HIV/AIDS: Part 1, Epidemiology to Treatment Flashcards
1
Q
Describe the global summary of the AIDS epidemic:
A
- Incredibly quick spreading since the 1980’s (>1000 compared to 1 million today!)
- 35 million globally infected
- AIDS related death is 1.5 million
- Over 7000 new infections a day in 2011!
- About 97% in low and middle income countries; about 900 in children < 15 YO and 6000 adults >15 YO
- Interesting correlation between women’s status and HIV rates
- Can be found in every population on the globe, and we know it comes from Africa d/t working with and butchering animals who had a version of HIV
- Numbers are starting to stabilize d/t new drugs
2
Q
What is the UNAIDS New plan?
A
- 90-90-90 plan
- By 2020:
- 90% of people will know diagnosis
- 90% have access to treatment
- 90% are virologically suppressed
- Estimated that if plan put into place, HIV infection will be controlled by 2030 and AIDS epidemic will be over
3
Q
What are some factors influencing high Canadian figures?
A
- Public misperceptions about effects of drug therapy, so people more likely to engage in high-risk sexual behaviors
- Rate of new infections among young gay men has increased significantly
- Con’t use of injection drugs, especially cocaine
- Alberta and Manitoba heterosexual activity accounts for half of transmission!
- Saskatchewan, IDU = 70% of new infections
- BC, Ontario, Quebec and Atlantic provinces primarily driven by MSM
- Increased incidence rate in BC compared to national average
4
Q
What is the big problem in this epidemic?
A
- 34% of heterosexuals unaware of positive status!
- 20% of MSM
- 24% of IDU
5
Q
What is the sex degrees of separation?
A
- When you sleep with someone, you are sleeping with every partner they ever had, as well as their partner’s previous partners
- It is estimated that if you have slept with between 6 and 9 people you have potentially had 2.8 million “partners”
6
Q
Who is vulnerable to HIV in Canada?
A
- Men who have sex with men (18% of gay men affected in Vancouver, 14% unaware! Anal is the highest risk activity in relation to HIV transmission)
- Injection drug users
- Women
- Aboriginal women
- Youth
- People with concurrent mental health problems
7
Q
Describe injection drug users and HIV:
A
- Rate of infection has declined in this group who now account for approx - 13.7% of new infections – 12.1% in BC
- Safe needle exchange and injection sites responsible for this largely
- Prevalence rate among IDUs in the Downtown Eastside is about 14% for non-Aboriginals and 28% for Aboriginals
- Almost 100% of IDUs are infected with hepatitis C
8
Q
Describe women and HIV:
A
- Women are increasingly represented in the statistics
- Rate of infection among women has risen from 12% of the total to approx 23.3% - this represents an increase of 12.6% since 2008
- Women between the ages of 15 and 29 account for 35% of new infections in this age group and in BC women between 20 and 29 account for majority of new infections in women
- Women between the ages of 15 and 19 account for more positive tests than men
- 76.6% of infections are a result of unprotected sex
- Between 20 and 50% of women report that first sexual experience is coerced
- 24 HIV+ pregnant women had babies in 2012 – no infected infants
- Male to female transfer of virus is 2 to 2.5x as efficient as female to male with sexual contact (by physiology, women are the receptive partner)
9
Q
Describe why younger women are especially vulnerable:
A
- First sexual partners for many young women and girls are older men
- First sexual encounters may be non-consensual
- Complex social determinants
- Poverty, inequality, power imbalances, fear, violence
- Immature genital mucosa (until 19 to 20 y.o)
- Less reliable mucous production (less lubrication)
- Undiagnosed/untreated STIs and inflammatory disorders of the genital tract
10
Q
Describe Aboriginal’s and HIV:
A
- Aboriginal women are considered to be one of the highest risk groups for HIV infection, comprising 47.3% of total infections in the Aboriginal population – - Aboriginal women in BC account for 37.9% of new positives in women
- Aboriginals comprise 4.3% of the population but 8.9% of prevalent infections and 12.2% of new infections – 31.6% of new infections in Aboriginal youth (15-29)
- The infection rate in aboriginal peoples is 3.5x higher than the general population
- Rate of HIV in pregnant women in BC is 3.4/10,000; for Aboriginal women the rate is 33/10,000
- 58.1% of new positives are a result of IDU, as opposed to 13.7% for general population – 30.2% heterosexual and 11.6% MSM
11
Q
Describe youth and HIV:
A
- Comprise 19% of population but 26.8% of new positive tests
- More males are positive than females but female rate is rising rapidly
- 1/3 have sex with more than one partner – 1/3 of males and 18.2% of females report having had more than 10 partners
- 68% use condoms – males more likely to use than females – no difference in condom use whether they have one partner or multiple partners
- For males who engage in receptive anal intercourse, only 50% use condoms
- Most common route of exposure is MSM followed by heterosexual intercourse, especially for females
- 46.5% of positive tests in this population are in Aboriginal youth
12
Q
Describe HIV and mental illness:
A
- Rate of HIV infection amongst people with a mental illness and excluding a substance use disorder is 5.9 to 8.9%
- Rate of HIV infection amongst those with a concomitant substance use disorder is 16.3 to 22.9%
- Rate of infection in general population «_space;1%
- 80% of people with HIV have a mental health condition
- Risk increases when substance use present as well
13
Q
Describe older adults and HIV:
A
- Adults over the age of 50 account for 15.3% of new infections
- HCPs have a low index of suspicion for HIV infection in this population
- Viagra use is an independent predictor of HIV risk in this population
14
Q
What are the five routes of transmission?
A
1) Unprotected sexual activities
2) Blood & blood products
3) Sharing needles
4) Accidental exposure (e.g. occupational exposure)
5) Mother-to-baby (25% risk of transfer to child; drugs during pregnancy has essentially eliminated this risk though)
15
Q
What is the relative risks of sex?
A
- Receptive anal intercourse – estimated to be about 1.4% or an average of one transmission for every 71 exposures – this is the highest risk because the rectum does not naturally lubricate and it is lined with CD4 receptors
- Insertive anal intercourse – estimated to be about 0.06% or one transmission for every 1667 exposures
- Receptive vaginal intercourse – estimated to be about 0.08% or about one transmission for every 1250 exposures
- Insertive vaginal intercourse – estimated to be about 0.04% or one in every 2500 exposures
- Oral sex – no good quality studies but it is thought to be low but non-zero transmission possibility
16
Q
Describe rates of HIV transmission risk:
A
- By contaminated blood transfusion products 95 in 100
- Mother to child (without HAART) 1 in 4
- Needle sharing 1 in 50
- Occupational needle stick (from positive person 1 in 300
- Male to male receptive 1 in 200
- Male to male penetrating 1 in 1500
- Male to female vaginal 1 in 1000
- Receptive oral 1 in 10,000
17
Q
Describe stigma of HIV:
A
- Only 63% know that HIV is transmitted through sexual intercourse
- Only 31% know that sharing needles transmits HIV
- 23% believe you can spread HIV through kissing
- 87% believe that their personal risk is low
- 85% believe that health care providers are the best source of information about HIV
- 19% of Canadian would be uncomfortable working with someone with HIV
- 38% would be uncomfortable is a child with HIV attended the same school as their child
- 51% would be uncomfortable if a close friend or relative was dating someone with HIV
- 24% believe that people with HIV should not be hairstylists
- 32% believe they shouldn’t be dentists
18
Q
What are characteristics of the HIV virus?
A
- HIV is a retrovirus
- All viruses lack the necessary cellular components for reproduction which is why they hijack the nucleus of the cell they have invaded. What makes retroviruses unique is that they have the ability to convert their RNA to DNA with the aid of an enzyme - converting RNA to DNA is opposite to usual genetic sequence
- Retroviruses are very fragile, being easily inactivated by mild detergent, gentle heating, drying, or moderately high or low pH
- A fragile virus, cannot survive outside of host
