STRATEGIES TO REDUCE HIV INFECTION AMONG HBCU COLLEGE STUDENTS

Transcription

1 STRATEGIES TO REDUCE HIV INFECTION AMONG HBCU COLLEGE STUDENTS ORLANDO O. HARRIS, PhD, RN, FNP, MPH FELLOW CENTER FOR AIDS PREVENTION STUDIES (CAPS) DEPARTMENT OF MEDICINE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO FEBRUARY 22, 2018

2 CME Disclosures: Planning Committee And Speaker Speaker: The following speaker has nothing to disclose in relation to this activity: Orlando O. Harris, PhD, RN, FNP, MPH

3 Howard University CME Accreditation Sponsor Accreditation: Howard University College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credits for Physicians: Howard University College of Medicine, Office of Continuing Medical Education, designates this live activity for a maximum of 1.0 AMA PRA Category I Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Goulda A. Downer, PHD, RD, LN, CNS Principal Investigator/Project Director

4 CME Disclosures: Planning Committee And Speaker AETC-Capitol Region Telehealth Project Planning Committee: The following committee members have nothing to disclose in relation to this activity: Goulda A. Downer, PhD, RD, LN, CNS John I. McNeil, MD John Richards, MA-AITP Denise Bailey, MED Speaker: The following speaker has nothing to disclose in relation to this activity: John I. McNeil, MD

5 Howard University CME Accreditation Requirements For Internet Viewers Intended Audience: Health service providers: Physicians, Physician Assistants, Nurse Practitioners, Pharmacists, Dentists, Nurses, Social Workers, Case Managers and other Clinical Personnel. Webinar Requirements: A computer, phone, etc., with internet accessibility and a telephone line. ØYour presence on the call must be acknowledged at the start of each session. Please log in for the session announce your name loud and clear at the beginning of the session. ØYou will not be able to receive CME credits if you leave the session early. ØAt the end of the Webinar our Training Coordinator will a CME Evaluation Survey. ØAll participants are required to complete and return the CME Evaluation Survey at the end of each session. It may be scanned and ed back to den_bailey@howard.edu, or faxed to: AETC-Capitol Region Telehealth Project (FAX#: ) ATTN: Project Coordinator. Please indicate in your or FAX if you would like to receive CMEs.

6 TEST YOUR KNOWLEDGE 6

7 TestYour Knowledge Question #1 Behavioral Risk Factors for STIs in young adults include all of the following except: A. Age at first sexual intercourse B. Sexual activity with a previous partner C. Multiple sexual partners D. Substance use

8 TestYour Knowledge Question #2 Risk Factors that put college students at a risk for HIV infection include all of the following except? A. Peer Pressure B. Limited Communication Among Partners About Safer Sex C. Intimate Partner Violence D. Use of Dental Dams

9 TestYour Knowledge Question #3 Which of the following is correct? Currently available data show that youth aged 13 to 24 account for more than: A. 1 in 5 New HIV Cases B. 1 in 4 New HIV Cases C. 1 in 3 New HIV Cases D. 1in 2 New HIV cases

10 LEARNING OBJECTIVES 1. Describe the epidemiology of STIs among young adults 2. Apply principles of peer support to reduce risk for STIs among adolescents 3. Identify important priorities for maintaining the health and wellness of HBCU College students

11 OUTLINE Ø Epidemiology of STIs among College students Ø Impact of the HIV epidemic on HBCU Campuses Ø Effective behavioral interventions for College students Ø Priorities for moving forward

12 HIV/AIDS AMONG COLLEGE YOUTH Ø 1 in 500 college students are infected with HIV Ø Risk Factors that put college students at a risk for HIV infection o Peer pressure o Lack of maturity o Alcohol and drug use multiple sex partners o Inconsistent condom use (vaginal, anal, oral - Dental Dams; Cervical caps; Diaphragms) o Tendency to combine alcohol and/or other drugs with their sexual experiences o Limited communication among partners about safer sex o Intimate partner violence Reference: State University Blog

13 ESTIMATED NEW HIV DIAGNOSES AMONG YOUTH AGED IN THE UNITED STATES, BY RACE/ETHNICITY AND SEX, 2014 Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, HIV Surveillance Report 2015;26.

14 HIV DIAGNOSES IN THE UNITED STATES FOR THE MOST- AFFECT SUBPOPULATIONS, 2015 Source: Diagnoses of HIV infection in the United States and dependent areas. 2015

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16 DIAGNOSES OF HIV INFECTION AMONG MSM BY RACE IN THE UNITED STATES CDC Data, 2016

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18 HIV AMONG YOUTH Ø Youth aged 13 to 24 accounted for more than 1 in 5 new HIV diagnoses in 2014 Ø Young gay and bisexual males accounted for eight in ten HIV diagnoses among youth in 2014 Ø Young Black/African American and Hispanic/Latino gay and bisexual males are especially affected Ø At the end of 2012, 44% of youth ages 18 to 24 years living with HIV did not know they had HIV Ø Youth with HIV are the least likely out of any age group to be linked to care Centers for Disease Controlhttps://

19 THE NUMBERS: HIV AND AIDS DIAGNOSES Ø From 2005 to 2014, HIV diagnoses among both Black and Hispanic/Latino gay and bisexual men aged 13 to 24 increased about 87%. Ø Among young White gay and bisexual men, HIV diagnoses increased 56%. However, the most recent 5 data ( ) indicate that the diagnoses among Black and White gay and bisexual men aged 13 to 24 have stabilized and the increase has slowed to 16% among Hispanic/Latinos Ø In 2014, an estimated 1,716 youth aged 13 to 24 were diagnosed with AIDS, representing 8% of total AIDS diagnoses that year Centers for Disease Controlhttps://

20 HIV DIAGNOSIS AMONG MEN WHO HAVE SEX WITH MEN BY RACE IN THE UNITED STATES (2015) Source: CDC- Diagnoses of Infection in the United States and dependent areas (2015)

21 HIV DIAGNOSIS DELAYS VARY BY RACE AND RISK GROUP

22 CHLAMYDIA RATES OF REPORTED CASES AMONG WOMEN AGED YEARS BY STATE, UNITED STATES AND OUTLYING AREAS, 2015

23 CHLAMYDIA RATES OF REPORTED CASES AMONG MEN AGED YEARS BY STATE, UNITED STATES AND OUTLYING AREAS, 2015

24 GONORRHEA RATES OF REPORTED CASES AMONG WOMEN AGED YEARS BY STATE, UNITED STATES AND OUTLYING AREAS, 2015 NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population estimates.

25 GONORRHEA RATES OF REPORTED CASES AMONG MEN AGED YEARS BY STATE, UNITED STATES AND OUTLYING AREAS, 2015 NOTE: Rates for Guam and the Virgin Islands were calculated by using the 2010 population estimates.

26 STI AND HIV TRANSMISSION

27 SEXUALLY-TRANSMITTED INFECTIONS AND HIV TRANSMISSION Ø STI s result in inflammation and migration of immune cells into the genital tract. Inflammatory cytokines increase HIV replication and make immune cells more susceptible to HIV infection Ø Genital Ulcer Disease (GUD) caused by STI s (HSV-1,2, syphilis) compromise the integrity of the mucosal barrier and facilitate HIV transmission

28 SEXUALLY-TRANSMITTED INFECTIONS AND HIV TRANSMISSION Ø STI s (e.g. gonorrhea) can increase the amount of HIV in semen and vaginal fluids up to 10x increasing exposure to the partner Ø Reproductive Tract Infections (RTI; bacterial vaginosis, Trichomonas) increase HIV in vaginal fluids and risk of transmission Ø STI s and RTI s increase the risk of HIV transmission from seropositive individuals and also HIV acquisition by a seronegative individual

29 ACQUISITION ROUTES FOR STIS (STD) Ø Sexually transmitted diseases (STDs), or sexually transmitted infections (STIs), are generally acquired by: Ø SEXUAL CONTACT o Blood o Semen o Vaginal o Anal o Other bodily fluids Ø NON-SEXUALLY o Neonatal transmission o Blood transfusions o Shared needles o Shared sex toys

30 LOW-RISK FLUIDS Ø Urine Ø Saliva Ø Sweat Ø Nasal secretions Ø Tears

31 Ø Viral load of the source RISK FOR TRANSMISSION Ø STI s in the source or subject Ø Type of sex Ø Type of bodily fluids

32 RISK OF HIV TRANSMISSION BY TYPE OF SEX Sexual Type of Exposure Risk per 10,000 Exposures Receptive anal intercourse 50 Receptive penile-vaginal intercourse 10 Insertive anal intercourse 6.5 Insertive penile-vaginal intercourse 5 Receptive oral intercourse Insertive oral intercourse Low a Low a

33 COMMON STIs Ø Chlamydia Ø Gonorrhea Ø Genital Herpes (HSV-2)* Ø Genital Warts (HPV)* Ø Hepatitis B Ø HIV and AIDS Ø Pubic Lice* Ø Syphilis Ø Trichomoniasis Reported STDs in the United States: 2012 National Data for Chlamydia, Gonorrhea, and Syphilis

34 SCREENING FACTORS TO CONSIDER

35 TIME-COURSE OF HIV INFECTION SEROLOGY

36 HIV TESTS FOR SCREENING AND DIAGNOSIS Ø Antibody tests Detect the presence of antibodies, proteins that a person s body makes against HIV, not HIV itself. Most HIV tests, including most rapid tests and home tests, are antibody tests. It can take three to twelve weeks for a person s body to make enough antibodies for an antibody test to detect HIV infection. In general, antibody tests that use blood can detect HIV slightly sooner after infection than tests done with oral fluid. Ø Combination or fourth-generation tests Looks for both HIV antibodies and antigens. Antigens are a part of the virus itself and are present during acute HIV infection. It can take two to six weeks for a person s body to make enough antigens and antibodies for a combination test to detect HIV. Combination tests are now recommended for testing done in labs and are becoming more common in the United States. There is also a rapid combination test available

37 HIV TESTS FOR SCREENING AND DIAGNOSIS Ø PCR Detect HIV the fastest by looking for HIV in the blood. It can take 7 to 28 days for NATs to detect HIV. This test is very expensive and is not routinely used for HIV screening unless the person recently had a high-risk exposure or a possible exposure with early symptoms of HIV infection Ø An initial HIV test Ø Will either be an antibody test or combination test. Ø It may involve obtaining blood or oral fluid for a rapid test or sending blood or oral fluid to a laboratory. Ø If the initial HIV test is a rapid test and it is positive, the individual will be directed to get follow-up testing. Ø If the initial HIV test is a laboratory test and is positive, the laboratory will usually conduct follow-up testing on the same blood specimen as the initial test. Ø Although HIV tests are generally very accurate, follow-up testing allows the health care provider to be sure the diagnosis is right

38 STI SCREENING RECOMMENDATIONS Ø Take a Comprehensive Sexual History using the Five P s Partners v Do you have sex with men, women, or both? v In the past 2 months, how many partners have you had sex with? Practices v To understand your risks for STDs, I need to understand the kind of sex you have had recently. v Have you had vaginal sex, meaning penis in vagina sex? If yes, Do you use condoms: never, sometimes, or always? Prevention of pregnancy v What are you doing for family planning? Protection from STIs v What do you do to protect yourself from STIs and HIV? Past history of STIs v Have you ever had an STI? v Have any of your partners had an STI?

39 STI SCREENING RECOMMENDATIONS Ø Screening of Asymptomatic and Symptomatic STIs v Men who have sex with men should be screened at least annually at sites of contact (pharynx, urethra, rectum) regardless of condom use. (If unable to obtained samples, an examination of these sites may assist in identifying and treating potential health related conditions.) v Every 3 to 6 months if at increased risk v For persons living with HIV and is sexually active, screen at first HIV evaluation, and at least annually thereafter. v More frequent screening might be appropriate depending on individual risk behaviors and local epidemiology. v Provide treatment for asymptomatic and symptomatic STI as appropriate.

40 OTHER FACTORS TO CONSIDER!!!!!

41 RISK FACTORS FOR STI s IN YOUNG ADULTS Ø Age at first sexual intercourse Women with 1st sexual intercourse < age 15 are: o Nearly four times as likely to report a bacterial STI o More than twice as likely to report PID o than women who first had sex after age 18 Ø Sexual activity with a new partner Several studies have shown that: o Being in a new sex partnership is a predictor of an STI o Due to greater uncertainty about partners sexual history & STI status

42 RISK FACTORS FOR STIs IN YOUNG ADULTS ØMultiple sexual partners o More than one at a time sexual partner increases exposure and therefore increases risk of STI. o CDC reports that about 16% of year olds reported four or more sexual partners in their lifetime. ØSubstance Use/Abuse o Lowers inhibitions and increase risky behaviors o Consider the use of alcohol and marijuana use o Risk of GHB (date rape drug)

43 CONSIDER THIS.. Ø About 9.5 million adolescents and young adults (ages 15-24) are diagnosed with STIs each year Ø An estimated four in 10 sexually active adolescent females between the ages of 14 and 19 have an STI Ø Adolescents who have multiple sexual partners, have unprotected sex, or take part in other high-risk sexual behaviors are at greater risk of getting an STI

44 CONSIDER THIS.. Ø Information from the CDC showed that among adolescent females who ever had sexual intercourse, the most common STIs are : o Human Papillomavirus Virus (HPV) Consider vaccination for both males and females o Followed by chlamydia o Trichomoniasis (more common in females) Males are often asymptomatic but consider NGU treatment if indicated

45 WHY FOCUS ON YOUNG ADULTS? Ø Younger people are more likely to adopt and maintain safe sexual behaviors than are older people with well-established sexual habits o To some degree Older adults are dating more frequently Ø Adolescents are excellent candidates for prevention efforts o Social behavioral considerations Ø Reducing adolescent infections will ultimately result in fewer infections among all age groups o To some degree Treating STI infections can decrease community transmission risk

46 STD TREATMENT GUIDELINES FOR YOUNG ADULTS

47 2015 SEXUALLY TRANSMITTED DISEASES TREATMENT GUIDELINES Ø Screening Recommendations o Routine laboratory screening for common STDs is indicated for sexually active adolescents o Routine screening for C. trachomatis on an annual basis o Routine screening for N. gonorrhoeae on an annual basis o HIV screening should be discussed and offered to all students o The routine screening of adolescents who are asymptomatic for certain STDs (e.g., syphilis, trichomoniasis, BV, HSV, HPV, HAV, and HBV) is not generally recommended. However, YMSM and pregnant adolescent females should be screened for syphilis

48 We Should Talk about Risk Reduction Counseling and Prevention

49 HIV Prevention Toolkit

50 CENTER FOR HEALTH & BEHAVIORAL TRAINING CHBT ROCHESTER, NEW YORK

51 PREVENTION CHALLENGES Ø Inadequate sex education o Low rates of testing o Low rates of condom use o Substance use Ø High rates of sexually transmitted infections (STIs) Ø Stigma and Discrimination around HIV testing and diagnosis Ø Feelings of isolation

52 PRIORITES FOR MOVING FORWARD

53 PRIORITIES FOR MOVING FORWARD Ø Address barriers to HIV/STD access to care and treatment Ø Provide comprehensive health and wellness for all students Ø Develop structural interventions and policy changes to improve the long term health disparity and disease burden among students of color Ø Culturally competent strategies are needed to encourage students to seek testing and, once aware of their status, to obtain and remain in care.

54 PRIORITIES FOR MOVING FORWARD Ø Adopt a strong resolution and a plan of action to address STI prevention strategies at the HBCU Ø HBCUs should commit to advocating for policy changes and action at local, regional and national level Ø HBCUs should use available state (and/or regional) data to determine the immediate need health and reproductive needs of their students

55 PRIORITIES FOR MOVING FORWARD Ø Increase the number of HBCU College students who know their HIV status o Persons aware of their HIV infection reduce their risk behaviors, which could reduce HIV transmission o People with unrecognized infection primarily responsible for ongoing epidemic o Efforts to ensure annual physical examination with HIV testing should be strengthened o Increase efforts to educate HBCU students and health-care providers about HIV testing guidelines and to reduce barriers to HIV testing

56 PRIORITIES FOR MOVING FORWARD Ø Cultural need to be incorporated to more effectively reach and impact HBCU students Ø Educate students to eliminate stigma, discrimination and homophobia. Ø Use structural-level interventions to effect change and to leverage potential assets for interventions such as the Student Health Center, Peer support groups, Fraternities & Sororities, etc. Ø Identify strategies that are responsive to the unique challenges that HBCU students face Ø Consider novel ways of disseminating HIV and STI prevention messages o o Text messaging Mobil applications

57 Thank You!

58 TestYour Knowledge Question #5 Behavioral Risk Factors for STIs in young adults include all of the following except: A. Age at first sexual intercourse B. Sexual activity with a previous partner C. Multiple sexual partners D. Substance use

59 TestYour Knowledge Question #6 Risk Factors that put college students at a risk for HIV infection include all of the following except? A. Peer Pressure B. Limited Communication Among Partners About Safer Sex C. Intimate Partner Violence D. Use of Dental Dams

60 TestYour Knowledge Question #7 Which of the following is correct? Currently available data show that youth aged 13 to 24 account for more than: A. 1 in 5 New HIV Cases B. 1 in 4 New HIV Cases C. 1 in 3 New HIV Cases D. 1in 2 New HIV cases

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