1 county of los angeles department of public health division of hiv and std programs disly juarez,...
TRANSCRIPT
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County of Los Angeles Department of Public Health
Division of HIV and STD Programs
Disly Juarez, MPHHealth Educator
The State of the HIV/AIDS Epidemic
HIV AIDS
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Immune
Acquired Deficiency
Syndrome
AIDSHumanHuman
Immunodeficiency Immunodeficiency
VirusVirus
HIVHIV
Special Characteristics of HIV
Weakens and compromises the immune system
HIV replicates in large quantities
Ability to mutate (change itself) very quickly
Progressively destroys body’s ability to fight infections and certain cancers
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HIV/AIDS Defined
CDC definition (AIDS):
• HIV+ test, T-cell count of < 200 (healthy T-cell count ranges from 800-1200)
- or –
• HIV+ test, and one or more opportunistic infections (OIs) or certain cancers*
“AIDS” applies to most advanced stage of HIV infection
*TB, Pneumocystis pneumonia, Candidiasis, Kaposi’s sarcoma, cervical cancer
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SPECTRUM OF HIV DISEASE
*No infection Infection *Initial *Asymptomatic * HIV AIDS T-
Illness/Disease Cell <200 OI’s symptoms
Exposed **(2 to12weeks) *(8 to 11 years) Asymptomatic Asymptomatic Mild flu like Night sweats, PCP,KS symptoms: fevers, fatigue, wasting fever, muscle diarrhea, syndrome, aches, swollen swollen lymph HIV-related glands for a nodes, oral and dementia few weeks vaginal candidiasis candidiasis, PID, TB Pap Smear
**Window Period: The average time it takes the body to produce antibodies in the blood, 2 to weeks up to six months to 1 year (rare).
* Average progression to HIV disease.
Common Opportunistic Infections
Pneumocystis carinii Pneumonia (PCP)CMV InfectionHIV Wasting SyndromeCandidiasis (oral, esophageal, vaginal)Kaposi’s SarcomaTuberculosisHIV - Related DementiaCervical Cancer
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HIV Transmission
• Breathing • Coughing • Sneezing • Kissing (dry)• Sharing or touching gum • Drinking from water fountains• Sharing food or drinks
• Causal touching • Telephones • Pools/tubs • Shaking hands • Toilet seats • Giving/donating blood
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People cannot get HIV from:People cannot get HIV from:
HIV Transmission
HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood. 8
By Infected Body Fluids:By Infected Body Fluids:
Breast milk
Blood
1 2 3 4Semen, pre-cum
Vaginal secretions
HIV Transmission
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OralVaginalAnal
By Unprotected Sex:By Unprotected Sex:
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HIV Transmission
By Exchanging Infected BloodBy Exchanging Infected Blood
Sharing needles for any purpose
Sharing needles for any purpose
Injectiondrug use
Piercing/tattooing
Insulin, hormone vitamin shots
Acu-puncture
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HIV Transmission
Mother To Child Transmission
during pregnancy (in uterus)
during birth process (delivery)
breastfeeding (through breast milk/blood)
Perinatal transmission can be significantly reduced to less than 2% through the use of anti-HIV drugs during pregnancy (AZT)
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Spectrum of Risk Activity
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HIV TEST HIV Antibody test
Looks for antibodies Accuracy of the test
99.9% Types of tests
Standard test – results will be known in 1 week
Rapid test – results will be known in 20 minutes Test settings Anonymous
Confidential 13
HIV Diagnosis (Testing)Antibody tests
- Uni-Gold Recombigen HIV- results will be known in 10 min. - Reveal G3 Rapid HIV-1 results will be known in 3 minutes - Multispot HIV 1/HIV-2- results will be known in 15 mi. - Clearview HIV 1/2 Stat-Pak - results will be known in 15 mi. - Clearview Complete HIV 1/2- results will be known in 15 min. - Insti HIV-1- results in as little as 60 seconds
FDA has, for the first time, approved an over-the-counter HIV Rapid test (Oraquick) for home use.
• 17 yrs. of older• Must confirm if reactive
HIV TESTInformed Consent
12 yrs of age or older
Benefits of Testing……..
Where to test? Private medical doctor County clinic Community-based
organizationswww.hivla.org1-800-367-AIDS (2437)
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California’s “Willful Exposure” Law (1998)/aka “Recalcitrant Behavior”:
Willfully exposing another to HIV through unprotected sex
8 years of imprisonmentIntention to infect others with HIV through sex
To be prosecuted under the law, one would have to do ALL of the following:
Have anal or vaginal sexKnow that they are HIV +Fail to disclose their HIV statusFail to use a condomHave a specific intent to infect another person
Actual knowledge of HIV infection without more evidence of “specific intent” is insufficient for prosecution.
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CONFIDENTIALITY LAWS
Disclosing a person’s HIV+ status to a third party without the individual’s specific signed consent, is illegal.
Penalties and damages for unauthorized disclosure of HIV status is a $5,000-$10,000 fine and/or jail sentence.
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FEDERAL ANTI-DISCRIMINATION LAWS
• Rehabilitation Act of 1973 and American with Disabilities Act (ADA) 1990
Prohibits discrimination against a person with a disability, including HIV disease or AIDS infection. This prohibits discrimination with regards to employment, public services, public accommodations, and medical care.
• Housing Discrimination• Care Discrimination
A doctor or dentist cannot refuse to treat an HIV+ person
• Fair Employment and Housing Act (FEHA)• Unruh Civil Rights Act
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PREVENTION
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PREVENTION“It is not who we are but what we do that puts us at risk for
HIV infection” Harm reduction Abstinence Safer Sex
Male Condom Female CondomDental Dams
Needle useNot Sharing NeedlesCleaning Needles (3x3x3 Method)Needle Exchange
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PREVENTION Universal Precautions
“Infection control measures that reduce the risk of transmission of blood-born germs from patients to health
care workers”
Wash hands thoroughly
Wear latex gloves
Use masks and eye protection
Wear a gown
Carefully handling and disposing of sharp instruments during and after use.
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PREVENTIONBREAST FEEDINGIt is recommended that HIV+ women do not breastfeed Infants.
POST–EXPOSURE PROPHYLAXIS (PEP)Exposure to HIV within the prior 72 hoursApprove for 13 yrs of age or olderFor more information call 213-351-7699
PRE-EXPOSURE PROPHYLAXIS (PREP)It refers to anti-HIV medication used daily or before sexual encounters Start prior to potential exposure
Prep should never be seen as the first line of defense against HIV
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TREATMENT
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TREATMENT
Goals of HIV/AIDS treatment;
Reduce HIV-related morbidity and prolong survival,
Improve quality of life,
Restore the immune system,
Suppress the viral load, and
Prevent vertical HIV transmission (mother to child).
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Treatment as Prevention
Science Magazine named 'HIV Treatment as Prevention' as the breakthrough of 2011
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TREATMENT What are Anti-retrovirals (ARVs) ?
Drugs that interrupt HIV replication & preserve immune system.
When to start ARVs?: There are severe symptoms of HIV infection or
diagnosis of AIDS with a CD4 count of < 350 cells/mm3
Patient has CD4 count less than 500 /mm3
Recommended for pregnant women who otherwise do not meet criteria to halt vertical transmission
Regardless of CD4 count, treatment is recommended for all pregnant patients, and patients with HIV-associated nephropathy (a kidney disorder) or those who need treatment for hepatitis B.
Treatment is considered optional for patients with CD4 counts over 500.
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Current classes of Anti-HIV medications
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Non-Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Protease Inhibitors
Entry inhibitors
Fusion inhibitors
Integrase inhibitors
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Who Pays For Treatment?
HMO insurance
Medi-Cal
Medicare Part D
ADAP
Shared cost
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Recent Advancements
Immune based therapies
Maturation inhibitors
Multi-class Combination Products
Gene Therapy
Vaccine
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Complementary Therapy
General Health Maintenance
Psychological Well-Being
Spiritual Well-Being
Social Well-Being
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QUESTIONS?
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For More Information Contact
http://publichealth.lacounty.gov/dhsp/
Disly Juarez, MPH
213-351-8102
BREAK
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CSULA, NURS 330- Emma Fredua, MPH, CHES
• Agenda for 10/21/13– Review 10/14/13 In-Class Assignment– Review sample articles for essay
• Essay is due on Mon, 11/18/13• Bring printed articles to class for approval on
11/4/13– Can bring them to class earlier
– 10/21/13 In-Class Assignment– Distribute Study Guide for Mid-term
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