Aids - YWAM England recommendations Ministering to People with HIV and AIDS

Ministering to People With HIV and AIDS
October 03

Facts About HIV and AIDS
HIV (Human Immunosuppression Virus) is a virus that attacks the human body's immune system, making it difficult to fight infection. Usually within three months of being infected with the virus, antibodies develop to HIV and the blood test becomes HIV +ve. Infection with HIV usually leads to AIDS (Acquired Immune Deficiency Syndrome), though the average length of time between becoming infected and developing AIDS averages about 10 years.

During this "latent period" the person infected with HIV is largely free of symptoms but is infectious to others. Early symptoms of AIDS include: chronic fatigue, diarrhoea, fever, mental changes in memory loss, weight loss, persistent cough, severe recurrent skin rashes, herpes and mouth infections and swelling of the lymph nodes.

There is no cure for AIDS. Although periods of illness may be interspersed with periods of remission, AIDS is almost always fatal. Research is currently under way into vaccines, but none is viable as yet. Antiretroviral drugs are available that slow the progression of the disease and prolong life; at present these are very expensive.

How is HIV Spread?
HIV is a fragile virus, which can only survive in a limited range of conditions. It can only enter the body through naturally moist places and cannot penetrate unbroken skin. It is transmitted through body fluids in particular blood, semen, vaginal secretions, sputum, faeces, vomit and breast milk. Transmission of HIV takes place in four ways: The virus is NOT SPREAD through normal social contact, even if close and prolonged or casual physical contact eg coughing, sneezing or kissing. It is not spread by using eating utensils or consuming food and beverages handled by someone who has HIV. There is no evidence that insects including mosquitoes can spread AIDS, nor do toilet seats, swimming pools or shared communion cups. It is not spread through mouth-to-mouth resuscitation. You would have to swallow a huge amount of someone's saliva to become infected.
 * Unprotected sexual intercourse with an infected partner (the most common)
 * Sharing needles when injecting or other use of contaminated injection or other skin-piercing equipment (eg, syringes, lancets, scalpels, dental instruments and razorblades).
 * Blood and blood products through, for example, infected transfusions and organ or tissue transplants.
 * Transmission from infected mother to child at birth or through breastfeeding.

By living in a country where AIDS is common you face a potentially greater risk of becoming infected than you would in your home country. But by following a few common-sense rules your risk of infection can become negligible. A small number of people, while overseas, develop an AIDS anxiety, which can seriously mar their quality of life. If having calmly faced up to the risks and taken appropriate precautions, you remain seriously worried; it would be worth discussing this with an appropriate person.

What is the Size of the Problem?
There are more that 45 million people currently living with HIV worldwide, with 5 million new cases being reported in 2002. Half of the new infections occur in young people with a majority of transmissions -- more than 70% - occurring through heterosexual sex.

UNAID says the AIDS epidemic is spreading twice as fast as five years ago. 3 million people died in 2002 and a further 5 million were infected. 3 million children are alive with HIV, a number increasing by almost a million a year. There are early days in a global pandemic that started relatively recently.

AIDS, which has already claimed more that 43 million lives, is set to reverse a half-century of efforts in the developing world, where the epidemic is hitting hardest. In these countries, which account for 95% of the global total, poverty, conflict, poor health systems and limited resources for prevention and cure fuel the spread of the virus.

I. Bases, Teams and Schools
Most locations are likely to have staff or students who are HIV+. We must assume from now on that we will probably have people, who because of the lifestyle that they have come from will be carrying the AIDS virus. Practical procedures to ensure that the virus is not passed on should be implemented immediately at all locations.

II. Outreaches, Especially to Developing World Countries
The risk of catching the AIDS virus is much greater in developing world countries, because of inadequate medical facilities. Especially through procedures needed when someone becomes ill and requires blood samples taken or injections given. Any needle or scalpel etc. could be infected with the virus. The following precautions are therefore sensible -

Before you go:
 * Complete immunisations before leaving;
 * A pre-outreach check is recommended for students with special health care problems;
 * Have a dental check up;
 * Find out your blood group and keep a record of it;
 * Take a supply of anti-malarial tablets and other anti-malarial equipment;
 * Take a medical travel kit and consider taking an AIDS protection kit containing an intravenous giving set and bottles of plasma substitute;
 * Good preventative health care advice should be given to everyone before they travel. If going to situations where the local medical facilities are known or suspected to be deficient, make all those going fully aware before you leave;
 * Adequate medical insurance is mandatory for all students and strongly recommended for staff;

While abroad:
 * Avoid casual sexual encounters. Married couples should be permanently loyal to one partner. As far as possible avoid situations and lifestyles which increase your risk of being raped.
 * Avoid road accidents. These are a major risk because serious accidents often necessitate medical treatment and blood transfusions.
 * Avoid infected blood transfusions. In case of an accident or emergency where serious blood loss is occurring you should follow these guidelines:
 * Refuse blood from an unknown source unless in a life-threatening situation. In many developing countries blood donors are HIV positive and blood may not be reliably tested.
 * Only accept blood which has been tested for HIV immediately before you receive it or from a donor whose lifestyle you trust.
 * Use a plasma substitute until you can reach a safe blood source.
 * Join a trusted donor group overseas. Many projects or embassies will have such a list.

Each location should have a medical officer experienced in tropical medicine to oversee arrangements. This may be a local GP or someone on staff.

III. YWAM Ministry Teams
The assumption should be made that any team ministering to the public will come across HIV+ people, especially in street and coffee bar work. Printed guidelines (see appendix 2) should be issued and followed. Adequate training should be given.

The virus is mainly spread through sexual intercourse with infected partners, especially promiscuous sex with numerous partners. Homosexuals have initially been most at risk, also, IV drug abusers and people needing blood transfusions where the blood is not checked.

Medical Travel Kits
Kits can be obtained from -- This is not an exhaustive list. You may be aware of other good local suppliers.
 * Interhealth, 157 Waterloo Road, London SE1 8US. Tel: 0207 902 9090. Email: [mailto:supplies@interhealth.org.uk supplies@interhealth.org.uk]
 * SAFA Ltd, 59 Hill Street, Liverpool L8 5SB. Tel: 0151 708 0397. http://www.safa.co.uk
 * Your local Boots the Chemist

Advice on Immunisation
Expert advice on immunisation needs is available through --
 * Interhealth, 157 Waterloo Road, London, SE1 8US. Tel: 0207 902 9090. Email: info@interhealth.org.uk
 * Look on the http://www.masta.org website
 * A simple pre-recorded message on malaria prophylaxis is available on 2027 636 7921 -- the Ross Institute Malaria Advisory Service

Appendix 2 AIDS and HIV +
Hints on how to handle staff and contacts in YWAM

Any team or base ministering to people involved in, or having come out of, sexual promiscuity or IV drug abuse, will probably come into contact with people who have the HIV virus. Thus each base or team could already have people who are infected. Some will have had the blood test and know they are positive, others who have not had the blood test will not know that they are a risk. To avoid discrimination the following points should be observed for everyone.

ALWAYS take precautions.
 * 1) There is a minute risk of the virus entering the body of an uninfected person through cuts or open wounds, and through swallowing infected fluids. If you have a cut or open wound, cover it with a waterproof dressing.
 * 2) The AIDS virus is not passed by ordinary everyday activities. It is safe to hug, kiss, and share crockery, towels, and toilets, but DONOT share razors or toothbrushes, as blood may possibly be left on these items.
 * 3) The virus is killed by a hot wash in a washing machine (71 degrees centigrade for three minutes)
 * 4) Soap and hot water will kill the virus but it is best to use bleach (domestic bleach diluted 1 in 10) and use good rubber gloves (without holes!)
 * 5) Body fluids such as spilt blood, diarrhoea, vomit or pus can spread the virus.Clear up ALL spillage with gloves and bleach. There is no way of knowing if a person has the virus by looking at them -- so

Obviously the Lord may call us to minister where these precautions cannot be taken -- this isn't the law, but take sensible precautions to minimise the small risk to which carers may be exposed.

Counselling Aids sufferers is a delicate and difficult topic. Such issues as -- should I have an HIV test? Can I marry if I'm HIV +ve? - need to be dealt with sensitively.

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