Download HIV/AIDS Defined

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