1. HIV/AIDS HIV/AIDS 1

2. Definitions HIV-human immunodeficiency virus –Impairs and destroys immune system –Progressive disease –Opportunistic infections that ordinarily are not life threatening Can lead to AIDS: Acquired immunodeficiency disease syndrome AIDS is the end stage of HIV disease 2

3. HIV Eliminates the body’s ability to fight infections and certain cancers Weakened immune system cannot fight microbes that normally don’t cause illness Opportunistic infections Virus does not live outside the body 3

4. HIV Patho HIV infects ______________ In particular the ___ T cell Virus replicates itself, rendering the CD4 cell nonfunctional Children are at greater risk because immune system is still developing –Little or no ability to fight HIV 4 T lymphocytes CD4

5. HIV/AIDS Criteria for AIDS diagnosis In addition to positive HIV antibody test and/or CD4 blood test of 200cells/mm3, in 1993 3 additional opportunistic infections were added: –Invasive cervical cancer –TB –Recurrent pneumonia 5

6. HIV/AIDS http://www.nlm.nih.gov/medlineplus/tutoria ls/aids/htm/_no_50_no_0.htmhttp://www.nlm.nih.gov/medlineplus/tutoria ls/aids/htm/_no_50_no_0.htm This is a good link for patient information 6

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8. Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas 8

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14. Trends in HIV in the US HIV was discovered in 1981 Devastating effect in the US and worldwide Estimated 1.6 million people living with HIV in the US, including 1 million with AIDS AIDS deaths over 500,000 according to CDC 14

15. Trends in HIV in the US AIDS deaths highest during mid 1990’s Death rates have dropped significantly HAART standardized treatment for HIV (also called ART) –Highly active antiretroviral therapy –Deaths now less than number of annual new cases of HIV 15

16. HIV Trends Worldwide More serious than in US Estimated more than 39.5 million people with HIV 95% live in developing countries 4.3 million new HIV infections in 2006 Half of those infected do not know they have HIV 16

17. Populations at risk for HIV In the US & Europe—primarily a male disease High rates of infection with homosexual and bisexual men, injection drug users (IDUs) and their sexual partners People with hemophilia prior to 1985 due to factor VIII 17

18. Populations at risk for HIV In the rest of the world, male/female incidence has always been equal –Primarily transmitted through heterosexual contact Industrial world new trends –Rates still high among homosexual and bisexual men, IDUs and sexual partners –Increase in women, adolescents, African Americans and Latinos 18

19. Populations at risk for HIV First identified in 1981 in the American homosexual, Caucasian, male population Prevention and treatment limited initially due to stigma of homosexual behavior Gay organizations were formed early and were instrumental in providing information and influencing HIV/AIDS policy in US 19

20. Populations at risk for HIV Men who have sex with men (MSM) Due to efforts of gay population –Behavior changes of white males in late 1990s –Numbers are up again now –Still largest group affected –Young males continue high risk behaviors –African American & Hispanic men account for half of HIV cases Greater stigma for these men 20

21. Populations at risk for HIV Ethnic minority populations –African American men #1 Killer Account for 50% of all new AIDS in US 13% of US population are African American men –Hispanic men Disproportionally affected Social barriers in education for these two groups 21

22. Populations at risk for HIV Men on the Down Low –DL –low low This refers to men who have sex with men as well as with women, but don’t ID themselves as gay or bisexual 22

23. Populations at risk for HIV Illicit drug users/Injection drug users (IDUs) New cases have decreased since 2001 Continue to be a significant number and contribute spread of the disease Impacts far beyond the user –Sexual partners, babies born to users, crack, trade sex for drugs, risky sexual behaviors 23

24. Populations at risk for HIV Adolescents More than half of all new cases are age 15- 24 Approximately 7,000 young people infected each day Those in developing countries most affected High risk in US and Canada 13% of all new US infections age 13-24 24

25. Populations at risk for HIV Adolescents hard to diagnose and treat Feel they are invincible Survival sex—make money to live on streets, still are not screened for HIV Prevention is key—teach in schools Community based programs for those not in school 25

26. Populations at risk for HIV Women are the fasting growing group Account for 50% of cases worldwide Women and girls traditionally have less access to education and HIV information Experience inequality in marriage and sexual relationships Poverty is highly correlated to HIV, women more likely to be poor 26

27. Populations at risk for HIV Women of childbearing age Children still become infected at birth Increased stigma so are not treated Children—approximately 4 million under 15years of age 90% were born to HIV positive mothers 13 million children have lost parents to HIV/AIDS 27

28. Populations at risk for HIV Older people over age 50 rapidly growing in HIV infections Social norms about sex, divorce and dating have changed Drugs such as Viagra facilitate a more active sex life for older adults Heterosexual women over age 50 most in need of prevention information 28

29. Populations at risk for HIV Inmates in correctional facilities May have history of drug use or high risk sexual behaviors Routinely screened 29

30. HIV today http://www.youtube.com/watch?v=oHFqm8 _zIJohttp://www.youtube.com/watch?v=oHFqm8 _zIJo http://hivaidsandme.wordpress.com/categor y/youtube/http://hivaidsandme.wordpress.com/categor y/youtube/ 30

31. Modes of transmission of HIV Sexual transmission—also direct contact Direct inoculation –IDU –Birth/breastfeeding –Blood/body fluids exposure –Unprotected sexual contact oral Vaginal anal 31

32. Healthy People 2020 goals Prevent human immunodeficiency virus (HIV) infection and its related illness and death. –Reducing the number of people who become infected with HIV. –Increasing access to care and improving health outcomes for people living with HIV. –Reducing HIV-related health disparities. 32

33. Primary prevention Reduce risk Safe sex practices Needle exchange Microbicides for women –Carraguard & Cyanoviran Education –Start in elementary school –Community education –Minorities, women, older adults 33

34. Secondary Prevention Screening for HIV all pregnant women Screening at risk individuals Early diagnosis Early treatment Screen those positive for TB 34

35. CDC Specific Recommendations for HIV Screening HIV screening is recommended for all persons who seek evaluation and treatment for STDs. HIV testing must be voluntary and free from coercion. Specific signed consent for HIV testing should not be required. sufficient to encompass informed consent for HIV testing. Use of rapid HIV tests should be considered, especially in clinics where a high proportion of patients do not return for HIV test results. Positive screening tests for HIV antibody must be confirmed by a supplemental test before the diagnosis of HIV infection can be established. Providers should be alert to the possibility of acute HIV infection and perform a nucleic acid test in addition to an antibody test for HIV, if indicated. 35

36. Tertiary Prevention Monitor HIV positive clients for opportunistic infections (OI) Prophylactic treatments to prevent OI Nutrition to treat anorexia, nausea & diarrhea Treat side effects of medication Advocate & educate community 36

37. Kaposi’s Sarcoma Purple discoloration under skin/mucous membranes Common in people with HIV/AIDS Used to be seen only in elderly Italian and Jewish men Is not curable Most people with Kaposi’s sarcoma will screen positive for HIV Kaposi Sarcoma Lesions 37

38. Kaposi’s Sarcoma 38

39. Kaposi’s Sarcoma 39

40. Pneumocystis carinii 40

41. Pneumocystis carinii Caused by a fungus Common in environment Rare before HIV/AIDS People with HIV do not get as ill with this infection as those who do not have HIV Almost exclusively seen in clients with HIV/AIDS or those receiving chemotherapy 41

42. Medications for AIDS & HIV http://www.cdc.gov/hiv/topics/treatment/M MP/pdf/HIVMedicationsChart.pdfhttp://www.cdc.gov/hiv/topics/treatment/M MP/pdf/HIVMedicationsChart.pdf 42

43. Nursing Role for Client with HIV Education of client and family In depth assessment of needs of all family members Discuss with client who is considered family and who does and doesn’t know of diagnosis Include physical, psychological, social and spiritual needs of all members of family 43

44. Nursing role continued Emotional support for primary caregiver May take several visits to complete assessment Multi-disciplinary family care plan Education sessions for all family members Anticipatory guidance for what may come Client may have no family and no support system http://www.youtube.com/watch?v=PqBfb69nI9w 44

45. 45 Good night my angel

46. Resources CDC Clark (2008). Community Health Nursing Lundby & Janes (2009). Community Health Nursing, Caring for the Public’s Health http://www.nlm.nih.gov/medlineplus/tutoria ls/aids/htm/_no_50_no_0.htmhttp://www.nlm.nih.gov/medlineplus/tutoria ls/aids/htm/_no_50_no_0.htm youtube.com 46