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HIV and Violence

Lissette Marrero, MSW Deputy Director Adolescent AIDS Program Children's Hospital at Montefiore

Lissette Marrero

on 11 October 2012

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Transcript of HIV and Violence

Goals and Objectives Understand the HIV epidemic in the U.S. and NYC
Understand the process of HIV in the body.
Understand HIV risk behaviors.
Understand the importance of HIV Confidentiality laws Understand HIV/AIDS as it relates to violence.
Understand the social implications of being HIV positive.
HIV and Violence

Lissette Marrero, MSW
Deputy Director
Adolescent AIDS Program
Children's Hospital at Montefiore National Statistics
HIV is the worst epidemic in history
56,300 new cases each year
Over half (53%) of these new infections occurred in gay and bisexual men.
African American men and women are estimated to have an incidence rate than is 7 times greater than the incidence rate among whites.
1 in 4 HIV+ American’s don’t know their status
41% of individuals diagnosed HIV+ are diagnosed with AIDS within one year of their positive HIV test

HIV/AIDS and HRC – Two Decades of Fighting for Life, 2000
www.cdc.gov – HIV Incidence
www.cdc.gov – HIV Incidence Estimate

New York City remains the epicenter of the HIV/AIDS epidemic in the U.S. Over 100,000 New Yorkers are living with HIV, but thousands don’t know they’re infected. New York City has the highest AIDS case rate in the country, with more AIDS cases than Los Angeles, San Francisco, Miami, and Washington DC combined.

Each year in New York City, 1,000 people are diagnosed with HIV when they are already sick with AIDS—this is three people each day, a little over a quarter of new AIDS diagnoses, which is the same proportion as nationally.

2008 survey of YMSM in the Ball community of NYC found that an HIV prevalence of 17% in the sample (N=504) and 73% were unaware of they were HIV-positive (Murrill, AJPH).

Between 2005 and 2009, 206 transgender persons were newly diagnosed with HIV in NYC.

New York City Department of Health and Mental Hygiene
New York State Department of Health-AIDS Institute
Centers for Disease Control and Prevention
HIV – Human Immunodeficiency Virus

AIDS – Acquired Immune Deficiency Syndrome
How are they different?
HIV is a viral infection that affects the entire immune system. It can take up to three months for your body to develop HIV antibodies after exposure to the virus.

A person is clinically diagnosed with AIDS when:
They have a T-Cell count of below 200 and/or an opportunistic infection. This is not to say that all persons living with AIDS are terminally ill, however, each case is different and should be treated accordingly. Unfortunately, most young people discover their HIV status once they have developed HIV Symptoms or an opportunistic infection.
Exposure - The virus gets inside the body, under the skin or into mucus membrane

Infection - The virus gets into a white blood cell and “sets up housekeeping” Acute HIV Infection (AHI)

Also known as “Primary HIV Infection” – is the 1st stage of HIV disease and lasts ~54 days
The 1st 3-6 wks of infection, antibodies are not detected; virus replicates rapidly (hundreds of thousands of virus per ml of blood) Natural History of HIV Infection

Immune cells capture HIV cells at mucosal surfaces, i.e., genitals, anus, or mouth and carry the HIV cells to the lymph nodes with in 36 hrs

HIV replicates in CD4 cells which are released into the blood spreading the virus through out the body
It only takes…
5-10 days for replication to occur

The virus doubles in the blood every 8 hrs
HIV Infection Is Almost Always Asymptomatic Persons with Acute HIV Infection
Can transmit HIV 100 to 3,000 times more that those with chronic or suppressed HIV infection
Post exposure prophylaxis (PEP)
For non-occupational exposure (vaginal , rectum, oral PEP will be given immediately and/or within 72 hours of exposure and continued for 28 days.
Effective November 27, 2012, hospitals providing treatment to victims of sexual assault will be required to:
•Provide a 7-day starter pack of HIV post-exposure prophylaxis to victims of sexual assault, and;
•Provide or arrange for an appointment for medical follow-up related to HIV post-exposure prophylaxis and other care as appropriate.
The amended Public Health Law Section 2805-i (2012) (PrEP) pre-exposure prophylaxis.
The HIV drug Truvada has been proven to reduce the risk of HIV in men who have sex with men. It is only recommended as a PrEP treatment in this group of men. The NYS HIV Confidentiality Law was enacted in 1988
Intent of the law:
Ensures maximum confidentiality protection for information related to HIV/AIDS;
Assures that HIV-related information is not improperly disclosed
Encourages expansion of voluntary HIV testing
Limits discrimination and harm of unauthorized disclosures
Who Complies With the Law?
All staff, volunteers and programs regulated, certified or licensed by and/or under the jurisdiction of:

Office of Alcohol and Substance Abuse Services (OASAS)
Division for Youth (DFY)
Department of Corrections (DOC)
Department of Health (DOH)
Office of Mental Retardation Developmental Disabilities (OMRDD)
Office of Mental Health (OMH)
Divisions of Parole and Probation; and Department of Social Services
Anyone who receives HIV-related information by way of an HIV release form
Who is Not Covered?
Private citizens
Police officers
Unregulated community based organizations
Partner Notification

Purpose: Contact tracing and notification for the reduction and/or elimination of HIV infection
Any partner who is known to the health care provider must be reported.
Known partners include:
Past or current spouse (exposed spouses/partners for the past ten years)
Any known present or past sexual or needle-sharing partner for the past ten years
DV screening

AIDS stigma is manifested through discrimination and social ostracism directed against individuals w/ HIV/AIDS, groups of people perceived to be likely infected, and against those individuals, groups and communities with whom these individuals interact.
HIV-positive clients….
Experience self-stigmatization and shame when they internalize negative reactions from others.
Leads to depression, withdrawal, isolation, and feelings of worthlessness.
Sometimes feels responsible for contracting HIV

These feelings can be relived and retrigger violence and trauma and in times of crises.
Intimate Partner Violence and HIV

Direct transmission through sexual violence
Indirect transmission through sexual risk taking
Indirect transmission through inability to negotiate condom use
Indirect transmission by partnering with riskier/older men
Violence as a consequence of being HIV+
HIV Disclosure and Violence

Charlie was 18 years old when he met David. Life was fine, a stable home, regular meals, an affectionate partner, and sex that was hot and safe. Charlie hadn't been feeling good and had gone to a clinic where he tested for HIV. The words "Your test results are positive" changed his life forever. He ran home to David, but when he told David, David had screamed, "You little slut!" and smacked him hard across the face. That was when the nightmare began. David refused to wear a condom after that, saying, "What do you care? You've already got it!" When Charlie resisted, David hit him again. It seemed to get worse every day, but Charlie couldn't imagine a life without David. Each episode was followed by David's remorse and promises that it would never happen again; until it did. Once Charlie threatened to leave if the hitting didn't stop. David just laughed and said, "Where the hell would you go, back to the streets? You'd better stay with me, because nobody else is going to want you now." And Charlie stayed -- his dreams shattered, his love turned to fear, and the sex with David, which he had enjoyed so much, turned to rape.
“ I DID IT TOO”... Role Play - Joe
21 year old African-American
Bronx, NY
Really afraid
Needs help
Lissette Marrero, MSW
Deputy Director
Adolescent AIDS Program
111 East 210th Street
Bronx, NY 10467
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