Critical Issues of HIV Care in Women

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  • The proportion of AIDS cases among female adults and adolescents (age ≥13 years) increased from 7% in 1985 to 27% in 2006.AIDS incidence among female adults and adolescents rose steadily through 1993, when the AIDS surveillance case definition was expanded, and leveled off at approximately 13,000 AIDS cases each year from 1993 through 1996. In 1996, incidence among women and adolescent girls began to decline, primarily because of the success of antiretroviral therapies. Cases have leveled since 2000.The data have been adjusted for reporting delays.
  • Rates of reported AIDS cases per 100,000 female adults and adolescents are shown for each state, the District of Columbia, and U.S. dependent areas. The highest rates were found in the District of Columbia, the U.S. Virgin Islands, Maryland, New York, and Florida. Rates were lowest in states in the Midwest.
    The District of Columbia is a metropolitan area, use caution when comparing its AIDS rate to state AIDS rates.Rates were not calculated for states reporting fewer than 5 AIDS cases in females in 2006.
  • In 2006, there were 53,564 female adults and adolescents 15 to 44 years of age reported to be living with AIDS in the United States and dependent areas. These women are of childbearing age and in the years of highest fertility. In most states with HIV surveillance, the number of reported HIV infected female adults and adolescents who have not progressed to AIDS exceeds the number of female adults and adolescents with AIDS (see slide 8). Together these numbers indicate the burden of HIV and the number of persons in need of HIV-related medical and social services for themselves and to prevent transmission of HIV to their children. States with integrated HIV and AIDS surveillance data may be better able to target programs and services to reduce transmission to newborns.
  • The pie chart on the left illustrates the distribution of HIV/AIDS cases diagnosed among female adults and adolescents in 2006 in 33 states by racial/ethnic group. The pie chart on the right shows the distribution of the female population of the 33 states in 2006.
    In 2006, black (not Hispanic) females made up 13% of the female population but accounted for 65% of HIV/AIDS cases among females. Hispanic females made up 11% of the female population but accounted for 15% of HIV/AIDS cases among females. Whites (not Hispanic) made up 71% of the female adult and adolescent population but accounted for 18% of HIV/AIDS cases among females.
    The following 33 states have had laws or regulations requiring confidential name-based HIV infection surveillance since at least 2003: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.
    The data have been adjusted for reporting delays.
  • Among female adults and adolescents diagnosed with HIV/AIDS in 2006, 80% of the 9,252 HIV/AIDS cases were attributed to high-risk heterosexual contact, 19% to injection drug use and 1% to other or unidentified risk factors.The following 33 states have had laws or regulations requiring confidential name-based HIV infection surveillance since at least 2003: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.
    Data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed.
  • Critical Issues of HIV Care in Women

    1. 1. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Critical Issues of HIV Care in Women Ronald D. Wilcox MD FAAP Principal Investigator/Program Director, Delta AETC Asst Professor of Medicine and Pediatrics LSU Health Sciences Center rwilco@lsuhsc.edu
    2. 2. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Nationwide AETC Network • We are part of a nationwide network of AIDS Education and Training Centers established by the Health Resources and Services Administration HIV/AIDS Bureau and are federally funded through the Ryan White HIV/AIDS Treatment Modernization Act.
    3. 3. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Create Unique ID Please darken the circles completely No check marks, X’s, or other markings Employment Setting Zip code
    4. 4. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Disclosure • The speaker receives or has received research monies from all pharmaceutical companies that produce antiretrovirals within the United States • This presentation contains some graphic images
    5. 5. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Pre-Test Question 1 • Women make up approximately ___% of people in the United States newly diagnosed with HIV in 2006: – 1. 10% – 2. 20% – 3. 30% – 4. 40% – 5. 50%
    6. 6. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Pre-Test Question 2 • Women with HIV most commonly report which risk factor as their means of HIV exposure: – 1. Heterosexual contact – 2. IV Drug Use – 3. Perinatal exposure – 4. Blood transfusion
    7. 7. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Pre-Test Question 3 • Which opportunistic infection is more common in women with HIV than men? – 1. Kaposi sarcoma – 2. Histoplasmosis – 3. Pneumocystosis – 4. Cryptococcal meningitis – 5. Candidal esophagitis
    8. 8. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Overview • Changes in Epidemiology • Risk Assessment • Mental Health / Substance Abuse Issues • Disclosure Issues • Prioritization of Healthcare • Biological Concerns • Sexuality • Fertility and Perinatal Transmission
    9. 9. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Changing Demographics • AIDS is a family disease, chronic in nature, that can affect people of both genders, all races, ages, sexual orientation, and socioeconomic class
    10. 10. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Major factors influencing the shift in demographics • Crack epidemic and behavior associated with crack use: hyper-sexuality and exchange of sex for money or drugs • Increasing rates of heterosexual transmission. Women may be unaware of their partner’s risk status
    11. 11. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
    12. 12. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org LA Statistics Living with HIV/AIDS (03/31/09) 11,553, 70% 4865, 30% males females
    13. 13. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org LA Statistics Newly Diagnosed with HIV in 2008 (03/31/09) 770, 67% 384, 33% Men Women
    14. 14. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
    15. 15. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
    16. 16. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
    17. 17. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Louisiana Statistics Women, by Race, living with HIV/AIDS (03/31/09) 83% 15% 2%0%0%0%0% Black White Hispanic Asian / PI Amer. Indian Unknown Multi-Race Nationally: 1 in 160 black, 1 in 3000 white
    18. 18. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Epidemiology in LA Number of Persons Living with HIV in Louisiana by Gender 1995-2007 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year NumberofPersonsLivingwithHIV Female Male Total Chart developed with the HIV/AIDS Program of OPH of LA 87% 70% 151% 22% 29%
    19. 19. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Epidemiology in LA Number of New HIV Diagnoses in Louisiana by Gender 1995-2007 0 200 400 600 800 1000 1200 1400 1600 1800 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year NumberofNewHIVDiagnoses Female Male Total Chart developed with the HIV/AIDS Program of OPH of LA 26% 32% 36% 32% 31%
    20. 20. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Overview • Changes in Epidemiology • Risk Assessment • Mental Health / Substance Abuse Issues • Disclosure Issues • Prioritization of Healthcare • Biological Concerns • Sexuality • Fertility and Perinatal Transmission
    21. 21. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Techniques for screening for risk for HIV • Don’t assume heterosexuality or monogamy • Be non-judgmental and open-minded • Ask about specific sexual behaviors
    22. 22. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Factors which may increase a woman’s risk of acquiring HIV via sexual transmission • Receptive anal intercourse • Multiple partners (relative) • Monogamous, unaware of the partner’s risk status • Practicing unsafe sex
    23. 23. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Anal Intercourse in Young Adults • Gorbach PM et al. Anal intercourse among young heterosexuals in three sexually transmitted disease clinics in the United States. Sex Transm Dis 2009 Mar 4; e- pub ahead of press. • 2001-2004: Interviewed 1084 heterosexual 18-26 y/o patients in Seattle, New Orleans, and St. Louis presenting to an STD clinic • 37% had anal intercourse at some point • 28.9% had anal intercourse with at least 1 of last 3 partners • 19% had anal intercourse with their last partner • Women reported less condom use with last AI than men (26% versus 45%, p<0.001) • Risk for AI for women: meeting partner same day, having over 3 partners in lifetime, and having sex for money
    24. 24. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Question • Which of the following reasons explains why adolescent females are more susceptible to HIV than post-menopausal women? – 1. Vaginal atrophy post-menopausal – 2. Decreased immune systems in adolescents – 3. Increased friability of vaginal tissue in adolescents – 4. Increased size of transformation zone in adolescents – 5. Bad luck
    25. 25. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Additional factors which may increase a woman’s risk of acquiring HIV via sexual transmission • Transformation zone • Genital ulcerative disease • Other sexually transmitted diseases
    26. 26. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Risk Assessment • Used Drugs or Alcohol to the point of impaired judgment – **Drugs don’t cause HIV, they just let it happen** • Had unprotected sex by consent or force • Received blood transfusion before 1985 • Shared drug works, i.e. needles • Had needlestick injury or splash to mucous membrane with HIV+ blood • Had unscreened insemination
    27. 27. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
    28. 28. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Risk Factors Reported for Women Living with HIV/AIDS in LA (03/31/09) 13% 36% 1% 0% 2% 48% Injection Drug Use Heterosexual Contact Transfusion Confirmed Other Perinatal No Identified Risk
    29. 29. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Overview • Changes in Epidemiology • Risk Assessment • Mental Health / Substance Abuse Issues • Disclosure Issues • Prioritization of Healthcare • Biological Concerns • Sexuality • Fertility and Perinatal Transmission
    30. 30. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Mental Health / Substance Abuse • Depression – 30-60% of women versus 20% of men – Twice as likely to die – Depressive symptoms associated with greater declines in CD4 cells • Anxiety – PTSD – 30-40% of women with HIV – 66% with lifetime history of domestic violence • Suicide – 24-26% attempt suicide after diagnosis • Substance Abuse
    31. 31. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Overview • Changes in Epidemiology • Risk Assessment • Mental Health / Substance Abuse Issues • Disclosure Issues • Prioritization of Healthcare • Biological Concerns • Sexuality • Fertility and Perinatal Transmission
    32. 32. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Disclosure • Benefits: – Support – No need to hide the information – Access to appropriate care – Decrease transmission – Some states have disclosure laws • Detriments – Difficulty with acceptance – Possible discrimination – Rejection in social or romantic situations – Domestic violence – Disclosure to others by informed person
    33. 33. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Disclosure • General Guidelines – Ask yourself the reason you are disclosing to this person – Anticipate the reaction – best vs. worse – Prepare by informing self about HIV – Get Support – Accept the reaction
    34. 34. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Disclosure • People potentially exposed – Sexual partners – Needle-sharing partners – Use of DIS workers / Medical provider • Employers • Family Members • Health Care Providers • Social Contacts
    35. 35. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Disclosure • People potentially exposed • Employers – If potentially interferes with job – Discuss confidentiality – Letter from primary care provider – Americans with Disability Act • Family Members • Health Care Providers • Social Contacts
    36. 36. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Disclosure • People potentially exposed • Employers • Family Members –Support –Possible rejection –Loss of housing –Questions regarding exposure • Health Care Providers • Social Contacts
    37. 37. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Disclosure • People potentially exposed • Employers • Family Members • Health Care Providers – Universal precautions – Appropriateness of health care – Gloving • Social Contacts
    38. 38. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Disclosure • People potentially exposed • Employers • Family Members • Health Care Providers • Social Contacts – Romantic • Legal requirement before intimacy • Safer sex – Need for support
    39. 39. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Overview • Changes in Epidemiology • Risk Assessment • Mental Health / Substance Abuse Issues • Disclosure Issues • Prioritization of Healthcare • Biological Concerns • Sexuality • Fertility and Perinatal Transmission
    40. 40. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Prioritization of Health Care • Place the health care of their family or significant others first – Adherence increased during pregnancy – Adherence to HAART inversely proportionate to number of children in household < 18 y/o • Often miss appointments or medication dosing • May ignore problems
    41. 41. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Overview • Changes in Epidemiology • Risk Assessment • Mental Health / Substance Abuse Issues • Disclosure Issues • Prioritization of Healthcare • Biological Concerns • Sexuality • Fertility and Perinatal Transmission
    42. 42. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Biologic Differences • LH: increases percentage of circulating CD4 cells • FSH: decreased CD4% but increased CD8% • Oral contraceptives: combined forms lower CD4 count • Nutrition: (gender differences) – IV drug users lower pre-albumin levels – CD4 < 200: increase in deficiencies of vitamin A, vitamin E, and selenium
    43. 43. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Gender Differences in OIs • Candida esophagitis more common in women • Kaposi Sarcoma more common in men
    44. 44. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Major Woman-specific Manifestations of HIV • Candidal vulvovaginitis • Abnormal Pap smears – HPV – CIN • Pelvic Inflammatory Disease • Altered course of other STDs • Idiopathic Genital Ulcers
    45. 45. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Candida Vulvovaginitis • More recurrent • Usually responds to standard treatment • May require longer courses of treatment
    46. 46. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Human Papilloma Virus • Major serotypes associated with carcinomas are 16 & 18 • Consider anal PAP smears in women with genital HPV or cervical disease
    47. 47. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Question • PAP smears are recommended in HIV+ women: – 1. every 6 months x 2 and if normal then yearly – 2. every 3 months x 3 and if normal then yearly – 3. every 12 months x 3 and if normal then every three years – 4. one initial one; if normal, no more needed unless have visible genital warts
    48. 48. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Cervical Abnormalities • More advanced cancer • Increased rates of persistence or recurrence • More multifactorial/ extensive lesions • More evidence HPV • More strains HPV present
    49. 49. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Cervical Disease in HIV + Women • Prospective cohort study from 10/91 to 6/96 • 328 HIV + / 325 HIV - women no evidence SILs by PAP or colposcopy at study entry • Results: – 20 % vs. 5 % developed SILs – Women who were HPV positive at enrollment (at 54 months) who developed SILs: • 10% of negatives (7 vs. 15%) • 24% of women + for non-16,18 • 48% of women + for 16, 18 (12% vs 54%) JAMA: 23 Feb 2000; 283: 1031-7
    50. 50. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Cervical Disease in HIV+ Women • Dames DN et al. The prevalence of cervical cytology abnormalities and human papillomavirus in women infected with the human immunodeficiency virus. Infect Agent Cancer 2009 Feb 10; e-pub ahead of print. • Bahamas • 100 non-pregnant HIV+ women screened • 67% had high risk HPV strains – More common in those with CD4 cell count < 400 • 44% had cytologic abnormalities – Most common LGSIL
    51. 51. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Appropriate GYN care • Aggressive diagnosis and early treatment of STDs • Pelvic exam with PAP smear and cultures every six months x 2 then yearly if normal – per 2008 OI Guidelines from DHHS • Colposcopy for abnormal PAP smears
    52. 52. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Pelvic Inflammatory Disease • More likely to require hospitalization and surgery • Usually polymicrobial • Lower WBC Count • Increase in TOAs • Higher and more persistent temperature
    53. 53. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Idiopathic Genital Ulcers • Rare manifestation • Occurs with advanced HIV disease • No standard treatment
    54. 54. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Overview • Changes in Epidemiology • Risk Assessment • Mental Health / Substance Abuse Issues • Disclosure Issues • Prioritization of Healthcare • Biological Concerns • Sexuality • Fertility and Perinatal Transmission
    55. 55. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Sexuality • Negotiation of safer sex – Intimacy – Fear of violence – Female condoms • Sexual practices – Anal versus vaginal versus oral sex • Sexual partners – Male versus female • Post-menopausal women • Microbicides
    56. 56. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Overview • Changes in Epidemiology • Risk Assessment • Mental Health / Substance Abuse Issues • Disclosure Issues • Prioritization of Healthcare • Biological Concerns • Sexuality • Fertility and Perinatal Transmission
    57. 57. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
    58. 58. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Question • If a woman is HIV+ and pregnant and takes NO ART during pregnancy, delivers vaginally, and the infant gets no ART, the chance the infant will have HIV is: – 1. 1-2% – 2. 8% – 3. 10-15% – 4. 25% – 5. 40%
    59. 59. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Fertility and Perinatal Transmission • Reproductive Options – Contraception • Oral contraceptives • Condom use • Injectables – Discordant couples • In vitro • Sperm washing – Concordant couples
    60. 60. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Perinatal Transmission • Prevention of infection in women of child- bearing age – Education in school systems – Easy availability of condoms despite the client’s age – Education through community-outreach organizations – Teaching while visiting their PCP – Testing all pregnant women
    61. 61. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Women in labor with unknown HIV status – rapid testing • Gaur S et al. Disparity in hospital utilization of rapid HIV-1 testing for women in labor with undocumented HIV status. Matern Child Health J 2009 Mar 4; e-pub ahead of print. • New Jersey • Evaluated use of rapid testing 6 months before CDC Recommendations in 2006 implementation and 6 months after • 22% of women before implementation had unknown status – 7.6% received rapid testing • 18.1% of women after implementation had unknown status – 9.6% received rapid testing • Less likely to be offered testing: white race, married, received prenatal care from a private obstetrician
    62. 62. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Perinatal Transmission • Prevention of pregnancy in infected women: – encourage dual methods of birth control, condoms plus one other, ie. Depoprovera or oral contraceptives (may have some interactions with the PIs)
    63. 63. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Perinatal Transmission • Interruption of vertical transmission: – If mother’s viral load <1000, may offer AZT (or full HAART) after the first trimester, give IV AZT at delivery, then give AZT to the infant for the first 4-6 weeks of life – If mother’s VL >1000, use HAART therapy – Want mother’s viral load < 1000 at time of delivery!!!!!
    64. 64. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Fertility and Perinatal Transmission • Pregnancy – Treatment • CD4 > 350 • CD4 < 350 – Regimens • AZT-based • Avoid: – Efavirenz – d4T + ddI together
    65. 65. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org HIV and pregnancy • Untreated mother: 25% - 40% • Nevirapine SD Therapy: 10-15% • O76 protocol: 8% • HAART therapy: 1-2%
    66. 66. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Fertility and Perinatal Transmission • Ceasarian section – Recommend if mother’s viral load is not < 1000 at the time of delivery – ~ 50% reduction in transmission – Not effective if mother has already began labor or had rupture of membranes
    67. 67. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Conclusions • Changing epidemiology has about 1/3 of newly infected as women, primarily minorities • Depression and anxiety more common in women with HIV • Disclosure may be very difficult and skills should be taught to HIV+ women • Women need to be empowered to place their healthcare needs first • Routine PAP smears very important for HIV+ women • Sexuality expression differs per patient and education needs to be tailored • With appropriate prenatal care, perinatal transmission can be decreased to < 2%
    68. 68. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Question • As compared to my knowledge on the subject before the presentation, my knowledge level now is: – 1. greatly enhanced – 2. moderately enhanced – 3. mildly enhanced – 4. I learned nothing new – 5. I am totally confused now
    69. 69. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Post-Test Question 1 • Women make up approximately ___% of people in the United States newly diagnosed with HIV in 2006: – 1. 10% – 2. 20% – 3. 30% – 4. 40% – 5. 50%
    70. 70. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Post-Test Question 2 • Women with HIV most commonly report which risk factor as their means of HIV exposure: – 1. Heterosexual contact – 2. IV Drug Use – 3. Perinatal exposure – 4. Blood transfusion
    71. 71. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org ARS Post-Test Question 3 • Which opportunistic infection is more common in women with HIV than men? – 1. Kaposi sarcoma – 2. Histoplasmosis – 3. Pneumocystosis – 4. Cryptococcal meningitis – 5. Candidal esophagitis
    72. 72. DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org Contact Info • Ronald D. Wilcox MD FAAP • E-Mail: rwilco@lsuhsc.edu • Delta AETC: www.deltaaetc.org • Office Phone: 504-903-0788 • Cell Phone: 504-491-1219 • Pager: 504-363-1692

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