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AIDS - Prevention is the only cure....

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