two pages paper

Picture Credit:

http://web.ukonline.co.uk/ruth.livingstone/little/scabies2.htm

42

Scabies (Cont.)

Diagnosis:

A visual exam of the genitals may be all that is needed

It is possible for the symptoms of scabies to be confused with the symptoms of other skin conditions

Medical provider may choose to scrape a lesion and examine using using magnification.

Treatment:

Usually a cream is applied topically to the skin from the neck down.

Important also to wash clothing, bedding etc. with which the infected individual has had contact

43

Men between 17-24

[email protected]

Free STD testing (812) 266-1978

Chlamydia

Gonorrhea

Trichomonas

$20 gift card

Confidential and voluntary

Bloomington Men’s S.T.R.O.N.G. Project

44

WEB SITES

American Social Health Association: www.ashastd.org and www.iwannaknow.org (for teens)

Centers for Disease Control: www.cdc.gov/health/std.htm

IUHC lab: http://healthcenter.indiana.edu/departments/laboratory/stdtest.html

Columbia University Health Education www.goaskalice.columbia.edu

Kinsey Institute Sexuality Information Service for Students

www.indiana.edu/~kisiss

Gay and Lesbian Medical Association www.glma.org

Gay Men’s Health Crisis: www.gmhc.org

Planned Parenthood: www.ppfa.org

PP for teens: www.teenwire.org

Advocates for Youth: www.advocateforyouth.com

www.itsyoursexlife.com

www.prevent.org/NCC: chlamydia

45

Women & HIV/AIDS

Overview and statistics

http:// www.youtube.com/watch?v=NNJIzhJGxjE&NR=1

“Today the HIV/AIDS epidemic represents a growing and persistent health threat to women in the US, especially young women of color.” (CDC - 2005)

46

Cumulative Effects

Women make up an increasing part of the epidemic. Increased from only 8% (in 1985 ) to 14% (1992) to 23% (1995) to 26% of new HIV/AIDS diagnoses in 2007.

http:// www.youtube.com/watch?v=OS93UvqfAPg&feature=related

Of the approximately 1 million people living with HIV in the US, between 120,000-160,000 women have HIV. Nearly ¼ of these women don’t know they’re infected; this puts them at high risk of passing the virus to their babies.

http:// www.youtube.com/watch?v=7Mpw80ApTuo&feature=related

Annual number of AIDS diagnoses increased 15% among women compared to 1% for men .

47

Cumulative Effects (continued)

According to a recent CDC study of more than 19,000 patients in 10 US cities, HIV+ women were slightly less likely than infected men to receive prescriptions for the most effective treatments for HIV infection.

In 2005, an estimated 4,128 women with AIDS died, representing 25% of the 16,316 persons with AIDS who died in the 50 states and the District of Columbia

48

Cumulative Effects (continued)

Of the women given an HIV or AIDS diagnosis in 2007, high risk heterosexual contact was the source for almost 83% of these infections; IDU in 16% of infections; 1% not identified. (CDC reported from 34 states)

Most women with HIV/AIDS receiving medical care had children under age 18 living at home (76%); child care may compromise a woman’s ability to manage her own illness

49

Cumulative Effects (continued)

Geography: HIV in some states more likely to have a woman’s face;

1/3 of those estimated to be living with AIDS in Maryland, Connecticut, NJ are female

(compared to 23% nationally)

New AIDS cases in women highest:

northeast

south

Women with HIV disproportionately low-income;

64% had annual income below $10,000

compared to 41% for HIV infected males

50

Living with HIV/AIDS: females by race & ethnicity

2007-CDC report from 34 states:

*66% African American women

*18% white women

*14% Hispanic/Latino women

Compared to their % of population (34 states):

*70% white women

*14% African American women

*11% Hispanic/Latino

51

African-American Women & HIV http:// www.youtube.com/watch?v=7Mpw80ApTuo   Gloria Rueben-- Positive Voices: Women & HIV

Rate of HIV diagnoses for AA women decreased significantly from 82.7/100,000 in 2001 to 60.2/100,000 in 2005; rate still remains 20x rate for white women.

The rate of AIDS diagnoses for AA women (45.5/100,000) was approximately 23x the rate for white women (2/100,000) and 4x the rate for Hispanic women (12/100,000).

AA and Hispanic women together make up 24% of US women, yet they account for 82% of AIDS diagnoses (2003).

52

African-American Women & HIV

2002: Was leading cause of death among AA women age 25-34

compared to 6th leading cause of death for women overall in this age group.

Good news: 2006 no longer leading cause of death (4th) for AA women in this age group

Young AA women are at highest risk for STIs compared to other young women.

(Ex. Gonorrhea rate among AA women age15-19 is 14x greater than white females in same age group.

According to the CDC, AA youth (m & f) comprised the largest single group of young people affected by HIV

53

HIV Risk Factors

Lack of recognition of partner’s risk:

Unprotected sex with multiple partners

including partners of both sexes and

Intravenous Drug Use;

Sexual Inequality in relationships with men:

lack of condom use due to fear of partner abuse or leaving the relationship;

power differential especially with younger women and older men.

Recent CDC study of urban high schools,

more than 1/3 of black and Hispanic women had their first sexual encounter with a male 3 or more years older.

These women, compared to those whose partners were approximately their own age, had been:

Younger at first intercourse,

Less likely to use a condom during first & most recent intercourse

Less likely to have used condoms consistently.

54

HIV Risk Factors Continued

Biologic vulnerability and STIs: a woman is twice as likely as a man to contract HIV during vaginal intercourse because the lining of the vagina provides a large area of potential exposure to HIV-infected semen; young women at even greater risk due to immature reproductive tract, especially the cervix.

Co-factors: having an STI greatly increases the likelihood of acquiring or transmitting HIV (can include those STIs which cause sores or breaks in the skin [herpes] or those which do not cause breaks [chlamydia]. Even with no breaks or sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely.)

55

HIV Risk Factors continued

Substance Abuse: An estimated 1/5 new HIV infections are related to IDU; trading sex for drugs; both casual and chronic substance abusers more likely to engage in high risk behaviors such as unprotected sex.

Socioeconomic and other societal factors: Nearly ¼ AA and 1/5 Hispanics live in poverty. Associated problems: limited access to high quality health care; higher levels of substance abuse; exchange of sex for drugs, $ or to meet other needs can directly or indirectly increase HIV risk factors.

56

HIV Risk Factors continued

Multiple risk factors: NC study of HIV infection in AA women, commonly reported that their reasons for risky sexual behavior were:

Financial dependence on a male

Feeling invincible

Low self-esteem

The need to feel loved by a male figure

Alcohol and drug use.

57

HIV Risk Factors for: Women who have sex with Women (WSW)

Woman to woman transmission appears to be rare.

Of HIV+ WSW

98% had another risk- difficulty in assessing true risk.

IV drug use in most cases or

sex with men.

Case reports indicate that vaginal secretions and menstrual blood are

potentially infectious especially during early and late-stage HIV infection

when amount of virus in blood is thought to be highest;

mucous membrane exposure (i.e. oral, vaginal) to these fluids have potential to lead to HIV infection.

58

IMPORTANT - Early HIV Diagnosis

Take advantage of antiretroviral treatments & preventive medicines for opportunistic infections when appropriate

Drug therapies can forestall AIDS-related symptoms and prolong life

Allow for more informed reproductive choices

Treatments can greatly reduce the chance of passing infection to baby

59

BARRIERS to Early Diagnosis

Poor access to health care

Denial; do not believe they’re HIV infected

May ignore symptoms/warnings of HIV infection

Some women are even afraid to tell their doctors they have HIV, fearing they won’t get good treatment. (PID and other symptoms should signal health care providers to offer women HIV testing and counseling.)

60

Gender-specific Manifestations of HIV/AIDS

Frequent and difficult-to-treat vaginal yeast infections

Other vaginal infections occur more frequently & with greater severity: bacterial vaginosis, and STIs such as chlamydia, gonorrhea and trich

Severe herpes outbreaks, sometimes unresponsive to standard drug therapy

HPV occurs more frequently; cervical dysplasia, a pre-cancerous condition associated with HPV, also more common, severe & recurring

61

Prevention Issues

Abstain from risky sexual behaviors

Be sexually monogamous with an uninfected partner; brings up issues of trust; may not know that partner is doing things that put him and her at risk for HIV; partner may not be aware of their own HIV status.

Communicate with a sex partner; self-esteem issues:

Talk about HIV and other STIs with each partner before you have sex.

Learn about each partner’s past behavior (sex and drug use) and consider the health risks before having sex.

Ask partners if they have recently been tested for HIV; encourage those who have not been tested to do so.

62

Prevention Issues (continued)

Problem: women may lack control in relationships and may be scared to say no to sex; scared to insist on condom use;

Problem: Substantial proportions of HIV+ adults engage in oral, anal or vaginal sex without telling a partner of their HIV status;

*13% of partnerships between an infected person and one who is HIV- or their status unknown, have involved unprotected intercourse without disclosure; this is against the law in most states.

Conclusion: substantial numbers of new HIV infections occur among partners of HIV+ persons who do not disclose. (American Journal of Public Health, 2003)

63

Prevention Issues (continued)

Use male or female condoms for sexual intercourse. Female condoms offer greater “area” of protection from STIs.

Even if both partners have HIV, use condoms to prevent possible infection with a different strain of HIV which could be drug-resistent.

Use latex barriers (dental dam or cut open non-lubricated latex condom) for oral sex.

Do not count on most birth control methods to protect against HIV.

64

Prevention Issues (continued)

Avoid use of IV drugs or shared needles. Drug use can affect treatment success. A recent study of HIV+ women found that women who use drugs, compared to those who do not, were less likely to take their medications as prescribed.

Do not douche; douching removes some of your body’s natural protection.

65

WSW: Prevention Issues

Sexual identity does not necessarily predict behavior; i.e. women who identify as lesbian may be at risk for HIV through unprotected sex with men;

Prevention interventions directed to WSW need to include messages about always using latex condoms for vaginal-penile intercourse;

No barrier methods for use during oral sex have been evaluated as effective by the FDA. However, natural rubber latex sheets, dental dams, condoms that have been cut and spread open, or plastic wrap may offer some protection from contact with body fluids during oral sex and thus may reduce the possibility of HIV transmission.

Not sharing sex toys;

Know their HIV status as well as that of their partner(s);

Include prevention messages about avoiding IV drug use or shared needles;

66

Prevention Research

Microbicides:

virus-killing gel applied vaginally prior to sex;

now in testing phase;

should kill HIV before it latches onto cells of the person;

important for woman whose male partner(s) won’t use a condom;

Women can control the method without a partner’s knowledge;

may provide protection against herpes, gonorrhea and chlamydia;

will allow conception to occur;

(African Study, Britain’s Medical Research Council; Herald-Times, Nov., 2005

A few studies have been suspended due to higher numbers of women becoming HIV infected. This is a huge disappointment to researchers and prevention educators. (2/07)

However, one large study from South Africa in 2009 shows promising results.

"Getting a negative result for one product certainly doesn't signal failure for the microbicide field or broader biomedical HIV prevention research effort as a whole. Each trial result is a puzzle piece and, together, they make up the complex picture that will show us how to develop successful new HIV prevention tools."

(Mitchell Warren , AIDS Vaccine Advocacy Coalition. [2/07]

67

Prevention: What is being done?

“Advancing HIV Prevention” A CDC (2003) initiative to include preventing new infections by working with HIV+ persons and their partners.

CDC: Looking at ways to utilize women’s social networks to reach high-risk persons in communities of color; (i.e. beauty parlors)

One Test. Two Lives. New CDC campaign focuses on ensuring that all women are tested for HIV early in their pregnancy. Provides quick access to resources for providers, materials for patients to help encourage universal voluntary prenatal testing for HIV.

68

Prevention: What is being done? (continued)

Conducting outreach and testing for partners of HIV+ men;

A program to increase the number of AA women who can negotiate condom use with their male partners;

Develop and widely implement social marketing campaigns designed to increase knowledge of HIV status and to promote HIV risk reduction. One such campaign - Take Charge, Take the Test - has been shown to increase HIV testing among African American women.

To ensure that people know whether or not they are infected and to ensure that those who are HIV+ can receive life-extending treatment and take steps to protect their partners, the CDC issued recommendations to make HIV screening a routine part of medical care for all patients between the ages of 13 and 64.

69

Mother to Baby Transmission

During the early 1990s, before treatments, an estimated 1-2,000 HIV+ infants were born each year in the US.

An estimated 50-70% of transmission probably occurs late in pregnancy or during birth. Exact mechanism is unknown, believed to occur when mother’s blood enters fetal circulation or by mucosal (i.e. mouth, eyes) exposure to the virus during labor and delivery.

Since about 1994, dramatic declines reported due to recommendations for routine counseling and testing for pregnant women; offering antiretroviral treatment to infected women during pregnancy and delivery and to infant following birth;

Between 1992-05, perinatally acquired AIDS cases declined 93% in the US.

70

Mother to Baby (continued)

Without treatment intervention, there is a 25% mother to baby transmission rate; with treatment to mother and baby it drops to about 2%.

CDC: since 1999 has distributed $10 million to states with high HIV rates to carry out prevention programs for pregnant women.

Doctors should determine the cause of a patient’s reluctance to be tested, so that it can be addressed.

71