1. The HIV/AIDS Epidemic © 2005 John B. Pryor Illinois State University

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

3. 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

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

5. 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.

6. 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

7. 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)

8. HIV/AIDS Trends in the USA

9. 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. 1983 – 1,476 deaths – CDC documented transmission of HIV from heterosexual contact. American Red Cross warned `high risk donors not to donate blood

16. Number of AIDS patients, AIDS deaths and patients on antiretroviral therapy among men who have sex with men (MSM), San Francisco, USA, 1980 to 1998 Source: San Francisco Department of Public Health (California), USA, 1999

21. 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 25-29 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.

23. HIV/AIDS Trends in Illinois

28. HIV/AIDS Global Trends

29. Adults and children estimated to be living with HIV, 2005 Total: 38.6 (33.4 – 46.0) million Western & Central Europe 720 000 [550 000 – 950 000] North Africa & Middle East 440 000 [250 000 – 720 000] Sub-Saharan Africa 24.5 million [21.6 – 27.4 million] Eastern Europe & Central Asia 1.5 million [1.0 – 2.3 million] South & South-East Asia 7.6 million [5.1 – 11.7 million] Oceania 78 000 [48 000 – 170 000] North America 1.3 million [770 000 – 2.1 million] Caribbean 330 000 [240 000 – 420 000] Latin America 1.6 million [1.2 – 2.4 million] East Asia 680 000 [420 000 – 1.1 million]

30. Estimated number of adults and children newly infected with HIV, 2005 Total: 4.1 (3.4 – 6.2) million Western & Central Europe 22 000 [18 000 – 33 000] North Africa & Middle East 64 000 [38 000 – 210 000] Sub-Saharan Africa 2.7 million [2.3 – 3.1 million] Eastern Europe & Central Asia 220 000 [150 000– 650 000] South & South-East Asia 830 000 [530 000 – 2.3 million] Oceania7200 [3500 – 55 000] North America 43 000 [34 000 – 65 000] Caribbean 37 000 [26 000 – 54 000] Latin America 140 000 [100 000 – 420 000] East Asia 97 000 [55 000 – 290 000]

31. Estimated adult and child deaths from AIDS, 2005 Total: 2.8 (2.4 – 3.3) million Western & Central Europe 12 000 [<15 000] North Africa & Middle East 37 000 [20 000 – 62 000] Sub-Saharan Africa 2.0 million [1.7 – 2.3 million] Eastern Europe & Central Asia 53 000 [36 000 – 75 000] South & South-East Asia 560 000 [370 000 – 810 000] Oceania3400 [1900 – 5500] North America 18 000 [11 000 – 26 000] Caribbean 27 000 [19 000 – 36 000] Latin America 59 000 [47 000 – 76 000] East Asia 33 000 [20 000 – 49 000]

32. HIV/AIDS Trends in Africa

33. Estimated number of people living with HIV in sub-Saharan Africa, 1985–2005 Number of people living with HIV 19851990199520002005 0 5 10 15 20 25 30 Million Year

34. Estimated number of adult and child (all ages) deaths due to AIDS in sub-Saharan Africa, 1985–2005 Number of adult and child deaths due to AIDS 0.0 0.5 1.0 1.5 2.0 2.5 Million 19851990199520002005 Year

35. HIV prevalence (%) in adults in Africa, 2005 2.5 Namibia Botswana Zimbabwe Zambia

36. Life expectancy at birth in selected most affected countries, 1980 − 1985 to 2005 − 2010 Source: UN Population Division, World Population Prospects: the 2002 Revision 2004 Report on the Global AIDS Epidemic (Fig 12) 20 30 40 50 60 70 1980-19851985-19901990-19951995-20002000-20052005-2010 Years Botswana South Africa Swaziland Zambia Zimbabwe

38. HIV/AIDS Trends in

39. HIV in Russia  The Russian Federation has the largest AIDS epidemic in the whole of Europe.  In 2005 - some 940,000 people were living with HIV in the country and national HIV prevalence was an estimated 1.1%.  Unsafe drug injecting practices are the main cause of new infections in Russia and large numbers of young people under 30 inject drugs.  In St Petersburg, HIV infection levels of 30% have been found among injecting drug users and HIV is spreading from injecting drug users to their sexual partners, with more women becoming infected.

40. HIV in Russia  People on the margins of society are especially at risk of HIV infection in Russia – a study at a temporary detention centre in Moscow found HIV prevalence 30-120 times higher than in the general population.  HIV prevalence in Russia’s prisons is estimated to be at least four times that found in the wider population.  In 2005, only 5,000 of the estimated 100,000 people in need of antiretroviral treatment in Russia were receiving it.

41. 33.3 63.5 34.1 40.0 0 20 40 60 80 100 % HIV prevalence 15-1920-2425-2930-34 Age-group HIV prevalence among female sex workers, by age-group, St. Petersburg, Russian Federation, 2003 Source: T. Smolskaya, et al., XV International AIDS Conference, 11-16 July 2004. Abstract No. ThOrC1371. AIDS epidemic update, December 2004. Fig.1 9.

42. 0.0 30.8 40.0 53.8 66.7 0 20 40 60 80 100 % HIV prevalence 0-1 partner 2-4 partners 5-9 partners 10-19 partners 20 or more partners HIV prevalence among sex workers, by number of commercial partners in past seven days, St. Petersburg, Russian Federation, 2003 Source: T. Smolskaya, et al., XV International AIDS Conference, 11-16 July 2004. Abstract No. ThOrC1371. AIDS epidemic update, December 2004. Fig 20.