1. HIV/AIDS Education For Providers: What You Need To Know Cynthia Davis, MPH Assistant Professor Charles R. Drew University of Medicine and Science

2. Goal of Presentation is to explain: How common is HIV/AIDS? How common is HIV/AIDS? What is the difference between HIV and AIDS? What is the difference between HIV and AIDS? How does HIV infect T-cells? How does HIV infect T-cells? How is HIV transmitted? How is HIV transmitted? Describe HIV testing procedures Describe HIV testing procedures Identify some local Community Resources Identify some local Community Resources

3. Understanding HIV/AIDS 32 years (1979-2011) 32 years (1979-2011) Over 25 different HIV/AIDS drugs available Over 25 different HIV/AIDS drugs available 33 million people living with HIV/AIDS worldwide 33 million people living with HIV/AIDS worldwide 1.1 million people living with HIV/AIDS in the United States 1.1 million people living with HIV/AIDS in the United States First the Bad News……..

4. Understanding HIV/AIDS HIV Infection is 100% preventable HIV Infection is 100% preventable It’s time to mobilize all communities to combat the further spread of HIV/AIDS, locally, nationally, and internationally. It’s time to mobilize all communities to combat the further spread of HIV/AIDS, locally, nationally, and internationally. Now the Good News……..

5. Understanding HIV/AIDS Estimated 33 million people living with AIDS. Estimated 33 million people living with AIDS. 80% of AIDS cases are in Sub-Saharan Africa. 80% of AIDS cases are in Sub-Saharan Africa. 70% of cases in Africa are among women. 70% of cases in Africa are among women. Globally, 7,000 new infections every day. Globally, 7,000 new infections every day. A Worldwide Impact……

6. Understanding HIV/AIDS Currently 14 million AIDS orphans. Currently 14 million AIDS orphans. 90% of AIDS orphans are found in Africa. 90% of AIDS orphans are found in Africa. Estimated 25 million deaths worldwide since the early 1980s. Estimated 25 million deaths worldwide since the early 1980s. A Worldwide Impact……

7. Understanding HIV/AIDS In the United States there are an estimated 900,000-1,000,000 people living with HIV. In the United States there are an estimated 900,000-1,000,000 people living with HIV. 56,300 new infections every year. 56,300 new infections every year. Youth under 25 represent 50% of all new HIV cases. Youth under 25 represent 50% of all new HIV cases. From a National Perspective…….

8. Understanding HIV/AIDS AIDS is the 6 th leading cause of death among youth 15-24. AIDS is the 6 th leading cause of death among youth 15-24. AIDS is the leading cause of death among African- Americans between the ages of 25-44. AIDS is the leading cause of death among African- Americans between the ages of 25-44. Estimated 1 in 50 African- American males are HIV+. Estimated 1 in 50 African- American males are HIV+. Estimated 1 in 150 African- American females are HIV+. Estimated 1 in 150 African- American females are HIV+. From a National Perspective…….

9. Understanding HIV/AIDS Cumulative total of AIDS cases in L.A. County is 47,382 *. Cumulative total of AIDS cases in L.A. County is 47,382 *. 30,000-40,000 people living with HIV/AIDS*. 30,000-40,000 people living with HIV/AIDS*. 9,000 new HIV infections were reported in July 2006 during the first 18 months of mandatory HIV reporting. 9,000 new HIV infections were reported in July 2006 during the first 18 months of mandatory HIV reporting. African-Americans and Latinos have the highest rates of infection. African-Americans and Latinos have the highest rates of infection. What’s Happening in L.A. County….. * As of December 2003

10. What is the Difference Between HIV and AIDS?

11. What is HIV? H = Human H = Human I = Immuno-deficiency I = Immuno-deficiency V = Virus V = Virus Human = a virus that is transmitted from one human being to another. Human = a virus that is transmitted from one human being to another. Immunodeficiency = causes the body’s immune system to become weak. Immunodeficiency = causes the body’s immune system to become weak. Virus = a group of tiny cells that multiply in the body and cause diseases. Virus = a group of tiny cells that multiply in the body and cause diseases.

12. What is AIDS? A = Acquired A = Acquired I = Immune I = Immune D = Deficiency D = Deficiency S = Syndrome S = Syndrome Acquired = something you are given or get. Acquired = something you are given or get. Immune = the part of the body that keeps us healthy. Immune = the part of the body that keeps us healthy. Deficiency = lacking or not enough. Deficiency = lacking or not enough. Syndrome = a group of diseases. Syndrome = a group of diseases.

13. How does HIV infect T-Cells to reproduce?

14. Understanding HIV/AIDS AIDS is a disease that impairs the body’s ability to fight off certain infections. Under normal circumstances certain cells in the blood, called T-lymphocytes sound an alarm whenever the body is invaded by disease producing organisms. This alarm causes other sets of cells, B-lymphocytes, to come into play to fight off the disease producing organisms. B-lymphocytes function to cause the production of antibodies which will normally destroy the invading organism (s). AIDS is a disease that impairs the body’s ability to fight off certain infections. Under normal circumstances certain cells in the blood, called T-lymphocytes sound an alarm whenever the body is invaded by disease producing organisms. This alarm causes other sets of cells, B-lymphocytes, to come into play to fight off the disease producing organisms. B-lymphocytes function to cause the production of antibodies which will normally destroy the invading organism (s). How does it work?………..

15. Understanding HIV/AIDS However, when HIV invades the body, it renders the T- lymphocytes ineffective. Thus, no antibodies are produced to kill the invading organisms. In time, the body is no longer able to respond when an alarm is sounded because too many T-lymphocytes have been in-activated or destroyed. At this point, the individual’s immune system has been rendered so deficient, that it has become susceptible to a host of what has been termed “ opportunistic infections ” (OIs). However, when HIV invades the body, it renders the T- lymphocytes ineffective. Thus, no antibodies are produced to kill the invading organisms. In time, the body is no longer able to respond when an alarm is sounded because too many T-lymphocytes have been in-activated or destroyed. At this point, the individual’s immune system has been rendered so deficient, that it has become susceptible to a host of what has been termed “ opportunistic infections ” (OIs). How does it work?………..

16. Understanding HIV/AIDS A normal and healthy immune system would be able to fight off these “ opportunistic infections ”, which overrun the body and eventually the individual dies as a result of one or more of these life threatening illnesses. A normal and healthy immune system would be able to fight off these “ opportunistic infections ”, which overrun the body and eventually the individual dies as a result of one or more of these life threatening illnesses. How does it work?………..

17. The HIV Life Cycle Understanding how it works……

18. The HIV Life Cycle Understanding how it works……

19. How is HIV transmitted?

20. Understanding Transmission Sexual contact and the change of body fluids ( semen, pre cum, blood, vaginal secretions, and breast milk / fluids ) with an HIV infected person. Sexual contact and the change of body fluids ( semen, pre cum, blood, vaginal secretions, and breast milk / fluids ) with an HIV infected person. Exchange of HIV contaminated blood when sharing needles, syringes and other instruments to pierce skin. Exchange of HIV contaminated blood when sharing needles, syringes and other instruments to pierce skin. Exchange of HIV contaminated blood used in blood transfusions prior to 1985 as well as HIV contaminated organ and/or tissue transplants. Exchange of HIV contaminated blood used in blood transfusions prior to 1985 as well as HIV contaminated organ and/or tissue transplants. From an HIV infected mother to her child during pregnancy, during birth, or during breastfeeding. From an HIV infected mother to her child during pregnancy, during birth, or during breastfeeding. HIV is transmitted in the following ways…….

21. Understanding HIV & Fluids The highest concentrations of HIV have been found in blood, semen, pre-cum, vaginal secretions, and breast milk / fluid. Smaller concentrations of HIV have been found in saliva, tears, and urine. To date, there have been no reported cases of HIV known to have been transmitted by saliva, tears, or urine. The highest concentrations of HIV have been found in blood, semen, pre-cum, vaginal secretions, and breast milk / fluid. Smaller concentrations of HIV have been found in saliva, tears, and urine. To date, there have been no reported cases of HIV known to have been transmitted by saliva, tears, or urine.

22. HIV and Casual Contact HIV is not transmitted by casual contact. Meaning you can NOT get HIV by kissing, hugging, shaking hands, sitting on a toilet seat, swimming, touching, or talking to someone who is infected with HIV and/or who has AIDS. HIV is not transmitted by casual contact. Meaning you can NOT get HIV by kissing, hugging, shaking hands, sitting on a toilet seat, swimming, touching, or talking to someone who is infected with HIV and/or who has AIDS.

23. Understanding HIV Infection Anyone having unprotected sex (oral, anal, vaginal). Anyone having unprotected sex (oral, anal, vaginal). Who is at risk?….

24. Understanding HIV Infection Anyone who shares HIV contaminated needles, syringes, and drug paraphernalia. Anyone who shares HIV contaminated needles, syringes, and drug paraphernalia. Who is at risk?….

25. Understanding HIV Infection Children born to HIV infected women or girls whose have not received ARV treatment during their pregnancy. Children born to HIV infected women or girls whose have not received ARV treatment during their pregnancy. Who is at risk?….

26. Understanding HIV Infection Anyone receiving a blood transfusion prior to 1985 as well as anyone receiving HIV contaminated organ / tissue transplants. Anyone receiving a blood transfusion prior to 1985 as well as anyone receiving HIV contaminated organ / tissue transplants. Who is at risk?….

27. Understanding HIV Infection Unprotected casual sex with many different partners. Unprotected casual sex with many different partners. Sharing non-sterile needles and syringes as well as any other non-sterile instruments used to pierce the skin. Sharing non-sterile needles and syringes as well as any other non-sterile instruments used to pierce the skin. Having unprotected sex with an HIV infected person(s). Having unprotected sex with an HIV infected person(s). Engaging in sex under the influence of alcohol and/or drugs. Engaging in sex under the influence of alcohol and/or drugs. Unprotected oral,anal, and/or vaginal sex. Unprotected oral,anal, and/or vaginal sex. What constitutes high risk behavior?…….

28. Symptoms of Progressing 1. Rapid weight loss of 10 or more pounds in 1-2 months. 2. Unexplained high fevers (IO3° or greater) lasting several months. 3. White coating or spots in the mouth or on the tongue (thrush). 4. Uncontrollable diarrhea or bloody stools. 5. Extreme fatigue or feeling tired all of the time. 6. Shortness of breath. 7. Skin rashes and lesions. 8. In women, reoccurring yeast infections that do not go away. HIV Infection……

29. How Do You Know If You Are Infected With HIV?

30. HIV Testing The HIV antibody test is a test to determine if someone has been infected with the virus that causes AIDS. The HIV antibody test is not a test for AIDS. It is a test used to detect the presence of antibodies to HIV. The HIV antibody test is a test to determine if someone has been infected with the virus that causes AIDS. The HIV antibody test is not a test for AIDS. It is a test used to detect the presence of antibodies to HIV. POSITIVE A POSITIVE HIV antibody test means that at some time the person was infected with HIV. NEGATIVE A NEGATIVE HIV antibody test means that the person has not been infected with HIV.

31. HIV Testing The “ Window Period ”: The “ Window Period ”: From the time that a person is initially infected with HIV until he or she begins to develop antibodies, it may take several weeks to several months for sufficient antibodies to be developed where they become detectable on the blood or oral swab test. The 2 week-6 month period is called the “window period”. Understanding the Window Period…..

32. HIV Testing Need for pre-test and post-test counseling. Need for pre-test and post-test counseling. Option to take confidential or anonymous test. Option to take confidential or anonymous test. Option to take blood, oral, or Rapid HIV test. Option to take blood, oral, or Rapid HIV test. All HIV test results have to be kept confidential. All HIV test results have to be kept confidential. Since July 2002, HIV is a reportable disease in California. Since July 2002, HIV is a reportable disease in California. Blood and oral test is 99.9% and 99.8% accurate,respectively. Blood and oral test is 99.9% and 99.8% accurate,respectively. People with HIV/AIDS face discrimination and stigma. People with HIV/AIDS face discrimination and stigma. Important issues to consider….

33. How Safe is the Blood Supply? Since March 1985, all donated blood is routinely screened/tested for the presence of HIV antibodies, and contaminated blood is discarded. It is estimated that 1 unit out of 3 million units may still get through this screening process. Since March 1985, all donated blood is routinely screened/tested for the presence of HIV antibodies, and contaminated blood is discarded. It is estimated that 1 unit out of 3 million units may still get through this screening process.

34. How Can HIV Infection Be Prevented?

35. Practice Abstinence. Practice Abstinence. Establish a monogamous relationship. Establish a monogamous relationship. How to Stop the Chain of Infection?

36. HIV Prevention Limit casual sex with many different partners. Limit casual sex with many different partners. Always use a latex condom. Always use a latex condom. Always use water-based lubricants. Always use water-based lubricants. How to stop the chain of infection…

37. HIV Prevention Do NOT share needles if you shoot drugs. Do NOT share needles if you shoot drugs. If you use drugs, clean your works and seek treatment. If you use drugs, clean your works and seek treatment. How to stop the chain of infection…

38. HIV Prevention Educate yourself and stay informed. Educate yourself and stay informed. Share information. Share information. Do your part to help eliminate the stigma associated with HIV/AIDS. Do your part to help eliminate the stigma associated with HIV/AIDS. How to stop the chain of infection…

39. Diseases More Common Among HIV Infected Individuals Diabetes Mellitus Diabetes Mellitus Cardiovascular Disease Cardiovascular Disease Cancer Cancer Kidney Problems Kidney Problems Cognitive Problems Cognitive Problems Osteoporosis Osteoporosis Low Testosterone Low Testosterone

40. Opportunistic Infections Candidiasis of bronchi,trachea or lungs Candidiasis of bronchi,trachea or lungs Candidias, esophageal Candidias, esophageal Cervical Cancer, invasive Cervical Cancer, invasive Coccidioidomycosis, disseminated Coccidioidomycosis, disseminated Cryptococcosis, extrapulmonary Cryptococcosis, extrapulmonary Cryptococcosis, chronic intestinal Cryptococcosis, chronic intestinal Cytomegalovirus Cytomegalovirus Encephalopathy Encephalopathy

41. Opportunistic Infections Herpes Simples, chronic Herpes Simples, chronic Histoplamosis Histoplamosis Isosporiasis Isosporiasis Kaposi’s Sarcoma Kaposi’s Sarcoma Lymphoma, Burkitt’s Lymphoma, Burkitt’s Lymphoma,primary of brain Lymphoma,primary of brain Mycobacterium avium complex Mycobacterium avium complex

42. Opportunistic Infections Mycobacterium, tuberculosis Mycobacterium, tuberculosis Pneumocystis Carinii Pneumonia Pneumocystis Carinii Pneumonia Pneumonia, recurrent Pneumonia, recurrent Progressive multifocal leukoencephalopathy Progressive multifocal leukoencephalopathy Salmonella septicemia, recurrent Salmonella septicemia, recurrent Toxoplasmosis, of brain Toxoplasmosis, of brain Wasting Syndrome due to HIV Wasting Syndrome due to HIV

43. HIV and Aging The natural history of HIV disease is that it is a slow progressive disease and normally it takes 8 to 10 years, once someone is infected, before they start experiencing symptoms of infection. The natural history of HIV disease is that it is a slow progressive disease and normally it takes 8 to 10 years, once someone is infected, before they start experiencing symptoms of infection. By 2017, over 50% of PLWHAs will be greater than 50 years old. Thus, you will see more chronic diseases among this population. HIV + people are aging faster than non-HIV infected people due to the effect of the virus on the immune system. By 2017, over 50% of PLWHAs will be greater than 50 years old. Thus, you will see more chronic diseases among this population. HIV + people are aging faster than non-HIV infected people due to the effect of the virus on the immune system.

44. HIV and Disability IOM recently released a report titled, “HIV and Disability: Updating Social Security Listings”. These recommendations will improve and clarify the criteria by which some individuals may now qualify for disability by providing clarity in areas that were previously left in the hands of an individual case-by-case decision making process. IOM recently released a report titled, “HIV and Disability: Updating Social Security Listings”. These recommendations will improve and clarify the criteria by which some individuals may now qualify for disability by providing clarity in areas that were previously left in the hands of an individual case-by-case decision making process.

45. HIV and Disability Great inequities and vast differences in criteria for disability are known to exist across the country; an individual in one region may be approved for disability that others in another region would not be approved. It is felt this report will help to eliminate disparities in approval by better quantifying disability criteria. Great inequities and vast differences in criteria for disability are known to exist across the country; an individual in one region may be approved for disability that others in another region would not be approved. It is felt this report will help to eliminate disparities in approval by better quantifying disability criteria.

46. HIV and Disability The IOM report if enacted would drastically reduce the eligibility criteria for many PLWHAs to obtain disability. In particular, the report recommends that PLWHAs must have a CD4 count of under 50, and that this criteria would be re- evaluated every three years. The IOM report if enacted would drastically reduce the eligibility criteria for many PLWHAs to obtain disability. In particular, the report recommends that PLWHAs must have a CD4 count of under 50, and that this criteria would be re- evaluated every three years.

47. HIV and Disability If an individual’s CD4 count increases to over 50, they would be subject to being de-certified. If an individual’s CD4 count increases to over 50, they would be subject to being de-certified.

48. PLWHAs Advocacy Ensure client is enrolled in care Ensure client is enrolled in care Determine if client has other co-occurring conditions such as, mental health issues, substance abuse, domestic violence, T.B., Hep B or C, STIs, etc. Determine if client has other co-occurring conditions such as, mental health issues, substance abuse, domestic violence, T.B., Hep B or C, STIs, etc. Many medically underserved clients not accessing care due to socio-environmental conditions (low educational attainment, illiteracy, lack of transportation, history of incarceration, substance abuse, unemployed, mental health diagnosis, cultural incompetency of medical and allied health professionals. Many medically underserved clients not accessing care due to socio-environmental conditions (low educational attainment, illiteracy, lack of transportation, history of incarceration, substance abuse, unemployed, mental health diagnosis, cultural incompetency of medical and allied health professionals.

49. PLWHAS Advocacy Obtain as much information as possible about the client(e.g. physical and mental health condition, do they have any learning disabilities Obtain as much information as possible about the client(e.g. physical and mental health condition, do they have any learning disabilities Determine if there are multiple co- morbidities including Active TB, COPD, Blindness, Heart conditions, Kidney Dialysis Determine if there are multiple co- morbidities including Active TB, COPD, Blindness, Heart conditions, Kidney Dialysis There is a need for providers to help reduce barriers and insure clients are being seen by HIV/AIDS Specialists There is a need for providers to help reduce barriers and insure clients are being seen by HIV/AIDS Specialists

50. Community Resources Charles Drew University HIV/AIDS Projects AIDS Healthcare Foundation Watts Healthcare Foundation OASIS Clinic L.A. County STD Clinics Local HIV/AIDS Education Programs

51. Contact Information Cynthia Davis, MPH Charles R. Drew University of Medicine and Science 1731 East 120 th Street Los Angeles, Ca 90059 (323) 563-9309 - office Email: cynthiadavis@cdrewu.edu