HIV 101 HIV/AIDS Program Public Health - Seattle & King County hivstd.info@metrokc.gov http://www.metrokc.gov/health/apu 206/205-STDS (7837) 1-800-678-1595

Key Messages HIV impacts our world and our local community. People of color are disproportionately represented among national and local new infections. The basic modes of transmission and prevention of HIV have not changed in 20 years. The AIDS epidemic is not over, but there is more hope than ever for those that are infected.

What is HIV? What is AIDS?

AIDS HIV infected + immune system breakdown (CD4 count < 200 or AIDS Defining illness) AIDS Defining Illnesses Pnuemocystis pnuemonia Toxoplasmosis Kaposi’s sarcoma Mycobacterium avium complex Invasive cervical cancer etc...

Persons estimated to be living with HIV as the end of 2004 Eastern Europe & Central Asia 1.4 million [920 000 – 2.1 million] Western & Central Europe 610 000 [480 000 – 760 000] North America 1.0 million [540 000 – 1.6 million] East Asia 1.1 million [560 000 – 1.8 million] North Africa & Middle East 540 000 [230 000 – 1.5 million] Caribbean 440 000 [270 000 – 780 000] South & South-East Asia 7.1 million [4.4 – 10.6 million] Sub-Saharan Africa 25.4 million [23.4 – 28.4 million] Latin America 1.7 million [1.3 – 2.2 million] Oceania 35 000 [25 000 – 48 000] map in the back of epi update Total: 39.4 (35.9 – 44.3) million World Health Organization

For cases reported in 2002, AIDS rates (cases per 100,000 population) are shown for each state, Washington, DC, Puerto Rico, the US Virgin Islands, Guam, and the US Pacific Islands. Areas with the highest rates in 2002 were Washington, DC, New York, Maryland, Florida, Puerto Rico, and Louisiana. Every state reported some AIDS cases in 2002.

USA Numbers of AIDS deaths have been falling. Number of AIDS diagnosis have increased by approximately 2.2% between 2001-2002. Rates of HIV infection overall have not changed although an increase has been noted among men who have sex with men over the past three years.

The upper curve represents estimated AIDS incidence (number of new cases); the lower one represents the estimated number of deaths of adults and adolescents with AIDS. The peak in 1993 was associated with the expansion of the AIDS surveillance case definition implemented in January 1993. In recent years, AIDS incidence has leveled and deaths of persons with AIDS have declined. The overall decline in new AIDS cases and deaths of persons with AIDS are due in part to the success of highly active antiretroviral therapies, introduced in 1996. The data have been adjusted for reporting delays.

Cumulative HIV/AIDS October 31, 2004 King Co. WA State U.S.* Adult/Adolescent 9,480 14,605 1,109,361 Pediatric (<13 yrs) 34 71 13,927 TOTAL CASES 9,514 14,676 1,123,288 Deaths 3,948 6,039 501,818 (42%) ( 41%) (45%) *Kaiser Family Foundation data as of 12/31/03

Persons Living with HIV/AIDS in WA by County Reported cases as of October 31, 2004 N= 8,637 King County is about 2/3 of the state total (incidentally, Seattle is 2/3 of King County, and central Seattle is 2/3 of Seattle) King 64% King Co. has 29% of the state’s population and 64% of persons living with HIV/AIDS.

Trends in Infection Younger People (25% under age 21) Women People in Prison Injection Drug Users Low Socioeconomic Status / Marginalized Populations

Trends in KC New HIV Diagnoses by Mode of Transmission, 2000-2002 HIV/AIDS diagnoses Percent of total The arrows, shown here, show the direction of the trends in transmission in new HIV diagnoses from 1994 through 2002. For MSM transmissions, the trend is downward--that is the percentage of HIV diagnoses attributable to MSM is falling. For Heterosexual transmissions, the trend is upward--the percentage of HIV transmitted through heterosexual contact is increasing. Trends comparing cases 1st diagnosed HIV 1994-96 versus 1997-99 versus 2000-2002

The pie chart on the left illustrates the distribution of AIDS cases reported in 2002 among racial/ethnic groups. The pie chart on the right shows the distribution of the US population (excluding US dependencies, possessions and associated nations) in 2002. Non-Hispanic blacks and Hispanics are disproportionately affected by the AIDS epidemic in comparison with their proportional distribution in the general population. In 2002, non-Hispanic blacks made up 13% of the population but accounted for 51% of reported AIDS cases. Hispanics made up 13% of the population but accounted for 17% of reported AIDS cases. Non-Hispanic whites made up 69% of the US population but accounted for 31% of reported AIDS cases. More information on the HIV/AIDS epidemic and HIV prevention among blacks and Hispanics is available in a CDC fact sheet at http://www.cdc.gov/hiv/pubs/facts.htm.

Persons Living with HIV/AIDS 10/31/2004 versus 2004 King County population by race / ethnicity Here we have two pie charts. The left-side chart is the percentage of persons living with HIV/AIDS in King County, for each race-ethnicity. The right-side chart is the percentage of the total King County population by race-ethnicity. You can see for whites the percent living with HIV & their percentage of the population are similar. Whites makeup 75% of King County’s population, and 73% of those living with HIV/AIDS are white.. But notice the HIV/AIDS pie-slice for blacks is two-and-a-half times as high as the population pie-slice for blacks. Therefore, the rate of HIV/AIDS infection among blacks is about two-and-a-half times the rate among whites. HIV Prevalence Population

Trends in New KC HIV Diagnoses by Sex and Race 2000-2002 HIV/AIDS diagnoses Percent of total Looking at the trends in new HIV diagnoses by Race-Ethnicity & Sex, we see that-- For Blacks, both male & female, their proportion of new HIV diagnoses has increased. For Hispanic males, their proportion of new HIV diagnoses has also increased. For White males, their proportion has decreased. Overall, the trend is downward for all males and upward for all females. Overall, the trend is downward for all whites, and upward for both black, and Hispanic populations. Trends comparing cases 1st diagnosed HIV 1994-96 versus 1997-99 versus 2000-2002

MOSQUITOES--NO!! KISSING--NO!! HIV Transmission Requires: 1) Infected body fluid. 2) Entry into the body. KISSING--NO!! Blood, Semen, Vaginal Secretions & Breast Milk Mucous Membrane--Anal, Oral or Vaginal Sex Blood to Blood--Needle or Broken Skin Perinatal- In utero, During birth, Breastfeeding

HIV Transmission Requires: 1) Infected body fluid. 2) Entry into the body. Blood, Semen, Vaginal Secretions & Breast Milk Mucous Membrane -- Anal, Vaginal or Oral Sex Blood to Blood -- Needle or Broken Skin Perinatal, In Utero, During Birth, Breastfeeding

Oral Sex Transmission Receptive partner (person having mouth to genital contact) is at greatest risk. Ejaculation in the mouth, poor oral hygiene, and brushing or flossing prior to sex are associated with transmission. Protective factor of enzymes in saliva. Oral sex often not associated with risk. Various studies indicate that 1-3% of new infections are due to oral sex transmission.

Perinatal Transmission Without treatment 25% of babies born to HIV+ mothers will be infected. Prenatal care, HIV treatment, and C-sections can lower risk of transmission close to 1%. Problems in developing countries. Women with higher viral loads more likely to transmit.

Factors Affecting Transmission Viral Load Stage of infection Treatment STD Co-infection (3-5 times) More likely to become infected More likely to transmit infection

Knowing You Are Infected Primary Infection 2-6 wks average 75 -90% have symptoms Only way to know for sure HIV Antibody Test “Window Period”: time to develop antibodies 3-6 weeks (most people) 3 months >99%

Testing HIV ANTIBODY TEST Negative HIV antibody test Consists of two tests Screening test ELISA - Enzyme Linked Immuno-Sorbent Assay EIA - Enzyme Immunosorbent Assay Confirmatory test Western Blot Assay IFA - Indirect Immunofluorescense Assay Negative HIV antibody test over 99% accurate (if it has been at least three months after a contact with a potentially HIV-infected partner). Positive HIV antibody tests over 99% accurate.

Anonymous/Confidential Anonymous Testing Clinic keeps no record of your name. They use a code to process your records and your blood specimen. Confidential Testing Clinic keeps your name in their records and your medical information. Private (clinic is generally prohibited from releasing HIV information except by your written permission. Patients often sign a consent to bill form which gives permission to release information to an insurance company. You can check this with your provider.

Disease Progression Getting HIV Primary Infection Antibody Development Time without symptoms (10-12 yrs average) AIDS (Opportunistic infections, CD4 200 or below)

Antiretroviral Treatment Triple Drug Cocktail--Attack the virus at different points in the replication process Difficult Drug Regimens Importance of Adherence Side Effects Expensive

Post Exposure Prophylaxis Treatment with antiretroviral drugs after an exposure to HIV. Must be started within 72 hours (sooner the better) and continued for a month. PEP showed a 80% reduction in HIV infections for occupational exposures.

Prevention Abstinence Mutual monogamy with uninfected partner Limited sexual contact (non-penetrative) Condoms - correct and consistent use Reduce number of sexual partners Talk with new partners about risk reduction Tx of curable STDs Avoid sex if you have symptoms of an STD Notify recent partners if you have an STD Universal Precautions

Key Messages Locally, the large majority of people with HIV continue to be men who have sex with men. People of color are disproportionately represented among local new infections. The basic modes of transmission and prevention of HIV have not changed in 20 years. The AIDS epidemic is not over, but there is more hope than ever for those that are infected