Jennifer Hansen Applied Epidemiology

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Jennifer Hansen

Applied Epidemiology

AIDS Synopsis – Week 1 Assignment

Epidemiologists must take on many roles when studying the distribution and determinants of health-related events in history and applying that knowledge toward preventing and controlling diseases. In 1981, epidemiologists began working diligently toward identifying risk factors for AIDS in order to describe its natural history, identifying those at greatest risk of acquiring HIV and where they are located spatially, monitoring all aspects of the disease and infected persons over time, aiding in gathering information, promoting public policy for prevention and treatment, and determining the efficacy of these policies and treatments, and informing the public of the various aspects and risk factors for the disease. Following is an outline depicting the ways in which epidemiologists carried out these duties in the fight against the AIDS pandemic.

Factors Identified as Increasing Risk of Acquiring AIDS

  • Being active in gay lifestyle

  • Having many sexual partners

  • IV drug use

  • Living in an area in which sex is commercialized and high rates of IV drug use is common

  • Being the spouse/child of someone who exhibits some/all of the above-mentioned risk factors

AIDS Natural History

  • After discovering the initial cases of AIDS died in just months of diagnosis, AIDS is termed a lethal disease

  • Using blood samples, discovered the first case of AIDS was passed from a single chimpanzee to a single human in 1930

  • Tracked first AIDS death to 1959 in Congo

  • Identification of HIV as virus that kills Helper-T cells to suppress the immune system and the molecular characteristics of HIV; determination that HIV causes AIDS

  • Description of what happens to HIV and infected person under antiretroviral therapy/triple cocktail

  • HIV never disappears from infected person’s bodies, even with triple cocktail/ART

  • Documentation of types of infections/illnesses/symptoms infected persons present with (Karposi’s sarcoma, pneumocystis pneumonia, etc)

  • Discovery of HIV as virus by its ability to pass through filter for production of Factor 8

Individuals and Populations at Greatest Risk for AIDS

  • Young, gay men

  • Sexually promiscuous

  • Populations with high rates of commercial sex workers

  • Hemophiliacs; those in need of blood transfusions

  • IV drug users (40% of all AIDS cases)

  • Those living in southern and eastern Africa and India

  • Babies of infected mothers (In Africa, almost 50% of children in pediatric wards tested positive for HIV)

Where Public Health Problem is Greatest

  • Countries whose leaders do not want to address the issue of AIDS due to stigmas, reputation, cultural beliefs; therefore, lack of education in these populations

  • Eastern Europe, southeast Asia, China due to following trends for drug trade and commercial sex business (clustering)

Monitoring AIDS over time

  • First AIDS case documented in 1981, then 5 more cases in Los Angeles over the course of a few months

  • Monitor spread from central Africa to US/Europe via Haitians

  • Documenting and tracking mortality and morbidity rates of AIDS throughout the span of the disease and prevalence rates from initial stages of outbreak to later stages when ART becomes available and prevention strategies are widely spread and in use

    • 1987 Asia reports 208 cases, US 45000 cases, Europe 7000 cases, Africa 6000 cases

    • 1995 AIDS is named as #1 cause of death for Americans ages 25-44 by CDC

    • 1996 AIDS is no longer #1 cause of death for all Americans, but still for African Americans

    • In 2005, estimated 16,000 AIDS related deaths and 1.2 million living with AIDS

    • South Africa has almost 5 million infected with AIDS, only 40,000 on ART

  • The impact on prevalence rates of people with hemophilia due to contamination of blood supplies

  • Tracking new cases in new locations (first appearance in Russia following heroine and commercial sex business) clustering

  • 95% of all new AIDS infections are in poor countries

Evaluation of the Efficacy and Effectiveness of Prevention and Treatment Programs

  • Monitoring vaccine efforts

  • ART treatments and undetectable viral loads, how long does this last?

  • Uganda efforts for educating and implementing prevention strategies proved successful, death rates began to decline

  • Effect of anti needle-exchange laws on infection rates

  • In absence of treatment, prevention and education only options

  • ABC approach – effectiveness of abstinence versus condom use

Provision of Useful Info in Health Planning and Decision Making for Establishing Health Programs with Appropriate Priorities

  • Determine how to help and implement effective programs for infected persons who have lost their support systems, jobs, families, etc due to stigmas involved in spread of AIDS

  • Showing blood transfusions can transmit AIDS in order to encourage formation of policies/procedures to stop this line of transmission

    • Baby dies of AIDS by transfusion from infected person

  • Researching and identifying means of transmission

    • Casual contact does not spread AIDS

  • Estimate over 40 million new infections over the next decade without advanced treatments and prevention methods

  • Research and understand different cultures, governing bodies, and their belief systems and how this will impact effectiveness of individual treatment programs and prevention strategies.

  • Figure out what prevention strategies are most effective

    • ABC approach

    • Abstinence versus condom education and use

Assistance in Carrying out Public Health Programs

  • Get audience with governing bodies and leaders in order to get attention focused on AIDS efforts and reducing the spread of fear

    • Nelson Mandela, Mbeki, Bush, Clinton, etc.

  • Encourage tolerance among leaders and physicians alike

  • Calling for action from political leaders to provide care for AIDS patients without insurance, funds for medications

Being a Resource

  • Collaborate with other experts to identify at-risk populations and predicted prevalence rates in locations throughout the world

  • Gain trust of AIDS populations in order to get them to cooperate with prevention methods

Communication of Public Health Information

  • Provide information and education for activists in order to encourage political leaders to move on AIDS stigmas and research

  • Constantly provide up-to-date information for physicians, experts, medical community, public health leaders, activists, and political leaders in order to maintain the best possible medical treatments, prevention strategies, and outcomes for AIDS patients

One of the initial approaches used by epidemiologists to study AIDS early on was the widespread study of gay men due to vast majority of cases being seen in gay men. This led to the labeling of AIDS as GRID (Gay-Related Immune Deficiency) syndrome, which turned out to be an inaccurate description and, unfortunately, caused a lot of fear and distrust of those in the gay community by the rest of the community. In contrast, researchers quickly found that there were many cases of women being infected with HIV, as many as men, and this helped to dispel some of the inequalities in stigmas surrounding AIDS and the gay community.

Another approach used to study AIDS as the disease progressed was laid out in the protocol for Project Inform. This was a proposal to have open lines of communication for sharing information regarding HIV and AIDS cases, accelerate advances in treatment, and promote prevention strategies. This was a positive approach because in accelerating advances in treatment programs, more people were allowed access to the antiretroviral therapy medications, which led to a reduction in self medication with potentially dangerous drugs.

As AIDS progressed and more people became infected, new strategies for developing and providing the expensive medications became necessary. In 1995, intensive studies were being conducted in attempts to find a viable vaccine for use against HIV. One such attempt initially failed to successfully use protease inhibitors to help the body overpower the reproduction of HIV, but did allow scientists to determine the rate at which HIV replicates inside the human body and how the body reacts by increasing production of helper T cells. With this information, scientists were able to develop a protease inhibitor, saquinavir, which was capable of slowing the reproduction rate of HIV; thus, prolonging quality and quantity of life for infected patients. Soon after, the triple cocktail became available. These advancements in medications for AIDS treatment were huge breakthroughs in the fight against the effects and spread of the disease. While there is still a lot of work to be done in this fight, combining the advancement of such medications with the promotion and education of prevention strategies and reduction of stigmatized thinking against AIDS sufferers, has allowed great strides to be made in the global community against AIDS.

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