HIV Medication Fact Sheets. Easy to Use Fact Sheets

HIV Medication Fact Sheets
Easy to Use Fact Sheets

This area of our site is provided as a quick reference only. We strongly urge you to discuss medication concerns with your physician.

Important Fact! - Remember to always take medications exactly as prescribed and not to change or stop your medications without first speaking with your physician.

Integrase Inhibitors
Integrase is an enzyme that does what the name implies; it integrates HIV genetic material into the DNA of human CD4 cells making it possible for the infected cell to make new copies of HIV. By interfering with integrase during the HIV life cycle, the integrase inhibitors prevent HIV genetic material from integrating into the CD4 cell, thus stopping viral replication.

Entry Inhibitors
Entry Inhibitors work by interfering with HIV's entry into the CD4 cell. By interfering during the entry phase of the HIV life cycle, entry inhibitors block HIV replication.

Non-Nucleosides Reverse Transcriptase Inhibitors (NNRTI's)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) work by binding tightly to the enzyme reverse transcriptase which prevents viral RNA from converting to the viral DNA that infects healthy cells.

Nucleotide Analogs
Like the nucleoside analogues such as Retrovir (AZT) and Videx EC (didanosine), nucleotide analogues inhibit reverse transcriptase. However, they are active in their native form, unlike nucleosides that only work in cells that have the machinery to activate the drug by a process called phosphorylation. This means that the nucleotide analogues may be active against HIV in a wider variety of infected cells.

Protease Inhibitors (PI's)
Protease Inhibitors stop HIV replication by preventing the enzyme protease from cutting the virus into the shorter pieces that it needs to make copies of itself. Incomplete, defective copies are formed which can't infect cells.

Nucleoside Reverse Transcriptase Inhibitors (NRTI's)
Nucleoside Reverse Transcriptase Inhibitors (NRTIs) work by being incorporated into the viral DNA, making it ineffective. These compounds suppress replication of retroviruses by interfering with the reverse transcriptase enzyme. The nucleoside analogs cause premature termination of the proviral (viral precursor) DNA chain.

Combination Medications
In an effort to improve medication adherence and to make it easier to take your medications each day, many medications are combined into one pill or capsule. Fewer pills each day has been shown to improve adherence which we know improves the effectiveness of HIV regimens.

HIV Medications. How Much Do They Cost?

HIV Medications
How Much Do They Cost?

It's no secret, HIV medicines are very expensive. For most, insurances, drug assistance programs, or community resources pay most of the cost. But what about those who are not so fortunate. While we all know HIV medications are very costly, not taking them can be even more costly. Have you ever wondered what those HIV medications you are taking cost each month? The following table will give you an idea just how pricey HIV medications can be.

Important Fact! - Prices will vary depending where they are purchased and how they are paid for. Mail-order pharmacies may be cheaper than your neighborhood pharmacy for instance. The prices given here are for estimates and comparisons only. Check with your local pharmacy and your drug insurance to find out just how much your HIV medications will cost you.

COST PER MONTH (estimates) - Medication Fact Sheets
Agenerase	$772
Aptivus	$1117.50
Combivir	$752.64
Crixivan	$570.96
Emtriva	$347.11
Epivir 300mg	$347.11
Epzicom	$813.55
Fortovase	$263.35
Fuzeon	$2315.40
Hivid	$273.00
Invirase	$748.50
Kaletra	$796.26
Lexiva	$658.99
Norvir	$321.46
Rescriptor	$316.35
Retrovir	$405.59
Reyataz	$892.91
Sustiva 600mg	$499.43
Trizivir	$1164.35
Truvada	$867.99
Videx EC 400mg	$346.04
Viramune	$442.45
Zerit	$385.88
Ziagen	$466.44

_{Source: Test Positive Aware Network; "Annual HIV Drug Guide"; 2006.}

Are HIV Positive People Disabled People?

Are HIV Positive People Disabled People?
Those Living with HIV are Considered Disabled People

A common question I get each day is from HIV positive people asking how to access disability benefits. That made me think; is HIV a disability? If so, what are your rights in the workplace? There are people who would say absolutely not. There are people living with HIV that would say yes, HIV is a disability. Thanks to an occurrence in 1994, we know the legal answer to the question; is HIV a disability?

It All Started With A Trip To The Dentist
In September of 1994, Sidney Abbott visited the office of dentist Randon Bragdon. This routine visit would spark a controversy that would eventually involve the United States Supreme Court. On that day, Dr. Bragdon refused to fill Ms. Abbott's simple cavity because she admitted to being HIV positive. Ms. Abbott felt she was being discriminated against because of her HIV.

A Disturbing Trend
At the time, Ms. Abbott's experience was just another in a growing number of such discrimination by doctors and dentists refusing to treat HIV positive people. AIDS activists and medical professionals feared that if this mentality were left to spread among a growing number healthcare professionals, the quality and availability of HIV care would decline, placing HIV infected people at a definite disadvantage and frankly in grave danger.

The Debate - Was Ms. Abbott's HIV a Disability?
How did Dr. Bragdon justify his decision not to treat Ms. Abbott? The dentist argued that since Ms. Abbott showed no physical signs or symptoms of HIV or AIDS, she was not disabled and therefore was not protected by Federal law. The law Dr. Bragdon was referring to was The Americans with Disabilities Act (ADA), a law that forbids discrimination against people who are disabled.

Ms. Abbott countered that her HIV impacted her ability to reproduced, rendering her disabled. She felt that because she was disabled, Dr. Bragdon's refusal to treat her was in direct violation of the ADA. The Supreme Court agreed. In June of 1998, the High Court stated that people infected with HIV were entitled to protection under the Americans with Disabilities Act, regardless of their symptoms or lack of symptoms. Ironically, if that same arguement was made today, Ms. Abbott may have a hard time proving her case since we know that HIV does not prevent an HIV positive women from pregnancy and having children. This would mean that Ms. Abbott's contention that HIV prevented her from reproducing and therefore she was disabled, had no medical basis.

How Does This Help You?
The ADA says the HIV positive person has rights and protections from discrimination based on HIV disease. That person is also entitled to workplace accomodations that allow them to perform their jobs efficiently, while protecting the health of the employee. For instance, if an HIV positive person has peripheral neuropathy in the feet, the ADA says the employer must provide the employee with a chair that will allow him or her to sit down while working to ease the discomfort of the neuropathy. If their job can't be performed while sitting, the employer must make every effort to place that employee in a job they can do while sitting.

The rights and provisions provided by the ADA are protected by Federal law and confirmed and backed by The United States Supreme Court. Because people both symptomatic and asymptomatic HIV infected people are protected by the ADA, employers must make reasonable accommodations for the infected person. For instance, under the ADA, employers must allow time away from work to seek medical care such as doctors' visits, trips to the pharmacy to pick up medication, and time to take that medication in a private setting. In addition, employers must make reasonable accommodations regarding schedule modification, reassignment to vacant positions that are better suited to the person's limitations, and must provide equipment that will allow the person to better perform his or her job.

What Should I Do if I Feel I'm Being Discriminated Against?
If you feel you are being discriminated against or you feel that you may need the provisions of the ADA to perform your job, consult your doctor. Take an honest, objective look at your general state of health, stamina, mental health, and ability to perform your job. If you feel accommodations such as those provided by the ADA are needed, take your request with supporting medical information to support your claim to your local ADA office. They can guide you through the process step-by-step and show you how to get the workplace accomodations you are entitled to. If after filing your ADA request in good faith and your employer does not make reasonable efforts to accommodate you, consult legal services to see if you do truly have a case. The key is to be realistic in what you are capable of and what you expect from your company.

Important Information!
Keep in mind that if you file an ADA request it may mean that at some point in the process you will be required to allow your employer access to some parts of your medical record, including those associated withyour HIV care. Simply put, in order to get the accomodations you feel you need in order to work, making your HIV+ status known to your employer may be necessary.

Important Instructions!
Never sign any document permitting your employer access to your medical records without first speaking with your doctor and attorney. If you can't afford an attorney, check with your local HIV/AIDS agency for the names of lawyers in your area that specialize in HIV legal matters (many of which are free of charge to those living with HIV).

The Family Medical Leave Act (FMLA)

The Family Medical Leave Act (FMLA)
How It Can Help The HIV Positive Person

What is the Family Medical Leave Act?
The Family Medical Leave Act of 1993 (FMLA) applies to private sector employers that have 50 or more employees living within 75 miles of the work site. Eligible employees may take leave for serious health conditions or to provide care for an immediate family member with a serious health condition, including HIV/AIDS. Eligible employees are entitled to a total of 12 weeks of job-protected, unpaid leave during any 12-month period.

What Protections Does FLMA Offer
An FMLA leave, allows an eligible employee to continue group health plan coverage just as if he or she was working. Upon return from leave, the law requires that employees be restored to the same or an equivalent position with equivalent pay, benefits, and working conditions.

Diagnosis Disclosure May Be Required
In order for individuals with HIV or AIDS to invoke FMLA protection, the disclosure of medical information to the employer may be required. Employers are not required to provide unpaid medical leave under FMLA if they are not informed that a disability or serious health condition exists. If an employee makes an employer aware of his or her AIDS or HIV infection, laws such as the American with Disabilities Act (ADA) require that information to be held in strict confidence.

How To Tell Someone You Have HIV
What is the Americans With Disabilities Act

Sources: Centers for Disease Control; "Business Responds to HIV/AIDS"; 2006.

Preventing Infections from your Pet. Kepping You and Your Pet Healthy

Preventing Infections from Your Pets
Kepping You and Your Pet Healthy

First and foremost, you DO NOT have to give up your pets. Secondly, HIV CAN NOT be spread by, or to your pets. While the risk of infection from your pets is real, taking a few simple precautions is all you need to do in order to own your pets safely.

Should I keep my pets?
Yes. Most people with HIV can and should keep their pets. Owning a pet can be rewarding can help you feel psychologically and even physically better. For many people, pets are more than just animals; they are like members of the family. However, you should know the health risks of owning a pet or caring for animals. Animals may carry infections that can be harmful to you. Your decision to own or care for pets should be based on knowing what you need to do to protect yourself from these infections.

What kinds of infections could I get from an animal?
Animals can have cryptosporidiosis ("crypto"), toxoplasmosis ("toxo"), Mycobacterium avium complex ("MAC"), and other diseases. These diseases can give you problems like severe diarrhea, brain infections, and skin lesions. You can learn more about many of these diseases and how to prevent them from other brochures in this series. These are listed at the end of this brochure.

What can I do to protect myself from infections spread by animals?

• Always wash your hands well with soap and water after playing with or caring for animals. This is especially important before eating or handling food.
• Be careful about what your pet eats and drinks. Feed your pet only pet food or cook all meat thoroughly before giving it to your pet. Don't give your pet raw or undercooked meat. Don't let your pets drink from toilet bowls or get into garbage. Don't let your pets hunt or eat another animal's stool.
• Don't handle animals that have diarrhea. If the pet's diarrhea lasts for more than 1or 2 days, have a friend or relative who does not have HIV take your pet to your veterinarian. Ask the veterinarian to check the pet for infections that may be the cause of diarrhea.
• Don't bring home an unhealthy pet. Don't get a pet that is younger than 6 months old; especially if it has diarrhea. If you are getting a pet from a pet store, animal breeder, or animal shelter (pound), check the sanitary conditions and license of these sources. If you are not sure about the animal's health, have it checked out by your veterinarian.
• Don't touch stray animals because you could get scratched or bitten. Stray animals can carry many infections.
• Don't ever touch the stool of any animal.
• Ask someone who is not infected with HIV and is not pregnant to change your cat's litter box daily. If you must clean the box yourself, wear vinyl or household cleaning gloves and immediately wash your hands well with soap and water right after changing the litter.
• Have your cat's nails clipped so it can't scratch you. Discuss other ways to prevent scratching with your veterinarian. If you do get scratched or bitten, immediately wash the wounds well with soap and water.
• Don't let your pet lick your mouth or any open cuts or wounds you may have.
• Don't kiss your pet.
• Keep fleas off your pet.
• Avoid reptiles such as snakes, lizards, and turtles. If you touch any reptile, immediately wash your hands well with soap and water.
• Wear vinyl or household cleaning gloves when you clean aquariums or animal cages and wash your hands well right after you finish.
• Avoid exotic pets such as monkeys, and ferrets, or wild animals such as raccoons, lions, bats, and skunks.
• Important note: If you are bitten, you should seek medical advice.

I have a job that involves working with animals. Should I quit?
Jobs working with animals (such as jobs in pet stores, animal clinics, farms, and slaughterhouses) carry a risk for infections. Talk with your doctor about whether you should work with animals. People who work with animals should take these extra precautions:

• Follow your worksite's rules to stay safe and reduce any risk of infection. Use or wear personal protective gear, such as coveralls, boots, and gloves.
• Don't clean chicken coops or dig in areas where birds roost if histoplasmosis [his-to-plaz-MO-sis] is found in the area.
• Don't touch young farm animals, especially if they have diarrhea.

Are there any tests a pet should have before I bring it home?
A pet should be in overall good health. You don't need special tests unless the animal has diarrhea or looks sick. If your pet looks sick, your veterinarian can help you choose the tests it needs.

What should I do when I visit friends or relatives who have animals?
When you visit anyone with pets, take the same precautions you would in your own home. Don't touch animals that may not be healthy. You may want to tell your friends and family about the need for these precautions before you plan any visits.

Source: Adapted from brochures provided by the Centers for Disease Control, 2000.

Proper & Healthy Pet Care. Keeping You and Your Pet Healthy

Proper and Healthy Pet Care
Keeping You and Your Pet Healthy

We have all heard the saying "a dog is a man's best friend". Indeed, pets provide comfort, love and have been shown to help people cope with illnesses and stresses. But in order to have a healthy environment, people living with HIV/AIDS need to know how to care for their pets in a way that is healthy for them as well as their animals. Here are a few simple guidelines to follow.

• Wash your hands often, especially before eating, drinking, smoking, or tending to wounds.
• Keep your pet's sleeping and eating area clean.
• Have your pets groomed often, keeping their skin and fur clean and healthy. Keep your pet's nails well-trimmed.
• Avoid contact with your pet's bodily fluids (urine, feces, vomit, saliva, etc). Wear disposable gloves when cleaning up after your pet.
• Keep your pets off kitchen surfaces such as counter tops. Clean surfaces with a mild disinfectant before using or before preparing food.
• Don't let your pet lick your face or any open wounds.
• Immediately clean and treat animal bites or scratches.
• Wash and rinse with warm water
• Disinfect with betadine, iodine, peroxide, etc.
• Apply over the counter antibiotic cream
• Keep clean and dry
• Be alert for any redness, heat, swelling, or fever. If so consult your doctor immediately.
• Schedule regular check-ups for your pet at a veterinarian. Make sure your pet's shots are up to date and complete. Get a complete check-up for your pet before bringing him home for the first time.
• Do not feed your pet raw or undercooked meat.
• Don't let you pets near their own feces or other animal's feces.
• Keep your pet out of the garbage and don't allow him to drink from the toilet.

Keep in mind that even if your pet is healthy, it can expose you to potential infection and illness. Here are some specific guidelines for your pets.

Proper Pet Care Guide. HIV Quick Facts

HIV Quick Facts - Proper Pet Care

These links will provide you with the proper pet care you need to know in order to be a healthy pet owner.

• Caring for your Cat
Being Safe While Caring for Your Pet

Proper and safe care of your cat includes:
• Avoid cat scratches. If your cat scratches often, talk to your vet about ways to change your pet's behavior and tools you can use to guard against scratches.
• Never store your cat's litter box in the kitchen or near warm, dry places in your home.
• Change the litter box daily. Wear disposable gloves each time you change the box. Avoid inhaling any litter box particles.
• Disinfect the litter box once a month. For example, each month empty the litter box, fill it with boiling water and leave stand for 10 minutes to kill off any bacteria.
• If your CD4 count is extremely low (e.g.150-200) ask someone else to change the litter box for you.
• Keep your cat indoors. If your cat goes outdoors, don't allow him to hunt birds or rodents.

• Caring for your Fish
Being Safe While caring for Your Fish

Caring for your fish properly and safely will keep you and your pet healthy.
• The most important guideline is to prevent contact with bacteria or other infectious agents in aquarium water.
• Always wear gloves when cleaning your fish tank.

• Caring for your Bird
Being Safe While Caring for Your Bird

Guidelines for proper and safe bird care include the following:
• Before purchasing a large bird or parrot, have it thoroughly examined by a vet before bringing it home.
• Limit your exposure to bird droppings. Wear a mask to prevent breathing in small airborne particles of droppings.
• Never kiss your bird or let it have contact with your mouth.

• Caring for your Reptile
Being Safe While Caring for Your Reptile

Proper and safe care of your pet reptiles include:
• Reptiles can carry Salmonella, often without showing signs of illness. The Salmonella germs can be anywhere on the reptile's body, therefore always use gloves when handling your reptile.
• Wash your hands thoroughly before and after handling your reptile even if gloves are worn.
• Never feed your reptile raw or undercooked meat. If you are feeding it live prey such as rodents, make sure the prey has been raised in a clean environment.

• Proper & Healthy Pet Care
• Preventing Infections from your Pet

Reduce the Risk of Injecting Drugs | HIV / AIDS |

Reduce the Risk...Tips for Injection Drug Users

The sharing of needles between injection drug users is a main source of HIV and Hepatitis C transmission. There are ways to reduce the risk to injection drug users, The Centers for Disease Control make several recommendations.

• Ideally, people who use injection drugs should be regularly counseled to stop using and injecting drugs.
• Enter and complete substance abuse treatment as well as relapse prevention.

For injection drug users who cannot or will not stop injecting drugs, the following steps may be taken to reduce personal and public health risks:

• Never reuse or "share" syringes, water, or drug preparation equipment.

• Only use syringes obtained from a reliable source (such as pharmacies or needle exchange programs).

• Use a new, sterile syringe each time to prepare and inject drugs.

• If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water).

• Use a new or disinfected container ("cooker") and a new filter ("cotton") to prepare drugs.

• Clean the injection site with a new alcohol swab prior to injection.

• Safely dispose of syringes after one use.

If people continue to inject drugs, then they must take other measures to reduce their risk and to stay healthy.

• Injection drug users and their sex partners also should take precautions, such as using condoms consistently and correctly.

• Persons who continue to inject drugs should regularly be tested for HIV.

What is My HIV Risk? Question and Answer

"Am I at Risk for HIV Infection? What Infections am I at Risk For?"

Question: "Am I at Risk for HIV Infection? What Infections am I at Risk For?"
Everyone wants to know if they are at risk for HIV infection or any of a number of sexually transmitted infections for that matter. Do the behaviors in which they engage increase their risk of HIV infection? Can I get HIV from one unprotected sexual encounter? What is your risk of sexually transmitted infections? Unfortunately, their is a lot of debate as to what the answer to these question are. There are behaviors we know put you at risk for HIV infection and sexually transmitted infections.

Answer: The risk of infection or infections really depends on the type of unprotected sexual contact.

• Receptive anal intercourse ("bottom")
According to the Guidelines for the Management and Post Exposure Prophylaxis of Individuals who Sustain Nonoccupational Exposure to HIV, ANCAHRD/CTARC Bulletin, February 2001, the risk of transmission as a result of receptive anal sex is somewhere between 1 in 125 to 1 in 31 or approximately three per cent. Other experts place the risk as low as 1 in 1300.

Important Fact!
Infection can and does occur with just one unprotected sexual encounter. It's important to note that even though the risk is 1 in 1300, that one chance in 1300 can be the first time.

• Insertive partner ("top") during anal intercourse
While the risk is about 10 times less than being the receptive partner, the risk is there and is real. And of course the same holds true...it only takes one time.

• Vaginal intercourse - infected men to uninfected women
There are so many variables that impact risk it is very difficult to place an exact number or give you exact odds. Risk estimates range from 1:1000 to 1:100,000, again depending on variables such as viral load, number of sexual contacts, etc. The important thing to remember is that it only takes once regardless of the odds so condoms are a must.

• Vaginal intercourse - infected women to uninfected men
Studies seem to confirm that the risk is quite low, much lower than male to female transmission. But again, a number of variables make it difficult to know the exact odds. Again, it only takes once so condoms are a must.

• Oral sex
Admittedly the risk of transmitting HIV during oral sex is extremely low, but the risk is there and it is not zero.

Important Fact!
Keep in mind that beside HIV, oral sex can transmit other sexually transmitted diseases such has herpes and syphilis.

Which type of exposures carry the highest risk?
Certain exposure routes do offer higher risk of infection than others. Those exposures that carry the highest risk include:

• Sharing needles to inject drugs
• Receptive unprotected anal intercourse
• Vaginal intercourse

Breatfeeding & Child Birth
There are two transmission routes that have very high incidence of HIV infection - upwards of 1 in 4.

• child birth - transmission from infected mom to her unborn baby
• breastfeeding - transmission from mother to baby during breast feeding.

Fortunately, the risk for these two transmission routes can be decreased dramatically by good prenatal HIV care, expert HIV care during delivery, and HIV care for the baby after the delivery.

• Preventing HIV Transmission from Mother to Unborn Child
• The Risks of Breastfeeding

Important Fact!
Numbers and percentages really are just guidelines. Infection can and does occur after one unprotected sexual encounter or after sharing a needle once. The only way to know if you've been infected is to get tested. Percentages and numbers should not be a substitute for testing and safer sex.

• 5 Reasons to Get HIV Tested

Sources
• AIDS Infonet Fact Sheet #152 - "How Risky is It?"; 25 Oct 2005.
• Murphy, D. "Risk reduction strategies for anal sex with casual partners."; AFAO/NAPWA Education Discussion Paper. Vol. 2, No. 4, 2000/2001; 1 Jun 2001.

Preventing HIV Infection. HIV Prevention Facts

HIV Prevention Facts
Slowing the Spread of HIV with These HIV Prevention Facts

HIV prevention is the key to slowing and stopping the HIV epidemic. And HIV prevention is up to all of us; we can't leave that responsibility with others. So here are some HIV prevention facts that will help you be responsibile and stay healthy and safe.
HIV Prevention - Ways to Reduce our Risk of HIV

• Always Use Condoms
• always have condoms readily available (at your bedside, in your overnight bag, or in your purse)
• make sure your condoms fit properly
• talk to your partner about condomsto find what works for both of you

• Be Picky When it Comes to Partners
• stay monogamous, avoiding anonymous "pick-ups" or sex partners
• sex and alcohol don't mix. One night of partying could cost you your health and change your life forever.
• get HIV tested if you haven't already.

• Stop Sharing Needles and Injecting Drugs
• Join a drug treatment center to address your drug use problem.
• When you use drugs you get careless with regard to safer sex. The best way to reduce your risk of HIV transmission is to address your drug problem and not have sex under the influence of drugs.
• If you can't stop using drugs, never share needles or "works".

HIV from Vaginal Sex

"Can I Get HIV from Vaginal Sex?"

Question: "Can I Get HIV from Vaginal Sex?"
One viewer asks a question about HIV transmission:

"Can I get HIV from vaginal sex?

Answer:
Yes, it is possible to get HIV through from vaginal sex. In fact, in much of the world it is the most common way the virus is transmitted. HIV can be found in the blood, semen, pre-seminal fluid ("pre-cum"), or vaginal fluid of a person infected with the virus. The lining of the vagina can tear and allow HIV to enter the body. Direct absorption of HIV through the mucous membranes that line the vagina also is a possibility.

Through vaginal sex the male is at less risk for HIV transmission than is the female. However, HIV can enter the body of the male through his urethra (the opening at the tip of the penis) or through small cuts or open sores on the penis, making infection with HIV possible. The risk of HIV infection increases if you or your partner has a sexually transmitted disease (STD).

If you choose to have vaginal intercourse, use a latex condom to protect both you and your partner from the risk of HIV and other STDs. Studies have shown that latex condoms are very effective in when used correctly and consistently. If either partner is allergic to latex, plastic (polyurethane) condoms for either the male or female can be used. Important Warning! - Lambskin condoms do not offer protection from HIV and STDs and therefore should be avoided.

Preventing HIV with Condoms. The Basics of STD and AIDS Prevention

The Basics of STD and AIDS Prevention
AIDS Prevention and the Role of Condom Use

With nearly 1 million Americans infected with HIV, AIDS prevention is more important than ever before. Most HIV infection is a result of sexual transmission. That combined with an estimated 15 million cases of other sexually transmitted diseases (STDs) occurring each year effective strategies for preventing these diseases are critical. AIDS prevention is not the only reason for condom use. STD prevention as well as AIDS prevention are important reasons for condom use. Refraining from having unprotected sexual intercourse with an infected partner is the best way to achieve AIDS prevention and other STD prevention. Latex condoms are highly effective when used consistently and correctly. The Centers for Disease Control (CDC) offers the following recommendation with regard to STD and AIDS prevention:

"Condoms are effective in preventing HIV and other STDs."

Facts About Condom Use and STD, HIV, and AIDS Prevention

• The correct and consistent use of latex condoms during sexual intercourse- vaginal, anal, or oral-can greatly reduce a person’ s risk of acquiring or transmitting most STDs, including HIV infection, gonorrhea, chlamydia, trichomonas, human papilloma virus infection (HPV), and hepatitis B.

• Protecting yourself and others against STDs is important because many of these diseases have serious complications. AIDS prevention is important because HIV is life threatening disease that can cause serious illness throughout life.

• Laboratory studies show that latex condoms are effective barriers to HIV and other STDs. In addition, several studies provide compelling evidence that latex condoms are highly effective in AIDS prevention when used for every act of intercourse. This protection is most evident in studies of serodiscordant couples; those couples with one positive and one negative partner.

• Several studies clearly show that condom breakage rates in this country are less than 2%. Most of the breakage and slippage likely is due to incorrect use rather than poor condom quality. Using oil-based lubricants can weaken latex, causing the condom to break. In addition, condoms can be weakened by exposure to heat or sunlight or by age, or they can be torn by teeth or fingernails. Studies also indicate that condoms slip off the penis in about 1-5% of acts of vaginal intercourse and slip down (but not off) about 3-13% of the time.

• Some persons have expressed concern about studies that report higher failure rates among couples using condoms for pregnancy prevention. Analysis of these studies indicates that the large range of efficacy rates is related to incorrect or inconsistent use. In fact, latex condoms are highly effective for pregnancy prevention and AIDS prevention, but only when they are used properly. Research indicates that only 30-60% of men who claim to use condoms for contraception actually use them for every act of intercourse. Further, even people who use condoms every time may not use them correctly from start to finish. Incorrect use contributes to the possibility that the condom could leak at the base or break. AIDS prevention and STD prevention depends on the proper use of condoms each and every time.

Barebacking.....a Right of Passage. HIV and Barebacking

HIV and Barebacking
Is Deliberate HIV Exposure a Rite of Passage

The term barebacking originated in the gay community as a slang for unprotected anal intercourse. The term is also used but not as frequently in the heterosexual community as a reference to unprotected sexual intercourse. Who uses the term is not important. What is important is the link between HIV and barebacking. And as unlikely as it would seem, Health professionals and HIV prevention specialists are seeing an unbelievable phenomenon among a small group of gay men. These gay men have expressed the desire to to get exposed and in some cases hope for HIV infection.

Can This Be True?
Often called "bug chasers" among the gay community, these men seek out other gay men who are infected, in hopes of having unprotected sex, barebacking, in an effort to become infected with HIV. Across the Internet, chat rooms and newsgroups are advertising "conversion parties" where negative men seek out those who are positive in hopes of getting infected. This practice of having deliberate unprotected anal sex has the potential to cause widespread HIV infection, especially among gay men and men who seek out anonymous sexual partners on the Internet

How Common is This Practice
The number of gay men looking to become positive seems to be growing. In fact, the Centers for Disease Control (The CDC) reports a new surge in the incidence of HIV among gay males, in part due to this unthinkable practice. But what can drive such a desire? Why would a life with HIV be desirable to some?

Why Do Healthy Men Want To Be Infected?
There are some very strong beliefs at work among men who bareback looking for HIV infection.

• No More Isolation
For some men, being infected is a way out of their isolation and loneliness. Social stigmas and prejudices add to an already strong feeling of isolation. The belief is that once infected, they will be welcomed into a supportive community where prejudice and stigma does not exist. For these men, HIV is a rite of passage into the gay community. Being positive gets you into the "family."

• A Different Perspective
When asked about being infected, men who are seeking out HIV infection show little fear. These feel HIV is simply a nuisance that can be treated with a few pills; a small price to pay to be a member of such a close knit group. One gay man reported an incredible feeling of belonging when he learned of his positive HIV status. Just as a teen-age boy joins a gang to belong to a family, so does the gay man who practice barebacking in hopes of becoming HIV positive.

• A Sense of Relief
Others who become infected feel a profound sense of relief. Some sexually active gay men grow tired of living with the uncertainty of if and when they will become HIV positive. Some are so troubled by that uncertainty that multiple HIV tests become the only means of dealing with what they feel is the inevitable. One man's face glowed with a sense of relief after his doctor told him he had been infected. He would never again have to worry if he had been infected because now he knew he had.

• A Sense of Intimacy
Still others are longing for a sense of intimacy. To these men, anal sex feels better and more intimate without condoms. They feel condoms decrease sensitivity and spontaniety. Others feel barebacking is a type of sexual intimacy they equate with mating and infection is equated with impregnating. Some even go as far as choosing the man who will "father" their infection. One gay man reported the most incredible feeling of intimacy being united with other gay men through HIV. Another allowed his positive partner to infect him as a way to show how deep his commitment was. Oddly enough, as soon as he found out he was positive, the man and his partner began using condoms.

• What Drives the Gift Giver?
But what of the positive man who infects the willing. What drives them to knowingly give an illness to an otherwise healthy man? One "gift giver", as positive men are often called, reported,

"It was the most incredible feeling of power. I was going to take something from him, and that power gave me a rush I'd never known."

Among this population of barebackers there is a distinct connection between masculinity, sexual prowess, and intentional unprotected anal sex.

Deliberatly seeking out HIV is a practice few of us would understand. Is such a practice a cry for help, a sign of depression or just a symptom of social stigmas and prejudices? Whatever drives this practice, one thing is for certain; it helps drive the epidemic. But before we can address the issue we have to understand it. As one gay man stated soon after he found out he had become HIV positive, "It's impossible to know how great it feels unless you have been where I have."

Source:
Halkitis, PN. "Intentional unsafe sex (barebacking) among hiv-positive gay men who seek sexual partners on the internet."; AIDS Care 2003 Jun;15(3):367-78.

Should Needle Exchange be Funded?

Should Needle Exchange Be Funded By The Federal Government?

The key to slowing the HIV epidemic is HIV prevention. There are several prevention techniques that slow the transmission of HIV from one person to another. One such prevention method is needle exchange.

Needle exchange involves providing clean, sterile needles and syringes to IV drug users in exchange for their used syringes and needles. If IV drug users can't stop injecting recreational drugs, then providing them with sterile needles and syringes should decrease the incidence of sharing needles. As we know, sharing needles is a source of HIV infection. Decrease needle sharing and HIV transmission will decrease. But how should needle exchange programs be funded? Right now, it's illegal to use federal monies to fund needle exchange programs. Because of this, funding is difficult and programs struggle to survive. Should needle exchange programs be funded by the federal government? There are two schools of thought.

Current Status
Globally, sex between men and women is by far the most common way of passing on HIV. But a second transmission route drives the epidemic in many countries outside Africa; transmission among men and women who inject drugs. Injection of any sort is a more efficient way of spreading HIV than sexual intercourse. Since injecting drug users are often linked in tight networks, sharing injection equipment is common. But because the injection equipment is rarely disinfected, HIV infection among this population is common.

Also, people who inject drugs may acquire HIV infection through their sexual partners while having unprotected sex. In the United States, it's estimated that 9 out of 10 cases of heterosexual transmission of HIV occurring in New York City is related to sex with a drug user. In some places, including much of China and parts of India and Myanmar, more women are infected through sex with drug users than any other way. Injecting drug use also contributes to mother-to-child transmission of HIV. In Uruguay, 40 percent of babies with HIV are born to mothers who inject drugs.

So it's clearly obvious that transmission of HIV by way of sharing dirty needles must be addressed. The way to address the issue is through needle exchange. But how do we pay for exchange programs?

What's all the Fuss About?
If needle exchange is the answer, then why all the fuss? Programs should be funded and put in place across the country. If only it were that easy. The fact of the matter is, needle exchange is a politically charged issue that few want to take on. It's because of the controversial nature of needle exchange that programs are not federally funded. In fact, the law states that needle exchange programs can't be paid for with federal monies. And because of the politics involved, few government leaders are willing to risk their careers by fighting for change.

Arguments For
Proponents of needle exchange site several reasons why the federal government should get involved and offer funding for such programs.

• Data shows that upwards of 90 percent of heterosexually transmitted HIV is related to IV drug use and the sharing of dirty needles.
• Data shows that in several communities in the US and around the world, HIV transmission has increased where needle sharing and injecting drug use is common.
• Many studies have proven that needle exchange programs lead to decreased rate of HIV transmission among IV drug users.
• Studies have concluded that needle exchange does not increase the incidence of IV drug use.
• Some studies have shown that entrance into drug treatment programs are increased in the presence of needle exchange programs.

Arguments Against
Opponents of federally funded needle exchange point out several concerns.

• Funding needle exchange programs sends the "wrong message" to children.
• Clean needle exchange will lead to an increase in IV drug use among populations already ravaged by recreational drug use.
• Federal funding of exchange programs would allow tax dollars to be used to increase the amount of drug paraphernalia in areas already overburdened with IV drug use.
• Distributing drug paraphernalia is in stark contrast to the accepted morals of our culture.

Where it Stands
While acceptance and funding of needle exchange programs has continued in the private sector as well as the state and local level, the federal government continues to balk at offering funding of any sort. Yet, studies continue to show that needle exchange programs are successful in decreasing HIV transmission. So the debate continues.

Does Needle Exchange Reduce HIV? Needle Exchange Programs

Needle Exchange Programs
Do They Help Prevent HIV Infection?

Why Do We Need Needle Exchange?
More than a million people in the United States inject drugs, at a cost to society (in health care, lost productivity, accidents, and crime) of more than $50 billion a year. Obviously, people who inject drugs imperil their health. But if they become infected with HIV or Hepatitis C they also imperil their needle sharing partners, sexual partners and offspring as well.

One-third of all AIDS cases are linked to injection drug use. For women, 64 percent of all AIDS cases are due to injection drug use or sex with partners who inject drugs. Injection drug use is the source of infection for more than half of all children born with HIV.

Around the world and in more than sixty locations in the United States, needle exchange programs have sprung up to address drug injection risks. These programs:

• distribute clean needles
• safely dispose of used needles
• offer referrals to drug treatment
• offer HIV counseling and testing

Why Do Drug Users Share Needles?
The answer is as simple as supply and demand. Needle sharing is common in part because there are not enough needles and syringes to go around. The overwhelming majority of intravenous drug users (IVDUs) are aware of the HIV risk associated with sharing contaminated equipment. However, sterile needles are not always available or affordable and their physical and emotional need for injectable drugs clouds their better judgement.

Most US states have paraphernalia (items used to inject or use drugs) laws that make it a crime to possess or distribute drug paraphernalia not for a "legitimate medical purpose". If caught those that break these laws are subject to prosecution. In addition, ten states and the District of Columbia have laws that require a prescription to buy a needle and syringe. Even where over-the-counter sales of syringes are permitted by law, pharmacists are often unwilling to sell to IVDUs.

In July of 1992, the state of Connecticut passed a law permitting the purchase and possession of up to ten syringes without a prescription. After the new law went into effect, the sharing of needles among IVDUs decreased, indicating a shift from street needle and syringe purchasing to pharmacy purchasing. It's believed that such a shift could decrease HIV infection due to needle sharing.

How Can Injection Risks Be Reduced?
Getting drug injectors into treatment and off drugs is the best answer. Unfortunately, not all drug injectors are ready to quit. Even those who are highly motivated may find few drug treatment services available. Drug treatment centers frequently have long waiting lists and fewer than 15 percent of IVDUs are in treatment at any given time.

For those who cannot or will not stop injecting drugs, the best way to avoid spreading HIV is to use a sterile needle for each injection, or at the very least not to share needles. Users who share should disinfect their injection equipment thoroughly with bleach, although this is not as safe as always using a sterile needle and syringe.

Does Needle Exchange Encourage Drug Use?
There is no evidence that needle exchange programs increase the amount of drug use by needle exchange clients in the community in general. A study of a San Francisco needle exchange program that opened in 1988 found that from 1987 to 1992, frequency of injecting drugs among street-recruited IVDUs declined from 1.9 to 0.7 injections per day. The mean age of IVDUs increased from 36 to 42 years, and the percentage of new initiates into injection drug use dropped from three percent to one percent. Drug abuse and the recruitment of new or younger users did not increase in the presence of the exchange; in fact, the exchange may have helped decrease the amount of drug abuse in the area.

Does Needle Exchange Reduce the Spread of HIV?
Simply put, the answer is yes, almost certainly. Needle exchange programs are based on a sound public health principle; the principle of eliminating the item that helps transmit infection from one person to another, just as, for example, reducing the number of mosquitoes helps prevent malaria.

Needle exchange programs have also achieved reductions in the rate of hepatitis infection, which can also be spread through sharing needles. In Tacoma, WA, clients of a needle exchange program were up to eight times less likely to contract Hepatitis B or C than non-client IVDUs.

Finally, needle exchange programs can act as a bridge to:

• drug treatment
• HIV testing and counseling
• primary medical care
• tuberculosis and sexually transmitted disease screening

Source: Lurie, P. and DeCarlo, P., The Center for AIDS Prevention Studies at the University of California San Franciso, 2005.

The Riskiest Activities. What Activities are Riskiest?

What Activities are Riskiest?

HIV can be transmitted from person to person in many different ways. But which activities are the riskiest? Which activities carry the highest risk of HIV infection? Here are the most risky:

1. Sharing needles to inject drugs
• Does Needle Exchange Reduce HIV?
• Should Needle Exchange be Funded?

2. Receptive Anal Intercourse
• Barebacking...a Right of Passage
• Preventing HIV with Condoms

3. Vaginal Intercourse
• HIV from Vaginal Sex
• What is My HIV Risk?

Source:
AIDS Infonet; "How Risky is It?; October 25, 2005.

Your Risk of HIV Infection

Your Risk of HIV Infection
Certain Conditions, Circumstances, and Behaviors Can Increase Your Risk

What is your risk of HIV infection? Certain conditions, circumstances, and behaviors can increase your risk of HIV infection. There are conditions and behaviors that make it easier for HIV to be transmitted from person to person. Without taking the proper precautions or being aware of high risk behavior, your risk of HIV can increase. Some of the more common ways your risk of HIV infection increases include:

• Being Coinfected With Syphilis
People with syphilis may have open sores on their genitals that provide a route for HIV to enter the body when engaging in unprotected sex.

A Guide to Syphilis

• Your Sexual Partner is in the Acute Stages of HIV Infection
The acute phase of HIV infection is characterized by very high HIV activity and very high viral loads. Having unprotected sex with someone in the acute stage of HIV increases the exposure to activily replicating HIV, in turn increasing the risk of HIV transmission.

What is Acute HIV?

• Either Partner Has a Weakened Immune System
The body's immune system protects us from illness, infection, and disease. Anytime that protection is weakened, the body is at increased risk of illnesses and infections, including HIV. If either partner in a sexual relationship has a weakened immune system, that person becomes more at risk for HIV.

Understand the Immune Response

• When Either Partner has an Open Wound
Open wounds provide a portal of entry for HIV. In other words, any open wound or break in the skin can allow HIV to enter the body

• The Presence of a Large Quantity HIV Infected Blood
Large quantities of HIV infected blood exposes the body to an increase number of active HIV, making HIV infection easier. These large quantities of infected blood can occur during sex due to mechanical trauma of the sexual structures or during delivery of an HIV+ mom's newborn baby. Sharing syringes and needles can also expose people to large quantities of HIV infected blood.

What Are The Riskiest Behaviors?

Source: AIDS Infonet Fact Sheet 152 - "How Risky is It?"; October 25, 2005.

HIV/AIDS Among Hispanics

HIV/AIDS Among Hispanics
A Growing Problem Among the Hispanic Population

While HIV does not discriminate among different races, genders, or ethnicities, certain populations are carrying a larger burden of the HIV epidemic than others. The Hispanic population is seeing their HIV population continue to grow and become a large proportion of the new HIV cases. Let's take a look at the HIV epidemic and see the impact of HIV/AIDS among Hispanics.

Cumulative Effects of HIV/AIDS in the Hispanic Community
• Although Hispanics make up only about 14 percent of the population of the United States and Puerto Rico, they account for 18 percent; almost 164,000 of the more than 886,500 AIDS cases diagnosed since the beginning of the epidemic.

AIDS in the Hispanic Community

• By the end of 2002, nearly 88,000 Hispanics had died of AIDS.
• Among people given a diagnosis of AIDS since 1994, a smaller proportion of Hispanics (61 percent), compared with whites (64 percent) and Asians/Pacific Islanders (69 percent), were alive after 9 years.
• The proportion of surviving Hispanics was larger than the proportions of surviving American Indians and Alaska Natives (58 percent) and African Americans (55 percent).
• Hispanics accounted for more than 8,000, or 20 percent, of the more than 42,000 new AIDS diagnoses in the United States in 2002.
• Of the rates of AIDS diagnoses for all racial and ethnic groups, the second highest was the rate for Hispanics. Here is the breakdown:
1. African Americans - 76.4 cases per 100,000 people
2. Hispanics - 26.0 per 100,000 people
3. American Indians and Alaska Natives - 11.2 per 100,000 people
4. Whites - 7.0 per 100,000 people
5. Asians and Pacific Islanders - 4.9 per 100,000 people
• The 76,052 Hispanics living with AIDS accounted for 20 percent of all people in the United States living with AIDS

HIV in the Hispanic Community

• Hispanics accounted for 13 percent of new HIV/AIDS diagnoses reported in the 30 areas with long-term, confidential name-based HIV reporting in the United States.
• From 1999 through 2002, the number of new HIV/AIDS diagnoses increased by 26 percent among Hispanics in the 30 areas.
• Most Hispanic men are exposed to HIV through sexual contact with other men, followed by injection drug use and heterosexual contact.
• Most Hispanic women are exposed to HIV through heterosexual contact, followed by injection drug use.

Statistics provided by The Centers of Disease Control, 2004 - Updated Oct. 2007.

What is the Status of HIV/AIDS Among Women

What is the Status of HIV/AIDS Among Women

HIV infection in women offers uniques challenges for the woman living with HIV and the person caring for her. Unfortunately, in some parts of the world HIV/AIDS among women is growing at an alarming rate. Let's take a look at the HIV statistics related to HIV and women. What is the status of HIV/AIDS among women of the world?

HIV Among Women
In the early years of the HIV epidemic, few women were diagnosed with the disease. Today about 25 percent of all new HIV cases are women. Women of color have been particularly hard hit. As of 2004:

* AIDS was the leading cause of death among black women aged 25 to 34 years old; the third leading cause of death among black women 35 to 44 years old; the fourth leading cause of death among black women 45 to 54 years old.

* AIDS is the fourth leading cause of death among Hispanic women 35 to 44 years old.

* HIV infection was the fifth leading cause of death among all women 35 to 44 years old; sixth leading cause of death among all women 25 to 44 years old.

* The only diseases that cause greater number of deaths among women are cancer and heart disease.

HIV Statistics - 2005

* Approximately 9700 women were diagnosed with HIV
o 80 percent were from heterosexual transmission

* Approximately 37,000 people were newly diagnosed with HIV
o 26 percent of these were women

* There were about 127,000 women living with HIV in 2005
o 64 percent were black
o 19 percent were white
o 15 percent were Hispanic
o one percent were Asian / Pacific Islander
o less than one percent were American Indian / Alaska Native

* The number of women with HIV decreased from almost 12,000 in 2001 to about 9700 in 2005.

AIDS Statistics - 2005

* Of the nearly 41,000 AIDS diagnoses in the US, 26 percent were women.

* The AIDS diagnosis rate for black women was 23 times greater than white women and 4 times the rate of Hispanic women.

* Of the 422,000 people living with AIDS in the US, 23 percent were women.

* 25 percent of all AIDS deaths in the US were women.

* 19 percent of all AIDS cases from 1981 to 2005 were women

* In 1992 women accounted for 19 percent of people living with AIDS. By 2005 that number had grown to 23 percent.

* While black and Hispanic women together represent 24 percent of the US female population, they represent 82 percent of the AIDS diagnoses in 2005.

Source
Center for Disease Control; "HIV/AIDS Among Women"; 1 Jun 2007.

Women Who Have Sex with Women

Women Who Have Sex with Women
What is the HIV Risk?

Female-to-female transmission of HIV appears to be a very rare occurrence. However, case reports of HIV in women who have sex with women (wsw) indicate that vaginal secretions and menstrual blood are potentially infectious and that mucous membrane (e.g., oral, vaginal) exposure to these secretions has the potential to transmit HIV.

What Does Surveillance Say About HIV Transmission Between Women?
Through 2004, almost 250,000 women were living with HIV. Of these, approximately 7400 were reported to have had sex with women; however, the vast majority had other risks (such as injection drug use, sex with high-risk men, or receipt of blood or blood products). Of the 534 women who were reported to have had sex only with women, 91 percent also had another risk.

What Does Follow-up Surveillance Show?
Follow-up surveillance was done on women whose only reported risk was sex with women. As of December 2004, none of these studies could definitely confirm the possibility of female-to-female HIV transmission. In those women studied, other risks were usually identified or women declined to participate in follow-up interviews. In fact, a separate study of more than 1 million female blood donors found no HIV-infected women whose only risk was sex with women. These findings suggest that female-to-female transmission of HIV is uncommon. However uncommon, these results do not rule out the possibility of female-to-female HIV transmission.

What Behaviors Place WSW at Risk of HIV Infection?
Surveys have shown that many wsw have increased rates of high-risk behaviors such as:

* injection drug use
* unprotected vaginal sex with gay/bisexual men who are injection drug users.

What Can WSW do to Reduce Their Risk of HIV?
While the occurence is rare, women who have sex with women need to realize that the risk of HIV transmission is there. These women need to know:

* that exposure of a mucous membrane(of the mouth) to vaginal secretions and menstrual blood is potentially infectious
* that condoms should be used properly each and every time during sexual contact with men or when using sex toys.
* sex toys should not be shared.
* women can use dental dams, cut-open condoms, or plastic wrap to help protect themselves from contact with body fluids during oral sex.
* to reduce their risk of becoming infected women should know their own HIV status as well as their partner's
* for women who are HIV positive knowing their status early improves their prognosis and helps prevent infecting others.

To accurately assess a women's HIV risk, health professionals also need to remember:

* that sexual identity does not necessarily predict behavior, and that women who identify as lesbian may be at risk for HIV through unprotected sex with men.
* that prevention interventions targeting wsw must address behaviors (injecting drugs and unprotected sex) that put wsw at risk for HIV infection.

Source: Centers for Disease Control, "HIV/AIDS Among Women Who Have Sex With Women"; 1 Jun 2006.