Washington State Department of Health HIV prevention and Education Services KNOW Curriculum – 6 th edition 1 HIV Prevention Education

We are now in our 3 rd decade of the HIV pandemic and although we have made giant steps to arrest the movement in terms of reducing the infection rates, in many ways we have began to move backwards by believing multiple myths associated with who Is “At risk” and refusing to pay attention. 2 Overview: We have come a long way baby, but… HIV is not over yet!!

 By the end of this session you will fully understand how to work with those living with or affected by HIV/Aids and utilize your skills to assist, educate and maintain safety standards. 3

According to the Center for Disease Control and Prevention, American Red Cross and the Health Departments, this virus can be classified in four categories: What it IS, What it’s NOT, How you Get IT and….. How you Don’t! 4

What it IS: Clinically defined as a Human Immunodeficiency Virus and only transmitted from Human to Human contact What it’s Not: Not transmitted through dogs, cats, mosquitoes etc... 5

How you get IT: Transmission occurs primarily through infected: Blood, semen vaginal secretions or breast milk 6

How you DON’T: The virus is not capable of transmitting through: Sweat, tears, saliva, urine and feces 7

8 AIDS is defined as an: Acquired Immunodeficiency (Sometimes Immune Deficiency) Syndrome Immunodeficiency:

Virus = “Lifetime companion” Bacteria 9

Necessary Conditions for Infection with HIV: An HIV Source 10

 A sufficient dose of virus: This involves the concentration and amount of HIV necessary for infection to occur.  Access to the bloodstream of another person This involves behaviors or circumstances that place someone at risk for infectious fluid entering their bloodstreams 11

 Blood: Unprotected sexual intercourse (anal, vaginal, oral) with an infected person Use of contaminated injection equipment for use in injecting drugs (Sharing needles)  Other sources for transmission: Tattooing, piercing, blood brother rituals and Infected women breastfeeding their infant Needle stick injuries or splashing blood into eyes. A transfusion prior to

 In extremely rare cases Sharing razors or toothbrushes if infected blood were deposited on the surfaces and the blood were to enter into an open membrane of another person. At Risk Populations:  Injection Drug Users (IDU’s)  Men having sex with Men )MSM’s)  Women and men in the sex industry (Prostitutes) 13

 Having multiple sex partners and unprotected sex  Those already infected with other STD’s (STI’s such as Chlamydia, syphilis, gonorrhea etc.)  Use of other substances, including alcohol and non-injected street drugs which tend to impair your judgment  Those with empowerment issues and lack the ability to insist on protection  Health, Safety and public service Workers 14

Syndrome: A collection of symptoms, diseases and infections. Case Definition: Assigned to a person living with the virus after T-cells drop below 200 allowing for opportunistic infections to invade the body. The term AIDS applies to the most advanced stages of an HIV infection. 15

 In order to diagnose AIDS a positive HIV antibody test is required or the evidence of HIV infection and the appearance of some very specific conditions/diseases Remember: ALL people diagnosed with AIDS have HIV, BUT… not all people with HIV have reached an AIDS diagnosis. 16

 In 1993 AIDS Surveillance Case Definition for Adolescents and Adults, which is the most current definition is comprised of a 3x3 staging system. In this definition, any person who is HIV infected and has either an AIDS indicator condition or a CD4+ (T- cell count) less than 200 cells/mm or less than 14%, is considered to have AIDS. 17

Three conditions must occur in order to transmit HIV, there must be:  An HIV source  A sufficient dose of virus  Access to the bloodstream of another person 18

19

 =  = Having sex with only one person who has sex with you and neither partner is at risk of exposure to HIV and STD’s; both partners must be free of disease and both partners must remain monogamous. 20

 Safer sex practices: Latex condoms Polyurethane condoms Animal skin Dental Dams/other barriers Sexual Abstinence Monogamous relationships 21

 Avoidance of injection drug use is another way to stop the risk of transmission or if not possible, use a clean needle and do not share. If not able to get into to treatment, become part of a needle exchange program until you are ready to make those changes in your life. Also, using bleach and water to clean syringes will kill the HIV inside it. 22

 Rule Scope: WAS , Occupational Exposure to Blood-born Pathogens, Provides requirements to protect employees from exposure to blood or other potentially infectious materials (OPIM) that may contain blood-born pathogens  Occupational Exposure  Exposure incident  Occupational Groups - Include but not limited to: Health care employees, law enforcement, fire, ambulance and other emergency & public service employees. 23

 Oregon and Washington Law (WAC and 209) requires all HIV testing be accompanied with counseling first. Yet, the law states that person who refuses counseling should not be denied an HIV test and the person conducting the HIV test does not have to provide the counseling themselves.  The person providing the test and counseling to clients should direct the counseling towards increasing the clients understanding of their own risk of acquiring/transmitting HIV; motivating the client to reduce their risk and assisting the client to build skills to reduce their risk 24

 Information about a person’s HIV test and results is confidential information and must not be shared with others. Those who perform HIV counseling and testing in public health departments or health agencies must sign strict confidentiality agreements.  Test results are kept in locked files, with only a few appropriate staff members having access to them.  HIV Testing is NOT MANDATORY and no one can be forced to submit a test without their consent.  Health care providers caring for pregnant clients are required by Washington law to ensure HIV counseling and testing for each pregnant woman who is seeking prenatal care. 25

 Sexual Assault  Assailant  Six month follow-up retest  Window periods  Partner Notification  Reporting requirements 26

Remember, If the test results is negative, it means one of two things 1. Either the person is not infected with the virus or ……. 2. The person became infected recently and has not produced enough antibodies to be detected by the test. If concerned about a recent incident…test 3 months from the date of their last possible exposure 27

A 27 yr old women went to the doctor to get the results of her HIV test and only took the test because her new job requested their employees to do so. The women has been married for 5 years and has 2 children; one 4 years old and the other 6 months. After receiving her test results she is shocked to find out she positive for HIV. What are some of the next steps that should be considered? 28

1. Request a retest and talk to tester/epidemiologist 2. List partner notification (Names reporting) 3. Encourage contact of family members 4. Schedule testing for Husband and children 5. Schedule follow up appointment 6. Provide referrals to medical and other support services 7. Get started on anti-retroviral drugs as soon as possible 29

 Partner notification: A voluntary service provided to HIV positive people and their sex and/or injection equipment sharing partners. This service is provided using a variety of strategies to maintain the confidentiality of both the HIV-Infected client and the partners. When partners are notified, they are notified of their exposure, provide counseling and information, and offer HIV testing without informing the partner who tested positive.  Reporting Requirements: HIV and AIDS are both reportable conditions for all State Health Boards 30

 Indeterminate or inconclusive Results: Western blot is used as a confirmatory test and usually might relate to recently engaging in behaviors that put them at risk for getting HIV…could also mean they are newly infected and developing antibodies.  False positives: Earlier testing found to be an issue with Orasure and required double testing or retesting using blood specimens 31

 The Natural History/Disease Progression of HIV Infection: Untreated HIV infection will experience several stages in infection, these include: 1. Viral transmission 2. Primary HIV Infection 3. Seroconversion 4. Asymptomatic HIV Infection 5. Symptomatic HIV infection 6. AIDS 32

 Viral Transmission: This is the initial infection with HIV. They will probably have the virus circulating in the bloodstream and may become infectious to other within five days and may be infectious before the onset of any symptoms.  Primary HIV infection: The first few weeks of HIV infection, the infected person has a very high amount of virus in their bloodstream. Unfortunately during this time many people are unaware that they are infected. Most common symptoms are; fever, swollen glands, in the neck, armpits and/or groin, rash, fatigue and a sore throat. Sometimes called “seroconversion syndrome or “seroconversion sickness. These symptoms unfortunately resemble and common with many other illnesses. They tend to go away in a few weeks but individual continues to be infectious to others. 33

 Primary Infection: It is important that healthcare providers consider the diagnosis of HIV primary infection if an individual has behaviors which put him at risk for HIV and is presenting with the above symptoms.  Seroconversion: The time that it takes from infection to the production of antibodies, which would show positive on an HIV test.  Asymptomatic HIV Infection: During this time a person has no noticeable signs or symptoms. They may look and feel healthy but can still pass the virus to others 34

35 Symptomatic HIV Infection: During this period, a person begins to have noticeable physical symptoms that are related to HIV infection. Although there are no symptoms that are specific Only to HIV infection, some common symptoms are: 1.Persistent low grade fever 2.Pronounced weight loss that is not due to dieting 3.Persistent headaches 4.Diarrhea that last more than one month 5.Difficulty recovering from colds and the flu 6.A person becomes sicker than normal 7.Women have recurrent vaginal yeast infections

 AIDS: An AIDS diagnosis can only be made by a licensed health care provider, However both county and statewide health organizations refer to both State and County Epidemiologist for results and reporting 36

 Pneumocystic Carinii pneumonia—(Most common opportunistic infection in aids patients.  Candidiasis of esophagus, trachea and lungs  Cervical cancer  Cryptosporidiosis with diarrhea greater than one month  Herpes simplex  HIV associated dementia  Kaposi’s sarcoma  Tuberculosis 37

Access to quality medical care is important and essential for continued wellness. To date, Drug therapies have greatly improved and HIV is now considered a disease of maintenance and not necessarily a death sentence. Side affects of HIV medications include: Nausea, diarrhea, neuropathy, osteoporosis, lipodystrophy, diabetes and changes in glucose, high cholesterol and damage to the nervous system 38

 Are HIV/AIDS reportable?: Both are reportable conditions in Washington State and Oregon since 1984, this assist local an state officials in tracking the epidemic  Are HIV positive results from an anonymous test reportable? Positive HIV results obtained through anonymous testing are not reportable. However if a patient with positive results seek medical care for conditions related to HIV/AIDS, the provider is required to report the case to the local and state health departments. 39

 Unless a person signs a release of information form, medical information may not be disclosed. There are some exceptions and can be disclosed under certain conditions 1. When it is given from one health provider to another health care provider for related on going medical care of the patient 2. In a life death emergency 3. To a third party payor (insurance provider) 4. In case of reporting notifiable conditions to the local health jurisdiction Violation of these laws is a misdemeanor and may result in civil liability actions for reckless or intentional disclosure up to 10, or actual damages. 40

Why are there additional confidentiality protections for HIV, mental health, substance abuse and other selected records? It has been determined that there exist a level of prejudice, fear an discrimination directed at people with these medical conditions. Therefore, there is a balance between civil protection and information access. 41

Difficult realities that are faced by persons living with HIV and families:  Even with retroviral drugs, persons with AIDS still die prematurely  MSM’s and IDU’s who are already stigmatized and subjected to social and job related discrimination, may encounter even more pressure and stress  90% of all adults with AIDS are in the prime of life and may not be prepared to deal with death and dying  Certain medication can diminish and disfigure the body  People living with HIV face the need to practice safer sex and take medications for the remainder of their lives. 42

Losses due to HIV:  Loss of physical strength and abilities  Loss of mental abilities  Loss of income and savings  Loss of health insurance  Loss of job  Loss of housing, personal possessions  Loss of emotional support from family, friends, co-worker  Loss of self sufficiency  Loss of self esteem 43

Although HIV/AIDS is like all diseases, “An Equal Opportunity Employer”; some groups have been significantly affected by the epidemic more than others. Listed are some as follows:  Men who have sex with men (MSM’s)  Injection Drug Users (IDU’s)  Hemophiliacs  Women  People of Color 44

Fact: African American and Hispanic women make up 25% of the total population, but account for 77% of all reported AIDS cases in women. African Americans make up about 12% of the population, but account for 37% of all AIDS cases and Hispanics being 13% in population, but account for 20% of AIDS cases. 45

 Poverty  Education  Racism/discrimination  Access/Insurance  Fear/Mistrust  Advocacy skills  Support or lack of resources 46

 Cascade AIDS Project (CAP)  Multnomah County Health Department – HIV Services (testing and needle exchanges)  Department of Health Services – State programs  Inside Out (Youth services)  Unity Project aka Brother to Brother  Project Quest  Our House  Esther’s Pantry  Partnership Project  Ainsworth Community Church  Africa Aids Response 47

End of Topic 48