Assignment Code: BSW-127/2021-22

Course Code: BSW-127

Assignment Name: Public Health and HIV/AIDS

Year: 2021-2022

Verification Status: Verified by Professor

Note:

(i) Answer any five of the following questions in about 300 words each.

(ii) All questions carry equal marks.

Q1. Explain briefly the different perspectives of public health. (20)

Ans) The different perspectives of public health are:

Curative Medicine

A dramatic shift occurred in the mid-twentieth century, bringing allopathic medicine, which is described as "the treatment of disease by the administration of a substance that creates a reaction that itself neutralises the sickness." The elimination of disease from the patient is the basic goal of curative medicine (rather than the mass). As a result, diagnostic and therapy approaches are used to achieve this goal. Medical technologies have evolved as a result of advances in science, technology, and understanding of the human body, which has aided in the development of specialty. Surgery, radiology, anaesthesia, ENT, ophthalmology, cardiology, gynaecology, paediatrics, geriatrics, and obstetrics are just a few of the disciplines that have emerged.

Preventive Medicine

Despite the fact that the phrase "public health" has lost its original meaning, terminology like "preventive medicine," "social medicine," and "community medicine" are used interchangeably. Preventive medicine originated in the United States, when public health was almost entirely focused on the prevention of infectious disease and was dominated by the medical profession. Preventive medicine is used on healthy people, usually through acts that affect large groups of people. Preventive medicine include health promotion, treatment, and disability prevention. It includes not only the prevention of disease, its progression, and mental and physical incapacity, but also the timely application of all methods to promote the health of people and the community as a whole, such as prophylaxis and health education.

Social Medicine

"The study of man as a social creature in his complete environment" is how social medicine is defined. Social medicine arose out of a concern about the significance of social variables in disease genesis and the necessity for government action in disease prevention and medical care. All factors impacting the distribution of health and poor health in communities, including the usage of health services, are addressed. It is a development of the public health concept, reflecting the close interaction that exists between medicine and the social sciences. Social medicine is an expression of the humanitarian tradition that involves patient care, disease prevention, and medical service administration. As a result, social medicine is not a new area of medicine, but rather a new approach to medicine in response to man's and society's evolving demands. It emphasises the close ties that exist between medical and social sciences.

Community and Family Medicine

Family and community medicine arose from a rediscovery of the human, social, local, and cultural components of health and disease, as well as a recognition of the family as a focal point of health care and the ideal location for integrating preventive, promotive, and curative treatments. Family oriented medicine is used to treat patients and their families, and it becomes a practise specialty. Similarly, community medicine has found common ground.

Q2. Briefly explain how HIV is not transmitted. (20)

Ans) Outside the body, HIV is a delicate virus. It can be killed by heat, regular soap and water, household bleach, Lysol, and chlorine (bleaching powder). Surgical instruments are simple to sterilise. Because HIV does not spread like a cold, it is comparatively difficult to contract. There hasn't been a single example of HIV transmission by air, tears, sweat, shaking hands, hugging, coughing, sneezing, swimming pools, toilet seats, sharing towels, bed linen, utensils, being bitten by mosquitoes or other animals, or any other type of common contact. Saliva has not been identified as a transmission method because it is not polluted by blood.

While providing medical/nursing care to HIV patients, it is virtually impossible to contract HIV. Medical personnel and HIV-positive individuals' families have nothing to worry, however a few universal or regular precautions must be maintained. As a result, quarantining HIV positive people, as was done to a patient in Goa in 1989; refusing hospital admission to HIV infected patients, as was ordered by several hospitals in Delhi in February 1990 for several months; or dismissing an HIV positive person from his or her job, as was done in Goa in 1989, are all unscientific and unethical.

No one will contract HIV as a result of a mosquito bite. There are numerous arguments in favour of this. Mosquito-borne infections are ubiquitous all throughout the world. Every organism that transmits disease via the mosquito has a life cycle in the mosquito. When a mosquito bites, it injects saliva into the victim. The saliva of the mosquito does not contain HIV. Older children are more likely to contract mosquito-borne diseases, whereas older children are less likely to contract HIV. When an insect bites a person, it does not inject its own or the blood of a previously bitten person or animal into the next victim.

Instead, it injects saliva, which functions as a lubricant, allowing the insect to eat more effectively. This is how diseases like dengue fever and malaria are spread. HIV, on the other hand, only lives for a short period inside an insect, and unlike microbes transferred through insect bites, HIV does not multiply or survive in insects. Furthermore, HIV-positive people do not have high amounts of the virus in their bloodstream all of the time. Second, the surfaces of insect mouth parts retain just a little amount of blood. Finally, biting insects do not usually fly from one person to the next after consuming blood; instead, they fly to a resting location to digest the meal.

Q3. What are the types of risks involved in different types of sexual practices with regard to transmission of HIV? (20)

Ans) There are a variety of ways to become infected with HIV. It is critical to understand the HIV transmission routes. This will assist us in preventing the spread of HIV. To put it another way, knowing how HIV spreads from one person to another will help us protect ourselves. It will also assist us in planning and implementing HIV/AIDS preventive and control programmes. HIV-positive people can spread the infection to people who aren't infected. The majority of transmission happens in people who do not have any signs or symptoms of AIDS. As a result, it is critical that everyone understands how HIV spreads. It's also crucial to understand who can become infected and how they do so. HIV can be found in all of the body's fluids, tissues, and organs. HIV has been identified in practically all body fluids, including blood, sexual secretions, saliva, tears, and breast milk (semen, cervical, and vaginal).

It's impossible to know the exact risk of HIV transmission from a single sexual act. According to population-based estimations, the risk of infection from penile-vaginal or penile-anal contact is less than one infection per hundred exposures. Such statistics, on the other hand, describe the average of a group of people and cannot be applied to a specific scenario. While some people have had several sexual encounters with HIV-positive people without becoming infected, others have become infected after just one. Sexual activity with an infected individual on a regular basis raises the risk of infection.

Four categories are used to categorise various sorts of practises. Unsafe practises with a high risk, unsafe procedures with a hazy danger, low risk methods with some risk, and practises with little to no risk are all examples of unsafe practises.

Unsafe practices with high risk of HIV transmission:

1. Multiple sex partners;

2. Unprotected anal receptive sex with an infected partner;

3. Unprotected anal penetration with hand (fisting);

4. Anal douching in combination with anal sex;

5. Oral-anal contact;

6. Vaginal intercourse without a condom with an infected partner.

Possibly unsafe practices with Unclear Risk of HIV Transmission:

1. Cunnilingus (Oral contact with female genitals and contact with sperm);

2. Fellatio (Oral contact with male genitals and contact with sperm);

3. iSharing sex toys and devices.

Low Risk Practices with some Risk of HIV Transmission:

1. Wet kissing (French kissing);

2. Fellatio interrupts are all examples of anal or vaginal sex with the proper use of an intact condom (contact with male genitals without ejaculations)

Practices with Probably No Risks of HIV Transmission:

1. Absence of sexual interaction; monogamous relationship in which both partners are free of infection;

2. Masturbation of oneself;

3. Masturbation of one's spouse (if neither partner's hands are cut);

4. Dry kissing;

5. Touching, caressing, cuddling, or stroking.

Q4. What are the types of tests used to detect HIV antibodies? (20)

Ans) Two different types of testing are utilised to check for antibodies. The ELISA (Enzyme linked immunosorbent assay) and Western Blot tests are the two.

ELISA Test

ELISA is a simple and inexpensive method of testing. It's also trustworthy and sensitive. The test's primary idea is to look for antibodies to the HIV virus in the blood of someone who has been infected.

Method:

Microplates with viral antigens are employed as the method. The viral antigens are mixed with serum from the patient's blood. An antigen-antibody complex will form if the serum contains antibodies against the virus. The test includes an antigen-antibody combination antibody as well as a chemical. The reaction is classified as good or negative depending on the colour changes.

Types of ELISA:

ELISA tests come in a variety of shapes and sizes. They are based on the methods for obtaining viral antigens. Whole viral lysate, recombination DNA, and synthetic polypeptide are the three approaches for obtaining viral antigens. Only synthetic polypeptide is now available on the market.

Western Blot Test

This test works on the same idea as the last one. Antigens from viruses are placed onto nitrocellulose sheets. At one end of the strip, the patient's serum is inserted. Electricity is applied to the paper for 24 hours. Antibodies travel along the paper, interacting with antigens. Antigen-antibody complexes migrate to distinct locations depending on their molecular size. These patterns are compared to the HIV-produced standard pattern. Antigen-antibody reactions must occur in all three regions, i.e. gag, pol, and eve, for the test to be considered positive. The test is termed indeterminate if there is reactivity only in one or two locations. After six weeks, the test must be redone.

Sensitivity and Specificity:

Any test that is used to diagnose an illness does not always detect the disease correctly. It does not necessarily rule out the disease, either. This is a test's inherent property. Even if the person does not have the condition, the test may come out positive. A false positive test is what this is called. Similarly, even if the patient has the condition, the test may come out negative. A false negative test is what this is called.

Sensitive Test:

A sensitive test will discover all cases with a remote chance of being infected with the disease. All false positives will be detected. To be used for disease screening, a test must be extremely sensitive. A negative result on a sensitive test proves the absence of the disease. A positive test result, on the other hand, does not imply that the diagnosis is correct.

Specific Test:

A special test will detect all cases in which the disease is not present. A large percentage of false negative tests will be detected. The presence of the disease is proven if a test has a high specificity. The assays used to detect HIV should have a high level of sensitivity and specificity. The sensitivity and specificity of an ELISA test are both more than 90%. It's possible that a false positive ELISA is caused by liver illness or recent influenza vaccination. When evaluating an HIV test, we must use caution.

Q5. What are the universal precautions to be followed for preventing HIV transmission? (20)

Ans) Universal precautions are a set of recommendations designed to avoid the spread of diseases spread through bodily fluids, as well as to safeguard caretakers and those who have such diseases. These measures were designed for medical workers who work in hospitals and are likely to come into touch with blood or other bodily fluids.

Because any patient could be infected, the Centers for Disease Control (CDC) in Atlanta, Georgia, introduced universal precautions to emphasise that precautions must be taken when exposed to any blood or body fluids. Because any patient could be infected, any person handling or exposed to blood must treat all blood as if it were infected. Other physiological fluids that are a potential source of HIV, such as semen, vaginal secretions, and tissue, are also subject to these measures.

These procedures are now referred to as standard precautions. Because these precautions must be taken in all cases and have become the acknowledged standard of care, the nomenclature has been changed.

The following are the universal steps to take in order to avoid HIV transmission:

1. Every patient should be treated as if they are infected. (By the time a patient is diagnosed with HIV, over half of all blood tests have been completed.)

2. Between each patient contact, wash your hands with soap and water. Before and after interaction with patients, hands should always be cleansed. Even if gloves are worn, hands should constantly be cleansed. If you come into contact with blood or other bodily fluids, wash your hands thoroughly.

3. If body fluids are encountered, use disposable gloves and double gloves during surgical procedures. If exposed to body fluids, those with open skin lesions should avoid performing procedures.

4. When garments may be exposed to bodily fluids, gowns are worn.

5. When performing treatments that may splatter the worker with bodily fluids, masks and eye protection are required.

6. Sharp tools should be disposed of immediately after use in puncture-resistant containers. Needles should be discarded without being recapped as soon as possible after usage. All areas where sharp objects are utilised should have disposal bins.