2. Refresher Course For J2J Fellows XVIII International AIDS Conference Vienna, Austria Presenter: Bob Meyers, NPF & J2J
3. Why are we doing this? To make sure that all J2J participants in Cape Town are on a level playing field , with all other J2Jers and all other journalists.
16. Slide courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
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18. Slide courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
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20. HIV replicates in CD4 cells. Amount of virus produced determines disease course Slide (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center 2-3 Days New virus assembly
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22. Typical Course of HIV infection Graph courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
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24. CD4 Count in Phases of HIV Infection 5-14 days Incubation CD4 cell count 1-4 mo. 4-10 years 1-2 years Primary Presymptomatic AIDS Slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota
25. The level of HIV in the blood predicts disease course Amount of Virus in Blood Rapid Progression Slow Progression Slide (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center One year
29. Function of the CD4 T Cell Resting CD4 Cell Activated CD4 Cell Macrophage, Dendritic Cell, or other Antigen Presenting Cell Promote B-cell Antibody Response (also called “ Humoral” response ) Promote Killer T-cells (also called “CTL” short for “Cytotoxic T-Lymphocyte”) Secrete ß Chemokines Rantes Mip 1 alpha Mip 1 ß Slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota
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31. Function of the CD4 T Cell after infection Resting CD4 Cell Activated CD4 Cell Macrophage, Dendritic Cell, or other Antigen Presenting Cell Promote B-cell Antibody Response (also called “ Humoral” response ) Promote Killer T-cells (also called “CTL” short for “Cytotoxic T-Lymphocyte”) Secrete ß Chemokines Rantes Mip 1 alpha Mip 1 ß Slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota
32. (Pause) Why are we spending so much time on this science stuff?
33. So everyone will know how complex this is And so you will be able refute anyone who denies that HIV causes AIDS
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35. Antibodies try to snare HIV Slide (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center New virus assembly B cell
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38. This is one scientific reason that HIV is so difficult to stop once it is in the body … and why AIDS is so difficult to cure. Look
39. HIV replicates mainly in lymph tissue, the immune-system stronghold Images from The National Cancer Institute, http://newscenter.cancer.gov/sciencebehind/immune/immune00.htm
40. Site of HIV Production and Storage Photos and slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota Lymph tissue with HIV stained to look bright. “Stars” are cells producing HIV. Close up of several cells in lymph tissue producing HIV
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42. Slide courtesy of Anthony S. Fauci, National Institute of Allergy and Infectious Diseases
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44. Lymph tissue in HIV-negative and HIV-positive people HIV-negative person Upper left-hand corner: round germinal center surrounded by healthy mantle HIV-positive for 5 years, no ARV treatment All “geographical” features destroyed—no discernible germinal centers Photos and information courtesy of Timothy Schacker, University of Minnesota
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47. Antiretroviral drugs (ARVs) block HIV’s assault on the CD4 T-cell Resting CD4 Cell Activated CD4 Cell Macrophage, Dendritic Cell, or other Antigen Presenting Cell Promote B-cell Antibody Response (also called “ Humoral” response ) Promote Killer T-cells (also called “CTL” short for “Cytotoxic T-Lymphocyte”) Secrete ß Chemokines Rantes Mip 1alpha Mip 1 ß Slide (slightly adapted) courtesy of Timothy Schacker, University of Minnesota. ARV graphic (slightly adapted) courtesy of Bruce D. Walker, Massachusetts General Hospital, Harvard Medical School, Partners AIDS Research Center ARVs
48. Lymph nodes in HIV-negative, HIV-positive, and ARV-treated patients HIV-negative person Upper left-hand corner: Round “germinal center” surrounded by healthy mantle HIV-positive for 5 years, no ARV treatment All “geographical” features destroyed—no discernible germinal centers The same HIV-positive patient after 6 months on ARV treatment Germinal centers discernible again but lack healthy surrounding mantle Photos and information courtesy of Timothy Schacker, University of Minnesota
AIDS is caused by HIV. HIV is a member of a family of viruses called retroviruses. You’ll learn more about the virus in the course, “Basic Science of HIV/AIDS” taught by Laurie. In this course, you will learn how HIV works in the body and the consequences of that.
GALT = Gut Associated Lympoid Tissue. It is lymph tissue that is located in the gut and intestines.
Inside those organs, many different types of cells are interacting with one another to orchestrate a complex attack against any invading virus or bacteria. This slide illustrates some of those kinds of cells, as they attempt to fight off an HIV infection. The arrows indicate messenger molecules that the cells secrete. They use these molecules to communicate with each other and organize their attack. Some of these molecules also directly inhibit viruses such as HIV
The electron-microscope photograph in Slide 3, showing HIV budding from a T-cell, depicts one new virus emerging from an infected cell. But HIV replicates at a very high rate, generating between 10 billion and one trillion new viruses per day in an infected person. The immune system tries to keep up. During the long asymptomatic phase of HIV infection, an infected person generates about a billion new CD4 cells every day to make up for those HIV has killed. Most HIV replication takes place in lymphatic tissues, and it damages those tissues. As HIV replicates, it mutates often, making it hard for the immune system to keep recognizing it.
This is a very important slide. It shows what happens to the amount of virus in the body during a typical case of HIV, and what happens to the amount of CD4 cells, the ones that HIV targets. The amount of virus is called viral load (or sometimes viral burden). The test or “assay” that measures it is called usually called a PCR test (a similar test is called “branch DNA.) The PCR test measures “copies” of HIV RNA in a milliliter of plasma. CD4 counts are measured by a different kind of test, which counts the number of such cells in a milliliter of blood. At first, HIV surges, but then the immune system fights back and suppresses it. It stays at this “steady state” for years. During this time, HIV and the immune system are locked in a pitched battle.Eventually, HIV wins and the amount of virus in the body, called “viral load,” rises. It typically takes about 10 years for HIV to run its course and kill the patient. That gives HIV a tremendous advantage, because it has 10 years to spread from that patient to other people. For HIV, keeping the host alive for a long time is one of its main advantages. Just the opposite is happening to CD4 cells. They decline at first, then level off for many years. But during this time their number slowly dwindles. Then, when HIV virual load surges, CD4 drops. What is the patient feeling? During primary infection, the paitent may feel flu-like symptoms. Then during the long steady state, he usually experiences very few symptoms. But as the level of CD4 drops, he gets prone to more and more “opportunistic infections” such as TB and pneumonia. These finally kill him.
GALT = Gut Associated Lympoid Tissue. It is lymph tissue that is located in the gut and intestines.
These are photographs of HIV-infected human lymph tissue. The tissue has been chemically stained so that HIV shows up as bright “stars” or dots. The second slide is a close-up, showing HIV+ cells. The assay technique is to put a radioactive probe that binds to to HIV RNA. Then the solution is coated with an photopgraphic emulsion. Silver grains cluster at the radio probes, allowing scientists to literally count the silver grains to see how many cells are infected.
This is an even more complex version of the earlier slide. It shows how complex the interactions are between the known elements of the immune system. This slide should remind us that there is always more going on than we, or the scientists, know.
Women are at risk from men who feel their masculinity is challenged if a woman uses protection Rape has been used as an instrument of war and domination Sex work in many countries is an economic necessity, because education and jobs are forbidden to women; women are also at risk for kidnapping and forced participation in sex work.
It doesn’t matter whether the contact is being men and women, or men and men, or women and women. HIV is spread through blood and body fluids from a positive-person entering the body of an uninfected person. People using intravenous drugs often share the same needle. Infected blood from one person is likely to be transferred to the second person. Use of previously unused needles is an effective preventive; a common disinfectant commonly used in non-medical environments is to sterilize the needle in bleach before reusing. Blood products and body fluids are common in clinical environments and protections must always be taken. A single dose of Navirapine can prevent mother-to-child transmission, especially when taken with other drugs.There has never been any valid scientific data that the Navirapine is risky or harmful, despite allegations about that in South Africa several years ago.
Communities are made up of individuals and when enough individuals are challenged by HIV/AIDS communities can suffer in unexpected ways: Lack of factory workers, or miners, or soldiers, or farm workers or teachers or students. Think about what happens to children whose parents die from AIDS and they are raised by grandparents, or raised on the streets. This is a prescription for ccrime and civic unrest.
Adult male circumcision – it has been shown to be effective about 50 – 60 % of the time with HIV-negative heterosexual circumcised populations. The implementation needs to be done carefully: all the instruments need to be sterile, the medical worker needs to be trained, the patient needs to avoid sexual intercourse for at least six weeks after surgery, and local customs and traditions need to be observed. For more information go to the NPF website, www.nationalpress.org and search the words “male circumcision.” Also go to the World Health Organization website.
T This slide is modified by a chart designed by Harvey Fineberg when he was Dean of the Harvard School of Public Health. I have shortened it and modified it for talks to journalists. The idea here is to show the differences between medicine and public health, at least as practiced in the U.S. On the left are subjects that we care about for OUR personal health – or MY personal health. That’s on the bottom right you can see that the doctor comes to my bedside. On the right are subjects that are important to a social view of health of all people in a society. The doctor doesn’t come to my bedside, but he or she may go into the fields to find out why I am sick. his slide is modified by a chart designed by Harvey Fineberg when he was Dean of the Harvard School of Public Health. I have shortened it and modified it for talks to journalists. The idea here is to show the differences between medicine and public health, at least as practiced in the US.
REGARDING DEATHS IN THE U.S., WE HAVE A 100-YEAR COMPARISON HERE, ON THE LEFT, DEATHS 100 YEARS AGO, ON THE RIGHT, CAUSES OF DEATH TODAY. ON THE LEFT, DISEAS THAT SPREAD THROUGH THE AIR, WATER, OVERCROWDING, OR THAT REFLECT PERSONAL HEALTH PROBLEMS LIKE HEART PROBLEMS, ETC. CANCERS ARE AT THE BOTTOM OF THE 100 YEAR LIST. BUT CURRENTLY, PERSONAL BEHAVIORS ARE BEHIND THE MAIN CAUSES OF DEATH. CANCERS ARE AT THE TOP OF THE LIST, AND MOST U.S. CANCERS ARE RELATED TO TOBACCO USE. Diet, lack of exercise, motor vehicle crashes… this is all public health – and a source of great stories
PERRISKY PERSONAL BEHAVIORS. Noticed I didn’t say “risky sexual behaviors,” because we approaching an area where these behaviors start to overlap. And the next series of pictures gives us a change to fully explore some issues of journalism ethics as well. These are teenage heroin users in the U.S. In light of common journalism practice in the U.S., as well as U.S. laws, we can ask whether these girls have given their permission to be photographed. EVEN THEY HAVE GIVEN THEIR PERMISSION, are they legally old enough to do so? And even if they have, should the picture have been taken? As drug addicts, what are they at risk for, besides the addition? It is common for groups that shoot up together to share needles, whatevere is in one person’s blood may well be passed on to the others. To calm the addiction they will need more drugs, and to get drugs they will need money. To get money the will probably rob, steal, and turn to sex work. Sex work exposes them to sexually transmitted diseases, like HIV/AIDS – but also gonorrhea, sythillis, and a wide variety of other health problems. AND THE LARGEST QUESTION OF ALL FOR JOURNALISTS IS – WHAT ARE KIDS THIS AGE DOING SHOOTING DRUGS? SONAL BEHAVIORS
THESE ARE MEN WHO HAVE SEX WITH MEN. UNPROTECTED SEX, OR SEX WITH MANY SEX PARTNERS, PUTS THEM AT RISK. IF THEY HAVE UNPROTECTED SEX WITH WOMEN, SUCH AS WIVES OR GIRLFRIENDS – AND THE WOMEN DON’T KNOW THAT THEIR MALE PARTRNERS ALSO HAVE SEX WITH OTHER MEN --THAT COULD PLACE THOSE UNSUSPECTING WOMEN AT RISK. Question for journalists – do we need to print the men’s names? Did they know they were bering photographed? What if they need they were bei9ng photographed, but thought it was for a vanity magazine, for good-looking men, and they see their picture in a story about HIV/AIDS? PERSONAL CHOICE – OR SOCIAL CIRCUMSTANCE – OR ECONOMIC NECESSITY? Sex workers in Thailand. PRIVACY QUESTION: what about the guy on the left? Is he just walking by? Or is he a client? And to run his name or picture do we need to get his permission?
PERSONPERSONAL CHOICE – OR SOCIAL CIRCUMSTANCE – OR ECONOMIC NECESSITY? Sex workers in Thailand. PRIVACY QUESTION: what about the guy on the left? Is he just walking by? Or is he a client? And to run his name or picture do we need to get his permission?
Yes! All of these are reasons why news organizations have an ethical and moral responsibility to cover HIV/AIDS.
