NURS Schedule for 2/3/14 HIV Lecture – Disly Juarez Return and Review Quiz Group Activity Distribute Study Guide for 2/10/14 Mid-term In-Class Assignment

2 County of Los Angeles Department of Public Health Division of HIV and STD Programs Disly Juarez, MPH Health Educator The State of the HIV/AIDS Epidemic

MYTHS AND FACTS ABOUT HIV/AIDS 3

Myth/Fact? HIV is the same as AIDS MYTH 4

HIV AIDS 5 Immune Acquired Deficiency Syndrome AIDS HumanHuman Immunodeficiency Immunodeficiency VirusVirus HIV

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 6

HIV/AIDS Defined CDC definition (AIDS): HIV+ test, T-cell count of < 200 (healthy T-cell count ranges from ) - 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

Myth/Fact? HIV only affects gay men and drug users MYTH 8

Although the AIDS rate in Los Angeles County is lower than the rate in other areas of the US, in sheer number, Los Angeles County is second only to New York City in the cumulative number of reported AIDS cases among major metropolitan areas. Only 4 states, including the rest of California, have reported more cases than LAC LAC has reported 36% of all California AIDS cases. 9

Myth/Fact? Once a person is diagnosed with HIV/AIDS, they will die soon MYTH 10

Manifestations of HIV Infection  No physical symptoms, and healthy results on tests of immune function.  No physical symptoms, but show some signs of immune system damage on medical tests of the immune system.  Mild or severe symptoms of HIV disease. 11

HIV Spectrum of Disease Exposure No infection Asymptomatic Infection Window period* Asymptomatic Initial Symptoms Lasts a few weeks Mild flu-like symptoms: Fever Muscle aches Swollen glands Asymptomatic Period years (Average progression, may vary depending on the person) HIV Illness Symptoms include: Night sweats Fevers Fatigue Diarrhea Swollen lymph nodes Oral and vaginal candidiasis PID Pap Smear positive for HPV AIDS T-Cells <200 1 or more OIs (PCP, KS, TB, CMV, Candidiasis, etc.) Wasting syndrome HIV-related dementia *Window Period: average time it takes the body to produce antibodies; usually weeks, up to 6 months - 1 year (rare)

Common Opportunistic Infections  Pneumocystis carinii Pneumonia (PCP)  CMV Infection  HIV Wasting Syndrome  Candidiasis (oral, esophageal, vaginal)  Kaposi’s Sarcoma  Tuberculosis  HIV - Related Dementia  Cervical Cancer 13

Myth/Fact? Casual contact CANNOT put you at risk for HIV FACT 14

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 15 People cannot get HIV from:

HIV Transmission HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood. 16 By Infected Body Fluids: Breast milk Blood 1234 Semen, pre-cum Vaginal secretions

HIV Transmission 17 Oral VaginalAnal By Unprotected Sex: 1 2 3

HIV Transmission By Exchanging Infected Blood Sharing needles for any purpose Sharing needles for any purpose Injection drug use Piercing/ tattooing Insulin, hormone vitamin shots Acu- puncture 1234

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) 19

Myth/Fact? HIV testing is unnecessary because I would know if my lover or I had it MYTH 20

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 21

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 TEST Informed Consent 12 yrs of age or older Benefits of Testing…….. Where to test? Private medical doctor County clinic Community-based organizations AIDS (2437) 23

Myth/Fact? A person who is HIV positive must tell partners their status MYTH 24

California’s “Willful Exposure” Law (1998)/aka “Recalcitrant Behavior”:  Willfully exposing another to HIV through unprotected sex  8 years of imprisonment  Intention 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 sex  Know that they are HIV +  Fail to disclose their HIV status  Fail to use a condom  Have a specific intent to infect another person Actual knowledge of HIV infection without more evidence of “specific intent” is insufficient for prosecution. 25

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. 26

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) and Unruh Civil Rights Act 27

PREVENTION 28

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 (Activity) Female Condom Dental Dams  Needle use Not Sharing Needles Cleaning Needles (3x3x3 Method) Needle Exchange 29

The Female Condom

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. 31

PREVENTION BREAST FEEDING It is recommended that HIV+ women do not breastfeed Infants. POST–EXPOSURE PROPHYLAXIS (PEP) Exposure to HIV within the prior 72 hours Approve for 13 yrs of age or older For more information call 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 32

TREATMENT 33

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). 34

Treatment as Prevention Science Magazine named 'HIV Treatment as Prevention' as the breakthrough of 2011 The HIV Prevention Trials Network (HPTN) 052 study of 1,700 sero-discordant couples reported that ARVs reduced the risk of heterosexual transmission by 96%. 35

TREATMENT  What are Anti-retrovirals (ARVs) ? Antiretrovirals are drugs that interrupt the HIV replication process and help preserve the health of the immune system.  When to start anti-HIV medications? Treatment should begin if: there are severe symptoms of HIV infection or a diagnosis of AIDS with a CD4 count of 350 cells/mm3 or less (especially if 200 or less). 36

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 37

Who Pays For Treatment?  HMO insurance  Medi-Cal  Medicare Part D  ADAP  Shared cost 38

Recent Advancements  Immune based therapies  Maturation inhibitors  Multi-class Combination Products  Gene Therapy  Vaccine 39

Complementary Therapy  General Health Maintenance  Psychological Well-Being  Spiritual Well-Being  Social Well-Being 40

QUESTIONS? 41

For More Information Contact Disly Juarez, MPH