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Acquired immunodeficiency syndrome (AIDS)

Classification and external resources

The Red ribbon is a symbol for solidarity with HIV-positive people and those living with AIDS. ICD-10 ICD-9 B24. 042

DiseasesDB MedlinePlus eMedicine MeSH

5938 000594 emerg/253 D000163

List of abbreviations used in this article AIDS: Acquired immune deficiency syndrome HIV: Human immunodeficiency virus CD4+: CD4+ T helper cells CCR5: Chemokine (C-C motif) receptor 5 CDC: Centers for Disease Control and Prevention WHO: World Health Organization PCP: Pneumocystis pneumonia TB: Tuberculosis MTCT: Mother-to-child transmission HAART: Highly active antiretroviral therapy STI/STD: Sexually transmitted infection/disease

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV).[1][2][3] This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk.[4][5] This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, breastfeeding or other exposure to one of the above bodily fluids. AIDS is now a pandemic.[6] In 2007, it was estimated that 33.2 million people lived with the disease worldwide, and that AIDS killed an estimated 2.1 million people, including 330,000 children.[7] Over three-quarters of these deaths occurred in subSaharan Africa.[7] Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century.[8][9] AIDS was first recognized by the U.S. Centers for Disease Control and Prevention in 1981 and its cause, HIV, identified in the early 1980s.[10]

Although treatments for AIDS and HIV can slow the course of the disease, there is currently no known cure or vaccine. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but these drugs are expensive and routine access to antiretroviral medication is not available in all countries.[11] Due to the difficulty in treating HIV infection, preventing infection is a key aim in controlling the AIDS pandemic, with health organizations promoting safe sex and needle-exchange programmes in attempts to slow the spread of the virus.

Contents

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1 Symptoms o 1.1 Pulmonary infections o 1.2 Gastrointestinal infections o 1.3 Neurological and psychiatric involvement o 1.4 Tumors and malignancies o 1.5 Other infections 2 Cause o 2.1 Sexual transmission o 2.2 Exposure to blood-borne pathogens o 2.3 Perinatal transmission o 2.4 Misconceptions 3 Pathophysiology o 3.1 Cells affected 3.1.1 The effect 3.1.2 Molecular basis 4 Diagnosis o 4.1 WHO disease staging system o 4.2 CDC classification system o 4.3 HIV test 5 Prevention o 5.1 Sexual contact o 5.2 Exposure to infected body fluids o 5.3 Mother-to-child transmission (MTCT) o 5.4 Education, health literacy and cognitive ability 6 Treatment o 6.1 Antiviral therapy o 6.2 Experimental and proposed treatments o 6.3 Complementary and alternative medicine 7 Prognosis 8 Epidemiology 9 History 10 Government reaction 11 Society and culture o 11.1 Stigma o 11.2 Economic impact o 11.3 Religion and AIDS o 11.4 AIDS denialism o 11.5 KGB disinformation 12 See also 13 Notes and references 14 Further reading 15 External links

Symptoms

Main symptoms of AIDS.

X-ray of Pneumocystis pneumonia (PCP). There is increased white (opacity) in the lower lungs on both sides, characteristic of PCP The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. Opportunistic infections are common in people with AIDS.[12] These infections affect nearly every organ system. People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness,

and weight loss.[13][14] The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.

Pulmonary infections
Pneumocystis pneumonia (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis jirovecii. Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 cells per L of blood.[15] Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is not easily treatable once identified,[16] Multidrug resistance is a serious problem. Tuberculosis with HIV co-infection (TB/HIV) is a major world health problem according to the World Health Organization: in 2007, 456,000 deaths among incident TB cases were HIV-positive, a third of all TB deaths and nearly a quarter of the estimated 2 million HIV deaths in that year.[17] Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per L), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.[18]

Gastrointestinal infections
Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV infected individuals, this is normally due to fungal (candidiasis) or viral (herpes simplex-1 or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.[19] Unexplained chronic diarrhea in HIV infection is due to many possible causes, including common bacterial (Salmonella, Shigella, Listeria or Campylobacter) and parasitic infections; and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and viruses,[20] astrovirus, adenovirus, rotavirus and cytomegalovirus, (the latter as a course of colitis). In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of antibiotics used to treat bacterial causes of diarrhea (common for Clostridium difficile). In the later stages of HIV infection, diarrhea is

thought to be a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.[21]

Neurological and psychiatric involvement

HIV infection may lead to a variety of neuropsychiatric sequelae, either by infection of the now susceptible nervous system by organisms, or as a direct consequence of the illness itself.[22] Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; it usually infects the brain, causing toxoplasma encephalitis, but it can also infect and cause disease in the eyes and lungs.[23] Cryptococcal meningitis is an infection of the meninx (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers, headache, fatigue, nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal. Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in latent form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.[24] AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia. These cells are productively infected by HIV and secrete neurotoxins of both host and viral origin.[25] Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and are associated with low CD4+ T cell levels and high plasma viral loads. Prevalence is 1020% in Western countries[26] but only 12% of HIV infections in India.[27][28] This difference is possibly due to the HIV subtype in India. AIDS related mania is sometimes seen in patients with advanced HIV illness; it presents with more irritability and cognitive impairment and less euphoria than a manic episode associated with true bipolar disorder. Unlike the latter condition, it may have a more chronic course. This syndrome is less often seen with the advent of multi-drug therapy.

Tumors and malignancies

Kaposi's sarcoma

Patients with HIV infection have substantially increased incidence of several cancers. This is primarily due to co-infection with an oncogenic DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV) (also known as human herpesvirus-8 [HHV-8]), and human papillomavirus (HPV).[29][30] Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a gammaherpes virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs. High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas. In HIV-infected patients, lymphoma often arises in extranodal sites such as the gastrointestinal tract.[31] When they occur in an HIVinfected patient, KS and aggressive B cell lymphomas confer a diagnosis of AIDS. Invasive cervical cancer in HIV-infected women is also considered AIDS-defining. It is caused by human papillomavirus (HPV).[32] In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, notably Hodgkin's disease, anal and rectal carcinomas, hepatocellular carcinomas, head and neck cancers, and lung cancer. Some of these are causes by viruses, such as Hodgkin's disease (EBV), anal/rectal cancers (HPV), head and neck cancers (HPV), and hepatocellular carcinoma (hepatitis B or C). Other contributing factors include exposure to carcinogens (cigarette smoke for lung cancer), or living for years with subtle immune defects. Interestingly, the incidence of many common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.[33] In recent years, an increasing proportion of these deaths have been from non-AIDS-defining cancers.

Other infections
AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include opportunistic infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and CMV retinitis can cause blindness. Penicilliosis due to Penicillium marneffei is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia.[34] An infection that often goes unrecognized in AIDS patients is Parvovirus B19. Its main consequence is anemia, which is difficult to distinguish from the effects of antiretroviral drugs used to treat AIDS itself.[35]

Cause

For more details on this topic, see HIV.

Scanning electron micrograph of HIV-1, colored green, budding from a cultured lymphocyte.

A generalized graph of the relationship between HIV copies (viral load) and CD4 counts over the average course of untreated HIV infection; any particular individual's disease course may vary considerably. CD4+ T Lymphocyte count (cells/mm)
HIV RNA copies per mL of plasma

AIDS is the ultimate clinical consequence of infection with HIV. HIV is a retrovirus that primarily infects vital organs of the human immune system such as CD4+ T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells.[36] Once HIV has killed so many CD4+ T cells that there are fewer than 200 of these cells per microliter (L) of blood, cellular immunity is lost. Acute HIV infection progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified either on the basis of the amount of CD4+ T cells remaining in the blood, and/or the presence of certain infections, as noted above.[37] In the absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2 months.[38] However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 years. Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function.[39][40] Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression.[38][41][42] The infected person's genetic inheritance plays an important role and some people are

resistant to certain strains of HIV. An example of this is people with the homozygous CCR5-32 variation are resistant to infection with certain strains of HIV.[43] HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression.[44][45][46]

Sexual transmission
Sexual transmission occurs with the contact between sexual secretions of one person with the rectal, genital or oral mucous membranes of another. Unprotected sexual acts are riskier for the receptive partner than for the insertive partner, and the risk for transmitting HIV through unprotected anal intercourse is greater than the risk from vaginal intercourse or oral sex. However, oral sex is not entirely safe, as HIV can be transmitted through both insertive and receptive oral sex.[47][48] Sexual assault greatly increases the risk of HIV transmission as condoms are rarely employed and physical trauma to the vagina or rectum occurs frequently, facilitating the transmission of HIV.[49] Other sexually transmitted infections (STI) increase the risk of HIV transmission and infection, because they cause the disruption of the normal epithelial barrier by genital ulceration and/or microulceration; and by accumulation of pools of HIV-susceptible or HIV-infected cells (lymphocytes and macrophages) in semen and vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe and North America suggest that genital ulcers, such as those caused by syphilis and/or chancroid, increase the risk of becoming infected with HIV by about fourfold. There is also a significant although lesser increase in risk from STIs such as gonorrhea, chlamydia and trichomoniasis, which all cause local accumulations of lymphocytes and macrophages.[50] Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma viral load does not necessarily indicate a low viral load in the seminal liquid or genital secretions. However, each 10-fold increase in the level of HIV in the blood is associated with an 81% increased rate of HIV transmission.[50][51] Women are more susceptible to HIV-1 infection due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases.[52][53] People who have been infected with one strain of HIV can still be infected later on in their lives by other, more virulent strains. Infection is unlikely in a single encounter. High rates of infection have been linked to a pattern of overlapping long-term sexual relationships. This allows the virus to quickly spread to multiple partners who in turn infect their partners. A pattern of serial monogamy or occasional casual encounters is associated with lower rates of infection.[54]

HIV spreads readily through heterosexual sex in Africa, but less so elsewhere. One possibility being researched is that schistosomiasis, which affects up to 50% of women in parts of Africa, damages the lining of the vagina.[55][56]

Exposure to blood-borne pathogens

CDC poster from 1989 highlighting the threat of AIDS associated with drug use This transmission route is particularly relevant to intravenous drug users, hemophiliacs and recipients of blood transfusions and blood products. Sharing and reusing syringes contaminated with HIV-infected blood represents a major risk for infection with HIV. Needle sharing is the cause of one third of all new HIV-infections in North America, China, and Eastern Europe. The risk of being infected with HIV from a single prick with a needle that has been used on an HIV-infected person is thought to be about 1 in 150 (see table above). Post-exposure prophylaxis with anti-HIV drugs can further reduce this risk.[57] This route can also affect people who give and receive tattoos and piercings. Universal precautions are frequently not followed in both sub-Saharan Africa and much of Asia because of both a shortage of supplies and inadequate training. The WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections.[58] Because of this, the United Nations General Assembly has urged the nations of the world to implement precautions to prevent HIV transmission by health workers.[59] The risk of transmitting HIV to blood transfusion recipients is extremely low in developed countries where improved donor selection and HIV screening is performed. However, according to the WHO, the overwhelming majority of the world's population does not have access to safe blood and between 5% and 10% of the world's HIV infections come from transfusion of infected blood and blood products.[60]

Perinatal transmission
The transmission of the virus from the mother to the child can occur in utero during the last weeks of pregnancy and at childbirth. In the absence of treatment, the transmission rate between a mother and her child during pregnancy, labor and delivery is 25%. However, when the mother takes antiretroviral therapy and gives birth by caesarean section, the rate of transmission is just 1%.[61] The risk of infection is influenced by the viral load of the mother at birth, with the higher the viral load, the higher the risk. Breastfeeding also increases the risk of transmission by about 4 %.[62]

Misconceptions
Main article: HIV and AIDS misconceptions A number of misconceptions have arisen surrounding HIV/AIDS. Three of the most common are that AIDS can spread through casual contact, that sexual intercourse with a virgin will cure AIDS, and that HIV can infect only homosexual men and drug users. Other misconceptions are that any act of anal intercourse between gay men can lead to AIDS infection, and that open discussion of homosexuality and HIV in schools will lead to increased rates of homosexuality and AIDS.[63][64]
Pathophysiology

This section may require cleanup to meet Wikipedia's quality standards. Please improve this section if you can. (April 2008) The pathophysiology of AIDS is complex, as is the case with all syndromes.[65] Ultimately, HIV causes AIDS by depleting CD4+ T helper lymphocytes. This weakens the immune system and allows opportunistic infections. T lymphocytes are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4+ T cell depletion differs in the acute and chronic phases.[66] During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4+ T cell depletion, although apoptosis may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4+ T cell numbers. Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4+ T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body.[67] The reason for the preferential loss of mucosal CD4+ T cells is that a majority of mucosal CD4+ T cells express the CCR5 coreceptor, whereas a small fraction of CD4+ T cells in the bloodstream do so.[68] HIV seeks out and destroys CCR5 expressing CD4+ cells during acute infection. A vigorous immune response eventually controls the infection and initiates the clinically

latent phase. However, CD4+ T cells in mucosal tissues remain depleted throughout the infection, although enough remain to initially ward off life-threatening infections. Continuous HIV replication results in a state of generalized immune activation persisting throughout the chronic phase.[69] Immune activation, which is reflected by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. Another cause is the breakdown of the immune surveillance system of the mucosal barrier caused by the depletion of mucosal CD4+ T cells during the acute phase of disease.[70] This results in the systemic exposure of the immune system to microbial components of the guts normal flora, which in a healthy person is kept in check by the mucosal immune system. The activation and proliferation of T cells that results from immune activation provides fresh targets for HIV infection. However, direct killing by HIV alone cannot account for the observed depletion of CD4+ T cells since only 0.01 0.10% of CD4+ T cells in the blood are infected. A major cause of CD4+ T cell loss appears to result from their heightened susceptibility to apoptosis when the immune system remains activated. Although new T cells are continuously produced by the thymus to replace the ones lost, the regenerative capacity of the thymus is slowly destroyed by direct infection of its thymocytes by HIV. Eventually, the minimal number of CD4+ T cells necessary to maintain a sufficient immune response is lost, leading to AIDS

Cells affected
The virus, entering through which ever route, acts primarily on the following cells:[71]

Lymphoreticular system: o CD4+ T-Helper cells o Macrophages o Monocytes o B-lymphocytes Certain endothelial cells Central nervous system: o Microglia of the nervous system o Astrocytes o Oligodendrocytes o Neurones indirectly by the action of cytokines and the gp-120

The effect The virus has cytopathic effects but how it does it is still not quite clear. It can remain inactive in these cells for long periods, though. This effect is hypothesized to be due to the CD4-gp120 interaction.[71]

The most prominent effect of HIV is its T-helper cell suppression and lysis. The cell is simply killed off or deranged to the point of being function-less (they do not respond to foreign antigens). The infected B-cells can not produce

enough antibodies either. Thus the immune system collapses leading to the familiar AIDS complications, like infections and neoplasms (vide supra). Infection of the cells of the CNS cause acute aseptic meningitis, subacute encephalitis, vacuolar myelopathy and peripheral neuropathy. Later it leads to even AIDS dementia complex. The CD4-gp120 interaction (see above) is also permissive to other viruses like Cytomegalovirus, Hepatitis virus, Herpes simplex virus, etc. These viruses lead to further cell damage i.e. cytopathy.

Molecular basis For details, see:

Structure and genome of HIV HIV replication cycle HIV tropism

Diagnosis

The diagnosis of AIDS in a person infected with HIV is based on the presence of certain signs or symptoms. Since June 5, 1981, many definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World Health Organization staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the Centers for Disease Control (CDC) Classification System is used.

WHO disease staging system

Main article: WHO Disease Staging System for HIV Infection and Disease In 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1. [72] An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people.

Stage I: HIV infection is asymptomatic and not categorized as AIDS Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.

CDC classification system

Main article: CDC Classification System for HIV Infection

There are two main definitions for AIDS, both produced by the Centers for Disease Control and Prevention (CDC). The older definition is to referring to AIDS using the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.[73][74] In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4+ T cell count below 200 per L of blood or 14% of all lymphocytes.[75] The majority of new AIDS cases in developed countries use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per L of blood or other AIDS-defining illnesses are cured.

HIV test
Main article: HIV test Many people are unaware that they are infected with HIV.[76] Less than 1% of the sexually active urban population in Africa has been tested, and this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counseled, tested or receive their test results. Again, this proportion is even lower in rural health facilities.[76] Therefore, donor blood and blood products used in medicine and medical research are screened for HIV. HIV tests are usually performed on venous blood. Many laboratories use fourth generation screening tests which detect anti-HIV antibody (IgG and IgM) and the HIV p24 antigen. The detection of HIV antibody or antigen in a patient previously known to be negative is evidence of HIV infection. Individuals whose first specimen indicates evidence of HIV infection will have a repeat test on a second blood sample to confirm the results. The window period (the time between initial infection and the development of detectable antibodies against the infection) can vary since it can take 36 months to seroconvert and to test positive. Detection of the virus using polymerase chain reaction (PCR) during the window period is possible, and evidence suggests that an infection may often be detected earlier than when using a fourth generation EIA screening test. Positive results obtained by PCR are confirmed by antibody tests.[77] Routinely used HIV tests for infection in neonates and infants (i.e., patients younger than 2 years),[78] born to HIV-positive mothers, have no value because of the presence of maternal antibody to HIV in the child's blood. HIV infection can only be diagnosed by PCR, testing for HIV pro-viral DNA in the children's lymphocytes.[79]
Prevention

Estimated per act risk for acquisition of HIV by exposure route (US only) [80] Estimated infections per 10,000 exposures to an infected source 9,000[81]

Exposure Route

Blood Transfusion

Childbirth (to child) Needle-sharing injection drug use Percutaneous needle stick Receptive anal intercourse Insertive anal intercourse*
*

2,500[61] 67[82] 30[83] 50[84][85] 6.5[84][85]

Receptive penile-vaginal intercourse* 10[84][85][86] Insertive penile-vaginal intercourse* 5[84][85] Receptive oral intercourse* Insertive oral intercourse*
*

1[85] 0.5[85]

assuming no condom use source refers to oral intercourse performed on a man

The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.[87] Anti-retroviral treatment of infected patients also significantly reduces their ability to transmit HIV to others, by reducing the amount of virus in their bodily fluids to undetectable levels.[88]

Sexual contact
The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. The primary mode of HIV infection worldwide is through sexual contact between members of the opposite sex.[89][90][91] During a sexual act, only male or female condoms can reduce the risk of infection with HIV and other STDs. The best evidence to date indicates that typical condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term, though the benefit is likely to be higher if condoms are used correctly on every occasion.[92] The male latex condom, if used correctly without oil-based lubricants, is the single most effective available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum jelly, butter, and lard not be used with latex condoms, because they dissolve the latex, making the condoms porous. If lubrication is desired, manufacturers recommend using water-based lubricants. Oil-based lubricants can be used with polyurethane condoms.[93] Female condoms are commonly made from polyurethane, but are also made from nitrile and latex. They are larger than male condoms and have a stiffened ring-shaped opening with an inner ring designed to be inserted into the vagina keeping the condom in place; inserting the female condom requires squeezing this ring. Female condoms have been shown to be an important HIV prevention strategy by preliminary studies which suggest that overall protected sexual acts increase relative to unprotected sexual acts where female condoms are available.[94] At present, availability of female condoms is very low and the price remains prohibitive for many women.

Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year.[95] Prevention strategies are well-known in developed countries, but epidemiological and behavioral studies in Europe and North America suggest that a substantial minority of young people continue to engage in high-risk practices despite HIV/AIDS knowledge, underestimating their own risk of becoming infected with HIV.[96][97] Randomized controlled trials have shown that male circumcision lowers the risk of HIV infection among heterosexual men by up to 60%.[98] It is expected that this procedure will be actively promoted in many of the countries affected by HIV, although doing so will involve confronting a number of practical, cultural and attitudinal issues. However, programs to encourage condom use, including providing them free to those in poverty, are estimated to be 95 times more cost effective than circumcision at reducing the rate of HIV in sub-Saharan Africa.[99] Some experts fear that a lower perception of vulnerability among circumcised men may result in more sexual risk-taking behavior, thus negating its preventive effects. [100] However, one randomized controlled trial indicated that adult male circumcision was not associated with increased HIV risk behavior.[101] Studies of HIV infection rates among women who have undergone female genital cutting (FGC) have reported mixed results; for details see Female genital cutting#HIV. A three-year study in South Africa, completed in 2010, found that an anti-microbial vaginal gel could reduce infection rates among women by 50% after one year of use, and by 39% after two and a half years. The results of the study, which was conducted by the Centre for the Aids Programme of Research in South Africa (Caprisa), were published in Science magazine in July 2010, and were then presented at an international aids conference in Vienna.[102]

Exposure to infected body fluids

Health care workers can reduce exposure to HIV by employing precautions to reduce the risk of exposure to contaminated blood. These precautions include barriers such as gloves, masks, protective eyeware or shields, and gowns or aprons which prevent exposure of the skin or mucous membranes to blood borne pathogens. Frequent and thorough washing of the skin immediately after being contaminated with blood or other bodily fluids can reduce the chance of infection. Finally, sharp objects like needles, scalpels and glass, are carefully disposed of to prevent needlestick injuries with contaminated items.[103] Since intravenous drug use is an important factor in HIV transmission in developed countries, harm reduction strategies such as needleexchange programmes are used in attempts to reduce the infections caused by drug abuse.[104][105]

Mother-to-child transmission (MTCT)

Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breast-feeding is recommended

during the first months of life and discontinued as soon as possible.[106] It should be noted that women can breastfeed children who are not their own; see wet nurse.

Education, health literacy and cognitive ability

One way to change risky behavior is health education. Several studies[citation needed] have shown the positive impact of education and health literacy on cautious sex behavior. Education works only if it leads to higher health literacy and general cognitive ability. This ability is relevant to understand the relationship between own risky behavior and possible outcomes like HIV-transmission.[107] In July 2010, a UNAIDS Inter-Agency Task Team (IATT) on Education commissioned literature review found there was a need for more research into non-African[clarification needed] (especially non-South African contexts), more research on the actual implementation of sex-education programmes (such as teacher training, access to related services through schools and the community, or parental attitudes to HIV and AIDS education) and more longitudinal studies on the deeper complexities of the relationship between education and HIV[108].
Treatment

See also HIV Treatment and Antiretroviral drug. There is currently no publicly available vaccine for HIV or cure for HIV or AIDS. The only known methods of prevention are based on avoiding exposure to the virus or, failing that, an antiretroviral treatment directly after a highly significant exposure, called post-exposure prophylaxis (PEP).[109] PEP has a very demanding four week schedule of dosage. It also has very unpleasant side effects including diarrhea, malaise, nausea and fatigue.[110]

Antiviral therapy

Abacavir a nucleoside analog reverse transcriptase inhibitor (NARTI or NRTI)

The chemical structure of Abacavir Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART.[111] This has been highly beneficial to many HIV-infected individuals since its introduction in 1996 when the protease inhibitor-based HAART initially became available.[11] Current optimal HAART options consist of combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents. Typical regimens consist of two nucleoside analogue reverse transcriptase inhibitors (NARTIs or NRTIs) plus either a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI). Because HIV disease progression in children is more rapid than in adults, and laboratory parameters are less predictive of risk for disease progression, particularly for young infants, treatment recommendations are more aggressive for children than for adults.[112] In developed countries where HAART is available, doctors assess the viral load, CD4 counts, rapidity of CD4 decline and patient readiness while deciding when to recommend initiating treatment.[113] Traditionally, treatment has been recommended for otherwise asymptomatic patients when CD4 cell counts fall to 200-250 cells per microliter of blood. However, beginning treatment earlier (at a CD4 level of 350 cells/microliter) may significantly reduce the risk of death.[114] Standard goals of HAART include improvement in the patients quality of life, reduction in complications, and reduction of HIV viremia below the limit of detection, but it does not cure the patient of HIV nor does it prevent the return, once treatment is stopped, of high blood levels of HIV, often HAART resistant.[115][116] Moreover, it would take more than the lifetime of an individual to be cleared of HIV infection using HAART.[117] Despite this, many HIV-infected individuals have experienced remarkable improvements in their general health and quality of life, which has led to the plummeting of HIV-associated morbidity and mortality.[118][119][120] In the absence of HAART, progression from HIV infection to AIDS occurs at a median of between nine to ten years and the median survival time after developing AIDS is only 9.2 months. [38] HAART is thought to increase survival time by between 4 and 12 years.[121][122] For some patients, which can be more than fifty percent of patients, HAART achieves far less than optimal results, due to medication intolerance/side effects, prior ineffective antiretroviral therapy and infection with a drug-resistant strain of HIV.

Non-adherence and non-persistence with therapy are the major reasons why some people do not benefit from HAART.[123] The reasons for non-adherence and nonpersistence are varied. Major psychosocial issues include poor access to medical care, inadequate social supports, psychiatric disease and drug abuse. HAART regimens can also be complex and thus hard to follow, with large numbers of pills taken frequently.
[124][125][126]

Side effects can also deter people from persisting with HAART, these include lipodystrophy, dyslipidaemia, diarrhoea, insulin resistance, an increase in cardiovascular risks and birth defects.[127] Anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS.

Experimental and proposed treatments

It has been postulated that only a vaccine can halt the pandemic because a vaccine would possibly cost less, thus being affordable for developing countries, and would not require daily treatments. However, even after almost 30 years of research, HIV-1 remains a difficult target for a vaccine.[128] Research to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the best sequence of regimens to manage drug resistance. A number of studies have shown that measures to prevent opportunistic infections can be beneficial when treating patients with HIV infection or AIDS. Vaccination against hepatitis A and B is advised for patients who are not infected with these viruses and are at risk of becoming infected.[129] Patients with substantial immunosuppression are also advised to receive prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP), and many patients may benefit from prophylactic therapy for toxoplasmosis and Cryptococcus meningitis as well.[110] Researchers have discovered an abzyme that can destroy the protein gp120 CD4 binding site. This protein is common to all HIV variants as it is the attachment point for B lymphocytes and subsequent compromising of the immune system.[130] Reactivation of the retrocyclin pseudogene has been proposed as a possible prevention method, as was demonstrated in a proof-of-concept study in tissue culture cells.[131] In Berlin, Germany, a 42-year-old leukemia patient infected with HIV for more than a decade was given an experimental transplant of bone marrow with cells that contained an unusual natural variant of the CCR5 cell-surface receptor. This CCR5-32 variant has been shown to make some cells from people who are born with it resistant to infection with some strains of HIV. Almost two years after the transplant, and even after the patient reportedly stopped taking antiretroviral medications, HIV has not been detected in the patient's blood.[132]

Complementary and alternative medicine

In the US, approximately 60% of HIV patients use various forms of complementary or alternative medicine (CAM).[133] Despite the widespread use of CAM by people living with HIV/AIDS, the effectiveness of these therapies has not been established. [134] A 2005 Cochrane review of existing high-quality scientific evidence concluded: "There is insufficient evidence to support the use of herbal medicines in HIV-infected individuals and AIDS patients."[135] Acupuncture has only been proposed for symptomatic relief, but not to treat or cure HIV or AIDS.[136] Vitamin or mineral supplementation has shown benefit in some studies. Daily doses of selenium can suppress HIV viral burden with an associated improvement of the CD4 count. Selenium can be used as an adjunct therapy to standard antiviral treatments, but cannot itself reduce mortality and morbidity.[137] There is some evidence that vitamin A supplementation in children reduces mortality and improves growth.[138] A large Tanzanian trial in immunologically and nutritionally compromised pregnant and lactating women showed a number of benefits to daily multivitamin supplementation for both mothers and children.[138] Dietary intake of micronutrients at RDA levels by HIV-infected adults is recommended by the World Health Organization (WHO).[139] The WHO further states that several studies indicate that supplementation of vitamin A, zinc, and iron can produce adverse effects in HIV positive adults.[139]
Prognosis

Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype,[7] and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study.[140] In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly diagnosed HIV-infected person to about 20 years.[141] As new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year after the individual progresses to AIDS.[38] Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system.[142] The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function[39][40][43] health care and co-infections,[38][142] as well as which particular strain of the virus is involved.[45][143][144] Even with anti-retroviral treatment, over the long term HIV-infected patients may experience neurocognitive disorders, osteoporosis, neuropathy, cancers, nephropathy, and cardiovascular disease. It is not always clear whether these conditions result from the infection, related complications, or are side effects of treatment.[145][146][136][29][30][147]
[127][148]

The largest cause of AIDS morbidity today, globally, is tuberculosis co-infection, see AIDS#Pulmonary_infections. In Africa, HIV is the single most important factor contributing to the increase in the incidence of TB since 1990.[149]
Epidemiology

Main article: AIDS pandemic This article may need to be updated. Please update this article to reflect recent events or newly available information, and remove this template when finished. Please see the talk page for more information. (December 2009)

Estimated prevalence of HIV among young adults (1549) per country at the end of 2005.

Estimated number of people living with HIV/AIDS by country

Disability-adjusted life year for HIV and AIDS per 100,000 inhabitants.
no data 10 10-25 2500-5000 5000-7500 25-50 50-100 100-500 7500-10000 10000-50000 500-1000 50000 1000-2500

The AIDS pandemic can also be seen as several epidemics of separate subtypes; the major factors in its spread are sexual transmission and vertical transmission from mother to child at birth and through breast milk.[6] Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS pandemic claimed an estimated 2.1 million (range 1.92.4 million) lives in 2007 of which an estimated 330,000 were children under 15 years.[7] Globally, an estimated 33.2 million people lived with HIV in 2007, including 2.5 million children. An estimated 2.5 million (range 1.84.1 million) people were newly infected in 2007, including 420,000 children.[7]

Sub-Saharan Africa remains by far the worst affected region. In 2007 it contained an estimated 68% of all people living with AIDS and 76% of all AIDS deaths, with 1.7 million new infections bringing the number of people living with HIV to 22.5 million, and with 11.4 million AIDS orphans living in the region. Unlike other regions, most people living with HIV in sub-Saharan Africa in 2007 (61%) were women. Adult prevalence in 2007 was an estimated 5.0%, and AIDS continued to be the single largest cause of mortality in this region.[7] South Africa has the largest population of HIV patients in the world, followed by Nigeria and India.[150] South & South East Asia are second worst affected; in 2007 this region contained an estimated 18% of all people living with AIDS, and an estimated 300,000 deaths from AIDS.[7] India has an estimated 2.5 million infections and an estimated adult prevalence of 0.36%.[7] Life expectancy has fallen dramatically in the worst-affected countries; for example, in 2006 it was estimated that it had dropped from 65 to 35 years in Botswana.[6] In the United States, young African-American women are also at unusually high risk for HIV infection.[151] African Americans make up 10% of the population but about half of the HIV/AIDS cases nationwide.[152] This is due in part to a lack of information about AIDS and a perception that they are not vulnerable, as well as to limited access to health-care resources and a higher likelihood of sexual contact with at-risk male sexual partners.[153] There are also geographic disparities in AIDS prevalence in the United States, where it is most common in rural areas and in the southern states, particularly in the Appalachian and Mississippi Delta regions and along the border with Mexico.[154] Approximately 1.1 million persons are living with HIV/AIDS in the United States, and more than 56,000 new infections occur every single year.[155]
History

Main article: Origin of AIDS AIDS was first reported June 5, 1981, when the U.S. Centers for Disease Control (CDC) recorded a cluster of Pneumocystis carinii pneumonia (now still classified as PCP but known to be caused by Pneumocystis jirovecii) in five homosexual men in Los Angeles.[156] In the beginning, the CDC did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.[73][74] They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.[157] In the general press, the term GRID, which stood for Gay-related immune deficiency, had been coined.[158] The CDC, in search of a name, and looking at the infected communities coined the 4H disease, as it seemed to single out Haitians, homosexuals, hemophiliacs, and heroin users.[159] However, after determining that AIDS was not isolated to the homosexual community,[157] the term GRID became misleading and AIDS was introduced at a meeting in July 1982.[160] By September 1982 the CDC started using the name AIDS, and properly defined the illness.[161]

The earliest known positive identification of the HIV virus comes from the Congo in 1959 and 1960 though genetic studies indicate that it passed into the human population from chimpanzees around fifty years earlier.[9] A recent study states that HIV probably moved from Africa to Haiti and then entered the United States around 1969.[162] A more controversial theory known as the OPV AIDS hypothesis suggests that the AIDS epidemic was inadvertently started in the late 1950s in the Belgian Congo by Hilary Koprowski's research into a poliomyelitis vaccine.[163][164] According to scientific consensus, this scenario is not supported by the available evidence.[165][166][167]
Government reaction

In 2010, former US President Bill Clinton said that countries receiving aid to combat the epidemic should redirect funding to local organizations who could spend it most effectively and efficiently. He said In too many countries too much money goes to pay for too many people to go to too many meetings, get on too many airplanes.
[168]

Society and culture

Stigma

Ryan White became a poster child for HIV after being expelled from school because of his infection. AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals.[169] Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.[170]

AIDS stigma has been further divided into the following three categories:

Instrumental AIDS stigmaa reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.[171] Symbolic AIDS stigmathe use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.[171] Courtesy AIDS stigmastigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.[172]

Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, prostitution, and intravenous drug use. In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual attitudes.[173] There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men.[171]

Economic impact
Main article: Economic impact of AIDS

Changes in life expectancy in some hard-hit African countries.

Zimbabwe Kenya South Africa Uganda

Botswana

HIV and AIDS affects economic growth by reducing the availability of human capital.[174] Without proper nutrition, health care and medicine that is available in developed countries, large numbers of people suffer and die from AIDS-related complications. They will not only be unable to work, but will also require significant medical care. The forecast is that this will probably cause a collapse of economies and societies in countries with a significant AIDS population. In some heavily infected areas, the epidemic has left behind many orphans cared for by elderly grandparents.
[175]

The increased mortality has results in a smaller skilled population and labor force. This smaller labor force consists of increasingly younger people, with reduced knowledge and work experience leading to reduced productivity. An increase in workers time off to look after sick family members or for sick leave lowers productivity. Increased mortality reduces the mechanisms that generate human capital and investment in people, through loss of income and the death of parents.

By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy. This results in a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.[175] On the level of the household, AIDS results in both the loss of income and increased spending on healthcare by the household. The income effects of this lead to spending reduction as well as a substitution effect away from education and towards healthcare and funeral spending. A study in Cte d'Ivoire showed that households with an HIV/AIDS patient spent twice as much on medical expenses as other households.[176]

Religion and AIDS

Main article: Religion and AIDS The topic of religion and AIDS has become highly controversial in the past twenty years, primarily because many prominent religious leaders have publicly declared their opposition to the use of condoms, which scientists feel is currently the only means of stopping the epidemic. Other issues involve religious participation in global health care services and collaboration with secular organizations such as UNAIDS and the World Health Organization.

AIDS denialism
Main article: AIDS denialism A small number of activists question the connection between HIV and AIDS,[177] the existence of HIV,[178] or the validity of current treatment methods (even going so far as to claim that the drug therapy itself was the cause of AIDS deaths). Though these claims have been examined and thoroughly rejected by the scientific community,[179] they continue to be promulgated through the Internet[180] and have had a significant political impact. In South Africa, former President Thabo Mbeki's embrace of AIDS denialism resulted in an ineffective governmental response to the AIDS epidemic that has been blamed for hundreds of thousands of AIDS-related deaths.[181][182]

KGB disinformation
Main article: Operation INFEKTION Operation INFEKTION was a worldwide Soviet active measures operation to spread information that the United States had created HIV/AIDS. Surveys show that a significant number of people believed - and continue to believe - in such claims.[183]
See also

What is AIDS?

AIDS stands for: Acquired Immune Deficiency Syndrome AIDS is a medical condition. A person is diagnosed with AIDS when their immune system is too weak to fight off infections. Since AIDS was first identified in the early 1980s, an unprecedented number of people have been affected by the global AIDS epidemic. Today, there are an estimated 33.4 million people living with HIV and AIDS and each year around two million people die from AIDS related illnesses.
What causes AIDS?

AIDS is caused by HIV. HIV is a virus that gradually attacks immune system cells. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off. It is at the point of very advanced HIV infection that a person is said to have AIDS. It can be years before HIV has damaged the immune system enough for AIDS to develop.
What are the symptoms of AIDS?

A person is diagnosed with AIDS when they have developed an AIDS related condition or symptom, called an opportunistic infection, or an AIDS related cancer. The infections are called opportunistic because they take advantage of the opportunity offered by a weakened immune system. It is possible for someone to be diagnosed with AIDS even if they have not developed an opportunistic infection. AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of an HIV positive person drops below a certain level.
Is there a cure for AIDS?

Worryingly, many people think there is a 'cure' for AIDS - which makes them feel safer, and perhaps take risks that they otherwise wouldnt. However, there is still no cure for AIDS. The only way to stay safe is to be aware of how HIV is transmitted and how to prevent HIV infection.
How many people have died from AIDS?

Since the first cases of AIDS were identified in 1981, more than 25 million people have died from AIDS. An estimated two million people died as a result of AIDS in 2008 alone.

Although there is no cure for AIDS, HIV infection can be prevented, and those living with HIV can take antiretroviral drugs to delay the onset of AIDS. However, in many countries across the world access to prevention and treatment services is limited. Global leaders have pledged to work towards universal access to HIV prevention and care, so that millions of deaths can be averted.
How is AIDS treated?

A community health worker gives an HIV positive patient antiretroviral drugs, Kenya Antiretroviral treatment can prolong the time between HIV infection and the onset of AIDS. Modern combination therapy is highly effective and someone with HIV who is taking treatment could live for the rest of their life without developing AIDS. An AIDS diagnosis does not necessarily equate to a death sentence. Many people can still benefit from starting antiretroviral therapy even once they have developed an AIDS defining illness. Better treatment and prevention for opportunistic infections have also helped to improve the quality and length of life for those diagnosed with AIDS. Treating some opportunistic infections is easier than others. Infections such as herpes zoster and candidiasis of the mouth, throat or vagina, can be managed effectively in most environments. On the other hand, more complex infections such as toxoplasmosis, need advanced medical equipment and infrastructure, which are lacking in many resource-poor areas. It is also important that treatment is provided for AIDS related pain, which is experienced by almost all people in the very advanced stages of HIV infection.

Why do people still develop AIDS today?

Even though antiretroviral treatment can prevent the onset of AIDS in a person living with HIV, many people are still diagnosed with AIDS today. There are four main reasons for this:

In many resource-poor countries antiretroviral treatment is not widely available. Even in wealthier countries, such as America, many individuals are not covered by health insurance and cannot afford treatment. Some people who became infected with HIV in the early years of the epidemic before combination therapy was available, have subsequently developed drug resistance and therefore have limited treatment options. Many people are never tested for HIV and only become aware they are infected with the virus once they have developed an AIDS related illness. These people are at a higher risk of mortality, as they tend to respond less well to treatment at this stage. Sometimes people taking treatment are unable to adhere to, or tolerate the side effects of drugs.

Caring for a person with AIDS

In the later stages of AIDS, a person will need palliative care and emotional support. In many parts of the world, friends, family and AIDS organisations provide home based care. This is particularly the case in countries with high HIV prevalence and overstretched healthcare systems. End of life care becomes necessary when a person has reached the very final stages of AIDS. At this stage, preparing for death and open discussion about whether a person is going to die often helps in addressing concerns and ensuring final wishes are followed.
The global AIDS epidemic

Around 2.7 million people became infected with HIV in 2008. Sub-Saharan Africa has been hardest hit by the epidemic; in 2008 over two-thirds of AIDS deaths were in this region.

Parc de l'espoir - AIDS Memorial Park in Montreal, Canada The epidemic has had a devastating impact on societies, economies and infrastructures. In countries most severely affected, life expectancy has been reduced by as much as 20 years. Young adults in their productive years are the most at-risk population, so many countries have faced a slow-down in economic growth and an increase in household poverty. In Asia, HIV and AIDS causes a greater loss of productivity than any other disease. An adults most productive years are also their most reproductive and so many of the age group who have died from AIDS have left children behind. In sub-Saharan Africa the AIDS epidemic has orphaned nearly 12 million children. In recent years, the response to the epidemic has been intensified; in the past ten years in low- and middle-income countries there has been a 6-fold increase in spending for HIV and AIDS. The number of people on antiretroviral treatment has increased, the annual number of AIDS deaths has declined, and the global percentage of people infected with HIV has stabilised. However, recent achievements should not lead to complacent attitudes. In all parts of the world, people living with HIV still face AIDS related stigma and discrimination, and many people still cannot access sufficient HIV treatment and care. In America and some countries of Western and Central and Eastern Europe, infection rates are rising, indicating that HIV prevention is just as important now as it ever has been. Prevention efforts that have proved to be effective need to be scaled-up and treatment targets reached. Commitments from national governments right down to the community level need to be intensified and subsequently met, so that one day the world might see an end to the global AIDS epidemic.
Learn more about HIV and AIDS

In addition to the hundreds of informative pages about HIV and AIDS, the AVERT website has interactive ways to learn more about HIV and AIDS.

The AVERT AIDS Game is a great way to see how much you know about HIV and AIDS. You can test your knowledge of HIV and AIDS by trying one of our online quizzes. Our photo gallery has hundreds of HIV and AIDS related photos from around the world. The AVERT video gallery has a number of short videos related to HIV and AIDS. Finally, you can read stories that have been sent to us from people who are either living with HIV or who have been affected by HIV and AIDS.

What is AIDS?

AIDS stands for: Acquired Immune Deficiency Syndrome AIDS is a medical condition. A person is diagnosed with AIDS when their immune system is too weak to fight off infections. Since AIDS was first identified in the early 1980s, an unprecedented number of people have been affected by the global AIDS epidemic. Today, there are an estimated 33.4 million people living with HIV and AIDS and each year around two million people die from AIDS related illnesses.
What causes AIDS?

AIDS is caused by HIV. HIV is a virus that gradually attacks immune system cells. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off. It is at the point of very advanced HIV infection that a person is said to have AIDS. It can be years before HIV has damaged the immune system enough for AIDS to develop.
What are the symptoms of AIDS?

A person is diagnosed with AIDS when they have developed an AIDS related condition or symptom, called an opportunistic infection, or an AIDS related cancer. The infections are called opportunistic because they take advantage of the opportunity offered by a weakened immune system. It is possible for someone to be diagnosed with AIDS even if they have not developed an opportunistic infection. AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of an HIV positive person drops below a certain level.
Is there a cure for AIDS?

Worryingly, many people think there is a 'cure' for AIDS - which makes them feel safer, and perhaps take risks that they otherwise wouldnt. However, there is still no cure for AIDS. The only way to stay safe is to be aware of how HIV is transmitted and how to prevent HIV infection.
How many people have died from AIDS?

Since the first cases of AIDS were identified in 1981, more than 25 million people have died from AIDS. An estimated two million people died as a result of AIDS in 2008 alone.

Although there is no cure for AIDS, HIV infection can be prevented, and those living with HIV can take antiretroviral drugs to delay the onset of AIDS. However, in many countries across the world access to prevention and treatment services is limited. Global leaders have pledged to work towards universal access to HIV prevention and care, so that millions of deaths can be averted.
How is AIDS treated?

A community health worker gives an HIV positive patient antiretroviral drugs, Kenya Antiretroviral treatment can prolong the time between HIV infection and the onset of AIDS. Modern combination therapy is highly effective and someone with HIV who is taking treatment could live for the rest of their life without developing AIDS. An AIDS diagnosis does not necessarily equate to a death sentence. Many people can still benefit from starting antiretroviral therapy even once they have developed an AIDS defining illness. Better treatment and prevention for opportunistic infections have also helped to improve the quality and length of life for those diagnosed with AIDS. Treating some opportunistic infections is easier than others. Infections such as herpes zoster and candidiasis of the mouth, throat or vagina, can be managed effectively in most environments. On the other hand, more complex infections such as toxoplasmosis, need advanced medical equipment and infrastructure, which are lacking in many resource-poor areas. It is also important that treatment is provided for AIDS related pain, which is experienced by almost all people in the very advanced stages of HIV infection.

Why do people still develop AIDS today?

Even though antiretroviral treatment can prevent the onset of AIDS in a person living with HIV, many people are still diagnosed with AIDS today. There are four main reasons for this:

In many resource-poor countries antiretroviral treatment is not widely available. Even in wealthier countries, such as America, many individuals are not covered by health insurance and cannot afford treatment. Some people who became infected with HIV in the early years of the epidemic before combination therapy was available, have subsequently developed drug resistance and therefore have limited treatment options. Many people are never tested for HIV and only become aware they are infected with the virus once they have developed an AIDS related illness. These people are at a higher risk of mortality, as they tend to respond less well to treatment at this stage. Sometimes people taking treatment are unable to adhere to, or tolerate the side effects of drugs.

Caring for a person with AIDS

In the later stages of AIDS, a person will need palliative care and emotional support. In many parts of the world, friends, family and AIDS organisations provide home based care. This is particularly the case in countries with high HIV prevalence and overstretched healthcare systems. End of life care becomes necessary when a person has reached the very final stages of AIDS. At this stage, preparing for death and open discussion about whether a person is going to die often helps in addressing concerns and ensuring final wishes are followed.
The global AIDS epidemic

Around 2.7 million people became infected with HIV in 2008. Sub-Saharan Africa has been hardest hit by the epidemic; in 2008 over two-thirds of AIDS deaths were in this region.

Parc de l'espoir - AIDS Memorial Park in Montreal, Canada The epidemic has had a devastating impact on societies, economies and infrastructures. In countries most severely affected, life expectancy has been reduced by as much as 20 years. Young adults in their productive years are the most at-risk population, so many countries have faced a slow-down in economic growth and an increase in household poverty. In Asia, HIV and AIDS causes a greater loss of productivity than any other disease. An adults most productive years are also their most reproductive and so many of the age group who have died from AIDS have left children behind. In sub-Saharan Africa the AIDS epidemic has orphaned nearly 12 million children. In recent years, the response to the epidemic has been intensified; in the past ten years in low- and middle-income countries there has been a 6-fold increase in spending for HIV and AIDS. The number of people on antiretroviral treatment has increased, the annual number of AIDS deaths has declined, and the global percentage of people infected with HIV has stabilised. However, recent achievements should not lead to complacent attitudes. In all parts of the world, people living with HIV still face AIDS related stigma and discrimination, and many people still cannot access sufficient HIV treatment and care. In America and some countries of Western and Central and Eastern Europe, infection rates are rising, indicating that HIV prevention is just as important now as it ever has been. Prevention efforts that have proved to be effective need to be scaled-up and treatment targets reached. Commitments from national governments right down to the community level need to be intensified and subsequently met, so that one day the world might see an end to the global AIDS epidemic.
Learn more about HIV and AIDS

In addition to the hundreds of informative pages about HIV and AIDS, the AVERT website has interactive ways to learn more about HIV and AIDS.

The AVERT AIDS Game is a great way to see how much you know about HIV and AIDS. You can test your knowledge of HIV and AIDS by trying one of our online quizzes. Our photo gallery has hundreds of HIV and AIDS related photos from around the world. The AVERT video gallery has a number of short videos related to HIV and AIDS. Finally, you can read stories that have been sent to us from people who are either living with HIV or who have been affected by HIV and AIDS.

Friday, July 18, 2008

SISTER CALLISTA ROY: ADAPTATION THEORY

When push comes to a shove, we will seldom disappoint ourselves. We all harbour greater stores of strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which we are made. Do not underestimate the power of a person to cope. He may be dependent now but deep within him lies the energy to adapt. I remember a particular a particular patient when I was still an ICU nurse. He was a pastor afflicted with a serious liver problem. Specialists come and go at his ICU bed but they cannot seem to diagnose the problem. Time is running out and the pastor is slipping fast. Hes bleeding and God knows how many units of blood have been transfused to him. He went into coma. Doctors were giving up, and so were we. Weve primed the family but they just wont give upyet. The wife is always there at his side during visiting hours, always cheerful and full of hope. So is the daughter who even lets her dad listen to praise songs as if he is not comatose. Many days passed and to our amazement, the pastor woke up from coma. Its been uphill from there. Everything just fell into the right place. He was transferred to a regular room and eventually discharged with a clean bill of health. Amazing? What could it be? A miracle? Or could it be the medications working, or the transfusion? Or the familys fervent prayers? We couldnt tell but one thing is certain: human beings are made to persist. And that is what Sister Callista Roy believed, too.

Sister Callista Roy is a member of the Sisters of Saint Joseph of Carondelet. She received a bachelor of science in nursing from Mount Saint Marys College in Los Angeles California, a master of science in nursing from UCLA, and a masters degree and doctorate in sociology from UCLA (Philips, 2002). Roy first proposed the RAM while studying for her masters degree at UCLA, where Dorothy Johnson challenged

students to develop conceptual models of nursing (Philips, 2002; Roy & Andrew, 1999). She received many honors and awards for her scholarly and professional work and is currently the Graduate Faculty Nurse Theorist at Boston College, School of Nursing (Roy, 2000).

PHILOSOPHICAL UNDERPINNINGS OF THE THEORY Johnsons nursing model was the impetus for the development of Roys Adaptation Model. Roy also incorporated concepts from Helsons adaptation theory, von Bertalanffys system model, Rapoports system definition, the stress and adaptation theories of Dohrenrend and Selye, and the coping model of Lazarus (Philips, 2002).

MAJOR ASSUMPTIONS, ASSUMPTIONS

CONCEPTS

AND

RELATIONSHIPS

In the Adaptation Model, assumptions are specified as scientific assumptions or philosophical assumptions. Scientific Assumptions

Systems of matter and energy progress to higher levels of complex selforganization. Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling

Humans by their decisions are accountable for the integration of creative processes. Thinking and feeling mediate human action System relationships include acceptance, protection, and fostering of interdependence Persons and the earth have common patterns and integral relationships Persons and environment transformations are created in human consciousness Integration of human and environment meanings results in adaptation (Roy&Andrew, 1999, p.35).

Philosophical Assumptions

Persons have mutual relationships with the world and God Human meaning is rooted in the omega point convergence of the universe. God is intimately revealed in the diversity of creation and is the common destiny of creation. Persons use human creative abilities of awareness, enlightenment, and faith. Persons are accountable for the processes of deriving, sustaining and transforming the universe (Roy & Andrew, 1999, p. 35).

Reading through Roys adaptation theory, I now understand mans immense capacity to adapt. I believe in a higher power, I believe in miracles, but I believe, too, that the greater miracle is the perfect interplay of all the factors that push a person to adapt at various modes.

The Four Modes of Adaptation

1. Physiologic-Physical Mode Physical and chemical processes involved in the function and activities of living organisms; the underlying need is physiologic integrity as seen in the degree of wholeness achieved through adaptation to change in needs. 2. Self-concept- Group Identity Mode Focuses on psychological and spiritual integrity and sense of unity, meaning, and purposefulness in the universe. 3. Role Function Mode Roles that individuals occupy in society, fulfilling the need for social integrity. It is knowing who one is in relation to others. 4. Interdependence Mode The close relationships of people and their purpose, structure and development individually and in groups and the adaptation potential of these groups.

So how did the pastor recover? At the physiologic level, it was good that he was brought to the ICU immediately since the basic physiologic needs are met at once. He was intubated (for oxygenation), an NGT was put in place (for nutrition), a foley catheter was inserted (for elimination), and enema was also done to facilitate elimination of wastes. Visitors were restricted early on to provide optimum rest and to minimize cross contamination. Isolation measures were also instituted. Routine ICU care, so to speak. Every time the patient is assigned to me, I try to talk to him as if he listens and can answer. His churchmates were also there every time they are allowed to see him telling him that they are waiting for him at their church. The wife and the daughter never gave up on him. They are always there to tell him how much they love and need him. The adaptation process was a long one, but he did adapt and went on to recover. The ICU environment is not a very ideal place for adaptation, but given the situation and condition of the patient at that time, it was the best place to support the bodys power to adapt.

ROYS THEORY AS APPLIED TO: NURSING PRACTICE

Using Roys six step nursing process, the nurse assesses first the behaviors and second the stimuli affecting those behaviors. In a third step the nurse makes a statement or nursing diagnosis of the persons adaptive state and fourth, sets goals to promote adaptation. Fifth, nursing interventions are aimed at managing the stimuli to promote adaptation. The last step in the nursing process is evaluation. By manipulating the stimuli and not the patient, the nurse enhances the interaction of the person with their environment, thereby promoting health. Hamner in 1989 discussed the Roy model and how it could be applied to nursing care in a cardiac unit (CCU). Hamner describes the model as enhancing care in the CCU and being consistent with the nursing process. Hamner found that the model assessed all patients behavior, so that none was excluded. The author discovered that the Roy model provides a structure in which manipulation of stimuli are not overlooked. The model puts emphasis on identifying and reinforcing positive behavior which speeds recovery.

EDUCATION The adaptation model is also useful in educational setting. Roy states that the model defines for students the distinct purpose of nursing which is to promote mans

adaptation in each of the adaptive modes in situations of health and illness.

In the early 1980s the School of Nursing at the University of Ottawa experienced a major curriculum change. This change included incorporating a nursing model by which to base their new curriculum. The change included incorporating a nursing model by which to base their new curriculum. The Roy adaptation model was one of the models to be included in the first year of the baccalaureate program. The professors had to meet four challenges during this change: 1. 2. 3. Adapting the course teaching of to be tools content congruent suitable for with for the Roy model, learning. learning

Developing Sequencing

student student

4. Obtaining competent role models. RESEARCH If research is to affect practitioners behavior, it must be directed at testing and retesting conceptual models for nursing practice. Roy has stated that theory development and the testing of developed theories are nursings highest priorities. The model must be able to regenerate testable hypotheses for it to be researchable.

Fawcett and Tulman used the model for the design of studies measuring functional status after childbirth. They also used the model for retrospective and longitudinal studies of variables associated with functional status during the postpartum period. The model was also used for ongoing studies of functional status during pregnancy and after the diagnosis of breast cancer. The model facilitated the selection of study variables and clarified thinking about the classification of study variables. The model was a useful guide for the design and conduct of studies of functional status.

GROUP D Cortez, Joyzen Cutay, Rose Ann Cristobal, Maureen De Jesus, David Daniel, Jane Dayao, Genevieve Thank you for your contributions.

Posted by Group G: UPOU Orem's Supporters at 11:46 PM 8 comments: issae guadalupe said...

hello there!! First of all congratulations!!! you have proven that we could really make interesting and substantial articles...!!! I was touched by the story... although I would like to know how long it really took him to recover from coma.. I now have a clearer view of what the theory is all about!!! thanks and hope we could hear more from your group!!! July 19, 2008 6:15 AM N207 Students said... Whew!!! Natapos din... Sa lahat ng nag-care at nakialam, salamat po. To Joyzen, David, at Sean, sa mga late night chats natin- from Roy, to nganga, to lovelives at samu't sari pang kwentuhan, salamat. To Jesper (Pender group) na walang sawang nagpapaalala sakin everytime may new updates sa moodle, salamat din. Kay Gen, na lagi nagtetext kung ano maitutulong nya, at kay Jane na humabol din para tumulong, salamat! At sa "techie" friends kong sila Annie at Marco, maraming salamat for keeping me afloat sa mga panahong "toxic" ako. Salamat! July 19, 2008 5:47 PM N207 Students said... Hi Issa! Thanks for the comment. When I was reading through Roy's theory, that particular patient instantly came to mind. He was in the hospotal for almost two months, pabalik-balik sa ICU. The longest duration that he was in coma was about three weeks if I remember it right. Then he was transferred to a regular room and eventually discharged. The last time I saw him was in the hallway, walking, aided by only a cane, when he came back for his follow-up check up. Truly, the body heals on its own...and I still believe there is a God. Good day! July 19, 2008 5:51 PM katrina anne limos said... Great job! You have successfully presented Sister Calixta Roy's theory in a brief and comprehensive manner. Truly, it's easier to impart knowledge on others by sharing your own experiences. Utilizing the pastor's case to present the theory makes it easier for us readers to relate on what you are talking about. These theories are mere theories on paper unless we nurses utilize it in our everyday practice. Congratulations. Great job! July 19, 2008 11:51 PM N207 Students said...

Roy Adaptation Model: Sister Callista... Theory Overview Sister Callista Roy developed the Roy Adaptation Model, which is based on the belief that the human being is an open system. The system responds to environmental stimuli through the cognator and regulator coping mechanisms for individuals and the stabilizer and innovator control mechanisms for groups. The responses occur through at least one of four modes physiological-physical, self-concept-group identity, role function, and interdependence. The responses in these modes are usually visible to others and can be identified as adaptive or ineffective. Adaptive behaviors that need support and ineffective behaviors are then analyzed to identify the associated stimuli. The major stimulus leading to one of these behaviors is the focal stimulus; other stimuli that are verified as being involved are contextual, and stimuli that might be involved but have not been verified are residual. Nursing care focuses on altering stimuli or strengthening adaptive processes to result in adaptive behaviors. Pearson Education, Inc., publishing as Pearson Prentice Hall Roy's work is a conceptual model that views the individual as an adaptive system that is a biopsychosocial being required to adapt to environmental stimuli. Adaptation is considered to take place in one biological and three psychosocial modes. I must say I was particularly spiritually enlightened with the pastors story. With all there is to define the word adaptation, this should be apparent: one shall decide that it needs to. The responses to the environment and to a particular situation entail a great deal of motivation from the one involved. I am honestly impressed with the article. It was briefly and substantially presented to create a comprehensive view of Sister Callista Roys Adaptation Theory. I regret to not have been actively involved with the material. It is good. But at least it is never too late. Congratulations group mates! abi July 20, 2008 8:13 AM mayang said... great job! the story is very amazing and heartrending... one thing i noticed, i could not read the texts in the first diagram. it looks interesting. what is it about? July 20, 2008 3:20 PM

luvinthelamb said... Thanks for the simple layout of Roy's Model. The shared story was a great example, and provided clear understanding of application. I have one question though: Under the Modes of Adaptation, no. 4- is this a description of the Interdependence Mode or separate info? I just noticed that this point is not aligned with previous points. October 20, 2008 2:30 PM Maggie said... Is any of this original material? I have seen all of this on other sites... including the models you posted. This is plagiarism if you do not site your references. July 14, 2009 3:04 PM Post a Comment Newer Post Older Post Home Subscribe to: Post Comments (Atom)

Roy Adaptation Model A thoroughly revised and updated book, this definitive new edition reflects the latest advances in the popular Roy Adaptation Model, one of the most widely implemented nursing theories. Compact and consistent, this book focuses on the essentials of nursing practice and theory while integrating the conceptual framework of the Model into contemporary practice. Standardized nursing NANDA diagnoses are used consistently throughout the book. New case studies are included in all adaptive mode chapters. Undergraduate nursing students.

Author: Delivery Type: Edition/Volume: Inventory Status: Publisher: Pages: Type:

Roy, C Physical 03 On Order With Supplier Pearson Education 553 Book

Published Date: Product Id: 0 USER REVIEW(s) FOUND Add Your Own Review

09/01/2008 88036

550 W. North Street Indianapolis, IN 46202 USA | 888.654.4968 (TOLL FREE - US/CANADA only) | +1.317.687.2256 (INTNL) Copyright 2010 Nursing Knowledge International. All rights reserved worldwide. Roy's model of nursing From Wikipedia, the free encyclopedia Jump to: navigation, search The introduction to this article provides insufficient context for those unfamiliar with the subject. Please help improve the article with a good introductory style. (October 2009) Sister Callista Roy developed the Adaptation Model of Nursing in 1976. This model comprises the four domain concepts of person, health, environment, and nursing and involves a six step nursing process. Andrews & Roy (1991) state that the person can be a representation of an individual or a group of individuals. Roy's models sees the person as "a biopsychosocial being in constant interaction with a changing environment" (Rambo, 1984). The person is an open, adaptive system who uses coping skills to deal with stressors. Roy sees the environment as "all conditions, circumstances and influences that surround and affect the development and behaviour of the person" (Andrews & Roy, 1991). Roy describes stressors as stimuli and uses the term 'residual stimuli' to describe those stressors whose influence on the person is not clear (Andrews & Roy). Originally, Roy wrote that health and illness are on a continuum with many different states or degrees possible (Rambo, 1984). More recently, she states that health is the process of being and becoming an integrated and whole person (Andrews & Roy). Roy's goal of nursing is "the promotion of adaptation in each of the four modes, thereby contributing to the person's health, quality of life and dying with dignity" (Andrews & Roy). These four modes are physiological, selfconcept, role function and interdependence. Roy employs a six-step nursing process which includes: assessment of behaviour, assessment of stimuli, nursing diagnosis, goal setting, intervention and evaluation. In the first step, the person's behaviour in each of the four modes is observed. This behaviour is then compared with norms and is deemed either adaptive or ineffective. The second step is concerned with factors that influence behaviour. Stimuli are classified as focal, contextual or residual (Rambo, 1984). The nursing diagnosis is the

statement of the ineffective behaviours along with the identification of the probable cause. In the fourth step, goal setting is the focus. Goals need to be realistic and attainable and are set in collaboration with the person (Andrews & Roy, 1991). Intervention occurs as the fifth step, and this is when the stimuli are manipulated. It is also called the 'doing phase' (Rambo). In the final stage, evaluation takes place. The degree of change as evidenced by change in behaviour, is determined. Ineffective behaviours would be reassessed, and the interventions would be revised (Andrews & Roy).
Contents

[hide]

1 Goals of nursing 2 Types of Stimuli 3 Four Modes of Adaptation 4 Applying Roys Model to [Assess]Families 5 Summary 6 Definition 7 See also 8 References 9 External links

[edit] Goals of nursing

Goal of Nursing To identify types of demands placed on client and clients adaptation to them Framework for practice Adaptation model based on four adaptive modes; physiological, psychological, sociological, and independence Sister Callista Roys adaptation model had its inception in 1964 when as a graduate student she was challenged by nursing faculty member Dorothy E. Johnson to develop a conceptual model for nursing practice. Roys model drew heavily on the work of Harry Helson, a physiologic psychologist (Roy, 1980). The Roy adaptation model is generally considered a "systerms" model; however, it also includes elements of an "interactional" model. The model was developed specifically for the individual client, but it can be adapted to families and to communities (Roy, 1983). Roy states (Clements and Roberts, 1983) that "just as the person as an adaptive system has input, output. and internal processes so too the family can be described from this perspective." Basic to Roys model are three concepts: the human being, adaptation, and nursing. The human being is viewed as a biopsychosocial being who is continually interacting with the environment. The human beings goal through this interaction is adaptation. According to Roy and Roberts (1981, p. 43), The person has two major internal processing subsystems, the regulator and the cognator." These subsystems are the mechanisms used by human beings to cope with stimuli from the internal and external environment. The regulator mechanism works primarily through the autonomic nervous system and includes endocrine, neural, and perception pathways. This mechanism prepares the individual for coping with environmental stimuli. The cognator mechanism includes emotions, perceptual/information processing, learning,

and judgment. The process of perception bridges the two mechanisms (Roy and Roberts, 1981).
[edit] Types of Stimuli

Three types of stimuli influence an individuals ability to cope with the environment. These indude focal stimuli, contextual stimuli, and residual stimuli. Focal stimuli are those that immediately confront the individual in a particular situation. Focal stimuli for a family include individual needs; the level of family adaptation; and changes within the family members, among the members and in the family environment (Roy, 1983). Contextual stimuli are those other stimuli that influence the situation. Residual stimuli include the individuals beliefs or attitudes that may influence the situation. Contextual and residual stimuli for a family system include nurturance, socialization, and support (Roy, 1983). Adaptation occurs when the total stimuli fall within the individuals/familys adaptive capacity, or zone of adaptation. The inputs for a family include all of the stimuli that affect the family as a group. The outputs of the family system are three basic goals: survival, continuity, and growth (Roy, 1983). Roy states (Clements and Roberts, 1983): Since adaptation level results from the pooled effect of all other relevant stimuli, the nurse examines the contextual and residual stimuli associated with the focal stimulus to ascertain the zone within which positive family coping can take place and to predict when the given stimulus is outside that zone and will require nursing intervention.

[edit] Four Modes of Adaptation

Roy believes that an individuals adaptation occurs in four different modes. This also holds true for families (Hanson, 1984). These include the physiologic mode, the selfconcept mode, the role function mode, and the interdependence mode (Roy, 1980). The individuals regulator mechanism is involved primarily with the physiologic mode, whereas the cognator mechanism is involved in all four modes (Roy and Roberts, 1981). The family goals correspond to the models modes of adaptation: survival = physiologic mode; growth = self-concept mode; continuity = role function mode. Transactional patterns fall into the interdependence mode (Clements and Roberts, 1983). In the physiologic mode, adaptation Involves the maintenance of physical integrity. Basic human needs such as nutrition, oxygen, fluids, and temperature regulation are identified with this mode (Fawcett, 1984). In assessing a family, the nurse would ask how the family provides for the physical and survival needs of the family members. A function of the self-concept mode is the need for maintenance of psychic integrity. Perceptions of ones physical and personal self are included in this mode. Families also have concepts of themselves as a family unit. Assessment of the family in this mode would include the amount of understanding provided to the family members, the solidarity of the family. the values of the family, the amount of companionship provided to the members, and the orientation (present or future) of the family (Hanson, 1984).

The need for social integrity is emphasized in the role function mode. When human beings adapt to various role changes that occur throughout a lifetime, they are adapting in this mode. According to Hanson (1984), the familys role can be assessed by observing the communication patterns in the family. Assessment should include how decisions are reached, the roles and communication patterns of the members, how role changes are tolerated, and the effectiveness of communication (Hanson, 1984). For example, when a couple adjusts their lifestyle appropriately following retirement from full-time employment, they are adapting in this mode. The need for social integrity is also emphasized in the interdependence mode. Interdependence involves maintaining a balance between independence and dependence in ones relationships with others. Dependent behaviors include affection seeking, help seeking, and attention seeking. Independent behaviors include mastery of obstacles and initiative taking. According to Hanson (1984), when assessing this mode in families, the nurse tries to determine how successfully the family lives within a given community. The nurse would assess the interactions of the family with the neighbors and other community groups, the support systems of the family, and the significant others (Hanson, 1984). The goal of nursing is to promote adaptation of the client during both health and illness in all four of the modes. Actions of the nurse begin with the assessment process, The family is assessed on two levels. First, the nurse makes a judgment with regard to the presence or absence of maladaptation. Then, the nurse focuses the assessment on the stimuli influencing the familys maladaptive behaviors. The nurse may need to manipulate the environment, an element or elements of the client system, or both in order to promote adaptation (Roy, 1980). Many nurses, as well as schools of nursing, have adopted the Roy adaptation model as a framework for nursing practice. The model views the client in a holistic manner and contributes significantly to nursing knowledge. The model continues to undergo clarification and development by the author.
[edit] Applying Roys Model to [Assess]Families

When using Roys model as a theoretical framework, the following can serve as a guide for the assessment of families.

I. Adaptation Modes o A. Physiologic Mode 1. To what extent is the family able to meet the basic survival needs of its members? 2. Are any family members having difficulty meeting basic survival needs? o B. Self-Concept Mode 1. How does the family view itself in terms of its ability to meet its goals and to assist its members to achieve their goals? To what extent do they see themselves as self-directed? Other directed? 2. What are the values of the family?

3. Describe the degree of companionship and understanding given to the family members, o C. Role Function Mode 1. Describe the roles assumed by the family members. 2. To what extent are the family roles supportive, in conflict, reflective of role overload? 3. How are family decisions reached? o D. Interdependence Mode 1. To what extent are family members and subsystems within the family allowed to be independent in goal identification and achievement (e.g., adolescents)? 2. To what extent are the members supportive of one another? 3. What are the familys support systems? Significant others? 4. To what extent is the family open to information and assistance from outside the family unit? Willing to assist other families outside the family unit? 5. Describe the interaction patterns of the family In the community. II. Adaptive Mechanisms o A. Regulator: Physical status of the family in terms of health?ie, nutritional state, physical strength, availability of physical resources o B. Cognator: Educational level, knowledge base of family, source of decision making, power base, degree of openness in the system to input, ability to process III. Stimuli o A. Focal 1. What are the major concerns of the family at this time? 2. What are the major concerns of the individual members? o B. Contextual 1. What elements in the family structure, dynamic, and environment are impinging on the manner and degree to which the family can cope with and adapt to their major concerns (i.e., financial and physical resources, presence or absence of support systems, clinical setting and so on)? o C. Residual 1. What knowledge, skills, beliefs, and values of this family must be considered as the family attempts to adapt (ie, stage of development, cultural background, spiritual/religious beliefs, goals, expectations)?

[edit] Summary

The nurse assesses the degree to which the familys actions in each mode are leading to positive coping and adaptation to the focal stimuli. If coping and adaptation are not health promoting, assessment of the types of stimuli and the effectiveness of the regulators provides the basis for the design of nursing interventions to promote adaptation.....

[edit] Definition

Roy's model of nursing sees an individual as a set of interrelated systems, biological, psychological, and social. The individual tries to maintain a balance between each of these systems and the outside world. However, there is no absolute level of balance. According to Roy we all strive to live within a band where we can cope adequately. This band will be unique to an individual. The adaptation level is the range of adaptability within which the individual can deal effectively with new experiences. Callista Roy maintains there are four main adaptation systems which she calls modes of adaptation. She calls these the 1. the physiological - physical system 2. the selfconcept group identity system 3. the role mastery/function system 4. the interdependency system.
[edit] See also

Nursing theory

[edit] References

Aggleton, P., & Chalmers, H. (1984). The Roy adaptation model. Nursing Times. October 3. Roy, C. (1980). The Roy adaptation model. In Riehl, J. P., & Roy, C. (Eds.), Conceptual Models for Nursing Practice. Norwalk: Appleton, Century Crofts. Andrews, H., & Roy, C. (1991). The Adaptation Model. Norwalk: Appleton & Lange. Rambo, B. (1984). Adaptive Nursing. Philadelphia: W.B. Saunders Company.

[edit] External links

Roy's page at Boston College web site

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Sister Callista Roy

A recognized nurse theorist, researcher, writer and teacher Martha Elizabeth Rogers was born on May 12, 1914 in Dallas Texas as the first born daughter and oldest of four siblings of Mr and Mrs. Rogers. As the oldest of four siblings Sister Callista Roy was born on October 14, 1939 as the second child but first daughter of Mr. and Mrs. Fabien Roy. Devote Catholics her parents name her after Saint Callistus from a Roman Catholic Calendar of the day on which she was born. The daughter of a licensed nurse Callista was continuously taught the importance of knowing all you could about people, the care they needed and most importantly the selfless giving as a nurse. By the age of 14 Callista began working at a large general hospital as a pantry girl and quickly moved up in rank to a nurse's aid. Being raised in a highly religious oriented family Callista reached a crossroads in her life and after much soA deep spirit of faith, hope, love and commitment to God and service to others was central in this family of seven boys and seven girls. Her mother was a licensed vocational nurse and instilled the values of always seeking to know more about people and their care and of selfless giving as a nurse. Dr. Roy notes that she also had excellent teachers in parochial schools, high school, and college. At age 14 she began working at a large general hospital, first as a pantry girl, then as a maid, and finally as a nurse's aid. After a soul-searching process of discernment, she decided to enter the Sisters of Saint Joseph of Carondelet, of which she has been a member for more than 40 years. Her college education began in a liberal arts program, where she earned a Bachelor of Arts with a major in nursing at Mount St. Mary's College, in Los Angeles. As a young Sister nurse, Sr. Callista worked in hospitals administered by the Sisters of St. Joseph in Idaho and Arizona. Here she expanded her love and concern for children,... Read Full Essay Already a Member? Login Now This essay and over 200,000 other essays are available now on OPPapers.com.

Submitted by: ivette Date Submitted: 11/10/2006 11:44 AM Category: Science and Technology Length: 6 pages (1,465 words) Views: 6119 Rank: 6350 Report this Essay Save Paper

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Sister Callista Roy

A recognized nurse theorist, researcher, writer and teacher Martha Elizabeth Rogers was born on May 12, 1914 in Dallas Texas as the first born daughter and oldest of four siblings of Mr and Mrs. Rogers. As the oldest of four siblings Sister Callista Roy was born on October 14, 1939 as the second child but first daughter of Mr. and Mrs. Fabien Roy. Devote Catholics her parents name her after Saint Callistus from a Roman Catholic Calendar of the day on which she was born. The daughter of a licensed nurse Callista was continuously taught the importance of knowing all you could about people, the care they needed and most importantly the selfless giving as a nurse. By the age of 14 Callista began working at a large general hospital as a pantry girl and quickly moved up in rank to a nurse's aid. Being raised in a highly religious oriented family Callista reached a crossroads in her life and after much soA deep spirit of faith, hope, love and commitment to God and service to others was central in this family of seven boys and seven girls. Her mother was a licensed vocational nurse and instilled the values of always seeking to know more about people and their care and of selfless giving as a nurse. Dr. Roy notes that she also had excellent teachers in parochial schools, high school, and college. At age 14 she began working at a large general hospital, first as a pantry girl, then as a maid,

and finally as a nurse's aid. After a soul-searching process of discernment, she decided to enter the Sisters of Saint Joseph of Carondelet, of which she has been a member for more than 40 years. Her college education began in a liberal arts program, where she earned a Bachelor of Arts with a major in nursing at Mount St. Mary's College, in Los Angeles. As a young Sister nurse, Sr. Callista worked in hospitals administered by the Sisters of St. Joseph in Idaho and Arizona. Here she expanded her love and concern for children,... Read Full Essay Already a Member? Login Now This essay and over 200,000 other essays are available now on OPPapers.com.

Submitted by: ivette Date Submitted: 11/10/2006 11:44 AM Category: Science and Technology Length: 6 pages (1,465 words) Views: 6119 Rank: 6350 Report this Essay Save Paper

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Johnson Behavioral System (JBS) Model Author Unknown retrieved from the internet September 1, 2002 http://www.myfreeessays.com/science_and_technology/041.shtml In this paper, I am going to summarize the Johnson Behavioral System (JBS) Model (Johnson, 1980, 1990), explain the perspectives for nursing practice, and explore its applicability in nursing practice. First, I am going to talk a little about Dorothy E. Johnson the nurse that wrote the Model. Dorothy E. Johnson was born August 21, 1919, in Savannah, Georgia (Lobo, 1995). She received her A. A. from Armstrong Junior College in Savannah, Georgia, in 1938; her B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her M.P.H. from Harvard University in Boston in 1948 (Conner, Harbour, Magers, and Watt 1994). Johnson was an instructor and an assistant professor in pediatric nursing at Vanderbilt University School of Nursing from 1944 to 1949. From 1949 until her retirement in 1978 and subsequent move to Key Largo, Florida, she was an assistant professor of pediatric nursing, an associate professor of nursing, and a professor of nursing at the University of California in Los Angeles (Conner et. al. 1994). In 1955 and 1956 she was eligible to go on a sabbatical and went to the Christian Medical College School of Nursing in Vellore, South India, were she was interested in starting a baccalaureate program which was received well (Lobo, 1995). Dorothy Johnson has had an influence on nursing through her publications since the 1950s. Throughout her career, Johnson has stressed the importance of research-based knowledge about the effect of nursing care on clients. Johnson was an early proponent of nursing as a science as well as an art. She also believed nursing had a body of knowledge reflecting both the science and the art. From the beginning, Johnson (1959) proposed that the knowledge of the science of nursing necessary for effective nursing care included a synthesis of key concepts drawn from basic and applied sciences. In 1961, Johnson proposed that nursing care facilitated the client's maintenance of a state of equilibrium. Johnson proposed that clients were "stressed" by a stimulus of either an internal or external nature. These stressful stimuli created such disturbances, or "tensions," in the patient that a state of disequilibrium occurred. Johnson identified two areas that nursing care should be based in order to return the client to a state of equilibrium. First, by reducing stressful stimuli, and second, by supporting natural and adaptive processes. Johnson's behavioral system theory springs from Nightingales belief that nursing's goal is to

help individuals prevent or recover from disease or injury. The "science and art" of nursing should focus on the patient as an individual and not on the specific disease entity. Johnson used the work of behavioral scientists in psychology, sociology, and ethnology to develop her theory. The model is patterned after a systems model; a system is defined as consisting of interrelated parts functioning together to form a whole (Conner et. al. 1994). Johnson states that a nurses should use the behavioral system as their knowledge base; comparable to the biological system that physicians use as their base of knowledge (Lobo, 1995). The reason Johnson chose the behavioral system model is the idea that "all the patterned, repetitive, purposeful ways of behaving that characterize each person's life make up an organized and integrated whole, or a system" (other). Johnson states that by categorizing behaviors, they can be predicted and ordered. Johnson categorized all human behavior into seven subsystems (SSs): Attachment, Achievement, Aggressive, Dependence, Sexual, Ingestive, and Eliminative. Each subsystem is composed of a set of behavioral responses or tendencies that share a common goal. These responses are developed through experience and learning and are determined by numerous physical, biological, psychological, and social factors. Four assumptions are made about the structure and function of each SS. These four assumptions are the "structural elements" common to each of the seven SSs. The first assumption is "from the form the behavior takes and the consequences it achieves can be inferred what drive has been stimulated or what goal is being sought" (Johnson, 1980). The ultimate goal for each subsystem is expected to be the same for all individuals. The second assumption is that each individual has a "predisposition to act, with reference to the goal, in certain ways rather than in other ways" (Johnson, 1980). This predisposition to act is labeled "set" by Johnson. The third assumption is that each subsystem has available a repertoire of choices or "scope of action" alternatives from which choices can be made. As life experiences occur, individuals add to the number of alternative actions available to them. At some point, however, the acquisition of new alternatives of behavior decreases as the individual becomes comfortable with the available repertoire. The fourth assumption about the behavioral subsystem is that they produce observable outcomes-that is, the individuals behavior (Johnson, 1980). The observable behaviors allow an outsider to note the actions the individual is taking to reach a goal related to a specified SS. In addition, each of the SSs has three functional requirements. First, each subsystem must be "protected from noxious influences with which the system cannot cope" (Johnson, 1980). Second, each subsystem must be "nurtured through the input of appropriate supplies from the environment." Finally each subsystem must be "stimulated for use to enhance growth and prevent stagnation." As long as the SSs are meeting these functional requirements, the system and the SSs are viewed as selfmaintaining and self- perpetuating. The internal and external environments of the system need to remain orderly and predictable for the system to maintain homeostasis. The interrelationships of the structural elements of the subsystem to maintain a balance that is adaptive to that individual's needs. Johnson's Behavioral Subsystems The Attachment subsystem is probably the most critical, because it forms the basis for all social organization. It provides survival and security. Its consequences are social

inclusion, intimacy, and formation and maintenance of a strong social bond. The Achievement subsystem attempts to manipulate the environment. Its function is control or mastery of an aspect of self or environment to some standard of excellence. Areas of achievement behavior include intellectual, physical, creative, mechanical, and social skills. The Aggressive subsystem function is protection and preservation. It holds that aggressive behavior is not only learned, but has a primary intent to harm others. However, society has placed limits when dealing with self-protection and that people and their property be respected and protected. The Dependency subsystem promotes helping behavior that calls for a nurturing response. Its consequences are approval, attention or recognition, and physical assistance. Ultimately, dependency behavior develops from the complete reliance on others for certain resources essential for survival. An imbalance in a behavioral subsystem produces tension, which results in disequilibrium. The The Ingestive and Eliminative SSs "have to do with when, how, what, how much and under what conditions we eat, and when, how, and under what conditions we eliminate". The Sexual subsystem has the dual functions of procreation and gratification. It begins with the development of gender role identity and includes the broad range of sex role behaviors (Johnson, 1980). When there is an alteration in the "equilibrium" that exists, Johnson's Model tends to diagnose to a subsystem rather than a specific problem. Johnson's Model states that it is at this point when the nurse is needed in order to return the client to homeostasis (Conner et al., 1994). Application in Nursing Practice

The application of any nursing model to practice requires three conditions: the model's congruence with practice requirements, its comprehensive development in relation to practice requirements, and its specificity in relation to practice requirements. These conditions governing a nursing model's applicability should be understood to enable practitioners to appropriately and effectively use models in practice (Derdiarian, 1993). What is nursing practice and what are requirements of the practice? Nursing practice derives its definition from that of professional practice, the action or process of performing something, the habitual or customary performance of something (Random House College Dictionary, 1988). Professional practice has three main requirements: perspective, structure and scientific substance. The first requirement is the perspective, or a mental view, of facts or ideas and their interrelationships pertinent of the professions' practice. In nursing, the perspective of the practice refers to nursing's view of the patient and its role in relation to the patient (Derdiarian, 1993). More specifically, the profession's perspective clarifies the nature, goal, focus, and scope of its realm of its science and practice (Derdiarian, 1993). By so doing, the profession's perspective distinguishes nursing's realm of science and practice from those of related fields. At the same time, the perspective identifies appropriate alignments between nursing's research and practice and those of other professions. In other words, the professional perspective provides the professional with a knowledge base and a mind-set about the patient, about her/his role in relation to the patient, and her/his actions necessary to fulfill that role (Derdiarian, 1993).

The second requirement of professional practice is a structure for practice to organize and standardize practice and, thus, render practice habitual and customary. Professional practice is structured to evaluate a client's well-being, identify problems, and provide solutions. The latter require organized and scientifically rational processes of assessment, diagnosis, intervention, and evaluation of outcomes. In nursing, this structure pertains to the Nursing Process (Derdiarian, 1993). Finally, the third requirement of professional practice is the coherent scientific body of knowledge that underlies it or the profession's actions and processes. The scientific body of knowledge includes facts, theories, hypotheses, and precepts, and assumptions underlying both the perspective and structure of practice. In nursing, this body of knowledge includes the facts, theories, hypotheses, and precepts about nursing, nursing practice actions, and nursing practice methods. Stated more specifically, nursing practice requires a body of scientific knowledge that rationalizes its view of the client, its role, nature, goal focus, and scope. Furthermore, nursing practice requires a body of scientific knowledge that rationalizes the nursing methods of assessment, diagnosis, intervention, and evaluation of outcomes (Derdiarian, 1993). The JBS model meets the professional perspective requirements because of its interaction between the SSs. The SSs are interactive and interdependent, restoration in one subsystem could effect restoration of behavior in another or others. Thus requiring diagnostic and interventive action directed at all the SSs (Derdiarian, 1993). The model as it stood before did not meet the practice structure requirements well (Derdiarian, 1983), but interaction and studies into the model prompted Johnson to add five types of interventions-nurturance, stimulation, protection, regulation, and control (Derdiarian, 1993). It still leaves a gap in where to actually look for the problems that exist. The JBS model does not meet the scientific substance for practice well because it needs to be tested on its concepts, propositions, and assumptions. Despite the obvious overall failure of the JBS model to pass the professional requirements, the model is always being tested by someone, and some! day maybe conclude its worth and add to its value. Summary as related to Nursing, Person, Health, and Environment Nursing is a force acting to preserve to organization of the patient's behavior while the patient is under stress by means of imposing regulatory mechanisms or by providing resources (Conner et al., 1994). An art and a science, it supplies external assistance both before and during system balance disturbance and therefore requires knowledge of order, disorder, and control (Johnson, 1980). Nursing activities are complementary of medicine, not dependent on. Person is viewed as a behavioral system with patterned, repetitive, and purposeful ways of behaving that link him to the environment (Johnson, 1980). Man's specific response patterns form an organized and integrated whole (Conner et al., 1994). Person is a system of interdependent parts that requires some regularity and adjustment to maintain a balance (Johnson, 1980). Health is perceived as an "elusive, dynamic state influenced by biological, psychological, and social factors. It focuses on the person rather than the illness (Conner et al., 1994). Health is reflected by the organization, interaction, interdependence, and integration of the SSs of the behavioral system (Johnson, 1980). Man attempts to achieve a balance in this system, which will lead to functional behavior. A lack of balance in the requirements of the SSs lead to poor health (Conner et al., 1994). Environment consists of all the factors that are not part of the

individual's behavioral system but that influence the system and the nurse to achieve the health goal for the client Conclusion Johnson's theory could help guide the future of nursing theories, models, research, and education. By focusing on behavioral rather than biology, the theory clearly differentiates nursing from medicine. But do we need to separate the behavioral from the biological. It can be an asset, and it can work, that has been proven by Johnson and some of her followers. In order to focus on the holistic idea of nursing, it is important to think of the behavioral and biological together as health. We cannot look at one without looking at the other. There is not sufficient research to substantiate the real applicability of this model. This theory does provide a conceptual framework to work from, but this model will never be the standard for nursing. Bibliography Conner, S. S., Harbour, L. S., Magers, J. A., and Watt, J. K. (1994). Dorothy E. Johnson: Behavioral System Model. In Ann Marriner-Tomey (3rd ed.), Nursing Theorists and Their Work (pp. 231-240). St. Louis: Mosby-Year Book, Inc. Derdiarian, A. K. (1983). An instrument for research and theory development using the Behavioral System Model for Nursing: The cancer patient. Part I. Nursing Research, 32:4, 196-201. Derdiarian, A. K. (1993). The Johnson Behavioral System Model. In M. E. Parker (Ed.), Patterns of Nursing Theories in Practice. New York: National League for Nursing Press. Johnson, D.E. (1980). The behavioral system model for nursing. In J.P. Riehl & C. Roy (Eds.), Conceptual models for nursing practice (2nd ed.). New York: AppletonCentury-Crofts. Lobo, M. L. (1995). Dorothy E. Johnson. In J. B. George (Ed.), Nursing Theories: The Base for Professional Nursing Practice (4th ed.). New York: M Dorothy M. Johnson From Wikipedia, the free encyclopedia Jump to: navigation, search Dorothy Marie Johnson (b. McGregor, Iowa December 19, 1905 November 11, 1984) was an American author best known for her Western fiction.

Contents

[hide]

1 Biography o 1.1 Early life o 1.2 Professional life 2 Bibliography o 2.1 Novels o 2.2 Juvenile Novels o 2.3 Short Story Collections o 2.4 Non-Fiction 3 References 4 Print References 5 External links

[edit] Biography

[edit] Early life

Dorothy Marie Johnson, born in McGregor, Iowa, was the only daughter of Eugene Johnson (December 20, 1870 December 13, 1915) and Mary Louisa Johnson (ne Barlow, December 30, 1879 December 28, 1960).[1] In March 1913 her family moved to Whitefish in northwestern Montana. She always considered Whitefish to be her home town, and later wrote a memoir of her early years there: "When You and I Were Young, Whitefish," published in 1982. She was appointed to the lifetime position of Whitefish's honorary chief of police. It was while she was a student at Whitefish High School that she began her professional writing career: She worked as a stringer for The Daily Inter Lake, a newspaper published in Kalispell, Montana, fourteen miles south of Whitefish.[2]

[edit] Professional life

Her writing career began to take off by the 1930s, when she sold her first magazine article to The Saturday Evening Post for the sum of $400. In 1935, her story "Beulah Bunny" was published and began a series of four stories. Her writing was temporarily sidetracked by World War II as she went to work for the Air Warden Service. After the war, she produced some of her best-known Western stories. These include "The Man Who Shot Liberty Valance" (1949), "A Man Called Horse" (1950) and "The Hanging Tree" (1957). These three stories would later be filmed.[3] Between 1956 and 1960, Dorothy taught creative writing at Montana State University in Missoula, Montana (subsequently renamed the University Of Montana). Prior to and during her tenure, she wrote numerous articles and fictional stories for many different magazines. Many of her stories were based on interviews with Western old-timers, American Indians and characters she met during her tenure as secretary and researcher for The Montana Historical Society. She was also secretary/manager of the Montana Press Association in the 1950s.

In 1957, the Western Writers Of America gave her its highest award, the Spur Award, for her short story "Lost Sister." In 1959, Dorothy was made honorary member of the Blackfoot Tribe. In 1976, the Writers again gave her a prestigious award, the Levi Strauss Golden Saddleman Award, for bringing dignity and honor to the history and legends of the West. In 2005, a 30-minute documentary film was made of her life by Sue Hart, an English Professor at Montana State University-Billings. The four-year effort was written and co-produced by Hart, along with producer Gene Bodeur, director Bill Bilverstone and film director Lansing Dreamer. Margot Kidder lent her voice to the effort. It was titled "Gravel in her Gut and Spit in her Eye," and was shown on PBS in November of that year. Dorothy always prided herself on her self-sufficiency after a failed marriage early in life and stated that her epitaph would read "Paid In Full." Her grave in the cemetery in Whitefish, Montana, reads simply "PAID." She died November 11, 1984.[4]
[edit] Bibliography

[edit] Novels

Buffalo Woman (1977) All the Buffalo Returning (1979)

[edit] Juvenile Novels

Farewell to Troy (1964) Witch Princess (1967)

[edit] Short Story Collections

Beulah Bunny Tells All (U.S. edition, 1942); Miss Bunny Intervenes (UK edition, 1948) Indian Country (1953) The Hanging Tree (1957) Flame on the Frontier: Short Stories of Pioneer Woman (1967) The Day the Sun Came Out (Too Soon a Woman)

[edit] Non-Fiction

The Private Secretary by John Robert Gregg (1943); ghost written by Johnson Famous Lawmen of the Old West (1963) Ancient Greek Dress (1964) Greece: Wonderland of the Past and Present (1964) Some Went West (1965) Artists of Carmel: 15 Profiles (1968) Warrior for a Lost Nation (1969) All About Riding: Learn to Rideand Ride Well (1969) Western Badmen (1970)

The Bloody Bozeman: The Perilous Trail to Montana's Gold (1971) Montana (States of the Nation series) (1971) The Bedside Book of Bastards (1973); with R.T. Turner When You and I Were Young, Whitefish (1982) Kansas Wildlife Chef (1985)

[edit] References

1. ^ Guide to the Dorothy M. Johnson Papers at the University of Montana 2. ^ Montana Newspaper Hall of Fame 3. ^ Biographical article written by Tialin Shaw, a Billings Senior High School student, Billings, Montana, ca. 2000-2004 4. ^ Guide to the Dorothy M. Johnson Papers at the University of Montana
[edit] Print References

Johnson's Behaviour System Model This page was last updated on 22/07/2010 Introduction

Dorothy E. Johnson was born August 21, 1919, in Savannah, Georgia. B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her M.P.H. from Harvard University in Boston in 1948. From 1949 until her retirement in 1978 she was an assistant professor of pediatric nursing, an associate professor of nursing, and a professor of nursing at the University of California in Los Angeles. Dorothy Johnson has had an influence on nursing through her publications since the 1950s. Throughout her career, Johnson has stressed the importance of researchbased knowledge about the effect of nursing care on clients.

Johnsons behavior system model

In 1968 Dorothy first proposed her model of nursing care as fostering of the efficient and effective behavioral functioning in the

patient to prevent illness". She also stated that nursing was concerned with man as an integrated whole and this is the specific knowledge of order we require. In 1980 Johnson published her conceptualization of behavioral system of model for nursing this is the first work of Dorothy that explicates her definitions of the behavioral system model.

Definition of nursing She defined nursing as an external regulatory force which acts to preserve the organization and integration of the patients behaviors at an optimum level under those conditions in which the behaviors constitutes a threat to the physical or social health, or in which illness is found Based on this definition there are four goals of nursing are to assist the patient:

Whose behavior commensurate with social demands. Who is able to modify his behavior in ways that it supports biological imperatives Who is able to benefit to the fullest extent during illness from the physicians knowledge and skill. Whose behavior does not give evidence of unnecessary trauma as a consequence of illness

Assumptions of behavioral system model There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system model Tthere are 4 assumptions of system: 1. First assumption states that there is organization, interaction,

interdependency and integration of the parts and elements of behaviors that go to make up The system 2. A system tends to achieve a balance among the various forces operating within and upon it', and that man strive continually to maintain a behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces impinging upon him. 3. A behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to man that is to say, it is functionally significant in that it serves a useful purpose, both in social life and for the individual. 4. The final assumption states system balance reflects adjustments and adaptations that are successful in some way and to some degree. The integration of these assumptions provides the behavioral system with the pattern of action to form an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relation of the person to the objects, events and situations in his environment. Assumptions about structure and function of each subsystem

from the form the behavior takes and the consequences it achieves can be inferred what drive has been stimulated or what goal is being sought Each individual has a predisposition to act with reference to the goal, in certain ways rather than the other ways. This predisposition is called as set. Each subsystem has a repertoire of

choices or scope of action The fourth assumption is that it produce observable outcome that is the individuals behavior.

Each subsystem has three functional requirements

System must be protected" from noxious influences with which system cannot cope. Each subsystem must be nurtured through the input of appropriate supplies from the environment. Each subsystem must be stimulated for use to enhance growth and prevent stagnation

Johnson believes each individual has patterned, purposeful, repetitive ways of acting that comprise a behavioral system specific to that individual. These actions and behaviors form an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relationship of the person to the objects event situations in the environment. These behaviors are orderly, purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation Johnsons Behavioral Subsystem

Attachment or affiliative subsystem: social inclusion intimacy and the formation and attachment of a strong social bond. Dependency subsystem: approval, attention or recognition and physical assistance Ingestive subsystem: the emphasis is on the meaning and structures of the social events surrounding the occasion when the food is eaten Eliminative subsystem: human cultures have defined different socially acceptable behaviors for

excretion of waste ,but the existence of such a pattern remains different from culture to Culture. Sexual subsystem:" both biological and social factor affect the behavior in the sexual subsystem Aggressive subsystem: " it relates to the behaviors concerned with protection and self preservation Johnson views aggressive subsystem as one that generates defensive response from the individual when life or territory is being threatened Achievement subsystem: " provokes behavior that attempt to control the environment intellectual, physical, creative, mechanical and social skills achievement are some of the areas that Johnson recognizes".

Representation of Johnson's Model Goal ----- Set --- Choice of Behavior --- Behavior

Affiliation Dependency Sexuality Aggression Elimination Ingestion Achievement

The four major concepts Johnson views human being as having two major systems, the biological system and the behavioral system. It is role of the medicine to focus on biological system where as Nursling's focus is the behavioral system.

Society relates to the environment on which the individual exists. According to Johnson an individuals behavior is influenced by the events in the

environment Health is a purposeful adaptive response, physically mentally, emotionally, and socially to internal and external stimuli in order to maintain stability and comfort. Nursing has a primary goal that is to foster equilibrium within the individual .she stated that nursing is concerned with the organized and integrated whole, but that the major focus is on maintaining a balance in the Behavior system when illness occurs in an individual.

Nursing process Assessment Grubbs developed an assessment tool based on Johnsons seven subsystems plus a subsystem she labeled as restorative which focused on activities of daily living .An assessment based on behavioral model does not easily permit the nurse to gather detailed information about the biological systems:

Affiliation Dependency Sexuality Aggression Elimination Ingestion Achievement Restorative

Diagnosis Diagnosis tends to be general to the system than specific to the problem. Grubb has proposed 4 categories of nursing diagnosis derived from Johnson's behavioral system model:

Insufficiency Discrepancy Incompatibility

Dominance

Planning and implementation Implementation of the nursing care related to the diagnosis may be difficult because of lack of clients input in to the plan. the plan will focus on nurses actions to modify clients behavior, these plan than have a goal ,to bring about homeostasis in a subsystem, based on nursing assessment of the individuals drive, set behavior, repertoire, and observable behavior. The plan may include protection, nurturance or stimulation of the identified subsystem. Evaluation Evaluation is based on the attainment of a goal of balance in the identified subsystems. If the baseline data are available for an individual, the nurse may have goal for the individual to return to the baseline behavior. If the alterations in the behavior that are planned do occur, the nurse should be able to observe the return to the previous behavior patterns. Johnson's behavioral model with the nursing process is a nurse centered activity, with the nurse determining the clients needs and state behavior appropriate for that need. Situation JK, 6 weeks brought into the clinic for a routine check-up. He presents with no weight gain since his check up at the age of 2 weeks .His mother stated she feeds him but he does not seem to eat much. He sleeps 4to 5 hour between the feedings. His mother holds him in her arms without trunk to trunk contact. As the assessment is made the nurse notes that Mrs. JK never looks at Johnny and never speaks to him. She stated he was a planned baby but that she never realized how much work a baby could be. She says, her mother told her she was not a good mother because John is not gaining weight like he should. She states she had not called the nurse when she knew John

was not gaining weight because she thought nurse would think she was a bad mother just like her own mother thought she was a bad mother. Assessment

Affiliative subsystem between mother and John. Dependency subsystem between mother and John Affiliative subsystem between Mrs.Kim and her mother. Insufficiency ingesion subsystem.

Diagnosis

Insufficient development of the affiliative subsystem. Insufficient development of the dependency subsystem

Planning and implementation

Increasing mothers awareness of the babys clues. Assisting her to talk with the baby. Teach her to bring a bond between her and the baby by touch, pat and cuddles etc.

Evaluation

Johnny's weight gain or weight loss will be carefully assessed. The infant interaction could be reassessed, using the nursing child assessment feeding scale. The interaction of Mrs. Kim with her mother.

Johnsons and Characteristics of a theory

Interrelate concepts to create a different way of viewing a phenomenon. Theories must be logical in nature. Theories must be simple yet

generalizable Theories can be bases of hypothesis that can be tested. Theories contribute to and assist in increasing the body of knowledge within the discipline through the research implemented to validate them Theories can be utilized by practitioners to guide and improve their practice. Theories must be consistent with other validated theories, laws and principles but will leave unanswered questions that need to be investigated.

Limitation

Johnson does not clearly interrelate her concepts of subsystems comprising the behavioral system model. The definition of concept is so abstract that they are difficult to use. It is difficult to test Johnson's model by development of hypothesis. The focus on the behavioral system makes it difficult for nurses to work with physically impaired individual to use this theory. The model is very individual oriented so the nurses working with the group have difficulty in its implementation. The model is very individual oriented so the family of the client is only considered as an environment. Johnson does not define the expected outcomes when one of the system is affected by the nursing implementation an implicit expectation is made that all human in all cultures will attain same outcome homeostasis. Johnsons behavioral system model

is not flexible. Summary Johnsons Behavioral system model is a model of nursing care that advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. The patient is defined as behavioral system composed of 7 behavioral subsystems. Each subsystem composed of four structural characteristics i.e. drives, set, choices and observable behavior. Three functional requirement of each subsystem includes

(1) Protection from noxious influences, (2) Provision for the nurturing environment, and (3) stimulation for growth. Any imbalance in each system results in disequilibrium .it is nursing role to assist the client to return to the state of equilibrium.

Reference 1. George B. Julia , Nursing TheoriesThe base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange. 2. Polit DF, Hungler BP. Nursing Research: Principles and Methods. Philadelphia: JB Lippincott Company; 1998. 3. Burns N, Grove SK. The practice of Nursing Research. 4th Ed. Philadelphia: WB Saunders Publications; 2001. 4. Treece JW, Treece EW. Elements of Research in Nursing (3rded.). St. Louis: Mosby; 1982.

About Us l Privacy Policy l Ad Policy l Disclaimer Hosted with support from AIPPG Copyright 2010@Current Dorothy Johnson's Nursing Theory Home Created By: Valerie Andrews, Kimberly Cromwell, Stephanie Fries & Zahira Hodge Dorothy Johnson was an early supporter of nursing as a science as well as an art. From the beginning, Johnson proposed that the knowledge of the science of nursing was composed from both basic and applied sciences. She felt that the science and art of nursing should focus on the clients, not on the disease process itself. Her early publications focused on a science of nursing (1959) and a conceptual basis for nursing care (1961) (Johnson and Webber, 2005). Johnson proposed that nursing care facilitated the clients maintenance of a state of equilibrium. Johnson felt that when faced with a stressor individuals responded in different ways. These stressors could be either internal or external, but caused a state of disequilibrium in individuals. It was the focus of her work, and the responsibility of nursing, to help the client return to a state of equilibrium through two steps. First, the stressor has to be reduced and removed if possible. Secondly, natural and adaptive processes had to be supported to maintain a state of equilibrium. Johnsons work focused on the person as well as nursing. She identified the person as a system with eight subsystems, four structural characteristics (assumptions), and three functional requirements. The eight subsystems are ingestive, eliminative, affiliative, dependency, sexual, aggressive-protective, achievement, and restorative. The four structural characteristics are drive, choices, act, and observable behaviors. The three functional requirements are protection, nurturance, and stimulation. When one or more of the subsystems is in disequilibrium, the person reacts in a patterned, purposeful, repetitive ways (Johnson and Webber, 2005). Johnson felt that by grouping these behaviors that it allowed them to be predicted and ordered. The goal of

nursing is achieve an environment in which the subsystems are nurtured and returned to a state of stability, so that equilibrium is restored.

**Please click on the links located to the left to learn more about Dorothy Johnson's Behavioral System Model. Subheadings exist, so make sure you explore all areas completely.** The Roy Adaptation Model History
The Roy Adaptation Model for Nursing had its beginning when Sr. Callista Roy entered the masters program in pediatric nursing at University of California Los Angeles in 1964. Her advisor and seminar faculty was Dorothy E. Johnson who was writing and speaking on the need to define the goal of nursing as a way of focusing the development of knowledge for practice. Dr. Roy had read a little about the concept of adaptation and was impressed with the resiliency of children she had cared for in pediatrics. At the first seminar in pediatric nursing, she proposed that the goal of nursing was promoting patient adaptation. Throughout her course work in the master's program Dorothy Johnson encouraged her to develop her concept of adaptation as a framework for nursing. The use of systems theory as defined by von Bertalanffy was an important early concept of the model, as was the work of Helson. Helson defined adaptation as a process of responding positively to environmental changes and described three types of stimuli, focal, contextual and residual. Dr. Roy made appropriate derivations of these concepts for use in describing situations of people in health and illness. Other authors that influenced the early development of the central concepts of the model included Dohrenwend, Lazarus, Mechanic, and Selye. The view of the person as an adaptive system took shape from this early work with the cognator and regulator being added as the major internal processes of the adapting person. The second phase of the development of the model was the 17 years of work with faculty at Mount St. Mary's College in Los Angeles. The model became the framework for a nursing-based integrated curriculum in March 1970, the same month that the first article on the model was published in Nursing Outlook. The four adaptive modes were added as the ways in which adaptation is manifested and thus as the basis for nursing assessment. Specifically a content analysis was done on 500 samples of patient behavior from all clinical areas, collected by the nursing students and major categories named as physiologic, self concept, role function and

interdependence. Contributors to the theoretical development of the adaptive modes included: Marie Driever for self concept; Brooke Randell for role function, and Joyce Van Landingham and Mary Tedrow for interdependence. Marsha Sato helped identify both common and primary stimuli affecting the adaptive modes and Joan Cho developed clinical tools for assessment. Many other faculty from Mount St. Mary's College were involved in writing the first three textbooks on the model in 1976, 1984 and 1991. Through curriculum consultation throughout the USA and eventually worldwide, Dr. Roy received input on the use of the model in education and practice. By 1987 at least 100,000 nurses had been educated in programs using the Roy Adaptation Model. As the discipline of nursing grew in articulating its scientific and philosophical assumptions, Dr. Roy also articulated her assumptions. Early descriptions included systems theory and adaptation-level theory, as well as humanist values. Later Dr. Roy developed the philosophical assumption of veritivity as a way of addressing the limitations she saw in the relativistic philosophical basis of other conceptual approaches to nursing and a limited view of secular humanism and published a major paper on her philosophical assumptions in 1988. By the late 1990s Dr. Roy felt on urgency to re-define adaptation for the 21st Century. She drew upon expanded insights in relating spirituality and science to present a new definition of adaptation and related scientific and philosophical assumptions. Her philosophical stance articulates that nurses see persons as co-extensive with their physical and social environments. Further, nurse scholars take a value-based stance and rooted in beliefs and hopes about the human person, they develop a discipline that participates in enhancing the well-being of persons and of the earth. Dr. Roy has used the term cosmic unity to describe that persons and the earth have common patterns and mutuality of relations and meaning and that persons through thinking and feeling capacities, rooted in consciousness and meaning, are accountable for deriving, sustaining, and transforming the universe. These ideas were explained in a 1997 publication and included in the 1999 revision of the theorist's textbook on the model. Other major developments of the model in the 1999 textbook, written with Dr. Heather Andrews, include: 1) expanding the adaptive modes to include relational persons as well as individual persons and 2) describing adaptation on three levels of integrated life processes, compensatory processes, and compromised processes. Dr. Roy has also outlined a structure for nursing knowledge development based on the Roy Adaptation Model and provided examples of research within this structure. Dr. Roy remains committed to developing knowledge for nursing practice and continually updating the Roy Model as a basis for this knowledge development. (Back to top)

Overview
ASSUMPTIONS

Scientific Systems of matter and energy progress to higher levels of complex self-organization Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Humans by their decisions are accountable for the integration of creative processes Thinking and feeling mediate human action System relationships include acceptance, protection, and fostering of interdependence Persons and the earth have common patterns and integral relationships Persons and environment transformations are crated in human consciousness Integration of human and environment meanings results in adaptation Philosophical Persons have mutual relationships with the world and God Human meaning is rooted in an omega point convergence of the universe God is intimately revealed in the diversity of creation and is the common destiny of creation Persons use human creative abilities of awareness, enlightenment, and faith Persons are accountable for the processes of deriving, sustaining, and transforming the universe

PERSONS AND RELATING PERSONS An adaptive system with coping processes Described as a whole comprised of parts Functions as a unity for some purpose Includes people as individuals or in groups (families, organizations, communities, nations, and society as a whole) An adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes: physiologic-physical, self-concept-group identity, role function, and interdependence

Individual Five needs-oxygenation, nutrition, elimination, activity and rest, protection Physiologic-physical Four complex processessenses; fluid, electrolyte, and acid-base balance; neurologic function; endocrine function

Adaptive Modes

Group

Operating resources: participants, capacities, physical facilities, and fiscal resources

Need is psychic and spiritual integrity so that Self-concept-group one can be or exist with a identity sense of unity, meaning, and purposefulness in the universe Need is social integrity; knowing who one is in relation to others so one can acct; role set is the complex of positions individual holds; involves role development, instrumental and expressive behaviors, and role taking process Need is to achieve relational integrity using process of affectional adequacy, i.e., the giving and receiving of love, respect, and value through effective relations and communication

Role function

Interdependence

Need is group identity integrity through shared relations, goals, values, and coresponsibility for goal achievement; implies honest, soundness, and completeness of identifications with the group Need is role clarity, understanding and committing to fulfill expected tasks so group can achieve common goals; process of integrating roles in managing different roles and their expectations; complementary roles are regulated Need is to achieve relational integrity using processes of developmental and resource adequacy, i.e., learning and maturing in relationships and achieving needs for food, shelter, health, and security through independence with others

ENVIRONMENT All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources Three kinds of stimuli: focal, contextual, and residual Significant stimuli in all human adaptation include stage of development, family, and culture HEALTH AND ADAPTATION Health: a state and process of being and becoming integrated and whole that reflects person and environmental mutuality Adaptation: the process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environmental integration

 Adaptive Responses: responses that promotes integrity in terms of the goals of the human system, that is, survival, growth, reproduction, mastery, and personal and environmental transformation Ineffective Responses: responses that do not contribute to integrity in terms of the goals of the human system Adaptation levels represent the condition of the life processes described on three different levels: integrated, compensatory, and compromised

NURSING Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation Nursing goals are to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity This is done by assessing behavior and factors that influence adaptive abilities and by intervening to expand those abilities and to enhance environmental interactions NURSING PROCESS A problem solving approach for gathering data, identifying the capacities and needs of the human adaptive system, selecting and implementing approaches for nursing care, and evaluation the outcome of care provided 1. Assessment of Behavior: the first step of the nursing process which involves gathering data about the behavior of the person as an adaptive system in each of the adaptive modes 2. Assessment of Stimuli: the second step of the nursing process which involves the identification of internal and external stimuli that are influencing the persons adaptive behaviors. Stimuli are classified as: 1) Focal- those most immediately confronting the person; 2) Contextual-all other stimuli present that are affecting the situation and 3) Residual- those stimuli whose effect on the situation are unclear. 3. Nursing Diagnosis:step three of the nursing process which involves the formulation of statements that interpret data about the adaptation status of the person, including the behavior and most relevant stimuli 4. Goal Setting: the forth step of the nursing process which involves the establishment of clear statements of the behavioral outcomes for nursing care. 5. Intervention: the fifth step of the nursing process which involves the determination of how best to assist the person in attaining the established goals 6. Evaluation: the sixth and final step of the nursing process which involves judging the effectiveness of the nursing intervention in relation to the behavior after the nursing intervention in comparison with the goal established. (Back to top)
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THE ROY'S ADAPTATION MODEL

This page was last updated on 17-05-2010 --------------------------------------------------------------Introduction

Sr.Callista Roy, a prominent nurse theorist, writer, lecturer, researcher and teacher Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College, Los Angeles in 1963. a master's degree program in pediatric nursing at the University of California ,Los Angeles in 1966. She also earned a masters and PhD in Sociology in 1973 and 1977 ,respectively. Sr. Callista had the significant opportunity of working with Dorothy E. Johnson Johnson's work with focusing knowledge for the discipline of nursing convinced Sr. Callista of the importance of describing the nature of nursing as a service to society and prompted her to begin developing her model with the goal of nursing being to promote adaptation. She joined the faculty of Mount St. Mary's College in 1966, teaching both pediatric and maternity nursing. She organized course content according to a view of person and family as adaptive systems. She introduced her ideas about Adaptation Nursing as the basis for an integrated nursing curriculum. Goal of nursing to direct nursing education, practice and research Model as a basis of curriculum impetus for growth--Mount St. Marys College 1970-The model was implemented in Mount St. Marys school 1971- she was made chair of the nursing department at the college.

Influencing Factors

Family Education

Religious Background Mentors Clinical Experience

THEORY DESCRIPTION

The central questions of Roys theory are: o Who is the focus of nursing care? o What is the target of nursing care? o When is nursing care indicated? Roys first ideas appeared in a graduate paper written at UCLA in 1964. Published these ideas in "Nursing outlook" in 1970 Subsequently different components of her framework crystallized during 1970s, 80s, and 90s Over the years she identified assumptions on which her theory is based.

Explicit assumptions (Roy 1989; Roy and Andrews 1991)

The person is a bio-psycho-social being. The person is in constant interaction with a changing environment. To cope with a changing world, person uses both innate and acquired mechanisms which are biological, psychological and social in origin. Health and illness are inevitable dimensions of the persons life. To respond positively to environmental changes, the person must adapt. The persons adaptation is a function of the stimulus he is exposed to and his adaptation level The persons adaptation level is such that it comprises a zone indicating the range of stimulation that will lead to a positive response. The person has 4 modes of adaptation: physiologic needs, self- concept, role function and inter-dependence. "Nursing accepts the humanistic approach of valuing other persons opinions, and view points" Interpersonal relations are an integral part of nursing There is a dynamic objective for existence with ultimate goal of achieving dignity and

integrity. Implicit assumptions

A person can be reduced to parts for study and care. Nursing is based on causality. Patients values and opinions are to be considered and respected. A state of adaptation frees an individuals energy to respond to other stimuli.

ROY ADAPTATION MODEL CONCEPTS: EARLY AND REVISED

Adaptation -- goal of nursing Person -- adaptive system Environment -- stimuli Health -- outcome of adaptation Nursing -- promoting adaptation and health

Concepts-Adaptation

Responding positively to environmental changes. The process and outcome of individuals and groups who use conscious awareness, self reflection and choice to create human and environmental integration

Concepts-Person

Bio-psycho-social being in constant interaction with a changing environment Uses innate and acquired mechanisms to adapt An adaptive system described as a whole comprised of parts Functions as a unity for some purpose Includes people as individuals or in groupsfamilies, organizations, communities, and society as a whole.

Concepts-Environment

Focal - internal or external and immediately confronting the person Contextual- all stimuli present in the situation that contribute to effect of focal stimulus

Residual-a factor whose effects in the current situation are unclear All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources, including focal, contextual and residual stimuli

Concepts-Health

Inevitable dimension of person's life Represented by a health-illness continuum A state and a process of being and becoming integrated and whole

Concepts-Nursing

To promote adaptation in the four adaptive modes To promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions

Concepts-Subsystems

Cognator subsystem A major coping process involving 4 cognitive-emotive channels: perceptual and information processing, learning, judgment and emotion. Regulator subsystem a basic type of adaptive process that responds automatically through neural, chemical, and endocrine coping channels

Relationships

Derived Four Adaptive Modes 500 Samples of Patient Behavior What was the patient doing? What did the patient look like when needing nursing care?

Four Adaptive Modes

Physiologic Needs

Self Concept Role Function Interdependence

Four Adaptive Mode Categories

Tested in practice for 10 years Criteria of significance, usefulness, and completeness were met

Sample Proposition and Hypothesis for Practice

Self Concept Mode: Increased quality of social experience leads to increased feelings of adequacy Providing support for new mothers can lead to positive parenting

THEORY DEVELOPMENT Derived Theory

91 Propositions Described relationships between and among regulator and cognator and four adaptive modes 12 Generic propositions

Questions Raised by 21st Century Changes

How can ethics and public policy keep pace with developments in science? How can nurses focus on human needs not machines? How can nurses contribute to creating meaning and purpose in a global society?

Scientific Assumptions for the 21st Century

Systems of matter and energy progress to higher levels of complex self organization Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Human decisions are accountable for the integration of creative processes. Thinking and feeling mediate human action System relationships include acceptance, protection, and fostering of interdependence

Persons and the earth have common patterns and integral relations Person and environment transformations are created in human consciousness Integration of human and environment meanings results in adaptation

Philosophical Assumptions

Persons have mutual relationships with the world and God Human meaning is rooted in an omega point convergence of the universe God is intimately revealed in the diversity of creation and is the common destiny of creation Persons use human creative abilities of awareness, enlightenment, and faith Persons are accountable for the processes of deriving, sustaining, and transforming the universe

Adaptation and Groups

Includes relating persons, partners, families, organizations, communities, nations, and society as a whole

Adaptive Modes A. Persons

Physiologic Self Concept Role Function Interdependence

B. Groups

Physical Group Identity Role Function Interdependence

Role Function Mode

Underlying Need of Social integrity The need to know who one is in relation to others so that one can act The need for role clarity of all participants in

group Adaptation Level

A zone within which stimulation will lead to a positive or adaptive response Adaptive mode processes described on three levels: Integrated Compensatory Compromised

Integrated Life Processes

Adaptation level where the structures and functions of the life processes work to meet needs Examples of Integrated Adaptation Stable process of breathing and ventilation Effective processes for moral-ethicalspiritual growth

Compensatory Processes

Adaptation level where the cognator and regulator are activated by a challenge to the life processes Compensatory Adaptation Examples: Grieving as a growth process, higher levels of adaptation and transcendence Role transition, growth in a new role

Compromised Processes

Adaptation level resulting from inadequate integrated and compensatory life processes Adaptation problem Compromised Adaptation Examples Hypoxia Unresolved Loss Stigma Abusive Relationships

THE NURSING PROCESS

RAM offers guidelines to nurse in developing the nursing process. The elements : First level assessment Second level assessment

Diagnosis Goal setting Intervention evaluation

Usefulness of Adaptation Model

Scientific knowledge for practice Clinical assessment and intervention Research variables To guide nursing practice To organize nursing education Curricular frame work for various nursing colleges

Characteristics of the theory

Theories can interrelates concepts in such a way as to present a new view of looking at a particular phenomenon. Theories must be logical in nature Theories should be relatively simple yet generalizable Theories can be the basis for the hypotheses that can be tested Theories contribute to and assist in increasing the general body of knowledge of a discipline through the research implemented to validate them Theories can be utilized by the practitioners to guide and improve their practice Theories must be consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated

Testability

RAM is testable BBARNS (1999) reported that 163 studies have been conducted using this model. RAM is complete and comprehensive It explains the reality of client, so nursing interventions can be specifically targeted.

Research studies using RAM

Middle range theories have been derived from RAM 1998-Ducharme et al described a longitudinal

model of psychosocial determinants of adaptation 1998-Levesque et al presented a MRT of psychological adaptation 1999-A MRNT , the urine control theory by Jirovec et al Dunn, H.C. and Dunn, D. G. (1997). The Roy Adaptation Model and its application to clinical nursing practice. Journal of Ophthalmic Nursing and Technology. 6(2), 74-78. Samarel, N., Fawcett, J., Krippendorf, K., Piacentino, J.C., Eliasof, B., Hughes, P., Kowitski, C., and Ziegler, E. (1998). Women's perception of group support and adaptation to breast cancer. Journal of Advanced Nursing. 28(6), 1259-1268. Chiou, C. (2000). A meta-analysis of the interrelationships between the modes in Roy's adaptation model. Nursing Science Quarterly. 13(3), 252-258 Yeh, C. H. (2001). Adaptation in children with cancer: research with Roy's model. Nursing Science Quarterly. 14, 141-148. Zhan, L. (2000). Cognitive adaptation and self-consistency in hearing-impaired older persons: testing Roy's adaptation model. Nursing Science Quarterly. 13(2), 158-165.

Summary

5 elements -person, goal of nursing, nursing activities, health and environment Persons are viewed as living adaptive systems whose behaviours may be classified as adaptive responses or ineffective responses. These behaviors are derived from regulator and cognator mechanisms. These mechanisms work with in 4 adaptive modes. The goal of nursing is to promote adaptive responses in relation to 4 adaptive modes, using information about persons adaptation level, and various stimuli. Nursing activities involve manipulation of these stimuli to promote adaptive responses. Health is a process of becoming integrated and able to meet goals of survival, growth, reproduction, and mastery.

The environment consists of persons internal and external stimuli.

References

George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process & Practice 3rd ed. London Mosby Year Book. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15 Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225

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NALYSIS OF THE ROY ADAPTATION MODEL OF NURSING Delineation and Analysis of The Theory Roy's Adaptation Model (see: Roy & Andrews, 1999) for nursing is based on the notion that a human being can successfully adapt to environmental requirements. There are five major concepts of nursing explicated in her model: the person, the goal of nursing, nursing activities, health, and the environment. These concepts are interrelated to the concept of adaptation. The person is viewed as having four different modes of adaptation: physiologic, self-concept, role function, and interdependence modes. Roy's model is concerned with the internal and external environmental stimuli affecting the development and behavior of the person. The level of adaptation of the person is assessed and ways to remove the stimuli, to enhance, or to maintain adaptation are explored by the person and the nurse.

The model contains the following scientific assumptions: 1. Systems of matter and energy progress to higher levels of complex self-organization, 2. Consciousness and meaning are constitutive of person and environment integration, 3. Awareness of self and environment is rooted in thinking and feeling, 4. Humans by their decisions are accountable for the integration of creative processes, 5. Thinking and feeling mediate human action, 6. System relationships include acceptance, protection, and fostering of interdependence, 7. Persons and the earth have common patterns an

nderstandings nurses need as the discipline grows and develops. Indeed, in some of her latest work (see: Roy & Andrews, 1999), she has extrapolated the model into the 21st century, attempting to provide a framework for nursing in this new millennium. Further, she has steadily worked to integrate new scientific knowledge into the model. The result of all of this work has been to increasingly add depth to the model's philosophical, scientific, and spiritual components; and this has added to its strength as a framework for nursing practice. Scope, Focus and Content of the Model Roy's Adaptation Model (1970, 1971, 1976, 1999) is very wide in scope. As can be seen by reference to the summary of the model provided in this report, it contains several scientific and philosophical assumptions as well as a number of postulates about human beings, human relational processes, and human relationships. Further, the model addresses the human being at both the individual and group levels in terms of his/her physiologic responses, self-concept, role functions, and interdependence. In addition, the model covers environmental components, discusses adaptation in relation to health, and defines nursing as both a science, a practice and a process co

Adaptation Model
Sister Callista Roy RN, Ph.D, FAAN Professor & Nurse Theorist William F. Connell School of Nursing Boston College Massachusetts

The major concepts are the person or group as an adaptive system; the environment as internal and external stimuli; health as being and becoming whole and integrated; and nursing as the art and science of promoting adaptation. The philosophic and scientific assumptions are basic underlying concepts. The model aims to direct nursing practice, research and education. The widespread us of the model in each of these areas is well documented, for example, in all areas of practice, all levels of education, and in quantitative and qualitative research. Dr. Roy is best known for developing and continually updating the Roy Adaptation Model as a framework for theory, practice, and research in nursing. Two recent publications that Dr. Roy considers of great significance are The Roy Adaptation Model (second edition) written with

Heather Andrews (Appleton & Lange) and The Roy Adaptation Model-Based Research: Twenty-five Years of Contributions to Nursing Science being published as a research monograph by Sigma Theta Tau. "The model provides a way of thinking about people and their environment that is useful in any setting. It helps one prioritize care and challenges the nurse to move the patient from survival to transformation." Sr. Calista Roy Website: Callista Roy. Nurse Theorist Page - Boston College.

Roy Adaptation Association - "Bridging nursing practice and knowledge" The Roy Adaptation Association (RAA) is a society of nursing scholars who seek to advance nursing practice by developing basic and clinical nursing knowledge based on the Roy Adaptation Model. Founded in 1991, membership to the association has recently been extended to the public. Students, clinicians, scholars, researchers, and institutions are encouraged to join. Books Available HERE from Amazon Callista Roy

Selected Publications: Roy, C. (1970). Adaptation: A conceptual framework for nursing. Nursing Outlook, 18(3), 4245. Mastall, M. F., & Hammond, H. (1980). Analysis and expansion of the Roy adaptation model: A contribution to holistic nursing. Advances in Nursing Science, 2(4), 71-81. Hammer, J. B. (1989). Applying the Roy adaptation model to the CCU. Critical Care Nurse, 9(3), 5-61. Roy, C., & Andrews, A. A. (1991). The Roy adaptation model: The definitive statement. Norwalk, CT: Appleton and Lange. Lutjens, L. R. J. (1995). Callista Roy: An adaptation model. In C. M. McQuiston & A. A. Webb (Eds.), Foundations of nursing theory: Contributions of 12 key theorists (pp. 89-138). Thousand Oaks, CA: Sage Publications, Inc. Barone, S. H., & Roy, C. (1996). The Roy adaptation model in research: Rehabilitation nursing. In P. H. Walker & B. M. Neuman (Eds.), Blueprint for use of nursing models: Education, research, practice and administration (pp. 64-87). New York: National League for Nursing. Tiedeman, M. E. (1996). Roys adaptation model. In J. J. Fitzpatrick & A. L. Whall (Eds.), Conceptual models of nursing: Analysis and application (3rd ed., pp. 153-181). Stamford, CT: Appleton & Lange. Phillips, K. D., Blue, C. L., Brubaker, K. M., Fine, J. M. B., Kirsch, M. J., Papazian, K. R., Riester, C. M., & Sobiech, M. A. (1998). Sister Callista Roy: Adaptation model. In A. M.Tomey & M. R. Alligood (Eds.), Nursing theorists and their work (pp. 243-266). St. Louis: Mosby. Roy, C., & Andrews, A. A. (1999). The Roy adaptation model (2nd ed.). Norwalk, CT: Appleton and Lange. Dixon, E. L. (1999). Community health nursing practice and the Roy Adaptation Model. Public Health Nursing, 16, 290-300. Roy, C. (2000). A theorist envisions the future and speaks to nursing administrators. Nursing

Administration Quarterly, 24(2), 1-12. Roy, C. (2000). The visible and invisible fields that shape the future of the nursing care system. Nursing Administration Quarterly, 25(1), 119-131. Hanna, D. R. & Roy, C. (2001).

he Roy Adaptation Model ASSUMPTIONS

Scientific

Systems of matter and energy progress to higher levels of complex selforganization Consciousness and meaning are constitutive of person and environment integration Awareness of self and environment is rooted in thinking and feeling Humans by their decisions are accountable for the integration of creative processes Thinking and feeling mediate human action System relationships include acceptance, protection, and fostering of interdependence Persons and the earth have common patterns and integral relationships Persons and environment transformations are created in human consciousness Integration of human and environment meanings results in adaptation

Philosophical

Persons have mutual relationships with the world and God Human meaning is rooted in an omega point convergence of the universe God is intimately revealed in the diversity of creation and is the common destiny of creation Persons use human creative abilities of awareness, enlightenment, and faith Persons are accountable for the processes of deriving, sustaining, and transforming the universe

PERSONS AND RELATING PERSONS

An adaptive system with coping processes Described as a whole comprised of parts Functions as a unity for some purpose Includes people as individuals or in groups (families, organizations, communities, nations, and society as a whole)

An adaptive system with cognator and regulator subsystems acting to maintain adaptation in the four adaptive modes: physiologic-physical, self-conceptgroup identity, role function, and interdependence

Adaptive Mo Individual Group des

Five needs oxygenation, nutrition, elimination, activity and rest, protection Four complex processessenses; fluid, electrolyte, and acid-base balance; neurologic function; endocrine function

Physiologicphysical

Operating resources: participants, capacities, physical facilities, and fiscal resources

Self-conceptgroup identity

Need is psychic and spiritual integrity so that one can be or exist with a sense of unity, meaning, and purposefulness in the universe

Need is group identity integrity through shared relations, goals, values, and coresponsibility for goal achievement; implies honest, soundness, and completeness of identifications with the group Need is role clarity, understanding and committing to fulfill expected tasks so group can achieve common goals; process of integrating roles

Role function

Need is social integrity; knowing who one is in relation to others so one can acct; role set is the complex of positions

individual holds; involves role development, instrumental and expressive behaviors, and role taking process Need is to achieve relational integrity using process of affectional adequacy, i.e., Interdependence the giving and receiving of love, respect, and value through effective relations and communication

in managing different roles and their expectations; complementary roles are regulated Need is to achieve relational integrity using processes of developmental and resource adequacy, i.e., learning and maturing in relationships and achieving needs for food, shelter, health, and security through independence with others

ENVIRONMENT

All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources Three kinds of stimuli: focal, contextual, and residual Significant stimuli in all human adaptation include stage of development, family, and culture

HEALTH AND ADAPTATION

Health: a state and process of being and becoming integrated and whole that reflects person and environmental mutuality Adaptation: the process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environmental integration

Adaptive Responses: responses that promotes integrity in terms of the goals of the human system, that is, survival, growth, reproduction, mastery, and personal and environmental transformation Ineffective Responses: responses that do not contribute to integrity in terms of the goals of the human system Adaptation levels represent the condition of the life processes described on three different levels: integrated, compensatory, and compromised

NURSING

Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation Nursing goals are to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity This is done by assessing behavior and factors that influence adaptive abilities and by intervening to expand those abilities and to enhance environmental interactions

NURSING PROCESS

A problem solving approach for gathering data, identifying the capacities and needs of the human adaptive system, selecting and implementing approaches for nursing care, and evaluation the outcome of care provided

1. Assessment of Behavior: the first step of the nursing process which involves gathering data about the behavior of the person as an adaptive system in each of the adaptive modes 2. Assessment of Stimuli: the second step of the nursing process which involves the identification of internal and external stimuli that are influencing the persons adaptive behaviors. Stimuli are classified as: 1) Focal- those most immediately confronting the person; 2) Contextual-all other stimuli present that are affecting the situation and 3) Residual- those stimuli whose effect on the situation are unclear. 3. Nursing Diagnosis:step three of the nursing process which involves the formulation of statements that interpret data about the adaptation status of the person, including the behavior and most relevant stimuli 4. Goal Setting: the forth step of the nursing process which involves the establishment of clear statements of the behavioral outcomes for nursing care. 5. Intervention: the fifth step of the nursing process which involves the determination of how best to assist the person in attaining the established goals 6. Evaluation: the sixth and final step of the nursing process which involves judging the effectiveness of the nursing intervention in relation to the behavior after the nursing intervention in comparison with the goal established.

981: The Beginning In 1981, the first cases of AIDS (Acquired Immune Deficiency Syndrome) were identified among gay men in the United States, acquiring the designation, GRID (Gay-Related Immune Deficiency); however, scientists later found evidence that the disease existed in the world for some years prior, i.e., subsequent analysis of a blood sample of a Bantu man, who died of an unidentified illness in the Belgian Congo in 1959, made him the first confirmed case of an HIV infection. Source: CNN In an article, "1959 and all that: Immunodeficiency viruses," by Simon Wain-Hobson of the Pasteur Institute in Nature (Volume 391, 5 February 1998, pp. 532-533), Wain-Hobson wrote: "Where did HIV [Human Immunodeficiency Virus] come from? Both of the AIDS viruses, HIV-1 and HIV-2, originated in Africa... As is often the case with microbes, a jump from one species to another is probably to blame... chimpanzees (for HIV-1) and sooty mangabeys (for HIV-2)... When did the AIDS epidemic begin?... the Big Bang seems to have occurred around, or just after, the Second World War. Emerging microbial infections often result from adaption to changing ecological niches and habitats." Cases of Pneumocystis carinii pneumonia (PCP, a lung infection) and Kaposi's sarcoma (a rare skin cancer) were reported by doctors in New York and Los Angeles in 1981, then the Centers for Disease Control and Prevention (CDC) began By the end of 2003, twelve million children in tracking a growing population of Sub-Saharan Africa were orphaned by AIDS. young men, women, and babies, Source: AVERT.ORG Image Source: CDC/Dr. Lyle Conrad whose immune systems were nearly destroyed. Late in 1982, the condition began to be referred to as AIDS. Source: American Red Cross For a few at first, their awareness of AIDS began with the publishing of a little noticed entry on page two of the CDC's Morbidity and Mortality Weekly Report of June 5, 1981, where a strange outbreak of killer pneumonia was spreading among gay men. Since this report, AIDS has graduated from a seemingly local phenomenon to a global epidemic. Source: CNN 1982-1985: The Faces of AIDS

Cases of AIDS in 1982 began to be reported by fourteen nations. And, as early as 1982, CDC received its first report of "AIDS in a person with hemophilia (from a blood transfusion), and in infants born to mothers with AIDS." Source: CDC Historical Highlights A contemporary update on this, concerning AIDS and blood transfusions, from the American Red Cross: "Like most medical procedures, blood transfusions have associated risk. In the more than fifteen years since March 1985, when the FDA first licensed a test to detect HIV antibodies in donated blood, the Centers for Disease Control and Prevention has reported only 41 cases of AIDS caused by transfusion of blood that tested negative for the AIDS virus. During this time, more than 216 million blood components were transfused in the United States... Scientific studies have proven that volunteer donors are the single greatest safeguard of the blood supply today." Source: Myths About AIDS and the Blood Supply To continue, Dr. Luc Montagnier of the Pasteur Institute in France announced the isolation of the LAV retrovirus (lymphadenopathy-associated virus) in 1983, which later was identified as the cause of AIDS. Source: CNN By 1983, 33 countries reported cases of AIDS. And, on the other side of the Atlantic, Dr. Robert Gallo of the National Cancer Institute isolated the HTLV-III (Human T-Cell Lymphotropic Virus III) retrovirus in 1984. Medical periodicals such as The Journal of the American Medical Association (JAMA) continued to reference HTLV-III as the "primary etiologic agent of the acquired immunodeficiency Leading causes of AIDS related deaths in the USA. syndrome (AIDS)" as late as 1985. Image Source: Wikimedia Source: JAMA However, in 1986, it was determined that HTLV-III and LAV were the same virus, and they were given the new designation of Human Immunodeficiency Virus or HIV. AIDS awareness was soon brought to the public's consciousness, when popular film star, Rock Hudson, died of AIDS on October 2, 1985, shortly after making public his AIDS on July 25, 1985, thus becoming the first major public figure to announce that he had AIDS. Another entertainer, the pianist Liberace died of AIDS on February 4, 1987. Many other well known personalities from the entertainment industry added their familiar faces to the cumulative weight of the AIDS crisis, when they succumbed to AIDS: (1) Amanda Blake (Miss Kitty of Gunsmoke) died in 1989 of AIDS related throat cancer, (2) Anthony Perkins (Norman Bates of Hitchcock's Psycho) died in 1992 of pneumonia brought on by AIDS, (3) Robert Reed (Mike Brady of The Brady Bunch) died in 1992 of intestinal cancer and complications of AIDS, and (4) Dack Rambo (Jack Ewing of Dallas) died in 1994 of complications of AIDS. What are the complications of AIDS? Any

secondary condition, symptom, or other disorder caused by an AIDS weakened immune system is a complication of AIDS, so that any number of opportunistic infections can take advantage of that weakness. An opportunistic infection (OI) occurs, when the germs normally in our body take advantage of the weakness of the immune system to cause health problems. If you have HIV and any of a list of about 24 designated Center for Disease Control opportunistic infections, then you have AIDS. Some of the more common opportunistic infections in conjunction with HIV are: (1) PCP (Pneumocystis pneumonia), (2) KS (Kaposi's sarcoma), (3) CMV (Cytomegalovirus, an infection usually affecting the eyes), (4) Candidiasis (Thrush: an infection of the mouth, throat, or vagina), (5) Mycobacterium tuberculosis (TB), and (6) Herpes simplex (can cause oral herpes or genital herpes). Source: New Mexico AIDS InfoNet << History of AIDS last page || History of AIDS next page >>
The History of AIDS 2005
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A Brief History of HIV/AIDS

Science & Government Community

195 9 197 8 197 9 198

Scientists isolate what is believed to be the earliest known case of AIDS. The discovery suggests that the multitude of global AIDS viruses all shared a common African ancestor within the past 40 to 50 years. Gay men in the US and Sweden -and heterosexuals in Tanzania and Haiti -- begin showing signs of what will later be called AIDS.

Deaths in US -- 31 (includes all known cases 1981 and before)

0 198 1

On June 5th, the CDC reports that in the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratoryconfirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. On July 4th, the CDC reports that during the past 30 months, 26 cases of Kaposi Sarcoma have been reported among Gay males, and that eight have died, all within 24-months of diagnosis. CDC (U.S.) links the new disease to blood. The term AIDS ("acquired immune dificiency syndrome") is used for the first time on July 27th. Larry Speakes, President Reagan's press secretary jokes about AIDS during press briefing on October 15th. US President Ronald Reagan has not mentioned the word "AIDS" in public yet. CDC (U.S.) warns blood banks of a possible problem with the blood supply. Institut Pasteur (France) finds the virus (HIV). US President Ronald Reagan has not mentioned the word "AIDS" in public yet. Dr. Robert Gallo (US) claims he discovered the virus that causes AIDS; however, this is about a year after the French discovery.

Number of known deaths in US during 1981 -- 234.

198 2

The Gay Mens Health Crisis is founded in New York City. Number of known deaths in US during 1982 -- 853.

198 3

Number of known deaths in US during 1983 -- 2304.

198 4

Opus BBS is released, becoming the first mainstream software system to donate 100% of its proceeds to AIDS

US President Ronald Reagan has not mentioned the word "AIDS" in public yet.

care/research. Number of known deaths in US during 1984 -- 4251, including -o

Gaetan Dugas, listed in The Band Played On as "patient zero."

198 5

The FDA (US) approves the first HIV antibody test. Blood products begin to be tested in the US and Japan. The first International Conference on AIDS is held in Atlanta (US). US President Ronald Reagan mentions the word "AIDS" in public for the first time in response to a reporters questions on September 17, 1985. See, also: Associated Press, Los Angeles Times President Reagan mentions AIDS in his Message to the Congress on America's Agenda for the Future on February 6, 1986. US Surgeon General Everett Koop publishes a report on AIDS. It calls for sex education. Switzerland begins testing of blood products. AZT (zidovudine, Retrovir) -- ViiV Healthcare(formerly GlaxoSmithKline) -- becomes the first anti-HIV drug approved by the FDA. The recommended dose is one 100mg capsule every four hours around the clock. Canada stops distribution of tainted blood products. The US shuts its doors to HIVinfected immigrants and travelers. On April 2nd, with virtually no mention made in the interim, President Reagan appeared before the College of Physicians in

AmFAR is founded in Los Angeles. The first AIDS-related play -- The Normal Heart, by Larry Kramer -- opens in New York. Number of known deaths in US during 1985 -- 5636, including -o

Rock Hudson, film star.

198 6

Ben Gardiner's AIDS BBS goes on-line in San Francisco, CA (U.S.). Number of known deaths in US during 1986 -- 2960. Cumulative known deaths: 16,301.

198 7

ACT UP is founded in New York City in March. A family -- including three HIV-positive sons (hemophiliacs) -- are driven from their home (Arcadia, Florida, US) after their home was torched by an arsonist. After an ACT UP demonstration, the FDA announces a two year shortening in the drugapproval process. The AIDS Memorial Quilt is started in San Francisco

Philadelphia, to deliver his first "major speech" on AIDS, calling it "public enemy number one." Vice President George Bush is heckled when he calls for mandatory HIV testing.

(US). And The Band Played On by Randy Shilts is published. Number of known deaths in US during 1987 -- 4,135. o Liberace, entertainer (PCP).
o

Michael Bennett, Broadway director (Chorus Line).

198 8

US bans discrimination against federal workers with HIV. US mails 107 million copies of "Understanding AIDS," a booklet by Surgeon General C. Everett Koop. FDA (US) okays importation of nonapproved treatment for PWA personal use. Haiti stops distribution of tainted blood products. FDA (US) approves pentamidine mist for use against PCP. After two years of intense ACT UP protests over the price of its drug, AZT, Burroughs Wellcome lowers AZT's price by 20%. Ronald Reagan apologizes for his neglect of the epidemic while he was president (US).

Number of known deaths in US during 1988 -- 4,855.

198 9

Number of known deaths in US during 1989 -14,544.

o

Amanda Blake, TV star ("Miss Kitty" on Gunsmoke)

199 0

GIS is founded by Sr. Mary Elizabeth and the Sisters Of St. Elizabeth Of Hungary. Number of known deaths in US during 1990 -18,447. o Halston, American fashion designer. o Keith Haring, artist.
o

Ryan White, teenager, hemophiliac, AIDS activist.

199 1

ddI (didanosine, Videx) -- BristolMyers Squibb -- a nucleoside reverse transcriptase inhibitor, is approved for use in the U.S.. 10 million have HIV worldwide (WHO). More than a million are in the US (CDC).

Professional basketball player Magic Johnson tells the world he has HIV. Kimberly Bergalis, who apparently got HIV from her dentist asks the US congress to force health care workers to be tested for HIV. Number of known deaths in US during 1991 -20,454.
o

Rock Singer Freddie Mercury

199 2

ddC (zalcitabine, Hivid) -- Roche -a nucleoside reverse transcriptase inhibitor, is approved for use in the U.S.. First clinical trial of multiple drugs is held. FDA (US) starts "accelerated approval" -- interim licensing -- to get promising drugs to PWAs faster. CDC (US) revises its definition of AIDS, including new opportunistic infections. The so-called "female condom" is approved. In the US, the FDA refused to allow testing for anal sex, saying sodomy is illegal in too many states. Four French blood bank officials sent to prison for allowing HIV-tainted blood into French blood banks. Researchers in Europe show taking AZT (monotherapy) early in the disease has no benefits (Concorde study). d4T (Zerit) -- Bristol-Myers Squibb -- a nucleoside reverse transcriptase inhibitor, is approved for use in the U.S..

PWAs Bob Hattoy and Elizabeth Glaser give speeches to the US Democratic National Convention. Number of known deaths in US during 1992 -23,411.
o

Robert Reed, actor

199 3

Number of known deaths in US during 1993 -41,920. o Arthur Ashe, tennis legend.
o

Rudolf Nureyev, ballet dancer.

199 4

A Benneton advertisement depicts US Pres. Ronald Reagan with K.S. lesions. Number of known deaths in US during 1994 -32,330.

John Curry, Olympic figure skater. Randy Shilts, Chronicled rise of AIDS. Elizabeth Glaser, CrU.S.der for Pediatric AIDS. Dack Rambo, actor

199 5

Saquinavir (Invirase) -- Roche -- is approved for use in the US. This is the first anti-HIV drug in the protease inhibitor class. 3TC (lamivudine; Epivir) -- ViiV Healthcare -- a nucleoside reverse transcriptase inhibitor, is approved for use in the US. Germany convicts four of selling HIV-tainted blood. US admits it was the Institut Pasteur (France), not Robert Gallo (NIH, US) who discovered the virus that causes AIDS. The HAART (Highly Active Antiretroviral Therapy) era begins. A combination of at least three ARV (antiretroviral) drugs are recommended. Nevirapine (Viramune) -Boehringer Ingelheim , approved for use in the US. This is the first antiHIV drug in the class called nonnucleoside reverse transcriptase inhibitor. Ritonavir (Norvir) -- Abbott -- a protease inhibitor, is approved for use in the U.S.. Indinavir (Crixivan) -- Merck -- a protease inhibitor, is approved for use in the U.S.. Japan busts Green Cross Pharmaceutical Corp. for dealing in HIV-tainted blood. Researchers at Columbia University identify herpesvirus-like DNA

Olympic diver Greg Louganis reveals that he has AIDS. Number of known deaths in US during 1995 -48,371. o Eric "Easy-E" Wright, "gangsta" rap star.
o

Paul Monette, Writer of Gay anguish.

199 6

Basketball star Magic Johnson returns to play basketball. Heavyweight boxer Tommy Morrison announces he is HIV positive. California voters passed Proposition 215 (55.7% to 44.3%) to allow medical use of marijuana. Arizona passed Proposition 200 by a much larger margin, 65.3% to 34.7%. Number of known deaths in US during 1996 -34,947, including: o Peter Adair, filmmaker.
o

Fela AnikulapoKuti,

sequences in AIDS-associated Kaposi's sarcoma Brazil becomes the first country to offer anti-AIDS drug "cocktails" to those who need them. TIME magazine's 1996 Man of the Year is AIDS researcher Dr. David Ho. Zidovudine/Lamivudine (Combivir) -- ViiV Healthcare--, is the first combination pill approved in the U.S. Delavirdine (Rescriptor) -- ViiV Healthcare -- is approved for use in the U.S. Nelfinavir (Viracept) -- ViiV Healthcare -- is approved for use in the U.S. CDC reports first case of probable HIV transmission through kissing. The UN reports it had been underestimating AIDS transmission rates. The CDC reports annual AIDS deaths dropped in the U.S. for the first time since the early 1980's. CDC also reports that HIV incidence declined for the first time. Researchers report from the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) they are beginning to understand the effect anti-HIV therapy has on CD4 T-cell counts. The American Medical Association and the U.S. Conference of Mayors call on U.S. Congress to revoke the 1988 law prohibiting needle exchange programs. Food and Drug Administration (FDA) approves Nelfinavir (Viracept) and Ritonavir (Norvir) for use in children. Abacavir (Ziagen) -- ViiV Healthcare -- and Efavirenz (Sustiva, Stocrin) -- Bristol-Myers Squibb -are approved for use in the U.S.

internationally renowned Afrobeat musician.

199 7

Number of known deaths in US during 1997 -21,399 Approximate total worldwide death count -6,400,000. Approximate number of HIV-positive people worldwide -- 22,000,000. To put this number in perspective, it is larger than the total population of the continent of Australia.

199 8

Number of known deaths in US during 1998 -17,403.

12th International AIDS Conference opens on June 28 in Geneva, Switzerland with the theme "Bridging the Gap". The conference reports that nearly 90% of people living with HIV disease are in developing countries where there have been little advancements in HIV/AIDS treatment and care. Efavirenz (Sustiva, Stocrin) -Bristol-Myers Squibb -- , the third non-nucleoside, reverse transcriptase inhibitor (NNRTI), is approved by the FDA for use in the U.S.. First formal trial begins to determine if people living with HIV/AIDS can stop taking anti-AIDS drugs safely. Researchers in France conclude that long-term breastfeeding by HIVpositive mothers increases the risk of HIV transmission to their babies substantially. Long-term side effects on metabolism from anti-AIDS therapy become increasingly worrisome. A team of researchers determine HIV came from chimpanzees.

Approximate number of HIV-positive people worldwide -- 33.4 million.

199 9

Number of known deaths in US during 1999 -18,491. For the first time there are more women living with HIV disease in Africa than men. South African Judge Edwin Cameron announces he is HIV positive. Number of known deaths in US during 2000 -17,741.

200 0

Zidovudine/Lamivudine/Abacavir (Trizivir ) -- ViiV Healthcare -- and Lopinavir (Kaletra, Aluvia) -Abbott -- are approved for use in the U.S. At a special UN Security Council meeting, HIV/AIDS is deemed a security threat for the first time. South African President Thabo Mbeki asserts HIV does not cause AIDS. Scientists from around the world sign the Durban Declaration, a document affirming HIV is the cause of AIDS. 13th International AIDS Conference

is held in South Africa. During the conference, demands are made for anti-AIDS drugs for pregnant women to reduce mother-to-child transmission.

200 1

Sandy Thurman is named the first US envoy on AIDS by President Clinton. Tenofovir (Viread) -- Gilead Sciences -- is approved for use in the U.S. HIV/AIDS is now the leading cause of death in sub-Saharan Africa. Brazil assists with World Trade Organization deal on medical patents giving poor countries access to discounts on drugs for AIDS. Rapid HIV test kit is approved by the FDA. The CIA's National Intelligence Council issues report stating HIV/AIDS is major threat to five countries. Barbados receives first World Bank loan to combat AIDS. 14th International AIDS Conference is held in Barcelona, Spain. Emtricitabine (Emtriva) -- Gilead Sciences -- , Atazanavir (Reyataz) -Bristol-Myers Squibb -- , and Fosamprenavir (Lexiva, Telzir) -ViiV Healthcare -- are approved for use in the U.S. President George W. Bush announces his Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion initiative to fight HIV/AIDS, primarily in Africa and the Caribbean. WHO and UNAIDS unveil 3 by 5 Initiative, a program to provide antiretroviral drugs to three million people in developing countries and those in transition by 2005. Abacavir/lamivudine (Epzicom) -ViiV Healthcare -- and

Number of known deaths in US during 2001 -18,524. Young South African activist Nkosi Johnson dies of AIDS.

200 2

Number of known deaths in US during 2002 -17,557. Cumulative deaths in US through 2003 -- 524,060.

200 3

AIDSVAX, an experimental AIDS vaccine, fails to block HIV infection among the more than 2,000 intravenous drug users who volunteered for the first large-scale clinical trial of an AIDS vaccine.

200

The U.S. porn industry is hit by fears of an HIV

Tenofovir/emtricitabine (Truvada) -- Gilead Sciences -- are approved for use in the U.S. The Three Ones, a landmark agreement to coordinate global efforts to fight HIV/AIDS and increase support was reached by the international community in partnership with UNAIDS. The first installment in the President's Emergency Plan for AIDS Relief (PEPFAR) has been distributed. FDA grants first tentative approval of HIV drug regimen for use under PEPFAR.

outbreak among its stars. By May, five actors have been found to be HIVpositive.

Keith Cylar, the cofounder, co-president and COO of Housing Works, passed away.

200 5

Nelson Mandela announces the death of his son from AIDS-related complications. Kenneth Cole, in conjunction with KNOW HIV/AIDS, a joint public education initiative of Viacom Inc. and the Kaiser Family Foundation, and amFAR today unveiled the "We All Have AIDS" campaign to reduce the stigma of HIV/AIDS. First annual national Women and Girls HIV/AIDS Awareness Day in US.

200 6 200 7 200 8

FDA approves Atripla as the first once-a-day treatment option. CDC releases revised HIV testing recommendations for health-care settings, recommending routine HIV screening for all adults 13-64 years old. Another major HIV vaccine trial is halted after preliminary results show no benefit. 17th International AIDS Conference takes place in Mexico City. It is the first time the conference is held in a Latin American country. Swiss researchers issue a report suggesting people on anti-HIV therapy drugs will not pass the virus

Around 33 million people are living with HIV, according to revised estimates in the 2007 AIDS Epidemic Update. CDC releases new HIV incidence estimate - 56,000 new infections in the U.S. each year.

to others. POZ magazine calls for a national AIDS strategy. Francoise Barre-Sinoussi and Luc Montagnier share the Nobel Medicine Prize for their discovery of the HIV virus. 2008 marks the 20th anniversary of World AIDS Day. President Barack Obama lifts the HIV travel ban. The first National AIDS Strategy is unveiled in the U.S. The World Health Organization estimates 5.2 million people are now receiving HIV treatment. The Council of the Global HIV Vaccine Enterprise develops the Scientific Strategic Plan for an AIDS vaccine.

200 9 201 0

Dennis deLeon, lawyer, former New York City human rights commissioner, co-founder of the Latino Commission on AIDS dies.

This information is designed to support, not replace, the relationship that exists between you and your doctor.

1998, 2010. AEGIS.

Symptoms of HIV/AIDS: Introduction

The symptoms of HIV infection are the result of HIV attacking the cells of the body's immune system. Early in the disease, many people with HIV infection have no symptoms. Some people may experience flu-like symptoms that occur about four to eight weeks after infection. Symptoms may include swollen glands, fever, headache and fatigue. These symptoms generally go away within several weeks. There then may be no symptoms for months to as many as ten years or longer after HIV infection. Over this time, HIV gradually destroys the helper T cells of the immune system. This eventually results in symptoms, such as swollen glands that remain enlarged, fatigue, weight loss, recurring fever and yeast infections. Eventually the immune system becomes so weak that other opportunistic infections and other serious complications occur. This stage is generally when a diagnosis of AIDS is made. Opportunistic infections and other complications include Pneumocystis carinii pneumonia, cytomegalovirus infections, Kaposi's sarcoma, tuberculosis, shingles, bacterial infections, herpes, meningitis, encephalitis and hepatitis....more about HIV/AIDS

Symptoms of HIV/AIDS

The list of signs and symptoms mentioned in various sources for HIV/AIDS includes the 87 symptoms listed below:

The initial phase of HIV infection occurs briefly, usually a month or two after exposure: o No early symptoms - some people notice no early infection symptoms o Flu-like symptoms o Fever o Headache o Tiredness o Enlarged lymph nodes Latent HIV phase - The latent phase of HIV can last from months to a decade, but is typically several years to more than 10 years. o No early symptoms - this phase of HIV does not cause any or many noticable symptoms o Swollen lymph glands Early AIDS symptoms - Early progression of HIV to AIDS has various symptoms: o Fatigue o Lack of energy o Weight loss o Frequent low-grade fevers o Night sweats o Frequent yeast infections (oral or vaginal) o Vaginal yeast infections o Bacterial vaginosis o Abnormal PAP smears o Genital ulcers - not necessarily from herpes o Persistent skin rashes o Flaky skin o Pelvic inflammatory disease - especially if it is difficult to treat o Short-term memory loss o Shingles o Severe herpes infections o Abscess Later AIDS symptoms - The progression of HIV to full AIDS causes many symptoms: o Opportunistic infections o Coughing o Shortness of breath o Seizures o Lack of coordination o Difficult swallowing o Painful swallowing o Mental symptoms o Confusion o Forgetfulness

Severe and persistent diarrhea Fever Night sweats Vision loss Nausea Abdominal cramps Vomiting Decreased appetite Mouth white spots Unusual mouth blemishes Skin lesions Weight loss Extreme fatigue Severe headaches Coma Kaposi's sarcoma Cervical cancer Lymphoma Infant and childhood HIV symptoms - HIV symptoms in infants and young children o No early symptoms - There are often no early signs of HIV in infants. o Failure to thrive o Slow weight gain o Sickly child o Delayed development o Delayed crawling o Delayed walking o Delayed speaking o Neurologic problems o Difficulty walking o Poor school performance o Seizures o Symptoms of HIV encephalopathy o Opportunistic infections o Conjunctivitis (pink eye) o Ear infections o Tonsillitis o Bacterial infections - more frequently than in non-HIV children; these cause various childhood symptoms Seizures Fever Pneumonia Recurrent colds Diarrhea Dehydration o Candidiasis symptoms Diaper rash Mouth infections Throat infections
o o o o o o o o o o o o o o o o o o

Difficulty eating more information...

Research symptoms & diagnosis of HIV/AIDS:

Overview -- HIV/AIDS Diagnostic Tests for HIV/AIDS Home Diagnostic Testing Complications -- HIV/AIDS Doctors & Specialists Misdiagnosis and Alternative Diagnoses Hidden Causes of HIV/AIDS Other Causes -- causes of these or similar sympto

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HIV/AIDS: Introduction

HIV is the acronym for the human immunodeficiency virus. HIV is virus that causes the incurable acquired immunodeficiency syndrome (AIDS). Over time, HIV destroys the helper T cells of the body's immune system, resulting in a critical deterioration of the immune system and the ability of the body to fight infection. HIV is most often a sexually transmitted virus. It is passed from one person another during sexual contact that involves vaginal, oral, or anal sex. HIV can also be passed to another person through other means, such as through contact with blood or body fluids. This can occur through such processes as blood transfusions or sharing needles contaminated with HIV. HIV can also be passed from an infected mother to her baby during pregnancy, childbirth or breastfeeding. Early infection with HIV often produces no symptoms. When there are symptoms, they can include flu-like symptoms that occur about four to eight weeks after infection. These symptoms generally go away within several weeks. There then may be no symptoms for months to years. The most serious complication of HIV infection is AIDS. For more details on complications and symptoms, refer to symptoms of HIV. Any person that engages in sexual activity can contract and pass on HIV. This includes heterosexual, homosexual, and bisexual men and women. The more sexual partners a person has, the greater the risk of catching and passing on HIV. Having another type of sexually transmitted disease, such as chlamydia, genital herpes, HPV or gonorrhea, also puts a person at greater risk for contracting an HIV infection and AIDS. The diagnostic test for HIV is a blood test that can reveal the presence of the specific antibodies (infection-fighting substances) that the body makes in response to an HIV infection. However, HIV may not be detectable in the first one to three months after infection.

During or after diagnosis, a physician or licensed health care provider will take a medical and sexual history to determine general health and immune system status. A complete physical and pelvic examination for women and physical and examination of the penis and testicles for men is also done. Additional tests are done to test for the presence of other potential disorders and diseases, including sexually transmitted diseases. Pelvic ultrasound and laparoscopic surgery may also be done in women if other sexually transmitted diseases or complications, such as pelvic inflammatory disease, are also present. Because there may be no symptoms, some people with HIV may be unaware of a problem, and a diagnosis can be missed or delayed. For more information on misdiagnosis, refer to misdiagnosis of HIV. Contracting HIV is highly preventable. Prevention of HIV is best accomplished by abstaining from sexual activity or having sex only within a mutually monogamous relationship in which neither partner is infected with HIV. Latex condoms also provide some protection from HIV when used properly.
ransmission of HIV/AIDS from Person to Person

HIV/AIDS is considered to be contagious between people. Generally the infectious agent may be transmitted by saliva, air, cough, fecal-oral route, surfaces, blood, needles, blood transfusions, sexual contact, mother to fetus, etc. HIV/AIDS, although infectious, is not a genetic disease. It is not caused by a defective or abnormal gene. The contagious disease, HIV/AIDS, can be transmitted:

by sexual conduct between people. from person to person by blood. from the mother to her fetus.

Contagion summary:

Spread by unprotected sex, oral sex, anal sex, heterosexual sex, blood exposure, transplacental contagion, childbirth transmission, breastfeeding. Not by saliva or kissing. Not by casual contact or touching. Not by clothing, food, or utensils. Not from public toilets or swimming pools. Not by insect bites.
Contagiousness properties for HIV/AIDS:

Contagious overall?: Yes Contagious by sex?: Yes Contagious by oral sex?: Yes Contagious by anal sex?: Yes Contagious by vaginal sex?: Yes

Contagious from water?: No Contagious in swimming pools?: No Contagious from food?: No Contagious by physical contact (non-sexual)?: No Contagious from bedding?: No Contagious from clothing?: No Contagious from kissing?: No Contagious from saliva?: No Contagious from surfaces (or objects)?: No Contagious from toilet seats?: No Contagious from blood?: Yes Contagious from blood transfusion?: Yes Contagious from intravenous needle usage?: Yes Contagious from needlestick injury?: Yes Contagious from organ transplant?: Yes Contagious from mother to fetus (transplacental)?: Yes Contagious mother to baby during childbirth?: Yes Contagious breastfeeding mother to infant?: Yes Contagious from insect bite (or exposure)?: No
HIV/AIDS: Introduction

HIV is the acronym for the human immunodeficiency virus. HIV is virus that causes the incurable acquired immunodeficiency syndrome (AIDS). Over time, HIV destroys the helper T cells of the body's immune system, resulting in a critical deterioration of the immune system and the ability of the body to fight infection. HIV is most often a sexually transmitted virus. It is passed from one person another during sexual contact that involves vaginal, oral, or anal sex. HIV can also be passed to another person through other means, such as through contact with blood or body fluids. This can occur through such processes as blood transfusions or sharing needles

contaminated with HIV. HIV can also be passed from an infected mother to her baby during pregnancy, childbirth or breastfeeding. Early infection with HIV often produces no symptoms. When there are symptoms, they can include flu-like symptoms that occur about four to eight weeks after infection. These symptoms generally go away within several weeks. There then may be no symptoms for months to years. The most serious complication of HIV infection is AIDS. For more details on complications and symptoms, refer to symptoms of HIV. Any person that engages in sexual activity can contract and pass on HIV. This includes heterosexual, homosexual, and bisexual men and women. The more sexual partners a person has, the greater the risk of catching and passing on HIV. Having another type of sexually transmitted disease, such as chlamydia, genital herpes, HPV or gonorrhea, also puts a person at greater risk for contracting an HIV infection and AIDS. The diagnostic test for HIV is a blood test that can reveal the presence of the specific antibodies (infection-fighting substances) that the body makes in response to an HIV infection. However, HIV may not be detectable in the first one to three months after infection. During or after diagnosis, a physician or licensed health care provider will take a medical and sexual history to determine general health and immune system status. A complete physical and pelvic examination for women and physical and examination of the penis and testicles for men is also done. Additional tests are done to test for the presence of other potential disorders and diseases, including sexually transmitted diseases. Pelvic ultrasound and laparoscopic surgery may also be done in women if other sexually transmitted diseases or complications, such as pelvic inflammatory disease, are also present. Because there may be no symptoms, some people with HIV may be unaware of a problem, and a diagnosis can be missed or delayed. For more information on misdiagnosis, refer to misdiagnosis of HIV. Contracting HIV is highly preventable. Prevention of HIV is best accomplished by abstaining from sexual activity or having sex only within a mutually monogamous relationship in which neither partner is infected with HIV. Latex condoms also provide some protection from HIV when used properly.
HIV/AIDS: Introduction (continue...)

There currently is no cure for HIV infection. However, prompt diagnosis and treatment can help to reduce or delay the onset of some serious complications, such as opportunistic infections, improve the quality of life, and minimize the spread of the disease to others. Treatment generally includes medication. Hospitalization may be necessary if a person has serious complications, such as meningitis or an opportunistic infection. For more information on treatment, refer to treatment of HIV. ...more

HIV/AIDS: HIV is a sexually transmitted virus and AIDS is the life-threatening immune failure that occurs late in the progression of HIV. AIDS was once in the top ten cause of death in the USA but has dropped out owing to better treatments and reduced transmission. Very early stages of HIV just after infection resemble the flu or another viral infection. There then follows a latent stage (often years) with no symptoms, and then an early AIDS stage (also often years) with various symptoms, many of them nonspecific and easy to misdiagnose. AIDS becomes much more characteristic in the latter stages of the disease where immune failure becomes almost total. ...more
HIV/AIDS: Symptoms

The symptoms of HIV infection are the result of HIV attacking the cells of the body's immune system. Early in the disease, many people with HIV infection have no symptoms. Some people may experience flu-like symptoms that occur about four to eight weeks after infection. Symptoms may include swollen glands, fever, headache and fatigue. These ...more symptoms
HIV/AIDS: Treatments

Treatment of HIV starts with prevention. Preventive measures include seeking regular medical care throughout the lifetime. Regular medical care allows a health care professional to best evaluate symptoms and the risks of catching HIV and regularly test for it as needed. These measures greatly increase your chances of catching and treating HIV in its earliest stages before ...more treatments
HIV/AIDS: Misdiagnosis

A diagnosis of the HIV can easily be missed or delayed because there are often no symptoms in the early stages, and the infected person may be unaware of an HIV infection. Embarrassment and not being honest with a health care provider about sexual activity can also delay a diagnosis. In addition, some symptoms of HIV infection, such as weight loss ...more misdiagnosis
Symptoms of HIV/AIDS

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The initial phase of HIV infection occurs briefly, usually a month or two after exposure: o No early symptoms - some people notice no early infection symptoms o Flu-like symptoms o Fever o Headache more symptoms...

See full list of 87 symptoms of HIV/AIDS

Treatments for HIV/AIDS

Nucleoside reverse transcriptase (RT) inhibitors - also called nucleoside analogs o Zidovudine (AZT) - also called ZDV o Zalcitibine (ddC) o Didanosine (ddI) o Stavudine (d4T) more treatments...

See full list of 33 treatments for HIV/AIDS

Home Diagnostic Testing

Home medical testing related to HIV/AIDS:

Home STD Testing o Home HIV Tests o Home Chlamydia Tests more...

Wrongly Diagnosed with HIV/AIDS?

Misdiagnosis of HIV/AIDS Failure to diagnose HIV/AIDS Hidden causes of HIV/AIDS (possibly wrongly diagnosed) Undiagnosed: HIV/AIDS