1

HIV Prevention for Patients and the

Community

HAIVNHarvard 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?

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 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

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 IncreasingSexual 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 ReducingSexual Transmission of HIV

*Auvert B. 2005.

Prevention of Sexual Transmission of HIV: the ABC’s

20

ReducingSexual 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?