1 Chapter 7 Reproductive Tract Infections and HIV/AIDS
2 Introduction Reproductive Tract Infections (RTIs) Infections caused by a variety of organisms that affect upper and/or lower reproductive tracts Most RTIs are transmitted by sexual intimacy and therefore are referred to as sexually transmitted infections (STIs) STIs include chlamydia, gonorrhea, syphilis, herpes, genital warts, hepatitis, and HIV Other infections include vaginitis, trichomoniasis, yeast infections, and bacterial vaginosis
3 STIs Are Very Common Infections The United States has the highest rate of STIs in industrialized nations. By age 24, 1 of every 4 Americans has contracted an STI. Estimated 65 million are living with an incurable STI.
4 STIs Are Biologically Sexist Higher frequency in females than males and more significant consequences. Women are also often at greater risk of getting an STI (if exposed).
5 Social Dimensions STIs carry significant stigma and are often seen as dirty or shameful, or as signs of deviant sexual behavior Stigma often makes STIs appear worse than they are, or makes people reluctant to get treatment (treatment can always help).
6 Hepatitis Inflammation of liver Several viruses: Types A, B, C, D, E, F, or G Hepatitis B: Considered an STI Prevention: Vaccination for types A and B
7 HIV/AIDS AIDS (acquired immunodeficiency syndrome) caused by HIV (human immunodeficiency virus) and characterized by destruction of the immune system HIV is a retrovirus a virus that incorporates its genetic material into the genome of the cell it attacks HIV is transmitted through sexual intercourse, shared intravenous needle use, or contaminated blood or blood products HIV incubation time ranges from a few months to several years Persons with HIV may be diagnosed with AIDS when they have one of 26 opportunistic infections
8 What is AIDS? AIDS stands for Acquired Immune Deficiency Syndrome Acquired: things that are not inherited. Diseases like the measles or chickenpox are acquired, because people do not inherit them. Immune: protected and invulnerable. Things that are immune cannot be hurt or defeated. Deficiency: shortage or not enough of something. Syndrome: group of symptoms that combine to create a particular condition or disease.
9 What is HIV? HIV stands for human immunodeficiency virus. HIV is a blood borne retrovirus that damages the immune system and may eventually lead to AIDS. Human: refers to human beings. HIV can infect humans but not animals. Immunodeficiency: Virus: is a microscopic organism that cause disease. Viruses cause illnesses such as measles, chickenpox, the flu (influenza), and colds
10 HIV/AIDS Historical Overview First diagnosed in the United States in ,000/year become infected with HIV 1 of 4 people with HIV in the United States are women Women infected: 75% through heterosexual sex; 25% through intravenous drug use
11 Global Perspective HIV: The most serious disease of this (and the next?) generation More than 33 million people worldwide are living with HIV Half of all people living with HIV are women Each year, 2 million deaths, <2.5 million new cases Massive public health campaign launched
12 Epidemiological Trends Reported AIDS Cases in Females by Race, U.S.
13 Social Issues Disproportionately affects African American women Lower socioeconomic status Lack of health insurance, access to treatment Other high-risk groups Homosexual and bisexual men Intravenous drug users Prostitutes Inmates
14 HIV Transmission Sexual intercourse with exchange of bodily fluids Injected with HIV-contaminated needles, syringes, etc. HIV-positive woman infecting her fetus during pregnancy or childbirth HIV-positive woman infecting her infant during breastfeeding
15 Clinical Dimensions and Treatment Issues of HIV/AIDS Testing for HIV Anonymous vs. confidential Waiting period Possible symptoms of HIV Temporary flulike illness 1 to 2 months after exposure
16 Living with HIV Treatment has greatly increased the quality and quantity of life for people living with HIV. HAART attacks HIV from three sides. Treatment is still very intensive (many pills a day, side effects).
17 Informed Decision Making Sexual Activities and Relative Risk
18 Prevention: Five Things to Remember A person can have an STI and not know it. A person can know about an STI and not be honest. (continued on next slide) Courtesy of the CDC
19 Prevention: Five Things to Remember Any activity that involves genital skin/genital skin contact or blood or sexual fluids getting inside someone s body can spread an STI. Latex condoms are very effective risk reducers for HIV and many other STIs. Also effective, if followed correctly, are abstinence and mutual monogamy with an uninfected partner.
20 Should Hao be concerned,even though Sam had no symptoms at the time they were using drugs together? Answer: Yes. People can transmit HIV even if they are asymptomatic. Lesson 1 What Happens When HIV Infects the Body? 264 GRADE 12 Ask, What
21 What can be done to find out Hao s HIV status?
22 What does an HIV antibody test detect?
23 What does an HIV antibody test detect? An HIV antibody test is a blood or oral fluid test that detects the antibodies specific to HIV infection produced by the immune system. An antibody is a type of protein produced by the body to help fight disease. The presence of antibodies can show that a person is fighting a certain type of germ.
24 How is HIV different from some other infections that create immune responses?
25 How is HIV different from some other infections that create immune responses? Answer: Some other infections will eventually leave the body, with only the antibodies that the body produced to fight the infection remaining as signs that the infection was there. In contrast, once someone is infected with HIV, their immune system cannot totally rid the body of all of the virus.
26 Suppose Hao got tested tomorrow morning and one week later got the results that said Hao was HIV negative. What could that indicate about Hao s HIV status?
27 Suppose Hao got tested tomorrow morning and one week later got the results that said Hao was HIV negative. What could that indicate about Hao s HIV status? No antibodies to HIV infection were detected in Hao s blood. Hao is not HIV infected. Hao is infected, but his immune system has not yet made antibodies to HIV.
28 What is a window period There's a period of time after a person is infected during which they won't test positive. This is called the hiv window period. The window period can be from 9 days to 3-6 months, depending on the person's body and on the HIV-test that's used. During that time, you can test HIV negative even though you're HIV infected. You can still catch HIV from someone who is in the window period. If you've had sexual activity with someone whose HIV status you don't know, make that very clear to the HIV test counselor.
29 What's the specific window period for different types of HIV tests? Antibody tests ("Rapid" tests) give a positive result based on antibodies to HIV, not the virus itself. 2-8 weeks (up to 2 months) after infection, most people will have enough antibodies to test positive 12 weeks (3 months) after infection, about 97% of people will have enough antibodies to test positive Antigen tests (RNA tests) show a positive result based on the presence of the virus. These tests are more expensive than anitbody tests, so are not offered in as many places. 1-3 weeks after infection, there will be enough viral material for a positive result
30 What's the specific window period for different types of HIV tests? Home testing kits As of Fall 2012, there are two "home tests" which have been approved by the FDA for use in the U.S.: OraQuick by OraSure is an antibody test that you complete at home, so the window period is the same as described above. Home Access HIV-1 by Home Access Health Corp is not actually a test, but a sample-collection kit. You use it to collect a blood sample which you then mail to a lab for processing.
31 What's the specific window period for different types of HIV tests? PCR tests (Polymerase chain reaction tests) also test for the actual virus. This type of test is often used for testing the viral load of HIV-positive people, as well as testing babies born to HIV-positive mothers. You can read more about PCR tests on the AIDS.gov website. 2-3 weeks after infection, there will be enough viral material for a positive result
32 Can I get HIV from oral sex? Oral sex is much less risky than anal or vaginal sex but HIV still can enter through open cuts and sores, or possibly by infecting the lining of the mouth. There are some documented cases of people getting HIV through their mouth. Once semen gets past the mouth, stomach acid and enzymes in the esophagus kill the virus. So swallowing or spitting out semen (cum or precum) reduces your risk for HIV, compared with letting it sit in your mouth. A popular jingle is: Spit or Swallow, Don t Let it Wallow.
33 Can I get HIV from oral sex? To reduce your risk even more, make sure you keep the mucous membranes in your mouth healthy don t perform oral for about 45 minutes after you brush your teeth, floss, or engage in any other aggravating oral behavior, and not at all when you have open sores. Remember, while the chance of catching HIV from oral sex is very low, you can easily catch other STDs, in particular gonorrhea and chlamydia.
34 Risk of HIV Risk of HIV is not the same for all sex acts. Different activities put us at different levels of risk for getting HIV from a positive partner. We know that all things being equal: (1) Oral sex is less risky than anal sex. (2) Anal sex with a condom is less risky than anal sex without a condom. (3) Topping without a condom is less risky than bottoming without a condom. If two people are in a relationship where one partner is HIV negative and one partner is HIV positive, can a healthy sex life exist? Of course! Here s a handy guide :
35 Risk of HIV No risk for HIV transmission Kissing, mutual masturbation, frottage, massage, water sports, bondage, dirty talk and role play, spanking, wrestling, handjobs Very low/low risk for HIV transmission Blow jobs (receiving less risky than giving), rimming, topping with a condom, bottoming with a condom, fisting with gloves, flogging, whipping Medium risk for HIV transmission Topping without a condom, bottoming without a condom but having the top pull out before cumming, fisting as a top without gloves, blood play such as cutting or piercing
36 Risk of HIV High risk for HIV transmission Bottoming without a condom and taking the load, getting fisted without gloves, sharing needles or works during intravenous drug use Of course, these ranges apply only to HIV, not for other STDs such as syphilis, gonorrhea, chlamydia, or hepatitis.
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Index Acknowledgements Table of Contents Introductory Letter by Jessica Danforth Introduction to the Manual i iii vii viii Chapter 1: Introduction Klinic 1 Teen Talk 2 Operating Principles 4 Facilitation101