HIV/AIDS North Dakota Department of Health HIV/AIDS Program

H Human I Immunodeficiency V Virus

H Human

I Immunodeficiency

V Virus

A Acquired I Immuno D Deficiency S Syndrome

A Acquired

I Immuno

D Deficiency

S Syndrome

HIV Transmission HIV enters the bloodstream through: Open Cuts Breaks in the skin Mucous membranes Direct injection

HIV enters the bloodstream through:

Open Cuts

Breaks in the skin

Mucous membranes

Direct injection

HIV Transmission Common fluids that are a means of transmission: Blood Semen Vaginal Secretions Breast Milk

Common fluids that are a means of transmission:

Blood

Semen

Vaginal Secretions

Breast Milk

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

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

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

HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus

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

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

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 < ---- ----

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

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

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

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

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 www.ndhiv.com

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 www.ndhiv.com

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

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

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

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)

Requires informed consent

No premarital testing requirement

Prenatal testing not required but recommended

School notification not required for positive staff or students (universal precautions)

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

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

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 HIV AIDS

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

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

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

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

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

Condoms Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections including HIV Condoms = Safer sex Condoms ≠ Safe sex

Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections including HIV

Condoms = Safer sex

Condoms ≠ Safe sex

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

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

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

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

HIV Exposure and Infection Some people have had multiple exposures without becoming infected Some people have been exposed one time and become infected

Some people have had multiple exposures without becoming infected

Some people have been exposed one time and become infected

“ 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

“ 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

HIV and Sexually Transmitted Diseases

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

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

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

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

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

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

HIV Post Exposure Prophylaxis

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

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

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 PREVENTION --- FIRST

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

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

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