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NCM 112:
NURSING CARE OF SEXUALLY-TRANSMITTED INFECTIONS,
HIV INFECTIONS & AIDS
I. NURSING PROCESS IN THE CARE OF CLIENTS WITH SEXAULLY TRANSMITTED INFECTIONS

A. Health history
 An STD (also known as a sexually transmitted infection [STI]) is a disease acquired through sexual contact
with an infected person.
 A sexual history allows you to identify those individuals at risk for STDs, including HIV, and to identify
appropriate anatomical sites for certain STD tests.
 Sexual health can greatly impact overall quality of life.
 The impact of STDs on a patient’s health can range from irritating to life threatening.
 Try to put patients at ease and let them know that taking a sexual history is an important part of a regular
medical exam or physical history

5 P’s
1. Partners
 Remember: Never make assumptions about the patient’s sexual orientation.
 It is important to determine the number and gender of your patient’s sex partners.
 Ask about the partner’s risk factors, such as current or past sex partners or drug use.
2. Practices
 If a patient has had more than one sex partner in the past 12 months or has had sex with a partner
who has other sex partners, you may want to explore further his or her sexual practices and
condom use (or non-use)
3. Protection from STDs
 Based on the answers, you may discern which direction to take the dialogue.
 Explore the subjects of abstinence, monogamy, condom use, the patient’s perception of his or
her own risk and his or her partner’s risk, and the issue of testing for STDs.
4. Past History of STDs
5. Prevention of Pregnancy
 You may determine that the patient is at risk of becoming pregnant or of fathering a child. If so,
first determine if pregnancy is desired.

B. Pathogenesis (Definition of terms)

a. Etiologic agent means a viable microorganism or its toxin which causes, or may cause, human
disease.
b. Incubation Period is the time between contact and development of the first signs and symptoms.
c. Period of communicability is the time period during which an infected person can spread their
infection to others.
d. Susceptibility is the state of being susceptible or easily affected / infected
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e. Resistance is defined as the ability to limit pathogen burden

C. Diagnostic Tests
 Gram Staining and Culture& Sensitivity- Gram stain where a sample is looked at under a
microscope after having a stain applied. A culture also helps determines what organism is
causing an infection by allowing the bacteria to grow to be better examined
and sensitivity determines how the organism can best be treated.
 Nucleic Acid Amplification Test- is a technique used to detect a particular nucleic acid sequence
and thus usually to detect and identify a particular species or subspecies of organism, often
a virus or bacteria that acts as a pathogen in blood, tissue, urine, etc.
o PCR- Polymerase Chain Reaction is a fast and inexpensive technique. A very small sample
of DNA is taken and amplified large enough amount to study in detail
 ELISA- Enzyme-Linked Immunosorbent Assay, is used to detect HIV infection
 Western Blot- detects the specific proteins (called HIV antibodies) that indicate an HIV infection.
The Western blot is used to confirm a positive ELISA

D. Analysis/ Nursing Diagnoses

 Deficient knowledge about the disease and risk for spread of infection and reinfection
 Anxiety related to anticipated stigmatization and to prognosis and complications
 Noncompliance with treatment
E. Planning
 Major goals are increased patient understanding of the natural history
 Treatment of the infection
 Reduction in anxiety
 Increased compliance with therapeutic and preventive goals
 Absence of complications.

F. Implementation

 Increasing Knowledge and Preventing Spread of Disease- Discussion should emphasize that the same
behaviors that led to infection with one STD increase the risk for any other STD, including HIV. The
relative value of condoms in reducing the risk for infection with STDs should be addressed.
 Reducing Anxiety- If the patient is especially apprehensive about this aspect, referral to a social worker
or other specialists may be appropriate.
 Increasing Compliance
 Monitoring and Managing Potential Complications
 Infertility and increase risk in ectopic pregnancy
 Congenital Infections. All STDs can be transmitted to infants in utero or at the time of birth
 Neurosyphilis, Gonococcal Meningitis, Gonoccocal arthritis, and Syphilitic Aortitis. STDs can
cause disseminated infection. The central nervous system may be infected, as seen in cases of
neurosyphilis or gonococcal
 HIV-related complications. HIV infection leads to the profound immunosuppression
characteristic of AIDS.

 Pharmacologic Therapy
1. Beta- Lactams- Penicillin
2. Cephalosporins- Cefriaxone
3. Macrolide- Azithromycin
4. Tetracycline- Doxycycline
5. Nitroimidazole- Metronidazole
6. Antiviral- Acyclovir
7. TCA-Trichloroacetic Acid
8. Antiretroviral Drugs-Efavirenz, Lamivudine, Ritonavir
 Nutritional Therapy
 Nausea and Vomiting- SFF, bland low-fat foods, avoid greasy/spicy food, cold food than hot foods
 Diarrhea-EOF, limit milk/caffeinated drinks, BRAT( Banana,Rice, Applesauce,toast),well-cooked
vegetables
 Lack of Appetite- exercise,don’t drink to much before meals, variety of textures,shapes,colors
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 Weight loss-dried fruits/nuts for snacks,more CHO CHON Fats, food supplements as prescribed
 Mouth/Swallowing Problems- eat soft food like yogurt/mashed potato, avoid raw foods, choose
softer fruits, no acidic foods like orange & lemons
G. Evaluation
1. Exhibits knowledge about STDs and their transmission
2. Demonstrates a less anxious demeanor
a. Discusses anxieties and goals for treatment
b. Inspects self for lesions, rashes, and discharge
c. Accepts support, education, and counseling when indicated
d. Assists with sharing information about infection with sexual partners
e. Discusses risk-reduction behaviors and safer sex practices
3. Complies with treatment
4. Achieves effective treatment
5. Reports for follow-up examinations if necessary
6. Absence of complications

II. SEXUALLY TRANSMITTED INFECTIONS

A. SYPHILIS
– etiologic agent: spirochete Treponema pallidum
– acquired through sexual contact or may be congenital in origin

Stages:
1. Primary Syphilis
 occurs 2-3 weeks after initial inoculation with the organism.
 CHANCRE- painless lesion at the site of infection
 these symptoms usually resolve on spontaneously within about 2 months

2. Secondary Syphilis
 spread of organism from the original chancre leads to generalized infection
 the rash occurs about 2 to 8 weeks after the chancre and involves the trunk and extremities, including
the palms of the hand and the soles of the feet.
 contact with these lesions can lead to transmission of the organism
 generalized s/s include: lymphadenopathy, arthritis, meningitis, hair loss, fever, malaise and weight
loss
 after this stage, there is a period of LATENCY -no s/s of syphilis

3. Tertiary Syphilis
 20%-40% of those infected does not exhibit s/s in this final stage
 slowly progressive disease with the potential to affect multiple organs
 most common manifestation: aortitis and neurosyphilis as evidenced by dementia, psychosis, paresis,
stroke or meningitis

Period of communicability: variable and indefinite

Assessment and Diagnostic Findings

• direct identification of the spirochete obtained from the chancre lesion of primary syphilis.
• Serologic test include:
-Nontreponemal or Reagin tests such as Venereal Disease Research Laboratory (VDRL) or the Rapid
Plasma Reagin Circle Card Test (RPR-CT)
-Treponemal test such as Fluorescent Treponemal Absorption Antibody Test (FTA-ABS) and
Microhemagglutination test (MHA-TP) are used to verify that the screening test did not represent a
false-positive result.

Incubation period: 10 days to 3 months, usually 3 weeks

Susceptibility and resistance:

 Susceptibility is universal, although only approximately 30% of exposures result in infection. Infection
leads to developing immunity against T. pallidum gradually and to some extent, but immunity usually

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fails to develop because of early treatment in the primary and secondary stages.

Medical Management
• Penicillin G benzathine is the medication of choice for early/ early latent syphilis of less than 1 year
duration. IM at a single session. Doxycycline if allergic to Pen G.
Nursing Management
• Lesions of primary and secondary syphilis are highy infective : wear gloves and hand hygiene
• Educate pt to refrain from sexual contact with previous or current partners until treated
• Condoms significantly reduce the risk of transmission of syphilis and other STI
• Having multiple partners increases the risk of acquiring syphilis and other STIs

B. GONORRHEA AND CHLAMYDIA

 most commonly reported infectious diseases in the United States.
 coinfection with C. trachomatis often occurs in patients infected with N. gonorrhoeae

Etiologic agent: Neisseria gonorrheae and Chlamydia trachomatis

Reservoir: Strictly a human disease
Mode of transmission: Sexual

Clinical Manifestations

Women:
- both C. trachomatis and N. gonorrhoeae infections frequently do not cause symptoms in women.
- but when present, dyspareunia, dysuria, bleeding and mucopurulent cervicitis with exudates in
the endocervical canal is the most frequent finding.
- with gonorrhoea, s/s of UTI and vaginitis can often occur
- If pregnant women are infected, stillbirth, neonatal death, and premature labor may occur
Men:
- burning during urination and penile discharge.
- Pus-like discharge from the tip of the penis
- with gonorrhea report of painful, swollen testicles is also present

Complications

o Women: pelvic inflammatory disease (PID), ectopic pregnancy, endometritis, and infertility
o Men: epididymitis (leads to infertility), urethritis
o Both: arthritis or bloodstream infection may be caused by N. gonorrhoeae.

Assessment and Diagnostic Findings

 The patient is assessed for fever, discharge (urethral, vaginal, or rectal), and signs of arthritis.
 N. gonorrhoeae : Gram stain (appropriate only for male urethral samples), culture, and nucleic acid
amplification tests (NAATs)
 Chlamydia: Gram stain and Direct Fluorescent Antibody
 samples are obtained from the endocervix ( female)/ urethra (male), anal canal, and pharynx.

Susceptibility and resistance: Susceptibility is general. No immunity following infection and reinfection is
common.

Medical Management

-the CDC recommends dual therapy even if only gonorrhea has been laboratory proven because of
coinfection
- Serologic testing for syphilis and HIV should be offered to patients with gonorrhea or chlamydia,
because any STD increases the risk of other STD infections.
-Chlamydia: Doxycycline or azithromycin (Zithromax)
- Gonorrhea:
* ceftriaxone (Rocephin), cefixime (Suprax)
* If the patient reports a new episode of symptoms or tests are positive for gonorrhea again, the
most likely explanation is reinfection rather than treatment failure.

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Nursing Management

 Gonorrhea and Chlamydia are reportable communicable diseases to ensure follow-up of the patient.
 The public health department also is responsible for interviewing the patient to identify sexual contacts,
so that contact notification and screening can be initiated.
 Target group for health teaching: teens and young adult population
 Along with reinforcing the importance of abstinence, when appropriate, education should address
postponing the age of initial sexual exposure, limiting the number of sexual partners, and using condoms
for barrier protection.
 Young women and pregnant women should also be instructed about the importance of routine screening
for chlamydia.
 Patients should be discouraged from assuming that a partner is “safe” without open, honest discussion.
Non-judgmental attitudes, educational counselling, and role playing may be helpful.
 Instructions also include the need for the patient to abstain from sexual intercourse until all of her sex
partners are treated (CDC, 2006a)

D. Trichomoniasis
- often called “trich”
- caused by infection with Trichomonas vaginalis, a flagellated protozoan
- more common in women than in men; may be transmitted by an asymptomatic carrier
- transmission: typically through vaginal, oral, or anal sex with an infected individual
- can also be passed from a mother to her baby at birth, as evidenced by the discovery of the parasite in
the newborn's lungs- babies born to infected mothers are more likely to have preterm delivery and low
birth weight
- In women, the most commonly infected part of the body is the lower genital tract (vulva, vagina, cervix,
or urethra)
- In men, the most commonly infected body part is the urethra
- may increase the risk of contracting HIV, in development of cervical neoplasia, postoperative infections,
adverse pregnancy outcomes, pelvic inflammatory disease (PID), and infertility

Clinical Manifestations
o Men:
- Itching or irritation inside the penis
- Burning after urination or ejaculation
- Discharge from the penis
o Women:
- Discomfort with urination;
- A change in their vaginal discharge (i.e., thin discharge or increased volume) that can be clear, white,
yellowish, or greenish with an unusual fishy smell
- An accompanying vulvitis may result, with vulvovaginal burning and itching

Assessment and Diagnostic Findings

- microscopic detection of the motile causative organisms or less frequently by culture
- Inspection with a speculum often reveals vaginal and cervical erythema (redness) with multiple small
petechiae (“strawberry spots”)
- Testing of a trichomonal discharge demonstrates a pH greater than 4.5.

Medical Management
 metronidazole or tinidazole (Tindamax)
- The most effective treatment for trichomoniasis
- Both partners receive a one-time loading dose or a smaller dose twice a day for 7 days
- Some patients complain of an unpleasant but transient metallic taste when taking metronidazole
- N/V, as well as a hot, flushed feeling can occur when this medication is taken with an alcoholic beverage
- Patients are strongly advised to abstain from alcohol during treatment and for 24 hours after taking
metronidazole or 72 hours after completion of a course
- of tinidazole
 Prevention:
- Abstinence
- Correct use of condoms
- monogamous relationship with a partner who has been tested and has negative STD test results

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Nursing Management
 Interventions to help reduce patient anxiety
 Avoiding unnecessary antibiotic agents, wearing cotton underwear, and douching
 treatment for woman and her partner, if indicated
 Advise to reduce tissue irritation caused by scratching or wearing tight clothing
 Vulvar self-examination- a good health practice for all women
 Educate patients about the risks of unprotected intercourse, particularly with partners who have had
sex with others

E. Genital Herpes (Herpes simplex virus)

- Is an STD caused by 2 types of viruses :

 herpes simplex virus type 1 (HSV-1)
 HSV-1 is mainly transmitted by oral-to-oral contact to cause oral herpes infection, via contact with
the HSV-1 virus in sores, saliva, and surfaces in or around the mouth
 can be spread through kissing or sharing objects such as toothbrushes or eating utensils
 vast majority of HSV-1 infections are oral herpes (infections in or around the mouth, sometimes
called orolabial, oral-labial or oral-facial herpes), but a proportion of HSV-1 infections are genital
herpes
 herpes simplex virus type 2 (HSV-2)
 HSV-2 infection is almost exclusively sexually transmitted, through contact with genital surfaces,
skin, sores or fluids of someone infected with the virus, causing genital herpes
 can be transmitted from skin in the genital or anal area that looks normal and is often transmitted
in the absence of symptoms
 is the main cause of genital herpes and is lifelong and incurable
 HSV-2 infection increases the risk of acquiring a new HIV infection by approximately three-fold
- Note: Genital herpes is mainly caused by HSV-2
- Sexual contact is the primary way that the virus spreads. After the initial infection, the virus ascends the
peripheral sensory nerves and remains inactive in the nerve ganglia and can reactivate several times a
year

Clinical Manifestations
- Genital herpes infections often have no symptoms, or mild symptoms that go unrecognized
- Itching and pain occur as the infected area becomes red and edematous
- macules and papules and progress to vesicles and ulcers
- The vesicular state often appears as a blister, which later coalesces, ulcerates, and encrusts. The lesions
last 2 to 12 days before crusting over.
- In women, the labia are the usual primary site, although the cervix, vagina, and perianal skin may be
affected
- In men, the glans penis, foreskin, or penile shaft is typically affected
- Inguinal lymphadenopathy
- minor temperature elevation, malaise, headache, myalgia and dysuria are often noted
- Pain is evident during the first week and then decreases

Complications
- Rarely, complications may arise from extragenital spread, such as to the buttocks, upper thighs, or even
the eyes, as a result of touching lesions and then touching other areas
- meningitis
- Neonatal herpes, although rare, can occur when an infant is exposed to HSV (HSV-2 or HSV-1) in the
genital tract during delivery. It is a serious condition that can lead to lasting neurologic disability or death
- severe emotional stress related to the diagnosis

Assessment and Diagnostic Findings

- The health history and a physical and pelvic examination
- The perineum is inspected for painful lesions
- Inguinal nodes are assessed and are often enlarged and tender during an occurrence of genital herpes
- Viral culture- involves taking a tissue sample or scraping of the sores for examination in the laboratory.
- Polymerase chain reaction (PCR) test- The DNA can then be tested to establish the presence of HSV and
determine which type of HSV is present.
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- Blood test to analyze a sample of blood for the presence of HSV antibodies to detect a past herpes
infection
Nursing Diagnosis
 Acute pain related to the genital lesions
 Risk for infection or spread of infection
 Anxiety related to the diagnosis
 Deficient knowledge about the disease and its management

Medical Management
 Currently, there is no cure for genital herpes infection, but treatment is aimed at relieving the symptoms.
 Management goals include preventing the spread of infection, making patients comfortable, decreasing
potential health risks, and initiating a counseling and education program
 acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir)—anti-viral agents which can
suppress symptoms and shorten the course of the infection; are effective at reducing the duration of
lesions and preventing recurrences
 Analgesics and a saline compress
 Prophylactic vaccine continues to be investigated in clinical trials

Nursing Management
 Assist with Sitz baths- may ease discomfort
 The patient is to be alert for possible bladder distention, and to contact primary provider immediately if
she cannot void because of discomfort
 Discomfort with urination can be reduced by pouring warm water over the vulva during voiding
 When oral antiviral agents are prescribed, the patient is instructed to note for rash and headache
 Encourage proper hand hygiene
 Provide health teachings:
o Abstain from sexual intercourse during treatment for active disease
o Avoid exposure to the sun, which can cause recurrences
o Avoid self-infection by not touching lesions during an outbreak
o Use barrier methods when engaging in intercourse to provide protection against viral transmission
o Inform sexual partners of herpes diagnosis as transmission is possible even in the absence of active
lesions
o Inform obstetric care provider about the history of genital herpes. In cases of recurrence at time
of delivery, cesarean section may be considered.
o Join a support group to share solutions and experiences and hear about newer treatments
o Take medication prescribed for outbreaks and avoid occlusive ointments, strong perfumed soaps,
or bubble bath.
o Take analgesic agents to control pain during outbreaks.
o Uses the appropriate hygiene practices including hand hygiene, perineal cleanliness, gentle
washing of lesions with mild soap and running water and lightly drying lesions
o Wears loose, comfortable clothing
o Eat a balanced diet; ingest adequate fluids get adequate rest during outbreaks.

F. Genital Warts (Human Papillomavirus/HPV)

- is the most common STI
- Most infections are self-limiting and without symptoms, and others can cause cervical and anogenital
cancers
- commonly causes skin or mucous membrane growths (warts)
- Of the more than 100 genotypes of HPV that exist, about 30 genotypes affect the anogenital tract
- Types 6 and 11-The most common strains of HPV; usually cause condylomata (warty growths) that can
appear on the vulva, vagina, cervix, and anus. HPV can be found in lesions of the skin, anus, penis, and
oral cavity
- Types 16 & 18- High-risk oncogenic types which affects the cervix, causing abnormal cell changes or
dysplasia found on a Papanicolaou [Pap] smear; It is thought that two proteins produced by high-risk
types of HPV interfere with tumor suppression by normal cells.
- Risk factors include having multiple sex partners, being an adolescent or young adult, having a weakened
immune system, having areas of punctured or open skin and contracting surfaces exposed to HPV such
as public showers or swimming pools
- Transmission

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o skin-to-skin contact; intercourse is not required for transmission to occur
o vaginal, anal, or oral sex with someone who has the virus
o The use of condoms can reduce the likelihood of transmission, but transmission can also occur
during skin-to skin contact in areas not covered by condoms
o HPV can be passed even when an infected person has no signs or symptoms

Complications
- Oral and upper respiratory lesions
- Certain strains of HPV can cause cervical cancer. These strains might also contribute to cancers of the
genitals, anus, mouth and upper respiratory tract
- HPV is also responsible for up to 70% of oropharyngeal cancers in the US, wh ich includes all
cancers of the oral cavity and oropharynx

Clinical Manifestations
o Genital warts
 appear as flat lesions, small cauliflower-like bumps or tiny stemlike protrusions.
 In women, genital warts appear mostly on the vulva but can also occur near the anus, on the
cervix or in the vagina.
 In men, genital warts appear on the penis and scrotum or around the anus. Genital warts rarely
cause discomfort or pain, though they may itch or feel tender.
o Common warts- appear as rough, raised bumps and usually occur on the hands and fingers; they can
also be painful or susceptible to injury or bleeding.
o Plantar warts-are hard, grainy growths that usually appear on the heels or balls of feet
o Flat warts- are flat-topped, slightly raised lesions. They can appear anywhere, but children usually get
them on the face and men tend to get them in the beard area. Women tend to get them on the legs.
o Condylomata are rarely premalignant but are an outward manifestation of the virus

Assessment and Diagnostic Findings

- Clinical examination of warts
o Vinegar (acetic acid) solution test
 The application of 3% or 5% acetic acid solution may detect genital mucosa infected with
HPV. The acid is applied to suspected mucosa to identify difficult to see flat lesions by
turning the affected area white.
o Pap test.
 sample of cells is collected from the cervix or vagina to send for laboratory analysis
 not diagnose HPV, however, HPV causes most of the cellular changes in abnormal Pap test
results.
 Doctors generally recommend repeating Pap testing every three years for women ages 21 to 65
 Women age 30 and older can consider Pap testing every five years if the procedure is combined
with testing for HPV.
o HPV DNA test
 detects high-risk HPV from scraped cervical cells
 conducted on cells from the cervix which can recognize the DNA of the high-risk varieties of HPV
that have been linked to genital cancers; recommended for women 30 and older in addition to
the Pap test.

Medical Management
 No cure for the virus; the goal of management is to relieve symptoms by removing any visible warts and
abnormal cells in the cervix
 Cryosurgery: Freezing the warts off with liquid nitrogen.
 Loop electrosurgical excision procedure (LEEP): Using a special wire loop to remove the abnormal cells.
 Electrocautery: Burning the warts off with an electrical current.
 Laser therapy: Using an intense light to destroy the warts and any abnormal cells.
 Prescription cream: Topical agents that can be applied by patients to external lesions which include
podofilox (Condylox) and imiquimod (Aldara)- not be used during pregnancy
 9-valent HPV vaccine (Gardasil 9 [9vHPV])
 88% effective in preventing the combined endpoint of persistent infection, genital warts, vulvar
and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to
HPV types

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 Initially approved in 2014, is the only available vaccine in the United States shown to decrease the
risk of certain cancers and precancerous lesions in males and females aged 9-45 years
 Children and adolescents aged 15 years and younger need two-rather than the previously
recommended three doses. The second dose should be given 6-12 months after the first dose.
 The schedule for older adolescents and young adults aged 15-45 years is 2-3 inoculations
(depending on immunization history) within 6 months
 is contraindicated for use in women who are pregnant

Nursing Management
 If the treatment includes application of a topical agent by the patient, the patient needs to be carefully
instructed in the use of the agent prescribed and must be able to identify the warts and be able to apply
the medication to them
 The patient is instructed to anticipate mild pain or local irritation with the use of these agents.
 For plantar warts, advise patient to wear shoes or sandals in public pools and locker rooms
 Healthcare professionals must remain alert to any preadolescent child who presents with
anogenital warts, as this may indicate sexual abuse. While the presence of anogenital warts is
not diagnostic for sexual abuse, it is suspicious and warrants further evaluation by a healthcare
provider
 Sexual partner counseling can decrease anxiety for the patient and their partner, and offer
opportunities for questions and education on the risk, potent ial infection, and counseling on
prevention.

HIV and AIDS

- HIV is the human immuno deficiency virus. Untreated HIV infects and kills CD4 cells.
- If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome)
- HIV infection in humans came from a type of chimpanzee in Central Africa.
- Two HIV strains have been identified: HIV-1 and HIV-2. HIV-1 is the prototype virus and is responsible
for most cases of AIDS in the United States. HIV-2 is found chiefly in West Africa, appears to be less easily
transmitted, and has a longer incubation period
- The median incubation period is 10 years
- Risks Associated with HIV Infection:
o Sharing infected injection drug use equipment
o Having sexual relations with infected individuals (both male and female)
o Infants born to mothers with HIV infection and/or who are breast-fedby HIV-infected mothers
o People who received organ transplants, HIV-infected blood, or blood products

A. Epidemiology

o Global situation and trends

 Since the beginning of the epidemic, 76 million people have been infected with the HIV virus and about
33 million people have died of HIV/AIDS
 Globally, 38.0 million [31.6–44.5 million] people were living with HIV at the end of 2019. Of these, 36.2
million were adults and 1.8 million were children (<15 years old), although the burden of the epidemic
continues to vary considerably between countries and regions
 The WHO African region remains most severely affected, with nearly 1 in every 25 adults (3.7%) living
with HIV and accounting for more than two-thirds of the people living with HIV worldwide

o HIV in the Philippines

 The first case of HIV infection in the Philippines was reported in 1984. Since then, there have been 68,401
confirmed HIV cases reported.
 94% of those diagnosed were male and 6% were female; At the time of diagnosis, more than half were
25-34 years old while (28%) were youth 15-24 years old
 Seventy-six percent (51,925) of the total diagnosed cases in the Philippines were reported from January
2014 to June 2019
 Report on the global HIV epidemic states that the number of new infections in the Philippines has more
than doubled in the past six (6) years from an estimated 4,300 in 2010 to an estimated 10,500 in 2016.
The Philippines has become the country with the fastest growing HIV epidemic in Asia and the Pacific,
and has become one of eight countries that account for more than 85% of new HIV infections in the
region

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B. HIV Transmission
- Higher amounts of HIV and infected cells in the body fluid are associated with the probability that the
exposure will result in infection
- Human immune deficiency virus type 1 (HIV-1) is transmitted in body fluids (blood, seminal fluid, vaginal
secretions, amniotic fluid, and breast milk) that contain infected cells through:
o sexual contact
o the use of needles contaminated by an HIV-infected person
o by blood or other HIV-infected fluids coming in contact with open lesions or mucous membranes
o Deep, open-mouth kissing if both partners have sores or bleeding gums and blood from the HIV-positive
partner gets into the bloodstream of the HIV-negative partner. HIV is not spread through saliva.
o Mother-to-child transmission of HIV-1 may occur in utero, at the time of delivery, or through breast-
feeding, but most perinatal infections are thought to occur after exposure during delivery.
o HIV is not transmitted through casual contact
o Blood and blood products can transmit HIV to recipients (generally blood products given between 1977
and 1985). However, the risk associated with transfusions has been virtually eliminated as a result of
voluntary self-deferral, completion of a detailed health history, extensive testing, heat treatment of
clotting factor concentrates, and more effective virus inactivation methods. Donated blood is tested for
antibodies to HIV-1 and human immunodeficiency virus type 2

C. Prevention

 Pre-exposure prophylaxis (PrEP)

- involves taking one pill containing two HIV medications (tenofovir disoproxil fumarate 300 mg and
emtricitabine 200 mg [Truvada]) daily in order to avoid the risk of sexual HIV acquisition in adults and
adolescents age 12 and older
 HIV status should be checked every 3 months to be sure that the person has not become infected.
 Prevention of HIV infection is achieved through:
o behavioral interventions have been effective in reducing the risk of acquiring or transmitting HIV by
ensuring that people have the information, motivation, and skills necessary to reduce their risk;
o HIV testing, because most people change behaviors to protect their partners if they know they are
infected with HIV
o linkage to treatment and care, which enables individuals with HIV to live longer, healthier lives and
reduce their risk of transmitting HIV
 Other than abstinence, consistent and correct use of condoms is the only effective method to decrease
the risk of sexual transmission of HIV infection

HEALTH PROMOTION:

All patients should be advised to:

 Abstain from exchanging sexual fluids (semen and vaginal fluid)
 Reduce the number of sexual partners to one
 Always use latex condoms. If the patient is allergic to latex, nonlatex condoms should be used; however,
they will not protect against HIV infection.
 Avoid using cervical caps or diaphragms without using a condom as well
 Always use dental dams (a flat piece of latex used by dentists to isolate a tooth for treatment) for oral–
genital or anal stimulation
 Avoid anal intercourse, because this practice may injure tissues; if not possible, use lubricant—there are
water and silicone-based products designed for anal sex.
 Avoid manual–anal intercourse (“fisting”)
 Avoid sharing needles, razors, toothbrushes, sex toys, or blood contaminated articles.
 Consider PrEP if regularly engage in high-risk behaviors

Patients who are HIV seropositive should also be advised to:

 Inform previous, present, and prospective sexual and drug-using partners of their HIV-positive status. If
the patient is concerned for their safety, advise the patient that many states have established
mechanisms through the public health department in which professionals are available to notify exposed
contacts.
 Avoid having unprotected sex with another HIV-seropositive person
 Not donate blood, plasma, body organs, or sperm.

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 ART, antiretroviral therapy; PrEP, pre-exposure prophylaxis.
 Total abstinence from addictive drugs might not be a realistic short-term goal.
 Other safe and effective woman-controlled methods such as microbicides remain elusive although
clinical trials continue globally. Microbicides are gels, films, or suppositories that can kill or neutralize
viruses and bacteria; vaginal and rectal microbicides are being researched to see if they can prevent
sexual transmission of HIV.
 Using a HARM REDUCTION FRAMEWORK:
 is an evidence-based, client-centered approach that seeks to reduce the health and social harms
associated with addiction and substance use, without necessarily requiring people who use
substances from abstaining or stopping
 acknowledges that many individuals coping with addiction and problematic substance use may
not be in a position to remain abstinent from their substance of choice
 those who engage in harm reduction services are more likely to engage in ongoing treatment as
a result of accessing these services
 Needle Exchange Programs- a type of harm reduction framework that helps protect individuals
from blood-borne infections like HIV, AIDS and hepatitis by getting used syringes off the streets,
thus reducing the potential for drug users to share a contaminated needle. These programs allow
a person who injects drugs to bring back his or her used needle and/or syringe and receive free,
sterile replacements. Because the exchange is made in person, it offers health care workers an
opportunity to engage people who inject drugs in counseling for health, HIV prevention and
treatment referral

Related Reproductive Education

 Attempts to achieve pregnancy by couples in which only one partner has HIV expose the unaffected
partner to the virus: Efforts at artificial insemination using processed semen from an HIV-infected
partner continue.
 Women who are HIV positive should be instructed not to breast-feed their infants, because HIV is
transmitted through breast milk.
 An increased risk of HIV infection in women is associated with hormonal contraceptive use, but a cause-
and-effect relationship has not been established
 Women who are HIV negative and who use hormonal contraceptives to prevent pregnancy should be
encouraged to use methods to block HIV infection including PrEP

Prevention in Lesbian, Gay, Bisexual, and Transgender

 LGBT youth, in particular, are at higher risk for contracting HIV
 this population experiences significant challenges due to family rejection, lack of social support, stigma,
isolation, minority stress, as well as abuse and harassment
 Nurses need to be nonjudgmental in order to be effective in educating this population about
prevention methods
 The risk of female-to-female sexual transmission is rare but Transmission is possible through sharing of
sex toys and exposure to blood during sex
 Gay and bisexual men can take the following steps to reduce their risk of HIV infection:
 Choose less risky sexual behaviors: Receptive anal sex is the riskiest type of sex for getting HIV.
Insertive anal sex (topping) is less risky for getting HIV than receptive anal sex (bottoming)
 Limit the number of sex partners
 Using condoms correctly
 Consider pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP)
 Geting tested for HIV: CDC recommends that all sexually active gay and bisexual men get
tested for HIV at least once a year. Some sexually active gay and bisexual men may benefit
from getting tested more often, for example, every 3 to 6 months.

Reducing the Risk of Transmission to Health Care Providers:

 Implementation of appropriate hand hygiene measures remains the most effective measure to prevent
transmission of organisms.
 Standard precautions are used when working with all patients in all health care settings, regardless of
their diagnosis or presumed infectious status.

D. Post-exposure prophylaxis to HC Providers

Initial management steps for healthcare personnel exposed to HIV include the following:

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 Immediate decontamination
o For percutaneous or cutaneous exposure, washing of the area with soap and water;
o for mucous membrane exposure or eye exposures, copious irrigation of the area with water or
sterile saline;
o for puncture wounds, cleanse with alcohol-based hand wipes
 Initiation of institutional PEP plan - Reporting of exposure; confirmation of medication availability;
provision of the initial supply; authorizing release of the drugs; determination of how the healthcare
worker will obtain the medications to complete the 28-day regimen
 Ordering of blood tests, immediate treatment, and follow-up within 72 hours, at which time further
review and evaluation can be carried out
 Source of exposure - Voluntary testing for HIV, hepatitis C virus antibody, and hepatitis B surface antigen
(HBsAg); if HIV test is positive, confirmatory HIV 1/2 Ab differentiation immunoassay; if HIV infection is
known to be present, obtain relevant information about disease stage
 Healthcare worker - Testing for HIV, HCV antibody, HBsAg, and hepatitis B surface antibody (HBsAb); in
females of child-bearing age, pregnancy testing; if HIV PEP is initiated, baseline complete blood (CBC)
count, renal and hepatic function
 When indicated, PEP should be initiated as soon as possible The approach to PEP depends on the type
of exposure, the source, and the HIV status of the source.
 Post-exposure prophylaxis (PEP)
 includes taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days)
after possible HIV exposure
 the sooner the better; every hour counts after a possible exposure to HIV to prevent the virus
from taking hold in your body
 Health care workers who are exposed to a needle stick involving HIV infected blood in a health
care setting have a 0.23% risk of becoming HIV infected
 Other applicable situations: Think you may have been exposed to HIV during sex (for example,
had a condom break), Shared needles or works to prepare drugs, Were sexually assaulted
 It is not a substitute for regular use of other proven HIV prevention methods, such as pre-
exposure prophylaxis (PrEP)
 PEP is a combination of three drugs taken once or twice a day for 28 days:
o For adults, the CDC recommends tenofovir, emtricitabine (these two drugs come in one pill), and a
third drug, either raltegravir or dolutegravir.
o Women who are in early pregnancy, who are sexually active and could become pregnant while
taking PEP, or who were sexually assaulted without birth control should take raltegravir rather than
dolutegravir because of a risk of birth defects.
 Follow-up HIV antibody testing
 Rechecking of CBC, renal function, and hepatic function at 2 weeks

E. Pathophysiology

Review about the viral structure:

 Viruses cannot survive or replicate without a host, and can only
do so inside a living cell.
 One commonality of viral, bacterial and human cells is that they
possess genetic material that contains all the information
needed to build and maintain an organism. In humans and
bacteria, this is called deoxyribonucleic acid (DNA). In viruses
such as HIV, genetic data is organised into single strands; this is
called ribonucleic acid (RNA).
 The RNA present in a virus is protected by a protein coat called
a capsid. Outside the capsid are enzymes the virus uses to infect
its host and replicate. These structures are surrounded by an
envelope comprising glycoproteins, which help the virus
identify and bind to its target

HIV:
 HIV targets and infects a particular type of T-cell called CD4 ‘helper’ cells. These are so called because
they do not kill or neutralize foreign antigens but, instead, signal to and recruit other immune cells to do
so.

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 After entering a host’s body, HIV rapidly seeks out the CD4 cells and infects them.
 The virus commandeers the function of the CD4 cells, turning them into factories that produce multiple
new copies of the virus; between 10 million and 10 billion new virus cells can be produced daily.
 Once infected, CD4 cells develop a much shorter lifespan and are eventually destroyed; their
progressively declining number in the host causes immunological failure and susceptibility to infection.

F. Stages of HIV Disease, Clinical Manifestations & Squelae

 Stage 1: Acute HIV Infection
- Within 2 to 6 weeks after infection with HIV, about two-thirds of people will have a flu-like illness. This
is the body’s natural response to HIV infection.
- These symptoms can last anywhere from a few days to several weeks. But some people do not have any
symptoms at all during this early stage of HIV.
- Only antigen/antibody tests or nucleic acid tests (NATs) can diagnose acute infection.
- Flu-like symptoms can include:
o Fever
o Chills
o Rash
o Night sweats
o Muscle aches
o Sore throat
o Fatigue
o Swollen lymph nodes
o Mouth ulcers
- Early testing is important because :
1. At this stage, levels of HIV in blood and bodily fluids are very high. This makes it especially contagious
2. starting treatment as soon as possible might help boost your immune system and ease your symptoms

 Stage 2: Chronic HIV Infection

- This stage is also called asymptomatic HIV infection or clinical latency.
- HIV is still active but reproduces at very low levels.
- People may not have any symptoms or get sick during this phase.
- Without taking HIV medicine, this period may last a decade or longer, but some may progress faster.
- At the end of this phase, the amount of HIV in the blood (called viral load) goes up and the CD4 cell count
goes down. CD4+ T-lymphocyte cells are between 200 and 499.
- The person may have symptoms as the virus levels increase in the body, and the person moves into Stage
3. People who take HIV medicine as prescribed may never move into Stage 3.

 Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

- The most severe phase of HIV infection.
- People with AIDS have such badly damaged immune systems that they get an increasing number of
severe illnesses, called opportunistic infections
- CD4 T-cell number drops below 200 and your immune system is badly damaged.,
- People with AIDS can have a high viral load and be very infectious.
- People with AIDS who do not take medication live about 3 years, or less if they get another infection but HIV
can still be treated at this stage.
- The CDC's definition of AIDS includes:
o Candidiasis of bronchi, esophagus, trachea or lungs
o  Less
Cervical than
cancer that 200 CD4+ T cells per cubic millimeter of blood, compared with about 1,000 CD4+ T
is invasive
o Coccidioidomycosis that has spread
o cells for healthy people.
Cryptococcosis that is affecting the body outside the lungs
o  CD4+ T cells
Cryptosporidiosis accounting
affecting the intestinesfor
and less
lastingthan 14 percent
more than a month of all lymphocytes, a type of white blood cell.
o  One of more of the illnesses listed below:
Cytomegalovirus disease outside of the liver, spleen or lymph nodes
o Cytomegalovirus retinitis that occurs with vision loss
o Encephalopathy that is HIV-related
o Herpes simplex including ulcers lasting more than a month or bronchitis, pneumonitis or esophagitis
o Histoplasmosis that has spread
o Isosporiasis affecting the intestines and lasting more than a month
o Kaposi's sarcoma
o Lymphoma that is Burkitt type, immunoblastic or that is primary and affects the brain or central nervous system
o Mycobacterium avium complex or disease caused by M kansasii
o Mycobacterium tuberculosis in or outside the lungs
o Other species of mycobacterium that has spread
o Pneumocystis jiroveci, formerly called carinii, pneumonia
o Pneumonia that is recurrent
o Progressive multifocal leukoencephalopathy
o Salmonella septicemia that is recurrent
o Toxoplasmosis of the brain, also called encephalitis
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Wasting syndrome caused by HIV infection

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Some OPPORTUNISTIC INFECTIONS WITH AIDS:

 Pneumocystis pneumonia (PCP)
- a serious infection caused by the fungus Pneumocystis jirovecii
- The most common manifestations are subacute onset of progressive dyspnea, fever, nonproductive
cough, and chest discomfort that worsens within days to weeks
- Oral thrush is a common co-infection
- Because clinical presentation, blood tests, and chest radiographs are not pathognomonic for PCP, and
because the organism cannot be cultivated routinely, histopathologic or cytopathologic demonstration
of organisms in tissue, bronchoalveolar lavage fluid, or induced sputum samples is required for a
definitive diagnosis

 Oropharyngeal candidiasis
- Is a fungal infection characterized by painless, creamy white, plaque-like lesions that can occur on the
buccal surface, hard or soft palate, oropharyngeal mucosa, or tongue surface

 HIV Wasting Syndrome

- is defined as the involuntary loss of more than 10% of one’s body weight while having experienced
diarrhea or weakness and fever for more than 30 days
- Wasting refers to the loss of muscle mass, although part of the weight loss may also be due to loss of
fat.

 Kaposi Sarcoma
- is a type of cancer that forms in the lining of blood and lymph vessels.
- The tumors (lesions) of Kaposi's sarcoma typically appear as painless purplish spots on the legs, feet or
face. Lesions can also appear in the genital area, mouth or lymph nodes
- In severe Kaposi's sarcoma, lesions may develop in the digestive tract and lungs
- Involvement of internal organs may eventually lead to organ failure, hemorrhage, infection, and death.

 Peripheral Neuropathy
- can by caused by the virus itself, by certain drugs used in the treatment of HIV/AIDS or other
complications, or as a result of opportunistic infections like cytomegalovirus [CMV], candidiasis
[thrush], herpes, tuberculosis
- symptoms patients usually experience include burning, stiffness, prickling, tingling, and numbness or a
loss of feeling in the toes and soles of the feet. Sometimes the nerves in the fingers, hands, and wrists
are also affected

 HIV encephalopathy
- was formerly referred to as AIDS dementia complex
- HIV causing the brain to swell
- HIV has been found in the brain and cerebrospinal fluid (CSF)
- Early manifestations include memory deficits, headache, difficulty concentrating, progressive confusion,
psychomotor slowing, apathy, and ataxia
- Later stages include global cognitive impairments, delay in verbal responses, a vacant stare, psychosis,
hallucinations, tremor, incontinence, seizures, mutism, and death.

 Depressive Manifestations
- Estimates suggest that the prevalence of current depression is between 30% and 40% in persons with
HIV/AIDS.
- Similarly, apathy, which refers to reduced, self-initiated, cognitive, emotional, and behavioral activity, is
also commonly reported among those living with a diagnosis of HIV with rates as high as 65%

G. Diagnostic Findings
- HIV can be diagnosed through blood or saliva testing.
- Blood tests can detect HIV infection sooner after exposure than oral fluid tests because the level of
antibody in blood is higher than it is in oral fluid. Likewise, antigen/antibody and RNA tests detect
infection in blood before antibody tests.
- The CDC recommends at least one HIV test for everyone ages 13 to 64 years. Yearly testing is
recommended if you are at higher risk of infection. The CDC recommends that sexually active gay and
bisexual men consider testing every three to six months
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 primary tests for diagnosing HIV and AIDs include:

 ELISA Test
 enzyme-linked immunosorbent assay, used to detect HIV infection
 detects antibodies in the blood
 If an ELISA test is positive, the Western blot test is usually administered to confirm the diagnosis.
 If an ELISA test is negative but the patient thinks he/she has HIV, he/she should be tested again
in one to three months.
 ELISA is quite sensitive in chronic HIV infection, but because antibodies are not produced
immediately upon infection, the patient may test negative during a window of a few weeks to a
few months after being infected. During this window, the patient may have a high level of the
virus and be at risk of transmitting infection.
 Home Tests- The only home test approved by the U.S. Food and Drug which is sold in pharmacies.
 Saliva Tests - A cotton pad is used to obtain saliva from the inside of the cheek. The pad is placed in a
vial and submitted to a laboratory for testing. Results are available in three days. Positive results should
be confirmed with a blood test.
 Viral Load Test
 measures the amount of HIV in the blood
 Generally used to monitor treatment progress or detect early HIV infection.
 Three technologies measure HIV viral load in the blood — reverse transcription polymerase chain
reaction (RT-PCR), branched DNA (bDNA) and nucleic acid sequence-based amplification assay
(NASBA). The basic principles of these tests are similar. HIV is detected using DNA sequences
that bind specifically to those in the virus.
 Western Blot - is a very sensitive blood test used to confirm a positive ELISA test result.

 If a patient receives a diagnosis of HIV/AIDS, several tests can determine the stage of your disease and
the best treatment, including:
 CD4 T cell count-CD4 T cells are white blood cells that are specifically targeted and destroyed by HIV.
Even if the patient has no symptoms, HIV infection progresses to AIDS when the CD4 T cell count dips
below 200.
 Viral load (HIV RNA)- This test measures the amount of virus in the blood. After starting HIV treatment,
the goal is to have an undetectable viral load. This significantly reduces your chances of opportunistic
infection and other HIV-related complications.
 Drug resistance. Some strains of HIV are resistant to medications. This test helps determine if the
specific form of the virus has resistance and guides treatment decisions.

 Other Screening Tests to aid diagnosis:

 CBC, PPD for presence of TB, Cultures for opportunistic infections, Biopsies for neoplastic lesions

H. Medical Management

Antiretroviral Therapy (ART)

- cannot cure HIV, but helps people with HIV live longer, healthier lives and also reduces the risk of HIV
transmission
- is usually a combination of three or more medications from several different drug classes. This approach
has the best chance of lowering the amount of HIV in the blood.
- There are many ART options that combine three HIV medications into one pill, taken once daily.
- Two drugs from one class, plus a third drug from a second class, are typically used
- categories of antiretroviral drugs:
 Nucleoside reverse transcriptase inhibitors (NRTIs)
o block the action of an enzyme called viral reverse transcriptase, which is necessary for HIV to
replicate.
o Examples: tenofovir (Viread), lamivudine (Epivir) and zidovudine (Retrovir)
 Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
o NNRTIs work similarly to NRTIs. The only difference is that they act on different sites of the
enzyme.
o Examples: efavirenz (Sustiva)
 Protease inhibitors (PIs)
o impede another viral enzyme, HIV protease. HIV requires protease to replicate.
o Examples: lopinavir/ritonavir (Kaletra)

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 Entry inhibitors
o prevent the virus from entering the targeted cells.
o To penetrate immune cells, HIV must fuse to the cells’ receptors, and these drugs work to stop
this from happening.
o Examples: enfuvirtide (Fuzeon)
 Integrase inhibitors
o HIV uses a protein called integrase to send its genetic material into the cells that it targets.
Integrase inhibitors block this action.
o Examples: dolutegravir (Tivicay)

Other management:
 Treatment of opportunistic infections. For Pneumocystis pneumonia, trimethoprim–sulfamethoxazole
(TMP-SMP)is the treatment of choice
 Antidiarrheal therapy. Therapy with octreotide acetate (Sandostatin), a synthetic analog of
somatostatin, has been shown to be effective in managing severe chronic diarrhea.
 Antidepressant therapy. involves cognitive behavioral therapy integrated with pharmacotherapy.
 Nutrition therapy. For all AIDS patients who experience unexplained weight loss, calorie counts should
be obtained, and appetite stimulants and oral supplements are also appropriate.

I. Complementary and Alternative Therapies

Alternative medicine
- many may interfere with other medications being taken
- Supplements that may be helpful
o Acetyl-L-carnitine. It may also ease neuropathy linked to HIV if the patient is lacking in the substance.
o Whey protein and certain amino acids. Early evidence suggests that whey protein, a cheese byproduct,
can help some people with HIV gain weight. Whey protein also appears to reduce diarrhea and increase
CD4 T cell counts. The amino acids L-glutamine, L-arginine and hydroxymethylbutyrate (HMB) may also
help with weight gain.
o Probiotics. There is some evidence that the probiotic Saccharomyces boulardii may help with HIV-
related diarrhea, but use only as directed by the doctor
o Vitamins and minerals
- Supplements that may be dangerous:
o St. John's wort. A common depression remedy, St. John's wort can reduce the effectiveness of several
types of anti-HIV drugs by more than half.
o Garlic supplements. Although garlic itself may help strengthen the immune system, garlic supplements
may interact with some anti-HIV drugs and reduce their ability to work. Occasionally eating garlic in food
appears to be safe.
o Red yeast rice extract. Some people use this to lower cholesterol, but it must be avoided if taking a
protease inhibitor or a statin.

J. Nursing Management

 PROMOTING SKIN INTEGRITY

 The skin and oral mucosa are assessed routinely
 The patient is encouraged to maintain a balance between rest and mobility whenever possible.
 Patients who are immobile are assisted to change position at least every 2 hours and more often as
needed.
 Regular oral care is also encouraged.
 Skin surfaces are protected from friction and rubbing by keeping bed linens free of wrinkles and avoiding
tight or restrictive clothing
 The perianal region is assessed frequently for impairment of skin integrity and infection.
 PROMOTING USUAL BOWEL PATTERNS
 The nurse monitors the frequency and consistency of stools and the patient’s reports of abdominal pain
or cramping associated with bowel movements.
 The quantity and volume of liquid stools are measured to document fluid volume losses.
 As the patient’s dietary intake is increased, foods that act as bowel irritants, such as raw fruits and
vegetables, popcorn, carbonated beverages, spicy foods, and foods of extreme temperatures, should be
avoided.
 Small, frequent meals help to prevent abdominal distention.

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 anticholinergic agents, antispasmodic agents, or opioids, can be prescribed to decrease diarrhea by
reducing intestinal spasms and motility.
 PREVENTING INFECTION
 monitor for signs and symptoms of infection
 The nurse also monitors laboratory test results that indicate infection
 IMPROVING ACTIVITY TOLERANCE
 Assistance in planning daily routines that maintain a balance between activity and rest may be necessary.
 energy conservation techniques, such as sitting while washing or preparing meals.
 Personal items that are frequently used should be kept within the patient’s reach.
 relaxation and guided imagery may be beneficial
 MAINTAINING COHERENT THOUGHT PROCESSES
 The patient is assessed for alterations in mental status
 Reorientation to surroundings and location is conducted as needed.
 Activities that the patient previously enjoyed are encouraged.
 IMPROVING AIRWAY CLEARANCE
 Respiratory status, as well as mental status and skin color, must be assessed
 Pulmonary therapy (coughing, deep breathing, postural drainage, percussion, and vibration) is provided
as often as every 2 hours to prevent stasis of secretions and to promote airway clearance.
 Adequate rest is essential to minimize energy expenditure and prevent excessive fatigue
 Humidified oxygen may be prescribed, and nasopharyngeal or tracheal suctioning, intubation, and
mechanical
ventilation may be necessary to maintain adequate ventilation.
 RELIEVING PAIN AND DISCOMFORT
 The patient is assessed for the quality and severity of pain associated with impaired perianal skin
integrity, the lesions of KS, and peripheral neuropathy.
 Antispasmodic and antidiarrheal medications may be prescribed to reduce the discomfort and frequency
of bowel movements.
 Pain management may include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids
plus nonpharmacologic approaches
 IMPROVING NUTRITIONAL STATUS
 Nutritional status is assessed by monitoring weight; dietary intake; and serum albumin, BUN, protein,
and transferrin levels.
 implement specific measures to facilitate oral intake.
 The dietitian is consulted to determine the patient’s nutritional requirements.
 The patient is encouraged to eat foods that are easy to swallow and to avoid spicy or sticky food items
and foods that are excessively hot or cold.
 Patients who cannot maintain their nutritional status through oral intake may require enteral feedings
or parenteral nutrition.
 DECREASING THE SENSE OF ISOLATION
 People with AIDS are at risk for double stigmatization
 People with HIV infection may be overwhelmed with emotions such as anxiety, guilt, shame, and fear.
 Nurses are in a key position to provide an atmosphere of acceptance and understanding for people with
AIDS and their social networks.
 IMPROVING KNOWLEDGE OF HIV
 The patient and family are educated about HIV infection
 The patient is instructed to avoid others with active infections, such as upper respiratory infections

 Health Teachings on proper condom use: (source: CDC)

Condom Do’s
 use a condom every time you have sex.
 put on a condom before having sex.
 read the package and check the expiration date.
 make sure there are no tears or defects.
 store condoms in a cool, dry place.
 use latex or polyurethane condoms.
 use water-based or silicone-based lubricant to prevent breakage.

Condom Don’ts
 store condoms in your wallet as heat and friction can damage them.

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 use nonoxynol-9 (a spermicide), as this can cause irritation.
 use oil-based products like baby oil, lotion, petroleum jelly, or cooking oil because they will cause the
condom to break.
 use more than one condom at a time.
 reuse a condom.

K. Emotional and Ethical Concerns

REPUBLIC ACT No. 11166 :Philippine HIV and AIDS Policy Act
- Approved: December 20, 2018
SCREENING, TESTING AND COUNSELING
- In every circumstance, proper counseling shall be conducted by a social worker, a health care provider,
or other health care professional accredited by the DOH or the DSWD

 Section 29. HIV Testing

 As a policy, the State shall encourage voluntary HIV testing. Written consent from the person taking the
test must be obtained before HIV testing.
 HIV testing shall be made available under the following circumstances:
a) 15- 18 years of age: consent to voluntary HIV testing shall be obtained from the child without the need
of consent from a parent or guardian;
b.) Any young person aged below fifteen (15) who is pregnant or engaged in high-risk behavior: with the
assistance of a licensed social worker or health worker; Consent to voluntary HIV testing shall be obtained
from the child without the need of consent from a parent or guardian
c.) below 15 years of age and mentally incapacitated: consent to voluntary HIV testing shall be obtained
from the child's parent or legal guardian

 Section 30. Compulsory HIV testing shall be allowed only in the following instances:
 When it is necessary to test a person who is charged with serious and slight physical injuries, and on rape
and simple seduction
 When it is necessary to resolve relevant issues under "The Family Code of the Philippines"
 As a prerequisite in the donation of blood

 Section 31. Routine HIV Counseling and Testing

the DOH shall:
 Accredit public private HIV testing facilities based on capacity to deliver testing services including HIV
counseling
 Develop the guidelines for HIV counseling and testing
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 Accredit institutions or organizations that train HIV and AIDS counselors in coordination with DSWD;
 Accredit competent HIV and AIDS counselors for persons with disability
 Set the standards for HIV counseling
 Ensure access to routine provider-initiated counseling and testing as part of clinical are in all health care
in all health care settings for the public.
 All HIV testing facilities shall provide free pre-test and post-test HIV counseling to individuals who wish
to avail of HIV testing, which shall likewise be confidential.
 No HIV testing shall be conducted without informed consent.
 Pre-test counseling and post-test counseling shall be done by the HIV and AIDS counselor, licensed social
worker, licensed health service provider for free.

 Section 32. HIV Testing for Pregnant Women- A health care provider who offers pre-natal medical care
shall offer provider-initiated HIV testing for pregnant women.

CONFIDENTIALITY
 Section 44. Confidentiality
- The confidentiality and privacy of any individual who has been tested for HIV, has been exposed to HIV,
has HIV infection or HIV- and AIDS-related illnesses, or was treated for HIV-related illnesses shall be
guaranteed.
Violations:
 Disclosure of Confidential HIV ad AIDS Information. - Unless otherwise provided, it shall be unlawful to
disclose, without written consent, information that a person has AIDS, has undergone HIV-related test,
has HIV infection or HIV-related illnesses, or has been exposed to HIV.
Penalty: Six months to two years of imprisonment for any person who breaches confidentiality, and/or a
fine of P50,000.00 to P150,000.00

 Media Disclosure. - It shall be unlawful for any editor, publisher, reporter or columnist, or any announcer
or producer or any other individual or organization in case of social media, to disclose the name, picture,
or any information that would reasonably identify persons living with HIV and AIDS, or any confidential
HIV and AIDS information, without the prior written consent of their subjects except when the persons
waive said confidentiality through their own acts and omissions
Penalty: Two years and one (1) day to five (5) years of imprisonment for any person who causes the mass
dissemination of the HIV status of a person, and/or a fine of P150,000.00 to P350,000.00

 Section 45. Exceptions

- Confidential HIV and AIDS information may be released by HIV testing facilities without consent:
 When informing other health workers directly involved in the treatment or care. Provided, that such
worker shall be required to perform the duty of shared medical confidentiality; and
 When responding to a subpoena issued by a court with jurisdiction over a legal proceeding where the
main issue is the HIV status of an individual: Provided, That the confidential medical record shall remain
anonymous and unlinked and shall be properly sealed by its lawful custodian, hand delivered to the
court, and personally opened by the judge

 Section 46. Disclosure of HIV-Related Test Results

 The result of any test related to HIV shall be disclosed by the trained service provider who conducts pre-
test and post-test counseling only to the individual who submitted to the test.
 below fifteen (15) years old, an orphan, or is mentally incapacitated:the result may de disclose to either
of the patient's parents, legal guardian, or a duly assigned licensed social worker or health worker
 below fifteen(15) years of age and not suffering from any mental incapacity, has given voluntary and
informed consent to the procedure: the result of the test shall be disclose to child: Provided,
further, That the child should be given age-appropriate counseling and access to necessary health care
and sufficient support services.

 Section 47. Disclosure to Persons with Potential Exposure to HIV

 Any person who, after having been tested, is found to be infected with HIV is strongly encouraged to
disclose this health condition to the spouse, sexual partners, and/or any person prior to engaging in
penetrative sex or any potential exposure to HIV
 A person living with HIV may seek help from qualified professionals including medical professionals
health workers, peer educators, or social workers to support him in disclosing this health condition to
one's partner or spouse

NURSING CARE 0F CLIENTS WITH STIS, HIV & AIDS COMPILED BY: AC MINOZA & EK VILLARANTE, 2020
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 Confidentiality shall likewise be observed
 Further the DOH shall establish an enabling environment to encourage newly tested HIV positive
individuals to disclose their status to partners.

DISCRIMINATORY ACTS AND PRACTICES AND CORRESPONDING PENALTIES

 Section 49. Discriminatory Acts and Practices

- The following shall be prohibited:
 Discrimination in Hospitals and Health Institutions - Denial of health services, or being charges with a
higher fee, on the basis of actual, perceived or suspected HIV status is discriminatory act and is
prohibited;
 Denial of Burial Services- Denial of embalming and burial services for a decease person who had HIV and
AIDS or who was known, suspected, or perceived to be HIV-positive;
 Act of Bullying- Bullying in all forms, including name-calling, upon a person based on actual, perceived,
or suspected HIV status, including bullying in social media and other online portals; and
 Others:
 Discrimination in the Workplace
 Discrimination in Learning Institution
 Restriction on Travel and Habitation
 Restrictions on Shelter
 Prohibition from Seeking or Holding Public Office
 Exclusion from Credit and Insurance Services

NURSING CARE 0F CLIENTS WITH STIS, HIV & AIDS COMPILED BY: AC MINOZA & EK VILLARANTE, 2020