Section I - Basic facts about AIDS

The starting point for teaching about AIDS is to provide yourself with the basic facts about transmission and prevention. It takes little study to learn the few facts you need to teach the basics. Statistics are not necessary and may even be a hindrance as they divert attention from the real message.

Most people have at least a little knowledge of HIV/AIDS, but it is often clouded by incorrect information. Much of your teaching may involve dispelling myths and overcoming unnecessary fears.

his section will provide you with the basic facts you need to get started. The next and most important step, getting people to choose healthy behavior, may depend more on your creative efforts to make people act on their knowledge. Other parts of the manual offer some ideas for creative teaching.

Information in this section is from World Health Organization (WHO).

Aids background " Q & A

QUESTION: Where did AIDS come from?

AIDS comes from a virus called HIV, but where this virus came from is not known. To find out, more information is being gathered through new research But as new facts are discovered about viruses, like HIV, the question of where HIV came from is becoming more complicated to answer. It is best to refocus this curiosity and attention on how to stop the spread of this disease. Questions of where and when it started can be answered later.

QUESTION: How can there suddenly be a disease that never existed before?

If we look at AIDS as a worldwide epidemic, it is something new and rather sudden. But if we look at AIDS as a disease and at the virus that causes it we get a different picture. We find that both the disease and the virus that causes it are not new. They were here well before the epidemic.

We know that viruses sometimes change genetically. A virus that was once harmless to humans can change and become harmful. This is probably what happened with HIV long before the AIDS epidemic.

What is new is the rapid spread of the virus. It may be compared with a weed that someone brings home from a distant place. In its original environment the weed survives, but does not spread much. However, once it gets started in the new environment, conditions may allow it to grow much better than it did in its old surroundings.

It spreads, chokes out other plants, and becomes a nuisance and then a widespread problem. The spread of HIV is somewhat similar.

Researchers believe that the virus was present in isolated population groups years before the epidemic began. Then the situation changed. People moved often and travelled more; they settled in big cities; and lifestyles changed, including patterns of sexual behavior. It became easier for HIV to spread, through sexual intercourse and contaminated blood. As the virus spread, the isolated disease already existing became a new epidemic.

AIDS and HIV infection " Q & A

QUESTION: What is AIDS?

AIDS is a disease caused by a virus that can break down the body's immune system and lead to fatal infections and some forms of cancer.

Before this brief answer is given more detail, six abbreviations that are often used need to be explained (some are used more often in Thailand than in other countries):

• AIDS stands for Acquired Immunodeficiency Syndrome.

• ARC stands for AIDS Related Complex.

• HIV stands for Human Immunodeficiency Virus, which causes the disease. In other words, HIV is the AIDS virus.

• HIV infection (HIV positive) means infection with the AIDS virus or AIDS virus infection.

• PWA stands for Person with AIDS.

• STDs stands for all Sexually Transmitted Diseases (formerly VD).

QUESTION: How does the virus cause AIDS?

The virus causes AIDS by disabling or destroying certain kinds of white blood cells that normally help the body fight disease. This system of cells is called the immune defence system. Without a healthy immune system the body can't defend itself against infections and other diseases.

Because of this, within 10 years of being infected with the virus, at least 50 percent of HIV-infected persons will have developed AIDS. Persons with AIDS are open to attack from infections and cancers that a healthy person who does not have AIDS can resist.

A diagnosis of AIDS is based on symptoms and illnesses, as well as an examination of the blood cells to determine the condition of the immune system.

People with AIDS may lose more than 10 percent of their weight and may have chronic diarrhea, and have fever for more than a month. They may suffer with problems of the skin, glands or throat. More critically, they are very vulnerable to deadly diseases like pneumonia and some cancers.

Although they may get different illnesses, all persons with AIDS have something in common: their immune defence systems are not working because of infection with the AIDS virus.

People do not die of AIDS. They die of the diseases acquired because their immune system does not protect them any longer.

The majority of people who have been diagnosed with AIDS die within two years of the diagnosis. A few have survived longer.

QUESTION: What happens to people infected with the AIDS virus?

After infection with the virus most people have a prolonged period without AIDS virus-related illnesses. They are considered to be HIV positive or infected with the AIDS virus. It is important to realize that at this stage they do not have AIDS.

They may, however, experience other symptoms and illnesses as the immune system loses its ability to protect the body. This stage is sometimes referred to as ARC or AIDS Related Complex.

It is important to understand that although the HIV-infected person may show no signs of illness, he or she can transmit the virus to others through shared needles, sexual intercourse or from infected mother to unborn child.

QUESTION: Can you tell who has HIV infection by looking at them?

No, there is no way of telling if a person has the AIDS virus just by looking at him or her. Many people who have HIV infection look and feel healthy for a long time, but they are carrying the virus and can pass it on to others.

QUESTION: Can you have HIV infection (AIDS virus infection) and not be sick?

Yes, some people have HIV infection but are not sick for as long as ten years. Almost all will eventually start to show symptoms of AIDS at some point.

Transmission, prevention and cure " Q & A

QUESTION: Who can get AIDS?

People who choose certain dangerous behaviors are at risk of HIV infection. Risky behavior determines who will become infected, NOT risk groups.

QUESTION: Are some people more at risk of getting AIDS than others?

Yes. Some people are more likely to get HIV infection than others. It depends on their behavior. This is because of the way the virus spreads.

At high risk are:

• people who have extra marital affairs

• people who have multiple sex partners

• people who already have other sexually transmitted diseases (STDs) and are sexually active, especially with multiple sex partners

• people who sleep with HIV infected person

• people who get injections with needles that are not sterilized properly or who inject themselves, or who share needles

• people who receive blood transfusions with contaminated blood

• infants born to mothers who have HIV infection.

QUESTION: Why not test as many people as possible to find out who has the infection?

Widespread testing for AIDS may tell us more about the epidemic, but it can also create many other problems.

Testing by itself does not stop the spread of AIDS. Widespread testing requires widespread follow-up work, and the testing must be matched by an equal capacity for counselling everyone who is tested, depending on their positive or negative result.

It is difficult for tests to give the full picture. There is a latency period, called a "window period," between the time when the virus enters the body and when its presence shows up on the test. Thus, a test shortly after the virus enters someone's body may find the person not infected. Testing blood during this window period may not give the correct result.

It is also difficult to reach all the persons for whom testing might be important, and if testing is made compulsory, it may drive underground the very people one is trying to help. It would certainly run counter to the voluntary testing and counselling that are important parts of a national AIDS program.

QUESTION: How can you avoid AIDS ?

It is fairly simple to avoid AIDS, even if some people find it hard to change their behavior. Many people are not at risk: they do not have sex with casual acquaintances or commercial sex workers, nor do they have multiple sex partners. For someone to be as safe as possible, he or she should stay with one sexual partner who is faithful to them and not infected.

If they have more than one sexual partner, men should use condoms every time they have sex and women should make sure that their partners use condoms. Remember, condom use alone is not 100% safe against infection. A properly used condom, however, can significantly reduce your chances of HIV infection.

Also, to avoid AIDS, needles and syringes used for injections should always be sterilized. This rule applies to any instrument that comes into contact with blood, such as ear piercing needles, knives and razor blades.

Finally, drugs such as alcohol are known to impair judgement and create situations that may put individuals at risk for HIV infection. Being aware of one's behavior is vital. Therefore, drug use must be checked to insure safe practices. Being under the influence of a drug such as alcohol has been known to raise risk factors towards HIV infection.

QUESTION: if you have HIV infection, can you still have sex?

You can hug and caress safely, but any sexual activities that involve sharing of sexual fluids will put your sexual partner at risk of getting the infection from you. Both you and any potential partner must know and understand the risk. You are responsible for informing your partners and for agreeing with them on what is safe. Health workers can help you with this sensitive question.

QUESTION: When should you use condoms?

Use condoms whenever you have sex with a person who is not your regular partner or who might be infected. If your regular sexual partner has sex with other people, the best practice is always to use condoms with him or her each time you have sex.

QUESTION: Is there a cure or vaccine for AIDS?

There is presently no cure for AIDS. There are some medicines that have prolonged the lives of some people. There is hope that additional treatments will be found to prolong life. Treatment is not the same as cure. There is no cure.

There is also no vaccine to prevent uninfected people from getting the infection. Researchers believe it may take years for an effective, safe vaccine to be found.

The most effective way to prevent AIDS is avoiding exposure to the virus, which you can control by your own behavior.

Questions about transmission " Q & A

QUESTION: What happens if you live close to a person with AIDS?

Living someone who has AIDS or who is infected with the AIDS virus (HIV positive) will not give you AIDS. You can live in the same neighborhood, building, or village and this will not give you the disease. In fact, you can live quite safely in the same room with someone who has AIDS, provided that he or she is not your sexual partner.

QUESTION: But what if an HIV infected person coughs on you?

The AIDS virus spreads through sexual fluids and through blood. It does not spread through the air, through breathing, or coughing. So if someone infected with HIV coughs on you, it is much the same as anyone else coughing on you; you may catch a cold, if the person has a cold, but you will not catch AIDS.

QUESTION: What about using the same toilet?

You will not get AIDS from toilets. This applies to both public and private toilets, and is true even if they are dirty.

QUESTION: If I am bitten by an insect that has just bitten a person with the AIDS virus, will I become infected?

Many people worry about AIDS from insects, but the evidence is that the AIDS virus is not spread by insects. If it were spread in this way everyone bitten by insects would be at high risk of infection.

QUESTION: Why can't mosquitos spread AIDS?

There are various reasons why mosquitos don't spread HIV. From the way they bite it might be thought that a mosquito was like a flying hypodermic needle, contaminated and spreading the virus by injection whenever it bites. This is an imaginative idea but it is NOT correct.

Mosquitos do not inject blood, they draw blood. When they bite, they inject a substance that keeps blood from dotting and then suck blood out. When they fly off, they do so to digest their meal, not to inject it into another human being. What is more, only tiny amounts of blood are involved, with a very low likelihood of the AIDS virus being present even in blood from an infected person. After a mosquito has drawn blood, there is another obstacle for any virus that might be inside the mosquito's body. We know that the virus lives in some cells of the human body and that it does not live in insect's cells; in other words, mosquitos are not a suitable home for HIV. The virus is NOT like the malaria parasite.

QUESTION: What about injections?

Avoid injections unless absolutely necessary. If you must have an injection, make sure the needle and syringe come straight from a sterile package or have been sterilized properly; a needle and syringe that have been cleaned and then boiled for 20 minutes are ready for reuse. Finally, if you inject drugs, of whatever kind, never use anyone else's equipment.

QUESTION: What about having a tattoo or your ears pierced?

Tattooing, ear-piercing, and acupuncture all involve instruments that must be sterile. In general, you should avoid any procedure where the skin is pierced unless absolutely necessary.

QUESTION: What about going to the dentist?

Most all dentists today follow what are known as universal precautions. Going to the dentist today and having invasive work done is usually quite safe. If you have any concerns or questions about procedures used to clean instruments or needles, discuss them with your dentist. Ask him or her to explain safety and sterilization techniques before you have work done. Also, your dentist should be wearing proper gowns and sterile gloves during the operation as well.

QUESTION: AIDS is a deadly disease, isn't it?

Yes, but that does not mean it is everywhere or in everything, just waiting to infect you. Infection does not spread through the air, by touch, or through food and drink. You can sit next to people with AIDS, work beside them, or ride in a crowded bus amongst them. The virus does not spread by this kind of contact.

Infection in the work place and loss of income from illness " O & A

QUESTION: Is it safe to work with someone infected with the AIDS virus?

Yes. Most workers face no risk of getting the virus while doing their work. If they are HIV positive themselves, they are not at risk to others because of their work.

QUESTION: What about working every day in close physical contact with an infected person?

You may share the same telephone with other people in your office or work side by side in a crowded factory, but that will not give you the AIDS virus, even if one of your co-workers is infected. You may have a job with lots of dirt and sweat or you may share the same food, and that kind of contact will not give you the infection.

QUESTION: Who are at risk while they work?

Health care workers, for example, doctors, dentists, nurses, laboratory technicians, and others have to take special care against possible contact with blood that may contain the AIDS virus. They can protect themselves by using the simple precautions (universal precautions) that are commonly taken in their type of work.

Other people at risk while working, and often overlooked, are Commercial Sex Workers (CSWs). Specifically in Thailand, female and male CSWs may service five, ten or even twenty people a night. Very often, they have to deal with a guest who has been drinking. Thus, the guest arriving at the place of entertainment is very rarely in a cooperative state. The Royal Thai government is implementing various projects, in cooperation with the bar and entertainment owners, to help protect the CSW from HIV infection.

QUESTION: If a worker has HIV infection, should he or she be allowed to continue work?

Workers with HIV infection who are healthy should be treated in the same way as any other worker. Infection with HIV is not a reason in itself for termination of employment.

QUESTION: What will happen in the future when more people become sick with AIDS and AIDS-related illnesses?

Many countries today, especially in Southeast Asia, are beginning to realize the dangerous implications of a high number of persons infected with the AIDS virus. Governments are just beginning to understand the enormous responsibility of health care, child care, and other costs associated with the disease.

Furthermore, these governments are realizing the economic relationship involved between AIDS and loss of workers from the work force. This has enormous implications, including loss of over all economic growth, loss of labor, and most important, loss of income for individual families. For Thailand, a National AIDS Committee (NAC) chaired by the Prime Minister has been set up. This NAC is responsible for budget allocation to all ministries in the control and prevention of AIDS at the national, provincial and district levels.

QUESTION: How can a family lose their income from AIDS?

A family can lose their income from AIDS when an infected head of the household starts to show symptoms severe enough to prevent them from earning a living. Thus, he or she is no longer providing an income, and this puts the burden of care and support for the remaining family on someone else.

AIDS and the family " Q & A

QUESTION: How can the HIV virus enter the family?

The HIV virus enters the family usually by one married partner becoming infected outside the marriage first, and then infecting the other partner.

A married partner may become infected by one or more of the following ways:

• having unsafe (i.e. unprotected) sex outside the marriage

• using unclean needles to shoot drugs or sharing needles and syringes with HIV infected person

• receiving a blood transfusion that is HIV infected.

QUESTION: Can a woman who a has HIV infection become pregnant?

Yes.

QUESTION: What happens to a woman with HIV infection if she becomes pregnant?

Pregnancy may increase the risk of her actually developing AIDS, instead of just carrying the virus. This has not been proved conclusively, but it is possible, especially if she has been infected for a long time.

QUESTION: What happens to a child born to a woman with HIV infection?

The child may be born infected with the virus. There is a real danger that a mother may pass the AIDS virus on to her child before or during childbirth.

Research suggests that up to 50 percent of infants from infected mothers will be born infected with the virus. In addition, infants will get HIV infection during delivery.

Infants with AIDS virus will develop severe illnesses during their first year of life. The majority of the infected infants will not survive until their fifth birthday.

QUESTION: How can I protect my family from AIDS/HIV infection?

The most important way to protect your family and yourself from infection is to know your marriage partner. This begins before you get married. Because of the danger of STDs, including HIV infection, both men and women should seriously consider abstaining from sex until you are in a serious relationship. You should also choose a partner that will remain faithful to you in your relationship.

Once you have found yourself in a serious relationship, you and your partner should consider having the HIV antibody test performed if there is any question about anyone's past sexual history or drug use.

If you are married already, and suspect that your partner is engaging in unsafe behavior, you should use a condom every time you have sex. Also, strongly encourage your partner to go with you to get HIV testing and counselling at the local Provincial or District Anonymous Clinic or ask your local Public Health Office for the testing and counselling clinic nearest you.