Shannon Rauh, M.Ed University Health Services 475-8465 HIV Prevention Shannon Rauh, M.Ed University Health Services 475-8465

Why HIV Prevention Why spend money on HIV prevention? Why is prevention important? Can prevention make a difference? Is prevention cost saving?

Why spend money on HIV prevention? Saves lives and slows down the epidemic. Estimated lifetime cost of care & treatment for just one HIV+ person is about $195,000. It reduces the number of persons who require expensive medications to combat their HIV disease.

Why spend money on HIV prevention? The cost of the AIDS epidemic is incurred not only in dollars. Affects young adults in their prime for work and childbearing. HIV is the fifth leading cause of death in the US for persons aged 25-44 (2002). HIV is the LEADING cause of death for African American men and the third leading cause of death for African American women aged 25-44 (2002).

Why is prevention important? As prospects for a cure or vaccine seem remote, HIV prevention efforts take on an even greater importance for helping stem the tide of this epidemic. Prevention is a hard sell. Its easier to get thousands of $’s spent to rescue a baby from a well than a few hundred $’s to safely cover the well and prevent children from falling in.

Can prevention make a difference? Prevention efforts have beneficial effects on other health conditions besides HIV. Some needle exchange programs have resulted in a reduction in Hepatitis B & C transmission. Consistent condom use prevents HIV infection, plus aid in reducing STDs and unintended pregnancies.

Is prevention cost saving? Successful HIV prevention programs that are targeted to the correct populations can be highly cost-effective. One million dollars spent on HIV prevention can save $2.7 million, depending on the target population. Lifetime cost of treatment is about $195,000.

Is prevention cost saving? The ideal prevention strategy uses combination of prevention/interventions. Different people are reached in different ways (needle exchange, condom distribution, HIV counseling and testing)

Levels of Prevention/Interventions Individual - HIV prevention counseling Dyadic/Familial – Mother and daughter attend workshops to promote delay or abstinence of sexual activity Community – A support group for HIV negative gay men Medical – Treating HIV+ women with AZT Policy/Legal – Needle exchange program

Prevention and Treatment of STDs as an HIV Prevention Strategy Parallel epidemics on HIV infection and other STDs Other STDs facilitate HIV transmission New evidence of the effectiveness of STD treatment in HIV Prevention

Morin Model The Morin Model was developed by S. F. Morin, Psychologist at the University of California, San Francisco. The model illustrates a relationship between personal beliefs and personal sexual behavior. Morin's research has shown that a person must hold these five basic beliefs in order to change his or her sexual behavior in relation to AIDS. Morin concludes that these beliefs can be directly influenced by educational and motivational programs.

Morin Model There must be a belief that AIDS is a personal threat. "I am personally threatened by AIDS.“ There must be a belief in prevention. "AIDS is preventable; certain actions will reduce or eliminate my risks." 

Morin Model There must be a belief in personal efficacy. "I am capable of managing these new low-risk behaviors.“ There must be a belief in the possibility of satisfaction. "I can carry out these new behaviors and still be sexually satisfied.“ There must be the belief in the existence of peer support. "My peers will support this new behavior."

Transmission of HIV Documented methods of transmission Activities which share infected blood Receiving infected blood products Health care workers via infected blood Infection passed from mother to fetus

Transmission of HIV Documented methods of transmission Sexual practices Anal, vaginal and oral intercourse Allows infected Semen Blood, and/or Vaginal secretions to enter another person’s blood stream

Transmission Categories AIDS Cases as of 12/01 MSM 46% IDU 25% MSM & IDU 6% Hemophilia/Coagulation Disorder 1% Heterosexual 11% Blood Transfusion Other/Pending 10%

Factors Increasing the Risk of Heterosexual Transmission Probable Factors Ulcerative sexually transmitted diseases; syphilis, chancroid Anal intercourse; increases risk for women Male not circumcised

Factors Increasing the Risk of Heterosexual Transmission Possible Factors; More research needed— Non-ulcerative STDs; GC, chlamydia, trichomonas, HPV Cervical ectopy Presence of IUD Advanced HIV disease Vaginal bleeding during intercourse; increases risk for women Intercourse during menstrual period; increases risk for men

Transmission of HIV Clarifying Myths about Transmission Virus detected in sweat, saliva, and tears, but no evidence of transmission via these routes No transmission by mosquitoes Not spread through airborne routes or casual contact

Prevention of HIV Infection Maintain one long-term exclusive sexual partner Abstain from sexual intercourse Not sharing needles Cleaning needles before sharing Universal Precautions (in health care setting) Testing before deciding to become pregnant

Prevention of HIV Infection If person will not or cannot stop using drugs Avoid sharing needles Clean “works” with bleach and then water before each use Needle-exchange programs decrease HIV transmission without increasing IDU Should be coupled with opportunity to enter substance abuse treatment facilities

Safer Sex Safety Chart

Condom Efficacy Health professionals citing only worst-case-scenario estimates of condom efficacy is unfortunate. May be a self-fulfilling prophecy, because condoms may be used less consistently by people who do not believe them to be effective.

Condom Efficacy For people who do not choose to abstain from sexual activity and do not have one long-term exclusive sexual partner… Consistent and correct use of a latex condom is highly effective in preventing HIV transmission Laboratory tests show high efficacy for latex condoms in preventing HIV transmission Studies in HIV-discordant couples show very high efficacy when latex condoms are used “consistently and correctly.”

Risk Reduction Decreasing # of sexual partners Getting to know your partners Staying sober Testing before sexual involvement Use of condoms Use of dental dams

Resources for HIV Disease Prevention CDC National Prevention Information Network www.cdcnpin.org UCSF Center for AIDS Prevention Studies www.caps.ucsf.edu www.caps.ucsf.edu/fsindex.html Lengthy guide to Safe Sex www.sexuality.org/safesex.html