Download Session 4 - Teaching Slides

HIV Prevention for
Patients and the
Community
HAIVN
Harvard Medical School AIDS
Initiative in Vietnam
1
Learning Objectives
By the end of this session, participants
should be able to:
 Identify the 3 routes of HIV
transmission
 List 4 factors that can reduce the
sexual transmission of HIV
 Counsel a patient on how to use
condoms and how to inject safely
 Explain risk of mother to child
transmission of HIV
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Why should be concerned about
HIV prevention?


HIV is a communicable disease, thus
affects individuals and the entire
community
The best way to stop the HIV epidemic
in Vietnam is through prevention
• HIV is 100% preventable

Our patients and their families:
• have many questions about HIV
transmission and prevention
• trust nurses and listen to your advice
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3 Routes of HIV Transmission
Blood/Parentally
Sexual
Perinatally
(mother to child)
• IV drug use
• Blood transfusion
• Occupational exposures
(needle sticks)
• Heterosexual
• Homosexual
• During pregnancy and labor
• Breastfeeding
Estimated HIV Risk
for a Single Exposure to HIV+ Source
Root of Transmission
Blood transfusion
Blood
Sharing needles among IDU
Occupational exposures (needle sticks)
Mother to child
Receptive anal sex
Receptive vaginal sex
Insertive vaginal sex
Sexual
Insertive anal sex
Receptive oral sex
Inceptive oral sex
Rate %
90%
0.67%
0.3%
25-35%
0.5%
0.1%
0.065%
0.05%
0.01%
0.005%
CDC, MMWR, 2005
Characterizes
of HIV Transmission

HIV is DIFFICULT
to contract,
spread only
through exposure
to certain bodily
fluids:
•
•
•
•
blood
semen
vaginal secretions
breast milk

In order for HIV to
be spread, these
infected fluids need
to be exposed to:
• a mucous
membrane (vagina,
eye, mouth)
• broken skin
• blood (needle stick,
infusion)
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How is HIV not spread?

HIV is NOT transmitted through casual
contact such as:
•
•
•
•
•
•
Hugging or kissing
Coughing or sneezing
Sharing utensils, cups or bowls
Sharing toilets
Swimming pools
Insect bites
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HIV Transmission and
Prevention through
Blood/Parental Sources
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Factors Increasing HIV
Transmission through IDU

Lack of access to:
• clean syringes:

Use of previously used syringes during
injection drug use
• effective drug abuse treatment
(methadone)

Concurrent sexual risk behavior
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Reduce HIV transmission among IDU:
Nurses’ Role(1)
Recognize drug use:
 Ask all patients about drug use
 Recommend HIV testing for IDU
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Reduce HIV transmission among IDU:
Nurses’ Role(2)
Help IDU reduce their risks:
 Educate patients on HIV transmission
 Educate them to:
• Use of new needles and syringes
• or clean needles and syringes
• Do not share of needles and syringes


Provide free needles and syringes to
IDU
Refer or provide treatment for drug
addiction
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Reduce HIV transmission among
IDU: Nurses’ Role (3)
Educate patients how to clean needles:
 2 x 2 x 2 (water, bleach, water)
 Bleach (ideally) for 30 seconds each
pass
 If no bleach, alcohol OK (but not wine
or beer)
 Boiling x 5 – 10 minutes also kills HIV
 If can’t use bleach, alcohol, or boil,
then recommend using clean water:
• 30 seconds each time x 3 times
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HIV Transmission and
Prevention among
Sexual Partners
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Sexual Transmission of HIV (1)


HIV is concentrated in semen in
men, vaginal secretions in women
HIV is more easily transmitted from
the insertive to the receptive partner
• Man to woman during vaginal sex
• Man to man or woman during anal sex
• Oral sex with ejaculation or during
menses
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Sexual Transmission of HIV (2)

Risk of transmission:
• Higher if HIV viral load in the infected
partner is high
• depends on route of sex:
Oral
<<
Low risk
Vaginal
< Anal
high risk
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Sexual Transmission of HIV (3)
Risk of transmission is associated with the
HIV viral load in the infected partner.
Serum HIV-1 RNA
in HIV+ partner
Risk of acquisition
among HIV- partner
<3,500 c/ml*
1.0
3,500 – 9,999 c/ml
5.81
10,000 – 49,999 c/ml
6.84
*chưa
≥50,000
gặp
ở bệnh nhânc/ml
HIV <1500c/ml
12.55
*There were no tx seen in patients with HIV < 1500 c/ml
Quin, T et al. N Engl J Med 2000. 342” 921 -9
Factors Increasing
Sexual Transmission of HIV


More sexual partners (FSW, MSM)
Sex:
• during menses
• with the presence of STDs- especially
genital ulcers
• through anal (no natural lubrication)



Rough or “dry” sex
Female douching after sex
Use of chemical spermicides
• Nonoxynol-9 (N-9)
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Factors Reducing
Sexual Transmission of HIV




Fewer Sexual Partners
Condom use
Non-penetrative sex (masturbation)
Male circumcision:
• 61% reduction in acquiring HIV infection
among circumcised man
*Auvert B. 2005.
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Prevention of Sexual
Transmission of HIV: the ABC’s
Abstinence (no sex)
Be Faithful (one sexual partner)
Condoms (if A & B not followed)
Reducing
Sexual Transmission
of HIV: Roles of Nurses
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Take a Sexual History (1)


Helps you to understand the
patient’s risk and provide correct
counseling on prevention
Allows the patient to ask questions
about sexual behavior that they
might have been ashamed to bring
up
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Take a Sexual History (2)

Sexual history should be taken:
• In a private room, with only the patient
and nurse present
• Be attentive and use non-judgmental
attitude

Advise the patient that:
• you will ask some personal or difficult
questions
• all information is confidential
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Take a Sexual History (3)

Ask detailed questions about the
patient’s sexual behavior
• number and type of partners
• route of sexual activity (oral, vaginal,
anal)
• homosexual sex (MSM)
• condom and lubricant use
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Provide Information

Provide information to patients on:
• risks for sexual transmission of HIV
• safe sexual behavior
• condom and lubricant use (provide them
freely, when possible)
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Assist the Patient
Encourage and assist the patient in:
 disclosing their HIV infection to their
partner(s). This will facilitate:
• condom use and
• HIV testing of the partner(s).


seek treatment for STDs
ARV treatment:
• Patients on ARV have lower HIV viral
loads thus, a lower risk of transmitting
the infection
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HIV Transmission and
Prevention Among
Mothers and Children
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HIV Transmission:
Mother To Child (1)

Transmission from mother to child
can occur:
• in utero
• during delivery
• post-partum through breast milk
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HIV Transmission:
Mother To Child (2)
Risk of Child acquiring HIV from
an HIV+ mother
No treatment
PMTCT
25%-35%
2%-8%
In developed countries
(Triple ARV, C-section, no
breast feeding)
<2%
Preventing HIV Transmission
from Mother To Child


Providing HIV counseling and testing to all
pregnant women
Pregnant woman with criteria for ARV
treatment should be:
• started on triple-ARV therapy at the HIV OPC
as soon as possible
• and also referred to the PMTCT program


Pregnant woman without criteria for ARV
should be referred to the PMTCT program
for prophylactic ARV
Babies born to HIV infected women should
not breastfeed, if powdered milk and clean
water are available
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Key Points




The 3 routes of HIV transmission are:
blood, sex and mother to child.
Disposable needles help reduce HIV
transmission though IDU
Sexual transmission reduces if safe sex
is practiced
Pregnant woman with criteria for ARV
treatment should be started on tripleARV therapy at the HIV OPC as soon as
possible
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Thank you!
Question?
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