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A vaccine jab by benbenzhou

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A vaccine jab

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									HIV/AIDS and Viral Hepatitis
            in the
 Criminal Justice Profession




            Course Number 3804
             Revised: July 2007




   TEXAS COMMISSION ON LAW ENFORCEMENT
     OFFICER STANDARDS AND EDUCATION
                                    Table of Contents


Table of Contents                                                         i - ii

Acknowledgement                                                           iii

Abstract                                                                  iv

Introduction                                                              v

Learning Objective                                                        vi – vii

Unit 1 Definitions and Overview of HIV, HAV, HBV and HCV                  1
      1.1      Human Immunodeficiency Virus (HIV)                         1
      1.2      Stages of HIV Infection                                    1
      1.3      Acquired Immune Deficiency Syndrome (AIDS)                 2
      1.4      Relationship between HIV and AIDS                          2
      1.5      Hepatitis A Virus (HAV)                                    3
      1.6      Hepatitis B Virus (HBV)                                    3
      1.7      Acute & chronic HBV Infection                              4
      1.8      Hepatitis C Virus (HCV)                                    4
      1.9      Acute & Chronic HCV Infection                              5

Unit 2 Transmission and Infection                                         6
      2.1      Methods of transmission                                    6
      2.2      Common exposure activities                                 7
      2.3      Relationship between HIV, HBV and HCV                      7

Unit 3 Personal and Occupational Risk Factors                             8
      3.1      High risk behaviors & substances abuse                     8
      3.2      Occupational risk exposure                                 9
      3.3      Job-related behaviors & risk for exposure                  10
      3.4      Universal precautions for occupational exposure            11
      3.5      Prevalence of reported HIV, HBV and HCV cases              11

Unit 4 Infection Control Procedures for Law Enforcement Personnel         12
      4.1      General infection control procedures                       12
               (Facts on AIDS a law enforcement guide)
      4.2      Procedures for conducting searches and evidence handling   12


                                               i
Unit 5 State and Local Laws governing communicable diseases     14
       5.1    Federal Laws & Legal Issues                       14
       5.2    State Laws & Legal Issues                         15
       5.3    Prison Study & HIV/AIDS Testing in Texas Prison   16
Resources                                                       18
References                                                      19
Appendix I (Glossary of Terms)                                  20
Appendix II (State of Texas Statistics)                         28
Appendix III (Hepatitis B Vaccine Declination – Mandatory)      31




                                            ii
                                  Acknowledgement


The occurrence of communicable diseases has dramatically affected every part of the
justice system worldwide; Legal, law enforcement and custody issues. HIV, AIDS,
hepatitis, and other sexual transmitted diseases (STDs) are big problems in the judicial
system.

The Texas Commission on Law Enforcement Officer Standards and Education
(TCLEOSE) and the following contributors developed this course for presentation to any
one associated with any entity of the law enforcement system, regardless of job
classification:


LaQueisa Wilson                                  Janice M. Washington
Training Specialist                              Program Specialist
Texas Department of State Health Services        TCLEOSE
HIV/STD Comprehensive Services Branch            6330 U.S. Hwy 290 E. Ste. 200
1100 W. 49th Street Austin, TX 78756             Austin, Texas 78723
Phone: (512) 533-3138                            Phone: (512) 936-7700
Fax: (512) 371-4675                              Fax: 512-936-7700
laqueisa.wilson@dshs.state.tx.us                 janicew@tcleose.state.tx.us

Tammy Foskey                                     Jonathan Hortman
HIV Training Manager                             Research Specialist
Texas Department of State Health Services        Texas Commission Jail Standards
HIV/STD Comprehensive Services Branch            300 W. 15th St, Ste. 503
1100 W. 49th Street Austin, TX 78756             Austin, Texas 78711-2585
Phone: (512) 533-3000                            Phone: (512) 463-5505
Fax: (512) 371-4675                              Fax: (512) 463-3185
Tammy.foskey@dshs.state.tx.us                    Jonathan.hortman@tcjs.state.tx.us




                                           iii
                                          Abstract


This course is designed to introduce and provide the basic concepts of communicable
diseases that impact individuals associated in a criminal justice profession and how
these communicable diseases impact the justice systems worldwide. This course
introduces the student to the occupational hazards and risk factors of HIV, AIDS, HBV
and HCV. The students will be taught how these communicable diseases are
transmitted, personal and occupational risk factors, state and local laws surrounding
them and the statistics for the State of Texas.

Note to the Training Providers:

This is curriculum serves as the instructor resources guide for HIV/AIDS and Viral
Hepatitis in the Criminal Justice Profession. A PowerPoint presentation and sample
test questions are available upon request, however it is the instructor’s responsibility to
create his/her own lesson plan to facilitate the instruction of this material. Instructors
do have the option to use additional training material in presenting this course. The
incorporation of scenarios and role-play is highly recommended to facilitate learning the
material. In this text ―he/his‖ is not gender specific.

It is the responsibility of the training provider to ensure individual copies of the course
are current. This may be done by checking the website at www.tcleose.state.tx.us.

Target Populations:          Anyone working in the law enforcement or the field of public
                             service field (i.e., peace officers, firefighters, EMS, jailers
                             corrections, civilians employees, etc)

Pre-Requisites:              None

Certification
Requirements:                None

Length of Course:            Minimum of 8 hours required

Material Requirements:       Computer, projector, VCR, TCLEOSE lesson plan,
                             PowerPoint slides, end-of-course exam, and course critiques
                             and any student handouts

Facility Requirements:       Standard classroom environment

Evaluation Process:          Classroom interaction with the instructor, examination and
                             end-of-course critique

           Sample test questions are available at TCLEOSE upon request




                                              iv
                                   Introduction


This course is developed by the Texas Commission on Law Enforcement Officer
Standards and Education (TCLEOSE) for presentation to any individual associated with
or employed by any entity of the criminal justice system.

The purpose of this course is to educate individuals on matters pertaining to
communicable diseases such as HIV/AIDS, HBV, and HCV which impacts the criminal
justice profession.




                                         v
                                Learning Objectives



1.0   Functional Area: This section will introduce the student to HIV/AIDS, HBV, and
      HCV. The student will be able to demonstrate on a written examination an
      understanding of the relevant terms and definitions of HIV/AIDS, HBV and HCV.

1.1   Learning Objective: The student will be able to write general statements
      regarding HIV.

1.2   Learning Objective: The student will be able to list and describe the general
      stages of HIV infection.

1.3   Learning Objective: The student will be able to write general statements
      regarding AIDS.

1.4   Learning Objective: The student will be able to describe in writing, the
      relationship between HIV and AIDS.

1.5   Learning Objective: The student will be able to write general statements
      regarding Hepatitis A (HAV).

1.6   Learning Objective: The student will be able to write general statements
      regarding Hepatitis B (HBV).

1.7   Learning Objective: The student will be able to describe the relationship
      between acute and chronic HBV infection.

1.8   Learning Objective: The student will be able to write general statements
      regarding Hepatitis C (HCV).

1.9   Learning Objective: The student will be able to describe the relationship
      between acute and chronic HCV infection.

2.0   Functional Area: This section will introduce the student to HIV/AIDS, HBV,
      and HCV. The student will be able to demonstrate on a written examination an
      understanding of the relevant terms and definitions of HIV/AIDS, HBV and HCV.

2.1   Learning Objective: The student will be able to list the four methods of
      transmission of HIV, HBV and HCV.

2.2   Learning Objective: The student will be able to describe common activities
      which will not result in exposure to the HIV or HBV.

2.3   Learning Objective: The student will be able to describe the relationship
      between HIV and HBV/HCV.



                                           vi
3.0   Functional Area: This section will introduce the student to personal and
      occupational practices that place individuals at risk of exposure to HIV, HBV, and
      HCV.

3.1   Learning Objective: The student will be able to identify personal behavior that
      places individuals at risk of exposure to HIV, HBV, and HCV.

3.2   Learning Objective: The student will be able to define occupational exposure,
      identify occupational risks to law enforcement and corrections personnel and the
      precautions that will reduce the chance of exposure.

3.3   Learning Objective: The student will be able to list specific criminal justice job
      related behaviors that may put them at risk for occupational exposure.

3.4   Learning Objective: The student will be able to list universal precautions for
      occupational exposure to HIV, HBV, and HCV.

3.5   Learning Objective: The student will be able to list the prevalence of reported
      HIV, HBV, and HCV cases.

4.0   Functional Area: In this unit of instruction the student will be able to list the
      infection control procedures and steps used to conduct searches and handling
      evidence during the performance of the job.

4.1   Learning Objective: Students will be able to list the eight general infection
      control procedures as outlined by the Texas Commission on Law Enforcement,
      ―Facts on AIDS: A Law Enforcement Guide‖.

4.2   Learning Objective: Students will be able to describe five of seven precautions
      that should be taken that with involved searches or evidence handling as outlined
      in the National Institute of Justice ―AIDS Bulletin,‖

5.0   Learning Objective: In this section, the student will be able to list and briefly
      describe state and local laws that govern communicable diseases identified in
      this curriculum.

5.1   Learning Objective: The student will be able to describe provisions of the
      federal law American Disability Act of 1990 and the Federal Rehabilitation Act of
      1973.

5.2   Learning Objective: The student will be able to list and briefly describe the
      state laws that govern the communicable diseases identified in this curriculum.

5.3   Learning Objective: The student will be able to briefly describe the prison
      population study and testing requirements as it relates to the State of Texas.




                                           vii
                                    Unit One
             Definition and Overview of HIV, HAV, HBV and HCV


1.0   Functional Area: This section will introduce the student to HIV/AIDS, HBV, and
      HCV. The student will be able to demonstrate on a written examination an
      understanding of the relevant terms and definitions of HIV/AIDS, HBV and HCV.

1.1   Learning Objective: The student will be able to write general statements
      regarding HIV.

       A. HIV is the common abbreviation for human immunodeficiency virus.
       B. HIV is the virus that causes AIDS.
       C. Once a person is infected, they can immediately transmit HIV to another
          person.
       D. HIV destroys the body's ability to fight infections and certain cancers by
          killing or damaging cells of the body's immune system.
       E. A person infected with HIV may remain without symptoms for a long period
          of time.
       F. There is no cure for HIV. Once an individual becomes infected with HIV the
          person is infected for life. Drugs to fight both HIV infection and its
          associated infections and cancers are currently available.
       G. Increased understanding of HIV disease progression, refinement and
          acceptance of holistic therapies, availability of sophisticated testing, ability
          to prevent or reduce the impact of opportunistic infections, and potent
          treatment therapies have made HIV an increasingly manageable chronic
          disease.

1.2   Learning Objective: The student will be able to list and describe the general
      stages of HIV infection.

      A. There are general stages of HIV infection that one may go through before
         AIDS develops.
      B. Infection. The earliest stage is right after infection with HIV. HIV can infect
         cells and copy itself before the immune system has started to respond.
         Individuals may feel flu-like symptoms during this time.
      C. Response. The next stage is the body responds to the virus. Even if a person
         doesn’t feel any different, their body is trying to fight the virus by making
         antibodies against it. This is called sero-conversion, when a person goes from
         being HIV negative to HIV positive.
      D. No symptoms. HIV infected individuals may enter a stage in which they have
         no symptoms. This is called asymptomatic infection. They still have HIV and it
         may be causing damage that they can’t feel.
      E. Symptoms. Symptomatic HIV infection is when symptoms are developed,
         such as certain infections, including PCP.


                                            1
      F. AIDS. AIDS is diagnosed when you have a variety of symptoms, infections,
         and specific test results. There is no single test to diagnose AIDS.

1.3   Learning Objective: The student will be able to write general statements
      regarding AIDS.

      A. AIDS is the common abbreviation for Acquired Immunodeficiency Syndrome.
      B. The term AIDS applies to the most advanced stages of HIV infection.
      C. AIDS is the result of the natural progression of HIV infection.

1.4   Learning Objective: The student will be able to describe in writing, the
      relationship between HIV and AIDS.

      A. Individuals don’t transmit AIDS they transmit HIV.
      B. As a result of HIV, infections that are allowed because of the immune system
         breakdown are called ―opportunistic infections.‖ These infections generally do
         not affect healthy people.
      C. The definition or diagnosis of AIDS includes all HIV-infected people who have
         fewer than 200 CD4+ T cells per cubic millimeter of blood. (Healthy adults
         usually have CD4+ T-cell counts of 1,000 or more.) Or a diagnosis of two or
         more of 26 clinical conditions that affect people with advanced HIV disease.
      D. Common opportunistic infections associated with HIV are:
         1. Pneumocystis carinii pneumonia (PCP)
         2. Kaposis Sarcoma (KS)
         3. Tuberculosis (TB)
      E. HIV infection progresses in each individual differently; individual immune
         systems, health behaviors, resources, and chance all contribute to the course
         of infection.
      F. How would I know if I have HIV?
         1. The only sure way to know your status is to be tested
         2. The most common test is an antibody test
         3. The antibody test (EIA) detects infection in most persons within 6 weeks to
            3 months
         4. Any positive antibody test must be confirmed with a second type of test,
            the Western Blot
         5. Both tests (EIA and Western Blot) must be positive for someone to be told
            s/he has HIV




                                                 2
1.5      Learning Objective: The student will be able to write general statements
         regarding Hepatitis A (HAV).

         A. Hepatitis is a disease that causes inflammation of the liver
         B. The liver is an organ that helps your body digest food and acts as a filter for
         poisons or anything toxic in the body
         C. The liver is it located in the upper right quadrant of the abdomen, tucked up
         under your rib cage.
         D. Hepatitis A (HAV) is a liver disease caused by the Hepatitis A virus
         E. 1/3 of Americans have evidence of past HAV infection
         F. It is found in the stool (feces) or persons infected with HAV
         G. It is usually spread when a person eats food or drinks water that has been
         contaminated with the feces of someone with HAV
         H. It is important to wear gloves when handling inmate linen or clothing
         I. Signs & Symptoms of HAV:
           1. Persons may not have any symptoms (older persons are more likely to
              have symptoms than children
            2. If symptoms are present, they usually occur quickly and may include fever,
               tiredness, and loss of appetite, nausea, abdominal discomfort, jaundice and
      dark urine
           3. The average incubation time from exposure to symptoms is 28 days (15-50
              days)
           4. Symptoms usually last less than 2 months

1.6      Learning Objective: The student will be able to write general statements
         regarding Hepatitis B (HBV).

         A. HBV is the common abbreviation for hepatitis B virus.
         B. Hepatitis B is an inflammation of the liver caused by infection with the
            hepatitis B virus
         C. HBV has both acute (new, short-term) and chronic stages (ongoing, long-
            term).
         D. The severity of the disease can range from mild or unapparent to severe or
            even fatal.
         E. Hepatitis B vaccination is recommended for all unvaccinated adolescents, all
            unvaccinated adults at risk for HBV infection, and all adults seeking protection
            from HBV infection.
         F. Transmission:
             1. Contacting blood/body fluids containing blood if you are not immune (via
                vaccine/ prior infection)


                                                  3
         2. Having sex with an infected person without using a condom
          3. Sharing needles to inject drugs or ―works‖ (spoons, cotton, water)
      G. Symptoms:
         1. Jaundice (eyes and/or skin), loss of appetite, nausea, vomiting, fever,
            stomach or joint pain and Fatigue lasting weeks or months
         2. The average incubation period (from exposure to symptoms) is
            approximately 4 months

1.7   Learning Objective: The student will be able to describe the relationship
      between acute and chronic HBV infection.

      A. Acute hepatitis B occurs shortly after exposure to the virus.
      B. Chronic hepatitis B is an infection with HBV that lasts longer than 6 months.
         Once the infection becomes chronic, it may never go away completely.
      C. About 95% of people who are infected are able to fight off the virus so their
         infection never becomes chronic.
      D. The younger you are when you become infected with the hepatitis B virus, the
         more likely you are to develop chronic hepatitis B.

1.8   Learning Objective: The student will be able to write general statements
      regarding HCV.

      A. HCV is the common abbreviation for hepatitis C virus.
      B. Hepatitis C is an inflammation of the liver caused by infection with the
         hepatitis C virus.
      C. HCV is the most common chronic blood borne viral infection in the United
         States.
      D. HCV is the #1 cause of chronic liver disease and liver transplants.
      E. HCV has both acute and chronic stages.
      F. There is no vaccine to prevent hepatitis C.
      G. Symptoms:
         1. Most persons with HCV do not have symptoms
         2. Many persons with chronic HCV have mild to moderate liver damage but
            do not feel sick
         3. Some people with an acute infection will have jaundice (skin and/or eyes)
            or mild flu-like symptoms
         4. Most people with chronic HCV will only have mild to moderate liver
            disease
         5. Symptoms may include jaundice, fatigue, loss of appetite and nausea




                                             4
1.9   Learning Objective: The student will be able to describe the relationship
      between acute and chronic HCV infection.

      A. Most persons with acute infection experience few, if any, symptoms and are
         unaware they’re infected.
      B. There is no treatment for acute hepatitis C.
      C. Out of 100 persons infected with HCV, approximately 15-25 will
         spontaneously clear the virus without treatment. The other 75-85 go on to
         develop chronic infection.
      D. Over time HCV may cause your liver to stop working and a new liver from a
         donor may be needed.
      E. Antiviral medicines for chronic hepatitis C are available.




                                            5
                                    Unit Two
                            Transmission and Infection


2.0   Functional Area: During this unit of instruction the student will become familiar
      with the methods of transmission of HIV, HBV, HCV and the relationship
      between HIV and HBV/HCV.

2.1   Learning Objective: The student will be able to list the four methods of
      transmission of HIV, HBV and HCV.

      A. HIV, HBV, and HCV have similar transmission routes and are spread by
      direct contact with body fluids.

      Body Fluids (confirmed risk)                           Body Fluids (theoretical risk)
        1. Blood                                             1. Saliva
        2. Semen                                             2. Perspiration
        3. Vaginal/cervical secretions                       3. Tears
        4. Breast milk (HIV & HBV only)                      4. Feces
                                                             5. Urine
      HIV, HBV, and HCV Transmission:

      Blood
         1. Sharing needles/syringes and/or equipment to inject drugs (IDU)
         2. Blood transfusions/blood products (because of blood-screening
            techniques developed and implemented the chance of becoming infected
            through transfusion is extremely small.
         3. Occupational exposures
         4. Tattooing/piercing
      Sex
        1. Unprotected vaginal, anal, oral sex regardless of partners gender
         2. Sexual transmission of HCV is low or inefficient, although any sexual
            activity that involves blood-to-blood contact (including menstrual blood)
            with an infected person can potentially transmit HCV.
         3. ―High-risk‖ sexual activity (e.g. multiple partners, presence of other
            sexually transmitted disease, exchange of sex for drugs and/or money,
            etc.) appears to increase the risk of HCV transmission.
      Birth
         1. From an HIV, HBV or HCV infected mother to her baby during pregnancy,
            birth, or possible breast-feeding (HIV & HBV only). Breast-feeding is
            considered safe for HCV, but cracked and/or bleeding nipples could
            increase the risk of HCV transmission.
         2. Transmission from HCV infected mother to baby occurs in less than 5% of
            births. Rates of infection can be as high as 20% if the mother is also HIV
            positive.


                                           6
2.2   Learning Objective: The student will be able to describe common activities
      which will not result in exposure to the HIV or HBV.

      A. There is no risk of exposure from donating blood.
      B. There is no evidence of transmission from human bites, insect bites,
         scratches, or spit (saliva).
      C. There is no evidence of transmission from casual contact; i.e. closed-mouth
         or ―social kissing.
      D. There is no evidence of transmission from sharing food, drink, or handling
         food trays.
      E. There is no evidence of transmission from sharing laundries or laundry
         facilities.
      F. There is no evidence of transmission; i.e. cold, flu, measles.

2.3   Learning Objective: The student will be able to describe the relationship
      between HIV and HBV/HCV.

      A. The potential for transmission of HBV is greater than HIV.
         1. HBV is easier to catch than HIV because it is more than 100 times more
            concentrated in an infected person's blood.
         2. HBV can live outside the body longer than HIV.
         3. Vaccines are available for prevention of HBV.

      B. Relationship between HBV and HIV
         1. HBV and HIV share the same transmission routes; persons at risk for HIV
            infection are also at risk for HBV infection.
         2. HIV infection can impair the response to hepatitis B vaccination.
         3. Acute HBV infection in HIV-infected persons is more likely to lead to
            chronic HBV infection.




                                               7
                                            Unit Three
                              Personal and Occupational Risk Factors


3.0        Functional Area: This section will introduce the student to personal and
           occupational practices that place individuals at risk of exposure to HIV, HBV, and
           HCV.

3.1        Learning Objective: The student will be able to list personal behavior that
           places individuals at risk of exposure to HIV, HBV, and HCV, and be able to list
           three substances that impair judgments that lead to high risk behaviors.

           A. Factors in the ―Formula‖ for assessing HIV, HBV, and HCV risk
              1. Which body fluid (blood, semen etc…?)
              2. Route of entry into body (blood stream, mucous membranes)
              3. Dose of infected fluid
              4. How long fluid is out of body
              5. Number of exposures
              6. Condition of host (how high is their viral load)
              7. Condition of recipient (immune system, other STDs)

           B. In descending order; the HIV risks for anal, vaginal, and oral sex1:
              1. Receptive anal intercourse with ejaculation and no condom
              2. Receptive vaginal intercourse with ejaculation and no condom
              3. Insertive anal intercourse and no condom
              4. Insertive vaginal intercourse and no condom
              5. Receptive anal or vaginal intercourse with a condom*
              6. Insertive anal or vaginal intercourse with a condom*
              7. Receptive oral sex with a man with ejaculation
              8. Oral sex with a woman
              9. Receptive oral sex with a man with pre-cum
              10. Receptive oral sex with a man with no ejaculation or seminal fluids
              11. Receptive oral sex with a man with a condom*
              12. Receptive oral sex with a woman with a latex barrier over the vulva

               *Risk is lower if there is no ejaculation

           C. High-risk individuals are those who participate in behaviors that increase the
           chance of exposure to HIV, HBV, and HCV.

               1.   Male to male sexual intercourse
               2.   People who share needles, syringes, or sharps
               3.   People who have sex fore money or drugs
               4.   People who have multiple sex partners
               5.   People who have sexual intercourse with any of the above




1
    Risk Reduction: Sex Without Condoms. HIV Counselor Perspectives. 2001; 10(2):1-8

                                                        8
      D. The use of substances which impair judgment can result in the high-risk
      behaviors listed above. These substances include:

            1.   intravenous drugs
            2.   alcohol
            3.   cocaine
            4.   marijuana
            5.   other substances with diminish the brain’s ability to function normally

3.2   Learning Objective: The student will be able to define occupational exposure,
      identify occupational risks to law enforcement and corrections personnel and the
      precautions that will reduce the chance of exposure.

      A. HIV and hepatitis are viruses that can be contracted anywhere—not just the
         workplace.
            1. Employees should be as careful in their personal lives as they are at
               work about protecting themselves against infection.
            2. Many myths still persist about how these viruses are transmitted (No,
               you can’t get AIDS from a mosquito bite), and it is to every employee’s
               advantage to get the facts.
      B. What is an occupational exposure?

      On January 20, 1990, the CDC published the definition of an occupational
      exposure in the Morbidity and Mortality Weekly Report. This definition says that
      an occupational exposure occurs when the following criteria are met:

            1. The exposure occurs during the performance of the employee’s duties;
            2. There is a route of exposure—in other words, a way for the viruses to
               enter your body. This could happen in one or more of the following
               ways:

                     A percutaneous injury (i.e., needle stick, puncture wound or cut
                      with a contaminated object, or from a human bite that breaks the
                      skin); or
                     Contact with the mucous membrane linings of the eyes, nose
                      and/or mouth; or
                     Contact with the skin, especially if the exposed skin is chapped,
                      abraded or afflicted with dermatitis, or the contact is prolonged or
                      involving an extensive portion of the body.

      C. If the employee is exposed to a body fluid to which universal precautions
         apply. These fluids include:

            1.   Blood (including menstrual)
            2.   Semen
            3.   Vaginal secretions
            4.   Amniotic fluid
            5.   Cerebrospinal (brain and backbone) fluid


                                                   9
             6. Synovial (joint) fluid
             7. Pleural (chest) fluid
             8. Peritoneal (abdominal) fluid
             9. Pericardial (heart) fluid
             10. Saliva (in a dental setting is considered a risk factor for HIV exposure
                 since it is possible that blood or tissue may be present in the saliva).

      D. In a law enforcement setting or correctional setting, the only fluids you should
         be concerned about coming into contact with are blood, semen, and possibly
         vaginal secretions. All the other fluids listed above are body cavity fluids and
         unless you are working in an operating room, you should never be exposed to
         them. (If you are a correctional officer and get spinal fluids on your hands,
         you’re probably operating outside of your job description.)
      E. The body fluids that correctional staff is most likely to come into contact with
         don’t transmit HIV or hepatitis unless visible blood is present. These fluids
         include:

             1.   Feces
             2.   Nasal secretions
             3.   Saliva*
             4.   Sputum
             5.   Sweat
             6.   Tears
             7.   Urine
             8.   Vomit

*Saliva in a human bite is considered a risk factor for the transmission of hepatitis B
only, although the CDC has never documented a case of a person contracting HBV this
way.

      F. NOTE: What are my chances of contracting HIV or hepatitis if I have an
         exposure? HIV: When we talk about the risks of occupational exposure we
         always use the example of getting stuck with a known HIV-positive patient’s
         contaminated (bloody) needle. Not just anybody’s needle—an HIV-positive
         patient’s needle. And not just any kind of needle—a used hypodermic (hollow-
         bored) syringe. (In corrections, tattoo needles found under bunks and behind
         dayroom benches are usually made from pieces of wire or staples filed to a
         point and therefore are far less of a risk than hypodermics.)

3.3   Learning Objective: The student will be able to list specific criminal justice job
      related behaviors that may put them at risk for occupational exposure.

      A. Law enforcement and corrections personnel may be at risk if they fail to utilize
         precautions when:
             1. Encountering blood or potentially infectious body fluids, cleaning up
                body fluid spills



                                                  10
             2. Conducting body searches, cell searches, or handling evidence that
                results in punctures of the skin
             3. Intervening in fights:
                As a law enforcement or correctional officer, you are not at risk if
                 potentially infectious body fluids are thrown at you and do not
                 penetrate the skin.
                You must, however, use common sense and good personal hygiene
                 since other disease causing organisms may be present.

3.4   Learning Objective: The student will be able to list universal precautions for
      occupational exposure to HIV, HBV, and HCV.


      A. Treat all persons as if potentially infected.
      B. Gloves should be worn during contact with blood or other body fluids that
         could possibly contain visible blood, such as urine, feces, or vomit. Gloves
         are recommended when conducting cell, clothing and body cavity searches,
         as well as in other situations where exposure to blood is likely to take place.
         Officers should select the type of glove that provides the best balance of
         protection and search efficiency.
      C. Cuts, sores, or breaks on both the care giver’s and patients exposed skin
         should be covered with bandages.
      D. Hands and other parts of the body should be washed immediately after
         contact with blood or other body fluids, and surfaces soiled with blood should
         be disinfected appropriately.
      E. Practices that increase the likelihood of blood contact, such as sharing of
         razors and toothbrushes, should be avoided.
      F. Needles and other sharp instruments should be used only when medically
         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.)

3.5   Learning Objective: The student will be able to list the prevalence of reported
      HIV, HBV, and HCV cases.
         A. To date there have been no reported cases of HIV in correctional or law
            enforcement officers a result of occupational exposure. Also, published
            reports do not document any increased risk for HBV infection among
            public safety workers.
         B. To date no reported HIV infections as a result of CPR, with or without a
            one way pocket mask.
         C. To date no reported HIV infections as the result of contaminated surfaces
            or environment


                                            11
                                   Unit Four
          Infection Control Procedures for Law Enforcement Personnel


4.0   Functional Area: In this unit of instruction the student will be able to list
      the infection control procedures and steps used to conduct searches and
      handling evidence during the performance of

4.1   Learning Objective: Students will be able to list the eight general infection
      control procedures as outlined by the Texas Department of State Health Services
      and the Texas Commission on Law Enforcement, ―Facts on AIDS: A Law
      Enforcement Guide‖.

      A. Use disinfectants such as:
         1. 70% isopropyl alcohol
         2. one part bleach to ten parts water
         3. waterless soap
      B. Wash hands after contact with bodily fluids with hot, soapy water.
      C. Clean and bandage all cuts and abrasions.
      D. Body fluid spills should be wiped up immediately and the surface area should
         then be disinfected.
      E. Soiled clothing may be cleaned in hot, soapy water or dry cleaned.
      F. Instruments, padding, helmets, weapons, floors, vehicles and other soiled
         items can be cleaned with soap and water, while wearing disposable latex
         gloves. Sterilize with disinfectants like diluted bleach and water (1:10 ratio) or
         rubbing alcohol.
      G. Dispose of used needles in puncture-proof containers. Do not break or try to
         re-cap a needle, as you may jab yourself.
      H. Prepare a first aid kit for your vehicle containing the following items:
         1. 70% isopropyl alcohol
         2. sterile wipes
         3. sterile gauze
         4. tape
         5. plastic sharps container
         6. latex gloves
         7. Ziploc plastic bags

4.2   Learning Objective: Students will be able to describe the five of seven
      precautions that should be taken with involved searches or evidence handling as
      outlined in the National Institute of Justice ―AIDS Bulletin,‖

      A. Whenever possible ask suspects to empty their own pockets.
      B. Whenever possible, use long-handled mirrors to search hidden areas.



                                            12
           C. If it is necessary to search manually, always wear protective gloves and feel
              very slowly and carefully.
           D. Use puncture proof containers to store sharp instruments and clearly marked
              plastic bags to store other possibly contaminated items.
           E. Use tape – never metal staples – when packaging evidence. 2
           F. Wash hands thoroughly with soap and running water when tasks are
              completed.
           G. Use good personal hygiene and common sense.




2
    David Bigber “The Collection and Handling of Evidence Infected with Disease Causing Organisms”


                                                       13
                                   Unit Five
            Federal & State Laws Governing Communicable Diseases


5.0   Learning Objective: The student will be able to list and briefly describe the
      Federal and State laws that govern the communicable diseases identified in this
      curriculum.

5.1   Learning Objective: The student will be able to describe provisions of the
      federal law American Disability Act of 1990, Federal Rehabilitation Act of 973,
      and 29 Code Federal Regulation 1910.1030

      A. American Disability Act 1990:
         1. In June of 1998, the high court stated that people infected with HIV/AIDS
             were entitled to protection under Americans with Disabilities Act,
             regardless if they were asymptomatic.
         2. Employers must make reasonable accommodations for the infected
            person.
         3. When criminal justice professionals learn about an individual’s HIV status
            through self-disclosure or other means, they must realize that if an
            individual exhibits no behavior for isolation, that the detention, booking
            and processing policies within their agency dictates how these individuals
            must be handled; HIV is no exception.
         4. Some criminal justice professionals practice selective enforcement
            because of someone’s known HIV status, which is discriminatory.
         5. Some peace officers also refuses to provide lifesaving first aid based on
            their opinion that the individual belongs to a high-risk group.

      B. Federal Rehabilitation Act of 1973:
         1. Section 504 PROTECTS QUALIFIED PERSONS WITH HIV INFECTION
         2. Applies to employers and organizations which receive federal financial
            assistance from any Federal department or agency, including the DHHS.
            The DHHS Section 504 regulation can be found at 45 CFR Part 84.
         3. If a person with HIV infection has been terminated from their jobs,
            denied access to social services, or denied medical treatment solely
            because of their handicap. Individuals have been similarly treated
            because they have been perceived as having HIV infection. Such actions
            by an agency, institution, hospital, nursing home, drug treatment center,
            clinic, organization or other entity receiving Federal funds may constitute
            unlawful discrimination under Section 504.




                                               14
      C. OSHA 29CFR 1910.1030:

         1. The employer shall make available the at no cost to the employee
            hepatitis B vaccine and vaccination series to all employees at risk, who
            have been exposed, and post exposure evaluation and follow-up to all
            employees who have had an exposure incident.
         2. Hepatitis B vaccination shall be made available after the employee has
            received training required in para (g)(92)(vii)(I) and within 10 working days
             of initial assignment of all employees who have occupational exposure
             unless the employee has received the complete hepatitis B vaccination
             series and antibody testing has revealed that the employee is immune or
             the vaccine is contraindicated for medical reasons.
         3. The employer shall not make participation in a prescreening program a
            prerequisite for receiving hepatitis B vaccination
         4. If an employee initially declines hepatitis B vaccination but at a later date
            while still covered under the standards decides to accept vaccination, the
            employer shall make available hepatitis B vaccination at that time.
         5. The employer shall assure that employees who decline to accept hepatitis
            B vaccination offered by the employer sign the statement in Appendix A of
            29CFR 1910.1030
         6. Each employer having an employee(s) with occupational exposure as
            defined by paragraph (b) of this law shall establish a written Exposure
            Control Plan designed to eliminate or minimize employee exposure.
         7. Employers shall ensure that a copy of the Exposure Control Plan is
            accessible to employees in accordance with 29CFR 1910.1020.
         8. Exposure plan shall be reviewed and updated at least annually and
            when ever necessary to reflect new or modified tasks and
            procedures.
         9. When there is occupational exposure, the employer shall provide, at no
            cost to the employee, appropriate personal protection equipment such as
            gloves, gown, lab coats, face shields (masks) and eye protection, mouth
            pieces, resuscitation bags, etc.

5.2   Learning Objective: The student will be able to list and briefly describe the
      State Laws that govern the communicable diseases identified in this curriculum.

      A. Texas Health and Safety Code, Chapter 81- Subchapter A
         –   Prevention, Control and Reports of Diseases

      B. Code of Criminal Procedure, Chapter 46A
         -   AIDS and HIV Testing in County and Municipal Jails




                                          15
      C. Government Code, Chapter 501- Subchapter A
         –   Inmate Welfare

      D. Government Code, Chapter 507- Subchapter A
         –   State Jail Felony Facilities

      E. Government Code, Chapter 607

5.3   Learning Objective: The student will be able to briefly describe the prison
      population study and testing requirements as it relates to the State of Texas.

      A. Prison Studies

         1. Studies of prison populations in California, Virginia, Connecticut, Maryland,
            and Texas has found evidence of HCV infection in 29%- 42% of inmates,
            and national figures for HCV infection among incarcerated populations
            estimate that 15%-30% of inmates across the country may be HCV
            positive.

         2. Injection drug use is the primary transmission route for HCV. High-risk
            sexual behaviors (such as unprotected sex with multiple partners) and
            injection drug use are the major transmission routes for HBV. A substantial
            majority of prison and jail inmates – as much as 80% – have serious drug
            problems, including injection drug use.

        3. Currently, there are no specific federal guidelines exist for screening or
           treating inmates who may be at risk or who are already infected with HBV
           and HCV, although such guidelines are currently being developed. Such
           guidelines should provide facilities with assistance in developing and
           implementing policies for routine screening, immunization, and medical
           evaluation and management.

      B. HIV/AIDs Testing in Texas Prison

         1. Across The Nation | Texas Attorney General Gregg Abbott Rules that State
            Law permits prison officials to mandate HIV Testing among State
            Prisoners.
         2. July 2006 statistics show that of 154,000 prisoners in Texas, 2,627 are
            HIV-positive.
         3. The state prison system in August 2006 had proposed a change to its HIV
            testing policy from saying new inmates "should be tested" upon entering
            prison to saying they "shall be tested" unless they opt out of testing.




                                            16
4. In Feb 05, 2007, Houston Chronicle reported that Texas Attorney General
   Greg Abbott (R) ruled that state law permits the Texas Board of Criminal
   Justice to mandate HIV testing among inmates upon entry to state prisons,
   the Houston Chronicle reports,
5. Sponsored legislation approved last year that requires inmates to be tested
   for HIV before departing prison.
6. About 80% of inmates have agreed to take an HIV test upon entering
   prison since the state began its testing program, and prison system
   statistics show more than 38,700 inmates received HIV tests in 2005. Of
   those, 372 tested HIV-positive.
7. Texas law mandates that HIV test results are confidential and that HIV-
   positive inmates are not separated from HIV-negative inmates.

8. Advocates for mandatory HIV testing upon entry into the prison system
   say mandatory testing would help prison officials properly treat HIV-
   positive people, it would provide more accurate data on the spread of the
   disease and it could help officials estimate how many people are becoming
   HIV-positive in prison.




                                 17
                                      Resources

The American Foundation for AIDS Research
120 Wall Street, 13th Floor, New York, NY 10005-3908
(212) 806-1600 (tel)
(212) 806-1601 (fax)
http://www.amfar.org/cgi-bin/iowa/index.html

American Public Health Association
800 I Street, NW, Washington, DC 20001
(202) 777-2742 (tel) (202) 777-2534 (fax)
http://www.apha.org/

C.A.R.E
Attn: Jennifer S. Guarin, LMSW
1631 E. 2nd St., Bldg E., Austin, Texas 78702
512-804-3654
http://www.atc.mhmr.com

Centers for Disease Control and Prevention
1600 Clifton Rd, Atlanta, GA 30333, U.S.A
(800) 311-3435
http://www.cdc.gov/nchstp/od/nchstp.html

Occupational Safety & Health Administration
1033 La Posada Dr., Suite 375, Austin, Texas 78752-3832
(512) 374-0271
(512) 374-0086 FAX
http://www.osha.gov/

Texas Department of State Health Services
909 West 45th Street, Austin, Texas 78756-3199
512) 458-7111 or 1-888-963-7111 (tel)
http://www.dshs.state.tx.us/

The U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Washington, D.C. 20201
202-619-0257 (tel) or Toll Free: 1-877-696-6775
http://www.hhs.gov/

United States National Library of Medicine
National Institute of Health
2 Democracy Plaza, Suite 510
6707 Democracy Blvd, MSC 5467, Bethesda, MD 20892-5467
301-496-1131 (tel) 301-480-3537 (fax)

http://www.cdcnpin.org/scripts/display/MatlDisplay.asp?MatlNbr=33876 (Free Video) –
Keeping Your Guard Up: Exposure Risk for HIV and Hepatitis for Detention and
Corrections Officers
www.AIDSvideos.org (Free Videos) – 10 Most Common Myths about HIV
                                            18
                                      References


David Bigber ―The Collection and Handling of Evidence Infected with Disease Causing
Organisms‖

Public Health Service Guidelines for the Management of Occupational Exposures to
HBV, HCV, and HIV and Recommendations for Post-exposure Prophylaxis.‖ MMWR.
June 29, 2001 / 50(RR11); 1-421; 10(2):1-8

Risk Reduction: Sex Without Condoms. HIV Counselor Perspectives. 200 CDC.
―Updated U.S.

Center for Disease Control and Prevention-
http://www.cdc.gov/nchstp/od/cccwg/default.htm

Texas Department of Criminal Justice Health Services-
http://www.tdcj.state.tx.us/health/health-preventmed.htm




                                          19
    Appendix I
(Glossary of Terms)




        20
                                GLOSSARY OF TERMS


ACUTE (disease) – of short duration, usually with an abrupt onset, and sometimes
sever (as opposed to chronic disease).

AIDS (Acquired Immunodeficiency Syndrome) – An acquired illness of the immune
system, which reduces the body’s ability to fight special types of infection and cancers.
The Human Immunodeficiency Virus (HIV) is though to be the cause of this illness
which is transmitted through intimate sexual contact, in particular, anal and vaginal
intercourse; direct exposure to or infection with infected blood or blood products; and
from an infected woman to her fetus or infant. AIDS is characterized by the death of
CD4 cells (an important part of the body’s immune system), which leaves the body
vulnerable to life-threatening conditions including the development of one or more
specific opportunistic infections.

Specific diseases must be present to be diagnosed officially as AIDS and to be reported
to the Centers of Disease Control. Theses diseases are defined separately in the
following section. In general, the diseases include unusual forms of bacterial, fungal
and viral infections as well as rare cancers.

AIDS-DEFINING CONDITION - Any of a list of illnesses that, when occurring in an HIV-
infected person, leads to a diagnosis of AIDS, the most serious stage of HIV infection.
AIDS is also diagnosed if an HIV-infected person has a CD4 count below 200
cells/mm3, whether or not that person has an AIDS-defining condition. The Centers for
Disease Control and Prevention (CDC) published a list of AIDS-defining conditions in
1993. The 26 conditions include candidiasis, cytomegalovirus disease, Kaposi’s
sarcoma, mycobacterium avium complex, pneumocystis carinii pneumonia, recurrent
pneumonia, progressive multifocal leukoencephalopathy, pulmonary tuberculosis,
invasive cervical cancer, and wasting syndrome.

AIDS DEMENTIA – Also know as AIDS Dementia Complex (ADC). A degenerative
disorder of the brain and central nervous system caused by infection with HIV that leads
to progressive deterioration of mental and neurological functions. Symptoms include:
memory loss, mood shifts, depression, difficulty in concentrating, and motor impairment,
including difficulty walking and weakness in arms and legs. With the advent of highly
active antiretroviral therapy (HAART), the frequency of ADC has declined in developed
countries. HAART may not only prevent or delay the onset of ADC in people with HIV
infection; it can also improve mental function in people who already have ADC.

ANTIBODY – Special protein developed by the body’s immune system in response to
exposure to specific foreign agents. A given antibody exactly matches as specific agent
that causes an infection; much like a key matches a lock; the antibody then helps to
destroy the infectious agent.

ANTIBODY POSITIVE – Also called ―reactive.‖ The result of a test or series of tests to
detect antibodies in blood. A positive results means that antibodies are present.




                                            21
ANTIGEN – Substance such as HIV, that is foreign to a person’s body. An antigen
causes the immune system to form antibodies to fight the antigen.

ANTIVIRAL DRUG – A drug that can interfere with the life cycle of a virus.

ASYMPTOMATIC – Without subjective or objective signs of illness. People, who are
infected with the HIV, as evidenced by the presence of HIV antibodies, may show no
symptoms of disease.

ASYMPTOMATIC HIV SEROPOSITIVE – The condition of testing positive for HIV
antibody without showing any symptoms of disease. A person, who is HIV positive,
even without symptoms, is capable of transmitting the virus to others.

AZT – The first FDA-approved drug used to treat AIDS

BLOOD/BODY FLUID PRECAUTIONS – Special procedures taken to prevent
infections transmitted by direct or indirect contact with infectious blood or body fluids.
These precautions include but are not limited to gloves, safety glasses, and masks,
when indicated by protocol. Personnel protective equipment should be used based on
task involved. Good hand washing techniques are also or major importance.

BODY FLUIDS – Fluids that the body makes, for example, semen, blood, vaginal
secretions, and breast milk.

CARRIER – A person who apparently is healthy, but is infected with some disease-
causing organism (such as HIV or HBV) that can be transmitted to another person.

CD4 CELL - Also known as helper T cell or CD4 lymphocyte. A type of infection-fighting
white blood cell that carries the CD4 receptor on its surface. CD4 cells coordinate the
immune response, signaling other cells in the immune system to perform their special
functions. The number of CD4 cells in a sample of blood is an indicator of the health of
the immune system. HIV infects and kills CD4 cells, leading to a weakened immune
system.

CD4 CELL COUNT - A measurement of the number of CD4 cells in a sample of blood.
The CD4 count is one of the most useful indicators of the health of the immune system
and the progression of HIV/AIDS. A CD4 cell count is used by health care providers to
determine when to begin, interrupt, or halt anti-HIV therapy; when to give preventive
treatment for opportunistic infections; and to measure response to treatment. A normal
CD4 cell count is between 500 and 1,400 cells/mm3 of blood, but an individual’s CD4
count can vary. In HIV-infected individuals, a CD4 count at or below 200 cells/mm3 is
considered an AIDS-defining condition.

CENTERS FOR DISEASE CONTROL (CDC) – Federal health agency that is a branch
of the U.S. Department of Health and Human Services. The CDC provides national
health and safety guidelines and statistical data on AIDS and other diseases.




                                            22
CHRONIC (disease) – Lasting a long time, or recurring often.

CONTAGIOUS DISEASE – An illness caused by a specific infectious agent (i.e., a
virus, bacteria, fungus) that is transmitted, directly or indirectly, from an infected person
to a susceptible host.

CYTOMEGALOVIRUS (CMV) – A viral infection that may occur without any symptoms
or result in mild flu-like symptoms. Serve CMV infections can result in hepatitis,
mononucleosis, or pneumonia. CMV is ―shed‖ in body fluids (urine, semen, sputum and
saliva). In the presence of immune deficiency, such as AIDS, it can also affect other
internal organs and vision, sometimes leading to blindness.

DECONTAIMINATION – Removing disease-causing agents, thus making the
environment or specific object safe to handle.

DIAGNOSIS – A conclusion reached by a licensed physician. Identifying a disease by
its signs, symptoms, course, and laboratory findings.

ELISA Test (Enzyme Linked Immunoabsorbent Assay) – A simple, rapid, sensitive
blood test that measures antibodies to HIV proteins. The ELISA test was licenses by
the Food and Drug Administration in 1985 to screen blood supplies only. As a blood
screening test, the ELISA is highly sensitive and produces a small number of ―false
positive‖ and ―false negative‖ test results. Because false positives are produced and the
virus has a long incubation period, ELISAs are usually repeated if the first test is
positive. If the patient tests positive a second time, then a more specific test the
Western Blot is performed to confirm the results.

EXPOSURE – The act or condition of coming in contact with, but not necessarily being
infected by, a disease-causing agent.

FALSE NEGATIVE – Incorrect test result indicating that no antibodies are present when
they are.

FALSE POSITIVE – Incorrect test result indicating that antibodies are present when
they are not.

HEPATITIS B IMMUNE GLOBULIN (HBIG) – The preparation that provides some
temporary protection following exposure to HBV if given within 7 days after exposure.

HEPATITIS B VIRUS (HBV) - The virus that causes hepatitis B, an inflammation of the
liver that can lead to liver damage and liver cancer. HBV is spread through contact with
the blood of an infected person, through sexual intercourse, or from mother to child
during childbirth. A vaccine is available to prevent infection with this virus, and hepatitis
B can be treated with several drugs.

HEPATITIS C VIRUS (HCV) - The virus that causes hepatitis C, an inflammation of the
liver that can lead to liver damage and liver cancer. HCV is primarily spread through
contact with the blood of an infected person. There is no vaccine for HCV.



                                             23
HIGH-RISK BEHAVIOR – A term that describes certain activities that increase the risk
of transmitting HIV or HBV. These include anal intercourse, vaginal intercourse without
a condom, oral-anal contact, and semen in the mouth, sharing intravenous needles.

INCIDENCE – The number of new cases of a disease over a specified period of time.

HIV ANTIGEN POSITIVE – The result of antigen testing where it has been found that
HIV is present. Antigen testing can be useful in predicting the progression of HIV
infection and monitoring treatment.

HIV DISEASE – The term used to describe the spectrum of HIV infections,
chronologically described as a progression from asymptomatic seropositive to AIDS.

HUMAN IMMUNODEFICIENCY VIRUS (HIV) - The specific AIDS retrovirus, which has
been identified as destroying the body’s immune system and making it susceptible to
life-threatening, opportunistic infections or rare cancers. HIV is particularly resistant to
treatment, as the HIV genetic material is incorporated into the healthy genetic material
of the blood cells and is reproduced. Because the HIV genetic material is reproduced,
individuals who are infected with the virus remain carriers for the rest of their lives. The
virus also has along incubation period. Thus, it may be a long time between the points
when a person is infected and when the antibodies can be detected (anywhere from
three weeks to six months). It may also take up to five years or more before the
disease becomes apparent and is diagnosed.

IMMUNE STATUS – The state of the body’s immune system. Factors affecting immune
status include heredity, age, diet and physical and mental health.

IMMUNE SYSTEM – A complex network of organs and cells that allow the body to
defend itself against infections and substances, which are foreign to the body.

IMMUNOSUPPRESSED – A condition or state o the body in which the immune system
does not work normally.

INCUBATION PERIOD – The time period between infection and appearance of disease
symptoms.

INFECTION – A condition or state of the body in which a disease – causing agent has
entered it.

INFECTIOUS DISEASE – An illness that results from the entry, development or
multiplication of a disease-causing organism. Not all infectious diseases are highly
contagious or easily communicable to other people. Although HIV is highly infectious, it
is not easily or casually transmitted.

INSERTIVE - To sexually penetrate. In the context of anal sex among men who have
sex with men (MSM), a receptive partner is the partner who penetrates.




                                             24
INTRAVENOUS DRUGS – Drugs injected by needle directly into a vein.

KAPOSI’S SARCOMA (KS) - A type of cancer caused by an overgrowth of blood
vessels, which causes pink or purple spots or small bumps on the skin. The condition
can also occur inside the body, especially in the intestines, lymph nodes, and lungs.
When inside the body, KS can be life threatening. In people infected with HIV, KS is
considered an AIDS-defining condition.

LATENCY PERIOD – The time period over which a disease exists without any
symptoms appearing or the time period from the point of infection to showing clinical
signs of the disease. Based on current data, the latency period for the AIDS virus is
estimated to range up to five or ten years.

MUCOUS MEMBRANE – A moist layer of tissue that lines the mouth, eyes, nostrils,
vagina, anus, or urethra.

NONINTACT SKIN – Skin that is chapped, abraded, weeping, or that has rashes or
eruptions.

OPPORTUNISTIC INFECTION – Infection that usually is warded off by a healthy
immune system. If the immune system is not strong and effective, those infections
―take the opportunity‖ to harm the body.

PERSONS WITH AIDS (PWA) – A preferred term for person diagnosed with AIDS.

PNEUMOCYSTIS CARINII PNEUMONIA (PCP) – A lung infection that occurs in people
with weakened immune systems, including people with HIV. It is considered an AIDS-
defining condition in HIV-infected individuals. The first signs of infection are difficulty
breathing, high fever, and dry cough.

RECEPTIVE - To be sexually penetrated. In the context of anal sex among men who
have sex with men (MSM), a receptive partner is the partner who is penetrated.

RISK FACTORS – Any personal characteristic or behavior that increases the likelihood
that a person will be affected by a given condition. The risk factors that are believed to
increase the chances of transmitting HIV infection include engaging in intimate sexual
contact (in particular, vaginal ,anal or oral intercourse) without a condom, sharing IV
needles, and other activities, which involve the exchange of infected body fluids. Co-
factors are additional characteristics or other conditions that work with other risk factors
to increase the chances of getting a disease. For instance, having diagnosed sexually
transmissible disease or already wakened immune system are believed to be co-factors
or increase the chances of being infected with HIV or progressing to HIV-related illness.

SAFE SEX – Sexual practices that involved no exchanged of blood, semen, or vaginal
secretions.




                                            25
SERONEGATIVE – Also called ―non-reactive.‖ The status of a person’s blood when it is
tested and the results cannot confirm that HIV antibodies are present. Generally, a
person is considered to be a seronegative, if: 1) the initial ELISA is negative; 2) the
initial ELISA is positive and the repeat is negative; or 3) both ELISAs are positive and
the Western Blot is negative.

SEROPOSTIVE – Also called ―reactive.‖ A condition in which antibodies to a disease
causing are found in the blood, a positive reaction to a blood test. The presence of
antibodies indicates that a person has been exposed to the agent.

SIGNIFICANT EXPOSURE TO HIV INFECTION – A person is believed to be at
particularly high risk of contracting HIV infection if he or she:
            is or was a sexual partner of an HIV-infected male;
            has shared needles with an HIV-infected drug user;
            has injected with or has broke or abraded skin exposed to substantial
               amounts of blood or body fluid from HIV-infected persons;
            has received blood, semen or body organs donated by an HIV-infected
               patient; or
            is a child born to an HIV-infected mother?

Vaginal intercourse allows for male-to-female transmission, but less frequently than via
anal intercourse. Female-to-male transmission via vaginal intercourse is believed to be
a less frequent means of transmitting the infection. Persons who have contacts with
HIV-infected individuals via other means, such as through sharing residential or
workplace facilities or even through casual kissing are not at high risk or being infected.
Therefore, these persons are not considered to have significant exposure to HIV
infection.

SYNDROME – A collection of signs and symptoms that occur together.

T CELL - A type of lymphocyte (disease-fighting white blood cell). The ―T‖ stands for the
thymus, where T cells mature. T cells include CD4 cells and CD8 cells, which are both
critical components of the body’s immune system.

TRANSMISSION – The way in which a disease can be transferred from one person to
another or the way in which a person is exposed to the disease. HIV can be transmitted
from one person to another through four body fluids: Blood, Semen, Vaginal Fluids, and
Breast Milk
This means that any behavior in which one of these 4 fluids from someone who is
infected with HIV enters the body of another person can lead to transmission of the
virus. These behaviors include:
     Sexual contact (vaginal, anal or oral) with an infected person
     Sharing needles and/or syringes with someone who is infected
     Babies born to HIV-infected mothers may become infected before or during birth
        or through breast feeding after birth
     Receiving a blood transfusion or infected blood or blood clotting factors (this is
        less common and now very rare in countries where blood is screened for HIV
        antibodies)


                                            26
TUBERCULOCIDAL – Capable of killing a moderately resistant bacterium,
Mycobacterium tuberculosis var. bovi. This organism is one used in laboratory tests to
classify disinfectant chemicals according to their power.

TUBERCULOSIS (TB) - An infection caused by the bacterium Mycobacterium
tuberculosis. TB bacteria are spread through the air when a person with active TB
coughs, sneezes, or speaks. Breathing in the bacteria can lead to infection in the air
sacs of the lungs. Symptoms of TB in the lungs include cough, tiredness, weight loss,
fever, and night sweats. Although the disease usually occurs in the lungs, it may also
affect the larynx, lymph nodes, brain, kidneys, or bones. A person with both TB and HIV
is more likely to develop tuberculosis disease than a person infected only with the TB
bacterium, and TB is considered an AIDS-defining condition in people with HIV.

VACCINE – A drug made from non-living or modified virus, bacteria, etc., primarily to
prevent certain infectious diseases. Vaccines stimulate the body’s defense
mechanisms, helping it to develop immunity to the disease without actually causing the
disease itself.

VIRUS – A microorganism that causes infectious diseases. It can only reproduce in
living cells, which it invades and then destroys as it multiples.

WESTERN BLOT – This is a highly sensitive blood test that is able to identify and
measure most, if not all, of the HIV antibodies in a blood sample. This more expensive
test uses viral proteins separated by size that attach to the HIV antibodies in the
patient’s serum. It is used to confirm previously positive ELISAs; when patients test
positive on the Western Blot, it’s assumed that they have HIV antibodies. However,
there is no guarantee that the virus can actually be isolated from the blood and,
therefore, it is not always clear how infectious an antibody positive patient actually is or
if he or she will progress to ARC or AIDS. In addition, laboratories use different
chemical compounds or less stringent criteria when performing the Western Blot may
produce more false-positive results.

WINDOW PERIOD – The time it takes the immune system to develop antibodies to the
virus after exposure to it.




                                             27
       Appendix II
(State of Texas statistics)




            28
Health Services Division

Statistical Information on HIV / AIDS

Statistical Information On HIV/AIDS
Calendar     Average Offender          #         #            HIV            AIDS
Year         Population                Tests     Positive     Population     Population

1996         132,386                   25,721    549          1,377          499

1997         140,729                   29,024    691          1,282          819

1998         142,924                   49,114    971          1,452          941

1999         145,474                   55,468    837          2,520          994

2000         149,021                   57,194    714          2,492          922

2001         144,900                   51,904    652          2,388          859

2002         144,097                   56,626    703          2503           828

2003         147,850                   64,885    656          2460           778

2004         149,120                   67,677    618          2405           801

2005         151,647                   70,064    615          2400           894


                  Statistical Information On HIV/AIDS
                  CDC Classification
                                       Year     Male    Female       Total
                  Asymptomatic

                  A1, A2               1996     954     174          1,128

                  A1, A2               1997     915     152          1,067

                  A1, A2               1998     1,006   181          1,187

                  A1, A2               1999     1,101   185          1,286

                  A1, A2               2000     1,141   192          1,333

                  A1, A2               2001     1,181   150          1,331

                  A1, A2               2002     1,280   183          1,463

                  A1, A2               2003     1,299   190          1,489

                  A1, A2               2004     1,272   149          1,421

                  A1, A2               2005     1,156   168          1,324




                                         29
Statistical Information On HIV/AIDS

CDC Classification
                      Year    Male    Female       Total
Symptomatic

B1, B2                1996    244     5            249

B1, B2                1997    205     10           215

B1, B2                1998    244     21           265

B1, B2                1999    222     18           240

B1, B2                2000    222     15           237

B1, B2                2001    190     8            198

B1, B2                2002    201     11           212

B1, B2                2003    178     15           193

B1, B2                2004    168     15           183

B1, B2                2005    168     14           182



         Statistical Information On HIV/AIDS

CDC Classification
                       Year    Male       Female    Total
     AIDS

   A3, B3, C1-3        1996    447          52       499

   A3, B3, C1-3        1997    744          75       819

   A3, B3, C1-3        1998    873          68       941

   A3, B3, C1-3        1999    915          79       994

   A3, B3, C1-3        2000    857          65       922

   A3, B3, C1-3        2001    798          61       859

   A3, B3, C1-3        2002    770          58       828

   A3, B3, C1-3        2003    728          50       778

   A3,B3,C1-3          2004    759          42       801

   A3, B3, C1-3        2005    840          54       894




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           Appendix III
(Hepatitis B Vaccine Declination)




               31
                               (Type on agency Letterhead)




              Hepatitis B Vaccine Declination – 29 CFR 1910.1030 App A

I understand that due to my occupational exposure to blood or other potentially
infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have
been given the opportunities to be vaccinated with hepatitis B vaccine, at no charge to
myself. However, I decline hepatitis B vaccination at this time. I understand that by
declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease.
If in the future I continue to have occupational exposure to blood or other potentially
infectious materials and I want to be vaccinated with hepatitis B vaccine, I can received
the vaccination series at no charge to me.




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