HIV infection ACT I

Scene: There is a room filled with 50 students, 1 teacher, and many

puppets. Everyone goes to the front of the room in front of these prying
eyes to speak on HIV. Saucey and the puppet will be the stars of the show.
There is a table in the front of the room. Everyone gets behind the table
with the narrator to the side of the table. This starts the beginning of the Act.
Nadia: Hello, my name is Nadia and I will be play Ona.
Kevin: I am Kevin and I will be playing Saucey.
Katelynn: I am Katie and I will be playing Meth.
Ciera: I am Ciera and I play Ana.
Elizabeth: I am Elizabeth and I play the teacher.
Koshy: I am Koshy and I will be playing Jack.
Melissa: I am Melissa and I play Consti.
And we will be putting on a puppet show
Elizabeth: And we are here to talk a little bit on HIV and Hepatitis as well as
describe a new program that would be beneficial to young teens in educating
them on these diseases. To start off, I will introduce you to our guest of
honor. This is Saucey.
Saucey: Hello, my name is Saucey and I have HIV which stands for Human
Immunodeficiency Virus. Im part human.
Elizabeth: [To classroom] Ok everyone say hello to Saucey!
Entire group: Hello Saucey!
Saucey: Hello, thanks for having me.
Elizabeth: HIV has been becoming a major concern in the United States and
abroad and we hear more about it every year. As a result we need more
programs to educate children, teenagers, and even adults on the risks of
contracting this virus. Worldwide, 38 million people live with HIV infection
and 2/3 of those people live in Sub-Saharan Africa. Since the epidemic
began, approximately 1.1 million people in the US have been diagnosed with
AIDS and nearly 619,000 died from it.

Kevin: The largest number of new HIV infections in 2010 were 11,200 white
males who had sex with other men followed by 10,600 black men having sex
with other men. Heterosexuals accounted for 25% of the estimated new
cases in 2010 and 27% of the people living with HIV infection in 2009.
Infections in women are primarily due to heterosexual contact or injection
drug use. IN 2010, women accounted for 20% of new HIV infections and in
2009 for 24% of the people living with HIV infection.
Melissa: Ugh so many facts (looks annoyed)
Elizabeth: Does anybody have anything else to add?
Nadia: Oh oh you want to know what my dad told me?[Holds up syringe]
Injection drug users represented 8% of new cases in 2010 and 16% of the
people in 2009. African Americans experience the most severe burden of
HIV in that they represent 12% of the US population and an estimated 44%
of new cases in 2010. Hispanic/Latinos represented 16% of the population in
2010 and 20% of new cases. Although persons over 50 years of age
continue to represent a relatively small proportion of new infections, those
who have unprotected sex, consume alcohol, or inject drugs are at higher
risk for contracting HIV/AIDS than younger people with the same lifestyle
characteristics.
Saucey: The geographic distribution of HIV infections is more concentrated
in urban areas like Sesame Street.. or even Houston. According to Aids.gov,
this prevalence has remained at a steady rate for the past few years at
50,000 new infections each year. The makes the population vulnerable
because it is still such a high number and approximately 12.8 of these
people, as young as 13, are not even aware they have HIV. [All puppets look
at Saucey with mouths wide open all at once]. This provides oppurtunities
for even more people to get infected each year furthering the prevalence of
HIV. The infection compromises the immune system, putting them at risk for
additional health concerns and thereby making them a vulnerable
population.
Katie: Well from what I heard Those with HIV and AIDS also experience
discrimination for many reasons, preventing them from obtaining proper
healthcare and the support they need, again making them vulnerable. In the
1980s for example, HIV and AIDS were a major concern and fear for a
majority of the population. People were ill educated and as a result, had
false beliefs about the infection and were not taking proper measures to
prevent its spread. Those with HIV and AIDS run the risk of social isolation,

job loss, financial concerns, and likely will suffer from feelings of
hopelessness, thereby decreasing self esteem. Drug use, sex and
homosexuality still today are considered taboo subjects that encounter
much resistance.
Saucey: Oscar the Grouch did not talk to me for months when he found out I
had HIV.
Elizabeth: So Saucey do you know how people can get HIV?
Saucey: Sure. HIV is contracted in four ways: Contaminated blood
transfusion (which doesnt happen very often in the U.S. because of
screening), Shared injection drug use, Mothers can even pass the virus onto
their newborns as well as through breastmilk, and unfortunately, I got it
through unprotected sex with Elmo. [Puts her hands in the air] Who knew he
had so many partners?
Elizabeth: Can anyone tell me what the stages for HIV are?
Students: Pick me Pick me
Elizabeth: Yes Ana?
Ciera: HIV usually includes three stages: The primary infection which usually
occurs within 1 month of contracting the virus, clinical latency which is a
period of time with no obvious symptoms, and the final stage of symptomatic
disease. In the begininning stages, a person can have such signs or
symptoms such as fever [Saucey puts her hand to her forehead], fatigue
[Saucey bends over on table], myalgias [Saucey crosses her arms and goes
OOOoooooo], sore throat [Saucey puts her hands to her throat], night
sweats [Saucey shivers], maculopapular rash [Saucey says, You cant see
mine because of my long hair], and headache [Saucey puts both hands on
sides of head and goes OOoooooo]. HIV is a retrovirus that selectively
attacks the CD4 T lymphocytes which are the immune cells responsible for
orchestrating and coordinating the immune response to infections. As a
consequence, persons with this infection have a deteriorating immune
system and thus is more susceptible to severe infections from ordinary
organisms.
Elizabeth: Would someone like to explain the 8 steps of HIV Transmition?
Koshy: Sure! HIV is spherical and contains an electron dense core
surrounded by a lipid envelope and the core contains a capsid or outer shell

made up of a protein called p24 and it uses RNA, instead of DNA, to replicate
itself into the host cell. It does this in eight steps. These are healthy CD4 T
cells which fight off infections in your body The first step involves the binding
of the virus to this cell which is called attachment. When it does this, it binds
with other surface molecules called chemokine coreceptors. The second
step involves the internalization of the virus. After attachment, the viral
envelope peptides fuse to the CD4 cell membrane which uncoats the cell so
the viruss contents can enter the host cell. Step three consists of DNA
synthesis. To reproduce, the virus much change its RNA into DNA using
reverse transcrptase enzyme. This enzyme makes a copy of the viral RNA,
and then in reverse makes a complementary DNA strand that will carry
instructions for viral replication. The fourth step is called integration. The
cDNA enters the nucleus and is inserted into the cells original DNA.
Melissa: The fifth step involves transcription of the double-stranded viral DNA
to form a single stranded messenger RNA with the instructions for building
new viruses. The sixth step includes translation of the viral mRNA.
Ribosomal RNA using the instruction from the mRNA to form polyproteins
which are essential in the construction of new viruses. The seventh step is
called cleavage. During cleavage, the protease enzyme cuts the polyprotein
chain into the individual proteins that will make up new viruses. Finally,
during the eighth step, the core proteins migrate to the cell membrane,
where they acquire a lipid envelope that buds off from the cell membrane.
Productive infections, associated with extensive viral budding lead to cell
death and these HIV viruses are ready for to dominate. As time goes on the
HIV cells replicate exponentially and kills off the CD4 cells.
Elizabeth: Can anyone explain at what point HIV turns into AIDS?
Saucey: Well once the CD4 count becomes less than 200 cell/uL or less than
14%, the infected person officially has AIDS which stands for Acquired
ImmunoDeficiency Syndrome. There is still hope however. There are
medications constantly being developed that help fight off the virus. New
technologies and research have invented new medicines to make life easier
with the virus; however, they are usually not a cure and may come with side
effects like everything else. There is still hope though and infected people
need to know that life can be easier if they seek out help and support
through family and organizations.
Elizabeth: Now since that is over with, we are now going to talk about our
pro

Saucey: [raises hand and interrupts Elizabeth] Hey hey I have something
else to say.
Elizabeth: What is that?
Saucey: I also have Hepatitis [lowers head]
Elizabeth: Well I guess we are going to talk about Hepatitis now! So Saucey,
what kind of information you have for us?
Saucey: Well the general form of Hepatitis is characterized by inflammation
of the liver. It can be easily acquired by different people, especially those
working in the healthcare industry. [Points to audience] You better be careful
nurses!! Viral hepatitis is a group of infections that primarily affect the liver
and there are several different forms of it along with its unique causes and
characteristics. It can make a population vulnerable because most of the
time, people are not even aware they have the virus and can pass it on to
other people. Depending on the type of Hepatitis, different body systems are
negatively affected. Examples include the digestive, circulatory, endocrine,
immune, and central nervous system as well as others. Because of the
adverse effects on the body system, those with Hepatitis are considered a
vulnerable population.
Elizabeth: Lets start from the beginning. Who can tell me about Hepatitis A?
Nadia: The first form is Hepatitis A is a benign infection and thanks to the
vaccination for hepatitis A, it is rarely seen in the U.S. today. It is carried
mainly through the fecal-oral route. This infection can cause a mild flu-like
illness or acute hepatitis with jaundice, and it could also cause acute liver
failure. Poor hygiene, improper food handling, poor sanitary conditions, and
contaminated food are the contributing factors. It is a ribonucleic acid virus
that is usually found in feces 2 or more weeks before the onset of symptoms
and up to 1 week after the onset of jaundice and the IgM antibody usually
shows up in the serum if the virus exists. To prevent ongoing outbreaks, it is
recommended that people get the Hepatitus A vaccine as well making sure
everyone washes their hands thoroughly before and after handling food.
This specific type is highly endemic in areas such as Central and South
America, Africa, the Middle East, Asia, and the Western Pacific. In the early
to mid 1990s, children ages 2 to 18 had the highest rate for Hepatitis A, but
since then the numbers have decreased by 93.7% overall.
Koshy: Theres another one.

Saucey: Well I have Hepatitis B which can either be an acute or chronic liver
disease and it is spread through infected blood or body fluids which includes
needle sticks, IV drug use, semen, vaginal secretions, and saliva with sexual
transmission being the most common mode. About 12 million Americans
have been infected with Hepatitis B and the majority of the people with
acute Hepatitis B were able to resolve it. Of the more than 1 million
Americans with chronic infections, approximately 15 to 25% die from chronic
liver disease. It is a DNA virus with a complex structure of 3 distinct
antigens: the surface antigen, the core antigen, and the e antigen. Either
one of these antigens lets the doctor know you most likely have the virus.
Hepatitis B can also live on a dry surface for at least 7 days and it is much
more infectious than HIV. In fact while I go through the statistics, Elizabeth
will show you my inflamed liver [Elizabeth takes liver from Saucey]. This
form of Hapatitis typically manifests during adulthood and 0.1-0.5% of the
population are chronic carriers. In countries such as China, Africa, Southeast
Asia, part of the Pacific Islands and the Middle East and the Amazon Basin,
15% of the population carry the virus. From 1990-2004, the number of cases
of Hep B declined by 75% as a result of prevention efforts. However, there
are still an estimated 800,000 to 1.4 million people in the United States are
chronically infected with Hep B.
Koshy: But wait! Theres another one
Katie: Hepatitis C can also cause both acute and chronic illnesses and acute
C is usually asymptomatic which makes it difficult to detect unless with
laboratory testing. The most common causes of acute Hepatitis C are
injection drug use and outbreaks among HIV positive men who have sex with
men. In fact, about 30 to 40% of HIV infected patients also have Hepatitis C
which is primarily related to IV drug use and places the person at greater risk
for progression to cirrhosis. The majority of people usually acquire the
chronic infection and most are unaware they have it as well. People can also
get hepatits C from getting tattoos as well. Thanks to Ms. Dominguez, we
found out that the virus can actually live in the ink itself. Sorry to tell you
this Garret! The chronic Hepatitis C disease usually results in progressive
liver disease and 20 to 30% of patients develop cirrhosis and Hep C is the
most common cause of chronic liver disease and the most common
indication for liver transplantation in the United States. Hep C is a RNA virus
that is primarily transmitted percutaneously with the most common mode
being the sharing of contaminated needles and equipment among IV drug
users. Chronic Hep B and Hep C account for 80% of the cases of
hepatocellular cancer. There are an estimated 170 million people living with

the Hep C virus and the prevalence in many developed countries such as the
United States is less than 2%.
Saucey: Hey it is just like the alphabet! A, B, C, and theres still more!!
Koshy: Another one
Ciera: Thats right! Hepatitis D is a defective single-stranded RNA virus that
cannot survive on its own so it needs the help of Hepatitis B to replicate it.
[Saucey states Thats me!] It can be acquired at the same time as Hep B,
and it is transmitted percutaneouldy similar to Hep B. Hep D can cause a
spectrum of illness ranging from asymptomatic chronic carrier state to acute
liver failure and there is no vaccine for the virus. Getting the vaccine for Hep
B; however, will reduce the risk for Hep D. Hepatitis D is fairly uncommon in
the United States.
Koshy: Another one
Melissa: Hepatitis E is an RNA virus transmitted by the fecal-oral route with
the usual mode of transmission being drinking contaminated water. Hep E
occurs primarily in developing countries with epidemics in India, Mexico, and
Africa; however, there have been a few reported cases in the U.S. but from
people who have traveled from other countries.
Saucey: Wow, thats a lot of Hepatitisesisis!
Elizabeth: Now we will talk about the program we are investing our time in
like what you are seeing now. We are proposing a puppet-derived program
called Puppets-R-Us. We encourage everyone to come but specifically are
targeting adolescents and young adults ages 13-35.
Saucey: Yes, we are doing this because most teenagers are not interested in
long boring meetings and if they do go, they are paying more attention to
their phone on facebook and snapchat than the speaker. As mentioned
previously teenagers as young as 13 can get these viruses and most dont
even know it. For example, [points to a random person on first row] you look
like your 15 and you would make the perfect candidate!

Program
Elizabeth: This is a puppet show that provides information regarding facts,
statistics, and preventative methods for HIV and Hepatitis. Every month or
two, we hope to bring in people who have or have had the infections to come
as guest speakers. For this particular program, there will be a total of 7
puppets, the main star being Saucey, all of whom use humor to try and
engage the audience and increase their learning. There are two umbrella
topics, HIV and Hepatitis. However, under HIV will be the sub topic of AIDS
and under Hepatitis will be the sub topics of the Hepatitis A, B, C, D, and E.
Each of the shows we put on will cover all main and subtopics but every
month, we will choose a specific sub topic to focus in on and rotate between
them throughout the year to add variety.
Elizabeth: As you can see we have a wide variety of puppets available for
different subjects to keep the program interesting and not boring. [Raises
both hands] Raise your hands if you think using puppets to bring this
message to the community would catch their attention! {Hopefully
everyone raises hands and so should you}
Everyone come out of hiding
Koshy: With this program, our goal is to decrease the prevalence of both HIV
and Hepatitis within the community by using the knowledge we provide them
with. (Elizabeth writes schedule on board) The meetings will be the first
Monday of every month at 10 am, and the last Thursday of every month at
7pm and it will last 30 min to 1 hour depending on the audience
participation. This way, we have a better chance of catching people who are
at work, school, or doing other things at one particular time. The overall
purpose of this program is to educate teenagers and young adults about
diseases that are prevalent in their population. As you have just seen, each
puppet will teach about a specific subject and they will employ humor as a
means to grab the attention of the audience.
Melissa: We will also use different ways that encourage participation from
the audience to enhance learning. For example, one day we may tape slips
of paper under selected chairs that have a fact or two written on them.
[Elizabeth takes a slip of paper from nearby chair]. Before the show begins,
the audience will be asked to check under their seats and read the note
should they feel comfortable doing this. [Elizabeth reads the note].

Nadia: Our main goal of this program is to create awareness and reduce the
number of preventable cases of both HIV and Hepatitis which brings me to
our three main objectives. The first objective is to increase public
participation in the overall programs being offered by 50% by the end of the
sixth month. We need to get the word out there and once people show up,
they can spread the word and by doing so, we will increase awareness and
knowledge as well as preventative measures.
Kevin: The second objective is at the end of every month, 40% of
participants will get tested for HIV. We will do this by keeping in touch with
the participants through their preferred method and ask that they let us
know when they get tested. We want to decrease the number of those who
are unaware that they have the infection, which theoretically will aid in the
prevention of its spread. The third objective is by the end of every year,
raise a sufficient amount of money to cover expenses as well as being able
to donate to the Bering Support Network for HIV/AIDS or Houston Medical
Center Support Group for Hepatitis or a local support group that supports our
cause.
Katie: successful completion of this program depends on the individual.
People are allowed to come as many times as they want, and they will
determine when they feel they have obtained enough information. If
someone wants that extra boost of confidence we can also offer a
completion certificate if someone decides to come a recommended period
of time such as at least one meeting per month for six straight months. This
may make them feel more accomplished that they have done something to
promote their health and they have proof. We will also provide flyers with
the names of local support groups and contact numbers as well as referrals
to websites such as the CDC and WHO were participants can find more
information.
Ciera: The location of the meetings will most likely be arranged in a
community center in the heart of the population where it is needed most.
There may be other places as well such as the school auditoriums, college
campuses, or even local churches. This is a not-for-profit organization that
does accept donations. We do not want to charge people to come to our
meetings, but we will take donations to help cover the costs. We will also
see if certain companies will sponsor our program as we come to their town
to help with expenses.

Elizabeth: Thank you all for coming and listening to us. It is always good to
learn more on diseases like Hepatitis and HIV. I hope you enjoyed our
program and if you want to donate any money, Saucey and the other
puppets will gladly accept your cash.