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  1. #11
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    Update on the HIV/AIDS Situation in Singapore 2009

    Update on the HIV/AIDS Situation in Singapore 2009
    Source : www.moh.gov.sg

    Update on the HIV/AIDS Situation in Singapore 2010

    Characteristics of new cases of HIV infection reported in 2009

    1. In 2009, another 463 Singapore residents[1] were newly reported with HIV infection. About 90% of the new cases were males and 10% were females. . This brings the total number of HIV infected Singaporeans to 4,404 as of end 2009. As at 31 Dec 2009, 2,089 persons are asymptomatic carriers, 1,037 have AIDS-related illnesses and 1,278 have died.

    2. Sexual transmission remains the main mode of HIV transmission among Singaporeans. Of the 463 cases reported in 2009, 449 cases acquired the infection through the sexual route, with heterosexual transmission accounting for 61% of infections, homosexual transmission 30% and bisexual transmission 6%. Intravenous drug use (7 cases) accounted for 2% of infections.

    3. 55% of all new cases reported in 2009 were aged between 30 to 49 years of age. Approximately 57% were single, 30% were married and 11% were divorced or separated.

    4. In 2009, more than half (57%) of the new cases already had late-stage HIV infection[2] when they were diagnosed. This was similar to the pattern in previous years.

    5. More than half of the new cases in 2009 (57%) had their HIV detected when they had HIV testing in the course of medical care, while another 16% were detected as a result of health screening. 9% were detected as a result of voluntary HIV screening. Another 7% of the cases were detected as a result of screening in prisons and drug rehabilitation centres. The rest were detected through contact tracing and other screening. When differentiated by sexual orientation, a higher proportion of homosexuals had their HIV infection detected via voluntary screening compared to heterosexuals (20% vs. 2%).

    6. There were 45 female cases in 2009, representing an increase of 50% from 2008. More than half of the 45 female cases (56%) were aged between 20-39 years old. 58% were married and 18% were single. The majority (96%) acquired HIV through heterosexual transmission. 47% had their HIV detected when they had HIV testing in the course of medical care, while another 18% were detected as a result of health screening. 22% were diagnosed as a result of contact tracing. 51% were diagnosed when they already had late stage infection.

    Preventing HIV infection

    7. The most effective way to prevent HIV infection is to remain faithful to one’s spouse/partner and to avoid casual sex and sex with prostitutes. A HIV-infected person looks and feels normal during the early stage of the infection. It is therefore not possible to tell if a person is infected or not by looking at his/her appearance.

    8. Persons engaging in high-risk sexual behaviour, such as having multiple sexual partners, engaging in casual sex or sex with prostitutes, are strongly advised to use condoms to reduce their risk of HIV infection. Condoms should be used consistently and correctly during every sexual encounter. They should also go for HIV testing regularly so that the disease is detected and treated as early as possible. HIV treatment can significantly delay the onset of AIDS and reduce the risk of death.

    9. It is an offence under the Infectious Diseases Act for persons who know that they are infected with HIV not to inform their sex partners of their HIV status before sexual intercourse. Furthermore, under the Infectious Diseases Act, a person who has reason to believe that he has, or has been exposed to a significant risk of contracting, HIV/AIDS must take reasonable precautions to protect his sexual partner, such as by using condoms, even if he is ignorant of his HIV positive status. Alternatively, he can go for a HIV test to confirm that he is HIV-negative. Otherwise, he must inform his partner of the risk of contracting HIV from him, leaving the partner to voluntarily accept the risk, if he or she so wishes.

    10. HIV testing is available in most medical clinics.The identities of persons who come forward for testing and those who are found to be HIV positive will be kept strictly confidential. Anonymous testing services are also available.

    11. HIV/AIDS is not transmitted through normal day-to-day contact with a HIV-infected person at home, in school or at the workplace. You cannot get HIV/AIDS from coughs, sneezes, shaking hands, hugging, sharing of food and cutlery, sharing of toilets, etc. More information about HIV and AIDS can be found at the HPB website at http://www.hpb.gov.sg/sexualhealth/s...c.aspx?id=1412.











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    Last edited by Meteor; 07-12-2012 at 11:51 PM.

  2. #12
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    Message From Singapore Health Minister

    http://www.youtube.com/watch?v=cI5Jl...layer_embedded








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    Last edited by Meteor; 07-12-2012 at 11:51 PM.

  3. #13
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    Questions & Answers

    Please, please clarify....
    Apr 28, 2003

    Hi Dr Bob,

    I hope you are well.... I'm confused about when to get tested. I've read 12 weeks which if my math is right comes out to 84 days. Then I've read it must be 90 days from possible exposure.

    My question is, when can I get tested? Can I do it at 12 weeks and be 99 sure I'm fine if testing comes back negative? I had one test at 5 weeks which was negative, and possible exposure was performing oral sex on a person of unkown status (female) and I did notice some blood on my chin afterwords. Please advise, I'm worried and pray for a whoo hoo!

    Thanks!!!




    Response from Dr. Frascino
    Hello,

    What were you? A math major in college? The immune system really doesnt know how to count days. Eighty-four days is indeed 12 weeks and 90 days is indeed 3 months. Now heres a mind game for you. Twelve weeks is also 3 months. So whether you read 12 weeks (84 days) or the equivalent 3 months (90 days), we are all saying the same thing. Yes, you can use the 12-week (84-day) criteria, and your test will be accurate. Oral sex, by the way, carries an extremely low risk for HIV transmission. The odds of your 12-week (or 3-month) HIV test being negative are very definitely in your favor! Good luck.









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    Dr. Bob
    Last edited by Meteor; 07-12-2012 at 11:51 PM.

  4. #14
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    Diagnosis of AIDS and HIV Testing Part 1

    DR B G GAZZARD
    Chelsea and Westminster Hospital
    London, UK



    Following exposure to the HIV virus the majority of individuals who become infected mount an antibody response which is detectable within three to six week. Although a much longer “negative window” i.e. between exposure and producing an antibody response has been recorded in the literature, these cases are very rare.With currently available sensitive tests, it is possible to be certain that individuals who apparently have been exposed but have no antibody response within three months, will not become infected. The ELISA assays have a high degree of sensitivity and specificity but the positive and negative predictive value of the test will depend upon the underlying prevalence of HIV infection. Most false positive tests will be due to transcription errors. It is for this reason that we have a police of two separate tests taken on different days and performed by different ELISA methods before we confirm an HIV positive test. Many countries still use western blot as a confirmatory test. This is expensive and sometimes non-specific.



    It is obviously important for preventing transmission, to test blood for HIV prior to transfusion. This also gives some measure of the overall seroprevalence of the condition. We have a confidential system of reporting so that although such individuals donate blood, this is discarded without the need for an HIV test. There are also guidelines about the procedures to take when an individual’s donated blood is found to be HIV positive.



    Determination of whether a child is HIV positive is particularly difficult immediately after birth because the IGG antibodies directed against HIV used in the ELISA test crosses the placenta passively at around the time of delivery. While viral culture or a positive HIV PCR test on cord blood available in the United Kingdom. However, PCR is being widely introduced. The importance attached to not incorrectly informing a mother that a child has been infected using PCR technology has led to the sensitivity of this tes being deliberately set at a low level to ensure a high specificity. Most babies produce an IGA antibody within three to six months of birth and these can be detected readily within ELISA assay. The risks of pneumocystis carnii pneumonia and its mortality are particularly high in the first few months of life and many in the UK are moving towards providing prophylaxis for the offspring of all known HIV positive mothers rather than those known to be infected. Despite the low prevalence of HIV in the UK, all mothers are counseled and offered HIV testing during pregnancy. This is less pejorative than “high risk testing” which is inaccurate as women has assumed greater importance because of studies showing the ability to reduce the rate of perinatal transmission, using drug intervention.



    Immunological markers

    The ability to follow the immunological deterioration which occurs following HIV infection is important for prognosis, for intervention with chemotherapy to prevent opportunistic infections and for trying to decide the optimum period to intervene with antiretroviral therapy. In the UK such monitoring is usually carried out with repeated measurements of the CD4 positive lymphocyte subsets. These have a relatively high degree of variability from day to day and, therefore, we have policy of not taking action on any one result and taking more notice of long term trends rather than sudden changes. We no longer routinely monitor serum neopterin or b-2 microglobulin in addition as this adds little to the information obtained by the CD4 count. Many other much simpler markers of clinical status give almost as much information as a direct measurement of the CD4 count including measurement of the lymphocyte count, erythrocyte sedimentation rate or haemoglobin.









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    Last edited by Meteor; 07-12-2012 at 11:52 PM.

  5. #15
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    Diagnosis of AIDS and HIV Testing Part 2

    Viral load

    It is now, of course, possible to measure the HIV viral load in the plasma. Although this is a composite measure of massive daily production and destruction of virus, it does remain relatively constant over time and is highly predictive of long term outcome within a few months of seroconversion. The ability to differentiate between people at high and low risk of progression is particularly valuable when the CD4 count remains high (greater than 500 cells mm-3). Although the precise values of the viral load remains a matter of debate, a viral load of less than 10, 000 copies is associated with relatively low progression rate compared with those above 50,000 copies who are likely to progress much faster. It seems biologically plausible that those with high viral load should be offered much earlier antiretroviral treatment but this has yet to proven in controlled studies.



    Skin Antiretroviral treatment

    Considerable improvements in antiretroviral treatment has occurred over the last five or six years and many of us believe that we stand on the threshold of a major breakthrough where long term control of disease may be possible. Three classes of antiviral treatment are currently in use. The nucleoside analogues all act as chain terminators of reverse transcriptase and prevent virus from forming a DNA template which can be incorporated into infected cells. Non nucleoside reverse transcriptase inhibitors (NNRTIs) also act the reverse transcriptase but in a different way, the most obvious difference being the failure to effect the replication of HIV-2. the third class of drugs, proteinase inhibitors, inhibit the unique enzyme shich cleaves the large polypetides that result from transciption of the viral genome. Proteinase inhibitors do not prvent cells becoming infected but inhibit the develoment of viral progeny.



    The initial studies in HIV disease use a nucleodide analogue, Zidovudine, and showed that this significantly prolonged life and reduced the risk of opportunistic infections in symptomatic individuals. A subsequent landmark study, Concorde, showe dthat this same drug had no effect if used earlier in asymptomatic individuals. It is now clear that drug failure is related to the develoment of quasi species of virus which are resistant to the drug and many of the patterns of mutations within the RT genome leading to resistance are now known. Unfortunately many drugs which have pronounced effects on HIV in vitro, in vivo lead to very rapid development of resistance, partly because a strong selection pressure, producing preferential growth of pre-existing mutations and partly because the development of de novo mutations at single points in the RT gene because of the very rapid rate of viral turnover. In general every possible viable mutant produced by a single codon mutation in the RT gene is produced daily during HIV viral replication l thus the appearance of virus displaying resistance to most of the M and RTIs and #TC, which require single mutations of the genome, occur very rapidly. Drugs will be effective for much longer if four or five mutations are required within a single genome to produce a resistant or if mutations are required which produce a virus less able to replicate. Thus combinations of drugs which require mutations at different sites to produce resistance, are used together and drugs which require four or five mutations within one genome to induce high level resistance, such as some of the proteinases, are particularly valuable forms of therapy.



    Landmark studies recently published show that compared with AZT monotherapy, combination of nucleosides, either AZT and ddI and AZT and ddC increased survival and reduced the incidence of opportunistic infection. A large number of smaller studies showed that using even more drugs in combination were able to produce a greater and sustained effect on the HIV viral load. An important new concept is the attempt to produce a considerable reduction in the rate of viral replication that the viral load falls below detectable limits of a sensitive assay. Such low replication rates are unlikely to be able to produce the complex mutation patterns required to overcome the effect of these drug combinations. This can be achieved with two nucleosides together in about 20% to 30% of patients and in between 70% and 80% with two nucleosides, to which the patient has not been previously exposed, are combined with either an NNRTI or proteinase inhibitor. It appears likely that NNRTIs work best in those who have not previously been exposed to therapy and for this reason, it may be that a triple combination, including one of these drugs, should be used first. The presently available compound, Nevirapine, is associated with rash in a significant proportion of patients but a number of other drugs are at advanced stages of development.



    It is clear that proteinase inhibitors are still effective in reducing viral load to below detectable limits if used later in the treatment cascade providing there are still at least two other nucleosides which the patient can be given in addition. Restriction on subsequent nucleosides, after initial therapy, will include the development of cross resistant viral swarms and shared toxicity such as peripheral neuropathy.



    The three proteinase inhibitors currently available all have some advantages and disadvantages. Saquinavir is relatively free from toxicity and from drug interaction which are very important in late HIV disease, the only important drug interaction being inablility to use it with strong cytochrome P450 inducing agents such as Rifabutin. The major disadvantage of Saquinavir, however, is in its present formulation it is only poorly bioavailable. However, this problem should be overcome shortly as different preparations come into use. Ritonavir is a highly potent antiretroviral but does strongly both induce and inhibit the cytochrome P450 system and this means there are a number of very complex drug interactions which preclude its use in a proportion of patients. Also there are very serious toxicities which reduce compliance, particularly in the gastrointestinal tract. Indinavir produces less interaction with cytochrome P450 than Ritonavir but it is only absorbed efficiently when on an empty stomach.

    It is clear that for long term suppressive theapy to work, compliance must be excellent and this is very difficult to achieve with any known theapy at present. Initiative will be required both for individuals who are themselves using the drug, pharmacists and dietitians to achieve a good compliance rate. It clearly needs to be established by controlled clinical trials that driving the viral load down below detectable limits does result in a considerable improvement in survival.



    A number of other new drugs are rapidly entering the HIV field which have further increased the options available to patients already on therapy and for clinicians when deciding what is the optimum therapy to start with. Particularly exciting is a Glaxo-Wellcome product, 1592 which appears to be a potent nucleoside and a new proteinase inhibitor with a novel resistance pattern, Nelfinavir. This drug may not be associated with corss resistance to the other proteinases and, therefore, can either be sequenced first or subsequently in a treatment cascade.










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    Last edited by Meteor; 07-12-2012 at 11:52 PM.

  6. #16
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    UK Study Finds Rapid HIV Test Safe, Reliable, and Cost Effective

    UK study finds rapid HIV test safe, reliable, and cost effective


    Health monitoring >



    Edwin J. Bernard

    Published: 03 June 2004


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    Further information



    A rapid HIV test that has been available in the UK for more than four years, and which delivers results 15-minutes after taking a finger prick blood sample, has been found to be safe, reliable, easy-to-use and cost effective. The results of the validation study from London’s Chelsea and Westminster hospital were presented late last month at the annual British Association for Sexual Health and HIV (BASSH) conference in Bath.

    Abbott Laboratories’ Determine HIV-1/2 test is an inexpensive immunochromatographic (lateral flow) device that detects antibodies to HIV-1 and HIV-2 in human serum, plasma and whole blood. It can be stored and transported at room temperature. After pre-test counselling, the rapid test is performed and 15 minutes later the result can be read. It is then given to the patient by the health adviser along with post-test counselling. The whole process takes around one hour.

    The Chelsea and Westminster validation study enrolled 1623 individuals across four London-based GUM clinics, including The Victoria Clinic for Sexual Health, the John Hunter Clinic and the West London Centre for Sexual Health.

    They found that the sensitivity of the test - the ability to detect all true positive results - was 100% (95% CI: 95.3%-100%) and the test’s specificity - the number of negative tests correctly identified as negative - was 99.9% (CI: 99.5%-100%), which compares very favourably with standard Enzyme immunoassay (EIA) tests used in routine HIV diagnosis.

    Although there were no false negative tests, there were two false positive results, which were picked up on standard confirmatory testing.

    Dr Alan McOwan, Director of Sexual Health at Chelsea and Westminster Healthcare NHS Trust, says that “the rapid HIV test has shown itself to be simple, quick, cost effective, reliable, and easily installed into the clinic environment using existing staff. It has allowed Chelsea and Westminster to offer a better service to its patients and I was amazed at just how quickly the new test became part of our routine offering.”

    In addition, a patient satisfaction survey conducted at the two youchoose one hour testing centres at the Soho Centre and Lighthouse West London which use the rapid test, found that 26% of the 205 respondents said that the availability of the rapid HIV test was the main factor in their taking an HIV antibody test.

    Despite the availability of the rapid HIV test in the UK since 1999, it has only been available at a handful of sites since then. A 2000 review from the UK Public Health and Laboratory Service found it to be highly sensitive and specific: comparable in sensitivity to laboratory tests in general use, though not quite as sensitive as the very best of modern tests, stressing that positive results would still need to be confirmed by another test method.

    It is hoped that the Chelsea and Westminster’s validation study will lead to an increase in availability, which should reduce the anxiety created by the one week-plus waiting times currently experienced at many GUM clinics in the UK. The Chelsea and Westminster will now routinely offer the rapid test at their GUM clinics - including their youchoose outreach services at the Soho Centre and Lighthouse West London - to all people at high risk, including gay men, people who have had sex in high-risk countries, or those with a past history of intravenous drug use.









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    Last edited by Meteor; 07-12-2012 at 11:52 PM.

  7. #17
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    Sexual Health Education

    While men sexual health products are often touted as the best solution for increasing sex drive, there are other things a man can do to raise his libido. Having a strong sex drive is essential to having good overall sexual health. For a man, the natural process of aging and reduction of hormones can easily trigger a decrease in the desire or physical ability to perform sexual activities on a regular basis. To achieve an increase in the man’s libido and the positive result of better sex, the basics of man sexual health education must be learned.

    A man’s sex drive is the combination of many different factors. Hormone levels play a definite part and a man that has lower testosterone levels will frequently have less of a desire for sex. Also, self-confidence and esteem in the bedroom may be obstacles that the man will need to overcome. Fortunately, there are a number of ways that a man can increase his overall sexual health, which will result in an increased sex drive.

    Although it may seem simple, the single most important thing that a man must do is make sure that he is correctly taking care of his body. This means that adequate time for sleep should be taken every night. In addition, a regular exercise program will help to increase the stamina of the man. More confidence and better self-esteem are two other benefits that often come with exercise as well. Diet is also a major factor. Eating fatty foods and excessive amounts of refined sugars can lead to a lethargic lifestyle that decreases sexual desire. Alcohol has also been proven to reduce a man’s sex drive. For that reason, careful attention should be paid to alcohol intake and the foods that are being eaten on a regular basis.

    A man is not alone when it comes to a reduced libido. Women can suffer this problem as well and there are a number of female sexual health aids to help raise sexual desire. The previously described activities for men work just as well for women. In addition, there are women sexual health clinics to help those women that may have a more serious problem. For some women, hormone therapy may be needed to maintain a healthy sexual life as hormone production often changes with menopause. These women sexual health clinics are adept at identifying the problem and advising the proper steps for correction.

    Both men and women can suffer from a decreased libido, but most cases can be solved with only a modicum of effort. Overall sexual health is a result of both a person’s lifestyle and physical factors, such as hormone levels and self-confidence. By taking care of these problems, the libido can be increased and better sex experienced more frequently. Instead of taking men sexual health products that only address the symptoms, a man should focus on the underlying problem and make behavioral changes that address these issues.









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  8. #18
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    STI / STD Testing

    Men

    In men, we test for:
    •Chlamydia
    •Gonorrhoea
    •NSU (if symptoms)

    Usually you only need to provide a urine sample.

    Routine check-ups do not need a swab from down your penis.

    Men note: Try to not pass urine for 2-3 hours before attending.

    --------------------------------------------------------------------------------


    Women

    In women, we test for:
    •Bacterial Vaginosis (if symptoms)
    •Candida "thrush" (if symptoms)
    •Chlamydia
    •Gonorrhoea
    •Trichomonas (if symptoms)
    •Pelvic Inflammation (if suspected)

    Routine check-ups only need a single swab to be taken from your vagina (no speculum needed).

    Women over 25 note: We do not offer cervical smear tests.

    --------------------------------------------------------------------------------


    Blood Tests

    Routine blood tests for:
    •Syphilis
    •HIV

    are recommended to all new patients and those who have been at risk.

    You will not be tested for HIV without prior discussion and consent.

    Testing and vaccination for Hepatitis - may be offered to individuals at specific risk

    --------------------------------------------------------------------------------


    Rapid HIV Testing

    If you want a “Rapid HIV test” please say this to the receptionist when you book an appointment or attend a walk-in clinic.

    A pin-prick blood sample will be taken, and your result available after 30 minutes

    --------------------------------------------------------------------------------


    Getting your test results

    Same day

    If you have symptoms, some results will be available by the end of your visit.

    If you have a rapid HIV test, the result is available after about 30 minutes.

    Some results will be available by the end of your visit.

    Later

    The remaining results will be available after 7-10 days.

    Ways to get your results:
    •Text / SMS
    •Telephone appointment
    •Follow-up visit

    We will need your correct details in case we find an infection.

    Any attempt to contact you will be discrete.











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  9. #19
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    Testing and Counselling Part 1

    Testing and counselling
    Pre-test counselling

    Informed consent

    Post-test counselling
    implications of negative result
    implications of positive result

    Preparing for possible positive test result

    Confidentiality

    Advantages of testing

    The test

    The HIV antibody test is the blood test that determines whether an individual has HIV antibodies. A positive test means that there are antibodies and that HIV has established itself in the body. As previously described, it can take as long as 3 months - the window period - for antibodies to be produced. A negative test can mean that either HIV is not present in the body, or that the body has not had sufficient time to respond to the virus by producing antibodies.

    Pre-test counselling
    It is important that people seeking testing have an opportunity to explore the issues that may confront them with either a positive or negative test result. Issues may include guarantees of confidentiality, the need for support, explanation of the test, personal issues (e.g. in relation to partners, insurance, safe sex practices, and safe drug use).

    Informed consent
    Informed consent should be obtained for all medical tests, and must be obtained before a HIV test is undertaken. Testing without consent constitutes an assault (unless authorised by the law). The person needs to be fully aware of the meaning of the test and its results, the procedures, and potential consequences. Consent obtained by deceit, withholding information, or giving misleading information does not constitute informed consent.

    Post-test counselling
    It is important that test results are given face-to-face by a medical practitioner or counsellor. The main aim of post-test counselling is to ensure that the person understands the implications and meaning of the results, and that follow-up is offered in the form of further appointments or referral. Results should not be given by telephone.

    Implications of a negative test
    A negative test result can provide reassurance and an opportunity to discuss prevention through safe sex and safe drug use. It is important to be aware that if exposure occurred less than 3 months ago a repeat test will be necessary.

    Implications of a positive test
    Since reactions to the diagnosis of HIV infection varies, it is important that the individual has access to counselling and support from a person (counsellor, nurse or doctor) experienced in HIV/AIDS issues. The doctor needs to check if there is a trusted support person available, to discuss medical follow-up and treatments, provide assurance of confidentiality, encourage notification of past and present sexual partners, support lifestyle changes, arrange referral to other support agencies where necessary, and arrange another appointment for further counselling. When first confronted with a positive test result, people frequently may not absorb much of the information they are given and follow-up appointments are important.

    The following needs to be taken into consideration by the counsellor and the individual diagnosed with HIV infection:

    the infection can be transmitted to others, and thus there is a need for lifestyle changes,

    social stigmatisation of people with HIV infection and irrational, fear-based responses of others make it even more difficult to come to terms with the infection.

    AIDS combines several areas that are subject to enormous taboos and heavy social conditioning in our society, namely:

    sexual behaviour and sexuality (and often homosexuality);
    injecting drug use;
    death.
    Individual reactions to a positive test result may depend upon a number of factors such as:












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    Last edited by Meteor; 07-13-2012 at 12:45 AM.

  10. #20
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    Testing and Counselling Part 2

    Gay men
    Reactions differ, depending on whether the individual:
    identifies with the gay community or has an unrevealed association with men;
    engages in sexual activity, involving male and female partners.
    Blood or blood-product recipients
    Some wish to distance themselves as "innocent victims".
    People who inject drugs
    Reactions differ, depending on whether:
    the use is casual and under control or an addiction problem;
    the person wishes to continue drug use, placing the emphasis on non-sharing;
    the person wants to discontinue use, placing the emphasis on social supports.
    Sex industry workers
    Reactions differ, depending on whether the person:
    is a female or male sex worker;
    injects drugs;
    identifies with the prostitute community or acts independently;
    perceives a potentially positive role for herself or himself as an educator in safe sex for clients.
    Women
    Reactions differ, depending on:
    socio-economic status;
    whether or not a woman has children or is pregnant.
    Interpersonal relationships
    Will infection destroy an existing relationship, or hinder new ones?
    What kinds of support does the person have?

    There may be guilt or hostility relating to who infected whom.

    Does infection disclose unrevealed sexual relationships, sexual orientation, or injecting drug use?

    Likely response of lovers, family, friends.

    Pre-existing psychological or intellectual problems
    Infection may exacerbate the existing condition.
    Intellectual disability may make the spread of infection more difficult to prevent or increase the risk of unplanned pregnancy and transmission to the baby.

    Knowledge and preparation for a possible positive result
    Studies show that the less knowledge and preparation an individual has, the greater the impact of the result will be.

    This underlines the importance of pre-test counselling.

    The most common initial reactions are extreme - severe shock which may temporarily immobilise the individual, or an apparently casual acceptance. The individual may deny the reality of the result for several days, weeks, or longer. Issues, such as relationship difficulties, self-blame, loss of self-esteem and/or loss of sexual libido may start to arise later. There are, of course, similarities between coming to terms with HIV and the process people go through when diagnosed with other fatal diseases. The difference is that HIV can result in rejection by friends, family, and health workers, and therefore social isolation. Thus, people often hide their diagnosis. It is important that individuals are informed of self-help and other groups available for HIV positive people.

    Confidentiality
    Information about one person should not be disclosed to another, except in the following circumstances:

    Where another person has a need to know (e.g. a health service provider) - but it is essential to have the client's consent in all situations.
    Where required by law (e.g. notifiable diseases).
    HIV-positive people may need to be counselled about whom they wish to tell - many breaches of confidentiality occur when individuals unwisely tell acquaintances, or leave identifying client documents around.

    Health workers can use a range of strategies to protect confidentiality (e.g. contacting clients only by a mechanism they have approved).

    Advantages of testing
    Access to appropriate treatments for HIV-positive individuals early in the infection can delay the onset of AIDS and prolong survival.
    The detection of infection at an asymptomatic stage may avoid a range of severe physical and social complications that may occur when infection is detected in an emergency situation (e.g. an accident, in a hospital emergency room, or after admission to hospital with advanced disease). Breaches of confidentiality and privacy are more likely in these late stages, and there may not be sufficient time for the individual to benefit from treatments, come to terms with the illness, make any necessary practical living arrangements, or prevent the further spread of infection.
    A negative test result can relieve anxiety after perceived exposure to infection.
    A positive result can encourage the practice of safe sex and safe drug use, preventing the spread of infection as well as protecting the infected person from other STDs, or different strains of HIV.
    Widespread testing helps to determine the extent and distribution of infection, which in turn can assist in planning support and prevention strategies.
    A positive result may affect a person's important life decisions, for example, about whether or not to have children.
    Individuals may make other lifestyle changes that improve their health status and life expectancy.
    People have the right to make their own choices about undergoing a test. If an individual chooses not to be tested, it is important that he or she practises safe sex and injects drugs safely to protect themselves as well as others. Individuals may not wish to be tested because they have never been offered pre-test counselling. Similarly, a more balanced community perception of HIV infection could help individuals feel less hesitant. Confidentiality should ensure that other people know an individual's status only if he or she tells them, and it is important that people who fear a breakdown in confidentiality are assured of this. People with positive test results need to be selective about whom they tell. Discrimination on the grounds of HIV infection is covered by anti-discrimination legislation, and is against the law, although it can be difficult to prove. Insurance companies will require a test before underwriting a substantial policy.

    From a public health perspective, all individuals at risk of HIV should be encouraged to have an HIV test.

    The test
    Four blood tests are available:

    Enzyme immuno-assay; Enzyme linked immunosorbent assay (EIA; ELISA)
    Western blot (WB)
    Immunofluorescent assay (IFA)
    Radio-immunoprecipitation assay (RIPA)
    The most common approach is the use of an EIA test for screening (the initial test) and a western blot for confirmation. It usually takes 7 days for the results to be ready.

    Treatment
    There are a wide range of medications that will slow the progression of HIV infection:

    Antiretroviral therapy - zidovudine (Retrovir or AZT) is the most widely used and reduces mortality, illness, and the number of opportunistic infections when given in combination with other agents such as ddI or ddC. In Australia, anti-HIV medications are available to people in the following circumstances:

    A person with a T4 count less than 500;
    Anyone with an AIDS-related condition;
    Someone with needle-stick injuries from a known HIV-positive person.
    The side-effects of zidovudine treatment can include anaemia, vomiting, insomnia, and myalgia (muscle pain). However, these side-effects are more common on high-dose regimes. The new low-dose regimes have fewer side-effects.

    Side-effects of ddI and ddC include inflammation of the pancreas and damage to nerves.

    Many new anti-HIV drugs have recently been introduced in Australia. More information about these medications is available on the HIV management page in the Diagnosis and Management section for doctors.

    Many of the opportunistic infections that occur with AIDS can be treated with medications such as antibiotics, anti viral drugs (aciclovir), and anti malarial medications.

    Legal and ethical issues
    In South Australia, HIV infection is a notifiable disease, which means that medical practitioners are required by law to notify the HIV Epidemiologist in the Public and Environmental Health Service of the South Australian Health Commission.

    Laws cover donor activities, including blood transfusion.

    Anti-discrimination laws apply to employment, accommodation, education, and the provision of goods and services. The law applies to any physical impairment, and probably includes asymptomatic HIV infection.

    Prevention
    The Australian Federation of AIDS Organisations (AFAO) has defined safe sex in the following way:

    Safe sex is any form of sex in which HIV does not pass from the blood, semen, or vaginal fluids of one person directly into the bloodstream of another person. (AFAO, 1991)

    This definition is specific to HIV/AIDS and does not attempt to deal with other STDs.

    There is more information about safe sex available at the Safe Sex and Condoms page.

    HIV-positive people
    In addition to providing general support, it is also important to support HIV-positive people in preventing the spread of infection. Counselling on safe sex practices so that individuals are clear about what is and what is not safe, is imperative. Education about clean needle and syringe use is important for people who choose to continue injecting drugs. People should be referred to needle exchange programs.

    Pre-test Counselling form "The HIV antibody test"
    (Provided to clients at Clinic 275)

    See HIV Information in the Information for Patients section.












    Post your discussions, comments and suggestions to this thread. Make it Live!
    Last edited by Meteor; 07-13-2012 at 12:45 AM.

 

 

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