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

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

3. 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.

5. 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 (2002).
HIV is the LEADING cause of death for African American men and the third leading cause of death for African American women aged (2002).

7. 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.

9. 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.

10. 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.

12. 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)

13. 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

14. 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

15. 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.

16. 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." 

17. 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."

19. 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

20. 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

22. 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%

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

24. 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

26. 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

27. 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

28. 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

29. Safer Sex Safety Chart

30. 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.

31. 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.”

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

33. Resources for HIV Disease Prevention
CDC National Prevention Information Network
UCSF Center for AIDS Prevention Studies
Lengthy guide to Safe Sex