1. STD/HIV Prevention Seattle & King County Robert Marks 744-2275 robert.marks@kingcounty.gov

2. 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

3. 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.

4. You Did What!?!? Stop That! You You

5. 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

6. STD Clinic at Harborview (206) 744-3590 Monday-Friday 8am-6:30pm 9:30am–6:30pm Tues

7. 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

8. 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.

9. King County STD/HIV Epidemiology

10. Chlamydia

11. CT Positivity*, King County and Other WA Counties, 1992-2007 * Positivity = # positive tests divided by # total tests (through IPP)

12. CT Incidence* among Women ages 15-29, 1992-2008 * Based on reported cases, countywide 3394 cases

13. CT Incidence among Women by Age, 1992-2008

14. Gonorrhea

15. GC Incidence* among Women ages 15-29, 1992-2008 *Based on reported cases, countywide 368 cases

16. GC Incidence* by Sex, 1992-2008 482 cases 812 cases * Calculate using reported cases, countywide

17. GC among MSM,* 1993-2008 *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

18. King County: Gonorrhea Incidence in 15-29 year old Women, by Race

19. King County: Gonorrhea Incidence in 15-29 year old Women, by Ethnicity

20. GC Incidence among Women by Age, 1992-2008

21. Syphilis

22. King County: Early syphilis*, 1994-2008 *Reported P, S, and EL syphilis **Excludes some male cases with unknown MSM status 2005 total cases = 193 2006 total cases = 185 2007 total cases = 194 2008 total cases = 191

23. MSM

24. GC, CT, and Early Syphilis among MSM, 1993-2008* * New “definition” of MSM in 2005, based on case report, interviews, site of infection

25. 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

26. HIV/AIDS

27. Who is living with HIV/AIDS in KC? (as of 3/31/09) 90% male 90% male 42% diagnosed between 30-39 years of age 42% diagnosed between 30-39 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 (2006-2008) 25% foreign-born at age of diagnosis (2006-2008)

28. Provider Role

29. 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.

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

31. Web Resources General STD info General STD info www.kingcounty.gov/health/std www.kingcounty.gov/health/std www.kingcounty.gov/health/std Lots of HIV info Lots of HIV info www.kingcounty.gov/health/hiv www.kingcounty.gov/health/hiv www.kingcounty.gov/health/hiv

32. Questions? Thoughts?