Bachelor of Science in Biology Major in Human Biology

College of Science
De La Salle University-Dasmarias
Dasmarias, Cavite Philippines

WHEN AIDS CAME HOME:

A FAMILY RESILIENCY PRESENTATION

Submitted by:
Ambion, Jamica
Baraquio, Jezza Mae
Barrinuevo, Clarisse
Bucao, Francesca
Callorina, Hiram
Dazo, Angelica
Dela Cruz, Ezekiel
Guingab, Karl
Jose, EJ
Roxas, Allia Alanis
Sarte, Glendale
Suzuki, Mitch

Submitted to:
Ms. Cuaresma

28 August 2015
INTRODUCTION

What gives a family the resilience to work through a crisis? Why it that some
families fall apart when is faced with adversities, while other thrives and become
stronger? What are the qualities of these resilient families? And how do these
families establish and maintain their strength?
HIV and AIDS pose one of the greatest challenges to families in history. It
touches at the very heart of families, drawing them close together or driving them
further apart.
To help the family remain resilient, often is the only safety net, playing a
critical role in determining how well individuals and communities cope with AIDS
and its consequences.
A strong and supportive family is one of the first lines of defense against
HIV/AIDS.
OBJECTIVE

To present a family which has been coping against Human immunodeficiency

Virus (HIV)

To identify and discus the various Family Resiliency Factors which made this
family respond positively in the midst of this catastrophic disease.

To discuss the family physicians role and intervention in a resilient family.

To formulate a family wellness plan.

BIOMEDICAL CONDITION/MEDICAL BACKGROUND

A. CLINICAL HISTORY
a.1. GENERAL DATA
VDs family is the focus of this study. VD is a 49-year old married man.
He is a born-again Christian and lives in Laguna. He is also an OFW who
worked as an aluminum fabricator. Eight months prior to consult while in
Saudi, VD tested positive for HIV on donor screening. He was completely
asymptomatic during this time.
VD is heterosexual. He had three sexual contacts. The first was with his
non-promiscuous girlfriend in the province when he was 18 years old. His
second was with a married woman whose promiscuity was not
established. The third was his wife. He denied having sex with men.

The results of his HIV tests were as follows: positive for HIV-ELISA
screening test, positive for HIV agglutination test, and positive for Western
blot confirmatory test. His wife was negative.

Epidemiology
UNAIDS estimates show that there were 33.3 million people living with
HIV at the end of 2009. In Asia, an estimated 4.9 million people were living
with HIV in 2009. The Philippines has a total of 6,498 cases since the first
reported case in 1984. In March 2011, there were 172 new HIV antibody
sero-positive individuals (DOH-NEC December 2010).
In Cambodia, the adult HIV prevalence declined in 2009 and in
Thailand, the epidemic appears to be stable. In the Philippines, the HIV
prevalence is still increasing (UNAIDS Global Report 2010).
There were a total 1,585 HIV positive OFWs, comprising 13% of cases
reported for the year.

a.2. HISTORY OF PRESENT ILLNESS

Patient VD is a 49 year old male HIV positive person which began eight
months while he was assessing the donor screening before his consultation in
Saudi because he was also asymptomatic at that time. Results from his tests
showed as follows: (+) HIV- ELISA screening test, (+) HIV agglutination test,
and (+) Western blot confirmatory test. VDs latest CD4+ count was 456 with
no Hepatitis B virus and has active TB disease; hence treatment with
Antiretroviral Therapy was not indicated. He shows no signs and symptoms
pointing to an opportunistic infection, hence prophylaxis (specified action
prevention for the disease) was not yet indicated. His hypertension was
controlled with Amlodipine. The lipid profile, kidney function test and 12-LECG
were all within normal.
After learning he has HIV, his mind was starting to picture things back
at Saudi and from his past. He was thinking that the possibility of getting this
disease aside from sexual and parenteral modes of transmission was from the
bites of big Saudi Arabian bed bugs in his bed which in diagnosis of Dr. Silva
according to a research says that there is no HIV virus replication observed in
the bed bug cells and that the risk of insect transmission of HIV appears to be
extremely low or non-existent at all. They also isolated the sharing of utensils
so that the disease cannot be transmitted although this was not true.

Another, this disease brought VDs family emotional burden like fear and
uncertainties. Questions like: Makakapagtrabaho pa kaya ako dok?, May
gamut pa ito dok?, and Ano ang mangyayari sa akin? were raised by VD in
the meeting. Answers to this questions were as follows: After the family
understood the information about AIDS is, VD will avail the needed
treatments and drugs, he will also continue to work at a construction site,
working for a subcontractor on aluminum fabrication with the help of his wife,
he will also continue to be involved in church as preacher and worker, and he
will start to practice sexual abstinence to protect his wife from getting this
disease.
a.2. PAST MEDICAL HISTORY
VD grew up in Surigao. He is the eldest child among the seven siblings, his
father died of an unknown cause when he was 18 years old. After the death
of his father, he went to Manila to try to find a job. He wanted a job to help
his mother who was diagnosed with diabetes and hypertension, and his
siblings. He started to work as an assistant in a shop eventually learning the
skills and then working alone. At age 29, VD married his girlfriend who was
the shop's secretary. She was also the eldest among 4 children and her
mother died when she was young so she had to take care of her siblings.
They lived with her father and two sisters in her father's house.
VD is heterosexual. He had three sexual contacts. The first one was
with his girlfriend in the province when he was 18 years old. His second was
with a married woman whose promiscuity was not established. The third was
his wife. He denied having sexual intercourse with men.

B. CASE DISCUSSION
b.1. CASE OVERVIEW
VD is (+) HIV-ELISA screening test, HIV agglutination test, and Western
blot confirmatory Test. His CD4+ cell count was 45. CD4+ is a blood test
to determine how well the immune system is working in people who have
been diagnosed with human immunodeficiency virus (HIV). CD4+ cells are
a type of white blood cell. CD4+ cells are also called T-lymphocytes, Tcells, or T-helper cells.
Biomedical Management:
There is no HBV (Hepatitis B Virus) infection and active TB disease;
hence treatment with ART (Antiretroviral Therapy) was not indicated.
There are also no signs and symptoms pointing out to an opportunistic
infection, hence prophylaxis was not yet indicated. His hypertension he

inherited is controlled with Amlodipine. His ipid profile, kidney function

tests, 12-LECG are all normal.
Psychosocial Management:
He is in state of shock; disbelief; denial, he asked second opinion in
PGH to know if its not HIV at all; fear and anxiety in sharing of
utensils. Sexual and parenteral modes of transmission were not
established. He denied having sex with men and he has little
knowledge about HIV disease
Agreement:
No HIV virus replication was observed in bed bugs and HIV
cannot be transmitted via eating utensils. He must avail all that is
needed and available for HIV. He continues to work in a construction
site as a subcontractor on aluminum fabrication and his service in
church ministries as preacher and worker. Sexual abstinence is done to
protect his wife.
b.2. PATHOPHYSIOLOGY
Acquired immune deficiency syndrome (AIDS) is caused by the HIV or
human immunodeficiency virus. The infection causes progressive destruction
of the cell-mediated immune (CMI) system, primarily by eliminating CD4+ Thelper lymphocytes.
Decreased immunity leads to opportunistic infections and certain
cancers. Opportunistic infections are caused by organisms that do not cause
infections in healthy individuals. HIV also directly damages certain organs like
the brain.
Time taken for AIDS to develop
AIDS indicates advanced HIV disease and has no cure and is
considered fatal. The time from HIV infection to death however
depends on the management with anti-HIV medications instituted on
time and continued over long term.
The time period usually ranges from 6 months (rarely) to 15+
years. In the United Kingdom the average time is around 12 years.
Pathology of AIDS
HIV infection passes through a series of steps or stages before it turns
into AIDS. These stages of infection as outlined in 1993 by the Centers
for Disease Control and prevention are:

1. Seroconversion illness this occurs in 1 to 6 weeks after

acquiring the infection. The feeling is similar to a bout of flu.
2. Asymptomatic infection After seroconversion, virus levels are
low and replication continues slowly. CD4 and CD8 lymphocyte levels
are normal. This stage has no symptoms and may persist for years
together.
3. Persistent generalized lymphadenopathy (PGL) The lymph
nodes in these patients are swollen for three months or longer and not
due to any other cause.
4. Symptomatic infection This stage manifests with symptoms. In
addition, there may be opportunistic infections. This collection of
symptoms and signs is referred to as the AIDS-related complex (ARC)
and is regarded as a prodrome or precursor to AIDS.
5. AIDS this stage is characterized by severe immunodeficiency.
There are signs of life-threatening infections and unusual tumours. This
stage is characterized by CD4 T-cell count below 200 cells/mm3.
6. There is a small group of patients who develop AIDS very slowly, or
never at all. These patients are called nonprogressors.
The pathological spectrum of HIV infection is changing as the
infection spreads into new communities with different potential
opportunistic diseases, and as medical science devises drugs against
HIV replication.

b.3. SIGNS AND SYMPTOMPS

Individuals infected with HIV mostly will not have any symptoms,
however they may experience a flu-like illness within a month or two after
exposure to the virus, with fever, headache, tiredness, and enlarged lymph
nodes (glands of the immune system easily felt in the neck and groin). These
symptoms usually disappear within a week to a month and are often
mistaken for those of other viral infections.
VD is a heterosexual man and had three sexual contacts. The first contact
was made when he was 18 years old with his non-promiscuous girlfriend in
the province. His second contact was with a married woman whose
promiscuity was not established. And lastly was with his wife. In his case, no
particular signs or symptoms were indicated until his doctor diagnosed him
positive of HIV after running several tests. The results were the following: HIV

tests results all positive for HIV-ELISA screening test, HIV agglutination test
and Western blot confirmatory test while his wifes was negative.
Upon hearing the bad news, VD was in a state of shock, disbelief denial,
fear and anxiety. He was worried about health deterioration and a shortened
life span. Despite this, VD managed to maintain a positive outlook in life
thanks to the support from his family and together they were able to face the
problems they were given.

b.4. DIAGNOSIS AND TREATMENT

AIDS (Acquired Immune Deficiency Syndrome) is a condition caused by a
virus called HIV (Human Immunodeficiency Virus). The illness alters the
immune system, making people much more vulnerable to infections and
diseases. This susceptibility worsens as the syndrome progresses and further
complications may occur within an individual.
There are several ways to diagnose a person with HIV. One of the most
common methods is by testing the blood or saliva of the patient for
antibodies to the virus. Unfortunately, it takes time for ones body to develop
these antibodies usually up to 12 weeks. In VDs case, a few factors were
carefully observed such as the following: a) Monitoring of CD4+ cell count
every 6 months, b) Viral load testing and assessing the need for prophylaxis,
c) Observance of weight every clinic visit, d) Detection of developing Ois
(opportunistic infections) e) Immunzation: Flu, Pneumococcal vaccine,
Tetanus toxoid, MMR booster, Hepatitis A, Meningococcal vaccine, f)
Depression screening, g) Hypertension monitoring, and h) Periodic Health
Checks.
No cure has been found yet for AIDS although NIAID and other
researchers have developed drugs to fight both HIV infection and its
associated infections and cancers. In addition with early detection through
HIV testing, available HIV therapies can greatly extend years and quality of
life, and have resulted in a dramatic decrease in AIDS deaths like that of in
America.

b.5. COMPLICATIONS
No complications happened to VD but he needs to:

Monitor CD4+ every 6 months and viral load testing once a year and
assess the need for prophylaxis

Undergo depression screening

Observe for signs and symptoms of opportunistic infections

Immunization: Flu yearly, Pneumococcal vaccine, Tetanus toxoid, MMR

booster, Hepatitis A, Meningococcal vaccine

Hypertension monitoring: BP diary, Adherence to medications, signs

and symptoms of complications

Periodic Health Check: DRE annually, Referral to Ophthalmology yearly

These are ways to prevent the probable complications to arise and develop.

But the possible complications that a person with HIV could acquire are as
follows:
Infections common to HIV/AIDS
Tuberculosis (TB). In resource-poor nations, TB is the most common
opportunistic infection associated with HIV and a leading cause of
death among people with AIDS.

Cytomegalovirus. This common herpes virus is transmitted in body

fluids such as saliva, blood, urine, semen and breast milk. A healthy
immune system inactivates the virus, and it remains dormant in your
body. If your immune system weakens, the virus resurfaces causing
damage to your eyes, digestive tract, lungs or other organs.

Candidiasis. Candidiasis is a common HIV-related infection. It causes

inflammation and a thick, white coating on the mucous membranes of
your mouth, tongue, esophagus or vagina.

Cryptococcal meningitis. Meningitis is an inflammation of the

membranes and fluid surrounding your brain and spinal cord
(meninges). Cryptococcal meningitis is a common central nervous
system infection associated with HIV, caused by a fungus found in soil.

Toxoplasmosis. This potentially deadly infection is caused by

Toxoplasma gondii, a parasite spread primarily by cats. Infected cats
pass the parasites in their stools, and the parasites may then spread to
other animals and humans.

Cryptosporidiosis. This infection is caused by an intestinal parasite

that's commonly found in animals. You contract cryptosporidiosis when
you ingest contaminated food or water. The parasite grows in your
intestines and bile ducts, leading to severe, chronic diarrhea in people
with AIDS.

Cancers common to HIV/AIDS

Kaposi's sarcoma. A tumor of the blood vessel walls, this cancer is
rare in people not infected with HIV, but common in HIV-positive
people.

Kaposi's sarcoma usually appears as pink, red or purple lesions on the

skin and mouth. In people with darker skin, the lesions may look dark
brown or black. Kaposi's sarcoma can also affect the internal organs,
including the digestive tract and lungs.

Lymphomas. This type of cancer originates in your white blood cells

and usually first appears in your lymph nodes. The most common early
sign is painless swelling of the lymph nodes in your neck, armpit or
groin.

Other complications
Wasting syndrome. Aggressive treatment regimens have reduced
the number of cases of wasting syndrome, but it still affects many
people with AIDS. It's defined as a loss of at least 10 percent of body
weight, often accompanied by diarrhea, chronic weakness and fever.

Neurological complications. Although AIDS doesn't appear to infect

the nerve cells, it can cause neurological symptoms such as confusion,
forgetfulness, depression, anxiety and difficulty walking. One of the
most common neurological complications is AIDS dementia complex,
which leads to behavioral changes and diminished mental functioning.

Kidney
disease. HIV-associated nephropathy (HIVAN) is an
inflammation of the tiny filters in your kidneys that remove excess fluid
and wastes from your bloodstream and pass them to your urine.
Because of a genetic predisposition, the risk of developing HIVAN is
much higher in blacks.

Regardless of CD4 count, antiretroviral therapy should be started in

those diagnosed with HIVAN.

FAMILY ASSESSMENT TOOLS

Family Genogram is a graphical presentation of the VDs family relationships
and medical history. It also shows the family hereditary patterns. This quickly
identifies and understands various patterns in the patients family history which
may have had influence on the patients current state of mind and condition. Below
shows VD and Wifes family genogram:

APGAR is a family therapy rating system in which the name APGAR contains
the first letters of five words: adaptability, partnership, growth, affection and
resolve. That represent 5-question assessment tool used for rapid assessment of
family and dysfunction. Each family member indicates a degree of satisfaction in
each of the five categories on a scale of 0 to 2 to measure an individuals level of
satisfaction about family relationships.
The genogram of VD and his wife shows that at an early age both had lost a
parent and as the eldest they became responsible for the role left. This life
experience is a positive resiliency factor which could help them cope against HIV.
But this doesnt stop them about worrying about how they will sustain for their twin
son whom just graduated high school. To address the worry, the present concern
was no different from their past experience of helping their younger siblings in their
schooling. There has been no major disagreement in the family, they communicate
via open communication between couple and their twins felt neither anger now
shame but wanted to keep it to themselves. There was no note of fear for their
fathers health or anxiety of potential separation. There is no shame or social
isolation as well from friends and classmates. And by looking at the APGAR, we see
a highly functional family.
Family ecomap is the snapshot of the patients social networks indication
their relative potential for providing support in the current clinical situation. It is a
support network and connection. The following support networks and connections
are:

1. Overseas and Local Church he received no blame and discrimination instead

he continued to received spiritual, psychological and financial support from
the group.

2. Friends and previous co-workers provided him with temporary jobs.

3. SAGIP or STD and AIDS Global Initiative Program provides free diagnostic
tests such as CD4+ cell count monitoring and viral load testing.
4. VDs father-in-law provided for their shelter and home.

RECOMMEND FAMILY INTERVENTIONS TO BE DONE

Once a person has been diagnosed with AIDS/HIV the primary response
of the people around would be to treat the person as if a slight contact would easily
cause the transmission. The tendency is to isolate the patient from everyone else
which is wrong. After being diagnosed of the said disease the first person that the
patient should seek for help and advice is family. Family because they are the
people that would not hesitate to extend their helping hand no matter what
circumstances an individual is in. Also it is the role of the family to strengthen the
will of the affected person. To achieve this below are the recommended family
intervention that can be done.
For the case of VD, all the members of the family were aware of the condition
of the patient and they know the accurate facts and knowledge about AIDS/HIV and
its available treatment. Having knowledge with the said condition would help the
patient to be convinced that it is not yet the end of everything and could site certain
facts that would prove it. His wife chose to accept and trust VD. In fact the whole
family exhibited acceptance, trust, and dedication so as to achieve the resilience of
the family. Also psychosocial support is needed for helping the affected patient of
AIDS/HIV to cope not just with their emotions and psychosocial needs, but the
disease as well. As for the children there was no note of fear for their fathers health
or anxiety of potential separation. There is no shame or social isolation as well from
friends and classmates. They all treated VD as if he had no AIDS/HIV and just
continued the life they had before being diagnosed with the disease although
certain prohibitions are taken into consideration. Things might not be 100% the
same as before but still the family tried to live like before. Most importantly they
maintained a stable spirituality and never lost the faith.
Summarizing the above data a family member under the circumstance of the
disease should be surrounded by people that has positive outlook that would give
strengths and possibilities, courage and show optimism. Never forget to strengthen
the spirituality. According to DeFrain (1999), Spirituality has been found as an
essential factor of resilience, as it provides the family with the ability to unite
understand and overcome stressful situations. Family togetherness should be the
sole inspiration, no blaming, isolation, or turning on each others back but rather be
supportive, have acceptance, trust and dedication to one another. Lastly, never
cease the communication between the family members. According again to DeFrain,

Harmonious communication is the essence of how families create a shared sense

of meaning, develop coping strategies, and maintain agreement and balance.
WELLNESS PLAN FOR THE FAMILY
Human Immunodeficiency Virus (HIV) is a disease that only affects human. It
weakens your immune system by destroying the important cells that fight disease
and infection. A deficient immune system wont be enough to protect our body. A
virus can only reproduce itself by taking over a cell in the body of the host.
Acquired Immunodeficiency Syndrome (AIDS) is something you acquire after
birth and is not from your parents. It is recognized as the last stage of HIV. People
at this stage of HIV disease have badly damaged immune systems and need
medical treatment to prevent death.
Associated with the following psychological issues:
Stable income to support needs
Long term concern
Secrecy in terms of Health status
Handling Interpersonal conflict
Disease progression manifested in phy. appearance and impact
on family
End-of-life issues
If a patient tested positive in HIV/AIDS, they are exposed to psychological
concerns such as having/obtaining a stable income to support the needs, having a
long term concern about the future of the family and thinking ahead of what needs
to be done especially with the children, keeping the situation under control and
limiting the people who needs to be aware of the problem for it may cause trauma
for the patient and the family. The patient must be able to handle the problem
because depression may lead to promoting the spread of the virus throughout the
body which will definitely bring changes in your body, which can affect the family,
and even death. The patient must inform the family about what is happening, for
them to understand and to prepare them to be strong on what is about to happen
next.
SUMMARY
The family of our patient, VD, faced and is still facing a huge barrier in their
life and that is VD being infected with HIV/AIDS. As we all know, this viral disease is
transmitted in many ways thus raising concerns from the members of the family
and society. VDs family, with the help of the family physician, became resilient in

facing the situation. There were certain issues that were addressed effectively
resulting to the maintenance of the familys harmonious relationship. The physician
was able to identify some important factors that helped VD and his family overcome
the situation. The family maintained a positive outlook in life. Exercising faith and
hope in times of trouble is a must. The family exercised spiritual strength. They
remained involved in their local churches. Having a strong faith truly helps in
keeping the family united. The family was always together and continued on
fulfilling their roles. Having someone to turn to in this type of crisis has a big impact
on the patient and the family as well. Their open communication also helped in
sustaining the family relationship. The family physician is important in determining
factors important in the patient and family. The physician helped the family in
setting up rules, addressing complains and monitoring the family. The wellness plan
made for the family was the continuous screening and checkups for VD, to further
identify the progression of the disease as well as clarifying inter and intrapersonal
problems. His wife is also monitored. Her blood pressure was monitored, her
intrapersonal and interpersonal problems along with conflicts that may arise when
she starts being a caregiver. For their twin sons, their school performance was
monitored; their health condition too was monitored. All were given immunization
and psychosocial attention.

CONCLUSION
The family is really important in facing harsh issues concerning ones health.
In our case, we can see the positivity of the family. Having an understanding family
is a blessing and should be treated with care. Understanding, loving, and supporting
each and every member through good and bad are major factors that can help the
family be resilient. Acceptance is the key. A resilient and functional family can face
challenges and situations, no matter how ill it may be. In conclusion we would like to
quote a passage from Jane However. Call it a clan, call it a tribe, call it a family.
Whatever you call it, whoever you are, you need one.