Acquired Immune Deficiency Syndrome (AIDS) is caused by the Human
Immunodeficiency Virus (HIV). The virus attacks and eventually
destroys certain white blood cells, which are a part of the body's
immune system that we need to fight off infections. The immune system
makes antibodies to combat the HIV virus. Their presence in the
blood can be measured. If a person has antibodies, they are called
"HIV positive" because they have been infected with the
HIV virus. However, the person may remain healthy for a long time,
even many years. AIDS is the late stage of the illness known as HIV
disease, and occurs when so many white blood cells have been
destroyed that the immune system cannot do its job well. The person
with AIDS develops infections, even from unusual organisms
(opportunistic infections) and various malignancies. HIV virus also
can affect the brain and nerves. There are medications to control the
infections and malignancies. There are also medications to slow the
growth of HIV. However, right now there is no cure and no
vaccination to prevent infection. The disease is fatal. However,
many new treatments are being developed and there is hope that
medical research will rapidly find better forms of treatment and prevention. HIV
is spread through the transmission of contaminated
body fluids such as semen, vaginal secretions and blood into the
body of another person. The entry occurs through broken skin and
mucous membranes (tissues that line the mouth, vagina, rectum, and
urethra). Any activity where one partner either heterosexual or
homosexual penetrates another sexually can spread the illness. Any
cutting into the body with contaminated instruments can cause
infection; this includes needles used by IV drug abusers,
unsterilized medical and dental equipment, as well as ear piercing,
tattooing, and manicure equipment. Take precautions. Always ask if
equipment used in medical, dental or cosmetic procedures is
sterilized, new, or disposable. Always practice safe sex. Mothers
infected with HIV should also know that they can pass the infection
to their children during pregnancy and breast feeding. However, the
virus is not spread by casual contact, such as hugging, holding
hands, close conversation, sharing a meal, etc. Don't assume AIDS
can't happen to you or your loved ones. It can. The only absolute
treatment is prevention. We must try hard not to stigmatize and
isolate those who are infected with HIV or have developed AIDS. If
you have questions about what is safe, consult your physician.
Should I be tested for HIV antibodies?
It is important that you know your HIV antibody status. There are
many places where you can take a test anonymously and where no
record is kept of your results. Taking the test is also important
because early diagnosis and treatment of HIV disease may prolong
life and reduce disability. Those who engage in high-risk behavior,
i.e., those who may become infected or infect others through IV drug
use or unprotected (without a condom) hetero or homosexual
intercourse should consider taking the test immediately. In addition,
anyone who received blood or blood products prior to screening of
the blood supply in 1985 may have been exposed to the HIV virus. You
should never take the test without careful preparation and
counseling, however. You should consider the emotional, social,
legal, financial, and insurance consequences. It often helps to
bring along a knowledgeable person whom you trust to help you ask
questions that will get you the information you need to make an
informed decision in the event you test positive. It is a good idea
as well to have an expert with whom you can discuss your results.
What should I do with my test results?
If you are HIV positive, find a physician who knows about HIV
disease and with whom you feel comfortable. You will need to work
together very closely and will want someone who cares what happens
to you. If you are HIV negative, consult your physician about the
need for future testing and about lifestyle changes you may need to
make in order to stay HIV negative.
If I'm HIV positive, should I tell other people?
It is important to tell those whom you may have exposed through
sexual contact, needle sharing or other risky behavior. They need to
be tested and have the knowledge that allows them to seek medical
care. This can be very difficult to do and counseling can help. You will profit from a network of helpful and supportive people.
However, you do need to be careful about whom you tell. Some people
have very strong reactions. Telling your boss and coworkers can have
financial and legal ramifications. It is best to start with a few
friends or family with whom you feel close and whom you can trust
not to tell others. Developing a community of support is a process
and takes time. There may be HIV-positive support groups in your
area or HIV hotlines that provide education and helpful support.
How does it feel to be HIV positive?
It is normal to have strong reactions such as fear, anger, and a
sense of being overwhelmed. Some people even have suicidal thoughts.
It is understandable that you might feel helpless and fear illness,
disability and death. Other reactions might include:
Denial: Often, people who find out they are HIV positive
will handle the news by denying that it is true. This denial may
come up soon after the diagnosis is made. Denial can be helpful: it
can give you time to get used to the idea of infection. It can,
however, cause problems for oneself and others if one engages in
risky behavior. And if it goes on too long it can get in the way of
your getting the assistance and medical attention you need.
Guilt: It is not unusual for people to blame themselves
for illness and to feel it is punishment. This guilt can be worsened
by society's prejudice and ignorance about HIV and AIDS. It is
important, if you are HIV positive, to seek out those who are
accepting and supportive.
Sadness: HIV disease means life changes and losses of one
kind or another. Sadness is an understandable reaction. Sadness
lifts for most people as they adjust. On the other hand, it can turn
sometimes slowly and subtly, sometimes quickly into a more serious
problem, called Depression. If you are feeling depressed, it is
important that you talk your feelings out. Your physician as well as
knowledgeable and supportive friends and loved ones can help.
Remember that there is always help through counseling, and any
strong and lasting reaction calls for some kind of assistance.
What other psychiatric reactions are possible with HIV disease?
Many people with HIV disease do not develop serious emotional
illness. However, if you develop any of the following reactions, it
is important that you seek treatment.
- Depression: Characterized by prolonged periods of
sadness and crying, feeling low or despairing, feelings of guilt
and lowered self-esteem, a tendency to see only the negative
side of things; also, fatigue, decreased ability to concentrate,
loss of pleasure in activities, changes in appetite and weight,
trouble sleeping, and, sometimes, thoughts of suicide.
- Anxiety disorders: Characterized by excessive worry,
feelings of being always on edge, muscle tension, restlessness;
and other physical symptoms such as shortness of breath,
sweating, rapid heart rate, nausea and diarrhea. They may also
appear as sudden attacks of intense anxiety.
- Mania: Characterized by an abnormally and persistently
elevated mood or great shifts of mood, often with marked
irritability. There is decreased desire for sleep, over activity,
rapid talking, poor concentration, and racing thoughts. People
with this disorder may also have grand and sometimes bizarre
ideas about themselves and impossible schemes for making money
and becoming famous. They may engage in spending sprees and
other impulsive behavior. They may become very disorganized in
their thinking and behavior and be unable to take care of
themselves.
- Psychotic symptom: People may develop hallucinations,
seeing things or hearing things that other people do not. They
also may become "delusional," developing strange,
unrealistic, and very unlikely ideas. For example, they may
think that even their closest friends are plotting to harm them
or that secret organizations are spying on them, bugging their
telephone or sending messages by television or radio. These are
just a few examples of the many forms psychosis can take.
- Alcohol and drug abuse: Some people may try to numb
their feelings by abusing drugs and alcohol. At times, the
person has a history of such problems. At other times, they
begin to abuse drugs and alcohol after they learn they are HIV
positive or develop symptoms of AIDS.
Difficulties with memory and thinking
Infections, malignancies, and nutritional deficiencies that are
the results of AIDS can affect brain functioning. Some medications
used to treat HIV infection or its complications can also have these
effects. HIV itself can infect the brain, causing a condition
doctors call AIDS Dementia Complex. Symptoms that might be a signal
of trouble include:-
- Forgetfulness Confusion- Difficulty paying attention
- Slurred or changed speech
- Sudden changes in mood or behavior
- Clumsiness or difficulty walking
- Muscle weakness or strange sensations, like numbness or
tingling
- Slowed thinking and difficulty finding words
If you have any of these problems you should discuss your
concerns with your physician. He or she may suggest the help of a
psychiatrist or other mental health specialist.
How can a psychiatrist help me?
A psychiatrist will talk with you and take a history in which he
or she will ask about your current problems and how you managed in
the past. He or she will need to know about any past or present
alcohol or drug abuse and whether there is any family history of
emotional problems or substance abuse. The psychiatrist, who is a
medical doctor, will need to speak with your other physicians and
review your medical history. The psychiatrist will ask specific
questions to test memory, attention, and other aspects of thinking
and problem solving. Your psychiatrist will tell you and your
physician what he or she thinks is the nature of your problem, and
will make recommendations for treatment. With your agreement, he or
she may provide the recommended treatment if the expertise of a
psychiatrist is required.
What treatments are available?
Various forms of psychotherapy may be useful, alone or in
combination with medications which can help people with HIV disease
express and understand their emotional reactions and find better
ways to cope. Some problems can be treated with medications. There
are anti-anxiety medications and antidepressants, including
psycho-stimulants, that are safe and effective for use in people
with HIV disease. People with Mania may need a mood stabilizing
medication and those with psychotic symptoms may need an
anti-psychotic medication. There is substance abuse counseling for
those with alcohol or drug abuse problems. In some areas of the
country, there may be support groups or AA groups for people who
have both HIV and substance abuse problems.
Are there other forms of help?
Many areas have community groups that provide services such as
food preparation, housing, buddy networks, hotlines, and information
on how to access medical care. There are also self-help support
groups where people with HIV or AIDS can meet with others coping
with the same or similar problems. Groups are also available to
provide support and services for friends and family members.
If you are HIV positive, are there things you can do to help
yourself?
It is important that you see your doctor regularly, and that you
follow his or her recommendations. You can help by making some
lifestyle adjustments. It is important to maintain good nutrition
and to get enough rest. If you smoke, try to stop. It is helpful to
stop or reduce alcohol use. It is very important to develop social
contacts and to enlist the support and help of friends and family. If
you feel that you are alone, it is important to recognize that help
and companionship are available. A local community group or hotline
that specializes in helping those with HIV disease and AIDS can be a
good place to start.
What sort of reaction should I expect from family and friends
when I tell them I'm HIV positive?
Your family and friends will be affected by the consequences of
your HIV infection, too. They may also experience feelings of
denial, anger, fear, and grief. Some, unfortunately, will suffer
from the same misunderstandings and prejudices that exist in society
at large concerning people with HIV disease. They may also have
questions about how they can prevent the spread of the infection, as
well as questions about what is to be expected as the consequence of
infections. Discussion with your physician can be helpful. It is
important to remember that counseling including couples and family
counseling is available and can be useful. There are also support
groups for spouses, partners, and close friends of those with HIV
disease.
Safer sex guidelines:
No Risk: Massage, Solo masturbation
Low risk: Mutual masturbation, Dry kissing, Body rubbing
Moderate risk: Wet (French) kissing, Fellatio without
climax, Cunnilingus, Anilingus ("rimming"), Anal or
vaginal intercourse with condom, Urination ("water
sports") external only
High risk: Anal or vaginal intercourse without condom,
Fisting (insertion of hand or fist into rectum), Sharing sex toys
and needles, Any sex act that draws blood
(Adapted from: Miller D. ABC of AIDS: Counseling. Brit Med J
1987;294:1671-4.)
Additional Resources
Telephone HotlinesPublic Health Service AIDS Hotline
800-342-AIDS/800-342-2437
National Institute on Drug Abuse Hotline
800-662-HELP
National Sexually Transmitted Diseases HotlineAmerican Social
Health Association
800-227-8922
National Gay and Lesbian Task Force AIDS Information Hotline
(212) 807-6016 ( NY State) 800-221-7044
Pediatric AIDS Hotline Albert Einstein College of Medicine
(212) 430-3333
American Association of Physicians for Human Rights
P.O. Box 14366, San Francisco, CA 94114
(415) 558-9353
AIDS Action Council
1875 Connecticut Ave., NW, Suite 700, Washington, D.C.20009
(202) 986-1300
Gay Men's Health Crisis
P.O. Box 274, 132 West 24th St., New York, NY 10011
(212) 807-6655
Hispanic AIDS Forum, c/o APRED
853 Broadway, Suite 2007, New York, NY 10003
(212) 870-1902 or (212) 870-1864
Information Sources
- US Public Health Service Public Affairs Office
Hubert H. Humphrey Bldg.
200 Independence Ave., SW, Room 725-H,
Washington, D.C. 20201
(202) 245-6867
- Local Red Cross or American Red Cross Education Office
1730 D St., NW, Washington, D.C. 20006
(202) 737-8300
- Mothers of AIDS Patients (MAP)c/o Barbara Peabody
3403 E St., San Diego, CA 92102
(619) 234-3432
- DC AIDS Task ForceWhitman Walker Clinic of Washington, D.C.
(202) 332-5295
- National Association of People with AIDS
1413 K St., NW., 10th Floor, Washington, D.C. 20005
(202) 898-0414
- American College Health Association
15879 Crabbs Branch Way, Rockville, Md 29855
(301) 963-1100
- American Medical Association
535 North Dearborn Chicago, IL 60610
(312) 645-4987
- American Social Health Assoc.
P.O. Box 13827
Research Triangle Park, NC 27709
(415) 321-5134
- Centers for Disease Control Office of Public Inquiries
Building 1, Rm. B-63, 1600 Clifton Rd.
Atlanta, GA 30333
(404) 329-2891
- The National Hemophilia Foundation National Resource and
Consultation Center
The Soho Building
110 Green St., Rm. 303A
New York, NY 10012
(212) 219-8180
- Minority Task Force on AIDS c/o New York City Council of
Churches
475 Riverside Dr., Rm 456, New York, NY 10115(212) 749-1214
- National Council of Churches AIDS Task Force
475 Riverside Dr., Rm. 572
New York, NY 10115
(212) 870-2421
- National Technical Information Services US Department of
Commerce
5285 Port Royal Rd.
Springfield, VA 22161
(703) 487-4650
- Baltimore Health Organization Resource Organization HERO
(301) 945-AIDS
- American Civil Liberties Union Local Chapters
600 Pennsylvania Ave., SE
Washington, D.C. 20003
(202) 544-1076
(c) Copyright 1993 American Psychiatric Association
This document contains the text from one in a series of pamphlets
designed to reduce the stigma surrounding mental illnesses by
promoting informed factual discussion of the disorders and their
psychiatric treatments. Revised December 1993
American Psychiatric Association
1400 K St.
N.W., Washington, DC 20005
Produced by the APA Joint Commission on Public Affairs and the
Division of Public Affairs with the assistance of the Washington
Psychiatric Society's AIDS Committee. This document was developed
originally as a pamphlet for educational purposes and does not
necessarily reflect opinion or policy of the American Psychiatric
Association.
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