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HIV Prevention for Patients and the
Community
HAIVNHarvard Medical School AIDS
Initiative in Vietnam
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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
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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?
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
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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
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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?
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HIV Transmission and Prevention through
Blood/Parental Sources
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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
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Recognize drug use: Ask all patients about drug use Recommend HIV testing for IDU
Reduce HIV transmission among IDU:Nurses’ Role(1)
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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)
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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)
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HIV Transmission and Prevention among Sexual Partners
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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)
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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 2000. 342” 921 -9
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 5.81
10,000 – 49,999 c/ml 6.84
≥50,000 c/ml 12.55
*There were no tx seen in patients with HIV < 1500 c/ml
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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 IncreasingSexual Transmission of HIV
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Fewer Sexual Partners Condom use Non-penetrative sex (masturbation) Male circumcision:
• 61% reduction in acquiring HIV infection among circumcised man
Factors ReducingSexual Transmission of HIV
*Auvert B. 2005.
Prevention of Sexual Transmission of HIV: the ABC’s
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ReducingSexual Transmission
of HIV: Roles of Nurses
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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)
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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)
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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)
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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
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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
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HIV Transmission and Prevention Among
Mothers and Children
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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)
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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
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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
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Thank you!
Question?