HIV/AIDS: Etiology and Oral Manifestations

HIV counseling means counseling that is directed toward:

Increasing the individual's understanding of HIV and AIDS;
Assessing the individual's risk of acquiring and transmitting HIV;
Motivating and negotiating with the individual about behavior changes to reduce their risk of acquiring and/or transmitting HIV infection;
Skills building (refusal and negotiation skills, how to use a condom, how to clean syringes, etc.); and
Explaining the nature of the HIV test, including the possible need to retest.

During a pre-test counseling session, the following is usually required to be provided during pretest counseling:

That anonymous testing is available and where to find it.
The nature, purpose, value and reason for the HIV test.
The possible effects of HIV testing and a positive HIV result related to employment, insurance, housing and other potential legal, social and personal consequences.
For persons at high risk for HIV infection:
- Personalized risk reduction education including abstinence from sex or drugs, mutual monogamy, use of condoms consistently and correctly, cleaning works or using a syringe exchange.
- The need to notify sex and/or needle sharing partners (including spouses), if the test is positive.
- Not to donate blood or blood products.
- The possible need to re-test.

Persons providing counseling are also to provide a non-judgmental environment; develop and maintain a system for referrals; obtain informed consent for testing; and maintain disclosure confidentiality.

Pretest counseling can be a time when patients learn about their personal risk of HIV and obtain skills-building (partner negotiation skills, correct condom or cleaning of injection drugs) to assist in their behavior change.

It is additional counseling following testing which will increase the individual's understanding of HIV infection, change the individual's behavior and, if necessary, encourage the individual to notify people with whom there has been contact capable of spreading HIV.

People providing post-test counseling must provide at least one individual counseling session at the time HIV results are disclosed for individuals testing positive for HIV or report behaviors that are at high risk for HIV transmission.

Each of the videos shown in the following tables can be found by linking to http://phil.cdc.gov/phil/quicksearch.asp, typing HIV in the Selected Keywords box, choosing VIDEOS ONLY from the dropdown list, and clicking the [SEARCH] button. Click a thumbnail image to view more information and watch the video.

Positive HIV test results must be reported confidentially to the state or local health officer, unless the individual has tested anonymously. People testing positive should be reminded about this reporting requirement.

People who have newly tested HIV-positive should also receive help notifying partners, including spouses. Providers must confirm those partners have been notified and/or seek agreement to refer the name of the individual to the local health officer for assistance in notifying partners.

Case Study #6

Mr. J. went to his primary care provider (PCP) with complaints of a flu-like syndrome. He was assured that this "bug" was making its rounds in the community, and he would probably feel much better in several days. He was encouraged to go home, rest, take extra fluids, and take Tylenol as needed for fevers. Five days later, he was still not feeling better. In fact, he noticed that his lymph nodes were enlarged and his whole body felt achy. Because it was a weekend, he went to the local ED, hoping to get something that would make him feel better before returning to work on Monday.

In the ED, the provider asked a lot more questions than his usual PCP had asked. In fact, he was irritated when he was asked about his sexual history and remarked, "What does that have to do with my sore throat and swollen glands?" The provider explained that people who are in the stage of seroconversion with HIV often come in for medical care with symptoms similar to the ones he was complaining of. He thought about a woman he had had sex with on his vacation several months earlier. They had not planned to be intimate, but things happened and he had not prepared by bringing a condom. Thinking back, he remembered her as being very attractive and healthy. Still, he agreed to have the HIV test.

Results of the test were positive. Mr. J. was early in the infection and his body was responding to invasion of the virus. An appointment was made for him the following week with an HIV specialist. The provider also offered to help him connect with the Department of Health Partner Notification Program, but he declined saying that he had not been sexually active since his vacation. The provider stressed the need to use condoms in the future whenever he planned on sexual activities.

People who perform HIV counseling and testing in public health departments or health districts must sign strict confidentiality agreements. These agreements regulate the personal information that may be revealed in counseling and testing sessions, and test results.

HIV test results are kept in locked files, with only a few appropriate staff members having access to them. More information on confidentiality requirements can be found in the Legal section of this course.

There are likely to be between 172,400 - 683,000 females raped each year in the U.S. Men can also be victims of sexual assault, but data and reporting are limited. Based on existing crime report data, an estimated 40% of female rape victims are under age 18; most sexual assault victims know their assailant. Apart from the emotional and physical trauma that accompanies sexual assault, there are other considerations. Many victims do not report their attack to the police.

According to CDC, the odds of HIV infection from a sexual assault in the U.S. are 2 in 1,000. There are additional risks for contracting other STDs, and females can become pregnant. Emergency contraception is part of the medical treatment for female rape victims. The emergency contraception hotline number, 1-888-668-2528, should be provided by telephone rape counselors or other counselors.

Most experts recommend that a sexual assault victim go directly to the nearest hospital emergency room, without changing their clothing, bathing or showering first. Trained staff in the emergency room will counsel the victim, and may also offer testing or referral for HIV, STDs and pregnancy. It is common practice for the emergency room physician to take DNA samples of blood or semen from the vagina, rectum, etc. which can be used as evidence against the attacker. Some emergency departments may refer sexual assault survivors to the local health jurisdiction for HIV testing.

Many people feel that the emergency room setting is a profoundly unpleasant time to question a sexual assault victim regarding her/his sexual risks, etc. However, testing shortly after a sexual assault will provide baseline information on her/his status for the various infections. This information can be useful for the victim and healthcare provider, especially for follow-up care and treatment. Additionally, baseline information can be used for legal and criminal action against the assailant.

The victim needs to consider whether to start post-exposure prophylaxis (PEP) independently of the source's test result, because the time between the attack and the conviction will likely be longer than the 24-48 hours recommended to start PEP.

Partner notification is a voluntary, confidential service provided to HIV-positive people and their sex and/or injection equipment-sharing partners. Partner notification is provided using a variety of strategies to make sure exposed partners, including spouses, are notified of their exposure to HIV and receive appropriate counseling in a way that respects the confidentiality of the source patient.

It is a federal and state law that a good faith attempt be made to notify the spouse of an HIV infected individual. Spouse is defined as the person(s) in a marriage relationship with the infected person up to 10 years prior to the test.