|
December 7, 1987 MEMORANDUM FOR: EDWARD J. BAIER, DIRECTOR Directorate of Technical Support THROUGH: LEO CAREY, DIRECTOR Directorate of Field Operations FROM: LINDA R. ANKURegional Administrator SUBJECT: AIDS Information
This is
in response to your memo concerning an OCIS subfile on AIDS. Such a file
would be quite useful. We are attaching a series
of questions with answers developed by the City of Philadelphia, Department
of Public Health. You may find it useful to be included in the file. Please contact Jim Johnston (FTS 596-1201) if you have any questions. 5/1/87 CITY OF PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH HEALTH PROMOTION/DISEASE CONTROL AIDS CONTROL PROGRAM T A B L E O F C O N T E N T S DEFINITION 1 INCIDENCE 3 TRANSMISSION 5 DIAGNOSIS & TREATMENT 12 CHILDREN AND AIDS 16 PREVENTING THE SPREAD OF AIDS 19 CARE OF AIDS PATIENTS 22 HUMAN RIGHTS ISSUES 27 HOW TO REDUCE THE RISK OF AIDS 29
D E F I N I T I O N 1. What is AIDS? Acquired
immune deficiency syndrome (AIDS) is a disease complex characterized by a
collapse of the body's natural immunity against disease. Because of this
failure of the immune system, patients with AIDS are vulnerable to one or more
unusual infections or cancers that do not pose a threat to anyone whose
immune system is working normally. 2. What causes AIDS? AIDS is
caused by a virus. This virus was discovered simultaneously in France, where
it was named lymphadenopathy- associated virus (LAV); and in the United
States, where it was given the name human T-lymphotropic virus, Type III
(HTLV-III). Today, the World Health Organization has agreed to call this
virus human immunodeficiency virus, or HIV. Infection
with HIV does not always lead to AIDS. Researchers are studying whether other
co-factors may be necessary to trigger the onset of the symptoms,
opportunistic infections or cancers associated with AIDS. Some people with
HIV remain in good health, while others may develop the relatively mild
symptoms we call AIDS Related Complex (ARC), and others go on to develop
AIDS. 3. Is AIDS a newly
diagnosed disease? How was it started? Is it in other countries? Yes, AIDS is
a "new" disease. We can say this for a number of reasons. First,
before the AIDS epidemic, Kaposi's sarcoma (KS) in this country was primarily
a disease of elderly men of Jewish or Mediterranean extraction. It presented
as superficial skin lesions, progressed slowly and responded to
chemotherapeutic agents. Life expectancy averaged 14 years, so many patients
died with KS and not of it. In the late
1970's and early 1980's, the epidemiologic and clinical characteristics
changed. KS became a disease of young, middle-aged males of all racial and
ethnic backgrounds. Lesions occurred throughout the body (superficial and
internal lesions), and did not respond to chemotherapeutic agents. Patients
died within a few years because of extensive disease and opportunistic
infections. Second,
Pneumocystis carinii pneumonia (PCP) was occurring in people who should not
be getting it, PCP used to occur in patients with known immunosuppression,
renal transplant patients and leukemia patients. In the late 70's and early
80's, young men with none of these conditions were developing PCP, for no
apparent reason. Third, a
search was conducted through past medical literature to see if KS and PCP
ever occurred in the same patient. There was no report of any individual who
was unlucky enough to have both PCP and KS. With the AIDS epidemic, many
individuals have had both diseases. Fourth,
health care workers and missionaries in Africa noted a change in health
problems there around the same time changes were being noted in the United
States. It is not
known at this time where the AIDS virus first appeared or why. But we do know
that it is a worldwide problem and has been found in over 92 countries, on 6
continents and in every state in the United States, as well as Washington, DC
and Puerto Rico. I N C I D E N C E 4. Do only men get AIDS? At present,
early 1987, about 7% of adult AIDS cases have been in women. Most of these -
50% - have been intravenous (IV) drug users; some (29%) have been sexual
contacts of men who were bisexual or drug users; some (10%) received
contaminated blood transfusions. 66% of all
AIDS cases have occurred in gay/bisexual males; 17% in heterosexual male and
female IV drug users; 8% in gay male IV drug users; 4% from heterosexual
contacts, 3% in hemophiliacs and transfusion-related cases, and 3% in none of
the above. At least 57% of these individuals diagnosed since 1981 have died
as of December, 1986. 5. How do we know for a
fact that 3% of the cases that don't fit into risk groups doesn't mean the
disease is transmitted by casual contact? About
one-third (170) of these patients either died before adequate information
could be obtained, lost to follow-up or refused to answer questions. They may
be in a high risk category, but we do not know and never will know. About
one-third (170) of these patients are still under investigation. Prior
experience has shown that many of these cases will be reclassified into the
risk behaviors previously described. That means that only about 170 of the
cases cannot be explained. That is not surprising since the questions we ask
are personal, and many patients do not want that type of information on any
government document. 6. How many cases of AIDS
have occurred so far? In the
United States, there have been over 35,000 cases of AIDS cumulative as of
April, 1987. Of this number, over 696 cases have been diagnosed in the
Philadelphia area. 7. How many men have
developed AIDS? As of April,
1987, a total of 32,000 males have been diagnosed with AIDS in the United
States. Of that number, 610 have been residents of the Philadelphia area. 8. How many women have
developed AIDS? As of April,
1987, a total of 2,388 women in the United States have developed AIDS, 23 of
whom are residents of the Philadelphia area. 9. How many blacks and
Latinos have developed AIDS? As of
December, 1986, about 7,800 blacks (24% of total) and 4,008 Latinos (14% of
total) have been reported with AIDS nationally. In the Philadelphia area, as
of April, 1987, there have been 217 cases in blacks (47.8% of total and 28 in
Latinos (62%). Over half of the AIDS cases in Philadelphia have occurred in
the minority population. 10. What is the
geographic distribution of reported AIDS cases in the United States? Five states
- New York, California, Texas, Florida and New Jersey - account for almost
75% of the reported cases. As of December, 1986, AIDS cases have been
reported in all 50 states, the District of Columbia and Puerto Rico. 11. Is the incidence of
AIDS increasing in Pennsylvania? As of
December, 1986, there were 613 cases of AIDS in Pennsylvania, twice as many
as there were one year before. Pennsylvania ranks 7th in cases in the United
States. 12. Is the incidence of
AIDS increasing among intravenous drug abusers? Nationally,
as of April, 1987, 17% of cases occurred in heterosexual IV drug abusers and
8% in gay/bisexual IV drug users - a total of 25%. Unfortunately, in some
areas of the country like northern United States, IV drug-related AIDS is
increasing dramatically. IV drug abuse is responsible for 79% of pediatric
AIDS cases nationally. AIDS education is particularly critical in IV drug
abuse populations because these individuals are at risk to both sexual and
needle sharing behaviors. By April, 1988, 12% of new cases were among
heterosexual IV drug users while 7% were in gay/bisexual men who use drugs. 13. Is AIDS occurring
only in our country? AIDS is a
worldwide phenomenon. In addition to the United States and Canada, AIDS has
been reported in 18 European countries, at least 21 African countries, the
Caribbean, South America, Australia and several other places including the
Middle East and Asia. 14. Do AIDS cases in
other countries show the same risk factors as here? In general,
the same risk factors -- exposure to contaminated blood and sexual activity
-- are associated with AIDS everywhere. The specific groups of people
affected by AIDS varies to some extent from country to country. For example,
there are few drug abusers identified as having AIDS in Europe, and more
females have developed AIDS in Africa. Studies are underway to gain a better
understanding of the similarities and differences of AIDS distribution in the
United States and other countries. T R A N S M I S S I O N
15. How contagious is
AIDS? Unlike many
communicable diseases -- colds, flu, measles, etc -- AIDS is not
transmitted through sneezing, coughing, eating or drinking from common
utensils, or merely being around an infected person for a long time. After
more than five years of experience, it is evident that casual contact with
AIDS patients does not place others at risk. No cases have been found where
AIDS has been transmitted through casual (non-sexual) contact to a household
member, relative, co-worker or friend. Health care workers and others who
care for AIDS patients on a daily basis have not become ill through routine
contact. 16. How is AIDS
transmitted? AIDS is not
an easily transmissible disease. All evidence indicates that AIDS is spread
through sexual contact, needle sharing or less commonly through transfusions
of blood or blood components before blood screening began in 1985. It can
also be passed from an infected mother to her unborn child. Direct
blood-to-blood or vaginal secretion/semen-to-blood contact appears necessary
to transmit the virus associated with AIDS. There is no evidence that AIDS
can be transmitted through air, water, food or casual body contact. 17. Why are homosexual
males especially at risk for AIDS? Anyone can
get AIDS if his or her sexual partner is carrying the HIV virus. In this
country, AIDS has spread widely among gay and bisexual men; but in other parts
of the world most people with AIDS have been heterosexual. AIDS is contracted
from intimate contact with an infected gay, bisexual or heterosexual partner
or IV drug sharing partner in the vast majority of cases. 18. Why are IV drug
abusers at increased risk for AIDS? IV drug
abusers often share needles for drug injection which can result in small
amounts of blood from an infected person being injected directly into the
blood stream of others who share needles with that person. 19. Why are hemophiliacs
at increased risk for AIDS? Hemophiliacs
receive frequent transfusions of a blood concentrate, Factor VIII, which must
be collected from several thousand donors. Cases of AIDS among hemophiliacs
are linked with receipt of blood serum from HIV infected donors. Presently,
all donated blood is screened for the presence of antibodies to the HIV
virus; infected blood is discarded. In addition, Factor VIII is heat treated
to kill any virus that may still be present. Unfortunately, many hemophiliacs
still carry the virus from Factor VIII which they received before testing and
heat treating began. 20. What kinds of
intercourse are associated with AIDS transmission? AIDS may be
transmitted in anal or vaginal intercourse. During anal intercourse, slight bleeding
may often occur, since the rectal lining is very fragile. But semen/vaginal
secretion-to- blood contact may occur anally or vaginally, whether or not
there is any visible bleeding. 21. Is AIDS passed by
kissing? HIV has been
found in the saliva of some AIDS patients, but there is not a single case of
AIDS that is known or suspected of having been transmitted by kissing. If
AIDS were transmitted by kissing, many family members of persons with AIDS
would be expected to have developed the condition. This has not occurred. 22. Can AIDS be
transmitted through oral/genital sex? It has not
yet been determined whether oral/genital sex transmits the disease, but any
direct contact with the semen or vaginal secretions of any infected person
may increase the risk of AIDS transmission. This may be most likely if the
receiving partner has slight cuts or bleeding within the mouth. 23. Can prostitutes
spread AIDS? Prostitutes
are likely carriers of HIV virus if they engage in unprotected sexual contact
with many partners or if they are IV drug users. Anyone who engages in sex
with a prostitute or other anonymous partner may be increasing the risk of
contracting AIDS and other sexually transmissible diseases. Condoms can
significantly reduce this risk. 24. Can use of a condom
during sex reduce the risk of AIDS? Proper use
of a condom during sex can probably reduce the risk of AIDS since it
minimizes direct contact with semen or vaginal secretions, body fluids known
to carry the AIDS-linked virus in infected persons. Manufacturers of condoms
point out, however, that their products are not failsafe and people should
not rely on condoms as their only defense against AIDS. A recent study
involving five brands of latex condoms showed that a high concentration of
AIDS virus could not pass through an intact condom after three weeks of
laboratory exposure. However, all sexually active people are advised to
refrain from sexual contact with persons whose history and health status are
unknown. Proper use of condoms is also essential: avoid oil-based lubricants
such as vaseline or baby oil; be sure the condom is applied without air
pockets which may result in breakage; and the condom must remain on from
beginning to end of penetration. Use of spermicidal lubricants or creams may
also be helpful as these can kill the HIV virus but they should not be used
without a condom. 25. On St. Elsewhere,
Mark Harmon's character died of AIDS which he contracted through heterosexual
contact. Is this a distortion? How common is it for women to pass on AIDS. How
common is AIDS in the heterosexual, non-drug population? No, this was
not a distortion. AIDS is a sexually transmitted disease that can be passed
from one partner to another, male-to- female, female-to-male, male-to-male
and female-to-female, although there is only one documented case of
female-to-female sexual transmission. The virus that causes AIDS is found in
semen and vaginal secretions. In the
United States (as of March, 1987), there have been over 1,180 cases of AIDS
attributed to heterosexual contact. This represents 4% of all AIDS cases in
the United States. About half of these cases are female-to-male. (This number
includes many individuals born in countries here heterosexual transmission is
more common.) Also, keep in mind that 25% of AIDS cases are in heterosexuals
(IV drug users, transfusion recipients, etc) who may have contracted the
disease through blood contact but can pass it on sexually. 26. What is the risk of
getting AIDS from a blood transfusion? The risk of
contracting AIDS through a blood transfusion has been significantly reduced,
if not fully eliminated, through screening of all blood donations since May
1985 for antibodies to HIV and removal of blood found antibody positive from
the transfusion pool. The risk of contracting AIDS through a blood
transfusion is now significantly lower than prior to HIV antibody screening. 27. Is there a danger of
contracting AIDS from donating blood? None at all.
Blood banks and other blood collection centers have always used sterile
equipment and disposable needles. The need for blood is always acute, and
people who are not at increased risk for AIDS are urged to continue to donate
blood as they have in the past. 28. Blood transfusions -
are they safe? In May of
1985, the government authorized the use of a blood test that is used to
screen all donated blood in the United States. If a pint of blood tests
positive for the AIDS virus antibodies, it is thrown away. Another method of
protecting the blood supply is through voluntary deferral. Members of high
risk groups have been asked to voluntarily refrain from giving blood and
their cooperation has been good. The chances of becoming infected with HIV
through a blood transfusion are now very small. However, the U.S. Public
Health Service recommends that any individual who was transfused with blood
or a blood product between 1978 and the spring of 1985 (prior to routine
testing of blood for HIV antibodies) be tested for HIV antibodies. Patients
are recommended to contact their physician who arranged the transfusion. 29. Can you get AIDS by
drinking from the same glass or eating from the same dishes as a person with
AIDS? No. More
than five years of experience indicates that AIDS is not transmitted in
households where people may drink or eat from common dishes or utensils. The
virus associated with AIDS does not survive long outside of the body and
would be killed by normal washing of dishes and other eating utensils. 30. Can you get AIDS from
public toilets, drinking fountains, telephones or public transportation? No. AIDS is
not transmitted through the air, food or water, or by touching any object
handled, touched or breathed on by an AIDS patient. The virus associated with
AIDS does not survive well outside of the human body, and cannot infect you
unless it is injected into the bloodstream. 31. Can you get AIDS from
eating in a restaurant where someone with AIDS is working as a cook or
waiter? No. Eating
in restaurants does not increase the risk for AIDS. There are no cases of
AIDS that have been transmitted through food preparation or food handling,
since there is no way for an infected cook or waiter's blood or semen to get
into the bloodstream of a restaurant patron. 32. Can you get AIDS by
touching someone who has it? No. After
more than five years of experience, there is no indication that AIDS is
spread through any form of casual contact, including handshakes, bumping
together in crowds, contact sports, even casual kissing. 33. Can AIDS be spread by
swimming pools? No. There
are no cases of AIDS suspected of having been transmitted through swimming
pools. The virus associated with AIDS would be killed by the chlorine used to
disinfect swimming pools. 34. Can you get AIDS from
trying on clothes in a department store? No. AIDS is
not transmitted through the air or by touching any object used or touched by
a person with AIDS. 35. Can you get AIDS from
handling money? No. More
than five years of experience indicates that AIDS is not transmitted through
objects touched by a person with AIDS. 36. Can you get AIDS from
using someone's razor or toothbrush? We don't
know for sure, but we think that it is not likely, since it appears to take
direct infusion of infected blood into your bloodstream to transmit the
disease. It would, however, be prudent to avoid sharing of instruments where
blood-to-blood contact could occur. 37. Can mosquitoes
transmit AIDS? No.
Mosquitoes bite people of all ages. We find AIDS in mature sexually active
adults. If mosquitoes could transmit AIDS, we would have more cases in
children, old people, people who are not gay or bisexual or who are not IV
drug users. 38. Can you get AIDS from
dental instruments? There are no
cases of AIDS that have been linked with dental instruments, and the
sterilization process would kill the HIV. Dentists are being advised to take
special precautions, such as wearing gloves, etc. to guard against cuts which
could result in direct blood-to-blood exchange with a patient and potentially
transmit AIDS, hepatitis B and other diseases. 39. Can AIDS be spread
through droplets such as from sneezing or tears. What about saliva? Although
small amounts of AIDS virus have been isolated in saliva and tears of
infected people, five years of intense study of this epidemic reveal that AIDS
is not spread this way. First and foremost, we have the evidence of who gets
AIDS and who does not. If it could be spread through sneezing, saliva and
tears, then surely household members of infected persons would show evidence
of infection or exposure. Studies of over 350 household members show that
this has not happened. Secondly, we
know that the amount of virus in saliva and tears is small to non-existent --
it's only been found in some cases, although the media tended to
over-emphasize this fact and many people became frightened. Even if a person
did have the virus in his/her saliva, it would still have to get into
someone's bloodstream, directly, in order to be a risk. It is unlikely that
anyone will spit or cry into someone else's open wound. 40. What about
"deep" kissing? Deep or
"French" kissing is unlikely to be a means of transmission, but we
don't consider it to be absolutely safe. It is difficult to determine whether
AIDS has ever been transmitted this way because most people who engage in deep
kissing also engage in high risk activities. But remember, AIDS is not
transmitted in saliva; and ingestion (swallowing) is also not an efficient
means of transmission because the stomach acids would kill the virus. The
only real concern here might be if both partners were to bleed very slightly,
such as from bleeding gums or extremely passionate kissing! With a person at
high risk for AIDS, though, you should probably be careful about very deep
kissing. "Dry" or "social" kissing, touching the lips
only, is considered safe. 41. Can you get AIDS by
being in the same house with an AIDS patient? No. Experts
point out that no household member of any AIDS patient other than a sexual
partner or child born to an infected mother has developed the disease. 42. Can you get AIDS from
a gay friend or co-worker? AIDS is not
transmitted through casual contact. After more than five years of experience,
no cases of AIDS have developed among casual friends or co-workers of AIDS
patients. There is no evidence that being around someone with AIDS, even for
an extended period of time, puts you at risk for AIDS. Of course, not all gay
men have AIDS. But almost anyone could be carrying the HIV virus. Thus, it is
fortunate that only sexual contact or needle sharing can transmit the virus. 43. What is the risk of
living in a neighborhood that has a hospital or home for AIDS patients? None, since
AIDS is not transmitted through the air or through casual contact. 44. Have any non-sexual
household contacts of AIDS patients become antibody positive? In no case
of actual AIDS has transmission been traced to non-sexual contact with an
AIDS patient in the household. As far as antibody positive status, seven
studies were done involving 350 family members of over 100 AIDS patients
(most of them children). None of these family members were HIV positive. The only
family members who have ever been reported to be HIV positive were sexual
partners, children born to an infected mother; or adults in the family who
used IV drugs or were gay or bisexual men. 45. What about breast
milk, can a nursing child develop AIDS if the mother is infected? The AIDS
virus has been found in the breast milk of HIV positive mothers. Ingesting
(swallowing) of the virus is not a very efficient means of transmission because,
in adults at least, presumably stomach acids can kill the virus. But an
infant may be more susceptible. Most babies
with AIDS probably got the disease while they were still in the womb, from
the mother's bloodstream. But there is one case where a woman after
childbirth got a blood transfusion, which turned out to be contaminated. She
was breastfeeding and, unfortunately, her baby did come down with AIDS. The
Centers for Disease Control (CDC) does recommend that mothers who may have
been infected or who are at risk should not breast- feed. 46. So many studies are
still being done on this disease "AIDS", therefore, isn't it
premature to say that AIDS can't be transmitted through casual contact? Is
this said so that there will not be a widespread panic in our nation? AIDS has
been traced back to 1978 in the United States. The medical community became
aware of the problem in 1981. Medical epidemiologists have carefully studied
who is getting AIDS and/or developing antibodies to HIV -- and who is not. Based
on more than five years of research and observation, it can be said that AIDS
is not spread through casual contact. This is not said just to keep people
calm. After all, the medical people who are in constant contact with people
with AIDS have a great interest in knowing the means of transmission. Research
has shown that no health care workers have gotten AIDS from casual contact
with a patient. 47. Are health care
workers or other occupational groups at special risk for AIDS? Health care
workers and other occupational groups who come into contact with AIDS
patients or their specimens have not developed AIDS. Safety protocols have
been developed for various occupational groups to minimize direct contact
with blood and other body secretions. The Centers for Disease Control (CDC)
is following over 2,500 health care workers who have been exposed to the body
fluids of AIDS patients. None of these workers has developed AIDS as a result
of an occupational exposure. However, two health care workers who experienced
needlestick injuries (out of a total of 716 and who deny any AIDS risk
behaviors, have been found positive for HIV, but neither has developed AIDS. In
contrast to the 6% to 30% risk of acquiring hepatitis B following needlestick
exposure to a carrier of that virus, the risk of acquiring HIV infection
after needlestick exposure to an infected patient is apparently on the order
of 1%. All scientific studies to date suggest that the risk to health care
workers and other occupational groups is low, or non-existent if they follow
safety protocols or minimize direct exposure to blood and body fluids. 48. I have heard that the
AIDS incubation period is fairly lengthy. That being so, isn't it premature
to advocate for a policy based on preliminary data and wouldn't a long-term
public health policy requite more dramatic action, such as isolation of
sufferers, screening of food handlers, etc.? It is
important to emphasize that current public health recommendations are not
based on who develops clinical disease following a prolonged incubation
period, but on who seroconverts (develops HIV antibodies) following exposure.
Since most people will develop HIV antibodies within 12 weeks of exposure,
and since we have a blood test to measure this antibody, we don't have to
wait for clinical disease to occur to determine if transmission has taken
place. The epidemiologic data clearly show that isolation and quarantine will
not prevent the further spread of this disease. 49. Can lesbians get
AIDS? Lesbians are
at lower risk than gay/bisexual men or heterosexuals. Statistically, lesbians
tend to have a much lower rate of sexually transmitted diseases than other
groups, partly because without an ejaculation within the vagina, it is harder
to transmit some diseases. There is one reported AIDS case where a woman
appears to have developed HIV infection from her IV drug using female sexual
partner. Lesbians may
have very intimate contact with one another's vaginal secretions or menstrual
blood. So a lesbian, who is at high risk due to a male sexual partner or to
drug use, would need to limit her sexual contact quite carefully to be on the
safe side. 50. Are people in certain
cities such as San Francisco and New York City at higher risk? People who
live in or visit cities with high numbers of AIDS cases need to practice safe
sex and must not share needles. A large number of AIDS cases in a given area
implies that there is a large number of infectious people in that area. D I A G N O S I S A N D T R E A T M E N T 51. Is there a test for
AIDS? There is no
test to determine if a person has AIDS or will develop AIDS in the future. A
test has been developed for detecting antibodies (substances produced in the
blood to fight disease organisms) to the virus linked with AIDS. Presence of
HIV antibodies means only that a person has been exposed to the virus. It
cannot show whether or not a person is still infected or if he/she has or
will develop AIDS. Most people feel that if you are antibody positive, you
should practice safe sex. Tests to determine presence of the virus (antigen
tests) are in the process of being developed and tested. 52. How is AIDS
diagnosed? There is no
single diagnostic test for AIDS. The AIDS diagnosis is based on the diagnosis
of an unusual cancer or opportunistic infection in an otherwise normal
individual. Only a licensed physician can make an official diagnosis. 53. What is the
incubation period for AIDS? The onset of
symptoms following infection with the HIV is thought to range from six months
to many years. HIV infection is a chronic infection which lasts for life. 54. What are the symptoms
of AIDS? Some people
with HIV infection develop no symptoms. Others go on to develop AIDS-Related
Complex (ARC) or AIDS. Most of the symptoms that people with ARC or AIDS eventually
develop are related to the diseases or infections that attack them because of
their inability to fight off infection. These
symptoms may include: - swollen
glands in the neck, armpits or groin persisting for at least 3 months for no
known reason; - extreme
tiredness, sometimes combined with headache, dizziness or lightheadedness
which lasts several months, for no known reason; - continued
fever or drenching night sweats; - weight
loss of more than 18 pounds in a couple of months which is not due to dieting
or increased physical activity; - purple or
discolored spots or lumps on the skin or the mucous membranes (inside the
mouth, anus, or nasal passages); - heavy,
continual dry cough that is not from smoking or that has lasted too long to
be a cold or flu; - continuing
bouts of diarrhea that can last for up to a year; - thrush, a
thick whitish coating on the tongue or in the throat which may be accompanied
by sore throat; -
unexplained bleeding from any body opening or from growths on the skin or
mucous membranes; bruising more easily than usual; - signs of
dementia caused by brain infection may include memory loss, loss of motor
coordination, disorientation, depression, delusions or hallucinations; -
progressive shortness of breath All of these
symptoms could also be signs of illness other than AIDS. Of course, a person
who develops any of these should see a doctor. 55. What are some of the
diseases affecting AIDS patients? About 85% of
the AIDS patients studied have had one or both of two opportunistic
infections or rare diseases: Pneumocystis carinii pneumonia (PCP), a
parasitic infection of the lungs which has symptoms similar to other forms of
pneumonia; and/or a rare type of cancer known as Kaposi's sarcoma (KS) which
usually occurs anywhere on the surface of the skin or in the mouth. In early
stages, it may look like a bruise or blue-violet or brownish spot. The spot
or spots persist, and may grow larger. KS may spread to, or appear in, other
organs of the body. AIDS patients also may develop unusually severe
infections with yeast, cytomegalovirus, herpes-virus, and parasites such as
Toxoplasma or Cryptosporidia; milder infections with these organisms do not
suggest immune deficiency. About 30% of patients show symptoms of brain
disease or severe damage to the spinal cord. It is now believed that a
majority of AIDS patients may develop dementia or neurological problems. Some
infections attack brain and central nervous system or the HIV virus itself
may directly affect the brain. 56. Can one contract an
opportunistic infection (OI) without contracting HIV? Any
condition, drug or abuse can leave one open to OI's, if it is
immunosuppressive; but one can only contract AIDS if there has been infection
with the HIV. 57. Can AIDS be put into
remission? It appears
that a person with AIDS does have some type of remission in that he/she may
be very ill with an opportunistic infection at one point and, after
treatment, appear to be fairly well for a period of time. But the virus does
not disappear and symptoms will reoccur. 58. At this point, is
there a cure for AIDS? If not, why not? No, there is
no cure for AIDS at this time. There is research going on for treatments, a
vaccine and a cure. However, AIDS is proving to be a tough virus to crack
because the virus is constantly changing. It will be a
difficult Disease to beat because: 1. the virus
lives inside a cell in the body; 2. the cell
that it lives in is the very cell that would initiate the body's normal
immune response; and 3. it is
difficult to identify an agent that can selectively destroy the virus without
also hurting the cells. It will be
difficult to develop a vaccine because: 1. the
antigenic structure of the virus is continually changing even inside a host;
and 2. the virus
and the antibody measured by the ELISA test can co-exist. In order to
have an effective vaccine, scientists would have to identify a portion of the
virus which does not change, and it would have to stimulate neutralizing
antibodies. 59. How soon might a
vaccine be available? Some
researchers feel that there is the possibility of a vaccine in about five
years. However, developing a vaccine is only a part of the work to be done. It
is important that a treatment be developed which calls for other technology
and information. In the interim, it is critical to practice safer sex and to
maintain awareness of how one may be at risk. 60. How is AIDS treated? Currently,
there are no drugs available anywhere that have been shown to cure AIDS,
although the search for such drugs is being pursued vigorously. Some drugs
have been found that inhibit the action of HIV, but these do not lead to
clinical improvement. Treatment is directed at the specific opportunistic
infections or cancer which attacks AIDS patients. 61. How effective are
Interlukin 2 and Interferon? To date,
they have not been effective in long term studies. 62. Azidothymidine (AZT)
[also known as Zidovudine or Retrovir]? AZT is a ray
of hope. It could conceivably prolong the lives of people with AIDS because
it stops the virus from replicating in the immune system. Because it does not
kill the virus, people have to take it for the rest of their lives. It does
have some toxic side effects such as bone marrow suppression. 63. Why are some AIDS patients
able to live? AIDS does
not cause instant death upon diagnosis. There are many factors which probably
contribute to a person with AIDS' length of life after diagnosis. However, at
this time, there is no cure and most persons diagnosed with AIDS will die
within about two years of their diagnosis. You may be
mixing up AIDS with HIV positivity. A person who is HIV positive and does not
have AIDS may never develop the disease and go on to live a normal life span.
So far, approximately 30% of people who are HIV positive will go on to
develop AIDS within seven years. We do not know what will happen to the other
70%. At least half of these patients have already developed ARC. 64. Can you have AIDS
virus and not develop AIDS? Yes, see
previous question. 65. Will AIDS carriers
eventually die from AIDS? So far,
approximately 30% of all HIV positive people will get AIDS within seven years
of infection. The ultimate proportion of HIV infected persons that develop
AIDS may be much higher. 66. Are people with AIDS
dying as a result of the virus or subsequent manifestations due to lack of
first-line defense? The HIV
virus itself is not fatal. It causes the immune system to break down to the
point where PCP, KS and opportunistic infections can cause death. 67. Are Kaposi's lesions
painful? Can there be drainage from them that would necessitate using gloves?
Kaposi's
sarcoma (KS) is a cancer which attacks the capillary walls of the blood
vessels in the skin. It is characterized by purplish or dark nodules, lumps
or other growths on the skin or mucous membranes (mouth, nostrils, anus,
eyes). As a rule, these lesions are not painful; but depending on the extent
of nerve and blood vessel involvement, there may be pain. Drainage would
result if the skin were significantly involved. AIDS
patients may have other skin conditions, such as shingles, which may be
painful and involve drainage and may require gloves when handling them. 68. What Philadelphia
hospital is the main center for AIDS research? None. But
several hospitals are studying different opportunistic infections common to
people with AIDS and a number of local hospitals have a great deal of
experience in caring for people with AIDS. 69. What is the City
doing? The City of
Philadelphia has an AIDS Control Program which has three components -- the
education component's main objectives are to provide accurate preventive
education to the public as well as epidemiological information to allay
public fears about the spread of this disease. Most of our work is with community
groups and agencies which provide service to the community. There is also a
surveillance component responsible for keeping an accurate case count and
interpreting data to monitor trends of the disease, and a medical component
to work with health care and public institutions. The City
also works with and supports independent AIDS related agencies. The
Philadelphia nursing home has accepted several patients with AIDS. C H I L D R E N A N D A I D S 70. Do any children get
AIDS? As of March
2, 1987, there are 453 children with AIDS in the United States. Five of them
are in Philadelphia. Over 60% (4 of the Philadelphia cases) have died. 71. How do children get
AIDS? The majority
(80%) of infected children acquired AIDS from their infected mothers,
presumably in the uterus or during birth. A few children have developed AIDS
following blood transfusions or from a blood product. 72. What happens to
children with AIDS? A child who
is born with AIDS probably will not make it past his/her second birthday. A
child who contracts AIDS through contaminated blood or blood products has a
prognosis more like an adult's. It is estimated that death will occur within
2-3 years after diagnosis. Children with AIDS who are of school age face
problems from other parents, children and school administrators who are
fearful of the disease and do not understand its modes of transmission. Even
when they do know the modes of transmission, they are often not able to
reason through their fears. The Centers for Disease Control and American
Academy of Pediatrics recommend that any child who is HIV positive, has ARC,
or AIDS be reviewed on an individual basis as to the appropriateness of their
attending school based on their medical condition. 73. What about breast
milk, can a nursing child develop AIDS if the mother is infected? The AIDS
virus has been found in the breast milk of HIV positive mothers. HIV positive
mothers are recommended by the Centers for Disease Control not to breastfeed
infants. 74. If a child has AIDS,
can he/she pass it on to another child? None of the
identified cases of AIDS in the United States are known or suspected to have
been transmitted from one child to another in the home, school, day care or
foster care setting. Theoretical transmission presumably would necessitate
exposure of open skin lesions or mucous membranes to blood or other body
fluids of an infected person. 75. What risk does mixing
with other children pose to a child with AIDS? Immune
suppressed children are highly susceptible to infections from other children
in a school or day care setting. The risk of some infections such as chicken
pox may be reduced by prompt use of a specific immune globulin following a
known exposure. Assessment of risk to an immune-suppressed child from
attending school is best made by the child's physician who is aware of the
child's immune status. 76. What precautions or
guidelines should be introduced in schools to prevent exposure to blood or
other bodily fluids from a child with AIDS? Because
other infections can be present in blood or body fluids, all schools and day
care facilities, regardless of whether children with AIDS are attending,
should adopt routine safety procedures for handling blood or body fluids. Soiled
surfaces should be promptly cleaned with disinfectants, such as household
bleach (diluted 1 part bleach to 10 parts water). Disposable towels or
tissues should be used whenever possible, and mops should be rinsed in the
disinfectant. Those who are cleaning should avoid exposure of open skin
lesions or mucous membranes to the blood or body fluids. 77. Is there a danger
having teachers, cooks or other school personnel infected with AIDS? AIDS is not
spread through air, food, water or any form of casual contact. There are no
cases of AIDS reported anywhere that are known or suspected of being
transmitted through food preparation, use of common toilets or drinking
fountains or merely having long-term casual contact with a person with AIDS. Therefore,
teachers, cooks or other school personnel with AIDS who feel well enough to
work would not represent a risk to students or other school personnel. 78. Should there be HIV
antibody screening for school children or school personnel? The test
that detects antibodies to HIV is not a diagnostic test for AIDS. Most
persons exposed to the HIV will not develop AIDS. Therefore, screening of
school children or other healthy persons will not provide any useful
information upon which to base a public health policy. 79. If a child is bitten
by another child with AIDS, what is the possibility of transmission? While HIV
virus has been identified in saliva, there are no cases of AIDS having been
transmitted through a bite. Transmission of the virus appears to require
direct blood-to-blood or semen (vaginal secretions)-to-blood contact. 80. Suppose my child
became a regular playmate of a child with AIDS? Casual
contact, even over a long period of time, is not regarded as dangerous,
primarily because no child in the family of an AIDS victim has been known to
contract HIV infection through day-to-day activities or contact. 81. What if my child is
in a classroom with an AIDS patient who threw up or had diarrhea? Care should
be taken to minimize direct exposure to bodily secretions or excretions from
any ill person. Persons cleaning up such secretions are advised to wear
gloves and to use a solution of household bleach and water (diluted 1 part
bleach to 10 parts water) as a disinfectant. While these precautions are
recommended, it should be noted that no cases of AIDS have ever been linked
with exposure to urine, saliva, vomit or feces. The body secretions linked
with AIDS are blood and semen/vaginal secretions. Also, the vomitus or stool,
even if it carried virus, would not easily get into the bloodstream of
another child. 82. Since AIDS is
transmitted through blood contact, could a child get it through a schoolyard
fight or during a contact sport like football? There is no
evidence of AIDS transmission through a sports injury. Blood transfusions have
transmitted the virus associated with AIDS, as have dirty needles shared by
IV drug abusers, but that is not the same thing as external contact with
blood as might occur in a sports injury. 83. If AIDS cases double
in the next year, will that mean more kids with AIDS will be attending
school? AIDS cases
in general are expected to double over the next year, but the number of cases
among school-age children is not expected to rise as fast. Children who are
infected at or before birth only live an average of two years. Cases among
children resulting from transfusions of blood and blood products are expected
to decrease as a result of testing blood supplies for antibodies to HIV. P R E V E N T I N G T H E S P R E A D O F A I D S 84. What is being done to
prevent the spread of AIDS? Knowledge is
the best weapon we have to fight the spread of AIDS at this time, as there is
not yet a vaccine or a cure. Nationwide,
AIDS education programs are picking up steam, especially since the Surgeon
General's Report on AIDS was made available to the public in October of 1986.
In his report, Dr. C. Everett Koop calls for sex education of all children,
beginning in the lowest grade possible. Locally, the Philadelphia Department
of Public Health has an AIDS Control Program that has three components:
Education, Infection Control and Surveillance. The Education component has
the responsibility of educating the people of Philadelphia about AIDS, the
means of transmission and prevention. The Infection Control Unit is responsible
for educating workers in institutions such as prisons, hospitals, nursing
homes, home health agencies, funeral homes, etc. about AIDS and the
guidelines established by the CDC. Finally, Surveillance keeps track of the
disease in the Philadelphia area, as AIDS is a reportable illness. In addition,
there are other organizations in the city which offer education programs and
support services to people with AIDS. They are: Blacks Educating Blacks About
Sexual Health Issues (BEBASHI), ActionAIDS and the Philadelphia AIDS Task
Force. Screening of
blood: All blood collected by the Red Cross in the United States is now being
tested for antibodies to HIV. Blood which tests positive is eliminated from
the transfusion pool. Persons in high risk groups are being advised to
refrain from donating blood. Sperm banks and organ banks have been advised by
the CDC to test potential donors for HIV positivity and to not accept sperm
or organ donations from individuals who are antibody positive. Voluntary
free HIV testing is provided by the City for persons who wish to determine if
they have been exposed to the virus linked with AIDS. Such testing is not
recommended for everyone, but may be advisable for some individuals who feel
they are at risk, so that they may modify their behavior to reduce further
exposure to the virus and potential transmission to others. Women who are
concerned about being at risk may wish to consider being tested before
deciding to become pregnant. 85. How successful have
educational efforts been in encouraging high risk persons to alter behaviors
which can spread AIDS? There has
been a change in sexual practices among male homosexuals, which is verified
through a significant reduction in the incidence of rectal gonorrhea. A study
of rectal gonorrhea cases in gay men was conducted by the San Francisco City
Clinic. The number of these cases went from a high of approximately 1500 in
the first quarter of 1988 to a low of approximately 150 in the first quarter
of 1986. Recent surveys of 500 homosexual and bisexual men conducted in San
Francisco show that 81% of those polled were now in monogamous relationships
or were remaining celibate. Moreover, only 36% of those surveyed reported
that they had had recent sexual contact with more than one partner. We have had
less success in educating IV drug users about the risks of sharing needles. Efforts
are continuing to develop educational materials and approaches targeted
toward this group. 86. What is meant by
"safer sex"? "Safer
sex" is the way to manage your sex life so that you have the least risk
of exposure to HIV. There are two main ideas to "safer sex": 1)
limit the number of your sex partners, and 2) avoid exposure to your
partner's body fluids and wastes. What we are recommending is that you use a
condom to prevent the exchange of body fluid during sexual intercourse. 87. Is oral sex safe sex?
There is a
lot of discussion on this topic and experts are divided in their opinions as
to whether it is safe or not. Although there is significant data which
suggest it may be a lower risk activity, the data are not conclusive. At this
time, it is recommended that a condom be used for fellatio and that a latex
barrier be used during cunnilingus with a partner who may be at risk. 88. AIDS virus - can it
live outside the body? For how long? AIDS, like
most other viruses, can live outside the body for a short period of time, but
it can be completely inactivated by a 1:10 solution of bleach and water,
within one minute of exposure. But remember, AIDS must get into the
bloodstream for a person to become infected. Merely coming into contact with
the skin will not cause infection because the skin acts as a barrier, both in
terms of keeping the infection within an infected individual and keeping the
infection out of a non-infected individual. 89. How many people have
been infected with HIV linked with AIDS? It is
estimated that for every person with AIDS, there are 100 HIV positive people.
["AIDS: What is now known. I. History and Immunology", Hospital
Practice, May 15, 1986, p. 74] Among some high risk individuals in some areas
(sexually active homosexual and bisexual males and TV drug users), the rate
of infection with the virus may be as high as 1 in 3. This does not mean that
all of these people are necessarily carriers of the virus or that they will
eventually develop AIDS. 90. Is Pennsylvania
offering HIV antibody testing? Yes. In the
Philadelphia metropolitan area alone, there are presently seven alternate
test site locations that offer HIV antibody testing. They are located in: Philadelphia (215-735-1911) Allentown (215-437-7725) Bethlehem (215-865-7087) Chester (215-447-3258) Norristown (215-270-3616) Reading (215-378-4377) Wilmington, DE (302-995-8422)
At the
Philadelphia alternate test site, testing is free, confidential and
anonymous. 91. Why doesn't the State
mandate testing of all persons for antibodies to HIV? Pennsylvania
does not have a position on this. However, the City of Philadelphia does not
support mandated HIV antibody testing of any groups or individuals since the
health implications of positive test results in an otherwise healthy person
are not known. The screening test indicates only the presence of antibodies
to HIV, not the presence of virus. The presence of antibodies in the blood
means only that the person has been exposed to the virus at some time. It
does not necessarily mean that the individual is carrying the virus and is
capable of transmitting it to others. However, at this time we must assume
all HIV antibody positive people are capable of transmitting the virus. 92. Why doesn't the State
isolate or quarantine persons with AIDS to prevent the spread of the disease?
There is no
evidence that persons with AIDS or those with positive antibodies to HIV pose
a risk to the public through casual contact. Therefore, there is no need to
isolate or quarantine these patients. The civil rights of any individual or
group cannot be abridged by society without sufficient scientific evidence
that it is necessary. All information accumulated during the past five years
indicates that AIDS is spread only through direct blood-to-blood or
semen-to-blood exchange, and not through the air, food or casual contact with
persons with AIDS or articles they have handled or used. Moreover, threat of
quarantine would be more likely to drive high risk individuals into hiding
where they could not be reached for education, counseling or voluntary
testing. 93. Why doesn't the State
legalize the sale of hypodermic needles or dispense clean needles to drug
addicts to prevent spread through that route? It is
questionable whether legalizing the sale of needles will have the desired
effect. Instead some people feel that such action might serve to encourage
use of illegal drugs. No immediate change in State regulations is
contemplated. 94. What is the State
doing to get accurate information to the public about AIDS? Pamphlets
and brochures directed to the general public and to various risk groups have
been developed and are being distributed through regional task forces, county
health departments and various State agencies. Educational
forums are provided for occupational and community groups who have concerns
related to AIDS by various local groups throughout the State. C A R E F O R A I D S P A T I E N T S 95. What precautions
should families caring for AIDS patients take? The first
thing to remember is that just as you cannot get AIDS from casual contact
with a person who has AIDS, or from a person who is healthy but is HIV
positive (carries the virus), you also are not going to get AIDS from a
person with AIDS in your home. However,
when a person becomes very ill, he or she is likely to require more intimate
kinds of contact -- cleaning open sores, cleaning after loss of bowel or
bladder control, cleaning bedpans, etc. So, the CDC has prepared recommended
guidelines for health care workers which could apply as well to family
members or friends caring for someone in the home. Your
hospital social worker or home care worker can go over these guidelines in
more detail. These are basically: avoid injury with needles or sharp instruments
such as razors -- do not recap needles; flush blood and body fluids down the
toilet; wrap disposable items that are soiled with blood in double plastic
bags before disposal; clean up blood spills or other body fluids with soap
and water followed by a household disinfectant such as a 1:10 solution of
bleach and water. 96. What safety protocols
have been developed for occupational groups? And how effective are they? All
occupational groups that may come into contact with body fluids in the course
of their work are advised to take special precautions to guard against AIDS,
hepatitis B and other infectious agents. These include: - take
special care in handling and disposing of used needles; - guard
against needlesticks, cuts and other injuries; - notify
supervisors of any direct exposure to blood, semen or other body fluids; - dispose of
body fluids down the toilet; - wear
protective clothing (gloves, gowns, goggles) if there is any danger of
splashing of body fluids. These safety
measures seem to be very effective, since no health care workers or others
who have followed these precautions have developed AIDS as a direct result of
occupational exposure. 97. The following
guidelines are suggested to minimize the risk of transmission of HIV to staff
caring for persons with AIDS or a risk of AIDS; and indeed are recommended
for the care of all patients, since anyone, in theory, could carry HIV. 1. In
administering health care, disposable needles and syringes should be used. Care
should be taken to prevent needlestick injuries by the proper disposal of
needles in designated plastic or metal containers, without recapping or
clipping the needles. 2. Persons
drawing blood should wear gloves and use Luer-lock syringes 3. Gloves
should be worn when handling blood, urine, sputum, fecal, ocular (tears) or
any other human fluids or tissue specimens. 4. Gowns
need only be worn when there is a likelihood of soiling of clothes with body
fluids. 5. Masks
need only be worn when there is a risk of contact with aerosolized secretions
such as suctioning of patients or high-speed drilling by dentists. 6. Whenever
possible, disposable instruments should be used such as thermometers, tongue
depressors, etc. 7. Soiled
instruments or other objects should be bagged and labeled "contaminated"
and processed in the appropriate manner. 8. A label
marked prominently with "Blood and Body Fluid Precautions" should
be affixed to all blood and other specimens. This warning label should
accompany the specimen through all phases of processing until ultimate
disposal. Specimens should be placed in an impervious bag or container for
transport. 9. Any
spills of body fluids should be cleaned using a freshly prepared (once daily)
10% solution of household bleach. 10. Hands
should always be washed, regardless of the use of gloves, after close patient
contact such as after physical examination and when soiled with possibly
infected body fluids. 11.
Laboratory workers should follow the same precautions recommended for processing
specimens from patients shown to be carriers of hepatitis B. These
guidelines are consistent with those approved by the American Hospital
Association. For more detailed comprehensive guidelines which may be
applicable to your particular situation or facility, see:
"Recommendations for Preventing Transmission of Infection with
HTLV-III/LAV in the workplace" (Morbidity and Mortality weekly Report
[MMWR], Vol 34, No.45, November 15, 1985). Accidental
parenteral or mucous membrane exposures to blood from definite or suspect
AIDS patients should be reported to your supervisor, or your local Infection
Control Officer. For additional recommendations on minimizing the possibility
of transmission of HTLV-III/LAV by ocular fluids, see the MMWR (Vol. 34, No.
34, August 30, 1985). 98. With persons with
AIDS with dementia symptoms, psychotic and assaultive systems, is it
appropriate to admit to medical or psychiatric hospital? When there
are opportunistic infections, medical attention is appropriate. But if there
is no medical emergency, then psychiatric intervention might be more
appropriate. (There are some combined medical/psychiatric units in the city.) 99. Do some precautions
have to be taken with persons with AIDS and persons with ARC? Is ARC as
transmittable as AIDS? Explain the difference. HIV and ARC patients may be
more likely to transmit the HIV virus than people with AIDS. People with AIDS
often have less virus present due to lower T-cell count. HIV multiplies by
invading T-cells, which are eventually destroyed. If a person with ARC
transmits the virus, then the person to whom it is transmitted can go on to
be HIV positive, have ARC or contract AIDS. People with ARC and AIDS have the
same symptoms, but people with AIDS get opportunistic infections and/or
cancer from which they can die. Of course, it is also true that a person with
AIDS is much less likely to feel like having sex than someone who is not ill.
100. If AIDS is only
spread through sex, or sharing needles, or perinatally, then why does the CDC
recommend such strict guidelines for health care workers like wearing gloves,
etc.? The CDC
guidelines for health care workers are based on the guidelines for working
with patients who have hepatitis B. The idea is to err on the side of safety
-- to be on the safe side. But hepatitis B is much easier to catch than AIDS. The main
reason for use of gloves, double bagging soiled sheets, etc. is in case a
health care worker has a cut or abrasion on the hand. Masks would only be
necessary in a case where blood was actually being spattered. For the most
part, a health care worker should avoid gloves, gowns and masks because they
are unnecessary and result in frightening and alienating the patient. 101. How is the risk of
spreading AIDS through blood transfusions being minimized? All blood
donated in Pennsylvania State has been tested for antibodies to HIV since May
15, 1985. Blood that tests positive is removed from the transfusion pool. The
process involves use of an ELISA (enzyme-linked immunosorbent assay) screening
test, with confirmation of positive results through a more specific antibody
test known as the Western Blot. Blood which
is reactive on the initial ELISA is retested by the ELISA method. If it is
reactive on a repeat ELISA test, a Western Blot test is conducted to confirm
the result. Blood which tests positive on any of these tests is removed from
the transfusion pool. All members of the AIDS risk groups are being asked to
voluntarily refrain from donating blood. This includes IV drug users, homosexual
or bisexual males who have had sexual contact with another male in the past
eight years. As a further precautionary measure, persons who appear at blood
banks may confidentially mark a box on the form indicating that their blood
should be used for research purposes only, not for transfusions. 102. Is the new blood
screening test 100% effective? All studies
indicate that the HIV antibody test is highly effective in eliminating blood
from the donor pool that may be infected with HIV. In fact, the test errs on
the side of "false-positive" readings, since only about 30% of
blood that tests positive on the initial ELISA test is confirmed positive
through a more specific test known as Western Blot. All blood that tests
positive on the initial screening test is removed from the transfusion pool. 103. Are sperm banks and
organ banks screening for AIDS? The Centers
for Disease Control has recommended that sperm and organ banks screen all
donations for antibodies to HIV. 104. Are there any
special precautions for pregnant women caring for AIDS patients? A pregnant
woman is at no more risk for getting AIDS by caring for an AIDS patient than
anyone else - that is, none at all, assuming she avoids needlestick injuries
and wears gloves when handling blood in case she has a cut on her hand. However, a
pregnant woman may be more susceptible to some of the opportunistic
infections an AIDS patient may have, and some of these could be damaging to
her fetus (unborn infant) - for example, cytomegalovirus (CMV), which is common
among AIDS patients. However, almost any patient could give her CMV, as about
half the population probably carries this virus. With normal sanitary
precautions, this should not be a problem, but some hospitals do put
"pregnant women precaution" signs on doors of AIDS patients for
this reason. It is the opportunistic infection but not AIDS itself that is a
slight risk. 105. Why doesn't the
State designate special hospitals and nursing homes to care for AIDS patients
to ensure they receive appropriate, non-discriminatory care and to protect
health care workers? Medical care
should be provided at the health facility of choice of the patient or at the
institution best equipped to provide the necessary treatment. There is no
evidence that AIDS patients pose any risk to other patients at a hospital or
nursing home, and health care workers are not at special risk if they observe
safety guidelines to minimize exposure to blood and other body fluids. 106. Who pays for
treatment of people with AIDS? Care for
AIDS patients is paid for by the same means as all medical care: the
government (Medicaid and Medicare); insurance companies; and individuals. 107. Does insurance cover
AIDS? In most
cases, insurance does cover AIDS medical treatment, though most policies have
maximum allowances. Other types of care, such as out-of-hospital nursing care
or home care, are not necessarily covered. 108. What services are
available to persons with AIDS or at risk for the disease? Philadelphia
persons with AIDS can receive help through ActionAIDS, the Philadelphia AIDS
Task Force, Blacks Educating Blacks About Sexual Health Issues (BEBASHI), as
well as City health and human services programs. These programs provide
housing, directions for eligibility for medical assistance, support groups
and buddies. For telephone numbers, check listing at end of book. 109. Where can persons
concerned about AIDS get HIV testing? Confidential
HIV antibody testing is provided through the Department of Health's regional
offices for persons who wish to know if they have been exposed to the virus. The
test is free and no names and addresses are exchanged. Persons who test
positive receive counseling as to what the test results mean and preventive
actions they may take to minimize further exposure to the virus or potential
transmission to others. (The test site numbers are at the end of this book.) 110. Where can AIDS
patients get diagnosis and care? Persons who
are concerned about AIDS may contact the City at 875-5919, ActionAIDS at
732-2155, BEBASHI at 546-4140 or the Philadelphia AIDS Task Force at 545-8686
for the names of doctors who are familiar with the diagnosis and management
of AIDS. Referrals are also provided for AIDS patients seeking dental care,
psychiatric counseling transportation to medical facilities, and social
services. 111. Where are AIDS
patients treated? AIDS
patients are treated in hospitals, physician's offices, clinics or other
health care settings, just like any other patients. There is no evidence that
AIDS patients pose a risk to other patients or to health care workers who
follow recommended safety precautions. H U M A N R I G H T S I S S U E S
112. What can an
individual do to appease public paranoia (i.e. parents, neighbors, friends,
relatives)? Some people just don't want to hear facts or truth about AIDS. The best
thing you, yourself, can do is learn all you can about AIDS. There are a lot
of facts that have been established. Learn them, know them and share them. You
can't force another person to hear what you're saying, but perhaps
persistence will work in some cases. Recognize the fears of another and do
your best to dispel them. It may take more than a few times to make any
inroads with a person who is resistant to the information. But it is our
responsibility to continue to try. 113. What rights do AIDS
patients have? They have
the same rights as those accorded to any other ill member of our society. Unfortunately,
discriminatory action has been taken against some AIDS patients by employers,
landlords, neighbors, co-workers and others who are apparently acting out of
unwarranted fears based on misinformation. 114. Is it right to keep
an AIDS patient's identity a secret? Since AIDS
does not pose a risk to the general public, there is no need for neighbors,
shopkeepers, co-workers or others who may have casual contact with a person
with AIDS to know. Discriminatory action has been taken against persons with
AIDS by those who are uninformed about the disease. 115. Can you be fired
because you have AIDS? Some
employers are reportedly discriminating against AIDS patients in spite of
continued advice from public health officials that there is no reason to
exclude AIDS patients from employment as long as they feel well enough to
work. Persons who believe they are being discriminated against by employers
may file complaints with the Philadelphia Commission on Human Relations
(PCHR) at (215) 686-4676. 116. Can a person with
AIDS get Social Security Disability (SSD)? Eligibility
for SSD is based on two criteria: a person's "insured status" and
documentation of his/her disability. "Insured status" is determined
by the length of time a person has paid into the Social Security system,
measured in quarters (four quarters per year). The decision
of what qualifies as a disability is made by the state, based on information
supplied by one's physician. A diagnosis of AIDS is automatic qualification
for disability under Social Security guidelines. 117. Should people who
have AIDS be banned from working in banks, restaurants and other
people-contact jobs? There have
been no cases of AIDS that are suspected of having been transmitted through
casual contact or through the air, food or water. If a person with AIDS is
well enough to work, he/she should be allowed to do so unless the work
environment poses a risk of potential direct blood to blood contact with
other individuals. 118. Can a hospital
worker or ambulance personnel refuse to care for an AIDS patient? Health care
workers who refuse to care for AIDS patients may be subject to firing and
possible disciplinary action by the State. Hospitals and ambulance services
have a responsibility to care for the sick, and to assemble a staff capable
of carrying out that mission. There is a need for greater educational efforts
to ensure that all health care workers understand the potential routes for
transmission of AIDS and follow recommended safety precautions. 119. Can funeral
directors refuse to embalm victims of AIDS? Yes. There
is no State law that can require a funeral director to accept the body of a
person with AIDS. Embalming also is not required by law. While some funeral
establishments have refused to accept AIDS victims, there are sufficient firms
available which will do so. Names of firms accepting AIDS victims are
available through regional AIDS task forces. 120. Is there a high rate
of suicide among people with AIDS? No
information is available on Philadelphia cases. There does seem to be higher
suicide risk for AIDS patients. This illustrates the need for supportive care
programs. 121. Is there any way to
deal with emotional reactions of other family members in the hospital? Some
hospitals have excellent hospice programs which include counseling for family
members of terminally ill patients. All hospitals have social workers who are
trained to deal with families as well. In general, handling of families would
depend upon the skills and sensitivities of individual doctors, nurses and
other workers. AIDS
organizations listed at the end of this book offer support groups for the
families, friends and lovers of persons with AIDS. H O W T O R E D U C E T H E R I S K O F A I D S Five years of experience
with AIDS indicates that the disease is not transmitted from one person to
another through any form of casual, non-intimate contact. There is very
strong evidence that AIDS is transmitted through direct blood-to-blood or
blood-to-semen or vaginal secretions exchange. Direct contact with other body
fluids of an infected person may also increase the risk of AIDS, although no
cases so far have been directly linked with other body secretions or
excretions. Based on this
information, there are precautions that can be taken by the general public and
by persons in several risk behaviors to eliminate or reduce the risk of
contracting AIDS: * DON'T have sexual
contact with any person whose past history and current health status is not
known. * DON'T have sexual
contact with multiple partners or with persons who have had multiple
partners. * DON'T have sexual
contact with persons known or suspected of having AIDS. * DON'T abuse intravenous
(IV) drugs. * DON'T share needles or
syringes (boiling does not guarantee sterility). * DON'T have sexual contact
with persons who abuse IV drugs. * Use of a CONDOM during
sexual intercourse may decrease the risk of AIDS. * DON'T share
toothbrushes, razors or other personal implements that could become
contaminated with blood. * Health workers,
laboratory personnel, funeral directors and others who work may involve
contact with body fluids should strictly follow recommended safety procedures
to minimize exposure to AIDS, hepatitis B and other diseases. * Persons who are at
increased risk for AIDS or who have positive human immunodeficiency virus
(HIV) antibody test results should not donate blood, plasma, body organs,
sperm or other tissue. * Persons with positive
HIV antibody test results should have regular medical checkups, and take
special precautions against exchanging body fluids during sexual activity. * Women who have positive
HIV antibody test results should recognize that if they become pregnant,
their children are at increased risk of getting AIDS. P H I L A D E L P H I A D I R E C T O R Y O F I N F O R M A T I O N A N D S E R V I C E A G E N C I E S RELATED TO
ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) (All numbers are within the 215 Area Code Region, unless otherwise indicated) ActionAIDS 732-2155 AIDS Control Program, City of Philadelphia, Department of Public Health General Number 875-5919 Education 875-5659Surveillance 875-5935, 36 Infection Control 875-5648 AIDS Interfaith Network 732-2155 Alternate HIV Test Site 735-1911 American Civil Liberties Union (ACLU) 592-1513 American Red Cross AIDS Program 1-800-26-BLOOD AZT Information Line (Retrovir) 1-800-843-9388 BEBASHI (Blacks Educating Blacks About Sexual Health Issues) 546-4140 CHOICE Hotline (information about birth control and sexually transmitted diseases) 592-0550 CODAAP (Coordinating Office for Drug and Alcohol Abuse Programs)/City of Phila 592-5403 Community Legal Services 893-5300 Episcopal Diocese of PA (services for AIDS patients and families) 567-6650 Family Planning Council of SE Pennsylvania 985-2600 Family Service of Philadelphia (FSP) 875-3300 Gay and Lesbian Peer Counseling (GLPC) 386-6110 Innerpride (organization of black lesbian women and gay men) 849-7597 Mayor's Commission on Sexual Minorities (MCSM) 686-2191 Mayor's Commission for Puerto Rican/Latino Affairs 686-7599 Mental Health/Mental Retardation Prog/City of Philadelphia (AIDS education division) 592-5544 National Gay Task Force AIDS Information Line 1-800-221-7044 National Hemophilia Foundation (212) 219-8180 New Jersey Dept of Health AIDS Hotline 1-800-624-2377 Parents and Friends of Lesbians and Gays 572-1833 Philadelphia AIDS Task Force 545-8686 (Hotline) 732-AIDS (Housing Program) 545-5272 (Minority Coordinator) 985-2991 Philadelphia Commission on Human Relations (PCHR) 686-4670 Philadelphia Community Health Alternatives (PCHA) 545-8686 Philadelphia Lesbian and Gay Task Force (PGLTF) Anti-Violence and Discrimination Hotline 563-4581 Philadelphia School District Health Services Dept 299-7481 Retrovir Information Line (AZT) 1-800-843-9388 Shalom, Inc. 546-3470 South Central Pennsylvania AIDS Assistance Network (717) 236-4772 or (717) 783-8307 South Jersey AIDS Alliance Task Force (609) 347-8799 Suicide Crisis Intervention Hotline 686-4420 Surgeon General's Report on AIDS (404) 329-3534 Telehelp 1- 884-2220 U.S. Public Health Service AIDS Hotline 1-800-342-AIDS U.S. Public Health Service Education Clearinghouse (404) 329-3534 Veterans Administration Drug & Alcohol Program 823-5809 |
