HIV/ AIDS… �Understanding the Epidemic

High School Health- Mrs. Rawlings

HIV

• Human
• Immunodeficiency
• Virus
• A virus that weakens the immune system of a human

AIDS

• Acquired- Transmitted by an infected person to an uninfected person
• Immune
• Deficiency
• Syndrome-Collection of symptoms

Modes of Transmission

• Blood
• Semen
• Vaginal Secretions
• Mother’s Milk
• 1+1=2
• 1 infected fluid + 1 point of contact (rash to gash)=Possible transmission
• The virus is extremely fragile and will die within minutes if there is not a host available

What’s the scoop?

• Myths
• HIV can be transmitted by mosquitoes, dog bites, drinking fountains, and toilet seats
• Condoms are 100% effective for preventing HIV infection

• Facts
• HIV can only be transmitted from human to human by exchanging body fluids
• Abstinence is the only 100% effective way to prevent infection (condoms ARE the next best option though)

Time Line of Events...�(In a nutshell…)

• 1920’s-30’s HIV is believed to have mutated from a virus called SIV in sub-Saharan Africa
• 1981 first symptoms seen in a flight attendant. Called “Gay Cancer”
• 1982 Flight Attendant Identified as “Patient Zero”
• 1983 CDC identifies AIDS. 89% of Hemophiliacs tested positive.
• 1989 Blood Supply starts to be screened

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Timeline continued…

• Has infected 60 million, has killed 20 million
• 90% of infections have occurred as a result of sexual intercourse
• Only 800,000 are medicated
• It’s estimated that more than 25 million people have been killed by AIDS since 1981
• 33.4 million people globally living with AIDS (2008)
• 14,000 new cases globally/day
• 280,000 people are infected and don’t know it.

The number of people living with HIV has risen from around 8 million in 1990 to 33 million today, and is still growing. Around 67% of people living with HIV are in sub-Saharan Africa.

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What happens when a� person is “infected”?

• Exposure- An amount of the virus enters the body in a body fluid. It attaches to a T4 (CD4) cell and begins replication.
• Stage one- Acute 2-8 wks after infection. Flu-like symptoms develop for 1-4 wks. Virus is rapidly reproducing
• Stage two- Asymptomatic No signs of infection. 1 month to 10 years after infection depending on how healthy the person is
• Stage three-Symptomatic -Development of Opportunistic Infections, Night sweats, “wasting”, lesions, extreme fatigue

How does the virus attack the immune system?

• The virus enters the body through a mucous membrane, via a body fluid
• Once inside the body, it attaches it’s self to a type of white blood cell called a T4 cell. Once inside the T cell it injects its’ RNA and makes it into DNA, which allows for the replication of the virus inside the cell. It’s just like a photo copier reproducing mass copies.

Opportunistic Infections...

• An infection that takes advantage of a compromised immune system.
• Examples include: Pneumocyctis carinii pneumonia (PCP), tuberculosis, thrush, cmv (attacks the retina of the eye, causing blindness), herpes, toxoplasmosis
• *people who die from AIDS, really die from the opportunistic infections*

HIV vs. AIDS… � what’s the difference?

• To be diagnosed with AIDS, a person must have a T cell count of 200 or less and/or an opportunistic infection
• The normal T4 count is somewhere between 500 and 1500 cells per cubic millimeter of blood (a drop, more or less).

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Testing...

• More than half of those infected with HIV do not know they are until they start showing symptoms (AIDS)
• Confidential testing- Information can not be shared with anyone else. It is reported to NY State though
• Anonymous testing- No name is given

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Benefits to testing?

• EARLY TREATMENT
• partner notification
• prevent the spread
• Prepare for the future

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What is involved in testing?

• An HIV test takes a sample of blood or an oral test of cheek cells and analyzes it for HIV antibodies. The initial test is called an ELISA test.
• If an ELISA test is done and it turns out to be positive, a Western Blot is done as a confirmatory test.
• A cheek cell (Rapid HIV) test can produce results in 20 minutes

What if the test is negative?

• If the test is negative, it’s suggested that the person be re-tested in 6 months to see if there are any antibodies at that time. It may be too soon to find them on a test.

Who has to be tested?

• There is mandatory testing in the military and in Prisons, newborn babies are also required to be tested before leaving the hospital. In NYS pregnant mothers are tested.
• Besides that, there is no mandatory testing.
• Testing positive in the military doesn’t mean they can’t be in, but they will have restricted service.

Treatments

• Immediate treatment is the best to decrease the “viral load”, and increase the T-cell count.
• Drug Cocktails are available to attack the production of HIV cells throughout the stages of production. Called combination therapy or HAART. (Highly active anti-retroviral therapy)

Common Medications...

• The most dramatic drops in both cases and deaths began in 1996, with the widespread use of combination antiretroviral therapy.

Life expectancy

• There has been a decline in life expectancy in these countries.
• In Botswana, for example the LE is 39, should be 72.
• Adult HIV prevalence of 23.9%
• 95,000 children have lost at least one parent to the epidemic
• In an address to the UN assembly in June 2001, President Festus Mogae summed up the situation by saying:
• "We are threatened with extinction. People are dying in chillingly high numbers. It is a crisis of the first magnitude
• In Haiti, it’s 51, should be 59

The hardest hit...

• Sub-Saharan Africa is still the hardest hit area (where it originated)
• Makes up 10% of the world’s population but 60% of all people living with HIV are in Sub-Saharan Africa
• 76% of all women living with HIV are here

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Why is Africa hit so hard?

• Lack of education
• culture-women do not have the same cultural role. Males are dominant.
• breastfeeding
• lack of medication or money to buy it
• lack of proper healthcare/testing- poor prenatal care prevents pregnant women from being tested and preventing spread to baby, or taking AZT during pregnancy

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Prevention…

• Areas to focus on:
• Sexual transmission
• Transmission through blood
• Mother to child

Sexual Transmission

• Abstain from having sex
• Be mutually monogamous
• Use a condom (male or female)
• ABC’s- Abstain, Be faithful, condomise

Blood transmission

Avoid sharing needles

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Use Universal precautions

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Controversial programs such as…. Needle exchange programs

Location Participants Report published Result in circumcised men

South Africa 3,274 July 2005 60% fewer infections

Kenya 2,784 February 2007 53% fewer infections

Uganda 4,996 February 2007 51% fewer infections

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Circumcision�

• There are several possible reasons why circumcision has this effect. The foreskin creates a moist environment in which HIV can survive for longer in contact with the most delicate parts of the penis, and the inner surface of the foreskin contains cells that are especially vulnerable to infection by HIV. If the foreskin is removed then the skin on the head of the penis tends to become tougher and more resistant to infection. In addition, any small tears in the foreskin that occur during sex make it much easier for the virus to enter the body.

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