Turning Point HIV Presentation
- 1. Peter Ceglarek Center for Sexuality and Health Disparities peterceg@umich.edu
- 2. • Pt. 1: Understanding HIV • Social Determinants • Stigma • Myths • Virus and Disease • Prevalence • Transmission • Prevention • Treatment • Law • Pt. 2: HIV & Sexual Violence • Links, Statistics, and Research • Addressing the Intersection • Barriers • Needs • Recommendations • Referrals
- 3. • “The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” • World Health Organization • An individual’s position in social hierarchy can influence health outcomes • Underlying drivers of HIV risk and vulnerability
- 5. • What are some social determinants related to HIV? • Conditions for early childhood development • Education • Employment, income, job security • Access to food • Access to health services • Housing • Social exclusion • Stigma • The extent to which each of these vary among different racial, ethnic, religious, social-economic status, sexual identity, gender identity, physical and mental disability populations
- 6. • People living with HIV often highly stigmatized • Negative outcomes of stigma: • Reduced likelihood of testing and treatment • Financial and work difficulties • Social isolation • Minority Stress Theory • High, constant stress • Poorer mental health • Poorer physical health
- 7. • https://www.youtube.com/watch?v=JqzR3gp-EDA • What are our thoughts on this video? • How is it potentially helpful? • How is it potentially harmful?
- 8. • T or F: AIDS is a medical condition without a cure, spread mainly by unprotected sex or sharing needles with someone who is living with HIV. • True
- 9. • T or F: New HIV/AIDS drug treatments have lowered the number of AIDS-related deaths in the United States. • True
- 10. • T or F: Only drug users and gay men need to worry about becoming infected with HIV. • False
- 11. • You can become infected with HIV by ... A. sharing utensils with or drinking from the same cup as someone with HIV B. mosquito bites C. hugging someone with HIV D. none of the above
- 12. • If you were infected with HIV, you might show symptoms ... A. within a few weeks B. within a year C. in 10 or more years D. any of the above
- 13. • HIV is not present in ... A. semen and vaginal secretions B. sweat C. blood D. breast milk
- 14. • Common myths: • HIV is airborne at close range • Possible transmission from a toilet • 100% chance of transmission via sexual or needle contact with LWHIV person • Vaginal intercourse 0.1 – 0.2% • Anal intercourse 0.5 – 3% • Transmission through touching HIV+ blood • Transmission through saliva • Undectable viral load = safe to have sex • A mother can’t transmit HIV to child • You can’t have a child if you are LWHIV • There is a low survival rate for HIV infection • HIV originated from sex with monkeys • Others?
- 15. • Human (affects humans) • Immunodeficiency (attacks the immune system) • Virus (unlike bacterial infections) • AIDS is advanced stage of HIV (stage 3) • Acquired • Immuno- • Deficiency • Syndrome
- 16. • Virus that attacks T Cells in immune system • Overtime, kills off T Cells • Decreases ability to defend against other infections
- 17. • Estimated 1,148,200 people over 13 years living with HIV in US • Most common: large cities, and the south • African Americans and MSM are disproportionately affected • 1/5 people with HIV do not know • Estimated 18,800 cases of HIV in Michigan, 940 in Macomb County, 6,840 in Detroit • HIV infection prevalence relatively steady in Macomb • Number of new cases slowly dropping • Young people—new cases not dropping
- 19. 8% of all SE MI cases
- 23. 53% 25% 3% 3% 6% 8% Percent of Cases White Male Black Male Hispanic Male Other Male
- 24. 1% 5% 15% 17% 31% 21% 6% 2% Percent of Cases 0-12 years 13-19 years 20-24 years 25-29 years 30-39 years 40-49 years 50-59 years 60+ years
- 26. • Sex with person living with HIV • Vaginal • Anal • Oral • Condomless sex greatly increases likelihood of transmission • Using needles used by person with HIV • IDU • Tattoo (rare) • Childbirth • Breastfeeding • Blood transfusion (rare)
- 27. • Opportunistic infections • Cancers • Mental illness • Depression • Anxiety • Others • Increased rates/severity/special issues, & earlier onset in aging comorbidities • Cardiovascular • Renal • Hormonal • Cognitive • Etc.
- 28. • Abstinence • Condoms • Not sharing needles/using used-needles • Sero-sorting • PrEP • Limiting partners or monogamy • Sperm washing & antiretroviral therapy (for vertical transmission) • Testing, dialogue, and sexual planning • Discussion and negotiation necessary for almost all methods • How are these methods potentially affected by sexual and relational violence?
- 29. • Window Period—6 weeks to 3 months; depends on test! • Rapid testing—finger prick, results in 20min • Usually free (free @ AIDS Service Organizations) • Private • For more information or to find a testing center near you, call Michigan HIV/AIDS Hotline 1-800-872-2437
- 30. • No cure… but treatment is available to EVERYONE! • Life-long medication • Stay healthy • Reduce chance of transmission • Side effects • Life-long medical supervision • Potential lifestyle changes
- 31. • Labs & Providers must report HIV status to local health dept. • Health depts. prohibited from keeping roster of names • Otherwise, HIV-related info is strictly confidential • But when might we accidently disclose HIV information? • Findings: discreteness, isolation or privacy, crowdedness, public, locale size, privacy procedure, discussion of anonymous testing, forced explanations
- 32. Why do you think violence may put individuals at increased risk for HIV? 32
- 33. • Sexual violence as a risk and consequence of HIV infection. • Individuals who have violent partners are less likely to negotiate condom use and more likely to be abused when they do. • Individuals who are assaulted are unable to negotiate protective strategies • Various adverse health effects related to intimate partner violence compromise women’s immune systems in a way that increases their risk of HIV. 33
- 34. • 12% of HIV/AIDS infection among women in romantic relationships are due to intimate partner violence (Sareen, et al., 2009) • Women who experience intimate partner violence were over 3 times more likely to have a diagnosis of HIV/AIDS (Sareen, et al., 2009) • The prevalence of intimate partner violence among women at risk for HIV may be as high as 67% (Cohen, et al., 2000) 34
- 35. • Violent or coerced sex increases individual’s risk for HIV through physical trauma: o Bleeding and tearing of genital area creates passageways for HIV. o Heightened risk of bleeding and tearing of anus and rectum. • Violence and threats of violence: o Limit negotiating power for safer sex. o Limit ability to leave/end a relationship. • Sexual abuse as a child: o Related to high HIV risk behaviors as an adult (multiple partners, unprotected sex). • Disclosure of HIV status: o Could result in increased violence (emotional, physical, sexual, economic). • Violent men more likely to be living with HIV* • Women living with HIV may experience more violence than others* 35
- 36. • Many service providers lack of understanding of the link between violence against women and increase in HIV risk. • Not enough resources or skills. • Many service providers discomfort discussing IPV, sexual assault, and risky behaviors for HIV. • Lack of coordination and referrals with other services. • Contrary beliefs, biases, attitudes. 36
- 37. • Understanding of the link between sexual violence and HIV. • Staff training and cross-training as needed. • Adequate policies and procedures that encourages integration of HIV and Survivor services. • Good risk-related information for clients. • Increased collaboration and referral between Survivor and HIV agencies. 37
- 38. • Potential indicators to discuss: • Engaging in risk behaviors for HIV (multiple sexual partners, condomless sex, sexual “acting out”). • Reluctant to get tested for HIV. • Resistant to disclosing a positive test result to a partner. • Unable to adhere to an HIV medication regimen. • How to: • Avoid judgmental/accusatory language • Actively listen • Provide information, not correction • Sensitively relate risk-reduction to individual’s life- goals • Offer referrals, when appropriate
- 39. • HIV Testing • Michigan HIV/AIDS Hotline 1-800-872-2437 • StatusSexy.com • UNIFIED (APM & HARC), CHAG, Horizons Project, MAC Teen Hype • YAC • Macomb County Public Health 586-465-8434 • Wayne County Dept. of Public Health 734-727-7078 • Oakland County Health Division 248-858-5416 or 888-350-0900 ext. 85416
- 40. • What can we do, in our professional settings, to be more sensitive to issues surrounding HIV? • What can we do to assist in HIV testing & care?
Editor's Notes
- #6: Ask audience for examples of underlying drivers of HIV risk and vulnerability Which groups do we think may be more affected by HIV due to their social determinants? Determinants of transmission, infection, and treatment.
- #7: Very important factor to social determinants—often overlooked or misunderstood
- #8: “The picture on the last slide may show a more intimate social setting, and may not seem that relevant to HIV to many of us. But here is a very real example of stigma regarding YMSM living with HIV from the NY Dept. of PH.” Example of how even professionals in healthcare/public health may perpetuate HIV-related stigma Video meant to target YMSM of color, and reduce idea that “HIV isn’t so serious—you just have to take some meds every day and you’re fine.”
- #9: A lot of what perpetuates stigma is silence, and what fills in that silence is misunderstanding and ignorance, which furthers the stigma. In light of this, I want to go through some common thoughts about HIV and AIDS, and separate the fact from fiction. Some of these statements you may have heard before, or even endorsed, and others will be unfamiliar, whether true or false.
- #15: Pass out “HIV Myths” handout to entire group
- #16: HIV leads to acquired immune deficiency syndrome (AIDS), a chronic and potentially life-threatening condition. AIDS is characterized by the emergence of opportunistic infections in body systems. There is no cure for HIV/AIDS, but medications can slow the progress of the disease.
- #17: Very quick, very brief
- #18: Brief --Estimations are all recorded cases + ~2,000 estimated unreported cases for each group Prevalence = all people living with HIV, currently New cases = incidence
- #19: HIV does not discriminate
- #22: Next several graphs from 2013 Macomb report (most recent for just Macomb) Asian/PI and Am Indian/AN are significantly less than 1%
- #23: American Indian/AN is less than 1% for both Asian is 3% of overall population See how prevalence does NOT match demographics—disproportionate burden (social determinants factoring in)
- #24: Males = 84% Females = 16%
- #25: Again—this is prevalence, not incidence
- #26: Think back to social determinants—risk factors intertwined into one’s socio-ecological environment Blood products less than 1% Heterosexual—more easily transferred to females during vaginal, due to greater surface area of exposed permeable tissue Anal intercourse higher transmission rates for similar reason ***Does this graph match our expectations for what puts people at greatest risk for HIV? “There is a sizeable chunk of people that we still don’t know about”ppl who don’t know they have HIV, lack of disease awareness/knowldedge, etc.
- #27: “Risk factors increase likelihood of transmission”
- #28: “Once HIV is transmitted, one is at higher risk for…”
- #29: “But what can we do to prevent this from ever occurring in the first place?” Multiple methods always better than just one Discuss dangers of only providing a few prevention methods? Mention Gary’s intervention in which promoting condom-negotiation status among young latina women actually led to increase in IPV—safety of women must be a priority **”but also remember, like IPV presentation mentioned, we do need to facilitate self-determination in order to successfully promote lasting-safety. It is a sensitive issue, which is why we need more awareness and training in the intersections between IPV and HIV” -Although consistent condom use is IDEAL… we need to be realistic and stress RISK REDUCTION
- #30: “One of the most important prevention strategies we mentioned is knowing your status” “More on testing locations/resources in a bit”
- #31: The drugs are often referred to as antiretrovirals, ARVs or anti-HIV or anti-AIDS drugs. Taking two or more antriretrovial drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is referred to as Highly Active Antiretroviral Therapy (HAART). Taking two or more treatments at the same time reduces treatment resistance. *Note to DV orgs: If a client is in shelter (or receiving services from your organization in another capacity) and being treated for HIV, make sure you help them continue treatment. This should be a priority! It is important for clients to adhere to HIV treatment.
- #32: Status can be reported to Dept. of Community Health by others without pt consent if it is to protect one’s health, prevent further transmission, or diagnose & care for a pt Other exemptions in confidentiality can be made to known contacts, foster parents, or if deemed necessary under child protection law BUT NOT AGENCIES! For example, if someone comes into shelter, it is not necessary that other shelter members know of this individuals HIV status! Staff may be aware in certain situations where clients may need assistance getting medications, etc.
- #33: Get into groups and come up with 1 or two reasons.
- #34: Source: UN (2011). Understand the linkages between HIV/AIDS and violence against women and HIV. Available at http://www.endvawnow.org/en/articles/677-understand-the-linkages-between-hiv-aids-against-women-and-girls-.html. Retrieved 11/30/11.
- #35: Real-world data to provide context to previous slide brief
- #36: Source: UN (2011). Understand the linkages between HIV/AIDS and violence against women and HIV. Available at http://www.endvawnow.org/en/articles/677-understand-the-linkages-between-hiv-aids-against-women-and-girls-.html. Retrieved 11/30/11. http://www.svri.org/hiv.htm Question: How do we explain last two, keeping in mind earlier discussion of HIV risk?
- #37: Ask audience: How do we feel about these? Do they seem pretty accurate? Add we, us, many in general…etc.
- #38: To audience: Now here is some structural real change! As participants in this training, you are ALREADY part of this great change. Pass out “The Global Coalition on Women & AIDS” document…explain that the back offers suggestions on how to move forward as a community.
- #39: Similar to all the work we do…validate the client
- #40: YAC has testing locator
- #41: To audience: Let’s brainstorm, what can we do right after this meeting? Please take some of the agency related information at the table on your way out. Recommended resource: http://www.nsvrc.org/sites/default/files/Publications_NSVRC_Guides_Sexual-Violence-and-HIV_A-Technical-Assistance-Guide-for-Victim-Service-Providers_0.pdf