Timeliness is an essential aspect of effective HIV treatment and prevention. Early detection of HIV infection facilitates the prompt initiation of behavioral changes aimed at reducing transmission and also may enhance treatment effectiveness. Unfortunately, many facilities for the treatment of alcohol or other drug use disorders do not routinely or consistently screen their patients for HIV. In addition, many people who test positive for HIV fail to seek medical care until the disease has reached an advanced stage (AHF, 2019). Alcohol abuse has been associated with longer delays in seeking treatment. Some evidence suggests that such problems may be ameliorated in part by designing programs that link primary medical care with treatment for abuse of alcohol and other drugs, HIV risk-reduction education, and psychiatric care The Florida Department of Health (FDH) has partnered with the CDC to develop a plan to address the high rate of HIV/ AIDS (FDH, 2019). Four key components: 1. Implement routine HIV and sexually transmitted infections (STIs) screening in health care settings and priority testing in non-health care settings . Everyone between the ages of 13-64 should have an HIV test in their lifetime. Those with ongoing risks should be tested more frequently by their health care provider, as should pregnant women, who should be tested in their first and third trimester. 2. Provide rapid access to treatment and ensure retention in care (Test and Treat) . In January 2016, the U.S. Department of Health and Human Services updated the HIV Treatment Guidelines to recommend that antiretroviral therapy be initiated as soon as possible, regardless of CD4 T-cell count or HIV viral load. Several research studies have now proven that persons living with HIV who stay in care and take antiretroviral medications every day to suppress HIV (viral load suppression, <200 copies/mL), have effectively no risk of transmitting the virus to an HIV-negative partner. Test & Treat is a program where the following occurs for a newly diagnosed individual or a person returning to care: ○ Immediate linkage to a clinician who can provide the following in a culturally appropriate manner: 1. Access to antiretroviral medications. 2. Medical assessments. 3. Education on what HIV is and how one can manage HIV and live healthy. ○ Linkage to an agency that can provide case management to assist the individual with accessing available resources in the community. 3. Improve and promote access to antiretroviral pre- exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) . To be effective, PEP must begin prior to 72 hours after exposure and consists of two to three antiretroviral medications that must be taken for 28 days. A physician must determine what treatment is appropriate based on the nature of the exposure. Starting PEP after a potential exposure does not guarantee that someone exposed to HIV will not be diagnosed with HIV.
when appropriate. In drug treatment programs, for example, both patients and clinicians may focus on what is perceived as the main problem (typically heroin or cocaine use), and neglect or minimize the use of other drugs, including alcohol. Yet in one study, a large proportion of patients in a residential drug treatment program reported daily consumption of large quantities of alcohol. In a randomized controlled trial, researchers demonstrated the feasibility of incorporating a multidisciplinary medical clinic within a detoxification unit designed to treat alcohol, heroin, and cocaine dependence. Because the integration of different services at a single site can be expensive, the researchers recommended that efforts be made to facilitate information transfer or patient transportation among programs based at multiple locations. 4. Increase HIV awareness and community response through outreach, engagement, and messaging . Knowledge and understanding of HIV, prevention strategies, and available resources to live healthy are critical to reducing HIV in Florida. Approximately 15 Floridians are diagnosed with HIV every day. Florida has two AIDS Education and Training Centers (AETC) that provide comprehensive resources for health care providers in the treatment and prevention of HIV/AIDS: ● North Florida AETC with the University of Florida Health. ● South Florida AETC with the University of Miami, Medical School. More than three decades after the first HIV diagnoses were made, stigma remains a barrier to addressing HIV in the U.S. Learn more about HIV-related stigma and how to address it in your community: CDC-Campaign-Lets-Stop-HIV-Together. The following paragraphs specifically address some of the more common misconceptions about HIV transmission. HIV in the environment Scientists and medical authorities agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote (CDC, 2020b). HIV is found in varying concentrations or amounts in blood, semen, vaginal fluid, breast milk, saliva, and tears. In order to obtain data on the survival of HIV, laboratory studies have required the use of artificially high concentrations of laboratory-grown virus. Erroneous interpretation of conclusions drawn from laboratory studies have alarmed people unnecessarily. Results from laboratory studies should not be used to determine specific personal risk of infection and to date no one has been identified with HIV due to contact with an environmental surface; Additionally, since HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions, it does not spread or maintain infectiousness outside its host. Other settings Although HIV has been transmitted between family members in a household setting, this type of transmission is very rare (CDC, 2020b). These transmissions are believed to have resulted from contact between skin or mucous membranes and infected blood. To prevent even such rare occurrences, precautions, as later described in this course, should be taken in all settings – including the home – to prevent exposures to the blood of persons who are HIV infected, at risk for HIV infection, or whose infection and risk status are unknown.
PREVENTION Florida’s plan to eliminate HIV transmission and reduce HIV-related deaths
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