1. Considerations for HIV/AIDS Calvin Dishmon Prevention Specialist Carrie Rheingans AmeriCorps Intern, School of Public Health

3. Immunodeficiency – Calvin

4. Virus Life Cycle/HIV Treatments – Carrie

5. HIV Progression – Carrie

6. Critically Ill AIDS Patient – Calvin

7. Prevention – Calvin

8. Policy – Carrie

9. Case Study – Carrie Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

10. Epidemiology - Global 33 million people [30–36 million] living with HIV, 2007 Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

11. Epidemiology – United States Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

12. Epidemiology – United States

14. 52% of known transmission mode among men who have sex with men (MSM)

15. 17% among injecting drug users

16. Fastest rising rates among African-American MSM, African-American women, especially young (13-24)Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

18. 16 among MSM

19. 0 among IDU

20. 9 among “low-risk” heterosexual

21. 22 among men

22. 6 among women

23. 16 among African-American

24. 11 among Whites

25. 16 among youth (15-29)Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

27. Most cases of immunodeficiency are acquired (“secondary”) but some people are born with defects in the immune system, or primary immunodeficiency.Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

29. Flu, Rabies, Polio and Smallpox

30. A person has to contract HIV before one can be diagnosed as having AIDS

32. Several clinically recognizable features, signs, symptoms, or characteristics that occur together

33. AIDS is not transmitted between people

34. Diagnosed by a medical doctorProviding HIV related services to our community through compassionate direct care, prevention and outreach activities.

36. Opportunistic infections include:

37. Thrush

38. Tuberculosis (TB)‏

39. Cervical Cancer

40. Epstein Barr (Mono)‏Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

41. Virus Life Cycle Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

43. Inhibit various proteins or mimic genetic materialProviding HIV related services to our community through compassionate direct care, prevention and outreach activities.

44. HIV Progression Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

46. Rare in US

47. Birthing process

48. Breastfeeding

49. Rape very rare mode of transmission in US

50. Blood transfusion very rare mode of transmission in US

52. May not take their meds due to schedule

53. May only take them when they feel sickProviding HIV related services to our community through compassionate direct care, prevention and outreach activities.

55. May live for decades

57. Low knowledge about current medical trends

58. Overall health

59. May need assistance with their care

60. Low risk perceptionProviding HIV related services to our community through compassionate direct care, prevention and outreach activities.

62. Patients need monitoring for diet, medications

63. Need social supports

64. Family

65. Faith community

66. Case manager

67. What else?

68. End of life

69. Little or no immune cells left

70. Possibly fighting many opportunistic infections

71. Need social supports

72. Wills, last requests

73. What else?Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

75. Discrimination against those living with HIV

76. Compulsory HIV testing (jobs, apartments)

77. Confidentiality issues

78. Violence

79. Intersecting stigmas include:

80. Race

81. Gender

82. Socio-economic Status

83. Sexuality

84. Drug useProviding HIV related services to our community through compassionate direct care, prevention and outreach activities.

86. Blood

87. Semen (including pre-ejaculate)

88. Vaginal Secretions

89. Breast Milk

90. Cerebrospinal fluid

91. Barrier Methods

92. Condoms

93. Internal Condoms (“female”, “Reality”)

94. Dental Dams

95. Risk Reduction

96. Lubricants

97. Outercourse

98. Syringe exchange

99. Less risky behaviorProviding HIV related services to our community through compassionate direct care, prevention and outreach activities.

101. Initiated 2003, renewed 2008

102. 15 focus countries, sub-Saharan African and Caribbean

103. Treatment available to many

104. Largest bilateral agreement in world

105. US Visas/Entry

106. Difficulty of getting visas

107. US was one of 12 countries

108. Syringe Exchange Programs

109. Ban on federal funding

110. PCRS: Partner Counseling & Referral Services

111. One is not required to participate, but it is encouraged that those living with HIV notify their past partners. County can do it anonymously.

112. Disclosure Law

113. HIV infected persons are required to disclose status to future partners before sexual penetration

114. Discrimination Law

115. No one can discriminate against a person infected with HIVProviding HIV related services to our community through compassionate direct care, prevention and outreach activities.

117. What concerns does Maria have with her children?

118. Who supports Maria? How? Who else?

119. What local organizations could help her?

120. How can we tell if Maria needs medications?

121. What resources would we use to get Maria on medication if needed?

122. What other considerations?

123. Recent immigrant to Ypsilanti from Mexico (18 mo. ago)

124. Spanish-speaking only

125. Two children, Manuel (3) and Alberto (8 mo.)

126. HIV diagnosis during pregnancy with Alberto (who remains uninfected)

127. Abusive husband refuses to get tested

128. Inconsistent work – lacks documents

129. Washtenaw Health Plan

130. Good overall diet

131. Breastfeeds Alberto

132. Not on medicationsProviding HIV related services to our community through compassionate direct care, prevention and outreach activities.