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Secondary Prevention

Secondary Prevention. Basis for Secondary Prevention. STDs Drug Resistance HIV super-infection Mother to child transmission Hepatitis C Hepatitis B. Condoms Protect ?. 98.5% risk reduction /single act with infected partner 14% failure with 10 acts 26% failure for 20 acts

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Secondary Prevention

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  1. Secondary Prevention

  2. Basis for Secondary Prevention • STDs • Drug Resistance • HIV super-infection • Mother to child transmission • Hepatitis C • Hepatitis B

  3. Condoms Protect ? • 98.5% risk reduction /single act with infected partner • 14% failure with 10 acts • 26% failure for 20 acts • 37% failure for 30 acts Fitch STD 2002, Mann STD 2002

  4. Condoms are not Perfect • Slippage • 0.8% (5y experience) • Breakage • 0.7% (5y experience) • Pregnancy Risk • 6% (< 2 y experience) • 3.6% (>4y experience) Messiah AJPH 1997

  5. Sexual Behavior RiskFisher and Fisher, Options Project • 51% of HIV+ clinic participants engaged in sexual activity in pat 3 mos. • 52/496 HIV + participants had risky vaginal or anal sex with 197 partners in past 3 mos.

  6. Drug Use RiskFisher and Fisher, Options Project • 35% of IDUs who injected in last month borrowed or lent dirty works to: • 75 HIV – • 113 HIV unknown • 65 HIV +

  7. Sexual Risk • 50-90% HIV+ remain sexually active after diagnosis • 20-60% HIV + and sexually active don’t use condoms consistently Darrow et. al 1998, Wilson 1999, Deren 1998, Fisher, 1999,

  8. Population HIV + Drug users Women HIV + MSM Increased Condom use Decreased sexual partners 26% decrease in unprotected sex Risk Reduction 0.81 (OR) 50% risk reduction at 6mos 0.69 (OR) 0.61(OR) 0.74 (OR) Shain STD 2002, Semaan JAIDS 2002, Johnson JAIDS 2002 Interventions to Reduce Sexual Risk Behaviors

  9. Mentally Ill • Cognitive-behavioral HIV risk reduction • Increased condom use • Higher percentage of intercourse occasions with condoms • More positive attitudes toward condoms • Behavior change present at 3,6,9 mos. • Behavior change diminished by 12 mos. Otto-Salag Com Mental Health J 2001

  10. Types of interventions • Social • Structural • Behavioral • Motivational Interviewing • Counseling • Education • Risk reduction • Risk consequences

  11. Approaches to Harm Reduction • Multiple attempts • Longitudinal follow up • Patient buy-in • Multidisciplinary • Consistent messages • Non judgmental

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