HIV/AIDS is caused by the human immunodeficiency virus (HIV) which weakens the immune system and allows opportunistic infections. It was first observed in the 1980s and has since caused over 25 million deaths globally, with about 40 million people currently living with HIV. The virus is transmitted through sexual contact, sharing needles, or from mother to child during birth or breastfeeding. While treatment can suppress HIV and reduce transmission, prevention through testing and safe practices is the best way to end the pandemic.

1. Chapter Sixteen HIV and AIDS

2. HIV/AIDS Human Immunodeficiency Virus (HIV) Immune system deficient, cannot resist disease Virus responsible for Acquired Immune Deficiency Syndrome (AIDS) Acquired Immune Deficiency Syndrome (AIDS) Descriptive of the infection and it’s progression First observed in U.S. cities in early 1980s Young, healthy men dying of rare diseases

3. Conditions Associated with AIDS Opportunistic infections Pneumocystis carinii pneumonia (PCP) Mycobacterium avium intracellulare Clinical conditions Wasting syndrome Cancers Kaposi’s sarcoma Other infections Candidiasis Herpes and cytomegalovirus

4. Symptoms of HIV Infection and AIDS Unexplained persistent fatigue Fever, chills, night sweats Unexplained weight loss Swollen lymph nodes Pink, red, purple, or brown blotches Persistent dry cough Persistent, fuzzy, white spots in mouth, tongue, or throat Memory loss or depression Abnormal pap smears Persistent vaginal candidiasis Abdominal cramping (due to Pelvic inflammatory Disease) Persistent Diarrhea

5. The Immune System and HIV Leukocytes – white blood cells Macrophages Engulf foreign particles Antigens Stimulate immune system, react with antibodies Antibodies Inactivate antigens, mark them for destruction B cells and T cells Lymphocytes Helper T cells

6. The Virus Protein coated package of genes Spherical GP 120 Reverse transcriptase Retrovirus Effect on T cells

7. How the Disease Progresses T cell (CD4) count Viral load counts Phases of infection Months to years Early flu-like symptoms AIDS Death

8. Epidemiology and Transmission of HIV Epidemiology – Study of incidence, process, distribution, and control of a disease World Health Organization reports 25 million people have died from AIDS Estimated that 40.3 million people are living with HIV

9. Epidemiology and Transmission of HIV Global increases in number of people living with AIDS African continent the largest concentration 2/3 of all AIDS cases are in Sub-Saharan Africa 77% of women living with AIDS are in Sub-Saharan Africa

10. Epidemiology and Transmission of HIV in the United States 944, 306 individuals living with AIDS 40,000 annual new HIV infections Changes in current transmission modes Changes across ethnic groups

11. Modes of Transmission Sexual contact Sharing needles Transfusions Passing virus from mother to fetus

12. Modes of Transmission Breastfeeding from HIV-positive mother Sharing sex toys Accidental contamination with infected blood Contaminated blood transfusions or organ transplants performed before April 1, 1985

13. Myths about Transmission Non sexual contact – touching a person Touching a surface – toilet seat Social contact – kissing, biting or tears Insect bites Accidental contact in sports Donating blood

14. Sexual Transmission Anal intercourse Vaginal intercourse Oral sex Sex toys

15. Injection Drug and Substance Use Sharing needles Sharing other paraphernalia Recreational use resulting in poor decision making

16. Mother to Child Transmission Peri natal transmission Greatly reduced by use of ZDV (AZT) Mother takes ZDV from week 14 to 34 Infant takes ZDV

17. Minority Races and Ethnicities and HIV In the early 80s, was viewed as a disease in Whites and gays Currently identified in all ethnic groups Occurs in groups with Poverty Lack of access to or willingness to use health care Substance abuse

18. Minority Races and Ethnicities and HIV African Americans Hispanics Asian/Pacific Islanders American Indians and Alaska Natives

19. The Gay Community Men who have sex with men Stigma slowed prevention efforts Special consideration of ethnic groups Psychological long term effects Increased risk taking Other STIs U.S. AIDS Demographics by Race

20. Other Groups and HIV Children Teens and college students Older adults Geographic region

21. Prevention and Treatment Protecting ourselves Be aware that alcohol and drug use increases risky behaviors Develop communication skills to be able to discuss risks and prevention with partners Use HIV testing and make appropriate decisions Use condoms

22. Prevention and Treatment Saving lives through prevention Reduced new infections from 150,000/year to 40,000/year Obstacles to education: blame and denial AIDS seen as disease of marginalized group, not “us” Needle exchange programs HIV testing

23. HIV Testing Tests should be taken 12 weeks after high-risk behavior, repeated 6 months after an uncertain result Types of tests ELISA - enzyme-linked immunosorbent assay Western blot –rechecks ELISA results Viral load tests measure HIV in bloodstream Getting tested Partner notification

24. Treatment Usually initiated with the diagnosis of AIDS Antiretroviral medications Nonnucleoside reverse transcriptase inhibitors Nucleoside reverse transcriptase inhibitors Protease inhibitors Fusion Inhibitor HAART – Highly Active Antiretroviral Therapy Combination of three or more medications Reduces HIV in blood to undetectable levels

25. Living with HIV or AIDS If you are HIV positive Taking care of your health Addressing your other needs If you are caring for someone with HIV or AIDS

26. Summary What is AIDS? The epidemiology and Transmission of HIV AIDS demographics Prevention and Treatment Living with HIV or AIDS