HIV/AIDS: Virulence, Infection, Terminology

Politically Correct Terminology

• "Prostitute/Sex Workers" is now referred to as Entertainment Establishment Workers (EEWs)/ People in Prostitution (PIP).
• RFSW stands for Registered Female Sex Worker.
• FFSW stands for Freelance Female Sex Worker.
• MSW stands for Male Sex Worker.
• "Men having sex with Men" is now referred to as "Males having sex with males" (MSMs).
• "Drug addict" is now referred to as "Drug dependent."
• "Injecting drug user" is now referred to as "Person/People who inject drugs".
• "HIV patient, AIDS patient" are now referred to as "Person Living with HIV" (PLHIV).
• "AIDS/HIV carrier" are now referred to as "Person Living with HIV" (PLHIV).
• "AIDS victim or AIDS sufferer" are now referred to as "Person Living with HIV" (PLHIV).

Global HIV/AIDS Epidemiology

• Globally, HIV trends are decreasing except in 9 countries.
• The 9 countries with a >25% increase in HIV cases are the Philippines, Indonesia, Bangladesh, Sri Lanka, Georgia, Moldova, Kazakhstan, Kyrgyzstan, and Guinea-Bissau.
• There were 35 million people living with HIV/AIDS (PLHIV) worldwide in 2012.

National HIV/AIDS in the Philippines (February 2017 Data)

• There were 849 new HIV antibody sero-positive individuals reported in the Philippines.

• 849 new HIV antibody sero-positive individuals reported is 13% than a year prior

• 89% of the 849 were asymptomatic at the time of reporting.

• 95% of the 849 reported cases were male.

• The median age of cases was 28 years old (age range from 1-64 years old).

• Most of the 849 (48%) belong to the 25-34 year old age group.

• Youth aged 15-24 years old accounted for 30% of the 849 cases.

• Regions with the most reported cases: National Capital Region (NCR) with cases, Region 4A, Region 3, Region 7, and Region 11.

• 828 newly reported HIV cases acquired the virus through sexual contact.

• Injecting drug use (IDU) was the mode of transmission for 19 cases.

• Mother-to-child transmission accounted for 2 of the new cases.

• 85% of infections transmitted through sexual contact were due to males having sex with males (MSM).

• There were 2 pregnant women diagnosed with HIV in February 2017; 1 case from Region 4A, 1 from Region 7.

HARP Data

• An April 2017 HARP Data summary reported 629 new HIV cases (27 cases per day).
• 545 of the new HIV cases were asymptomatic
• 84 of the new HIV cases had AIDS when diagnosed
• 596 of the new cases were male
• 33 of the new cases were female
• The cumulative HIV cases reported from 1984-April 2017 was 42,912.

HIV Trends in the Philippines

• The HIV epidemic in the Philippines has evolved over time.
• From 1985-1993, the HIV epidemic was "Low and Slow" with 475 cases.
• From 1994-2003 , the HIV epidemic was "Hidden and Growing".
• From 2004-2013, the HIV epidemic was "Fast and Furious" with 14,515 cases.
• The Philippines currently has a concentrated HIV epidemic.
• Key populations in the Philippines include males having sex with males, injecting drug users in central Visayas, and entertainment establishment workers.

ASEAN and UN Goals for Eliminating AIDS

• ASEAN is aiming to get to zero new HIV infections, zero AIDS-related stigma and descrimination, and zero AIDS related deaths; target ended December 2015.
• The UN has set fast track targets for 2016-2030 to end HIV by 2030.
• 90% of all people living with HIV will know their HIV status.
• 90% of people living with HIV will receive sustained antiretroviral therapy.
• 90% of people receiving antiretroviral therapy will have durable viral suppression.

Sexually Transmitted Infections (STIs)

• An STI is an infection primarily transmitted through sexual contact.
• STIs can also be transmitted through non-sexual means.
• Types of STIs include:

Bacterial STIs:

• Gonorrhea
• Syphilis
• Chlamydia
• Chancroid

Viral STIs:

• Genital herpes
• Genital warts
• Genital molluscum
• HIV
• Hepatitis B *

Protozoal STIs

• Trichomonas

Fungal STIs:

• Candidiasis

Skin Parasites:

• Pubic Lice
• Scabies (passed on by close body contact and do not require actual penetrative intercourse)

Common STI signs and symptoms include:

• Pain passing urine
• Severe itchiness
• Pain
• Yellowish or abnormal discharge
• Ulcerations
• Abdominal pain

Gonorrhea

• Gonorrhea can cause infertility in men and women.
• Gonorrhea can cause blindness, infection and sores on the baby's scalp if contracted during pregnancy
• Swollen Lymph nodes are common in the affected individuals.
• Severe Gonorrhea symptoms can include Eye sensitivity to light and pain in testicles.

Gonarrhea symptoms in men

• Symptoms usually appear 2-5 days after infection.
• In men symptoms may take up to a month to appear.
• Some people do not have any symptoms
• In men; burning and pain while urinating, increased urinary frequency or urgency, discharge from the penis (white, yellow, or green), red or swollen opening of the penis, tender or swollen testicles, sore throat

Gonarrhea symptoms in women

• In women; vaginal discharge, burning and pain while urinating, increased urination, sore throat, painful sexual intercourse, severe pain in lower abdomen, fever (if the infection spreads to the fallopian tubes and stomach are symptoms)

Chronic Gonorrhea

• Pain when urinating mild or absent
• Itching of the meatus
• Urethral sponge can be a little inflamemd, edematous
• Slight discharge from the urethra (usually in the form of "morning drop")
• Threads and flakes of pus are detected in a urine analysis
• Especially in chronic gonorrhea
• Often has a variety of complications

Clinical Features of Gonorrhea

• Fresh acute gonorrheal urethritis
• Fresh subacute gonorrhea
• Fresh torpid gonorrhoea is characterized by sluggish progress
• Chronic gonorrhoea is characterized by sparse clinical features
• Complications: balanoposthitis, phimosis, paraphimosis, thysonitis, paraurethritis, littritis, inflammation of Cowper's glands, prostatitis, vesiculitis, epididymitis, stricture of urethra, cystitis, metastatic complications.

Urogenital infection in women

• Primary site of infection in urogenital infection in women is the endocervical canal
• Urethral colonization is seen in 70-90% of infected women, but is uncommon in absence of endocervical infection.
• Infection of Bartholin's gland ducts is also common.
• The IP is variable but usually 10 days

Syphilis- Signs and Symptoms

• Lesion/ Chancre
• What is chancre? -Progresses from macule to Painless indurated lesion

Chlamydia Symptoms

• Painful urination
• Vaginal and penile discharge
• Painful sexual intercourse
• Vaginal bleeding between periods and after sex
• Sore throat
• Conjunctivitis
• Women: PID (infection of the uterus and fallopian tube causes pelvic pain)
• Epididymitis: infection near the testicles
• Prostate Gland Infection: can cause pain during or after sex, fever, painful urination
• Ectopic pregnancy
• Infection in newborn: causes pneumonia and serious eye infection

Chancroid

• Presents as a painful and red ulcer that may leak pus.
• Causes Swollen lymph nodes.

Chancroid treatments include:

• Azithromycin 1 gram orally as a one time dose.
• Ceftriaxone 250 mg IM in one dose.
• Erythromycin 500 mg orally 3x a day for 7 days.

Genital Warts

• Caused by human papilloma virus (some strain causes genital warts/other cancer of the penis, anus, mouth, throat, vulva
• Appears like cauliflower
• Can form at the mouth through oral sex
• Detected through papsmear, which helps to identify the cancer of the cervix

Genital Molluscum

• Skin infection
• Round, firm, painless bumps
• If bump is injured/scratched, infection can spread to nearby skin
• Weak Immunity
• If left untreated, it disappears in 6 months to 2 years

Trichomonas

• Symptoms include: foul smelling vaginal or penile discharge
• Causes Genital itch
• Painful urination during sex
• Presents with no symptoms, typically in men
• It can be associated with discomfort over lower stomach area
• Causes Itchy / irritation inside the penis
• Results in Burning sensation after ejaculation
• Results to Premature babies

Candidiasis

• Accumulates on the lining of the mouth, tongue, inner cheeks, gums, tonsils, roof of the mouth, throat
• Creamy white lesion, cottage cheese like appearance
• Dysphagia, burning/soreness
• Bleeding
• Loss of taste
• Cracking and redness at the corners of the mouth

Pubic Lice

• Commonly called "crabs"
• Commonly called "crabs"
• Bite: severe itching
• It can spread through sharing of towels, clothes, bedsheets with infected person.

What is HIV?

• Human: This virus can only infect human beings.
• Immuno-deficiency: The virus creates a deficiency (a failure to work properly) within the body's immune system.
• Virus: It means it can reproduce itself by taking over the machinery of the human cell

Principles of HIV Transmission

• Exit
• Survival
• Sufficiency
• Entry

Conditions Needed for the Survival of HIV

• Normal Body Temperature
• No exposure to Air
• Moist Environment
• Acidity (pH Level)

HIV Infection

• HIV is a successful entry of the virus in the human body.
• It is a lifetime infection
• There is no vaccine to prevent HIV
• There is no cure for HIV
• Displays no specific signs and symptoms
• HIV destroys the immune system

Window Period

• 2 weeks to 6 months= 3 MONTH

Definitions of AIDS

• AIDS can be transmitted from one person to another
• IMMUNE: The immune system is compromised
• DEFICIENCY: The body can no longer fight off infections, individual may suffer from 2 or more opportunistic infections
• SYNDROME: A person experiences a collection of symptoms which could be fatal

Link Between Tuberculosis (TB), Pregnancy & Human Immunodeficiency Virus (HIV):

• Most common cause of morbidity and mortality for people with HIV is TB
• A person with HIV is likely to develop other diseases
• TB is most common cause of deaths world wide
• Pregnancy is as a result of unprotected sex
• STI such as HIV can be transmitted to babies

Link between STIs and HIV

• Same mode of transmission
• Same preventive measures
• A Person with STI is more easily infected with HIV
• Clinical entry is for HIV Education and VCT

Modes of Transmission

• Penetrative sexual intercourse through anal, vaginal, and oral
• Infected blood or blood products through blood transfusion or organ transplantation
• Infected mother-to-child

Body Fluids for transmission of HIV

• Blood
• Semen
• Vaginal fluid
• Breastmilk

Activities That Do Not Allow HIV Transmission

• Casual contac
• Feces, urine, saliva, sweat, tears
• Donating
• Sharing toilets
• Insect bites
• Swimming pools

HIV and STI Prevention with ABCDE:

• Abstinence (Ayoko)
• Be monogamous (Basta Ikaw at Ako Lamang)
• Correct and consistent condom use (condoms ay gamitin ng palagian)
• Do NOT inject drugs (Dapat pang injection laging bago)
• Education & Early detection (Edukasyon at tamang kaalaman)

Additional Advice on HIV and STIs

• Never self medicate
• If with signs and symptoms, go to the nearest healthcare facility (RHUs, Social Hygiene Clinic/ RHWC, Hospitals, ART Facilities)

HIV Workplace Settings

• RA 8504 and DOLE: Department Order 102-10
• Provide basic information about HIV and AIDS
• Covers all employees regardless of employment status
• Conduct HIV and AIDS awareness and education
• Provide referral to health care services
• HIV Testing and Counseling Centers
• HIV Treatment Hubs
• HIV Support Groups

Social Policy

• Non-discriminatory policy and practices
• Pre-Post employment

• hiring,
• promotion,
• assignment, -termination of employment based on actual, perceived or suspected HIV status

• Workplace management of sick employees: same for everyone
• Penalty for discriminatory act done by

Confidentiality and Nondisclosure Policy

• Access to personal data related to a workers HIV status
• Non-disclosure of HIV status of job applicants/workers
• Co-employers can't disclose HIV status of fellow workers

Work Accommodation and Arrangement

• Measures and accommodation of employees with AIDS related illnesses
• Flexibility with leave arrangements

Key Provisions of RA 8504(Philippine AIDS Prevention and Control Act of 1998/AIDS Law)

• Article I Education and Information
• Article II Safe Practices and
• Article III Testing, Screening, and
• Article IV Health and Support Services
• Article V Monitoring
• Article VI Confidentiality
• Article VII Discriminatory Acts and
• Article VIII The PNAC

Article VII

Persons living with HIV and AIDS cannot be denied access to:

• Employment and livelihood
• Admission in schools
• Travel and habitation
• Elective or appointive office
• Credit and insurance
• Health care
• Decent burial services

Explore HIV virulence factors, opportunistic infections, and immune deficiency mechanisms. Understand HIV infectious stages and antiretroviral therapy management. Learn politically correct terminology for discussing HIV and AIDS, including appropriate terms for affected individuals and risk groups.