“The Odyssey of HIV Epidemic”From Despair & Death to Longevity & Life

TAHSEEN J. SIDDIQUI, M.DInfectious Disease Specialist

Medical Director, Infectious Disease/Infection Control

Vice Chair, Department of Medicine

Clinical & Teaching Faculty

Norwegian American Hospital, Chicago

Medical Director of Clinical Excellence

Saint Bernard Hospital, Chicago

Infectious Disease Consultant

Advocate Illinois Masonic Hospital, Chicago

Jackson Park Hospital & Medical Center, Chicago

Roseland Community Hospital, Chicago

“The HIV epidemic not only affects

the health and life of individuals, it

impacts households, communities,

and the development and economic

growth of entire nations”

Thirty years ago the world was just becoming aware of a new epidemic

called the Acquired Immune Deficiency Syndrome or AIDS, caused by HIV virus.

HIV in the United States:

At A Glance

In 2015

39,513 people were diagnosed with HIV infection in the United States

From 2005 to 2014

The annual number of new HIV diagnoses declined 19%.

• In 2015:

• Gay and bisexual men accounted for 82% (26,375) of HIV diagnoses among

males and 67% of all diagnoses.

• From 2005 to 2014:

• Diagnoses among all heterosexuals declined 35%,

• And among people who inject drugs, diagnoses declined 63%.

HIV in the United States

Diagnoses of HIV Infection and Populationby Race/Ethnicity, 2014—United States

Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

a Hispanics/Latinos can be of any race.

Diagnoses of HIV Infection among Adults and Adolescents,

by Sex and Race/Ethnicity, 2014—United States and

6 Dependent Areas

Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been

statistically adjusted to account for reporting delays, but not for incomplete reporting.a Hispanics/Latinos can be of any race.

From 2005 to 2014:

Diagnoses among all women declined 40%,

and among African American women, diagnoses declined 42%.

HIV in the United States by Geographic Distribution

Northeast: CT, ME, MA, NH, NJ, NY, PA, RI, VT

Midwest: IL, IN, IA, KS, MI, MN, MO, NE, ND, OH, SD, WI

South: AL, AR, DE, DC, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, WV

West: AK, AZ, CA, CO, HI, ID, MT, NV, NM, OR, UT, WA, WY.

• African Americans continue to experience the greatest burden of HIV

• Hispanics/Latinos are also disproportionately affected by HIV. In 2015:

• African Americans represented about 13% of the US population, but

accounted for 45% (17,670) of HIV diagnoses.

• Hispanics/Latinos represented about 17% of the US population, but

accounted for 24% (9,290) of HIV diagnoses.

From 2005 to 2014:

• Among white gay and bisexual men, HIV diagnoses dropped steadily,

declining 18% overall.

• Although diagnoses among African American gay and bisexual men,

who accounted for the largest number of HIV diagnoses in U.S,

increased 22%, they have leveled off in the past 5 years

• Among Hispanic/Latino gay and bisexual men, diagnoses rose by 24%.

HIV in the United StatesThe Demographic Disparities

Impact of HIV on Hispanic/Latino Community

• Hispanics/Latinos are disproportionately affected by HIV.

• About 7 in 10 new HIV diagnoses among Hispanics/Latinos occur in gay

and bisexual men.

• Only about half of Hispanics/Latinos diagnosed with HIV are retained in

HIV care.

• Higher rates of sexually transmitted diseases (STDs).

Hispanics/Latinos have relatively high rates for STDs compared to some other

races/ethnicities, including chlamydia, gonorrhea, and syphilis.

Presence of another STD makes it easier to become infected with HIV.

Impact of HIV on Hispanic/Latino Community

• In 2014, Hispanics/Latinos accounted for 24% (10,887) of the estimated

44,784 new diagnoses of HIV infection in the United States and 6 dependent

areas.

• Of those, 86% were in men, and 14% (1,490) were in women.

• Gay, bisexual, and other men who have sex with mend accounted for 84%

(7,893) of the estimated HIV diagnoses among Hispanic/Latino men in 2014.

• Among Hispanic women/Latinas, 86% (1,282) of the estimated HIV diagnoses

were attributed to heterosexual contact.

From 2005 to 2014

– Diagnoses among Hispanic women/Latinas declined steadily (35%).

– Diagnoses among all Hispanic/Latino gay and bisexual men increased (24%).

– Diagnoses among young Hispanic/Latino gay and bisexual men (aged 13 to 24)

increased (87%).

– If current rates continue, 1 in 4 Hispanic/Latino gay and bisexual men will

be diagnosed with HIV in their lifetime.

In 2014, an estimated 4,689 Hispanics/Latinos were diagnosed with AIDS. (CDC)

Diagnoses of HIV Infection among Adult and Adolescent

Hispanics/Latinosa, by Sex and Transmission Category

2014—United States and 6 Dependent Areas

Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting.

a Hispanics/Latinos can be of any race.b Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. c Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

Rates of Diagnoses of HIV Infection among Adult and

Adolescent Hispanics/Latinosa, 2014—United States N = 10,182 Total Rate = 24.2

Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

a Hispanics/Latinos can be of any race.

STIGMA, DISCRIMINATION AND HIV

• HIV-related stigma and discrimination refers to prejudice, negative attitudes and abuse directed at people living with HIV and AIDS.

Key Elements of HIV-Related Stigma

• Lack of awareness (HIV and AIDS are always associated with death/HIV is only transmitted through sex, which is a taboo subject in some cultures)

• Fear of contagion-casual contact stemming from incomplete knowledge about HIV transmission

• Linking HIV to improper or immoral behavior (like homosexuality, drug use, sex work or infidelity)

HIV Stigma

• Research by the International

Centre for Research on Women

(ICRW) found the possible

consequences of HIV-related

stigma to be:

• Loss of income and livelihood

• Loss of marriage and

childbearing options

• Poor care within the health

sector

• Withdrawal of caregiving in the

home

• loss of hope and feelings of

worthlessness

• Loss of reputation and self

prestige

What Can I Do to Stop HIV Stigma?

• Break the silence surrounding HIV stigma in our community. Talk about your experiences, fears and concerns about getting HIV or transmitting HIV with friends, a counselor, or a sexual partner.

• Challenge attitudes, beliefs and behaviors that contribute to HIV stigma.

• Don't be a silent witness to it when it happens around you.

• Take responsibility for the prevention of HIV.

• Get informed about how to protect yourself and others from HIV.

• Treat people with HIV with respect, empathy, and compassion.

Who Can/Cannot Get HIV Infection?

You Won’t Get HIV From:

• Touching, hugging, shaking hand, or social contact, such as schools and offices.

• Casual kissing- risky only if you both have large open sores or bleeding gums and blood is exchanged

• Coughing, sneezing or spitting from an infected person

• Sharing drinking glasses or exposure to infected person’s saliva, sweat, tears, urine, or feces.

• Sharing toilet seats, faucet handles, tables, door handles, cutlery, towels

• Swimming pools, baths, shower areas or from drinking fountains.

• Oral sex, used condoms, mutual masturbation ( if you use sex toys make sure you use a new condom on them when switching between partners)

• Tattoos and piercings

• In the U.S, HIV does not spread by blood transfusion, organ transplants, vaccines, surgical/dental procedures etc.

• HIV does not spread by insects/mosquitoes/animal bites.

How Can I Prevent Being Infected?

It is easy to protect against HIV

Use condoms correctly every time you have sex.

Don’t inject drugs. If you do, use only clean

needles and equipment and don’t share your

equipment with others

PrEP

Pre-Exposure Prophylaxis

• People who are HIV-negative and at very high

risk for HIV can take daily medicine to prevent

HIV before gets exposure.

• Truvada reduces the risk of injection drug

users and uninfected partners acquiring HIV

by up to 92%

• Remember- Only condoms can help protect

against other STDs.

PEPPost Exposure Prophylaxis

• Taking antiretroviral

medicines(Truvada/Isentress) after being

potentially exposed to HIV to prevent

becoming infected

• Must be started within 72 hours after a

possible exposure to HIV and continued for

28 days

• PEP is effective in preventing HIV, but not

100%

• PEP is NOT a morning after pill!

Know Your HIV Status

HIV Testing is Really Simple & Important

• Testing is an integral part of HIV prevention

• 21% of the infected Americans are not aware that they are infected

• Identify HIV infection early:- Improve health status of the individual - Increase life expectancy- Decrease the risk of transmission to others

- Decrease risk of progressing from HIV to AIDS

- Helps decrease high risk behavior

- - Offer access to needed health services and life saving medications

• Testing is only the entry point.

• Linkage to Care.

• To date, more than 75% of persons who tested positive for the first time were linked to medical care, and nearly 80% received partner services to help notify and ensure that their partners get tested.

HIV Tests

• HIV tests may be performed on blood, oral fluid, or urine.

• It can take 3 to 12 weeks for an HIV-positive person’s body to make enough antibodies for a screening test to detect HIV infection. (window period)

• OraQuick Rapid HIV Test-involves taking an oral fluid sample by swabbing the mouth and use a kit to test it. Results are available in 20 minutes.

• Home Access HIV-1 Test System is a home collection kit, which involves pricking your finger to collect a blood sample, sending the sample by mail to a licensed laboratory, and then calling in for results as early as the next business day. This test is anonymous.

• If you use any type of antibody test and have a positive result, you will need to take a follow-up blood test to confirm your results.

Being HIV-positive does not mean you have AIDS. AIDS is the most

advanced stage of HIV disease. HIV can lead to AIDS if not treated.

Where Can I Get Tested?

What Should I expect When I go In for HIV Test?

• At Vida SIDA, (NAH), a health care provider will perform rapid HIV/HCV

screening tests on blood/oral fluid, and you may be able to wait for the test

results

• If the test comes back negative, and you haven’t had an exposure for 3

months, you can be confident you’re not infected with HIV.

• If the test is negative, and you had an exposure within 3 months, a follow up

HIV test to be repeated after 3 months.

• If your HIV test result is positive, you will be referred to HIV specialist for

confirmatory tests/ treatment and follow-ups.

• Your health care provider or counselor may talk with you about your risk

factors, answer questions about your general health, and discuss next steps

with you, especially if your result is positive.

• It is important that you start medical care and begin HIV treatment (ART) as

soon as you are diagnosed with HIV.

Will Other People Know My HIV Test Results?

• If you take an anonymous test, no one but you will know the result.

• If you take a confidential test, the results will go in your medical record and may be shared with your health care providers and your health insurance company.

• Your results are protected by state and federal privacy laws, and they can be released only with your permission.

• If you test positive for HIV, the test result and your name will be reported to the state or local health department to help public health officials get better estimates of the rates of HIV in the state.

• The state health department will then remove all personal information about you (name, address, etc.) and share the remaining non-identifying information with CDC

Should I Share My Positive Test Results With

My Partners?

• It’s important to disclose your HIV status to your sex partners even if you’re

uncomfortable doing it.

• Many resources can help you learn ways to disclose your status to your

partners.

• Partner Notification Services. Health departments do not reveal your name to

your partners. They will only tell your partners that they have been exposed to

HIV and should get tested.

• At least 35 states have criminal laws that punish HIV-positive people for

exposing others to the virus, even if they take precautions such as using a

condom.

• The state of Illinois makes it a crime (Class 2 felony offense-3-7 yrs prison

time, up to $25,000 fines, probation, and other penalties) for anyone who

knows that he or she carries, or is infected by HIV virus to engage in sexual

activity or intimate contact with someone else; nor can they donate blood,

semen, bodily tissue, organs, or other bodily material to someone else.

• Also, a person with HIV cannot legally exchange non-sterile drug

paraphernalia with others.

Should I Share My Positive Test Results with

Family & Friends?

• Your family and friends will not know your test results unless you tell them yourself.

• Disclosure to close and trusted friend/family member or coworker actually has benefits to your emotional and mental health and may help you cope and begin to work HIV treatment into your life

• If you are a minor, aged 12 – 18 yrs, living in IL, you may consent to confidential testing, treatment, and counseling for sexually transmitted infections (STIs including AIDS, HIV ).

• Providers must report positive results to the Department of Health or the local board of health, where the report will remain confidential.

• Providers are encouraged, where appropriate, to involve a minor’s family in the minor’s treatment for STIs, but must first obtain the minor’s consent.

• If a minor tests positive for HIV, it is up to the discretion of the provider to determine if it’s in the minor’s best interest to notify a parent.

Will My Employer Knows About My

Positive Test Result?

In most cases, your employer will not know your HIV status unless you tell them.

• Your employer does have a right to ask if you have any health conditions that would affect your ability to do your job or pose a serious risk to others.

• If you have health insurance through your employer, the insurance company cannot legally tell your employer that you have HIV.

• But it is possible that your employer could find out if the insurance company provides detailed information to your employer about the benefits it pays or the costs of insurance.

• All people with HIV are covered under the Americans with Disabilities Act. This means that your employer cannot discriminate against you because of your HIV status as long as you can do your job.

Does HIV Infection Always Associated with Immoral

Behavior (Homo/bisexuality/Infidelity)?

Is HIV a “Gay’s Disease”

• Everyone is at risk of HIV if you get HIV into your bloodstream.

• Some people have a higher risk of getting HIV because they engage in certain activities (e.g. injecting drugs) that are more likely to transmit the virus, or they have lots of sex partners and don’t use a condom.

• Previously –many acquired infection via contaminated blood transfusion ( Ryan White- Hemophiliac), and other non sexual ways.

• The notion that HIV is a consequence of a person’s sexual orientation was discounted just over a year after the disease was first identified.

• AIDS is a global issue affecting different groups in different countries in different ways.

• Globally, most new infections are now transmitted heterosexually

If I have HIV Does It Mean My

Life Is Over?

No-HIV Doesn’t Have To Be A life Sentence

• People diagnosed with HIV in the early 1980’s were lucky to survive 8 years since there were no effective drugs to treat.

• But now there are dozens of highly active drugs available to treat HIV very effectively (HAART)

• If these drugs are started early, taken regular and consistently, then the chances of developing AIDS are dramatically reduced.

• AIDS-related deaths have fallen by 45% since the peak in 2005.

• In fact, people with HIV are likely to have a life-span generally the same as uninfected people, and are more likely to die of other causes, such as heart conditions or cancer

Thanks To HAART Medications

More and More People Are Living with HIV Instead of Dying

If I Get Infected!

Can I Be Treated Successfully?

• Absolutely. HIV infection can safely and effectively be

treated with HAART medications.

• These medications reduce the amount of virus in the

body (viral load), prevents illness by keeping the

immune system functioning and ensure healthy life.

• They also prevent HIV transmission to others through

sex, needle sharing, and from mother-to-child during

pregnancy and birth.

• When taken consistently, ART can reduce the risk of

HIV transmission to a negative partner by 96%.

How Safe and Effective HIV Medications Are?

• All FDA approved HIV medications (HAART) are safe, well tolerated, allow simple once daily dosing, with minimal drug-food interactions.

• If one regimen doesn’t suit or work for you, there are plenty of other options.

HIV Medications (HAART)

Truly Saves Lives

How Accessible Life-Saving

HIV Medications Are?

People living with HIV

• In 2015, there were 36.7 million people living with HIV Worldwide

People living with HIV accessing antiretroviral therapy

• As of June 2016, 18.2 million people living with HIV were accessing antiretroviral therapy, up from 15.8 million in June 2015 and 7.5 million in 2010.

• In 2015, around 46% of all people living with HIV had access to treatment.

• In 2015, some 77% of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their babies.

In U.S.A-Everyone has access to HIV Care and

Medications

How Can I Afford HIV Testing/Treatment Costs?

• Vida/Seda and several other agencies offers free HIV (and HCV)

Testing & Counseling.

• HIV screening is covered by health insurance without a co-pay, as

required by the Affordable Care Act.

• If you have health insurance, your insurer is required to cover

some medicines used to treat HIV.

• If you don’t have health insurance, or you’re unable to afford your

co-pay or co-insurance amount, you may be eligible for

government programs that can help through Medicaid, Medicare,

the Ryan White HIV/AIDS Program, ADAP, and community

health centers.

• If your insurance does not cover the full amount of the drug,

generic versions of HIV drugs can be up to 30% cheaper than the

branded version

Living With HIV Doesn’t Mean A Life-Time of Monitoring

• See your doctor every 3-6 months during first 2

years of ART or if viremia develops while patient

on ART or CD4 count <300

• Thereafter once every 12 months with consistent

viral suppression, and your CD4 counts are >500

AIDS Is Not Over, But It Can Be !

• Huge progress has been made since 2000 and millions of lives have been saved.

• But there are still important milestones to reach, barriers to break and frontiers to cross.

• The world has agreed to meet a set of global targets by 2020 as part of UNAIDS Fast-Track strategy to end the AIDS epidemic as a public health threat.

Thank You

• Questions?

• Comments!

• Concerns #