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The State of the HIV/AIDS Epidemic County of Los Angeles Department of Public Health Division of HIV and STD Programs Disly Juarez, MPH Health Educator [email protected] 1 HIV AIDS Immune Human Immunodeficiency Acquired AIDS Deficiency HIV Virus Syndrome 2 Special Characteristics of HIV Weakens and compromises the immune system HIV replicates in large quantities Ability to mutate (change itself) very quickly Progressively destroys body’s ability to fight infections and certain cancers 3 HIV/AIDS Defined CDC definition (AIDS): • HIV+ test, T-cell count of < 200 (healthy T-cell count ranges from 8001200) - or – • HIV+ test, and one or more opportunistic infections (OIs) or certain cancers* “AIDS” applies to most advanced stage of HIV infection *TB, Pneumocystis pneumonia, Candidiasis, Kaposi’s sarcoma, cervical cancer 5 Common Opportunistic Infections Pneumocystis carinii Pneumonia (PCP) CMV Infection HIV Wasting Syndrome Candidiasis (oral, esophageal, vaginal) Kaposi’s Sarcoma Tuberculosis HIV - Related Dementia Cervical Cancer 6 HIV Transmission People cannot get HIV from: • • • • • • • Breathing Coughing Sneezing Kissing (dry) Sharing or touching gum Drinking from water fountains Sharing food or drinks • • • • • • Causal touching Telephones Pools/tubs Shaking hands Toilet seats Giving/donating blood 7 HIV Transmission By Infected Body Fluids: 1 Blood 2 Semen, pre-cum 3 Vaginal secretions 4 Breast milk HIV is NOT transmitted by urine, feces, saliva, sweat, tears 8 or giving/donating blood. HIV Transmission By Unprotected Sex: 1 2 3 Anal Vaginal Oral 9 HIV Transmission By Exchanging Infected Blood Sharing needles for any purpose 1 2 3 4 Injection drug use Piercing/ tattooing Insulin, hormone vitamin shots Acupuncture HIV Transmission Mother To Child Transmission during pregnancy (in uterus) during birth process (delivery) breastfeeding (through breast milk/blood) Perinatal transmission can be significantly reduced to less than 2% through the use of anti-HIV drugs during pregnancy (AZT) 11 Spectrum of Risk Activity 12 HIV TEST HIV Antibody test Looks for antibodies Accuracy of the test 99.9% Types of tests Standard test – results will be known in 1 week Rapid test – results will be known in 20 minutes Test settings Anonymous Confidential 13 HIV Diagnosis (Testing) Antibody tests - Uni-Gold Recombigen HIV- results will be known in 10 min. - Reveal G3 Rapid HIV-1 results will be known in 3 minutes - Multispot HIV 1/HIV-2- results will be known in 15 mi. - Clearview HIV 1/2 Stat-Pak - results will be known in 15 mi. - Clearview Complete HIV 1/2- results will be known in 15 min. - Insti HIV-1- results in as little as 60 seconds FDA has, for the first time, approved an over-the-counter HIV Rapid test (Oraquick) for home use. • • 17 yrs. of older Must confirm if reactive HIV TEST Informed Consent 12 yrs of age or older Benefits of Testing…….. Where to test? Private medical doctor County clinic Community-based organizations www.hivla.org 1-800-367-AIDS (2437) 15 California’s “Willful Exposure” Law (1998)/aka “Recalcitrant Behavior”: Willfully exposing another to HIV through unprotected sex 8 years of imprisonment Intention to infect others with HIV through sex To be prosecuted under the law, one would have to do ALL of the following: Have anal or vaginal sex Know that they are HIV + Fail to disclose their HIV status Fail to use a condom Have a specific intent to infect another person Actual knowledge of HIV infection without more evidence of “specific intent” is insufficient for prosecution. 16 CONFIDENTIALITY LAWS Disclosing a person’s HIV+ status to a third party without the individual’s specific signed consent, is illegal. Penalties and damages for unauthorized disclosure of HIV status is a $5,000-$10,000 fine and/or jail sentence. 17 FEDERAL ANTIDISCRIMINATION LAWS • Rehabilitation Act of 1973 and American with Disabilities Act (ADA) 1990 Prohibits discrimination against a person with a disability, including HIV disease or AIDS infection. This prohibits discrimination with regards to employment, public services, public accommodations, and medical care. • Housing Discrimination • Care Discrimination A doctor or dentist cannot refuse to treat an HIV+ person • Fair Employment and Housing Act (FEHA) • Unruh Civil Rights Act 18 PREVENTION 19 PREVENTION “It is not who we are but what we do that puts us at risk for HIV infection” Harm reduction Abstinence Safer Sex Male Condom Female Condom Dental Dams Needle use Not Sharing Needles Cleaning Needles (3x3x3 Method) Needle Exchange 20 PREVENTION Universal Precautions “Infection control measures that reduce the risk of transmission of blood-born germs from patients to health care workers” Wash hands thoroughly Wear latex gloves Use masks and eye protection Wear a gown Carefully handling and disposing of sharp instruments during and after use. 21 PREVENTION BREAST FEEDING It is recommended that HIV+ women do not breastfeed Infants. POST–EXPOSURE PROPHYLAXIS (PEP) Exposure to HIV within the prior 72 hours Approve for 13 yrs of age or older For more information call 213-351-7699 PRE-EXPOSURE PROPHYLAXIS (PREP) It refers to anti-HIV medication used daily or before sexual encounters Start prior to potential exposure 22 TREATMENT 23 TREATMENT Goals of HIV/AIDS treatment; Reduce HIV-related morbidity and prolong survival, Improve quality of life, Restore the immune system, Suppress the viral load, and Prevent vertical HIV transmission (mother to child). 24 Treatment as Prevention Science Magazine named 'HIV Treatment as Prevention' as the breakthrough of 2011 25 TREATMENT What are Anti-retrovirals (ARVs) ? Drugs that interrupt HIV replication & preserve immune system. When to start ARVs?: There are severe symptoms of HIV infection or diagnosis of AIDS with a CD4 count of < 350 cells/mm3 Patient has CD4 count less than 500 /mm3 Recommended for pregnant women who otherwise do not meet criteria to halt vertical transmission Regardless of CD4 count, treatment is recommended for all pregnant patients, and patients with HIV-associated nephropathy (a kidney disorder) or those who need treatment for hepatitis B. Treatment is considered optional for patients with CD4 counts over 500. 26 Current classes of Anti-HIV medications Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Non-Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Protease Inhibitors Entry inhibitors Fusion inhibitors Integrase inhibitors 27 28 Who Pays For Treatment? HMO insurance Medi-Cal Medicare Part D ADAP Shared cost 29 Recent Advancements Immune based therapies Maturation inhibitors Multi-class Combination Products Gene Therapy Vaccine 30 Complementary Therapy General Health Maintenance Psychological Well-Being Spiritual Well-Being Social Well-Being 31 QUESTIONS? 32 For More Information Contact http://publichealth.lacounty.gov/dhsp/ Disly Juarez, MPH [email protected] 213-351-8102 BREAK 34 CSULA, NURS 330Emma Fredua, MPH, CHES • Agenda for 10/21/13 – Review 10/14/13 In-Class Assignment – Review sample articles for essay • Essay is due on Mon, 11/18/13 • Bring printed articles to class for approval on 11/4/13 – Can bring them to class earlier – 10/21/13 In-Class Assignment – Distribute Study Guide for Mid-term 35