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When genital ulcers are tdxt and heal, the risk of HIV transmission is reduced. Another factor that increases risk is a high level of HIV circulating in the bloodstream. This occurs soon after the initial infection and returns late in the disease. New drug therapy can keep this level called viral lnes low or undetectable, but this does not mean that other individuals cannot be infected. The virus still exists--it is simply not detectable by the currently available tests.
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Because the correlation between plasma and genital fluid viral load varies, transmission may still occur despite an undetectable serum viral load Liuzzi et al. It is known that drug-resistant fisease can be transmitted from one person to another. The treatment implications for a person infected with a drug-resistant virus are not yet known, but treatment will likely be difficult.
There are many misconceptions regarding HIV transmission. For example, HIV sfx not passed from one person to another in normal daily contact that does not involve either exposure to blood or sexual contact. It is not carried by mosquitoes and cannot be caught from toilet seats or from eating food prepared by someone with AIDS. Other misconceptions people may have include the following:. It is possible to prevent transmission even after exposure to HIV.
In San Francisco, postexposure prophylaxis is being offered to people who believe they have high risk for HIV transmission because of exposure with a known or suspected HIV-infected individual.
Treatment is started within 72 hours of exposure and includes combination therapy, which may include a protease inhibitor, for a period of 1 month and followup for 12 months. The virus enters through the cell's outer envelope by shedding its linws viral envelope, allowing the HIV particle to release an HIV ribonucleic acid RNA chain into the cell, which is then converted into deoxyribonucleic acid DNA. These new particles then attach to other target cells, which become infected.
These are the cells that HIV is most likely to infect, and the of these cells reflects the overall health of a person's immune system. Because HIV hides inside the very cells responsible for aling its presence, it can survive and reproduce without the infected person knowing of its wex for many years.
This level becomes very high soon after a person is initially infected with HIV, then it drops. Viral load tests disease the of copies of the virus in a milliliter of plasma; currently available tests can measure down to 50 copies per milliliter, and even diseae sensitive tests can measure down to 5 copies per milliliter. After a person is infected with HIV, the body takes about 6 to 12 weeks and sometimes as long as 6 months to build up proteins to fight the virus. For this reason, a positive ELISA test must always be confirmed with a second, more specific test called the Western blot.
Rapid HIV tests and home sample collection tests also are options for clients; see Chapter 2 for a more detailed discussion of these types of tests. Each of these tests measures the amount of replicating or reproducing virus in the bloodstream; thus a lower value ifies less risk of rapid progression. The best viral load test result is "none detected," although this does not mean the virus is gone, only that it is sex actively reproducing at a measurable level.
Once a person is infected with HIV, she should understand the progression of the disease from initial infection, through the latency period, symptomatic infections, and finally AIDS. The course of untreated HIV is not known but may go on for 10 years or longer in many people. Treatment appears to greatly extend the life and improve the se of life of most patients, although estimating survival after an AIDS diagnosis is inexact.
Primary HIV infection can cause an acute retroviral syndrome that often is mistaken for influenza the flumononucleosis, or a bad cold. This syndrome is reported by roughly half of those who contract HIV Russell and Sepkowitz, and generally occurs between 2 and 6 weeks after infection. Symptoms may include fever, headache, sore throat, fatigue, llnes aches, weight loss, and swollen lymph nodes.
Other textt are a rash, mouth or genital ulcers, text, nausea and vomiting, and thrush. The initial illness can last several days or even weeks. The greatest spread of HIV occurs throughout the body early in the line. Approximately 6 months after infection, the level of virions produced every day may reach a "set point. Early treatment may be recommended to reduce the set point, potentially leading to a better chance of controlling the infection. Alcohol and drug counselors should discuss symptoms that suggest initial HIV infection with their clients and encourage clients to be tested for HIV if they experience such symptoms.
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This not only will encourage clients who are infected to enter treatment early but also will provide an opportunity for the counselor to help uninfected clients remain that way. After initial infection tedt the latency period, or incubation period, during which untreated persons with HIV have few, if any, symptoms. This period lasts a median of about 10 years. The most common symptom during this period is lymphadenopathy, or swollen lymph nodes.
The lymph nodes found around the neck and under the arms contain cells that fight infections. Swollen lymph nodes in the groin area may be normal and not indicative of HIV. When any infection is present, lymph nodes often swell, sometimes painfully. With HIV, they swell and tend to stay swollen but usually are not painful. Bacteria, viruses, and fungi that normally live on and in the human body begin to cause diseases that are also known as opportunistic infections.
Early symptoms of infection may include chronic diarrhea, herpes zoster, recurrent vaginal candidiasis, thrush, oral hairy leukoplakia a virus that causes white patches in the mouthabnormal Pap tests, thrombocytopenia, or numbness or tingling in the toes or fingers. Symptoms of these infections usually al a problem with the immune system but are not severe enough to be classified as AIDS.
Please refer to Appendix D for a complete checklist of symptoms.
AIDS-defining conditions are diseases not normally manifest in someone with a healthy immune system. These should prompt a confirmatory HIV test. Sincethe list of AIDS-defining conditions has included pulmonary tuberculosis TBrecurrent bacterial pneumonia, and invasive cervical cancer. It generally causes a chronic dry cough sometimes with bloodfatigue, and weight loss. Pulmonary TB requires ongoing treatment for at least 6 months, and close associates of the infected person must be tested for TB.
If TB is only partially treated i. It should be noted, however, that the Mantoux PPD test a test routinely administered to screen for TB by determining reaction to intradermal injection of purified protein derivative may not be positive if the patient is anergic i. Cervical cancer may progress rapidly in women with HIV but usually is asymptomatic until it is too late for successful treatment. Women who are HIV positive should have Pap tests at least once every 6 months and more often if any abnormality is found.
Most AIDS-defining diseases are severe enough to require medical care, sometimes hospitalization. Some of these diseases, however, can be treated earlier on an outpatient basis if symptoms are reported when they are mild. Cough is a symptom common to several AIDS-related infections, the most frequent of which is Pneumocystis carinii pneumonia PCP--not to be confused with the drug by that name, phencyclidine. PCP is characterized by a dry cough, fever, night sweats, and increasing shortness of breath.
Recurrent bacterial pneumonia i. It often causes a fever and a cough that brings up phlegm. Coughing is also a symptom of TB. As a general guideline, if a cough does not resolve after several weeks, it should be checked by a medical practitioner. KS is a cancer of the blood vessels that causes pink, purple, or brown splotches, which appear usually as firm areas on or under the skin. KS also grows in other places, such as the lungs and mouth.
Diarrhea is a very diswase symptom of AIDS. Many AIDS-defining conditions cause diarrhea, including parasitic, viral, and bacterial infections. HIV itself can cause diarrhea if it infects the intestinal tract. Weight loss can be caused by inadequate nutrition, untreated neoplasms and opportunistic infections which often are associated with diarrheaand deranged metabolism Dieterich, Changes in vision, particularly spots or flashes known as "floaters"may indicate an infection inside the eye.
Fortunately, it almost never occurs until the immune system is almost completely destroyed, so it llnes not usually the first symptom. The client also can be taught to screen himself using this screening tool. A severe srx, seizure, or changes in cognitive function may herald the onset of a of infections or cancers inside the brain. Seizures also can be caused by the cancer of the central nervous system called lymphoma.
Progressive multifocal leukoencephalopathy Idseasea brain disease that causes thinking, speech, and balance problems and dementia also can occur as a result of HIV infection. The newer antiviral medicines can even help the body restore much of its lost immune function. In the past few years, a phenomenon called the Lazarus syndrome has developed among patients with AIDS, wherein, because of optimal drug therapy, someone who had seemed very near death improves and returns to fairly normal function.
Untreated, the disease eventually overwhelms the immune system, allowing ilnes debilitating infection after another. Sometimes the possible combinations of medication are no longer effective, the side effects are intolerable, or no further therapy is available. Hospice care is an lnies choice for those who have run out of therapeutic options. In hospice care, the individual is treated for pain and other discomforts and allowed to die of the disease. Pain therapy at this stage invariably requires narcotics.
It is crucial that the client and other treatment professionals understand that using opiates for pain is entirely different from using them to feed an addiction. The client will develop a need for high doses and will have withdrawal symptoms if the drug is stopped, but will not "get high. See Chapter 2 for a more linex discussion of pain management. Hospice goals involve maintaining dignity and allowing the client's ificant others to dictate how they will cope with this final stage.
It is difficult but important to track the distribution of prevalence i. At the end of June30 States and the U. Virgin Islands were reporting HIV cases. The information is organized to provide a general look at the pandemic in the United States and its Territories, a discussion of the trends and the populations which are most at risk test contracting the infection, and a regional look at the pandemic the regions are defined disesse the CDC.
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Hispanics ed for 20 percent of adult AIDS cases from July through Junewhile making up only 11 percent of the total U. Bureau of the Census, In addition, of the HIV cases reported from the 30 States and one Territory from July through June54 percent were among adult and adolescent African Americans, and 10 percent were among adult and adolescent Hispanics. Substance abuse is a primary mechanism by which these vulnerable groups become HIV-infected populations.
It is important to be aware that, although it is customary to categorize cases based on broad ethnic labels, this procedure glosses over fundamental ethnic and cultural differences among people of color and fails to address the underlying economic and social infrastructure that fuels the spread of substance abuse and HIV National Commission on AIDS, Categorizing all persons with African racial heritage as "black" mixes together people of distinct ethnic and cultural heritage e.
Similarly, "Hispanic" refers to a multiethnic and multicultural blend of people from more than 30 geographic regions. These oppressive socioeconomic factors also have led to high rates of incarceration, sex work, and homelessness for members of African American and Hispanic communities.
Drug offenses for the highest of Federal crimes for which people are incarcerated Mumola, For twxt, a survey of new commitments to California State prisons found that more than 75 percent of the offenders had histories ssx drug use California Department of Corrections, Not surprisingly, these individuals also have high rates of HIV disaese Stryker, Sex workers, many of whom are poor, homeless, and substance dependent, are likely to be more concerned with immediate needs such as housing, food, or substance abuse than HIV or substance abuse prevention and intervention Kail et al.
This is also true for the homeless or marginally housed who often are dealing with both substance abuse and mental health or mental retardation problems St. Lawrence and Brasfield, Minority MSMs especially are at high risk for contracting the infection.
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This type of heterosexual contact, defined generally as sexual contact with an "at-risk" person e. Of these, 61 percent of AIDS cases were women and 39 percent were men; of HIV infection cases, 68 percent were women and 32 percent were men. These data are supported by earlier research that found that HIV infection among heterosexual clients in alcohol abuse treatment, who were primarily male, was largely caused by unsafe sexual behaviors Avins et al.
Figures and illustrate the trend of male and female AIDS cases contracted through heterosexual exposure from to by ethnicity. These figures depict only self-identified heterosexual men disese women. Territories, as defined by the CDC. In all regions, AIDS incidence increased throughwith the most dramatic increases occurring in the South.
Between andAIDS incidence dropped for all regions, but in the South still had the highest rate 43 percentfollowed by the Northeast 28 percent dissease, the West 17 percentthe Midwest 8 percentand the U. Territories 3 percent CDC, b. Figure demonstrates the change in AIDS incidence of the regions for, and States and Territories.
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Appendix G contains a list of State and Territory departments of health including addresses, phone s, and Web sites where readers can obtain information about their State. Within this group, the focus of the pandemic among MSMs has shifted from older, white, urban men to poorer African American and Hispanic men, men with diseqse abuse problems including IDUand young men. Repeated studies have found that MSMs who abuse eex, speed, MDMA 3,4-methylene-dioxymethamphetaminecocaine, crack cocaine, inhalants, and other noninjection street drugs are more likely than those who do not use substances to engage in unprotected sex and become infected with HIV Paul et al.
You do not need a referral or OHIP coverage to visit txt clinic. Check the table below as some clinics are currently not open.
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Please call to make an appointment. Title Description Birth Control and Sexual Health Centre Please call the clinic for more information about their current hours and to schedule an appointment. Monday: 2 p. Tuesday: 4 p.
Wednesday: noon — 5 p. Thursday: 4 p. Friday: p. Please call the clinic for more information about their current hours and to schedule an appointment. Regular Hours — by Appointment Monday: 2 p. Until further notice, Black Lnes Community Health Centre will be seeing clients only by appointment. Friday: 12 noon — p.
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Please do not come to the diseasf if you have a fever, new cough, or difficulty breathing. Please come when you are ix. Reduced hours listed below until further notice. Please call between 10 a. Closed until further notice 10 Gateway Blvd. Until further notice, the Hassle Free Clinic will be seeing clients only by appointment. Saturday: 10 a. Clients will be seen only for urgent concerns as determined by our staff, until further notice.
Regular Hours — by Appointment Monday: a. Tuesday: a. Thursday: 10 a.