AIDS and HIV Infection [618313]

AIDS and HIV Infection
Information for
United Nations
Employees and
Their Families
UNAIDS

UNAIDS/99.31E (English original, June 1999)
1st revision, April 2000
© Joint United Nations Programme on HIV/AIDS (UNAIDS) 2000. All rights reserved. This document, which is not
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AIDS and HIV Infection
Information for
United Nations
Employees and
Their Families
UNAIDS
Geneva, Switzerland
2000

Foreword
United Nations HIV/AIDS Personnel Policy
Chapter 1 — The Facts
What is AIDS?
How HIV is transmittedHow HIV is not transmitted
Chapter 2 — Preventing HIV Transmission
Preventing sexual transmission of HIVPreventing transmission of HIV via blood and blood productsPreventing transmission of HIV via contaminated needlesProtecting children
Chapter 3 — Being Tested
What the HIV antibody test can tell youThe HIV antibody test and employmentThe HIV antibody test and pregnancy
Chapter 4 — Living with HIV and AIDS
Coping with confirmed HIV infectionHIV and your infant's health
Chapter 5 — A Global Overview of the Epidemic
Chapter 6 — The UN Response to AIDS
Chapter 7 — Staying Informed and Getting Help
Glossary
References
Further Reading from UNAIDSTable of Contents
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Information for United Nations Employees and Their Families — 5Foreword
As we leave the 20th century, there is still no cure in sight for one of the most fright-
ening and devastating diseases the world has known.
HIV and AIDS continue to affect the lives of millions around the world. But they
are not faceless millions. Almost all of us know afriend, family member or co-worker who hasbeen affected. In our work as United Nationsemployees, we also see at first hand how thepandemic is ravaging the developing world, par-ticularly Africa and South Asia.
Until a vaccine or a cure is found, our greatest weapon against HIV/AIDS is
knowledge. The United Nations is committed to providing a supportive workplace forits employees, regardless of their HIV status. To do this, we must foster a work envi-ronment of compassion and understanding, not discrimination or fear.
This booklet is a straightforward and practical resource, designed to give you
and your families the most up-to-date information available on HIV and AIDS, suchas:
Ibasic facts about HIV/AIDS, how it is transmitted and how it is not transmitted;
Iways to protect yourselves and your families against infection;
Iadvice on HIV antibody testing and how to cope with the disease if you or a
family member test positive;
Ia global overview of the epidemic and the UN's response to AIDS at inter-
national and country levels; and
Ia list of valuable resources to direct you and your family to additional information
or support services.
This booklet also contains the United Nations HIV/AIDS Personnel Policy. It is
important that each of us be aware of the policy and be guided by it in our daily lives.I urge you to seek out additional information and to stay informed. The United NationsStaff Counsellors and the United Nations Medical Directors, both part of the Office ofHuman Resource Management, are available to answer your questions.
When the world looks back on the end of the 20th century, let us be remembered
for our vigilance in combatting one of the greatest killers in our lifetime. But let us alsobe remembered for our solidarity with all those who suffer from this terrible disease.
Kofi A. Annan
United Nations Secretary-General“…we must foster a work
environment of compassion
and understanding, not
discrimination or fear.”

Information for United Nations Employees and Their Families — 7HIV/AIDS Personnel Policy
A. Information, education and other preventive health
measures
i. UN Staff and their families should be provided with sufficient, updated information
to enable them to protect themselves from HIV infection and to cope with the pres-ence of AIDS.
To this end, all UN bodies are encouraged to develop and implement an active
staff education strategy for HIV/AIDS using the handbook on AIDS for UN employ-ees and their families produced by UNAIDS and identifying in the field local sourcesexperienced in HIV/AIDS counselling, to provide confidential follow-up.
The staff of the UN Medical Service should be fully involved in such staff edu-
cation programmes. They should receive any additional professional education thatmay be required; and all pertinent information material on HIV/AIDS, supplied andupdated by UNAIDS, should be available through them at all duty stations.
ii. All UN staff members and their families should be made aware of where safe blood
may be obtained.
To accomplish this task, the WHO Blood Safety Unit, in cooperation with the UN
Medical Service, should establish and regularly update a list of reliable and opera-tional blood transfusion centres for circulation to UN headquarters, regional officesand duty stations. The UN Medical Service and local linked medical facilities shouldalso make efforts to ensure that blood transfusions are performed only whenabsolutely necessary.
iii. UN Resident Coordinators must exercise their responsibility to adopt measures to
reduce the frequency of motor vehicle accidents, not only because of their attendanthigh mortality and morbidity, but because they represent a particular risk for HIVinfection in those localities lacking safe blood supplies.
UN Resident Coordinators are, therefore, encouraged to consider the following
measures for reinforcement or for general adoption if not already applied; and to cir-culate them to all personnel at the duty station together with instructions on the useof public transport:
Ithe fitting of and compulsory use of seat belts in all UN vehicles;
Iproper training in off-road use of 4-wheel drives;
Iprohibition against the personal use of vehicles when an official driver is available;
Icompulsory use of helmets for all riders of motorbikes; United Nations

8 — AIDS and HIV InfectionIprohibition against substance abuse by vehicle drivers;
Iorganization of first-aid training sessions; and
Iequipping UN vehicles with first-aid kits containing macromolecular solutions
(plasma expanders).
iv. All UN staff members and their families should have access to disposable
syringes and needles.
The UN Medical Service should provide disposable syringes and needles to
staff on duty travel areas where there is no guarantee of the proper sterilization ofsuch materials. They should be accompanied by a certificate in all UN official lan-guages explaining the reasons why they are being carried. Regional offices andother duty stations should stock disposable injection material for use by UN staff andtheir families. This stock should be available at UN dispensaries, where such exist,or at the WHO duty station in the country.
v. All UN staff members and their families should have access to condoms.
Condoms should be available through the United Nations Population Fund
(UNFPA) and/or WHO at those duty stations where there is not a reliable and con-sistent supply of high quality condoms from the private sector. Access should befree, simple and discreet.
B. Voluntary testing, counselling and confidentiality
Voluntary testing with pre- and post-counselling and assured confidentiality
should be made available to all UN staff members and their families.
Adequate and confidential facilities for voluntary and confirmatory testing and
counselling should be made available locally to UN staff members and their families,with UN bodies acting in close collaboration with the UN Medical Service and WHO.Specific procedures must be developed by UN bodies to maintain confidentialitywith respect to negative as well as positive results from an HIV test, includingwhether such a test has been taken. Only the person tested has the right to releaseinformation concerning his/her HIV status.
C. Terms of appointment and service
Pre-recruitment and Employment Prospects
IThe only medical criterion for recruitment is fitness to work.
IHIV infection does not, in itself, constitute a lack of fitness to work.
IThere will be no HIV screening of candidates for recruitment.
IAIDS will be treated as any other medical condition in considering medical clas-
sification.

Information for United Nations Employees and Their Families — 9IHIV testing with the specific and informed consent of the candidate may be
required if AIDS is clinically suspected.
INothing in the pre-employment examination should be considered as obliging any
candidate to declare his or her HIV status.
IFor any assignment in a country which requires HIV testing for residence, this
requirement must appear in the vacancy notice.
Continuity of Employment
IHIV infection or AIDS should not be considered as a basis for termination of
employment.
IIf fitness to work is impaired by HIV-related illness, reasonable alternative working
arrangements should be made.
IUN staff members with AIDS should enjoy health and social protection in the same
manner as other UN employees suffering from serious illness.
IHIV/AIDS screening, whether direct (HIV testing), indirect (assessment of risk
behaviours) or asking questions about tests already taken, should not be required.
IConfidentiality regarding all medical information, including HIV/AIDS status, must
be maintained.
IThere should be no obligation on the part of the employee to inform the employer
regarding his or her HIV/AIDS status.
IPersons in the workplace affected by, or perceived to be affected by HIV/AIDS,
must be protected from stigmatization and discrimination by co-workers, unions,employers or clients.
IHIV-infected employees and those with AIDS should not be discriminated against,
including access to and receipt of benefits from statutory social security pro-grammes and occupationally-related schemes.
IThe administrative, personnel and financial implications of these principles under
terms of appointment and service should be monitored and periodically reviewed.
D. Health insurance benefits programmesi. Health insurance coverage should be available for all UN employees regardless of
HIV status.
There should be no pre- or post-employment testing for HIV infection.
ii. Health insurance premiums for UN employees should not be affected by HIV status.
No testing for HIV infection should be permitted with respect to any health insur-
ance scheme.

Information for United Nations Employees and Their Families — 11Chapter 1
The Facts
What is AIDS?
AIDS stands for acquired immunodeficiency syndrome, a pattern of devastating
infections caused by the human immunodeficiency virus, or HIV, which attacks anddestroys certain white blood cells that are essential to thebody's immune system.
When HIV infects a cell, it combines with that cell's
genetic material and may lie inactive for years. Most peopleinfected with HIV are still healthy and can live for years withno symptoms or only minor illnesses. They are infected withHIV, but they do not have AIDS.
After a variable period of time, the virus becomes acti-
vated and then leads progressively to the serious infectionsand other conditions that characterize AIDS. Although thereare treatments that can extend life, AIDS is a fatal disease.Research continues on possible vaccines and, ultimately, a cure. For the moment,however, prevention of transmission remains the only method of control.
The route of infection in adults
HIV targets two groups of white blood cells
called CD4+ lymphocytes and monocytes/macrophages. Normally, CD4+ cells andmacrophages help recognize and destroy bacte-ria, viruses or other infectious agents that invadea cell and cause disease. In an HIV-infected per-son, the CD4+ lymphocytes are killed by thevirus, while the macrophages act as reservoirs,carrying HIV to a number of vital organs.
HIV attaches itself to the CD4+ lymphocyte
and makes its way inside. This causes the cell toproduce more HIV but, in doing so, the cell isdestroyed. As the body's CD4+ cells are deplet-ed, the immune system weakens and is lessable to fight off viral and bacterial infections. Theinfected person becomes susceptible to a widerange of "opportunistic" infections, such as
Persons who are
HIV-positive are
both infected and
infectious for life.
Even when they
look and feel
healthy, they can
transmit the virus
to others.

12 — AIDS and HIV InfectionA history of the epidemic
A pattern of highly unusual infections in otherwise healthy young adults emerged
in the early 1980s. This pattern, or syndrome, was caused by an unknown entitythat apparently attacked the body's immune system. It became known as AIDS.Between 1983 and 1984, researchers isolated a new virus—HIV—the cause ofAIDS. This made possible a blood test for antibodies to the virus. HIV was foundto be an infectious agent known as a retrovirus. Different retroviruses were foundin some animals but, until that point, were rare in humans. HIV may have beeninfecting some human populations relatively benignly for more than 20 years (1).
Since the discovery of HIV, several strains of the virus have been identified.
In 1985, a related virus was found in parts of West Africa and was called HIV-2to distinguish it from the earlier virus (HIV-1). The pattern of illness is similar forboth HIV-1 and HIV-2.
In the early 1980s, only about 100,000 adults worldwide were thought to
have been infected with HIV. As of the end of 1998, the number of adults andchildren living with HIV or AIDS rose to more than 33.4 million (2). More infor-mation on the history of HIV/AIDS can be found in the Encyclopedia of AIDS athttp://www.thebody.com/encyclo/encyclo.htmlPneumocystis carinii pneumonia, which rarely occurs
in persons with normal immune systems. Tuberculosis(TB) poses a particular threat to HIV-positive people,especially in areas of the world where both TB and HIVinfection are increasing at alarming rates. Millions ofTB carriers who would otherwise have escaped activetuberculosis are now developing the disease becausetheir immune systems are under attack from HIV. TBalso progresses faster in HIV-infected persons, and ismore likely to be fatal if undiagnosed or untreated. TBis now the leading killer of HIV-infected Africans.
HIV-infected persons are also more susceptible to
otherwise rare cancers such as Kaposi’s sarcoma, a
tumour of the blood vessels or the lymphatic vessels. HIV may also attack the brain,causing neurological and neuro-psychiatric problems.
In general, about 50 percent of HIV-infected adults are likely to develop AIDS
within 10 years after first becoming infected. The good news is that early treatmentwith improved drugs is significantly prolonging life for persons with AIDS. The symptoms of HIV
disease are varied andcomplex, but can include:
Fever
Enlarged lymph glandsSkin rashPersistent diarrhoeaCoughSevere weight lossFatigueSkin lesionsLoss of appetite

Information for United Nations Employees and Their Families — 13The route of infection in infants and children
Most HIV-infected infants and children acquired the infection from their mothers
before, during or shortly after birth, or during breastfeeding. Only a small proportionare infected through HIV-contaminated blood transfusions or injections. There aretwo patterns of disease progression in children infected from birth. About half thesechildren progress rapidly to AIDS, but others remain symptom free for years, asadults do. Studies show that, in developed countries, approximately two-thirds ofinfected children are still alive at age 5 years. In developing countries, the figureranges between 30 and 65 percent. (For more information, see the section on mother-to-child transmission of HIV later in this chapter.)
How HIV is transmitted
To date, there are only four primary methods of transmission:
Isexual intercourse (anal and vaginal);
Icontaminated blood and blood products, tissues and organs;
Icontaminated needles, syringes and other piercing instruments; and
Imother-to-child transmission (MTCT).
Sexual intercourse
HIV can be transmitted through unprotected sexual intercourse—that is, any
penetrative sexual act in which a condom is not used. Anal and vaginal intercoursecan transmit the virus from an HIV-infected man to a woman or to another man, orfrom an infected woman to a man.
The risk of becoming infected through unprotected sexual intercourse depends
on four main factors: the probability that the sex partner is infected, the type of sexact, the amount of virus present in the blood or sexual secretions (semen, vaginalor cervical secretions) of the infected partner, and the presence of other sexuallytransmitted diseases and/or genital lesions in either partner. Age may also be a factor as young girls are physiologically more vulnerable.
The probability of HIV infection in the partner
The prevalence of HIV infection among sexually active men and women varies
according to geographical area or population subgroup, such as heterosexuals, menwho have sex with men (MSM), sex workers, or injecting drug users (see page 36).Generally, the likelihood of becoming infected with HIV sexually is related to thenumber of sexual partners and unprotected sex acts you have. In other words, themore sexual partners you have, the greater your chance of becoming infected.

14 — AIDS and HIV InfectionThe type of sex act
All unprotected acts of sexual penetration (anal,
vaginal, oral) carry a risk of HIV transmission becausethey bring body fluids secreted during sex directly intocontact with exposed mucous membranes (the liningof the rectum, the vagina, the urethra and the mouth).
IMen and women who engage in unprotected
receptive anal intercourse with an HIV-infected
partner run the highest risk of becoming infected.
IThe next highest risk is that associated with unpro-
tected vaginal intercourse.
IUnprotected oral intercourse involves some risk
as well, particularly if there are mouth or throatinjuries present such as bleeding gums, lesions,sores, abscessed teeth, throat infections, oralgonorrhoea or other STDs present.
This risk is reduced, although not entirely elim-
inated, by the proper use of condoms. Injury to themucous membrane of the rectum, vagina or mouthmay help the virus enter the bloodstream. However,HIV can be transmitted even through unbrokenmucous membrane.
Kissing has not been shown to transmit HIV, as
saliva contains very little of the virus. Nevertheless,there is a theoretical risk of HIV transmission duringdeep or "wet" kissing (tongue kissing) if blood fromgum or mouth sores is present in the saliva. There
is no evidencethat HIV hasactually been transmitted this way.
Self-masturbation involves no risk of HIV
transmission. There are no known cases oftransmission through mutual masturbation,either. However, masturbation of a partnerposes a theoretical risk of HIV transmission ifhis or her sexual secretions come in contactwith mucous membrane or broken skin.

Information for United Nations Employees and Their Families — 15The amount of virus present in the infected partner
HIV-infected individuals become more infectious as they progress to HIV-relat-
ed disease and AIDS. There is also an early one- to two-week period of infectious-ness around the time of seroconversion—that is, when antibodies first develop.
The presence of other sexually transmitted diseases
in either partner
There is a strong link between sexually transmitted diseases (STDs) and the
sexual transmission of HIV infection (3). The presence of an untreated STD—suchas gonorrhoea, chlamydial infection, syphilis, herpes or genital warts—can enhanceboth the acquisition and transmission of HIV by a factor of up to 10. Thus, STD treat-ment is an important HIV prevention strategy in a general population.
Contaminated blood or blood products,
tissues and organs
Blood transfusions save millions of lives each year, but in places where a safe
blood supply is not guaranteed, those receiving transfused blood have an increasedrisk of being infected with HIV.
In most industrialized coun-
tries, the risk of acquiring HIV infec-tion from transfusions is extremelylow. This is due in large part toeffective recruitment of regular, vol-unteer blood donors; improveddonor testing procedures; universalscreening of blood and blood prod-ucts with highly sensitive and spe-cific tests for the antibody to HIV;and the appropriate use of blood.
In the developing world, how-
ever, the risk is much higher. Oneestimate is that up to 5 percent ofHIV infections may be caused bytransfusions in high-prevalenceareas such as sub-Saharan Africa.The lack of coordinated nationalblood transfusion systems, theabsence of non-remunerated volunteer blood donors, lack of testing, and inappro-priate use of blood products compound the problem (4-6).WHO's Blood Safety Unit is helping
countries strengthen their blood trans-fusion systems. Partners includeUNAIDS, WHO, UNDP, theInternational Federation of Red Crossand Red Crescent Societies and sever-al other interested organizations.Goals include:
1. educating, motivating, recruiting
and retaining low-risk volunteer,non-remunerated blood donors;
2. screening all donated blood;3. reducing unnecessary or inappro-
priate transfusions;
4. developing a sustainable national
blood transfusion service; and
5. improving political commitment
and support from within countries.

16 — AIDS and HIV InfectionTo prevent transmission by tissue and organ donation, including sperm for artifi-
cial insemination, the HIV-infection status of the donor should be carefully evaluated.
Contaminated needles, syringes or
other piercing instruments
HIV can be transmitted through the use of HIV-contaminated needles or other
invasive instruments. The sharing of syringes and needles by injecting drug users isresponsible for the very rapid rise in HIV infection among these persons in manyparts of the world.
A risk is also attached to non-medical procedures if the instruments used are not
properly sterilized. Such procedures include ear- and body-piercing, tattooing,acupuncture, male and female circumcision, and traditional scarification. The actualrisk depends on the local prevalence of HIV infection.
HIV transmission by means of injection equipment can also occur in health care
settings where syringes, needles and other instruments, such as dental equipment,are not properly sterilized, or through injury by needles and other sharps.
Mother-to-child transmission (MTCT)
Mother-to-child transmission (MTCT) is the
overwhelming source of HIV infection in youngchildren. The virus may be transmitted during preg-nancy, labour, delivery or after the child's birth dur-ing breastfeeding. Among infected infants who arenot breastfed, most MTCT occurs around the timeof delivery (just before or during labour and deliv-ery). In populations where breastfeeding is thenorm, breastfeeding may account for more thanone-third of all cases of MTCT transmission (7,8).
Paediatric AIDS can be difficult to diagnose
because some symptoms of HIV infection, such asdiarrhoea, are also common in infants and children
who are not infected.Therefore, these symptoms cannot be considered areliable basis for diagnosis. There are blood-basedtests that allow early diagnosis of HIV infection ininfants. These are used extensively in developed coun-tries. However, these tests are quite expensive and arenot readily available in developing countries.
For more information,
read the UNAIDS
Technical Update on
Mother-to-Child
Transmission of HIV at
http://www.unaids.org

Information for United Nations Employees and Their Families — 17How HIV is not transmitted
Family, friends and co-workers should not fear becoming infected with HIV through
casual contact with an HIV-infected person at home, at work, or socially. Theseactivities will not transmit the virus:
Ishaking hands, hugging or kissing (see paragraph on deep kissing, page 14)
Icoughing or sneezing
Iusing a public phone
Ivisiting a hospital
Iopening a door
Isharing food, eating or drinking utensils
Iusing drinking fountains
Iusing toilets or showers
Iusing public swimming pools
Igetting a mosquito or insect bite.
AIDS and work
For the vast majority of occupations, the workplace does not pose a risk of
acquiring HIV. The exceptions include laboratory workers, health care workers, per-sons dealing with hospitalwaste products, emergencymedical response personneland any other occupationwhere there is a possibility ofexposure to blood. Their risk isvery low, but real. Among thehazards to which these personsmay be exposed are needle-stick injuries and other skin-piercing accidents, and bloodsplashing into the eyes whilethey are administering treat-ment or otherwise performingtheir duties.
AIDS and sports
There are no documented
cases of HIV being transmittedduring participation in a sportsWHO Guidelines on AIDS and
First Aid in the Workplace
Mouth-to-mouth resuscitation is a life-sav-
ing procedure that you should not withholdbecause of an unsubstantiated fear of con-tracting HIV or other infection. No case ofHIV transmission via this route has beenreported. A theoretical risk exists if the per-son you must resuscitate is bleeding fromthe mouth. In this case, use a clean cloth towipe away any blood from the person'smouth.
A person who is bleeding needs
immediate attention. Apply pressure to thewound with a clean, thick cloth. Avoid bloodcontact with your eyes, mouth and any bro-ken skin. Ensure that any open cuts orwounds you have are covered before givingfirst aid. Always wash your hands with soapand water as soon as possible after givingfirst aid (9).

18 — AIDS and HIV Infectionactivity. The very low risk of transmission during sports participation would involve
sports with direct body contact in which bleeding might be expected to occur (10).
It is theoretically possible for the virus to be transmitted if an HIV-infected
athlete had a bleeding wound or skin lesion with fluids that came in contact withanother athlete's skin lesion, cut or exposed mucous membrane. Even in such anunlikely event, risk of transmission would be very low. However, in sports involvingdirect body contact or combative sports where bleeding might occur, it is sensible tofollow two simple procedures:
Icleanse any skin lesion with antiseptic and cover it securely; and
Iif a bleeding injury occurs, interrupt participation until the bleeding has stopped
and the wound has been both cleansed with antiseptic and securely covered.

Information for United Nations Employees and Their Families — 19Preventing sexual transmission of HIV
Know your partner
Whether you are male or female—heterosexual,
homosexual or bisexual—your risk of acquiring HIVinfection is directly related to the likelihood that yourpartner is infected. Your risk is substantially higher ifyour partner has ever injected drugs, has unprotect-ed sex with casual partners, or has a sexual historyunknown to you.
Understand which sexual acts put
you at most risk
All forms of penetrative sexual intercourse (anal, vaginal, oral) with an HIV-
infected man or woman carry a risk of transmission. Unprotected anal intercourse isone of the riskiest practices. This is true even when a condom is used because ofthe increased likelihood that the condom will be damaged during this form of sex.
Unprotected vaginalintercourse carries thenext highest risk ofinfection. Oral sex alsocarries a small risk oftransmission, particu-larly if there are mouthor throat injuries pre-sent such as bleedinggums, lesions, sores,abscessed teeth, throatinfections, or oral STDspresent.
To protect your-
self, always use a con-dom during penetrativesexual acts (11). Chapter 2
Preventing HIV Transmission
Be aware that it is impossi-
ble to detect someone'sHIV-infection status simplyfrom his or her physicalappearance. Individuals wholook perfectly clean andhealthy may be infected—even if they are unaware ofit themselves—and hence,capable of infecting you.
Preventing transmission if you are
infected with HIV…
IDo not donate blood, semen or organs
(kidney, cornea, etc.)
IInform sexual partners. Avoid penetration,otherwise always use a condom.
IDo not share syringes or needles.
IInform any doctors or dentists consulted.
IConsider pregnancy carefully (see page 32).
ICover any cuts or scratches with a dressing
until healed.
IDo not share toothbrushes, razors or sharpinstruments (12).
ISeek early and correct treatment for STDs.

20 — AIDS and HIV InfectionWhat you need to know about condoms
Latex condoms lubricated with silicone or a
water-based lubricant are recommended as abarrier method to reduce the risk of HIVtransmission during anal, vaginal and oralintercourse. (If additional lubricant is desired,a water-based variety such as K-YLubricating Jelly® should be used rather thanan oil-based lubricant such as Vaseline®,which can break down the latex.) Latex con-doms are only effective if they are used prop-erly and do not break.
Natural membrane condoms, often
made from sheep gut, are not recommendedbecause they have tiny pores through whichHIV could pass.
For maximum effectiveness, the condom
must be puton beforethe penistouches anypart of therectum, vagina or mouth. It should be put onwhen the penis is erect, taking care to leave areservoir at the tip to contain the semen. Careshould be taken during withdrawal of the penis(with the condom still in place) to avoidspillage.
Female condoms, such as the REALITY®
condom, are now available. The female con-dom is a soft, loose-fitting plastic pouch madeof polyurethane (not latex) that lines the vagina.It has a semi-stiff plastic ring at each end. Theinner ring is used to insert the device inside thevagina and hold it in place. The outer ring part-ly covers the labia area and holds the condomopen.
Female condomMale condom

Information for United Nations Employees and Their Families — 21Or, to be even safer, you can engage in
sexual practices that involve no penetrationsuch as caressing or massaging any part ofthe body, masturbation (provided that sexualsecretions do not come in contact with cuts orsores on the other partner's skin), and kissingthat does not involve heavy exchange of saliva and possibly blood. The safest courseof all is abstinence.
Seek medical advice or
treatment for STDs
The presence of an untreated sexually
transmitted disease—such as gonorrhoea,chlamydial infection, syphilis, herpes or geni-tal warts—can enhance both your acquisitionand transmission of HIV by a factor of up to10. If you suspect you have an STD, or havebeen exposed to one, it is imperative that youseek medical advice and treatment immedi-ately.
Common symptoms include an unusual
discharge from the vagina or penis, burningor pain during urination, and sores or blistersnear the mouth or genitals. Other symptoms in women may include unusual bleed-ing (other than the menstrual cycle) and vaginal pain during intercourse.
Preventing transmission of HIV via blood
and blood products
In industrialized countries, the risk of transmission of HIV via blood and blood prod-ucts is very rare for each unit of blood transfused.
It is also very rare to contract HIV in the health care setting. For example, evi-
dence from the USA indicates that health care workers who accidentally puncturetheir skin with a needle contaminated with HIV have an estimated risk of less thanfive in a 1000 (0.5 percent) of developing HIV infection.
Also, HIV is a fragile virus, meaning it is vulnerable to changes in temperature
and other environmental factors, and has been shown not to be viable in dried bloodfor more than an hour. The concentration of virus particles of HIV per millilitre ofblood is also very low in contrast to other viruses. Despite the low level of occupa-Microbicides and
HIV prevention
Microbicides are products
intended for vaginal orrectal administration thatcan decrease the transmis-sion of HIV and othermicro-organisms thatcause STDs. Discovery ofan effective microbicide isneeded to expand preven-tion options. In recentyears, it was suggestedthat spermicides mighthave microbicidal proper-ties. To date, two trialshave failed to show thatthe spermicide nonoxynol-9 is effective against HIVand STD transmission.However, more than 35microbicides are undergo-ing trials, and researchcontinues into this methodof prevention (13).

22 — AIDS and HIV Infectiontional risk posed by HIV, safe work practices should be followed at all times by lab-
oratory personnel and health workers (14). Don't be afraid to ask your health careprofessional, clinic or hospital if they follow "universal precautions”, or safety mea-sures to prevent the transmission of HIV in health care settings.
If you must travel to areas of the world where the safety of the blood supply is
not guaranteed, you should follow these measures (15,16):
Ibefore you travel, identify sources of reliable medical help in your destination
country;
Icarry sterile disposable needles and syringes for your personal use (as part of
the WHO medical kit);
Ibe aware of emergency medical evacuation procedures;
Ireduce your risk of injury by following safety precautions such as using seatbelts
and driving carefully; and
Iif you are injured and lose blood, consider using a plasma substitute (crystal-
loids/colloids). If severe or acute blood loss has occurred, efforts should be madeto ensure that the blood has been screened for HIV and hepatitis B virus.
Preventing transmission of HIV via
contaminated needles
Do not share needles
or syringes
Injecting drug use is one of
the fastest growing routes of HIVinfection in many parts of theworld, primarily because needles,syringes and drug preparationequipment are frequently shared,enabling rapid spread of the virus.
Avoid invasive, skin-piercing procedures
Ear- or body-piercing, tattoos, acupuncture or any procedure that requires inva-
sive, skin-piercing instruments carry some risks of transmission. If you are consid-ering any of these procedures, make sure that all equipment is properly sterilized.Do not be afraid to ask questions of the technician or health care personnel. HIV iseasily destroyed by heat; instruments should be sterilized by steam or by dry heat.If this is not possible, instruments should be disinfected by boiling (17).

Information for United Nations Employees and Their Families — 23Protecting children
Parents should make sure that children know the facts about HIV transmission and
how they can protect themselves against infection. Specifically, children should:
Ibe aware that HIV is transmitted through blood;
Iavoid any skin-piercing procedures or accidental injury from unsterilized needles
and other sharp instruments;
Ireceive injections or other medical or dental treatment only when necessary and
only with properly sterilized equipment;
Ireceive blood transfusions only when medically necessary and only with proper-
ly screened blood; and
Iavoid the risk of traumatic injury necessitating blood transfusion.
Older children need information and encouragement that will help them avoid
becoming infected through unprotected sexual intercourse or through sharing drug-injecting equipment.
Children also need
to be reassured aboutthe ways in which HIVcannot be transmitted(see Chapter 1).
They should be
encouraged to be sym-pathetic toward childrenand adults who areinfected, and should notfear becoming infectedthrough casual contactwith these persons.If you have difficulty or are embarrassed
speaking to your children about sex, druguse and AIDS, these resources can help.
A Children's Book About HIV/AIDS: By
Children For Children available online at
http://www.sonic.net/yofee/hivaids
Does AIDS Hurt? Educating Young Children
About AIDS by Sylvia Villarreal, MD
(1992)*
100 Questions and Answers About AIDS: A
Guide for Young People by Michael Thomas
Ford (1992)*
*Both available for purchase from
http://www.amazon.com

Information for United Nations Employees and Their Families — 25Chapter 3
Being Tested
What the HIV antibody test can tell you
The standard tests to determine whether you are infected with HIV are based on
detection of antibodies to HIV in the blood, not of the virus itself (11). Different typesof antibody tests exist such as the enzyme-linked immunosorbent assay (ELISA)and simple rapid (S/R) tests. In recent years, tests have been developed that detectHIV antibodies in saliva and urine.
The first antibody test a person gets is called a screening test. If the screening
test is negative, it means that no antibodies were found. The person tested is con-sidered HIV-negative and confirmatory tests are not necessary. If the screening testis repeatedly positive, it must be confirmed.Confirmation can be done by using special tests,e.g. Western Blot or line immunoassays (LIA). It isalso possible to confirm a positive result by usingcombinations of ELISA or S/R tests. Although theconfirmation can be done on the same sample ofblood, it is preferable to do the confirmation on a second blood sample in order toavoid any errors.
HIV screening tests can sometimes give false-positive readings, especially in
populations where HIV is not present in high numbers, which is why confirmatorytesting is always done on positive screening test results. This confirmation is need-ed to rule out false-positive screening results.
In regard to the accuracy of the antibody tests:
IIt takes, on average, 25 days for an HIV test to show positive after a person
becomes infected with HIV. This is a much shorter timeframe than before theintroduction of very sensitive tests now used.
IIf a person has been infected very recently, the test may show a negative result.
IWhen saliva and urine are tested, it takes longer for antibodies to become
detectable.
IMore than 99 percent of infected persons will show positive after three months.
The HIV antibody test and employment
In the vast majority of occupations and occupational settings, work does not involve
a risk of transmitting HIV between workers or from worker to client. The followingrecommendations have been put forward on AIDS and the workplace.“More than 99 percent
of infected persons
will show positive
after three months.”

26 — AIDS and HIV InfectionIPre-employment HIV/AIDS testing as part of assessing fitness to work is unnec-
essary and should NOT be required. This applies to both direct methods suchas HIV testing and indirect assessment of risk behaviours and questioning theapplicant about HIV tests already taken. Pre-employment HIV/AIDS screeningfor insurance or other purposes raises serious concerns about discrimination,and merits close scrutiny.
IFor persons currently employed, HIV/AIDS screening, whether direct or indirect,
should NOT be required.
IAll medical information, including HIV/AIDS status, must be kept confidential.
IEmployees should not be required to inform the employer regarding their
HIV/AIDS status.
IPersons in the workplace who are HIV-infected (or perceived to be) must be pro-
tected from stigmatization and discrimination by co-workers, unions, employersand clients. Information and education are essential to maintain a climate ofmutual understanding necessary to ensure this protection.
IHIV-infected employees should not be
discriminated against with respect to theiraccess to and receipt of benefits fromstatutory social security programmes andoccupationally-related schemes.
IHIV infection alone does not limit fitness
to work. If fitness to work is impaired byHIV-related illness, reasonable alterna-tive working arrangements should bemade.
IHIV infection is not a cause for termination of employment. As with many other
illnesses, persons with HIV-related illnesses should be allowed to work for aslong as they are medically fit for available, appropriate work (18).
While these measures are designed to protect your rights if you are HIV-infect-
ed, you also have a responsibility to adopt behaviour that does not put others in yourworkplace at risk of infection.
The HIV antibody test and pregnancy
If you or your partner are concerned about your HIV status, and you are thinkingabout having a baby, the HIV antibody test may help clarify your choices.
HIV testing should be available, with pre- and post-test counselling, on a vol-
untary, confidential basis. You and your sex partner should be counselled on theimplications that a positive test result will have for both of you, for the fetus and forthe infant if pregnancy is considered. “Persons in the
workplace who are HIV-
infected (or perceived to
be) must be protected
from stigmatization and
discrimination by
co-workers, unions,
employers and clients.”

Information for United Nations Employees and Their Families — 27An HIV-infected woman can transmit HIV to her infant. The most likely time for
an HIV-infected pregnant woman to pass the virus on to her baby is either in the veryearly stages or in the advanced stage of her infection. Thus, the risk of transmissionranges from low (if the HIV-infected woman has no signs and symptoms) to high (ifshe has AIDS). The transmission rate ranges from 12% to over 30%.
If you are pregnant and HIV-infected, you should be counselled on the options
of continuing or terminating your pregnancy (where abortion is legal) and aboutreducing mother-to-child transmission (MTCT) through treatment with zidovudine(sometimes called ZDV or AZT) during your pregnancy (see page 32 for moreinformation).
Pregnancy does not appear to accelerate the progression of the clinical course
of HIV infection.

Information for United Nations Employees and Their Families — 29Chapter 4
Living with HIV and AIDS
Coping with confirmed HIV infection
Learning that you are infected with HIV will change your life dramatically. You may
experience a wide range of emotions—fear, loss, grief, depression, denial, anger,anxiety. No matter how reassuring the doctor, how effective drug therapies are nowand will become, how minimal the physical impact of the infection, or how intellec-tually prepared you may be, your need for counselling and support will be great.
The psychological issues faced by most persons with HIV infection revolve
around uncertainty. Your future hopes and expectations, your relationships and yourcareer will all require some adjustment inorder for you to cope with your illness and leada happy, productive life.
The impact on your health
The impact to your health is likely to
depend on the stage of infection you havereached when you discover you are HIV-positive, the psychological support availableto you, and your access to good medical care.
Soon after becoming infected with the
virus, some people experience a brief flu-likeillness with fever, swollen lymph glands, skinrash or cough. You may then remain perfectlyfit and healthy for many years despite beinginfected. For approximately 50 percent ofinfected persons, the time between becominginfected and the appearance of the oppor-tunistic infections that characterize AIDS is more than 10 years.
Antiretroviral combination therapy, while expensive, has been shown to slow the
onset of AIDS and prolong life expectancy. Your quality of life could also be improvedby the preventive and therapeutic use of drugs that fight off common opportunisticinfections and other diseases to which HIV-infected person are vulnerable, such astuberculosis. Active TB screening and contact tracing through sputum examinationare also important for families with an HIV-positive member.
In addition to good medical care, psychological support—from family, friendsPut your health first!
If you are HIV-infected, it is
important to take care of yourphysical health to decrease therisk of progression toward asymptomatic form of AIDS (12).
IAdopt a healthy diet.
IExercise regularly.
IAvoid alcohol and tobacco.
IAvoid stress.
IAvoid all forms of infection if
possible because they couldcompromise your health.
IDo not use illicit drugs.
ISee your doctor regularly.

30 — AIDS and HIV Infectionand counselling—is critical. In many coun-
tries, there are support groups made up ofpersons living with HIV and AIDS. There arealso numerous support groups and resourcesto be found on the Internet (see Chapter 7).
The impact on your
personal relationships
Partners are likely to suffer the conse-
quences of HIV infection and disease as muchas the infected person, albeit indirectly. This isso even if partners know that they are not HIV-infected themselves. Their lives are likely toexperience the same kind of pressures andupheavals, and they can experience similarfeelings of uncertainty, grief, loss and anger.
Communication between the two partners and between partners and profes-
sional counsellors is important to foster understanding of the adjustments that will beneeded. For example, adjustments in sexual behaviour are necessary to stop furtherDo not lose hope!
Maintaining the quality of your life
is just as important as maintainingyour physical health. Here are tworesources that recognize the phys-ical, psychological, spiritual andsocial needs of persons living withHIV and AIDS.
POZ Magazine
http://www.thebody.com/poz/pozix.html
Body Positive
http://www.bodypositive.org.uk/homepage.html

Information for United Nations Employees and Their Families — 31transmission of infection. Counselling can also address the physical and psycho-
logical changes and needs that the partners will experience.
If you have HIV, you have an opportunity to make others more aware of the dis-
ease. By educating others, you may decrease the prejudice against persons withHIV or AIDS. However, consider carefully to whom you reveal your HIV status.Misunderstanding and discrimination do exist, and can affect you and the ones youlove. Again, professional counselling can help with these issues.
Often, families are the main source of care and support for HIV-infected per-
sons, and the type of care required may change depending on the stage of the infec-tion. Counselling for family members, both as individuals and as the family unit, canbe very important, particularly as the disease progresses.
The impact on your work life
How your work life is impacted will depend on how you feel physically and men-
tally, and at what stage your infection is discovered. Experience has shown that per-sons with HIV infection, with or without symptoms, should keep working as long aspossible. After the initial period of coming to terms with HIV infection, there usuallycomes a period of wanting to move on with life—and work can be an important partof this transition.
Although you are not obliged to inform your employer and colleagues of your
HIV status, certain circumstances may make it necessary for you to do so. If yourjob calls for you to travel, for example, you may need to go to countries where entrydepends on a certificate that shows you are not HIV-infected. In addition, you mayrequire certain vaccinations. Theoretically, you could become infected by the "live"but weakened pathogens in certain vaccines, particularly if your immune system hasalready been damaged by HIV. It is always best to consult your physician to deter-mine the risks involved with vaccines or if alternatives exist.
Your workplace rights as an UN employee
The United Nations is committed to workplace rights for all persons, regardless
of their HIV status. HIV infection or AIDS is not considered a basis for terminat-ing your employment. If your fitness to work is impaired by HIV-related illness,reasonable alternative working arrangements should be made. The UN believesthat staff members with AIDS should enjoy the same health and social protec-tions as other UN employees suffering from serious illness.
The complete UN HIV/AIDS Personnel Policy is included at the beginning
of this booklet. Also, turn to pages 25-26 in Chapter 3 for more information onrecommendations regarding AIDS and the workplace.

32 — AIDS and HIV InfectionHIV and your infant's health
Having a baby
Pregnancy is something you and your partner will need to discuss very careful-
ly with your physician and possibly your counsellor if either or both of you are infect-ed. It is very important to receive medical care early in your pregnancy.
Your HIV treatment should not change very
much from what it was before you became preg-nant. If you decide to continue your pregnancy,talk with your doctor about how you can preventgiving HIV to your baby. The chances of passingHIV to your baby before or during birth are about15-25 percent in developed countries and 25-45percent in developing countries. Treatment withzidovudine (sometimes called ZDV or AZT)associated with replacement feeding has beenshown to greatly lower this risk.
Although you are pregnant, you should still
use condoms each time you have sex to avoidcontracting other diseases and to avoid spreading HIV. Even if your partner alreadyhas HIV, he should still use condoms. After birth, your baby should be tested for
HIV, even if you took ZDV and/or otherdrugs during pregnancy. Talk with yourdoctor about your baby's special medicalneeds and any medications he or shewill need (19).
Breastfeeding
Breastfeeding is normally the best
way to feed an infant. However, if amother is HIV-infected, it may be prefer-able to replace breastmilk to reduce therisk of HIV transmission to the infant.The risk of replacement feeding should
be less than the potential risk of HIV transmission through infected breastmilk, sothat infant illness and death from other causes do not increase. Otherwise, there isno advantage to replacement feeding. According to joint guidelines from UNAIDS,UNICEF and WHO (20), the following issues should be considered:

Information for United Nations Employees and Their Families — 33Ireplacement feeding needs to provide all the infant's nutritional requirements as
completely as possible;
Ibreastmilk substitutes must be prepared and given hygienically to avoid conta-
mination with bacteria. This requires access to clean water and fuel;
Ibreastmilk substitutes must be affordable to families; and
Iaffordable family planning must be accessible, as women who do not breastfeed
lose the child-spacing benefits that breastfeeding can provide.
Childhood immunizations
Some parents may worry that their HIV-infected children might be adversely
affected by routine childhood immunizations. In response, WHO and UNICEF haveissued the following guidelines. HIV-infected children should be immunized againstdiphtheria, tetanus and pertussis (with DTP); poliomyelitis (with OPV or IPV); andmeasles (with measles vaccine), according to standard schedules. Children withknown or suspected HIV infection are at increased risk of severe measles, andthese children should be given an extra dose of measles vaccine as soon after sixmonths as possible, with the scheduled dose given at nine months as usual.
Parents of HIV-infected children are often HIV-infected themselves and have a
higher incidence of tuberculosis than the general population. Early protectionagainst tuberculosis with BCG immunization is therefore recommended for HIV-infected children who are not symptomatic. Symptomatic HIV-infected children,however, should not be immunized with BCG (21) or yellow fever vaccine.

Information for United Nations Employees and Their Families — 35Chapter 5
A Global Overview of
the Epidemic
By the end of 1998, the number of people living with HIV is estimated to have grown
to 33.4 million, according to estimates from UNAIDS and WHO. Most of these peopledo not know that they are infected. The epidemic has not been overcome anywhere.Virtually every country in the world saw new infections in 1998 and the epidemic isfrankly out of control in many places.
More than 95 percent of all HIV-infected people now live in the developing world,
which has experienced 95 percent of all deaths to date from AIDS. These deaths arelargely among young adults who would normally be in their peak productive and repro-ductive years. The multiple repercussions of these deaths are reaching crisis level insome parts of the world. Whether measured against the yardstick of deteriorating childsurvival, crumbling life expectancy, overburdened health care systems, increasingorphanhood, or bottom-line losses to business, AIDS has never posed a bigger threatto development.
According to UNAIDS/WHO estimates, 11 men, women and children around the
world were infected per minute during 1998—close to 6 million people in all. One-tenthof newly-infected people were under age 15, which brings the number of children nowalive with HIV to 1.2 million. Most of them are thought to have acquired their infectionfrom their mother before or at birth, or through breastfeeding.
While mother-to-child transmission can be reduced by providing pregnant HIV-
positive women with antiretroviral drugs and alternatives to breastmilk, the ultimate
Hot zones of HIV around the world

36 — AIDS and HIV Infection
Sub-Saharan Africa
North Africa and Middle EastSouth and South-east AsiaEast Asia and PacificLatin AmericaCaribbeanEastern Europe and Central AsiaWestern EuropeNorth AmericaAustralia and New ZealandTOTALlate '70s—early '80s
late '80slate '80slate '80slate '70s—early '80slate '70s—early '80searly '90slate '70s—early '80slate '70s—early '80slate '70s—early '80s22.5 million
210,000
6.7 million
560,000
1.4 million
330,000270,000500,000890,000
12,000
33.4 million4.0 million
19,000
1.2 million
200,000160,000
45,00080,00030,00044,000
600
5.8 million8.0%
0.13%0.69%
0.068%
0.57%1.96%0.14%0.25%0.56%
0.1%1.1%50%
20%25%15%20%35%20%20%20%
5%
43%Hetero
IDU, HeteroHeteroIDU, Hetero, MSMMSM, IDU, HeteroHetero, MSMIDU, MSMMSM, IDUMSM, IDU, HeteroMSM, IDURegion Epidemic startedAdults and
children living
with HIV/AIDSAdults and
children newly
infected with HIV
in 1998Adult
prevalence
rate
1Percentage of
HIV-positive
adults who are
womenMain mode(s) of
transmission for
those living with
HIV/AIDS2
1 The proportion of adults (15 to 49 years of age) living with HIV/AIDS in 1998, using 1997 population numbers.
2 MSM (sexual transmission among men who have sex with men), IDU (transmission through injecting drug use), Hetero (heterosexua l transmission).

Information for United Nations Employees and Their Families — 37aim must be effective pre-
vention for young women sothat they can avoid becom-ing infected in the firstplace. Unfortunately, when itcomes to HIV infection,women appear to be head-ing for an unwelcome equality with men. While they accounted for 41 percent ofinfected adults worldwide in 1997, women now represent 43 percent of all peopleover age 15 living with HIV and AIDS. There are no indications that this equalizingtrend will reverse.
Since the start of the epidemic around two decades ago, HIV has infected more
than 47 million people. And though it is a slow-acting virus that can take a decadeor more to cause severe illness and death, HIV has already cost the lives of nearly14 million adults and children. An estimated 2.5 million of these deaths occurred dur-ing 1998, more than ever before in a single year.The entire text of the AIDS Epidemic
Update, including regional
overviews and information on fac-
tors fuelling the epidemic today, is
available from UNAIDS at
http://www.unaids.org

Information for United Nations Employees and Their Families — 39Chapter 6
The UN Response to AIDS
Meeting the complex long-term challenge of HIV/AIDS calls for an expanded
response. Direct health interventions and action to influence AIDS prevention andcare must be pursued and intensified, while innovative action must address thebroader context of the epidemic, including its socio-economic causes and conse-quences.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) was established
in January 1996 for this purpose. UNAIDS is a cosponsored programme that bringstogether the United Nations Children's Fund(UNICEF), the United Nations DevelopmentProgramme (UNDP), the United NationsPopulation Fund (UNFPA), the United NationsInternational Drug Control Programme (UNDCP),the United Nations Educational, Scientific andCultural Organization (UNESCO), the World HealthOrganization (WHO) and the World Bank in a com-mon effort against the epidemic.
The UNAIDS Cosponsors bring to this effort
complementary mandates and multisectoral exper-tise, ranging from education and socio-economicdevelopment to women's reproductive health. Theyare committed to joint planning and action, giving UNAIDS a "cooperative advan-tage”. Benefits include more effective advocacy, more effective use of UN systemresources through the sharing of costs, and greater coherence in United Nationssupport to national AIDS programmes.
Guiding principles
IStrengthening of countries' capacity for long-term action ranging from prevention
and care to impact alleviation.
IIdentification and use of technically-sound policies, strategies and tools.
ISocietal and structural changes to reduce the vulnerability of women, young
people, migrants, drug users, sexual and ethnic minorities, and other populationgroups.
ISupportive social, political and legal environments that allow individuals to exer-
cise their responsibility to protect themselves and others from HIV infection.
IEntitlement to all human rights without discrimination, including discriminationThe UNAIDS Mission
As the main advocate for
global action on HIV/AIDS,UNAIDS leads, strengthensand supports an expandedresponse aimed at prevent-ing the transmission of HIV,providing care and support,reducing the vulnerability ofindividuals and communitiesto HIV/AIDS, and alleviatingthe impact of the epidemic.

40 — AIDS and HIV Infectionbased on HIV infection status. These include the right to health, travel and pri-
vacy, the right to freedom from sexual violence and coercion, and the right to theinformation and means to prevent infection.
IParticipation and partnership.
INational responsibility to design, implement and coordinate the response to
HIV/AIDS at the country level. The role of external partners, including UNAIDS,is to support and build on national action.
IComplementarity. Rather than undertaking itself what can be or is already being
done by others, UNAIDS attempts to facilitate these efforts and to fill gaps inaction and research.
Global and local impact
At the global level, UNAIDS is the AIDS programme of the seven Cosponsors
and is responsible for policy development and research, technical support, advocacyand coordination. At the same time, the seven cosponsoring organizations integrateHIV/AIDS-related issues and UNAIDS policies and strategies into their ongoing work.
At the country level, UNAIDS can best be seen as the sum of AIDS-related
activities carried out by its Cosponsors with the backing of UNAIDS technical guid-ance and resources. In countries where some or all of the Cosponsors are present,their representatives meet regularly in a special UN Theme Group to jointly plan,implement and evaluate AIDS-related activities. UN staff who are HIV-positive areencouraged to participate in these Theme Groups for they lend both technical exper-tise and personal perspective to issues surrounding HIV infection. These staff alsohelp educate their colleagues about the stigma and discrimination that infected indi-viduals face in the workplace.
In addition, UNAIDS staff known as Country Programme Advisers are posted in
selected countries to support the UN Theme Groups on HIV/AIDS, to strengthencooperation with national partners and to provide technical support.
Important partners in national AIDS activities include governments (through both
political leadership and the relevant ministries); community-based organizations;nongovernmental organizations (NGOs); the private sector; academic and researchinstitutes; religious and other social and cultural institutions; and people living withHIV/AIDS.
The programme also supports research to develop new tools and innovative
approaches for slowing the spread of HIV and improving the quality of life of peopleliving with HIV/AIDS. Examples are vaccine development, vaginal microbicides forwomen, methods of reducing mother-to-child transmission of HIV, and improvedmethods for preventing and treating the common opportunistic infections in HIV-infected individuals.

Information for United Nations Employees and Their Families — 41Chapter 7
Staying Informed and
Getting Help
The resources in this chapter and throughout the manual are included for informa-
tion purposes only. Their inclusion does not imply any endorsement by the UnitedNations or UNAIDS. This is not a comprehensive list. Check your local area for addi-tional resources and sources of support.
Resources on the Internet (United Nations)
UNAIDS — Joint United Nations Programme on HIV/AIDS
http://www.unaids.org
United Nations Children's Fund
http://www.unicef.org
United Nations Development Programme
http://www.undp.org/hiv
United Nations Population Fund
http://www.unfpa.org
United Nations International Drug Control Programme
http://www.undcp.org
United Nations Educational, Scientific and Cultural Organization
http://www.unesco.org
World Health Organization
http://www.who.org
World Bank
http://www.worldbank.org
Resources on the Internet (USA and UK)
AIDS Action League
http://www.aidsactionleague.org
AIDS Survival Project
http://www.atl.mindspring.com/~asp
AIDS Treatment News
http://galen.library.ucsf.edu/sc/ahp/atn.html
AIDS Vaccine Advocacy Coalition

Homepage

42 — AIDS and HIV InfectionAIDS Virtual Library
http://planetq.com/aidsvl/index.html
American Foundation for AIDS Research (AmFAR)
http://www.amfar.com
The Body — AIDS and HIV Information Resource
http://www.thebody.com
Body Positive — Living Positively with HIV
http://www.bodypositive.org.uk
Center for AIDS Prevention Studies
http://www.caps.ucsf.edu
Centers for Disease Control and Prevention Division of HIV/AIDS Prevention
http://www.cdc.gov/nchstp/hiv_aids
Clinical Care Options for HIV
http://www.healthcg.com/hiv
Harvard AIDS Institute
http://www.hsph.harvard.edu/organizations/hai
HIV/AIDS Treatment Information Service
http://www.hivatis.org
HIV Coalition
http://www.hivco.org
The Johns Hopkins University AIDS Service
http://www.hopkins-aids.edu
Journal of the American Medical Association HIV Information Center
http://www.ama-assn.org/special/hiv/hivhome.htm
International Association of Physicians in AIDS Care

Home

Managing Desire (information on safe sex, testing and counselling, etc.)
http://www.managingdesire.org
Mother's Voices: United to End AIDS
http://www.mvoices.org
National Association of People with AIDS
http://www.napwa.org
National Institutes of Health Division on AIDS
http://www.niaid.nih.gov/research/daids.htm

Information for United Nations Employees and Their Families — 43National Minority AIDS Council

Home

Nevada AIDS Hotline Forum on Safe Sex
http://www.thebody.com/cgi/safeans.html
POZ Magazine (information on living with HIV)
http://www.thebody.com/poz/pozix.html
The Terrence Higgins Trust (London-based NGO to support people with HIV/AIDS)
http://www.tht.org.uk
Treatment Action Group (advocates for research for a cure for AIDS)
http://www.aidsnyc.org/tag
UC San Francisco AIDS Research Institute
http://hivinsite.ucsf.edu/ari/ev.html
Resources on the Internet (International)
ABIA-Brazil
http://www.alternex.com.br/~abia
Action for AIDS Singapore
http://www.afa.org.sg/afa.htm
AIDES Federation National
http://www.aides.org
AIDS Di Indonesia
http://www.rad.net.id/aids
AIDS Infoshare Russia
http://solar.rtd.utk.edu/ccsi/nisorgs/russwest/moscow/aidsinfo.htm
AIDS Net Austria
http://www.aidshilfe.or.at
AIDS Organization of Iceland
http://www.centrum.is/aids
Albergues de México I.A.P. — Private Institution for the Assistance
of AIDS-HIV Patientshttp://www.agora.stm.it/albergues/alber_en.htm
Brazilian AIDS and STD Programme
http://www.aids.gov.br
Coalition des organismes communautaires québécois de lutte contre le Sida
http://pages.infinit.net/cocqsida

44 — AIDS and HIV InfectionDenmark AIDS Information System
http://www.aids-info.dk
Deutsche AIDS-Hilfe (Germany: AIDS Information)
http://www.aidshilfe.de ( see also e.g. www.muenster.org/Aids-Hilfe)
HIV/AIDS in Zambia
http://www.zamnet.zm/zamnet/health/aids/aidszam.htm
HIV-Nieuws-Amsterdam
http://www.xs4all.nl/~tjerk
International Council of AIDS Service Organizations
http://www.web.net/~icaso/icaso.html
Mexican Government Page on AIDS
http://cenids.ssa.gob.mx
New Zealand AIDS Foundation
http://nz.com/NZ/Queer/NZAF
SEA-AIDS in Thailand
http://www.inet.co.th/org/unaids
SIDA en México
http://jeff.dca.udg.mx/sida/sida.html
SIDAnet
http://www.sidanet.asso.fr/home2.htm
Straight Talk in Uganda
http://www.swiftuganda.com/~strtalk
UNAIDS in China
http://www.unchina.org/unaids
UNAIDS in Namibia
http://www.un.na/unaids
UNAPRO
http://www.redkbs.com/unapro
Union Positiva
http://www.unionpositiva.org
University of Zambia Medical Library
http://www.medguide.org.zm

Information for United Nations Employees and Their Families — 45Resources by Phone
USA National
CDC National AIDS Hotline — 1 (800) 342-AIDS CDC AIDS Hotline in Spanish — 1 (800) 344-SIDAAIDS Action Council — 1 (202) 986-1300American Foundation for AIDS Research (AmFAR) — 1 (212) 682-7440National AIDS Clearinghouse — 1 (800) 458-5231National Association for Children with AIDS — 1 (202) 639-5170National Association of People with AIDS —- 1 (800) 673-8538National Minority AIDS Council — 1 (202) 544-1076National Pediatric HIV Resource Center — 1 (800) 362-0071
United Kingdom
National AIDS Helpline — 0800 567123

Information for United Nations Employees and Their Families — 47AIDS (acquired immunodeficiency syndrome) — The last and most severe stage of
the clinical spectrum of HIV-related disease.
Antibodies — Immunoglobulin molecules in the blood produced by the body's
immune system and directed against specific agents, such as "alien" viruses or bac-teria. In HIV infection, the antibodies produced against the virus for some reason failto protect against it.
Asymptomatic — Without symptoms.
Autologous transfusion — Transfusion of a person's own blood that has been donat-
ed and stored prior to need, or salvaged during or after an operation and reused.
Bacteria — Microbes composed of single cells that reproduce by division. Bacteria
are responsible for a large number of diseases. Bacteria can live independently, incontrast with viruses, which can only survive within the living cells that they infect.
Bisexual — A person who is sexually attracted to both males and females.
Condom — One type of prophylactic that can prevent sexually transmitted diseases
and AIDS.
DNA (deoxyribonucleic acid) — A nucleic acid that carries genetic information in all
organisms except certain viruses, the RNA viruses, which include HIV.
ELISA — Enzyme-linked immunosorbent assay. A laboratory test to determine the
presence of antibodies to HIV in the blood. A positive ELISA result generally is con-firmed by the Western blot test.
False-negative HIV antibody test — A negative test result that suggests a person is
not HIV-infected when, in fact, he or she is infected.
False-positive HIV antibody test — A positive test result that suggests a person is
HIV-infected when, in fact, he or she is not infected.
Heterosexual — A person sexually attracted to persons of the opposite sex. The
word "straight" has become synonymous with heterosexual.
High-risk behaviour — Activities that put an individual at greater risk of developing
a particular disease. High-risk activities associated with AIDS include unprotectedsexual intercourse and sharing of needles and syringes.
HIV(human immunodeficiency virus) — The retrovirus that causes AIDS in humans.
HIV-1 — The retrovirus that is the principal worldwide cause of AIDS.Glossary

48 — AIDS and HIV InfectionHIV-2 — A retrovirus closely related to HIV-1 that also causes AIDS in humans,
found principally in West Africa.
HIV-antibody-negative — Containing no antibodies to HIV.
HIV-antibody-positive — Containing antibodies to HIV.
Homosexual — A person sexually attracted to persons of the same sex.
Homosexuals include males (gays) and females (lesbians).
IDU — Injecting drug user
Immune system — All of the mechanisms that act to defend the body against exter-
nal agents, particularly microbes (viruses, bacteria, fungi and parasites).
Incubation period — The period of time between entry of the infecting pathogen into
the body and the first symptoms of the disease.
Kaposi’s sarcoma — A cancer or tumour of the walls of the blood vessels or the lym-
phatic vessels.
Lymphadenopathy — Swelling of the lymph nodes. Persistent and generalized lym-
phadenopathy is one of the early clinical signs of HIV infection.
Maternal antibodies — In an infant, these are antibodies that have been passively
acquired from the mother in utero . Because maternal antibodies to HIV continue to
circulate in the infant's blood up to the age of 15-18 months, it is difficult to deter-mine whether the infant is infected.
MSM —Men who have sex with men.
Opportunistic infection — An infection with a micro-organism that does not ordinar-
ily cause disease, but that becomes pathogenic in a person whose immune systemis impaired, as by HIV infection.
Pathogen — An agent such as a virus or bacteria that causes disease.
Plasma — The fluid portion of the blood.
Retrovirus — An RNA-containing virus that can transcribe its genetic material into
the DNA of its host's cells by the action of an enzyme called reverse transcriptase.This is the reverse of the usual, or DNA-to-RNA, transcription.
RNA (ribonucleic acid) — A nucleic acid associated with the control of chemical
activities inside a cell. Some viruses, including HIV, carry RNA instead of the moreusual DNA.
Semen — Fluid produced by the seminal vesicles and the prostate that contains the
spermatozoa. Semen can contain cells infected with the AIDS virus and is conse-quently able to transmit the infection to sexual partners.

Information for United Nations Employees and Their Families — 49Seroconversion — The development of antibodies in response to an antigen. With
HIV, seroconversion usually occurs 4-12 weeks after infection is acquired, but in avery few cases, it has been delayed for six months or more.
Serological testing — Testing of a sample of blood serum.
Seronegative — Showing negative results in a serological test.
Seropositive — Showing positive results in a serological test. A person who is
seropositive for HIV antibody is considered HIV-infected.
Seroprevalence — The proportion of a given population with a particular marker in
the blood, such as antibody to HIV, at a specific time.
Serosurvey — Systematic testing of sera from a group of persons to determine the
frequency of a particular marker, such as antibody to HIV, in that population.
STD — Sexually transmitted disease(s). These are diseases that can be transmit-
ted by means of sexual relations. AIDS is essentially a sexually transmitted disease.STDs are increasingly being referred to as sexually transmitted infections.
Symptomatic — With symptoms.
Viraemia — The presence of virus in the blood, which implies active viral replication.
Virus — Infectious agent (microbe) responsible for numerous diseases in all living
beings. They are extremely small particles, and in contrast with bacteria, can onlysurvive and multiply within a living cell at the expense of that cell.
White blood cells — Blood cells responsible for the defence of the body against for-
eign disease agents and microbes. HIV targets two groups of white blood cellscalled CD4+ lymphocytes and monocytes/macrophages.

Information for United Nations Employees and Their Families — 511. Resolution WHA40.26. Global strategy for the prevention and control of AIDS.
In: Handbook of resolutions and decisions of the World Health Assembly and the
Executive Board . Vol. 3, 1985-1989. 2nd ed. Geneva, WHO, 1987.
2. UNAIDS. AIDS epidemic update, December 1998 . Geneva, UNAIDS, 1998.
3. UNAIDS. The public health approach to STD control . UNAIDS Technical Update,
May 1998. Geneva, UNAIDS, 1998.
4. UNAIDS. Blood safety and AIDS . UNAIDS Point of View, October 1997. Geneva,
UNAIDS, 1997.
5. WHO. Consensus statement on accelerated strategies to reduce the risk of
transmission of HIV by blood transfusion . Unpublished (but available) WHO
document WHO/GPA/INF/89.13. Geneva, WHO, 1989.
6. Safe blood and blood products . (Distance Learning Materials)
WHO/GPA/CNP/93.2A-E. Geneva, WHO, 1993.
7. UNAIDS, UNICEF and WHO. HIV and infant feeding: a review of HIV transmis-
sion through breastfeeding . Geneva, UNAIDS, UNICEF and WHO, 1998.
8. UNAIDS. Mother-to-child transmission of HIV . UNAIDS Technical Update,
October 1998. Geneva, UNAIDS, 1998.
9. WHO. Guidelines on AIDS and first aid in the workplace . WHO AIDS Series No.
7. Geneva, WHO, 1990.
10. CDC. Should I be concerned about getting infected with HIV while playing
sports? Internet site http://www.cdc.gov/nchstp/hiv_aids, November 1998.
11. WHO. Prevention of sexual transmission of human immunodeficiency virus .
WHO AIDS Series No. 6. Geneva, WHO, 1990.
12. Montagnier L, ed. AIDS facts and hopes , 8th ed. Paris, MED-EDITION and The
Pasteur Institute.
13. UNAIDS. Microbicides for HIV prevention . UNAIDS Technical Update, April
1998. Geneva, UNAIDS, 1998.
14. WHO. Report of a WHO consultation on the prevention of human immunodefi-
ciency virus and hepatitis B virus transmission in the health care setting .
Unpublished (but available) WHO document WHO/GPA/DIR/91.5. Geneva,WHO, 1991.References

52 — AIDS and HIV Infection15. WHO/GPA. AIDS information for travellers (brochure). Geneva, WHO Global
Programme on AIDS, 1987.
16. Blood transfusion guidelines for international travellers . Unpublished (but avail-
able) WHO document WHO/GPA/INF/88.4. Geneva, WHO, 1988.
17. Guidelines on sterilization and disinfection methods effective against human
immunodeficiency virus (HIV) , 2nd ed. WHO AIDS Series No. 2. Geneva, WHO,
1989.
18. WHO. Statement from the consultation on AIDS and the workplace . Unpublished
(but available) WHO document WHO/GPA/INF/88.7 (rev.1). Geneva, WHO,1988.
19. Centers for Disease Control and Prevention. Living with HIV/AIDS . Atlanta, GA,
CDC, 1998.
20. UNAIDS, UNICEF, WHO. HIV and infant feeding: guidelines for healthcare man-
agers and supervisors . Geneva, UNAIDS, UNICEF, WHO, 1998.
21. Joint WHO/UNICEF statement on early immunization for HIV-infected children.
Weekly epidemiological record , 1989, 64:48-52.

Information for United Nations Employees and Their Families — 53Further Reading from UNAIDS
See also http://www.unaids.org for a full listing of UNAIDS publications
Access to drugs . UNAIDS Best Practice Collection Technical Update, Geneva,
UNAIDS, 1998 (available in English, French and Spanish)
AIDS and men who have sex with men . UNAIDS Best Practice Collection Point of
View, Geneva, UNAIDS, 1998 (available in English, French and Spanish)
AIDS epidemic update: December 1999 , Geneva, UNAIDS, 1999 (available in
English, French, Spanish and Russian)
Blood safety and AIDS . UNAIDS Best Practice Collection Point of View, Geneva,
UNAIDS, 1997 (available in English, French and Spanish)
Blood safety and HIV . UNAIDS Best Practice Collection Technical Update, Geneva,
UNAIDS, 1997 (available in English, French and Spanish)
Counselling and HIV/AIDS . UNAIDS Best Practice Collection Technical Update,
Geneva, UNAIDS, 1997 (available in English, French and Spanish)
Counselling and voluntary HIV testing for pregnant women in high HIV prevalence
countries: Elements and issues , UNAIDS Best Practice Collection Key Material,
Geneva, UNAIDS, 1999 (available in English, French and Spanish)
From Principle to Practice: Greater Involvement of People Living with or Affected by
HIV/AIDS (GIPA) , UNAIDS Best Practice Collection Key Material, Geneva, UNAIDS,
1999 (available in English, French and Spanish)
Gender and HIV/AIDS . UNAIDS Best Practice Collection Technical Update, Geneva,
UNAIDS, 1998 (available in English, French and Spanish)
Knowledge is power: voluntary HIV counselling and testing in Uganda . UNAIDS
Best Practice Collection Case Study, Geneva, UNAIDS, 1999 (available in Englishand French)
Mother-to-child transmission . UNAIDS Best Practice Collection Technical Update,
Geneva, UNAIDS, 1998 (available in English, French and Spanish)
Prevention of HIV transmission from mother to child – Strategic options , UNAIDS
Best Practice Collection Key Material, Geneva, UNAIDS, 1999 (available in English,French and Spanish)

54 — AIDS and HIV InfectionThe UNAIDS Report, Geneva, UNAIDS, 1999 (available in English, French and
Spanish)
UNAIDS & WHO. Report on the global HIV/AIDS epidemic . Geneva, UNAIDS &
WHO, 1998 (available in English, French and Spanish)
Women and AIDS . UNAIDS Best Practice Collection Point of View, Geneva,
UNAIDS, 1997 (available in English, French and Spanish)

Information for United Nations Employees and Their Families — 55Notes

Credits
Writer/Editor and Designer: Mandy Mikulencak
Illustrator: Estelle Carol
The Joint United Nations Programme on HIV/AIDS (UNAIDS) is the leading advocate
for global action on HIV/AIDS. It brings together seven UN agencies in a common effortto fight the epidemic: the United Nations Children's Fund (UNICEF), the United NationsDevelopment Programme (UNDP), the United Nations Population Fund (UNFPA), theUnited Nations International Drug Control Programme (UNDCP), the United NationsEducational, Scientific and Cultural Organization (UNESCO), the World HealthOrganization (WHO) and the World Bank.
UNAIDS both mobilizes the responses to the epidemic of its seven cosponsoring orga-
nizations and supplements these efforts with special initiatives. Its purpose is to leadand assist an expansion of the international response to HIV on all fronts: medical,public health, social, economic, cultural, political and human rights. UNAIDS workswith a broad range of partners—governmental and NGO, business, scientific and lay—to share knowledge, skills and best practice across boundaries.

UNAIDS
20 avenue Appia 1211 Geneva 27, SwitzerlandTel: (+41 22) 791 46 51 Fax: (+41 22) 791 41 65 E-mail: unaids@unaids.org Internet: http://www.unaids.org
UNAIDS Best Practice Collection
Key Material