1. HIV Prevention
Understanding the HIV virus is very important. Each of us needs information, not only for ourselves, but to be able to discuss it with others.

2. Historical Perspective
Probably originated in west Africa
Virus thought to have jumped species (from chimpanzees to hunters)
Identified as GRID in U.S. 1981
Scientists identified a type of Chimpanzee in West Africa as the source of HIV infection in humans. It is believed the Chimpanzee version of the virus was most likely transmitted to humans when they hunted these Chimpanzees for food and came into contact with their infected blood. This may have happened as far back as the late 1800s. Over a period of years, the virus slowly spread across Africa and later into other parts of the world. The virus has been in the U.S. since the mid to late 1970s. In 1981 it was called the GRID virus because the first documented cases in the U.S. were among gay men. In 1982, the name was changed to AIDS indicating the disease infected all populations.

3. Data About 50,000 Americans are infected yearly
About 1.1 million Americans are living with HIV (16% do not know their status)
More than 635,000 have died in U.S.
About 30 million have died worldwide
Here are a few relevant statistics. [Allow students time to read the data.] It is still considered a deadly epidemic is some parts of the world. The infection rate is fairly steady in the United States, which tells us that much more needs to be done in the area of prevention.

4. What is HIV? What is AIDS? Human immunodeficiency virus
Can lead to acquired immunodeficiency syndrome (AIDS)
Attacks body’s immune system, allowing opportunistic infections
Untreated, AIDS is
almost universally fatal
HIV stands for human immunodeficiency virus. It affects specific cells of the immune system called T-cells. Unlike some viruses, the human body cannot get rid of HIV. There is no vaccine against HIV. In other words, if you have HIV, you have it for life. But remember, having the HIV virus does not mean one will develop AIDS. Over time, HIV destroys the body’s immune cells. With the right medicines, one can have HIV for years or even decades without progressing to AIDS. AIDS is diagnosed when one has HIV as well as certain opportunistic infections.

5. How HIV is Spread Through blood or body fluid contact with
infected person
Unprotected sexual intercourse (oral, anal, and penis-vagina)
Sharing needles
From mother to child
While baby develops in mother’s uterus
At time of birth
During breastfeeding
The 2 most prevalent ways HIV is spread are by having unprotected sex and sharing needles used to inject drugs or other substances, including contaminated needles for injecting steroids and tattooing and body art. Also possible is the spread of the virus from mother to child.

6. How HIV is NOT Spread Hugs or handshakes Drinking glasses
Sneezes, coughs
Kissing
Mosquitos
Towels
Toilet seats
Doorknobs
It is important to know ways that HIV is NOT spread. One cannot get HIV through casual contact.

7. Signs and Symptoms of HIV: Teens and Adults
Often show no symptoms at time of infection
Can pass virus to others before status is known
May take up to 10 years for symptoms to show
The only way to know if one is infected with HIV is to be tested. Many people with HIV do not have any symptoms at for up to 10 years. Symptoms of HIV include: fever, enlarged nymph nodes in the thyroid and neck, sore throat, and rash.
Which teen has HIV?

8. Stages of HIV Acute infection
2 – 4 weeks after infection
May feel sick with flu-like symptoms
Clinical latency (often called asymptomatic)
Those on ART, this stage may last decades
Those not on ART, this stage may last up to a decade
AIDS
Immune system badly damaged
Vulnerable to opportunistic infections
In some cases, people have no symptoms at the beginning of the infection. During the acute infection phase, ones ability to spread the virus is very high. Some may have flu-like symptoms. During the clinical latency phase, the HIV is still active, but reproduces at low levels. One may not have any symptoms or get sick during this time. People on medication may live with this phase for several decades. For people not on medication, the period can last up to a decade. It is important to know one is still able to transmit the virus to others during this phase.
AIDS: this is the stage of infection that occurs when ones immune system is badly damaged and on becomes vulnerable to infections and opportunistic illnesses. When the number of CD4 cells falls below 200 cells/ per cubic millimeter of blood, one is considered to have progressed to AIDS. One can also be diagnosed with AIDS if having developed opportunistic illnesses, regardless of the CD4 cell count.

9. Symptoms of AIDS: Teens and Adults
Rapid weight loss
Intense fatigue
Swollen lymph nodes
Persistent diarrhea
Night sweats
Pneumonia
If one receives no treatment for HIV infection, the disease typically progresses to AIDS within 10 years. Other symptoms include: fever for several weeks, shortness of breath, cough, headaches, and blurred vision.

10. Opportunistic Infections
Definition: HIV weakens one’s immune system, increasing susceptibility to:
Tuberculosis
Viral and bacterial infections
Cancers
Kaposi’s sarcoma
Lymphomas
Pneumonia
Wasting syndrome
Kidney disease
Dementia
Opportunistic infections (those that take advantage of a person’s weakened immune system) are the most common complications of HIV/AIDS.

11. Prevention of HIV Delay intimate sexual behavior Limit sexual partners
Get tested and share results with potential partner
Use latex condoms and dental dams with all intimate sexual behaviors
Do not share injection drug equipment
These are the strategies for preventing the spread of HIV. [Allow students to read slide.] Ask, Which of these practices might be most effective for teens to practice?

12. Prevention of HIV in Babies
Get tested if planning a pregnancy or early in pregnancy
If pregnant and HIV positive, ART can reduce risks from 20% to 2%
If HIV positive, do not breastfeed baby
There are also strategies for preventing the transmission of HIV from mother to baby.

13. Testing for HIV Testing only way to know HIV tests detect antibodies
in saliva or blood
Go to
Testing is easy, free, and only takes 20 minutes
Antibodies can be detected between 12 weeks and 6 months after exposure
Care should be taken to avoid infecting others
When a person is initially infected, the immune system creates antibodies to try and remove the virus from the body. Detection of these antibodies in saliva or blood is how it is determined whether a person is HIV positive or not.

14. Testing for HIV: Where to Go
HIV testing zip code locator website:
Public Health Department
Health care provider
Testing for HIV is easily available to anyone at risk. [Post the website and phone # for local health department in classroom.]

15. HIV Tests Confidential Blood or saliva
Standard blood test: results in 2 weeks, sent to state lab
Rapid test: results in 20 minutes
Counseling and provision of resources:
status
treatment options
scheduling medical appointment
preventing infection of others
notification of partner
Here is the type of testing and follow up support available at most health departments in North Carolina. Some health departments have a somewhat different protocol, but this is typical.

16. HIV Testing (may be different in some counties)
See a nurse to assess risk factors
Receive counseling on risk reduction
Sent to lab to get test
Come back in 2 weeks for results
If negative, no contact will be made
If positive, disease intervention specialist will discuss treatment and contact partners (name not divulged)
If a teenager goes to a health department for HIV testing in North Carolina, these are the usual sequence of steps for being tested.

17. Barriers to Testing Stigma Fear Lack of awareness of risk factors
Unwillingness to change behavior
In spite of all we have learned about HIV, many people still fear others will think less of them if they are diagnosed with the disease. They also worry they could be discriminated against if it is known they are HIV positive. Some people won’t get tested because they are scared of what the results might be. In earlier days of the HIV epidemic, being diagnosed with HIV was like receiving a death sentence. However there have been tremendous advances in treatment for HIV. Early detection improves outcomes. Benefits of treatment are reduced the longer one waits, so it is one’s best interest to get treated sooner rather than later. To ignore the possibility of HIV/AIDS is not in anyone’s best interest.

18. If Test is Positive . . . Regular blood tests
Treatment usually starts when immune system weakens
NCDHHS will inform partner(s)
Use condoms consistently and correctly
If you are diagnosed with HIV, you will have regular blood tests to monitor the progress of the virus before starting treatment. You will not usually need to start treatment until the virus has begun weakening your immune system.

19. Treatment
ART is antiretroviral therapy (combination of HIV medications)
ART cannot cure HIV, but can help people live longer healthier lives
1 or 2 pills once a day
There are side effects
Must be taken the rest of one’s life
The aim of treatment is to reduce the level of HIV in the blood and prevent or delay any HIV-related illnesses. The treatment for HIV infection is called Antiretroviral Therapy (ART). ART involves taking a combination of HIV medicines (called HIV regimen): one to three or more pills every day. ART prevents HIV from multiplying and destroying infection-fighting immune cells. ART can prevent HIV infection from advancing to AIDS. ART will not cure HIV, but it can help people infected with HIV to live longer and healthier lives. ART also reduces the risk of HIV transmission. The overall benefits of ART far outweigh its risks. Treatment is for life.

20. Overcoming Apathy
Many of us think HIV/AIDS is not going to “happen to me”. Because new treatments have been so successful in allowing patients to live longer, the disease isn’t perceived as an immediate death threat. The survival rate from HIV continues to rise and this has unfortunately has caused people to become more lax in terms of prevention. Having newer and improved drugs to deal with HIV can lead one to lose focus on prevention. Not enough discussion on what really causes HIV/AIDS and difficulty of treatment can create a sense of apathy, leading some people to believe that it is a curable disease. Prevention is the key.