Volunteer Canada All rights reserved.

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1 Volunteer Canada All rights reserved. What is HIV? Human - this virus infects humans Immuno-deficiency - the effect of the virus is to create a deficiency, a failure to work properly, within the body s immune system Virus - because this organism is a virus, which means one of its characteristics is that it is incapable of reproducing by itself. It reproduces by taking over the machinery of the human cell What is AIDS? Acquired - it s a condition one acquires/gets infected with Immune - because it affects the body s immune system, the part of the body which usually works to fight off germs such as bacteria and viruses Deficiency - because it makes the immune system work improperly Syndrome - because someone with AIDS may experience a wide range of different illnesses and opportunistic infections AIDS is the advanced stage of the disease caused by a virus called HIV. What HIV does and how your body fights HIV HIV attacks the immune system chiefly by damaging the cells of the immune system (CD4 or T4/T-helper) Your body fights back by making more CD4 cells. This process starts as soon as the virus gets into your body Even when you are feeling fine, HIV is attacking CD4 cells When the number of CD4 cells goes down too much, your body can t protect itself. Then you can get sick from other germs more easily The more HIV you have in your body, the greater chance you have of getting sick 1

2 How HIV Works Epidemiological Statistics and Trends Since the beginning of the epidemic in the early 1980 s Globally As of December, 2003: People living with HIV/AIDS globally 40 million Adults 37 million Children under 15 years 2.5 million People newly infected with HIV in million Adults 4.2 million Women 2 million Children under 15 years AIDS deaths in million Adults 2.5 million Women 1.2 million Children under 15 years

3 In Canada As of December 31, 2003: 55,180 HIV cases reported; 21,226 AIDS cases Est. over 18,000 who do not know they are infected In New Brunswick As of December 31, 2003: 313 HIV cases reported; 159 AIDS cases new cases new cases new cases new cases new cases How is HIV Spread? How do you get HIV? HIV must be present Must be a means of transmission It must get into the bloodstream HIV is passed from one person to another by the exchange of infected blood, semen, vaginal fluid or breast-milk. You can get HIV from: Having vaginal or anal intercourse without a condom Having oral sex without protection during which semen, vaginal fluid or menstrual blood enters open cuts or sores in the mouth Sharing sex toys without cleaning them Sharing needles to inject any substances including steroids (invisible amounts of blood are transmitted through sharing needles, syringes, water for diluting, cotton filters, and straws or pipes) Sharing needles when piercing (ears, nose etc.) or sharing needles or inks when tattooing Sharing other sharps (razors, toothbrushes, etc.) 3

4 A mother can transmit HIV to her baby (during pregnancy, birth or breast-feeding) Some people have been infected through blood transfusions and blood products. Since 1985 all donated blood in Canada is tested for HIV How do I avoid getting HIV? Wear a latex condom on your penis or a female condom in your vagina when you have sex Use lots of water-based lubricant (don t use Vaseline or oil-based products like cooking oil or massage oil they weaken condoms) Use a latex condom for oral sex and when sharing sex toys (for oral sex on a woman you can use a barrier a dental dam or cut open an unused, unlubricated condom) Use a new needle and syringe every time you inject. If new needles and syringes are not available, then cleaning the old ones offers some protection against HIV fill and empty the syringe completely 1 time with water, 2 times with bleach and 1 time with water (for 30 seconds each time) Use sterilized equipment when tattooing and piercing. Use new, unused ink every time! Abstinence is always an option What are the risks? High Risk Anal or vaginal sex without a condom Sharing needles or syringes (works, rigs) and other mixing equipment (e.g., spoons, water) to inject drugs, steroids or other substances Sharing needles, sharps and/or inks for tattooing or piercing Sharing sex toys Low (some) risk Performing oral sex on a man or a woman without a barrier (a condom on a man and a dental dam - or an unused, unlubricated condom which is cut open on a woman) Anal or vaginal sex with a condom 4

5 Injection of a substance (or tattooing or piercing) using a used needle or syringe which has been cleaned although this is still high risk for hepatitis C Negligible (very little) Risk Performing or receiving oral sex with the use of a barrier Receiving oral sex without the use of a barrier Licking the anus (rimming) Digital-anal intercourse (fingering someone s bum) or digital-vaginal intercourse (fingering someone s vagina) Wet, open-mouth kissing (with exchange of blood) No Risk Wet, open-mouth or dry, closed-mouth kissing (with no exchange of blood) Self masturbation or being masturbated by a partner (without using semen or vaginal fluid as a lubricant) Using unshared sex toys Peeing on someone or being peed on Ejaculation (cumming) on unbroken skin Massage, touch, body rubbing Injection of a substance (or tattooing or piercing) using a new needle and syringe and unshared mixing equipment(e.g., spoons, water, inks) Myths You will not get HIV from: mosquitoes or other insects, animals swimming pools, toilet seats, water fountains gym equipment, public telephones, door knobs sharing cups, plates, knives, forks, towels sharing food sneezing or coughing kissing, hugging, body rubbing, shaking hands self masturbation, being masturbated by a partner donating blood injection of a substance using a new needle and syringe 5

6 How do I know if tattooing or piercing will be safe? In tattooing or piercing, HIV can be passed when tiny, invisible particles of blood stay on the equipment that has not been well sterilized These particles can also stay in the tattoo ink Professional piercers use jewelry made of surgical steel or niobium and they don t use stud guns Professional tattooists pour ink into new, disposable containers and use the container for you only Professional piercers and tattooists use new sterile needles every time, wear latex gloves, have information about safety in their waiting area, give instructions afterwards on how to prevent infection, are experienced and knowledgeable, and sterilize reusable equipment in an autoclave (a machine that uses very hot water to sterilize equipment 121 degrees C for 30 minutes) How do I choose a safe place to get a tattoo or piercing? Shop around and get recommendations from friends. Ask to see special containers for disposing needles, disposable ink cups for tattoo colours, the autoclave, and sterilized packages. Ask questions; if you are not satisfied, go somewhere else! Perinatal Transmission of HIV Definition: Transmission of HIV from an HIV-infected pregnant women to her newborn child Transmission can occur during gestation (in utero), during delivery (when the fetus makes contact with maternal blood, mucosa in the birth canal), and through breast milk Number of infants born to HIV infected mothers increased steadily until 1994, has remained constant New Brunswick Medical Society s Subcommittee on Perinatal Health Care recommended that physicians should routinely encourage all pregnant women to be tested for HIV with appropriate and pre- and post-test counseling and informed consent (1999) 6

7 HIV screening during pregnancy can provide the opportunity to offer antiretroviral treatment to the mother and infant Full AZT protocol (includes administering AZT to the mother during the second or third trimester, during labor and delivery, and after delivery to the infant for 6 weeks) can reduce the likelihood of transmission from mother to newborn to less than 2%. Other things to think about... Using drugs or alcohol can affect your decision making about sex If you can t get your partner to wear a condom, then putting a lot of lubricant in your vagina or in your anus (bum) is a good way to prevent small cuts or tears. This is still considered high risk! Using a female condom may make it easier for you to protect yourself and your partner if you have sex If you have any open cuts, sores or burns in your mouth, or if you have bleeding gums, then you should always use a latex condom for oral sex...use it either on the penis or cut a condom lengthwise and spread it against someone s vagina or anus Any sexual activities where there is contact between the mouth and someone s penis, vagina or anus have a high risk of getting other STIs (Sexually Transmitted Infections). Using a barrier reduces the risk of getting other STIs If you have HIV, the virus can be passed on to your baby during pregnancy, during delivery or through breast milk. Early and proper medical treatment may keep your baby from getting HIV If you have HIV, taking a combination of different anti-hiv drugs may help keep you healthier for longer How do I know if I have HIV? Many people who have HIV don t know that they have it. The only way to know is to have an HIV antibody test. HIV Antibody Tests As the body fights a virus, it creates antibodies to that virus. HIV antibody tests measure the presence of antibodies to HIV. They do not measure or detect the virus itself. 7

8 Window period The window period is the time it takes for a person who has been infected with HIV to seroconvert (test positive) for HIV antibodies. Antibodies generally appear within three months after infection with HIV, but may take up to six months in some rare cases During the window period before you test positve, you can still infect others. Why should I be tested? The encouraging side If you know you are HIV positive, you can take advantage of immune system monitoring and early treatment and intervention You can find out whether or not you can infect others Regardless of the result, testing often increases your commitment to overall good health habits If you test negative, you may feel less anxious after testing Women and their partners considering pregnancy can take advantage of treatments that potentially prevent transmission of HIV to the baby The potentially not so encouraging side If you test positive, you may show an increase in anxiety and depression When testing is not strictly anonymous, you risk job and insurance discrimination. You can prevent this by ensuring that you test at an anonymous testing site Whether or not to take the antibody test is an extremely personal decision Anonymous HIV Testing Anonymous testing means that absolutely no one has access to your test results since your name is never recorded at the test site. Free anonymous HIV testing services are available at seven Sexual Health Centres throughout New Brunswick. 8

9 In NB, at anonymous testing sites, you must call to set up an appointment/time slot in advance You choose, or are given a letter/number code that will match you to your test results Most anonymous testing sites provide pre-test/post-test counseling and risk assessment A blood sample is drawn You must return, in person, in approximately three weeks to obtain the results A positive test result is reported to the District Medical Health Officer, but no name or any form of identification is included If you are positive, a health provider will offer to help you contact anyone you may have put at risk. There are confidential ways to do this. Anonymous Testing sites in New Brunswick Moncton (506) Saint John (506) Fredericton (506) Miramichi (506) Campbellton (506) Bathurst (506) Edmundston (506) Call for Anonymous Testing Info! Confidential HIV Testing (Non-Nominal) Testing can be ordered through a private physician, some clinics, and hospitals A code/initials are placed on the test requisition -confidential testing means that you and the health care provider know your results; may be recorded in your medical file Recommended that you ask the health care provider how confidentiality and contact tracing are handled 9

10 Health care provider must report a positive test result to the District Medical Health Officer Stages of HIV Infection Primary/Acute HIV Infection Virus multiplies rapidly during this stage 2 to 4 weeks after infection, a person may experience flu-like symptoms i.e., fatigue, fever, sore throat, swollen lymph nodes, headache, loss of appetite, or skin rash - may last as long as a few weeks A person may test negative for HIV at this point, but it can still be passed on to someone else These symptoms are wide-ranging and can occur for a number of reasons (e.g., flu virus, stress). Not everyone will have these symptoms. Seroconversion 1 to 2 months after infection Refers to a person s body responding to HIV by making antibodies After a person seroconverts, a blood test for the HIV antibody will come back positive Asymptomatic (no symptoms) The infected person may feel perfectly well May experience swollen lymph nodes in two or more areas (i.e., neck, under arms) This stage may last for months or even years Symptomatic (with symptoms) Characterized by whole-body symptoms of HIV infection May include swollen lymph nodes, night sweats, fever, diarrhea, weight loss, tiredness May develop infections such as thrush, persistent vaginal yeast infections, or oral hairy leukoplakia AIDS AIDS is diagnosed when one or more specific secondary opportunistic infections and/or cancer occurs. These may affect many different parts of the body: the brain, lungs, liver, bowel, skin, eyes, etc. 10

11 Treatment HIV is called a Retrovirus. Medications called antiretrovirals or antivirals slow down the production of new viruses (T4 cells increase; amount of virus in the system decreases) Progress has been made in producing effective drugs which combat HIV directly. Combination therapies may slow down the effect of HIV on the immune system by interfering with the replication of HIV Combination therapy is often successful and can improve the health of PLWHIV, sometimes causing remission of their symptoms and reduced viral load (amount of HIV in their body), increased number of CD4 cells, and reduced likelihood of progressing to AIDS Combination therapy does not work for everyone - drug resistance can set in, making the drugs ineffective Some people living with HIV use complementary therapies(e.g. acupuncture, vitamin supplementation, massage, Reflexology, Tai Chi) to alleviate side effects, reduce stress and improve immune function Healthy living, eating right, exercise is important! Referral Resources AIDS New Brunswick or AIDS Saint John & Needle Exchange Program (506) or SIDA AIDS Moncton (506) or Healing Our Nations or Canadian AIDS Society or 11

12 Canadian AIDS Treatment Information Exchange (CATIE) or Canadian HIV/AIDS Information Center or Canadian HIV/AIDS Legal Network (514) or UNAIDS United Nations Program on HIV/AIDS 12