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AN OVERVIEW
FOR THE
HEALTH CARE PROFESSIONAL
2ND Edition
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The Institute for Advanced Therapeutics, Inc.
HIV/AIDS
AN OVERVIEW
FOR THE
HEALTH CARE PROFESSIONAL
2nd Edition
Consultant:
Mark D. Blum, D.D.S.
Research and Development:
Charles Edwin Cook, L.M. T., C.R.T.
By:
Renee J. Demmery
Renee J. Demmery
Copyright,

2005All Rights Reserved
2
HIV/AIDS
AN OVERVIEW
FOR THE
HEALTH CARE PROFESSIONAL
2nd Edition
Published By:
The Institute for Advanced Therapeutics, Inc.
P.O. Box 848152
Pembroke Pines, Florida 33084
1-954-441-9553 tel
1-954-432-1824 fax
This course was developed to help expand the knowledge and skills of
massage therapists with respect to the subject of HIV/AIDS. The information in
this course has been derived from various professional sources including but
not limited to Laws and Rules Chapter 480, Massage Practice, Florida Statutes
published by Florida Department of Health Division of Medical Quality
Assurance Board of Massage Therapy 2004, Laws and Rules Chapter 456,
Health Professions and Occupations: General Provisions. Florida Statutes
published by Florida Department of Health Division of Medical Quality
Assurance Board of Massage Therapy 2004, and Rule Chapter 64B7, Florida
Administrative Code published by Florida Department of Health Division of
Medical Quality Assurance Board of Massage Therapy, 2004.
It is the responsibility of the massage therapist to determine which principles
and theories contained herein are appropriate with respect to his/her personal
limitations and scope of practice.
The information in this course has been carefully researched and is generally
accepted as factual at the time of publication. The Institute for Advanced
Therapeutics, Inc. disclaims responsibility for any contradictory data prior to the
publication of the next revision of this course.
NOTE: In this book and test, the use of the words patient and client can be
interchanged. In this book and test, the use of the words massage therapist,
therapist, and practitioner can be interchanged.
The images used herein were obtained from IMSI's MasterClips® and
MasterPhotos Premium Image Collection, 1895 Francisco Blvd. East, San
Rafael, CA 94901-5506, USA.
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TABLE OF CONTENTS
COURSE DIRECTIONS
MAILING INSTRUCTIONS
COURSE OBJECTIVES
WHAT IS HIV/AIDS?
PREVENTION
REDUCING RISK IN THE WORKPLACE
HIV/AIDS TEST
TEST ANSWER CARD/COURSE EVALUATION
REFERENCES
4
COURSE DIRECTIONS
HOW TO BEST PROCEED WITH THIS COURSE
Each chapter should be approached systematically in a careful and objective manner. It
is important to master each chapter before going on to the next. Relax, take your time,
and go at your own pace. As 1 credit of continuing education is rewarded after
successfully completing this course, the reading of this manual and completion of the
test questions should not take less than 1 hour. Only after you have successfully
mastered all the material in the course should you proceed to the test questions.
COMPLETING THE TEST
Before beginning, please clearly write your name, address, zip code, and license
number on your professional ethics test answer card. Read each question carefully
before answering. Please use a #2 pencil to fill-in your answers on the answer card by
completely shading your choice. Keep in mind that each question has only one correct
answer. The test consists of 12 questions. For a passing grade, you must correctly
answer 9 questions. We encourage your input and would welcome any suggestions to
improve our course or test questions. Please feel free to note your suggestions or
comments on the course evaluation found at the bottom of the test answer card.
INFORMATION FOR CERTIFICATION
In order to receive your 1 hour of HIV/AIDS continuing education credit, you must be
a registered purchaser of this course. Only one person per purchase of this course is
eligible to receive credit. Please notify us of any address or name changes as we keep
permanent records for certification and licensure.
MAILING INSTRUCTIONS
Please send your completed test answer card/course evaluation to:
The Institute for Advanced Therapeutics, Inc.
P .0. Box 848152
Pembroke Pines, Florida 33084
If you have any questions regarding this course, please contact our Customer
Service Department at 1-954-441-9553 or fax us at 1-954-432- 1824.
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COURSE OBJECTIVES
Upon completion of this course, you will be able to:
1.
Understand how HIV/AIDS is acquired.
2.
Recognize signs of early HIV infection.
3.
Identify behavior known to increase risk of infection.
4.
Learn ways to reduce risk in the workplace.
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?
WHAT IS HIV/AIDS?
Acquired Immunodeficiency Syndrome (AIDS) has climbed to
epidemic proportions worldwide. According to the Centers for
Disease Control and Prevention (CDC), the cumulative estimated
number of diagnoses of AIDS through 2003 in the United States
is 929,985. Approximately 43,000 people contract HIV in the
United States annually.
Women are now accounting for
approximately 25% to 40% of new cases of HIV infection in the
United States. According to the Joint Nations Programme on
HIV/AIDS, there are 39.4 million people estimated to be living
with HIV/AIDS worldwide today. During 2004, there were an
estimated 4.9 million new HIV infections globally. During 2004,
an estimated 3.1 million people died worldwide as a result of
AIDS.
In the United States, men who have sex with men (MSM) are at
highest risk for infection representing the largest proportion of
new infections.
Unfortunately, to this date, there is no cure and the disease is
100% fatal. As frightening as these statistics are, HIV/AIDS is
largely preventable.
HIV is a virus so tiny it can only be seen with a special electron
microscope. The virus looks like a marble covered with spikes.
As the virus enters the bloodstream, these spikes attach
themselves to receptors on T-4 helper cells.
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Next, the cell membrane begins to swallow the virus at the
receptor site by fusing into the plasma membrane of the T-cell.
Once inside the T-cell, the virus tricks the T-cell into making
copies of it’s HIV genes.
When the HIV copies finally leave the T -cell, thousands of
copies of the original virus pop through the T -cell membrane and
float into the bloodstream and eventually attach to other cells.
This process causes the helper T -cell to die.
8
Since T-4 helper cells are responsible for producing many of the
body’s immune responses, reduction of these cells results in
opportunistic infections and loss of immune defenses – thus the
name human immunodeficiency virus (HIV).
As the immune system weakens, the HIV-infected victim begins
presenting with flu-like symptoms. In the early stages of the
disease, many patients suffer from:
1. Fever.
2. Swollen lymph glands.
3. Fatigue.
4. Diarrhea.
5. Weight loss.
These symptoms then temporarily disappear and the patient feels
much better. Months or years may go by before they begin to feel
sick again. Unfortunately, as the virus spreads, patients become
even sicker, develop more serious infections, and eventually die.
Normally, the human body has 1000 T cells per milliliter of
blood. As T helper cells (CD4 cells) are destroyed, HIV
eventually progresses to AIDS.
A diagnosis of AIDS is made by a physician using specific
clinical or laboratory standards.
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People with AIDS die from opportunistic infections caused by a
weakened immune system. The following are a few conditions
that often develop in people infected with AIDS.
1. Pneumocystis carinii pneumonia.
2. Kaposi’s sarcoma.
3. Extrapulmonary cryptococcosis.
4. Candidiasis of bronchi, trachea, lungs, or esophagus.
5. Tuberculosis.
6. Non-Hodgkin’s lymphoma.
7. Invasive cervical cancer.
8. Disseminated or extrapulmonary histoplasmosis.
9. Progressive multifocal leukoencephalopathy.
10.
Toxoplasmosis of the brain.
11.
Disseminated or extrapulmonary coccidioidomycosis.
12.
Cytomegalovirus (excluding liver, spleen, or nodes).
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PREVENTION
Education is the best prevention against the spread of HIV/AIDS
infection. There are many behaviors that result in transmission of
the disease. As HIV/AIDS is transmitted through blood and body
fluids, avoidance of the exchange of these substances can help
prevent the spread of infection.
There are several groups of people most at risk for HIV/AIDS
based on their high risk behavior:
1.
Homosexual men.
2.
Intravenous drug users.
3.
Prostitutes (male or female).
4.
Hemophiliacs or those with coagulation disorders (via blood
transfusions).
Homosexual men are considered at risk because of the tendency
towards having multiple sex partners and engaging in anal
intercourse. Lack of lubrication during anal intercourse can lead
to micro-abrasions in the anal canal and on the penis allowing for
easier admission of contaminated blood and/ or body fluids into
the bloodstream.
Prostitutes are also at high risk because of multiple partners. This
increases the chance of coming in contact with an HIV- infected
individual. Prostitutes also have a tendency to be users of
intravenous drugs and engage in anal intercourse. They also tend
to have sexually-transmitted diseases that cause lesions thereby
leaving an opening for the HIV virus to enter the body.
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Intravenous drug users who share needles and syringes are at
high risk of contracting HIV by inadvertently using blood-tinged
syringes infected with the HIV virus. Also, the use of mindaltering drugs may inhibit good judgment leading to unprotected
sex and other high risk behaviors.
Hemophiliacs and persons with coagulation disorders that have
frequent blood transfusions increase the chance of receiving
blood from an HIV-infected donor. This is becoming less likely,
however, as donated blood is now tested for HIV among other
diseases. Unfortunately however, the risk is still there because
HIV-infected donors who have recently acquired the virus may
not yet have HIV antibodies detected in the blood.
The following behaviors are considered low risk.
1. Sex with a limited number of partners.
2. Proper latex condom use along with spermicide containing
nonoxynol-9.
3. Sex with partners testing negative for HIV.
4. The use of appropriate protective barriers among health
care professionals who may come in contact with blood
and/or body fluids.
The following are considered no risk behavior.
1. Sexual abstinence.
2. Avoidance of blood and/or body fluids of other individuals.
3. Mutual monogamy when both partners are HIV negative.
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Some individuals may falsely believe that proper latex condom
use completely eliminates the risk of HIV infection. While it may
be true that latex condom use greatly reduces the risk of HIV
transmission, condoms sometimes break, leak, or slip off during
intercourse.
Another misconception is having one's sexual partner test
negative for HIV completely eliminates the risk of contracting
HIV. The truth is, newly infected individuals may test negative
for HIV antibodies for up to several months after acquiring the
virus.
REDUCING RISK IN THE WORKPLACE
As health care professionals, there are precautions we can take to
avoid infection. First, we must treat every patient as if they are
HIV-infected. Many persons with HIV/AIDS do not exhibit
obvious symptoms of the disease and may appear to be healthy.
Precautions should even be taken with patients who deny being
infected with HIV, as they may not realize they are infected or
they may be concealing their disease for fear of discrimination.
THE BARRIER METHOD
Today, health care professionals have a wide variety of physical
barrier devices available. These devices are designed to reduce or
prevent contact with blood and/or body fluids of patients who
may be infected with the HIV virus or other communicable
diseases. Some examples of protective gear include:
1. Gloves.
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2. Protective face shields or safety glasses.
3. Face masks.
4. Gowns and aprons.
Gloves should always be worn on practitioners with dry, chapped
hands or cuts on the hands. Patients may have minute breaks in
the skin which may allow for easy transfer of the HIV virus.
Gloves should never be re-used. They should be removed by
rolling them off the hands inside out and discarded in a container
for infectious waste.
Contaminated gowns and aprons should be placed in an
appropriately labeled covered container and undergo a
sterilization process before being reused. The water temperature
should reach at least 140° F. The heat generated in most dryers
will usually be sufficient for decontamination.
Protective face shields or safety glasses prevent blood or body
fluids from getting into the eyes, which is one of the most
vulnerable openings in the body.
NEEDLES AND SHARP INSTRUMENTS
Needles and sharp instruments should be handled with care.
Needles should never be recapped or transported out of the
treatment room. They must be discarded in a puncture resistant
container visibly labeled for biomedical infectious waste. Heavy
duty gloves and appropriate face protection should be worn when
giving patients injections or drawing blood.
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DISINFECTION AND STERILIZATION
Before coming in contact with each patient, each health care
worker should wash their hands with antibacterial soap and
water. Soaps containing 4% chlorhexidine gluconate or 3%
parachlorometaxylenol (PCMX) are considered the best. If
unprotected skin should come in contact with a patient's body
fluids or blood, a solution of 70% alcohol or povidone iodine
(Betadine) is recommended to disinfect the skin.
If blood or body fluids should spill, disinfection can be
accomplished using a solution of sodium hypochlorite (1 part
household bleach to 99 parts water or 1/4 cup bleach to 1 gallon
of water) prepared daily.
Bleach, however, is corrosive to metals (especially aluminum)
and should not be used to decontaminate medical instruments
with metallic parts.
Gloves should always be
decontaminating procedures.
worn
during
cleaning
and
Disinfect all equipment and surfaces in the workplace after
contact with each patient using the above technique. Keeping a
sanitary work environment will reduce the risk of HIV and other
infectious diseases.
END OF COURSE
15
REFERENCES
1. Laws and Rules Chapter 381, Public Health:
Provisions, The 2004 Florida Statutes.
General
2. HIV/AIDS Surveillance Reports December 2003, Centers for
Disease Control and Prevention.
3. “Laundry”. Division of Healthcare Quality Promotion, Issues
in Healthcare Settings. November 2000.
4. “Surveillance of Health Care Workers with HIV/AIDS”.
Centers for Disease Control and Prevention. February 2002.
5. “Can I Get HIV From Oral Sex?” Centers for Disease Control
and Prevention.
Divisions of HIV/AIDS Prevention.
December 2003.
6. “Can I Get HIV From Vaginal Sex?” Centers for Disease
Control and Prevention. Divisions of HIV/AIDS Prevention.
December 2003.
7.
“Can I Get HIV From Anal Sex?” Centers for Disease
Control and Prevention. Divisions of HIV/AIDS Prevention.
December 2003.
8.
“How Effective are Latex Condoms in Preventing HIV?”
Centers for Disease Control and Prevention. Divisions of
HIV/AIDS Prevention. December 2003.
9.
“Can I Get HIV From Kissing?” Centers for Disease Control
and Prevention.
Divisions of HIV/AIDS Prevention.
December 2003.
10. “How is HIV Passed from One Person to Another?” Centers
for Disease Control and Prevention. Divisions of HIV/AIDS
Prevention. December 2003.
16
11. “How Does HIV Cause AIDS?” Centers for Disease Control
and Prevention.
Divisions of HIV/AIDS Prevention.
December 2003.
12. “Sterilization of Disinfection of Medical Devices: General
Principles”. Division of Healthcare Quality Promotion, Issues
in Healthcare Settings. August 2002.
13. “What is HIV?” Centers for Disease Control and Prevention.
Divisions of HIV/AIDS Prevention. December 2003.
14. “What is AIDS? What Causes AIDS?” Centers for Disease
Control and Prevention. Divisions of HIV/AIDS Prevention.
December 2003.
15. “Why Do Some People Make Statements that HIV Does Not
Cause AIDS?” Centers for Disease Control and Prevention.
Divisions of HIV/AIDS Prevention. December 2003.
16. “How Long Does it Take for HIV to Cause AIDS?” Centers
for Disease Control and Prevention. Divisions of HIV/AIDS
Prevention. December 2003.
17. “How Can I Tell if I’m Infected with HIV? Centers for
Disease Control and Prevention. Divisions of HIV/AIDS
Prevention. December 2003.
18. “Preventing Occupational HIV Transmission to Healthcare
Personnel.” Centers for Disease Control and Prevention.
Divisions of HIV/AIDS Prevention. February 2002.
19. “Sterilization of Disinfection of Patient-Care Equipment: HIV
Related”. Division of Healthcare Quality Promotion, Issues in
Healthcare Settings. November 2000.
17
20. “Appendix A. Practice Recommendations for Health-Care
Facilities Implementing the U.S. Public Health Service
Guidelines for Management of Occupational Exposures to
Bloodborne Pathogens”. MMWR Recommendations and
Reports June 29, 2001 / 50(RR11);43-44.
21. “Updated U.S. Public Health Service Guidelines for the
Management of Occupational Exposures to HBV, HCV, and
HIV and Recommendations for Postexposure Prophylaxis”.
MMWR Recommendations and Reports. U.S. Department of
Health and Human Services. June 29, 2001 / Vol. 50 / No.
RR-11.
22. Larson, Elaine and 1992, 1993, and 1994 APIC Guidelines
Committee Association for Professionals in Infection Control
and Epidemiology, Inc. “APIC Guideline for Hand Washing
and Hand Antisepsis in Health-Care Settings”. APIC, Inc.
1995.
23. “Exposure To Blood: What Healthcare Personnel Need To
Know.” National Center for Infectious Diseases. Centers for
Disease Control and Prevention. July 2003.
24. Joint
Nations
www.unaids.org.
Programme
18
on
HIV/AIDS
2004.