RUNNING HEAD: HIV/AIDS

HIV/AIDS ANTHONY DAVIS Stony Brook University School of Health Technology and Management Public Health Concentration

Authors Note: This assignment is being submitted on April 17, 2013, for Professor Patricia Sondgeroths HAN 452 Epidemiology and Biostatistics course.

HIV/AIDS TABLE OF CONTENTS

...................................................................................................................................Page Definition of Problem........................................................................................3 (Nature of Problem, Extent of Problem, Significance of Problem) Description of Agent..............................................................................................3 Description of Condition...................................................................................................4 (Etiology, Risk Factors, Clinical Presentation, Morbidity Rates, Mortality Rates, Treatment, Methods of Prevention) Description of Host Characteristics.................................................................................5 Ethnic Group..............................................................................................5 Gender.................................................................................................................5 Age...............................................................................................................6 Global Number of People Living with HIV by Year..........................................6 Description of Environmental Attributes........................................................................7 (Geographic Areas, Socioeconomic Factors, Occupation, Education) Description of Temporal Variations.............................................................................8 (Secular, Cyclic, Seasonal, Epidemic) Additional Epidemiologic Variables........................................................................9 Summary of Current Hypotheses...................................................................................10 Gaps In Knowledge..........................................................................................10 Suggestions for Further Research..........................................................................10 Conclusion................................................................................................................11

HIV/AIDS DEFINTION OF PROBLEM It is important to first touch on the nature of the HIV/AIDS problem. According to the Center for Disease Control HIV began from a mutated version of the Simian Immunodeficiency Virus originating in West African chimpanzees. These apes were

killed and used for their meat and thus were able to spread the disease to humans. (CDC, 2012) In terms of the extent of the problem, the CDC states that every nine and a half minutes another person in America is infected with HIV. (CDC, 2010) This staggering statistic is breathtaking because it means that an average of one hundred and fifty one people per day are diagnosed with HIV. This numbers are instrumental in speaking to the significance of the epidemic because this means that greater prevention methods need to be put into place by public health officials to help decrease incidence rates. DESCRIPTION OF AGENT The next area of importance is to understand what causes both HIV and AIDS. In terms of HIV, a person will be infected with HIV due to the transmission of body fluids of an HIV infected person to a non-HIV infected person. Henceforth, HIV-infected body fluid transmission is the agent for HIV infection. In addition, if a person is exposed to the HIV virus, then HIV becomes the agent for AIDS (Acquired Immunodeficiency Syndrome). Initially when HIV enters the body, the body develops an immune response and uses the CD4+ T cells to fight off the presence of the HIV. (CDC, 2012) However, HIV is an aggressive virus and eventually mutates T-cells into additional HIV cells, i.e. HIV cell proliferation. This cell proliferation continues into the last stage of HIV where the disease is now classified as AIDS, where the body finds it difficult to fight off

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infections and different types of uncontrolled cell proliferation due to a depleted immune system. (CDC, 2012) Henceforth, this explains how HIV serves as the agent for AIDS. DESCRIPTION OF CONDITION The first area to focus on is the etiology of the disease. As mentioned earlier, HIV is caused most frequently by unprotected sex with an infected person. However, it can also be spread from sharing dirty needles, contact with an infected persons blood, or from infected mother to child during pregnancy. (Medline Plus, 2013) To touch on the signs and symptoms present when HIV is in the body system, it is imperative to check for signs of swollen glands and flu-like symptoms, however symptoms may be non-existent and the virus may lie dormant in the system from months to years. (Medline Plus, 2013) Risk factors for the disease include: unprotected anal sex, men who have sex with men (MSM), having multiple partners, unprotected oral sex, sharing needles, blood transfusions, and being born from an HIV infected mother. (CDC, 2012) Since people may have a lack of symptoms for months to years, as mentioned earlier, there is a lack of clinical presentation. However, in a clinical setting, a clinician may check for fever, fatigue, swollen lymph nodes, diarrhea, weight loss and shortness of breath. (MayoClinic, 2012) Being proactive will aid in reducing both morbidity and mortality rates associated with HIV/AIDS. The CDC stated that the number of new AIDS cases was 34,247, in 2009, and the number of deaths was 8,369. (CDC, 2013) Treatment for HIV/AIDS comes in the form of drugs and medications to assist the immune system in fighting off the HIV virus in an effort to prevent the disease from mutating all CD4+ T cells into HIV viral cells so that HIV does not get to its last stage, i.e. AIDS. Aids is primarily prevented by individuals knowing the HIV status and practicing safe sex

HIV/AIDS methods, secondarily prevented through the use of drugs and medications, and also

through tertiary prevention in which already-infected-HIV-persons seek to restore health after any sort of compromising influence on the immune system. Other methods of prevention are: preventing an engagement in illicit drugs, not sharing needles, and practicing proper precautionary methods in the clinical setting. DESCRIPTION OF HOST CHARACTERISTICS The next area of importance is to discuss the host characteristics of HIV. The following chart is a representation of estimates of new cases of HIV infections in terms of gender and ethnicity, in the United States, in 2009:

(AIDS, 2012) As it reads, there is a higher prevalence of HIV/AIDs in the African American race as a whole, preferably men. The lower percentages are in that of the individuals who are classified as white. In terms of age, the following charts helps to draw a picture of how the epidemic affects various age groups:

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(The Body, 2011) According to the chart, the highest incidence of HIV occurs in the 20 24 age group, as of 2009, with a 6,237 persons. Overall, the 20-49 year old age group makes up the majority of the population of ages that at high-risk for becoming infected. In terms of the global figures associated with the HIV/AIDS epidemic, the following chart is helpful:

(Avert, 2011)

HIV/AIDS According to the above chart, as of 2009, just fewer than 35 million people are living with HIV across the world, with only a slight decrease from 2008. All the above host characteristics are instrumental in giving visuals to emphasize the true impact of HIV/AIDs. DESCRIPTION OF ENVIRONMENTAL ATTRIBUTES The next field of interest is the area of environmental attributes. Things like geographic location, socioeconomic factors, occupation, and education are all topics that are necessary to over when discussing HIV/AIDS and the environment. In terms of

geographic location, the CDC reports that in 2011 an estimated 8,717, 12%, of the people in the west of the United States are diagnosed with HIV infection. (CDC, 2013) For the south, it is 20.9%, in the northeast it is 18.1%, and in the Midwest it is 9.3%. (CDC, 2013) To touch on socioeconomic status, poverty is one limiting factor on access to health care that can help lower susceptibility to disease contraction and it has even been shown that persons living in low-income areas have an increased chance of becoming susceptible to HIV than persons living in the same area who live above the poverty line. (CDC, 2013) In addition, language barriers in low-income communities could present with health literacy difficulty, which in turns effects patient health status. In terms of occupation, the following chart details occupationally acquired HIV infection from the years of 1981 2010:

Possible Occupationally Acquired HIV Infection, by Occupation, 1981-2010

Occupation Nurse Laboratory worker, clinical Physician, nonsurgical Laboratory technician, nonclinical Documented 24 16 6 3 Possible 36 17 13 -

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Housekeeper/maintenance worker Technician, surgical Embalmer/morgue technician Health aide/attendant Respiratory therapist Technician, dialysis Dental worker, including dentist Emergency medical technician/paramedic Physician, surgical Other technician/therapist Other healthcare occupation Total 2 2 1 1 1 1 57 14 2 2 15 2 3 6 12 6 9 6 143

(CDC, 2011) From this chart we are able to see that the number of documented case was only 57 during a 29-year period, with a possible 143 cases. While having just one case of occupationally acquired HIV can be life altering for the host individual, in the grand scheme of things, it is great to have a very low incidence rate of HIV infection amongst healthcare workers overall. This is especially true when held in comparison to the national figures for HIV incidence previously mentioned in the paper. Lastly, in terms of education, it important to reiterate that health literacy plays a large role in HIV prevention. When an individual from a low-income area is able to understand health care information they will be more apt to engage in safer health practice. DESCRIPTION OF TEMPORAL VARIATIONS If we look at the Avert 2011 chart on prevalence of new HIV cases, then we can see that, secularly, HIV prevalence has increased over the years, from 1990 2009. (Avert, 2011) This steady increase and subsequent stagnation may be a result of poor public health programs designed to reduce statistical figures associated with HIV/AIDS. In terms of cyclic/seasonal variations, one 2005-cohort study, conducted on undiagnosed HIV patient seroprevalence, found that the summer cohort had a lower seroprevalence

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than the fall-winter cohort. (Brady, K., Berry, S. Gupta, R., Weiner, M., Turner, B., 2005) This was significant because it called for a higher need for testing in the fall to winter months. Lastly, to touch on the area of the HIV/AIDS epidemic as a whole the following facts are helpful in grasping a small snapshot of the effects of HIV: Figure 1: Key Snapshot of the U.S. Epidemic Today Number of new HIV infections, 2010: 47,500 Number of people living with HIV: 1.1 million Number of AIDS deaths since beginning of epidemic: 658,992, (Including more than 16,000 in 2010) Percent of people infected with HIV who dont know it: 18% Percent of people with HIV who are virally suppressed: 25% (The Kaiser Family Foundation, 2013) So, based on these figures, it is evident that the HIV/AIDS epidemic is a very serious one. The most significant of bunch being the percentage of persons living with HIV who dont know it because it contributes to the spread of the epidemic and also makes it difficult to help with preventative methods. ADDITIONAL EPIDEMIOLOGIC VARIABLES One of the most important variables that need be considered in addition to the previously mentioned ones is sexuality. When it comes to HIV the term men-who-havesex-with-men (MSM) is used often, which is not to be confused with those who identify as gay males. This is important because MSM encapsulates gay males within their statistics. According to the CDC, from 2008 to 2010, young gay black men HIV rates increased by 20%. (CDC, 2013) However, white MSM accounted for a greater population, 11, 200 cases, of people who served as the most-affected subpopulations of new HIV infections in 2010, with black MSM at 10, 600 cases.

HIV/AIDS SUMMARY OF CURRENT HYPOTHESIS One excellent form of current research is the CDCs involvement in identifying and testing for potential HIV microbicides that can protect against the transmission of some sexually transmitted diseases if rubbed on the vagina before sexual intercourse.

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(CDC, 2010) If they are successful in identifying one effective against HIV, then it may open the gates for more advanced methods of HIV prevention. In addition to this, the CDC is working on a vaccination to stop the spread of HIV. However one of the major challenges is balancing the development of a new vaccine with the current methods of prevention put in place in that not practicing safe sex methods due to the develop of a vaccine should not be encouraged. GAPS IN KNOWLEDGE As mentioned throughout the paper, the biggest gap in knowledge is the absence of a cure that will completely rid the body of HIV infection. The aim is to close this gap in knowledge so that the statistical figures presented throughout this paper drastically reduce in number. SUGGESTIONS FOR FURTHER STUDY A suggested area for further study is most importantly a continued effort in the search for a cure. Finding a cure would aid in eliminating one of the biggest epidemic faced today. In addition, one other area that should be further researched is to look qualitatively at why the cohort study, mentioned earlier in the paper, had a high prevalence of fall-winter undiagnosed HIV seroprevalence. It may help to both prevent the incidence levels and take into account patient perception.

HIV/AIDS CONCLUSION As a last note, the HIV/AIDS epidemic is one that has plagued the world since 1980s in the United States. This paper has proven the statistical, practical, and clinical

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significance and help to urge why it is important to continue public health practice in this area. With continual effort to rid the world of HIV/AIDs, the world should soon be able to speak of HIV/AIDS as a thing of the past with other conditions like smallpox, cholera, and the plague. Overall, a continued practice of safe sex should serve as the optimally sufficient method of HIV/AIDS prevention, along with all other forms of STIs (Sexually Transmitted Infections).

HIV/AIDS REFERENCES 1. Basic information about HIV and AIDS. (2012). CDC. Retrieved from http:// www.cdc.gov/hiv/topics/basic/index.htm#origin 2. Brady, K., Berry, S. Gupta, R., Weiner, M., Turner, B. (2005). Seasonal variation in undiagnosed HIV infection on the general medicine and trauma services of two urban hospitals. Journal of General Internal Medicine, 20(4): 324 330. doi: 10.1111/j.1525-1497.2005.40300.x 3. Centers for Disease Control and Prevention. (2013). CDC/National Center for Health Statistics. CDC. Retrieved from http://www.cdc.gov/nchs/fastats/aidshiv.htm

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4. Centers for Disease Control and Prevention. (2013). Diagnoses of HIV infection in the United States and dependent areas, 2011. CDC, 23. Retrieved from http://www.cdc.gov/hiv/surveillance/resources/reports/2011report/pdf/2011_HIV _Surveillance_Report_vol_23.pdf#Page=17 5. Centers for Disease Control and Prevention. (2013). HIV among gay and bisexual men. CDC. Retrieved from http://www.cdc.gov/hiv/topics/msm/ 6. Centers for Disease Control and Prevention. (2011). Surveillance of Occupationally Acquired HIV/AIDS in healthcare personnel, as of December 2010. CDC. Retrieved from http://www.cdc.gov/HAI/organisms/hiv/Surveillance-Occupationally-AcquiredHIV-AIDS.html 7. Global HIV and aids estimates, 2009 and 2010. (2010). Avert.org. Retrieved from http://www.avert.org/worldstats.htm

HIV/AIDS 8. HIV/AIDS. (2013). Medline Plus. Retrieved from http://www.nlm.nih.gov/ medlineplus/hivaids.html 9. Mayo Clinic Staff. (2012). HIV/AIDS. MayoClinic. Retrieved from http:// www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION=symptoms 10. NCHHSTP Newsroom. (2013). Socioeconomic factors affecting HIV risk. CDC. Retrieved from http://www.cdc.gov/nchhstp/newsroom/HIVFactSheets/ Epidemic/Factors.htm

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11. Obama administration announces new campaign to refocus national attention on the HIV crises in the United States. (2010). CDC. Retrieved from http:// www. cdc.gov/nchhstp/newsroom/AAAPressRelease.html 12. U.S. Centers for Disease Control and Prevention. (2011). The Body. Retrieved from http://www.thebody.com/content/17110/hiv-among-youth.html 13. U.S. Statistics. (2012). Aids.gov. Retrieved from http://aids.gov/hiv-aidsbasics/hiv-aids-101/statistics/ 14. The Henry J. Kaiser Family Foundation. (2013). HIV/AIDS policy. Kff.org. Retrieved from http://www.kff.org/hivaids/upload/3029-14.pdf