Download HIV/ AIDS

Infectious Diseases in Healthcare
Focusing on HIV/ AIDS
SM II
Objective
• The purpose of this unit is to increase
your knowledge and understanding of
HIV and AIDS and review some
important information about other
infectious diseases commonly
encountered in healthcare.
Outline
• Dates and StatisticsHIV/ AIDS
• HIV Transmission and
Infection
• HIV Testing
• Stages of HIV Infection
• How HIV Works in the
Body
• Treatment for HIV
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Tuberculosis
Hepatitis B
Hepatitis C
Risk of BBP
Transmission
Disinfecting and
Disposal
Treatment after
Potential Exposure
Legal and Ethical Issues
Psychosocial Issues
Dates and Statistics- HIV/ AIDS
Dates and Statistics- HIV/ AIDS
• In 1999, an international team of
researchers reported that they traced
the origin of HIV-1 to a subspecies of
chimpanzees native to west equatorial
Africa. The researchers believe that
HIV-1 was introduced into the human
population when hunters became
exposed to infected blood.
Dates and Statistics- HIV/ AIDS
• AIDS was first recognized in the United
States in 1981.
• The first reported case in Washington
State was in 1982.
• In 1983, HIV was discovered to be the
cause of AIDS.
• The first HIV antibody test was
available in 1985.
Dates and Statistics- HIV/ AIDS
• Globally, most of the people who are
infected with HIV have not been tested
and are unaware that they are living
with the virus.
• The CDC estimates that 25% of people
with HIV are unaware that they have
the disease.
Dates and Statistics- HIV/ AIDS
• The CDC estimates that there are
between 1,039,000 and 1,185,000
persons infected with HIV in the US.
• The CDC estimates that there are
40,000 people in the US who become
newly infected with HIV each year.
Dates and Statistics- HIV/ AIDS
• 2000: 3 million deaths from AIDS worldwide.
• 2005: The United Nations AIDS Program
estimates there were 38.6 million people in
the world living with HIV or AIDS.
• 2005: An estimated 4.1 million people
worldwide became infected with HIV. Half of
the new infections were in people between
the ages of 15 and 24.
Dates and Statistics- HIV/ AIDS
• 2004: Estimated 41,000+ cases of AIDS
in the United States.
• 2004: Estimated 15,000+ deaths of
persons with AIDS, down from 17,000+
in 2000.
Dates and Statistics- HIV/ AIDS
• The discovery of antiviral “combination”
drug therapies in 1996 resulted in a
dramatic increase in the number of
deaths due to AIDS (in the people
taking the drug therapies).
HIV Transmission and Infection
HIV Transmission and Infection
• HIV is considered to be a fragile virus
when exposed to air and room
temperatures and is not spread by
casual contact.
• It must be acquired.
HIV Transmission and Infection
•
In order for HIV transmission to occur,
this means:
1. There must be a source of HIV (pathogen
present).
2. There must be a sufficient dose of the
virus (sufficient quantity).
3. There must be access to the bloodstream
of another person (correct entry site).
HIV Transmission and Infection
• Anyone infected with the virus is potentially a
source of HIV infection.
• Transmission occurs primarily through
infected:
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Blood
Semen
Vaginal Secretions
Breast Milk
From Infected Mother to Baby either before or
during birth
HIV Transmission and Infection
• Unless visibly contaminated with
blood the following are not generally
considered capable of transmitting HIV:
– Sweat
– Tears
– Saliva
– Urine
– Feces
HIV Transmission and Infection
• Other bodily fluids such as:
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Cerebrospinal Fluid
Synovial Fluid (joint)
Pleural Fluid (lung)
Pericardial Fluid (heart)
Amniotic Fluid
• May be considered infectious if the source is
HIV positive.
• However, these fluids are not generally found
outside a hospital setting.
HIV Transmission and Infection
• HIV is not transmitted through the air.
• Sneezing, breathing and coughing do
not transmit HIV.
• Touching, hugging and shaking hands
do not transmit HIV.
• HIV transmission is not possible from
food that is prepared by an HIVinfected people.
HIV Transmission and Infection
• HIV is not transmitted through casual
contact in the workplace.
• No cases of HIV transmission have been
linked to sharing computers, food,
telephone, paper, water fountains,
swimming pools, bathrooms, desks,
office furniture, toilet seats, showers,
tools, equipment, coffee pots or eating
facilities.
HIV Transmission and Infection
• However, personal items which may be
contaminated with blood, such as
toothbrushes and razors, should not be
shared.
HIV Transmission and Infection
• There aren’t any documented cases of
HIV transmission through participation
in athletics.
HIV Testing
HIV Testing
• The first HIV antibody test was
available in 1985.
• Currently antibody tests have a two
step process:
– Screening Test
• And if the screening test is reactive a:
– Confirmatory Test
HIV Testing
• The first test is a screening test that
screens for the presence of antibodies
to HIV in blood, urine or oral fluid.
• Screening tests are inexpensive tests
that are highly accurate.
HIV Testing
• There are conventional screening tests where
a specimen is collected from a person and
sent to the laboratory for testing.
• If the screening test is negative, results are
given to the patient.
• If the screening test is positive, an addition
confirmatory test is performed on the same
specimen before results are given to the
patient.
HIV Testing
• There are also rapid screening tests
where the test is conducted at the
testing site.
• Since testing is done at the testing site,
results are often available in an hour or
so.
• “Reactive” or positive test results must
be confirmed by additional testing.
HIV Testing
• There is a small chance that HIV
screening tests may detect proteins
related to other autoimmune diseases
and “react” to these proteins with a
“positive” result.
• Any positive screening test need to be
confirmed by a confirmatory test called
the Western Blot Test.
HIV Testing
• The Western Blot Test is done to verify
the presence of HIV antibodies.
• The Western Blot Test is much more
specific (but more expensive) than the
screening tests.
HIV Testing
• Note: The virus is the disease. The
virus causes infection. Antibodies are
the immune system’s response to the
disease. Antibodies are not the disease
and do not cause the disease, they fight
the infection.
HIV Testing
• It is important to remember that HIV
antibody testing has a “window period”.
• Until the infected person’s immune
system makes enough antibodies to be
detected, the test will be negative even
though the person is infected with HIV.
HIV Testing
• Some infected people are able to
produce antibodies as early as two
weeks after infection and almost
everybody who is infected will produce
enough antibodies by 12 weeks.
• Therefore, to be sure people should test
three months after the last potential
HIV exposure.
HIV Testing
•
A positive screening test and Western
Blot Test (confirmatory test) means:
1. The person is infected with HIV.
2. The person can spread the virus to
others.
3. The person is infected for life.
HIV Testing
•
Remember, if the test is negative it
means one of two things:
1. The person is not infected with HIV
OR
2. The person became infected recently and
has not produced enough antibodies to
be detected by the test
HIV Testing
• If a person is tested confidentially (he
or she gives real name), a positive HIV
test result is reported to the local
healthcare officer.
• Anonymous testing does not involve
giving a real name so a positive HIV
result is not reportable.
HIV Testing
• It is important to remember that
information about a person’s HIV status
is confidential and must not be shared
with others.
• People who perform HIV counseling and
testing must sign strict confidentiality
agreements.
• Patient records are kept in locked files.
How HIV Works in the Body
How HIV Works in the Body
• HIV enters the bloodstream and seeks out
“T-helper lymphocyte”, the white blood cells
(lymphocytes) essential to the functioning of
the immune system.
• One of the functions of the T-helper
lymphocytes is to regulate the immune
system response in the event of an attack
from disease-causing organisms such as
bacteria or viruses.
• When HIV infects the T-helper lymphocytes,
the cell sends signals to other cells which
produce antibodies.
How HIV Works in the Body
• Antibodies are produced by the immune
system to help get rid of specific foreign
invaders that can cause disease.
• Producing antibodies is an essential function
of our immune system.
• The body makes a specific antibody for each
disease.
• When our immune system is working
properly, it protects against these foreign
invaders.
How HIV Works in the Body
• HIV infects and destroys the T-helper
lymphocytes and damages their ability
to signal for antibody protection.
• This results in the eventual decline of
the immune system.
How HIV Works in the Body
• HIV Affects:
– The kind and number of blood cells
– The amount of fat and muscle distribution
in the body
– The structure and functioning of the brain
– The normal functioning of the immune
system
– The body’s basic metabolism
How HIV Works in the Body
• HIV Can Cause:
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Confusion or dementia
Diarrhea
Fatigue
Fever
Nausea or vomiting
Painful joints, muscles or nerve pain
Difficulty breathing
Vision or hearing loss
Chronic pneumonias, sinusitis or bronchitis
Loss of muscle tissue and body weight
How HIV Works in the Body
• It is important to know that children show
significant differences in their HIV disease
progression.
• Without drug treatment, most children are
very sick by age 7.
• Significant improvements have been made
and in 1994, it was discovered that a short
course of the medication AZT for HIV positive
pregnant women would dramatically decrease
the number of children infected in he womb.
Stages of HIV Infection
Stages of HIV Infection
• After viral transmission, the first stage of HIV
disease is primary/ acute HIV infection,
typically lasting only a week or two, when the
virus first establishes itself in the body.
• During the first few weeks of HIV infection,
an infected person has a very high amount of
virus in his or he bloodstream.
• An HIV infected person may become
infectious to other within 5 days of viral
transmission.
Stages of HIV Infection
• Remember, during primary infection, most
people are unaware they have HIV.
• The most common symptoms noticed by
persons newly infected by HIV are fever,
swollen glands, rash, fatigue and a sore
throat.
• These symptoms are also common with many
other types of infections (like mononucleosis).
Stages of HIV Infection
• The “Window Period” is the period of time
between when the body first becomes
infected with HIV and when the body is able
to produce antibodies to HIV.
• It may take between two weeks to three
months for antibodies to develop. Most
people develop antibodies by 6 to 12 weeks.
• During the window period, the person is
“infectious”, meaning he or she can pass the
virus to someone else, and will remain
infectious throughout life.
Stages of HIV Infection
• The window period is the time when a person
may not produce sufficient antibodies to be
detectable on an HIV antibody test.
• This means they might get a negative result
on an antibody test, while actually having
HIV.
• This is why a newly infected person can infect
others before antibodies develop, when high
amounts of virus in the blood are present,
and the newly infected person does not yet
know they have HIV.
Stages of HIV Infection
• After the acute stage of HIV infection,
people infected with HIV continue to
look and feel completely well for long
periods, usually for many years.
• This is generally referred to as the
asymptomatic stage.
Stages of HIV Infection
• During this time, the virus is replicating
and slowly destroying T-helper
lymphocytes and the immune system.
• This means that although the person
may look and feel healthy, he or she
can infect other people, especially if the
person has not been tested and doesn’t
know he or she is infected.
Stages of HIV Infection
• Without antiretroviral therapy, there is
an average of ten years between the
time a person is infected with HIV and
the start of persistent symptoms of
AIDS.
Stages of HIV Infection
• During the symptomatic stage of HIV
infection, the person begins to have
noticeable physical symptoms that are
related to HIV.
• There are no symptoms that are
specific to HIV.
Stages of HIV Infection
• Some common symptoms include:
– Persistent low grade fever
– Pronounced weight loss not due to dieting
– Persistent headaches
– Diarrhea lasting more than one month
– Difficulty recovering from colds and the flu
– May become sicker than they normally
would
Stages of HIV Infection
• An AIDS diagnosis must be made by a
licensed healthcare provider.
• The diagnosis is based on a positive
HIV blood test and the person’s
physical condition.
• There is a list of “AIDS- defining
illnesses” as well as white blood cell
counts and other conditions.
Stages of HIV Infection
• Once a person has been diagnosed with
AIDS, they do not “go backwards” in
diagnosis even though they may feel better.
• Over time, people with AIDS frequently have
a reduced white blood cell count and develop
poor health.
• When a person’s immune system is
suppressed, they have weaker defenses
against a variety of bacteria, viruses and
other pathogens.
Treatment for HIV
Treatment for HIV
• Research led an important discovery in HIV
therapy in 1996.
• Taking combinations of medications, called
“highly active antiretroviral therapy” (HAART)
may drastically reduce the amount of HIV in a
person’s bloodstream.
• It is important to note that this therapy DOES
NOT CURE HIV/ AIDS.
Treatment for HIV
• Not everyone with HIV benefits from
HAART.
• Some people cannot tolerate the side
effects or follow the complex treatment
schedule.
• The cost of these medications may be
upwards of $2,000 each month.
Treatment for HIV
• Many promising developments have
been made towards an HIV vaccine.
• It is possible that a vaccine will be
available this decade……
• Right now, prevention is the only way
to avoid HIV infection.
Tuberculosis
Tuberculosis
• Tuberculosis (TB) is transmitted by
airborne droplets from people with
active TB during coughing, sneezing or
talking.
• TB can live anywhere in the body, but
pulmonary (lungs) or laryngeal (larynx)
TB is the greatest threat to public
health.
Tuberculosis
• There are probably 8 million active
cases of TB in the world each year.
• TB is one of the leading causes of death
globally.
Tuberculosis
• When infectious secretions from a
person with TB are breathed in by
another person, the bacteria may come
to rest in the lungs.
• After several weeks, the bacteria
multiply and some pneumonia-like
symptoms may occur.
Tuberculosis
• The TB bacteria are carried through the
bloodstream and lymph system,
pumped through the heart and to the
body.
• The largest amount of bacteria usually
goes to the lungs.
• In most cases this process resolves by
itself.
Tuberculosis
• In 90% of the cases of TB, “latent TB”
develops and the person never
experiences subsequent disease.
• In 10% of the cases, the person will
develop active TB at some point.
Tuberculosis
• Symptoms of TB Include:
– Cough
– Weight Loss
– Fever
Tuberculosis
• Studies have shown that daily
preventative therapy for 6 months may
reduce the risk for TB disease by 69%
in patients with latent TB.
Hepatitis B
Hepatitis B
• Hepatitis B (HBV) is a virus that is
transmitted by the blood and bodily
fluids of an infected person.
Hepatitis B
• Each year in the US, an estimated
60,000 people become infected with
HBV.
• There are an estimated 1,250,000
carriers of HBV in the US.
• Each year, 4,000 to 5,000 people will
die in the US from chronic liver disease
or liver cancer caused by HBV.
Hepatitis B
• It is important to remember that HBV is a
blood borne pathogen and is spread by
contact with infected blood or bodily fluids.
• HBV is NOT Transmitted By:
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Sneezing
Hugging
Coughing
Sharing eating utensils or drinking glasses
Food or water
Hepatitis B
• The average incubation period for HBV
is about 12 weeks.
• HBV causes damage to the liver and
other body systems, which can range in
severity from mild, to severe, to fatal.
Hepatitis B
• Most people recover from their HBV
infection and do not become carriers.
• Carriers (about 2-6% of people who
become infected) have the virus in their
body for months, years or life.
• They can infect others with HBV
through contact with their blood or
other bodily fluid.
Hepatitis B
• People with HBV may look and feel fine.
• Some people with HBV display only mild
symptoms:
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Loss of appetite
Extreme fatigue
Abdominal pain
Jaundice
Joint Pain
Malaise
Dark urine
Nausea or vomiting
Skin rashes
Hepatitis B
• Some people who are infected with HBV
experience more severe symptoms, and may
be incapacitated for weeks or months.
• Long-term complications are also possible
and include:
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Chronic hepatitis
Recurring liver disease
Liver failure
Chronic liver damage (cirrhosis)
Hepatitis B
• A vaccine is available to prevent HBV
(and has been since 1982).
• The vaccine is given intramuscularly by
3 shots over 6 months.
• More than 90% of people who complete
the 3 injections are immune to HBV.
• The vaccine is suitable for all ages,
even infants.
Hepatitis B
• Follow Standard and Universal
Precautions to avoid contact with blood,
bodily fluid or accidental needle sticks.
Hepatitis C
Hepatitis C
• Hepatitis C (HCV) is a liver disease caused by
the hepatitis C virus.
• HCV is the leading cause of chronic liver
disease in the US.
• Globally, 180 million people are infected with
HCV.
• In the US, an estimated 4.1 million people
have been infected with HCV.
• The CDC estimates that 3.75 million
Americans do not know they are HCV
positive.
Hepatitis C
• In the US, 8,000 to 10,000 deaths per
year are attributed to HCV-associated
liver disease and the number of deaths
is expected to triple in the next 10- 20
years.
Hepatitis C
• HCV is transmitted primarily by blood and
blood products (transfusions).
• HCV is not transmitted by:
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Sneezing
Hugging
Kissing
Coughing
Sharing eating utensils or drinking glasses
Food or water
Hepatitis C
• The CDC estimates that for every 100
people who are infected with HCV:
– About 15% will recover fully and have no
liver damage
– 85% may develop long term infection
– 70% may develop chronic liver disease
– 20% may develop liver damage (cirrhosis)
over a period of 20-30 years
– 1-5% may die from chronic liver disease
Hepatitis C
• The symptoms of HCV include:
– Nausea and vomiting
– Weakness
– Fever
– Muscle and joint pain
– Jaundice
– Dark-colored urine
– Tenderness in the upper abdomen
Hepatitis C
• There is no vaccine to prevent HCV
infection.
• Follow Universal and Standard
Precautions to avoid contact with blood,
bodily fluids or accidental needle sticks.
Risk of BBP Transmission
Risk of BBP Transmission
• The risk of HIV infection to a healthcare
worker through a needle stick is less
than 1 percent. Approximately 1 in 300
exposures through a needle or sharp
instrument result in infection.
Risk of BBP Transmission
• The risk of HIV infection through
splashes of blood to the eyes, nose or
mouth is even smaller- approximately 1
in 1,000.
Risk of BBP Transmission
• There have been no reported cases of
HIV transmission from blood contact
with intact skin.
• There is a theoretical risk of of blood
contact to an area of skin that is
damaged, or from a large area of skin
that is covered in blood from a long
period of time.
Risk of BBP Transmission
• The risk of getting HBV from a needle
stick is 22-31%.
• The risk of getting HCV from a needle
stick is 1.8%
Risk of BBP Transmission
• The risk of getting HBV or HCV from a
blood splash to the eyes, nose or moth
is possible but believed to be very
small.
Disinfectant and Disposal
Disinfectant and Disposal
• If there is blood on a vinyl floor, pre-treat
with full-strength disinfectant or detergent.
• Wipe up the body fluid spill with either a mop
and hot, soapy water or appropriate gloves
and paper towels.
• Use a good disinfectant (1 part bleach to 10
parts water) to disinfect the area where the
spill occurred.
• If a mop or sponges are used to clean up
bodily fluid, they should be soaked and water
disposed of in the toilet instead of a sink.
Disinfectant and Disposal
• If there is a blood spill on the carpet, pour
dry kitty litter or other absorbent on the spill.
• Then pour full-strength liquid detergent on
the carpet to help disinfect the area.
• Use a carpet safe liquid disinfectant (instead
of 10% bleach solution) on the entire
contaminated area.
• Follow this by absorbing the spill with paper
towels and sturdy rubber gloves.
• Vacuum normally afterwards.
Disinfectant and Disposal
• If there is blood or OPIM on clothing, remove
it as soon as possible.
• Soak the clothing in cold, soapy water to
remove any blood from the clothing. Hot
water permanently sets blood stains.
• Use hot soapy water for the next washing
cycle and include sufficient detergent which
will act as a disinfectant.
• Dry items in a clothes dryer.
Disinfectant and Disposal
• Disposal of needles and other sharp
instruments (“sharps”) needs to be
done in a puncture resistant container
(sharps container).
Disinfectant and Disposal
• Found used syringes or needles present
a risk for HIV, HBV, HCV and other
pathogens.
• If you find a syringe or needle, do not
pick it up with your bare hands. Use
gloves and tongs, shovel or broom and
dustpan to pick it up.
• Hold the needle away from your body.
Disinfectant and Disposal
• Do not break the needle from the
syringe.
• Do not flush needles or syringes down
the toilet.
Disinfectant and Disposal
• Please used sharps and syringes in a safe
container- one with at least a one-inch
opening and a lid that will seal tightly.
• An empty plastic laundry detergent,
shampoo, pickle, oil or similar bottle or jar
will work.
• If a glass jar is used, place it in a larger
plastic bucket or container that has a tight
fitting lid.
• Soda cans are not good disposal containers
(people often try to recycle discarded cans).
Disinfectant and Disposal
• Tape the lid hut for added safety.
• Label it with the warning, “Sharps, do
not recycle”.
• Call the local health department to find
a disposal site.
Treatment after Potential
Exposure at Work
Treatment after Potential Exposure
at Work
• Follow the protocol of your employer.
• As soon as safely possible, wash the
affected area (s) with soap and water.
• Application of antiseptics should not be
a substitute for washing.
• It is recommended that any potentially
contaminated clothing be removed as
soon as possible.
Treatment after Potential Exposure
at Work
• If the exposure is to the eyes, nose or
mouth, flush thoroughly with water,
saline or sterile irrigates.
• The risk of contracting HIV through this
type of exposure is estimated to be less
one percent.
• Follow up with your employer and
healthcare provider ASAP.
Treatment after Potential Exposure
at Work
• If you have a SHARPS injury or needle stick,
wash the exposed area with soap and water.
• You may use antiseptics if you like, but there
is no evidence to show it will reduce the risk
of transmission.
• The risk of contracting HIV from this type of
exposure is 0.3%.
• Follow up with your employer and healthcare
provider ASAP.
Treatment after Potential Exposure
at Work
• If you have a bite or scratch wound, it is
important to know that exposure to saliva is
not considered substantial unless there is
visible contamination from blood or the saliva
is from a dental procedure.
• Wash the area with soap and water and
cover with sterile gauze.
• Follow up with your employer and healthcare
provider ASAP. All bites should be evaluated
by a doctor.
Treatment after Potential Exposure
at Work
• Exposure to urine, feces or vomit is not
considered a potential BBP exposure
unless the fluid is visibly contaminated
with blood.
Treatment after Potential Exposure
at Work
• Post-exposure prophylaxis (PEP)
provides anti-HIV medications to
someone who has had a substantial
exposure, usually to blood.
• Research suggests that cellular HIV
infection happens within 2 days of
exposure to HIV and the virus is
detectable in the blood within 5 days.
Treatment after Potential Exposure
at Work
• PEP should be started as soon as
possible, within hours not days, after
exposure and continued for 28 days.
Treatment after Potential Exposure
at Work
• PEP is not as simple as swallowing one
pill. The medications must be started
as soon as possible and continued for
28 days.
• Many people experience significant
medication side effects.
Treatment after Potential Exposure
at Work
• Please note: PEP for HIV does not
provide prevention of other BBPs, like
HBV or HCV.
• PEP for HBV for susceptible persons
would include administration of HBV
vaccine and hepatitis B immune globulin
and needs to occur no later then 7 days
after exposure.
Treatment after Potential Exposure
at Work
• Antibody testing for HIV, HBV and HCV
should be conducted for more than 6
months after exposure at work.
• After baseline testing at the time of the
exposure, follow-up testing should be
done at 6 weeks, 12 weeks and 6
months after exposure (up to 12
months if there is the possibility of
exposure to HIV and HCV).
Legal and Ethical Issues
Surrounding HIV and BBPs
Legal and Ethical Issues
• AIDS, symptomatic HIV infection and
asymptomatic HIV infection are all reportable
conditions.
• “Reportable” means that in the case of HIV
or AIDS, the provider who diagnoses the
person, must submit a confidential case
report to the local health jurisdiction within 3
days.
• Reporting of HIV and AIDS cases assists local
and state officials in tracking the epidemic
and allows for planning and intervention
efforts.
Legal and Ethical Issues
• All medical records are confidential and
there are special requirements
concerning HIV and AIDS.
• Confidentiality of medical records
means that a person’s medical
information (including HIV and AIDS
status) may not be disclosed to anyone
unless the individual signs a medical
release.
Legal and Ethical Issues
• However, there are some exceptions to this.
• Medical information can be disclosed under
certain circumstances including:
– From one health care provider to another for
related on-going medical care.
– Life or death emergency
– To a third party payor (insurance)
– In the case of reportable conditions to the
Department of Health (DOH)
Legal and Ethical Issues
• Violation of confidentiality of medical
records is a misdemeanor and may
result in fines of $10,000 or the actual
damages in the case, whichever is
greater.
Legal and Ethical Issues
• HIV and AIDS status (and other
conditions) fall under additional
protection because disclosure of the
information to the wrong person or
agency could result in additional harm
to the patient.
• There is a level of prejudice, fear and
discrimination directed at people with
these medical conditions.
Legal and Ethical Issues
• People with AIDS and HIV are protected
under a number of state and federal
(national) laws including the Americans with
Disability Act (ADA).
• These laws mean that it is illegal to
discriminate against people with AIDS or HIV,
on the basis of their medical condition and
that reasonable accommodations need to be
made in the workplace.
Legal and Ethical Issues
• Washington State law also gives state
and local health care officials the
authority to carry out certain measures
to protect the public from the spread of
sexually transmitted diseases including
HIV.
• The local health officer is a physician
hired to direct the operations of the
local county’s health department.
Legal and Ethical Issues
• The local health officer has the authority to:
– Interview persons with a disease
– Notify partners of exposure to a disease
– Order persons suspected of being infected to
receive testing and treatment
– Issue orders to cease and desist from behaviors
that endanger the public
– Can take the additional step of detention of an
HIV infected individual who continues to endanger
the health of others
Psychosocial Issues
Psychosocial Issues
• Persons with HIV and their families and
friends must face many difficult realities
including (but not limited to):
– Even with current therapies, people with AIDS still
die prematurely
– Social pressure, stress and discrimination
– 90% of all adults with AIDS are in the prime of life
and not prepared to deal with death and dying
– The infections and malignancies that accompany
AIDS can diminish and disfigure the body
– Taking medications for the rest of their lives
Psychosocial Issues
• HIV often produces many losses including
(but not limited to) loss of:
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Physical strength and abilities
Mental abilities
Income and savings
Health insurance
Job/ work
Housing and personal possessions (pets)
Self-sufficiency and privacy
Social contacts
Self Esteem
Psychosocial Issues
• People experiencing these types of
losses may feel:
– Guilt
– Grief
– Helplessness
– Rage
– “Numbness”
Psychosocial Issues
• Don’t forget that friends and caregivers
may go through some of these same
stages and need support as well as the
patient.
References/ Resources
•
•
•
•
www.cdc.gov
Arnheim’s Principles of Athletic Training
Sports Medicine Essentials
Washington State DOH KNOW 2007