Unit 9- Investigating Disease.

Part A A definition of disease is an abnormal condition or change of a system or organism in the body that impairs any body part, function or organ. And is associated with specific symptoms and signs. It may be caused by external factors, such as an infectious disease or internal dysfunctions, for example autoimmune diseases www.nhs/diseasedefinaition.asp As part of my Health and Social care A-level course, I am going to be developing a piece of coursework based around the investigation of disease. esearching and widening my understanding of disease will be a ma!or part of this piece of coursework. I plan to compare a communicable disease with a non-communicable disease and will look at how both are caused, as well as the impact they have on society and finally the treatment available. "hrough my research I have found that there are a range of #iseases that affect the human race, and that they are narrowed down into two categories - communicable and non-communicable. A communicable disease is infectious and can be carried by micro-organisms and transmitted through people, animals, surfaces, foods or respiratory systems $breathing%. "here are four main types of communicable diseases& 'viruses ( like influen)a '*acteria- for e+ample ".* ',ungi- such as athlete-s foot 'Proto)oa- e.g. .alaria/ "hese types of diseases are caused by 0germs1. How they are transmitted, period of dormancy, how easy they are to catch and how dangerous they are differs considerably depending on the disease. "he government, societal campaigns and health agencies spend a lot of time and money when studying the risk or spread of various contagious diseases in order to identify outbreaks, prevent reoccurrences, or develop treatment.. Also it is important to remember that communicable diseases rely heavily on the e+change of bodily fluids, contaminated surfaces or close contact which allows them to travel from an infected carrier to a healthy individual. Some communicable diseases may be e+changed through blood via an in!ection, passed on by a snee)e2cough, transmitted by the e+change of bodily fluids or spread through childbirth. 3+amples of communicable diseases include Herpes, .umps, Influen)a, HI42AI#S, 5hicken po+ and 6hooping cough. .ost of these can be prevented by the use of gloves, washing hands, safe se+, proper disposal of waste and covering mouth and nose when snee)ing or coughing. .ost communicable diseases are now considered harmless as our bodies provide their own defense systems via the immune system as well as the many medications and vaccinations that we have. However each and every disease has a chance of becoming more severe and can be dangerous with ma!or conse7uences ( some may even result in death. As part of my coursework I have chosen the HI4 and Aids virus, as the communicable disease I plan to investigate. I am keen to focus on this disease as it is often misunderstood and ill-informed due to the very negative stigma surrounding it. Also this disease is now considered a ma!or pandemic. After looking into the background of the disease I found that in 899:, it was estimated that there are ;;.; million people worldwide living with HI42Aids, with 8.< million new HI4 infections per year and =.> million annual deaths due to Aids. As well as the internet and various books I researched the background of the disease by using past newspaper stories, for e+ample the Sunday "imes 7uoted more than 8.= million people last year were killed by Aids, ;;9,999 of those where children and ?<@ of those deaths occurred in sub-Saharan Africa, and predicted that these numbers will increase by half as well as dramatically growing to an alarming rate in western societies . And according to the ABAI#S 89=9 report, worldwide <9 million people have been infected with some 8C million deaths, and =D million orphaned children in southern Africa alone since the epidemic occurred. Ac7uired Immune #eficiency Syndrome $AI#S% is a disease of the human immune system caused by the human 1

immunodeficiency virus $HI4%. HI4 is a virus and is referred to by specialists as being a retrovirus, which means it is capable of changing BA into #BA%. "he disease develops like any other virus $e.g. influen)a%, taking over a multiplying the mutated cells, however what makes this disease much more dangerous than the flu is that it attacks our immune system, aiming to break it down leaving our bodies defenseless. It does this by destroying a special type of defense cell in the body called a 5#D helper lymphocyte $pronouncedE lim-fuh-site%. "hese lymphocytes are part of the bodyFs immune system, they are found in the blood and fight unknown infections that come into our body. *ut as HI4 destroys these lymphocytes, people with the virus begin to get serious infections that they normally wouldnFt G that is, they become immune deficient.

I have conclude that the virus is one of the world-s most slow acting diseases. "his is because the body attempts to make more 5#D cells in an attempt to fight off the intruder, however over time the number of these cells begins to decline and this eventually results in the shutdown of the immune system. In other words, as the virus develops it will get more serious, and once the disease is into the later stages $HI4 has become fully fledged Aids% the infected people are at a very high risk of being infected by diseases their body would usually fight off such as pneumonia as well as being more likely to develop some non-communicable disease such as 5ancer. "he most important thing about this disease and the conse7uences of it are that unlike most communicable disease there is no effective cure for the Aids virus yet. As well as the difficulties in treating HI42Aids, there is another point in the biological basis of this disease that makes it different to other communicable diseases and that is how it is transmitted. Hne of this biggest problems of HI42AI#S on our society is that there are misunderstandings of how the disease is passed on, I found that due to most Se+ual Health Awareness campaigns people consider this virus as HBIJ being a se+ually transmitted disease and although this isn-t entirely wrong, it isn-t correct either. Anlike most communicable disease this disease is BH" airborne, which means that it cannot be e+changed simply through snee)ing2coughing. Bor is it passed on via surfaces as the virus can only live in the human body. However it is highly susceptible to human to human contact, and not !ust se+ual contact. "he HI4 virus is spread through the e+change of bodily fluids& 4aginal fluids Salvia $although these chances are generally = to =.C million% Semen And *lood. "he HI4 virus is most commonly transmitted through se+ual intercourse without protection $still not to be confused with only being an S"I% as this is a time when people are most likely to share bodily fluids in large amounts. People most at risk of catching this disease are& Kay men who have unprotected se+ People who have lived in or travelled e+tensively within sub-Saharan Africa People who have had unprotected se+ with a person who has lived in2 travelled to Sub-Saharan Africa. People who in!ect illegal drugs. People who share needles 2

 People who have had se+ with somebody who in!ects illegal drugs People who have caught another se+ually transmitted disease People who have received a blood transfusion while in Africa, 3astern 3urope, the countries of the former Soviet Anion, Asia or central2southern America. HttpE22www.nhs.uk2condition2HI42diagnosispg.asp+ "he most important indication of a disease, as well as how to diagnose and treat it is how the body responds to it. "he biological basis to a disease is like a person-s fingerprints, uni7ue. 6hen researching HI42Aids I looked at several medical !ournals and learnt about the biological basis of the disease as well as a number of facts about how the body responds to the disease. "he development of the disease is similar to that of any ordinary virus such as the flu. However unlike the flu virus as this disease develops it rapidly prevents the body from protecting itself and is therefore very dangerous. It mutates and shields itself with a protein membrane. It has the ability to survive by reproducing and mimicking itself as a good cell but in turn destroys other cells that are beneficial to the body. "he HI4 cell is not part of the human biological system and kills the host by eradicating the logical immune system by multiplying itself and eventually killing the host from defending itself from other non threatening deceases. It is a pathogen of opportunity. In many cases, HI4 has the ability to hide within the human body for years while it adapts to its new environment and subse7uently invades the body. 6hen a person becomes infected with the virus, the body responds by attempting to eliminate it. "his is the !ob of the Immune system, and one way the immune system tries to get rid of viruses like HI4, is making antibodies to fight. Antibodies are proteins and they circulate in the blood. "hey are an important part of the immune system, when an antibody comes across a germ in the blood it may stick to it. Hther immune cells eventually destroy this antibodyand-germ pair, the antibodies kind of act like flags, marking germs as being foreign so that they are easily recogni)ed and destroyed, however the HI4 virus aims to bring down this defence system. "he main response of the body to this disease is that the immune system shuts down. 6ithin the body there are * cells and " cells, the * cells produce the antibodies that flag up foreign germs and the " cells help to destroy it. HI4 effects the " cell count and If there is no " cells to help produce the antibodies than the * cells start killing damaged or different cells. 6ithout the " cells helping than the body cannot make the antibodies properly and the intracellular pathogens $cells containing HI4% are not eliminated from the body and therefore the infected cells can multiply and kill the helper " cells that contain more " cells, this cycle is then repeated until eventually there is a rapid loss of helper " cells. "he body responds to the " cells being killed by making new " cells, but only some of these mature into helper " cells, the virus than affects these, killing them as well. "he fight between the immune system and the virus can last up to ten years, when the body finally realises that it cannot produce anymore " cells, that-s when it begins to shut down because without helper " cells the body cannot fight off any sort of bacteria. Another response of the body when infected by HI4 is how the 5#D cells are affected. 5#D cells inhabit the " cells within the immune system becomes weaker and is unable to fight off germs that infect the body. C99-=,C99 5#D cells is considered as being a normal count by HI4 decreases this number as it progresses, killing about C9-=99 cells a year, this is when the individual becomes more likely to develop illnesses like cancer. People with a 5#D count above C99 than they are considered as having a normal healthy immune system and are low risk. However people with a 5#D count of ;C9 are likely to have contracted HI4, and if it falls below 899 they will probably be diagnosed with AI#S. People should start having HI4 treatment before their 5#D count falls below ;99 this will increase 5#D levels when the HI4 treatment starts to slow the virus down. And finally the last response to take place is the onset of AI#S $Ac7uired immune #eficiency Syndrome%. Aids is caused by HI4, but it should not be confused with being the same as being HI4 positive. Aids develops after the immune system shuts down, people who have developed Aids become more vulnerable to getting cancers as well as catching communicable diseases like pneumonia. Aids is the name of the group of illnesses that people with the later 3

stage of HI4 can get. "he body responds to Aids by becoming failing, and becoming more likely to gain other life threatening illnesses. I also arranged to talk to my local Keneral practitioner to find out more about the disease $see witness statement for evidence in appendi+% "he increase in the transmission of HI4 in the last three years has been enormous and it is now e+tremely common for doctors to see individuals with this disease. "his is the reason that i interviewed my local doctor on the body-s response to HI42Aids. "he KP informed me that when diagnosing and treating the illness, they look at it as following four stages& =. Primary stage 8. Asymptomatic stage ;. Symptomatic stage $early HI4 disease% D. AI#S $advanced HI4 disease% "he primary stage is the first stage of the infection. "he doctor told me that this stage begins as soon as the HI4 virus gets into the blood stream and lasts from two to si+ weeks. HI4 reproduces very fast at this stage, he said that it is in this stage that the virus infects and kills many 5#D cells, as the levels of HI4 in the blood $sometimes called the viral load% can get very high. Some people develop flu-like symptoms during this period while others have no symptoms at all. He also said that during this stage the number of 5#D cells drops for a while but more than often returns to near normal levels by the end of this stage. Bormal 5#D cell counts are D99-=,C99 in men, and D99-=,>99 in women. "he ne+t stage is the Asymptomatic stage ( this means L6ithout symptoms- and during this period most people infected with HI4 show few or no signs of HI4 disease. "his stage lasts from one to =C years, with ten years being about the average. #uring this stage HI4 keeps reproducing and killing 5#D cells even in people taking anti-HI4 drugs. "he third stage is the symptomatic stage $early HI4 disease%, this stage is recognised by doctors as the development of symptoms, during this stage 5#D cells continue to die and the immune system begins to fail. A person may feel tired a lot, sweat at night while sleeping, begin losing weight or get an infection in their mouth or vagina $yeast infection%. Some people develop an opportunistic infection, one of several disease that usually happen only in people with weak immune systems. "he finale stage is AI#s $advanced HI4 disease, this develops as 5#D cell counts drop below 899. People with AI#s are very likely to develop one or more opportunistic infections. HI4 can also damage nerves and brain cells, and some people with AI#s begin to lose their memory or find it hard to concentrate. .ost people with AI#s die from opportunistic infections or from one of several kinds of cancer. However, the KP informed me that drug treatments have improved the health of people with AI#s so opportunistic infections are less common now than in the early =::9s. 3ach communicable disease can often be identified by the particular set of signs and symptoms that it presents within a body and this can make it easier when it comes to treating it. while visiting and discussing the disease with my local KP, he showed me a couple of health promotion leaflets containing information about the illness. "hese contained information about signs and symptoms a person may show if they are infected by HI4 or Aids. I found that within the primary stage, the individual develops flu like symptoms two to si+ weeks after they are first infected. "hese include& 4

 "iredness Sore throat Moint and muscle pain ,ever Swollen nodes ash on the chest

It is these symptoms that can often lead to HI4 being mistaken for a common cold, because they are very mild and cannot cause symptoms for years, although the virus is still damaging your immune system and reproducing. After the immune system has been damaged it can cause serious infection and this can cause symptoms such as& night sweats weight loss that id une+plained constant diarrhea dry cough white spots in mouth blurred vision swollen glands that last over three months #IAKBHSIKBK HI4Symptoms of Aids are "*, pneumonia and some cancers if you have HI4 and get any of these illnesses than this means that the immune system has been badly damaged and shut down, which indicates that your illness has moved in to the last stage of the illness, leaving your body open to opportunistic diseases. "he most important thing to remember about signs and symptoms of a disease as well as the body-s response to it is that the changes in the body as a result of a 4irus often coincide with the method of diagnose and treatment. "he KP e+plained to me that the symptoms that show within the first few weeks are the most important indicators for diagnosing HI4- as they simulate flu like symptoms they are easily recogni)ed by an individual, although this can cause confusions in treatment the KP told me that if people do not respond to antibiotics and can be considered as being in any of the at risk groups that they would then be sent for a test to find out whether or not they are HI4 positive. As well as discussing the different signs and symptoms with me the local Keneral practitioner that I interviewed, he informed me about how they diagnose the disease. "he more commonly used diagnoses of is via a blood test, however these only show up after a person has been infected for three months. "hese tests can come back as either positive or negative.

*IHH# "3S"s Positive- if your test results come back as positive than you have HI4 and could have passed it on through unprotected se+, in!ecting drugs or sharing needles although, even if you have tested positive for HI4 this doesn-t mean you have AI#s and you may not develop it. Begative- if after three months a test shows up negative for HI4 you can be sure that you do not have it, but this does not mean that you cannot get it in the future, if you have the test before the three month time period than the test may come back negative, this could be a faulty result because you may actually have the disease, so it is always better to wait for the three month period to run over. HI4 AB"I*H#J "3S" HI4 antibody testing is used to determine whether or not a person is infected with HI4. 3arly treatment of HI4 infection and immune system monitoring can greatly improve long-term health. Also, knowing your HI4 status may help you change behaviors so that you and others are not put at risk.

Antibodies to the HI4 virus can be detected by a screening test called an 3IISA. "he 3IISA method is very sensitive but re7uires another test, a 6estern *lot, to confirm the results because false positives can occur. A healthy individual has no antibodies to HI4. If you test positive for HI4 antibodies on both the 3IISA and the 6estern *lot tests, you are considered to be infected with HI4 5#D "3S" Another that the doctor e+plained about to me, was the 5#D test. "his test is most effective after the disease has been in the system a while as it measures the number of " cells. A person who does not have HI4 will have around C99 to =899 cells, where as the normal count for someone with the disease is ;C9 and below. "his test is usually done at the doctors, hospital or a clinic and is in the form of a blood test. "his method of diagnosis is related to the changes of the 5#D count as a result of the disease. "he KP told me that this test is commonly used in relation to the changes that occur in the body during the symptomatic stage this stage is recognised as the development of symptoms, during this stage 5#D cells continue to die and the immune system begins to fail. 6hen administrating this test the nurse or practitioner places a tourni7uet around the persons arm above their elbow, this swells up the vein in the arm that the blood will be drawn from, the vein is wiped with an antiseptic wipe and then the blood is drawn by the needle being placed into vein and syringed out into the attached vacuum vial. "he blood is than measured for the number of 5#D cells. 4I AI IHA# "3S" "his is a test that is administrated after a person has started treatment with A 4 $antiretroviral%, this tests how well it is working, and relates to the changes that occur in the body due to the disease as it looks at how well the medication is working. It does this using a 4iral load test, which measures the amount of HI4 in the blood stream and can establish what stages of HI4 a person is on. Iike the 5#D test this test is done with a blood test. "he blood is taken from the vein in the arm that has a tourni7uet above the elbow the area is first wiped and then the needle is inserted and draws blood out into an attached vacuum vial and then sent for e+amination. 6

"he viral load test is 7uantitative measurement of HI4 nucleic acid $ BA% that provides important information that is used in con!unction with the 5#D cell countE

to monitor the status of HI4 disease, to guide recommendations for therapy, and to predict the future course of HI4.

3vidence shows that keeping the viral load levels as low as possible for as long as possible decreases the complications of HI4 disease and prolongs life. Public health guidelines state that treatment should be considered for asymptomatic HI4-infected people who have viral loads higher than ;9,999 copies per milliliter of blood using a test known as a branched #BA test, or more than CC,999 copies using an "-P5 test. httpE22www.labtestsonline.org.uk2understanding2analytes2viralNload2test.html I also found out about cross infection for people living with the HI4 virus, if an individual tests positive for HI4 it does not prevent them from being infected with another strain of the virus. "his means that the immune system is attacked more aggressively and increases the chances of getting more chronic illnesses and may effect treatment options and outcomes. BHB-5H..ABI5A*I3 #IS3AS3S As well as communicable diseases, health problems can be placed in another category, Bon-communicable. "he most important thing to remember about diseases in this group are that they cannot be caught and are non infectious. "hese diseases can either be& #egenerative- this means that they develop and get progressively worst i.e. Alt)imers. "hey can be a deficiency caused by the lack of something in an individual-s diet for instance Scurvy is caused by the lack of 4itamin 5. "hey can be an effect of lifestyle or environmental factors ( this means that a person-s health if impacted my e+ternal influences such as poor diet causing heart disease or smoking causing lung cancer. ,inally a non communicable disease can be passed on from a parent-s genetic profile or Linherited- e.g. cerebral palsy Historically, many B5#s were associated with economic development and so-called Odiseases of the richO. However, today an estimated >9@ of the four main types of B5#s - cardiovascular diseases, cancers, chronic respiratory diseases and diabetes - occur in low- and middle-income countries In September 89==, the Anited Bations is hosting its first Keneral Assembly Special Summit on the issue of noncommunicable diseases. Boting that B5#s are the cause of some ;C million deaths each year, the international community is being increasingly called to take important measures for the prevention and control of chronic diseases, and mitigate their impacts on the world population especially on women, who are usually the primary caregivers. 7

"hese types of diseases mostly re7uire long term support and treatment. "hey are often linked to certain life stages e.g. Al)heimer-s is often seen in later adulthood. "he non communicable disease I have chosen to investigate is 5ystic ,ibrosis. "his main reason that I picked this disease is that I know someone who suffers from the disease, I also want to investigate because, like HI4 it is a commonly misunderstood disease yet it is one of the APFs most common life-threatening inherited diseases, it affects over 8C,C99 people in the AP alone. It is a common recessive genetic disease which affects the entire body, causing progressive disability and often early death. "he name cystic fibrosis refers to the characteristic scarring $fibrosis% and cyst formation within the pancreas, first recogni)ed in the =:;9s. #ifficulty breathing is the most serious symptom and results from fre7uent lung infections that are treated with, though not cured by, antibiotics and other medications. A multitude of other symptoms, including sinus infections, poor growth, diarrhea, and infertility result from the effects of 5, on other parts of the body. 5, is caused by a mutation in the gene for the protein cystic fibrosis transmembrane conductance regulator $5," %. "his gene is re7uired to regulate the components of sweat, digestive !uices, and mucus. Although most people without 5, have two working copies of the 5," gene, only one is needed to prevent cystic fibrosis. 5, develops when neither gene works normally. "herefore, 5, is considered an autosomal recessive disease. 5, is most common among 5aucasians& one in 8C people of 3uropean descent carry one allele for 5,. Iooking at newspaper articles I discovered that Ireland has both the highest incidence of 5, in the world ( at 8.:> per =9,999 - and the highest carrier rate in the world with = in =: individuals classed as carriers. 5ystic fibrosis is IrelandFs most common life-threatening inherited disease. Ireland also has the largest proportion of families with more than one child suffering from 5,, this could be due to the small population meaning that the chances of someone with the 5, trait marrying someone else with the trait are higher than anywhere else. I also found that Appro+imately ;9,999 Americans have 5,, making it one of the most common life-shortening inherited diseases in the Anited States. "he Sunday times also stated that in AP 5ystic fibrosis killed ?,:99 people infected with it last year, making it the Ak-s second biggest genetic killer. However after researching the disease on the BHS website I found that in the last five years there has been a large increase in the survival rate of 5, individuals. 5ystic fibrosis is caused by a single faulty gene in an individual-s genetic make-up, and the !ob of this gene is too control the movement of the salt in the body. In people with cystic fibrosis the internal organs constantly become clogged with thick, sticky mucus which results in infections and inflammation making it hard to breathe and digest food. In my research of 5ystic ,ibrosis I looked at one of the most prestigious medical !ournals published based on the disease. "he Hfficial Mournal of the 3uropean 5ystic ,ibrosis Society publishes original scientific articles, editorials, case reports, short communications and other information relevant to cystic fibrosis and is published four times a year. "he most important indication of a disease, as well as how to diagnose and treat it is how the body responds to it. "he biological basis to a disease is like a person-s fingerprints, uni7ue. And this !ournal was e+tremely helpful in investigating how an individual with the disease responds to it and the effect it has on the body. 5ystic ,ibrosis is a chronic, progressive disease, which means that it is a constant problem for an individual-s body and that as time goes on it develops and continues to worsen. "he most common knowledge of the disease is that it leads to a reduced life e+pectancy with the average age of death occurring between ;92;C years of age. "he disease primarily affects the respiratory and digestive systems in children and young adults suffering from the disease as well as their reproductive system and sweat glands. "he disease is caused by mutations in a large gene that encodes a large protein called the 5ystic fibrosis transmembrane conductance regulator $5," %, which is found in cell membranes, its role it to transport chloride ions out of the cell. However when it is mutated, it either produces a 5," protein that does not work or as in a large 8

number of cases, the body does no produce any 5," . 6hen there is no 5," proteins present this is because part of the #BA code in the 5," gene is missing, making the 5," protein shorter than normal, as the cells 7uality control system is too short it destroys the 5," protein. Iike most communicable and non-communicable disease 5, does affect different people in different ways and to various levels and scales. However in all cases, they have the same basic problem, an abnormality in the glands that produce or secrete sweat and mucus. Sweat is the body-s response to heat and is a defence mechanism to cool the body down when it increase its own temperature. .ucus is needed to lubricate the respiratory, digestive and reproductive systems and preventing them from drying out and from becoming infected. 5ystichttpE22 www.suite=9=.com2content2cystic-fibrosis-a8;=9DQi+))=HPIaySbl As well as looking at the biological basis of the disease I also investigated the various ways in which the body responds to the disease as this is useful when diagnosing and treating this non communicable disease. I found out that the disease causes an abnormality in the gene 5," and this affects the way in which sodium and water are able to move in and out of the body-s cells. "hese are supposed to help the body produce thin, slippery mucus, which lubricates the linings of the airways, reproductive system, digestive system and some organs2 bodily tissues. I found that more than =,999 mutations in the 5," gene have been identified in individuals with 5,. "he severity of 5, depend on which particular mutation the gene has suffered. "hese mutations alter the organi)ation or stability of the cell. "hese changes or mutations impair the movement of the water and salt in and out of cells. "hese mutations in the 5," gene will result in thick, sticky mucus. "his is the main and most commonly know response to 5ystic ,ibroses. "his mucus than blocks small ducts and tubes throughout the body, especially in the lungs and pancreas. "he abnormally think mucus causes a variety of complications including airway obstruction, bacterial infections, lung damage and digestive difficulties. www.nhs2cysticfibrosis2campaing.asp2bodysresponse.com #efective ion transport in the lung reduces the water content of the fluid in the lungs making it more viscous and difficult for the ciliated cells to move it up out of the lungs. Precisely how defective 5," function produces this effect is still under investigation. In any case, the accumulation of mucus plugs the airways and provides a fertile breeding ground for pathogenic fungi and bacteria. All of this damages the airways G interfering with breathing and causing a persistent cough. "he most life-threatening responses that the body presents to 5, occur in the lungs. "he !ob of the lungs is to take o+ygen from the air and deliver it to blood, which than takes o+ygen to the cells of the body, where it is used to make energy. "here is a lining of mucus around the lungs which have a number of functions, the main one being to prevent infection of the lungs. "he !ob of the mucus is to capture bacteria and other viruses that might cause disease. It than passes these back out of the lungs and into the throat to be coughed up or swallowed. However in patients with 5,, the mucus in the lungs is much thicker. #isease-causing agents are still captured, but they cannot be passed back into the throat easily, instead the thick mucus holds bacteria, viruses, organisms and bacteria in the lining of the lungs. "he longer these remain in the lungs the greater the chance they will cause an infection of the lungs. "he presence of these causes the immune system to become active, it sends speciali)ed cells to fight the diseasecausing organisms trapped in the patients lungs. "hese cells cause the lungs to become inflamed and swollen. "his may close down passageways in the lungs, making it difficult for the patient to breath as it is hard to pass air in and out of the lungs. Another response of the body is the development of emphysema. 3mphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath. In people with emphysema, the tissues necessary to support the 9

physical shape and function of the lungs are destroyed. It is included in a group of diseases called chronic obstructive pulmonary disease or 5HP# $pulmonary refers to the lungs%. 3mphysema is called an obstructive lung disease because the destruction of lung tissue around smaller sacs, called alveoli, makes these air sacs unable to hold their functional shape upon e+halation. "his is often developed by 5, patients in later life and is a result of the constant build up of mucus and infection in the lungs. As well as looking up the biological basis of the disease and how an individual-s body responds to it I also looked up different signs and symptoms this disease presents in the human body. I gathered most of this information when I spoke to my local KP, although he himself has never treated someone with the disease he referred me to a specialist at Saint Mames-s hospital, which is the main adult 5, unit in Jorkshire.

Hne of the first symptoms of 5, in young babies is .econium ileu. .econium ileus is characteri)ed by a thick, sticky, dark stool. "he stool has these features because the mucus it contains is thicker than normal. .econium ileus is also marked by abdominal swelling and vomiting. "he presence of meconium ileus is a strong indication of cystic fibrosis. A defective 5," gene also causes damage to the pancreas. "he pancreas provides en)ymes needed in the digestion of food. 3n)ymes are chemicals present in all cells that make possible hundreds of different chemical reactions. If these en)ymes are not present, necessary chemical reactions may not occur. In the case of 5,, the pancreas makes a very thick type of mucus. "he mucus blocks openings in the pancreas and en)ymes produced by the pancreas cannot get out of the organ. ,ood passes through the stomach without being digested. ,ailure to digest food can produce a number of symptoms. "he feces may become bulky, oily, and foul-smelling. "he patient may constantly be hungry because food that is eaten is not digested. "he patient may not grow to normal si)e without the nutrients provided by food. Hver time, other symptoms that may develop include malnutrition, anemia, bloating, and loss of appetite. Another sign of 5, is that it causes bowel abnormalities. 5, causes mucus to become thick and sticky. "he pancreas secretes en)ymes to help disgust food and control blood-glucose levels. 5ystic fibrosis causes mucus to become thick and sticky. "he pancreas secretes en)ymes to help digest food and control blood-glucose levels. "he thick, sticky mucus in the intestines prevents the en)ymes from reaching the food. If the en)ymes are unable to reach the food, proper digestion does not take place. "he bodyFs inability to digest food correctly causes a variety of bowel difficulties. "he bowel abnormalities may includeE ',re7uent ',oul '#iarrhea '*lockage in the bowels 10 greasy, smelling bulky stools stools

As well as looking at leaflets and talking to doctors who have treated 5ystic ,ibrosis I spoke to my friend, #avid who is suffering from cystic fibrosis, to find out about the signs and symptoms that he himself has e+perienced and are present in his body while suffering from the disease. 6hile talking to him the first thing that I noticed is that he was unable to take deeper breaths when talking especially, meaning he had to keep pausing to catch his breath. He e+plained to me that one of the main symptoms he has which is common in 5, suffers, and this is 5, related diabetes. "his has been recogni)ed as a complication of 5, for almost C9 years. #avid developed 5, related diabetes at age 8=& this is around the common age of development. He e+plained to me that 5, # features characteristics of both type = and type 8 diabetes but is distinct from these. "his type of diabetes is associated with Insulinopenia, which is low blood insulin levels and resistance. In 5, patients the buildup of thick secretions in the pancreas eventually damages the hormone-producing cells, causing insulin deficiency. "his sounds like type = diabetes, but it is not 7uite the same thing because it does not start in childhood, but in adulthood, and is caused by damage to a pancreas that used to produce insulin normally. In addition to insulin deficiency, people with cystic fibrosis often wind up with insulin resistance because ofE 5hronic infections High levels of cortisol, a hormone that the body secretes in its response to stress ,re7uent e+posure to corticosteroids which are anti-inflammatory drugs sometime used in the treatment of lung conditions that mimic the action of cortisol Symptoms "he symptoms of 5, # are the same as the symptoms for any type of diabetesE

3+cessive thirst ,re7uent urination 3+cessive fatigue Ane+plained weight loss

"he problem is that all of these symptoms mostly occur in people with cystic fibrosis, whether or not they have 5, #. "his makes early detection difficult. #avid also told me that another symptom that he usually has is with his Sweat Klands. "his is because of a defective 5," gene can also affect the formation of sweat. "his is because cystic fibrosis causes his sweat to be much saltier than someone who is not suffering. However he e+plained to me that this problem is not that serious e+cept for when he is doing heavy e+ercise or hot weather, which is when his body produces more sweat. "o overcome this he usually eats foods with more salt in them in order to make up for that lost in their sweat. Hne of the biggest symptoms that affect #avid is the effect 5, has on the male reproductive system. "he disease causes the body to produce abnormally thick mucus, and this mucus can block the vas deferens in males, these are the tubes which the sperm passes through. And the problems with 5, individuals is that if these tubes become blocked it can cause problems for males when producing sperm and can therefore lead to infertility. 11

As well as talking to the 5, specialist at Saint Mames-s and interviewing #avid I also looked at a variety of health promotions and leaflets to learn about signs and symptoms, and I found out about signs and symptoms that individuals with 5, usually e+perience on a daily basis and these are& shortness of breath. "ickle cough *ad cough Salty sweat ,evers apid weight loss

4omiting Diagnosis Since symptoms of 5 ,# may not be noticed in the early stages of the disease, the 5ystic ,ibrosis ,oundation recommends routine screening for diabetes at least once a year for all patients age =D and older. 5, # is diagnosed by blood tests that detect the levels of glucose in the blood. Treatment 5, # is usually treated with a combination of insulin, e+ercise and diet. "he diet for people with 5, # is different than the calorie-restricted diet typically prescribed for people with other types of diabetes. #espite their diabetes, people with 5, must maintain high-calorie, high-fat diets and compensate by ad!usting insulin doses. If you have 5, #, you will need to work closely with your physician and nutritionist to develop the treatment plan that works best for you. #IAKBHSIBK 5JS"I5 ,I* HSIS "he most important thing to remember about signs and symptoms of a disease as well as the bodies response to it is that the changes in the body as a result of an illness often coincide with the method of diagnose and treatment. .y local general practitioner e+plained to me that 5ystic ,ibrosis individuals, especially those with mild or moderate forms, used to go years without being diagnosed or treated, as the more serious symptoms only begin to show in later adolescents. However, in the last ten year non-premature babies who had to be incubated due to breathing problems where tested to identify whether they have 5ystic ,ibrosis and in the last D years it is now compulsory for maternity units to test every new born baby for the disease. As well as discussing the different signs and symptoms with me the specialist that I talked to informed me about how they diagnose the disease& S63A" "3S"- this is the most commonly used diagnoses of 5ystic ,ibrosis and has been the test of choice for diagnosing 5, since =:C:. Some reasons for having a sweat test areE

A baby has had a positive newborn screening for 5, A person of any age has symptoms of 5,

"he sweat test is usually done on the forearm, but may be done on the thigh of infants and children with small arms. "here are two steps to the test. "he first is stimulating sweat& the nurse2doctor2technician will place two electrodes 12

containing a sweat-inducing drug known as Pilocarpine on the skin. A small electric current is delivered through the electrodes to help the Pilocarpine stimulate sweat. "he second step is collecting the sweat& after about =9 minutes, the technician stops the current and removes the electrodes. "he skin is wiped dry and a piece of filter paper covered with plastic, referred to as a Lsweat patch- is placed on the site to collect sweat. 6hen a sufficient amount has been collected, usually takes about ;9 to DC minutes, the paper is removed and sent to be tested. People with cystic fibrosis have high levels of salt, known as sodium chloride, in their sweat. "he sweat test measures the amounts of sodium and chloride in the sweat, but the amount of chloride is the factor that determines the outcome of the test the sweat test is :>@ accurate, but some factors can cause the results to be incorrect or inconclusive. How Accurate is the Sweat Test? False positives 5ertain rare disorders can also produce high chloride levels in sweat, but those disorders have different symptoms than cystic fibrosis. If a sweat test produces positive results in a person who has symptoms that are not typical for 5,, further testing should be done to confirm the diagnosis. False negatives Sometimes, a person with cystic fibrosis will have a normal chloride level in his or her sweat. If this happens, it is usually either because not enough sweat was provided in the sample, or the sweat was diluted. ,alse negatives are most often seen inE

Infants less than 8 weeks old or weighing less than ? pounds who may not be able to produce enough sweat. People with tissue swelling caused by fluid retention, known as edema, whose sweat may become diluted with tissue fluids. httpE22cysticfibrosis.about.com2od2relateddiseases2a25, #.htm

*ASI5 K3B3"I5 "3S"IBK- It is estimated that in the AP, more than 8C,999 people have cystic fibrosis, and more than =9 million people carry the 5, trait. A carrier does not have the disease or any of the symptoms, but is capable of passing 5, on to his or her children. Kenetic testing for cystic fibrosis is done to determine if a person has, or is a carrier of, cystic fibrosis. "he test is usually done on a blood sample, but sometimes can be done on other #BA-containing cells such as a swab from the inside of the cheek. "he sample is e+amined for a specific panel of mutations of the 5," gene. 3veryone has two copies of the 5," gene in every one of their cells. If one copy, also known as an allele, is found to have a mutation, the person is a carrier. If both copies of the gene are mutated, the person has cystic fibrosis disease. "here are more than =,C99 different 5," mutations known to cause 5,, and new mutations are being discovered as research on the gene continues. Bo test checks for all of the possible 5,-causing mutations, but several tests are available that check for the most common 5," mutations. "he cost of genetic testing ranges from a few hundred to several thousand dollars, and may or may not be covered by insurance. "he basic genetic test for cystic fibrosis, sometimes referred to as the A5.K2A5HK .utation Panel or the 8;mutation panel, looks for the most commonly occurring 5," mutations. It is about :9@ effective in detecting 5, mutations in the 5aucasian population, but only about ?9@ effective in African-Americans and <9@ effective in the Hispanic population.

13

A!vance! Testing Some companies have developed tests that can identify less common mutations in addition to those in the A5.K2A5HK recommended panel. "hese tests can be especially helpful in detecting rare 5, mutations when done as follow-up tests if the basic panel produced normal results. Some people opt to have this more thorough testing for their initial test, especially if they are likely to have a less common 5," mutation. "he advanced tests are highly speciali)ed and must be sent to the labs that offer them. "hey may cost more and take longer to receive results than the basic testing panel done at a local lab. httpE22cysticfibrosis.about.com2od2relateddiseases2a25, #.htm

Part * As well as investigating the basis of communicable and non-communicable diseases, looking at my own chosen diseases, e+ploring their biological background and how the body responds differently to each disease, I looked up and researched information about the causes of the diseases, how they are distributed and how society deals with it. 5ommunicable diseases are the ones that cause the most problems in society as most of them are easily spread& this makes them difficult to contain, which means that society is constantly threatened by epidemics and worldwide pandemics. 5ommunicable diseases are spread via contact from person to person, or sometimes animal to person. It is =99@ likely that everyone will come down with more than one communicable disease at some point in their lives. "he causes of communicable diseases are often misunderstood and this is the reason that it is important to learn about the causes of communicable disease and ways to prevent them being spread. ,or instance the communicable disease I choose to investigate is HI42Aids virus, as most people think that this is 5AAS3# by se+ual contact, which is not true, this is simply HB3 of the ways that it is spread. 5auses of communicable disease are dependent on a number of factors. Such as the agent, environment, transfer method and host& "he agent- in most cases, communicable diseases is either viruses or bacteria. "hese are known as agents and both have the ability to cause remarkably similar symptoms, but how easy they are to spread is different. HI42Aids is a virus, which is e+tremely easy to pass on, however unlike most viruses HI4 is not an airborne virus and therefore cannot be passed through coughs and snee)es, which is another common false impression of the disease. "he 3nvironment- one of the primary causes of communicable diseases is the environment. #iseases are much more likely to spread in places where hygienic practices are minimal. Also being around those with a communicable 14

disease is a high-risk factor in passing it one. "his is the reason that society aims to accentuate the importance of hygiene and cleanliness as well as isolating people with communicable disease in order to avoid direct contact between an infected person and places in which crowds of people are in close pro+imity. 3.g. schools. However with HI4 the virus is only passed on through the e+change of bodily fluids so this isn-t as important. Host- every 4irus must have a host in order to carry out a life cycle of replication, this is responsible for the signs and symptoms we see, making a person ill. *acteria can live outside of a host for an e+tended period of time, where as a virus cannot really survive for very long outside the body and therefore these agents are engineered by evolution to seek out a host as 7uickly as possible. However even though HI4 is a virus it cannot live outside of a host and therefore !umps from one to the other via direct contact of bodily fluids. "he communicable disease that I chose to investigate is HI42AI#S, because it is not like most viruses and therefore there is a lot of misunderstanding and misinterpretation when it comes to this disease. Also it has recently been classified as a ma!or pandemic due to the mass distribution and spreading of it in the last seven years. As well as looking at the range of information about the disease including its description, basis and signs2 symptoms I identified and reviewed all the facts about the spreading of the disease and what leads to it being distributed. I gathered most of this information from health leaflets that I collected from the general practitioner on my visit. Hne of the leaflets I looked at was the N ! "A#$ %& to AI'! leaflet. And this had a lot of information on HI4 and how it is distributed. "he virus is distributed from one infected person into the body of an uninfected person via bodily fluids such as blood, semen, pre seminal fluid, vaginal fluid and breast milk. I found that the most common ways of passing on HI42Aids virus are& "hrough se+ual intercourse ( the most common misconception about HI4 is that it is an S"I and can therefore only be spread through unprotected se+& this is not true as there are many other ways that the disease can be distributed. However with an increase in the rates of people having unprotected se+ with multiple partners se+ual transmission has become the most common way to spread HI4 and is the main factor in the disease being distributed on such a massive scale, with 8 in C people now infected with it. "he virus can enter the body during se+ual intercourse via the lining of the vagina, penis, rectum or mouth. Se+ual activities that can result in HI4 infection are through heterose+ual intercourse, anal se+ $heterose+ual or homose+ual%, oral se+ $heterose+ual or homose+ual%. Hne of the main confusions made about HI4 is whether or not it is passed on through kissing, and the answer is that although it HI4 has been found in tiny amounts in saliva of some infected people, there is no evidence that HI4 is spread to other people through kissing , although it is recommended in HI4 health leaflets to avoid open mouthed kissing because of the possibility of contact with blood is the people kissing #irect 5ontact 6ith Infected *lood have any cuts in the mouth.

15

 Hne of the other ways that HI4 can be spread is through direct contact with infected blood. "his is the second most common way that this disease is distributed and can pass the virus on in three ways.

" The #irst way is through in$ecting !rugs % HI4 is fre7uently spread amongst users of illegal drugs that are in!ected, with one in here of these people having the disease. "his happens when needles or syringes are contaminated with minute 7uantities of blood of someone infected with the disease are shared with someone who isn-t. "his is because HI4 is a virus so even if a small amount gets into your body it will replicate with twice as more agents in the body after !ust two weeks.

"the secon! way it can &e passes on is in a health care setting- it has been known for the disease to be transmitted from patient to health-care worker or vice-versa. "his happens when people are accidentally stuck with contaminated needles or other medical instruments $however this is 7uite rare%

"the thir! way that HI' can &e transmitte! through &loo! via trans#usion ( before screening blood transfusions to look for evidence of HI4 infection and before the introduction in =:>C f heattreating techni7ues to destroy HI4 in blood products, the virus was commonly transmitted through transfusions of contaminated blood or blood components. However because of blood screening and heat treatment today, the risk of ac7uiring HI4 this way is e+tremely small

Another way that the disease is passed on is from an infected mother to her unborn child ( this happens because women can transmit HI4 to their fetuses during pregnancy or birth. Appro+imately one-7uarter to one-third of all untreated pregnant women infected with HI4 will pass the infection to their unborn babies. "he virus can be spread to babies through their mother-s breast milk as well. Although women who live in countries where safe alternatives to breast feeding are available and affordable, this eliminated the risk of transmitting the virus through breast milk by bottle-feeding their babies. However in developing countries safer alternatives are not readily available of economically feasible, breast-feeding may offer benefits that outweigh the risk of HI4 transmission and this can lead to and increase in children in these countries receiving the virus via breast milk.

As well as looking at how HI42AI#S can be distributed I used a range of health care leaflets to investigate common misconceptions about the virus. "he fear of catching this disease can often lead to people making mistakes about the facts, which means people actually infected with the disease are discriminated against and treated badly because of it. An accurate e+ample of this is the film &hiladelphia in which a homose+ual lawyer is persecuted against by his firm for having aids. "his was a first real media breakthrough for HI4 as it 16

portrays the disease through the perspective of someone who has the disease. I have looked at common errors people make about the distribution of the disease and my research shows that HI4 cannot be transmitted through casual contact such as

"ouching or hugging Sharing household items such as utensils, towels, and bedding 5ontact with sweat or tears Sharing facilities such as swimming pools, saunas, hot tubs, or toilets with HI4-infected people 5oughs or snee)es

In order for a communicable disease to flourish, all of factors must be in place. In some cases, the agent can be prevented through a vaccine. In other cases, fighting communicable disease centers on the environment, transfer method or host. Peeping surroundings clean, avoiding transfer methods and practicing healthy eating and e+ercise habits can all help. In an attempt to prevent further spread of HI42Aids the AP government has made a range of campaigns to help raise awareness of the disease and the importance of using protection when having se+, be careful with open cuts and sharing syringes ect as well as looking at the cause of the disease and how it is distributed I have looked into how society deals with it, I did this by using the societal campaigns designed by the government.

"his is the AI#S awareness campaign. "his aims to stress the significance of being fully aware of what the HI4 virus is, what causes it and how to protect ourselves from it. "he use of Health campaigns are not the only way that society attempts to deal with the never ending spreading of HI42Aids .aking a wide range of condoms- as I found in my research of how the disease is spread, the passing the disease through se+ual activity has increased by <9@ in the last three years. And so one of the biggest solutions that the government has come up with is the production of suitable protection/ L5ondoms-- this is the// HI4 can be passed on through different acts of se+ with different people and to overcome this problems the government makes a wide range of condoms, for men, women and oral se+. Another way that society attempts to prevent HI4 from being distributed is through the use of educational campaigns 'adolescents- the government now aim to make all young people aware about HI4, unprotected se+ and the conse7uences of having se+ with multiple partners - through schools, this is because the numbers of young people having unprotected se+ have rocketed in the last seven years, and due to this society has seen an increase in the number of younger people contracting the disease. 17

'adults- the government has also made it easier for adults to learn about HI4 through the educational campaigns and information through confidential clinics, help lines and local KPs. "he government also tries to prevent the disease spreading through monitoring and helping to support drug users in order to avoid people from sharing contaminated needles. "hey have done this by creating support systems such as rehab, drug users anonymous and private help lines, these aim to prevent people from taking drugs altogether, however that does also help the problem of spreading HI4. "here are also other solutions designed to help the problem of cross infection with in!ections and these are things like confidential clinics that teach the conse7uences of sharing needles, and in some cases heavy drug users are given clean needles.

Hne of the most ma!or changes that society has made in the struggle to contain HI4 has happened in the last C years. And this deals with the problem of women passing the disease onto their babies, society deals with this by having more advanced treatments, and designing more advanced e7uipment and ways of diagnosing and delivering the baby in order to prevent the distribution of HI4. Another solution that prevents this is the mass production of milk substitutes, meaning mothers don-t have to breast feed their babies.

,inally the biggest solution that society has come up with and that is the obvious one of treatment. P3PS3 is a combination of anti-HI4 tablets and stands for post e+posure prophyla+is se+ual e+posure. "his can be taken to try and stop somebody getting HI4 following e+posure during safer se+ although this treatment is not available in shops but can be prescribed by KA. clinics and the accident and emergency department. "he tablets should be taken as soon as possible after e+posure to HI4 and within no later than ?8 hours, than there is a course of HI4 medication that has to be taken for D weeks.

Part * ( BHB 5H..ABI5A*I3 #IS3AS3S "he causes of Bon-communicable diseases are e+tremely different from infectious diseases as they are usually classed as chronic conditions and they do not result from an acute infectious process. All of these types of disease can cause dysfunction, impairment in the 7uality of life or even death. "hey usually develop over a relatively long time period. Also unlike communicable disease these type of diseases rarely cause symptoms at first, however once the disease manifestations develop there may be a protracted period of impaired health. "he causes of these disease range from& #egenerative- this means that they develop and get progressively worst i.e. Alt)imers.

"hey can be a deficiency caused by the lack of something in an individual-s diet for instance Scurvy is caused by the lack of 4itamin 5. "hey can be an effect of lifestyle or environmental factors ( this means that a person-s health if impacted my e+ternal influences such as poor diet causing heart disease or smoking causing lung cancer. ,inally a non communicable disease can be passed on from a parent-s genetic profile or Linherited- e.g. cerebral palsy "he non communicable disease that I have chosen to look at for my coursework is 5ystic fibrosis, which is an inherited condition which affects mainly the lungs and the pancreas. "hick, sticky mucus builds up in these organs causing infections and damage in the lungs and making digesting food difficult. "he reason that I have chosen to 18

investigate this disease to investigate is because it is the APs biggest inherited disease, with one in five babies being born with it. As well as looking at the biological basis of this disease as well as how the body responds to it I also researched how it is distributed and what the repercussions of the disease are on society. I gathered some of my information via different leaflets as well as internet websites. *ut I found most of my information from a primary source, I interviewed my friend #avid, who is 8: years of age and a sufferer of 5ystic ,ibrosis and he told me about how 5, is passed on. Anlike HI4 5ystic ,ibrosis is very limited as to how it can be passed on. It can only be distributed through genes, not through any direct contact with a person. 5, is caused by a recessive gene which means it is passed on through people-s genetic make-up. ,or a baby to be born with the disease both parents have to be carriers of the faulty gene, this must not be confused with actually having the disease. 5arriers do not suffer from any symptoms of the disease however they can pass it onto their offspring. 6here both parents carry the faulty gene, each child has a one in four chance of having 5,, a two in four chance of being a carrier and a one in four chance of not having any 5, genes. "he affected 5," gene is inherited from a child-s parent and is a recessive gene. 6ith recessive genes, children need to inherit two copies of the affected gene, one from each parent. If a child inherits one affected gene from one parent and one unaffected gene from the other parent, they will not have 5, but they will be carriers of 5,. Individuals who are carriers of 5, are healthy and e+hibit no signs or symptoms.

Hn the L5, and you- leaflet that I looked at I found the biological basis behind how the disease is passed on from parents to their children& 'if both parents have the 5, trait $only one 5, gene% than the child has C9@ chance of inheriting 5ystic ,ibrosis trait, 8C@ chance of inheriting 5, disease and 8C@ chance of not inheriting either the trait or the disease. 'if one parent has a 5, trait $one normal and one 5, gene% and the other parent has two normal hemoglobin genes the child has C9@ chance of inheriting the 5, trait, and C9@ chance of not inheriting either the trait or the disease. 'if one parent has the K, disease $two K, genes% and the other parent has the trait than the child has C9@ chance of inheriting the 5, trait and C9@ chance of inheriting the disease $two 5, genes%. 'if one parent has 5, and the other parent other parent has two normal hemoglobin genes the child has =99@ chance of inheriting the trait but not the disease 'if both parents have the 5, disease the child has a =99@ chance of inheriting the 5, disease.

As well as looking at leaflets and talking to my friend #avid I also spoke to a health professional at Saint Mames Hospital, which is the main adult 5, unit in Jorkshire. "he specialist told me that although the disease can only be passed on through inheritance, i.e. passed down to child from parents through their genetic make-up, he said that one of the biggest problems with the distribution of the disease is that the disease isn-t really that well know, which 19

means that people don-t know whether they are carrying the disease or not. Hn average over two million people in the AP are carriers of the faulty gene that causes 5ystic ,ibrosis, which is around =in 8C people, and not even one 7uarter of this group know that they are carriers or the risk that they have of having a 5, child if they have a child with another carrier. "he chance of two people with the trait becoming partner is 8 in ?9 and yet passing on the disease to offspring happens more often than you-d think because people are unaware that the gene runs in their family, therefore although the chances of meeting someone with the trait and than passing it to your offspring are 7uite slim there is still a ma!or risk factor because of people being unaware that they are a carrier.

As well as looking at the distribution of the disease I looked at how society deals with the disease. Anlike communicable disease like HI4, 5ystic ,ibrosis cannot be passed on, which means that there aren-t a lot of campaigns and health promotions giving information about it, or solutions put forward in order to prevent people from getting it. However like with each and every disease there are various ways in which our society deals and copes with the disease, during the research for my coursework I looked up the different ways society deal with 5, as well as how they treat 5, sufferers. People with 5, generally have to work their lives around their disease, especially as they get older and the 5, get progressively worse. 5, suffers often are unable to work because of their strict health regime, e+traneous factors in the workplace such as dust and cross infection and then making time for outpatient meetings. In order to deal with this problem, the government has created the disability allowance, the amount of allowance depends on the disability of the individual. 6hile talking to me friend #avid who suffers from 5, I found that people with 5, have the choice of R8D9 a month or if they don-t need the money e.g. they live with their parents they can have a car ( to make it easier for them to get around on their own, e.g. to appointments, so that they have a bit more freedom as most people with 5, are reliant on family members. "here are also other benefits that people with 5, can apply for such as statutory sick pay, which goes to people who are either unable to work because of their own disease or in some cases to parents who cannot work due to sick children . Some 5, sufferers can also apply for income support when moving house, due to the fact they don-t have a steady income.

Another problem is that people with 5, often feel isolated and can even become depressed because there disease can often lead to them feeling that they are being re!ected by people because of 5, or that they struggle to make friends because of the disease. "hey may also feel fed up with the e+tensive treatment every day as well as not having the freedom to take care of their own treatment. "o overcome these problems society has made the 5, esearch "rust, which has clinics and help lines as well as counselors, this helps with 5, individuals feeling like they have help and not that they have to deal with it alone..

#iagnoses- another way that society deals with the disease is the number of diagnosing techni7ues designed over the years to catch the disease early on so that treatment can start, which although cannot cure the disease it can give a helping hand to giving the individual a normal life as possible. "here are two diagnoses that have proven to be most effective in changing the disease within society and these are& (ew&orn Screening ) Bewborns screened for cystic fibrosis can benefit from early diagnosis and treatment, which canE

Improve growth& Help keep lungs healthy& educe hospital stays& and

20

Add years to life.

6hile newborn screening is not a definitive diagnostic test for cystic fibrosis, it may lead to tests that can rule out or confirm a 5, diagnosis. And Kenetic *arrier Testing G .ore than 8 million people in the AP are symptomless carriers of the defective 5, gene. "his blood test can help detect carriers, who could pass 5, onto their children. "o have cystic fibrosis, a child must inherit one copy of the defective 5, gene from each parent. 3ach time two carriers of the 5, gene have a child, the chances areE

8C@ $= in D% the child will have 5,& C9@ $= in 8% the child will carry the 5, gene but not have 5,& and 8C@ $= in D% the child will not carry the gene and not have 5,

Another ma!or solution that society uses to deal with the disease is the different treatments. In the last =8 years the life span of 5, patients has doubled and this is due to the treatment that has been designed by society to help cope with the disease. ,or instance those with 5, have to undergo a rigorous daily regime of treatment to stay healthy, this includes taking a range of drugs to clear mucus with physiotherapy, fight infections and help digest food . Another type of treatment that has recently been developed for 5, patients is "ransplants. .ost of the transplants done on people with 5, are lung transplants, as usually these are the organs most affected by 5ystic ,ibrosis. However some people with 5, will have problems with their liver or kidneys and may need these organs transplanted. "he statistics show that around ?9@ of those with 5, survive for five years post transplant

,inally although society has come up with a lot of positive solution when dealing with this disease, like HI4 there are a lot of misconceptions about the disease, and I have found that this can lead to people being treated negatively by society because they have 5ystic ,ibrosis. 5, is a terminal illness, and therefore this is all it is seen as by non 5, sufferers, parents see their children being diagnosed with the disease as a life sentence which means that people suffering from 5, can be treat very differently.

As well as looking at my two chosen diseases individual and investigating each one separately for my coursework I also looked at the similarities and differences between communicable and non-communicable diseases as well as comparing and contrasting my two chosen disease. 3ach and every disease that affects the human race is uni7ue, however each disease can either be categori)ed as either communicable and non communicable. "here is one ma!or difference between these types of disease- communicable ones are highly infectious which means they can be passed on where as non communicable disease cannot be passed on, they are not infectious but are generally chronic $ constant%. However similarities can be drawn between the two groups, for instance all disease have some kind of signs and symptom, making people ill is what categori)es a condition as a disease. HI4 and 5ystic ,ibrosis are two completely different diseases& they have uni7ue biological backgrounds, affect the body differently, have their own set of signs and symptoms and are passed on differently as well. However there are a range of similarities between the two diseases which I have come across while looking at them, and these are& 21

 Although both disease can be treated this only works to prolong the infected individual-s life span, there is no cure to either dieses. "here are a number of treatments for HI4 to stop it from progressing into Aids even though there is no cure or vaccine for it. However, combination therapy, also called highly active antiretroviral therapy $HAA "%, slows the progression of the condition and can prolong life. A combination of medicines is used because HI4 can 7uickly adapt and become resistant to one single medicine. HI4 medicines are known as antiretroviral $A 4s%. Similarly there is no cure for 5ystic ,ibrosis, but like HI4 in the last seven years treatments have become available that have doubled the life e+pectancy including physiotherapy and drug treatment. "hey are both progressive diseases which mean they get worse over time. *oth 5ystic ,ibrosis and HI4 start off with similar level of symptoms and with age get progressively worse. "his is because with both diseases the infected person-s body attempts to fight with the disease and eventually finds it more and more difficult to fight, this is what leads to their condition deteriorating and eventually to the person-s death.

"hey both affect the immune system. *oth of these diseases infect the body in different ways but both of them aim to prevent the immune system from working effectively to fight off illness. *y doing this both diseases allow themselves to regenerate and pass on to other parts of the body and this is the reason that the infected person gets worse.

"hey both leave the body open to opportunistic diseases. *y infecting and bringing down the immune system in order to take over the body both disease accidently leave the body open to opportunistic infections which is what causes people to get progressively worse. *oth diseases can also cause problems with cross infections.

Iike 5ystic ,ibrosis HI4 can be passed from parent to child. 5ystic fibrosis is only passed on through a parent-s genetic make-up to their child, similarly HI4 L5an- also be passed on from mother to child as it is distributed through the e+change of fluids.

"hey are both often mis-diagnosed. In my research I found that both diseases can be miss treated at first because they both show signs and symptoms that are similar to some more common disease, for instance HI4 first prevents symptoms that are very similar to that of the everyday flu and because blood test do not show HI4 until the body has been infected for three weeks but some of the symptoms show straight away, which means people are often given antibiotics first and not treated accurately until more serious symptoms begin to show. Iikewise 5ystic ,ibrosis in babies can be mis-diagnosed as breathing problems as the only symptoms are coughing, struggling with breathing and salty skin and in later life it can also be missed because the symptoms can vary greatly in different people and mimic symptoms of a wide variety of other conditions, such as pneumonia, bronchopulmonary dysplagia, celiac disease and malnutrition.

22

However although there are a range of similarities with these two disease, it has to be remembered that they are still uni7ue separate disease and there are therefore a range of e+clusive differences, uni7ue to each disease. As well as comparing the similarities of my chosen disease I also looked at contrasting them both, I found that difference include&

they are distributed differently- HI4 is a communicable disease and this means that it is contagious however unlike most communicable disease it can only be passed on through the e+change of fluids and not direct contact. *ut 5ystic fibrosis is a non communicable disease and this means that it cannot be passed on like HI4 as it is not infectious, 5, can only be passed on through inheritance.

"here is no trait for HI4 you either have it or you don-t. unlike HI4 people can be carriers of 5,, which means that they do not get ill from the disease or show any signs or symptoms, but there is a chance that the faulty gene could cause their children to have 5,, however HI4 infected people carry the disease and can pass it on to anyone, but everyone with HI4 in their system displays the signs and symptoms.

HI4 develops into the more serious form off AI#S where as 5ystic fibrosis stays the same, although it does get progressively worse like HI4.

"here are solutions that prevent HI4 from being distributed like condoms and sterile needles but there is nothing to prevent 5, from being distributed e+cept chance. #epending on whether both parents have theS trait, there is a =in D chance that their child will be infected by the disease

HI4 can be prevented from begin distributed to children where as 5, is genetic and cannot be. A pregnant woman can greatly reduce the risk of infecting her baby if she takes the anti-HI4 drug AT" during her pregnancy. *ecause the risk of transmission increases with longer delivery times, the risk can be further reduced by delivering the baby by cesarean section, a surgical procedure in which the baby is delivered through an incision in the motherFs abdominal wall and uterus. 5ombining AT" treatment with cesarean delivery can reduce the infection rate to between =@ and 8@. 6hereas so far there is no way a baby with two 5, traits from each parent can be prevented from having the disease, all doctors can do it tell you if you have the gene and your partner if they have the gene, if you both do than it is your decision to have the baby with a 8C@ chance of it having the disease.

HI4 can only be detected after three weeks of being infected, where as 5, can be diagnosed from birth, also HI4 can take 8months to show symptoms where as 5, shows it straight away.

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 5, 5ABBH" be passed on through fluid e+change or direct contact with an infected person where as HI4 can be.

PA " 5 As part of my coursework I also analy)ed the availability of support, facilities for diagnosis, treatment and factors that affect the outcome of both my chosen diseases, every disease is different and the e+tent of the harm each disease causes depends on a number of factors, such as individual differences and circumstances, this is similar with the outcome of treatment on communicable and non communicable diseases as there are a number of e+traneous variables that can affect the effectiveness of the treatment. I looked at different factors that affect HI42AI#S virus and the number of issues that affect the outcome of treatment on 5ystic ,ibrosis. HI' A(D AIDS 'I+US % I found on the internet a range of different issues surrounding the outcome of treatment for HI4 and I picked out what I think are the si+ biggest factors that have the biggest effect on the outcome of people-s treatments, I have e+amined and e+plained them below& Hne of the biggest things that affect the e+tent to which an infected person suffers from the disease as well as the outcome of treatment on a HI4 sufferer is L"I.3-. "his is important because HI4 is one of the slowest acting diseases of the human race& taking place at it-s fastest over at least =8 years, and it progresses at different stages which means that the treatment for it also depends on the stage. ,or instance the Post 3+posure Prophyla+is Se+ual 3+posure treatment is a combination of anti- HI4 tablets and is referred to as the P3PS3 treatment. "his can be taken in a very short time period of a person being e+posed to HI4, the tablets should be taken as soon as possible within no later than ?8 hours after e+posure to the disease, and are followed by a course of HI4 medication that has to be taken for D weeks, this treatment works as a filter In the short time period by flushing out any trace of the disease before it has chance to regenerate and multiply. Also if the disease is caught early on and treated 7uickly this can have an effect on the blood cells and 5#D count. "he average amount of a normal 5#D count is C99 to =899, and if a person with HI4 begins treatment early and the 5#D count doesn-t drop below ;C9 this means that the HI4 may not progress onto the symptomatic stage which means that they won-t show more server symptoms and their immune system may not be affected- although this is not a cure for the disease but treating it in the early stages will help to increase the individuals life e+pectancy. Also the factor of time can affect whether a person-s HI4 progresses 24

into the more serious AI#S, as a prolonged amount of treatment can prevent this from happening early on in life, although most HI4 patients do eventually contract Aids and then die from opportunistic diseases.

Another e+traneous factor that can have a huge affect on the outcome of treatment of HI4 is drug treatments. "here have been lots of drugs that have been developed for treating HI4 in the last four years and all work for different severities of the disease, each individual of the disease and the different stages of it. there are over 8o approved antiviral drugs but not all of them are licensed in every country, which prevents countries most populated with the disease from the most effective treatment such as in third world countries like Africa. "here are also problems with drug treatments because of how wide spread the disease is, which causes difficulties with money, time, mass production ect. ,or instance the most recent drug to treat HI4 is called protease inhibitors PIs and they inhibit the protease which is a protein involved in the HI4 replication process, however the factors that have so far affected the outcome of this treatment are that they are very unsuitable for starting treatment in settings because of the cost, the number of pills that have to be taken and the side effects that they have on people, these may be affecting the outcome of treatment on the disease as these drugs have used the latest technology and therefore may be the most effective. ,inally the problem with taking tablets for HI4 is that research has found that the body can become immune and begin to resist the treatment because they have been taking them for so long, which can have a problem with the outcome of treatment because it means people may have to change their treatment plan or that the disease will get worse due to a lack of effective treatment.

I also found that a big factor in how the disease affects a person depends on their genetics, which means is also affects the course and outcome of that persons treatment. ,or instance I found that patients who have certain genetic mutations or variations may have 5#D cells that are either more of less susceptible to HI4 infection, which may occur in people who either lack the co-receptors 55 C or 5U5 D, and this can have an effect on the outcome of treatment as it may mean that they either need more medication to make up for their weak 5#D cells $which will be killed more 7uickly% or visa-versa and they may not need as much 5#D treatment, it can also effect the treatment as it may influence the persons diagnoses because it if the 5#D cells are more susceptible to the disease, for instance, than it may give the impression that the individual is in the later stages of the disease. Also one meta-analysis which found that a variation in the 55 C co-receptor can reduce the risk of a HI4 patient developing AI#s by ;=@, and a lowered risk of death by ;:@, which has a big difference in how that person is treated. Also there is a human protein called APH*35;K and this can affect the outcome of treatment because it is an antiviral protein that prevents HI4 from replicating once in the body, as it changes the HI4-s #BA molecules. According to one study that evaluated more than ;,9?9 HI4 patients, variations in the APH*35;K gene may influence the rate of HI4 disease progression. "he researchers found that one variant called H=>< , common among African Americans, was associated with a rapid drop in 5#D cell counts.

Another less common factor is whether or not the patient has a pre-e+isting condition. As HI4 can be passed on to anyone through the e+change of bodily fluids it does not discriminate against people who are already suffering from another health related problem. "his can affect the outcome of treatment in numerous ways 25

because first of all, if someone is already very poorly and they contract HI4 than their body will be less likely to be able to fight it off for a long time, which means a lot of treatment open to HI4 suffers may not work for them because the time period before moving into more advanced stages may increase rapidly due to this. Also if a person all ready has a pre-e+isting illness that they are taking medication for this can affect the treatment for the HI4 as they maybe be unable to take some of the drugs in case it reacts with their other medication or is cancelled out by the treatment they are already receiving.

epeated e+posure to HI4 has also been proven to have a massive affect on the outcome of treatment. "his mostly affects drug users with the disease who are still using infected needles as well as people still sleeping with partners who have the disease. I found information on one study in a research book based on the disease, the study involved :;? HI4-infected men who received little or no antiretroviral therapy, the patients who had unprotected receptive anal intercourse e+perienced more rapid declines in their 5#D cell counts than men who did not engage in unprotected se+. However, the researchers could not determine whether the 5#D cell count decrease was the result of re-infection with HI4 or e+posure to other se+ually transmitted infections or diseases. "his can affect the outcome of treatment as it may mean they need more severe treatment to prevent the re-e+posure to the disease 7uickening the process of the illness

Iastly I found that the infection route has also been known to have an effect on the treatment and its conclusion, as it has suggested that how the disease was transmitted may impact the rate of HI4 progression in patients. ,or instance, HI4 can be spread by se+ual contact with an infected person, by sharing needles2syringes with someone who is infected, through breastfeeding, during vaginal birth or, less commonly $and rare in countries where blood is screened for HI4 antibodies%, through transfusions with infected blood. Some studies have found faster rates of disease progression among HI4-infected patients who were infected via blood transfusion. However these studies may not have considered the age of the blood transfusion recipients. Patients who are infected at an older age are more likely to e+perience a faster disease progression. It has also been suggested that patients who ac7uire the disease via in!ection-drug use are more likely to e+perience a faster disease progression, and this could all effect how the treatment is given and the e+tent it works for the person infected with the disease.

*,STI* FI-+.SIS % I also used the internet to research what factors can affect the treatment of 5ystic ,ibrosis and it-s outcome. I investigated and analy)ed the different factors and have written about five of them below& Iike with HI4 one of the biggest factors that affect the outcome of the disease is time. 5ystic ,ibrosis is a Bon communicable disease and this means that it is an advancing chronic disease and so worsens over time, similarly to HI4. And so the time of diagnoses can have a ma!or effect on the treatment of the disease as well as the e+tent to which the individuals health is affected. ,or instance before the last si+ years babies were often misdiagnosed at birth as another disease such as breathing problems, pneumonia and bronchitis because the only notable symptoms are that the baby struggles to get air in and out of the lungs, therefore the disease often went without the appropriate treatment for years, and this is what lead to a shorter life 26

span. However if the disease is caught early the health practitioners can set up a course of treatment including physiotherapy and drugs, the 7uicker this is started the more likely a person-s life e+pectancy will be greater.

"here is also the factor of transplant - people who haven-t been treated till later on can really struggle with severe symptoms are more likely to be given the option of transplant, in the form of Iungs, Pidneys, pancreases or liver, this can effect the outcome of treatment in a positive way as it may mean that the patient is in less pain, doesn-t need as much physiotherapy or doesn-t need to take so many drugs, it can also prevent the disease from getting worse, which means that the patient may not be as susceptible to infections and this can affect the treatment as it means they won-t need to go to a lot of outpatient appointments to have an I4 to flush out their system $Intro-4enus treatment%. However it could also have a negative outcome as people may become more susceptible to infections, or their body may not accept the new organ as it recogni)es it as foreign and as a result re!ects it, this could result in organ failure, and can cause ma!or problems in life or even death.

Another factor that can affect the result of treatment of 5ystic ,ibrosis is also drugs. I have found that the amount of drugs a 5, patient has to take though out their day is e+tensive with a range of different drugs in order to keep their body functioning because the disease affects the whole body. I interviewed my friend #avid about his own health regime. He told me that in a morning he has a range of drugs to take which include& "aking vitamins- multi vitamins $A and #% 4itamin P for his skin "aurine tablets $for the liver% 5reon capsules $to help digest food% these have to be done every time he eat. 8 Bebulised antibiotics Pulma)yme $too open airways on the lungs% 5olymicin to prevent infection Insulin- nova rapid- three times a day to stop him having LHypo#avid e+plained to me that failure to take these drugs can cause a number of problems with his health, for instance failure to take the 5reon capsules with each of his meals means that his body won-t be able to digest his food which can cause a range of problems. Also depending on the person with the disease and the severity of their condition the drugs may affect the outcome of treatment differently as they may not be effective for some people. In conclusion drugs are a ma!or in the outcome of treatment, especially the lack of them. Another factor is whether people can be bothered to keep up the regime. 5ystic ,ibrosis is a life long disease which means treatment is a constant Lchore- in the patient-s life and as the condition worsens so does the 27

amount of treatment that they have to do2put up with. #avid told me that by 89 years old most 5, patients are sick of constantly up keeping their therapy, and this can result in a negative outcome of the treatment as they begin to slack off with things like their drug and physio therapies which can result in them getting even more poorly as well as becoming more susceptible to opportunistic diseases which can result an increase in the amount of hospital treatment.

#avid also told me that the attitude of family members can influence the outcome of treatment. ,or instance most family-s base their lives around 5, but some family-s like #avid-s take a more rela+ed approach basing the 5, around their lives. *oth approached can have different effects on the outcome of treatment. It can have a positive effect, as it can mean that people keep up to the treatment without getting sick of doing it because it is not all their life revolves around, also if people are not forced to do it they may be able to grasp the conse7uences of not doing it more easily. However it can also affect the outcome of treatment negatively as little children rely on their parents to give them the treatment and if the parents don-t pay it vital attention the disease can get out of hand and may be even worse in later life than it would have been if regular treatment had been kept up also people with the disease may adopt their family-s attitude towards the therapy and not keep up to it which could result in a need for more severe treatment at clinics or hospitals.

In conclusion, after looking at a range of information on the internet, leaflets and through people I talked to I have found that both my chosen communicable and non-communicable diseases are affected by numerous factors which influence the outcome of treatment, some of these factors are very similar and are the same for other communicable and non-communicable, for instance the use of drugs as well as the time periods in which diagnoses and treatment occurs.

As well as looking at the different factors that can affect the outcome of treatment of both of my chosen diseases, I also looked at the different provisions that are available for these diseases. "he whole world is affected by communicable and non-communicable diseases and as well as the number of health promotions, campaigns, solutions, preventions and treatments that the government comes up with in order to deal with all these disease there are thousands of different types of support available to individuals suffering from both infectious and chronic diseases. #uring my piece of coursework I looked at a range of different support services both locally and nationally that are available to those suffering from HI42Aids and 5ystic ,ibrosis&

HI'/AIDS % people that have HI4 suffer from the disease for their life, and the disease usually develops into AI#s so there has to be confidential and supportive services that helps people to deal with their disease, most of these services aims to give people a place and people to talk to so that they can cope with their illness and not feeling alone.HI4 is often classed as a se+ually transmitted diseases due to the fact that it can be distributed through se+ual activity, and compared to other diseases that are spread this way HI4 has the most available support groups for people suffering from the disease. I looked at a range of different

28

support services for my chosen communicable disease by talking to my local Keneral practitioner about it $see witness statement in appendi+%

Health pro#essionals'#octors surgeries- one of the main sources of support for people suffering from HI4 is their local doctor. "his is the primary source of support for patients because this is generally were people are first diagnosed with the disease. If a patient would like to speak to a medical professional face-to-face to talk about HI4 testing, treatment, or to ask for advice then they usually contact their local KP surgery or KA. clinic. A general practitioner $KP% is a 7ualified doctor that can diagnose and treat illnesses and people with the disease can go to the KP for support as they can discuss the effects of their disease, how to deal with it, their medication and dosages as well as information on secondary sources of support for the disease. #octors can also send patients to see other doctors or specialists who are better suited to treating that illness. 'Kum clinic - KA. $Kenitourinary .edicine% clinics are run by the BHS and deal with all aspects of se+ual health. "hey provide free, confidential advice and treatment, and can be attended without a referral from a doctor. "hey are open to people of any age or se+ual orientation. KA. clinics do not contact anyone, including KPs, without the patient-s permission the information and support they give is completely confidential and they help out by providing a safe environment to talk about the disease with out the worry of the people you know finding out. 'emergency treatment- another source of support for people in the later stages of the disease is the A and 3 department. If a patient suffering from the disease is in severe pain and need immediate treatment, they can go to the Accident and 3mergency $A V 3% department at their nearest hospital. A V 3 is open 8D hours, ? days a week, including public holidays and provides support in the form of 7uick urgent treatment. However they do not provide support on dealing or coping with the disease only emergency help. 'HI4 specialists- people suffering from the disease are often referred to other medical professionals that are more aware of the disease in depth. Such as speciali)ed units, and HI4 technicians. "hese are known as secondary health services because the patient has to be referred to them, and their support works in much the same way as the doctor helping out with the everyday ins and outs of the disease such as medication, treatment and other information and advice. 'counsellors - this type of service is doesn-t help with the biological side of the disease, but people suffering from life threatening disease and in the case of HI4 disease with a highly negative profile, the patient can feel alone and as if they have no one to talk to, the !ob of a counsellor is to be there to listen and to give ob!ective advice, this is helpful and supportive because people often find it more productive to talk to strangers rather than family members and friends, so this service helps them to come to terms with their disease and get a lot off of their chest. 'social workers ( the !ob of any social worker is to provide protection and help to vulnerable people, people with HI4 may get referred to social services because of two reasons. ,irstly the nature of the disease often means people are classed as terminal $dyeing% which can have a range of problems both physically and negatively, the aim of the social worker is to be an authority figure that is there to support the individual with advice ect, their second !ob is to protect their clients rights, especially with HI4 people can be discriminated against by places like work, school ect and the social worker is there to make sure that this doesn-t happen 29

 'oluntary wor0ers an! services %

'*arnardos 5orner stone pro!ect ( this is a local group in which adolescents and adults can go to talk about many things including HI4, which the group highly supports $for giving help%, although this services does also focus on other S"I-s, it offers different kinds of se+ual protection such as condoms and gives advice to people its main aim is to educate people about the risks of HI4 as this is the most problematic virus that can be caught through unprotected se+. "his pro!ect is a secondary support service and falls into the volunteer setting as it is provided by people volunteering their own services and funds in order to produce the pro!ect.

'6orld Aids day ( this is an opportunity for people in communities around the world to support people who have the virus by wearing a red ribbon& it is on the = st of #ecember. "his is important to people who have the virus because it is one day were the negative stigma is forgotten and it tells people with the disease that there is support out their for them and that they do deserve to be treat with e7ual rights. "his support is only available to people with HI4 there is no day that supports other diseases classed as S"Is as this is the only se+ually transmitted virus that is terminal.

'help stop HI4 ( charities. 5harities for all the different communicable diseases are what make up a huge part of the voluntary health sector. "here are a range of different charities for HI4 and AI#S that aim to stop the spread of HI4 and help people suffering from it. "his support comes in the form of raising money for the development of other support services, new drugs and treatments ect, these charities also help to raise support and awareness for the disease as people with HI4 can offer suffer from discrimination and abuse because of common misunderstandings and the negative air that surrounds the disease.

'drug facilities and rehab for Aids patients one of the ways people can be infected with HI4 and AI#s is through the use of illegal drugs and in!ecting them with infected needles due to sharing, this is what has lead to the mass distribution of this disease in first world countries especially in underdeveloped areas. "here are many different facilities and rehab clinics that support people who are coming off drugs and by providing information and advice. However there are also a lot of clinics and facilities that don-t !ust base their support around drug addicts but around drug addicts who are suffering from HI4. An individual suffering from this disease as well as addiction can go to these types of clinics for day use in which they will get the chance to talk to counsellors and health professionals as well as gather information on both living with the disease and dealing with addiction, or they can be sectioned $either by themselves or against their will by a family member, health professional or court% this means they are detained for a short amount of time and given support on both their disease and their addiction this type of support may also talk the form of treatment for both conditions.

30

Iocal groups ' Iaura .itchell clinic $se+ual health clinic in west Jorkshire% this is a local medical2se+ual health center that offers a range of health services to se+ually active people and it has an area that is specifically concentrates on se+ually transmitted infections, although the clinic focuses on all S"I-s it does offer a single blood test for HI4 as well as the P3PS3 drug for people that may have been e+posed to the virus. "hey also have a range of leaflets, campaigns and postures that educate people about HI4 as well as information for people suffering from the disease. '*runswick center- support is also available through this service, the center provides support and advocacy for people living with HI4 in Pirklees and 5alderdale. "he center is a registered charity, there are two service teams within the center, the intervention, support and prevention team which provides services to people infected with or directly affected by HI42AI#S and the prevention team which provides HI4 prevention and se+ual health promotion services to gay, bi-se+ual, heterose+uals and black Africans and other communities at increased risk of HI4. "he center also administers the 5alderdale and Pirklees condom distribution scheme and the Pirklees c-card scheme. "hese schemes provide condoms to services who work with vulnerable communities and to young people. "he service teams can also provide training on HI42AI#S, se+ual health and se+uality issues. "he *runswick 5enter has offices in Halifa+, Huddersfield and #ewsbury. "he *runswick center also works at a strategic level within Pirklees and 5alderdale and works with a variety of partners, including the BHS, local Authorities and 5ommunity and 4oluntary sector organi)ations to ensure incidences of HI4 infection are reduced and the se+ual health of local population improved. httpE22www.thebrunswickcentre.org.uk2about2HI4 '.S.- this is a se+ual health promotion, HI4 prevention and community development service for gay, bise+ual men and other men who have se+ with men living in Pirklees or 5alderdale 'local HI42Aids organi)ations- "he local AI#S service organisations provide a range of free services to people infected or affected by HI42AI#S living locally. "hese services can include case management, support groups and individual counselling as well as assistance with treatment, housing and nutrition. Some organisations also offer free HI4 tests or run education and prevention programs. (ational groups '6orld health organi)ation. "he world health organi)ation is a government funded group and it aims to educate, inform and support people with every health condition, communicable disease and non-communicable disease. "his supports HI4 suffers as it raises the most awareness for the disease world wide as well as helping all the other support services to function ade7uately be presenting guidelines. However a problem with this service is that it is one of the only national groups that tackles HI4 yet it doesn-t really deal with patients individually only as a collective group suffering from the same disease. *ystic Fi&rosis- as well as looking at HI4 and the different support groups available to people suffering from it I also looked as those available to people with 5ystic ,ibrosis. 5, is one of the APs biggest non communicable disease, however it is 7uite unfamiliar to most people who do not suffer from it I have found that there are 7uite a few support systems that attempt to make life easier for people suffering from the disease. I looked at a range of different support services for my chosen communicable disease by talking to my local Keneral practitioner about it $see witness statement in appendi+% I also got the perspective from someone actually suffering from the disease and who therefore uses a range of local support services& Health pro#essionals 31

'#octors surgery- like HI4 one of the main sources of support for people suffering from 5ystic ,ibrosis is their local doctor. "his is the primary source of support for patients because this is generally were people with the disease often spend their time going for check-ups regularly to check the progression of the disease as well as for prescriptions of medication . If a patient would like to speak to a medical professional face-to-face to talk about their illness, treatment, or to ask for advice then they usually contact their local KP surgery. 'Private Physiotherapist- while talking to my friend #avid I found out that one of the biggest support systems that he himself has is his regular physiotherapy- people suffering from 5, often have problems with breathing because of the thick mucus build up therefore they doing physio and breathing e+ercises to help stop the buildup of mucus to a point where they cannot breath. "his support is important for a number of reasons, firstly it helps 5, patients to live reasonably normal lives, secondly not only does this service help support them through their treatment it also shows both the family and the patient how to do their own physiotherapy, breathing techni7ues and e+ercise so that they can lead more independent lives. '5ounseling ( this service supports people with the emotional side of the disease and it is important as it is not uncommon for people struggling with 5, to feel alone and isolated especially if they are an only child $which is common with 5, families as the parents don-t want to risk passing the trait on again%. As 5, is 7uite an ambiguous disease with non sufferers not really knowing about it, it is e+tremely important for patients to know they have someone to talk to about how they are feeling so that they can cope with their illness and feel like they can live normally and be the same as others. 'Social workers ( like with HI4 and other diseases, 5, patients can often be discriminated against by non suffers due to misunderstanding of the disease and people who have got it. Social workers often work with 5, patients as they cannot work and therefore can be classed as disabled $vulnerable% and in need of support. Also because the disease causes people with it to have such a short life span it is important that the individual feels like they have someone to talk to that isn-t a family member. 'oluntary wor0ers/groups ',amily members- I was e+tremely surprised to find that the only voluntary support available to 5, suffers is their own family members such as their parents who often have to give up big chunks of their own lives in order to be there for the individual. Hn average >8@ of 5, families only have one parent in work and one parent looking after the child, as there are different clinics, appointments and treatment regimes that have to be administrated and attended ect, looking after a 5, individual is a full time !ob and because it is 7uite unknown by people not suffering from it there isn-t much help available for the families, unlike other diseases such as HI4 which are e+tremely high profile as well as being easily distributed so there are much more voluntary support services available to them.

1ocal groups '5, unit team at saint Mames Hospital ( I learnt about this service from #avid and it is the main adult 5, unit in Jorkshire. "his provides the most support locally in the form of a professional 5, unit team which includes& ; doctors 8 dieticians 8 physiotherapists

32

= D staff nurses

social

#avid told me that on an average outpatient appointment to the hospital includes first meeting the staff nurse who check the weight of the patient as well as their blood sugar levels, blood pressure and temperature, then they go to the physiotherapist who checks their lung function, ne+t it-s the dietician who focuses on their appetite and what they-ve been eating and if their sugar levels have been proven to be too high they look at the reason for that. "hey then have the option of seeing a social worker if they chose to $it is the same one that deals with them every time%. ,inally they see the doctor who listens to the sound of their chest for tell tale crackles $mucus%, reviews the other tests and then goes through a new treatment plan. "his is an important support process and it is a care plan cycle that is constantly reviewed to make sure the patient has the best standard of health possible. 'local support groups- the biggest problem in lack of support for 5, patients is that they are advised to not associate with other 5, patients which makes it hard to provide support groups, however in my local area there are some places which do support groups for 5, patients with their family members as people can sometimes struggle to talk about things that are emotional for them, this type of support is important as it can help air out some problems to avoid hostile feelings in the family. (ational groups '"he 5ystic ,ibrosis "rust- this is the biggest support service available to 5, patients. Its ob!ectives areE - "o fund medical and scientific research provide effective treatments and develop a cure for cystic fibrosis - "o ensure appropriate clinical care for those with cystic fibrosis - "o provide information, advice, support and, where appropriate, financial assistance to anyone affected by cystic fibrosis "he aim of the 5ystic ,ibrosis "rust research is to understand, treat and cure cystic fibrosis. It is the ma!or funder of medical and scientific 5, research in the AP. "he "rustFs research falls into two main categoriesE Kene therapy - "he "rust currently invest over R; million a year in a programme of research into gene therapy to make it a clinical reality in the foreseeable future. Kene therapy aims to add a healthy copy of the faulty 5, gene to the lung. "he 5ystic ,ibrosis "rust has brought together over D9 of the AP-s leading scientists to drive this research forward through the AP 5ystic ,ibrosis Kene "herapy 5onsortium. "he scientists have developed a product, which they plan to take to clinical trials in 899>. "hese trials will cost an additional RD.? million. .edical and Scientific research ( "he "rust supports research aimed at treating and curing the symptoms of 5, and improving the lives of those living with the condition. "he "rust currently spends around R= million a year on this nongene therapy research which will have important and2or imminent clinical benefit to those with cystic fibrosis. 5ystic fibrosis re7uires considerable specialist treatment. In the last =C years, the "rust has helped to set up and staff DC specialist 5, treatment centre-s throughout the AP. Since =::?, the 5ystic ,ibrosis "rust has invested over R=9 million in the BHS to improve clinical care for the >,999 people in the AP with 5,& helping fund doctors, nurses and multidisciplinary teams. "he "rust continues to fund the training of the 5, specialists of tomorrow. "he 5ystic ,ibrosis "rust sets national standard on clinical care, provides and funds a AP 5, 5linical #atabase and measures levels of service provision. "he "rustFs 3+pert Patient Advisers $who all have 5,% work with health providers and 33

government to influence and improve the care of those with 5, across the AP. "he 5ystic ,ibrosis "rust provides a confidential, :-C .onday to ,riday helpline service for advice and support on any aspect of cystic fibrosis. "he "rust also offer information and advice to those affected, their families and friends, schools and employers and anyone interested in cystic fibrosis. "he "rust also advises families on benefits and, where appropriate, provides financial assistance and welfare grants. "he 5ystic ,ibrosis "rust receives donations and support from local communities and outlines on their website a number of ways for interested individuals and groups to get involved with the cause.W In addition to the contributions, fund raising efforts have been undertaken. A portion of the proceeds from the e+hibition and book sales will go to the 5ystic ,ibrosis "rust while the e+hibition describes the recessive gene inheritance pattern that causes ginger, or red, hair - the same inheritance pattern that causes cystic fibrosis. www.cftrust.org.uk2aboutcf2whatiscf2 After e+amining and e+ploring all the different charities, services, people, groups and campaigns out there that have been devised to support people suffering from one of the diseases I also compared and contrasted what I found. In conclusion both my chosen communicable and non-communicable diseases have a range of helpful and effective services that provide support for their every need, they are both similar in that they also have primary, secondary and third sources of support during the different stages of the disease and treatment. However I also think that there are much more support areas for people suffering with HI4 rather that 5ystic ,ibrosis. I think that this is because of a number of reasons, firstly HI4 is a communicable disease, and has become a worldwide pandemic in the last : years, which means that more people have HI4, also it is better known that many other communicable and non communicable disease because of the nature of it. 6hereas 5ystic ,ibrosis isn-t s well known and is a fairly ambiguous disease, also it isn-t as wide spread and I think that these are the reasons that their isn-t as many support services. As well as looking at and comparing the support of both my chosen diseases I also looked at a range of the most common communicable and non communicable diseases that affect people and compared some of these support services to the ones that I investigated while researching my own diseases. I found the communicable and non communicable diseases like LSwine ,lu- and L*reast cancer- had much more services and groups which offer support locally and nationally through health professionals, voluntary and local groups. Such as for swine flu the L5atch it, *in it, Pill it campaign, or the breast cancer awareness day. I think that this is because they are both much more well known then my chosen diseases, much more likely to be contracted $or thought by people that they will be more likely to get them%. And also unlike HI4 they are much more talked about and not considered as taboo sub!ects or have big negative stigmas surrounding them which prevent people from wanting to get close to someone suffering from the dieses, I also found that these other two disease both had much more volunteer work and charity available to them unlike 5ystic ,ibrosis, this could be because as 5, is only distributed through genetics not many people are aware of it because it is not considered to be a ma!or health risk like L*reast cancer- which can affect anyone, and therefore no one has thought to set up a charity for it, this could also be due to the short life span of 5, individuals. 6H PPIA53 ISSA3SHne of the biggest problems with suffering from a disease is the way it affects an individual-s life. 6hile investigating diseases for my coursework I also looked at work related issues and problems that can be caused by diseases. A communicable disease is infectious and can be passed from person to person. And this can cause many problems in the workplace especially if there are a lot of people coming in direct contact i.e. in a open planned office, and this is how communicable dieses like swine flu can be so easily distributed. "hese kinds of dieses can cause a range of issues such as& 34

If people are off the other work load may increase "here may be an uncontainable cycle of infection2rein!ection "emporary closure especially in smaller companies Iegal issues .ore cost i.e. sick pay as well as paying substitutes Identify problems of HI4- the reputation of the company i.e. discrimination2bullying

Impact of communicable diseases& 5ompany2service suffers costs time cost money less efficient may cause hostile environment workplace may have to close

I used the internet to investigate how being HI4 positive can affect a person-s livelihood as well as other in the workplace and the people that they work for. I found the people with HI4 are protected under the #isability #iscrimination Act but to gain this protection they must tell their employer about their diagnosis and if they tell their employer that they don-t have the disease even though they do this can be seen as a breach of mutual trust which could cause problems, however there is no legal obligation the says an individual must tell their employer unless they are specifically asked. "here are a number of reasons that may cause a range of problems in the workplace for instance& If the individual are starting and changing medication they may cause problems such as& .edication can cause a range of side effects which may mean they need to take time off work, this may not be such a big problem if the employer knows about the virus but if they do not know than the individual could get sacked due to taking too much time off without e+planation. 3+tra time off may also have precautions for your employer or collages because they would either have to pay for someone to cover the sick persons workload or it may be put on the other workpeople people to prevent the company from falling behind. People may also feel that it is unfair that they are not allotted the same amount of time off which may cause problems with hostile feeling and a breakdown in team work. "he amount of the persons work may also need reducing after starting a new drug because some of the medication can cause people to feel tired, withdrawn and di))y. Again if an employer is unaware of the disease this can cause all sorts of problems as you may get into trouble for not meeting targets however even if the employer is aware it will cause problems such as e+tra costs as well as e+tra time to meet

35

deadlines this means depending on the company they may fall behind or lose out on custom because they cannot meet previous deadlines. Another problems in the workplace depends on whether the person works with things like machinery as side effects can include nausea and drowsiness because if the person begins to feel drowsy while operating the machine than they could cause a ma!or accident, in!uring themselves or their colleges which can have ma!or repercussions for either themselves of the company they work for. If the individual is discriminated against or treated differently because of their disease. HI4 in the workplace can be an e+tremely controversial because of the nature of disease the sub!ect of HI4 and AI#S is considered as a taboo sub!ect and is treated as such when known about in the workplace. Hften people with the disease cannot avoid the negative stigma that surrounds their disease and they can be treated differently by all society. If people are aware of the disease they may be uncomfortable in front of that individual, they may refuse to come into direct contact with them, the person could even be asked to refrain from using the office toilet because of the misunderstandings of how the disease is passed on.

Another problem that can effect a person in the workplace is that the individual may feel isolated if others are making an effort to avoid them. "here is also the problem of bullying in the workplace, AI#s stigma has been divided into three groups

Instrumental AI#S stigma- which is a reflection of fear and apprehension that are likely to be associated with any deadly and transmissible disease Symbolic aids stigma ( the use of HI4 to e+press attitudes towards the social groups or lifestyles associated with the disease 5ourtesy AI#S stigma- stigmati)ation of people connected to the issue of HI42AI#S.

And because of all these misconceptions there has been a ;:@ increase of abuse and violence in the workplace in the last three years. And this can have persecutions for the company as it is their reputation on the line as well as the problem of law issues to do with discrimination and this is the reason employers are reluctant to employ HI4 positive people. .ay prevent people from being promoted or treat properly- there is also the problem because HI4 is stigmati)ed as being a terminal disease and employers may bypass HI4 individuals due to the fact that they perceive them as not having any future prospects, in other words they are giving them a death sentence that may not e+ist. Also people may not be promoted or treat properly due to the time off they take, employers may not want to pay them as much if they aren-t going to be doing enough work even if they are the Lbest person for the !ob-

36

 A good e+ample of people being discriminated against by their company is Philadelphia which is a =::; American drama film that was one of the first mainstream Hollywood films to acknowledge HI42AI#S, homose+uality and homophobia. In the film "om Hank-s character is LAndrew *eckitt- a homose+ual lawyer who is suffering from AI#S takes his law company to court for unfair dismissal after they set him up to look incompetent when they find out about his disease and se+uality. "he film is a beautiful attempt to rectify the misconceptions of the disease as well as arguing the unfairness of people being discriminated against for such things. It was an e+tremely controversial film but I think it has made a huge difference in how people view HI4 especially in the workplace

Another real life e+ample of HI4 discrimination is yan 6hite who become a poster child after being e+pelled from school because of his infection. A hemophiliac, he became infected with HI4 from a contaminated blood treatment and, when diagnosed in #ecember =:>D, was given si+ months to live. #octors said he posed no risk to other students, but AI#S was poorly understood at the time, and when 6hite tried to return to school, many parents and teachers rallied against his attendance. A lengthy legal battle with the school system ensued, and media coverage of the case made 6hite into a national celebrity and spokesman for AI#S research and public education. "his is also another e+ample of a breakthrough in AI#S discrimination, after 6hite it was ruled that no one suffering from the disease could be dismissed from education or the workplace unfairly.

I also used the internet to look at how suffering from a non-communicable disease can affect the workforce. I found that it isn-t as severe as a communicable disease affecting the workplace as they are not infectious and cannot be passed on no matter cramped or full the workplace is. However like communicable diseases these types of conditions can also effect the workplace, I have found a range of factors that someone suffering from a disease can have on their work place

5onstantly taking time off .ay cause problems between workers if the ill person is given special allowances Hard to find people to cover so often Paying people for not being there, but at the same time that person is legally entitled to that !ob

Impact of non-communicable diseases

Self esteem of the individual Ioses friends2 lack of communication

37

People may feel isolated by their workplace "ime2cost Hard to arrange cover 5onstantly having to play catch up

As well as looking at how my communicable disease and how having it can effect the workplace I also looked at how having 5ystic ,ibrosis can affect it as well, to do this I used the internet but also found out from my friend #avid when I interviewed him. I found that there are fewer problems in the workplace with this type of disease than with viruses like HI4 as it cannot be passed on, it does not have a negative stigma that may affect people-s opinions but most importantly most 5ystic ,ibrosis patients find it difficult to work because of the nature of their condition as well as the time it takes to manage it, which often means that they cannot manage any workload what so ever. However if a 5, patient did choose to work there are a few problems that would affect their own work lives as well as others. Has to be part time work- firstly the most ma!or problem is that if a 5, patient was to find work it would have to be part time in order for them to manage a work load as well as their treatment and many different health appointments, they may also need fle+ible hours and on off days may call up sick without any notice what so ever. "his can be very bad for a workplace as the unreliability can effect a range of things from e+tra costs, not getting all the work done and having to find cover staff at the last minute. Also designing hours around someone can cost time and money and take a lot of effort on the part of the employer

"he workplace has to be e+tremely clean and free of things that might make it difficult to breath- people with 5, suffer from severe breathing difficulties and are constantly being advised to keep areas where they spend a lot of time e+tremely clean, this means free of dirt, dust, pollution and animal hair, which means the !obs they can do are very limited and also puts added pressure on their employer to keep the work space immensely clean as it is their !ob to protect the health and safety of their employees.

"hey may find it difficult to get a !ob because of their condition- do to all the problems with cost, time, effort and fle+ible hours that the person needs to be given to manage their disease employers will often be reluctant to hire someone with such a severe condition as it can often mean that they are being constantly affected and losing out. It can have a massive impact if the company is suffering and they may not be able to afford to keep paying someone who isn-t working as well as paying someone to cover, however that person is entitled to sick pay and this may be the reason that employers often bypass sick people for new !obs.

Hther workers may feel that they are getting special treatment- another problem for the company is that if one person is afforded special treatment and others are it may create a hostile environment between workers this could directly lead to problems with work production due to a breakdown in teamwork which means the company will have to spend more money and time ect and it may even result in the loss of custom or even a 38

bad reputation. However there is also the problem of discrimination and bullying, people with 5, are protected under the #isability #iscrimination Act, which means the company could be taken to court for any unprofessional behavior going on. "his problem can also have direct issues for the individual as they may feel isolated and lonely from the other employees, they may also develop a low self esteem if they are made to feel different by their colleges because of the help they receive

Iike with HI4 5, is a life threatening illness and the knowledge of this may prevent their employers from promoting them. Hn average 5, people don-t live past ;C, which means they can often be bypassed by their employees for promotions and raises as they are not seen to have many future prospects in the company.

As well as identifying work related issues and different problems having one of my chosen diseases I have also looked at and suggested how some of these work related issues may impact on the prevention support and treatment available. I found that work related issues can have a massive impact on prevention support and available treatment. ,or instance HI4, one of the biggest prevention strategies is stressing the importance of hygiene e.g. wearing gloves and putting plaster over any open cuts, and this prevention support has been massively influenced by workplaces such as hospitals, garages, kitchens and health settings as transferring HI4 through blood via direct contact with infected blood, through being accidently stuck with a needle are even from eating food with infected blood on it $which is 7uite a rare occurrence% health professionals thought it e+tremely important to stress the vitality that people need to be aware of HI4 in the work place and the different ways that it can be spread. 6ork related problems have also impacted on discrimination issues that occur when HI4 comes into the picture, and now people are openly advised to be up front about their illness to avoid distribution problems as well as to make sure that they can get the best treatment without being worried about any repercussions. Also work problems have had some effect on the prevention support and treatment of the disease. ecently doctors have developed a new on the go I4 treatment that 5, patients can do themselves so that they don-t have to take much time off work, this can benefit them as it means that their disease won-t have as much an effect as before.

PA " # ,or my health and social coursework I have investigated what is meant by communicable and non communicable diseases, what they do and how they are caused, I have chosen two diseases to investigate in detail, I have looked at how our body responds when infected with each disease, what signs and symptoms we would e+pect to see, what methods health professionals use to diagnose the diseases, how society deals with them, how they are distributed, what influences the outcome of treatment of both of them, work related issues and support available to those suffering from each disease. ,inally I plan to look at strategies for the prevention of the diseases I looked at as well as reasons why they are not always successful.

39

"he biggest strategy for preventing communicable and non communicable diseases that the human race has got is the distribution of vaccinations and the development of cures for disease like swine flu, pneumonia, measles, mumps chicken po+ ect. ,or instance Lsmall po+- used to kill thousands of people per year but has been made e+tinct now due to the vaccination available. However both the diseases I have chosen do have some useful treatments and therapies all these do is make people healthier and increase their life span so far there has been no cure developed for HI4 or 5ystic ,ibrosis although there are certain strategies that the government and health organi)ations have come up with in an attempt to prevent the diseases from being passed on& 3valuation of HI4 and strategies for prevention. 5ondoms and protection- one of the most common ways that HI4 is now distributed is through the e+change of fluids during intercourse and therefore one of the biggest strategies the government has come up with is the importance of safe se+. 5ondoms are available in the shops for both women and men and they are not !ust available for se+ual intercourse but there are also ones available for oral se+ and anal se+ as well. I think that the availability of condoms is very important because it can stop the distribution of HI4 and other unwanted S"Is, the use of protection to prevent the spread of the diseases has proven to be a very useful strategy and there are a range of positive reasons of how it works. ,irstly because you can buy it on the market and it is therefore e+tremely accessible for any age to buy, it also means that people don-t have to feel embarrassed as se+ual intercourse is 7uite a taboo sub!ect even today. Also the wide range of condoms for different types of se+ and se+ualities as well as a variation in coulors, flavors and te+tures means people don-t see it as a boring, uptight thing to use and may therefore be more convinced to use one. However there are also negative points to this strategy that can result in it sometimes being unsuccessful, for instance some people do not pay attention to them and therefore carry on having unprotected se+ and constantly put themselves at risk of catching the dieses, also I found that people having underage se+ are sleeping with multiple partners and don-t often use condoms either because they are not fully aware of the conse7uences of unprotected se+ our they are too scared of getting caught buying them. Another problem Is that condoms are very fragile and can often split by accident during se+ual intercourse which can result in a person contracting HI4 without knowing it, however to overcome this there has been a mass production of e+tra safe condoms that are much more stronger. "here is also the risk of people being allergic to the late+ that condoms are made out of, this may effect the use of them and the availability for them to get hold of ones they can used as these are only available at doctors surgeries and KA. clinics, so this can impact this strategy for protection as they may !ust not feel bothered to go to that much effort and continue having unprotected se+ instead.

40

,inally the biggest reason why this type of prevention is not always successful Is because of L one night stands- if people commit to one of these at last minute they may not have a condom or may !ust forget to use it in the heat of the moment, this is the biggest problem as they don-t know that person and probably never think to ask them if they have HI4

"his shows that condoms can prevent the risk of HI4 being spread it is !ust getting people to use them effectively, there are adverts shown on the television as well which tell people to use a condom, but they are more concentrated on the S"Is like 5hlamydia and unwanted pregnancies. I think that the biggest problems that affect how successful this strategy is, is ignorance if people knew more about the disease and conse7uences they may think more likely to use a condom. However I do think that most people pay attention to the importance of condoms and that they are one of the most effective methods of preventing the disease spreading. Screening of blood transfusions- <<@ of the HI4 population actually contracted the disease through mistakes of the health sector. A lot of infected blood was given to people during hospital blood transfusions and to prevent this health care sector came up with a strategy which included asking people who were donating blood to fill out a health 7uestioner which included 7uestions asking if the donator had ever been e+posed to the disease, if they had the disease or if they had come in direct contact with the disease. Although this did decrease a few of the numbers of people receiving infected blood there was also a lot of holes in this prevention strategy which often resulted in it being unsuccessful&

People may not know if they have the disease- this could happen because people infected with the disease can go years without reali)ing they have it and in this time they can pass the disease on to others without knowing it, this is because HI4 is often referred to as the Lsilent disease- due to the fact that it doesn-t present many symptoms and the ones that we can see mimic that of the average flu virus. "his means that when being asked if they have the disease people may answer no truthfully even though they have the disease which would result in them giving their infected blood. "his is a ma!or problem as blood donators often repeat their donation and until they reali)e that they have the disease they may continue infecting people in this way. "hey may lie about it because either they are embarrassed or they don-t care if they pass it onthis could be another problem with this prevention strategy as people have been proven to lie about things like this, especially on 7uestionnaires where they are not lying to someone-s face so it may be easier. I think there are a number of reasons why people might lie about having HI4, firstly when faced with personal 7uestions people lie so that they sound more socially correct, this is known as social desirability bias, and may happen in this case as people are embarrassed of their disease due to the negative idea people have about it. "here is also the problem of people lying for the sake if it, for instance some HI4 infected people may actually like the idea of infecting people because they see it as unfair that they are infected or they may

41

even be in denial about their disease thinking Lit won-t have happened to me- and may therefore see no problems in giving blood. *ecause of misconceptions some people may think that they can-t have it because they haven-t had unprotected se+, however they may have caught it through other ways. *ecause of common misunderstandings that the disease is passed on through se+ only the person donating the blood may not reali)e that they could be passing on their disease as it is not being se+ually transmitted. "hey may also believe that they don-t have the disease because they haven-t has unprotected se+ however they could of got the disease through other ways like oral se+ or getting the blood or someone into a open cut.

However to overcome the problem of passing on infected blood through transfusions, the health organi)ation came up with a new strategy for prevention and this is LScreening all blood transfusionsthis is a test that all donated blood goes through to check for foreign and perhaps harmful cells in the blood such as the HI4 virus, this test happens to all blood transfusions before it is cleared to be used. However although this is a much more professional and safer way to prevent HI4 being passed on via blood as it gets rid of all the problems listed above I have suggested below a few problems that may even cause this new strategy to be unsuccessful& "he disease cannot be detected until it has inhabited the body for three weeks, so people may Have been checked out and got the all clear even if it isn-t- this is a big problem as the disease cannot be detected in the blood unless it has had chance to regenerate over three weeks and started having an effect on the inside of the body. "his means newly infected blood might get through the screening as negative even if it is carrying the disease. In some cases some of the blood transfusions may slip through the system due to technical problems and other issues- any man made solution can have flaws and if workers are a bit slack or there is something wrong with the technology and machines then it could be possible for infected blood to miss being screened and then passed onto someone via transfusion.

.aking drugs illegal and setting up clinics where people can get clean needles ( many drugs that can be in!ected straight into the blood stream directly through the veins are no illegal, these include heroin, cocaine and amphetamines. People found with a supply of illegal drugs on them can get a criminal record from the police as they are breaking the law. In!ecting drugs and sharing needles through the process causes around ;9@ of HI4 cases outside of sub-Saharan Africa and this can cause barriers to accessing ade7uate treatment services. In!ect able drugs are not available to buy on the market they are only available to buy illegally from Ldealer- or other Lusers- a problem with this is not only the risk of catching HI4 but also the fact that the drugs may not be safe. People take illegal drugs for many different reasons and this is where the problems for prevention arise. #rugs can be taken for the feeling of euphoria they create, rela+ation, energy boost, sleep or because of peer pressure, dependency or
42

other circumstances. .aking these drugs illegal and therefore harder to get and use is one of the strategies put in place by the law to prevent the disease being passed on this hasn-t worked out as planned for a number of reasons& ,or instance peer pressure in groups- the plan for this strategy in cases like this is people would refrain from sharing needles in large groups of peers due to the fact that the drugs are illegal however people still feel like they may have to do drugs to fit in and know that they are illegal some people find it more entertaining to do them. Another problem that prevents this strategy from being successful could be the availability of drugs. "here are around ==.< million people worldwide that are in!ecting drugs, which show the availability of supposed Lillegal- drugs, which means it is easier to get hold of them. However the availability of needles to in!ect the drugs isn-t as easy and this is the reason people carry on sharing needles.

I think that making drugs illegal has not been an effective way of stopping HI4 being distributed and that the use of condoms if much more effective because drugs are so addictive people would rather take the risk of breaking the law and catching HI4 than not getting their drug fi+. However private health provisions have come up with a newer more controversial strategy for preventing this and that it through handing out clean needles to drug addicts. However effective this has been for decreasing the numbers of drug users with the disease there are a lot of problems that prevent this strategy from being totally successful& ,or instance there are a lot of ethical issues with it as drugs are illegal and some people argue that handing out clean needles to drug users is condoning drug use whereas others argue that there is nothing else they can do with the increase in the numbers of the disease spreading. "his means there have been a lot of arguments with the strategy preventing it from being used in some circumstances and places. People are scared about getting done and therefore use unclean needles instead of risking getting done. #rug users are e+tremely paranoid by nature and don-t trust health authorities enough to go and get clean needles off them for fear of being prosecuted for taking illegal drugs.

Preventing mothers from passing it on to unborn child. A pregnant woman can greatly reduce the risk of infecting her baby if she takes the anti-HI4 drug AT" during her pregnancy. *ecause the risk of transmission increases with longer delivery times, the risk can be further reduced by delivering the baby by cesarean section, a surgical procedure in which the baby is delivered through an incision in the motherFs abdominal wall and uterus. 5ombining AT" treatment with cesarean delivery can reduce the infection rate to between =@ and 8@. 6hereas so far there is no way a baby with two 5, traits from each parent can be prevented from having the disease, all doctors can do it tell you if you have the gene and your partner if they have the gene, if you both do than it is your decision to have the baby with a
43

8C@ chance of it having the disease. "heir aren-t really any problems with this prevention strategy however if the mother doesn-t know that she has the disease she won-t be able to start the treatment which can result in her baby getting the disease.

Stressing the importance of knowing your partners se+ual past and getting regular tests- this prevention strategy comes in the form of health campaigns and educating people about the importance of knowing your partners se+ual past for instance the Lse+ual health awareness- campaign leaflets state LIf you are sleeping with someone without protection you might as well be sleeping with everyone they have slept with and everyone they have slept with and everyone they have slept with/- however there are also some problems with this prevention strategy that can cause it to be unsuccessful.

People don-t want to ask new partners if they have been tested- HI4 is 7uite an embarrassing topic and some people may !ust not want to ask someone they have only !ust started seeing if they have get it as it calls all sorts of problems in to 7uestion such as trust and past relationships ect. Also this is a big problem with people who fre7uently have one night stands as HI4 is often not something they think about. *y having unprotected se+ with strangers often people can increase their chance of catching the disease by ;C@ ,inally if you ask your partner about HI4 they may honestly think they haven-t got it and therefore not bother to get it checked out.

In conclusion, after looking at all the strategies for preventing the disease I have come to the conclusion that most of them are very successful and useful as there production has caused a decrease in the amount of people contracting the disease however I have also found that each and every strategy that has been produced thus far also has 7uite a few problems that can lead to it sometimes being ineffective in some cases, however I think a combination of the different strategies has help and been a success in the battle to prevent HI4 from being passed on. 3valuating 5ystic ,ibrosis and strategies for prevention. As well as looking at a number of strategies and how they affect the prevention of HI42 AI#s I also looked at strategies for preventing 5ystic ,ibrosis and whether or not they are successful. However 5ystic ,ibrosis is a non-communicable disease and unlike HI4 is not distributed through direct contact but only through certain peoples genetic make- up and although there are a range of different diagnoses and treatments for the disease there are not yet any known preventions of it being passed on to a baby it is really =99@ chance depending on both parents carrying the trait. However although there aren-t any preventions for the disease being passed on, people can be screened at their local doctors to see if they have the disease, especially if there is history in their family of the disease. However there can be some problems that lead to this strategy not being successful.
44

 "est could be wrong ( this actually happens more fre7uently than it would be thought as no test can be declared as a hundred percent accurate, with 5, screening doctors generally say that it may detect the cystic fibrosis gene in <9 - :9@ of carriers, depending on the test used. "his can be 7uite a miniscule number as 7uite a lot of people do actually carry the trait for the disease and therefore although the test may come up negative it may not be right and can result in people going on to have children with 5,.

People often don-t think to ask for the test as it is not a well known disease- unlike disease like breast cancer, heart disease and leukemia 5, is a very low profile disease as it is only passed on through genetics and the sufferer-s life span is so short. "his means that often people never even think to check if they and their partner have the gene that could cause their child to have such a terrible illness.

Some people decide to risk having a baby even after the test is positive ( as there is only a = in D chance that a baby will be born with the disease if both parents have the 5, gene it is actually 7uite well know for people to have the test and find out that both parents have got the trait and still decide to go ahead with conceiving anyway despite the risk, this is known as denial as most people think Lit won-t happen to us- and this can be a ma!or problem in this strategy for prevention as it means there are still lots of babies being born with the disease. Although their isn-t may strategies for the actual disease I also looked at how people with the disease can prevent more serious health problems associated with the disease , I gathered this information while interviewing #avid about his condition& people who have cystic fibrosis can help prevent more serious health problems such as lung infections byE Peeping immuni)ations current. 5hildren who have cystic fibrosis should have all the recommended immuni)ations in addition to pneumococcal shots ( this is a prevention strategy to stop people with 5, patient from being as susceptible to opportunistic diseases like pneumonia however there are also some problems with this& Parents missing appointments which means their child won-t get all the shots they need, this can be for a number a reason from busy lifestyles to the children !ust not wanting to have an in!ection however the problem is that not using this prevention plan can mean the child gets really poorly and can result in death.

3ating nutritious, high-calorie foods , not smoking, not drinking not having a pet ect ( there are a lot of rules that 5, patients must follow as part of prevention strategies for opportunistic disease however these can often not be followed as people want to live normal lives which can lead to this strategy being unsuccessful as people have unhealthy lifestyles that lead to them catching a range of other infections.

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 Also, parents of a newborn who has been diagnosed with cystic fibrosis should care for the baby at home and avoid placing him or her in day care for at least < months to = year, if possible.

If parents are both working full time they may have to put their child in full time care and as their aren-t any day cares available for children specifically suffering from 5, this can cause problems with this specific prevention strategy

-i&liography. www.nhs/diseasedefinaition.asp www.nhs.co.uk2HI4.org www.nhs2cf2diagnoses2org Health and Social care, ede+cel, 5ollins, .ark 6alsh. www.cftrust.org.uk2aboutcf2whatiscf2 HttpE22www.nhs.uk2condition2HI42diagnosispg.asp+

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