The Community Readiness Model

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Advancing HIV/AIDS Prevention in Native
Communities
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What Is HIV?

• H Human, because this virus can only infect
  human beings
• I Immuno-deficiency, because the effect of the
  virus is to create a deficiency within the bodys
  immune system
• V Virus, because this organism is a virus,
  which means one of its characteristics is that it
  is incapable of reproducing by itself. It
  reproduces by taking over the human cell

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How Is HIV Spread?

• HIV must be present and in sufficient quantity
  (in blood very concentrated) and it must enter
  the bloodstream

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What Is AIDS?

• A Acquired, because its a condition one must
  acquire, not something transmitted through
  genetics
• I Immune, because it affects the bodys immune
  system, the part of the body which usually works
  to fight off germs such as bacteria and viruses
• D Deficiency, because it makes the immune
  system deficient
• S Syndrome, because someone with AIDS may
  experience a wide range of different diseases and
  opportunistic infections

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CDC Definition Of AIDS

• Has changed over the years and includes the
  following conditions
• HIV positive, AND
• CDC (T-Cell) count below 200, OR presence of one
  or more opportunistic infections
• Kaposis Sarcoma
• AIDS Dementia
• TB outside of the lung
• Pulmonary TB
• Recurring bacterial pneumonia
• Invasive cervical cancer, etc.

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HIV Survival Outside The Body

• Length of time depends on
• Amount of HIV present in the body fluid
• What conditions the fluid is subjected to
• HIV is very fragile, and many common substances
  like hot water, soap, bleach and alcohol will
  kill it

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HIV Survival Outside The Body

• Minimal chance of being infected by handling a
  body fluid w/HIV unless it enters the bloodstream
  through broken skin or touches mucous membranes
  (like around eyes)
• Air does not kill HIV, but dries the fluid that
  contains the virus thus destroying it
• HIV can survive for several days in small amounts
  of blood found in needles. Needles are very
  risky for transmission!

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Where Is HIV Found In The Body?

• Possibly infectious bodily fluids
• Pre-seminal fluid
• Pre-seminal fluid presents a much lower risk for
  HIV transmission than fluid from ejaculation, but
  there is some risk, depending on where this fluid
  is deposited

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Where Is HIV Found In The Body?

• Infectious Bodily Fluids
• Blood (including menstrual blood)
• Semen
• Vaginal secretions
• Breast Milk
• Blood contains the highest concentration of the
  virus, followed by semen, then vaginal fluids.
  Breast milk is a means of transmission for
  infants.

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Non-infectious Bodily Fluids

• Saliva
• Tears
• Sweat
• Feces
• Urine

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Activities That Promote HIV Transmission

• Unprotected sexual contact (body fluids)
• Direct blood contact
• Drug injection, blood transfusion, health
  accident
• Mother to Baby (before or during birth, or
  through breast milk)

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Sexual Routes Of Transmission

• Sexual intercourse (vaginal anal) - HIV may
  infect the mucous membranes directly or enter
  through cuts/sores
• Oral sex - Some what lower risk due to enzymes,
  acids, air, which destroy the virus, etc
• Heterosexual transmission From Males to Females
  is higher than from Females to Males

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Non-sexual Routes Of Transmission

• Sharing injection needles
• Needle sticks
• Blood transfusions
• Hemophilia treatments
• Other blood products,
• i.e. platelets-red blood cells
• Mother to child
• Donor insemination

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HIV is NOT Transmitted By..

• Insect bites -mosquitoes, flies, ticks, fleas,
  bees, or wasps
• Casual contact/sharing dishes or food (not
  transmitted by saliva)
• Donating blood (sterile needles)
• Swimming pools/hot tubs (chemicals kill)
• House Pets (cats, dogs)
• Saliva/tears/sweat/feces/urine

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Transmission through tattooing, piercing,
acupuncture, electrolysis and shaving

• When needles or razors are used on more than one
  person, there is a risk BUT the risk can be
  reduced by using sterilization procedures.
• No documentation in the U.S. of being infected
  through tattooing or piercing

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CDC Created Guidelines

• Any instruments designed to penetrate the skin
  such as tattoo or acupuncture needles should be
  used once and discarded or thoroughly cleaned and
  sterilized after each use

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Treatment Three Primary Approaches

• Antiviral Therapy
• Goal is to stop HIV replication with use of
  drugs such as AZT and Protease inhibitors
• Immune boosting therapy
• Attempt to bolster the bodys ability to fight
  HIV and/or fortify immune system (vaccines)
• Treatment prevention of specific infections
• Many infections can be controlled, prevented or
  eliminated

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Monitoring The Immune System

• When to begin if one is asymptomatic and before
  the T-cell count declines
• Contact a testing site for a physician referral
• Find a doctor who is familiar with treating HIV
  disease

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Tests That Monitor the Immune System

• HIV viral load measures amount of HIV in blood
  plasma
• CD4 count measures the number of CD 4 cells in
  blood sample. CD4 count is one indicator of how
  much damage HIV has caused the immune system.
• CD8 count- higher count indicates lower immune
  function

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Immune Monitoring Tests

• A doctor MUST order the monitoring tests and
  interpret the results

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Interpreting CD4 (T-Cell) Results

• Most Doctors Agree
• Greater than 500 T-cells normal
• Between 200-500 indicate immunodeficiency
• Less than 200 indicates severe immunodeficiency
  (and is the basis for an AIDS diagnosis)
• Single count does not count, should have 3 tests

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When To Begin Treatment

• Most recommend when
• CD4 count less than 500
• Viral load is greater than 10,000 copies/ml

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Natural Approaches

• Chinese herbal remedies
• Native Spiritual healers and herbalists
• Massage
• Acupuncture
• Healthy diet
• Ceremony

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(as of the end of November 2007)
Global Summary Of HIV/AIDS
Number of People living with HIV/AIDS Total
.............33.2 million Adults
..30.8 million Children under 15 years
old..2.5 million
(women account for nearly 1/2 of all people
worldwide living with HIV/AIDS)
UNAIDS World Health Organization. (2007). AIDS
epidemic update December 2007.
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HIV/AIDS In The US

• It is estimated that 1.2 million people are
  living with HIV and 25 of those are unaware of
  their status
• Of the new HIV infections each year

• 74 are diagnosed among males
• 26 among females

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Cumulative estimated of AIDS cases through
December 2006 by race/ethnicity
Centers for Disease Control and Prevention, Basic
Statistics, http//www.cdc.gov/hiv/topics/surveill
ance/basic.htmaidsrace, June 2007
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Growth in Native AIDS cases 1984 - 2006
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Data Collection Concerns

• CDC surveillance reports are based on state data
• 7 states do not collect data on Natives!
• Tribes do no report to IHS
• Neither tribes or IHS report data to states

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Other Areas Of Concern

• Problems with collection of data
• Frequent misclassification of ethnicity
• Inclusion of community leaders in HIV/AIDS
  dialogues
• HIV diagnosis is often made late in the
  progression of the disease

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Native Risk Factors

• Biological
• Economic
• Social
• Behavioral

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Biological Risk Factors

• Sexually Transmitted Infections are
• a Strong indicator of high risk behavior
• a Key factor in the transmission of HIV
• Appear to intensify by economic hardship

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Economic Risk Factors

• POVERTY/ECONOMIC HARDSHIP
• Can PREVENT or INHIBIT
• Obtaining health education
• Accessing good health care
• Utilizing proper medical treatment
• If impoverished, results can be
• Poor health
• Poor diet
• Related diseases

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Diseases Associated With Poverty
DIABETES

• Diabetes rates are high among Natives
• Diabetic death rates for Natives are 3.3 times
  the rate for other races

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Diseases Of Poverty
TUBERCULOSIS

• High rates of tuberculosis are
• found among Native people
• (rates reflect 22 times higher among
• Natives than other races)
• From 1992-1994 Native death rate
• from tuberculosis was 475 greater
• than other races

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Social Risk Factors

• Homophobia
• Stigma
• Mistrust/distrust of provider system
• Denial
• Confidentiality

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Behavioral Risks

• Alcohol Abuse Plays a critical role in the
• AIDS epidemic

• Decreases inhibitions
• Alters perceptions
• Interferes with the bodys use of
• vitamins and minerals that are
• critical to maintain a healthy
• immune system

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Behavioral Risks

• Injection Drug Use
• Reported as the source of 28 of all Native AIDS
  cases among women
• Drug use results in high-risk behaviors such as
  unprotected sex and sharing of needles

• High risk heterosexual contact
• Reported as the source of 44 of all Native AIDS
  cases among women
• Multiple sex partner increase risk among Native
  women

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Where Do We Begin?

• Community Decides to Act
• Community Readiness Determined
• Community Empowerment