The HIV/AIDS Epidemic © 2013 John B. Pryor Illinois State University

AIDS -  Acquired  Immune  Deficiency  Syndrome HIV -  Human  Immunodeficiency  Virus

Ways HIV is Transmitted: 1) through unprotected sexual intercourse 2) through sharing needles 3) through exposure to contaminated blood 4) perinatal exposure 5) mother’s milk

Ways you cannot transmit HIV: 1) mosquito bites 2) casual contact 3) toilet seats 4) sharing food

Can I get HIV from oral sex?  CDC says “yes.”  Not as dangerous as vaginal sex or anal sex  Actual risk level is unknown  Oral sex is more dangerous if the person performing it has bleeding gums or cuts/abrasions in the mouth.  Oral sex is more dangerous if the person who receives it has cuts, abrasions, or sores in the genital area.

Natural History of HIV/AIDS HIVInfection 3-6 Weeks AcuteHIVSyndrome 6 Months Positive HIV Test 9.8 Years 14.8 Years ClinicalAIDS Death May be extended by new drug therapies

Advances in HIV-Testing  OraQuick Rapid HIV Test  A swab of the outer gums, upper and lower - collects oral fluid  Test takes 20 minutes  Accuracy - Correctly identified 99.3% of people who were infected with HIV (sensitivity) and 99.8 % of people who were not infected with HIV (specificity)

HIV/AIDS Trends in the USA

History of the Epidemic 1981 – 121 deaths – A disease was identified among men who have sex with men. It was first called “gay cancer” and later named Gay Related Immuno Deficiency (GRID) 1982 – 447 deaths – Institut Pasteur in France discovered Human Immunodeficiency Virus (HIV) the virus that causes Acquired Immunodeficiency Syndrome (AIDS). CDC in US announced that HIV can be spread through sexual contact or exposure to contaminated blood – 1,476 deaths – CDC documented transmission of HIV from heterosexual contact. American Red Cross warned `high risk donors not to donate blood

Why is the prevalence of HIV/AIDS higher in African Americans?  POVERTY – Almost 1 in 4 African Americans live in poverty. Research by CDC shows that poverty is a strong predictor of HIV infection.  IMPRISONMENT OF BLACK MALES – Black men are more than 6 times more likely than White men to have served in prison. 1 out of every 7 Black men is in prison. Prison is a place where there are high risks for HIV infection: male- to-male unprotected sex, IV drug use, & prison tattoos. Black men are no more likely to perform risky behaviors than White men while in prison. They are just more likely to be there. When they get out they spread HIV to their communities.  POVERTY also predicts IMPRISONMENT.

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HIV/AIDS Trends in Illinois

HIV/AIDS Global Trends

Total: 35.3 million [32.2 million – 38.8 million] Western & Central Europe [ – ] Middle East & North Africa [ – ] Sub-Saharan Africa 25.0 million [23.5 million – 26.6 million] Eastern Europe & Central Asia 1.3 million [1.0 million – 1.7 million] South & South-East Asia 3.9 million [2.9 million – 5.2 million] Oceania [ – ] North America 1.3 million [ – 1.9 million] Latin America 1.5 million [1.2 million – 1.9 million] East Asia [ – 1.2 million] Caribbean [ – ] Adults and children estimated to be living with HIV  2012

Estimated number of adults and children newly infected with HIV  2012 Western & Central Europe [ – ] Middle East & North Africa [ – ] Sub-Saharan Africa 1.6 million [1.4 million – 1.8 million] Eastern Europe & Central Asia [ – ] South & South-East Asia [ – ] Oceania2100 [1500 – 2700] North America [ – ] Latin America [ – ] East Asia [ – ] Caribbean [9400 – ] Total: 2.3 million [1.9 million – 2.7 million]

Estimated adult and child deaths from AIDS  2012 Western & Central Europe 7600 [6900 – 8300] Middle East & North Africa [ – ] Sub-Saharan Africa 1.2 million [1.1 million – 1.3 million] Eastern Europe & Central Asia [ – ] South & South-East Asia [ – ] Oceania1200 [<1000 – 1800] North America [ – ] Latin America [ – ] East Asia [ – ] Caribbean [9400 – ] Total: 1.6 million [1.4 million – 1.9 million]

Western & Central Europe 1600 [1300 – 2000] Middle East & North Africa [ – ] Sub-Saharan Africa 2.9 million [2.7 million – 3.3 million] Eastern Europe & Central Asia [ – ] South & South-East Asia [ – ] Oceania3100 [2400 – 4100] North America 4500 [4000 – 5800] Latin America [ – ] East Asia 8200 [5800 – ] Caribbean [ – ] Children (<15 years) estimated to be living with HIV  2012 Total: 3.3 million [3.0 million – 3.7 million]

Western & Central Europe <200 [<100 – <200] Middle East & North Africa 3000 [2000 – 4600] Sub-Saharan Africa [ – ] Eastern Europe & Central Asia <1000 [<500 – 1200] South & South-East Asia [ – ] Oceania<500 [<200 – <500] North America <200 [<200 - <500] Latin America 2100 [<1000 – 4600] East Asia 1500 [<1000 – 3300] Caribbean<500 [<500 – <1000] Estimated number of children (<15) newly infected with HIV  2012 Total: [ – ]

Western & Central Europe <100 [<100 - <100] Middle East & North Africa 1800 [1200 – 2800] Sub-Saharan Africa [ – ] Eastern Europe & Central Asia <1000 [<1000 – 1500] South & South-East Asia [ – ] Oceania<500 [<200 – <500] North America <100 [<100 – <200] Latin America 1800 [1000 – 3100] East Asia <1000 [<500 – 2000] Caribbean<1000 [<1000 – 1100] Estimated deaths in children (<15 years) from AIDS  2012 Total: [ – ]

Adult HIV prevalence (%) HIV prevalence among adults  2012 Source: WHO (2014)

About 6,300 new HIV infections a day in 2012  About 95% are in low- and middle-income countries  About 700 are in children under 15 years of age  About 5,500 are in adults aged 15 years and older, of whom: ─ almost 47% are among women ─ about 39% are among young people (15-24) Source: WHO (2014)

The prevalence is higher among women in Africa and generally in low/middle income countries

It is projected that circumcising 80% of all uncircumcised adult men in the countries with high HIV prevalence and low prevalence of male circumcision by 2015 would avert one in five new HIV infections by 2025, with long-term prevention benefits for women as well as men.

How has the advent of anti-retroviral therapy affected mortality rates?

Estimated number of AIDS-related deaths with and without antiretroviral therapy, globally, 1995–2012

Estimated number of people receivingeligible forAntiretroviral antiretroviral therapy coverage Sub-Saharan Africa6,200,00011,000,00056% Eastern and Southern Africa5,200,0008,200,00064% West and Central Africa1,000,0002,800,00035% Latin America and the Caribbean660,000850,00077% Latin America585,000740,00079% The Caribbean73,000110,00067% East, South and South-East Asia1,100,0002,400,00046% Europe and Central Asia137,000520,00026% North Africa and the Middle East16,000100,00016% Total8,100,00014,800,00055% How many people receive antiretroviral therapy in some of the most affected areas?

Estimated number of Life-years added due to antiretroviral therapy, by region, 1996 – (millions) 2 1 Sub-SaharanAfricaAsiaCaribbeanMiddleEast and North AfricaWesternEurope AmericaLatinAmericaEasternEurope and Central AsiaOceania 0 Figure VII 7.2 million 2.3 million 1.4 million