Yes, this is the virus itself

AIDS 101
An Introduction to AIDS

Since people approach AIDS with varying levels of education and understanding, this bulletin board service provides what we call "AIDS 101". It is okay to start with little or no knowledge of AIDS, ARC, or safer sex. It is not okay to never find out. When it comes to AIDS prevention, knowledge really is power. <1> What is AIDS? <2> What is ARC? <3> How Does HIV Affect the Body? <4> What Are Symptoms of AIDS and ARC? <5> How is AIDS Transmitted? <6> Who Gets AIDS? <7> How Do I Prevent AIDS? <8> What is Safer Sex? <9> Everything You Need to Know About Condoms <10> AIDS and Drugs <11> Should I Take the AIDS Antibody Test? <12> Does Everyone Infected with the AIDS Virus Die? <13> Where Can I Get More Information on AIDS and AIDS Testing? <14> The Global Impact of AIDS <15> Pamphlet: About HIV Disease: Testing for HIV, Stages of HIV Disease, Therapies <16> Pamphlet: Staying Healthy <17> 11 Questions Most Frequently Asked by Physicians <18> Voluntary HIV Counseling and Testing: Facts, Issues, and Answers <00> AIDS INFORMATION HOTLINES (National and State) 1) What is AIDS? ---------------- AIDS stands for Acquired Immune Deficiency Syndrome. First discovered in the United States in 1981, AIDS has spread rapidly, killing men, women and children, Blacks, whites, Latinos and Asians, heterosexuals, homosexuals, the rich and the poor. To date over 90,000 people in the United States have died from AIDS and the number of diagnosed AIDS case doubles every 13 to 15 months. There is no cure for AIDS: PREVENTION is the only way to stem the spread of this deadly virus. Human immunodeficiency virus (HIV), the virus which causes AIDS, debilitates the immune system - that part of the body which normally protects against disease -leaving the individual vulnerable to rare infections which they could have easily fought off earlier. These infections can be deadly. More than half the people diagnosed with AIDS have already died from the disease. Once a person is infected with HIV there is no way to destroy or rid the body of the virus. There is hope for effective treatments to thwart the effects of HIV. The drug AZT (Zidovudine) inhibits replication of the virus within the body. AZT may prolong the lives of people with AIDS and even prevent the appearance of symptoms related to HIV infection. Researchers are continuing to search for other ways to fight AIDS. Experimental vaccines to protect against HIV infection are now being tested. If one of these proves to be successful immunization against AIDS infection may begin in the 1990s. AIDS is not contagious, that is, it is not spread by casual contact; therefore there is no need to fear people who have HIV or AIDS. You can not get AIDS by touching people, eating in restaurants, or being near someone who has with AIDS. You won't get AIDS from your pets, toilets, swimming pools, dishes or bugs. AIDS is spread mainly through sexual intercourse and sharing drug needles with infected IV drug users. Women who are infected with the virus can also transmit the disease to their unborn child. Why haven't we heard about it before? AIDS was not recognized or described as a disease until 1981. Tracking of AIDS only began when doctors had seen enough of it to recognize that they were faced with a serious, previously unknown disease. In 1981, 316 people in the United States had AIDS. Five years later (by August, 1986), over 23,000 cases were reported here. A tremendous growth in the rate of the disease has continued and today we have over 60,000 reported cases. This is alarming, and scientists, health professionals and the general public have all become extremely concerned about it. The exact origins of AIDS are not known. Either it is a new human disease that developed recently, or it is a disease that was, until recently, isolated in a particular geographic group of people. The prevailing scientific opinion now is that the virus originated in Africa. A particular kind of monkey, the African green monkey, is know to carry a virus quite similar in structure to the human AIDS virus. The best scientific guess is that at some point in time, as a natural part of the process of all living organisms, there was a chance mutation of one of the simian (monkey) viruses, which make it possible for the virus to cross the species barrier from monkey to human. While mutations at the cellular level are fairly common, this particular type of mutation would be very unusual. In certain areas of Africa, the green monkey is considered a food delicacy. Possibly through ingesting some uncooked organs, or through an accidental cut while preparing a carcass, the first human was infected. The disease may have begun in this simple, quiet manner, spreading to others from this point through sexual intercourse and shared needle use. We want to note that many African government representatives are sensitive about this view, understandably, since it is often set forth in a manner that seems to blame Africa for the appearance of the virus. While scientific events are not themselves racist, observations and reporting of them may be so. It is important to remember that no one person, nation or population is responsible for the development of AIDS, and we must all share the responsibility of stopping the spread of the virus. 2) What is ARC? --------------- ARC stands for AIDS Related Complex, and is caused by the same virus which causes AIDS. People with ARC may show many of the same symptoms as a person with AIDS - ranging from persistent swollen lymph glands to extreme fatigue and rapid weight loss - though it differs from AIDS in that a person with AIDS also has an opportunistic infection. Opportunistic infections take advantage of the already weakened immune system, the most common opportunistic infections in people with AIDS are Pneumocystis carinii pneumonia (PCP) and Kaposi's sarcoma (KS), a rare skin cancer. "Immunosuppressed" or "immunocompromised" are other terms used to refer to people with a weakened immune system. The effects of HIV (Human Immunodeficiency Virus) on the immune system may weaken the body so much that other health-related problems may lead to death for the person with ARC, making it no less serious as AIDS. Usually, persons with ARC lead active, productive lives, having only mild symptoms that don't normally affect daily activities. People can also be without any symptoms for extended periods of time. Studies show some people with ARC may never go on to develop full-blown AIDS, and most do not progress to AIDS within five years. In a study conducted by researchers in New York City, 29% of people with ARC were diagnosed as having AIDS within 4 1/2 years. Public health officials estimate that there are between 100,000 and 200,000 persons with ARC in the United States. 3) How Does HIV Affect the Body? -------------------------------- Discovery of the virus which causes AIDS was first reported in May, 1983 by Dr. Luc Montagnier and fellow researchers at the Pasteur Institute in Paris. They named the virus lymphadenopathy-associated virus (LAV), because they had isolated it from the lymph node of a patient who had what is now known as ARC. At approximately the same time, Dr. Robert Gallo and his colleagues at the National Cancer Institute also identified the causative agent of AIDS. They named it human T-cell lymphotropic virus-III (HTLV-III), in light of its apparent similarity to other viruses isolated by Gallo and his staff, namely, HTLV-I and HTLV-II. Controversy surrounding the labeling of this newly identified virus led the International Committee on the Taxonomy of Viruses to give it the name human immunodeficiency virus (HIV). This is the designation which the medical community now uses to refer to the virus. HIV is different from many other viruses. It belongs to a special family of viruses known as retroviruses. Like other viruses, retroviruses consist of a tightly packed core of genetic information and a protein coat. Retroviruses contain their genetic information in ribonucleic acid (RNA) rather than in deoxyribonucleic acid (DNA). In order to replicate, the retrovirus must use an enzyme known as reverse transcriptase to create DNA from viral RNA. This newly manufactured viral DNA is then inserted into the DNA of the host cell. The inserted viral DNA is termed the provirus. The provirus then uses the genetic machinery of the host cell to reproduce itself. In this way, retroviruses, like all viruses, depend upon the host cell to provide the mechanism for the production of new viral particles. The primary target of HIV is a special type of white blood cell known as the T-4 helper cell, the cell responsible for directing the immune system's fight against invading organisms. When HIV enters the body, it seeks out the T-4 helper cell, attaches itself to this cell and then enters it. Once inside, it uses the genetic material of the T-4 helper cell to replicate. New viral particles are then released into the blood stream, where they can find new T-4 helper cells to infect. The presence of HIV inside the T-4 helper cell can cause the cell to function poorly or destroy the helper cell completely. When the number of T-4 helper cells decreases drastically in the body, the immune system is unable to fight off many infections which normally pose no threat. Complications related to these opportunistic infections can lead to death for the person with AIDS. Macrophages, another type of white blood cell, can also be infected by the AIDS virus. These cells often travel throughout the body, destroying invading organisms that may be present outside of the circulatory system. But macrophages can carry HIV into the brain. Once in the brain, HIV attacks the glial cells, the cells that provide structural support and insulation for neurons. If a large number of glial cells are destroyed, the intellectual functioning of the individual may be dramatically impaired. The manifestations of HIV infection can vary widely from person to person. The range of infections seen is quite broad, with people being affected by fungal, bacterial, protozoal and viral disease as well as some cancers. Two diseases we hear most often about are Kaposi's Sarcoma (KS) and Pneumocystis carinii pneumonia (PCP). KS is a cancer of the cells that line certain small blood vessels. People with KS develop purple lesions on the skin or possibly internally where they cannot be seen. In time, the lesions increase in both number and size, causing complications as they spread. PCP is the most common opportunistic infection seen in people with AIDS. It is caused by a protozoan, a microscopic organism. People with PCP usually become quite ill at the time of diagnosis, with fatigue, weight loss, fevers, dry cough and difficulty breathing, often PCP requiring hospitalization. PCP can be treated, but as with other AIDS-related disease, successful treatment of PCP does not cure the underlying immune problems. In time a person may again be affected by PCP or any one of a number of opportunistic infections. People with HIV may also suffer from infections that can lead to confusion, loss of memory, poor motor control, inability to speak clearly, seizures, or other manifestations of dementia. These problems may be caused by direct HIV infection of the brain, or by diseases such as toxoplasmosis or cryptococcal meningitis. Other illnesses seen are either very unusual diseases rarely diagnosed in anyone who does not have HIV infection, or more common human illnesses that appear in unusually severe forms. For example, a person with AIDS might have a thrush infection (Candida) which is not limited to the mouth but spreads throughout the esophagus and intestinal tract. An HIV infected individual might develop a herpes simplex infection that spreads well beyond the usual mucous membrane sites for herpes (mouth, genitals) over other skin surfaces, in spinal fluid, or in the lungs. Estimates of the incubation period for AIDS have changed as research continues and we have more experience with the disease. The most recent research suggests the average length of incubation is seven to eight years, with people developing AIDS sooner than this and in some instances AIDS has appeared later than this. There are reported cases of people being infected with the AIDS virus for ten years and still show no symptoms. 4) What Are the Symptoms of ARC and AIDS? ----------------------------------------- Many of the symptoms associated with ARC and AIDS are the same as those associated with a cold or the flu; but for people with ARC or AIDS these symptoms are persistent and seem to have no apparent cause. The person just isn't able to overcome what ever is making them ill. ***>> Only a health-care professional is qualified <<*** ***>> to diagnose the cause of these symptoms. <<*** * Unexplained, persistent fatigue that interferes with physical and mental activities. * Weight loss greater than 10 pounds in less than 2 months not due to changes in diet or level of physical activity. * Unexplained fever (greater than 100 degrees F) that lasts for more than several weeks. * Night sweats that drench the individual's bedclothes and pajamas. * Swollen glands (enlarged lymph nodes usually in the neck, armpits, or groin) which remain swollen for more than 2 months for no apparent reason. * White spots or unusual blemishes on the tongue or roof of the mouth. * Persistent diarrhea. * A dry cough which has lasted too long to be caused by a common respiratory infection, especially if accompanied by shortness of breath. * Pink to purple flat or raised blotches or bumps occurring on or under the skin. Initially they may resemble bruises but do not disappear. They are usually harder than the skin around them. 5) How is AIDS Transmitted? --------------------------- Although the AIDS virus is found in several body fluids, a person acquires the virus during sexual contact with an infected person's blood or semen and possibly vaginal secretions. The virus then enters a person's blood stream through their rectum, vagina or penis. Small (unseen by the naked eye) tears in the surface lining of the vagina or rectum may occur during insertion of the penis, fingers, or other objects, thus opening an avenue for entrance of the virus directly into the blood stream; therefore, the AIDS virus can be passed from penis to rectum and vagina and vice versa without a visible tear in the tissue or the presence of blood. Drug abusers who inject drugs into their veins are another population group at high risk and with high rates of infection by the AIDS virus. Intravenous drug users make up 25 percent of the cases of AIDS throughout the country. The AIDS virus is carried in contaminated blood left in the needle, syringe, or other drug related implements and the virus is injected into the new victim by reusing dirty syringes and needles. Even the smallest amount of infected blood left in a used needle or syringe can contain live AIDS virus to be passed on to the next user of those dirty implements. Some persons with hemophilia (a blood clotting disorder that makes them subject to bleeding) have been infected with the AIDS virus either through blood transfusion or the use of blood products that help their blood clot. Now that we know how to prepare safe blood products to aid clotting, this is unlikely to happen. If a woman is infected with the AIDS virus and becomes pregnant, she is more likely to develop ARC or classic AIDS, and she can pass the AIDS virus to her unborn child. Approximately one third of the babies born to AIDS-infected mothers will eventually develop the disease and die. Several of these babies have been born to wives of hemophiliac men infected with the AIDS virus by way of contaminated blood products. Some babies have also been born to women who became infected with the AIDS virus by bisexual partners who had the virus. Almost all babies with AIDS have been born to women who were intravenous drug users or the sexual partners of intravenous drug users who were infected with the AIDS virus. Many more such babies can be expected. The AIDS virus has been found in blood, semen, urine, vaginal secretion, spinal fluid, tears, saliva and breast milk. Of these, only semen, vaginal secretions, and blood are implicated in transmission. There are a few reported cases in which babies have contracted AIDS through infected breast milk. Feces are also considered a risk because they may carry blood. People are naturally concerned about some of the other fluids contact with tears or saliva is much more common in day-to-day life. Evidently, these other fluids do not carry a strong enough concentration of the virus to cause infection, even in the unlikely event one's blood system were to come into direct contact with them. In all reported U.S. case so far, there is not a single case of transmission of the AIDS virus by saliva. Occasional news reports of such transmission, in the U.S. and elsewhere have all turned out to be incorrect. So far, the AIDS virus has not been detected in sweat. Even if it is found here at a future time, sweat, like tears or saliva, would most likely not be implicated in transmission. Finally, a small number of health care workers who have had unusual exposure to patient blood have become infected. For example, a lab technician, because of an equipment malfunction, was splashed in the eye with copious quantities of AIDS-infected blood. She has subsequently become infected herself. Instances such as these, while rare, remind health professionals to follow infection control guidelines carefully. 6) Who Gets AIDS? ----------------- Remember that anyone infected with the AIDS virus might develop AIDS; though people in the United State diagnosed with AIDS usually fall into one of several risk categories. It is behaviors, not membership in any particular group, which will put someone at risk for AIDS or HIV infection. As of July 1990, the breakdown for source of infection in adolescents and adults with AIDS in the United States was as follows (while absolute numbers in these reports change weekly, the percentages represent more general trends and will not be likely to change significantly for some time): Gay or bisexual men 63% IV Drug Users 20% Gay Male & IV Drug User 6% Hemophilia/coagulation Disorder 1% Heterosexual contact 3% Blood Transfusion 1% Undetermined 5% 7) How Do I Prevent AIDS? ------------------------- Obviously, if you avoid having sex you will not become infected with the AIDS virus through sexual contact. Abstinence can be a viable choice for many people at different times in their lives. It's a choice that many people seem to be making these days in the wake of AIDS. The more people you have sex with - the greater the risk. Each new partner increases the chance that you will be exposed to the HIV virus: its like playing Russian Roulette with your life. Latex condoms can provide effective protection against infection with the AIDS virus. Condoms act as a physical barrier which prevents the passage of the virus form one person to another. Use condoms to reduce the risk associated with vaginal and anal intercourse. Condoms can also be used during oral sex to eliminate any possible risk associated with this activity. See Section *: "Everything You Need to Know about Condoms" to find out more about how condoms can help protect against infection with the AIDS virus. By finding out which sexual activities are riskiest, you will be able to make changes in your sex life so that you can reduce your own level of risk. There are many types of sexual expression that are not considered to be very risky. However, some activities, such as intercourse without a condom, can readily lead to transmission of the AIDS virus. Take the time to learn about making sex safer so that you can protect yourself and the people you love from AIDS. 8) What is Safer Sex? --------------------- Safer sex means cutting your risk of being exposed to AIDS by changing your sexual behavior. The following shows the various levels of risk associated with different sexual activities. NO RISK ======= Dry Kissing: There have been no documented cases of an individual becoming infected from kissing. Masturbation: You can not become infected by contact with your own body fluids. In order for infection with HIV to take place you must come in contact with the body fluids of someone who already has the virus inside his or her own body. Protected Oral Sex: By using a latex condom or a rubber dam (a square piece of latex which can be placed over the vagina) during oral sex, individuals can reduce any possible risk associated with this activity. Both act as a physical barrier which prevents HIV from being passed from one partner to the other. Touching: You won't get AIDS just by touching someone who carries the virus. SOME RISK ========= Deep Kissing: Deep kissing is considered to be risky only when one or both persons has cuts or open sores in the mouth which could allow the virus to enter the blood stream. Oral Sex: The risk of becoming infected with HIV through oral sex is much less than the risk associated with sexual intercourse. However, virus contained in semen or vaginal secretions can be transmitted during oral sex if there are open cuts or sores in the mouth. Vaginal Intercourse: Although latex condoms have been shown to prevent with Condom transmission of HIV in the laboratory, they are not always 100% effective in real-life situations. Anal Intercourse with Condom: If used properly, condoms can greatly reduce the risk associated with sexual intercourse. See "Everything You Need to Know about Condoms" for more information. HIGH RISK ========= Anal Intercourse without Condom: Anal and vaginal intercourse WITHOUT a condom are the riskiest sexual activities that an individual can engage in. The virus can be passed by either vaginal Intercourse partner, although the receptive partner is at the without Condom greatest risk. You can give yourself protection by avoiding sexual intercourse outside of a mutually monogamous relationship with an uninfected person or by always using condoms. Oral/Anal Contact: Some researchers have found oral/anal contact to be correlated with HIV infection. Others have not. Because many diseases such as hepatitis B, can be transmitted in this way, it is best to consider oral/anal contact a high risk activity. 9) Everything You Need to Know About Condoms -------------------------------------------- There are a few important things everyone needs to know about condoms: 1. Buy good quality latex condoms. 2. Put on when erection first occurs. 3. Leave 1/2 inch space at tip of condom for semen. 4. Use a non-greasy lubricant - preferably a spermicidal jelly. Vaseline, Crisco, and oil-based lubricants can weaken rubber and cause it to break. 5. Hold the top of the condom when withdrawing to keep it from coming off. 6. Dispose of condom safely - put into plastic bag and seal bag. NOT ALL CONDOMS ARE THE SAME Laboratory studies have shown that latex condoms can prevent the transmission of the AIDS virus. "Natural" condoms, made from lamb intestine, do not provide the same protection. The pores of a natural condom can be large enough to allow the virus to pass through the surface of the condom. The virus isn't able to pass through the surface of a latex condom. CHECK THE EXPIRATION DATE Just like milk and yogurt, condoms can get old. If condoms have been left lying around too long they may become dried out, causing them to break more easily. If condoms are left in warm places, like the glove compartment or a wallet, they can dry out in a short period of time. Condoms often have expiration dates printed on the outside of the box or on the wrapper of each individual condom. Sometimes the date shown is when the condom was manufactured, and this should not be confused with an expiration date. Condoms that are old shouldn't be used. LUBRICANTS A water-based lubricant, like K-Y jelly, should be used for intercourse. Do not use an oil-based lubricant, like Vaseline, because it can break down the surface of the condom, causing it to break. Use of Spermicidal Jellies -------------------------- Most spermicidal jelly contains *nonoxynol-9* which has been shown to inactivate the AIDS virus in laboratory tests. Thus, use of nonoxynol-9-containing jelly for lubrication during vaginal or anal intercourse, or mutual masturbation, provides added protection. The jelly is usually called "contraceptive jelly" on the label and is found in drug stores near to condoms and/or feminine hygiene products. Note: DO NOT RELY ON JELLY ALONE FOR INTERCOURSE; use it IN ADDITION to condom (for men) or diaphragm (for women). Some common brands and their nonoxynol-9 content: Brand of Concentration Contraceptive Jelly Nonoxynol-9 ------------------- ------------- Ramses 5 % Conceptrol 4 % Koromex 3 % Koromex crystal 2 % clear gel Ortho Creme 2 % Gynol II 2 % READ THE DIRECTIONS In order to provide effective protection, condoms need to be used properly. It's not difficult to use a condom correctly, but there are some basic directions you need to follow. These are included in condom packages. ONCE IS ENOUGH You can't recycle condoms. Old condoms should be thrown away. Use a new condom every time you have intercourse. When used correctly, condoms can provide effective protection against infection with the AIDS virus. Condoms break only about 2% of the time because of manufacturing defects. Actual breakage rates may be higher, because people often don't use them properly. There is no guarantee that these measures will absolutely prevent AIDS, but they should cut down on the risk considerably. The most important preventive measures are to cut down on the number of sexual partners and modify sexual activities so that there is no exchange of bodily fluids. 10) AIDS and Drugs ------------------ ANYONE WHO SHOOTS UP AND SHARES NEEDLES IS PUTTING HIMSELF OR HERSELF AT RISK FOR GETTING AIDS. THE RISK OF SHOOTING UP Shooting up drugs has always been considered to be a high-risk activity, even before AIDS was around. Many other blood-borne diseases such as hepatitis-B and endocarditis, can also be spread by using a dirty needle. The danger of a drug overdose is also a very real threat to the user's health. It's often difficult to tell how much of the drug is being injected because the strength of "street" drugs can differ so much. Accidental injection of tiny air bubbles can stop the flow of blood to parts of the body. Using a dirty needle can also cause other infections such as abscesses and tetanus. Now there is an even greater risk--AIDS. The AIDS virus can be transmitted from one person to another by sharing IV-drug needles. Sharing dirty needles is one of the easiest ways to become infected with this virus. About 25% of people with AIDS were users of IV drugs. The San Francisco AIDS Foundation has recommended the following to reduce the risk associated with IV-drug use: DON'T SHARE NEEDLES If you continue to inject drugs reduce your risk don't share needles. Sharing drugs can share diseases too. Obtain your own "works" and don't let anyone else use them. CLEAN YOUR WORKS Wash them with alcohol after each use, then leave them to soak in alcohol until the next use. CLEAN YOUR SKIN With alcohol, before injecting. STAY HEALTHY If you are in a weakened state, you are more likely to get a disease. Eat a balanced diet, get enough rest and exercise, and get medical care when you need it. 11) Should I take the AIDS Antibody Test? ----------------------------------------- Soon after the virus (HIV) that causes AIDS was discovered, several tests were developed to test for HIV infection. The three tests that are used, ELISA, IFA, and Western blot, all work by detecting the presence of antibody to HIV. This antibody is developed by the immune system in response to the presence of HIV. The presence of this antibody indicates that a person has been infected with the virus. All three of the antibody tests are very accurate. A positive test result indicates that antibody was present. A person who tests positive has been infected with HIV. A positive test result does not mean that a person has AIDS, or will become ill later. About 30 to 50 percent of persons who test positive go on to develop AIDS within seven years. Although a person receiving a positive test result may not go on to develop AIDS, he or she could spread the virus through sexual intercourse or by sharing an IV-drug needle. A negative test result means that the antibody to HIV was not found. There are two possible explanations for a negative test result: 1 - The person being tested has not been infected with the virus. 2 - Infection may have occurred recently, and the body hasn't had enough time to develop antibody. "Enough time" is about two to eight weeks, though in some cases it be up to six months and possibly as long as a year to develop the antibody. If there is concern about recent exposure to the virus, re-test again in six months. Since March of 1985, these tests have been used to screen all blood that is used in the United States. Blood that is found to be infected is discarded. The use of these tests has helped to make the nation's blood supply much safer. Anyone concerned about their own possible exposure to the AIDS virus can ask their doctor to perform an AIDS antibody test (it is against the law for a physician to give this test without the individual's permission). In the many states, the AIDS-antibody test is also available at Alternative Testing Sites, established to provide free testing in an anonymous and confidential setting. The individual's identity is protected, as well as the results of the test. Anyone infected with the AIDS virus has HIV infection. Such people fall into one of three categories: 1. Some people infected with the virus do not appear or feel ill. They are able to pass the virus on to others through unsafe sexual contact or the sharing of needles in intravenous drug use. These people are said to have asymptomatic HIV infection. Sometimes they are called asymptomatic carriers because they carry the virus without showing symptoms. 2. Some people infected with the virus develop mild to severe symptoms caused by the infection, but do not meet the criteria set by the CDC for an AIDS diagnosis. These people are said to have AIDS Related Complex, or ARC. 3. Finally, some people who have HIV infection and symptoms of illness do meet the criteria for an AIDS diagnosis, and so have AIDS, by definition. In 1981, when AIDS was first described, we did not know what caused the disease and we had no way to test for infection. The CDC developed a definition of AIDS so it could monitor the number of cases occurring. Their scientists described AIDS by listing common symptoms of the disease in its most serious state. These were the cases coming to the attention of physicians. This definition said a person had AIDS if he or she had no underlying cause of immune system problems, but did have one or more of the following: 1. Kaposi's sarcoma (KS), 2. Pneumocystis carinii pneumonia (PCP), or 3. Other opportunistic infections (OI). (These diseases are explained further below.) This definition left out a lot of people affected by HIV infection, but it was several years before the broader range of HIV infection was understood. The CDC has make a few changes in its definition since 1981, but feels that broadening the definition too much will invalidate the data they have already collected on AIDS. There are some difficulties with this situation. For one thing, people with ARC often are not eligible for the same benefits and services as people with AIDS, though they may need such assistance. For another, the uncertainties of having ARC are many (Will I die? Will I be able to continue working? Will I recover my health?), and numerous studies have shown people with ARC experience greater anxiety than people with AIDS or those who are well. Finally, the official CDC surveillance of the disease caused by the AIDS virus only counts a small percentage of those actually affected, and the concerns of people with ARC are often neglected in health policy and research planning. Today, in 1990, the CDC estimates that 1.5 million Americans are infected with HIV. The CDC updated its definition of AIDS in August, 1987. People showing signs of direct brain infection with the virus and those who have "wasting" disease (severe and persistent loss of weight associated with AIDS virus infection) are now also considered to have AIDS. In 1986, a four-tier system of classifying all stages of HIV infection was developed. Many people working in the aids field now talk more generally of people having HIV infection or disease rather than making many distinctions between "AIDS," "moderate ARC," severe ARC," "mild AIDS-related symptoms," and so forth. 12) Does Everyone Infected with the AIDS Virus Die? --------------------------------------------------- At this point, most of the people in the U.S. who are infected with the AIDS virus are not ill. However, in studies of people who have been infected for some time, rates of illness are quite high. In one well-known San Francisco study, a group of men who are known to have been infected since 1978 or 1979 has been followed carefully. After seven years, about 75% of these men had AIDS, ARC, or lymphadenopathy (swollen lymph glands) presumed to be related to infection with the AIDS virus. As time goes on, this number is likely to grow. These findings are startling. If they hold true in other groups, it means that most people infected will become ill. And, while it is true that some people are only mildly ill or have episodes of illness alternating with periods of health, AIDS-related infections overall appear to be progressive in nature--that is, over time the state of health deteriorates. There is a very small number of individuals who may have recovered some of their immune functioning (their immune systems have become stronger), but most people have not done so once they become ill. The answer to this question, then, is that we do not know if everyone infected with the AIDS virus will die. We certainly hope this is not the case. Out of respect for the thousands of people living with this disease today, it seems inappropriate to make any sort of blanket statements to this effect without better evidence than we currently have. 13) Where Can I Get More Information on AIDS and AIDS Testing? -------------------------------------------------------------- The National AIDS Clearinghouse P.O. Box 6003 Rockville, MD 20850 Voice: 1 (800) 458-5231 TTY/TDD: 1 (800) 243-7012 The Centers for Disease Control 1600 Clifton, N.E. Atlanta, GA 30333 1 (800) 342-2437 AIDS Clinical Trials Information Service P.O. Box 6421 Rockville, MD 20850 Voice: 1 (800) 874-2572 TTY\TDD: 1 (800) 243-7012 Aids Library of Philadelphia 32 North Third Street Philadelphia, PA 19106 (215) 922-5120 Hours: 10:00 a.m. - 8:00 p.m. Mon-Thurs 10:00 a.m. - 5:00 p.m. Friday 1:00 p.m. - 5:00 p.m. on Saturday 14) The Global Impact of AIDS ----------------------------- AIDS has become a global pandemic that may eventually kill millions of people by the end of this century. The World Health Organization (WHO) reported that 446,681 cases of AIDS were reported by 1992. WHO has estimated that ten to 15 million people are currently infected with the virus that causes AIDS. In the next five years, many of these people will go on to develop full-blown AIDS. WHO has projected that because of under-diagnosis and delays in reporting, the true worldwide total of people with AIDS is estimated at close to 1.5 million at the end of 1992. The effects of AIDS will have a profound impact on the economic, political, and social structure of every country around the world. This impact will be felt well into the 21st century. 15) Pamphlet: About HIV Disease: Testing for HIV, Stages of HIV Disease, Therapies By Leon McKusick, Ph.D. Center for AIDS Prevention Studies (CAPS) University of California, San Francisco ----------------------------------------------------------- HIV DISEASE AFFECTS EVERYONE HIV disease is a spectrum of illnesses caused by the human immunodeficiency virus (HIV), also called the AIDS virus. HIV disease is a potential threat to everyone - men, women, and children. Over fifty thousand people have died of HIV disease, hundreds of thousands of people have symptoms caused by HIV infection, and over a million people in the United States are infected with HIV. From the beginning of the epidemic, men and women of all backgrounds and ages have been affected. Advanced HIV disease - also known as AIDS (Acquired Immune Deficiency Syndrome) and ARC (AIDS-Related Complex) - is the last stage of a long-lasting disease that destroys the body's ability to fight off infections. It is these infections, and sometimes cancers, that cause people with advanced HIV disease to feel sick. Some of these infections are very difficult to cure, partly because HIV destroys the body's defenses - the immune system. This destruction of the immune system by HIV is signaled by the loss of a certain type of white blood cell, called the CD4 lymphocyte or T4 cell, that is vital to functioning of the immune system. People with advanced HIV disease suffer from these infections frequently, and each one leaves them weaker and worse off than before. Today more than a million Americans have the virus that causes AIDS in their bodies - the human immunodeficiency virus (HIV), also called the AIDS virus. Persons who have contracted the HIV infection and AIDS include homosexual men, hemophiliacs, persons who received blood transfusions in the early 1980s before blood banks were able to test for HIV, users of intravenous drugs - and their sexual partners who may have never used intravenous drugs - and babies born to women infected with HIV. Both men and women are becoming infected through intravenous (IV) drug use (sharing needles or works) and sexual intercourse. Outwardly, most of these people seem perfectly healthy and may remain so for many years. They carry HIV, but it has not yet made them sick. It is not currently known how many will eventually develop advanced HIV disease. However, because their bodies cannot destroy the HIV they carry, most may become ill. Fortunately, there are now effective treatments to delay progression to advanced HIV disease. Persons who are infected with HIV may transmit the virus to other persons because either they don't know they are carrying it or don't know how to prevent its spread. AIDS ISN'T JUST A HOMOSEXUAL DISEASE The disease now called AIDS or advanced HIV disease was first recognized about 10 years ago. Although many of the early AIDS patients were gay (homosexual) men - that is, men who have sex with other men - and most persons with AIDS in the United States are gay men, many persons who are not gay are infected with HIV. Because there are many ways of catching HIV, the fact that a man is infected with HIV or has symptoms of advanced HIV disease does NOT mean he is a homosexual. A man does not have to have sexual relations with another man to catch HIV disease. Many men and women - and their babies - have become infected with HIV as the result of using intravenous drugs, receiving blood transfusions or blood products, or through heterosexual (straight) relations - that is, sex between a man and a woman. In 1990, gay men are usually aware of the risk of contracting HIV and have taken steps to avoid infecting or being infected, but many other people who are at risk for catching HIV are not taking precautions because they do not know they are at risk. In 1990, HIV testing to determine if you are infected is very important not only to prevent infecting others, but also because there are now treatments for HIV infection before it has progressed to advanced HIV disease (AIDS or advanced ARC). NOT ALL GERMS ARE THE SAME Many diseases are caused by germs, including viruses. But every germ or virus is different. Some viruses, like those that cause colds or the flu, are spread from person to person through the air or by simple physical contact. Other germs, such as those causing syphilis or gonorrhea, are spread only by intimate physical contract such as sexual intercourse. HIV is spread only by intimate physical contact that involves mixing of body fluids - blood or semen. This can happen during sex if you don't use a condom, or when sharing improperly cleaned needles to inject drugs. HIV is NOT spread by casual contact, but is spread by direct contact with the blood or other body fluids from an infected person. Some germs are very hardy and live a long time outside the body, but others die unless they are kept warm and moist in body fluids. HIV is easily killed by soapy water or by chlorine bleach. Some germs, like those causing measles or mumps, produce a short illness that may be serious; then the germs disappear from the body. HIV is a very persistent virus. An infected person is infected for life. Some viruses, like those causing colds, cannot at this time be controlled or suppressed with antiviral drugs, while others, like herpes and HIV, can be suppressed, but not completely eliminated, with antiviral drugs. WHAT YOU CAN DO The best thing to do is not to become infected with HIV. It is not as difficult as you might think to avoid infection. HIV is transmitted during sexual intercourse as are syphilis and gonorrhea. Condoms - for infection control, not birth control - help stop the spread of HIV as well as other sexually transmitted diseases. But condoms must be used correctly and must be used every time you have sexual intercourse and used throughout the time of intimate physical contact. Even then, condoms are not 100% effective for preventing any sexually transmitted disease. HIV can also be spread through sharing needles or other instruments that penetrate the skin. Sharing needles with other IV drug users, for example, is very likely to spread HIV if any of the persons involved is infected. Remember, you cannot catch HIV from ordinary casual physical contact, including all the normal activities involved in sharing a living space. You cannot catch HIV by sitting is the same waiting room with a person with AIDS. If you live with or are caring for someone who has AIDS, common sense and simple precautions can keep you from coming in direct contact with body fluids or wastes that may contain HIV. FIND OUT IF YOU ARE INFECTED WITH HIV Knowledge is much better than ignorance. If you think that you are participating in risky behavior or that you may have been exposed to HIV, consider having your blood tested even if you don't have any symptoms. If you think you might be infected, find out. Take the blood test for HIV, which is available free and anonymously through many clinics. The test results can be positive, negative, or inconclusive. IF YOUR HIV TEST IS NEGATIVE, STAY UNINFECTED If you are NOT infected with HIV, can stay that way. You can avoid behavior that exposes you to HIV. Don't have unprotected sex (without a condom) with someone who may carry HIV - man OR woman. Don't share needles. Don't do anything where blood or other body fluids are exchanged. IF THE HIV TEST IS INCONCLUSIVE, you may have to have another blood sample taken or you may be tested again after several weeks. Try not to worry too much - the majority of inconclusive tests are negative. Listen to your doctor's advice. IF THE HIV TEST IS POSITIVE, DON'T PANIC If the first test result is positive, it will probably be repeated to make sure the result is correct. If the second test is positive, it means you have been infected with HIV and you may develop HIV disease (and ultimately AIDS) some years from now. It can take a long time for HIV to damage your ability to fight infections. A positive test also means that you can spread HIV to others, even while you feel healthy. But if you are infected, you can take action to protect others and avoid spreading the virus. The situation is not hopeless. A lot of progress has been made in treating HIV disease and the so-called opportunistic infections that affect persons with advanced HIV disease. There are treatments that can suppress HIV itself, helping infected people to live longer and stay healthier. There are also drugs to treat or to prevent infections that occur because of the weakening of the immune system. Follow your doctor's advice. SOME SYMPTOMS THAT MAY BE CAUSED BY HIV If you think that you have participated in risky behavior or that you have been exposed to HIV, tell your doctor and ask if you should have a blood test for HIV. Report any of the following symptoms to your doctor or clinic promptly, especially if your blood test for HIV is positive: Persistent Fever: Temperature above 101 to 102 degrees Fahrenheit that lasts for longer than 2 or 3 days, especially if it is associated with "night sweats" that soak or drench the bedding several nights in a row. Persistent Cough: Persistent dry cough, particularly with the sensation of tightness or pressure in the front of the chest under the breastbone. Shortness of Breath: Shortness of breath or difficulty breathing, especially during ordinary daily activities such as walking. Persistent Diarrhea: Loose or watery stool with more than several bowel movements each day lasting for several days. Increased Fatigue: Excessive tiredness after moderate physical activity such as climbing stairs. Slow-healing Sores: Slow-healing mouth sores (chancre) or whitish patches on your mouth, gums, or tongue OR the sudden appearance of hives or itchy rashes that you do not usually have OR worsening episodes of such OR purplish spots on your skin that do not fade. Difficulty in Swallowing: Pain or discomfort in the throat, especially when swallowing liquids, OR you feel a persistent lump in your throat or under your breastbone. Unexplained Weight Loss: Loss of more than 8 to 10 pounds or more than a pound a week that is not due to dieting. Severe Headaches: Headaches that are worse than or different from those you may usually experience. These symptoms are quite common, so you should not worry too much if you have one or more of them. If you are HIV positive, your doctor may advise you to come in for an examination and lab tests. If you are HIV negative, your doctor may advise testing your blood for antibodies to HIV. Listen to your doctor's advice and follow your doctor's instructions. There is a lot of incorrect information about HIV on the street and in popular newspapers and magazines. Ask your doctor what works and what doesn't work. THERE ARE NOW EFFECTIVE TREATMENTS FOR HIV DISEASE If your blood test for HIV is positive, your doctor will obtain further blood tests to determine how much HIV has affected your immune system and to determine when to start medical treatment. Your doctor will probably want to examine you and take blood samples regularly so that you can begin medical treatment as soon as appropriate. Many persons infected with HIV may eventually develop the symptoms of AIDS resulting from damage to the immune system. Fortunately, many of the infections associated with AIDS can now be treated effectively or even prevented. For example, the pneumonia characteristic of AIDS (sometimes called PCP because it is caused by Pneumocystis carinii) and several other infections common in persons with HIV disease can be controlled, although not cured. Also clinical studies have shown that AZT, a drug also know as Retrovir or zidovudine, delays the onset of symptoms of HIV disease and thereby improves the quality of life of certain individuals infected with HIV. Until recently you had to have AIDS or advanced HIV disease to take AZT. Now there are effective therapies which may be administered even before you feel sick. AZT therapy is indicated for asymptomatic or mildly symptomatic HIV-positive individuals who have evidence of impaired immune function. Good health habits such as taking exercise, eating well, and avoiding drugs, alcohol, and tobacco are all helpful. Because there are now treatments for HIV disease before you become seriously ill, it is very important to find out if you are HIV positive or not as early as possible. FACTS YOU SHOULD KNOW ABOUT AZT AZT is not a cure for HIV infection or for AIDS, but it delays the progression of HIV disease and thereby improves the quality of life. AZT is no longer used only in people who have AIDS or advanced ARC, and a reduced dosage has been shown to be as effective as the former dosage with the occurrence of less severe side effects. If AZT is prescribed, follow the directions your doctor gives you. AZT will help you most if you follow your doctor's instructions exactly. Take all medications as prescribed. Come in for tests as requested. If you are taking other medications, underground anti-AIDS drugs, or other remedies, tell your doctor. SIDE EFFECTS OF AZT The major severe side effects of AZT involve the blood: anemia (too few red blood cells), for example. These side effects occur less often and are less severe in persons receiving AZT before they have advanced symptoms of HIV disease. They are less common at the new lower dosage of AZT also. You should report any unusual tiredness, unusual bleeding or bruising, sore throat, fever, or slow-healing injuries to your doctor immediately. Common minor or moderate side effects of AZT are nausea, headache, vomiting, and sleeplessness. While these symptoms are bothersome, aspirin, acetaminophen, ibuprofen, or anti-nausea drugs can be taken to control them. If you take these or any other medications for more than 3 days, tell your doctor. PROSPECTS FOR THE FUTURE Many drugs against HIV disease are being tested for safety and effectiveness, and some of these will be available soon. Even more effective drugs to suppress HIV and to prevent or suppress the various infections that affect persons with HIV infection will be available in the next few years. However, prevention is better than treatment. If you think you are at risk, take the test for HIV antibodies. If you are not infected, do not become infected. If you are infected, don't infect others. In any case, knowledge is better than ignorance. WHAT YOU CAN DO TO STOP AIDS If you are reading this pamphlet, it is probably because you or someone close to you has tested positive for the AIDS virus (HIV) or has symptoms of HIV disease. AIDS IS AN ILLNESS, NOT A SIN. If you think you have been exposed to HIV, find out if you have caught it. There are now treatments for HIV and for infections associated with it that should be started BEFORE you become sick. These treatments will delay the onset of symptoms and thereby improve the quality of life. KNOWLEDGE IS BETTER THAN IGNORANCE. Take the HIV blood test. With the knowledge you gain, there are things you can do. IF YOU ARE NOT INFECTED, you can stay uninfected. Avoid high risk behaviors. If your sexual partner - a man OR woman - is HIV positive, insist on using condoms. If you inject drugs, don't share needles or works. IF YOU ARE INFECTED, you can avoid spreading the disease. Use safer sex practices. Use condoms. Do not share needles. Maintain a healthy life style. Eat right and get enough rest. Most important of all, because there are now effective treatments which may be administered even before you feel sick, see your doctor and follow his or her advice. ****************************************************************** This pamphlet is published by Leon McKusick, Ph.D., of the Center for AIDS Prevention Studies (CAPS) of the University of California, San Francisco, who is responsible for its content, with support from an educational grant from World Health Communications Inc., 41 Madison Avenue, New York, NY 10010. The opinions or views expressed in this educational publication do not necessarily reflect the opinions or recommendations of World Health Communications Inc. Please consult a physician as appropriate. Prescription medications mentioned in this publication should be taken only under a physician's supervision. Copyright 1990 World Health Communications Inc. All rights reserved. Printed in USA. 50M June 1990 16) Pamphlet: STAYING HEALTHY: AIDS INFORMATION FOR GAY MEN (NOTE: This brochure is available at Whitman-Walker Clinic.) ------------------------------------------------------------ WE'RE ALL IN THIS TOGETHER AIDS is a life-threatening health condition. There is no vaccine for AIDS and no cure. People with AIDS can't fight off the disease. They get sick very easily with a whole set of illnesses -- from mild to very serious infections and cancers. In DC, 90 percent of the AIDS patients are gay or bisexual men. Learning about AIDS, stopping the spread of the virus, and taking care of our bodies and minds are responsibilities we all share. WHAT CAUSES AIDS? ================= Much remains unknown. But we do know that AIDS is caused by a virus (called "HIV"). Factors such as other infections, alcohol and drugs, poor diet, and stress may also play a role in weakening the immune system. HOW DO YOU GET THE VIRUS? ========================= The AIDS virus is found mainly in blood and semen of infected people. It doesn't seem to live long outside the body. To become infected, you have to get semen, or pre-semen, or blood from another person into your own body. This can happen during sex, or by sharing needles and other works used to inject drugs. What about saliva, tears, and urine? The virus has occasionally been found in these body fluids, but in much lower amounts than in blood and semen. There is no evidence that AIDS is transmitted by these fluids. Nonetheless, be careful with them. You *CAN'T* get the virus from toilet seats, water fountains, eating utensils, or air -- or by touching, holding, or hugging someone with AIDS. WHAT HAPPENS WHEN SOMEONE IS INFECTED WITH THE AIDS VIRUS? ========================================================== It is impossible to predict precisely how the virus will affect an individual. Various things may happen: *Nothing may happen at all.* Many infected people look healthy, remain healthy, and show no symptoms. But they can probably pass the virus to other people. *Some people will get sick with ARC (AIDS-Related Complex).* Many of the symptoms of ARC are similar to those of AIDS as well as to a variety of other infections and diseases. They include: - Fever and/or night sweats over several weeks - Serious diarrhea over several weeks - Unexplained weight loss - Swollen glands in the neck, armpits, or groin - Thick white coating on the tongue, or other white spots or unusual blemishes in the mouth. - Unexplained bruising, or bleeding more easily than normal - Serious, unexplainable fatigue Remember, these symptoms can also be caused by a lot of problems other than AIDS or ARC. A thorough medical evaluation is essential, since many can be easily treated and cured. *Some people will develop AIDS.* Their immune systems are so severely damaged that they can develop a rare kind of pneumonia called "Pneumocystis carinii", or other unusual infections that they would normally be able to fight off. They can also develop a cancer called Kaposi's sarcoma (KS). KS grows in spots on or under the skin, inside the mouth, nose, eyelids, or anal area, as well as in internal organs. In light-skinned people, KS is pink or purple. In dark-skinned people, it is brown. WHAT ABOUT THE AIDS ANTIBODY TEST? ================================== The AIDS antibody test will *NOT* tell you if you have the AIDS virus in your system. It doesn't tell you if you have AIDS, or if you will get AIDS. It will tell you if you have been INFECTED with the virus. Most people who have been exposed to the AIDS virus are not aware of it. The vast majority have not developed symptoms of AIDS or ARC. HELP, HELP! HELP YOURSELF! ========================== You *CAN* help yourself. You can help yourself by practicing safer sex and by taking care of your body and your mind. SAFER SEX IS... First ... its sex. It's fun and exciting, or it's dull and boring. Like any kind of sex, it depends on how much you put into it. Second ... its safer. Safer sex means you don't get the blood or semen of another person inside your body through your mouth, rectum, or through cuts on your skin. With safe sex, you can enjoy yourself and greatly reduce or eliminate your chances of giving or getting the AIDS virus. WHO SHOULD PRACTICE SAFER SEX? Unless you and your partner have had sex with no one but each other for 10 years, you should practice safer sex. Anyone who is sexually active can get the AIDS virus. Because many people carry the AIDS virus, reducing the number of sexual partners does not mean you are safe. If you've been infected with the virus, it's especially important that you take steps to prevent giving it to others AND re-exposure to yourself. TAKE CARE OF YOUR BODY AND MIND Help yourself by taking care of your body and mind. While no one knows exactly how AIDS develops in the body, we do know that a healthy lifestyle keeps the body and mind strong and helps to fight disease. -- Stay clean from all drugs. That means speed, poppers, cocaine, crack, pot, PCP, heroin and MDA. They hurt your immune system and they *MESS UP YOUR MIND*. -- Limit your consumption of alcohol. Alcohol probably hurts the immune system too. Besides, when you're drunk, you might not think about safer sex. -- Eat well. Eat a balanced diet. The immune system rebuilds itself with the food you eat. -- Exercise. Exercising seems to help the body make immune system cells. It also relieves tension and worry. -- Sleep. Get a decent amount of sleep every night. -- Relax your body. Relax as much as possible. If you don't know how, find out how you can. Ask someone. -- Relax your mind. If you're worried about AIDS, talk about it with someone. If there's no one you can talk to, call the hotline at (202)-332-AIDS. We're all in this together. FOR MORE INFORMATION, PLEASE CONTACT: AIDS Program 1407 S St NW Washington, DC 20009 17) 11 Questions Most Frequently Asked by Physicians Paul A. Volberding, MD University of California, San Francisco Reproduced with the permission of Abbott Laboratories, Diagnostic Division, Abbott Park, IL Copyright 1987 by Abbott Laboratories ------------------------------------------------------- ABSTRACT: Now that primary care physicians are seeing office patients who have AIDS, several basic questions arise in connection with diagnosis, treatment, and transmission of this disease. The author answers these, as well as others concerning preventive measures to be taken by health care workers, the outlook for a vaccine against AIDS, and effectiveness and limitations of azidothymidine. The author considers also the initial signs and symptoms of AIDS, accuracy of antibody testing, significance of seropositivity in healthy-appearing persons, and ethical questions posed by the diagnosis. With the menace of acquired immune deficiency syndrome (AIDS) now threatening even larger populations, primary care physicians (especially those in several key areas) are seeing increasing number of such patients. These physicians seed answers to several basic questions that deal not only with diagnosis of AIDS and care of patients, but also with ethical issues, public health considerations, and risk of infection run by office staff members and themselves. In order to help deal rationally and effectively with the implications of this deadly viral infection, I have answered those questions that have been most repeatedly asked. I should like to emphasize that patients with AIDS can be treated in their own communities, by their own primary care physicians, guided when necessary by specialists in infectious disease. 1. What constellation of symptoms is now considered diagnostic for AIDS? Before I answer that question I must stress the fact that, despite the increasing concern for heterosexual spread of human T-cell-lymphotropic virus type III/lymphadenopathy- associated virus (HTLV-III/LAV), or human immunodeficiency virus (HIV), most AIDS cases in this country have been seen in persons belonging to groups known for several years to be at highest risk. These classifications include homosexual men, intravenous drug users who share the use of needles, hemophiliacs, recipients of contaminated blood units, and sexual partners of all of these persons. It is within these groups, therefore, that the occurrence of one or more of a fairly well-described list of opportunistic infections and malignancies is considered diagnostic for AIDS. The opportunistic infections include Pneumocystis carinii pneumonia, disseminated aspergillosis, invasive esophageal candidiasis or disseminated candidiasis, cryptococcal meningitis, cytomegalovirus, nocardiosis, strongyloidiasis, toxoplasmosis, and atypical mycobacterial infection. Other such infections include chronic cryptosporidiosis, progressive multifocal leukoencephalopathy, deep and chronic herpes simplex infection (lasting for more than five weeks), disseminated histoplasmosis, and chronic isosporiasis (lasting for more than a month). Malignancies considered diagnostic for AIDS include Kaposi's sarcoma in persons under age 60 and primary CNS lymphoma. Aggressive B-cell lymphomas of high histologic grade or Kaposi's sarcoma in patients over age 60 are considered diagnostic of AIDS only if the patient tests positive for HIV antibody. The incidence of infection may or may not vary with the route of transmission. The initial epidemiologic studies suggested more efficient viral transmission by homosexual men engaging in anal intercourse than by heterosexuals; however, later cases have raised doubt about the validity of this speculation. Currently, it seems prudent to assume there is substantial risk of transmitting HIV by all forms of unprotected sexual activity, including contact of mucosal membranes with genital secretions. In almost all cases, the diagnosis of AIDS is straightforward. Although considerable controversy surrounds the need for more extensive and costly laboratory testing, the clinical diagnosis for most patients does not require such confirmation. At the beginning of the epidemic, the initial diagnosis of HIV infection was made on the basis of Kaposi's sarcoma almost as often as for Pneumocystis carinii infection. However, this is no longer the case. Kaposi's sarcoma appears to be decreasing in incidence and, in addition to P carinii pneumonia, patients with AIDS are increasingly being afflicted by such life-threatening opportunistic infections as toxoplasmosis affecting the central nervous system and cryptococcal meningitis. Also increasing in relative importance is a group of HIV-related importance is a group of HIV-related neurologic complications. These include an asymptomatic meningitis that occurs early in the course of infection, and a more severe, prolonged course of encephalopathy resulting in dementia, which may develop in a smaller subset of AIDS patients. 2. What, then, would arouse your suspicion of AIDS in a person not confined to high-risk groups? The patient with an opportunistic infection who does not fall into an obvious risk group presents a more perplexing diagnostic problem-as does the high-risk patient who develops a medical condition that in itself is not considered diagnostic of AIDS. In these cases, you must combine an appropriate level of clinical suspicion with diagnostic laboratory studies in order to formulate the differential diagnosis. Your first suspicion of AIDS is likely to arise when you find that a patient's symptoms are caused by one or more of the associated opportunistic infections. With the most common infection, for example-P carinii pneumonia--the patient frequently complains of fever, cough (either nonproductive or with whitish sputum), shortness of breath (especially following exertion), and a sensation of tightness on deep inspiration. These symptoms and signs may be relatively acute at onset, although some patients describe a progressive increase over a period of several months before the diagnosis is established. Both cryptococcal meningitis and toxoplasmosis affecting the CNS are frequently manifested by high fever and severe headache. Patients with toxoplasmosis are more likely to have frequent neurologic deficits, including seizures. Suspect Kaposi's sarcoma when a patient has painless, red to blue, palpable skin lesions that are often quite small (3 to 5 mm) when first discovered. They may occur anywhere on the body, including the oral cavity, and may also be observed on endoscopic evaluation. For reasons as yet unclear, Kaposi's sarcoma in AIDS is almost exclusively a tumor of homosexual men. The usual blood chemistry workup shows no specific changes. The patient's CBC may indicate anemia, thrombocytopenia, or leukopenia, and the ESR is frequently elevated. In the blood chemistry profile, suggestive changes include elevated globulin, decreased cholesterol, and (especially in those patients who have P carinii pneumonia) elevated lactic dehydrogenase (LDH). It should be stressed that none of these changes is diagnostic for HIV infection. However, these values should be obtained because such variations can support the diagnosis. During the early stages of HIV-related chronic symptoms, the differential diagnosis includes many conditions, particularly other chronic viral infections. Suspicion of an AIDS-related problem may be strengthened if the patient is in a high-risk group, and from the presence of such specific findings as oral hairy leukoplakia and diffuse lymphadenopathy. 3. What is the AIDS-related complex and why is it important? The AIDS-related complex (ARC) embraces a spectrum of clinical illnesses. Quite early in our experience with patients having AIDS, we also encountered large numbers of men whose symptoms did not meet the Centers for Disease Control criteria for AIDS, yet who clearly suffered from some element of immune deficiency. First recognized was a group of patients with diffuse enlargement of lymph nodes, a condition that was originally called lymphadenopathy syndrome and more recently, persistent generalized lymphadenopathy (PGL). This syndrome is a component of ARC. Lymphadenopathy, in fact represents the least threatening of the ARC subsets. Other patients with ARC suffer from isolated cytopenias, especially thrombocytopenia; viral infections such as persistent cutaneous herpes simplex or herpes zoster; or oral hairy leukoplakia. Still others may have unexplained chronic symptoms such as fever, night sweats, weight loss, and diarrhea, which may often be severely debilitating. Despite the degree of infirmity that is incurred by this illness, many patients with AIDS related complex do not qualify for the medical and insurance benefits that are afforded to patients with AIDS. The diagnosis of AIDS qualifies as presumptive disability, allowing patients social security supplementation of income when needed. This is not true of ARC; in this condition, it must be established that disability exists, and the patient may die before benefits are awarded. The CDC is considering eliminating the ARC diagnosis. Those with advanced symptoms would be said to have presumptive AIDS. Remember, however, that instead of attempting to categorize patients according to the name of their illness, we should increasingly consider all AIDS-related medical problems as part of the symptom complex of HIV infection. 4. Has heterosexual transmission of AIDS become more common thus changing the composition of high-risk groups? The likelihood of broader heterosexual transmission of HIV has been one of the more important concerns in the United States during the past two years. In exploring the possibility, we could almost say that there are two types of AIDS epidemics, determined by geographic area. In developed Western countries, the epidemic is largely confined to certain high-risk groups such as homosexual men and intravenous drug users, whereas in central Africa, the situation is far different: HIV infection appears to be acquired almost exclusively from heterosexual vaginal intercourse, and the ratio of men to women patients is approximately one to one. This information suggests that infection is transmitted with relatively equal efficiency between both sexes. According to statistics, AIDS infection in the United States has remained confined to the high-risk groups previously described. Nevertheless, recent and rather frightening evidence suggests that the incidence might be changing. In New York City, for example, more cases of AIDS are found among intravenous drug users (seroprevalence estimated at 75% or more) than among homosexual men. Here, too, increasing numbers of cases are caused by heterosexual contact with nonusers of drugs, and transmission to fetuses by mothers who either use I.V. drugs or have sexual contact with users. Further reason for concern about heterosexual transmission comes from surveys of military recruits, which show a real, although low, seroprevalence in recruits across the country, but with a much higher incidence in potential military recruits in the New York area. Within this region, the virus seems to have gained a foothold in school-age youngsters, especially among minority, urban youth. In view of the high rate of other sexually transmitted diseases in this population, we fear that HIV may continue to spread, unsuspected, through heterosexual intercourse. Finally, growing evidence from Miami and from Brussels supports the case for heterosexual transmission of HIV from women to men as well from men to women. Earlier statements about the heterosexual's lack of risk for HIV infection may have been to reassuring. 5. How good are the antibody tests? Each technique has its own advantages and disadvantages, but in good hands, each is highly accurate. These inexpensive, reproducible, and accurate tests for detection of the HIV-related antibody were developed shortly after the AIDS virus was cultured by investigators in France and the United States. The tests that are the most commonly used antibody tests include the enzyme-linked immunosorbent assay (ELISA), immunofluorescence, and the Western blot test. The ELISA test, which is the most widely used, is extremely accurate for persons who are at relatively high risk for HIV infection, but its predictive value declines somewhat within populations of lower seroprevalence. Among blood bank specimens, for example, many that originally test positive for HIV according to ELISA are later proved to be false-positive when Western blot and virus culture produce negative results. The reasons for false-positive tests vary, but they are found with higher frequency in persons who have underlying liver disease and in multiparous women. Some of the inaccuracies in antibody testing can be traced to reagent preparation. As the manufacturing methods improve, we expect that these tests will become even more accurate. The difficulty that has been encountered with HIV antibody tests is caused not by their inaccuracy but rather by the stigma associated with AIDS and with HIV infection in general. There have been extremely well documented and not infrequent cases in which persons known to harbor the HIV antibody (or suspected of it) became objects of discrimination regarding housing, employment, and insurance. For this reason, it is essential that you be judicious when you consider ordering HIV antibody testing. In my opinion, this means that you should utilize the test as though it were more expensive and invasive than it might appear at first glance. The test actually is more expensive than it seems because of its potential cost, in terms of the effect on income and insurability, to the person who is found seropositive. Moreover, the test should be considered invasive because of the obvious need to protect the confidentiality of the test results. 6. Given these caveats, when should the HIV antibody test be used? The antibody test should be carried out prudently by public health authorities in an effort to educate patients about the risk, and about their need to follow sexual practices that reduce the risk of HIV transmission. As a clinician, you should utilize the antibody test when it is necessary to confirm the AIDS diagnosis that is not readily apparent from physical findings. A more frequent clinical use of HIV antibody testing is for patients who are suspected of having ARC. For these persons, the tests can help formulate a more accurate differential diagnosis that might help separate HIV infection from other causes of chronic symptoms. 7. If an apparently healthy person is infected with HIV, what is his or her risk of developing AIDS or ARC? At this time, we have no precise answer to this question, but the risk of a seropositive person developing AIDS or ARC is one of the most important problems currently confronted by physicians. As many as 2 million Americans may already be infected with HIV. Their estimated risk of developing AIDS or ARC was originally thought to be 10% to 30%, but prospective serological studies lead us to suspect that the figure might be much higher. Because their health is clearly threatened by this infection, these persons require counseling, and they should be followed by a physician who is knowledgeable about the medical problems associated with HIV, and their treatment. 8. What ill effects have your health workers experienced from frequent contact with AIDS patients? What preventive measures should be taken by primary care physicians and their office staff? When we started working with patients having AIDS at San Francisco General Hospital, we gave little thought to the possible contagious nature of this disease. Initially, we were involved with cases of Kaposi's sarcoma and we approached these patients as we would those with any malignancy. We tried to remember-but often forgot-to wash our hands between patient contacts, and we made at least passing reference to the need to avoid needlestick injuries. In anything, we were more concerned about the risk of contracting hepatitis B while working with these patients, because even from the beginning it was well known that this virus was present. In retrospect, our approach to infection control was probably quite appropriate and adequate. We did go through a period of substantial personal fear in 1983 when it became inescapable clear that AIDS was caused by an infectious agent, probably a virus. Many of us were afraid we had become infected and might spread the virus to others. When HIV antibody testing became available in 1984, our hospital participated in an epidemiologic study of the occupational risk of HIV transmission. More than 300 of our health care workers were serotested for the virus. The results of the study were extremely encouraging: Of more than 250 persons who lacked outside risk for HIV infection, none were found to be seropositive. Even among 84 workers (heterosexual and nonusers of I.V. drugs) who were accidentally stuck by contaminated needles, none demonstrated seroconversion to HIV. Considering that the median incubation period to seroconversion is eight weeks, we believe this study conclusively proves that our willingness to care for patients with AIDS does not put us at personal risk for injury. We do recognize, of course, that AIDS is a devastating disease and that even a small chance of exposure is probably not acceptable. We therefore caution you, and members of your office and hospital staff, to recognize that your occupational risk of infection, slight though it may be, derives from accidental injury with sharp objects contaminated with blood containing HIV. For this reason, we recommend that you take precautions in using and disposing of needles, glass tubes, and other potentially injurious objects. For example, provide puncture-proof containers directly at the patient's bedside and the phlebotomy area, and label tubes containing blood from patients known to have AIDS or ARC. Also, have disinfectant solutions such as 70% alcohol, dilutebleach, or strong soaps available for prompt cleanup of blood. 9. What are the uses and limitations of the new drug, azidothymidine (AZT)? AZT was developed for use as an anticancer drug. An analog of thymidine, it acts to block reverse transcriptase, the enzyme necessary for replication of the AIDS virus. AZT may also have an antiviral effect in other parts of the HIV life cycle. Some properties of AZT are beneficial for effective AIDS therapy. For example, it is available in an oral form, it does not cause severe subjective side effects, and it achieves high CNS levels. AZT was compared to placebo in a large multicenter trial involving 282 patients. Approximately half of the patients had histories of severe, symptomatic ARC; the other half had just recovered from their first episode of pneumocystis pneumonia. This trial was terminated after about six months, when it became apparent that almost all of the subjects who died had been members of the placebo group. This was a highly significant difference in mortality. As a result, all placebo patients are now being given AZT, and the drug has been approved for wider distribution under what is called an investigational new drug treatment. In this protocol, physicians can apply for registration to prescribe AZT, which must be dispensed through registered hospital pharmacies. Patients who are currently eligible to receive AZT are those who have recovered from one or more episodes of pneumocystis pneumonia and who are not receiving other systemic medications that might alter the side effects of AZT. One important side effect is the suppression of bone marrow; many patients receiving AZT have developed severe anemia and require periodic blood transfusions. Neutropenia has also been observed. The effect of AZT on asymptomatic, seropositive persons and on patients with mild ARC is one of the most pressing questions that must be addressed by clinical researchers. It is certainly hoped that this drug will prevent progression to overt disease. The availability of AZT in quantities sufficient to carry out these important clinical trials is threatened to a certain degree, as the drug has become approved for marketing. Moreover, it may become difficult to enroll patients for participation in properly controlled clinical trials if AZT is available by prescription. 10. What is the outlook for other methods of AIDS treatment or for a vaccine against the virus? Although the AIDS epidemic is a growing national disaster, there is cause to hope that our rapid progress in understanding the virus, and the nature of the immune deficiency that it causes, will result in beneficial treatment for those who currently have AIDS. Certainly the progress that has been made with AZT gives us reason for hope. The ideal AIDS antiviral drug would be conveniently administered, have minimal short- and long-term toxicity, and would control replication of the virus in the central as well as in the peripheral nervous system. Ideally, such a drug could be used early in the course of HIV infection, thus preventing development of symptomatic immune deficiency and decreasing risk of contagion. Many laboratories and companies are working hard to develop and HIV vaccine as well. Their progress is complicated by the variable nature of the HIV envelope protein, which appears to limit the cross neutralization of HIV between individuals. Nevertheless, we hope that with the tools currently available, the biotechnology industry will yield a vaccine. Until that time, educational and preventive measures remain critical for all patients and health care providers. 11. What should primary care physicians do in caring for patients whom they suspect may be at risk? Primary care physicians have an extremely responsible role in dealing with the AIDS epidemic. They should be able to identify factors that might increase a patient's risk for becoming infected, and teach the patient how to prevent such infection. Basically, this requires physicians to become well versed in public health aspects of AIDS, the nature of the AIDS virus, and the current status of our knowledge about its transmission. Physicians can also recommend antibody testing for HIV when appropriate, as part of a program designed to reassure those who are uninfected and to help reinforce the behavior change in patients already infected with HIV. Physicians must become comfortable in discussing risk behaviors with their patients, including sexual practices and drug use. Such discussion should be frank, but nonjudgmental. If a patient is found to be seropositive, the physician should readily be able to discuss possible methods of treatment. Physicians should also be prepared to advise infected persons on techniques that might decrease the likelihood of progression to clinical AIDS. Although we still have but little firm data, many of us believe that when a person is already infected with HIV, additional viral or bacterial infection may hasten the progression of HIV infection, and also that reinfection with HIV itself might be detrimental. For this reason, we strongly recommend that all persons, whether known to be infected or not, follow the so-called safe sex guidelines, which are being refined as we learn more about the nature of the virus and its transmissibility. Essentially, the main need is to adopt sexual practices that prevent contact of rectal and vaginal mucosa with the partner's semen or vaginal secretions. The most basic element is the recommendation for use of condoms if there is any remote possibility that either partner has been exposed to HIV. We also believe there is increasing evidence for the detrimental effect of stress on persons who are infected but clinically asymptomatic. Accordingly, we recommend careful attention to diet, exercise, and other methods of reducing external stress such as biofeedback and relaxation techniques. However, no studies have been made of the last two approaches. Primary care physicians, especially those in areas having many patients infected with HIV, should become familiar with experts on AIDS who can help in patient management. Nevertheless, the generalist can be primarily responsible for the care of these patients in almost all cases, enhancing an understanding and supportive approach with guidance from specialists when required. 18) Voluntary HIV Counseling and Testing: Facts, Issues, and Answers Department of Health and Human Services Public Health Services Centers for Disease Control HIV/NAIEP/10-90/11 ------------------------------------------------------------ NEW CHOICES: HIV AND AIDS MEDICAL CARE OFFERS VITAL BENEFITS? There are clear benefits to early medical attention for infection with the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). If you are infected with HIV, the virus slowly weakens your ability to fight illness. But new medical treatments, including medicines and earlier use of medications, can help your body resist the virus. They do this by slowing the growth of HIV and delaying or preventing certain life-threatening conditions. For example, some medicines can prevent the type of pneumonia that is a common problem for people who have HIV infection or AIDS. Doctors can also find out then your immune system begins to weaken. By evaluating your immune system with a blood test every 3 to 6 months, doctors can help you avoid illnesses related to HIV infection and treat them more effectively when they occur. Without the help of medical care your body may develop serious illnesses more quickly. WHAT IS HIV, AND HOW COULD I BECOME INFECTED? It is important that you consider these new medical options as you decide whether to seek counseling and testing for HIV infection. Deciding whether to seek counseling and testing can be very hard. Your choice can have a major impact on your life. The new medical options have increased the benefits of counseling and testing. This brochure gives you the information you need to understand these benefits and consider them with other issues important to you. Use this brochure to make the choice that is right for you. HIV, the Human Immunodeficiency Virus, is the virus that causes AIDS. HIV can be in the blood, semen, and vaginal fluids of infected people. The HIV-infected person can infect others, even if no symptoms are present. HIV is transmitted by: * Having sex - vaginal, anal, or oral - with an infected person. * Using or being stuck with a needle or syringe that has been used by or for an infected person. * Giving birth - women with HIV infection can pass the virus to their babies during pregnancy or childbirth. In some cases, they can also pass it on when breast-feeding. * Receiving blood - Some people have been infected by receiving blood transfusions. However, the risk of infection through blood transfusions has been practically eliminated since 1985 when careful and widespread screening and testing of the blood supply for evidence of HIV became standard practice. However, there is still a very small chance of infection. WHAT HAPPENS IF I BECOME INFECTED WITH HIV? Being infected with HIV does not always mean you have AIDS. Being infected means the virus is in your body for the rest of your life. Therefore, you can infect others if you engage in behaviors that can transmit HIV. You can infect others even if you feel fine and no symptoms of illness are present. You can infect others even if you do not know you are infected. HIV weakens your body's immune system. This means that HIV infection can make your body more and more vulnerable to other illnesses and infections over time. Early symptoms may include tiredness, fever, diarrhea, enlarged lymph nodes, loss of appetite, or night sweats. People with HIV infection can develop many different health problems. These can include sever pneumonia, several forms of cancer, damage to the brain and nervous system, and extreme weight loss. These conditions signal the onset of AIDS, the most serious stage of HIV infection. Without treatment, most people with HIV infection will develop AIDS, but, with treatment, the HIV infection can usually be slowed and the onset of AIDS can be delayed. How fast does HIV infection develop into AIDS? In some people, AIDS-related illnesses may develop within a few years. Without treatment, half the HIV infected people will develop an AIDS-related illness within 10 years. To stay healthy for as long as possible, it is important to learn your HIV status, obtain medical advice, monitor your health, and consider your treatment options. THE BEST WAY TO KNOW WHETHER YOU ARE INFECTED: HIV-ANTIBODY COUNSELING AND TESTING You cannot tell by looking at someone whether he or she has HIV infection. Someone can look and feel perfectly healthy and still be infected. For this reason, most people who have HIV infection do not know it. The HIV-antibody test is the only way to tell whether you are infected. When any virus enters your body, your immune system responds by making proteins called antibodies. Different viruses cause the body to make different antibodies. You make antibodies to HIV when you have HIV infection. The HIV-antibody test detects HIV antibodies in your blood. It tell you whether you are infected with HIV. The test does not tell you if you have AIDS or when you will get AIDS. HIV antibodies are a sign of infection, but, unlike antibodies for many other infections, they do not protect your body from disease. They do not protect you from AIDS, do not make you immune, and do not prevent you from giving HIV to someone else. The HIV-antibody test should always include before-test and after-test counseling. This counseling is to help you understand your result, how to protect your own health, and (if you are infected) how to keep from infecting other people. It is a central part of the testing process whether you are infected or not. SHOULD I SEEK HIV COUNSELING AND TESTING ? If you have engaged in behavior that can transmit HIV, it is very important that you consider counseling and testing. The following checklist will help you assess your degree of risk. AT RISK There is evidence that HIV, the virus that causes AIDS, has been in the U.S. at least since 1978. The following are known risk factors for HIV. If you answer yes to any of these questions, you should definitely seek counseling and testing. You may be at the increased risk of infection if any of the following apply to you since 1978. - Have you shared needles or syringes to inject drugs or steroids? - If you are male, have you had sex with other males? - Have you had sex with someone who you know or suspect was infected with HIV - Have you had a sexually transmitted disease (STD) ? - Have you received blood transfusions or blood products between 1978 and 1985? - Have you had sex with someone who would answer yes to any of the above questions? If you had sex with someone and you didn't know their risk behavior, or you may have had many sexual partners in the last 10 years, then you have increased the chance that you might be HIV infected. If you are a woman in any of the above risk categories and you plan to become pregnant, counseling and testing is important. HIV- infected women have about a one-in-three chance of infecting their baby during pregnancy or delivery. REASONS FOR SEEKING COUNSELING AND TESTING People consider counseling for a number of reasons, some which may apply to you. * Knowing whether you have HIV infection would alert you to your need to seek medical care to prevent or delay life-threatening illness. Your test result (positive or negative) would also help your doctor determine the cause and best treatment of various illnesses you may have now or in the future. For example, if you are HIV positive, tuberculosis (TB) and syphilis are treated differently than if you are HIV negative. * If you find out you are infected, knowing your result would help you protect your sexual partner(s) from infection and illness. If they are not infected, you can avoid infecting them. * Knowing your result would help you assess the safety of having a child. * Knowing your result, even if you are infected (positive test result) may be less stressful for some people than anxiety of thinking you might be infected but not knowing. If your result indicates you are not infected (negative), you can take action to be sure you don't become infected in the future. REASONS FOR NOT SEEKING COUNSELING AND TESTING People may not seek counseling and testing for a number of reasons. For instance, if they are certain they have never engaged in behavior that could infect them with HIV, or had a blood transfusion, they do not need to be counseled and tested. Other reasons are less clear-cut. For instance, they think the stress of a positive test result - and issues it would raise among family members, friends, and sexual partners - would be more harmful than not knowing if they are infected. Perhaps they fear that others may find out their result without their permission. They might also be concerned about discrimination; some people have been denied housing, jobs, and insurance because the have HIV infection. Many people are troubled by these concerns. You should decide for yourself whether these concerns out-weigh the benefits of testing and early medical attention. The latest medical knowledge gives added weight to the benefits of knowing if you are infected or not. If you have any doubts about what you should do, get counseling. Then decide whether to go ahead with testing. However, if you decide not to be tested you should prevent the transmission of any possible HIV in your body to sexual or needle sharing partners. UNDERSTANDING THE HIV COUNSELING AND TESTING PROCESS It is very important that you understand the confidentiality policies of the testing center. Ask your testing counselor how they will protect your test results. Most counseling and testing centers follow one of two policies. * Confidential testing The confidential testing site records your name with the test result. They will keep your record secret from everybody except medical personnel or, in some states, the state health department. You should ask who will know the result and how it will be stored. If you have your HIV antibody test done confidentially, you can sign a release form to have your test results sent to your doctor. * Anonymous testing (not available in all states) No one asks your name. You are the only one who can tell anyone else your test result. If you wish to be tested, ask your health department, doctor, or the National AIDS Hotline (1-800-342-AIDS) about the location of facilities near you. DECIDING WHERE TO GO FOR COUNSELING AND TESTING Depending on the area where you live, there are different counseling and testing places from which to choose. These options include publicly funded HIV testing centers, community health clinics, sexually transmitted disease (STD) clinics, family planning clinics, hospital clinics, drug treatment facilities, TB clinics, and your doctors office. In making your choice, you may want to consider these factors. * If you have been to a particular place for health care before for other reasons, you may feel comfortable with the staff who will counsel you and offer you testing. * If the center can provide immune system monitoring and medical care if you are infected with HIV, it might speed up the beginning of your medical treatment. * Some counseling and testing centers offer special features. For instance, if you use drugs, you can receive counseling, testing, and help for addiction at the drug treatment facility. At some centers, such as doctors' offices or clinics, information about your test result may become part of your medical record and may be seen by health care workers, insurers, or employers. Your status may become known to your insurance company if you make a claim for health insurance benefits or apply for life insurance or disability insurance. If any health care provider proposes to test you for HIV antibodies, discuss the reasons and the potential benefits before deciding whether or not to take the test. Do not go to a hospital emergency room to be counseled and tested. You should go to an emergency room only if you have a health problem that demands urgent attention. Also, do not give blood at a blood donation center as a way to get tested for HIV antibodies. Blood donation centers are not HIV-antibody counseling and testing centers and should not be used as such. You can call the National AIDS Hotline (1-800-342-AIDS) to get the address of places where you can get counseling and testing. THE PROCESS OF COUNSELING AND TESTING **** Counseling **** You should be given materials to read before you enter a group or private session with a counselor or doctor. He or she might ask why you want to be tested. Your counselor should also ask about your behavior and that of your sexual partner(s). This will help your counselor and you to determine whether testing is appropriate for you. If testing is appropriate, your counselor or doctor should: * Describe the test and how it is done. * Explain AIDS and the ways HIV infection is spread. * Discuss ways to prevent the spread of HIV. * Explain the confidentiality of the test results. * Discuss the meaning of possible test results * Ask what impact you think the test result will have on you. * Address the question of whom you might tell about your result. * Discuss the importance of telling your sexual and/or drug partner(s) if the result indicates HIV infection. If these questions are not covered, or if you have any other questions, ask them. You should come prepared with questions that have been on your mind. Also ask your doctor or counselor how you will be told of your test result. The best way to receive your results is in a face-to-face discussion, not by mail or over the phone. If your test result is negative, the post-test counselor will talk to you about how to avoid behaviors that will put you at risk. **** Informed Consent **** You have the right to refuse any medical procedure, to be fully informed about it, and to agree to it. You should be asked to read a statement saying that you have been informed about the HIV- antibody testing procedure, you understand it, and you consent to have it done. **** The Blood Test **** A small amount of blood will be drawn from your arm, taken to a lab, and tested. The time it takes to get the results back varies in different areas. It can take anywhere from a few days to a few weeks. **** The Waiting Period **** This period of days or weeks can produce anxiety and tension. Some people decide during this time that they do not want to know their test results and never return to receive it. It is very important that you finish the process and find out the test results in spite of your anxiety. It is important that until you return for your result and post-test counseling you act as if you were infected and could transmit the virus. In other words, don't have unprotected sex or share needles. When your result arrives, you will be asked to return to the counseling and testing center to receive the information in person. Everyone tested is asked to return for counseling, whether the result is positive or negative. **** Counseling After The Test **** When you return, your counselor should tell you your result and, regardless of whether it is positive or negative, how to protect your health and the health of others. He or she will review methods to prevent the spread of HIV. If your result is negative, your counselor may discuss retesting if, during the 6 months before your test, you engaged in any behaviors that might have infected you. You may be infected but your body may not yet have produced enough antibodies for the test to detect. Since it takes time for your body to develop antibodies, you may need to be retested. If your test result is positive, your counselor will tell you what this means for you. Any questions you have will be answered and your counselor will refer you for follow-up health care, support services, or further counseling. Your counselor will also talk to you about telling your sexual and/or drug-using partner(s). Types Of Tests The ELISA (Enzyme-Linked Immunosorbent Assay) is a screening test that is widely used. It can be performed relatively quickly and easily. If a positive (reactive) result occurs, the test is repeated to check it. If an ELISA test yields two positive results, a different test such as the Western Blot is used to confirm it. The Western Blot is more specific and takes longer to perform than the ELISA. Together, the two tests are more than 99.9 percent accurate. Further evaluation can be done if results of repeated ELISA and Western Blot tests are unclear. Your testing facility should do the ELISA twice on the same blood sample and confirming test such as the Western Blot if the ELISA tests are positive. THE MEANING OF YOUR TEST RESULT **** Negative Result **** A negative result means that no HIV antibodies were found in your blood. Your condition is called seronegative. This usually means you are not infected. Testing negative does not mean you are immune to HIV. No one is immune to HIV. Even if you test negative, there are steps you should take to protect your health and the health of your sexual and/or drug-using partner(s). Do not engage in behaviors that can transmit HIV. These behaviors include having sexual intercourse with an infected person or sharing needles or syringes with an infected person. Your post-test counselor will discuss these behaviors with you. There is a small chance that you may be infected, even though you tested negative. It takes time for your body to develop HIV antibodies after infection. Almost all people develop HIV antibodies within 2 to 12 weeks, but it can take up to 6 months after infection. If you engaged in behavior that can transmit the virus during the 6 months just before your test, you may be infected but still test negative because your body may not yet have produced antibodies. To be sure, you must be retested at least 6 months after you last engaged in behavior that can transmit HIV. **** Positive Result **** A positive result means the antibodies to HIV were found in your blood. This means you have HIV infection. Your condition is called HIV-positive, or seropositive. You will most likely develop AIDS, but no one can know when you will get sick. Within 10 years after infection, about half of untreated people have developed AIDS. However, prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. HIV-antibody test results are extremely accurate when proper procedures are followed. However, a very small number of people may test positive even though they are not infected. These are called false positive results. If your test result is positive, there are a number of important steps you should take immediately to protect your health. * See a doctor, even if you don't feel sick. Ask if the doctor has experience treating people with HIV infection and is familiar with AIDS and HIV-related issues. Tell the doctor your test result and discuss immune system monitoring and treatment. Monitoring and appropriate medical action are the ways to slow the growth of HIV and to delay the onset of AIDS. * Have a tuberculosis (TB) test done. You may be unknowingly infected with TB. You can become seriously ill if your TB goes undetected. TB can be treated successfully if detected early in your HIV infection. * Ask you doctor if you should get flu vaccine or other vaccines. * Enroll in a program to help you stop using drugs, drinking a lot of alcoholic beverages, or stop smoking. This will help you reduce or stop engaging in behaviors that can weaken your body. * Consider joining a support group for people with HIV infection. Such support can help you cope with being HIV- infected. You should take steps to protect the health of others. * You may infect others if you engage in behavior that can transmit the virus (sexual intercourse - vaginal, anal, or oral - or sharing drug needles or syringes). * To reduce the risk of transmitting HIV if you have sexual intercourse, always use latex condoms. Use them from the beginning to the end every time you have sex and make sure to use them properly. * There is no known risk of infection except in situations where we come into contact with blood, semen, or vaginal fluids. * If you are a woman, you should strongly consider avoiding pregnancy. There is about a one-in-three chance that you will pass HIV to your unborn baby. * Do not donate blood, organs, sperm, corneas (eyes), or even bone marrow. Revise any organ donor permissions you have given. * Tell any doctor or dentist who treats you that you are infected. You should tell anyone you have had sex (oral, anal, or vaginal) or shared needles since 1978 that you are (and they may be) infected with HIV. It is especially important that you tell current and recent partners. Health professionals can tell your sexual and/or drug-using partner(s) for you or help you tell them yourself. All of your present and past partners should be referred for counseling and testing. If they are HIV positive, prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. Also, they may unknowingly infect others. You have an important role to play in helping stop the spread of HIV infection. Telling people about your test results can be a very sensitive matter. You may want to discuss it with your testing counselor. They can assist you in telling your sexual or drug-using partner(s). If you choose to tell your partner(s) yourself, do not make accusations. Be prepared for partners to become upset or hostile. Urge them to be counseled and tested as soon a s possible. You may want to give them a copy of this brochure. HOW A POSITIVE TEST RESULT MIGHT AFFECT YOUR LIFE Being infected with HIV is not only a health matter. It raises financial and social issues as well. One of these issues is insurance. These issues should be discussed with a qualified counselor. Your ability to pay for health care can affect your access to monitoring and treatment. If you do not have health insurance or if you depend upon Medicaid, you may need special assistance to get treatment. Centers that offer experimental drug treatments for AIDS-related illnesses may not be available everywhere. To find out about experimental treatments, call the AIDS Clinical Trails Information Service (1-800-TRAILS-A), that is, 1-800-874-2572), Monday through Friday between 9 a.m. and 7 p.m. Eastern time. Some people who do not understand AIDS may avoid persons who know they are infected with HIV. Some people who are infected have been targets of discrimination in employment, housing, and insurance. Some have been deeply hurt by the reactions of friends and family members. You should be prepared to encounter uncomfortable reactions and to deal with these issues. ANSWERS TO YOUR QUESTIONS Here are answers to some questions you may have about HIV-antibody counseling and testing. Why get tested? If you know you are infected, you can take steps to protect your health and the health of others. There are clear benefits to early treatment, even though there is no cure for the HIV infection. New medical options, including medications and other approaches, can help slow the infection and delay or prevent life-threatening conditions. I think I recently placed myself at risk of infection with HIV. Should I get counseled and tested right away? Yes. If you get infected with HIV, test may not detect it until at least 2 weeks after infection. The test detects HIV antibodies in your blood. If you are infected, your body takes time to make enough antibodies for the test to measure. It can take as little as 2 weeks. But it might take a month. Nearly all infected people develop antibodies within 6 months of infection. If you think you placed yourself at risk for HIV infection, you should get counseling, and, until you know you are not infected, you should protect others as if you were infected. Does it take long to get an appointment to be counseled and tested? It depends on where you live. Some counseling and testing facilities can schedule appointments very quickly. Others may take a few weeks. Call you local health department to find out. How much does HIV counseling and testing cost? Most publicly-funded testing sites are free or require only a minimum fee. If you go to your doctor for counseling and testing, the cost can vary. In some areas, it can be more than $200. You can ask the cost beforehand. When I had a blood test done for my physical, marriage license, or insurance, was I tested for HIV antibodies? Do hospitals routinely test for HIV infection? You should not assume that your blood was tested for HIV antibodies. If you are concerned, ask your health care provider what tests will be done whenever you have blood taken. If you are still concerned, ask specifically if your blood will be tested for HIV antibodies. If I am pregnant or thinking about having a baby, should I be counseled and tested? If you or your sex or drug partner have engaged in behaviors that can transmit HIV, you should get counseling and testing. If you test positive and are not yet pregnant, you should strongly consider the consequences of pregnancy. There is a one-in-three chance that you will pass the virus to your unborn baby. If you are already pregnant, you should tell your health care provider you tested positive. This will help your provider care for you and your baby during and after pregnancy. What if my insurance company wants me to take the test? An insurance company may require that you be tested for HIV infection if you apply for a health or life policy. You have the right not to take the test. You must choose whether to take the test or find an insurer who will not ask you to do so. Will my insurer find out if I test positive? Your insurer will know you took the test if you pay for the test through insurance. Insurers can find out your test result only if you release it. On some insurance forms, your signature authorizes release of medical records. If you are concerned, do not sign medical release forms unless you know their purpose. You may also choose to be counseled and tested at a facility separate from your health care provider. These facilities include publicly-funded testing sites, sexually transmitted disease clinics, and family planning clinics. Call your local health department or the National AIDS Hotline (1-800-342-AIDS) to find out the nearest facility that offers confidential counseling and testing. Does the Government keep track of those who test positive? The U.S. Public Health Service does not collect names of people who test positive. The state health departments that do collect names treat this information as highly confidential. Most states have laws against releasing confidential information without permission. Call your state or local health department to find out the laws in your state. Why do I have symptoms after testing negative? See a doctor about you symptoms. They are most likely caused by something other than HIV infection. Early symptoms of HIV infection can be the same as these of many other diseases that occur in people who are not infected with HIV. If you test negative and still think you might be infected, consider retesting. If you test negative again, and you have not engaged in behavior that can transmit HIV in the past 6 months, you are probably not infected with HIV. My partner tested negative. That means I am not infected, right? Your partner's test does not always tell your status. The only way to know whether you are infected is to have your own test. Can I continue to work if I have HIV infection? Yes, you can continue working if you have HIV infection. It depends on your health and your job duties. HIV cannot be spread by contact that does not involve blood, semen. or vaginal secretions. Many years after infection, some people still have no symptoms and continue to work productively. In later stages of HIV infection, illness may cause you to be too sick to work. How can I find a doctor who will treat me? Call your local medical society. They should be able to refer you to a doctor who will help you. For additional help, you can contact a local AIDS organization. The people there may be able to help you find a doctor who is experienced with HIV and AIDS-related issues. For the telephone numbers of these organizations, call the National AIDS Hotline [1-800-342-AIDS; Spanish 1-800-344-7432; Deaf Access 1-800-243-7889 (TTY)] 00 AIDS HOTLINES ================= National HIV/AIDS Hotline 1-800-342-AIDS (run by the American Social Health Assoc under a grant from CDC) Spanish AIDS Hotline 1-800-344-SIDA Hearing Impaired AIDS Hotline 1-800-243-7889 AIDS Hotline for Teens 1-800-234-TEEN Mondays - Saturdays 4-8pm Central time (234-8336) AIDS Clinical Trial Information Center 1-800-TRIALS-A Drug Abuse Hotline 1-800-662-HELP Gay Men's Health Crisis 1-212-807-6655 National AIDS Information Clearing House 1-800-458-5231 National Gay Task Force Crisis Line 1-800-221-7044 National Sexually Transmitted Diseases Hotline (American Social Health Association) 1-800-227-8922 Pediatric and Pregnancy AIDS Hotline 1-212-430-3333 Project Inform (AIDS Experimental Drug info) 1-800-822-7422 RECORDED INFORMATION from the CENTERS FOR DISEASE CONTROL (CDC) Current number of AIDS cases and deaths: 1-404-330-3020 Distribution of cases by transmission category: 1-404-330-3021 Top ten cities and states with AIDS residents: 1-404-330-3022 CDC Printed Materials: 1-404-329-3534 AIDS HOTLINES BY STATE (updated 3/91) Alabama 1-800-228-0469 Michigan 1-800-872-AIDS Alaska 1-800-478-AIDS Minnesota 1-800-752-4281 Arizona 1-800-334-1540 Mississippi 1-800-826-2961 Arkansas 1-800-445-7720 Missouri 1-800-551-2728 California(N) 1-800-FOR-AIDS Montana 1-800-233-6668 California(S) 1-800-922-AIDS Nebraska 1-800-782-AIDS Colorado 1-800-252-AIDS Nevada 1-702-687-4804 Denver 1-303-333-4336 New Hampshire 1-800-342-AIDS other question 1-303-331-8310 New Jersey 1-800-624-2377 Connecticut 1-800-342-AIDS New Mexico 1-800-545-AIDS Delaware 1-800-422-0429 New York 1-800-541-AIDS D.C. 1-202-332-AIDS Albany 1-800-962-5065 Florida 1-800-352-AIDS Brooklyn 1-718-638-AIDS Spanish 1-800-545-SIDA New York City 1-212-340-4432 Creole 1-800-AIDS-101 North Carolina 1-800-342-AIDS Georgia 1-800-551-2728 North Dakota 1-800-472-2180 Atlanta 1-404-876-9944 Ohio 1-800-332-AIDS Hawaii 1-800-922-4379 Oklahoma 1-800-522-9054 Honolulu 1-808-924-2437 Oregon 1-800-777-AIDS Kauai 1-808-245-4495 Portland 1-503-223-AIDS Maui 1-808-244-4288 Pennsylvania 1-800-662-6080 or 1-808-667-0655 Puerto Rico 1-809-765-1010 Hawaii 1-808-961-7276 Rhode Island 1-800-726-3010 Oahu 1-808-735-5303 South Carolina 1-800-332-AIDS Idaho 1-208-345-2277 South Dakota 1-800-592-1861 Illinois 1-800-243-AIDS Tennessee 1-800-525-AIDS Indiana 1-800-848-AIDS Texas 1-800-255-1090 Iowa 1-800-445-AIDS Utah 1-800-537-1046 Kansas 1-800-232-0040 Salt Lake City1-801-538-6094 Kentucky 1-800-445-AIDS Vermont 1-800-882-AIDS Louisiana 1-800-992-4379 Virginia 1-800-533-4148 Maine 1-800-851-AIDS Washington 1-800-272-AIDS Maryland 1-800-638-6262 West Virginia 1-800-642-8244 Baltimore 1-301-333-AIDS Wisconsin 1-800-334-AIDS Massachusetts 1-800-235-2331 Wyoming 1-800-327-3577 Boston 1-617-522-4090 AIDS Council of Northeast New York 514-445-AIDS (you may call collect) Bronx Teen Pregnancy Network 212-585-7996 (you may call collect) Caroline Islands/Micronesia 011-691-9-619 Marianas Islands/Saipan 011-670234-8950 Marshall Islands 011-692-9-3487 U.S. Virgin Islands - St. Croix 1-809-773-AIDS ..
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