732
Chapter 21: Neurocognitive Disorders
Table 21.5-4
AIDS Safe-Sex Guidelines
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
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.)
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.)
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
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
