HIV/AIDS & Communicable Diseases

Origins of HIV

Scientists have identified a type of chimpanzee in Central Africa as a source of HIV infection in humans. Scientists believe that the chimpanzee version of the immunodeficiency virus, called simian immunodeficiency virus or SIV, most likely was transmitted to humans and mutated into HIV when humans hunted these chimpanzees for meat and encountered their blood. Studies show that HIV may have transmitted from apes to humans as far back as the late 1800’s. Over decades the virus slowly spread across Africa and later into other parts of the world. The virus has existed in the United States since at least the mid to late 1970’s.

HIV Infection

Human Immunodeficiency Virus (HIV) can lead to Acquired Immunodeficiency Syndrome (AIDS), if not treated. Unlike other viruses the human body is unable to rid itself of HIV completely even with treatment. So once, an individual acquires HIV, they then live with the virus for the remainder of their life. The HIV virus is spread through certain bodily fluids that attack the body’s immune system, specifically the CD4 cells, which are often called T-cells. Left untreated HIV reduces the number of T-cells in the body. Over time HIV can destroy so many of these cells that it is difficult for the body’s immune system to fight off other infections and diseases.

HIV Stages

Treatment can slow or prevent progression from one stage to the following stages in individuals and help with transmitting HIV to someone else. Pharmaceutical prescriptions help HIV at all stages if taken right away, every day. When individuals who are infected with HIV reject or fail to receive treatment, they will typically progress through these three stages of the disease.

Stage One: Acute HIV Infection

After conception of HIV, within 2-4 weeks an individual may feel flu like symptoms which can last for a few weeks. This is the body’s natural response in fighting infection. Individuals with acute HIV infection are often unaware that they are infected because they may not have symptoms right away or at all. When individuals have acute HIV infection, they have larger amounts of the virus in their blood and are very contagious. A fourth-generation antibody/antigen test or a nucleic acid (NAT) test is necessary to know whether one has an acute infection.

Stage Two: Clinical Latency (HIV Inactivity or dormancy)

Stage Two is sometimes called asymptomatic HIV infection or chronic HIV infection. During this stage HIV is still active but reproduces at exceptionally low levels. Individuals may not have symptoms or feel sick during this stage. For individuals who are not treating themselves with prescriptions properly (everyday), could stay in this stage for decades. During this stage it is important that individuals know that they can still transmit HIV. Although, individuals who are under treatment and are virally suppressed (having low viral levels in one’s blood) are much less likely to transmit HIV than those who are not virally suppressed. At the end of this stage, one’s viral load starts to increase and the CD4 cell count starts to decrease. As this happens, symptoms will arise as the viral levels increase in the body, and the individual transfers into final stages of HIV.

Stage Three: Acquired Immunodeficiency Syndrome (AIDS)

Diagnosis of AIDS will occur when CD4 cells drop below 200 cells per millimeter, or if they develop certain opportunistic illnesses, due to having a compromised immune system. Individuals will live roughly three years on average without receiving treatment. This is the most severe stage of the HIV infection and individuals with AIDS can have a high viral load and be very infectious.

Superinfection

If you have HIV it is possible to contract another form of HIV. This is called superinfection. HIV superinfection is when a person with HIV develops an infection with another strain of the virus. The new strain of HIV can replace the original strain. The effects of superinfection differ from person to person. Superinfection may cause individuals to experience symptoms earlier because they become infected with a strain of the virus that is resistant to the antiretroviral medicines (ART), that they are taking to treat their original infection. Taking medicine to treat HIV may reduce someone’s chance of getting a superinfection. Research suggests that a superinfection is rare and hard to treat.

Testing for HIV

The only way to know for sure whether you or anyone has HIV is to receive testing. Knowing your status is important because it helps you make healthy decisions to help with receiving or transmitting HIV. If you have symptoms that include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, or mouth ulcers it does not mean you have HIV. Each of these symptoms can be caused by other illnesses. However, if you have these symptoms after a potential exposure to HIV, see a healthcare provider and discuss your risk. After testing for HIV, it is important that you receive your results and discuss with your healthcare provider treatment options if you are HIV positive and learn ways to prevent getting HIV if you are HIV negative.

To find a place near you that offers confidential HIV testing visit:

• gettested.cdc.gov
• Text your zip code to KNOW IT (566948)
• Call 1-800-CDC-INFO (232-4636),
• You can also use a home testing kit, available for purchase in most pharmacies or online.

HIV Treatments

There is not an effective cure that currently exist for HIV but with proper medical care HIV can be controlled. Treatment for HIV is antiretroviral therapy or ART. If taken properly, ART can dramatically prolong the lives of many people infected with HIV, keep them healthy, and greatly lower their chances of infecting others. Before the introduction of ART in the mid 1990’s, individuals with HIV could progress into AIDS within a few years. Today, someone that is diagnosed with HIV and given treatment before the disease is far advanced can live as long as someone who does not have HIV. 

Prevention Options

Pre-exposure prophylaxis (PREP) is when individuals with an extremely high risk for HIV take HIV medicine daily to lower their chance of getting infected. PREP can stop HIV from taking hold and spreading throughout your body. PREP is highly effective for preventing HIV, if used as prescribed, but it is much less effective when not taken consistently. Daily PREP reduces the risk of getting HIV from sex by more than 99%, when taken as prescribed. Among people who inject drugs, it reduces the risk by more than 74% when taken as prescribed. Your risk of getting HIV from sex can be even lower if you combine PREP with condoms and other prevention methods.

Post Exposure Options

Post exposure prophylaxis (PEP) is taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent becoming infected. PEP should be started within 72 hours after a recent possible exposure to HIV. If you think that you have recently been exposed to HIV during sex or through sharing needles, or if you have been sexually assaulted, talk to your healthcare provider or an emergency room doctor about PEP immediately.

Transmission of HIV

Myths persist about how HIV is transmitted. You can contract or transmit HIV only through specific activities. Most commonly, people get or transmit HIV through sexual behaviors and needle or syringe use. Only certain body fluids such as blood, semen, pre-seminal fluid, rectal and vagina fluids, and breast milk of an infected person can transmit HIV. These fluids must encounter a mucous membrane or damaged tissue or be directly injected into the bloodstream (needle or syringe) for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth. In the United States HIV is spread mainly by having sex with someone who has HIV without using a condom and not taking medicines to prevent or treat HIV. For the HIV negative partner receptive anal sex (bottoming) is the highest risk sexual behavior, but you can also contract HIV from insertive anal sex (topping). Either partner can contract HIV through vaginal sex though it is less of a risk than anal sex. Sharing needles and syringes with someone who has HIV can lead to dangerous infections and diseases. HIV can live in a used needle up to 42 days, depending on the temperature and other factors. Even though it is less common HIV can spread from mother to child during pregnancy, birth, or breast feeding. Although, the risk can be high if the mother is living with HIV and not taking medicine. Recommendations to test all pregnant women for HIV and start HIV treatments immediately have lowered the number of babies who are born with HIV. You can be infected by being stuck by an HIV contaminated needle or sharp object. This is a risk mainly for health care workers. In extremely rare cases, HIV has been transmitted by:

• Oral Sex- Putting the mouth on the penis, vagina, or anus. In general, there is little to no risk of getting HIV from oral sex. But transmission of HIV, though extremely rare, is theoretically possible if an HIV positive man ejaculates in his partners mouth during oral sex.
• Receiving blood transfusions, blood products or organ/tissue transplants that are contaminated with HIV. This was more common in the early years of HIV, but now is extremely small because of rigorous testing of the US blood supply and donated organs and tissue.
• Eating food that has been pre-chewed by an HIV infected person. The contamination occurs when the infected blood from a caregiver’s mouth mixes with food while chewing. The only known cases are among infants.
• Being bitten by a person with HIV. Each of the small, documented cases had involved severe trauma with extensive tissue damage and the presence of blood. There is no risk of transmission if the skin is not broken.
• Contact between broken skin, wounds, or mucous membranes and HIV infected blood or blood-contaminated body fluids.
• Deep open mouth kissing if both partners have sores or bleeding gums and have blood from the HIV positive partner gets into the bloodstream of the HIV negative partner. HIV is not spread through saliva.

HIV does not survive long outside the human body and it cannot reproduce outside a human host. It is not spread by:

• Mosquitoes, ticks, or other insects.
• Saliva, tears, or sweat that is not mixed with the blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk of an HIV positive person.
• Hugging, shaking hands, sharing toilets, sharing dishes, or closed mouth or “social” kissing with someone who is HIV positive.
• Other sexual activities that do not involve the exchange of body fluids (for example touching)

STD’S

Having another sexually transmitted disease (STD) can increase the risk of contracting or transmitting HIV to others. Some of the most common STDs include gonorrhea, chlamydia, syphilis, trichomoniasis, human papillomavirus (HPV), genital herpes, and hepatitis. If you are sexually active, you and your partner should get tested for STDs (including HIV, if you are currently HIV negative) regularly, even if you do not have symptoms. If you are HIV negative, but you have a STD you are three times as likely to get HIV if you have unprotected sex with someone who has HIV. This appears to happen because there is an increased concentration of HIV in the semen and genital fluids of HIV positive people who are infected with another STD. There are two ways that having STDs can increase the likelihood of getting HIV. If the STD causes irritation of the skin (for example, from syphilis, herpes, or HPV) breaks or sores may make it easier for HIV to enter the body during sexual contact. Even STDs that cause no breaks or open sores (for example, chlamydia, gonorrhea and trichomoniasis) can increase your risk by causing inflammation that raise the number of cells that can serve as targets for HIV. 

Prevention of HIV

Today, more tools than ever before are available to prevent HIV. You can use strategies such as abstinence, limiting your number of sexual partners, using condoms the proper way (every time you have sex) and never sharing needles. You may also be able to take advantage of newer HIV prevention medicine such as PREP and PEP. Abstinence is the only 100% effective way to prevent HIV, other STDs, and pregnancies. Using condoms properly each time you have sex will also lower your risk. The correct way to use male condoms is to use a new condom each time you have sex, read the package and check expiration dates, make sure there are no tears or defects, store condoms in a cool dry place, use latex or polyurethane condoms, and use water-based or silicone-based lubricant to prevent breakage. There are two types of condoms, male and female. A male condom is a thin layer of latex, polyurethane, polyisoprene, or natural membrane worn over the penis during sex. Latex condoms provide the best protection against HIV. Polyurethane (plastic) or polyisoprene (synthetic rubber) condoms are good options for people with latex allergies, but plastic condoms break more often than latex ones. Natural membrane (such as lamb skin) has small holes in them, so they do not block HIV or other STDs. Use water-based or silicone lubricants to lower the chances that a condom will break or slip during sex. Do not use oil-based lubricants (for example, vaseline, shortening, mineral oil, massage oils, body lotions, and cooking oils) with latex condoms because they weaken the condom causing the condom to break. Do not use lubricants containing nonoxynol-9, this can irritate the lining of the vagina and anus and increases the risk of contracting HIV. A female condom is a thin pouch made of synthetic latex product called nitrile. It is designed to be worn by a woman in her vagina during sex. When worn in the vagina, female condoms are comparable to male condoms at preventing HIV, STDs, and pregnancy. Some people use female condoms for anal sex. Currently there is no certainty that female condoms prevent HIV and STD’s when used by men and women for anal sex. But there is certainty that HIV cannot travel through the nitrile barrier. It is safe to use any lubricant with nitrile female condoms.

Living with HIV

Today an estimated 1.2 million people are infected with HIV in the United States. Thanks to better treatments, people with HIV are now living longer, and with a better quality of life, than ever before. If you are living with HIV, it is important to make choices that keep you healthy and protect others. You should start medical treatment as soon as you are diagnosed with HIV. Taking medicine to treat HIV is recommended for all people with HIV. Taking medicine to treat HIV slows the progression of HIV and helps protect your immune system. The medicine can keep you healthy for many years and greatly reduce your chances of transmitting HIV to sex partners. Receiving a diagnosis of HIV can be a life changing event. People can feel many emotions like sadness, hopelessness, and even anger. Health care providers and social service providers are often available at your health care providers office or your local health department. They will have tools to help you work through the early stages of your diagnosis as you begin to manage your HIV. Talk with others who have HIV and learn about how others with HIV have handled their diagnosis. Find a local support group.

Statistics

HIV and AIDS remain a persistent problem for the United States and countries around the world. While great progress has been made in preventing and treating HIV, there is still much to be done. Here is a broad overview of the effects of HIV and AIDS in the United States and globally.

• In 2018, 37,968 people received a HIV diagnosis in the United States and dependent areas. The annual number of new diagnoses declined 7% from 2014 to 2018 in the 50 states and District of Columbia.
• An estimated 1.2 million people in the United States were living with HIV at the end of 2018. Of these people 14%, or 1 in 7, were unaware they were infected.
• If we look at infection by transmission category, we see that gay, bisexual, and other men who have sex with men are at the highest risk. In 2018, gay and bisexual men accounted for 69% of all new HIV infections. In the same year, individuals infected by heterosexual sex made up 24% of all new infections.
• If we look at HIV diagnosis by race and ethnicity, we see that African Americans are most affected by HIV. In 2018, African Americans made up 42% of all new HIV diagnoses. Additionally, Hispanic/Latinos are also strongly affected making up 27% of all new HIV diagnosis. Whites were 25% of all new diagnosis followed by Asians 2%, multiple races 2%, American Indian/Native Alaskans 1%, and Native Hawaiians/Other pacific islanders less than 1%.
• In 2018, there were 15,820 deaths among people with diagnosed HIV in the United States and 6 dependent areas. These deaths may be due to any cause.
• HIV is largely an urban disease, with most cases occurring in metropolitan areas of 500,000 or more people in the United States of America. The southern region has the highest number of people living with HIV, but if population size is considered the northeast region has the highest rate of people living with HIV.
• HIV disease continues to be a serious health issue for parts of the world. Worldwide there were roughly 1.7 million new cases of HIV in 2018.
• About 37.9 million people were living with HIV around the world in 2018, and 24.5 million of them were receiving medicines to treat HIV. An estimated 770,000 people died from AIDS related illnesses since the start of the epidemic. Sub-Saharan Africa which bears the heaviest burden of HIV/AIDS worldwide, accounts for roughly 61% of all new HIV infections. Other regions significantly infected by HIV/AIDS include Asia and the pacific, Latin American and the Caribbean, and Eastern Europe and Central Asia.

Occupational Exposure

As a barber, you have a low risk of infection through occupational exposure. You will be exposed to blood if you or your client are cut with implements used in services. Universal precautions should be used when you or your client have been cut and blood is exposed. HIV positive service providers and customers are not required to disclose personal HIV status in the workplace, to co-workers or colleagues, or to others who provide services to the public. In fact, they are only required to inform healthcare providers (doctors, clinical workers, dentists, etc.) and sex or needle-sharing partners by law. Some infected people may keep this information private when securing barber services. Therefore, it is important that all services should be provided using standard precautions thus, a disclosure from clients is not necessary to maintain safety and prevention. 

Connecting Between HIV and Other Diseases

People that are HIV positive are more likely to get other infections and diseases as well. Tuberculosis (TB) is one these diseases. TB is an infectious disease that is spread through the air. TB usually infects the lungs but can affect other areas of the body such as the brain or the spine. Symptoms include weakness, nausea, weight loss, fevers, night sweats, long term cough, chest pain, or coughing up blood. Hepatitis is also a threat to the HIV patient, especially Hepatitis C (HCV). About 1/4 of HIV infected persons in the United States are also infected with HCV. HCV is one of the most common causes of chronic liver disease in the United States and the HCV infection progresses more rapidly to liver damage in HIV infected persons. HCV infection may also impact the course and management of HIV infection. Hepatitis is an inflammation of the liver. There is Hepatitis A, B, and C. Although Hepatitis A, B, and C have similar symptoms the virus themselves can be quite different, the hepatitis A (viral hepatitis) can either enter a person’s body when they eat or drink something that has been contaminated by the blood or stool of someone that has the virus. Symptoms usually appear within 2-3 weeks, but it is not chronic. Hepatitis B (HBV) and Hepatitis C (HCV) can be transmitted through blood, wound discharge, semen, or vaginal fluids of an infected person. HBV and HCV are chronic however there is a vaccine for HBV and treatments for HCV.

Prevention of Communicable Diseases

The definition of communicable disease is an infectious disease, transmissible (as from person to person) by direct contact with an infected individual or the individual’s discharges or by indirect means (as by a vector).

There are many ways to prevent the spread of disease. Vaccinations have helped eliminate or greatly reduce disease threats. Kids, teens, and adults should all be protected and stay up to date with their recommended immunizations. To rid germs properly, wash your hands often, especially before and after handling food and using the restroom. Other important ways to slow or stop disease transmission are by ensuring the food we eat and the beverages we drink are safe and avoiding people who are sick and who are not practicing safe sex.

There are more than 200 infectious diseases listed in The American Public Health Association’s (APHA) Control of Communicable Diseases Manual. Some include:

• Cellulitis
• Ebola
• Flu
• Hepatitis A
• Hepatitis B
• Hepatitis C
• HIV/AIDS
• Impetigo
• Measles
• Shingles
• Staph
• Tuberculosis
• West Nile Virus
• Zika