HIV/AIDS: The forgotten epidemic? James G. Dobbins Ph.D.

Size: px

Start display at page:

Download "HIV/AIDS: The forgotten epidemic? James G. Dobbins Ph.D."

Virginia Stone
6 years ago
Views:

1 HIV/AIDS: The forgotten epidemic? James G. Dobbins Ph.D.

3 HIV/AIDS: The forgotten epidemic? James G Dobbins, PhD

4 OK you know the drill...

6 HIV/AIDS: The forgotten Epidemic?

7 But first things first when should you get your flu shot?

8 Three Important Questions Regarding Influenza Vaccination? 1. Should you be vaccinated against influenza? 2. If yes, when should you be vaccinated? 3. If yes, which vaccine should you receive?

9 1. Should you be Vaccinated Against Influenza? The problem: Vaccine is at best only 48% effective against hospitalization Repeated vaccination from year to year can blunt the effects of the vaccine and possibly increase your risk of illness 1 Protection from immunization wanes after 4 months so timing of immunization is important

10 1. Should you be Vaccinated Against Influenza? The problem: Vaccine is at best only 48% effective against hospitalization Repeated vaccination from year to year can blunt the effects of the vaccine and possibly increase your risk of illness* Protection from immunization wanes after 4 months so timing of immunization is important

11 1. Should you be Vaccinated Against Influenza? The problem: Vaccine is only 48% effective against hospitalization Repeated vaccination from year to year can blunt the effects of the vaccine and possibly increase your risk of illness* Protection from immunization wanes after about 4 months so timing of immunization is important

12 1. Should you be Vaccinated Against Influenza? The answer: YES Influenza is the greatest killer in human history Vaccination is the only effective way to protect yourself New vaccines may outperform the existing ones Previous studies may not have considered timing of vaccination

13 2. When Should you be Vaccinated? The problem: That depends on the progress of the flu season

16 4 months flu season

17 4 months vaccine protection 4 months flu season

18 4 months vaccine protection 4 months flu season

19 4 months vaccine protection 4 months flu season

20 4 months

21 2. When Should you be Vaccinated? The answer: So far, this looks like a normal flu season Should begin during the last two or three weeks of December; end in the last week of April You should be fully immunized by the beginning of Epi Week 50, which is December 10th Want to allow 2 weeks for antibodies to develop

22 2. When Should you be Vaccinated? The answer: Right after Thanksgiving, Friday November 24th [End of Epi Week 47] The time of day is up to you perhaps late afternoon is best so that if your arm becomes sore, it will be sore while you are sleeping OK...4:00pm

23 3. Which Vaccine Should you Receive? Eleven vaccines approved for use in adults > 65 Two vaccines approved specifically for adults > 65 Three new vaccines for this year that might be superior to existing vaccines Two of these three new vaccines are approved for adults > 65

24 H N Glycoproteic surface, covered by projections glycoproteins, corresponding with : Hemagglutinin (H) 16 known antigens Neuraminidase (N) 9 known antigens

25 Components of the Influenza Vaccine Included in trivalent vaccines: A/H1N1 (pdm09) Michigan/45/2015* A/H3N2 Hong Kong/4801/2014 B/Victoria Brisbane/60/2008 Also included in quadrivalent vaccines: B/Yamagata Phuket/3073/2013

28 Trade name Manufacturer Presentation Age indication AFLURIA Quadrivalent FLURIX Quadrivalent FLULAVAL Quadrivalent FLUZONE Quadrivalent AFLURIA Trivalent FLUVIRIN Trivalent Traditional Influenza vaccines United States, influenza season Inactivated influenza vaccines, quadrivalent (IIV4s), standard-dose Growth Medium Route Seqirus 0.5 ml prefilled syringe 18 years Egg IM GlaxoSmithKline 0.5 ml prefilled syringe 3 years Egg IM ID Biomedical Corp. of Quebec (distributed by GSK 0.5 ml prefilled syringe 6 months Egg IM Sanofi Pasteur 0.5 ml prefilled syringe 3 years Egg IM Inactivated Influenza Vaccines, trivalent (IIV3s), standard-dose Seqirus 0.5 ml prefilled syringe 5 years Egg IM Seqirus 0.5 ml prefilled syringe 4 years Egg IM

29 Trade name Manufacturer Presentation Age indication AFLURIA Quadrivalent FLURIX Quadrivalent FLULAVAL Quadrivalent FLUZONE Quadrivalent AFLURIA Trivalent FLUVIRIN Trivalent Traditional Influenza vaccines United States, influenza season Inactivated influenza vaccines, quadrivalent (IIV4s), standard-dose Growth Medium Route Seqirus 0.5 ml prefilled syringe 18 years Egg IM GlaxoSmithKline 0.5 ml prefilled syringe 3 years Egg IM ID Biomedical Corp. of Quebec (distributed by GSK 0.5 ml prefilled syringe 6 months Egg IM Sanofi Pasteur 0.5 ml prefilled syringe 3 years Egg IM Inactivated Influenza Vaccines, trivalent (IIV3s), standard-dose Seqirus 0.5 ml prefilled syringe 5 years Egg IM Seqirus 0.5 ml prefilled syringe 4 years Egg IM

30 Trade name Manufacturer Presentation Age indication AFLURIA Quadrivalent FLURIX Quadrivalent FLULAVAL Quadrivalent FLUZONE Quadrivalent AFLURIA Trivalent FLUVIRIN Trivalent Traditional Influenza vaccines United States, influenza season Inactivated influenza vaccines, quadrivalent (IIV4s), standard-dose Growth Medium Route Seqirus 0.5 ml prefilled syringe 18 years Egg IM GlaxoSmithKline 0.5 ml prefilled syringe 3 years Egg IM ID Biomedical Corp. of Quebec (distributed by GSK 0.5 ml prefilled syringe 6 months Egg IM Sanofi Pasteur 0.5 ml prefilled syringe 3 years Egg IM Inactivated Influenza Vaccines, trivalent (IIV3s), standard-dose Seqirus 0.5 ml prefilled syringe 5 years Egg IM Seqirus 0.5 ml prefilled syringe 4 years Egg IM

31 Trade name Manufacturer Presentation Age indication AFLURIA Quadrivalent FLURIX Quadrivalent FLULAVAL Quadrivalent FLUZONE Quadrivalent AFLURIA Trivalent FLUVIRIN Trivalent Traditional Influenza vaccines United States, influenza season Inactivated influenza vaccines, quadrivalent (IIV4s), standard-dose Growth Medium Route Seqirus 0.5 ml prefilled syringe 18 years Egg IM GlaxoSmithKline 0.5 ml prefilled syringe 3 years Egg IM ID Biomedical Corp. of Quebec (distributed by GSK 0.5 ml prefilled syringe 6 months Egg IM Sanofi Pasteur 0.5 ml prefilled syringe 3 years Egg IM Inactivated Influenza Vaccines, trivalent (IIV3s), standard-dose Seqirus 0.5 ml prefilled syringe 5 years Egg IM Seqirus 0.5 ml prefilled syringe 4 years Egg IM

32 Trade name Manufacturer Presentation Age indication Fluzone High-Dose Advanced Influenza Vaccines United States, influenza season Inactivated Influenza Vaccine, trivalent (IIV3), high-dose Growth Medium Route Sanofi Pasteur 0.5 ml prefilled syringe 65 years Egg IM Fluzone Intradermal Fluad Adjuvented Inactivated influenza vaccine, quadrivalent (IIV4), standard-dose, intradermal 0.1 ml single-dose prefilled Sanofi Pasteur 18 through 64 years Egg ID microinjection system Adjuvented Inactivated influenza vaccine, trivalent (aiiv3), standard-dose Seqirus 0.5 ml prefilled syringe 65 years Egg IM Inactivated influenza vaccine, quadrivalent (cciiv4), standard-dose, cell culture-based Flucelvax Quadrivalent Seqirus 0.5 ml prefilled syringe 4 years MDCK Cells IM Recombinant Influenza Vaccine, quadrivalent (RIV4) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM Recombinant Influenza Vaccine, Trivalent (RIV3) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM

33 Trade name Manufacturer Presentation Age indication Fluzone High-Dose Advanced Influenza Vaccines United States, influenza season Inactivated Influenza Vaccine, trivalent (IIV3), high-dose Growth Medium Route Sanofi Pasteur 0.5 ml prefilled syringe 65 years Egg IM Fluzone Intradermal Fluad Adjuvented Inactivated influenza vaccine, quadrivalent (IIV4), standard-dose, intradermal 0.1 ml single-dose prefilled Sanofi Pasteur 18 through 64 years Egg ID microinjection system Adjuvented Inactivated influenza vaccine, trivalent (aiiv3), standard-dose Seqirus 0.5 ml prefilled syringe 65 years Egg IM Inactivated influenza vaccine, quadrivalent (cciiv4), standard-dose, cell culture-based Flucelvax Quadrivalent Seqirus 0.5 ml prefilled syringe 4 years MDCK Cells IM Recombinant Influenza Vaccine, quadrivalent (RIV4) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM Recombinant Influenza Vaccine, Trivalent (RIV3) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM

34 Trade name Manufacturer Presentation Age indication Fluzone High-Dose Advanced Senior Influenza Vaccines United States, influenza season Inactivated Influenza Vaccine, trivalent (IIV3), high-dose Growth Medium Route Sanofi Pasteur 0.5 ml prefilled syringe 65 years Egg IM Adjuvented Inactivated influenza vaccine, trivalent (aiiv3), standard-dose Fluad Adjuvented Seqirus 0.5 ml prefilled syringe 65 years Egg IM Inactivated influenza vaccine, quadrivalent (cciiv4), standard-dose, cell culture-based Flucelvax Quadrivalent Seqirus 0.5 ml prefilled syringe 4 years MDCK Cells IM Recombinant Influenza Vaccine, quadrivalent (RIV4) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM Recombinant Influenza Vaccine, trivalent (RIV3) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM

35 Trade name Manufacturer Presentation Age indication Fluzone High-Dose Advanced Senior Influenza Vaccines United States, influenza season Inactivated Influenza Vaccine, trivalent (IIV3), high-dose Growth Medium Route Sanofi Pasteur 0.5 ml prefilled syringe 65 years Egg IM Adjuvented Inactivated influenza vaccine, trivalent (aiiv3), standard-dose Fluad Adjuvented Seqirus 0.5 ml prefilled syringe 65 years Egg IM Inactivated influenza vaccine, quadrivalent (cciiv4), standard-dose, cell culture-based Flucelvax Quadrivalent Seqirus 0.5 ml prefilled syringe 4 years MDCK Cells IM Recombinant Influenza Vaccine, quadrivalent (RIV4) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM Recombinant Influenza Vaccine, trivalent (RIV3) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM

36 Trade name Manufacturer Presentation Age indication Fluzone High-Dose Advanced Senior Influenza Vaccines United States, influenza season Inactivated Influenza Vaccine, trivalent (IIV3), high-dose Growth Medium Route Sanofi Pasteur 0.5 ml prefilled syringe 65 years Egg IM Adjuvented Inactivated influenza vaccine, trivalent (aiiv3), standard-dose Fluad Adjuvented Seqirus 0.5 ml prefilled syringe 65 years Egg IM Inactivated influenza vaccine, quadrivalent (cciiv4), standard-dose, cell culture-based Flucelvax Quadrivalent Seqirus 0.5 ml prefilled syringe 4 years MDCK Cells IM Recombinant Influenza Vaccine, quadrivalent (RIV4) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM Recombinant Influenza Vaccine, trivalent (RIV3) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM

37 Advanced Senior Influenza Vaccines United States, influenza season Trade name Manufacturer Presentation Age indication Fluzone High-Dose Inactivated Influenza Vaccine, trivalent (IIV3), high-dose Growth Medium Route Sanofi Pasteur 0.5 ml prefilled syringe 65 years Egg IM Adjuvented Inactivated influenza vaccine, trivalent (aiiv3), standard-dose Fluad Adjuvented Seqirus 0.5 ml prefilled syringe 65 years Egg IM Inactivated influenza vaccine, quadrivalent (cciiv4), standard-dose, cell culture-based Flucelvax Quadrivalent Seqirus 0.5 ml prefilled syringe 4 years MDCK Cells IM Recombinant Influenza Vaccine, quadrivalent (RIV4) Flublok Recombinant Protein Sciences 0.5 ml prefilled syringe 18 years Insect virus on insect cells IM

38 Trade name Manufacturer Advantages Disadvantages Availability Fluzone High-Dose Flucelvax Cell Culture Flublok Recombinant Fluad Adjuvented Comparison of Advanced Senior Vaccines Sanofi Pasteur Seqirus Protein Sciences Routine for Seniors 4X viral antigen Available in most clinics Grown in mammalian cells Quadrivalent Large-scale, rapid production Exact HA match to circulating human virus Quadrivalent 3X standard dose of HA Large-scale, rapid production Seqirus Possibly higher potency Trivalent vaccine Egg-based Known to be mediocre Standard dose Possibly harder to find Possibly harder to find [GMO] Trivalent vaccine Egg-based Possibly harder to find Carle Christie CVS Schnucks Walgreens Carle* CVS Schnucks (24 hour)?

39 Trade name Manufacturer Advantages Disadvantages Availability Fluzone High-Dose Flucelvax Cell Culture Flublok Recombinant Fluad Adjuvented Comparison of Advanced Senior Vaccines Sanofi Pasteur Seqirus Protein Sciences Routine for Seniors 4X viral antigen Available in most clinics Grown in mammalian cells Quadrivalent Large-scale, rapid production Exact HA match to circulating human virus Quadrivalent 3X standard dose of HA Large-scale, rapid production Seqirus Possibly higher potency Trivalent vaccine Egg-based Known to be mediocre Standard dose Possibly harder to find Possibly harder to find GMO Trivalent vaccine Egg-based Possibly harder to find Carle Christie CVS Schnucks Walgreens Carle* CVS Schnucks (24 hour)?

40 Trade name Manufacturer Advantages Disadvantages Availability Fluzone High-Dose Flucelvax Cell Culture Flublok Recombinant Fluad Adjuvented Comparison of Advanced Senior Vaccines Sanofi Pasteur Seqirus Protein Sciences Routine for Seniors 4X viral antigen Available in most clinics Grown in mammalian cells Quadrivalent Large-scale, rapid production Exact HA match to circulating virus Quadrivalent 3X standard dose of HA Large-scale, rapid production Seqirus Possibly higher potency Trivalent vaccine Egg-based Known to be mediocre Standard dose Possibly harder to find Possibly harder to find GMO Trivalent vaccine Egg-based Possibly harder to find Carle Christie CVS Schnucks Walgreens Carle* CVS Schnucks (24 hour)?

41 Headline in the News-Gazette on 09/29/2017 CDC WARNING Bad flu season forecast

42 What was Actually Said in the Article...there s no good way to predict how bad the upcoming flu season will be. Dr. Daniel Jernigan, CDC, quoted in the News-Gazette on 09/29/2017

43 Now back to our actual topic for today

44 HIV/AIDS: The forgotten Epidemic?

45 Recent Claims by Lawyers Representing Clients who have been Charged with Failing to Disclose their HIV Status to Sex Partners Infection with HIV is no longer a big deal HIV is no different from any other sexually transmitted disease The law discriminates against homosexuals and therefore should be declared unconstitutional The law discourages people from being tested for HIV There is no scientific basis for the law

46 The Current Law in Illinois Regarding Compulsory Disclosure of HIV Status to Sexual Partners Law was originally written in 1989 when there was no treatment for HIV infection The law was amended in 2012 to state that the lack of disclosure had to be related to a deliberate intention to transmit HIV The law was modified to only refer to vaginal or anal intercourse without the use of a condom Note that according to the law there does not have to be actual transmission of the virus Note also that there is no reference to the sexual orientation of either the perpetrator or the victim

47 Rationale Behind the 1989 Law and its Revision in 2012 Law was prompted by some highly publicized cases of people deliberately infecting their sex partners with HIV, plus the widely publicized case of the dentist Dr. David Acer who was suspected of having deliberately infected six of his patients with HIV in 1987 The legislature sought to amend the law in 2012 because a clear-cut case of deliberate transmission could not be prosecuted because of other laws restricting access to medical records that contained information on HIV status One of the main HIV advocacy groups which first fought the law decided that if they couldn t stop the law then they would try to amend it to make it less onerous They were successful so that the revised law required proof of intent to transmit HIV and refers only to vaginal or anal sex without a condom

49 Some Alphabet Soup CD4 ART HAART PrEP TasP PLHIV PEPFAR - Important immune cells that are targeted by HIV - Antiretroviral therapy - Highly active antiretroviral therapy - Pre-exposure prophylaxis - Treatment as prevention - Persons Living with HIV - President s Emergency Plan for AIDS Relief, $15 billion allocated

50 First, just a few scientific facts about HIV

52 High probability of Transmission High probability of Transmission

54 Timeline in the History of HIV/AIDS CDC publishes first report of a series of cases of a rare lung infection Dr. Robert Gallo at NIH and Dr. Luc Montagnier from Pasteur Institute confirm the co-discovery of HIV First antiretroviral drug, AZT, is approved for use in the U.S The number of HIV cases in the U.S. reaches 100, First protease inhibitor approved, beginning HAART - The number of HIV cases in the U.S. reaches 500,000 - The number of new HIV infections in the U.S. drops for the first time HIV cases worldwide tops 30 million; 16 new infections each day - Combivir approved; two drugs in one pill

55 Timeline in the History of HIV/AIDS CDC publishes first report of a series of cases of a rare lung infection Dr. Robert Gallo at NIH and Dr. Luc Montagnier from Pasteur Institute confirm the co-discovery of HIV First antiretroviral drug, AZT, is approved for use in the U.S The number of HIV cases in the U.S. reaches 100, First protease inhibitor approved, beginning HAART - The number of HIV cases in the U.S. reaches 500,000 - The number of new HIV infections in the U.S. drops for the first time HIV cases worldwide tops 30 million; 16 new infections each day - Combivir approved; two drugs in one pill

56 Timeline in the History of HIV/AIDS Resistance to protease inhibitors becomes a serious problem First HIV vaccine begins field trials in Thailand Agreement to reduce the cost of HIV/AIDS drugs in developing countries - Triple-acting drugs usher in a new era for HIV treatment Agreement to allow generic HIV/AIDS drugs in developing countries PEPFAR created by President Bush, $15 billion allocated - First HIV vaccine fails in field trial in Thailand Field trial of PrEP is successful New guidelines to treat ALL infected persons regardless of CD4 count ART for infected men is shown to effectively reduce HIV transmission (TasP)

57 Timeline in the History of HIV/AIDS Resistance to protease inhibitors becomes a serious problem First HIV vaccine begins field trials in Thailand Agreement to reduce the cost of HIV/AIDS drugs in developing countries - Triple-acting drugs usher in a new era for HIV treatment Agreement to allow generic HIV/AIDS drugs in developing countries PEPFAR created by President Bush, $15 billion allocated - First HIV vaccine fails in field trial in Thailand Field trial of PrEP is successful New guidelines to treat ALL infected persons regardless of CD4 count ART for infected men is shown to effectively reduce HIV transmission (TasP)

58 CLAIM #1: Infection with HIV is no big deal

59 Effects of Infection with HIV Necessary to take medication every day Medication is expensive, even with insurance Medication produces side effects, some of which can be severe Susceptible to other infectious diseases such as TB and other opportunistic infections Susceptible to other chronic conditions such as heart disease Continued stigma and restrictions

60 Current Status of Global HIV Epidemic 36.7 million people living with HIV/AIDS in million new cases of HIV infection in 2015 Currently only 60% of infected persons are aware of their HIV status (22 million people) Of these, 83% (18.2 million people) are using ART In 2016, 1 million people died from HIV-related illnesses There have been 35 million deaths from AIDS since the beginning of the epidemic

67 What is the Status of the HIV/AIDS Epidemic in Illinois? How many people are living with HIV/AIDS? What is the mode of exposure for these people? Is the outbreak still expanding?

HIV Diagnoses by Region, 2009-2013 HIV Diagnoses by

1988 1990 1992 1994 1996 1998 2000 2002 2004 2006

68 HIV Diagnoses by Region, HIV Diagnoses by Year, Illinois, HIV Disease Diagnoses per 100,000 Population

69 HIV Diagnoses by Region,

70 People Living with HIV/AIDS in Illinois, 2017 With AIDS = 19,481 With HIV = 19,055

71 Sex of PLWHIV Female = 7,846 People Male = 30,690 Female 20% Male 80%

72 Race/Ethnicity of PLWHIV Other = 2,241 Other 6% Hispanic = 6,916 Hispanic 18% White 28% White = 10,849 Black 48% Black = 18,128

73 Race/Ethnicity of PLWHIV Rate per 100,000 Population White Black Hispanic Other

74 Mode of Exposure for PLWHIV Other = 6,610 OTHER 17% Hetero = 5,775 HETERO 15% MSM 58% MSM = 22,268 IVDU 10% IVDU = 3,883

75 Conclusion on Claim #1 Although HIV prevalence is declining sharply, it continues to be a major threat to the health of the world s population, including the people of Illinois 37 million people are living with the infection and any change in viral resistance to current ART drugs would put all of their lives in danger There continues to be a constant search for an effective vaccine that could both prevent infection and clear an existing infection from a person In other words, infection with HIV is still a big deal

76 CLAIM #2: HIV is no different from any other sexually transmitted disease

77 Is HIV Infection any Different from Other STDs? Let s compare HIV with four other common STDs Genital herpes Syphilis Gonorrhea Chlamydia

78 Comparison of Five Sexually Transmitted Diseases STD Lethal? Treatable? Curable? Medication Side Effects HIV/AIDS Yes Yes No Daily for lifetime Fat deposits Allergies Nausea, etc. Genital Herpes No Yes Yes* Syphilis Yes Yes Yes Gonorrhea No yes Yes Chlamydia No Yes Yes Daily until no outbreaks* Single injection of antibiotics Single injection plus single dose of an oral drug Single injection or oral drug for 7 days none None None None

79 Conclusion on Claim #2 HIV remains different from other STDs The medication is much more onerous than for others Long-term health concerns are still present The infection can still not be cleared from the body The stigma surrounding the disease is still present

80 CLAIM #3: The law discriminates against homosexuals and therefore should be declared unconstitutional

81 What Information is Available to Answer this Question? Look for evidence of past governmental discrimination Look at the proportion of HIV-positive men who are gay Look at the proportion of men who are charged under this law who are gay

87 What has Been the Experience Under the Illinois Law? I can only find reports of 13 men prosecuted under this law, including one man who was prosecuted (and convicted) twice Among the 12 defendants in these cases, 9 were heterosexual males (75%) 3 were men who had sex with men (25%) These figures are in contrast to the sexual orientation of men with HIV that show the opposite trend, MSM 79% Heterosexual 21%

88 Conclusion on Claim #3 Gays have every reason to fear discrimination from the government In this case, however, there doesn't seem to be any clear signs that the law was either meant to discriminate against gays or that it actually does so The sexual orientation of 21% of the HIV-positive population is heterosexual Three-quarters of the men charged under the law are heterosexuals Finally, the law is designed to protect the HIV-negative sex partner, who in the vast majority of cases is gay

89 CLAIM #4: The law discourages people from being tested for HIV

90 Argument Against the Law Discouraging Testing There is simply no evidence that this is true No studies conducted in MSM populations have ever, to my knowledge, found this to be even remotely true The most common reasons for avoiding testing are fear of knowing the results, fear of loss of confidentiality, and worry that one s life would never be the same

91 Conclusion on Claim #4 No evidence that people avoid being tested so that they won t have to tell their sex partners the results Possible that if you ask people to choose from a list all of possible reasons for not being tested for HIV and list this as one of the options, I am sure that a few people would check it off But in studies with open-ended questions this does not appear to be a reason for avoiding testing

92 CLAIM #5: There is no scientific basis for the law

93 The Argument Against there being a Scientific Basis for the Law HIV/AIDS advocacy groups point to a study conducted by CDC showing that states with mandatory disclosure laws have similar HIV prevalence as those without the laws Q.E.D.

94 The Problem with This Argument These laws were never intended to affect the general HIV prevalence in the states Rather, the laws were designed to protect individuals who were HIV-negative from deliberate infection by persons who were HIV-positive Whether or not the law actually encourages people to divulge their HIV status is a separate question

95 Conclusion on Claim #5 We know from scientific studies that HIV is transmitted during sexual intercourse This law is designed to hinder the deliberate transmission of HIV through sexual intercourse Whether or not the law actually does this has not been studied so there is no scientific information one way or the other

96 Overall Conclusion on Claims Against the Law Infection with HIV is STILL a big deal The law does NOT discriminate against homosexuals Infection with HIV IS different from other STDs NO EVIDENCE that the law discourages people from being tested for HIV There IS a scientific basis for the law, but whether the law is actually accomplishing its goal is unknown

97 Thank You! NB: Please don t forget to turn your cell phones back on!

Talkin Flu Mid-America Immunization Coalition August 18, William Atkinson, MD, MPH Immunization Action Coalition

Talkin Flu Mid-America Immunization Coalition August 18, 2016 William Atkinson, MD, MPH Immunization Action Coalition Disclosures William Atkinson has worked as a consultant to Merck and as a speaker for