1. o Hypothesized region of origin and original source and transmission route of HIV-1 virus
    § West Africa region§ Chimpanzees were the original host of HIV-1, so probably Zoonotic (animal to human) transmission
  2. o First signs and symptoms of the epidemic that were discovered
    § Deaths of adult males from Kaposis sarcoma or Pneumocystis Pneumonia
  3. · Origin and discovery of the HIV/AIDS epidemic:
    § Los Angeles, San Francisco, and New York
  4. o Type of virus for HIV
    § lentivirus that is a family of the retroviruses§ RNA makes up the genetic material of the HIV virus
  5. o Number and names of the HIV virus strains
    § HIV-1 and HIV-2
  6. o Most common strain of HIV in humans
    § HIV-1
  7. o Most common clade of the HIV-1 virus among humans
    § HIV-1 M clade (90% of HIV-1 cases)
  8. o Main drivers of the HIV-1 epidemic in East Africa
    • -Labor migration,
    • -high ratio of men to women in urban settings
    • - low social and economic status of women
    • - low circumcision rates
    • - Co-occurrence of STI's
    • - Sex work
  9. o Region of the world most impacted by HIV/AIDS (i.e. most number of cases and deaths)
    § sub-Saharan Africa
  10. o Time trend over the past two decades of the global epidemic
    • § increasing prevalence and increasing incidence
    • § as of 2009 incidence rate is beginning to decrease
    • § annual death rate starting to decrease as of 2009
  11. o Demographic, geographic, and transmission trends of HIV/AIDS epidemic in sub-saharan Africa
    • § Women make up the majority of cases
    • § Generalized epidemic (i.e. heterosexual transmission is dominant mode)
    • § Swaziland has the highest prevalence in all of Africa
  12. o Country where ARV's were originally produced
    § United States
  13. o Only region of the world where AIDS death rate is increasing
    § Eastern Europe and Central Asia
  14. o Concentrated HIV/AIDS epidemic
    § Highest transmission and prevalence among CSW, IDU, and MSM
  15. § Concentrated epidemic in the U.S.
    § MSM most common mode of HIV transmission and highest prevalence and incidence rates
  16. o Factors that increase risk of HIV transmission
    • § high viral load
    • § recent infection (acute infection)
    • § mucosal infections
  17. o Order of most efficient (highest probability) modes of HIV transmission
    • § Mother-to-child
    • § Male-male anal sex
    • § man-to-woman vaginal sex
    • § woman-to-man vaginal sex
  18. o Modes of HIV transmission
    • § mother to child via breast milk and in the womb
    • § sexual mucosal contact
  19. o Factors that increase susceptibility to HIV infection
    • § mucosal infections
    • § females sex
    • § un-circumcised men
    • § vaginal irritants
    • § traumatic contact (such as forced vaginal or anal sex)
  20. o Know difference between Behavioral versus Biological based interventions
    § Behavioral = Voluntary counseling and testing, abstinence, be faithful, promoting condom use, delaying intercourse, family planning, breastfeeding counseling

    § Biological = condoms, microbicides, Circumcision, treating STI's, ARV's
  21. o Know the main effect that HIV/AIDS has on people
    • § lowered immune function (reduced ability to fight off infections, and increased susceptibility to dieing from the infection)
    • § results from lowered CD4 cell count
  22. o Know the best HIV prevention method currently available for sexual contact, in addition to other interventions
    • § condoms are the most effective at prevention
    • § other interventions include male circumcision, and treatment of STD's, treatment of infected individuals with ARV's to supress viral load
  23. o Know what a microbicide is
    compound or substance whose purpose is to reduce the infectivity of microbes, such as viruses or bacteria
  24. o Know what Pre-exposure prophylaxis means
    Pre-exposure prophylaxis (PrEP) is any medical or public health procedure used before exposure to the disease causing agent
  25. o Know about PMTCT (Prevention of mother-to-child transmission)
    • § Mothers using ARV's to suppress viral load during pregnancy and during breastfeeding
    • § discouraging breastfeeding in high income countries and encouraging use of baby formula for feeding babies
  26. o Typical groups associated with migration and put at risk to HIV exposure in Africa
    • § Commercial sex workers
    • § Long distance truck drivers
    • § Miners
    • § Refugees
    • § Military personnel
  27. o Know what oscillating migration refers to and be familiar with the definition of sex trafficking (migration lecture)
    •traveling for work long distances and periodically returning home

    Sex Trafficking = “The recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of person having control over another person, for purpose of exploitation,” which includes prostitution or other forms of sexual exploitation.
  28. o Know some of the public health ethics issues that hindered HIV testing and reporting early on in the U.S. AIDS epidemic
    • § confidentiality to protect against stigma,
    • § avoid discrimination of infected individual
    • § severe psychological burden of having a deadly disease
    • § lack of effective treatment early on
    • § strict interpretation of protection of patient's
    • rights
  29. o Know reasons why testing and reporting became more prominent in the fight against AIDS
    • § improved treatment efficacy to fight off AIDS
    • § improved prophylaxis treatment to fight off opportunistic infections
    • § improved treatment to prevent mother-to-child transmission
    • § AIDS activists lobbied for more access to testing
  30. o Know how Cuba responded to their HIV/AIDS epidemic early on
    mandatory HIV testing, mandatory reporting of infected individuals, forced quarantine of HIV positives
  31. o Know the current U.S. Policy with regard to HIV testing and reporting
    • § pregnant women are automatically tested for HIV unless they refuse testing
    • § voluntary counseling and testing for the general population
    • § mandatory reporting of HIV and AIDS cases to local health departments and the CDC
  32. o Know the reasons why ARV's became more widely available and more affordable
    • § intellectual property rights regarding ARV's were relaxed
    • § generic ARV drugs were allowed to be produced
    • § Price-equity measures were agreed upon by drug companies
  33. § know what price-equity refers to
    § low cost ARV's for poor countries and higher costs for ARV's for rich countries
  34. o Know some of the early mistakes made in the global response to HIV/AIDs epidemics
    • § misunderstanding of the biology of HIV
    • § “Gay-related infecious disease”
    • § stigma associated with the disease so politicians refused to respond
    • § Biological interventions were too heavily relied upon
    • § sexual behavioral interventions were ignored and discouraged
    • § a lack of mandatory reporting of HIV positive individuals
    • § lack of understanding the local context of the local conditions in Africa
    • § condoms were not culturally appropriate in Africa
    • § over reliance on commodities in poor countries (condoms, drugs)
    • § applying a “once size fits all” approach to interventions
    • § high level of gender inequality in Africa
  35. o Know the regions of the world most impacted by HIV/AIDS
    • sub-Saharan Africa
    • Carribean
    • Eastern Europe and Russia
  36. o Number of people estimated to be infected with HIV/AIDS
    § 33.3 million
  37. o Know the epidemiology of HIV/AIDS in the U.S.
    • § groups most impacted by race, age group, sexual preference, and IDU
    • § Mode of transmission most common :
    • 1. MSM
    • 2. heterosexual contact
    • 3. IDU
    • § White-gay men, African Americans and Hispanics are disproportionately impacted by HIV/AIDS
    • § White's and mother-to-child transmission have seen a decrease in HIV incidence over the past few decades
    • § Most cases are in urban cities
    • § 15-24 make up half of new HIV cases
    • § major risk factors: STI infection, poverty, substance abuse, younger women having sex with older men, biology of women
  38. o Know the major prevention interventions
    • § sexual health education
    • § safer sex, discourage substance abuse, delaying intercourse, discourage multiple partners,
    • § Harm reduction strategies for IDU
    • § safe needle and syringe exchange programs
    • § drug treatment
    • § promotion of condoms
    • § testing as prevention (especially during pregnancy)
    • § counseling along with testing
    • § partner notification
    • § prompt treatment after testing positive
    • § peer based interventions
    • § targeting MSM and Sex Worker communities
    • § Structural interventions
    • § improving gender equality
    • § improving health systems (including quality, accessibility and availability of services)
    • § PreP (Pre-exposure prophylaxis)
  39. o Know the definition of serostatus
    the presence or absence of particular antibodies in an individual's blood
  40. o Know the definition of HAART and what it consists of
    § highly active antiretroviral therapy – a combination of three drugs typically
  41. o Know the most common barriers to HAART treatment adherence
    • can't afford costly drugs
    • lack of access to health facilities
    • side effects of drugs
    • substance abuse
    • drug stock outs
  42. o Know the problems posed by HIV/AIDS-related stigma
    • § lack of disclosure of HIV status to partners
    • § barrier to people seeking treatment or testing
    • § discrimination in the work place and among family and friends
    • § causes psychological trauma
  43. o Know the issues that hinder treatment as prevention efforts
    • § lack of ARV treatment adherence
    • § ARV's not completely effective at suppressing viral load
    • § could lead to perception that condoms are not necessary for protection
    • § substance abuse
    • § can take away funds from other prevention interventions among at-risk groups
  44. o Know some of the attitudes and behaviors that hinder education efforts on HIV/AIDS
    • strong biologic urge for sex
    • drug addictions
    • cultural and religious values
    • mistrust of public health
    • lack of consistent, credible, and targeted sex education programs
  45. o Know what PEPFAR stands for
    § President's Emergency Plan for AIDS Relief
  46. PEPFAR goals:
    • § provide ARV treatments, treatment and care facilities, voluntary counseling and testing centers, education program (condom, abstinence and monogamy) for millions of people in poor and low income countries
    • § strengthen health systems for sustainable country programs to combat HIV/AIDS
    • § prevention of mother-to-child transmission
  47. What phase is PEPFAR in?
    Phase 2
  48. When was PEPFAR authorized and who authorized it?
    President Bush in 2003
  49. When/Who REauthorized PEPFAR?
    2008/President Bush
  50. T/F:
    PEPFAR strategy was altered under the Bush Administration
    • False.
    • It was altered under the Obama Administration
  51. Major partners of PEPFAR
    • § Global Fund to fight AIDS, Malaria, and Tuberculosis
    • § Bill and Melinda Gates Foundation
    • § UNAIDS
    • § WHO
Card Set
OSU Eric Coker Final