HIV/AIDS AND STI/STD UPDATE

1. HIV/AIDS AND STI/STD UPDATE Calvert County Health Department Kristen Craft Adolescent Health Coordinator

2. A little history… 1978…Strange sickness among gay men AIDS deaths = 31 1981…Kaposi Sarcoma and Pneumonia; Failing immune systems AIDS deaths = 234 1982…CDC links new disease to blood; Acquired Immune Deficiency Syndrome (AIDS) is named; Opportunistic infections AIDS deaths = 853 1983…CDC warns blood banks; France finds human immunodeficiency virus (HIV) AIDS deaths = 2304 1985…FDA approves HIV antibody test; blood banks start testing blood; Ryan White/Rock Hudson; 1st International AIDS conference AIDS deaths = 5636

3. A little history… 1986…U.S. Surgeon General Koop reports on AIDS and calls for sex education and use of condoms Cumulative AIDS deaths = 26,710 with 42,355 known cases 1987…AZT approved; AIDS Memorial Quilt; Condom labels; Violence against AIDS victims; HIV+ immigrants and travelers banned AIDS deaths = 4135 1988…FDA allows non-approved treatments; CDC mails AIDS info to all homes; Women/African Americans fastest growing in epidemic AIDS deaths = 4855 1989…First World AIDS Day; cost of drugs reduced AIDS deaths = 14,544

4. A little history… 1990…Americans with Disabilities Act; Ryan White dies Cumulative AIDS deaths = 159,818 with 257,607 known cases 1991…HIV 10 million worldwide (1 million in U.S.); Restrictions on HIV+ healthcare workers; Magic Johnson AIDS deaths = 20,454 1992…Multiple drug trials accelerated; Top killer of men ages 25-44 in U.S.; Political events AIDS deaths = 23,411 1993…Female condom; Blood bank investigations/prosecutions; Arthur Ashe/Rudolf Nureyev AIDS deaths = 41,920

5. A little history… 1994…Orasure saliva test kit; leading cause of death for all Americans ages 25-44; Mother/child transmission; Elizabeth Glaser AIDS deaths = 32,330 1995…Combination drug therapies; Greg Louganis AIDS deaths = 48371 1996…United Nations HIV/AIDS program; HIV cocktails; vaccine initiative Cumulative AIDS deaths = 386,046 with 611,325 known cases Worldwide AIDS deaths = 6,400,000 with 22,000,000 HIV+ 1997…Significant drop in AIDS deaths but report shows HIV able to hide in body AIDS deaths = 21,399

6. A little history… 1998…AIDS increasing in African Americans; Supreme Court rules HIV+ protected by ADA; Vaccine testing First known AIDS death was African man 1959 First U.S. case was teen prostitute with Kaposi Sarcoma 1969 2000…UN Security Council considers AIDS global security threat 2001…AIDS drugs for developing countries through United Nations Cumulative AIDS deaths = 479,983 with 819,779 known cases 2005…Rise in HIV+ rates at college campuses; STD rates increasing again (especially HPV, herpes, syphilis, and gonorrhea) Worldwide 40.3 million living with HIV/AIDS with 4.9 million newly infected 2006…Cumulative AIDS deaths = 559,000 with 1,025,000 AIDS cases

7. Now… • CDC estimates 40,000 persons become infected with HIV each year in the U.S. • 2 people under the age of 25 get infected with HIV every hour, every day! • African Americans (12% of U.S. population) account for almost half of HIV/AIDS cases • Advances in treatment have slowed the progression of HIV infection to AIDS • Increased emphasis on testing

8. Now… • Greatest increase in HIV/AIDS in China and India • African countries still lead the world in the number of AIDS deaths • Abstinence vs. Condoms • AIDS prevention and treatment reaching billions of dollars for developing countries

9. HIV Infection and Spread • Blood • Sexual contact: semen and vaginal fluids (anal, oral, vaginal) • Sharing needles (IV drug users) • Breast milk • Found in tears, saliva, urine but NO transmission • Highest risk groups are men who have sex with men (MSM) and IV drug users (IDU) • Greatest increase in infection seen in heterosexual women

10. HIV Testing • Tests the level of HIV antibodies in your blood, saliva, or urine (not as accurate) • Develop antibodies in 3 to 6 months after exposure • 97% of those tested develop antibodies in 3 months

11. Fact or Fiction? You can get HIV from a mosquito bite. Fiction HIV is not transmitted by insects.

12. Fact or Fiction? You can get HIV by having oral sex with an infected person. Fact Any type of sexual activity (where bodily fluids are exchanged) with an infected person is a risk of HIV transmission.

13. Fact or Fiction? HIV survives well in the environment, so you can get it from toilet seats and door knobs. Fiction Scientists and medical authorities agree that HIV does not survive well in the environment - so forget about those toilet seats!

14. Fact or Fiction? You can get AIDS by hugging a person with HIV who is sweating. Fiction Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

15. Fact or Fiction? You can get HIV by kissing someone who is HIV infected. Fiction Casual contact through closed-mouth or "social" kissing is not a risk for transmission of HIV.

16. Fact or Fiction? Condoms aren't really effective in preventing HIV transmission. Fiction Studies have found that even with repeated sexual contact, 98-100% of those people who used latex condoms correctly and consistently did not become infected.

17. Fact or Fiction? There is a connection between other STDs and HIV infection. Fact Having a sexually transmitted disease (STD) can increase a person's risk of becoming infected with HIV.

18. The Unknown Can Be a Real Killer Accounting for: ~25% Unaware of Infection ~54% of New Infections ~75% Aware of Infection ~46% of New Infections New Sexual Infections Each Year: ~32,000 People Living with HIV/AIDS: 1,039,000-1,185,000

19. HIV/AIDS by Transmission Category 33 States, 2001–2004 MSM/IDU 5% Other 3% Other 1% Heterosexual 17% IDU 21% MSM 61% IDU 16% Heterosexual 76% Females (n ≈ 45,000) Males (n ≈ 112,000)

20. HIV Prevalence 1999-2002 4.5 4 3.5 3 2.5 Prevalence of HIV Antibody 2 1.5 1 0.5 0 White M White F BlackM Black F Hispanic M Hispanic F White M White F Black M Black F Hispanic M Hispanic F Age 18-39 years Age 40-49 years

21. Maryland • HIV testing is not reportable (expected to change 2008) • HIV testing now routine part of prenatal care • Now ranked 3rd among states for AIDS cases • Baltimore-Towson area ranked 2nd for AIDS cases among metropolitan areas in U.S. (DC is ranked 1st)

22. Calvert County • Currently low number of HIV/AIDS cases reported* • Growing concern regarding the increase of STD’s in Southern Maryland counties • Testing and treatment of adolescents for STD’s is on the rise • STD’s provide an open doorway to HIV/AIDS • Several cases of antibiotic resistant strain of Gonorrhea now present in the county

23. Calvert County STD Totals

25. STD’s in America • The American Social Health Association (ASHA) estimates there are nearly 19 million NEW cases of sexually transmitted diseases in the United States each year. • It is important to consider that some STD’s cannot be cured while others use antibiotics at such a rate that they are becoming drug resistant. Another key point is the lack of symptoms in many infected persons that leads to increased transmission when multiple partners are involved.

26. STD’s in America *Number of new cases each year Viral infections CANNOT be cured. The only protection against a virus is through vaccination. Currently, only two STD’s (Hepatitis B and HPV) have a vaccine available.

27. STD’s in America *Number of new cases each year Bacterial and parasitic infections CAN be treated with medication. Any damage that occurs to the body during the period of infection is permanent. Constant re-infection can occur if both (all) partners are not treated. Drug resistant forms of gonorrhea are becoming a problem.

28. Sources • Maryland AIDS Administration • Maryland Department of Health and Mental Hygiene/Division of Sexually Transmitted Diseases (MHDH) • Centers for Disease Control and Prevention (CDC) • National Center for HIV, STD, and TB Prevention