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NURS 330 - Schedule for 2/3/14

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. The State of the HIV/AIDS Epidemic. County of Los Angeles Department of Public Health Division of HIV and STD Programs

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NURS 330 - Schedule for 2/3/14

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  1. 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

  2. The State of the HIV/AIDS Epidemic County of Los Angeles Department of Public Health Division of HIV and STD Programs Disly Juarez, MPH Health Educator djuarezmunoz@ph.lacounty.gov 2

  3. MYTHS AND FACTS ABOUT HIV/AIDS

  4. Myth/Fact? HIV is the same as AIDS MYTH

  5. Human Immunodeficiency Virus HIV HIV AIDS Immune Acquired AIDS Deficiency Syndrome

  6. 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

  7. 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

  8. Myth/Fact? HIV only affects gay men and drug users MYTH

  9. 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.

  10. Myth/Fact? Once a person is diagnosed with HIV/AIDS, they will die soon MYTH

  11. 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.

  12. HIV Spectrum of Disease Exposure No infection Asymptomatic • 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 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) *Window Period: average time it takes the body to produce antibodies; usually 2 - 12 weeks, up to 6 months - 1 year (rare)

  13. 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

  14. Myth/Fact? Casual contact CANNOT put you at risk for HIV FACT

  15. 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 People cannot get HIV from:

  16. By Infected Body Fluids: 1 2 3 4 Semen, pre-cum Vaginal secretions Blood Breast milk HIV Transmission HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood.

  17. By Unprotected Sex: Oral Vaginal Anal HIV Transmission 2 1 3

  18. By Exchanging Infected Blood 1 2 3 4 Injection drug use Piercing/ tattooing Insulin, hormone vitamin shots Acu-puncture HIV Transmission Sharing needles for any purpose

  19. 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)

  20. Myth/Fact? HIV testing is unnecessary because I would know if my lover or I had it MYTH

  21. 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

  22. 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

  23. HIV TEST Informed Consent 12 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)

  24. Myth/Fact? A person who is HIV positive must tell partners their status MYTH

  25. 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.

  26. 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.

  27. 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

  28. PREVENTION

  29. 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 Condom Dental Dams • Needle use Not Sharing Needles Cleaning Needles (3x3x3 Method) Needle Exchange

  30. The Female Condom

  31. 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.

  32. PREVENTION BREAST FEEDING It is recommended that HIV+ women do not breastfeed Infants. POST–EXPOSURE PROPHYLAXIS (PEP) Exposure to HIV within the prior 72 hours Approve for 13 yrs of age or older For 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

  33. TREATMENT

  34. 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).

  35. 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%.

  36. TREATMENT • What are Anti-retrovirals (ARVs) ? Antiretrovirals are drugs that interrupt the HIV replication process 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).

  37. 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

  38. Who Pays For Treatment? • HMO insurance • Medi-Cal • Medicare Part D • ADAP • Shared cost

  39. Recent Advancements • Immune based therapies • Maturation inhibitors • Multi-class Combination Products • Gene Therapy • Vaccine

  40. Complementary Therapy • General Health Maintenance • Psychological Well-Being • Spiritual Well-Being • Social Well-Being

  41. QUESTIONS?

  42. For More Information Contact http://publichealth.lacounty.gov/dhsp/ Disly Juarez, MPH djuarezmunoz@ph.lacounty.gov 213-351-8102

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