1 HIV Prevention for Patients and the Community HAIVN Harvard Medical School AIDS Initiative in Vietnam

2 By the end of this session, participants should be able to: Identify the 3 routes of HIV transmission List 4 factors that can reduce the sexual transmission of HIV Counsel a patient on how to use condoms and how to inject safely Explain risk of mother to child transmission of HIV Learning Objectives

3 HIV is a communicable disease, thus affects individuals and the entire community The best way to stop the HIV epidemic in Vietnam is through prevention HIV is 100% preventable Our patients and their families: have many questions about HIV transmission and prevention trust nurses and listen to your advice Why should be concerned about HIV prevention?

IV drug use Blood transfusion Occupational exposures (needle sticks) Blood/Parentally Heterosexual Homosexual Sexual During pregnancy and labor Breastfeeding Perinatally (mother to child) 3 Routes of HIV Transmission

Rate % 90% 0.67% 0.3% 25-35% 0.5% 0.1% 0.065% 0.05% 0.01% 0.005% Root of Transmission Blood Blood transfusion Sharing needles among IDU Occupational exposures (needle sticks) Mother to child Sexual Receptive anal sex Receptive vaginal sex Insertive vaginal sex Insertive anal sex Receptive oral sex Inceptive oral sex Estimated HIV Risk for a Single Exposure to HIV+ Source CDC, MMWR, 2005

6 HIV is DIFFICULT to contract, spread only through exposure to certain bodily fluids: blood semen vaginal secretions breast milk In order for HIV to be spread, these infected fluids need to be exposed to: a mucous membrane (vagina, eye, mouth) broken skin blood (needle stick, infusion) Characterizes of HIV Transmission

7 HIV is NOT transmitted through casual contact such as: Hugging or kissing Coughing or sneezing Sharing utensils, cups or bowls Sharing toilets Swimming pools Insect bites How is HIV not spread?

8 HIV Transmission and Prevention through Blood/Parental Sources

9 Lack of access to: clean syringes: Use of previously used syringes during injection drug use effective drug abuse treatment (methadone) Concurrent sexual risk behavior Factors Increasing HIV Transmission through IDU

10 Recognize drug use: Ask all patients about drug use Recommend HIV testing for IDU Reduce HIV transmission among IDU: Nurses’ Role(1)

11 Help IDU reduce their risks: Educate patients on HIV transmission Educate them to: Use of new needles and syringes or clean needles and syringes Do not share of needles and syringes Provide free needles and syringes to IDU Refer or provide treatment for drug addiction Reduce HIV transmission among IDU: Nurses’ Role(2)

12 Educate patients how to clean needles: 2 x 2 x 2 (water, bleach, water) Bleach (ideally) for 30 seconds each pass If no bleach, alcohol OK (but not wine or beer) Boiling x 5 – 10 minutes also kills HIV If can’t use bleach, alcohol, or boil, then recommend using clean water: 30 seconds each time x 3 times Reduce HIV transmission among IDU: Nurses’ Role (3)

13 HIV Transmission and Prevention among Sexual Partners

14 HIV is concentrated in semen in men, vaginal secretions in women HIV is more easily transmitted from the insertive to the receptive partner Man to woman during vaginal sex Man to man or woman during anal sex Oral sex with ejaculation or during menses Sexual Transmission of HIV (1)

15 Risk of transmission: Higher if HIV viral load in the infected partner is high depends on route of sex: Sexual Transmission of HIV (2) Oral << Vaginal < Anal Low risk high risk

Risk of transmission is associated with the HIV viral load in the infected partner. Sexual Transmission of HIV (3) * chưa gặp ở bệnh nhân HIV <1500c/ml Quin, T et al. N Engl J Med ” Serum HIV-1 RNA in HIV+ partner Risk of acquisition among HIV- partner <3,500 c/ml * 1.0 3,500 – 9,999 c/ml ,000 – 49,999 c/ml6.84 ≥50,000 c/ml12.55 *There were no tx seen in patients with HIV < 1500 c/ml

17 More sexual partners (FSW, MSM) Sex: during menses with the presence of STDs- especially genital ulcers through anal (no natural lubrication) Rough or “dry” sex Female douching after sex Use of chemical spermicides Nonoxynol-9 (N-9) Factors Increasing Sexual Transmission of HIV

18 Fewer Sexual Partners Condom use Non-penetrative sex (masturbation) Male circumcision: 61% reduction in acquiring HIV infection among circumcised man Factors Reducing Sexual Transmission of HIV *Auvert B

Abstinence (no sex) Be Faithful (one sexual partner) Condoms (if A & B not followed) Prevention of Sexual Transmission of HIV: the ABC’s

20 Reducing Sexual Transmission of HIV: Roles of Nurses

21 Helps you to understand the patient’s risk and provide correct counseling on prevention Allows the patient to ask questions about sexual behavior that they might have been ashamed to bring up Take a Sexual History (1)

22 Sexual history should be taken: In a private room, with only the patient and nurse present Be attentive and use non-judgmental attitude Advise the patient that: you will ask some personal or difficult questions all information is confidential Take a Sexual History (2)

23 Ask detailed questions about the patient’s sexual behavior number and type of partners route of sexual activity (oral, vaginal, anal) homosexual sex (MSM) condom and lubricant use Take a Sexual History (3)

24 Provide information to patients on: risks for sexual transmission of HIV safe sexual behavior condom and lubricant use (provide them freely, when possible) Provide Information

25 Encourage and assist the patient in: disclosing their HIV infection to their partner(s). This will facilitate: condom use and HIV testing of the partner(s). seek treatment for STDs ARV treatment: Patients on ARV have lower HIV viral loads thus, a lower risk of transmitting the infection Assist the Patient

26 HIV Transmission and Prevention Among Mothers and Children

27 Transmission from mother to child can occur: in utero during delivery post-partum through breast milk HIV Transmission: Mother To Child (1)

Risk of Child acquiring HIV from an HIV+ mother No treatment 25%-35% PMTCT 2%-8% In developed countries (Triple ARV, C-section, no breast feeding) <2% HIV Transmission: Mother To Child (2)

29 Providing HIV counseling and testing to all pregnant women Pregnant woman with criteria for ARV treatment should be: started on triple-ARV therapy at the HIV OPC as soon as possible and also referred to the PMTCT program Pregnant woman without criteria for ARV should be referred to the PMTCT program for prophylactic ARV Babies born to HIV infected women should not breastfeed, if powdered milk and clean water are available Preventing HIV Transmission from Mother To Child

30 The 3 routes of HIV transmission are: blood, sex and mother to child. Disposable needles help reduce HIV transmission though IDU Sexual transmission reduces if safe sex is practiced Pregnant woman with criteria for ARV treatment should be started on triple- ARV therapy at the HIV OPC as soon as possible Key Points

31 Thank you! Question?