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AIDS AND YOU

AIDS is a serious disease that has reached epidemic proportions in our country and around the world. The disease is transmitted by a virus and is almost always fatal. First reported in 1981, almost 38,000 individuals in the United States had contracted AIDS by the end of 1986 and nearly 20 Americans will die each day of AIDS this year. The US Public Health Service estimated 270,000 cases of AIDS in the United States by 1991. Few if any of them will recover.

The name AIDS is shorthand for Acquired (transmitted from another infected person) Immune Deficiency (a breakdown in the body's ability to defend itself against disease) Syndrome (a spectrum of clinical signs and symptoms). The disease is fatal because no one can survive for long without an immune system to defend against viral and bacterial infections and ward off cancer. The virus also infects the central nervous system, often leading to serious mental disorders.

AIDS is not the only fatal disease to threaten humans, nor is it the most contagious. What makes AIDS an unusually serious threat is that the virus which causes the disease does not have its effect immediately upon infection. Recently infected people usually show no symptoms of the disease at all. Only much later, typically years, does the virus begin to multiply and attack the immune system. During these years, the infected person is, unknowingly, a carrier, able to transmit the virus to others. It is the large reservoir of undiagnosed infected individuals that casts such a shadow over our future. Current estimates of the number of individuals in their 20's and 30's who are infected with the virus in the united States approach 1% of the population, suggesting both a staggering load of future suffering that will be difficult to avoid, and a great danger that the infection will spread further.

What causes AIDS? The virus which causes AIDS is called Human Immunodeficiency Virus (HIV). It is a fragile virus which does not survive outside body cells. It is present in the body fluid of infected individuals (notably in blood, semen, and vaginal fluid). The HIV virus is transmitted from one individual to another when body fluid is transferred from an infected individual. It is not transmitted in the air or by casual contact. You cannot catch AIDS from a toilet seat, from a hot tub shared with a person with AIDS, from kissing a person with AIDS, or by being bitten by a mosquito that bit a person with AIDS. In studies of 619 households of AIDS victims, not one family member contracted the AIDS virus. The only way you can become infected with HIV is to come into contact with the body fluids of an infected person. The two most important routes of infection are: Another transmission route is from a pregnant mother who carries the disease to her unborn baby. The newborn is then born with AIDS and the outcome is fatal.

A. Absorption across the vaginal or anal walls or into the penis offers a ready means for the virus to enter the body.

B. The tiny tears produced during anal sex may facilitate entry even better.

C. The microscopic abrasions which everybody has in his or her mouth from eating and chewing are a third easy means of entry, making oral sex also dangerous.

The safest (and this is not 100% safe) way to have sex with anyone (infected or not) is to sues a condom and to use it correctly. When used correctly, condoms offer the best available protection from infection. Condoms are easily purchased and only the latex products should be used. Condoms made of natural products may allow for the transmission of the virus.

It is important that condoms be used properly. Some 10% of couples using condoms for birth control subsequently become pregnant, almost always as a result of careless use. This suggests that it is not wise to mix alcohol or other drugs with sexual encounters; they may cloud your judgement and lead you to do things you wouldn't do with a clearer head --such as forgetting to use a condom, or using it carelessly. It is a mistake that could cost you your life.

If you are sexually active and don't want to use condoms, you can lessen the uncertainty (and any danger to yourself or to future partners) by sharing an AIDS antibody test with your sexual partner. It is important to keep in mind that the more sexual partners you have, the more the risk of contracting AIDS is increased.

Who is at Risk?
You are. AIDS is commonly and incorrectly perceived as a disease of homosexual men because the disease first appeared in this country among the gay community. Because homosexuals tend to confine their sexual interactions to one another, the disease initially spread among homosexuals without entering the larger heterosexual community. That initial segregation appears to have ended. While only 4% of AIDS cases diagnosed in 1986 were heterosexual non-drug users, the incidence of HIV virus among heterosexuals is now thought to be expanding rapidly. Estimates vary widely. The Public Health Service estimates that between 1.5 and 2 million people in the United States now harbor the virus. In Africa, where the virus infected humans several years before it spread to this country, the epidemic has proceeded further than in the United States, even though homosexuality is rare there. In Africa, sexual transmission of AIDS is almost exclusively heterosexual, and occurs in both directions, female to male as well as male to female. In some central African countries, as many as 10% of the adult individuals are thought to carry the HIV virus.

The AIDS Antibody Test
Can a person find out if he or she has been infected with the AIDS virus? Yes, easily. A simple test identifies infected individuals by detecting antibodies in their blood directed against HIV virus. Such antibodies are detectable only in the bodies of infected individuals; they are the remnants of the body's attempt to ward off the HIV infection.

How an AIDS test works The standard test for detecting the presence of antibodies directed against HIV virus is called the ELISA antibody test. In the test, about 5 cc of blood (roughly the amount that would fit in a paper drinking straw) is drawn and checked to see if any antibodies are present that will interact with bits of HIV attached to the surface of a plastic dish. If there are, the test is said to be "positive."

If the result of the ELISA test is negative, no further tests are required since there are almost no false negatives (a result indicating no antibodies when in fact the person has been infected) unless the test is given within five to eight weeks after the infection, before the body has begun to produce antibodies. This six to eight weeks when the ELISA may be ineffective is known as a "window period" and if a person has been sexually active during this period of time, the test should probably be repeated in order to insure accurate results.

False positives (a result inaccurately indicating the presence of antibodies) are also rare, but if the ELISA test result is positive, it should be repeated. Two positive ELISA's are the signal for a more elaborate test called a western blot which although far more expensive is very accurate.

Testing for AIDS An AIDS test should be done with complete confidentiality. No one but you should be able to gain the results. If possible, the test should be coded by number and the results of that test should be identified only by that number. Keep in mind, however, that maintaining the confidentiality of a positive result is very difficult. This will be particularly true if you choose to have your medical insurance cover the costs of the tests and any subsequent medical treatment. You will be asked to sign a medical release form that will allow your files to be accessed by the insurance company. At a very realistic level, it is nearly impossible to maintain confidentiality over a long period of time.

When an individual does have a positive AIDS test, it is necessary to see a doctor frequently in order to monitor possibilities of disease progression. Opportunistic diseases take advantage of the impaired immune system and careful medical supervision is an absolute necessity to good health care and the maintenance of good functioning.

The key to surviving AIDS is not to contract it.
The only way (short of contaminated syringes and needles during drug use) for you to contract AIDS is by having unprotected sex with someone who has the virus. But the five year lag prevents anyone from knowing who is infected and who is not, and the disease continues to spread. Although widespread antibody testing on college campuses has been proposed by some, in order to identify infected individuals and so minimize the spread of the virus while it is still confined to a relatively few individuals, the proposal is extremely controversial and the associated dangers of invasion of privacy are a real concern. In the absence of such widescale testing, any person you have sex with might be a carrier and not know it. To avoid becoming a part of the epidemic, you have to accept that responsibility.

If you should contract AIDS (or be concerned because you have tested positively), it is extremely important that you have adequate, sensitive, caring medical attention on a continuing basis. The effects of AIDS are not only physiological; there is a strong psychological component as well. A person with AIDS must deal not only with the effects the syndrome has on his or her body but also with the anxiety and stress that this illness causes. Psychological counseling can provide real help as a person attempts to sort out all the complicated feelings, decisions, and adjustments that having AIDS presents. There is the need for a supportive, caring environment that the counseling relationship can make available. Any illness can create a sense of helplessness, loneliness, and isolation. AIDS is no exception. Seeking counseling can be seen as one additional step in getting the most complete care a person with AIDS deserves.

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