STD/HIV Prevention Seattle & King County Robert Marks

My discussion… Public Health Goal Public Health Goal PH Prevention Services PH Prevention Services STD Program STD Program STD & HIV Epidemiology STD & HIV Epidemiology Your Role Your Role STD & HIV Resources STD & HIV Resources

Public Health Goal Stop the spread of disease and ensure individual health as well as the health of communities. Stop the spread of disease and ensure individual health as well as the health of communities.

You Did What!?!? Stop That! You You

Public Health Prevention Services HIV Counseling and Testing HIV Counseling and Testing STD Clinic/District Sites/CBO’s STD Clinic/District Sites/CBO’s Disease Investigation & Partner Notification Disease Investigation & Partner Notification Syringe Access & Disposal Syringe Access & Disposal Community Coalition Leadership Community Coalition Leadership Black Leadership Council Black Leadership Council Educational Materials Development Educational Materials Development Technical Assistance and Training Technical Assistance and Training

STD Clinic at Harborview (206) Monday-Friday 8am-6:30pm 9:30am–6:30pm Tues

STD Clinic at Harborview Walk-in clinic (if after 3:00pm, call) Walk-in clinic (if after 3:00pm, call) STD screening/treatment STD screening/treatment HIV testing and early intervention services HIV testing and early intervention services Fees are based on income (No person will be turned away due to inability to pay.) Fees are based on income (No person will be turned away due to inability to pay.) No charge for STD medications No charge for STD medications If symptomatic, most likely expedited If symptomatic, most likely expedited Interpreter services available Interpreter services available

Disease Intervention Specialists Provide health information to diagnosed individuals. Provide health information to diagnosed individuals. Assure appropriate medical care. Assure appropriate medical care. Elicit sex partners (and needle sharing partners for HIV diagnosed individuals) in order to get the partners into medical care. Elicit sex partners (and needle sharing partners for HIV diagnosed individuals) in order to get the partners into medical care.

King County STD/HIV Epidemiology

Chlamydia

CT Positivity*, King County and Other WA Counties, * Positivity = # positive tests divided by # total tests (through IPP)

CT Incidence* among Women ages 15-29, * Based on reported cases, countywide 3394 cases

CT Incidence among Women by Age,

Gonorrhea

GC Incidence* among Women ages 15-29, *Based on reported cases, countywide 368 cases

GC Incidence* by Sex, cases 812 cases * Calculate using reported cases, countywide

GC among MSM,* *MSM cases included MSM cases diagnosed in the STD clinic, as well as rectal infections diagnosed elsewhere ^Starting in 2005, MSM definition also includes interview data

King County: Gonorrhea Incidence in year old Women, by Race

King County: Gonorrhea Incidence in year old Women, by Ethnicity

GC Incidence among Women by Age,

Syphilis

King County: Early syphilis*, *Reported P, S, and EL syphilis **Excludes some male cases with unknown MSM status 2005 total cases = total cases = total cases = total cases = 191

MSM

GC, CT, and Early Syphilis among MSM, * * New “definition” of MSM in 2005, based on case report, interviews, site of infection

STD Summary Chlamydia rates stable over past 3 years Chlamydia rates stable over past 3 years MSM relatively unchanged MSM relatively unchanged STD Clinic numbers dropped in women STD Clinic numbers dropped in women Gonorrhea rates down (again) Gonorrhea rates down (again) Down in heterosexuals and MSM Down in heterosexuals and MSM Down in most age groups Down in most age groups Down in most race groups Down in most race groups Early syphilis cases similar to 2007 Early syphilis cases similar to 2007 Increase in EL cases vs. P&S continues Increase in EL cases vs. P&S continues MSM stable for CT and syphilis, GC down MSM stable for CT and syphilis, GC down

HIV/AIDS

Who is living with HIV/AIDS in KC? (as of 3/31/09) 90% male 90% male 42% diagnosed between years of age 42% diagnosed between years of age 74% currently 40 years and older 74% currently 40 years and older Race Race 68% white 68% white 17% black 17% black 10% Hispanic 10% Hispanic 3% Asian 3% Asian Risk Risk 69% MSM 69% MSM 8% MSM-IDU 8% MSM-IDU 5% IDU 5% IDU 10% heterosexual contact 10% heterosexual contact 25% foreign-born at age of diagnosis ( ) 25% foreign-born at age of diagnosis ( )

Provider Role

What is my role in STD/HIV Prevention? Talk about sex, drugs, disease & transmission. Talk about sex, drugs, disease & transmission. Encourage and/or refer for screening/testing. Encourage and/or refer for screening/testing. Assist individual to reduce risk. Assist individual to reduce risk. Encourage discussion between partners.*** Encourage discussion between partners.*** Let patient know that Public Health will be contacting…confidentiality maintained. Let patient know that Public Health will be contacting…confidentiality maintained. Provide Expedited Partner Therapy. Provide Expedited Partner Therapy. Inform of STD Clinic services. Inform of STD Clinic services. Complete Case Report for diagnosed disease. Complete Case Report for diagnosed disease.

Clarify/define! Sex Sex Monogamy Monogamy Agreements? Agreements? What happens if someone strays? What happens if someone strays?

Web Resources General STD info General STD info Lots of HIV info Lots of HIV info

Questions? Thoughts?