Nancy’s case highlights the complexities of long-term HIV management, including the potential development of opportunistic infections like esophageal candidiasis. With proper medical care, adherence to treatment, and ongoing support, individuals like Nancy can continue to lead healthy lives while effectively managing their HIV infection and its associated complications. Self-Assessment Quiz Question #4 You are the healthcare provider for Nancy. When discussing her diagnosis of candidiasis of the esophagus, you correctly tell her which of the following? a. “This is an opportunistic infection in people living with HIV.” b. “This has nothing to do with HIV infection.” c. “This is caused by eating too much sugar.” d. “This is because you have not been taking your medication as you should.” Transgender care in HIV The term transgender holds diverse meanings across various cultures and communities. Nevertheless, there remains a scarcity of research on the healthcare needs of transgender individuals, as highlighted by the CDC in 2023. Transgender people indeed have unique requirements when interfacing with the healthcare system. For example, they may possess legal names distinct from their preferred names, identities, or expressions. In the U.S., nearly 1 million people identify as transgender and constitute approximately 2% of new HIV diagnoses (CDC, 2023). Notably, transgender women of color have one of the highest HIV prevalence rates, and HIV is often Prevention strategies for healthcare workers Healthcare workers who are exposed to a needlestick involving HIV-infected blood have a 0.23% risk of becoming infected, which is equivalent to just over 1 in 500. There is a much greater risk of healthcare providers acquiring hepatitis B or hepatitis C through a needlestick, as these are much hardier viruses outside of a human host. As with any virus transmitted through a needlestick, the risk is greatest if the puncture was from a hollow needle that was in a vein or an artery of an HIV-positive person. The risk of HIV transmission via exposure because of splashes with body fluids is believed to be near zero, even if the fluids are overtly bloody. Splashes of fluids to intact skin or mucous membranes are considered to have an extremely low risk for HIV transmission, whether blood is involved or not. However, healthcare workers need to be aware of the risk potential and take all precautions against exposure, no matter how small the risk (Webb, 2019). CDC recommendations for the management of healthcare workers who have a body substance exposure that may contain HIV stress the following guidelines (Webb, 2019). ● Primary prevention strategies, such as encouraging the wound to bleed. ● Prompt reporting and management of occupational exposures. ● Adherence to recommended HIV postexposure prophylaxis (PEP). ● Expert consultation regarding exposure management. ● Follow-up and monitoring of exposed healthcare workers. ● Psychological counseling.
Evidence-Based Practice Research indicates that not using condoms consistently or at all can lead to the transmission of sexually transmitted infections (STIs). Studies comparing HIV infection rates between individuals who use condoms consistently and those who do not when engaging with HIV-infected partners have shown that consistent condom use is highly effective in preventing HIV transmission. Healthcare professionals should educate patients on the correct and effective use of condoms (HIV.gov, 2020a; Mayo Clinic, 2020). Individuals who are pregnant or are thinking about getting pregnant should get tested for HIV and other STIs. If treated during pregnancy, the baby’s risk of infection is significantly reduced (HIV.gov, 2020a). accompanied by substance use disorders, mental health challenges, and experiences of violence or victimization. It’s essential to recognize that similar issues are encountered by other individuals living with HIV. Furthermore, there is a notable scarcity of studies examining HIV outcomes among transgender individuals (CDC, 2023). Existing evidence suggests that many transgender women do not attain viral suppression or other critical benchmarks in HIV care. Factors such as prioritization of other health concerns over HIV treatment may contribute to issues with treatment adherence in this population. ● Close follow-up for exposed workers, including counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity beginning within 72 hours of exposure. ● Follow-up testing using a fourth-generation combination HIV p24 antigen–HIV antibody test; if this test is utilized, testing can stop at four months after exposure. If this test is not available, testing should continue for six months. ● Expert consultation when the source patient is positive for HIV. PEP is not 100% effective, so persons undergoing treatment should continue to practice safe sex and other preventative behaviors. PEP is expensive. Healthcare workers who experience occupational exposure usually have the medications paid for by their workplace health insurance or workers’ compensation (HIV.gov, 2020d). Healthcare workers should strictly adhere to standard precaution guidelines as part of their strategies to prevent on-the-job exposure to HIV, including: ● Plan safe handling and disposal before any procedure. ● Use safe and effective needle alternatives when available (needless devices, shielded needle devices, etc.). ● Immediately dispose of contaminated needles in OSHA- compliant sharps containers. ● Participate in blood-borne pathogen training (osha.gov/ sharps).
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