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AIDS Prevention Group 6 Megan Felske Holly Teige Mary Ballingham PREVENTING AIDS CAMPAIGN What impact has AIDS had in the past? This figure shows the number of adults infected with HIV, according to region 1980 to 2003. http://content.nejm.org/cgi/content/full/351/2/115/F1 2006 Statistics • For the United States, annual AIDS deaths peaked at slightly over 51,000 in 1995, just prior to the introduction of more effective drug therapies, and since 1998, AIDS deaths nationally have hovered around 15,000 per year (Henry J. Kaiser Family Foundation 2006). • With controlling for the panel nature of the data, the results of this study show that AIDS mortality in the United States is noticeably influenced by per capita income, physician supply, per capita prescription drug expenditure, and race. (Gallet, Craig Arthur) • In the united states treatment for the HIV virus starts later than what is recommended. 38.3% of people that are newly diagnosed with the virus were diagnosed with AIDS one year later. • In the united states, an estimated 1.1 million people were living with the HIV infection, 56,000 of them were newly infected. (World AIDS Day) Carriers of AIDS/HIV in 2006 • Gays Bisexuals- 53% of all new infections • Heterosexuals- 31% of all new infections • IV Drug users- 12% of all new infections 2008 HIV/AIDS Dilemma • On August 2nd 2008, CBS News correspondent Priya David reported that today over 56,300 new HIV infections are reported yearly, opposed to the 40,000 annual estimate used for the last dozen years. • It is said that the reasons why the numbers have increased is because of the advance in blood testing's. With these advancements scientists can determine when exactly a person conducted the HIV virus.(CBS 2009) • U.S. HIV cases are 40% higher than what was estimated.(CBS 2009) • In 2008 650 million dollars is being funded for HIV/AIDS relief which is about the same as a decade ago, More new cases of people infected with the virus does not increase the resource supply.(CBS 2009) • Based on new calculations, officials believe annual HIV infections have been stable around 55,000 for several years now.(CBS 2009) • The new estimate is "evidence of a failure by government and society to do what it takes to control the epidemic," said Julie David's, executive director of the Community HIV/AIDS Mobilization Project. (CBS 2009) • "This is the biggest news for public health and HIV/AIDS that we've had in a while," said Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors. • Various biologic, cultural, and political factors combine to make women especially vulnerable to HIV. In 2008, estimated 16.5 million women worldwide were living with HIV infection. (World AIDS Day) Incorporating the health and economic variables as well as the sociodemographic variables, state fixed effects, and state time trends, the complete AIDS mortality rate specification for each gender becomes:” (Gallet, Craig Arthur) Life Expectancy The average life expectancy after HIV diagnosis increased from 10.5 to 22.5 years from 1996 to 2005. Life expectancy was better for women than for men. In 2005, life expectancy for African American males were reported the shortest, followed by Hispanic Males. ( Kathleen McDavid Harrison) 2008 CBS Video “ This is the most reliable estimate we’ve had since the beginning of the epidemic” –Dr. Julie Gerbending (CDC Director) ..\..\Downloads\watch.htm Hyperlink) (Highlight- right click- click open MTV and Staying Alive Ignite • MTV and the U.S. President’s Emergency Plan for AIDS relief (PREFAR) and UNICEF unveiled at International Conference 2010, that new research on its “Staying Alive Ignite Campaign” found that creating compelling prosocial entertainment for young people can positively impact the attitudes and behaviors towards HIV/ AIDS. • The funding from the Bill & Melinda Gates Foundation and MTV, commissioned Johns Hopkins University to evaluate the Project Ignite HIV prevention and education campaign. • Alive’s TV drama series Shuga, which is Africa’s hard hitting drama for young adults with compelling HIV prevention and educational messages. Evidence from the Johns Hopkins study suggests that young adults took a liking to receiving important information about HIV/ AIDS through programming. According to Jimmy Kolker, the Chief of HIV and AIDS for UNICEF, “ Preventing new HIV infections among young people requires more knowledge, but even more important, changes in behavior and attitudes, Shuga has been successful because it presents realistic information in a way that adolescents see as relevant to their own lives and behaviors.” ( Obesity, Fitness & Wellness, Aug 7th, 2010,: p3040) Success in Thailand • “ Analysis of HIV transmission rates has provided insight into the impacts of HIV related prevention programming and policies in the United States by providing timely information beyond incidence or prevalence alone. The purpose of this analysis is to use transmission rates to assess past prevention efforts”. (Findings from School of Public Health in HIV/AIDS) • “A national HIV/AIDS program implemented in Thailand in the 1990’s that targeted sex workers and the general population was correlated with a decrease in new cases despite high prevalence. The epidemic in 1991 was when the national transmission rate was 32%, and by the late 1900’s, the rate had dropped to less than 4%. This outcome is the result of a prevention success correlated with the national HIV/AIDS program” (L.S. Park and colleagues, School of Public Health) Population Services International • PSI (Population Services International) is a leading global organization operating in more than 60 countries around the world, they are currently attending the 18th International AIDS Conference in Vienna to showcase PSI’s innovative, evidence based HIV prevention methods, which in fact have helped to successfully avert more than one billion cases of HIV infection over the past 40 years. This meeting is considered a critical gathering for those who work within the fields of HIV/AIDS to assess current progress and evaluate scientific developments in the fight to prevent the spread of HIV. (Global Health) • Krishna Jafa, the Director of HIV, Reproductive Health and Tuberculosis at PSI says, “ As attempts to find a cure continue, we must renew our commitment to HIV prevention and treatment programs that have been proven to work”. • PSI/ Zimbabwe and the partners at the UK Department for International Development and USAID, launched a highly successful HIV prevention program which consisted on counseling, HIV testing’s, Male circumcision, concuuency communications and condom promotions. ( Obesity, Fitness & Wellness Week, Aug 7th 2010) HAART • HAART ( Highly Active Antiretroviral Therapy) is estimated to have saved at least three million years of life at a discounted cost that depends on when therapy is initiated of $350,000 or more per person. • HAART provides many programs for people to cope with HIV/AIDS such as: – “Helping Hands” a transitional supportive housing program (SHP) – “Homes In Harmony” a permanent housing program (HOPWA) – “Hope For Healing” housing for disabled persons with other challenges (SHP) • To Reach HAART: HAART (HIV/AIDS) alliance for region two, Inc 4550 North Blvd., Suite 101 Baton Rouge, LA 70806 (225) 927-1269- Phone (225) 927-7365- Fax Use of Needle Exchange Programs to Reduce New HIV Infection Rates Biological Anthropology Cascadia Community College Summer 2010 Holly Teige “There is no successful intervention for HIV that does not include a comprehensive prevention package for intravenous drug users. That is non-negotiable.” – International AIDS Society President Julio Montaner By the Numbers… How many intravenous drug users (IDUs) are there? • The real number is unknown due to the notorious unreliability of self-reported usage data from users. How many HIV infections are caused by intravenous drug use? • Outside of sub-Saharan Africa approximately 30% of HIV infections are believed to be caused by IV drug use (Fabio Mesquita 2004). • In the United States 12% of new HIV infections originated in the IDUs (PBS:Frontline 2006). Needle Exchange Programs (NEP) What is an NEP? • A community-supported organized system providing IDUs the ability to safely swap dirty needles and syringes for sterile ones, reducing infection rates from blood-borne pathogens, such as HIV and Hepatitis. (PBS:Frontline 2006) Is IV Drug Use Driving HIV Infections? • In many countries, including several in Asia and Eastern Europe, IV drug use is a significant contributing factor in rising HIV infection rates among IDUs (Fabio Mesquita 2004). • Injection drug use makes up 75% of HIV infections in Kuala Lumpur, Malaysia, 69% in Ukraine, and 90% in Russia (ibid). Needle Exchange Programs (NEP) EARLY HISTORY (1970s – 1980s): • In the beginning of the AIDS epidemic IDUs were quickly identified as a large source of new infections. • Initial needle distribution efforts were illicit and unsupported by local governments. • Amsterdam Junkiebond, a drug-users advocacy group, began the first documented open needle exchange in 1984. • First efforts in the United States were underground often driven by users and/or supportive friends and family. In 1986 John Parker, a needle exchange activist, began an informal program in New Haven, Connecticut. • In April 1988 Dave Purchase formed the first openly operated needle exchange program in the US, based in Tacoma, Washington. – This program ultimately grew to become the Point Defiance AIDS project. (Sandra D. Lane 1993) Needle Exchange Programs Cont’d RECENT HISTORY (1990s – 2000s) • Globally there are NEPs in 77 countries including: – – – – Western Europe: 25,000 NEPs United States: 185 NEPs Latin America and Brazil: 122 NEPs Eastern Europe and Central Asia: All countries except Kosovo and Turkmenistan have NEPs – China: 775 NEPs (Avert.org 2010) • Until December 2009 when the Obama administration repealed a 21-year-long ban, the policy the US was the only country to explicitly bar the use of government funds for NEPs (Dillon 2009). Needle Exchange Programs: Clean Needles Save Lives - Needle Exchange in the US http://www.youtube.com/watch?v=zpTKQAaC-Yw Needle Exchange Program: Costs Financial • Initial investment in needle exchange sites can be high. • Ongoing investment in staffing, site maintenance, and needle/syringes/injection equipment is required to provide long-term support. • Possible increase in crime rates and low-income residents in and around needle exchange sites decrease property values. • Increased IDU population also strains public budgets due to their often lowincome status and high level of need for supportive services, often publicly funded. Social • Needle exchange program sites are often considered detrimental to the local community safety although this has not proven true overall. • Increased IDU population in and around region of needle exchange location can drive down community satisfaction. • IDUs may be less likely to pursue treatment for drug abuse if the use of the drug itself is openly permitted. This has not been a consistent outcome however, studies have routinely showed no change in the rate of IDUs entering rehabilitative treatment. (Beiser 2008) Needle Exchange Program: Benefits Financial • Reduced taxpayer-funded expenses to provide healthcare for HIV infected IDUs, saving over $600k per user in potential HIV treatment costs (Schackman, et al. 2006). Social • Improved capacity for understanding and awareness among both the community members and the IDUs themselves. • Increased ability for IDUs to begin effectively contributing to the community through jobs and volunteer efforts. Research Summary Drawbacks • Insufficient confirmation that a large enough supply of syringes was available to make sure every syringe was replaced in every facility within all programs. – NEPs may indeed reduce new HIV infection rate but available data may reflect a gap between what has been done and what can be done. • Uncertainty remains regarding exactly how many needles are required per user. – Impacts cost-benefit analysis in program evaluation. • Information is often reported by the IDUs themselves and as such can be inaccurate and subjective. (Beiser 2008) Are Needle Exchange Programs Effective at Reducing New HIV Infections in Intravenous Drug Users? Yes. All available data reflects at least some reduction in HIV infection rates among intravenous drug users in areas with operating needle exchange programs. Works Cited • • • • • • • • Avert.org. Needle Exchange and Harm Reduction. 07 20, 2010. http://www.avert.org/needle-exchange.htm (accessed 08 05, 2010). Beiser, Vince. Vancouver's Safe Environment for Drug Addicts. 10 27, 2008. http://www.millermccune.com/health/first-reduce-harm-4151/ (accessed 08 05, 2010). Dillon, Connecticut State Rep. Patricia. Needle Exchange Ban Lifted; Ball's in Rells Court. 12 21, 2009. http://newhavenindependent.org/index.php/archives/entry/needle_exchange_ban_lifted_balls_in_rells_court/ (accessed 08 03, 2010). Fabio Mesquita, Telma de Souza, Joan R. Villalbi, M. Teresa Brugal, Patricia Garcia de Olalla, Joan A. Cayla, Gregory M. Lucas, Robert Newman, Paisan Suwannawong, Michel Kazatchkine, France Lert, Jay Franklin Dobkin, Mario Pecheny. Breaking Down Barriers: Lessons on Providing HIV Treatment to Injection Drug Users. New York: Open Society Institute, 2004. Jauffret-Roustide, M., J. Emmanuelli, M. Quaglia, F. Barin, P. Arduin, A. Laporte, and J.-C. Desenclos. "Impact of a Harm-Reduction Policy on HIV and Hepatitis C Virus Transmission Among Drug Users: Recent French Data—The ANRS-Coquelicot Study." Substance Use & Misuse 41, no. 10-12 (11 2006): 1603-1621. PBS:Frontline. Frontline: The age of AIDS: Past/Future: Needle Exchange: A Primer. 05 30, 2006. http://www.pbs.org/wgbh/pages/frontline/aids/past/needle.html (accessed 08 03, 2010). Sandra D. Lane, R.N., Ph.D., M.P.H. "Needle Exchange: A Brief History." HIV/AIDS Information provided by AEGIS.org. 1993. http://www.aegis.com/law/journals/1993/HKFNE009.html (accessed 08 03, 2010). Schackman, Bruce R. PhD, et al. "The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States." Medical Care 44, no. 11 (11 2006): 990-997. Sexual Education Mary Ballingham Biological Anthropology Summer, 2010 Abstinence Only Education • Abstinence Only Education emphasizes following a specific set of strenuous moral guidelines which include: – Abstinence from sexual activity outside the context of marriage – A mutually faithful, monogamous relationship between two people with no other sexual partners Abstinence Only Education (cont.) • The majority of supporters of abstinence only education believe/emphasize: – Abstinence is the only way to prevent unwanted pregnancy and the spread of Sexually Transmitted Diseases – Sexual activity of any kind outside the context of marriage has consequences, both psychologically, physically, and socially – The teaching of comprehensive sexual education encourages early onset of sexual behavior Avert.org Comprehensive Sexual Education • Comprehensive sexual education addresses both the benefits of abstinence and ageappropriate medical information about reproduction and the use of contraceptives • It usually includes developmentally appropriate information on relationships, peer pressure, and self-esteem Advocates for Youth Abstinence Only v. Comprehensive • Many abstinence only supporters believe that comprehensive education will promote or encourage sexual activity. However, studies have shown that teen pregnancy and rates of STD’s actually decreased in schools that taught comprehensive sex-ed • The biggest difference is that comprehensive education acknowledges that some teens will have sex, while abstinence only refuses to acknowledge that youth will be sexually active Collins Statistics • Between 1995 and 2002, the number of teens aged 15-17 who had ever engaged in sexual intercourse declined 10%. • Approximately 14% of the decline in teen sexual activity between 1995 and 2002 was due to teens delaying sex or having sex less often, while 86% was due to an increase in contraceptive use. • By 2002, one-third of teens had not received any formal instruction about contraception. • More than one in five adolescents (21% of females and 24% of males) received abstinence education without receiving instruction about birth control in 2002 • In 2002, only 62% of sexually active female teens had received instruction about contraception before they first had sex • More than nine in 10 teachers believe that students should be taught about contraception, but one in four are prohibited from doing so. Guttmacher Support of Comprehensive Sexual Education • Evidence shows that comprehensive sex education programs that provide information about both abstinence and contraception can help delay the onset of sexual activity among teens, reduce their number of sexual partners and increase contraceptive use when they become sexually active. These findings were underscored in all to Action to Promote Sexual Health and Responsible Sexual Behavior, issued by former Surgeon General David Satcher in June 2001. Guttmacher Programs and Organizations • Advocates for Youth – http://www.advocatesforyouth.org/index.php?option=com_content&task=view&id=450 &Itemid=336 • Healthy Teen Network – http://www.healthyteennetwork.org/vertical/Sites/%7BB4D0CC76-CF784784-BA7C-5D0436F6040C%7D/uploads/%7B4C5F842E-E67A-4AC2-921B287950431BD7%7D.PDF • AVERT.org – http://www.avert.org/abstinence.htm Works Cited • "AVERT.org Abstience and Sexual Education." July, 2008.http://www.avert.org/abstinence.htm (accessed July 22, 2010). • "Advocates for Youth - Comprehensive Sexual Education." January, 2008.http://www.advocatesforyouth.org/index.php?option=com_content &task=view&id=46&Itemid=75 (accessed July 22, 2010). • Collins, Aligiri, Summers, "Abstinence Only vs. Comprehensive Sexual Education: What are the facts." March, 2002."Advocates for Youth Comprehensive Sexual Education." January, 2008.http://www.advocatesforyouth.org/index.php?option=com_content &task=view&id=46&Itemid=75 (accessed July 22, 2010). (accessed July 22, 2010). • "Facts on Sex Education in the United States." Jan, 2010.hhttp://www.guttmacher.org/pubs/fb_sexEd2006.html (accessed July 22, 2010). Conclusion • AIDS is a very serious virus that effects millions of people every day • The best defense against AIDS is to be educated and protected