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