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AIDS - Prevention is the only cure....

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  • 1. HIV/AIDS North Dakota Department of Health HIV/AIDS Program
  • 2.
    • H Human
    • I Immunodeficiency
    • V Virus
  • 3.
    • A Acquired
    • I Immuno
    • D Deficiency
    • S Syndrome
  • 4. HIV Transmission
    • HIV enters the bloodstream through:
      • Open Cuts
      • Breaks in the skin
      • Mucous membranes
      • Direct injection
  • 5. HIV Transmission
    • Common fluids that are a means of transmission:
      • Blood
      • Semen
      • Vaginal Secretions
      • Breast Milk
  • 6. HIV in Body Fluids Semen 11,000 Vaginal Fluid 7,000 Blood 18,000 Amniotic Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml of these body fluids
  • 7. Routes of Transmission of HIV
    • Sexual Contact: Male-to-male
    • Male-to-female or vice versa
    • Female-to-female
    • Blood Exposure: Injecting drug use/needle sharing
    • Occupational exposure
    • Transfusion of blood products
    • Perinatal: Transmission from mom to baby
    • Breastfeeding
  • 8. HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus
  • 9. Window Period
    • This is the period of time after becoming infected when an HIV test is negative
    • 90 percent of cases test positive within three months of exposure
    • 10 percent of cases test positive within three to six months of exposure
  • 10. HIV Infection and Antibody Response Infection Occurs AIDS Symptoms ---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage--- Flu-like Symptoms Or No Symptoms Symptom-free < ---- ----
  • 11. Importance of Early Testing and Diagnosis
    • Allows for early treatment to maintain and stabilize the immune system response
    • Decreases risk of HIV transmission from mother to newborn baby
    • Allows for risk reduction education to reduce or eliminate high-risk behavior
  • 12. HIV Testing
    • Requires a blood or oral fluid sample
    • HIV test detects the body’s antibody response to HIV infection
    • The test does NOT detect the HIV virus
  • 13. HIV Testing in North Dakota
    • Confidential vs. anonymous testing
    • Testing offered free-of-charge at state-funded HIV test sites for those at risk
    • Test results are available within a week
    • For a list of HIV test sites in North Dakota call 1.800.70.ndhiv or visit
  • 14. HIV Testing
    • Those recently exposed should be retested at least six months after their last exposure
    • Screening test (EIA/ELISA) vs. confirmatory test (IFA)
    • EIA/ELISA (Reactive)
      • Repeat EIA/ELISA (Reactive)
      • IFA (Reactive)
      • Positive for HIV
  • 15. EIA/ELISA Test Positive Negative Run IFA Confirmation Repeat Positive Positive End Testing Repeat ELISA Every 3 months for 1 year Negative Positive Negative Indeterminate Repeat at 2-4 months Repeat at 3 weeks HIV Testing No HIV Exposure Low Risk HIV Exposure High Risk Negative HIV + Repeat every 6 months for continued High risk behavior
  • 16. North Dakota Law for HIV Testing
    • Requires informed consent
    • No premarital testing requirement
    • Prenatal testing not required but recommended
    • School notification not required for positive staff or students (universal precautions)
  • 17. North Dakota Law for HIV Testing (cont.)
    • Allows testing of individuals:
      • 14 years of age or older without parental consent
      • Mandatory testing for prison inmates in grade 1, grade 2, regional facilities, and the state penitentiary as defined in NDCC:23-07-07.5
      • Court ordered testing for defendants charged with a sex offense as defined in NDCC: 23-07.7-01
  • 18.
    • Once a person is infected they are always infected
    • Medications are available to prolong life but they do not cure the disease
    • Those who are infected are capable of infecting others without having symptoms or knowing of the infection
  • 19. HIV Risk Reduction
    • Avoid unprotected sexual contact
    • Use barriers such as condoms and dental dams
    • Limit multiple partners by maintaining a long-term relationship with one person
    • Talk to your partner about being tested before you begin a sexual relationship
  • 20. HIV Risk Reduction
    • Avoid drug and alcohol use to maintain good judgment
    • Don’t share needles used by others for:
        • Drugs
      • Tattoos
      • Body piercing
    • Avoid exposure to blood products
  • 21. Condoms
    • Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections including HIV
    • Condoms = Safer sex
    • Condoms ≠ Safe sex
  • 22. Condom Use
    • Should be used consistently and correctly
    • Should be either latex or polyurethane
    • Should be discussed with your partner before the sexual act begins
    • Should be the responsibility of both partners for the protection of both partners
    • Male and female condoms are available
  • 23. People Infected with HIV
    • Can look healthy
    • Can be unaware of their infection
    • Can live long productive lives when their HIV infection is managed
    • Can infect people when they engage in high-risk behavior
  • 24. HIV Exposure and Infection
    • Some people have had multiple exposures without becoming infected
    • Some people have been exposed one time and become infected
  • 25.
    • “ When you have sex with someone, you are having sex with everyone they have had sex with for the last ten years.”
        • Former Surgeon General
    • C. Everett Koop
  • 26. HIV and Sexually Transmitted Diseases
  • 27. HIV and Sexually Transmitted Diseases
    • STDs increase infectivity of HIV
      • A person co-infected with an STD and HIV may be more likely to transmit HIV due to an increase in HIV viral shedding
      • More white blood cells, some carrying HIV, may be present in the mucosa of the genital area due to a sexually transmitted infection
  • 28. HIV and Sexually Transmitted Diseases
    • STDs increase the susceptibility to HIV
      • Ulcerative and inflammatory STDs compromise the mucosal or cutaneous surfaces of the genital tract that normally act as a barrier against HIV
      • Ulcerative STDs include: syphilis, chancroid, and genital herpes
      • Inflammatory STDs include: chlamydia, gonorrhea, and trichomoniasis
  • 29. HIV and Sexually Transmitted Diseases
    • The effect of HIV infection on the immune system increases the the risk of STDs
      • A suppressed immune response due to HIV can:
        • I ncrease the reactivation of genital ulcers
        • Increase the rate of abnormal cell growth
        • Increase the difficulty in curing reactivated or newly acquired genital ulcers
        • Increase the risk of becoming infected with additional STDs
  • 30. HIV Post Exposure Prophylaxis
  • 31. HIV Occupational Exposure
    • Review facility policy and report the incident
    • Medical follow-up is necessary to determine the exposure risk and course of treatment
    • Baseline and follow-up HIV testing
    • Four week course of medication initiated one to two hours after exposure
    • Liver function tests to monitor medication tolerance
    • Exposure precautions practiced
  • 32. HIV Non-Occupational Exposure
    • No data exists on the efficacy of antiretroviral medication after non-occupational exposures
    • The health care provider and patient may decide to use antiretroviral therapy after weighing the risks and benefits
    • Antiretrovirals should not be used for those with low-risk transmissions or exposures occurring more than 72 hours after exposure
  • 33. HIV Non-Occupational Exposure
    • Provider Considerations:
      • Evaluate HIV status of patient and risk history of source patient
      • Provide necessary medical care and counseling
      • Evaluate risk event and factors for exposure
      • Determine elapsed time from exposure
      • Evaluate potential for continuous HIV exposure
      • Obtain informed consent for testing and treatment
      • Evaluate pregnancy status of females
      • Monitor for drug toxicity and acute infection