1. Current Issues and Trends in the Prevention, Treatment, and Management of HIV/AIDS  Nigerian Nurses Association of USA, INC.  June 30, 2006  New York Hospital, Queens Auditorium

2. The Epidemiology of HIV infection  Kathleen M. Nokes, PhD,RN,FAAN  Professor  Hunter College, CUNY  Hunter-Bellevue School of Nursing  425 East 25 St. Box 874  New York, NY 10010  kathynokes@aol.com and knokes@hunter.cuny.edu kathynokes@aol.com knokes@hunter.cuny.edu kathynokes@aol.com knokes@hunter.cuny.edu

3. United States Centers for Disease Control and Prevention (CDC) HIV/AIDS surveillance system Tracks the epidemic Process: CDC funds and assists state and local health departments, which collect the information. Health departments in turn report their data to CDC so that information from around the country can be analyzed to determine who is being affected and why. Web page: http://www.cdc.gov/hiv/topics/surveillance/index.htm

4. AIDS Cases - 2004 (new cases – incidence)  Estimated number of diagnoses of AIDS in the US was 42,514.  Adult and adolescent AIDS cases totaled 42,466 with 31,024 cases in males and 11,442 cases in females.  There were 48 AIDS cases estimated in children under age 13. –Web page: http://www.cdc.gov/hiv/topics/surveillance/basic.htm.

5. AIDS Cases by Age At time of diagnosis Web page: http://www.cdc.gov/hiv/topics/surveillance/basic.htm  Estimated # of AIDS Cases in 2004  Under age 13: 48  Ages 13 to 14: 60  Ages 15 to 19: 326  Ages 20 to 24: 1,788  Ages 25 to 29: 3,576  Ages 30 to 34: 5,786  Ages 35 to 39: 8,031  Ages 40 to 44: 8,747  Ages 45 to 49: 6,245  Ages 50 to 54: 3,932  Ages 55 to 59: 2,079  Ages 60 to 64: 996  Ages 65 or older: 901  Cumulative Estimated # of AIDS Cases, Through 2004  Under age 13: 9,443  Ages 13 to 14: 959  Ages 15 to 19: 4,936  Ages 20 to 24: 34,164  Ages 25 to 29: 114,642  Ages 30 to 34: 195,404  Ages 35 to 39: 208,199  Ages 40 to 44: 161,964  Ages 45 to 49: 99,644  Ages 50 to 54: 54,869  Ages 55 to 59: 29,553  Ages 60 to 64: 16,119  Ages 65 or older: 14,410

6. AIDS Cases by Race/Ethnicity (Use these categories) Web page: http://www.cdc.gov/hiv/topics/surveillance/basic.htm  Estimated # of AIDS Cases in 2004  White (not Hispanic) 12,013  Black, not Hispanic 20,965  Hispanic 8,6721  Asian/Pacific Islander 488  American Indian/Alaska Native 193  Cumulative Estimated # of AIDS Cases, Through 2004  White (not Hispanic) 375,155  Black, not Hispanic 379,278  Hispanic 177,164  Asian/Pacific Islander 7,317  American Indian/Alaska Native 3,084

7. AIDS Cases: Exposure Category 2004 http://www.cdc.gov/hiv/topics/surveillance/basic.htm  Male/Female/Total  Male-to-male sexual contact –Male: 17,69 Female: 0Total 17,691  Injection Drug Use –Male: 5,968 Female:3,184 Total 9,152  Male-to-male sexual contact and injection drug use –Male: 1,920 Female: 0Total 1,920  Heterosexual contact –Male: 5,149 Female: 7,979Total 13,128  Other –Male: 298Female: 279Total: 577

8. Cumulative estimated number of diagnoses of AIDS through 2004  United States: 944,305.  Adult and adolescent AIDS cases total 934,862 –756,399 cases in males –178,463 cases in females. –9,443 AIDS cases were estimated in children under age 13.  Web page: http://www.cdc.gov/hiv/topics/surveillance/basic.htm.

9. State/Territory # of AIDS Cases in 2004 Web page: http://www.cdc.gov/hiv/topics/surveillance/basic.htm New York Florida California Texas New Jersey Illinois Georgia Pennsylvania Maryland North Carolina 7,641 5,822 4,679 3,298 1,848 1,679 1,640 1,629 1,451 1,137

10. CDC surveillance goals  Currently tracks: –AIDS cases –New HIV infections –Behaviors and characteristics of people at high risk  Web page: http://www.cdc.gov/hiv/topics/surveillance/index.htm http://www.cdc.gov/hiv/topics/surveillance/index.htm

11. CDC obtains behavioral information from several different populations. HIV-related behaviors of the general population. Few examples: MMP (Morbidity Monitoring Project) is a new surveillance system designed to collect information from HIV/AIDS patients who received care from randomly selected HIV care providers. NHBS (National HIV Behavioral Surveillance System), for populations at high risk, began in 2003. NHbS conducts surveys in cities with high levels of AIDS among MSM, IDUs, and heterosexuals at high risk to determine their risk behavior, testing behavior, and use of prevention services. Web page: http://www.cdc.gov/hiv/topics/surveillance/index.htm

12. Trends in HIV testing  CDC recommends confidential name- based surveillance as opposed to code-based or name to code (anonymous). (http://www.cdc/gov/hiv/PUBS/0705 05_dearcolleague_gerberding.pdf) (July 5, 2005). http://www.cdc/gov/hiv/PUBS/0705 05_dearcolleague_gerberding.pdfhttp://www.cdc/gov/hiv/PUBS/0705 05_dearcolleague_gerberding.pdf

13. HIV reporting (not AIDS)  AIDS – reportable infection since epidemic identified.  HIV – NOT reportable.  With treatment options, need to report HIV not only AIDS.  Now, all states report HIV and AIDS. (http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2004report /commentary.htm)  35 areas with confidential name- reporting

14. New HIV infection  One method for estimating HIV incidence is to apply the serologic testing algorithm for recent HIV seroconversion (STARHS) to the serum specimens from which new HIV diagnoses were made. A total of 34 areas are using this method to estimate population-based HIV incidence.  Web page: http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2004report/commentary.htm

15. 2001-04 – 35 areas

16. Race/ethnicity – 35 areas

18. Transmission category

19. Prevalence

20. Incidence

21. HIV/AIDS Estimate  At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS, with 24-27% undiagnosed and unaware of their HIV infection.  Web page: http://www.cdc.gov/hiv/topics/surveillance/basic.htm.

22. International Resources  Global Health: www.globalhealth.org www.globalhealth.org  Weekly updates  From their web page: Global Health Council is the world's largest membership alliance dedicated to saving lives by improving health throughout the world. The Council works to ensure that all who strive for improvement and equity in global health have the information and resources they need to succeed..

23. Global Fund to Fight AIDS, TB, & Malaria http://www.theglobalfund.org  The Global Fund's international Board includes representatives of donor and recipient governments, non-governmental organizations, the private sector (including businesses and foundations) and affected communities.  Key international development partners also participate, including the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Bank. The latter also serves as the Global Fund's trustee.

24. The President's Emergency Plan For AIDS Relief (PEPFAR) web page http://www.whitehouse.gov/infocus/hivaids/  After Two Years, this program has Supported Life-Saving Treatments For Approximately 400,000 Sub-Saharan Africans Living With HIV/AIDS.  Before the President (George W. Bush) announced PEPFAR in 2003, only 50,000 of the more than four million people in sub-Saharan Africa needing immediate AIDS treatment were getting medicine.

25. Treatment  Based on CD4 counts – below 200  (WHO has a classification system & CDC has classification system but trend is toward use of CD4 cell counts)

26. Kaiser Family Foundation http://www.kff.org/hivaids/aidsat25.cfm  June 5, 2006, marks twenty-five years since the U.S. Centers for Disease Control and Prevention issued its first warning.  Several new and updated resources:  Evolution of an Epidemic: 25 Years of HIV/AIDS Media Campaigns in the U.S. Evolution of an Epidemic: 25 Years of HIV/AIDS Media Campaigns in the U.S.Evolution of an Epidemic: 25 Years of HIV/AIDS Media Campaigns in the U.S.  AIDS at 25: An Overview of Major Trends in the U.S. Epidemic AIDS at 25: An Overview of Major Trends in the U.S. EpidemicAIDS at 25: An Overview of Major Trends in the U.S. Epidemic  The Global HIV/AIDS Timeline is an interactive, up-to-date web- based timeline of key HIV-related events and noteworthy activities from 1981 through today. The Global HIV/AIDS TimelineThe Global HIV/AIDS Timeline  Webcasts on AIDS at 25 from kaisernetwork.org. Webcasts on AIDS at 25Webcasts on AIDS at 25  The Survey of Americans on HIV/AIDS released May 2006 finds that Americans increasingly believe the U.S. should be a global leader on HIV/AIDS, including spending more money to fight the epidemic abroad and at home. The Survey of Americans on HIV/AIDSThe Survey of Americans on HIV/AIDS  Fact Sheets on HIV/AIDS Fact Sheets on HIV/AIDSFact Sheets on HIV/AIDS

27. William J. Clinton Foundation http://www.clintonfoundation.org/cf-pgm-hs-ai-home.htm  The Clinton Approach aims to assist countries in implementing large-scale, integrated, care, treatment and prevention programs that will turn the tide on the epidemic. It partners with countries in Africa, the Caribbean and Asia to develop operational business plans to scale-up care and treatment.

28. 2006 Report on the Global AIDS Epidemic http://data.unaids.org/pub/GlobalReport/2006/2006_GR-ExecutiveSummary_en.pdf  UNAIDS/WHO  Download the Executive Summary

29. Nigeria http://www.globalhealthfacts.org/country.jsp?c=162&sn=1  3 rd highest HIV/AIDS rates in the world (according to UNAIDS)  Population: 131,859,728  People living with HIV/AIDS (2005): 2,900,000.  Prevalence rate: 3.9%  New TB (2004): 373,682  Malaria (2003): 2,608,479

30. Questions?