nurs 330 - schedule for 4/28/14
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NURS 330 - Schedule for 4/28/14
• HIV Lecture – Disly Juarez, MPH• Return and Review Quiz• Group Activity• Distribute Study Guide for 5/5/14 Mid-term• In-Class Assignment
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County of Los Angeles Department of Public Health
Division of HIV and STD Programs
Disly Juarez, MPHHealth Educator
djuarezmunoz@ph.lacounty.gov
The State of the HIV/AIDS Epidemic
MYTHS AND FACTS ABOUT HIV/AIDS
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Video:
Myths/Facts about HIV
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Myth/Fact?
HIV is the same as AIDS
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HIV vs AIDS
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HIV AIDS
What it stands for
Human Immunodeficiency Virus
Acquired ImmunoDeficiency
Syndrome
What it is A virus: an agent that replicates inside a living cell
A syndrome: a collection of multiple symptoms or characteristics that often occur together
How it is diagnosed
A test that shows HIV antibodies or antigens in a person’s blood or saliva
• HIV positive test • A T- Cell count of < 200 -OR-• 1 or more opportunistic
infections
AIDS Criteria (CDC)HIV positive test AND a T-Cell count of <200 or 14%
(healthy T-Cell count ranges from 800-1200)
ORHIV positive test AND one or more opportunistic infections
(OIs)/certain cancers
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If the T-Cell count goes up, or the opportunistic infection goes away, does the
person still have AIDS?YES
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HIV & the Immune System
HIV attacks the T cells (aka CD4 cells) weakening the immune system
Over time HIV can lead to AIDS
Special Characteristics of HIV
Weakens and compromises the immune system
HIV replicates in large quantities
Ability to mutate (change itself) very quickly
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Myth/Fact?
HIV only affects gay men and drug users
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25,895
16,155
13,2503,200
Estimate ~ 61,700 living
with HIV & AIDS in LAC
3,200
Estimated Number of Persons Living with HIV and AIDS in LAC at End of 2013
(1) CDC estimates 15.8% of persons with HIV are unaware of their infection.(2) Reported cases includes half of 3,500 lab reports pending investigation and half of 3,300 cases reported to us only by code likely
to result in unduplicated named cases.
Estimate ~ 60,050 persons living
with HIV (including AIDS) in LAC
50,550
1,500
Source: LAC Division of HIV and STD Programs, reported as of 12/31/13.
9,500
Impact on Los Angeles County
LA County is second only to NYC among US metropolitan areas in cumulative number of reported AIDS cases
Only 4 states (CA, TX, NY, FL) have reported more AIDS cases than LAC
42% of all California AIDS cases are reported from LAC in 2010
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Persons living with HIV Infection from HIV/AIDS Annual Surveillance
Summary
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*Reported as of 2011, CDC. HIV Surveillance Report, Volume 23(1), February 28, 2013
** Reported as of 12/31/12, California Office of AIDS, HIV/AIDS Surveillance Section.
*** Report as of 12/31/12, LAC Division of HIV/STD Programs
Jurisdiction No. living with HIV/AIDS
U.S. (50 states) 872,990*
California 117,695**
LA County 45,474 ***
Transmission Category for Persons Living with HIV/AIDS
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Male (n=40,315)
Female (n=5,159)
as of December 31, 2012 by Gender in Los Angeles County
* Persons with an undetermined transmission category are assigned a risk factor using multiple imputation (MI) methods. Other risks include hemophilia or coagulation disorder, transfusion recipient, perinatal exposure and confirmed other risk.
** Data are provisional due to reporting delaySource: HIV/AIDS Surveillance Summary, data as of December 2012.
*Sometimes called “Prevalence Rate”; it is really a proportion.
988
768
486379
1090
200
400
600
800
1000
Black AI/AN White Latino A/PI
per 1
00,0
00 Po
pula
tion
Source: HIV/AIDS Surveillance Summary, data as of 12/31/2012.
Persons Living with HIV/AIDS in LAC per 100,000 population* by
Race/Ethnicity
Myth/Fact?
Once a person is diagnosed with HIV/AIDS, they will die soon
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HIV Spectrum of Disease
ExposureNo infection
Asymptomatic
Initial SymptomsLasts a few weeks
Mild flu-like symptoms: • Fever• Muscle aches• Swollen glands
InfectionWindow period*
Asymptomatic
*Window Period: average time it takes the body to produce antibodies; usually 2 - 12 weeks, up to 6 months - 1 year (rare)
Asymptomatic Period
8 - 11 years
(Average progression, may vary depending on the person)
HIV IllnessSymptoms include:• Night sweats• Fevers• Fatigue• Diarrhea• Swollen lymph
nodes• Oral and
vaginal candidiasis
• PID• Pap Smear
positive for HPV
AIDS• T-Cells <200 • 1 or more
OIs (PCP, KS, TB, CMV, Candidiasis, etc.)
• Wasting syndrome
• HIV-related dementia
Common Opportunistic Infections Pneumocystis Carinii Pneumonia (PCP)
CMV Infection
HIV Wasting Syndrome
Candidiasis (oral, esophageal, vaginal)
Kaposi’s Sarcoma
Tuberculosis
HIV - Related Dementia
Cervical Cancer
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Myth/Fact?
Casual contact CANNOT put you at risk for HIV
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You CANNOT get HIV from…
• Breathing • Coughing• Sneezing• Kissing• Hugging• Shaking hands• Sharing food or
drinks
• Drinking fountains
• Telephones• Toilet seats• Pools/Tubs• Mosquito bite • Giving/donating
blood in US
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HIV Transmission
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Blood Semen, Pre-cum
Vaginal Secretio
ns
Breast Milk
HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood.
1 32 4
Infected Body Fluids
HIV Transmission
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Anal Vaginal Oral1 32
Unprotected Sex
HIV Transmission
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InjectionDrug Use
Piercing/Tattooing
Insulin, hormone, vitamin
shots
Acu-punctur
e
1 32 4
Exchanging Infected Blood :
Sharing needles for any purpose
HIV TransmissionMother To Child Transmission
during pregnancy (in uterus)
during birth process (delivery)
breastfeeding (through breast milk/blood)
*Perinatal transmission can be significantly reduced to less than 2% with proper care
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TIME FOR AN ACTIVITY
“The Spectrum of Risk”
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Myth/Fact?
Having another STD puts a person at greater risk for
contracting HIV
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STDs and HIV
STDs increase the
concentration of “infection
fighting” CD4 cells in genital secretions, a
favorite target of HIV
STDs cause breaks in the skin on and
surrounding the penis, vagina and
anus, which provides a
perfect entry way for HIV
STD infection increases risk of contracting HIV (susceptibility)
-
HIV+ individuals who are also
infected with an STD have more
HIV in their genital
secretions
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STDs and HIV
HIV+ men who are also infected with an STD have much more HIV in their semen than
HIV+ men without an STD
STD infection increases risk of passing HIV to a partner (infectiousness)
+
? ? ?
Myth/Fact?
HIV testing is unnecessary because I would know if my lover
or I had it
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HIV TEST
HIV Antibody test Looks for antibodies
Accuracy of the test 99.9%
Types of tests Standard test – results will be known in
1 week Rapid test – results will be known in 20-
40mins
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HIV TESTOther Test - Uni-Gold Recombigen HIV- results will be known in 10 min. - Reveal G3 Rapid HIV-1 results will be known in 3 minutes - Multispot HIV 1/HIV-2- results will be known in 15 mi. - Clearview HIV 1/2 Stat-Pak - results will be known in 15 mi. - Clearview Complete HIV 1/2- results will be known in 15 mi. - Insti HIV-1- results in as little as 60 seconds
FDA has, for the first time, approved an over-the-counter HIV Rapid test (Oraquick) for home use.
Test settings Anonymous
Confidential
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HIV TESTInformed Consent12 yrs of age or older
Benefits of Testing……..
Where to test? Private medical doctor County clinic Community-based organizations
www.hivla.org 1-800-367-AIDS (2437) 32
Myth/Fact?
A person who is HIV positive must tell partners their status
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What are the differences between ethical and legal aspects?
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California’s “Willful Exposure” Law (1998)aka “Recalcitrant Behavior”:
Willfully exposing another to HIV through unprotected sex 8 years of imprisonment Intention to infect others with HIV through sex
To be prosecuted under the law, one would have to do ALL of the following: Have anal or vaginal sex Know that they are HIV + Fail to disclose their HIV status Fail to use a condom Have a specific intent to infect another person
Actual knowledge of HIV infection without more evidence of “specific intent” is insufficient for prosecution.
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CONFIDENTIALITY LAWS Disclosing a person’s HIV+ status to a third
party without the individual’s specific signed consent, is illegal;
Penalties and damages for unauthorized disclosure of HIV status is a $5,000-$10,000 fine and/or jail sentence.
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FEDERAL ANTI-DISCRIMINATION LAWS
Rehabilitation Act of 1973 and American with Disabilities Act (ADA) 1990 Prohibits discrimination against a person with a disability, including HIV disease or AIDS. infection.This prohibits discrimination with regards to employment, public services, public accommodations, and medical care.
Housing Discrimination
Care DiscriminationA doctor or dentist cannot refuse to treat an HIV+ person
California Anti-Discrimination LawsFair Employment and Housing Act (FEHA) and Unruh Civil Rights Act 37
PREVENTION
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It is not who we are but what we do
that puts us at risk for HIV infection
The Prevention “Toolbox”1. Abstinence
2. Safer SexMale Condom (Activity)Female CondomDental Dams
3. Safer Needle UseNot Sharing NeedlesCleaning Needles (3x3x3 Method)Needle Exchange
4. Harm Reduction39
PREVENTION: Abstinence
Abstinence: not having sex of any kind or sharing needles. Not exchanging any bodily fluids is the only 100% sure way to avoid becoming infected with HIV.
If one is not going to abstain, what other options do they have?
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PREVENTION: Needle use
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Needle Exchange van in Berkley, CA
PREVENTION: Standard Precautions Infection control measures that reduce the
risk of transmission of blood-born germs from patients to health care workers
Wash hands thoroughly Wear gloves Use masks and eye protection Wear a gown Carefully handling and disposing of sharp
instruments during and after use.
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TREATMENT
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• Goals of HIV/AIDS treatment:
• Reduce HIV-related morbidity and prolong survival,
• Improve quality of life,
• Restore the immune system,
• Suppress the viral load, and
• Prevent vertical HIV transmission (mother to child).
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TREATMENT
TREATMENTWhat are Anti-retrovirals (ARVs) ?
• Anti-retrovirals are drugs that interrupt the HIV replication process and help preserve the health of the immune system
• These drugs must be taken in combinations in order to have a lasting effect. The three drug combination is commonly known as a “triple cocktail”
• Using a combination of anti-retrovirals creates multiple obstacles to HIV replication. This is designed to keep the virus from replicating freely and reduce the possibility of a mutation.
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When to start anti-HIV medications?
2 schools of thought:
1.Treatment should begin if there are severe symptoms of HIV infection or a diagnosis of AIDS with a CD4 count of 350 cells/mm3 or less
2.Starting treatment immediately following diagnosis
Because of the complexity of selecting and following a regimen, the severity of the side-effects, and the importance of compliance to prevent resistance, it is extremely important to engage patients in treatment decisions. 46
Current classes of Anti-HIV medications Nucleoside Reverse Transcriptase Inhibitors
(NRTIs) Non-Nucleoside Reverse Transcriptase
Inhibitors (NRTIs) Protease Inhibitors Entry inhibitors Fusion inhibitors Integrase inhibitors
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Who Pays For Treatment? HMO insurance
Medi-Cal
Medicare Part D
ADAP
Shared cost
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Complementary Therapy General Health Maintenance
Psychological Well-Being
Spiritual Well-Being
Social Well-Being
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Recent advancements
Immune based therapies
Maturation inhibitors
Multi-class Combination Products
Gene Therapy
Vaccine
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QUESTIONS?
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For More Information Contact
http://publichealth.lacounty.gov/dhsp/
Disly Juarez, MPHdjuarezmunoz@ph.lacounty.gov
213-351-8102
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