nurs 330 - schedule for 2/3/14 hiv lecture – disly juarez return and review quiz group activity...
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NURS 330 - Schedule for 2/3/14
• HIV Lecture – Disly Juarez• Return and Review Quiz• Group Activity• Distribute Study Guide for 2/10/14 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
The State of the HIV/AIDS Epidemic
MYTHS AND FACTS ABOUT HIV/AIDS
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Myth/Fact?
HIV is the same as AIDS
MYTH
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HIV AIDS
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Immune
Acquired Deficiency
Syndrome
AIDSHumanHuman
Immunodeficiency Immunodeficiency
VirusVirus
HIVHIV
Special Characteristics of HIV
Weakens and compromises the immune system
HIV replicates in large quantities
Ability to mutate (change itself) very quickly
Progressively destroys body’s ability to fight infections and certain cancers
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HIV/AIDS Defined
CDC definition (AIDS):
• HIV+ test, T-cell count of < 200 (healthy T-cell count ranges from 800-1200)
- or –
• HIV+ test, and one or more opportunistic infections (OIs) or certain cancers*
“AIDS” applies to most advanced stage of HIV infection
*TB, Pneumocystis pneumonia, Candidiasis, Kaposi’s sarcoma, cervical cancer
Myth/Fact?
HIV only affects gay men and drug users
MYTH
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• Although the AIDS rate in Los Angeles County is lower than the rate in other areas of the US, in sheer number, Los Angeles County is second only to New York City in the cumulative number of reported AIDS cases among major metropolitan areas.
• Only 4 states, including the rest of California, have reported more cases than LAC
• LAC has reported 36% of all California AIDS cases.
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Myth/Fact?
Once a person is diagnosed with HIV/AIDS, they will die soon
MYTH
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Manifestations of HIV Infection
No physical symptoms, and healthy results on tests of immune function.
No physical symptoms, but show some signs of immune system damage on medical tests of the immune system.
Mild or severe symptoms of HIV disease.
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HIV Spectrum of Disease
Exposure
No infection
Asymptomatic
Infection
Window period*
Asymptomatic
Initial Symptoms
Lasts a few weeks
Mild flu-like symptoms: • Fever• Muscle aches• Swollen glands
Asymptomatic Period
8 - 11 years
(Average progression, may vary depending on the person)
HIV Illness
Symptoms 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
*Window Period: average time it takes the body to produce antibodies; usually 2 - 12 weeks, up to 6 months - 1 year (rare)
Common Opportunistic Infections
Pneumocystis carinii Pneumonia (PCP)CMV InfectionHIV Wasting SyndromeCandidiasis (oral, esophageal, vaginal)Kaposi’s SarcomaTuberculosisHIV - Related DementiaCervical Cancer
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Myth/Fact?
Casual contact CANNOT put you at risk for HIV
FACT
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HIV Transmission
• Breathing • Coughing • Sneezing • Kissing (dry)• Sharing or touching gum • Drinking from water fountains• Sharing food or drinks
• Causal touching • Telephones • Pools/tubs • Shaking hands • Toilet seats • Giving/donating blood
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People cannot get HIV from:People cannot get HIV from:
HIV Transmission
HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood. 16
By Infected Body Fluids:By Infected Body Fluids:
Breast milk
Blood
1 2 3 4Semen, pre-cum
Vaginal secretions
HIV Transmission
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OralVaginalAnal
By Unprotected Sex:By Unprotected Sex:
1 2 3
HIV Transmission
By Exchanging Infected BloodBy Exchanging Infected Blood
Sharing needles for any purpose
Sharing needles for any purpose
Injectiondrug use
Piercing/tattooing
Insulin, hormone vitamin shots
Acu-puncture
1 2 3 4
HIV Transmission
Mother 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% through the use of anti-HIV drugs during pregnancy (AZT)
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Myth/Fact?
HIV testing is unnecessary because I would know if my lover or I had it
MYTH
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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 minutes Test settings Anonymous
Confidential 21
HIV Diagnosis (Testing)Antibody tests
- 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 min. - 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.
• 17 yrs. of older• Must confirm if reactive
HIV TESTInformed Consent
12 yrs of age or older
Benefits of Testing……..
Where to test? Private medical doctor County clinic Community-based
organizationswww.hivla.org1-800-367-AIDS (2437)
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Myth/Fact?
A person who is HIV positive must tell partners their status
MYTH
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California’s “Willful Exposure” Law (1998)/aka “Recalcitrant Behavior”:
Willfully exposing another to HIV through unprotected sex
8 years of imprisonmentIntention 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 sexKnow that they are HIV +Fail to disclose their HIV statusFail to use a condomHave 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 Discrimination
A doctor or dentist cannot refuse to treat an HIV+ person
• Fair Employment and Housing Act (FEHA) and Unruh Civil Rights Act
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PREVENTION
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PREVENTION“It is not who we are but what we do that puts us at risk for
HIV infection” Harm reduction Abstinence Safer Sex
Male Condom (Activity)Female CondomDental Dams
Needle useNot Sharing NeedlesCleaning Needles (3x3x3 Method)Needle Exchange
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The Female Condom
PREVENTION Universal Precautions
“Infection control measures that reduce the risk of transmission of blood-born germs from patients to health
care workers”
Wash hands thoroughly
Wear latex gloves
Use masks and eye protection
Wear a gown
Carefully handling and disposing of sharp instruments during and after use.
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PREVENTIONBREAST FEEDINGIt is recommended that HIV+ women do not breastfeed Infants.
POST–EXPOSURE PROPHYLAXIS (PEP)Exposure to HIV within the prior 72 hoursApprove for 13 yrs of age or olderFor more information call 213-351-7699
PRE-EXPOSURE PROPHYLAXIS (PREP)It refers to anti-HIV medication used daily or before sexual encounters Start prior to potential exposure
Prep should never be seen as the first line of defense against HIV
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TREATMENT
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TREATMENT
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 as Prevention
• Science Magazine named 'HIV Treatment as Prevention' as the breakthrough of 2011
• The HIV Prevention Trials Network (HPTN)
052 study of 1,700 sero-discordant couples reported that ARVs reduced the risk of heterosexual transmission by 96%.
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TREATMENT
What are Anti-retrovirals (ARVs) ?
Antiretrovirals are drugs that interrupt the HIV replicationprocess and help preserve the health of the immune system.
When to start anti-HIV medications?
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 (especially if 200 or less).
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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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Recent Advancements
Immune based therapies
Maturation inhibitors
Multi-class Combination Products
Gene Therapy
Vaccine
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Complementary Therapy
General Health Maintenance
Psychological Well-Being
Spiritual Well-Being
Social Well-Being
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QUESTIONS?
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For More Information Contact
http://publichealth.lacounty.gov/dhsp/
Disly Juarez, MPH
213-351-8102