WHO/POTI: Health Of Peace Operations Personnel Training course.

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This was a training manual for an East African audience with 9 modules of varying lengths, totalling over 59,000 words and produced over a one month period. Successfully concluded, with no hitches and is currently available at the World Health Organisation website.

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English

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Middle Aged (35-54)

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African (General) East African (General) Kenyan (East Africa)

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Note: Transcripts are generated using speech recognition software and may contain errors.
Lesson five HIV A I DS and sexually transmitted infections. ST while HIV continues to be a major global public health issue. HIV, infection has become a manageable chronic health condition. Lesson objectives, recognize the signs and symptoms, transmission and risk factors of HIV A I DS. Understand the standards for the diagnosis, prevention and treatment of HIV A I DS. Understand the range of combined methods available to prevent HIV. Infection. Describe the complex interaction between HIV A I DS and emergency settings. Identify some of the most at risk populations for HIV A I DS in conflict and humanitarian crises recognize and describe some of the most common sexually transmitted infections. ST section 51 overview of HIV A I DS human immunodeficiency virus. HIV continues to be a major global public health issue. In 2021 there were 38.4 million people globally living with HIV and 1.5 million people became newly infected with HIV. In the same year, there is no cure for HIV infection. However, with increasing access to effective HIV prevention diagnosis, treatment and care including for opportunistic infections. HIV, infection has become a manageable chronic health condition enabling people living with HIV to lead long and healthy lives. The world is embarking on a fast track strategy to end the acquired immunodeficiency syndrome A I DS epidemic. By 2030 see figure 5-1 joint United Nations program on HIV A I DS UA I DS has set the 95-95 dash 95 targets for 2030. These state that by 2030 95% of people living with A I DS will know their HIV status. 95% of people who know their status will be on treatment and 95% of people on treatment will have suppressed viral loads. This program has also set the target of no more than 200,000 new infections among adults by 2030 aims for everyone everywhere to live a life free of HIV related discrimination to reach this visionary goal. After three decades of the most serious epidemic in living memory countries will need to use the powerful tools available, hold one another accountable for results and make sure that no one is left behind. There is a strong global consensus that the tools now exist to end the A I DS epidemic. This confidence is based on a combination of major scientific breakthroughs and accumulated lessons learned over more than a decade of scaling up the A ID response worldwide. The achievement of targets built on these tools now needs to be fast tracked HIV. Infections may not disappear in the foreseeable future. But the A I DS epidemic can be ended as a global health threat to achieve this by 2030 the number of new HIV infections and A I DS related deaths will need to decline by 95% compared to 2010. There are major benefits of fast tracking the A I DS response in low and middle income countries. 28 million HIV infections will be averted between 2015 and 2030 21 million A I DS related deaths will be averted between 2015 and 2030 HIV targets the immune system and weakens people's defense against many infections and some types of cancer that people with healthy immune systems can more easily fight off as the virus destroys and impairs the function of immune cells. Infected individuals gradually become immunodeficient. Immune function is typically measured by CD four cell count. The most advanced stage of HIV infection is A I DS which can take many years to develop if not treated. Depending on the individual A I DS is defined by the development of certain cancers infections or other severe long term clinical manifestations, signs and symptoms. The symptoms of HIV vary depending on the stage of infection. Though people living with HIV tend to be most infectious in the first few months after being infected, many are unaware of their status until later stages. In the first few weeks after the initial infection, people may experience no symptoms or an influenza like illness including fever, headache, rash, or sore throat. As the infection progressively weakens the immune system. Patients can develop other signs and symptoms such as swollen lymph nodes, weight loss, fever, diarrhea, and cough without treatment. People can also develop severe illnesses such as tuberculosis, TB, cryptococcal meningitis, severe bacterial infections and cancers such as lymphomas and Kaposi's sarcoma transmission and risk factors. HIV can be transmitted via the exchange of a variety of body fluids from infected people such as blood, breast milk, semen and vaginal secretions. HIV can also be transmitted from a mother to her child during pregnancy and delivery. Individuals cannot become infected through ordinary day to day contact such as kissing, hugging, shaking hands or sharing personal objects, food or water. It is important to note that people with HIV, who are taking antiretroviral therapy. AR T and are virally suppressed do not transmit HIV to their sexual partners, early access to A T and support to remain on treatment is therefore critical, not only to improve the health of people with HIV, but also to prevent HIV transmission behaviors and conditions that put individuals at greater risk of contracting HIV include having unprotected anal or vaginal sex. Having another sexually transmitted infection ST such as syphilis, herpes chlamydia, gonorrhea, or bacterial vaginosis, sharing contaminated needles, syringes and other injecting equipment and drug solutions. When injecting drugs, receiving unsafe injections, blood transfusions and tissue transplantation and medical procedures that involve Unsterile, cutting or piercing and experiencing accidental needle stick injuries, including among HCP prevention. Individuals can reduce the risk of HIV infection by limiting exposure to risk factors. Key approaches for HIV prevention which are often used in combination include male and female condom use, prevention, testing and counseling for HIV and sexually transmitted infections. ST voluntary medical male circumcision, VM MC. Use of antiretroviral drugs for prevention, oral preexposure, antiretroviral prophylaxis, prep and long acting products. The dine vaginal ring and injectable long acting carbot, Gravier harm reduction for people who inject and use drugs and elimination of mother to child transmission of HIV diagnosis. HIV can be diagnosed through rapid diagnostic tests that provide same day results. This greatly facilitates early diagnosis and linkage with treatment and care. People can also use HIV self test to test themselves. However, no single test can provide a full HIV diagnosis. Confirmatory testing is required conducted by qualified and trained HCP or community worker at a community center or clinic HIV. Infection can be detected with great accuracy using who prequalify tests within a nationally approved testing strategy and algorithm since 2019 who strongly recommends the three test strategy that uses three consecutive reactive tests to provide an HIV positive diagnosis. Most widely used HIV. Diagnostic tests detect antibodies produced as part of their immune response to fight HIV. In most cases, people develop antibodies to HIV within 28 days of infection. During this time, people experience the so called window period. When HIV antibodies have not been produced at high enough levels to be detected by standard tests and when they may have no signs of HIV infection, but also when they may transmit HIV to others after infection, an individual who is not yet on A T may transmit HIV to a sexual or drug sharing partner or for pregnant women to their infants during pregnancy or during the breastfeeding period. Self testing is also an important part of the comprehensive strategy to prevent people from going undiagnosed with HIV and to ensure access to life saving ar T while preventing the risk of potentially exposing others. Self testing is safe and accurate and increases testing uptake among people who may not otherwise test. Self testing means people can test wherever and whenever they want empowering people to find out their HIV status quickly and privately HIV. Self testing also reduces stigma and helps rich people who are left behind such as among key populations. Finally, self testing relieves the burden of health care centers lacking resources following a positive diagnosis. People should be retested using another sample before they are enrolled in treatment and care to rule out any potential testing or reporting errors prior to starting lifelong treatment. While testing for adolescents and adults has been made simple and efficient. This is not the case for babies born to HIV, positive mothers for Children less than 18 months of age. Serological testing is not sufficient to identify HIV infection. Virological testing must be provided as early as birth or at six weeks of age. New technologies are now becoming available to perform this test at the point of care and enable same day results which will accelerate appropriate linkage with treatment and care treatment. HIV disease can be managed by treatment regimens composed of a combination of three or more antiretroviral drugs. Current A T does not cure HIV infection but highly suppresses viral replication within a person's body and allows an individual's immune system to recover, to strengthen and regain the capacity to fight off opportunistic infections and some cancers since 2016, who has recommended that all people living with HIV be provided with lifelong AR T including Children, adolescents, adults and pregnant and breastfeeding women regardless of clinical status or CD four cell count by June 2021 187 countries had already adopted this recommendation covering 99% of all people living with HIV globally. In addition to the treat all quote unquote strategy, who recommends a rapid ar T initiation to all people living with HIV including offering A T on the same day as diagnosis. Among those who are ready to start treatment, the offer of same day ar T initiation should include approaches to improve uptake treatment, adherence and retention such as tailored patient education counseling and support by June 2022 97 countries reported that they had adopted this policy and almost two thirds of them reported countrywide implementation. Globally, 28.7 million people living with HIV were receiving a T in 2021. Global ar T coverage was 75% in 2021. However, more efforts are needed to scale up treatment, particularly for Children and adolescents. Only 52% of Children, 0 to 14 years old were receiving A T at the end of 2021 advanced HIV disease remains a persistent problem in HIV. Response. People continue to present or represent for care with advanced immune suppression, putting them at a higher risk of developing opportunistic infections. Who is supporting countries in implementing the advanced HIV disease package of care to reduce illness and death, who recommends a package of interventions including screening treatment and all prophylaxis for major opportunistic infections, rapid ar T initiation and intensified adherence to support, which should be offered to everyone presenting with advanced HIV disease. It is important to support people with HIV to stay on treatment and provide a variety of services such as counseling messages, support groups, peer support, differentiated service delivery for HIV treatment and person centered services. When there are concerns about the meaning of their diagnosis or if they stop treatment and care and need to be re engaged. Section 5.2 Combination HIV prevention, combination prevention programs use a mix of evidence based biomedical behavioral and structural interventions to meet the current HIV prevention needs of individuals and communities to have the greatest possible impact on reducing the number of people who have been newly infected. Well designed combination prevention programs need to reflect the local HIV epidemiology and context. They should focus resources on reaching populations at the greatest HIV risk with effective acceptable prevention to address both immediate risks and underlying vulnerability. Combination prevention, mobilizes communities, civil society, the private sector, governments and global resources in a collective undertaking. it requires and benefits from enhanced partnership and co ordination and should incorporate mechanisms for learning capacity building and flexibility to permit continual improvement and adaptation to the changing epidemiological environment. Condom use, male condoms are estimated to reduce heterosexual transmission by at least 80% and to offer 64% protection in anal sex among men who have sex with men if used consistently and correctly, fewer data are available for the efficacy of female condoms. But evidence suggests that they can have a similar prevention effect. VM MC in areas with high HIV prevalence and low rates of male circumcision. VMC can greatly contribute to HIV prevention. VMC provides lifelong partial protection against female to male HIV transmission, reducing heterosexual male vulnerability to HIV infection by approximately 60%. VM MC can also act as an entry point for providing adolescents 15 years and older and adult men in settings with generalized epidemics with broader health packages to improve their health outcomes when combined with high levels of treatment coverage and viral suppression. Evidence shows that the impact of VM MC is particularly significant preexposure prophylaxis prep for preventing the accusation of HIV prep is the use of A T by HIV negative individuals to reduce the acquisition of HIV infection. Based on evidence from randomized trials, open label extension studies and demonstration projects in 2015 who recommended daily oral prep containing tenofovir as an additional prevention choice in people at a substantial risk of HIV infection. In 2019, wo updated this recommendation to include an additional dosing regimen called event driven prep for cisgender. Men who have sex with men. In 2021 wo released a conditional recommendation that the DPI vine vaginal ring may be offered as an additional prevention choice for women at substantial risk of HIV infection as part of combination prevention approaches as evidence for other prep products, including long acting formulations becomes available, who may make new or updated recommendations for prep in many countries. Individuals interested in prep must go to a health care facility. Often an HIV clinic to obtain a prescription from HCP, often a physician in recent years and particularly during the COVID-19 pandemic. The shift towards differentiated prep service delivery has accelerated. A differentiated prep service delivery approach is person and community centered and adapt services to the needs and preferences of the people who are interested in and could benefit from prep differentiated prep service delivery may also support more efficient and cost effective use of health care resources who recommends differentiated service delivery for HIV testing and A T delivery of person centered health services is one of the key strategic directions of the global health sector strategies on HIV, viral hepatitis and ST and differentiated service delivery is recognized as a key action post exposure preventive pep treatment. Pep treatment is an emergency medical response for individuals exposed to HIV. PEP treatment consists of medication, laboratory tests and counseling. Pep treatment must be initiated within hours of possible HIV exposure and must continue for a period of approximately four weeks. Pep treatment was originally designed for HCP who accidentally become exposed to HIV during the course of their work, for example, from needle stick injuries. However, the value of pep treatment is now recognized for other situations involving possible exposure to HIV, such as sexual assault, pep treatment has not been proven to prevent the transmission of HIV. However, research studies suggest that if the medication is initiated as quickly after possible HIV exposure, ideally within two hours and not later than 72 hours following such exposure, it may be beneficial in preventing HIV infection HIV testing and diagnosis. The 2019 consolidated guidelines on HIV testing services bring together the latest evidence, informed guidance and recommendations for delivering high impact HIV testing services including linkage to HIV prevention and treatment in diverse settings and populations. A key objective of these guidelines is to encourage greater national and global commitment to implementing effective and efficient HIV testing services as a vital element of the national and global HIV response. These guidelines also provide operational guidance on demand creation and messaging for HIV testing services, implementation consideration for priority populations HIV testing strategies for diagnosing HIV, optimizing the use of dual HIV and syphilis rapid diagnostic tests and considerations for strategic planning and rationalization resources such as optimal time points for maternal retesting. These 2021 consolidated HIV guidelines also incorporate additional recommendations and considerations for improved infant diagnosis. Engaging key populations over the past decade. It has become increasingly clear that certain key populations are less likely to test for HIV, initiate A T and remain engaged in care. They are also dying from A I DS related causes at disproportionately higher rates. Unaids considers *** men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people as the five main key population groups that are particularly vulnerable to HIV and frequently lack access to services. Key populations account for less than 5% of the global population, but they and their sexual partners comprised 70% of new HIV infections in 2021. The neglect of the HIV related needs of key populations not only contributes to needless suffering and death among those groups, but also exposes their sexual partners to considerable risks. Moreover, failure to use available simple strategies for preventing HIV. Acquisition among Children is not only a tragedy for each child living with HIV. But also for their families and communities, society bears the long term costs of lifelong ar T for Children who did not need to acquire HIV in the first place practices that reinforce patriarchal societal norms can also discourage men from seeking the services that they need. Transgender and gender diverse people. In many countries also experience significant levels of stigma and discrimination and violence and lower access to HIV services than the rest of the population. Transforming harmful gender and masculinity norms among men and boys will help reduce their HIV risks, but it will also reduce risks and vulnerabilities to HIV among women and adolescent girls including by respecting their sexual and reproductive health and rights and upholding zero tolerance for any violence against them. A human rights based approach is essential to ending A I DS as a public health threat rights based approaches, create an enabling environment for successful HIV responses and affirm the dignity of people living with or vulnerable to HIV HIV. Testing for a changing epidemic. People's knowledge of their own HIV status and that of their partners is essential to the success of the HIV response HIV. Testing servicess provide a pathway to HIV prevention treatment care and other support services. HIV. Testing services refer to the full range of services that should be provided with HIV testing including counseling, pre-test information and post test counseling, linkage to appropriate HIV prevention treatment care and other clinical services and co ordination with the laboratory services to support quality assurance and the delivery of accurate results. The overarching goals of HIV testing services are to identify people living with HIV by providing high quality testing services for individuals, couples and families to effectively link individuals and their families to HIV, treatment care and support and to HIV prevention services based on their status and to support the scaling up of high impact interventions to reduce HIV, transmission and HIV related morbidity and mortality. All HIV testing services should continue to be provided in accordance with the who essential five CS consent, confidentiality, counseling, correct test results and connection or linkage to prevention care and treatment. HIV. Testing services should always be voluntary, protecting and maintaining client confidentiality is important especially when offering testing as part of partner services. And when the pre-test information session includes questionnaires, screening for risks, symptoms or indicator conditions. An enabling environment that removes barriers such as stigma, discrimination, criminalization and age of consent issues is important to increase access to an uptake of HIV testing services especially among those at high ongoing risk and key populations. Section 5.3 guidelines for HIV A I DS interventions in emergency settings. Over the last two decades, complex emergencies resulting from conflict and natural disasters have occurred with increasing frequency throughout the world. At the end of 2001/70 different countries experienced an emergency situation resulting in over 50 million affected persons worldwide. Sadly, the very conditions that define a complex emergency conflict, social instability, poverty and powerlessness are also the conditions that favor the rapid spread of HIV A I DS and other ST the rationale for a specific HIV A I DS intervention in crises. At the end of 2021 there were 38 million people worldwide living with HIV A I DS. The long term consequences of HIV A I DS are often more devastating than the conflicts themselves. Mortality from HIV A I DS each year invariably exceeds mortality from conflicts. Most people are already living in precarious conditions and do not have sufficient access to basic health and social services during a crisis. The effects of poverty, powerlessness and social instability are intensified, increasing people's vulnerability to HIV A I DS. Particular attention is needed to ensure people from vulnerable populations including racial and gender. Minorities are protected during the response and are not further marginalized HIV, related stigma and discrimination significantly impact the health lives and the well being of people at risk for HIV, especially in key populations as the emergency and the epidemic simultaneously progress. Fragmentation of families and communities occurs threatening stable relationships. The socio norms, regulating behavior are often weakened in such circumstances. Children, adolescents and women are at an increased risk of violence and can be forced into having sex to gain access to basic needs such as food, water or even security. Displacement may bring populations each with different HIV A I DS prevalence levels into contact. This is especially true in the case of populations migrating to urban areas to escape conflict or disaster in rural areas. As a consequence, the health infrastructure may be greatly stressed, inadequate supplies may hamper HIV A I DS prevention efforts during the acute phase of an emergency. This absence or inadequacy of services facilitates HIV A I DS transmission through a lack of universal precautions and the unavailability of condoms in war situations. There is evidence of increased risk of transmission of HIV A I DS through the transfusion of contaminated blood. The presence of military forces, peace operations, personnel or other armed groups is another factor contributing to the increased transmission of HIV AIDS. These groups need to be integrated into all HIV prevention activities. Recent humanitarian crises reveal a complex interaction between the HIV A I DS epidemic, food insecurity and weakened governance. The interplay of these forces must be borne in mind when responding to emergencies. There is an urgent need to incorporate the HIV A I DS response into the overall emergency response. If not addressed the impacts of HIV A I DS will persist and expand beyond the crisis event itself, influencing the outcome of the response and shaping future prospects for rehabilitation and recovery. Increasingly, it is certain that unless the HIV A I DS response is part of the wider response, all efforts to address a major humanitarian crisis in high prevalence areas will be insufficient risk of transmission in emergency contexts. Although arriving at definitive conclusions is based on the scant HIV prevalence data available in emergency settings. We do know that many of the conditions that facilitate the spread of HIV are common in these settings. Such conditions include but are not limited to rape and sexual violence including rape used as a weapon of war by fighting forces against civilians. This is most often exacerbated by impunity for crimes of sexual violence and exploitation. Severe impoverishment that often leaves women and girls with few alternatives but to exchange sex for survival, mass displacement that leads to the breakup of families and relocation into crowded refugee and internally displaced camps where security is rarely guaranteed, broken school health and communication systems that had usually been used to program against HIV, transmission and limited access to condoms and treatment for ST people already living with HIV A I DS in emergencies in general, people already infected with HIV are at a greater risk of physically deteriorating during an emergency because people living with HIV A I DS are more prone to suffer from disease and death as a consequence of limited access to food, clean water and good hygiene than our people with functioning immune systems. Caretakers may be killed or injured during an emergency, leaving behind Children already made vulnerable by infection with HIV A I DS or the loss of parents to A I DS health care systems may break down attacks on health centers and inability to provide supplies. Flight of HCP and populations have limited access to health facilities because roads are blocked or mined and financial resources are even more limited than usual. And A T may be discontinued due to a lack of access to health infrastructures because of the adoption of protective security or other measures or due to the destruction of these facilities or supply chain interruptions. What should be done for HIV A I DS in emergencies for years, humanitarian organizations have ignored HIV in emergencies focusing their attention on life saving measures such as health, water, shelter and food HIV was not seen as a direct threat to life recently. However, a number of humanitarian organizations have realized the importance of preventing HIV transmission early on in an emergency emergency preparedness plans are developed in order to minimize the adverse effects of a disaster and to ensure the organization and delivery of the emergency response are timely appropriate and sufficient. Such preparedness plans should be part of a long term development strategy and not introduced as a last minute response to the unfolding emergency. In the case of HIV A I DS, such preparedness means that all relief workers would have received basic training before the emergency in HIV A I DS as well as sexual violence, gender issues and non discrimination towards HIV A I DS patients and their caregivers. It also implies that adequate and appropriate supplies specific to HIV are prepositioned. These are cross cutting issues that are relevant to all sectors, groups at risk. Women in emergencies, women are highly vulnerable to HIV A I DS in times of civil strife, war and displacement, women and Children are at an increased risk of sexual violence and abuse in acute emergency situations where there is severe food insecurity and hunger. Women and girls may find themselves coerced to engage in casual or commercial sex as a survival strategy to gain access to food and other fundamental needs. In addition, the disruption of communities and families, particularly when people flee from their land involves the breakup of stable relationships and the dissolution of social and familiar cohesion. Thus facilitating a context of new relationships with high risk behavior. Children emergencies also aggravate the vulnerable condition of Children affected by the HIV A I DS epidemic including orphans HIV infected Children and child headed households, displaced people and refugee Children confront completely new social and livelihood scenarios with notable vulnerability a circumstance that facilitates HIV transmission and aggravates A I DS impact on well being emergency situations also deprive Children of education opportunities including the opportunity to learn about HIV A I DS and basic health, Children in situations of armed conflict and displaced migrant and refugee Children are particularly vulnerable to all forms of sexual exploitation. Key populations, key populations which include sex workers, people who inject drugs, prisoners, transgender people and *** men and other men who have sex with men constitute small proportions of the general population, but they are at an elevated risk of acquiring HIV infection. In part due to discrimination and social exclusion. Despite remarkable achievements in reducing the number of new HIV infections and increasing access to effective treatment. Governments and humanitarian aid institutions struggle to address HIV care needs in emergency and humanitarian contexts and fragile states. People in those countries face serious problems with reduced or complete loss of access to HIV, prevention, treatment care and support services. People with less social power and fewer protections under the law are often at a higher risk of HIV infection. Mobile populations emergencies often result in the movement or displacement of people, displaced persons, refugees, returnees and demobilized military personnel including child soldiers are among society's most vulnerable. Most are separated from their families, spouses or partners. They are exposed to unique pressures, working constraints and living conditions. They are often seen as a threat to the cultural integrity or to the job security of the hosting population. A misperception that often gives rise to xenophobia. They feel anonymous and tend to cluster on the margins of cities or are housed in camps that were intended to be temporary or to have no homes at all. Vulnerability to HIV infection is greatest when people live and work in conditions of poverty, social exclusion, loneliness and anonymity. These factors may provoke risk taking behaviors that would not have been exhibited prior to displacement, the rural poor people in the developing world, particularly the rural poor are highly vulnerable to disasters. In fact, most emergencies involve poor people living in rural areas, poor communities and households have fewer means to protect themselves from and cope with the consequences of natural disasters due to their poverty. They also are often forced to live in areas that are prone to natural disasters such as landslides or floods. Access to basic health services is often minimal or non existent climatic and agricultural disasters such as drought and large scale pest infestations hit rural people hardest devastating their food sources and disrupting their agricultural and livelihood systems. Civil strife and war further exacerbate both their poverty and vulnerability leading to acute emergencies where poor people endure starvation, fear for their survival and may be forced to flee from their homes and land. The forced migration of the rural poor towards cities increases the risk of contracting HIV A I DS as zero prevalence in urban areas is higher. Rural populations are also less aware of the means of prevention and might lack access to them. Section 5.4 ST sts are spread predominantly by unprotected sexual contact. Some sts can also be transmitted during pregnancy, childbirth, and breastfeeding and through infected blood or blood products. ST have a profound impact on health if untreated. They can lead to serious consequences including neurological and cardiovascular disease, infertility, ectopic pregnancy, stillbirths and an increased risk of HIV. They are also associated with stigma and domestic violence and affect quality of life. The majority of ST have no symptoms when they are present. Common symptoms of STIs are vaginal or urethral discharge genital ulcers and lower abdominal pain. The most common and curable STIs are trichomonas, chlamydia, gonorrhea and syphilis. Rapidly increasing antimicrobial resistance is a growing threat for untreatable gonorrhea. Viral ST include HIV, genital herpes simplex virus, HSV, viral hepatitis B, human papilloma virus, HPV, and human T lymphotropic virus type one, HTLV. One, these lack or have limited treatment options. Vaccines are available for Hepatitis B to prevent infection that can lead to liver cancer and for HPV to prevent cervical cancer. HIV. HSV and HTLV. One are lifelong infections for HIV and HSV. There are treatments that can suppress the virus but currently there are no cures for any of these viral ST condoms used correctly and consistently are effective methods to protect against STIs and HIV. Screening with the early diagnosis of people with ST and their sexual partners offers the best opportunity for effective treatment and preventing complications and further transmission symptoms. A person can have an without having obvious symptoms of the disease when present common symptoms of STIs include abnormal vaginal discharge, urethral discharge, genital ulcers and lumps and lower abdominal pain. The symptoms of some specific STIs are outlined below gonorrhea and chlamydia infection. These ST cause cervicitis in women, urethritis in men and extragenital infections including rectal and oropharyngeal manifestations. Common symptoms include vaginal or penile discharge and burning with urination. Infants of infected mothers can contract neonatal conjunctivitis, red eyes due to exposure to ST during vaginal delivery, rectal and pharyngeal infections can be asymptomatic syphilis. Syphilis is often asymptomatic when symptoms occur. Primary syphilis presents as a solitary painless ulcer. Secondary syphilis may manifest as generalized lesions affecting the skin mucus membranes and lymph nodes including classic rash on the palms of the hands and soles of the feet. Latent syphilis is asymptomatic and characterized by positive syphilis, serology, trichomoniasis. The predominant symptoms include abdominal vaginal discharge with the redness of the vulva itching and painful intercourse. Gene to HSV. HSV. Most commonly presents as painful sores vesicles or ulcerations on the external genitalia and mouth symptomatic genital HSV is a lifelong condition that can be characterized by frequent symptomatic recurrences. HTLV. One generally asymptomatic the chronic form of HTLV. One can cause severe disease including adult T cell leukemia, lymphoma and a progressive nervous system condition known as HTLV. One associated myelopathy or tropical spastic paraparesis treatment. Effective treatment is currently available for several ST three bacterial ST chlamydia, gonorrhea and syphilis and one parasitic ST trichomoniasis are usually curable with existing effective single or multiple dose regimens of antibiotics for viral ST HIV. HSV and HTLV. One, the most effective medications available are AR T and anticancer drugs in the case of HTLV. One that can modulate the cause of the diseases though they cannot cure these three diseases, antimicrobial resistance. AMR to antibiotics used to treat ST in particular, gonorrhea has increased rapidly in recent years and has reduced successful treatment outcomes. Results from the current gonococcal AMR surveillance program show trends of high rates of quinolone resistance, increasing Aromasin resistance and emerging resistance to extended spectrum cephalosporins. The emergence of the decreased susceptibility of gonorrhea to extended spectrum cephalosporins together with established high levels of resistance to penicillins, sulfonamides, tetracyclines, quinolones and macros make gonorrhea a multidrug resistant organism. AMR for other ST though less common also exists making prevention and prompts treatment critical to adequately treat ST it is important to take the appropriate antimicrobials at the correct dose and for the recommended duration for the specific ST to ensure adequate treatment or cure and to prevent the development of antimicrobial resistance. Case study, sex workers with active syphilis. Sex workers face an increased burden of STIs and blood borne infections. Globally, female sex workers are estimated to be 30 times more likely to be living with HIV than other women of reproductive age. In 2019 unaids estimated a mean HIV prevalence of 36% among sex workers. While less is known about the prevalence or incidence of other sts and viral hepatitis infections. Among sex workers, increased rates have been documented in different contexts around the globe. Sex workers face high levels of stigma and criminalization almost everywhere. Modeling studies indicate that decriminalizing sex work could lead to a 46% reduction in new HIV infections in sex workers over 10 years. While eliminating sexual violence against sex workers could lead to a 20% reduction in new HIV infections. Wo supports countries in their efforts to address these structural barriers, ensure human rights for sex workers and implement a comprehensive package of HIV and others ST services through community led approaches. A number of priority health interventions can target the prevention of HIV and other ST among sex workers. Sex workers comprise a high risk group for ST disease burden syphilis infection in sex workers is a marker of syphilis prevalence in the community and thus a measure of the effectiveness of ST prevention programs. This indicator is useful in measuring the overall burden of disease and may provide an early warning of potential changes in HIV transmission in the general population. Syphilis infected over 5% of sex workers in 11 of 32 reporting countries for 2019 and over 10% in four countries. Among these 32 reporting countries for 2019, an average of 10.8% range 5.8% to 30.3% of sex workers tested were diagnosed with active syphilis. Sex workers include female, male and transgender adults and young people who receive money or goods in exchange for sexual services, either regularly or occasionally sex workers in many places are highly vulnerable to HIV and other ST such as syphilis due to multiple factors including large numbers of sex partners, unsafe working conditions and their inability to negotiate consistent condom use. Syphilis, screening and treatment among sex workers have the potential to both improve the health of individual sex workers as well as their clients. Summary, while HIV continues to be a major global public health issue with increasing access to effective HIV prevention, diagnosis, treatment and care including for opportunistic infections. HIV, infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives. The approach known as combination prevention offers the best prospects for addressing documented weaknesses in HIV prevention programming and for generating significant sustained reductions in HIV incidents in diverse settings. Combination prevention programs operate on different levels, eeg individual relationship, community societal to address the specific but diverse needs of the populations at risk of HIV infection. While the impact of HIV A I DS is generally well documented and understood. Considerably less attention has been given to the spread of HIV A I DS in emergency settings. The interplay between the epidemic and the emergency settings results in people affected by the crisis being at greater risk of contracting HIV A I DS ST are spread predominantly by sexual contact including vaginal anal and oral sex. Some ST can also be transmitted from mother to child during pregnancy, childbirth, and breastfeeding. A person can have an sti without showing symptoms of disease. Common symptoms of STIs include vaginal discharge, urethral discharge or burning in men, genital ulcers and abdominal pain, ST have a profound impact on sexual and reproductive health worldwide and can have serious consequences beyond the immediate impact of the infection itself, ST like herpes gonorrhea and syphilis can increase the risk of HIV acquisition, mother to child transmission of ST can result in stillbirth, neonatal death, low birth weight and prematurity, sepsis, pneumonia, neonatal conjunctivitis and congenital deformities when used correctly and consistently condoms offer one of the most effective methods of protection against STIs including HIV. Condoms also protect against unintended pregnancy in mutually consented sexual relationships. Although highly effective condoms do not offer protection for ST that cause extragenital ulcers, ie syphilis or genital herpes. When possible condoms should be used in all vaginal and anal sex health interventions, prevention, condom, prep, etcetera and harm reduction interventions, needle and syringe programs, opioid substitution therapy, naloxone behavioral interventions. HIV testing services HIV, treatment and care prevention and management of tuberculosis, hepatitis and mental health and sexual and reproductive health interventions, structural interventions, supportive legislation policy and funding including decriminalization of behaviors, drug use and possession sex work, same gender sex, addressing stigma and discrimination available, accessible and acceptable health services, community empowerment and addressing violence resources. More about the topics covered in this lesson can be found in the following resources. Global HIV program consolidated guidelines on HIV testing services for a changing epidemic guidelines for HIV A I DS interventions in emergency settings. Policy brief, consolidated guidelines on HIV, viral hepatitis and ST prevention diagnosis, treatment and care for key populations. Consolidated guidelines on HIV, prevention, diagnosis, treatment and care for key populations. End of lesson quiz one HIV stands for a human immunodeficiency virus. B human insulin virus, C Hypertrophy intubation virus, D hepatitis intestinal virus. Correct answer. A human immunodeficiency virus. Two true or false people with HIV taking antiretroviral therapy A T and who are virally suppressed can still transmit HIV to their sexual partners. Correct answer false three pre exposure prophylaxis prep is the use of blank by HIV, blank individuals to reduce the acquisition of HIV infections. A structural interventions, positive B, antiretroviral drugs, positive C structural interventions, negative D antiretroviral drugs, negative. Correct answer D antiretroviral drugs, negative four postexposure preventative pep treatment is an emergency medical response for individuals exposed to HIV. It consists of a medication treatment and postnatal care. B non medical therapies, laboratory testing and condoms. C medication, laboratory testing and care. D non medical therapies, laboratory testing and care. Correct answer C medication, laboratory testing and care. Five. The overarching goals of HIV testing services are A to identify people living with HIV by providing high quality testing services for individuals, couples and families. B to effectively link individuals and their families to HIV treatment, care and support and HIV prevention services based on their status C to support the scaling up of high impact interventions to reduce HIV, transmission and HIV related morbidity and mortality. D all of these correct answer. D all of these six at the end of 2001/70 different countries experienced an emergency resulting in over blank affected persons worldwide. A 20 million B 30 million C 40 million D 50 million. Correct answer. D 50 million seven. True or false. The same conditions that define a complex emergency conflict, social instability, poverty and powerlessness are also the conditions that favor the rapid spread of HIV A I DS. Correct answer. True. Eight. Unless an HIV A I DS response is incorporated into a wider emergency response. All efforts to address a major humanitarian crisis in high prevalence areas will be blank. A sufficient b insufficient C successful d conditionally successful correct answer be insufficient. Nine. Most ST have blank symptoms. A visible B mild C no D painful correct answer. C no 10 syphilis infection in sex workers is a marker of syphilis prevalence in the blank. And thus a measure of the effectiveness of ST prevention programs. A nation B community C region D, none of these correct answer B community.