v HIV and Its Transmission

How HIV Is Transmitted

HIV in the Environment

Households

Businesses and Other Settings

Kissing

Biting

Saliva, Tears, and Sweat

Insects

Effectiveness of Condoms

v Human Immunodeficiency Virus Type 2

Which countries have a high prevalence of HIV-2 infection?

What is known about HIV-2 in the United States?

Who should be tested for HIV-2?

Persons at risk for HIV-2 infection include HIV-2 testing also is indicated for

Are blood donors tested for HIV-2?

Is the clinical treatment of HIV-2 different from that of HIV-1?

What is known about HIV-2 infection in children?

How should physicians and patients decide whether to start treatment for HIV-2?

What can be done to control the spread of HIV-2?

v Introduction

v HIV Transmission

Modes of Transmission

Factors Facilitating Transmission

Infectiousness of the Host

Susceptibility of the Recipient

Viral Properties

v Natural History and HIV Disease Progression

Staging

Developing World

Untreated Natural History

Primary or Acute Infection

Established Infection

Time Course

Laboratory Indicators and Predictors

Long-Term Non-Progressors

Gender Effects

Natural History in HAART Era

Industrialized Countries

Developing Countries

v Future Issues

Global Impact

Containing the Epidemic

References

v HIV/AIDS Among U.S. Women

Heterosexual Contact Now Is Greatest Risk for Women

Prevention Needs of Women

v HIV/AIDS Among African Americans

Prevention Efforts Must Focus on High-Risk Behaviors

Interrelated Prevention Challenges in African American Communities

v HIV/AIDS Among Hispanics in the United States

Historical Trends in AIDS Cases Among U.S. Hispanics

Building Better Prevention Programs for Hispanics

v HIV/AIDS Among America’s Youth

Improving HIV Prevention for Young People

v Healthcare Workers with HIV/AIDS

v Overview for HIV Antibody Testing

v Rapid HIV Tests: Questions/Answers

General Questions

What has been the routine test for HIV antibody testing?

What is rapid HIV testing?

What is the difference between a rapid HIV test and an EIA?

What rapid HIV tests are available?

Will other rapid HIV tests be available in the future?

Who can be tested with a rapid HIV test?

Does the rapid HIV test cost more than the EIA?

Can I expect to see rapid HIV testing in most clinics and doctors’ offices soon?

Are rapid HIV tests more accurate or less accurate than EIAs?

What is predictive value?

Does a negative rapid HIV test result mean that a person has nothing to worry about?

What is a "reactive" HIV test result?

After a reactive rapid HIV test result, how long does a person have to wait for the confirmatory test result?

Questions–Technical, Counseling, and Implementation

What is the cost of a rapid HIV test?

If a confirmatory test is still needed, what is the advantage to sexually transmitted disease (STD) clinics of using rapid HIV testing?

What is the advantage to clients of using rapid HIV testing?

Will people who have progressed to the late stages of AIDS continue to test positive on the rapid HIV tests?

Can rapid HIV tests be performed on infants?

Can clinic staff batch rapid HIV tests?

How long does the rapid HIV test take after the lab receives the specimen?

What type of training will be available for HIV counselors at sites that use rapid HIV tests?

Are educational materials (e.g., handouts, videos) available for the clinics that want to use rapid HIV tests?

Would telephoning clients to provide the results of a positive confirmatory HIV test be acceptable?

What does the counselor tell a client who has a reactive rapid HIV test?

Do you start partner notification and referral services immediately upon receiving a reactive rapid HIV test result, or do you wait for the confirmatory test result?

Should a physician prescribe antiretroviral treatment for a pregnant woman on the basis of rapid HIV test results (per the PHS Guidelines)?

Are confirmatory tests necessary for a rapid HIV test result to be considered a diagnosis of HIV infection?

Resources

v Understanding Viral Load

Introduction

What is viral load and how is it measured?

When should viral load be measured?

What prompts changes in viral load?

What does an "undetectable" level mean?

Is there still a need to have CD4+ levels monitored?

v Prevention and Treatment of Sexually Transmitted Diseases as an HIV Prevention Strategy

The Parallel Epidemics of HIV Infection and Other STDs

Other STDs Facilitate HIV Transmission

New Evidence of the Effectiveness of STD Treatment in HIV Prevention

v Condoms and Their Use in Preventing HIV Infection and Other STDs

Condoms are effective in preventing HIV and other STDs

Condoms must be used consistently and correctly to provide maximum protection

Condom users have product options

Education about condom efficacy does not promote sexual activity

Prevention is cost-effective

v Primary HIV Infection Associated with Oral Transmission

What is the risk of HIV transmission from oral sex?

What are the exact ways that HIV was transmitted in this study?

How do you know if the study participants were telling the truth about their sexual history?

Was this a surprise finding?

What can be done to prevent HIV?

Bibliography

v HIV Prevention Among Men who Have Sex with Men

Continuing Risk Among Young MSM

Need to Combat Other STDs

Prevention Services Must Reach Both Uninfected and Infected

v Women Who Have Sex With Women (WSW)

What do surveillance tools tell us about transmission between women?

What do investigations of female-to-female transmission show?

What are the behaviors that place WSW at risk of HIV infection?

What can WSW do to reduce their risk of contracting HIV?

References

6. IDUs and HIV

Introduction

Are healthcare workers at risk of getting HIV on the job?

How can occupational exposures be prevented?

If An Exposure Occurs

What should I do if I am exposed to the blood of a patient?

Risk of Infection After Exposure

What is the risk of infection after an occupational exposure?

How many healthcare workers have been infected with bloodborne pathogens?

Treatment for the Exposure

Is vaccine or treatment available to prevent infections with bloodborne pathogens?

What about exposures to blood from an individual whose infection status is unknown?

What specific drugs are recommended for postexposure treatment?

How soon after exposure to a bloodborne pathogen should treatment start?

Has the FDA approved these drugs to prevent bloodborne pathogen infection following an occupational exposure?

What is known about the safety and side effects of these drugs?

Can pregnant healthcare workers take the drugs recommended for postexposure treatment?

Follow-Up After An Exposure

What follow-up should be done after an exposure

What precautions should be taken during the follow-up period?

Are patients in a dentist’s or doctor’s office at risk of getting HIV?

Local Solutions to Local Problems

Essential elements of comprehensive programs

Guiding Principles

Access to voluntary HIV counseling, testing, and partner counseling is critical

Reaching HIV-infected individuals and linking them with care and treatment services is a priority

Comprehensive efforts are needed for reducing sexual risk behaviors

Comprehensive efforts are needed for reducing drug-related behaviors

Status of Perinatal HIV Prevention: U.S. Declines Continue

Comprehensive programs for youth are essential

Improved prevention programs in correctional facilities are needed

Continued efforts are needed for reducing occupational risks of healthcare workers

Confidentiality Must Remain Paramount

Sound Public Health Policy Must Be the Goal

v A Comprehensive Approach To Preventing Blood-Borne Infections Among IDUs:

New Attitudes & Strategies

Injection Drug Users are Important in the Transmission of HIV and Other Blood-borne Diseases

The Legal, Social, and Policy Environment Limits Options for IDUs

The Solution: A Comprehensive Approach to Working with IDUs

The Principles

The Strategies

v Combating Complacency in HIV Prevention

The challenge of monitoring the HIV/AIDS epidemic

What is meant by antiretroviral therapy for exposures to HIV?

What is meant by "nonoccupational exposure"?

What does existing research say on the use of antiretroviral drugs for nonoccupational HIV exposures?

What are the safety and efficacy considerations of antiretroviral drugs used for potential nonoccupational exposures to HIV?

What are the factors related to the possible use of antiretroviral drugs for potential nonoccupational exposures to HIV?

What are the mechanisms for reinforcing behavioral risk-reduction efforts?

Are there existing recommendations for the use of antiretroviral drugs after exposures to HIV?

What is the recommendation of Centers for Disease Control?

References

v Attacking AIDS with a ‘Cocktail’ Therapy Drug Combo Sends Deaths

Plummeting

A "One-Two Punch"

Regimen has drawbacks

AIDS-related illnesses

Pregnant women and children

In the future

v Prevention of Opportunistic Infections in Persons Infected with HIV

What is tuberculosis?

How is TB spread?

How can I avoid TB?

How do I know if I might have active TB?

Does TB affect only the lungs?

Am I at greater risk of getting TB because I have HIV?

Since I have HIV, should I be tested for TB?

If I have latent TB, can drugs help prevent it from becoming active TB?

If I have active TB, can it be cured?

Can I give TB to other people?

I am taking protease inhibitors to fight HIV infection. Can I also take medicine to cure TB?

What is drug-resistant TB?

What is HIV and how did I get it?

What is the difference between HIV and AIDS?

How can I stay healthy longer?

What can I expect when I go to the doctor?

What is the treatment for HIV or AIDS?

What are some of the other diseases I could get?

How do I protect other people from my HIV?

Family Planning and Pregnancy

Is there any special advice for women with HIV?

What if I become pregnant?

Where can I find help in fighting HIV?

v Safe Food and Water: A Guide for People With HIV Infection

 Why should I be careful about food and water?

What illnesses caused by germs in food and water do people with HIV commonly get?

Do only people with HIV get these illnesses?

Are these illnesses the same in people with HIV as in other people?

If I have HIV, can I eat meat, poultry, and fish?

Can I eat eggs if I have HIV?

Can I eat raw fruits and vegetables?

How can I make my water safe?

What should I do when shopping for food?

Is it safe for me to eat in restaurants?

Should I take special measures with food and water in other countries?

v Caring for Someone with AIDS at Home

What You Need to Know About HIV and AIDS

How HIV is Spread

How HIV is Not Spread

Children with AIDS

Post-Test

Index