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CLOSE THIS BOOKWhere Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)
Chapter 17: AIDS (Acquired Immune Deficiency Syndrome)
VIEW THE DOCUMENT(introduction...)
What Are HIV and AIDS?
VIEW THE DOCUMENT(introduction...)
VIEW THE DOCUMENTHow HIV/AIDS is spread and is not spread
VIEW THE DOCUMENTWhy HIV and AIDS Are Different for Women
VIEW THE DOCUMENTPreventing HIV/AIDS
VIEW THE DOCUMENTThe HIV Test
VIEW THE DOCUMENTLiving Positively with HIV and AIDS
VIEW THE DOCUMENTPregnancy, Childbirth, and Breastfeeding
Care for Persons with AIDS
VIEW THE DOCUMENT(introduction...)
VIEW THE DOCUMENTPreventing HIV infection at home
VIEW THE DOCUMENTStaying Healthy for as Long as Possible
Common Medical Problems
VIEW THE DOCUMENT(introduction...)
VIEW THE DOCUMENTFever
VIEW THE DOCUMENTDiarrhea
VIEW THE DOCUMENTSkin rashes and itching
VIEW THE DOCUMENTNausea and vomiting
VIEW THE DOCUMENTCough
VIEW THE DOCUMENTProblems with the mouth and throat
VIEW THE DOCUMENTWounds and sores
VIEW THE DOCUMENTMental confusion (Dementia)
VIEW THE DOCUMENTPain
VIEW THE DOCUMENTCaring for Someone Who Is Near Death
Working for Change
VIEW THE DOCUMENT(introduction...)
VIEW THE DOCUMENTHow you can help prevent AIDS

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 17: AIDS (Acquired Immune Deficiency Syndrome)


Figure

¨ AIDS is everyone’s problem.

You must have heard about AIDS by now - on the radio, in the market, from your neighbors, or at the health center. You may think AIDS is not your problem. Yet millions of people are infected with the AIDS virus. More and more of them are women.

We can only protect ourselves from AIDS if we understand what AIDS is, and if we talk about AIDS with our families and friends.

“AIDS is a disease that shines in hush and thrives on secrecy. It was prospering because people were choosing not to talk about it... I wanted to talk about AIDS so that at least my children, and yours, would be spared. They would know and have the information about AIDS before they became sexually active, and be able to talk about it.”

- Noerine Kaleeba, Uganda, whose husband died of AIDS

WHY SO MANY WOMEN GET HIV/AIDS

AIDS is spreading fastest in parts of the world where people are poor and do not have education. If there is famine (not enough food), war, or not enough work, people are often forced to move to cities, away from their families. Traditions often break down and sex with new partners is common.

These conditions are especially hard for women. Poor women have even less power to control their lives. Often laws and tradition keep women from getting an education, skills to support themselves, or information about their bodies.

¨ Lack of power and information make women more vulnerable to AIDS.

What Are HIV and AIDS?

HIV (Human Immunodeficiency Virus) is a very small germ, called a virus, that you cannot see. AIDS is a disease that develops later, after a person has been infected with HIV, the AIDS virus.

HIV

When a person becomes infected with HIV, the virus attacks the immune system, the part of your body that fights off infection. HIV slowly kills the cells of the immune system until the body cannot defend itself against germs anymore. Although a person may feel well for only a short time, many people feel well for 5 to 10 years after getting HIV. But eventually the immune system will no longer have enough cells to fight off germs that normally do not make you sick. Because HIV takes many years to make someone sick, most people with HIV feel healthy and do not know they have it.

¨ As long as you feel well you have HIV, but you do not yet have AIDS.

IMPORTANT
You can pass HIV to others as soon as you are infected, even though you look and feel healthy. You cannot tell from looking at a person if he or she has HIV. The only way to know if you are infected is to get the HIV test.


Figure

The body has millions of white blood cells that attack germs and fight off infection.

HIV kills the white blood cells until there are not enough cells left to attack the germs. This is when the person has AIDS.

AIDS

A person has AIDS when the immune system gets so weak that it can no longer fight off common infections and illnesses. The signs of AIDS are different in different people, and they can be different for women than for men. Often the signs are lasting infection with other common illnesses.

Good nutrition and some medicines can help the person’s body fight infections caused by AIDS and allow her or him to live longer. But there is no cure for AIDS itself. So after a while, a person infected with HIV will get more and more illnesses until the body is too weak to survive.

How HIV/AIDS is spread and is not spread

HOW HIV/AIDS IS SPREAD

HIV lives in body fluids - such as blood, semen, and the fluids in the vagina - of people infected with HIV. The virus is spread when these fluids get into the body of another person. This means that HIV/AIDS can be spread by:


unsafe sex with someone who has the virus.


unclean needles or syringes, or any tool that pierces or cuts the skin.


blood transfusions, if the blood has not been tested to be sure it is free from HIV


an infected mother to her baby through pregnancy, birth or breastfeeding.


infected blood that gets into cuts or an open wound of another person.

HOW HIV/AIDS IS NOT SPREAD

HIV does not live outside the human body for more than a few minutes. It cannot live on its own in the air or in water. This means you cannot give or get HIV in these ways:


by touching, kissing, or hugging.


by sharing food.


by sharing a bed.


by sharing or washing clothes, towels, bed covers, latrines, or toilets.


by caring for someone with HIV/AIDS.


from insect bites.

Why HIV and AIDS Are Different for Women

HIV and AIDS are different for women because:

· women get infected with HIV more easily than men do. A man puts his semen in the woman’s vagina, where it stays for a long time. If there is HIV in semen it can pass easily into a woman’s body through her vagina or cervix, especially if there are any cuts or sores.

· women are often infected at a younger age than men. This is often because young women and girls are less able to refuse unwanted or unsafe sex.

· women get more blood transfusions than men because of problems during childbirth.

· women become sick with AIDS more quickly after becoming infected with HIV than men do. Poor nutrition and childbearing may make women less able to fight disease.

· women are blamed unfairly for the spread of AIDS. But men are just as responsible as women (if not more). For example, they are the ones who buy sex, which is a common way that AIDS spreads.

· a pregnant woman infected with HIV can pass it to her baby.

· women are usually the caretakers for family members who are sick with AIDS, even if they are sick themselves.

Preventing HIV/AIDS

You can prevent AIDS in these ways:

· If possible, have sex with only one partner who has sex only with you.

· Practice safer sex - sex that prevents the germs in a man’s semen from getting into your vagina, anus, or mouth.

· Avoid piercing or cutting the skin with needles or other tools that have not been disinfected between uses.

· Avoid blood transfusions except in emergencies.

· Do not share razors or toothbrushes.

· Do not touch someone else’s blood or wound without protection.


Figure


Women and girls should have a right to protect their lives against AIDS. To do this we need

PREVENTING HIV/AIDS IS NOT ALWAYS EASY


Figure


Figure


Figure

The HIV Test

When HIV enters the body, the body starts to make antibodies right away to fight the virus. These antibodies usually show in the blood 4 to 8 weeks later, but it can take as long as 6 months for the body to make enough of them to show up in a test. This time between infection and when the antibodies appear in the blood is called the ‘window period’.

¨ Your local Red Cross or Red Crescent may offer testing and counseling at a low cost, Check with your national AIDS control program to find out where you can be tested in your country. It can take about 2 weeks to get the test results.

The HIV test looks for these antibodies in the blood. It is the only way to know if a person has been infected with HIV. It is not a test for AIDS.

A positive HIV test means that you are infected with the virus and your body has made antibodies to HIV. Even if you feel completely well, you can spread the virus to others.

A negative HIV test means I of 2 things:

· you are not infected with HIV, or
· you are infected but have not yet made enough antibodies to HIV to test positive (the window period).

If you have tested negative for HIV but think you might be infected, you should take the test again in a few months. Sometimes a positive test also needs to be repeated. A health worker can help you decide.

¨ If possible, have someone you trust go with you to get your HIV test results.

THE WINDOW PERIOD

This is different for different people. Here is an example of how long the window period was for one woman:

1. He was HIV-infected. They had unprotected sex. She became infected too.


Figure

2. Three weeks later, she tested negative for HIV. But she was still infected and could give the virus to others. She was in the ‘window period’.


Figure

3. Nine weeks later she tested positive for HIV.


Figure

4. The time between her first contact with HIV, and when antibodies appear in her blood is the window period.


Figure

Since the window period can be as long as 6 months, it is best to wait that long after being exposed before getting the HIV test If you think you may have come into contact with HIV again during that 6-month window period, you will need to get another test in 6 months from the date of the new contact.

WHEN SHOULD YOU HAVE THE HIV TEST?

It is usually more important to change unsafe behavior than to have an HIV test. But you and your partner may want to be tested if:

· you want to get married (or start a faithful sexual relationship with one person) or have children.

· you, your partner, or your baby have signs of AIDS.

· you or your partner have had unsafe sex.

¨ The HIV test should always be done:

· with your permission.
· with counseling before and after the test.
· with privacy. No one should know the results except you and those you want to know.

The advantages of knowing the test results

If your test is negative, you can learn how to protect yourself so that you stay negative and never get HIV/AIDS.

If your test is positive, you can:

· prevent the spread of HIV to your partner.
· get treatment early for health problems.
· make changes in how you live so you can stay healthy longer.
· get support from other HIV-infected people in your community.
· plan for yourself and your family’s future.

The disadvantages of knowing the test results

You may have many different feelings if you find out you are infected. It is normal at first to be shocked and deny that your test results are positive. You may also feel anger and despair, and blame yourself or others.


AIDS is not a curse or a punishment.

It often helps to talk with someone, such as the health worker who gave you the test results or someone close to you. But be careful who you tell. Your husband or partner may blame you, even if he is also infected with HIV. Other people may act afraid and shun you, because they do not understand HIV/AIDS or how it is spread. If possible, see a trained HIV/ AIDS counselor, who can help you decide who to tell and how to face this change in your life.

IMPORTANT
A negative test does not mean that you will never become infected with HIV. If you practice unsafe sex, you can still get infected.


Figure

Practice safer sex.

Counseling

A counselor is someone who listens and talks with a person and his or her family to help them to cope with their worries, concerns, and fears, and to make their own decisions.

¨ Counseling for HIV-infected people and their families can mean the difference between hope and despair. As an HIV-infected woman from Kenya says, “When you meet a good counselor, you feel as if you have healed.”


Figure

Counseling is important throughout the life of a person with HIV, not only when they first discover they are infected. If you are infected, a skilled counselor may be able to help you:

· decide who to tell about being HIV-infected.

· find the support of others who are also HIV-infected.

· get the care you need from health centers.

· explain to your family what it means to be HIV-infected, and how HIV is spread. This will help them to accept and care for you without being afraid.

· understand how to stay healthy for as long as possible.

· plan for your future.

· learn how to be sexual in a safe way.

If you are a health worker or a leader of a religious group, you are in an ideal position to get training to help those suffering with the problems of HIV. Some people who have lost family members to AIDS have learned to counsel others about living with HIV.

Living Positively with HIV and AIDS

¨ Most people with HIV can be healthy for many years.

Modern medicine and traditional healers still do not have a cure for AIDS. But most people with HIV can be healthy for many years. During this time it can help to:

· make the best of every moment of your life.
· spend time with friends and family.
· try to keep active by doing your daily work.
· be sexual if you want to. Enjoying sexual touch can help you stay healthier longer

If your partner is HIV infected

Although it is risky, if you practice safer sex carefully, you can continue to have sex with an HIV infected partner without becoming infected yourself. Besides using safer sex methods, watch your own health carefully. Watch for breaks in the skin or other places where infection could occur. And remember, there are other ways to be sexual besides having sex. It is safe to hug, to hold someone in your arms, and to kiss them.


Figure

· Try joining or starting a group of people with HIV and AIDS. Some people with HIV and AIDS work together to educate the community, to provide home care to those who are sick with AIDS, and to support the rights of people with HIV and AIDS.


Figure


Figure

· Look after your spiritual and mental health. Your faith and traditions can bring you hope and strength.


Figure

· Think about the future. If you have children:

- spend time with them now, and give them care and guidance.

- make arrangements for family members to look after them when you are no longer able to do so.

- make a will. If you have some money, a house, or property, try to make sure that they will go to those you want to have them. Sometimes women who are not legally married cannot leave their possessions to their children and other family members. So it may be helpful to get legally married in order to leave your possessions to those you want to have them.

¨ If you have children, make staying healthy for them a goal.

Take care of your health

· Take care of medical problems early. Each infection can weaken your immune system more.

· Eat nutritious food to keep your body strong. The same foods that are good to eat when you are healthy are good for you when you are sick. Buy nutritious food instead of spending money on vitamin tablets or injections.

· Avoid tobacco, alcohol, and other drugs.

· Practice safer sex for your own health as well as your partner’s. Safer sex can prevent new infections and unplanned pregnancies that could weaken the immune system even more.

· Try to get enough rest and exercise. This will help your body stay strong to fight infection.

· Prevent infection by washing often.


Figure

Pregnancy, Childbirth, and Breastfeeding

Preventing pregnancy may keep you healthier and help you live longer. If you are HIV infected and already pregnant, it is especially important to take good care of yourself.


Figure

PREGNANCY

Pregnancy can be dangerous for a woman with HIV or AIDS. During pregnancy and childbirth she is more likely to have some of the following problems than a woman who does not have HIV or AIDS:

· lose the baby during pregnancy (miscarriage)
· fevers, infections, and poor health
· serious infections after giving birth, which are hard to treat and may threaten her life

In addition, her baby may:

· be infected with HIV.
· be born too soon, or be sickly and die.

Some women who become infected with HIV may still want to get pregnant Or they may have no way to prevent pregnancy.

If you want to get pregnant

If you are not sure whether you or your partner are infected with HIV and you can get a test for HIV, both of you should wait 6 months before having the test. While you wait, use condoms every time you have sex, and have sex with only each other.

If you cannot get an HIV test, you can reduce your risk by following this advice:

· Have sex with a condom, except during your fertile time.
· When you are not fertile, practice safer sex.
· Never have sex when there are signs of an STD.


Figure

About 1 out of 3 babies born to HIV-infected mothers becomes infected.


This baby is HIV positive.


These 2 babies are HIV negative.

A baby can become infected while it is in your womb, or during birth, or while breastfeeding. Some anti-viral drugs (like AZT) are being tested that may reduce the risk of passing HIV to your baby. Check with a health worker who has been trained to treat HIV/AIDS during pregnancy.

An HIV-positive mother always passes antibodies (but not always HIV itself) to her unborn baby. This means that a new baby will always test positive for HIV because the mother’s antibodies show up in the baby’s blood. But many babies later have a negative test. This means they were not actually infected with HIV itself. It is impossible to tell from the usual HIV test if the baby has the virus or just the antibodies until the baby is I 8 months old. At that time, the mother’s antibodies will disappear from its blood.

CHILDBIRTH

If you think your midwife or birth attendant would be understanding, tell her that you are HIV infected so she can protect both of you from infection.

After the birth, wash your genitals 2 times a day with mild soap and clean water Learn the signs of infection after birth and get treated immediately if necessary.


Figure

BREASTFEEDING

HIV infection is sometimes passed to the baby in breast milk. No one knows yet how often this happens or why it happens to some babies and not others. There is more HIV in the breast milk of mothers who have become infected recently, and in those who are very sick with AIDS.


Figure

Some mothers find a friend or relative who is not HIV infected who can breastfeed their baby for them. This can be the safest choice for your baby. But even if you are HIV infected, it is usually better to breastfeed than to use other milks or formula. In many communities the risk of diarrhea and malnutrition from other milks is greater than the risk of HIV, especially in the baby’s first 6 months of life.

After 6 months, when your baby is bigger and stronger, there is less danger of diarrhea and infection. You can then switch to other milks and feed your baby other foods. This way your baby has many of the benefits of breastfeeding with less risk of getting HIV.


Figure

Talking with a trained health worker about breastfeeding and HIV can help you answer some of the following difficult questions and make a decision about whether to breastfeed your baby:

· Are you certain you have HIV or AIDS? Perhaps you should be tested.

· Do children in your area often get sick or die from infections, diarrhea, or poor nutrition? If the answer is yes, then breastfeeding may be best.

· Are other clean, nutritious milks or formula available? You will need to buy them for at least 6 months, which is very costly. You will also need enough clean, boiled water and some training in how to feed other milks or formula with a cup or spoon.

· Is there another woman who can breastfeed your baby? Are you certain she is not infected with HIV?


Figure

Whatever you choose to do, do not blame yourself if your baby becomes infected with HIV. There is no way to know for sure how to protect your baby.

Care for Persons with AIDS

The health and medical problems of AIDS may last a long time. These problems can take a lot of the energy and resources of the sick person and her or his family.

If you have AIDS, you will probably need to see a health worker or go to a clinic from time to time to have an infection treated. But you may never need to stay in the hospital. You may be more comfortable at home, cared for by family members in familiar surroundings.

If you have a problem that does not get better with home treatment, try to find a health worker, clinic, or doctor you trust who is experienced with AIDS. Then go to the same person whenever you have a problem. Going from clinic to clinic wastes time, energy, and money.

A stay in the hospital usually costs more than the food and medicine needed for good care at home.


Figure


Figure

¨ A good counselor is key to helping you care for someone with AIDS at home.

Much of the work in caring for sick people at home is done by women, who are usually the family’s caregivers. If you are caring for someone with AIDS, be sure to take care of your own needs, too. Try to get help from other family members, friends and people in the community. Community clubs, religious groups, youth clubs, and AIDS self-help groups may assist you.

When Rosa was in bed because of AIDS complications, her mother kept a cheerful attitude. Every day she bathed her daughter dressed her with nice clothes, and put a little flower next to her bed. Rosa was not hungry but her mother arranged the food in a way that could make her want to eat. The family would talk to Rosa about daily life, and their work and community. With their good humor and positive comments, Rosa felt that she was not cast aside. Even though Rosa was often tired or didn’t feel well, the family arranged for her friends to visit her in the moments she felt better. Music, conversation, and good spirit made the house full of life. Rosa felt that she was loved and needed, and that AIDS could not ruin her closeness and her time with her family.


Figure

Preventing HIV infection at home

If you follow these rules, there is no risk of spreading HIV from an infected person to others around her, or of getting HIV yourself:

· Avoid touching body fluids, like blood, vomit, stool, and urine.

· Do not share anything that touches blood. This includes razors, needles, any sharp instruments that cut the skin, and toothbrushes. If you must share such things, disinfect them before another person uses them. If you are unable to disinfect them, boil them in water for 20 minutes.


Figure


Figure

¨ Burn or bury soiled bandages that cannot be rewashed.

· Keep wounds covered. Both caregivers and persons with HIV or AIDS should cover all open wounds with a clean bandage or cloth.

· Use a piece of plastic or paper gloves, or a big leaf to handle dirty bandages, cloths, blood, vomit, or stool.


Figure

· Wash your hands with soap and water after changing dirty bedding and clothes.

· Keep bedding and clothing clean. This helps keep sick people comfortable and helps prevent skin problems. To clean clothing or sheets stained with blood, diarrhea, or other body fluids:

- keep them separate from other household laundry.

- hold an unstained part and rinse off any body fluids with water. Be especially careful if there are large amounts of blood, such as after childbirth.

- wash the bedding and clothing in soapy water, hang to dry - if possible in the sun - and fold or iron as usual.


You will not get HIV from washing the clothes of an infected person if you follow the advice above.

¨ The following things are helpful but not necessary:

· Add bleach to the soapy water and soak 10 minutes before washing.
· Wear gloves or plastic bags on your hands.


Figure

Staying Healthy for as Long as Possible

When a person has AIDS, the body’s immune system is no longer able to fight off common infections and illnesses. The immune system gets weaker with each illness, making it even less able to fight infection the next time. This continues until the person’s body is too weak to survive.

Preventing infections and illness is the best way to slow down the weakening of the immune system. It is also important to treat any infections to keep them from spreading or getting worse. This way a person with AIDS can stay healthy for as long as possible.

Preventing some infections with medicines

For persons with AIDS, regular use of the antibiotic co-trimoxazole may help prevent some kinds of pneumonia and diarrhea. You can start taking it as soon as you begin to fall ill from serious lung infections, diarrhea, and skin infections.

Take: co-trimoxazole 480 mg (80 mg trimethoprim and 400 mg sulfamethoxazole), I tablet by mouth daily, or 2 tablets by mouth 2 times a week. Drink a lot of water every day if you take co-trimoxazole.

IMPORTANT
Allergic reactions to co-trimoxazole are more common in persons with AIDS. Stop taking it if you get a new skin rash or any other sign of drug allergy. Taking antibiotics regularly usually causes problems with fungal infections of all kinds: in the mouth, on the skin, in the vagina. You may be able to prevent some of these infections by eating yogurt or sour milk products every day.

Women will usually have more problems with yeast infections of the vagina when they take antibiotics. Eating yogurt or sour milk, or sitting in a bowl of water with yogurt or vinegar in it can help.

MENTAL HEALTH


Figure

Good mental health is very important for staying healthy and avoiding illness. AIDS places a heavy stress on the mind and the emotions. Often people feel very afraid and tense (anxiety), or feel sadness or have no feelings at all (depression). Sometimes these feelings are so strong they cause physical signs. Anxiety and depression can also weaken the body and make a person more likely to get sick.

It is important to try to tell the difference between signs of illness that are caused by physical problems, and signs that are caused by anxiety or depression. Knowing the cause of a problem may make it easier to treat. It is also important to try and overcome these feelings so that they do not contribute to making a person with AIDS become sicker.


Figure

Common Medical Problems

A person with AIDS can get sick very easily from many different common medical problems. The rest of this chapter has information about the most common of these problems and how an individual or family may care for them.

Just because someone has one of these problems does not mean she has AIDS. This information will be helpful to anyone suffering from one of these illnesses.

¨ For the medical problems mentioned in this chapter, also see Where There Is No Doctor or another general medical book.

Fever

Fevers often come and go. It is hard to know if the fever is from an infection that can be treated, like tuberculosis, pelvic inflammatory disease (PID), or malaria, or if it is from HIV itself. If the fever is caused by an infection, then make sure the infection itself is also treated.

To check for fever, use a thermometer, or put the back of one hand on the sick person’s forehead and the other on your own. If the sick person feels warmer, she probably has a fever.


Figure


Figure

Treatment:

· Remove extra clothing and let fresh air into the room.

· Cool the skin by pouring water over it, wiping the skin with wet cloths, or putting wet cloths on the chest and forehead and fanning them.

· Give plenty of liquids even if the person is not thirsty. With fever it is easy to become dehydrated (lose too much water).

· Take a medicine like paracetamol, aspirin, or ibuprofen to help reduce fever.

· Keep the skin clean and dry. Use lotion or corn starch to help prevent sores and rashes.

Get help when:

· the temperature is very high.

· the fever goes on for many days.

· there is coughing, difficulty breathing, and loss of weight.

· there is a stiff neck, severe pain, or sudden, severe diarrhea with the fever.

· the person with the fever is pregnant or recently had a baby, miscarriage, or abortion.

· the person is being treated for malaria, and the fever has not gone away after the first treatment.

· there is discharge from the vagina and pain in the belly with the fever


Figure


Figure

Diarrhea

Diarrhea is passing 3 or more loose or watery stools in a day. Passing many normal stools is not the same as having diarrhea. Diarrhea may come and go and can be hard to cure. The most common causes of diarrhea in persons with AIDS are infections in the intestines from unclean food or water, infection because of HIV, or the side effects of some medicines.

Diarrhea can cause:

· malnutrition, if the food passes through the body so quickly that the body cannot use it. Also, people with diarrhea often do not eat because they are not hungry.

· dehydration, if the body loses more liquid in the stools than you take in. Dehydration happens faster in hot climates and in people who have fever.

Signs of dehydration:

· thirst
· little or no urine
· dry mouth
· loss of stretchiness of the skin
· feeling dizzy when standing up


Lift the skin between two fingers...


...if the skin fold does not fall right back to normal, the person is dehydrated.

IMPORTANT
If someone has these signs and is also vomiting, she needs liquids in the vein (IV) or in the rectum. Get medical help fast. Severe dehydration is an emergency.

Treatment:

· Prevent dehydration by drinking more liquids than usual. Fruit juices, coconut milk, sweetened weak tea, gruel, soup, rice water, and rehydration drink are good for fighting dehydration. Even if the person does not feel thirsty, she should still sip something every 5 to 10 minutes.

· Keep eating. Try to eat small amounts of foods that are easy for the body to digest. Cook food well, and then mash and grind it. Some good foods are cereals mixed with beans, meat, or fish; dairy products, such as milk, cheese and yogurt; and bananas. Do not eat uncooked vegetables, whole grains, fruit peels, hot peppers, or food or drink with a lot of sugar. These make diarrhea worse.


Figure

Take medicine only for these kinds of diarrhea:

· Sudden, severe diarrhea with fever (with or without blood in the stool). Take co-trimoxazole 480 mg (80 mg trimethoprim and 400 mg sulfamethoxazole), 2 tablets twice a day for 10 days. If you are allergic to sulfa drugs, take norfloxacin instead, 400 mg, one time only. If you are no better after 2 days, see a health worker.

· Bloody diarrhea without fever, which can be caused by amoebas (tiny animals that live in water or in the intestines). Take metronidazole 500 mg, 3 times a day for 7 days. If you are not better after 2 days, see a health worker.

· When someone has diarrhea for a long time, she may get a red, sore area around the anus. It may help to apply petroleum gel or zinc oxide cream each time after passing stool. The person may also get piles (hemorrhoids).

¨ If you are pregnant or breastfeeding, do not take norfloxacin. For more information about these medicines, see the “Green Pages.”


Figure

Get help if the person:

· has the signs of dehydration.
· cannot eat or drink as usual.
· does not seem to be getting better no matter what she does.
· has a high fever.
· passes many watery stools in a day.
· passes bloody stools the do not go away with medicine.
· is also vomiting.


Figure

Prevention:

· Drink clean water. Purify your water before using it in food or drink.

· Eat clean, safe food. Make sure raw foods are washed or peeled, and that meat is well cooked. Protect food from dirt, flies, crawling insects and animals, which can give you germs.

· Always wash your hands:

- after using or helping someone use the latrine or toilet.
- after cleaning soiled children or sick people.
- before making food or drink.


Figure

· Protect your community’s water source.


Figure

Skin rashes and itching

It is often difficult to know what causes skin rashes and itching. Many skin problems can be helped by keeping the body clean. Try to wash once a day with mild soap and clean water

If the skin becomes too dry, wash less often and do not use soap. Try rubbing petroleum gel, glycerin, or vegetable oils into the skin after bathing. Wear loose cotton clothing.


Figure

Allergic reactions

Allergic reactions, which often cause an itchy rash, are more common in people with AIDS. Medicines that contain sulfa (like co-trimoxazole) may cause especially bad reactions. If you are using these medicines and you get an itchy rash, itchy eyes, vomiting or dizziness, stop taking them immediately and see a health worker. She may be able to give you a non-sulfa medicine that will work.

Fungal infections (yeast, Candida)

Fungal infections are difficult to describe because they can look like many different things. Some fungal infections look like round, red, or scaly patches that itch. Women with AIDS can also get frequent yeast infections in the vagina.

You may have a fungal infection if you have a skin problem in one of these areas:


Figure

Treatment:

· If you have red, itchy patches, keep the area clean and dry. If possible, keep the area uncovered and open to the air and sunlight.

· Apply nystatin cream 3 times a day or Gentian Violet 2 times a day until the rash is completely gone.

· If you have a very bad fungal infection, taking ketoconazole by mouth may help. Take one 200 mg tablet each day for 10 days (but do not take this medicine if you are pregnant).

Brown or purple patches on the mouth or skin

These patches are caused by a cancer of the blood vessels or lymph nodes called Kaposi’s sarcoma. Medicines are not helpful. If you are having problems, like difficulty eating because of patches in your mouth, see a health worker.

Itching

Treatment without medicines:

· Cool the skin or fan it.

· Avoid heat and hot water on the skin.

· Avoid scratching, which causes more itching and sometimes infection. Cut the fingernails short and keep them clean to avoid infection.


Figure

· Use cool cloths soaked in water from boiled and strained oatmeal, or plant medicines from local healers.

These can also help itching:

· tincture of tea tree from Australia

· juice from aloe vera plants


Figure

Treatment with medicines (use any one of these):

· Apply calamine lotion with a clean cloth as needed.

· Apply small amounts of 1% hydrocortisone cream or ointment 3 times a day.

· Take an antihistamine, such as diphenhydramine or hydroxyzine, by mouth. Take 25 mg, 4 times a day. Antihistamines may make you sleepy.

¨ Antihistamines should be used with caution by women who are pregnant or breastfeeding (see the “Green Pages”).

Herpes zoster (shingles)

Shingles is an infection caused by a herpes virus. It usually begins as a painful rash with blisters, which may then break open. It is most common on the face, back, and chest. The area may burn and be very painful. The rash may start to heal in a few weeks, but the pain may last longer.


Figure

Treatment:

· Apply calamine lotion 2 times a day to help with pain and itching.

· Keep sores dry. Cover with a loose bandage if clothing rubs the sores.

· To prevent infection, apply Gentian Violet liquid. If the sores do become infected, see Wounds and Sores.

· Pain medicine is often needed.

· The medicine acyclovir may help.

Do not touch your eyes because shingles can damage your eyesight and can cause blindness.

Nausea and vomiting


Figure

If nausea and vomiting prevent a person from eating or drinking, she can become weak, malnourished, and dehydrated. For some people, nausea or vomiting may go on day after day. Nausea and vomiting may be caused by:

· infections.
· some medicines.
· problems with the stomach and intestines.
· HIV infection itself.

Treatment:

· Take small bites of dry food (bread, crackers, chapati, tortilla) when you wake up in the morning.

· Try to avoid the smell of food as it cooks. If a food or smell seems to cause nausea, avoid that food.

· Drink small amounts of mint, ginger, or cinnamon tea.

· Lick a lemon.

· Clean the teeth and rinse the mouth often, to get rid of the bad taste after vomiting.

· Let fresh air into the house or room often.

· Soak a cloth in cool water and put it on the forehead.

· If the problem is caused by a medicine, see if another medicine can be used instead.


Figure

If vomiting is severe:

1. Do not drink or eat for 2 hours.

2. Then, for the next 2 hours, sip 3 tablespoons of water, rehydration drink, or other clear liquid every hour. Slowly increase the amount of liquid to 4 to 6 tablespoonfuls every hour. If the person does not vomit, keep increasing the amount of liquid.

4. If the person cannot stop vomiting, use promethazine 25 mg to 50 mg every 6 hours as needed.

5. As nausea gets better, start to eat small amounts of food again. Start with plain foods such as bread, rice, cassava, or porridge.


Figure

When to get help:

· The person cannot keep any food or drink in her body for 24 hours.

· The person vomiting has pain in the belly or a high fever

· The vomiting is very strong, it is dark green or dark brown, it smells like stool, or has blood in it.

· The person has signs of dehydration.

Cough

Coughing is the body’s way of cleaning the breathing system and getting rid of mucus. Coughing is also a common sign of lung problems, such as pneumonia or tuberculosis. The lungs make more mucus when they are irritated or infected.

¨ DO NOT smote if you have a cough.

When a cough produces mucus, do not take medicine to stop the cough. Instead, do something to help loosen and bring up the mucus. This will make the cough heal faster

¨ Persons with AIDS often get pneumonia or TB. For more information, see below.

Treatment:

· Drink lots of water. Water is better than any medicine. It loosens the mucus so you can cough it up more easily.

· Cough several times during the day to clear the lungs. Be sure to cover your mouth.

· Keep active by walking, or by turning in bed and sitting up. This helps the mucus come out of the lungs.

· Soothe the throat by drinking tea with lemon and honey, or your own herbal remedy. Cough syrups that you buy are more expensive and no more helpful.

· If the cough is very bad and keeps you awake at night, take codeine, 30 mg, or codeine cough syrup.

Have someone hit you on the back of the chest (postural drainage). This can make it easier to cough up the mucus.


Figure

IMPORTANT
If you cough up yellow, green, or bloody mucus, the cough could be caused by pneumonia or TB, and you will need special medicines.

TUBERCULOSIS (TB)

Tuberculosis (TB) is a serious infection caused by a germ that usually affects the lungs. The signs of AIDS and TB are similar, but they are different diseases. Most men, women, and children with TB do not have AIDS.

But someone with AIDS can get TB very easily because the person’s body is too weak to fight it. In I out of every 3 people who die from AIDS, it is TB that actually kills them.

A woman infected with HIV/AIDS is even more likely to get TB if her body is also weak from many pregnancies, poor nutrition and weak blood (anemia).

TB can be cured, even in persons with AIDS, so it is important to get treatment early. But people with AIDS should never take thiacetazone for TB. For complete information, see the chapter on “Tuberculosis”.

You can make this syrup for all kinds of cough, especially a dry cough. Take 1 teaspoon every 2 or 3 hours.

Mix:


Figure

Pneumonia

Pneumonia is caused by germs that infect the small breathing tubes deep in the lungs. Old people and very sick or weak people often get pneumonia.

Pneumonia can be very serious for people with AIDS. It should be treated with antibiotics right away. Sometimes pneumonia must be treated in the hospital with medicines in the vein (IV).


Figure

Signs:

· Breaths are small and fast (more than 30 breaths a minute in an adult). Sometimes the nostrils open wide with each breath.

· You feel as if you cannot get enough air

· You have a sudden, often high, fever.

· You cough up mucus that is green, rust-colored, or bloody.

· You feel very ill.

Treatment:

· Take co-trimoxazole for 10 days or more (see the “Green Pages”).
· Drink plenty of liquids.
· Try to bring the fever down.
· If you are no better in 24 hours or if you are getting worse, get medical help right away.

Problems with the mouth and throat

Problems with the mouth, or with other parts of the body that food passes through, can keep a person from eating normally. She may then become weak, malnourished, and have a harder time fighting infections. She should try to:

· eat small amounts of food often.
· add vegetable oil or groundnut paste (peanut butter) to foods to give more energy.
· avoid uncooked vegetables. They are hard for the body to digest and may have germs.
· drink a lot of liquids and watch for dehydration.


Figure

Using a straw to drink can help with painful mouth problems.

Soreness in the mouth and throat

Many people with AIDS have soreness in the mouth, and problems with their teeth and gums. Try to:

· eat soft foods - not hard or crunchy foods.
· eat plain foods - not spicy foods.
· use a straw to drink liquids and soups.
· try cold foods, drinks, or ice to help ease pain.

Sores, cracks, and blisters around the mouth

Painful blisters and sores (also called cold sores or fever blisters) on the lips can be caused by the herpes virus. A healthy person can get these sores after a cold or fever. Someone with AIDS can get these sores at any time. The sores may last a long time, but they usually go away on their own. To help prevent infection, apply Gentian Violet to the sores. A medicine called acyclovir may also help (see the “Green Pages”). Wash your hands after touching the sores.


Figure

¨ Cracks and sores in the corner of the mouth can also be caused by malnutrition.

White patches in the mouth (thrush)

Thrush is a fungal infection that causes white patches and soreness on the skin inside the mouth, on the tongue, and sometimes down the tube that connects the mouth and stomach (esophagus). This can cause pain in the chest.


Figure

The patches look like milk curds stuck to the cheek or tongue. If the patches can be scraped off, it is probably thrush. Thrush happens more often when someone is taking antibiotics.

Treatment:

Gently scrub the tongue and gums with a soft toothbrush or clean cloth 3 or 4 times a day. Then rinse the mouth with salt water or lemon water and spit it out (do not swallow). In addition, use any ONE of these remedies:

1. Suck a lemon if it is not too painful. The acid slows the growth of the fungus. Or,

2. Rinse the mouth with 1% Gentian Violet liquid 2 times a day. Do not swallow. Or,

3. Put I ml of nystatin solution in the mouth and hold it there I minute and then swallow it. Do this 3 or 4 times a day for 5 days. Or,

4. If thrush is very bad, ketoconazole may help. Take one 200 mg tablet, 2 times a day for 14 days (but do not take this medicine if you are pregnant).

Wounds and sores

Wounds are caused by an injury that breaks the skin. Sores are often caused by bacteria or pressure on the skin (pressure sores). They can happen very easily to people who stay in bed a long time. Take special care of any cut, wound, or open sore so that it does not become infected.


Figure

General care of open wounds and sores:

1. Wash the wound or sore with clean water and mild soap at least once a day. Wash around the edge of the wound first, then wash from the center out to the edges. If possible, use separate pieces of cloth for each wipe.


Figure

2. If the wound has pus or blood in it, cover the area with a clean piece of cloth or bandage. Leave the bandage loose, and change it every day. If the wound is dry, it can be left open to the air. It will heal more quickly that way.

3. If the wound is on the legs or feet, raise the leg above the level of the heart. Do this as often as possible during the day. During the night, sleep with the feet raised. Avoid standing or sitting for a long time. Some walking is helpful.


Figure

4. Wash soiled cloth and bandages in soap and water, then put them in the sun to dry. Or boil them for a short time and hang them to dry. If the cloths and bandages will not be used again, burn them or throw them in a pit latrine.

Home treatments for pressure sores

Papaya (paw paw): This fruit contains chemicals that help make the old flesh in a pressure sore soft and easy to remove.


Figure

Soak a sterile cloth or piece of gauze in the ‘milk’ that comes from the trunk or green fruit of a papaya plant. Pack this into the sore. Repeat this 3 times a day.

Honey and sugar: These will kill germs, help prevent infection, and speed healing. Mix honey and sugar together into a thick paste. Press this deep into the sore, and cover with a thick, clean cloth or gauze bandage. (Molasses or thin pieces of raw sugar can also be used.)


Figure

IMPORTANT
Clean out and refill the sore at least 2 times a day. If the honey and sugar becomes too filled with liquid from the sore, it will feed germs rather than kill them.

Treatment of open wounds and sores that ore infected:

Wounds and sores are infected if they:

· become red, swollen, hot, and painful.
· have pus in them.
· begin to smell bad.

Treat the infected area as in steps 1 through 4 on the previous page, and also do the following:

1. Put a hot compress over the wound 4 times a day for 20 minutes each time. Or try to soak the wound in a bucket of hot water with soap or potassium permanganate in the water. Use one teaspoon of potassium permanganate to 4 or 5 liters (or quarts) of water. When you are not soaking the infected part, keep it raised up above the level of the heart

2. If part of the wound looks gray or rotten, rinse it with hydrogen peroxide after soaking it. Try to pick off the gray parts with a clean piece of gauze or tweezers that have been properly cleaned.

3. If you can, put Gentian Violet on the wound before putting on the dressing.

4. If there are many infected sores at the same time, especially with a fever, treat with antibiotics. Use erythromycin, dicloxacillin or penicillin for 10 days (see the “Green Pages”).


Hot compress

¨ Be careful: If you use too much potassium permanganate or very hot water, you will burn the skin.

Treatment of closed wounds that are infected (abscesses and boils):

Abscesses and boils are raised, red, painful lumps on the skin. They are most common in the groin and armpits, and on the buttocks, back, and upper legs.


Figure

If you notice a lump, start using warm compresses right away for 20 minutes, 4 times a day. Often this will make the lump open and the pus inside will come out. Keep applying clean, warm cloths until the pus stops coming out and the area begins to heal. Cover the lump with a loose, clean bandage. If it becomes too large and painful, see a health worker who has been trained to drain abscesses using sterile equipment.

When to get help:

See a health worker trained to treat the signs of AIDS if you have a wound and:

· a fever.
· a red area around the wound is getting bigger.

Get medical help if you have a wound and:

· you can feel swollen glands in your neck, groin, or armpits.

· the wound has a bad smell, or brown or gray liquid comes out, or it turns black and bubbles, or blisters form. This could be gangrene.

· you are taking antibiotics and not getting better

Mental confusion (Dementia)

Some mental confusion or mental change is common among people with AIDS, especially if a person has been sick for a long time. These changes may be caused by HIV infection in the brain, by other infections, by depression, or by the side effects of a medicine.

Pain

In the later stages of AIDS (and other serious illnesses like cancer), pain may become a part of daily life. Pain can be caused by many things, such as:

· not being able to move.
· pressure sores.
· swelling of the legs and feet.
· infections, like herpes.
· headache.
· nerve pains

Treatment for pain, without medicines:

· Try relaxation exercises, meditation, or prayer.

· Try to think about other things.

· Play music, or have someone read aloud or tell stories.

· For pain from swelling in the hands and feet, try raising the swollen part.

· For a burning feeling in the hands and feet caused by nerve pain, put the body part in water.

· For skin that hurts to touch, line the bed with soft covers and pillows or animal skins. Be gentle when touching the person.


Figure

· For headache, keep the room dark and quiet.

· Acupressure may help some kinds of pain.

Treatment for pain, with medicines:

The following medicines may be used to control pain that comes day after day (chronic pain). Take the medicines regularly, according to instructions. If you wait until the pain has become very bad, the medicines will not work as well.

· mild pain medicine, like paracetamol
· ibuprofen - if you need something stronger
· codeine - if the pain is very bad

¨ Pain medicines work best if you take them before the pain gets very bad.


Figure

Caring for Someone Who Is Near Death

At some point there is nothing more that can be done for a person with AIDS. You may know this time has come when:

· the body starts to fail.
· medical treatment is no longer effective or is not available.
· the person says she is ready to die.

If the sick person wants to remain at home, you can help her die with dignity by:

· giving comfort.
· having family and friends stay with her.
· allowing her to make decisions.
· helping her prepare for death. It may help her to talk about death, about fears of dying, and about worries for the family’s future. It does not help to act as if she is not dying. Assure her that you will do what you can to prevent pain and discomfort. Talk about funeral arrangements if she wishes.


Figure

As she nears death, she may be unconscious, stop eating, breathe very slowly or very fast and unevenly, stop passing urine, or lose control of passing urine or stool.

Care of the body of someone who has died of AIDS

The AIDS virus can live up to 24 hours in a person’s body after death. During that time, take the same precautions with the body as you did when the person was alive.

Working for Change

AIDS IS EVERYONE’S PROBLEM

It is important that everyone in the community know how AIDS is spread and how to prevent it. But this information will not help them unless they also realize that AIDS can happen to anyone - even them. If people think that AIDS can not touch them, they will not act to prevent infection.

¨ Fight AIDS, not the people who have it.

Placing the blame on any group of people (such as sex workers, homosexuals, or drug users) makes others think that only that group is at risk. It is true that some people, like sex workers, may be more likely to get AIDS (because their work requires that they have sex with many men). But everyone - especially young women - is at risk for AIDS. And every person in the community needs to take responsibility for fighting it.

It is also important to remember to fight against the conditions that lead to the spread of AIDS, and not against the people who have AIDS.

How you can help prevent AIDS

In the community

Education is one of the main ways a community can work to keep AIDS from spreading. Here are some ideas:

· Train girls and women to work as peer educators. They can talk with others alone or in groups to help girls and women understand their bodies and sexuality, and gain the self-confidence and skills to demand safer sex.

· Tell the truth about women’s risk of AIDS. Help people see that AIDS has roots in poverty and in women’s lack of control over their sexual relations.

· Use theater and media to help women feel it is OK to know about and to prevent AIDS. For example, use a play or comic book to show that ‘good’ girls or women can discuss AIDS with their partners, or can buy condoms and ask their husbands or boyfriends to use them.


Figure

At the same time, you can show different ideas about what it means to be a man or a woman. Help people question the idea that men should have many sex partners and that women should be passive about sex. Show how these ideas are dangerous to both men’s and women’s health.

· Help parents, teachers, and other adult role models become more comfortable talking about sex and AIDS with young people.

· Make sure that all people have access to information and sexual health services, including condoms, to keep AIDS from spreading in the community.

· Bring education about AIDS to community meeting places - like bars, schools, religious meetings, and military bases.


Figure

Train men as outreach workers. They can go to the places where men gather and talk to them about AIDS.

Here is an example of how women can work together to protect themselves from AIDS:

To help fight the spread of AIDS, the women of Palestina, a small town in northeastern Brazil, began a ‘sex strike’. After women in the community learned that a man infected with HIV had unsafe sex with at least two women in the town, they decided to stop having sex with their husbands and boyfriends. They demanded that their partners take the test for HIV before they would begin to have sex again and then insisted upon safer sex practices.

The women will now demand safer sex and proof of an HIV test before they have sexual relations with a partner One woman said, “If he won’t practice safer sex, we won’t go together anymore.

If you are a health worker

Health workers can play a very important role in helping to stop the spread of AIDS. You can do this if you:

· give information about how AIDS is spread and how it is not spread to every person you see - especially if they already have other STDs.

· encourage both men and women to use condoms, even if they are already using another form of family planning.

· use precautions against HIV infection with every person you see. Since most people with HIV appear healthy, it is best to act as if everyone you care for is HIV-infected. Any time you have to cut the skin or touch body fluids, follow the advice. This includes any time you must give an injection, stitch skin or tissue, help with childbirth, or examine a woman’s vagina.

· make health services private, confidential, and accessible to all members of the community, including young people.

· invite someone from a regional AIDS organization to meet with health workers in your area. He or she can help you learn about the best ways to treat the infections that people with AIDS often get. Discuss the other problems that people with AIDS face. Try to decide how you can help people using the resources you have, and think about where you might find more resources to help meet people’s needs. If health workers can work together and share resources, they will not have to confront this huge problem alone.

¨ If every health worker can offer the same information and services, it will save people time, money, and energy because they will not have to search for the best treatment.

Fight the fear and negative attitudes that many people have about AIDS

A good way to begin is to plan a meeting with other health workers in your area to discuss AIDS. Help all the health workers learn about AIDS so they will be able to provide accurate, consistent information to the people in their communities. If all health workers can give the same information, it will help prevent the fear caused by wrong ideas about AIDS. With less fear from their neighbors, people with AIDS - as well as those who care for them - can become more accepted in the community. Then they can help others understand every person’s real risk of getting AIDS.


Figure

A health worker’s sympathy and compassion can also help others change their attitudes toward people with AIDS. Then she can fight HIV/AIDS together with the community.

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