Paradox of Risk Its not who you are - it’s what you do On an individual level this is true The anus is an equal opportunity site for HIV infection transmission AND

Disparities in HIV Distribution HIV is NOT equally distributed in the US or internationally Some communities bear a heavier burden of HIV infection On a population level-who you are does make a difference in risk

Basic Prevention Sexual Not taking blood, semen, pre-ejaculate or vaginal secretions into mouth, vagina, anus. Contact w/eyes, open cuts, wounds to be avoided Avoid breast milk (greatest risk is for infants) Presence of another STD increases risk of transmission “Safer Sex”- can reduce or eliminate risk Insertive partner at less risk than receptive partner (though insertive partner can still be infected)

Seroadaptation a range of HIV risk reduction strategies undertaken based on one’s own and one’s partner’s serostatus. Seroadaptation includes a range of HIV risk reduction practices and refers to the selection of sexual partners, practices and positions based on one’s own and one’s partner’s serostatus, in order to reduce the risk of contracting and/or transmitting HIV. Serosorting is an example of seroadaptation

Basic Prevention Shared Needles/Injection Equip. To completely eliminate risk, avoid sharing needles or other equipment exposed to HIV- infected blood Dispose of used equip. at pharmacies and needle exchange; access sterile equip at same locations. Clean equip w/bleach to lower risk. Hard liquor, rubbing alcohol, hydrogen also may lower risk of infection. Soapy water may help reduce transmi

Basic Prevention Perinatal (mother->fetus or newborn) Medical treatment during labor/birth reduces risk of transmission; prenatal care also reduces risk Sensitivity and referrals—choice to conceive, carry, or abort a pregnancy always remains with the individual woman

Basic Prevention Blood Contact Universal precautions: wear gloves, goggles, face masks and protective clothing when performing procedures involving blood; dispose of needles/sharps; wash hands after patient contact Precautions w/blood and body fluids containing blood Blood transfusion risk very low Casual contact with clients does not require wearing protective gear

Biomedical Approaches to Prevention Post-Exposure Prophylaxis (PEP) -within 72 hrs of exposure to HIV, medications may be accessed to try to keep exposure from leading to infection

Pre-Exposure Prophylaxis (PREP) - researchers still developing safe and effective use guidelines-initial studies saw average of 44% reduction in HIV transmission in MSM in US w/ other strategies including; monthly HIV testing, condom provision, counseling, & management of other STI’s

Harm Reduction A public health strategy or set of strategies to reduce physical, social, emotional, and economics harms (individuals and communities) from activities that may result in HIV infection or other injury by reducing the risk of an activity; while working to increase overall health and well-being. -Strategies determined by client -Supported without judgment

Harm Reduction Meet clients “where they’re at” Works to minimize harmful effects rather than ignore or condemn Acknowledges continuum of behavior from severe abuse to total abstinence Establishes quality of life for individual/community as criteria for successful interventions and policies Non-judgmental/non-coercive provision of resources and services

Harm Reduction Clients have a voice in creation of policies/programs and affirms them as the primary agents of reducing the harms of their behavior Recognizes realities of race, class, poverty, trauma, etc. affect people’s vulnerability to and capacity for dealing with harm Does not minimize or ignore real harm and danger associated with behaviors

Community Assessment-Mapping Deficits Viewing a neighborhood as an endless list of needs and problems undermines community wisdom and makes development of solutions more difficult-denies wisdom of communities Directs funding to service providers, not to residents Have to denigrate local leadership and community in order to attract resources Encourages perception that only outsiders can provide help Things must get worse in order for funding to continue Doesn’t tap into energy of a community Can never lead to serious change

Community Assessment-Mapping Assets The gifts and skills of individuals, households & families Citizen associations—religious, athletic, cultural, recreational Formal institutions: schools, libraries, parks, police & fire stations, non-profits, social svcs. Physical Characteristics-land, buildings, infrastructure

Asset Mapping

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