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Bibliographic Information: Rubenson, B. (1987) What is AIDS? A manual for health workers. Geneva, Switzerland: Christian Medical Commission.

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What is AIDS? Manual for Health Workers

By: Christian Medical Commission


Published by:    Christian Medical Commission

World Council of Churches
150 Route de Ferney 1121 Geneva 20
Switzerland


Available from: Christian Medical Commission

World Council of Churches
150 Route de Ferney 1121 Geneva 20
Switzerland

Reproduced with permission

Reproduction of this microfiche document in any form is subject to the same restrictions as those of the original document.


What is AIDS? A Manual for Health Workers

Published by the Christian Medical Commission, 1987 – Birgitta Rubenson


Any parts of this book, including the illustrations may be copied, reproduced, or adapted to meet local needs, without permission from the author or publisher, provided the parts reproduced are distributed for free or at cost – not for profit. For any reproduction with commercial ends, permission must first be obtained from the author or publisher. The author would appreciate being sent a copy of any materials in which text or illustrations have been used.


We are also in the process of producing the manual in French, Spanish and Portuguese.

We thank MacMillan Press (Nutrition and Families, by Jean Ritchie), MEDEX and VHAI foe permission to use their illustration and, Ingrid Hartig for her drawings.

We also thank the Special Programme on AIDS at WHO for their cooperation in the preparation of this publication.


This small manual is written to help health workers learn about this new disease called AIDS. It is a new deadly infection, for which there is yet no cure, and no vaccine. It is a disease, which has spread to most countries around the world.


In June 1986 the World Council of Churches organized a consultation, to study how the churches could be involved in the AIDS crisis. The churches were called to respond to the crisis, in three areas: pastoral care, social ministry and education-prevention. In the WCC the Christian Medical Commission (CMC) is one of the three sub-units with the responsibility to support the churches in this task. This small manual is one of our contributions towards this.


AIDS is a disease which is mainly sexually transmitted, and as such, is dependent on actions taken by the individual person. Education for prevention is the only possible way to control the spread. A change of risk-behaviour to responsible sexual behaviour is necessary. Sex must be seen as part of a long-term faithful relationship, not as a consumption of good, available when wanted, possibly for money. AIDS is related a great deal to the life style, but also depends on the health status at the time of exposure. The existence, or non-existence of reliable basic health services also influences the spreading of the infection. So, the activities to care for AIDS patients and to control the spread must be seen as an integral part of Primary Health Care.


Health workers must care with love and compassion for these patients, who are sick and dying. They must know how to inform those who might be carriers of the virus and how not to spread it. And most of all, they must share with the community their knowledge about the disease and the responsibility to control its spread.


The first cases were diagnosed in North American, Europe and Central Africa at about the same time. These have remained the regions with the highest number of cases, but 113 counties from all regions of the world are now reporting AIDS cases. The number of patients with AIDS is a reflection of the number of HUB-carriers, of whom the majority will develop the disease within 5 to 10 years. In North American and Europe, the disease is mainly spread among homosexual men and drug abusers, while in Africa, it is spread in all groups of society.


We hope that this manual will be useful in your work. If you have any suggestions or question, or need additional information, you can write to us at the Christian Medical Commission. If you need sterilization equipment, or syringes and needs and cannot receive it through normal channels of supply, we will try to help you.


More copies of this manual can be ordered from:

Christian Medical Commission

World Council of Churches

150 Route de Ferney 1121 Geneva 20

Switzerland


Contents

[edit] What is AIDS?

It is Acquired Immune Deficiency Syndrome

AIDS is an infectious disease spread by a virus. It is called syndrome because it consists of several signs and symptoms. The first case of AIDS was diagnosed in 1981. Since then there has been a rapid spread of the disease in North and South America, Europe and Africa. Cases are being reported from around the world, and most countries now have people with AIDS, or infected with the virus.


[edit] What is HIV?

It is Human Immune deficiency Virus

HIV is a retrovirus, a group of virus that is still largely unknown. HIV was first described in 1983 in Paris. It has had several names during its short history, but HIV has now been accepted internationally.

The virus enters the T-helper cells of the immune system. In the cells it destroys genetic material, and the damage is permanent. All the body fluids contain T-helper cells. The concentration is high in BLOOD, SEMEN and VAGINAL SECRETION.


[edit] Who is a Carrier?

Anybody who has the virus is a carrier and can infect others.

Very often the person does not know that she/he is a carrier. She/he has no symptoms of disease and the person who infected him/her may have no symptoms, either.

A person can be a carrier knowingly for many years before the virus has destroyed so much of the immune system that she/he falls ill.

Some months after the infection the body has produced anti-bodies to the virus. These can be detected by a special tests.


[edit] How does the virus spread?

AIDS is spread when blood, semen or vaginal secretion of an infected person come in contact with the blood or mucous membranes of a healthy person.

The virus is not very active so the concentration o the virus in the fluid must be high to cause infection. Or the person must be exposed to the infection several times. The virus is spread

  • By sexual intercourse (homosexual or heterosexual) when one of the partners is infected
  • By contaminated needles and syringes
  • By transfusion of infected blood
  • By an infected mother to her unborn child


[edit] How does the virus not spread?

The virus is not spread through every day social contact such as:

  • Shaking Hands
  • Living together
  • Playing together
  • Eating together


It is not spread by:

  • Food
  • Water
  • Communion cups
  • Insects
  • Toilet seats


[edit] How to Prevent the Spread of AIDS

There is no vaccine against AIDS.

HEALTH EDUCATION is very important. Everybody should know how to protect themselves from infection, by living responsibly. The whole community should be involved.


[edit] Who Should Be Informed?

Everybody:

  • Women
  • Men
  • School Children


[edit] What is a Responsible Lifestyle?

The AIDS virus is spread through semen, vaginal secretion, and blood. Therefore:

  • Have sex with only one faithful partner [1][2]
  • Use a condom if you know or suspect that you or your partner is infected
  • Do not have sex with prostitutes (male/female) or people who go with them
  • Do not have an injection, except in a recognized health institution, where you are sure the instruments are sterilized
  • Make sure instruments for circumcision are boiled


[edit] Who is at Risk for Infection?

Everybody who is exposed to the infection. But especially:

  • Persons with venereal diseases and sores on their genital parts
  • Persons who have many sexual partners
  • Prostitutes (male/female) with many clients per day
  • Patients receiving injections with non-sterile equipment
  • Patients receiving untested blood from unknown donors

[edit] AIDS and pregnancy

AIDS can spread from the mother to the unborn child during pregnancy or delivery.

A pregnancy might cause the onset of AIDS.

A woman who know or suspects that she is an HIV-carrier should avoid becoming pregnant.

Some hospitals can make a test to find out if a person is infected. A woman who is unsure and wants a baby should try to have a test first. If she lives in an area with many persons with AIDS.


[edit] Does AIDS spread through breast-feeding?

The virus has been found in breast-milk in low concentrations. It is not yet known if the small amount of virus in milk can infect the baby.

Many women do not know if they are infected or not.

Since the risks of bottle-feeding are well-known, while the risks of breast-feeding by an infected mother remain unproven breast-feeding should always be encouraged.


[edit] AIDS and Immunizations

To immunize, syringes and needles are used. These can be a source of infection.

Every child should be immunized with a sterile needle and syringe. Make sure that they are boiled for 20 mins.

Where disposable needles are used, they should be put into a closed container and buried later.

Blood should never be aspirated into the need and syringe.

The risk of spreading AIDS through immunization programs is nil as needles and syringes are adequately sterilized.


[edit] What the HIV-carrier should know

Persons who suspect or know that they are HIV-carriers should:

Avoid being reinfected by the AIDS virus Avoid spreading the infection by:

  • not having sexual intercourse or
  • using a condom
  • washing their soiled linen or clothes themselves
  • not giving blood for transfusion


Treat other infections as:

  • tuberculosis
  • venereal diseases, etc.


[edit] How to care for a person with AIDS

Remember that these people are in need of social contact and support, just as we are. Their skin or breathing does not transmit the infection and they need physical and psychological closeness, as all of us do.

They may know they have a deadly disease, especially once they know the diagnosis. This can cause fear, anxiety and anger. Health personnel and relatives need to be prepared for this. People with AIDS need time an help to struggle with these feelings. They need somebody who is prepared to listen and support them. They need to be encouraged to continue to live and take part in daily activities, as mush as they can.

Perhaps they want to talk to a pastor or counselor, or someone else, who can give them spiritual and emotional reassurance. The health worker should encourage this and arrange it.


[edit] How to recognize a person with AIDS

Some persons past through a first stage with fever and throat infections like a bad cold. They can then be without symptoms for a time period.

For some period before the final diagnosis can be made the person might suffer from different symptoms of infection. They are grouped into what is called ARC (AIDS related complex).

The manifestation of the disease varies widely in the world. Some signs and symptoms are more common in certain parts than in others. "Slim Disease", stressing the weight loss, is most common in the Africa, while pneumonia is common in the USA.

The symptoms of AIDS are the same as for many other infections and a final diagnosis can only be made by testing.


[edit] Diagnosing an adult with AIDS

To make the diagnosis the person should show at least 2 major and 1 minor sign.

  • MAJOR SIGNS:

   -loss of more than 10% of body weight
   -chronic diarrhoea for more than 1 month
   -prolonged fever for more than 1 month

  • MINOR SIGNS:

   -persistent cough for more than 1 month
   -generalized itchy skin disease
   -recurrent herpes zooster
   -chronic, generalized herpes simplex
   -thrush in mouth and throat
   -swollen glands
   -loss of memory
   -loss of intellectual capacity
   -peripheral nerve damage

AIDS should be suspected, if the symptoms persist, especially in an area with many people with AIDS.


[edit] Diagnosing a child with AIDS

To make the diagnosis, the infant or child should show at least 2 major and 1 minor sign.

  • MAJOR SIGNS:

   -weight loss or slow growth
   -chronic diarrhoea for more than 1 month
   -prolonged fever for more than 1 month

  • MINOR SIGNS:

   -generalized swollen glands
   -thrush in mouth and throat
   -repeated common infections
   -persistent cough
   -generalized skin disease

Note from transcriber: Following side text (next paragraph) is missing content due to poor image quality.
"Many children ... have these sym... The diagnosis... confirmed if... of the parents... (or both) is a... ill."


[edit] How to treat a person with AIDS

There is still no drug available to cure AIDS. A few drugs such as ATZ can help slow down the process, but they are very expensive and in short supply everywhere.

Patients suffering from symptoms, because they cannot fight infections, should be given treatment to ease these symptoms as far as possible. Everything should be done to make them feel comfortable.

Where herbal medicines are traditionally used, their use should be encouraged to relieve pain, itching and fever, or any other symptoms.


[edit] Symptomatic Treatment

Diarrhoea
is a common symptom, especially among children. As with other diarrhoeas, it is important to prevent dehydration. Give:
   -salt-sugar solution
   -oral rehydration solution
   -fluids
   -Do not give antibiotics or antidiarrhoeal drugs

Thrush
   -paint with gentian violet
   -rinse with mineral water

Herpes Zooster
   -aspirin or paracetamol

Fever
This is a common symptom in both adults and children. Give:
   -Much fluid
   -Bath or cool rubbing
   -Aspirin or paracetamol

Cough/Pneumonia/Otitis
   -A course of antibiotics

Itching skin
   -Antihistamine
   -Pain reliever


[edit] Where should a person with AIDS be treated?

Hospital/Health Centre Patients who suffer badly from fever, diarrhea and pain may need to be cared for in a medical institution for a period of time. They will need symptomatic treatment and nursing care.

Home Persons who can be cared for at home should be sent home. Families can better respond to the social and psychological needs of their sick member.


[edit] Patient care in the Hospital/Health Centre

Isolation There is no need to isolate AIDS patients for the sake of protecting others from the infection. Sometimes, though, it may be necessary to isolate a patient to protect her/him from surrounding infections.

Personal hygiene AIDS patients should be helped with their personal hygiene, just as everybody else. This can normally be done without risk. But some things should be remembered:
   -Soiled or bloodstained linen can transmit the virus
   -Bleeding or infected wounds can transmit the virus

WASH HANDS OFTEN


[edit] How to handle infected equipment

The AIDS virus can spread through the use of syringes, needles and instruments, which have been in contact with the blood of a person who is carrying the AIDS virus, even if he is not sick. It is therefore IMPORTANT to only use STERILE syringes, needles and instruments. The virus is very fragile and dies at only 56⁰C, or when soaked in common disinfectants.

There are four ways to sterilize equipment:

1. Boiling for 20 minutes
2. Steam or pressure cooking, autoclaving
3. Soaking for 20 minutes in disinfectant solution
      - Chlorine: 5 gr per litre, or 1 per household bleach in 10 parts of water
      - Alcohol: 700 gr ethanol in 1 litre water

Solutions should be prepared fresh daily as they lose strength over time.


[edit] How to handle soiled linen

Laundry Soiled or bloodstained laundry should be handled with care.

To kill the virus, it should be either:

   a) Soaked in a chlorine solution or
   b) Boiled


[edit] How to care for a person with AIDS at home

A person with AIDS is in need of both psychological support and physical care. As there is no cure that the health services can provide, the best care can often be given by the relatives. At home she/he is in well-known social surrounding where she/he feels more secure.

The relatives should be informed about the disease, how it spread and how it does not spread.

They should be taught how to protect themselves and how to care for the patient.

They should be given a disinfectant to use for cleaning clothes and utensils.

They should be informed that the patient can become emotionally and mentally disturbed.

The family needs support and should be visited, when possible.

[edit] References