Download STD Clinic at Harborview

STD/HIV Prevention
Seattle & King County
Robert Marks
744-2275 [email protected]
My discussion…
Public Health Goal
 PH Prevention Services
 STD Program
 STD & HIV Epidemiology
 Your Role
 STD & HIV Resources

Public
Health
Goal
 Stop
the
spread of
disease and ensure individual
health as well as the health of
communities.

You
You Did
What!?!?
Stop That!
Public Health
Prevention Services

HIV Counseling and Testing
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Disease Investigation & Partner Notification
Syringe Access & Disposal
Community Coalition Leadership

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
STD Clinic/District Sites/CBO’s
Black Leadership Council
Educational Materials Development
Technical Assistance and Training
STD Clinic at Harborview
(206) 744-3590
Monday-Friday 8am-6:30pm
9:30am–6:30pm Tues
STD Clinic at Harborview
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Walk-in clinic (if after 3:00pm, call)
STD screening/treatment
HIV testing and early intervention services
Fees are based on income (No person will be
turned away due to inability to pay.)

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No charge for STD medications
If symptomatic, most likely expedited
Interpreter services available
Disease Intervention
Specialists


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Provide health information to diagnosed
individuals.
Assure appropriate medical care.
Elicit sex partners (and needle sharing partners for HIV
diagnosed individuals) in order to get the partners
into medical care.
King County
STD/HIV Epidemiology
Chlamydia
CT Positivity*, King County and
Other WA Counties, 1992-2007
0.08
0.07
0.071
Positivity
0.06
0.056
0.05
0.04
0.03
0.02
0.01
King County
All other WA
counties
0
1998 1999 2000 2001 2002 2003 2004 2005 2007
* Positivity = # positive tests divided by # total tests (through IPP)
CT Incidence* among Women
ages 15-29, 1992-2008
Incidence per 100,000
2500
2000
3394
cases
1500
1000
King County
Washington
U.S.
500
* Based on reported cases, countywide
20
08
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
0
CT Incidence among Women
by Age, 1992-2008
3000
2500
2000
1500
1000
500
0
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
Cases per 100,000 women
3500
0-9 years
10-14 years
15-19 years
20-24 years
25-29 years
30-34 years
35-44 years
45-54 years
>=55 years
Gonorrhea
GC Incidence* among Women
ages 15-29, 1992-2008
Incidence per 100,000
700
King County
600
Washington
U.S.
500
400
300
200
368
cases
100
0
1992
1994
1996
1998
*Based on reported cases, countywide
2000
2002
2004
2006
2008
GC Incidence* by Sex, 1992-2008
Incidence per 100,000
180
160
Men
Women
140
120
812
cases
100
80
60
482
cases
40
20
0
1992 1994 1996 1998 2000 2002 2004 2006 2008
* Calculate using reported cases, countywide
GC among MSM,* 1993-2008
2000
Incidence per 100,000
1800
1600
1400
1200
1000
800
600
400
200
0
1993
1995
1997
1999
2001
2003
2005*
2007
*MSM cases included MSM cases diagnosed in the STD clinic, as well as rectal
infections diagnosed elsewhere
^Starting in 2005, MSM definition also includes interview data
King County: Gonorrhea Incidence in
15-29 year old Women, by Race
3000
White
Incidence (per 100,000)
2500
Black
Nat Am
Asian/PI
2000
1500
1000
500
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
King County: Gonorrhea Incidence in
15-29 year old Women, by Ethnicity
400
Incidence (per 100,000)
350
300
250
200
150
100
50
Latinas
Non-Latinas
0
1992
1994
1996
1998
2000
2002
2004
2006
2008
GC Incidence among Women
by Age, 1992-2008
800
700
600
500
0-9 years
15-19 years
25-29 years
35-44 years
>=55 years
10-14 years
20-24 years
30-34 years
45-54 years
400
300
200
100
0
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
Cases per 100,000 women
900
Syphilis
King County: Early syphilis*,
1994-2008
188
179
180
MSM syphilis**
160
Heterosexual syphilis
185
174
140
140
2005 total cases = 193
2006 total cases = 185
2007 total cases = 194
2008 total cases = 191
120
100
77
80
60
60
58
60
50
32
40
16
20
26
15
2 3
2
1 1
5
4
9
12
2
3
13
5
10
5
*Reported P, S, and EL syphilis
**Excludes some male cases with unknown MSM status
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
99
19
98
19
97
19
96
19
95
19
94
0
19
Early syphilis cases
200
6
MSM
GC, CT, and Early Syphilis
among MSM, 1993-2008*
800
700
Gonorrhea
Chlamydial infection
600
Syphilis
Cases
500
400
300
200
100
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
0
* New “definition” of MSM in 2005, based on case report, interviews, site of infection
STD Summary
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Chlamydia rates stable over past 3 years
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Gonorrhea rates down (again)
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Down in heterosexuals and MSM
Down in most age groups
Down in most race groups
Early syphilis cases similar to 2007
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MSM relatively unchanged
STD Clinic numbers dropped in women
Increase in EL cases vs. P&S continues
MSM stable for CT and syphilis, GC down
HIV/AIDS
Who is living with HIV/AIDS in KC?
(as of 3/31/09)
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90% male
42% diagnosed between 30-39 years of age
74% currently 40 years and older
Race
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Risk
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68% white
17% black
10% Hispanic
3% Asian
69% MSM
8% MSM-IDU
5% IDU
10% heterosexual contact
25% foreign-born at age of diagnosis
(2006-2008)
Provider
Role
What is my role in
STD/HIV Prevention?

Talk about sex, drugs, disease & transmission.

Encourage and/or refer for screening/testing.
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Assist individual to reduce risk.
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Encourage discussion between partners.***
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Let patient know that Public Health will be
contacting…confidentiality maintained.
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Provide Expedited Partner Therapy.
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Inform of STD Clinic services.
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Complete Case Report for diagnosed disease.
Clarify/define!
Sex
 Monogamy
 Agreements?
 What happens if
someone strays?
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Web Resources
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General STD info
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www.kingcounty.gov/health/std
Lots of HIV info
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www.kingcounty.gov/health/hiv
Questions?
Thoughts?