BLOOD DISEASE

HIV/AIDS

NAME STUDENT ID SUBJECT CODE SUBJECT TITLE LECTURER DATE BEGIN DATE DUE

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MALVINDERJIT SINGH A/L KULDIP SINGH DOSHM0710433 : : : : : SCI 2110 THE HUMAN BODY MRS. ROZITA BINTI OSMAN 10TH AUGUST 2011 (WEEK 5) 9TH SPETEMBER 2011 (WEEK 8)

CONTENTS NO. 1. 2. 2.1 2.2 2.3 3. 3.1 3.2 3.3 3.4 4. 5. 5.1 5.2 5.3 5.4 6. 7. 8. Introduction Cause Sexual transmission Blood products Prenatal transmission Effects Effects of HIV/AIDS on the human body Demographic effects of HIV/AIDS Effects on mortality and life expectancy Effects on societies and economies Signs & Symptoms Prevention Sexual contact Body fluid exposure Mother-to-child Education Attachments Conclusion References TITLE PAGE 3 46 45 56 6 7 11 79 9 9 10 10 11 12 13 14 16 14 15 15 15 16 16 17 18 19 20

INTRODUCTION Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV).
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This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumours. HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk. This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, breast feeding or other exposure to one of the above bodily fluids. Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century. AIDS was first recognized by the U.S. Centres for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s. Although treatments for AIDS and HIV can slow the course of the disease, there is no known cure or vaccine. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but these drugs are expensive and routine access to antiretroviral medication is not available in all countries. Due to the difficulty in treating HIV infection, preventing infection is a key aim in controlling the AIDS pandemic, with health organizations promoting safe sex and needle-exchange programmes in attempts to slow the spread of the virus. In the beginning, the U.S. Centres for Disease Control (CDC) did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus. The earliest known positive identification of the HIV-1 virus comes from the Congo in 1959 and 1960 though genetic studies indicate that it passed into the human population from chimpanzees around fifty years earlier. The HIV virus descends from the related simian immunodeficiency virus (SIV), which infects apes and monkeys in Africa. There is evidence that humans who participate in bush meat activities, commonly acquire SIV. To explain why HIV became epidemic, there are several theories, each invoking specific driving factors that may have promoted SIV, rapid transmission of SIV through unsterile injections, colonial abuses and unsafe smallpox vaccinations or prostitution and the concomitant high frequency of genital ulcer diseases (such as syphilis) in nascent colonial cities. CAUSE

AIDS is the ultimate clinical consequence of infection with HIV. HIV is a retrovirus that primarily infects vital organs of the human immune system such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. Once the number of CD4+ T cells per microliter (L) of blood drops below 200, the cellular immunity is lost. Acute HIV infection usually progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified either on the basis of the amount of CD4+ T cells remaining in the blood, and/or the presence of certain infections. In the absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2 months. However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 years. Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function. Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression. The infected person's genetic inheritance plays an important role and some people are resistant to certain strains of HIV. An example of this is people with the homozygous CCR5-32 variation are resistant to infection with certain strains of HIV. HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression. 2.1 Sexual transmission Sexual transmission occurs with the contact between sexual secretions of one person with the rectal, genital or oral mucous membranes of another. Unprotected sexual acts are riskier for the receptive partner than for the insertive partner, and the risk for transmitting HIV through unprotected anal intercourse is greater than the risk from vaginal intercourse or oral sex. However, oral sex is not entirely safe, as HIV can be transmitted through both insertive and receptive oral sex. Sexual assault greatly increases the risk of HIV transmission as condoms are rarely employed and physical trauma to the vagina or rectum occurs frequently, facilitating the transmission of HIV.
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Drug use has been studied as a possible predictor of HIV transmission. Perry N. Halkitis found that methamphetamine usage does significantly relate to unprotected sexual behaviour. The study found methamphetamine users to be at a higher risk for contracting HIV. Other sexually transmitted infections (STI) increase the risk of HIV transmission and infection, because they cause the disruption of the normal epithelial barrier by genital ulceration and or micro ulceration, and by accumulation of pools of HIV-susceptible or HIV-infected cells (lymphocytes and macrophages) in semen and vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe and North America suggest that genital ulcers, such as those caused by syphilis and/or cancroids, increase the risk of becoming infected with HIV by about fourfold. There is also a significant although lesser increase in risk from STIs such as gonorrhoea, chlamydia and trichomoniasis, which all cause local accumulations of lymphocytes and macrophages. Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma viral load does not necessarily indicate a low viral load in the seminal liquid or genital secretions. However, each 10-fold increase in the level of HIV in the blood is associated with an 81% increased rate of HIV transmission. Women are more susceptible to HIV-1 infection due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases. People who have been infected with one strain of HIV can still be infected later on in their lives by other, more virulent strains. Infection is unlikely in a single encounter. High rates of infection have been linked to a pattern of overlapping long-term sexual relationships. This allows the virus to quickly spread to multiple partners who in turn infect their partners. A pattern of serial monogamy or occasional casual encounters is associated with lower rates of infection. HIV spreads readily through heterosexual sex in Africa, but less so elsewhere. One possibility being researched is that schistosomiasis, which affects up to 50% of women in parts of Africa, damages the lining of the vagina. 2.2 Blood Products This transmission route is particularly relevant to intravenous drug users, haemophiliacs and recipients of blood transfusions and blood products. Sharing and reusing syringes contaminated with HIV-infected blood represents a major risk for infection with HIV.
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Needle sharing is the cause of one third of all new HIV-infections in North America, China, and Eastern Europe. The risk of being infected with HIV from a single prick with a needle that has been used on an HIV-infected person is thought to be about 1 in 150. Postexposure prophylaxis with anti-HIV drugs can further reduce this risk. This route can also affect people who give and receive tattoos and piercings. Universal precautions are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training. The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections. Because of this, the United Nations General Assembly has urged the nations of the world to implement precautions to prevent HIV transmission by health workers. The risk of transmitting HIV to blood transfusion recipients is extremely low in developed countries where improved donor selection and HIV screening is performed. However, according to the WHO, the overwhelming majority of the world's population does not have access to safe blood and between 5% and 10% of the world's HIV infections come from transfusion of infected blood and blood products. 2.3 Prenatal Transmission The transmission of the virus from the mother to the child can occur in the uterus during the last weeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate between a mother and her child during pregnancy, labour and delivery is 25%. However, when the mother takes antiretroviral therapy and gives birth by caesarean section, the rate of transmission is just 1%. The risk of infection is influenced by the viral load of the mother at birth, with the higher the viral load, the higher the risk. Breast feeding also increases the risk of transmission by about 4 %.

EFFECTS 3.1 Effects of HIV/AIDS on the human body Human immunodeficiency virus (HIV) takes its toll on the body by damaging a persons immune system, paving the way for numerous diseases to move in. While many of the diseases and infections that strike people with HIV are common, others are unusual and their presence is what often leads to a diagnosis of acquired immune deficiency syndrome (AIDS), the final stage of HIV disease. Skin Effects

Varicella zoster virus (VZV) infection. VZV is a herpes virus which causes both chicken pox (varicella) and shingles (herpes zoster). Most adults have already been exposed to this virus. HIV-infected individuals may develop new skin sores from either of these diseases. HIV patients who didnt have chicken pox earlier in their life may develop the condition, which in some cases can affect their organs and become life-threatening. Shingles can be localized to one area or it can spread over large areas of the skin. Shingles lesions can become infected and even lead to the development of encephalitis (brain inflammation) in people with HIV.

Herpes simplex virus (HSV). HSV was one of the first diseases identified in people with advanced HIV disease and is now considered one of the AIDS-defining diseases by the U.S. Centres for Disease Control and Prevention. HSV causes open sores that may look like a cluster of blisters. They pop and crust over before healing completely; this process takes about 7 to 10 days in otherwise healthy individuals, but in people with advanced HIV disease, the sores may enlarge to 2 to 10 centimetres in diameter, becoming crusted and painful.

Kaposis sarcoma (KS). Kaposis sarcoma is a cancer caused by a herpes virus called Kaposi sarcoma herpes virus. Healthy individuals may be infected with Kaposi sarcoma herpes virus without developing the cancer. However, as HIV-infected people become sicker, KS may develop. KS tumours grow from cells which line blood vessels and lymph nodes. The cells form tumours on the skin that appear as brown, purple, or red splotches, called
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lesions. In some cases, the lesions look worse than they are, as they may cause no other symptoms. Other people with KS may experience painful swelling, particularly around the eyes, in the legs, or in the groin. Although less common, KS lesions can also form in organs, like the liver, digestive system, or the lungs, which could be deadly. Oral Health Problems

Candidiasis. Candidiasis is a fungal infection that HIV patients often get as their CD4+ cell count decreases. One of the most common types associated with HIV, thrush (or pseudo membranous candidiasis), appears as white patches in the mouth or pharynx.

Periodontal disease. HIV-positive individuals very often have periodontal disease caused by bacterial infections even if they do not have any other symptoms of HIV. At first, the periodontal disease is characterized by the sudden and rapid loss of soft tissue and jaw bone. As the disease progresses, the person may also develop gingivitis with ulcers that leave craterlike crevices after healing.

Neurological Effects Although HIV does not appear to infect nerve cells, it does somehow affect their ability to function normally. People with HIV can experience:

AIDS-related dementia A decrease in the ability to think properly and process information Brain tumours that either begin in the brain or spread to the brain from elsewhere in the body

Progressive multifocal leukoencephalopathy (PML), which is caused by a virus most people are already infected with, but does not cause disease in people with healthy immune systems. Symptoms include difficulty walking and talking, weakness in the limbs, and seizures.

Weight Effects and Wasting Syndrome

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A big concern for people who has HIV that has progressed to AIDS is AIDS wasting syndrome, which is defined as any unintentional weight loss of 10 percent or more of your body weight. HIV patients may lose muscle as well as fat, and once lost, the weight is difficult to regain. The person may also have diarrhoea and a slight fever. These symptoms are usually accompanied by a complete loss of appetite. AIDS wasting syndrome is extremely dangerous for HIV-infected people. While HIV infection can lead to a variety of very serious complications, advances in treatments have significantly improved the outlook for people with HIV infection. In fact, a recent study found that today, only about 10 percent of people with HIV die of one of the conditions that define AIDS. Since HIV infected individuals are now living longer, they are more likely to die from other causes. 3.2 Demographic effects of HIV/AIDS Countries that have been hard hit by the AIDS epidemic have seen mortality surge and life expectancy drop in the last decade. But because the severely affected countries in sub-Saharan Africa also have high fertility (average births per woman) and most have relatively small populations, the epidemic has not led to population decline in the region. In a few countries, such as Botswana, Lesotho, and South Africa, population growth has slowed dramatically or stopped due to AIDS, but overall growth in the region surpasses that of other world regions. Even accounting for AIDS-related mortality, sub-Saharan Africas population is projected to grow from 767 million in 2006 to 1.7 billion in 2050. AIDS has nevertheless taken a devastating toll on societies. It ranks fourth among the leading causes of death worldwide and first in sub-Saharan Africa. In 2005, UNAIDS estimated that 3.1 million adults and children died of AIDS, 2.4 million of whom were in sub-Saharan Africa. 3.3 Effects on mortality and life expectancy People living with HIV and AIDS are prone to developing other illnesses and infections because of their suppressed immune system. AIDS-related deaths are altering the age structure of populations in severely affected countries. In developing countries with low levels of HIV and AIDS, most deaths occur among the very young and very old. But AIDS primarily strikes adults in their prime working-ages people who were infected as adolescents or young adults, shifting the usual pattern of deaths and distorting the age structure in some countries. Because of increasingly high AIDS-mortality in southern Africa, for example, people ages 20 to 49 accounted for almost three-fifths of all deaths in that region between 2000 and 2005, up from
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just one-fifth of all deaths between 1985 and 1990. Because AIDS deaths are concentrated in the 25 to 45 age group, communities with high rates of HIV infections lose disproportionate numbers of parents and experienced workers and create gaps that are difficult for society to fill. Women are more vulnerable than men in some regions, and their deaths rob families of the primary caregivers. In sub-Saharan Africa and the Caribbean, where the virus is spread predominantly through heterosexual contact, HIV infections are higher among women than among men result. In sub-Saharan Africa, mortality rates among children under age 5 are substantially higher than they would be without HIV. Without life saving drugs, one-third of children who are born infected with HIV die before their first birthday, and about 60 percent die by age 5. In Lesotho, where one fourth of adults were estimated to be living with HIV/AIDS in 2005, life expectancy was nearly 60 years in 1990-1995, but plummeted to 34 years by 2005-2010, primarily because of AIDS-related mortality. The UN projected that Lesothos life expectancy would have improved to 69 years by 2015-2020 if not for excessive AIDS mortality. Countries expected to see a drop in life expectancy include the Bahamas, Cambodia, Dominican Republic, Haiti, and Myanmar. 3.4 Effects on societies and economies In countries hard hit by the AIDS epidemic, the tragic and untimely loss of parents and productive citizens has not only affected families, but also farms and other workplaces, schools, health systems, and governments. Households experience the immediate impact of HIV/AIDS, because families are the main care givers for the sick and suffer AIDS-related financial hardships. During the long period of illness caused by AIDS, the loss of income and cost of caring for a dying family member can impoverish households. When a parent dies, the household may dissolve and the children are sent to live with relatives or left to fend for themselves. Health care systems also experience enormous demands as HIV/AIDS spreads. The epidemic has already crippled health systems in Africa, where systems were weak before the epidemic struck. Expenses have been rising for the treatment of AIDS and AIDS-related infections. Allocating scarce resources for HIV/AIDS can divert attention from other health concerns, and as public funds for health care grow scarce, the costs are increasingly borne by the private sector and by households and individuals. Business and agriculture have also been seriously affected by HIV/AIDS. Employers are hard hit by a loss of workers, absenteeism, the
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rising costs of providing health-care benefits (including the expensive AIDS drugs), and the payment of death benefits. The economic viability of small farms and commercial agriculture is also compromised by a loss of farm workers. Economic stability is therefore compromised as businesses and agriculture suffer. But the longer-term impact may be more serious than these analyses suggest. It is difficult to account for the loss of human capital as childrens education, nutrition, and health suffer directly and indirectly due to AIDS. The effects of lower investments in the younger generation could affect economic performance for decades.

SIGNS & SYMPTOMS The symptoms of HIV and AIDS vary, depending on the phase of infection. Within the first few weeks When first infected with HIV, the person may have no signs or symptoms at all, although they are still able to transmit the virus to others. Many people develop a brief flu-like illness two to four weeks after becoming infected. Signs and symptoms may include:
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Fever Flu Headache Sore throat Swollen lymph glands Rash

Years later People may remain symptom-free for years. But as the virus continues to multiply and destroy immune cells, they may develop mild infections or chronic symptoms such as: Swollen lymph nodes often one of the first signs of HIV infection Diarrhoea Weight loss Fever Cough and shortness of breath

Progression to AIDS If people receive no treatment for their HIV infection, the disease typically progresses to AIDS in about 10 years. By the time AIDS develops, the immune system has been severely damaged, making them susceptible to opportunistic infections diseases that wouldn't trouble a person with a healthy immune system. The signs and symptoms of some of these infections may include:
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Soaking night sweats Shaking chills or fever higher than 100 F (38 C) for several weeks Cough and shortness of breath Chronic diarrhoea Persistent white spots or unusual lesions on your tongue or in your mouth Headaches Persistent, unexplained fatigue Blurred and distorted vision Weight loss Skin rashes or bumps Nausea, abdominal cramps and vomiting

PREVENTION The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to foetus or child during prenatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible. Anti-retroviral treatment of infected patients also significantly reduces their ability to transmit HIV to others, by reducing the amount of virus in their bodily fluids to undetectable levels.
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5.1 Sexual contact The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. The primary mode of HIV infection worldwide is through sexual contact between members of the opposite sex. During a sexual act, only male or female condoms can reduce the risk of infection with HIV and other STDs. The best evidence to date indicates that typical condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term, though the benefit is likely to be higher if condoms are used correctly on every occasion. The male latex condom, if used correctly without oil-based lubricants, is the single most effective available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum jelly, butter, and lard not be used with latex condoms, because they dissolve the latex, making the condoms porous. If lubrication is desired, manufacturers recommend using water-based lubricants. Oil-based lubricants can be used with polyurethane condoms. Female condoms are commonly made from polyurethane, but are also made from nitrile and latex. They are larger than male condoms and have a stiffened ring-shaped opening with an inner ring designed to be inserted into the vagina keeping the condom in place; inserting the female condom requires squeezing this ring. Female condoms have been shown to be an important HIV prevention strategy by preliminary studies which suggest that overall protected sexual acts increase relative to unprotected sexual acts where female condoms are available. At present, availability of female condoms is very low and the price remains prohibitive for many women. Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year. Prevention strategies are well-known in developed countries, but epidemiological and behavioural studies in Europe and North America suggest that a substantial minority of young people continue to engage in highrisk practices despite HIV/AIDS knowledge, underestimating their own risk of becoming infected with HIV. Randomized controlled trials have shown that male circumcision lowers the risk of HIV infection among heterosexual men by up to 60%. It is expected that this procedure will be actively promoted in many of the countries affected by HIV, although doing so will involve confronting a number of practical, cultural and attitudinal issues. However, programs to
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encourage condom use, including providing them free to those in poverty, are estimated to be 95 times more cost effective than circumcision at reducing the rate of HIV in sub-Saharan Africa. A three-year study in South Africa, completed in 2010, found that an anti-microbial vaginal gel could reduce infection rates among women by 50% after one year of use, and by 39% after two and a half years. The results of the study, which was conducted by the Centre for the Aids Programme of Research in South Africa (CAPRISA), were published in Science magazine in July 2010, and were then presented at an international aids conference in Vienna. 5.2 Body fluid exposure Health care workers can reduce exposure to HIV by employing precautions to reduce the risk of exposure to contaminated blood. These precautions include barriers such as gloves, masks, protective eyewear or shields, and gowns or aprons which prevent exposure of the skin or mucous membranes to blood borne pathogens. Frequent and thorough washing of the skin immediately after being contaminated with blood or other bodily fluids can reduce the chance of infection. Finally, sharp objects like needles, scalpels and glass, are carefully disposed of to prevent needle stick injuries with contaminated items. Since intravenous drug use is an important factor in HIV transmission in developed countries, harm reduction strategies such as needle-exchange programmes are used in attempts to reduce the infections caused by drug abuse. 5.3 Mother-to-child The drugs that can reduce the risk of HIV transmission from a mother to her baby are called antiretroviral (ARV) drugs. ARVs are the drugs that are taken by people living with HIV to prevent them from becoming ill. The most important time for an HIV positive pregnant woman to take ARVs to prevent her baby becoming infected is during labour. When a mother is HIV positive, a caesarean section is done to protect the baby from direct contact with her blood and other bodily fluids. HIV is found in breast milk, and if a HIV positive mother breastfeeds her baby there is a significant chance of passing HIV to the baby. So if mothers have access to safe breast milk substitutes (formula) then they are advised to not breastfeed. Allowing another mother who is HIV-free to breastfeed the baby would also be a good alternative. 5.4 Education
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The expansion and improvement of HIV and AIDS education around the world is critical to preventing the spread of HIV. There are an estimated 33.3 million people living with the virus, and each year millions more people become infected. Effective HIV and AIDS education can help prevent new infections by providing people with information about HIV and how it is passed on, and in doing so equip individuals with the knowledge to protect themselves from becoming infected with the virus. HIV and AIDS education also plays a vital role in reducing stigma and discrimination. Around the world, there continues to be a great deal of fear and stigmatisation of people living with HIV, which is fuelled by misunderstanding and misinformation. This not only has a negative impact on people living with HIV, but can also fuel the spread of HIV by discouraging people from seeking testing and treatment.

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ATTACHMENTS

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HIV LIFE CYCLE DIAGRAM

SKIN EFFECTS OF HIV & AIDS

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Varicella zoster virus (VZV) infection

Herpes simplex virus (HSV)

Kaposis sarcoma (KS) CONCLUSION We all know that HIV is a virus that is transmitted from person to person through the exchange of body fluids. Sexual contact, sharing needles, childbirth and breastfeeding is the most
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common way to spread the HIV virus. HIV damages the body's immune system and the body becomes susceptible to illness and infection and progresses to AIDS. HIV and AIDS cause debilitating illness and premature death in people during their prime years of life and have devastated families and communities. Since there is no known cure for HIV and AIDS, prevention is the best way to deal with the spread of these infections. Everyones experience will be different but being diagnosed with HIV can create a raft of emotions including anger, denial, depression, anxiety, shock, and fear of death. Further emotional stress could stem from thoughts about who people should tell, how lifestyle will change and if it will be possible to have children. Some may also experience guilt, viewing their infection as a punishment for being gay or taking drugs, or for the worry they may cause to other people and for possibly infecting others. Just as reactions differ, so too will the ways in which people deal with them. Discussing feelings with others, taking part in relaxing activities, reading about HIV, and maintaining health through exercise and good eating are a few of the ways people can help themselves through hard times. It is generally advised not to suppress emotions artificially through alcohol or substance abuse. Where available, support groups and help lines should be able to offer advice and put people in touch with local services. These groups could allay any fears or anxieties that have resulted from rumours or misinformation, and offer advice on all aspects of coping with HIV. Peer-support groups run by people with HIV can enable those living with the virus to realise they are not alone in what they have gone through, and they might be able to offer the best advice. With enough support from family and friends, people living with HIV and those affected can learn to manage the emotional impact that the epidemic continues to have on millions of people worldwide. While there is no single way to deal with the emotionally demanding episodes caused by HIV including diagnosis, disclosure, grief and bereavement, not to mention the continual adapting to living or supporting someone with a chronic condition, it is possible to find ways to successfully cope.

REFERENCES 1. http://en.wikipedia.org/wiki/AIDS 2. http://www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION

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3. http://www.ucsfhealth.org/conditions/aids/signs_and_symptoms.html 4. http://kidshealth.org/teen/sexual_health/stds/std_hiv.html 5. http://www.avert.org/pregnancy.htm 6. http://www.avert.org/emotional-needs-support.htm 7. http://en.wikipedia.org/wiki/HIV 8. http://www.cdc.gov/hiv/topics/basic/ 9. http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/fluids-of-transmission/ 10. http://aids.gov/hiv-aids-basics/diagnosed-with-hiv-aids/hiv-in-your-body/immunesystem-101/

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