Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 21: Neurocognitive Disorders

Table 21.5-4 AIDS Safe-Sex Guidelines

Table 21.5-5 Centers for Disease Control and Prevention Guidelines for the Prevention of HIV Transmission from Infected to Uninfected Persons Infected persons should be counseled to prevent the further transmission of HIV by: 1. Informing prospective sex partners of their infection with HIV so they can take appropriate precautions. Abstention from sexual activity with another person is one option that would eliminate any risk of sexually transmitted HIV infection. 2. Protecting a partner during any sexual activity by taking appropriate precautions to prevent that person’s coming into contact with the infected person’s blood, semen, urine, feces, saliva, cervical secretions, or vaginal secretions. Although the efficacy of using condoms to prevent infections with HIV is still under study, the consistent use of condoms should reduce the transmission of HIV by preventing exposure to semen and infected lymphocytes. 3. Informing previous sex partners and any persons with whom needles were shared of their potential exposure to HIV and encouraging them to seek counseling and testing. 4. For IV drug abusers, enrolling or continuing in programs to eliminate the abuse of IV substances. Needles, other apparatus, and drugs must never be shared. 5. Never sharing toothbrushes, razors, or other items that could become contaminated with blood. 6. Refraining from donating blood, plasma, body organs, other tissue, or semen. 7. Avoiding pregnancy until more is known about the risks of transmitting HIV from the mother to the fetus or newborn. 8. Cleaning and disinfecting surfaces on which blood or other body fluids have spilled in accordance with previous recommendations. 9. Informing physicians, dentists, and other appropriate health professionals of antibody status when seeking medical care, so that the patient can be appropriately evaluated. HIV, human immunodeficiency virus; IV, intravenous. (From Centers for Disease Control (CDC). Additional recommendations to re- duce sexual and drug abuse-related transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus. MMWR Morb Mortal Wkly Rep . 1986;35:152.) may develop in as many as 25 percent of those informed of a positive HIV test result. confidentiality .  No one should be given an HIV test without previous knowledge and consent, although various jurisdictions and organizations, such as the military, now require HIV testing for all inhabitants or members. The results of an HIV test can be shared with other members of a medical team, although the information should be provided to no one else except for special circumstances. The patient should be advised against disclosing the result of HIV testing too read- ily to employers, friends, and family members; the information could result in discrimination in employment, housing, and insurance. The major exception to restriction of disclosure is the need to notify potential and past sexual or IV substance use partners. If a treating physi- cian knows that a patient who is HIV infected is putting another person at risk of becoming infected, the physician may try either to hospitalize the infected person involuntarily (to prevent danger to others) or to notify the potential victim. Clinicians should be aware of the laws about such issues, which vary among the states. These guidelines also apply to inpa- tient psychiatric wards when a patient with HIV infection is believed to be sexually active with other patients. Clinical Features  non - neurological factors .  About 30 percent of persons infected with HIV experience a flulike syndrome 3 to 6 weeks

Remember: Any activity that allows for the exchange of body fluids of one person through the mouth, anus, vagina, bloodstream, cuts, or sores of another person is considered unsafe at this time. Safe-sex practices Massage, hugging, body-to-body rubbing Dry social kissing Masturbation Acting out sexual fantasies (that do not include any unsafe-sex practices) Using vibrators or other instruments (provided they are not shared) Low-risk sex practices These activities are not considered completely safe: French (wet) kissing (without mouth sores) Mutual masturbation Vaginal and anal intercourse while using a condom Oral sex, male (fellatio), while using a condom Oral sex, female (cunnilingus), while using a barrier External contact with semen or urine, provided there are no breaks in the skin Unsafe-sex practices their bodies, have the potential to transmit the virus to another person, and will almost certainly eventually develop AIDS. Those who test negative have either not been exposed to the HIV virus and are not infected or were exposed to the HIV virus but have not yet developed the antibodies, which is a possibility if the exposure occurred less than 1 year before testing. Serocon- version most commonly occurs 6 to 12 weeks after infection, although in rare cases seroconversion can take 6 to 12 months. counseling .  Although specific groups of persons are at high risk for contracting HIV and should be tested, any person who wants to be tested should probably be tested. The reason for requesting a test should be ascertained to detect unspoken concerns and motivations that may merit psychotherapeutic intervention. Past practices that may have put the testee at risk for HIV infection and safe sexual practices should be discussed. During posttest counseling, counselors should explain that a negative test finding implies that safe sexual behavior and the avoidance of shared hypodermic needles are recommended for the person to remain free of HIV infection. Those with positive results must receive counseling about safe practices and potential treatment options. They may need additional psychotherapeutic interven- tions if anxiety or depressive disorders develop after they dis- cover that they are infected. A person may react to a positive HIV test finding with a syndrome similar to posttraumatic stress disorder. Adjustment disorder with anxiety or depressed mood Vaginal or anal intercourse without a condom Semen, urine, or feces in the mouth or the vagina Unprotected oral sex (fellatio or cunnilingus) Blood contact of any kind Sharing sex instruments or needles AIDS, acquired immunodeficiency syndrome. (From Moffatt B, Spiegel J, Parrish S, Helquist M. AIDS: A Self-Care Manual . Santa Monica, CA: IBS Press; 1987:125, with permission.)