1. Sexually Transmitted Infections
Cathlene Hardy Hansen and
Pat Nagel--Health Educator

2. IU Health Center Services
Massage: $33 with paid health fee
Nutrition: 1 session free/semester
Tobacco Cessation: Free, including cessation products
CAPS therapy sessions: 2 free semester
Sexual Assault Counseling: free, unlimited sessions
Gynecological exams: free (tests, pay)

3. INTRODUCTION
“This is a hidden and silent epidemic. Normally an epidemic of this proportion would have attracted more attention.”
1996, Chancellor of Baylor College of Medicine
Refers to the 12 million new STI cases/year in
1996; now estimated to be 15 million/year (increase due to higher numbers and better testing)
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4. INTRODUCTION Hidden – 2 meanings Silent – 3 meanings
1. taboo subject of sex; not talked about publicly in a serious way
2. most Americans not aware of this epidemic
Silent – 3 meanings
1. some STIs have no symptoms
2. lack of communication between individuals and their health care providers
3. lack of communication between sexual partners

5. STI vs. STD STI STD Someone who is an infected person
ASYMPTOMATIC may not have any symptoms,
Could be unaware that they are even sick.
STD
A disease is any abnormal condition
of the body or mind with some type of symptom,
in other words your body tells you that you are unwell.

6. BACTERIA VIRUS Living organism
May be stopped with appropriate antibiotic
Mild  Severe
Not “alive;” lives on host
No known cures
Controlled by vaccine
Mild  Severe

7. IMPACT ON WOMEN
Lack of symptoms; more difficult to diagnose until serious problems develop
150,000 (estimate) women become infertile each year due to PID (pelvic inflammatory disease)as a result of an STI
15-30% (estimate) of the 2.3 million US couples who are infertile may by result of an STI

8. RISK FACTORS Most STIs more easily transmitted to women than to men
Co-factor: infected with an STI makes one more likely to contract another STI, including HIV, after unprotected sexual contact with an infected partner
Multiple sex partners increase risk of exposure over one’s lifetime

9. Viral
Viral:
Herpes
HPV
HIV
Hepatitis B

10. HERPES GENITALIS Caused by: Herpes Simplex Virus (HSV);
Type 1: 50-80% exposure rate; prefers facial area;
Type 2: 20% exposure rate; prefers genital areas;
Once in body, migrates to a nerve cluster (ganglia) and goes dormant; evades detection from body’s immune system; probably not contagious at this time.
May stay dormant forever or may migrate back to its first entry point on skin (active phase); it infects healthy cells, making new viruses. The immune system attacks and destroys infected cells; this “battle” is a herpes “outbreak.”

11. Herpes - symptoms
Incubation period: 1-12 days after sex with an infected person; may not appear for months or years
Duration: may last 12 days; flu-like symptoms; average of 4-5 outbreaks per year;
Sores: single or multiple fluid-filled blisters; painful; some outbreaks are mild and go unnoticed, especially in men
Outbreaks: not known for sure what causes successive outbreaks; they seem to occur more often when a person is rundown, under extreme stress, sick or sunburned, when the body is weak, in some way.
Future outbreaks? Duration, frequency and severity depend on: 1. is virus in preferred site (HSV-1 on genitals recurs less often than HSV-2; HSV-2 can be transmitted to the mouth, although rare);
2. each individual’s immune system;
3. how long person has had the virus.

12. Herpes - transmission
Skin to skin contact with infected person; includes oral, anal and vaginal sex; most contagious when sores are present;
Asymptomatic viral shedding (virus on skin surface but no symptoms); probably most common way virus is transmitted; approximately 80-90% of those with genital HSV do not know they’re infected; viral shedding most significant in year following first outbreak;
Viral shedding continues about 5-10% of each year; days can’t be predicted;
No documented cases of transmission from inanimate object such as toilet seat

13. Genital Herpes - Penis Genital Herpes - Vulva Picture Credits:
University of Erlangen, Department of Dermatology and American College Health Association

14. Human Papilloma Virus Caused by: Mode of Transmission: Symptoms:
Human papilloma virus (HPV) on genitals (vagina, cervix, urethra, penis, anus)
Over 100 types of HPV, of which can infect genitals
Mode of Transmission:
Skin-to-skin contact with an infected person; penetration not needed; could happen during anal, vaginal and oral sex
Virus can be transmitted when no warts or symptoms are present
Symptoms:
Dry, painless, firm, rough warts – may be large or small, multiple or single. May itch or cause irritated area (only small percentage will have warts)
Cervical changes detected on Pap test
HPV may be present without visible warts or cervical changes

15. Genital Warts Penis Genital Warts (HPV) Vulva Picture Credits:
University of Erlangen, Department of Dermatology and Health Awareness Connection

16. Human Papilloma Virus (Cont.)
Diagnosis:
Clinical observation of genital warts. Symptoms may appear 1-8 months or longer after exposure.
Colposcopy - a procedure in which a colposcope (a lighted magnifying device) is used to identify the area of HPV infection on the cervix.
Pap test which detects cervical cell changes and HPV typing (determines high or low risk)
When an HPV test is positive, it does not mean that the virus is new or that a partner has been unfaithful. HPV can persist in cells for decades.
No diagnosis for asymptomatic males
Treatment:
Removal of warts by caustic chemical treatment, cryosurgery (freezing), laser treatment, electrocautery, or surgical removal of genital warts.
Careful follow-up of abnormal Pap test
May be transient infection. Immune system may clear HPV from the body over time or suppress the virus. Contagious? Probably not.

17. Human Papilloma Virus (Cont.)
Potential Complications:
Several strains, 23 types of HPV, are associated with an increased risk of cervical cancer (These strains generally do not cause visible warts.) Persistent infection with high risk type increases risk for cervical cancer.
Less common, but also reported, are increased risk of cancer of the vagina, penis, and anus as well as mouth cancers.
Transmission rate to newborn is unknown, but thought to be low.
VACCINE is now available; Gardasil is for females AND males ages 9-26; works against 2 strains most often implicated in cervical cancer and 2 strains that cause about 90% of genital warts; series of 3 shots ($155/shot at HC);
NEW VACCINE just FDA approved: Cervarix; only for females and only protects against the 2 most common strains related to cancer
pap test for women still necessary due to 30% of cervical cancers caused by other strains.
Women age 27+ may obtain shot from HC; must see dr. or NP first, sign consent form. May not be as effective as compared to younger women.

18. Human Papilloma Virus (Cont.)
Comments:
5.5 million new cases are diagnosed yearly; numbers are probably higher
Most common STI in the U.S.
Recent study reports: more than ½ of young adults in a new sexual relationship were infected with HPV; among those infected, nearly ½ were from an HPV type that causes cancer. Take away message? All young people should expect to be exposed to HPV.
HPV is the leading cause of cervical cancer
Condoms may help but may not cover all areas

19. Hepatitis B Caused by: Mode of Transmission: Hepatitis B virus
Unprotected anal, oral, or vaginal sex with an individual infected with Hep B
Sharing Hep B contaminated needles and syringes
Mother-to-child transmission during breastfeeding or childbirth

20. Hepatitis B (Cont.) Diagnosis: Treatment: Potential Complications:
Blood test for Hep B
Treatment:
No specific treatment
Supportive care is given
Nutritious diet is important
Alpha interferon for treatment of chronic Hep B infection
Vaccination available
Potential Complications:
Chronic Hep B infection increases risk of liver disease, liver cancer, death
5-10% of adults and adolescents become chronic carriers

21. HIV Infection Caused by: Human Immunodeficiency Virus
Mode of transmission:
SEX: Unprotected anal, oral, or vaginal sex with an individual infected with HIV/AIDS
BLOOD: Sharing contaminated needles and syringes with an HIV positive individual
BIRTH: Mother-to-child via breastfeeding or childbirth

22. HIV Infection (Cont.) Symptoms:
Flu-like symptoms – usually 2-4 weeks; up to 12 weeks
Antibodies usually develop within three months, but can take up to six months
Asymptomatic (No symptoms)
Symptomatic HIV disease – average 8-11 years between exposure to virus and symptoms appear. May be longer with treatment
AIDS: Specific diseases, opportunistic infections. Weakened immune system - < 200 T-cell; the virus works by invading specific immune system cells, makes more copies of itself so that immune system is unable to fight off infections.

23. HIV Infection (Cont.) Diagnosis:
HIV antibody test, accurate at 3-6 months after exposure to virus.
Two ways of being tested:
1. anonymous: no identifying information associated with your test results;
2. confidential: test results put into your medical records.
Newer form of testing that does not require a blood sample; a sample of mouth cells is used; Positive link offers anonymous and confidential testing with Oraquick, results available in approximately minutes; cost

25. Prevention – What can you do?
Abstain from risky sexual behaviors
Be sexually monogamous with an uninfected partner
Communicate with a sexual partner; self-esteem issues
Needle Exchange program
AZT Medications

26. Do condoms work all the time?
Effectiveness: 95-98% when used correctly and consistently
Heterosexual couple study – 1994
256 discordant couples (163 HIV+ M; 93 HIV+ F)
½ couples reported condom use every time (vaginal or anal intercourse); no HIV+ conversions
Of the 121 couples reporting inconsistent or never using condoms, 12 HIV+ conversions

27. Bacterial
Bacterial:
Chlamydia
Gonorrhea
Syphillis
Vaginitis

28. Chlamydia Caused by: Mode of transmission:
Chlamydia trachomatis bacteria
Prevalence: 4 million new cases per year
Mode of transmission:
Unprotected oral, vaginal, or anal sex with an infected person in which there is an exchange of vaginal or cervical secretions or semen
Mother-to-infant during childbirth

29. Chlamydia (Cont.) Symptoms:
Symptoms may appear 1-3 weeks after sex with an infected partner (incubation period)
Men
Discharge from urethra
Painful urination
20-40% of men have no symptoms of infection
Women
Vaginal discharge
Burning and bleeding with intercourse
Fever
Abdominal pain
Swollen lymph glands
60-80% of women have no symptoms of infection

30. Chlamydia (Cont.) Diagnosis: Treatment: Cell culture
Microscopic examination of discharge
Urine test for men
Treatment:
Specific antibiotic regimen such as doxycycline, zithromax, or tetracycline
Those infected and their partners should be treated at the same time to prevent the passing of infection back and forth between partners.

31. Gonorrhea Caused by: Mode of transmission:
Neisseria gonorrhea bacteria
Mode of transmission:
Unprotected oral, vaginal, or anal sex with an infected person in which there is an exchange of vaginal or cervical secretions or semen
Mother-to-infant during childbirth

32. Gonorrhea (Cont.) Symptoms:
Symptoms may appear 2-10 days after sex with infected partner
Men
Discharge from urethra
Increased frequency and pain during urination
25% of men have no symptoms
Women
Vaginal discharge
Abnormal menses
Painful urination
80% of women have no symptoms

33. Syphilis (Cont). Symptoms: Primary Secondary Latent Late (Tertiary)
1-12 weeks after sex with infected partner, painless sore on genitals (chancre)
Secondary
2 weeks to 6 ½ months after exposure, a skin rash (on entire body, hands or soles of feet) and flu-link symptoms may develop
Latent
Patients are without clinical signs of infection – not contagious and no symptoms
Late (Tertiary)
1/3 of persons not treated will develop complications such as damage to the heart, brain, eyes, nervous system, bones, and joints

34. Primary Syphillis (sore on penis) Secondary Syphillis (rash on hands)
Picture Credits:
University of Erlangen, Department of Dermatology

35. Syphilis (Cont.) Diagnosis: Treatment: Potential complications:
Serologic (blood) test for syphilis
Treatment:
Penicillin by injection or other antibiotic
Potential complications:
If left untreated – blindness, heart disease, brain damage, death
Comments:
Rare

36. Vaginitis
Caused by:
Trichomonas vaginitis – protozoan: women will most likely be symptomatic while most men will be asymptomatic
Bacterial vaginosis – bacteria
Yeast (candida) – fungus
Mode of transmission:
Unprotected oral, anal, or vaginal intercourse
Not always sexually transmitted

37. Vaginitis (Cont.) Symptoms: Diagnosis: Men Women
If symptomatic, inflammation of the urethra
Skin irritation of the penis
Women
Swelling
Itching or pain of the external genitalia
Discharge is excessive or malodorous
Diagnosis:
Microscopic examination of discharge

38. Vaginitis (Cont.) Treatment: Potential complications: Trichomonas
Metronidazole – partner also treated to prevent reinfection
Bacterial vaginosis
Metronidazole or clindamycin
Yeast (Candida)
Miconazole nitrate or clotrimazole
Potential complications:
Recurrent infections are common

39. Other STIs

40. Pubic Lice (Crabs) Cause: Mode of Transmission: Symptoms:
Lice that infect the genital region in both men and women
Phthirus pubis
Mode of Transmission:
Skin-to-skin contact with someone who is infected
Contact with bedding or clothing of some who is infected
Symptoms:
For some, there is noticeable itching
Individuals may notice nits – tiny white specks on hair follicles
May take a few days to a month to develop symptoms
Picture Credits:

41. Pubic Lice (Crabs) Cont.
Diagnosis:
Usually only a visual exam of the genitalia is needed to diagnose pubic lice
Medial providers may also look at nits and lice under a microscope
Treatment:
Usually treated with a medicated shampoo
Those infected do not necessarily have to shave pubic hair
Important also to wash clothing, bedding etc. with which the infected individual has had contact
Comments:
May be transmitted from an inanimate object like a toilet seat.

42. Scabies Cause: Mode of Transmission: Symptoms: A skin mite
Sarcopetes scabei
Mode of Transmission:
Skin-to-skin contact with someone who is infected
Contact with bedding or clothing of some who is infected
Symptoms:
A rash that appears about 2-4 weeks after infection usually on the hands, wrists, and genitals
Itching – more prominent at night and after showers
Picture Credit:

43. Scabies (Cont.) Diagnosis: Treatment:
A visual exam of the genitals may be all that is needed
It is possible for the symptoms of scabies to be confused with the symptoms of other skin conditions
Medical provider may choose to scrape a lesion and examine using using magnification.
Treatment:
Usually a cream is applied topically to the skin from the neck down.
Important also to wash clothing, bedding etc. with which the infected individual has had contact

44. Bloomington Men’s S.T.R.O.N.G. Project
Men between 17-24
Free STD testing (812)
Chlamydia
Gonorrhea
Trichomonas
$20 gift card
Confidential and voluntary

45. WEB SITES
American Social Health Association: and (for teens)
Centers for Disease Control:
IUHC lab:
Columbia University Health Education
Kinsey Institute Sexuality Information Service for Students
Gay and Lesbian Medical Association
Gay Men’s Health Crisis:
Planned Parenthood:
PP for teens:
Advocates for Youth:
chlamydia

46. Women & HIV/AIDS Overview and statistics
“Today the HIV/AIDS epidemic represents a growing and persistent health threat to women in the US, especially young women of color.” (CDC )

47. Cumulative Effects
Women make up an increasing part of the epidemic. Increased from only 8% (in 1985 ) to 14% (1992) to 23% (1995) to 26% of new HIV/AIDS diagnoses in 2007.
Of the approximately 1 million people living with HIV in the US, between 120, ,000 women have HIV. Nearly ¼ of these women don’t know they’re infected; this puts them at high risk of passing the virus to their babies.
Annual number of AIDS diagnoses increased 15% among women compared to 1% for men .

48. Cumulative Effects (continued)
According to a recent CDC study of more than 19,000 patients in 10 US cities, HIV+ women were slightly less likely than infected men to receive prescriptions for the most effective treatments for HIV infection.
In 2005, an estimated 4,128 women with AIDS died, representing 25% of the 16,316 persons with AIDS who died in the 50 states and the District of Columbia

49. Cumulative Effects (continued)
Of the women given an HIV or AIDS diagnosis in 2007, high risk heterosexual contact was the source for almost 83% of these infections; IDU in 16% of infections; 1% not identified. (CDC reported from 34 states)
Most women with HIV/AIDS receiving medical care had children under age 18 living at home (76%); child care may compromise a woman’s ability to manage her own illness

50. Cumulative Effects (continued)
Geography: HIV in some states more likely to have a woman’s face;
1/3 of those estimated to be living with AIDS in Maryland, Connecticut, NJ are female
(compared to 23% nationally)
New AIDS cases in women highest:
northeast
south
Women with HIV disproportionately low-income;
64% had annual income below $10,000
compared to 41% for HIV infected males

51. Living with HIV/AIDS: females by race & ethnicity
2007-CDC report from 34 states:
*66% African American women
*18% white women
*14% Hispanic/Latino women
Compared to their % of population (34 states):
*70% white women
*14% African American women
*11% Hispanic/Latino

52. African-American Women & HIV http://www. youtube. com/watch
African-American Women & HIV   Gloria Rueben-- Positive Voices: Women & HIV
Rate of HIV diagnoses for AA women decreased significantly from 82.7/100,000 in 2001 to 60.2/100,000 in 2005; rate still remains 20x rate for white women.
The rate of AIDS diagnoses for AA women (45.5/100,000) was approximately 23x the rate for white women (2/100,000) and 4x the rate for Hispanic women (12/100,000).
AA and Hispanic women together make up 24% of US women, yet they account for 82% of AIDS diagnoses (2003).

53. African-American Women & HIV
2002: Was leading cause of death among AA women age 25-34
compared to 6th leading cause of death for women overall in this age group.
Good news: 2006 no longer leading cause of death (4th) for AA women in this age group
Young AA women are at highest risk for STIs compared to other young women.
(Ex. Gonorrhea rate among AA women age15-19 is 14x greater than white females in same age group.
According to the CDC, AA youth (m & f) comprised the largest single group of young people affected by HIV

54. HIV Risk Factors Lack of recognition of partner’s risk:
Unprotected sex with multiple partners
including partners of both sexes and
Intravenous Drug Use;
Sexual Inequality in relationships with men:
lack of condom use due to fear of partner abuse or leaving the relationship;
power differential especially with younger women and older men.
Recent CDC study of urban high schools,
more than 1/3 of black and Hispanic women had their first sexual encounter with a male 3 or more years older.
These women, compared to those whose partners were approximately their own age, had been:
Younger at first intercourse,
Less likely to use a condom during first & most recent intercourse
Less likely to have used condoms consistently.

55. HIV Risk Factors Continued
Biologic vulnerability and STIs: a woman is twice as likely as a man to contract HIV during vaginal intercourse because the lining of the vagina provides a large area of potential exposure to HIV-infected semen; young women at even greater risk due to immature reproductive tract, especially the cervix.
Co-factors: having an STI greatly increases the likelihood of acquiring or transmitting HIV (can include those STIs which cause sores or breaks in the skin [herpes] or those which do not cause breaks [chlamydia]. Even with no breaks or sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely.)

56. HIV Risk Factors continued
Substance Abuse: An estimated 1/5 new HIV infections are related to IDU; trading sex for drugs; both casual and chronic substance abusers more likely to engage in high risk behaviors such as unprotected sex. Socioeconomic and other societal factors: Nearly ¼ AA and 1/5 Hispanics live in poverty. Associated problems: limited access to high quality health care; higher levels of substance abuse; exchange of sex for drugs, $ or to meet other needs can directly or indirectly increase HIV risk factors.

57. HIV Risk Factors continued
Multiple risk factors: NC study of HIV infection in AA women, commonly reported that their reasons for risky sexual behavior were:
Financial dependence on a male
Feeling invincible
Low self-esteem
The need to feel loved by a male figure
Alcohol and drug use.

58. HIV Risk Factors for: Women who have sex with Women (WSW)
Woman to woman transmission appears to be rare.
Of HIV+ WSW
98% had another risk- difficulty in assessing true risk.
IV drug use in most cases or
sex with men.
Case reports indicate that vaginal secretions and menstrual blood are
potentially infectious especially during early and late-stage HIV infection
when amount of virus in blood is thought to be highest;
mucous membrane exposure (i.e. oral, vaginal) to these fluids have potential to lead to HIV infection.

59. IMPORTANT - Early HIV Diagnosis
Take advantage of antiretroviral treatments & preventive medicines for opportunistic infections when appropriate
Drug therapies can forestall AIDS-related symptoms and prolong life
Allow for more informed reproductive choices
Treatments can greatly reduce the chance of passing infection to baby

60. BARRIERS to Early Diagnosis
Poor access to health care
Denial; do not believe they’re HIV infected
May ignore symptoms/warnings of HIV infection
Some women are even afraid to tell their doctors they have HIV, fearing they won’t get good treatment. (PID and other symptoms should signal health care providers to offer women HIV testing and counseling.)

61. Gender-specific Manifestations of HIV/AIDS
Frequent and difficult-to-treat vaginal yeast infections
Other vaginal infections occur more frequently & with greater severity: bacterial vaginosis, and STIs such as chlamydia, gonorrhea and trich
Severe herpes outbreaks, sometimes unresponsive to standard drug therapy
HPV occurs more frequently; cervical dysplasia, a pre-cancerous condition associated with HPV, also more common, severe & recurring

62. Prevention Issues Abstain from risky sexual behaviors
Be sexually monogamous with an uninfected partner; brings up issues of trust; may not know that partner is doing things that put him and her at risk for HIV; partner may not be aware of their own HIV status.
Communicate with a sex partner; self-esteem issues:
Talk about HIV and other STIs with each partner before you have sex.
Learn about each partner’s past behavior (sex and drug use) and consider the health risks before having sex.
Ask partners if they have recently been tested for HIV; encourage those who have not been tested to do so.

63. Prevention Issues (continued)
Problem: women may lack control in relationships and may be scared to say no to sex; scared to insist on condom use;
Problem: Substantial proportions of HIV+ adults engage in oral, anal or vaginal sex without telling a partner of their HIV status;
*13% of partnerships between an infected person and one who is HIV- or their status unknown, have involved unprotected intercourse without disclosure; this is against the law in most states.
Conclusion: substantial numbers of new HIV infections occur among partners of HIV+ persons who do not disclose. (American Journal of Public Health, 2003)

64. Prevention Issues (continued)
Use male or female condoms for sexual intercourse. Female condoms offer greater “area” of protection from STIs.
Even if both partners have HIV, use condoms to prevent possible infection with a different strain of HIV which could be drug-resistent.
Use latex barriers (dental dam or cut open non-lubricated latex condom) for oral sex.
Do not count on most birth control methods to protect against HIV.

65. Prevention Issues (continued)
Avoid use of IV drugs or shared needles. Drug use can affect treatment success. A recent study of HIV+ women found that women who use drugs, compared to those who do not, were less likely to take their medications as prescribed.
Do not douche; douching removes some of your body’s natural protection.

66. WSW: Prevention Issues
Sexual identity does not necessarily predict behavior; i.e. women who identify as lesbian may be at risk for HIV through unprotected sex with men;
Prevention interventions directed to WSW need to include messages about always using latex condoms for vaginal-penile intercourse;
No barrier methods for use during oral sex have been evaluated as effective by the FDA. However, natural rubber latex sheets, dental dams, condoms that have been cut and spread open, or plastic wrap may offer some protection from contact with body fluids during oral sex and thus may reduce the possibility of HIV transmission.
Not sharing sex toys;
Know their HIV status as well as that of their partner(s);
Include prevention messages about avoiding IV drug use or shared needles;

67. Prevention Research Microbicides:
virus-killing gel applied vaginally prior to sex;
now in testing phase;
should kill HIV before it latches onto cells of the person;
important for woman whose male partner(s) won’t use a condom;
Women can control the method without a partner’s knowledge;
may provide protection against herpes, gonorrhea and chlamydia;
will allow conception to occur;
(African Study, Britain’s Medical Research Council; Herald-Times, Nov., 2005
A few studies have been suspended due to higher numbers of women becoming HIV infected. This is a huge disappointment to researchers and prevention educators. (2/07)
However, one large study from South Africa in 2009 shows promising results.
"Getting a negative result for one product certainly doesn't signal failure for the microbicide field or broader biomedical HIV prevention research effort as a whole. Each trial result is a puzzle piece and, together, they make up the complex picture that will show us how to develop successful new HIV prevention tools."
(Mitchell Warren , AIDS Vaccine Advocacy Coalition. [2/07]

68. Prevention: What is being done?
“Advancing HIV Prevention” A CDC (2003) initiative to include preventing new infections by working with HIV+ persons and their partners.
CDC: Looking at ways to utilize women’s social networks to reach high-risk persons in communities of color; (i.e. beauty parlors)
One Test. Two Lives. New CDC campaign focuses on ensuring that all women are tested for HIV early in their pregnancy. Provides quick access to resources for providers, materials for patients to help encourage universal voluntary prenatal testing for HIV.

69. Prevention: What is being done? (continued)
Conducting outreach and testing for partners of HIV+ men;
A program to increase the number of AA women who can negotiate condom use with their male partners;
Develop and widely implement social marketing campaigns designed to increase knowledge of HIV status and to promote HIV risk reduction. One such campaign - Take Charge, Take the Test - has been shown to increase HIV testing among African American women.
To ensure that people know whether or not they are infected and to ensure that those who are HIV+ can receive life-extending treatment and take steps to protect their partners, the CDC issued recommendations to make HIV screening a routine part of medical care for all patients between the ages of 13 and 64.

70. Mother to Baby Transmission
During the early 1990s, before treatments, an estimated 1-2,000 HIV+ infants were born each year in the US.
An estimated 50-70% of transmission probably occurs late in pregnancy or during birth. Exact mechanism is unknown, believed to occur when mother’s blood enters fetal circulation or by mucosal (i.e. mouth, eyes) exposure to the virus during labor and delivery.
Since about 1994, dramatic declines reported due to recommendations for routine counseling and testing for pregnant women; offering antiretroviral treatment to infected women during pregnancy and delivery and to infant following birth;
Between , perinatally acquired AIDS cases declined 93% in the US.

71. Mother to Baby (continued)
Without treatment intervention, there is a 25% mother to baby transmission rate; with treatment to mother and baby it drops to about 2%.
CDC: since 1999 has distributed $10 million to states with high HIV rates to carry out prevention programs for pregnant women.
Doctors should determine the cause of a patient’s reluctance to be tested, so that it can be addressed.