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HIV/AIDS AND SIMILARLY TRANSMITTED DISEASES: A MATTER OF PERSONAL RESPONSIBILITY. Originally presented at WORLD AIDS DAY OBSERVANCE NOVEMBER 29, 2006 San Bernardino Valley College, California Ronald P. Hattis, MD, MPH Beyond AIDS Foundation. Warning!.

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hiv aids and similarly transmitted diseases a matter of personal responsibility
HIV/AIDS AND SIMILARLY TRANSMITTED DISEASES:A MATTER OF PERSONAL RESPONSIBILITY

Originally presented at

WORLD AIDS DAY OBSERVANCE NOVEMBER 29, 2006

San Bernardino Valley College, California

Ronald P. Hattis, MD, MPH

Beyond AIDS Foundation

warning
Warning!
  • X-rated photos of genital infections with sexually transmitted diseases are included toward the end of this presentation!
  • “Viewer discretion advised”
slide3

The AIDS Memorial QuiltIn 1987, the Names Project Foundation began a tradition of honoring persons who died of AIDS with hand-made quilts about their lives. Thousands of quilts are shown on display in 1992 in Washington.

Beyond AIDSworks to control transmission, so that further quilts will be unnecessary

how can hiv transmission be controlled
How canHIV transmission be controlled?
  • HIV/AIDS does not have:
    • a vaccine
    • a cure
    • an environmental fix
  • Once infected, a person is infectious to others lifelong
  • Infection is symptom-free for years
how can hiv transmission be controlled contd
How canHIV transmission be controlled? (contd.)
  • Transmission routinely occurs before the transmitter is even aware of having been exposed, let alone infected
  • Prevention therefore depends on reduction of high-risk behavior:
    • by those at risk (due to sex and needle practices)before they become infected
    • by those known to already be infected before they transmit the virus
how can hiv transmission be controlled contd6
How canHIV transmission be controlled? (contd.)
  • Prevention of HIV/AIDS and similarly transmitted diseases is a matter of personal responsibility
  • Identification of infection requires early testing of persons with no symptoms, and intervening rapidly with those testing positive
how bad can hiv aids get
How bad can HIV/AIDS get?
  • Up to 40% of entire population of some countries in central and southern Africa, are infected
    • Millions of young adults dead or dying
    • Millions of AIDS orphans
  • Infections in populous countries like India and China rapidly increasing
    • An added 1% prevalence among a billion people means 10 million more cases
so what about the u s
So what about the U.S.?
  • Estimated 40,000 new cases continue to occur yearly
    • Actually an combination of many overlapping epidemics in different groups
      • Increasing among young people and minorities
      • African American community has highest rates
what works then
What works, then?
  • A few countries have actually reduced HIV/AIDS incidence (new cases) and prevalence (proportion of population infected). How?
    • Through changing average sexual practices of the entire population at risk
      • Personal responsibility needs to spread to become cultural responsibility
what works then contd
What works, then? (contd.)
  • Uganda reduced national prevalence through the “ABC” program:
    • Abstinence (delaying onset of sexual activity)
      • In a society like U.S. with illicit drugs, also means abstaining from injection drug abuse with needle sharing
    • Be faithful (avoiding external sexual partners)
      • In U.S., where testing is available, this means being monogamous with both partners HIV negative
    • Condoms, if A and B not possible (least effect in Uganda)
on the personal responsibility level decisions each young person needs to make
On the personal responsibility level:Decisions each young person needs to make
  • What does sexuality mean to me?
    • Something with emotional meaning?
    • Something to be shared only with someone special, or in marriage?
    • Or something totally casual?
      • (Which can become totally dangerous?)
on the personal responsibility level contd decisions each young person needs to make
On the personal responsibility level: (contd.)Decisions each young person needs to make
  • What risks am I prepared to take?
    • Regarding sex?
    • Regarding experimenting with drugs?
what is safest
What is safest?

Avoiding the possibility of exposure to disease is always safest

Abstinence = the “A” of “ABC”

Not having sex with anyone

Not sharing needles with anyone

Safest, but not for everyone, right?

what is safest contd
What is safest? (contd.)
  • A little late for abstinence?
  • “Secondary abstinence” works for many
    • Who have had sex already
    • But who decide to discontinue sex at this time
      • May be many reasons, including how you feel about yourself and your behavior
so what is next safest
So what is next safest?
  • You can’t catch a disease from someone who doesn’t have it!
  • Unless you are both virgins: Get tested for HIV!
  • Insist that any partner be tested before having sex or doing anything that might share body fluids!
is hiv the only thing i should be tested for
Is HIV the only thing I should be tested for?
  • If you’ve EVER shared a needle, get tested for hepatitis B and C
  • If you’ve ever had unprotected sex, ask for tests for other STDs too
  • One of you might have another STD or bloodborne disease
    • With no symptoms and for which you were not tested
if you both test negative for hiv
If you both test negative for HIV
  • Still a slight risk for first 6 months
    • If either of you has had recent sex or shared a needle with someone else
    • May take that long for test to turn positive
if you both test negative for hiv contd
If you both test negative for HIV (contd.)

If relationship is new

  • How can you be sure it will remain mutually monogamous?
  • How can you be sure your new partner is not using drugs?
if you both test negative for hiv contd19
If you both test negative for HIV (contd.)
  • Get retested in 6 months
  • Meanwhile use Condoms
    • For “harm reduction” – they reduce the chance of harm if you are being exposed
    • To prevent pregnancy and other STDs too!
  • If using drugs, also use Cleanneedles/syringes
if you both test negative for hiv contd20
If you both test negative for HIV (contd.)
  • Being faithful (the “B” in “ABC”), if you are both HIV negative, is the next most effective after abstinence
after the 6 month retest are condoms necessary forever
After the 6-month retest(Are condoms necessary forever?)
  • If relationship seems mutually monogamous after 6-month retest (or if both partners were virgins), and
  • If neither partner is using drugs
  • Then may not need condoms after negative retest, unless using for contraception
what if either my partner or i have not been tested
What if either my partner or I have not been tested?
  • If you are not Abstaining…
  • And not sure you are bothBeing Faithful
    • (In a relationship in which you were both virgins or extremely low risk)
  • What precautions are left?
what if either my partner or i have not been tested contd
What if either my partner or I have not been tested? (contd.)
  • Better use Condoms (the “C” in “ABC”), every time!
  • If using drugs, also use Clean needles/syringes every time, never share
slide24

Dress made entirely of condoms

Women as well as men should take personal responsibility to carry condoms

(Actually, however, only one needs to be worn at a time!

isn t oral sex safer
Isn’t oral sex safer?
  • Risk does appear quite low for HIV, but not zero
    • Higher risk if blood or sores in mouth
  • Can get other STDs, including
    • Herpes
    • Gonorrhea
    • Chlamydia
    • Syphilis
    • HPV
isn t oral sex safer contd
Isn’t oral sex safer? (contd.)
  • Barriers can help
    • Condoms for fellatio
      • Flavored are available
      • Avoid bitter lubricants like nonoxynol-9
    • Latex sheets (dental dams)
      • Also can be purchased flavored
    • Plastic wrap
      • As close as your kitchen
      • But cut a square in advance
slide27
The “Zebra” latex panty with built-in female condom pouch:for much safer sex (new product, being tested)www.zebrafoundation.org
what if you test positive for hiv or another std
What if you test positivefor HIV or another STD?
  • If you have HIV, herpes, or HPV, always use Condoms
    • Not perfect protection, but best available for couples in which only one is infected
    • Especially effective against HIV
  • You have a personal responsibility (ethical) to inform any partner of your infection before initiating sex
    • Also, can be sued if do not warn
what if you test positive for hiv or another std contd
What if you test positivefor HIV or another STD? (contd.)
  • Safest to select a partner who has the same condition
  • “Prevention for positives” involves changing risk behavior that led to the disease, to avoid passing the disease to others
what if you test positive for hiv or another std contd30
What if you test positivefor HIV or another STD? (contd.)
  • Get medical care
    • Even incurable STDs are treatable
    • Counseling may be needed
  • If you have a curable STD, get treatment and avoid sex till cured
what about other stds sexually transmitted diseases
What about other STDs (sexually transmitted diseases)?
  • HIV tends to dominate attention
  • But HIV is only one of more than 25 diseases spread mainly through sexual activity
    • A personal risk for every young person
  • All STDs are preventable
other stds contd
Other STDs (contd.)
  • 15 million new STD infections each year in the U.S.
    • Tens of millions have HPV, herpes
    • STDs often go unrecognized, especially in women, causing serious, sometimes irreversible, even fatal complications
complications of stds there are a lot of them
Complications of STDs: There are a lot of them
  • Pelvic inflammatory disease (PID)
  • Infertility
  • Ectopic pregnancy
  • Preterm labor/premature infants
  • Uterine infections before and after delivery
  • Cervical cancer, penile cancer
  • Anal cancer
  • Cirrhosis and liver cancer
  • Increased risk of HIV infection
stds can be passed from mother to infant
STDs can be passed from mother to infant
  • Like HIV, several other STDs can be passed from mother to fetus in uterus, to newborn during birth, and/or to infant via breast milk.
    • Syphilis
    • Gonorrhea
    • Chlamydia
    • Genital herpes
    • Genital human papillomavirus (HPV)
    • Hepatitis B
curable stds
Curable STDs
  • Chlamydia
  • Gonorrhea
  • Syphilis
  • Trichomoniasis
  • Molluscum contagiosum

Chancroid

Scabies

Pediculosis pubis (genital lice)

Bacterial vaginosis (NOT an STD but is associated with sexual activity)

incurable stds all treatable but not curable
Incurable STDs(All treatable, but not curable)
  • HIV
  • Hepatitis B
    • 5-10% of infections become chronic
      • May lead to cirrhosis, liver cancer, or liver failure after many years
  • Hepatitis C
    • Sexual transmission uncommon (15% of cases), not usually considered an STD, but 4-5 million Americans infected by sharing needles
    • 85% of infections become chronic
      • May lead to cirrhosis, liver cancer, or liver failure after many years
incurable stds contd all treatable but not curable
Incurable STDs (contd.)(All treatable, but not curable)
  • HPV (Human papillomavirus)
    • Usually resolves within a few years, but some types may progress to cancer)
  • Herpes Simplex Virus (HSV)
    • Can cause lifelong recurrent infections
    • Recurrences usually less severe than primary infection

(READY FOR THOSE X-RATED PICS?)

slide44
Secondary syphilis(Develops after 6-12 weeks without treat ment,spreads throughout body)In this photo, condyloma lata wartlike lesions
slide45
Tertiary syphilis (Develops after many years without treatment, spreads throughout body)In this photo, ulcerating gumma
hpv human papilloma virus
HPV (human papilloma virus)
  • Most common STD among young, sexually active people
    • Estimated prevalence (all types including less dangerous)
      • 15% among Americans ages 15-49
      • 28-46% among women < 25 y/o
  • Condoms help but do not cover all areas of contact
hpv human papilloma virus contd
HPV (human papilloma virus)(contd.)
  • 2 types causing 70% of cervical cancer now in new GardasilR vaccine
    • Vaccine only approved for females 18-26 so far
    • Penile and anal cancer also caused by HPV
    • Regular Pap smears critical for detecting early cervical cancer
  • 2 other types causing 90% of genital warts included in vaccine
  • Female college students should get immunized!
herpes simplex type 2
Herpes simplex, type 2
  • Prevalence > 20% in U.S.
    • Probably second commonest STD
  • HSV-1 causes recurrent oral/perioral cold sores but can spread to genitals by oral sex
  • HSV-2 causes recurrent painful genital ulcers and cervicitis
herpes simplex type 2 contd
Herpes simplex, type 2 (contd.)
  • Treatable, and recurrences can be suppressed with medication, but no cure
  • HSV-2 infection may increase risk of HIV
  • Condoms help but do not cover all areas of contact; virus may shed even without visible sores
points to remember
Points to remember
  • The same safer behavior that can prevent HIV also reduces the risk of many other sexually transmitted and bloodborne diseases
  • STDs cause serious consequences, including increased risk of HIV
  • Personal decisions can determine whether you get or transmit HIV, other sexually transmitted diseases, and viral hepatitis
points to remember contd
Points to remember(contd.)
  • Preventing all STDs and viral hepatitiscan be as simple as “ABC”:
    • Abstinence lowers risk to zero (with a few minor exceptions)
    • Being faithful within a monogamous, uninfected couple avoids exposure
    • Condoms greatly reduce risk of most STDs, including the incurable, potentially deadly ones (HIV, Hepatitis B & C, HPV)
it s a matter of personal responsibility
It’s a matter of personal responsibility
  • You can take personal responsibility to avoid becoming infected
  • If you already have HIV or another STD or hepatitis, not giving it to others is also a matter of personal responsibility
  • You can take personal responsibility to help control these global epidemics by joining an organization like Beyond AIDS
    • www.beyondaids.org
sources
Sources
  • Tracking the Epidemics: Trends in STDs in the United States, 2000 www.cdc.gov/nchstp/dstd/dstdp.html. Accessed 6/2003
  • www.cdc.gov/od/oc/media/pressrel/r021101b.htm. Accessed 5/30/03
  • Photos from www2.cdc.gov/STDclinic
  • Other charts and statistics from various CDC sites
  • Current Medical Diagnosis and Treatment, 2002
  • 41st ed. Editors: Tierney LM Jr., McPhee SJ, & Papadakis MA. McGraw-Hill 2002
  • Human papillomavirus and vaccine: http://www.cancer.gov/cancertopics/factsheet/risk/HPV-vaccine
  • Zebra Foundation safer sex panty: www.zebrafoundation.org