HIV 1

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV).
This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk.
This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, child birth, breastfeeding or other exposure to one of the above bodily fluids.
AIDS is now a pandemic. In 2007, it was estimated that 33.2 million people lived with the disease worldwide, and that AIDS killed an estimated 2.1 million people, including 330,000 children. Over three-quarters of these deaths occurred in sub-Saharan Africa, retarding economic growth and destroying human capital.
Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century. AIDS was first recognized by the U.S. Centres for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s.
Although treatments for AIDS and HIV can slow the course of the disease, there is currently no vaccine or cure. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but these drugs are expensive and routine access to antiretroviral medication is not available in all countries. Due to the difficulty in treating HIV infection, preventing infection is a key aim in controlling the AIDS pandemic, with health organizations promoting safe sex and needle-exchange programmes in attempts to slow the spread of the virus.

SYMPTOMS:
The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages.
Opportunistic infections are common in people with AIDS. These infections affect nearly every organ system.
People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss. The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.

Epidemiology:

The AIDS pandemic can also be seen as several epidemics of separate subtypes; the major factors in its spread are sexual transmission and vertical transmission from mother to child at birth and through breast milk. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS pandemic claimed an estimated 2.1 million (range 1.9–2.4 million) lives in 2007 of which an estimated 330,000 were children under 15 years. Globally, an estimated 33.2 million people lived with HIV in 2007, including 2.5 million children. An estimated 2.5 million (range 1.8–4.1 million) people were newly infected in 2007, including 420,000 children.
Sub-Saharan Africa remains by far the worst affected region. In 2007 it contained an estimated 68% of all people living with AIDS and 76% of all AIDS deaths, with 1.7 million new infections bringing the number of people living with HIV to 22.5 million, and with 11.4 million AIDS orphans living in the region. Unlike other regions, most people living with HIV in sub-Saharan Africa in 2007 (61%) were women.
Adult prevalence in 2007 was an estimated 5.0%, and AIDS continued to be the single largest cause of mortality in this region.
South Africa has the largest population of HIV patients in the world, followed by Nigeria and India. South & South East Asia are second worst affected; in 2007 this region contained an estimated 18% of all people living with AIDS, and an estimated 300,000 deaths from AIDS. India has an estimated 2.5 million infections and an estimated adult prevalence of 0.36%.Life expectancy has fallen dramatically in the worst-affected countries; for example, in 2006 it was estimated that it had dropped from 65 to 35 years in Botswana.
In the United States, young African-American women are also at unusually high risk for HIV infection. This is due in part to a lack of information about AIDS and a perception that they are not vulnerable, as well as to limited access to health-care resources and a higher likelihood of sexual contact with at-risk male sexual partners.
There are also geographic disparities in AIDS prevalence in the United States, where it is most common in rural areas and in the southern states, particularly in the Appalachian and Mississippi Delta regions and along the border with Mexico. Approximately 1.1 million persons are living with HIV/AIDS in the United States, and more than 56,000 new infections occur every single year.

HIV/AIDS situation in India:
India is one of the largest and most populated countries in the world, with over one billion inhabitants. Of this number, it's estimated that around 2.3 million people are currently living with HIV. HIV emerged later in India than it did in many other countries. Infection rates soared throughout the 1990s, and today the epidemic affects all sectors of Indian society.
“Unlike developed countries, India lacks the scientific laboratories, research facilities, equipment, and medical personnel to deal with an AIDS epidemic. In addition, factors such as cultural taboos against discussion of sexual practices, poor coordination between local health authorities and their communities, widespread poverty and malnutrition, and a lack of capacity to test and store blood would severely hinder the ability of the Government to control AIDS if the disease did become widespread.”
“HIV infection is now common in India; exactly what the prevalence is, is not really known, but it can be stated without any fear of being wrong that infection is widespread… it is spreading rapidly into those segments that society in India does not recognise as being at risk. AIDS is coming out of the closet.”

CURRENT ESTIMATES:
In 2006 UNAIDS estimated that there were 5.6 million people living with HIV in India, which indicated that there were more people with HIV in India than in any other country in the world. In 2007, following the first survey of HIV among the general population, UNAIDS and NACO agreed on a new estimate – between 2 million and 3.1 million people living with HIV.
In 2008 the figure was confirmed to be 2.5 million, which equates to a prevalence of 0.3%. While this may seem a low rate, because India's population is so large, it is third in the world in terms of greatest number of people living with HIV. With a population of around a billion, a mere 0.1% increase in HIV prevalence would increase the estimated number of people living with HIV by over half a million.
The national HIV prevalence rose dramatically in the early years of the epidemic, but a study released at the beginning of 2006 suggests that the HIV infection rate has recently fallen in southern India, the region that has been hit hardest by AIDS.20 In addition, NACO released figures in 2008 suggesting that the number of people living with HIV has declined.






HIV PREVALANCE IN DIFFERENT STATES:

Andhra Pradesh
Andhra Pradesh in the southeast of the country has a total population of around 76 million, of whom 6 million live in or around the city of Hyderabad. The HIV prevalence at antenatal clinics was 1% in 2007. This figure is smaller than the reported 1.26% in 2006, but is still highest out of all states. HIV prevalence at STD clinics was very high at 17% in 2007. Among high-risk groups, HIV prevalence was highest among men who have sex with men (MSM) (17%), followed by female sex workers (9.7%) and IDUs (3.7%).26

Goa
Goa, a popular tourist destination, is a very small state in the southwest of India (population 1.4 million). In 2007 HIV prevalence among antenatal and STD clinic attendees was 0.18% and 5.6% respectively. The Goa State AIDS Control Society reported that in 2008, a record number of 26,737 people were tested for HIV, of which 1018 (3.81%) tested positive.

Karnataka
Karnataka, a diverse state in the southwest of India, has a population of around 53 million. HIV prevalence among antenatal clinic attendees exceeded 1% from 2003 to 2006, and dropped to 0.5% in 2007. Districts with the highest prevalence tend to be located in and around Bangalore in the southern part of the state, or in northern Karnataka's "devadasi belt". Devadasi women are a group of women who have historically been dedicated to the service of gods. These days, this has evolved into sanctioned prostitution, and as a result many women from this part of the country are supplied to the sex trade in big cities such as Mumbai. The average HIV prevalence among female sex workers in Karnataka was just over 5% in 2007, and 17.6% of men who have sex with men were found to be infected.

Maharashtra
Maharashtra is a very large state of three hundred thousand square kilometres, with a total population of around 97 million. The capital city of Maharashtra - Mumbai (Bombay) - is the most populous city in India, with around 14 million inhabitants. The HIV prevalence at antenatal clinics in Maharashtra was 0.5% in 2007. At 18%, the state has the highest reported rates of HIV prevalence among female sex workers. Similarly high rates were found among injecting drug users (24%) and men who have sex with men (12%).

Tamil Nadu
With a population of over 66 million, Tamil Nadu is the seventh most populous state in India. Between 1995 and 1997 HIV prevalence among pregnant women tripled to around 1.25%. The State Government subsequently set up an AIDS society, which aimed to focus on HIV prevention initiatives. A safe-sex campaign was launched, encouraging condom use and attacking the stigma and ignorance associated with HIV. Between 1996 and 1998 a survey showed that the number of men reporting high-risk sexual behaviour had decreased.
In 2007 HIV prevalence among antenatal clinic attendees was 0.25%. HIV prevalence among injecting drug users was 16.8%, third highest out of all reporting states. HIV prevalence among men who have sex with men and female sex workers was 6.6% and 4.68% respectively.

Manipur
Manipur is a small state of some 2.4 million people in northeast India. Manipur borders Myanmar (Burma), one of the world's largest producers of illicit opium. In the early 1980s drug use became popular in northeast India and it wasn't long before HIV was reported among injecting drug users in the region. Although NACO report a state-wise HIV prevalence of 17.9% among IDUs, studies from different areas of the state find prevalence to be as high as 32%.
Estimated adult HIV prevalence is the highest out of all states, at 1.57%.
Mizoram
The small northeastern state of Mizoram has fewer than a million inhabitants. In 1998, an HIV epidemic took off quickly among the state's male injecting drug users, with some drug clinics registering HIV rates of more than 70% among their patients. In recent years the average prevalence among this group has been much lower, at around 3-7%.44 HIV prevalence at antenatal clinics was 0.75% in 2007.

Nagaland
Nagaland is another small northeastern state where injecting drug use has again been the driving force behind the spread of HIV. In 2003 HIV prevalence among IDUs was 8.43%, but has since declined to 1.91% in 2007. HIV prevalence at antenatal clinics and STD clinics was 0.60% and 3.42% respectively in 2007.

TARGET GROUPS:

1. SEX WORKERS:
Sex work is very widespread in India, and occurs on a much larger scale than in many other countries. Women often get involved as a result of poverty, marital break-up, or because they are forced into it. HIV prevalence among sex workers varies between districts and states, although there has been a general decline in prevalence in recent years. One study found prevalence ranged between 2 percent and 38 percent (averaging at 14.5 percent) among districts in the four high prevalence south Indian states Andhra Pradesh, Maharashtra, Tamil Nadu and Karnataka.
In the city of Mysore, southern India, around a quarter of sex workers are infected with HIV. This situation is not surprising given that in one study only 20 percent of sex workers had always used condoms with commercial clients in the past month.
Sex workers are often labeled as key risk group in the context of HIV and AIDS. Historically, the AIDS epidemic in India was first identified amongst sex workers and their clients, before other sections of society became affected.

MEANS OF TRANSMISSION:
MULTIPLE PARTNERS, INCONSISTENT CONDOM USAGE:
In general, sex workers have relatively high numbers of sexual partners. This in itself does not necessarily increase their likelihood of becoming infected with HIV – if they use condoms consistently and correctly then they will probably be protected no matter how many people they have sex with. The reality, however, is that sex workers and their clients do not always use condoms. In some cases, this is because sex workers have no access to condoms, or are not aware of their importance. Clients may refuse to pay for sex if they have to use a condom, and use intimidation or violence to enforce unprotected sex.
“Sex workers have told us that when they ask a client to use a condom, he offers double the price to have sex without the condom. These women are trying to provide for their children and families, so they take the offer.” - Ndeye Astou Diop, Aboya (an organisation that works with HIV-positive women in Senegal)

MODES OF PREVENTION:
There are several steps that can be taken towards achieving these goals. Effective measures include the provision of condoms; educating sex workers and their clients about HIV; encouraging peer education (where sex workers inform one another about HIV); helping sex workers to group together; reducing the stigma that communities attach to sex work; and ensuring that laws and policies respect sex workers’ human and citizen rights.







2. MALE SEX WITH MALE:
The term men who have sex with men (MSM) refers to all men who have sex with other men. With MSM, there are two main forms of sexual activity that carry greater risks, anal and oral sex, although not all MSM engage in them. MSM may also have greater risks in that they can switch sex roles.
In MSM, HIV transmission can involve anal or oral sex, blood transfusion, contaminated hypodermic needles, or other exposure to one of the above bodily fluids. Regardless of the gender of the receptive partner, anal sex carries a higher risk of infection than most sex acts, but most penetrative sex acts carry some risk. The main route of transmission is through unprotected sex. Properly used condoms can reduce this risk. The adult prevalence rate in the United States is 0.7%, with over 1 million people currently living with HIV. In the United States from 2001–2005, the highest transmission risk behaviors were sex between men (40–49% of new cases) and high risk heterosexual sex (32–35% of new cases). HIV infection is increasing at a rate of 12% annually among 13-to-24-year-old American men who have sex with men. Experts attribute this to "AIDS fatigue" among younger people who have no memory of the worst phase of the epidemic in the 1980s and early 1990s, as well as "condom fatigue" among those who have grown tired of and disillusioned with the unrelenting safer sex message. The increase may also be because of new treatments. In developing countries, HIV infection rates have been characterized as skyrocketing among MSM. Studies have found that less than 5% of MSM in Africa, Asia, and Latin America have access to HIV-related health care.
A large study in Andhra Pradesh found that 42% of MSM in the sample were married, that 50% had had sexual relations with a woman within the past three months and that just under half had not used a condom.33 As such, unprotected sex between men can also present a risk to any women that they may subsequently have sex with.

3. TRUCK DRIVERS:
Truck drivers are a very high-risk group for HIV infection. Louis Hollander, the chairman of Trucking against AIDS, says about 45% of truck drivers are HIV-positive. Contributing factors are that truck drivers are away from their families for long periods of time and that there are high numbers of sex workers at truck stops. Many areas that truck drivers travel through are rife with poverty and unemployment so women are ready to sleep with them in exchange for money to survive.
India has one of the largest road networks in the world, involving millions of drivers and helpers. Truck drivers spend long periods of time away from home, and it is common practice for them to have relations with sex workers while on the road. A 2008 study showed that nearly a third of the long-distance truckers had paid for sex in the past twelve months.
A startling study indicates that almost 40 percent of India's truck drivers and their helpers are infected with AIDS virus. "The findings are certainly alarming. One in every three truckers visits commercial sex workers. The shocking part is that only 18 percent of them use condoms.”
Their highly mobile lifestyle requires a lot of travel. In other stopover town locations they visit other commercial male/female sex workers thereby potentially transmitting the virus.










4. STREET CHILDREN:
No one knows how many street children are at risk of contracting, or have died of, HIV/AIDS. They are not even listed as a vulnerable group, like commercial sex workers and homosexuals. Yet the sexual exploitation and drug abuse that is an inevitable part of their lives, points to a serious problem in urgent need of attention, says Charumathi Supraja
Street children are not basically depraved, lazy, trouble-mongerers. They are deprived, abjectly neglected children who are barely visible except as a threat or nuisance. Runaway children, missing children, children orphaned by AIDS, children of street dwellers (who do not keep in touch with their parents or vice versa) land up on the streets. If social service organisations do not interrupt their induction into street life, they turn into ‘hard-core’ street children. Such children are highly mobile, abused at multiple levels and totally deprived of adult affection and normal adult influence. They survive the threats of street life by joining gangs that introduce them to strategies like “sex for comfort, pleasure and money” and “drugs for bliss and loss of pain”. Lacking a nutritious environment in more ways than one, these children fall prey to the worst diseases that affect neglected groups and communities. HIV-AIDS is just one of them
In 2001-2002, a clinical child and adolescent psychologist from the Netherlands, Meindert Schaap, conducted in-depth research on the sexual life-worlds of 25 teenage street boys, aged 12-16. The research showed ‘an early onset of sexual activity and a very rapid sexual career among street boys. Same-sex activities (mutual masturbation and anal sex) are far more common than sex with girls. Most street boys have sex with multiple partners and have had sexual encounters with (street) prostitutes.’
The motives to engage in sex include ‘pleasure, immediate lust-reduction and material gain (food, money, drugs).’ Meindert recorded that ‘sexual activities may start as experimenting for pleasure but soon become a sort of commodity as well as …an addictive means to get immediate pleasure. Only a relatively small part of the boys' sexual activities involve real force and are considered to be abusive. All in all, sex is not a big deal: “You eat, you drink, you have sex”.’
The study also found that only a few street boys seemed to have reasonably good knowledge of sexual health. The misconceptions were widespread and included beliefs like anal sex with boys is harmless and that ‘HIV/AIDS can be easily recognised by sight and that HIV is easily spread by mouth.’ Condoms are used, if at all, for heterosexual activities.

ID USERS:
Nationally, HIV prevalence among injecting drug users (IDUs) appears to have declined slightly in recent years to around 7 percent in 2006. However, transmission through injecting drug use is still a major driving factor in the spread of HIV in India, particularly in north-eastern areas, such as Manipur and Nagaland. One study found HIV prevalence ranged from 23 percent to 32 percent in different areas of Manipur.27 In 2006 new sites of high HIV prevalence among IDUs were identified in Punjab, Tamil Nadu, West Bengal, Kerala and Maharastra.
The alarming levels of infection occurring through needle-sharing have implications that extend beyond networks of drug users. Some of those who inject drugs are also sex workers or truck drivers, and many are sexually active, which can result in infection being passed on to their partners. Experts have argued that there needs to be more information aimed at both injecting drug users and their sexual partners.29
The Indian government’s approach to drug use is based around law-enforcement and prosecution, with very little done in terms of treating drug users or helping them to stop using drugs. Harm reduction – a method of HIV prevention that has been successful in other countries, which acknowledges that drug use occurs and seeks ways to reduce HIV transmission in this context – has not been adopted in the government’s drug policies.




APPROACH TO PATIENTS WITH SUSPECTED HIV INFECTION:

The moment that an adult or child is suspected of having HIV infection, the issue of his/her care and management is thrust into the spotlight. The responsibility for providing care is usually shared by the professional team, the community, and the patient. Excellent communication between all parties becomes vital especially when the patient is receiving antiretroviral drugs (ARVs), for they must be continued without interruption.
(Cange in rural Haiti is an example of a best practice in such a situation;
there, patients choose trustworthy persons from the community to serve as accompagnateurs who complete regular, direct observation and documentation of the patients taking their medications.)
The first meeting between the healthcare professional and the patient is often at the request of the patient, the family, or a concerned friend. From the first moment of meeting, the professional must focus on beginning a cooperative partnership with the patient, for what often begins is a process of negotiation between the professional caregiver and patient. From the caregiver’s perspective, the primary objective of the partnership is adherence--not just to drug treatment, but to further clinical and laboratory investigations and to any necessary aspects of lifestyle change.
Building trust between these parties is paramount, because the validity and reliability of
Communication depends squarely on trust and trustworthiness. Understanding the patient’s mental and emotional status is vital to the success of communication and, by extension, to the success of treatment. The healthcare worker must also get a clear picture of the patient’s circumstances, including employment, economic status, and social support network.
(For example, in some larger Caribbean countries, the cost of transportation to and from the health clinic or hospital is prohibitive, absorbing monies usually devoted to investigations and therapy. Or, a patient living on the street may be less adherent to medications than someone who has a home.)

Many needs of PLWHA are identical to those of persons with other illnesses, but because of the aura and stigma that often surrounds HIV/AIDS, the patient and the family may have additional requirements as outlined in the following tables.

Table 1: Medical Needs of PLWHA*
• Access to health team
• Means of transport
• Medical monitoring (e.g. interviews, examinations, laboratory tests)
• Patient education
• Nutritional plan of action
• Dietary and/or nutritional supplements
• ARVs and drugs for opportunistic infection (OI) prophylaxis and treatment
• Provision of condoms, when necessary
• Crisis care and terminal care
• Education of significant others (e.g. knowledge, skills, attitudes)
• Supervision and supplies for caregivers at home, hospice, or hospital
• Response to special needs

Table 2: Counselling& Needs of PLWHA†
• Pre- and post-test counselling
• Individual and group support for counselling concerning general life issues
• Counselling regarding interpersonal relationships, sexuality, and sexual issues
• Spiritual counselling
• Discussion and clarification of issues related to personal and family confidentiality
• Counselling and support in preparation for dying, and when necessary, including arrangements for children
Table 3: Counselling& Needs of Family and Friends of PLWHA∞
• Education about HIV, including reassurance about personal safety in long-term social contact situations
• Emotional and spiritual support
• Bereavement counselling

Table 4: Self-Care Needs of PLWHA*
Physical and mental:
• Keeping physically fit
• Maintaining the best possible nutrition
• Living a balanced life including work, rest, recreation, and sleep
• Good personal hygiene and sexual safety in order to avoid unnecessary contact with infection.

Table 5: Social Support Needs of PLWHA†
• Companionship
• Legal advice and services
• Employment
• Income-generating activities
• Occupational therapy
• Cash and kind for short-term support
• Food and shelter
• Means of transport
• Child welfare
• Involvement in community life



PRE – TEST AND POST – TEST COUNSELLING:

The aims of pre-test and post-test discussions are:
• To provide information and support around the testing procedure.
• To minimise the personal impact of diagnosis.
• To change health-related behaviour and to reduce anxiety of the person being tested.
• To educate the patient regarding risk of transmission.
• To obtain informed consent, and to follow up and arrange referrals as indicated.


Summary of pre-test discussion
• Reason for testing and risk assessment
• Timing of risk and option of post-exposure prophylaxis (PEP)
• Need for other STI and blood-borne virus testing
• History of testing
• Confidentiality and privacy issues around testing
• Ensuring there is informed consent for the test
• Natural history and transmission information
• Prevention of transmission and risk reduction through behaviour change
• Implication of a positive or indeterminate test result, including availability of treatment
• Implications of a negative test result
• Explanation of the window period
• General psychological assessment and assessment of social supports in the event of a positive result
• Logistics of the test: time taken for results to become available and the need to return for results

Pre-test discussion has several objectives:
• To provide information about the implications of a
positive or negative result
• To enable informed decision-making about testing
• To communicate the health benefits of testing
• To educate patients about modes of transmission,
safe sex and risk reduction measures
• To prepare for a possible positive result.

HIV Pre-Test Discussion
While pre- and post- test discussion is generally associated with testing for HIV, components of pre- and post- test discussion apply to testing for many sexually transmissible and blood-borne infections.
• Ensure client is aware of the confidentiality surrounding the test
Assess risk factors such as types of sexual behaviour, number of partners:
• Potential for exposure to HIV
• Determine when exposure to risk occurred
Previous testing
• when, where
• is result available?
• what was tested?


Explain the test:
• Why the test is done (treatment, improve outcomes, reduce risk of transmission)
• How the test is done
• What the test tells and does not tell (ie discuss exactly what you are testing for)
• For infections with window periods, discuss implications, advise if and when repeat testing will be necessary
Confidentiality issues:
• Discuss ways the patient should protect their own confidentiality (eg carefully consider who they will tell)
• Inform the patient of legal requirements for and mechanisms of notification in the case of a positive test for a notifiable infection
• Inform the patient of the procedures relating to contact tracing in the case of a positive test
Discuss how and when to obtain results:
• It is strongly recommended all HIV (and probably Hep B and Hep C) results are given in person by medical practitioners or experienced sexual health nurses. It is important to stress to the patient prior to the test that test results will not be given over the phone to ensure the patient does not assume the worst when asked to come into the surgery to get the results. Consider making an appointment to give back the results at the time the test is taken
Discuss implications of a negative result:
• Discuss prevention - don't let people go away with the idea a negative test somehow confers immunity on them for future risk taking behaviour.
• Reinforce the positive aspects of safe sex practises. Opportunity for further education
• May require repeat test if exposure still within 12 week window period
Discuss implications of a positive result:
• What a positive result would mean
• Discuss the options for medical treatment and follow-up
• Consider the availability of family or friends who may be available to talk with if the result is positive (support systems)
• Does the patient have any holidays available if needed to be able to come to terms with the result
• Discuss contact tracing and what this means
• Evaluate patient's coping skills
Risk reduction:
• Stress importance of ongoing risk reduction strategies
• Specifically address any risks identified in history
• Offer follow-up support.


HIV Post-Test Discussion

Summary of post-test discussion giving a negative result:

• Explain the negative test result and the window period (if relevant)
• Reinforce education regarding safe behaviours
• Further discuss anxiety or risk behaviours, Discuss testing for other STIs.

A negative result:
• Review:
- risk behaviours
- what test tells and does not tell
- window period: may require repeat test if exposure still within window period
• Prevention:
- maximise educational opportunity
- don’t let people go away with the idea a negative test somehow confers immunity on them for future risk taking behaviour.

Summary of post-test discussion giving a positive result:

First post-test consultation
• Establish rapport and assess readiness for the result
• Give positive test result
• Avoid information overload
• Listen and respond to needs (the patient may be overwhelmed and hear little after being told the positive result)
• Discuss immediate implications
• Review immediate plans and support
• Reassess support requirements and available services
• Arrange other tests and the next appointment
• Begin contact tracing process and discuss options available to facilitate this

Subsequent consultations
• Treatment options diet and exercise
• Effect of diagnosis on relationships and prevention information
• Issues of disclosure
• Assessment of contact tracing process and difficulties encountered
• Access to life insurance may be affected
• Workplace implications
• Impact of other issues (eg. drug use, poverty, homelessness) on ability to access health care and treatments
• Referral for on-going counselling, social worker, medical specialist as appropriate.





A positive result:
• Before giving the result, check that the person has come for the result. The person may have come for a different reason and may not be ready for you to launch into a discussion of a positive result
• Allow plenty of time
• Explain the result and what it means
• Be straightforward
• Listen, encourage questions
• Be willing to talk
• How much information to give? – be guided by the person’s response and do not overload

Arrange follow-up:
• Offer ongoing medical and psychological support
• Offer referral to another support agency such as Queensland Positive People and the Queensland AIDS Council, as necessary
• Offer referral for management as necessary
• Check there is a trusted support person available

Contact tracing:
• timing of contact tracing will vary according to circumstances
- if others are at immediate risk, contact tracing is a priority
- if a person understands the risk to others and is having difficulty adjusting to the diagnosis, contact tracing may be deferred































SEXUALLY TRANSMITTED INFECTION:
A sexually transmitted disease (STD), also known as sexually transmitted infection (STI) or venereal disease (VD), is an illness that has a significant probability of transmission between humans or animals by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex.

STI Definition Incubation
Period Mode of Transmission Symptoms Treatment
Gonorrhea Gonorrhea is a common sexually transmitted infection caused by the bacterium Gonococcus. In both men and women if gonorrhea is left untreated, it may spread throughout the body, affecting joints and even heart valves. 2 to 30 days with most symptoms occurring between 4–6 days after being infected. The infection is transmitted from one person to another through vaginal, oral, or anal sexual relations. Men may complain of pain on urinating and thick, copious, urethral pus discharge, scrotal pain or swelling.
Women may complain of vaginal discharge, difficulty in urinating (dysuria), projectile urination, off-cycle menstrual bleeding, or bleeding after sexual intercourse. Antibiotics may be used to treat gonorrhea
Syphilis Syphilis is a sexually transmitted disease caused by the
spirochetal
bacterium.
10 – 90 days after the first exposure. The route of of syphilis is through
sexual contact, although there are examples of
congenital syphilis from mother to child in utero.
A skin lesion often on the penis, vagina or
rectum. Other symptoms common at this stage include fever, sore throat, malaise,
weight loss, headache,
meningismus, and enlarged lymph nodes.
Syphilis can generally be treated with
antibiotics, including
penicillin.
If left untreated, syphilis can damage the heart,
aorta, brain, eyes, and bones.

Herpes Simplex Herpes simplex is a viral disease caused by both herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). 2 – 21 days. Herpes simplex is most easily transmitted by direct contact with a lesion or the body fluid of an infected individual. Common infection of the skin or mucosa may affect the face and mouth, genitalia, or hands. More serious disorders occur when the virus infects and damages the eye, or invades the central nervous system, damaging the brain. There is no cure for herpes. Once infected, the virus remains in the body for life.



STI Definition Incubation Period Mode of Transmission Symptoms Treatment
Genital warts Genital warts, caused by some types of HPV (human papilloma virus), can appear on the skin anywhere in the genital area as white or flesh-coloured, smooth, small bumps, or larger, fleshy, cauliflower-like lumps. 10 days to one or two months. Genital HPV is transmitted by genital skin-to-skin contact, or through the transfer of infected genital fluids. This is usually during vaginal or anal sex. Warts can appear on or around the penis, the scrotum, the thighs or the anus. In women warts can develop around the vulva or inside the vagina and on the cervix. There is no treatment that can completely eliminate genital warts once a person has been infected. Often outbreaks of genital warts will become less frequent over time, until the body naturally clears the virus and the warts disappear of their own accord.
Chlamydia Chlamydia is caused by the bacterium chlamydia trachomatis. This bacteria can infect the cervix in women and the urethra and rectum in both men and women. Occasionally chlamydia can also affect other parts of the body, including the throat and eyes. Chlamydia symptoms usually appear between 1 and 3 weeks after exposure but may not emerge until much later. By having unprotected vaginal, anal or oral sex with someone who is infected. Chlamydia is known as the ‘silent’ disease as in many people it produces no symptoms. It is estimated that 70-75% of women infected with chlamydia are asymptomatic (have no symptoms) and a significant proportion of men also have no symptoms. The treatment of chlamydia is simple and effective once the infection has been diagnosed. It consists of a short course of antibiotic tablets, which if taken correctly, can be more than 95 percent effective.