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

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)

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) http://www.medicinenet.com/stds_pictures_sl ideshow/article.htm

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

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.

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

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

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

Viral Viral: Herpes HPV HIV Hepatitis B

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.”

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.

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

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

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, 30-40 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 http://www.youtube.com/watch?v=RjBpLeBzkng

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

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.

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); http://www.youtube.com/watch?v=DXST0MITOFE 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.

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

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

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

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

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.

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 20-40 minutes; cost

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

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

Bacterial Bacterial: Chlamydia Gonorrhea Syphillis Vaginitis

Chlamydia Caused by: Mode of transmission: Chlamydia trachomatis bacteria Prevalence: 4 million new cases per year http://www.youtube.com/watch?v=CO9okOAlij4&NR=1 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

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

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.

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

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

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

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

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

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

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

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

Other STIs

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: http://naturalginesis.com/index.htm

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.

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: http://web.ukonline.co.uk/ruth.livingstone/little/scabies2.htm

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

Bloomington Men’s S.T.R.O.N.G. Project Men between 17-24 patnagel@indiana.edu Free STD testing (812) 266-1978 Chlamydia Gonorrhea Trichomonas $20 gift card Confidential and voluntary

WEB SITES American Social Health Association: www.ashastd.org and www.iwannaknow.org (for teens) Centers for Disease Control: www.cdc.gov/health/std.htm IUHC lab: http://healthcenter.indiana.edu/departments/laboratory/stdtest.html Columbia University Health Education www.goaskalice.columbia.edu Kinsey Institute Sexuality Information Service for Students www.indiana.edu/~kisiss Gay and Lesbian Medical Association www.glma.org Gay Men’s Health Crisis: www.gmhc.org Planned Parenthood: www.ppfa.org PP for teens: www.teenwire.org Advocates for Youth: www.advocateforyouth.com www.itsyoursexlife.com www.prevent.org/NCC: chlamydia

Women & HIV/AIDS Overview and statistics http://www.youtube.com/watch?v=NNJIzhJGxjE&NR=1 “Today the HIV/AIDS epidemic represents a growing and persistent health threat to women in the US, especially young women of color.” (CDC - 2005)

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. http://www.youtube.com/watch?v=OS93UvqfAPg&feature=related Of the approximately 1 million people living with HIV in the US, between 120,000-160,000 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. http://www.youtube.com/watch?v=7Mpw80ApTuo&feature=related Annual number of AIDS diagnoses increased 15% among women compared to 1% for men .

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

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

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

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

African-American Women & HIV http://www. youtube. com/watch African-American Women & HIV http://www.youtube.com/watch?v=7Mpw80ApTuo   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).

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

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.

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.)

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.

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.

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.

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

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.)

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

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.

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)

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.

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.

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;

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]

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.

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.

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 1992-05, perinatally acquired AIDS cases declined 93% in the US.

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.