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Individual at Risk for Human Immunodeficiency Virus

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Case Study: Individual at Risk for

Human Immunodeficiency Virus (HIV)

Submitted by:





Laura, Tom, Jack, Jordana

A paper submitted in partial fulfillment of the

course requirements for NSG 255

Joyce Joevenazzo, RN, APO, BN, MHS

Lethbridge College

February 14, 2008

Individual at Risk for HIV

The human immunodeficiency virus (HIV) is a type of retrovirus that causes acquired immunodeficiency syndrome (AIDS). HIV attacks the body's immune system, leaving it unable to fight off infections and disease (Public Health Agency of Canada, 2007).

HIV transmission

HIV can be spread through contact with an infected person's body fluids such as semen, vaginal fluid, breast milk, or blood, including menstrual blood (AIDS Vancouver, 2005). The most common modes of transmission are unprotected vaginal or anal intercourse, sharing of needles, or during pregnancy and birth. HIV can also be spread during oral sex, or by sharing sex toys, razors, or tooth brushes. Individuals who engage in anal sex are at increased risk of HIV transmission because the anus and rectum tear more easily than the vaginal lining (AIDS Vancouver, 2005). Saliva, urine, and tears cannot transmit the virus unless they are mixed with blood (Health Canada, 2003). According to the Public Health Agency of Canada, "You can only get HIV by having the virus enter your blood stream" (2007, p.24). Therefore, activities such as cuddling and sharing toilet seats will not spread the infection.

HIV prevalence in Canada

According to Offer, Grinstead, Goldstein, Mamary, Alvarado, Euren, and Woods (2007), those individuals most at risk in Canada are homosexual males, intravenous (IV) drug users, and individuals who have unprotected sex. The Testing and Referral American Family Physician Journal (2004) stated those with current sexually transmitted infections (STI) have a higher likelihood of acquiring HIV. Not only are these individuals engaging in high risk sexual activity, but inflammatory STIs, such as gonorrhea, can break down genital tissue barriers increasing the receptor site's availability to the HIV virus (Gallant). Ball and Bindler affirmed "the adolescent who acquires an STI has a 40% chance of acquiring another STI within a year, especially if gonorrhea is the first infection" (2006, p.1227)

* In 2005, 60 160 Canadians tested positive for HIV. Of those 45 690 were male. This statistic does not include the 20 353 people diagnosed with AIDS (AIDS Vancouver, 2005). This number only represents the people who chose to be tested. There are many people who do not get tested, partly because they feel they are not part of the high-risk population.

* Studies indicate that most people who learn they are infected take steps to protect their partners; unfortunately, people who are unaware of their infection account for 50-70% of new sexually transmitted infections (Hellwig, 2007).

* The number of HIV and AIDS related deaths totaled 13 293 in 2005 (AIDS Vancouver, 2005).

HIV Testing

There are three main types of HIV tests: the HIV antibody test, the antigen test, and the Polymerase Chain Reaction Test (PCR). The standard test is the HIV antibody test, also known as ELISA (Enzyme-Linked Immunosorbent Assay) test. Once the HIV virus enters the body, the immune response starts to form antibodies. It can take between six weeks and six months for detectable numbers of antibodies to be in one's system. This time is referred to as the "window period" (AIDS Vancouver, 2005). Therefore, it is imperative to be tested again six months after the initial testing. A person is confirmed to be HIV negative only after the second test returns negative. It is important to understand that unsafe sex or IV drug use between testing times will nullify prior results (AVERTing HIV and AIDS, 2008).

In Lethbridge, the sexual health clinic, or any physician, can give you a requisition for blood work to be carried out at any clinic. All blood samples are sent to Calgary for processing. The results are available in two weeks (J.I. personal communication, February 5, 2008). If tests return positive, the individual will receive a phone call and be required to make an appointment with a physician. At the time of the appointment, results will be given in person--absolutely no positive HIV results are revealed over the phone (Gallant, 2004). Alberta health is notified of all positive results.

Risk Reduction

Safe Sex

The Pubic Health Agency of Canada (2007) advocated "condoms used consistently and correctly provide protection against getting or spreading STIs including HIV" (McKay, p.57). Condoms provide a wall barrier against the spread of vaginal fluid, semen, blood, bacteria, and viruses. United States Center for Disease Control and Prevention declared that "using a latex condom was estimated to reduce exposure to HIV by at least 10 000 times compared to not using a condom" (Mckay, p.57). However, condoms are only proven effective if they have not expired, if they are applied and fit correctly, and if they stay intact throughout intercourse (Alberta Health, 2006).

Individuals with knowledge are empowered to make educated choices. By limiting the number of sexual partners and knowing each partner's sexual history, the rate of HIV transmission can be reduced. Regular testing, particularly before sexual contact with a new partner, is another important factor in risk reduction. Additionally, sexual intercourse while under the influence of alcohol or drugs inhibits ones ability to make wise choices and should be avoided. "Alcohol use was significantly associated with inconsistent condom use and multiple sexual partners in both sexes" (Zablotska, Gray, Serwadda, Nalugoda, Kigozi, Sewankambo, Lutalo, Mangen, Wawer, & 2006).

Other Preventative Measures

Because HIV is found in body fluids, there are many



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