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November 3, 2014 NURS 330 Human Reproductive Health
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Agenda for 11/3/14 Mid-term –Review 10/20/14 In-Class Assignment –Return and Review Review Grades Guest Lecture on HIV (Disly Juarez) 11/3/14 In-Class Assignment
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Grades DateAssignmentPossible Points 10/6/14In-Class #110 10/13/14In-Class #210 10/20/14In-Class #310 10/27/14Mid-term100 Total Possible Points (through 10/27/14) 130 11/3/14In-Class #410 11/10/14Quiz #125 11/17/14In-Class #510 11/24/14Quiz #225 12/1/14In-Class #710 12/8/14Final Exam200
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4 County of Los Angeles Department of Public Health Division of HIV and STD Programs Disly Juarez, MPH Health Educator djuarezmunoz@ph.lacounty.gov The State of the HIV/AIDS Epidemic
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MYTHS AND FACTS ABOUT HIV/AIDS 5
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Video: Myths/Facts about HIV 6
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Myth/Fact? HIV is the same as AIDS 7
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HIV vs AIDS 8 HIVAIDS 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
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AIDS Criteria (CDC) HIV positive test AND a T-Cell count of <200 or 14% (healthy T-Cell count ranges from 800-1200) OR HIV positive test AND one or more opportunistic infections (OIs)/certain cancers 9 If the T-Cell count goes up, or the opportunistic infection goes away, does the person still have AIDS? YES
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10 HIV & the Immune System HIV attacks the T cells (aka CD4 cells) weakening the immune system Over time HIV can lead to AIDS
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Special Characteristics of HIV Weakens and compromises the immune system HIV replicates in large quantities Ability to mutate (change itself) very quickly 11
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Myth/Fact? HIV only affects gay men and drug users 12
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25,895 16,155 13,250 3,200 Estimate ~ 61,700 living with HIV & AIDS in LAC 3,200 Estimated Number of Persons Living with HIV and AIDS in LAC at End of 2013 (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. Estimate ~ 60,050 persons living with HIV (including AIDS) in LAC 50,550 1,500 Source: LAC Division of HIV and STD Programs, reported as of 12/31/13. 9,500
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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 14
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Myth/Fact? Once a person is diagnosed with HIV/AIDS, they will die soon 15
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16 HIV Spectrum of Disease Exposure No infection Asymptomatic Initial Symptoms Lasts a few weeks Mild flu-like symptoms: Fever Muscle aches Swollen glands Infection Window period* Asymptomatic *Window Period: average time it takes the body to produce antibodies; usually 2 - 12 weeks, up to 6 months - 1 year (rare) Asymptomatic Period 8 - 11 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
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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 17
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Myth/Fact? Casual contact CANNOT put you at risk for HIV 18
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You CANNOT get HIV from… Breathing Coughing Sneezing Kissing Hugging Shaking hands Sharing food or drinks Drinking fountains Telephones Toilet seats Pools/Tubs Mosquito bite Giving/donating blood in US 19
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HIV Transmission 20 Blood Semen, Pre-cum Vaginal Secretions Breast Milk HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood. 132 4 Infected Body Fluids
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HIV Transmission 21 AnalVaginalOral 132 Unprotected Sex
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HIV Transmission 22 Injection Drug Use Piercing/ Tattooing Insulin, hormone, vitamin shots Acu- puncture 132 4 Exchanging Infected Blood : Sharing needles for any purpose
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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 23
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TIME FOR AN ACTIVITY “The Spectrum of Risk” 24
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Myth/Fact? Having another STD puts a person at greater risk for contracting HIV 25
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26 STDs and HIV STDs increase the concentration of “infection fighting” CD4 cells in genital secretions, a favorite target of HIV STDs cause breaks in the skin on and surrounding the penis, vagina and anus, which provides a perfect entry way for HIV STD infection increases risk of contracting HIV (susceptibility) -
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HIV+ individuals who are also infected with an STD have more HIV in their genital secretions 27 STDs and HIV HIV+ men who are also infected with an STD have much more HIV in their semen than HIV+ men without an STD STD infection increases risk of passing HIV to a partner (infectiousness) + ? ??
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Myth/Fact? HIV testing is unnecessary because I would know if my lover or I had it 28
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HIV TEST HIV Antibody test 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 29
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HIV TEST 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 30
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HIV TEST Informed Consent 12 yrs of age or older Benefits of Testing…….. Where to test? Private medical doctor County clinic Community-based organizations www.hivla.org 1-800-367-AIDS (2437) 31
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Myth/Fact? A person who is HIV positive must tell partners their status 32
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What are the differences between ethical and legal aspects? 33
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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. 34
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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. 35
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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 36
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PREVENTION 37 It is not who we are but what we do that puts us at risk for HIV infection
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The Prevention “Toolbox” 1.Abstinence 2.Safer Sex Male Condom (Activity) Female Condom Dental Dams 3.Safer Needle Use Not Sharing Needles Cleaning Needles (3x3x3 Method) Needle Exchange 4.Harm Reduction 38
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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? 39
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PREVENTION: The Male Condom 40
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The Female Condom
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PREVENTION: Needle use 42 Needle Exchange van in Berkley, CA
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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
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TREATMENT 44
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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
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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
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When to start anti-HIV medications? 2 schools of thought: 1.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 2.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
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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
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Who Pays For Treatment? HMO insurance Medi-Cal Medicare Part D ADAP Shared cost 49
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Complementary Therapy General Health Maintenance Psychological Well-Being Spiritual Well-Being Social Well-Being 50
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Recent advancements PrEP Immune based therapies Maturation inhibitors Multi-class Combination Products Gene Therapy Vaccine 51
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QUESTIONS? 52
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For More Information Contact http://publichealth.lacounty.gov/dhsp/ Disly Juarez, MPH djuarezmunoz@ph.lacounty.gov 213-351-8102
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