Download HIV/AIDS/STDs in Virginia

HIV/AIDS/STDs
Presenter
Brenda Hill, R.N.,B.S.N.
HIV/STD/ADAP Coordinator
Virginia Department of Health
Peninsula Health District
757-594-7549
HIV/AIDS
Transmission
Signs & Symptoms
Prevention
Testing
Community Resources
Transmission
HIV is
transmitted by
Infected:
 Blood
 Semen
 Vaginal Fluids
 Breast milk
TRANSMISSION





There are still NO
reports of HIV
transmission
through:
Saliva
Tears
Urine
Sweat
Opportunistic Infections of AIDS
CMV
Toxoplasmosis
Cryptococcal meningitis
Candida
Herpes simplex
CMV
Pneumocystis
CMV
MAI
Neoplasm's
Kaposi’s sarcoma
Lymphomas
Cryptosporidium
Salmonella
PrEP & PEP
PrEP
What is PrEP?
“PrEP” stands for preexposure
prophylaxis. The goal of PrEP is to prevent
HIV infection from taking hold if someone
is exposed to the virus.
This is done by taking a pill that contains 2
HIV medications every day.
PEP
PEP stands for post-exposure prophylaxis.
It means taking antiretroviral (ART)
medicines after being potentially exposed to
HIV to prevent becoming infected.
PEP must be started within 72 hours after a
recent possible exposure to HIV.
If PEP is prescribed, ART med is taken once
or twice daily for 28 days.
HIV Testing
HIV Types 1 & 2
In Virginia
As
of December 2015 there
were 24,853 people known to
be living with HIV and AIDS.
Eastern Region
7,697
HIV/AIDS Transmission in the
Eastern Region
Reporting through December 2015
 3354
 666
252
Men having sex with men(MSM)
Injectable Drug Users(IDU)
MSM & IDU
 1430
Heterosexual Transmission
 1890
No risk identified
 90
Pediatric (Ages 0-19)
In Virginia
As of December 2015 there
were 24,583 people, or about
1 in 334 VA residents known
to be living with HIV and
AIDS.
Males
18,243
Females
6,430
HIV/AIDS in the Eastern
Region by December
2015
Eastern Region
7,697
HIV 4,351
AIDS 3,346
HIV/AIDS Transmission in the
Eastern Region
Reporting through December 2015
 3,354
 666
252
Men having sex with men(MSM)
Injectable Drug Users(IDU)
MSM & IDU
 1,430
Heterosexual Transmission
 1,890
No risk identified
 90
Pediatric (Ages 0-19)
Diagnosed in 2015
Eastern Region
Health Districts
• Peninsula
52
• Hampton
26
City
• Newport News
• Hampton
301
38
26
In the City of Newport News there
were 934 persons living with
HIV/AIDS as of 12/31/2014. 69%
were male and 31% were female.
Overall, 76% of the 934 living
cases in Newport News were AA.
AA females living with HIV
disease in Newport News
account for 83% of the cases
among females.
HIV Disease in VA
According to the VDH report
on estimating the HIV
incidence in VA, between
2008-2012, the number of
annual HIV infections for
adults in VA remained
relatively stable with new
infections ranging from 839 to
1,037.
HIV Disease in VA
By December 2014, nearly 75%
of persons living with HIV were
ages 40 and older.
The rate of persons living with
HIV disease still remains
highest in the Eastern Region
with 433 cases per 100,000
HIV Disease in VA
Among AA Females
According to HIV & AIDS Impacts Black Women
in VA a fact sheet from Sisters Promoting
HOPE VDH data as of Dec 2013;
• AA females represent approx. 10% of the
total population in VA and account for 19% of
all VAs living with HIV disease.
• 1 out of every 5 VAs living with HIV disease
is an AA female. In VA 3 out of every 4 female
living with HIV disease are AA.
•
AA females are 15 times more likely to be
living with HIV disease than white females.
In Virginia
As of December 2015 there
were 24,583 people, or about
1 in 334 VA residents known
to be living with HIV and
AIDS.
Males
18,243
Females
6,430
HIV/AIDS in the Eastern
Region by December
2015
Eastern Region
7,697
HIV 4,351
AIDS 3,346
HIV/AIDS Transmission in the
Eastern Region
Reporting through December 2015
 3,354
 666
252
Men having sex with men(MSM)
Injectable Drug Users(IDU)
MSM & IDU
 1,430
Heterosexual Transmission
 1,890
No risk identified
 90
Pediatric (Ages 0-19)
Diagnosed in 2015
Eastern Region
Health Districts
• Peninsula
52
• Hampton
26
City
• Newport News
• Hampton
301
38
26
In the City of Newport News there
were 934 persons living with
HIV/AIDS as of 12/31/2014. 69%
were male and 31% were female.
Overall, 76% of the 934 living
cases in Newport News were AA.
AA females living with HIV
disease in Newport News
account for 83% of the cases
among females.
HIV Disease in VA
According to the VDH report
on estimating the HIV
incidence in VA, between
2008-2012, the number of
annual HIV infections for
adults in VA remained
relatively stable with new
infections ranging from 839 to
1,037.
HIV Disease in VA
By December 2014, nearly 75%
of persons living with HIV were
ages 40 and older.
The rate of persons living with
HIV disease still remains
highest in the Eastern Region
with 433 cases per 100,000
HIV Disease in VA
Among AA Females
According to HIV & AIDS Impacts Black Women
in VA a fact sheet from Sisters Promoting
HOPE VDH data as of Dec 2013;
• AA females represent approx. 10% of the
total population in VA and account for 19% of
all VAs living with HIV disease.
• 1 out of every 5 VAs living with HIV disease
is an AA female. In VA 3 out of every 4 female
living with HIV disease are AA.
•
AA females are 15 times more likely to be
living with HIV disease than white females.
Virginia
AIDS Drug Assistance
Program(ADAP)
Community Resources






Virginia HIV/AIDS Resource & Consultation Center
(VHARCC)
Self Protection Awareness (SPA)
AIDS Center for Care, Education and Support
Services(ACCESS)
Southeastern Virginia Health System
Hampton-NN CSB HIV/AIDS Services
HIV/STI Disease Intervention Specialists Services
Chlamydia
Chlamydia
Chlamydia
is caused by a
Incubation
Period: 2-3
bacteria
weeks
The
person can pass it on
May
be asymptomatic
30
Chlamydia: #1 reportable STD
locally and in the nation
 2014
Virginia statistics
 Total cases 35,473
Ages
Cases reported
0- 9
17
10-14
214
15-19
8,886
20-24
14,720
Newport News 1,796
Hampton
1,405
VA
Chlamydia cases reported in
2014
Female
24,158
Male
11,045
CDC Reported Cases of
Chlamydia in U.S.
Metropolitan Statistical
Areas
VA Beach-NorfolkNewport News-VA-NC
Ranks #2 in the nation as
of 2014
Chlamydia
Total cases reported for VA Military
in 2014(1340)
Reported military cases in the
following Health Districts:
 Peninsula Health District –145
(11%)
 Norfolk
306 (23%)
 VA Beach 211(16%)
Chlamydia
Treatment
Abstain from sex for 7 days
after treatment with single
dose of Zithromax or a 7-day
regimen of Doxycycline.
HPV
Human Papillomavirus
(commonly called Genital Warts)

Human Papillomavirus (HPV) is also
known
as “venereal warts”
 Genital Warts are caused by a virus

Incubation Period: 3 weeks—9 months

HPV infection is causally associated with
cervical cancer and probably other anal,
penile, vulvar, vaginal cancers

Over 99% of cervical cancers have HPV
DNA
detected within the tumor
36
HPV
Common Symptoms of
Genital Warts in Males &
Females
 The
symptoms may include single or
multiple fleshy growths around the
penis, vagina, anus, urethra
 They
may also include: itching,
bleeding, or burning, and pain
 The
symptoms may recur from time
to time
37
Treatment for HPV
 Application
acid
of Trichloroacetic
HPV Vaccines
Gardasil-4
Garsasil-9
Offered to all teens in STI/FP with no
insurance.
Center for Disease Control estimates
that by the age of 50, at least 80%
of women would have acquired
HPV.
Latest development in HPV and Cervical
Cancer
GARDASIL
Vaccine given to prevent HPV types
6,11,16,18
Indicated in females ages 9-26 years
cancer is the 3rd most common
cancer in women worldwide.
In the 1990s it was estimated that 10
women died everyday in the U.S. from
cervical cancer. Today it has become
uncommon according to Medscape News
7/14/2014.
Cervical
Gardasil- 9
 Gardasil
-9 used for the protection
against HPV types 16, 18, 31, 33, 45, 52,
58, 6, and 11.
 Approved for:
 Females
9-26
 Males
9-15
Untreated
complications in
females
PID
Sterility
Gonorrhea
Complications in Males
Swollen
or tender testicles
(epididymitis)
Disseminated
infection
(DGI)
gonococcal
44
Test of Cure/Nucleic Acid
Amplification testing(NAAT)
The use of chlamydial NAATs at <3
weeks after completion of therapy
is not recommended because the
continued presence of nonviable
organisms (394,395,519) can lead
to false-positive results.
CDC 2015 guidelines
Test if Cure for CT/GC
Men and women who have been
treated for chlamydia should be
retested approximately 3 months
after treatment, regardless of
whether they believe that their sex
partners were treated.
CDC 2015 Guidelines
Gonorrhea
Virginia 2014 Statistics 8128
Male
3825
Female 4293
Ages
Reported Cases
0- 9
4
10-14
43
15-19
1708
20-24
3033
Reported cases of Gonorrhea
2014
Peninsula Health District
596 cases
Hampton Health District
388 cases
Total cases reported from Military
in VA 137
Reported military cases from the following
Health Districts
Peninsula
18 cases(13%)
Norfolk
37 cases Highest (27%)
Treatment
250 mg injection of Rocephin
and 1 gram Zithromax
Abstain from sex for 7 days
after therapy
is initiated with no symptoms
and partner has been
adequately treated.
The use of dual therapy for the treatment of
gonorrhea is important for two reasons:
First is to ensure clinical cure in this era of
evolving antimicrobial resistance
Second is to prevent further development of
resistance.
If patients are treated with
azithromycin for urethritis on one
day, and screening tests return
positive for gonorrhea on the next.
The goal of dual therapy is to have
both drugs active
simultaneously. Because
azithromycin’s half-life is 68 hours, it
is probably safe to administer
ceftriaxone within five days of the
azithromycin dose.
Hepatitis
ABCDE
Hepatitis A
Transmitted by saliva (spit)
and stool.
Risk behaviors for Hepatitis A
Kissing
Anal to oral sex
HBV vaccine
Offered to patients with the following
risks:
 Men who have sex with men(MSM)
 Persons with multiple sex
 partners(more
than one sex partner during the previous
6 months)
 Current or previous injection-drug
user(IDU)
Note: If patient is an IDU offer
HCV testing under the HCV Pilot
Program.
HCV Talking Points
Important News!
• Hepatitis C (HCV) is curable!
• Treatment is usually only 12 weeks.
• HCV medications have less side effects than
ever before.
How To Get Treatment
• HCV medications are available through the
Virginia AIDS Drug Assistant Program (ADAP)
for people who are co-infected with HIV/HCV.
• Medications are free if a person’s private or
public health coverage (insurance, Medicaid,
Medicare D, etc.) does not cover them for any
reason. ADAP also pays for copayments if
coverage pays any part. Certain eligibility
requirements apply.
• ADAP pays for the medical visits and labs needed for HCV
treatment if other coverage does not (including
copayments).
• Program information is located at
http://www.vdh.virginia.gov/disease-prevention/virginia-aidsdrug-assistance-program-adap/hepatitis-chiv-co-infectedtreatment-assistance-program
Eligibility for Assistance
• ADAP eligible (at or below 400% FPL).
• On an HIV medication regimen.
• At least 6 months HIV undetectable.
• Has chronic HCV with at least one detectable HCV viral
load.
Did you know?
• About 30% of people living with HIV also
have HCV.
• Anyone can get HCV, which is most often
spread through contact with blood from an
infected person. Most people with HCV don’t
know they are infected and don’t have any
symptoms.
• HCV can lead to serious health problems if
not treated, including liver damage or failure,
cirrhosis, or liver cancer.
• The Centers for Disease Control and
Prevention (CDC) recommends that adults born
from 1945 – 1965, regardless of risk factors,
should be screened for HCV at least once.
While not completely understood, people born
during these years are 5 times more likely to be
infected than other adults.
• Ongoing substance use including drinking
alcohol, using illicit drugs including marijuana, or
participating in opioid substitution therapy
should not exclude patients from receiving or
being referred for HCV treatment.
Twinrix vaccine
Offered to clients with
Hepatitis C risk factors
Herpes
Genital Herpes
 There
are two common kinds of
Herpes and both are caused by a
virus
 Herpes
I is also called a cold
sore, or a fever blister
 Herpes

II is Genital Herpes
Incubation Period: 2-7 days
63
Herpes
Common Symptoms of
Genital Herpes

Small red sores that can last up to 2-3
weeks, and may be on the: penis, vagina,
anus, buttocks, thighs, mouth, or finger

Symptoms may include swollen lymph
glands, muscle aches, headache, fever,
and difficult urination

Symptoms may or may not recur. On
average, symptoms can occur
approximately 5 times a year
64
Syphilis
Syphilis
 Syphilis
is sometimes called “bad
blood ,” pox, lues, or a “zipper cut”
 Syphilis
is caused by a bacterium
 Incubation
Period: 10-90 days
(average 21 days)
65
Syphilis
Common Symptoms of
Syphilis
Primary Stage

Occurs in males and females

A painless sore called a chancre. The
sore may be located on the genitals, lips,
anus, or other area of direct contact

The chancre will last 1-5 weeks and heal
without treatment

The person can pass it on
66
HIV/Syphilis coinfection
Persons at risk for
syphilis should be
screened for HIV
Syphilis
Common Symptoms of
Syphilis
Secondary Stage
 May
include skin rashes, fever,
swollen lymph glands, headache,
hair loss, and muscle ache
 The skin rash may be on the palms of
hands, bottoms of the feet, or any
part of the body
 The rash may last 2-6 weeks (average
of 4 weeks); it will heal without
treatment
 The person may be able to pass it on. 68
Syphilis
Common Symptoms of
Syphilis
Late Stage
 Symptoms
may include: paralysis,
insanity, blindness, damage to knee
joints, personality changes,
impotency, aneurysm (ballooning of
a blood vessel), or tumor on the skin
or internal organs
69
RPR labs
Note on the lab slip if patient tested
positive and/or treated in the past.
Titers often remain positive even after
treatment.
Treatment
 2.4
million units Bicillin IM x1
for early and secondary cases
and once weekly x3 for latent
cases.
 If 10 days lapse between
Bicillin x 3 doses for latent
cases series must be restarted.
RPR Follow-up
•
•
•
Primary and secondary cases, 6- 12 months
Latent cases, 6,12, 24 months
HIV positives, 3, 6, 9, 12, and 24 months.
Syphilis
Congenital Syphilis
A
mother can
pass syphilis on
to her unborn
child
73
What is the Ultimate
complication of STI
infection?
Treatment for
Trichomoniasis
One time dose of
2gm Metronidazole
BV
 If
Clindamycin cream is ordered advise
patient it is oil-based and may weaken latex
condoms and diaphragms.
 If
Metronidazole is used advise patient to
avoid alcohol consumption until 24-72
hours after last dose of medication
regimen.
STIs Caused by viruses.
There is no cure, and can
infect unborn babies and
future spouses
4-Hs
 HIV
 HEPATITIS
(A,B,C)
 HUMAN PAPILLOMA VIRUS(HPV) OR
GENITAL WARTS
 HERPES
What practice affords
100% means of
prevention from
STDs?
STIs
Routes of Transmission

Drip or discharge
-Gonorrhea
-Chlamydia
-Trichomonas
-Bacterial vaginosis
-HIV
-Hepatitis (A, B, C)
 Ulcers or skin-to-skin contact
-Syphilis
-Herpes
-Crab lice
-Genital Warts or Human papilloma virus (HPV)
Prevention education
Nonoxynol-9 is not recommended for
vaginal or anal use.
Associated with disruption of genital
epithelium.
 May damage the cells lining the rectum
which may serve as a portal of entry for HIV.
 Associated with UTIs in females.
 Shorter shelf life than other lubricated
condoms.
MMWR 8/4/06
If initial results are negative the
day of screening:
Encourage patients to abstain from sex until
results are received or use barrier
protection.
Test of cure
Not recommended by VDH for any
STDS. However there are
recommendations made by CDC.
Please note:
Repeat labs after Chlamydia treatment
maybe positive for up to 3 months after
therapy.
Retesting is not recommended until 3
months after treatment for GC or
Chlamydia.
ABC Prevention Intervention
Abstinence


Abstain from sex
Abstain from drugs and alcohol because drugs
is just another way AIDS can kill
Be faithful, Be educated
Condom use

Get tested
Photos from Color Atlas of Sexually
Transmitted Diseases by Anthony Wisdom
Transmission Risk
of STDs Based on
Level of Physical
Intimacy
Physical Intimacy Scale
 --Embracing
and hand holding.
 --Cuddling and gentle caressing.
 --Polite kissing on the lips.
 --Intense and prolonged total mouth
kissing.
 --Fondling breasts and genitals outside the
clothes.
 --Oral and genital stimulation to orgasm
under the clothes.
 --Genital Intercourse.
L&L Parrott 1998
Reasonable Reasons to Wait
Advantages of Premarital Abstinence
 Sex before marriage is a class 1
misdemeanor in the State of Virginia
 Freedom from pregnancy
 Freedom from HIV/STDs
 Freedom from side effects of
contraceptives and prophylactics.
Reasons to Wait(cont.)
 Freedom
to have a healthy dating
relationship
 Freedom to know you are not infecting
your future spouse
 Freedom to have healthy babies
 Freedom from constant medical check-ups
 Freedom to enjoy being a teenager
Signs of Dangerous
LOVE(cont.)







Increasing demands for exclusive attention to him
or her.
Abuses drugs and alcohol and pressures you to
do the same.
Makes threats; Won't accept breaking up.
Mistreats you and say you provoked the
mistreatment.
Pushes, shoves, slaps or hits you.
Is abusive to you and then comes back on hands
and knees promising to change.
Will not take no for an answer and tries to
pressure, intimidate, or force you to have sex.
Signs of Dangerous LOVE
 Won't
let you have friends, checks up on
you.
 Limits who you can talk to. Tries to
separate you from the life you knew before
the relationship.
 Gives you orders and makes all the
decisions.
 Mean teasing and putting you down in front
of others.
 Loses temper quickly and frequently, fights
with others.