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KASTURBA GANDHI NURSING COLLEGE

OBSTETRICS AND GYNECOLOGICAL NURSING

SEMINAR

ON

NATIONAL POLICIES,
GUIDELINES & ISSUES
OF HIV &AIDS

SUBMITTED TO: SUBMITTED BY:


MS. NIVETHA. G, MS. JAYANTHI. B,

TUTOR, M.SC NURSING,

DEPT. OF OBG NURSING, SECOND YEAR,

KGNC. KGNC.

SUBMITTED ON:
NATIONAL POLICIES, GUIDELINES & ISSUES OF HIV &AIDS

OVERVIEW OF HIV/ AIDS

INTRODUCTION

Human immunodeficiency virus infection and acquired immune deficiency

syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human

immunodeficiency virus (HIV). Following initial infection, a person may not notice any

symptoms or may experience a brief period of influenza-like illness. Typically, this is

followed by a prolonged period with no symptoms. As the infection progresses, it interferes

more with the immune system, increasing the risk of developing common infections like

tuberculosis, as well as other opportunistic infections, and tumors that rarely affect people

who have working immune systems. These late symptoms of infection are referred to as

acquired immunodeficiency syndrome (AIDS). This stage is often also associated with

unintended weight loss.

AIDS (Acquired Immunodeficiency Syndrome)

AIDS (acquired immunodeficiency syndrome) is a syndrome caused by a virus called

HIV (human immunodeficiency virus). The disease alters the immune system, making

people much more vulnerable to infections and diseases. This susceptibility worsens if the

syndrome progresses.

CAUSES OF HIV/AIDS

HIV infection is caused by the human immunodeficiency virus from contact with

infected blood, semen, or vaginal fluids. Most people get the virus by having unprotected

sex with someone who has HIV. Another common way of getting it is by sharing drug

needles with someone who is infected with HIV.


AIDS (Acquired Immune Deficiency Syndrome) is the final and most serious stage of

HIV disease, which causes severe damage to the immune system. The Centers for Disease

Control has defined AIDS as beginning when a person with HIV infection has a CD4 cell

(also called "t-cell", a type of immune cell) count below 200.

MODE OF TRANSMISSION

Sexual transmission — it can happen when there is contact with infected sexual fluids

(rectal, genital, or oral mucous membranes). This can happen while having sex without a

condom, including vaginal, oral, and anal sex, or sharing sex toys with someone who is

HIV-positive.

Perinatal transmission — a mother can transmit HIV to her child during childbirth,

pregnancy, and also through breastfeeding.

Blood transmission — the risk of transmitting HIV through blood transfusion is extremely

low in developed countries, thanks to meticulous screening and precautions. However,

among people who inject drugs, sharing and reusing syringes contaminated with HIV-

infected blood is extremely hazardous.

SIGNS AND SYMPTOMS

There are three main stages of HIV infection: acute infection, clinical latency and

AIDS

Acute infection phase

Main symptoms of acute HIV infection


The initial period following the contraction of HIV is called acute HIV, primary HIV

or acute retroviral syndrome. Many individuals develop an influenza-like illness or a

mononucleosis-like illness 2–4 weeks after exposure while others have no significant

symptoms. Symptoms occur in 40–90% of cases and most commonly include

 fever,

 large tender lymph nodes,

 throat inflammation,

 a rash,

 headache,

 tiredness, and/or sores of the mouth and genitals

 Gastrointestinal symptoms, such as vomiting or diarrhea may occur.

 Neurological symptoms of peripheral neuropathy.

The duration of the symptoms varies, but is usually one or two weeks.

Clinical Latency phase

The initial symptoms are followed by a stage called clinical latency, asymptomatic

HIV, or chronic HIV. Without treatment, this second stage of the natural history of HIV

infection can last from about three years to over 20 years (on average, about eight years).

While typically there are few or no symptoms at first, near the end of this stage many

people experience

 fever,

 weight loss,

 gastrointestinal problems and muscle pains.


 persistent generalized lymphadenopathy, characterized by unexplained, non-painful

enlargement of more than one group of lymph nodes (other than in the groin) for

over three to six months.

Late-stage HIV infection phase

If left untreated, HIV weakens the ability to fight infection. The person becomes

vulnerable to serious illnesses. This stage is known as AIDS or stage 3 HIV.

Symptoms of late-stage HIV infection may include:

 blurred vision

 diarrhea, which is usually persistent or chronic

 dry cough

 fever of above 100 °F (37 °C) lasting for weeks

 night sweats

 permanent tiredness

 shortness of breath (dyspnea)

 swollen glands lasting for weeks

 unintentional weight loss

 white spots on the tongue or mouth

DIAGNOSIS OF HIV/AIDS
HIV infection is commonly diagnosed by blood tests. Testing for HIV is usually a

two-step process. First, a screening test is done. If that test is positive, a second test (Western

blot) is done to confirm the result.

There are three common types of screening tests that use a blood specimen:

1. HIV antibody tests;

2. a fourth-generation combination antibody/antigen test that detects both antibodies

and a piece of the virus called the p24 antigen;

3. RNA tests (HIV RT PCR or viral load);

4. in addition, a blood test called a Western blot is necessary to confirm the diagnosis.

Classification Of HIV/AIDS By Stages

Stage 0: the time between a negative or indeterminate HIV test followed less than 180 days

by a positive test

Stage 1: CD4 count ≥ 500 cells/µl and no AIDS defining conditions

Stage 2: CD4 count 200 to 500 cells/µl and no AIDS defining conditions

Stage 3: CD4 count ≤ 200 cells/µl or AIDS defining conditions

TREATMENT

There is currently no cure for HIV or AIDS. Treatments can stop the progression of

the condition and allow most people living with HIV the opportunity to live a long and

relatively healthy life.

Earlier HIV antiretroviral treatment is crucial — it improves quality of life, extends life

expectancy, and reduces the risk of transmission


Antiretroviral drugs

HIV is treated with antiretroviral (ARVs). The treatment fights the HIV infection and slows

down the spread of the virus in the body. Generally, people living with HIV take a

combination of medications called HAART (highly active antiretroviral therapy) or CART

(combination antiretroviral therapy).

There are a number of subgroups of antiretrovirals; these include:

 Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)

 Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

 Chemokine co-receptor antagonists

 Protease inhibitors

 Integrase inhibitors

PREVENTION

To prevent contracting HIV, healthcare professionals advise precautions related to:

Condomless sex - having sex without a condom can put a person at risk of contracting HIV

and other sexually transmitted infections (STIs). HIV can be transmitted by having sex

without a condom (vaginal, oral, and/or anal sex). It can also be transmitted by sharing sex

toys with someone infected with HIV. Condoms should be used with every sexual act.

Drug injection and needle sharing - intravenous drug use is an important factor in HIV

transmission in developed countries. Sharing needles can expose users to HIV and other
viruses, such as hepatitis C. Strategies such as needle-exchange programs are used to

reduce the infections caused by drug abuse. If someone needs to use a needle, it must be a

clean, unused, unshared needle.

Body fluid exposure - exposure to HIV can be controlled by employing precautions to

reduce the risk of exposure to contaminated blood. Healthcare workers should use barriers

(gloves, masks, protective eyewear, shields, and gowns) in the appropriate circumstances.

Frequent and thorough washing of the skin immediately after coming into contact with

blood or other bodily fluids can reduce the chance of infection.

Pregnancy - some ARVs can harm the unborn child. But an effective treatment plan can

prevent HIV transmission from mother to baby. Precautions have to be taken to protect the

baby's health. Delivery through cesarean section may be necessary.

HIV-infected mothers can pass the virus through their breast milk. However, if the mother

is taking the correct medications, the risk of transmitting the virus is greatly reduced. It is

important for a new mother to discuss the options with a healthcare provider.

Education - teaching people about known risk factors is vital.

HIV IN PREGNANCY

Unlike viral flu, HIV does not spread by contact, breathing the same air or through

food and water. HIV can be spread in ways similar to the Hepatitis B virus:

 Sexual intercourse (most common)

 Blood / blood-contaminated products / other body fluid / organ transplantation

 Vertical transmission: From mother to child via the placenta or breast milk
The chance of transmission depends on the viral load that is the number of viruses per ml of

the blood. Also, during pregnancy, high levels of the hormone progesterone increase the

level of virus receptors. This aids the entry of virus and increases the chance of

transmission.

SYMPTOMS

AIDS in pregnant women has symptoms depending on how low the immunity is. Your

doctor would check the immune status by asking for the CD4 count. CD4 is a type of blood

cell that helps the body’s immune system and a low count of it is the strong indication of

AIDS. Various problems that AIDS can cause are:

 Infections: As the CD4 count falls, more serious and deadly infections set in,

tuberculosis being the most common.

 Cancer: Various forms of cancer are common in AIDS. Women may suffer from

genital tumours which may be cancerous.

 STDs: Other sexually transmitted infections in addition to HIV like syphilis may addto

the problem for the mother and child

HIV/ AIDS related guidelines

List of Circulars in the field of prevention, screening, management, treatment and follow-up
of HIV infection (in Hebrew):

1. Directive for implementation of the National Program for Prevention of


HIV and Treatment of HIV Positive Migrants without Health Insurance.
Directive of the Director General of the Ministry of Health. No. 9/2016 from 27.10.2016. 

2. Circular for implementation of the community programme for the follow


up and anti-retro-viral treatment (ART) of HIV positive migrants without health insurance.
Circular of the Director General of the Ministry of Health No. 03/2014 from 15.01.2014.
3. Regulations for the provision and delivery of treatment in the framework
of the community programme for the follow up and anti-retro-viral treatment (ART) of HIV
positive migrants.
Circular of the Department of Tuberculosis and AIDS from 20.01.2014.

4. Guidelines for HIV testing. Circular of the Director General of the


Ministry of Health No. 22/2011 from 25.08.2011; update No. 08/2013 from 30.06.2013. 

5. Regulation for the provision of milk substitutes for newborns from


mothers leaving with HIV/AIDS.  
Circular of the Head of the Public Health Services No. 05/2006 from 9.07.2006.

6. Regulation for the dental treatment of HIV positive children.


Circular of the Department of Tuberculosis and AIDS and the Division of Dental
Health from 26.02.2006; update from April 2014.

7. Guidance for addressing issues to the National Ethics Committee on


HIV/AIDS according to the Law for Patients' Rights.
Circular from the Department of Tuberculosis and AIDS from 9.02.2006. 

8. Regulation for the prevention of HIV transmission among sexual partners.


Circular of the Head of Medical Administration No. 45/2005 from 18.12.2005. 

9. Guidelines for prevention of HIV infection after blood exposure or unsafe


sexual relation.
Circular of the Head of the Public Health Services No. 05/2001 from 5.11.2001; Circular of
the Head of Medical Administration No. 82/2001 from 10.12.2001.   

10. Provision of medical services against HIV for pregnant HIV positive
women not being covered by the National Health Insurance.
Circular from the Department of Tuberculosis and AIDS, 1.08.2001.

11. Medical Absorption of new immigrants from Ethiopia – update.  


Circular of the Head of the Department of Epidemiology No. 45/2000 from
30.08.2000; update No. 09/2001 from 24.01.2001.
12. Pupils suffering from HIV/AIDS.  
Circular of the Director General of the Ministry of Education No. 2.2-13 from October 1999.

13. Regulation for sending blood samples to the HIV Reference Laboratory.
Circular of the Head of the Laboratory Department No. 11/1999 from 15.02.1999.

14. Notification of HIV/AIDS individuals treated with Protease Inhibitors.


Circular of the Head of Medical Administration No. 74/1998 from 3.12.1998.

15. Early diagnosis of HIV positive woman and her treatment.


Circular of the Head of the Public Health Services No. 04/1998 from 15.03.1998; update No.
09/2000 from 27.11.2000; update No. 01/2007 from 4.03.2007.  

16. Circular for payment and notification of the diagnosis of HIV infection.  
Circular of the Head of the Public Health Services No.B404-1 from 17.02.1998; update No.
749-1 from 5.01.1999.

Ethical Issues of HIV and AIDS in Health Care

 Disclosure
 Disability rights
 Economical resources
 Employment rights
 Medication & Treatments
 Suicide
 Duty to warn

1. Disclosure

 To tell or not?
 Decisions whether to disclose the diagnosis in the workplace.
 A doctor with HIV needs not to disclose?
2. Disability rights

Disability rights awareness

e.g., “Somehow a check-out person at a local grocery store found out I had
AIDS and started wearing latex gloves every time she waited on me. I called their
legal department and informed them that this needed to stop or I would sue them”

3. Economical resources

 Financing treatment

e.g., “Medicare doesn’t pay for my prescriptions anymore.”

 Different kind and degree of services than a person who is employed and who
has health insurance and other resources available.

4. Employment

 Can they decide whether to stay in their current position or not?

e.g., “My old job as a nursing assistant was too high risk, so I had to leave.”

 Emotionally missing work

e.g., “Work had always been important to me and it really hit me all at once that I wasn’t
able to do it anymore.”

5. Medication & Treatments


 Dissatisfactory with the treatment providers
e.g., “A lot of times I’m not in the mood to talk with the doctors in the clinic.
They don’t listen and they are very clinical.”
 Treatment effect
e.g., “I had a very bad reaction to the drug I was taking and had to go back into the
hospital”

6. Suicide: the dilemma of the right to die

 High suicidal rate


 the relative risk of suicide in men with AIDS aged 20-59 years was 36.30 times…
that of men aged 20-59 years without this diagnosis. (New York City, 1988)
 Seven people during a 6-week period took their own lives after testing positive for
the virus, even though they were asymptomatic (Miami, 1987)
7. Is there a legal duty to protect or warn third parties

Whether a therapist has a duty to protect third parties when his or her patient,
if HIV-positive, persists in engaging in unprotected sex with an unknowing partner involves
complex clinical and legal questions which have not been adequately addressed.

8. Counselor’s guide to make an ethical decision

Moral principles

 Autonomy: individual freedom and choice


 Nonmaleficence: do no harm to clients
 Beneficence: the welfare of the clients
 Justice: If an individual is to be treated differently, the counselors needs to offer a
rationale that explains
 Fidelity: loyalty, faithfulness and honoring commitments

Ethical decision making model

 Identify the Problem

 Apply the ACA Code of Ethics

 Determine the nature and dimensions of the dilemma

 Generate potential consequences of all options and determine a course of action

 Consider the potential consequences of all options and determine a cause of


action.

 Evaluate the selected course of action.

 Implement the course of action.

9. Counseling implications

 Counselors require to be knowledgeable about federal, state, and local laws.


 Especially when illegal treatment in the workplace takes place, counselors
advocate for clients who have encountered discrimination.

10. About the treatment issues

 May find their clients feeling overwhelmed with their medical treatment, medical
personnel, and health care systems.

 Can help clients to cope with emotional reactions to their illness and to
interpersonal insensitivity from medical care providers.

JOURNAL PRESENTATION

Mother-to-child transmission of HIV and its predictors among HIV-exposed infants at

Bamenda Regional Hospital, Cameroon

Victor N. Fondoh1 and Njong A. Mom2

Background

Mother-to-child transmission (MTCT) of HIV, has been a major global public health

burden. Despite the use of antiretroviral prophylaxis by HIV-positive pregnant women and

their infants, safe obstetric practice and safe infant feeding habits in the prevention of

MTCT of HIV, the prevalence of HIV among HIV-exposed infants is still high in Cameroon.

Objective

Our objectives were to determine the prevalence, assess the predictors and

determine the effect of combination antiretroviral therapy (cART) on MTCT of HIV at the

regional hospital in Bamenda, Cameroon.

Methods

This was a retrospective study. Secondary data from 877 HIV-exposed infants aged

≤ 72 weeks were extracted from the records between January 2008 and December 2014.
The predictors and effect of cART on MTCT of HIV were analysed using a multivariable

logistic regression model and risk analysis, respectively.

Results

Out of 877 HIV-exposed infants, 62 were positive for HIV, giving a prevalence of

7.1%. Maternal antiretroviral intervention and infant age group were statistically

significant predictors of MTCT of HIV. HIV-positive mothers who were on cART were 2.49

times less likely to transmit HIV than those who were not on cART.

Conclusion

In order to reduce the prevalence of HIV among HIV-exposed infants, maternal

antiretroviral intervention should be targeted and the use of cART by HIV-positive pregnant

women should be encouraged.

THEORY APPLICATION

SUMMARY

So far we have discussed about in detail about HIV/ AIDS, in that we have seen about

the definition, causes, transmission of HIV, diagnosis, treatment and their prevention. We

discussed about HIV during pregnancy and standard safety measures taken by health care

professionals.

CONCLUSION

Standard Precautions are recommended in care delivery to all patients, regardless of

their presumed infectious state. It is a very important principle and practice among health

workers globally. Practice of hand washing and hygiene, use of protective barriers,

handling and adequate discarding of sharp instruments including needles, patient’s


accommodation in accord to requirement levels as an infection transmission source are

necessary in all clinical settings.

BIBLIOGRAPHY

BOOK REFERENCE

 DC Dutta’s, “Textbook of obstetrics”, 8thed, edited by Hiralalkonar

 Myles, “Textbook for midwives”, 15thed, published by Margaret A. cooper

 Holland and Brews, “Manual of Obstetrics”, 4thed, published by Elsevier

NET REFERENCE

 www.scribd.com

 https://en.m.wikipedia.org/wiki/Prevention_of_HIV/AIDS

 https://www.webmd.com/hiv-aids/tc/human-immunodeficiency-virus-hiv-

infection-prevention

 http://www.pitt.edu/~super7/24011-25001/24381.ppt

JOURNAL REFERENCE

 Published online 2017 Dec 14. doi: 10.4102/ajlm.v6i1.589

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803518/