1. The Connection Between STDs and HIV
Larry Keil
HIV/AIDS Program, SKCDPH

2. Three Main Points
There is a causal link between infection with STDs and increased transmission of HIV
Preventing and treating STDs will reduce the number of new HIV infections
You can make a difference by helping people prevent, identify and treat STDs

3. What is the STD-HIV Connection?
Similar behaviors put people at risk of both STDs and HIV
A current STD can increase risk of getting HIV by 2-5 times
People with both HIV infection and another STD have increased HIV viral loads and can more easily infect others with HIV
People with HIV can have more serious complications of other STDs

4. Disease Transmission Need an “agent” or “germ”
bacteria, virus, protozoa, fungus
Need exposure to the agent
foodborne, waterborne, aerosol, sexually transmitted, insect transmitted
Need a portal of entry
Need a susceptible host
Need a high enough dose to infect

5. STDs ulcerative: syphilis, chancroid, genital herpes
inflammatory: gonorrhea, chlamydia, trichomoniasis
US has highest rates of STDs in industrialized countries
especially chlamydia, gonorrhea and genital herpes

6. Many STDs Have No Symptoms
In women: over 50% with gonorrhea and 70% with Chlamydia had no symptoms
In men: 68-92% with gonorrhea and 92% with Chlamydia reported no symptoms

7. Epidemiologic Evidence
Researchers have observed a strong association between having STDs and HIV in a number of studies.
The association is termed “epidemiological synergy”
2-5 fold increased risk for HIV infection among persons who have other STDs.

8. Why the Increased Risk
Ulcers and inflamed areas provide an easy portal of entry
STDs attract T-helper cells to the infected area
Even asymptomatic STDs can cause abnormal cellular changes that allow easier passage of infectious agents.
Some STDs increase viral load and shedding of HIV

9. Early Identification and Treatment Trials
In Tanzania
Six intervention vs controlled communities
Effective drugs and training in treating symptomatic STDs in intervention communities resulted in 38% lower HIV incidence
In Uganda
Episodic mass treatment of STDs in matched areas
No difference in HIV incidence despite reduction in STDs

10. Why a Difference in the Trials
Difference in delivery of treatment services--continual vs episodic
Difference in stage of HIV epidemic
Tanzania: early epidemic, HIV prevalence 4%
Uganda: later epidemic, HIV prevalence 16%

11. Early Identification and Treatment of STDs Prevents HIV
Epidemiological, biological evidence
Controlled trials in Africa suggest effectiveness
Conclusion: Any activity that decreases STDs in a community will also decrease HIV transmission

12. Recommendations Use condoms with all new sexual partners
Reduce the number of new sexual partners
Identify and treat new STDs
Know that most STDs do not produce symptoms
People already infected with HIV should be screened routinely for STDs

13. Recommendations (Continued)
Regular screening for those at risk of STDs
Those particularly at risk: sexually active young adults, especially those with multiple partners, those who exchange sex for drugs or money, and young men who have sex with men
Easy access for all to STD care and treatment
Education that douching (vaginal or anal) may increase the risk of acquiring HIV or another STD

14. Conclusions
There is a direct link between other STDs and HIV transmission
Early identification and treatment of STDs will reduce HIV transmission
You can make a difference by helping people know these facts and working with those at risk to get screened and treated

15. Resources HIV/STD Information Line: 206-205-7837(STDS)
Harborview STD walk-in Clinic
STD and HIV information on the Internet