HIV Basics

What is HIV? Human Immunodeficiency Virus ◦ Two Strains  HIV-1  HIV-2 Kills special blood cells that help fight off infections ◦ CD4+ Virus that can lead to Acquired Immune Deficiency Syndrome

AIDS Final stage of infection by the HIV virus Defined by the number for CD4+ cells ◦ Absolute count < 200 cells/mL or ◦ If CD4+ cells < 14% total lymphocytes OR Hallmark infections ◦ Examples: Kaposi’s sarcoma, pneumocystis pneumonia

NOT TRANSMITTED BY: Air or water. Insects, including mosquitoes. ◦ CDC studies say no Saliva, tears, or sweat. ◦ There is no documented case of HIV being transmitted by spitting. Casual contact like shaking hands or sharing dishes. Closed-mouth or “social” kissing.

Living with HIV/AIDS Worldwide: 34 million

Living with HIV/AIDS US-1.1 million people Worldwide: 34 million

Living with HIV/AIDS US-1.1 million people Worldwide: 34 million Washington~ 11,000

Living with HIV/AIDS US-1.1 million people Worldwide: 34 million Washington~ 11,000 Clark County 456

Is spread by: Sex ◦ Not all sex has the same risk Exposure to an infected persons blood ◦ Sharing needles & works Mom to Baby ◦ Pregancy, birth, & breastfeeding

WHAT IF:

History Where did HIV come from? ◦ Monkeys ◦ Most likely from hunting & handling the meat US Patient Zero Theory ◦ Rumor/unfounded  Patient zero was a flight attendant who got AIDS by having sex with a monkey in Africa ◦ Likely part of a group of highly sexually active men who participated in spreading the disease

Citation:Auerbach,.D.Darrow W, Jaffe, H.Curran, J. Cluster of cases of the acquired immune deficiency syndrome. The American Journal of Medicine Volume 76, Issue 3, Pages AuerbachDarrowJaffeurranVolume 76, Issue 3

TRENDS IN ANNUAL AGE-ADJUSTED* RATE OF DEATH DUE TO HIV INFECTION BY SEX, UNITED STATES, 1987 − 2009 Note: For comparison with data for 1999 and later years, data for 1987 − 1998 were modified to account for ICD- 10 rules instead of ICD-9 rules. *Standard: age distribution of 2000 US population

Why Stigma At the Beginning Gay Related Immune Deficiency (GRID) Gay Cancer Initially untreatable and transmission method unknown

Who gets HIV now? Bring up CDC slide

HIV infections by risk group /incidence.htm /incidence.htm

Why Stigma Now? Promiscuous Drug users People who make bad decisions and their partners Race

HIV infections The new infection rate among blacks/African americans was 7.9 times higher than whites. ◦ 50% of these infections are MSM ◦ Fastest increasing group is black females The new infection rates in Latino/Latinas was 3 times higher ◦ ~70% of these infections are MSM

US AIDS Spread Map esources/slides/dot/index.htm

Is the risk of contracting HIV with all sexual encounters equal?

Spread & Risk Not using a condom when having sex with a person who has HIV. All unprotected sex with someone who has HIV contains some risk. However: ◦ Unprotected anal sex is riskier than unprotected vaginal sex. ◦ Among men who have sex with other men, unprotected receptive anal sex is riskier than unprotected insertive anal sex.

Spread & Risk Unprotected oral sex can also be a risk for HIV transmission, but it is a much lower risk than anal or vaginal sex.

Sex Risk Hierarchy Unprotected Receptive Anal Sex>Unprotected Insertive Anal Sex Unprotected Insertive Anal Sex> Unprotected Vaginal Sex Unprotected Vaginal Sex> Unprotected Oral Sex

Spread & Risk IDU Sharing ◦ Needles ◦ Syringes ◦ Rinse water, ◦ “Works” other equipment used to prepare illicit drugs for injection.

CDC, 2002 report

Spread & Risk Multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the risk of infection during sex.

Spread & Risk Being born to an infected mother—HIV can be passed from mother to child during pregnancy, birth, or breast-feeding.

Detection of HIV HIV is detectable in body ◦ 2 weeks to 6 months after infection  In US 25 days average

Testing Primary Testing ◦ Antibody Test  Rapid Oral Swab  Oral Swab  Blood Confirmatory Testing ◦ Western Blot  Separates proteins

HIV Testing and Counseling Trained Professionals This class does NOT prepare you to do this

So what is your responsibility? Brief Risk Intervention Endangering Behaviors Reporting

Endangering Behaviors Knowingly exposing other to HIV through behaviors ◦ Sex ◦ Sharing injection drug works, needles