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HIV Prevention for Patients and the Community

HIV Prevention for Patients and the Community. HAIVN Harvard Medical School AIDS Initiative in Vietnam. Learning Objectives. By the end of this session, participants should be able to: Identify the 3 routes of HIV transmission List 4 factors that can reduce the sexual transmission of HIV

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HIV Prevention for Patients and the Community

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  1. HIV Prevention for Patients and the Community HAIVN Harvard Medical School AIDS Initiative in Vietnam

  2. Learning Objectives By the end of this session, participants should be able to: • Identify the 3 routes of HIV transmission • List 4 factors that can reduce the sexual transmission of HIV • Counsel a patient on how to use condoms and how to inject safely • Explain risk of mother to child transmission of HIV

  3. Why should be concerned about HIV prevention? • HIV is a communicable disease, thus affects individuals and the entire community • The best way to stop the HIV epidemic in Vietnam is through prevention • HIV is 100% preventable • Our patients and their families: • have many questions about HIV transmission and prevention • trust nurses and listen to your advice

  4. 3 Routes of HIV Transmission

  5. Estimated HIV Risk for a Single Exposure to HIV+ Source CDC, MMWR, 2005

  6. Characterizes of HIV Transmission • In order for HIV to be spread, these infected fluids need to be exposed to: • a mucous membrane (vagina, eye, mouth) • broken skin • blood (needle stick, infusion) • HIV is DIFFICULT to contract, spread only through exposure to certain bodily fluids: • blood • semen • vaginal secretions • breast milk

  7. How is HIV not spread? • HIV is NOTtransmitted through casual contact such as: • Hugging or kissing • Coughing or sneezing • Sharing utensils, cups or bowls • Sharing toilets • Swimming pools • Insect bites

  8. HIV Transmission and Prevention through Blood/Parental Sources

  9. Factors Increasing HIV Transmission through IDU • Lack of access to: • clean syringes: • Use of previously used syringes during injection drug use • effective drug abuse treatment (methadone) • Concurrent sexual risk behavior

  10. Reduce HIV transmission among IDU:Nurses’ Role(1) Recognize drug use: • Ask all patients about drug use • Recommend HIV testing for IDU

  11. Reduce HIV transmission among IDU:Nurses’ Role(2) Help IDU reduce their risks: • Educate patients on HIV transmission • Educate them to: • Use of new needles and syringes • or clean needles and syringes • Do not share of needles and syringes • Provide free needles and syringes to IDU • Refer or provide treatment for drug addiction

  12. Reduce HIV transmission among IDU: Nurses’ Role (3) Educate patients how to clean needles: • 2 x 2 x 2 (water, bleach, water) • Bleach (ideally) for 30 seconds each pass • If no bleach, alcohol OK (but not wine or beer) • Boiling x 5 – 10 minutes also kills HIV • If can’t use bleach, alcohol, or boil, then recommend using clean water: • 30 seconds each time x 3 times

  13. HIV Transmission and Prevention among Sexual Partners

  14. Sexual Transmission of HIV (1) • HIV is concentrated in semen in men, vaginal secretions in women • HIV is more easily transmitted from the insertive to the receptive partner • Man to woman during vaginal sex • Man to man or woman during anal sex • Oral sex with ejaculation or during menses

  15. Sexual Transmission of HIV (2) • Risk of transmission: • Higher if HIV viral load in the infected partner is high • depends on route of sex: Oral << Vaginal < Anal Low risk high risk

  16. Sexual Transmission of HIV (3) Risk of transmission is associated with the HIV viral load in the infected partner. *chưa gặp ở bệnh nhân HIV <1500c/ml *There were no tx seen in patients with HIV < 1500 c/ml Quin, T et al. N Engl J Med 2000. 342” 921 -9

  17. Factors IncreasingSexual Transmission of HIV • More sexual partners (FSW, MSM) • Sex: • during menses • with the presence of STDs- especially genital ulcers • through anal (no natural lubrication) • Rough or “dry” sex • Female douching after sex • Use of chemical spermicides • Nonoxynol-9 (N-9)

  18. Factors ReducingSexual Transmission of HIV • Fewer Sexual Partners • Condom use • Non-penetrative sex (masturbation) • Male circumcision: • 61% reduction in acquiring HIV infection among circumcised man *Auvert B. 2005.

  19. Prevention of Sexual Transmission of HIV: the ABC’s

  20. ReducingSexual Transmission of HIV: Roles of Nurses

  21. Take a Sexual History (1) • Helps you to understand the patient’s risk and provide correct counseling on prevention • Allows the patient to ask questions about sexual behavior that they might have been ashamed to bring up

  22. Take a Sexual History (2) • Sexual history should be taken: • In a private room, with only the patient and nurse present • Be attentive and use non-judgmental attitude • Advise the patient that: • you will ask some personal or difficult questions • all information is confidential

  23. Take a Sexual History (3) • Ask detailed questions about the patient’s sexual behavior • number and type of partners • route of sexual activity (oral, vaginal, anal) • homosexual sex (MSM) • condom and lubricant use

  24. Provide Information • Provide information to patients on: • risks for sexual transmission of HIV • safe sexual behavior • condom and lubricant use (provide them freely, when possible)

  25. Assist the Patient Encourage and assist the patient in: • disclosing their HIV infection to their partner(s). This will facilitate: • condom use and • HIV testing of the partner(s). • seek treatment for STDs • ARV treatment: • Patients on ARV have lower HIV viral loads thus, a lower risk of transmitting the infection

  26. HIV Transmission and Prevention Among Mothers and Children

  27. HIV Transmission: Mother To Child (1) • Transmission from mother to child can occur: • in utero • during delivery • post-partum through breast milk

  28. HIV Transmission: Mother To Child (2)

  29. Preventing HIV Transmission from Mother To Child • Providing HIV counseling and testing to all pregnant women • Pregnant woman with criteria for ARV treatment should be: • started on triple-ARV therapy at the HIV OPC as soon as possible • and also referred to the PMTCT program • Pregnant woman without criteria for ARV should be referred to the PMTCT program for prophylactic ARV • Babies born to HIV infected women should not breastfeed, if powdered milk and clean water are available

  30. Key Points • The 3 routes of HIV transmission are: blood, sex and mother to child. • Disposable needles help reduce HIV transmission though IDU • Sexual transmission reduces if safe sex is practiced • Pregnant woman with criteria for ARV treatment should be started on triple-ARV therapy at the HIV OPC as soon as possible

  31. Thank you! Question?

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