Healthy Life...

Health Information

2010-02-27T03:12:00.000-08:00

Millions of Americans search for health information on the web every year. Whether the health information is needed for personal reasons or for a loved one, millions of health-related web pages are viewed by millions of consumers. Sometimes the information found is just what was needed. Other searches end in frustration or retrieval of inaccurate, even dangerous, information.

This guide outlines the collective wisdom of medical librarians who surf the web every day to discover quality information in support of clinical and scientific decision making by doctors, scientists, and other health practitioners responsible for the nation's health. This guide is supported by the Medical Library Association (MLA), the library organization whose primary purpose is promoting quality information for improved health and whose members were the first to realize that not all health information on the web is credible, timely, or safe.

Evaluating Health Information:

Millions of consumers get health information from magazines, TV or the Internet. Some of the information is reliable and up to date; some is not. How can you tell the good from the bad?
First, consider the source. If you use the Web, look for an "about us" page. Check to see who runs the site: Is it a branch of the government, a university, a health organization, a hospital or a business? Focus on quality. Does the site have an editorial board? Is the information reviewed before it is posted? Be skeptical. Things that sound too good to be true often are. You want current, unbiased information based on research.

Understanding Medical Research:

It seems to happen almost every day - you hear about a new result of medical research on television or read about it in the paper. Sometimes the results of one study seem to disagree with the results of another study.
It's important to be critical when reading or listening to reports of new medical findings. Some questions that can help you evaluate.
health information include:

• Was the study in animals or people?
• Does the study include people like you?
• Was it a randomized controlled clinical trial?
• Where was the research done?
• If a new treatment was being tested, were there side effects?
• Who paid for the research?
• Who is reporting the results?

Clinical Trials:

Clinical trials are research studies that test how well new medical approaches work in people. Each study answers scientific questions and tries to find better ways to prevent, screen for, diagnose or treat a disease. Clinical trials may also compare a new treatment to a treatment that is already available.
Every clinical trial has a protocol, or action plan, for conducting the trial. The plan describes what will be done in the study, how it will be conducted, and why each part of the study is necessary. Each study has its own rules about who can participate. Some studies need volunteers with a certain disease. Some need healthy people. Others want just men or just women.
In the United States, an independent committee of physicians, statisticians and members of the community must approve and monitor the protocol. They make sure that the risks are small and are worth the potential benefits.

Healthy Living:

Many factors affect your health. Some you cannot control, such as your genetic makeup or your age. But you can make changes to your lifestyle. By taking steps toward healthy living, you can help reduce your risk of heart disease, cancer, stroke and other serious diseases. For example,
• See your doctor for regular screenings not just when you are sick.
• Maintain a healthy weight.
• Eat a variety of healthy foods, and limit calories and saturated fat.
• Be physically active.
• Control your blood pressure and cholesterol.
• Quit smoking.
• Protect yourself from too much sun.

Health Checkup:

Also called: Annual checkup, Annual physical examination, Routine physical examination
Regular health exams and tests can help find problems before they start. They also can help find problems early, when your chances for treatment and cure are better. Which exams and screenings you need depends on your age, health and family history, and lifestyle choices such as what you eat, how active you are, and whether you smoke.
To make the most of your next check-up, here are some things to do before you go:
• Review your family health history.

Family History:

Your family history includes health information about you and your close relatives. Family history is an important risk factor for problems like heart disease, stroke, diabetes and cancer. A risk factor is anything that increases your chance of getting a disease. The reason a family history can help predict risk is that families share their genes, as well as other factors that affect health, like environment, lifestyles and habits.
Having a family member with a disease raises your risk, but it does not mean that you will definitely get it. Realizing that you are at risk gives you a chance to reduce that risk by following a healthier lifestyle and getting tested as needed.
You can get started by talking to your relatives about their health. Draw a family tree and add the health information. Having copies of medical records and death certificates is also helpful.

Personal Medical Records:
Also called: Electronic Health Records, Patient Health Record, Personal Health Record

You've probably seen your chart at your doctor's office. In fact, you may have charts at several doctors' offices. If you've been in the hospital, you have a chart there, too. To keep track of all this information, it's a good idea to keep your own records.
What kind of information would you put in a personal health record? You could start with

• Your name, birth date, blood type and emergency contact.
• Date of last physical.
• Dates and results of tests and screenings.
• Major illnesses and surgeries, with dates.
• A list of your medicines, dosages and how long you've taken them.
• Any allergies.
• Any chronic diseases.
• Any history of illnesses in your family.
• Find out if you are due for any general screenings or vaccinations.
Immunization:

Also called: Vaccination
Shots may hurt a little... but the diseases they can prevent can hurt a lot more! Immunization shots, or vaccinations, are essential. They protect against things like measles, mumps, rubella, hepatitis B, polio, diphtheria, tetanus and pertussis (whooping cough). Immunizations are important for adults as well as for children Here's why.
Your immune system helps your body fight germs by producing substances to combat them. Once it does, the immune system "remembers" the germ and can fight it again. Vaccines contain germs that have been killed or weakened. When given to a healthy person, the vaccine triggers the immune system to respond and thus build immunity.
Before vaccines, people became immune only by actually getting a disease and surviving it. Immunizations are an easier and less risky way to become immune.

Childhood Immunization:

Also called: Shots
Today, children in the United States routinely get vaccines that protect them from more than a dozen diseases such as measles, polio and tetanus. Most of these diseases are now at their lowest levels in history, thanks to years of immunization. Children must get at least some vaccines before they may attend school.
Vaccines help make you immune to serious diseases without getting sick first. Without a vaccine, you must actually get a disease in order to become immune to the germ that causes it. Vaccines work best when they are given at certain ages. For example, children don't receive measles vaccine until they are at least one year old. If it is given earlier it might not work as well. The Centers for Disease Control and Prevention publishes a schedule for childhood vaccines.
Although some of the vaccines you receive as a child provide protection for many years, adults need immunizations too.

Course Objectives (HIV)

2010-02-26T15:43:00.000-08:00

Course Objectives

By completing this course the healthcare professional will be able to:

1. Identify the psychosocial and cultural considerations necessary when working with HIV positive patients.
2. Describe the stigma associated with the HIV virus.
3. Describe counseling techniques that can be used before and after HIV testing.
4. Identify the treatment protocol most often used with HIV/AIDS patients.
5. Describe the tests most often used to detect the HIV virus.
6. Describe the risks and benefits of drug treatment for pregnant women.

HIV stands for Human Immunodeficiency Virus.

The immune system is responsible for fighting off viruses in the body. White blood cells protect the body from the germs such as viruses, parasites, fungi and bacteria. The HIV disease is a deterioration of the body’s immune function.

The term AIDS stands for Acquired Immune Deficiency Syndrome.

A positive HIV test result means that the person has been infected with HIV (Human Immunodeficiency Virus), the vi type of whrus that causes AIDS (Acquired Immune Deficiency Syndrome). HIV disease progresses to AIDS when the CD4+ T cell count drops below 200 cells/mm, and/or you develop an AIDS-defining condition. CD4+ T cells are aite blood cell that fights infections. When HIV enters a person’s CD4+ T cell, it uses the cell to make copies of itself. This process destroys the CD4+ T cells, weakening the immune system and making it harder for the body to fight infections.The AIDS Surveillance Case Definition of the U.S. Centers for Disease Control and Prevention

A diagnosis of AIDS is made whenever a person is HIV-positive and:

he or she has a CD4+ cell count below 200 cells per micro liter OR his or her CD4+ cells account for fewer than 14 percent of all lymphocytes OR that person has been diagnosed with one or more of the AIDS-defining illnesses listed below.

AIDS Infection

AIDS is caused by infection with a virus called human immunodeficiency virus (HIV). This virus is passed from one person to another through blood-to-blood and sexual contact. In addition, infected pregnant women can pass HIV to their babies during pregnancy or delivery, as well as through breast feeding.

White blood cells of the immune system provide a first line of defense against viruses and cancers. White blood cells affected with the HIV virus resist treatment by disguising themselves as protease inhibitors. Other cells of the immune system that get infected with AIDS are CD4-possitive T-cells, which orchestrate the immune response, and monocyte macrophage cells, which collect infected cells.

Body fluids that pass the Virus:

• blood
• semen
• vaginal fluid
• breast milk
• other body fluids containing blood

These are additional body fluids that may transmit the virus that health care workers may come into contact with:

• cerebrospinal fluid surrounding the brain and the spinal cord
• synovial fluid surrounding bone joints
• amniotic fluid surrounding a fetus

HIV and Its Transmission

Research has revealed a great deal of valuable medical, scientific, and public health information about the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The ways in which HIV can be transmitted have been clearly identified.

HIV is spread by sexual contact with an infected person, by sharing needles and/or syringes (primarily for drug injection) with someone who is infected through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth or through breast-feeding after birth.

In the health care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker’s open cut or a mucous membrane (for example, the eyes or inside of the nose).

Kissing

Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV. Because of the potential for contact with blood during "French" or open-mouth kissing, the Center for Disease Control recommends against engaging in open mouth kissing with a person that has been infected with the virus. The risk of acquiring HIV during open-mouth kissing is believed to be very low.

Saliva, Tears, and Sweat

HIV has been found in saliva and tears in very low quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

Oral Sex Is Not Risk Free

Like all sexual activity, oral sex carries some risk of HIV transmission when one partner is known to be infected with HIV, when either partner’s HIV status is not known, and/or when one partner is not monogamous or injects drugs. Even though the risk of transmitting HIV through oral sex is much lower than that of anal or vaginal sex, numerous studies have demonstrated that oral sex can result in the transmission of HIV and other sexually transmitted diseases (STDs). Abstaining from oral, anal, and vaginal sex altogether or having sex only with a mutually monogamous, uninfected partner are the only ways that individuals can be completely protected from the sexual transmission of HIV. However, by using condoms or other barriers between the mouth and genitals, individuals can reduce their risk of contracting HIV or another STD through oral sex.

Oral Sex is a Common Practice

Oral sex involves giving or receiving oral stimulation (i.e., sucking or licking) to the penis, the vagina, and/or the anus. Fellatio is the technical term used to describe oral contact with the penis. Cunnilingus is the technical term which describes oral contact with the vagina. Anilingus (sometimes called “rimming”) refers to oral-anal contact. Studies indicate that oral sex is commonly practiced by sexually active male-female and same-gender couples of various ages, including adolescents. Although there are only limited national data about how often adolescents engage in oral sex, some data suggest that many adolescents who engage in oral sex do not consider it to be “sex;” therefore they may use oral sex as an option to experience sex while still, in their minds, remaining abstinent. Moreover, many consider oral sex to be a safe or no-risk sexual practice. In a national survey of teens conducted for The Kaiser Family Foundation, 26% of sexually active 15- to 17-year-olds surveyed responded that one “cannot become infected with HIV by having unprotected oral sex,” and an additional 15% didn’t know whether or not one could become infected in that manner.

Oral Sex and the Risk of HIV Transmission

The risk of HIV transmission from an infected partner through oral sex is much less than the risk of HIV transmission from anal or vaginal sex. Measuring the exact risk of HIV transmission as a result of oral sex is very difficult. Additionally, because most sexually active individuals practice oral sex in addition to other forms of sex, such as vaginal and/or anal sex, when transmission occurs, it is difficult to determine whether or not it occurred as a result of oral sex or other more risky sexual activities. Finally, several co-factors may increase the risk of HIV transmission through oral sex, including: oral ulcers, bleeding gums, genital sores, and the presence of other STDs. What is known is that HIV has been transmitted through fellatio, cunnilingus, and anilingus.

Other STDs Can Also Be Transmitted From Oral Sex

In addition to HIV, other STDs can be transmitted through oral sex with an infected partner. Examples of these STDs include herpes, syphilis, gonorrhea, genital warts (HPV), intestinal parasites (amebiasis), and hepatitis A.

Oral Sex and Reducing the Risk of HIV Transmission

The consequences of HIV infection are life-long. If treatment is not initiated in a timely manner, HIV can be extremely serious and life threatening. However, there are steps you can take to lower the risk of getting HIV from oral sex.

Generally, the use of a physical barrier during oral sex can reduce the risk of transmission of HIV and other STDs. A latex or plastic condom may be used on the penis to reduce the risk of oral-penile transmission. If your partner is a female, a cut-open condom or a dental dam can be used between your mouth and the vagina. Similarly, regardless of the sex of your partner, if your mouth will come in contact with your partner’s anus, a cut-open condom or dental dam can be used between your mouth and the anus.

At least one scientific article has suggested that plastic food wrap may be used as a barrier to protect against herpes simplex virus during oral-vaginal or oral-anal sex. However, there are no data regarding the effectiveness of plastic food wrap in decreasing transmission of HIV and other STDs in this manner and it is not manufactured or approved by the FDA for this purpose.

Needles

At the start of every intravenous injection, blood is introduced into needles and syringes. HIV can be found in the blood of a person infected with the virus. The reuse of a blood-contaminated needle or syringe by another drug carries a high risk of HIV transmission. Infected blood can be introduced into drug solutions by:

• using blood-contaminated syringes to prepare drugs
• reusing water
• reusing bottle caps, spoons, or other containers ("spoons" and "cookers") used to dissolve drugs in water and to heat drug solutions
• reusing small pieces of cotton or cigarette filters ("cottons") used to filter out particles that could block the needle

"Street sellers" of syringes may repackage used syringes and sell them as sterile syringes. For this reason, people who continue to inject drugs should obtain syringes from reliable sources of sterile syringes, such as pharmacies.

HIV/AIDS and Stigma

HIV-related stigma refers to all unfavorable attitudes, beliefs, and policies directed toward people perceived to have HIV/AIDS as well as toward their significant others and loved ones, close associates, social groups, and communities. Patterns of prejudice, which include devaluing, discounting, discrediting, and discriminating against these groups of people, play into and strengthen existing social inequalities—especially those of gender, sexuality, and race—that are at the root of HIV-related stigma.

Erving Goffman is widely credited for conceptualizing and creating a framework for the study of stigma. His work was seminal in creating an environment for ongoing academic research on the topic. In his landmark book Stigma: Notes on the Management of Spoiled Identity (1963), Goffman described stigma as “an attribute that is deeply discrediting within a particular social interaction” (p. 3). His explanation of stigma focuses on the public’s attitude toward a person who possesses an attribute that that falls short of societal expectations. The person with the attribute is “reduced in our minds from a whole and usual person to a tainted, discounted one” (p. 3). Goffman further explained that stigma falls into three categories:

1. Abominations of the body—various physical deformities.
2. Blemishes of individual character—weak will, domineering or unnatural passions, treacherous and rigid beliefs, or dishonesty. Blemishes of character are inferred from, for example, mental disorder, imprisonment, addiction, alcoholism, homosexuality, unemployment, suicidal attempts, or radical political behavior.
3. Tribal stigma of race, nation, and religion—beliefs that are transmitted through lineages and equally contaminate all members of a family (Goffman, 1963).

The stigma concept has been applied to myriad circumstances (Link and Phelan, 2001). Goffman’s ideas are a common thread in much of the published research and provide the theoretical underpinnings for much of the literature on stigma and stereotyping.

According to Goffman and other researchers, diseases associated with the highest degree of stigma share common attributes:

• The person with the disease is seen as responsible for having the illness
• The disease is progressive and incurable
• The disease is not well understood among the public
• The symptoms cannot be concealed.

HIV infection fits the profile of a condition that carries a high level of stigmatization (Goffman, 1963; Herek, 1999; Jones et al., 1988). First, people infected with HIV are often blamed for their condition and many people believe HIV could be avoided if individuals made better moral decisions. Second, although HIV is treatable, it is nevertheless a progressive, incurable disease (Herek, 1999; Stoddard, 1994). Third, HIV transmission is poorly understood by some people in the general population, causing them to feel threatened by the mere presence of the disease. Finally, although asymptomatic HIV infection can often be concealed, the symptoms of HIV-related illness cannot. HIV-related symptoms may be considered repulsive, ugly, and disruptive to social interaction (Herek, 1999).

The discrimination and devaluation of identity associated with HIV-related stigma do not occur naturally. Rather, they are created by individuals and communities who, for the most part, generate the stigma as a response to their own fears. HIV-related stigma manifests itself in various ways. HIV-positive individuals, their loved ones, and even their caregivers are often subjected to rejection by their social circles and communities when they need support the most. They may be forced out of their homes, lose their jobs, or be subjected to violent assault. For these reasons, HIV-related stigma must be recognized and addressed as a life-altering phenomenon.

HIV-related stigma has been further divided into the following categories:

Instrumental HIV-related stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness (Herek, 1999)

Symbolic HIV-related stigma—the use of HIV/AIDS to express attitudes toward the social groups or “lifestyles” perceived to be associated with the disease (Herek, 1999)

Courtesy HIV-related stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people (Snyder, 1999, based on Goffman, 1963).

Stigma and Access to Care

The literature devoted to stigma and access to care falls roughly into three categories. Most of the literature deals with barriers to care that HIV-positive individuals encounter across the continuum from HIV diagnosis to end of life. The next largest category of studies documents the reluctance of health care providers to treat individuals with HIV infection. Finally, a few studies cover the stigma experienced by providers of ancillary and support services to people living with HIV/AIDS.

Individuals

HIV/AIDS-related stigma affects issues related to HIV testing including delays in testing, the effect of delay on further transmission of HIV, and individuals’ responses to testing positive (Chesney and Smith, 1999). Early detection of HIV infection is important. Knowledge of one’s HIV seropositivity can lead to earlier treatment and improved outcomes (Herek, 1990). Knowledge of seropositivity also can lead to changes in risk behaviors that can reduce or eliminate the risk of HIV transmission. A Kaiser Health Poll report (2000) suggested that fear of being stigmatized by HIV/AIDS has some relationship to people’s decisions about getting tested for HIV. One-third of survey respondents said that if they were tested for HIV, they would be “very” or “somewhat” concerned that people would think less of them if they discovered that they had been tested. In addition, 8 percent of people who had never been tested for HIV said that worries about confidentiality played a part in their decision not to have the test.

Studies provide evidence that stigma is associated with delays in HIV testing among individuals who are at high risk of being infected with HIV (Myers et al., 1993; Stall et al., 1996). In a study of gay and bisexual men who were unaware of their HIV status, two-thirds of the participants expressed a fear of discrimination against people with HIV and said it was a reason for not getting tested (Stall et al., 1996). Earlier in the epidemic, HIV stigmatization was shown to influence the way in which at-risk populations approached HIV testing. People at risk for HIV infection were more likely to seek testing that was offered anonymously (i.e., no names were recorded) than testing that was offered confidentially (i.e., names were kept in confidential files) (Fehrs et al., 1988; Johnson et al., 1988).

HIV/AIDS-related stigma also influences individuals’ responses to testing positive: It aggravates the psychological burden of receiving a positive HIV test (Chesney and Smith, 1999). Earlier in the epidemic, there were reports of severe psychological responses to notification, including denial, anxiety, depression, and suicidal ideation (Coates et al., 1987; Ostrow et al., 1989). Over time, studies have shown a decrease in severe reactions to being notified of positive test results; however, research continues to show that notification is associated with high distress. Distress is greatest immediately after notification and typically declines within 2 to 10 weeks (Ironson et al., 1990; Perry et al., 1990). Stigma also affects the care of HIV-positive individuals. After a person tests positive, he or she faces decisions that include how to enter and adhere to care and whether to disclose HIV seropositivity to partners, friends, family, colleagues, employers, and health care providers (Chesney and Smith, 1999). At each level, a decision to disclose seropositivity may either enhance access to support and care or expose the individual to stigmatization and potential discrimination.

HEALTH CARE PROVIDERS

Accessing health care can be a challenge for people who are HIV positive, because the health care system itself is often a source of stigma. Health care professionals, particularly those who infrequently encounter HIV-positive people, can be insensitive to their patients’ concerns about stigma. In addition, health care professionals are not always knowledgeable about appropriate procedures for maintaining patient confidentiality (Herek et al., 1998).

The literature on caregiving reveals that stigmatization is evident among health care providers. Fear of contagion and fear of death have clear negative effects on health care providers’ attitudes toward and treatment of HIV-positive patients (Gerbert et al., 1991; Weinberger et al., 1992). Health care providers also may fear stigmatization themselves because of their work with HIV-positive patients (Durham, 1994). Caregivers, whether professionals or volunteers, risk what Goffman called “courtesy stigma,” in which they are stigmatized as a result of their association with HIV/AIDS and people living with HIV disease. That stigma may influence their willingness to work with people with HIV or may make their work more difficult (Snyder et al., 1999).

Statistics

United States: Through December 2001, a total of 816,149 cases of AIDS had been reported to the CDC.

Worldwide: Based on estimates from the United Nations AIDS program (UNAIDS), approximately 65 million people have been infected with HIV since the start of the global epidemic. At the end of 2002, an estimated 42 million people were living with HIV infection or AIDS.

UNAIDS estimates 5.0 million new HIV infections occurred in 2002. This represents about 14,000 new cases per day. An estimated 3.1 million adults and children died of HIV/AIDS in 2002.

United States Statistics

HIV ranks 5th among the leading causes of death for all persons between the ages of 35 and 44, but 2nd among Hispanic males of that age group and 1st among African-American males of that age.

HIV/AIDS was the 5th leading cause of death for U.S. women aged 25-44. Among African American women in this same age group, HIV/AIDS was the third leading cause of death in 1999.

Areas Reporting Most Cases

State/Territory Number of Cumlative AIDS Cases

New York 149,341
California 123,819
Florida 85,324
Texas 56,730
New Jersey 43,824
Pennsylvania 26,369
Illinois 26,319
Puerto Rico 26,119
Georgia 24,559
Maryland 23,537
Men Who Have Sex with Men

In the United States, HIV-related illness and death historically have had a tremendous impact on men who have sex with men. Even with the increase among drug users, men having sex with men continues to account for the largest number of people reported with AIDS each year.

Impact of HIV Infection on African Americans

In the early 1980s, HIV/AIDS was primarily considered a gay white disease in the U.S. Today, however, the epidemic has expanded and the disease is also a major health problem in the African-American community.

The HIV/AIDS epidemic continues to be a major health crisis facing the African-American community. Although African Americans make up about 12 percent of the U.S. population, they accounted for half of the new HIV cases reported in the United States in 2001. African-American women accounted for nearly 64 percent of HIV cases reported among women in 2001.

Overall, it is estimated that half of new HIV infections occur among teenagers and young adults aged 25 years and younger.

Hispanic Population and Aids

The Hispanic population accounts for 19% of the number of new U.S. AIDS cases reported each year. 81% of the Hispanic population infected with the AIDS virus is male. In 1993, 18% of those estimated to be living with AIDS were Hispanic, while in 1999, 20% were Hispanic. In comparison, non-Hispanic whites represented 46% of people estimated to be living with AIDS in 1993, but only 38% in 1999. . Sixty percent of Hispanics reported with AIDS in 2000 were born in the U.S. 47% of the Hispanic AIDS cases are linked to heterosexual sex.

HIV Testing

The tests commonly used to detect HIV infection actually look for antibodies produced by the body to fight HIV. Most people will develop detectable antibodies within 3 months after infection, the average being 25 days. In rare cases, it can take up to 6 months.

Many places provide testing for HIV infection. Common testing locations include local health departments, offices of private doctors, hospitals, and sites specifically set up to provide HIV testing. It is important to seek testing at a place that also provides counseling about HIV and AIDS. Counselors can answer any questions the person might have about risky behavior and ways they can protect themselves and others in the future. In addition, they can help you understand the meaning of the test results and describe what AIDS-related resources are available in the local area.

Only the Home Access test is approved by the Food and Drug Administration. The Home Access test kit can be found at most local drug stores. The testing procedure involves pricking your finger with a special device, placing drops of blood on a specially treated card, and then mailing the card in to be tested at a licensed laboratory. Customers are given an identification number to use when phoning for the test results. Callers may speak to a counselor before taking the test, while waiting for the test result, and when getting the result.

A rapid test for detecting antibody to human immunodeficiency virus (HIV) is a screening test that produces very quick results, in 30 minutes or less. In comparison, results from the commonly used HIV antibody screening test, the enzyme immunoassay (EIA), are not available for 1-2 weeks. OraQuick is a test that can detect antibodies to HIV in finger-stick whole-blood specimens and provide results in as little as 20 minutes.

The viral load is to be tested 2–8 weeks after the start of treatment. If the drugs are working, the viral load should decrease. It should continue to decrease as they continue to take the medication. Throughout HIV treatment, the viral load should be tested every 3–4 months to make sure the drugs are still working. If the viral load is still detectable within 4–6 months after starting treatment, they should talk to the doctor about possibly changing the HIV drugs.

Anonymous HIV testing should be available to increase options for individuals seeking to learn their HIV status. In this age of effective treatment, it is increasingly important for people to know their HIV status. Recent studies show that eliminating the availability of anonymous HIV testing services has a deterrent effect on some people's willingness to come forward for testing. People with legitimate concerns about discrimination or people who are unfamiliar with or distrust the public health system are able to gain access to the system through anonymous testing and subsequently receive referrals for needed treatment, care, or prevention services. Partner counseling also can be provided following anonymous testing, if requested.

Voluntary, confidential notification of potentially exposed partners is to be an essential component of a comprehensive HIV prevention program. Partner counseling is a primary prevention service with the following objectives:

• To provide prevention information to people who are at very high risk of becoming HIV infected, but who may be unaware of or misunderstand their risks
• To assist these individuals in obtaining HIV prevention counseling and voluntary testing, and referral
• To provide access to partners who are already infected to prevention and treatment services that can improve their health and quality of life.

Effectiveness of Condoms

Condoms are classified as medical devices and are regulated by the Food and Drug Administration (FDA). Condom manufacturers in the United States test each latex condom for defects, including holes, before it is packaged. The proper and consistent use of latex or polyurethane (a type of plastic) condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person’s risk of acquiring or transmitting sexually transmitted diseases, including HIV infection.

There are many different types and brands of condoms available--however, only latex or polyurethane condoms provide a highly effective mechanical barrier to HIV. In laboratories, viruses occasionally have been shown to pass through natural membrane ("skin" or lambskin) condoms, which may contain natural pores and are therefore not recommended for disease prevention (they are documented to be effective for contraception). Women may wish to consider using the female condom when a male condom cannot be used.

For condoms to provide maximum protection, they must be used consistently (every time) and correctly. Several studies of correct and consistent condom use clearly show that latex condom breakage rates in this country are less than 2 percent. Even when condoms do break, one study showed that more than half of such breaks occurred prior to ejaculation.

Treatment

Treatment of HIV Infection
When AIDS was first recognized in 1981, patients with the disease were unlikely to live longer than a year or two. Since then, scientists have developed an effective arsenal of drugs that can help many people infected with HIV (human immunodeficiency virus) live longer and healthier lives.

Drugs for Treating HIV

As of 2003, antiretroviral drugs have been approved for treating HIV infection. They are called antiretroviral because they attack HIV, which is a retrovirus. Once inside the cell, HIV uses specific enzymes to survive. Antiretroviral drugs work by interfering with the virus' ability to use these enzymes.

Reverse transcriptase inhibitors interfere with an enzyme called reverse transcriptase or RT that HIV needs to make copies of itself. There are two main types of RT inhibitors and they each work differently

Nucleoside/nucleotide drugs provide faulty DNA building blocks, halting the DNA chain that the virus uses to make copies of itself.

Non-nucleoside RT inhibitors bind RT so the virus cannot carry out its copying function.

Protease inhibitors interfere with the protease enzyme that HIV uses to produce infectious viral particles.

In March 2003, the Food and Drug Administration (FDA) announced the accelerated approval of Fuzeon (enfuvirtide) for use in combination with other anti-HIV medications to treat advanced HIV-1 infection in adults and children ages 6 years and older.

FDA’s accelerated approval of Fuzeon makes it the first product in a new class of medications called fusion inhibitors to receive marketing approval anywhere in the world. Drugs in this class interfere with the entry of HIV-1 into cells by inhibiting the fusion of viral and cellular membranes. This inhibition blocks the virus’ ability to infect certain components of the immune system. The approved labeling for Fuzeon warns physicians to carefully monitor patients for signs and symptoms of pneumonia. Patients receiving Fuzeon are advised to seek medical evaluation immediately if they develop signs or symptoms suggestive of pneumonia such as cough with fever, rapid breathing and shortness of breath. In addition, Fuzeon can cause both serious systemic allergic reactions and local skin reactions at the site of injection.

Symptoms of a serious systemic allergic reaction with Fuzeon can include: trouble breathing, fever and skin rash, chills, vomiting and low blood pressure. Patients taking Fuzeon should contact their healthcare provider right away if they get any of these symptoms. People with HIV must take complicated treatment regimens, often taking several drugs on a daily basis. Patients may forget to take their medicine, find the food restrictions difficult to deal with, and may experience unpleasant side effects. Aside from the complicated dosing regimens, antiretroviral drugs themselves may cause serious medical problems. Metabolic changes are occurring in people with chronic HIV infection Researchers have found garlic supplements can cause a potentially harmful side effect when combined with a type of medication used to treat HIV/AIDS. Investigators from the National Institutes of Health (NIH) observed that garlic supplements sharply reduced blood levels of the anti-HIV drug saquinavir.

The Pharmaceutical Research and Manufacturers Association list nearly two dozen new anti-HIV drugs now in development. They include new protease inhibitors and more potent, less toxic RT inhibitors, as well as drugs that interfere with entirely different steps in the virus' lifecycle. These new categories of drugs include:

• Fusion inhibitors -- drugs that interfere with HIV's ability to enter a cell

• Integrase inhibitors -- drugs that interfere with HIV's ability to insert its genes into a cell's normal DNA.

HIV and Pregnancy

For those who are pregnant or want to become pregnant, they must consider the general risks and benefits of drug treatment to both themselves and the child. Some of the drugs (such as efavirenz and hydroxyurea) should be avoided, because they may cause birth defects if taken early in pregnancy.

Most women with HIV/AIDS in the United States reside in the Northeast and the South. The highest numbers of cases were first observed in the Northeast, but the South has reported the greatest increases in recent years. African-American and Hispanic women are disproportionately affected by the epidemic and account for 80% of AIDS cases reported in U.S. women in 1999. Over time, the proportion of cases in women attributable to injection-drug use has declined, whereas the proportion of cases from heterosexual contact has increased, particularly among young women. Worldwide, approximately 600,000 infants each year become infected through mother-to-child transmission of the HIV virus. In the United States, widespread implementation of the PHS guidelines for universal counseling and testing and perinatal use of ZDV has sharply reduced transmission risk and the number of perinatally acquired HIV infections.

Despite the declines, cases of perinatal HIV transmission continue to occur, largely because of missed opportunities for prevention, particularly among women who lack prenatal care or who are not being offered voluntary HIV counseling and testing during pregnancy. The estimated 280–370 infants born with HIV infection each year represent populations in which prevention efforts are impeded by lack of timely HIV testing and treatment of pregnant women.

Dynamics of Perinatal HIV Transmission

Prenatal transmission can occur during pregnancy (intrauterine), during labor and delivery (intrapartum), or after delivery through breast-feeding (postpartum). In the absence of breast-feeding, intrauterine transmission accounts for 25%–40% of infection, and 60%–75% of transmission occurs during labor and delivery. Among women who breast-feed, approximately 20%–25% of perinatal infections are believed to be associated with intrauterine transmission, 60%–70% with intrapartum transmission or very early breast-feeding, and 10%–15% with later postpartum transmission through breast-feeding. In a randomized trial of formula feeding versus breast-feeding, approximately 44% of HIV infection was attributed to breast-feeding. In breastfeeding populations, a shift toward an increasing proportion of transmission related to breast-feeding is likely to occur as a consequence of successful preventive interventions directed at late prenatal and intrapartum transmission.

Intrapartum transmission can occur during labor through maternal-fetal exchange of blood or during delivery by contact of the infant’s skin or mucous membranes with infected blood or other maternal secretions. Several studies have indicated that most infections transmitted through breast-feeding probably occurred during the first few weeks to months of life. Risk factors during breast-feeding include viral load in breast milk, sub clinical or clinical mastitis, breast abscesses and maternal seroconversion during the lactation period.

Several risk factors are associated with perinatal HIV transmission. Clinical factors that increase the likelihood of transmission include immunologic ally or clinically advanced HIV disease in the mother, high plasma viral load, and maternal injection-drug use during pregnancy, preterm delivery, no receipt of the PACTG 076 regimen, and breastfeeding. No link has been established between perinatal HIV transmission and maternal age, race/ethnicity, or history of having a previously infected child.

Obstetric factors also influence HIV transmission risk. The risk for perinatal transmission increases per hour duration of membrane rupture after controlling for other risk factors. Delivery >4 hours after the rupture of the fetal membranes can double the risk for HIV transmission. Maternal infection with another sexually transmitted disease (STD) during pregnancy and certain obstetrical procedures can also increase risk. Chorioamnionitis (i.e., uterine infection) has been associated with an increased risk for HIV transmission.

Most of these risk factors were identified before the recommended use of ZDV to prevent perinatal HIV transmission. Their effects are unknown now that most pregnant women infected with HIV are receiving ZDV chemoprophylaxis to prevent mother-to child transmission, as well as combination therapy for their own health. Because of the sharp reductions in perinatal HIV transmission associated with effective antiretroviral interventions, factors that interfere with women or their infants receiving ZDV treatment (e.g., barriers to prenatal care, lack of HIV testing for some pregnant women) are increasingly important.

Prevention of Perinatal Transmission

The birth of every perinatally HIV-infected infant is a sentinel health event signaling either a missed prevention opportunity or, more rarely, a failure of prophylaxis. An opportunity is missed whenever a woman of childbearing age is unaware of her HIV status or her risk for HIV or when an HIV-infected pregnant woman a) does not receive prenatal care, b) is not offered HIV testing, c) is unable to obtain HIV testing, d) is not offered chemoprophylaxis, e) is unable to obtain chemoprophylaxis, or f) does not complete the chemoprophylaxis regimen. Prophylaxis failures occur when an infant becomes infected despite chemoprophylaxis and other preventive interventions. Each of these missed opportunities or failures deserves attention from service providers and prevention programs.

Early Prenatal Care

Maximum reduction of perinatal transmission depends on preventing HIV infection in women or identifying HIV infection before pregnancy or as early as possible during pregnancy. Diagnosis allows a woman to receive effective antiretroviral therapies for her own health and preventive drugs (e.g., ZDV) to improve the chances that her infant will be born free of infection. Early knowledge of maternal HIV status is also important for decisions regarding obstetrical management. Achieving these goals requires increased access to and use of prenatal care.

HIV Treatment Adherence

Adherence is a major issue in HIV treatment for two reasons.

• First, adherence affects how well the HIV drugs decrease viral load. When patients skip medication doses even once, the virus has the opportunity to make copies of itself more rapidly. This makes it difficult for the drugs to be effective. Other factors that may affect treatment effectiveness include the baseline viral load and CD4+ T cell count, whether they have any AIDS-related illnesses, and whether you they used HIV drugs before.
• Second, adherence to HIV treatment is very important to prevent drug resistance. Studies have shown that when the patient skips doses, they may develop strains of HIV that are drug-resistant. This may leave them with fewer treatment options if the viral load does not decrease. Because drug-resistant strains can be transmitted to others, it has serious consequences for anyone with whom they engage in risky behavior.
• There are several reasons why many patients have difficulty adhering to an HIV treatment plan.
• One reason is that HIV treatment plans are very complicated. Studies have shown that many people may have difficulty adhering to even simple treatment plans. Yet HIV treatment may involve taking 25 or more pills each day. In addition, some HIV drugs must be taken on an empty stomach, while others must be taken with meals. This can be difficult for many people, especially those who are sick or experiencing HIV symptoms. Also, HIV-infected patients may need to continue their treatment regimens for a long time, perhaps for their entire lives.
• HIV-infected patients have reported other reasons for poor adherence, including unpleasant side effects (like nausea), sleeping through doses, traveling away from home, being too busy, feeling sick or depressed, or simply forgetting to take their medications.

AIDS Wasting

AIDS wasting is the involuntary loss of more than 10% of body weight, plus more than 30 days of either diarrhea, or weakness and fever. Wasting is linked to disease progression and death. Losing just 5% of body weight can have the same negative effects. Wasting is still a problem for people with AIDS.

Part of the weight lost during wasting is fat. More important is the loss of muscle mass. This is also called "lean body mass," or "body cell mass." Lean body mass can be measured by bioelectrical impedance analysis (BIA). This is a simple, painless office procedure.

AIDS wasting and lipodystrophy both can cause some body shape changes. Wasting is the loss of muscle. Lipodystrophy is a loss of fat. They are not the same thing. However, wasting in women can start with a loss of fat.

Several factors contribute to AIDS wasting:

Low food intake: Low appetite is common with HIV. Also, some AIDS drugs have to be taken with an empty stomach, or with a meal. It can be difficult for some people with AIDS to eat when they're hungry. Drug side effects such as nausea, changes in the sense of taste, or tingling around the mouth also decrease appetite. Opportunistic infections in the mouth or throat can make it painful to eat. Infections in the gut can make people feel full after eating just a little food. Finally, lack of money or energy may make it difficult to shop for food or prepare meals.

Poor nutrient absorption: Healthy people absorb nutrients through the small intestine. In HIV disease, several infections (including parasites) can interfere with this process. HIV may directly affect the intestinal lining and reduce nutrient absorption. Diarrhea causes loss of calories and nutrients.

Altered metabolism: Food processing and protein building are affected by HIV disease. Even before any symptoms show up, you need more energy. This might be caused by the increased activity of the immune system. People with HIV need more calories just to maintain their body weight.

Hormone levels can affect the metabolism. HIV seems to change some hormone levels. Also, cytokines play a role in wasting. Cytokines are proteins that produce inflammation to help the body fight infections. People with HIV have very high levels of cytokines. This makes the body produce more fats and sugars, but less protein.

Unfortunately, these factors can work together to create a "downward spiral." For example, infections may increase the body's energy requirements. At the same time, they can interfere with nutrient absorption and cause fatigue. This can reduce appetite and make people less able to shop for or cook their meals. They eat less, which accelerates the process.

Wasting Treatment

The best prevention for AIDS Wasting is a baseline nutrition assessment by a Registered Dietitian, with general healthy eating nutrition counseling at diagnosis of HIV. As weight loss occurs, or with the development of symptomatology that interfere with maintaining an adequate intake, follow-up visits to the Dietitian can allow an evaluation with a detailed individualized plan of treatment. Once weight is lost, it is difficult to return to pre-illness weight with similar body composition.

Nutrition Guidelines for People with HIV

Good nutrition means getting enough macronutrients and micronutrients. Macronutrients contain calories (energy): proteins, carbohydrates, and fats. They help maintain body weight. Micronutrients include vitamins and minerals. They keep cells working properly, but will not prevent weight loss. Good nutrition can be a problem for many people with HIV. When the body fights any infection, it uses more energy and the patient needs to eat more than normal. But when one feels sick, they eat less than normal.

Some medications can upset the stomach, and some opportunistic infections can affect the mouth or throat. This makes it difficult to eat. Also, some medications and infections cause diarrhea. With diarrhea, the body actually uses less of what you eat. With weight lose, they might be losing fat, or they might be losing lean body weight like muscle. If they lose too much lean weight, the body chemistry changes. This condition is called wasting syndrome or cachexia. Wasting can kill. If the patient loses more than 5% of their body weight, it could be a sign of wasting.

A moderate exercise program will help the body turn food into muscle. Take it easy, and work exercise into daily activities. Drinking enough liquids is very important when the person has HIV. Extra water can reduce the side effects of medications. It can help avoid a dry mouth and constipation. Be aware that drinking tea, coffee, colas, chocolate, or alcohol can actually make you lose body liquid.

Important Nutrients

There has not been a lot of research on specific nutrients and HIV disease. Also, many nutrients interact with each other. Most nutritionists believe in designing an overall program of supplements.

• People with HIV may benefit from taking supplements of the following vitamins and minerals:
• B Vitamins: Vitamin B-1 (Thiamine), Vitamin B2 (Riboflavin), Vitamin B6 (Pyridoxine), Vitamin B12 (Cobalamin), and Folate (Folic Acid).
• Antioxidants, including beta-carotene (the body breaks down beta-carotene to make Vitamin A), selenium, Vitamin E (Tocopherol), and Vitamin C.
• Magnesium and Zinc
HIV counseling seeks to reduce HIV acquisition and transmission through the following:
• Information. Clients should receive information regarding HIV transmission and prevention and the meaning of HIV test results. Provision of information is different from informed consent.
• HIV prevention counseling. Clients should receive help to identify the specific behaviors putting them at risk for acquiring or transmitting HIV and commit to steps to reduce this risk. Prevention counseling can involve >1 sessions. Inform all clients who are recommended or who request HIV testing should receive the following information, even if the test is declined:
• Information regarding the HIV test and its benefits and consequences.
• Risks for transmission and how HIV can be prevented.
• The importance of obtaining test results and explicit procedures for doing so.
• The meaning of the test results in explicit, understandable language.*
• Where to obtain further information or, if applicable, HIV prevention counseling.
• Where to obtain other services (see Typical Referral Needs).

* For example, “A negative test means no HIV was found. But if you were exposed to HIV

Recently — in the last 1–2 months — this test may not be able to pick that up.” See Negative

HIV Test Results

In certain settings where HIV testing is offered, other useful information includes

a) Descriptions or demonstrations of how to use condoms correctly
b) Information regarding risk-free and safer sex options
c) Information regarding other sexually transmitted and bloodborne diseases
d) Descriptions regarding the effectiveness of using clean needles, syringes, cotton, water, and other drug paraphernalia
e) Information regarding drug treatment; and f) information regarding the possible effect of HIV vaccines on test results for persons participating in HIV vaccine trials (see Additional Counseling Considerations for Special Situations and Positive HIV Test Results).

For efficiency, information can be provided in a pamphlet, brochure, or video rather than a face-to-face encounter with a counselor. This approach allows the provider to focus face-to-face interactions on prevention counseling approaches proven effective with persons at increased risk for HIV infection. Information should be provided in a manner appropriate to the client’s culture, language, sex, sexual orientation, age, and developmental level. Certain informational videos and large-group presentations that provide explicit information regarding correct use of condoms have proven effective in reducing new STDs and could be effective in reducing HIV.

HIV Prevention Counseling

HIV prevention counseling should focus on the client’s own unique circumstances and risk and should help the client set and reach an explicit behavior-change goal to reduce the chance of acquiring or transmitting HIV. HIV prevention counseling is usually, but not always, conducted in the context of HIV testing. The client-centered* HIV prevention counseling model involves two brief sessions, whereas other effective models are longer or involve more sessions. Regardless of the model used, in HIV prevention counseling, the counselor or provider focuses on assessing the client’s personal risk or circumstances and helping the client set and reach a specific, realistic, risk-reduction goal. These guidelines avoid using the terms “pretest” and “posttest” counseling to underscore that prevention counseling is a risk-reduction process that might involve only one or >1 session.

Several models for HIV prevention counseling in conjunction with HIV testing have been developed, evaluated in controlled studies, and documented to be efficacious in changing behavior or reducing sexually transmitted infections, including individual face-to-face counseling, large and small-group counseling with a facilitator, and video-based counseling.

Client-Centered HIV Prevention Counseling

Since 1993, CDC has recommended one interactive counseling model, called client centered HIV prevention counseling, which involves two face-to-face sessions with a provider or counselor. This model has traditionally used a two-step HIV script.

* Client-centered is used here to mean that the counseling sessions focus on the client’s own risk circumstances, risk behaviors, and prevention needs. This term should not be confused with the more intensive, client-centered approach advocated by psychologist Carl R. Rogers, although some skills and strategies that involve the client in the prevention counseling process might be similar (Rogers CR. Client-centered therapy: its current practice, implications, and theory. Boston, MA: Houghton Mifflin, 1951). Vol. 50 / No. RR-19 MMWR 15 testing approach in which clients are physically present at a setting for the HIV test (initial session) and then return for HIV test results (follow-up session). Each session might require 15–20 minutes (including testing and referral) for clients at increased risk for HIV, but could take only a few minutes for those at lower risk. In the first session, a personalized risk assessment* encourages clients to identify, understand, and acknowledge the behaviors and circumstances that put them at increased risk for acquiring HIV. The session explores previous attempts to reduce risk and identifies successes and challenges in these efforts. This in-depth exploration of risk allows the counselor to help the client consider ways to reduce personal risk and commit to a single, explicit step to do so. In the second session, when HIV test results are provided, the counselor discusses the test results, asks the client to describe the risk-reduction step attempted (and acknowledges positive steps made), helps the client identify and commit to additional behavioral steps, and provides appropriate referrals (e.g., to PCRS).

In one large, randomized, controlled trial, this model was reported to be;

• Effective at reducing high-risk sexual behaviors and new STDs;
• Feasible to use even in busy publicly funded clinics;
• Acceptable to clients, counselors, and health-care providers; and
• Cost-effective at preventing STDs in persons at increased risk for HIV.

The model was reported to be especially effective among adolescents and persons with ongoing sexual risk behaviors (e.g., newly diagnosed STDs). Although the benefits of client-centered HIV prevention counseling in reducing high-risk drug behaviors are unknown, studies have indicated that similar counseling approaches that help clients explore risks and set specific risk-reduction goals reduce risky drug use behaviors.

Observational studies and reviews of programs in various settings have indicated that many counselors are still unfamiliar with the specific goals of the client-centered HIV prevention counseling model (Amy S. DeGroff, M.P.H., written communication, 2000). Because “client-centered” is sometimes misinterpreted as “face-to-face,” providers in many HIV test sites deliver face-to-face informational messages in response to a generic checklist risk assessment. This type of counseling provides advice rather than encouraging client participation or discussion of personal risk; it seldom focuses on personal goal setting. “Client-centered” can also be misinterpreted to mean that the counselor should avoid directing the session. Although attentive listening and respect for clients’ concerns are important elements of effective counseling, the primary goal of client-centered HIV prevention counseling is risk reduction. HIV prevention counseling usually requires provider training and support and ongoing quality assurance to achieve optimal benefit. Providers can contact their state health department’s HIV/AIDS program office for information on local training opportunities.

* Personal risk assessment is an essential element of HIV prevention counseling in which the client and counselor work to understand and acknowledge the client’s personal risk for HIV. Risk assessment is not synonymous with risk screening, which helps determine which clients should be recommended HIV CTR.

Elements of HIV Prevention Counseling

Regardless of the HIV prevention counseling model used, some counseling elements have been used repeatedly in effective interventions and are recognized by many specialists as critical in counseling success.

The following elements should be part of all HIV prevention counseling sessions:

• Keep the session focused on HIV risk reduction. Each counseling session should be tailored to address the personal HIV risk of the client rather than providing a predetermined set of information. Although counselors must be willing to address problems that pose barriers to HIV risk reduction (e.g., alcohol use in certain situations), counselors should not allow the session to be distracted by the client’s additional problems unrelated to HIV. Certain counseling techniques (e.g., open ended questions [Box 5], role-play scenarios, attentive listening, and a nonjudgmental and supportive approach) can encourage the client to remain focused on personal HIV risk reduction.

• Include an in-depth, personalized risk assessment. Sometimes called “enhancing self-perception of risk,” risk assessment allows the counselor and client to identify, acknowledge, and understand the details and context of the client’s HIV risk. Keeping the assessment personal, instead of global, will help the client identify concrete, acceptable protective measures to reduce personal HIV risk (Box 6). The risk assessment should explore previous risk-reduction efforts and identify successes and challenges in those efforts. Factors associated with continued risk behavior that might be important to explore include using drugs or alcohol before sexual activity, underestimating personal risk, perceiving that precautionary changes are not an accepted peer norm, perceiving limited self-efficacy for successful change efforts, receiving reinforcement for frequent unsafe practices (e.g., a negative HIV test result after risk behaviors), and perceiving that vulnerability is associated with “luck” or “fate”.

• Acknowledge and provide support for positive steps already made. Exploring previous risk-reduction efforts is essential for understanding the strengths and challenges faced by the client in reducing risk. Support for positive steps already taken increases the clients’ beliefs that they can successfully take further HIV risk reduction steps. For some clients, simply agreeing to an HIV test is an important step in reducing risk.

• Clarify critical rather than general misconceptions. In most situations, counselors should focus on reducing the client’s current risk and avoid discussions regarding HIV transmission modes and the meaning of HIV test results. However, when clients believe they have minimal HIV risk but describe more substantial risk, the counselor should discuss the HIV transmission risk associated with specific behaviors or activities the clients describe and then discuss lower-risk alternatives. For example, if clients indicate that they believe oral sex with a risky sex partner poses little or no HIV risk, the counselor can clarify that, although oral sex with an infected partner might result in lower HIV transmission risk than anal sex, oral sex is not a risk-free behavior, particularly when commonly practiced. If clients indicate that they do not need to be concerned about HIV transmission among needle-sharing partners if they use clean needles, the counselor can clarify that.

Examples of closed-ended versus open-ended questions Closed-ended questions, which might interfere with client-centered human immunodeficiency virus (HIV) prevention counseling.

Have you ever injected drugs?

OR

Have you (for a male client) ever had sex with a man?

OR

Have you (for a female client) ever had sex with a bisexual man?

Have you ever had sex when you were under the influence of alcohol or drugs?

Do you (always) use condoms when you have sex?

OR

Can you always use condoms when you have sex?

Can you always use clean works (i.e., needles, syringes, cottons, or cookers*) when you inject?

Open-ended questions, which promote client-centered HIV prevention counseling;

• What are you doing that you think may be putting you at risk for HIV infection?
• What are the riskiest things that you are doing?
• If your test comes back positive, how do you think you may have become infected?
• When was the last time you put yourself at risk for HIV? What was happening then?
• How often do you use drugs or alcohol?
• How do you think drugs or alcohol influence your HIV risk?
• How often do you use condoms when you have sex?
• When/with whom do you have sex without a condom? When with a condom?
• What are you currently doing to protect yourself from HIV? How is that working?
• What kinds of things do you do to protect your partner from getting infected with HIV? (for HIV-infected clients)
• Tell me about specific situations when you have reduced your HIV risk. What was going on that made that possible?
• How risky are your sex/needle sharing partners? For example, have they been recently tested for HIV?
• Cottons are filters used to draw up the drug solution. Cookers include bottle caps, spoons, or other containers used to dissolve drugs.
• Examples of global versus specific risk-reduction steps for HIV prevention counseling Global risk-reduction steps, which are unlikely to be effective in changing behavior;
• Always use condoms.
• Have fewer or less risky partners.
• Have safer sex.
• Stop injecting drugs.
• Specific risk-reduction steps, which are more likely to be effective in changing behavior
• Buy a condom tomorrow and try it on.
• Carry a condom next time I go out (e.g., to the bar/nightclub).
• Starting today, put condoms on the night stand beside the bed.
• Starting tonight, require my partner to use a condom next time, or I will not have vaginal (anal) sex.
• Stop seeing (specific partner) who is seeing other people.
• Break up with (specific partner) before getting together with someone new.
• Talk honestly with (specific partner) about my HIV status and ask about his/her HIV status.
• Next time I’m out with friends and may have sex, avoid getting “high” on drugs or alcohol.
• Only kissing, etc., with (specific partner) until we both have an HIV test.
• Tomorrow, ask (specific partner ) if he or she has had a recent HIV test and has been tested for other sexually transmitted diseases.
• Obtain clean works (i.e., needles, syringes, cottons, or cookers*) tomorrow so I have them before I use next time.
• Contact drug treatment center and make appointment.

Cottons are filters used to draw up the drug solution. Cookers include bottle caps, spoons, or other containers used to dissolve drugs.

HIV can be transmitted through the cooker, cotton, or water used by several persons sharing drugs. With newly identified or uninformed HIV-infected clients, the counselor should discuss HIV transmission risks associated with specific sexual or drug-use activities, including those in which the client might not be currently engaged.

• Negotiate a concrete, achievable behavior-change step that will reduce HIV risk. Although the optimal goal might be to eliminate HIV risk behaviors, small behavior changes can reduce the probability of acquiring or transmitting HIV. Behavioral risk-reduction steps should be acceptable to the client and appropriate to the client’s situation. For clients with several high-risk behaviors, the counselor should help clients focus on reducing the most critical risk they are willing to commit to changing. The step does not need to be a personal behavior change. For many clients, knowledge of a partner’s recent HIV status (and talking with the partner about getting an HIV test) might be more critical than personal behavior changes.

The step should be relevant to reducing the client’s own HIV risk and should be a small, explicit, and achievable goal, not a global goal. Identifying the barriers and supports to achieving a step, through interactive discussion, role-play modeling, recognizing positive social support, or other methods will enhance the likelihood of success. Writing down the goal might be useful. For clients with ongoing risk behaviors, referral to additional prevention and support services is encouraged.

• Seek flexibility in the prevention approach and counseling process. Counselors should avoid a “one-size-fits-all” prevention message (e.g., “always use condoms”). Behaviors that are safe for one person might be risky for another.

For example, unprotected vaginal intercourse might be unsafe with anonymous partners whose HIV status is unknown, but safe for uninfected persons in a mutually monogamous relationship. The length of counseling sessions will vary depending on client risk and comfort (e.g., adolescents might require more time than adults).

• Provide skill-building opportunities. Depending on client needs, the counselor can demonstrate or ask the client to demonstrate problem-solving strategies such as a) communicating safer sex commitments to new or continuing sex partners; b) using male latex condoms properly; c) trying alternative preventive methods (e.g., female condoms); d) cleaning drug-injection equipment if clean syringes are unavailable; or e) communicating safer drug-injection commitments to persons with whom the client shares drug paraphernalia.

• Use explicit language when providing test results. Test results should be provided at the beginning of the follow-up session. Counselors should never ask the client to guess the test results. Technical information regarding the test can be provided through a brochure or other means so the session can focus on personal HIV risk reduction for clients with negative tests and other considerations for clients with positive or indeterminate test results (see Additional Counseling Considerations for Special Situations). In-depth, technical discussions of the “window period (i.e., the time from when a person is infected until they develop detectable HIV antibody) should be avoided because they could confuse the client and diffuse the importance of the HIV prevention message. Counselors should clarify that negative test results do not mean the client has no HIV risk and work with the client to reconsider ongoing HIV risk behaviors and the benefits of taking steps to reduce those risks. A client with ongoing risk behaviors should not be given a false sense of the safety of those behaviors (i.e., avoid statements like “whatever you were doing seems to be safe” or “continue to do whatever you are doing now”). These counseling elements are considered necessary for high-quality counseling. Specialists in the field (Technical Expert Panel Review of CDC HIV Counseling, Testing, and Referral Guidelines; February 18–19, 1999; Atlanta, Georgia) also suggested adoption of the following:

• Ensure that the client returns to the same counselor. Consistency of the client and counselor relationship helps the client feel secure, reduces misunderstanding, and promotes the likelihood of effective risk reduction. Effective counseling models tended to use the same counselor for all sessions. When follow-up prevention counseling sessions must be provided by a different counselor, careful record keeping is recommended to ensure high-quality counseling.

• Use a written protocol to help counselors conduct effective sessions. A structured protocol outlining session goals can help keep the counselor focused on risk reduction. The protocol can include examples of open-ended questions (to help a new counselor avoid closed-ended questions) and a list of explicit risk-reduction steps (to help a new counselor avoid accepting a client’s suggestion of global risk reduction steps).

• Ensure ongoing support by supervisors and administrators. Supervisory support is essential for effective counseling. Training in HIV counseling approaches that focus on personal risk reduction is recommended for persons supervising counselors. Staff appraisals should acknowledge that completion of critical counseling elements has higher priority than completion of paperwork.

• Avoid using counseling sessions for data collection. If required, paperwork should be completed at the end of the counseling session or by staff members who are not counseling. Checklist risk assessments driven by data collection forms are detrimental to effective counseling because they can encourage even skilled counselors to use closed-ended questions, limit eye contact, and miss critical verbal and nonverbal cues. The relevance of any routinely collected data should be periodically assessed.

• Avoid providing unnecessary information. An emphasis on providing information might prompt counselors to miss critical HIV prevention opportunities and cause clients to lose interest. Discussion of theoretical HIV risks (e.g., sex with a person with hemophilia or needle exposures through tattoos) tends to shift the focus away from the client’s actual HIV risk situations to topics that are more “comfortable” or easy to discuss but irrelevant to the client’s risk.

Prevention:

The essential elements of comprehensive prevention programs are based on several key principles and include a number of essential activities. These are highlighted below.

• A community planning process to ensure efforts are directed to communities at greatest risk

• Epidemiologic and behavioral surveillance to effectively guide prevention efforts

• Voluntary HIV counseling, testing, referral, and partner counseling to provide a pathway to needed prevention and treatment services

• Health education and risk-reduction activities, including individual-, group-, and community-level programs to provide the skills and support necessary for reducing risks

• Accessible diagnosis and treatment of other sexually transmitted diseases to decrease risk of HIV transmission

• School-based prevention efforts for youth to provide young people the skills and support they need to keep from initiating risky behaviors and to adopt healthy ones

• Public information programs to ensure that knowledge and awareness of how to prevent HIV remain high

• Training and quality assurance to provide those implementing programs needed skills

• Laboratory support to keep pace with diagnostic and testing services and related research efforts

• HIV prevention capacity-building activities to support organizations in expanding their abilities to implement effective programs

• An HIV prevention technical assistance assessment and plan to ensure that programs keep pace with prevention technologies

• Evaluation of major program activities, interventions, and services to ensure efforts are effective

The following components should be part of all HIV prevention counseling sessions:

Keep the session focused on HIV risk reduction. Each counseling session should be tailored to address the personal HIV risk of the client rather than providing a predetermined set of information.

Include an in-depth, personalized risk assessment. This assessment allows the counselor and client to identify, acknowledge, and understand the details and context of the client's HIV risk. Keeping the assessment personal, instead of global, will help the client identify concrete, acceptable protective measures to reduce personal HIV risk.

Acknowledge and provide support for positive steps already made. Exploring previous risk-reduction efforts is essential for understanding the strengths and challenges faced by the client in reducing risk.

Clarify critical rather than general misconceptions. In most situations, counselors should focus on reducing the client's current risk and avoid discussions regarding HIV transmission modes and the meaning of HIV test results. However, when clients believe they have minimal HIV risk but describe more substantial risk, the counselor should discuss the HIV transmission risk associated with specific behaviors or activities the clients describe and then discuss lower-risk alternatives.

Negotiate a concrete, achievable behavior-change steps that will reduce HIV risk. Although the optimal goal might be to eliminate HIV risk behaviors, small behavior changes can reduce the probability of acquiring or transmitting HIV. Behavioral risk-reduction steps should be acceptable to the client and appropriate to the client's situation.

Seek flexibility in the prevention approach and counseling process. Behaviors that are safe for one person might be risky for another.

Use explicit language when providing test results. Test results should be provided at the beginning of the follow-up session. Counselors should never ask the client to guess the test results. Technical information regarding the test can be provided through a brochure or other means so the session can focus on personal HIV risk reduction for clients with negative tests and other considerations for clients with positive or indeterminate test results.

Ensure that the client returns to the same counselor. Consistency of the client and counselor relationship helps the client feel secure, reduces misunderstanding, and promotes the likelihood of effective risk reduction.

Additional Counseling Considerations

Clients with newly identified HIV infection have immediate and long-term needs. Some clients might be better prepared to receive positive test results than others. The emotional impact of hearing an HIV-positive test result might prevent clients from clearly understanding information during the session in which they receive their results. Providers should provide appropriate referrals and, when necessary, additional sessions.

When a client receives the test result, the provider should ensure that the client understands it. As part of HIV prevention counseling, providers should explicitly discuss and clarify any misconceptions regarding HIV transmission risk to partners associated with specific sexual or needle-sharing activities. Clients should be advised to refrain from donating blood, plasma, or organs. For sexually active clients who are not in mutually monogamous partnerships, providers should also address strategies to prevent other sexually transmitted or blood borne infections (e.g., gonorrhea, syphilis, Chlamydia, herpes simplex virus, human herpes virus type 8, hepatitis B virus, hepatitis C virus, and cytomegalovirus).

The first few months after persons learn they are HIV infected are important for accessing medical and other support services to help them obtain treatment and establish and maintain behavior changes that reduce the likelihood of transmitting the virus to others. For example, persons with ongoing risks might be referred for prevention counseling to prevent transmission to others or for prevention case management. For all newly identified clients, a follow-up appointment 3--6 months after diagnosis is recommended.

Psychological Impact of AIDS

Communicating with children and extended family members can be very difficult for parents with HIV infection. Many parents appropriately choose to defer discussing their illness during the early stages of infection when health problems are minimal or nonexistent. As the disease progresses, parents may feel increased pressure to talk about the illness with children and family members, especially during times when parental functioning is disrupted (e.g., during hospitalizations or when the illness becomes debilitating).

Because parents may feel guilt or shame about behaviors associated with HIV infection (e.g., drug use, choice of partner), they may have difficulty communicating with their children and families about the disease. In addition, many adults believe that not telling children painful facts will somehow reduce the impact. Ultimately, children cannot be protected from the realities of parental illness and loss. Children need their parents to acknowledge the illness and to indicate, particularly as the parents’ health worsens, that the children’s needs will continue to be met. Emphasis is usually placed on parents simply disclosing their HIV status to their children; however, children need ongoing communication concerning parents’ health status and prognosis. Such communication could play an important role in decreasing children’s anxiety and increasing their ability to adapt to parental illness.

Nevertheless, health care providers should respect the wishes of parents who are either unwilling or unable to explain the nature of their illness to their children. Parents should be encouraged to discuss the more general issues surrounding illness and prognosis with their children. If, however, during the late stages of HIV disease, parents are still unable to discuss the situation with family members, primary care practitioners should consider referring patients to mental health or social services. Often the complex mental health and psychosocial issues holding parents back from revealing the truth about their illness require ongoing mental health intervention before parents can open up to their children or families.

Treatment of psychiatric disorders that result from or are comorbid with HIV infection

Psychiatric disorders associated with HIV/AIDS should be accurately identified and treated. In adults and children with HIV infection, changes in mental status or the emergence of new psychiatric or cognitive disorders require ruling out treatable and reversible causes; medical causes are of increasing concern if CD4 counts are low or viral load has begun to rise.

The more common diagnoses found in association with HIV/AIDS are dementia and the spectrum of cognitive disorders; delirium; mood disorders; substance use disorders; anxiety disorders; psychotic disorders; adjustment disorders; sleep disorders; disorders occurring in infants, children, and adolescents; and HIV-associated syndromes with psychiatric implications. Both psychopharmacologic and psychotherapeutic treatment strategies are often indicated.

The management of disturbances in mood, such as major depression or mania, for patients with HIV infection is similar to that for other patients with medical comorbidity [I]. Choice of an antidepressant or mood-stabilizing agent may be influenced by the antiretroviral regimen in place, and dose adjustments may be necessary if drug-drug interactions are likely. A wide array of antidepressant agents are effective in the treatment of HIV-associated major depression, including newer agents such as the selective serotonin reuptake inhibitors (SSRIs) and medications such as psychostimulants and testosterone. Psychotherapy, particularly interpersonal psychotherapy, either alone or in combination with antidepressant agents, is also an effective treatment for HIV-related depression. Mania associated with HIV infection, particularly late in the course of HIV disease, may be difficult to treat; however, treatment studies suggest that traditional antimanic agents are effective and tolerated.

The constellation of other disorders associated with HIV infection requires treatment. Substance use disorders are prevalent among persons with or at risk for HIV infection, and treatment is a high priority. Psychotherapist should be aware that by treating substance abuse, they may well be preventing HIV infection. One component of a comprehensive approach to HIV prevention among injection drug users is access to sterile syringes. Treatment of anxiety and sleep disorders among HIV-infected patients has not been well studied. For patients who are taking protease inhibitors, benzodiazepines are generally contraindicated because of drug-drug interactions. Thus, benzodiazepines should be given only as a short-term intervention in most instances. Psychotic symptoms in late-stage HIV infection are generally managed with atypical antipsychotic medications at the lowest effective dose, since standard neuroleptic medications have been associated with severe and difficult-to-treat extrapyramidal side effects. Adjustment disorders may require treatment with psychotherapy or medication to prevent progression to a more severe psychiatric disturbance. HIV-associated syndromes with psychiatric implications encompass wasting syndrome, fatigue, pain, and sexual dysfunction. Wasting syndrome has been effectively treated with testosterone (or its derivatives), growth hormone, and thalidomide. Psychostimulants are one of the main interventions used for fatigue. Chronic pain from peripheral neuropathy is often treated with tricyclic antidepressants and anticonvulsant medications, but published treatment studies of pain syndromes in patients with HIV infection have not supported their use. In men, HIV-related hypogonadism can be treated with testosterone replacement.

Treatment of children and adolescents with antiretroviral medications has increased survival rates and slowed progression to AIDS. The effectiveness of treatment of other mental and behavioral disorders associated with HIV infection in children and adolescents is largely unstudied.

Depression:

Clinical depression is the most commonly observed psychiatric disorder among patients with HIV infection and affects up to 20% of such patients. Multiple risk factors for depression exist in this group. The diagnosis of HIV infection itself may lead to sadness and fears of stigmatization. People with HIV infection who are members of stigmatized minorities may find it difficult to avoid internalizing negative self-images; moreover, HIV infection may result in wasting, weakness, pain, confusion, and disfigurement, which add to patients’ negative feelings. Although sadness and grief are normal responses to these factors, clinical depression, which causes substantial morbidity and may increase mortality, is not.

Practitioners should screen for depression on a yearly basis and more often when symptoms suggest. If the practitioner’s evaluation indicates depression, even though the patient denies that he or she is depressed, the diagnosis should be made and treatment should be strongly recommended. For diagnosis of depression, practitioners should be familiar with and use the diagnostic criteria established in the Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV).

Practitioners should be aware of potential side effects of all medications patients are taking. Specifically, efavirenz for HIV/AIDS and interferon-[1][1] for HCV are associated with episodes of depression varying in intensity. These medications may need to be discontinued or used with antidepressant therapy. Should these medications be continued, the primary care practitioner should work closely with a psychiatrist.

Because weight loss, irritability, restlessness, disturbed sleep, fatigue, anorexia, lethargy, or diminished interest in sex (all symptoms commonly observed in HIV-infected persons) may indicate depression, it is important for primary care practitioners to determine if patients are experiencing the effects of HIV, side effects of medications, or clinical depression.

HIV infection can lead to a confluence of severe medical, psychological, and social stresses that can result in alienation from family and friends, loss of job and income, and chronic physical pain. While many people who are infected with HIV think of suicide at some time, only a small minority of HIV-infected persons commit suicide. A great many people with HIV infection lead fulfilling lives (sometimes even more fulfilling after the HIV diagnosis); nevertheless, the potential for suicide in this population should be recognized.

Suicide

Prevalence studies of suicidality in patients infected with HIV have yielded varied results. One early retrospective study of medical examiner reports indicated a 36-fold greater prevalence of suicide in persons with HIV infection than in age-matched persons without HIV. A more recent study by the same investigators found only a small increase in the rate of suicide compared to other populations. In the general population, approximately 70% of suicides are committed by those who are depressed. Because anyone with HIV infection is likely to experience periods of intense sadness, thoughts of suicide are not uncommon. However, such factors as improved social support and prognosis can decrease the depth of true clinical depression and, therefore, the potential for suicide. The risk of suicide today may be less than that during earlier years of the epidemic when patients had fewer treatment options and a greater sense of isolation.

Anxiety Disorders

Mental Health Clinicians should recognize the distinct anxiety disorders that are common in persons with HIV infection. Anxiety is a common symptom in patients with HIV infection. When anxiety is severe or persistent, patients may have an anxiety disorder. These disorders include adjustment disorder, obsessive compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and generalized anxiety disorder. Primary care practitioners need to be aware of the differences among the specific disorders in order to appropriately treat or refer patients and to help them receive optimal care. People with histories of anxiety disorders or major depression and those with limited social support are particularly susceptible, although anyone can experience severe anxiety during the course of HIV infection. As HIV disease progresses, anxiety may increase.

I. DIAGNOSIS

When patients present with common medical symptoms (e.g., chest pain, diaphoresis, dizziness, gastrointestinal disturbances, and/or headache), practitioners should consider anxiety disorders when medical etiologies can not be established.

Mental health practitioners should be aware that disturbances of sleep patterns, which may result from illness or medication schedules, may lead to symptoms of anxiety and poor concentration during the day. Sleep management should be an adjunctive component of treatment in these patients.

A diagnosis of panic disorder or panic attack should be considered if the patient experiences episodic anxiety with multiple, overwhelming somatic symptoms that adversely affect his or her life (e.g., the patient dreads having another attack and avoids situations that might evoke panic) or the symptoms are sufficiently severe to require repeated emergency room visits.

Medical Conditions and Medications That May Cause Anxiety

Practitioners may need to exclude HIV-related central nervous system (CNS) disease or other medical conditions in patients who present with severe anxiety.

Practitioners should review the medication regimens of patients who present with sudden onset of anxiety without clear emotional cause and should obtain a thorough substance use history.

Patients can present with anxiety-like symptoms due to delirium, other medical conditions, medications, or substance use. For example, anxiety may be triggered by CNS pathologies, including HIV-related infections, hypoxia, and decreased perfusion of the brain, sepsis, delirium, dementia, metabolic imbalances, or endocrinopathies. In addition, patients may present with anxiety from the effects of withdrawal from caffeine, nicotine, alcohol, cocaine, and/or amphetamines.

PTSD (Post Traumatic Stress Disorder)

Although PTSD has a lifetime prevalence rate of approximately 1.3% to 7.8% in the general population, the rates of PTSD in the HIV-infected population are much higher. Although chronic illness can sometimes in itself be a traumatic experience leading to PTSD, more often a history of physical or psychological trauma (and diagnosis of PTSD) co-occurs with an individual’s HIV status.

Trauma can affect both psychological and physical functioning. Some research has suggested that the physical effects of trauma have been related to significant health problems such as diminished functioning of the immune system and increased susceptibility to infections. The psychological effects of PTSD may manifest themselves in increased risk-taking behavior, such as substance use, poor eating habits, or unsafe sexual activity. In addition, patients with PTSD may suffer from depression, self-isolation, impairments in trust and attachments, and feelings of anger. Patients with HIV/AIDS may also be affected by past trauma to the point that it manifests in disease-management problems such as disrupted or negative interactions with medical personnel and/or medication non-adherence.

Family Issues for Patients with HIV/AIDS

General Recommendations:

Practitioners should assess family configuration, functioning, and existing social support as part of the routine evaluation of patients who are primary caretakers of children. These assessments should ideally be done during times of stability. Practitioners should be aware of the impact of single parent homes, same sex parent homes, and teenage parent homes where there is little to no adult presence. Practitioners should refer children who present with behavioral changes in response to illness of a family member for mental health evaluation.

As more women of childbearing age become HIV infected, HIV/AIDS increasingly becomes a disease that involves the family. Primary care practitioners working with HIV-infected parents should, therefore, be aware of the needs of their patients' families, as the burden of HIV infection becomes much greater when children are involved. By providing treatment and solutions for common problems found in HIV-affected families, primary care practitioners help ease the pressure on these patients.

Family members of an HIV-infected person also may face particular difficulties. When confronted with the knowledge of a person's illness or lifestyle, family members can become confused or angry. If not addressed, these emotions can be turned against the HIV-infected person. Children who are infected must cope with and adapt to their own chronic and perhaps terminal illness. They often lack the emotional maturity that can help adults, yet they still must try to deal with the psychological effects that the disease can have on them and their families. Similarly, children who live with an HIV-infected family member must bear the psychological impact of this situation. The impact can be especially traumatic if the infected family member is the child's parent or sibling.

Assessing the family's configuration, functioning, and existing social support should be a routine part of evaluating an HIV-infected patient who is the primary caretaker of children. Determining how a family functioned and how family members interacted before the patient was diagnosed with HIV infection will allow primary care practitioners to assess more effectively family problems that may develop over the course of HIV disease.

Components of a basic assessment can be compiled by asking the following questions:

• Who makes up the household (including adults and children)?
• What are the relationships among household members?
• What are the ages of children and adolescents?
• If they don't live with the parents being assessed, with whom do they live?
• How do the patient's children and adolescents function?
• Are there problems at home or at school or during times of parent's illness?
• Are there people in the patient's extended families or social networks who
• can be called on during times of crisis?

I. COMMUNICATING HIV STATUS

Recommendations:

Practitioners should encourage patients with HIV infection to communicate with their children, family members, and significant others about the disease. If patients are reluctant to engage in these discussions, however, practitioners should respect their wishes (see Section V: Domestic Violence and HIV Infection).

Practitioners should consider referring patients with HIV infection for mental health or social services if they present with advanced HIV/AIDS without having informed their children and other relations about their disease.

Communicating with children and extended family members can be very difficult for parents with HIV infection. Many parents appropriately choose to defer discussing their illness during the early stages of infection when health problems are minimal or nonexistent. As the disease progresses, parents may feel increased pressure to talk about the illness with children and family members, especially during times when parental functioning is disrupted (e.g., during hospitalizations or when the illness becomes debilitating).

Because parents may feel guilt or shame about behaviors associated with HIV infection (e.g., drug use, choice of partner), they may have difficulty communicating with their children and families about the disease. In addition, many adults believe that not telling children painful facts will somehow reduce the impact. Ultimately, children cannot be protected from the realities of parental illness and loss. Children need their parents to acknowledge the illness and to indicate, particularly as parents' health worsens, that the children's needs will continue to be met. Emphasis is usually placed on parents simply disclosing their HIV status to their children; however, children need ongoing communication concerning parents' health status and prognosis. Such communication could play an important role in decreasing children's anxiety and increasing their ability to adapt to parental illness.

Nevertheless, health care providers should respect the wishes of parents who are either unwilling or unable to explain the nature of their illness to their children. Parents should be encouraged to discuss the more general issues surrounding illness and prognosis with their children. If, however, during the late stages of HIV disease, parents are still unable to discuss the situation with family members, primary care practitioners should consider referring patients to mental health or social services. Often the complex mental health and psychosocial issues holding parents back from revealing the truth about their illness require ongoing mental health intervention before parents can open up to their children or families.

II. ARRANGING FOR FUTURE CARE OF CHILDREN

Recommendations:

Primary care practitioners should refer parents to social service providers for assistance with formal and informal options, each having unique advantages and disadvantages, for the placement of children.

Primary care practitioners should also be aware of the permanency planning resources available to their patients.

When preparing for the possibility of death, HIV-infected parents face the difficult task of planning for their children's living arrangements. Any such planning is best done by taking into account family wishes and resources. Options that involve family court or children's services can take months to implement and, therefore, should be considered early enough in the course of the disease so that the plan may be operative and available when needed. In general, this planning is best carried out with the help of personnel familiar with the various options available to parents.

Protection against Swine Flu

2010-02-25T21:28:00.001-08:00

Protection from Swine Flu infection:

Wash your hands often.

Use hand sanitizer (such as Purell.)

Avoid touching things in public such as bannisters, doorknobs, countertops, etc..

Clean things such as doorknobs, telephone receivers, etc. with rubbing alcohol.

Avoid touching other people and pets.

Don't share food, drinks, cigarettes, etc. with others.

Encourage children to cover their mouth/nose when they cough or sneeze.

Stay home if you suspect you're sick.

Don't send sick children to school.

Consider use of herbs and other alternative remedies. Research to see what might be right

for you in your situation. Suggestions include Golden Seal, Elderberry Extract, Mushrooms, and Colloidal Silver (see links below.)

Wear a mask if you're in a place where Swine Flu is spreading.

Use a zapper.

Stock up on food, water, medication, or whatever else you need, and prepare to stay indoors while others in your community are sick.

MAIN SYMPTOMS:

[Some Swine Flu victims do not have all the symptoms.]

Fever and chills

Breathing difficulties

Coughing

Sore throat

Runny nose

Headaches

Muscle aches

Nausea and vomiting

Diarrhea

Lethargy

Medications:

According to the CDC, Swine Flu is resistant to the antiviral medications amantadine and rimantadine, but is sensitive to oseltamivir (Tamiflu) and zanamivir.

MEDICAL AUTHOR:

CHARLES PATRICK DAVIS, MD, PhD

Dr. Charles "Pat" Davis is a Clinical Professor in the Department of Surgery, Division of Emergency Medicine at the University of Texas Health Science Center at San Antonio (UTHSCSA) and is staff member at TexSan Heart Hospital, Department of Emergency Medicine, San Antonio. He actively practices clinical emergency medicine and teaches medical students, physician assistants, interns and residents. He has been the supervising professor for several successful PhD candidates.

Dr. Davis obtained a BS degree from St. Edward's University and a PhD in microbiology from the University of Texas, both in Austin, Texas. He completed his MD and residency training in Internal Medicine at the University of Texas Medical Branch (UTMB) in Galveston, Texas. He is Board Certified in Emergency Medicine and has served as an editor and chapter author for several medical textbooks. Dr. Davis has served as the Medical Director of the Emergency Center at UTMB and UTHSCSA. He does research and has published over 190 publications on many microbiological and emergency-medicine topics.

Dr. Davis lives in San Antonio, Texas, with his wife Barbara and son "Drew." They all share hobbies of water and snow skiing, fishing (especially eating the catch!), traveling, and reading. Dr. Davis also enjoys scuba.

Swine Flu UPDATE and Details

Swine Flu Details.

2010-02-25T20:02:00.000-08:00

UPDATE: World Health Organisation took us to Phase 6 on June 11, which only means that they see the distribution of the virus across the globe as being at levels associated with a flu pandemic, the first such declaration since 1968. The virus itself has not become any worse nor have the chances of any individual dying from the disease increased.

Swine flu is still with us although the media hype has died down. There have been numerous cases and many deaths, but nothing on the scale of the millions predicted early on. Could this first wave strain now be evolving into a more virulent form that will affect the northern hemisphere more severely after the summer is over?

I’ve previously discussed the many latent diseases in hosts as rodents, birds, and cattle. Many of these are ready and willing to make the species leap to humans given the opportunity. For the last ten years or so bird flu and Asia have been the focus of much research and concern. However, the wave of swine flu (H1N1) infections that began in March-April 2009 in Mexico highlight the fact that a potentially lethal strain of virus can emerge from other species and not necessarily in Asia.

Currently, not all the deaths attributed to swine flu have been definitively associated with type A H1N1 influenza, the actual mortality rate could be as low as 1% or as high as 6.5% depending on how you count.

Should we be worried?

No. We should be cautious, but not worried. While some observers are suggesting serious caution others are advising that there is no reason for real concern yet. We are not quite at the danger levels of even the worldwide SARS epidemic and certainly not close to the Spanish flu pandemic that ravaged the world in 1918-9.

Is the WHO scaremongering too?

The World Health Organization (WHO) has declared the Mexican/US swine flu outbreak as a “public health emergency of international concern”. It moved us to a Phase IV alert and then a Phase V alert and told us that the disease could no longer be contained. However, as things are panning out it would seem that this latest emergent virus is not even as bad as the common seasonal flu that kills tens of thousands of people every year. But, there a new strain could evolve in the coming weeks and months.

What is swine flu?

Swine flu is a type A influenza virus. It’s a subtype of H1N1 and is something of a misnomer.

Why is this new H1N1 virus called swine flu?

In the original testing many of the viral genes were shown to be similar to influenza viruses that normally occur in pigs in North America. But further studies have shown that this new virus is very different. It also has two genes from flu viruses present in European and Asian pigs as well as genes from bird flu and human flu strains. It is referred to as a “quadruple reassortant” virus.

What is unusual about the present strain?

The new strain is a hybrid of swine, human and avian flu viruses and the US Centers for Disease Control and Prevention (CDC) says it might spread from human to human but the level of virulence is not yet clear. UPDATE: There have been numerous deaths, but so far the vast majority of people infected have shown only mild symptoms and after treatment have recovered.

What are the symptoms?

Symptoms are similar to regular human flu: fever and chills, a cough, sore throat, aching limbs, headaches, and general malaise. However, there are reports of swine flu also causing diarrhoea and vomiting. Pneumonia and respiratory failure can occur leading to death as also happens in regular human flu.

Are there warning signs in children?

Children having trouble breathing, being averse to drinking, lethargy not waking up or not interacting, being so irritable that the child does not want to beheld, flu-like symptoms improve but then return with fever and worse cough, fever with a rash.

Are there any drugs to treat swine flu?

Oseltamivir (Tamiflu) and zanamivir (Relenza) are the possible pharmaceutical frontline defences against the virus and are proving effective in treating patients diagnosed early enough. There is as yet no vaccine, although researchers are working hard to develop one. It takes several months to create a flu vaccine and any such vaccine will be effective against only the specific strain for which it was created. By the time we have a vaccine the virus may have either died out or evolved into a different strain resistant to the vaccine.

Has the disease spread to the USA?

Cases in California, Texas, and Kansas, have been confirmed and tests are being carried out on students at a school in New York. Cases have been seen in New Zealand, Spain, Scotland, and elsewhere; those infected have been recovering well.

How can we prevent the spread of swine flu?

People at risk should cover their mouth when they cough. They should regularly wash their hands with an alcohol-based cleaner and and avoid close contact with the sick. Patients with the disease should stay at home. There is no need to avoid eating pork.

Will there be a global flu epidemic?

“We do not know whether this swine flu virus or some other influenza virus will lead to the next pandemic,” says, Richard Besser, acting director of the CDC, “However, scientists around the world continue to monitor the virus and take its threat seriously.” UPDATE: the WHO raised its alert level from Phase IV to V, with recent infection rates in Japan, the WHO has been hinting that they will need to upgrade to pandemic Phase VI.

Will there be a second wave?

One of two outcomes are being forecast, first that this rather poorly virulent strain will continue spreading slowly but ultimately die out, thanks to a combination of low virulence and monitoring and isolation of outbreaks, or secondly it will mutate into something much more virulent and bring with it a fast-spreading and more lethal wave of influenza. Thankfully, in the Northern hemisphere, we are heading into summer and influenza viruses do not spread as efficiently in the summer as they do in the winter.

What’s next?

It is impossible to predict what virus will emerge from which host, there are countless different types of pathogen lying dormant in the countless different mammals across the globe. No one predicted SARS, AIDS, Ebola, West Nile virus, or swine flu. This time, health agencies have responded well and although the WHO is saying it is now impossible to “contain” swine flu, it seems that the first wave is not revealing itself to be quite as lethal as was at first feared. However, that does not detract from the possibility of a second wave of H1N1 emerging.

Is this a wake-up call?

At the very least this swine flu outbreak should wake us all up to either getting the dust off our (bird flu) pandemic plans (as the response is the same) or getting started with putting them together. This includes both businesses and individuals. If the outbreak dies out quickly and this turns out not to be the next global pandemic then we can be sure another strain will try to be at some point in the future. Pandemic preparedness for businesses should now be at the forefront of every business manager’s mind.

What is cyberchondria?

Cyberchondria is an anxiety disorder related to hyperchondria and brought on by reading too many tweets with the #swineflu tag, listening to conspiracy theorists, and viewing online news stories about diseases that scare the sheesh kebab out of you. But, just because you’re paranoid does not mean the disease isn’t out to get you.

Protection Against Swain Flu

Obesity

2010-02-24T21:04:00.000-08:00

Weight Control:
If you are overweight, you are not alone. Sixty-six percent of adults in the U.S. are overweight or obese. Achieving a healthy weight can help you control your cholesterol, blood pressure and blood sugar. It might also help you prevent weight-related diseases, such as heart disease, diabetes, arthritis and some cancers.
Eating too much or not being physically active enough will make you overweight. To maintain your weight, the calories you eat must equal the energy you burn. To lose weight, you must use more calories than you eat. A weight-control strategy might include
Choosing low-fat, low-calorie foods
Eating smaller portions
Drinking water instead of sugary drinks
Being physically active
Weight Loss Surgery: Also called: Bariatric surgery, Bypass surgery, Gastric banding, Obesity surgery
If you're very overweight and can't lose pounds with a healthy diet and exercise, surgery might be an option for you. The surgery is usually for men who are at least 100 pounds overweight and women who are at least 80 pounds overweight. If you are somewhat less overweight, surgery still might be an option if you also have diabetes, heart disease or sleep apnea.
Weight loss surgery limits the amount of food you can take in. Some operations also restrict the amount of food you can digest. Many people who have the surgery lose weight quickly. If you follow diet and exercise recommendations, you can keep most of the weight off. The surgery has risks and complications, however, including infections, hernias and blood clots.

Fat Burning:
Learn how to burn fat and stay fit and healthy.
Whether you were once at your ideal weight and have recently become fat, or have been overweight all your adult life, you have now come to the right site and you will now burn the extra fat that has accumulated in your body.
Although burning fat can be an extremely difficult and often a frustrating experience, especially if you are impatient about seeing results, but by sticking to your fat burning exercise plan, eating properly, and employing a few of the fat burning tricks, you'll begin to notice the extra pounds slowly melting away. Some of these tricks may sound a little strange too but nobody has to know. Our Fat Burning section has been divided into four sub categories:.................................................................................................

*Obesity* For More Details Click Here

BOBY BUILDING

*BOBY BUILDING* For More Details Click Here.

Exercise and Physical Fitness

*Exercise and Physical Fitness* For More Details Click Here

Diet

2010-02-24T21:02:00.001-08:00

Diet and Nutrition’s play important role for getting the body you want. You have to eat good to look good. Then you look great! No matter what your goals are, 1 thing is the same. You need protein, and you don't need fat. That’s the most important role, Stay away from fatty foods. Like Cookies, chips, candy, chocolate, cake, fast food, fried food etc. all fatty food are not bad for you. Which in fish, nuts and some oils such as flax seed oil?

Use these 11 nutritional tips to increase your size and strength.

1- Consume lots of protein:

Consume at least one gram of protein per pound of bodyweight each day. For example, if you weight 150 pounds, you should be eating at least 150 grams of protein each and every day.

2 - Use nutritional supplements to enhance your nutritional program:

Nutritional supplements are meant to enhance an already great nutritional program. If you have the right combination of nutrients and the right nutrition program, a sport supplement schedule may serve to enhance your performance.
In order for nutrition supplements to function properly, they must be taken at the proper times and in the proper amounts. I suggest you do your homework when it comes to using weight loosing supplements and make an informed decision before consuming any powder, pill, or brew.
You will also want to ensure that the nutritional supplement manufacturer is well established in the industry and not a fly by Night Company.

3 - Eat 5-6 small meals a day:
Unlike most people's string of painfully low-calorie days, which puts the body in a fat-storing mode since it has no idea when it will be fed next, eating a small meal every three hours keeps our muscles in a fat-burning mode since they're receiving a steady but not excessive supply of nutrients. This practice also helps increase our energy levels and fight the hungry feeling that often leads to cheating with fat-building, between-meal snacks. Eating only 2-3 large meals a day like most people, however, can overwhelm our bodies. Since they can only use a certain amount of food at a time, the remainder will usually be stored as fat.
Here's an example schedule.
• Breakfast: eggs, whole-wheat toast, fruit etc.
• Mid-morning: protein shake such as Myoplex (I eat this meal in my P.E. class)
• Lunch: sandwich (meat, veggies, and whole-wheat bread) fruit or veggies etc.
• Mid-afternoon: anything that's good and healthy (I eat this one after school)
• Post workout: something with lots of protein- i.e. protein shake, protein bar etc.
• Supper: a good meal with protein and some whole grains and veggies.

4 - Consume lots of carbohydrates:

Consume at least 3 to 4 grams of carbohydrates per pound of bodyweight each day. Make sure that most of these carbohydrates come from compels sources such as pasta, rice, oatmeal, potatoes and yams and fibrous veggies such as broccoli and asparagus. The only time you should be feeding your body fast acting carbs is immediately after your workouts.
5 - Keep good fats in your meal plan:

While TV tells us that eating fat makes you fat, the reality of the situation is that since the "fat-free" craze began, studies are showing that Americans continue to get fatter and fatter. While limiting fat intake is a good idea, totally eliminating it is not. Besides being necessary for healthy skin and hair, fat is involved in the production of many hormones, including testosterone. That's why it's almost impossible to build muscle mass when on an extremely low fat diet. Fat also lowers the glycemic index of many high carb foods, so we don't get that huge fat-producing insulin surge commonly associated with eating fat-free goodies by them selves. More importantly, we need a certain amount of fat to process body fat metabolism. In other words, eating too little fat makes it harder for us to burn unwanted fat.
6 - Don't starve you:

Simply put, fat gains and losses are mathematical events. You're not going to look like a sleek, defined racehorse if you eat like a pig. It's important to eat enough good foods to maintain lean muscle mass, but not overindulging to the point of increasing fat storage. Since this line is an easy one to cross, I recommend writing down in a small notebook the calorie content and macronutrient breakdown (grams of protein, carbohydrates, and fat) of what you eat. This technique also helps keep me more focused on my goal.
7 - Diet ratio:

Your diet ratio should be 50 to 55% carbohydrates, 25 to 30% protein and 15 to 20% fat.
8 - Drink lot of water:

Drink water...lots of it! I try to drink at least 2 gallons a day during and in between my meals. Muscle is composed of 70 percent water. A high protein diet and intense exercise require more water since these are dehydrating activities. Water is needed to transport vitamins, minerals, and supplements and even foods throughout our bodies. if our water intake is too low, muscle fullness decreases and a toxic buildup of ammonia, urea, and other waste products can result. Contrary to popular belief, restricting water intake can actually lead to more water retention than providing the body with a steady supply.
9 - Consume more calories:

When boosting your caloric intake, gradually increase the amount of calories over a period of 7 to 10 days. This way, you are using the extra calories as fuel as opposed to storing it as fat. If you find yourself stuck, gradually increase the amount of calories per day.
10 - Eat whole grains:

No more white bread and flower. Eat whole-wheat bread and cook with whole-wheat flower. You will get more nutrients from them and they take longer to digest, so they stick with you longer.
11 - No meals within two hours of bedtime:

To prevent unwanted fat storage, I eat my biggest meals early in the day when I'm most active. I particularly limit my carbohydrate foods in later meals. I've found eating too close to bedtime is a good way to lose definition since my body doesn't burn the same level of calories during the sleeping maintenance mode as it does during the waking hours.

Smoking

2010-02-24T21:00:00.000-08:00

Smokeless Tobacco
Also called: Chewing tobacco, Dip, Oral tobacco, Snuff, Spit tobacco
Many people who chew tobacco or dip snuff think it's safer than smoking. But you don't have to smoke tobacco for it to be dangerous. Chewing or dipping carries risks like
• Cancer of the mouth
• Decay of exposed tooth roots
• Pulling away of the gums from the teeth
• White patches or red sores in the mouth that can turn to cancer
Recent research shows the dangers of smokeless tobacco may go beyond the mouth. It might also play a role in other cancers, heart disease and stroke.
Smokeless tobacco contains more nicotine than cigarettes. Nicotine is a highly additive drug that makes it hard to stop using tobacco once you start. Having a quit date and a quitting plan can help you stop successfully.
Smoking:Also called: Cigar smoking, Cigarette smoking, Pipe smoking, Tobacco smoking
There's no way around it. Smoking is bad for your health. Smoking harms nearly every organ of the body. Cigarette smoking causes 87 percent of lung cancer deaths. It is also responsible for many other cancers and health problems. These include lung disease, heart and blood vessel disease, stroke and cataracts. Women who smoke have a greater chance of certain pregnancy problems or having a baby die from sudden infant death syndrome (SIDS). Your smoke is also bad for other people - they breathe in your smoke secondhand and can get many of the same problems as smokers do.
Quitting smoking can reduce your risk of these problems. The earlier you quit, the greater the health benefit.
Quitting Smoking:Also called: Smoking cessation
Tobacco use is the most common preventable cause of death. About half of the people your blood pressure starts to return to normal. Your sense of smell and taste return and breathing starts to become easier. In the long term, giving up tobacco can help you live longer. Youwho don't quit smoking will die of smoking-related problems. Quitting smoking is important for your health and provides many benefits. Soon after you quit, your circulation begins to improve, andr risk of getting cancer decreases with each year you stay smoke-free.
Quitting is not easy. You may have short-term effects such as weight gain, irritability and anxiety. Some people try several times before succeeding. There are many ways to quit smoking. Some people stop "cold turkey." Others benefit from step-by-step manuals, counseling or medicines or products that help reduce nicotine addiction. Your health care provider can help you find the best way for you to quit. from the burning end of a cigarette, cigar or pipe and the smoke exhaled by the smoker.
Secondhand Smoke:
Also called: Environmental tobacco smoke, Passive smoking, Tobacco smoke pollution
You don't have to be a smoker for smoking to harm you. You can also have health problems from breathing in other people's smoke. Secondhand smoke is the combination of smoke that comes Secondhand smoke contains more than 50 substances that can cause cancer. Health effects of exposure to secondhand smoke include lung cancer, nasal sinus cancer, respiratory tract infections and heart disease.
There is no safe amount of secondhand smoke. Children, pregnant women, older people and people with heart or breathing problems should be especially careful.
Smoking and Youth: Also called: Teen smoking
Nearly a quarter of high school students in the U.S. smoke cigarettes. Another 8% use smokeless tobacco. Smoking has many health risks for everyone. However, the younger you are when you start smoking, the more problems it can cause. For example:

• People who start smoking before the age of 21 have the hardest time quitting.

• About 30% of youth smokers will continue smoking and die early from a smoking-related disease.

• Teen smokers are more likely to use alcohol and illegal drugs.

• They are more likely to have panic attacks, anxiety disorders and depression.

Parents and other adults who work with children can help by warning them of the risks of smoking. They can also set a good example by not smoking themselves.

Depression

2010-02-24T20:55:00.003-08:00

Depression:
Also called: Clinical depression, Dysthymic disorder, Major depressive disorder, Unipolar depression.

Depression is a serious medical illness that involves the brain. It's more than just a feeling of being "down in the dumps" or "blue" for a few days. If you are one of the more than 20 million people in the United States who have depression, the feelings do not go away. They persist and interfere with your everyday life. Symptoms can include.

• Sadness.
• Loss of interest or pleasure in activities you used to enjoy.
• Change in weight.
• Difficulty sleeping or over sleeping .
• Energy loss.
• Feelings of worthlessness.
• Thoughts of death or suicide.

Suicide:

Suicide is the eleventh most common cause of death in the United States. People may consider suicide when they are hopeless and can't see any other solution to their problems. Often it's related to serious depression, alcohol or substance abuse or a major stressful event.
People who have the highest risk of suicide are white men, though women and teens report more suicide attempts. If someone talks about suicide, you should take it seriously. Urge them to get help from their doctor or the emergency room, or call 911.
Therapy and medicines can help most people who have suicidal thoughts. Treating mental illnesses and substance abuse can reduce the risk of suicide.

Alcoholism:

Also called: Alcohol dependence.

For most adults, moderate alcohol use is not harmful. However, nearly 17.6 million adults in the United States are alcoholics or have alcohol problems. Alcoholism is a disease with four main features:
• Craving - a strong need to drink
• Loss of control - not being able to stop drinking once you've begun
• Physical dependence – withdrawal symptoms, such as nausea, sweating or shakiness after stopping drinking
• Tolerance - the need to drink greater amounts of alcohol in order to get “high”
Alcoholism carries many serious dangers. Heavy drinking can increase the risk of certain cancers. It can cause damage to the liver, brain and other organs. It can cause birth defects It increases the risk of death from car crashes and other injuries as well as the risk of homicide and suicide.

Antidepressants:

Also called: Selective serotonin reuptake inhibitors, Tricyclic antidepressants.

Antidepressants are medicines that treat depression. Your doctor can prescribe them for you. They can improve your mood, sleep, appetite and concentration. It may take several weeks for them to help. There are several types of antidepressants. You and your doctor may have to try several before finding what works best for you.

Medicines sometimes cause unwanted side effects. For example, when you first start your antidepressant you may feel tired, have trouble sleeping or feel sick to your stomach. The side effects usually go away after a short time. Tell your doctor if you have any side effects. You should also let your doctor know if you take any other
It is important to keep taking your medicines, even if you feel better. Do not stop taking your medicines without talking to your doctor. You often need to stop antidepressants gradually.

Is it Bipolar Disorder or Depression? For More Details

*Stress* For More Details

*Deperession* For More Details

*Headache* For More Details

*Phobias* For More Details

*Panic* For More Details

Disease

2010-02-24T20:48:00.003-08:00

Depression:
Also called: Clinical depression, Dysthymic disorder, Major depressive disorder, Unipolar depression.

Alcoholism:

Also called: Alcohol dependence.

Antidepressants:

Also called: Selective serotonin reuptake inhibitors, Tricyclic antidepressants.

Is it Bipolar Disorder or Depression? For More Details

*Stress* For More Details

*Deperession* For More Details

*Headache* For More Details

*Phobias* For More Details

*Panic* For More Details

*Blood Pressure* For More Details

*Diabetes* For More Details

ENT

2010-02-24T20:01:00.000-08:00

Ear Disorders:

Your ear has three main parts: outer, middle and inner. You use all of them in hearing. Sound waves come in through your outer ear. They reach your middle ear, where they make your eardrum vibrate. The vibrations are transmitted through three tiny bones, called ossicles, in your middle ear. The vibrations travel to your inner ear, a snail-shaped organ. The inner ear makes the nerve impulses that are sent to the brain. Your brain recognizes them as sounds. The inner ear also controls balance.

A variety of conditions may affect your hearing or balance. Ear infections are the most common illness in infants and young children. Tinnitus, a roaring in your ears, can be the result of loud noises, medicines or a variety of other causes. Meniere's disease may be the result of fluid problems in your inner ear; its symptoms include tinnitus and dizziness. Some ear disorders can result in hearing disorders and deafness.

Ear Infections:

Also called: Otitis media

Ear infections are the most common illnesses in babies and young children. Most often, the infection affects the middle ear and is called otitis media. The tubes inside the ears become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that fluid.
If your child does not yet talk, you need to look for signs of an infection:

Tugging at ears
Crying more than usual
Ear drainage
Trouble sleeping
Balance difficulties
Hearing problems

Often, ear infections go away on their own, but your health care provider may recommend pain relievers. Severe infections and infections in young babies may require antibiotics. Children who get frequent infections may need surgery to place small tubes inside their ears. The tubes relieve pressure in the ears so that the child can hear again.

Meniere's Disease:

Meniere's disease can cause severe dizziness, a roaring sound in your ears called tinnitus, hearing loss that comes and goes and the feeling of ear pressure or pain. It usually affects just one ear. It is a common cause of hearing loss.

Scientists don't yet know the cause. They think that it has to do with the fluid levels or the mixing of fluids in the canals of your inner ear. Symptoms occur suddenly and can happen as often as every day or as seldom as once a year. An attack can be a combination of severe dizziness or vertigo, tinnitus and hearing loss lasting several hours.

There is no cure. However, you may be able to control symptoms by changing your diet or taking medicine so that your body retains less fluid. Severe cases may require surgery.

Nose Disorders:

Also called: Nasal disorders

Whether it's large or small, button-like or beak-like, your nose is important to your health. It filters the air you breathe, removing dust, germs and irritants. It warms and moistens the air to keep your lungs and tubes that lead to them from drying out. Your nose also contains the nerve cells that help your sense of smell. When there is a problem with your nose, your whole body can suffer. For example, the stuffy nose of the common cold can make it hard for you to breathe, sleep or get comfortable.

Many problems besides the common cold can affect the nose. They include

Deviated septum - a shifting of the wall that divides the nasal cavity into halves
Nasal polyps - soft growths that develop on the lining of your nose or sinuses
Nosebleeds
Rhinitis - inflammation of the nose and sinuses sometimes caused by allergies. The main symptom is a runny nose

Common Cold:

Sneezing, sore throat, a stuffy nose, coughing - everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people in the United States suffer 1 billion colds.

You can get a cold by touching your eyes or nose after you touch surfaces with cold germs on them. You can also inhale the germs. Symptoms usually begin 2 or 3 days after infection and last 2 to 14 days. Washing your hands and staying away from people with colds will help you avoid colds.
There is no cure for the common cold. For relief, try

Getting plenty of rest
Drinking fluids
Gargling with warm salt water
Using cough drops or throat sprays - but not cough medicine for children under four
Taking over-the-counter pain or cold medicines
However, do not give aspirin to children. And do not give cough medicine to children under four.

Cold and Cough Medicines

Sneezing, sore throat, a stuffy nose, coughing -- everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people in the United States suffer 1 billion colds.

What can you do for your cold or cough symptoms? Besides drinking plenty of fluids and getting plenty of rest, you may want to take medicines. There are lots of different cold and cough medicines, and they do different things.

Nasal decongestants - unclog a stuffy nose
Cough suppressants - quiet a cough
Expectorants - loosen mucus so you can cough it up
Antihistamines - stop runny noses and sneezing
Pain relievers - ease fever, headaches, and minor aches and pains

Here are some other things to keep in mind about cold and cough medicines. Read labels, because many cold and cough medicines contain the same active ingredients. Taking too much of certain pain relievers can lead to serious injury. Do not give cough medicines to children under four, and don't give aspirin to children. Finally, antibiotics won’t help a cold.

Throat Disorders:

Also called: Pharyngeal disorders

Your throat is a tube that carries food to your esophagus and air to your windpipe and larynx. The technical name for throat is pharynx.

Throat problems are common. You've probably had a sore throat The cause is usually a viral infection, but other causes include allergies, infection with strep bacteria or the upward movement of stomach acids into the esophagus, called gastric reflux.

Other problems that affect the throat include

Tonsillitis - an infection in the tonsils

Pharyngitis - inflammation of the pharynx

Cancers

Tonsils and Adenoids:

Your tonsils and adenoids are part of your lymphatic system. Your tonsils are in the back of your throat and your adenoids are higher up, behind your nose. They help protect you from infection by trapping germs coming in through your mouth and nose. Sometimes your tonsils and adenoids become infected themselves. Tonsillitis makes your tonsils sore and swollen. Enlarged adenoids can be sore, make it hard to breathe and cause ear problems.

The first treatment for infected tonsils and adenoids is antibiotics. If you have frequent infections or trouble breathing, you may need surgery. Surgery to remove the tonsils is tonsillectomy. Surgery to remove adenoids is adenoidectomy.

Tuberculosis

2010-02-24T19:53:00.000-08:00

Also called: TB

Tuberculosis (TB) is a bacterial infection caused by a germ called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes or talks. If you have been exposed, you should go to your doctor for tests. You are more likely to get TB if you have a weak immune system.

Symptoms of TB in the lungs may include

A bad cough that lasts 3 weeks or longer

Weight loss
Coughing up blood or mucus
Weakness or fatigue
Fever and chills
Night sweats

If not treated properly, TB can be deadly. You can usually cure active TB by taking several medicines for a long period of time. People with latent TB can take medicine so that they do not develop active TB.

AIDS

2010-02-24T19:45:00.000-08:00

Also called: Acquired immunodeficiency syndrome, HIV, Human immunodeficiency virus

AIDS stands for acquired immunodeficiency syndrome. It is the most advanced stages of infection with the human immunodeficiency virus (HIV). HIV is a virus that kills or damages cells of the body's immune system.

HIV most often spreads through unprotected sex with an infected person. AIDS may also spread by sharing drug needles or through contact with the blood of an infected person. Women can give it to their babies during pregnancy or childbirth.

The first signs of HIV infection may be swollen glands and flu-like symptoms. These may come and go a month or two after infection. Severe symptoms may not appear until months or years later.

There is no cure, but there are many medicines to fight both HIV infection and the infections and cancers that come with it. People can live with the disease for many years.

AIDS and Pregnancy

If you have AIDS and find out you are pregnant or think you may be pregnant, you should let your health care provider know as soon as possible. Some AIDS medicines may harm your baby. Your health care provider may want you to take different medicines or change the doses.

It is also possible to give HIV, the virus that causes AIDS, to your baby. This is most likely to happen around the time you give birth. For this reason, treatment during this time is very important for protecting your baby from infection. Several treatments can help the virus from spreading from you to your baby. Your health care provider can recommend the best one for you.

Your baby will also need to have treatment for at least the first six weeks of life. Regular testing will be needed to find out if your baby is infected.
AIDS Medicines:

In the early 1980s, when the AIDS epidemic began, AIDS patients rarely lived longer than a few years. But today, people infected with HIV, the virus that causes AIDS, have longer and healthier lives. The main reason is that there are many effective medicines to fight the infection.

Most medicines fall into one of the following three categories
• Reverse transcriptase (RT) inhibitors. These medicines interfere with a critical step during the HIV life cycle and keep the virus from reproducing.
• Protease inhibitors. These medicines interfere with a protein that HIV uses to produce infectious viral particles.
• Fusion inhibitors. These medicines block the virus from entering the body's cells.

While these medicines help people with HIV, they are not perfect. They do not cure HIV infection or AIDS. People with HIV infection still have the virus in their bodies, so even when they are taking medicines they can transmit HIV to others through unprotected sex and needle sharing.

AIDS--Living with AIDS:

Infection with HIV, the virus that causes AIDS, is serious. But the outlook for people with HIV and AIDS is improving. If you are infected with HIV, there are many things you can do to help ensure you have a longer, healthier life. One important thing is to take your medicines. Make sure you have a health care provider who knows how to treat HIV. You may want to join a support group. Learn as much as you can about your disease and its treatment. And eat healthy foods and exercise regularly - things that everyone should try to do.

AIDS and Infections:

Also called: AIDS-related opportunistic infections, OIs

Having AIDS weakens your body's immune system. Your immune system normally fights germs that enter your body. When AIDS makes it weak, it can't fight germs well. This can lead to serious infections that don't often affect healthy people. These are called opportunistic infections (OIs).

There are many types of OIs. Tuberculosis and a serious related disease, Mycobacterium avium complex (MAC) are bacterial infections. Viral infections include cytomegalovirus (CMV) and hepatitis C. Fungi cause thrush (candidiasis), cryptococcal meningitis, pneumocystis carinii pneumonia (PCP) and histoplasmosis, and parasites cause crypto (cryptosporidiosis) and toxo (toxoplasmosis).

Having AIDS can make any infection harder to treat. People with AIDS are also more likely to suffer complications of common illnesses such as the flu.

The good news is that you can help prevent infections by taking your AIDS medicines. Other things that can help include practicing safe sex, washing your hands well and often and cooking your food well.

HIV AIDS Complete Details

HIV AIDS and Hepatitis B & C

Fever

2010-02-24T19:19:00.000-08:00

Malaria:

Malaria is a serious disease caused by a parasite. Infected mosquitoes spread it. Malaria is a major cause of death worldwide, but it is almost wiped out in the United States. The disease is mostly a problem in developing countries with warm climates. If you travel to these countries, you are at risk. There are four different types of malaria caused by four related parasites. The most deadly type occurs in Africa south of the Sahara Desert.

Malaria symptoms include chills, flu-like symptoms, fever, vomiting, diarrhea and jaundice. The disease can be life-threatening. However, you can treat malaria with medicines. The type of medicine depends on which kind of malaria you have and where you were infected.

Malaria can be prevented. When traveling to malaria-prone regions

• See your doctor for medicines that protect you
• Wear insect repellent with DEET
• Cover up
• Sleep under mosquito netting

Fever:

Also called: Pyrexia

A fever is a body temperature that is higher than normal. It is not an illness. It is part of your body's defense against infection. Most bacteria and viruses that cause infections do well at the body's normal temperature (98.6 F). A slight fever can make it harder for them to survive. Fever also activates your body's immune system.

Infections cause most fevers. There can be many other causes, including

• Medicines
• Heat exhaustion
• Cancers
• Autoimmune diseases

Treatment depends on the cause of your fever. Your health care provider may recommend using over-the-counter medicines such as acetaminophen or ibuprofen to lower a very high fever. Adults can also take aspirin, but children with fevers should not take aspirin. It is also important to drink enough liquids to prevent dehydration.

Infectious Diseases:

Also called: Communicable diseases

Infectious diseases kill more people worldwide than any other single cause. Infectious diseases are caused by germs. Germs are tiny living things that are found everywhere - in air, soil and water. You can get infected by touching, eating, drinking or breathing something that contains a germ. Germs can also spread through animal and insect bites, kissing and sexual contact. Vaccines, proper hand washing and medicines can help prevent infections.

There are four main kinds of germs:
Bacteria - one-celled germs that multiply quickly and may release chemicals which can make you sick
Viruses - capsules that contain genetic material, and use your own cells to multiply
Fungi - primitive vegetables, like mushrooms or mildew
Protozoa - one-celled animals that use other living things for food and a place to live

Bacterial Infections:

Bacteria are living things that have only one cell. Under a microscope, they look like balls, rods or spirals. They are so small that a line of 1,000 could fit across a pencil eraser. Most bacteria won't hurt you - less than 1 percent makes people sick. Many are helpful. Some bacteria help to digest food, destroy disease-causing cells and give the body needed vitamins. Bacteria are also used in making healthy foods like yogurt and cheese.

But infectious bacteria can make you ill. They reproduce quickly in your body. Many give off chemicals called toxins, which can damage tissue and make you sick. Examples of bacteria that cause infections include Streptococcus, Staphylococcus, and E. coli.

Antibiotics are the usual treatment. When you take antibiotics, follow the directions carefully. Each time you take antibiotics, you increase the chances that bacteria in your body will learn to resist them. Later, you could get or spread an infection that those antibiotics cannot cure.

Viral Infections:

Viruses are capsules with genetic material inside. They are very tiny, much smaller than bacteria. Viruses cause familiar infectious diseases such as the common cold, flu and warts. They also cause severe illnesses such as AIDS, smallpox and hemorrhagic fevers.

Viruses are like hijackers. They invade living, normal cells and use those cells to multiply and produce other viruses like themselves. This eventually kills the cells, which can make you sick.

Viral infections are hard to treat because viruses live inside your body's cells. They are "protected" from medicines, which usually move through your bloodstream. Antibiotics do not work for viral infections. There are a few antiviral medicines available. Vaccines can help prevent you from getting many viral diseases.

heart Disease details

2010-02-24T19:00:00.000-08:00

Coronary Artery Disease:

Also called: CAD, Coronary arteriosclerosis, Coronary atherosclerosis

Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. As the buildup grows, less blood can flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage.

Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can't pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart.

Heart Transplantation:

A heart transplant removes a damaged or diseased heart and replaces it with a healthy one. The healthy heart comes from a donor who has died. It is the last resort for people with heart failure when all other treatments have failed. Heart transplants are now the third most common organ transplant operation in the U.S.

Doctors may recommend a heart transplant for heart failure caused by
• Coronary artery disease
• Cardiomyopathy - disease of the heart muscle
• Heart valve disease
• In babies, multiple congenital heart defects that are too complex to repair

Cardiomyopathy:

Also called: Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Myocardiopathy, Restrictive cardiomyopathy

Cardiomyopathy refers to diseases of the heart muscle. These diseases enlarge your heart muscle or make it thicker and more rigid than normal. In rare cases, scar tissue replaces the muscle tissue.

Some people live long, healthy lives with cardiomyopathy. Some people don't even realize they have it. In others, however, it can make the heart less able to pump blood through the body. This can cause serious complications, including

• Heart failure
• Abnormal heart rhythms
• Fluid buildup in your lungs or legs
• Endocarditis, an inflammation of the heart lining

Heart attacks, high blood pressure or infections can all cause cardiomyopathy. Some types of cardiomyopathy run in families. In many people, however, the cause is unknown. Treatment might involve medicines, surgery, other medical procedures and lifestyle changes.

Arrhythmia:

Also called: Irregular heartbeat

Has your heart ever skipped a beat? Sometimes it really does if you have an arrhythmia. An arrhythmia is any disorder of your heart rate or rhythm. It means that your heart beats too quickly, too slowly or with an irregular pattern. When the heart beats faster than normal, it is called tachycardia. When the heart beats too slowly, it is called bradycardia.

Many factors can affect your heart's rhythm, such as having had a heart attack, blood chemistry imbalances or abnormal hormone levels. Some substances or medicines may also cause arrhythmias.

Symptoms of arrhythmias include

• Fast or slow heart beat
• Skipping beats
• Lightheadedness, dizziness
• Chest pain
• Shortness of breath
• Paleness
• Sweating

Your doctor can run tests to find out if you have an arrhythmia. Treatment to restore a normal heart rhythm may include medicines, an implantable cardioverter-defibrillator (ICD) or a pacemaker.

Heart Diseases--Prevention:

Heart disease is the leading cause of the death in the U.S. Over one quarter of all deaths are from heart disease. It is also a major cause of disability. The risk of heart disease increases as you age. You have a greater risk of heart disease if you are a man over age 45 or a woman over age 55. You also are at greater risk if you have a close family member who had heart disease at an early age.

Fortunately, there are many things you can do reduce your chances of getting heart disease. You should

• Know your blood pressure and keep it under control
• Exercise regularly
• Don't smoke
• Get tested for diabetes and if you have it, keep it under control
• Know your cholesterol and triglyceride levels and keep them under control
• Eat a lot of fruits and vegetables
• Maintain a healthy weight

Triglycerides:

Triglycerides are a type of fat in the bloodstream and fat tissue. Too much of this type of fat can contribute to the hardening and narrowing of your arteries. This puts you at risk of having a heart attack or stroke. Diseases such as diabetes, obesity, kidney failure or alcoholism can cause high triglycerides. Often, high triglycerides occur along with high levels of cholesterol, another type of fat.

Triglycerides are measured along with cholesterol as part of a blood test. Normal triglyceride levels are below 150. Levels above 200 are high. If your triglyceride level is high, you can lower it by

• Getting medical treatment for the problem causing the high triglycerides
• Following a healthy diet low in sugars and carbohydrates
• Exercising regularly
• Taking cholesterol-lowering medicines

Heart Disease

Heart Diseases

2010-02-24T18:28:00.000-08:00

Also called: Cardiac disease

If you're like most people, you think that heart disease is a problem for other folks. But heart disease is the number one killer in the U.S. It is also a major cause of disability. There are many different forms of heart disease. The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and happens slowly over time. It's the major reason people have heart attacks.

Other kinds of heart problems may happen to the valves in the heart, or the heart may not pump well and cause heart failure. Some people are born with heart disease.

You can help reduce your risk of heart disease by taking steps to control factors that put you at greater risk:

• Control your blood pressure

• Lower your cholesterol
• Don't smoke
• Get enough exercise

Heart Attack:
Also called: MI, Myocardial infarction

Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include

• Chest discomfort - pressure, squeezing, or pain
• Shortness of breath
• Discomfort in the upper body - arms, shoulder, neck, back
• Nausea, vomiting, dizziness, lightheadedness, sweating

These symptoms can sometimes be different in women.

What exactly is a heart attack? Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat – called an arrhythmia - that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die.

Heart Disease in Women:

Although many people think of heart disease as a man's problem, women can and do get heart disease. In fact, heart disease is the number one killer of women in the United States. It is also a leading cause of disability among women.

The most common cause of heart disease is narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart itself. This is called coronary artery disease and happens slowly over time. It's the major reason people have heart attacks. Prevention is important: two-thirds of women who have a heart attack fail to make a full recovery.

The older a woman gets, the more likely she is to get heart disease. But women of all ages should be concerned about heart disease. All women can take steps to prevent it by practicing healthy lifestyle habits.

Heart Valve Diseases:

Also called: Valvular heart disease

Your heart has four valves. Normally, these valves open to let blood flow through or out of your heart, and then shut to keep it from flowing backward. But sometimes they don't work properly. What can happen?

• Blood can leak back through the valve in the wrong direction, which is called regurgitation

• One of the valves, the mitral valve, sometimes has "floppy" flaps and doesn't close tightly. This is called mitral valve prolapse, and it's one of the most common heart valve conditions. Sometimes it causes regurgitation

• When the valve doesn't open enough, which blocks blood flow, it is called stenosis

Valve problems can be present at birth or caused by infections, heart attacks, or heart disease or damage. Some valve problems are minor and do not need treatment. Others might require medicine, medical procedures or surgery to repair or replace the valve.

Mitral Valve Prolepses:

Also called: Barlow's syndrome, Floppy valve syndrome, MVP

Mitral valve prolepses (MVP) occur when one of your heart's valves doesn't work properly. MVP is one of the more common heart valve conditions. Most often, it's a lifelong condition that a person is born with. Most people with MVP have no symptoms or problems, need no treatment, and are able to lead normal, active lives.

MVP puts you at risk for infective endocarditic, a kind of heart infection.To prevent it, doctors used to prescribe antibiotics before dental work or certain surgeries. Now, only people at high risk of endocarditis need the antibiotics.

If you need treatment for MVP, medicines can help relieve symptoms or prevent complications. Very few people will need surgery to repair or replace the mitral valve.

Endocarditic:

Endocarditic is an inflammation of your heart's inner lining. The most common type, bacterial endocarditic, occurs when germs enter your heart. These germs come through your bloodstream from another part of your body, often your mouth. Bacterial endocarditic can damage your heart valves. If untreated, it can be life-threatening. It is rare in healthy hearts. Coronary Artery Disease

Risk factors include having

• An abnormal or damaged heart valve
• A severe case of mitral valve prolepses
• An artificial heart valve
• Certain heart defects

If you have a high risk of bacterial endocarditic, your doctor might prescribe antibiotics before dental work and certain types of surgery.

Early treatment can help you avoid complications. Symptoms you might notice include fever, shortness of breath, fluid buildup in your arms or legs, tiny red spots on your skin and weight loss. Treatment usually involves high-dose antibiotics.

prevent it, doctors used to prescribe antibiotics before dental work or certain surgeries. Now, only people at high risk of endocarditic need the antibiotics.

If you need treatment for MVP, medicines can help relieve symptoms or prevent complications. Very few people will need surgery to repair or replace the mitral valve.

Heart Diseases Details

Diabetic Kidney & Eye Problems

2010-02-21T17:01:00.000-08:00

Also called: Diabetic nephropathy

If you have diabetes, your blood sugar levels are too high. Over time, this can damage your kidneys. Your kidneys are filters that clean your blood. If they are damaged, waste and fluids build up in your blood instead of leaving your body.

Kidney damage from diabetes is called diabetic nephropathy. It begins long before you have symptoms. An early sign of it is small amounts of protein in your urine. A urine test can detect it. A blood test can also help determine how well your kidneys are working.

If the damage continues, your kidneys could fail. In fact, diabetes is the most common cause of kidney failure in the United States. People with kidney failure need either dialysis or a kidney transplant.

You can slow down kidney damage or keep it from getting worse. Controlling your blood sugar and blood pressure, taking your medicines and not eating too much protein can help.

Diabetic Eye Problems

Also called: Diabetic retinopathy

Do you know what causes the most blindness in U.S. adults? It is an eye problem caused by diabetes, called diabetic retinopathy. Your retina is the light-sensitive tissue at the back of your eye. You need a healthy retina to see clearly.

Diabetic retinopathy happens when diabetes damages the tiny blood vessels inside your retina. You may not notice at first. Symptoms can include

• Blurry or double vision
• Rings, flashing lights or blank spots
• Dark or floating spots
• Pain or pressure in one or both of your eyes
• Trouble seeing things out of the corners of your eyes

If you have diabetes, you should have a complete eye exam every year. Finding and treating problems early may save your vision. Treatment often includes laser treatment or surgery.

Diabetes Complications

Diabetes Medicines

Diabetic Nerve Problems

Diabetic Foot

Diabetic Pregnancy & Diabetic Diet

Diabetic Kidney & Eye Problems

Diabetes and Pregnancy & Diabetic Diet

2010-02-21T16:57:00.000-08:00

Also called: Gestational diabetes

Diabetes is a disease in which your blood glucose, or sugar, levels are too high. When you are pregnant, too much glucose is not good for your baby. Out of every 100 pregnant women in the United States, between three and eight get gestational diabetes. Gestational diabetes is diabetes that happens for the first time when a woman is pregnant. Gestational diabetes goes away when you have your baby, but it does increase your risk for having diabetes later.

If you already have diabetes before you get pregnant, you need to monitor and control your blood sugar levels.

Either type of diabetes during pregnancy raises the risk of problems for the baby and the mother. To help reduce these risks, you should follow your meal plan, exercise, test your blood sugar and take your medicine.

Diabetic Diet:

If you have diabetes, your body cannot make or properly use insulin. This leads to high blood glucose, or sugar, levels in your blood. Healthy eating helps to reduce your blood sugar. It is a critical part of managing your diabetes, because controlling your blood sugar can prevent the complications of diabetes.

Wise food choices are a foundation of diabetes treatment. Diabetes experts suggest meal plans that are flexible and take your lifestyle and other health needs into account. A registered dietitian can help you design a meal plan.

Healthy diabetic eating includes

• Limiting sweets
• Eating often
• Being careful about when and how many carbohydrates you eat
• Eating lots of whole-grain foods, fruits and vegetables
• Eating less fat
• Limiting your use of alcohol

Diabetes Complications

Diabetes Medicines

Diabetic Nerve Problems

Diabetic Foot

Diabetic Pregnancy & Diabetic Diet

Diabetic Kidney & Eye Problems

Diabetic Foot

2010-02-21T16:55:00.000-08:00

If you have diabetes, your blood sugar levels are too high. Over time, this can damage your nerves or blood vessels. Nerve damage from diabetes can cause you to lose feeling in your feet. You may not feel a cut, a blister or a sore. Foot injuries such as these can cause ulcers and infections. Serious cases may even lead to amputation. Damage to the blood vessels can also mean that your feet do not get enough blood and oxygen. It is harder for your foot to heal, if you do get a sore or infection.

You can help avoid foot problems. First, control your blood sugar levels. Good foot hygiene is also crucial.

Diabetes Complications

Diabetes Medicines

Diabetic Nerve Problems

Diabetic Foot

Diabetic Pregnancy & Diabetic Diet

Diabetic Kidney & Eye Problems

Diabetes Medicines

2010-02-21T16:53:00.000-08:00

Diabetes means your blood glucose, or blood sugar, is too high. If you can't control your diabetes with wise food choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends on your type of diabetes, your schedule, and your other health conditions.

With Type 1 diabetes, your pancreas does not make insulin. Insulin is a hormone that helps glucose gets into your cells to give them energy. Without insulin, too much glucose stays in your blood. If you have type 1 diabetes, you will need to take insulin.

Type 2 diabetes, the most common type, can start when the body doesn't use insulin as it should. If your body can't keep up with the need for insulin, you may need to take pills. Some people need both insulin and pills. Along with meal planning and physical activity, diabetes pills help people with type 2 diabetes or gestational diabetes keep their blood glucose levels on target. Several kinds of pills are available. Each works in a different way. Many people take two or three kinds of pills. Some people take combination pills. Combination pills contain two kinds of diabetes medicine in one tablet. Some people take pills and insulin.

Diabetes Complications

Diabetes Medicines

Diabetic Nerve Problems

Diabetic Foot

Diabetic Pregnancy & Diabetic Diet

Diabetic Kidney & Eye Problems

Diabetic Nerve Problems

2010-02-21T16:51:00.000-08:00

Also called: Diabetic neuropathy

If you have diabetes, your blood sugar levels are too high. Over time, this can damage the covering on your nerves or the blood vessels that bring oxygen to your nerves. Damaged nerves may stop sending messages, or may send messages slowly or at the wrong times.

This damage is called diabetic neuropathy. About half of people with diabetes get it. Symptoms may include

• Numbness in your hands, legs or feet
• Shooting pains, burning or tingling
• Nausea, vomiting, constipation or diarrhea
• Problems with sexual function
• Urinary problems
• Dizziness when you change positions quickly

Controlling your blood sugar can help prevent nerve problems, or keep them from getting worse. Treatment may include pain relief and other medicines.

Diabetes Complications

Diabetes Medicines

Diabetic Nerve Problems

Diabetic Foot

Diabetic Pregnancy & Diabetic Diet

Diabetic Kidney & Eye Problems

Diabetes Complications

2010-02-21T16:49:00.000-08:00

If you have diabetes, your blood sugar levels are too high. Over time, this can cause problems with other body functions, such as your kidneys, nerves, feet, and eyes. Having diabetes can also put you at a higher risk for heart disease and bone and joint disorders. Other long-term complications of diabetes include skin problems, digestive problems, sexual dysfunction, and problems with your teeth and gums.

Very high or very low blood sugar levels can also lead to emergencies in people with diabetes. The cause can be an underlying infection, certain medicines, or even the medicines you take to control your diabetes. If you feel nauseated, sluggish or shaky, seek emergency care.

Diabetes Complications

Diabetes Medicines

Diabetic Nerve Problems

Diabetic Foot

Diabetic Pregnancy & Diabetic Diet

Diabetic Kidney & Eye Problems

Diabetes

2010-02-21T16:44:00.000-08:00

Diabetes is a disease in which your blood glucose, or sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With Type 1 diabetes, your body does not make insulin. With Type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.

Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes.

Symptoms of Type 2 diabetes may include fatigue, thirst, weight loss, blurred vision and frequent urination. Some people have no symptoms. A blood test can show if you have diabetes. Exercise, weight control and sticking to your meal plan can help control your diabetes. You should also monitor your glucose level and take medicine if prescribed.

Diabetes Type 1

Also called: Insulin-dependent diabetes, Juvenile diabetes

Diabetes means your blood glucose, or blood sugar, is too high. With Type 1 diabetes, your pancreas does not make insulin. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your heart, eyes, kidneys, nerves, and gums and teeth.

Type 1 diabetes happens most often in children and young adults but can appear at any age. Symptoms may include

• Being very thirsty
• Urinating often
• Feeling very hungry or tired
• Losing weight without trying
• Having sores that heal slowly
• Having dry, itchy skin
• Losing the feeling in your feet or having tingling in your feet
• Having blurry eyesight

A blood test can show if you have diabetes. If you do, you will need to take insulin for the rest of your life.

Diabetes Complications

Diabetes Medicines

Diabetic Nerve Problems

Diabetic Foot

Diabetic Pregnancy & Diabetic Diet

Diabetic Kidney & Eye Problems

Low Blood Pressure

2010-02-21T16:18:00.000-08:00

Also called: Hypotension, LBP

You've probably heard that high blood pressure is a problem. So what about low blood pressure?

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure. Your blood pressure reading uses these two numbers. Both are important. Usually they're written one above or before the other, such as 120/80. If your blood pressure reading is 90/60 or lower, you have low blood pressure.

Some people have low blood pressure all the time. They have no symptoms and their low readings are normal for them. In other people, blood pressure drops below normal because of some event or medical condition. Some people may experience symptoms of low pressure when standing up too quickly. Low blood pressure is a problem only if it causes dizziness, fainting or in extreme cases,

Low blood pressure symptoms:
ethargy, weakness, dizziness

the patient with chronic low blood pressure may complain of lethargy, weakness, fatigue, and dizziness. The patient may faint, especially if arterial pressure is lowered further when he assumes an erect position. These symptoms are presumably due to a decrease in perfusion of blood to the brain, heart, skeletal muscle, and other organs.

Low blood pressure causes
Faulty nutrition, Malnutrition
The most important cause of low blood pressure is faulty nutrition. It makes the tissues forming the walls of the blood vessels over-relaxed, and flabby or streched. This results in less supply of oxygen and nutrients to the tissues. Malnutrition can result from a diet deficient in calories, proteins, vitamin C, or almost any one of the B vitamins.

Loss of blood, slow internal bleeding

Sometimes the blood pressure falls rapidly because of loss of blood. Low blood pressure may also develop gradually because of slow bleeding in the gastrointestinal tract, kidneys, or bladder.

Emotional instability

Emotional problems are a far more frequent cause of low blood pressure. To a lesser degree, prolonged disappointment and frustration may result in a subnormal blood pressure.

Low blood pressure home remedies

Low Blood Pressure treatment using Beetroot
The juice of raw beetroot is one of the most effective home remedies for low blood pressure. The patient should drink a cup of this juice twice daily for treating this condition Considerable improvement will be noticeable within a week.

Low Blood Pressure treatment using Indian Spikenard

The herb Indian spikenard is another effective home remedy for low blood pressure. It should be taken in doses of thirty to forty grains with a pinch of a little camphor and cinnamon (dalchini). An infusion can also be prepared by steeping 15 to 20 gm of the herb in 250 ml of boiling water, and taking it thrice a day.

Low Blood Pressure treatment using Epsom Salts Bath

Hot Epsom salt bath are one of the simplest remedy for low blood pressure. An Epsom salt bath is prepared by dissolving one to one and half kg of commercial Epsom Salt in an ordinary bath of hot water. The patient should remain immersed in the bath for ten to twenty minutes. This bath should be taken just before retiring to bed, and care should be exercised not to catch a chill afterwards.

Low Blood Pressure treatment using Nutrients

Protein, vitamin C, and all vitamins of the B group have been found beneficial in the prevention and treatment of low blood pressure. Of these, pantothenic acid is of particular importance. Liberal use of this vitamin alone often helps in raising the blood pressure. A diet which contains adequate quantities of complete proteins, B vitamin and, particularly, the nutrients that stimulate adrenal production, quickly normalizes low blood pressure.

Low Blood Pressure treatment using Salt

The use of salt is valuable in low blood pressure. Until the blood pressure reaches normal levels through proper dietary and other remedies, it is essential that the patient should take salty foods and half a teaspoon of salt in water daily.

Low blood pressure diet
Exclusive fruit diet

The treatment for low blood pressure should aim at rejuvenation of the whole system. To begin with, the patient should adopt an exclusive fresh fruit diet for about five days, taking three meals a day of fresh fruity fruits at five-hourly intervals.

Milk and fruit diet

Thereafter he may adopt a fruit and milk diet for two or three weeks. After the fruit and milk diet the patient may gradually embark upon a well balanced diets consisting of seeds nuts and grains with emphasis on fresh fruit and raw vegetables. Further period of all fruit diet followed by a milk and fruit diet may be necessary every two or three months in some cases, depending on the progress being made.

Other Low blood pressure treatment

Warm-Water enema treatment

A warm-water enema should be used daily to cleanse the bowels during the first few days of the treatment, and afterwards, if necessary. Those who are habitually constipated should take all the possible steps for its eradication. Daily dry friction and sponging should be undertaken by those suffering from low blood pressure.

Light walking, cycling, swimming and Breathing exercises

They should undertake breathing and other light exercises like walking , swimming and cycling. The patient should take sun and air baths and spend as much time as possible in the fresh air.

Avoid excessive work, anxiety

All living habits which tend to enervate the system, such as overwork, excesses of all kinds, needless worry, and negative thinking must be eliminated as far as possible.

High Blood Pressure

High Blood Pressure

2010-02-21T16:05:00.000-08:00

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.

Your blood pressure reading uses these two numbers, the systolic and diastolic pressures. Usually they are written one above or before the other. A reading of

• 120/80 or lower is normal blood pressure

• 140/90 or higher is high blood pressure

• 120 and 139 for the top number, or between 80 and 89 for the bottom number is prehypertension

High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. You can control high blood pressure through healthy lifestyle habits and taking medicines, if needed.

Cholesterol

Hypercholesterolemia, Hyperlipidemia, Hyperlipoproteinemia, and LDL

Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. Your body needs some cholesterol to work properly. But if you have too much in your blood, it can stick to the walls of your arteries. This is called plaque. Plaque can narrow your arteries or even block them.

High levels of cholesterol in the blood can increase your risk of heart disease. Your cholesterol levels tend to rise as you get older. There are usually no signs or symptoms that you have high blood cholesterol, but it can be detected with a blood test. You are likely to have high cholesterol if members of your family have it, if you are overweight or if you eat a lot of fatty foods.

You can lower your cholesterol by exercising more and eating more fruits and vegetables. You also may need to take medicine to lower your cholesterol.

Blood Pressure Medicines

Also called: Antihypertensive Medicines, High blood pressure medicines

High blood pressure, also called hypertension, usually has no symptoms. But it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. If you cannot control your high blood pressure through healthy lifestyle habits such as losing weight and reducing sodium in your diet, your doctor may prescribe medicines.

Blood pressure medicines work in different ways to lower blood pressure. Some remove extra fluid and salt from the body to lower blood pressure. Others slow down the heartbeat or relax and widen blood vessels. Often, two or more medicines work better than one.

Low Blood Pressure

HIV and Hepatitis B or C

2010-02-21T15:21:00.000-08:00

Filed under: HIV hepatitis B C treatment BHIVA guidelines
BHIVA has written new guidelines for the management of co-infection with HIV and hepatitis B or C and want people's comments. These guidelines replace the existing separate guidelines for HIV and Hepatitis B, and HIV and Hepatitis C.

these 2009 guidelines incorporate all new relevant information since the previous versions in 2005.
For 2009 we have decided to amalgamate the two guides for hepatitis confection into a single document. This avoids duplication, because general treatment for chronic liver disease is similar for both.

The translation of study data into clinical practice is often difficult, even with the best possible evidence, because of differences in factors such as trial design and inclusion criteria. Recommendations based upon expert opinion have the weakest evidence but provide an important reason for writing the guidelines – to produce a consensual opinion about current practice. The Writing Group seeks to provide guidelines that optimize treatment and management, but this needs to be tailored to fit the person - the draft is not suggesting a fixed standard for all.

Changes
The major changes/amendments include:
• More discussion on hepatitis screening and prevention;
• Clarification on the role of liver biopsy and non-invasive liver fibrosis assessment;
• More emphasis on screening for delta virus;
• More discussion on end-stage liver disease management and HCC screening;
• Molecular diagnostic tests used for the diagnosis and management of Hepatitis B and Hepatitis C;
• Revised CD4-based guidance on the management of chronic Hepatitis B;
• Management of acute Hepatitis B;
• Revised guidance on the management of chronic HCV, including ART interactions;
• Management of acute Hepatitis C
• Management of treatment non-responders and relapses in both chronic Hepatitis B and C.