County of Los Angeles Department of Public Health Division of HIV and STD Programs

1. 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 1

2. Human Immunodeficiency Virus HIV HIV AIDS Immune Acquired AIDS Deficiency Syndrome

3. Special Characteristics of HIV • Weakens and compromises the immune system • HIV replicates in large quantities • Ability to mutate (change itself) very quickly • Progressively destroys body’s ability to fight infections and certain cancers

4. HIV/AIDS Defined CDC definition (AIDS): • HIV+ test, T-cell count of < 200 (healthy T-cell count ranges from 800-1200) - or – • HIV+ test, and one or more opportunistic infections (OIs) or certain cancers* “AIDS” applies to most advanced stage of HIV infection *TB, Pneumocystis pneumonia, Candidiasis, Kaposi’s sarcoma, cervical cancer

6. 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

7. HIV Transmission • Breathing • Coughing • Sneezing • Kissing (dry) • Sharing or touching gum • Drinking from water fountains • Sharing food or drinks • Causal touching • Telephones • Pools/tubs • Shaking hands • Toilet seats • Giving/donating blood People cannot get HIV from:

8. By Infected Body Fluids: 1 2 3 4 Semen, pre-cum Vaginal secretions Blood Breast milk HIV Transmission HIV is NOT transmitted by urine, feces, saliva, sweat, tears or giving/donating blood.

9. By Unprotected Sex: Oral Vaginal Anal HIV Transmission 2 1 3

10. By Exchanging Infected Blood 1 2 3 4 Injection drug use Piercing/ tattooing Insulin, hormone vitamin shots Acu-puncture HIV Transmission Sharing needles for any purpose

11. 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% through the use of anti-HIV drugs during pregnancy (AZT)

12. Spectrum of Risk Activity

13. 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 minutes • Test settings Anonymous Confidential

14. HIV Diagnosis (Testing) Antibody tests - 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 min. - 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. • 17 yrs. of older • Must confirm if reactive

15. 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)

16. 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.

17. 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.

18. 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 • Fair Employment and Housing Act (FEHA) • Unruh Civil Rights Act

19. PREVENTION

20. PREVENTION “It is not who we are but what we do that puts us at risk for HIV infection” • Harm reduction • Abstinence • Safer Sex Male Condom Female Condom Dental Dams • Needle use Not Sharing Needles Cleaning Needles (3x3x3 Method) Needle Exchange

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

22. PREVENTION BREAST FEEDING It is recommended that HIV+ women do not breastfeed Infants. POST–EXPOSURE PROPHYLAXIS (PEP) Exposure to HIV within the prior 72 hours Approve for 13 yrs of age or older For more information call 213-351-7699 PRE-EXPOSURE PROPHYLAXIS (PREP) It refers to anti-HIV medication used daily or before sexual encounters Start prior to potential exposure Prep should never be seen as the first line of defense against HIV

23. TREATMENT

24. 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).

25. Treatment as Prevention Science Magazine named 'HIV Treatment as Prevention' as the breakthrough of 2011

26. TREATMENT • What are Anti-retrovirals (ARVs) ? Drugs that interrupt HIV replication & preserve immune system. • When to start ARVs?: • There are severe symptoms of HIV infection or diagnosis of AIDS with a CD4 count of < 350 cells/mm3 • Patient has CD4 count less than 500 /mm3 • Recommended for pregnant women who otherwise do not meet criteria to halt vertical transmission • Regardless of CD4 count, treatment is recommended for all pregnant patients, and patients with HIV-associated nephropathy (a kidney disorder) or those who need treatment for hepatitis B. • Treatment is considered optional for patients with CD4 counts over 500.

27. 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

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

30. Recent Advancements • Immune based therapies • Maturation inhibitors • Multi-class Combination Products • Gene Therapy • Vaccine

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

32. QUESTIONS?

33. For More Information Contact http://publichealth.lacounty.gov/dhsp/ Disly Juarez, MPH djuarezmunoz@ph.lacounty.gov 213-351-8102

34. BREAK

35. CSULA, NURS 330- Emma Fredua, MPH, CHES • Agenda for 10/21/13 • Review 10/14/13 In-Class Assignment • Review sample articles for essay • Essay is due on Mon, 11/18/13 • Bring printed articles to class for approval on 11/4/13 • Can bring them to class earlier • 10/21/13 In-Class Assignment • Distribute Study Guide for Mid-term