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Roni D'Andria

on 1 April 2015

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Transcript of HIV AND AIDS

Understanding how it starts
A list of ethical issues related to HIV/AIDS
Informed consent, confidentiality, justice and fairness are just a few of the ethical issues that can surround the nursing care of an HIV/AIDS patient.
• The needle exchange program
• Informed consent
• Discrimination
• Disclosure
• Decreased employment opportunities
• Stigma/ reputation
• Insurance benefits being negatively affected
• Violations of privacy

According to the 1992 Americans with Disabilities Act it prohibits discrimination on the basis of disabling conditions, such as HIV. This being said we have to keep in mind we are trusted as nurses. Our profession is continuously being nominated as the number one most trusted profession. We know the deepest secrets of our patients. Often we know things our patients families do not know and we cannot discriminate these individuals. It is our job to care for them as we would any other patient. We need to keep their HIV status confidential and maintain the dignity of these patients. 
Mandatory Human Immunodeficiency Virus (HIV) Testing and Disclosure

Currently, a consent must be obtained in order to test for HIV. What if it was as common as a CBC or BMP upon admission? 

Veronica D'Andria Jessica Misbach
Katie Franciosa Obenson Pascal
Chelsea Fruggiero Felicia Peak
Brian Hupps Juan Raya
Flavia Koester Tyrone Wheeler

“Center for Disease Control suggest that all adults and adolescents (ages 13-64) should be given voluntary, automatic, and routine HIV tests upon entering a healthcare facility so as to normalize HIV screening as a routine part of medical care (Aultman, 2011, p e51).”
Murray, E. (1994).

Ethics and accountability in nursing people with HIV infection.
British Journal Of Nursing, 3
(21), 1143-1147.
Aultman, J. M & Borges, N. J. (2011).
The ethics of HIV testing and disclosure for healthcare professionals: What do our future doctors think
? Medical Teacher, 33. e50-e56
Sexy Moxie Mama. (2013). Physical therapy humor (image). Retrieved from http://www.sexymoxiemama.com/2013/11/15/physical-therapy-humor
Timeline of HIV/AIDS Epidemic
1994 - 1999
1981 - "Gay cancer," later called GRID, (Gay Related Immuno Deficiency) claims 121 deaths in the U.S. since the mid-1970s

1982 - Scientists call the new disease AIDS (Acquired Immune Deficiency Syndrome)
Center for Disease Control says sexual contact or infected blood could transmit AIDS; U.S. begins formal tracking of all AIDS cases
285 cases reported in 17 U.S. states, five European countries

1983 - Dr. Robert Gallo of the National Institutes of Health, Bethesda, Maryland, and Dr. Luc Montagnier of France's Pasteur Institute independently identify Human Immunodeficiency Virus (HIV) that causes AIDS

1985 - Movie actor Rock Hudson dies of AIDS; the resulting publicity greatly increases AIDS awareness
Congress allocates $70 million for AIDS research
First international AIDS conference held in Atlanta
Blood test for HIV approved; screening of U.S. blood supply begins

1994 - AIDS-related illnesses are the leading cause of death for adults 25-44 years old in U.S.

1995 - Saquinavir, the first protease inhibitor (which reduces the ability of AIDS to spread to new cells) is approved

1996 - Patients are often able to delay the onset of full-blown AIDS by taking a combination of as many as 60 different drugs called an AIDS "cocktail"
AIDS is 8th leading cause of death in U.S.

1997 - Worldwide death toll climbs to 6.5 million (since mid-1970s)
U.S. government spends $4.5 billion on AIDS/HIV treatment
AIDS-related illnesses drop to the fifth leading cause of death for adults 25-44 years old

1998 - Clinical trials begin for AIDS vaccine, AIDSVAX, the only one of 40 AIDS vaccines developed since 1987, that is considered promising enough to widely test on human volunteers
U.S. AIDS deaths drop to 17,000 per year, due to drug therapies; AIDS drops to 14th leading cause of death in U.S.

1999 - AIDS cases in Russia rise by one-third, to 360,000
World Health Organization (WHO) estimates that AIDS has caused the life expectancy in Southern Africa to drop from 59 years in the early 1990s to 45 years after 2005
AIDS infections skyrocket in Southeast Asia
U.S. government spends $6.9 billion on AIDS/HIV treatment
1986 - Soviet Union reports first AIDS case
Surgeon General C. Everett Koop sends AIDS information to all U.S. households
Scientists locate second type of AIDS virus, HIV-2, in West Africa; original virus is HIV-1

1987 - FDA approves AZT, a potent new drug for AIDS patients, which prolongs the lives of some patients by reducing infections

1988 - World Health Organization begins World AIDS Day to focus attention on fighting the disease

1991 - 10 million people worldwide estimated to be HIV-positive, including 1 million in U.S.; more than 36,000 Americans have died of AIDS since the late 1970s

1992 - The first clinical trials using combinations of multiple drugs begin
FDA begins accelerated approval of experimental AIDS drugs

1993 - U.S. annual AIDS deaths approach 45,000
2000 - Officials note the spread of drug-resistant strains of HIV
21.8 million people have died of AIDS since the late 1970s; infections rise in Eastern Europe, Russia, India, and Southeast Asia
10% of the population between the ages of 15 and 49 has HIV/AIDS in 16 African countries, while in 7 African countries, infection rates reach 20%

2001 - Drug companies begin offering AIDS drugs to poor countries at a discount
An estimated $6.9 billion is spent in the U.S. on the treatment of AIDS patients
The UN estimates that, around the world during 2001, there were 3 million deaths from AIDS, of which 2.3 million were in Sub-Saharan Africa. There were 5 million new infections, bringing the total to 40 million infected; and Africa has the most infected (more than 16 million) followed by South and Southeast Asia (more than 6 million).
AIDS is spreading most rapidly in Eastern Europe and the Russian Federation, with 250,000 new infections in 2001
AIDS has lowered the life expectancy in Botswana, Malawi, Mozambique, and Swaziland by 20 years, to under 40 years of age

2002 - HIV is the leading cause of death worldwide for those 15–59
FDA approves the first rapid finger-prick AIDS test

2003 - President Bush announces PEPFAR, a $15-billion, 5-year plan to combat AIDS in African and Caribbean nations
WHO announces the "3 by 5" initiative, aiming to start providing AIDS drugs to 3 million people in poor countries by 2005

2004 - AIDS spreads rapidly in Russia and eastern Europe; according to a UN survey, almost 1% of Russians are HIV-positive
FDA approves a saliva-based AIDS test
A study finds that the rate of HIV prevalence in Uganda has dropped 70% since the early 1990s, due to local prevention efforts
95% of those with AIDS live in the developing world
From 1981 through the end of 2004, more than 20 million people have died of AIDS

2005 - FDA begins approving generic AIDS drugs, enabling U.S.-funded programs to provide more cost-effective treatment to poorer nations
Several African nations insist on medication approved by WHO; in response, FDA and WHO agree to share information on generic drugs to expedite their approval
Russian president Putin promised to increase AIDS funding from $5 million in 2005 to at least $100 million in 2006
AZT's patent expires, and FDA approves several generic versions
The number of people living with HIV in 2005 reached its highest level ever—an estimated 40.3 million people, nearly half of them women.

2006 - June 5 marks the 25th anniversary of the first journal article (in Morbidity and Mortality Weekly Report) about what would become identified as AIDS, reporting on a set of unusual pneumonia-related deaths among five homosexual men.
A UN report issued the week before has both good news and bad news.

Good news:
Many countries have achieved targets set in 2001, reducing the number of new infections and providing antiretroviral therapy to more victims. HIV testing, counseling, and education are all up. In many sub-Saharan countries, more young teens are staying abstinent, and condom use is increasing. And with 126 nations reporting, investigators have more data than ever.

Bad news
: Goals for youth education and prevention services aren’t being met, those most at risk for AIDS are often not reached, many countries fell far short of all goals, and social issues underlying the spread of AIDS are being ignored.

In short, "A quarter century into the epidemic, the global AIDS response stands at a crossroads. For the first time ever the world possesses the means to begin to reverse the epidemic. But success will require unprecedented willingness on the part of all actors in the global response to fulfil their potential, to embrace new ways of working with each other, and to . . . sustain the response over the long term."

July 2006: The FDA approves the first single-pill, once-a-day AIDS treatment, thereby allowing patients to manage their disease without a complicated regimen of drugs that must be strictly followed to be effective. The pill, called Atripla, is considered an enormous breakthrough in AIDS treatment, and will help prevent the disease from mutating into drug-resistant strains, which occurs when drugs are not taken regularly. Two rival drug companies cooperated in creating the drug.
2007 - The World Health Organization revises their figures of the number of people living with AIDS worldwide. In their December 2007 report, the WHO says the number has fallen from 39.5 million to 33.2 million in one year, suggesting that the biggest reason for the 16% decline was improved data collection and more accurate estimates in India and five sub-Saharan African countries.

2008 - An international team of researchers announced that new evidence shows the earliest cases of HIV/AIDS circulating between humans occured between 1884 and 1924 in sub-Saharan Africa. Tracking the origin of the virus will help in understanding how it jumped from chimpanzees to humans, as well as increasing our knowledge of the conditions that help viruses spread and how to be better prepared for other epidemics. See this article for more information.
A man in Berlin, Germany seems to be cured of AIDS after doctors gave him transplanted blood stem cells from a person naturally resistant to the virus. Such a treatment is difficult, the patient's immune system must essentially be shut down and restarted with the new stem cells, but first a donor must be found who is a good tissue match for the patient and has a rare genetic mutation, called Delta 32, which is resistant to H.I.V. People who have Delta 32 produce white blood cells in the bone marrow which lack the surface receptors that allow H.I.V. to invade the immune system. Doctors hope this case helps in developing therapies that artificially induce the Delta 32 mutation.
2009 - President Obama removes the 22-year-old travel ban that prevented HIV-positive people from entering the United States.
Four million HIV-positive people in developing and transitional countries are receiving treatments, but over 9 million still need immediate treatment.

2011 - Elizabeth Taylor, co-founder of the American Foundation for AIDS Research (amfAR), dies. One of the first public personalities to devote time and money toward HIV and AIDS-related projects and charities, she helps raise over $100 million and expand public awareness in her thirty years as an AIDS activist.
In September, gamers of the free online game Foldit create the correct structure of a protein that the virus HIV uses to replicate itself. With this breakthrough, published in Nature as "Crystal structure of a monomeric retroviral protease solved by protein folding game players," not only is the usefulness of the citizen scientist validated, but a real-world scientific problem is also solved. The discovery paves the way for new antiretroviral drugs in the battle against HIV/AIDS.

2014 - The medical community announces the curing of an infant of an HIV infection. In a 2010 birth, a Mississippi baby exposed to HIV was treated aggressively with antiretroviral drugs starting almost immediately after delivery. The baby, now 2 1/2 years old, remains infection free.
Johnson, D., Ross, S. (2015). Key events, important people, activism, and breakthroughs.
Timeline: Aids Epidemic.
Retrieved from http://www.infoplease.com/spot/aidstimeline2.html
HIV/AIDS remains an ongoing epidemic worldwide. HIV/AIDS is present among infants, children, adolescents, men, and women. The lack of HIV/AIDS testing and education has been associated with certain risk groups that have historically been subjects of discrimination. Nurses have a duty to inform their patients about testing and treatment options that are available to their patients. It is only through continued study of the impact of HIV, on both the individual living with HIV, and his or her significant others, that we will expand nursing knowledge and strengthen nursing care for those impacted with this life-threatening condition. There are many ethical dilemmas nurses will come across when taking care of a patient with HIV and or AIDS. It is the nurse's responsibility to educate themselves on the subject so that they can appropriately handle these ethical decisions when they arise.
Stigma of caring for a patient with HIV/AIDS

Ethical dilemma of resource distribution

In the acute/chronic settings, nurses caring for HIV patients may face different kind of ethical dilemmas. One example is resource distribution. Nurses may feel that end stage HIV patients are consuming resources that could be used elsewhere where lives could be saved. Especially when the care will not improve the patients' condition.

Ethical dilemma
of resource distribution
According to the Centers for Disease Control and Prevention (CDC), in 2010, a lifetime treatment of an HIV patient is $367,134.


Policies Enacted Nationally:

Housing Works
Ryan White HIV/AIDS Program
Federal Budget Advocacy
Syringe Access
It is no exaggeration to say that HIV/AIDS has profoundly affected legal structures in the United States and internationally. No disease in modern history has provoked more domestic legislation and litigation. In the United States alone, the federal government and the fifty states have enacted HIV-specific legislation covering almost every conceivable aspect of AIDS policy.
Countries throughout the world have imposed travel and/or immigration restrictions on persons living with HIV/AIDS. Many countries have enacted HIV-specific criminal laws, and one country (Cuba) has even implemented universal screening and isolation
Ryan White HIV/AIDS Program

"About the Ryan White HIV/AIDS Program." About the Ryan White HIV/AIDS Program. Web. 30 Mar. 2015.

AIDS United. (2015). Syringe Access. Retrieved from http://www.aidsunited.org/Programs-0024-Grantmaking/Syringe-Access.aspx

HIV (Human Immunodeficiency Virus) is an irreversible virus that can lead to the development of AIDS (Acquired Immunodeficiency Syndrome). Unfortunately, there is no safe or effective cure, but the virus can be controlled. HIV is transmitted through sexual intercourse or by sharing infected needles. This virus is preventable through abstinence, limiting the number of sexual partners, never sharing needles, and properly using condoms. In order to confirm you are positive for HIV you have to get tested specifically for it. In the United states alone, approximately 50,000 people are newly diagnosed with HIV each year.
("About HIV/AIDS CDC," 2015)
Centers for Disease Control and Prevention (CDC). (2015). About HIV/AIDS. Retrieved from http://www.cdc.gov/hiv/basics/whatishiv.html
Centers for Disease control and Prevention (CDC). (2013). HIV Cost-effectiveness. Retrieved from www.cdc.gov/hiv/prevention/ongoing/costeffectiveness/
Sex Education & HIV/AIDS Prevention
HIV/AIDs prevention starts with education. The dilemma is when to educate and who should be educating about this incurable disease. "Three major ethical concerns... clearly stated sexual abstinence, intimacy, and abstinence-only programs". Adolescents around the world continue to participate in unprotected sex. The amount of parental-adolescent communication is a large factor. It is proven that more frequent parent/adolescent conversation, the adolescent is influenced in making a more healthy and less sexual risk behaviors.
Education & Prevention
Education provided on the means of intimacy is another issue. Sex is becoming the main relationship glue for adolescents. The challenge to educators and parents is how can they "discourage premature sexual intimacy among those who intensely desire physical sexual intimacy and who often assume they are emotionally mature enough to form intimate relationships without shaming" them? Family-based interventions have proven to show positive effects on continued communication in reducing risky behaviors. The abstinence-only programs do not teach about risky behaviors and therefore have more negative outcomes when it involves teenagers and sexual behaviors.
Abstinence does not have clearly defined definition which makes it a difficult subject to educate on. It is said that educators and parents continue teach to adolescents "just say no to sex" or save yourself for marriage. The abstinence-only programs may deter adolescents from using contraceptives and increase the risk of unplanned pregnancies and sexually transmitted diseases, such as HIV/AIDs. In the article, "The Impact of Parent Involvement...", it states that parents who join their adolescent to an HIV prevention intervention program actually increased the frequency of communication between parent and adolescent on the issue of sexual tendencies.
Wang, B., Stanton, B., Deveaux, L., Li, X., Koci, V., & Lunn, S. (2014). The Impact of Parent Involvement in an Effective Adolescent Risk Reduction Intervention on Sexual Risk Communication and Adolescent Outcomes. AIDS Education & Prevention, 26(6), 500-520. doi:10.1521/aeap.2014.26.6.500
Butts, J., & Rich, K. (2013). Nursing ethics: Across the curriculum and into practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
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