Topic: Combating HIV

Introduction to HIV/AIDS
The first cases of acquired immunodeficiency syndrome (AIDS) were reported in the United States in the
spring of 1981. By 1983 the human immunodeficiency virus (HIV), the virus that causes AIDS, had been
isolated. Early in the U.S. HIV/AIDS pandemic, the role of substance abuse in the spread of AIDS was clearly
established. Injection drug use (IDU) was identified as a direct route of HIV infection and transmission among
injection drug users. The largest group of early AIDS cases comprised gay and bisexual men (referred to as
men who have sex with men (or MSMs). Early cases of HIV infection that were sexually transmitted often were
related to the use of alcohol and other substances, and the majority of these cases occurred in urban,
educated, white MSMs.
Currently, injection drug users represent the largest HIV-infected substance-abusing population in the United
States. HIV/AIDS prevalence rates among injection drug users vary by geographic region, with the highest
rates in surveyed substance abuse treatment centers in the Northeast, the South, and Puerto Rico. From July
1998 through June 1999, 23 percent of all AIDS cases reported were among men and women who reported
IDU
IDU practices are quick and efficient vehicles for HIV transmission. The virus is transmitted primarily through
the exchange of blood using needles, syringes, or other IDU equipment (e.g., cookers, rinse water, cotton) that
were previously used by an HIV-infected person. Lack of knowledge about safer needle use techniques and
the lack of alternatives to needle sharing contribute to the rise of HIV/AIDS.
Another route of HIV transmission among injection drug users is through sexual contacts within relatively
closed sexual networks, which are characterized by multiple sex partners, unprotected sexual intercourse, and
exchange of sex for money). The inclusion of alcohol and other non injection substances to this lethal mixture
only increases the HIV/AIDS caseload). A major risk factor for HIV/AIDS among injection drug users is crack
use; one study found that crack abusers reported more sexual partners in the last 12 months, more sexually
transmitted diseases (STDs) in their lifetimes, and greater frequency of paying for sex, exchanging sex for
drugs, and having sex with injection drug users.
Following are the key concepts about HIV/AIDS and substance abuse disorders that influenced the creation of
this TIP:

Substance abuse increases the risk of contracting HIV. HIV infection is substantially associated with
the use of contaminated or used needles to inject heroin. Also, substance abusers may put themselves
at risk for HIV infection by engaging in risky sex behaviors in exchange for powder or crack cocaine.
However, this fact does not minimize the impact of other substances that may be used (e.g.,
hallucinogens, inhalants, stimulants, prescription medications).
Substance abusers are at risk for HIV infection through sexual behaviors. Both men and women
may engage in risky sexual behaviors (e.g., unprotected anal, vaginal, or oral sex; sharing of sex toys;
handling or consuming body fluids and body waste; sex with infected partners) for the purpose of
obtaining substances, while under the influence of substances, or while under coercion.

Substance abuse treatment serves as HIV prevention. Placing the client in substance abuse
treatment along a continuum of care and treatment helps minimize continued risky substance-abusing
practices. Reducing a client's involvement in substance-abusing practices reduces the probability of
infection.

HIV/AIDS, substance abuse disorders, and mental disorders interact in a complex fashion. Each
acts as a potential catalyst or obstacle in the treatment of the other two--substance abuse can
negatively affect adherence to HIV/AIDS treatment regimens; substance abuse disorders and HIV/AIDS
are intertwining disorders; HIV/AIDS is changing the shape and face of substance abuse treatment;
complex and legal issues arise when treating HIV/AIDS and substance abuse; HIV-infected women with
substance abuse disorders have special needs.

Risk reduction allows for a comprehensive approach to HIV/AIDS prevention. This strategy
promotes changing substance-related and sex-related behaviors to reduce clients' risk of contracting or
transmitting HIV.

Origin of HIV/AIDS
Of the many theories and myths about the origin of HIV, the most likely explanation is that HIV was introduced
to humans from monkeys. A recent study (Gao et al., 1999) identified a subspecies of chimpanzees native to
west equatorial Africa as the original source of HIV-1, the virus responsible for the global AIDS pandemic. The
researchers believe that the virus crossed over from monkeys to humans when hunters became exposed to
infected blood. Monkeys can carry a virus similar to HIV, known as SIV (simian immunodeficiency virus), and
there is strong evidence that HIV and SIV are closely related (Simon et al., 1998; Zhu et al., 1998).
AIDS is caused by HIV infection and is characterized by a severe reduction in CD4+ T cells, which means an
infected person develops a very weak immune system and becomes vulnerable to contracting life-threatening
infections (such as Pneumocystis carinii pneumonia). AIDS occurs late in HIV disease.
Tracking of the disease in the United States began early after the discovery of the pandemic, but even to date,
tracking data reveal only how many individuals have AIDS, not how many have HIV. The counted AIDS cases
are like the visible part of an iceberg, while the much larger portion, HIV, is submerged out of sight. Many
States are counting HIV cases now that positive results are to be gained by treating the infection in the early
stages and because counting only AIDS cases is no longer sufficient for projecting trends of the pandemic.
However, because HIV-infected people generally are asymptomatic for years, they might not be tested or
included in the count. The CDC estimates that between 650,000 and 900,000 people in the United States
currently are living with HIV (CDC, 1997c).
In 1996, the number of new AIDS cases (not HIV cases) and deaths from AIDS began to decline in the United
States for the first time since 1981. Deaths from AIDS have decreased since 1996 in all racial and ethnic
groups and among both men and women (CDC, 1999a). However, the most recent CDC data show that the
decline is slowing (CDC, 1999b). The decline can be attributed to advances in treating HIV with multiple
medications, known as combination therapy; treatments to prevent secondary opportunistic infections; and a
reduction in the HIV infection rate in the mid-1980s prior to the introduction of combination therapy. The latter
can be attributed to improved services for people with HIV and access to health care. In general, those with the
best access to good, ongoing HIV/AIDS care increase their chances of living longer.
HIV/AIDS is still largely a disease of MSMs and male injection drug users, but it is spreading most rapidly
among women and adolescents, particularly in African American and Hispanic communities. HIV is a virus that
thrives in certain ecological conditions. The following will lead to higher infection rates: a more potent virus,
high viral load, high prevalence of STDs, substance abuse, high HIV seroprevalence within the community,
high rate of unprotected sexual contact with multiple partners, and low access to health care. These ecological
conditions exist to a large degree among urban, poor, and marginalized communities of injection drug users.
Thus, MSMs and African American and Hispanic women, their children, and adolescents within these
communities are at greatest risk
HIV Transmission
HIV cannot survive outside of a human cell. HIV must be transmitted directly from one person to another
through human body fluids that contain HIV-infected cells, such as blood, semen, vaginal secretions, or breast
milk. The most effective means of transmitting HIV is by direct contact between the infected blood of one
person and the blood supply of another. (See Figure 1-1 for an illustration of the structure of the virus.) This
can occur in childbirth as well as through blood transfusions or organ transplants prior to 1985. Using injection
equipment that an infected person used is another direct way to transmit HIV.
Sexual contact is also an effective transmission route for HIV because the tissues of the anus, rectum, and
vagina are mucosal surfaces that can contain infected human body fluids and because these surfaces can be
easily injured, allowing the virus to enter the body. A person is about five times more likely to contract HIV
through anal intercourse than through vaginal intercourse because the tissues of the anal region are more
prone to breaks and bleeding during sexual activity
A woman is eight times more likely to contract HIV through vaginal intercourse if the man is infected than in the
reverse situation (Center for AIDS Prevention Studies, 1998). HIV can be passed from a woman to a man
during intercourse, but this is less likely because the skin of the penis is not as easily damaged. Female-tofemale transmission of HIV apparently is rare but should be considered a possible means of transmission
because of the potential exposure of mucous membranes to vaginal secretions and menstrual blood (CDC,
1997a).

Oral intercourse also is a potential risk but is less likely to transmit the disease than anal or vaginal intercourse.
Saliva seems to have some effect in helping prevent transmission of HIV, and the oral tissues are less likely to
be injured in sexual activity than those of the vagina or anus. However, if a person has infections or injuries in
the mouth or gums, then the risk of contracting HIV through oral sex increases.
DOH records 500 new HIV cases in 1 month
By Sheila Crisostomo (The Philippine Star) | Updated January 5, 2015 12:00am
MANILA, Philippines - Almost 500 new cases of human immunodeficiency virus (HIV) infections were
documented in November 2014, two-thirds of whom were aged 15 to 24 and mostly infected through sexual
contact.
Based on the registry prepared by the DOHs National Epidemiology Center, there were 492 new cases of HIV,
including 40 cases of acquired immunodeficiency syndrome (AIDS). A total of 134 of them were aged 15 to 24.
There were 10 deaths.
The DOH said the 492 cases are 28 percent higher than the 384 cases recorded in November 2013.
Sexual contact accounted for 464 cases and 250 of them were due to homosexual contact and 146 due to
bisexual contact. Twenty-eight cases were injecting drug users who shared infected needles.
Males having sex with other a male (85 percent) was the predominant type of sexual transmission Eightythree of the new HIV cases came from the National Capital Region, Region 4-A, Region 2 and Region 11, the
DOH said.
The new cases brought to 5,502 the number of cases since January this year and to 22,018 since 1984.
Records showed that 20,519 cases were infected through sexual contact; 1,035 through needle sharing among
injecting drug users; 66 through mother-to-child transmission; 20 through blood transfusion and three through
needle prick injury.
Of the 22,018 cases, 2,011 developed AIDS while 1,101 have died.A total of 5,750 of them belonged to the 15
to 24 age group, while 69 were below 15 years old.

HIV/AIDS in the Philippines

Prevalence
Officially, the Philippines is a low-HIV-prevalence country, with less than 0.1 percent of the adult population
estimated to be HIV-positive. As of January 2013, the Department of Health (DOH) AIDS Registry in the
Philippines reported 10,514 people living with HIV/AIDS.
Means of transmission
Of the 10,514 HIV positive cases reported from 1984 to 2013, 92% (9,637) were infected through sexual
contact, 4% (420) through needle sharing among injecting drug users, 1% (59) through mother-to-child
transmission, <1% (20) through blood transfusion and needle prick injury <1% (3). No data is available for 4%
(375) of the cases.
Cumulative data shows 33% (3,147) were infected through heterosexual contact, 41% (3,956) through
homosexual contact, and 26% (2,534) through bisexual contact. From 2007 there has been a shift in the
predominant trend of sexual transmission from heterosexual contact (20%) to males having sex with other
males (80%)
DOH: 460 HIV cases in Pampanga
By Ferth Vandensteen Manaysay
Tuesday, January 13, 2015
ANGELES CITY -- The province of Pampanga now has 460 people living with Human Immunodeficiency Virus (HIV),
according to the Department of Health (DOH) Philippine HIV and Acquired Immune Deficiency Syndrome (AIDS)
Registry.

According to the January 2015 Philippine HIV and AIDS Registry report, this figure is 2.1 percent of the 22, 018 HIV
cases that have been recorded in the country from 1984 to January 2015.
Central Luzon, based on the latest tally, was among the top five regions, which registered the most number of HIV cases
along with Metro Manila, Calabarzon, Central Visayas, and Southern Mindanao.
Of the 1478 cases in the region, most were reported from the province of Bulacan (519) followed by Pampanga (460),
Zambales (168), Nueva Ecija (150), Tarlac (106), Bataan (71), and Aurora (4).
Earlier, the DOH reported that Central Luzon recorded 359 cases out of the 5, 502 new cases of HIV in the Philippines
from January 2014 to November 2014.
For the 2014 data, the registry said the top five provinces in the region which registered the most number of HIV cases
were: Bulacan (13), Pampanga (95), Nueva Ecija (54), Tarlac (33), and Zambales (25).
The AIDS-Free Philippines (AFP) also previously listed Angeles City as one of the metropolitan areas with the most
number of HIV cases in the country along with Metro Manila and Metro Cebu.
Since 1984, the Angeles City has registered a total of 233 HIV cases, which accounted for at least 50 percent of the total
cases in the province.
Health experts, nevertheless, noted that the figure is just based on the number of people who have willingly undergone
the HIV-AIDS test.
We can say that this is not an accurate figure of how many people in the country are living with HIV or AIDS. In the
Philippines, many people still hesitate to take the test because of the social stigma it entails, said Angeles City health
officer Dr.Lenario Santos.
The local health officers, meanwhile, hope to mitigate the impacts of the disease to the victims by working closely with
non-government organizations.
We have been very active in raising the awareness of the people about HIV-AIDS. In fact, the city government helps the
citizens in the form of free voluntary HIV counseling and testing service, community assemblies and forums to reduce
stigma, and building to improve sexually-transmitted infections and HIV proficiency training, among others, Santos said.
How Do You Get HIV or AIDS?

SURVEY
Based on our survey, some of our respondents are familiar about Human Immunodeficiency Virus
but the other they just know that this virus can kill a person. Others are having the same
answers or opinion about the HIV virus but some are not yet familiar, but they know the cause
and effect of the virus.
We interview some Doctors and nurses.
Questions:
1. Are you familiar about the Human Immunodeficiency Virus (HIV)?
2. What can you say about this?
3. How can you prevent this?
4. What types of contraceptives do you know?
5. Is it true that if you are going to use contraceptives can really prevent the virus?
6. Can this lessen the chance of people that can get this virus?

Answers:
1. Yes.
2. It is an Immunodeficiency that cannot be threatened.
3. Using contraceptives, discard Synge after use. Proper use of IV transfusions.
4. Condoms, cream, birth control pills, injectibles, and jelly.
5. Contraceptives, sometimes not effective.
6. No, because the only solution to prevent or lessen the chance of acquiring HIV is through
abstinence.

CELIA FLOR C. BRILLANTES, MD.

PHSAE, FPSVI
MEDICAL OFFICER IV
HEALTH SERVICES OFFICE
Answers:
1. Yes.
2. Very risky and not curable.
3. Avoid in contact to homosexuals and proper use of IV injections.
4. Condoms, pills, jelly and injectibles.
5. It can help but it depends to the person if they use it in a proper way.
6. No.
NANCY G. MANALO
NURSE
BAGUIO GENERAL HOSPITAL
Answers:
1. Yes.
2. It is a transferrable disease by contact.
3. Safe sex and monogamous partners.
4. Natural contraceptives.
5. Yes.
6. No.
UNKNOWN
FACULTY AT NURSING DEPARTMENT