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Lesson 1, Topic 1
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HIV/AIDS Continued

Prevention of HIV

There are many tools available to prevent HIV. Talk to your clients about strategies to prevent HIV infection. Some of the most powerful tools that can prevent HIV transmission are:

  • Choosing sexual activities that don’t involve contact with body fluids (semen, vaginal fluid, or blood).
  • Using condoms—they are highly effective in preventing HIV and other sexually transmitted diseases (STDs).
  • Taking PrEP (pre-exposure prophylaxis)—a medicine people at risk for HIV take to prevent HIV. It must be taken as prescribed.
  • Decide not to have sex (abstinence). Not having sex prevents other STDs and pregnancy.
  • Get tested and treated for other STDs—people who have another STD are more likely to get HIV. Getting tested and treated for other STDs can lower the chance of getting HIV.

Treatment for HIV/AIDS

There is no cure for HIV, but it is treatable. In fact, most people are able to take a simple once-a-day medication to treat their HIV. Anti-Retroviral Therapy (ART) reduces the amount of HIV in the blood. Treatment can lead to a viral load so low that it can be referred to as an “undetectable viral load.” When people living with HIV achieve and maintain an undetectable viral load, they cannot sexually transmit the virus to others. This progress in treatment is called “U=U” (Undetectable = Untransmittable). U=U is a “treatment as prevention” strategy.

Undetectable Equals Untransmittable (U=U)

The U=U concept means that people living with HIV who achieve and maintain an undetectable viral load cannot sexually transmit the virus to others. The success of U=U as an HIV prevention method depends on achieving and maintaining an undetectable viral load by taking ART daily as prescribed. As a Home Care Aide, you can support a client with HIV by assisting them to take their medications as prescribed.

Testing for HIV

Any person exposed to the blood or body fluids of another person may need an HIV test. If you work in a residential facility, follow the protocol where you work. If your employer is the client, call your physician to discuss the need for testing.

The Window Period

No HIV test can detect HIV immediately after infection. If you think you have been exposed to HIV in the last 72 hours, immediately talk to your healthcare provider about post-exposure prophylaxis (PEP). The time between when a person may have been exposed to HIV and when a test can confirm whether they have the virus is called the window period. The window period varies from person to person and depends on the type of test used to detect HIV. It can be as short as 10 days or up to 3 months. Ask your healthcare provider or test counselor about the window period for the test you’re taking.

Being Tested

According to the CDC, you should be tested for HIV as soon as possible after exposure to gain a baseline. You will need retests during the next several months. Discuss with your doctor or the staff of your
initial tests for what works in your situation. You must give verbal or written informed consent for HIV testing. The consent must be documented. People may test for HIV at home, at public health departments, through their medical provider, at family planning, or at community health centers. Testing usually involves drawing a small amount of blood or providing a saliva or urine sample.

Confidential or Anonymous Testing

Testing can be either confidential or anonymous. Confidential testing means the results of the test stay private. The test results only go to the person being tested and their health care worker who provides medical care and/or the test counselor. With confidential testing, the person gives their real name. Healthcare providers must submit a confidential report of positive HIV test results to
local public health officials. Anonymous testing means that the clinic keeps no record of the person’s name. They use only a code to process records and blood specimens. Anonymous testing cannot be used in cases of occupation exposure.

Counseling

Pretest preventative counseling is required only for people at increased risk for HIV infection or for those who request it. Counseling topics are based on recommendations from the CDC, including risk assessment for getting or transmitting HIV, helping to set behavior change goals and risk reduction strategies, and offering referrals. Post-test prevention counseling must be offered. Only people who test positive must be provided counseling. In this case, the person is referred to the local health department or other community organization providing this service.

Reporting Requirements

Healthcare providers must report HIV and AIDS cases to local health jurisdictions within three working days of diagnosis. Positive results obtained through anonymous testing are not reportable. However, when HIV-positive patients are seen for health care or tests are obtained, the health care provider and labs must report the case. Federal law also requires that states take action to require a “good faith effort” be made to notify all spouses of HIV-infected persons.

Law Against Discrimination (RCW Chapter 49.60)

HIV infection and AIDS are medical conditions that are considered disabilities under the Washington State Law Against Discrimination, Chapter 49.60 RCW and the Federal Americans with Disabilities Act. This means it is illegal to discriminate against someone who has or is believed to have AIDS or who is HIV-positive. The following areas are covered by law:

  • Employment
  • Rental, purchase, or sale of apartment, house, or real estate
  • Places of public accommodation (restaurants, theaters, etc.)
  • Health care, legal services, home repairs, and other personal services available to the general public applying for a loan or credit card, or other credit transaction
  • Certain insurance transactions

See HIV and Employment Protection in the Resource Directory on page 332 for more information.

Living with HIV

In 2020, 50% of all Americans living with HIV were over 50 years old. This population is likely to grow significantly. While living with HIV, some people may experience losses of the following.

  • Physical strength and abilities
  • Mental abilities
  • Income and savings
  • Health insurance
  • Housing, personal possessions, including pets
  • Emotional support from family, friends, coworkers, religious and social institutions
  • Job
  • Independence and privacy
  • Social contacts/roles
  • Self-esteem
  • Friends, who may pass away from HIV/AIDS

Psychosocial Support

Infection with HIV can cause distress for those who have HIV and for those who care for them. Physical weakness and pain can diminish a person’s ability to get pleasure from normal daily activities. Some people with HIV/AIDS may become socially isolated, which can lead to loneliness and other mental health issues, including depression and thoughts of suicide.
Some of the feelings common for people with HIV/ AIDS may include feelings such as the following.

  • Loss and desperation—life as they knew is gone forever
  • Disbelief, numbness, and inability to face facts
  • Fear of the “unknown” and developing aids
  • Rejection by family, friends, and co-workers
  • Guilt about the disease, about past behaviors, or about the possibility of having transmitted it to others
  • Sadness, hopelessness, helplessness, withdrawal, and isolation
  • Anger at the disease, at the prospect of a lonely, painful death, at the discrimination that usually accompanies the disease, and at the lack of effective and affordable treatment

Often a caregiver may have similar feelings to the person living with HIV. Caregivers may experience the same isolation as the person with HIV infection. Finding a support system, including a qualified counselor, can be just as important for the caregiver as for the person who has HIV/AIDS. Support from co-workers can be especially important. There are also several organizations throughout Washington that provide case management services, including support for housing, transportation, food, and linkage to Washington’s drug assistance program (ADAP).

The Washington State Department of Health has a list of providers that are able to assist clients living with HIV with case management services: doh.wa.gov/YouandYourFamily/IllnessandDisease/ HIV/ClientServices/CaseManagement See Risk After Exposure on page 331 in the Resource Directory for additional contacts in your local area.

Stigma

People living with HIV/AIDS may face negative attitudes and discrimination. This can cause harm
and prevent the person from receiving the care and support they need.
Always treat people with respect and dignity regardless of their HIV status. Maintain a client’s confidentiality and do not discuss their HIV status with others unless necessary for their care.

Other than protecting their privacy, what can you do to help stop stigma against people living with HIV/AIDS?