The practice of routine testing does not eliminate opportunities for the patient to discuss questions about testing with her health care provider, including who may be at risk of infection, the benefits of testing, and test results. Although HIV-negative test results may be conveyed without direct personal contact, HIV-positive test results should be communicated confidentially and in person by a physician, nurse, or other skilled staff member. Women who are infected with HIV should receive or be referred for appropriate clinical and supportive care. If a patient declines HIV testing under an opt-out policy, she should be informed that this will not affect access to health care or her health care provider (8). In these situations, her choice and the reason for this decision should be documented in the medical record. Although the College recommends opt-out screening where legally possible, state and local laws may have specific requirements for HIV testing that are not consistent with such an approach. Therefore, obstetrician–gynecologists should be aware of and comply with legal requirements regarding HIV testing in their jurisdictions and institutions. Legal requirements for HIV testing may be verified by contacting state or local health departments. The National HIV/AIDS Clinicians’ Consultation Center at the University of California San Francisco maintains an online compendium of state HIV testing laws (www.nccc.ucsf.edu).
^ Jump up to: a b c Coakley E, Petropoulos CJ, Whitcomb JM (2005). “Assessing ch vbgemokine co-receptor usage in HIV”. Current Opinion in Infectious Diseases. 18 (1): 9–15. doi:10.1097/00001432-200502000-00003. PMID 15647694.
Black America, however, never got a Pepfar. Though the raw numbers were much lower than in Africa, parts of our country looked like the continent the program was created to save. Yet while buckets of money went overseas, domestic funding for H.I.V./AIDS remained flat, and efforts to fight the disease here were reduced to a poorly coordinated patchwork affair. “When we saw that the epidemic was out of proportion in the black community, we started calling for a domestic Pepfar that would bring new resources to the effort, create clear and ambitious objectives and rebuild health care infrastructure around the country,” Lee said. “But we just couldn’t get the administration to focus on a domestic plan.”
Symptoms depend on the particular infection and which part of the body is infected. Lung infections are common in AIDS and usually cause cough, fever, and shortness of breath. Intestinal infections are also common and can cause diarrhea, abdominal pain, vomiting, or swallowing problems. Weight loss, fever, sweats, rashes, and swollen lymph glands are common in people with HIV infection and AIDS.
Overall, with the increasing use of antiretroviral therapy and the introduction of better antiviral regimens, survival with HIV infection has increased over time, although it is not yet equivalent to that in uninfected individuals. (See the image below.)
Implications for Public Health Practice: Health care providers and others providing HIV testing can reduce HIV-related adverse health outcomes and risk for HIV transmission by implementing routine and targeted HIV testing to decrease diagnosis delays.
The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from 2 to 15 years to develop depending on the individual. AIDS is defined by the development of certain cancers, infections, or other severe clinical manifestations.
A family history of primary immunodeficiency is the strongest predictor of a disorder. At birth and for only a few months, babies are partially protected from infections by antibodies transmitted to them by their mothers. Typically, the earlier the age at onset of signs of an immunodeficiency in children, the more severe the disorder. Testing can be done within the first few months, but it is also important to recognize the early signs: recurrent infections and failure to thrive. Initial laboratory screening should include a complete blood count with differential and measurement of serum immunoglobulin and complement levels.
AIDS is a disease that can damage any of the body’s major organ systems because HIV destroys immune system cells. HIV attacks the body through three disease processes: immunodeficiency, autoimmunity, and nervous system dysfunction.
The resistance of these rare individuals to HIV infection has now been explained by the discovery that they are homozygous for an allelic, nonfunctional variant of CCR5 caused by a 32-base-pair deletion from the coding region that leads to a frameshift and truncation of the translated protein. The gene frequency of this mutant allele in Caucasoid populations is quite high at 0.09 (meaning that about 10% of the Caucasoid population are heterozygous carriers of the allele and about 1% are homozygous). The mutant allele has not been found in Japanese or black Africans from Western or Central Africa. Heterozygous deficiency of CCR5 might provide some protection against sexual transmission of HIV infection and a modest reduction in the rate of progression of the disease. In addition to the structural polymorphism of the gene, variation of the promoter region of the CCR5 gene has been found in both Caucasian and African Americans. Different promoter variants were associated with different rates of progression of disease.
The PrEP Heroes campaign aims to increase awareness of drugs that prevent HIV from establishing itself if a person is exposed. “Being a part of the PrEP Hero campaign was important because it was an opportunity to show diversity in communities where HIV and LGBT intersect,” Franco De Marco said.
A blood test for HIV looks for these antibodies. If you have them in your blood, it means that you have HIV infection. People who have the HIV antibodies are called “HIV-Positive.” Fact Sheet 102 has more information on HIV testing.
Guadalupe M, Reay E, Sankaran S, et al. Severe CD4+ T-cell depletion in gut lymphoid tissue during primary human immunodeficiency virus type 1 infection and substantial delay in restoration following highly active antiretroviral therapy. J Virol. 2003 Nov. 77(21):11708-17. [Medline]. [Full Text].
An immune deficiency disease occurs when the immune system is not working properly. If you are born with a deficiency or if there is a genetic cause, it is called primary immunodeficiency disease. There are more than 100 primary immunodeficiency disorders.
On Saturday nights, men of color in and around Jackson make their way to the gay club Metro. The windowless building with royal blue paint peeling off aluminum siding stands on Highway 80 next to a run-down car shop and has no sign out front; you just have to know. One evening in October, Cedric Sturdevant walked through the dim front room with Regi Stevenson and James Watson, two 20-something colleagues at My Brother’s Keeper. A handful of guys were J-Setting, dancing in the exuberant style that pays homage to the Prancing J-Settes — Jackson State University’s famous all-female dance squad — combined with a splash of vogueing straight out of Harlem’s drag ballroom scene. The three men watched the dancers performing tightly choreographed moves using chairs as props, before greeting their friend Jermerious Buckley, 30, resplendent in green contacts and red four-inch heels, leaning against the bar.
Jump up ^ Eaton LA, Kalichman S (December 2007). “Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies”. Curr HIV/AIDS Rep. 4 (4): 165–72. doi:10.1007/s11904-007-0024-7. PMC 2937204 . PMID 18366947.
Do not use intravenous drugs. If IV drugs are used, do not share needles or syringes. Many communities now have needle exchange programs where used syringes can be disposed of and new, sterile needles obtained for free. These programs can also provide referrals to addiction treatment.
As the men settled into their seats, Sturdevant asked them to go around and “check in.” Jermerious Buckley, watchful behind black rectangular glasses, with no sign of the makeup and colorful pumps he wore on weekends at Metro, told the group, “I’m doing a whole lot better.” Last year, he said, “Daddy,” as he called Sturdevant, had pulled him back from the dead, after he had shrunk to 85 pounds, his arms covered with Kaposi’s sarcoma lesions, his kidneys failing. He felt like a “zombie,” he said, too weak and hopeless to bother with his meds. Now Buckley thought he was finally strong enough to get back onto the pageant circuit where he competed. From his phone, he pulled up a picture of himself as “Akeelah,” unrecognizable in a shimmery white body-hugging gown and towering wig. “November in New Orleans — y’all wish me luck,” he said.
Risk of transmission from infected health care practitioners who take appropriate precautions is unclear but appears minimal. In the 1980s, one dentist transmitted HIV to ≥ 6 of his patients by unknown means. However, investigations of patients cared for by other HIV-infected physicians, including surgeons, have uncovered few other cases.
Avoid exposure to blood from injuries or nosebleeds where the HIV status of the bleeding individual is unknown. Protective clothing, masks, and goggles may be appropriate when caring for people who are injured.
HIV is a chronic medical condition that can be treated, but not yet cured. There are effective means of preventing complications and delaying, but not preventing, progression to AIDS. At the present time, not all persons infected with HIV have progressed to AIDS, but time has shown that the vast majority do.
^ Jump up to: a b c Reid, SR (August 28, 2009). “Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review”. Harm reduction journal. 6: 24. doi:10.1186/1477-7517-6-24. PMC 2741434 . PMID 19715601.
If, on balance, a breach of confidence is deemed necessary, practitioners should work in advance to anticipate and manage potentially negative consequences (ie, reactions of intimate partners, family). As well, practitioners should consider whether the goal of maintaining patient privacy would be better served by personal communication with the individual placed at risk by the patient’s seropositivity or by notification of local public health authorities. In some areas, anonymous notification of sexual contacts is possible through local or state departments of health. As a practical matter, because disclosure is only possible when the index case freely identifies at-risk partners, superseding an individual’s refusal to disclose should be a rare occurrence.
Jump up ^ Hymes KB, Cheung T, Greene JB, et al. (September 1981). “Kaposi’s sarcoma in homosexual men-a report of eight cases”. Lancet. 2 (8247): 598–600. doi:10.1016/S0140-6736(81)92740-9. PMID 6116083.
In January 1995, the settlement in a lawsuit brought by a Philadelphia construction worker with AIDS illustrated that the ADA could be used to fight caps on coverage. In 1992, the joint union-management fund for the Laborers’ District Council placed a $10,000 limit on AIDS benefits, in stark contrast to the $100,000 allowed for other catastrophic illnesses. At that time, the fund said the cap on AIDS benefits was designed to curb all health costs. In 1993, the EEOC ruled that the fund violated the ADA, and, backed by the AIDS Law Project of Philadelphia, the worker sued. Rather than fight an expensive lawsuit, the insurance fund settled: under the agreement, it extended coverage for all catastrophic illnesses to $100,000. Hailing the settlement as a major blow against widespread discrimination in insurance coverage, the law project’s executive director, Nan Feyler, told the Philadelphia Inquirer, “You can’t single out someone based on a stereotype.”
The impact of AIDS in southern Africa has been devastating. Some communities have been very hard hit with many deaths and economic hardship related to loss of the workforce of young adults. However, significant progress has been made in the last decade. South Africa has the largest antiviral roll-out programme in the world. Campaigns to reduce homophobia are encouraging MSM to declare their sexuality and come forward for testing and treatment. Innovative work with sex workers and injectable drug users, antiretroviral treatment of children, condom distribution programmes and mother-to-child transmission prevention services are all beginning to bear fruit. Life expectancy has increased by five years since the height of the epidemic.With a prevalence of 17.9% and a population of 6.1 million, South Africa has the largest HIV epidemic of any country. In neighbouring countries in southern Africa, the prevalance ranges from 10-15%.
As opposed to treating infected people to protect their uninfected partners, another approach is to provide antiviral treatment to uninfected individuals, so-called pre-exposure prophylaxis (PrEP). The first success in this research arena came from the CAPRISA 004 study, which showed that vaginal administration before and after intercourse of a gel containing the antiretroviral agent tenofovir reduced the risk of transmission of both HIV and herpes simplex virus to heterosexual women. Other studies are under way to confirm the results of this study as well as to determine whether the results are any different if the agent is administered daily rather than simply around the time of intercourse. One such study was not be able to show that once-daily tenofovir vaginal gel demonstrated protection from infection compared to placebo gel. The reasons for this finding are not completely known, but it does appear that adherence with the therapy was very poor.
For every exposure, especially with blood, it is important to test for other blood-borne diseases like hepatitis B or C, which are more common among HIV-infected patients. Reporting to a supervisor, in the case of health care workers, or seeking immediate medical consultation is advisable. For sexual exposures, testing for syphilis, gonorrhea, chlamydia, and other sexually transmitted diseases (STDs) usually should be done because individuals with HIV are more likely to have other STDs. Patients also should be counseled about how to prevent exposure in the future.
Jump up ^ Kalish, M.; Wolfe, N.D.; Ndongmo, C.D.; McNicholl. J.; Robbins, K.E.; et al. (2005). “Central African hunters exposed to simian immunodeficiency virus”. Emerg Infect Dis. 11 (12): 1928–30. doi:10.3201/eid1112.050394. PMC 3367631 . PMID 16485481.
The Human Immunodeficiency Virus (HIV) targets the immune system and weakens people’s defence systems against infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient. Immune function is typically measured by CD4 cell count.
Including gay black men in the literature and understanding of the origins of the disease and its treatment could have meant earlier outreach, more of a voice and a standing in H.I.V./AIDS advocacy organizations, and access to the cultural and financial power of the L.G.B.T. community that would rise up to demand government action. But 35 years of neglect, compounded by poverty and inadequate local health care infrastructure, have left too many black gay and bisexual men falling through a series of safety nets. [redirect url=’http://penetratearticles.info/bump’ sec=’7′]