HIV Screening and Women’s Health

1. Originally developed by: Health Care Education & Training, Inc. HIV Screening and Women’s Health Section 3: Heterosexual Transmission of HIV

2. 2007 Contributors from AETC Women’s Health and Wellness Workgroup: • Joyce Alley, RN; Health Care Education and Training, Inc. • Laura Armas, MD; Texas/Oklahoma AETC • Andrea Norberg, MS, RN; AETC National Resource Center • Tonia Poteat, MPH, MMSc, PA-C; Southeast ATEC (SEATEC) • Barbara Schechtman, MPH; Midwest ATEC (MATEC) • Karen Sherman, MA; Health Care Education and Training, Inc. • Jamie Steiger, MPH; AETC National Resource Center The original curriculum was developed in 2002 by MATEC and Health Care Education & Training, Inc. HIV Screening and Women’s Health

3. Objectives for Section 3: • Describe the route of HIV transmission in vaginal sex • Identify factors for increased susceptibility • Discuss the risk of HIV infection from anal and oral sex • Review risk reduction methods for sexual and drug-using behaviors HIV Screening and Women’s Health

4. Route of Vaginal Transmission HIV Screening and Women’s Health

5. Biologic Factors that Increase HIV Susceptibility Epithelial cells Susceptibility Langerhan’s cells lumen submucosa HIV Screening and Women’s Health

6. Progesterone & Increased Vulnerability to HIV-1 (Marx et al., 1996) HIV Screening and Women’s Health

7. Young Women and HIV Risk • Young women are at an increased risk for HIV • infection because: • They are biologically vulnerable • They are less likely to be able to negotiate safer sex with an older partner • They may feel invincible • They may be more worried about pregnancy than about STIs and HIV HIV Screening and Women’s Health

8. Older Women and HIV Risk • Older women are at an increased risk for HIV • infection because: • They have physiological changes associated with menopause • They may perceive their risk of infection to be low • They may not think about condom use because they are no longer concerned about pregnancy HIV Screening and Women’s Health

9. Female Male (MMWR, July 18, 2003) HIV Screening and Women’s Health

10. Discussing Anal Sex with Your Clients • It is imperative that we discuss the risk of STI/HIV • transmission from anal sex, regardless of the • sexual orientation of our clients, since: • Anal sex is prevalent among heterosexuals • Women may have anal sex for pleasure, to prevent pregnancy, or to preserve virginity • Effective prevention methods exist for anal sex (condoms, female condoms) HIV Screening and Women’s Health

11. Prevalence of Anal Sex Among Heterosexuals • It is important to discuss the risk from anal sex with • female clients: • In a study of 1,268 sexually active women, 32% (n=432) reported anal sex in the previous six months (Gross et al., 2000) • In a study of men & women aged 13-19, 20% of women and 27% of men reported at least one episode of heterosexual anal intercourse (Moscicki, Millstein, Broering, & Irwin, 1993) • In 2002, 11% of males and females aged 15-19 had engaged in anal sex with someone of the opposite sex (Mosher, Chandra, & Jones, 2002) HIV Screening and Women’s Health

12. Discussing Oral Sex with Your Clients • It is also imperative to discuss the risk of • transmission of HIV from oral sex, since: • Oral sex is highly prevalent among heterosexuals • Oral sex has been shown to transmit HIV • More than half of adults in the U.S. do not consider oral sex to be sex • Effective prevention measures exist (condoms, dental dams, plastic wrap) HIV Screening and Women’s Health

13. Clients Should Be Counseled About Risk Reduction • Vaginal and anal sex: • Condom use • Female condom use • Abstinence • Reduce # of partners and/or frequency of sex • Limit the use of substances prior to sexual activity • Mutual monogamy with HIV negative partner HIV Screening and Women’s Health

14. Clients Should Be Counseled About Risk Reduction • Oral sex: • Condom use • Dental dams or plastic wrap use • No brushing or flossing prior to performing oral sex • Avoiding ejaculation inside the mouth HIV Screening and Women’s Health

15. Clients Should Be Counseled About Risk Reduction • Injection Drug Use: • Needle exchange • Cleaning with bleach in absence of new needles • No sharing of works • Choose less risky route of use HIV Screening and Women’s Health

16. Clients Should Be Counseled About Risk Reduction • Non-Injection Drug Use: • Reduce intake • Don’t combine drugs • Choose the least risky route of use • Avoid sexual activity when drunk or high HIV Screening and Women’s Health

17. How To Pick A Partner • Don’t even think about it… • Involved in a crime • Needle drug user • Violent (emotionally, physically, verbally, sexually) • You deserve better… • Wants you to have a baby when you are not ready • Doesn’t want you to have friends • This could work! • Listens to you • Respects your wishes • Never, ever scares you HIV Screening and Women’s Health

18. Resources • AIDS Education and Training Centerswww.aidsetc.org • Title X Family Planning Regional Training Centershttp://opa.osophs.dhhs.gov/titlex/ofp-training-grantees-listing.html • Centers for Disease Control and Prevention (CDC) • CDC National Prevention Information Network (NPIN) (800) 458-5231 • CDC National STD/AIDS Hotline • (800) 342-AIDS (English) • (800) 344-7432 (Spanish) • (800) 243-7889 (TTY) • Sexuality Information and Education Council of the United States (SIECUS) http://www.siecus.org HIV Screening and Women’s Health

19. References • Centers for Disease Control and Prevention. Incorporating HIV Prevention into the Medical Care of Persons Living with HIV. MMWR, July 18, 2003, 52 (RR12);1-24 • Gross, M., Holte, S.E., Marmor, M., Mwatha, A., Koblin, B.A., & Mayer, K.H. (2000). Anal Sex Among HIV-Seronegative Women at High Risk of HIV Exposure. Journal of Acquired Immune Deficiency Syndrome, 24: 393-398. • Marx, P.A., Spira, A.I., Gettie, A., Dailey, P.J., Veazey, R.S., Lackner, A.A., Mahoney, C.J., Miller, C.J., Claypool, L.E., Ho, D.D., & Alexander, N.J. (1996). Progesterone implants enhance SIV vaginal transmission and early virus load. Nature Medicine, 2(10): 1084-9. • Morrison, C. & Best, K. (2004). Hormonal Contraception and HIV: An Update. Family Health International. Retrieved on August 1, 2007 at http://www.fhi.org/en/RH/Pubs/booksReports/hcandhiv.htm • Moscicki, A.B., Millstein, S.G., Broering, J., & Irwin, C.E. (1993). Risks of human immunodeficiency virus infection among adolescents attending three diverse clinics. Journal of Pediatrics, 122 (5 Pt 1): 813-20. • Mosher, W., Chandra, A., & Jones, J. (2005). Sexual behavior and selected health measures: men and women 15-44 years of ages, United States, 2002. Advance Data from Vital and Health Statistics, Number 362: 21-26. HIV Screening and Women’s Health