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SUBSTANCE ABUSE
COMMUNICABLE DISEASE
TRAINING
Laura Fredrickson
Jill Fries
Marquette County
Health Department
June 6 , 2007
STI’s

Sexually Transmitted Infection’s
 Identify
the most Common STI’s
Chlamydia
Trichomoniasis
Gonorrhea
Syphillis
HPV
Genital Herpes
HBV
HIV
Crabs
Symptoms - Bacterial
Chlamydia
 Gonorrhea
 Syphillis
 Trichomoniasis

Symptoms - Viral
HPV (Genital Warts)
 Genital Herpes
 HIV
 HBV

HPV

An Excellent Brochure is available through
the CDC:
www.cdc.gov/std/hpv
When the window opens, you will find on the
right side of screen an option to download
an HPV poster and/or Brochure.
Treatment
Antibiotics
 Anti-virals
 Problems with Symptoms (or lack there of)

The Three R’s of STI’s

Risk
 Identify

the Risk Behavior
Recognition
 Symptoms

Response
 Accessing
Services
VIRAL HEPATITIS
MAJOR CONCERN FOR HEALTHCARE
WORKERS
BLOOD
SEMEN
VAGINAL
FLUIDS
SALIVA
Liver Primer

Understanding the Liver
 Largest
Internal Organ
 Filter & Warehouse
 Complications of Hepatitis:
 Inflammation
 Cirrhosis
(Shrinking)
 Loss of Function
HEPATITIS A
Cause of Hepatitis A
Hepatitis A Virus (HAV)
Hep A Signs and Symptoms
Fatigue
 Abdominal Pain
 Loss of Appetite
 Nausea and diarrhea
 Fever
 Jaundice
 Adults will have signs and symptoms
more often than children

Long Term Effects
There is no chronic (long-term) infection
Once you have had hepatitis A, you will not
get it again
About 15% of people infected with HAV have
a prolonged or relapsing symptoms over 69 month period
Persons at Risk of Infection
Household contacts of infected persons
 Sexual contacts of infected persons
 Persons, especially children, living in
areas with increased rates of HAV infection
 International travelers
 Men who have sex with men
 Injecting and noninjecting drug users

Prevention of HAV Infection
Hepatitis A vaccine is the best protection
Short term protection is available from
immune globulin (IG). It is most effective
when given within two weeks of exposure.
Meticulous hand hygiene
Vaccine Recommendations
(2 years or older)
Travelers to areas with increased rates
of HAV
 Men who have sex with men
 Injecting and noninjecting drug users
 Persons with clotting factor disorders
 Persons with chronic liver disease
 Children who live in areas with
increased rates of HAV

Trends and Statistics




Occurs in epidemics both nationwide and
in communities
During epidemic years, the number of
reported cases in the US reached 35,000
Since the vaccine has been licensed, the
number of cases reached historic lows
1/3 Americans have evidence of past
infection
HEPATITIS B
HBV
Caused by the Hepatitis B Virus
 Exposure to the blood/body fluids of an
infected person
 Sexual exposure, IVDU, needlestick or
sharps exposure on the job, or
perinatally
 Persons at risk for HBV are also at risk
for Hepatitis C virus

Signs and Symptoms








Fatigue
Abdominal pain
Loss of appetite
Nausea, vomiting
Joint pain
Jaundice
30% of persons have no signs/symptoms.
Signs/symptoms are less common in children
than adults
Long Term Effects of HBV
Infection

Chronic infection occurs in:
- 90% of infants infected at birth
 - 30% of children infected at age 1-5 years
 - 6% of persons infected after 5 years


Death from chronic liver disease occurs
in:

- 15-25% of chronically infected persons
Risk Groups for HBV







Persons with multiple sexual partners or a
diagnosis of a STD
Men who have sex with men
Sexual contacts of infected persons
Injection drug users
Household contacts of chronically infected
persons
Infants born to infected mothers
Infants/children of immigrants from areas with
high rates of HBV infection
Risk Groups for HBV
(continued)
Health care and public safety
workers
Hemodialysis patients
Prevention of HBV






Hepatitis B vaccine is the best protection
Safer sex practices
Screening of all pregnant women and
appropriate treatment of infants
No IVDU
Tattoos or body piercing only from reputable
establishments with good health practices
Screening of blood, organ and tissue donors
Prevention of HBV (continued)
Universal precautions in the
workplace
HBV Vaccine
Recommendations
Hepatitis B vaccine available since
1982
 Routine vaccination of 0-18 year olds
 Vaccination of risk groups of all ages

Treatment and Medical
Management
Infected persons should be evaluated for
liver disease
 Certain drugs are licensed for treatment,
not to be used by pregnant women
 Drinking alcohol can make your liver
disease worse

HBV Trends and Statistics




Number of new infections per year has declined
from an estimated 260,000 in the 80s to about
60,000 in 2004.
Highest rate of disease is in 20-49 year olds
Greatest decline in disease has happened in
children and adolescents due to routine HBV
vaccination
There are 1.25 million Americans who are
chronically infected, 20-30% acquired their
infections in childhood
Hepatitis C
HCV
Transmitted by: Exposure to an infected
person's blood/body fluids
 IVDU, needle sticks or sharps exposures
in the workplace, or perinatal exposure

Hepatitis C Signs and
Symptoms
Fatigue
 Dark urine
 Abdominal pain
 Loss of appetite
 Nausea
 Jaundice
 80% of acutely infected persons have
no signs or symptoms

Long Term Effects of HCV
Infection
Chronic infection: 75-85% of infected
persons
 Chronic Liver Disease: 70% of
chronically infected persons
 Deaths from chronic liver disease: <3%
 Leading indication for liver transplant

Who Should be Tested?







Testing recommended for:
- Injecting drug users
- Recipients of clotting factors made before
1987
- Hemodialysis patients
- Recipients of blood/solid organ
transplantation before 1992
- Persons with undiagnosed liver disease
Infants born to infected mothers after 12-18
months of age
Who Should be Tested?
(continued)
Healthcare/Public Safety Workers
only after known exposure
Not recommended for persons with
multiple sexual partners or an
infected steady partner
HCV Prevention







No vaccine is available
NO IVDU use
Don't share personal care items that may have
be infected with blood (razors, toothbrushes)
Universal precautions in the workplace
Safe tattooing or body piercing
Safer sex practices
Screening of blood, organ and tissue donors
HCV Treatment
Infected persons should be evaluated
for liver disease
Drug therapy is available
Drinking alcohol can make liver
disease worse
HCV Trends and Statistics
Number of new infections has declined
from 240,000 in the 80s to about 26,000
in 2004.
 Most infections are due to illegal
injection drug use
 Transfusion related cases occurred
prior to blood donor screening; now
occurs in less than one per million
transfused unit of blood.

HCV Trends and Statistics
(continued)
Estimated 4.1 million (1.6%) Americans
are infected, 3.2 million are chronically
infected.
Over 431 reports of HCV infected
persons in Marquette County have
been received.
Heptatitis Information

For More Detailed Information Regarding
Hepatitis A – E, please visit:
www.cdc.gov/diseasesconditions/
When the window opens, click on hepatitis.
Tuberculosus
TB
Tuberculosis Facts
TB cases are
reported in every
state
 10-15 million
Americans are
infected
 Without treatment
10% will develop
active TB at some
point

Infection Process of TB




Spread by droplet
nuclei
Expelled when
infectious person
coughs, sneezes,
speaks or sings
Close contacts are at
highest risk of
becoming infected
Latent infection
cannot transmit
High Risk to Dev Active TB






HIV infected
Substance abuse
Recent infection
CXR indicates
previous TB
Diabetes mellitus
Silicosis
Testing for TB Infection and
Disease

TB skin testing
Test must be read in 48-72 hours
 Measure only indurations

Chest x-ray
 Sputum smears and cultures

Pulmonary TB Symptoms
Prolonged cough (3wks or longer)
 Chest pain
 Bloody sputum (phlegm)
 Fever, chills and night sweats
 Fatigue
 Loss of appetite/ wt. loss

High Risk Groups for TB
Exposure
Close contacts of infectious cases
 Foreign born persons
 Residents and employees of high risk
settings (Prison, nursing home, etc.)
 HCW's who serve high risk clients
 Persons who inject illicit drugs

TB Treatment
Provide safest, most effective therapy in
the shortest length of time
 Ensure adherence to therapy (DOT?)
 Initially four drugs can be used
 In most cases children can be treated
with the same regimens as adults

HIV
HIV TRANSMISSION








BLOOD to BLOOD
SEMEN
VAGINAL FLUID
IN UETRO
BREAST FEEDING
MUST HAVE ROUTE INTO BODY
BLOOD ON INTACT SKIN NOT A RISK
IMMEDIATE TRANSMISSION TO OTHERS
HIV Testing



 Blood draw
HIV antibody test.
 (ORASURE)
Window Period
 Rapid Test: 20 minutes
Re-testing may
 Anonymous or Confidential
recommended
 1. ELISA: Screens for
depending on time frame
antibodies
and risk of exposure

2. Western Blot:
Confirms HIV
Low incidence Health Departments are no longer funded to provide
HIV Counseling and Testing.
Progression of HIV

HIV ENTERS BODY

HIV BEGINS TO WEAKEN IMMUNE SYSTEM

ATTACKS CD4 CELL

BEGINS MAKING NEW HIV VIRUS

SYMPTOMS MAY NOT BE PRESENT FOR YEARS. (VARIES
FROM PERSON TO PERSON)
Progression of HIV

HIV CAN PROGRESS INTO AIDS. TIME FRAME DEPENDS
ON PERSON AND CARE AND TREATMENT

AIDS DIAGNOSIS = CD4 COUNT < 200

A WEAKENED IMMUNE SYSTEM MAKES A PERSON MORE
SUSCEPTIBLE TO OPPORTUNISTIC INFECTIONS

PEOPLE CAN LIVE LONG HEALTHY LIVES

FEWER PEOPLE DYING
LIFE CYCLE OF HIV
SYMPTOMS OF HIV/AIDS









Weight loss >10 lb..
Night sweats > 2 weeks
Yeast infections ( recurring)
Chronic/diarrhea
Fungal infections
Swollen lymph nodes
Skin cancer (Kaposi's Sarcoma)
Pneumonia (PCP)
Dementia
OPPORTUNISTIC
INFECTIONS

CANCERS










Cervical
Kaposi's Sarcoma
PNEOMONIA (PCP)
CYTOMEGALOVIRUS (CMV)
HERPES
MYCOBACTERIUM AVIUM COMPLEX (MAC)
TOXOPLASMOSIS (TOX0)
TUBERCULOSIS (TB)
CANDIDIASIS (ORAL THRUSH)
HEP C
TREATMENT
Life long treatment
 Very toxic/side effects
 Very large pills
 Sometimes many pills
 Liver/kidney damage
 Manage illness/not cure
 Missed doses can cause resistance
 Resistant virus can be transmitted

LAB WORK
CD4
 HIV VIRAL LOAD
 HIV GENOTYPE
 HIV PHENOTYPE
 SCREENS FOR LIVER/KIDNEY DAMAGE

RISK REDUCTION

VERY CHALLENING

BEHAVIOR CHANGE IS DIFFICULT

SUBSTANCE ABUSE INCREASES RISK

CONTINUUM OF RISK BEHAVIOR

NEGOTIATE TO REDUCE RISK
ASSESSING RISK

HOW MANY PARTNERS?

HOW OFTEN SHARE NEEDLES?

WHAT KIND OF SUBSTANCE USE?

WHAT KIND OF SEXUAL ACTIVITY?
RISK REDUCTION PLAN
WHAT IS LESS RISKY BEHAVIOR?

NON PENETRATING SEX

HAVE SEX WITH LESS PARTNERS

USE CONDOMS AT LEAST 3 TIMES A WEEK
INSTEAD OF ONLY ONCE.
PYSCHO-SOCIAL ISSUES
LIVING WITH HIV
STIGMA
Observations by Gregory M Herek, Ph.D., a professor of psychology at the
university of California
at Davis. Internationally recognized
authority of HIV related stigma.
People with HIV are viewed more negatively than people diagnosed
with other incurable diseases. Gay men and injection drug users are
disproportionately susceptible to HIV related stigma and
discrimination. People who acquire HIV through no action of their
own are often referred to as "innocent" or "blameless"
HIV related stigma not necessarily a stigma of the diseased; rather it
is often related to perceived lifestyle "choices" of infected
populations or to perceptions about racial and ethnic minorities .
STIGMA
STIGMA: "an attribute that is deeply discrediting
within a particular social interaction" HRSA
Care Action August 2003 Erving Goffman Stigma:
Notes on the Management of Spoiled Identity
HIV-related stigma: Unfavorable attitudes, beliefs, and
policies directed toward people perceived to have
HIV/AIDS as well as their loved ones, associates, social
groups, and communities. The stigma is rooted in
prejudices involving gender, sexuality, illness, and race.
PROFESSIONAL
CHALLENGES









BE AWARE OF OWN FEELINGS AND
JUDGMENTS
BE HONEST WITH YOURSELF
EDUCATE YOURSELF
DON'T PASS JUDGMENTS ON
RESPECT
DON'T BLAME
DON'T MORALIZE
EDUCATE OTHERS
DON'T TOLERATE JOKES ECT. FROM OTHERS
LAWS
MICHIGAN HIV LAWS
CONFIDENTIALITY
 All reports, records and data pertaining to
testing, care treatment, reporting and research
associated with HIV/AIDS.
PENALTIES

Misdemeanor
 Prison
up to one year.
 Fine up to $5,000 or both

Liable in civil action
 Actual
damages or $1,000
 Costs and attorney fees
 Can also apply to the employer of violator
NOTIFYING PARTNERS

PARTNER COUNSELING & REFERRAL

Notify past sex/needle sharing partners
Self
 Physician
 Health Department



Central Michigan District Health Dept.
DUTY TO WARN


Felony Law
Must notify future sex/needle sharing partners
OTHER LAWS

HIPPA

ADA


HIV + and family members protected by ADA
REPORTING
Local Health Departments
 Lab based reporting

 Started
in April 2005
LAW WEB SITES
MICHIGAN HIV LAWS
How They Affect Physicians & Other Health
Care Providers
michigan.gov/documents/mihivlaws_49845_7.pdf
AMERICAS WITH DISABILITIES ACT
www.usdoj.gov
PUBLIC HEALTH CODE
www.legislature.mi.gov
Confidentiality: MCL Section 333.5131
HIV Disclosure: MCL Section 333.5210
Universal Precautions





Universal Precautions
adopted in 1987
An approach to
infection control.
To reduce our risks of
infection by utilizing
safe work methods
ALL Human blood and
other fluids treated as
infectious
Gloves, gowns, eye
protection, hand
washing.
STATISTICS
LOCAL HIV/AIDS STATISTICS:
MICHIGAN DEPARTMENT OF COMMUNITY
HEALTH
End of July 2006

HIV/AIDS IN OUR
COMMUNITY

11,291 HIV+ reported in Michigan
16,200 estimated HIV+ in MI






About 900 new infections each year
6 reported HIV+ in Marquette
County
12 reported AIDS cases in
Marquette County
61 reported HIV/AIDS in U.P
150- 175 estimated HIV+ in U.P.
25 To 75 estimated HIV+ in
Marquette County
National HIV Statistics
CDC Estimates




Total living with HIV/AIDS (end of 2003):
1,039,000 – 1,185,000
24-27% Undiagnosed
Total AIDS deaths in 2004: 42,514
Total Cumulative through 2004: 529,113
Approximately 40,000 new infections each year
 73% men
 27% women (1/2 younger than 25 years)
WOMEN & HIV
CDC Through 2003

87,940 WOMEN
ESTIMATED
HIV/AIDS

MAJORITY - 75%
INFECTED BY SEX
WITH HIV-INFECTED
MAN

25% IDU
GLOBAL SUMMARY of the HIV and AIDS
EPIDEMIC, 2005
UNAIDS JOINT UN PROGRAM ON HIV/AIDS
Number of people living
with HIV in 2005
Total
Adults
Women
Children under 15 years
38.6 million [33.4 – 46.0 million]
36.3 million [31.4 – 43.4 million]
17.3 million [14.8 – 20.6 million]
2.3 million [1.7 – 3.5 million]
People newly infected
with HIV in 2005
Total
Adults
Children under 15 years
4.1 million [3.4 – 6.2 million]
3.6 million [3.0 – 5.4 million]
540 000 [420 000 – 670 000]
Total
Adults
Children under 15 years
2.8 million [2.4 – 3.3 million]
2.4 million [2.0 – 2.8 million]
380 000 [290 000 – 500 000]
AIDS deaths
in 2005
HIV/AIDS WORLD WIDE
UNAIDS JOINT UN PROGRAM ON HIV/AIDS
Regional HIV and AIDS statistics and features, 2003 and 2005
REGION
Adults (15+) and children
living with HIV
2005
2003
Adults (15+) and children
newly infected with HIV
2005
2003
Adult (15-49)
prevalence
(%)
2005
2003
Adult (15+) and child
deaths due to AIDS
2005
2003
Sub-Saharan Africa
24.5 million
23.5 million
2.7 million
2.6 million
6.1
6.2
2.0 million
1.9 million
[21.6‒27.4 million]
[20.8‒26.3 million]
[2.3‒3.1 million]
[2.3‒3.0 million]
[5.4‒6.8]
[5.5‒7.0]
[1.7‒2.3 million]
[1.7‒2.3 million]
North Africa and
Middle East
440 000
380 000
64 000
54 000
[250 000‒720 000]
[220 000‒620 000]
[38 000‒210 000
[31 000‒150 000
Asia
8.3 million
7.6 million
930 000
860 000
[5.7‒12.5 million]
[5.2‒11.3 million]
[620 000‒2.4 million]
[560 000‒2.3 million]
Oceania
78 000
66 000
7200
9000
[48 000‒170 000]
[41 000‒140 000]
[3500‒55 000]
[4300-69 000]
Latin America
Caribbean
Eastern Europe and
Central Asia
North America,
Western and Central
Europe
TOTAL
1.6 million
1.4 million
140 000
130 000
[1.2‒2.4 million]
[1.1‒2.0 million]
[100 000‒420 000]
[95 000‒310 000]
330 000
310 000
37 000
34 000
[240 000‒420 000]
[230 000‒400 000]
[26 000‒54 000]
[24 000‒47 000]
1.5 million
1.1 million
220 000
160 000
[1.0‒2.3 million]
[790 000‒1.7 million]
[150 000‒650 000]
[110 000‒440 000]
2.0 million
1.8 million
65 000
65 000
[1.4‒2.9 million]
[1.3‒2.7 million]
[52 000‒98 000]
[52 000‒98 000]
0.2
0.2
[0.1‒0.4]
[0.1‒0.3]
0.4
0.4
[0.3‒0.6]
[0.2‒0.6]
0.3
0.3
[0.2‒0.8]
[0.2‒0.7]
0.5
0.5
[0.4‒1.2]
[0.4‒0.7]
1.6
1.5
[1.1‒2.2]
[1.1‒2.0]
0.8
0.6
[0.6‒1.4]
[0.4‒1.0]
0.5
0.5
[0.4‒0.7]
[0.3‒0.6]
37 000
34 000
[20 000‒62 000]
[18 000‒57 000]
600 000
500 000
[400 000‒850 000] [340 000‒710 000]
3400
2300
[1900‒5500]
[1300‒3600]
59 000
51 000
[47 000‒76 000]
[40 000‒67 000]
27 000
28 000
[19 000‒36 000]
[19 000‒38 000]
53 000
28 000
[36 000‒75 000]
[19 000‒39 000]
30 000
30 000
[24 000‒45 000]
[24 000‒45 000]
38.6 million
36.2 million
4.1 million
3.9 million
1.0
1.0
2.8 million
2.6 million
[33.4‒46.0 million]
[31.4‒42.9 million]
[3.4‒6.2 million]
[3.3‒5.8 million]
[0.9‒1.2]
[0.8‒1.2]
[2.4‒3.3 million]
[2.2‒3.1 million]
RESOURCES
UPPER PENINSULA
CONTINUUM OF CARE PROGRAM
MARQUETTE COUNTY HEALTH DEPARTEMENT

Provides case management and advocacy
services to HIV + residents who live in the U.P.



AIDS Drug Assistance Program
Dental Assistance Program
Insurance Assistance Program
FEDERAL AND STATE
WWW.CDC.GOV
Disease and Conditions/ (HIV) (HEP) (TB)
WWW.MICHIGAN.GOV
STATE WEB SITES
COMMUNITYHEALTH/PREVENTION/ (HIV/STD)
(HEP) (TB)
LOCAL PUBLIC HEALTH
MARQUETTE HEALTH DEPARTMENT
WWW.MQTHEALTH.ORG
LAURA FREDRICKSON, HIV/AIDS COORDINATOR
(906) 475-7651
[email protected]
JILL FRIES, HEALTH EDUCATOR
(906) 315- 2627
[email protected]
LORI MARTA, COMMUNICABLE DISEASE NURSE
(906) 315-2631
[email protected]
LOCAL PUBLIC HEALTH
Luce-Mackinac-Alger-Schoolcraft District Health
Dept.
Newberry
Phone: 906-293-5107
 Munising



Phone: 906-387-2297
St. Ignace
Phone: 906-643-1100
Manistique
Phone: 906-341-4113
LOCAL PUBLIC HEALTH
Western Upper Peninsula District Health
Dept.



Baraga
Phone 906-524-6142
Ontonagon
Phone 906-884-4485
Bessemer
Phone: 906-667-0200
LOCAL PUBLIC HEALTH
Chippewa County Health Dept.

Sault Ste. Marie
906-635-1566
LOCAL PUBLIC HEALTH
Public Health Delta and Menominee
Counties

Escanaba
906-786-4111

Menominee
906-863-4451
LOCAL PUBLIC HEALTH
Dickinson-Iron District Health Dept.

Iron River
Phone906-265-9913

Kingsford
Phone: 906-774-1868