Help Find the Missing Millions

Hepatitis is an inflammation of the liver. Viruses are the most common cause of hepatitis, but the condition can also be caused by other infections, heavy alcohol use, toxins, certain medications, and autoimmune disease. There are five main virus types that cause hepatitis—type A, B, C, D and E.

Hepatitis A and E are typically caused by ingesting contaminated food or water. Type B commonly occurs through contact with infected blood, semen or other bodily fluid through sex, sharing needles or other drug-injection equipment or from mother to baby at birth. Hepatitis type C is a blood-borne virus that is largely spread by sharing needles or other drug injection equipment. Hepatitis D, which is transmitted through contact with infectious blood, occurs only among people with hepatitis B infection.

Hepatitis B, C, and D afflict more than half a billion people worldwide and are responsible for more than a million deaths a year. Chronic infection with these viruses can lead to cirrhosis of the liver, end-stage liver disease, and liver cancer.

World Hepatitis Day is July 28th and is an opportunity to learn about the global burden of this disease and support efforts to combat viral hepatitis around the world. People can also find out if they should be tested or vaccinated for hepatitis A, B or C by taking CDC’s online Hepatitis Risk Assessment, which is based on CDC recommendations for the United States.

WORLD HEPATITIS DAY 2018 THEME: ELIMINATE HEPATITIS

In 2016, 194 governments adopted WHO’s Global Strategy on Viral Hepatitis, which includes a goal of eliminating hepatitis B and C by 2030, yet only a handful of countries are on track to meet these targets.

We are at a critical juncture. Unless we take action now, our chance to eliminate a cancer-causing illness will be missed. On WHD 2018, we are calling on all individuals and organizations to unite under the theme of “Eliminate Hepatitis” to drive action, build momentum and hold governments accountable. Because only together can we eliminate viral hepatitis by 2030.

WORLD HEPATITIS DAY 2018 CAMPAIGN: FIND THE MISSING MILLIONS

No one should have to live with viral hepatitis without knowing. Yet, globally more than 290 million men, women and children do. Unless there is a massive scale-up in screening, diagnosis and linkage to care, more people will become infected and lives will continue to be lost.

The World Hepatitis Alliance’s (WHA) global campaign – Find the Missing Millions – is a three-year global awareness-raising and advocacy campaign aimed at tackling the main barriers to diagnosis by putting civil society organizations and the affected community at the heart of the solution.

The Disease

The five hepatitis viruses – A, B, C, D and E – are distinct; they can have different modes of transmission, affect different populations, and result in different health outcomes.

  • Hepatitis A is primarily spread when someone ingests the virus from contact with food, drinks, or objects contaminated by feces from an infected person or has close personal contact with someone who is infected. Hepatitis A does not cause chronic liver disease and is rarely fatal, but it can cause serious symptoms. Hepatitis A can be prevented through improved sanitation, food safety, and vaccination.
  • Hepatitis B is often spread during birth from an infected mother to her baby. Infection can also occur through contact with blood and other body fluids through injection drug use, unsterile medical equipment, and sexual contact. The hepatitis B virus is common in sub-Saharan Africa, Asia and the Pacific Islands, but also has increased rates in the Amazon region of South America, the southern parts of eastern and central Europe, the Middle East and the Indian subcontinent. The hepatitis B virus can cause both acute and chronic infection, ranging in severity from a mild illness lasting a few weeks to a serious, chronic illness. If infected at birth or during early childhood, people are more likely to develop a chronic infection, which can lead to liver cirrhosis or even liver cancer. Getting the hepatitis B vaccine is the most effective way to prevent hepatitis B. WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, followed by 2-3 additional doses. In many parts of the world, widespread infant vaccination programs have led to dramatic declines of new hepatitis B cases.
  • Hepatitis C is spread through contact with blood of an infected person. Infection can occur through injection drug use and unsafe medical injections and other medical procedures. Mother-to-child transmission of hepatitis C is also possible. Hepatitis C can cause both acute and chronic infections, but most people who get infected develop a chronic infection. A significant number of those who are chronically infected will develop liver cirrhosis or liver cancer. With new treatments, over 90% of people with hepatitis C can be cured within 2-3 months, reducing the risk of death from liver cancer and cirrhosis. The first step for people living with hepatitis C to benefit from treatments is to get tested and linked to care. There is currently no vaccine for hepatitis C but research in this area is ongoing.
  • Hepatitis D is passed through contact with infected blood. Hepatitis D only occurs in people who are already infected with the hepatitis B virus. People who are not already infected with hepatitis B can prevent hepatitis D by getting vaccinated against hepatitis B.
  • Hepatitis E is spread mainly through contaminated drinking water. Hepatitis E usually clears in 4-6 weeks so there is no specific treatment. However, pregnant women infected with hepatitis E are at considerable risk of mortality from this infection.  Hepatitis E is found worldwide, but the number of infections is highest in East and South Asia. Improved sanitation and food safety can help prevent new cases of hepatitis E. A vaccine to prevent hepatitis E has been developed and is licensed in China, but is not yet available elsewhere.

Missing Millions

An estimated 290 million (89%) of the 325 million people living with viral hepatitis B and C are unaware that they are infected (WHO, 2017a), irrespective of gender, age, ethnicity or geography. This puts them at risk of unknowingly transmitting the virus to others and developing extrahepatic manifestations (e.g. autoimmune diseases, diabetes), liver complications, including fatal end-stage liver disease and liver cancer. Without a massive scale-up in awareness coupled with diagnostic services, to ensure that everyone infected gets tested, treatment rates will not increase and infection rates may rise (European Union HCV Collaborators, 2017).

Today, there is now a policy framework to combat and ultimately eliminate viral hepatitis. The United Nations’ Sustainable Development Goals (SDGs), adopted by all countries in 2015, call for combatting viral hepatitis (United Nations, 2015) and in 2016 the World Health Organization (WHO) adopted the Global health sector strategy on viral hepatitis, 2016–2021 (GHSS), which set the goal of eliminating viral hepatitis as a public health threat by 2030 and specifically for 30% of people infected to know their status by 2020 and 90% by 2030 (WHO, 2016). Thus, without  finding these “missing millions” and linking them to care, efforts to eliminate viral hepatitis will fail.

The “Find the Missing Millions” program, initiated by the World Hepatitis Alliance (WHA) in 2018, is a three-year effort intended to assist countries to reach the diagnosis targets they committed to when adopting the WHO viral hepatitis strategy. The program builds on the mission of WHA to “harness the power of people living with viral hepatitis to achieve its elimination” and this white paper highlights how involving civil society and the affected community can strengthen the response. While acknowledging the vast amount of work to date, including viral hepatitis testing guidance from clinical associations and technical agencies (AASLD, 2018; Chávez, 2013; EASL, 2018; Omata, 2016; WHO, 2017b), WHA, working with experts and key partners worldwide, developed a series of complementary recommendations, set out below, focusing on the role civil society and the affected community have in scaling up equitable diagnostic services to  nd the missing millions.

The Importance of Involving Civil Society and the Affected Community in the Response

People living with viral hepatitis and the affected community should be at the heart of every effort to eliminate viral hepatitis. Aside from fulfilling the need for trusted entities that consistently disseminate reliable information, civil society organizations bring fundamentally important perspectives and experiences which greatly enhance the effectiveness of strategies and programs.

In the context of addressing the barriers to diagnosis, a meaningful partnership with the affected community and civil society organizations can, amongst other things, contribute to the delivery of stronger awareness campaigns; strengthen innovative approaches to finding the undiagnosed through peer support services; help identify gaps within action plans which would otherwise be missed; and o er a platform to address stigma and discrimination, ensuring an equitable response so that the most vulnerable and marginalized are not left behind in the effort to eliminate viral hepatitis. As such, policy-makers should harness the voices of those affected by viral hepatitis, recognising them as vital partners in the elimination e ort.

Further, as more people living with viral hepatitis are aware of their diagnosis, they and those in their social environment can be part of the drive to prevent the disease by ensuring access to services, from prevention to testing to treatment and follow-up care, and by encouraging innovation, such as health systems reforms that facilitate new, more people-centered health services.

Methodology

Available research on the barriers to diagnosis of viral hepatitis and strategies to overcome them is limited to a small number of mainly high-income countries, or speci c regions and populations (Ishizaki, 2017). These studies are also limited with regard to the number and category of respondents. To address these data gaps, WHA conducted a global survey on the barriers to diagnosis of hepatitis B and hepatitis C.

WHA commissioned DJS Research, an independent research agency, to undertake a global consultation, in the form of an online survey that ran from 22 February to 21 March 2018. DJS Research sent approximately 3000 emails in English, French or Spanish to WHA member organizations, people living with viral hepatitis, medical professionals, policy-makers and other stakeholders. An open link to the survey was also provided on websites worldwide, which could be accessed by the wider hepatitis community.  Five hundred and sixty-one surveys were completed.

Following the online survey, telephone interviews were conducted with 17 respondents from Argentina, Australia, Brazil, Canada, Cyprus, Germany, Guatemala, Mali, Portugal, Spain, Switzerland, the United Kingdom and the United States of America. The interviews were designed to gather more detailed views on the barriers that were identified as major within the online survey.

The implications of the overall small sample size are that the data from individual regions can best be regarded as indicative and do not permit comparison or robust conclusions. Further, it is important to note that geographic representation in the survey is not proportionate to the prevalence and incidence of viral hepatitis in the different regions. Nonetheless, the  findings  provide useful avenues for exploration which then need to be adapted to the needs of each individual region. Details on barriers to the diagnosis of viral hepatitis B and C can be found in Find the Missing Millions: Barriers to Diagnosis Global Report (World Hepatitis Alliance, 2018).

The focus of the two-day global stakeholder consultation, held in London on 17–18 May 2018, was to further explore the role that civil society and the affected community can play in overcoming the identified barriers to diagnosis BOX 1 . Participants discussed the barriers to diagnosis identified by the survey and developed a set of recommendations; highlighting the unique role that civil society and the affected community have to play in a sustainable response.

Recommendations

 These recommendations should be considered complementary to WHO guidelines for viral hepatitis testing (WHO, 2017b) and the WHO Global health sector strategy on viral hepatitis, 2016-2021 (WHO, 2016) in that they set out to enhance the role of civil society and the affected community in overcoming the barriers to diagnosing viral hepatitis.

It is important to note that implementing these recommendations requires a multi-stakeholder response and this may mean policy-makers and other stakeholders will need to look beyond current partners. The response will be enhanced by involving not just those already engaged but also anyone who has contact with affected populations or populations at risk. This will vary depending on the setting but potential allies to consider include addiction specialists, nephrologists and hematologists, pharmacists, refugee and migrant support organizations, religious/cultural leaders who have played a role in developing and fostering health services, patient groups representing affected communities such as those with kidney disease, hemophilia or thalassemia and peers in general. Target groups may be different for e orts to combat hepatitis B versus hepatitis C and will likely differ by country or locality.

Overcoming the main barriers to diagnosis requires all stakeholders to engage in three main activities:

1.  Raising Awareness

Lack of public knowledge of the diseases, lack of knowledge among healthcare professionals and stigma and discrimination are all underpinned, in part, by a lack of awareness and so it is recommended that these three barriers should be collectively addressed.

When raising awareness, improving education and combatting stigma and discrimination, different strategies are required for different populations and, as WHO suggests, they will be dependent on the country context and may include promotion through the mass media (WHO, 2017b). In the GHSS it is stated that “Concerted advocacy e orts, particularly by political and community leaders, and a sound communication strategy are required to increase public and political awareness of the public health importance of viral hepatitis… and to mobilize action” (WHO, 2016).

Civil society and the affected community can enhance the response that WHO calls for by:

Partnering with stake holders to advocate for:

  • Health authorities to ensure continuous medical and professional education on viral hepatitis is provided from the early stages of training
  • Enabling frameworks such as anti-discrimination laws and their enforcement and redress of discriminatory acts
  • Decriminalization of drug use and homosexuality as punitive laws hamper public health efforts National governments to join all countries in upholding the commitment made at the 63rd World Health Assembly (2010) to use World Hepatitis Day to improve education and understanding of viral hepatitis

Partnering with stakeholders to take action to:

Promote the use of  findings  from national and/or WHO monitoring and evaluation frameworks to:

  • develop focused awareness strategies which target populations that are being left behind
  •  develop focused awareness strategies which target populations that are being left behind
  • create civil society-led shadow reports highlighting the experiences and expertise of civil society and the affected community to add further weight to national or WHO findings
  • Highlight in campaign materials that viral hepatitis is potentially a cancer-causing disease
  • Highlight that hepatitis can cause severe extrahepatic manifestations
  • Find influencers beyond the usual stakeholders that can help raise awareness (e.g celebrities and political leaders)
  • Create enabling environments where people living with viral hepatitis are able to share their stories in order to humanize the experience of living with viral hepatitis and reduce the stigma around it
  • Contribute to communication and awareness-raising campaigns by helping to formulate culturally speci c messaging to debunk myths, convey a sense of urgency, and reduce stigma
  • To ensure testing for hepatitis B and C is carried out alongside education on viral hepatitis so that awareness is increased in all people tested, not just those with viral hepatitis
  • Use the Find the Missing Millions campaign or other awareness-raising initiatives like World Hepatitis Day and NOhep to promote testing and improve understanding of viral hepatitis

2.  Making Testing More Accessible

The promotion of human rights and equity are core to both the SDGs (United Nations, 2015) and WHO initiatives to eliminate viral hepatitis. In particular these principles are evident within the guidance on access to testing, with WHO calling for testing services to be “accessible to the populations most affected” (WHO, 2017b). WHO further elaborates that: “Rapid expansion of programs to improve coverage should not compromise the quality of services, nor contribute to inequities in access to services and health outcomes” and “Actively engaging affected populations in developing strategies and programs should result in better targeted and acceptable services” (WHO, 2016).

Building on the foundation provided by WHO, civil society and the affected community can help national governments, national health institutions and other stakeholders to make testing more readily available by:

Partnering with stakeholders to advocate for:

  •  Development of a partnership response to viral hepatitis, where people living with the infections are included in ministerial and other global and national advisory structures
  • Better data to shape testing strategies so that they are targeted and client-centered
  • Available and effective testing, integrating both simple and appropriate testing technologies, while incentivizing testing at the primary care level
  • Provision of testing services through new models of care that allow for a “one-stop shop” experience where chronic infection can be confirmed and appropriate linkage to care implemented
  • Gaps in services to be addressed, specifically at sites where testing is not available or where it is underutilized
  • Broad availability of quality-assured rapid tests to screen for viral hepatitis

Partnering with stakeholders to take action to:

  •  Participate in the design of testing policies and strategies at the national level to ensure appropriate considerations that can enhance implementation are accounted for
  • Build the capacity of non-governmental organizations and community-based organizations, including patient groups, to test for viral hepatitis
  • Stimulate political will at all levels of government for increased access to testing
  • Help to ensure an equitable response by setting targets, especially for vulnerable populations, as they are frequently under-represented in testing efforts
  • Recruit peers from the affected communities to conduct testing, act as case managers, provide pre- and post-test counselling, provide reliable information to support those newly diagnosed and address transmission fallacies
Spotlight on peers:

Peer networks span multiple and intersecting groupings and have been successful in community mobilization. For example, peer involvement by community leaders or family members has been shown to promote access and subsequent participation in services for migrant populations, who are often cut o  from services, particularly where language and a fear of using services are barriers (Seedat, 2014; Sweeney, 2015).

The role of peers could extend beyond the current focus on testing and diagnosis to also serve to provide education on viral hepatitis, including how infection/reinfection occurs (Batchelder, 2017). For example, peer-driven testing campaigns for speci c populations such as people living with HIV (PLHIV), men who have sex with men (MSM), and people who inject drugs (PWID) can enable the scale up of diagnosis and treatment, as well as disseminate information on the distinct, available resources for those with a positive diagnosis to prevent stigmatization (Crawforth & Bath, 2013; Meyer, 2015; Scott, 2014; Sharma, 2015).

 3.  Removing Cost Barriers for Viral Hepatitis Testing

The WHA global survey found that out-of-pocket costs to patients were one of the principal barriers to diagnosis. To date, viral hepatitis testing costs have mainly been approached from a provider rather than user perspective in WHO initiatives (WHO, 2017b). However, the 4th strategic direction of the GHSS is: “Financing for sustainability: proposing strategies to reduce costs, improve efficiencies and minimize the risk of  financial hardship for those requiring the services” and the proposed priority actions for countries include reducing  financial barriers to patients by phasing out direct, out-of-pocket payments (WHO, 2016).

A coordinated and decided approach to curb this barrier is needed and civil society and the affected community can contribute by:

Partnering with stakeholders to advocate for:

  •  No, or limited and easily affordable, out-of-pocket costs for patients through inclusion of viral hepatitis services in health insurance schemes
  • Hepatitis testing and treatment to be included in universal health coverage packages, as set out by the Universal Health Coverage Forum in the Tokyo Declaration (2017)
  • The use of central procurement of quality-assured and affordable tests in order to obtain price-volume agreements
  • Leveraging of existing services in order to decrease investment costs for testing infrastructure and personnel, e.g. within HIV or other settings

 

Partnering with stakeholders to take action to:

  • Be a part of multi-stakeholder initiatives at the national level to inform the negotiation of pricing for diagnostic technologies and services
  • Assist in collecting and monitoring pricing data

Get Connected

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Get Lynked today!  Go to HealthLynked to sign up for Free and start taking control of your medical care.

Sources:  Adapted from

WHA.org

CDC.org

WHO.org

 

References from WHA Whitepaper

American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society  of America (2018). HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis. Last Updated: May 24, 2018. Available from https://www. hcvguidelines.org/sites/default/ les/ full-guidance-pdf/HCVGuidance_ May_24_2018a.pdf, accessed 19 June 2018.

Batchelder AW, Cockerham-Colas L, Peyser D, Reynoso SP, Soloway I, Litwin AH (2017). Perceived benefits of the hepatitis C peer educators: a qualitative investigation. Harm Reduct J;14(1):67.

Chávez-Tapia NC, Ridruejo E, Alves de Mattos A, Bessone F, Daruich J, Sánchez-Ávila JF, et al (2013). An update on the management of hepatitis C: guidelines for protease inhibitor-based triple therapy from the Latin American Association for the Study of the Liver. Ann Hepatol;12 Suppl 2:s3-35.

Crawford S, Bath N (2013). Peer support models for people with a history of injecting drug use undertaking assessment and treatment for hepatitis C virus infection. Clin Infect Dis;57:S75–S79.

European Association for the Study of the Liver (2018). EASL Recommendations on Treatment of Hepatitis C 2018. J Hepatol. pii: S0168-8278(18)31968-8.

European Union HCV Collaborators (2017). Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study. Lancet Gastroenterol Hepatol;2(5):325-336.

Ishizaki A, Bouscaillou J, Luhmann N, Liu S, Chua R, Walsh N, et al (2017). Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries. BMC Infect Dis.;17(Suppl 1):696.

Meyer JP, Moghimi Y, Marcus R, Lim JK, Litwin AH, Altice FL (2015). Evidence-based interventions to enhance assessment, treatment, and adherence in the chronic Hepatitis C care continuum. Int J Drug Policy;26(10):922-35.

Omata M, Kanda T, Wei L, Yu ML, Chuang WL, Ibrahim A, et al (2016). APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing. Hepatol Int;10(5):681-701

Scott HM, Pollack L, Rebchook GM, Huebner DM, Peterson J, Kegeles SM (2014). Peer social support is associated with recent HIV testing among young black men who have sex with men. AIDS Behav.;18(5):913–20.

Seedat F, Hargreaves S, Friedland JS (2014). Engaging new migrants in infectious disease screening: a qualitative semi-structured interview study of UK migrant community health-care leads. PLoS One; 9(10):e108261.

Sharma M, Ying R, Tarr G, Barnabas R (2015). Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature;528(7580):S77–85.

Sweeney L, Owiti JA, Beharry A, Bhui K, Gomes J, Foster GR, Greenhalgh T (2015). Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: qualitative study of at-risk immigrant communities and healthcare professionals. BMC Health Serv Res;15:97.

United Nations (2015). Sustainable Development Goals. https:// sustainabledevelopment. un.org/?menu=1300 Universal Health Coverage Forum (2017). Tokyo Declaration on Universal Health Coverage: All Together to Accelerate Progress towards UHC. http://www.who.int/universal_health_coverage/tokyo- decleration-uhc.pdf?ua=1 World Health Organization (2016).

Global health sector strategy on viral hepatitis, 2016-2021. WHO: Geneva. http://www.who.int/ hepatitis/strategy2016-2021/ghss- hep/en/World Health Organization (2017a). Global hepatitis report, 2017. WHO: Geneva http://apps. who.int/iris/bitstream/handle/10665/255016/9789241565455- eng.pdf?sequence=1

World Health Organization (2017b).  Guidelines on hepatitis B and C testing. WHO: Geneva http:// apps.who.int/iris/bitstream/handle/10665/254621/9789241549981- eng.pdf?sequence=1

World Health Assembly (2010). 63rd World Health Assembly. Viral hepatitis. 21 May 2010. http://apps. who.int/gb/ebwha/pdf_ les/WHA63/ A63_R18-en.pdf

World Health Assembly (2014). 73th World Health Assembly. Hepatitis. 24 May 2014. http://www.wpro.who. int/hepatitis/wha67_r6-en.pdf

World Hepatitis Alliance (2018). Find the Missing Millions: Barriers to Diagnosis Global Report, http:// www.worldhepatitisalliance.org/ missing-millions/wp-content/ uploads/2018/06/Find-the-Missing- Millions-Survey-Report-FINAL.pdf

 

 

 

“Doing It My Way, Testing for HIV” | HIV Testing Day 2018

National HIV Testing Day (NHTD) is an annual observance encouraging people of all ages to get tested for HIV and to know their status.  Too many people are unaware they have HIV. At the end of 2014, an estimated 1.1 million persons aged 13 and older were living with HIV infection in the United States, including an estimated 166,000 (15%, or 1 in 7) persons whose infections had not been diagnosed.

Getting tested is the first step to finding out if you have HIV. If you have HIV, getting medical care, taking medicines regularly and changes in behavior help you live a longer, healthier life and will lower the chances of passing HIV on to others.

Testing is the only way for the Americans living with undiagnosed HIV to know their HIV status and get into care. CDC estimates that more than 90% of all new infections could be prevented by proper testing and linking HIV positive persons to care. HIV testing saves lives! It is one of the most powerful tools in the fight against HIV

How do I know if I am at risk to get HIV? 

Knowing your risk can help you make important decisions to prevent exposure to HIV.  Overall, an American has a 1 in 99 chance of being diagnosed with HIV at some point in his or her lifetime. However, the lifetime risk is much greater among some populations. If current diagnosis rates continue the lifetime risk of getting HIV is:

  • 1 in 6 for gay and bisexual men overall
  • 1 in 2 for African American gay and bisexual men
  • 1 in 4 for Hispanic gay and bisexual men
  • 1 in 11 for white gay and bisexual men
  • 1 in 20 for African American men overall
  • 1 in 48 for African American women overall
  • 1 in 23 for women who inject drugs
  • 1 in 36 for men who inject drugs

Your health behaviors also affect your risk. You can get or transmit HIV only through specific activities. HIV is commonly transmitted through anal or vaginal sex without a condom or sharing injection and other drug injection equipment with a person infected with HIV. Substance use can increase the risk of exposure to HIV because alcohol and other drugs can affect your decision to use condoms during sex. To learn more about your HIV risk and ways to reduce these risks, visit: https://wwwn.cdc.gov/hivrisk/

How do HIV, Viral Hepatitis, and STDs relate to each other? 

Persons who have an STD are at least two to five times more likely than uninfected persons to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if a person who is HIV positive also has an STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons.

Hepatitis B virus (HBV) and HIV are bloodborne viruses transmitted primarily through sexual contact and injection drug use. Because of these shared modes of transmission, a high proportion of adults at risk for HIV infection are also at risk for HBV infection. HIV-positive persons who become infected with HBV are at increased risk for developing chronic HBV infection and should be tested. In addition, persons who are co-infected with HIV and HBV can have serious medical complications, including an increased risk for liver-related morbidity and mortality.

Hepatitis C Virus (HCV) is one of the most common causes of chronic liver disease in the United States. For persons who are HIV infected, co-infection with HCV can result in a more rapid occurrence of liver damage and may also impact the course and management of HIV infection.

How do I protect myself and others from HIV, Viral Hepatitis, and STDs? 

HIV Prevention

Your life matters and staying healthy is important. It’s important for you, the people who care about you, and your community that you know your HIV status.  Knowing give you powerful information to help take steps to keep you and others healthy. You should get tested for HIV, and encourage others to get tested too.

For people who are sexually active, there are more tools available today to prevent HIV than ever before. The list below provides a number of ways you can lower your chances of getting HIV. The more of these actions you take, the safer you can be.

  • Get tested and treated for other STDs and encourage your partners to do the same.All adults and adolescents from ages 13-64 should be tested at least once for HIV, and high-risk groups get tested more often.  STDs can have long-term health consequences.  They can also increase your chance of getting HIV or transmitting it to others. It is important to have an honest and open talk with your healthcare provider and ask whether you should be tested for STDs.  Your healthcare provider can offer you the best care if you discuss your sexual history openly. Find an HIV/STD testing site.
  • Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex for HIV transmission. Anal sex is the highest-risk sexual activity for HIV transmission. Sexual activities that do not involve the potential exchange of bodily fluids carry no risk for getting HIV (e.g., touching).
  • Use condoms consistently and correctly.
  • Reduce the number of people you have sex with.  The number of sex partners you have affects your HIV risk. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV transmission.
  • Talk to your doctor about pre-exposure prophylaxis (PrEP). CDC recommends that PrEP be considered for people who are HIIV-negative and at substantial risk for being exposed to HIV.For sexual transmission, this includes HIIV-negative persons who are in an ongoing relationship with an HIV-positive partner. It also includes anyone who 1) is not in a mutually monogamous relationship with a partner who recently tested HIV-negative, and 2) is a gay or bisexual man who has had sex without a condom or been diagnosed with an STD in the past 6 months; or heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners). For people who inject drugs, this includes those who have injected drugs in the past 6 months and who have shared injection equipment or been in drug treatment for injection drug use in the past 6 months.
  • Talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable. Starting medicine immediately (known as post-exposure prophylaxis, or PEP) and taking it daily for 4 weeks reduces your chance of getting HIV.
  • If your partner is HIV-positive, encourage your partner to get and stay on treatment.  ART reduces the amount of HIV virus (viral load) in blood and body fluids. ART can keep people with HIV healthy for many years, and greatly reduce the chance of transmitting HIV to sex partners if taken consistently and correctly.

Hepatitis Prevention

The best way to prevent both Hepatitis A and B is by getting vaccinated.   There is no vaccine available to prevent Hepatitis C.  The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, such as sharing needles or other equipment to inject drugs.

STD Prevention

The only way to avoid STDs is to not have vaginal, anal, or oral sex. If you are sexually active, you can do several things to lower your chances of getting an STD, including:

  • Get tested for STDs and encourage your partner(s) to do the same. It is important to have an honest and open talk with your healthcare provider and ask whether you should be tested for STDs.  Your healthcare provider can offer you the best care if you discuss your sexual history openly.  Find an STD testing site.
  • Get vaccinated. Vaccines are safe, effective, and recommended ways to prevent hepatitis A, hepatitis B, and HPV.
  • Be in a sexually active relationship with only one person, who has agreed to be sexually active only with you.
  • Reduce your number of sex partners.  By doing so, you decrease your risk for STDs. It is still important that you and your partner get tested, and that you share your test results with one another.
  • Use a condom every time you have vaginal, anal, or oral sex. Correct and consistent use of the male latex condomis highly effective in reducing STD transmission.

What puts me at risk for HIV, Viral Hepatitis, and STDs? 

Risks for HIV

The most common ways HIV is transmitted in the United States is through anal or vaginal sex or sharing drug injection equipment with a person infected with HIV. Although the risk factors for HIV are the same for everyone, some racial/ethnic, gender, and age groups are far more affected than others.

What puts me at risk for Hepatitis A?

Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces or stool of an infected person. Due to routine vaccination of children, Hepatitis A has decreased dramatically in the United States. Although anyone can get Hepatitis A, certain groups of people are at higher risk, including men who have sex with men, people who use illegal drugs, people who travel to certain international countries, and people who have sexual contact with someone who has Hepatitis A.

What puts me at risk for Hepatitis B?

Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.

Among adults in the United States, Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases. Hepatitis B is 50–100 times more infectious than HIV.

What puts me at risk for Hepatitis C?

Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Hepatitis C was also commonly spread through blood transfusions and organ transplants prior to the early 1990’s. At that time, widespread screening of the blood supply began in the United States, which has helped ensure a safe blood supply.

STDs

Risks for  Genital Herpes

Genital herpes is a common STD, and most people with genital herpes infection do not know they have it.   You can get genital herpes from an infected partner, even if your partner has no herpes symptoms.  There is no cure for herpes, but medication is available to reduce symptoms and make it less likely that you will spread herpes to a sex partner.

Risks for Genital Human Papillomavirus (HPV)

HPV is so common that most sexually active people get it at some point in their lives. Anyone who is sexually active can get HPV, even if you have had sex with only one person. In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer. HPV is passed on through genital contact (such as vaginal and anal sex). You can pass HPV to others without knowing it.

Risks for Chlamydia

Most people who have chlamydia don’t know it since the disease often has no symptoms.  Chlamydia is the most commonly reported STD in the United States.  Sexually active females 25 years old and younger need testing every year. Although it is easy to cure, chlamydia can make it difficult for a woman to get pregnant if left untreated.

Risks for Gonorrhea

Anyone who is sexually active can get gonorrhea, an STD that can cause infections in the genitals, rectum, and throat. It is a very common infection, especially among young people ages 15-24 years. But it can be easily cured.  You can get gonorrhea by having anal, vaginal, or oral sex with someone who has gonorrhea. A pregnant woman with gonorrhea can give the infection to her baby during childbirth.

Risks for Syphilis

Any sexually active person can get syphilis. It is more common among men who have sex with men. Syphilis is passed through direct contact with a syphilis sore. Sores occur mainly on the external genitals, anus, or in the rectum. Sores also can occur on the lips and in the mouth. A pregnant women with syphilis can give the infection to her unborn baby.

Risks for Bacterial Vaginosis

BV is common among women of childbearing age. Any woman can get BV, but women are at a higher risk for BV if they have a new sex partner, multiple sex partners, use an intrauterine device (IUD), and/or douche.

Managing Your Appointments

HIV is a treatable condition. If you are diagnosed early, get on antiretroviral therapy (ART), and adhere to your medication, you can stay healthy, live a normal life span, and reduce the chances of transmitting HIV to others. Part of staying healthy is seeing your HIV care provider regularly so that he or she can track your progress and make sure your HIV treatment is working for you.

Your HIV care provider might be a doctor, nurse practitioner, or physician assistant. Some people living with HIV go to an HIV clinic; others see an HIV specialist at a community health center, Veterans Affairs clinic, or other health clinic; and some people see their provider in a private practice. Current guidelines recommend that most people living with HIV see their provider for lab tests every 3 to 4 months. Some people may see their provider more frequently, especially during the first two years of treatment or if their HIV viral load is not suppressed (i.e. very low or undetectable). Current guidelines say that people who take their medication every day and have had a suppressed viral load at every test for more than 2 years only need to have their lab tests done two times a year.

In addition to seeing your HIV care provider, you may need to see other health care practitioners, including dentists, nurses, case managers, social workers, psychiatrists/psychologists, pharmacists and medical specialists. This may mean juggling multiple appointments, but it is all part of staying healthy. You can help make this easier by preparing a plan for yourself.

Before Your Visit

For many people living with HIV, appointments with their HIV care provider become a routine part of their life. These tips may help you better prepare for your visits to your HIV care provider and get more out of them:

  • Start with a list or a notebook. Write down any questions you have before you go. (The Department of Veterans Affairs offers a useful list of sample questions you can bring with you.)
  • Make a list of your health and life goals so that you can talk about them with your HIV provider and how she/he can help you reach them.
  • Make a list of any symptoms or problems you are experiencing that you want to talk to your provider about.
  • Bring a list of all the HIV and non-HIV medications that you are taking (or the medications themselves), including over-the-counter medications, vitamins, or supplements. Include a list of any HIV medications you may have taken in the past and any problems you had when taking them.
  • Bring along a copy of your medical records if you are seeing a new provider who does not already have them. You have the right to access your medical records and having copies of your records can help you keep track of your lab results, prescriptions, and other health information. It can also help your new provider have a better understanding of your health history. The best way to do this is by using a global, portable personal health record like the one you will maintain here at HealthLynked.
  • Be prepared to talk about any changes in your living situation, relationships, insurance, or employment that may affect your ability to keep up with your HIV appointments and treatment or to take care of yourself. Your provider may be able to connect you with resources or services that may assist you.
  • Be on time. Most healthcare providers have full appointment schedules—if you are late, you throw the schedule off for everyone who comes after you. If you are late, there is a chance your provider will not be able to see you the same day.

During Your Visit

  • If your provider wants to run some lab tests during your visit, make sure you understand what the lab tests are for and what your provider will do with the results. If you don’t understand, ask your provider to explain it in everyday terms. Typically, you will be asked to give a sample (blood, urine) during your visit and your provider’s office will call you with your results in a few days. Keep track of your results and call your provider back if you have any questions.
  • Be honest. Your provider isn’t there to judge you, but to make decisions with you based on your particular circumstances. Talk about any HIV medication doses you have missed. Tell your provider about your sexual or alcohol/drug use history. These behaviors can put you at risk of developing drug resistance and getting other sexually transmitted infections (STIs) as well as hepatitis. Your provider will work with you to develop strategies to keep you as healthy as possible.
  • Describe any side effects you may be having from your HIV medications. Your provider will want to know how the HIV medications are affecting your body in order to work with you to solve any problems and find the right combination of medications for you.
  • Ask your provider about your next visit and what you should bring to that appointment.
  • Ask for a list of your upcoming appointments when you check out. Work with your case manager, if you have one, to develop a system to help you remember your appointments, such as a calendar, app, or text/e-mail reminders.

Asking Questions and Solving Problems

It’s important for you to be an active participant in your own health care and it’s your right to ask questions. You may need to direct your questions to different people, depending on what you need/want to know:

HIV care providers (doctors, nurse practitioners, physician assistants) can answer specific questions about a wide range of issues that affect your health. They can also help you find resources and solutions to problems you may have that affect your health, including:

  • Your prognosis (how your HIV disease is affecting your body)
  • How to manage any symptoms you may be experiencing
  • Medication issues, including medication changes, new medications, and how the HIV medications may interact with other medications you take.
  • Sexual health issues, including questions about any sexual symptoms you may be having, and how you can prevent or treat STIs, and how you can prevent transmitting HIV to your partner(s).
  • Family planning considerations, including your goals; birth control options for you and/or your partner, if relevant; your options for having children should you wish to do so; and, if you are an HIV-positive woman who is pregnant or considering getting pregnant, how you can reduce the risk of transmitting HIV to your baby
  • Substance use issues, including how alcohol/drug use can affect your HIV treatment and overall health, and whether you should be referred for substance abuse treatment
  • Mental health issues, including questions about any mental health symptoms you may be having, and whether you should be referred for mental health treatment
  • Referrals for other medical issues you may be experiencing
  • The meaning of lab test results
  • The need for surgical procedures, if relevant
  • Medication adherence strategies (tips for keeping up with your medication and ensuring you take it as scheduled and exactly as prescribed)
  • Any clinical trials or research studies that may be relevant for you
  • Information about resources and services that can help you with issues or challenges you may be having that affect your health.

Nurses and case managers often have more time to answer questions about what you discuss with your provider and to help identify solutions to problems that are affecting your health, particularly around:

  • Understanding your HIV treatment plan, including how many pills of each medicine you should take; when to take each medicine; how to take each medicine (for example, with or without food); and how to store each medicine
  • Understanding possible side effects from your HIV medication and what you should do if you experience them
  • Challenges you may have in taking your medications and/or keeping your medical appointments, and strategies for overcoming these challenges
  • Resources to help you better understand lab reports, tests, and procedures
  • Mental health and/or substance abuse treatment, housing assistance, food assistance, and other resources that exist in your community
  • Insurance and pharmacy benefits, and other aspects of paying for care
  • Understanding other medical conditions you may have
  • How to quit smoking and resources that are available to assist you
  • Information about resources and services that can help you with issues or challenges you may be having that affect your health.

If you are HIV positive, attending your medical appointments is one of the most important things you can do to ensure your HIV is optimally managed. Make sure you are ready for your appointments with HealthLynked.  Using our novel healthcare ecosystem, you can collate your medical information in one place and Connect there with the physicians who care for you.

Ready to get Lynked?  Go to HealthLynked.com today to sign up for Free!

 

Adapted from:

HIV.org

CDC.foc

Aidsinfo.NIH.gov