HIVppt 12 05

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The HIV/AIDS Epidemic is Still With Us: 

The HIV/AIDS Epidemic is Still With Us Monica S. Ruiz, Ph.D., M.P.H Prevention Sciences Branch Division of AIDS, NIAID, NIH, DHHS

Slide2: 

How far have we come in the HIV/AIDS epidemic?

1981: 

1981 June 5th: CDC reports the first cases of a rare pneumonia occurring in a small group of previously healthy young gay men in Los Angeles July: CDC reports on the occurrence of a rare skin cancer among previously healthy young gay men in New York October: CDC declares this new disease to be an epidemic

1982: 

1982 CDC links disease to blood The Four H’s Homosexuals Heroin Users Hemophiliacs Haitians Naming the disease The Gay Cancer…GRID… AIDS

1984: 

1984 New evidence confirms heterosexual and asymptomatic transmission Gay men attacked in the media for infecting “innocent victims” DHHS Secretary announces that a vaccine will be ready for testing within 2 years

1986: 

1986 Surgeon General Koop issues report on AIDS Ricky Ray barred from school because of his HIV infection 1st panel of the AIDS Memorial quilt is created

1987: 

1987 CDC launches “America responds to AIDS” Univ. of Miami demonstrates no transmission through casual contact

1987: 

1987 The Ray Family home is torched by arsonists Delta Airlines attempts to ban PWAs from commercial flights AMA rules that doctors are obliged to treat infected individuals AIDS Memorial Quilt is displayed on the National Mall for the first time

Slide10: 

1990: Ryan White dies

Slide12: 

1991: Magic Johnson announces that he’s HIV+

1993: 

1993 In the media: September: HBO premieres “And the Band Played On” December: “Philadelphia” is released in theaters

1994: 

1994 Pedro Zamora appears in MTV’s The Real World He dies that same year.

1995: 

1995 CDC releases first OI prevention guidelines FDA approves first protease inhibitor (saquinavir) for combination with other AIDS drugs Research shows that many young MSM are becoming infected: the “second wave”

1996: 

1996 HIV is no longer the leading cause of death for all 25-44 y.o. Americans, but remains the leading cause for 25-44 y.o. African Americans The number of new AIDS cases declines for the first time since the beginning of the epidemic, but it doesn’t decline for everyone.

1997: 

1997 AIDS deaths in the U.S. decline by over 40% But… Total global AIDS death count = 6.4 million Number of HIV+ people worldwide = 22,000,000

1998: 

1998 African American leaders declare a “state of emergency” regarding AIDS in AA communities DHHS Secretary Donna Shalala states that NEP is effective and doesn’t encourage drug use Clinton Administration doesn’t lift ban on use of federal funds for NEP

1998: 

1998 WHO estimates that, AIDS will reduce the life expectancy in South Africa from 59 years in the 1990’s to 45 years after 2005 The number of AIDS cases in Russia increases by 1/3 to 360,000

1999: 

1999 July 19th: LIFE Initiative is announced Congressional Hispanic Caucus convenes a Congressional hearing regarding the impact of HIV/AIDS in the Latino community 1st National HIV Prevention Conference focuses on the leveling off of new AIDS diagnoses and AIDS-related deaths, and the rise in risk behavior among MSM

1999: 

1999 Health officials note spread of drug-resistant HIV Thai study finds that short course nevirapine significantly reduces MTCT AIDS incidence increases in SE Asia, E. Europe, India, Russia

2000: 

2000 In 7 African countries, an estimated 20% of the population is infected with HIV.

2000: 

2000 13th International AIDS Conference is held in Durban, South Africa Heightens awareness of the global pandemic “Durban Declaration” South African President Thabo Mbeki states his skepticism that AIDS is caused by HIV

2001: 

2001 During 2001, there were 3 million AIDS deaths, 2.3 million of which were in sub-Saharan Africa In Botswana, Malawi, Mozambique, and Swaziland, AIDS has lowered the life expectancy to less than 40 years of age China stops denying their AIDS epidemic

Slide28: 

So where are we now? Is the AIDS epidemic over in the US? Absolutely not!

So what do we do about this?: 

So what do we do about this? Is there a Vaccine? What about treatment? Prevention is our best tool so far!

Question of the day:: 

Question of the day: If we want to keep someone from getting infected with HIV, what factors do we need to consider?

HIV Prevention Strategies: 

HIV Prevention Strategies Infected Person (transmission & disease progression) Susceptible Person (acquisition) Rx Addiction NEP/SEP Perinatal Microbicide Rx HIV Rx STD Rx OI Rx Addiction NEP/SEP Rx STD Perinatal Microbicide VCT Behavioral Risk Reduction ART VCT Behavioral Risk Reduction Vaccine Vaccine PEP/PREP

The More Important Question:: 

The More Important Question: If we want to keep adolescents from getting infected with HIV, what factors do we need to consider?

Slide44: 

It’s a lot more than just A, B, and C…

Individual factors: 

Individual factors Sense of self-worth and belonging Mental health status Self-efficacy to enact prevention Knowledge about risks and how to protect oneself Attitudes about AIDS and prevention Attitudes about sex Attitudes about drugs Perceived support for prevention Desire for autonomy Desire for acceptance

Interpersonal factors: 

Interpersonal factors Family relationships Peer relationships Relationships with other important adults Culturally or socially defined roles that influence behavior Comfort with and self-efficacy for negotiating prevention with friends and partners Comfort with saying “no”. Social acceptance

Social & environmental factors: 

Social & environmental factors Stigma Racism and discrimination Access to prevention services Access to care Homophobia Conflicting messages from society Media Poverty Social class Institutions and policies that aren’t youth-friendly

Slide48: 

How do I fit into all this? You have the power to give kids what they want most: EMPOWERMENT!

Ways to empower youth: 

Ways to empower youth “Just the facts, ma’am!” “I hear where you’re coming from.” “I’m here for you.” “I respect you for who you are.” “How can I help you to help yourself?”