1. HIV 101 for Providers Jennifer Marshall Assistant Director jmarshall@mcrh-tn.org 901-791-9384

2. Why Parallel Paths? Individuals have sexual and reproductive health needs related to HIV testing and prevention. Routine HIV Testing Prevention Counseling Linkages to HIV Care if Infected Persons Living with HIV have sexual and reproductive health needs. Pregnancy Prevention Pregnancy Planning Basic GYN Care STI Testing and Treatment Abortion Prenatal Care

3. HIV 101  HIV is the Human Immunodeficiency Virus  HIV is the virus that causes AIDS  AIDS is the Acquired Immune Deficiency Syndrome

4. HIV 101  HIV belongs to a family of viruses called retroviruses  Retroviruses mutate so quickly a person’s immune system does not have any defenses against the new version of the virus  HIV is also a lentivirus – a virus with a long delay between initial infection and the time the infected person starts to show symptoms 3/1/2010 AM

5. HIV 101  HIV needs 2 (two) things to live: An Air-tight container (the human body) Protein  HIV only lives in four body fluids  Blood ( including menses)  Semen ( including pre-ejaculate)  Vaginal Fluids  Breast milk

6. HIV 101  Shelby County:  As of 12/2009:  6,304 PLWHA  394 new HIV infections

7. HIV 101  Having unprotected sex with an infected individual Anal Vaginal Oral  Acts listed in descending order from the greatest to least risk

8. HIV 101  Blood-to-blood contact with an infected person, which includes sharing needles for any reason

9. HIV 101  Mother to Child ( perinatal transmission) can occur during pregnancy, labor, delivery, or breastfeeding  If NO treatment is received during pregnancy the risk of mother-to-child transmission is around 25%  If HAART IS received during pregnancy, delivery and after birth the risk drops to as low as 0.5% to 2%

10. HIV 101  HIV is NOT transmitted via…  Saliva  Urine  Sweat  Tears  HIV is not transmitted through casual contact!

11. The Stages of HIV Disease Primary Infection:  The first stage of HIV disease  2 to 4 weeks after infection, 87% of HIV+ persons suffer flu-like symptoms (acute HIV syndrome)  After infection, the body begins to produce antibodies to the virus, or to seroconvert  It takes between 3-12 weeks for the body to produce enough antibodies to be detected on a test (rare cases 6 months)  If antibody test is done too early in this process it may not be accurate

12. HIV in the Body Acute HIV Infection  2-8 weeks after infection, most people experience flu-like symptoms  Viral load spikes dramatically after initial infection and then stabilizes.  High levels of HIV in sexual fluids during this period.  More HIV=More Infectious

13. Window Period for HIV Antibody Detection 3 months Infected with HIV Earliest detection Over 99% of infections detected Note: In very rare situations, detection of antibodies may take up to 6 months or longer. 85% of infections detected 3 weeks6 weeks0 weeks Majority of HIV infections can be identified here

14. The Stages of HIV Disease Chronic HIV Infection:  Asymptomatic Period Also called clinical latency – person has no signs or symptoms of HIV disease Although individual shows no symptoms, the virus is actively multiplying and infecting and killing immune system cells  Immune System Decline The more HIV a person has (the plasma viral load) the lower the number of CD4+ cells; ultimately results in the rapid decline of the immune system

15. The Stages of HIV Disease Asymptomatic HIV Infection  Can last up to 10 years  No symptoms  Virus is actively multiplying and impacting the immune system  Even though a person may look and feel healthy, they can spread HIV to other people.  At this stage, person should show as positive on a HIV Antibody test.

16. HIV in the Body Symptomatic HIV Infection  Over time the immune system becomes severely damaged. The body fails to keep up with replacing the CD4+cells that are lost.

17. Immune System Decline Non-specific Symptoms:  When the immune system is damaged, people begin to experience mild symptoms Swollen lymph nodes Fatigue Weight loss Frequent fevers and sweats Frequent or persistent yeast infections Persistent skin rashes Shingles 3/1/2010 AM

18. Advanced HIV Disease (AIDS) The CDC has two different sets of criteria for diagnosing AIDS: Set 1—An HIV infection, confirmed by testing, plus a CD4+ T-cell count of less than 200 per cubic millimeter of blood Set 2—An HIV infection, confirmed by testing, plus one of 26 clinical conditions, primarily opportunistic Infections that do not normally affect healthy people

19. Opportunistic Infections Examples Pneumocystis Carinii Pneumonia (PCP) Kaposi's Sarcoma (KS) HIV wasting syndrome (extreme weight loss) Non-Hodgkin's lymphoma HIV encephalopathy (AIDS Dementia) Candidiasis (Yeast Infection) of the trachea, bronchi, or lungs Candidiasis (Yeast Infection) of the esophagus

21. HIV Testing Recommendations  Everyone ages 13-64 in all healthcare settings  Everyone beginning treatment for TB  Everyone seeking treatment for STDs  All pregnant women 3/1/2010 AM

22. HIV Testing  Antibody test  Blood  Oral Fluid  Confidential  Minors age 13 and up  Rapid Testing

23. HIV Testing FREE and CONFIDENTIAL HIV Testing  CHOICES: Memphis Center for Reproductive Health  1726 Poplar Avenue (901) 274-3550  Friends for Life  43 N. Cleveland (901) 272-0855  Planned Parenthood Greater Memphis Region  2430 Poplar Ave. Suite 100 (901) 725-1717  Memphis and Shelby County Health Dept.  814 Jefferson Ave. (901)544-7552  Primary Care Physician

24. HIV Testing  ELISA (Enzyme-Linked Immunosorbent Assay): determines if HIV antibodies are present in blood or oral fluids  Western Blot : A highly specific test that is used for confirming the ELISA test  Rapid HIV tests : Screening tests using oral mucose transudate, urine or blood. At home HIV antibody testing kits fall into this category  HIV RNA tests : Diagnose HIV infection very early, before antibodies are even formed

25. HIV Testing What if a person is NEGATIVE? HIV is preventable  Individuals who are sexually active and/or use needles should continue to be tested on a regular, usually every 6 months basis  The CDC recommends that everyone be tested for HIV at least one a year regardless of perceived risk.

26. HIV Testing What if a person is POSITIVE?  Treatment is available  Ryan White Services  www.hivmemphis.org  Early treatment and intervention are key to maintaining the quality of life

27. HIV/STI Prevention  100% Safe  Abstinence  Masturbation  98% Male Condoms  95% Female Condoms  Dental Dams  Finger Cots

28. HIV/ STI Prevention The Male Condom  Can be made of Latex or Polyurethane  Only Water-based and Silicone lubricants can be used  Comes in a variety of sizes, styles, colors, and flavors  Can be used during anal, oral, and vaginal sex.  Cannot be used in conjunction with the female condom or with another male condom (1 @ a time!)  Must use a new condom with each sex act

29. HIV/STI Prevention The Female Condom  Made of Polyurethane-transmits heat better than latex (more natural feeling)  Can be used with non- water based lubricants  Can be used during vaginal sex  Can be inserted up to 8 hours before sex  Offers more skin to skin protection than the male condom  Comes in one size fits most women  Can only be used one time  Cannot be used in conjunction with the male condom.

30. HIV/STI Prevention  Used for anal or vaginal digital sex (fingering)  Helps prevent bacterial infections  Reduces risk for STI associated with fingering  Dental Dams are latex barriers used for oral/anal and oral/vaginal sex  If Dental Dam is not available non- microwavable plastic wrap or a latex condom cut open to lay flat, may be used.

31. Pre-Exposure Prophylaxis (PrEP)  HIV negative people who are at high risk, take antiretroviral medication daily to try to lower their chances of becoming infected with HIV  Shown to be effective in men who have sex with men (MSM) and heterosexual men and women

32. Pre-Exposure Prophylaxis (PrEP)  November 2010, NIH iPrEx clinical trial  daily oral use of Truvada provided an average of 44% additional protection to men who have sex with men (MSM)  July 2011, CDC TDF2 study  once-daily Truvada reduced the risk of acquiring HIV infection by roughly 63 percent in the study population of uninfected heterosexual men and women. More info, including study results: http://www.cdc.gov/hiv/prep/ http://www.cdc.gov/hiv/prep/

33. Post-Exposure Prophylaxis (PEP)  Usually consists of a month long course of two or three different types of the antiretroviral drugs  needs to be taken as soon as possible, and definitely within 72 hours of exposure to HIV.  Longer and it is thought that the effectiveness of the treatment is severely diminished.  Occupational Exposures  Sexual Assault Victims