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What Are HIV & AIDS?

Lea esta hoja informativa en español इस फैक्ट शीट को हिंदी में पढ़ने के लिए, य हां क्लिक करें ।

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What is hiv, what is aids, what is the difference between hiv and aids, how do i know if i have hiv, do i need to get tested for hiv, why should i get tested, how is hiv spread, is there a vaccine or cure for hiv, additional information.

HIV stands for Human Immunodeficiency Virus. HIV is the virus that causes AIDS.

Your immune system is your body's defense system. While the immune system can control many viruses, HIV targets and infects the same immune system cells that protect us from germs and illnesses. These cells are a type of white blood cell called CD4 cells (which are a type of T cells).

Without medication to control the virus, HIV usually takes over CD4 cells and turns them into factories that produce millions of copies of the virus. As the virus makes copies, it damages or kills the CD4 cells, weakening the immune system. This is how HIV causes AIDS.

There are many different strains of HIV that are grouped into two main types:

• HIV-1: most common type worldwide
• HIV-2: found mostly in West Africa, Asia, and Europe

It is possible for one person living with HIV to carry several different strains of HIV in their body at the same time.

Click above to view or download this fact sheet as a PDF slide presentation

AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is the most advanced stage of HIV disease.

HIV causes AIDS by attacking CD4 cells. The immune system uses these cells to protect the body from disease. When it loses too many CD4 cells, the body is less able to fight off infections and can develop serious, often deadly, infections. These are called opportunistic infections (OIs).

When someone dies of AIDS, death is usually due to OIs or other long-term effects of HIV. AIDS refers to the weakened state of the body's immune system, which can no longer stop opportunistic infections.

You do not have AIDS as soon as you acquire HIV. You can live with HIV for many years with no signs of disease, or only mild-to-moderate symptoms. People living with HIV and taking HIV drugs as prescribed have a very low risk of progressing to AIDS. But without treatment, HIV will eventually wear down the immune system in most people to the point where they have few CD4 cells and develop opportunistic infections.

The definition of AIDS was established before there was effective treatment for HIV. It indicated that a person was at higher risk for illness or death. In countries where HIV treatment is readily available, AIDS is no longer as relevant as it once was. With access to effective HIV treatment, people can stay healthier even at low CD4 cell counts. Also, someone could have received an AIDS diagnosis years ago, but their immune system has recovered since then. They may still have that diagnosis, but no longer have a low CD4 count.

The US Centers for Disease Control and Prevention (CDC) identifies someone as having AIDS if they are living with HIV and have one or both of these conditions:

• At least one AIDS-defining condition (see our list of AIDS-Defining Conditions )
• A CD4 cell count of 200 cells or less (a normal CD4 count is about 500 to 1,500)

People with AIDS can rebuild their immune system with the help of HIV drugs and live a long, healthy life. Even if your CD4 cell count goes back above 200 or an OI is successfully treated, you may still have a diagnosis of AIDS. This does not necessarily mean you are sick or will get sick in the future. It is just the way the public health system counts the number of people who have had advanced HIV.

People cannot tell that they have been exposed to, or have acquired, HIV. Initial, or acute, symptoms of HIV infection may show up within two to four weeks of exposure to HIV, and can include:

• Swollen glands
• Sore throat
• Night sweats
• Muscle aches
• Extreme tiredness (fatigue)

Some people do not have any symptoms or do not notice the symptoms because they are mild, or they think they have a cold or the flu. After these "flu-like" symptoms disappear, people living with HIV can go for years without showing any symptoms. The only way to know for sure if you are living with HIV is to take an HIV test .

If you have some of the initial or acute symptoms of HIV, it is important that you be tested for HIV antigen (not just HIV antibody). Antigens are pieces of the HIV virus, or viral particles. If an HIV antigen is in your blood, tests can identify HIV acquisition as soon as two weeks after you have been exposed to the virus.

Antibodies are proteins that your body makes to mark HIV for destruction by your immune system. The body takes one to three months and occasionally up to six months to develop these antibodies. This period between acquiring HIV and the production of antibodies is called the "window period." Therefore, tests that detect antibodies are only reliable one to three months after you have been exposed to HIV.

The CDC estimates that about 13 percent of people living with HIV in the US do not know that they live with the virus. Many of these people look and feel healthy and do not think they are at risk. But the truth is that anyone of any age, gender, race, ethnicity, sexual orientation, social group, or economic class can acquire HIV. Humans may discriminate on the basis of these factors, but the virus does not. For more on how HIV is spread, see our fact sheet on HIV transmission .

To see if you need to get tested for HIV, answer the following questions:

• Have you ever had a penis inserted into your vagina or anus ("butt"), or oral sex without a condom or other latex barrier (e.g., dental dam)? Note: oral sex is a low-risk activity. Vaginal and anal sex are much higher risk.
• Do you not know your partner's HIV status or is your partner living with HIV?
• Are you pregnant or considering becoming pregnant ?
• Have you ever had a sexually transmitted infection or disease (STI or STD) ?
• Do you have hepatitis C (HCV) ?
• Have you ever shared needles, syringes, or other equipment to inject drugs (including steroids or hormones)?

If you answered yes to any of these questions, you should definitely get an HIV test. In the US, everyone between 13-64 years old should be screened for HIV at least once.

You cannot get the health care and treatment you need if you do not know your HIV status.

If you are worried because you think you may have been exposed to HIV, get tested. Then, if you learn you are HIV-negative, you can stop worrying. You can also consider taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). PrEP means taking an HIV drug before being exposed to HIV, to prevent yourself from acquiring the virus, similar to taking birth control pills to prevent pregnancy. PEP means taking HIV drugs for about a month immediately after possible exposure to HIV, to prevent HIV acquisition.

If you test HIV+, there are effective medications to help you stay healthy. These medications are also part of HIV prevention. When a person living with HIV is taking HIV drugs and their viral load (amount of HIV in their blood) has reached undetectable levels (not enough HIV in their bloodstream for a standard test to measure) for more than six months, that person cannot sexually transmit HIV to a partner who is HIV-negative.

But you cannot get the health care and treatment you need if you do not know your HIV status (whether you are living with HIV or are HIV-negative). If you don't know your status, you could also pass HIV to others without knowing it.

For people who plan to become pregnant, testing is especially important. If a person with a uterus is living with HIV, medical care and certain HIV drugs taken during pregnancy can lower the chance of passing HIV to their baby. For more information, see our fact sheet on  Pregnancy and HIV .

In the US, you can go to your primary care doctor and request a test or to the National HIV, STD and Hepatitis Testing  website or the HIV.gov website  to find a testing location near you. You can also call the CDC's information line at 800-CDC-INFO (800-232-4636, or TTY at 888-232-6348) or call your state's HIV/AIDS hotline (numbers listed here ). For more information on getting tested for HIV — types of tests, how they work, and where to get them — see our fact sheet on HIV Testing .

HIV is spread primarily through contact with the following body fluids:

• Blood (including menstrual blood)
• Semen ("cum") and other male sexual fluids ("pre-cum")
• Vaginal fluids
• Breast milk

For people living with HIV, taking HIV drugs and reducing their viral load makes these fluids far less likely to transmit HIV to others. This is called HIV treatment as prevention . If a person living with HIV takes HIV drugs and maintains an undetectable viral load for more than six months, their semen or vaginal fluids will not pass HIV on to their sexual partner. The most common ways HIV is spread from person to person is through unprotected sex (no condoms, other barriers, or treatment-as-prevention methods used), sharing needles used for injecting drugs, hormones or steroids, and from a pregnant person to their child (during pregnancy, birth, or breast-feeding).

HIV is not spread through contact with these body fluids:

• Saliva (spit)
• Feces (poop)
• Urine (pee)

In other words, you CANNOT acquire HIV by touching or hugging someone who is living with HIV, kissing someone living with HIV, or by using a toilet also used by someone living with HIV.

There is neither a vaccine nor a cure for HIV. The best way to prevent HIV is to use prevention methods every time, including  safer sex  (choosing low- or no-risk activities, using condoms, taking HIV drugs if you are living with HIV, or  PrEP if you are HIV-negative), and using sterile needles (for drugs, hormones or tattoos). For more information, see our fact sheets on HIV Vaccines  and on Finding a Cure for HIV .

As you learn more about HIV, you may find these articles helpful:

• HIV Testing
• Did You Just Test HIV-Positive?
• Considerations Before Starting HIV Treatment
• HIV Transmission
• Undetectable Equals Untransmittable: Building Hope and Ending HIV Stigma
• Pregnancy, Birth, and HIV
• Women and HIV

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• Español (Spanish)

HIV Overview

Hiv and aids: the basics.

• The human immunodeficiency virus (HIV) is the virus that causes HIV infection. If untreated, HIV may cause acquired immunodeficiency syndrome (AIDS) , the most advanced stage of HIV infection.
• People with HIV who are not on medication and do not have consistent control of their HIV can transmit HIV through vaginal or anal sex, sharing of needles, pregnancy, and/or breastfeeding. If HIV is controlled, the risk of transmission is close to zero.
• Antiretroviral therapy (ART) is the use of HIV medicines that reduce the level of HIV in the blood (called viral load). ART is recommended for everyone who has HIV. ART cannot cure HIV infection, but HIV medicines help people with HIV have about the same life expectancy as people without HIV.
• HIV medicines (ART) can eliminate the risk of HIV transmission . For parents with HIV that want to breastfeed, the risk of transmitting HIV through breast milk is less than 1% with the consistent use of HIV medicine (ART) and an undetectable viral load.
• People on ART take a combination of HIV medicines (called an HIV treatment regimen ) every day (pills) or by schedule (injections). In many cases oral medicines may be combined into a single pill or capsule. There are newer long-acting medicines given by an injection every 2 months that may be used in some people.

What is HIV and AIDS?

HIV stands for human immunodeficiency virus , which is the virus that causes HIV infection. The abbreviation “HIV” can refer to the virus or to HIV infection.

AIDS stands for acquired immunodeficiency syndrome . AIDS is the most advanced stage of HIV infection.

HIV attacks and destroys the infection-fighting CD4 cells ( CD4 T lymphocyte ) of the  immune system . The loss of CD4 cells makes it difficult for the body to fight off infections, illnesses, and certain cancers. Without treatment, HIV can gradually destroy the immune system, causing health decline and the onset of AIDS. With treatment, the immune system can recover.

How is HIV transmitted?

HIV can be transmitted from one person to another when certain bodily fluids are shared between people. Bodily fluids that can transmit HIV include blood, semen (“cum”), pre-seminal fluid (“pre-cum”), vaginal fluids, rectal fluids, and breastmilk. HIV can be transmitted during vaginal or anal sex, through sharing needles for injecting drugs or tattooing, by getting stuck with a needle that has the blood of someone with HIV on it, through pregnancy, and through breastfeeding.

The transmission of HIV from a birthing parent with HIV to their child during pregnancy, childbirth, or breastfeeding is called perinatal transmission of HIV. For more information on perinatal transmission, read the HIVinfo fact sheet on  Preventing Perinatal Transmission of HIV .

You cannot get HIV by shaking hands or hugging a person who has HIV. You also cannot get HIV from contact with objects, such as dishes, toilet seats, or doorknobs, used by a person with HIV. HIV is not spread through the air or water or by mosquitoes, ticks, or other insects. Use the HIVinfo You Can Safely Share…With Someone With HIV  infographic to spread this message.

What is the treatment for HIV?

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. People on ART take a combination of HIV medicines (called an HIV treatment regimen ) every day (pills) or by schedule (injections). In many cases oral medicines may be combined into a single pill or capsule. There are newer long-acting medicines given by an injection every 2 months that may be used in some people.

ART is recommended for everyone who has HIV. ART prevents HIV from multiplying, which reduces the amount of HIV in the body (called the  viral load ). Having less HIV in the body protects the immune system and prevents HIV infection from advancing to AIDS. ART cannot cure HIV, but HIV medicines can help people with HIV live long, healthy lives.

How can a person reduce the risk of transmitting HIV?

ART reduces the risk of HIV transmission. ART can reduce a person’s viral load to an undetectable level. An  undetectable viral load  means that the level of HIV in the blood is too low to be detected by a viral load test . People with HIV who maintain an undetectable viral load have no risk of transmitting HIV to their HIV-negative partner through sex.

HIV medicines taken during pregnancy, childbirth, and breastfeeding can also reduce the risk of perinatal (parent to infant) transmission of HIV. Previously, replacement feeding (properly prepared formula or pasteurized donor human milk from a milk bank) was recommended instead of breastfeeding since the risk of HIV transmission was considered high. Now, there is evidence that the risk of transmission through the breastmilk of someone consistently using ART and maintaining an undetectable viral load is low (less than 1%). Pregnant people with HIV can speak with their health care provider to determine what method of feeding their baby is right for them.

How can a person reduce the risk of getting HIV?

For people without HIV, there are several ways to reduce the risk of acquiring (getting) HIV infection.  Using condoms correctly with every sexual encounter, particularly with partners that are HIV positive with a detectable viral load or with partners whose HIV status is unknown, can reduce the risk of acquiring HIV. Reducing HIV risk also involves limiting and reducing sexual partners, and avoiding sharing needles.

Persons who do not have HIV should talk to their health care provider about pre-exposure prophylaxis (PrEP) . PrEP is an HIV prevention option for people who do not have HIV but who are at risk of becoming infected with HIV. PrEP involves taking a specific HIV medicine every day or a long-acting injection. For more information, read the HIVinfo fact sheet on Pre-exposure Prophylaxis (PrEP) .

What are the symptoms of HIV and AIDS?

Within 2 to 4 weeks after infection with HIV, some people may have flu-like symptoms, such as fever, chills, or rash. The symptoms may last for a few days to several weeks. Other possible symptoms of HIV include night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. Having these symptoms does not mean you have HIV. Other illnesses can cause the same symptoms. Some people may not feel sick during early HIV infection (called acute HIV ). During this earliest stage of HIV infection, the virus multiplies rapidly. After the initial stage of infection, HIV continues to multiply but at lower levels.

More severe symptoms of HIV infection for persons not on ART may not appear for many years until HIV has developed into AIDS. People with AIDS have weakened immune systems that make them prone to opportunistic infections. Opportunistic infections are infections and infection-related cancers that occur more frequently or are more severe in people with weakened immune systems than in people with healthy immune systems.

Without treatment, HIV transmission is possible at any stage of HIV infection—even if a person with HIV has no symptoms of HIV.

How is AIDS diagnosed?

Symptoms such as fever, weakness, and weight loss may be a sign that a person’s HIV has advanced to AIDS. However, a diagnosis of AIDS is based on the following criteria:

• A drop in CD4 count to less than 200 cells/mm 3 . A CD4 count measures the number of CD4 cells ( CD4 T lymphocyte ) in a sample of blood. OR
• The presence of certain opportunistic infections.

Although an AIDS diagnosis indicates severe damage to the immune system, HIV medicines can still help people at this stage of HIV infection.

This fact sheet is based on information from the following sources:

From Centers for Disease Control and Prevention:

• AIDS and Opportunistic Infections
• HIV and Perinatal Transmission

From the Department of Health and Human Services (HHS):

• Introduction
• Infant Feeding for Individuals with HIV in the United States

From the National Institute of Allergy and Infectious Diseases (NIAID):

Also see the  HIV Source  collection of HIV links and resources.

• What Are HIV and AIDS?
• How Is HIV Transmitted?
• Who Is at Risk for HIV?
• Symptoms of HIV
• U.S. Statistics
• Impact on Racial and Ethnic Minorities
• Global Statistics
• HIV and AIDS Timeline
• In Memoriam
• Supporting Someone Living with HIV
• Standing Up to Stigma
• Getting Involved
• HIV Treatment as Prevention
• Pre-exposure Prophylaxis (PrEP)
• Post-exposure Prophylaxis (PEP)
• Preventing Sexual Transmission of HIV
• Alcohol and HIV Risk
• Substance Use and HIV Risk
• Preventing Perinatal Transmission of HIV
• HIV Vaccines
• Long-acting HIV Prevention Tools
• Microbicides
• Who Should Get Tested?
• HIV Testing Locations
• HIV Testing Overview
• Understanding Your HIV Test Results
• Living with HIV
• Talking About Your HIV Status
• Locate an HIV Care Provider
• Types of Providers
• Take Charge of Your Care
• What to Expect at Your First HIV Care Visit
• Making Care Work for You
• Seeing Your Health Care Provider
• HIV Lab Tests and Results
• Returning to Care
• HIV Treatment Overview
• Viral Suppression and Undetectable Viral Load
• Taking Your HIV Medicine as Prescribed
• Tips on Taking Your HIV Medication Every Day
• Paying for HIV Care and Treatment
• Other Health Issues of Special Concern for People Living with HIV
• Alcohol and Drug Use
• Coronavirus (COVID-19) and People with HIV
• Hepatitis B & C
• Vaccines and People with HIV
• Flu and People with HIV
• Mental Health
• Mpox and People with HIV
• Opportunistic Infections
• Sexually Transmitted Infections
• Syphilis and People with HIV
• HIV and Women's Health Issues
• Aging with HIV
• Emergencies and Disasters and HIV
• Employment and Health
• Exercise and Physical Activity
• Food Safety and Nutrition
• Housing and Health
• Traveling Outside the U.S.
• Civil Rights
• Workplace Rights
• Limits on Confidentiality
• National HIV/AIDS Strategy (2022-2025)
• Implementing the National HIV/AIDS Strategy
• Prior National HIV/AIDS Strategies (2010-2021)
• Key Strategies
• Priority Jurisdictions
• HHS Agencies Involved
• Learn More About EHE
• Ready, Set, PrEP
• Ready, Set, PrEP Pharmacies
• Ready, Set, PrEP Resources
• AHEAD: America’s HIV Epidemic Analysis Dashboard
• HIV Prevention Activities
• HIV Testing Activities
• HIV Care and Treatment Activities
• HIV Research Activities
• Activities Combating HIV Stigma and Discrimination
• The Affordable Care Act and HIV/AIDS
• HIV Care Continuum
• Syringe Services Programs
• Finding Federal Funding for HIV Programs
• Fund Activities
• The Fund in Action
• About PACHA
• Members & Staff
• Subcommittees
• Prior PACHA Meetings and Recommendations
• I Am a Work of Art Campaign

Awareness Campaigns

• Global HIV/AIDS Overview
• U.S. Government Global HIV/AIDS Activities
• U.S. Government Global-Domestic Bidirectional HIV Work
• Global HIV/AIDS Organizations
• National Black HIV/AIDS Awareness Day February 7
• HIV Is Not A Crime Awareness Day February 28
• National Women and Girls HIV/AIDS Awareness Day March 10
• National Native HIV/AIDS Awareness Day March 20
• National Youth HIV & AIDS Awareness Day April 10
• HIV Vaccine Awareness Day May 18
• National Asian & Pacific Islander HIV/AIDS Awareness Day May 19
• HIV Long-Term Survivors Awareness Day June 5
• National HIV Testing Day June 27
• Zero HIV Stigma July 21
• Southern HIV/AIDS Awareness Day August 20
• National Faith HIV/AIDS Awareness Day August 27
• National African Immigrants and Refugee HIV/AIDS and Hepatitis Awareness Day September 9
• National HIV/AIDS and Aging Awareness Day September 18
• National Gay Men's HIV/AIDS Awareness Day September 27
• National Latinx AIDS Awareness Day October 15
• World AIDS Day December 1
• Event Planning Guide
• U.S. Conference on HIV/AIDS (USCHA)
• National Ryan White Conference on HIV Care & Treatment
• AIDS 2020 (23rd International AIDS Conference Virtual)

Want to stay abreast of changes in prevention, care, treatment or research or other public health arenas that affect our collective response to the HIV epidemic? Or are you new to this field?

HIV.gov curates learning opportunities for you, and the people you serve and collaborate with.

Stay up to date with the webinars, Twitter chats, conferences and more in this section.

Several Federal agencies have developed public awareness and education campaigns about HIV prevention, treatment, or care with tools and resources you can use and share. On this page, you’ll find a snapshot of these Federal HIV campaigns and links to help you access more information about each one. Also included is information about campaigns about HIV-related issues including hepatitis B and hepatitis C, sexually transmitted infections, and drug use.

Campaigns for consumers and the public

• I am a Work of ART

Let’s Stop HIV Together

Let’s stop hiv together: hiv prevention, let’s stop hiv together: hiv stigma, let’s stop hiv together: hiv testing, let’s stop hiv together: hiv treatment, at the intersection: stories of research, compassion, and hiv services for people who use drugs, get yourself tested, know hepatitis b, know more hepatitis, hpv vax now, campaigns for health care providers, let’s stop hiv together: hiv screening, let’s stop hiv together: transgender health.

“I am a Work of ART"

I am a Work of ART , and its Spanish-language version, Celebro mi salud, are a community-informed national campaign funded by the U.S. Department of Health and Human Services designed to encourage people with HIV who are not in care for HIV to seek care, stay in care, and achieve viral suppression by taking antiretroviral therapy (ART).

HASHTAG: #WorkOfART

• Let’s Stop HIV Together Site
• Let’s Stop HIV Together Español

CDC’s Let’s Stop HIV Together (Together) campaign is the national campaign of the Ending the HIV Epidemic in the U.S. (EHE) initiative and the National HIV/AIDS Strategy . Together is an evidence-based campaign created in English and Spanish. It aims to empower communities, partners, and health care providers to reduce HIV stigma and promote HIV testing, prevention, and treatment.

HASHTAG: #StopHIVtogether

• Let’s Stop HIV Together Instagram Exit Disclaimer
• Let’s Stop HIV Together Facebook Exit Disclaimer

The anti-stigma component of CDC’s Let’s Stop HIV Together campaign highlights the role that each person can play in stopping HIV stigma and gives a voice to people with HIV, as well as their friends, families, and allies. Campaign participants share their stories and call on everyone to work together to stop HIV stigma.

HASHTAGS: #StopHIVStigma #DetenelEstigmadelVIH

• Let’s Stop HIV Together: HIV Stigma Site
• Let’s Stop HIV Together: HIV Stigma Español
• Let’s Stop HIV Together: HIV Stigma Instagram Exit Disclaimer
• Let’s Stop HIV Together: HIV Stigma Facebook Exit Disclaimer

The HIV testing component of CDC’s Let’s Stop HIV Together campaign is designed to motivate all adults to get tested for HIV, making HIV testing part of everyone’s regular routine. It encourages people to test however they feel comfortable, including at in-person locations or by HIV self-test on their own time, in their own space.  It highlights the importance of everyone knowing their HIV status and knowing what their next steps should be depending on their status.

HASHTAGS: #DoingItTogether #HaciéndoloJuntos

• Let’s Stop HIV Together: HIV Testing Site
• Let’s Stop HIV Together: HIV Testing Español
• Let’s Stop HIV Together: HIV Testing Instagram Exit Disclaimer
• Let’s Stop HIV Together: HIV Testing Facebook Exit Disclaimer

The HIV prevention component of CDC’s Let’s Stop HIV Together campaign includes messaging for all adults about knowing their prevention options, communicating effectively about those options, and choosing the ones that are right for them. The campaign resources promote and provide information on abstinence, condoms, and medicines that prevent and treat HIV.

HASHTAGS: #StartTalkingHIV #IniciaHablandoVIH

• Let’s Stop HIV Together: HIV Prevention Site
• Let’s Stop HIV Together: HIV Prevention Español
• Let’s Stop HIV Together: HIV Prevention Instagram Exit Disclaimer
• Let’s Stop HIV Together: HIV Prevention Facebook Exit Disclaimer

The treatment component of CDC’s Let’s Stop HIV Together campaign focuses on helping people with HIV stay healthy and live longer, healthier lives. The campaign shows how people with HIV have been successful getting in care and staying on treatment, despite the challenges they may face, and encourages those around them to provide social support. It also promotes that being undetectable means individuals won’t transmit HIV to their sexual partners.

HASHTAGS: #HIVTreatmentWorks #TratamientodelVIHFunciona

• Let’s Stop HIV Together: HIV Treatment Site
• Let’s Stop HIV Together: HIV Treatment Español
• Let’s Stop HIV Together: HIV Treatment Instagram Exit Disclaimer
• Let’s Stop HIV Together: HIV Treatment Facebook Exit Disclaimer

You can’t end the HIV epidemic without understanding drug use. So says Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. The At the Intersection: Stories of Research, Compassion, and HIV Services for People who Use Drugs web video series highlights the ways in which evidence-based harm reduction and holistic care is necessary to end the HIV epidemic for people who use drugs.

• At the Intersection: Stories of Research, Compassion, and HIV Services for People who Use Drugs Site
• At the Intersection: Stories of Research, Compassion, and HIV Services for People who Use Drugs Twitter Exit Disclaimer
• At the Intersection: Stories of Research, Compassion, and HIV Services for People who Use Drugs Facebook Exit Disclaimer

CDC’s GYT: Get Yourself Tested campaign encourages young people to get tested and treated for STDs and HIV to protect their health and that of their partners. STDs affect people of all ages, yet these diseases take a particularly heavy toll on young people. The GYT campaign highlights the idea that preventing, testing for, and treating STDs is very straightforward. The campaign offers streamlined materials to help focus efforts on STD awareness, prevention, testing, and treatment among young people.

HASHTAG: #GYT

• Get Yourself Tested Site
• Get Yourself Tested Facebook Exit Disclaimer
• Get Yourself Tested Twitter Exit Disclaimer

CDC's Know Hepatitis B is a multilingual national education campaign that increases awareness of hepatitis B among Asian Americans and Pacific Islanders and promotes hepatitis B testing. Campaign materials are available in English. Chinese, Korean, and Vietnamese.

HASHTAG: #KnowHepatitisB

• Know Hepatitis B Site
• Know Hepatitis B Twitter Exit Disclaimer

CDC’s Know More Hepatitis campaign is designed to help implement CDC’s 2020 recommendations that all adults, age 18 years and up, get tested for hepatitis C. An estimated 2.4M Americans have hepatitis C, yet many do not know know it. The campaign goal is to reduce the morbidity and mortality associated with hepatitis C by increasing testing so those who have it can get linked to life-saving care and treatment, which can cure hepatitis C for most people.

HASHTAG: #KnowHepC

• Know More Hepatitis Site
• Know More Hepatitis Twitter Exit Disclaimer

To encourage young adults to get the human papillomavirus (HPV) vaccine to protect against HPV-related cancers, the HHS Office on Women’s Health (OWH) supports the HPV Vax Now campaign. HPV can cause 6 types of cancer and genital warts. The HPV vaccine is recommended for young adults through age 26 who didn't complete the series when they were younger. HPV is one of the four STIs of focus in the STI National Strategic Plan .

HASHTAG: #HPVvaxNOW

• HPV Vax Now Site
• HPV Vax Now Facebook Exit Disclaimer
• HPV Vax Now Twitter Exit Disclaimer

CDC’s Let’s Stop HIV Together campaign provides HIV screening resources for clinicians to encourage primary care providers to promote routine HIV screening during patient visits per the CDC HIV testing recommendations. Additional materials can be found on CDC’s HIV Nexus website , a one-stop source of the latest HIV information for clinicians.

HASHTAG: #ScreenForHIV

• Let’s Stop HIV Together: HIV Screening Site
• Let’s Stop HIV Together: HIV Screening Twitter Exit Disclaimer
• Let’s Stop HIV Together: HIV Screening Facebook Exit Disclaimer

CDC’s Let’s Stop HIV Together campaign HIV prevention resources for clinicians encourage health care providers to prescribe pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to prevent new HIV infections. Additional materials can be found on CDC’s HIV Nexus website , a one-stop source of the latest HIV information for clinicians.

HASHTAG: #PrescribeHIVPrevention

• Let’s Stop HIV Together: HIV Prevention Twitter Exit Disclaimer

CDC’s Let’s Stop HIV Together campaign includes HIV treatment resources for clinicians that provide tools and information to help health care providers start the conversation with patients about HIV treatment, care, and transmission prevention. Additional materials can be found on CDC’s HIV Nexus website , a one-stop source of the latest HIV information for clinicians.

HASHTAG: #HIVCareCDC

• Let’s Stop HIV Together: HIV Treatment Twitter Exit Disclaimer

CDC’s Let’s Stop HIV Together: campaign includes Transgender Health resources for clinicians to help health care providers offer gender-affirming care, reduce new HIV infections among transgender people, and improve the health of transgender people who have HIV. Additional materials can be found on CDC’s HIV Nexus website , a one-stop source of the latest HIV information for clinicians.

HASHTAG: #CDCTransHealth

• Let’s Stop HIV Together: Transgender Health Site
• Let’s Stop HIV Together: Transgender Health Twitter Exit Disclaimer
• Let’s Stop HIV Together: Transgender Health Facebook Exit Disclaimer

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Institute of Medicine (US) Committee to Study HIV Transmission Through Blood and Blood Products; Leveton LB, Sox HC Jr., Stoto MA, editors. HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking. Washington (DC): National Academies Press (US); 1995.

HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking.

• Hardcopy Version at National Academies Press

8 Conclusions and Recommendations

The HIV epidemic has taught scientists, clinicians, public health officials, and the public that new infectious agents can still emerge. The nation must be prepared to deal with a fatal illness whose cause is initially unknown but whose epidemiology suggests it is an infectious disease. The AIDS epidemic has also taught us another powerful and tragic lesson: that the nation's blood supply—because it is derived from humans—is highly vulnerable to contamination with an infectious agent. A nation's blood supply is a unique, essential, life-giving resource. Whole blood and many blood products are lifesaving for many people. As a whole, our nation's system works effectively to supply the nation with necessary blood and blood products and its quality control mechanisms check most human safety threats. The events of the early 1980s, however, revealed an important weakness in the system—in its ability to deal with a new threat that was characterized by substantial uncertainty. The potential for recurring threats to the blood supply led this Committee to reappraise the processes, policies, and resources through which our society attempts to preserve its supply of safe blood and blood products.

• General Conclusions

The events and decisions that the Committee has analyzed underscore the difficulty of decisionmaking when the stakes are high, when decisionmakers may have personal or institutional biases, and when knowledge is imprecise and incomplete. The Committee attempted to understand the complexities of the decisionmaking process during the period analyzed in this report and develop lessons to protect the blood supply in the future. In retrospect, the system was not dealing well with contemporaneous blood safety issues such as hepatitis, and was not prepared to deal with the far greater challenge of AIDS .

By January 1983, the Centers for Disease Control (CDC) had accumulated enough epidemiological evidence to conclude that the agent causing AIDS was almost certainly transmitted through blood and blood products and could be sexually transmitted to sexual partners. The conclusion that the AIDS agent was blood-borne rested on two findings. First, AIDS was occurring in transfusion recipients and individuals with hemophilia who had received AHF concentrate; these AIDS patients did not belong to any other known high-risk group for contracting AIDS. Second, the epidemiologic pattern of AIDS was similar to hepatitis B, another blood-borne disease. However, the magnitude and consequences of the risk for transfusion and blood product recipients was not known at this time. Furthermore, the epidemiological pattern of the new disease was difficult to interpret because, unlike most infectious diseases, there seemed to be several years between exposure leading to infection and the development of symptoms. As a result, physicians and public health officials underestimated the large number of infectious people who had no symptoms of AIDS but could transmit the disease to others and therefore substantially understated the risk of infection.

Compared to the pace of many regulatory and public health decision processes, the federal government responded relatively swiftly to the early warnings that AIDS might be transmitted through blood and blood products. Public and private sector officials considered a range of clinical and public health interventions for reducing the risk of AIDS transmission through blood and blood products. This period, however, was characterized by a great deal of scientific uncertainty about the risks of HIV infection through blood and blood products and about the costs and benefits of the available options. The result, the Committee found, was a pattern of responses which, while not in conflict with the available scientific information, was very cautious and exposed the decisionmakers and their organizations to a minimum of criticism. This limited response can be seen in the refusal of blood banks in 1983 and 1984 to screen for and defer homosexuals or use surrogate tests ( Chapter 5 ), in the Food and Drug Administration's (FDA) cautious and inadequate regulatory approach to the recall of potentially contaminated AHF concentrate ( Chapter 6 ), and in the failure of physicians and the National Hemophilia Foundation to disclose completely the risks of using AHF concentrate and the alternatives to its use ( Chapter 7 ).

Blood safety is a shared responsibility of many diverse organizations. They include U.S. Public Health Service agencies such as the CDC, the FDA, and the National Institutes of Health (NIH), and private-sector organizations such as community blood banks and the American Red Cross, blood and plasma collection agencies, blood product manufacturers, groups such as the National Hemophilia Foundation (NHF), and others. The problems the Committee found were inadequate leadership and inadequate institutional decisionmaking processes in 1983 and 1984. No person or agency was able to coordinate all of the organizations sharing the public health responsibility for achieving a safe blood supply.

Decisionmaking Under Uncertainty

The management of a public health risk requires an evolving process of decisionmaking under uncertainty. It includes interpretive judgment in the presence of scientific uncertainty and disagreement about values. Public health officials must characterize and estimate the magnitude of the risk, which involves considering both the likelihood that infection might occur in various circumstances, and the costs and benefits associated with each of the possible uncertain outcomes. They must also develop and test public health and clinical care strategies, and communicate with the public about the risk and strategies for reducing it. When confronted with a poorly understood and anomalous public health threat, inertia often influences decisions. It is often easier to maintain the status quo than to make a change. In fact, regulatory policymakers, health scientists, and medical experts often require substantial scientific evidence before informing the public and adopting remedial action. Lack of scientific consensus becomes a kind of amplifier for the usual discord and conflict that can be expected whenever an important science-based public policy decision—one profoundly affecting lives and economic interests—must be made. First, uncertainty creates opportunities for advocates of self-interested and ideological viewpoints to advance plausible arguments that favor their desired outcome. Second, uncertainty intensifies bureaucrat cautiousness.

In the course of its investigations, the Committee learned several lessons about decisionmaking under uncertainty. These are set out here both as general lessons and to provide a framework for the recommendations that follow.

Risk Perception

Risk perception is shaped by social tensions, and cultural, political, and economic biases (Douglas 1985). It is important to understand the different contexts in which risk is perceived and the complex system of beliefs, values, and ideals that shape risk perception (Nelkin 1989). There are several other factors that influence risk perception, including locus of control, the type of risk posed by the threat, and the time interval involved in evaluating the risk. For example, people tend to underestimate risks that they perceive to be under their control, risks associated with a familiar situation, and low probability events (Douglas 1985). People have difficulty accepting estimates of a risk that is involuntary, uncertain, unfamiliar, and potentially catastrophic (Fischoff 1987). The epidemic caused by HIV in the blood supply illustrates these patterns of perception and behavior with respect to risk.

Risk Assessment Versus Risk Management

A central precept of risk management is to separate the assessment of risk from the management of its consequences (NRC 1983). Otherwise, risk managers tend to bias their estimates of the magnitude of the risk in favor of their preconceived notions about appropriate or desirable policy choices. The events that the Committee studied provide examples of what can happen when this precept is not followed. When there is uncertainty, it may be necessary to assess risk by making subjective estimates rather than by obtaining objective measures. Such was the case in 1983 when, as part of implicit risk-benefit calculations about donor screening and deferral, blood banks and blood product manufacturers had to make judgments about the risk that their products could transmit AIDS (see Chapter 5 ). Anticipating the consequences of taking action, which is in the domain of risk management, may bias risk estimates toward values that support risk-averse action. When blood bank officials estimated the risk of transmitting AIDS as ''one per million" transfusions, they chose a rate that was low enough to justify their reluctance to take further action. Despite mounting evidence that the risk was much higher, they maintained their original estimate throughout 1983. If the CDC had made numeric estimates of the risk, and the blood banks, blood product manufacturers, or the FDA had used these estimates in a formal analysis of the decision problem, they might have reached different conclusions about, for example, surrogate testing for AIDS.

Consider the Full Range of Possibilities

When there is uncertainty about the facts that will determine the consequences of a decision, a systematic approach is usually best (NRC 1994). One important principle is to consider the full range of assumptions and alternative actions, not only worst-case scenarios. In the events studied by the Committee, systematic denial of worst-case scenarios was a recurring theme, as can be seen in the way that the NHF and the FDA discussed the CDC's warnings in 1982 and early 1983. The plasma fractionators introduced a worst case scenario of their own at the July 1983 Blood Products Advisory Committee (BPAC) meeting, when they estimated that three or four suspect donors and an automatic recall policy could lead to recall of all of the nation's supply of AHF concentrate ( Chapter 6 ). A closely related principle is to scrutinize the evidence to ascertain what is based on fact, what is a "best-guess" estimate, and what is simply untested conventional wisdom.

One approach to such an analysis would be to use a formal group process to systematically sample expert opinion on relevant factors such as the probability of infection and the economic and noneconomic costs and benefits of each of the possible outcomes. Often these officials should use decision analysis, which takes into account the likelihood of events and the magnitude of their outcomes, as a tool to compare the expected value of the outcome of the policy alternatives under consideration. Two somewhat analogous models to consider include those used in Institute of Medicine studies to establish priorities for the development of new vaccines (IOM 1985) and to evaluate the artificial heart program of the National Heart, Lung, and Blood Institute (IOM 1991). The book Acceptable Risk (Fischoff, et al. 1981) also offers sensible approaches to dealing with this kind of situation.

Risk Reduction Versus Zero Risk

Decisionmakers tend to seek zero-risk solutions even when they are unattainable or unrealistically costly (NRC 1994). In doing so, they may run the risk of failing to implement solutions that are less effective but are certain to reduce illness. The failure to adopt risk-reduction strategies can be seen in the resistance of blood banks to screening for homosexual activity or using surrogate tests for AIDS ( Chapter 5 ) and in FDA's limited approach to product recall decisions ( Chapter 6 ). Chapter 7 also points out that many risk-reduction strategies for individuals with hemophilia were available but not fully disclosed or recommended. The perfect should not be the enemy of the good.

Risk Communication

Risk communication is a sensitive area because of its influence on the perceptions and behaviors of health professionals and consumers, regulatory policies, and public decisionmaking (Nelkin 1989). Many public health officials and physicians wish to appear in command and infallible. When uncertain, they remain silent rather than disclose their ambivalence (NRC 1989). In the Committee's view, however, the greater the uncertainty, the greater the need for communication. The Committee's analysis of physician–patient communications at the beginning of the AIDS era illustrates the tragedies that can accompany silence about risks ( Chapter 7 ). Risk-communication skills are equally important when presenting information to the general public. The blood banks' reluctance to acknowledge the risk of transfusion-associated AIDS ( Chapter 5 ) seems to have been due in part to the difficulties that they foresaw in presenting this information to potential donors and recipients.

Other important principles of risk communication are that the source of the information must be credible, the process should be open and two-way, and the message should be balanced and accurate (NRC 1989). When there was no other sources of information for physicians treating people with hemophilia and for their patients, the NHF and its Medical and Scientific Advisory Council (MASAC) took on an important risk-communication role—providing what would now be called "clinical practice guidelines." The NHF's credibility in this area was eventually seriously compromised by its financial connections to the plasma fractionation industry.

Bureaucratic Management of Potential Crises

Federal agencies had the primary responsibility for dealing with the national emergency posed by the AIDS epidemic. The Committee scrutinized bureaucratic function closely, and came to the following conclusions about the management of potential crises.

Coordination and Leadership

A crisis calls for extraordinary leadership. Legal and competitive concerns may inhibit effective action by agencies of the federal government. Similarly, when policymaking occurs against a backdrop of a great deal of scientific uncertainty, bureaucratic standard operating procedures designed for routine circumstances seem to take over unless there is a clear-cut decisionmaking hierarchy. An effective leader will insist upon coordinated planning and execution. Focusing efforts and responsibilities, setting timetables and agendas, and assuming accountability for expeditious action cannot be left to ordinary standard operating procedures. These actions are the responsibilities of the highest levels of the public health establishment.

The Public Health Service failed to bring these leadership functions to bear when CDC scientists raised concerns about the blood supply at the January 4, 1983 meeting but received no public support from the director of the CDC or the office of the Assistant Secretary for Health. Similarly, the record does not indicate that the highest levels of the FDA or the PHS were involved in responding to advice from the BPAC regarding donor deferral or product recall. Part of this leadership problem may stem from major changes in the PHS leadership that took place during this period: the leadership of the FDA, the CDC, and the NIH, and the person serving as the Assistant Secretary for Health all changed between 1982 and 1984.

Advisory Mechanisms

In the early 1980s, the FDA and other agencies did not have a systematic approach to conducting advisory committee proceedings. Such an approach requires that agencies tell their advisory committees what is expected of them, keep attention focused on high-priority topics, and independently evaluate the advice offered. No regulatory process should have its information base effectively controlled by an advisory panel. Public agencies must be able to generate and analyze the information that they need to assure that decisions serve the needs of the public. The FDA failed to observe this principle when it allowed statements and recommendations of the BPAC to go unchallenged, apparently because it could not independently analyze the information ( Chapter 6 ).

Because mistakes will always be made and opportunities sometimes missed, regulatory structures must be organized and managed to assure both the reality and the continuous appearance of propriety. The prominence of representatives from blood banks and blood product manufacturers on the BPAC, with no balancing influence from consumers and no process within the FDA to evaluate its recommendations ( Chapter 6 ), is a failure of advisory committee management. Perhaps advisory committees should contain fewer topical experts and more members with expertise in principles of good decisionmaking and the evaluation of evidence. A committee so constituted might run a reduced risk of standing accused of having conflicts of interest.

Analytic Capability and Long-Range Vision

Leadership passes to the organization that has access to information and the ability to analyze it. Federal agencies should avoid exclusive reliance upon the entities which they regulate for analysis of data and modeling of decision problems. The FDA should have had some independent capacity to analyze the information presented at the July 1983 BPAC meeting that suggested that with only three or four suspect donors, an automatic recall policy would completely deplete the nation's supply of AHF concentrate ( Chapter 6 ). In addition, there did not seem to be any focus within the Public Health Service prepared to, or charged to, analyze the options, costs, and benefits of the options for protecting the blood supply that were discussed at the January 4, 1983, meeting convened by CDC.

In addition, agencies need to monitor more systematically the long-term outcomes of blood transfusion and blood product infusion and to think far ahead to anticipate both new technologies and new threats to the safety of the blood supply. Because new pathogens can enter the blood supply and be propagated very rapidly through it, a low level of suspicion about a threat should trigger high-level consideration of how to manage and monitor the problem.

Through its fact-finding interviews and through written documents, the Committee found little evidence that the PHS agency heads and the Assistant Secretary for Health were involved in making decisions about protecting the blood supply in 1983 and 1984 when HIV was becoming increasing apparent as a threat. Most decisions and interagency communication seems to have occurred several levels below the top.

Presumptive Regulatory and Public Health Triggers

The Committee believes that the Public Health Service should prepare for future threats to the blood supply by specifying in advance the types of actions that should occur once the level of concern passes a threshold. In the face of scientific uncertainty, the PHS needs a series of criteria or triggers for taking regulatory or other public health actions to protect the safety of blood and blood products. The Committee favors a series of triggers in which the response is proportional to the magnitude of the risk and the quality of the information on which the risk estimate is based. Not all triggers should lead to drastic or irrevocable actions; some merely require careful consideration of the options or developing new information. This general principle is detailed by examples in each of the Committee's four areas of inquiry. Table 8.1 summarizes these triggers and corresponding actions.

Triggers for Taking Actions in Response to Uncertain.

Product Treatment

Whenever they propose new methods of protecting the safety of the blood supply, blood regulatory agencies must perform cost-utility or cost-benefit analyses to evaluate whether the intervention will advance the public health at reasonable costs. If manufacturers do not have market incentives, resources, or access to data to test promising methods, public agencies should create incentives or provide resources or access to data. In this case, the trigger is a new proposal to increase safety, and the action is for the public sector to assume responsibility for thorough analysis and development, or to create incentives for industry to do so.

When performing a cost-effectiveness analysis of new treatments for blood products, the potential to protect against other threats should always be a part of the analysis. Here, the trigger is the initiation of a cost-effectiveness analysis, and the action is to ensure that the analysis takes into account secondary benefits.

Donor Screening

Whenever epidemiologists identify a high-risk donor group, the FDA should immediately tell blood banks to create a way to defer that group and tell collection agencies to segregate and separately treat supplies obtained from those populations. Concerns about stigmatizing subpopulations and maintaining the supply of blood products should influence the means of taking actions, not whether to take action. In this case, the trigger to action is the identification of a high-risk population, and the action is deferral and segregation of lots.

Whenever any segment of the industry institutes a donor screening program, the FDA should require all segments of the industry to follow suit with actions that they believe will be at least as effective in promoting safety. Public regulators have a responsibility to monitor these efforts and to forge consensus or to impose the most effective methods as information concerning efficacy becomes available. Here, the trigger is one company's action to take an additional safety measure, and the response is for all companies to follow suit, or to be held accountable when they do not.

Blood banks should use a partially effective intervention that has little or no risk unless they can show that a better method will rapidly supersede it. In this case the trigger is the availability of an inherently risk-free, partially effective intervention, and the response to use that test/intervention unless it is certain to become redundant prior to realizing its full benefits.

When a test or treatment makes a product safer, manufacturers should withdraw all stocks of untested or untreated product as quickly as possible. Where immediate complete withdrawal might injure the public health, withdrawals should be partial or staged. Here, the trigger is the implementation of a new test or treatment process, and the action is to recall untested or untreated products as expeditiously as possible, given other considerations of public health.

A limited, staged, or selective recall places responsibility on public regulatory agencies to establish criteria for selecting lots for recall, to provide processes to permit effective implementation of the recall by industry, and to monitor the recall to assure that removal of the products occurs in the prescribed manner. In this case the trigger is the initiation of a recall action, and the response is to provide clear guidance and monitoring.

Communication to Patients and Providers

Whenever new information triggers inquiry into a possible threat to the blood supply, both patients and their physicians should have access to the information. Public officials should presume that candid statements and rigorous actions will enhance rather than erode public confidence and that persons using blood or blood products have the right to understand fully the risks and benefits of using these products. In this case, the trigger is new information relevant to the public health, and the action is to tell affected individuals what they need to make an informed choice: the facts, the gaps in knowledge, and the implications thereof.

• Recommendations

The Committee's charge was to learn from the events of the early 1980s the lessons that would help the nation prepare for future threats to the blood supply. The Committee identified potential problems with the system in place at that time (as summarized earlier in this chapter) and proposes changes that, if implemented in the early 1980s, might have moderated some of the effects of the AIDS epidemic on recipients of blood and blood products. This analysis has led the Committee to the following recommendations for Public Health Service agencies, for the blood and plasma fractionation industry, and for health care providers and the public. These recommendations address both public health options and individual clinical options.

The Committee is mindful of several caveats. First, the Committee is acutely aware of the difficulties of retrospective analysis, as described in Chapter 1 . Second, the Committee has not considered its recommendations from perspectives other than blood safety. Finally, the Committee tried to identify opportunities for institutional change that would respond to the problems that the Committee diagnosed. The Committee based its recommendations on the institutions as they functioned in the early 1980s, not as they exist now. The organizations responsible for blood safety and public health will have to evaluate their current policies and procedures to see if they fully address the issues raised by our recommendations.

The Public Health Service

Several federal agencies necessarily play important, often different roles in managing a public health crisis such as the contamination of blood and blood products by the AIDS virus. The National Blood Policy of 1973 charged the Public Health Service (including the CDC, the FDA, and the NIH) with responsibility for protecting the nation's blood supply.

The Committee has come to believe that a failure of leadership contributed to delay in taking effective action, at least during the period from 1982 to 1984. This failure led to incomplete donor screening policies, weak regulatory actions, and insufficient communication to patients about the risks of AIDS .

In the event of a threat to the blood supply, the PHS must, as in any public health crisis, insist upon coordinated action. The Secretary of Health and Human Services is responsible for all the agencies of the Public Health Service, 1 and therefore the Committee makes

Recommendation 1: The Secretary of Health and Human Services should designate a Blood Safety Director, at the level of a deputy assistant secretary or higher, to be responsible for the federal government's efforts to maintain the safety of the nation's blood supply.

Choosing a "lead person" is important because it is in the nature of federal agencies and their leaders to be at once competitive and protective. This condition is healthy in reasonable measure and in normal times. However, a serious threat to public health requires that agencies communicate, cooperate, and learn to view the world through each other's lenses. Once there is an action plan, the Secretary of Health and Human Services must hold the agency leaders accountable for enforcing cooperation in implementing the plan.

To be effective in coordinating the various agencies of the PHS, the Blood Safety Director should be at the level of a deputy assistant secretary or higher, and should not be a representative of any single PHS agency. When a threat does arise, the Blood Safety Director should create a crisis management team.

One such action was to establish, in July 1982, the Committee on Opportunistic Infections in Hemophiliacs (see Chapter 3 ). This group seems to have been organized by the CDC, but there is no record of its operations after August of that year.

Blood Safety Council

The AIDS crisis revealed that the institutions in place to ensure blood safety, both public and private, were unable to work cooperatively toward a common goal of a safe blood supply. The institutions were not accountable to anyone but themselves, and they failed to cooperate, to coordinate their activities, and to communicate effectively with physicians and the public. The Committee has become convinced that the nation needs a far more responsive and integrated process to detect, evaluate, and respond to emerging threats to the blood supply. To this end the Committee makes

Recommendation 2: The PHS should establish a Blood Safety Council to assess current and potential future threats to the blood supply, to propose strategies for overcoming these threats, to evaluate the response of the PHS to these proposals, and to monitor the implementation of these strategies. The Council should report to the Blood Safety Director (see Recommendation 1). The Council should also serve to alert scientists about the needs and opportunities for research to maximize the safety of blood and blood products. The Blood Safety Council should take the lead to ensure the education of public health officials, clinicians, and the public about the nature of threats to our nation's blood supply and the public health strategies for dealing with these threats.

Supplying safe blood and blood products to the nation—a public good—requires the cooperation of public and private institutions. The Blood Safety Council would give voice to the public's interest in having these institutions cooperate and would provide opportunities for them to do so.

The lessons of HIV transmission through blood and blood products show the need for an advisory council with a significantly greater level of diversity, responsibility, and authority than the current Blood Products Advisory Committee of the FDA. The BPAC is limited by the regulatory mission of the FDA which it advises, and there is no other body primarily concerned with blood safety as a whole. Representatives from governmental agencies, academia, the blood bank community, industry, and the public all have relevant expertise and perspectives and should be involved in the Blood Safety Council. A broad-based range of expertise in areas of hematology, infectious diseases, epidemiology, blood product manufacturing, blood collection and delivery, risk assessment, consumer advocacy, and cost-benefit analysis is essential.

The proposed Blood Safety Council would facilitate the timely transmission of information, assessment of risk, and initiation of appropriate action both during times of stability and during a crisis. The Council should report to the Blood Safety Director (see Recommendation 1). The Council would not replace the PHS agencies responsible for blood safety but would complement them by providing a forum for them to work together and with private organizations. The PHS agencies would be represented on the Council (see below and Figure 8.1 ). The Council would not have its own surveillance capability, but would work with CDC and FDA to interpret the information that those organizations can provide. It would not carry out or fund research itself, but would work with those at NIH and in the private sector to identify priorities for blood safety research. The Council would not have regulatory power, but would inform FDA actions from a blood safety rather than a product-specific perspective.

Figure 8.1.

Blood Safety Council relationships.

The organizations and groups that should be included in the Blood Safety Council, and the reasons for including them, are as follows:

• The FDA can provide a direct link between itself, the essential regulatory agency responsible for the safety of blood and blood products, and important sources of information, scientific support, and disease surveillance findings.
• The CDC can provide expertise in epidemiology, infectious diseases, and immunology as well as communicate the results of ongoing disease surveillance studies. The CDC's newly established emerging infectious disease program would also provide valuable information.
• The NIH can provide scientific expertise and the means to communicate information about essential research needs to the appropriate institutes for support of research.
• Representatives from academia can bring independent scientific and medical expertise, especially in hematology, infectious diseases, epidemiology, risk assessment, and cost-effectiveness analysis.
• Representatives from the volunteer blood collection community can bring experience with blood safety concerns and the knowledge of blood bank operations that is necessary to evaluate proposed change.
• Representatives from the private-sector blood product manufacturers and biotechnology companies can bring both experience with blood safety concerns and knowledge of plasma fractionation operations.
• Representatives of the general public (who may in the future require blood transfusions) and individuals who currently require frequent use of blood products, such as hemophilia patients, bring important perspectives on the trade-offs that must be considered in evaluating response options.

The Blood Safety Council should consider the following activities and issues:

Surveillance. Although the FDA and the CDC keep track of events in blood and blood product recipients, their surveillance systems are passive and incomplete. The Blood Safety Council should work with the CDC to design a system of active surveillance for adverse reactions in blood recipients, as described in Recommendation 5 below. If such a system is established, the Council would benefit from its results and should participate in its governance.

Expert Panel on Best Practices . Drawing on its members' knowledge about blood and blood product safety concerns, and about clinical alternatives, the Blood Safety Council could establish a panel of experts to provide the public and providers of care with information about risks and benefits, alternatives to using blood products, and recommended best practices, as described in more detail in Recommendation 13 below.

Investigate Methods to Make Blood Products Safer. The Council should evaluate new methods to make blood and blood products safer. One promising approach is double inactivation in the preparation of blood products, which minimizes the risk of transmission of infectious pathogens in the blood of the donor pool. At present, the FDA requires only a single inactivation process (usually solvent detergent or heat treatment) for most blood products manufactured in the United States. With the goal of maximizing the safety of the blood supply at minimal added cost, the Blood Safety Council should encourage the FDA to evaluate double inactivation methods and expeditiously relicense products manufactured by the improved technologies, if appropriate. The Blood Safety Council should also consider, at least yearly, in a public forum, opportunities to maximize the safety of the blood supply.

Another promising approach is to reconsider minimum pool size requirements in plasma product manufacturing. The FDA currently requires a large number of donors to be included in plasma pools used in the manufacture of plasma products in order to ensure a wide range of antibodies in preparations of intravenous gamma globulin. Pooling of plasma obtained from numerous donors, although permitting some economy of scale, also increases the risk that a large fraction of manufactured blood products will be contaminated by a single infected donor. The Blood Safety Council should consider this issue and address the safety and efficiency trade-offs in changing the minimum pool size.

The Blood Safety Council would provide information relevant to the decisions that individuals as well as public and private decisionmakers need to make. The forum would not have direct regulatory or other authority, but would function as a forum for holding the organizations with authority responsible for blood safety. In short, the Blood Safety Council could advocate the public's need for a responsible process for decisionmaking about public health policy. The following examples illustrate how regular public discussions of blood safety issues, in the presence of representatives from the relevant organizations' perspectives, could provide an opportunity to hold the organizations with authority accountable for blood safety.

If it had existed in the 1970s, for instance, the Blood Safety Council might have called for the development of heat-treated AHF concentrate to reduce the risk of hepatitis, which would have also reduced the risk of HIV transmission. It would have been able to do so if the NIH and blood products industry representatives on the Council had been called upon to make periodic reports to the Council during the 1970s about their efforts to deal with the hepatitis problem. These representatives would have fed the discussions of the Council back into their own organizations' decisionmaking.

In 1983, the Council could have provided a forum for CDC to present its concerns about HIV in the blood supply and held the FDA, the NHF, and the blood banks and fractionators accountable for responding constructively. CDC created a forum on its own by convening the January 4, 1983, meeting in Atlanta, but as the Committee's analysis indicates, the follow-up on this meeting was insufficient. If a standing Blood Safety Council had existed, the CDC scientists who had concerns about the safety of blood and blood products would have had an opportunity to hold blood collection organizations accountable for their decisions regarding donor deferral and surrogate testing. It would also provide an opportunity to hold plasma fractionators and the FDA accountable for its decisions with regard to heat-treated AHF.

Later that year, the Council could have provided a mechanism to evaluate the claims that automatic recall of AHF would have virtually eliminated the supply of AHF. As the analysis in Chapter 6 indicates, neither the BPAC nor the FDA staff had the capacity to analyze claims that a automatic recall would have such an effect. The Blood Safety Council could have insisted that the FDA commission a formal decision analysis of the options for surrogate testing, or the Council might have performed such an analysis itself. The FDA would retain its regulatory authority, and continue to get advice from the BPAC, but the Council would have provided critical information relevant to the agency's decision.

Finally, if the Council had established an expert panel on best practices as described above and in Recommendation 13, hemophilia patients and their physicians would have had a more credible source of information about the risks of HIV infection and their clinical options than the NHF was able to provide. The operations of such a panel are described below under Recommendation 13.

Compensation Policy

When a product or service provided for the public good has inherent risks, the common law tort system fails to protect the rightful interests of patients who suffer harm resulting from the use of those products or services. Each claim requires extended, costly, and complex adjudicative procedures to establish liability. The results are erratic and unpredictable, and therefore inequitable (IOM 1985).

The doctrine of strict liability holds manufacturers accountable for injuries that are incurred from products that are inherently dangerous because diligence cannot fully eliminate their risks. The public health imperative of assuring enough vaccine for widespread use argues for limits on the strict liability doctrine for vaccine-related injuries. The chief concern is that fear of liability will discourage manufacturers from producing a vital public good. To vitate this concern, a federal compensation system has removed vaccine-related injuries from the scope of strict liability laws (Mariner 1992). The federal government established a mechanism for compensating individuals suffering harm from vaccine-related complications. Its rationale is that consent to undergo vaccination confers benefits to the entire community.

Blood -product-related injuries have also been removed from the scope of strict liability law by blood shield laws, which are in force in most states, and which protect society's interests in having an adequate blood supply. The blood shield laws serve to protect providers and manufacturers of blood and blood products from liability claims in instances where they take all due care to ensure the safety of the product. These laws, however, are unique in the manner in which they limit liability. The shield laws have made it difficult, and often impossible, to obtain compensation for HIV infection acquired from blood or blood products. To address this asymmetry between the protection that blood shield laws offer for manufacturers and adequate protection of individual rights, the Committee makes

Recommendation 3: The federal government should consider establishing a no-fault compensation system for individuals who suffer adverse consequences from the use of blood or blood products. 2

An effective no-fault system requires prospective standards and procedures to guide its operations. In a no-fault system, individual plaintiffs would not have to prove that their adverse outcome was a result of negligence related to manufacture of a blood product. Therefore, there needs to be an objective, science-based process to establish which categories of adverse outcomes are caused by blood-borne pathogens and which individual cases deserve compensation. As with vaccines, a tax or fee paid by all manufacturers or by the recipients of blood products could finance a compensation system. Rather than attempt to allocate blame for HIV infections through blood and blood products, some countries have established such no-fault compensation programs for individuals infected with HIV as a result of their use of blood and blood products. Countries fund these programs in a variety of ways, including direct government support and joint public/private resources.

Making recommendations about compensating affected individuals for damages incurred in the past is outside the Committee's mandate. However, had there been a no-fault compensation system in the early 1980s, it could have relieved much financial hardship suffered by many who became infected with HIV through blood and blood products in the United States. The no-fault principles outlined in this recommendation might serve to guide policymakers as they consider whether to implement a compensation system for those infected in the 1980s.

The Centers for Disease Control and Prevention

The CDC has an indispensable role to play in protecting our nation's health: to detect potential public health risks and sound the alert. Because of its expertise in detecting and evaluating possible infectious disease outbreaks, the Committee believes that the CDC should take responsibility for a surveillance system to detect adverse outcomes from blood and blood products. The following two recommendations embody an important principle: separating the assessment of risk from the management of the consequences of risk. The FDA, in its role as guarantor of the safety of the blood supply, has the responsibility for managing threats to the blood supply. The CDC should detect potential threats and assess the magnitude of the danger.

Early Warning Systems

A nation needs individuals and organizations that identify problems and raise concerns that may be difficult to confront. The CDC plays this role in the Public Health Service. The CDC appears to have been prescient in raising the possibility that the blood supply was contaminated early in the AIDS epidemic, but it was relatively ineffective in convincing other agencies of the potential gravity of the situation. In order to improve CDC's efficacy in this critical role, the Committee makes

Recommendation 4: Other federal agencies must understand, support, and respond to the CDC's responsibility to serve as the nation's early warning system for threats to the health of the public.

Officials in the government, scientists, and physicians in the private sector seem to have discounted the CDC warnings about the transmissibility of AIDS through blood and blood products because the swine flu episode in the 1970s had cost the agency considerable credibility. If, in 1983, the involved public and private organizations had the attitude called for in this recommendation, CDC's recommendations regarding donor screening and surrogate testing might have led to earlier, more effective screening and donor deferral policies.

Consistent with the precept of separating risk assessment and risk management as described above, CDC's role is to characterize and assess risks, and communicate this to others. The FDA and other organizations have the responsibility to manage the risks through regulation, clinical practice guidelines, and other means. The Committee believes that CDC should be able to play its designated role without fearing loss of credibility if it sometimes proves to be wrong. Implementing this recommendation may be difficult. As a start, the Secretary of Health and Human Services should insist that an agency that wishes to disregard a CDC alert should support its position with evidence that meets the same standard as that used by the CDC in raising the alert.

Surveillance

In order to carry out its early warning responsibility effectively, the CDC needs good surveillance systems. Because blood products are derived from human beings and may contain harmful biologic agents that were present in the blood of a donor, blood products are inherently risky, a principle long recognized by blood shield laws. The Committee, believing that the degree of surveillance should be proportional to the level of risk, makes

Recommendation 5: The PHS should establish a surveillance system, lodged in the CDC, that will detect, monitor, and warn of adverse effects in the recipients of blood and blood products.

If such a system had existed in 1982, data about the risks of HIV transmission through blood and blood products might have been available sooner and might have been more definitive. In dealing with newly approved pharmaceuticals, the FDA increasingly demands careful post-approval study of potential adverse effects (the so-called ''Phase IV Trial"). Two existing systems for vaccine adverse events—the CDC/FDA Vaccine Adverse Event Reporting System (VAERS) and the CDC's Large-Linked Database (LLDB)—might be useful models (Institute of Medicine 1994).

The Food and Drug Administration

The FDA has legal authority to protect the safety of the nation's blood supply. Accordingly, it is the lead federal agency in regulating blood-banking practice, the handling of source plasma, and the manufacture of blood products from plasma. The Committee found cause for concern when it evaluated the FDA's actions in protecting the public from HIV in the nation's blood supply during the 1980s. The record reveals many opportunities to improve the agency's capacity to deal with crises involving the blood supply, most notably with respect to the safety of AHF concentrate. In responding to these opportunities, the Committee's recommendations focus on decisionmaking and the role of advisory committees in formulating the FDA's response to crises.

Risk Reduction

In a crisis, decisionmakers may become so preoccupied with seeking solutions that will dramatically reduce danger that they will fail to implement solutions that are less effective but are likely to improve public safety to some degree. Partially effective risk-reducing improvements, as described herein, can save lives, pending the development of more efficacious safety measures. In order that the perfect not be the enemy of the good, the Committee makes

Recommendation 6: Where uncertainties or countervailing public health concerns preclude completely eliminating potential risks, the FDA should encourage, and where necessary require, the blood industry to implement partial solutions that have little risk of causing harm.

In the event of a future threat to the blood supply, the FDA should encourage small, low-risk solutions to large, difficult problems. The FDA's actions during the early 1980s are evidence that the agency should change its attitude toward regulation in order to adopt this proactive approach. Some examples from Chapter 6 illustrate how the FDA might have encouraged practices that would have reduced the risk faced by recipients of blood or a blood product.

Example: Destroy Unscreened Blood When Possible . When hospital blood banks first started to screen donors by questioning them for risk factors, there was a period of transition during which its stocks contained two classes of blood or plasma: blood from screened donors, which was relatively safe; and blood from unscreened donors, which had a higher probability of containing HIV. Within a few weeks of starting to screen donors, blood from unscreened donors would have been either used or discarded. In the instructions contained in its letter of March 24, 1983, the FDA could have recommended that blood banks adopt a policy of using blood from screened donors whenever possible during the transition period, a policy that some blood banks may have adopted on their own. Requiring all blood banks to adopt this policy would not have compromised the nation's blood supply, and it would have prevented at least a few instances in which a patient received an infected unit of blood.

Example: Destruction of Potentially Contaminated Cryoprecipitate . Blood banks store cryoprecipitate from a single unit of donated blood in the frozen state for up to one year. The FDA could have issued a directive that required the blood banks to check their inventory of frozen cryoprecipitate and destroy possibly contaminated units whenever they learned of a previous donor who had AIDS or was strongly suspected of having AIDS.

Example: Phased Recall. In July 1983, there was considerable reluctance to recall untreated Factor VIII concentrate at a time when much of the supply was almost certainly contaminated with HIV. The FDA apparently feared that the ensuing shortage of Factor VIII would have caused more harm than the HIV virus. A phased withdrawal would have been a compromise between no withdrawal and immediate total withdrawal. This middle path might have avoided a factor concentrate shortage and still reduced the number of hemophiliacs who became infected.

Example: Lookback. The FDA formally instituted a "lookback" policy in 1991, years after it was clear that AIDS had a long incubation period during which a patient could transmit HIV through sexual contact or contact with blood. Lookback required blood banks to contact recipients of blood from infected donors and notify them that they might be a HIV carrier and should be tested for HIV antibodies. Earlier action on lookback might have reduced secondary transmission of HIV.

Decision Processes

In all fields, decisionmaking under uncertainty requires an iterative process. As the knowledge base for a decision changes, the responsible agency should reexamine the facts and be prepared to change its decision. The agency should also assign specific responsibility for monitoring conditions and identifying opportunities for change. In order to implement these principles at the FDA, the Committee makes

Recommendation 7: The FDA should periodically review important decisions that it made when it was uncertain about the value of key decision variables.

An example illustrates the principle of iterative decisionmaking. During 1983, most blood bank officials opposed asking prospective male donors if they had ever had sex with a man. They were worried that regular donors might take offense and stop donating blood. They were also concerned about some gays would lie about their homosexuality and donate blood in reprisal for being singled out as the target of the questioning. Eventually, some blood collection centers began to ask questions about sexual preference. If the FDA had carefully monitored these experiments, it would have soon learned that the blood bank officials' fears were groundless. The FDA might then have revised its requirements for donor screening to include direct questions about high-risk sexual practices.

Regulatory Efforts

Although the FDA has a great deal of regulatory power over the blood products industry, the agency appears to regulate by expressing its will in subtle, understated directives. This informal approach to regulation is often necessary to permit a timely response and to preserve needed flexibility. The FDA used this approach, for example, in July 1983 when it issued recommendations to withdraw lots of AHF concentrate that plasma fractionators had identified as containing material from a donor that had AIDS . The language in the July 1983 communication failed to specify, however, whether the agency considered the recommendations to be binding on industry. While most regulated industries might have interpreted these letters as mandatory, that question should not have been left to the judgment of individual entities. Taking this into account, the Committee makes

Recommendation 8: Because regulators must rely heavily on the performance of the industry to accomplish blood safety goals, the FDA must articulate its requests or requirements in forms that are understandable and implementable by regulated entities. In particular, when issuing instructions to regulated entities, the FDA should specify clearly whether it is demanding specific compliance with legal requirements or is merely providing advice for careful consideration.

In 1983, the FDA chose a middle ground when faced with the decision to withdraw all AHF concentrate. The agency recommended that plasma fractionators withdraw individual lots of AHF concentrate when a donor was suspected of having AIDS . This decision was certainly defensible. However, the process for this "case-by-case" withdrawal was seriously compromised by the vagueness of the criteria specified for a recall. The agency failed to specify a process for deciding whether a donor may have had AIDS. The agency should have specified a process for reviewing donors who did not fully satisfy the diagnostic criteria for AIDS but who were suspected of having the disease. When deciding whether to withdraw a lot of AHF concentrate, the FDA asked plasma fractionators to take into account the time of the donation in relation to the diagnosis of AIDS and the effect of the recall on product availability. However, the FDA did not specify parameters for assessing either of these decision criteria. With greater forethought, the FDA could have avoided the potential for a seriously flawed implementation of a policy that otherwise appeared to balance benefits, risks, and harms.

Advisory Committees

The FDA made several decisions in 1983 that appear to have been influenced by the blood-industry-based (profit and nonprofit) members of the BPAC. The BPAC membership did not include individuals with expertise in the social, ethical, political, and economic aspects of the issues that BPAC was deliberating at the time. The FDA apparently did not seek independent analysis of the recommendations made by the members of the BPAC, some of whom were employed by the blood industry. In the early 1980s, the FDA appeared too reliant upon analyses provided by industry-based members of the BPAC and the BPAC. For example, see the discussion in Chapter 6 of the July 19, 1983, BPAC meeting which resulted in the decision for case-by-case rather than automatic recall of lots of AHF when one donor was suspected of having AIDs. Chapter 6 also contains a discussion of the December 15, 1983, BPAC meeting, which effectively curtailed actions on surrogate testing of blood for months. The Committee's analysis of the FDA's management of its advisory committee leads to the following three recommendations:

Recommendation 9: The FDA should ensure that the composition of the Blood Products Advisory Committee reflects a proper balance between members who are connected with the blood and blood products industry and members who are independent of industry.

The FDA should select some BPAC members because they can provide independent judgment, question the analyses provided by blood-industry-based BPAC members, and hold the FDA accountable for a high standard of public responsiveness. The BPAC should have at least one voting member who is a representative of consumer interests. BPAC members who vote to establish policy should have neither the appearance of a conflict of interest nor a true conflict of interest.

An agency that is practiced in orderly decisionmaking procedures will be able to respond to the much greater requirements of a crisis. The BPAC meetings cited before Recommendation 9 above provide examples to support this recommendation. Applying this principle to the use of advisory committees, the Committee makes

Recommendation 10: The FDA should tell its advisory committees what it expects from them and should independently evaluate their agendas and their performance.

The FDA staff and its advisory committees should structure their relationship so that they invigorate each other. The agency should hold an advisory committee accountable for its performance through periodic independent evaluation. By placing unresolved issues on future agendas, the committee can hold the FDA accountable for taking follow-up action between committee meetings. The IOM Committee to Study the Use of Advisory Committees by the Food and Drug Administration makes further recommendations to strengthen the FDA advisory committee system (IOM 1992).

Advisory committees provide scientific advice to the FDA; they do not make regulatory decisions for the agency (IOM 1992). As Chapter 6 indicates, the FDA in 1983 did not independently verify the estimates of the risk of blood-product-related HIV infection. The FDA did not analyze the public health implications of the BPAC's recommendation against automatic recall of AHF concentrate that contained plasma from donors suspected of having AIDS . The FDA's lack of independent information and its own analytic capacity meant that it had little choice but to incorporate the advice of the BPAC into its policy recommendations. To ensure the proper degree of independence between the FDA and the blood products industry, the Committee makes

Recommendation 11: The FDA should develop reliable sources of the information that it needs to make decisions about the blood supply. The FDA should have its own capacity to analyze this information and to predict the effects of regulatory decisions.

Communication to Physicians and Patients

One of the crucial elements of the system for collecting blood and distributing blood products to patients is the means by which to convey concern about the risks inherent in blood products. In today's practice of medicine, in contrast to that of the early 1980s, patients and physicians each accept a share of responsibility for making decisions. Patients' informed consent is required for risky procedures. From early 1983, it was clear that AHF concentrate was a risky product. The failure to tell hemophilia recipients of Factor VIII concentrate about the risks of this treatment and about alternative treatments seems especially serious in the light of present-day emphasis on the autonomy of patients in decisions involving their health.

Clinical Practice

One powerful lesson of the AIDS crisis is the importance of telling patients about the potential harms of the treatments that they are about to receive. The NHF dedicated itself to providing information to individuals with hemophilia and their physicians. Their strategy, however, was seriously flawed. As discussed in Chapter 7 , the NHF provided treatment advice, not the information on risks and alternatives that would enable physicians and patients to decide for themselves on a course of treatment. Hemophilia patients did not have the basis for informed choice about a difficult treatment decision.

Considerable scientific and medical uncertainties characterized the early years of the AIDS epidemic. For individuals medically dependent on the use of blood and blood products, these uncertainties created complex dilemmas about clinical options for their continued care. In instances of great uncertainty, it is crucial for patients to be fully apprised of the full range of options available to them and to become active participants in the evaluation of the relative risks and benefits of alternative treatments. As the case studies in Chapter 7 indicate, the failure to communicate adequately about these options prevented many hemophiliacs from making choices in which they accepted responsibility for balancing the risk of AIDS and the risks of bleeding. Ultimately the failure to communicate led to a powerful sense of betrayal that exacerbated the tragedy of the epidemic for many patients and their families. To encourage better communication, the Committee makes

Recommendation 12: When faced with a decision in which the options all carry risk, especially if the amount of risk is uncertain, physicians and patients should take extra care to discuss a wide range of options.

Medicine has many "gray areas" in which the correct course of action is not clear. Guidelines should identify these areas and spotlight the importance of full disclosure of risks, discussion of the broadest range of clinical options, and incorporation of the patient's preferences into an individualized recommendation. Given the inherent risks and uncertainties in all blood products, the public and the providers of care need expert, unbiased information about the blood supply. This information includes risks and benefits, alternatives to using blood products, and recommended best practices. As Chapter 7 indicates, the NHF (the only organization that stepped in to provide information to hemophiliacs and the physicians who were treating them) focused on practice recommendations rather than complete information on risks and options. In order to provide the public and providers of care with the information they need, the Committee makes

Recommendation 13: An expert panel should be created to inform the providers of care and the public about the risks associated with blood and blood products, about alternatives to using them, and about treatments that have the support of the scientific record.

One lesson of the AIDS crisis is that a well-established, orderly decisionmaking process is important for successfully managing a crisis. This applies as much to clinical decisionmaking as to the public health decision process addressed by the earlier recommendations. As the narrative indicates, there are both public health and clinical approaches to reducing the risk of blood-borne diseases. The Blood Safety Council called for in Recommendation 2 would deal primarily with risk assessment and in the public health domain, actions that would reduce the chance that blood products could be vectors of infectious agents. The primary responsibility of the expert panel on best practices called for in Recommendation 13 would be to provide the clinical information that physicians and their patients need to guide their individual health care choices. To be most effective, this panel should be lodged in the Blood Safety Council (see Recommendation 2) so that both bodies can interact and coordinate their activities in order to share information about emerging risks and clinical options.

Any organization that supplies this information must adhere to accepted norms for documenting evidence. The Committee believes that the public's interest would be best served by creating one publicly accountable source of this information. This function would build on the experience of the Agency for Health Care Policy and Research, which has an established guideline development process and issues guidelines on topics such as the management of chronic pain, screening for AIDS , and management of urinary incontinence (El-Sadr, et al. 1994; Jacox, et al. 1994).

Experience in developing practice guidelines for hemophilia treatment and blood transfusion is an important element of preparedness for future threats to the blood supply. There are now well-established processes such as those recommended by the IOM Committee to Advise the Public Health Service on Practice Guidelines (IOM 1990, 1992) and used by the Agency for Health Care Policy and Research. The U.S. Preventive Services Task Force (1989) uses another system process. Guideline developers should perform a thorough literature search, identify well-designed studies, describe fully the evidence on harms and benefits, and explain the connection between the evidence and the recommendations. They should seek critical evaluation from a wide spectrum of individuals and organizations and should periodically reexamine the recommendations in the light of changing knowledge.

Credibility

During the early 1980s, in its role as the guardian of the interests of the hemophilia patient community, the NHF was the principal source of information about using blood products. The outcome of the NHF efforts was that individuals with hemophilia and their families lost faith in the NHF as the rightful steward of their interests. The reasons discussed in Chapter 7 include the NHF's unwavering recommendation to use AHF concentrate, its dependence on funds contributed by the plasma fractionation industry, and the composition of the NHF expert panel (MASAC) that formulated treatment recommendations (e.g., the panel's lack of infectious disease experts and decision analysts).

Toward the end of providing the highest-quality, most credible information to patients and providers, the Committee makes

Recommendation 14: Voluntary organizations that make recommendations about using commercial products must avoid conflicts of interest, maintain independent judgment, and otherwise act so as to earn the confidence of the public and patients.

One of the difficulties with using experts to give advice is the interconnections that experts accumulate during their careers. Organizations that regulate an industry may get advice from the same experts who advise the industries. Organizations that give treatment advice may rely on experts whose employer relies upon support from industry. As a result, an expert may have a history of relationships that raise concerns about whether he or she can be truly impartial when advising a course of action in a complex situation. The Committee believes that the best way to avoid these risks is to choose some panelists who are not expert in the subject of the panel's assignment but have a reputation for expertise in evaluating evidence, sound clinical judgment, and impartiality.

Financial conflicts of interest influence organizations as well as individuals. As indicated in Chapter 7 and above, the financial relationships between the NHF and the blood products industry seriously compromised the NHF's credibility. The standards for acknowledging conflicts of interest are higher than they were 12 years ago. Public health officials and the medical professions must uphold this new standard. Failure to do so will threaten the fabric of trust that holds our society together.

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Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)

Learn about the nursing care management of patients with HIV /AIDS in this nursing study guide .

Table of Contents

• What are HIV and AIDS? 

Classification

Pathophysiology, statistics and epidemiology, clinical manifestations, complications, assessment and diagnostic findings, medical management, nursing assessment, planning & goals, nursing interventions, discharge and home care guidelines, documentation guidelines.

• Practice Quiz: HIV/AIDS

What are HIV and AIDS?

Since HIV was first identified almost 30 years ago, remarkable progress has been made in improving the quality and duration of life for people living with HIV disease.

• HIV or human immunodeficiency virus and acquired immunodeficiency syndrome is a chronic condition that requires daily medication.
• HIV- 1 is a retrovirus isolated and recognized as the etiologic agent of AIDS.
• HIV-2 is a retrovirus identified in 1986 in AIDS patients in West

The stages of HIV disease is based on clinical history, physical examination, laboratory evidence of immune dysfunction, signs and symptoms, and infections and malignancies.

• Primary infection (Acute/Recent HIV Infection). The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection.
• HIV asymptomatic (CDC Category A). After the viral set point is reached, HIV-positive people enter into a chronic stage in which the immune system cannot eliminate the virus despite its best efforts.
• HIV symptomatic (CDC Category B). Category B consists of symptomatic conditions in HIV-infected patients that are not included in the conditions listed in category C.
• AIDS (CDC Category C). When the CD4+ T-cell level drops below 200 cells/mm3 of blood , the person is said to have AIDS.

Because HIV infection is an infectious disease, it is important to understand how HIV-1 integrates itself into a person’s immune system and how immunity plays a role in the course of HIV disease.

• In this first step, the GP120 and GP41 glycoproteins of HIV bind with the host’s uninfected CD4+ receptor and chemokine coreceptors, usually CCR5, which results in the fusion of HIV with the CD4+ T-cell membrane.
• The contents of HIV’s viral core are emptied into the CD4+ T cell .
• DNA synthesis. HIV changes in genetic material from RNA to DNA through the action of reverse transcriptase, resulting in double-stranded DNA that carries instruction for viral replication.
• New viral DNA enters the nucleus of the CD4+ T cell and through the action of integrase is blended with the DNA of the CD4+ T cell, resulting in permanent, lifelong infection.
• When the CD4+ T cell is activated, the double-stranded DNA forms single-stranded messenger RNA, which builds new viruses.
• The mRNA creates chains of new proteins and enzymes that contain the components needed in the construction of new viruses.
• The HIV enzyme protease cuts the polyprotein chain into the individual proteins that make up the new virus.
• New proteins and viral RNA migrate to the membrane of the infected CD4+ T cell, exits from the cell, and starts the process all over.

Pathophysiology of HIV and AIDS by Osmosis

Check out this awesome pathophysiology and easy-to-understand video by Osmosis. Let us support them via Patreon to make more informative videos like this.

In the fall of 1982, after the first 100 cases were reported, the Centers for Disease Control and Prevention (CDC) issued a case definition for AIDS.

• In 2008, the CDC reported that approximately 56, 300 new HIV infections occurred in the United States in 2006.
• The figure was roughly 40% higher than their former estimate of 40, 000 HIV infections per year.
• Almost 7000 people still contract HIV infection every day.
• An estimated 33 million people are living with HIV/AIDS; however, the number of new infections declined from 3 million in 2001 to 2.7 million in 2007.
• The global percentage of women among people with HIV/AIDS remains at 50%.
• Sub-Saharan Africa continues to be most heavily affected by HIV/AIDS, with 67% of all people living with the disease.
• In 2007, 72% of deaths from HIV/AIDS occurred in the same region.

HIV is transmitted through body fluids that contain free virions and infected CD4+ T cells .

• Sharing infected drug use equipment such as needles.
• Having sexual relations with infected individuals (both male and female).
• Blood transmission. Receiving HIV-infected blood or blood products especially before blood screening.
• Maternal HIV. Infants born to mothers with HIV infection.

HIV has four categories with specific manifestations for each stage.

• This is experienced during the early infection stages.
• People who are acutely infected with HIV infection experiences this symptom.
• This symptom is mostly present in category B wherein the patient has already entered the chronic stage.
• Constitutional symptoms. Fever more than 38.5⁰C or diarrhea exceeding 1 month in duration may also indicate presence of HIV infection.
• Patients with HIV category C experience wasting syndrome or severe wasting of the muscles.

Until an effective vaccine is developed, nurses need to prevent HIV infection by teaching patients how to eliminate or reduce risky behaviors.

• Safe sex. Other than abstinence , consistent and correct use of condoms is the only effective method to decrease the risk of sexual transmission of HIV infection.
• In March 2007, based on the results of three clinical trials, the WHO and UNAIDS recommended that circumcision be recognized as an effective strategy to reduce the risk of HIV acquisition in men.
• Sex partners. Avoid sexual contact with multiple partners or people who are known to be HIV positive or IV/injection drug users.
• Blood and blood components. People who are HIV positive or who use injection drugs should be instructed not to donate blood or share drug equipment with others.

The patient should be monitored for presence of complications and should be managed appropriately.

• Opportunistic infections. Patients who are immunosuppressed are at risk for opportunistic infections such as pneumocystis pneumonia which can affect 80% of all people infected with HIV.
• Respiratory failure. Impaired breathing is a major complication that increases the patient’s discomfort and anxiety and may lead to respiratory and cardiac failure.
• Cachexia and wasting. Wasting syndrome occurs when there is profound involuntary weight loss exceeding 10% of the baseline body weight and it is a common complication of HIV infection and AIDS.

Several screening tests are used to diagnose HIV infection.

• Confirming Diagnosis: Signs and symptoms may occur at any time after infection, but AIDS isn’t officially diagnosed until the patient’s CD4+ T-cell count falls below 200 cells/mcl or associated clinical conditions or disease.
• CBC:   Anemia and idiopathic thrombocytopenia ( anemia occurs in up to 85% of patients with AIDS and may be profound). Leukopenia may be present; differential shift to the left suggests infectious process (PCP), although shift to the right may be noted.
• PPD:  Determines exposure and/or active TB disease. Of AIDS patients, 100% of those exposed to active Mycobacterium tuberculosis  will develop the disease.
• Serologic:  Serum antibody test: HIV screen by ELISA. A positive test result may be indicative of exposure to HIV but is not diagnostic because false-positives may occur.
• Western blot test:  Confirms diagnosis of HIV in blood and urine .
• RI-PCR: The most widely used test currently can detect viral RNA levels as low as 50 copies/mL of plasma with an upper limit of 75,000 copies/mL.
• bDNA 3.0 assay: Has a wider range of 50–500,000 copies/mL. Therapy can be initiated, or changes made in treatment approaches, based on rise of viral load or maintenance of a low viral load. This is currently the leading indicator of effectiveness of therapy.
• T-lymphocyte cells: Total count reduced.
• CD4+ lymphocyte count (immune system indicator that mediates several immune system processes and signals B cells to produce antibodies to foreign germs): Numbers less than 200 indicate severe immune deficiency response and diagnosis of AIDS.
• T8+ CTL (cytopathic suppressor cells): Reversed ratio (2:1 or higher) of suppressor cells to helper cells (T8+ to T4+) indicates immune suppression .
• Polymerase chain reaction (PCR) test: Detects HIV-DNA; most helpful in testing newborns of HIV-infected mothers. Infants carry maternal HIV antibodies and therefore test positive by ELISA and Western blot, even though infant is not necessarily infected.
• STD screening tests:   Hepatitis B envelope and core antibodies, syphilis, and other common STDs may be positive.
• Protozoal and helminthic infections: PCP, cryptosporidiosis, toxoplasmosis.
• Fungal infections: Candida albicans (candidiasis), Cryptococcus neoformans (cryptococcus), Histoplasma capsulatum (histoplasmosis).
• Bacterial infections: Mycobacterium avium-intracellulare (occurs with CD4 counts less than 50), miliary mycobacterial TB, Shigella (shigellosis),Salmonella (salmonellosis).
• Viral infections: CMV (occurs with CD4 counts less than 50), herpes simplex, herpes zoster.
• Neurological studies, e.g., electroencephalogram (EEG), magnetic resonance imaging (MRI), computed tomography (CT) scans of the brain ; electromyography (EMG)/nerve conduction studies:  Indicated for changes in mentation, fever of undetermined origin, and/or changes in sensory/motor function to determine effects of HIV infection/opportunistic infections.
• Chest x-ray :  May initially be normal or may reveal progressive interstitial infiltrates secondary to advancing PCP (most common opportunistic disease) or other pulmonary complications/disease processes such as TB.
• Pulmonary function tests:  Useful in early detection of interstitial pneumonias.
• Gallium scan:  Diffuse pulmonary uptake occurs in PCP and other forms of pneumonia .
• Biopsies:  May be done for differential diagnosis of Kaposi’s sarcoma (KS) or other neoplastic lesions.
• Bronchoscopy /tracheobronchial washings:  May be done with biopsy when PCP or lung malignancies are suspected (diagnostic confirming test for PCP).
• Barium swallow, endoscopy, colonoscopy :  May be done to identify opportunistic infection (e.g., Candida, CMV) or to stage KS in the GI system.

Medical management focuses on the elimination of opportunistic infections.

• Treatment of opportunistic infections. For Pneumocystis pneumonia , TMP-SMZ is the treatment of choice; for mycobacterium avian complex, azithromycin or clarithromycin are preferred prophylactic agents; for cryptococcal meningitis , the current primary treatment is IV amphotericin B .
• Prevention of opportunistic infections. TMP-SMZ is an antibacterial agent used to treat various organisms causing infection.
• Antidiarrheal therapy. Therapy with octreotide acetate (Sandostatin), a synthetic analog of somatostatin, has been shown to be effective in managing severe chronic diarrhea .
• Antidepressant therapy. Treatment for depression in patients with HIV infection involves psychotherapy integrated with imipramine , desipramine or fluoxetine.
• Nutrition therapy. For all AIDS patients who experience unexplained weight loss, calorie counts should be obtained, and appetite stimulants and oral supplements are also appropriate.

Nursing Management

The nursing care of patients with HIV/AIDS is challenging because of the potential for any organ system to be the target of infections or cancer .

Nursing assessment includes identification of potential risk factors, including a history of risky sexual practices or IV/injection drug use.

• Nutritional status. Nutritional status is assessed by obtaining a diet history and identifying factors that may affect the oral intake.
• Skin integrity. The skin and mucous membranes are inspected daily for evidence of breakdown, ulceration, or infection.
• Respiratory status. Respiratory status is assessed by monitoring the patient for cough , sputum production, shortness of breath, orthopnea, tachypnea, and chest pain .
• Neurologic status. Neurologic status is determined by assessing the level of consciousness; orientation to person, pace, and time; and memory lapses.
• Fluid and electrolyte balance. F&E status is assessed by examining the skin and mucous membranes for turgor and dryness.
• Knowledge level. The patient’s level of knowledge about the disease and the modes of disease transmission is evaluated.

The list of potential nursing diagnoses is extensive because of the complex nature of the disease.

• Impaired skin integrity related to cutaneous manifestations of HIV infection, excoriation, and diarrhea .
• Diarrhea related to enteric pathogens of HIV infection.
• Risk for infection related to immunodeficiency.
• Activity intolerance related weakness , fatigue, malnutrition, impaired F&E balance, and hypoxia associated with pulmonary infections.
• Disturbed thought processes related to shortened attention span, impaired memory , confusion , and disorientation associated with HIV encephalopathy.
• Ineffective airway clearance related to PCP, increased bronchial secretions, and decreased ability to cough related to weakness and fatigue.
• Pain related to impaired perianal skin integrity secondary to diarrhea, KS, and peripheral neuropathy.
• Imbalanced nutrition , less than body requirements related to decreased oral intake.

Main Article: 13 AIDS (HIV Positive) Nursing Care Plans

Goals for a patient with HIV/AIDS may include:

• Achievement and maintenance of skin integrity.
• Resumption of usual bowel pattern.
• Absence of infection.
• Improve activity intolerance .
• Improve thought processes.
• Improve airway clearance.
• Increase comfort.
• Improve nutritional status.
• Increase socialization.
• Absence of complications.
• Prevent/minimize development of new infections.
• Maintain homeostasis .
• Promote comfort.
• Support psychosocial adjustment.
• Provide information about disease process/prognosis and treatment needs.

The plan of care for a patient with AIDS is individualized to meet the needs of the patient.

• Promote skin integrity. Patients are encouraged to avoid scratching; to use nonabrasive, nondrying soaps and apply nonperfumed moisturizers ; to perform regular oral care ; and to clean the perianal area after each bowel movement with nonabrasive soap and water.
• Promote usual bowel patterns. The nurse should monitor for frequency and consistency of stools and the patient’s reports of abdominal pain or cramping.
• Prevent infection. The patient and the caregivers should monitor for signs of infection and laboratory test results that indicate infection.
• Improve activity intolerance. Assist the patient in planning daily routines that maintain a balance between activity and rest.
• Maintain thought processes. Family and support network members are instructed to speak to the patient in simple, clear language and give the patient sufficient time to respond to questions.
• Improve airway clearance. Coughing, deep breathing , postural drainage, percussion and vibration is provided for as often as every 2 hours to prevent stasis of secretions and to promote airway clearance.
• Relieve pain and discomfort. Use of soft cushions and foam pads may increase comfort as well as administration of NSAIDS and opioids .
• Improve nutritional status. The patient is encouraged to eat foods that are easy to swallow and to avoid rough, spicy, and sticky food items.

Expected patient outcomes may include:

• Achieved and maintained of skin integrity.
• Improved activity intolerance.
• Improved thought processes.
• Improved airway clearance.
• Increased comfort.
• Improved nutritional status.
• Increased socialization.

Before discharge, the nurse should educate the patient and the family about precautions and the transmission of HIV/AIDS.

• Patients and their families or caregivers should receive instructions about how to prevent disease transmission, including hand-washing techniques and methods for safely handling and disposing of items soiled with body fluids.
• Patients are advised to avoid exposure to others who are sick or who have been recently vaccinated.
• Medication administration . Caregivers in the home are taught how to administer medications, including IV preparations.
• The patient’s adherence to the therapeutic regimen is assessed and strategies are suggested to assist with adherence.
• Infection prevented/resolved.
• Complications prevented/minimized.
• Pain/discomfort alleviated or controlled.
• Patient dealing with current situation realistically.
• Diagnosis, prognosis, and therapeutic regimen understood.
• Plan in place to meet needs after discharge.

The focus of documentation in a patient with HIV/AIDS should include:

• Characteristics of lesions or condition.
• Impact of condition in personal image and lifestyle.
• Assessment findings including characteristics and pattern of elimination.
• Individual risk factors including recent or current antibiotic therapy.
• Signs and symptoms of infectious process.
• Breath sounds, presence and character of secretions, use of accessory muscles for breathing.
• Caloric intake.
• Individual cultural or religious restrictions and personal preferences.
• Plan of care.
• Teaching plan.
• Response to interventions, teaching, and actions performed.
• Attainment or progress toward desired outcomes.
• Modifications to plan of care.
• Long term needs.

Practice Quiz: HIV/AIDS

Here’s a 5-item quiz about the study guide. Please visit our nursing test bank for more NCLEX practice questions .

1. A widely used laboratory test that measures HIV-RNA levels and tracks the body’s response to HIV infection is the:

A. CD4/CD8 ratio. B. EIA test. C. Viral load test. D. Western blot.

2. The most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is:

A. Anorexia . B. Chronic diarrhea. C. Nausea . D. Vomiting.

3. Abnormal laboratory findings seen with AIDS include:

A. Decreased CD4 and T cell count. B. P24 antigen. C. Positive EIA test. D. All of the above.

4. The most common infection in persons with AIDS (80% occurrence) is:

A. Cytomegalovirus . B. Legionnaire’s disease. C. Mycobacterium tuberculosis. D. Pneumocystis pneumonia.

5. A diagnosis of wasting syndrome can be initially made when involuntary weight loss exceeds what percentage of baseline body weight?

A. 10% B. 15% C. 20% D. 25%

Answers and Rationale

1. Answer: C. Viral load test.

• C: Viral load test measures plasma RNA levels.
• A: CD4/CD8 ratio measures the number of CD4 T cells in the body.
• B: EIA test identifies antibodies directed specifically against HIV.
• D: Western blot is used to confirm seropositivity when the EIA result is positive.

2. Answer: B. Chronic diarrhea.

• B: Chronic diarrhea occurs in up to 90% of patients with AIDS.
• A: Anorexia is not as incapacitating as chronic diarrhea.
• C: Nausea is not as incapacitating as chronic diarrhea.
• D: Vomiting is not as incapacitating as chronic diarrhea.

3. Answer: D. All of the above.

• D: All of the mentioned laboratory results are seen in an AIDS patient.
• A: Decreased CD4 and T cell count is seen in an AIDS patient.
• B: P24 antigen is seen in an AIDS patient.
• C: Positive EIA test is seen in an AIDS patient.

4. Answer: D. Pneumocystis pneumonia.

• D: Pneumocystis pneumonia can affect 80% of all people infected with HIV.
• A: Cytomegalovirus is not the most common infection in AIDS patients.
• B: Legionnaire’s disease is not the most common infection in AIDS patients.
• C: Mycobacterium tuberculosis is not the most common infection in AIDS patients.

5. Answer: A. 10%

• A: Wasting syndrome occurs when there is profound involuntary weight loss exceeding 10% of the baseline body weight.
• B: It is not 15%, but 10% of the baseline body weight.
• C: It is not 20%, but 10% of the baseline body weight.
• D: It is not 25%, but 10% of the baseline body weight.

Posts related to HIV/AIDS:

• 13 AIDS (HIV Positive) Nursing Care Plans

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Introduction to HIV

What are HIV and AIDS? How AIDS Works in the Body HIV Treatment Who Should be Tested for HIV? HIV Contraction Common Misconceptions About Contraction The Importance of HIV Testing and Diagnosis How Does HIV Testing Work? Test Counseling Conclusion

What are HIV and AIDS?

The Human Immunodeficiency Virus, which is commonly called HIV, is a virus that directly attacks certain human organs, such as the brain, heart, and kidneys, as well as the human immune system. The immune system is made up of special cells, which are involved in protecting the body from infections and some cancers. The primary cells attacked by HIV are the CD4+ lymphocytes, which help direct immune function in the body. Since CD4+ cells are required for proper immune system function, when enough CD4+ lymphocytes have been destroyed by HIV, the immune system barely works. Many of the problems experienced by people infected with HIV result from a failure of the immune system to protect them from certain opportunistic infections (OIs) and cancers.

Defining the terms

People infected with HIV are broadly classified into those with HIV disease and those with Acquired Immunodeficiency Syndrome, or AIDS. A person with HIV disease has HIV but does not yet have any symptoms or related problems, and still has a relatively intact immune system (that is, a CD4+ lymphocyte count greater than 200 cells/mm3). A person with AIDS, on the other hand, has very advanced HIV disease and his or her immune system has incurred significant damage. As a result, people with AIDS are at very high risk for a number of OIs, cancers, and other AIDS-related complications. The Centers for Disease Control have defined the conditions that mark a progression from HIV disease to AIDS. They are: certain infections, such as repetitive pneumonias, Pneumocystis carinii pneumonia (PCP), and cryptococcal meningitis certain cancers, such as cervical cancer, Kaposi's sarcoma, and central nervous system lymphoma CD4+ count less than 200 cells/mm3 or 14 percent of lymphocytes

How AIDS Works in the Body

Before highly active antiretroviral therapy (HAART) became available, most people who contracted HIV eventually progressed to AIDS and had some AIDS-related complication, such as:

• a deterioration of immune system function and an increased risk of infections and cancers
• brain damage that may cause dementia or memory loss
• heart problems that can cause heart failure and symptoms such as shortness of breath, fatigue, and swelling of the abdomen and legs
• severe kidney damage requiring dialysis
• an inability to perform activities of daily living such as balancing a checkbook or driving a car
• metabolic changes that may cause significant weight loss or diarrhea

Due to these potential problems, a person with AIDS is at very high risk of becoming very ill, and, if some action is not taken to protect the person from these infections or reverse the damage done by HIV, he or she is at risk of dying.

The speed of progression to AIDS The damage caused by HIV occurs more quickly in some people than in others, but generally an untreated HIV-infected person can expect that they will progress to AIDS within 10 years of their infection. During the time the person is infected with HIV, a war rages between the person's immune system and HIV , with HIV slowly wearing the immune system out.

A slow progress: A number of factors can affect how rapidly HIV progresses, some that can be controlled, and some that can't. Some people have certain genes that slow HIV progression, or they are infected with a weak strain of HIV that their immune system is more able to control. In general, taking better care of yourself and following your doctor's advice also slows the progression of HIV disease to AIDS.

A more rapid progress: Factors that may cause a more rapid progression to AIDS are: infection by a virulent strain of HIV, having a high viral load setpoint (a certain level of HIV replication that varies from person to person), older age, and the abuse of drugs or alcohol .

HIV Treatment

In the time between initial infection and AIDS, the infected person may feel relatively normal, despite the constant attack by HIV. People living with HIV have to understand, however, that despite feeling well on the outside, significant damage can be occurring on the inside. Fortunately, over the past five years, significant progress has been made regarding the treatment of HIV and prevention of some of the infections and cancers that may be caused by it. Antiretroviral medications can directly attack HIV and stop it from reproducing and causing further damage. For most people, the biggest factor in preventing progression to AIDS is adherence to HAART, which can suppress HIV replication to very low levels and not allow it to continue to attack the body.

Prophylactic medications In addition to HAART, other steps can be taken to prevent illness in people living with HIV and AIDS. Certain antibiotics, called prophylactic medications, can effectively prevent opportunistic infections. A physician can help to assess the appropriateness of these medications in a particular treatment program, and which ones to use, but it is important that they be taken as prescribed so that infections can be prevented. With careful monitoring, OIs and certain cancers can be detected in their early stages before they have spread, and the antibiotics can work more effectively to ward off further serious complications. I recommend that every person living with HIV or AIDS see a physician for appropriate monitoring and treatment.

Who Should be Tested for HIV?

In the early 1980s, when HIV infections were first starting to appear, HIV was associated primarily with gay men. Then it became associated with intravenous drug users and hemophiliacs. During the past 20 years, however, HIV has become a disease that can affect almost anyone who is not monogamous with an uninfected person .

HIV contraction

HIV is contracted through an exchange of bodily fluids, such as blood, semen, or vaginal secretions. As a result, the most common ways of acquiring HIV are sharing needles while doing intravenous drugs, and sex, especially anal intercourse. While the highest risk of HIV transmission is associated with anal intercourse, vaginal intercourse is becoming a common means of spreading HIV. Vaginal intercourse is the most rapidly growing risk factor for acquiring HIV infection in the United States and in the developing world it is the most common method of HIV transmission. Everyone must take appropriate steps to prevent the spread of HIV : Safer sex with condoms and dental dams and not sharing needles can help prevent the spread of HIV.

Common misconceptions about HIV contraction

People are often concerned that HIV can be contracted through common contacts with an HIV-infected person, such as shaking hands or sharing glasses or eating utensils. These are not risk factors for contracting HIV. There is no evidence that HIV can be spread through these means, and people should not be afraid to be around people who have HIV or to use a glass, eating utensils, or plate that an HIV-infected person has used, or to have other common contacts.

Those who should consider being tested for HIV include :

• people who received a blood transfusion or blood product at any time, but especially in the late 1970s or 1980s
• homosexuals and heterosexuals who have a history of unprotected sex with potentially infected persons
• people who have had multiple sex partners
• people who have had a sexually transmitted disease such as syphilis or gonorrhea
• people who are intravenous drug users
• pregnant women

The importance of testing and diagnosis

The importance of HIV testing and diagnosis has increased over the past five years. Before the improvements in antiretroviral therapies, many people believed that there was little that could be done to prevent the progression of HIV and so they did not get tested. While these people were right about the ineffectiveness of the antiretroviral therapy available at that time, they failed to recognize that medicines had been discovered that could prevent many of the common infections that afflict AIDS patients. Thus, many people were diagnosed with HIV only after they were admitted to the hospital with severe infections, especially PCP. Some died needlessly because they had not sought appropriate medical care and did not receive one of the medications that could have prevented PCP from occurring.

Now, there are even more reasons to seek HIV testing and medical care. Within the past five years, the medicines to prevent infections have been significantly improved and effective antiretroviral therapies have been developed that can not only halt the progression of HIV, but can also reverse much of the damage that has already been done. Therefore, it is important that HIV is diagnosed while the person is relatively healthy and before a major, potentially life-threatening OI occurs, such as PCP or cerebral toxoplasmosis. With HIV, what you don't know can hurt you.

If you think you are at even slight risk of having HIV-if you have had numerous sex partners or if you have had sex with someone who might have been bisexual or had a history of intravenous drug use-you should be tested. If you test positive , you can then receive medical care necessary to keep you healthy and prevent the diseases that occur in untreated AIDS patients. If, on the other hand, you wait until you feel sick before you are tested, you may already have progressed to AIDS and your immune system may already have incurred significant damage that may not be reversible.

Pregnant women Recent advances in therapy have also led to effective methods of preventing mother-to-child transmission of HIV. Virtually every pregnant woman, especially those who have a history of intravenous drug use, have had sex with someone in a high-risk group, or who have had numerous sexual partners, should be tested for HIV. HIV-infected mothers should consider taking antiretrovirals, which can effectively prevent transmission to the infant. Since breast-feeding can also cause transmission of HIV to the infant, HIV-infected mothers should not breast-feed their infants if there is an available alternative. Many states also require testing of the infant at birth, so that appropriate treatment can be provided.

Testing is voluntary and confidential Under most circumstances, HIV testing is voluntary. Unless there are special circumstances, most states require a person to give specific permission, called informed consent, before he or she can be tested for HIV. Privacy and confidentiality are legitimate concerns for people who are being tested for HIV. Most people do not want other people or organizations , such as their employer, to know they are HIV-infected and most don't even want them to know that they are being tested. Most states have laws that protect the confidentiality of HIV testing and the diagnosis of infection. While accidental disclosure of a person being HIV positive can occur, in my experience it is extremely rare. It's a mistake to avoid testing because of fear of accidental disclosure.

Also, there are other options including anonymous testing in a clinic or at home (for example, Home AccessR), where you are identified by a number, not by name, and no one but you knows your number. The cost of testing is generally between $30 and $100, and some groups, including many health departments, provide testing free of charge.

How Does HIV Testing Work?

HIV is usually diagnosed by a blood test , but newer tests can be done on saliva or urine. If you're squeamish about getting blood drawn, there are alternatives you can discuss with your doctor. Generally, the purpose of the test is to search for antibodies to the virus. The initial test is an enzyme-linked immunoabsorbent assay (ELISA) and is confirmed using a test called the Western Blot. The antibody tests are very reliable, but may not be able to detect an infection during the first six months after an exposure. There is also a test that can test for the presence of the virus itself, and this test is called an HIV PCR. HIV PCR is used to test for HIV after a potential HIV exposure, but before antibodies have developed. Because infants may have their mother's antibodies in their blood confounding the HIV antibody test, HIV PCR is also useful for them. However, HIV PCR may not be reliable in detecting HIV in all infected patients, especially those with a low viral load.

How long do the results take?

It used to take several days to a week to get test results back. Now there are rapid detection methods that allow reliable results in less than an hour. As a result, HIV testing can be completed while you are still in your doctor's office.

Test counseling

Pre-test and post-test counseling and education are important parts of HIV testing. Counseling gives people who test negative for HIV an opportunity to learn more about HIV and how to avoid becoming infected . For those who test positive for HIV, counseling gives them a chance to learn about the importance of being medically evaluated and, if appropriate, treated so as to prevent disease progression or OIs. These counseling sessions take about 15 minutes, including time for questions. They are a very valuable part of the testing process, regardless of the test results.

HIV disease is a chronic disease that used to be fatal for virtually everyone who got it. Now, things have changed and effective treatments are available to treat HIV and, in most cases, these treatments can prevent HIV from doing further damage and can keep the person healthy. In order to take advantage of these treatments, you must be tested and diagnosed with HIV. All persons who may have been infected with HIV and virtually all pregnant women should be tested as soon as possible.

Brian Boyle, MD, JD, is an Attending Physician at the New York Presbyterian Hospital-Weill Cornell Medical Center and Assistant Professor of Medicine in the Department of International Medicine and Infectious Diseases at Weill Medical College of Cornell University. Dr. Boyle has authored and co-authored more than 100 publications and abstracts relating to the treatment of HIV and hepatitis. In addition, he has lectured across the country on the latest advances in the treatment of HIV, Hepatitis C Virus and Hepatitis B Virus as well as many other HIV/AIDS and hepatitis related topics.

next: HIV, AIDS, and Older Adults

APA Reference Staff, H. (2021, December 23). Introduction to HIV, HealthyPlace. Retrieved on 2024, April 9 from https://www.healthyplace.com/sex/diseases/introduction-to-hiv

Medically reviewed by Harry Croft, MD

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• Biology Article

What is AIDS?

AIDS or Acquired Immune Deficiency Syndrome is a disease caused by the HIV virus. In this condition, a person’s immune system becomes too weak to fight any kind of infection or disease. AIDS is usually the last stage of HIV infection; a stage where the body can no longer defend itself and thus spawns various diseases. AIDS, when untreated, leads to death.

AIDS is an advanced HIV infection or late-stage HIV. Someone with AIDS may develop a wide range of health conditions like – pneumonia, thrush, fungal infections, TB, toxoplasmosis.

There is also an increased risk of developing a medical illness like cancer and brain illnesses. CD4 count refers to the number of T-lymphocytes in a cubic millimetre of blood. A person may be referred to as “AIDS-affected” when the CD4 count drops below 200 cells per cubic millimetre of blood.

Also Read:  Difference between AIDS and HIV

Symptoms of AIDS

As AIDS is a virus infection, the symptoms related to acute HIV infection can be similar to flu or other viral illnesses, like –

• Muscle & Joint Pain
• Sore throat
• Night Sweats
• Mouth sores
• Swollen lymph glands
• Weight Loss

Symptoms of late-stage HIV infection may include –

• Blurred vision
• Persistent or Chronic Diarrhea
• Fever of above 37 degrees Centigrade (100 degrees Fahrenheit)
• Permanent tiredness
• Shortness of breath
• Swollen glands lasting for weeks
• Weight loss
• White spots on the tongue or mouth

Cure for AIDS

There is no specific or perfect cure for AIDS, but with proper diagnosis, treatment and support, one can fight it and live a relatively healthy and happy life. One needs to take treatment correctly and deal with any possible side-effects.

Medicines are used to stop the virus from multiplying. One major treatment for HIV/AIDS is called antiretroviral therapy (ART) .

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Client Services

Prevention and Screening

Advocacy and Awareness

” I’ve got nothing but good things to say about APW, they’ve done nothing but looked out for me. ”

Bonita - Long term client

AIDS Project Worcester (APW) started in 1987, during the early to mid-80’s, residents of the city of Worcester and its surrounding suburbs began to be infected with Human Immunodeficiency Virus ( HIV) in increasing numbers. With few government or community services available at the time, those early individuals and families found comfort and support particularly in Pakachoag Community Church in Auburn, MA. As the numbers grew through the mid-80’s the complexity of needs expanded. As a result, the need for more services became clearly evident. Out of community discussions concerning how best to meet those needs AIDS Project Worcester, INC. was born.

APW was incorporated as a 501(c)(3) not-for-profit corporation to provide education to the community about HIV/AIDS and services to individuals and families infected with HIV. APW has grown from a narrowly focused, case management AIDS (Acquired Immunodeficiency Syndrome) services organization into the primary provider of non-medical HIV/AIDS support services in Central Massachusetts. The agency later expanded from a small Shrewsbury street store-front office into three strategic locations, Worcester (main office), Leominster and Southbridge. During this time period, APW enhanced service provision by increasing the professionalism of the service-delivery staff while strengthening the organization’s volunteer base. By the mid-90’s, APW ‘s community profile had been raised significantly and signature fundraising activities had been well established, including the annual Walk for Life .

APW has been an industry leader in the design and implementation of customer-oriented service delivery systems. Two major examples can be found in APW ‘s case management system and in the agency’s creative unique prevention/education programs. The model of delivering client services through a “triage” evaluation system is now being implemented by the Massachusetts Department of Public Health in the Boston-Cambridge-Somerville area (with plans for future implementation statewide). APW ‘s clinical-services-based prevention and education program targeting men who have sex men is unique in the New England area. Its success is being viewed by the Massachusetts Department of Public Health as a model for implementation of similar programs outside the Boston metropolitan area. Because of the quality and diversity of its services, APW experienced growth in the number of consumers of greater than 15% per year.

In the late 90’s, APW began a restructuring of its programs and administration to respond to the dramatically changing needs of consumers resulting from improvement in medical treatments. These changes can be expressed in two basic concepts. 1). Moving from an organization focused on helping people die, to one which assists people to live. 2.) Moving organizationally and programmatically from the crisis, short-term responses, to long-term strategic planning. These changes formed the foundation that would ensure the continued delivery of relevant, caring and comprehensive HIV/AIDS services to individuals and families in Central Massachusetts through the end of the millennium.

APW ‘s mission statement is centralized around three core values; education, advocacy, and service. these care values are achieved through comprehensive client service programs, prevention, and education services and the staff are strong advocates for people living with HIV. Services extend to those who are at risk for HIV disease as well as those who are living with HIV/AIDS.

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CSR’s primary role is to handle the receipt and review of ~ 75% of the grant applications that NIH receives. NIH separates the review process from funding decisions.

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Reviewers are critical to our mission to see that NIH grant applications receive, fair, independent, expert, and timely scientific reviews. We appreciate the generosity with which reviewers give their time.

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Applications are reviewed in study sections (Scientific Review Group, SRG). Review Branches (RBs) are clusters of study sections based on scientific discipline.

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Hiv/aids research.

HIV/AIDS-related grant applications are reviewed on an expedited cycle (as mandated by Congress) by one of the study sections listed below. For an application to be eligible for expedited review there must be a clear and compelling HIV/AIDS research component (HIV/AIDS-associated). Those applications deemed insufficiently HIV/AIDS-associated are assigned to other study sections and must be submitted in time to meet the non-AIDS application due dates.

• HIV Coinfections and HIV Associated Cancers HCAC
• HIV Comorbidities and Clinical Studies HCCS
• HIV/AIDS Intra- and Inter-personal Determinants and Behavioral Interventions HIBI
• HIV Immunopathogenesis and Vaccine Development HIVD
• HIV Molecular Virology, Cell Biology, and Drug Development HVCD
• Population and Public Health Approaches to HIV/AIDS PPAH
• Fellowships: HIV/AIDS Biological (formerly part of F17) F17A
• Fellowships: HIV/AIDS Behavioral (formerly part of F17) F17B

Because small business (SBIR/STTR) review also operates on an expedited cycle, AIDS-related SBIR/STTR applications are reviewed in one of the existing CSR small business study sections based on research topic.

Last updated: 10/27/2020 10:41

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Biology Project On AIDS For Class12

Table of Contents

AN OVERVIEW OF AIDS

The Human Immunodeficiency Virus (HIV) is the medical illness known as Acquired Immune Deficiency Syndrome (AIDS). The immune system is attacked by HIV and destroyed, making the body susceptible to numerous infections and disorders. Since its discovery in the 1980s, AIDS has claimed millions of lives, making it one of the worst pandemics in human history.

Blood, semen, vaginal fluids, and breast milk are just a few of the biological fluids that can spread AIDS. It can be passed from woman to kid through pregnancy, childbirth, and breastfeeding, as well as through sexual contact, sharing needles, blood transfusions, and blood transfusions.

Antiretroviral therapy (ART) can greatly reduce the spread of the illness and enhance the quality of life for HIV-positive individuals, despite the fact that there is no known cure for AIDS. It’s critical to spread knowledge about AIDS, encourage preventative efforts, and provide assistance to people who are afflicted.

WHAT IS HIV?

The retrovirus known as HIV targets the immune system by infecting and destroying CD4+ T-cells, a subset of white blood cells that aids in the defence against infections. As a result of HIV’s primary immune system-targeting behaviour, significant immunological deficiencies and the emergence of AIDS may result.

Blood, semen, vaginal fluids, and breast milk are just a few of the biological fluids that can spread HIV. It can be passed from woman to kid through pregnancy, childbirth, and breastfeeding, as well as through sexual contact, sharing needles, blood transfusions, and blood transfusions.

Many people may not show any symptoms after the initial infection or may show flu-like symptoms. Nevertheless, HIV can stay in the body for years without manifesting any symptoms, during which time the immune system can continue to be harmed.

Although there is presently no cure for HIV, antiretroviral medication (ART) can dramatically halt the disease’s course and enhance the lives of those who are infected. To stop the virus from spreading, it is crucial to encourage HIV testing, prevention, and education.

DIFFERENCE BETWEEN HIV AND AIDS

Although they are not the same thing, HIV and AIDS are frequently used interchangeably. AIDS is a disease that arises from severe HIV infection, whereas HIV is a virus that targets the immune system.

HIV can remain in the body for years without manifesting any symptoms, during which time the immune system can continue to be harmed. Once the immune system has been badly damaged, AIDS may develop in the person. An immune system that is compromised due to AIDS makes a person more vulnerable to infections and illnesses.

A blood test that finds the presence of the virus in the blood can be used to diagnose HIV. Contrarily, AIDS is identified through the detection of certain opportunistic infections and a highly compromised immune system.

The progression of HIV and the onset of AIDS can be considerably slowed down by antiretroviral medication (ART). However, neither HIV nor AIDS are now curable. Promoting prevention, information, and assistance for people who are infected with the virus is essential.

TRANSMISSION

Blood, semen, vaginal fluids, and breast milk are among the biological fluids most commonly used in the transmission of HIV. The most popular transmission methods are as follows:

HIV can be spread through unprotected sexual intercourse, such as vaginal, anal, or oral sex with a partner who is infected.

Sharing Needles: When using intravenous drugs, sharing needles or syringes with someone who is HIV-positive might spread the disease.

HIV can be spread during blood transfusions by obtaining contaminated blood or blood products.

HIV can be passed from a mother who is infected to her unborn child during pregnancy, childbirth, or breastfeeding.

It’s crucial to remember that incidental contact, such as hugging, kissing, or sharing of utensils, does not transmit HIV. By using safe methods of sexual contact, avoiding sharing needles, and checking blood and blood products for HIV, the risk of transmission can be considerably decreased.

EFFECTS OF HIV

White blood cells known as CD4+ T-cells, which aid in the defence against infections, are infected and killed by HIV, which targets the immune system. The immune system deteriorates throughout time, making a person more vulnerable to infections and illnesses.

Depending on the individual, the effects of HIV might be minimal or severe. Within the first several weeks following infection, some people may not show any symptoms while others may show flu-like symptoms. Without treatment, HIV can evolve into AIDS over time, which is characterised by an immune system that is severely compromised as well as the emergence of opportunistic infections and malignancies.

COMMON HIV SIDE EFFECTS INCLUDE

Opportunistic Infections: People with HIV are more prone to catching numerous illnesses, such as pneumonia, tuberculosis, and several types of cancer.

Neurological Disorders: HIV can also have an impact on the nerve system, which can result in depression, cognitive decline, and other neurological problems.

Skin Disorders: Various skin conditions, such as rashes, blisters, and fungus infections, can be brought on by HIV.

Other Complications: HIV can also result in other consequences, including wasting syndrome, which causes the person to lose a lot of weight and have atrophying muscles, as well as cardiovascular disease and kidney disease.

Antiretroviral therapy (ART) can dramatically halt the spread of HIV and postpone the onset of AIDS, lowering the risk of complications and enhancing the quality of life for those infected with the virus.

HIV SYMPTOMS

Some people may not experience any HIV symptoms at all, and symptoms might vary from person to person. HIV, however, can generally result in the following signs and symptoms:

Flu-like Symptoms: such as fever, exhaustion, sore throat, and body aches, can appear in some persons within the first few weeks after infection.

Rash: The chest, back, and face are the most common places for an HIV-related skin rash to appear.

Swollen Lymph Nodes: HIV can produce enlarged lymph nodes, particularly in the armpits, groyne, and neck.

Night Sweats: Night sweats are a type of excessive nighttime perspiration that can soak the bed linens. HIV can cause night sweats.

Fatigue: HIV can lead to fatigue, which is a state of acute exhaustion and tiredness that does not go away with rest.

Weight Loss: Unintentional weight loss brought on by HIV can often account for more than 10% of a person’s body weight.

It is crucial to remember that these symptoms can also be brought on by other diseases, and a blood test is the only way to positively identify an HIV infection. Antiretroviral therapy (ART) and early diagnosis can greatly enhance the long-term prognosis for HIV-positive individuals.

AIDS PREVENTION

In order to slow the spread of AIDS, it is essential to prevent HIV transmission. Here are several strategies to stop HIV from spreading:

Practice Safe Sex: Use condoms to limit the risk of HIV transmission during every sexual activity, including oral, anal, and vaginal sex.

Avoid Sharing Needles: Don’t let people use your needles or other injectable supplies.

Get Tested: Regularly test yourself for HIV, particularly if you engage in high-risk activities.

Use Pre-Exposure Prophylaxis (PrEP): Use Pre-Exposure Prophylaxis (PrEP) to lessen the risk of HIV transmission. PrEP is a drug that can be taken every day.

Use post-exposure prophylaxis (PEP): PEP is a drug that can be used to lessen the risk of infection within 72 hours following a probable HIV encounter.

Screening Blood and Blood Products: Checking Blood and Blood Products for HIV Before a Transfusion, check blood and blood products for HIV.

Prevent Mother-to-Child Transmission: Antiretroviral therapy (ART) should be given to HIV-positive pregnant women in order to stop mother-to-child transmission of the virus.

Educate Yourself and Others: Become knowledgeable about HIV/AIDS, including how it spreads and how to avoid getting it.

We can drastically minimise the spread of HIV and ultimately stop the onset of AIDS by implementing these preventive strategies.

HIV DIAGNOSIS

A blood test that looks for HIV antibodies in the blood can be used to diagnose HIV. The most widely used test is the ELISA, or enzyme-linked immunosorbent assay, which can identify HIV antibodies in blood as early as a few weeks after infection.

A Western blot test is used to confirm the presence of HIV antibodies if the ELISA test results are positive. The genetic makeup of HIV can sometimes be found in the blood using a nucleic acid test (NAT), which can find the virus much earlier than antibody tests.

In order to assure reliable findings, it is advised to get tested three months after a probable HIV encounter because it can take up to three months for HIV antibodies to form in the blood.

HIV testing is private and available in a number of settings, including medical centres, hospitals, and community-based organisations. In order to help patients deal with the emotional and psychological impacts of receiving an HIV diagnosis, counselling and support services are frequently offered.

ART, OR ANTIRETROVIRAL THERAPY

Human immunodeficiency virus (HIV) suppression is achieved through the use of a cocktail of drugs known as antiretroviral therapy (ART). ART slows the course of HIV and helps to halt the development of AIDS by preventing the virus from multiplying and reducing the amount of virus in the bloodstream.

As part of ART, patients must take three or more antiretroviral medications from various kinds, such as integrase inhibitors, protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and nucleoside reverse transcriptase inhibitors. The combination of these medications is referred to as highly aggressive antiretroviral therapy (HAART).

The long-term prognosis for HIV-positive individuals can be considerably improved by using ART, which is very successful at lowering the amount of virus in the bloodstream. People with HIV can live long, healthy lives and have a lower chance of spreading the infection to others with early diagnosis and treatment.

It is significant to remember that ART calls for careful adherence to the medication schedule and is a lifelong treatment. Nausea, vomiting, diarrhoea, lethargy, and headaches are possible ART side effects, however these are frequently treatable with medication changes or dietary modifications.

New Hiv Treatment Developments

There have been a number of improvements in HIV therapies during the past few years, including:

Long-Acting Antiretroviral Therapy (LAART): Rather than taking daily pills, long-acting antiretroviral therapy (LAART) entails receiving injections of antiretroviral medication once every several months. This strategy may help to increase drug adherence and lessen the number of clinic visits.

Two-Drug Regimens: Historically, HIV treatment has included combining three or more medications, but more recent two-drug regimens have demonstrated to be similarly successful in suppressing the virus, with perhaps fewer adverse effects.

Gene Editing: By focusing on and eliminating the virus from infected cells, gene editing tools like CRISPR/Cas9 have showed promising results in laboratory tests for potentially treating HIV.

Neutralising Antibodies: As a potential HIV therapy option, researchers are looking at the use of neutralising antibodies, which the immune system naturally produces to fight HIV.

HIV vaccines: Several clinical trials for HIV vaccines that may prevent or treat HIV infection are now taking place.

Overall, these advancements raise hopes for new and better HIV treatments that might lessen the severity of the disease and enhance the quality of life for those who are HIV positive.

GLOBAL AIDS DAY

Every year on December 1st, World AIDS Day is commemorated to spread awareness of HIV/AIDS and to offer support for those who are afflicted with the condition. Since it was originally commemorated in 1988, the day has grown to be a global celebration, with organisations, governments, and people from all over the world taking part in celebrations and festivities.

Every year, World AIDS Day has a different subject; in the past, it has had the following slogans: “Global solidarity, shared responsibility,” “Communities make the difference,” and “Ending the HIV/AIDS epidemic: Resilience and impact.” The day provides an opportunity to mourn those who have died from AIDS, to honour people who are HIV-positive, and to draw attention to the advancements made in the fight against the disease.

On World AIDS Day, activities include HIV testing and counselling, community gatherings and marches, fund-raising activities, and awareness-raising efforts for HIV prevention and treatment. The day provides an opportunity to promote policies that protect HIV-positive people as well as increased financing for programmes that fight the disease.

World AIDS Day serves as a wake-up call to people and communities to unite in the battle against the illness and strive for a world free of HIV/AIDS as well as a reminder that HIV/AIDS remains a significant public health concern.

In conclusion, the prevalence of HIV/AIDS, which affects millions of people globally, continues to be a serious global health issue. However, there remains hope for a world free of HIV/AIDS thanks to advancements in HIV prevention, diagnosis, and treatment. Pre-exposure prophylaxis (PrEP), condom use, and HIV testing are all effective preventative methods that can assist to lower the risk of HIV transmission. Antiretroviral therapy (ART) and early diagnosis and treatment can greatly improve long-term outcomes for HIV-positive individuals and lower the risk of transmission to others.

Even while the fight against HIV/AIDS has achieved significant strides, there is still much to be done, especially in tackling the social and economic injustices that contribute to the disease’s disproportionately negative effects on marginalised populations. World AIDS Day is a crucial reminder that more must be done to prevent and treat HIV/AIDS, including raising awareness, funding, and taking action. We can keep moving forward towards a time without HIV/AIDS by cooperating.

CERTIFICATE OF COMPLETION

This is to certify that I, [Your Name], a student of Class 12 at [Your School/College Name], have successfully completed my Biology Project on “An Overview of AIDS” with great dedication and effort.

During the course of this project, I delved into the vast realm of HIV and AIDS, understanding their impacts on the immune system and the human body. I researched various aspects, including the transmission, symptoms, effects, prevention, diagnosis, and treatment of HIV/AIDS. Through comprehensive research, I gained in-depth knowledge about the virus, its transmission methods, and the measures to prevent its spread.

I have learned about the importance of raising awareness about HIV/AIDS and promoting preventative efforts to protect individuals from this devastating disease. The project has allowed me to comprehend the significance of timely diagnosis and antiretroviral therapy (ART) in managing HIV infections and improving the quality of life for those affected.

In addition to exploring existing treatments, I also had the opportunity to study recent advancements in HIV therapy, such as long-acting antiretroviral therapy (LAART), gene editing, and the potential of neutralising antibodies. These innovative approaches have instilled hope for a brighter future in the fight against HIV/AIDS.

Furthermore, I dedicated a section of the project to discuss World AIDS Day, an essential global event observed on December 1st annually. Through this section, I recognized the significance of solidarity and collective efforts in battling HIV/AIDS and promoting awareness about the disease.

I am grateful for the guidance and support provided by my Biology teacher [Teacher’s Name], who motivated and assisted me throughout this project. Their encouragement and valuable insights have played a significant role in shaping the project’s success.

I sincerely hope that this project will contribute to spreading knowledge about HIV/AIDS and inspire others to join in the global efforts to combat this pandemic. I firmly believe that through education, prevention, and support, we can create a world free from the burden of HIV/AIDS.

Once again, I express my heartfelt gratitude to everyone who supported me in completing this project, and I am honored to have been able to present my findings on this critical topic.

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AIDS - Acquired Immune Deficiency Syndrome

What is aids.

The term AIDS refers to Acquired Immune Deficiency Syndrome caused by the HIV virus. AIDS is a condition in which the person’s Immune system weakens to an extent where it is unable to fight any infection. AIDS is commonly considered to be the last stage of HIV infection; the body completely loses its defense system and this further causes illness. Loss of immunity causes organ failure and ultimately death. HIV is a type of retrovirus. Its genetic material is RNA and is called the human immuno deficiency virus.

HIV (Human immunoDeficiency virus) is the virus or germ that causes AIDS (Acquired Immune Deficiency Syndrome). Acquired refers to getting infected with it, Immune Deficiency refers to a weakness in the body's system that fights diseases, whereas Syndrome refers to a group of health problems that make up a disease.

It is vital to get AIDS diagnosed when one develops certain OIs, or his/her CD4 cell count drops below 200 cells per milliliter of blood. An official list of Ols from CDC includes Kaposi sarcoma (KS), a skin cancer, Cytomegalovirus (CMV), an infection that usually affects the eyes, Pneumocystis pneumonia (PCP), a lung infection, and Candidiasis, a fungal infection that can cause thrush (a white film in the mouth) or infections in the vagina or throat.

How Does AIDS Affect the Eye?

AIDS causes a breakdown of the Immune system of the body, and therefore all parts of the body can get an infection including the eye. People who are in good health, when diagnosed with AIDS are less likely to have eye problems associated with a suppressed Immune system. It is estimated that 70% of patients with advanced AIDS undergo eye disorders.

The following are the AIDS-related eye problems because of a suppressed Immune system,

HIV retinopathy

Detached retina

CMV retinitis

Kaposi sarcoma

Squamous cell carcinoma of the conjunctiva

Causes of AIDS

HIV is held responsible for affecting the macrophages present in the blood of the human body. HIV was instigated in non-human primates and eventually spread to hominids over the eons. So, what accurately is the distinction between AIDS and HIV? Principally, HIV is the virus that sources AIDS. It causes destruction on the body’s immunity up until it is incompetent of fending off diseases on its own. It is a retrovirus and has RNA as the genetic material.

On infection, the RNA of the virus enters the host cell.

Through reverse transcription, DNA production is carried out.

This DNA is integrated into the genome of the host here it multiplies exponentially to form RNA copies

These RNA copies turn into virus copies and infect the bloodstream.

HIV also does the same in T lymphocytes thereby decreasing the immunity of the body

Even minor infections do not get treated because of an immunocompromised system.

Apart from this, significant weight loss, fever bouts and diarrhea are also observed.

Symptoms of AIDS 

The Symptoms of HIV typically fluctuate from individual to individual and in several cases, a patient festering with the HIV infection may not undergo any indications at all. The common signs and symptoms of HIV include:

Diarrhoea 

Red rashes on the body

Fatigue 

Joint pains

Sore throat

Nausea 

Shortness of breath

Blurred vision

Muscle aches

Sweating during the night

Enlarged Glands

How Do People Know if They Have AIDS?

AIDS generally is transmitted through contact with infected blood and also bodily fluids. Such contact can occur through sharing of needles or other drug-injection equipment, through unprotected sex, through receipt of infected blood transfusions, through mother-to-child transmission during pregnancy or breastfeeding, and also through plasma products during medical care in some cases. Currently, there is no cure for AIDS. Once an individual gets AIDS, he or she has it for life.

When an individual gets infected with HIV, the body will try to fight the infection by making antibodies (also called special Immune molecules the body makes to fight HIV). Individuals who have HIV antibodies are called "HIV-Positive." However, Being HIV-positive, or having HIV disease, is not the same as having AIDS. It has been observed that many people who are HIV-positive do not get sick for many years. HIV disease slows down the Immune system as it spreads in the body. On the other hand, parasites, fungi, viruses and bacteria that usually don't cause any problems can make an individual very sick if his/her Immune system is damaged. These are referred to as opportunistic infections.

Mode of Transmission of HIV-AIDS

The HIV infection spreads in the course of the following ways: 

Unprotected sexual interaction with a previously infected person.

Reusing needles used up by an infected individual.

From a deceased mother to the baby through the placenta.

Blood transfusion from an infected individual.

The incubation period of this virus is relatively large and it takes ample time to attack the system, sometimes even 10 years. HIV makes it hard for the patient to ward off any illness. 

Prevention of AIDS

HIV infection can be uncovered with the help of an assessment termed ELISA which is the full form of ‘Enzyme-Linked Immunosorbent Assay’. AIDS is fatal; thus, HIV prevention is the most reliable option. For example – Using one-use needles, practising protected sex, i.e., use of safety like condoms, regular health check-ups and regulating blood transfusion and pregnancy can help in the prevention of AIDS. One more imperative influence is the awareness of AIDS. As it does not spread by simple physical contact, the infected individuals ought to not be distinguished and must be preserved in an approachable way.

Side-Effects of AIDS

As discussed AIDS is an advanced HIV infection or late-stage HIV. Someone with AIDS may acquire a wide range of health disorders like – pneumonia, thrush, fungal infections, TB, toxoplasmosis and cytomegalovirus. There is also an amplified danger of obtaining a medical illness like cancer and brain illnesses. 

Cure for AIDS

There is no precise or absolute cure for AIDS, but with appropriate diagnosis, management and facility, one can combat it and live a comparatively hale and hearty and happy life. One must take treatment appropriately and deal with any conceivable side effects. Medications are used to discontinue the virus from reproducing. One major treatment for HIV/AIDS is called antiretroviral therapy (ART).

Remaining on effective ART with an undetectable HIV viral load in the blood is the best way for you to stay healthy. For ART to be operative, it's significant that you take the drugs as prescribed, without missing or avoiding any doses. 

FAQs on AIDS - Acquired Immune Deficiency Syndrome

1. What is AIDS?

The term AIDS refers to Acquired Immune Deficiency Syndrome caused by the HIV virus. It is a condition in which the person’s Immune system weakens to an extent where it is unable to fight any infection. AIDS affects a person’s Immune system i.e. the part of the body that fights off germs such as bacteria and viruses. Moreover , the Immune system does not work properly and becomes deficient. An individual diagnosed with AIDS may have other diseases and infections because of a weak Immune system.

2. How Transmission of the AIDS Infection is Possible in the Body?

The HIV infection spreads in the course of the following ways

Unprotected sex

Reusing needles  

If a person receives an HIV diagnosis, it means that he/she has HIV. The human body cannot get rid of HIV completely like other viruses and diseases. Once a person has HIV, he/she has it for life. However, with appropriate care and precautions, HIV can be controlled. With the help of effective HIV treatment, individuals with HIV can live healthy lives and protect their partners.

3. What is the Incubation Period of AIDS Infection?

The incubation period of this virus is relatively large and it takes ample time to attack the system, sometimes even 10 years. HIV makes it hard for the patient to ward off any illness. The duration from initial infection with HIV to the development of symptoms of the disease is defined as the incubation period of AIDS infection. The timing of diagnosis varies based on the criteria used and their interpretation in different studies. The length of the early incubation period is shorter in parentally infected infants (1 year) and it does not differ in groups of transfusion cases and homosexuals.  

4. How HIV-AIDS Can be Prevented?

With the help of an assessment termed ELISA which is the full form of ‘Enzyme-Linked Immunosorbent Assay’. Practicing sexual abstinence and avoiding high-risk behavior are the only effective ways to prevent contracting HIV or to reduce risk to a maximum extent. If someone is at a very high risk of contracting HIV, he or she must ask his/her doctor about medications that may significantly reduce the risk of getting the virus. The medications do not guarantee that he/she will not become infected with HIV, but they certainly reduce the risk.

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Biology • Class 12

Assignment on AIDS

Introduction

Society is like a looking glass. Each and every phenomenon in society is very conspicuous and crystal clear before us. Like many affairs and issues, the vulnerability of HIV/AIDS patient is blatant and flagrant to us. In a complex and complicated social fabrics, AIDS is spreading by leaps and bounds mainly because of unsafe sexual intercourse, coition and copulation. At present, traditional social values and ethos are declining and eroding in full gear. As a result, it is noted that an astronomical and massive change in behavioral, cultural pattern in society. It is straining that the HIV/AIDS patients are deprived and diverted culturally and socially. Most people think that they are the burden of family as well as society. They are dealt with humiliation by the larger segment of society. As a consequence, they do not get enough space and scope to expose themselves to others. For the overall wellbeing of AIDS patients, each and every individual should change his/her behavioral patterns towards them. To this end, all and sundry should come forward with an enriched cultural legacy in the truest sense.

AIDS is a disease that is incurable and intricate in nature. If any body is infected and afflicted with this disease, the aftermath of him/her is sure for death. Because of having this dire nature of the disease, I tried to overhaul the social, behavioral and cultural facets and factors that are intimately associated with this fatal disease. Besides, I postulated to comprehend the anticipated behavior that the infected receive from the remaining social setting in their way of life and livings.

Methodology

In the way of doing this assignment, I went through many medical journals, newspapers and most importantly, I followed lectures of my venerable class teacher. Moreover, I talked to some medical professionals about the service delivery of government and non-government infirmary in case of HIV positive patients. Admittedly, I delve into the social, behavioral and cultural factors that are inexorably coupled and compounded with the very disease, i.e., HIV/AIDS.

Causes, incidence, and risk factors

Important facts about the spread of AIDS include:

• AIDS is the sixth leading cause of death among people ages 25 – 44 in the United States, down from number one in 1995.
• The World Health Organization estimates that more than 25 million people worldwide have died from this infection since the start of the epidemic.
• In 2008, there were approximately 33.4 million people around the world living with HIV/AIDS, including 2.1 million children under age 15.

Human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers.

Common bacteria, yeast, parasites, and viruses that usually do not cause serious disease in people with healthy immune systems can cause fatal illnesses in people with AIDS.

HIV has been found in saliva, tears, nervous system tissue and spinal fluid, blood, semen (including pre-seminal fluid, which is the liquid that comes out before ejaculation), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk have been shown to transmit infection to others.

The virus can be spread (transmitted):

• Through sexual contact — including oral, vaginal, and anal sex
• Through blood — via blood transfusions (now extremely rare in the U.S.) or needle sharing
• From mother to child — a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk

Other methods of spreading the virus are rare and include accidental needle injury, artificial insemination with infected donated semen, and organ transplantation with infected organs.

HIV infection is NOT spread by:

• Casual contact such as hugging
• Participation in sports
• Touching items that were touched by a person infected with the virus

AIDS and blood or organ donation

• AIDS is NOT transmitted to a person who DONATES blood or organs. People who donate organs are never in direct contact with people who receive them. Likewise, a person who donates blood is never in contact with the person receiving it. In all these procedures, sterile needles and instruments are used.
• However, HIV can be transmitted to a person RECEIVING blood or organs from an infected donor. To reduce this risk, blood banks and organ donor programs screen donors, blood, and tissues thoroughly.

People at highest risk for getting HIV include

• Injection drug users who share needles
• Infants born to mothers with HIV who didn’t receive HIV therapy during pregnancy
• People engaging in unprotected sex, especially with people who have other high-risk behaviors, are HIV-positive, or have AIDS
• People who received blood transfusions or clotting products between 1977 and 1985 (before screening for the virus became standard practice)
• Sexual partners of those who participate in high-risk activities (such as injection drug use or anal sex)

AIDS begins with HIV infection. People who are infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops.

Acute HIV infection progresses over time (usually a few weeks to months) to asymptomatic HIV infection (no symptoms) and then to early symptomatic HIV infection. Later, it progresses to AIDS (advanced HIV infection with CD4 T-cell count below 200 cells/mm3 ).

Almost all people infected with HIV, if they are not treated, will develop AIDS. There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors, and many seem to have a genetic difference that prevents the virus from significantly damaging their immune system.

The symptoms of AIDS are mainly the result of infections that do not normally develop in people with a healthy immune system. These are called opportunistic infections.

People with AIDS have had their immune system damaged by HIV and are very susceptible to these opportunistic infections. Common symptoms are:

• Sweats (particularly at night)
• Swollen lymph glands
• Weight loss

Note: At first, infection with HIV may produce no symptoms. Some people, however, do experience flu-like symptoms with fever, rash, sore throat, and swollen lymph nodes, usually 2 – 4 weeks after contracting the virus. Some people with HIV infection stay symptom-free for years between the time when they are exposed to the virus and when they develop AIDS.

Signs and tests

CD4 cells are a type of T cell. T cells are cells of the immune system. They are also called “helper cells.”

The following is a list of AIDS-related infections and cancers that people with AIDS may get as their CD4 count decreases. In the past, having AIDS was defined as having HIV infection and getting one of these other diseases. Today, according to the Centers for Disease Control and Prevention, a person may also be diagnosed with AIDS if they are HIV-positive and have a CD4 cell count below 200 cells/mm3, even if they don’t have an opportunistic infection.

AIDS may also be diagnosed if a person develops one of the opportunistic infections and cancers that occur more commonly in people with HIV infection. These infections are unusual in people with a healthy immune system.

There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life for those who have already developed symptoms.

Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. This is measured by the viral load (how much free virus is found in the blood). Preventing the virus from replicating can improve T-cell counts and help the immune system recover from the HIV infection.

HAART is not a cure for HIV, but it has been very effective for the past 12 years. People on HAART with suppressed levels of HIV can still transmit the virus to others through sex or by sharing needles. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mm3), life can be significantly prolonged and improved.

However, HIV may become resistant to one combination of HAART, especially in patients who do not take their medications on schedule every day. Genetic tests are now available to determine whether an HIV strain is resistant to a particular drug. This information may be useful in determining the best drug combination for each person, and adjusting the drug regimen if it starts to fail. These tests should be performed any time a treatment strategy begins to fail, and before starting therapy.

When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs on the market for treating drug-resistant HIV.

Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are:

• Collection of fat on the back (“buffalo hump”) and abdomen
• General sick feeling (malaise)

When used for a long time, these medications increase the risk of heart attack, perhaps by increasing the levels of cholesterol and glucose (sugar) in the blood.

Any doctor prescribing HAART should carefully watch the patient for possible side effects. In addition, blood tests measuring CD4 counts and HIV viral load should be taken every 3 months. The goal is to get the CD4 count as close to normal as possible, and to suppress the amount of HIV virus in the blood to a level where it cannot be detected.

Other antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as erthythropoetin (Epogen, Procrit, and Recomon) and filgrastim (G-CSF or Neupogen) are sometimes used to treat AIDS-associated anemia and low white blood cell counts.

Medications are also used to prevent opportunistic infections (such as Pneumocystis jiroveci pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.

Complications

When a person is infected with HIV, the virus slowly begins to destroy that person’s immune system. How fast this occurs differs in each individual. Treatment with HAART can help slow or halt the destruction of the immune system.

Once the immune system is severely damaged, that person has AIDS, and is now susceptible to infections and cancers that most healthy adults would not get. However, antiretroviral treatment can still be very effective, even at that stage of illness.

• Do not use illicit drugs and do not share needles or syringes. Many communities now have needle exchange programs, where you can get rid of used syringes and get new, sterile ones. These programs can also provide referrals for addiction treatment.
• Avoid contact with another person’s blood. You may need to wear protective clothing, masks, and goggles when caring for people who are injured.
• Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. Infected people should tell any sexual partner about their HIV-positive status. They should not exchange body fluids during sexual activity, and should use preventive measures (such as condoms) to reduce the rate of transmission.
• HIV-positive women who wish to become pregnant should seek counseling about the risk to their unborn child, and methods to help prevent their baby from becoming infected. The use of certain medications dramatically reduces the chances that the baby will become infected during pregnancy.
• Safer sex practices, such as latex condoms, are highly effective in preventing HIV transmission. HOWEVER, there is a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV.

The riskiest sexual behavior is receiving unprotected anal intercourse. The least risky sexual behavior is receiving oral sex. There is some risk of HIV transmission when performing oral sex on a man, but this is less risky than unprotected vaginal intercourse. Female-to-male transmission of the virus is much less likely than male-to-female transmission. Performing oral sex on a woman who does not have her period has a low risk of transmission.

HIV-positive patients who are taking antiretroviral medications are less likely to transmit the virus. For example, pregnant women who are on effective treatment at the time of delivery, and who have undetectable viral loads, give HIV to their baby less than 1% of the time, compared with 13% to 40% of the time if medications are not used.

The U.S. blood supply is among the safest in the world. Nearly all people infected with HIV through blood transfusions received those transfusions before 1985, the year HIV testing began for all donated blood.

If you believe you have been exposed to HIV, seek medical attention IMMEDIATELY. There is some evidence that an immediate course of antiviral drugs can reduce the chances that you will be infected. This is called post-exposure prophylaxis (PEP), and it has been used to prevent transmission in health care workers injured by needlesticks.

There is less information available about how effective PEP is for people exposed to HIV through sexual activity or injection drug use, but it appears to be effective. If you believe you have been exposed, discuss the possibility with a knowledgeable specialist (check local AIDS organizations for the latest information) as soon as possible. Anyone who has been sexually assaulted should consider the potential risks and benefits of PEP.

AIDS is a disease caused by the HIV infection, which is basically a weakening of one’s immune system. It can only be spread through blood transfusions, sexual contact and from an infected mother to her unborn child. There are significant misconceptions in the country about the spread and treatment of the HIV/AIDS virus even after so many years of expert knowledge on the subject. Regrettably, even within the medical professions some laid back attitudes exist. This may have been prompted by two factors. Firstly, there are hardly any separate, specialized wards for HIV/AIDS patients. Secondly, medical professionals somehow harbor superstitions about the virus.

Awareness campaigns should be conducted for the greater well being and welfare of the HIV/AIDS patients. The government should immediately ensure adequate access to treatment of the HIV/AIDS victims complete with screening and after care facilities. There should also be separate HIV/AIDS wards in health care facilities and amenities.

• The Daily Star, P-7-8, Date- 1 st December , 2011.
• Del Rio C, Curran JW. Epidemiology and prevention of acquired immunodeficiency syndrome and human immunodeficiency virus infection. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 118.
• Piot P. Human immunodeficiency virus infection and acquired immunodeficiency syndrome: A global overview. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadlelphia, Pa: Saunders Elsevier; 2007:chap 407.
• Sterling TR, Chaisson RE. General clinical manifestations of human immunodeficiency virus infection (including the acute retroviral syndrome and oral, cutaneous, renal, ocular, metabolic, and cardiac diseases). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 121.

Biography of Bill Gates

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FIU receives $100,000 grant to commemorate Miami's HIV/AIDS history

By Alex Bassil

April 8, 2024 at 2:52pm

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Reports to: Finance & Administration Officer

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) is an international non-profit human development organization on a mission to create a world where no mother, child, or family is devastated by HIV and AIDS, and we are making an impact. Join us in our fight for an AIDS-free generation!

Job Summary:   The Finance Assistant will also ensure the timely and accurate reporting of EGPAF financial and accounting information.

Key Duties and Responsibilities:

• In liaison with the program officers, support the District Health Officer and/or designated district health office staff in developing budgets and quarterly cash requests.
• Ensure swift disbursement of funds for program activities and ensure that all requests rhyme with the district-approved work plans and budgets.
• Participate in monitoring the implementation of the project-funded activities and ensure that these get implemented in line with the agreed-upon implementation plan.
• Prepare quarterly activity financial reports for various Districts.
• Prepare other regular financial reports, spreadsheets, and correspondence as required.
• Inputting accounting data into the accounting system with speed and accuracy.
• Plan, organize, and manage your workload to ensure your contribution to the organization’s monthly financial reporting process is achieved in a timely and accurate manner.
• In liaison with the Finance & Administration Officer, track monthly advances to the project staff and district teams.
• Provide financial support to the team members and resolution of finance-related queries.
• Carry out any other duties reasonably assigned by the Supervisor.
• The ideal candidate must hold a Bachelor’s degree in business Management, Accounting, Finance, Commerce, and at least CPA or ACCA level 2.
• One year of relevant experience in accounting in non-profit organizations with a proven track record in financial management and an understanding of accounting processes and procedures.
• Experience in an international donor environment.
• Previous experience in managing US government funds and possess Knowledge of the USAID rules and regulations.
• Prospective candidates should have experience working with Local Government partners and knowledge of their operations.
• Possess strong accuracy, attention to detail, and the ability to follow through.
• Highly organized with the ability to meet deadlines, troubleshoot, and problem-solve.
• Training in Computer and knowledge of accounting software systems (e.g., QuickBooks Pro).
• Team player with good interpersonal skills and the ability to work in a diverse social and cultural environment.
• Possess strong accuracy, Good analytical ability, attention to detail, and ability to follow through.
• Excellent verbal and written communication skills in English.
• Good knowledge & experience in using Quick Books accounting package. Good level of competence in excel, word, and PowerPoint.
• Ability to work under pressure and meet targets and deadlines.
• Knowledge of local languages will be an added advantage.
• Willingness to travel to the project districts.

NB: NO HAND DELIVERED APPLICATIONS WILL BE ACCEPTED.

How to Apply:

All qualified and interested candidates should apply online at the link below.

Deadline: 19 th April 2024

For more of the latest jobs, please visit  https://www.theugandanjobline.com or find us our facebook page  https://www.facebook.com/UgandanJobline

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