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HIV 101. HIV/AIDS Program Public Health - Seattle & King County [email protected] http://www.metrokc.gov/health/apu 206/205-STDS (7837) 1-800-678-1595. Key Messages. HIV impacts our world and our local community.

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HIV 101

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Hiv 101 l.jpg

HIV 101

HIV/AIDS Program

Public Health - Seattle & King County

[email protected]

http://www.metrokc.gov/health/apu

206/205-STDS (7837) 1-800-678-1595


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Key Messages

  • HIV impacts our world and our local community.

  • People of color are disproportionately represented among national and local new infections.

  • The basic modes of transmission and prevention of HIV have not changed in 20 years.

  • The AIDS epidemic is not over, but there is more hope than ever for those that are infected.


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What is HIV?

What is AIDS?


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AIDS

HIV infected + immune system breakdown

(CD4 count < 200 or AIDS Defining illness)

AIDS Defining Illnesses

Pnuemocystis pnuemonia

Toxoplasmosis

Kaposi’s sarcoma

Mycobacterium avium complex

Invasive cervical cancer

etc...


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Persons estimated to be living withHIV as the end of 2004

Eastern Europe & Central Asia

1.4 million

[920 000 – 2.1 million]

Western & Central Europe

610 000

[480 000 – 760 000]

North America

1.0 million

[540 000 – 1.6 million]

East Asia

1.1 million

[560 000 – 1.8 million]

North Africa & Middle East

540 000

[230 000 – 1.5 million]

Caribbean

440 000

[270 000 – 780 000]

South & South-East Asia

7.1 million

[4.4 – 10.6 million]

Sub-Saharan Africa

25.4 million

[23.4 – 28.4 million]

Latin America

1.7 million

[1.3 – 2.2 million]

Oceania

35 000

[25 000 – 48 000]

Total: 39.4 (35.9 – 44.3) million

World Health Organization


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USA

  • Numbers of AIDS deaths have been falling.

  • Number of AIDS diagnosis have increased by approximately 2.2% between 2001-2002.

  • Rates of HIV infection overall have not changed

    • although an increase has been noted among men who have sex with men over the past three years.


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Cumulative HIV/AIDSOctober 31, 2004

King Co. WA State U.S.*

Adult/Adolescent9,48014,6051,109,361

Pediatric (<13 yrs)347113,927

TOTAL CASES9,51414,6761,123,288

Deaths 3,948 6,039 501,818

(42%)( 41%)(45%)

*Kaiser Family Foundation data as of 12/31/03


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Persons Living with HIV/AIDSin WA by County Reported cases as ofOctober 31, 2004 N= 8,637

King 64%

King Co. has 29% of the state’s population and 64% of personsliving with HIV/AIDS.


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Trends in Infection

  • Younger People (25% under age 21)

  • Women

  • People in Prison

  • Injection Drug Users

  • Low Socioeconomic Status /Marginalized Populations


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Trends in KC New HIV Diagnosesby Mode of Transmission, 2000-2002

Percent of total

HIV/AIDS diagnoses

Trends comparing cases 1st diagnosed HIV

1994-96 versus 1997-99 versus 2000-2002


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Persons Living with HIV/AIDS 10/31/2004versus 2004 King County populationby race / ethnicity

Population

HIV Prevalence


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Trends in New KC HIV Diagnosesby Sex and Race 2000-2002

Percent of total

HIV/AIDS diagnoses

Trends comparing cases 1st diagnosed HIV

1994-96 versus 1997-99 versus 2000-2002


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HIV Transmission

MOSQUITOES--NO!!

Requires:

1) Infected body fluid.

2) Entry into the body.

KISSING--NO!!

Blood, Semen, Vaginal Secretions & Breast Milk

Mucous Membrane--Anal, Oral or Vaginal Sex

Blood to Blood--Needle or Broken Skin

Perinatal- In utero, During birth, Breastfeeding


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HIV Transmission

Requires:

1) Infected body fluid.

2) Entry into the body.

Blood, Semen, Vaginal Secretions & Breast Milk

Mucous Membrane -- Anal, Vaginal or Oral Sex

Blood to Blood -- Needle or Broken Skin

Perinatal, In Utero, During Birth, Breastfeeding


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Oral Sex Transmission

  • Receptive partner (person having mouth to genital contact) is at greatest risk.

  • Ejaculation in the mouth, poor oral hygiene, and brushing or flossing prior to sex are associated with transmission.

  • Protective factor of enzymes in saliva.

  • Oral sex often not associated with risk.

  • Various studies indicate that 1-3% of new infections are due to oral sex transmission.


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Perinatal Transmission

  • Without treatment 25% of babies born to HIV+ mothers will be infected.

  • Prenatal care, HIV treatment, and C-sections can lower risk of transmission close to 1%.

  • Problems in developing countries.

  • Women with higher viral loads more likely to transmit.


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Factors Affecting Transmission

  • Viral LoadStage of infectionTreatment

  • STD Co-infection (3-5 times)More likely to become infectedMore likely to transmit infection


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Knowing You Are Infected

  • Primary Infection

    • 2-6 wks average

    • 75 -90% have symptoms

  • Only way to know for sure

    • HIV Antibody Test

      “Window Period”: time to develop antibodies

      • 3-6 weeks (most people)

      • 3 months >99%


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    Testing

    • HIV ANTIBODY TEST

      • Consists of two tests

        • Screening testELISA - Enzyme Linked Immuno-Sorbent Assay EIA - Enzyme Immunosorbent Assay

        • Confirmatory testWestern Blot AssayIFA - Indirect Immunofluorescense Assay

    • Negative HIV antibody test

      • over 99% accurate (if it has been at least three months after a contact with a potentially HIV-infected partner).

    • Positive HIV antibody tests

      • over 99% accurate.


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    Anonymous/Confidential

    • Anonymous Testing

      • Clinic keeps no record of your name.

      • They use a code to process your records and your blood specimen.

    • Confidential Testing

      • Clinic keeps your name in their records and your medical information.

      • Private(clinic is generally prohibited from releasing HIV information except by your written permission. Patients often sign a consent to bill form which gives permission to release information to an insurance company. You can check this with your provider.


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    Disease Progression

    • Getting HIV

    • Primary Infection

      • Antibody Development

    • Time without symptoms(10-12 yrs average)

    • AIDS (Opportunistic infections, CD4 200 or below)


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    Antiretroviral Treatment

    Triple Drug Cocktail--Attack the virus at different points in the replication process

    • Difficult Drug Regimens

    • Importance of Adherence

    • Side Effects

    • Expensive


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    Post Exposure Prophylaxis

    • Treatment with antiretroviral drugs after an exposure to HIV.

    • Must be started within 72 hours (sooner the better) and continued for a month.

    • PEP showed a 80% reduction in HIV infections for occupational exposures.


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    Abstinence

    Mutual monogamy with uninfected partner

    Limited sexual contact (non-penetrative)

    Condoms - correct and consistent use

    Reduce number of sexual partners

    Talk with new partners about risk reduction

    Tx of curable STDs

    Avoid sex if you have symptoms of an STD

    Notify recent partners if you have an STD

    Universal Precautions

    Prevention


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    Key Messages

    • Locally, the large majority of people with HIV continue to be men who have sex with men.

    • People of color are disproportionately represented among local new infections.

    • The basic modes of transmission and prevention of HIV have not changed in 20 years.

    • The AIDS epidemic is not over, but there is more hope than ever for those that are infected


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