Standard Interpretations - (Archived) Table of Contents|
|NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.|
December 7, 1987
This is in response to your memo concerning an OCIS subfile on AIDS. Such a file would be quite useful.
We are attaching a series of questions with answers developed by the City of Philadelphia, Department of Public Health. You may find it useful to be included in the file.
Please contact Jim Johnston (FTS 596-1201) if you have any questions.
CITY OF PHILADELPHIA
DEPARTMENT OF PUBLIC HEALTH
HEALTH PROMOTION/DISEASE CONTROL
AIDS CONTROL PROGRAM
T A B L E O F C O N T E N T S
DEFINITION 1 INCIDENCE 3 TRANSMISSION 5 DIAGNOSIS & TREATMENT 12 CHILDREN AND AIDS 16 PREVENTING THE SPREAD OF AIDS 19 CARE OF AIDS PATIENTS 22 HUMAN RIGHTS ISSUES 27 HOW TO REDUCE THE RISK OF AIDS 29
ATTACHMENT: PHILADELPHIA DIRECTORY OF INFORMATION AND SERVICE AGENCIES RELATED TO AIDS
D E F I N I T I O N
1. What is AIDS?
Acquired immune deficiency syndrome (AIDS) is a disease complex characterized by a collapse of the body's natural immunity against disease. Because of this failure of the immune system, patients with AIDS are vulnerable to one or more unusual infections or cancers that do not pose a threat to anyone whose immune system is working normally.2. What causes AIDS?
AIDS is caused by a virus. This virus was discovered simultaneously in France, where it was named lymphadenopathy- associated virus (LAV); and in the United States, where it was given the name human T-lymphotropic virus, Type III (HTLV-III). Today, the World Health Organization has agreed to call this virus human immunodeficiency virus, or HIV.3. Is AIDS a newly diagnosed disease? How was it started? Is it in other countries?
Yes, AIDS is a "new" disease. We can say this for a number of reasons. First, before the AIDS epidemic, Kaposi's sarcoma (KS) in this country was primarily a disease of elderly men of Jewish or Mediterranean extraction. It presented as superficial skin lesions, progressed slowly and responded to chemotherapeutic agents. Life expectancy averaged 14 years, so many patients died with KS and not of it.
I N C I D E N C E
4. Do only men get AIDS?
At present, early 1987, about 7% of adult AIDS cases have been in women. Most of these - 50% - have been intravenous (IV) drug users; some (29%) have been sexual contacts of men who were bisexual or drug users; some (10%) received contaminated blood transfusions.5. How do we know for a fact that 3% of the cases that don't fit into risk groups doesn't mean the disease is transmitted by casual contact?
About one-third (170) of these patients either died before adequate information could be obtained, lost to follow-up or refused to answer questions. They may be in a high risk category, but we do not know and never will know. About one-third (170) of these patients are still under investigation. Prior experience has shown that many of these cases will be reclassified into the risk behaviors previously described. That means that only about 170 of the cases cannot be explained. That is not surprising since the questions we ask are personal, and many patients do not want that type of information on any government document.6. How many cases of AIDS have occurred so far?
In the United States, there have been over 35,000 cases of AIDS cumulative as of April, 1987. Of this number, over 696 cases have been diagnosed in the Philadelphia area.7. How many men have developed AIDS?
As of April, 1987, a total of 32,000 males have been diagnosed with AIDS in the United States. Of that number, 610 have been residents of the Philadelphia area.8. How many women have developed AIDS?
As of April, 1987, a total of 2,388 women in the United States have developed AIDS, 23 of whom are residents of the Philadelphia area.9. How many blacks and Latinos have developed AIDS?
As of December, 1986, about 7,800 blacks (24% of total) and 4,008 Latinos (14% of total) have been reported with AIDS nationally. In the Philadelphia area, as of April, 1987, there have been 217 cases in blacks (47.8% of total and 28 in Latinos (62%). Over half of the AIDS cases in Philadelphia have occurred in the minority population.10. What is the geographic distribution of reported AIDS cases in the United States?
Five states - New York, California, Texas, Florida and New Jersey - account for almost 75% of the reported cases. As of December, 1986, AIDS cases have been reported in all 50 states, the District of Columbia and Puerto Rico.11. Is the incidence of AIDS increasing in Pennsylvania?
As of December, 1986, there were 613 cases of AIDS in Pennsylvania, twice as many as there were one year before. Pennsylvania ranks 7th in cases in the United States.12. Is the incidence of AIDS increasing among intravenous drug abusers?
Nationally, as of April, 1987, 17% of cases occurred in heterosexual IV drug abusers and 8% in gay/bisexual IV drug users - a total of 25%. Unfortunately, in some areas of the country like northern United States, IV drug-related AIDS is increasing dramatically. IV drug abuse is responsible for 79% of pediatric AIDS cases nationally. AIDS education is particularly critical in IV drug abuse populations because these individuals are at risk to both sexual and needle sharing behaviors. By April, 1988, 12% of new cases were among heterosexual IV drug users while 7% were in gay/bisexual men who use drugs.13. Is AIDS occurring only in our country?
AIDS is a worldwide phenomenon. In addition to the United States and Canada, AIDS has been reported in 18 European countries, at least 21 African countries, the Caribbean, South America, Australia and several other places including the Middle East and Asia.14. Do AIDS cases in other countries show the same risk factors as here?
In general, the same risk factors -- exposure to contaminated blood and sexual activity -- are associated with AIDS everywhere. The specific groups of people affected by AIDS varies to some extent from country to country. For example, there are few drug abusers identified as having AIDS in Europe, and more females have developed AIDS in Africa. Studies are underway to gain a better understanding of the similarities and differences of AIDS distribution in the United States and other countries.
T R A N S M I S S I O N
15. How contagious is AIDS?
Unlike many communicable diseases -- colds, flu, measles, etc --16. How is AIDS transmitted?
AIDS is not an easily transmissible disease. All evidence indicates that AIDS is spread through sexual contact, needle sharing or less commonly through transfusions of blood or blood components before blood screening began in 1985. It can also be passed from an infected mother to her unborn child. Direct blood-to-blood or vaginal secretion/semen-to-blood contact appears necessary to transmit the virus associated with AIDS. There is no evidence that AIDS can be transmitted through air, water, food or casual body contact.17. Why are homosexual males especially at risk for AIDS?
Anyone can get AIDS if his or her sexual partner is carrying the HIV virus. In this country, AIDS has spread widely among gay and bisexual men; but in other parts of the world most people with AIDS have been heterosexual. AIDS is contracted from intimate contact with an infected gay, bisexual or heterosexual partner or IV drug sharing partner in the vast majority of cases.18. Why are IV drug abusers at increased risk for AIDS?
IV drug abusers often share needles for drug injection which can result in small amounts of blood from an infected person being injected directly into the blood stream of others who share needles with that person.19. Why are hemophiliacs at increased risk for AIDS?
Hemophiliacs receive frequent transfusions of a blood concentrate, Factor VIII, which must be collected from several thousand donors. Cases of AIDS among hemophiliacs are linked with receipt of blood serum from HIV infected donors. Presently, all donated blood is screened for the presence of antibodies to the HIV virus; infected blood is discarded. In addition, Factor VIII is heat treated to kill any virus that may still be present. Unfortunately, many hemophiliacs still carry the virus from Factor VIII which they received before testing and heat treating began.20. What kinds of intercourse are associated with AIDS transmission?
AIDS may be transmitted in anal or vaginal intercourse. During anal intercourse, slight bleeding may often occur, since the rectal lining is very fragile. But semen/vaginal secretion-to- blood contact may occur anally or vaginally, whether or not there is any visible bleeding.21. Is AIDS passed by kissing?
HIV has been found in the saliva of some AIDS patients, but there is not a single case of AIDS that is known or suspected of having been transmitted by kissing. If AIDS were transmitted by kissing, many family members of persons with AIDS would be expected to have developed the condition. This has not occurred.22. Can AIDS be transmitted through oral/genital sex?
It has not yet been determined whether oral/genital sex transmits the disease, but any direct contact with the semen or vaginal secretions of any infected person may increase the risk of AIDS transmission. This may be most likely if the receiving partner has slight cuts or bleeding within the mouth.23. Can prostitutes spread AIDS?
Prostitutes are likely carriers of HIV virus if they engage in unprotected sexual contact with many partners or if they are IV drug users. Anyone who engages in sex with a prostitute or other anonymous partner may be increasing the risk of contracting AIDS and other sexually transmissible diseases. Condoms can significantly reduce this risk.24. Can use of a condom during sex reduce the risk of AIDS?
Proper use of a condom during sex can probably reduce the risk of AIDS since it minimizes direct contact with semen or vaginal secretions, body fluids known to carry the AIDS-linked virus in infected persons. Manufacturers of condoms point out, however, that their products are not failsafe and people should not rely on condoms as their only defense against AIDS. A recent study involving five brands of latex condoms showed that a high concentration of AIDS virus could not pass through an intact condom after three weeks of laboratory exposure. However, all sexually active people are advised to refrain from sexual contact with persons whose history and health status are unknown. Proper use of condoms is also essential: avoid oil-based lubricants such as vaseline or baby oil; be sure the condom is applied without air pockets which may result in breakage; and the condom must remain on from beginning to end of penetration. Use of spermicidal lubricants or creams may also be helpful25. On St. Elsewhere, Mark Harmon's character died of AIDS which he contracted through heterosexual contact. Is this a distortion? How common is it for women to pass on AIDS. How common is AIDS in the heterosexual, non-drug population?
No, this was not a distortion. AIDS is a sexually transmitted disease that can be passed from one partner to another, male-to- female, female-to-male, male-to-male and female-to-female, although there is only one documented case of female-to-female sexual transmission. The virus that causes AIDS is found in semen and vaginal secretions.26. What is the risk of getting AIDS from a blood transfusion?
The risk of contracting AIDS through a blood transfusion has been significantly reduced, if not fully eliminated, through screening of all blood donations since May 1985 for antibodies to HIV and removal of blood found antibody positive from the transfusion pool. The risk of contracting AIDS through a blood transfusion is now significantly lower than prior to HIV antibody screening.27. Is there a danger of contracting AIDS from donating blood?
None at all. Blood banks and other blood collection centers have always used sterile equipment and disposable needles. The need for blood is always acute, and people who are not at increased risk for AIDS are urged to continue to donate blood as they have in the past.28. Blood transfusions - are they safe?
In May of 1985, the government authorized the use of a blood test that is used to screen all donated blood in the United States. If a pint of blood tests positive for the AIDS virus antibodies, it is thrown away. Another method of protecting the blood supply is through voluntary deferral. Members of high risk groups have been asked to voluntarily refrain from giving blood and their cooperation has been good. The chances of becoming infected with HIV through a blood transfusion are now very small. However, the U.S. Public Health Service recommends that any individual who was transfused with blood or a blood product between 1978 and the spring of 1985 (prior to routine testing of blood for HIV antibodies) be tested for HIV antibodies. Patients are recommended to contact their physician who arranged the transfusion.29. Can you get AIDS by drinking from the same glass or eating from the same dishes as a person with AIDS?
No. More than five years of experience indicates that AIDS is not transmitted in households where people may drink or eat from common dishes or utensils. The virus associated with AIDS does not survive long outside of the body and would be killed by normal washing of dishes and other eating utensils.30. Can you get AIDS from public toilets, drinking fountains, telephones or public transportation?
No. AIDS is not transmitted through the air, food or water, or by touching any object handled, touched or breathed on by an AIDS patient. The virus associated with AIDS does not survive well outside of the human body, and cannot infect you unless it is injected into the bloodstream.31. Can you get AIDS from eating in a restaurant where someone with AIDS is working as a cook or waiter?
No. Eating in restaurants does not increase the risk for AIDS. There are no cases of AIDS that have been transmitted through food preparation or food handling, since there is no way for an infected cook or waiter's blood or semen to get into the bloodstream of a restaurant patron.32. Can you get AIDS by touching someone who has it?
No. After more than five years of experience, there is no indication that AIDS is spread through any form of casual contact, including handshakes, bumping together in crowds, contact sports, even casual kissing.33. Can AIDS be spread by swimming pools?
No. There are no cases of AIDS suspected of having been transmitted through swimming pools. The virus associated with AIDS would be killed by the chlorine used to disinfect swimming pools.34. Can you get AIDS from trying on clothes in a department store?
No. AIDS is not transmitted through the air or by touching any object used or touched by a person with AIDS.35. Can you get AIDS from handling money?
No. More than five years of experience indicates that AIDS is not transmitted through objects touched by a person with AIDS.36. Can you get AIDS from using someone's razor or toothbrush?
We don't know for sure, but we think that it is not likely, since it appears to take direct infusion of infected blood into your bloodstream to transmit the disease. It would, however, be prudent to avoid sharing of instruments where blood-to-blood contact could occur.37. Can mosquitoes transmit AIDS?
No. Mosquitoes bite people of all ages. We find AIDS in mature sexually active adults. If mosquitoes could transmit AIDS, we would have more cases in children, old people, people who are not gay or bisexual or who are not IV drug users.38. Can you get AIDS from dental instruments?
There are no cases of AIDS that have been linked with dental instruments, and the sterilization process would kill the HIV. Dentists are being advised to take special precautions, such as wearing gloves, etc. to guard against cuts which could result in direct blood-to-blood exchange with a patient and potentially transmit AIDS, hepatitis B and other diseases.39. Can AIDS be spread through droplets such as from sneezing or tears. What about saliva?
Although small amounts of AIDS virus have been isolated in saliva and tears of infected people, five years of intense study of this epidemic reveal that AIDS is not spread this way. First and foremost, we have the evidence of who gets AIDS and who does not. If it could be spread through sneezing, saliva and tears, then surely household members of infected persons would show evidence of infection or exposure. Studies of over 350 household members show that this has not happened.40. What about "deep" kissing?
Deep or "French" kissing is unlikely to be a means of transmission, but we don't consider it to be absolutely safe. It is difficult to determine whether AIDS has ever been transmitted this way because most people who engage in deep kissing also engage in high risk activities. But remember, AIDS is not transmitted in saliva; and ingestion (swallowing) is also not an efficient means of transmission because the stomach acids would kill the virus. The only real concern here might be if both partners were to bleed very slightly, such as from bleeding gums or extremely passionate kissing! With a person at high risk for AIDS, though, you should probably be careful about very deep kissing. "Dry" or "social" kissing, touching the lips only, is considered safe.41. Can you get AIDS by being in the same house with an AIDS patient?
No. Experts point out that no household member of any AIDS patient other than a sexual partner or child born to an infected mother has developed the disease.42. Can you get AIDS from a gay friend or co-worker?
AIDS is not transmitted through casual contact. After more than five years of experience, no cases of AIDS have developed among casual friends or co-workers of AIDS patients. There is no evidence that being around someone with AIDS, even for an extended period of time, puts you at risk for AIDS. Of course, not all gay men have AIDS. But almost anyone could be carrying the HIV virus. Thus, it is fortunate that only sexual contact or needle sharing can transmit the virus.43. What is the risk of living in a neighborhood that has a hospital or home for AIDS patients?
None, since AIDS is not transmitted through the air or through casual contact.44. Have any non-sexual household contacts of AIDS patients become antibody positive?
In no case of actual AIDS has transmission been traced to non-sexual contact with an AIDS patient in the household. As far as antibody positive status, seven studies were done involving 350 family members of over 100 AIDS patients (most of them children). None of these family members were HIV positive.45. What about breast milk, can a nursing child develop AIDS if the mother is infected?
The AIDS virus has been found in the breast milk of HIV positive mothers. Ingesting (swallowing) of the virus is not a very efficient means of transmission because, in adults at least, presumably stomach acids can kill the virus. But an infant may be more susceptible.46. So many studies are still being done on this disease "AIDS", therefore, isn't it premature to say that AIDS can't be transmitted through casual contact? Is this said so that there will not be a widespread panic in our nation?
AIDS has been traced back to 1978 in the United States. The medical community became aware of the problem in 1981. Medical epidemiologists have carefully studied who is getting AIDS and/or developing antibodies to HIV -- and who is not. Based on more than five years of research and observation, it can be said that AIDS is not spread through casual contact. This is not said just to keep people calm. After all, the medical people who are in constant contact with people with AIDS have a great interest in knowing the means of transmission. Research has shown that no health care workers have gotten AIDS from casual contact with a patient.47. Are health care workers or other occupational groups at special risk for AIDS?
Health care workers and other occupational groups who come into contact with AIDS patients or their specimens have not developed AIDS. Safety protocols have been developed for various occupational groups to minimize direct contact with blood and other body secretions. The Centers for Disease Control (CDC) is following over 2,500 health care workers who have been exposed to the body fluids of AIDS patients. None of these workers has developed AIDS as a result of an occupational exposure. However, two health care workers who experienced needlestick injuries (out of a total of 716 and who deny any AIDS risk behaviors, have been found positive for HIV, but neither has developed AIDS. In contrast to the 6% to 30% risk of acquiring hepatitis B following needlestick exposure to a carrier of that virus, the risk of acquiring HIV infection after needlestick exposure to an infected patient is apparently on the order of 1%. All scientific studies to date suggest that the risk to health care workers and other occupational groups is low, or non-existent if they follow safety protocols or minimize direct exposure to blood and body fluids.48. I have heard that the AIDS incubation period is fairly lengthy. That being so, isn't it premature to advocate for a policy based on preliminary data and wouldn't a long-term public health policy requite more dramatic action, such as isolation of sufferers, screening of food handlers, etc.?
It is important to emphasize that current public health recommendations are not based on who develops clinical disease following a prolonged incubation period, but on who seroconverts (develops HIV antibodies) following exposure. Since most people will develop HIV antibodies within 12 weeks of exposure, and since we have a blood test to measure this antibody, we don't have to wait for clinical disease to occur to determine if transmission has taken place. The epidemiologic data clearly show that isolation and quarantine will not prevent the further spread of this disease.49. Can lesbians get AIDS?
Lesbians are at lower risk than gay/bisexual men or heterosexuals. Statistically, lesbians tend to have a much lower rate of sexually transmitted diseases than other groups, partly because without an ejaculation within the vagina, it is harder to transmit some diseases. There is one reported AIDS case where a woman appears to have developed HIV infection from her IV drug using female sexual partner.50. Are people in certain cities such as San Francisco and New York City at higher risk?
People who live in or visit cities with high numbers of AIDS cases need to practice safe sex and must not share needles. A large number of AIDS cases in a given area implies that there is a large number of infectious people in that area.
D I A G N O S I S A N D T R E A T M E N T
51. Is there a test for AIDS?
There is no test to determine if a person has AIDS or will develop AIDS in the future. A test has been developed for detecting antibodies (substances produced in the blood to fight disease organisms) to the virus linked with AIDS. Presence of HIV antibodies means only that a person has been exposed to the virus. It cannot show whether or not a person is still infected or if he/she has or will develop AIDS. Most people feel that if you are antibody positive, you should practice safe sex. Tests to determine presence of the virus (antigen tests) are in the process of being developed and tested.52. How is AIDS diagnosed?
There is no single diagnostic test for AIDS. The AIDS diagnosis is based on the diagnosis of an unusual cancer or opportunistic infection in an otherwise normal individual. Only a licensed physician can make an official diagnosis.53. What is the incubation period for AIDS?
The onset of symptoms following infection with the HIV is thought to range from six months to many years. HIV infection is a chronic infection which lasts for life.54. What are the symptoms of AIDS?
Some people with HIV infection develop no symptoms. Others go on to develop AIDS-Related Complex (ARC) or AIDS. Most of the symptoms that people with ARC or AIDS eventually develop are related to the diseases or infections that attack them because of their inability to fight off infection.55. What are some of the diseases affecting AIDS patients?
About 85% of the AIDS patients studied have had one or both of two opportunistic infections or rare diseases: Pneumocystis carinii pneumonia (PCP), a parasitic infection of the lungs which has symptoms similar to other forms of pneumonia; and/or a rare type of cancer known as Kaposi's sarcoma (KS) which usually occurs anywhere on the surface of the skin or in the mouth. In early stages, it may look like a bruise or blue-violet or brownish spot. The spot or spots persist, and may grow larger. KS may spread to, or appear in, other organs of the body. AIDS patients also may develop unusually severe infections with yeast, cytomegalovirus, herpes-virus, and parasites such as Toxoplasma or Cryptosporidia; milder infections with these organisms do not suggest immune deficiency. About 30% of patients show symptoms of brain disease or severe damage to the spinal cord. It is now believed that a majority of AIDS patients may develop dementia or neurological problems. Some infections attack brain and central nervous system or the HIV virus itself may directly affect the brain.56. Can one contract an opportunistic infection (OI) without contracting HIV?
Any condition, drug or abuse can leave one open to OI's, if it is immunosuppressive; but one can only contract AIDS if there has been infection with the HIV.57. Can AIDS be put into remission?
It appears that a person with AIDS does have some type of remission in that he/she may be very ill with an opportunistic infection at one point and, after treatment, appear to be fairly well for a period of time. But the virus does not disappear and symptoms will reoccur.58. At this point, is there a cure for AIDS? If not, why not?
No, there is no cure for AIDS at this time. There is research going on for treatments, a vaccine and a cure. However, AIDS is proving to be a tough virus to crack because the virus is constantly changing.59. How soon might a vaccine be available?
Some researchers feel that there is the possibility of a vaccine in about five years. However, developing a vaccine is only a part of the work to be done. It is important that a treatment be developed which calls for other technology and information. In the interim, it is critical to practice safer sex and to maintain awareness of how one may be at risk.60. How is AIDS treated?
Currently, there are no drugs available anywhere that have been shown to cure AIDS, although the search for such drugs is being pursued vigorously. Some drugs have been found that inhibit the action of HIV, but these do not lead to clinical improvement. Treatment is directed at the specific opportunistic infections or cancer which attacks AIDS patients.61. How effective are Interlukin 2 and Interferon?
To date, they have not been effective in long term studies.62. Azidothymidine (AZT) [also known as Zidovudine or Retrovir]?
AZT is a ray of hope. It could conceivably prolong the lives of people with AIDS because it stops the virus from replicating in the immune system. Because it does not kill the virus, people have to take it for the rest of their lives. It does have some toxic side effects such as bone marrow suppression.63. Why are some AIDS patients able to live?
AIDS does not cause instant death upon diagnosis. There are many factors which probably contribute to a person with AIDS' length of life after diagnosis. However, at this time, there is no cure and most persons diagnosed with AIDS will die within about two years of their diagnosis.64. Can you have AIDS virus and not develop AIDS?
Yes, see previous question.65. Will AIDS carriers eventually die from AIDS?
So far, approximately 30% of all HIV positive people will get AIDS within seven years of infection. The ultimate proportion of HIV infected persons that develop AIDS may be much higher.66. Are people with AIDS dying as a result of the virus or subsequent manifestations due to lack of first-line defense?
The HIV virus itself is not fatal. It causes the immune system to break down to the point where PCP, KS and opportunistic infections can cause death.67. Are Kaposi's lesions painful? Can there be drainage from them that would necessitate using gloves?
Kaposi's sarcoma (KS) is a cancer which attacks the capillary walls of the blood vessels in the skin. It is characterized by purplish or dark nodules, lumps or other growths on the skin or mucous membranes (mouth, nostrils, anus, eyes). As a rule, these lesions are not painful; but depending on the extent of nerve and blood vessel involvement, there may be pain. Drainage would result if the skin were significantly involved.68. What Philadelphia hospital is the main center for AIDS research?
None. But several hospitals are studying different opportunistic infections common to people with AIDS and a number of local hospitals have a great deal of experience in caring for people with AIDS.69. What is the City doing?
The City of Philadelphia has an AIDS Control Program which has three components -- the education component's main objectives are to provide accurate preventive education to the public as well as epidemiological information to allay public fears about the spread of this disease. Most of our work is with community groups and agencies which provide service to the community. There is also a surveillance component responsible for keeping an accurate case count and interpreting data to monitor trends of the disease, and a medical component to work with health care and public institutions.
C H I L D R E N A N D A I D S
70. Do any children get AIDS?
As of March 2, 1987, there are 453 children with AIDS in the United States. Five of them are in Philadelphia. Over 60% (4 of the Philadelphia cases) have died.71. How do children get AIDS?
The majority (80%) of infected children acquired AIDS from their infected mothers, presumably in the uterus or during birth. A few children have developed AIDS following blood transfusions or from a blood product.72. What happens to children with AIDS?
A child who is born with AIDS probably will not make it past his/her second birthday. A child who contracts AIDS through contaminated blood or blood products has a prognosis more like an adult's. It is estimated that death will occur within 2-3 years after diagnosis. Children with AIDS who are of school age face problems from other parents, children and school administrators who are fearful of the disease and do not understand its modes of transmission. Even when they do know the modes of transmission, they are often not able to reason through their fears. The Centers for Disease Control and American Academy of Pediatrics recommend that any child who is HIV positive, has ARC, or AIDS be reviewed on an individual basis as to the appropriateness of their attending school based on their medical condition.73. What about breast milk, can a nursing child develop AIDS if the mother is infected?
The AIDS virus has been found in the breast milk of HIV positive mothers. HIV positive mothers are recommended by the Centers for Disease Control not to breastfeed infants.74. If a child has AIDS, can he/she pass it on to another child?
None of the identified cases of AIDS in the United States are known or suspected to have been transmitted from one child to another in the home, school, day care or foster care setting. Theoretical transmission presumably would necessitate exposure of open skin lesions or mucous membranes to blood or other body fluids of an infected person.75. What risk does mixing with other children pose to a child with AIDS?
Immune suppressed children are highly susceptible to infections from other children in a school or day care setting. The risk of some infections such as chicken pox may be reduced by prompt use of a specific immune globulin following a known exposure. Assessment of risk to an immune-suppressed child from attending school is best made by the child's physician who is aware of the child's immune status.76. What precautions or guidelines should be introduced in schools to prevent exposure to blood or other bodily fluids from a child with AIDS?
Because other infections can be present in blood or body fluids, all schools and day care facilities, regardless of whether children with AIDS are attending, should adopt routine safety procedures for handling blood or body fluids. Soiled surfaces should be promptly cleaned with disinfectants, such as household bleach (diluted 1 part bleach to 10 parts water). Disposable towels or tissues should be used whenever possible, and mops should be rinsed in the disinfectant. Those who are cleaning should avoid exposure of open skin lesions or mucous membranes to the blood or body fluids. 77. Is there a danger having teachers, cooks or other school personnel infected with AIDS?
AIDS is not spread through air, food, water or any form of casual contact. There are no cases of AIDS reported anywhere that are known or suspected of being transmitted through food preparation, use of common toilets or drinking fountains or merely having long-term casual contact with a person with AIDS. Therefore, teachers, cooks or other school personnel with AIDS who feel well enough to work would not represent a risk to students or other school personnel.78. Should there be HIV antibody screening for school children or school personnel?
The test that detects antibodies to HIV is not a diagnostic test for AIDS. Most persons exposed to the HIV will not develop AIDS. Therefore, screening of school children or other healthy persons will not provide any useful information upon which to base a public health policy.79. If a child is bitten by another child with AIDS, what is the possibility of transmission?
While HIV virus has been identified in saliva, there are no cases of AIDS having been transmitted through a bite. Transmission of the virus appears to require direct blood-to-blood or semen (vaginal secretions)-to-blood contact. 80. Suppose my child became a regular playmate of a child with AIDS?
Casual contact, even over a long period of time, is not regarded as dangerous, primarily because no child in the family of an AIDS victim has been known to contract HIV infection through day-to-day activities or contact.81. What if my child is in a classroom with an AIDS patient who threw up or had diarrhea?
Care should be taken to minimize direct exposure to bodily secretions or excretions from any ill person. Persons cleaning up such secretions are advised to wear gloves and to use a solution of household bleach and water (diluted 1 part bleach to 10 parts water) as a disinfectant. While these precautions are recommended, it should be noted that no cases of AIDS have ever been linked with exposure to urine, saliva, vomit or feces. The body secretions linked with AIDS are blood and semen/vaginal secretions. Also, the vomitus or stool, even if it carried virus, would not easily get into the bloodstream of another child.82. Since AIDS is transmitted through blood contact, could a child get it through a schoolyard fight or during a contact sport like football?
There is no evidence of AIDS transmission through a sports injury. Blood transfusions have transmitted the virus associated with AIDS, as have dirty needles shared by IV drug abusers, but that is not the same thing as external contact with blood as might occur in a sports injury. 83. If AIDS cases double in the next year, will that mean more kids with AIDS will be attending school?
AIDS cases in general are expected to double over the next year, but the number of cases among school-age children is not expected to rise as fast. Children who are infected at or before birth only live an average of two years. Cases among children resulting from transfusions of blood and blood products are expected to decrease as a result of testing blood supplies for antibodies to HIV.
P R E V E N T I N G T H E S P R E A D O F A I D S
84. What is being done to prevent the spread of AIDS?
Knowledge is the best weapon we have to fight the spread of AIDS at this time, as there is not yet a vaccine or a cure.85. How successful have educational efforts been in encouraging high risk persons to alter behaviors which can spread AIDS?
There has been a change in sexual practices among male homosexuals, which is verified through a significant reduction in the incidence of rectal gonorrhea. A study of rectal gonorrhea cases in gay men was conducted by the San Francisco City Clinic. The number of these cases went from a high of approximately 1500 in the first quarter of 1988 to a low of approximately 150 in the first quarter of 1986. Recent surveys of 500 homosexual and bisexual men conducted in San Francisco show that 81% of those polled were now in monogamous relationships or were remaining celibate. Moreover, only 36% of those surveyed reported that they had had recent sexual contact with more than one partner.86. What is meant by "safer sex"?
"Safer sex" is the way to manage your sex life so that you have the least risk of exposure to HIV. There are two main ideas to "safer sex": 1) limit the number of your sex partners, and 2) avoid exposure to your partner's body fluids and wastes. What we are recommending is that you use a condom to prevent the exchange of body fluid during sexual intercourse.87. Is oral sex safe sex?
There is a lot of discussion on this topic and experts are divided in their opinions as to whether it is safe or not. Although there is significant data which suggest it may be a lower risk activity, the data are not conclusive. At this time, it is recommended that a condom be used for fellatio and that a latex barrier be used during cunnilingus with a partner who may be at risk.88. AIDS virus - can it live outside the body? For how long?
AIDS, like most other viruses, can live outside the body for a short period of time, but it can be completely inactivated by a 1:10 solution of bleach and water, within one minute of exposure. But remember, AIDS must get into the bloodstream for a person to become infected. Merely coming into contact with the skin will not cause infection because the skin acts as a barrier, both in terms of keeping the infection within an infected individual and keeping the infection out of a non-infected individual.89. How many people have been infected with HIV linked with AIDS?
It is estimated that for every person with AIDS, there are 100 HIV positive people. ["AIDS: What is now known. I. History and Immunology", Hospital Practice, May 15, 1986, p. 74] Among some high risk individuals in some areas (sexually active homosexual and bisexual males and TV drug users), the rate of infection with the virus may be as high as 1 in 3. This does not mean that all of these people are necessarily carriers of the virus or that they will eventually develop AIDS.90. Is Pennsylvania offering HIV antibody testing?
Yes. In the Philadelphia metropolitan area alone, there are presently seven alternate test site locations that offer HIV antibody testing. They are located in:
Philadelphia (215-735-1911) Allentown (215-437-7725) Bethlehem (215-865-7087) Chester (215-447-3258) Norristown (215-270-3616) Reading (215-378-4377) Wilmington, DE (302-995-8422)
At the Philadelphia alternate test site, testing is free, confidential and anonymous.91. Why doesn't the State mandate testing of all persons for antibodies to HIV?
Pennsylvania does not have a position on this. However, the City of Philadelphia does not support mandated HIV antibody testing of any groups or individuals since the health implications of positive test results in an otherwise healthy person are not known. The screening test indicates only the presence of antibodies to HIV, not the presence of virus. The presence of antibodies in the blood means only that the person has been exposed to the virus at some time. It does not necessarily mean that the individual is carrying the virus and is capable of transmitting it to others. However, at this time we must assume all HIV antibody positive people are capable of transmitting the virus.92. Why doesn't the State isolate or quarantine persons with AIDS to prevent the spread of the disease?
There is no evidence that persons with AIDS or those with positive antibodies to HIV pose a risk to the public through casual contact. Therefore, there is no need to isolate or quarantine these patients. The civil rights of any individual or group cannot be abridged by society without sufficient scientific evidence that it is necessary. All information accumulated during the past five years indicates that AIDS is spread only through direct blood-to-blood or semen-to-blood exchange, and not through the air, food or casual contact with persons with AIDS or articles they have handled or used. Moreover, threat of quarantine would be more likely to drive high risk individuals into hiding where they could not be reached for education, counseling or voluntary testing.93. Why doesn't the State legalize the sale of hypodermic needles or dispense clean needles to drug addicts to prevent spread through that route?
It is questionable whether legalizing the sale of needles will have the desired effect. Instead some people feel that such action might serve to encourage use of illegal drugs. No immediate change in State regulations is contemplated. 94. What is the State doing to get accurate information to the public about AIDS?
Pamphlets and brochures directed to the general public and to various risk groups have been developed and are being distributed through regional task forces, county health departments and various State agencies.
C A R E F O R A I D S P A T I E N T S
95. What precautions should families caring for AIDS patients take?
The first thing to remember is that just as you cannot get AIDS from casual contact with a person who has AIDS, or from a person who is healthy but is HIV positive (carries the virus), you also are not going to get AIDS from a person with AIDS in your home.96. What safety protocols have been developed for occupational groups? And how effective are they?
All occupational groups that may come into contact with body fluids in the course of their work are advised to take special precautions to guard against AIDS, hepatitis B and other infectious agents. These include:97. The following guidelines are suggested to minimize the risk of transmission of HIV to staff caring for persons with AIDS or a risk of AIDS; and indeed are recommended for the care of all patients, since anyone, in theory, could carry HIV.
1. In administering health care, disposable needles and syringes should be used. Care should be taken to prevent needlestick injuries by the proper disposal of needles in designated plastic or metal containers, without recapping or clipping the needles.98. With persons with AIDS with dementia symptoms, psychotic and assaultive systems, is it appropriate to admit to medical or psychiatric hospital?
When there are opportunistic infections, medical attention is appropriate. But if there is no medical emergency, then psychiatric intervention might be more appropriate. (There are some combined medical/psychiatric units in the city.)99. Do some precautions have to be taken with persons with AIDS and persons with ARC? Is ARC as transmittable as AIDS? Explain the difference. HIV and ARC patients may be more likely to transmit the HIV virus than people with AIDS. People with AIDS often have less virus present due to lower T-cell count. HIV multiplies by invading T-cells, which are eventually destroyed. If a person with ARC transmits the virus, then the person to whom it is transmitted can go on to be HIV positive, have ARC or contract AIDS. People with ARC and AIDS have the same symptoms, but people with AIDS get opportunistic infections and/or cancer from which they can die. Of course, it is also true that a person with AIDS is much less likely to feel like having sex than someone who is not ill.
100. If AIDS is only spread through sex, or sharing needles, or perinatally, then why does the CDC recommend such strict guidelines for health care workers like wearing gloves, etc.?
The CDC guidelines for health care workers are based on the guidelines for working with patients who have hepatitis B. The idea is to err on the side of safety -- to be on the safe side. But hepatitis B is much easier to catch than AIDS.101. How is the risk of spreading AIDS through blood transfusions being minimized?
All blood donated in Pennsylvania State has been tested for antibodies to HIV since May 15, 1985. Blood that tests positive is removed from the transfusion pool. The process involves use of an ELISA (enzyme-linked immunosorbent assay) screening test, with confirmation of positive results through a more specific antibody test known as the Western Blot.102. Is the new blood screening test 100% effective?
All studies indicate that the HIV antibody test is highly effective in eliminating blood from the donor pool that may be infected with HIV. In fact, the test errs on the side of "false-positive" readings, since only about 30% of blood that tests positive on the initial ELISA test is confirmed positive through a more specific test known as Western Blot. All blood that tests positive on the initial screening test is removed from the transfusion pool.103. Are sperm banks and organ banks screening for AIDS?
The Centers for Disease Control has recommended that sperm and organ banks screen all donations for antibodies to HIV.104. Are there any special precautions for pregnant women caring for AIDS patients?
A pregnant woman is at no more risk for getting AIDS by caring for an AIDS patient than anyone else - that is, none at all, assuming she avoids needlestick injuries and wears gloves when handling blood in case she has a cut on her hand.105. Why doesn't the State designate special hospitals and nursing homes to care for AIDS patients to ensure they receive appropriate, non-discriminatory care and to protect health care workers?
Medical care should be provided at the health facility of choice of the patient or at the institution best equipped to provide the necessary treatment. There is no evidence that AIDS patients pose any risk to other patients at a hospital or nursing home, and health care workers are not at special risk if they observe safety guidelines to minimize exposure to blood and other body fluids.106. Who pays for treatment of people with AIDS?
Care for AIDS patients is paid for by the same means as all medical care: the government (Medicaid and Medicare); insurance companies; and individuals.107. Does insurance cover AIDS?
In most cases, insurance does cover AIDS medical treatment, though most policies have maximum allowances. Other types of care, such as out-of-hospital nursing care or home care, are not necessarily covered.108. What services are available to persons with AIDS or at risk for the disease?
Philadelphia persons with AIDS can receive help through ActionAIDS, the Philadelphia AIDS Task Force, Blacks Educating Blacks About Sexual Health Issues (BEBASHI), as well as City health and human services programs. These programs provide housing, directions for eligibility for medical assistance, support groups and buddies. For telephone numbers, check listing at end of book.109. Where can persons concerned about AIDS get HIV testing?
Confidential HIV antibody testing is provided through the Department of Health's regional offices for persons who wish to know if they have been exposed to the virus. The test is free and no names and addresses are exchanged. Persons who test positive receive counseling as to what the test results mean and preventive actions they may take to minimize further exposure to the virus or potential transmission to others. (The test site numbers are at the end of this book.)110. Where can AIDS patients get diagnosis and care?
Persons who are concerned about AIDS may contact the City at 875-5919, ActionAIDS at 732-2155, BEBASHI at 546-4140 or the Philadelphia AIDS Task Force at 545-8686 for the names of doctors who are familiar with the diagnosis and management of AIDS. Referrals are also provided for AIDS patients seeking dental care, psychiatric counseling transportation to medical facilities, and social services.111. Where are AIDS patients treated?
AIDS patients are treated in hospitals, physician's offices, clinics or other health care settings, just like any other patients. There is no evidence that AIDS patients pose a risk to other patients or to health care workers who follow recommended safety precautions.
H U M A N R I G H T S I S S U E S
112. What can an individual do to appease public paranoia (i.e. parents, neighbors, friends, relatives)? Some people just don't want to hear facts or truth about AIDS.
The best thing you, yourself, can do is learn all you can about AIDS. There are a lot of facts that have been established. Learn them, know them and share them. You can't force another person to hear what you're saying, but perhaps persistence will work in some cases. Recognize the fears of another and do your best to dispel them. It may take more than a few times to make any inroads with a person who is resistant to the information. But it is our responsibility to continue to try.113. What rights do AIDS patients have?
They have the same rights as those accorded to any other ill member of our society. Unfortunately, discriminatory action has been taken against some AIDS patients by employers, landlords, neighbors, co-workers and others who are apparently acting out of unwarranted fears based on misinformation.114. Is it right to keep an AIDS patient's identity a secret?
Since AIDS does not pose a risk to the general public, there is no need for neighbors, shopkeepers, co-workers or others who may have casual contact with a person with AIDS to know. Discriminatory action has been taken against persons with AIDS by those who are uninformed about the disease.115. Can you be fired because you have AIDS?
Some employers are reportedly discriminating against AIDS patients in spite of continued advice from public health officials that there is no reason to exclude AIDS patients from employment as long as they feel well enough to work. Persons who believe they are being discriminated against by employers may file complaints with the Philadelphia Commission on Human Relations (PCHR) at (215) 686-4676.116. Can a person with AIDS get Social Security Disability (SSD)?
Eligibility for SSD is based on two criteria: a person's "insured status" and documentation of his/her disability. "Insured status" is determined by the length of time a person has paid into the Social Security system, measured in quarters (four quarters per year).117. Should people who have AIDS be banned from working in banks, restaurants and other people-contact jobs?
There have been no cases of AIDS that are suspected of having been transmitted through casual contact or through the air, food or water. If a person with AIDS is well enough to work, he/she should be allowed to do so unless the work environment poses a risk of potential direct blood to blood contact with other individuals.118. Can a hospital worker or ambulance personnel refuse to care for an AIDS patient? Health care workers who refuse to care for AIDS patients may be subject to firing and possible disciplinary action by the State. Hospitals and ambulance services have a responsibility to care for the sick, and to assemble a staff capable of carrying out that mission. There is a need for greater educational efforts to ensure that all health care workers understand the potential routes for transmission of AIDS and follow recommended safety precautions.
119. Can funeral directors refuse to embalm victims of AIDS?
Yes. There is no State law that can require a funeral director to accept the body of a person with AIDS. Embalming also is not required by law. While some funeral establishments have refused to accept AIDS victims, there are sufficient firms available which will do so. Names of firms accepting AIDS victims are available through regional AIDS task forces.120. Is there a high rate of suicide among people with AIDS?
No information is available on Philadelphia cases. There does seem to be higher suicide risk for AIDS patients. This illustrates the need for supportive care programs.121. Is there any way to deal with emotional reactions of other family members in the hospital?
Some hospitals have excellent hospice programs which include counseling for family members of terminally ill patients. All hospitals have social workers who are trained to deal with families as well. In general, handling of families would depend upon the skills and sensitivities of individual doctors, nurses and other workers.
H O W T O R E D U C E T H E R I S K O F A I D S
Five years of experience with AIDS indicates that the disease is not transmitted from one person to another through any form of casual, non-intimate contact. There is very strong evidence that AIDS is transmitted through direct blood-to-blood or blood-to-semen or vaginal secretions exchange. Direct contact with other body fluids of an infected person may also increase the risk of AIDS, although no cases so far have been directly linked with other body secretions or excretions.
Based on this information, there are precautions that can be taken by the general public and by persons in several risk behaviors to eliminate or reduce the risk of contracting AIDS:
* DON'T have sexual contact with any person whose past history and current health status is not known.
* DON'T have sexual contact with multiple partners or with persons who have had multiple partners.
* DON'T have sexual contact with persons known or suspected of having AIDS.
* DON'T abuse intravenous (IV) drugs.
* DON'T share needles or syringes (boiling does not guarantee sterility).
* DON'T have sexual contact with persons who abuse IV drugs.
* Use of a CONDOM during sexual intercourse may decrease the risk of AIDS.
* DON'T share toothbrushes, razors or other personal implements that could become contaminated with blood.
* Health workers, laboratory personnel, funeral directors and others who work may involve contact with body fluids should strictly follow recommended safety procedures to minimize exposure to AIDS, hepatitis B and other diseases.
* Persons who are at increased risk for AIDS or who have positive human immunodeficiency virus (HIV) antibody test results should not donate blood, plasma, body organs, sperm or other tissue.
* Persons with positive HIV antibody test results should have regular medical checkups, and take special precautions against exchanging body fluids during sexual activity.
* Women who have positive HIV antibody test results should recognize that if they become pregnant, their children are at increased risk of getting AIDS.
P H I L A D E L P H I A D I R E C T O R Y O F I N F O R M A T I O N A N D S E R V I C E A G E N C I E S
RELATED TO ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
(All numbers are within the 215 Area Code Region, unless otherwise indicated) ActionAIDS 732-2155 AIDS Control Program, City of Philadelphia, Department of Public Health General Number 875-5919 Education 875-5659 Surveillance 875-5935, 36 Infection Control 875-5648 AIDS Interfaith Network 732-2155 Alternate HIV Test Site 735-1911 American Civil Liberties Union (ACLU) 592-1513 American Red Cross AIDS Program 1-800-26-BLOOD AZT Information Line (Retrovir) 1-800-843-9388 BEBASHI (Blacks Educating Blacks About Sexual Health Issues) 546-4140 CHOICE Hotline (information about birth control and sexually transmitted diseases) 592-0550 CODAAP (Coordinating Office for Drug and Alcohol Abuse Programs)/City of Phila 592-5403 Community Legal Services 893-5300 Episcopal Diocese of PA (services for AIDS patients and families) 567-6650 Family Planning Council of SE Pennsylvania 985-2600 Family Service of Philadelphia (FSP) 875-3300 Gay and Lesbian Peer Counseling (GLPC) 386-6110 Innerpride (organization of black lesbian women and gay men) 849-7597 Mayor's Commission on Sexual Minorities (MCSM) 686-2191 Mayor's Commission for Puerto Rican/Latino Affairs 686-7599 Mental Health/Mental Retardation Prog/City of Philadelphia (AIDS education division) 592-5544 National Gay Task Force AIDS Information Line 1-800-221-7044 National Hemophilia Foundation (212) 219-8180 New Jersey Dept of Health AIDS Hotline 1-800-624-2377 Parents and Friends of Lesbians and Gays 572-1833 Philadelphia AIDS Task Force 545-8686 (Hotline) 732-AIDS (Housing Program) 545-5272 (Minority Coordinator) 985-2991 Philadelphia Commission on Human Relations (PCHR) 686-4670 Philadelphia Community Health Alternatives (PCHA) 545-8686 Philadelphia Lesbian and Gay Task Force (PGLTF) Anti-Violence and Discrimination Hotline 563-4581 Philadelphia School District Health Services Dept 299-7481 Retrovir Information Line (AZT) 1-800-843-9388 Shalom, Inc. 546-3470 South Central Pennsylvania AIDS Assistance Network (717) 236-4772 or (717) 783-8307 South Jersey AIDS Alliance Task Force (609) 347-8799 Suicide Crisis Intervention Hotline 686-4420 Surgeon General's Report on AIDS (404) 329-3534 Telehelp 1- 884-2220 U.S. Public Health Service AIDS Hotline 1-800-342-AIDS U.S. Public Health Service Education Clearinghouse (404) 329-3534 Veterans Administration Drug & Alcohol Program 823-5809
|NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.|
Standard Interpretations - (Archived) Table of Contents|