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Joining hands for health


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Joining hands for health Love carefully, AIDS kills : caring and sharing at school time
Abbreviated Title:
Joining hands for health
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40 p. ; 28 cm.
Ministry of Health ( Publisher )
Ministry of Health, Health Education Division
Place of Publication:
Nassau, Bahamas
completely irregular


Subjects / Keywords:
Health care. -- Bahamas   ( lcsh )
Public health -- Bahamas
serial   ( sobekcm )
government publication   ( marcgt )
periodical   ( marcgt )
Temporal Coverage:
1983 - 1988
Spatial Coverage:
Caribbean Area


Statement of Responsibility:
Ministry of Health, Health Education Division

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College of The Bahamas
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College of The Bahamas
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TABLEOFCONTENTSPageWhatisAIDS Dionne Benjamin 1 Editorial .2AIDS'"Owasa Duah 3 AIDSisHardtoGet.. Kenneth Ofosu-Barko 4 Acquired Immune Deficiency Syndrome Prevention Peter Diggory 6 The Public Speak Shandalanae Edwards 8 AIDS: Its ImpactonMothers&Children David Sassoon 9 Your Tests Results Are Rosa Mae Bain10UpDate Felicity Aymer15The Nurse's Responsibilities Alice Gardner& JuliethMinnis22AIDS A Legal Perspective Emanuel Osadebay23The Pastoral Care of AIDS Patients Emmette Weir25AIDSinPregnancy Madlene Sawyer28Income Replacement Audrey Deveaux29The Impact of AIDSonHospitalisationPamrica Ferguson31The State of AIDSinthe Caribbean&Northern America Mark Crowley32The Christian Responsetothe AIDS Crisis A Reflection Alfred Culmer34Acquired Immune Deficiency Syndrome SurayyaKazi35Two Patients' Views Felicity Aymer37The Story of AIDS Dionne Benjamin38Evaluation39About the Contributors...................................................................................................................................... insidebackEditorial Committee........................................................................................................................................... insideback


.......WHAT,sAIDS?1VI(3)Vi(2)Contaminated BloodAIDS (HIV)is a serious illness thatimpairsthe body'sabilitytofightinfection. Without full resistance, a person with AIDSisunable to fightoff diseases&infections which otherwise healthy people-ea .,rrlr,1'I'T'iT\(1)Sexual ContactHow,sAIDSSPREAD?IWHATARETHESYMPTOMS?IProfound Fatigue, Chronic Diarrhoea, Swollen Glands (neck&armpits), Rapid Unexplained Weight Loss, Dry Cough, Shortness ofBreath, Skin Changes, Night Sweating.How,sAIDSPREVENTED?IPractice Abstinence (no sex) or Monogamy (one partner); avoid shar ing instruments which puncture skin (needles, razor blades), Reduce your sexual partners, Use a condom with spermicide.Note:YOUCANNOTGETAIDSTHRUCASUALCONTACTFor Example:


EDITORIALThis issue of Joining Hands For Health, CaringandSharing at School Time, deals exclusively with the dis ease AIDS (Acquired Immune Deficiency Syndrome, now referred toasHIV);wehave soughttoshareasmuch information about this diseaseaspossible with our col leagues. Both the infectionandthe disease itself are incurable. Less than halfofthose infectedsofar have goneonto develop the.disease.The diseaseisoften fatal. For the most part, young men and womeninthe prime of their lives are affected. The costs to them, their families and the nation when computed are likelytobephenomenal.Itshouldbemost reassuring though for the publictolearn that AIDS is NOT a communicable diseaseandtherefore that, by adopting certain behaviours, theycanreadily reduce and/or eliminate their risks of both getting the virus (becoming infected)andpossibly later of devel oping the disease. Unfortunately, AIDS reflects a side of our lives about whichweare not only often reluctant to speak but also, one whichisshroudedinmystery, double talkandmoral ity, human sexuality. AIDS also forces individuals to assume greaterresponsibility for their personal health nutrition, personal cleanliness, adequate rest and physical activity, non-de pendenceonsubstances. The presence and prevalenceofAIDSInThe Baha mas is indeed a cause for grave concern. The MinisterofHealth, the Han.Dr.NormanGay,inrecognitionofthis fact and also that this disease has been recognised glob ally as the number one public health problem ofthecen tury by the World Health Organisation (WHO) has devel oped a major co-ordinated strategyandappointed a Standing Committee for the PreventionandControlofAIDS. Its termsofreferenceare:-1.Tofurther developandensure implementation of a programme for the Health Educationforthe communityasa whole;2.1,:>continue monitoring blood bankingprocedures and ensure its safety;3.to further develop and monitor treatmentprotocols for patients with AIDS;4.topromote and disseminate protocolsforHealth Care and Allied Health Care Workers;5.todevelop policyonNational ScreeningProgrammes and to recommend regulatory and/or legislative measures;6.to monitor research on AIDS epidemiology,clinical course and treatmentinthe Bahamas. The Chairperson of this CommitteeisDr.VernellAllen, Chief Medical Officer.Wein the Ministry of Health and more especiallytheHealth Education Division now have the uneviabletaskof reassuring the public that AIDSishardtogetandthattheyCANtake positive stepstoreduce theirrisks.Because the HIV lives in body fluids mainly bloodandsemen, with basic precautionary measures theycanlive,work worship, relax, indeed have any numberofsocialcontacts with any AIDS patients or carrier without fearofcontracting the disease. They should, however,allbealerted to the fact that greater responsibility thanheretofore exerted in sexual encounters willnowhavetobetaken.Inthis regard, only theycanmake the decision. \AIDS IN THE AMERICASCases NotifiedBy19June 1987Excluding the USA2Canada1052Mexico487French Guiana68Venezuela69Argentina78Bahamas105Trinidad&Tobago134DominicanRepublic200Puerto Rico374Others392


AIDSOWASA DUAHDuring the past five to six years, AIDS AcquiredImmuneDeficiency Syndrome has been a medical mystery often surrounded by fear and confusion. Since itwasidentifiedin1981, scientists worldwide have put forwardmany theories to explain this tragic illness. Muchhasbeen learned to further our understanding but many questions are yet to be answered. This summary is intended to give you the factsaboutAIDS and correct some of the myths and miscon ceptions that have resulted from fear of this illness.WHATIS AIDS?AIDSisa condition that, by attacking the immunesystem,affects the body's natural ability to fight disease. A normal immune system, likea well organised army,ralliesits forces to combat invasion by foreign agents.AIDSweakens the body's defences; as a result, the body becomes vulnerable to unusual, serious illnesses.WHAT CAUSES AIDS?AIDSiscaused by a virus referred to as HIV. Therearenow two types of virus, HIV I and HIVII.The formerisfound to be the culpritinthe Americas, Europe, CentralAfrica, and Caribbean. HIV "isfound to cause AIDSInWest Africa.WHOGETS AIDS?AIDS PRIMARILY AFFECTS YOUNG PEOPLE:a)Homosexual and bisexual men between the ages of 20 and 39 yearsb)intravenous drug abusers use of dirty and contaminated needles and syringes.c)blood tranfusions e.g. Haemophiliacsd)heterosexuals are also now affected by the ill ness.REMEMBER!AIDS has mainly occurredinvery well-defined groups of people. If you or your sexual partner(s)do not belong to one of these groups, your chancesof gettingAIDSare virtually zero.IS THERE A CURE?Not yet but scientists are getting closer to finding one. There are now drugs such as AZTinexperimental and clinical trials. PREVENTIONISTHE KEY TO THE CONTROL OF THIS ILLNESS. All that doctors can do at the present time is treat the illnesses contracted because of the weakened im mune system such as tuberculosis and fungal infections. Unfortunately, without help from the body's natural de fences, illnesses may recur or new ones may develop.HOWCAN AIDS BE PREVENTED?The following precautions will help prevent the spread of AIDS1)Decrease your number of different sexualpart ners.2)Use condoms. 3) Maintain high standards of health and personal cleanliness.4)Do not have sexual relations with persons known or suspected of having AIDS or who is a known carrier of AIDS.5)Donot share needles and syringes ifyouuse intravenous drugs.6)Do not donate blood if you belong to a group affected by AIDS. REMEMBER!! AIDS may be contagious long before symptoms appear.WHAT IS BEING DONE NOW TO DEAL WITH AIDS IN THE BAHAMAS?The government of The Bahamas, through the Min istry of Health, has set up a Standing Committee to look into the problems of AIDSinthe country. Various sub committees have been set up and are now in the proc ess of submitting their reports to the main Committee.3


AIDSISHARD TOGETKENNETHOFOSU-BARKOAIDSisnowa diseaseofchoiceandnotof chance!!!YOUWON'T GETAIDSIFYOUDONOT WANTTO!Acquired Immune Deficiency Syndrome(AIDS)has'been acknowledgedasthemajor public health problem facing mankindinthis century. However,itmay notbeanexaggerationtosay that the other disease "FRAIDS" the fear of AIDS -hascaused more havoc than AIDS itself. AIDSiscausedbythe Human Immunodefi ciency virus (HIV), formally knownasHTLV-Ill/LAV. The World Health Organization (WHO)hasoffered the following definition forAIDSinadultsandchildren,intheabsence of confirmatory test forHIVantibody. Adults: Aidsinanadultisdefinedbythe existenceofatleast two ofthemajor signs associatedwithatleastoneminor sign,inthe absence of known causes of immuno suppression such as cancer or severe malnutrition or other recognized causes.1.Major Signsa)weight loss greaterthanorequaltotenpercent of body weight;b)chronic diarrhoea longer thanonemonth;c)prolonged fever longerthanonemonth (intermit tent or constant).2.Minor Signsa)persistent cough for more than one month;b)generalized pruritic dermatitis; (itchy rashes)c)recurrent herpes zoster; (shingles)d)oro-pharyngeal candidiasis (thrushinmouthandthroat)e)chronic progressiveanddisseminated herpes simplex infection (fever blisters)f)generalized lymphadenopathy (swollen glands) The presenceofgeneralized Kaposi's sarcoma and/or cryptoccoccal menigitisaresufficientbythem selves for the diagnosis of AIDS. Children AIDSissuspectedinaninfantorchildpresenting withatleasttwoof the following major signs asso ciated withatleast two ofthefollowing minor signsinthe absenceofknowncauses of immunosup pression suchascancer or other recognized causes.41.Major Signsa)weight lossorabnormal slow growth.b)chronic diarrhoea of more thanonemonth'sduration.c)prolonged fever for morethanonemonth.2.Minor Signsa)generalised lymphadenopathy;b)oro-pharyngeal candidiasis; ,c)repeated common infections (otitis,ear;pharyngitis, throat);d)persistent cough;e)generalized dermatitis;f)confirmed maternalHIVinfection'Ifafter readingtheabove signsandsymptomsofAIDSyouare beginningtosuspect thatyouhaveAIDS,just relax, thisisa normal phenomenon.Remember,thesignandsymptomsofAIDSarenonspecificandmayoccurinother disease states!WhentheHumanImmunodeficiency Virusinvadesthebody,theimmune system producesantibodiesagainst theHIVbefore the immune systemisdestroyed,ifitisgoing tobe.Generallywhenthebodyisinvadedbyorganisms that cause infection, it producesantibodiesagainst those organisms.Onsubsequent contract,theseantibodies are usedtofight this specific invader.Theseantibodiesaresaidtobeprotective antibodies.Theantibodies producedinAIDSdonothavesuchprotectivefunction. The presence of these antibodiesisaconfirmationthat the individual hasbeeninfectedbythevirus.Intheabsence oftheabove signsandsymptoms,heorsheissaid tobea healthy carrierofthevirus.Inthepresenceof the above signsandSymptomsheissaidtohaveAIDS. These antibodiestoHIV do not commonlyappearbefore six weeks after infection.Themajorityofpeoplewhoare infectedwilldevelop antibody responseswhichcanbedemonstrated overthefollowingsixweeks.However, there willbesomerareindividualswhoharborthevirusandwill not developtheantibody response.Whentested, these rare individuals will show a negativeresponse but willinactual fact continuetotransmitthevirus. Thereisalso a short "window" of time duringwhichantibody test will not identify a newly infectedperson


eventhoughheor sheiscapableorpassingonthe virustohisorhersexual partners. All currently available antibodytestswould miss such a person during this shorttimeinterval.Improvementsintesting methods mayreducethedurationofthe "window" phenomenon,but willnoteliminateitzHIVInfected individuals canbedivided into fourbroadgroups:1.wellwithnosignsofinfection. Thesearetheasymptomatic carriers.2.wellwith swellings (kernels) (lymphadenopathyinarmpits, neck, groin.) These individualsaresaidtohave persistent generalized lymphadenopathy (PGL)3.Lesswell with fatigue and night sweats. Theymayhave minor infections suchasshingles or oral thrush. They are classifiedashaving AIDS related complex (ARC).4.Those who meet the established diagnosisofAIDS.3Atpresent thereisnocure for the disease, but luckilyformankind, it canbeprevented. TransmissionofHIVhasbeenestablished tobethe sameinall parts oftheworldwhereithas occurred. The three major routesoftransmission are:1.transmission by sexual intercourse (heterosexual or homosexual)2.transmissionbyblood or blood productsas,for example, through blood transfusion or the useofunsterilized syringes and needles.3.transmission from mother to child, before, during or shortly after birth. With the advent of screening for HIV infectioninblood donors, the only people who may get AIDSbychance are those who might have been transfused withHIVinfected blood prior to 1985.(inThe Bahamas)Itis important that certain misconceptions about HIV transmission are dispelled. YOUDONOT GET AIDS BY:1.livinginthe same house withanAIDS patient.2.using the same plates and cutlery withanAIDS patient.3.travellingonthe samebus,boatorairplane withaninfected person.4.shaking hands withaninfected person. However,youare advised to avoid sharing tooth brushes or razors with other people. These objects allow the possibilityofblood contact.Asa matter of factyouhave no means of distin guishing a healthy carrierofHIVfroma healthy non-in fected person! Persons with AIDS represent only the late stageofHIV infectionandit is believed that theymaynotbeasinfectiousasthose individuals who areinthe ear lier stageoftheir infection. Short of askingyoutoabstain fromsex,the follow ing measures should reduce the riskofHIV infection:a)DONOT have multiple partners. Limit your sex ual partnerstothe minimum number tolerable, perferably to one.b)Use condoms.Ifused correctly, they shouldreduce the riskofHIV infection. The protection is increased when usedincombination with spermi cidal agents suchasDuragel which destroys the HIV.c)Begentleasusual and avoid traumatothe geni tal tract. PRACTICE SAFE SEX ALWAYS.Itisstill not known what percentage of infected indi viduals willgoonto develop the disease. The present evidence indicates that only a minority have doneso.There is every indication that the majority of HIV antibo dy positive individuals will never become unwell, let alone developAIDS.3Soeven ifyougolooking forit,youmay not get it. BUT JUST DON'TBE"RUDE". Ref: 1. Carec Surveillance ReportsVol.12NO.6.June, 1986.2.Report of the consultation on International TravelandHIV Infection. Geneva 2-3 March, 1987.3.Farthing Charles: Advice for people whoareHIV antibody positive. Postgraduate Doctor Vol. 3No.31987.5


ACQUIREDIMMUNEDEFICIENCYSYNDROMEPREVENTION-AROLEFOREVERYONEPETER DIGGORYThe first report of the Human immunodeficiency virus (the virus which causes AIDS) wasin1959 from Kinshasa, Zaire. This early detection was followedbyreports of 1.4%positivityinthe sera (blood samples) of 144 children from Burkina Faso this sera was collected for another purposeinthe later sixties. Simi larly, 50 out of75sera collected from Ugandan chil dren in 1972-73 had positive sera. However, these observations have not gone unchal lenged. The ELISA (Enzyme linked immunabsorbent assays) and Western Blot confirmations were the first generation of such tests (for AIDS) and believedbysome to have cross-reacted with malariaandother parasities. However, thereisnodoubt that there was a marked increaseincases of AIDS during the late 1970sinKinshasa and the early 1980sinUganda and Tanza nia where the syndrome became knownasthe slim disease duetothe characteristic wasting.Inthe USA,itwas the observation,in1981,ofthe occurrence of a rare formofcancer and pneumoniainyoung men, which servedasanalert.Oninvestiga tion, it was found that they wereallhomosexually ac tive. It was also discovered that their immune system had been severely damaged and,asmore cases were discovered,itwas noted that infections that individuals with normal immune systems could fight off, without being aware of the infecting agenUprotective mech anism battle, wouldbeinthese immune compromised individuals life threatening.These observations of a series of illnessesinhomosexual men led to the syn drome being called Acquired Deficiency Syndrome and the infections being called opportunistic infections. There was then a major effort launchedinNorth America and Europetodiscover the casual agent. This resultedinthe almost simultaneous discovery of a virus, a retrovirus,inUSA and France and given the names HTLVIIIand LAVI,respectively. Later by in ternational standardization, the virus has been re named Human Immunodeficiency virus and HIV for short. Much research had been undertakentodetermine the origin of the HIV and recent published evidence sug gests the origininthe Simian Immunodeficiency Virus from monkeys. As already mentioned, AIDS was seenasprimarily a problem for homosexuals. Indeed, it was stated tobe6a divine jUdgement by those who bitterly opposedthegay community. However,itwas soon realisedintheUSA that others were at risk, including intravenous drug abusers, recipients of blood products suchashaemophilics and occasionally recipients ofbloodtransfusions. The ratio of male to female caseswas14.1. However,inEuropeitwas observed that whereastheindigenous population had similar predominanceofhomosexual and intravenous drug abuser cases,immigrant workers from Central and East Africawerealso developing AIDS, but most gave histories ofheterosexual activity.Itwas also observed that theirpredominant clinical presentation wasofgastricsymptoms and opportunistic infections. This observation led to the intensificationofepidemio logical studiesinCentral and East Africa withmostsurprising results. Instead of the 14to1 ratiobetweenmale and female cases, the ratio was only 1.4 to1.Itwas foundinthe female cases that two out ofthreehad never been married and nearly one third ofthemarried AIDS cases hadhad one previous marriage or "Union Libre" persistent cohabitation withoutformal marriage. Eighty percent gave a history ofreceiving injections from health care workers and/ortraditional healersinthe past three years.Itmustbepointed out that for economic reasons re-usableneedles are the norm and sterilisation procedures,evenwhen practised, are often suspect. Interestingly,noless than nine percent gave a history of receiving a blood transfusion during a threey-:;arperiod beforetheonset of illness. The AIDS patients had a higher number of heterosex ual partners than controls (mean 32). There wasanapparent association between sexually transmitteddis-\leas:and AIDS, especially the presence of genitalul-tIts found that with the urban drift from ruralareasenfrequently prostitutes. Sequential studies ofthesame group of prostitutes over a four year periodhaverevealed rapid build-Up of infectivity, between27to83%insome studies. Similarly, observationshavebeen madeinprostitutesinthe USA includingMiamiand the Belleglade area of Florida, but there prostitu tion may be secondarytointravenous drug abuse. Heterosexual casesinAfrica werequestionedastosexual practices, anal intercourse of bisexuality,butthese were not significant factors.


Thisheterosexual transmission pattern will gaininim portance throughout the world unless effective mea sures are implemented.Thelesson from the known distribution and epidemio logical studiesisthat neither the infecting virus nor the resulting AIDS is exclusively associated with any singlerace, culture or sexual activity preference.Allareatthe risk without appropriate precautions andallshouldbeconcerned and support the necessary edu cational programmesandother prevention and control measures.l]PRESENTWORLDWIDE STATUSAsof July 1987, 55,396 cases of AIDS have been reported to PAHOIWHO from91countries. Compare this with only771cases reportedin1982 from only16countries. The 55,396 consists of 38,808 cases fromtheUSA, followed by Brazil (1,695), France (1,632), Uganda (1,138), Tanzania (1,130), West Germany (1,089), Canada (1,000), United Kingdom (870), Haiti(851), Ifaly (771).However, itisestimated that the number of cases worldwideismore than 100,000. WHO further estimatesthat between 5 and10million persons are currentlyinfected with HIV.Itisa sobering thought thatitisestimated that10to 30% of positive individuals willdevelopAIDS plus another 20 to 50%will developAIDSrelated illnesses. The recent discovery that theHIVcandamage the brainandcause dementia,asalongterm effect, brings into possibilityanepidemic of progressive neurological disorders. Notwithstandingtheunparalleled intensity of high quality researchasofnow,thereisnothing that will alter the ultimate courseofthediseaseinthose already infected, althoughmuchcanbe done to prevent further spread.gTHECARIBBEANSITUATION.CAREChas been receiving AIDS reports from the English-speaking Caribbean and Suriname since1983.ByMarch 31, 1987, 370 cases had been reportedbutthisisanunderestimateas7 countries havenotsentinreports for the first quarter of 1987. Only Anguilla and Montserrat have not reported a case.Unfortunately, itisonly recently that countries havebeenproviding informationonageand sex of cases..Outof 130 cases for which such informationisavailable,27 occurred in females(4:1ratio). Of the18adult female cases,13hadhadheterosexual contactwithaninfected individual, 1 hadhad a blood transfusion,1 wasanIVdrug abuser andnorisk factorscouldbeidentifiedin3.aREVENTIONAND CONTROL ACTIVITIESEverysexually active person mustbeabletounderstandthe risk of casual sex and adjust their lifestlye accordingly, whether heterosexual, homosexual, or bi-.sexual. Condom useisanadded safety measure. Un fortunately, the disease prevention role of the condomistoo often confused by someasa birth control cam paign. There isnoroom for infightinginthis serious situation; all shouldbeonthe side of promoting mean ingful relations and the discouragement of casual sex. The gay community who, dependingonlocal cultural pressures maybeunderground, needstobereached to discuss their special risks and the precautionstotake. The bisexuals are a special risk since they facili tate heterosexual spread and maybehardtoidentify.Itisimportant that those who think they may have been exposedtothe risk of infection can obtain a confidential test. This shouldbedoneinconsultation with their physician, who will ensure that thisisnot a frivolous request.Itisanexpensive procedure, since being positiveonthe first ELISA testisnot conclusiveastherecanbefalse positives. Additional special tests canbedone at CAREC or other facilities whichcanconfirm true positivity. Thereismuch workinpro gressonimproved testing and newproceduresshouldbeavailable within the next12months. Both those who are apparently well but are positive for HIV and those who are AIDS cases need counsellingonlifestyle modification and howtomaintain the qual ity of life when facing a life-threatening situation. The families need much support and where the individual can still work or attend school, appropriate action hastobetakentokeep the public aware that HIV cannotbetransmittedinnon-sexual relationships. Everything from handshaking to sharing the chalice at church should be cearly understoodbythe publictopose no risk. The Bahamas Government took early stepstoscreenallblood before transfusion to ensure thatitwas free of the virus. Long before AIDS was known, care has been taken with needlesandsyringesandsurgical instrumentstoensure that either disposables were used or safe sterilisation procedures were followed. Such precautions were long known to be necessarytoprevent the spreadofthe Hepatitis B virus (serum sickness)inblood contaminated equipment. Inciden tally, HIVismuch less contagious than the hepatitis virus andiseasily destroyed by a1in10mixture of household bleach. Pregnancy has a special risk both for the HIV positive motherandher baby.Ithas been observed that pre gnancy seems to bringonAIDSandsecondly that. thereisa 50% risk of AIDS developinginthe baby. This percentage may rise with longer term studies of babies. There has been at least one report of trans mission through breast milk. Therefore, for those women positive for HIV who continue tobe'sexually active, birth control methods, besides condom use, should be advised. For those who are pregnant, abor tion shouldbeseriously considered. Where sperm do-7


nors are free of infection. Similar care hastobetaken with the donation of body parts. Besides the wealthofmedical research articles, the AIDS pandemic has stimulated much literature for the public. Catchy titlesareinvogue "SafesexintheAgeof AIDS" or AIDS -Youcan't reachitbyholding hands. National educational programmes are endeavouringtoreach both thepublic and those withriskbe haviours through a varietyofapproaches. Australia has used the frightening approach with its Grim Reap er video,inwhichtheReaper bowls away men, womenand children. I understand the bowling alley ope rators were not too impressed but the programme has been reported to have greatly increased public aware ness. Switzerland has used a standard logo STOP AIDS where the'0'instopisthe end of a condom. Switzerland has also promoted a musical video aimed at the adolescentandyoung adult audience. The theme music became one of thetoptenhits. Ghana hasattention getting videoonthe deteriorationofayoung woman with AIDS -a living proof of wasting disease and her unawarenessofthe riskofher life style. The United Kingdom has undertaken a satu ration type public education programme, which includedthe deliveryofliteraturetoevery householdanda coordinated arrayofadvertisementsinthe media, both for the general public and for the high risk behaviours. WHOisencouraging the sharingofideas and experi encesonthe development and evaluation of commu nity education programmes. I had the privilegetoattend the meetingontheExchange of Strategies. Information and Materials for AIDS Public Health Communication, which was heldinGenevaon6-9July, 1987. CARECisbeing strengthened to provide supporttothe member countriesinthis vital areaofpublic education. May I leaveyouwith the thought thatnoamountofbrilliant scientific studies will have the impactonAIDSofourindividual efforts geared to the common goalofavoiding infectio!. and unnecessary anxiety .THEPUBLIC SPEAKS?SHANDALANAE EDWARDSInour search for objectivityinpresenting a complex and subjective topic suchasAIDS,wedecidedtoinvite public opinion. A short questionnaire, designedtodeter mine knowledge and attitude towards the diseasewasused. The sample survey was carried out duringthemonth of July. The study population comprised people offthestreets, workersininsurance companies, health care workers and school teachers. They fell into the age groups between fifteen and forty yearsofage. Analysis ofthe study would seem to indicate that:while theyhadsome superficial knowledge ofthediseaseegoAcquired Immune Deficiency Syndrome, a break down oftheim mune system, a fatal contagious disease, gleaned mainly from the media, newspaper, radioandtelevision, one person's source was gossip, this knowledge was limited and vague and showed very little if any understandingofthe implicationsofthe disease. Their concerns were mainly because therewasnocure for the AIDS virus and because they feltitcould have a great effectonsociety. With regardtotheir knowledge about the signs and symptomsofAIDS, again this was very limited. The majorityofanswerstothe question,some of the signs and symptoms of AIDS" was "weight loss". While the answeriscorrect,itisnot by itself a conclusive sign and therefore not enough to show any understanding of the disease.8With regardtochildren's knowledge aboutthedisease, many felt that children should learn aboutAIDSata yl)ung age, five or a little olderandthat parentsand"influential" friends shouldbethe source of theirknowledge.Onthe other hand, they stated that childrenwithAIDS should not be allowedinschools becauseotherchildren might contract the disease unknowingly,throughcuts, spitting or biting.Onthe whole the study population seemedtoleranttowards AIDS patients; they would not treatthemanydifferently or would show added understanding.Somewould prefertohavenosexual nor physical contactatallwith the person.CONCLUSION:Ifthis tiny study populationisany truereflectionofthe wider public's knowledge and attitudetowardsAIDSand,inlight ofthe difficultyindeterminingtheratealwhichthedisease is spreading in the population,itwouldseem that the public'sknOWledgeneedstobesubstantially increasedsothat they may protectthemselvesagainst the deadly virus.Atthis pointintime, public educationseemstobethe most effective answer.


AIDS:ITSIMPACTONMOTHERSANDCHILDRENDAVID SASSOONThe global epidemic of AIDS is posing what one expert has called the greatest challenge to public healthin50years. A reportonthe tollitis takingandthe issues itisraising. Excerpts from: Action For Children, Volume11,1987No.1A publication of the NGO Committee of UNICEF. Thereisa bit of good news about AIDS.Ifthis incurabledisease, whichiscurrently causing a global pandemic,appeared 20 years ago,wewouldn't have had thefaintestidea what was going on. Thanks to advancesinbiotechnology, the AIDS virus hasatleast been identified.But as Jonathan Mann, head of WHO's Control Programmeon AIDS, recently said, "That's the end of thegoodnews." Cases of AIDS, or Acquired Immune Deficiency Syndrome,have now been reportedin74 countries,andithasbeen estimated that several million people worldwidehavebeen infected with the causative agent of the disease,the human immunodeficiency virus orHIV.AIDS is a disease that attacks the body's immunesystem,rendering a person incapable of fighting off almostany infection by another virus, a bacterium, fungusor a parasite.Ithas proven fatalin85% of all cases within 2-3 years after it manifests, and hope for a vaccineisstill years into the future, if atallpossible. Whatisparticularly alarmingisthe impact the AIDS pandemic is currently havingonmothersandchildrenandhow it might impactontheir healthandwell-being, both directly and indirectly,inthe future.AIDS Striking Mothers and ChildrenWhen AIDS was first "discovered"in1981, it was thoughttobe a disease transmitted primarily through homosexual activity. Africa, where the virusisstriking women and meninequal numbers, has shown the threat of heterosexual transmission. Now there is the third generation of AIDS victims: Children. Children are acquiring the disease from in fected mothers, eitherinutero or during birth. Experts have found that two of every three women with AIDS will pass on the fatal disease to their babies. Since 1980, close to 1,000 infants have been born with AIDSinthe United States, and some experts predict that by1991the number willbe25,000.InAfrica, where fare more women have contracted the disease, the rate of infectionisastronomically higher. Zambia alone ex pects to be caring for 6,000 infants with AIDS this year. Whatisalso alarming expertsisthe threat AIDS poses to beneficial interventions which today are saving the lives of millionsofchildren each year. Because AIDS can be transmitted through the use of unsterilized nee dles, extra care mustbetakeninhospitals, clinicsandimmunization drives; manyareworried that unfounded fears could drive people away from any contact with hy podermic needles one of modern medicine's most basic and important tools.Immunization Deemed Safe and NecessaryThus far, there has been no demonstrated transmis sion of the HIV virus as a result of immunization.Itisthought that this is because properly sterilized injection equipmentiswidely used, and because relatively small numbers of vaccinations are received per child. The Global Advisory Group of the Expanded Pro gramme of Immunization, which includes officials from both UNICEF and the World Health Organization, pro posed that "given the benefits of immunization, pro grammes should continuetotrytoachieve the highest level of coverage possible." Vaccine injections represent,bysome estimates, less than 1% of all injections administeredinthe devel oping world. The riskofacquiring vaccine-preventable disease is thousands of times greater than the risk of acquiring AIDS. The benefits of immunization far outw eigh the miniscule risk of acquiring AIDS through vacci nation, and vaccinations have already saved thousands of livesinAfrica. Nevertheless,inthe world's developing nations, AIDSisstill being transmitted through contaminated blood transfusions and exposurestounsterilized needles,aswellasfrom infected mothers.tonewborns...Education One Key To Halting TransmissionThe basis of protectioniseducation, and education needs communication even about a subject like sex whichisnot a part of public discussion. Ever since the AIDS virus was "discovered"in1981, standards of ac ceptable discourse have been evolvinginthe news me dia. What words canbeprinted? Utteredontelevision? Spokenonthe radio? 9


Similarly, a debate has eruptedinschool boards throughout the United States. Should AIDS education become a part of regular sex education curricula? Par ents, teachers and health officials are struggling to deter mine just to properly educate children about such a SEN SITIVE TOPIC.African Nations Start to RespondInAfrica, too, AIDSisbecoming a topicofwide discussion. Initially silent about the virus, governmentsincountries particularly affected are becoming aggressive about combating the spread of AIDS, where incidenceissecondinabsolute numbers onlytothe United States.InRwanda, the government,incollaboration with the NorwegianRedCross, begananeducation programme using television and widely distributed pamphlets, and is not integrating information about AIDSinschool curricula and targeting other effortsatwomen, the segmentofthepopulation most afraidof,but least informed aboutthedisease...While this new openness is welcome, it comesasa response toanalready well-entrenched problem...World health experts hopetobegin the fight against AIDSinother nations before the disease becomessowide spread.Screening of Blood Supplies a PriorityInaddition to public education, therefore, the World Health Organization, the lead agencyinthe campaigntocombat AIDS, has launched a global campaigntocleanupblood supplies...Itcosts about US$6toscreen one pint ofbloodforthe virus, adding roughly 25% to the costofbloodtransfusions, anditrequires special equipmentandtrainingoflaboratory and medical personnel. WHO's global programme calls for US$1.5billionannually several times its current annualoperatingbUdgetto accomplish this task. A quickresponsetoWHO's effortsisanurgent priority for the medicalestablishmentsinallnations, whether AIDS is currentlyprevalent or not. Policymakers are being asked tomobilizetheir health delivery systems to respond.Prostitution Poses High RisksAnother areaofgreat concerntohealth expertsisprostitution...Prostitution could become a dangerousavenue for the transmissionofAIDStothe populationatlarge.Atthe same time, it puts many mothersanddren at risk.Itisnosecret that many prostitutesarethemselves little more than children. Thisisthemosthorrifying possibility; prostitutes infected withAIDS,manyof them mere children, giving birthtomore childrenbornwith the fatal disease. AIDS is challenging mankindina way thatdiseasehas never done before.itis threatening the efficacyofsome of modern medicine's most fundamental toolsofhealing; itistesting the abilityofmankindtoworkcooperativelyona global scale;inshort, this simplebiologicaldevelopmentisaffecting the behaviour ofindividuals,communities, and nations .YOURTESTRESULTSARE...(PATIENTS'REACTIONSToINFECTIONWITHHIV)ROSA MAE BAINTesting for the Human Immune-deficiency Virus (HIV) began at the Princess Margaret HospitalinNew Providence in August, 1985. Testing began one month later,inSeptember,attheRandMemorial Hospital, Freeport. Since that time, some private laboratoriesinthe country have also begun testing for the HIV. Between August 1985 and June, 1987, The Bahamas has recordedthe following statistics relativetoAIDS.August-December.1985January-December,1986January-June,19871036cases15sempositive(HIV)50cases71seropositive(HIV)40cases52sero(HIV)5blooddonors24deaths12blooddonors19deaths14blooddonors12deathsOnce a person tests positive for the HIV, he/sheisplaced into one of the following groups:1.A CASE(or AIDS, Acquired ImmuneDeficiencySyndrome with positive HIV) The personisillhe/she hasan"Opportunistic infection".InTheBahamas, such persons usually present withanycombination of the following ---chronicdiarrhoea,weight loss, prolonged fever and persistent cough, diagnosedaspneumonia or tuberculosis. A significant number' also have othersexually


transmitted diseasessuchasherpes, syphilis or gonorrhea.2.AIDS RELATED COMPLEX(ARC), positiveHIV.These persons are usuallynotill,butmaypresent with one or more symptomssuchasswollenglands (lymphadenopathy), fever, diarrhoeaandcoughwhichisintermittentbutpersistent for more than a month.3.ASYMPTOMATIC INFECTIONwithpositiveHIVseropositive group. These persons test posi tive forthevirusbutareallphysically well. TheyareknownasCARRIERSandcaninfect others. They may/may not becomeillfromthevirus, but those personswhomthey infectcanquicklybecome illanddieasa result.Whena person tests positive for theHIVantibody,whetherhehassymptoms ornot,thefollowingprocedureisfollowed:-i)thephysician for infection disease informs him/her of the positive test;ii)further laboratory testsonallsystems of the body are donetodeterminehowwellthesystemsarefunctioningsothatifthereisa problem, itcanbetreated early; for example low ironorsome other infection. Tests doneare:-fullbloodcount; a liver function test; a kidney function test; test for syphilis; stoolandurine tests. iii) a complete physical examinationisthencarriedout.NEWPATIENTSiv)A return appointment foroneweekisgiventoassess the laboratory results.Allother personsaremonitored. Theyareeitherseenona three monthly basisifasymptomatic (havenosymptoms),ormorefrequently, de pendingontheir illnessandthetreatment necessary. Further,allnewpersonswhotest positive forHIVarereferred to the Infection Disease Consultantandseenata special Infectious DiseaseClinic. The physicianandCommunity Health Nurseworkingwiththesenewreferrals witnessatfirsthandtheemotional changesandstress these patients undergowhentoldtheyarecarriersoforhave the disease -AIDS.Onceinformed, individuals become very anxiousbecausemostofthem know very little if anything aboutthedisease. Many are convinced that itisonly a matteroftime before theydie.Because of this, QUALITY TIMEhastobespent educating them.Indealingwithsexuality,thebiggest concern of these individualsisfor strict confidentiality. Theyareassured that this important request willberespected,anditisadheredto.They are appropriately advisedandurged thatallsexual contacts mustbenotifiedsotheycanbetested fortheHIV.Counselling done attheSpecial Clinicandonhomevisitsinclude:-i)bUildingupa rapportwithclients.ii)bolstering their self-image. Thisisimportant. iii) discussing their conditionanddetermining what theyknowalready aboutit.iv)giving standard advicetohelp personswhoare not ill,buthavea positiveHIVtoreduce their riskofbecomingillanddeveloping the full blown disease (AIDS). they are advised abouttheimportance of rel evancetothem of having adequate nutrition, adequate exerciseandrest;they are advisednottobecome exhausted; theyareadvised about proper ventilationandsunlight; theyarehelpedandencouragedtoaccept their condition,toavoid stress,toavoidbecoming depressedandreferred for profes sional counselling if necessary; they are further encouragedtoavoid drugsandalcohol abuse; they are urgedtopractice safesexonly-forexampletohaveonepartner,orpersonwithsameHIV antibody status, tousecondoms alwaysandpaystrict attentiontogoodper-sonal hygiene. 'Weexplain that personswithHIVinfectioncanliveathomeand maintain a normal lifeasthevirus isNOTspreadbycasual, non-sexual, household contact.Westresstheurgency of not infecting others. Althoughyoumaynotbeill,wesay,youhave the HIVandcantransmit ittoothers whose resistancemaynotbeasgoodasyours.Youcaninfect themandtheymaydevelop AIDSanddie after a short time.Toavoid thisyoumustNOTengageinanyformofsexthatcanresultintheexchangeofbody fluids, semenandblood,ORcause injurytobody tissueashappensin,for example,analsex.Youmust ALWAYSusea condom.Ifyouhavecuts or lesionsonyour handsyoumustnotengageinfond lingormanual masturbation.YoumustNOT become pregnant.Youmust notusedrugsoralcohol, sharerazors or toothbrushes.11


Inaddition to the above, you should practice good personal hygiene, good health and housekeeping habits; use 1:10solution of household. bleach for cleaning up any spills of body fluidssuch as blood, semen, urine, faeces or vomit. On being told that they test positive for the HIV per sons attending the infectious disease clinic, not surpris ingly, undergo tremendous emotional strain. Their reac tion can be anything from shock, disbelief, denial, fright, depression, anger, concern for loved ones, revenge, sui cide to total dependency on others. Their immediate reactions, to list a few: Are you sure? Can you repeat the test? How did I get it? Why me? How long do I have and what about my family? Am I going to infect them too? SID, a 24 year old intelligent young man, was re ferred to the Clinic for investigation of swollen glands and generalized fatigue.Hewas obviously well read and knew a lot about Acquired ImmuneDeficiency Syndrome. Becausehefell into the "At Risk" group of bisexual male prostitute and drug abusers and had swollen glands with intermittent diarrhoea, he told the doctorhefelthehas AIDS even before his test confirmed this. Sid was given the standard counselling and health education. His list of sexual contacts was,tosay the least, shocking, approxi mately fifty; most known only by nick names withnoknown address. They usually met at the base houses where anything goes for another hit of drugs. His reac tion to his condition was, "I' don't feel sick, Iamnot a risk to my immediate family; the diseaseisnot spreadbycasual contact, I live alone anyway and I am sure the group I hang out with must all be already infected. His reaction to avoid infecting others and changing his lifestlye and practices was"Iknow I can do a lot to helpinthe fight against AIDS but sorry, I am not ready just yet. LateronI will re-enter the drug programme, start going to church and visit at risk areas where the disease is spread and teach people how to avoid contracting and spreading the virus.Inthe meantime, I will continue to work, make good money, use my drugs and enjoy life. You see, I don't feel sick yet". He was classified as ARC (Aids Related Complex). DICK, a 19 year old quiet, reserved young man, was homosexual. He developed a chest infection and pre sented with swollen glands (kernels) everywhere. He was ill and required weeks of treatment and care.Onlearning of his position HIV testing, his reactions were fright and concern for his immediate family. He agreed to consel ling sessions with them.Inthat setting the disease was discussedinrelationtoits spread and prevention. Guidelines were given for household contacts. It was stressed that persons with the infection can safely live at home and maintain a normal life since the virus is not spread by casual contact. Family members were very supportive, although initially they were obviously upset and emotionally strained. They cried and prayed and 12 promised to do all possible to help him keephis resis tanceupby ensuring he got adequate nutrition, rest and exercise, to help to reduce stress and remind him about keeping his clinic appointments regularly. Today, two years later, Dick, has developed AIDS. He is adjusted, still working, receiving family support and is very active in his church. His main concern and that of his family was CONFIDENTIALITY by all those con cerned in his care. Since his diagnosis, he has avoided sex, changed his attitude toward sexual practices and knows that ifhedoes engage in any form of sexual activity he MUSTusea condom to prevent contact with semen, vaginal and/or salivary secretions and blood. RON,an18 year old, was very excited abouthisgirlfriend having their second child. Feeling strong, healthy and almost like He-man,hewent to donatebloodin case it was needed during her delivery. When he got a call from the Blood Bank to visit them, his immediate reaction was, "Gosh, you mean they need more blood?" his chest swelled and he felt the proud father-to-do. When givenanappointment to see a hospital doctor because of a problem with his blood, he said,"tfeelO.K., how come my blood is low?" He was politelybutgently told that the doctor would discuss it with himandexplain the problem. Thinking there might be a small problem andhemayneed some iron tablets, Ron went to see thedoctor,surprisingly, taking his mother along for company.Soonthe Nurse called himinand mother sat smiling andwaiting for her son's return. Then like a wild bull,Rondashed from the room calling to his mother,"Comemammy, come here".Together two very frightenedpersons entered the examination room. The parentalrolethen came to the fore, "Goodness child, whatisthematter, what so bad you crying, sweating and shakinglikethat? Nothing could be that bad, only AIDS and Iknowyou don't have that. Come doctor, what wrong withmychild, he has cancer?" Following the education, advice, counsellingandsupport given the family that day, both the nurseandthedoctor were weary. They were also two concerned,disturbed individuals, who wondered whereitcould allend.Ron had completed his high school educationata private school at 16 years and started working.Hehadcontinued seeing his high school sweetheart andwassaving money for the down payment on a lowcosthouse. Unfortunately, his girlfriend had becomepregnant,but both families supported the young couple, eachcontinued to live at home. They were upset that theyhadstarted a family before marrying but the weddingwasplanned for as soon as they got the house. Apparently Ron's biggest mistake was thathehadaccompanied friends from work on a few occasionstoa prostitute house for kicks.


Neithermother norsoncould believehehadAIDS.Incontrasttothe mother,thereactionwasoneofextreme anger. She actually threatenedtostabhim.Ittook days of continuous counselling, emotionalsupportandvisiting before she actually acceptedthesituation. Her boyfriend, herself and the new babywereallpositive for the HIV. Alas, the new infant developedthedisease and dies.Todaytheyoung family is married, closer than everandobtaining active support from parents.Inthis instance, one or two slips endedinchaos foryoungsterswho had their whole life mapped outfromschooldays.How sad.JANE,a25year old, had two children by her firstboyfriend.After they brokeup,shehadone childbythesecondboyfriend. The baby boy died shortly after birthin1983.Shethen got pregnant for her third boyfriendandhasanother baby boy.Bythe ageofeight months, thechildhadbeen admitted to hospital with FailureToThriveandseveral episodesofgastro-enteritis (diarrhoea).In1985, the child was positive for AIDSanddiedshortlyafterwards.Bythis time, she was not only alreadypregnantagain, but almost to term (due to have herbaby).Blood testsonher and the father were positive,thenewbaby was also positive for the HIV. The first two children's tests were negative along with their father.Themother refused to have her tubes tied after herdelivery,despite intensive counsellingfromthe healthteam,Infectious Disease Doctor, Obstetrician, Nurseanda Spiritual Leader. The new baby has already been admittedtohospital four times with diarrhoea, skin rashesandFailure to Thrive. Seven months later, Jane has left her boyfriend whotookhisinfant daughter and sheisnow living with a new partner andispregnant again! The new boyfriend's bloodtestis presently negative,but,for how long?./Jane's case history is presently under review.Shehasnot only refusedtohave a tubal-ligation butshealso refuses to use condoms. SUSAN,isa15year old student. Sheistaken for treatment for her drug problembyher mother, a single parent who has three children involvedindrug abuse. Becauseofthe association between drug abuseandpromiscuity which resultinnumerous sexually trans mitted disease including AIDS, screeningwasdone,itshowed a positive HIV. Double trouble!!! Susan who never missed a school day, admittedtousing drugs from the age of12,she became sexually active at 13 years. She can only give first names of her contacts and doesn't know their addresses. Her condition has been explainedtoher and her mother. Advice and counselling have been given. The Psychiatrist and Social Workers are working with the family since she dropped outofthedrug programme. The family's attitudeis"sowhat, she broughtitonher self". SALLY, another15year old high school student, was broughttotheclinicbyher mother after she viewed the five part seriesonAIDS,onZNSTV13.She really came for advice because her daughterhadlost weight and got swollen glands all overinthepast few months. The test for AIDS was positive. The studentwastoldofher problem. Her reaction wastocontinue smilingandnodding her head...shocknodoubt.Sheadmittedtobecoming sexually activeatChristmas 1986, but did not know where the boy wasnow.Although the motherhadinitially brought her daugh ter to hospital, her reaction wasoneofextreme shock.Onbeing told the results, she jumpedup,took off her glasses and saidtothe doctor, "repeat whatyousaid."Thedistraught mother then lashed out at her daughter, but she very qUickly composed herself. The following day, she requested a letter from the clinic stating her daughter's test resultsandproblem. Shehad already sent her offtorelativesinthe United States; she was at this time emotionally unabletocope with questions from friends or others about her daugh ter's condition.Shewanted everythingtoremain anony mous and confidential. Another young student engagingina casual sexual relationship, the first timeinher life, she becameinfected. NANCY, a beautiful, caring parent spared her only 18son nothing she could afford once she con sidereditgood for him.Hewas attending school abroad, became ill, saw a doctor, was diagnosedasAIDS and returned home tohisyoung36yearoldmother. What a blow! Shockedandhurting, she set outtocontinue giving her son the loving care that only true mothers can provide. Her first task wastovisit a doctor and learnallshe could about the disease process. She then stopped working, stayed homeandwith the support of her doctor, nurse and spiritual leader, stoodbyher son untilhesuccumbed to the dreaded disease. Here was a promising young Bahamian, preparing himself to return home after equipping himselftocontrib ute to the economic developmentofhis countrybut,alas, a few casual affairs cost himhislife andhisfamily and friends atonofdistress. The message, loudly, clearlyanunequivocally must be: DO NOT ENGAGEINCASUALSEX.FORMA13


LONG-LASTING STABLE RELATIONSHIP WITHONEPERSON. SAVE SEXFORAFTER MARRIAGE.BEN,a 40 year old seasoned worker took illonhisjob.Hefelt weakandblackedout.Whileinhospital,hehadroutine investigations forhisblackout.One test showedhewas positive for the AIDS virus. Physicallyhewas thin, had lymph nodes, skin changes, fever, weight loss and a chest infection.Hewas diagnosedashaving AIDS. His reaction was oneofshock and disbelief.Ittook a while for him to acrually accepthiscondition.Asthe disease progressed, Ben's condition deterio rated.HefUllyunderstands howhecontracted the dis ease and how he may have spreadittomany others.Benvisited base housesandhadmany casual sexualpartners.Heprovided the drugsandthe money, they the sex. His main objectiveinlife nowisto abstain fromsex.Hesuggested thatallpersons with positive HIVdothe same.Heis'also prepared to assistineducatingthegeneral public so that adolescents, young adults, adults like himself, mothers, mothers-tobe,unbornandnew born infants may not become infected. JACK, a22yearoldyoung businessman, being a good corporate citizen, wenttodonate blood.Histest showed positive for the AIDS virus.Hisinitial reaction wasoneof disbeliefandshock. When screened, two ofhisthree contacts also showed positive HIV. Jack lives aloneandseesnoreason to involvehisfamilyinhis health problems.Heunderstandsthedis ease, its methods of transmission and prevention.Hekeepsincontact withtheclinicandattendshisprivate physician. Twoanda half years after his bloodwaspositive for the HIV Jack has lymph glands butisotherwise wellandcontinues torunhis business whichisdoing well.Hehas changed his sexual practicesandknows thathemust practice safe sex.Hetooisworking with young people and helping to channel them into areaswhere they will not contractthedisease.Fromthe above nine cases studies,allnames havebeenchanged, itishoped that others like young Sid, intelligent and a first class employer, will not get involvedindrugs and casual sex, and automaticallyatrisk for the AIDS virus. Young Dick, a homosexual,wasvery muchatrisk for getting AIDS. YoungRona heterosexual, went with female prosti tutes twice only.Hehadhadonly one girlfriend.Hisen counters with prostitutes resultedintwo innocent persons being positive fortheHIV.14Jane, a young woman with numerous sexual part ners, infected her unborn/newly born children, they died very young. Susan,anadolescent,hadhad only one sexual partner.A young adulthadcasual affairs while abroad, A mature adult with a family involvedindrugsandmultiple casual sexual contacts. The main thrustofthe counselling sessionsareto:1.Provide support for clientsandtheir families.2.Provide information about AIDS to clients and familiesandtoadvise them aboutpreventiveandprotective measures they should adopt. EmphasisisplacedonadheringtoSAFE SEXsoasnot to infect others. Patients are urgedto:-A)Avoid exchangeofbody fluidsinanyandeverysexual encounter;B)Avoid analsex-itistraumatic, itcausesbleedingandsemen is readily absorbedintothe circulation thus allowing easy accessofthe, AIDS virustothe blood.C)Usecondoms they are a barrierandassuchgive protection.D)Avoid casual affairs/one night stands.E)Avoid multiple partnersF)Avoid drugs. Working with personswhohave AIDS orarepositivefor the HIV(ARCorcarriers) and their familiesrequiresanimmense sensitivity to persons' needs, deepcommitmenttohelping others, a firmnessofwillandabottomless pit of emotional strength.Atthe endofthespecialclinicweare often exhausted. Some patientsobviouslyrequire much more than others. The co-operationofcolleagues in every departmentofthe MinistryofHealthisvitaltohelping patientsandtheir families copeassuccessfUllyaspossible with their disease. Needlesstosay,Confidentiality, divulgingofinformation aboutthepatient's condition to anyone, unknowntoorwithouthis/herconsent mustbeour hallmarkjfAIDSistobecontrolledin ourItalso makes the taskofworkingcloselywith these patientsandtheir families slightlylessonerous.EDITOR'S NOTE:Theadvice relative to safe sex is also most germaneforALL sexually active membersofthe public. Abstinence and/or monogamous relationships for each memberofthe couple are the recommended precautions.Maintaining high standardsofpersonal health and cleanlinessarealso suggested.


UP-DATEFELICITY AYMER WELCOMEToThe Health EducationDivision:- Mrs. Dale CLARKE, Typist, on transfer from the Sup plies Section of the Princess Margaret Hospital effec tive 1st June, 1987. Mrs. Clarke brings with her a degree of quiet elegance and willingness to work which is just as weff becausesofar, the volume of work has been heavy and is expected to increase. Mrs. Clarke is married to Mr. Theadore Clarke a Cus toms Broker/Sales Manager at Bahamas Drug Agency and the couple have a son Kedar Tavares aged two years. Mrs. Joan DEMERITIE, Chief Clerk,ontransfer from the Public Health Department, effective21st July, 1987. Mrs. 0 as she is fondly called, is like a family member returning home; but, as is to be expected after a long absence, the family's composition has changed. Mrs. Demeritte is quickly settlinginand is attempting to imprint on the Division her unique stampofcalm effi ciency and order.Itis most reassuring tobeworking with a new member of staff but one whose capacity for hard work, efficiency and dedication are known and proven. Summer Students Dionne BENJAMIN and Shandala nae EDWARDS. Dionne isanArt Student at the College of The Baha mas. Her understanding of health and her willingness to interpret ideas are indeed refreshing. Our regretsarethat her stay with us has been so short and that the possibilities of her returning to work with us, re mote. The Divisionyour graphic contributions most sincerely and wishes you all the very bestinyour studies and laterinyour professional life. Thank you for passing through Dionne and thank you Stanley (Burnside) for identifying her. Miss Edwards joined the Division having completed a first degreeinhealth education at Morris Brown Col lege, Atlanta, Georgia,inMay of this year and it is hoped that she will continueinthe Divisionasa Health Education Officer at the end of the summer period. Miss Edwards left The Bahamas with her family at the age of nine years. She has now finally returned home to work and contribute to her country. She is young, attractive, quietly confident, willing and able to work. The Division welcomes you, Shanda. We hope you will spend many years with us especially as you have already demonstrated a capacity for "soliciting sup port" for the Division! Welcome. Having welcomed four persons we have said goodbyeto: Mrs. Keva NEWBOLD and Mrs. Patricia FERGUSON. Mrs. Ne.wbold our young, exuberant typist of many years, discovered she had a flair for figures and has eventually been transferredtothe Accounts Section. Best wishesinyour new job Keva, we hope you con tinue to enjoy it and that you continue to progress up the accounting ladder. Mrs. Patricia Ferguson transferred to Ministry of Health Headquarters in mid-June and is happily busy. Very best wishes Mrs. Ferguson. To the Princess MargaretHospital:- Dr. Mario BLANCO, Pathology Department, 1st July, 1987 Dr. Owasa DUAH, Registrar, Pathology Department, 11th June, 1987. Dr. Duah completed basic medical studies at the Uni versity of Ghana's Medical School and wentonto post graduate training at the University of Western OntarioinCanada. His fields of specialisation areinTropical Medicine, Clinical Immunology/Allergy and Laboratory Medicine. His research interests include Immunologi cal Diseases including AIDS, Haematological (blood) Disease and Oncology (cancer).Dr.Duah is married and the father of five children. Dr. Jill GIBSON, dentist, andDr.Ellen STRACHAN, also a dentist, to the dental department bothon1 st July, 1987. Manessia SMITH tothe-ECG DepartmentinJuly, 1987. The following nurses to the Princess Margaret Hospi tal: Staff Nurses Kayla COLEBY: Donnel DEVEAUX: Jan et FORBES; Berthamae FRAZIER: Portio FERGU SON: Clarabell GARDINER: Maria HALL: Katie Mc PHEE; Sabrina MUNNINGS: Julian NAIRN; Agatha 15


STRACHAN: Karen THOMPSON,InNovember, 1986. Jane BYRANinApril,1987.Trained Clinical Nurses: Kendra ADDERLEY; Sandramae BETHEL; Carmila EDGECOMBE; Roslyn FARRINGTON;KimHARRIS; Canal HEPBURN; Vernita INGRAHAM; Naomi JOHN; Lescetus McGREGOR; Sophia M!LLER; Patricia MITCHELL; Esther ROBERTS; MeldaROLLE;Valarie RICHARDS: Melony SANDS; Valarie SMITH; Doro thea TAYLOR,inmidJanuary,1987.Toallauxiliary nursesandmembers ofthehouse keeping staff joining the large family oftheMargaret Hospital duringthepast year.Tothe Sandilands RehabilitationCentre:-*Mrs.Carolyn MINUS-ROBERTS, Pychologist*Mrs.MargotROLLE,Executive Officer.Allauxiliariesandsupport staffwhojoinedthefamily atthe Sandi lands Rehabilitation Centre duringthepast year.*AttendantMr.JosephPENNafter alongillness; Wel come back. CONGRATULATIONS:-*Mr.Nathaniel BASTIANonyour promotiontoAssis tant Maximum Security Officer, Sandilands Rehabilita tion Centre.*Dr.Barrington NELSONonyour appointmenttoSenior House Officer, Sandilands Rehabilitation Centre.*Gloria ANDREWS, Gabrielle O'BRIENandBrian SEY MOUR (Medical Records Department, PrincessMargaret Hospital); DencieBROWN,DorettaROLLEandSonia THOMPSON (Administration, Princess Margaret Hospital); Merril COOPER (Accounts Department);andAnita BURROWS (Eye Clinic)onyour promotiontoSenior Clerk. CONGRATULATIONS:-Tothe ninety four nurseswhograduatedon15thAugust, 1987. Ceremonies were heldatThe Wyndham Ambassador Hotel, Cable Beach. Graduants comprised forty-three Registered Nurses, thirty-seven Trained Clinical NursesandfourteenPsychiatric Nurses. CONTINUING EDUCATIONS:-Dr.Donald COOPER, Public AnalystandMr.Carlton SMITH, Acting Senior Health Inspector, Grand Baha-16ma, attendedanInternational WorkshoponImpact Assessment for International Development, sponsoredbythe Inter American Development BankandheldinBarbados 31st May 4th June, 1987. Mr.Edwin STRACHAN, Deputy Director, Department of Environmental Health Services, attendedtheNational Environmental Health AssociationandEducationalConference 13-18 June, 1987,heldinSanDiego,California.*Health Inspector GradeI,Melony McKENZIEandSenior Laboratory Technologist, Dwayne CURTISattended a SeminaronCanned Foods: ThermalProcessingandContainer Evaluation 22-26 June,1987inBarbados. The following NursesfromtheCommunity Nursing Services attended aDrugAbuse WorkshopheldatThe Bahamas School of Nursing 13-17JUlyand2024, July,1987:-BrendaARMBRISTER; Linda ABERE; Sandra COLEBY; BrendaCOX;Kathleen JOHNSON; Dorothy MILLER (New Providence); Pattie DANIELS, Inagua; BernadetteMOSS,Exuma;BarbaraRECKLEY, Abaco; Edna TINABOO, HarbourIsland; 13-17 July, 1987. Albertha BAIN; Thirza DEAN; Norma GORDON;Bowlene NIXON; Maggie TURNER(NewProvidence)2024July, 1987. TCNs Pearl MILLSandLuella MONROE(CNS)attended Refresher Work Improvement 2 course18-22May,1987,atthePublic Service Training Centre,ArawakCay.Also attending coursesatthePublic ServiceTrainingCentre were:*NOs2 Gloria GARDNERandBernadetteGODET(CNS) Effective WorkinginGovernment;*NOs2 Philabertha CARTERandDeborahFOX,SNMaggie TURNER,(CNS)Management Improvement 1 29th June 3rd July, 1987. HAsPearline BURROWSandLilian CLARKERefresher Work Improvement1,13-17 July, 1987. CONGRATULATIONS:- Ms.Lynn GARDNERonhaving obtained a B.Sc.degreeinDieteticsattheTexas Women's UniversityinMayofthis year.Ms.Gardner returned to workattheSandilands Rehabilitation CentreinJune.*Anthony DEVEAUXonsuccessfully completing a courseinElectrical Installation (with Honours);WayneGardiner, Air ConditioningandRefrigeration;BrianJOHNSON, Plumbing; Erwin JOHNSON,Masonry;Elijah McKENZIE, Carpentry;PaulRAMSEY,Electrical Installation;atthe Industrial Training Centre.Allarestaff members attheSandilands RehabilitationCentre.*Dr.Herbert ORLANDER, Princess Margaret Hospital,onobtaining a MastersinPublic Health (MPH)atthe


University of the West Indies, Mona, Jamaica.Dr.Orlanderhas already returnedtowork intheComprehensiveClinic. SN.Tanya THOMPSON, Princess Margaret Hospitalonsuccessfully completing a diplomainmidwifery. Dr.RobinROBERTSonhaving successfully completeda four year periodonspecialised traininginUrologicalSurgery at The University of Dalhousie'sMedicalSchool, Canada. Dr.PaulWARD, Senior House Officer, Princess MargaretHospital, is presently pursuing a three yearcourseinObstetricsandGynaecologyatthe UniversityoftheWest Indies, (Jamaica) DepartmentofMedicine.SNRemaBURROWS (PMH)ispresently pursuing aoneyear course (started 1st May, 1987)inmidwiferyattheUniversity of the West Indies Hospital. PrincipalNursing Officer (PMH) Mrs. Theda GODETandFinancial Controller (PMH) Mrs. Francina HORTONproceededonanobservation tour (one week) oftheEast General Hospital, Toronto; Canada. Nursing Officers Ruth FERGUSON and Rose AHWAHbothof(SRC) willbetravellingtoLondon to pursue aoneyear courseinNursing Administration at the RoyalCollege of Nursing. Nursing Officer Julian ARANHA willbetravellingtoJamaica to pursue a one year courseinNursing Ad ministration at theU.W.I. Psychologists at Sandi lands Rehabilitation Centre:HarryFERERE who willbeleaving to enter the doctoralprogrammeinClinical Psychology at Nova Uni versity, Fort Lauderdale, Florida. FabianTHURSTON who has been accepted for graduatestudies in Clinical Psychology at New Mexico Highlands University. Kerry WORREL-HIGGS who willbestarting studies in Guidance Counselling Education at the UniversityofSouthFlorida. Attendants at Sandi lands Rehabilitation Centre AllenSmithand Zack FRANCIS have been given In-Service Awards to enable them to enteranAssociate Degree ProgrammeinOccupational Therapyinthe United States. Lorinda HANNA, Health Aideinthe LaboratoryatPrin cess Margaret Hospital willbeentering a BachelorofScience degree programmeinMedical TechnologyatFlorida Memorial Hospital, Miami. Tomacina ROLLE, Clerk in the Accounts Department, MinistryofHealth has gained admissiontotheB.Se.programmeinBusiness Administration Managementatthe Universityofthe District of Columbia, Washington. Wendymae FERNANDER, Clerk (PMH), has gained admission to the BA programmeinPsychology with a minorinPersonnel Administration atSt.Benedicts' Minnesota. Staff members at the local PAHO office said a fond butsadfarewell to one of their most efficient col leagues, Miss Althamese HALL,whohas goneonstu dy leave.WeinHealth Education and Joining Hands For Health will also miss Miss Hall'scheerful and speedy efficiency. Verybest wishes for your successinfurther studies.Welook forward to your return. The Training Department, (SRC)incollaboration withthePublic Service Training, Centre, sponsoredanin house seminar for its supervisors and headsofde partment. From all reports, the seminarwasa re sounding success andallparticipants received certifi catesonits completion. The on-going summer programme at the Child Guidance Centre has been successful.Inaddition to formal instruction, the children were takenonnumer ous field trips including a triptoCoral World. CHANGE AND???Changeisaninevitable part of life and the Public Health Department hashadits fair share recently.On12th June, 1987, staff members oftheDepart ment metinthe Health Education Division ConferenceRoomto say goodbye toDr.Farhat MAHMOOD, Act ing Medical Officer of Health since the retirement ofDr.Cora DavisinAugust, 1985.Dr.Mahmood joined the DepartmentinSeptem ber, 1978 and was particularly interested in Occupatio nal Health matlers and health education.Hespear headed the epidemiological surveyinGrand Bahama whichisstill underway and expanded the workforce in the department of almost unrecognisable proportions. UnderDr.Mahmood's leadership, the complementofMedical Officers in the department grew from fivetosevensothat two physicians_havebeenonduty at each ofthe main Child Health Clinics since February of this year.Inaddition, a physicianisalso present during all clinic sessions.Dr.and Mrs. Mahmood and their two sons left The Bahamas for a well earned vacationintheirnative Pakistan via the UnitedStates. This Journal joins with the staff of the departmentinextending best wishes for health, happiness and success to the Mah mood family.17


The Department took the opportunity to offer best wishes toDr.Sandra HEADLEY, Medical Officer who has worked mainlyinthe Ann's Town Clinic and who has now left for further studiesinPublic HealthinFlorida. Joining Hands for Health extends its best wishes for your successinacademia,Dr.Headley.*After twenty-five years withtheMinistry of HealthandPrincipal Nursing Officer, Community Nursing Services for the past four, Evelin PRESCOD decided to take lifeata more leisurely pace.With hindsight we appreciate and thank youforthose wordsofdiscipline and advice.Ona wet eveningatthe endofJuly, Colleagues gathered at Longley House, HeadquartersoftheNurs es' Association,toextend envious farewells and remi nesce over the "old days" when Mrs. Prescod, known thenasMiss Stewart, joinedthenursing sororityasa general duty nurse and steadily movedupthroughtheranks. While Mrs. Prescod seemstohavehadanout standing careeringeneral nursing she seems to have further excelledintheCommunity Nursing Services. Her colleagues have agreedtoallow her a shortrespite"10cool out under the cherry tree in her garden".They will then request and expect hertograciously agree to lending themoneor two helping handsas.Wemissyou Mrs.P.we wish you all that is good and lovely In the yearstocome.18Werejoice and say thank you for the time spent amongus.the situation dictates. They will most certainly missherobjectivily and ability to see the other sideofthecoin.Verybest wishes for a long, healthy, excitingandproductive retirementMrs.Prescod.Weshallkeepintouch.*Dr.Kenneth Ofosu-BARKO knownasDr.Barko,ispresently carrying out the functions of the MedicalOfficer of Health.*Mrs. Celeste LOCKHART, veteran nurse, pastpresident of the Nurses' Association of The BahamasandSenior Nursing Officer, Community NursingServices,is currently sittinginthe hot seat recently vacatedbyMrs. Prescod.*Mrs. Jacqueline MYCHLEWHYTE, for manyyearsChief Executive Officer at the SandilandsRehabilitation Centre hasbeentransferredtothePersonnelDepartment at the Ministry (of Health's) Headquarters. TRANSFERS:*SNs Cleala HAMILTON and Ervine STUBBSfromSandilands Rehabilitation Centre to the PrincessMargaret Hospital, 13th April, 1987.*SNs Phillip' GAY and Marcel COOPER fromthePrincess Margaret HospitaltoSandilandsRehabilitationCentre, 13th April, 1987.*SNs Carolyn BENEBY and Juliette SAUNDERSfromthe Princess Margaret Hospital to CommunityNursingServices, 11thMay,1987.*TCN Francita McDONALD from PrincessMargaretHospitaltotheRandMemorial Hospital 17thAugust,1987.*TCNs Sylvy BELIZIARE: Yvonia BETHEL;LaverneCHARLTON; Charlene GARDINER; BrendamaeMcKAY' Brendamae SMITH-ROLLE; VanessaSMALL,


fromthePrincess Margaret HospitaltoCommunityNursingServices,11thMay, 1987. TCNBrendamae ROLLE movedtoKempsBay,Andros,11thJune, 1987while TCNSylvy BELIZAIRE movedtoMarsh Harbour, Abaca,15thJune, 1987. TCNAlthea WILLIAMS for Princess Mar9aret HospitaltoCommunity Nursing Service, Rock Sound, SouthEleuthera,inJune, 1987. TCNEsther MILLER from Princess Margaret HospitaltoCommunity Nursing Service, where she is currentlyonorientation. SNLeahWILLIAMS from Princess Margaret HospitaltoCommunityNu'sing Service.*SNValdamae ROLLE from Princess Margaret HospitattoCommunity Nursing Service, KempsBay,Andros.NOEdna IJEOMA from Princess Margaret HospitaltoCommunity Nursing Service, 10th August, 1987. SNsPatriceKINGand Lola KNOWLES from the CommunityNursing Service to Princess Margaret Hospital. SNLolitaPRAD from Community Nursing Service(MarshHarbour, Abaco, where shehadworkedforthepastyear)tothePrincess Margaret Hospital.TheCommunity Nursing Service takes this opportunitytoexpress its sincere thankstothose nurses whohavereturnedtoPrincess Margaret Hospital especiallySNPRAD.SNMaggie TURNER from CNS (School Health Service)toThe Bahamas School of Nursing, 10th August,1987.Thefollowing staff nurses at the Princess Margaret Hospital haveresigned:- Karlene CAREY; Linda RUSSELandSylvia WHYLLY.Dr.Julius FUFHIK, having completed his tourofdutyattheSRC(Geriatrics) has left and will further his medical education. Verybest wishes toDr.Fughik Social Worker Tracey GODETandAlvinKING(Main tenance Department) bothofthePMHhave resigned.GETWELL SOON:Dr.Glen BENEBY (PMH) CONGRATULATIONS:ToDr.Norman Gayonbeing re-elected to the House of Representatives and alsoonhisreappointmentasMinister of Health. Joining Hands For Health wishesyoua most successful and not too stressful periodatthe helmMr.Minister.Ifyouare able to wave a magic wandSir,weshould sincerely ask that you wave itinfavour of and imprintanindelible mark for health promotion. FROM THE MINISTRY OF HEALTH:-The Minister of Health,Hon.Dr.NormanGay,accompanied by Chief Medical Officer,Dr.VernalAlIenandUnder Secretary Mrs. Veta Brown, travelledtoWashingtonDC(22-26 June, 1987)toattend the 99th meeting of the Executive Committee of thePanAmericanHealth Organisation (PAHO).Dr.Gay chaired the meetingatwhich fifteen resolutions were approved together with the PAHO's proposed budget for the biennium 1988-89. The total budget approved wasinexcessof$121million. The Bahamaswasallocated $867,000 for the period, up from $785,500 for 1986-87.Itcontribution during that two year period was $56,370. Other resolutions taken at the meeting concerned Women, Health and Development, Emergency Pre paredness and Disaster Relief Co-ordination, Co-ordi nationofSocial SecurityandPublic Health Institutions and AIDS Prevention and Control.Inthis respect, countries were being urgedtodevelop, implementandsustain national programmes. Mrs. Brown was the Rapporteur of the sub-com mitteeonplanning and programming. Source: Bahamas Information Service Release. The Pan American Health Organisation (PAHO) the regional office of the World Health Organisation, (WHO) willbeholding its first teleconferenceonAIDSInQuito, Ecuador 14-15 September, 1987. The Conference willbebeamed live, via satellitetoa numberofcountries inclUding The Bahamas. In terestedpersons can participate via satellite and ask questions from remote reception sites. These willbesimultaneous translationsinEnglish, Spanish, French and Portuguese. The objectiveis:-to increase the awarenessofhealth workers, decision makers, the media and the general public regarding AIDS. Further details maybeobtained from the MinistryofHealth, co-ordinator of The Bahamas arrangements. Recently, Mrs. Dorothy Philips, First Assistant Secretary, MinistryofHealth, travelledtoWashingtontoattend the sub-committee meeting of the PAHOonWomen, Health and Development (17-19 July). Faculty and studentsofthe former DepartmentofNursing Education, now The Bahamas School of19


Nursing, are gradually settling into their splendidnewpremises, hewn outofthe rock at theendof Grosve nor Close, which were officially openedbytheHon.Clement Maynard, Deputy Prime Minister,onMonday 15th June, 1987. Guests fortheoccasion included such luminariesinBahamian nursingasMiss Hilda Bowen first Baha mian matron, later, Director of NursingandMrs. Mon ica Knowles, first nursing tutor at the DepartmentofNursing Education; the architect of the building Mrs. Dorothy King; the Manager of WorldBan!

1TheDivision of Environmental Sanitation and ConsumerProtection. 2TheDivision of Environmental Monitoring and Risk Assessment. 3TheDivision of Solid Waste Management and Restorationthis division includes maintenance of vehiclesandRoadsand Parks. The Department of Environmental Health Serviceisplanning a seminar on Environmental Pollution andControlfor 5-7 October, 1987, to be heldinFreeport,GrandBahama. The seminar is tobesponsored jointlybythe department (Ministry of Health, Industry andtheCommunity). Presentations will be made by externalpersons who are all experts in the field of industrialhealth and hygiene. The primary objective of the seminar is to providethepublic with information on environmental pollutionlcontroland reassure them that their interests are con stantly being monitored and reviewed. .FromSandi lands Rehabilitation Centre. Congratulations to Mr. Owen CAMPBELL, a patient,whowon a silver medal at the Special Olympics,heldinIndiana recently. This year their annual fair will be held on Saturday31st October, noon -9 p.m. All staff members oftheMinistry of Health, relatives and friends are askedtosupport this most worthy cause. Other newsforNewProvidence:-At a recent monthly meetingOTIne Bahamas Di abetic Association held on Saturday 25th July 1987, two glucometers (blood testing equipment for diabe tes) were presented to Dr. Ronnie Knowles, Consul tant Physcian, Princess Margaret Hospital, for use atthePrincess Margaret Hospital. From Grand Bahama. World Health Activities spread over the month of April included schools essay and poster competi tions, a well baby contest and culminated with a staff picnic. DeepestSympathytostaffmembersattheRand: Mr.Herbert BROWN on the death of his nephew, An thony Edwards. Mrs. Cabrena ADDERLEYonthe death of her brother Rodney Bowe. Ms.Jacinta McGREGOR on the death of her sister Stacy McGregor. Ms. Shirley WEECH Senior Housekeeper on the deaths of her brother and sister. Maintenance Manager Valentine WEECH on the death of his sister.*No. 2 Barbara SWEETING. VITAL STATISTICS Births Congratulations: Social Worker Telicia (SRC) and Wilfred McKENZIE on the birth of their daughter Wilicia on 12th July, 1987.*Grounds Supervisor Lawrence (SRC) and Linda ROKERon the birth of their daughter.*TCN Yvonia BETHEL (CNS) on the birthofher baby 15th August, 1987. *TeNSheila HUMES (CNS, Ann's Town Clinic) on thebirthofher baby in June. Nurse Humes has now re turned to her duties at the Ann's Town Clinic.*HA Dora SAUNDERS (CNS) on the birth of her babyinMay. MARRIAGES Wedding Bells rang outfor:-*HA Loretta DEAN-MAYCOCK (SRC)InMay*Clerk Sonia McNEIL-GILCOTT (SRC)inJuly.*Chief Clerk Orlene L1GHTBOURN-RODGERS (SRC)InAugust.*Dr. Alfred ALiNGU and Juliette ANGOLE. 18th July, 1987 in Grand Bahama.*NA Patrice BUTLER (PMH) and Wilman COOPER 27th September, 1986.*TCN Felecia ROLLE (PMH) and Ashwood TURN QUEST, 11th April, 1987. DEATHS JoiningHands for Health extends deepest sympathy to the following persons on the deathofa lovedone:-*Dr. Farhat Mahmood Acting Medical Officer of Heahh, Public Health Department, on the deathofhis father in Pakistan, May 1987. Dr. Mahmood was unable to at tend the funeral.*Dr.linnelleHaddox, Medical Staff Co-ordinator, PMH on the death of her mother, famous educator Mrs. Mable Walker on 8th July, 1987.*TCN Barbara BURROWS (PMH) on the death of her husband.NO.2Janice BROOKS (PMH) on the death of her father.21


No. 3 Letitica CURRY (PMH) on the death of her mother. SN Genevieve JACKSON (PMH)onthe death of her brother. TCN Margaret KINLOCK (PMH) on the death of her sister.SNMarilyn KNOWLES (PMH)onthe death of her brother. SN Virginia MORTIMER (PMH)onthe death of her mother.SNMerlina MOSS (PMH)onthe death of her grand father. TCN Clara SMITH (PMH) on the death of her grand mother.TCN Jacqueline STIRRUP (PMH)onthe deathofher brother. TCN Sharon TURNQUEST (PMH) on the death ofherfather.EOElizabethKEJUand Lynn GARDINER, dietary technician, both oftheSRC,onthedeathoftheir father. Deepest sympathytothe familiesofMessrs. Howard THOMPSON and Lionel STURRUP bothoftheMaintenance Department (PMH) ERRATA:Ms.Ellen Deveaux was a maid at the (SRC)andnotthe Medical Records OfficeasindicatedinVolume 4NO.3THENURSE'SRESPONSIBILITYTOAIDSPATIENTSANDTHEIRFAMILIESALICE GARDNER and JULIETH MINNIS Nurses'responsibilitytothepatientsufferingfromAIDSontheInfectiousUnit. The nurse plays a pivotal roleinthe care of all pa tients in any hospital but this is more evidentinpatients suffering from AIDS. The nurse interacts with the patient twenty four hours a day. Despite personal fears, she/he must administer to the needs of these patientsina friendly and caring manner.Infact the nurse maybethe only person to exhibit love and a caring attitude during the initial phase of the patients' illness as family mem bers become frightened and abandon their relatives when they learn the diagnosis. At this time also, patients go through a phase of denial. They may become very hostile and withdrawn. The nurse then enlists the support of the Psychiatric teamaswellasthat of ministers.Inaddition, they try to involve all patientsindaily devotions and recreational activities. Whileinhospital, the nurse's main responsibility is to teach the patient healthy habits as wellashow to pre vent the spread of AIDS. The patientisstrongly advised to use condoms in any future sexual encounters and to limit his/her sexual contacts.Inaddition, the nurse must keep abreast of all the latest developments in AIDS and share this information with her colleagues. She must adhere strictly to the guidelines laid down by the Ministry of Healthinrelation to blood and body fluids, namely wearing of gloves, gowns and masks. She must also instruct and insist thatallother per sonnel on the ward, for example Laboratory technicians and Maids, adhere to the above precautions.22The nurse must everbevigilant that suppliesofgloves,masks, gowns, bleach and hibiscrub are always available. Responsibility Towards The Family And TheirReactions. The familyisfearfulandtheir knowledge aboutAIDSis limited. The nurse's primary responsibility hereistodistill their fears by teaching them about howAIDSisspread that itisthrough sexual intercourse,infectedblood transfusion (no longer a riskinThe Bahamas)andsharing contaminated needles. She emphasises thatcasualcontact, like for example, sharing the samebathroom, holding hands and beinginthe sameroomcannotcause one to "catch AIDS". Relativesareencouragedtovisit and theyareregularly brought uptodateonthe patient's condition.Theyare also encouraged to ask questions whichweanswerhonestly andby50doing trytodispel anymythstheymay have about the disease. They are giveninformationonhow to care for their relativesathome. Theyaretoldthat clothes, for exampleandeating utensilsmustbewashed separatelyindetergent and bleach, that asolution of bleach oneinten shouldbeused forhouseholdcleaning. Proper handwashing after attendingtotheAIDS patientisstressed. The challenges for nursing are immenseasthenumber of patients affectedbyAIDSisincreasing daily.Wemust however never trytojudge patients but continuetooffer them the best care thatwecanand abovealloursympathy and love.


AIDS -A LEGAL PERSPECTIVEEMANUEL OSADEBAYSometime ago I wroteanarticle AIDS AND THEDUTYOFCARE which was publjshedbythe twoleadingdailiesinTheBahamas. The article was centeredonthedutyofcare,if any, owed by doctors to the general publicwherea doctor,inthe course of his practice, discoveredthatoneof his patients suffered from the diseaseAIDS.Thepurpose of this articleistofurther assist doctorsandhealth-care workersinthe performance of their respectiveduties.Itisnowknown that the disease AIDSisa diseasetransmissiblethrough sexual contact. Thereforeitisclassifiedasa "venereal disease" within the law. RecentlyIwasprivilegedtoread two articles onein"TheObserver"newspaper(publishedinEngland) of Sunday,19thJuly,1987 and the otherin"The Atlanta JournalWeekend,The Atlanta Constitution" of Saturday, August1st,1987.InEngland, the British Medical AssociationvotedinJuly for doctorstotest for AIDS without patients'consent.The argument was that tests, including routinetestsbefore operation, were essentiala)tocontrol thespreadofthe virus,b)toprolong HIV patients' lives andc)toprotect hospital staff who may beatrisk by unknowinglytreating sufferers.InAtlanta, law enforcement officersincluding Prison Officers were seeking wider disclosureofinformationonthe results of tests carried out.Theirargument was that from timetotime these officersrisktheir lives while arresting or dealing with personswhohavebeen determinedascarriers of the virus. Not infrequently they found themselves giving first-aid treatmenttopersons who have been injuredina fight orinanaccident. Therefore they were entitled to informationonknowncarriers of the virusinorder that they mightbebetterpreparedtoprotect themselves. Whichever side of the argument one prefers,itcannotbedisputed that disseminationofinformation and education are some of the ways of containing this disease.Within the society there maybepersons who arecarriersof the virus without knowledge of that fact. Theymighthave acquired the virus through relationships withcarriersof the virusorthrough blood transfusion.TheVenereal Disease Act, Chapter 222 Laws of The Bahamas may serve asaneffective instrument for combatingthis disease.ItprOVidesaneffective weapon fortracingcontacts.Itplaces certain legal obligationsondoctors who, through their work, have acquired knowledgeand information about their patients. 5of the Act obligates, under penalty offinEor Impflsonment, personssufferingfromvenerealdisease(inthe case AIDS) to place themselves under the care of a qualified Medical Practitionerfortreatment.Ifthe patient desires to or changes his medical practitioner, then the new medical practitioner must notify the pre vious practitioner of the change. Section 6 of the Act obligates the medical practitionertorequire the patient to obey the doctor's instructions. If the doctor discovers that the patient has failedtoobey the instructions given him in every such case such medi cal officer or practitioner shall forthwith notify the Chief Medical Officer in writing of such failure of the patient to obey his instructions. The obligation placedonthe doctorbythis section is important because it has been revealed that certain known carriers have refused to obey their doctor's instructions. Persons who have been certified as carriers of the virus have been known to continue their sexual activities with innocent parties. Failure to obey the medical practitioner's instructionsisanoffence punisha ble by a fine or imprisonment. Section 7 of the said Venereal Diseases Act endows the Chief Medical Officer with powers to trace and find "contacts". By "contacts" I mean persons who are known to have had relationships with known carriers of the virus. If a person is suspected of being a carrier of the virus, regardless of the means of acquisition the Chief Medical Officer may require such person to present her/himself within three days from the date of the service of the notice at the hospitaltoundergo medical examina tion for the purpose of ascertaining whether or not such person is so suffering from the venereal disease, and ifsosuffering, to receive medical treatment. The Chief Medical Officer may request a warrant from a Magistrate directing a peace officertotake such person to the hos pital for the said examination. The certification of a per sonasbeing a carrier of the virus mustbedoneinwrit ing by the medical practitioner. A copy of the certificate mustbegiventothe patient. It is important for the doc tor,ifpossible,toobtain evidence of the service of such notice or certificate. This may assist the doctorinprov ing, should it become necessary. that the patient was informed of the findings or result of the medical examina tion. Once a person has been certified as a carrier of the virus then the medical practitioner is obligedtoserve the patient with a warninginthe followingform:-23


THE VENEREAL DISEASES ACTTO:-...............................................................................................................................................................................................................................................................Whereas you have been found to be suffering from a venereal disease, to wit.. You are hereby notified that the disease is highly infectious and that should you infect another or others with the said disease you may be liable on summary conviction to a fine of one hundred pounds ()orto imprisonment for any term exceeding twelve (12) months or to both such fine and such imprisonment. You are hereby warned not to have sexual intercourse nor to contract a marriage with any person until youhavebeen granted a certificate of cure in accordance with section 9 of the above Act: Enclosed herewith is the following printed information relating to the venereal disease from which you are suffering and to dutiesofpatientssosuffering as aforesaid. Dated at Nassau, Bahamas, this day of A.D., 19 Medical Practitioner or Medical Officer Received from..the following printed information relating to the venereal disease known as..................................................................................................Dated the day of 1 9..It is important to note that the law prescribes abso lute confidentiality in these matters. All communications and information must be kept confidential.Inthe event that a carrier of a venereal diseaseiscured the medical practitioner responsible, if requested by the patient, shall give to the person a certificatetothat effectinthe followingform:-THE VENEREAL DISEASESACTTO:-....... ..............'"'"This is to certify that I have medically examined the above named.....................and am satisfiedthat:-a)he;scuredofthe attack of..the venereal disease from whichhehas recently been suffering; or b) he is free from venereal disease. Dated at Nassau, Bahamas, this day of... A.D.19 Medical Practitioner or Medical Officer24


Itisanoffence, punishable by a fine or imprisonment,for a carrier of any venereal disease includingAIDStoknowingly infect others with the disease.Inordertomaintain secrecy and confidentialityinthesematters the Venereal Diseases Act prescribes the following:Section 13. Every person who acts or assistsinthe administrationofthis Act and every person presentinany court when any proceedingstakenunder thisActoranappeal therefromarebeing heard, shall preserve secrecy with regard toallmatters and things which cometohis knowledge while soacting orassisting or present and shall not commu nicate any such matters or thing to any per son exceptinthe performance of his duties under this Act orinpursuanceofany legalorofficial duty. Section 14. All proceedings under this Actoronappeal from any judgement or order given under this Act shallbeheldincamera. Section 15. If any person found by a medical officer or a medical practitioner tobesUffering from a venereal disease gives him informationastoa contact, such information shallbedeemed for the purposes ofthe law relating to defamation to have been communicatedinpursuance of a statutorydUty.section 16. No action shall lie against a medical officer or a medical practitioner or any person ap pointed by the Chief Medical Officer for the purposes of this Act for anything done by him or them in good faithinpursuance of the powers conferred by this Act. Section 17. Any person who shall fail, neglect or refusetocomply with the provisions of this Act for which no specific penaltyisprovided shall be liable on summary conviction to a fine of fifty pounds or to imprisonment for twelve months. Some have argued that contact-tracinginthe disease AIDSisa waste of time. Some doctorshave argued thatbecause the incubation period is not known,itmay take months from the date of the sexual relationship before the first signs and symptoms appear. They also argue that at present there is no known curefor the disease AIDS and therefore contact-tracing will be of no value because there is no medicine to give the patient. But doctorsinfavour of contact-tracing argue that we are dealing with AIDSasa contagious, transmissible virus. Contact-tracing will assist in identifying people who are HIV positive and help canbeoffered and these persons willbealerted to be sensible in the future. There is no doubt that we are all worried about the spread of AIDS. Doctors are worried and the public is worried. Doctors have argued in favour of testing at the hospitals before surgery.Itis well known that during op erations doctors and nurses comeincontact with the patient's blood. It has also been shown that during such operations doctors often pierce their gloves and some of the gloves sustain damages causing the doctor or nurse to come in contact with the patient's blood. It is reassuring therefore to note that the Ministry of Health has established a Committee to deal with these matters .THEPASTORALCAREOFAIDSPATIENTSEMMETIE WEIR"And heal the sick that are therein, and say untothem,the Kingdom of God has come nigh unto you."(Luke10:9) The pastoral care of patients suffering from AIDS (Acquired Immune Deficiency Syndrome) is one ofthemostdifficult and urgent facing the church today. It ismostchallenging and complex. There are several reasonsfor this phenomenon.Inthe first place, there remains a tremendous amount of ignoranceinregard to this disease.AsDr.Perry Gomez hassorightly pointed out, it is a new disease, having manifested itselfinthe late seventies. As a result, there is widespread fear and the very mention of AIDS evokes alarm and terrorinthe minds of many. Those who are suffering from AIDS are often therefore, shunned by relatives and friends. This increases their suffering as they are made to feel like "social outcasts." Many indeed are very lonely and live their last days in remorse and isolation. What then should the ministry of the churchbewhen it comes to treatment of AIDS? The responsibility ofthe church in the care of AIDS patients should be seen at three levels: the educative, the area of pastoral care, and the ministry of the church for those whose conditions is regarded as terminal.25


First, the church hasanimportant educative ministry.Th\'i>ithM.to'i>ha{e 'Nithmedicine.Becauseottheim mense fear and ignorance which presently surrounds the disease, people think that they can "get AIDS"inall sorts of ways.Inmany cases these are just rumours, and as such have no real foundation in truth. The church here has an important ministry of educating. It is called upon to shareinthe task of letting people know the facts about AIDS. Through its parish ministry, its bulletins, and even pulpit notices, the church may spread the message of how AIDSiscontracted and accordingly, warn its members against doing what may lead to suffering from this deadly disease. It is important to note that the spread of AIDS has been caused largely by the lax moral standards of our times, an age of widespread promiscuity and rapidly de clining moral standards. The church has the responsibili ty of reiterating its ancient moral codes which advocate the very responsible exercise of sexual relationships as sociated with a strong sense of commitment (Exodus 20:14, Mark 10:2-10). The fear of AIDS is very great. It is therefore highly 'significant that a maior American denomination,inits report on AIDS, begins with a seminaronhow to dispel the fear of AIDS. Surely this is an extremely important ministry for, where thereisfear and ignorance no real progress can be made. Specifically, the church has a ministry of pastoral care to exercise to the AIDS patients themselves; the dispelling of fear is a ministryasmuch to the family as to thepatienthimself or herself. The pastor who is called to minister to those suffering from AIDS mustbesensitive to their needs. Perhaps he has to, first of all, assure the patient that he is genuin.ely interestedinhis welfare.Inapproaching the patient, the pastor must never betrayanattitude of condescension nor give the impression that he is concerned about his personal health.Inshort, he must make the patient feel comfortable and assure him of his concern. Since it has been established that AIDSisa disease which is contracted mainly by means of sexual relationships, there may be in many cases, a strong el ement of guilt. The pastor, then, may be called upon to deal with the patient's moral and spiritual position as well as his or her physical state as it will be important for the pastor to come to terms with the patient's moral and spiritual conditions. What should be the approachofthe pastor to a pa tient who is suffering say from guilt because he or she has contracted AIDS as a result of sexual promiscuity? What is the case of the married man who has been unfaithful to his wife or vice versa and as a resultissuffering from AIDS? There can be no doubt thatinmany cases those who suffer from AIDS also have the scars of moral and26spiritual lapse. Here the biblical incident of the healil1g tothepa{a\'jtic2::t-1A\ismost il'\stmct\'le. Itisnoteworthy that the friends of the paralytic,intheir determination to bring their sick to Jesus, letshimdown through the roof. It is quite obvious that the manisvery sick physically. The Pharisees, the enemies ofJesus, survey the scene. Jesus, however, does not immediately heal theman.RatherHedeclares to the paralytic, "Thy sinsbeforgiven thee." This pronunciation of forgiveness invokes the wrath of the Pharisees who regard it as presumptu ous of Jesus to forgive the man since it was heldbythem that only God could forgive. Itishighly significant that Jesus heals the man physically afterHehasdealtwith this spiritual condition. There was FORGIVENESS OF SINS FIRST, followed by healing of the man'sbody.Or, to put it another way, Jesus dealt with the man's spiritual condition beforeattempting to tackle his physical condition. A similar method maybeoften necessaryinthepastoral care of AIDS patients. The pastor, ever sensitivetothe needs of the {'atient, may enquire about the wayinwhich he/she contracted the disease. If the personknowsthat it has been through a sexual relationship whichmaybe regarded as immoral (whether involving homosexuali ty, prostitution or adultery), then he/she may have a strong sense of guilt. Put another way, along withthedepth of emotional and physical pain, the personmayalsobesuffering from the guilt caused by his/herimmorality. This maybethe situation especiallyinthecaseofsomeonewithastrong religious background.Having determined the wayinwhich the patienthascontracted the disease, the pastor, if he senses guilt,hemany attempt to deal with the person's moral andspiritualstate.Ifthe person desires sincerely tobeforgivenforhis/her sin, then the pastor may lead the personinreceiving the forgiveness whichisat the heart of thechristian revelation. The main purposeistobear on thesituation of the AIDS sufferer the abundant resourcesofthechristian faith to bring about forgiveness andreconciliation to the sufferer. The example of Christ Himself, again,isinstructive.Inbiblical times leprosy was greatly dreadedastherewas no cure forit(IKings). As persons suffering from AIDS today are ostracised so those suffering from leprosyinthose times wereisolated from the rest of humanity. But Jesus did notneglectthe lepers. RatherHeministered to them and metthemattheir point of need (Mark 1 :40-45). The sensitive contemporary pastor must alsobeprepared to meet those suffering from AIDS just wheretheyare. He or she must not betrayanattitude of fearorscorninregard to their condition. The patient canalwayssense an attitude and when this occurs, the effectiveness


ofone'sministry is compromised. Nor must the pastorbemoralisticor condemnatoryinattitude. Rather it mustbehisdesiretobring the healing resources of the Gospeltothebeliever.Herethen, the pastor has to exercise a ministryinwhichhedeals with the problem ofgUilt.His mustbeaministryof forgiveness and reconciliation. The wordsofJohnarerelevant: "My little children, I write you thatyoumay not sin; but if any man sin,wehaveanadvocate with the Father. Jesus Christ the righteousandHeisthe propitiation for our sins."Herethe writer, points out that the christian idealandobjectiveisthatwesinnot,thatweattain christian perfection.However,heis realistic, he understands thatmortalmandoes sin because man is sinful, God hasmadeprovision for forgivenessinsending HisSontobetheSaviour ofus.He,theSon,is able to cleanse fromallunrighteousness.Thepatient, burdenedbyguilt, has tobeassured thatasherepents, thereisforgivenessinthe Blood of Jesus.Thus,ransomed, forgiven, restored and healed, the personwO;Jldbeina much better position, spirituallyconsequently,physically,tocope with his or her situationthanwould have been the case without the elementtoconfession.It has been truly said that "Confession isgoodforthe soul."Itis also good for the body.BecauseAIDSissuch a difficult disease, itisessentialthatthepastor works closelyandincooperation with themedicalauthorities. There are important rules regardingthecareof AIDS patients which shouldbestrictly observedbyhim.Itwouldbeprudent forhimtoenquirefromthemedical authorities before visiting the patientswhetheror notheis required to wear any protectiveclothinginorder to prevent any infection (tohimortothepatient).The pastor should ensure thatheobserves allrulesandthathecooperatesfUllywith those whoareinchargeof caring for AIDS patients.Itis also important to remember that all those workingwithAIDS patients, for example doctors, nurses andmedicaltechnicians are constantly under pressure,andthatthey maybeconcerned about the possibility of contractingthe disease themselves. A warm greetingandawordof encouragement to all involvedinthe treatment of .AIDSpatients by the pastor, can prove most effective.Thepastor has a ministry, then, not onlytothe AIDS patient and his family, but also(inthe light of contemporaryproblems),tothose involvedinthe treatment ofthosewho are the victims of this modern scourage. Finally, thereisthe matter of the pastoral care ofthoseina terminal condition. AIDS is often fatal. De stroying the body's immune system, it leaves the individualweak, unable to resist the ravages of many diseaseswhichprey upon his or her debilitated state. Itisindeed a very sobering and disturbing fact that many of the world's great leadersin"all walks of life" haveinrecent years, been victims of AIDS.Insome cases, the person suffering from AIDS realises that his life is short. He knows that "his days are numbered." The realization that one may soon die, or that he or sheissuffering from a disease for which there isnocure must indeedbea shattering experience and one for which the pastor is especially equipped, the ministry to the dying. What is the responsibility of thepastor to a young man, stillinthe "flower of youth," very promising, with a brilliant college career behind him and (up until the timehediscovered he had AIDS) a very promising fu ture? Itiscertainly not easy to help such a person to come to terms with the fact that he has a limited time to live exceptheor she were to experience a real miracle. Here the pastor goes a step beyond that of offering the abundant resources of forgiveness available to those who are willing to receive it.Hehas to inspire the patientandencourage the belief that there is "more to life than this transitory life." The pastor may have to help the patientto"face the fact" that life is shortandthat death is not far away. Forinmany cases, people do not readily accept the fact that their days are numbered. Here more than at any other time, the christian pastor has to speak to the patient of the christian hope of the Resurrection, of the life beyond "the sunset" and of the hope that will be theirs trustinginChrist. Suffering from AIDS is a new malady. At this time, many approach it with fear and terror. Those who are suffering from itaswellastheir families are in need of pastoral care of the highest order. The minister has to exercise compassionandhelp the patient to face up to the fact.Hehas to workinconcert with the medical authorities so thathemay know the most suitable ap proach to take. A young promising patient has to be treated differently toanold person who mayberesigned to the idea of death anyhow.Inhis ministry, the pastor should follow the example of Jesuswhoidentifiedwithpublicansandsinners.HeorshecannottumhisbackupontheAIDSsufferer.Theministry is universalinits scope asweknow from the gos pels, especially that ofSt.Mark. Moreover, since the gospel is for allandsince it proclaims forgiveness, then because AIDS is often associated with sin, then the pas tor is called upon to show the AIDS sufferer thatheor she canbeforgivenbyChrist. Most of all, the pastor called upon to minister to the terminally ill AIDS patient, must seek to lead him or hertoa deep understanding of the christian faith.He,the pas!or, needs to assure the patient that, trustinginChrist, although ravagedandsufferinginthis life,heorca.nlook forward to a new lifeinChrist, and eternal life which begins on earthinobedience to Christ andisconsummatedina new lifeinunion with the Christ who27


has conquered death. Let the churchinthis age of AIDS then once again proclaim with boldness the morality which encourages the responsible exercise of sexual relationships. Let thosewho are called to ministertothe sufferers from AIDS do all they can to bring them the resources of forgiveness which aretobe found in Christ. Let the church assure those who are sUffering from AIDS in a terminal condition, that in Christ there is the mes sage of a new life beyond the bounds of this transitory'''-.. ..,'from this new and devastating disease thatweunderstand the profound words ofSt.Paul, "For I reckonthatthe sufferings of this present time are not worthytobecompared with the glory which shallberevealedtous.For the earnest expectation of the creation waitethforthe revealing of the sons of God. That the creation itself also shallbedelivered from the bondage of corruption into the liberty of the glory of the children of God. "Iampersuaded that neither death nor life, nor angels,norprincipalities, nor things present, nor thingstocome,nor"P"'"""'","""",""""'J,.,"'0""tt01e0;:>eparmeusfrom God, whichisinChrist Jesus our Lord."ACQUIREDIMMUNODEFICIENCYSYNDROME(AIDS)INPREGNANCYMADLENE SAWYERAt the present time, the virus that causes acquired immunodeficiency syndrome (HIV) is thought to pass through infected blood, genital secretions and breast milk. It is estimated that at least twenty five percent of exposed individuals with antibody will develop clinically significant disease over a five year period. Women with asymptomatic infection may continue to pass the infec tion to their unborn and newborn baby. Most of the women infected with the virus are childbearing ageand areinthe following high risk groups: Intravenous drug abusers Sexual partners of high risk men Prostitutes Women who received blood containing the virus.Ofthe children who have been found to have AIDS, eighty percent are believed to have been exposed to the virus while in the uterus or around the time of birth. The risk ofaninfected woman passing the virus to her baby is approximately forty to seventy percent. How ever, the proportion of infected babies who will eventually develop the full blown diseaseisunclear, butthe pro gression to severe disease seems to be substantially higherinbabies thaninadults. Babies delivered by Caesarean section who hadnofurther contact with their infected mothers have devel oped the infection, this suggests that the baby was in fected even before birth.Inaddition, a baby has devel oped AIDS after being breast fed by a mother who acquired the virus after the child was born.28Women with the full blown disease present additional problems since their disease may become worseduringpregnancy. There is a normal suppression of cellularimmunity and other changes which are similartothosecaused by the immunodeficiency virus. Therefore,thecombination of these normal changes of pregnancyandthose duetothe virus may leadtoprogression ofthediseaseinthe pregnant woman. Also of concernisthe recently reported combination of abnormalitiesinthe infants born with the virus.Theaffected children are small with smaller head sizeandabnormal facial structures. These findings,however,need further study. At present thereisnocure for this disease.Sincepregnancyinwomen infected with the immunodeficiency virusisassociated with risks to herself and herbaby,women of high risk groups should be tested for thevirusregardless of symptoms. Those women who testpositiveshouldbeadvised to avoid pregnancy and thosewhotest negative should be tested again duringpregnancy,since the antibody may not develop for up to fourmonthsafter infection.Inaddition, women with positive test resultswhoarealready pregnant mustbefollowed carefully forworsening of their disease. These women should alsobecautioned against breast feeding. Finally, high riskwomenwho test negative shouldbeeducatedinwaystoreduce their risk, especially during pregnancy.Avoidusing dirty needles. Insistoncondom use duringsexualintercourse, reduce sexual partners, maintain highstandards of personal health and hygiene.


INCOMEREPLACEMENTFORAIDSPATIENTSAUDREY DEVEAUXThestatisticsonAIDS are frightening: Each statistic,forexample, forty known cases by June, 1987, representsoneperson and many possible contacts. Unfortunately,fromallthatisknown about viruses they are very,veryfriendly little organisms. They lovetotravel from onepersontoanother communicating and the AIDS virusisnoexception.Whenitmoves into a new home (the host's body), ittakesalong its own very special friends. Some of thesefriendsinclude, butarenot limitedto,weight loss, pneumonia,various types of cancer, tuberculosis, fear andlerror,anger, ostracism, loss of job, income, friends, family,lifestyle and especially,:'badfeelings". What can the "host" do about suchaninvasion?Elsewherein"Joining Hands For Health," other articlesfocuson"howtopreventaninvasion from taking place";"howtominimise the effects of such invasion" palliativeorsymptomatic treatments;' "howtofeel betterinthemidstof the invasion spiritual counselling;"andalso"howtoensure that you getanopportunity to serveashostmethods of infection."Thisarticle will briefly highlight how some of the effectsof the AIDS, "friends" thatis(temporary) "loss ofincome"(sickness), andinextreme cases "loss of job" (invalidity due to the progressively debilitating effects oftheinvaders),canbeovercome.TEMPORARY AND PERMANENT INCOME REPLACEMENTJohn, a normallyfunloving and hyperactive 25 yearoldtravel agent, has been having severeheadaches forthepast three weeks. They have,infact, beensobadthatonfour occasionshewas forced to callintoworkandcancel tours and speaking engagements. This hasworriedboth Johnandhis supervisor; forinthefouryearsthat John has been with the firm,hehas neverbeenlate nor absent.Toset both their minds at rest,Johnmadeanappointmenttosee his doctor. Mary, a48year old thrice-divorced mother of twogrownsons, was wondering if she should makeanap pointment to see her doctor before goingona cruise withhernew boyfriend. She had been feeling weak and tiredforsometime,anddispite drinking gallons of bad-tasting serasee, she just could not shake her nagging cough. The situation was taken out of her hands when she quietly and inelegantly "passed out" while shopping forsomenew clothesinone of the most elegant downtownbo'utiques.Anambulance was summonedandshe was transportedtohospital, where she was admitted withaninitial diagnosis of tuberculosis. Mary's job paid a maxi-mumof two weeks sick leave, her insurance would cover the hospital bills, but, she would have nothing left. What was she to do? Two months later, Johnwas very worried. His head achehadbeen too severe for him to make his doctor's appointment. Eventually he had seen another doctor. nearer to his work onanbasis, who had given him some tablets for his headache, some more for his "nerves" to deal with the "stress of his job," and seven days sick leave. Over the past two months he had missed a total of fifteen work days and his salary was being cut for the first time. Additionally, he was not getting any overtime, John's total income (salary and overtime) was needed to payallthe billshehad incurred as a result of his high style of living. What was hetodo? His supervisor ad visedhimto call National Insurance, either the Local Office or the Consumer Hotlines 322-1280/322-2009. John called the hotline number 322-2180. Mary has been moved to the special AIDS ward, sheismuch better than many of the patients there, she willbeabletogo home soon and is looking forward to going back to work eventually. The doctor has advised her to apply for Sickness Benefit in the meantime. In the unlikelyevent that sheISunable to return to work, he also informed her that she would be able to apply for Invalidi ty Benefit after she had used up her Sickness Benefit entitlement. Marywantedtoknow more. A nurse advised her to call the National Insurance Board, either one of the Local Offices or the Consumer Hotlines 322-1280/322-2009. Mary was worried about her eligibility for the benefit as she had been out of work for six months the previous year and had only worked on her new job for nine months. Mary called the hotline number 322-2009. John was toldinresponse to his question, "Do I qualify for Sickness Benefit?" that, as he had worked continuously for the past four years and was paying Na tional Insurance at the maximum of the insurable wage ceiling ($250 per weekl$1,083 per month), he would be entitledtoSickness Benefit. He was advised to go to the New Providence Local Office, take the medical certificate whichhehad been given a few weeks ago, and he wouldbeassisted with completing a claims form by the staff of the Customer Relations Department. John was further told that even though it would be submitted a little late, (claims for Sickness Benefit maybesubmitted up to six months following the illness),hewould be awarded his benefit for that week, less three waiting days (he should receive a cheque for $100, if29


Sunday was one of the "waiting days," within a week to ten days). Additionally, John was advised thatashis headaches were persisting, he should visit his own doc tor for a thorough examination, and, if he needed additio nal sick leave, he would then be paid for the full week (no further "waiting days"asthe claims wouldbecontin uous). John was told that a doctor's medical certificateisrequired for processing of Sickness Benefit claims.7'Inresponse to his question "For how long and how much Sickness Benefit can I get?" John was informed that he couldbeawarded Sickness Benefit forupto twenty six weeks.Hewas further told that this benefit period canbeextended for a maximum of forty weeks nine months, provided that the Board's Medical Officer certifies that he is likely, with additional medical treat ment, to recover his health and return to work. John was also informed thathewouldbepaid Sick ness Benefit at the rate of $150 per week. Thisis60percent of the weekly insurable wage on which his contri butions are paid.Onquestioning Mary, it was found that shehadhad a number of jobsover the years since the introductionofNational Insurance (October 7th, 1974).Ona fewofthese, no National Insurance salary deductionshadbeen made. However, she had worked for Batelco for three years in the late 70's before relocating briefly to Florida with her third husband. She was told that she satisfied the qualifying condi tions for Sickness Benefit. These conditions are that: The claimant had workedasanemployed or self employed person and had paid at least 40 contribu tions since the Scheme began (shehaddone this during her tenure at Batelco); The claimant had paid or been credited with at least either:i)Thirteen (13) contributions and credits in the26contribution weeks immediately preceding the first day of the continuous period of incapacity for work; (Mary met this contributiononher most recent job), or ii) Twenty-six (26) contributions and creditsinthe 52 weeks immediately preceding the first day of the continuous period of incapacity for work; (Mary also met this condition, although she was already eligible for the award, by reason of hav ing met the first two conditions), or iii) Twenty-six (26) contributions and creditsinthe contribution year, immediately preceding the first day ofthe continuous periodofincapacity for work (Mary alsomet this condition).30Inresponse to her question "how much benefit would I get?" Mary was told thatasshe had earned/paid contri butionsonanaverage weekly salary of $210 over the qualifying period, she would receive60percent of this each weekasbenefit, or $126 each week. She was greatly relieved. Shewasalso very touched when the Board's employee offered to send the necessary forms neededtoprocess her claimtothe hospitaltoher, and told her that she wouldbecalled when her cheque was ready for collection.AsMary's doctorhadalso raised the pointofInvalidi ty Benefit withher,she also asked for more information whenshe called the Board's Consumer Hotlines. She was told that Invalidity Benefitispaidtoinsured persons whohada minimumof150 contributions, who were seen by one of the Board's medical referees, andhadbeendiagnosedasbeing permanently incapable of work. She was further told that application for this benefit follows the expirationofthe Sickness Benefit payment period, and once awarded, the benefitispaid fortheremainder of the claimant's life, thisisconvertedtoRetirement Benefit when the claimant reaches age65.This benefit, like Sickness Benefitisalso paidasa percentage of the insured person's average weekly insur able wage/income. The amount paid for the minimum qualifying period three years or 150 contributions)is15percent, (minimum paymentis$100 per month,maximum is $650 per month). Mary was reassured to know thatatthe end ofhermaximum Sickness Benefit period(26weeks/40 weeks), she could make application for Invalidity Benefit.Shewas also informed that shouldshenot have the minimum 150 paid contributions, she could for InvalidityAssistance. Invalidity Assistanceisawardedtoeligible,needyclaimants who do not meet the contribution conditionsforthe awardofthe benefit. All applicants for assistance awards, must satisfy a "test of resources,"Le.,adeterminationofneed,bea Bahamian citizen, or a resident whohadworked for twelve months continuously overthepast fifteen years.Formore informationonany of the Board's ninebenefits and four assistance awards, please visit oneoftheLocal Offices situated throughout the Commonwealth,orcall the Consumer Hotline 322-1280 or 322-2009. EDITOR'S NOTE: Both John and Mary are fictitious persons. The two case historiesaredesignedtoa)remindb)informreaders of someofthe manybenefits which are available undertheNational Insurance Programme


TheImpactOfAidsOnHospitalizationPAMRICA FERGUSONFromApril 1985 uptothe present time (August1987),hospitalisation periods of AIDS patients re-admissionshave totalledanunsuspected or shocking numberofhospital days. The Table below depicts the overalltotalof their recurrent hospitalization periods, givinganideaasto what has transpired. Total PeriodsofAdmissionsofAIDS PatientsApril1985 -August1987TotalofHospital Periods Males Females Total1day-1week29 (8) 16 45 2weeks-3weeks41(4) 18 (1) 594weeks-5weeks19 (3) 17 366weeks-8weeks15 (1)520 9weeks-12weeks121(1) 313weeks-16weeks2 1 317weeks-20weeks1121weeks-14weeks1 225weeks -28weeks129weeks -32weeks TOTAL109 (16)61(2) 170 (18) (93) (59) (152)N.B.The18casesinparenthesis were suspected cases. These patients had some of all of the clinical manifesta tions of AIDS.Ten of them were admitted, threetofour months prior to the screening of bloodinour Blood Bank. Most of these cases cametohospital and died within one day or one week of admission. Also, priortoscreening here, some of our cases were confirmed by tests performedinMiami. They were extremelyillpatients.Due to opportunistic infections associated with AIDS,somepatients have had as many as five admissionsfromconfirmation of diagnosis up to the time of their demise. However, a few were admitted and died within aperiodof one day or one week. Overall the average number of admissions for these patients have been three. One hospitalization periodisusually two to three weeks but there was a patient who hospitalization spanneda period of three months. Prior to the opening of the Infectious Ward, these patients were accommodated throughout the hospital children on paediatrics, adultsonmedical and surgical areas and wherever their specific wardsinthe isolationroom.Now that the Infectious Ward exists, most of the AIDS patients are nursedonthis ward and when discov eredonthe other wards they are transferred here. Butinsituations when all beds are occupied, a patientisnursed on the ward of his/her admission.TheInfectiousWard/and AccommodatIon For AIDS Patients The male section has twenty-four beds, twelve beds (located at the back of the ward) are allocated for nurs ing AIDS patients,andthe twelve beds at the front of the ward are utilised for nursing tuberculosis and chest cases. Since children require more care and attention, their cots are placedinthe front section of the ward. Thereisalso a single (private) room which is used for very ill cases. The female section has twelve beds, eight are allo cated for AIDS patients and four for tuberculosis and other chest cases. Thereisalso a private room which is used for very ill or special cases. The average number of AIDS patients varies from-sixto eight adults per month and there are usually two children.Insofar as there exists no vaccine or cure for AIDS, public education is the only way the AIDS epidemic can be controlled. This will also control the spiralling cost of caring for AIDS patients and reduce the number of recur rent admissions. Caring for patients with AIDS is difficult and frustrating work. Dr. Harold Jaffe (Centre For DiseaseControl) be lieves that the AIDS epidemic maybe teaching us some thing about ourselves. Most of us are believing that no answer. Usually that was true. We are now safe from answer. Usually that was true.Weare not safe from diseases like syphilis, poliomyelitis and smallpox, the scourges of the past. When we encountered the AIDS epidemic, it was reasonable to think that science was the answer. If we could not develop effectively treatment or vaccine in a year or two, then we should spend more money and we would get the answer. But so far it has not. However, there is another answer and thatistaking responsibility for our own actions. The great majority of AIDS transmission occurs through consenting acts sexual transmission and sharing needles. The gay man who enters into a monogamous relationship withanunin fected man will not become infected himself. The addict who can get off drugs or at least stop sharing needles will be safe from this disease. AIDS forces ustoreturn to earlier times. Although inanage of medical miracles we must some how return to the time when each of us has more responsibility for our health and the health of others. We cannot afford to wait for science to save us. We must learn to save ourselves.31


Education and lifestyle are intertwined whenwethink of preventive measures. Here are some basic facts for avoiding AIDS: Preventive measures relative to blood/body fluids: reduce your number of sexual partners. avoid oral ingestion of faecal matter, semen or urine. use condoms. curtail use of drugs (speed, cocaine, marijuana, poppers, tobacco and alcohol.donot share needles.donot share tooth brushes or razor blades. General preventive measures: exercise regularly. eat a balanced diet. get plenty of rest. have regular check-ups. Symptoms are: Unexplained fatigue; weight loss; swollen glands; persistent cough; persistent diarrhoea; fever; chills; night sweats; pink purplish spotsonskin.Inconclusionwemust remember that AIDSdoesnot discriminate! The AIDS virus doesnotcare ifyouarestraight or gay, male or female,oldor young, doing drugs or not, black, white or otherwise. Theykeytocontrolling the spread of AIDSisthrough educationandtofollow the guidelines of prevention. References1.Dr.Jaffe, Harold, (CD) AIDS Lecturer for National Foundation for Infectious DiseasesandAssociation for PractitionersinInfection Control,LasVegas,Nevada, May4,1986.2.Readers Digest June 1987.3.Information (Princess Margaret Hospital).THESTATEOFAIDSINTHECARIBBEANANDNORTHERNAMERICAMARK CROWLEYNever before in the memory of present generations has a disease conjured up so much fear, anxiety and respectinso short a time as has the deadly Acquired Immunodeficiency Syndrome, more commonly knownbythe acronym AIDS. The AIDS pandemic global or international epidemic spread silently from the early 1980s when the human immunodeficiency virus1)was first discovered. The inter national impact of the AIDS problem began to become evidentdUringthe mid 1980's as countries on all five continents began to report AIDS cases to the World Health(WHO). As of December 1982,711AIDS cases were reported to WHO.ByJune 1987, a total of 51,535 AIDS cases had been reported from 113 countries. While a portion of this increase is due to im proved diagnosing and reporting, the trend is clear. The number of countries reporting cases of the disease has more than doubled, from51inJanuary of 1986 to 113inone year and a half. The extent and magnitude of the AIDS pandemic had been underestimated and ignored on a global basis. Regionally, what does this mean?Asof June18,1987, a total of 39,090 cases of AIDS had been reported to the Pan American Health Organization (PAHO), the Regional Office for the World Health Organizationinthe western hemisphere, from the Caribbean and Northern America. It should be emphasized that as of June18,1987 and at the time of this writing August 1987-the32 actual number of reported AIDS cases wouldbenoticeably higher than statedinthis article.Also,WHOviewsthe number of countries reporting cases ofAIDSasa more reliable indicator of the magnitudeandextentofthedisease since numerous countries suffer fromunder-recognition of AIDS and from under-reportingtothenationalhealth authorities. This implies that the numberofreported AIDS cases represents only a fraction ofthetotalcases to date estimated tobeover 100,000worldwide. WHO also estimates that between fivetotenlion individuals are currently infected withthevirus.Insome areas of the world,itis estimated thatbetweenfour and fifteen percent of healthy adults -THATISFOUR TO FIFTEEN OUTOFEVERYONEHUNDREDADULTS are already infected andUPTOSIXTYTOEIGHTY OUTOFONE HUNDREDPERSONSINVARIOUS HIGH RISK GROUPS (homosexuals,bisexuals,intravenous drug usersandprostitutes)arepossiblyinfected with the virus. Table 1 gives the distribution of these 39,090reportedAIDS cases and deaths along with the lastreportingdate,bycountry. Looking at cases alone,wefind theUnitedStatesranking firstinnumber reported with36,133,followedbyCanada with 1,052 and Haiti with810reportedcases.However, out of a total populationintheU.S.A.ofabout241,000,000(241million)in1986, one wouldgenerallyexpect a relatively higher number of casessincethere


aremorepersons at potential risk. We therefore need tocalculateanindicator to approximatethe magnitude oftheAIDSsituation by country. For example: If the cumulativenumber,or the total number to date, of reportedAIDScasesto PAHOIWHO from the U.S.A. are dividedbythetotalpopulation of the country, we can arrive atanAIDScumulative incidence indicator per 100,000 populationwhichallows for international comparisons as it adjustseachcountry's reported cases by population size.Thisresultsina U.S.A. AIDS cumulative rate of 15.0 per100,000population-meaning that TO DATE, a total ofapproximately15 out of every 100,000 personsintheU.S.A.havebeen diagnosed with Acquired ImmunodeficiencySyndrome.Theserates are not perfect: they include cases reportedover sometimes different time intervals. The rates are using mid-year 1986 populations, through the report ing periods go beyond that date and, being cumulative, they do not reflect the risk of acquiring AIDS. Further more,asthis indicator is basedonreported cases in some areas, it may actually be higher. The rates are, however, the only available tool at the present time which allow for international comparisons of the reported AIDS situation. Table 2 shows the cumulative reported AIDS cases per 100,000 population for the countries in Table1.On a per capital basis, the U.S.A. with the most reported cases, ranks sixth while French Guiana apparently ranks first. It should be emphasized that these indicators are subject to change as more countries improve their diag nostic and reporting systems and, being cumulative, they are unlikely to decrease in the near future. BERMUDA CANADA U.S.A. NORTHERN AMERICA CARIBBEAN ANTIGUA 2.5 BAHAMAS 44.5 BARBADOS 15.4 CAYMAN ISLANDS 10.0MDOMINICA 3.9 DOMINICAN REPUBLIC3.1FRENCH GUIANA 81.0 GRENADA 3.5 GUADELOUPE 11.3 GUYANA 0.2 HAITI 12.0 JAMAICA 0.9 MARTINIQUE 7.0 PUERTO RICO 10.7ST.CHRISTOPHER-NEVIS2.1ST.LUCIA 2.3ST.VINCENT&THEGRENADINES 2.9 SURINAME 0.8 TRINIDAD&TOBAGO11.1TURKS&CAICOS 25.0U.S.VIRGIN ISLANDS 6.5 SUBREGION AND COUNTRY TABLE 2 CUMMULATIVE REPORTED AIDS CASES PER100,000POPULATION,BycountryIntheCaribbeanandNorthernAmerica (NotifiedasofJune18, 1987)CUMMULATIVE REPORTED CASES PER100,000POPULATIONTABLE1 REPORTED CASES AND DEATHS FROM AIDS, By country IntheCaribbean and NorthernAmerlc.(Notifieda8ofJune 18, 1987)SUBREGIONAND COUNTRY CASES DEATHS LAST REPORTCARIBBEANANTIGUA2 2 31-Mar-87BAHAMAS1054931-Mar-87BARBADOS3925 31-Mar-87CAYMANISLANDS 2 2 31-Mar-86 CUBA. 3 3 31-Mar-86DOMINICA3 3 31-Mar-87DOMINICANREPUBLIC2003531-Dec-86FRENCHGUIANA685231-Dec-86GRENADA4 3 31-Mar-87GUADELOUPE382231-Dec-86GUYANA2 0 31-Mar-87HAITI810 124 31-Dec-86JAMAICA2117 31-Mar-87MARTINIQUE231531-Mar-87PUERTORICO 374') 8-Jun-87ST.CHRISTOPHER-NEVIS 1 0 31-Dec-86ST.LUCIA 3 2 31-Dec-86ST.VINCENT&THEGRENADINES 3 2 31-Dec-86SURINAME3 3 31-Mar-87 TRINIDAD&TOBAGO1349331-DeC-86TURKS&CAICOS 2 2 31-Dec-86U.S.VIRGIN ISLANDS 7t )8-Jun-87NORTHERNAMERICA BERMUDA583931-Mar-87 CANADA 10525211-Jun-87U.S.A.36133 21155 8-Jun-871)deaths Includes under United States SOURCE: PAN AMERICAN HEALTH ORGANIZATIONIWORLD HEALTH ORGANIZATION33


THECHRISTIANRESPONSETOTHEAIDSCRISIS:A ReflectionALFRED CULMERInrecent timeswehave been confronted with a new and fatal disease, AIDS (acquired immune deficiency syndrome).Itis important that AIDSbeseenasa human-6"'<>any other disease. This is the context in which this short reflection is being presented. The Christian community must overcome fear and prejudice towards AIDS victims and become a commu nity of healing and reconciliationinwhich those who are suffering from AIDS can move from a sense of alienation to one of unity, from a sense of judgement to one of unconditional love. When we minister to persons with AIDS, like Jesus, we do so with love and compassion.Itis not a task to make judgements but to call ourselves and those to whomweminister to a deeper conversion and healing. As a faith communitywemust reject any form of discrimination against AIDS victims as a violation of their basic human dignity and inconsistent with the Christian ethic.Itcalls for collaborative segments of society to address the acute health care, educational and psycho logical needs created by the AIDS crisis. There are many persons in the community at large and in the Christian community in particular, who share the expressed opinion that AIDS is a divine punishment for what they describe as the "sin of homosexuality". Without questioning their sincerity, I disagree with this assessment. First, medically speaking, AIDS is not a disease re stricted to homosexuals.Infact, it appears that originally it might have been spread through heterosexual genital encounters.Inmany parts of the world, it has been shown that persons exposed to the AIDS virus or those who have contracted it have done so through intrave nous drugs, tainted blood transfusions and heterosexual genital activity. Consequently, even though a large per centage of those persons concerned who have been ex posed to the AIDS virus are homosexual, AIDS is a hu man disease, not a specifically homosexual one. Second, God is loving and compassionate, not veng eful. Made in God's image, every human being is of inestimable worth, and the life ofallpersons, whatever their sexual orientation, is sacred and their dignity must be respected. Third, the Gospel reveals that while Jesus did not hesitate to proclaim a radical ethic of life groundedinthe 34 promiseofGod's Kingdom,henever ceased to reach out to the lowly, to the outcastsofhis time even if they did not liveuptothe full demands of his teaching. Jesusunereo"'rorgweness-antine-wmg"toatlWTlOsoug))ln.When some objected to this compassion, he responded,"Let the one among you whoisguiltless be the firsttothrow the stone" (In. 8:7). That is whywewho are followers of Jesus seetheAIDS crisisasboth a challenge to respondina Christlike way to persons who are in dire need and a responsibilitytowork with othersinour society to respondtothatneed.Inthe light of these facts,itisunderstandable,thatthis disease, which spreadssoquickly andisinvariably fatal, would occasion misunderstanding, fear, prejudice and discrimination. Quite frankly, people are afraidthatthey may contractit.This is not a newphenomenon.Recall, for example, howweused to isolate tubercular patientsanddiscriminate subtly(andsometimes notsosubtly) against cancer patients. So also, for differentreasons,wespoke with moral righteousness and indignation about the "sin" of alcoholism.Intime, however, scientific advances and growthinhuman awareness andunderstanding helpedusto see thingsinnew lightandtodevelop better ways of relatingtothose sufferingfromthese diseases. Similarly,weare now called to relateinanenlightened and just way to those suffering from AIDS orfromAIDS-related complex (ARC)aswellasthose whohavebeen exposed to the AIDS virus. While itisunderstand able thatnoone wants to put himself or herselfina vulnerable position,wemust make sure that ourattitudesand actions are basedonfacts, not fiction.Atthe present time thereisnomedical justification for discrimination against these people and,infact,suchdiscriminationisa violation of their basic humanand inconsistent with the Christian ethic. To theextentthat they can, persons with AIDS should be encouraged to continue to lead productive lives,intheircommunityand placeofwork. Similarly, governmentaswellashealth providers and human services should collaborate to provide adequate funding and care of AIDS patients.Ifitbecomes necessary, all agenciesinourcommunityshouldbecontactedtoseek ideas and supportofwhatcanbedone to further assistinthe financial supportofcaring for the AIDS victims. The church also has a specific role to playinministering to those suffering from AIDS, their familiesand


theirfriends.Thechurch should collaborate with othersasitseekstofulfill itsownresponsibilities.Thefinalpoint I wishtomakeinregardtoThe Christian Response To The AIDS Crisis,isthat whenweministertopersons with AIDS, like Jesus,wedosowithloveandcompassion.Itisnot our tasktomakejudgementsbuttocall ourselvesandthosetowhomweministertoa deeper conversionandhealing.Itwould be amistaketouseour personal encounters with AIDS patientsonlyasanoccasionto speak about moral principlesofbehaviour. Nonetheless,aspersons concerned about the well being ofallour sistersandbrothers,weshould do allwecanas ministers to the broader community to en courage people to liveina way that will enhance life, not threaten or destroyit.It seems appropriate, therefore, to remind ourselves of the call touseGod'sgift of sexuality morallyandresponsibly, as wellasthe obligationtoseek helpwhenproblems with drugs or other substances de velop.Inadditiontobeing the correct thing todo,it could do a great deal to preventthespread of the AIDS virusinthe future.SURAYYA KAZIACQUIREDIMMUNODEFICIENCYSYNDROMETherehasbeennodiseaseinrecent memory thathasoccupied the attentionandstimulated the concern ofthemedical communityandlay publicashas theAcquiredImmunodeficiency Syndrome (AIDS). The first recognisedcases of AIDS occurredinthe Summer of1981inAmerica.Reports begantoappear ofanunusualpneumonia(pneumonocystis carinii)inyoungmenwhomitwassubsequently realised were both homosexualandimmunocompromised. The virus now knowntocauseAIDSwasdiscoveredin1983andgiven various names.Theinternationally accepted termisnowthehuman im munodeficiency virus (HIV). More recently a new varienthasbeenisolatedinpatients with West African connection-HIVII.VIRUSAlthough itisclear that HIVisthe cause of AIDS, itsoriginremains obscure. It seemstohave infectedhumansfor the first time15to20yearsago,but earlierunrecognisedinfection may have occurred. TheHIVisa.humanretrovirus which preferentially infects certainbloodcellsT-Iymphocytes subsets (Helper/Inducer cells).Thesecells have been termed "the leader oftheimmunologicalorchestra" because of the central roleintheimmuneresponse. Thus destruction of these cellscausesthe severe immunodeficiency characteristic ofthisdisease. TRANSMISSION OF THE VIRUSHIVhasbeen isolatedfromsemen,Cervicalsecretion,lymphocytes, cell free plasma, cerebrospinal fluid, tears, saliva,andbreast milk. Thisdoes not mean, how ever, that these fluids all transmit infection since the con centration of virusinthem various considerably. Partic ularly infectious are semen, bloodandpossibly cervical secretions. The commonest mode of transmission of'Ihevirus throughout the worldisbysexual intercourse. Whether thisisanalorvaginalisunimportant. Other methods of transmission are through the receipt of in fected blood or blood productsanddonated organsandsemen. Transmission also occurs through the sharing or re-use of contaminated needles by injecting' drug abusers or for therapeutic proceduresandfrom mother to child. Itisstill uncertain whether the virus is transmitted through breast milk; onlyonecase has been recorded of possible infectioninthis way. Thereisnowell documented evidence that the virusisspreadbysaliva.Itis not spread by casual or social contact. Finally, thereisno evidence thatthevirusisspreadbymosquitoes, lice, bed bugs,inswimming pools, orbysharing cups, eating and cooking utensils, toilets,andair space withaninfected individual. Hence,HIVinfectionandAIDS are not'COntagious.PAlTERNOFEPIDEMICIntheUnited States the rates for cases of AIDS per million of the population show wide geographical varia tion. New York has a rate of 991, San Francisco 966, Miami584,LosAngeles 363 compared with 140/million for the U.S.A.asa whole.Inthe U.S.A.andU.K.the first wave of the epidemic occurredinhomosexual men. The nextandcurrent waveisamong intravenous drug abus-35


ers and after thisitmight affect the heterosexual popula tion. Case reports and epidemiological surveys clearly showthat the virus canbetransmitted from mentowomenand from women to men. The AIDS epidemic has not left out The Bahamas and the incidence of cases since 1985 seems tobein creasing.In1985, thirty-six cases were reported,in1986, fifty andinthe first halfof1987 forty cases were reported.Ingeneral males were affectedalmost twice as commonlyasfemales. Of the total reported cases in 1985 and 1986,19were children.CLINICAL PICTUREInfection with the HIV can produce a very varied clinical picture ranging fromanacute illness with arecently positive test for HIV to full blown AIDS, many years later. Infectioncanbeasymptomatic or symptomatic.Probably not all of those who have a recent positive test for HIV will progress to chronic infection. Thosewho do not, probably go into a latent phase of infection. Nev ertheless, it is prudent to assume that the individualisstill infectious despite the latency. A positive antibody test toHIVindicatesonly that a person has been ex posed to the virus and not thatheor she has gained any natural immunity. Patients who have some of the constitutional symp toms and signsofAIDS without the opportunistic infec tions or tumors foundinthe end stage disease are de scribed as having the AIDS related complex. (ARC). Common presenting clinical features are: fever, weight loss (greater than 10%), enlargement of the lymph node, diarrhoea, fatigue, night sweats and laboratory abnormalities showing depression of blood cells. The two main clinical manifestations of AIDS are tu mors and a series of opportunistic infections. The clinical presentation in our Bahamian patients has been identi fied to that described above.TEST FOR ANTIBODY AGAINST HIVSince the tests for antibody against HIV became com mercially available in 1985, they have been widely used in diagnostic and transfusion laboratoriesallover the world. The accuracy ofthe testisbeing improved all the time and the occurrence of false positive and false neg ative results is less and less frequent. The test usually becomes positive three weeks to three months afterintercourse. At the present moment the test is performedinThe Bahamasinthe 'high risk' population and all pro spective blood donors.MANAGEMENTFirstly, it is important that asymptomatic patients with only a positive test shouldbereassured thathaVinga36positive testisnot the same thingashaving AIDSandthat at the present timeitisknown that a minorityofthoseinfected willinfact progresstothe full blownsyndrome. Oneofthe most important aspects of dealing withanyantibody positive patientisconfidentiality. Maintaining confidentiality mightbecomplicated: for example,thepatient's family or friends may not knowhisdiagnosisorindeed his sexual orientation; people at work (orschool)may seek medical information (especially jf the patientishaving time off work); or the patient may fear thatinformation may inadvertentlybegiventothird parties.Special precautions mayberequired, firstly, to reassurethepatient that confidentialityisprotected and, secondly,tolimit any unwarranted disseminationofconfidentialinformation. The routine medical management of these patientsisusually straight-forward. Patients shouldbeseenregularly for example every twotothree months.Atvisit the patient's weight shouldberecorded andspeCialattention given to mouth or skin problems.Ifnecessary the patient shouldbereferred to the appropriateist. Repeating a full blood count and measunngtheerythrocyte sedimentation rate at each visitisoftenhelpful. Patients shouldbeadvisedtore-attendiftheydevelop signs or symptoms suggestiveofKaposi's sarcoma.oropportunistic infection purplish lesions oftheskm,shortnessofbreath, cough, dysphagia (difficulty inswallowing), diarrhoea, weight loss, fever, headaches,fittingor altered consciousness. Patients should alsobeadvised about reducingtherisk of transmission. Psychological and emotionalsupportof the patient, the family, and friends are a vital aspectofmanagement. The physician may alsobeaskedtoadvise about dental treatment, insurance, and work.Patients shouldbeadvised to tell their dentists abouttheinfection, anditmay sometimesbenecessarytoreferthem to a dental unit withaninterestinHIV andrelatedproblems. People with antibodies will often haveconsiderable difficultyinobtaining life insurance. Someinsurance companies are asking specific questions aboutthevirus and refusingtoinsure those who are positive.Finally, patients shouldbetold that being positiveisnobartoemployment. Because of widespread misconceptions about infectivity, however, information about the patient's condition should notbedivulgedtoemployers. Patients with acquired immunodeficiency syndromedieofoverwhelming infectionsasa consequence ofthedestructionofa subset of lymphocytes. ApproachestothetreatmentofAIDS have involved attempt to re-establish immune competenceaswellasto treat opportunisticinfections. Among the various antiviral drugs thathavebeen tested one drug,ALT.has providedencouragingresults and has now been approved by the F.D.A.intheU.S.A. for treatmentofAIDS.


TWOPATIENTS'VIEWSFELICITY AYMERBothpatients were young men,Inthe prime of life buttheylooked like old men! They were both courageous,willingand able to talk, they both did. They both know they were suffering from AIDS andthatitwas fatal, butatthat time, they felt well and werelookingforward to going home. They both had difficulty insharingthe information about their illness with relativesandfriends but one felt comfortable enough to shareitwitha special "lady friend" who visited him regularlyinhospitaland helped with providing personal comfortssuchascombing his sparse hair whichhewas unable todofor himself. They had both accepted, each on his own, the inevitable,that AIDSisfatal and spent much of their timereadingtheir bibles. They both admitted to living hectic lives, substanceabusingand sex. Neither accepted the use of condomsasa preventative measure. One suggested sexual intercoursebetween persons only after they had been testedlortheHIV and were negative, and/or some means ofreducingsexual urges.Forboth, AIDS was a personal illness which eachdealtwithinhis own way, drawingonhis own innerresourcesofstrength. It was,asone said "his business".Hewould tell no one.Hedidn't want to find out aboutanyoneelse either nor was heissearch of information.Hewould accept whatever the doctor told him, wheneverhewastoldit.Theyhad both been feeling unwell, weak, tired andhadhaddiarrhoea continuously for over two weeks. Theyhadboth lost a lot of weight, but neither had visited adoctoruntil they lost consciousness and were taken tohospital.Mr.A.,aged about forty, had taken various kinds ofbushmedicine for his diarrhoea which had given himvery,very temporary relief.Hehad had severe itchingabouta year previously and had been diagnosedashavingdiabetes. Later, however, when his diarrhoea developedand he was admitted to hospital, unconscious,hehadlearnt he had AIDS. Initially he refused to believe the diagnosis but, as his condition deteriorated, he lostweight,his sense of balance and ability to walk and his eyesight deteriorated, he gradually accepted the diagnosis.Mr.Aisanintelligent man. His lady friend has beentestedandissero-negative. Even thoughheisweak,talksand walkswith great difficulty, he maintains asenseofhumour. Heisconvinced that condoms are unnaturalandisnot willing to sacrifice health for unnaturalr:less. Reasonably well informed about his condition, Mr. A is looking forward to his independence on discharge. He will work as a craftsman, live alone, do his chores and enjoy his environment. A close, supportive relative who lives nearby will keep an eye on him. He cannot face sharing his illness with this relative. Mr. B aged about thirty, a bisexual, knew he was sick but did nothing to get himself better untilhewas brought to the hospital in an unconscious state. He had been vomitting, hadhad diarrhoea for about ten days previously and was very weak. With rest and treatment, his general condition and his diarrhoea have improved but he feels nauseous all the time. He is resigned to the fact that he has AIDS, a condition for which there isatpresent no known cure and to whichhewill eventually succumb. Although he felt well at the timeofthe inter view he admitted that one week he was up another down. His first words of advice were that all his friends, mostly men, should "go for testing and have routine check-Ups" but he would not personally offer that advice. AIDS was his business and heWOlJldtell no one that he hadit.He was not concernedaboutanyone who may have it. His girt friend(s) and children have all been tested and are negative. His mother with whom he lives, along with his seven children, knows he isilland collects his medication as and when necessary, but he will not, under any circumstances, share the nature of his illness with her. Mr. B knew he was ill initially but did nothing to change his life style because he said there was nothing that anyone could do to help patients with AIDS or pre vent its spread. Subsequently though he stopped drink ing and severed all contacts with friends. Now he is also suggesting that everyone should "check with the doctor" before they become sexually active. Mr. B is content to follow his doctor's instructions on discharge, he will get plenty of rest and take his medica tion on time. Mr.A,starting young had abused drugs, you name it, he had used it, but he has not admitted to being an addict. He had frequented basehouses which are numer ousinNassau, he says, adding .that they canbefound in the most unlikely places. Mr. B had abused alcohol. He hadhad an enjoyable period with his drinking buddies but had stopped seeing them and drinking when he learnt he had AIDS. They were bothasit were resigned "to their fate" but Mr. A was more positive, he wouldbewilling to assist in an AIDS education programme because he recognised the importance of "'ooking after one's body".37


THESTORYOFAIDSDIONNE BENJAMINOnceupon a time there lived a young woman named Lana. She was very popular with the men.Shehad 'relations' with all kinds oldmen,youngmen,homosexuals, bisexuals, and the like.Herfriends tried to warn her about her lifestyle but she wouldn't listen. Until one day it was too late.Thedoctor said she had AIDS. Lana was shocked. There wasnocureortreatment for her. She was going to die!Thedays of casual sex with manymenand drug abusing via needles had caught up with her. She should've listened to her friends.Itwas all a matter of time then.Astime passed, Lana grew thinner and weaker. Every weekshewould get sicker. Her life was pure torture then. Now sheisdead.Now sheISatpeace.38


------------------------------------------------------------------------------------EVALUATIONHelpustomakethenewsletterasinterestingandinfonnativeaspossible. Please complete. detachandreturnthisshortevaluation form totheHealthEducation Division,MinistryofHealth.Nassau. Bahamas. Tickthemostappropriateresponse.1.How did you findthenewsletter?a) veryinterestingb)interestingc)somewhatinterestingd)uninterestinge)didnotread2.Wasthereanyarticleofparticularinterestto you?YesDNoDIfyes, please givetitle..3.Whatchanges,ifany,would you like to see?........................................................................................................................................................................................4.Whattopics would you likeinfutureissues?..5. Would youliketocontributetothisnewsletter? Yes DNoDIfyes, please givenameandaddress. Name:..Address: .Thankyouforyourco-operation!39




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ABOUT THE CONTRIBUTORSAYMER,Felicity is a Health Education Officer, Ministry of Health, Editor. SAIN,Rosa Mae Is a Community Health Nurse. BENJAMIN, Dionne is an Art Student, CollegeofThe Bahamas. CROWLEY,Mark is a Statical Advisor, PAHOIWHO based in The Bahamas. CULMER,Alfred is a Roman Catholic Priest. DEVEAUX, Audrey is the Public Relations Director, National Insurance Board and a member of the Editorial Committee. DIGGORY, Peter is the Director, Caribbean Epidemiological Centre (CAREC) based in Trinidad. DUAH,Owasa is a Registrarinthe department of Pathology, PMH. EDWARDS, Shandalanae is a summer studentinthe Health Education Division, MinistryofHealth. FERGUSON, Pamrica is the Nurse with responsibility for Infection Control PMH. GARDNER, Alice is a Nursing Officer (Grade 2) PMH. KAZI,Surayya is adepartment of medicine PMH. MINNIS, Julieth is a Senior Nursing Officer, PMH. OFOSU-BARKO, Kenneth is acting for the Medical Officer of Health, New Providence and a member of the editorial committee. OSADEBAY, Emanuel is a Barrister-at-Iaw. SASSOON, David is the Managing Editor of Action For Children, a publication of the NGO Committee on UNICEF. SAWYER, Madleneis a practising Obstetrician and Gynaecologist in Grand Bahama. WEIR, Emmette is the Chairman and General Superintendent of the Methodist Church in The Bahamas and Turks&Caicos Island.EDITORIAL COMMITTEEFelicity AYMER Ken OFOSU-BARKO Lyall BETHEL AUdrey DEVEAUX Harcourt PINDER Donna SMITH-DIAL Health Education Division (Editor) Public Health Department The Counsellors National Insurance Board Health Education Council Broadcasting 90rporation of The Bahamas.


\--Baby,letl1letalkYou/to-HeySexy!Come over here!--hICover designs by: Dionne BenjaminNASSAU,BAHAMAS

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