BBH Exam4
Centers for Disease Control and Prevention says HPV ...
-is the most common sexually transmitted infection (STI) -a different virus than HIV and HSV (herpes) -so common that nearly all sexually active men and women get it at some point in their lives
Acute stress can increase...
-humoral immunity
The Course of HIV/AIDS: Stage 3
-T cell concentration falls -immune function impaired -oppotunistic infections
Psychosocial Barriers to AIDS Interventions: Sensation-Seeking Personality
-Subjective reinforcement of unprotected anal intercourse strongly predicts condom use among gay and bisexual men (Kelley & Kalichman, 1998)
Benefits of Good Sexual Health
-positive relationships -feeling good about yourself and having peace of mind -a healthier body -a satisfying sex life
How Might Cognitive-Behavioral Stress Management (CBSM) Work?
-May lower norepinephrine levels, which tend to be elevated in HIV-infected people [a marker of stress and SAM activation] and inhibit the proliferation of lymphocytes -May contribute to increased sense of mastery over the disease and lead to better diet, more exercise and other self-care behaviors
AIDS (Acquired Immunodeficiency Syndrome)
- life-threatening disease -caused by the human immunodeficiency virus (HIV) -the body's CD4 lymphocytes are destroyed, leaving the victim vulnerable to opportunistic infections
Dr. Betsy Nabel @TEDMED: Humility is Knowing
-"The universe of what we don't know dwarfs that of what we do know," she said. "By having the intellectual courage to say, 'I don't know,' we can give ourselves permission to feel comfortable in this uncomfortable place. And only then can we add, 'I'm going to find out.'" -I DONT KNOW
Global Causes of Death by Income Group
-1000 people from around the world who died in 1year. Of those people: (a) 163 come from low-income countries (where HIV/AIDS is 3rd-leading cause of death), (b) 677 from middle income countries (where HIV/AIDS is the 6th-leading cause of death), and (c) 159 from high-income countries (where HIV/AIDS is not in the top 10 causes of death).
A Brief History of AIDS: global deaths peaks
-1984: HIV virus is isolated (to white, gay men) -Late 1980s: begins to spread general population -1991: 100k victims -1993: 200k victims -1994: 400k victims -2006: 65 million HIV infections, 25 million deaths ***peaks in 2005
The Neurological Impact of AIDS
-AIDS affects many body systems, including the central nervous system -AIDS Dementia Complex
Impact on Family Members and Caregivers
-AIDS changes the family structure and roles, often reversing developmental patterns -AIDS can have a profound impact on a surviving partner -AIDS has powerful impact on the psychological and physical health of long-term caregivers
Promoting Disclosure of HIV-Positive Status: Legal stystem
-AIDS is having broad effects on legal systems -In some states, persons who knowingly transmit any STD are guilty of a misdemeanor; in others, a felon
Physiological Factors in the Progression of AIDS: Immunocompetence
-AIDS progresses more slowly among those with strong immune systems
Zika: Virus Transmission
-Africa and South / Central America are affected -1 in 5 people infected with it will get sick
The Neurological Impact of AIDS: AIDS Dementia Complex
-An AIDS-related syndrome involving memory loss, confusion and personality changes
Physiological Factors in the Progression of AIDS
-Average time from HIV infection to AIDS is about 10 years -The period from diagnosis of AIDS until death may be as short as several months or as long as 5 years -Immunocompetence -Genetic vulnerability
Adaptive/Specific immunity: Humoral immunity
-B-cells -produce antibodies -proteins that neutralize pathogens and make it easier to destroy them.
STD: Syphilis
-Bacterial disease with several stages, can result in dementia, paralysis, or death
STD: Gonorrhea
-Bacterial infection of genital tract and urethra
STD: Chlamydia
-Bacterial parasite that can cause sterility in women if it infects the fallopian tubes
STI: Hepatitis B Virus
-Can cause scarring of the liver, liver failure, and liver diseases (cirrhosis, liver cancer) ~350 million chronic cases worldwide
HIV Counseling
-Comprehensive interventions to help people who are HIV-positive to live with the infection -Attempt to counteract emotionally intense, rushed nature of many sexual encounters that is not conducive to clear thinking and negotiating about safe sex -Teaching young men and women to exercise self control and how to resist coercive sexual pressure -Helping people improve their outlook on life, feelings of self-efficacy and sense of personal control should be the focus of interventions
Stigma associated with STDs
-May reduce disclosure -May not seek health care
Inflammation and Heart Disease (a PBS Production)
-Measured Interleukin 6, IL-6 (a pro-inflammatory cytokine) every year for 6 years across a large sample of caregivers and controls in different age groups -Caregivers have higher IL-6 levels when stressed and less able to cope (older ages) -Younger caregivers actually show lower IL-6 levels than controls
Zika: Recommendations (CDC, April 2016): For a man that traveled to or resides in an area with active Zika virus transmission & couples where the woman is pregnant
-Couples in which a woman is pregnant should use condoms consistently and correctly or abstain from sex -Other couples concerned about sexual transmission* -Couples in which a man had confirmed Zika virus infection or clinical illness consistent with Zika virus disease should consider using condoms or abstaining from sex for at least 6 months after onset of illness. -Couples in which a man traveled to an area with active Zika virus transmission but did not develop symptoms of Zika virus disease should consider using condoms or abstaining from sex for at least 8 weeks after departure from the area. -Couples in which a man resides in an area with active Zika virus transmission but has not developed symptoms of Zika virus disease might consider using condoms or abstaining from sex while active transmission persists. -Couples who do not desire pregnancy should use the most effective contraceptive methods that can be used correctly and consistently in addition to condoms, which also reduce the risk for sexually transmitted infections.
If sexually active...
-Critically important to be safe -Get tested regularly -Get treatment promptly
Symptoms and Stages: From HIV to AIDS: DNA
-DNA of infected lymphocyte remains dormant until activated against another virus or foreign agent, at which point it divides and replicates
Adaptive/Specific immunity: Cell-mediated immunity
-Directed by T-cells -Assassins -directly kill cells or command other cells.
Strategies to Combat HIV Reproduction
-Doctors have a number of potent anti-HIV drugs at their disposal. -These widely used drugs block specific steps in the HIV life cycle. -Psychosocial Interventions
AIDS is not transmitted by
-Donating blood -Exposure to airborne particles, food or insect bites -Shaking hands, drinking from same cup -Sharing a work or home environment
Demographic Patterns
-Ethnic/racial differences in rates of HIV transmission are thought to reflect sociocultural differences in drug use and the acceptance of homosexual and bisexual practices -Needle sharing -Initial spread among U.S. drug users and gay men in part due to the small, closed nature of these communities
Innate/Natural immunity: Response
-Fast, eliminates antigens, recruits help
AIDS: History: Patient Zero
-Gatan Dugas
Symptoms and Stages: From HIV to AIDS
-HIV infects mostly lymph tissues -HIV infects and destroys a type of lymphocyte called the T cell -Retrovirus: virus that copies its genetic information onto the DNA of a host cell
STI: Human Immunodeficiency Virus (HIV)
-HIV is an incurable sexually transmitted virus that attacks and weakens a person's immune system (more on HIV shortly)
People infected with other STIs are up to five times more likely to acquire HIV infection if exposed to the virus...
-HIV-infected individuals are also more likely to transmit HIV to others sexually if they are also infected with another STI. -STIs increase susceptibility to HIV -Genital ulcers cause lesions in genital tract lining -Inflammation increases concentration of CD4+ and other cells, serve as targets for HIV
HIV Counseling: Antoni et al. (2000)
-HIV-positive men received a 10-week cognitive-behavioral stress management (CBSM) intervention consisting of relaxation training, cognitive restructuring to identify and change cognitive distortions, techniques to improve coping skills, manage anger
Stress and Social Support: Theorell et al. (1995)
-HIV-positive patients who reported greater social isolation and less emotional support showed a significantly greater decline in T cells over the five-year study
STI: Human Papilloma Virus (HPV)
-HPV is the most common viral infection -There are over 30 types of sexually transmitted HPV -Can lead to genital warts (benign) or precancerous lesions
The Epidemiology of AIDS
-In U.S., AIDS has taken greatest toll on young men, particularly African-Americans and Hispanic-Americans -An estimated 1.1 million people in the United States are living with HIV, - almost one in five (18 percent) are unaware of their infection -Increase in HIV among those over age 50 is partly due to advanced HIV therapy, which has increased life expectancy -Risk and symptoms of HIV and other STIs may be masked in older people
Sexually Transmitted Infections (STIs)
-Infections that are spread primarily through person-to-person sexual contact
Findings Encouraging, But Many Trials Have Methodological Problems
-Insufficient power -No controls for nonspecific aspects of intervention -Broad markers of immune function (specific?) -Lack of understanding of the active elements of multimodal interventions -Longer follow-ups needed -Clinically-relevant outcomes needed -Choice of appropriate populations to study
Overall, Research Findings Encouraging, But Many Trials Have Methodological Problems
-Insufficient power (not enough participants to understand what's going on) -No controls for nonspecific aspects of intervention -Broad markers of immune function are typical ( less specific?) -Lack of understanding of the active elements of multimodal interventions -Longer follow-ups needed -Clinically-relevant outcomes needed -Choice of appropriate populations to study
Chronic stress can decrease humoral immunity
-Long-term caregivers have reduced antibody response in response to vaccination -greater IL-6 (inflammation) levels at older ages -Kiecolt-Glaser et al. (2003)
Factors That Distinguish Long-Term Survivors
-Maintaining physical fitness by engaging in regular exercise (Aerobic exercise bolsters immunocompetence) -Keeping an upbeat, positive outlook (AIDS progresses more rapidly among the chronically depressed_ -Avoiding social isolation (having a large social network is positively correlated with longevity among AIDS patients)
Psychosocial Barriers to AIDS Interventions Why safe sex behaviors are low
-Media depictions of sexual encounters do little to promote interventions aimed at promoting safe sex -Misconceptions of HIV/AIDS are common (e.g., that danger of infection depends on the depth of the relationship with one's partner)
Genital Human Papillomavirus (HPV)
-Most common sexually transmitted infection -Passed on through genital contact, most often during vaginal and anal sex -Also may be passed on through oral sex, even when the infected person has no signs or symptoms -Highest prevalence rates for HPV infection found among women aged 20-24 -Many are symptom-free: some develop into serious health problems
Educational Programs
-Most likely to be effective when messages are adapted to the target group -Messages that focus on culturally relevant themes, such as cultural pride, family responsibility
Demographic Patterns: Three global patterns of HIV transmission
-N. America/W. Europe: gay men and IV drug users -Sub-Saharan Africa/Caribbean: HIV/AIDS commonly found in heterosexuals, equally distributed among women and men -Asia, E. Europe, N. Africa and some Pacific countries: HIV infection rates still relatively low ***Globally, heterosexual transmissions far outnumber all other sources of HIV transmission
What are the two key abilities of the immune system?
-Natural / Innate Immunity -Adaptive / Specific Immunity
Innate/Natural immunity: Recognition
-Nonspecific
Strategies to Combat HIV Reproduction: Psychosocial Interventions
-Often based on social-cognitive theory -Perceived social norms regarding peer acceptance of HIV risk-reducing behaviors -Self-efficacy beliefs controlling one's thoughts, emotions -Social skills - the ability to respond assertively in negotiating risky behaviors
Why does $$ matter with AIDS?: Mathato Notsi, 29
-Only 1 in 4 children can receive life-saving antiretroviral treatments in Lesotho South Africa -her daughter is one of those children
Pre- and Post-CBSM Treatment Anxiety and Anger in HIV-Positive Men
-Prior to intervention, the men assigned to CBSM showed mood and anxiety scores similar to those men assigned to the control condition, as measured by scores on the Profile of Mood States. -Following the intervention, CBSM participants reported significantly lower post-treatment anxiety and anger than their control group counterparts.
Adaptive/Specific immunity: Response
-Slow acting -takes days to mount a response -recruits help -has MEMORY -this is why you get vaccinated
Stress and Social Support: Galvan et al. (2008)
-Social support, particularly from peers is critical factor in the progression of HIV and AIDS -Even if delivered over the Internet (Mo & Coulson, 2008)
Physiological Factors in the Progression of AIDS: Genetic vulnerability
-Some people inherit a gene that may convey AIDS immunity
Adaptive/Specific immunity: Recognition
-Specific - even to a specific strain of the flu or a bacteria
Psychosocial Factors in the Progression of AIDS
-Stress, negative emotions, social isolation -May influence the pace at which AIDS progresses -May alter the hormonal and immune environments that affect the resistance of host cells to HIV -Pessimistic outlook, depression, negative beliefs about self are all linked with a decline in T cells -Psychological inhibition linked to more rapid development of cancer and other chronic illnesses
HIV Counseling: Research Findings
-Strong association between perceived self-efficacy and condom use among college students, gay men and African-American teenagers -Relationship among self-efficacy, outlook on life and tendency to engage in high-risk sexual behaviors
"Hidden" epidemic
-Symptoms are often delayed or minimal Individual may be unaware -This contributes to spread of disease
What are the two key abilities of the immune system?: Adaptive / Specific Immunity
-Takes several days to engage -more efficient -Lymphocytes -B-cells -T-cells -CD8 "cytotoxic" -CD4 "helper"
Community-Wide Interventions: Effective interventions are those that...
-Target high-risk behavior among at-risk individuals -Teach specific skills to reduce risk -Promote communication skills necessary to maintain lower-risk sexual relationships -Address social, cultural norms surrounding sexual activity -Focus on improving self-esteem and feelings of self-efficacy -Address faulty thinking -Involve coordinated, community-level education
New HIV Infections in the United States by Risk
-The estimated incidence of HIV has remained stable in recent years, at about 50,000 new cases each year. -Some groups are affected more than others, especially men who have sex with other men (MSM), intravenous drug users (IDUs), and, among races/ethnicities, African-Americans.
AIDS and Gender
-The rate of AIDS among women is increasing at a faster rate than that of men -In 2010, women accounted for estimated 20 percent of new HIV infections -Most of these (84 percent) were from heterosexual contact -African-American women and Latinas are disproportionately affected by HIV compared with women of other races/ethnicities -Globally, girls and women are more likely to contract HIV
The AIDS Epidemic: HIV (Human Immunodeficiency Virus)
-The retrovirus that causes AIDS -HIV injects its genome into lymphocytes so that it reproduces when the cells are activated
AIDS-Preventing Precautions
-There are a number of simple precautions that will protect against AIDS and other STIs -Health experts offer the following specific precautions: -Stay sober -Avoid anal intercourse -Be selective in choosing partners -Use latex condoms -Never share needles -Don't become complacent about AIDS and STDs
AIDS: History
-originated in West-central Africa -spread to humans when an animal handler was bitten -1980: 55 young men diagnosed with "rare form of cancer" of blood vessels (Kaposi's Sarcoma)
Medical Interventions
-Until recently, HIV infections were almost always a progressive, fatal disease -The HAART Regimen (highly active antiretroviral therapy)
STD: Herpes
-Viral disease with painful lesions and no cure
What are the two key abilities of the immune system?: Natural / Innate Immunity
-Vital, immediate, and general neutrophils, macrophages, NK cells, complement proteins
AIDS and Gender: Why are girls and women more likely to contract HIV?
-Women often less able to protect themselves -are economically and culturally subordinate to men -More of the virus is found in ejaculate -Women progress to AIDS at a lower viral load
Medical Interventions: The HAART Regimen:
-Zidovudine (AZT) : first anti-AIDS drug; many side effects -often combined with protease inhibitors which block production of mature viral proteins -Expensive -Poor adherence to regimen -25 percent stop therapy within first year -Interventions to promote HIV adherence
Zika: US Transmission of Zika (as of 4/6/16)
-Zika virus disease and Zika virus congenital infection are nationally notifiable conditions. -354 cases reported
The Course of HIV/AIDS: Stage 4
-all immunity lost -full-blown AIDS
Symptoms and Stages: From HIV to AIDS: Genome
-all of the DNA information for an organism
General Conclusions
-brain talks to the immune system through endocrine and nervous systems -immune system talks to the brain -stressors of all types can alter immune activity -Estimated that 2/3 studies show an intervention-related change in at least one immune parameter -No consistent pattern with regard to immune changes -Some evidence that decreases in negative moods may be an important mediator of intervention effects -Social support may be an active ingredient -Positive expectancies/placebo effects
General Conclusions on Psychoneuroimmunology
-brain talks to the immune system through endocrine and nervous systems; immune system talks to the brain; stressors of all types can alter immune activity -Estimated 2/3 of studies show an intervention-related change in at least one immune parameter -No consistent pattern with regard to immune changes -Some evidence that decreases in negative moods may be an important mediator of intervention effects -Social support may be an active ingredient -Positive expectancies/placebo effects
Trichomoniasis
-caused by a parasite -infections vagina in women and in urethra for men -spread through unprotected vaginal sex -treated with antibiotics -abdominal pain, unusual discharge -increased HIV susceptibility
Genital Herpes
-caused by herpes symplex virus -blisters on vaginal & anal area & sometimes mouth -spread through unprotected vaginal sex -treated with antibiotics, but no cure -fatigue, fever -hides in nerve endings and reoccurs
2 foundational observations led to founding of field of Psychoneuroimmunology: Ader & Cohen (1975)
-classical conditioning of immune function -Conditioned "Pavlovian" responses in rats -Saccharin-sweetened water (conditioned stimulus) + Nausea and taste-aversion drug -Later, just giving conditioned stimulus led to death in some rats -Hypothesized immunosuppression supported by direct experiment: -Highly reproducible finding of lower antibodies following immunization of conditioned animals compared to control unconditioned animals
Medical Interventions: Dynamic tailoring
-delivery of individualized health messages over multiple time periods to provide unique feedback based on patient status
Zika: Symptoms
-fever -headache -red eyes -rash -fatigue -muscle pain
How HIV Is Transmitted: Hemophilia
-genetic disease -blood fails to clot quickly enough -uncontrollable bleeding
Gonorrhea
-infects genitals, anus, throat -caused by bacteria -spread during unprotected sex -treated with antibiotics -women do not show symptoms, men do
The Course of HIV/AIDS: Stage 1
-initial HIV infection -immune system destroys most of the virus -symptoms are mild or nonexistent
HIV Counseling: Research Findings: Carvajal et al. (1998)
-inner-city minority adolescents who were more optimistic were more confident of their ability to practice safe sex
The Course of HIV/AIDS: Stage 2
-latency period -T cell concentration falls -HIV concentration rises -symptoms: swollen lymphnodes ***the symptoms cannot show for many years while the person has it--it remains dormant--the person spreads HIV without even knowing they have it
Types of HPV
-many different types
Chlamydia
-most common -infections in throat, genital, & anus -caused by bacteria -spread during unprotected sex -treated with antibiotics -women do not show symptoms, men do -if untreated, men and women can become infertile
2 foundational observations led to founding of field of Psychoneuroimmunology: Felten and colleagues (1981)
-nerve network to blood vessels, and immune system (thymus and spleen, terminating near lymphocytes, macrophages, and mast cells)
How HIV Is Transmitted
-present in high concentration in the blood and semem of seropositive persons -can enter through the body through any tear in the skin or mucous membrane -less easily transmitted than most other viruses -Children are usually infected through the mother's blood that passes through the placenta during labor and birth -Very low risk of accidental infection
Strategies to Combat HIV Reproduction: social-cognitive theory
-reciprocally determined relationships among environmental events, internal process and behavior
Zika: Treatment
-rest -water -medicine
Zika: Prevention
-sleep under mosquito net -keep doors and windows closed
Types of HPV: Health Problems
-some can cause health problems -genital warts, cancers -vaccines that can stop health problems from happening
Promoting Disclosure of HIV-Positive Status: Research studies reveal...
-that many college students would lie about their sexual history to obtain sex
HIV Counseling: Research Findings: Morrill et al. (1996):
-women who avoided unprotected intercourse had more favorable attitudes toward condoms and a greater internal locus of control regarding their health
Regional HIV/AIDS Statistics, End of 2010
1. (most) sub-sahara Africa 2. South and Southeast Asia 3. (least) Oceana
Psychosocial Barriers to AIDS Interventions
1. Despite massive educational efforts, rates of condom use and other safer sex behaviors are low 2. Optimistic bias and perceived invincibility are common 3. AIDS Complacency 4. Sensation-Seeking Personality
Regional HIV/AIDS
1. Subsahara Africa 2. Asia / The Pacific 3.Western / Central Europe & North America
5 Action Steps to Good Sexual Health
1. Value who you are and decide what's right for you 2. Treat your partners well and expect them to treat you well 3. Build positive relationships 4. Get smart about your body and protect it 5. Make sexual health part of your healthcare routine
People infected with other STIs are up to ____ times more likely to acquire HIV infection if exposed to the virus
five
2 foundational observations led to founding of field of Psychoneuroimmunology: Psychoneuroimmunology (1981), Ader, Cohen, & Felten (eds)
stimulus goes into brain --> products: behavioral responses hypothalamus -->atomic nervous system --> immune competence hypothalamus -->pituitary --> adrenal --> immune competence
Coping With HIV and AIDS: Impact on the Individual
• Stigma of AIDS • Acknowledging the possibility of dying young • Depressive, suicidal thoughts common, especially among those who feel a withdrawal of family and social support • Not all patients who test HIV-positive develop psychological problems
Psychosocial Barriers to AIDS Interventions: AIDS Complacency
• Women involved in casual sexual relationships are 11 times more likely than women in more committed relationships to maintain safer sexual behaviors