17b. HIV/AIDS 12/2 Flashcards
HIV/Aids
is a human retroviruses
Adults and children estimated to be living with HIV 2011
34.2 million
Adults and children estimated to be infected with HIV 2011
2.5 million
AIDS deaths in 2011
1.7 million
Over 7000 new HIV infections a day in 2011
About 97% are in low and middle income countries
HIV/AIDS – USA 2009
Living with HIV/AIDS = 1.2 million
Incidence = 56,000/year
MSM = 53%
Heterosexuals = 31%
IDUs = 12%
Ethnicity
African-American = 45%
African-American women vs European/Caucasian women = 15:1
Hispanic-Americans vs European-Americans = 3:1
Percent unaware and potentially transmitting = 20%
Cost per lifetime treatment = $355,000
MODES OF TRANSMISSION
Blood
Semen/genital secretions
Vertical
RISK ACTIVITIES THAT PROMOTE TRANSMISSION OF HIV (1)
Receiving blood contaminated with HIV
Being born to an HIV-infected mother
Engaging in anal intercourse with an HIV-infected partner
Engaging in vaginal intercourse with an HIV-infected partner
RISK ACTIVITIES THAT PROMOTE TRANSMISSION OF HIV (2)
Engaging in oral-genital intercourse with an HIV-infected partner
Sharing needles with an HIV-infected individual
Being exposed to HIV-infected material; e.g., health or laboratory worker
RISK GROUPS
Homosexual/bisexual Intravenous drug users Promiscuous heterosexuals Spouses of promiscuous persons Blood product and organ recipients Children of infected individuals Health/laboratory workers
RISK OF HIV TRANSMISSION (1)
Transfusion of 1 unit of blood 90-95% From mother to fetus/infant 7-39% During birth 10-20% During breastfeeding 5-15% In utero 5-10% ART at delivery 6-8% With HAART 4th-9th months <1%
RISK OF HIV TRANSMISSION (2)
Sexual intercourse* Receptive anal intercourse 1-30% Insertive anal intercourse 0.1-10% Vaginal intercourse – female 0.1-10% Vaginal intercourse – male 01-1% Oral-genital <1% *STDs multiply risk Other Accidental exposure (laboratory 0.09% or clinical worker) per exposure Injection drug use (per sharing 0.67% episode)
The major force maintaining the epidemic
The major force maintaining the epidemic is persons who do not know they are infected
Impact of the HIV/AIDS EpidemicOn the Individual
Uncertain future Contemplating painful death Stigmatization and social isolation Loss of employment Limited access to health care Loss of self-esteem
Impact of the HIV/AIDS EpidemicOn the Family
Potential infection of spouse and children
Loss of economic support of family
Ostracism and social isolation
Children become orphans
Impact of the HIV/AIDS Epidemic On Society
Loss of productive segment of society
Increased number of dependents
Breakdown of family structure
Sense of fear and distrust
Impact of the HIV/AIDS Epidemic on Developing CountriesIncreased Health Care Costs
Diversion of funds from other urgent health problems
Issues and costs of care and hospitalization
Impact of the HIV/AIDS Epidemic in Developing CountriesAlteration of the Producer:Dependent Ratio
Decreased productivity due to illness Removal of producers by death Increased number of dependents: Sick babies Increased number of orphans
Impact of the HIV/AIDS EpidemicOn the Economic and Political Well-Being of the Nation
Alteration of the producer:dependent ratio
Increased health care costs
Social impact
Political impact
Impact of the HIV/AIDS Epidemic in Developing CountriesPolitical impact
Political instability
Increased dependency on rich nations
Key Elements for Successful Intervention (1)
Mobilization of political will and commitment Good surveillance Learn and adapt from past experiences Unified national planning Multisectoral response Rapid implementation
Key Elements for Successful Intervention (2)
Focused intervention; e.g., involve marginalized and high-risk groups
Assure access to intervention tools; e.g. condoms, testing, drugs
Early education
Community involvement
Combining of interventional strategies
Key Elements for Successful Intervention (3)
Reduce barriers to intervention Address restrictive cultural norms (e.g. refusal to acknowledge sexuality) Stigmatization Promote testing (opt out) Treatment Adults Pregnant women Development of effective vaccine
Key Elements for Successful Intervention (4)
Development of an effective microbicide
Issues of testing i.e. mandatory condom use
Recognition of risk by participants
Adherence
Drug resistance for anti-HIV microbicides
Irritation of vaginal mucosa
Same microbicide for low- and high-risk women?
Efficacy of tenofovir – 43%
