retrieved from http://www.asiasociety.org/policy-politics/global-health/hiv-aids/in-iran-a-new-fight-against-aids

Canadian Aids Society. (2004). HIV Transmission: Guidelines for Assessing Risk. Retrieved from

http://www.cdnaids.ca/web/repguide.nsf/65d569a62d6d8804852571c4006cf905/45a115ebbcba2586852570210054fc3e/$FILE/HIV%20TRANSMISSION%20Guidelines%20for%20assessing%20risk.pdf

San Francisco Aids Foundation. (2010). HIV Testing. Retrieved from

http://www.sfaf.org/aids101/hiv_testing.html#orasure

Simple Facts Project. (2006). Protease Inhibitors. Retrieved from

http://www.aegis.com/factshts/network/simple/protease.html

U.S. Centers for Disease Control and Prevention. (1999). [Graph shows pregnant women in 13 states

who  1) discussed HIV testing with their doctors or another medical professional and 2) those who actually got tested for HIV]. Prenatal Discussion of HIV Testing and Maternal HIV Testing -- 14 States, 1996-1997. Retrieved from http://www.thebody.com/content/art17423.html

  


 

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