Don't myth the facts on hiv ORNAC Conference 2013


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What are the chances that you will get HIV from a needle stick injury and does it actually matter? Do you feel more comfortable knowing that your patient is HIV negative? Your values and professional ethics related to HIV impact your professional and personal life; it should not impact the care you give to your patients. Wise practices in perioperative clinical practice needs to recognize that HIV is a chronic illness with patients living longer lives and requiring care that includes surgery. The law regarding HIV in Canada is unique. Ethical treatment of positive patients is a requirement of professional nursing practice. Myths can lead to stigma, discrimination, and negative patient outcomes. The facts on HIV support best practices for perioperative nursing. We will explore consent, testing, attitudes and values and look at research on circumcision, transplant, double gloving and how needle exchange programs impact you and your patients.

Published in: Health & Medicine
  • Am from England, Oxford,UK ...HIV has been ongoing in my family for long..I lost both parents to HIV and it is so much pain has not been able to get over. As we all know medically, there is no solution or cure for HIV and the cost for Medication is very expensive. Someone introduced me to a man (Native Medical Practitioner) in oxford. I showed the man all my Tests and Results and I told him have already diagnosed with HIV and have spent thousands of dollars on medication. I said I will like to try him cause someone introduced me to him. He asked me sorts of questions and I answered him correctly. To cut the story short, He gave me some medicinal soaps and some herbs(have forgot the name he called them) and he thought me how am going to use them all. At first I was skeptical but I just gave it a try. I was on his Medication for 2 weeks and I used all the soaps and herbs according to his prescription. That he will finish the rest himself. And I called him 3 days after, I arrived and I told him what is the next thing he said, he has been expecting my call. He told me to visit my doctor for another test. Honestly speaking, i never believe all he was saying until after the test when my doctor mention the statement that am, HIV negative and the doctor started asking me how do I do it....Am telling this story in case anyone may need this man’s help. He is the Great Dr Dr BENEDICT here is via email address(} So,if you are in a similar problem or any kind of problems you can also contact him via his email(}he is the solution to all your problems and predicaments in life.his email again is{}. HE ALSO SPECIALIZE IN THE THE FOLLOWING PROBLEMS; (1) If you want your ex back. (2) If you want to be promoted in your office. (3) If you want a child. (4) if you have any sickness like ( H I V/AIDS ),(CANCER) or any sickness (5) if you are deaf and blind and you want to see and hear again. ONCE again,his email address is{}
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  • I have been suffering hardship from HIV/AIDS since 7yrs now, and i happen to have 2 kids for my husband, and now we cannot proceed to have another kids all because of my disease and now i have do all what a human like i and my husband can do just to get my disease healed, i have went to several places to seek for help not even one person could ever help, until i melt a comment on the daily news paper that was commented by Desmond about how this powerful traditional doctor help him get cured of the disease (HIV-AIDS) ' my fellow beloved' i firstly taught having a help from a spiritual traditional healer was a wrong idea, but i think of these, will i continue to stress on these disease all day when i have someone to help me save my life?' so i gather all my faiths and put in all interest to contact him through his Email address at so after i have mailed him of helping get my disease cured, he respond to me fast as possible that i should not be afraid, that he is a truthful and powerful doctor which i firstly claimed him to be. So after all set has been done, he promise me that i will be healed but on a condition that i provide him some items and obeyed all his oracle said. I did all by accepting his oracles fact and only to see that after some weeks of taking his herbal medicine i notice some changes in my body system and i went for check up the day he ask me to go for check up to confirm if the sickness was still there,to my greatest surprise i could not find any sickness in my body i was first shocked and later arise to be the happiest woman on earth after i have concluded my final test on the hospital by my doctor that i am now HIV- Negative. My papers for check are with me and now i am happy and glad for his miraculous help and power. With these i must tell everyone who might seek for any help, either for HIV cure or much more to contact him now at these following email now, Email:
    ' sir thank you so much for your immediate cure of my disease, i must say a big thanks for curing my disease, i owe you in return.and be blessed sir.
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  • Really great presentation and great information for any Operating Room nurse.
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  • It pushes all the news buttons: it is a health emergency, it has a human face, it has elements of science, medicine, religion, it has deep grief and moments of extreme joy. It often has enemies: governments, the church, religious bodies, the fraudsters and snake-oil salesmen. It has heroes: the people living with HIV, community groups and NGOs fighting on the frontline of the epidemic, the scientists and researchers working for new treatments, a vaccine, a cure, and the doctors and nurses caring for the sick and dying. It is clear that HIV and AIDS is more than a disease that infects individuals. It is a social, economic and, in some countries, security crisis.
  • I may be controversial. I am not an OR nurse. When I was in university a stood in on a Whipple procedure. Wasn't my cup of tea. I like hiv. Small piece of RNA that can only replicate within our T-cells. 100% preventable. Yet 2.7millin people will be infected this year.  Almost 2million will die. It is pretty fascinating. Chances are there are people in the audience that are positive. Many hiding their illness. CARNA believes those positive nurse need to disclose their status. I am not too sure. How many people know their hiv status?  How many people have had risk factors in their lives. think about the last time you were tested. What are the legal impacts of a pos dx? 25% do not know that they are pos. here is a secret. I finish all my conf ppt the night before I present. Especially with new audiences. Good to get a feeling and talk to and learn about who you will be talking with. Same shud go for our pts but the system rarely gives us time for that. I fly out today and ......LV presentation 2moro which is not done yet either. Magic johnson slide. 1.8 million people die eveRy urear. No one choses hiv but our degree of empathy or blames is a choice we make that can impact the care we give and impact the quality of care rec'd and whether or not pts come back. Double glove Image and looks. Compare your thots of me when I wore a shirt compared to t shirt. Think about your industry reps and their fancy clothes. Think about the aboriginal idu. We beat up and put down those who most desire care and acceptance. Shameful really. And we judge each other. How many people work with someone who is positive MD RN LPN? And does it matter?  Judging is a natural thing it's what aided in evolution. If we couldn't discern the differences between a mouse and a lion we wouldn't have gotten too far. But that same natural judgement does interfere with the patients and families we work with. Any contact with health care professionals pos or neg impacts pts and families and has an effect on whether or not out pts will come back when they are Sick and need care. One of my patients had cheeks, temples, biceps, calf, buttocks, pecs,
  • Testing client/provider HIV POCT Compulsory Human rights Attitudes of service providers Morals Values Blame Religion – MD refusing to perform surgery NEP Endocardtitis Organ Transplant Donation, recipient Needle Exposure Conjunctival splashes Reusing sterile equipment? Blunt needles Circumcision propofol C-section Viral load? Standard Universal Precautions Compensation, new HIV staff?
  • Consent??? Assault??? Would surgery be withheld if a patient refuses an HIV test?
  • Provider-Patient Interactions Attitude related to drug abuse is critical to the development of a trusting relationship. Providers who openly diminishes the needs, complaints, requests of addicted patients is most often excluded from decisions that impact the patients ability to maintain adherence or enter care Despite multiple and repeated documentation of the efficacy of drug treatment programs, care givers and politicians often view treatment programs as ineffective Complications of Substance Abuse Medical: Needle induced: viral, bacterial, fungal infections, peripheral vascular disease Drug induced: Overdose, withdrawal, organ-specific complications (e.g.,nephropathy due to heroin, cardiac ischemia due to cocaine, gastrointestinal, cardiac and neurologic disease due to alcohol Tuberculosis Other: Sexually Transmitted Disease, HCV, HBV
  • Medical care and its connection to incarceration
  • Since HIV is not spread through ordinary workplace activities, there is no reason why a person living with HIV must disclose his or her HIV status at work. This is also the law. It is possible that an employee living with HIV may never become ill during the period of employment. Many people living with HIV have been living with the virus for many years and are actively engaged in full-time work. For some, it can take years for symptoms to develop.
  • Review facility policy and report the incident Medical follow-up is necessary to determine the exposure risk and course of treatment Baseline and follow-up HIV testing Four week course of medication initiated one to two hours after exposure Liver function tests to monitor medication tolerance Exposure precautions practiced Here is a quick quote form 1 of my favourite periop tests, Nancymarie Phillips, Berry & Kohn’s Operating Room Technique, 12 th ed., 2013, Elsevier, Toronto p 53, Chapter 3, Legal Regulatory & Ethical Issues   “ Knowing that HIV infection is transmitted by blood & body secretions, conscientious of standard precautions for infection control should provide protection against occupational  exposure to HIV, hepatitis, tuberculosis and other communicable or resistant infections”.
  • Department of Health. HIV post-exposure prophylaxis: guidance from the UK Chief Medical Officers' expert advisory group on AIDS. London, UK; 2004. Health care workers can get HIV if they prick themselves with a needle that's been used on someone who has the virus. The chance that they'll get HIV is very small. The chance of getting infected from a needlestick is less than 1 in every 300 accidents. [34] There's also a chance that you can become infected if blood from someone with HIV gets inside your body. For example, if you're taking a blood sample and some of the blood gets into a cut on your skin or splashes into your eye. However, the chances of this happening are very small. Up to 2005, only five health care workers in the UK had become infected with HIV through their work. [35] There's also a chance that a further 14 people may have got HIV through a needlestick injury. But these people may have got HIV another way. Most of these people worked in countries where many people had HIV. They are not thought to have been infected through their work in the UK. It's important to remember that casual, everyday contact with a person who has HIV doesn't put you at risk of catching the virus. If you do prick yourself with a needle then you should get medical help immediately . There are drugs you can take to lower your chances of getting infected.
  • in the workplace: • Bandage all cuts right away to avoid contact with other people. • Blood and other body fluids should be cleaned using a solution of 1 part bleach, 9 parts water. • Do not use bare hands to clean up items soiled with blood or other body fluids; wear gloves. • Put sharp items into a solid sealable container that won’t puncture garbage bags, to prevent those handling garbage from pricking themselves. • Wash your hands with soap and hot water for at least 20 seconds after you have had contact with blood or other body fluids, after going to the bathroom, before preparing or eating food, and after removing latex gloves. • Use hand lotion to help keep your hands from becoming chapped or irritated. Intact skin is your first defense against infection. • Flush eyes, nose, or mouth with water if exposed to another person’s blood or body fluid. First Aid When administering first aid, follow the universal precautions and the following guidelines: • All workplaces should be equipped with first aid kits that contain a pair of gloves, latex barriers and mouth guards to protect both the person giving and the person receiving first aid. • Administer first aid without delay. If required to perform mouth-to-mouth resuscitation, use a mouth guard to avoid coming into contact with blood. • Report any workplace accidents to a supervisor as soon as possible.
  • Infection risk The risk for blood-borne exposure and infection is highest in the operating room 1 Average infection risk after percutaneous injury with contaminated sharp instruments varies 2 : • Hepatitis B (HBV): 6-30% • Hepatitis C (HCV): 4-10% • Human Immunodeficiency Virus (HIV): 0.3% Chronic HBV infection among surgeons is 3 times greater than that of general population Amazingly double gloving increase perforations, but does offer more protection
  • A little more recent No evidence indicated that HIV or hepatitis B virus (HBV) has been transmitted via aerosolization and inhalation.   A little more recent No evidence indicated that HIV or hepatitis B virus (HBV) has been transmitted via aerosolization and inhalation.    A little more recent No evidence indicated that HIV or hepatitis B virus (HBV) has been transmitted via aerosolization and inhalation.
  • “ There should not be a duty to disclose when there is an undetectable viral load,” he said. “People should not go to jail.” HIV is effectively the only disease with criminal law consequences, said Peck. In Canada, approximately 70,000 people live with HIV and Canada is a world leader for prosecutions, with at least 150 on the books. “ HIV is radically different than it was 10 years ago. It’s a chronic illness, but it’s manageable if a person has access to meds,” said Peck. “ It’s harder to transmit than people suppose.” For those who are maliciously trying to infect others with HIV, then of course the justice system should intervene, he said. “ This is not about giving people with HIV a free pass to rape – we’re not talking about that,” said Peck. Most HIV patients actually want to protect their sexual partners, he said. Not only doesn’t the new law address oral sex, it doesn’t say what happens if a condom breaks. “ Now people don’t know what kind of behaviour will land them in jail,” said Peck. Peck’s talk, sponsored by the AIDS Committee of Simcoe County, comes as a local trial is playing out in the courts. Jennifer Murphy is before the courts after being charged with aggravated sexual assault in 2011. It is alleged she engaged in oral sex and intercourse and didn’t reveal her HIV-positive status. Her Superior court trial is set for the end of June. In 2005, she pleaded guilty to aggravated sexual assault for engaging in sexual intercourse and oral sex with two men at Canadian Forces Base Borden. She was sentenced to a year of house arrest and a three-year probation. In 2007, while living in St. John’s, Newfoundland, Murphy was again charged with aggravated sexual assault, but the charges were withdrawn.
  • Richard Elliott, the executive director of the Canadian HIV/AIDS Legal Network, which also intervened in the case, said the decision was not a good one for people living with HIV. His group's position is that either a low viral load or the use of a condom should be the required test to avoid being prosecuted, but not both, as the top court said in Friday's ruling. "We know from the science now that if either you use a condom or you have a low viral load, the risk of transmission is extraordinarily small," he said. Jessica Whitbread, who contracted HIV from a former boyfriend more than a decade ago, said she thought Friday's ruling was a step forward — at first. But upon closer examination, she said this ruling could make her the criminal. "I can still have a vindictive lover say that I did or didn't use a condom," she told CBC News. "It still becomes 'he said, she said. he said, he said.' …That can still play a very important role in the courts."
  • Richard Elliott, the executive director of the Canadian HIV/AIDS Legal Network, which also intervened in the case, said the decision was not a good one for people living with HIV. His group's position is that either a low viral load or the use of a condom should be the required test to avoid being prosecuted, but not both, as the top court said in Friday's ruling. "We know from the science now that if either you use a condom or you have a low viral load, the risk of transmission is extraordinarily small," he said. Jessica Whitbread, who contracted HIV from a former boyfriend more than a decade ago, said she thought Friday's ruling was a step forward — at first. But upon closer examination, she said this ruling could make her the criminal. "I can still have a vindictive lover say that I did or didn't use a condom," she told CBC News. "It still becomes 'he said, she said. he said, he said.' …That can still play a very important role in the courts."
  • Does not adequately respect or protect human rights Most likely will be under review by the Canadian HIV/AIDS Legal Network
  • Myths about NEP can impact the care u give and impacts how u think about people who are pos^ve esp if a risk factor was idu. The sharing of drug injecting equipment remains unacceptably high among people who use injection drugs. The level of reported, unprotected sexual intercourse is also high among people who use injection drugs. Needle exchange programs alone are not sufficient to prevent HIV transmission among people who use injection drugs. and should be complemented with a range of appropriate additional services.
  • Most recent studies show this A track…
  • Current state in SK Provides knowledge, insight, understanding etc What else can it do? re separating data on aboriginal specific... Note 2010 to 2011 for next slide Can an event or condition ever be said to have a single cause? So, when HIV prevalence is reported for Aboriginals in Saskatchewan, what does this mean? In most cases, HIV prevalence cannot be accurately determined from reported cases because many infections are undiagnosed or unreported. The best estimates are mainly based on the results of surveys of large groups of people.
  • Part of education at nursing colleges and universities we need to challenge ideas
  • Further research is needed on the pattern of HIV/AIDS and HIV testing among Aboriginal peoples to increase our understanding of the specific impact of HIV on Aboriginal peoples to guide prevention and control strategies.
  • Don't myth the facts on hiv ORNAC Conference 2013

    1. 1. Don’t Myth the Facts on HIVORNAC 23rd National Conference & IFPN ConferenceOttawa, CanadaGreg Riehl
    2. 2. HIV is a Great Story
    3. 3. Once a person is infected they are alwaysinfectedMedications are available to prolong life butthey do not cure the diseaseThose who are infected are capable of infectingothers without having symptoms or knowing ofthe infectionHIV AIDS
    4. 4. Answer questions► Describe your values when it comes to HIV/AIDS► How do you feel about HIV or AIDS?► What is the perception of the situation within your NursingTeam where you work?► Does HIV impact your professional/personal lives?
    5. 5. Discussion points Consent Testing PEP Double Glove Organ Transplant Advocacy Attitudes of service providers NEP
    6. 6. Should ALL hospital patients be tested forHIV?
    7. 7. Should ALL hospital patients be tested forHIV?Many departments across the nationare piloting routine testing programsI wonder if someone will get sued fortesting without consent, which is assault!
    8. 8. One size fits all?One single approach does not alwaysapply to the medical presentation: Mustbe versatile and opportunistic, for themost part let the patient tell you
    9. 9. Approach to the Patient who is HIVpositive & uses injection drugsProvider-Patient Interactions
    10. 10. Approach to the Patient who is HIVpositive & uses injection drugs Screening for Diagnosis of Substance Abuse Often unrecognized by physicians Medical system prejudicial towards active IDU Raise multiple co-morbidities that impact both diagnostic and caredecisions Understanding the unique aspects of the injecting community and thesocial system in which they live Social/Legal implications must be acknowledged
    11. 11. Approach to the Patient who is HIVpositive & uses injection drugs History Medical Schools do not emphasize the complexmedical and psychosocial aspects of the HIV positivepatient who uses injection drugs Drug Addiction: Relapse Rates >75-97% Empathy and a nonjudgmental stance are critical inobtaining a comprehensive and accurate history Understanding the addiction may involve multiplesubstances makes history taking more complex
    12. 12. Substance Use and Acute Care Assess patients fully andask about their use, howthey support their use, &ifthey are withdrawing It isn’t your life, so avoidjudgment Manage withdrawalproperly –withdrawal is aMEDICAL EMERGENCY Set realistic boundaries Understand the impact oftrauma, pain and anxiety Ask patients to tell you ifthey use Don’t punish patients forusing Keep the door open –review your AMA policy Be clear about whatpatients can expect fromyou & what you expectfrom them“They may have made somebad choices but your job isto look after their needs”Remember Maslow????
    13. 13. What is happening with circumcision?
    14. 14. Male Circumcision May Help ProtectAgainst Spread of HIV?
    15. 15. Disclosure & Reporting of Infection withBlood-Borne Pathogens: Guidelines forRNs CARNA Since HIV is notspread throughordinary workplaceactivities, there is noreason why a personliving with HIV mustdisclose his or herHIV status at work.This is also the law.
    16. 16. HIV Occupational Exposure - PEPNeutral zone“Knowing that HIV infection is transmittedby blood & body secretions, conscientiousof standard precautions for infection controlshould provide protection againstoccupational exposure to HIV, hepatitis,tuberculosis and other communicable orresistant infections”.
    17. 17. What are the chances that you will getHIV from a needle stick injury & does itactually matter?
    18. 18. Universal or Standard Precautionsshould be put into practiceFor Everyone
    19. 19. The value of double gloving withinthe operating environment The risk for blood-borne exposure and infectionis highest in the operating room. Average infection risk after percutaneous injurywith contaminated sharp instruments varies. Chronic HBV infection among surgeons is 3times greater than that of general population.
    20. 20. HIV surgical plume? Surgical plume can carry dangerous bacteria and viruses,including HIV. As such, they can produce upperrespiratory irritation, and have in-vitro mutagenicpotential. NASTIMy research shows no evidence that HIV or hepatitis B virus(HBV) has been transmitted via aerosolization andinhalation.I guess the theoretical risk is there, but…
    21. 21. Crime and PunishmentViral Load Duty to Disclose
    22. 22. Legal issues or Health issuesDecember 2011 AIDSLAW & bill c-10– “With injection drug use as the single greatest category ofexposure to HIV for Aboriginal persons, they are thusdisproportionately vulnerable to policies that punish peoplewho use drugs, such as the “tough-on-crime” lawenforcement measures that Bill C-10 will impose and barriersto harm reduction services, both inside and outside ofprison.”
    23. 23. Law is not black and white in Canada “A low viral load or the use of a condom should be the requiredtest to avoid being prosecuted, but not both,…” Richard Elliot He said she said he said…
    24. 24. Legal issues or Health issuesHIV disclosure ruling clarified by top court– People with low-level HIV and condoms neednt disclose infection– The court ruled Friday that the "realistic possibility of transmissionof HIV is negated" provided the carrier of the virus has a low viralload and a condom is used during sexual intercourse. Otherwise…– HIV carriers have to disclose their status to their partners.
    25. 25. Legal issues in NursingPractice Testing without consent is an assault in most places inCanada. The person must know and understand all of the potentialconsequences of getting tested that a reasonable personwould want to know. Being HIV positive can result in criminal liability Very important to understand legal implications in pre-test counseling, prior to consent being obtained. HIV and the Law Update, Ruth Carey, April 20th, 2004
    26. 26. Rights of the Positive Person Forced HIV testing is a violation of human rights Rights of people living with HIV/AIDS andthose vulnerable to HIV infection, need to berespected and protected New to SK: Mandatory Testing and Disclosure(Bodily Substances) Act, October 2005
    27. 27. Needle Exchange Program (NEP) Why do we need needle exchanges? Do Needle Exchange Programs create moredrug users? Will there be more used needles on the street?
    28. 28. What does HIV look like now? Some stats
    29. 29. Population
    30. 30. HIV Prevalence
    31. 31. HIV/AIDS Deaths
    32. 32. Reality is people do not know they arepositive…Approximately 25% of HIV positivepeople in Canada do not know theyare positive!!!
    33. 33. Do you feel more comfortable knowingthat your patient is HIV negative?
    34. 34. What’s happening?Stats from HIV and AIDS in Saskatchewan 2011, SK Ministry of Health, Nov 30, 2012
    35. 35. Canadian picture
    36. 36. HIV is a Chronic disease, for some people…“I have come to the conclusion that HIV/AIDSis not entirely about death. People die and willcontinue to die for one reason or the other.AIDS is also about the living.” Kiiza Ngonzi,2004
    37. 37. Challenge the next generation of Nurses
    38. 38. Key Messages The HIV epidemic shows no signs of slowing down. IDU is the most common mode of HIV transmission Women make up a large part of the HIV epidemic Aboriginal peoples are infected at a younger agethan non-Aboriginal persons. (PHAC, Dec 2004)
    39. 39. Finally…HIV testing is the key to slowing theepidemicEarly intervention is so importantKnow your status
    40. 40. Thank you
    41. 41. Contact informationGreg Riehl RN BScN MAAboriginal Nursing Student AdvisorAboriginal Nursing Student Achievement ProgramSaskatchewan Institute of Applied Science and Technology (SIAST)Room 150.1 Wascana Campus4500 Wascana Parkway, PO Box 556Regina SK S4P 3A3Phone:  306.775.7383Cell: 306.550.8176 Twitter @griehlEmail: gregriehl@sasktel.netYou can find our Professional Practice Group here,please like us -
    42. 42. 