III. What is AIDS?

Source: AIDS Facts & Hopes, edited by Pr. Luc Montagnier, The new update by Institut Pasteur, International English edition, Paris, 1991.

The first virus responsible for AIDS to be isolated (HIV1) is an extremely small particle (1 ten thousandth of a mm.).

AIDS is a disease caused by destruction of the immune system by a virus called HIV.

This virus is principally transmitted by sexual secretions and blood. For this reason, the two predominant modes of transmission at the present time are: penetrative sexual relations (homo- and heterosexual) and the sharing of contaminated syringes by injecting drug users.

What does AIDS mean?
A	Acquired:	not hereditary but due to an (acquired) virus encountered by the patient during his or her lifetime
I	Immuno:	major collapse of the immune system
D	Deficiency:
S	Syndrome:	the group of manifestations (symptoms) that characterize a disease
In French SIDA:		Syndrome d'Immunodcience Acquise

Although some of the medical terms about AIDS may be unfamiliar to you, it is important to know the facts. AIDS is caused by a virus named the human immunodeficiency virus (HIV). The virus enters the body through the blood and usually attacks a specific type of white blood cell (called the T-helper cell). When HIV attacks this cell, the body loses its ability to fight diseases that would only rarely affect a healthy person. AIDS is the late stage of infection with HIV. Among the illnesses often found in people with AIDS are certain types of pneumonia, other infections and cancer.

There may be a long period between the time a person is infected and the time he or she begins to get sick. Most people who become infected, however, will eventually get sick. (Members infected with HIV may, of course, need help from the union even before they start to get sick.)

People infected with the HIV virus including those who do not yet have any symptoms of AIDS, can give the HIV infection to their sex partners, to anyone with whom they share contaminated needles (e.g. when injecting drugs), or, in the case of pregnant women, to their unborn child.

Here are four important facts that everyone should know: · HIV does not discriminate. It can infect persons of any race, age, sex or sexual orientation. It is not a disease found only among ethnic minorities or homosexuals. · AIDS has no cure. There is currently no cure in sight, although drug treatments are now available that can sometimes lengthen the life span of people with HIV infection and AIDS and allow them to lead more productive lives. · HIV is transmitted in only a few specific ways. The virus is not highly contagious. There is no evidence that AIDS can be passed on through casual contact like shaking hands, touching, or sharing restrooms. Nor is there any evidence that it can be transmitted through the air or through food. Most commonly, HIV is transmitted through sexual contact or sharing needles with an HIV-infected person. Transmission occurs only when infected blood or certain other body fluids enter another person's body. Babies born to HIV-infected women may become infected before, during or shortly after birth. · The transmission of HIV can be prevented. The risk of sexual transmission can be greatly reduced with "safer sex" practices. If you use drug-injecting needles, do not share them. · Workplace exposure to blood/body fluids that may be contaminated with the virus is much less likely if workers and their employers are well trained, have safe equipment, adopt good work practices and use proper personal protective equipment.

How do you get HIV?

For HIV to be spread (transmitted), infected blood, semen or vaginal secretions of an infected person must enter the bloodstream of another person. The virus is dangerous once it is in the bloodstream. However, outside the body, the virus is very fragile and is easily "killed" when it is exposed to heat, light and common cleaners like household bleach. It is not, however, killed by cold.

There are three main ways that HIV is known to be transmitted

1. Sexual intercourse

HIV can spread by sexual intercourse, both heterosexual (man to woman or woman to man) and homosexual (man to man). It is most commonly transmitted when an HIV-infected person's semen or vaginal fluids come into contact with the partner's mucous membrane (the thin lining of the rectum, the vagina, the urethra and the mouth) during unprotected sexual intercourse (without a latex condom, also called a preservative) - anal, vaginal or oral.

2. Blood-to-blood contact

The virus can be spread by:

· transfusion of blood or blood products if they have not been screened for HIV;

· sharing or reusing contaminated needles and syringes, such as when injecting illegal drugs, injecting steroids or tattooing;

· being accidentally stuck by a contaminated syringe or sharp object;

· having large amounts of infected blood splashed in the eyes or mouth;

· having infected blood come into contact with damaged skin (cuts, or dermatitis).

In most industrialized countries, all blood used in blood banks and hospitals and in the preparation of blood products is now screened for HIV, so there is little danger. In some developing countries where blood is not routinely or accurately screened, transfusion is still an important mode of transmission. HIV is not transmitted by donating blood provided sterile procedures are used.

3. Infected mother to unborn child

A mother who is infected with the virus can infect her child during pregnancy or delivery, and sometimes by breastfeeding.

Prevention

The AIDS virus is principally transmitted by sexual activity and via blood

1. Prevention of sexual transmission

The virus is present in high concentrations in semen, vaginal secretions and blood.

Homosexual or heterosexual relations, with anal or vaginal penetration, carry a high risk of transmission of the HIV virus. Anal intercourse is associated with the highest risk. The presence of other sexually transmitted diseases (STD), responsible for genital lesions, may promote transmission of HIV.

Oral contact with pre-ejaculatory fluid, semen or vaginal secretions carries a theoretical risk of transmission when there is one or several lesions inside the mouth.

The very great majority of infected subjects became infected during sexual intercourse. The more traumatic the sexual relations, the greater the risk of injury and the greater the risk of transmission. Reducing the number of partners decreases the risk of being exposed, but having a single regular infected partner constitutes a high risk.

You must know your partners well

"I like you, you like me, let's make love". Now you must think twice.

Having a sexual relationship with another person involves certain consequences which must be taken into consideration.

It is therefore important to get to know your partner/to develop confidence in each other and to discuss the possibilities of previous infection or current sexual behaviour which could be a source of infection.

There are many different forms of prevention

With an infected partner or with any person in whom the risk of exposure is unknown, you should avoid vaginal or anal penetration or sharing any sexual objects and it is important to give each other pleasure by certain forms of safe sexual activity such as caressing or mutual masturbation.

If you decide to have sexual intercourse with anal or vaginal penetration, it is important to always use a well lubricated condom.

Having a sexual relationship with another person involves certain consequences which must be taken into consideration.

Use condoms

A condom is a rubber sheath that is rolled like a stocking onto the erect penis. There has been a great deal of progress in the manufacture of condoms, and they are now much thinner and much stronger than before.

Condom in its sachet	1. Check the expiry date on the box.
	2. Choose lubricated latex condoms.
	3. Open the sachet carefully, avoiding damage to the condom with sharp objects such as rings. Some condoms are lubricated with an antiseptic and spermicidal solution. It has not been proven that this improves the protection against AIDS.
With reservoir	4. Put the condom on the penis before any sexual contact.
	5. Check the right direction for unrolling the condom. The ring is situated on the outside.
· Apply the condom by unrolling it onto the erect penis · Put it on before starting intercourse	6. Condoms without a reservoir should be unrolled for 1 to 2 cm before being applied in order to create reservoir.
Figure	7. Pinch the reservoir tip to expel any air.
	8. Unroll the condom as far as the base of the penis.
	9. It is recommended to use a water-based lubricant. Avoid using an oil-based lubricant such as vaseline which can damage the latex.
	10. The addition of a spermicidal foam increases the efficacy.
It is important to withdraw and remove the condom, holding it at its base, before complete loss of erection in order to avoid any leaking of semen.	11. Condoms must only he used once. Carefully throw it in the rubbish bin, as condoms are biodegradable.
Figure	Putting on a condom just before sexual intercourse may be far from exciting, especially when you don't know how to go about it. A little bit of practice before and a little bit of humour during ill help to dissipate these difficulties rather than the erection.

Condoms have been proven to reduce the incidence of all sexually transmitted

Prevention

2. Transmission by sharing contaminated needles and syringes

The transmission of the AIDS virus by drug injections (syringes, needles, spoons and instruments necessary for the preparation of the drug) is another reason to avoid or to stop using intravenous drugs. If, however, you continue to use drugs or other injectable products:

· Never share syringes and needles.

· Use a new disposable syringe each time, or a syringe which can be disinfected by means of one of the following three methods:

Figure

1. Rinse and immerse the syringe or needle for 10-15 minutes in alcohol or dilute bleach solution and rinse again in water.

2. Place in boiling water for 10 to 15 minutes.

3. Introduce bleach solution into the syringe or needle. Repeat several times and rinse twice with clean water.

Do not accept acupuncture, mesotherapy or tattoos unless the needles are sterilized. Sharp beauty care instruments should be disinfected by heat or with an antiseptic before being used by another person. Hairdressers and manicurists must respect these basic rules of hygiene.

DON'T USE DRUGS, DON'T SHARE SYRINGES The AIDS virus can be avoided. Sexual transmission and sharing of syringes are the two major sources of transmission and preventive measures can be adopted for both of them.

3. Prevention of transmission by blood transfusion and injections of blood products

Today, all blood is tested and the risk of HI V transmission is now very low, but cannot be considered to be non-existent. It must be remembered that blood transfusion is a vital procedure that is only performed when absolutely necessary. It would be absurd to refuse transfusion because of the minimal risk of transmission of HIV by transfusion.

Figure

Figure

Now that the AIDS virus can be killed by heat treatment of blood products, the risk of transmission to haemophiliacs and other patients should disappear.

4. Transmission from the infected mother to her foetus

Any woman who feels that she may have been infected should consult her doctor before becoming pregnant or as soon as possible after becoming pregnant. The risk of transmission from the infected mother to her child is between 20 and 50 per cent.

Figure

There are many ways that HIV is not transmitted.

AIDS and everyday life

Handshake

Hugging

Drinks at a cafB>

Toilets

Work environment

Cinemas

Money in the bank

Public telephone

Fast-food

Going to the doctor

This does not transmit AIDS

Cutlery, silverware

Linen

Children at school

Taxis

Opening a door

Buses

HIV cannot be transmitted through casual contact. Personal contact in the workplace is casual. You cannot get HIV by any of the following activities:

· patting a co-worker on the back;
· sharing equipment;
· sharing restrooms;
· shaking hands;
· hugging;
· coughing;
· sneezing;
· using the same drinking fountain;
· using the same telephone;
· eating together.

Research shows that family members of people with HIV/AIDS have not been infected with the virus through normal household contact. Even people who have bathed or slept in the same bed with AIDS patients have not become infected.

In the absence of any effective treatment, prevention is the only way to combat the spread of AIDS, since certain sexual and drug-related practices greatly increase the risk of contracting the disease. Only a change in this behaviour can protect us and limit the spread of the disease until treatment and a vaccine are available. Your state of health in relation to AIDS depends to a large degree on you...

What is safer sex?

The safest sex is no sex, or sex with only one partner who is not infected. Take precautions if you are sexually active with more than one partner, or if you are unsure about whether your sexual partner is infected or not. Use latex condoms (also called preservatives or rubbers) for all penetrative sexual acts (anal, vaginal, oral). Using a spermicide may also help to reduce the risk of sexually transmitted diseases, including HIV, but spermicides are not an alternative to condoms.

Exposure to blood

Always avoid exposure to large quantities of blood. Intact skin (no cuts, tears, breaks, dermatitis, etc.) is a good barrier against the AIDS virus. However, it is not always possible to know if you have minor cuts or scratches. Cover known wounds with dressings. Treat all blood as potentially infected: this avoids discrimination and protects against other bloodborne diseases, e.g. hepatitis. Therefore the best rule is to avoid skin contact with blood, and to wear gloves if you come into contact with blood. Remember: the virus has to get inside the bloodstream in a relatively high concentration for a person to get infected.

Cleaning up blood spills

Spilt blood should be soaked up with absorbent material (cloth, rags, paper towels or sawdust), direct skin contact with the blood being avoided. Blood spills can be cleaned up using detergent-disinfectant formulations - chemical germicides. In addition to these, a solution of household bleach and water (prepared daily) is an inexpensive and effective germicide and will kill the HIV virus when used properly. Remember to wear disposable gloves when cleaning up blood spills using chemical germicides or bleach and use them in well ventilated areas. See Appendix II.

How can the AIDS virus be inactivated?

Fortunately, the AIDS virus is not very resistant outside of the body. For this reason, it is relatively easy to inactivate in the ambient environment.

THE VIRUS CAN BE EASILY KILLED BY:

Fresh bleach solution prepared daily in the proportions of one volume of bleach to nine volumes of water (applications for 20 minutes is sufficient)

Fresh hydrogen peroxide and detergents

- 70% alcohol

- heat (+60° C)

* Bleach solution loses its properties after a certain period of time. After the expiry date, its disinfectant properties are no longer guaranteed.

HOWEVER, THE VIRUS IS RESISTANT:

To cold

To gamma and X-rays

To ultraviolet radiation

IT IS THEREFORE IMPORTANT:

Figure

* To clean immediately and disinfect any split blood or body fluid. The wound must be cleaned with soap and water for several minutes.

Figure

* To wash contaminated clothes in hot water (70° C) with detergent. When washing in cold water, use a disinfectant, for example bleach. Dry cleaning is not very effective.

If you think you may come into contact with blood, you are urged to take certain recommended precautions. This is especially important for people who may have cuts, abrasions or lesions (from dermatitis, for example) who perform first aid or clean-up functions that may expose them to blood or body fluids containing visible blood. Appendix II at the back of this Module contains the World Health Organization Guidelines on AIDS and first aid in the workplace. You can get other information on AIDS from:

Global Programme on AIDS, PPC
World Health Organization
20, avenue Appia
1211 Geneva 27
Switzerland

Can saliva, sweat, tears or urine spread HIV?

Although small amounts of the virus have been found in the saliva, sweat, tears and urine of some AIDS patients, the concentrations were extremely low. These body fluids are not considered likely to transmit HIV because the quantity found is generally below the level necessary to cause infection. However, if these body fluids contain visible blood, then the recommended precautions referred to above should be used.

Can HIV be spread through food?

Scientists have never found a single documented case of AIDS which was transmitted through food. Cooking food would kill the virus anyway.

Can mosquitos spread HIV?

There have been no recorded cases of anyone becoming infected from mosquito bites (or bites from any other insects).

Is there a risk of becoming infected with HIV when providing first aid?

First aid treatment which involves contact with blood presents a very small risk of transmission of HIV (and other bloodborne infections such as hepatitis B) from an infected person. In fact, there are no reported cases of HIV transmission from mouth-to-mouth resuscitation with an infected person. However, as a precaution, when providing first aid, you can reduce the possibility of infection by following these rules:

· A worker who is unconscious and not breathing requires mouth-to-mouth resuscitation. Mouth-to-mouth resuscitation is a life-saving procedure and should not be withheld due to a fear of getting HIV or other infections.

· If a person is bleeding from the mouth, use a clean cloth or other suitable material to wipe away any blood. Do not use mouthpieces, resuscitation bags or other ventilation bags unless you are trained in their use. You should provide mouth-to-mouth resuscitation in an emergency whether you have such equipment or not.

· A worker who is bleeding requires immediate attention. Do not hesitate to help a bleeding co-worker, since some wounds may be life-threatening. Bleeding can usually be stopped by putting pressure on a wound using suitable material like a clean cloth. Gloves should be used if available. Always wash with soap and water your hands and any other parts of the body which have been splashed with or exposed to blood. (Mucous membranes, such as in your mouth or eyes, should be rinsed with water only.)

· If you are required to give cardio-pulmonary resuscitation (CPR) at work, then your employer should provide pocket masks, gloves, and training on how to use them.

Is there a test for AIDS?

There is a test for the HIV antibody - which is a test for HIV infection, not for AIDS. When the virus enters the body, "antibodies" are produced by the body's immune system. There are tests to find these antibodies in the blood. A positive test means that antibodies have been found and that the person has been infected with the virus, can transmit the virus to others, and is likely to develop AIDS. A negative test means that no antibodies have been found and the person is not infected. However, there is a "window period" between the time of exposure to the virus and the time antibodies appear (up to three months) when the test will show a negative result even though the person is actually infected (a false-negative result). This means that a test may not be able to find antibodies for up to three months after the person has been exposed to the virus.

Who should get tested?

If you are worried that you have been exposed to HIV, you may want to consider being tested. You should always seek counselling before deciding whether or not to be tested. Counselling will give you information about the testing procedure and help you to understand the implications of the test result, whether it is negative or positive.

Points to remember about AIDS 1. AIDS stands for Acquired Immunodeficiency Syndrome. It is caused by HIV, the human immunodeficiency virus. 2. HIV damages the body's immune system, leaving the body susceptible to illness. 3. There may be a long period between the time a person is infected and the time he or she begins to get sick. 4. There are three ways that HIV is known to be transmitted: (1) by sexual intercourse (usually through exposure to an HIV-infected person's semen or vaginal fluids); (2) by blood-to-blood contact; (3) from an infected mother to her unborn child. 5. HIV is not transmitted through casual contact. 6. The safest sex is no sex, or sex in a monogamous relationship with one sexual partner who is not infected. In all other situations, precautions should be taken by using condoms (preservatives) for all penetrative sexual acts (anal, vaginal, oral). 7. Skin contact with blood should be avoided. Wear gloves if you come into contact with blood. 8. Blood spills should be soaked up first and cleaned up using chemical germicides or household bleach and water. 9. Saliva, sweat, tears, urine, food and mosquito bites are not considered to spread HIV. 10. First aid treatment which involves contact with blood presents a very small risk of transmission of HIV. Mouth-to-mouth resuscitation should not be withheld due to a fear of getting HIV or other infections. Follow WHO-recommended preventive measures to reduce the possibility of infection when providing first aid. 11. There is a test for the HIV antibody, which is a test for HIV infection, not for AIDS. Antibodies may not be detectable for up to three months after exposure to the virus. During this time, a test for the HIV antibody may be falsely negative and the infected person may transmit the virus to others without knowing that he or she is infected.