November 3, 2014 NURS 330 Human Reproductive Health

1. November 3, 2014 NURS 330 Human Reproductive Health

2. Agenda for 11/3/14 • Mid-term • Review • 10/20/14 In-Class Assignment • Return and Review • Review Grades • Guest Lecture on HIV (Disly Juarez) • 11/3/14 In-Class Assignment

3. Grades

4. 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 4

5. MYTHS AND FACTS ABOUT HIV/AIDS

6. Video: Myths/Facts about HIV

7. Myth/Fact? HIV is the same as AIDS

8. HIV vsAIDS

9. AIDS Criteria (CDC) HIV positive test AND a T-Cell count of <200 or 14% (healthy T-Cell count ranges from 800-1200) OR HIV positive test AND one or more opportunistic infections (OIs)/certain cancers If the T-Cell count goes up, or the opportunistic infection goes away, does the person still have AIDS? YES

10. HIV & the Immune System HIV attacks the T cells (aka CD4 cells) weakening the immune system Over time HIV can lead to AIDS

11. Special Characteristics of HIV • Weakens and compromises the immune system • HIV replicates in large quantities • Ability to mutate (change itself) very quickly

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

13. Estimate ~ 60,050 persons living with HIV (including AIDS) in LAC Estimated Number of Persons Living with HIV and AIDS in LAC at End of 2013 13,250 1,500 3,200 9,500 3,200 16,155 50,550 Estimate ~ 61,700 living with HIV & AIDS in LAC 25,895 (1) CDC estimates 15.8% of persons with HIV are unaware of their infection. (2) Reported cases includes half of 3,500 lab reports pending investigation and half of 3,300 cases reported to us only by code likely to result in unduplicated named cases. Source: LAC Division of HIV and STD Programs, reported as of 12/31/13.

14. Impact on Los Angeles County • LA County is second only to NYC among US metropolitan areas in cumulative number of reported AIDS cases • Only 4 states (CA, TX, NY, FL) have reported more AIDS cases than LAC • 42% of all California AIDS cases are reported from LAC in 2010

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

16. HIV Spectrum of Disease Exposure No infection Asymptomatic Infection Window period* 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 • 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)

17. 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

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

19. You CANNOT get HIV from… • Breathing • Coughing • Sneezing • Kissing • Hugging • Shaking hands • Sharing food or drinks • Drinking fountains • Telephones • Toilet seats • Pools/Tubs • Mosquito bite • Giving/donating blood in US

20. HIV Transmission Infected Body Fluids HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood. 1 2 3 4 Vaginal Secretions Semen, Pre-cum Breast Milk Blood

21. HIV Transmission Unprotected Sex 1 2 3 Anal Vaginal Oral

22. HIV Transmission Exchanging Infected Blood : 1 2 3 4 Insulin, hormone, vitamin shots Injection Drug Use Piercing/ Tattooing Acu-puncture Sharing needles for any purpose

23. 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% with proper care

24. TIME FOR AN ACTIVITY  “The Spectrum of Risk”

25. Myth/Fact? Having another STD puts a person at greater risk for contracting HIV

26. STDs and HIV STDs increase the concentration of “infection fighting” CD4 cells in genital secretions, a favorite target of HIV STDs cause breaks in the skin on and surrounding the penis, vagina and anus, which provides a perfect entry way for HIV STD infection increases risk of contracting HIV (susceptibility) -

27. STDs and HIV STD infection increases risk of passing HIV to a partner (infectiousness) HIV+ individuals who are also infected with an STD have more HIV in their genital secretions HIV+ men who are also infected with an STD have much more HIV in their semen than HIV+ men without an STD + ? ? ?

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

29. 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 20-40mins

30. HIV TEST Other Test - 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 mi. - 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. Test settings Anonymous Confidential

31. 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)

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

33. What are the differences between ethical and legal aspects?

34. 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.

35. 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.

36. 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 California Anti-Discrimination Laws Fair Employment and Housing Act (FEHA) and Unruh Civil Rights Act

37. PREVENTION It is not who we are but what we do that puts us at risk for HIV infection

38. The Prevention “Toolbox” • Abstinence • Safer Sex Male Condom (Activity) Female Condom Dental Dams • Safer Needle Use Not Sharing Needles Cleaning Needles (3x3x3 Method) Needle Exchange • HarmReduction

39. PREVENTION: Abstinence Abstinence:not having sex of any kind or sharing needles. Not exchanging any bodily fluids is the only 100% sure way to avoid becoming infected with HIV. If one is not going to abstain, what other options do they have?

40. PREVENTION: The Male Condom

41. The Female Condom

42. PREVENTION: Needle use Needle Exchange van in Berkley, CA

43. PREVENTION: Standard Precautions Infection control measures that reduce the risk of transmission of blood-born germs from patients to health care workers • Wash hands thoroughly • Wear gloves • Use masks and eye protection • Wear a gown • Carefully handling and disposing of sharp instruments during and after use.

44. TREATMENT

45. 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).

46. TREATMENT What are Anti-retrovirals (ARVs) ? • Anti-retrovirals are drugs that interrupt the HIV replication process and help preserve the health of the immune system • These drugs must be taken in combinations in order to have a lasting effect. The three drug combination is commonly known as a “triple cocktail” • Using a combination of anti-retrovirals creates multiple obstacles to HIV replication. This is designed to keep the virus from replicating freely and reduce the possibility of a mutation.

47. When to start anti-HIV medications? 2 schools of thought: • 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 • Starting treatment immediately following diagnosis Because of the complexity of selecting and following a regimen, the severity of the side-effects, and the importance of compliance to prevent resistance, it is extremely important to engage patients in treatment decisions.

48. 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

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

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