Encourage both Mike and Jennifer to undergo regular HIV testing to ensure their sexual health and promote responsible sexual practices. Suggest couples counseling as a means of facilitating open communication, rebuilding trust, and navigating the challenges posed by Mike’s disclosure. Mike’s case underscores the importance of addressing complex issues related to sexual orientation, communication within relationships, and HIV risk perception. Healthcare professionals should offer support, education, and resources to help individuals like Mike make informed decisions, reduce risks, and maintain healthy relationships while addressing their sexual health concerns. Self-Assessment Quiz Question #3 When counseling Mike on HIV, which of the following statements regarding acquiring or transmitting HIV is accurate? a. Anal sex carries the highest risk of transmitting HIV. b. Vaginal sex carries the highest risk of transmitting HIV. c. Oral sex has the highest HIV transmission rate. d. There is no risk for HIV. Evidence-Based Practice Even in cases where an individual possesses a low or undetectable viral load, it remains conceivable for them to transmit HIV to others, as highlighted by the CDC (2020f). ● HIV may persist in semen and vaginal fluids, even though it may not be quantifiable through standard viral load tests, which primarily measure virus levels in the bloodstream. ● The viral load can fluctuate and potentially increase between testing intervals. Consequently, an individual’s viral load may unexpectedly rise, even if their last test indicated a low or undetectable level of HIV in their blood. ● Notably, individuals with HIV who concurrently have other sexually transmitted infections (STIs) may exhibit elevated viral loads in their genital fluids, such as semen and vaginal secretions. Healthcare professionals should be mindful of these considerations when advising individuals with HIV on prevention and transmission risk reduction.
Despite his sexual encounters with men, Mike holds a belief that he can minimize the risk of HIV infection as long as he is “careful” and “discreet.” He justifies this belief by assuming that his primary partner is his wife, Jennifer. From a healthcare perspective, several clinical concerns and considerations arise in Mike's case. The absence of open communication with Jennifer about his bisexuality and sexual history poses both emotional and physical risks. Mike's secrecy may affect trust and intimacy within the marriage. Mike’s assumption that being “careful” and “discreet” eliminates the risk of HIV transmission is a misconception. It overlooks the importance of comprehensive risk assessment, including the use of protection, regular testing, and informed decisions about sexual practices. Engaging in sexual encounters with multiple partners, irrespective of their gender, can increase Mike's risk of HIV transmission. His perception of reduced risk is based on a false sense of security. It is crucial for healthcare professionals to provide Mike with education on HIV prevention, the importance of consistent condom use, regular testing, and the availability of PrEP (preexposure prophylaxis) for individuals at higher risk. Psychological impact: Mike’s internal struggle with his bisexuality, secrecy, and the fear of being discovered can have significant psychological implications, potentially affecting his mental health and overall well-being. Healthcare professionals should approach Mike's case with sensitivity, empathy, and a focus on holistic care. Key considerations include: Encourage Mike to engage in open and honest communication with Jennifer about his bisexuality and sexual history, acknowledging the challenges this may entail. Provide Mike with accurate and comprehensive educational information about HIV, transmission risks, prevention strategies, and the importance of regular testing. Assess Mike’s mental and emotional well-being, offering support and counseling to address any psychological distress or internal conflicts. Discuss and recommend appropriate HIV prevention methods and strategies, such as condom use and PrEP, tailored to Mike’s specific circumstances.
DIAGNOSIS
(CDC, 2020h). Experts also recommend that all pregnant women be tested once during their pregnancy. And for women at high risk for HIV infection, a second test in the third trimester is recommended. For newborns whose mothers are HIV positive or whose HIV status is unknown, repeated, frequent testing is recommended throughout the first 6 months of life (HIV.gov, 2023). rapid HIV test for the simultaneous detection of HIV-1 and antibodies to both HIV-1 and HIV-2 in human serum, plasma, venous, fingerstick whole blood, and oral specimens. This again allows for earlier detection of the virus compared to antibody testing alone. Results from the finger stick take 30 minutes or less, and the oral specimen provides results in 20 minutes or less. This rapid test is advantageous in outreach settings to identify HIV-positive patients who do not have access to traditional healthcare settings. The disadvantage to the rapid test is that it does not differentiate between HIV-1 and HIV-2, so it should not be used to screen blood donors (CDC, 2020l; Gilroy, 2023).
Persons who are part of high-risk groups or have high- risk behaviors previously listed should be tested more often and/or as soon as they have participated in high-risk behaviors. Yearly screening is recommended. Additionally, the CDC recommends at least one HIV screening for all adolescents and adults 13 to 64 years of age who are not in high-risk populations and do not have high-risk behaviors Diagnostic testing The first step in testing for HIV is a fourth-generation test that identifies the virus in the blood; this appears before antibodies do and is, therefore, able to diagnose earlier. If this test is positive, an immunoassay that differentiates HIV-1 from HIV-2 antibodies should be performed. Compared to the Western blot test, this test is faster. Sometimes, the initial antigen test is positive, but the antibody differentiation test is negative or indeterminate. In these situations, HIV-1 nucleic acid testing should be conducted (Gilroy, 2023). The FDA approved the Alere Determine HIV-1/2 Ag/Ab Combo test (Orgenics, Ltd.) in 2013. This was the first
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