HIV, AIDS and other STD

Myleen L. Escalona, M.D., FPCP

Why is HIV and AIDS education important?

expansion and improvement of education

critical to preventing the spread

estimated 33.3 million people living with the virus

reducing stigma and discrimination fuelled by misunderstanding and misinformation

negative impact on people living with HIV

encouraging people from seeking testing and treatment

Who needs HIV and AIDS education?

targeted at specific groups at risk

early years - men who have sex with men - injecting drug users Now - heterosexual African Americans - Hispanic/Latino population

AIDS affects many parts of society, and so everyone needs to be aware of HIV and AIDS.

not at risk missing out on HIV and AIDS education

lead to a rise in HIV infection rates

spread of accurate information

promoting awareness tackling stigma and discrimination

 already infected with HIV

Living positively w/out passing to anyone else prevent themselves infected with a different strain

ensure a good quality of life Information about medication and support available

The start of AIDS

History of AIDS
1970s no one was aware of deadly illness
one of the greatest threats to human health and development

Now much has been learnt about science of AIDS

The global picture

Statistics yearly
end of 2009 around 33.3 M has HIV

2.6 M infected w/ HIV 1.8 million die of AIDS

2001-2009

Eastern Europe & Central Asia people w/ HIV increased 54.2%

In the Philippines
DOH 500 in the 1st quarter of 2011

-172 individuals for March -cases boosted to 483 overall in the first quarter

Majority who are affected 20 - 35 age

primary factors triggering surge frequent intercourse with different partners

 Approx 6,498 Filipinos National HIV and AIDS Registry 1st case recorded in Philippines 1984 increased >5x 0.08 % in 2007 0.47 % in 2009

HIV/AIDS in Philippines Population, 2009 People living with HIV/AIDS, 2009 Women (aged 15+) with HIV/AIDS, 2009

92,200,000 8,700 2,600

Children with HIV/AIDS, 2009

Adult HIV prevalence (%), 2009 AIDS deaths, 2009 nd = No data

nd
<0.1 <200

2011 6,498

ignore sexual health precautions

by 2015 46,000

Is HIV and AIDS the same thing?

HIV
Human Immunodeficiency Syndrome

A specific type of virus (a retrovirus)

HIV invades the helper T cells to replicate itself.

AIDS
Acquired Immunodeficiency Syndrome HIV is the virus that causes AIDS

Disease limits the bodys ability to fight infection

very weak immune system

No Cure

Key points:
HIV is the virus that causes AIDS. AIDS is the result of HIV infection.

HIV infection can be prevented. HIV is not spread through everyday casual contact.

People cannot get HIV when they give blood

Key points:
People with HIV
-look and feel healthy for a long time -Can infect others even if dont look or fell sick

- symptoms are same as other illnesses

Can have illnesses that healthy people dont get Test show if you are infected

Only a doctor can diagnose AIDS

HIV

damages human immune cells

weakens immune system

AIDS

How HIV is passed on

a virus can be passed - person to person

found in blood and other body fluids

sexual fluids, blood and breast milk cannot live for long outside the body

most common ways of transmission

sexual intercourse w/ infected partner

injecting drugs using a needle or syringe used by someone who is infected as a baby of an infected mother, during pregnancy, labor or delivery, or through breastfeeding

Vaginal sex
sexual fluids Man pre-come semen fluids before and during sex Woman vaginal fluids produced by the vagina to keep it clean and to help make intercourse easier

Vaginal sex

Man w/ HIV w/o condom

Vaginal inter course

lining of vagina cervix womb

Woman infected

Vaginal sex
risk of transmission is increased

a cut or sore inside or around vagina

easier for the virus to enter bloodstream cut or sore not always visible so small to notice

Vaginal sex
sore patch -penis - getting into urethra -inside foreskin

woman w/ HIV w/o condom

Vaginal intercourse

Man will be infected

Vaginal sex
Any contact with blood during sex increases the chance of infection

blood in the vagina during a woman's period

sexually transmitted diseases herpes and gonorrhea raise the risk of transmission

Anal sex
Receptive anal intercourse (i.e. being the bottom) higher risk than vaginal intercourse lining of the anus is more delicate more likely to be damaged Any contact with blood during sex increases the risk of infection man takes the insertive (top) position in anal sex w/ HIV person at risks for infection

Oral sex
Carries small risk of HIV licking or sucking penis w/ HIV bleeding gums or tiny sores or ulcers

Oral sex
same if infected sexual fluids from a woman get into the mouth of partner

person w/ HIV gives oral sex a small risk bleeding gums or wound in mouth

Saliva does not pose a risk

Injecting drugs
a high-risk group for exposure

Sharing needles and works (syringes, spoons, filters and blood-contaminated water) 3x risk than sexual intercourse Disinfection between each use can reduce the chance but does not eliminate entirely

Mother to child transmission

An infected pregnant woman pass on unborn baby pregnancy, labor and delivery through breastfeeding woman infected w/ HIV drugs can be taken to reduce chances of infecting child

Blood transfusions and blood products

infected blood transfusion

developed countries all blood for transfusions tested for HIV Now rare people w/ hemophilia blood are heat-treated for safety

Tattoos / piercing
equipment has not been sterilized

most developed countries Have hygiene regulations ask staff at the shop what procedures taken to avoid infection

HIV is Not Spread

everyday casual contact

Kissing
Saliva does contain HIV only very small quantities Not enough to cause infection

large open sores in mouths, or severely bleeding gums

Sneezing, coughing, sharing glasses/cups, etc

unable to reproduce outside living host

does not survive in open air no environmental transmission has been recorded

Insects
Studies conducted by many researchers no evidence of transmission

insects do not transmit HIV

HIV only lives for a short time and cannot reproduce inside an insect

Protected sex
condoms are highly effective correctly and consistently

Effective during both vaginal and anal sex help to reduce the risks during oral sex too

What are the symptoms of HIV and AIDS?

not possible to diagnose on symptoms alone symptoms are very similar to other illnesses only way to know an HIV test

feel and look completely well immune systems damaged

important to remember! once someone is infected w/ HIV pass the virus immediately, even if healthy

HIV

Weak immune system

AIDS (Opportunistic infections)

Symptoms caused by opportunistic infections

caused by germs that are around all the time normally be fought off by healthy immune system

symptoms can be very severe

diagnosis of AIDS signs of severe immune deficiency cannot be explained by any factor

Why should I take an HIV test?

Who should have HIV test?

unprotected sex

shared drug injecting equipment

exposed to HIV during a medical procedure or at work

Afraid of taking an HIV test it is better to know status than not to know
If HIV negative - Peace of mind

If diagnosed as HIV positive:

offered emotional support, and advice on what to do next

health assessment and begin antiretroviral treatment if necessary (and available)

measures to ensure protection of partner and (if woman) any future children

doctor is going to take symptoms more seriously start to make plans for the future Knowing may be a shock, but can do amazing things that never considered before!

When to do the test:

person infected -infectious themselves -very rapidly (within a day or so) await before HIV test will produce an accurate result Standard test detects antibody of virus
Production takes 6 wks to 3 mons Others 6 mons

What is HIV antiretroviral drug treatment?

not a cure

can stop from severely ill for many years drugs taken everyday for the rest of a persons life

aim of antiretroviral treatment

keep the amount of HIV at a low level stops any weakening of immune system

allows recovery from any damage that HIV might have caused already

U.S. Agency for International Development (USAID), the Philippines received $1 million in fiscal year (FY) 2009 for essential HIV/AIDS programs and services

How can we avoid HIV?

As easy as.
A bstain

B e faithful
C ondomise

Effects of HIV/AIDS

On the Individual

On the Individual
Immunodeficiency -weakening of the immune system defenses against infections -secondary infections (diarrhea, skin cancer, pneumonia)

50% adults diagnosed w/ AIDS die w/in 18 mons of diagnosis

Rejection by friends, loved ones isolation from social or community activities

30% of children born to HIV-positive mothers will be HIV-positive themselves

Psychological issues
Fear of pain and dying Feelings of loss related to ambitions, confidence, physical attractiveness, potency, sexual relationships, status in the community, financial stability, future plans, and independence

Anger towards themselves (self-blame) and towards others for abuse of body or privacy Suicidal tendency way avoiding pain and discomfort or lessen shame and grief

Loss of self-esteem and feelings of self-worth by rejection by colleagues or loved with physical impacts of HIV such as disfigurement, physical wasting, and loss of strength Hypochondria - an obsessive state due to a preoccupation with health and avoiding infections

Grief about the losses experienced or anticipating Guilt over the possibility of infecting others, over the behavior, and over the hardship their illness will cause loved ones, especially children Depression due to the absence of a cure, and the resulting feelings of helplessness and loss of personal control Denial as a means of handling the shock of diagnosis Denial of entry into certain countries dismissal from employment or denial of employment for no other apparent cause Fear, anxiety, paranoia, and loss of self-esteem on the part of uninfected people close to HIV-positive individuals Further acts of discrimination against members of certain groups such as gay men, intravenous drug users, and prostitutes

Anxiety over the

Short-term or long-term prognosis Risk of infection with other diseases Risk of infecting others with HIV Loss of physical and financial independence Declining ability to function efficiently Future social and sexual unacceptability Loss of privacy Availability of appropriate medical/ dental treatment Fear of dying in pain or without dignity Possibility of abandonment and isolation

On the family

On the Family:
Psychological stress of all members -anger, sorrow, frustration, and inability to cope with the needs

Discrimination and rejection faced by all members with care

Economic problems due to cost of drugs and hospitalization combined with inability to continue working

On the Community:

Funds are drained by costs associated w/ prevention, diagnosis, treatment, and care

Strain on the health-care system and insurance companies

Loss of economic output and productivity due to illness in prime working years

Economic Impacts of AIDS

Sector Health Individual Increased expenditure
Absenteeism

Community Increased expenditure

Decreased value of future human resources Increased emigration

Education

National Need to expand health infrastructure Loss of trained people

Trade & Industry

Loss of productivity

Effects on tourism

Agriculture

Loss of productivity

Reduction in cultivated land

Threat to food security

Costs and Stages of HIV Infection

Cost Direct Before Infection Infection Testing & outpatient care Lower productivity of ill members Reduction in consumption & investment Illness Inpatient care Death Control & preventive measures Indirect Precautionary savings Insurance Funeral & associated expenses Lower productivity Income & loss of income foregone Reduction in consumption & investment Drop in family income

Acceptance of Opportunity cost of Opportunity cost less risky, but less looking after ill member of looking after ill well-paid jobs member Psychological cost to ill & other family members Psychological cost Costs to others unwittingly affected by ill member

Poor health of surviving members

The spread of HIV and AIDS

What are sexually transmitted diseases (STDs)?

 passed from one person to another during sex at least 25 of different symptoms

spread through vaginal, anal and oral sex

 affect if had sexual contact with an STD

Scabies can be passed w/ other ways

What are sexually transmitted infections (STIs)?

sexually transmitted infections

another name for sexually transmitted disease (STD)
Chlamydia - infect a person without causing any actual disease (i.e. unpleasant symptoms) w/o symptoms think is not having a disease -infection needs treatment

Which are the most common sexually transmitted diseases?

Bacterial Vaginosis

Bacterial Vaginosis (BV)

imbalance in the normal healthy bacteria found in the vagina
harmless and may pass unnoticed unpleasant fishy smelling discharge

Bacterial Vaginosis (BV)

not strictly an STD

not transmitted via sexual intercourse

-exacerbated by sex -more frequently found in sexually active women

Bacterial Vaginosis (BV)

Mechanism not clearly defined alkaline nature of semen upset the acidic nature of vaginal bacteria intrauterine contraceptive device

woman cannot pass BV to a man cause a more serious infection in uterus and fallopian tubes

Treatment : cream to the vagina/ antibiotics

Chlamydia

Chlamydia
one of the most commonly reported bacterial STDs

caused by chlamydia trachomatis

cervix in women urethra and rectum men and women

Occasionally affect other parts - throat and eyes

symptoms
known as the silent disease
70-75% of women are asymptomatic

significant proportion of men have no symptoms

Women symptoms
increase vaginal discharge caused by inflamed cervix
need to urinate more frequently, or pain whilst passing urine;

pain during sexual intercourse or bleeding after sex

lower abdominal pains

irregular menstrual bleeding

Men symptoms
white/cloudy and watery discharge from penis that stain underwear

burning sensation and/or pain when passing urine

pain and swelling in the testicles.

Men are more likely to notice chlamydia symptoms than women but may be asymptomatic.

transmission
unprotected vaginal, anal or oral sex with infection mother to baby during vaginal childbirth

transferring on fingers from the genitals to the eyes

Treatment of chlamydia
simple and effective

short course of antibiotic tablets

partners w/ sexual contact w/in past six months -need to get tested

Complications
left undiagnosed and untreated - cause serious health problems women
Pelvic inflammatory diseases cervicitis

men
Epididymitis and Urethritis Reactive arthritis

Complications of chlamydia are less common in men than women

Genital warts

some types of HPV (human papilloma virus)

anywhere in genital area

white or flesh-coloured, smooth, small bumps, or larger, fleshy, cauliflower-like lumps

>100 subtypes of HPV around 30 affect the genitals

Not everyone with HPV develop genital warts Appear 1 to 3 months after initial infection Itchy painless transmitted by genital skin-to-skin contact transfer of infected genital fluids

treatment
Podophyllin resin Podopfilox lotion/gel

Cryocautery (also called cryotherapy)

Electrocautery Laser treatments Surgical excision

prevention
vaccines Cervarix and Gardasil protect against 2 types of HPV Gardasil also protects against two types of HPV that cause genital warts

Gonorrhea

infect the urethra, cervix, rectum, anus and throat

Symptoms: 1-14 days after exposure

Men more likely notice symptoms than women

Women symptoms:
change in vaginal discharge -abundance - yellow or greenish -strong smell

burning sensation or pain w/ passing urine

Irritation and/or discharge from the anus

Men symptoms
white or yellow discharge burning sensation or pain whilst passing urine Irritation and/or discharge from the anus

 Transmitted: vaginal sex, anal sex, oral sex

Treatment: easy and essential antibiotic in tablet, liquid or injection

Complications: Women: PID / child birth gonoccocal eye infection

Men: inflammation of the testicles and the prostate gland epididymitis Without treatment narrowing of the urethra or abscesses

Genital herpes

2 strains: type 1 (HSV-1) and type 2 (HSV-2)

HSV-2: -more common - genital and anal area HSV-1: - mouth and lips in the form of cold sores

Symptoms: 2 to 7 days after first exposure and last 2 -4 weeks

Symptoms:
itching or tingling (genital or anal) small fluid-filled blisters w/ painful sores

pain on urination over the open sores

headaches

backache

flu-like symptoms (swollen glands or fever)

transmission
vaginal sex anal sex

oral sex (HSV-1 or HSV-2) kissing (HSV-1 only)

Treatment:
no cure

treatment is not needed

clear up by itself

antiviral tablets prevents virus from multiplying

Crabs or Pubic Lice

small crab-shaped parasite - burrow into the skin to feed on blood live on coarse body hair - pubic hair, armpit hair, facial hair and eyelashes easily passed on during sex sharing clothes, towels or beddings Cant be transmitted via toilet seats or swimming pools

Symptoms
around 5 days to 7 weeks after infection

itchy skin

inflammation of the affected area

sometimes visible lice and eggs

spots of blood as lice feed from blood vessels in the skin

prevent

no effective way during sex reduced by washing bedding, towels and clothes on a hot wash

treatment

special shampoos, lotions and creams shaving pubic hair not effective

Syphilis

caused by Treponema pallidium usually sexually transmitted infected woman to her unborn child

primary and secondary stages are very infectious symptoms difficult to recognize 3 mons after sexual contact Left untreated progresses latent stage tertiary syphilis seriously affect organs (heart) death

symptoms
one or more painless ulcers on the penis, vagina, vulva, cervix, anus or mouth

small lumps in the groin due to swollen glands

a non-itchy rash

fever or flu-like symptoms

 a two-week course of intramuscular penicillin injections antibiotic tablets or capsules

treated and confirmed clear still positive test body retains antibodies against the bacteria

Doctors can give a certificate explaining they have been treated and no longer have syphilis

trichomoniasis

single-celled organism trichomonas vaginalis

Often this STD presents no symptoms women are more likely have symptoms than men

Transmission is usually through vaginal, anal or oral sex

symptoms
discharge in both men and women (copious and unpleasant smelling) discomfort or pain whilst having sex

pain when urinating and inflammation of the urethra

Test: taking samples observed the trichomonads through a microscope Treatment: metronidazole orally or as a gel
male partners often have no symptoms - Should be evaluated and treated as well