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Border Health Foundation
Tucson, Arizona
PRESENTS
Understanding
HIV/AIDS
Capacity Building Assistance-Migrant Project
A Centers for Disease Control and Prevention (CDC) Funded Project
Presented by
Ernest D. Pérez
Capacity Building Assistance Trainer
May, 2009
Training Objectives
At the end of this training, participants
will have a better understanding of:
• The basics, facts, risks, and
prevention of HIV.
• Knowing how to apply the facts
about HIV to their own behavior.
• How to gain education for personal
growth and sharing with others.
Ground Rules
•
•
•
•
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Cell phones…vibrate only please
Confidentiality
Take notes and pass this on
Participate
Have fun
Introduction
Material on HIV and AIDS varies
greatly.
• There are factual information
sources.
• There are preventative measures.
• Some information is intended to
motivate specific audiences.
HIV/AIDS Represented
• What is HIV?
• What is AIDS?
Historic Notes
• Earliest known infection was a gentleman
from Belgian Congo in the 1950’s.
• A sailor from Norway died of immune
deficiency in 1966.
• Additional deaths occasionally occurred in
the 1970’s from individuals who once lived
in Africa.
• During 1979 to 1981, increased
documented cases of a mysterious ailment
was caused by “needle sharing.”
Historic notes, continued
• The first official publication on the
existence of HIV (not yet named that)
MMWR in 1981.
• In March 1983, CDC described the risk
factors that were producing this unusual
ailment.
• Before named AIDS in 1982, there were
various names for the strange ailment that
was afflicting gay men and IDU’s.
• Secretary of HHS reports in a news
conference on April 23, 1984 that Robert
Gallo of France successfully isolated the
HIV Virus.
Historic notes continued
• In 1985, AIDS was officially attributed
to HIV infection.
• Ryan White was barred from
attending school in Kokomo, Indiana.
He had AIDS.
• Also in 1985,Gay Men’s Health Crisis
was formed in New York City,
thereafter activist organizations,
social service agencies and support
agencies were created in cities
across the country.
Historic Notes
• Cleve Jones, AIDS activist came up with
an idea for remembrance and healing that
originated in 1985, as a means of honoring
all those who died from AIDS by creating
the “AIDS Quilt.”
• The “Quilt was first displayed in Oct 1987
in Washington DC.
• In the years that followed, many people
known to the public will confirm their HIV
Status and /or die from AIDS.
Historic Notes
• In January 2000, at the 7th Conference
on Retroviruses and Opportunistic
Infections, suggested that the first
case of HIV-1 occurred around 1930.
• In 2002, Kami, a Muppet playing a 5year HIV-positive child orphaned by
AIDS, joined the South African cast of
Sesame Street.
Transmission
In order for HIV to pass from person
to person, four factors must exist:
Germ
Dose
Route
Susceptible Person
Transmission
•
•
•
•
•
Unprotected sex is the primary
means of transmitting the virus.
Sexual contacts that transmit the
virus vary:
Vaginal-Penile
Anal-Penile
Oral-Penile
Oral-Vaginal
Oral-Anal
HIV is not a strong virus, nor is it easily
transmitted from person to person,
however, when in the human system it
is extremely detrimental and resilient.
HIV infected cell
Healthy white blood cell
• Our blood cells are labeled by what two colors?
• What is the major function of red cells?
• What is the major function of white blood cells?
Some of the main cells in your immune system are:
• – The macrophage: Macro = Big, Phage = Eater. The Big
Eater.– The T4 Helper Cell (CD4): Captain of your immune
system.
• – The B Cell: Like a factory. It identifies the shape of the
invader (antigen) and makes “antibodies” (like keys)
•
The T8 (CD8) or Cytotoxic or Killer Cell: Also called by the
T4 Helper Cell to attack the invader and kill it directly.
• What is an antigen? An antigen is a foreign invader or germ
that enters our system. It can be a virus, a bacteria, fungus,
protozoa, and so forth.
• What is an antibody? An antibody is a response to an
invading antigen. Antibodies are produced by B cells. They
work like “keys,” fitting the shape of the antigen “locks.”
When an antigen enters the system again, it is recognized
and attacked by antibodies.
• What is Human Immune–Deficiency Virus (HIV)? The virus
that attacks the T4 Helper Cell. When it cripples enough T4
Helper Cells, the rest of the immune system is not called
into action. Other antigens invade the body and cause
disease. At this point, the infected person develops
Acquired Immune Deficiency Syndrome (AIDS).
Germ
•In the case of HIV, the germ is
a virus.
•This is a picture of HIV. The
green particles are HIV
particles, which are infecting
the much larger T helper cells.
HIV infects the T Helper cell
because it has the protein CD4
on its surface. HIV needs to use
CD4 to enter cells it infects.
Once inside a T helper cell, HIV
takes over the cell and
replicates. In this process the
infected cell often dies. New
virus then seeks out new T helper cells to infect
DOSE
o It is not possible to say what dose is
necessary to infect people
o What is known is that certain bodily
fluids carry higher doses of HIV than
others (ex. Blood more than Tears
and Saliva)
o Four fluids carry a sufficient dose of
HIV for transmission from person to
person
“How is HIV contracted?”
4 body fluids that
can spread HIV;
• blood
•semen
•vaginal fluids
•and breast milk.
•If other body fluids contain visible blood, they can
also spread the virus.
Susceptible person
Non-infected or infected person –(re-infection or
infection of a new strain of HIV)
Exhibits behaviors that put them at risk
•A person can be susceptible for
many reasons;
•Malnutrition
•Heredity
•Drug and alcohol abuse
•STDs
What tests are used to detect
HIV?
These tests detect antibodies to HIV:
• Enzyme-Linked Immunobsorbent
Assays (ELISA)
• Enzyme Immuno-Assay (EIA)
• Western Blot (WB)
Testing Techniques
• Oral Fluid that requires saliva from
gums.
• Finger stick that requires blood or
blood plasma.
Rapid tests are cost effective; have
high specificity detection.
Epidemiology
• There are two types of HIV virus, HIV-I and
HIV-2 . Each type has sub-types. Research
suggests:
Type 1 HIV is linked to a simian
immunodeficiency virus (SIV) found in a
particular species of Chimpanzee; 90% of
the world’s HIV infections are from this
virus. Also known as lentivirus.
Type 2 similar SIV found in sooty Mangabey
monkeys of West Africa. A rare and less
infectious and progresses more slowly to
AIDS that HIV-1
Epidemiology
• Most cases occur among men
• Cases increase each year among
women.
• Communities of color are affected
disproportionately.
• AIDS has shifted from a “terminal
illness” to a manageable condition.
Which act is more risky ?
1 Transfusion
2 Injecting drugs with dirty works
3 STDs
4 Anal Sex
(Unprotected)
5 Hetero receptive (woman) (unprotected)
6 Hetero insertive (man) (unprotected)
7 Oral sex (unprotected)
8 (unsafe sex…) Play the odds, roll the dice!
Factors, include STDs, lubrication (natural or unnatural) age, age of partner, partner’s viral load
The Different Stages of HIV
Infection
HIV infection can generally be broken
down into four distinct stages:
• Clinical stage 1 : primary infection,
• Clinical stage 2: clinically
asymptomatic stage,
• Clinical stage 3: symptomatic HIV
infection,
• Clinical stage 4: progression from HIV
to AIDS.
Stages of HIV
Clinical stage l:
1. Asymptomatic
2.
Generalized lymphadenopathy
Performance scale 1: asymptomatic, normal activity
Clinical Stage II:
•
3. Weight loss <10% of body weight
4. Minor mucocutaneous manifestations (seborrheic
dermatitis, prurigo, fungal nail infections, recurrent
oral ulcerations, angular cheilitis)
5. Herpes zoster within the last five years
6. Recurrent upper respiratory tract infections (i.e.
bacterial sinusitis)
•
And/or performance scale 2: symptomatic, normal
activity
Clinical Stage III:
7. Weight loss >10% of body weight
8. Unexplained chronic diarrhea, >1 month
9. Unexplained prolonged fever (intermittent
or constant), >1 month
10. Oral candidiasis (thrush)
11. Oral hairy leucoplakia
12. Pulmonary tuberculosis
13. Severe bacterial infections (i.e.
pneumonia, pyomyositis)
• And/or performance scale 3: bedridden <50%
of the day during last month
Clinical Stage IV:
• 14. HIV wasting syndrome [i]
15. Pneumocystic carinii pneumonia
16. Toxoplasmosis of the brain
17. Cryptosporidiosis with diarrhea >1 month
18. Cryptococcosis, extra pulmonary
19. Cytomegalovirus disease of an organ other than liver, spleen
or lymph node (e.g. retinitis)
20. Herpes simplex virus infection, mucocutaneous (>1 month) or
visceral
21. Progressive multifocal leucoencephalopathy
22. Any disseminated endemic mycosis
23. Candidiasis of esophagus, trachea, bronchi
24. Atypical mycobacteriosis, disseminated or pulmonary
25. Non-typhoid Salmonella septicemia
26. Extra pulmonary tuberculosis
27. Lymphoma
28. Kaposi's sarcoma
29. HIV encephalopathy [ii]
• And/or performance scale 4: bedridden >50% of the day during last
month
“So what’s the difference between
HIV and AIDS?”
•CD4 HT cell count of 200
•Only a doctor can diagnose this
•HIV (human immunodeficiency virus) is the virus that
causes AIDS (acquired immunodeficiency syndrome).
•People with HIV have what is called “HIV infection” and
will eventually develop AIDS as a result.
Viral Load
Viral load is highest in the window
period and in the later (AIDS) stages
Higher viral load leads to higher
likelihood of transmission
Window Period
• The period between infection and the point
at which the tests can detect the signs of
infection is called the window period. If
people are tested during this time with
standard tests they may test negative
despite a positive prescence of HIV in their
bodies.
• The window period is 3 months.
Get tested 3 months after you were at-risk.
• The window period can occur from 2
weeks to 24 weeks, so the average is 3
months. The average time is 25 days!
Symptomatic versus
Asymptomatic
Asymptomatic a period of time (up to
15+years) where are person shows
no signs of infection, even to the
point that they are unaware that they
can transmit HIV to another partner.
Symptomatic stages occur later in the
HIV infection and into the AIDS stage.
Symptoms
•Most people who become infected with HIV do not
notice any immediate change in their health.
•People living with HIV may feel and look completely
well but their immune systems may nevertheless be
damaged.
•Once HIV has broken down the body's defenses,
such infections can take hold and produce any of a
wide range of symptoms - some of them very
severe.
•Such symptoms are, however, not caused directly
by HIV, and they can't by themselves be interpreted
as definite signs of HIV infection or AIDS.
Symptoms (cont.)
•rapid weight loss
•dry cough
•recurring fever or profuse night sweats
•profound and unexplained fatigue
•swollen lymph glands in the armpits, groin, or
neck
•diarrhea that lasts for more than a week
•white spots or unusual blemishes on the tongue,
in the mouth, or in the throat
•pneumonia
•red, brown, pink, or purplish blotches on or under
the skin or inside the mouth, nose, or eyelids
•memory loss, depression, and other neurological
disorders
Treatment
Treatment drugs used today were or originally developed as cures
for HIV. All failed, but when used together in combination therapy,
they can combat the effects of HIV
Some drugs are used to combat HIV replication, HIV cell
penetration, or cell destruction/manipulation. Others are
designed to boost the body’s natural immune system defenses.
Combination therapy is a treatment
designed for you by you and your doctor.
Each treatment is experimental and unique
for each patient.
Taking Treatment
•HIV/AIDS treatment and
the side affects of this
treatment, the
continuous medication
of those side affects.
•With inconsistency this
virus may and often does
develop a resistance to
medication.
• People who are already
infected can be reinfected with a drug
resistant strain of HIV.
Treatment continued
•Each treatment is experimental
•Each treatment is designed for the
patient by the patient and his doctor
•Many drugs are toxic to the body
and side effects are often severe
•The regiment or schedule of
treatment must be adhered to strictly.
With inconsistency this virus may and
often does develop a resistance to
medications (as seen in malarial
treatments)
•Viral load tests (expensive) are
necessary to determine the true
effect of the drugs in the patient’s
system
Longevity of people living with
HIV/AIDS (PLWA)
•HIV stage (average
conditions) 10+ years
•AIDS lasts 4+years on
average
•The maximum survival time
is unknown
•Factors:
Diet, mental and physical
well being, stress
Protection-Prevention
The ABC’s of HIV:
Abstinence is preferred;
Be faithful is nice, better not think twice;
Condomize, if one is unable to fulfill these
first two rules of behavior.
This is a picture of a roadside sign in Botswana. The sign is used to educate people
about HIV and AIDS. The sign reads as 'Avoiding AIDS is as easy as... Abstain, Be
faithful and Condomise'. This sign is a first step in publicly acknowledging the AIDS
crisis in Botswana.
Protection - Prevention
• Prevention programs take into
account cultural values, social
norms, ethnographic data.
• Effective interventions.
• What about condoms?
Putting the Condom on
•Use a new condom every
time you have sex
•When penis is erect
(before any contact),
place condom on the head
of the penis
•Gently squeeze the tip of
the condom to remove the
air (any excess air could
case the condom to
break)
•Carefully roll the condom
down the shaft of the
penis all the way to the
base
Female Condoms
While yes, this product may look like protection in the form of a gaping plastic
bag, the female condom does offer some potential advantages.
Female condoms are made from polyurethane, rather than latex. It transmits
heat better but does not stretch like latex.
•The cost of a female condom is much higher than that of the male condom.
More than a million Americans living with HIV
Future Prospects
• 40 million people worldwide are
currently infected with HIV.
• AIDS is the leading cause of death
worldwide for people aged 15-19.
• One-half of all new infections
worldwide occur in people under age
25.
• A estimated 40 million more people
will contract HIV over the next
decade.
( Frontline 2006- “The age of AIDS”)
END OF TRAINING
THANK YOU
ERNEST D. PÉREZ
CAPACITY BUILDING ASSISTANCE TRAINER
BORDER HEALTH FOUNDATION
TUCSON, ARIZONA
[email protected]
1-877-749-3727