Education AIDs prevention

STDs don't discriminate.

Rich people get STDs. Poor people get them. Athletes get them. Math geeks get them. CEOs and professors get them. Even someone having sex for the first time can get an STD. The only people who have no risk of getting an STD are people who haven't had sex or any kind of sexual contact.

What can you do? If you decide to have sex, always use a condom every time. Even if you're already on another kind of birth control, like the Pill, you should still use a condom. That's because condoms are the only type of birth control that reduces the risk of getting an STD.

There's often no sign that a person has an STD.

Even doctors often can't tell by looking if people have STDs. So they need to do tests, like bloodwork. People with STDs might not know they have them: STDs don't always cause symptoms. But it is possible to carry and spread the virus without ever having an outbreak. Untreated STDs can add up to serious health problems, like infertility (the inability to have a baby) or pelvic inflammatory disease (PID), which may land you in the hospital. What can you do? Even if you both think you're clean, get checked out before having sex. Then use a condom every time, just to be sure. It can take a while for some STDs to show up on tests.

Prevalence

The adult prevalence of HIV in the Dominican Republic is 1.1 percent, and UNAIDS estimates that 66,000 Dominicans are HIV-positive. Together with neighboring Haiti, it accounts for almost three-quarters of the Caribbean's HIV cases. HIV was first reported in the Dominican Republic in 1983 and spread until the mid-1990s, when prevalence started to decrease. Heterosexual intercourse is reported to be the primary form of transmission of the disease, accounting for 81 percent of HIV infections in 15- to 44-year-olds of both sexes.

However, because of strong stigma against homosexuality, it is possible that the number of infections resulting from men having sex with men may be higher than listed. Currently, the epidemic appears to have stabilized. In the Dominican Republic, HIV/AIDS is the leading cause of death among women of reproductive age, according to the World Bank. HIV prevalence in pregnant women was relatively stable for many years. However, 2005 sentinel surveillance reported HIV prevalence of more than 4.5 percent in pregnant women at two sites. In 2006, sentinel surveillance of pregnant women of all ages reported seroprevalence of 3.4 percent at four sites and 5.9 percent at one site.

However, in the Santo Domingo National District, antenatal clinics have noted a decline in prevalence, probably because of a successful prevention campaign.

The country's epidemic is driven by people with multiple sex partners, younger women in union with older men, sex workers and their clients and partners, and men who have sex with men (MSM). According to the 2002 Demographic and Health Survey, 29 percent of men had sex with more than one partner in the preceding 12 months. According to UNAIDS, females under 24 years of age are twice as likely to contract HIV as their male counterparts. This is due in part to the common practice of young women establishing relationships with older men, who are more likely to have acquired HIV. A sentinel surveillance study in 2006 reported that prevalence among commercial sex workers (CSWs) is 4.1 percent (2.4 to 6.5 percent, depending on location). In some sites, the prevalence among CSWs is declining and equals that of pregnant women.

For example, in Santo Domingo, prevalence in sex workers has been decreasing for the last eight years and is reaching the same level as in pregnant women nationally. This may be attributable.

Prevention Recommendations Preventing Exposure

Caregivers and HIV-infected children should be educated and counseled about the different ways Cryptosporidium can be transmitted. Modes of transmission include directly contacting fecal material from adults, diaper-aged children, and infected animals; contacting contaminated water during recreational activities; drinking contaminated water; and eating contaminated food. Hand washing after exposure to potentially fecally contaminated material, including diapers, is important in reducing the risk or Cryptosporidium infection. HIV-infected children should not be allowed contact with ill pets or stool from pets, particularly dogs and cats <6 months of age; stray pets; or surfaces contaminated with human or animal stool. HIV infected children should avoid direct contact with calves and lambs at farms or petting zoos. HIV-infected children should not be allowed to drink water directly from lakes or rivers, including swallowing water while swimming or playing in recreational water.

Caregivers and HIV-infected children should be aware that lakes, rivers, saltwater beaches, certain swimming pools, recreational water parks, and ornamental water fountains might be contaminated with human or animal waste that contains Cryptosporidium. Some outbreaks of cryptosporidiosis have been linked to ingestion of water from municipal water supplies. During outbreaks or in other situations in which a community advisory to boil water is issued, water used in preparing infant formula and for drinking should be boiled for >3 minutes to eliminate risk for cryptosporidiosis.

Nationally distributed brands of bottled or canned carbonated soft drinks are safe to drink. Commercially packaged noncarbonated soft drinks and fruit juices that do not require refrigeration until after they are opened (i.e., can be stored unrefrigerated on grocery shelves) also are safe. Nationally distributed brands of frozen fruit juice concentrate are safe if they are reconstituted by the user with water from a safe water source. Fruit juices that must be kept refrigerated from the time they are processed to the time of consumption might be either fresh (i.e.,unpasteurized) or heat-treated (i.e., pasteurized); only juices labeled as pasteurized should be considered free of risk from Cryptosporidium.

Other pasteurized beverages also are considered safe to drink. Cryptosporidium-infected patients should not work as food handlers, especially if the food to be handled is intended to be eaten without cooking. All HIV-infected children and adolescents and their caregivers should be counseled about sources of T.gondii infection. They should be advised not to eat raw or undercooked meat, including undercooked lamb, beef, pork, or venison (BIII). All meat (lamb, beef, pork, and chicken) should be cooked to an internal temperature of 165°F-170°F (559) until it is no longer pink inside. Hands should be washed after contact with raw meat and after gardening or other contact with soil; in addition, fruits and vegetables should be washed well before being eaten raw (BIII). Stray cats should not be handled or adopted; a cat already in the household should be kept inside and the litter box changed daily, preferably by an HIV-negative, nonpregnant person (BIII). Cats should be fed only canned or dried commercial food or well-cooked table food, not raw or undercooked meats (BIII). Patients need not be advised to part with their cats or to have their cats tested for toxoplasmosis (EII).
www.cdc.gov/mmwr

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