Developing Awareness and Adherence in HIV-Positive Women - Essay Example

Developing Awareness and Adherence in HIV-Positive Women A Research Report from a Clinical Outlook Name: Roll No: Class: Subject: Teacher: December 18, 2007 University Promote Adherence/compliance to HIV treatment Developing Awareness and Adherence in HIV-Positive Women Developing Awareness and Adherence in HIV-Positive Women Mostly people think it’s not healthy to talk about the horrible disease HIV. But lately the awareness campaign of HIV and its prevention has taken up speed in every country. It is being assured through this campaign that people around the globe know and understand the preventions, precautions and treatment of HIV Positive people. It is encouraged for every person to get HIV tested and ask their spouses or partners to do the same thing making sure none of them are infected. You should be well aware of you and your partner drug and sex history which might be uncomfortable to do but remembering that precaution is better than cure. Be very cautious in getting an injection for anything, making sure the needle is new and taken out from the pack rather than using an old one. Due to the lack of awareness and precaution tips many people have suffered from HIV/AIDS which has become a common disease now in developing as well as developed countries which has already killed over 2 million people around the world. Approximately 1 in 4 people who are infected with HIV virus are unaware of their HIV status (CBS, 2006). Now that one might believe that knowledge and understanding of HIV, its prevention and treatment is known by majority of the people, the issue of financing HIV devoted organizations and institutions raises. For developed countries it might be a bit easy for them to have finances to support patients with AIDS and treat them properly. But due to the lack of finances in developing countries it was suggested to have an international fund to be established which would provide necessary facilities, institutes, treatments and environment for HIV patients to recover quickly. Ignorance is not a blessing due to which different types of HIV tests are offered by hospitals. Some of them are mentioned below: • The most common type of HIV test is the blood test where you submit your blood sample taken by a health care provider. The results are available from 3 days to 2 week of time period. • Another method of HIV testing is oral fluid test where the health service provider takes some of your saliva and tests it in the lab. These are called Rapid Tests which are faster than other tests giving the result within 20 minutes, only these tests are not definitely accurate. Incase of a negative result no more tests are further required but if the result comes in positive, further tests are recommended to verify the results. • Home test. HIV kits in United Kingdom were introduced, a home kit to check if you are HIV Positive. The kit is called +EZ 5 Rapid HIV Screen test which is tested and certified reliable, accurate and successful by major highly regarded hospitals in Singapore. You can find many other HIV kits in the store that can be purchased and tested by you in your own home, privacy without submitting blood samples and waiting for test results. • Urine test. A urine sample is collected by a health care provider and tested at a lab. Calypte is the only FDA-approved urine HIV test. Results are provided within few days to few weeks of time frame. The question mostly raised by developing countries is that is Anti-Retroviral (ARV) treatment considered to be a higher or lower level of priority? To that answer Katherine Floyd and Charles Gilks (December 2002) "Cost and Financing Aspects of Providing Anti-Retroviral Therapy" put forward the statistics claiming that if a country is financing treatment for patients of HIV it can cost about 9% and 67% of total GDP, for developing countries. An article written by Nicholas Prescott (1998-06-24) "Setting Priorities for Government Involvement with Antiretroviral" also suggests that countries should have ARV treatment as a high level of priority to cure their patients with proper treatment. Chapter 4 of Confronting AIDS (1997, pp. 173-233) Public Priorities in a Global Epidemic (World Bank, Martha Ainsworth and Mead Over, co-authors) has a detail discussion on how AIDS effects health sectors in countries and stating that subsidies for HIV treatment should be higher than any other diseases. According to Global Report Chapter 2: Overview of the global AIDS epidemic (UNAIDS, 2006) about 2 million people is HIV Positive and three quarters of them are women. HIV positive women must have a lot of questions. For those who results in HIV Positive should have concerns about keeping this disease from passing on to others. Find a good doctor who take recommends appropriate tests and suggest the best combination of drug treatment for you. In case of a HIV+ woman, female doctors and nurses should be available and approached to as the problems and burden bear by HIV Positive women are different than men. The issue being outcast in their society is a whole different problem, proper care and attention is being lacked. Therefore, the studies for women suffering from HIV started in 1994 since then many development has been made in the fled of Anti-Retroviral (ARV) treatment. Women are to make critical treatment decisions which are tricky yet complicated, while trying to find a reliable drug for your immune system that goes well with your body as well. Organizations have been working for HIV Positive especially women as observation shows that women are most likely t have HIV than men. The reason for that is usually heterosexual intercourse which transmits AIDS in women faster than men (AVERT, November 2007). Institutions and communities are set up for Positive women making sure they get just the right environment, friendly doctors and nurses who they can open up to with their personal problems, right treatment making sure they live a healthy and longer life. These organizations welcome every woman who is HIV Positive despite of her age, nationality, religion, background, mode of infection and sexual orientation keeping their given information and reports classified and confidential from other patients. Many unconventional ways are adopted by countries to spread the word for AIDS while Russia came with an HIV Positive Beauty Pageant to spread awareness about AIDS. In 2005, a 24 year old Russian won the title for “Miss Positive.” In her interview Svetlana Izambayeva, 24, shares her thought stating "I decided I should go out and talk to young people and tell them about AIDS," she says. "Most Russians think people with AIDS are either homeless people or drug addicts — that they're not even people anymore! They don't know its normal people like me." (CBS news, December 2005) Symptoms of HIV Early symptoms of HIV are as follows: Flu like illness CD4 cell count decreases Opportunistic Infections Later symptoms of HIV: Lack of energy, weight loss, frequent sweats and fever, headaches, lightheadedness, shortness of breath, dizziness, paralysis or loss of muscular strength, vaginal yeast infection, weight loss, dry coughing, bruising more easily than normal, diarrhea for longer period of time. A thick, whitish coating of the tongue or mouth along with a sore throat The appearance of discolored or purplish growths on the skin or inside the mouth Unexplained bleeding frequent or unusual skin rashes An altered state of consciousness, personality change or mental weakening. Numbness or pain in hands and feet Swelling of glands located in the throat, groin or armpit. Survival among HIV-Positive Women Researches show that women who are detected of HIV in early stages, if provided with proper treatment survive as long as men infected with HIV (HSRC, 2002). Although it is believed that HIV Positive men are more likely to live longer than HIV Positive women probably because of the reason women are less likely to be diagnosed HIV Positive soon than men. The major aspect of HIV treatment is well trained, intelligent and friendly nurses and doctors who can ease in the necessary details of ARV treatment that a woman or man will be going through. In this case nurses should be given the responsibility to educate HIV positive women, making them comfortable and gaining their trust. Anti-Retroviral (ARV) Treatment: Anti-Retroviral is the main type of treatment practiced for patients who are HIV positive. It may be not a permanent cure but it slows down the procedure of people getting ill. It is to be understood by the patient that he or she will take these drugs for the rest of their lives to help them live a healthier life. Mostly the drugs given to an HIV patient are referred as: anti-HIV drugs antiretroviral HIV antiviral drugs Researches and studies have shown that HIV positive people are suppose to take more than one drug to keep them healthy which is known as Combination Therapy which has so far good results (Science Daily, Dec. 2006). Usually it consists of a handful of drugs and pills that are given to the HIV patients. Therefore, to illustrate a combination of four or more drugs as ARV treatment the term Highly Active Antiretroviral Therapy (HAART) is used recommended by United States National Institutes of Health. The reason why multiple drugs are to be taken is due to the reason, when a person is infected with AIDS, there are multiple strains of viruses and each virus when further develops is resistant to the single drug which is being taken. Therefore, Highly Active Antiretroviral Therapy (HAART) is practiced to reduce the rate at which the opposition develops keeping the treatment effective. Groups of Antiretroviral Drugs The basic ARV treatment pills are being given to the patients. These drug combinations have reduced the death rate of people due to HIV to a lot more than it was before, but has not completely cured the disease. Therefore, HIV Positive patients can still transmit this virus to other people through sexual intercourse or needle sharing. The Antiretroviral Drugs make sure that the person lives a life with lesser complications and problems which he or she would have faced without being on any medication. All these pills and drugs attack the virus in different ways. Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) Also known as nucleoside analogues or nukes are the first group which became available in 1987 to treat HIV patients. The basic role of this drug was to stop the HIV protein called reverse transcriptase from developing which performs the function of making new copies of the virus. An ARV treatment cannot be considered without this drug. The ARV treatment consists of two drugs from this group and is called to be the “backbone” of the combination therapy. Side Effects of Nucleoside/Nucleotide Reverse Transcriptase Inhibitors Abacavir: Rashes, headache, vomiting, diarrhea, nausea, fever. Didanosine: Nausea, diarrhea, Pancreatitis, Peripheral neuropathy. Emtricitabine: Headache, nausea, insomnia, hyper pigmentation of palms and soles which usually happens more in dark-skinned people. Lamivudine: Dry mouth and headache Tenofovir: Nausea, diahrea, Asthenia, Chronic renal insufficiency, abdominal discomfort, Fanconi syndrome. Stavudine: Pancreatitis, Diarrhea, Dyslipidemia, Peripheral neuropathy. Zidovudine: Fatigue, Nausea, vomiting, hyper pigmentation of skin and nails, Myalgia, myopathy, neutropenia, malaise, Anemia. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) was introduced in 1997 which also performs the same function as Nucleoside/Nucleotide Reverse Transcriptase Inhibitors stopping the reverse transcriptase to further replicate. Side Effects of Nonnucleoside Reverse Transcriptase Inhibitors Delavirdine: Hepatitis, Nausea, diarrhea, fatigue. Efavirenz: Abnormal dreams, dizziness, confusion, drowsiness, Hyperlipidemia. Nevirapine: Hepatitis and liver failure Protease Inhibitors Protease Inhibitors was approved in 1995 also known as PI group. As the name suggests, these Protease Inhibitors prevent the Reverse Transcriptase to replicate. Side Effects of Protease Inhibitors Amprenavir: Diarrhea, nausea, vomiting, Rash, increase in Liver Function Test (LFT) Atazanavir: PR interval prolongation, jaundice, Hyperbilirubinemia and increase in Liver Function Test (LFT). Fosamprenavir: Diarrhea, nausea, vomiting, Rash and increase in Liver Function Test (LFT). Indinavir: Nephrolithiasis, flank pain, Insomnia, taste falsification, dry skin, ingrown nails, Hyperbilirubinemia, Alopecia. Lopinavir/ ritonavir: Diarrhea, nausea, vomiting, taste falsification, increase in Liver Function Test (LFT) and Dyslipidemia. Nelfinavir: Diarrhea, nausea, vomiting, Fatigue and increase in Liver Function Test. Ritonavir: Nausea, vomiting, diarrhea, abdominal pain, Fatigue, Hyperuricemia, taste falsification, peripheral numbness and increase in Liver Function Test. Saquinavir: Nausea, vomiting, diarrhea, Headache, Oral ulcerations and increase in Liver Function Test. Tipranavir: Nausea, vomiting, diarrhea, Rash, increased total cholesterol and in LFT. Integrase Inhibitors The fourth group in antiretroviral drugs is the Integrase Inhibitors which consists of only one drug, raltegravir, recently approved in the United States in October 2007. Raltegravir inhibits an enzyme called integrase, which helps the HIV to convert into human cells. Side Effects of Integrase Inhibitors Raltegravir: Nausea, diarrhea, flatulence, headache, Pruritis, rash, Fatigue, muscle pain and Elevations in amylase and liver function tests. Fusion or Entry Inhibitors The fifth and final group of antiretroviral drugs as a treatment for HIV patients is Fusion or Entry Inhibitors which help prevent the HIV virus to enter into human immune cells. One drug from this group called the T-20 was given a licensed by the Europe and United States in 2003 allowing this drug use to only patients who have tried every other drug. The drug has to be injected in to the human body, swallowing the drug like other pills will make the drug digest in the stomach without being effective to the patient. Another Entry Inhibitor called the CCR5 inhibitor, approved in 2007 protects the human cells to be attacked by the HIV virus. Side Effects of Fusion or Entry Inhibitors Enfuvirtide: Neutropenia, increased frequency of pneumonia, erythema, cysts and nodules at injection sites. Chemokine Coreceptor Antagonists These inhibitors are important for keeping the immune system safe from HIV virus infecting it. CXCR4 and CCR5 are the two most applicable receptors and by inhibition which perform this task. Supremacy of multiple HIV strains, a double blockage of CXCR4 and CCR5 could be extremely helpful for inhibiting viral transmission and replication. Side Effects of Chemokine Coreceptor Antagonists Maraviroc: Diarrhea, nausea, fatigue, dizziness, headache, Joint pain, muscle pain and hepatitis. Recent Development in antiretroviral Treatment Fixed dose combinations: These are multiple antiretroviral drugs combined into a single pill which according to Bandolier, an independent journal about evidence-based healthcare, written by Oxford scientists tends to be more effective and adhered to by patients (RAM AND HJM, March 2005; 133-4) Synergistic enhancers: The advantage of taking Synergistic enhancers is when they are concurrently taken they develop the effect of one or more of those drugs which would have been taken before NIAID, an organization working for the benefit of HIV Positive patients have expanded their researches on the side effects of antiretroviral treatment and finding ways to reduce less drug exposure to HIV Positives. The Pharmaceutical Research and Manufacturers Association of America have a database of new development in the treatment of AIDS introducing new protease inhibitors and more powerful, less toxic RT inhibitors. Other categories it has included in its database are: Entry inhibitors that hinder with HIV's capability to enter cells Integrase inhibitors that defend a normal human cell from being attacked by an HIV virus. Assembly and budding inhibitors that makes sure that new particles of HIV virus are not discharged in the immune system. Cellular metabolism modulators that hold up with the cellular processes needed for HIV replication. Gene therapy that develops T-helper cells those are resistant to IV virus and making the immune system stronger and is anti HIV. Drugs included in Combination Therapy Both HAART and Combination therapy consist of a cocktail of three or more drugs. The common treatment pills given by the doctors to be given to early stage treatment of HIV positive patients are two NRTIs, either an NNRTI or a "boosted" protease inhibitor. Ritonavir, is a drug most commonly used as a boosted protease inhibitor. The use of Combination Therapy and HAART has been increased from 41% till 43% in treating HIV Positive pregnant women that fortunately did not result in defected births or other complications. Other Treatments Apart from HAART: Although the availability of HAART treatment is common and easily accessible by any country, developed or under developed, but incase of the unavailability of HAART treatment. The patients can be treated with opportunistic infections, which can be given to the patients incase of weakened immune system. This treatment is although temporary as it does not deal with the underlying immune deficiency itself. Starting the Treatment: Choosing the right time to start the treatment for AIDS patients is a very important decision which should be made by the help of professional doctors. Once it is started it should be adhered to, in spite of other problems or side effects that can be faced by the patient. Various clinical tests are taken before starting the treatment, after which the treatment starts and is hold on to forever. There is no right time to start the treatment, according to expertise the early the treatment starts the better. The effectiveness of the antiretroviral treatment in advanced stages may not be successful at all. Preparing for the Treatment: Two tests are usually taken before starting the antiretroviral treatment: 1. The CD4 Test 2. The Viral Load Test The CD4 Test The CD4 test determines the current position of the immune system. As an HIV virus enters a human body it first attacks a particular immune system cell called the T-helper cell. This cell bears a surface of protein called the CD4. This is the cell which HIV virus uses to attach to before gaining complete entry to the immune system. The major role of T-helper cell is to fight all the diseases that may enter in to the human body. A major reduction in the number of T-helper cells can cause serious illness affecting the immune system. Therefore, the HIV virus attacks the T-helper cell first before entering the immune system damaging most of the cells leaving the immune system and human body vulnerable to HIV itself and other diseases. The CD4 Test counts the numbers of the T-helper cell in your blood before starting the antiretroviral treatment. The fewer cells you have per cubic millimeter of blood in your immune system the weaker your body and immune system is. The weaker your immune system, the harder it is to fight against diseases and AIDS. It is believed that low number of CD4 in your test does not mean that you will certainly become ill but it certainly raises the level of becoming sick. After the results, generally, the antiretroviral treatment begins when the results show 200 to 350 T-helper cells per cubic millimeter of blood. The Viral Load Test The second test prescribed by the doctors for HIV patients is the Virus Load test. This test refers to the amount of HIV virus in your blood present at that particular time. This test also helps in making a decision for the treatment to start while screening if the HIV in your blood is minimum, medium or maximum. Opportunistic Infections The main goal of an HIV virus is to weaken the body and immune system leaving it vulnerable to other germs and diseases. As to which when the immune system weakens, diseases that may not be that harmful to a healthy, stronger immune system can result in death for HIV infected immune system. Opportunistic Infections are caused when the immune system is damaged and low T-helper cells which results in PCP, a type of pneumonia which can be life-threatening. If the immune system is infected with Opportunistic Infections then antiretroviral treatment for the patient is suggested right away. To find if a patient is infected with opportunistic infection, blood is tested for antigens and antibodies. If antigens are found that means you are infected by OI and incase of finding antibodies in your blood means you have been exposed to OI. Following are some of the diseases that can be expected in an HIV infected immune system: Bacterial and Mycobacterial 1. Mycobacterium Avium Complex 2. Turberculosis 3. Salmonellosis 4. Bacillary angiomatosis 5. Syphilis and Neuroshyphilis Malignancies 1. Kaposi's Sarcoma Viral Infections 1. Cytomegalovirus 2. Hepatitis 3. Herpes Zoster 4. Herpes Simplex 5. Oral Hairy Leukoplakia 6. Human Papiloma Virus 7. Progressive Multifocal Leukoencephalopathy 8. Molluscum Contagiosum Neurological Conditions 1. Peripheral Neuropathy 2. AIDS Dementia Complex Fungal Infections 1. Aspergillosis 2. Candidiasis 3. Cryptococcal Meningitis 4. Histoplasmosis 5. Coccidioidomycosis Protozoal Infections 1. Isosporiasis 2. Toxoplasmosis 3. Pneumocystis Carinii Pneumonia 4. Cryptosporidiosis 5. Microsporidiosis Final Decision After the results for Virus Load test and CD4 test are received, it helps in making a decision. The results can be shown to the doctor and his or her decision should be followed. The drugs are then given to the HIV Positives according to the results making sure it affects the body of the patient efficiently. When the drug treatment is started it is usually for life and it should be understood by the patient that the commitment to the treatment is as important as the drugs themselves. The treatment may be demanding but it only is effective if the patient says adhered to. So, start the antiretroviral treatment when you are sure and ready for it, committed to the entire procedure. Even though in serious opportunistic infections circumstances, the antiretroviral treatment should be started without any further delay. Selecting the best Antiretroviral treatment Combination There are a number of combinations for the patients to choose from depending on the CD4 Test and Virus Load test results of each patient. There are more than 20 approved drugs belonging to four different groups (AVERT, 2007) Generally it’s harder to decide if one combination used by a patient can be effective to the health of another patient as side effects and results may vary. The first combination taken by the patient are considered to be the mat effective therefore, it should be carefully decided to prefer the bet option. After the combination has been chosen, the guidelines and instructions given by the doctor should be strictly followed. Certain drugs which are suggested by the doctors for HIV positives may affect your lifestyle and put limitations on your life which should be talked through with your doctor. Some of the issues that become a problem in the process of antiretroviral treatment are: How effective is the combination therapy for the patient? In combination therapy, some combinations may suit you more than others. Taking drugs and pills randomly from one group to another ARV group may result in weakening your immune system and making HIV virus more stronger giving them resistance to the drugs that will later be taken. Also some of HIV treatment drugs have side effects that may occur in taking random drugs from random ARV groups resulting in other serious problems or Opportunistic Infections. Some people face the adherence of the treatment due to the frequent dosage or the size of the pills can also become a problem. In this case Fixed Dose Combination (FDC) can be chosen to decrease the number of dosages and drugs. Taking one single pill rather than taking multiple. Are there any food limitations? How many pills are there and how often must they be taken? Some drugs, particularly protease inhibitors, have to be taken with food to improve absorption rates. Also some drugs impose food limitations. There may be a need for lifestyle changes to accommodate the prescription drugs. What are the possible side effects? Common side effects should be taken into consideration when choosing a combination. It is also important to consider existing medical state of affairs that may be worsened by some anti HIV drugs. Are drug relations an issue? If an HIV Positive patient is already taking or planning to take drugs for other problems or diseases, your doctor should be consulted making sure they won’t interrupt with the HIV treatment that you are going through. Are there any special handling requirements? Storage of some anti HIV drugs can be an issue. Example Ritonavir needs to be refrigerated for use otherwise it can expire. Getting ready for Adherence First one should be clear about the definition of adherence which basically means being devoted, loyal and conscious about the prescription drugs and restrictions given to you by the doctor. The reason why there is so much stress on adherence in the antiretroviral treatment is as it may be demanding and time consuming, one need to make some changes to stick to the prescription drugs. It is a sacrifice that has to be made keeping in mind the seriousness of the illness. Give yourself sometime to get used to the routine and changes it will bring. The major setback for not following the treatment or instructions is that the drugs will not be absorbed and cannot be effective to the HIV patient’s body and immune system. Therefore, the time that is being given to you by the doctor or the financial changes that are made for the treatment are going in vain. In result, the CD4 can increase; the virus load can increase making the HIV virus strains to become resistant to the drugs which could have been effective if taken with adherence. Side effects of the drugs and frequency of dosage can effect your adherence in such a case doctors should be contacted for advice to be more loyal to your treatment. Pregnancy and HIV treatment It is strongly recommended to show adherence to the antiretroviral treatment during pregnancy no matter if it is in the starting or in the end of the pregnancy even though if the treatment is stopped after the baby is born. This is due to the reason of stopping the HIV disease to be transmitted in to the baby regardless of the CD4 count and virus load. A term used “Treat as non-pregnant adult” which means to be treated for HIV as if you are not pregnant. This of course may vary and have exceptions depending on situations of every pregnant woman. Researches were done on pregnant as well as non-pregnant women showing that HIV Positive pregnant women overall have much better reports and progress than women who did not become pregnant. Kathryn Anastos (VOA News, 9/24/2007) of Montefiore Medical Center at the Albert Einstein College of Medicine in an accompanying JID editorial writes that women who become pregnant during their HIV treatment are likely to be more confident and adhered to their antiretroviral treatment making sure their babies do not inherit this disease and knowing their own health will not be compromised due to their pregnancy. Recommended options for pregnant women who are HIV positive by HIV, pregnancy & women's health (i-Base guide, 2007) are 1. START 2. AZT plus C-section 1. Short Term Triple Antiretroviral Therapy (START). In START, treatment for a pregnant woman starts during the second trimester at 20 to 28 weeks and then stops after delivery. You can decide to plan a C-section or not. Though choosing the treatment procedure of START does not mean you will absolutely not have a C-section. You may need to for other reasons. Benefits of START Using 3 drugs will decrease your viral load to barely discernible You will have a choice over method of delivery. Risks of START You and your baby will be exposed to more drugs which may result in premature birth of the baby. 2. AZT monotherapy plus a planned pre-labor C-section. AZT plus C-section is only appropriate for women with a high CD4 count and a low viral load who would not need to use antiretroviral treatment for several years. Benefits of AZT plus C-section The risk of diffusion is low almost about 1%. You will use smaller quantity of drugs. Risks of AZT plus C-section Caesarean sections are major surgery and can carry extra risks for the mother. A very low risk of developing confrontation to AZT Apart from these two treatments, the two major reasons for delaying antiretroviral treatment in pregnancy can be: The first is organogenesis in which the baby’s organ is being developed in the first 12 weeks in the womb. Therefore, HIV treatment is stopped for the women carrying the children, making sure the health of the baby is not affected by the therapy. Studies show that adhering to the treatment in the first trimester does not cause any danger to the baby than the women who did not take any drugs. Another main reason to stop the treatment in the first few weeks is to avoid any nausea or vomiting that may be caused by pregnancy as well as the drug treatment that has just started. You do not want both at the same time which may cause decrease in the adherence of the treatment which is a risk that cannot be taken. If the morning sickness does not stop after the first trimester, your doctor should be consulted as it may be the indication of other problems. Friendly and co-operative nurses should be hired for women suffering from AIDS who can understand and help them with their problems and complications. The environment should give out a confidential message, gaining the trust of each woman that their personal problems and hurdles are classified from others. The frequent dosage of hand full of pills can be de-motivating factor, because of which constant contact with doctors should be kept who will encourage an HIV patient to stay dedicated to the treatment. Like some of the factors put forward by Friedland GH, “Adherence: the Achilles’ heel of highly active antiretroviral therapy” (1997, 5:13-15) stress on trusted relationship between doctor and the patient and knowledge. The only thing to remember for HIV Positive women is to stay adhered and committed to the treatment. Do not lose hope as this may fall their morals even more than they already are. References: Antiretroviral Treatment, Offering Information on HIV/AIDS Treatment, Prevention and Research, http://www.aidsinfo.nih.gov/guidelines/ Avert is an International Aid Charity, http://www.avert.org/introtrt.htm Broomberg J. and Schopper D. "Global Spending on HIV/AIDS prevention, care and research", Chapter 37 in "AIDS in the World II", 1996, eds. Mann J. and Tarantola D. Gorsky R.D., Farnham P.G., Straus W.L., Caldwell B., Holtgrave D.R., Simonds R.J., Rogers M.F., Guinan M.E. "Preventing Perinatal Transmission of HIV - Costs and Effectiveness of a Recommended Intervention", Public Health Reports July/August 1996 Vol. 111 p 335-341 prenatal care and HIV treatment, http://www.ibase.info/guides/pregnancy/Prenatal.html prenatal care and HIV treatment, http://www.i-base.info/guides/pregnancy/drugs.html National Institute of Allergy and Infectious Disease, Treatment of HIV Infection, http://www.niaid.nih.gov/factsheets/treat-hiv.htm Sabatier R., Foreman M., Tinker J. and Radlett M. "AIDS and the Third World", Panos Institute, London 1989 Schitovsky A.A., Cline M.W., and Abrams D.I. "Effects of the use of AZT on the medical care costs of persons with AIDS in the first 12 months" Journal of Acquired Immune Deficiency Syndromes, 1990, p904-912 Read More