AIDS Risk Assessment for Rescue Missions

Most Important Issues Related to HTLV-3 Infection

It is recommended that all clients be screened for AIDS risk as part of the medical assessment using the following material. At-risk clients should be provided with prevention counseling and, if warranted, offered referral for pre-AIDS testing counseling.

Explanation of content areas in the risk assessment interview:

Exposure through shared drug inject ion equipment

Most clients in treatment for drug abuse are at risk for HTLV-3 p infection from sharing needles or other components of injection equipment during the past two to five years. The degree of that risk is related to the frequency of needle—sharing and the number of persons involved in needle exchanges, as well as the seroprevalence rates for the cohort of iv drug users involved.

The counselor will ordinarily know the client’s drug use history, including any substances that have been used intravenously, from the intake assessment and previous discussions. This knowledge can be referenced during the interview and verified for accuracy/currency.

All clients who have ever used drugs intravenously should be asked about sharing injection equipment —— "works" or needles —— with anyone, the number of persons involved, and whether any one of them is known or suspected to be seropositive for HTLV—3 or diagnosed with ARC or AIDS. exposure through sexual practices

In addition to clients’ potential infection with HTLV—3 through their needle—sharing practices, exposures may have occurred through sexual activities with already infected and contagious partners. Remember, these partners need not have been or even have known they were infected to be "carriers."

In calculating infection risk from sexual activity, clients in 3 most danger are:

  1. those with numerous partners or regular partners who are also members of high risk groups, and
  2. those who frequently exchange bodily fluids during sex, particularly recipients of potentially infected semen in the rectum or a traumatized vagina or mouth. (as often occurs in homosexual activities).

Exposure from contaminated blood, blood products or instruments

Drug users who have had transfusions or other blood product treatments very likely know about risks or may even have been informed of potential infection. Exposure through contaminated instruments —— used for ear—piercing, tatooing, electrolysis, acupuncture —— is unlikely unless performed by amateurs in unsanitary conditions where other persons at high risk for AIDS were also likely to have participated.

Exposure through travel

Travel to some cities in the united states —— New York or San Francisco, for example —— is considered a risk factor if any of the client’s activities involved potential exposure to HTLV—3; e.g., Needle sharing or sexual promiscuity, with residents who were also high risks. Travel to or immigration from some countries in Central Africa or Haiti since the mid—1970s is also regarded risky if sharing needles, homosexual activities, or other dangerous practices were engaged in while there.

Possible early symptoms

You’ll finally need to review and discuss any potential early symptoms of immune suppression from HTLV—3 infection that you or the client observe. Remember that two or more of these symptoms that have persisted for a month or longer may be significant early warning signals of ARC or AIDS —— if there are no other explanations for them.

Many of these early warning signs and symptoms are easily confused with those of withdrawal from addiction. In one New York study, three—fifths of the drug abusing respondents who had no exposure to HTLV—3 had nonetheless experienced one or more symptoms consistent with the AIDS diagnosis in the five years before the interview.

Obviously sick junkies may continue to insist that their illnesses aren’t AIDS—related but just the "usual reactions" to drug abuse that can be masked or "cured" by another "hit." This may be a cover for real fear of AIDS (denial) or a genuine ambiguity about the cause of such common symptoms among drug abusers as weight loss, fever, diarrhea, fatigue or swollen lymph nodes.

Counselors and medical staff in programs that have worked with numerous AIDS cases usually fee confident that differences between drug—related and HTLV—3—related symptoms are not too difficult to distinguish. Poor nutrition associated with continuous heavy use of cocaine or amphetamines often causes rapid weight loss, but the behavior of a "speed freak on a "run" is quite different from that of an AIDS patient who is "wasting." Similarly, although withdrawal from narcotics usually precipitates diarrhea and fever, these symptoms are not the same as the prolonged intestinal disturbances and drenching night sweats associated with AIDS—related illnesses. However, some common infections among drug abusers, (e.g., Mononucleosis or sexually transmitted diseases) may cause such very similar symptoms as prolonged fatigue and swollen lymph glands. Other AIDS—related symptoms —— thrush or dry cough —— are not related to drug abuse at all.

It is important that all drug users in whom AIDS/arc—like symptoms persist be referred to a physician for consultation and examination. Additionally, many drug users —— especially those who are also immigrants from third world countries with a high prevalence of tuberculosis —— are infected with tb bacillus that will not become clinically active tuberculosis unless immune system deficiencies allow the tubercle bacilli to multiply, therefore. High, risk clients who are likely to be seropositive for HTLV—3 should have a mantoux tuberculin skin test and, if positive. Given medication to prevent clinically active tuberculosis from developing.


Suggested Questions for Assessing Residents' Risk for HTLV-3 Infection?

Sharing drug injection equipment?

Engaging in "unsafe" sex?

Exposure to contaminated blood, blood products or instruments?

What other potentially risky blood-exchanging procedures have you had in the last two years? Such as:

blood transfusions/hemophilia treatments
ear-piercing by a non-professional

Risky practices in locations with high AIDS prevalence?

What, if any, risky activities such as needle-sharing or unsafe sex have you conducted during the last 2 to 5 years in or with residents of other locations where AIDS is very common?

Possible early symptoms of ARC or AIDS?


Key Issues to be Reviewed with All Clients Individually