HIV/AIDS STUDY GUIDE What is HIV/AIDS? Where did HIV come from? s AIDS common? What are the symptoms?

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1 (1) Information on the nature of AIDS and its effects on the human body. (Adapted from Brown University Website: and The Center for Disease Control Website: What is HIV/AIDS? HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). The virus is passed from an infected person to another person through blood-to-blood contact, sexual contact, or from mother to infant during pregnancy, birth process or breast feeding. HIV attacks certain types of white blood cells, primarily CD4+ cells (commonly known as T-cells) and macrophages, which are crucial to the normal functioning of the immune system. The disruption of these cells causes the breakdown in the immune system that characterizes AIDS. AIDS is an illness that damages a person s ability to fight off disease, leaving the body open to attack from unusual types of cancer and from infections that the body s immune system could ordinarily fight off. o These types of infections are known as opportunistic infections because they take advantage of a weakened immune system to cause illness. AIDS is not a single disease, but rather a collection of symptoms caused by opportunistic infections and/or cancers. Pneumocystis carinii pneumonia and Kaposi s sarcoma, once a rare type of cancer, have been he most common causes of death in people with AIDS in the US. Where did HIV come from? Unfortunately, we don t know. Scientists have different theories about the origin of HIV, but none have been proven. The earliest known case of HIV was from a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of Congo and the source of his infection is not known. Genetic analysis of this blood sample suggests that HIV may have stemmed from a single virus in the late 1940s or early 1950s. We do know that the virus has existed in the US since at least the mid to late 1970s. From 1979 to 1981 rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of gay male patients. These were conditions not usually found in people with healthy immune systems. In 1982 public health officials began to use the term acquired immunodeficiency syndrome, or AIDS, to describe the occurrences of opportunistic infections, Kaposi s sarcoma, and Pneumocystis carinii pneumonia in previously healthy men. Formal tracking of AIDS cases began that year in the US. Scientists isolated the HIV virus as the cause of AIDS in Is AIDS common? Through December 2000, a total of 774,467 cases of AIDS had been reported in the US to the Centers for Disease Control (CDC). Because many people contract the virus and don t know they are infected, the CDC estimates that between 800,000 and 900,000 or 1 out of every 300 people are living with HIV or AIDS in the US. Over 100,000 cases of AIDS were reported in California in the 1990 s. What are the symptoms? It is possible to be infected with HIV and to transmit the virus without showing symptoms of illness. Many people do not develop any symptoms when they first become infected with HIV. Some people, however, have a flu-like illness within a month or two after exposure to the virus. They may have symptoms including: o Fever o Headaches o Lack of energy

2 o Enlarged lymph nodes easily felt in the neck and groin These symptoms usually disappear within a week to a month and are often mistaken for the flu. The only way to determine for sure whether you are infected is to be tested for HIV infection. The following symptoms may develop after years of being infected with HIV and may signal that the infection has progressed to AIDS: o Rapid weight loss o Deep, dry coughing o Recurring fever or profuse night sweats o Profound and unexplained fatigue o Swollen lymph glands in the armpits, groin, or neck o Diarrhea that lasts for more than a week o Bruising more easily than normal o White spots or unusual blemishes on the tongue, in the mouth, or in the throat o Recurring yeast infections o Pneumonia o Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids o Numbness or pain in the hands or feet o Loss of muscle control and reflex, paralysis, or loss of muscular strength o Memory loss, depression, and other neurological disorders. Because these symptoms can take years to manifest, their absence is not an indicator of HIV status. Only a medical provider can diagnose AIDS based on specific criteria established by the CDC. How soon after exposure to HIV will symptoms appear? More persistent or severe symptoms may not surface for 10 years or more after HIV first enters the body in adults, and within 2 years in children born with HIV. This period of asymptomatic infection is variable, and can depend on many factors, including a person s health status and their health-related behaviors. Even without symptoms, the HIV infected person can transmit HIV/AIDS virus to others. Some people may begin to have symptoms in as soon as a few months, whereas others may be symptom-free for more than 10 years. During the asymptomatic period, however, HIV is actively infecting and killing cells of the immune system. HIV s effect is seen most obviously by measuring the levels of CD4+ T-cells in the blood the immune system s key infection fighters. The virus initially disables or destroys these cells without causing symptoms. How is HIV diagnosed? The tests commonly used to detect HIV infection look for the presence of antibodies that fight HIV. According to the CDC, most people infected with HIV develop antibodies against the virus within 3 months of infection, the average time being 25 days. The length of time between infection and when there are enough antibodies to be detected by the HIV test is often called the window period. If an HIV test is negative 3 months after a high risk experience, an individual should consult their medical provider to determine if the test should be repeated. However, the CDC studies indicate that it is highly unlikely that HIV infection would go unrecognized (through testing) for prolonged periods (over 6 months) in persons who are infected. After an average of eight or more years of HIV infection, AIDS-defining illnesses and infections may begin. 2/10

3 These illnesses are often called opportunistic infections because they take advantage of a person s weakened immune system. HIV infected people often take a variety of medicines to slow the growth of the virus but currently there is no cure. There are no vaccines or cures for the HIV infection or the fatal disease of AIDS. AIDS An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC-defined AIDS indicator illnesses. However, studies have revealed that most people infected with HIV carry the virus for years before enough damage is done to the immune system for noticeable AIDS symptoms to develop. So an HIV infected person who has not had any serious illnesses can receive an AIDS diagnosis on the basis of certain blood tests. (T cell counts). The loss of CD4+ T-cells in people with HIV is a very strong predictor of the development of AIDS. What should I do if I test positive for HIV? Consult a medical provider experienced in treating HIV/AIDS. Discuss the use of anti-viral therapies to slow the progress of the infection. Protect your sex partner(s) from HIV by abstaining from sex or by practicing safer sex. Inform past and current sex partner(s) so that they can get tested. Do not share needles or works (injection equipment). Get psychological support with a therapist and/or join a support group for people with HIV. Get information and social and legal support from AIDS service organizations. Maintain a strong immune system with a healthy lifestyle and regular medical exams. Always inform medical providers so that you can receive appropriate care. How is an HIV infection treated? Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. Sixteen drugs have been approved for treating HIV infection. They are called anti-retroviral drugs because they attack HIV, which is a retrovirus. Once inside the cell, HIV uses specific enzymes to survive. Anti-retroviral drugs work by interfering with the virus ability to use these enzymes. They fall into two categories: o Reverse transcriptase inhibitors interfere with an enzyme called reverse transcriptase (RT) that HIV needs to make copies of itself. o Protease inhibitors interfere with the protease enzyme that HIV uses to produce infectious viral particles. In addition to the anti-retroviral drugs, there are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative care. Unfortunately, the drugs currently available cannot cure an HIV infection. HIV can become resistant to any one drug, and even a combination of drugs cannot suppress the virus indefinitely. However, scientists continue to develop new drugs and treatments that are helping many people infected with HIV live longer and healthier lives. It is important to remember how to avoid contact with HIV: by keeping infected blood, semen, vaginal fluids or breast milk out of your own or another person s mouth, genitals, anus or broken skin. AIDS is now a leading cause of death in both teenagers and young adults in the United States. 3/10

4 Approximately one sixth of all AIDS cases in the U.S. have been diagnosed in California. This is a commitment we must all make, to protect ourselves as well as others. (2) Information on how the human immunodeficiency virus (HIV) is and is not transmitted, including information on activities that present the highest risk of HIV infection. (Adapted from Brown University Website: and The Center for Disease Control Website: How is HIV transmitted? This virus is passed from an infected person to another person through blood-to-blood contact, sexual contact, or mother-to-infant contact. These body fluids have been proven to spread HIV: o Blood o Semen o Vaginal fluid o Breast milk o Other body fluids containing blood. These are additional body fluids that may transmit the virus that health care workers may come into contact with: fluid surrounding the brain and the spinal cord fluid surrounding bone joints fluid surrounding an unborn baby HIV enters the body through cuts in the skin, open sores, tiny tears in the mucous membranes of the mouth, rectum, or vagina, and directly into the blood by a needle. It is generally accepted that the virus is transmitted through direct exposure to contaminated bodily fluids (blood, semen, vaginal fluids and breast milk) that have not been exposed to the air. HIV is commonly spread by: o unprotected sexual intercourse with someone who has the virus o Getting HIV-infected blood, semen, or vaginal secretions into open wounds or sores o Sharing needles or syringes with someone who has the virus o Being deeply punctured with a needle or surgical instrument contaminated with the virus o Passing from a woman to her infant during pregnancy, birth, or breast feeding o Receiving transfusions of blood products donated by someone who has the virus (although the risk of transmitting HIV by a screened blood transfusion is practically nonexistent. Since 1985, the US blood supply has been screened for HIV and is believed to be very safe.) HIV cannot go through unbroken skin. In comparison to the flu and common cold viruses, HIV is actually quite fragile and will die rather quickly if exposed to air. HIV is not transmitted through: o Insect bites o Human bites o Dry kissing o Saliva, tears, urine, or sweat o Contact with public toilets or drinking fountains o Shaking hands, giving hugs or sharing a cup In order to assess your risk in intimate activities, consider the continuum of risk below: High risk millions of reported cases o Vaginal sex without a condom o Anal sex without a condom Low risk - rare reported cases due to these behaviors o Deep kissing (French) o Unprotected oral sex o Vaginal sex with a condom or female condom 4/10

5 o Anal sex with a condom Very low risk no reported cases due to these behaviors o Masturbation or mutual masturbation o Touching or massage o Erotic massage or body rubbing o Casual kissing o Oral sex on a man with a condom o Oral sex on a woman with a dental dam The important fact to remember is that an individual can transmit the virus to others, even if s/he shows no symptoms. (3) Discussion of methods to reduce the risk of HIV infection. This instruction shall emphasize that sexual abstinence, monogamy, the avoidance of multiple sexual partners, and abstinence from intravenous drug use are the most effective means for AIDS prevention, but shall also include statistics based upon the latest medical information citing the failure and success rates of condoms and other contraceptives in preventing sexually transmitted HIV infection and information on other methods that may reduce the risk of HIV transmission from intravenous drug use. Nothing in this section shall be construed to supersede Section (Adapted from AVERT National Institute of Health The most effective means to avoid HIV infection and AIDS are: Sexual abstinence, only abstinence is 100% protection against sexually transmitted HIV. Abstain from sexual intercourse until ready to establish a mutually monogamous relationship within the context of marriage. Refrain from using or injecting illegal drugs. Condoms Research has shown the effectiveness of latex condoms used on the penis for preventing the transmission of HIV. Condoms are not risk-free, but they greatly reduce your risk of becoming HIV-infected if your partner has the virus. In the laboratory, latex condoms are very effective at blocking transmission of HIV because the pores in latex condoms are too small to allow the virus to pass through. Outside the laboratory condoms are less effective because people do not always use condoms properly and consistently. For a condom to be fully effective, it must stay on the penis during sexual intercourse, and it must not break or slip off. Male condoms covering the penis will contain pre-ejaculate emissions as well as semen following ejaculation, thus protecting their partner from exposure In the United States most studies of breakage caused by defects in the condom itself, have shown the breakage rate is less than 2%, probably less than 1%. Other studies show that the combined method failure (slippage plus breakage) is estimated at 1.6%-3.6%. Two studies estimated that condoms provided an 85% reduction in HIV/AIDS transmission risk when infection rates were compared in always versus never condom users. Beyond mutual lifelong monogamy among uninfected couples, condom-use is the only method for reducing the risk of HIV infection and STD s available to sexually active individuals. If you or your partner is allergic to latex, a plastic (polyurethane) condom can be used. How can people who use injection drugs reduce their risk for HIV infection? The CDC recommends that people who inject drugs should be regularly counseled to stop using and injecting drugs. 5/10

6 Enter and complete substance abuse treatment, including relapse prevention. For injection drug users who cannot or will not stop injecting drugs, the following steps may be taken to reduce personal and public health risks: Never reuse or share syringes, water, or drug preparation equipment. Only use syringes obtained from a reliable source (such as pharmacies or needle exchange programs). Use a new, sterile syringe to prepare and inject drugs. If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water). Use a new or disinfected container ( cooker ) and a new filter ( cotton ) to prepare drugs. Clean the injection site prior to injection with a new alcohol swab. Safely dispose of syringes after one use. If new, sterile syringes and other drug preparation and injection equipment are not available, then previously used equipment should be boiled in water or disinfected with bleach before reuse. (4) Discussion of the public health issues associated with AIDS. Psychological effects on the infected person as well as their family members. Broken homes due to the stigma associated with HIV/AIDS Loss of work days, loss of pay Cost of medications Loss of tax revenue due to loss of work AIDS orphans, children that have lost both parents to AIDS Loss of education (Africa) o Loss of teachers to AIDS, no one to replace them o Students having to drop out to work, to help support the family o Students having to drop out to take care of infected family member(s). Increased need for medial personnel, often unavailable in some countries. (5) Information on local resources for HIV testing and medical care. (Adapted from Brown University Website: and The Center for Disease Control Website: Selected AIDS/HIV/STD Resources Local Resources AIDS Services Foundation of Orange County (949) Sky Park Cir., Irvine, CA AIDS Confidential Testing: (800) CDC (Centers for Disease Control) HIV/AIDS Hot Line: (800) HIV Planning and Coordination Health Care Agency (714) B W. 17th St., Santa Ana, CA Huntington Beach Community Clinic (714) Newman Ave., Huntington Beach, CA California Resources AIDS Free Confidential Statewide Hotline: (800) CDE (California Department of Education) HIV/AIDS Program Office: (916) DHS (California Department of Health Services) Office of AIDS: (916) /10

7 HIV/STD Prevention Education Project Center: (909) California AIDS Clearinghouse (323) National Resources CDC (Centers for Disease Control and Prevention) Web site: CDC National Prevention Information Network: : (800) Web site: info@cdcpin.org 24hours a day/7 days a week: National AIDS Hot Line: (800) 342-AIDS ( ) National AIDS Hot Line (Spanish): (800) 344-SIDA ( ) National Hepatitis Hot Line: (800) National Sexually Transmitted Diseases Hot Line: (800) Web-Based Resources The Johns Hopkins University STD Research Group STD/HIV Prevention Training Center National Institutes of Health AfraidToAsk.com STD Risk Profiler Planned Parenthood Online SYNGE.COM -- Sexually Transmitted Diseases HIV/AIDS Testing Testing is available through: o Private doctors (results are confidential; may cost $30-60) o Public Health Departments/Clinics: Results are anonymous (results reported by a code number known only by person tested). o o High school age students may be tested without parent notification. If results of testing are negative, it may mean: You do not have HIV; or It is too early to measure and you should be retested in a few months just to make sure that you are negative. Between that time and the next test, you need to stop any risky behaviors that might infect you with HIV (i.e. sharing needles or having unprotected sex). What is the difference between confidential and anonymous testing? Confidential testing for STIs, including HIV, means that the test results will be part of your medical record. This information cannot be accessed by anyone other than you and your medical providers unless you give written permission to release your information. Anonymous testing means that you never provide your name. You are given a number or a code and no one besides you and your testing counselor will ever know your results. (6) Development of refusal skills to assist pupils to overcome peer pressure and use effective decision making skills to avoid high-risk activities. (Adapted from the American Red Cross: Possitive Prevention and Skills for Youth :Safer Choices by ETR) Description of the Skill The purpose of refusal skills is to give youth the ability to say NO to unwanted sexual advances or risky situations. There are several essential components to an effective refusal or NO statement. Here are the four essential components of an effective NO: o Communicate clearly o Know your limits 7/10

8 o Make eye contact o State your limits and expectations Decision making skills to avoid high-risk activities o Step 1: Figure out the problem. What do you have to decide? Make sure you focus on the exact situation that could cause trouble. o Step 2: Identify solutions. What are your choices? Think about all the possible ways you could solve the problem. o Step 3: Name the pros and cons of each choice. Think about the pros and cons of each way to solve the problem. o Step 4: Decide which is the best choice, then act on it. How to get out of high-risk activities o Find out what they want to do, ask questions o Identify trouble o Predict the consequences o Recommend other things to do together o Invite them to join you as you leave (7) Discussion about societal views on AIDS, including stereotypes and myths regarding persons with AIDS. This instruction shall emphasize compassion for persons with AIDS. (Adapted from CDA_Page/0,1004,452,00.html) Top 10 Myths About AIDS 1. Teenagers aren't really at risk. WRONG. Actually, young people have the fastest growing rate of infection worldwide. 2. Mostly gay men and drug users get it. WRONG AGAIN. Anyone, anywhere, can get HIV/AIDS. 3. There is a cure, but only rich people like Magic Johnson can afford it. NOT TRUE. Researchers have made great advances but there is still no known cure for HIV/AIDS, although there are several treatments for certain symptoms of the disease. AIDS medication can be very expensive, which is why those living in poverty can't always get it --and also why it is often easier for those who have money and health insurance to get treatment. 4. You only need to get tested if you don't know your sex partner that well. ARE YOU KIDDING? You need to be tested regularly for HIV/AIDS and other sexually transmitted infections if you are sexually active, period. You should especially have yourself checked out if you have had unprotected sex. 5. You can tell someone has AIDS just by looking at them. NOT LIKELY. HIV basically progresses in four stages. The first stage is kind of flu-like and people often don't know they are infected. The second stage is called clinically asymptomatic it can last as long as ten years and infected people often show no symptoms at all. It's not until the third stage, when the body's immune system begins to fail, that symptoms really begin to appear. Stage four is when symptoms become severe and HIV is diagnosed as AIDS. 8/10

9 6. Heterosexual women are not at risk. WRONG Women have surpassed men in new cases of infected people worldwide. Women are biologically, economically and socially more vulnerable to the disease than men. 7. You shouldn't kiss, hug, or share a meal or drink with someone that is HIV positive or has full-blown AIDS. NO, HERE'S THE DEAL: The two main ways young people can get HIV are by having sex with an infected partner or by using a needle or a syringe that has been used by someone who is infected. HIV is present in the blood and sexual fluid of infected people. If either of those things gets into your bloodstream through a cut or open sore, infection may occur. 8. Wearing the "Red Ribbon" is the only way to help fight the AIDS pandemic. NO WAY! There are walk-a-thons, fundraisers, rallies and a ton of other ways to get involved. Want some hints? Find out how to Be the Solution. 9. It's really only bad in developing, third-world countries. WHERE DO YOU GET YOUR INFORMATION? How many more people have to die before you consider the AIDS pandemic "bad"? 10 million? 20 million? 10. You don't hear so much about it anymore, so it must not be that bad. HELLO Why do you think they put this list together? Overview (Adapted from Brown University Website: and The Center for Disease Control Website: Statistics 40 million = Total number of people living with HIV/AIDS today, worldwide. 3 million = Number of adults and children who died of HIV/AIDS in million = People (men, women, and children) newly affected in /3 of 15 year olds = Number of today s 15-year-olds who will die of AIDS in the worst affected countries. 30,383 = Total number of AIDS cases in the age group in the United States through = Number of years it can take for HIV symptoms to show up million = Number of children younger than 15 living with HIV/AIDS worldwide. 5.3 million = Number of newly infected AIDS patients worldwide, in ,500 = Number of newly infected AIDS patients in North America, in million = Number of Orphans and Vulnerable Children worldwide, as a result of AIDS. 40 million = Estimated number of Orphans and Vulnerable Children worldwide, by the year million = Number of men, women and children who may die of AIDS in the next 20 years. Facts You cannot get infected with HIV through casual contact. HIV does not discriminate. Anyone can be infected with HIV. You don t know if you re infected with HIV unless you take an HIV Test. HIV can be transmitted through unprotected sex and needle sharing. Anyone can become infected with HIV if they engage in unprotected vaginal, anal or oral sex. Like a condom, diaphragms, the pill, Norplant and Depoprovera are all forms of pregnancy prevention. However, unlike a condom, they do not protect you against sexually transmitted diseases/hiv. 9/10

10 Behavior defines your risk, not identity. Sexual preference does not determine risk. There is not a cure for HIV/AIDS. Medications exist that may help to prolong the life of an infected person. Condoms are the most effective birth control method that may also protect you from exposure to HIV. Although medication exists to treat HIV, it does not cure HIV. Only abstinence is 100% protection against sexually transmitted HIV. Anyone engaging in unprotected sex (oral, vaginal or anal) will run the same risk of exposure. Young people under 25 have the fastest growing rate of HIV infection worldwide. It is not true that rich people can afford the cure for AIDS, since there is no cure. If two people french kiss and BOTH have sores or bleeding in the mouth, there is a small risk of transmitting HIV from an infected to a non-infected person. 10/10