Download Secondary Prevention

Secondary Prevention
Basis for Secondary
Prevention
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STDs
Drug Resistance
HIV super-infection
Mother to child transmission
Hepatitis C
Hepatitis B
Condoms Protect ?
• 98.5% risk reduction /single act with
infected partner
– 14% failure with 10 acts
– 26% failure for 20 acts
– 37% failure for 30 acts
Fitch STD 2002, Mann STD 2002
Condoms are not Perfect
• Slippage
– 0.8% (5y experience)
• Breakage
– 0.7% (5y experience)
• Pregnancy Risk
– 6% (< 2 y experience)
– 3.6% (>4y experience)
Messiah AJPH 1997
Sexual Behavior Risk
Fisher and Fisher, Options Project
• 51% of HIV+ clinic participants engaged
in sexual activity in pat 3 mos.
• 52/496 HIV + participants had risky
vaginal or anal sex with 197 partners in
past 3 mos.
Drug Use Risk
Fisher and Fisher, Options Project
• 35% of IDUs who injected in last
month borrowed or lent dirty works
to:
– 75 HIV –
– 113 HIV unknown
– 65 HIV +
Sexual Risk
• 50-90% HIV+ remain sexually active
after diagnosis
• 20-60% HIV + and sexually active don’t
use condoms consistently
Darrow et. al 1998, Wilson 1999, Deren 1998, Fisher, 1999,
Interventions to Reduce Sexual
Risk Behaviors
• Population
– HIV + Drug users
– Women
– HIV + MSM
• Increased
Condom use
• Decreased sexual
partners
26% decrease in
unprotected sex
• Risk Reduction
– 0.81 (OR)
– 50% risk
reduction at 6mos
– 0.69 (OR)
• 0.61(OR)
• 0.74 (OR)
Shain STD 2002,
Semaan JAIDS 2002,
Johnson JAIDS 2002
Mentally Ill
• Cognitive-behavioral HIV risk reduction
– Increased condom use
– Higher percentage of intercourse
occasions with condoms
– More positive attitudes toward condoms
– Behavior change present at 3,6,9 mos.
– Behavior change diminished by 12 mos.
Otto-Salag Com Mental Health J 2001
Types of interventions
• Social
• Structural
• Behavioral
– Motivational Interviewing
– Counseling
• Education
– Risk reduction
– Risk consequences
Approaches to Harm Reduction
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Multiple attempts
Longitudinal follow up
Patient buy-in
Multidisciplinary
Consistent messages
Non judgmental