Border Health Foundation Tucson, Arizona

1. PRESENTS Border Health FoundationTucson, Arizona Understanding HIV/AIDS Capacity Building Assistance-Migrant Project A Centers for Disease Control and Prevention (CDC) Funded Project Presented by Ernest D. Pérez Capacity Building Assistance Trainer May, 2009

2. Training Objectives At the end of this training, participants will have a better understanding of: • The basics, facts, risks, and prevention of HIV. • Knowing how to apply the facts about HIV to their own behavior. • How to gain education for personal growth and sharing with others.

3. Ground Rules • Cell phones…vibrate only please • Confidentiality • Take notes and pass this on • Participate • Have fun

4. Introduction Material on HIV and AIDS varies greatly. • There are factual information sources. • There are preventative measures. • Some information is intended to motivate specific audiences.

5. HIV/AIDS Represented • What is HIV? • What is AIDS?

6. Historic Notes • Earliest known infection was a gentleman from Belgian Congo in the 1950’s. • A sailor from Norway died of immune deficiency in 1966. • Additional deaths occasionally occurred in the 1970’s from individuals who once lived in Africa. • During 1979 to 1981, increased documented cases of a mysterious ailment was caused by “needle sharing.”

7. Historic notes, continued • The first official publication on the existence of HIV (not yet named that) MMWR in 1981. • In March 1983, CDC described the risk factors that were producing this unusual ailment. • Before named AIDS in 1982, there were various names for the strange ailment that was afflicting gay men and IDU’s. • Secretary of HHS reports in a news conference on April 23, 1984 that Robert Gallo of France successfully isolated the HIV Virus.

8. Historic notes continued • In 1985, AIDS was officially attributed to HIV infection. • Ryan White was barred from attending school in Kokomo, Indiana. He had AIDS. • Also in 1985,Gay Men’s Health Crisis was formed in New York City, thereafter activist organizations, social service agencies and support agencies were created in cities across the country.

9. Historic Notes • Cleve Jones, AIDS activist came up with an idea for remembrance and healing that originated in 1985, as a means of honoring all those who died from AIDS by creating the “AIDS Quilt.” • The “Quilt was first displayed in Oct 1987 in Washington DC. • In the years that followed, many people known to the public will confirm their HIV Status and /or die from AIDS.

10. Historic Notes • In January 2000, at the 7th Conference on Retroviruses and Opportunistic Infections, suggested that the first case of HIV-1 occurred around 1930. • In 2002, Kami, a Muppet playing a 5-year HIV-positive child orphaned by AIDS, joined the South African cast of Sesame Street.

11. Transmission In order for HIV to pass from person to person, four factors must exist: • Germ • Dose • Route • Susceptible Person

12. Transmission Unprotected sex is the primary means of transmitting the virus. Sexual contacts that transmit the virus vary: • Vaginal-Penile • Anal-Penile • Oral-Penile • Oral-Vaginal • Oral-Anal

13. HIV is not a strong virus, nor is it easily transmitted from person to person, however, when in the human system it is extremely detrimental and resilient. HIV infected cell Healthy white blood cell

14. • Our blood cells are labeled by what two colors? • What is the major function of red cells? • What is the major function of white blood cells? Some of the main cells in your immune system are: • – The macrophage: Macro = Big, Phage = Eater. The Big Eater.– The T4 Helper Cell (CD4): Captain of your immune system. • – The B Cell: Like a factory. It identifies the shape of the invader (antigen) and makes “antibodies” (like keys)

15. The T8 (CD8) or Cytotoxic or Killer Cell: Also called by the T4 Helper Cell to attack the invader and kill it directly. • What is an antigen? An antigen is a foreign invader or germ that enters our system. It can be a virus, a bacteria, fungus, protozoa, and so forth. • What is an antibody? An antibody is a response to an invading antigen. Antibodies are produced by B cells. They work like “keys,” fitting the shape of the antigen “locks.” When an antigen enters the system again, it is recognized and attacked by antibodies. • What is Human Immune–Deficiency Virus (HIV)? The virus that attacks the T4 Helper Cell. When it cripples enough T4 Helper Cells, the rest of the immune system is not called into action. Other antigens invade the body and cause disease. At this point, the infected person develops Acquired Immune Deficiency Syndrome (AIDS).

16. Germ • In the case of HIV, the germ is a virus. • This is a picture of HIV. The green particles are HIV particles, which are infecting the much larger T helper cells. HIV infects the T Helper cell because it has the protein CD4 on its surface. HIV needs to use CD4 to enter cells it infects. Once inside a T helper cell, HIV takes over the cell and replicates. In this process the infected cell often dies. New virus then seeks out new T -helper cells to infect

17. DOSE • It is not possible to say what dose is necessary to infect people • What is known is that certain bodily fluids carry higher doses of HIV than others (ex. Blood more than Tears and Saliva) • Four fluids carry a sufficient dose of HIV for transmission from person to person

18. “How is HIV contracted?” 4 body fluids that can spread HIV; • blood • semen • vaginal fluids • and breast milk. • If other body fluids contain visible blood, they can also spread the virus.

19. Susceptible person • A person can be susceptible for many reasons; • Malnutrition • Heredity • Drug and alcohol abuse • STDs Non-infected or infected person –(re-infection or infection of a new strain of HIV) Exhibits behaviors that put them at risk

20. What tests are used to detect HIV? These tests detect antibodies to HIV: • Enzyme-Linked Immunobsorbent Assays (ELISA) • Enzyme Immuno-Assay (EIA) • Western Blot (WB)

21. Testing Techniques • Oral Fluid that requires saliva from gums. • Finger stick that requires blood or blood plasma. Rapid tests are cost effective; have high specificity detection.

22. Epidemiology • There are two types of HIV virus, HIV-I and HIV-2 . Each type has sub-types. Research suggests: Type 1 HIV is linked to a simian immunodeficiency virus (SIV) found in a particular species of Chimpanzee; 90% of the world’s HIV infections are from this virus. Also known as lentivirus. Type 2 similar SIV found in sooty Mangabey monkeys of West Africa. A rare and less infectious and progresses more slowly to AIDS that HIV-1

23. Epidemiology • Most cases occur among men • Cases increase each year among women. • Communities of color are affected disproportionately. • AIDS has shifted from a “terminal illness” to a manageable condition.

24. Which act is more risky ? 1 Transfusion • Injecting drugs with dirty works • STDs • Anal Sex (Unprotected) • Hetero receptive (woman) (unprotected) • Hetero insertive (man) (unprotected) • Oral sex (unprotected) • (unsafe sex…) Play the odds, roll the dice! Factors, include STDs, lubrication (natural or un-natural) age, age of partner, partner’s viral load

25. The Different Stages of HIV Infection HIV infection can generally be broken down into four distinct stages: • Clinical stage 1 : primary infection, • Clinical stage 2: clinically asymptomatic stage, • Clinical stage 3: symptomatic HIV infection, • Clinical stage 4: progression from HIV to AIDS.

26. Stages of HIV Clinical stage l: • Asymptomatic 2. Generalized lymphadenopathy Performance scale 1: asymptomatic, normal activity Clinical Stage II: • 3. Weight loss <10% of body weight 4. Minor mucocutaneous manifestations (seborrheic dermatitis, prurigo, fungal nail infections, recurrent oral ulcerations, angular cheilitis) 5. Herpes zoster within the last five years 6. Recurrent upper respiratory tract infections (i.e. bacterial sinusitis) • And/or performance scale 2: symptomatic, normal activity

27. Clinical Stage III: 7. Weight loss >10% of body weight 8. Unexplained chronic diarrhea, >1 month 9. Unexplained prolonged fever (intermittent or constant), >1 month 10. Oral candidiasis (thrush) 11. Oral hairy leucoplakia 12. Pulmonary tuberculosis 13. Severe bacterial infections (i.e. pneumonia, pyomyositis) And/or performance scale 3: bedridden <50% of the day during last month

28. Clinical Stage IV: 14. HIV wasting syndrome [i] 15. Pneumocystic carinii pneumonia 16. Toxoplasmosis of the brain 17. Cryptosporidiosis with diarrhea >1 month 18. Cryptococcosis, extra pulmonary 19. Cytomegalovirus disease of an organ other than liver, spleen or lymph node (e.g. retinitis) 20. Herpes simplex virus infection, mucocutaneous (>1 month) or visceral 21. Progressive multifocal leucoencephalopathy 22. Any disseminated endemic mycosis 23. Candidiasis of esophagus, trachea, bronchi 24. Atypical mycobacteriosis, disseminated or pulmonary 25. Non-typhoid Salmonella septicemia 26. Extra pulmonary tuberculosis 27. Lymphoma 28. Kaposi's sarcoma 29. HIV encephalopathy [ii] And/or performance scale 4: bedridden >50% of the day during last month

29. “So what’s the difference between HIV and AIDS?” • HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immunodeficiency syndrome). • People with HIV have what is called “HIVinfection” and will eventually develop AIDS as a result. • CD4 HT cell count of 200 • Only a doctor can diagnose this

30. Viral Load • Viral load is highest in the window period and in the later (AIDS) stages • Higher viral load leads to higher likelihood of transmission

31. Window Period • The period between infection and the point at which the tests can detect the signs of infection is called the window period. If people are tested during this time with standard tests they may test negative despite a positive prescence of HIV in their bodies. • The window period is 3 months.Get tested 3 months after you were at-risk. • The window period can occur from 2 weeks to 24 weeks, so the average is 3 months. The average time is 25 days!

32. Symptomatic versus Asymptomatic Asymptomatic a period of time (up to 15+years) where are person shows no signs of infection, even to the point that they are unaware that they can transmit HIV to another partner. Symptomatic stages occur later in the HIV infection and into the AIDS stage.

33. Symptoms • Most people who become infected with HIV do not notice any immediate change in their health. • People living with HIV may feel and look completely well but their immune systems may nevertheless be damaged. • Once HIV has broken down the body's defenses, such infections can take hold and produce any of a wide range of symptoms - some of them very severe. • Such symptoms are, however, not caused directly by HIV, and they can't by themselves be interpreted as definite signs of HIV infection or AIDS.

34. Symptoms (cont.) • rapid weight loss • dry cough • recurring fever or profuse night sweats • profound and unexplained fatigue • swollen lymph glands in the armpits, groin, or neck • diarrhea that lasts for more than a week • white spots or unusual blemishes on the tongue, in the mouth, or in the throat • pneumonia • red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids • memory loss, depression, and other neurological disorders

35. Treatment Treatment drugs used today were or originally developed as cures for HIV. All failed, but when used together in combination therapy, they can combat the effects of HIV Some drugs are used to combat HIV replication, HIV cell penetration, or cell destruction/manipulation. Others are designed to boost the body’s natural immune system defenses. Combination therapy is a treatment designed for you by you and your doctor. Each treatment is experimental and unique for each patient.

36. Taking Treatment • HIV/AIDS treatment and the side affects of this treatment, the continuous medication of those side affects. • With inconsistency this virus may and often does develop a resistance to medication. • People who are already infected can be re-infected with a drug resistant strain of HIV.

37. Treatment continued • Each treatment is experimental • Each treatment is designed for the patient by the patient and his doctor • Many drugs are toxic to the body and side effects are often severe • The regiment or schedule of treatment must be adhered to strictly. With inconsistency this virus may and often does develop a resistance to medications (as seen in malarial treatments) • Viral load tests (expensive) are necessary to determine the true effect of the drugs in the patient’s system

38. Longevity of people living with HIV/AIDS (PLWA) • HIV stage (average conditions) 10+ years • AIDS lasts 4+years on average • The maximum survival time is unknown • Factors: Diet, mental and physical well being, stress

40. Protection-Prevention The ABC’s of HIV: Abstinence is preferred; Be faithful is nice, better not think twice; Condomize, if one is unable to fulfill these first two rules of behavior.

41. This is a picture of a roadside sign in Botswana. The sign is used to educate people about HIV and AIDS. The sign reads as 'Avoiding AIDS is as easy as... Abstain, Be faithful and Condomise'. This sign is a first step in publicly acknowledging the AIDS crisis in Botswana.

42. Protection - Prevention • Prevention programs take into account cultural values, social norms, ethnographic data. • Effective interventions. • What aboutcondoms?

43. Putting the Condom on • Use a new condom every time you have sex • When penis is erect (before any contact), place condom on the head of the penis • Gently squeeze the tip of the condom to remove the air (any excess air could case the condom to break) • Carefully roll the condom down the shaft of the penis all the way to the base

44. Female Condoms • While yes, this product may look like protection in the form of a gaping plastic bag, the female condom does offer some potential advantages. • Female condoms are made from polyurethane, rather than latex. It transmits heat better but does not stretch like latex. • The cost of a female condom is much higher than that of the male condom.

45. More than a million Americans living with HIV

46. Future Prospects • 40 million people worldwide are currently infected with HIV. • AIDS is the leading cause of death worldwide for people aged 15-19. • One-half of all new infections worldwide occur in people under age 25. • A estimated 40 million more people will contract HIV over the next decade. ( Frontline 2006- “The age of AIDS”)

47. END OF TRAINING THANK YOU ERNEST D. PÉREZ CAPACITY BUILDING ASSISTANCE TRAINER BORDER HEALTH FOUNDATION TUCSON, ARIZONA eperez@ambhf.org 1-877-749-3727