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Primary Prevention of HIV

Primary Prevention of HIV. 2014 HHS Health Game JAM Leigh A. Willis, PhD, MPH Centers for Disease Control and Prevention. Estimated per-act probability of acquire HIV from an infected source. *risk is considered to be low compared to others but not 0. Issues In Primary Prevention. Safer Sex

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Primary Prevention of HIV

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  1. Primary Prevention of HIV 2014 HHS Health Game JAM Leigh A. Willis, PhD, MPH Centers for Disease Control and Prevention

  2. Estimated per-act probability of acquire HIV from an infected source *risk is considered to be low compared to others but not 0

  3. Issues In Primary Prevention • Safer Sex • Injection Drug Use • HIV Testing • Pre Exposure Prophylaxis (PrEP) • HIV Stigma

  4. Safer Sex • Abstinence is the only method that is 100% effective in preventing transmission of HIV • While there is the possibility of transmitting HIV with sexual acts there are methods available for reducing transmission • Condom Use • Male Condom • Female Condom • Barriers to using condoms (SME discussion) • Using condoms along with PrEP lowers the risk HIV transmission

  5. HIV Testing • HIV testing is important to reducing the number of HIV infections • 1in 6 (16%) of all people infected with HIV do not know they are infected • Maybe unknowingly spreading the disease to others • Reasons/barriers people don’t get tested • Perception the test will be painful • Fear of the stigma of getting an HIV test • Scared to find out they are HIV positive • Perceptions that it will take a long time to get results

  6. HIV Prevention:The Science of HIV testing and Preexposure Prophylaxis (PrEP) HHS Game Jam 2014 Dawn K. Smith, MD, MS, MPH CDC, Division of HIV/AIDS Prevention “The findings and conclusions in this presentation have not been formally disseminated by the CDC and should not be construed to represent any agency determination or policy”

  7. The Science of HIV Testing

  8. HIV infection • HIV enters the body • It causes local infection (1-3 days) • Virus replicates • Local infection spreads (3+ days) • Amount of virus in the blood increases

  9. Immune Response Antibodies • Immune cells recognize HIV as “not self” • Immune cells generate antibodies • As more virus appears, more antibodies develop

  10. Growth of Virus and Antibody

  11. Measuring Virus and Antibody Levels

  12. HIV Testing Methods • Blood tests • Fingerstick(point-of-care) • Venipuncture (laboratory) • Some rapid, some not • Antibody and/or virus • Confirm by 2nd blood test • Oral test • Point-of-care • Rapid (<20 minutes) • Antibodies only • Confirm by blood test

  13. The Science of PrEP

  14. The Science of PrEP • Daily dose of two antiretrovirals in 1 pill • Gets into mucosal cells and is activated • Prevents HIV from replicating there • Gets into lymph nodes and is activated • Prevents HIV from replicating there

  15. PrEP works if you take it(in clinical trials) Activated drug (TVF) across multiple visits †Modified intent to treat, all randomized patients *Drug detected at visit closest to HIV infection

  16. PrEP works if you take it(in community settings) iPrEx Open Label Extension Study (MSM) STD clinics (MSM)

  17. Prescribing PrEP Who is it for? What’s required? HIV-negative persons Adults with substantial, ongoing risk for getting HIV infection Men who have sex with men Heterosexuals Injection drug users Those in HIV discordant couples Attempting conception with partner of positive or unknown HIV status Clinical care HIV testing No medical contraindications Visits every 3 months HIV testing STD assessment Other safety tests (e.g., kidney function) Insurance or eligible for medication assistance program

  18. Potential Impact of PrEP New York State Plan MSM in New York City “Bending the Curve”: Identify persons with HIV and link them to health care Link and retain persons diagnosed with HIV to health care for anti-HIV therapy to maximize HIV virus suppression Provide access to PreexposureProphylaxis (PrEP) for high-risk persons to keep them HIV negative. The New York State Department of Health AIDS institute urges clinical providers and prevention programs to view PrEP as a first line intervention …

  19. The Influence of HIV Stigma

  20. Disclaimer • "The information presented in this portion of the presentation are the results of a scientific literature review and do not necessarily represent the views of the Centers for Disease Control and Prevention”

  21. What is Stigma? • Definition – type of “spoiled identity” that occurs when a person or group possesses an attribute that is viewed by others as an undesirable difference. • HIV is what is known as a “blemish of individual character” • Condition is due to some fault in of your own; due to poor character • Outcome: Social sanctions against those who possess the attribute (Goffman, 1963, Stigma : Notes on the Management of Spoiled Identity)

  22. What is Stigma? • Can affect us in two ways • External: Anticipation of negative treatment by others, usually a dominant group • Internal: Self-directed internalization of negative societal attitudes held by others Stuber, Meyer , Link B, 2008

  23. HIV Related Stigma • Definition • Socially shared attitudes, beliefs or actions that promote and perpetuate the devalue status of people living with or affected by HIV • Manifested in Two Ways • External-negative attitudes or acts of discrimination against people living with HIV and individuals or groups with whom they are associated • Internal-negative feeling, beliefs or actions experienced by people living with HIV (Herk, Capitanio, Widaman, 2002; Steward, Herek, Ramakrishna, Bharat, Chandy, Wrubel, Ekstrand, 2008

  24. How Stigma Effects Primary Prevention Efforts • ↓HIV Testing • People do not see themselves at risk they are not one of those people • People are afraid to take a test because of what other might think • ↓Condom Use • People are hesitant to use condoms due to partner perceptions • People are hesitant to discuss using condoms with partners Gerbert, Maguire, Bleecker, et al, 1991; Herek, 1990; Herek, Glunt, 1988; Steward, Herek, Ramakrishna, et al, 2008; Lee Kochman, Sikkema, 2002

  25. Questions Leigh A. Willis Lnw8@cdc.gov 404-639-8447

  26. For more information • CDC HIV website • http://www.cdc.gov/hiv/default.html • http://www.cdc.gov/hiv/prevention/programs/pwp/services.html • Subject matter expert panels on Friday night • Subject matter experts available throughout the Game Jam

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