How Did HIV Spread?
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How Did HIV Spread?. Cities. dirty needles, unsafe blood transfusions. more sexual partners . greater mobility. How Did HIV Spread?. Jet travel. How Did HIV Spread?. How was the Epidemic Discovered?. HIV spread silently around the world for fifty years. 1930s. 1981.

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How Did HIV Spread?

Cities

  • dirty needles, unsafe blood transfusions

  • more sexual partners

  • greater mobility


How Did HIV Spread?

Jet travel


How Did HIV Spread?


How was the Epidemic Discovered?

HIV spread silently around the world for fifty years

1930s

1981


How was the Epidemic Discovered?

June 5, 1981

  • Five cases

  • Los Angeles

  • pneumocystis pneumonia

30 Morbidity and Mortality Weekly Report 250

http://www.cdc.gov/mmwr/preview/mmwrhtml/00043494.htm


=

APB

all points bulletin


How was the Epidemic Discovered?

November 5, 1982

  • Just 17 months after the first LA cases

  • Similar pattern: hepatitis B

  • Possible cause:

  • unidentified bloodborne agent

31 Morbidity and Mortality Weekly Report at 577

http://www.cdc.gov/mmwr/preview/index82.html


How was the Epidemic Discovered?

December 10, 1982

  • 1 month later

  • Infant: multiple blood transfusions developed AIDS

  • Donor had developed AIDS

31 Morbidity and Mortality Weekly Report at 652

http://www.cdc.gov/mmwr/preview/index82.html


How was the Epidemic Discovered?

And six months later?


How was the Epidemic Discovered?

June 1983

  • French announce:

  • New bloodborne pathogen


How was the Epidemic Discovered?

2008 The Nobel Prize in Physiology or Medicine

Françoise Barré-Sinoussi

Luc Montagnier


How was the Epidemic Discovered?

ARV

HTLV-III

LAV


How was the Epidemic Discovered?

HIV

Human

Virus

Immunodeficiency


How was the Epidemic Discovered?

June 1981

June 1983

24 months


HIV

is

bloodborne


The Law

Discrimination:

People living with HIV & AIDS

have the

same civil rights

as all persons living with

serious illness.

Mainstreaming Principle


The Law

Workplace Safety:

Treat all blood,

Universal precautions:

at all

as if it is infectious.

from all sources,

times,

How We Protect Others


The Law

Privacy and Confidentiality:

to protect

Heightened privacy protections

people living with HIV & AIDS

from other people’sfear and stigma.

How -- and Why -- We Specially Protect People with HIV


The Law

Discrimination

Privacy and Confidentiality

Workplace Safety

HIV is Bloodborne


AIDS/HIV

Epidemics

  • contagious

1955 - 1981

  • new

BriefGolden Age

  • stigma

of

Infectious Disease Control

  • sexuality

  • race

  • death


Case Study #1:

Paramedics

Should HIV information be broadcast?


Case Study #1:

Paramedics

Discrimination

Workplace Safety


Case Study #1:

Paramedics

Privacy and Confidentiality

Workplace Safety


Case Study #1:

Paramedics

Privacy and Confidentiality

Discrimination


Case Study #2:

Dentists

Can dentists refuse to treat persons with HIV

because of therisk to others?

  • Dentist

  • Staff

  • Other patients


Case Study #2:

Dentists

Workplace Safety:

Universal precautions: Treat all blood, at all times, from all sources, as if it is infectious.


Case Study #2:

Dentists

What if there’s an accident???

But . . .

  • Cut off your hand?

  • Jump out the window?


Case Study #2:

Dentists

Early 1980s:

200 HCWs died each year HBV

seroconversion rate 1: 2.5

Late 1980s: HIV

seroconversion rate 1:

250

“remote risk”

lowered further by

post-exposure prophylaxis (PEP)


Case Study #2:

Dentists

US Supreme Court:

School Board of Nassau County v. Arline

480 U.S. 273 (1987)

“significant risk”

“remote risk”


Case Study #2:

Dentists

US Supreme Court:

Bragdon v. Abbott

524 U.S. 624 (1998)

Courts should defer to the reasoned judgement of public health officials,

not the unsupported judgment of a single dentist.


© 2002 - 2009 CITY OF LOS ANGELES


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