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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.