1. North Dakota Department of Health HIV/AIDS Program

2. H Human
I Immunodeficiency
V Virus

3. A Acquired
I Immuno
D Deficiency
S Syndrome

4. HIV Transmission HIV enters the bloodstream through: Open Cuts
Breaks in the skin
Mucous membranes
Direct injection

5. HIV Transmission Common fluids that are a means of transmission: Blood
Semen
Vaginal Secretions
Breast Milk

6. HIV in Body Fluids
Blood
18,000
Semen
11,000
Vaginal
Fluid
7,000
Amniotic
Fluid
4,000
Saliva 1
Average number of HIV particles in 1 ml of these body fluids

7. Routes of Transmission of HIV
Sexual Contact: Male-to-male
Male-to-female or vice versa
Female-to-female
Blood Exposure: Injecting drug use/needle sharing
Occupational exposure
Transfusion of blood products
Perinatal: Transmission from mom to baby
Breastfeeding

8. HIV-Infected T-Cell
New HIV
Virus
HIV
Virus
HIV Infected
T-Cell
T-Cell

9. Window Period
This is the period of time after becoming infected when an HIV test is negative
90 percent of cases test positive within three months of exposure
10 percent of cases test positive within three to six months of exposure

10. HIV Infection and Antibody Response
---Initial Stage----
Intermediate or Latent Stage
---Illness Stage---
Flu-like Symptoms Or
No Symptoms
Symptom-free
AIDS Symptoms
----
Infection
Occurs
----
<

11. Importance of Early Testing and Diagnosis
Allows for early treatment to maintain and stabilize the immune system response
Decreases risk of HIV transmission from mother to newborn baby
Allows for risk reduction education to reduce or eliminate high-risk behavior

12. HIV Testing Requires a blood or oral fluid sample
HIV test detects the body’s antibody response to HIV infection
The test does NOT detect the HIV virus

13. HIV Testing in North Dakota
Confidential vs. anonymous testing
Testing offered free-of-charge at state-funded HIV test sites for those at risk
Test results are available within a week
For a list of HIV test sites in North Dakota call ndhiv or visit

14. HIV Testing
Those recently exposed should be retested at least six months after their last exposure
Screening test (EIA/ELISA) vs. confirmatory test (IFA)
EIA/ELISA (Reactive)
Repeat EIA/ELISA (Reactive)
IFA (Reactive)
Positive for HIV

15. HIV Testing EIA/ELISA Test HIV + Positive Negative No HIV Exposure
Low Risk
HIV Exposure
High Risk
Repeat
Positive
Repeat ELISA
Every 3 months
for 1 year
Negative
Run IFA
Confirmation
Positive
Repeat every
6 months for continued
High risk behavior
Indeterminate
Negative
Positive
Repeat at
3 weeks
Repeat at
2-4 months
End Testing
Negative
HIV +

16. North Dakota Law for HIV Testing
Requires informed consent
No premarital testing requirement
Prenatal testing not required but recommended
School notification not required for positive staff or students (universal precautions)

17. North Dakota Law for HIV Testing (cont.)
Allows testing of individuals:
14 years of age or older without parental consent
Mandatory testing for prison inmates in grade 1, grade 2, regional facilities, and the state penitentiary as defined in NDCC:
Court ordered testing for defendants charged with a sex offense as defined in NDCC:

18. HIV AIDS Once a person is infected they are always infected
Medications are available to prolong life but they do not cure the disease
Those who are infected are capable of infecting others without having symptoms or knowing of the infection

19. HIV Risk Reduction Avoid unprotected sexual contact
Use barriers such as condoms and dental dams
Limit multiple partners by maintaining a long-term relationship with one person
Talk to your partner about being tested before you begin a sexual relationship

20. HIV Risk Reduction
Avoid drug and alcohol use to maintain good judgment
Don’t share needles used by others for:
Drugs
Tattoos
Body piercing
Avoid exposure to blood products

21. Condoms
Using condoms is not 100 percent effective in preventing transmission of sexually transmitted infections including HIV
Condoms = Safer sex
Condoms ≠ Safe sex

22. Condom Use Should be used consistently and correctly
Should be either latex or polyurethane
Should be discussed with your partner before the sexual act begins
Should be the responsibility of both partners for the protection of both partners
Male and female condoms are available

23. People Infected with HIV
Can look healthy
Can be unaware of their infection
Can live long productive lives when their HIV infection is managed
Can infect people when they engage in high-risk behavior

24. HIV Exposure and Infection
Some people have had multiple exposures without becoming infected
Some people have been exposed one time and become infected

25. “When you have sex with someone, you are having sex with everyone they have had sex with for the last ten years.”
Former Surgeon General
C. Everett Koop

26. HIV and Sexually Transmitted Diseases

27. HIV and Sexually Transmitted Diseases
STDs increase infectivity of HIV
A person co-infected with an STD and HIV may be more likely to transmit HIV due to an increase in HIV viral shedding
More white blood cells, some carrying HIV, may be present in the mucosa of the genital area due to a sexually transmitted infection

28. HIV and Sexually Transmitted Diseases
STDs increase the susceptibility to HIV
Ulcerative and inflammatory STDs compromise the mucosal or cutaneous surfaces of the genital tract that normally act as a barrier against HIV
Ulcerative STDs include: syphilis, chancroid, and genital herpes
Inflammatory STDs include: chlamydia, gonorrhea, and trichomoniasis

29. HIV and Sexually Transmitted Diseases
The effect of HIV infection on the immune system increases the the risk of STDs
A suppressed immune response due to HIV can:
Increase the reactivation of genital ulcers
Increase the rate of abnormal cell growth
Increase the difficulty in curing reactivated or newly acquired genital ulcers
Increase the risk of becoming infected with additional STDs

30. HIV Post Exposure Prophylaxis

31. HIV Occupational Exposure
Review facility policy and report the incident
Medical follow-up is necessary to determine the exposure risk and course of treatment
Baseline and follow-up HIV testing
Four week course of medication initiated one to two hours after exposure
Liver function tests to monitor medication tolerance
Exposure precautions practiced

32. HIV Non-Occupational Exposure
PREVENTION --- FIRST
No data exists on the efficacy of antiretroviral medication after non-occupational exposures
The health care provider and patient may decide to use antiretroviral therapy after weighing the risks and benefits
Antiretrovirals should not be used for those with low-risk transmissions or exposures occurring more than 72 hours after exposure

33. HIV Non-Occupational Exposure
Provider Considerations:
Evaluate HIV status of patient and risk history of source patient
Provide necessary medical care and counseling
Evaluate risk event and factors for exposure
Determine elapsed time from exposure
Evaluate potential for continuous HIV exposure
Obtain informed consent for testing and treatment
Evaluate pregnancy status of females
Monitor for drug toxicity and acute infection