WHAT IS AIDS?

AIDS stands for Acquired Immune Deficiency Syndrome:

• Acquired means you can get infected with it;
• Immune Deficiency means a weakness in the body's system that fights diseases.
• Syndrome means a group of health problems that make up a disease.

AIDS is caused by a virus called HIV, the Human Immunodeficiency Virus. If you get infected
with HIV, your body will try to fight the infection. It will make "antibodies", special molecules
that are supposed to fight HIV. When you get a blood test for HIV, the test looks for these
antibodies. If you have them in your blood, it means that you have HIV infection. People who
have the HIV antibodies are called "HIV-Positive". Being HIV-positive, or having HIV disease,
is not the same as having AIDS. Many people are HIV-positive but don't get sick for many
years. As HIV disease continues, it slowly wears down the immune system. Viruses,
parasites, fungi and bacteria that usually don't cause any problems can make you very sick
if your immune system is damaged. These are called "opportunistic infections".

How Do You Get Aids?

You don't actually "get" AIDS. You might get infected with HIV, and later you might develop
AIDS. You can get infected with HIV from anyone who's infected, even if they don't look sick,
and even if they haven't tested HIV-positive yet. The blood, vaginal fluid, semen, and breast
milk of people infected with HIV has enough of the virus in it to infect other people. Most
people get the HIV virus by:

• Having sex with an infected person.

• Sharing a needle (shooting drugs) with someone who's infected
• Being born when the mother is infected, or drinking the breast milk of an infected
woman.
• Getting a transfusion of infected blood used to be a way people got AIDS, but now
the blood supply is screened very carefully and the risk is extremely low.

There are no documented cases of HIV being transmitted by tears or saliva, but it is possible
to be infected with HIV through oral sex or in rare cases through deep kissing, especially if
you have open sores in your mouth or bleeding gums.

What Happens If I'm HIV Positive?

You might not know if you get infected by HIV. Some people get fever, headache, sore
muscles and joints, stomach ache, swollen lymph glands, or a skin rash for one or two
weeks. Most people think it's the flu. Some people have no symptoms.

The virus will multiply in your body for a few weeks or even months before your immune
system responds. During this time, you won't test positive for HIV, but you can infect other
people. When your immune system responds, it starts to make antibodies. When this
happens, you will test positive for HIV.

After the first flu-like symptoms, some people with HIV stay healthy for ten years or longer.
But during this time, HIV is damaging your immune system and you might start having signs
of HIV disease like:

• prolonged fever or night sweats;

 • sudden, unexplained weight loss (more than 10 pounds);
• swollen glands in the neck, armpits or groin areas;
• persistent, dry cough that is not caused from smoking;
• thick, white coating on the tongue or throat sometimes accompanied by a sore
throat);
• shortness of breath;
• bruising more easily than normal;
• purple patches on or beneath the skin, sometimes first appearing on the ankles, legs
or inside the mouth; and
• diarrhea.

How Do I Know If I Have Aids?

HIV disease becomes AIDS when your immune system is seriously damaged. If you have less
than 200 CD4+ cells or if your CD4+ percentage is less than 14%, you have AIDS. If you get
an opportunistic infection, you have AIDS. There is an official list of these opportunistic
infections, put out by the Centers for Disease Control (CDC). The most common ones are:

• PCP (Pneumocystis pneumonia), a lung infection;

• KS (Kaposi's sarcoma), a skin cancer;
• CMV (Cytomegalovirus), an infection that usually affects the eyes; and
• Candida, a fungal infection that can cause thrush (a white film in your mouth) or
infections in your throat or vagina.

AIDS-related diseases also includes serious weight loss, brain tumors, and other health
problems. Without treatment, these opportunistic infections can kill you.

AIDS is different in every infected person. Some people die soon after getting infected, while
others live fairly normal lives for many years, even after they "officially" have AIDS. A few
HIV-positive people stay healthy for many years even without taking anti-HIV medications.

Is There A Cure For Aids?

There is no cure for AIDS. There are drugs that can slow down the HIV virus, and slow down
the damage to your immune system. But there is no way to get all the HIV out of your body.
There are other drugs that you can take to prevent or to treat opportunistic infections (OIs).
In most cases, these drugs work very well. The newer, stronger anti-HIV drugs have also
helped reduce the rates of most OIs. A few OIs, however, are still very difficult to treat.

(Reviewed November 2003)

HOW RISKY IS IT?

What's My Risk Of Getting Infected with HIV?

Most people know how HIV is transmitted. They also know about safer sex guidelines.
However, they may still be exposed to HIV. This can be by accident or because they take
part in some risky behavior. They always want to know how likely it is that they got infected
with HIV.

There Are No Guarantees!

You can't be sure that you're not infected with HIV unless you are 100% certain that you did
not engage in any risky behavior and that you were not exposed to any HIV-infected fluids.
The only way to know for sure whether you have been infected is to get tested. You should
wait for 2 or 3 months after a possible exposure. Then get an HIV blood test. You might
know that you were exposed to HIV by sharing needles, a work-related accident, or unsafe
sexual activity. In these cases, talk to your doctor immediately. Ask whether you can use HIV
treatments to prevent infection.

What Activities Are Riskiest?

The highest risk of becoming infected with HIV is from sharing needles to inject drugs with
someone who is infected with HIV. When you share needles, there is a very high probability
that someone else's blood will be injected into your bloodstream. Hepatitis can also be
transmitted by sharing needles.

The next greatest risk for HIV infection is from unprotected sexual intercourse. Receptive
anal intercourse carries the highest risk. The lining of the rectum is very thin. It is damaged
very easily during sexual activity. This makes it easier to HIV to enter the body.

Vaginal intercourse has the next highest risk. The lining of the vagina is stronger than in the
rectum, but it can still be damaged by sexual activity. All it takes is a tiny scrape that can be
too small to see. The risk of infection is increased if there is any inflammation or infection in
the vagina.

What Increases The Risk Of HIV Infection?

Syphilis can increase the risk of transmitting HIV. Rates of syphilis are increasing in many
parts of the US. People with syphilis probably engage in unprotected sexual activity, so they
have a higher than average chance of being infected with HIV. Also, syphilis causes large,
painless sores. It is easy for someone to be infected with HIV through syphilis sores. An
active case of syphilis increases the amount of HIV in someone's system and can make it
easier for them to pass it on to another person.

Several other factors increase the risk of transmitting HIV, or becoming infected. These
factors apply to just about every possible way HIV can be transmitted.

• When the HIV-infected person is in the "acute infection" phase, the amount of
virus in their blood is very high. This increases the chance that they can pass on the
infection. Unfortunately, almost no one knows when they are in this phase of HIV
infection. There's no way to tell by looking at them.
• When either person has a weakened immune system. This could be because of a
long-term illness or an active infection like a herpes outbreak, syphilis, or the flu.
• When either person has open sores that get exposed to infected fluids. These could
be cold sores, genital herpes, mouth ulcers, syphilis sores, or other cuts or breaks in the
skin.
• When there is blood present.

(Reviewed 22 October 2004)

DRUG USE AND HIV

How Does Drug Use Relate To HIV?

Drug use is a major factor in the spread of HIV infection. Shared equipment for using drugs
can carry HIV and hepatitis, and drug use is linked with unsafe sexual activity. Drug use can
also be dangerous for people who are taking anti-HIV medications. Drug users are less likely
to take all of their medications, and street drugs may have dangerous interactions with HIV
medications.

Injection and Infection

HIV infection spreads easily when people share equipment to use drugs. Sharing equipment
also spreads hepatitis B, hepatitis C, and other serious diseases. Infected blood can be
drawn up into a syringe and then get injected along with the drug by the next user of the
syringe. This is the easiest way to transmit HIV during drug use because infected blood goes
directly into someone's bloodstream. Even small amounts of blood on cookers, filters,
tourniquets, or in rinse water can be enough to infect another user. Blood on your hands -
even small amounts - can also be dangerous when you help someone else find a vein,
steady their arm, or when you pass equipment.

To reduce the risk of HIV and hepatitis infection, never share any equipment used with
drugs, and keep washing your hands. Carefully clean your cookers and the site you will use
for injection. A recent study showed that HIV can survive in a used syringe for at least 4
weeks. If you have to re-use equipment, you can reduce the risk of infection by cleaning it
between users. If possible, re-use your own syringe. It still should be cleaned because
bacteria can grow in it. The most effective way to clean a syringe is to use water first, then
bleach and a final water rinse. Try to get all blood out of the syringe by shaking vigorously
for 30 seconds. Use cold water because hot water can make the blood form clots. To kill
most HIV and hepatitis C virus, leave bleach in the syringe for two full minutes. Cleaning
does not always kill HIV or hepatitis. Always use a new syringe if possible.

Drug Use and Unsafe Sex

For a lot of people, drugs and sex go together. Drug users might trade sex for drugs. Some
people think that sexual activity is more enjoyable when they are using drugs. Drug use,
including alcohol, increases the chance that people will not protect themselves during sexual
activity. Someone who is trading sex for drugs might find it difficult to set limits on what they
are willing to do. Anyone using drugs is less likely to remember about using protection, or to
care about it.

Medications and Drugs

It is very important to take every dose of anti-HIV medications. People who are not adherent
(miss doses) are more likely to have higher levels of HIV in their blood, and to develop
resistance to their medications. Drug use is linked with poor adherence, which can lead to
treatment failure.

Some street drugs interact with medications. The liver breaks down some medications used
to fight HIV, especially the protease inhibitors and the non-nucleoside analog reverse
transcriptase inhibitors. It also breaks down some recreational drugs, including alcohol.
When drugs and medications are both "in line" to use the liver, they might both be
processed much more slowly. This can lead to a serious overdose of the medication or of the
recreational drug. An overdose of a medication can cause serious side effects. An overdose
of a recreational drug can be deadly. At least one death of a person with HIV has been
blamed on mixing a protease inhibitor with the recreational drug Ecstasy.
Some antiviral drugs can change the amount of methadone in the bloodstream. It may be
necessary to adjust the dosage of methadone in some cases. See the fact sheets for each of
the medications you are taking.

(Reviewed 22 May 2003)

SAFER SEX GUIDELINES

Unsafe Activities

Unsafe sex has a high risk of spreading HIV. The greatest risk is when blood or sexual fluid
touches the soft, moist areas (mucous membrane) inside the rectum, vagina, mouth, nose,
or at the tip of the penis. These can be damaged easily, which gives HIV a way to get into
the body. Vaginal or rectal intercourse without protection is very unsafe. Sexual fluids enter
the body, and wherever a man's penis is inserted, it can cause small tears that make HIV
infection more likely. The receptive partner is more likely to be infected, although HIV might
be able to enter the penis, especially if it has contact with HIV-infected blood or vaginal
fluids for a long time or if it has any open sores.

Safer Activities

Most sexual activity carries some risk of spreading HIV. To reduce the risk, make it more
difficult for blood or sexual fluid to get into your body.

Be aware of your body and your partner's. Cuts, sores, or bleeding gums increase the risk of
spreading HIV. Rough physical activity also increases the risk. Even small injuries give HIV a
way to get into the body.

Use a barrier to prevent contact with blood or sexual fluid. Remember that the body's
natural barrier is the skin. If you don't have any cuts or sores, your skin will protect you
against infection. However, in rare cases HIV can get into the body through healthy mucous
membranes. The risk of infection is much higher if the membranes are damaged. The most
common artificial barrier is a condom for men. You can also use a female condom to protect
the vagina or rectum during intercourse.

Lubricants can increase sexual stimulation. They also reduce the chance that condoms or
other barriers will break. Oil-based lubricants like Vaseline, oils, or creams can damage
condoms and other latex barriers. Be sure to use water-based lubricants.

Safe Activities

Safe activities have no risk for spreading HIV. Abstinence (never having sex) is totally safe.
Sex with just one partner is safe as long as neither one of you is infected and if neither one
of you ever has sex or shares needles.

What If Both People Are Already Infected?

Some people who are HIV-infected don't see the need to follow safer sex guidelines when
they are sexual with other infected people. However, it still makes sense to "play safe". If
you don't, you could be exposed to other sexually transmitted infections such as herpes or
syphilis. If you already have HIV, these diseases can be more serious. Also, you might get
"re-infected" with a different strain of HIV. This new version of HIV might not be controlled by
the medications you are taking. It might also be resistant to other HIV antiviral drugs. There
is no way of knowing how risky it is for two HIV-positive people to have unsafe sex. Following
the guidelines for safer sex will reduce the risk.

Set Your Limits

Decide how much risk you are willing to take. Know how much protection you want to use
during different kinds of sexual activities. Before you have sex,

• think about safer sex

• set your limits
• get a supply of lubricant and condoms or other barriers, and be sure they are easy to
find when you need them
• talk to your partners so they know your limits.

Stick to your limits. Don't let alcohol or drugs or an attractive partner make you forget to
protect yourself.

(Reviewed 12 August 2004)

HARM REDUCTION AND HIV

Harm reduction is a way of dealing with behavior that damages the health of the person
involved and of their community. Harm reduction tries to improve individual and community
health. Much of the work on harm reduction has been in connection with drug use. This
topic focuses on harm reduction applied to drug use and HIV.

Some key points of harm reduction:

• Drug use won't disappear but its harmful effects can be reduced. Harm reduction
should be a goal for service organizations and governments.
• Some drugs are safer than others. Some ways of using drugs are less harmful than
others.
• Drug users can best reduce the harm of their own drug use.
• Abstinence is the ultimate goal. However, it is also good to reduce drug use and drug-
related deaths, disease and crime.
• The criminal justice approach should not be the only method for dealing with drug
use. Combining it with a public health approach is more productive.
• Services for drug users should be non-judgmental. They should not force people to
receive services.

Harm Reduction in Action

Harm reduction related to drug use includes:
• Teaching drug users about the risks of different drugs and their use.
• Information on using drugs more safely, and reducing the harm of overdoses.
• Provide methadone as a substitute for heroin. Offer medication to counteract a drug
overdose.
• Education and referral to drug treatment opportunities.
• Permit drug users to exchange used syringes for new ones, or buy new syringes.
• Outreach services in areas where drug sales occur.

Harm Reduction and HIV

Some harm caused by drug use is related to HIV
 o Sharing equipment for drug use can spread HIV infection if it contains even a tiny
amount of infected blood.
o Drug use is linked to unsafe sexual activity. This increases the spread of HIV infection.
o It is also related to missing doses of HIV medications (poor adherence.) This can
make HIV disease get worse.

Challenges to Harm Reduction

Drug use and its effects require the coordinated efforts of treatment specialists, law
enforcement agents, public health professionals, corrections experts, and drug users
themselves. Harm reduction suggests that drug treatment is usually more effective than
arrest and imprisonment. It also is working with drug users. It also says that the best
approach to drug use problems involves public health providers working with drug users
rather than imposing legal punishment. Exceptions would be where drug use results in
criminal activity that harms others, such as theft, violence, and driving under the influence
of drugs.

Is Harm Reduction Legal?

Some aspects of harm reduction are legal. Drug users can get information on methadone, on
using drugs more safely, or referrals to drug treatment programs. People can get information
on reducing the risk of HIV infection through sexual activity. Many other aspects of harm
reduction require changes in laws or in law enforcement procedures.

(Reviewed 8 September 2004)

STOPPING THE SPREAD OF HIV

How Do You Get Infected With HIV?

The Human Immunodeficiency Virus (HIV) is not spread easily. You can only get HIV if you
get infected blood or sexual fluids into your system. You can't get it from mosquito bites,
coughing or sneezing, sharing household items, or swimming in the same pool as someone
with HIV. Some people talk about "shared body fluids" being risky for HIV, but no
documented cases of HIV have been caused by sweat, saliva or tears. However, even small
amounts of blood in your mouth might transmit HIV during kissing. Blood can come from
flossing your teeth, or from sores caused by gum disease, or by eating very hot or sharp,
pointed food. To infect someone, the virus has to get past the body's defenses. These
include skin and saliva. If your skin is not broken or cut, it protects you against infection from
blood or sexual fluids. Saliva contains chemicals that can help kill HIV in your mouth. If HIV-
infected blood or sexual fluid gets inside your body, you can get infected. This can happen
through an open sore or wound, during sexual activity, or if you share equipment to inject
drugs.

HIV can also be spread from a mother to her child during pregnancy or delivery. This is called
"vertical transmission." A baby can also be infected by drinking an infected woman's breast
milk. Adults exposed to breast milk of an HIV-infected woman may also be exposed to HIV.

How Can You Protect Yourself and Others?

Unless you are 100% sure that you and the people you are with do not have HIV infection,
you should take steps to prevent getting infected. Following is an overview of HIV
prevention.
1. Sexual Activity. You can avoid any risk of HIV if you practice abstinence (not having sex).
You can reduce the risk of infection with HIV and other sexually transmitted diseases by
using barriers like condoms. Traditional condoms go on the penis, and a new type of
condom goes in the vagina or in the rectum.
2. Drug Use. If you're high on drugs, you might forget to use protection during sex. If you
use someone else's equipment (needles, syringes, cookers, cotton or rinse water) you
can get infected by tiny amounts of blood. The best way to avoid infection is to not use
drugs. If you use drugs, you can prevent infection by not injecting them. If you do inject,
don't share equipment. If you must share, clean equipment with bleach and water before
every use.
3. Vertical Transmission. With no treatment, about 25% of the babies of HIV-infected
women would be born infected. The risk drops to about 4% if a woman takes AZT during
pregnancy and delivery, and her newborn is given AZT. The risk is 2% or less if the
mother is taking combination antiviral therapy. Caesarean section deliveries probably
don't reduce transmission risk if the mother's viral load is below 1000. Babies can get
infected if they drink breast milk from an HIV-infected woman. Women with HIV should
use baby formulas or breast milk from a woman who is not infected to feed their babies.
4. Contact with Blood. HIV is one of many diseases that can be transmitted by blood. Be
careful if you are helping someone who is bleeding. If your work exposes you to blood, be
sure to protect any cuts or open sores on your skin, as well as your eyes and mouth. Your
employer should provide gloves, facemasks and other protective equipment, plus
training about how to avoid diseases that are spread by blood.

If you think you have been exposed to HIV, talk to your health care provider or the public
health department, and get tested. If you are sure that you have been exposed, call your
doctor immediately to discuss whether you should start taking anti-HIV drugs. This is called
"post exposure prophylaxis" or PEP. You would take two or three medications for several
weeks. These drugs can decrease the risk of infection, but they have some serious side
effects.

(Reviewed 9 October 2004)

TREATMENT AFTER EXPOSURE TO HIV (PEP)

Prophylaxis means disease prevention. Post-exposure prophylaxis (or PEP) means taking
antiviral medications as soon as possible after exposure to HIV, so that the exposure will not
result in HIV infection. These medications are only available with a prescription. PEP should
begin within 24 to 36 hours after exposure to HIV. Treatment should continue for 4 weeks, if
tolerated.

Who Should Use PEP?

Workplace exposure. PEP has been standard procedure since 1996 for healthcare workers
exposed to HIV. Workers start taking medications within a few hours of exposure. Usually the
exposure is from a "needle stick", when a health care worker accidentally gets jabbed with a
needle containing HIV-infected blood. PEP reduced the rate of HIV infection from workplace
exposures by 79%. However, some health care workers who take PEP still get HIV infection.

Other exposure. In the last few years, community activists and researchers began asking
why PEP shouldn't be used after HIV exposures that are not work-related. People can be
exposed to HIV during unsafe sexual activity, when a condom breaks during sex, or if they
share needles for injecting drugs. Infants can be exposed if they drink breast milk from an
infected woman. In a study of PEP in 400 cases of possible sexual exposure to HIV, not one
person became infected with HIV.
How Is PEP Taken?

PEP should be started as soon as possible after exposure to HIV. The medications used in PEP
depend on the exposure to HIV. The following situations are considered serious exposure:

• Exposure to a large amount of blood

• Blood came in contact with cuts or open sores on the skin
• Blood was visible on a needle that stuck someone
• Exposure to blood from someone who has a high viral load (a large amount of virus in
the blood).

What Are The Side Effects?

The most common side effects from PEP medications are nausea and generally not feeling
well. Other possible side effects include headaches, fatigue, vomiting and diarrhea.

PEP is a four-week program of two or three antiviral medications, several times a day. The
medications have serious side effects that can make it difficult to finish the program. PEP is
not 100% effective; it can not guarantee that exposure to HIV will not become a case of HIV
infection.

(Reviewed 22 August 2004)

ANTIVIRAL THERAPY

Antiviral therapy means treating viral infections like HIV with drugs. The drugs do not kill the
virus. However, they slow down the growth of the virus. When the virus is slowed down, so is
HIV disease. Because HIV is a retrovirus, these drugs are sometimes called antiretroviral
therapy.

The HIV Life Cycle

There are several steps in the HIV life cycle.

1. Free virus circulates in the bloodstream.

2. HIV attaches to a cell.
3. HIV empties its contents into the cell (infects the cell).
4. The HIV genetic code (RNA) is changed into DNA by the reverse transcriptase
enzyme.
5. The HIV DNA is built into the infected cell's DNA by the integrase enzyme.
6. When the infected cell reproduces, it activates the HIV DNA, which makes the raw
material for new HIV viruses.
7. Packets of material for a new virus come together.
8. The immature virus pushes out of the infected cell in a process called "budding."
9. The immature virus breaks free of the infected cell.
10. The new virus matures: raw materials are cut by the protease enzyme and assembled
into a functioning virus.

The Antiviral Drugs

Each type, or "class", of antiviral drugs attacks HIV in a different way. The first class of anti-
HIV drugs was the nucleoside reverse transcriptase inhibitors, also called "nukes". These
drugs work by blocking Step 4, where the HIV genetic material is converted from RNA into
DNA. Approved drugs in this class include:

• AZT (ZDV, zidovudine, Retrovir) • Trizivir (AZT/3TC/Abacavir

• ddI (didanosine, Videx) combination)
• ddC (zalcitabine, Hivid) • Emtricitabine (FTC, Emtriva)
• d4T (stavudine, Zerit) • Epzicom (3TC/abacavir
• 3TC (lamivudine, Epivir) combination)
• Abacavir (Ziagen) • Truvada(tenofovir/emtricitabine
• Tenofovir (Viread) combination)
• Combivir? (AZT/3TC combination)

Another class of drugs blocks the same step of the life cycle, but in a different way. This
class is the non-nucleoside reverse transcriptase inhibitors, or NNRTIs. Three NNRTIs have
been approved:

• Nevirapine (NVP, Viramune)

• Delavirdine (DLV, Rescriptor)
• Efavirenz (EFV, Sustiva)

The third class of antiviral drugs block Step 10, where the raw material for new HIV virus is
cut into specific pieces. Nine protease inhibitors have been approved:

• Saquinavir (SQV, Invirase and • Amprenavir (APV, Agenerase)

Fortovase) • Lopinavir (LPV, Kaletra)
• Indinavir (IDV, Crixivan) • Atazanavir (TAZ, Reyataz)
• Ritonavir (RTV, Norvir) • Fosamprenavir (908, Lexiva)
• Nelfinavir (NFV, Viracept)

The newest class of antiviral drugs includes fusion and attachment inhibitors. They prevent
HIV from attaching to a cell by blocking Step 2 of the life cycle. One fusion inhibitor has been
approved:

• Enfuvirtide (T-20, Fuzeon)

How Are The Drugs Used?

When HIV multiplies, most of the new copies are mutations: they are slightly different from
the original virus. Some mutations keep multiplying even when you are taking an antiviral
drug. When this happens, the drug will stop working. This is called "developing resistance"
to the drug. If only one antiviral drug is used, it is easy for the virus to develop resistance.
But if two drugs are used, a successful mutant would have to "get around" both drugs at the
same time. And if three drugs are used, especially if they attack HIV at different points in its
life cycle, it's very hard for a mutation to show up that can resist all three drugs at the same
time. Using a triple-drug combination means that it takes much longer for resistance to
develop. For this reason, using just one antiviral drug (monotherapy) is not recommended.
Can These Drugs Cure Aids?

A blood test called the "viral load" measures the amount of HIV virus in your bloodstream.
People with lower viral loads stay healthier longer. Some people's viral load is so low that it
is "undetectable" by the viral load test. This does not mean that all the virus is gone.
Researchers used to believe that antiviral therapy could eventually kill off all of the HIV virus
in the body. Now this seems unlikely. The drugs do not "cure" AIDS. However, they make it
possible for people with AIDS to live a long time.

When to Start and Which Drugs to Use?

There is not a clear answer to this question. Most doctors will consider three things: 1) your
viral load; 2) your T-cell count; and 3) any symptoms you've had. Antiviral therapy is usually
started if your viral load is over 55,000, if your T-cell count is below 350, or if you have had
any symptoms of HIV disease. This is an important decision you should discuss with your
doctor.

Each antiviral drug has side effects. Some are serious. Some combinations of drugs are
easier to tolerate than others, and some seem to work better than others. Each person is
different, and you and your doctor will have to decide which drugs to use. The viral load test
is now being used to see if antiviral drugs are working. If the viral load does not go down, or
if it goes down but comes back up, it might be time to change antiviral drugs.

(Reviewed 17 October 2004)

NUTRITION

Why Is Nutrition Important?

Good nutrition means getting enough macronutrients and micronutrients. Macronutrients

contain calories (energy): proteins, carbohydrates, and fats. They help you maintain your
body weight. Micronutrients include vitamins and minerals. They keep your cells working
properly, but will not prevent weight loss. Good nutrition can be a problem for many people
with HIV. When your body fights any infection, it uses more energy and you need to eat
more than normal. But when you feel sick, you eat less than normal.

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

Nutrition Guidelines for People With HIV

1. Eat more. Extra muscle weight will help you fight HIV. This is very important. Many people
want to lose weight, but for people with HIV, it can be dangerous.

2. Make sure you eat plenty of protein and starches, with moderate amounts of fat.
• Protein helps build and maintain your muscles. Meats, fish, beans, nuts, and seeds
are good sources.
 • Carbohydrates give you energy. Complex carbohydrates come from grains, cereals,
vegetables, and fruits. They are a "time release" energy source and are a good
source of fiber and nutrients. Simple carbohydrates or sugars give you quick energy.
You can get sugars in fresh or dried fruit, honey, jam, or syrups.
• Fat gives you extra energy. You need some - but not too much. The
"monounsaturated" fats in nuts, seeds, canola and olive oils, and fish are considered
"good" fats. The "saturated" fats in butter and animal products are "bad" fats.

3. A moderate exercise program will help your body turn your food into muscle. Take it easy,
and work exercise into your daily activities.

4. Drinking enough liquids is very important when you have HIV. Extra water can reduce the
side effects of medications. It can help you avoid a dry mouth and constipation.
Remember that drinking tea, coffee, colas, chocolate, or alcohol can actually make you
lose body liquid.

Practice Food Safety

It's very important to protect yourself against infections that can be carried by food or water.
Be sure to wash your hands before preparing food, and keep all of your kitchen tools and
work areas clean. Wash all fruits and vegetables carefully. Don't eat raw or undercooked
eggs or meat, and clean up juices from raw meat quickly. Keep leftovers refrigerated and eat
them within three days. Check the expiration date on foods. Don't buy them or eat them if
they're outdated. Some germs are spread through tap water. If your public water supply
isn't totally pure, drink bottled water.

What about Supplements?

Some people find it difficult to go shopping and prepare meals all the time. Supplements can
help you maintain your body weight and get the vitamins and minerals you need. Don't use
a product designed to help you lose weight, even if it says it contains everything needed for
good nutrition! Your health care provider can help you choose a supplement that's right for
you.
Vitamin and mineral supplements can be very helpful.

(Reviewed 22 August 2004)

AIDS IN THE PHILIPPINES

HIV Situation

The first case of HIV was reported in 1984. The epidemic in the Philippines has been classified as ‘low
level.’ It is estimated that 9,400 people were living with HIV/AIDS in the Philippines by the end of 2001.
The Philippines has a relatively low prevalence rate in the world with less than one percent of Filipino
adults infected with HIV.

Table 1. Estimated HIV infection in selected countries, UNAIDS 2001

Estimated number of infected Adult Infection

Countries
Adults and Children Rate (%)
Zimbabwe 2,300,000 33.7
Botswana 330,000 38.8
Thailand 670,000 1.8
Myanmar 530,000 1.99
India 3,970,000 0.8
United States of America 900,000 0.6
Malaysia 42,000 0.4
Singapore 3,400 0.2
Australia 12,000 0.1
Philippines 9,400 <0.1
Indonesia 120,000 0.1
China 850,000 0.1
Cambodia 170,000 2.7
Vietnam 130,000 0.3

As of January 2004, the National Epidemiology Center of the Department of Health recorded 1979 cases
of people with HIV/AIDS of which 1343 (68%) were asymptomatic and 636 (32%) were AIDS cases at the
time of the report. Of the total AIDS cases, 257 (40%) were already dead due to AIDS-related
complications. Of the total HIV and AIDS cases, 1145 were men (62 per cent.) The predominant mode of
transmission was heterosexual contact (1251), followed by homosexual (356) and bisexual contact (101.)
Perinatal transmission accounted for 29, blood/blood products (13) and injecting drug use (6). The
Center also revealed 640 (32 per cent) of the 1979 HIV seropositive cases were Overseas Filipino
Workers (OFWs) of which 473 (74 per cent) were men.

While the Philippines has successfully kept the epidemic in check, an active sex industry and a population
of injecting drug users are potential threats for the spread of the disease. The low prevalence in
Philippines has been attributed to a number of factors including circumcision, which reduces the risk of
transmission; a culture of sexual conservatism; geography- no land borders; relatively low number of
foreign tourists; low levels of intravenous drug use although drugs do pose a problem.

The Spread of Aids in the Philippines

While the number of those infected with Human Immunodeficiency Virus (HIV), the virus that leads to
AIDS, remains relatively low in this largely Roman Catholic country, "the virus is there and it could
spread," Dayrit told reporters on World AIDS Day.

Official figures show 1,935 HIV cases since 1984, with only 628 infected with full-blown AIDS. But based
on conservative estimates, there could be between 4,000 to 6,000 "unreported cases," Dayrit said, most
of whom could be Filipino workers who have recently returned home.
Between five and seven million Filipinos work abroad, official figures show. Many are sailors who dock in
ports such as Mombasa in Kenya where AIDS rates among prostitutes are nearly 75 percent, Dayrit said.
However, Dayrit said only 0.1 percent of all Filipino overseas workers are believed to have contracted
HIV/AIDS.
Population at Risk

About 20 percent of the 1.2 million seafarers worldwide are Filipino. In 1996, there were 307 shipping
companies deploying 200,000 Filipino seamen.

Macho values put seafarers at risk because of the belief that it is but natural for men to pursue sex at
every opportunity. FGDs and interviews conducted by HAIN revealed that seafarers believe that one of
the benefits of becoming a seafarer is to "taste" women at every port. Many commercial sex workers are
available in almost every port, and are sometimes brought on board. But according to a study by the
DOLE-OSHC, only 49 percent of seafarers practice safe sex. Knowledge on HIV/AIDS among seafarers
was found to be low, accompanied by the high-risk secxual [sic] practices.

Forget for a moment about the seven million overseas contract workers, and all the sex tourists from
North America, Europe and Japan who visit the Philippines (many of them in organized sex tour groups),
and the many sex workers that service them in the major cities and tourist resorts. 51% of the 200,000
Filipino seamen don't practice safe sex and are having sex with multiple partners in different countries.
The government has 2,000 cases of AIDS/HIV infections on their books, and says there might be 6,000
cases at the most at this moment. Does their math sound realistic to you?

Table 2. FHSIS UPDATES. Notifiable Diseases. Philippines, 2002

AIDS/HIV Meningitis/
Leprosy Schistosomiasis Filariasis
AREA Infection Encephalitis
No. Rate No. Rate No. Rate No. Rate No. Rate
Philippines 23 0.03 907 1.1 7,426 9.3 2,095 2.6 207 0.3
NCR - - 77 0.7 - - - - 11 0.1
CAR 10 0.7 20 1.4 - - - - - -
Region 1 - - 49 1.1 - - - - 4 0.1
Region 2 - - 36 1.2 - - - - 4 0.1
Region 3 10 0.1 41 0.5 - - 1 0.01 25 0.3
Region 4 - - 44 0.4 - - 51 0.4 4 0.03
Region 5 - - 31 0.6 - - 7 0.1 27 0.5
Region 6 - - 66 1.0 - - - - 46 0.7
Region 7 - - 80 1.4 - - 1 0.02 4 0.1
Region 8 3 0.1 125 3.2 973 24.9 44 1.1 12 0.3
Region 9 - - 116 3.8 613 20.1 12 0.4 53 1.7
Region 10 - - 74 2.6 308 10.6 125 4.3 2 0.1
Region 11 - - - - 896 16.3 - - - -
Region 12 - - 110 3.9 20 0.7 15 0.5 13 0.5
ARMM - - 6 0.3 1 0.04 49 2.2 - -
CARAGA - - 32 1.4 4,615 201.6 1,790 78.2 2 0.1

Table 3. Knowledge of AIDS

KNOWLEDGE OF AIDS
Percent of respondents who know that using condoms reduces the risk of getting
HIV/AIDS virus
- Women (15-49 years old) 48.4 49.7 46.7
- Men (15-54 years old) 62.4 64.4 60.0
 Percent of respondents who know that limiting sex to one uninfected partner reduces
the risk of getting HIV/AIDS virus
- Women (15-49 years old) 77.4 79.3 74.8
- Men (15-54 years old) 77.0 78.8 74.9
Percent of respondents who believe there is a way to avoid HIV/AIDS virus
- Women (15-49 years old) 88.3 90.8 84.8
- Men (15-54 years old) 89.3 92.7 85.4

Table 4. Estimates

Value Year Source

UNAIDS Global HIV/AIDS Report
Figures 9,000 2003
2004
Estimated Number of HIV cases (Adults and UNAIDS Global HIV/AIDS Report
children) 8,900 2003
2004
Adults (15-49 years)
UNAIDS Global HIV/AIDS Report
Women (15-49) 2,000 2003
2004
Children
Esimated number of deaths due to AIDS -- -- --
Estimated Number of AIDS orphans UNAIDS Global HIV/AIDS Report
<500 2003
2004
-- -- --

The National Response

The Philippine National AIDS Council (PNAC) is the country’s highest policy making and directing body on
HIV/AIDS. The council members represent 17 national government agencies including local governments
and the two houses of Congress, 7 non-governmental organisations and an association of people living
with HIV/AIDS. PNAC is also the country’s lead agency in the fight against HIV/AIDS. It coordinates and
oversees programs and activities that prevents and controls HIV/AIDS in the Philippines.

The centre- piece of the national response to HIV/AIDS is the enactment of the Philippine AIDS
Prevention and Control Act of 1998 (Republic Act 8504), a model for HIV/AIDS related human rights
legislation. The entire process - the years of consultations, advocacy and lobbying, has been hailed as a
‘best practice.’

The legislation is often described as path breaking for it –

• Prohibits mandatory testing of HIV

• Respects human rights including the right to privacy of individuals living with HIV/AIDS
• Integrates HIV/AIDS education in schools
• Prohibits discrimination against people living with HIV/AIDS in the workplace and elsewhere
• Provides for basic health and social services for individuals with HIV

While the law provides a clear basis for policies and plans to address the problem of HIV/AIDS, its
effectiveness has yet to be proven. Six years after its passage, the law has been inadequately
implemented and put into action. A multi-sectoral approach to HIV/AIDS has enabled HIV/AIDS education
and services to seep into almost every government department be it education, labour and employment,
tourism or foreign affairs. Efforts have also been on to localize response to the epidemic by forming and
energizing Local AIDS Councils, some of which are NGO led and some, piloted by the government.
While sustaining the low and slow character of the epidemic is one of the challenges faced by the
government, skeptics suspect the figures put out by the government and warn that the Philippines is
sitting on a social time bomb fueled by complacency and denial (Wilkinson; 2003).

Dr. Nafis Sadik, the UN secretary general’s special envoy for HIV/AIDS in Asia and the Pacific has also
indicated a “huge explosion potential" in the Philippines. This is primarily because all known routes of HIV
transmission exist in the country: low condom use, even among commercial sex workers, high-risk
adolescent sexual activity, a large number Facts about AIDS!
of overseas workers who are vulnerable to infection while
NO AIDS Task Force
abroad, and rising prevalence of other sexually transmitted diseases and infections.

Approximately 700,000 to 900,000 Americans are currently infected with HIV. With
40,000 new infections each year, that is one new infection every 13 minutes.
Worldwide, in 1999, 5.6 million people were newly infected with HIV.
The number of U. S. teenagers infected with HIV doubles every 14 months-worldwide,
half of all new infections occur in persons between the ages of 15 to 19 years old.

Worldwide, 35 million people have been infected and 5 million have developed AIDS.
The number of AIDS cases among women in the U. S. doubles every one to two years.
AIDS is the leading cause of death for all African Americans between the ages of 25 to
44.

African American and Hispanic women together account for more than 77% of AIDS
cases reported among women, yet represent less than one-fourth of the total female
population in the U.S.

In Louisiana, there have been more than 18,899 individuals infected with HIV. Of those,
11,747 are still living. More than half of those reported cases are in the Metro New Orleans
area.
Minorities, primarily African Americans and Hispanics, now account for some 54% of
----------------------------------------------
more than 5,000,000 cases of AIDS reported since the epidemic began in 1981.
References:
The disease shows no sign of ending and no cure is at hand.
AIDS. ORG
Community Blood services of Illinois. 1999.
THE ABC'S OF AIDS PREVENTION
10th Conference on Retroviruses and Opportunistic Infections. The New AIDS Fight: A Plan
as Simple as ABC. Boston, Mass, Feb 10-14, 2003
AIDS prevention, as proposed by those who have worked in other countries like Uganda to
Health Secretary
successfully Manuel
control the Dayrit. The
spread of Spread
HIV, of AIDS
is more in the
simple thanPhilippines. Dec 1,
you may think. 2003.
The "ABC's" of
Middle East Natives Testing Orientation and Referral Services. January 6, 2006.
AIDS prevention lists in order a checklist of what you can do to keep yourself, and those you
The Remedios AIDS Foundation's. Populations at Risk.
are intimate with, safer:
UNDP. YOUANDAIDS. The HIV/AIDS Portals for Asia Pacific. January 6, 2006.

Abstain
Be Faithful
Use Condoms

Abstain: Indisputably, abstaining from sex is the best way to avoid becoming infected.

Be Faithful: If you choose to have sex, be monogamous - striving to limit your exposure and
creating strong relationships.

Use Condoms: when abstinence isn't an option for you, and you are not in a monogamous
relationship, always use condoms.
 Telling the Truth: AIDS Rates for Thailand and the Philippines

By RENE JOSEF BULLECER, M.D.

Executive Director, HLI Visayas Mindanao

There has been a wealth of misinformation and misleading interpretations of facts surrounding
the spread of HIV/AIDS in Thailand and the Philippines. Anti-life forces, of course, continually
push and spin facts while working toward their deadly agenda. These organizations view
condom distribution as the one great solution to curb the spread of HIV/AIDS even though time
and experience has proven just the opposite. Recently, BBC and UNFPA's Director, Ms.
Thoraya Ahmed Obaid, suggested that even calling into question the effectiveness of the
condom, as Cardinal Lopez-Trujillo, president of the Pontifical Council for the Family recently
did, would actually spread the disease. She boldly stated that "the statements of Cardinal
Trujillo could contribute to the further spread of HIV/AIDS."

Let's examine the actual figures:

The first AIDS case in Thailand was diagnosed in 1984, when a homosexual prostitute tested
positive for the disease. Later it spread among the female and male prostitutes, and among
intravenous drug users. The first AIDS case in the Philippines was also diagnosed in 1984.

By 1987, there were 112 cases of HIV/AIDS infection in Thailand and 135 cases in the
Philippines.

In 1991 the World Health Organization (WHO) AIDS Program forecasted that by 1999 Thailand
would have 60,000 to 80,000 cases, and that the Philippines would experience between 80,000
and 90,000 cases of HIV/AIDS.

During that same year the Minister of Health of Thailand, Mr. Viravedya, launched the heavy-
handed, "100% Condom Use Program." All brothels were required to stock a large supply of
condoms, and condom vending machines appeared in supermarkets, bars and other public
places. This initiative was widely accepted by the people of Thailand. I was able to visit Bangkok
in both 1994 and 1997 to see this first-hand.

A year after this program was set loose upon Thailand (1992), the infamous Secretary of Health
(now a senator), Mr. Juan Flavier, tried to implement the program in my own country, the
Philippines. This small, 4'11'' man tried every technique he could think of to get his country to
accept the flood of condoms waiting to invade. He even went so far as to mock and deride
Church leaders.

Flavier's efforts in the Philippines failed, however, and in 1999 the UNAIDS reported 755,000
total confirmed cases of HIV infection in Thailand-65,000 had died of the disease. That same
year, in the Philippines, the total number of HIV cases was only 1,005. The disease had killed
only 225 people.

The discrepancy in the infection rates between the two countries, Thailand with severe condom-
oriented programs and the Philippines without, has continued and only grown wider. As of
August 2003 there were 899,000 HIV/AIDS cases documented in Thailand and approximately
125,000 deaths attributed to the disease. These numbers are many times those projected by
the WHO (60,000-80,000 cases) in 1991.

These numbers contrast sharply with those of the Philippines where, as of September 30, 2003,
there were 1,946 AIDS cases resulting in 260 deaths. This is only a mere fraction of the number
of cases (80,000-90,000) that the WHO projected would be reached by 2000.

Due to the unabated rise of cases of HIV/AIDS in Thailand, the UNPFA sponsored a meeting in
Bangkok in September 2003. Unable to curb the spread of the disease, they are focusing now
on AIDS care. Ironically, records show that majority of the AIDS hospice centers are currently
owned and being run by the Catholic missionaries, particularly the Camillian Fathers!

The discrepancy between the numbers of HIV/AIDS cases in Thailand and the Philippines is
particularly poignant considering that the Philippines is actually the more populous country.
According to the U.N., Thailand has 66 million people. While according to the USAID-funded
Commission on Population, the Philippines is now home to 82 million souls.

To what does the Philippines owe its great success in the fight against AIDS?

The AIDS-Free Philippines which I personally organized in 1991 got the blessings from the
Catholic Bishops Conference of the Philippines in 1993 as the official program to combat the
pro-condom advocates nationwide. Despite extremely limited local funds (we never received
any foreign funds) we were able to spread our program widely among our target groups ranging
from the Maritime students, inter-island seamen, prison inmates, secondary and college
students, civic organizations, and religious groups and institutions.

AIDS-Free Philippines is the only pro-chastity/abstinence and truth based anti-AIDS program in
the Philippines. I have participated in scores of radio and television interviews through these
years and even debates (where I debunked the claims of condom effectiveness) with pro-
condom Department of Health officials and NGO's.

Our secret weapon is, of course, prayer. We always start each lecture, seminar, training
session, and convocations with a prayer and we always emphasized the moral aspect of the
problem.

Of course, though years of experience in examining the differing AIDS infection rates in the
Philippines and Thailand would seem to prove beyond any doubt the disastrous ineffectiveness
of the condom solution, there are still efforts to implement these and similar strategies in the
Philippines. Despite so much evidence, the culture of death never gives up on the condom.