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Sex Education LCHS Mark Ewoldsen, Ph.D. Young People Need to Make Healthy Decisions ©The Alan Guttmacher Institute Sex Education A sexually active woman today is less likely to use birth control than she was in 1995 National sample of 7,643 women conducted in 2002. Laura Lindberg, PhD, senior research associate for the Alan Guttmacher Institute But don't blame teenage sex. The drop in contraceptive use is due to adult women in their 20s who, despite forgoing birth control, don't want to have children A sexually active woman today is less likely to use birth control than she was in 1995 This means that 4.5 million U.S. women are at very high risk of unintended pregnancy That's 1.43 million more women at risk than in 1995, according to the U.S. Department of Health and Human Services survey. A sexually active woman today is less likely to use birth control than she was in 1995 98% of women of childbearing age use birth control Half of unplanned pregnancies occur among the 2% of women not using contraception," A sexually active woman not using contraception has an 85% chance of getting pregnant This means almost a million more unplanned pregnancies might occur Unintended pregnancy is a real problem The majority are happening in adult women, not teens Unplanned pregnancies get less prenatal care more likely to be exposed to dangerous substances such as alcohol or cigarettes higher rate of abortions, carry higher risks of low birth weight babies and infant deaths AND Every day, 7,750 U.S. Teenagers become “Sexually Active”... . . . and 2,750 teenagers become pregnant . Recent trends: Median age at first intercourse is rising. Teen pregnancy rate is dropping. Drop in percentage of teens having abortions. ©The Alan Guttmacher Institute 33.2 28.5 26.7 30 35 30.9 25 26.0 20 25.1 WOMEN 15 17.4 10 12.6 AGE 14.0 MEN 16.9 Young people are at high risk of unintended pregnancy and STDs for many years Sex Education Many teenagers experience pregnancy and STDs More than 800,000 women younger than 20 become pregnant each year 80% of these pregnancies are unintended Nine million teenagers and young adults acquire an STD each year Two young people every hour become infected with HIV ©The Alan Guttmacher Institute Sex Education Teenage Pregnancy Rate is Going Down Pregnancies per 1,000 women aged 15-19 120 100 80 60 40 20 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 ©The Alan Guttmacher Institute Sex Education Teen Pregnancy Rates, Girls Aged 15-19 (number of pregnancies per 1,000 girls) After increasing 23 percent between 1972 and 1990 (including 10 percent between 1987 and 1990), the teen pregnancy rate for girls aged 15-19 decreased 17 percent between 1990 and 1996. 120 117.1 115 111.0 110 106.6 105 100 95 97.3 95.1 90 85 80 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 The Alan Guttmacher Institute. (1999). Special report: U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24. New York: Author. Just the Facts (October 2000) – Page 16 Number of Teen Pregnancies, 1996 Nearly 1 million teen pregnancies occurred in 1996. To put it another way, more than 100 U.S. teens become pregnant each hour. Forty percent of these pregnancies were to girls under age 18, and 60 percent were to girls aged 18-19. Total: 905,000 18-19 60% 542,640 337,530 15-17 37% 24,830 under 15 3% The Alan Guttmacher Institute. (1999). Special report: U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24. New York: Author. Just the Facts (October 2000) – Page 15 Pregnancy Outcomes, Teens 15-19, 1996 In 1996, just over one-half of teen pregnancies ended in birth, about one-third ended in abortion, and 14 percent ended in miscarriage. miscarriage 14% birth 56% 124,700 491,577 263,890 abortion 30% The Alan Guttmacher Institute. (1999). Special report: U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24. New York: Author. Just the Facts (December 2000) – Page 25 Some Common Characteristics of Pregnant Teens Stress - laden homes Strained mother- daughter relationship Sense of hopelessness Four steps to reduce teen pregnancy: Sex education, family planning Access to contraceptives “Life opportunities” approach Broad community involvement John Conger Regretting Sex? Most sexually active teens (80% of girls, 60% of boys) say they wish they had waited to have sex until they were older. The younger a girl starts sexual activity, the more likely she reports it as unwanted or forced. National Campaign to Prevent Teen Pregnancy Abstinence and Contraceptive use are Responsible for the Decline in Teenage Pregnancy 25% Increased abstinence Cause of decline More effective contraceptive use 75% ©The Alan Guttmacher Institute Sex Education The Proportion of High School Students who have had Sex has Declined % of students 100 80 60 40 20 0 Male Female 1991 ©The Alan Guttmacher Institute 2001 Sex Education Proportion of Sexually Active High School Students Who use Condoms has Risen % of students 100 80 60 40 20 0 Male Female 1991 ©The Alan Guttmacher Institute 2001 Sex Education International Pregnancy Rates, Teens 15-19 The United States has much higher pregnancy and birth rates than other fully industrialized countries. U.S. pregnancy rates are nearly twice as high as rates in Canada and England and seven to eight times as high as rates in Japan and the Netherlands. 120 100 80 60 40 20 0 United States (1996) Canada (1995) Denmark (1995) England & Wales (1995) France (1995) Pregnancy Rate Japan (1995) Netherlands (1992) Norway (1996) Sweden (1996) Birth Rate Singh, S., & Darroch, J.E. (2000). Adolescent pregnancy and childbearing: Levels and trends in developed countries. Family Planning Perspectives 32(1), 14-23. Pregnancy rates calculated as the sum of births, abortions, and estimated miscarriages (20 percent of births plus 10 percent of miscarriages). Just the Facts (October 2000) – Page 34 U.S. Teenagers have Higher Rates of Pregnancy, Birth and Abortion than Teenagers in most other Developed Countries Pregnancy rate Russian Federation United States Bulgaria England and Wales Canada Sweden France Japan 0 20 40 Birth ©The Alan Guttmacher Institute 60 80 100 120 Abortion Sex Education Why Do U.S. Teenagers Fare Worse Than Teenagers in Other Developed Countries? ©The Alan Guttmacher Institute Sex Education Levels of Teenage Sexual Activity across Developed Countries are Similar… % of women aged 20-24 who had sex in their teenage years United States Great Britain Canada Sweden France 0 ©The Alan Guttmacher Institute 20 40 60 By age 15 By age 18 By age 20 80 100 Sex Education U.S. Teenagers have Higher Rates of Unintended Pregnancy and STDs because they Are less likely to use contraceptives Have shorter relationships Have more sexual partners ©The Alan Guttmacher Institute Sex Education What Accounts for Lower Teenage Pregnancy and STD Rates in other Countries? Clear and unambiguous prevention messages Strong condemnation of teenage parenthood Societal supports for young people Greater access to contraceptive and reproductive health services Comprehensive ©The Alan Guttmacher Institute sex education Sex Education Sexually Transmitted Infections Facts Infection rates highest among 15-19 year olds 86% of all STD’s are found in ages 15-29 Estimated total annual cost of STD’s in US is >$35 billion Issues reluctance to tell provider or partner, embarrassed risk-taking behaviors CDC Treatment Guidelines MMWR Jan 23, 1998: 47: RR-01 http://www.cdc.gov STI Complications for Women Pelvic InflammatoryDisease > 1 million cases/yr Symptoms: abdominal pain, abnormal vaginal bleeding, fever, abdominal pain, occurs within 1 week of menses Increased risk of ectopic pregnancy Fitzhugh-Curtis syndrome (liver problem) infertility Risk factors for PID Adolescent Low socioeconomic Previous PID Multiple partners Recent gynecological procedure First week of menstrual cycle IUD Chlamydia Pelvic Inflammatory Disease: Diagnostic Criteria Minimum: Lower abdominal tenderness Adnexal tenderness (reproduction system) Cervical motion tenderness Additional: Oral temp > 101F (>38.3C) Abnormal vaginal or cervical discharge Elevated ESR and Creactive protein + Chlamydia STI Complications for Men Epididymitis Sx: sudden severe scrotal pain, flank pain, fever, urethral d/c, scrotal edema, tender epididymis organisms: Chlamydia, GC, coliforms, pseudomonas, gram + cocci Diff dx:testicular tumor, testicular torsion, mumps orchitis, testicular trauma may take 2-4 weeks for complete resolution Sexually Transmitted Disease Crabs Hepatitis Scabies Chlamydia Gonorrhea Syphilis Trichomoniasis Bacterial Vaginosis B Herpes (Herpes Simplex Virus) Genital Warts (Human Papillomavirus) HIV/AIDS Exoparasitic STD’s Pubic Lice Pubic lice is known as “crabs” Usually found around the genitals in pubic hair Look like tiny crabs grey Lice or brownish red live by feeding on human blood Lay their eggs at the base of the hair Eggs are called nits Pubic Lice How do you get pubic lice? Pubic lice is transmitted both by sexual and non-sexual contact An example of non-sexual contact is sharing towels with an infected person Pubic Lice How can you tell if you have pubic lice? If you have pubic lice you may feel itching in the genital area Tiny blood spots on your underwear Blue spots on the skin of your pubic area or thighs Pubic lice or eggs. Pubic Lice Dry clean or machine wash in hot water any clothing that has been in contact with pubic lice Wash all bed linen Store quilts and blankets for two weeks if unable to be washed Expose lice to freezing temperature Get a spray at the drugstore to clean everything that has been infested with lice Pubic Lice Do you need a follow-up test? The treatment usually works May need to try the treatment again after one week May still feel the itching after you are cured Don't use the treatment a third time If you still feel that you have lice, talk to a doctor or nurse. Scabies Scabies is an infestation of the skin with the microscopic mite Sarcoptes scabei Infestation is common, found worldwide, and affects people of all races and social classes Scabies spreads rapidly under crowded conditions where there is frequent skin-to-skin contact between people, such as in hospitals, institutions, child-care facilities, and nursing homes Scabies Symptoms Pimple-like irritations, burrows or rash of the skin, especially the webbing between the fingers; the skin folds on the wrist, elbow, or knee; the penis, the breast, or shoulder blades Intense itching, especially at night and over most of the body Sores on the body caused by scratching sores can sometimes become infected with bacteria Scabies How? By direct, prolonged, skin-to-skin contact with a person already infested with scabies Contact must be prolonged Infestation is easily spread to sexual partners and household members Infestation may also occur by sharing clothing, towels, and bedding Once away from the human body, mites do not survive more than 48-72 hours When living on a person, an adult female mite can live up to a month Scabies T&T Diagnosis is most commonly made by looking at the burrows or rash A skin scraping may be taken to look for mites, eggs, or mite fecal matter to confirm the diagnosis. Lotions are available to treat scabies Bacterial STD’s Chlamydia Caused by a bacterium called chlamydia trachomatis Chlamydia is the most common bacterial STD in the United States 15-19 year olds have the highest rates, followed by 20-24 yr olds At least 75% of women and 50% of men who are infected have no symptoms Chlamydia can be cured with antibiotics Having chlamydia can increase your chances of Chlamydia How? Unprotected vaginal or anal sex Contact with semen, vaginal fluids or discharge Most people with chlamydia do not know they have it, but they can still pass the disease Women: infects the cervix and is in vaginal fluids Men: infects the urethra (where urine and semen come out) Also infects the rectum Pregnant woman:can pass it to her newborn baby during childbirth. Chlamydia Symptoms Women: Strange discharge from your vagina Itchy vagina A little bit of bleeding even when it is not time for your period Bleeding during or after you have vaginal sex Pain in your lower abdomen Pain when you urinate Chlamydia Symptoms Men: Needing to urinate a lot A feeling of burning when you urinate Watery discharge coming out of your penis Burning or itching around the hole of your penis Pain in your testicles Chlamydia Complications If not treated, it can spread in the reproductive organs In women In Pelvic Inflammatory Disease (PID) can cause infertility and chronic pelvic pain, and can increase the risk of a life threatening ectopic (tubal) pregnancy men a painful infection of the testicles known as epididymitis, which can cause sterility A newborn baby born to a mother with chlamydia may develop infections in the eyes or lungs Chlamydia Testing and Treatment How do you get tested for chlamydia? For women doctor or nurse will check for infection by taking a swab of the cervix, the opening to the uterus For men doctor or nurse will swab the urethra, the opening of the penis. How It is chlamydia treated? can be cured with antibiotics It is important to tell your sexual partner(s) that you have chlamydia as they also need to be treated. Chlamydia Prevention Latex condoms provide protection The female condom and polyurethane (plastic) condoms are equally effective Sexually active persons under age 25 should be tested every six months to a year Pregnant women should seek prenatal care early, to prevent passing chlamydia to the newborn Gonorrhea Caused by a bacterium called Neisseria gonorrohoeae Also called "clap", "drip", or GC 15-24 year olds in the U.S. have the highest rates of gonorrhea, followed by 20-24 year olds At least 50% of women and 10% of men who are infected have no symptoms Gonorrhea can be cured with antibiotics Having gonorrhea can increase your chances of getting HIV Gonorrhea How? Unprotected contact Most but vaginal or anal sex with semen, vaginal fluids or discharge people do not know they have it can still pass the disease A pregnant woman with gonorrhea can pass it to her newborn baby during childbirth Gonorrhea Symptoms Women: Strange discharge from your vagina Itchy, red, or swollen vagina Pain when you urinate Pain in your lower abdomen Pain when you have vaginal intercourse Men: Pain when you urinate Discharge from your penis that is thick, white, and yellow Gonorrhea Complications If not treated, Women it can spread in the reproductive organs scarring and inflammation of the fallopian tubes and ovaries, a condition called Pelvic Inflammatory Disease (PID) infertility and chronic pelvic pain, and can increase the risk of a life threatening ectopic (tubal) pregnancy Men painful Rare infection of the testicles epididymitis sterility cases spread to the blood stream and cause a general infection with rash and joint pain Baby born to a mother with gonorrhea may develop an eye infection which can cause blindness Gonorrhea Testing & Treatment How do you get tested for gonorrhea For Doctor or nurse will check for infection by taking a swab of the cervix For How It women men Doctor or nurse will swab the urethra, the opening of the penis is gonorrhea treated can be cured with antibiotics You should tell your sexual partner(s) that you have gonorrhea A lot of people who have gonorrhea also have the STI called chlamydia Gonorrhea Prevention Latex condoms provide excellent protection against gonorrhea The female condom and polyurethane (plastic) condoms are equally effective Pregnant women should seek prenatal care early, to prevent passing gonorrhea to the newborn Syphilis Caused by a bacterium called Treponema pallidum Syphilis is currently at historic low levels in the U.S. 25 to 34 year-olds have the highest rates Syphilis can be cured with antibiotics Having syphilis can increase your chances of getting HIV Syphilis How? Syphilis is passed during vaginal, anal, oral sex, or skin-to-skin contact with infected areas Pregnant women with syphilis can pass it to their unborn child during pregnancy Syphilis Symptoms Syphilis is a disease of stages. Each stage is characterized by different symptoms. These symptoms come and go, but unless syphilis is treated and cured, it will remain in the body and can cause serious damage over time. The early stages are: Primary Secondary Latent Primary Syphilis A painless sore (or sores) called a chancre appears on, around, or inside the penis, vagina, mouth, or anus. The chancre appears 10 days to three months after exposure. The sore is full of bacteria and is very infectious. Many people never notice the chancre because it may be inside the vagina or somewhere else hard to see or feel. Chancres generally last two to six weeks and then disappear on their own. Secondary Syphilis A few weeks after the chancres disappear, a rash may appear on the body, hands, and/or feet. The rash is infectious and can look like other rashes and even wart-like growths. Other symptoms may include mild fever, sore throat, or clumpy hair loss. These symptoms may come and go for about a year. Latent Syphilis A year after infection, symptoms usually disappear on their own and the person is no longer infectious to sex partners. However, the disease is still in the body and can cause serious complications years later. Syphilis Complications If left untreated, syphilis can affect the heart, brain and other organs Damage becomes apparent in the final stage of syphilis, known as tertiary or late syphilis Complications occurs decades (10 years or more) after infection damage to the skin bones and internal organs neural problems including swelling of the brain, blindness, seizures, and insanity damage to blood vessels and the heart. These complications can lead to death. A baby born to a mother with syphilis can be born dead or with birth defects Syphilis T, T, and P A blood sample is required to test for syphilis. Syphilis can be easily treated and cured with certain antibiotics (given as a shot) Latex, polyurethane, and female condoms offer some protection against syphilis, but may not cover all infectious areas Pregnant women should seek prenatal care early and should be tested for syphilis during the first trimester If syphilis is detected and treated early, pregnant women can prevent damage to the baby Primary and Secondary Syphilis — Age- and GenderSpecific Rates: United States, 2000 Men 7.5 Rate (per 100,000 population) 6.0 4.5 3.0 1.5 0.0 0.0 1.6 4.6 5.8 5.7 5.4 4.6 3.0 Age 1.4 Gender Total 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-54 55-64 65+ 0.1 2.3 4.9 4.9 4.9 4.5 3.5 2.0 0.8 0.2 Total 2.2 0.5 2.6 Age 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-54 55-64 65+ Total 0.0 Women 1.5 3.0 4.5 6.0 0.2 3.1 5.2 4.1 4.1 3.5 2.5 1.0 0.2 0.0 1.8 7.5 Trichomoniasis Most common curable STD among sexually active women There are an estimated 5 million cases in the U.S. annually Approximately 30% of women with chlamydia also have trichomoniasis Transmitted through vaginal or urethral secretions during sexual contact Non-sexual transmission is possible but extremely rare Trichonomads are very sensitive to drying, but can survive for several hours in various body fluids or on moist objects such as sponges or towels Trichomoniasis Symptoms Fifty percent of women have no symptoms Incubation period is from three to 28 days, but can be longer vulva, vaginal walls, cervix and the urethra can be affected symptoms include abnormal, increased vaginal discharge that may be white, yellow, green or gray in color frothy (bubbly) discharge may be thin or thick in texture itching, irritation and tenderness in the vulva area foul odor occurs in about 10-50% of cases burning can accompany urination About 10% of women have “strawberry cervix” (the cervix is inflamed and red dots are visible from very tiny hemorrhages) Trichomoniasis Symptoms 90% of men have no symptoms Trichomoniasis most often infects the urethra Urethral discharge is usually present in small amounts Discharge may come and go Other symptoms are burning with urination and mild itching Trichomoniasis Complications In females, trichomoniasis infection during pregnancy has been associated with premature rupture of membranes, pre-term delivery, low birth weight, and postpartum endometritis In males, a few cases of epididymitis have been attributed Trichomoniasis T, T, & P Go to a doctor or a health clinic discharge sample is usually needed to test for trichomoniasis. can be treated and cured with antibiotics (taken orally) takes one week for the medicine to completely cure trichomoniasis Latex condoms provide the best protection against infection Talk to your sex partners about STDs before having sex Limit your number of sex partners; it can lower your chances of getting infected Bacterial Vaginosis Most common vaginal infection in women of childbearing age accompanied by discharge, odor, pain, itching, or burning Scientific studies suggest that BV is common in women of reproductive age in the United States 16 percent of pregnant women have BV varies by race and ethnicity 6 percent in Asians 9 percent in non-Hispanic whites 16 percent in Hispanics 23 percent in African Americans Bacterial Vaginosis an imbalance in the bacteria that are normally found in a woman's vagina normally contains mostly "good" bacteria, and fewer "harmful" bacteria. develops when there is a change in the environment. Activities or behaviors can put women at increased risk new sex partner or multiple sex partners, Douching Using an intrauterine device (IUD) for contraception Do not get BV from toilet seats, bedding, swimming pools, or from touching objects around them Virgins are rarely affected Bacterial Vaginosis Abnormal vaginal discharge with an unpleasant odor a strong fish-like odor, especially after intercourse usually white or gray; it can be thin May also have burning during urination or itching around the outside of the vagina, or both Some women with BV report no signs or symptoms at all. Bacterial Vaginosis Increase a woman's susceptibility to HIV infection Increases the chances that an HIV-infected woman can pass HIV to her sex partner Having BV has been associated with an increase in the development of PID following surgical procedures such as a hysterectomy or an abortion Pregnant women often have babies who are born premature or with low birth weight (less than 5 pounds) Viral STD’s Hepatitis B About 30% of persons have no signs or symptoms. jaundice fatigue abdominal loss pain of appetite nausea, vomiting joint pain Hepatitis B Number of new infections per year has declined from an average of 260,000 in the 1980s to about 78,000 in 2001 Highest rate of disease occurs in 20-49-year-olds. Greatest decline has happened among children and adolescents due to routine hepatitis B vaccination Estimated 1.25 million chronically infected Americans, of whom 20-30% acquired their infection in childhood Hepatitis B Chronic infection occurs in: 90% of infants infected at birth 30% of children infected at age 1 - 5 years 6% of persons infected after age 5 years Death from chronic liver disease occurs in: 15-25% of chronically infected persons Hepatitis B Occurs when blood or body fluids from an infected person enters the body of a person who is not immune. spread through having sex with an infected person without using a condom by sharing drugs, needles, or "works" when "shooting" drugs needlesticks or sharps exposures on the job an infected mother to her baby during birth. Herpes (Herpes Simplex Virus) Caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2) No or only minimal signs or symptoms from HSV-1 or HSV-2 infection Symptoms one or more blisters on or around the genitals or rectum blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreaks Increases the women’s risk of developing cervical cancer The infection can stay in the body indefinitely Herpes – How? Found in and released from the sores Cause recurrent painful genital sores in many adults also are released between outbreaks from skin that does not appear to be broken or to have a sore. can be severe in people with suppressed immune systems Frequently causes psychological distress in people who know they are infected. Potentially fatal infections in babies if the mother has sores at the time of delivery Herpes (Herpes Simplex Virus) There is no treatment that can cure herpes Antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication A condom may not cover all infected areas even correct and consistent use of latex condoms cannot guarantee protection from genital herpes Genital Warts Caused by human papillomavirus (HPV) name of a group of viruses that includes more than 100 different strains or types more than 30 of these viruses are sexually transmitted infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum Most people who become infected with HPV will not have any symptoms Warning HPV and Cervical Cancer HPV has been proposed as the first ever identified, "necessary cause" of a human cancer The concept of a necessary cause implies that cervical cancer does not and will not develop in the absence of the persistent presence of HPV DNA. Cervical cancer is still the second most common cancer in women worldwide, although it is a theoretically preventable disease “The causal relation between human papillomavirus and cervical cancer”, F X Bosch, A Lorincz, N Muñoz, C J L M Meijer and K V Shah, Journal of Clinical Pathology 2002;55:244-265. Genital Warts Some are called “high-risk” types Others are called “low-risk” types may cause abnormal Pap tests may also lead to cancer of the cervix, vulva, vagina, anus, or penis may cause mild Pap test abnormalities or genital warts Genital warts are single or multiple growths or bumps that appear in the genital area, and sometimes are cauliflower shaped Prevalence The CDC report revealed that HPV is the most common sexually-transmitted infection (STI) in America 20,000,000 Americans currently have the infection, new infections occur at a staggering rate of 5.5 million infections per year The report also revealed that by age 50, at least 80 percent of women will have acquired genital HPV infection HPV is responsible for 12,000 cases of invasive cervical cancer and 4000 deaths per year. Genital Warts Approximately 20 million people are currently infected At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives By age 50, at least 80 percent of women will have acquired genital HPV infection About 5.5 million Americans get a new genital HPV infection each year Genital Warts There is no “cure” for HPV infection, although in most women the infection goes away on its own All types of HPV can cause mild Pap test abnormalities that do not have serious consequences Approximately 10 of the 30 identified genital HPV types can lead to development of cervical cancer Although only a small proportion of women have persistent infection, persistent infection with “high-risk” types of HPV is the main risk factor for cervical cancer What is HIV? HIV (human immunodeficiency virus) is the virus that causes AIDS. + HIV = AIDS A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria I Heard It through the Grapevine AIDS Mythology Fact or Fiction? You can get AIDS from a mosquito bite Fiction HIV is not transmitted by insects Fact or Fiction? You can get AIDS by having oral sex with an infected person Fact Any type of sexual activity (where bodily fluids are exchanged) with an infected person is a risk of HIV transmission Fact or Fiction? HIV survives well in the environment, so you can get it from toilet seats and door knobs Fiction Scientists and medical authorities agree that HIV does not survive well in the environment - so forget about those toilet seats! Fact or Fiction? You can get AIDS by hugging a person with HIV who is sweating Fiction Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV. Fact or Fiction? You can get AIDS by kissing someone who is HIV infected Fiction It would be extremely unlikely to get HIV from kissing, even open-mouth deep kissing. HIV is transmitted through blood, semen, vaginal fluids, and breast milk and these fluids are not usually present during kissing. Fact or Fiction? Condoms aren't really effective in preventing HIV transmission Fiction Studies have found that even with repeated sexual contact, 98-100 percent of those people who used latex condoms correctly and consistently did not become infected. Fact or Fiction? There is a connection between other STDS and HIV infection Fact Having a sexually transmitted disease (STI) can increase a person's risk of becoming infected with HIV up to 10x Fact or Fiction? Patients in a dentist or doctors office are at risk for getting HIV Fiction Studies of more than 22,000 patients of 63 health care providers who were HIV-infected have found no evidence of transmission from provider to patient in health care settings Worldwide 3 million deaths in 2003 Over 21 million deaths since the beginning of the epidemic 17.5 million adults 4.3 million children (under 15 years old) (www.avert.org/worldstats.htm) Worldwide Approximately 40 million people living with AIDS worldwide in 2003 Approximately 14 million children orphaned by AIDS by the end of 2002 Number of orphans expected to rise to 25 million by 2010 (www.avert.org) People living with HIV/AIDS Adults and Children estimated to be living with HIV/AIDS as of the end 2000 Western Europe Eastern Europe & Central Asia 540 000 700 000 North America 920 000 Caribbean 390 000 Latin America 1.4 million North Africa & Middle East 400 000 Sub-Saharan Africa Source: UNAIDS 640 000 South & South-East Asia 25.3 million Total: 36.1 million East Asia & Pacific 5.8 million Australia & New Zealand 15 000 Human Immunodeficiency Virus (HIV) Every day 7,000 young people worldwide acquire HIV 2.6 million new infections a year among young people--two million of them in Africa Of the 30 million people alive today with HIV infection or AIDS 10 million are young people ages 10-24 Human Immunodeficiency Virus (HIV) AIDS has also caused a sharp escalation in the number of orphans in Africa in the past few years. Around two percent of the child population in developing countries globally was orphaned before the appearance of AIDS Today AIDS has made orphans of 11 percent of all children in Uganda and nine percent of Zambian children Human Immunodeficiency Virus (HIV) in Africa While women's greater biological susceptibility to HIV helps explain this difference, a host of sociocultural and economic factors rooted in gender power inequities exacerbate women's vulnerability to infection Gender power inequities play a key role in the HIV epidemic through their effects on sexual relationships In South Africa, multiple partnerships are condoned and even encouraged for men, while women are expected to be monogamous and unquestioning of their partner's behavior Human Immunodeficiency Virus (HIV) in Africa Sexual refusal or negotiation may result in suspicions of infidelity and carry the risk of violent outcomes Younger women are likely to be at a particular disadvantage A study of youth in a Xhosa township showed "pervasive male control over almost every aspect of [women's] early sexual experiences," enacted in part through violent and coercive sexual practices Growth of the AIDS Epidemic People With HIV/AIDS, Cumulative Regional Totals Millions 45 40 35 30 25 20 15 10 5 0 1981 1986 Hig hly Industrialized* Latin America/Caribbean 1991 Sub-Saharan Africa Eastern Europe, other** 1996 South and East Asia *North America, Europe (except Eastern Europe), Japan, Australia, and New Zealand. **Eastern Europe, Central Asia, Middle East, and North Africa. Source: UNAIDS, “Twenty Years of HIV/AIDS: Fact Sheet,” 2002, and unpublished data. © 2003 Population Reference Bureau Image from http://www.prb.org/presentations/d_growth-aids-epidemic.ppt 2001 Human Immunodeficiency Virus (HIV) In the USA National Trends: 1 in 3 new cases in the young adult population was attributed to heterosexual contact. Prevalence in women 18-22 years old increased by 36% from 1988-1993 Human Immunodeficiency Virus (HIV) In the USA The Centers for Disease Control (CDC) estimate Between 8 - 900,000 Americans are living with HIV 1 in 300 Americans 70 people in La Cañada An estimated 40,000 people become infected each year Human Immunodeficiency Virus (HIV) In the USA As of December 31, 2000 774,467 persons had been reported with AIDS in the U.S 448,060 Americans with AIDS have died 440,004 Americans were reported as living with HIV/AIDS Human Immunodeficiency Virus (HIV) In the USA Women account for 32% of all HIV cases reported in 2000 Females account for 47% of the reported cases of HIV in the 13-24 age group during the year 2000 61% of all reported HIV cases in 13 to 19 year olds during the year 2000 were females At least 112,000 children in the United States currently have mothers living with HIV or AIDS The mothers of an additional 15,000 children test positive for HIV each year. The American Medical Association estimates that more than 144,000 children and teens will be orphaned because of AIDS by December 2000. Young Americans between the ages of 13-24 are contracting HIV at a rate of 2 per hour. Persons ages 13-24 years account for 17% of all reported cases of HIV in 2000. More than 123,000 young adults in the United States have developed AIDS in their twenties. Persons ages 20-39 represent 70% of all reported cases of HIV in the United States; 26% of those cases are among females. Behavioral Risk Factors in HIV+ Adolescents: More likely to have been sexually abused Engage in anal sex and survival sex Have unprotected sex with casual partners Have had sex under the influence of drugs/ use multiple drugs Have an STI Have multiple problem behaviors United States By the end of 2002: 384, 906 people living with AIDS 46% White 34% Black 18% Hispanic 298,248 men 82,764 women (www.avert.org/statsum.htm) United States Cont’d Of the 298,248 U.S. men living with AIDS, 57% were men who had sex with men (MSM) 23% were I.V. drug users 10% were exposed through heterosexual contact 8% were both MSM and IV (www.avert.org/statsum/htm) United States Of the 82,764 U.S. women living with AIDS 61% were exposed through heterosexual contact 36% were I.V. drug users (www.avert.org/statsum/htm) Image from http://www.cdc.gov/hiv/graphics/images/l178/l178-3.htm Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936 How is HIV Transmitted? It can be transferred from an infected partner by: Sharing needles with infected individuals Unprotected sexual intercourse Oral sex, if lesions in the mouth exist via breast milk, from mother to child before, during after birth Blood transfusion with infected blood Any open sore is a port of entry for HIV!! A strong link exists between sexually transmitted diseases or infections (STIs) and the sexual transmission of HIV infection Data from a large number of studies conducted in four continents provide compelling evidence that STI is a cofactor for HIV transmission Any open sore is a port of entry for HIV!! An untreated STI can increase both the acquisition and transmission of HIV by up to tenfold This suggests that STI control has the potential to play an important role in the reduction of sexually acquired HIV transmission How A Healthy Immune System Works Physical Barriers: skin, mucus, etc. Immune System: body’s immediate response to a pathogen. Not antigen specific. Immunity a person is born with. Innate Acquired Immune System: Body takes a few days to build this immunity. Antigen specific. Immunity that is acquired through life. Key Structures of the Immune System Image from http://health.allrefer.com/pictures-ages/immune-system-structures-1.html Physical Barriers Skin image from http://health.allrefer.com/picturesimages/skin-layers.html Mucosa image from http://www.health.allrefer.com/health/mucosa-info.html Innate Immunity If pathogens penetrate physical barriers, phagocytic cells in the area begin to engulf pathogen Image from http://health.yahoo.com/health/ency/adam/000821/i9478 Innate Immunity Phagocytes also release chemical signals (cytokines) to “call” other phagocytes to the area, resulting in inflammation (redness, heat, swelling). The pus that we often observe is a combination of dead pathogen, white blood cells, and injured body cells. Image from http://occawlonline.pearsoned.com/bookbind/pubbooks/campbell6e_awl/chapter43/deluxe.html Acquired Immunity If pathogens are not completely eliminated by the innate immune system, the acquired immune system is activated. Key Players: Lymphocytes (T and B cells) Image from http://occawlonline.pearsoned.com/bookbind/pubbooks/campbell6e_awl/chapter43/deluxe.html Acquired Immunity Macrophage (yellow) attacking bacteria (blue) • Phagocytes active in the innate immune system display some of the proteins from the pathogen on their surfaces, “advertising” that the pathogen is present. Image from http://www.rit.edu/~photo/IFS/index-pages/IFS37.html Acquired Immunity Macrophage (yellow) attacking bacteria (blue) • These cells then travel to the lymph nodes and spleen, where they help to activate T and B cells. • The increase in T and B cell production when you are ill can often be detected by swollen lymph nodes (glands). Image from http://www.rit.edu/~photo/IFS/index-pages/IFS37.html Acquired Immunity cells – Defend against pathogens located outside of body’s cells. * Plasma cells – produce antibodies which attach to antigens and help to destroy them, or block the harmful effects of the antigen B • Image from http://www.accessexcellence.org/AB/GG/Antibody.html Acquired Immunity • Memory cells – Can react quickly to produce antibodies upon additional exposures to the antigen *Dr. Starnbach lecture 7/13/04 Image from http://www.accessexcellence.org/AB/GG/Antibody.html Acquired Immunity cells – Defend against pathogens located inside of body’s cells.* T Helper T cells: secrete cytokines to call in other T, B, and phagocytic cells, activate B cells to produce antibodies T cell (SEM) Image from http://ca.encarta.msn.com/media_461519550/Lymphocyte.html Acquired Immunity Killer T cells: recognize an infected cell and lyse it Memory T cells: remain in body to react when pathogen is encountered again T cell (SEM) Image from http://ca.encarta.msn.com/media_461519550/Lymphocyte.html *Dr. Starnbach lecture 7/13/04 Image from http://occawlonline.pearsoned.com/bookbind/pubbooks/campbell6e_awl/chapter43/deluxe.html Image from http://occawlonline.pearsoned.com/bookbind/pubbooks/campbell6e_awl/chapter43/deluxe.html How does HIV interrupt the Normal Functioning of the Immune System? HIV infected T-cell Image from http://ca.encarta.msn.com/media_461518877/TLymphocyte_Infected_With_HIV.html What is HIV? – human immunodeficiency virus Works by infecting the cells of the immune system, using them to make more virus, and then killing them. HIV Image from http://medlib.med.utah.edu/WebPath/TUTORIAL/AIDS/AIDS001.html What is HIV? The immune system is able to battle this virus fairly successfully for up to 8-10 years, before the virus eventually wins. Image from http://medlib.med.utah.edu/WebPath/TUTORIAL/AIDS/AIDS001.html HIV Structure HIV is composed of three main layers: Envelope Viral Matrix Core Image from http://www.brown.edu/Courses/Bio_160/Projects1999/hiv/images/Virion2.jpg Relative Cell Size Cells are measured in nanometers, one millionth of a millimeter. HIV Syphilis 12000nm or 0.012mm 125nm or 0.000125mm Gonorrhea 800nm or 0.0008mm Human sperm 3000nm or 0.003mm Overview of how HIV works HIV attacks cells of the body, especially the helper T cells. (Approx. 100 billion new HIV particles generated/day during clinical latency) When the number of helper T cells is depleted, the body cannot fight infection Death results from infection or cancer that the body can’t fight off, not from AIDS itself. (Dr. Lue’s lecture 7/16/04) HIV infection Animation of HIV infection HIV proteins attach to receptors on cell membrane HIV inserts genetic material (RNA) Reverse transcriptase used to make viral DNA from RNA Viral DNA inserted into one of the cell’s chromosomes Cell manufactures viral proteins and RNA New copies of virus bud off of host and infect new cells Progression of HIV Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936 Phases of HIV/AIDS 1. 2. 3. 4. 5. 6. Infection Window period Seroconversion Asymptomatic period HIV/AIDS - related illness AIDS CD4 counts Number of CD4 cells in blood provides a measure of immune system damage CD4 count reflects phase of disease CD4 count: 500 – 1200: Normal 200 – 500: Beginning of HIV illness < 200: AIDS Window period Time between infection & enough antibodies for a positive HIV test Duration: approximately 3 months No symptoms or signs of illness HIV test is negative Virus is multiplying rapidly - viral load is high Person is very infectious Seroconversion Point at which HIV test becomes positive Body starts making antibodies to HIV a few weeks after infection HIV test becomes positive when antibody levels are high enough to be measured Happens about 3 months after infection Person may have a mild flu-like illness, lasting a week or two Afterwards, the person is well again Asymptomatic period Time period between seroconversion and onset of HIV/AIDS-related illness Duration variable: < 1 year to > 15 years Most people remain healthy (asymptomatic) for about three years Duration may depend on socio-economic factors The CD4 count is above 500 cells/ml HIV/AIDS-Related Illness Time period between onset of illness & diagnosis of AIDS Duration is variable: average about 5 years Illnesses initially mild, with gradual increase in frequency and severity CD4 count is between 500 & 200 cells/ml AIDS Final phase of HIV/AIDS Duration: without antiretroviral drugs, less than 2 years with antiretrovirals, potentially many years CD4 count is below 200 cells/ml Viral loads are high & the person is very infectious HIV test may become negative Phases of HIV/AIDS 1. Infection: The moment the virus gets into the body 2. Window period: The time between infection & enough antibodies for a positive HIV test 3. Seroconversion: The body starts to make antibodies to HIV Phases of HIV/AIDS 4. Asymptomatic period: No illness 5. HIV/AIDS-related illness: Less serious illnesses 6. AIDS: Serious illnesses Important Facts Duration of different phases of HIV/AIDS will vary in different people It is not possible to predict the course of the disease in any one person Factors affecting the course of HIV/AIDS include nutrition, emotional stress, and access to health care People infected with HIV can infect others at any phase of the disease Re-Infection Different strains of HIV exist within the same HIV type It is possible to be re-infected with a different strain When re-infection occurs, the immune system is weakened more rapidly NB Re-infection can hasten the progression of the disease Do some people have resistance to HIV? Resistance to HIV Mutations to HIV – will those without the ccr5 receptor still be resistant? (www.teachersdomain.org/9-12/sci/life/gen/hivimmunity/index.html) Why is HIV so hard to fight? Some antibodies that the body produces actually work to enhance HIV replication. Some antibodies that work to neutralize HIV replication can become enhancing antibodies when the virus mutates. Why is HIV so hard to fight? Cells other than helper T-cells can be infected, therefore the virus can colonize many tissues of the body. HIV can kill cells that it doesn’t even infect. Progression of HIV Image from http://www.hivaidssearch.com/hiv-aids-links.asp?id=936 Opportunistic Infections: Pneumocystis carinii Thrush Mycobacterium CMV Varicella RSV HSV* Measles HPV* molluscum* Kaposi’s sarcoma, GI- salmonella Shigella Campylobacter Giardia C. difficile Thrush Pneumocystis carinii Varicella Mycobacterium Chickenpox Measles Molluscum Kaposi’s Sarcoma Is there any Reason to be Optimistic? Drug Therapy “Old” drugs - reverse transcriptase and protease inhibitors. BUT, many strains of the virus are becoming resistant. Salvage drugs T-20 in phase III trials (prevents fusion of HIV with T-cell) T-1249 in phase II trials (prevents fusion of HIV with T-cell). Both are promising, but already see some resistance Availability of Drugs • • • Widely available in U.S and other industrialized nations, but cost tens of thousands of dollars/year Clearly not feasible in developing countries Problems of patent infringement to produce generic versions HIV/AIDS is a preventable disease But controlling the epidemic will require behavioral changes worldwide Stop! In the Name of Love Bibliography ‘Sexually Transmitted Disease Program,’ Los Angeles County Department of Health Services - Public Health @ http://lapublichealth.org/std, 4/22/04 2. Pubic Lice or "Crabs” Pthirus pubis (THEER-us pu-bis), CDC @ http://www.cdc.gov/ncidod/dpd/parasites/lice/factsht_pubic_lice.htm, 4/22/04 3. Spiderbytes: A New Spin on Sexual Health for Teens, http://www.spiderbytes.ca/Health/Health_STIs_STIsByNames.shtml, 1/30/05 4. Global AIDS Program : Strategies http://www.cdc.gov/nchstp/od/gap/strategies/default.htm, 1/30/05 5. Thyng, Kristine, outreach.mcb.harvard.edu/site_update/ teachers/KristineThyng/HIVAIDSpresentation.ppt , 2/2/2005 6. “Averting AIDS and HIV”, www.avert.org 7. Lue, Dr. Robert, “Evasion and Destruction of the Immune System by HIV”, Department of Molecular and Cellular Biology, Harvard University. Lecture July 16, 2004, July 22, 2004. 8. Starnbach, Dr. Michael, “Adaptive Immune responses to bacterial pathogens”, Department of Microbiology and Molecular Genetics, Harvard Medical School. Lecture July 13, 2004. 9. IMAGE SOURCES: All images were obtained from the web between the dates of 7/13/04 – 7/22/04 10. “Access Excellence @ the national health museum”, http://www.accessexcellence.org/AB/GG/Antibody.html 11. “Bio 160, Development of Vaccines to Infectious Disease” Brown University, http://www.brown.edu/Courses/Bio_160/Projects1999/hiv/ 12. Campbell and Reece, Biology, 6th edition http://occawlonline.pearsoned.com/bookbind/pubbooks/campbell6e_awl/chapter43 13. “Centers for Disease Control and Prevention”, http://www.cdc.gov/hiv/graphics/images/l178/l178-3.htm 14. “Free Graphics”, http://www.freegraphics.com/images/downloads/worldaids/index3.html 15. “Galaxy Goo, An Online Exploration of Science and Community”, http://www.galaxygoo.org/hiv/hiv_lifecycle.html 16. “Health”, AllRefer.com, http://health.allrefer.com 17. “The HIV/AIDS Search Engine”, http://www.hivaidssearch.com/hiv-aids-links.asp 18. “MSN Encarta: Multimedia”, http://ca.encarta.msn.com/media 19. “Population Reference Bureau”, http://www.prb.org 20. Rochester Institute of Technology, http://www.rit.edu/~photo/IFS/index-pages/IFS-37.htmleluxe.html 21. Spencer S. Eccles Health Sciences Library, University of Utah, http://medlib.med.utah.edu/WebPath/TUTORIAL/AIDS/AIDS001.html 22. Teachers’ Domain, Multimedia Resources for the Classroom and Professional Development”, www.teachersdomain.org/912/sci/life/gen/hivimmunity/index.html 23. “Yahoo Health” http://health.yahoo.com/health/ency/adam/000821/i9478 1.
