NATIONAL AIDS COUNCIL
2009
Draft copy
PURPOSE:
The purpose of this policy is to ensure the following:
1. Protection of human rights and dignity of youth infected with and affected by HIV and
AIDS.
2. Elimination of stigma and discrimination against youth infected with and affected by HIV
and AIDS or are perceived to be same.
3. Intensification of HIV and AIDS prevention strategies through information, education
and training.
4. Protection of the right of youths infected with and affected by HIV and AIDS to engage
in productive employment
5. Care, treatment and support for youths living with HIV and AIDS and their families.
SCOPE:
This document will be used as a tool for the development of procedures, projects and activities to
guide and protect young people between the ages 15-35 in Grenada. It is intended to be used in
the context of social dialogue and the promotion of best practices among youths.
POLICY STATEMENT:
The Ministry of Youth is committed to its responsibility as a governing body to provide a safe
system of work and a healthy work environment. The Ministry recognizes that life threatening
illnesses such as HIV and AIDS can have social, economic and human rights implications for the
young people. As the Ministry of youth, we embrace our responsibility to provide an enabling
and productive environment to all young people to lead a normal life.
DIFINITION OF TERMS:
Youth:
Young women and men age 15-35yrs seeking opportunities and making decisions affecting their
future status as adults.
Gender:
Gender refers to differences in social roles and relations between males and females. Gender
roles are learned through socialization and vary widely within and between cultures. Gender
roles are affected by age, class, race, ethnicity and religion, and by the geographical, economic
and political environment.
Sex:
Sex refers to biologically determined difference; it is whether a person is male or female.
Sexuality:
Total expression of who we are: our anatomy, morals, values, beliefs, passions, fears, spirituality
and sexual orientation.
Most at Risk Populations:
PLHIV/AIDS, MSM, Women, Youth, OVC, Prison Populations, Ex-Prisoners, Drug Abusers
and Sex Workers.
HIV: (Human Immuno-Deficiency Virus)
HIV belongs to a unique group of viruses known as retroviruses- these viruses reverse the usual
flow of genetic information within an infected cell. It is a virus that weakens the body's immune
system, ultimately causing AIDS.
AIDS:
The Acquired Immune Deficiency Syndrome is a range of medical conditions that occurs when a
person's immune system is seriously weakened by infection with the Human Immunodeficiency
Virus (HIV). HIV injures cells in the immune system. This impairs the body's ability to fight the
disease. People living with AIDS are susceptible to a wide range of unusual and potential lifethreatening diseases and infections.
Anti-retroviral
Drugs used to kill or inhibit the multiplication of retroviruses such as HIV.
PEP
Measures and treatment given to a person who has recently been exposed to diseases which
causes organisms, preventing them from developing the disease.
Stigma
A powerful social label that radically changes the way people are viewed and view themselves.
Discrimination
Any action or measure that results in someone being treated less favourably because they have,
or are believed to have, HIV.
Infected
A person who is living with the human immunodeficiency virus that causes AIDS.
Affected
A person whose life is changed in any way by HIV and AIDS due to the broader impact of this
epidemic.
STI- Sexually Transmitted Infections
Infections which are passed on by intimate body contact and sexual intercourse. They are caused
by tiny organism/germs (bacteria, germs and protozoa). Eg. Herpes, Syphilis and Gonorrhea
Opportunistic Infections
Infection by organisms that usually cause diseases in people with weakened immune systems.
Persons living with advanced HIV infection suffer opportunistic infections of the lungs, brain,
eyes, and other organs. Opportunistic infections common in persons diagnosed with AIDS
include Pneumocystis Carinii pneumonia; Kaposi's sarcoma; cryptosporidiosis; histoplasmosis;
other parasitic, viral and fungal infections; and some types of cancer.
Community
Local institutions which provide leadership or support on social, economic and political issues
relevant to citizens, such as private employers or business, non-governmental social welfare
organizations, health care providers, faith-based organization, cultural institutions. Etc
VCT – Voluntary Counseling and Testing
VCT is voluntary HIV testing that involves a process of pre- and post- test counseling, that helps
people to know their sero-status and make informed decisions.
Social Dialogue
Any form of information sharing, consultation or negotiation (with or without formal agreements
concluded) between educational authorities, public and private, and employees or their
representatives (i.e., workers' representatives as defined below). In the context of this policy
social dialogue is applied to youth and stakeholders.
Universal Precautions
A simple standard of infection control practice to be used to minimize the risk of blood-borne
pathogens
Employer
A person who engages others to perform certain tasks for payment of a wage or salary.
Employee
An administrator, Youth officer, Monitoring officer and Outreach officers attached to the
Ministry of Youth.
Orphan
A person under the age of 18 years who has lost one or both parent
Parent
The biological and adoptive persons or custodians, or legal guardians of children.
Capacity Building
An element of operations management that determines an organization’s capability to produce
the products/services, resources to meet demand.
Holistic (care, treatment and support)
Ways and means that address physical, psychological, emotional and other needs of affected and
infected individuals.
Reasonable Accommodation
Any modification or adjustment to a job or to the workplace that is reasonable, practicable and
shall enable a person living with HIV and AIDS to have access to or participate or advance in
employment.
Screening
Measures to assess HIV status, whether direct (HIV testing) or indirect (assessment of risktaking measures) asking questions about health or about medication used in this policy in the
context of exclusion from employment or education.
Workplace
Occupational settings, stations and places where workers spend time for gainful employment
Prevalence
A measure of the proportion of people in a population affected with a particular disease at a
given time.
Peer Educator
The trained employee or volunteer who develops or implements a developmental counseling
programme to meet the social, psychosocial and educational or training needs of employees or
students in relation to HIV and AIDS.
Psychosocial Support
The support meant to address challenges of isolation, depression, anxiety, other psychiatric
impairment and serious interpersonal problems as a result of HIV and AIDS. The purpose of
psychosocial support is to ensure that quality of life and motivation to live are effectively
optimized. Psychosocial support is understood to include spiritual sport.
Sexual Abuse
Abuse of a person targeting their sexual organs, e.g. rape, touching their private parts, or
inserting objects into their private parts.
PRINCIPLES GUIDING THE POLICY
Access to Information
All youths within the age group (15-35yrs) have the right to relevant and factual HIV and AIDS
information and behaviour change communication that is appropriate to their age, gender,
culture, language and context.
Human Rights
All youths within the age group (15-35yrs) have the same rights, opportunities and
responsibilities and shall be protected from all forms of discrimination, including discrimination
based on actual or perceived HIV status.
Access to Treatment, Care and Support
All infected and affected persons guided by the Ministry of Youth policy have the right to access
care, treatment and support in line with available resources. The Ministry shall work in
partnership with agencies offering support and care including institutions, community NGO’s,
CBO’s and private and public health care systems.
Privacy and Confidentiality
All personal medical information, whether oral, written or in electronic format obtained from an
individual or third party shall be treated as confidential. No Ministry personnel is mandated to
disclose HIV status to authorities at their workplace, learning institution or otherwise.
Supportive and Caring Environment
The Ministry of Youth shall provide a supportive and caring environment for all persons
including those infected with and affected by HIV and AIDS that guarantees access to treatment,
and provides for reasonable accommodation, provision for or referral to counseling, and healthy
living information.
Safe and Healthy Work Environment
All workplace and learning environments have a responsibility to minimize the risk of infections
by taking the appropriate first aid/universal infection control precautions.
Gender Equality
HIV and AIDS affect and impact women and men differently due to their biological, sociocultural, sexual orientation and economic circumstances. Application of all aspects of this policy
should be responsive to the different needs of males and females.
Fair Labor Practices
HIV and AIDS is not a cause for termination, suspension, involuntary transfer or denial of career
advancement of youth employees. Persons living with HIV related illnesses should be able to
work for as long as they are medically able.
Screening and Testing
Screening or testing shall not be a requirement of job applicants for positions in both private and
public sectors, or students who wish to enroll in schools in Grenada.
Involvement of Persons Living with and affected by HIV/AIDS
The involvement of Persons Living with HIV and AIDS to educate and inform shall be promoted
at all levels within the Ministry of Youth.
Partnership
While the Ministry of Youth shall be responsible and accountable for implementation of this
policy, it shall at all times seek to develop effective partnerships and involve all possible persons
and institutions to enhance the success of its implementation.
PREVENTION
HIV is preventable, and the Ministry of Youth Empowerment will do all that is reasonable
practicable to ensure that the contraction rate among youth is minimized, through education and
the following: abstinence programmes, Promotion of attitude and behavioural change strategies,
healthy life choices and the consistent application of Universal Precautions.
Access to Information and training:
The Ministry of Youth shall ensure the availability of appropriate resources on HIV and AIDS
prevention to all youth and Ministry’s employees. A training programme shall be developed to
inform youth about methods of prevention and transmission of HIV, and related communicable
diseases; promotion of safe sex practices and risk reduction measures in relation to sexually
transmitted infections. Every effort shall be made to ensure that resources are provided in a
fashion that is both effective and sustainable.
Voluntary Confidential Counseling and Testing
The Ministry of Youth shall partner with National and district medical authorities to facilitate
access to Voluntary, Confidential Counseling and Testing (VCCT) services by all staff and as
appropriate, by youth, on a demand-driven basis. Emphasis shall be placed on referral and
counseling to promote risk reduction and access to VCCT. VCCT and follow-up services should
utilize a structured, monitored and evaluated approach.
Peer Education Programmes
The Ministry of Youth shall promote Peer-education approach and peer support groups for all
youths such as Prevention Club, Counseling Groups, Youth Councils and Youth Friendly
Centers. The Ministry shall collaborate with appropriate governmental, Non-Governmental
Organisation, Faith-Based and Community Based Organisation in the training of peer educators
and the designing, developing, implementation, monitoring and evaluation of such programmes.
Community Mobilization
The Ministry shall foster networks of communities and church groups in building awareness,
support and participation among young people to improve on skill-building, information and
services through outreach programmes or other special interventions.
Through its outreach officers shall provide communities with materials and other support and to
seek funds and technical support from stakeholders for the mitigation of the social-economic and
health problems in the community.
Prevention of Mother to Child Transmission
The Ministry of Youth shall promote and facilitate a holistic approach to HIV and AIDS
prevention through promotion of education and Voluntary Counseling and Testing in health
facilities for all mothers within the youth age group (15-35).
Access to Condom
The Ministry of Youth shall facilitate access to condoms for youths within the age group (18-35)
and employees of the Ministry using responsible methods of distribution, proper storage
facilitate and appropriate locations.
Universal Precautions
Where there is exposure to blood and body fluids, the Ministry shall employ the Universal
Precautions to reduce the risk of HIV transmission or other blood borne pathogens. The Ministry
of Youth shall ensure the capacity of all education institutions and offices to implement
Universal Precautions by providing First AID kits and training of the community and church
groups in the application of this protocol.
Care and Support
All youths (15-35) affected or infected by HIV and AIDS are entitled to care and treatment.
All managers, educators, employers, parents, stakeholders have a duty to ensure that the rights
and dignity of all infected or affected are respected.
The Ministry of Youth have the responsibility to develop and implement systems that address
the psychosocial, physical, emotional, educational and spiritual needs of infected and affected
persons.
Access to Health Services
Every infected and affected youth should have access to health services and this should be
facilitated by the Ministry of Youth with other Ministries and service providers.
The Ministry of Youth shall provide lists of referral services for treatment as well as provide
basic literature on the treatment of HIV and AIDS.
The Ministry of Youth shall continue to liaise with the Ministry of Health to facilitate access to
health services.
Psycho-Social Support
Psycho-Social Support should be provided in a secure and confidential environment, free from
Stigma and Discrimination. The Ministry shall provide access to professional counselling
services for the infected and affected, including a referral service.
Orphans and Vulnerable Children (OVC)
The Ministry of Youth is expected to assist young people who are ill, OVC or students with
special needs (above the age of fifteen) so that they are able to continue with their education.
The Ministry together with the Ministry of Education has a responsibility to identify vulnerable
students with special needs and to identify resources that can support them and develop systems
to address those needs.
The Ministry of Youth should reach out to young OVC and students with special needs in the
community and make efforts to compensate for any lack of care and support they may
experience in their home environment.
Staff of the Ministry of Youth should ensure that all students within the compulsory age groups
complete their education in accordance with the provisions of the Education Act.
Non-formal education programmes, including those for out-of-school youth are encouraged to
address the educational needs of OVC’s and students with special needs including life skills and
HIV and AIDS Education.
Financial support
Bursary schemes and other financial aid schemes must incorporate provisions to cover the needs
of deserving affected, infected and other vulnerable youth and those with special needs at all
levels whether it’s educational or employment.
Compulsory HIV testing of applicants for bursaries, scholarships and financial aid schemes
provided by the Ministry of Youth is prohibited.
HIV and AIDS IN THE WORKPLACE
There must be recognition that HIV and AIDS is a workplace issue and is an issue that affects all
stakeholders within the age group of 18-35.
Non-discrimination
No individual infected or affected by HIV and AIDS or perceived to be infected or affected by
HIV and AIDS shall be discriminated against in terms of access to or continued employment,
training, promotion or benefits or enrolment on the basis of their HIV status.
All staff in the Ministry of Youth shall receive instruction on the fundamental Human Rights and
Freedoms as contained in the Constitution of the Grenada and all other relevant UN conventions
ratified by the Government.
Any individual who experiences discrimination or perceived discrimination shall be entitled to
redress.
HIV Testing and Confidentiality
No individual should be required to undergo compulsory testing for HIV for the purposes of
employment, promotion, training and/or admission.
Voluntary testing may be carried out at the request of a staff member in a suitable environment
in accordance with the prevailing legislation.
Disclosure shall be voluntary and any Youth employee to whom such information is disclosed
shall be bound to keep that information confidential.
HIV & AIDS information, prevention and support programmes for employees
A sustainable HIV and AIDS education programme shall be developed by the Ministry of Youth
for implementation throughout the Communities. This programme shall be designed and
implemented in consultation with all levels and categories of employees, stakeholders including
worker associations as well as persons infected and affected by HIV and AIDS and shall be
sensitive to cultural, developmental and socio-economic factors.
The HIV and AIDS programme shall include basic information about HIV and AIDS, how it is
transmitted and how it can be prevented; promotion of positive living by PLWHA; promotion of
non-discrimination, supportive and sensitive attitudes towards PLWHA and those affected by
HIV and AIDS; information on sexuality and safer sexual practices including abstinence,
faithfulness and the use of a condom correctly and consistently; information about Rights and
Services available to PLWHA within the education sector; referrals to relevant personnel,
agencies and networks that provide support and services to PLWHA and persons affected by
HIV and AIDS.
The Heads of the Ministry’s personnel and other workplace (who have youth employee) shall
establish and maintain communication channels to enable PLWHA and those affected by HIV
and AIDS to raise concerns, grievances and to access support,
Ill-health
PLWHA shall be entitled to continue to work or attend institutions of learning for as long as they
are medically fit.
Measures shall be taken to reasonably accommodate PLWHA and AIDS related illness to enable
them to continue working as long as possible. Reasonable accommodation shall include rearrangement of working/learning hours; modified tasks or jobs; provision of rest periods; flexible
work arrangements and leave provisions.
Exposure at the workplace
The Ministry of Youth shall ensure that adequate provision is made at all workplaces for the
implementation of Universal Precautions. (see Appendix 11.1_)
There shall be provisions for access to Post-Exposure Prophylaxis (PEP) in the event of sexual
abuse or in cases of accidental exposure while attending an educational institution or while on
duty on the part of any employee in the HIV and AIDS IN THE WORKPLACE
Responsibility and Accountability
All employees and members of staff in the Ministry of Youth are bound by all the provisions of
this policy.
It shall be the responsibility of all heads of workplaces to ensure that the provisions contained in
this policy are implemented.
All workers associations and organisations shall be actively involved in planning for the
implementation of this policy.
Sanctions
No individual of the Ministry of Youth shall refuse to work with, teach/facilitate or engage in
learning activities with PLWHA or affected by HIV and AIDS solely because of their status,
should this occur the individual shall be offered counseling or education. If after counseling the
individual still refuses to work with, teach/facilitate or engage in learning activities with
PLWHA or affected by HIV and AIDS the appropriate disciplinary procedures shall be initiated.
Should any head of any workplace refuse to reasonably accommodate PLWHA and AIDS
related illness to enable them to continue working the appropriate disciplinary procedures shall
be initiated. The provisions on sanctions shall need to be subjected to particularly rigorous legal
scrutiny before inclusion in a final draft.
RIGHTS TO EQUALITY
Stigma and Discrimination:
No individual infected or affected by HIV and AIDS or perceived to be same shall be
discriminated against in terms of access to or continued employment, training, promotion,
benefits or enrolment on the basis of their HIV status.
All youths (15-35) and staff in the Ministry of Youth, Culture and Sports shall receive instruction
on the fundamental Human Rights and Freedoms as contained in the Constitution of Grenada and
all other relevant UN conventions ratified by the Government.
Any individual who experiences discrimination or perceived discrimination shall be entitled to
redress.
Most at Risk Populations:
There shall be no discrimination, either directly or indirectly, against any persons from the “most
at risk populations” infected or affected by HIV and AIDS, or perceived to be infected or
affected by same.
Persons in the “high risk group” have the right as any other to continue employment and to
attend and be reasonably accommodated by educational institutions.
Testing, Disclosure and Confidentiality
There should be no HIV testing of persons (youth) as a prerequisite for admission, appointment
or promotion, nor is there medical justification for routine HIV testing of persons of continued
education and employment
No one (youth, high-risk groups) or employee within the Ministry of Youth may be mandated to
disclose his or her HIV and AIDS status.
Voluntary disclosure of someone (15-35) HIV or AIDS status should be encouraged through the
creation of an enabling environment in which such disclosure remains confidential.
Sanctions shall be implemented by the Ministry of Youth, Culture and Sports against employees
who breach this confidentiality through unauthorized disclosure of an individual’s HIV and
AIDS status.
MANAGING YOUTH RESPONSE
The Establishment of a HIV and AIDS Coordinating Unit within the Ministry of Youth.
The Ministry of Youth recognizes that HIV and AIDS is a serious issue in Grenada especially
among the youth population and has resolved to establish an HIV and AIDS Coordinating Unit
(HACU).
The unit will be advised by an advisory committee which will be comprised of the Head of the
Division of the Ministry and shall include representation from the PLWA community, NonGovernmental Organisation, youth representation from community and church based groups, the
higher educational institutions, and the Ministry responsible for Science and Technology. See
appendix for organizational structure.
The Unit shall have an administrative body to carry out the mandate of the Unit.
The Unit shall report directly to the Permanent Secretary within the Ministry of Youth.
The unit shall be responsible for developing and promoting a plan for the implementation of
policy at the Ministry as well as the monitoring, evaluation and review of the plan.
The unit shall be responsible for advising the Permanent Secretary and Minister on matters with
respect to HIV and AIDS.
The unit shall also be responsible for directing the delivery of the policy agenda to ensure that
staff, administrators, parents, and youth are knowledgeable and informed of the content of the
policy and committed to its dissemination.
The unit shall be responsible for forging partnerships with key stakeholders such as the
Ministries of Health, Education, Social Development, Tourism and aviation, Community and
church groups and other NGOs.
National Youth Council Coordination and Accountability
Each National Youth Council should identify seven Programme Officers within the seven
parishes to assist in the implementation of the plan.
The Programme Officers are to report on the progress of the parish to the HIV and AIDS
Coordinator within the Ministry of Youth.
The Programme Officers must be responsible for the implementation of the plan in their area.
The Programme Officers are responsible for communicating the policy and plan to all youth
(employed, unemployed and students).
The National Council together with the Ministry of Youth HIV and AIDS Programme
Coordinator shall develop specific advocacy strategies to support the implementation of the HIV
and AIDS policy.
The Programme Officers shall be required to provide the necessary data, including key indicators
of impact for the development of a consolidated and accessible information system.
Planning
The Ministry of Youth shall plan for and mobilize resources to support the implementation of
this policy.
The HIV and AIDS Coordinating Unit shall coordinate resource planning and budgeting and
liaise with other sector partners to develop a shared strategy aimed at preventing the further
infections and at mitigating the impacts on youth.
Human Resource Training and Development
As part of the response to HIV and AIDS, the Ministry of youth shall liaise with other ministries
and agencies involved in human resource planning and development, in order to sustain a
positive and effective education delivery.
The Ministry shall ensure adequate monitoring and planning so that there is an efficient and
adequate supply of appropriately skilled officers and other staff to meet our educational needs.
Pre-service and in-service training of staff and community officers shall be required to ensure
that they have the skills to protect themselves from infection, to implement the appropriate life
skills curriculum, and to deal with the effects of HIV and AIDS.
Partnerships
The Ministry of Youth shall make deliberate and systematic efforts to form, manage, and sustain
partnerships for the benefit of youth with agencies and institutions from inside and outside the
Ministry.
Research
Special attention shall be given to research on levels of HIV prevalence affecting youth, levels of
orphan hood and vulnerability, access to education the effectiveness of prevention programmes,
impacts of HIV and AIDS on the workplace, and the differential impacts on gender. Examples of
good practices shall be highlighted and replicated across each Ministry programme. The
University of the West Indies, St. George’s University, CAREC and other research institutions in
the sector shall be encouraged and supported to play a leading role in this regard.
Monitoring and Evaluation
Coordinators at all levels of the Ministry shall be expected to integrate strategies and
mechanisms for monitoring and evaluating the quality of programmes, the responses to
interventions and the efficiency of resource utilization in the Ministry, as well as using this
information for planning and management purposes. The HIV and AIDS Coordinating Unit
(HACU), in conjunction with the Planning Division in the Ministry shall be expected to play a
leading and facilitating role in particular with the development of baseline and suitable indicators
for monitoring and evaluation.
Advocacy
The Ministry of Youth shall ensure that all managers and stakeholders pertaining to youth are
knowledgeable and informed of the content of this policy, and committed to its dissemination.
Further policy development and review
This policy shall be reviewed from time to time to ensure that it remains relevant to the needs of
youth.
(NB) This could be a supporting document or part of the document.
ANNEXURES
HIV and AIDS FACTS:
What is HIV?
Human:
The virus can only affect humans.
ImmunoDeficiency:
The virus causes the immune system to lack the required elements for it to
function properly.
Virus:
The germ (micro-organism) responsible for the infection. It is extremely small
and can only survive and multiply within living cells at the expense of these cells
What is AIDS?
AIDS stands for Acquired Immune Deficiency Syndrome and is caused by a virus know as
Human Immunodeficiency Virus (HIV).
Acquired:
Meaning that it is a virus that a person contracts as opposed to a condition that is
hereditary (passed on through genes)
Immune:
Your immune system is the part of the body that protects you from germs, viruses
and bacteria and so keeps you healthy
Deficiency:
It creates a deficiency or weakness in your immune system, causing it to
malfunction
Syndrome:
A wide range of different diseases, conditions and opportunistic infections some
one with AIDS may experience.
How does my body protect me?
•
The first line of protection that your body provides against infections is your skin. Your
skin acts as a barrier, and the sweat glands in it get rid of waste. An injury such as a cut
provides a way for germs to enter and infect your body.
•
The small hairs and fluids in your body openings also protect you. Nostrils have hair
and mucous to keep out germs carried in the air.
•
The saliva in your mouth contains enzymes that may destroy germs
•
You eyelashes, eyelids and tears protect your eyes.
•
Your vagina, urethra (the tube you urinate through), anus, and bowels (guts) are line with
mucous membranes, which protect them.
What about my Immune System? What is it function?
•
Your body’s health is protected by its immune system, which is a network of chemicals,
cells, tissues and organs found throughout your body. This work together to protect you
from germs. Your immune systems can distinguish the difference between what belongs
in your body and what does not belong. When your immune system detects something
foreign, it tries to destroy and remove it to keep you healthy.
•
White blood cells (part of the immune system) call lymphocytes (B- cells and T-cells)
protect the body from germs such as ciruses, bacteria, parasites and fungi.
•
The two main types of T-cells are the T-4 (CD-4) cells and T-8 (CD-8) cells.
•
When a germ or virus or bacterium enters you body, the immune system recognizes it as
foreign to the body and potentially harmful. The T-4 cells begin the attack against
infections by activating killer T-cells and antibody-producing B-cells while the T-8 cells
end the immune response.
•
Another way your immune system protects you is by the production of antibodies
against what is not part of your body. The activated B-cells try to destroy any foreign
particles not recognized as belonging to your body by creating antibodies to attack and
destroy these foreign particles. This occurs when a virus such as HIV infects you. Your
body recognizes HIV as being foreign and potentially dangerous and therefore produces
anti-bodies against it. Although effective at first, the antibodies do not eliminate the
infection.
•
Some HIV are killed but many more viruses will infect the T-4 cells, the very same cells
that are supposed to co-ordinate the defense against the virus. Infected T-4 cells (CD-4)
cells become virus factories, which if activated, will produce viruses instead of triggering
the production of more antibodies against it.
•
One way to determine how healthy your immune system is?
•
One of the blood cells infected and killed by HIV is the T-4 (CD-4) cell. It is required to protect
your body from other infections. The number of CD-4 cells in your blood shows how strong your
immune system is. If infected by HIV a test called CD-4 count will determine the progress of
HIV infection.
TRANSMISSION OF HIV
Where can HIV are found?
Which body fluids contain HIV?
HIV is present in infectious quantities in:
• Blood and blood products.
• Semen and possibly pre-cum (pre-ejaculate).
• Vaginal and cervical secretions.
• Breast milk.
During invasive surgical procedures health care workers may also come into contact with the following
body fluids, which contain significant amounts of HIV:
• Amniotic fluids.
• Cerebrospinal fluids.
• Synovial fluid around bone joints.
In HIV+ persons, HIV is either not present or present in very minute amounts in:
• Saliva (only found in minute amounts in a small number of people),
• Tears and Blister fluid
• Urine, Faeces, Vomit or Sweat
Finding a small amount of HIV in a body fluid does not necessarily mean that HIV can be transmitted by
that body fluid. Contact with saliva, tears, or sweat has never been shown to result in transmission of
HIV.
How is HIV transmitted?
The main route of HIV transmission is through:
• Unprotected sexual contact with an infected person
• By sharing needles with an infected person and
• From an infected mother to child during pregnancy, during birth or shortly after birth while
breastfeeding
For HIV transmission to occur the following criteria must be met:
1. HIV must be present.
2. There must be a sufficient quantity of HIV present.
3. It must get into the bloodstream via the mucosae (vaginal or rectal) and through breaks in the skin
(and many times these are not visible).
Note: HIV is most concentrated in blood.
Who is at risk?
• You are at a high risk
if you have sex without condoms
if your have many sex partners and do not use condoms
if your sex partner(s) has/have sex with other persons without using condoms
if your have shared unsterilised needles for intravenous drug use
if you have sex with only one partner who is HIV positive
Will a condom protect me from getting HIV the AIDS virus?
• Used correctly, a condom will protect you from contracting AIDS.
• A condom is the only barrier that is now available to prevent the transmission of HIV and other
sexually transmitted infections, during sexual intercourse.
Using the condom (Male)
1. Carefully remove condom from package. Avoid using teeth or nails as this can burst the condom.
2. Hold the tip of condom to squeeze out air and place on erect penis.
3. Unroll the condom down the shaft to base of penis.
4. Does not use grease (Vaseline). This can cause the condom to burst. Use a water-based lubricant
(such as KY) which is available at the drugstore.
5. After your ejaculate (cum, break), withdraw while still hard, otherwise there might be a spill.
6. Wrap condom and dispose of safely.
Using a condom (female)
Careful remove condom from the package. Avoid using teeth or nails as this can burst the condom.
Find an appropriate position to insert the condom.
There are two rings; the inner ring is removable and flexible. The outer ring stays on the outside of the
vagina; it protects the surface of the vagina.
How safe is oral sex?
• It is possible to become infected with HIV through oral sex; however the risk of becoming infected
this way is lower than for unprotected sexual intercourse with a man or woman.
• When giving oral sex to a man, a person could become infected with HIV if infected semen gets into
any cuts, sores or receding gums they might have in their mouth.
• Giving oral sex to a woman is considered relatively low risk. Transmission could take place if
infected fluids from a woman get into the mouth of her partner. The likelihood of infection occurring
might be increased if there is menstrual blood involved or if the woman is infected with another STI,
which causes breaks in the skin, therefore increasing exposure to blood.
What are the chances of becoming infected with HIV if he doesn’t come inside me?
• Whilst research suggests that high concentrations of HIV can sometimes be detected in pre-cum (preejaculate), it is difficult to judge whether HIV is present in sufficient quantities for infection to occur.
To guard against the possibility of infection with HIV or any other STI it is the best to practice safer
sex i.e. sex with a condom from start to finish.
• Note that if there is an open wound on the penis then the risk for transmission is greatly increased.
Is deep kissing a route of HIV transmission?
• Deep or open-mouthed kissing is a very low risk activity in terms of HIV transmission.
• There has been only one documented case of someone becoming infected with HIV through kissing; a
result of exposure to infected blood during open-mouthed kissing.
• If you or your partner has open wounds in your mouth, you should avoid kissing until the wound has
healed.
Can I become infected with HIV through normal social contact or activities such as shaking hands,
kissing, using toilet seats and swimming pools, sharing cutlery or exposure to sneezes and coughs?
• No. This is because HIV is not air-borne, water-borne or food-borne virus.
• Therefore ordinary social contact such as kissing, shaking hands, coughing and sharing cutlery does
not result in the virus being passed from one person to another.
How long can HIV survive outside the human body?
• Generally the fragile nature of the virus prevents it from surviving for substantial amount of time in
the open air. The length of time HIV can survive outside the body is dependent on the amount of HIV
present in the body fluid and the conditions the fluid is subjected to.
• Note that HIV is fragile and many common substances such as hot liquid, soap, bleach, alcohol and
the gastric juices found within your stomach can destroy the virus.
• The only studies on the survival of HIV outside the body have been conducted in the laboratory under
controlled scientific conditions. These studies found HIV is not affected by extreme cold, but it is
inactivated by heat and destroyed after 30 minutes at 60˚ C.
• Scientific studies have found that HIV can sometimes survive in dried blood at room temperature for
up to six days. It is extremely difficult to assess exactly the length of survival of HIV outside the body
in a non-laboratory setting.
Is there a risk of HIV transmission when having a tattoo, during body piecing or at the barber or
hairdresser?
• At the barber there is no risk of infection unless the skin is cut (which may occur if the barber
accidentally cuts you) and if there is a transfer of infected blood.
If the instruments are contaminated with infected blood and are not sterilized between clients
there is a risk of HIV transmission
• To reduce the risk of blood-borne infections such as hepatitis and HIV, ensure that the
razor/instruments used are new or have been properly sterilized.
• However, people who carry out body piercing, tattoos, or hair-dressing should follow procedures
called “universal precautions”, which are designed to prevent the transmission of blood-borne
infections such as HIV and hepatitis B.
Am I at risk of becoming infected with HIV when visiting the doctor or dentist?
• Transmission of HIV in a health care setting is extremely rare. All health professionals are required to
follow infection control procedures when caring for any patient. These procedures are called universal
precautions for infection control. They are designed to protect both patients and health care
professionals from the transmission of blood-borne diseases such as hepatitis B and HIV.
If I have sex with a sex worker (prostitute) will I get HIV?
• Unprotected sex (sex without a condom) places you at a high risk of contracting the virus whether it is
with a commercial sex worker or another person.
• However, statistics from the Caribbean and several other parts of the world have shown that there is a
higher prevalence or occurrence of HIV in commercial sex workers (prostitutes). Therefore by having
unprotected sex with a commercial sex worker the risk of contracting HIV is high.
Can I infect my unborn child if I am HIV positive?
• Women with HIV can transmit the virus to their fetus.
The use of special drugs, during pregnancy and at birth, can now help to prevent the transmission of HIV
from mother to child.
Can the virus be transmitted through breast-feeding?
• Yes, HIV is present in infectious amounts in breast milk. HIV can be passed from an HIV infected
mother to her baby through breastfeeding. Most HIV+ children in the Caribbean got infected through
mother-to-child transmission of HIV.
This can be prevented when an HIV infected mother does not breastfeed her baby and uses other alternate
milk recommended by her doctor.
All pregnant women are advised to take a blood test for HIV as early as possible in their pregnancy. If a
pregnant woman is HIV infected her baby does not have to get HIV. Ask your doctor or nurse more
about pregnancy and HIV prevention.
Can I get HIV from a mosquito?
• No, it is not possible to get HIV from mosquitoes or other biting and bloodsucking insects. The
results of experiments and observations of insect-biting behavior indicated that when an insect bites a
person, it does not inject its own or a previously bitten person’s or animal’s blood into the next person
bitten. Rather, it injects saliva, which acts as a lubricant so that the insect can feed efficiently.
• Diseases such as yellow fever and malaria are transmitted through the saliva of specific species of
mosquitoes. However, HIV lives for only a short time inside an insect. Unlike organisms that are
transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if
the virus enters a mosquito or another insect, the insect does not become infected and cannot transmit
HIV to the next human it bites.
• There is also no reason to fear that a mosquito or other insect could transmit HIV from one person to
another through HIV-infected blood left on its mouth parts. Several reasons help explain why this is
so.
1. Infected people do not have constantly high levels of HIV in their blood streams.
2. Insect mouth parts retain only small amounts of blood on their surfaces.
3. Finally, scientists who study insects have determined that biting insects normally
do not travel from one person to the next immediately after ingesting blood.
rather they fly to a resting-place to digest the blood meal.
Am I at higher risk if I have sex with a member of the same sex?
• HIV is transmitted sexually regardless of your sexual preference. Note however, that world wide there
is a higher prevalence of the virus in certain groups because of their sexual practices and therefore
having unsafe sex with someone from one of these groups places you at a higher risk of contracting
the virus. Men who have sex with men, commercial sex workers, and people who have sexually
transmitted infection are examples of such groups.
• By following safe sexual practices (using a condom every time) you can reduce your chances of
becoming infected.
A member of my family or close friend of mine has HIV; am I also at risk?
• Although HIV has been transmitted between family members in household setting, this type of
transmission is very rare.
• These transmissions are believed to have resulted from contact between skin or mucous membranes
and infected blood.
• To prevent even such rare occurrences, precautions should be taken in all settings including the home
to prevent exposure to the blood of persons who are HIV infected, at risk for HIV infection, or whose
infection and risk status are unknown.
• For example, gloves should be worn during contact with blood or other body fluid possible contains
visible blood, such as urine, faeces, or vomit.
• Cuts, sores, or breaks on both the caregivers’ and patients’ exposed skin should be covered with
bandages.
• Hands and other parts of the body should be washed immediately after contact with blood or other
body fluids.
• Surfaces soiled with blood should be disinfected appropriately.
• Practices that increase the likelihood of blood contact, such as sharing razors and toothbrushes should
be avoided.
• Needles and other sharp instruments should be used only when necessary and handled according to
recommendations for health care settings. (Do not put caps back on needles by hand or remove
needles from syringes. Dispose of needles in puncture-proof containers out of the reach of children
and visitors).
Signs and Symptoms of HIV and AIDS
What are the first symptoms of HIV infection?
• The symptoms of initial HIV infection are not very specific. Initial symptoms include a dry cough,
shortness of breath and a flu-like sickness.
• During this early period of infection only a small minority of people experience symptoms, which are
serious enough to require a doctor’s attention.
• During this stage, which is also called the acute infection, the virus multiplies rapidly. You might test
negative for HIV antibodies during this stage, but you can still pass HIV on to someone else. This is
called the window period of roughly three to six months from the time of infection to the time when
you will show antibodies against HIV. HIV antibodies begin to show in an infected person’s blood
when they seroconvert.
How can you determine if someone has HIV?
• The only way to ascertain if you are infected with HIV is to have a test for HIV.
What is Servoconversion?
• This refers to your body responding to HIV by making antibodies. After you seroconvert, a blood test
for the HIV antibody will come back positive. This stage usually happens roughly three to six months
after you are infected with HIV.
When do I develop AIDS?
• Several years after infection with HIV a person may experience symptoms of particular illnesses and
cancers. These are the result of the infected person’s immune system being damaged by HIV to the
point where it is no longer able to fight off these opportunistic infections.
What are signs that I have AIDS?
• The current Caribbean Epidemiology Centre (CAREC) case definition for AIDS in adults and
adolescents (age 13 and over) is:
1. they are HIV positive and they have
2.
at least 2 major signs and at least 1 minor sign or at least 1 AIDS defining illness
(the presence of one or more opportunistic infections)
• Refer to the CAREC publication “Guidelines” for the Clinical Management of HIV Disease” for
further information on major and minor signs.
About HIV testing and Viral Load
Why should I go for an HIV test?
• It is recommended that you determine your HIV status if you have experienced the following:
-
unprotected sex
shared needles
-
rape
accidental needle stick at work
Some advantages of knowing your HIV status are:
• if you know you are HIV-positive, you can take advantage of immune system monitoring, early
treatment and intervention, as well as self-help activities such as good nutrition and hygiene.
• By taking the test, you can find out whether or not you can infect others.
• Testing often increases your commitment to overall good health habits.
• If you test negative, you may feel less anxious after knowing your HIV status.
• Women and their partners considering pregnancy can take advantage of treatments that can help
prevent transmission of HIV to the baby.
Some disadvantages are:
• if you test positive, you may show an increase in anxiety and depression. However with proper
information, support from friends and family and access to services you can learn how to live with the
infection.
• When testing is not strictly confidential, you may risk job and insurance discrimination. To prevent
this, make sure you test at a confidential site.
• The decision to take an HIV test is an extremely personal one. No one can make that decision for
anyone. No one should insist that you do a test. We can only advise you of the possible implications
of a positive and a negative result in your life.
What does the test for HIV check for?
• These tests use saliva, urine or a small blood sample to determine if you’ve been infected with HIV.
The tests look for antibodies to HIV, not for HIV itself. Labs use two test to look for these antibodies:
1. The ELISA (Enzyme Linked Immunosorbent Assay) test is done first, as a general
screening test. If the ELISA test is positive, a second test, is done to confirm the
results.
2.
When both tests are positive, it means that the antibody to HIV has been found.
What is the Viral Load?
• Viral load refers to the amount of HIV present in the blood. It is measured in number of viral copies
per milliliter of blood.
• Viral load is a very important measure used to monitor HIV patients on antiretroviral treatment.
• A high viral load can indicate a greater risk for the progression to HIV disease.
transmission of HIV from a woman to her fetus also increases if the viral load is higher.
The risk of
Will I know whether I was infected with HIV if I got tested right after I was or believe I was
exposed to HIV?
• Infection with HIV causes flu-like symptoms. The routine way to determine if you are infected with
HIV is by taking the HIV antibody test. However, the p24 antigen and PCR (Polymerase Chain
Reaction) tests can tell you whether you are infected earlier than an HIV antibody test can. The HIV
antibody test looks for antibodies against the virus in the person’s blood.
• Getting tested before the three-month period may result in an unclear test result, as an infected person
may have not yet developed antibodies to HIV. So it is best to wait for at least three months after the
last time you were exposed before taking the test.
• It is also important that you are not at risk of further exposures to HIV during this time period. Most
importantly you should continue to practice safe sex (use a condom every time you have sex) and not
share needles.
What should I do after I have taken my HIV blood tests and am waiting for the results?
• While waiting for the results of your HIV blood tests it is important not to expose yourself to possible
infection. Use a condom every time you have sex during this period and beyond.
Social Issues
I don’t use a condom with my regular partner but I believe they may be having affairs outside of our
relationship, what should I do?
• If your partner has unprotected sex (sex without a condom), and has sex with other persons besides
yourself or engages in high-risk behaviors outside of your relationship then he or she may be placing
you at risk and in such a situation you should insist on using condoms. If you do not, you will
continue to be at risk.
• Contact a counseling centre that deals with HIV/AIDS or your church or a professional counselor for
further advice.
I was raped: what are the chances that I have HIV and what should I do?
• Post exposure prophylaxis (treatment) is recommended as soon as possible.
• Any assault where the assailant’s blood or semen has access to the person’s bloodstream is risky, as is
the case in rape. If the assault is violet and the person bleeds, this may be more likely.
• Anal penetration is the highest risk; vaginal penetration is somewhat less risky; semen in the mouth
presents the smallest risk. Ejaculation in any of these cases increases the risk significantly.
• The HIV status of the rapist should be determined (if this is possible).
• For medical and legal purposes, it is highly recommended that a person who has been raped be tested
immediately. This can establish that the person was not infected at the time of the assault. If he/she is
HIV negative and later testes positive for HIV, there may be a basis for legal action beyond the assault
charge.
I may have been exposed to HIV at work via a needle prick; what should I do?
• Post exposure prophylaxis (treatment) is recommended as soon as possible.
• The HIV status of the source of your exposure through the needle prick should be determined.
• For medical and legal purposes, it is highly recommended that an HIV test be done immediately after
the needle prick. Both the source of exposure and the exposed person should be tested immediately to
establish the baseline status. (for further information, refer to the regional guidelines on Post
Exposure Prophylaxis).
Treatment, Opportunistic Infections and other STIs
Is there a connection between HIV and other sexually transmitted infections?
• Yes. Having a sexually transmitted infection (STI) can increase a person’ risk of becoming infected
with HIV, whether the STI causes open sores or breaks in the skin e.g. syphilis, herpes, chancroid or
does not cause breaks in the skin e.g. Chlamydia, gonorrhea.
• If the STI causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body
during sexual contact. Even when the STI causes no breaks or open sores, the infection can stimulate
an inflammatory reaction in the genital area that can make HIV transmission more likely.
• In addition, if an HIV-infected person is also infected with another STI, that person is three to five
times more likely than other HIV-infected persons to transmit HIV through sexual contact.
• Not having (abstaining from) sexual intercourse is the most effective way to avoid STIs, including
HIV. For those who choose to be sexually active, the following STI/HIV prevention activities are
highly effective:
-
Engaging in sex that does not involve vaginal, anal, or oral penetration
Having intercourse with only one uninfected partner or
Using latex condoms every time you have sex
What are some opportunistic infections?
• Some common opportunistic infections are Pneumocystis Pneumonia (PCP), Tuberculosis,
Toxoplasmosis, mouth problems such as candidiasis (oral thrush) and eye infections due to
Cytomegalovirus.
• Note that one person may get certain symptoms or infections and another may get completely different
ones. Some persons won’t get all of them. Some may not get any. Men and women, children and
adults, and people from different parts of the world get different kinds of infections.
Are there any treatments for HIV & AIDS and opportunistic infections?
• In addition to drugs and other treatments that can treat, control or prevent opportunistic infections
progress has been made in producing effective drugs that combat HIV directly. These drugs, often
known as “combination therapies” or “the cocktail” slow down the effect of HIV on the immune
system by interfering with the replication of HIV.
• This form of therapy usually consists of a number of drugs taken on a strict timetable. Successful
combination therapy can improve the health of people with AIDS. Very frequently, taking these drugs
causes remission of symptoms, in addition to reduced viral load (a reduced amount of HIV in the
blood) accompanied by an increased number of CD4 cells.
• Combination therapy does not work in everyone. The length of time that the drugs are effective
against the virus varies, and drug resistance can set in, making the drugs ineffective.
• Through the regional initiatives on price reduction, antiretroviral are now more affordable. Therefore,
it is recommended that all CAREC member countries make them available to patients who need them.
• Some practical steps that can be done to help you stay healthy if infected are
1. Good hygiene
2. Proper nutrition and
3. Avoidance of alcohol, cigarettes and drugs.
• Antiretroviral have been a major success in the treatment of AIDS, and in many cases have turned an
inevitable fatal disease into a chronic one.
What does Tuberculosis have to do with HIV /AIDS?
Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis. Anyone can become infected
with TB; you don’t have to have HIV/AIDS or a weakened immune system. TB bacteria can be spread
from person to person through coughs and sneezes, but usually only after lengthy exposure or close
contact with a person with active TB in their lungs or throat. If you’re HIV positive, you should take
special care around anyone who has active TB, as you may easily develop Tuberculosis due to your
weakened immune system. One of the highest causes of deaths in AIDS patients is due to TB.
Immunization
Infants of mothers with HIV infection should not receive the BCG vaccine against Tuberculosis but can
be vaccinated against other childhood diseases.
What is Syphilis?
Syphilis is caused by the bacterium Treponema pallidum. If untreated, it goes through three stages, with
different symptoms at each stage.
• During the first stage, a single chancre (painless sore) forms on your genitals, rectum or mouth or
throat. It will disappear on its own in three to six weeks without treatment.
• The second stage occurs about six months later. Sores and a rash may occur anywhere on you body.
You may feel like you have the flu, with headache and aches and pains in your joints or bones. You
may also experience hair loss and flat, wart-like growth inside your anus or vagina. Without treatment
these symptoms may come and go.
• Symptoms of the third stage may take 10 to 20 years to develop. They can be very serious and can
result in blindness, heart or brain damage, and, in some cases, death. People with HIV/AIDS seem to
develop third-stage syphilis much faster than others.
• Syphilis is diagnosed by a series of blood tests. The first test, called the VDRL, is a screening test.
Usually, if this test is negative, you don’t have syphilis. However, people with HIV/AIDS may have
false negative VDRL tests. If you suspect you have been exposed to syphilis, you may want to ask
your doctor to run two other tests, called the FTA-ABS and the MHA-TP. Syphilis is treatable with
antibiotics, and should be treated as soon as possible.
What is Gonorrhea?
Gonorrhea is caused by the bacterium Neisseria gonorrhoea. It may cause a thick discharge (stuff that
comes out) from your penis or from your vagina, and sometimes a burning feeling while you’re urinating
(peeing). In many people, especially women, there may be no symptoms. Gonorrhoea can also occur in
your rectum or throat. It can develop into a chronic, serious infection if not treated. It can spread through
your blood to other parts of your body, and can lead to sterility (inability to have children). In women, it
can cause pelvic inflammatory disease (PID). Gonorrhoea is treatable with antibiotics. If you have it,
anyone you’re having sex with should be checked, and, if necessary, treated.
What is Chlamydia?
Chlamydia trachomatis is a bacterium that causes one of the most common STIs. Symptoms of
Chlamydia include a burning feeling when you’re urinating (peeing) and a discharge from your penis or
vagina. Chlamydia can also infect your throat, rectum and eyes. Many people, especially women, won’t
have any symptoms at all. If left untreated in men, Chlamydia can cause an inflammation of the
epididymis - the thin tube that connects your testes (balls) to your urethra (the tube you urinate through).
In women, it can cause pelvic inflammatory disease (PID). Chlamydia can be treated with antibiotics. If
you have Chlamydia, anyone you’re having sex with should be treated; otherwise, you and they can get
re-infected again and again.
What are universal precautions?
• These are set of guidelines that were designed to protect both workers and their customers from HIV
and other blood-borne illnesses such as hepatitis.
• The guidelines state that any instruments designed to penetrate the skin such as tattoo or acupuncture
needles either should be used only once and discarded, or should be thoroughly cleaned and sterilized
after each use.
Universal blood and body fluid precautions
Universal blood and body-fluid precautions (known as “Universal Precautions” or “Standard
Precautions”) were originally devised by the United States Centers for Disease Control and Prevention
(CDC) in 1985, largely due to the HIV/AIDS epidemic and an urgent need for new strategies to protect
hospital personnel from blood-borne infections. The new approach placed emphasis for the first time on
applying blood and body fluid precautions universally to all persons regardless of their presumed
infectious status. Universal precautions are a simple standard of infection control practice to be used in
the care of all patients at all times to minimize the risk of blood-borne pathogens. Universal Precautions
consist of:
• Careful handling and disposal of sharps (needles or other sharp objects);
• Hand-washing before and after a procedure;
• Use of protective barriers - such as gloves, gowns, masks - for direct contact with blood and other
body fluids;
• Safe disposal of waste contaminated with body fluids and blood;
• Proper disinfection of instruments and other contaminated equipment; and
• Proper handling of soiled linen.
Proposed minimum content of a safety kit
First Aid Kits
• Store first aid kits in selected rooms in the education institution.
• Ensure that the first aid kits contain at least 4 disposable single-use latex gloves, gauze, scissors, and
materials to help heal the wound.
• Check the contents of first aid kits every week.
• Ensure that the responsible persons know where the first aid kits are stored.
Additional checklist of precautions to prevent HIV transmission
Emergencies and Mouth-to-Mouth Resuscitation
• If you are trained to do so, perform mouth-to-mouth resuscitation in emergencies with persons living
with HIV/AIDS.
• Although saliva has not been implicated in HIV transmission, to minimize the need for contact with
the mouth, you may use mouthpieces, or other ventilation devices.
How to Manage Injuries Involving Blood
•
•
•
•
•
•
Put on your gloves.
Cover any abrasions or cuts on your arms with a waterproof dressing.
Clean the wound.
Remove the gloves and place in a resealable bag.
Do not touch your eyes before washing up.
Wash hands immediately after touching body, blood fluids, and contaminated items, whether or not
gloves had been worn.
• Wash hands with soap and water for at least 15-20 seconds.
• Change any bloodstained clothes as quickly as possible.
• Immediately discard contaminated sharps and materials in resealable bag.
Disinfecting
• Prior to disinfecting, ensure that adherent blood is scraped from surfaces and objects.
• HIV does not survive in the environment. None the less, potentially contaminated spills should be
disinfected by using household bleach, 1 part bleach to 10 parts water. Pour the solution around the
periphery of the spill.
• Ensure that mops, buckets and other cleaning equipment are disinfected with fresh bleach solution.
Cleaning Staff
• Inform all cleaning staff about the universal precautions for handling body fluids.
Universal precautions
(extract from the ILO code of practice on HIV/AIDS and the word of work, Appendix II)