HIV / AIDS :HIV / AIDS


Objectives :Objectives Describe the HIV/AIDS Epidemic Explain the basic immunology related to HIV/AIDS Explain the virology of HIV Describe the epidemiology of HIV infection Define and describe the stages of the HIV/AIDS disease


Objectives :Objectives Describe clinical care; HIV counseling, testing and partner notification Explain the different modes of HIV transmission Describe the methods for prevention and control of HIV infection


Objectives :Objectives Describe the modes to conquer fear through knowledge and education Explain personalized safer behaviors Discuss methods to maintain healthy lifestyles Describe the legal issues (Florida) as it relates to HIV/AIDS Describe policy development within the healthcare environment


The HIV/AIDS Epidemic :The HIV/AIDS Epidemic


HIV/AIDS Global Epidemiology (2007) :HIV/AIDS Global Epidemiology (2007) People infected worldwide: 33.2 million More than 25 million people have died of AIDS since 1981. Africa : 70% HIV/AIDS cases; 12 million AIDS orphans. 50% of all new HIV infections worldwide: under 25 years old In developing and transitional countries 9.7 million people are in immediate need of AIDS drugs (31% receiving drugs) New treatments have resulted in a decrease in the number of AIDS related deaths Published by UNAIDS/WHO, November 2007


: Estimated Numbers Of AIDS Diagnoses, Deaths, And Persons Living With AIDS, In The United States (2002–2006)


Slide 10:By Age Age of persons with HIV/AIDS diagnosed during 2006


The 5 States Reporting The Highest Number of AIDSState/Dependent Area # of AIDS Cases In 2006 :The 5 States Reporting The Highest Number of AIDSState/Dependent Area # of AIDS Cases In 2006 New York 5,495 Florida 4,932 California 3,960 Texas 2,998 Pennsylvania 1,893


Florida County Specifics (2007) :Florida County Specifics (2007) Greatest numbers of AIDS cases Broward, Miami-Dade, and Orange. Combined total of 1,758 cases in 2007, or 46% of the statewide total County-specific AIDS case rates per 100,000 Broward County (rate of 43.5) Miami-Dade (39.2) Duval (35.6) Orange (34.5) Counties


Florida 2007 :Florida 2007 AIDS cases among heterosexuals (26%) MSM/IDU cases accounted for 5% No identified risk (NIR) (13%) AIDS cases among blacks (54%) Women (32%)


Timeline Of The HIV/AIDS Epidemic :Timeline Of The HIV/AIDS Epidemic -1959 Earliest documented AIDS case in England (documented from preserved tissue) -1981 June, First AIDS case reported (GRID).(152) -1984 HIV identified/ “Patient Zero” dies (9,920) -1985 March: FDA approves ELISA assay. (20,470) -1986 HIV 1st used as name for AIDS virus (37,061) -1989 U.S. deaths pass 100,0000 (113,786)


Timeline Of The HIV/AIDS Epidemic :Timeline Of The HIV/AIDS Epidemic -1993 CDC expands case definition; AIDS is leading cause of death for young adults in 64 cities (399,250) -1994 ACTG 076; FDA approves AZT for prevention of vertical transmission, and Ora Sure (441,528) -1990 Ryan White Comprehensive AIDS Emergency Act authorizes Emergency relief to 16 cities (161,073)


Timeline Of The HIV/AIDS Epidemic :Timeline Of The HIV/AIDS Epidemic -1995 Jeff Getty receives controversial baboon bone marrow transplant; 1stPI approved (513,486) -1996 FDA approves 1st OTC home test kit; VL test is approved (572,833) -1997 Death due to AIDS in U.S. drop 19% (619,982)


Timeline Of The HIV/AIDS Epidemic :Timeline Of The HIV/AIDS Epidemic -1999 Single dose Virammune reduces perinatal transmission, T-20 enters clinical trial (638,718) -2000 “Durban Declaration” is signed at the International conference in Durban. Drug companies reduce price; WHO estimates 36.1 million with HIV/AIDS (714,735)


Timeline Of The HIV/AIDS Epidemic :Timeline Of The HIV/AIDS Epidemic -2003 CDC launches the Advancing HIV Prevention initiative (rapid HIV testing) -2004-2006 CDC funded a demonstration project to provide rapid HIV testing and referral to medical care, targeted to racial/ethnic minority populations and others at high risk in outreach and other community settings -2006 UNAIDS and the WHO estimate that 25 million people have died from AIDS since it was first discovered


Healthcare Personnels with HIV/AIDS As OF December 2002 :Healthcare Personnels with HIV/AIDS As OF December 2002 Adults reported with AIDS and a history of employment in healthcare 23,212 Documented occupationally acquired AIDS/HIV infection 57 Documented Cases 139 Possible Cases


Basic Immunology & Virology :Basic Immunology & Virology


VIROLOGY :VIROLOGY Characteristics of viruses: Cannot reproduce outside of a living host cell Consist of a strand of DNA or RNA surrounded by a protein coat Viruses are extremely small Viruses do not produce toxins, but rather kill their host by some pathologic mechanism such as rupture or production of giant cells


AIDS :AIDS Acquired: Passed from one person to another Immune: The body’s defense system against disease Deficiency: Lack/ shortage of or breakdown Syndrome: A combination of symptoms AIDS is a life threatening illness caused by HIV and characterized by specific illnesses &/or infections in a person with lab evidence for HIV infection (Acquired Immune Deficiency Syndrome)


: Human: Virus can only infect human beings Immuno-deficiency: Failure of the body’s immune system to work properly Virus: Incapable of reproducing by itself so it takes over the machinery of the human cell HIV(Human Immuno-Deficiency Virus)


Origin of HIV :Origin of HIV Scientists identified a type of chimpanzee in West Africa as the source of HIV infection in humans (HIV-1) The virus most likely jumped to humans when humans hunted these chimpanzees for meat and came into contact with their infected blood Over several years, the virus slowly spread across Africa and later into other parts of the world


Types of HIV :Types of HIV There are two types of HIV: HIV-1 and HIV-2. These cause clinically indistinguishable disease, although the time to disease onset is longer for HIV-2. The worldwide epidemic of HIV and AIDS is caused by HIV-1 while HIV-2 is mostly restricted to west Africa.


Structure & Life Cycle of HIV :Structure & Life Cycle of HIV Viral envelope Spikes (gp120 & gp41) Matrix: gag p17 Viral core (capsid) Enzymes Reverse transcriptase Protease & integrase Genetic material RNA (retrovirus) HIV Genes Structual: gag, pol, env Code: tat, ref, nef, vif, vpr, vpu


How HIV Reproduces? :How HIV Reproduces? HIV is a lentivirus (retrovirus) Prolonged latency periods Viral capsid enters the cell Enzyme called reverse transcriptase liberates the single-stranded (+) RNA from the attached viral proteins and copies it into a complementary DNA Reverse transcription is extremely error prone (mutation) – Drug resistance


Cells of The Immune System :Cells of The Immune System Macrophage “scout” Front line phagocyte; Warns T- cells Helper t-cell “general” Coordinates immunologic response Killer t-cell “marine” Kills infected body cells B-cell “soldier” Produces chemical weapons


Cells of The Immune System :Cells of The Immune System Antibodies “weapons” Y-shaped protein; Coats, deactivates, & kills Suppressor t-cell “politician” Slows down attack Memory cell “green beret” B & T’s that circulate for years


Immune System Response :Immune System Response B-cells multiply and produce antibodies Antibodies attack, coat & deactivate virus Virus destroyed Memory cells (CD4+, T4 lymphocytes) remain


The Immune System & HIV :The Immune System & HIV HIV enters the body and macrophages detects and warns the t-cells Helper t-cells are activated and call out the B-cells HIV attaches to t-cells, infects and destroys them


The Immune System & HIV :The Immune System & HIV B-cells produce antibodies Antibodies attack but not successful T-cells factories for viral particles Over time the immune system is destroyed It is the loss of T4 helper lymphocytes that leads to immunosuppression in the patient and the consequent fatal opportunistic infections


The 1993 AIDS Surveillance Case Definition By the U.S. CdC :The 1993 AIDS Surveillance Case Definition By the U.S. CdC A diagnosis of AIDS is made whenever a person is HIV-positive and: he or she has a CD4+ cell count below 200 cells per microliter OR His or her CD4+ cells account for fewer than 14 % of all lymphocytes OR That person has been diagnosed with one or more of the AIDS-defining illnesses


Stages of HIV/AIDS :Stages of HIV/AIDS


Window Period :Window Period Infected person gives a negative western blot HIV test or ELISA even though viral load is high and patient shows symptoms Starting point: Infection with HIV Ending point: Seroconversion (Test becomes positive) Minimum period of time: 3 weeks Maximum period of time: 3 - 6 months


Incubation Period (Latency) :Incubation Period (Latency) Starts with infection with HIV Ends with development of symptoms: 5-10 yrs Virus reaches “set point” which predicts onset of clinical disease 10 yrs 100,000 copies/ml of blood: < 10 yrs to AIDS


Continuum of Disease Process :Continuum of Disease Process Exposure to Infection Initial infection: 3 weeks – 3 months HIV (+) / AIDS (-) Asymptomatic: 5 – 10 years HIV (+) /AIDS (-) Symptomatic: 1 – 3 years HIV (+) / AIDS (+) 1-2 years


HIV / AIDSEarly Warning Signs :HIV / AIDSEarly Warning Signs Fatigue Continuous flu-like symptoms Weight loss Night sweats Diarrhea Cough Persistent fever Swollen glands Oral problems


HIV and AIDS Facts :HIV and AIDS Facts A person infected with HIV may not show symptoms for five to ten years. People who look completely healthy can still have HIV. HIV can ALWAYS be passed to others, even if they have no symptoms of AIDS. Once HIV begins to destroy the body’s immune system, the affected person progresses through different phases of AIDS until they die.


Opportunistic Infections :Opportunistic Infections Pneumocystis carinii pneumonia Cough, fever, shortness of breath Kaposi’s sarcoma (Herpes simplex type 8) Pink or purple lesions (flat or smooth) Herpes simplex Lesions in the mouth, throat, rectal & genital area Candida Infections White coated tongue


Opportunistic Infections :Opportunistic Infections Criptococcal Miningitis Severe headache, blurred vision, dizziness, confusion, nausea, vomiting, speech difficulties, memory changes, irritability, fever, seizures & difficulty walking Cytomegalovirus (CM) Shortness of breath, coughing, chest pain, diarrhea, nausea, vomiting, weight loss, confusion, headaches,blindness


Opportunistic Infections :Opportunistic Infections Toxoplasmosis (TOXO) Paralysis of half of the body, inability to speak, confusion, dizziness, headaches, fever & weakness Mycobacterium Avium-Intracellulare Fever, swollen glands, night sweat & diarrhea Tuberculosis (Tb) Fatigue, feeling ill, loss of appetite, weight loss, fever, night sweats, cough, chest pain, coughing up blood


TB/HIV Connection :TB/HIV Connection TB is seen with increasing frequency among persons infected with HIV HIV is one of the strongest risk factors for the progression of TB from infection to disease Of the diseases associated with HIV infection, TB is one of the few that is transmissible, treatable, and preventable


The HIV/STD Connection :The HIV/STD Connection STDs make HIV transmission two to five times more likely during unprotected sex STDs provide port of entry for the virus into the bloodstream Early detection and treatment of curable STDs could reduce the risk of infection with HIV


Testing Sites :Testing Sites Before the test, you will talk with a counselor who explains the testing process, answers your questions about HIV, assess your risk for HIV infection and your knowledge of HIV transmission Anonymous sites you are given an identification number so that you do not have to give your name Confidential sites Patient’s name is linked with record, but record is confidential


Types of HIV Test :Types of HIV Test HIV Antibody Test ELISA: Enzyme-linked Immuno-absorbent assay) Rapid HIV test (single-use and does not require lab) Results available in 30 minutes p24Antigen(earlier and more accurate detection than ELISA) PCR: Polymerase chain-reaction test Detects genetic material of HIV itself Viral load can be tested with RNA or DNA PCR


HIV Testing :HIV Testing Standard test looks for antibodies in a person’s blood Most people develop antibodies with 6 to 12 weeks of infection (rare: 6 months) Getting tested <3 months is not accurate Wait for at least 3 months after the last time you were at risk before taking the test, and abstain from unprotected sex or drug use Test again at 6 months if you are deemed high risk


How Accurate Are HIV Testing? :How Accurate Are HIV Testing? Any HIV positive result given by an ELISA test must be confirmed: Secondary tests include: Western Blot Assays–most accurate confirmatory Ab test Indirect Immunofluorescence Assay – Like the Western blot, but uses a microscope to detect HIV antibodies. Line Immunoassay -. Reduces chance of sample contamination and is as accurate as the Western Blot. A second ELISA – May be used to confirm a diagnosis; usually a different commercial brand; use a different method of detection to the first. When two tests are combined, the chance of getting an inaccurate result is less than 0.1%.


Home Test Kits :Home Test Kits Home sampling kits Sampling device purchased; blood sample taken at home and sent to lab for testing Low potential for mistake Reliable as conventional testing Home testing kits Not approved for sale in the United States


Baseline Evaluation* :Baseline Evaluation* Laboratory tests for initial patient visits: • HIV antibody testing • CD4 T-cell count (1000 copies/ml:genotypic resistance testing) • CBC, chemistry profile, transaminase levels, BUN and creatinine, urinalysis, RPR or VDRL, tuberculin skin test (TST) or interferon-γ release assay (IGRA) (unless a history of prior tuberculosis or positive TST or IGRA), Toxoplasma gondii IgG, Hepatitis A, B, and C serologies, and PAP smear in women • Fasting blood glucose and serum lipids: For cardiovascular disease and for baseline evaluation prior to initiation of combination antiretroviral therapy (AIII); *The Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents (Jan 29,2008)


Baseline Evaluation :Baseline Evaluation Patients living with HIV infection must often cope with multiple social, psychiatric, and medical issues. Evaluation should also include assessment of substance abuse, economic factors, social support, mental illness, co-morbidities, and other factors that are known to impair the ability to adhere to treatment and to alter outcomes. Once evaluated, these factors should be managed accordingly.


Objectives of Treatment :Objectives of Treatment In treatment naïve: long term suppression In treatment experienced: lower viral load For very experienced patients: focus on reducing viral load


Adherence & Compliance :Adherence & Compliance Adherence The extent to which a client’s behavior coincides with the prescribed health care regimen Compliance is the actual percentage that measures adherence Importance of compliance Reduces or maintains low viral load Reduces the possibility of resistance to medications


Resistance :Resistance Why it happens? Drug levels too low Viral resistance Genetic factors Initial failure rate regardless of adherence: 10% - 50 %


Anti-HIV Chemotherapy :Anti-HIV Chemotherapy Drug design is based on vital functions unique to the virus: Nucleoside/nucleotide reverse transcriptase inhibitors   Interferes with action of HIV protein (make copies of itself) Non-nucleoside reverse transcriptase inhibitors Inhibit reverse transcriptase (stops HIV replication) Protease inhibitors (PI) Inhibits protease which is involved with HIV replication Fusion or entry inhibitors FI called T-20 is used when other treatments have failed (via stomach) Entry inhibitors prevent HIV from entering cells Maraviroc blocks CCR5 co-receptors on human immune cells


Highly Active Antiretroviral Therapy (HAART) :Highly Active Antiretroviral Therapy (HAART) Combination of three or more anti-HIV drugs for effective treatment for a long time Reduces the rate at which resistance develops Beginning treatment: Two NRTIs zidovudine and lamivudine combined with the NNRTI efavirenz.


Side Effects Of HAART :Side Effects Of HAART Lipodystrophy (40-60% of patients) Hemolytic anemia Hemorrhaging Enlargement of the breasts Visceral fat Enlargement of the dorsocervical fat pad ("buffalo hump") Diabetes


On-Going ResearchAnti-HIV Drugs :On-Going ResearchAnti-HIV Drugs Target the initial attachment of HIV to the cell surface   Inhibit uptake of the virus   Agents that block interaction of gp120 with co-receptors Agents that block fusion by interacting with gp41 Inhibit uncoating of the nucleocapsid   Inhibit integrase activity Block post-translational modifications


Slide 59:Transmission Of HIV


Body Fluids :Body Fluids Infectious Blood Semen Vaginal / Cervical Secretions Breast milk Cerebrospinal Pericardial Amniotic Peritoneal Non-Infectious Sweat Saliva Urine Tears Feces Vomit


Sexual Transmission :Sexual Transmission Unprotected sex with an infected partner: (heterosexuals, bi-sexuals and homosexuals) Vaginal, oral, or anal sex Does not include casual kissing (unless open mouth sores are present )


Blood & Blood Products Transmission :Blood & Blood Products Transmission Needle sharing Occupational Exposure Blood & organ Recipients Transfusions of infected blood or blood clotting factors, but since blood screening began in the early 90’s, those risks have been greatly diminished


PerinatalTransmission :PerinatalTransmission In utero exchange Birthing Breast-feeding


Other Co-Factors :Other Co-Factors Other infections Other STDs Drug/alcohol use Nutritional status Stress Repeated HIV infections


Occupational ExposureIncreased Risk for HIV Infection :Occupational ExposureIncreased Risk for HIV Infection Exposure to a larger quantity of blood from the source person as indicated by 1) a device (e.g., a needle) visibly contaminated with the patient's blood, 2) a procedure that involved a needle being placed directly in a vein or artery, or 3) a deep injury. Exposure to blood from source persons with terminal illness, possibly reflecting either the higher titer of HIV in blood late in the course of (AIDS) or other factors (e.g., the presence of syncytia-inducing strains of HIV).


Prevention & Control Of HIV Infection :Prevention & Control Of HIV Infection


You can’t get HIV by: :You can’t get HIV by: Any type of casual contact Shaking hands, giving a hug or dry kissing* Using restrooms, water coolers or telephone Eating in a restaurant or cafeteria Swimming in a pool or using hot tubs By insects/animals By objects (door knobs, eating utensils) Donating blood 􀂃 * Kissing can spread other STD’s (sexually transmitted diseases), such as herpes.


Prevention :Prevention The A-B-C of HIV Prevention “A” is for ABSTINENCE No Sex = NO Infection “B” is for BE WITH ONE PARTNER Mutual Monogamy with One Uninfected Partner means NO Infection


A – B-C :A – B-C “C” is for Communication Wait Delay Refuse Negotiate Discuss other options such as outercourse Set boundaries Be monogamous


Safe Sex(Nobody Has A Body to Die For) :Safe Sex(Nobody Has A Body to Die For) Fantasies Erotic Literature Sex Toys Talk Masturbation Dry Kissing Flirting Cyber Sex Erotic Movies Hugging Phone Sex Massages


HIV / AIDS Prevention :HIV / AIDS Prevention 1. If you have sex, LATEX CONDOMS are the most effective protection against HIV and other sexually transmitted diseases (STD’s) . 2. Natural membranes have small microscopic holes that can let STD’s through. 3. Novelty condoms (like ones that glow in the dark) should not be used. 4. Don’t use oil based lubrication because it will cause the condom to tear.


HIV/AIDSPrevention For Women :HIV/AIDSPrevention For Women Female condom Is the only female-initiated HIV prevention method presently available (used correctly and consistently Requires some degree of male cooperation Post-exposure prophylaxis Rape victims if started within 72 hours Microbicide (On-going trials but none that actually works) - a gel or cream that could be applied vaginally without a partner even knowing and which would prevent HIV infection


Clean Your “Works” :Clean Your “Works” 3X Water 3X Bleach 3X Water Hold for 30 seconds and Tap


Universal Precautions :Universal Precautions Wash Before and after patient contact Glove Before touching body substances Gown Or waterproof apron if soiling of clothing is likely Mask And goggles for aerosolization or splashing


Universal Precautions :Universal Precautions Sharps Place needles in sharps container, do not recap Waste Use plastic bags for disposal Linen Use laundry bag for soiled linen Body substances Blood, drainage, feces, mucus, pus, saliva, urine Report Exposures


PPE Cuts Risks :PPE Cuts Risks Selecting PPE may include gloves, gowns, laboratory coats, face shields or masks, eye protection, pocket masks, and other protective gear Potentially infectious materials pose a hazard through the eyes, nose or mouth Goggles and masks, glasses with solid side shields, and masks or chin-length face shields Decontaminating and disposing of PPE


Handling Body Fluids :Handling Body Fluids Put on disposable gloves Paper towels to absorb spill, then dispose of Apply bleach solution or disinfectant Clean-up and dispose of towels in plastic bag Remove gloves by pulling inside-out, then in thrash Wash hands with soap and water Use COMMON SENSE


Protect Yourself When Handling Sharps :Protect Yourself When Handling Sharps Approximately 8,700 health care workers each year contract hepatitis B and about 200 will die as a result. The new OSHA standard covering bloodborne pathogens specifies measures to reduce these: Prompt Disposal Sharps Containers Handling Containers


Hand-Washing/Sanitizing :Hand-Washing/Sanitizing Wet hands and apply appropriate amount of soap Scrub at least 15 seconds with friction Rinse to squeaky clean and then pat dry with paper towels


Other Protective Practices :Other Protective Practices If an employee's skin comes into contact with blood, wash with soap and water and flush eyes with water as soon as feasible. Wash hands immediately or asap after removing protective equipment If soap and water are not immediately available, employers may provide other handwashing measures such as moist towelettes. Employees still must wash with soap and


Post-Exposure Prophylaxis (PEP) :Post-Exposure Prophylaxis (PEP) PEP is a type of antiviral therapy for HIV that is designed to reduce (not to eliminate) the possibility of infection with the virus after known exposure For effective treatment within an hour of exposure and no later than 72 hrs Basic Regimen: 4 weeks of both AZT and 3TC Expanded Regimen The Basic Regimen plus either indinavir or nelfinavir


Attitude & Behavior Change :Attitude & Behavior Change


Reasons To Get Tested :Reasons To Get Tested Getting a negative result test put your mind at rest If test is positive, many things can be done to help you cope Doctor can keep an eye on your health (many people stay healthy for several years) Anti-retrovirals can help slow down the disease process Protect other people by practicing safe sex Knowing that you have HIV may affect some of your future decisions and plans, for example starting a family.


Why AIDS Education? :Why AIDS Education? To prevent new infections from taking place To improve quality of life for HIV positive people need to be able to access medical services and drug provision need to be able to find appropriate emotional and practical support and help. To reduce stigma and discrimination a great deal of fear and stigmatization of people who are HIV positive Discrimination against positive people can help the AIDS epidemic to spread


Who Needs To Be Educated? :Who Needs To Be Educated? People who have not yet been educated and may be at risk of becoming infected young people, who need to know the risks involved in unsafe sex and drug use before they are old enough to find out for themselves. People who have already been educated for whom the education was not effective People who are already infected need to know: How to live positively without passing the virus on to anyone else How to avoid coming into contact with a strain of the virus that differs from the one they are already have.


Barriers To Safer Behaviors :Barriers To Safer Behaviors Invincibility Magical Timing Peer Pressure Experimentation Societal Reinforcement Drugs / Alcohol


Legal & Ethical IssuesFlorida :Legal & Ethical IssuesFlorida


Minors :Minors Minors in Florida (children under 18 yrs) are adults for the purpose of consenting to an HIV test. Indeed, Florida specifically forbids telling parents of the fact of the minor’s HIV test or its results either directly, or indirectly, for instance by billing a parent without the child’s permission


Informed Consent :Informed Consent The patient’s right to receive all information relative to his or her condition and then to make a decision regarding treatment based upon that knowledge Informed consent does not necessarily mean a written consent The health care provider needs only to enter a note in the medical record that the test was explained and consent was obtained


Exceptions To Informed Consent :Exceptions To Informed Consent A provider may test without consenting a “bona fide” medical emergency The act allows a “therapeutic privilege” to bypass informed consent requirement State laws permit HIV testing on certain subjects such as convicted prostitutes and cadavers


Exceptions To Informed Consent :Exceptions To Informed Consent Victims of sexual offenses may require the person charged with or convicted of the offense to be tested for HIV without consent form By court order


Court Order :Court Order The omnibus AIDS act prohibits releasing in response to a subpoena a medical record with an HIV test result in it A court order (a document signed by a judge after a hearing ) is required


Written Informed Consent :Written Informed Consent No provision permits testing blood for evidence of HIV infection in a general setting on a routine basis without informed consent Includes a fair explanation of the test, including its purpose, potential uses, and limitations, and the meaning of its results and the right to confidential treatment of information. Use of a form approved by the office shall raise a conclusive presumption of informed consent.


Notification of Positive HIV Testing :Notification of Positive HIV Testing By a physician designated by applicant or, DOH and includes: Face-to-face posttest counseling on the meaning of the test results; the possible need for additional testing; and the need to eliminate behavior which might spread the disease to others; Availability of appropriate health care services, (mental health care, social and support services) The benefits of locating and counseling any sexual partners that may have caused or have been exposed to the virus Locating and counseling any individual who had sexual contact with patient


Confidentiality :Confidentiality Section 384.29 & 381.004(3), F.S. Covers medical file and contact investigation of HIV and STD information in record Section 384.34, F.S. Penalties First Degree Misdemeanor Breaches of confidentiality (s.384.29, F.S.) Third degree felony Malicious or for personal gain


Legally Effective Releases :Legally Effective Releases Specific release Where the test subject in writing specifically authorizes the release of his or her HIV test results General Release A “general release” is a document directing disclosure of an entire medical record to a third party Prior written authorization is required


Legal And Ethical IssuesFlorida :Legal And Ethical IssuesFlorida Florida Omnibus AIDS Act Passed in 1998 Federal Rehabilitation Act of 1973 American with Disabilities Act (ADA)


Florida Omnibus ActHightlights :Florida Omnibus ActHightlights Confidentiality If a person chooses to have a blood test for HIV, medical records are confidential Counseling When an HIV test is done, counseling on HIV prevention, exposure and transmission must be performed Noncompliant Carriers An HIV infected individual may not have sex or share a drug needle with a prospective partner without first informing them of their HIV status


Florida Omnibus Act :Florida Omnibus Act Reporting All individuals diagnosed with AIDS by a physician must be reported to the local county public health unit Discrimination HIV infected individuals, people diagnosed with AIDS and individuals perceived to be infected are protected from discrimination


Florida Omnibus ActHighlights :Florida Omnibus ActHighlights Blood Banks All blood, human tissues and organs that are donated must be tested for HIV and discarded if positive Informed Consent If a person chooses to have a confidential HIV test, they must give their written consent


Florida Omnibus ActHighlights :Florida Omnibus ActHighlights Education Individuals who are licensed by the Florida Department BPR and the AHCA are required by their specific boards to have AIDS education; state employees, students in schools and universities, and employees of licensed facilities Hospitals A hospital cannot require an HIV test as condition for admission Prostitutes A convicted prostitute or a person who is convicted for soliciting a prostitute may be required to undergo and HIV test


Florida Omnibus ActHighlights (continued) :Florida Omnibus ActHighlights (continued) Laboratories Only HRS-licensed labs may perform HIV test in Florida Only FDA approved tests may be used for HIV testing Insurance Insurance companies may not discriminate due to sexual orientation in underwriting policies or deciding who to test. They cannot cancel or refuse to renew a policy due to HIV/AIDS differently than what is common practice for other health conditions


Disease Reporting :Disease Reporting Section 384.25(1), Florida Statutes provides additional information regarding the reporting of sexually transmitted diseases, including HIV/AIDS. Section 392.53(1, 2), Florida Statutes Health department staff interview persons diagnosed with a STD in order to obtain the names of sexual partners and notify the partners of their possible exposure. Health department staff can notify someone that they have been exposed to an STD without telling them the name of the person originally diagnosed.


Disease Reporting :Disease Reporting Section 381.0031(1,2), Florida Statutes states that, “Any practitioner, licensed in Florida to practice medicine, osteopathic medicine, chiropractic, naturopathy, or veterinary medicine, who diagnoses or suspects the existence of a disease of public health significance shall immediately report the fact to the Department of Health.” Florida’s county health departments serve as the primary contact for disease reporting.


Policy Development Workplace Issues :Policy Development Workplace Issues


HIV-Infected Patients :HIV-Infected Patients A physician may not ethically refuse to treat a patient because the patient is seropositive for HIV A physician who is unable to provide the services required by an HIV-infected patient, should make appropriate referrals to those physicians, or facilities equipped to provide such service


HIV-Infected Physicians :HIV-Infected Physicians A physician who knows that he is seropositive should not engage in any activity that creates a significant risk of transmission of the disease to others


Federal Rehabilitation Act of 1973 :Federal Rehabilitation Act of 1973 The first federal law to protect “handicapped” people from discrimination. (HIV/AIDS is considered a handicap) Provides basic legal protections that are expanded by the ADA and many local laws Applies only to employers who receive federal funds


Americans With Disabilities Act of 1990 :Americans With Disabilities Act of 1990 Expands protections of the Rehabilitation Act of 1973 to almost all employers Signed by the president on July 26, 1990 Requires that employment provisions be phased in: Employers of 25 or more employees, July 26,1992 Employers of 15 or more employees, July26, 1994


Disability :Disability Means with respect to an individual: A physical or mental impairment that substantially limits one or more life activities A record of such impairment; or Regarded as having such an impairment


Requirements of Federal Disability Discrimination Laws :Requirements of Federal Disability Discrimination Laws Employers Must not discriminate on the basis of disability Must make reasonable accommodation


Reasonable Accommodation :Reasonable Accommodation Any job modification that makes it possible for an otherwise qualified individual with a known disability to perform the essential functions of a job, without imposing undue hardship on the employer


Undue Hardship :Undue Hardship Accommodations not required if it would Be unduly costly, extensive, substantial, disruptive Fundamentally alter the nature or operation of the business Factors to be considered: Nature and cost of the accommodation Overall financial resources of employer and facility Size of operation and number of employees Impact on operation of facility


What does HIPAA mean? :What does HIPAA mean? HIPAA is the acronym for the Health Information Portability & Accountability Act of 1996. The Privacy Rule established national standards to protect a person’s confidential information, and to give patients more access to their own medical records. The Security Rule provided standards for protecting confidential information, both in hard copy and electronic formats. The Transaction Code Set Rule provided national standards for transmitting electronic billing information from one provider to another.


HIPAA Violation :HIPAA Violation HIPAA Privacy Rule does not give patients the express right to sue Person must file a written complaint with the Secretary of HHS through the office for Civil Rights The US Dep. Of Health and Human Services (HHS) may impose civil penalties ranging from $100 to $25,000 per offense The U.S. Dep.of Justice may enforce criminal sanctions ranging from $50,000 to $250,000 for each offense with corresponding prison terms


OSHA Bloodborne Pathogen Standards :OSHA Bloodborne Pathogen Standards Title 29 of the Code of Federal Regulations 1910.1030, details what employers must do to protect workers whose jobs put them at a reasonable risk of coming into contact with blood and other potentially infectious materials


OSHA Standard Requires Employers to do the following: :OSHA Standard Requires Employers to do the following: Establish an exposure control plan Use engineering control Enforce work practice control Provide personal protective equipment Make Hepatitis B vaccinations available Use labels and signs to communicate hazards Provide information and training to employees Maintain employee medical and training records.


What’s New :What’s New A vote by US senators to repeal a travel ban on HIV-positive visitors or immigrants to the United States Congress boosted the President's Emergency Plan For AIDS Relief, known as PEPFAR, to $48 billion, tripling current funding New research into the earliest events occurring immediately upon infection with HIV-I shows that the virus deals a stunning blow to the immune system earlier than was previously understood. According to scientists at Duke University Medical Center, Suggests the window of opportunity for successful intervention may be only a matter of days


Bibliography :Bibliography Panlilio, A. (2004). Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. Center for Disease Control. Retrieved July 20,2008, from http: www.cdc.gov/mmwrhtml/rr5409a1.htm Basic HIV/AIDSInfo. Bureau of HIV/AIDS. Retrieved on July 20, 2008 from http://www.doh.state.fl.us/disease_ctrl/aids/Bas ic_HIV_AIDS_info.pdf Judson, K et.al.(2006). Laws & Ethics for Medical Careers(4th ed.) New York: McGraw-Hill