Download The Community Readiness Model

Advancing HIV/AIDS Prevention in
Native Communities
What Is HIV?
H: Human, because this virus can only infect human
beings
I:
Immuno-deficiency, because the effect of the virus
is to create a deficiency within the body’s immune
system
V: Virus, because this organism is a virus, which means
one of its characteristics is that it is incapable of
reproducing by itself. It reproduces by taking over
the human cell
How Is HIV Spread?
HIV must be present and in sufficient
quantity (in blood very concentrated) and
it must enter the bloodstream
What Is AIDS?
A: Acquired, because it’s a condition one must
acquire, not something transmitted through
genetics
I:
Immune, because it affects the body’s immune
system, the part of the body which usually works to
fight off germs such as bacteria and viruses
D: Deficiency, because it makes the immune system
deficient
S: Syndrome, because someone with AIDS may
experience a wide range of different diseases and
opportunistic infections
CDC Definition Of AIDS
Has changed over the years and includes the following
conditions:
HIV positive, AND
CDC (T-Cell) count below 200, OR presence
of one or more opportunistic infections
~ Kaposi’s Sarcoma
~ AIDS Dementia
~ TB outside of the lung
~ Pulmonary TB
~ Recurring bacterial pneumonia
~ Invasive cervical cancer, etc.
HIV Survival Outside The Body
Length of time depends on:
Amount of HIV present in the body fluid
What conditions the fluid is subjected to
HIV is very fragile, and many common
substances like hot water, soap, bleach and
alcohol will kill it
HIV Survival Outside The Body
Minimal chance of being infected by handling a
body fluid w/HIV unless it enters the
bloodstream through broken skin or touches
mucous membranes (like around eyes)
Air does not kill HIV, but dries the fluid that
contains the virus thus destroying it
HIV can survive for several days in small
amounts of blood found in needles. Needles
are very risky for transmission!
Where Is HIV Found In The Body?
Possibly infectious “bodily fluids”
Pre-seminal fluid
Pre-seminal fluid presents a much
lower risk for HIV transmission than
fluid from ejaculation, but there is
some risk, depending on where this
fluid is deposited
Where Is HIV Found In The Body?
Infectious “Bodily Fluids”
~ Blood (including menstrual blood)
~ Semen
~ Vaginal secretions
~ Breast Milk
Blood contains the highest concentration of
the virus, followed by semen, then vaginal fluids.
Breast milk is a means of transmission for
infants.
Non-infectious “Bodily Fluids”
Saliva
Tears
Sweat
Feces
Urine
Activities That Promote
HIV Transmission
Unprotected sexual contact (body fluids)
Direct blood contact
Drug injection, blood transfusion, health
accident
Mother to Baby (before or during birth,
or through breast milk)
Sexual Routes Of Transmission
Sexual intercourse (vaginal & anal) - HIV may
infect the mucous membranes directly or enter
through cuts/sores
Oral sex - Some what lower risk due to
enzymes, acids, air, which destroy the virus, etc
Heterosexual transmission – From Males to
Females is higher than from Females to Males
Non-sexual Routes Of Transmission
Sharing injection needles
Needle sticks
Blood transfusions
Hemophilia treatments
Other blood products,
i.e. platelets-red blood cells
Mother to child
Donor insemination
HIV is NOT Transmitted By..
Insect bites -mosquitoes, flies, ticks, fleas,
bees, or wasps
Casual contact/sharing dishes or food (not
transmitted by saliva)
Donating blood (sterile needles)
Swimming pools/hot tubs (chemicals kill)
House Pets (cats, dogs)
Saliva/tears/sweat/feces/urine
Transmission through
tattooing, piercing, acupuncture,
electrolysis and shaving
When needles or razors are used on more
than one person, there is a risk BUT the
risk can be reduced by using sterilization
procedures.
No documentation in the U.S. of being
infected through tattooing or piercing
CDC Created Guidelines
Any instruments designed to penetrate the
skin such as tattoo or acupuncture needles
should be used once and discarded or
thoroughly cleaned and sterilized after each
use
Treatment : Three Primary Approaches
Antiviral Therapy
~ Goal is to stop HIV replication with use of
drugs such as AZT and Protease inhibitors
Immune boosting therapy
~ Attempt to bolster the body’s ability to fight
HIV and/or fortify immune system (vaccines)
Treatment & prevention of specific infections
~ Many infections can be controlled, prevented or
eliminated
Monitoring The Immune System
When to begin: if one is asymptomatic and
before the T-cell count declines
Contact a testing site for a physician
referral
Find a doctor who is familiar with treating
HIV disease
Tests That Monitor
the Immune System
HIV viral load – measures amount of HIV in
blood plasma
CD4 count – measures the number of CD
4 cells in blood sample. CD4 count is one
indicator of how much damage HIV has
caused the immune system.
CD8 count- higher count indicates lower
immune function
Immune Monitoring Tests
A doctor MUST order the monitoring
tests and interpret the results
Interpreting CD4 (T-Cell) Results
Most Doctors Agree:
~ Greater than 500 T-cells normal
~ Between 200-500 indicate immunodeficiency
~ Less than 200 indicates severe immunodeficiency
(and is the basis for an AIDS diagnosis)
Single count does not count, should have 3 tests
When To Begin Treatment
Most recommend when—
~ CD4 count less than 500
~ Viral load is greater than 10,000
copies/ml
Natural Approaches
Chinese herbal remedies
Native Spiritual healers and herbalists
Massage
Acupuncture
Healthy diet
Ceremony
Global Summary Of HIV/AIDS
(as of the end of November 2007)
Number of People living with HIV/AIDS
Total………………………………….............33.2 million
Adults………………………………………..…30.8 million
Children under 15 years old……..2.5 million
(women account for nearly 1/2 of all people worldwide living with
HIV/AIDS)
UNAIDS & World Health Organization. (2007). AIDS epidemic update: December 2007.
HIV/AIDS In The US
It is estimated that 1.2 million people are
living with HIV and 25% of those are
unaware of their status
Of the new HIV infections each year:


74% are diagnosed among males
26% among females
Cumulative estimated # of AIDS cases
through December 2006 by race/ethnicity
409,982
42%
White
Black
161,505
17%
Hispanic
API
394,024
40%
7,951
1%
AI/AN
3,345
<1%
Centers for Disease Control and Prevention, Basic Statistics, http://www.cdc.gov/hiv/topics/surveillance/basic.htm#aidsrace, June 2007
20
20
20
20
20
20
20
19
19
19
19
19
19
19
19
19
19
19
19
19
19
06
05
04
03
02
01
00
99
98
97
96
95
94
93
92
91
90
89
88
87
86
85
84
8
44
2
32
19
3500
45
33 8
3
32
84
30
26
30
75
28
3000
37
25
37
23
2500
32
21
40
19
2000
83
17
69
15
33
13
1500
65
10
1000
8
81
500
3
23
7
15
89
56
31
13
6
19
Growth in Native AIDS cases
1984 - 2006
4000
0
Data Collection Concerns
CDC surveillance reports are based on
state data
7 states do not collect data on Natives!
Tribes do no report to IHS
Neither tribes or IHS report data to
states
Other Areas Of Concern
Problems with collection of data
Frequent misclassification of ethnicity
Inclusion of community leaders in
HIV/AIDS dialogues
HIV diagnosis is often made late in the
progression of the disease
Native Risk Factors
Biological
Economic
Social
Behavioral
Biological Risk Factors
Sexually Transmitted Infections are:
~ a Strong indicator of high risk behavior
~ a Key factor in the transmission of HIV
~ Appear to intensify by economic hardship
Economic Risk Factors
POVERTY/ECONOMIC HARDSHIP
Can PREVENT or INHIBIT
Obtaining health education
Accessing good health care
Utilizing proper medical treatment
If impoverished, results can be
Poor health
Poor diet
Related diseases
Diseases Associated With Poverty
DIABETES
Diabetes rates are high among
Natives
Diabetic death rates for Natives are
3.3 times the rate for other races
Diseases Of Poverty
TUBERCULOSIS
High rates of tuberculosis are
found among Native people
(rates reflect 22 times higher among
Natives than other races)
From 1992-1994 Native death rate
from tuberculosis was 475% greater
than other races
Social Risk Factors
Homophobia
Stigma
Mistrust/distrust of provider system
Denial
Confidentiality
Behavioral Risks
Alcohol Abuse Plays a critical role in the
AIDS epidemic
Decreases inhibitions
Alters perceptions
Interferes with the body’s use of
~ vitamins and minerals that are
~ critical to maintain a healthy
~ immune system
Behavioral Risks
Injection Drug Use
Reported as the source of 28% of all Native AIDS cases
among women
Drug use results in high-risk behaviors such as unprotected sex
and sharing of needles
High risk heterosexual contact
Reported as the source of 44% of all Native AIDS cases
among women
Multiple sex partner increase risk among Native women
Where Do We Begin?
Community Decides to Act
Community Readiness Determined
Community Empowerment