Unbroken skin forms an impervious barrier against HIV and other bloodborne pathogens. However, infected blood can enter the system through: ● Open sores. ● Cuts. ● Abrasions. ● Acne. ● Any sort of damaged or broken skin, such as sunburn or blisters. one pill per day (FDA, 2019; NIAID, 2018) or an injection every other month (Williamson, 2022). The mid-1990s saw the development of new, less expensive drugs (NIAID, 2018). In 2007, a drug called maraviroc , which targets the primary receptor that HIV uses to gain entry into an immune cell, was developed. Also in 2007, a new class of drugs that inhibit one of the steps in the process of HIV’s incorporation into the host cell’s genome was introduced (Scarsi et al., 2020). One current weapon against HIV is post-exposure prophylaxis (PEP). Taken within 72 hours of possible exposure to HIV, this combination of antiretroviral drugs is highly effective in preventing seroconversion (CDC, 2022d). Also available is pre-exposure prophylaxis (PrEP), which reduces the risk of acquiring HIV from sexual activity by 99% (CDC, 2022e) and from injection drug use by at least 74% (HIV.gov, 2022d). These medications may be right for people who engage in risky behaviors. The HIV/AIDS drugs lamivudine and adefovir can help patients with hepatitis B who have no other options. Protease inhibitors have been developed to combat infections such as hepatitis C, influenza, and even COVID-19 (FDA, 2022; Pfizer, n.d.). A modified version of a drug called cidofovir , used to treat eye infections in AIDS, is now being developed to treat and possibly prevent smallpox infection (CDC, 2021c). (Naturally occurring smallpox is considered eradicated, but bioterrorists could weaponize the disease.) The antiretroviral drugs adefovir (used for HBV) and tenofovir can eradicate the banana streak virus, which endangers banana crops (CORDIS, 2003). The ADA also requires employers to provide “reasonable accommodations” for employees with disabilities. Reasonable accommodations are changes or adjustments in the job or work environment that permit individuals with disabilities to perform the essential functions of a job. An employer may choose to go beyond the ADA and provide an accommodation that would not be required under the law. For example, removing an essential function from an employee’s job description and providing HIV education for all employees are not examples of reasonable accommodations. Similarly, while allowing an employee to work part-time is a type of reasonable accommodation, continuing to pay that employee a full-time salary is not required by the law. The ADA establishes a baseline—a floor, not a ceiling. Specific legal boundaries of reasonable accommodation Many people with HIV or AIDS will need minimal or no accommodations (HIV.gov, 2017a). Employers should consider the ADA implications of any decisions involving an employee with HIV infection or AIDS, including any decisions about disclosing an employee’s HIV status.
Rarely, in work situations, transmission occurs through accidental puncture from contaminated needles, broken glass, or other sharps; contact between broken or damaged skin and infected body fluids; or contact between mucous membranes and infected body fluids. Whenever there is blood-to-blood contact with infected blood or body fluids, there is a slight potential for transmission. Advances in treatment of HIV/AIDS Research has led to dramatic improvements in length and quality of life for people with HIV. In the early days of the AIDS epidemic, the average life expectancy after a person developed AIDS was 1 year (NIAID, 2018). Now life expectancy with HIV is close to normal (Hanes, 2020). In the 1980s, a drug called azidothymidine (AZT, also called zidovudine) was found to suppress replication of HIV. At first, AZT was used only to treat AIDS, but research showed that the drug could also delay the onset of AIDS in people with HIV infection (NIAID, 2018). The rapid mutation of HIV often conferred resistance to a one-drug treatment. For this reason, another, similar drug was added to the AZT regimen. In 1996, yet another drug was added. This new triple-drug therapy became known as highly active antiretroviral therapy (HAART) . The new, third drug was a protease inhibitor (NIAID, 2018). With two kinds of drugs in use, viral loads started to drop to undetectable levels. The next step was to simplify the regimen, so that now many people with HIV may take only HIV research and other diseases HIV/AIDS research is helping solve other medical mysteries (Goodenow, 2018; Schwetz & Fauci, 2019). Scientists have learned, for example, that Kaposi’s sarcoma is caused by a herpesvirus. Also, the development of antiviral medications for HIV helped to lead to effective antiviral therapies for hepatitis C. The research has led to insights into immune activation and inflammation in other diseases and may help improve treatment of Alzheimer’s disease (Guengerich, 2020).
Workplace accommodations for employees with HIV/AIDS Today, people living with HIV infection and even AIDS can work productively for many years. HIV/AIDS raises difficult medical, legal, and emotional issues—fear, stigma, death, and dying. Employment provisions under the Americans with Disabilities Act of 1990 The Americans with Disabilities Act (ADA) prohibits discrimination against all people with disabilities or
perceived disabilities, including people with HIV infection and AIDS. A detailed explanation of the ADA is beyond the scope of this course but can be found at https://www. ada.gov. In most cases, unless an employee is requesting accommodations, the employee is not required to disclose HIV status (HIV.gov, 2017b). However, the employer does have the right to ask if a potential employee has any health conditions that would affect his or her ability to do the job or pose a serious risk to others. Similar legal requirements have been in place for employers covered by the Rehabilitation Act of 1973 and by certain state and municipal ordinances covering disability discrimination in employment.
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