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PATRICK D. ALBIT, RN PATRICK D. ALBIT, RN BCC Coordinator BCC Coordinator Davao Davao S T I S T I

The Truth about STI, HIV & AIDS

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The Truth aboutSTI/STD, HIV & AIDS (Lecture Guide)Tagalog/Filipino/Pinoy version.This is a genuine compilation of my lecture about STI, HIV and AIDS in the Department of Health, community/barangay outreach and orientation.Short but Comprehensive.Made Easy

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Page 1: The Truth about STI, HIV & AIDS

PATRICK D. ALBIT, RNPATRICK D. ALBIT, RNBCC CoordinatorBCC Coordinator

DavaoDavao

S T IS T I

Page 2: The Truth about STI, HIV & AIDS

Maslow’s Hierarchy of Needs(Pangangailangan ng Tao)

Page 3: The Truth about STI, HIV & AIDS

SEXuallyTransmitted Infections

Page 4: The Truth about STI, HIV & AIDS

Ano ang STI?Ano ang STI?

Sexually Transmitted Infections

Page 5: The Truth about STI, HIV & AIDS

STD STD VSVS STI STISTD

• May Negatibong pananaw; diskriminasyon

• Pag-inicip ng isang tao ang salitang ‘disease’ sa tingin nila ito ay sakit na pang habangbuhay

• Kadalasan din ang sabi ng iba ito ay palaging my mga Nakikitang SINTOMAS

STI

* Hindi masakit pakinggan/not offensive term

• Kadalasan sa mga STI, ito ay nagagamot at may lunas.

• Karamihan sa iba’t-ibang klase ng STI ay walang SINTOMAS na nararamdaman. Tulad ng Chlamydia, gonorrhea, herpes, at HPV.

Renamed: WHO,1998

Page 6: The Truth about STI, HIV & AIDS

Sexually Transmitted Infections

* Ito ay mga sakit na “komon” nakukuha sa pakikipagtalik

* Daanan / Entrance

* Parehong nakakaapekto sa babae at lalaki

* Bacteria, Viruses, Protozoa or Parasites

* Impeksyon na nakukuha sa pamamagitan ng di ligtas na pakikipagtalik sa taong mayroon nito.

* Maaaring ang isang tao ay may STI ngunit ito’y hingi nya alam.

Page 7: The Truth about STI, HIV & AIDS

Paano naiilipat ang mga STI?

Walang proteksyon na

pakikipagtalik= “AVO”

* Anal

* Vaginal

* Oral

Body contact (Ari o puwitan)

Kulang o maling paglilinis ng ari

Page 8: The Truth about STI, HIV & AIDS

.

Common:

1. GONORRHEA2. CHLAMYDIA3. TRICHOMONIASIS4. CANDIDIASIS5. BACTERIAL VAGINOSIS6. HERPES GENITALIS7. GENITAL WARTS8. SYPHILIS9. PUBIC LICE

Iba’t-ibang Uri ng STI sa Pilipinas

Page 9: The Truth about STI, HIV & AIDS

SYMPTOMATIC

ASYMPTOMATIC

SYMPTOMS

(Nararamdaman)

* Masakit / pain

* Lower abdominal pain* Sore throat

SIGNS

(Nakikita)

* Nana; pamumula

* Sugat; pamamaga* Nana sa puwitan * Dugo sa ihi

Page 10: The Truth about STI, HIV & AIDS

BABALA

ANG MGA SUMUSUNOD NA EKSENA NA INYONG MASASAKSIHAN AY PAWANG KATOTOHANAN LAMANG AT MAARING SENSITIBO ITO PARA SA IBA. PATNUBAY SA MGA MANUNUOD AY KAILANGAN….

PINAPAYUHAN DIN PO NAMIN ANG LAHAT NA WAG MASYADONG MAGREACT DAHIL ANG MAG REACT, GUILTY! ….

Page 11: The Truth about STI, HIV & AIDS
Page 12: The Truth about STI, HIV & AIDS

Sexually Transmitted Infections

Trichomonas Trichomonas Genital herpes

Genital warts

Genital

molluscum

HIV

Hepatitis B *

Genital herpes

Genital warts

Genital

molluscum

HIV

Hepatitis B *

Gonorrhea

Syphilis

Chlamydia

Chancroid

Gonorrhea

Syphilis

Chlamydia

Chancroid

ProtozoalProtozoalViralViralBacterialBacterial

CandidiasisCandidiasis

Skin

Parasites

Skin

ParasitesFungalFungal

Pubic Lice

Scabies

Pubic Lice

Scabies

passed on by close body contact and do not require actual penetrative intercourse

Page 13: The Truth about STI, HIV & AIDS

GONORRHEA

“Tulo”

Signs and symptoms in males :

* malapot, mabaho, madilaw, at puting nana

ang lumalabas sa ari. (80%)

* madalas at mahapdi na pag-ihi, lagnat

* pangangati ng puwitan o ari

* dugo sa ihi

* walang sintomas(10%)

Page 14: The Truth about STI, HIV & AIDS

Gonorrhea (Lalaki)

Page 15: The Truth about STI, HIV & AIDS

1. GONORRHEA (Babae)

Signs and symptoms:

* malapot, mabaho, madilaw,

at puting nana ang lumalabas sa ari. (50%)

* madalas at mahapdi na pag-ihi, lagnat

* pangangati ng puwitan o ari

* dugo sa ihi

* sore throat; 75 % walang sintomas

Page 16: The Truth about STI, HIV & AIDS

Genital discharges

Gonorrhea sa Babae

Page 17: The Truth about STI, HIV & AIDS

WANTED:Gonorrhea aka

“Tuls”

Modus: Masakit at Nana sa pag-ihi

Targets: Babae at Lalaki

Piyansa: Nagagamot

Page 18: The Truth about STI, HIV & AIDS

CHLAMYDIA

“CHLAMY”

Signs and symptoms:

* malapot at walang kulay na likido sa ari

* madalas na pag-iihi, mahapdi, mabaho

* walang sintomas sa mga kalalakihan

* lagnat, abnormal na pagreregla

Page 19: The Truth about STI, HIV & AIDS

Non-Gonococcal Genital Discharges

Chlamydia trachomatis sa Babae

Page 20: The Truth about STI, HIV & AIDS

Chlamydia sa Lalaki

Page 21: The Truth about STI, HIV & AIDS

WANTED:Chlamydia aka

“Chlamy”

Modus:Masakit pag-ihi, mahapdi

Targets: Babae at Lalaki

Piyansa: Nagagamot

Page 22: The Truth about STI, HIV & AIDS

TRICHOMONIASIS

“TRICH”

Signs and symptoms:

* sa babae. vaginal discharge (50%), madilaw, maberde, mabula at mabaho ang lumalabas sa ari

* madalas at mahapdi na pag-ihi

* matinding pangangati ng ari

* walang sintomas (10-50%)

Page 23: The Truth about STI, HIV & AIDS

Trichomoniasis Trichomoniasis

Page 24: The Truth about STI, HIV & AIDS

Strawberry –like appearance of cervix (puerta)

Trichomonas vaginalis

Page 25: The Truth about STI, HIV & AIDS

WANTED:Trichomonas aka

“Trich”

Modus:Masakit na pag-ihi, Nana

Targets: Babae at Lalaki

Piyansa: Nagagamot

Page 26: The Truth about STI, HIV & AIDS

Bacterial Vaginosis Bacterial Vaginosis (BV)(BV)

maaaring walang sintomas

mabaho (fishy), manipis at maputi hindi masakit

pero ito ay hindi isang STI by CDC

Page 27: The Truth about STI, HIV & AIDS

WANTED:Bacterial Vaginosis

aka “BV”

Modus: Mabaho sa pang-amoy (Fishy)

Targets: Babae

Piyansa: Nagagamot

Page 28: The Truth about STI, HIV & AIDS

CANDIDIASIS

“CANDY”

Signs and symptoms:

* Nana- malapot at makapal

* makati

* mahapdi at madalas na pag-ihi

* dyspareunia

(masakit ang ari habang nakikipagtali)

Page 29: The Truth about STI, HIV & AIDS

Candidal Vaginitis

Page 30: The Truth about STI, HIV & AIDS

WANTED:Candidiasis aka

“Candy”

Modus: Thrush, masakit sa pag-ihi at habang

nakikipagtalik

Targets: Babae at Lalaki

Piyansa: Nagagamot

Page 31: The Truth about STI, HIV & AIDS

GENITAL ULCERATIVE DISEASES/MAY MGA SUGAT

SYPHILIS

UNANG YUGTO

- nakukuha sa paghalik at pakikipagtalik

Signs: Chancre o singaw sa bibig o ari na hindi makati at masakit. Nakakahawa ito kahit walang sintomas.

Page 32: The Truth about STI, HIV & AIDS

Unang Yugto ng Syphilis

Page 33: The Truth about STI, HIV & AIDS

SyphilisSyphilisUNANG YUGTO

Chancre- indurated border with clean base

Page 34: The Truth about STI, HIV & AIDS

Syphilis in female

Hindi Masakit

Page 35: The Truth about STI, HIV & AIDS

PANGALAWANG YUGTO

*multi system involvement

*6 weeks to 6 months after the chancre

- pantal-pantal sa buong katawang na parang tigdas na matigas at kumakalat maging sa palad at talampakan, sugat sa bibig, pamamaga ng lalamunan, pang hihina, lagnat, patse-patseng pagkakalbo.

Signs: skin rash - condyloma lata

Page 36: The Truth about STI, HIV & AIDS

SyphilisSyphilisPangalawang Yugto

Page 37: The Truth about STI, HIV & AIDS

SyphilisSyphilisPANGALAWANG YUGTO

Page 38: The Truth about STI, HIV & AIDS

SyphilisSyphilisPANGALAWANG YUGTO

Page 39: The Truth about STI, HIV & AIDS

Latent Stage

Latent syphilis –pagkawala ng mga sintomas ngunit ang bakterya ay patuloy sa pagdami at pagkalat patungo sa ikatlong yugto.

Sa panahong ito malakas makahawa ang syphilis, subalit ito ay maaring magamot kung maagapan sa yugtong ito.

Page 40: The Truth about STI, HIV & AIDS

IKATLONG YUGTOIKATLONG YUGTO

5 - 20 years after the initial infection5 - 20 years after the initial infection

only Treponemal tests only Treponemal tests

Pwedeng makadulot ng pirmanenteng Pwedeng makadulot ng pirmanenteng pagkapinsala sa puso at pag-iisippagkapinsala sa puso at pag-iisip

Page 41: The Truth about STI, HIV & AIDS

SyphilisSyphilisTertiary

Gumma

Page 42: The Truth about STI, HIV & AIDS

WANTED:Syphilis aka “Black Lion”

Modus: Singaw na hindi masakit; warty rashes

Targets: Babae at Lalaki

Piyansa: Nagagamot

Page 43: The Truth about STI, HIV & AIDS

Phthiriasis Phthiriasis

‘Phthirus pubis”

Crab Louse

Page 44: The Truth about STI, HIV & AIDS

WANTED:Phthiriasis aka

“Lu-sa”

Modus: ITCH

Targets: Babae at Lalaki

Piyansa: Nagagamot

Page 45: The Truth about STI, HIV & AIDS

GENITAL HERPES

Signs and symptoms:

Lagnat,

Kumpol-kumpol na paltos (parang chicken pox),

Sa Babae: pangangati at pananakit ng paltos sa loob at labas ng ari.

Mahapdi sa pag-ihi,

Masakit ang ari kung nakikipagtalik,

mga sugat, pananakit ng puson, binti at hita.

Page 46: The Truth about STI, HIV & AIDS

Herpes Genitalis GENITAL ULCERATIVE DISEASES

Masakit

Page 47: The Truth about STI, HIV & AIDS

Stages of Herpes simplex infection

Herpes

Healing-20 days

Page 48: The Truth about STI, HIV & AIDS

WANTED:Herpes genitalis aka

“Herp”

Modus: kumpol-kumpol at masakit na paltos

Targets: Babae at Lalaki

Piyansa: Walang gamotNo Cure

Page 49: The Truth about STI, HIV & AIDS

Human Papilloma Virus (HPV)

GENITAL WARTS

Sintomas:

-Pangangati kung saan may kulugo na matatagpuan sa loob at labas ng ari

-Maliliit na butlig sa simula, lumalaki na parang

“cauliflower” habang tumatagal.

Komplikasyon: Kanser sa puwit at puerta.

Tandaan!

Naisasalin sa sanggol.

Kahit na ipagamot ito ay nakakahawa parin, ginagamot lamang ang kulugo pero hindi ang virus na sanhi nito

Page 50: The Truth about STI, HIV & AIDS

Genital Wart

Page 51: The Truth about STI, HIV & AIDS

Genital Wart

Page 52: The Truth about STI, HIV & AIDS

WANTED:Genital Warts aka

“GenWa / HPV”

Modus: Kalugo

Targets: Babae at Lalaki

Piyansa: With treatment but NO CURE

Page 53: The Truth about STI, HIV & AIDS

HEPATITISHEPATITIS

Hepatitis A Hepatitis B Hepatitis C

Dumi ng tao / tae Dugo Blood to blood products

Maruruming pagkain Tamod / sex Possible with Sex

Maruruming inumin Hima Infected needles

Raw foods Gatas ng ina

Sobrang pag-inom ng alak Laway

Mother-to-child

Infected needles

Magkatulad ng Hepatitis E Magkatulad ng Hepatitis D

Hepa A: pagkahilo, pagtatae, pagduduwal, paninilaw at sobrang pagodHepa B: matamlay, nasusuka, kumikirot na tiyan, sakit sa kasukasuan, tsa-ang ihi at paninilawHepa C: lagnat, sobrang pagod, pagkahilo, pagsusuka, maitim na ihi, pagtatae, paninilaw, masakit na sikmura, walang gana kumain at pag-ayaw sa sigarilyo,

Page 54: The Truth about STI, HIV & AIDS

WANTED:Hepatitis aka

“Hep”

Modus: Paninilaw; Target ang Atay

Targets: Babae at Lalaki

Piyansa: NO CURE

Page 55: The Truth about STI, HIV & AIDS

THE COMPLICATIONS

Cervical CancerCervical CancerSterilitySterility

AbortionAbortionStillbirths Stillbirths

Death Death

Page 56: The Truth about STI, HIV & AIDS

Complications

Epididymo-orchitisEpididymo-orchitisGonoccocal / Chlamydial

• Epididymitis• Orchitis• Prostatitis • Seminal

vesiculitis

INFERTILITY

Page 57: The Truth about STI, HIV & AIDS

Ophthalmia Ophthalmia NeonatorumNeonatorum

Swelling RednessPurulent eye discharge One or both eyesWithin first 21 days of birth

Page 58: The Truth about STI, HIV & AIDS

Ophthalmia Ophthalmia Neonatorum Neonatorum

From infected birth canalMost likely caused by: Neisseria gonorrheae Chlamydia trachomatis

Corneal scarringPAGKABULAG

Page 59: The Truth about STI, HIV & AIDS

Eye Infection in AdultsEye Infection in Adults

Gonococcal and Chlamydial Ophthalmia

Refer for Ophthalmologic evaluation

Page 60: The Truth about STI, HIV & AIDS

TEKA MUNA…Tanong: Anong unang pumapasok sa isipan nyo kapag naririnig nyo ang salitang HIV?

AIDS Society of the Philippines – ASP / RHWC

Page 61: The Truth about STI, HIV & AIDS

ANG…

H. I. V.

HumanImmunodeficiencyVirus

AIDS Society of the Philippines – ASP/RHWC

Page 62: The Truth about STI, HIV & AIDS

33.3 MILLION IN THE WORLD

6,016 Philippines

140 Davao

Page 63: The Truth about STI, HIV & AIDS

MGA KABABAYAN SA BUONG MUNDO

2009#169 Philippines

2010#108 Philippines

Philippines 2009-10 IHBSS# 3 Davao City# 2 Davao MSM group

Page 64: The Truth about STI, HIV & AIDS

DAVAO CITY AIDS REGISTRY ( As of MARCH 2011 )DAVAO CITY AIDS REGISTRY ( As of MARCH 2011 )

TABLE 1. QUICK FACTS

DEMOGRAPHIC DATA

1993-Sept2010 Sept-Dec 31 2010

Cumulative1993-March 31. 2011

Total cases 82 36 140

Males 72 35 128

Females 10 1 12

Youth 15-24 14 0 32

Reported Deaths due to AIDS

16 0 17

DEC 2008- 32 cases

DEC 2009- 47 cases

DEC 2010-118

Page 65: The Truth about STI, HIV & AIDS

TABLE 2. QUICK FACTS

Mode of Transmission

1993-Dec 2010

Dec 31,2010 March 31 2011

Cumulative1993-March 31. 2011

Sexual Contact

Heterosexual 10 1 11

Homosexual 102 21 123

Bisexual 5 0 5

Blood/blood products

IDU 1 0 1

Needle prick

Mother-to-child

No available

Page 66: The Truth about STI, HIV & AIDS

Bakit Kelangan natin malaman ang tungkol saHIV at AIDS

AIDS Society of the Philippines – ASP / RHWC

Page 67: The Truth about STI, HIV & AIDS

Pandaigdigang Problema

Walang pinili kung anu man ang istado mo sa buhay; Mahirap o Mayaman; Matanda o Bata

Problema sa Kalusugan

Walang Lunas o gamot

Page 68: The Truth about STI, HIV & AIDS

Paniniwala: It only affects foreigners, gay men, and sex workers

Katotohanan: LAHAT AY

PWEDENG MAHAWAAN

NG HIV AT AIDS

AIDS Society of the Philippines – Patrick Albit, RN

Page 69: The Truth about STI, HIV & AIDS

Bakit patuloy tumataas?

• Pagtaas ng populasyon

• Pagtaas ng pagamit ng droga

• Sex workers

• Kulang at maling edukasyon tungkol sa mga sakit

• Ayaw magpakonsulta

• At kulang/maling paggamit ng condom

• Mayroon na noon at ngayon lang nagpakonsulta

ASP / RHWC

Page 70: The Truth about STI, HIV & AIDS

H I VHuman Immunodeficiency VirusHuman Immunodeficiency Virus

Targets CD4 cells na makikita sa: dugo

tamod gatas ng ina

likido ng babae

• Asymptomatic for 5-10 years

• Panghabang buhay na sakit

• Walang Bakuna; Ang hangganan nito ay AIDS

Page 71: The Truth about STI, HIV & AIDS

71

Saan Nanggaling ang sakit na ito?

Ang sabi ng mga Teorya:

Chimpanzee o Onggoy

Animal Hunting

Page 72: The Truth about STI, HIV & AIDS

Ang Pagpasok ng HIV

CD4

Page 73: The Truth about STI, HIV & AIDS

 

How HIV infects ?

HIVHIV

OI’s

Dadame ang HIV Virus sa katawan mauubos ang CD4 cells

Page 74: The Truth about STI, HIV & AIDS

• Hangganan / Terminal stage ng HIV

• Maglalabasan ang mga signs and symptoms

• Cancers

• Pagkakaroon ng oportunistang Impeksyon

ASP / RHWC

Page 75: The Truth about STI, HIV & AIDS

HIV Positive: Asymptomatic

AIDS: 2-15 y (ave; 10)

AIDS Society of the Philippines

Page 76: The Truth about STI, HIV & AIDS

PERSON WITH AIDS

AIDS Society of the Philippines ASP / RHWC

Page 77: The Truth about STI, HIV & AIDS

Signs and SymptomsCANCER Kaposi’s sarcoma

AIDS Society of the Philippines ASP / RHWC

Page 78: The Truth about STI, HIV & AIDS

AIDS Society of the Philippines / RHWC

Page 79: The Truth about STI, HIV & AIDS

* INFECTED BLOOD & BLOOD PRODUCTS

A S P / R H W C

Page 80: The Truth about STI, HIV & AIDS

* INFECTED MOTHER TO CHILD

During pregnancy During delivery During breast feeding

A S P / R H W C

Page 81: The Truth about STI, HIV & AIDS

A S P / R H W C

Page 82: The Truth about STI, HIV & AIDS

A S P / R H W C

KAHIT SINO PWEDENG HAWAAN NG HIV

Page 83: The Truth about STI, HIV & AIDS

* EXPOSURE

* WINDOW PERIOD (6 weeks to 6 months )

•ASYMPTOMATIC STAGE (5 - 10 years )

•AIDS ( 6 months to 2 years )

* DEATH

A S P / R H W C

Page 84: The Truth about STI, HIV & AIDS

WANTED:HIV

Modus: Ubusin ang Resistensya

Targets: Babae at Lalaki

Piyansa: Walang gamotHindi nagagamot ng antibiotics o

vitamins!

Page 85: The Truth about STI, HIV & AIDS

Tandaan!Paano Naisasalin? Hindi nakakahawa ang HIV sa:

Walang proteksyon na pakikipagtalik

PakikipaghalikanWala sa laway at pag-ubo

Kontaminadong dugo Yakapan o besobeso

Kontaminadong Heringgilya

Pawis at luha

Mother-to-child at breastmilk

Pakikipagkamay

Paghatsing

Hiraman ng gamit

Hiraman ng kubyertos o pagkain

Kagat ng lamokPagtabi sa pagtulog

Paggamit ng banyo

Page 86: The Truth about STI, HIV & AIDS

Nagagamot Hindi Nagagamot

Tulo / Gonorrhea Herpes

Chlamydia HPV / Genital Warts

Trich Hepatitis

Bacterial Vaginosis HIV

Candidiasis

Pubic lice

Syphilis

TANDAAN!Nagagamot vs Hindi Nagagamot?

4H’s

Page 87: The Truth about STI, HIV & AIDS

ANO ANG DAPAT GAWIN?

A – Abstain

B – Be faithful

C – Careful sex / condom use

D – Don’t use illegal drugs o

sharing of needles

E – EducationF- Fantasize

Page 88: The Truth about STI, HIV & AIDS

A - Abstinence

AIDS Society of the Philippines ASP / RHWC

Page 89: The Truth about STI, HIV & AIDS

B – Be faithful

AIDS Society of the Philippines ASP

Page 90: The Truth about STI, HIV & AIDS

CONDOM

C – Careful Sex

AIDS Society of the Philippines ASP

Page 91: The Truth about STI, HIV & AIDS

D – Don’t inject drugs/Don’t share N/S

AIDS Society of the Philippines – ASP / RHWC

Page 92: The Truth about STI, HIV & AIDS

2 Screening Test (+):(Particle Agglutination)

Confirmatory Test(Western Blot)

(-) Screening Test:•Negative for HIV•Window period (repeat after 3-6 mos.)

AIDS Society of the Philippines – ASP / RHWC

Page 93: The Truth about STI, HIV & AIDS

MAY GAMOT BA ANG HIV AT AIDS?

Hindi pa rin natutuklasan ang gamot para sa HIV/AIDS peromay mga libreng ARVs para masugpo ang virus sa pagkalat.

KAPAG NAGING HIV + ? ….

Healthy lifestyle / Exercise Puntahan ang mga support groups Uminom ng Anti-retroviral drugs o ARVs Wag ma depress at Ma-stress

93

Page 94: The Truth about STI, HIV & AIDS

Sa Maikling Salita,In Short….

Page 95: The Truth about STI, HIV & AIDS

95

Makuha ba natin ang HIV sa …QUIZ:

HINDI!

Page 96: The Truth about STI, HIV & AIDS

96

QUIZ:

Mosquito bite

Makuha ba natin ang HIV sa …

HINDI!

Page 97: The Truth about STI, HIV & AIDS

Swimming Pool Toilet bowl

HINDI!

Page 98: The Truth about STI, HIV & AIDS

National AIDS/STI Prevention & Control ProgramDepartment of Health

KISSING SHARING UTENSILS

HINDI!

Page 99: The Truth about STI, HIV & AIDS

99

HINDI!

Page 100: The Truth about STI, HIV & AIDS

100

HINDI!

Page 101: The Truth about STI, HIV & AIDS

National AIDS/STI Prevention & Control ProgramDepartment of Health

tears saliva sweat

Page 102: The Truth about STI, HIV & AIDS

Kunwari….

H+ = H+ couple

Kelangan pa ba gumamit ng condom pagnakikipagtalik?

YES!

Page 103: The Truth about STI, HIV & AIDS

Ano ang Gagawin Kung May STI/HIV?

Ipamigay alam sa partner

Magpakunsulta

Kumpletuhin ang pag-inom ng gamot ayon sa reseta

Gumamit ng condom

Huwag hayaan lumala

Page 104: The Truth about STI, HIV & AIDS

PALAGING ISIPIN…

WALANG DISKRIMINASYON

Para walang nasasaktan

I-RESPETO ANG BAWAT ISA

IBIGAY ANG TAMANG EDUKASYON

At MAGTULUNGAN PO TAYO

Page 105: The Truth about STI, HIV & AIDS

Para tayong lahat ay…..

MASAYA…..

Page 106: The Truth about STI, HIV & AIDS

MARAMING SALAMAT PO . . .

(^^,)MABUHAY!

P A T R I C K D. A L B I T, R N