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The HIV virus

The HIV virus. HIV/AIDS worldwide by region. The overwhelming majority of people with HIV live in low- and middle-income countries. Sub-Saharan Africa accounts for two-thirds of all infected people. South and South-East Asia has the second highest number of people living with HIV.

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The HIV virus

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  1. The HIV virus

  2. HIV/AIDS worldwide by region The overwhelming majority of people with HIV live in low- and middle-income countries. Sub-Saharan Africa accounts for two-thirds of all infected people. South and South-East Asia has the second highest number of people living with HIV. http://www.avert.org/worlstatinfo.htm

  3. El-Sadr WM, Mayer KH, Hodder SL. AIDS in America - Forgotten but not gone. NEJM 362(11):968, 2010.

  4. http://www.avert.org/worldwide-hiv-aids-statistics.htm

  5. A Global View of HIV Infections Among Adolescents and Young Persons

  6. UNAIDS Global Report, 2012

  7. UNAIDS Global Report, 2010

  8. Ortblad et al. The burden of HIV. AIDS 27(13):2006, 2013.

  9. Ortblad et al. The burden of HIV. AIDS 27(13):2008, 2013.

  10. Percent of adults (15+) living with HIV who are female, 1990–2007 70 Sub-Saharan Africa 60 GLOBAL 50 Percent female (%) Caribbean 40 Asia 30 E Europe & C Asia 20 Latin America 10 0 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007 Year 5

  11. http://www.avert.org/children-orphaned-hiv-and-aids.htm

  12. Children orphaned by AIDS 0-14 years, (most recent) by country http://www.nationmaster.com/red/graph/hea_hiv_chi_orp_by_aid_0_14_yea-orphaned-aids-0-14-years&b_map=1

  13. DETERMINANTS OF TRANSMISSION FROM AN INFECTED PERSON (1) • Duration of infection/stage of disease • Risk of transmission per sexual act • Viral RNA level • Presence/absence of concurrent STD and other infections • Condom use • Treatment

  14. DETERMINANTS OF TRANSMISSION FROM AN INFECTED PERSON (2) • Circumcision status (reservoir of HIV) • Partner exchange rate • Mixing pattern • Patterns of sexual behavior (anal, vaginal, etc.) • Injection equipment sharing • Networks, core transmitters

  15. TARGET GROUPS FOR INTERVENTION STRATEGIES • Youth 13-25 years • Men who have sex with men • Injection drug users • Promiscuous heterosexuals • Health care workers • Biomedical laboratory workers • Blood/plasma donors • Pregnant women in high-risk populations • Persons living with HIV/AIDS • Spouses of high-risk persons

  16. BARRIERS TO HIV/AIDS CONTROL (1) • Stigma (risk groups, HIV-infected, testing) • Status of women • Low condom acceptance (esp. for non-commercial sex) • Emphasis (& $s ) on treatment, not prevention • Dependence on external support • Long-term sustainability of external support • Low awareness/acceptance of vulnerability (women/youth)

  17. BARRIERS TO HIV/AIDS CONTROL (2) Low acceptance of testing (emphasis on “opt-in” and individual rights) • High proportion of uncircumcised men • Reluctance to be circumcised • Low literacy rates • Effectiveness of female-controlled prevention strategies (e.g. microbicides) • Vaccine unlikely in the near future • High proportion of asymptomatic STIs

  18. Prep and Pep – will it be utilized http://www.unicef.org/publications/files/Opportunity_in_Crisis-Report_EN_052711.pdf

  19. Key Elements for Successful Intervention (1) • Mobilization of political will and commitment • Good surveillance • Learn and adapt from past experiences • Unified national planning • Multisectoral response; e.g., police • Rapid implementation • Focused intervention; e.g., involve marginalized and high-risk groups

  20. Key Elements for Successful Intervention (2) • Assure access to intervention tools; e.g. condoms, testing, drugs • Early education before exposure • Community involvement • Access to treatment • Compliance/adherence/sustainability • Intensified testing efforts • Combining strategies

  21. Key Elements for Successful Intervention (3) • Reduce barriers to intervention • Address restrictive cultural norms (e.g. refusal to acknowledge sexuality) • Stigmatization • Promote testing (opt out) • Treatment as prevention • Adults • Pregnant women • Development of effective vaccine

  22. Key Elements for Successful Intervention (4) • Testing for an effective microbicide • Issues of testing i.e. mandatory condom use • Recognition of risk by participants • Inducing essential level of adherence • Drug resistance for anti-HIV microbicides

  23. Key Elements for Successful Intervention (5) • PreP • Efficacy at individual level • Achieving essential adherence levels • Low effectiveness  increased resistance and increased community viral load • Cost – who pays? • Target groups • PEP • Speed/interval post-exposure essential • Cost-effective if it prevents HIV • Who pays? • Identifying exposure

  24. The HIV/AIDS Epidemic in the U.S. through 2011

  25. Black Americans and HIV/AIDS. HIV/AIDS Policy, Kaiser Family Foundation, March 2013.

  26. Slide 2: Rates of Diagnoses of HIV Infection, 2010 - 46 States and 5 U.S. Dependent Areas In 2010, in the 46 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2007, the estimated rate of diagnoses of HIV infection was 16.3 per 100,000 population. The estimated rates of diagnoses of HIV infection ranged from 0.0 per 100,000 in American Samoa and the Northern Mariana Islands to 42.8 per 100,000 in the U.S. Virgin Islands.

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