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Good Things for Corrections Staff to Know

An HIV/AIDS Primer

November/December 2009

Inmates and their advocates report misinformation about HIV/AIDS on the part of many staff members working in correctional facilities. Below are some good things to know about HIV behind bars, especially where medications are concerned.


Privacy and Confidentiality

Remember, ignorance of corrections staff pales in comparison to that of the inmate population. Privacy and confidentiality are extremely important in HIV, on the outside as well as in corrections. Opening a can of worms may only lead to an infestation that can be difficult to control.

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Inmates known to have HIV or to take medicine may be subjected to abuse, no matter the condition for which they are being treated. They may be ostracized or even beaten. If nothing else, this could create a mess for staff to clean up. Masks are unnecessary, but the use of latex gloves is called "universal protection" for a reason -- you don't know what anyone has!


Transmission

HIV is spread through bodily fluids, but that transfer is not necessarily easy. We know that HIV spreads through unprotected sex, as well as the sharing of needles and syringes. Saliva, sweat, and tears, however, are another matter.

To begin with, there's very little HIV in saliva, not considered enough to infect. Then, there's a substance in saliva that neutralizes HIV. Moreover, HIV seeks certain cells in the body to infect. Those cells are not on the skin. Unbroken skin protects against microbes like HIV (use bandages on cuts -- you wouldn't want to pick up hepatitis). Broken skin would have to be very broken and again, you would need a lot of saliva to give someone HIV.

"Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV," according to a factsheet from the U.S. Centers for Disease Control and Prevention (CDC). "HIV has been found in saliva and tears in very low quantities from some AIDS patients. It is important to understand that finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by that body fluid. HIV has not been recovered from the sweat of HIV-infected persons."

Still, all of that hasn't stopped judges from imposing prison time on people with HIV who spit on police officers or corrections staff.

The real concern is blood, which may be present in the mouth, especially in someone with oral disease (such as gingavitis or ulcers). Even so, oral transmission has been rare. Note that the presence of disease in the mouth increases the risk of bleeding.

In cases where a high-risk encounter does occur, as with a needlestick injury, there are protocols to protect someone from becoming infected with HIV. These protocols consist of taking certain HIV medications for up to 28 days. Learn more about post-exposure prophylaxis (PEP) guidelines at www.cdc.gov or call the 24-hour PEPline of the National HIV/AIDS Clinicians' Consultation Center at 1-888-448-4911. PEP is most effective when taken as soon as possible, preferably within 48 hours. According to the guidelines, as of June 2000 there have been 56 documented cases of HIV seroconversion and 138 other possible infections in health care providers, not so many when you consider the numbers of needlestick injuries. One of the things that increases risk is uncontrolled HIV (high viral loads), another reason to make sure people receive their medications.

The factsheet also reports that, "In 1997, the CDC published findings from a state health department investigation of an incident that suggested blood-to-blood transmission of HIV by a human bite. There have been other reports in the medical literature in which HIV appeared to have been transmitted by a bite. Severe trauma with extensive tissue tearing and damage and presence of blood were reported in each of these instances. Biting is not a common way of transmitting HIV. In fact, there are numerous reports of bites that did not result in HIV infection."


Adherence

One of the biggest complaints about HIV behind bars is a delay in receiving medications. Among other problems: medications may be stolen. Delaying or confiscating these vital and expensive medications is a huge mistake.

It is extremely important to take HIV drugs on time, every time (and correctly, such as with or without food -- depending on the medications). They are usually prescribed in combination and must be taken that way -- in order to work correctly, none of the medications in the regimen can be witheld. This isn't heart disease. It isn't diabetes. It's not one of the many conditions in which a night off meds here and there presents no problem. The problem with HIV is the potential of the virus to quickly develop drug resistance.


Resistance

Here's why taking HIV medications correctly is so important: if they're not taken on time, every time, the virus gets a chance to change itself (mutate). These changes allow it to survive in the presence of the medications being taken, and even some that have never been used by the patient. This is the same issue that led to MRSA (methicillin-resistant Staphylococcus aureus) -- the use of the wrong medication or the wrong dose that, in turn, helped create a medical menace threatening lives around the globe.

This isn't heart disease. It isn't diabetes. It's not one of the many conditions in which a night off meds here and there presents no problem.
In effect, the HIV medication can no longer fight that patient's virus. It may have worked like a charm yesterday, but today it could be kaput, thanks to a brief absence of therapy. Certain factors complicate the situation even more, such as disruptions inherent in a transfer.

Adherence to treatment and the development of drug resistance is not just a humanitarian concern. There are increased costs with placing a patient on a new regimen. These include a need for drug resistance testing, the possibility of a more complicated and expensive regimen, and perhaps an increase in illness that in turn needs to be treated.

There may also be increased risk of HIV transmission in people whose therapy is no longer keeping their virus suppressed. Moreover, drug-resistant HIV can be transmitted to someone else, limiting that person's options for therapy.


IRIS

Look out for a worsening condition in patients starting HIV medicines. If Immune Reconstitution Inflammatory Syndrome (IRIS) occurs, they may become very ill as their immune system gets stronger. Symptoms of IRIS include rash, sometimes fever, flu-like symptoms, difficulty breathing, and eye inflammation.


Other Health Concerns

With a serious condition like HIV, as well as its potent medications, what may seem minor can become major. Believe it or not, even a rash can become fatal. Take complaints seriously and notify health care providers right away.

Got a comment on this article? Write to us at publications@tpan.com.



  
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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
 

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