W CLINICAL
REPORTS
Margaret California
Brady, PhD, RN, CPNP State University, Long Beach Department of Nursing
Dispelling n
Margaret Crey, DrPH, RN, CPNP University of Pennsylvania School of Nursing Philadelphia, Pennsylvania
Common Myths About HIV Infection 9
Deborah Gleason-Morgan,
MSN, RN, CPNP
Myths and misconceptions about human immunodeficiency virus (HIV) are prevalent in both the lay and health care populations. It is imperative that health professionals have accurate knowledge about HIV infection and feel comfortable as they educate parents .and children about this major health problem confronting society. Health care providers are always looking for innovative ways to approach the subject of patient teaching. Thus, this quiz was developed as a teaching tool to educate parents and older children about MIV infection. You can use the following true/false quiz or parts of it in any type of practice setting to teach about HIV infection and to dispel the myths and misconceptions that surround this illness. After your clients have completed the quiz, go over their responses with them using the explanation or rationale provided in the key for each answer.
Circle the correct response: True = T, False = P 1. There is a cure for acquired immunodeficiency syndrome (AIDS). T F 2. The Government, through the Centers for Disease Control (CDC), gathers statistics on the number of people in the United States who are infected with HIV. T F 3. AIDS is rhe disease of homosexual men. T F 4. You can tell that someone is infected with HIV just by looking at the person. T F 5. A person infected with HIV has AIDS. T F 6. You can become infected with HIV by being in the same room and in close physical proximity. T F 7. The blood supply in the United States is now 100% safe. T F 8. You can get HIV by&&~ blood. T F 9. Body fluids that can infect you with the HIV are stool, tears, saliva and urine. T F
Deborah Angeles, 25/8/318bb
264
Gleason-Morgan is clinical Los Angeles, California.
nurse specialist,
Childrens
Hospital
Los
10. Health care professionals should always wear gloves when examining a patient who is at risk for HIV infection. T F 11. Condoms are 100% effective in the prevention of HIV transmission. T F 12. The likelihood of transmitting HIV through “French kissing” is high. T F 13. All babies born to HIV-infected women will get AIDS. T F 14. School and day care center personnel have a legal right to know which children attending their programs are HIV-infected. T F 15. Most HIV-positive women know that they are infected before they become pregnant. T F 16. The use of alcohol, cocaine, or marijuana (noninjectable drugs) does not put a person at risk for HIV infection. T F Optional questions 17. Health care providers are free to tell others about their patient’s HIV status without written consent. T F 18. It is safe for HIV-positive mothers to breast-feed their infants. T F 19. The majority of children who are HIV-infected know their diagnosis. T F JOURNAL
OF PEDIATRIC
HEALTH
CARE
Journal of Pediatric Health Care
Patient Management
20. Children with HIV infection shotid receive all of their regular childhood immunizations. T F ANSWERS 1. False. Currently, there is no cure for AIDS. Antiviral drugs that slow virus replication are available, but none of these drugs eliminates the virus. Zidovudine (AZT), dideoxyinosine (ddi), and dideoxycytidine (ddC) are three antiviral medications that currently are used in adults and children with HIV infection. 2. Palse. The CDC receives reports of “full blown” AIDS casesfrom across the nation. Currently, there are no consistent regulations or legislation among the various state about reporting HIV infection to local or state #health departments when the individual does not yet meet the criteria for CDCdefined AIDS. As of October 1990, 33 states require that information about HIV infection in individuals who do not yet meet the criteria for CDC-defined AIDS be provided to local or state health departments. Some of these states require HIV reporting by name while other states report anonymbusly (CDC, 1990). 3. False. In the early years of the AIDS epidemic, AIDS was considered a disease of homosexual men. We now know that men, women, and children can be infected with this virus. 4. False. Most people infected with HIV look normal. At a later stage in the disease process, one may notice physical (and/or mental) deterioration, indicating that an individual has a serious medical problem. The exact cause of this deterioration would not ble evident by just looking at the individual. 5. False. Many people believe that an HIV-infected person has AIDS. This assumption is not true. Rather, the spectrum of disease manifestations associated with HIV infection ranges fi-om being infected but asymptomatic to being in the final stage of illness with an AIDS-defined infection or problem. 6. False. HIV is not transmitted by casual contact. Casual contact refers to activities such as living in the same holuse with an infected person, holding hands, sharing items such as eating utensils and dishes, going to school with an infected child, using the same toilet, or swimming in a pool with an infected person. 7. False. Every unit of donated blood is being tested for antibodies to HIV, cytomegaiovirus (CMV), and hepatitis. In some instances, units containing HIV-infected blood may go undetected. If a blood
8.
9.
10.
11.
12.
13.
14.
15.
Exchange
265
donor was exposed to HIV but had not yet had sufficient time to develop antibodies to the virus, that donor’s blood would test negative and would be cleared for use. This phenomenon is called the “window period,” False. Absolutely no risk exists for a blood donor in the United States. A new sterile needle is used each time a person donates blood. False. There are no documented cases of HIV transmission occurring as a result of stool, tears, saliva, or urine exposure. HIV has been found in small amounts in saliva and tears but has not been found in urine or stool..Scientists believe that it is nearly impossible to transmit HIV through these fluids. False. Gloves are necessary only when there is a risk of blood or body fluid exposure to the examiner. Gloves are not needed when doing a routine physical assessment. The CDC (1987) guidelines for universal blood and body fluid precautions should be strictly adhered to by ail health professionals. False. Latex condoms, when used correctly every time intercourse takes place, can be effective in preventing HIV infection and other sexually transmitted disease (STD). Condoms are not 100% effective in preventing HIV infection, STDs, or pregnancy because they may break or be used incorrectly. The presence of a spermacide called nonoxynol-9, used in some brands of condoms, is known to help in preventing HIV infection. False. No cases of HIV transmission from saliva have been documented. Therefore it is highly unlikely that HIV could be transmitted by French kissing. False. Approximately 30% of babies born to HIV-infected mothers become HIV infected. A baby born to an HIV-infected mother will test HIV antibody-positive at birth. This reflects passively transferred maternal antibody. It can take up to a year or more before it is known whether a baby is infected with the virus. Therefore babies born to HIV-positive mothers should have their HIV status followed until they are at least 1.5 months of age. False. All children have the right to an education. It is the parents’ decision whether to disclose their child’s HIV status to school officials. Most parents choose not to tell school or day care personnel about their child’s diagnosis. False. Many HIV-infected mothers do not know that they are infected until their children are diagnosed.
266
Patient Management
Exchange
16. False. All behavior-altering substances are associated with increased risk of HIV infection resulting from reduced inhibitions and increased risk-taking behaviors. 17. False. In most states, a health care provider may not give anyone except direct medical care providers information about an individual’s HIV status without written authorization from the infected person. The health care providers must obtain written authorization for each person who is to receive this confidential information. 18. False. Breast milk has been implicated in the transmission of HIV to infants. In the United States, HIV-positive women are discouraged from breastfeeding. In developing countries, breast-feeding continues to be accepted because there is a lack of available resources and formula. 19. False. Most children do not know their HIV diagnosis. This stems from parental concern that the child may tell others about his or her illness. Experienced health care providers can guide families through the process of telling children about their diagnosis. 20. False. Children with HIV infection need to be protected from preventable childhood diseases; however, a modification in the normal childhood immunization schedule is necessary. Children with HIV infection should not receive oral polio vaccine because live attenuated polio vaccine can cause polio in individuals with damaged immune systems. Rather they should be given inactivated polio vaccine. Uninfected children who live in a home with an HIV-infected adult or child also should
Volume 5, Number 5 September-October 1991
receive the inactivated polio vaccine. The sles/Mumps /Rubella vaccine, another live uated virus vaccine, can be given to clinically children with HIV infection according to guidelines and with physician approval.
Meaattenstable CDC
This quiz includes just a few examples of the many questions and concerns that are frequently voiced about HIV infection. Before health care providers can effectively educate about HIV infection, the provider first must determine what parents, children, and teenagers know or have heard about HIV infection. Myths and misconceptions about HIV infection and AIDS can then be dispelled. Education about HIV infection is a priority public health issue. Unfortunately, as studies on various teenage groups have shown repeatedly, knowledge about HIV transmission does not necessarily result in avoidance of high-risk sexual behaviors or in termination of intravenous drug use. Parents, children, and teenagers must be convinced that the 1990s are risky times for all. There can be no more hiding under the false notion that HIV infection is a disease of homosexual men and intravenous drug users. Health professionals need to continue to dispel myths about HIV infection and provide accurate information so that knowledge translates into positive health behaviors. REFERENCES Centers for Disease Control. (1987). Recommendations for prevention of HIV transmission in health-care settings. MMWR, 36(28), 3-19. Centers for Disease Control. (1990). Update: Public health surveillance for HIV infection-United States, 1989 and 1990. MMWR, 39(47), 853-861.
REPORTS
Margaret California
Brady, PhD, RN, CPNP State University, Long Beach Department of Nursing
Dispelling n
Margaret Crey, DrPH, RN, CPNP University of Pennsylvania School of Nursing Philadelphia, Pennsylvania
Common Myths About HIV Infection 9
Deborah Gleason-Morgan,
MSN, RN, CPNP
Myths and misconceptions about human immunodeficiency virus (HIV) are prevalent in both the lay and health care populations. It is imperative that health professionals have accurate knowledge about HIV infection and feel comfortable as they educate parents .and children about this major health problem confronting society. Health care providers are always looking for innovative ways to approach the subject of patient teaching. Thus, this quiz was developed as a teaching tool to educate parents and older children about MIV infection. You can use the following true/false quiz or parts of it in any type of practice setting to teach about HIV infection and to dispel the myths and misconceptions that surround this illness. After your clients have completed the quiz, go over their responses with them using the explanation or rationale provided in the key for each answer.
Circle the correct response: True = T, False = P 1. There is a cure for acquired immunodeficiency syndrome (AIDS). T F 2. The Government, through the Centers for Disease Control (CDC), gathers statistics on the number of people in the United States who are infected with HIV. T F 3. AIDS is rhe disease of homosexual men. T F 4. You can tell that someone is infected with HIV just by looking at the person. T F 5. A person infected with HIV has AIDS. T F 6. You can become infected with HIV by being in the same room and in close physical proximity. T F 7. The blood supply in the United States is now 100% safe. T F 8. You can get HIV by&&~ blood. T F 9. Body fluids that can infect you with the HIV are stool, tears, saliva and urine. T F
Deborah Angeles, 25/8/318bb
264
Gleason-Morgan is clinical Los Angeles, California.
nurse specialist,
Childrens
Hospital
Los
10. Health care professionals should always wear gloves when examining a patient who is at risk for HIV infection. T F 11. Condoms are 100% effective in the prevention of HIV transmission. T F 12. The likelihood of transmitting HIV through “French kissing” is high. T F 13. All babies born to HIV-infected women will get AIDS. T F 14. School and day care center personnel have a legal right to know which children attending their programs are HIV-infected. T F 15. Most HIV-positive women know that they are infected before they become pregnant. T F 16. The use of alcohol, cocaine, or marijuana (noninjectable drugs) does not put a person at risk for HIV infection. T F Optional questions 17. Health care providers are free to tell others about their patient’s HIV status without written consent. T F 18. It is safe for HIV-positive mothers to breast-feed their infants. T F 19. The majority of children who are HIV-infected know their diagnosis. T F JOURNAL
OF PEDIATRIC
HEALTH
CARE
Journal of Pediatric Health Care
Patient Management
20. Children with HIV infection shotid receive all of their regular childhood immunizations. T F ANSWERS 1. False. Currently, there is no cure for AIDS. Antiviral drugs that slow virus replication are available, but none of these drugs eliminates the virus. Zidovudine (AZT), dideoxyinosine (ddi), and dideoxycytidine (ddC) are three antiviral medications that currently are used in adults and children with HIV infection. 2. Palse. The CDC receives reports of “full blown” AIDS casesfrom across the nation. Currently, there are no consistent regulations or legislation among the various state about reporting HIV infection to local or state #health departments when the individual does not yet meet the criteria for CDCdefined AIDS. As of October 1990, 33 states require that information about HIV infection in individuals who do not yet meet the criteria for CDC-defined AIDS be provided to local or state health departments. Some of these states require HIV reporting by name while other states report anonymbusly (CDC, 1990). 3. False. In the early years of the AIDS epidemic, AIDS was considered a disease of homosexual men. We now know that men, women, and children can be infected with this virus. 4. False. Most people infected with HIV look normal. At a later stage in the disease process, one may notice physical (and/or mental) deterioration, indicating that an individual has a serious medical problem. The exact cause of this deterioration would not ble evident by just looking at the individual. 5. False. Many people believe that an HIV-infected person has AIDS. This assumption is not true. Rather, the spectrum of disease manifestations associated with HIV infection ranges fi-om being infected but asymptomatic to being in the final stage of illness with an AIDS-defined infection or problem. 6. False. HIV is not transmitted by casual contact. Casual contact refers to activities such as living in the same holuse with an infected person, holding hands, sharing items such as eating utensils and dishes, going to school with an infected child, using the same toilet, or swimming in a pool with an infected person. 7. False. Every unit of donated blood is being tested for antibodies to HIV, cytomegaiovirus (CMV), and hepatitis. In some instances, units containing HIV-infected blood may go undetected. If a blood
8.
9.
10.
11.
12.
13.
14.
15.
Exchange
265
donor was exposed to HIV but had not yet had sufficient time to develop antibodies to the virus, that donor’s blood would test negative and would be cleared for use. This phenomenon is called the “window period,” False. Absolutely no risk exists for a blood donor in the United States. A new sterile needle is used each time a person donates blood. False. There are no documented cases of HIV transmission occurring as a result of stool, tears, saliva, or urine exposure. HIV has been found in small amounts in saliva and tears but has not been found in urine or stool..Scientists believe that it is nearly impossible to transmit HIV through these fluids. False. Gloves are necessary only when there is a risk of blood or body fluid exposure to the examiner. Gloves are not needed when doing a routine physical assessment. The CDC (1987) guidelines for universal blood and body fluid precautions should be strictly adhered to by ail health professionals. False. Latex condoms, when used correctly every time intercourse takes place, can be effective in preventing HIV infection and other sexually transmitted disease (STD). Condoms are not 100% effective in preventing HIV infection, STDs, or pregnancy because they may break or be used incorrectly. The presence of a spermacide called nonoxynol-9, used in some brands of condoms, is known to help in preventing HIV infection. False. No cases of HIV transmission from saliva have been documented. Therefore it is highly unlikely that HIV could be transmitted by French kissing. False. Approximately 30% of babies born to HIV-infected mothers become HIV infected. A baby born to an HIV-infected mother will test HIV antibody-positive at birth. This reflects passively transferred maternal antibody. It can take up to a year or more before it is known whether a baby is infected with the virus. Therefore babies born to HIV-positive mothers should have their HIV status followed until they are at least 1.5 months of age. False. All children have the right to an education. It is the parents’ decision whether to disclose their child’s HIV status to school officials. Most parents choose not to tell school or day care personnel about their child’s diagnosis. False. Many HIV-infected mothers do not know that they are infected until their children are diagnosed.
266
Patient Management
Exchange
16. False. All behavior-altering substances are associated with increased risk of HIV infection resulting from reduced inhibitions and increased risk-taking behaviors. 17. False. In most states, a health care provider may not give anyone except direct medical care providers information about an individual’s HIV status without written authorization from the infected person. The health care providers must obtain written authorization for each person who is to receive this confidential information. 18. False. Breast milk has been implicated in the transmission of HIV to infants. In the United States, HIV-positive women are discouraged from breastfeeding. In developing countries, breast-feeding continues to be accepted because there is a lack of available resources and formula. 19. False. Most children do not know their HIV diagnosis. This stems from parental concern that the child may tell others about his or her illness. Experienced health care providers can guide families through the process of telling children about their diagnosis. 20. False. Children with HIV infection need to be protected from preventable childhood diseases; however, a modification in the normal childhood immunization schedule is necessary. Children with HIV infection should not receive oral polio vaccine because live attenuated polio vaccine can cause polio in individuals with damaged immune systems. Rather they should be given inactivated polio vaccine. Uninfected children who live in a home with an HIV-infected adult or child also should
Volume 5, Number 5 September-October 1991
receive the inactivated polio vaccine. The sles/Mumps /Rubella vaccine, another live uated virus vaccine, can be given to clinically children with HIV infection according to guidelines and with physician approval.
Meaattenstable CDC
This quiz includes just a few examples of the many questions and concerns that are frequently voiced about HIV infection. Before health care providers can effectively educate about HIV infection, the provider first must determine what parents, children, and teenagers know or have heard about HIV infection. Myths and misconceptions about HIV infection and AIDS can then be dispelled. Education about HIV infection is a priority public health issue. Unfortunately, as studies on various teenage groups have shown repeatedly, knowledge about HIV transmission does not necessarily result in avoidance of high-risk sexual behaviors or in termination of intravenous drug use. Parents, children, and teenagers must be convinced that the 1990s are risky times for all. There can be no more hiding under the false notion that HIV infection is a disease of homosexual men and intravenous drug users. Health professionals need to continue to dispel myths about HIV infection and provide accurate information so that knowledge translates into positive health behaviors. REFERENCES Centers for Disease Control. (1987). Recommendations for prevention of HIV transmission in health-care settings. MMWR, 36(28), 3-19. Centers for Disease Control. (1990). Update: Public health surveillance for HIV infection-United States, 1989 and 1990. MMWR, 39(47), 853-861.
