HIV Preventative Measures Health Article

Surveillance

There has been recognition by researchers that behavior that places an individual at risk for other STDs increases the risk of HIV infection. Sexually-transmitted disease (STD) surveillance can provide important indicators of sites to which HIV infection may spread, as well as point to targets to which efforts to promote safe sexual behavior should be aimed.

Monitoring

Patient care activities, patient progress, and response to symptomatic or preventive therapies need to be documented by nurses. Medical record information is vital to

KEY TERMS

Acquired immune deficiency syndrome (AIDS)—The final stage of a series of health problems caused by the human immunodeficiency virus (HIV).

Epidemiological studies—Medical research that deals with the incidence, distribution, and control of disease in a population; the sum of factors controlling the presence or absence of a disease, or pathogens.

Highly active antiretroviral therapy (HAART)—Also known as drug "cocktail," this is a combination of powerful drugs prescribed to arrest HIV infection and delay the onset of AIDS. It is not a cure for HIV/AIDS.

Human immunodeficiency virus (HIV)—The virus that causes AIDS. HIV weakens the body's ability to fight infections.

Opportunistic infection (OI)—Condition caused by a microorganism that does not ordinarily cause disease, but which becomes pathogenic under certain circumstances.

Sexually transmitted disease (STD)—Also called venereal disease; any disease transmitted through sexual contact.

continued research in the field. All information must be kept confidential and maintained in compliance with state and federal laws.

Education

Education about HIV prevention has been proven cost-effective when compared with the rising cost of lifetime medical management of people with AIDS. Different types of preventive messages, skills, and support are needed to help reduce sexual and drug-related risks.

Drug injectors should be educated about their high-risk behavior. Drug counseling may help them stop using drugs or sharing needles. These individuals need to be taught how to protect themselves from sexual transmission if their partners have ever been IV drug users and may have shared needles.

Substance abuse is a major problem. The combination of substance abuse and sexual HIV transmission must be given serious attention. Substance abuse prevention and intervention are sorely lacking for users of morphine, cocaine, marijuana, and alcohol. These substances not only alter users' behavior, but weaken their immune systems. This weakening may make them more susceptible to infection with HIV. Counseling and treatment should be available to those who abuse drugs and alcohol. They, too, are in need of assistance in helping them stop using drugs and to help them prevent HIV infection.

Comprehensive health education programs need to be directed toward generation-specific behavior and epidemiology. Programs for children and young adults should involve parents and educators. The most effective programs begin educating young people at an early age and are designed to promote healthy behaviors—such as exercising, eating healthy food, avoiding drug use, excessive alcohol consumption, smoking, and premature sexual activity.

Occupational HIV transmission

Although it is not a primary means of transmitting the spread of HIV, there are documented cases of HIV seroconversion among health workers. Responsibility for preventing occupational exposure to HIV and other bloodborne pathogens is that of the nurse. Precautions include the routine use of gloves for one-time use, goggles, and disposable protective clothing. These function as preventive barriers when there is the possibility of coming in contact with infectious materials. Good hand-washing practices are essential. It is necessary that sharp instruments and contaminated materials are handled and disposed of in a proper manner.

Prevention

Sustained, comprehensive efforts of the 1980s have had a significant impact on slowing the spread of HIV/AIDS in the United States. Although it is difficult to determine exactly how many thousands of infections were prevented as a result of deliberate effort, the mid-1980s witnessed an epidemic growing at an annual rate greater than 80%. As of mid-2001, this rate has stabilized. Nationally, 30 of every 100,000 men and nine of every 100,000 women have AIDS. Despite the occurrence of 40,000 new cases per year, fewer people are dying from AIDS and AIDS-related complications. This is indicative of tremendous progress. In general, previous preventive efforts resulted in many behavioral changes, thereby helping to slow the epidemic overall.

The decline in the number of deaths from AIDS and the effectiveness of antiretroviral therapies increase the number of HIV infected people in the general population. These successes may contribute to a person's false sense of security when he or she believes and behaves as if preventing the spread of HIV is no longer important. Complacency about the need for prevention adds a complex dimension to disease management for health care professionals and the at-risk population. The complicated nature of HIV/AIDS strongly supports valuable opportunities for prevention and intervention.

Primary HIV prevention means keeping people from becoming infected with HIV in the first place. Intervention must focus on preventing the spread of HIV by infected individuals as well as on acquisition by uninfected populations. Infected individuals need to develop skills to reduce the risk of infecting others. It is essential that there be easy access to voluntary blood testing; this will enable early detection of HIV infection.

Comprehensive school-based HIV and sex education programs are suspected to delay initiation of sexual activity in teenagers, reduce the frequency of intercourse for those who are sexually active, decrease the number of sexual partners they have, and increase the use of condoms and other contraceptives.

Stringent screening of donor blood supply for HIV antibodies, and heat-treating blood products used to treat hemophilia have nearly eliminated HIV transmission through transfusions.

Secondary HIV prevention is keeping HIV-infected people safe and healthy by helping them avoid opportunistic infections and stopping the infection from progressing to AIDS.

Scientists are exploring the possibility that combination drug therapies may reduce the infectious nature of the disease. With the lines between prevention and treatment beginning to merge, ongoing services for people who are HIV positive must balance medical advances with the behavioral and social support needed to preserve their quality of life and prevent the spread of infection.

A focus on behavioral change is paramount. Vaccines are not able to prevent disease if people are not vaccinated. No vaccine for lifelong immunity has yet been developed. Further, medical advances are unsuccessful unless their implementation parallels that of effective prevention strategies. People must be receptive to both in order for HIV rates to be reduced.

Pregnant women who may not know they are infected with HIV cannot reduce the risk of transmitting the disease to their unborn children unless that they get prenatal care, routine HIV counseling, and submit to voluntary testing. Infected patients must have access to anti-retroviral drugs. Programs that identify and treat HIV-infected pregnant women have shown dramatic success in reducing HIV transmission to their babies. A woman who is HIV-positive and pregnant may be advised by her doctor to deliver by cesarean section (cs) to eliminate the chance of transmitting the virus during childbirth.

Efforts to reduce the risk for HIV infection of injection drug users through public attitudes and policies have been very effective. State health departments have reported significant reductions in the sharing of drug injection equipment after implementing programs to increase access to sterile injection equipment.

Infected individuals need assistance developing skills to use the new medical treatments. Highly active antiretroviral therapy (HAART) involves complex treatment regimens and requires compliance-related skills. Patients need to learn how to deal with the side effects of medications and drug interactions. They must learn how to decrease the risk of developing drug resistance by taking their medications as recommended and also learn how to work with complicated medication schedules. HIV-positive individuals also depend on the support of family and friends to continue their drug regimens and to encourage prevention of transmission to others.