HIV 101. HIV/AIDS Program Public Health - Seattle & King County firstname.lastname@example.org 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 HIV/AIDS Program Public Health - Seattle & King County email@example.com http://www.metrokc.gov/health/apu 206/205-STDS (7837) 1-800-678-1595
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.
What is HIV? What is AIDS?
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...
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
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.
Cumulative HIV/AIDSOctober 31, 2004 King Co. WA State U.S.* Adult/Adolescent 9,480 14,605 1,109,361 Pediatric (<13 yrs) 34 71 13,927 TOTAL CASES 9,514 14,676 1,123,288 Deaths 3,948 6,039 501,818 (42%) ( 41%) (45%) *Kaiser Family Foundation data as of 12/31/03
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.
Trends in Infection • Younger People (25% under age 21) • Women • People in Prison • Injection Drug Users • Low Socioeconomic Status / Marginalized Populations
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
Persons Living with HIV/AIDS 10/31/2004versus 2004 King County populationby race / ethnicity Population HIV Prevalence
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
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
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
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.
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.
Factors Affecting Transmission • Viral Load Stage of infection Treatment • STD Co-infection (3-5 times) More likely to become infected More likely to transmit infection
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%
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.
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.
Disease Progression • Getting HIV • Primary Infection • Antibody Development • Time without symptoms(10-12 yrs average) • AIDS (Opportunistic infections, CD4 200 or below)
Antiretroviral Treatment Triple Drug Cocktail--Attack the virus at different points in the replication process • Difficult Drug Regimens • Importance of Adherence • Side Effects • Expensive
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.
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
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