Preventative potential of Contraceptive practice NO CONFLICTS OF INTEREST.. Epidemiology of HIV in Scotland (2014) Dr Fiona Fargie

Size: px

Start display at page:

Download "Preventative potential of Contraceptive practice NO CONFLICTS OF INTEREST.. Epidemiology of HIV in Scotland (2014) Dr Fiona Fargie"

Morgan Nash
5 years ago
Views:

The contraceptive consultation for women living with HIV role in promoting women s health and wellbeing as well as

. Dr Fiona Fargie Epidemiology of women with HIV in Europe in 2009 % of people with HIV aged 15 years who are women by

Available at: http://www.unaids.org/globalreport/documents/2 0 1 0 11 23 _GlobalReport_full_en.pdf.

Main route of HIV transmission in women in West, East and Central Europe is heterosexual, 2010 Epidemiology of HIV in

Other*: 20% *Other includes transfusion recipients, cases of nosocomial infection and mother-to-child transmission

eu/en/publications/publications/111129_sur_annual_hiv _R ep o rt. p d f. A ccessed Feb 2 0 1 2 ; 2.

uk/webc/hpawebfile/hpaweb_c/1237970242135.

1 The contraceptive consultation for women living with HIV role in promoting women s health and wellbeing as well as reducing mother to child transmission of HIV Preventative potential of Contraceptive practice NO CONFLICTS OF INTEREST.. Dr Fiona Fargie Epidemiology of women with HIV in Europe in 2009 % of people with HIV aged 15 years who are women by country 2,500 26,000 18% 12,000 30% 8,200 32% 48,000 34% 4,600 25% 48,000 32,000 UNAIDS report. Available at: _GlobalReport_full_en.pdf. Accessed February Main route of HIV transmission in women in West, East and Central Europe is heterosexual, 2010 Epidemiology of HIV in Scotland (2014) West Central East UK 1 Heterosexual: 84% IDU: 2 % Othe r*: 1 4 % West Heterosexual: 77% ID U: 3% Other*: 20% *Other includes transfusion recipients, cases of nosocomial infection and mother-to-child transmission HIV/AIDS surveillance ineurope HIV/AIDS Surveillance in Europe 2010.Available at: _R ep o rt. p d f. A ccessed Feb ; 2. H P A Un ited K in gd o m. New H I V D i agn o ses to en d o f Ju ne Avai l ab l e at: Accessed Feb 2012 East Heterosexual:73% ID U: 20% Other*: 7% Central Heterosexual: 67% ID U: 3% Other*: 30% Population Scotland = 5.4 million The cumulative total of HIV diagnoses in Scotland is 7384 [5351 (72%) male and 2033 (28%) female] At least 1860 (25%) are known to have died. It is estimated there are 4479 individuals in Scotland living with HIV (1/3 women) Prevalence

Lets talk about Susan.. "This epidemic unfortunately remains an epidemic of women.

Biology Gender based violence Ø Unable to protect their sexual health Ø 50% increased risk of

btw partners) Lack of access to healthcare Ø Poor resources or barriers to access Ø SRH care

1/3 women in SA cant read variable health literacy How women living with HIV think you think

CD4 counts (more immune suppressed) 1 Women are more likely to have a detectable viral load at

to die from AIDS defining illnesses 2 Increased incidence of socioeconomic factors in women cf

Socioeconomic factors associated with poorer disease control BUT when analysed with adjustment

healthcare systems are significant issues 1. Burch PS6/3, 2. Jose PE12/7, 3.

Emotional/ counselling referral Menopause care Sexual dysfunction /problems Support to

2 Lets talk about Susan.. "This epidemic unfortunately remains an epidemic of women." - Mi chel Sidibé, Executiv e Dire ctor of UNAIDS Why are women at increased risk of HIV? Biology Gender based violence Ø Unable to protect their sexual health Ø 50% increased risk of HIV if IPV (South Africa) Ø Societal norms (males allowed to have extramarital sex, age gaps btw partners) Lack of access to healthcare Ø Poor resources or barriers to access Ø SRH care may be married women only Ø Stigma Education Ø early marriage/pregnancy if complete school Ø 1/3 women in SA cant read variable health literacy How women living with HIV think you think about them STIGMA Treatment outcomes for women living with HIV Women start treatment with lower CD4 counts (more immune suppressed) 1 Women are more likely to have a detectable viral load at 1 & 2 yrs (poorer adherence to treatment) 1 Women, Black Africans and young people more likely to die from AIDS defining illnesses 2 Increased incidence of socioeconomic factors in women cf MSM (including poverty, unstable housing, poor education and employment, depression) 3 Socioeconomic factors associated with poorer disease control BUT when analysed with adjustment for these factors there was no difference between groups 3 Lone parenting and negotiating healthcare systems are significant issues 1. Burch PS6/3, 2. Jose PE12/7, 3. O connell PS6/5 EACS 2015 What the contraceptive provider may offer? Emotional/ counselling referral Menopause care Sexual dysfunction /problems Support to disclosed GBV/IPV Contraception incl. Access to Termination STI tes ting/prevention (vaccination)/ cervical screening Fertility desires/support to safely conceive Weight Management/ smoking cessation 2

Mental health concerns EMOTIONAL/COUNSELLING SUPPORT IPV/FGM 70% women with HIV experienced mental health issues in last 12 months (cf 50% HIV neg women) and 24% missed ARV due to symptoms 1 Some

3 Mental health concerns EMOTIONAL/COUNSELLING SUPPORT IPV/FGM 70% women with HIV experienced mental health issues in last 12 months (cf 50% HIV neg women) and 24% missed ARV due to symptoms 1 Some evidence of increased seroprevalence in serious chronic mental illness (US) 2 Contraceptive providers often approached by women for help with mood/ mood problems assumed to be related to contraception 1. Positively UK: States of Mind 2013, 2. WHO: HIV/AIDS mental health 2008 Intimate partner violence (IPV) and HIV HIV IPV Increased risk of IPV for women living with HIV in comparison to uninfected women Poorer outcomes more likely to interrupt treatment A history of childhood abuse, incarceration, illicit substance abuse, smoking, and psychiatric disease all independently predicted past or present IPV Routine enquiry Targeted i n terven ti o n s J Acquir Immune Defic Syndr 2013;64:32 38 CONTRACEPTION AND PRECONCEPTION ADVICE Redefining the prevention/ emtct strategy Mmeje et al. JAIDS 2015;70: The role of the contraception provider? Support around conception/prevention of Vertical Transmission! What do women want/need to know - EMPOWERMENT and INFORMATION! Their reproductive choices are valid! Optimal time for conception Maximising maternal health Partner issues (The Swiss statement) Pregnancy issues (Transmission rates Baby issues (Management post delivery/ breast feeding) 3

4 What is the best contraceptive method for women living with HIV....Whichever method she chooses?? Common concerns around contraceptive prescribing: ØThe great Condom Debate ØDepo Provera BMD issues, concerns around increased transmission? ØLARC Cost and barriers ØEmergency contraception Dosage/ IUD Drug-Drug Interactions Resources Older drugs have significant enzyme induction Ritonavir, Efavirenz Newer classes of drugs present fewer concerns about DDI Integrase inhibitors Paradigm shift - Women's contraceptive choices can now inform their Antiretroviral choices Ø UK MEC - Ø Liverpool website - Ø EACS guideline - -english_rev pdf The Glasgow Model of Care for women living with HIV Integrate key services/support into routine HIV care Ø Contraception and preconception counselling Ø Emotional support/counselling/psychiatry input Ø Sexual Health Advisor support Ø Cervical screening/vaccination Ø Child/baby friendly staff Ø Home visits Ø Support attending other appointments Ø Home delivery of Medication Ø Peer support Ø Financial advice Why increase testing? Diagnosed On treatment Virally suppressed AND FINALLY HIV TESTING? An ambitious treatment target for 2020 to help end the AIDS epidemic UNAIDS 4

Estimated number of people living with HIV (both diagnosed and undiagnosed): UK, 2013 Late diagnoses 1 : proportion of adults diagnosed with a CD4 count <350 cells/mm 3 : UK, 2013 2 HIV in the United

5 Estimated number of people living with HIV (both diagnosed and undiagnosed): UK, 2013 Late diagnoses 1 : proportion of adults diagnosed with a CD4 count <350 cells/mm 3 : UK, HIV in the United Kingdom: HIV in the United Kingdom: 2014 Opportunities to diagnose women Inc arc eration 1 Immigration? HIV associated diseases Antenatal Te s tin g / termination services Malignancies STD c linic s / contraception clinics Needleexchange centres Why are women not tested? Lack of universal testing ANC testing universal in most EU countries but not in colposcopy/top Assumptions of low risk equating to no risk/no provider offer (older or not pregnant) Clinicians anxiety Patients anxiety/ fear of discrimination/ mental health problems/aware high risk Lack of resource/distance to resource/ barriers to access Adapted from Gazz ardb, et al. HIV Med ;9 Suppl 2: Beckwith CJ, et al. AIDS PatientCare STDS 2007 ;21 : CDC Fact sh ee t o n s yrin g e ex ch an ge prog rams. Av ail able at :h t tp : / www. cd c. g ov/ i du/ fa ct s/ a ed_idu_ syr. pdf.a c ces se d Ma r ch2012. In conclusion Women with HIV have poorer outcomes compared with MSM living with HIV due to socioeconomic factors and mental health issues Contraception providers are well placed to ask about these issues and support/signpost as appropriate Look for opportunities to test women for HIV this can be a life prolonging intervention! Questions? 5

Program to control HIV/AIDS

90-90-90 Program to control HIV/AIDS Hamid Sharifi Associate Professor in Epidemiology [sharifihami@gmail.com] 1 Targets for ending the AIDS epidemic 2 New HIV infections in low- and middle-income countries,