cities dirty needles, unsafe blood transfusions more sexual partners greater mobility how did hiv...

Cities

• dirty needles, unsafe blood transfusions

• more sexual partners

• greater mobility

How Did HIV Spread?

How Did HIV Spread?

Jet travel

How Did HIV Spread?

HIV spread silently around the world for fifty years

1930s

1981

How was the Epidemic Discovered?

June 5, 1981

• Five cases

• Los Angeles

• pneumocystis pneumonia

30 Morbidity and Mortality Weekly Report 250http://www.cdc.gov/mmwr/preview/mmwrhtml/00043494.htm

How was the Epidemic Discovered?

= APB

all points bulletin

November 5, 1982

• Just 17 months after the first LA cases

• Similar pattern: hepatitis B

• Possible cause:

unidentified bloodborne agent

31 Morbidity and Mortality Weekly Report at 577http://www.cdc.gov/mmwr/preview/index82.html

How was the Epidemic Discovered?

December 10, 1982

• 1 month later

• Infant: multiple blood transfusions developed AIDS

• Donor had developed AIDS

31 Morbidity and Mortality Weekly Report at 652http://www.cdc.gov/mmwr/preview/index82.html

How was the Epidemic Discovered?

And six months later?

How was the Epidemic Discovered?

June 1983

• French announce:

New bloodborne pathogen

How was the Epidemic Discovered?

2008 The Nobel Prize in Physiology or Medicine

Françoise Barré-Sinoussi Luc Montagnier

How was the Epidemic Discovered?

ARV

HTLV-III

LAV

How was the Epidemic Discovered?

HIV

Human Immunodeficiency Virus

How was the Epidemic Discovered?

June 1981

June 1983

24 months

How was the Epidemic Discovered?

HIV is bloodborne

People living with HIV & AIDS

The Law

Discrimination:

same civil rightshave the

as all persons living withserious illness.

Mainstreaming Principle

Universal precautions:

How We Protect Others

The Law

Workplace Safety:

Treat all blood, at alltimes, from all sources,as if it is infectious.

Heightened privacy protections

How -- and Why -- We Specially Protect People with HIV

The Law

Privacy and Confidentiality:

from other people’s fear and stigma.people living with HIV & AIDS

to protect

HIV is Bloodborne

Discrimination Privacy and Confidentiality

Workplace Safety

The Law

AIDS/HIV

• contagious

• new

• stigma

• sexuality

• race

• death

Epidemics

Brief Golden Ageof

Infectious Disease Control

1955 - 1981

Paramedics

Should HIV information be broadcast?

Case Study #1:

Discrimination

Workplace Safety

Case Study #1: Paramedics

Privacy and Confidentiality

Workplace Safety

Case Study #1: Paramedics

Privacy and Confidentiality

Discrimination

Case Study #1: Paramedics

Can dentists refuse to treat persons with HIVbecause of the risk to others?

• Dentist• Staff• Other patients

DentistsCase Study #2:

Workplace Safety:

Case Study #2: Dentists

Universal precautions: Treat all blood, at all times, from all sources, as if it is infectious.

But . . . What if there’s an accident???

• Cut off your hand?• Jump out the window?

Case Study #2: Dentists

Early 1980s: 200 HCWs died each year HBV

Late 1980s: HIV

seroconversion rate 1: 2.5

seroconversion rate 1:

post-exposure prophylaxis (PEP)

“remote risk”

Case Study #2: Dentists

250

lowered further by

US Supreme Court:

School Board of Nassau County v. Arline

“significant risk”“remote risk”

480 U.S. 273 (1987)

Case Study #2: Dentists

524 U.S. 624 (1998)

Bragdon v. Abbott

Courts should defer to the reasoned judgement of public health officials,

Case Study #2: Dentists

US Supreme Court:

not the unsupported judgment of a single dentist.

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