Hiv 101 2011 latest edition


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HIV/AIDS Education for community classes or just information. Some of the information is from the CDC and other websites put in power point form.

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  • Reported AIDS cases and annual rates (per 100,000 population), by area of residence 2006.
  • It is estimated that sexual transmission accounts for 32,000 of the 40,000 new infections each year. Conservative estimates based on the changes in behavior observed once people find out they are infected with HIV indicate that the 25% of people who are unaware that they are infected account for at least 54%, and potentially as much as 70%, of the new sexually transmitted infections each year. The transmission rate among those who don’t know they are infected is 3.5 times higher than for people who know about their HIV infection. The importance of getting these individuals tested and into care that includes both treatment and prevention interventions is critical.
  • On the surface of the helper T-cell, HIV finds a protein molecule called CD4+. This is why the helper T-cells are often referred to as CD4+ cells or T-4 cells. The CD4+ acts as a specific receptor for HIV. IT is this perfect match between the virus and the molecule that makes the helper T-cells of our immune system so vulnerable to HIV.
  • Seroconversion = development of detectable specific antibodies to microorganisms in the serum as a result of infection
  • Sexual contact accounts for most of the HIV cases transmitted both in the US and worldwide
  • Generally 15-18 months for baby to develop it’s own immune system, but can always perform a PCR to detect the actual virus.
  • Tenofovir, Trudvada South Africa, MSM in the US Some are safety and efficacy and others such as MSM in the US are both.
  • Slide 4: This presentation breaks down the National AIDS Strategy by Goal, Action Steps, and steps within Action Steps. Each state is encouraged to develop, implement, report, and evaluate coordinated efforts to meet the Strategy goals. Please note that the bulk of these strategy recommendations are federally funded.
  • Slide 5 The Vision for the National HIV/AIDS Strategy is worth stating: “The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”
  • Slide 9: We must also move away from thinking that one approach to HIV prevention will work, whether it is condoms, pills, or information. The Strategy’s four Goals are: Reduce the number of HIV infections Increase access to care and better health outcomes for PLWHAs. Reduce HIV related health disparities, discrimination and stigma And, achieve a more coordinated national response
  • Slide 11: For the first couple of years of implementing the Strategy, the focus will be to take the necessary steps to ensure that we have the data we need, and that we use these data to enhance efforts to ensure that resources for prevention follow incidence levels of the epidemic. We also believe that a short-term focus needs to be on identifying and evaluating effective combinations of HIV prevention methods for specific high risk groups, as well as evaluating the success of existing programs. In future years, we expect to know more about which combinations of interventions work for which communities and then we can turn to scaling up our efforts to deploy effective prevention combinations.
  • Hiv 101 2011 latest edition

    1. 1. HIV/AIDS Sherrie Serpas Early Intervention Consultant Bay County Health Department
    2. 2. Topics <ul><li>Epidemiology – World, US and Florida Trends </li></ul><ul><li>History </li></ul><ul><li>Transmission & Opportunistic infections </li></ul><ul><li>Testing </li></ul><ul><li>Prevention </li></ul><ul><li>Treatment </li></ul><ul><li>Co-morbidities / HIV related conditions </li></ul><ul><li>Legal & Social Status </li></ul>
    3. 3. HISTORY <ul><li>1981……First Reported Case of AIDS </li></ul><ul><li>1982……..First Use of “AIDS” Acronym </li></ul><ul><li>1984……..Causative Agent Identified </li></ul><ul><li>1985…….First HIV Antibody Test </li></ul><ul><li>1986……First Use of “HIV” Acronym </li></ul><ul><li>1987……First Medication </li></ul>
    4. 4. What is HIV? <ul><li>HIV is a virus that compromises the immune system. </li></ul><ul><li>The virus invades the T-cell and multiplies once it gets inside of it. </li></ul><ul><li>The newly manufactured virus buds from the T-cell, eventually destroying the host cell. </li></ul><ul><li>This process, unchecked, continually repeats until there are a low number of T-cells and high viral load. </li></ul>Once an individual is infected with HIV, the virus is never dormant in their system.
    5. 5. Where did it come from? <ul><li>Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans. The virus most likely jumped to humans when humans hunted these chimpanzees for meat and came into contact with their infected blood. Over several years, the virus slowly spread across Africa and later into other parts of the world. </li></ul>
    7. 7. AIDS PANDEMIC 2007 Estimates Globally New Infections: 9.5 / minute, 6,800 /day, 2.1 million /yr <ul><li>2.5 million newly infected </li></ul><ul><li>with HIV </li></ul><ul><li>68% in Africa </li></ul><ul><li>50% females </li></ul><ul><li>2.5 million children <15 </li></ul>Half of new infections in People age 15-24 Worldwide 90% are heterosexual transmissions >33.2 million living with HIV 2.1 Million Deaths
    8. 8. HIV in the U.S. AND FLORIDA The #1 cause of death in FL African Americans age 25-44 2009 42,959 people infected with HIV. 5,500 in Florida. >550,000 AIDS DEATHS >1,107,404 Living With HIV 1,142,714 living with AIDS IN FLORIDA 2009 - 166 new HIV diagnoses in children under the age of 13 Approximately 19 MSM die each week in FL 21% of all people in Florida do not know they are infected
    9. 9. Cumulative Reported AIDS Cases State Number of Cases % of Total 1. New York 199,433 18 % 2. California 160,998 15 % 3. Florida 120,701 11 % 4. Texas 79,568 7 % 5. New Jersey 54,483 5 % “ Top 5 Total” 615,183 56 % All Other States 408,223 44 % TOTAL U.S. 913,433 100% At the end of 2008 the number of persons living with AIDS was 479,161 FLORIDA IS SECOND IN THE U.S. IN PEDIATRIC HIV/AIDS CASES
    10. 10. Pediatric HIV/AIDS, Florida <ul><li>Second in the United States behind New York. </li></ul><ul><li>Thru 2007 Fl has reported a cumulative total of 2,253 HIV & AIDS cases </li></ul><ul><li>2007 604 babies born to mothers known to be HIV-infected, 13 were known to be infected. </li></ul>
    11. 11. Race <ul><li>Asian ..............................................2 </li></ul><ul><li>Black ..........................................521 </li></ul><ul><li>Hispanic .........................................83 </li></ul><ul><li>White ...........................................513 </li></ul><ul><li>Amer indian/alaskan .......................4 </li></ul><ul><li>Mixed ..............................................7 </li></ul><ul><li>Missing data ...................................28 </li></ul><ul><li>Native hawaiian/pac isle ................2 </li></ul>
    12. 12. Site Type <ul><li>STD Clinic .................................388 </li></ul><ul><li>Family Planning ........................303 </li></ul><ul><li>Adult Health ..............................63 </li></ul><ul><li>Private MD ................................31 </li></ul><ul><li>Anonymous ................................0 </li></ul><ul><li>TB ............................................18 </li></ul><ul><li>Prison/Jail..................................355 </li></ul><ul><li>Prenatal/OB................................2 </li></ul>
    13. 13. Risk Factors <ul><li>MSM/IDU ...............................2 </li></ul><ul><li>MSM ......................................24 </li></ul><ul><li>IDU .......................................40 </li></ul><ul><li>STD Diagnosis ..........................382 </li></ul><ul><li>Sexual Assault .........................52 </li></ul><ul><li>Heterosexual ..........................490 </li></ul><ul><li>Occupational ..........................61 </li></ul><ul><li>No Identifiable Risk .................16 </li></ul><ul><li>Missing Data ..........................26 </li></ul><ul><li>Refused ...............................1 </li></ul>
    14. 14. Age Group (tested) <ul><li>< 2 0 </li></ul><ul><li>5 – 12 2 </li></ul><ul><li>13 – 19 189 </li></ul><ul><li>20 – 29 494 </li></ul><ul><li>30 -39 245 </li></ul><ul><li>40 – 49 147 </li></ul><ul><li>50 + 73 </li></ul>
    15. 15. Positives in age groups <ul><li>13-19 ...................1 </li></ul><ul><li>20 – 29.................2 </li></ul><ul><li>30 – 39..................3 </li></ul><ul><li>40 – 49..................2 </li></ul><ul><li>50+ .......................4 </li></ul><ul><li>Total......................12 </li></ul>
    16. 16. HIV & AIDS Prevalence <ul><li>Worldwide, 22 in every 100,000 people is infected. </li></ul><ul><li>Florida is 3rd in reported U.S. AIDS cases, and 2nd in pediatric AIDS. </li></ul><ul><li>Estimated HIV prevalence in Florida: </li></ul><ul><ul><ul><li>1 in 374 Whites </li></ul></ul></ul><ul><ul><ul><li>1 in 110 Blacks </li></ul></ul></ul><ul><ul><ul><li>1 in 216 Hispanics </li></ul></ul></ul>
    17. 17. 09/07/11
    18. 18. CELL ACTION
    19. 19. HIV Life Cycle <ul><li>HIV binds to the T-cell </li></ul><ul><li>Viral RNA is released into the host cell </li></ul><ul><li>Reverse transcriptase converts viral RNA into viral DNA. </li></ul><ul><li>Viral DNA enters the T-cells nucleus and inserts itself into the T-cell’s DNA. </li></ul><ul><li>The T-cell begins to make copies of the HIV components. </li></ul><ul><li>Protease helps create new virus particles. </li></ul><ul><li>The new HIV virion is released from the T-cell. </li></ul>
    20. 20. The HIV Life Cycle
    21. 21. On the surface of the helper T-cell, HIV finds a protein molecule called CD4+. This is why the helper T-cells are often referred to as CD4+ cells or T-4 cells. The CD4+ acts as a specific receptor for HIV. IT is this perfect match between the virus and the molecule that makes the helper T-cells of our immune system so vulnerable to HIV.
    22. 22. HIV life cycle animation video
    23. 23. Electron microscope image of HIV, seen as small spheres on the surface of white blood cells
    24. 24. HIV- Natural History of Disease <ul><li>Virus enters and attacks cells </li></ul><ul><li>Host immune system attempts to respond </li></ul><ul><li>Acute retroviral syndrome </li></ul><ul><ul><ul><li>Sudden drop in CD4 </li></ul></ul></ul><ul><ul><ul><li>High viremia </li></ul></ul></ul><ul><ul><ul><li>Flu-like symptoms </li></ul></ul></ul><ul><ul><li>Antibody response </li></ul></ul><ul><ul><li>Partial CD4 recovery </li></ul></ul><ul><li>Slow decline of CD4 </li></ul>Kalynn B. Pressly, ARNP, DSN Bay County Health Department
    25. 25. When an individual is first infected with HIV it is not readily detectable on an HIV test. It takes up to three months for a person to seroconvert from HIV negative to HIV positive. It takes a median of 25 days before the HIV antibody test indicates a positive result. We refer to the amount of time that it takes an individual to seroconvert as the window period . Symptoms of acute HIV infection generally occur 2 to 6 wks
    26. 26. HIV – Natural History <ul><li>Asymptomatic period typically 3 – 10 years </li></ul><ul><li>Evidence of opportunistic infections and cancers </li></ul><ul><ul><li>CD4 <400 – yeast/thrush </li></ul></ul><ul><ul><li>CD4 <200 – pneumonia </li></ul></ul><ul><ul><li>CD4 <100 – Toxoplasmosis </li></ul></ul><ul><ul><li>CD4 < 50 – disseminated MAC </li></ul></ul>Kalynn B. Pressly, ARNP, DSN Bay County Health Department
    27. 27. HIV/AIDS Symptoms <ul><li>Some symptoms may include: </li></ul><ul><li>Chronic headaches </li></ul><ul><li>Night sweats </li></ul><ul><li>Diarrhea </li></ul><ul><li>Vomiting </li></ul><ul><li>Rashes </li></ul><ul><li>Sores </li></ul><ul><li>Assorted aches and pains neurological dysfunctions </li></ul><ul><li>Other manifestations </li></ul>
    28. 28. AIDS-related Herpes Kaposi’s Sarcoma Oral thrush Wasting syndrome
    29. 29. Acute Stage, when first infected you may have a fever and a rash.
    30. 30. Transmission
    31. 31. Primarily through sexual contact <ul><li>Most commonly unprotected sex with an infected person. </li></ul><ul><li>Most efficient means of sexual transmission is rectal or anal (penis to rectum) </li></ul><ul><li>Blood-to-Blood contact mostly by sharing injection needles </li></ul><ul><li>Infected woman to her unborn child </li></ul><ul><li>Breast feeding </li></ul>
    32. 32. An HIV infected mother can infect her child: <ul><li>In-utero (in the womb) </li></ul><ul><li>During birth </li></ul><ul><li>During breastfeeding </li></ul>
    33. 33. All babies born to HIV positive mothers will test positive at birth! This is because when a child is first born, their antibodies reflect that of the mother. It is not until the babies own immune system develops that we know if that child is infected or not. The 26% refers to the number of newborns actually infected by their mother . TAKE NOTE!
    34. 34. HOT OFF THE PRESS! <ul><li>The latest studies show that if an infected mother starts AZT at the beginning of pregnancy and : </li></ul><ul><li>high doses of AZT is given at the birth </li></ul><ul><li>child goes on 6 week regimen of AZT after being born </li></ul><ul><li>mom delivers baby three weeks prior to due date via c-section……. </li></ul>
    35. 35. The chance of HIV transmission is lowered down to 2% !!
    36. 36. NON - SEXUAL <ul><ul><li>NEEDLES </li></ul></ul><ul><li>I.V. </li></ul><ul><li>I.M </li></ul><ul><li>TATTOOS </li></ul><ul><li>BODY PIERCING </li></ul><ul><li>BLOOD TO BLOOD </li></ul><ul><li>DIRECT CONTACT </li></ul>
    37. 37. Drug Use <ul><li>Drug use is a major factor in the spread of HIV infection. </li></ul><ul><li>Shared equipment for using drugs can carry HIV </li></ul><ul><li>Drug use is linked with unsafe sexual activity </li></ul><ul><li>Even small amounts of blood on your hands, cookers, filters, tourniquets, or in rinse water. </li></ul><ul><li>A recent study showed that HIV can survive in a used syringe for at least 4 weeks ( </li></ul>
    38. 38. HIV is a very fragile virus <ul><li>Hot water, soap, bleach and alcohol will kill the virus </li></ul><ul><li>The length of time the virus can survive outside the body depends on the amount of HIV present in the fluid </li></ul><ul><li>What conditions the fluid is subjected to </li></ul><ul><li>The CDC reports drying HIV reduces the viral amount 90-95%, </li></ul>
    39. 39. HIV—Transmission <ul><li>Must be present in the body fluid of source patient </li></ul><ul><li>Must have entry into host </li></ul><ul><li>QUANTITY must be sufficient for transmission </li></ul>
    40. 40. Being exposed to the HIV virus does not guarantee that a person will be infected. <ul><li>There are other co-factors that may increase an individuals chances of being infected such as: </li></ul><ul><li>Injection drug use or the use of any mind altering substance. </li></ul><ul><li>High number of sexual partners. </li></ul><ul><li>Type of exposure. </li></ul><ul><li>Presence of a co-infection (e.g., STD) </li></ul>
    41. 41. HIV-- Transmission <ul><li>Point of Entry </li></ul><ul><ul><li>Percutaneously </li></ul></ul><ul><ul><ul><li>Puncture/needle </li></ul></ul></ul><ul><ul><ul><li>Break in the skin </li></ul></ul></ul><ul><ul><li>Mucous membrane </li></ul></ul><ul><ul><ul><li>Eyes </li></ul></ul></ul><ul><ul><ul><li>Nose </li></ul></ul></ul><ul><ul><ul><li>Mouth </li></ul></ul></ul><ul><ul><ul><li>Genitals </li></ul></ul></ul><ul><ul><ul><li>Anus </li></ul></ul></ul>
    42. 42. HIV can be transmitted sexually when the virus enters the body through ports of entry (breaks) in the mucosal surfaces in the mouth, vagina and anus. HIV must have a way to enter the bloodstream in order to cause an infection .
    43. 43. The most efficient way to transmit the HIV virus sexually is through anal sex . The next most efficient route is vaginally . While the risk is not as high as anal or vaginal sex it has been found that there is significant risk associated with oral sex .
    44. 44. HIV is not spread by: Hugging and Kissing Shaking hands Bugs Public restrooms <ul><li>HIV/STDs are not spread through casual contact!! </li></ul>
    45. 45. There is no risk of contracting HIV through giving blood. There is about a 1 in 500,000 chance of contracting HIV through receiving a blood transfusion today.
    46. 46. All blood that is drawn is tested for a number of diseases, including HIV, within 24 hours. A special test called the NAAT (nucleic acid amplification test) is used to ensure blood is HIV-negative before being used. This test can detect the virus even in the early stages of HIV infection.
    47. 47. TESTING
    48. 48. When a person is infected with HIV their immune system produces HIV antibodies. The antibodies are what the HIV test looks for. The production of antibodies is an autoimmune response, it does not mean that the body will fight off HIV infection. The HIV test is an antibody test .
    49. 49. HIV - Testing <ul><li>Antibody Tests </li></ul><ul><ul><li>Elisa/EIA </li></ul></ul><ul><ul><li>Western Blot </li></ul></ul><ul><li>Tests for the Virus </li></ul><ul><ul><li>Qualitative PCR </li></ul></ul><ul><ul><li>Quantitative PCR </li></ul></ul><ul><li>Tests to Monitor Therapy </li></ul><ul><ul><li>CD4—absolute and percent </li></ul></ul><ul><ul><li>Quantitative PCR </li></ul></ul><ul><ul><li>Genotype </li></ul></ul>Kalynn B. Pressly, ARNP, DSN Bay County Health Department
    50. 50. Rapid Testing <ul><li>OraQuick FDA approved in 1/2003 </li></ul><ul><li>Test results within 20 minutes, 99.6% accurate </li></ul><ul><li>Only a finger-stick blood sample is required </li></ul><ul><li>Allows people to quickly learn their HIV status </li></ul><ul><li>An effective tool in targeting high-risk, low-return rate populations </li></ul><ul><li>31% of people tested in 2000 did not come back for results </li></ul><ul><li>Increased post-test counseling rates </li></ul>Positive Negative
    51. 51. HIV TESTING <ul><li>Orasure: oral swab, results 2 to 3 weeks </li></ul><ul><li>Blood sample: results 2 to 3 weeks </li></ul><ul><li>Clearview: test for antibodies in blood, serum or plasma samples, results in 15 minutes </li></ul><ul><li>FDA approved a new test recently that only takes one minute! </li></ul>
    52. 52. When a person takes an HIV test they have the option of taking it anonymously or confidentially. The difference is as follows: <ul><li>Anonymous testing- no identifying information is given. The person’s testing information is tracked by a number system. </li></ul><ul><li>Confidential testing- all identifying information is given but just like an anonymous test all information collected is confidential. </li></ul>
    53. 53. There are three results that one can get from an HIV antibody test . <ul><li>They are: </li></ul><ul><li>Positive </li></ul><ul><li>Negative </li></ul><ul><li>Indeterminate </li></ul>Anyone who comes in to take an HIV test should be made aware of what possible results they can get and what each result means. + - ?
    54. 54. PREVENTION
    55. 55. Prevention <ul><li>Abstinence and Monogamy </li></ul><ul><li>Latex Condoms </li></ul><ul><li>Polyurethane Condoms </li></ul><ul><li>Abstain from injection drug use, do not </li></ul><ul><li>share needles or works. </li></ul><ul><li>Universal Precautions for Health Care </li></ul><ul><li>Workers </li></ul>
    56. 56. Protection is a barrier that is placed between a person and any fluids that may transmit the HIV virus. Some examples of effective barriers that prevent sexual HIV transmission are: <ul><li>Condoms </li></ul><ul><li>Dental dams </li></ul><ul><li>Latex finger cots </li></ul><ul><li>Latex gloves </li></ul>
    57. 57. Trials of Pre-exposure Prophylaxis <ul><li>Researchers believe that an antiretroviral drug taken as a daily oral preventative is one of the most important new prevention approaches being investigated today </li></ul><ul><li>Theoretically, if HIV replication can be inhibited from the very first moment the virus enters the body, it may not be able to establish a permanent infection. </li></ul>
    58. 58. Treatment
    59. 59. 5 Classes of Drugs <ul><li>Nucleoside reverse transcriptase inhibitors (NRTIs), also called &quot;nukes &quot; NRTIs are like fake building blocks that HIV needs to make more copies of itself. When HIV uses an NRTI instead of a normal building block, reproduction of the virus is slowed. </li></ul><ul><li>Non-nucleoside reverse transcriptase inhibitors (NNRTIs), also called &quot;non-nukes&quot; NNRTIs disable a protein that HIV needs to reproduce. That protein is called reverse transcriptase . </li></ul><ul><li>Protease inhibitors (PIs) PIs disable a protein that HIV needs to reproduce. That protein is called protease. </li></ul><ul><li>Entry/Fusion inhibitors Entry/Fusion inhibitors work by blocking HIV entry into cells. </li></ul><ul><li>Integrase inhibitors Integrase inhibitors work by blocking the action of the protein integrase. This protein inserts HIV’s genes into the CD4 cells' genes. </li></ul><ul><li>There are more than 30 drugs approved by the Food and Drug Administration (FDA) for the treatment of HIV. To find out more about specific HIV meds, talk to your healthcare provider </li></ul>
    60. 60. <ul><li>`1 </li></ul>A.D.A.P. AIDS Drug Assisstance Program
    62. 62. HIV/AIDS Patient Care Programs <ul><li>Ryan White Title II Program </li></ul><ul><li>AIDS Insurance Continuation Program AICP </li></ul><ul><li>AIDS Drug Assistance Program ADAP </li></ul><ul><li>Housing Opportunities for Persons with AIDS HOPWA </li></ul><ul><li>Partner Services PS </li></ul>
    63. 63. FACTORS INFLUENCING WHEN AND WITH WHAT TO START <ul><li>Readiness </li></ul><ul><ul><li>Adherence potential </li></ul></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Acute Infection </li></ul></ul><ul><li>Convenience </li></ul><ul><ul><li># of pills </li></ul></ul><ul><ul><li># of doses/day </li></ul></ul><ul><li>Toxicity </li></ul><ul><li>Cost </li></ul><ul><li>Pre-existing resistance </li></ul>
    64. 64. HIV -- Treatment <ul><li>When to Start </li></ul><ul><ul><li>Symptomatic </li></ul></ul><ul><ul><li>CD4 <350 </li></ul></ul><ul><ul><li>Consider with high (>100,000) viral load </li></ul></ul>
    65. 65. CO-MORBIDITY and Opportunistic Infections
    66. 66. HIV/AIDS Co-Morbidities <ul><li>Liver failure, cardiac disease, renal failure, osteonecrosis </li></ul><ul><li>Malignancies </li></ul><ul><li>Hepatitis (A,B,C), TB, STDs </li></ul>
    67. 67. HIV/AIDS Co- Morbidities <ul><li>Increasing co-morbid conditions may be the result of immune suppression, long-term disease progression or long term treatment: </li></ul>
    68. 68. HIV/AIDs Opportunistic Infections <ul><li>Tuberculosis </li></ul><ul><li>Kaposi’s Sarcoma </li></ul><ul><li>Mycobacterium Avium Complex </li></ul><ul><li>Salmonellosis </li></ul><ul><li>Pneumocystis Carinii Pneumonia (PCP ) </li></ul>
    69. 69. HIV / HEPATITIS-C CO-INFECTION <ul><li>1 in 4 HIV infected Americans co-infected </li></ul><ul><ul><li>Much Higher in IDU populations </li></ul></ul><ul><li>Hepatitis C has accelerated course in HIV </li></ul><ul><ul><li>HIV may have accelerated course in Hepatitis C </li></ul></ul><ul><li>A leading cause of hospitalization/death among HIV infected individuals </li></ul><ul><ul><li>Higher rates of hepatotoxicity with HAART </li></ul></ul><ul><li>Directed therapy for selected individuals (Previously piloted in ADAP) </li></ul><ul><ul><li>Pegylated interferon-alpha and ribavirin </li></ul></ul><ul><ul><ul><li>studies suggested  response rates in co-infected individuals. </li></ul></ul></ul>
    70. 70. HIV and STDs “ Epidemiological Synergy &quot; <ul><li>In the US, 12 million Americans contract sexually transmitted diseases each year, including 40,000 new HIV infections. 1 in 5 adults has herpes. </li></ul><ul><li>Sexual transmission of HIV accounts for 75% of infections worldwide. </li></ul><ul><li>STDs enhance HIV transmission in several ways: </li></ul><ul><ul><li>Increase concentration of HIV in genital secretions </li></ul></ul><ul><ul><li>Increase the the number of cells receptive to HIV and the number of receptors per cell </li></ul></ul><ul><ul><li>Inflammation and lesions associated with STDs increases risk of transmission 2-5 times </li></ul></ul>
    71. 71. Challenges in HIV/AIDS Research <ul><li>Reducing HIV transmission by reducing viral load </li></ul><ul><li>Pre-exposure prophylaxis with antiretroviral drugs </li></ul><ul><li>Topical microbicides </li></ul><ul><li>Preventing or treating co-infections </li></ul><ul><li>HIV vaccines </li></ul>
    73. 73. O.S.H.A.
    74. 74. Summary of OSHA Guidelines <ul><li>Occupational Exposure to Bloodborne Pathogens; Needlestick and Other Sharps Injuries; January 18, 2001. </li></ul><ul><li>Requires employers with 11 or more employees to maintain a log of injuries from contaminated sharps. </li></ul><ul><ul><li>Covers all employees whose duties cause them to come in contact with blood and other potentially infectious materials. </li></ul></ul><ul><li>Requires employers to have an “exposure control plan” </li></ul><ul><li>“ Methods of Compliance” </li></ul><ul><ul><li>Universal precautions </li></ul></ul><ul><ul><li>Personal protective equipment </li></ul></ul><ul><ul><li>Exposure control plan </li></ul></ul>
    75. 75. HIV/AIDS Occupational Exposures US data for 195 occupational HIV cases through 12/2005 (57 confirmed and 139 reported / possible) <ul><li>Profession: (% of total cases) </li></ul><ul><ul><li>54 Nurses (29%) </li></ul></ul><ul><ul><li>23 Physicians (18%) </li></ul></ul><ul><ul><li>16 Health Aides (9%) </li></ul></ul><ul><ul><li>12 EMTs / Paramedics (6%) </li></ul></ul><ul><ul><li>11 Housekeepers (6%) </li></ul></ul><ul><ul><li>9 Therapists / Technicians (5%) </li></ul></ul><ul><ul><li>17 Other (37%)- 7 Dental, 4 OR Techs,3 Lab staff, 3 Resp.Therapists </li></ul></ul>CDC Report, “Surveillance of Health Care Workers with HIV/AIDS”, 10/2005
    76. 76. Bloodborne Pathogens <ul><ul><li>OSHA estimates that 5.6 million workers in the health care industry and related occupations are at risk of occupational exposure to bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV). </li></ul></ul>
    77. 77. Bloodborne Pathogens <ul><li>Exposure/Transmission Risk: </li></ul><ul><ul><li>HIV: .3% = 3/1,000 </li></ul></ul><ul><ul><li>Hep C: 3-10% = 30-100/1,000 </li></ul></ul><ul><ul><li>Hep B: 10-30% = 100-00/1,000 </li></ul></ul>
    78. 78. Needle Sticks <ul><li>Reported cause of 84% of occupational HIV transmissions </li></ul><ul><li>600,000 – 800,000 injuries reported yearly </li></ul><ul><li>33% of all sharps injuries are related to the disposal process. </li></ul><ul><li>62%- 88% of sharps injuries could be prevented by the use of safer medical devices . </li></ul><ul><li>Needle stick Safety and Prevention Act became Public Law 106-430 on November 6, 2000. Provides broader protection for front line staff. </li></ul>
    79. 79. <ul><li>First responders are at risk for occupational exposure to bloodborne pathogens, including hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV). </li></ul><ul><ul><ul><ul><ul><li>Exposure incidents may occur through the following: </li></ul></ul></ul></ul></ul><ul><li>Needlesticks or cuts from sharp objects contaminated with another person’s blood. </li></ul><ul><li>Contact of the eyes, mouth, nose, or broken skin with blood or other potentially </li></ul><ul><ul><ul><ul><ul><li>infectious body fluids. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Some employees are reluctant to report exposure incidents. Encourage your employees to report all exposures. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>This way, you can carry out your responsibility to take appropriate post-exposure actions to protect your workers, their families, and the public against infection from bloodborne pathogens. </li></ul></ul></ul></ul></ul>
    80. 80. Why Are Employees Reluctant to Report Exposures? . <ul><li>Although rates of underreporting are difficult to ascertain, studies estimate that high percentages of workers do not report all exposures. </li></ul><ul><li>Employees give many reasons for not reporting exposures: </li></ul><ul><li>They do not think they will get an infection from the exposure. </li></ul><ul><li>They think the exposure may have been their fault. </li></ul><ul><li>They were not wearing the proper personal protective equipment. </li></ul><ul><li>They are embarrassed by the exposure incident. </li></ul><ul><li>They think it takes too much time away from work to report. </li></ul><ul><li>They think reporting may result in a negative performance evaluation. </li></ul><ul><li>They fear losing their job. </li></ul><ul><li>They think that wiping blood or other body fluids off their skin is sufficient. </li></ul><ul><li>They are not sure whether certain incidents should be considered exposures . </li></ul>
    81. 81. Significant Exposures <ul><li>Significant exposures to any of the following may pose a risk for bloodborne pathogen (BBP) transmission and require further evaluation: </li></ul><ul><ul><li>Blood, Semen, Vaginal secretions, Cerebrospinal fluid, Synovial fluid, Pleural fluid, Peritoneal fluid, Pericardial fluid, Amniotic fluid </li></ul></ul><ul><li>Body fluids that do NOT pose a risk of BBP transmission unless visibly bloody include: </li></ul><ul><li>Urine, Sputum, Saliva, Stool, Emesis, Nasal Discharge, Tears, Sweat </li></ul>
    82. 82. HIV-Post-exposure Prophylaxis <ul><li>Determine that a significant exposure has occurred </li></ul><ul><li>Initiate therapy ASAP, within 2 hours if possible </li></ul><ul><li>Consent/Test source patient </li></ul><ul><ul><li>If refuses consent </li></ul></ul><ul><ul><ul><li>Use available blood </li></ul></ul></ul><ul><ul><ul><li>Get Court order to draw specimen </li></ul></ul></ul><ul><li>Consent/test exposed individual </li></ul><ul><li>Refer to Florida Statute 381.004 for details about exemptions from consent </li></ul>
    83. 83. Post –Exposure Prophylaxis <ul><li>Hotline open 24 hours a day </li></ul><ul><li>1-888-HIV-4911 </li></ul><ul><li>Available for clinicians nationwide </li></ul><ul><li>Provides expert guidance in managing healthcare worker exposures to HIV and Hepatitis B & C. </li></ul><ul><li>Callers receive immediate recommendations. </li></ul>
    84. 84. <ul><ul><ul><ul><ul><li>For Additional Information on compliance Issues: </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>• Occupational Safety and Health Administration (OSHA) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Bloodborne Pathogens Web site and phone number: </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li> index.html 1-800-321-OSHA </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>on health issues: </li></ul></ul></ul></ul></ul><ul><ul><li>• National Institute for Occupational Safety and </li></ul></ul><ul><ul><ul><ul><li>Health (NIOSH) Bloodborne Pathogens Web site and phone number: </li></ul></ul></ul></ul><ul><li> 1-800 </li></ul>
    85. 85. LEGAL
    86. 86. An HIV test may not be performed unless informed consent is obtained. <ul><li>The explanation of informed consent </li></ul><ul><li>should include: </li></ul><ul><li>An HIV test is a test to determine if an individual is infected with the virus which leads to AIDS. </li></ul><ul><li>The potential uses and limitations of the test. </li></ul><ul><li>The procedures to be followed, including pre- and post-test counseling. </li></ul>
    87. 87. Omnibus AIDS Act <ul><li>Florida’s Omnibus AIDS Act: A Brief Legal Guide for Health Care Professionals </li></ul><ul><li>Created numerous programs and established requirements for state agencies and health care providers. </li></ul><ul><li>Deals with HIV Testing, Confidentiality, Partner Notification , Significant Exposures, Discrimination, and Public Health Measures. </li></ul><ul><li>Available online (read only) : </li></ul><ul><ul><li>www9. </li></ul></ul>
    88. 88. Privilege to Warn No Duty to Warn <ul><li>Medical providers have the legal privilege but no duty to warn exposed partners. </li></ul><ul><li>Licensed medical providers are protected if third party notification complies with provisions in the law. </li></ul><ul><li>If client discloses name of partner but refuses personal notification, the practitioner must inform client of intent to notify partner. </li></ul><ul><li>Document client refusal without partner’s name. </li></ul><ul><li>Inform partner in private, face-to-face meeting, without identifying name of contact. </li></ul>
    89. 89. Legal Issues Concerning HIV <ul><li>1991 amendment requires licensed professionals to take HIV education classes for relicensure </li></ul><ul><li>Not informing sexual partners of HIV+/AIDS status is a 3 rd degree felony (July 1998). Up to 5 yrs. imprisonment and/or $5000 fine. Repeated violations upgrade to a 1 st degree felony. </li></ul><ul><li>BREACHING CONFIDENTIALITY of someone with HIV/AIDS is a 3 rd DEGREE FELONY. </li></ul>
    90. 90. On July 13, 2010, the White House released the National HIV/AIDS Strategy (NHAS). This ambitious plan is the nation’s first-ever comprehensive coordinated HIV/AIDS roadmap with clear and measurable targets to be achieved by 2015.
    91. 91. Achieving a More Coordinated National Response to the HIV Epidemic in the United States Vision for the National HIV/AIDS Strategy “ The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination ”
    92. 92. The Urgency of Now: Reduce incidence. Improve access. Promote equity . NHAS calls for alleviating the epidemic among gay and bisexual men, transgender persons, and among racial and ethnic populations disproportionately affected by the epidemic. By focusing limited resources on populations and risk groups in geographic areas most affected by the epidemic, the United States can break through the persistent pattern of HIV infection in this country.
    93. 93. Strategy Goals <ul><li>Reduce the number of people who become HIV infected </li></ul><ul><li>Increase access to care and optimize health outcomes for people living with HIV </li></ul><ul><li>Reduce HIV-related health disparities, discrimination and stigma </li></ul><ul><li>Achieve a more coordinated national response to the domestic HIV epidemic </li></ul>
    94. 94. Action Steps <ul><li>Reduce New HIV Infections </li></ul><ul><li>Intensify HIV prevention efforts in the communities where HIV is most heavily concentrated </li></ul><ul><li>Expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches </li></ul><ul><li>Educate all Americans about the threat of HIV and how to prevent it </li></ul>
    95. 95. NHAS Cont. <ul><li>Reducing HIV-Related Health Disparities </li></ul><ul><li>• Improve access to prevention and care services for all Americans. </li></ul><ul><li>• By 2015, increase the proportion of HIV diagnosed gay and bisexual men with undetectable viral load by 20%. </li></ul><ul><li>• By 2015, increase the proportion of HIV diagnosed Blacks with undetectable viral load by 20%. </li></ul><ul><li>• By 2015, increase the proportion of HIV diagnosed Latinos with undetectable viral load by 20%. </li></ul>
    96. 96. <ul><li>1. HIV is transmitted from one person to another by: </li></ul><ul><li>A. Blood-to blood contact </li></ul><ul><li>B. Contact with someone else’s semen </li></ul><ul><li>C. Contact with vaginal secretions </li></ul><ul><li>D. All of the above </li></ul>Test
    97. 97. 2. One behavior that can result in HIV transmission is: A. Shaking hands with someone B. Kissing someone C. Having sex with an HIV-infected person D. Eating from the same plate as an HIV-infected person
    98. 98. 3. The time it usually takes from infection until major opportunistic diseases occur is more than: A. Six week B. Six months C. Four years D. 10 years
    99. 99. 4. Which of the following body fluids does not transmit HIV? A. Blood B. Urine C. Vaginal secretions D. Breast milk
    100. 100. 5. T-helper (CD4+) cells are: A. The main target of HIV in the bloodstream B. Part of the body’s defense system C. Not likely to be affected by HIV D. A & B
    101. 101. 6. What type of condom is best for HIV protection? A. Lambskin B. Cloth C. Latex D. Metal
    102. 102. 7. Two opportunistic infections associated with an AIDS diagnosis are: A. Mononucleosis and tetracycline B. The common cold and the influenza virus C. Tuberculosis and Kaposi’s sarcoma D. Chickenpox and Herpes
    103. 103. <ul><li>8. HIV is not transmitted by </li></ul><ul><li>Kissing an infected person </li></ul><ul><li>B. Working with someone with AIDS </li></ul><ul><li>C. Shaking hands with an infected person </li></ul><ul><li>D. All of the above </li></ul>
    104. 104. 9. The BEST way to avoid HIV infection is to: A. Have sex with as many people as possible B. Clean used needles before injection of drugs C. Use a condom every time you have sex D. Not have sex or use drugs at all
    105. 105. <ul><li>10. Except in special circumstances, a person must give his informed consent to be tested for </li></ul><ul><li>HIV Antibodies . </li></ul><ul><li>True </li></ul><ul><li>B. False </li></ul>
    106. 106. 11. From this list, who is the most at risk and should consider being tested for HIV antibodies? A. A person who had unprotected sex with more than one person in the past year B. A health care worker who correctly follows standard universal precautions C. A person who never used drugs or had sex D. A person who has been in a mutually monogamous relationship for 20 years
    107. 107. 12. Confidential HIV testing means the person being tested can only be identified by a number: A. True B. False
    108. 108. 13. Mosquitoes can transmit HIV. A. True B. False
    109. 109. <ul><li>14. Protease inhibitors are: </li></ul><ul><li>Drugs that prevent side effects to AIDS medications </li></ul><ul><li>B. Drugs that prevent HIV from being successfully assembled and released from an infected T-cell </li></ul><ul><li>C. Drugs that prevent HIV from being absorbed into the blood stream </li></ul><ul><li>D. Drugs that prevent transmission of HIV if you have sex with an infected person </li></ul>
    110. 110. 15. A “person with AIDS” is defined as: A. Someone who has had the HIV virus for six years or more B. Someone who practices unsafe sex and uses IV drugs C. Someone who has HIV and is Homosexual D. Someone who is infected with HIV and has T-cell count of less than 200 T-cells per cubic millimeter.
    111. 111. Florida Department of Health Bureau of HIV/AIDS 4052 Bald Cypress Way BIN A09 Tallahassee, Florida 32399-1715 (850) 245-4335 FAX: (850) 414-6719 Florida AIDS Hotline: 1-800-FLA-AIDS For more information contact:
    112. 112. References <ul><li>CDC </li></ul><ul><li>Florida Department of Health </li></ul><ul><li>Mara Michniewicz </li></ul><ul><li> </li></ul>