AIDS Fundamentals (PUBLIC HEALTH PORTION)

Week 7 Quiz The Health Decision Model considers _______, which the Health Belief Model does not. Choose all that apply. Experience Knowledge Interaction Severity

Experience Knowledge Interaction

Risk Anchoring: * Define it. - What does it affect? * How does this factor into our HIV/AIDS risk?

Anchoring: The starting point for our assessment - our initial estimate or base - affects how we adjust subsequent estimates. * How does this factor into our HIV/AIDS risk?

Transmission and Prevention Know "Let's Talk About AIDS" * What was this? * During what time was this released?

"Let's Talk About AIDS" * Alternate version of Salt-n-Pepa's 1991 hit "Let's Talk About Sex". - The AIDS education version was ABC News anchor Peter Jennings's idea. * Released at a time when... - Explicit sexuality was often censored in pop music by radio, MTV. - Stigma around HIV/AIDS was intense. - African-American community, along with the rest of the US, shocked about Magic Johnson's HIV disclosure.

Transmission and Prevention Understand Estimated Per-Act Probability of Acquiring HIV from an Infected Source, by Exposure Act (PT. 2)

"Other": hasn't happened, but possible.

Uganda's ABC Campaign Compare: Incidence/Prevalence vs. Time and Condom Availability vs. Time Graphs * What does this tell us?

* Clearly condoms weren't the "game changers" leading to the dramatic decline of HIV cases. - Condoms helped, but the data doesn't match up to prove C was the cause of the decline. * Big drop in incidence was in early 90s, when condoms weren't readily available yet.

Uganda's ABC Campaign Debate: Was it A, B, or C? * Who was Helen Epstein (what did she claim Uganda's success was due to)? - What is important to note specifically? "It was _____, not _______". * Define collective efficacy. - Explain how this was demonstrated among the people of Uganda.

* Helen Epstein: Uganda's success was due to partner reduction (B) and "collective efficacy". - It was partner reduction, not abstinence. * Collective efficacy: ability of people to join together (and do something!), rely on one another. * Small, intimate discussions led by "government workers, home-based volunteers, churchgoers, women's-rights activists". - They got together to discover ways to decrease partners. Men dramatically decreased their sexual partners because women told them to.

Transmission and Prevention Know the relationship between stigma and knowledge.

* Knowledge gets rid of stigma. The more people learn about HIV, the less they believe and spread stigmas. PIC: As time goes on, and more and more information is put out about HIV, people become more educated and less gullible to believing stigmas surrounding HIV/AIDS, and more comfortable being around people with the disease, due to no longer fearing contracting HIV in ways that stigmas created.

Positive Prevention Implementing Positive Prevention: * Know the contributors of implementation of positive prevention. - Explain what makes each of these components a contributor. * What is the Positive Leadership Development Institute?

* Knowledge of one's HIV status. - Facilitate early entry into care. * Disclosure of HIV status to partner. - To help with prevention, care, support: (involves parter) -> support for partner as well. * Prevention of mother-to-child transmission. * Testing of partners of those with HIV. - Facilitates HIV status and prevention. * Provide ARV (antiretroviral) therapy, reduce viral load. - Lowering risk of transmission. * Treating other sexually transmitted infections. - STIs associated with increased viral load in genital secretions. * Reduce behaviors that increase transmission risk. - e.g., reduce number of unprotected sexual acts. * Boost HIV+ leadership: increase in leaders, who become actively involved in helping other HIV+ people. * Preventative interventions. - Microbicides, PEP, PrEP. Positive Leadership Development Institute: where people can learn how to develop leadership skills

Positive Prevention * Define MIPA. * Define GIPA. * How did MIPA originate? * What groundbreaking demands led to MIPA? Explain this. * What did MIPA focus on? * Define PWA. - What is significant about the term "PWA"?

* MIPA: meaningful involvement of people with HIV/AIDS (former "greater" involvement and GIPA). * Originated with the "Denver Principles" created in 1983. * Demands were groundbreaking in US healthcare, which had treated many patients as passive: patients just had to lay there and let doctors do whatever. Other people made decisions for them about their healthcare. * Focused on empowerment and determination for People With Aids - or PWAs. - PWAs: pushes that AIDs is just something you deal with, it's not your whole identity.

Uganda's ABC Campaign Debate: Was it A, B, or C? * Know the beliefs of each group involved. * Why does this debate matter? - What was this debate about? * Explain the struggle of answering this debate. * What must we rely on to answer this debate? * What did surveys show us in the trend in sexual relations with casual or multiple partners? * What do we know about the condom availability time-frame? - What does this tell us? * What appears to be the true answer to this debate: was it A, B, or C?

* Some groups (mostly religious-based) attribute success to abstinence programs. * Others suggest that success is due to partner reduction. * Most donors (WHO, USAID) and donor nations attribute success to condom distribution. And why does it matter? - "The abstinence-versus-condoms rhetoric...appears more related to culture wars in the USA than in African social reality". * About politics of funding things. * Without randomized controlled trial, no way to answer definitively. * Must rely on observational data. * Surveys in 1989 and 1995 showed 50% decline in sexual relations with casual or multiple partners. - Huge decline. * Condoms became more readily available in the mid-to-late 1990s. - They weren't even available til late. * Appears partner reduction (B) preceded increase use of condoms (C) with casual partners.

Positive Prevention Positive Prevention Flow Chart: * Know goals, interventions, and outcomes. * Define agency.

* agency: self efficacy, confidence, leadership, etc.

Transmission and Prevention Understand Estimated Per-Act Probability of Acquiring HIV from an Infected Source, by Exposure Act

1. "administered or occurring elsewhere in the body than the mouth". 2. current risk of transfusion-transmitted HIV infection in the US is one in approximately 1.6-2.3 million units.

HIV Testing "HIV Self-Testing" * What is a mail-in HIV test? - What type of test is it? (antibody, antibody/antigen, NAT, etc.) - What does the kit include? For what? - Where can you get one? How would you get your results? - Are they approved? - How would one use a mail-in HIV test?

A mail-in HIV test is an antigen/antibody test that includes supplies to collect a small sample of blood from a finger stick. You or your health care provider can order the test online and send the sample to a lab for testing. If your provider orders the test, they will contact you with the test results. Mail-in HIV tests are not approved. However, labs that offer this service are required to establish and verify the test's accuracy. Read the instructions included in the test kit before you start. For a mail-in HIV test, you must prick your finger and collect a very small sample of blood. You or your health care provider will mail the sample to a lab for testing. If your health care provider orders the test, they will contact you when your test results are ready.

Week 7 Quiz The ABC campaign successfully helped reduce HIV incidence in Uganda, but the reasons why have been debated. Some NGOs like UNAIDS have claimed that it was ____________, various religious charities and social conservatives claimed it was_____________, but others such as journalist Helen Epstein, have said it was more likely _______________.

Answer 1: mass access to condoms Answer 2: the focus on abstinence and preventing pre-marital sex Answer 3: partner reduction and collective efficacy

HIV Testing "Understanding a (-) Result" What does a (-) HIV test result mean? What does it NOT mean? - For what a (-) test result doesn't mean, explain why. * If you get an HIV test after a potential HIV exposure and the result is (-), what should you do? * If you test again, after the window period, and have no possible HIV exposure during that time, and the result is negative, what does this mean? * If you're sexually active or use needles to inject drugs, what should you do? * If you have certain risk factors, what should you do? "If I have a negative result, does that mean my partner is HIV-negative also?" * Explain why. * How does the chance of getting HIV vary? * What is NOT a way to find out if your partner has HIV? * In this situation, what should you talk to your partner about? - What should you keep in mind in this situation? - What should you consider in this situation?

A negative result doesn't necessarily mean that you don't have HIV. That's because of the window period — the time between HIV exposure and when a test can detect HIV in your body. If you get an HIV test after a potential HIV exposure and the result is negative, get tested again after the window period for the test you took. If you test again after the window period, have no possible HIV exposure during that time, and the result is negative, you do not have HIV. If you're sexually active or use needles to inject drugs, continue to take actions to prevent HIV, like taking medicines to prevent HIV. If you have certain risk factors, you should continue getting tested at least once a year. If I have a negative result, does that mean my partner is HIV-negative also? No. Your HIV test result reveals only your HIV status. HIV is not necessarily transmitted every time you have sex or share needles, syringes, or other drug injection equipment (for example, cookers). And the chance of getting HIV varies depending on the type of exposure or behavior. Taking an HIV test is not a way to find out if your partner has HIV. Be open with your partners and ask them to tell you their HIV status. But keep in mind that your partners may not know, may be wrong, or may not tell you about their status. Consider getting tested together so you can both know your HIV status and take steps to keep yourselves healthy.

Transmission and Prevention * What is the most effective way of transmitting HIV? - Give examples. - Explain why this is the most effective way of transmitting HIV? * What prevents this form of transmission? - Give examples. * Is this transmission mechanism high risk currently? See pic.

Blood Transfusion or Organ Donation: * HIV transmission by direct contact of HIV fluid with receptive blood cells (most effective way of transmitting HIV). - Transfusion of blood products. - Transplant of organ or tissue. - Both place foreign matter in direct contact with recipient's bloodstream. * Screening of blood + organ donors is essential to reducing transmission: - HIV testing. - Donor questionnaire. * Transmission is very rare. PIC: Number of cases of transfusion-transmitted HIV infection from contaminated blood products, by transfusion year in the US, 1985-2008.

Week 7 Quiz What does it take for a person to be transferred from the HIV Prevention Continuum to the HIV Care Continuum? Choose all that apply. The desire of the person to be transferred to the other group A psychological assessment of the person Consistent high risk behaviors A positive HIV test result

A positive HIV test result

Uganda's ABC Campaign * What does ABC stand for?

Abstinence Be faithful Condomize

HIV Testing "HIV Self-Testing" * What is an HIV self-test? - What type of test is it? (antibody, antibody/antigen, NAT, etc.) - Where can it be used? - How soon can you get your results? * "How do I find an HIV self-test"? - Where are free or reduced-cost self-tests offered? - The only approved HIV self-test currently available tests what bodily fluid? * "How do I use an HIV self-test?" - What may result if one doesn't follow instructions as described? - How should one interpret HIV self-test results? - If the HIV self-test is invalid, what does this mean? What will one need to do? Give examples.

An HIV self-test (or rapid self-test) is an antibody test that can be used at home or in a private location. With an HIV self-test, you can get your test results within 20 minutes. You can buy an HIV self-test at a pharmacy or online. Your local health department or another organization near you may offer free or reduced cost self-tests. The only FDA-approved HIV self-test currently available in the United States is an oral fluid test. How do I use an HIV self-test? Read the instructions included in the test kit before you start. For an HIV self-test, you must swab your gums to collect an oral fluid sample and then test your sample. Your results will be ready within 20 minutes. If you don't follow the directions as described, the test may not work. There is a phone number included with the HIV self-test if you need help using the test. You should always interpret HIV self-test results according to the manufacturer's instructions. If the HIV self-test is invalid, then the test did not work. You will need to use another HIV self-test, use a mail-in HIV test, or find testing at a health care provider or testing center.

HIV Testing "Types of HIV Tests" What types of tests are available, and how do they work? * What does an antibody test look for? Where does it look for this? - An antibody test using blood from ____ can detect HIV sooner than tests done with blood from ____ or with _____. * What does an antigen/antibody test look for? - Antigen/antibody tests are recommended for testing done in ____. - Are these tests common? - What does this test involve? - What type of antigen/antigen test is available? Describe how this test is done. * What does a nucleic acid test look for? - Describe how this test will be done. - What can this test tell the patient? - How does this test compare to other tests? - What populations should consider using this test? * What type of test are most rapid tests? * What type of test is the only approved HIV self-test?

Antibody Test An antibody test looks for antibodies to HIV in your blood or oral fluid. Most rapid tests and the only HIV self-test approved by the U.S. Food and Drug Administration (FDA) are antibody tests. In general, antibody tests that use blood from a vein can detect HIV sooner than tests done with blood from a finger stick or with oral fluid. Antigen/Antibody Test An antigen/antibody test looks for both HIV antibodies and antigens. Antigen/antibody tests are recommended for testing done in labs and are common in the United States. This lab test involves drawing blood from a vein. There is also a rapid antigen/antibody test available that is done with blood from a finger stick. Nucleic Acid Test (NAT) A NAT looks for the actual virus in the blood. With a NAT, the health care provider will draw blood from your vein and send the sample to a lab for testing. This test can tell if a person has HIV or how much virus is present in the blood (HIV viral load test). A NAT can detect HIV sooner than other types of tests. This test should be considered for people who have had a recent exposure or a possible exposure and have early symptoms of HIV and who have tested negative with an antibody or antigen/antibody test.

HIV Testing * What is an antibody test? - What does it detect? - When do antibodies develop? Know relevant terminology. - Where can antibodies be detected? - What does an antibody test directly measure? Clarify. - What methodology do antibody tests use? - Are antibody tests fast or slow? When can results be returned?

Antibody test: * Detects antibodies created by the body in response to HIV. - Antibodies develop between 2 weeks and 3 months later (window period). - Can detect in blood, mouth and urine. - Doesn't directly measure virus, measures antibodies. * Uses ELISA (enzyme-linked immunosorbent assay). * Rapid tests can return results in 10 or 20 minutes. - Or blood samples sent to a lab.

Week 7 Quiz According to the CDC you should be tested for HIV if you can answer yes to which of the following questions? Choose all that apply. Are you between the ages of 13 and 64? Are you attracted to people of the same sex or gender? Have you been diagnosed with or treated for another sexually transmitted disease? Have you had more than one sex partner since your last HIV test? Are you a regular marijuana smoker?

Are you between the ages of 13 and 64? Have you been diagnosed with or treated for another sexually transmitted disease? Have you had more than one sex partner since your last HIV test?

Risk Availability: * Define it. * Understand examples. * Define familiarity. * Define salience. * How does this factor into our HIV/AIDS risk?

Availability: we judge something is more probable if it is more present in our memory. - If you see many news stories about crime, you think crime is increasing. * Familiarity is the frequency of occurrence in our memory. * Salience is the distinctiveness, vividness in our memory. * How does this factor into our HIV/AIDS risk?

Transmission and Prevention * Describe HIV in terms of stability and activity. * Where does HIV exist? * In what cells is HIV found? - Where are these cells found? * In what fluids is HIV found? * Know the degree of HIV infectivity of different body fluids, and products of individuals known to be HIV+. - When is amount of infectious HIV in fluids particularly high in individuals? - In what individuals is the amount of infectious HIV in fluids particularly high?

Biological Basis of HIV Transmission: * HIV is quite fragile and becomes inactive under air and light. * Exists in different amounts in different cells and bodily fluids. * Cells: macrophages, T-helper cells, and Langerhans. - Macrophages throughout the body and found in mucosal membranes. - Langerhans are in mucosal membranes and under the skin. * Fluids: high amounts in blood, semen, vaginal, and anal secretions. The amount of infectious HIV in these fluids is particularly high in individuals during the initial (acute) phase of infection and in individuals with clinical AIDS.

Transmission and Prevention * What is a requirement for HIV to infect target cells? * HIV will only appear in fluids with _______. - Know examples. * HIV can only survive when ________. * What cells, specifically, does HIV infect? - What do these cells have? - Where are these cells found? * How can they be infected (based on location)? - Know examples of locations where this is true. * Know an example of potential HIV transmission.

Biological Basis of HIV Transmission: * HIV must survive long enough to travel into a host, infect target cells. * HIV only appears in fluids with live cells (blood and semen), and can only survive when cells are alive. * The CD4 surface protein is found on T-helper lymphocytes, macrophages, and dendritic cells (like Langerhans cells). * These are found in blood and mucosa. * EX: Intercourse can damage the mucosal linings of genital tracts and rectum, allowing blood or semen into circulatory system. - EX: macrophages and dendritic cells in mucosal surfaces can be infected directly. - Vaginal, anal, urethra walls. - Eye, nose, mouth, but less likely (possible, not likely, only ever happened with cuts in mouth). * EX: Langerhans in the inner mucosa of the uncircumcised foreskin.

Risk * What is CDC's "Should I get tested for HIV?" based on? - Know what falls under this list, and understand why they're included in the list. "Getting Tested": * How often does CDC recommend everyone 13-64 get tested? - How does this compare to those with certain risk factors? * Before having sex with a new partner for the first time, what should you talk with them about?

CDC's "Should I get tested for HIV?": CORRELATIONS * Are you a man who has had sex with another man? * Have you had anal or vaginal sex with a partner who has HIV? * Have you had more than one sex partner since your last HIV test? * Have you injected drugs and shared needles, syringes, or other drug injection equipment (for example, cookers) with others? * Have you exchanged sex for drugs or money? (increase likelihood of getting HIV, likely you won't care how safe the sex is if you're in desperate need). * Have you been diagnosed with or treated for another sexually transmitted disease? * For hepatitis or tuberculosis (TB)? - Hepatitis: transmitted the same way as HIV. - TB: Compromised immune system, more susceptible. This is about risk, often people who have HIV have TB (higher risk to get HIV if you have TB). * Have you had sex with someone who could answer yes to any of the above questions, or someone whose sexual history you don't know? * Chlamydia: if you have this, you likely participate in risky behaviors (more susceptible to HIV). "Getting Tested": CDC recommends everyone between the ages of 13 and 64 get tested for HIV at least once. People with certain risk factors should get tested more often. You should get tested at least once a year if: (see list above). Before having sex for the first time with a new partner, talk about your sexual and drug-use history, disclose your HIV status, and consider getting tested for HIV together.

Uganda's ABC Campaign Incidence/Prevalence vs. Time Graph * Understand what this trend is showing. * What dramatic change did we see, and when did we see it?

Incidence and prevalence began a steep decline in the mid-1990s. * Incidence in the mid 90s: dramatic drop, huge decline in incidence.

Week 7 Quiz One of the reason AIDS Fundamentals was created was to help reduce HIV incidence among UCI students. What is the main principle of behavior change being used by this class? Cognitive Emotional Behavioral Interpersonal

Cognitive

HIV Testing What are the different confirmatory tests? Know characteristics of each.

Confirmatory Tests: * Western Blot: - Most common test to confirm positive results from a typical antibody test. - Generally used only as a confirmatory test because it is difficult to perform. - More effectively distinguishes HIV antibodies from other antibodies. - Inconclusive results in some samples. * Indirect Fluorescent Antibody (IFA) - Compound that makes specific antibodies glow apple-green under ultraviolet light. - More expensive than Western blot.

Risk * What is "Dallas Buyers Club"? * What groups of people questioned the veracity of "Dallas Buyers Club"? * How does epidemiology's interpretation of risk compare to views on risk in day-to-day life?

Dallas Buyers Club * Film about Ron Woodroof, cowboy who started a club to distribute smuggled HIV medications. * Woodroof tested positive in 1986, died in 1992. * Won Oscars for Best Actor (Matthew McConaughey), Best Supporting Actor (Jared Leto as Rayon). * The veracity of the film questioned by people who knew Woodruff. - An example of how anything based on real-life are never completely true. * And by transgender activists (why wasn't a transgender actor/actress hired). * Epidemiology: risk is specific (certain behaviors, %, etc.) * In life: we use risk generally "that's risky".

HIV Testing ELISAs: * Know 1st gen: what did it detect? what was the antigen? * Know 2nd gen: what did it detect? * Know 3rd gen: what did it detect? * Know 4th gen: what did it detect? - Define different detection component(s) when relevant, and what their significance is. - What do some 4th gen ELISAs strictly only test for?

ELISAs: * ELISA tests have changed over the years. * 1st generation detected infected viral cell lysate as an antigen - no longer used. * 2nd gen: detects immunoglobulin G (IgG) antibody. * 3rd gen: detects IgG and Immunoglobulin M (IgM). * 4th gen: detects IgG, IgM, and the p24 antigen. - p24 antigen part of HIV itself (makes detection more sensitive). - Some tests only look for p24.

Week 7 Quiz Contrary to the normative model, our decision-making becomes more rational the more complex a problem is. True False

False

Week 7 Quiz In California, you can be convicted of a felony if you do not tell a sexual partner you are HIV-positive, even if you are taking anti-viral medications and have an undetectable viral load. True False

False

HIV Testing * Describe HIV At-Home Testing - How long does it take to complete and get a result? - What is collected, and what is detected from this? - What is the method of obtaining this collection, and the result? - What confirms the test is working properly? - What confirms HIV infection?

HIV Home Testing: * EX: The OraQuick In-Home HIV Test. * 20-minutes to complete and get a result. * HIV antibodies from oral fluid are collected through a swab. * The swab is inserted into a test tube, and then oral fluid mixes with the solution, and travels up the test stick. * There is place for a C line and T line. * A line for the C line confirms test is working properly. * A T line confirms HIV antibodies.

Uganda's ABC Campaign Define: * HIV Prevalence * HIV Incidence Understand examples of both definitions. For both HIV prevalence and incidence, what do we focus on? What do these things tell us about HIV? - What conclusions does looking at these two focus areas help us draw?

HIV Prevalence: number of people living with HIV at any given time. EX: "In US, prevalence = 1 mil": this is the amount of people with HIV in the US at a given time. HIV Incidence: number of new cases of HIV during a span of time. EX: "Annual incidence = 35,000": this means, over the course of a year, there were 35,000 new cases of HIV. For both, focus on: * Demographics: gender, sexuality, race, age. - What are differences based on different populations? * Geography: community, nation. - Where should we put resources? This is how we gage how big the problem is, and how things are changing (or not changing).

HIV Testing What is the HIV Testing process? * Know step-by-step, and components of each step. * What are different ways the test can be performed? Compare, depending on different ways the test is given, when results will be returned. * What do you do if your test result is negative. * What do you do if your test result is "preliminary positive"? - Define "preliminary positive".

HIV Testing Process: 1. HIV risk assessment and counseling (questionaire). 2. HIV test. - Small blood sample or mouth swab. - Some send blood draws to lab. - Most tests are now rapid - 10 to 20 min. 3. You wait - in the office or at home. 4. If test result is negative. - HIV-risk reduction counseling. 5. If test is "preliminary positive" (need 2nd test to confirm). * Confirmatory test * Counseling and support * Linkage to health care, social services, further counseling.

Week 7 Quiz Which of the following are true? Choose all that apply. HIV can be detected in the urine but cannot be transmitted by urine. RNA and antibody tests for HIV can return results in 10 to 20 minutes HIV testing counselors use the term "preliminary positive" because every positive test must be confirmed. Federal guidelines now state that you must give written consent to be tested for HIV.

HIV can be detected in the urine but cannot be transmitted by urine. HIV testing counselors use the term "preliminary positive" because every positive test must be confirmed.

HIV Testing * What kinds of tests are used for HIV testing? * Define "window period". - Window periods are referring to detection of what? - Know what types of tests are involved in different window periods. * Define "incubation period". * Define anonymous testing. * Define confidential testing. * Define reporting. * Define partner notification.

HIV testing: * Three kinds of tests: - Antibody test - Antigen-antibody test - RNA test * Window period: time between infection and production of enough antibodies to detect. - There's also a window period for the viral particle test (RNA test). Window period between infection and enough viral particles to detect. * Incubation period: time between infection and the presentation of symptoms. * Anonymous testing: identity of test subject not linked to result (simply result to send to government officials for statistics on HIV). * Confidential testing: links the test subject's identity to the test result; California and US law prohibits unauthorized disclosure (need permission). * Reporting: By law, positive HIV tests, AIDS diagnoses, and CD4 counts must be reported to county and state agencies (confidential). * Partner notification: Doctors and public health officials can inform partners of their exposure.

HIV Testing "Getting Tested" * "Who will pay for my HIV test?" - Know how to answer this for those with and without health insurance. * "What should I expect when I go in for an HIV test?" - Health care setting or lab. * What will they take a sample of? * What are the test options available? Describe them, and how they differ. * What may come up between patient and health care provider? - Outside of a health care setting or lab. * Know test option(s) available, and what they consist of. * What may come up between patient and counselor?

HIV tests are covered by health insurance without a co-pay, as required by the Affordable Care Act. If you do not have medical insurance, some places offer free or low-cost tests. Health Care Setting or Lab If you get an HIV test in a health care setting or lab, the health care provider will take a sample of blood or oral fluid. With a rapid test (oral fluid or finger stick), you may be able to wait for the results. With a lab test, it may take several days for your results to be available. Your health care provider may talk with you about your risk factors, answer any questions you might have, and discuss next steps. Outside of a Health Care Setting or Lab If you are tested outside of a health care setting or a lab, you will likely receive a rapid test (oral fluid or finger stick). The counselor providing the test should be able to answer questions and provide referrals for follow-up testing, if needed.

HIV Testing "Sharing Your Test Result" * Will other people know my HIV test result? - What happens when you take an anonymous HIV test? - What is another way you can test anonymously? - Define confidential testing. * Where will your results end up? * What will be attached to your results? * Will they be shared? If so, with who? * Are your results protected? * With confidential testing, if your result is positive, what happens?

HIV tests may be anonymous or confidential. Anonymous testing means only you will know the test result. When you take an anonymous HIV test, you get a unique identifier that allows you to get your test results. You can also buy an HIV self-test if you want to test anonymously. Confidential testing means your test result will be part of your medical record. Your name and other personal information will be attached to your test results. The results will go in your medical record and may be shared with your health care provider and health insurance company. Otherwise, your results are protected by state and federal privacy laws, and they can only be released with your permission. With confidential testing, if your test result is positive, the result and your name will be reported to the state or local health department to help public health officials estimate HIV rates in the state. The state health department will then remove all personal information about you (name, address, etc.) and share the remaining information with CDC. CDC does not share this information with anyone.

Risk * Define HIV vulnerability. - What factors contribute to HIV vulnerability? Give examples. * Define HIV risk. - What creates, enhances, and/or perpetuates HIV risk?

HIV vulnerability: result of a combination of factors reducing ability of individuals or groups to avoid HIV infection. * Personal factors: knowledge, skills. * Access to health services: cost, distance, environment. - (EX: Uncomfortability, maybe all doctors are a different race, making you fear discrimination). * Societal factors: laws, norms, beliefs, and practices. - Norms: norms of talking about these things. * Scared of being judged, since HIV isn't talked about, and experiences aren't shared. - Beliefs: whether true or not true - Practices: emotional, etc. HIV risk: Probability that a person may acquire HIV infection (risk of getting it). * Behaviors and situations create, enhance, and perpetuate risk. * CDC's statistical risk estimator: https://hivriskcdc.gov

Week 7 Quiz Positive Prevention is focused on helping _______. Choose all that apply. HIV-positive people improve their health and well-being HIV-positive people prevent HIV transmission HIV-negative people learn how to prevent themselves from becoming positive HIV-negative people improve their health and well-being so that they do not put themselves at risk for HIV infection

HIV-positive people improve their health and well-being HIV-positive people prevent HIV transmission

Uganda's ABC Campaign Condom Availability vs. Time Graph * What is this graph showing us?

Huge increase in access to condoms in the 90s.

HIV Testing "Understanding a (+) Result" * What does a (+) HIV result mean?: - If you use any type of antibody test and have a positive result, what will you need to do? - If you test in a community program or take an HIV self-test and it's positive, what should you do? - If you test in a health care setting or a lab and it's positive, what will happen? What will make the lab determine you have HIV? * "What should I do if I just got diagnosed with HIV?": - Where can you find support, and what will you need to do? * What is ART? Who is it recommended for? Be specific. * What is the result of HIV treatment? * What is the best way to stay healthy and protect others? * "If I test positive for HIV, does that mean I have AIDS?" - What is AIDS? - What is the relationship between HIV and AIDS? - If someone with HIV takes their HIV treatment as prescribed, what might their life look like?

If you use any type of antibody test and have a positive result, you will need a follow-up test to confirm your results. If you test in a community program or take an HIV self-test and it's positive, you should go to a health care provider for follow-up testing. If you test in a health care setting or a lab and it's positive, the lab will conduct the follow-up testing, usually on the same blood sample as the first test. If the follow-up test is also positive, it means you have HIV. Allied health care providers and social service providers can help you work through the early stages of your diagnosis. They can also help you find HIV care and treatment that will help you live a long and healthy life. HIV treatment (antiretroviral therapy or ART) is recommended for all people with HIV, regardless of how long they've had the virus or how healthy they are. HIV treatment can make the amount of HIV in the blood (viral load) so low that a test can't detect it (undetectable viral load). Getting and keeping an undetectable viral load is the best way to stay healthy and protect others. No. Testing positive for HIV does not mean you have AIDS. AIDS is the most advanced stage of HIV disease (Stage 3). HIV can lead to AIDS if a person with HIV does not get treatment or take care of their health. But if someone with HIV takes their HIV treatment as prescribed, they can live long, healthy lives, and may never develop AIDS.

HIV Testing "Getting Tested" * "If I'm a sexually active gay or bisexual man, how often should I get tested?" - Who should they talk to? About what? * "Should I get tested if I'm pregnant?" - Why not/why should they get tested? - What's their benefit of getting tested for HIV/treating their HIV? - When would HIV treatment be most affective? * Compare the ideal start time to the later start time option. * What is the risk of transmitting HIV to the baby if a pregnant person gets HIV treatment early in their pregnancy? * For those who test negative, what should they do? * "Should I get tested for HIV if I don't have any risk factors?" - What does the CDC recommend? * Is this different for those that participate in high risk behavior? * What do they recommend for partners who only have sex with each other?

If you're a sexually active gay or bisexual man, you may benefit from more frequent testing (every 3 to 6 months). Talk to your health care provider about your risk factors and what testing options are available to you. All pregnant people should get tested for HIV so they can take steps to stay healthy and protect their baby. Testing pregnant people for HIV and treating those who have HIV has decreased the number of babies born with HIV. HIV treatment is most effective when started as early as possible during a pregnancy. However, there are still great health benefits to beginning treatment even during labor or shortly after the baby is born. If a pregnant person gets HIV treatment early in their pregnancy, the risk of transmitting HIV to their baby is extremely low (1% or less). Pregnant people who test negative for HIV can talk to their health care provider about taking PrEP (pre-exposure prophylaxis) to prevent HIV. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care, and more often if you do things that might increase your chance of getting HIV. Even if both you and your partner are having sex only with each other, you should both find out your HIV status.

Transmission and Prevention * Explain why injection drug use is a focus area of HIV prevention. * What is the most effective method of prevention of HIV transmission through injection drug use. * What is controversial about some prevention methods? * Describe the opposition. * Understand picture showing relationship between states with SSP and their vulnerability to HIV in US.

Injection Drug Use: * Sharing syringes and other "works", while injecting drugs like heroin, synthetic opiates, and meth. * If blood of one user is infected with HIV, virus can be spread to subsequent users. * Most effective method of prevention is using new syringes every time. - Clean syringe exchanges are very effective, but very controversial. - Opposition is moral, not scientific. PIC: Blue is not a vulnerable county, has syringe service programs.

HIV Testing "Types of HIV Tests" * "How long will it take to get my HIV test results?": - What does this depend on? * Compare HIV self-tests, rapid antibody tests, rapid antigen/antibody tests, NAT, antigen/antibody lab test. * "Can an HIV test detect the virus immediately after exposure?" - Why/why not? - Define window period, and know how it varies with each different test. * What test can detect HIV the soonest? How soon after exposure?

It depends on the type of HIV test and where you get tested. HIV self-tests provide results within 20 minutes. With a rapid antibody test, usually done with blood from a finger stick or with oral fluid, results are ready in 30 minutes or less. The rapid antigen/antibody test, done with blood from a finger stick, takes 30 minutes or less. It may take several days to receive your test results with a NAT or antigen/antibody lab test. No HIV test can detect HIV immediately after infection. That's because of the window period—the time between HIV exposure and when a test can detect HIV in your body. The window period depends on the type of HIV test. A nucleic acid test can usually detect HIV the soonest (about 10 to 33 days after exposure).

Risk Judgement heuristics: * Define judgement heuristics. * What does it use to process information? * What does it use to help make decisions? Understand examples. * Describe judgement heuristics, and its processing of information and decision-making. * Is judgement heuristics good or bad? * Is judgment heuristics accurate? * What does judgement heuristics help with?

Judgement heuristics: Shortcuts to apply probabilistic, general facts in specific circumstances. * Rules of thumb and shortcuts use to process information. - Using previous experiments to help make decisions. * EX: where to find coffee in the morning (which cabinet), who to ask for help in a store (employee). * Unconscious and almost automatic. * Neither good, nor bad. * Mostly accurate, helps with problem solving.

HIV Testing "Getting Tested" How does taking an HIV test help someone? * How is knowing your HIV status helpful? - If your test result comes back positive, what can you do? * What is the benefit of responding this way? - If your test result comes back negative, what can you do?

Knowing your HIV status gives you powerful information to keep you and your partner healthy. If your test result is positive, you can take medicine to treat the virus. HIV treatment reduces the amount of HIV in your blood (viral load). Taking HIV treatment as prescribed can make the viral load so low that a test can't detect it (undetectable viral load). Getting and keeping an undetectable viral load (or staying virally suppressed) is the best way to stay healthy and protect others. If your test result is negative, you can take actions to prevent HIV.

Transmission and Prevention * Define occupational exposure. * Explain why occupational exposure is a focus area of HIV prevention. * What are the most effective prevention strategies?

Occupational Exposure * Accidental needle-sticks by health care workers. - 800,000 accidental needle-sticks in US. - 2% with HIV-contaminated needles. - 0.5% risk of contracting HIV from contaminated needle. - 1 out of 10,000 risks contracting HIV. * Most effective prevention is sharps containers and education. * Also: Post Exposure Prophylaxis administration (PEP).

HIV Testing * Define Opt-in testing. * Define Opt-out testing. * Compare guidelines prior to 2006, to guidelines now. * What did research on prenatal HIV testing show us? - What type of testing was used (opt-in or opt-out)? - Describe the reason for the results that were recorded.

Opt-in vs. Opt-out Testing: * Opt-out testing: notifying the patient that the test is normally performed but that the patient may elect to decline or defer testing. * Opt-in testing: testing is offered, and the patient is required to actively give permission. * Guidelines prior to 2006: - Only risk-based testing recommended (only high risk people have to test). - Opt-in process - Consent had to be written. * Current guidelines: - Everyone 13-64 years of age (regardless of risk). - Recommend opt-out process. - In many cases, consent can be oral. * Research on prenatal HIV testing: - RCT of 4 counseling models with opt-in consent. - 35% accepted testing, some felt accepting an HIV test indicated high risk behavior. - Testing offered as routine, chance to decline (opt-out) - 88% accepted, significantly less anxious.

Risk Optimistic bias: * Define personal invulnerability. Give examples of mindset. * What population is most affected by this mindset? * How does this factor into our HIV/AIDS risk? * What do we see on a graph that displays the variation in positive illusions among the population at large? What does this mean for the population average and their assessment of life?

Optimistic bias: Personal invulnerability: viewing ourselves as less vulnerable to experiencing bad outcomes. * Bad things will not happen to us, but good things will. * Mindset especially in younger people, while men tend to be more optimistic than women. * How does this factor into our HIV/AIDS risk? Figure 3: Conceptual scheme of variation in positive illusions among the population at large. Most people tend to overestimate their abilities, their control events, and the future, so the population average exceeds a realistic assessment of these things.

Week 7 Quiz Using the CDC's Risk Estimator Tool (https://hivrisk.cdc.gov/risk-estimator-tool/#Links to an external site.) determine which of the following situations poses the lowest risk for HIV transmission for Person A? Person A is an HIV-negative man, and he has receptive anal sex with a man who is HIV-positive, on anti-viral medications, and has an undetectable viral load. Person A is an HIV-negative woman, and she has receptive vaginal sex with an HIV-positive man who wears a condom. Person A is an HIV-negative woman, and she has receptive vaginal sex with a man with AIDS and he does not use a condom. Person A is an HIV-negative man, and he has insertive vaginal sex with a woman with AIDS and he does not use a condom.

Person A is an HIV-negative man, and he has receptive anal sex with a man who is HIV-positive, on anti-viral medications, and has an undetectable viral load.

Transmission and Prevention * What is assigning risk to behaviors based on? - Define components. * Define biological plausibility: - What relationship does it involve, and between what? - In order to be biologically plausible, what must something be? * Define. - What does biological plausibility allow us to figure out? * Define epidemiological causation. * Use plausibility and causation to rule out airborne HIV infection.

Plausibility and causation: * Assigning risk to behaviors is based on: 1. theoretical biological analysis: based on agent and what we know about disease - is theory biologically possible? 2. empirical epidemiological data: collecting data to prove theory. * Biological plausibility: - Cause-and-effect relationship between a biological agent (virus, bacteria, parasite) and a disease. - Must be biologically coherent: possible based on what is known about the agent and disease. - This is how we figure out how someone got infected. EX: Airborne HIV infection? * HIV is not present in exhaled breath. * Ergo, not likely inhaling HIV, or being infected by HIV, is plausible. * Epidemiological causation: statistical association between an observed risk factor and a disease. * EX: Epidemiological data on airborne HIV: people who have lived with HIV-positive people show no infections from sharing air.

Positive Prevention * What does positive prevention involve? * Define positive prevention. - What is it? - What does it focus on? * What is the benefit of positive prevention? - How is this possible? Be able to explain each contribution. * What is positive prevention consistent with?

Positive Prevention: Empowering HIV-Positive People to Help Prevent Transmission. * Positive prevention: interventions for HIV-positive people. - Collection of interventions (old), focuses on HIV+ people and helping them prevent transmission to others. * Sustain healthy lives and reduce HIV transmission through: - Knowledge of status: helping people know they're HIV+, so they can take drugs, be self aware, and behave correctly. - Biomedical treatment (so they can be healthy). - Effective use of prevention methods (of all prevention methods: risk reduction). - Boost confidence and self-efficacy: you know your ability to make better decisions. * CDC officially endorsed positive prevention in 2008. * Consistent with MIPA.

Risk Probabilistic thinking: * What does probabilistic information contain? Give examples. * What is an example of a probabilistic science? * What do most people think about their decision making? How does this compare to reality? Why is the contrary not true?

Probabilistic Thinking: * Probabilistic information contains an estimate related to a topic. * Likelihood, frequency, or prevalence. * Epidemiology is a probabilistic science. * Most of us think we make decisions rationally. * Rather: people are more "predictably irrational" than rational. - It is impossible to think without emotions, even logic is emotional.

HIV Testing Know the Pros and Cons of HIV Self-Testing: * What does it increase the likelihood of? * What does it provide? * Anonymous benefits? * What isn't offered? * What population is most often buying these tests? Is this good or bad? * Anonymous cons? * How might personal barriers interfere with the test? * How does this test compare to tests at clinics?

Pros and Cons with HIV Self-Testing * Pros: - Increase likelihood of knowing HIV status. - Increase likelihood of linking to care sooner rather than later. - Provides resources and referrals via a call-in support center. - Anonymous: a test result is not linked to person's identifying information. * Cons: - No counseling offered. - Are the right people taking the test? Only the likely seronegative or those confirming HIV-positive status. * People that are testing voluntarily are usually the ones that are safe and responsible -> negative, or are confirming that they're positive. We want high risk people that are unaware of their status to discover they're HIV+ so that they can respond accordingly. - Anonymous: no health record; health pros cannot support your health. - Not everyone can follow testing directions. - Not as sensitive as tests used in clinics and testing sites.

Transmission and Prevention Describe HIV transmission: * Through what kind of contact? Between what and who? * Know the 3 modes of transmission. - Describe each mode. * What are the five prevention focus areas?

Public Health Focus on 3 Modes, 5 Foci: HIV transmission: "direct contact between HIV-tainted fluid from an infected person and the bloodstream or a mucosal lining of another person". * Three modes of transmission: - Birth: Perinatal transmission from an infected mother to her gestating infant. - Blood: Transmission from an HIV-infected source to the bloodstream. - Sex: Intimate sexual contact with an HIV-infected person. Five prevention focus areas: * Blood transfusion or organ donation. * Injection drug use. * Occupational exposure. * Sexual contact. * Mother-to-child.

Transmission and Prevention What do humans often like to do? * What's the benefit of this? * Describe old designations of pure and impure - do they make sense? * What is important to think about when we're pondering our fears?

Purity and Danger: * Humans like to categorize! - Often to extreme extents. * Categorizing makes it easier to manage them - and our responses. * Old designations of pure and impure seem illogical now. - But still have so much power over our emotions and behaviors. - EX: Witches, vampires. * But sometimes, the categories make sense. - Such as....? * Important to ponder why we are scared, and what we're actually afraid of. * How did we overcome disgust? EX: Is it really the cockroach we're afraid of? Or is it the presence of something not being clean? EX: HIV transmission involves blood, semen, and bodily fluid - all of which we have a strong response to.

Risk Representativeness: * Define representativeness. * What is it based on? * How does it factor into our HIV/AIDS risk? * Understand examples of representativeness. * Be able to summarize representativeness well.

Representativeness: If objects are highly similar, we then conclude that one object is representative of the other. * Based on what we know or think we know. * How does this factor into our HIV/AIDS risk? * EX: you walk into a grocery store and see a pile of apples. One apple is plastic in store, but it looks like one you've purchased and enjoyed before. You bite into it and realize you made the wrong choice, you bought a fake apple. * EX: a cat looks like an adorable cat, similar to ones you've seen before, but it turns out to be a mean monster that is a super villain hidden in a cat's body. SUMMARY: You can't trust things that just look like other things you know, not everything that is similar is the same.

Risk * Know the basic model of decision making. - Know each step, what each involves, and understand what each step means. * How does individual decision-making relate to HIV and risk? - Give examples.

Risk and decision-making: * Basic model of decision making - Knowledge: information collection and synthesis. * You know something. - Attitude: condenses this information into a conclusion. * You develop attitude about it. - Intention: readiness to take action. * You intend to do something. - Behavior: action actually taken. * You behave a certain way in response to newfound knowledge. Individual decision-making: the foundation of HIV and behavioral risk in general. - Am I going to get drunk in a club so I can find someone to have sex with? - Will I go to the LGBT center open to pick-up free condoms and lube? - How likely is it that I'll actually get HIV from this guy?

Uganda's ABC Campaign * What was Uganda's HIV prevention campaign considered to be? * What was the government active in promoting in regards to this campaign? - To comply with these rules, what should one practice?

Uganda's HIV prevention campaign: considered a model. The government was active in promoting.: - Partner reduction through abstinence (no partner), be faithful (if you have a partner, stay with only one). - Expanded condom distribution - Also: HIV testing and STI treatment.

Risk * Define risk perception. - What does it result in? Understand examples. - On what scales is risk perception classified? * Define risk assessment. - What does it estimate? - How can we calculate well-known risks? - How can we calculate poorly understood risks?

Risk perception: Involves psychological factors of ourselves (how we interpret things). * Results in the apparent irrationality of the public in response to risks that experts estimate to be small (or very large). - Very large: danger of speeding = high, but it's still very common, and people are nonchalant about it. - Very small: danger of getting killed by shark = low, but some people won't even stick their toe in the water. * Is classified on two scales: dread and knowability. Risk assessment: Identifies events and exposures that may be harmful to humans. * Estimates the statistical probabilities of occurrence. * Estimates extent of harm. * For well-known risks, we can calculate from historical data. * For poorly understood risks, we must make many assumptions.

Transmission and Prevention Explain why Mother-to-child transmission is a focus area of HIV prevention: * What are the routes of perinatal infection? * What threat does it pose to adults? How does this compare to infants? * How does birth/perinatal infection occur? * What is the % occurrence of MTCT without use of antiviral drugs? * What is the % occurence of MTCT with aggressive prophylactic use of antiviral drugs? * Understand: Estimated # of MTCT AIDS Cases, by Year of Diagnosis

Routes of perinatal infection: * Blood of mom enters blood of child. * Breast milk contains HIV. * Perinatal infection: poses no significant threat of infection to adults, but is a risk for infants. * Birth or perinatal transmission occurs when the HIV-infected blood of mother enters the bloodstream of the fetus. * MTCT is 23% without use of antiviral drugs and 2% with aggressive prophylactic use of antiviral drugs.

Transmission and Prevention Explain why sexual contact is a focus area of HIV prevention: * What does transmission through sexual contact require? * What are less risky practices involving sexual contact? * What are most risky sexual practices? * What used to be the only effective methods of prevention? * What leads to 99.99% prevention effectiveness? - What barriers prevent people from accessing these?

Sexual contact: * Requires direct contact between HIV-infected bodily fluids and a target site. * Least risky practices: HIV-infected fluids don't contact target sites. * Most risky sexual practices: Vaginal and anal intercourse. * Physical barriers and abstinence used to be only effective methods. * Pre-Exposure Prophylaxis (PrEP) and HIV-treated undetectability (aka U=U) are 99.99% effective. * But there are many non-physical barriers to accessing these methods (less accessible).

HIV Testing Should everyone get tested? * What does the CDC recommend? * Who is at high risk of infection?

Should You Get Tested? * Yes * CDC recommends routine HIV screening in health-care settings for all adults, aged 13-64, and repeat screening at least annually for those at higher risk. If you: - Are sexually active, gay or bisexual men. - Have had sex with an HIV-positive partner. - Have had more than one partner since last HIV test. - Have shared needles or works to inject drugs. - Have exchanged sex for drugs or money. - Have another STI, hepatitis, or tuberculosis. - Have had sex with someone who has done any of the above activities - or someone who's history you don't know.

Risk * Describe a subjective model: - Describe decision making of a subjective model. - What are decisions framed by? * Define relevant terminology. * Describe a normative model: - How is information weighted? - Is this model common among the population's decision making? Explain.

Subjective model: * Actual decision making is subjective. * Decisions are framed by: - Emotions, present and past. - Immediate environments (where we are right now). - Cognitive structures. - Way brain puts things into boxes to deal with them. - Judgement heuristics. Normative model: * Information is weighted according to statistical rules to reach conclusions. * Most people do not and cannot use the normative model for most of their decision making. * Even if we wanted to use the normative model, we will not have necessary data or the processing power.

Transmission and Prevention * What do epidemiological studies identify? - What question do they ask themselves once they've made an identification? - What is important to note about this identification? Understand example. - What do we need to focus on instead? * Understand example.

The Risk of "Risk Groups": * Epidemiological studies always identify groups experiencing disease. - "Why them, and not others getting infected?" * However, it's not nature of the group that causes the disease. - Various factors increase behaviors that have higher risk for HIV infection. * EX: HIV is over-represented in gay and bisexual men and African Americans. - But, it's not gayness or blackness that makes them more likely to contract HIV. * Focus on social determinants of health behaviors over group's identity. - EX: Poor people got COVID more often than wealthy people. Poor people still had to work during COVID, so they were more likely to contract it due to their higher interaction with others.

Risk Know the dread/knowability axis.

The dread/knowability axis.

Risk Know the dread/knowability axis. * Know what's on the x and y-axis, and what falls under each category. What is the underlying cause of most irrational fears?

The dread/knowability axis: * Controllable (not dread): not global catastrophic, consequences not fatal, equitable, individual, low risk to future generations, easily reduced, risk decreasing, voluntary. * Uncontrollable (dread): global catastrophic, consequences fatal, not equitable, catastrophic, high risk to future generations, not easily reduced, risk increasing, involuntary. * Not observable (unknown): unknown to those exposed, effect delayed, new risk, risks unknown to science. * Observable (known): known to those exposed, effect immediate, old risk, risks known to science. Observable = what we know. * The most irrational fears one has is due to: - Not knowing enough about something. - Inability to control/prevent something from happening.

HIV Testing "Types of HIV Tests" What types of tests are available (name them, vague)? * Define antibodies. * Define antigens, how do they affect your immune system? * Define p24. * What are HIV tests typically performed on (what bodily fluids are used)?

There are three types of HIV tests: antibody tests, antigen/antibody tests, and nucleic acid tests (NAT). Antibodies are produced by your immune system when you're exposed to viruses like HIV. Antigens are foreign substances that cause your immune system to activate. If you have HIV, an antigen called p24 is produced even before antibodies develop. HIV tests are typically performed on blood or oral fluid. They may also be performed on urine.

Uganda's ABC Campaign How was it possible for things to change in Uganda? * How would this be more complicated for the US? What is so difficult about what Uganda was able to do? What does highly active HIV prevention involve? - Be able to give examples of these things. Explain social justice and human rights, and how this contributed to the change in Uganda.

Things really changed in Uganda because there was an actual culture change. -> Compared to the US, Uganda is a much less diverse place, people share more of the same ideas, so a cultural change among everyone was actually possible. It's difficult to get everyone to totally change their culture in a couple years, culture shock. EX: Everyone reduce your sexual partners! Really highly active HIV prevention, or behavioral change involves lots of different things. * Behavioral change: actually changing how you are behaving (whether or not you're having sex), * Treatments you're doing * Testing * Biomedical strategies * Social justice and human rights Social justice and human rights: women's increased cultural power and collective efficacy was really a big deal. It changed how people are interacting.

HIV Testing How accurate are all HIV tests? * What are blood tests NOT influenced by? * What are oral tests influenced by? * What are all tests influenced by? * Define false negative. * Define false positive.

Validity of HIV Tests: * All HIV tests are over 99% accurate. * Blood tests not influenced by: - Illness, like the flu or a cold. - Medications. - Alcohol or recreational drugs. - Vaccinations. * Oral tests are influenced by: - Eating and drinking. - Mouthwash and dental cleaning. * All tests are influenced by: - The window period: time since exposure/infection. - Sensitivity of the HIV test. * Things to know: - False negative: when HIV test does not detect antibodies in person who has the HIV virus. This is extremely rare. - False positive: when HIV test incorrectly detects antibodies. This is extremely rare, though it happens; this is why there are always confirmatory tests.

HIV Testing * What are the different viral load tests? * What do these tests tell you? * What types of people use this method of HIV testing? * What does this test detect? How soon? Compare to antibody tests. * Compare the cost of viral load tests to antibody tests. * How is this test done? When are results returned?

Viral Load tests: * PCR or RNA tests or HIV NAAT (nucleic acid amplification testing). - Tells you about viral load, common for people to use that know they have HIV, but want to monitor treatment and effectiveness of drugs. * Detects the virus directly as soon as 10 days after infection (virus shows up earlier in blood stream). - As soon as it appears in the bloodstream, before antibodies develop. * Cost more than antibody tests, generally not used for screening. * Done with blood sample drawn from a vein, and results can take a few days or even a week or two.

HIV Testing * If positive, what happens to your results? Why? - Describe confidentiality. * Define partner notification laws. * What can occur if these laws aren't followed? * What is an old California law relating to the transmission of HIV to others? - Compare the consequences of this law to situations involving other diseases. * What is the new version of this law? Explain.

What Does the Law Say? * It's complicated. * If positive, results are reported to your state health department. - To allocation of resources and funding (to determine if there's an outbreak occurring). * State health department removes all personal info, sends to the CDC. - CDC does not share this information. * Partner-notification laws are common. - If you test positive, you or your provider may be legally obligated to tell partners. - In some states, if you don't tell partners, you can be charged with a crime. * California's SB 239, signed in 2017. * Old law: HIV could trigger a felony prosecution - up to 8 years in prison. - Exposure to all other communicable diseases could lead to misdemeanors. * Current law: HIV is treated the same as all other major communicable diseases. - Must prove intended to transmit a communicable disease. - If taking precautions to reduce risk (confoms, meds) you don't have intent.

Transmission and Prevention * What doesn't transmit HIV? * Who was Ryan White?

What doesn't transmit HIV: * Casual contact: - Breathing in the same air. - Shaking hands. - Swimming in the same pool. - Sharing a water glass. * Super safe sex: - Kissing. - Cuddling. - Frottage Ryan White: Banned from school due to being HIV+.

Week 7 Quiz The early AIDS PSA titled "Macho" focuses on which two principles of behavior change? Choose all that apply. behavioral emotional structural interpersonal

behavioral emotional

Week 7 Quiz Brenda is going to donate one of her kidneys to her twin sister. They are both 14 and have never had sex. Should the hospital screen Brenda for HIV? Yes, it is always performed no matter the risk profile of the donor No, Brenda is clearly not at risk Yes, because people, even teen-agers, lie on those forms No, because kidneys donations cannot transmit HIV

Yes, it is always performed no matter the risk profile of the donor

HIV Testing "Sharing Your Test Result" * "Should I share my positive HIV test result with others?" - Partners: what is the benefit of sharing your status with them? - Family and friends: what is the benefit of sharing your status with them? - Employers: how might your employer find out? How? * How would you be protected as an employee against potential responses by your employer?

You should share your HIV status with your sex or needle-sharing partners. Whether you disclose your status to others is your decision. Partners You should disclose your HIV status to your sex or needle-sharing partners even if you're uncomfortable talking about it. Communicating your HIV status allows each person to take steps to stay healthy. Family and Friends Telling friends and family can provide an important source of support in managing your HIV. Studies show that people who disclose their HIV status respond better to treatment than those who don't. Employers Your employer has the right to ask if you have any health conditions that may affect your ability to do your job or that pose a serious risk to others (you may have to disclose your health conditions if you're a health care provider who does procedures where there is a risk of blood or other body fluids being exchanged). If you have health insurance through your employer, the insurance company cannot legally tell your employer that you have HIV. But your employer could find out if the insurance company provides detailed information to your employer about the benefits it pays or the cost of insurance. All people with HIV are covered under the Americans with Disabilities Act. This means that your employer cannot discriminate against you because of your HIV status if you can do your job.

Week 7 Quiz Bobby learned in AIDS Fundamentals last Fall Quarter that around 15% of men who have sex with men who live in Los Angeles are HIV-positive. When he was home in LA over Winter Break, he started dating a guy who he really liked. Bobby didn't worry about condoms when they had sex and didn't think he needed to bother with PrEP. Bobby's attitude could have been the result of which of the following? optimism bias anchoring salience representativeness

optimism bias

Week 7 Quiz HIV can be transmitted in all of the following ways except ... Choose all that apply. blood breast milk vaginal secretions perspiration urine

perspiration urine