Category:

HIV/AIDS

The first evidence of the AIDS epidemic in the United States appeared in groups of individuals who shared a common exposure risk. Sexually active homosexual men were among the first to present with manifestations of HIV disease, followed by recipients of blood or blood products, then injection drug users, and ultimately children of mothers at risk. Virtually all cases of HIV transmission can be attributed to these exposure categories.

In the United States, HIV-related illness and death historically have had a tremendous impact on men who have sex with men (MSM). Even though the toll of the epidemic among injection drug users (IDUs) and heterosexuals has increased during the last decade, MSM continue to account for the largest number of people reported with AIDS each year. In 1999 alone, 15,464 AIDS cases were reported among MSM, compared with 10,138 among IDUs and 7,139 among men and women who acquired HIV heterosexually.

Past experiences in planning, implementing, and evaluating efforts to stem the U.S. epidemic have clearly shown that preventing HIV infection depends on two equally important factors–studying and implementing biomedical interventions to thwart the virus, and influencing millions of individuals in diverse populations to adopt or maintain safe behaviors. Comprehensive, sustained prevention activities offer the best hope for slowing the epidemic’s spread.

In the United States, complacency about the need for HIV prevention may be among the strongest barriers communities face as they plan to meet the next century’s prevention needs. The great success that many people, but not all, have had with new highly active therapies (HAART, also known as drug “cocktails”) and the resulting decline in the number of newly reported AIDS cases and deaths are indeed good news. The underlying reality, however, is that the HIV epidemic in our country is far from over. This is true not only for the nation, but for the continuing number of HIV-infected individuals who now must face years – perhaps a lifetime – of multiple daily medications, possible unpleasant or severe side effects, and great expense associated with the medicines needed to suppress HIV and prevent opportunistic infections.

The success of HAART may lull people into believing that preventing HIV infection is no longer important. This complacency about the need for prevention adds a new dimension of complexity for both program planners and individuals at risk.

Course Outline

  1. Human Immunodeficiency Virus (HIV)
    • 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
    • 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?
  2. Epidemiology and Natural History of HIV Infection
    • Introduction
    • HIV Transmission
      • Modes of Transmission
      • Factors Facilitating Transmission
        • Infectiousness of the Host
        • Susceptibility of the Recipient
        • Viral Properties
    • 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
    • Future Issues
      • Global Impact
      • Containing the Epidemic
      • References
    • HIV/AIDS Among U.S. Women
      • Heterosexual Contact Now Is Greatest Risk for Women
      • Prevention Needs of Women
    • HIV/AIDS Among African Americans
      • Prevention Efforts Must Focus on High-Risk Behaviors
      • Interrelated Prevention Challenges in African American Communities
    • HIV/AIDS Among Hispanics in the United States
      • Historical Trends in AIDS Cases Among U.S. Hispanics
      • Building Better Prevention Programs for Hispanics
    • HIV/AIDS Among America’s Youth
      • Improving HIV Prevention for Young People
    • Healthcare Workers with HIV/AIDS
  3. HIV Testing
    • Overview for HIV Antibody Testing
    • 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
    • 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?
  4. HIV Counseling
    • HIV Counseling and Testing-Overview
      • Historical Perspective
      • Goals of HIV Counseling, Testing, and Referral Services
      • Objectives of HIV Counseling, Testing, and Referral Services
      • Necessary Elements of HIV Counseling,Testing, and Referral Services
    • HIV Prevention Case Management
      • Staff Characteristics of the Prevention Case Manager
      • Characteristics of the Prevention Case Management Program Plan
    • HIV-Prevention Counseling
      • Notification of HIV Results and Prevention Counseling
        1. Negative HIV Test Result
        2. Positive HIV Test Result
        3. Indeterminate Test Result
      • Counseling and Repeat Testing
        1. Persons with Continued Risk – Previous HIV Test Negative
        2. Persons with Continued Risk—Previous HIV Test Positive
        3. Persons with Indeterminate Test Results
        4. Persons with No Risk—Negative Test Results
        5. Persons Who Doubt Previous Seropositive Test Results
    • Referral Process
    • Partner Notification for Preventing (HIV) Infection
      • Terms
  5. Sex and HIV Prevention
    • 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
    • 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
    • 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
    • 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
    • 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

Student Course Evaluation Form

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  • Category: HIV/AIDS
  • Evaluation of the learning experiences provided by the Internet study course completed: (Check one letter: A = Excellent, B = Good, C = Fair, D = Unsatisfactory)
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Learning Objectives

  1. Describe how HIV is transmitted and dispel some of the common misconceptions about how one cannot get HIV.
  2. Describe the presence and possibility of transmission of HIV in households, food- service establishments, through kissing, biting, saliva, tears, sweat and insects.
  3. Distinguish HIV-2 from HIV-1 with respect to its infectiousness, prevalence, testing and clinical treatment.
  4. Describe the natural history of HIV infection in adults and the progression of the disease to AIDS.
  5. Discuss the CDC system for classifying HIV infection and AIDS in adults and adolescents in the U.S. and identify clinical conditions under each of the three categories.
  6. Contrast the clinical HIV staging system used by the World Health Organization with the one used in the U.S. and identify the performance scale criteria that define the classical stages of the disease.
  7. Define “viral set-point” and indicate its use in predicting the rate of future progression of the illness.
  8. List various laboratory tests used as indicators of prognosis and/or stage of illness in HIV infection and weigh their advantages and disadvantages.
  9. List host factors, viral factors, acquired factors and clinical indicators that influence the rate of HIV-disease progression.
  10. Describe the measures that should be taken to control the HIV epidemic world- wide.
  11. Identify the three primary routes of HIV transmission and indicate the relative risk of infection.
  12. Discuss the three factors_infectiousness of the host, susceptibility of the recipient and the quantity and infectivity of the virus_that influence the transmission of HIV infection.
  13. Identify the HIV/AIDS prevention needs of women.
  14. Address the special challenges posed to the prevention of HIV epidemic in the African American community.
  15. Describe the epidemiology of HIV/AIDS among Hispanics in the U.S. and compare HIV exposure risks for U.S.-born Hispanics and Hispanics born in their countries.
  16. Describe the epidemiology of HIV/AIDS among America’s youth.
  17. Indicate various categories of persons for whom counseling and early diagnosis of HIV infection are recommended.
  18. List the categories of people for whom HIV-2 testing is indicated.
  19. Describe the standard screening test for antibody to HIV and contrast it with the rapid HIV testing.
  20. Discuss the various advantages and disadvantages of rapid HIV test as compared to an EIA.
  21. Understand the importance of measuring HIV-RNA blood levels (viral load.)
  22. Explain what “undetectable” level of HIV in the blood means.
  23. List 5 steps for the correct use of condoms.
  24. List 4 goals and 9 objectives of HIV counseling, testing and referral services.
  25. Describe 5 necessary elements of HIV counseling, testing and referral services.
  26. Develop and monitor standards and guidelines for HIV counseling, testing and referral program.
  27. Formulate an HIV-prevention counseling program based on the standards and guidelines established by the CDC.
  28. Design and set up a program for notification of HIV test results depending upon the results being positive, negative or indeterminate.
  29. Describe what the counselor should do with respect to repeat testing if the previous HIV-test was positive or negative or indeterminate
  30. Provide counseling to clients who doubt previous seropositive test results.
  31. Discuss the partner notification program as a means to identify and target risk reduction eduction to individuals at high risk for contracting or transmitting HIV infection.
  32. Identify and describe the two complementary notification processes used to identify partners: patient referral and provider referral.
  33. Describe the five goals of HIV prevention case management (PCM).
  34. Differentiate PCM from other HIV risk-reduction activities, such as street outreach and HIV counseling and testing.
  35. Make the connection between sexually transmitted diseases and HIV and explain how other STDs facilitate HIV transmission.
  36. Point to the new evidence of the effectiveness of STD treatment in HIV prevention.
  37. Point to statistics showing the effectiveness of condoms in preventing HIV and STDs.
  38. Discuss the study sponsored by the CDC that quantified the risk of HIV infection associated with oral transmission.
  39. Describe the prevalence of HIV among men who have sex with men and outline the measures to combat the spread of STDs and HIV in this population group.
  40. Describe the risk of HIV transmission among women who have sex with women and list 3 specific measures that should be taken to reduce their risk of contracting HIV.
  41. Discuss the injection drug use and the transmission of HIV and other blood-borne infections.
  42. Make 3 specific recommendations to drug users who continue to inject to reduce the public and individual health risks.
  43. Describe the extent of the problem in curbing the transmission of HIV and other blood-borne diseases in the intravenous drug-using (IDU) population.
  44. Enunciate the 4 basic principles underlying the comprehensive approach to working with IDUs.
  45. Outline various strategies to prevent blood-borne infections among IDUs that include substance abuse treatment, community outreach, access to sterile syringes, services in the criminal justice system, prevention through sexual transmission and counseling and testing services.
  46. Define universal precautions and list body fluids to which universal precautions apply and those to which they do not apply.
  47. Discuss precautions that a healthcare worker should take for other body fluids in special settings.
  48. Describe general guidelines for healthcare workers in the use of protective barriers.
  49. Discuss why the routine use of gloves for all phlebotomies is not necessary.
  50. Identify general guidelines in the selection and use of gloves in healthcare settings.
  51. Explain the existing recommendations for the use of antiretroviral drugs after occupa- tional and nonoccupational exposures to HIV.
  52. Articulate why antiretroviral drug therapy for sexual, drug use, or other nonoccupational exposures to HIV should not be used.
  53. Discuss the risk of infection to HBV, HCV and HIV following occupational exposures to blood and explain the treatment measures that should be taken following the exposure.
  54. Identify 12 essential elements of comprehensive programs for the prevention of HIV Infection.
  55. Discuss 7 guiding principles that form the basis of comprehensive HIV prevention programs targeted toward specific population groups, such as high-risk individuals, partners of infected individuals, HIV-infected individuals engaging in sexual and drug- related behaviors that put them at risk, youth, inmates in correctional facilities and healthcare workers.
  56. Provide comprehensive HIV prevention interventions for substance abusers.
  57. Identify the prevention measures for the transmission of perinatal HIV.
  58. Evaluate the risk healthcare workers face of getting HIV on the job.
  59. Evaluate the risk of patients in a dentist’s or doctor’s office of getting HIV.
  60. Review the effectiveness of HIV prevention programs targeted toward changing personal behaviors, sexual education, intravenous drug users, HIV-infected pregnant women, blood banks and healthcare workers.
  61. Recount the dramatic success of protease inhibitors in the treatment of patients infected with HIV.
  62. Answer specific questions of people living with HIV/AIDS, including progression to AIDS, opportunistic infections, antiretroviral drug therapy and safe sexual behavior.
  63. Counsel an HIV-infected person with the precautions he or she should take with food and water to avoid illnesses.
  64. Provide specific tips to HIV-infected individuals regarding safe drinking water, fruits, vegetables, meat, poultry and fish to remain healthy.

To assess the effectiveness of the course material, we ask that you evaluate your achievement of each learning objective on a scale of A to D (A=excellent, B=good, C=fair, D=unsatisfactory). Please indicate your responses next to each learning objective and return it to us with your completed exam.

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