1990 Living Healthy with the AIDS Virus report

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AIDS Helptine 933r5419

INTRODUCHON Yu have found outdown. you are HIV positive and it seemsyou like your has eenjust tuned upside You have a million questions want to life ask and you are not sure who or even what to ask!

This book was written especially for you, to try to answer some of those puzzling

questions and to give you ideas on where you can turn for help. Each chapter contains answers to questions commonly asked by persons such as yourself. We know because we talk to them everyday and they have become our closest friends.

They have helped us to understand the needs and concerns of persons who are HIV positive and we want to share this information with others.

Just always remember - you and your well being are inportant to us. In fact, you and people like you are the reason our organization and others like us exist. We c.areaboutyouandwanttodoeverythinginourpowertoassistyouandtobethere when you need us. If there is anything we can do just pick up the phone and call or, better yet, when you're ready, come join us. You will find your experiences can help us and others too!

The AIDS Task Force of Alabama, Inc. (AIFA) is a non-profit, volunteer organization. Our mission is to provide preventive education, advocaey, support and technical assistance to other community based organizations throughout the State of Alabama.

This book was prepared under the auspices of the Education Comrittee of ATFA. Committee members and contributors included: Gail Jeuson, PhD (Chair), Mary Ann Schmitz, Joan Turner, PhD, Ruth Vann, Susan Wilder, BSW, Tom STnizick, MSW, Sharon Shaw, RPT and Sandi Sandridge. Special thanks go to Ms. Margret Bowman for the book's cover design.

Ajoint effort of the Jefferson County Department of Health and the AIDS Task Force of Alabama

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AIDS Hetptine 933.5419

C-I QUESTIONS AND ANSWERS ABOUT IITV When you were told you had tested positive for the Human Immunodeficieney Virus (HIV) or that you had the AIDS virus, you probably felt shock, confusion, frustration. guilt, anger, panic, helplessness and many other emotions. You probably had so much to deal with all at once that you did not have time to think aboutallthequestionsyouwantedtoask.Thisisaverynormalreactionforanyone who is told he or she may have a medical condition that can affect their lives.

Chances are you will continue to have some of these same feelings and this book has been written to help you sort through some of the important things you may need or want to think about.

It has also been written to help you answer some of those questions you might not have thought about right after you were told you had tested positive for the virus or that you might be confused about. This first chapter is designed to answer questions that people who have tested positive tend to ask the most. The other cliapters in the book provide more details on some of these important questions and which you may want to consider as time goes by.

• `hrllAT DOES MY HIV TEST RESUIJT MEAN? The purpose of the HIV test is to determine whether or not a person has the Human Immunodeficieney Vies (HIV) in his or her blood. When you were tested, you probably had an ELISA (sometimes called EIA) blood test first. If this test was positive (meaning the test showed you had antibodies to the virus in your blood), then another test (called the Western Blot) should have been run on your same blood sample to confirm the results of the ELJSA test. If a second test was not conducted, then you need to have it done because the ELISA test some times shows that a person has tested positive when he or she does not have the virus.

(This is called a false positive). If you were tested at a health department in Alabama you can be sure that both tests were done before you were given results.

• `VIIAT IS THE DIFFERENCE BETWEEN BEING HIV POSITIVE AND HAVING AIDS? Acquired Immune Deficieney Syndrome or AIDS is caused by the Human lmmunodeficieney Virus or HIV. The virus attacks a person's immune system and decreases the body's ability to fight infectious, diseases and certain cancers. Like other viruses, HIV may cause no symptoms at all; or it may cause oldy mild or moderate symptoms (sometimes called AIDS Related Complex or ARC); or, it

may.cause more serious symptoins or diseases related to AIDS. More information on HIV and the immune system is found in Chapter 2.

• SINCE I DONT IIAVE AIDS, CAN I INFECT SOMEONE EI.SE

Thus, when you were told that you are "HIV positive" or that you were "antibody positive", it means that you have the virus in your body. IT DOES NOT MEAN YOU HAVE AIDS. While the virus can cause AIDS, research indicates that not everyone who is HIV positive will become ill or develop diseases like AIDS. Scientists are unable to predict if and when persons who are HIV positive will develop illnesses or AIDS. Studies have shown it may take 10 years or more for some people to eventually develop AIDS. Given the advances taking place in AIDSresearch,undoubtedlymorewillbediscoveredaboutthevirusthatwillhelp us find answers to these questious! It is endrely possible these discoveries will be made in time to benefit you!

YES! No matter how you got the virus, as a person who is HIV positive, you can

In the meantime, it is important to remember that YOU ARE NOT AT THE MERCY OF THE VIRUS. While the virus is in the cells of your immune system, there is much you can do that will affect whether or not you develop illnesses or AIDS. The most important things you can do are to stay healthy and keep a positive attitude.

• HOWDID I GETTHE VIRUS? HIV is spread through blood, birth and sex. Therefore, a person can become infected with the virus through: 1.

2.

Unprotected sexual contact with partners of the same sex (male to male, female to female), or opposite-sex (male to female).

The sharing of needles or works for the injection of drugs.

3.

Transfusion with infected blood or blood products. (Since the screening of blood products began in 1985, risk from this method is believed to be almost zero).

4.

A woman who is HIV positive may infect her unborn or newborn infant during pregnaney, birth or breast feeding.

Theriskofinfectionisincreasedbyhavingmultiplesexpartners(eithersame-sex or opposite-sex), and the sharing of needles, even if the needles are shared only occasionally. Some sexual practices, as described in Chapter 3, and even the presenceofcertainsexuallytrausmitteddiseasessuchassyphiliscanincreaseyour chances of infection.

|V|'n| rlHE VIRUS? give the virus to others by having unprotected sex and by sharing needles of any sort. Women can pass the virus to their unborn child.

• CAN I INFEor My FAMILy, FRIENDs OR pEOpLE I WORK wrlH7 NO! Not unless you engage in one or more of risky behaviors described in

Chapter 3. Compared to most vinses, HIV IS HARD TO CATCH! Years of cumulativeresearchhasverifiedthatHIVcannotbetransmittedbycasualcontact.

You cannot get it from a toilet seat, by sharing drinking glasses or other eating utensils, shaking hands, kissing or hugging. You cannot give it to anyone else by sneezing or coughing on them or by preparing their food. In order to infect someone else, you must have direct sexual contact with them; or, there must be a sharingofblood(suchasthroughthesharingofneedlesorduringpregnaneyfrom mother to child).

• WIIAT ABOUT SOMEONE I MIGHT HAVE INFECTED BEFORE I

KNEw I wAs Hlv posmvE? This is a very responsible and important question. If you had sex without using a condomor other protective device or shared needles with anyone in the past, it is important to notify them that they may have been exposed to the virus. This is important for three reasons: 1) for their health; 2) for your peace of mind; and, 3) to help prevent the spread of the virus to others.

In order to notify them, you have two choices. You may decide to tell them

yourself; or, your local health department can help you determine who needs to be told and can notify them if you prefer. The health department will probably ask you for their names, addresses and/or telephone numbers. This infomation js kept in the strictest of confidence. In fact, the procedure is for the health department to inform the person(s) they may have been exposed to the virus, but not to reveal your name or HIV status. You should ask your health department about its notification procedures.

Should you decide to tell your past or present partners yourself, there are important facts you need to remember. One has to do with the incubation period of the virus which is the tine between when a person is first exposed to the virus (through sex or needle sharing) and the time when antibody tests (such as the ELISA) should be done. For most people, this incubation period can range from 3 to 24 weeks. Because the incubation period is different for each person, your contacts should be told they need to be retested for the virus every six months for up to a year to be sure they do not develop the virus. You also need to tell them

they need to notify any sexual or needle sharing partners they may have had other than yourself. Finally, it is important for them to know they need to be tested. If they too are HIV positive, like you, the sooner tbey get medical care and monitoring, the better chance they have to receive treatment that can delay the onset of infectious and/or AIDS. The reasons for this are explained in Chapter 2.

• lvIIO EI.SE SHOULD I TELL ABOUT MY IIIV STATUS AND WIIAT SHOULD I TELL THEM? Beside your sexual or needle sharing contacts, who you tell and what you tell them is really up to you, but most experts agree it is a good idea to tell someone

you can trust because you will probably need someone to talk to. You need to know, however, that not everyone can be trusted with this information. There have been cases of people infected with the virus who have lost their jobs and insurance and faced other kinds of discrimination when they told. their employer or a co-worker. Therefore, you need to think carefully about who you want and need to tell. Unless yourwork involves a dangerous or risky activity in which there is some chance that you or another worker could be hurt and exposed to blood, then there is probably no need to tell your employer. You should also be aware that if you file an insurance claim for blood tests or medicines related to your HIV status, your employer or fellow workers may find out about your HIV status. Be sure to talk to your doctor about ways to handle this (For information on employment and insurance, see Chapter 6.)

Whenever you seek medical or dental care, be sure to tell the medical people working with you about your HIV status. This will help protect them and you.

They are required by law to keep your medical information confidential.

Finally, if you need someone to talk to and you are not ready to tell your loved ones or a friend, contact your local AIDS organization. You can talk to someone on the phone without giving your name; or, the organization can put you in touch with another person or a group of people with whom you can share you feelings and concerns. These organizations are there to help you and they understand your needs and everything you say is kept confidential. They can also help you with other concerns and provide up-to-date information on services available to you.

A list of these organizations is provided for you at the end of this book.

• BECAusE I AM Hlv posmvE, Do I IIAVE To GlvE Up SEX? Absolutely not. There are many healthy and safe ways to have sex that can be eroticandsatisfying.However,itisimportanttorememberthatanybodypenetration increases the risk and anal intercourse is the most risky practice of all. The use of condoms and spermicides like nonorynol-9 is highly recommended during intercourse. This and other "safer sex" practices are discussed in Chapter 3.

You must also remember that a mother can infect her unborn child so you do not want to get pregnant or cause someone else to get pregnant!

• WIIAT EI.SE CAN I DO SO THAT I DONT INFECT OTHERS? Don't donate blood or other blood products (such as plasma), organs, body tissues or sperm. You should know that all orgahizatious that accept blood donations routinely test donated blood for HIV and they report to each other the names of persons who donate HIV infected blood. Also, you should not have commercial ear piercing, get tattooed or have acupuncture because you can't L`e sure the people doing these things sterilize their needles. If they don't, otliers might become infected.

• I HAVE A FRIEND WIIO IS A DRUG ADDICT. WHAT CAN I DO TO STOP HIM/IIER FROM GETTING HIV OR GIVING IT T0

0"ERS? First, continue to encourage your friend to seek help and treatment for their problem. If they won't, be sure to tell them that they should never share their needles or works with anyone else ever. If they are ever uncertain about whether or not their works have been used before, they should clean them by rinsing the needle and syringe twice with bleach, then rinse them twice with water. To be safe, they can carry a little vial of bleach with them at all times.

• \VHERE DO I GO FROMHERE? Just remember, you are one of approximately 1.5 million people in our country who are HIV positive. You are not alone and there are many, many people who are willing to help you. But the most important thing you can do is to put yourself first. Do what you want to do and enjoy everyday to its fullest. You don't have to make any major decisions right now. Think about what you want to do that will help you take advantage of the full, productive life ahead of you. Help yourself, stay healthy and when you're ready, let us help you too!

need some professional help to measure the effectiveness of your efforts. In other words,itiscrucialforeverypersonwhoisHIVpositivetoestablishagoodworking relationship with a physician who will then routinely monitor your health on an ongoing basis. At the very least, you should be seen by your physician roughly every six months as long as you are feeling well. When you feel ill, it will be necessary to see your doctor more often.

• DO I NEED MY OWN DOCTOR AND HOW DO I FIND ONE? One of the first positive things you can do for yourself once you've been told that you are HIV positive is to establish a relationship with a physician who specializes in Family Practice, Internal Medicine or lnfectiousAmmune Disorders. If you are to receive the utmost benefit from this relationship, it's important that you feel comfortable discussing your medical and social (including sexual) history with the physician. You must be able to engage in effective, two-way communication. That is, your physician must be able to listen to and understand what you say, and you in turn must be able to understand what the doctor is saying to you. If a physician should "talk over your head" but you are still happy with the care you're getting, thenaskquestionsofthenursesorothertrainedprofessionalsatthedoctor'soffice or clinic. If for some reason people in the clinic or office can't answer your questions,trycallingyourlocalcommuhityorganizatiouswhospecializeinhelping persons who are HIV positive (See telephone numbers in the back of this book).

If you already have a physician who expresses willingness to monitor your health on a regular basis, and one with whom you feel comfortable, you've passed an important hurdle and yoilr main responsibility is that you see and communicate with the doctor as often as necessary. If you don't have a physician, you can call the county medical association or any community based organization for suggestions.

If you have to see more than one physician before you select one, that's OK. The important thing is that you seek and receive sympathetic, non-judgmental, stateof-the-art medical care.

• ARE THERE O"ER RINDS OF HEALTH CARE PROFESSIONAI.S IVIIO CAN HELP ME? Yes. Some people who are HIV positive may seek other kinds of care providers in their quest for good overall health. For exanple, soine consult nutritional therapists to leam more about special diets and diet supplements. Others consult Specialists in massage or touch therapy or meditation. Our stance is, if it works for you without doing harm, it's probably OK. However, no matter who you choose to help you manage your health and well-being, you must also continue to see your physician on a regular basis. Furthermore, anyone who tells you Something that seems too good to be true, who charges you a lot of money, or Who

tells you that you no longer need to see your physician, is likely to be a fraud and should be treated as such.

• WHAT EI.SE SHOUID I D0 TO STAY HEALTHY? Life as an individual who is HIV positive requires a personal commitment to pay close attention to your health. Health experts generally agree that anything that promotes good health also promotes healthy immune system functioning. In fact, there are three general rules to follow: Promote overall liealth and individual well-being so that the imlnune system can fight off infection of any sort.

Theat infections immediately and aggressively. To do this will require that you have ready access to your physician. This is NOT the time to find a physician; this is a time when you need to call your established physician for a visit within 2448 hours or sooner if your symptoms are severe.

Take drugs as ordered byyour physician. It is OK to take usual over-the-counter products like aspirin and multivitamius, but if special dietary oT vitamin supplements are prescribed by someone other than your physician, it is important to let the physician know. Usually, a call to the office is all that's required.

If you should hear of experimental studies, consult your physician to help you decide whether or not to enroll, and if you hear of "street drugs" that supposedly kill the HIV or make other unusual claims, you should check with your physician before taking such substances no matter how "safe" they are supposed to be.

Finally, as mentioned earlier in this book, recent medical evidence has shown that the earlier the HIV infected person is started on antiviral therapy, like AZT, the better. Be aware that not all physicians are aware of this information and some

peoplebelievethatdrugslikeAZTarepoisonous.In fact,AZTlikeallotherdrugs is associated with side effects; however, the benefits of taking anti-HIV agents such as AZT early in the course of infection far outweigh the risks. Tn addition, the side effects of AZT are often short lived and may go away after being on the drug 6 to 8 weeks. Your physician may also be able to prescribe other medicines that will ease the side effects.

You are much better off at least trying to take a drug such as AZT when recommendedbyyourphysician.ThefactthatAZTactstopreventreproduction oftheHIVvirusmeansthatfewerT4cellswillbedestroyedandtherefore,people taking this drug can generally stay healthier longer because they have stronger immune systems and greater numbers of T4 cells.

• HOW CAN I ACTIVELY PROMOTE MY GOOD HEALTH? We said before that anything that improves your overall health also improves

your immune functioning, and people who are IIIV positive need to do everything in their power to inprove or enhance immune functioning. So let's talk about the things that you can do to help yourself.

1.

Whatyou eat isbasic to health.

No matter how much you feel you know about the principles of good riutrition, this may be the time to update and/or review your understanding. For example, while most people know that fresh fruit is nutritionally superior to things like high faticecreamorpastry,therearetimeswhenyourbodymayneedtheextracalories.

There are a number of good books and a variety of health professionals such as health educators, nurses, and nutritionists who can help you with your diet. A healthy diet should be appetizing, nourishing and affordable. Avoid extremes and try to maintain your weight within normal limits.

Junk food does not give your body the vitamins and minerals it needs to stay healthy. Eat a well balanced diet that includes chicken, fish, fruits and vegetables.

Cook your food properly so that you don't lose the fresh nutrients you paid for.

Steaming and baking are prefeITed cooking methods. Check out fad health diets very carefully - they are usually better for the retailer's pocket book than for your health.

If you are not already taking a multivitamin, then choose one that contains 100% of the RDA (Recommended Daily AIlowance) for all known nutrients. Mega doses of vitamjus and minerals can be harmful. Be sure that you do not take more than 10 times the RDA for any nutrient (except for vitamin A, which is 5 times the RDA). For more information on nutrition, see Chapter 5.

2.

Cutdownonstress!

Stress is a part of life and some stress helps us perform better. You may be under a lot of stress right now, and that's OK. Anxiety and depression are perfectly normal reactions to learning that you are HIV positive. Be aware of how you typically handle anxiety and depression. Don't try to run from it or escape it.

Drugs and alcohol won't help! You'll still be HIV positive when you come down or get sober. Face the fact that you are very anxious and depressed about being HIV positive. Ventilate these feelings to someone else - talk about it. It really helps to know that someone else knows and understands how you feel. Take some action to alleviate your depression and stress. The most essential element in overcoming stress and depression is taking action to do something about it. The majorfactorthatseparateshealthypeoplefromothersistheabilitytotakecharge

of their life and to be responsible for making positive decisions that prove that they are in charge!

This stress, anxiety and depression may last for a while. In that case, you may very well experience some stress related physical symptoms (such as diarrhea, nausea, sweating, weight loss, fatigue, etc.) that are very similar to AIDS symptoms. Be aware that most, if not all, of these symptoms can be stress related and not caused by AIDS! But if you are concerned discuss them with your doctor.

Inanycase,youshouldspendyourenergiesonlearningtocopewithandovercome your andety and depression and these physical symptoms will usually disappear

on their our.

If you typically suffer from chronic stress from work, finances, relationships and othermattersthatcausesheartburn,sleeplessness,headachesandirritability,then take some action that relieves these stresses, or learn some better methods of coping with them. This chronic stress can really harm your immune system and open you up for more infectious.

3.

Getplentyofrest!

Fatigue causes your immune system to not work as well and opens you up to illness. Avoid over tiring yourself and rest at regular intervals, avoid "all nighters" at all costs.

4.

Don't smoke or use drugs, andwatch the alcohol!

Smokingcausesmorerespiratoryinfectiouswhichactivatesyourimmunesystem

(which is not good, remember??). At the very worst, smoking can cause heart disease and/or cancer. Drugs can harm your immune system and can cause you to use bad judgment in making decisions that can harm you and others. Poppers (nitrites) are especially dangerous and have been directly linked to Kaposi's Sarcoma (a form of cancer that strikes people with AIDS). Nitrites are also found in prepared meats, such as ham, wieners, bacon and luncheon meats and these should be avoided. Alcohol can also cloud yourjudgement so use it wisely.

5.

Avoid people who have contagious diseases!

Getting around people who are obviously sick (with a contagious illness like colds, flu, hepatitis, measles, etc.) can expose you to germs that can make you sick.

When you find yourself around someone who has a contagious illness, use commom sense precautions like not letting them cough or sneeze on you, not eating or drinking after them, and washing your hands regularly (which you should always dointhefuturetoprotectyourselffromgermsthatyoucomeincontactwithevery day).

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6.

Exercise regularly!

Regular physical exercise has proven to strengthen the immune system and it helps you feel better, both physically and mentally. If you are not accustomed to regular physical exercise, then start slowly, but do start. A simple aggressive walking program can accomplish a lot. Keep at it until it becomes a regular, enjoyable part of your daily healthy lifestyle.

7.

Enjoypels but be cautious!

Pets can be a great source of comfort and enjoyment, but they can also expose you to some serious diseases. Do not let your pets lick you in the face. Wash your hands after handling your pets (there we go with washing your hands again. Are you getting the point?). Avoid cleaning bird cages, cat litter boxes and fish tanks -these are especially risky! If you must do these, be sure and wear gloves and wash very good afterwards. (More specifics on pets are discussed in Chapter 2).

8.

Do not forget about physical, social and spiritual areas that are essentia] to your health and well being.

For example, try to keep a program of physical activity that is adjusted to any changes you may have in strength and endurance. Pay attention to yourself, your needs for involvement and support from others. Your relationships with family members and friends should continue to be close and supportive. Your emotional well-being is important and finding or maintaining a support system of friends and family is a logical choice. There is no reason why you cannot interact with friends and fahily members as you did in the past. Hugging, kissing the skin, and other forms of affectionate behavior that don't involve intimate or sexual contact are safe.

ÂŽ How CAN I MONITOR My OWN HEAI;nl so I KNow I'M oK? You can regularly monitor your own health in a few simple ways. First of all, checking yourself out on a routine basis may help reduce your own fears about your physical condition. Secondly, a few simple procedures will guarantee that you have baseline information on your normal or usual health, and this information may be critical when it comes to judging whether you have HIV related conditions or common infections that everyone gets from time to time. The best idea is p.robably to take a writing pad or spiral notebook and begin a diary of all of the following, including the dates of your physicians visits:

1. Checkyourweight everyweek. Try toweigh onthe same dayofthe week each week, at the same time using the same scales whenever possible. If

you lose five or more pounds in a month when you are not dieting, you should let your physician know.

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2. Check your normal temperature. When you're feeling good or normal, take your temperature every evening and every morning for a week. The purposeofthisistodetermineifyounormallyhaveahighertemperature during one part of the day than another, and to understand the normal up and down changes in your temperature. For example, most people's temperatures rise as the day goes along, ranging from 96.0 or 97.0 degrees in the early morning to 98.0 or 99.0 degrees in the evening. You should not drink liquids or eat or smoke for at least fifteen minutes before checking your temperature by mouth.

Whenyouestablishwhatisnormalforyou,writetheinformationinyour diary, and then when you feel that you have a fever or suspect you have an infection, you can check your temperature and compare that reading to your normal one. Doctors often ask patients who have low-grade fevers, "what's your normal temperature?"

3. Checkyour lymph nodes for swelling once or twice aweek (orwhenever

you don't feel well). People who are HIV positive sometimes have swollen lymph nodes in the neck, underarm and/or groin. If you find

your glands are swollen, it is important to report that finding to your doctoralongwithsuchthingsastemperature,whetherthenodeistender to the touch and other symptoms such as nausea or diarrhea.

4. Keep track of all fluctuations in well-being. Don't panic if you get the flu or a cold, but DO enter that information in your log or journal.

Record your temperature, how many days of work you lose, any rashes or lesions that appear anywhere on the body and anything that you associate with not feeling well like unusual tiredness or fatigue. Writing these things down in a journal is helpful when you want to communicate to your physician or other health professional.

o WHY IS IT IMPORTAI\IT THAT I TALK TO OTHERS ABOUT MY PROBLEMS? Social support is important to your self esteem and your attitude toward the world. Therefore, it is a vital part of taking care of yourself. There may be times whenyoufeellikeyouareallalonedealingwiththeproblemsofyourHIVpositive Status. You are not alone. There are several community based organizations which can provide a variety of services for you. As you establish your social network. there are several factors especially important to your well being.

c:nTroot,ioÂŁ::Ls:E#.c:inmbe:v#:f::::a,n.ti=Y:hTo::nf,e:|ssheee'!l:s;r=fgs:iu.tn:i Couuselortohelpyoudealwiththesefeelings.ManycounselorshaveslidingScales for their fees according to their c|ient's income. There are also support groups

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whicharerunfreeofchargewhereyoucanmeetwithotherswhoaregoingthrough similar situations as yours. You may feel the need for one-on-one contact with someone who will just listen and understand. You may experience some "panic attacks" and feel anxious and afraid. Sometimes these attacks last only a few minutes but they may last for several hours. Remember, these are normal reactions,buttheycanbefrightening.It'shelpfultohavesomeonetosharethesetimes with. One of the worst things you can do for your mental health is to isolate yourself from others! Stay healthy mentally and physically.

CHAPIER3 SARER SEX Sometimes people are uncomfortable or too embarrassed to talk openly about sex even if they have questions they want or need to ask. Because of this, they can become very frustrated and/or confused about what to do with regard to their intimaterelationships.Thischapterhasbeenwhttentoanswersomeofthesevery intimate and personal questions and therefore contains some very explicit information and language about a variety of sexual activities.

• YOU SAID BEFORE THAT I DIDNT HAVE TO GIVE UP SEX

BECAusE I'M Hlv posmvE. wllAT ARE My OpTIONs? Again, it is important to remember that the virus is spread through sex and HIV has been found in such body fluids as blood, semen (cum), vaginal secretions, urine, feces, menstrual blood and saliva. These body fluids are also known to be carriers for other sexually transmitted diseases (STDs) such as the hepatitis-B virus, chlamydia and bacteria that cause syphilis and gonorrhea. Practicing healthy, safer sex reduces the risk of HIV infection and mal]y other sexually transmitted diseases.

Avoiding or not having sex (called abstinence) isthe safest thing to do. If abstinence is not your choice, then sex with only one person who is not HIV infected and whom you believe you can really trust to remain faithful to you is the next safest. You should always avoid sex with anyone who has sex with many

partners and/or who use drugs.

Making decisions about maintaining sexually intimate relationships and expressing sexual desire is a very difficult issue for many people who are HIV positive.

Your choices seem to range from not having sex with anyone ever again, to only engaging in sex with yourself (called masturbation), to having sex with others in ways that eliminate or significantly reduce the possibility of your transmitting the virus or other sexually transmitted diseases to someone else and someone else adding more HIV to your immune system.

The important point to consider is what you want and need in terms of your interest in or desire for sexual activity. You may decide to postpone any type of Sexual activity with anyone, including yourself, because of guilt, shame, anxiety, fear,etc.,thatyoumightbefeelingbecauseofyourrllvstatus.ManypeopleWho are HIV Positive have felt like this, especially when they first found out. Some People Who are HIV positive have decided to remain abstinent and are Comfortable with that decision.

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I Other people have gone through a short period of abstirience and then started to want or need some type of sexual intimaey. In either case, if you decide that sexual activity with someone else is important in your life, remember, there are many ways you can be physically sexual with that person.

However,sinceyouknowtheHIVisinyourbodyandthatyourbody'ssexfluids can pass the virus to your partner, you will want to consider two important points.

First, you will want to tell your sexual partner that you are HIV positive. This will allow you and your partner to make decisions together about what kinds of sexual activity will be okay. Telling your partner beforehand may also increase your enjoyment of sexual activities because you will not feel uncomfortable about not telling him or her.

Youwillalsowanttoconsiderwaysofreducingthepossibilityofyourpassingthe HIV on to your partner. There are many types of se"al activity which present different degrees of risk of HIV transmission. You may have heard about safe sex, or safer sex, and know that condoms, lubricants, spermicides, and other protection devices or materials all play a role in reducing the risk of sexually transmitted diseases, including HIV infection. There is a good bit to know about what is less risky, what is completely safe, and how to decide what sexual activities are best with your partner. The following are guidelines to safer sex.

• WHAT Is MEANT By "SAFER sEx", ARE THERE DIFFEREr`IT DEGREES OF RISK? The following sexual activities are considered to be no risk practices for heterosexual (male with female), homosexual (male with male), bi-sexual (person has both male and female partners) and lesbian (female with female) partners.

KISSING: Dry kissing is considered to be safe if neither person has open oats or sores in the mouth or on the lips. Kissing or licking of unbroken skin (cheeks, nipples, harids) is also safe.

TOUCHING: Massage, cuddling, hugging and body-to-body rubbing is safe as longasyourskinisfreeofouts,woundsorrashes.However,body-to-bodyrubbing should not include vulva^ragina to penis or vulva/vagina-to vulva/vagina contact.

FANTASYAND VOYEURISM: Your mind is a powerful stimulant. It can create exotic images and words that will arouse you and give sexual pleasure and satisfaction.

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• LOw RlsK OR pOsslBLy SAFE sEx pRAcmcEs DEEP OR "FRENCH KISSING": Exchanging salvia may pose a risk, especially if you or your partner have cuts or sores in the mouth or on the gums or tongue.

PROTECTEDORALSEX:Oralsexonamanwhoiswearingacondoin(rubber) is considered to be low risk. Some risk may exist because there could be a leak in the condom that allows semen to enter your mouth. Cuts or sores on your gums could then allow the virus to enter your bloodstream. Because of the possibility of leaks, some people prefer to use two condoms.

Oral sex on a man who is not wearing a condom is known to pose the risk for spreading gonorrhea and syphilis. As long as he does not ejaculate (oum) in your mouth,itisbelievedthatthiswillprobablynotpassHIVorthehepatitis-Bviruses to you. However, it is difficult to always tell when ejaculation will occur. At the present time, it is uncertain whether or not the pre-ejaoulatory fluid Ore-oum) contains the virus and therefore poses unknown risks.

Safe principles to follow for oral-penile sex are to always wash the p.enis, scrotum and anus thoroughly both before and after oral sex. Always avoid having semen and pre-oum enter your mouth.

The risk of transmitting HIV through unprotected oral sex with a woman is uncertain. We know, however, that such activity can spread gems that cause chlamydia, gonorrhea and syphilis. Because vaginal secretions contain small amounts of the virus that might enter the bloodstream through openings in the mouth, gums or tongue, the safest practice is to place a barrier between the mouth and vagina. Latex or rubber sheets (called dental dams which can be purchased at the drug store) or sheets of saran wrap can be placed over the vagina to prevent infected secretions from entering the mouth. When enjoying oral-vaginal\clitoral sex, always wash the vulva, labia and anus thoroughly before and after oral sex.

NEVER HAVE ORAL.VAGINA,CLITORAL SEX DURING MENsr[RUA. TI0N OR HER PERIOD).

FINGERING THE CLITORIS, VAGINA OR AINUS: If your finger or hand has a Cut or a wound, the virus may be passed to the vagina or anus, or it may enter

your bloodstream from either the anus or vagina. To prevent this, you can use a finger-cot (similar to a surgical glove) for your finger. These can be purchased at drugstores.

MASTURBATION: This practice is safe if semen or vaginal secretions come in contact with intact or healthy skin. Contact with cuts or sores is not safe.

WATERSPORTS: Urinating on healthy or unbroken skin is safe. However, Since urine can contain the virus, you should avoid getting it in the vagina, anus, eyes, nose or mouth.

SEX TOYS: vibrators, dildos and other sex toys are safe to use if they are carefullycleanedbetweenuseswithsoapandhotwater.DONOTSHARETOYS, either label them with your partner's name or purchase different color toys.

PROTECTED ANAL SEX: Anal sex (insertion of the penis into the anus) Without a Condom often bruises or breaks the rectal lining and allows the virus to

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enter the blood stream. Use of a condom, if it does not break or leak, can prevent semen from coming into contact with injured anal tissue. Because condoms can leak, you may wish to use double condoms. Also, the use of lubricated condoms can greatly reduce the risk of damaging or hurting the anal tissues. ANAL

INTERCOURSE W]rrHOUT A CONDOM [S THE MOST DANGEROUS

pRACTlcE OF ALL sExuAL AclTvrnEs. PROTECTED VAGINAL INTERCOURSE: Research has shorn that the AIDS virus can be passed from male to female and from female to male. In addition to the use of a condom to prevent transmission, research has shorn that spermicidal jelly or contraceptive creams containing nonoxynol-9 kills HIv in laboratory tests.

However. it is still unknown whether use of such spermicides during vaginal (or anal) intercourse prevents infection. What is known is that USING SPERMICIDE VVITHOUT A CONDOM WILL NOT PREVENT INFECTION. Even when using a condom, withdrawal before ejaculation is the safest practice. The use of a diaphragm which contains nonoxynol-9 cream or jelly is also recommended for women even when the man is wearing a condom. The diaphragm blocks the cervix and prevents the virus from entering the uterus and the bloodstream.

• HIGH RISK SEXUAL PRACTICES The following sexual activities pose the highest risk of passing the virus to your

Panner.

• Unprotected (without a condom) oral, vaginal or anal intercourse with a male partner who ejaculates in you.

- Unprotected oral sex with men or women.

natural barrier to the AIDS virus there is. Therefore, unless there is a cut or sore, there is no need to worry about getting semen or vaginal secretions on skin. The best practices to remember are "On me, not in me" and always use a condom or other barrier.

• WHAT IS THE CORRECT WAY TO USE A CONDOM? Theprimaryreasoncondomsbreakorleakisbecausetheyarenotusedcorrectly.

While simple to use, instructions must be carefully followed. Remember, "practice makes perfect" and you should use a condom every time you have sex of any kind. Follow these steps to safer sex.

1. Always put the condom on before you ever have sex.

2. Open the package carefully. Do not tear it with your nails or teeth as you may damage it.

3. Before placing the condom on the erect (hard) penis, take your thumb and forefinger and press the air out of the closed tip (air bubbles can cause it to break). You can put a.small amount of water-based lubricant (K-Y jelly) in the tip. This will solve the air problem and increase sensation. Also, make sure which way the condom unrolls before you start to put it on.

4. If you or your male partner have not been circumcised, pull the foreskin back before putting the condom on.

5. Place the condom over the head of the penis and unroll it until it covers the entire penis all the way down to the pubic hair. Be sure to use only

Semen or pre-cum or vaginal

the tips of your fingers or your hands. DO NOT USE YOUR FINGER-

NAII.S OR TEETH TO UNROLL THE CONDOM. You may punc-

secretions could enter your mouth.

- Any unprotected sex during menstruation or a woman's period. This is considered a high risk practice for transmission of the virus for lesbians and bisexual Women.

- Rilrming. Oral contact with the anus or feces should be avoided to reduce the risk of HIV and other sexually transmitted diseases.

- Fisting. Putting a hand or fist into the anus or vagina is extremely dangerous

because it causes the tissues to tear and break.

- Internal watersports. Urinating in your partLer is considered extremely risky.

ture or tear it. If you condom is plain-ended (does not have a tapered tip), you should leave about 1/2 inch free at the tip to catch the cum.

6. Before inserting the penis into the vagina or anus, put a water soluble lubricant such as K-Y jelly all over the outside of it. If the vagina or anus is too dry, it can pull the condom off or tear it.

7. Certain sexual positions can cause the condom to slip off (such as a woman sitting on top of a man). Therefore, it will sometimes be necesSary to hold the base of the condom during intercourse to keep it from coming off.

- S and M activities which cause blood to be drawn or exchanged is very dangerous.

Remember, any body penetration increases the risk of transmitting the virus.

Anal intercourse is very dangerous and not recommended. Intact skin is the best

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8.

After ejaculation and before the penis gets soft, take hold of the base of the condom and withdraw from your partner. Holding the condom in place will prevent its coming off.

9. To remove the condom, pinch off the tip containing the oum so it does not spill and remove the condom. Once removed, tie off the open end

and throw it away. NEVER USE A CONDOM MORE THAN ONCE..

• OTHER IrmoRTANTTlps TO succEssFUL CONDOM USE 1. Keep your condoms in a cool, dry place.

2. Do not apply baby oil, skin lotion or petroleum jelly (vaseline) because they weaken the condom and can cause it to break or tear.

3. Do not test condoms by stretching them or blowing them up.

4. Lubricated condoms do not break as easily as non-lubricated ones and seem to provide greater sensation.

5. Nonoxynol-9 has been shown to kill the AIDS virus in laboratory studies.

Condoms lubricated with this substance may provide added protection against the AIDS virus. Some people, however, have found nonorynol-9 to be irritating to the tissue. Therefore, these products should be tested on the skin prior to use.

6. Consider using two condoms to play it even safer.

• THERE ARE SO MANY KINDS 0F CONDOMS, WHICH ONE SHOULD I USE? Condoms come in all colors, sizes, shapes and tastes. To find the one right for

you, experiment with different ones during masturbation or other low risk activities. Condoms can be fun and sensuous. Make them a part of your sex play and be creative.

• CAN I CONTINUE TO HAVE UNPROTECIED SEX WITII SOMEONE ELSE WHO ls AI.sO Hlv posmvE? No, this is not recommended. If you have unprotected sex with another person who is also HIV positive, you may re-infect yourself. If this happens, you may activateyourimmunesystemandincreaseyourchancesofdevelopingopportuhistic infections. Also, your sexual partner may have another disease which you could

get that would also harm your immune system. The best rule to follow is to always practice safer sex!

I I I ] I I I ]

CILAPRER4 WOMEN AND CHLDREN It is very important that you do not become pregnant or cause someone to become pregnant if you are HIV positive. While many things are not yet known about how pregnant women can transmit HIV to their infants, it is now believed that about 40% of babies born to HIV positive mothers will become infected with the virus. The virus has been transmitted from mother to baby in the womb before birth, during delivery, or in rare cases, from breast milk. At this time, there is no way to know which infant will be infected during pregnaney. Some HIV positive women who become pregnant have decided that the risk of passing such a serious disease to their infants was too great and decided to terminate their pregnancies.

Termination of a pregnaney because of HIV infection is a personal decision and it is recommended that you discuss all your options with your physician, counselor and/or minister. Remember, put yourself and what you want first!

• `VIIAT ABOUT MY CHILDREN? If you are HIV positive and have had or have fathered a child since you became infected, that child is at risk for HIV infection. Any baby born to a mother who is HIV positive needs very close medical attention from the time it is born in order to know whether the child is infected with HIV or not. It is not usually possible to know during the infant's first 15 months whether or not the child is infected, but the infant needs the best medical care possible during those critical months.

The reason it is hard to know for sure is that HIV is generally transmitted from mother to child during the last three months of pregnancy. When the newborn baby's blood is tested for antibodies to HIV, the test will be positive because the baby is still carrying the mother's antibodies. The mother's antibodies may not disappear from the child's blood tests for up to 15 months, and it is difficult for a doctor to determine if the baby is infected unless she or he becomes ill. There are some new tests which diagnose HIV infection very early in babies. These tests, however, are only available at medical centers with special research facilities.

If you have a child who may have been born at risk, the sections which follow regarding personal hygiene, nutrition, housekeeping and pets are as important for

your child as they are for you. A supportive and loving home life is as important for any child at risk as it is for the HIV positive parent.

• WHAT IF M¥ CHILD ls Hlv posrlTVE? Children who are HIV positive share the same needs as other children who are not infected and they pose little, if any, risk to anyone around them. Every child

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3. Double bag or use bags with melt away linings for soiled diapers, sanitary napkins, band-aids and other disposable articles soiled with body excretious and secretions.

who is HIV positive should be thoroughly assessed, and if judged healthy enough, should be allowed to engage in usual activities such as attendance at day care or school.

Since we can't tell until a baby is 15 months old whether he/she will be infected if born to parents who are infected, it is important that babies who are at risk for HIV infection and children who are HIV positive receive regular care from a

4. Wash toys, furniture and any other articles soiled with blood and body excretions with a clearing agent, then wipe again using a solution of 1: 10 householdbleachandwateror70%alcohol.Preparethebleachsolution daily as bleach dissipates (gets weak) quickly once diluted.

physician or the clinic at Children's Hospital. This would include well-baby care and shots. The child should not receive the oral vaccine (OPV), but should receive the inactivated polio vaccine (IPV). It is also recommended that you do not breastfeed the baby.

5. Wear smocks if there is a possibility that your clothing will be contaminated with blood or secretions/excretions.

6. For items requiring laundry, use double bag or use bags with melt away linings for contaminated linen until laundered. Rinse in cold water with bleach added and then wash in hot water. Bleach loses its effectiveness when added to hot water.

If you see any of the signs below call your doctor or call the Acute Medical Clinic in Birmingham at 205/939-9140. Make sure they know who your baby is or that he/she could be HIV positive.

1.

Fevermorethan 102

2.

Refuses to take food or liquids

3.

Vomiting that lasts more than 8 -12 hours

Caregivers of infants and children who are HIV positive in Birmingham and who have questions about how to contain infection can call the Infection Control Nurse

4.

Drowsyeven when awake

at Chi]dren's Hospital 939-9265.

5.

Sleepsallthetime

6.

Extremely fussy

7.

Seizure (fits)

8.

Problems with breathing

9.

Prolonged bleeding from any place

7. Store toothbrushes separately and do not allow children to share eating utensils, plates, glasses, or oops.

10. Baby looks yellow 11. Diarrhea (loose stools)

12. Diaper rash that will not clear up 13. Sores or white rash in mouth (thrush)

• WIIAT SHOULD I D0 WHEN CARING FOR MY CHILD? 1. Wash hands before and after working with each child.

2. Wear disposable gloves when handling blood and body excretions or secretions and for diapering and toileting. Gloves should also be worn for oral care or assessment and whenever the care provider has open oats, dry skin or weeping lesions.

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CILARER5 PERSONAL CONCERNS As an HIV positive person, there are some precautions you can take regarding personal hygiene and cleanliness which will help you stay healthy and avoid catching common infections that may be carried by people, animals or objects you encounter in daily life. Probably the one most important general rule to remember is to wash your hands often. Your first goal is to prevent infection and handwashingistheverybestwaytodoit.Whenpossibleyoushouldusedisposable latex gloves to handle any body fluids or garbage. Any time you handle body fluids or trash, whether or not latex gloves are used, washing your hands in hot, soapy water will greatly reduce your risk of infection.

Personal toilet articles can transmit infection and should not be shared.

In

general, it is best for each member of the household to have their own set of toilet articles, including toothbrushes, towels, washcloths, razors, etc.

Wash your bed linen and clothing regularly and do not overload the washing machine. Use hot, sudsy water. Chlorine bleach can be used on colorfast items and a phenol solution like a capful of lysol can be used for heavily stained non-colorfast clothing or linen.

• DO I NEED TO DO ANYTHING SPECIAL FOR HOUSEKEEPING? Ensuring that one's home is reasonably clean is just good common sense. Clean the bathroom regularly with 1 part bleach to 10 parts water or any other commercial product that disinfects and kills germs.

A 1 to 10 solution of bleach kills troublesome germs like the one which causes athlete's foot. Use full strength bleach to clean the toilet bowl.

In general, keep your home well ventilated and remember that sunshine is a natural and strong disinfectant. To safely clean up blood, simply put on disposable gloves and clean the area with the 1 part bleach. to 10 parts water solution.

• WHAT ABOUT PREPARING FOOD FOR MYSELF, FAMILY AND FRIENDS? Concern that HIV is transmitted through food is uusubstantiated. The Centers for Disease Control has reported that a vims that is blood-borne and sexually transmitted, such as HIV, will not be transmitted during the preparation or serving of food and beverages.

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In the interest of your overall health, eat well-balanced regular meals. The goal of your diet should be to maintain a normal body weight for you. High energy foods will nourish your immune system and will help fight off infectious. Wash

• IF SWALLOWING IS DIFFICULT, WIIAT CAN BE DONE? If you have having trouble swallowing, your main concern should be to eat foods that will not irritate your throat. Choose single texture foods (such as mashed

your hands before eating, cooking or preparing food. Wash dishes in hot, soapy water and allow them to air dry. Fresh fruits and vegetables have germs on them which may be harmful so wash them thoroughly and peel them before cooking or eating raw. Do not eat raw egg (included in some homemade ice cream and hangover remedies), unpasteurized milk products, or meat that is not thoroughly cooked. Cook your foods properly so you don't lose those fresh nutrients you paid extra for. Steaming and baking are preferred cooking methods. Check out fad health diets very carefully -of course that occasional triple decker burger and fries are OK, but your general daily eating pattern should be much healthier.

potatoes and oatmeal) rather than combination foods (such as stews). Avoid coarse single particle foods (such as nuts, corn and rice) that can get stuck in your throat. Avoid sticky, dry foods, such as peanut butter than can be hard to swallow, as well as slippery foods (like bologna, macaroni and j.ello) that may slide down too fast. Use a straw to help when you are drinking. Try tilting your head back or moving it forward to make swallowing easier.

• WHY IS THE TASTE DIFFERENT FOR SOME FOODS?

® ih/IIAT CAN I DO TO MAINTAIN GOOD NUTRmoN? Eating both the right amounts and the right types of food will give you energy, protein and other nutrients that will help give you strength and may improve your ability to fight infection.

Eatingawidevarietyoffoodsisoneofthebestwaystomeetyourdailynutritional needs. Breakfast is an important meal. Because you may become more tired as the day progresses, it will be extra important for you to have a healthy meal to get your day off to a good start.

Because bacteria that can cause infectious exist in the environment, you should always wash all fruits and vegetables thoroughly. Cook meat well, avoid raw fish

(sushi) and raw eggs (including homemade AL 721 preparations). Remember to purchase only pasteurized daily products. Avoid "fad" diets or products that promise to cure illness. It is important to eat food that provides adequate calories, protein, vitamins or minerals needed by your body.

• WHAT CAN BE EATEN IF I HAVE MOUTH PAIN AND SORES? Cool, smooth and mildly-flavored foods make eating more enjoyable. Eat foods served at moderate temperatures rather than extremes in temperature (hot or cold). Choose mild foods and drinks (like apple juice) rather than acidic foods

(such as orange, grapefruit and Pineapple). Limit spices (such as chili power, red pepper) and salted foods when you have open mouth sores. Dunk toast, cookies and crackers in liquids (such as milk, soup and tea) to make them softer. Eat non-abrasive, easy-to-swallow, moist foods like puddings, eggs, canned fndts, baked fish, soft cheeses, noodle dishes and ice cream. Popsicles can be a tastyway to numb the pain. Add a nutritionally balanced drink to your regular diet to help boost calories when you are having trouble eating. Several varieties are available.

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Taste changes or dry mouth may result from medications or mouth sores. Different flavors,texturesandtemperaturewillimproveyourabilitytotasteandenjoy food. Choose different flavors such as sour, spiny and sweet. Select foods that smell good to help improve your desire to eat. Eat acidic foods (such as citrus and pineapple) to help thin saliva and make chewing easier. Experiment with herbs and spices to perk up the taste and smell of your food. Marinate foods or add chopped oliion, garlic, bacon bits, ham strips or cheese to foods for more flavor.

When you have a dry mouth, try smacking on foods that keep your mouth moist (such as ice chips, hard candy and gum). Drinking small amounts of liquids at mealtime can also help keep your mouth moist.

• IS rrHERE SOMETHING THAT CAN BE DONE FOR DIARRHEA? Drug therapy, infection and certain foods can cause diarrhea which may lead to weight loss and dehydration. It is important to eat and drink even when you are experiencing frequent bouts of diarrhea. When diarrhea becomes severe, be sure to contact your doctor. You can help to manage a problem with diarrhea, by drinking plenty of liquids including water, diluted fruit juices and flavored drink mixes. Eat and drink caffeine-free foods and beverages. Choose low-lactose foods such as Lactaid products, aged cheese and cultured yogurt. Select low-fat foods including lean meat and 1% fat dairy products. Choose bananas, mangos and diluted orange and nectar juices to replace minerals you may have lost. Eat white rice, white bread and cooked fruits and vegetables without the skin, rather than high fiber foods such as whole wheat bread, brown rice, raw fruits and vegetables and corn.

• wllAT CAN BE DONE wllEN you IIAVE A POOR AppETTrE? Loss of appetite, or disinterest in food is sometimes experienced by people who are taking certain kinds of medications or who are feeling depressed. A pleasant environment and snacking can help improve your desire to eat. Ask a companion to join you at mealtime. Choose the foods you enjoy most because you are likely

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problem with your cat, you may wish to consider having it declawed. If you do get scratched or bitten, wash the wound immediately with soap and water and apply an antiseptic. Contact a doctor if redness or swelling develops.

to eat more. Eat several small meals a day. Drink small amounts of liquids with

your meals, so you don't fill up before you've eaten enough. Serve foods at cool temperamres since they tend to have less odor. Select foods with faint odors.

Foods with strong odors (like orion and fish) may discourage your interest in eating. If you don't want to eat meat, consider other sources of protein such as tofu, beaus (black and kidney) with rice, dairy products, fish, nuts and peanut butter or eggs. rliry adding grated cheese to sauces, vegetables and casseroles.

Keep ready-to-eat snacks on hand such as crackers with cheese or peanut butter, ice cream and canned fruit. Drink an instant breakfast shake between meals to boost calories.

Clean up all messes your pet makes with a disinfectant and use gloves. Wash your hands when you remove the gloves.

Use disposable rubber gloves to clean and empty bird cages, cat litter boxes, fish tanks, or other pet cages or enclosures. Keep pet cages, litter boxes and sleeping areas away from cooking and eating areas. Keep your pets eating and sleeping areas clean. Be sure your pet's vaccinations are current.

Feed your pet commercial pet foods. Don't feed them raw food that they can acquire infectious from. Don't let your pet drink water from the toilet.

• WHAT sHouLD I Do ABouT NAusEA AND voMmNG? Nauseaandvomitingoftenocourasaresultofthemedicationyouaretakingand are usually temporary. The best way to tackle the problem is to experiment with different foods until you find foods that you can eat without difficulty. When you arefeelinggood,eatcompletemealstohelptideyouoverduringtheperiodswhen

Restrict your animal to the indoors or supervised walks on a leash. This will

prevent them from killing and eating wild animals or other refuse which can make them sick. Control ticks and fleas.

you do not feel like eating. Drink clear, cool beverages (such as ginger ale and apple juice) and try clear soups (such as broth) and gelatin, particularly between meals. Try popsicles and ice cubes made from clear fruit juices since they can be soothing. Eat slowly, rest after meals, but do not lie down for at least two hours after eating. Have small, frequent meals to increase the overall amount of food

For Cats. Use disposable cat box liners and change them when you change the litter. Wear disposable rubber gloves when changing the cat litter and put into a sealed plastic bag for disposal. In the unfortunate event that your cat tests positive for feline leukemia virus, you may wish to give it up since it is very susceptible to infectjons you can also get.

you eat during the day. Choose low-fat foods rather than greasy, high-fat fried foods like those served in "fast food" restaurants. Select milk (bland) foods rather thanspieyfoodswhichmayirritateyourstomach.Tlrychilledfoodssuchascottage cheese with fruit, chicken or tuna salad. Eat salted foods (such as pretzels) and dry foods (such as crackers). When the smell of food bothers you, make sure your cooking area is well ventilated or ask someone else to prepare your meals. Eat meals before taking medication that is known to cause nausea.

For Fish. Wear rubber gloves when touching the water and wash your hands afterward. Keep the tank clean.

When your dietary needs cannot be met by a regular well-balanced diet, altemativc nutrition support options should be discussed with your physician or nutritioulst. Remember, good nutrition promotes good health.

• WRATABOUTMY PETS? Pets can be wonderful companions but also carry germs that can affect your health.Ingeneral,yourbodyisprobablyusedtoanygermsyourpresentpetshave but if you get new pets be sure they are healthy. Try to get new pets from a kennel or breeder you can trust. Have new pets examined by a veterinarian. Kittens and puppies older than six months are less likely to have diseases you can get. Sick pets should be taken to the vet as soon as possible.

Wash your hands after handling your pet especially before eating or smoking.

Keep your pet's nails trilrmed so it won't scratch you. If scratching is a continual

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CHIARER6

[1

PIANNING FOR TIIE FUTURE

[`,I

[„ mH [H

You have a fulfilling and productive future to look forward to and like everyone else you should consider planning for that future. There are many important things to think about and one of these is your financial well being. The following questions are typically asked by persons who find out they are HIV positive. If you have other questions, just call your local AIDS organization.

• DO I NEED TO KEEP MY HEALTH INSURANCE? Definitely!Thecostofhealthcaretodayisveryexpeusiveanditisveryimportant that you maintain your health insurance policies.

If you have private insurance, it is extremely important for you to keep it even if the monthly premiums are difficult for your budget. You should have a copy of

your insurance plan (obtain one from your employer or the insurance carrier) and make yourself familiar with your benefits. Some questions to consider are: does my po]jcy cover outpatient drugs, home nursing care, and, if so to what extent? Be concerned about the co-pay and any deductible you rfiay need to meet. Also, investigatewhatthestatusofyourpolicywouldbeifyouweretoleaveyourcurrent job. Would you be eligible to purchase an individual policy with the same company? What would be the cost of the premiums?

a CAN MY INSURANCE COMPANY CANCEL MY POLICY OR CHANGE MY BENEFITS? If you have had insurance coverage for two or three years you should not anticipate any problems. The most likely reasons insurance companies would deny or reduce benefits are: utilization of a non-approved health care provider (physician) or failure to comply with preauthorizations, reviews, ljhitations, exclusious and/or a pre-existing conditions.

A pre-existing condition is an illness or condition which existed, was treated, (or shouldhavebeen)priortothecoveragestarting.Thespecificperiodoftimevaries with insurance companies but generally is from 270 days until two years, after which full polity benefits start. You should be aware than an HIV positive test

prior to starting coverage may be considered a pre-existing condition. THE MOST IMPORTANT ADVICE one can receive is before making a]]y insurance changes, discuss your poliey and coverage with a benefits counselor, an attorney, or a tra].ned professional. Keep good records (keep a record of letters or phone calls, checks, etc.) and if in doubt or confused seek advice.

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• WHAT HAPPENS IF I WANTTO CHANGE EMPLOYERS?

nl

You may want to consider finding an employer or company that has more than 20 employees and provides coverage under a group plan. That way, it may be possible to enroll for coverage without having a blood test. Enrollment requirements vary by employer and insurance company so you will need to check out different requ i rements.

[]

Another reason to seek employment in a firm with 20 employees or more enrolled in a group plan is that if you were to leave that company you could be elig].ble for COBRA benefits. COBRA benefits are provided for under Federal Law, Title X and require that all employers of 20 or more employees must offer up to 18 months of continuous coverage for employees who leave the company for any reason.

SSI, your medical condition and current financial situation are assessed. A person does not have to have worked to be eligible for benefits. You can apply for SSI at any Social Security office. You may call, write, or visit and should plan to take your Social Security card, birth certificate, general financial information, rent receipts,

property tar records, information about income, and medical records, including names and addresses of all doctors, hospitals, and clinics that have treated you.

Apply even if you do not have all of the information needed, since benefits, if approved, are retroactive (paid back) to the date you first applied for them.

General processing takes approximately three months. However, with medical proof of an HIV related diagnosis, one can receive a presumptive disability for up to three months in as short a time period as one month.

A person who is eligible for SSI is eligible for Medicaid. In the state of Alabama, currently the maximum SSI payment is $386.00 a month. Presently, Medicaid pays for most medications required for HIV related conditions and a Medicaid waiver may also pay for up to 720 hours a year of nursing or homemaker services if the

• WIIAT IF I DONT HAVE INSURANCE COVERAGE, CAN I GET IT?

person qualifies.

There are several different alternatives available. Many different trade groups and associations offer group insurance fo.r individuals and for people who are self-employed. Also, some insurance companies and health maintenance or-

In order to qualify for SSD benefits, again one must meet the same medical criteria in addition to having worked five of the last ten years and paid Social Security tares (FICA). The amount one receives depends on how long and how much one has paid into the system. A disability determination takes longer to evaluate, usually two to three months. If written notification of approval is received, you should expect the benefits to start on or about the second day of the sixth month. After receiving disability benefits for 24 months, one is eligible for Medicare. Medicare has two parts -A and 8, hospital insurance which is provided and medical insurance which is optional.

ganizations (HMOs) have certain times when they offer open enrollment periods in which they will accept applications for coverage. These are often advertised in the newspaper and on TV. You can watch for these and try to take advantage of these opportunities.

• \VIIAT IF THEY ASK ABOUT MY HIV STATUS ON THE INSURANCE APPLICATION? SHOULD I LIE? No, you should not lie because the insurance company may check your medical records and discover your HIV status. If this happens, they can cancel your polity or deny payment on a claim by claiming that you misrepresented your medical status. Therefore, you need to be honest.

The most common mistake people make in applying for a disability is not documenting all of the medical records. Be sure to include all doctors, hospitals, and treatments.

® IF I DON'T QUALIFY FOR MEDICAID OR OTHER SUCH PROGRAMS, IS THERE ANY OTHER WAY I CAN GET MEDICATION SUCH AS AZT?

• WHAT IF I CAN'T AFFORD THE PREMIUMS, AM I ELIGIBLE FOR SOCIAL SECURITY DISABILITY OR MEDICAID? Typically,justbeingpositiveforHIvdoesnotqualifyapersonforsocialsecufity benefits. You must be disabled in some way. The definition of a disability according to social security is related to the ability to work. A person is considered disabled when he/she has a severe physical or mental impairment or combination of impairments that will prevent him/her from working for a year or more or that is expected to result in death. The work does not necessarily have to be of the type done previous to the disability, it can be any work for pay found in the economy.

Maybe. Currently, you can apply to the Alabama Department of Health in Montgomery for assistance with AZT. Also, many of the local community based organizations offer some financial assistance with medication. Ask your physician or community based organization about what is required for this plan.

There are two programs administered by the Social Security Administration: Supplemental Security Income (SSI) and Social Security Disability. To qualify for

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• \VHAT ABOUT LIFE INSURANCE? CAN MY LIFE INSURANCECOVERAGE BE CANCELLED IF THEY FIND OUT ABOUT MY HIV STATUS? No. As long as you are enrolled in a group plan, your coverage cannot be cancelled because of your HIV status. If you quit yourjob, you should be able to convert your policy for up to 30 days, but you will have to pay your own premiums.

COMMUNITY BASED ORGANIZATIONS IN BIRNINGIIAM AND JEFFERSON COUNTY AIDS Task Force of Alabama, In

324-AIDS

:edL(;;C(£;L!r°eT::rd#:racy.techniealassistanceand

• DOES COBRA COVER MY GROUP LIFE POLICY? No. COBRA does not include either life or disability insurance.

• SHOULD I MAKEAVILL? It is a good idea for everyone to have a will. This is the only way you have to control and protect your property and assets. No one knows when an accident or something might happen to them and if you want to make sure your loved ones or others are taken care of, having a will is the most prudent thing you can do.

• SHOULD I MAKE MY O\VN VILL? You can, but it is generally recommended that you at least consult with a lawyer.

Lavyers are most familiar with all the processes involved in drawing up and executing a will and can help assure your will cannot be challenged or overturned.

322-OJSJ

;F:§a¥o:[gg:afug;:I::e§:o;§s#g:+¥alTdee¥tea:Tns£T{nng Crisis Center Counseling and support

3;R:3-m77

326-6821

8;euasti:rgBi:rsEi:ghceTfo#S#jkes

324-4975

±edf:ecr:t::n?::;;yofr%gsMiind°:it£::services Jefferson County AIDS-STD Helpline

933-5419

Eianmanbgi:I(gs:iys,¥ndcc+ef:)bo;3nb::ike,n::od!psuppor[

326-8600

• WHAT ABOUT A LIVING \VILL? This is a personal decision. Because of advances in medical technology, some

people are concerned that they may eventually become ill and will be kept alive by machines and many people don't want this to happen.

Alabama Association of Persons with AIDS Support groups

252-2255

Project Share (al Red Cross)

322-5661

Financial assistance with utilities

One way to avoid this is to make a Living Will. A Living Will allows you to say what treatment you do or do not want to receive in the future and in certain circumstances. To be honored, this document typically must be drawn up in advance of an illness or life threatening inj.ury. Again, consult your attorney for assistance.

31

32

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I,I COMMUNITY BASED ORGANIZATIONS IN

AREARA

I..I

AII>s ACTloN coALmoN oF HUNTsvlLLE P.O. BOX 871

HUNTSVILLE, AL 35804 533-AIDS

ALABAMA ASSOCIATION 0F PERSONS VITH AIDS P.0. BOX 550181 BIRMINGHAM, AL 35255 252-2255

AIDS SUPPORT THROUGH ENOWLEDGE

References Springer, Michael J. So. Yoi]'re, IIIV Positive.

11 Em HL

P.O. BOX 1392

EEari°9ngE,.sAUEEir#TfTrmpuunb°Hq:fiti€ineysyndrfm±ewforphysical Living w].th AIDS: A Giii.de. Gay Meus Health Crisis. New York, 1989.

Health Sources: A Resource Mam]al for People with HIV or AIDS. Health Crisis Network, Inc. Miami, FL 1989.

Ilie rrmr)Ietc rTiiide in Sflfe Sex: The Institute for Advanced Study of Human Ssexuality, Specific Russ, Sam Francisco, 1982.

ANNISTON, AL 36202 835-0923

HE

AIDS TASK FORCE 0F ALABAMA, Inc P.O. BOX 55703 BIRMINGHAM, AL 35255

[.I

32+AIDS BIRMINGHAM AIDS OUTREACH P.O. BOX 550070

BIRMINGHAM, AL 35255

I_I

92:2.-UrlsJ JEFFERSON CO. AIDS IN MINORITIES P.0. BOX 55703 BIRMINGHAM, AL 35255

]L

324-4975

LEE COUNTY AIDS OUTREACH

EH

P.O. BOX 1971

AUBURN, AL 36830 MONTGOMERY AIDS OUTREACH, INC. P.O. BOX 5213

MONTGOMERY, AL 35103 284-2273

]1

Nutr].tion and ATI)S. ThhiTig Charge of your Diet. Tdsk Force on Nutrition Support in AIDS. New York, NY. Maki.ng Sex Safe, Safer. The American College Health Association.

Resounes Alabama AIDS Information Hotline

800-228-0469

National AIDS Hotline

800-500-AIDS

Jefferson County AIDS-STl) He]pline

205/933-5419

Clinical Trials Information Service

800-TRIALS-A

AZT Information

800-843-.9388

U.S. Public Health Service

800-342-7514

[1

MOBILE AIDS COALITION P.O. BOX 40051

MOBILE, AL 36640

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MOBILE AIDS SUPPORT SERVICES

1208 N. IAFAYETIE ST. MOBILE, AL 36604

[1

WEST ALABAMA AIDS OUTREACH P.O. BOX 031947

TUSCALOOSA, AL 35403

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