1. NURS 330 - Schedule for 4/28/14 HIV Lecture – Disly Juarez, MPH
Return and Review Quiz
Group Activity
Distribute Study Guide for 5/5/14 Mid-term
In-Class Assignment

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

3. MYTHS AND FACTS ABOUT HIV/AIDS

4. Video: Myths/Facts about HIV

5. Myth/Fact?
HIV is the same as AIDS

6. Human Immunodeficiency Virus Acquired ImmunoDeficiency Syndrome
HIV vs AIDS
HIV
AIDS
What it stands for
Human Immunodeficiency Virus
Acquired ImmunoDeficiency Syndrome
What it is
A virus: an agent that replicates inside a living cell
A syndrome: a collection of multiple symptoms or characteristics that often occur together
How it is diagnosed
A test that shows HIV antibodies or antigens in a person’s blood or saliva
HIV positive test
A T- Cell count of < 200
-OR-
1 or more opportunistic infections

7. AIDS Criteria (CDC) OR YES
HIV positive test AND a T-Cell count of <200 or 14% (healthy T-Cell count ranges from ) OR
HIV positive test AND one or more opportunistic infections (OIs)/certain cancers
If the T-Cell count goes up, or the opportunistic infection goes away, does the person still have AIDS?
YES

8. HIV & the Immune System Over time HIV can lead to AIDS
HIV attacks the T cells (aka CD4 cells) weakening the immune system
Over time HIV can lead to AIDS

9. Special Characteristics of HIV
Weakens and compromises the immune system
HIV replicates in large quantities
Ability to mutate (change itself) very quickly

10. HIV only affects gay men and drug users
Myth/Fact?
HIV only affects gay men and drug users

11. with HIV (including AIDS) in LAC
Estimated Number of Persons Living with HIV and AIDS in LAC at End of 2013
Estimate
~ 60,050 persons living
with HIV (including AIDS) in LAC
13,250
1,500
3,200
9,500
3,200
16,155
50,550
We estimate that over 60,000 persons were living with HIV in Los Angeles County at the end of 2013.
Nearly 10,000 of whom are unaware of their infection.
The footnotes:
1. The CDC estimates 15.8% of PLWH are unaware of their infection.
2. The number reported here includes (1) half of our pending lab notifications and (2) half of our coded cases, that we believe represent real cases of HIV, but have not yet reported as a case in our registry by name.
Estimate
~ 61,700 living
with HIV & AIDS in LAC
25,895
(1) CDC estimates 15.8% of persons with HIV are unaware of their infection.
(2) Reported cases includes half of 3,500 lab reports pending investigation and half of 3,300 cases reported to us only by code likely to result in unduplicated named cases.
Source: LAC Division of HIV and STD Programs, reported as of 12/31/13. 11

12. Impact on Los Angeles County
LA County is second only to NYC among US metropolitan areas in cumulative number of reported AIDS cases
Only 4 states (CA, TX, NY, FL) have reported more AIDS cases than LAC
42% of all California AIDS cases are reported from LAC in 2010

13. Persons living with HIV Infection from HIV/AIDS Annual Surveillance Summary
Jurisdiction
No. living with HIV/AIDS
U.S. (50 states)
872,990*
California
117,695**
LA County
45,474 ***
*Reported as of 2011, CDC. HIV Surveillance Report, Volume 23(1), February 28, 2013
** Reported as of 12/31/12, California Office of AIDS, HIV/AIDS Surveillance Section.
*** Report as of 12/31/12, LAC Division of HIV/STD Programs

14. Transmission Category for Persons Living with HIV/AIDS
as of December 31, 2012 by Gender in Los Angeles County
Male (n=40,315)
Female (n=5,159)
* Persons with an undetermined transmission category are assigned a risk factor using multiple imputation (MI) methods. Other risks include hemophilia or coagulation disorder, transfusion recipient, perinatal exposure and confirmed other risk.
** Data are provisional due to reporting delay
Source: HIV/AIDS Surveillance Summary, data as of December 2012.

15. Persons Living with HIV/AIDS in LAC per 100,000 population
Persons Living with HIV/AIDS in LAC per 100,000 population* by Race/Ethnicity
*Sometimes called “Prevalence Rate”; it is really a proportion.
Source: HIV/AIDS Surveillance Summary, data as of 12/31/2012.

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

17. 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)

18. 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

19. Casual contact CANNOT put you at risk for HIV
Myth/Fact?
Casual contact CANNOT put you at risk for HIV

20. You CANNOT get HIV from…
Breathing
Drinking fountains
Coughing
Telephones
Sneezing
Toilet seats
Kissing
Pools/Tubs
Hugging
Mosquito bite
Shaking hands
Giving/donating blood in US
Sharing food or drinks

21. HIV Transmission Semen, Pre-cum Vaginal Secretions Breast Milk Blood
Infected Body Fluids 1 2 3 4
Semen,
Pre-cum
Vaginal
Secretions
Breast Milk
Blood
HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood.

22. HIV Transmission
Unprotected Sex 1 2 3
Anal
Vaginal
Oral

23. HIV Transmission Insulin, hormone, vitamin shots Injection Drug Use
Exchanging Infected Blood : 1 2 3 4
Insulin, hormone, vitamin
shots
Injection
Drug Use
Piercing/
Tattooing
Acu-puncture
Sharing needles for any purpose

24. 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% with proper care

25. TIME FOR AN ACTIVITY 
“The Spectrum of Risk”

26. Having another STD puts a person at greater risk for contracting HIV
Myth/Fact?
Having another STD puts a person at greater risk for contracting HIV

27. STD infection increases risk of contracting HIV (susceptibility)
STDs and HIV
STD infection increases risk of contracting HIV (susceptibility)
STDs cause breaks in the skin on and surrounding the penis, vagina and anus, which provides a perfect entry way for HIV
STDs increase the concentration of “infection fighting” CD4 cells in genital secretions, a favorite target of HIV -

28. STDs and HIV
STD infection increases risk of passing HIV to a partner (infectiousness)
HIV+ men who are also infected with an STD have much more HIV in their semen than HIV+ men without an STD +
HIV+ individuals who are also infected with an STD have more HIV in their genital secretions ? ? ?

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

30. HIV TEST HIV Antibody test Accuracy of the test Types of tests
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 20-40mins

31. HIV TEST - Uni-Gold Recombigen HIV- results will be known in 10 min.
Other Test
- 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 mi.
- 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. 
Test settings
Anonymous
Confidential

32. 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)

33. A person who is HIV positive must tell partners their status
Myth/Fact?
A person who is HIV positive must tell partners their status

34. What are the differences between ethical and legal aspects?

35. 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.

36. 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.

37. 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
California Anti-Discrimination Laws
Fair Employment and Housing Act (FEHA) and Unruh Civil Rights Act

38. that puts us at risk for HIV infection
PREVENTION
It is not who we are
but what we do
that puts us at risk for HIV infection

39. The Prevention “Toolbox”
Abstinence
Safer Sex
Male Condom (Activity)
Female Condom
Dental Dams
Safer Needle Use
Not Sharing Needles
Cleaning Needles (3x3x3 Method)
Needle Exchange
Harm Reduction

40. PREVENTION: Abstinence
Abstinence: not having sex of any kind or sharing needles. Not exchanging any bodily fluids is the only 100% sure way to avoid becoming infected with HIV.
If one is not going to abstain, what other options do they have?

41. PREVENTION: Needle use
Needle Exchange van in Berkley, CA

42. PREVENTION: Standard Precautions
Infection control measures that reduce the risk of transmission of blood-born germs from patients to health care workers
Wash hands thoroughly
Wear gloves
Use masks and eye protection
Wear a gown
Carefully handling and disposing of sharp instruments during and after use.

43. TREATMENT

44. 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).

45. TREATMENT What are Anti-retrovirals (ARVs) ?
Anti-retrovirals are drugs that interrupt the HIV replication process and help preserve the health of the immune system
These drugs must be taken in combinations in order to have a lasting effect. The three drug combination is commonly known as a “triple cocktail”
Using a combination of anti-retrovirals creates multiple obstacles to HIV replication. This is designed to keep the virus from replicating freely and reduce the possibility of a mutation.

46. When to start anti-HIV medications?
2 schools of thought:
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
Starting treatment immediately following diagnosis
Because of the complexity of selecting and following a regimen, the severity of the side-effects, and the importance of compliance to prevent resistance, it is extremely important to engage patients in treatment decisions.

47. 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

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

49. Complementary Therapy
General Health Maintenance
Psychological Well-Being
Spiritual Well-Being
Social Well-Being

50. Recent advancements Immune based therapies Maturation inhibitors
Multi-class Combination Products
Gene Therapy
Vaccine

51. QUESTIONS?

52. For More Information Contact
Disly Juarez, MPH