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• Published: 24 November 2021

A study of awareness on HIV/AIDS among adolescents: A Longitudinal Study on UDAYA data

• Shobhit Srivastava   ORCID: orcid.org/0000-0002-7138-4916 1 ,
• Shekhar Chauhan   ORCID: orcid.org/0000-0002-6926-7649 2 ,
• Ratna Patel   ORCID: orcid.org/0000-0002-5371-7369 3 &
• Pradeep Kumar   ORCID: orcid.org/0000-0003-4259-820X 1  

Scientific Reports volume  11 , Article number:  22841 ( 2021 ) Cite this article

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Acquired Immunodeficiency Syndrome caused by Human Immunodeficiency Virus (HIV) poses a severe challenge to healthcare and is a significant public health issue worldwide. This study intends to examine the change in the awareness level of HIV among adolescents. Furthermore, this study examined the factors associated with the change in awareness level on HIV-related information among adolescents over the period. Data used for this study were drawn from Understanding the lives of adolescents and young adults, a longitudinal survey on adolescents aged 10–19 in Bihar and Uttar Pradesh. The present study utilized a sample of 4421 and 7587 unmarried adolescent boys and girls, respectively aged 10–19 years in wave-1 and wave-2. Descriptive analysis and t-test and proportion test were done to observe changes in certain selected variables from wave-1 (2015–2016) to wave-2 (2018–2019). Moreover, random effect regression analysis was used to estimate the association of change in HIV awareness among unmarried adolescents with household and individual factors. The percentage of adolescent boys who had awareness regarding HIV increased from 38.6% in wave-1 to 59.9% in wave-2. Among adolescent girls, the percentage increased from 30.2 to 39.1% between wave-1 & wave-2. With the increase in age and years of schooling, the HIV awareness increased among adolescent boys ([Coef: 0.05; p  < 0.01] and [Coef: 0.04; p  < 0.01]) and girls ([Coef: 0.03; p  < 0.01] and [Coef: 0.04; p  < 0.01]), respectively. The adolescent boys [Coef: 0.06; p  < 0.05] and girls [Coef: 0.03; p  < 0.05] who had any mass media exposure were more likely to have an awareness of HIV. Adolescent boys' paid work status was inversely associated with HIV awareness [Coef: − 0.01; p  < 0.10]. Use of internet among adolescent boys [Coef: 0.18; p  < 0.01] and girls [Coef: 0.14; p  < 0.01] was positively associated with HIV awareness with reference to their counterparts. There is a need to intensify efforts in ensuring that information regarding HIV should reach vulnerable sub-groups, as outlined in this study. It is important to mobilize the available resources to target the less educated and poor adolescents, focusing on rural adolescents.

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Introduction.

Acquired Immunodeficiency Syndrome (AIDS) caused by Human Immunodeficiency Virus (HIV) poses a severe challenge to healthcare and is a significant public health issue worldwide. So far, HIV has claimed almost 33 million lives; however, off lately, increasing access to HIV prevention, diagnosis, treatment, and care has enabled people living with HIV to lead a long and healthy life 1 . By the end of 2019, an estimated 38 million people were living with HIV 1 . More so, new infections fell by 39 percent, and HIV-related deaths fell by almost 51 percent between 2000 and 2019 1 . Despite all the positive news related to HIV, the success story is not the same everywhere; HIV varies between region, country, and population, where not everyone is able to access HIV testing and treatment and care 1 . HIV/AIDS holds back economic growth by destroying human capital by predominantly affecting adolescents and young adults 2 .

There are nearly 1.2 billion adolescents (10–19 years) worldwide, which constitute 18 percent of the world’s population, and in some countries, adolescents make up as much as one-fourth of the population 3 . In India, adolescents comprise more than one-fifth (21.8%) of the total population 4 . Despite a decline projection for the adolescent population in India 5 , there is a critical need to hold adolescents as adolescence is characterized as a period when peer victimization/pressure on psychosocial development is noteworthy 6 . Peer victimization/pressure is further linked to risky sexual behaviours among adolescents 7 , 8 . A higher proportion of low literacy in the Indian population leads to a low level of awareness of HIV/AIDS 9 . Furthermore, the awareness of HIV among adolescents is quite alarming 10 , 11 , 12 .

Unfortunately, there is a shortage of evidence on what predicts awareness of HIV among adolescents. Almost all the research in India is based on beliefs, attitudes, and awareness of HIV among adolescents 2 , 12 . However, few other studies worldwide have examined mass media as a strong predictor of HIV awareness among adolescents 13 . Mass media is an effective channel to increase an individuals’ knowledge about sexual health and improve understanding of facilities related to HIV prevention 14 , 15 . Various studies have outlined other factors associated with the increasing awareness of HIV among adolescents, including; age 16 , 17 , 18 , occupation 18 , education 16 , 17 , 18 , 19 , sex 16 , place of residence 16 , marital status 16 , and household wealth index 16 .

Several community-based studies have examined awareness of HIV among Indian adolescents 2 , 10 , 12 , 20 , 21 , 22 . However, studies investigating awareness of HIV among adolescents in a larger sample size remained elusive to date, courtesy of the unavailability of relevant data. Furthermore, no study in India had ever examined awareness of HIV among adolescents utilizing information on longitudinal data. To the author’s best knowledge, this is the first study in the Indian context with a large sample size that examines awareness of HIV among adolescents and combines information from a longitudinal survey. Therefore, this study intends to examine the change in the awareness level of HIV among adolescents. Furthermore, this study examined the factors associated with a change in awareness level on HIV-related information among adolescents over the period.

Data and methods

Data used for this study were drawn from Understanding the lives of adolescents and young adults (UDAYA), a longitudinal survey on adolescents aged 10–19 in Bihar and Uttar Pradesh 23 . The first wave was conducted in 2015–2016, and the follow-up survey was conducted after three years in 2018–2019 23 . The survey provides the estimates for state and the sample of unmarried boys and girls aged 10–19 and married girls aged 15–19. The study adopted a systematic, multi-stage stratified sampling design to draw sample areas independently for rural and urban areas. 150 primary sampling units (PSUs)—villages in rural areas and census wards in urban areas—were selected in each state, using the 2011 census list of villages and wards as the sampling frame. In each primary sampling unit (PSU), households to be interviewed were selected by systematic sampling. More details about the study design and sampling procedure have been published elsewhere 23 . Written consent was obtained from the respondents in both waves. In wave 1 (2015–2016), 20,594 adolescents were interviewed using the structured questionnaire with a response rate of 92%.

Moreover, in wave 2 (2018–2019), the study interviewed the participants who were successfully interviewed in 2015–2016 and who consented to be re-interviewed 23 . Of the 20,594 eligible for the re-interview, the survey re-interviewed 4567 boys and 12,251 girls (married and unmarried). After excluding the respondents who gave an inconsistent response to age and education at the follow-up survey (3%), the final follow-up sample covered 4428 boys and 11,864 girls with the follow-up rate of 74% for boys and 81% for girls. The effective sample size for the present study was 4421 unmarried adolescent boys aged 10–19 years in wave-1 and wave-2. Additionally, 7587 unmarried adolescent girls aged 10–19 years were interviewed in wave-1 and wave-2 23 . The cases whose follow-up was lost were excluded from the sample to strongly balance the dataset and set it for longitudinal analysis using xtset command in STATA 15. The survey questionnaire is available at https://dataverse.harvard.edu/file.xhtml?fileId=4163718&version=2.0 & https://dataverse.harvard.edu/file.xhtml?fileId=4163720&version=2.0 .

Outcome variable

HIV awareness was the outcome variable for this study, which is dichotomous. The question was asked to the adolescents ‘Have you heard of HIV/AIDS?’ The response was recorded as yes and no.

Exposure variables

The predictors for this study were selected based on previous literature. These were age (10–19 years at wave 1, continuous variable), schooling (continuous), any mass media exposure (no and yes), paid work in the last 12 months (no and yes), internet use (no and yes), wealth index (poorest, poorer, middle, richer, and richest), religion (Hindu and Non-Hindu), caste (Scheduled Caste/Scheduled Tribe, Other Backward Class, and others), place of residence (urban and rural), and states (Uttar Pradesh and Bihar).

Exposure to mass media (how often they read newspapers, listened to the radio, and watched television; responses on the frequencies were: almost every day, at least once a week, at least once a month, rarely or not at all; adolescents were considered to have any exposure to mass media if they had exposure to any of these sources and as having no exposure if they responded with ‘not at all’ for all three sources of media) 24 . Household wealth index based on ownership of selected durable goods and amenities with possible scores ranging from 0 to 57; households were then divided into quintiles, with the first quintile representing households of the poorest wealth status and the fifth quintile representing households with the wealthiest status 25 .

Statistical analysis

Descriptive analysis was done to observe the characteristics of unmarried adolescent boys and girls at wave-1 (2015–2016). In addition, the changes in certain selected variables were observed from wave-1 (2015–2016) to wave-2 (2018–2019), and the significance was tested using t-test and proportion test 26 , 27 . Moreover, random effect regression analysis 28 , 29 was used to estimate the association of change in HIV awareness among unmarried adolescents with household factors and individual factors. The random effect model has a specific benefit for the present paper's analysis: its ability to estimate the effect of any variable that does not vary within clusters, which holds for household variables, e.g., wealth status, which is assumed to be constant for wave-1 and wave-2 30 .

Table 1 represents the socio-economic profile of adolescent boys and girls. The estimates are from the baseline dataset, and it was assumed that none of the household characteristics changed over time among adolescent boys and girls.

Figure  1 represents the change in HIV awareness among adolescent boys and girls. The percentage of adolescent boys who had awareness regarding HIV increased from 38.6% in wave-1 to 59.9% in wave-2. Among adolescent girls, the percentage increased from 30.2% in wave-1 to 39.1% in wave-2.

The percenate of HIV awareness among adolescent boys and girls, wave-1 (2015–2016) and wave-2 (2018–2019).

Table 2 represents the summary statistics for explanatory variables used in the analysis of UDAYA wave-1 and wave-2. The exposure to mass media is almost universal for adolescent boys, while for adolescent girls, it increases to 93% in wave-2 from 89.8% in wave-1. About 35.3% of adolescent boys were engaged in paid work during wave-1, whereas in wave-II, the share dropped to 33.5%, while in the case of adolescent girls, the estimates are almost unchanged. In wave-1, about 27.8% of adolescent boys were using the internet, while in wave-2, there is a steep increase of nearly 46.2%. Similarly, in adolescent girls, the use of the internet increased from 7.6% in wave-1 to 39.3% in wave-2.

Table 3 represents the estimates from random effects for awareness of HIV among adolescent boys and girls. It was found that with the increases in age and years of schooling the HIV awareness increased among adolescent boys ([Coef: 0.05; p  < 0.01] and [Coef: 0.04; p  < 0.01]) and girls ([Coef: 0.03; p  < 0.01] and [Coef: 0.04; p  < 0.01]), respectively. The adolescent boys [Coef: 0.06; p  < 0.05] and girls [Coef: 0.03; p  < 0.05] who had any mass media exposure were more likely to have an awareness of HIV in comparison to those who had no exposure to mass media. Adolescent boys' paid work status was inversely associated with HIV awareness about adolescent boys who did not do paid work [Coef: − 0.01; p  < 0.10]. Use of the internet among adolescent boys [Coef: 0.18; p  < 0.01] and girls [Coef: 0.14; p  < 0.01] was positively associated with HIV awareness in reference to their counterparts.

The awareness regarding HIV increases with the increase in household wealth index among both adolescent boys and girls. The adolescent girls from the non-Hindu household had a lower likelihood to be aware of HIV in reference to adolescent girls from Hindu households [Coef: − 0.09; p  < 0.01]. Adolescent girls from non-SC/ST households had a higher likelihood of being aware of HIV in reference to adolescent girls from other caste households [Coef: 0.04; p  < 0.01]. Adolescent boys [Coef: − 0.03; p  < 0.01] and girls [Coef: − 0.09; p  < 0.01] from a rural place of residence had a lower likelihood to be aware about HIV in reference to those from the urban place of residence. Adolescent boys [Coef: 0.04; p  < 0.01] and girls [Coef: 0.02; p  < 0.01] from Bihar had a higher likelihood to be aware about HIV in reference to those from Uttar Pradesh.

This is the first study of its kind to address awareness of HIV among adolescents utilizing longitudinal data in two indian states. Our study demonstrated that the awareness of HIV has increased over the period; however, it was more prominent among adolescent boys than in adolescent girls. Overall, the knowledge on HIV was relatively low, even during wave-II. Almost three-fifths (59.9%) of the boys and two-fifths (39.1%) of the girls were aware of HIV. The prevalence of awareness on HIV among adolescents in this study was lower than almost all of the community-based studies conducted in India 10 , 11 , 22 . A study conducted in slums in Delhi has found almost similar prevalence (40% compared to 39.1% during wave-II in this study) of awareness of HIV among adolescent girls 31 . The difference in prevalence could be attributed to the difference in methodology, study population, and study area.

The study found that the awareness of HIV among adolescent boys has increased from 38.6 percent in wave-I to 59.9 percent in wave-II; similarly, only 30.2 percent of the girls had an awareness of HIV during wave-I, which had increased to 39.1 percent. Several previous studies corroborated the finding and noticed a higher prevalence of awareness on HIV among adolescent boys than in adolescent girls 16 , 32 , 33 , 34 . However, a study conducted in a different setting noticed a higher awareness among girls than in boys 35 . Also, a study in the Indian context failed to notice any statistical differences in HIV knowledge between boys and girls 18 . Gender seems to be one of the significant determinants of comprehensive knowledge of HIV among adolescents. There is a wide gap in educational attainment among male and female adolescents, which could be attributed to lower awareness of HIV among girls in this study. Higher peer victimization among adolescent boys could be another reason for higher awareness of HIV among them 36 . Also, cultural double standards placed on males and females that encourage males to discuss HIV/AIDS and related sexual matters more openly and discourage or even restrict females from discussing sexual-related issues could be another pertinent factor of higher awareness among male adolescents 33 . Behavioural interventions among girls could be an effective way to improving knowledge HIV related information, as seen in previous study 37 . Furthermore, strengthening school-community accountability for girls' education would augment school retention among girls and deliver HIV awareness to girls 38 .

Similar to other studies 2 , 10 , 17 , 18 , 39 , 40 , 41 , age was another significant determinant observed in this study. Increasing age could be attributed to higher education which could explain better awareness with increasing age. As in other studies 18 , 39 , 41 , 42 , 43 , 44 , 45 , 46 , education was noted as a significant driver of awareness of HIV among adolescents in this study. Higher education might be associated with increased probability of mass media and internet exposure leading to higher awareness of HIV among adolescents. A study noted that school is one of the important factors in raising the awareness of HIV among adolescents, which could be linked to higher awareness among those with higher education 47 , 48 . Also, schooling provides adolescents an opportunity to improve their social capital, leading to increased awareness of HIV.

Following previous studies 18 , 40 , 46 , the current study also outlines a higher awareness among urban adolescents than their rural counterparts. One plausible reason for lower awareness among adolescents in rural areas could be limited access to HIV prevention information 16 . Moreover, rural–urban differences in awareness of HIV could also be due to differences in schooling, exposure to mass media, and wealth 44 , 45 . The household's wealth status was also noted as a significant predictor of awareness of HIV among adolescents. Corroborating with previous findings 16 , 33 , 42 , 49 , this study reported a higher awareness among adolescents from richer households than their counterparts from poor households. This could be because wealthier families can afford mass-media items like televisions and radios for their children, which, in turn, improves awareness of HIV among adolescents 33 .

Exposure to mass media and internet access were also significant predictors of higher awareness of HIV among adolescents. This finding agrees with several previous research, and almost all the research found a positive relationship between mass-media exposure and awareness of HIV among adolescents 10 . Mass media addresses such topics more openly and in a way that could attract adolescents’ attention is the plausible reason for higher awareness of HIV among those having access to mass media and the internet 33 . Improving mass media and internet usage, specifically among rural and uneducated masses, would bring required changes. Integrating sexual education into school curricula would be an important means of imparting awareness on HIV among adolescents; however, this is debatable as to which standard to include the required sexual education in the Indian schooling system. Glick (2009) thinks that the syllabus on sexual education might be included during secondary schooling 44 . Another study in the Indian context confirms the need for sex education for adolescents 50 , 51 .

Limitations and strengths of the study

The study has several limitations. At first, the awareness of HIV was measured with one question only. Given that no study has examined awareness of HIV among adolescents using longitudinal data, this limitation is not a concern. Second, the study findings cannot be generalized to the whole Indian population as the study was conducted in only two states of India. However, the two states selected in this study (Uttar Pradesh and Bihar) constitute almost one-fourth of India’s total population. Thirdly, the estimates were provided separately for boys and girls and could not be presented combined. However, the data is designed to provide estimates separately for girls and boys. The data had information on unmarried boys and girls and married girls; however, data did not collect information on married boys. Fourthly, the study estimates might have been affected by the recall bias. Since HIV is a sensitive topic, the possibility of respondents modifying their responses could not be ruled out. Hawthorne effect, respondents, modifying aspect of their behaviour in response, has a role to play in HIV related study 52 . Despite several limitations, the study has specific strengths too. This is the first study examining awareness of HIV among adolescent boys and girls utilizing longitudinal data. The study was conducted with a large sample size as several previous studies were conducted in a community setting with a minimal sample size 10 , 12 , 18 , 20 , 53 .

The study noted a higher awareness among adolescent boys than in adolescent girls. Specific predictors of high awareness were also noted in the study, including; higher age, higher education, exposure to mass media, internet use, household wealth, and urban residence. Based on the study findings, this study has specific suggestions to improve awareness of HIV among adolescents. There is a need to intensify efforts in ensuring that information regarding HIV should reach vulnerable sub-groups as outlined in this study. It is important to mobilize the available resources to target the less educated and poor adolescents, focusing on rural adolescents. Investment in education will help, but it would be a long-term solution; therefore, public information campaigns could be more useful in the short term.

WHO. HIV/AIDS . https://www.who.int/news-room/fact-sheets/detail/hiv-aids (2020).

Singh, A. & Jain, S. Awareness of HIV/AIDS among school adolescents in Banaskantha district of Gujarat. Health Popul.: Perspect. Issues 32 , 59–65 (2009).

Google Scholar  

WHO & UNICEF. adolescents Health: The Missing Population in Universal Health Coverage . 1–31 https://www.google.com/search?q=adolescents+population+WHO+report&rlz=1C1CHBF_enIN904IN904&oq=adolescents+population+WHO+report&aqs=chrome..69i57.7888j1j7&sourceid=chrome&ie=UTF-8 (2018).

Chauhan, S. & Arokiasamy, P. India’s demographic dividend: state-wise perspective. J. Soc. Econ. Dev. 20 , 1–23 (2018).

Tiwari, A. K., Singh, B. P. & Patel, V. Population projection of India: an application of dynamic demographic projection model. JCR 7 , 547–555 (2020).

Troop-Gordon, W. Peer victimization in adolescence: the nature, progression, and consequences of being bullied within a developmental context. J. Adolesc. 55 , 116–128 (2017).

PubMed   Google Scholar  

Dermody, S. S., Friedman, M., Chisolm, D. J., Burton, C. M. & Marshal, M. P. Elevated risky sexual behaviors among sexual minority girls: indirect risk pathways through peer victimization and heavy drinking. J. Interpers. Violence 35 , 2236–2253 (2020).

Lee, R. L. T., Loke, A. Y., Hung, T. T. M. & Sobel, H. A systematic review on identifying risk factors associated with early sexual debut and coerced sex among adolescents and young people in communities. J. Clin. Nurs. 27 , 478–501 (2018).

Gurram, S. & Bollampalli, B. A study on awareness of human immunodeficiency virus among adolescent girls in urban and rural field practice areas of Osmania Medical College, Hyderabad, Telangana, India. (2020).

Jain, R., Anand, P., Dhyani, A. & Bansal, D. Knowledge and awareness regarding menstruation and HIV/AIDS among schoolgoing adolescent girls. J. Fam. Med. Prim Care 6 , 47–51 (2017).

Kawale, S., Sharma, V., Thaware, P. & Mohankar, A. A study to assess awareness about HIV/AIDS among rural population of central India. Int. J. Commun. Med. Public Health 5 , 373–376 (2017).

Lal, P., Nath, A., Badhan, S. & Ingle, G. K. A study of awareness about HIV/AIDS among senior secondary school Children of Delhi. Indian J. Commun. Med. 33 , 190–192 (2008).

CAS   Google Scholar  

Bago, J.-L. & Lompo, M. L. Exploring the linkage between exposure to mass media and HIV awareness among adolescents in Uganda. Sex. Reprod. Healthcare 21 , 1–8 (2019).

McCombie, S., Hornik, R. C. & Anarfi, J. K. Effects of a mass media campaign to prevent AIDS among young people in Ghana . Public Health Commun. 163–178 (Routledge, 2002). https://doi.org/10.4324/9781410603029-17 .

Sano, Y. et al. Exploring the linkage between exposure to mass media and HIV testing among married women and men in Ghana. AIDS Care 28 , 684–688 (2016).

Oginni, A. B., Adebajo, S. B. & Ahonsi, B. A. Trends and determinants of comprehensive knowledge of HIV among adolescents and young adults in Nigeria: 2003–2013. Afr. J. Reprod. Health 21 , 26–34 (2017).

Rahman, M. M., Kabir, M. & Shahidullah, M. Adolescent knowledge and awareness about AIDS/HIV and factors affecting them in Bangladesh. J. Ayub. Med. Coll. Abbottabad 21 , 3–6 (2009).

Yadav, S. B., Makwana, N. R., Vadera, B. N., Dhaduk, K. M. & Gandha, K. M. Awareness of HIV/AIDS among rural youth in India: a community based cross-sectional study. J. Infect. Dev. Countries 5 , 711–716 (2011).

Alhasawi, A. et al. Assessing HIV/AIDS knowledge, awareness, and attitudes among senior high school students in Kuwait. MPP 28 , 470–476 (2019).

Chakrovarty, A. et al. A study of awareness on HIV/AIDS among higher secondary school students in Central Kolkata. Indian J. Commun. Med. 32 , 228 (2007).

Katoch, D. K. S. & Kumar, A. HIV/AIDS awareness among students of tribal and non-tribal area of Himachal Pradesh. J. Educ. 5 , 1–9 (2017).

Shinde, M., Trivedi, A., Shinde, A. & Mishra, S. A study of awareness regarding HIV/AIDS among secondary school students. Int. J. Commun. Med. Public Health https://doi.org/10.18203/2394-6040.ijcmph20161611 (2016).

Article   Google Scholar  

Council, P. UDAYA, adolescent survey, Bihar and Uttar Pradesh, 2015–16. Harvard Dataverse https://doi.org/10.7910/DVN/RRXQNT (2018).

Kumar, P. & Dhillon, P. Household- and community-level determinants of low-risk Caesarean deliveries among women in India. J. Biosoc. Sci. 53 , 55–70 (2021).

Patel, S. K., Santhya, K. G. & Haberland, N. What shapes gender attitudes among adolescent girls and boys? Evidence from the UDAYA Longitudinal Study in India. PLoS ONE 16 , e0248766 (2021).

CAS   PubMed   PubMed Central   Google Scholar  

Fan, C., Wang, L. & Wei, L. Comparing two tests for two rates. Am. Stat. 71 , 275–281 (2017).

MathSciNet   Google Scholar  

Kim, T. K. T test as a parametric statistic. Korean J. Anesthesiol. 68 , 540–546 (2015).

PubMed   PubMed Central   Google Scholar  

Bell, A., Fairbrother, M. & Jones, K. Fixed and random effects models: making an informed choice. Qual. Quant. 53 , 1051–1074 (2019).

Jarrett, R., Farewell, V. & Herzberg, A. Random effects models for complex designs. Stat. Methods Med. Res. 29 , 3695–3706 (2020).

MathSciNet   CAS   PubMed   PubMed Central   Google Scholar  

Neuhaus, J. M. & Kalbfleisch, J. D. Between- and within-cluster covariate effects in the analysis of clustered data. Biometrics 54 , 638–645 (1998).

CAS   PubMed   MATH   Google Scholar  

Kaur, G. Factors influencing HIV awareness amongst adolescent women: a study of slums in Delhi. Demogr. India 47 , 100–111 (2018).

Alene, G. D., Wheeler, J. G. & Grosskurth, H. Adolescent reproductive health and awareness of HIV among rural high school students, North Western Ethiopia. AIDS Care 16 , 57–68 (2004).

CAS   PubMed   Google Scholar  

Oljira, L., Berhane, Y. & Worku, A. Assessment of comprehensive HIV/AIDS knowledge level among in-school adolescents in eastern Ethiopia. J. Int. AIDS Soc. 16 , 17349 (2013).

Samkange-Zeeb, F. N., Spallek, L. & Zeeb, H. Awareness and knowledge of sexually transmitted diseases (STDs) among school-going adolescents in Europe: a systematic review of published literature. BMC Public Health 11 , 727 (2011).

Laguna, E. P. Knowledge of HIV/AIDS and unsafe sex practices among Filipino youth. in 15 (PAA, 2004).

Teitelman, A. M. et al. Partner violence, power, and gender differences in South African adolescents’ HIV/sexually transmitted infections risk behaviors. Health Psychol. 35 , 751–760 (2016).

Oberth, G. et al. Effectiveness of the Sista2Sista programme in improving HIV and other sexual and reproductive health outcomes among vulnerable adolescent girls and young women in Zimbabwe. Afr. J. AIDS Res. 20 , 158–164 (2021).

DeSoto, J. et al. Using school-based early warning systems as a social and behavioral approach for HIV prevention among adolescent girls. Preventing HIV Among Young People in Southern and Eastern Africa 280 (2020).

Ochako, R., Ulwodi, D., Njagi, P., Kimetu, S. & Onyango, A. Trends and determinants of Comprehensive HIV and AIDS knowledge among urban young women in Kenya. AIDS Res. Ther. 8 , 11 (2011).

Peltzer, K. & Supa, P. HIV/AIDS knowledge and sexual behavior among junior secondary school students in South Africa. J. Soc. Sci. 1 , 1–8 (2005).

Shweta, C., Mundkur, S. & Chaitanya, V. Knowledge and beliefs about HIV/AIDS among adolescents. WebMed Cent. 2 , 1–9 (2011).

Anwar, M., Sulaiman, S. A. S., Ahmadi, K. & Khan, T. M. Awareness of school students on sexually transmitted infections (STIs) and their sexual behavior: a cross-sectional study conducted in Pulau Pinang, Malaysia. BMC Public Health 10 , 47 (2010).

Cicciò, L. & Sera, D. Assessing the knowledge and behavior towards HIV/AIDS among youth in Northern Uganda: a cross-sectional survey. Giornale Italiano di Medicina Tropicale 15 , 29–34 (2010).

Glick, P., Randriamamonjy, J. & Sahn, D. E. Determinants of HIV knowledge and condom use among women in madagascar: an analysis using matched household and community data. Afr. Dev. Rev. 21 , 147–179 (2009).

Rahman, M. Determinants of knowledge and awareness about AIDS: Urban-rural differentials in Bangladesh. JPHE 1 , 014–021 (2009).

Siziya, S., Muula, A. S. & Rudatsikira, E. HIV and AIDS-related knowledge among women in Iraq. BMC. Res. Notes 1 , 123 (2008).

Gao, X. et al. Effectiveness of school-based education on HIV/AIDS knowledge, attitude, and behavior among secondary school students in Wuhan, China. PLoS ONE 7 , e44881 (2012).

ADS   CAS   PubMed   PubMed Central   Google Scholar  

Kotecha, P. V. et al. Reproductive health awareness among urban school going adolescents in Vadodara city. Indian J. Psychiatry 54 , 344–348 (2012).

Dimbuene, T. Z. & Defo, K. B. Fostering accurate HIV/AIDS knowledge among unmarried youths in Cameroon: do family environment and peers matter?. BMC Public Health 11 , 348 (2011).

Kumar, R. et al. Knowledge attitude and perception of sex education among school going adolescents in Ambala District, Haryana, India: a cross-sectional study. J. Clin. Diagn. Res. 11 , LC01–LC04 (2017).

ADS   PubMed   PubMed Central   Google Scholar  

Tripathi, N. & Sekher, T. V. Youth in India ready for sex education? Emerging evidence from national surveys. PLoS ONE 8 , e71584 (2013).

Rosenberg, M. et al. Evidence for sample selection effect and Hawthorne effect in behavioural HIV prevention trial among young women in a rural South African community. BMJ Open 8 , e019167 (2018).

Gupta, P., Anjum, F., Bhardwaj, P., Srivastav, J. & Zaidi, Z. H. Knowledge about HIV/AIDS among secondary school students. N. Am. J. Med. Sci. 5 , 119–123 (2013).

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This paper was written using data collected as part of Population Council’s UDAYA study, which is funded by the Bill and Melinda Gates Foundation and the David and Lucile Packard Foundation. No additional funds were received for the preparation of the paper.

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Conception and design of the study: S.S. and P.K.; analysis and/or interpretation of data: P.K. and S.S.; drafting the manuscript: S.C., and R.P.; reading and approving the manuscript: S.S., P.K., S.C. and R.P.

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Srivastava, S., Chauhan, S., Patel, R. et al. A study of awareness on HIV/AIDS among adolescents: A Longitudinal Study on UDAYA data. Sci Rep 11 , 22841 (2021). https://doi.org/10.1038/s41598-021-02090-9

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Case study of a patient who has been diagnosed HIV positive

14 Case study of a patient who has been diagnosed HIV positive Brian Thornton Chapter aims • To provide you with a case study of a patient who is living with a diagnosis of HIV together with the rationale for care • To encourage you to research and deepen your knowledge of HIV/AIDS Introduction This chapter provides you with an example of the nursing care that a patient with HIV might require. The case study has been written by an HIV nurse specialist and provides you with a patient profile to enable you to understand the context of the patient. The case study aims to guide you through the assessment, nursing action and evaluation of a patient with HIV together with the rationale for care. Patient profile Ms Jessie Chitalwa is a 27-year-old Nigerian lady who has lived in the UK since the age of 22. She is doing a business studies degree at a local university. She attended accident and emergency (A&E) with a 2-week history of increasing shortness of breath and lethargy. She tested HIV positive on a point of care test in A&E. Her working diagnosis is pneumocystis pneumonia and she has been prescribed intravenous co-trimoxazole to treat this. She arrived on the ward overnight, at 11 p.m., and you are her nurse for the morning shift, starting at 7.15 a.m. Activity A definition of HIV was given in Chapter 1 and asked you to revise your anatomy and physiology (see Montague et al 2005 ). Before reading the case study, try to find out how HIV affects the immune system. What key issues did you discover for how HIV affects the immune system? This comprehensive article may help you to research this: Flannigan J (2008). HIV and AIDS: transmission, testing and treatment. Nursing Standard 22(34):48–56. Online. Available at: http://nursingstandard.rcnpublishing.co.uk/archive/article-hiv-and-aids-transmission-testing-and-treatment (accessed July 2011). Assessment on admission When greeting and introducing yourself to Ms Chitalwa, you notice she is very anxious and visibly upset. Her vital signs are: pulse 118 regular, respiratory rate 28, temperature 37.3°C tympanic, oxygen saturation 94% (receiving 2-L oxygen via nasal specs). She is in a bay with five other patients on your medical ward. During your assessment discussion with Ms Chitalwa, using the Roper, Logan and Tierney ( Roper et al 2000 ) model of activities of daily living, you note that she is normally totally independent in all activities of daily living (see Table 14.1 ). Table 14.1 Assessment of Ms Chitalwa using the Roper, Logan and Tierney model Maintaining a safe environment She requires assistance due to reduced mobility and lethargy. Local hazards include the oxygen tubing for her nasal specs and the drip stand and tubes for her intravenous co-trimoxazole Communicating She is fluent in English, which is her second language. Shortness of breath is reducing her sentence length. Recent HIV diagnosis has been a shock to her and she appears to be upset and withdrawn. She is very worried that her HIV status will be discovered by the other patients in her bay, as well as by her flatmates when they come to visit her. She seems reluctant to communicate about her HIV diagnosis. She has spent a lot of her time reading her bible. She is happy to be called Jessie Breathing Jessie becomes short of breath easily. She is receiving oxygen therapy via a humidification system and nasal specs. She finds it difficult to have a deep breath, and starts coughing Eating and drinking Her appetite has been reduced for the last week. She is a vegetarian. She feels nauseous when she tries to eat Eliminating She is too weak to walk to the bathroom, even with assistance Personal cleansing and dressing She is able to wash herself with a bowl at the bedside. She has been unable to bathe or shower for the last 3 days due to her lethargy and shortness of breath Controlling body temperature Currently no problems Mobility Severely reduced. Can barely manage five steps without becoming distressed. Oxygen and IV therapy are continuous so her range is already restricted due to the length of the tubes and IV lines Working and playing Does not want to discuss this right now Expressing sexuality Does not want to discuss this right now Sleeping Feels tired but has had a very unsettled night. Has not slept properly for several days, cannot remember how long Dying She is convinced that she is dying. The recent HIV diagnosis has made her resign herself to this fact. She has seen people die of HIV in Nigeria when she was younger and remembers the pain and suffering they went through, as well as the stigma for them and their families Ms Chitalwa’s problems Based on your assessment of Ms Chitalwa, the following problems should form the basis of your care plan: • Jessie is unable to independently maintain a safe environment. Activity See Appendix 4 in Holland et al (2008) for possible questions to consider during the assessment stage of care planning. • Jessie has reduced communication ability, partly due to shortness of breath and partly due to her current psychological state and fear of her HIV diagnosis being discovered. • Jessie has pneumonia. • Jessie has reduced blood oxygen saturation levels and is short of breath. • Jessie has reduced appetite and is at risk of inadequate nutritional intake. • Jessie has reduced mobility and is at risk of deep vein thrombosis and other hazards of prolonged immobility. • Jessie is unable to walk to the bathroom. • Jessie is tired but unable to sleep. • Jessie is worried that she is going to die. • Jessie has an intravenous cannula in situ, and is receiving intravenous therapy. Jessie’s nursing care plans 1. Problem: Jessie is unable to independently maintain a safe environment. Goal: To ensure a safe environment. Nursing action Rationale Ensure the call buzzer is within reach at all times So Jessie is able to summon assistance as required and not attempt to do things beyond her current level of capability, potentially causing her condition to deteriorate or for her to fall Ensure Jessie is aware that she should summon assistance and not try to push herself to do things which she is not currently capable of To re-enforce to Jessie that she is unwell and that it is OK for her to ask for assistance Evaluation: Jessie’s environment remained safe throughout her hospital stay and recovery. 2. Problem: Jessie has reduced communication ability, partly due to shortness of breath and partly due to her current psychological state and fear of her HIV diagnosis being discovered. Goal: To ensure optimum communication with Jessie. Goal: To support Jessie psychologically with her recent HIV diagnosis. Nursing action Rationale Try to ask closed questions, if possible To reduce the need for Jessie to feel she has to respond with long answers Ensure privacy for discussions, taking Jessie to a private room as soon as this is feasible Jessie will hopefully be more able to have conversations about HIV infection in a private setting, when she is aware that the rest of the patients will not be able to overhear Make Jessie aware of the good prognosis and longevity for people with HIV infection To reduce her fears of death or pain because of her HIV infection To enable Jessie to realise that she should recover and lead a normal life, but will have to take medicines every day Refer to psychology service To ensure an appropriately trained health professional is able to assess and support Jessie with her concerns and worries Ensure all healthcare professionals are aware of Jessie’s concerns over confidentiality of her HIV infection To reduce the risk of her HIV status being mentioned or discussed either in front of her, therefore disclosing to the other patients in her bay, or in public areas where the discussions could be overheard by other patients or visitors Evaluation:

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Case study: 33-year-old female presents with chronic sob and cough.

Sandeep Sharma ; Muhammad F. Hashmi ; Deepa Rawat .

Affiliations

Last Update: February 20, 2023 .

• Case Presentation

History of Present Illness:  A 33-year-old white female presents after admission to the general medical/surgical hospital ward with a chief complaint of shortness of breath on exertion. She reports that she was seen for similar symptoms previously at her primary care physician’s office six months ago. At that time, she was diagnosed with acute bronchitis and treated with bronchodilators, empiric antibiotics, and a short course oral steroid taper. This management did not improve her symptoms, and she has gradually worsened over six months. She reports a 20-pound (9 kg) intentional weight loss over the past year. She denies camping, spelunking, or hunting activities. She denies any sick contacts. A brief review of systems is negative for fever, night sweats, palpitations, chest pain, nausea, vomiting, diarrhea, constipation, abdominal pain, neural sensation changes, muscular changes, and increased bruising or bleeding. She admits a cough, shortness of breath, and shortness of breath on exertion.

Social History: Her tobacco use is 33 pack-years; however, she quit smoking shortly prior to the onset of symptoms, six months ago. She denies alcohol and illicit drug use. She is in a married, monogamous relationship and has three children aged 15 months to 5 years. She is employed in a cookie bakery. She has two pet doves. She traveled to Mexico for a one-week vacation one year ago.

Allergies:  No known medicine, food, or environmental allergies.

Past Medical History: Hypertension

Past Surgical History: Cholecystectomy

Medications: Lisinopril 10 mg by mouth every day

Physical Exam:

Vitals: Temperature, 97.8 F; heart rate 88; respiratory rate, 22; blood pressure 130/86; body mass index, 28

General: She is well appearing but anxious, a pleasant female lying on a hospital stretcher. She is conversing freely, with respiratory distress causing her to stop mid-sentence.

Respiratory: She has diffuse rales and mild wheezing; tachypneic.

Cardiovascular: She has a regular rate and rhythm with no murmurs, rubs, or gallops.

Gastrointestinal: Bowel sounds X4. No bruits or pulsatile mass.

• Initial Evaluation

Laboratory Studies:  Initial work-up from the emergency department revealed pancytopenia with a platelet count of 74,000 per mm3; hemoglobin, 8.3 g per and mild transaminase elevation, AST 90 and ALT 112. Blood cultures were drawn and currently negative for bacterial growth or Gram staining.

Chest X-ray

Impression:  Mild interstitial pneumonitis

• Differential Diagnosis
• Aspiration pneumonitis and pneumonia
• Bacterial pneumonia
• Immunodeficiency state and Pneumocystis jiroveci pneumonia
• Carcinoid lung tumors
• Tuberculosis
• Viral pneumonia
• Chlamydial pneumonia
• Coccidioidomycosis and valley fever
• Recurrent Legionella pneumonia
• Mediastinal cysts
• Mediastinal lymphoma
• Recurrent mycoplasma infection
• Pancoast syndrome
• Pneumococcal infection
• Sarcoidosis
• Small cell lung cancer
• Aspergillosis
• Blastomycosis
• Histoplasmosis
• Actinomycosis
• Confirmatory Evaluation

CT of the chest was performed to further the pulmonary diagnosis; it showed a diffuse centrilobular micronodular pattern without focal consolidation.

On finding pulmonary consolidation on the CT of the chest, a pulmonary consultation was obtained. Further history was taken, which revealed that she has two pet doves. As this was her third day of broad-spectrum antibiotics for a bacterial infection and she was not getting better, it was decided to perform diagnostic bronchoscopy of the lungs with bronchoalveolar lavage to look for any atypical or rare infections and to rule out malignancy (Image 1).

Bronchoalveolar lavage returned with a fluid that was cloudy and muddy in appearance. There was no bleeding. Cytology showed Histoplasma capsulatum .

Based on the bronchoscopic findings, a diagnosis of acute pulmonary histoplasmosis in an immunocompetent patient was made.

Pulmonary histoplasmosis in asymptomatic patients is self-resolving and requires no treatment. However, once symptoms develop, such as in our above patient, a decision to treat needs to be made. In mild, tolerable cases, no treatment other than close monitoring is necessary. However, once symptoms progress to moderate or severe, or if they are prolonged for greater than four weeks, treatment with itraconazole is indicated. The anticipated duration is 6 to 12 weeks total. The response should be monitored with a chest x-ray. Furthermore, observation for recurrence is necessary for several years following the diagnosis. If the illness is determined to be severe or does not respond to itraconazole, amphotericin B should be initiated for a minimum of 2 weeks, but up to 1 year. Cotreatment with methylprednisolone is indicated to improve pulmonary compliance and reduce inflammation, thus improving work of respiration. [1] [2] [3]

Histoplasmosis, also known as Darling disease, Ohio valley disease, reticuloendotheliosis, caver's disease, and spelunker's lung, is a disease caused by the dimorphic fungi  Histoplasma capsulatum native to the Ohio, Missouri, and Mississippi River valleys of the United States. The two phases of Histoplasma are the mycelial phase and the yeast phase.

Etiology/Pathophysiology 

Histoplasmosis is caused by inhaling the microconidia of  Histoplasma  spp. fungus into the lungs. The mycelial phase is present at ambient temperature in the environment, and upon exposure to 37 C, such as in a host’s lungs, it changes into budding yeast cells. This transition is an important determinant in the establishment of infection. Inhalation from soil is a major route of transmission leading to infection. Human-to-human transmission has not been reported. Infected individuals may harbor many yeast-forming colonies chronically, which remain viable for years after initial inoculation. The finding that individuals who have moved or traveled from endemic to non-endemic areas may exhibit a reactivated infection after many months to years supports this long-term viability. However, the precise mechanism of reactivation in chronic carriers remains unknown.

Infection ranges from an asymptomatic illness to a life-threatening disease, depending on the host’s immunological status, fungal inoculum size, and other factors. Histoplasma  spp. have grown particularly well in organic matter enriched with bird or bat excrement, leading to the association that spelunking in bat-feces-rich caves increases the risk of infection. Likewise, ownership of pet birds increases the rate of inoculation. In our case, the patient did travel outside of Nebraska within the last year and owned two birds; these are her primary increased risk factors. [4]

Non-immunocompromised patients present with a self-limited respiratory infection. However, the infection in immunocompromised hosts disseminated histoplasmosis progresses very aggressively. Within a few days, histoplasmosis can reach a fatality rate of 100% if not treated aggressively and appropriately. Pulmonary histoplasmosis may progress to a systemic infection. Like its pulmonary counterpart, the disseminated infection is related to exposure to soil containing infectious yeast. The disseminated disease progresses more slowly in immunocompetent hosts compared to immunocompromised hosts. However, if the infection is not treated, fatality rates are similar. The pathophysiology for disseminated disease is that once inhaled, Histoplasma yeast are ingested by macrophages. The macrophages travel into the lymphatic system where the disease, if not contained, spreads to different organs in a linear fashion following the lymphatic system and ultimately into the systemic circulation. Once this occurs, a full spectrum of disease is possible. Inside the macrophage, this fungus is contained in a phagosome. It requires thiamine for continued development and growth and will consume systemic thiamine. In immunocompetent hosts, strong cellular immunity, including macrophages, epithelial, and lymphocytes, surround the yeast buds to keep infection localized. Eventually, it will become calcified as granulomatous tissue. In immunocompromised hosts, the organisms disseminate to the reticuloendothelial system, leading to progressive disseminated histoplasmosis. [5] [6]

Symptoms of infection typically begin to show within three to17 days. Immunocompetent individuals often have clinically silent manifestations with no apparent ill effects. The acute phase of infection presents as nonspecific respiratory symptoms, including cough and flu. A chest x-ray is read as normal in 40% to 70% of cases. Chronic infection can resemble tuberculosis with granulomatous changes or cavitation. The disseminated illness can lead to hepatosplenomegaly, adrenal enlargement, and lymphadenopathy. The infected sites usually calcify as they heal. Histoplasmosis is one of the most common causes of mediastinitis. Presentation of the disease may vary as any other organ in the body may be affected by the disseminated infection. [7]

The clinical presentation of the disease has a wide-spectrum presentation which makes diagnosis difficult. The mild pulmonary illness may appear as a flu-like illness. The severe form includes chronic pulmonary manifestation, which may occur in the presence of underlying lung disease. The disseminated form is characterized by the spread of the organism to extrapulmonary sites with proportional findings on imaging or laboratory studies. The Gold standard for establishing the diagnosis of histoplasmosis is through culturing the organism. However, diagnosis can be established by histological analysis of samples containing the organism taken from infected organs. It can be diagnosed by antigen detection in blood or urine, PCR, or enzyme-linked immunosorbent assay. The diagnosis also can be made by testing for antibodies again the fungus. [8]

Pulmonary histoplasmosis in asymptomatic patients is self-resolving and requires no treatment. However, once symptoms develop, such as in our above patient, a decision to treat needs to be made. In mild, tolerable cases, no treatment other than close monitoring is necessary. However, once symptoms progress to moderate or severe or if they are prolonged for greater than four weeks, treatment with itraconazole is indicated. The anticipated duration is 6 to 12 weeks. The patient's response should be monitored with a chest x-ray. Furthermore, observation for recurrence is necessary for several years following the diagnosis. If the illness is determined to be severe or does not respond to itraconazole, amphotericin B should be initiated for a minimum of 2 weeks, but up to 1 year. Cotreatment with methylprednisolone is indicated to improve pulmonary compliance and reduce inflammation, thus improving the work of respiration.

The disseminated disease requires similar systemic antifungal therapy to pulmonary infection. Additionally, procedural intervention may be necessary, depending on the site of dissemination, to include thoracentesis, pericardiocentesis, or abdominocentesis. Ocular involvement requires steroid treatment additions and necessitates ophthalmology consultation. In pericarditis patients, antifungals are contraindicated because the subsequent inflammatory reaction from therapy would worsen pericarditis.

Patients may necessitate intensive care unit placement dependent on their respiratory status, as they may pose a risk for rapid decompensation. Should this occur, respiratory support is necessary, including non-invasive BiPAP or invasive mechanical intubation. Surgical interventions are rarely warranted; however, bronchoscopy is useful as both a diagnostic measure to collect sputum samples from the lung and therapeutic to clear excess secretions from the alveoli. Patients are at risk for developing a coexistent bacterial infection, and appropriate antibiotics should be considered after 2 to 4 months of known infection if symptoms are still present. [9]

Prognosis 

If not treated appropriately and in a timely fashion, the disease can be fatal, and complications will arise, such as recurrent pneumonia leading to respiratory failure, superior vena cava syndrome, fibrosing mediastinitis, pulmonary vessel obstruction leading to pulmonary hypertension and right-sided heart failure, and progressive fibrosis of lymph nodes. Acute pulmonary histoplasmosis usually has a good outcome on symptomatic therapy alone, with 90% of patients being asymptomatic. Disseminated histoplasmosis, if untreated, results in death within 2 to 24 months. Overall, there is a relapse rate of 50% in acute disseminated histoplasmosis. In chronic treatment, however, this relapse rate decreases to 10% to 20%. Death is imminent without treatment.

• Pearls of Wisdom

While illnesses such as pneumonia are more prevalent, it is important to keep in mind that more rare diseases are always possible. Keeping in mind that every infiltrates on a chest X-ray or chest CT is not guaranteed to be simple pneumonia. Key information to remember is that if the patient is not improving under optimal therapy for a condition, the working diagnosis is either wrong or the treatment modality chosen by the physician is wrong and should be adjusted. When this occurs, it is essential to collect a more detailed history and refer the patient for appropriate consultation with a pulmonologist or infectious disease specialist. Doing so, in this case, yielded workup with bronchoalveolar lavage and microscopic evaluation. Microscopy is invaluable for definitively diagnosing a pulmonary consolidation as exemplified here where the results showed small, budding, intracellular yeast in tissue sized 2 to 5 microns that were readily apparent on hematoxylin and eosin staining and minimal, normal flora bacterial growth. 

• Enhancing Healthcare Team Outcomes

This case demonstrates how all interprofessional healthcare team members need to be involved in arriving at a correct diagnosis. Clinicians, specialists, nurses, pharmacists, laboratory technicians all bear responsibility for carrying out the duties pertaining to their particular discipline and sharing any findings with all team members. An incorrect diagnosis will almost inevitably lead to incorrect treatment, so coordinated activity, open communication, and empowerment to voice concerns are all part of the dynamic that needs to drive such cases so patients will attain the best possible outcomes.

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Histoplasma Contributed by Sandeep Sharma, MD

Disclosure: Sandeep Sharma declares no relevant financial relationships with ineligible companies.

Disclosure: Muhammad Hashmi declares no relevant financial relationships with ineligible companies.

Disclosure: Deepa Rawat declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Sharma S, Hashmi MF, Rawat D. Case Study: 33-Year-Old Female Presents with Chronic SOB and Cough. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)

Learn about the nursing care management of patients with HIV /AIDS in this nursing study guide .

Table of Contents

• What are HIV and AIDS? 

Classification

Pathophysiology, statistics and epidemiology, clinical manifestations, complications, assessment and diagnostic findings, medical management, nursing assessment, planning & goals, nursing interventions, discharge and home care guidelines, documentation guidelines.

• Practice Quiz: HIV/AIDS

What are HIV and AIDS?

Since HIV was first identified almost 30 years ago, remarkable progress has been made in improving the quality and duration of life for people living with HIV disease.

• HIV or human immunodeficiency virus and acquired immunodeficiency syndrome is a chronic condition that requires daily medication.
• HIV- 1 is a retrovirus isolated and recognized as the etiologic agent of AIDS.
• HIV-2 is a retrovirus identified in 1986 in AIDS patients in West

The stages of HIV disease is based on clinical history, physical examination, laboratory evidence of immune dysfunction, signs and symptoms, and infections and malignancies.

• Primary infection (Acute/Recent HIV Infection). The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection.
• HIV asymptomatic (CDC Category A). After the viral set point is reached, HIV-positive people enter into a chronic stage in which the immune system cannot eliminate the virus despite its best efforts.
• HIV symptomatic (CDC Category B). Category B consists of symptomatic conditions in HIV-infected patients that are not included in the conditions listed in category C.
• AIDS (CDC Category C). When the CD4+ T-cell level drops below 200 cells/mm3 of blood , the person is said to have AIDS.

Because HIV infection is an infectious disease, it is important to understand how HIV-1 integrates itself into a person’s immune system and how immunity plays a role in the course of HIV disease.

• In this first step, the GP120 and GP41 glycoproteins of HIV bind with the host’s uninfected CD4+ receptor and chemokine coreceptors, usually CCR5, which results in the fusion of HIV with the CD4+ T-cell membrane.
• The contents of HIV’s viral core are emptied into the CD4+ T cell .
• DNA synthesis. HIV changes in genetic material from RNA to DNA through the action of reverse transcriptase, resulting in double-stranded DNA that carries instruction for viral replication.
• New viral DNA enters the nucleus of the CD4+ T cell and through the action of integrase is blended with the DNA of the CD4+ T cell, resulting in permanent, lifelong infection.
• When the CD4+ T cell is activated, the double-stranded DNA forms single-stranded messenger RNA, which builds new viruses.
• The mRNA creates chains of new proteins and enzymes that contain the components needed in the construction of new viruses.
• The HIV enzyme protease cuts the polyprotein chain into the individual proteins that make up the new virus.
• New proteins and viral RNA migrate to the membrane of the infected CD4+ T cell, exits from the cell, and starts the process all over.

Pathophysiology of HIV and AIDS by Osmosis

Check out this awesome pathophysiology and easy-to-understand video by Osmosis. Let us support them via Patreon to make more informative videos like this.

In the fall of 1982, after the first 100 cases were reported, the Centers for Disease Control and Prevention (CDC) issued a case definition for AIDS.

• In 2008, the CDC reported that approximately 56, 300 new HIV infections occurred in the United States in 2006.
• The figure was roughly 40% higher than their former estimate of 40, 000 HIV infections per year.
• Almost 7000 people still contract HIV infection every day.
• An estimated 33 million people are living with HIV/AIDS; however, the number of new infections declined from 3 million in 2001 to 2.7 million in 2007.
• The global percentage of women among people with HIV/AIDS remains at 50%.
• Sub-Saharan Africa continues to be most heavily affected by HIV/AIDS, with 67% of all people living with the disease.
• In 2007, 72% of deaths from HIV/AIDS occurred in the same region.

HIV is transmitted through body fluids that contain free virions and infected CD4+ T cells .

• Sharing infected drug use equipment such as needles.
• Having sexual relations with infected individuals (both male and female).
• Blood transmission. Receiving HIV-infected blood or blood products especially before blood screening.
• Maternal HIV. Infants born to mothers with HIV infection.

HIV has four categories with specific manifestations for each stage.

• This is experienced during the early infection stages.
• People who are acutely infected with HIV infection experiences this symptom.
• This symptom is mostly present in category B wherein the patient has already entered the chronic stage.
• Constitutional symptoms. Fever more than 38.5⁰C or diarrhea exceeding 1 month in duration may also indicate presence of HIV infection.
• Patients with HIV category C experience wasting syndrome or severe wasting of the muscles.

Until an effective vaccine is developed, nurses need to prevent HIV infection by teaching patients how to eliminate or reduce risky behaviors.

• Safe sex. Other than abstinence , consistent and correct use of condoms is the only effective method to decrease the risk of sexual transmission of HIV infection.
• In March 2007, based on the results of three clinical trials, the WHO and UNAIDS recommended that circumcision be recognized as an effective strategy to reduce the risk of HIV acquisition in men.
• Sex partners. Avoid sexual contact with multiple partners or people who are known to be HIV positive or IV/injection drug users.
• Blood and blood components. People who are HIV positive or who use injection drugs should be instructed not to donate blood or share drug equipment with others.

The patient should be monitored for presence of complications and should be managed appropriately.

• Opportunistic infections. Patients who are immunosuppressed are at risk for opportunistic infections such as pneumocystis pneumonia which can affect 80% of all people infected with HIV.
• Respiratory failure. Impaired breathing is a major complication that increases the patient’s discomfort and anxiety and may lead to respiratory and cardiac failure.
• Cachexia and wasting. Wasting syndrome occurs when there is profound involuntary weight loss exceeding 10% of the baseline body weight and it is a common complication of HIV infection and AIDS.

Several screening tests are used to diagnose HIV infection.

• Confirming Diagnosis: Signs and symptoms may occur at any time after infection, but AIDS isn’t officially diagnosed until the patient’s CD4+ T-cell count falls below 200 cells/mcl or associated clinical conditions or disease.
• CBC:   Anemia and idiopathic thrombocytopenia ( anemia occurs in up to 85% of patients with AIDS and may be profound). Leukopenia may be present; differential shift to the left suggests infectious process (PCP), although shift to the right may be noted.
• PPD:  Determines exposure and/or active TB disease. Of AIDS patients, 100% of those exposed to active Mycobacterium tuberculosis  will develop the disease.
• Serologic:  Serum antibody test: HIV screen by ELISA. A positive test result may be indicative of exposure to HIV but is not diagnostic because false-positives may occur.
• Western blot test:  Confirms diagnosis of HIV in blood and urine .
• RI-PCR: The most widely used test currently can detect viral RNA levels as low as 50 copies/mL of plasma with an upper limit of 75,000 copies/mL.
• bDNA 3.0 assay: Has a wider range of 50–500,000 copies/mL. Therapy can be initiated, or changes made in treatment approaches, based on rise of viral load or maintenance of a low viral load. This is currently the leading indicator of effectiveness of therapy.
• T-lymphocyte cells: Total count reduced.
• CD4+ lymphocyte count (immune system indicator that mediates several immune system processes and signals B cells to produce antibodies to foreign germs): Numbers less than 200 indicate severe immune deficiency response and diagnosis of AIDS.
• T8+ CTL (cytopathic suppressor cells): Reversed ratio (2:1 or higher) of suppressor cells to helper cells (T8+ to T4+) indicates immune suppression .
• Polymerase chain reaction (PCR) test: Detects HIV-DNA; most helpful in testing newborns of HIV-infected mothers. Infants carry maternal HIV antibodies and therefore test positive by ELISA and Western blot, even though infant is not necessarily infected.
• STD screening tests:   Hepatitis B envelope and core antibodies, syphilis, and other common STDs may be positive.
• Protozoal and helminthic infections: PCP, cryptosporidiosis, toxoplasmosis.
• Fungal infections: Candida albicans (candidiasis), Cryptococcus neoformans (cryptococcus), Histoplasma capsulatum (histoplasmosis).
• Bacterial infections: Mycobacterium avium-intracellulare (occurs with CD4 counts less than 50), miliary mycobacterial TB, Shigella (shigellosis),Salmonella (salmonellosis).
• Viral infections: CMV (occurs with CD4 counts less than 50), herpes simplex, herpes zoster.
• Neurological studies, e.g., electroencephalogram (EEG), magnetic resonance imaging (MRI), computed tomography (CT) scans of the brain ; electromyography (EMG)/nerve conduction studies:  Indicated for changes in mentation, fever of undetermined origin, and/or changes in sensory/motor function to determine effects of HIV infection/opportunistic infections.
• Chest x-ray :  May initially be normal or may reveal progressive interstitial infiltrates secondary to advancing PCP (most common opportunistic disease) or other pulmonary complications/disease processes such as TB.
• Pulmonary function tests:  Useful in early detection of interstitial pneumonias.
• Gallium scan:  Diffuse pulmonary uptake occurs in PCP and other forms of pneumonia .
• Biopsies:  May be done for differential diagnosis of Kaposi’s sarcoma (KS) or other neoplastic lesions.
• Bronchoscopy /tracheobronchial washings:  May be done with biopsy when PCP or lung malignancies are suspected (diagnostic confirming test for PCP).
• Barium swallow, endoscopy, colonoscopy :  May be done to identify opportunistic infection (e.g., Candida, CMV) or to stage KS in the GI system.

Medical management focuses on the elimination of opportunistic infections.

• Treatment of opportunistic infections. For Pneumocystis pneumonia , TMP-SMZ is the treatment of choice; for mycobacterium avian complex, azithromycin or clarithromycin are preferred prophylactic agents; for cryptococcal meningitis , the current primary treatment is IV amphotericin B .
• Prevention of opportunistic infections. TMP-SMZ is an antibacterial agent used to treat various organisms causing infection.
• Antidiarrheal therapy. Therapy with octreotide acetate (Sandostatin), a synthetic analog of somatostatin, has been shown to be effective in managing severe chronic diarrhea .
• Antidepressant therapy. Treatment for depression in patients with HIV infection involves psychotherapy integrated with imipramine , desipramine or fluoxetine.
• Nutrition therapy. For all AIDS patients who experience unexplained weight loss, calorie counts should be obtained, and appetite stimulants and oral supplements are also appropriate.

Nursing Management

The nursing care of patients with HIV/AIDS is challenging because of the potential for any organ system to be the target of infections or cancer .

Nursing assessment includes identification of potential risk factors, including a history of risky sexual practices or IV/injection drug use.

• Nutritional status. Nutritional status is assessed by obtaining a diet history and identifying factors that may affect the oral intake.
• Skin integrity. The skin and mucous membranes are inspected daily for evidence of breakdown, ulceration, or infection.
• Respiratory status. Respiratory status is assessed by monitoring the patient for cough , sputum production, shortness of breath, orthopnea, tachypnea, and chest pain .
• Neurologic status. Neurologic status is determined by assessing the level of consciousness; orientation to person, pace, and time; and memory lapses.
• Fluid and electrolyte balance. F&E status is assessed by examining the skin and mucous membranes for turgor and dryness.
• Knowledge level. The patient’s level of knowledge about the disease and the modes of disease transmission is evaluated.

The list of potential nursing diagnoses is extensive because of the complex nature of the disease.

• Impaired skin integrity related to cutaneous manifestations of HIV infection, excoriation, and diarrhea .
• Diarrhea related to enteric pathogens of HIV infection.
• Risk for infection related to immunodeficiency.
• Activity intolerance related weakness , fatigue, malnutrition, impaired F&E balance, and hypoxia associated with pulmonary infections.
• Disturbed thought processes related to shortened attention span, impaired memory , confusion , and disorientation associated with HIV encephalopathy.
• Ineffective airway clearance related to PCP, increased bronchial secretions, and decreased ability to cough related to weakness and fatigue.
• Pain related to impaired perianal skin integrity secondary to diarrhea, KS, and peripheral neuropathy.
• Imbalanced nutrition , less than body requirements related to decreased oral intake.

Main Article: 13 AIDS (HIV Positive) Nursing Care Plans

Goals for a patient with HIV/AIDS may include:

• Achievement and maintenance of skin integrity.
• Resumption of usual bowel pattern.
• Absence of infection.
• Improve activity intolerance .
• Improve thought processes.
• Improve airway clearance.
• Increase comfort.
• Improve nutritional status.
• Increase socialization.
• Absence of complications.
• Prevent/minimize development of new infections.
• Maintain homeostasis .
• Promote comfort.
• Support psychosocial adjustment.
• Provide information about disease process/prognosis and treatment needs.

The plan of care for a patient with AIDS is individualized to meet the needs of the patient.

• Promote skin integrity. Patients are encouraged to avoid scratching; to use nonabrasive, nondrying soaps and apply nonperfumed moisturizers ; to perform regular oral care ; and to clean the perianal area after each bowel movement with nonabrasive soap and water.
• Promote usual bowel patterns. The nurse should monitor for frequency and consistency of stools and the patient’s reports of abdominal pain or cramping.
• Prevent infection. The patient and the caregivers should monitor for signs of infection and laboratory test results that indicate infection.
• Improve activity intolerance. Assist the patient in planning daily routines that maintain a balance between activity and rest.
• Maintain thought processes. Family and support network members are instructed to speak to the patient in simple, clear language and give the patient sufficient time to respond to questions.
• Improve airway clearance. Coughing, deep breathing , postural drainage, percussion and vibration is provided for as often as every 2 hours to prevent stasis of secretions and to promote airway clearance.
• Relieve pain and discomfort. Use of soft cushions and foam pads may increase comfort as well as administration of NSAIDS and opioids .
• Improve nutritional status. The patient is encouraged to eat foods that are easy to swallow and to avoid rough, spicy, and sticky food items.

Expected patient outcomes may include:

• Achieved and maintained of skin integrity.
• Improved activity intolerance.
• Improved thought processes.
• Improved airway clearance.
• Increased comfort.
• Improved nutritional status.
• Increased socialization.

Before discharge, the nurse should educate the patient and the family about precautions and the transmission of HIV/AIDS.

• Patients and their families or caregivers should receive instructions about how to prevent disease transmission, including hand-washing techniques and methods for safely handling and disposing of items soiled with body fluids.
• Patients are advised to avoid exposure to others who are sick or who have been recently vaccinated.
• Medication administration . Caregivers in the home are taught how to administer medications, including IV preparations.
• The patient’s adherence to the therapeutic regimen is assessed and strategies are suggested to assist with adherence.
• Infection prevented/resolved.
• Complications prevented/minimized.
• Pain/discomfort alleviated or controlled.
• Patient dealing with current situation realistically.
• Diagnosis, prognosis, and therapeutic regimen understood.
• Plan in place to meet needs after discharge.

The focus of documentation in a patient with HIV/AIDS should include:

• Characteristics of lesions or condition.
• Impact of condition in personal image and lifestyle.
• Assessment findings including characteristics and pattern of elimination.
• Individual risk factors including recent or current antibiotic therapy.
• Signs and symptoms of infectious process.
• Breath sounds, presence and character of secretions, use of accessory muscles for breathing.
• Caloric intake.
• Individual cultural or religious restrictions and personal preferences.
• Plan of care.
• Teaching plan.
• Response to interventions, teaching, and actions performed.
• Attainment or progress toward desired outcomes.
• Modifications to plan of care.
• Long term needs.

Practice Quiz: HIV/AIDS

Here’s a 5-item quiz about the study guide. Please visit our nursing test bank for more NCLEX practice questions .

1. A widely used laboratory test that measures HIV-RNA levels and tracks the body’s response to HIV infection is the:

A. CD4/CD8 ratio. B. EIA test. C. Viral load test. D. Western blot.

2. The most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is:

A. Anorexia . B. Chronic diarrhea. C. Nausea . D. Vomiting.

3. Abnormal laboratory findings seen with AIDS include:

A. Decreased CD4 and T cell count. B. P24 antigen. C. Positive EIA test. D. All of the above.

4. The most common infection in persons with AIDS (80% occurrence) is:

A. Cytomegalovirus . B. Legionnaire’s disease. C. Mycobacterium tuberculosis. D. Pneumocystis pneumonia.

5. A diagnosis of wasting syndrome can be initially made when involuntary weight loss exceeds what percentage of baseline body weight?

A. 10% B. 15% C. 20% D. 25%

Answers and Rationale

1. Answer: C. Viral load test.

• C: Viral load test measures plasma RNA levels.
• A: CD4/CD8 ratio measures the number of CD4 T cells in the body.
• B: EIA test identifies antibodies directed specifically against HIV.
• D: Western blot is used to confirm seropositivity when the EIA result is positive.

2. Answer: B. Chronic diarrhea.

• B: Chronic diarrhea occurs in up to 90% of patients with AIDS.
• A: Anorexia is not as incapacitating as chronic diarrhea.
• C: Nausea is not as incapacitating as chronic diarrhea.
• D: Vomiting is not as incapacitating as chronic diarrhea.

3. Answer: D. All of the above.

• D: All of the mentioned laboratory results are seen in an AIDS patient.
• A: Decreased CD4 and T cell count is seen in an AIDS patient.
• B: P24 antigen is seen in an AIDS patient.
• C: Positive EIA test is seen in an AIDS patient.

4. Answer: D. Pneumocystis pneumonia.

• D: Pneumocystis pneumonia can affect 80% of all people infected with HIV.
• A: Cytomegalovirus is not the most common infection in AIDS patients.
• B: Legionnaire’s disease is not the most common infection in AIDS patients.
• C: Mycobacterium tuberculosis is not the most common infection in AIDS patients.

5. Answer: A. 10%

• A: Wasting syndrome occurs when there is profound involuntary weight loss exceeding 10% of the baseline body weight.
• B: It is not 15%, but 10% of the baseline body weight.
• C: It is not 20%, but 10% of the baseline body weight.
• D: It is not 25%, but 10% of the baseline body weight.

Posts related to HIV/AIDS:

• 13 AIDS (HIV Positive) Nursing Care Plans

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