The Connection Between STDs and HIV Larry Keil HIV/AIDS Program, SKCDPH 206-296-4649 larry.keil@metrokc.gov

Three Main Points There is a causal link between infection with STDs and increased transmission of HIV Preventing and treating STDs will reduce the number of new HIV infections You can make a difference by helping people prevent, identify and treat STDs

What is the STD-HIV Connection? Similar behaviors put people at risk of both STDs and HIV A current STD can increase risk of getting HIV by 2-5 times People with both HIV infection and another STD have increased HIV viral loads and can more easily infect others with HIV People with HIV can have more serious complications of other STDs

Disease Transmission Need an “agent” or “germ” bacteria, virus, protozoa, fungus Need exposure to the agent foodborne, waterborne, aerosol, sexually transmitted, insect transmitted Need a portal of entry Need a susceptible host Need a high enough dose to infect

STDs ulcerative: syphilis, chancroid, genital herpes inflammatory: gonorrhea, chlamydia, trichomoniasis US has highest rates of STDs in industrialized countries especially chlamydia, gonorrhea and genital herpes

Many STDs Have No Symptoms In women: over 50% with gonorrhea and 70% with Chlamydia had no symptoms In men: 68-92% with gonorrhea and 92% with Chlamydia reported no symptoms

Epidemiologic Evidence Researchers have observed a strong association between having STDs and HIV in a number of studies. The association is termed “epidemiological synergy” 2-5 fold increased risk for HIV infection among persons who have other STDs.

Why the Increased Risk Ulcers and inflamed areas provide an easy portal of entry STDs attract T-helper cells to the infected area Even asymptomatic STDs can cause abnormal cellular changes that allow easier passage of infectious agents. Some STDs increase viral load and shedding of HIV

Early Identification and Treatment Trials In Tanzania Six intervention vs controlled communities Effective drugs and training in treating symptomatic STDs in intervention communities resulted in 38% lower HIV incidence In Uganda Episodic mass treatment of STDs in matched areas No difference in HIV incidence despite reduction in STDs

Why a Difference in the Trials Difference in delivery of treatment services--continual vs episodic Difference in stage of HIV epidemic Tanzania: early epidemic, HIV prevalence 4% Uganda: later epidemic, HIV prevalence 16%

Early Identification and Treatment of STDs Prevents HIV Epidemiological, biological evidence Controlled trials in Africa suggest effectiveness Conclusion: Any activity that decreases STDs in a community will also decrease HIV transmission

Recommendations Use condoms with all new sexual partners Reduce the number of new sexual partners Identify and treat new STDs Know that most STDs do not produce symptoms People already infected with HIV should be screened routinely for STDs

Recommendations (Continued) Regular screening for those at risk of STDs Those particularly at risk: sexually active young adults, especially those with multiple partners, those who exchange sex for drugs or money, and young men who have sex with men Easy access for all to STD care and treatment Education that douching (vaginal or anal) may increase the risk of acquiring HIV or another STD

Conclusions There is a direct link between other STDs and HIV transmission Early identification and treatment of STDs will reduce HIV transmission You can make a difference by helping people know these facts and working with those at risk to get screened and treated

Resources HIV/STD Information Line: 206-205-7837(STDS) Harborview STD walk-in Clinic STD and HIV information on the Internet www.metrokc.gov/health/apu