Human Sexuality December 5, 2012 Chapter 15: Sexually Transmitted Infections

1. Human Sexuality December 5, 2012Chapter 15: Sexually Transmitted Infections

2. Acquired immunodeficiency syndrome (AIDS)

3. What is AIDS? • AIDS results from infection with the human immunodeficiency virus (HIV) • Appears to have been introduced to humans from chimpanzees in Africa, possibly by people eating infected animals • Probably arose sometime around 1930, but did not spread worldwide until the 1970s when Africa became less isolated • HIV specifically attacks a type of immune cell called T-helper cells, destroying them • Without T-helper cells, we are susceptible to many other illnesses that would not be problematic for a healthy person

4. AIDS incidence • More than 1 million people in the U.S. have been diagnosed with AIDS since 1981 and more than 570,000 have died • However, that is a small number compared to rates of AIDS in Africa • The HIV/AIDS pandemic may be losing some of its momentum finally • Worldwide, most AIDS transmission is from heterosexual contact

5. AIDS in the U.S. • Most common among men who have sex with men (MSM), and among ethnic and racial minority groups • Higher rates among minorities may be due to: • Reduced access to health care in these groups • Cultural or language barriers that limit access to AIDS prevention information • Differences in HIV risk behavior, especially injection drug use

6. Transmission of HIV • Saliva, semen, blood, vaginal secretions, urine, and breast milk can contain HIV virus, though in varying amounts • It is easier to transmit HIV from a man to a woman than from a woman to a man • Anal intercourse spreads the virus more easily than vaginal intercourse • Can be transmitted from mother to child during birth or from breastfeeding • Can be transmitted by oral-genital contact • “Viral load” is often highest right after infection • Circumcision has been shown to reduce transmission of HIV

7. Transmission of AIDS through blood transfusions • In the early 1980s, there was no test for HIV, and approximately 25,000 people contracted HIV from blood transfusions • Since 1985, all blood has been screened for HIV antibodies, although tests are not 100% accurate • MSM, IV drug users, and other high-risk individuals are not allowed to donate blood

8. Symptoms and complications of HIV • Flulike symptoms often appear within the first few weeks of infection • Virus then often becomes dormant for several years • Common later symptoms include fevers, night sweats, weight loss, fatigue, diarrhea, headaches, chronic cough and oral candidiasis (also known as “thrush” • The fact that many people are asymptomatic for a long time leads to delays in detecting infection, during which time many more people may be infected

9. AIDS symptoms • AIDS is defined as having one or more severe, debilitating diseases associated with extreme impairment of the immune system after HIV infection • Common complications of AIDS include Kaposi’s sarcoma (at right), Pneumocystis carinii pneumonia, tuberculosis, meningitis, and toxoplasmosis

10. AIDS treatment • Death rates from HIV have been decreasing in the U.S. since 1996 • This is primarily due to treatment with highly active antiretroviral therapy (HART) • These are drugs that target the HIV family of viruses, and because multiple drugs are given at once, they prevent the virus from mutating to be resistant to any one drug • Drawback: these drugs can have serious side effects, including anemia, insomnia, mouth sores, diarrhea, inflammation of the pancreas, GI problems, liver damage, and others

11. An AIDS vaccine? • Viral illnesses are harder to treat than bacterial illnesses, so it is desirable to prevent infection through vaccination • In 1984 Health & Human Services Secretary Margaret Heckler predicted that there would be an AIDS vaccine within 2 years! • Hard to test, and to develop, but efforts are still underway

12. avoiding transmission of STI’s

13. Know your risk status & your partners’ risk status • Have you been tested for STIs? • Many STIs have few or no symptoms • Effective communication about risk factors is key; be honest with yourself and with your partners and choose partners who will do the same for you! • One review of HIV disclosure found that 12–33% of people did not disclose to their partners that they were HIV positive

14. Use latex condoms • With proper use, condoms drastically reduce rates of transmission of most STIs • Major exception: ectoparasitic infections such as crabs and scabies • Syphilis, HSV, and HPV can also be spread without direct genital contact in some cases • “Natural skin” or “natural membrane” condoms made from sheepskin do not protect against viruses • Spermicide can increase STD risk • Both male and female condoms decrease risk

15. Store condoms correctly! • Store in a cool, dry, place out of direct sunlight • Check the expiration date! Throw out any condoms that are in damaged packages, brittle, discolored, or show other signs of aging, even if the expiration date has not passed. • Handle condoms so they are not punctured • Make sure you have them when you need them

16. Prepare to use condoms correctly! • Put on a condom BEFORE genital contact for STD prevention • Make sure the condom is adequately lubricated with a water-based lubricant ONLY • Do not fill a condom with water or blow it up like a balloon to check it for leaks!

17. Use condoms correctly! • For an uncircumcised penis, pull back foreskin before using a condom • Unroll the condom directly onto the penis while pinching the reservoir tip at the end to leave room for ejaculate • If a condom breaks, replace it immediately • Remove the condom while the penis is still erect • Never re-use condoms

18. Other ways to reduce STI risk • Have fewer partners • Inspect your partner’s genitals • Washing genitals before and after sex MAY reduce transmission • Get tested for STIs regularly if you are sexually active, preferably every 3 months • Inform your partner if you have an STI

19. Low-Cost reproductive health care options in the East Bay • Planned Parenthood 510-300-3800 (Oakland) • Asian Health Services 510-986-6830 (Oakland) • Native American Health Center 510-535-4400 (Oakland) • La Clinica de la Raza 510-535-4000 (Oakland) • Berkeley Free Clinic 510-548-2570 (Berkeley) • STD community hotline 1-800-227-8922