HIV and AIDS Epidemic of the 21 st Century

1. HIV and AIDSEpidemic of the 21st Century Paul G. Blazer Senior High School Department of Health and Physical Education

2. Sophomore Health Presentation • By AJ “Doc” Stadelmeyer MA, ATC • Teacher/Head Athletic Trainer • Paul G. Blazer Senior High • December 2003

3. The Purpose of this Presentation: The student will learn the basic facts and information about HIV and AIDS, including how the virus is transmitted and how to prevent becoming infected with it. Scientific and medical information about the virus, a history of the disease, and some current statistics and epidemiology will also be presented.

4. AIDS Stands for Acquired Immune Deficiency Syndrome It is a group of symptoms and infections that eventually lead to death, caused by damage and weakening of a human’s immune system by HIV. There is no cure or vaccine for AIDS or HIV.

5. HIV Stands for Human Immunodeficiency Virus It is the actual virus that causes AIDS.

6. HIV is transmitted by these body fluids: A.Blood and blood products B.Vaginal mucus and secretions C.Semen D.Any body fluid that is mixed with infected blood E. Sometimes breast milk

7. HIV is sometimes found in, but has never been transmitted by the following body fluids: A.Saliva B.Sweat C.Tears D.Urine E.Feces F.Plasma G.Brain Tissue H.Spinal Fluid I. Respiratory Mucus

8. HIV is Transmitted Through/By: A.Male Homosexual Activity B.Heterosexual Activity (male – female) C.Vaginal, anal, and/or oral sexual intercourse D.Sharing intravenous needles, syringes and injection supplies E.Contact with infected blood, semen, or vaginal secretions F.Mother to child during or before birth G. Transfusion of infected blood or blood products

9. The Faces of HIV and AIDS

10. A.Casual contact B.Objects C.Coughing or sneezing D. Mosquitoes, ticks, fleas, lice, insects E.Animals, birds, fish, cats, dogs, apes, monkeys, etc. F.Normal kissing G.Shaking hands H. Touching, hugging, massaging, holding hands HIV is NOT transmitted by:

11. I.Playing sports with an infected person J.Working with an infected person K.Going to school with an infected person L. Eating food prepared or served by an infected person M.Using the phone, computers, fax machines, copy machines, cell phones N. Sharing cigarettes, joints, pipes, cigars HIV is NOT Transmitted By:

12. O.Donating blood P.Using public restrooms Q.Sharing food, drinks, pop cans, dishes, glasses, utensils R. Sweat or saliva S.Bathtubs, showers, saunas, hot tubs, whirlpools T.Swimming pools U.Sharing clothing, underwear V. Sharing the same bed HIV is NOT Transmitted By:

13. How do you prevent HIV infection and AIDS? A.Practicing sexual abstinence until you establish a mutually monogamous relationship within the context of marriage. B.Refraining from injecting and using illicit intravenous drugs.

14. If you already engage in sexual intercourse and/or have injected or are injecting illicit drugs: A.Stop engaging in sexual intercourse until you are ready to establish a mutually monogamous relationship within the context of marriage B. Stop using and/or injecting illicit drugs.

15. If you are unwilling to adopt behavior that would virtually eliminate the risk of HIV and AIDS infection, then: A.Avoid sexual intercourse with anyone that is known to be infected, anyone who is at risk of being infected, or with anyone whose HIV status is not known; B.Use a latex condom with nonoxynol 9 spermicide every time you engage in any type of sexual intercourse; C.Seek treatment if addicted to illicit drugs; D. Do not share intravenous needles or other injection equipment; ESeek HIV/AIDS counseling, testing, and treatment if possible infection is suspected.

16. Other things that you should do to prevent HIV transmission include: A.   Know your sexual partners sex history B.Avoid sharing toothbrushes and dental floss. C.Be very careful with body piercing and tattoos. D.Get an HIV antibody test every 3 to 6 months if you participate in high-risk behaviors or belong to a high risk group for HIV/AIDS. E.Use universal medical precautions when coming in contact with wounds, with body fluids and with objects/items covered or saturated with body fluids, especially blood, semen or vaginal secretions.

17. High Risk Groups for HIV/AIDS Infection A.Homosexual/bisexual men B.Heterosexual teenagers and young adults (Latin American and African American male heterosexual teenagers, and white heterosexual female teenagers are considered high risk groups right now in the United States for HIV infection) C.All intravenous drug users/abusers D.Prostitutes, Pornographic Movie actors and actresses E. Hemophiliacs

18. High Risk Activities for Transmission: A.Direct blood to blood contact B.Anal intercourse C.Sharing intravenous needles D.Vaginal intercourse E. Oral intercourse

19. Other Facts About HIVTransmission A.The HIV Virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sexual activity. B.Having a sexually transmitted disease such as syphilis, genital herpes, chlamydial infection, gonorrhea, orbacterial vaginosis appears to make people more susceptible to getting HIV infection during sex with infected partners. C.Only about 1% of all cases of HIV infection in the United States have occurred from blood transfusions or perinatally (mother to baby).

20. Other Facts About HIVTransmission D.   The same behaviors that prevent exposure to HIV also mayprevent unwanted pregnancies, and exposure to organisms that cause sexually transmitted diseases. E. 4 million teenagers are infected each year with an STD.

21. What does HIV do when it enters the human body? A.   HIV attaches to T-4 Helper Cells in the Immune System B.   The virus reproduces itself many times inside the nucleus of the T-4 cell. It sort of sets up a virus factory inside the cell. C.  The T-4 cells breaks open, and the new HIV cells travel in the immune system looking for new T-4 cells to infect. D.  The old T-4 cell is damaged and is destroyed. E.   As this process repeats itself over and over in the infected persons immune system, they eventuallystart to have a decrease in the number of T-4 cells in their immune system. This gradually weakens the person’s immune system. F.   When the infected persons immune system begins to fail, they are diagnosed with AIDS.

22. The AIDS Diagnosis A.   A normal healthy persons T-4 cell count is 1000 cells/ml of blood. B.   To be diagnosed with AIDS a persons T-4 cell count must be at or below 200/ml of blood. C.  Also in order to be diagnosed with AIDS, the person must have been diagnosed with at least one of the 26 opportunistic infections that are common in AIDS patients with compromised immune system function. (there will be more about opportunistic infections later)

23. The Medical Stages ofHIV/AIDS A.   Exposure to HIV. They are infectious at this stage. This stage may last 6 weeks to 6 months or longer. HIV will not show up on HIV blood tests. B.   The virus is detectable in the body by antibodytesting. This Occurs usually 6 weeks to 6 months after exposure. They are infectious at this stage. Their T-4 cell count is normal. Some people have stayed in this stage 12 years or longer. C.  The immune system weakens. The T-4 cell count begins to Decrease. The person has chronic swollen glands, increased illness, and they are chronically tired. They may have some unexplained weight loss. They are infectious. This stage may last from several months to 2 or 3 years.

24. The Medical Stages ofHIV/AIDS D. AIDS is diagnosed. The T-4 cell count goes below 200/ml of Blood. The immune system is damaged and opportunistic infections begin to occur. It is very hard to resist diseases. They are still infectious. This stage may last months to 1 or 2 years. E. Very sick. The immune system begins to shut down. There F. Are multiple infections, the person is probably hospitalized, in a nursing home or in hospice care, they have massive weight loss and exhaustion. They are still infectious. This stage usually only lasts a few months. G. Total immune system failure, leading to death.

25. The OpportunisticInfections ** This is an infection caused by organisms and disorders that do not infect people with healthy immune systems. There are 26 identified opportunistic infections that people with AIDS may have. These infections include: A.   Pneumocystic Carinii Pneumonia (PCP) B.   Candida (Thrush) C.  Cytomegalovirus (CMV) D.  Herpes Simplex E.   Herpes Zoster (Shingles) F.   Cryptococcal Meningitis G.  Toxoplasmosis H. AIDS Dementia Brain Disorder

26. The OpportunisticInfections I.      Mycobacterium Avium Complex (MAI or MAC) J.    Mycobacterium Tuberculosis K.  Kaposi’s Sarcoma (KS) L.   Rare Lymphomas M.Severe Diarrhea N.  AIDS Wasting Syndrome O.  Cryptosporidiosis P.    Severe Out of Control Rashes (Seborrheic Dermatitis, Psoriasis, Fungal Infections) Q.  Severe Vulvovaginal Candidiasis R.   Severe Human Papilloma Virus (HPV) Genital Warts Severe Pelvic Inflammatory Disease (PID)

27. The Symptoms of AIDS A.   Unexplained, persistent fatigue B.   Unexplained fever, shaking, chills, or night sweats lasting more than a few weeks. C.  Unexplained weight loss greater than 10 pounds. D.  Swollen lymph glands in the neck, arm pit or groin which are otherwise unexplainable and/or which last more than 2 months. E.  Pink or purple flat raised blotches or bumps occurring on or under the skin, inside the mouth, nose, eyelids, or rectum. They initially resemble bruises, but they do not disappear, and they are usually harder than the skin around them. F.   Persistent weight spots or unusual blemishes in the mouth. G.  Persistent diarrhea. H.  Persistent dry cough with has lasted too long to be caused by a normal respiratory infection, especially if accompanied by a shortness of breath. I.   Appearance of any of the opportunistic infections. J. A T-4 cell count at or below 200/ml of blood.

28. The Symptoms of HIV During the incubation period for HIV (6 months to 10 or more years) there are usually no symptoms at all. The person is totally asymptomatic. They look, act, and feel just like everyone else. However, during this period the person is infectious and can infect other people. Their risky body fluids are contagious.

29. What tests are used todetect HIV? A.   HIV can be detected with 2 different types of blood tests. B. The ELISA (Enzyme Linked Immunosorbent Assay) test is done first, and is repeated if it comes back positive for HIV. C.   The Western Blot Test is then used if there are at least 2 positive ELISA test results. It is a more accurate and specific, but more expensive test. D.  Combined the two test results are about 99% accurate. E.  There is a saliva test for HIV, but it must be followed up by blood testing to assure accuracy. F. HIV often will not show up on these tests for the first 6 weeks to 6 months after exposure.

30. HIV and AIDS Treatment A.There is no cure for HIV or AIDS. B.Early diagnosis is very important. C.HIV and AIDS patients must practice very good health and hygiene habits. They must have good general health maintenance. D.There is no vaccine for HIV or AIDS yet. E.There are several drugs that are used to slow down the spread of HIV once it enters the immune systems. These include AZT (azidothymidine), Protease Inhibitors, and Reverse Transcriptase Inhibitors. Protease inhibitors decrease virus replication, decrease viral load, and increase T-Cells. AZT and DDI make it harder for HIV to enter T-cells. F. There are several drugs used to prevent and treat the opportunistic infections that occur. These include anti-viral drugs and antibiotics.

31. HIV and AIDS Treatment G.The cost for drugs for an average HIV or AIDS patient can be more than $10,000 per month. H.Most HIV and AIDS patients are encouraged to get help from counselors and support groups. I.People with HIV and AIDS must get regular medical check ups and care. J. They must have regular lab tests, including T-4 cell counts, P24 antigen and antibody tests (P24 is produced by HIV), and Beta-2 Micro globulin Tests (they show cellular death).

32. The “Safe Sex” Message A.There is no such thing as “safe sex”, only safer sex. B.Condoms are not 100% effective, and can break, leak, and slip off. C. In actual use by teenagers, condoms may only be 40 to 60%effective. D.You are gambling with your life if you think that condoms will totally 100% protect you. However, if you are not going to practice abstinence no matter what, then you should use a condom every time you have any type of sexual contact.

33. Some Truths About HIV andAIDS A.Chlorine bleach can kill HIV outside the body. B.HIV does not last very long outside the human body. C.Nothing can kill HIV inside the human body. D.Nonoxynol 9 spermicide will damage cell-free HIV outside of the immune system. E.HIV has never been transmitted by saliva, sweat or tears. F.Very few health care workers have been infected with HIV from patients. Most that do get stuck with needles orscalpels thathave infected blood on them. G. It is 100% safe to donate blood.

34. Some Truths About HIV andAIDS H.Most blood transfusions are safe. The blood supply at hospitals and at the American Red Cross has been tested for HIV several times before it is used. I.Only one case of HIV has been transmitted in sports, at a soccer game in South America after a severe head to head collision between two players. J.It is against State and Federal law to discriminate against someone because of their HIV or AIDS status in education, housing, employment, insurance, or medical care. K. The basic facts and science about HIV and AIDS has not changed since it was identified in 1981.

35. Some Terminology to RememberAbout HIV/AIDS A.Heterosexual – male and female relationship B.Homosexual – same sex relationship (gay or lesbian) C.Bisexual – relationships with both sexes D.Antibodies – substances in the blood produced by the immune system. They destroy germs and organisms that enter the body. E.Blood Transfusion – the injection of blood into another person. F. Immune System – a body system that fights germs that enter the body.

36. Terminology G.   Incubation Period – the time period between when a person first becomes infected with a germ and the appearance of disease symptoms. H. Monogamous – a relationship in which the two people have sex only with each other. They have no other partners. I.    Transmission – passing from one person to another person. J.   Virus – a microscopic organism that produces disease. There are no cures for viruses. K. PWA – People With AIDS or Person With AIDS

37. Terminology L.  HIV Positive – this means that the person has tested positive for HIV in their blood stream and immune system. They are able to transmit the virus to other people, they are asymptomatic, and they will eventually develop AIDS and die. M. Asymptomatic – without signs or symptoms. N. T 4 Lymphotrophic Cell – one of the helper cells in the immune system that helps the body fight off diseases and infections. O. Donating Blood – having some of your blood taken out of you. You can not get HIV or AIDS from donating blood.

38. HIV/AIDS Problems A.Many HIV and AIDS patients can not afford good health careor the medications. B.Many HIV and AIDS patients are poor and have no health insurance. C.Many HIV and AIDS patients are in poor health, practice poor health habits (drugs, alcoholism, tobacco use, poor nutrition, poor fitness, poor living conditions, poor hygiene) D.There is no cure or vaccine for HIV or AIDS. E. Tests for HIV are not 100% accurate. There are false positives and false negatives.

39. HIV/AIDS Problems F.Some people who are HIV positive or who have AIDS become depressed, mentally ill, and suicidal. G.Some schools, churches, organizations, businesses, employers, and communities still discriminate against people with HIV and AIDS, even though it is illegal. H.Many schools still do not teach about abstinence, HIV/AIDS or STD’s I. Many adults (including many teachers and health care workers) still do not know the basic facts about HIV and AIDS.

40. HIV/AIDS Problems J.Many people feel that the government does not spend enough money on AIDS research; others feel that we spend too much on such a preventable disease. K.Some people believe that people with AIDS deserve their disease and that they deserve to die. L.Many PWA’s still lose their jobs because of employers and/or customers fears. M. It is nearly impossible for PWA’s to get and/or keep health and life insurance.

41. HIV/AIDS Problems N.Many doctors and dentists refuse to treat PWA’s. This is actually against the Hippocratic Oath the doctors are supposed to follow. O.Drug and alcohol abuse, sharing needles, frequent sex, and high risk/unprotected sex all contribute to the spread of HIV and AIDS among teens and college age people. P.Millions of people are infected and do not know it, and their sexual partners do not know it either. Q. Some PWA’s lose child custody, have trouble finding places to live, and are rejected by their partners, familiesand friends.

42. The History of HIV/AIDS A. AIDS was first conclusively identified in the United States in 1981, when 189 cases were reported to the CDC. B. Gay men and IV drug users were dying in the New York City and San Francisco areas from rare cancers and a rare type of pneumonia. The doctors did research and identified the syndrome. C. It was originally called GRID (Gay Related Immune Disorder). D. In 1982 the CDC renamed it AIDS and declared it an epidemic.

43. The History of HIV/AIDS E. In 1984, HIV was identified in Paris, France at the Pasteur Clinic, and in Atlanta at the CDC. F. Earlier possible cases may have existed: 1979 A nurse in Africa died of what appears to be AIDS. She was exposed to blood from patients with unusual infections and immune system problems. 1952 Some men who died of pneumocystis pneumonia and kaposis sarcoma in England may have had AIDS. Scientists have found cells that are similar to HIV in the men’s preserved tissues.

44. The History of HIV/AIDS G. In March of 1985 the American Red Cross began testing the blood supply for HIV. They probably should have started doing this earlier. H. Patient Zero: A homosexual male flight attendant named Gaton De`Gas probably helped to spread HIV from Europe to the United States. He was infected with HIV, and had hundreds of male and female sexual partners in the late 70’s and early 80’s in New York and California. He has died of AIDS.

45. The History of HIV/AIDS So Where Did AIDS Come From? A. The monkeys gave it to us: very unlikely. HIV is not transmitted by bites. Monkeys also get SIV, not HIV. B. A Plague From God: unlikely, ask your minister/pastor/priest/rabbi about this possibility. C. Germ Warfare: unlikely, too many people from too many different demographic groups are infected world wide. if appropriate

46. The History of HIV/AIDS D. The virus has always been here: This is probably true. Most experts believe that HIV had been present in Africa, Europe and the United States for decades or longer before the earliest cases of AIDS appeared. 3 things happened: 1. The virus mutated and became more infectious. 2. Sexual promiscuity (homosexual and heterosexual) along with IV drug use became more common in the 1970’s and early 1980’s. 3. Doctors and the media did not know what the syndrome was when the first AIDS cases appeared and they were slow to get prevention information out to the general public.

47. The History of HIV/AIDS 1. We will never know how many people in the world may have died from AIDS before the 1980’s. 2. Why do we ask where did AIDS came from? Does it matter? Do we ask where cancer, strep throat, influenza, or mononucleosis comes from? 3. Remember, the basic facts about HIV and AIDS have not changed since 1981. 4. Myths are easy to believe, truths are tough to follow.

48. How diseases are transmitted How do infections occur? 1. Indirect Contact: objects, coughing, airborne 2. Direct Contact: contact with fluids, tissues, the infectious agent 3. Vector Transmission: bites

49. The Diseases of Concern Today: 1. Herpes Simplex 2 A virus spread by direct contact. 2. Meningitis: A virus or bacteria spread by direct, indirect and airborne contact. 3. Tuberculosis: A bacteria spread by airborne, direct and indirect contact. 4. Hepatitis A , B and C: A virus spread by direct and indirect contact. 5. HIV/AIDS: A virus spread by direct and indirect contact. 6. HPV (Human Papilloma Virus) A virus spread by direct and indirect contact. 7. Chlamydia: A bacteria spread by direct and indirect contact.

50. HIV and AIDS World Statistics Total # of people living withHIV/AIDS in the world = 40 Million Adults = 37 million Children = 2.5 million People newly infected with HIV in2003 = 5 million 14, 000 people become infected each day in the world.