HIV Speaks on Jones Street: NC HIV & Hepatitis Advocacy Day

On Tuesday, March 12, 2019, the North Carolina AIDS Action Network (NCAAN) hosted its annual HIV Speaks on Jones Street event.  This year, there were two issues chosen to advocate for in the NC General Assembly.  The two issues included:

1. Allocate an increased appropriation of $900,000 to the Communicable Disease Branch of the NC Division of Public Health, and
2. Close the Medicaid coverage gap (NCAAN, HIV Speaks, 2019).

Although there has been progress made in addressing both HIV and Hepatitis C (HCV), there is still progress to be made.  Because a suppressed HIV viral load can prevent transmission through sexual contact, it is important that individuals living with HIV have access to medications (NCAAN, HIV Speaks, 2019).  It is also important that individuals who are HIV negative protect themselves.  One option is the use of PrEP, which is a medication that can help decrease the likelihood of contracting HIV.  Fifty percent of the 100,000 individuals living with HCV in North Carolina have yet to receive a diagnosis (NCAAN, HIV Speaks, 2019).  There is a need for testing for both HIV and HCV, HIV prevention and HCV treatment.  These needs were the basis for asking the NC General Assembly for $900,000 for the Communicable Disease Branch of the NC Division of Public Health to provide and support these services.

The expansion of Medicaid was the other issue advocated for.  Of the 400,000 people in North Carolina who would qualify for and obtain coverage through the expansion, more than 5,000 of those are currently living with HIV (NCAAN, Closing the Medicaid coverage gap, 2019).  Providing individuals would not only allow them to access needed healthcare services, but would also assist in combating the opioid epidemic by providing access to substance abuse and mental health treatment and services and boosting local economy by creating new jobs, increasing business activity and decreasing healthcare costs that are currently not being paid for, particularly in rural areas (NCAAN, Closing the Medicaid coverage gap, 2019).

On Tuesday, many advocates from different parts of the state met with state senators and representatives to garner support for these issues.  Support was expressed by some legislators concerning the issues.  Mike Woodard, Zack Hawkins, and Marcia Morey all expressed support while others and I met with each of them.  Jeremy Collins, the Director of the Office of Public Engagement in the Governor's Office, also expressed support when welcoming the advocates to the event.  Advocates, those who have been infected and those who have been affected, shared information and stories as to how the issues have impacted them.  There is much more work to be done in order for changes to be made.  In order for those in North Carolina to contact their state senators and representatives and express their support for these issues, check out www.ncleg.gov to find who represents your area.  Although this website is for North Carolina, there are other states that still have not expanded Medicaid.  Access to healthcare is still an issue within the United States and should be considered an important issue.


#NCHIV
#NCGA

NCAAN. (2019)  Closing the Medicaid Coverage Gap.  North Carolina AIDS Action Network.

NCAAN. (2019)  HIV Speaks on Jones Street:  NC HIV & Hepatitis Advocacy Day.  North Carolina AIDS Action Network.

Congestive Heart Failure

Congestive Heart Failure occurs when the heart is unable to pump adequately enough to meet the needs of the body.  There are several conditions that may result in Congestive Heart Failure including: 

• Coronary Artery Disease, 
• High Blood Pressure, 
• long term alcohol abuse, 
• heart valve disorders, 
• heart attack and 
• cardiomyopathy  (Kulik, 2018)(Mayo Clinic, 2023).  

There are approximately six million people in the United States affected by Congestive Heart Failure and approximately 670,000 people are diagnosed each year.  Among individuals 65 and older, Congestive Heart Failure is the leading cause of hospitalization (WebMD, 2018).

Because a heart is weakened by Congestive Heart Failure, its pumping ability is also weakened and moves blood throughout the body slower (decreased cardiac output) and increases the pressure within the heart.  As a result, decreased amounts of Oxygen and nutrients reach the body.  With the increase in pressure within the heart, its chambers are stretched and may become stiff and thickened.  The stiff, thickened heart muscle is less able to pump blood.  Ejection fraction is the measurement of how effective the heart is pumping.  Normal ejection fractions are above or equal to 50% (Mayo Clinic, 2023).  Congestive Heart failure can occur in the left, right or both sides of the heart, but usually starts in the left side of the heart (Mayo Clinic, 2023).  Types of Congestive Heart Failure include: 

• Systolic dysfunction - heart does not create enough force to pump Oxygen rich blood through the body
• Diastolic dysfunction - heart is able to contract, however, because the ventricles do not properly relax, less blood is able to enter the heart (WebMD, 2018).

As the heart muscle becomes weakened, stiff and thickened, its pumping effectiveness decreases.  As efficiency decreases, kidneys begin to retain fluid and salt.  The fluid building up in extremities (arms, legs, feet), lungs and organs causes the body to become congested.  Symptoms of Congestive Heart Failure include: 

• fluid retention
• dizziness
• fatigue 
• weakness
• rapid or irregular heartbeats
• shortness of breath 
• diminished exercise capacity (Kulick, 2018)(WebMD, 2018). 

Shortness of breath is the hallmark symptom and can occur at rest, with activity, lying flat or can wake an individual up during sleep.  Risk factors include: high blood pressure, coronary artery disease, heart attacks, Diabetes, some Diabetic medications, other medications, sleep apnea, congenital heart defects, valvular heart disorders, viruses, age, alcohol use, tobacco use, obesity, and irregular heartbeats (Mayo Clinic, 2023).

Tests, in addition to physical exam, can be performed to help diagnose Congestive Heart Failure.  Tests such as cardiac blood tests, chest x-ray, electrocardiogram, echocardiogram, stress test, cardiac CT scan, MRI, coronary angiogram, and myocardial biopsy may all assist in diagnosis.  Once Congestive Heart Failure has been diagnosed, the stage can be determined.  According to the American Heart Association and the American College of Cardiology, stages range from A to D and are based on symptoms present and treatments needed.  According to the New York Heart Association, stages range from I to IV and are based on symptoms and level of shortness of breath (Mayo Clinic, 2023).

Once diagnosed with Congestive Heart Failure, there are times when you should contact your primary clinician including:

• if your symptoms worsen suddenly
• you have a new symptom
• you gain 5 or more pounds within a few days 

These can implicate that Congestive Heart Failure is worsening or the current treatment is not appropriate.  (Mayo Clinic, 2023)

Complications of Congestive Heart Failure may include:

• Kidney damage or failure: due to reduced blood flow to kidneys
• Other heart problems: due to changes in heart size and/or function
• Liver damage:  due to fluid build up in the liver
• Sudden cardiac death:  due to irregular heart rhythm (Mayo Clinic, 2023)

Treatments for Congestive Heart Failure include medications, surgery, and devices.  Medications used are:

• ACE Inhibitors
• Angiotensin  II Receptor blockers
• Beta Blockers
• Diuretics
• Aldosterone Antagonists
• Inotropes
• Digoxin
  

Surgeries and medical devices that can be utilized are:

• Coronary Bypass Surgery
• Heart Valve Repair or Replacement
• Implantable Cardioverter-Defibrillators
• Cardiac Resynchronization Therapy
• Biventricular Pacing
• Ventricular Assist Devices
• Heart Transplant (WebMD, 2018)

Things that can be done to improve Congestive Heart Failure are:

• improve blood pressure
• monitor weight and swelling
• monitor fluid intake and output
• limit salt
• lose weight
• monitor symptoms (Kulick, 2018)(Mayo Clinic, 2023).

Eating a healthy diet, exercising, and obtaining vaccines to prevent respiratory infections can also improve living with Congestive Heart Failure (WebMD, 2018).

To learn more about Congestive Heart Failure, watch our Youtube video.

Updated 3/11/2023

Kulick, D. (2018) Congestive Heart Failure (CHF) Symptoms, Stages, Prognosis.  MedicineNet.com        Retrieved from https://www.medicinenet.com/congestive_heart_failure_chf_overview/article.htm

Mayo Clinic, (2023) Heart Failure.  Mayo Clinic.  Retrieved from

     https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142

WebMD. (2018) Congestive Heart Failure and Heart Disease.  Retrieved from

     https://www.webmd.com/heart-disease/guide-heart-failure#6-11

Alzheimer's Disease

Alzheimer's disease is a type of dementia that affects more than five million individuals in the United States.  This number could rise as high as sixteen million by 2050 (Alzheimer's Association, 2017).  Symptoms of dementias include progressive memory loss and decrease in cognitive abilities and social skills.   Alzheimer's Disease makes up 60 - 80% of the dementias experienced (2017).  The cause of Alzheimer's Disease is the degeneration and death of brain cells.  Plaques made up of Beta-amyloid protein damage and destroy the brain cells.  The plaques also interrupt communication between cells.  Threads of Tau protein within the brain carry nutrients throughout the brain.  The threads becoming tangled decreases nutrients reaching brain cells, which contribute to the death of the brain cells (Mayo Clinic, 2018).

The first symptoms of Alzheimer's include forgetfulness and confusion.  At a rate that is individual, the symptoms progress and worsen.  As the disease progresses, memory losses can affect lives in ways such as:

• Repeating statements and questions
• Forget everyday events such as conversations, appointments or events
• Misplacing possessions
• Getting lost, even in familiar places
• Forgetting names of family and friends
• Difficulty in identifying objects or expressing thoughts (Mayo Clinic, 2018).

Symptoms also include difficulty in identifying and thinking effectively responding to activities of daily living, performing activities with sequential steps and changes in behavior and personality.  These changes include:

• Depression
• Apathy
• Social withdrawal
• Mood Swings
• Distrust in others
• Irritability
• Aggressiveness
• Changes in sleeping habits
• Wandering
• Loss of inhibitions
• Delusions (Mayo Clinic, 2018).

Alzheimer's is diagnosed through a medical history, mental status test, mood testing, physical and neurological exam, and blood and brain imaging tests that rule out other disorders.  Risk factors include:

• Age
• Family history
• Down Syndrome
• Sex
• Mild cognitive impairment
• Past head trauma
• Lifestyle and heart health
• Lifelong learning and social engagement (Mayo Clinic, 2018).

Although there is no cure for Alzheimer's Disease, there are treatments.  There are medications used to treat memory loss, behavior changes, and  sleep changes (Alzheimer's Association, 2017).  A safe and Supportive environment should also be established.

Watch Youtube video below.  Click like, share and subscribe.

https://www.youtube.com/watch?v=DXu4XJyn6W4

Alzheimer's Association. (2017) Diagnosis of Alzheimer's Disease and Dementia.  Alzheimer's Association.  Retrieved from https://www.alz.org/alzheimers_disease_diagnosis.asp

Alzheimer's Association. (2017) Treatment of Alzheimer's Disease.  Alzheimer's Association.  Retrieved from https://www.alz.org/alzheimers_disease_treatments.asp

Mayo Clinic (2018) Alzheimer's Disease.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/diagnosis-treatment/drc-20350453

Migraines

Migraines are a type of headache that can be intense and at times, debilitating.  They can occur with an aura, a classical migraine, or without an aura, a common migraine.  Common migraines are more common than classical migraines.  The fact that migraines not only involves debilitating pain, but also has classic migraine symptoms differentiate them from other types of headaches.  They are indeed different from a "really bad headache".  Symptoms associated with migraines are:

• nausea
• pain behind one eye or ear
• pain in the temples
• seeing spots or flashing lights
• sensitivity to light and/or sound
• temporary vision loss
• vomiting (Nall, 2015)

It is common for migraines to affect one side of the head.  Another characteristic that differentiates migraines is that the intense pain has a throbbing quality.  A migraine can cause debilitating pain for either hours or days (Mayo, 20).  Without treatment, a migraine can last 72 hours or longer.  As someone who suffers from migraines, I can attest to the fact that they can indeed last this long.  I have had migraines for up to four days.

There are several types of migraines, including:

• Migraine with aura (Classical migraine)
• Migraine without aura (Common Migraine)
• Basilar - Type Migraine:  may include temporary partial or total blindness
• Hemiplegic Migraine:  rare and can cause temporary paralysis
• Migraine without headache:  aura symptoms without a headache
• Status Migrainosus:  rare, severe and can last over 72 hours (NIH, 2023)

Classical migraines occur after an aura which occurs ten to thirty minutes before the migraine.  Common migraines do not have these symptoms beforehand.  Sensations that occur during an aura are:

• feeling less mentally alert or having trouble thinking
• seeing flashing lights or unusual lines
• tingling or numbness in the face or hands
• blurred vision
• unusual sense of smell, taste, or touch (Nall, 2015)

A prodrome may also occur one to two days before a migraine.  Symptoms that can occur during this phase are:

• constipation
• neck stiffness
• increased thirst and urination
• frequent yawning (Nall, 2015)

A postdrome may also occur for approximately 24 hours after the migraine.  Symptoms during this phase include:

• confusion
• moodiness
• dizziness
• weakness
• sensitivity to light and sound (Mayo, 2023) 

There are several theories as to why migraines occur.  Changes in the brainstem and how it interacts with the trigeminal nerve is thought to be involved.  It is also thought that imbalances in brain chemicals, particularly serotonin, also plays a role.  It is thought that when serotonin levels decrease, the trigeminal nerve release neuropeptides which cause the pain associated with migraines by acting on the meninges, the brains outer coverings (Mayo, 2023).

Several things can be done to diagnose migraines.  These include:

• Medical History
• Family History
• Physical Exam
• Including a Neurological examination
• MRI
• CT scan (Mayo. 2023)

There are certain things that may trigger migraines including:

• hormonal changes in women
• foods - salty foods, chocolate
• food additives
• drinks - alcohol and highly caffeinated drinks
• stress
• sensory stimuli - bright lights, loud sounds, strong smells
• changes in wake - sleep patterns
• Intense physical exertion
• changes in environment
• medications (Mayo, 2023)

There are risk factors that make some people more susceptible to migraines.  These individuals who have a family history of migraines are more likely to develop them as well.  Although migraines can occur at any age, they tend to increase during an individual's 30s, then decrease.  Women are three times more likely to be affected by migraines (Mayo, 2023).

There are several treatments for migraines.  

• Pain relievers: ibuprofen or Tylenol
• Triptans: help to block pain pathways. 
• Ergots: block pain messages
• Ubrelvey: relieves both pain and symptoms
• Preventive medications
• Beta blockers
• Calcium channel blockers
• Tricyclic antidepressants
• Anti-seizure medication (NIH, 2023)

To learn more about Migraines, watch our Youtube video.

REVIEWED AND UPDATED 4/7/23

Mayo Clinic. (2023) Migraine.  Mayo Clinic.  Retrieved from http://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/dxc-20202434

Nall, R. (2015) Migraines vs Headache: How to tell them apart.  Healthline.  Retrieved from http://www.healthline.com/health/migraine/migraine-vs-headache#overview1

NIH (2023)  Migraine.  National Institutes of Health.  Retrieved from https://www.ninds.nih.gov/health-information/disorders/migraine#

Alcohol use

Alcohol use is a common occurance.   Although consuming alcohol in moderation may not generally be an issue, alcohol affects different people in different ways. There are individuals who should not consume alcohol including:

• individuals under 21 years old
• women who are pregnant
• individuals who will be driving
• individuals taking medications as there are many medications that interact with alcohol
• individuals who have cetain medical conditions as alchol can aggrevate their condition
• individuals in recovery of Alcohol Use Disorder (CDC, 2024)

Factors that determine how alcohol will affect someone include:

• how much someone drinks
• how often someone drinks
• age
• health status
• family history 
• sex
• weight
• medications
• eating while consuming alcohol (Stanford, n.d.)(NIH, Overview, n.d.).

Factors may determine the rate in which alcohol is absorbed, however, consuming too much alcohol will indeed have consequences.  As the amount of alcohol increases in someone's blood, their blood alcohol concentration level (BAC), the more impaired someone becomes, the more consequences they experience. 

Consequences of having a high BAC include:

• reduced inhibitions
• slurred speech 
• motor impairments 
• confusion
• memory problems
• concentration problems
• coma
• breathing problems 
• death (NIH, Overview, n.d.).  

Excessive drinking can be broken down into Binge drinking or Heavy drinking.  Binge drinking is defined by the CDC as four or more alcoholic drinks in a single occasion for women and five or more alcoholic drinks in a single occasion for men.  Heavy drinking is defined by the CDC as eight or more alcoholic drinks per week for women and 15 or more alcoholic drinks per week for men (CDC, 2024).

Alcohol related consequences can lead to greater consequences.  Because of these consequences, car accidents, risky or violent behavior, or suicide or homicide are all risks of drinking alcohol (NIH, Overview, n.d.).  When drinking alcohol in excess over a long period of time, other effects can occur such as:

• alcohol use disorder
• interference in brain pathways
• stroke
• cardiomyopathy
• hepatitis 
• cirrhosis
• pancreatitis 
• increased risk of certain cancers (Mouth, stomach, esophagus, throat, liver) (NIH, Effects, n.d.). 

Additionally, alcohol use can have effects during pregnancy.  It can increase the risk of miscarrage, stillbirth or caue Fetal Alcohol Syndrome (CDC, 2024) Long term alcohol use can also lead to Wernicke-Korsakoff Syndrome which is a brain disorder caused by Vitamin B1 (Thiamine) deficiency.  Long term alcohol use can lead to Vitamin B1 deficiency (NIH, Effects, n.d.).



References

Centers for Disease Control and Prevention (2024)  Alcohol Use and Your Health.  Centers for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm#:~:text=Long%2DTerm%20Health%20Risks,liver%20disease%2C%20and%20digestive%20problems.&text=Cancer%20of%20the%20breast%2C%20mouth,liver%2C%20colon%2C%20and%20rectum.

National Institutes of Health. (n.d.)  Alcohol Effects on the Body.  National Institute on
Alcohol Abuse and Alcoholism.  Retrieved from https://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body

National Institutes of Health. (n.d.)  Overview of Alcohol Consumption.  National Institute on Alcohol Abuse and Alcoholism.  Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption

Stanford University. (n.d.) Factors That Affect How Alcohol is Absorbed.  Stanford University.  Retrieved from https://alcohol.stanford.edu/alcohol-drug-info/buzz-buzz/factors-affect-how-alcohol-absorbed

UPDATED 4/23/24

NC HIV Advocacy Day - June 7, 2016

Tuesday, June 7, 2016 is HIV Advocacy Day in North Carolina.  Unknown numbers will convene in Raleigh to advocate for issues surrounding HIV.  This is a day that has been sponsored by NC AIDS Action Network (NCAAN).  This year, an issue they are raising with lawmakers is the ability, really inability,  for those individuals living with HIV and receiving funds from the AIDS Drug Assistance Program (ADAP) to pay for health insurance premiums bought through the Affordable Care Act's Marketplace with funds received from ADAP.

North Carolina is one of the few states that does not allow ADAP funds to be used for premiums.  Funding for ADAP comes from both state and federal funds as well as rebates from the Pharmaceutical Industry.  The program helps individuals with low incomes to purchase HIV medications.  The ultimate goal is not only to treat as many people with HIV as possible, but to keep them treated as continuous treatment contributes to viral suppression.  Viral suppression helps individuals live longer and healthier lives.  It also makes transmission of HIV more difficult.

Allowing premiums to be purchased with ADAP funds would save North Carolina millions of dollars and improve quality of health.  This is because individuals not only need medications, but need access to healthcare as well.  A guidance was proposed by the US Health Resources & Services Administration in September, 2015 that would require states to use ADAP funding to pay for premiums in order to receive rebates from the pharmaceutical industry.  In states that don't allow funding to be used for premiums, such as North Carolina, money received from rebates would be lost.  This would add up to millions of dollars not being available to those people participating in ADAP in North Carolina.  This would negatively impact the health of these individuals and may contribute to transmission rates of HIV as viral loads go up.  If you are interested in this issue or participating on June 7, visit NCAAN's website, www.ncaan.org, or visit http://statevoices.salsalabs.com/o/72/p/salsa/event/common/public/?event_KEY=649  to register.

REFERENCES

Keeton, K;  Storrow, L.  (2016)   Ken Keeton and Lee Storrow: Better access to HIV medications would save lives.  Greensboro News and Record.  Retrieved from http://www.greensboro.com/opinion/columns/ken-keeton-and-lee-storrow-better-access-to-hiv-medications/article_30abe3dc-4ba7-55a9-b491-c214cb5b5955.html

NCAAN.  (2015)  Lack of Premium Assistance in North Carolina threatens ADAP budget. A Sustainable Future For The NC AIDS Drug Assistance Program.  Retrieved from http://www.ncaan.org/uploads/7/5/8/9/7589793/adap_funding_handout.pdf

HIV/AIDS

 

Human Immunodeficiency Virus (HIV) is the virus that causes Acquired Immune Deficiency Syndrome (AIDS).  HIV attacks an individual's immune system, specifically CD4 cells, a type of White Blood Cell.  There is a process of differentiation and responses that occur with CD4 cells, but what is important to know is that CD4 cells "kick into gear", so to speak, when someone is exposed to an infectious agent, HIV included.  HIV destroys CD4 cells, and therefore, destroys a person's immune system.  There are treatments for HIV, but there is no cure.  Sometimes HIV and AIDS are thought to be synonymous, but there is a difference.  HIV is the virus.  Someone can be said to be HIV+ if they are infected with the virus.  AIDS is the end stage of the HIV Infection.  Not everyone who is HIV+ has AIDS.  The stage at which someone is diagnosed with AIDS is when they are HIV+,  their CD4 count drops below 200, CD4 cells make up less than 14% of a person's white blood cell count and an individual has developed an opportunistic infection which is an infection that takes advantage of a weakened immune system (UCSF, n.d.).

There are over 1.2 million people in the United States living with HIV.  1 in 8 of these individuals are unaware they are HIV+.  Youth between 13 and 24 make up 25% of new HIV infections.  Men who have sex with men (MSM), African Americans and Hispanics are other groups who are at higher risk of being infected.  Across the globe, 36.9 million people are living with HIV/AIDS.  2.6 million of these people are children (AIDS.gov, n.d.).

Historically, there have been misconceptions about how HIV is transmitted.  HIV is found in bodily fluidds such as blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids and breast milk (AIDS.gov, n.d.).  The ways that HIV is transmitted is primarily through unprotected anal, vaginal and oral sex with someone who is HIV+ and sharing needles/syringes with someone who is HIV+.  It is less common, but it is also possible for a mother to pass HIV to a child, either during pregnancy, childbirth or breastfeeding.  There is also the risk of healthcare workers being stuck with a needle contaminated with HIV+ blood.  Again, this is less common, especially if the health care worker is practicing Universal Precautions.  HIV does not live outside the human body and therefore is not spread by air, water, insects, saliva, tears, sweat, hugging or water fountains (AIDS.gov, n.d.)

The only way to know if someone has been infected with HIV is to be tested.  There are symptoms an individual may experience soon after being infected.  It is usually described as flu like symptoms; fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes and mouth ulcers (AIDS.gov, n.d.).  They can last up to several weeks.  As time progresses, an individual may either not have symptoms or only have mild symptoms.  If someone progresses to AIDS, someone may experience rapid weight loss, recurring fever, extreme and unexplained fatigue, diarrhea lasting more than a week, pneumonia, memory loss or depression (AIDS.gov, n.d.). 

There are ways to protect yourself.  Having sex within a committed relationship, using condoms, not using intravenous or other drugs and using barriers during oral sex are all ways to reduce the likelihood of contracting or transmitting HIV.  For individuals who are in a relationship with someone who is HIV+, using condoms and taking Pre Exposure Prophylaxis (PrEP) can reduce the chances of transmission (WebMD, 2016).

Although there is no cure, there are treatments for HIV.  Different drugs affect HIV in different ways.  Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) inhibits HIV's ability to copy itself.  Nucleoside Reverse Transcriptase Inhibitors (NRTIs) alters what HIV uses to copy itself.  Protease Inhibitors (PIs) disable a protein HIV uses to make copies.  Fusion inhibitors block a protien HIV uses to incorporate its genetic material into a CD4 cell (Mayo Clinic, 2015).  It is important that individuals who are HIV+ start treatment.  It is important that once on treatment, the treatment is continued with no breaks.  While on treatment, the amount of HIV in the body can be lowered to the point where it is hard to detect the virus.  Having the HIV in the body at this level lowers the chance of transmission.

It is possible to live a long time with HIV and there are treatments.  If you are HIV+, it is important to be treated.  If you are HIV-, it is important that you stay HIV-.  It is not possible to look at someone and tell that they are HIV+.  It is possible to be around someone who is HIV+ and not know.  Whether you realize that you know someone with HIV or AIDS or not, it is important to remember that even if you are not INFECTED with HIV, you are still AFFECTED by HIV.

REFERENCES

AIDS.gov.  (n.d.)   HIV Basics.  AIDS.gov.  Retrieved from https://www.aids.gov/hiv-aids-basics/index.html

Avert. (2015)  What are HIV and AIDS?  Avert.  Retrieved from http://www.avert.org/about-hiv-aids/what-hiv-aids

Mayo Clinic. (n.d.)  HIV/AIDS Treatments and Drugs.  Mayo Clinic.  Retrieved from http://www.mayoclinic.org/diseases-conditions/hiv-aids/basics/treatment/con-20013732

UCSF Medical Center.  (n.d.)  AIDS Diagnosis.  University of California San Fransisco.  Retrieved from https://www.ucsfhealth.org/conditions/aids/diagnosis.html

WebMD.  (2015)  Understanding AIDS/HIV Prevention.  WebMD.  Retrieved from http://www.webmd.com/hiv-aids/guide/understanding-aids-hiv-prevention