New combinations of STI drugs

• Addis cure –for urethral discharge syndrome

• Addis cure plus-for Vaginal discharge

• Ulcure –for ulcerative STIs

1
• Flow charts for the Mx of
the STI syndromes(see
next slide) Flow chart for
STI Mx\FlowchartSTI.pdf
3
4
5
Image/photos of some STIs

Syphilis
Syphilis cont….
Gonorrhea and chlamydia
GENITAL WARTS
SCABIES
HERPES
Moluscum contagiosum
Warts
 HIV/AIDS in Ethiopia
• HIV/AIDS recognized about two decades ago
– First HIV positive sera in 1984
– First two AIDS cases in 1986
• HIV/AIDS now considered as an over all developmental
crisis
• There are HIV-1 (worldwide) & 2 (west Africa)species
• There is screening of donated blood
• Screening blood of visa applicants
• Screening VCT clients
• Screening those in PMTCT programs
• Diagnostic screening
• Premarital screening of couples

14
Magnitude of HIV/AIDS
• Adults & children living with HIV - 734,048
• Adult HIV prevalence is 1.5% ( 4.2 % in urban and
0.6% in rural)
• Urban 10.5 %
• Rural 1.9 %
• Male 3.0 %
• Female 4.0 %
• Overall HIV incidence estimate – 0.26% & projected
to remain stable until 2010
15
HIV and disease progression
Anti-HIV Seroconversion
T-cell response Antibody response

10,000,000
Intermediate Stage AIDS

CD4 Cell Count

1,000,000
Plasma HIV RNA

100,000
Plasma RNA Copies
10,000

1,000 Viral set point

1,000
100
CD4 Cells
10 500

1
4-8 Weeks Up to 12 Years 2-3 Years
Modes of transmission

– Heterosexual --- principal mode (87%)

– Mother to child transmission (about 10%)
– Utilization of un safe sharps
– Skin piercing instruments
– Blood & blood products

• National incidence appears to be leveling

– Some behavioral change in the population
• Increased awareness
• Increase in condom use
17
Determinants of transmission
– Underlying determinants
• Poverty
• Illiteracy
• Stigma & discrimination of the infected
• High rate of unemployment
– Direct determinants
• Wide spread commercial sex work
• HTPs
• Low coverage of health services

18
Risk factors for transmission
 Presence of STIs
 Multiple sexual partners
 Harmful traditional practices
• Female genital mutilation
• Uvulectomy
• Skin cutting and piercing practices

19
Impact of HIV/AIDS
– Growing number of AIDS cases
– Growing number of PLWHAs
– Increasing number of orphans
– Increasing demand for services
– Challenge for overall socio-economic development
• Deepening poverty
– Impact on child survival
• 30-40% of infants born infected
– AIDS is an over all developmental crisis
• No sector is immune to the impact

20
Priority interventions
– IEC and BCC

– Condom promotion and distribution

– Voluntary counseling and testing (VCT)

– Managment of STIs

– Blood safety & Universal precaution

– PMTCT

– Care & support to the infected

21
 MTCT of HIV with out interventions
• During pregnancy 5-10%
• During labor & delivery 10 -15%
• During breast feeding 5-20%

Varies with breast feeding & duration

• Overall without breast feeding 15-25%
• Overall with breast feeding to six months 20-35%
• Overall with breast feeding to 18-24 months 30-
45%
22
 Risk factors for MTCT of HIV
1. Maternal factors
– Rupture of membrane for >4 hours

– Injuries to birth canal during child birth (vaginal and cervical

tears)

– Ante partum procedures , eg. External cephalic version

– Invasive child birth procedures eg. Episiotomy, etc.

– Vaginal delivery

– Delayed infant cleaning and eye care

23
Cont’d
2. Infant factors
– First infant in multiple birth
– Pre-term
– Low birth weight babies
– Longer duration of breast feeding
– Early mixed feeding
– Oral diseases in the child

24
The four-pronged approach to PMTCT

1. Primary prevention of HIV infection

2. Prevention of unintended pregnancies
among HIV-infected women
3. Prevention of HIV transmission from HIV-
infected women to their infants
4. Treatment, care and support of HIV-
infected women, their infants and families