Care Connection Newsletter

Jenn Sobolik is a Certified Nurse Practitioner at Complete Health in Rapid City, SD where she specializes in sexual and reproductive health.
A significant portion of new HIV infections are transmitted by people who don’t know their HIV status. This is especially concerning when you consider less than 30% of North and South Dakotans have ever received an HIV test. About 70% of people living in our states don’t know their HIV status.

You’ve likely seen the syphilis statistics for our area. (If you haven’t, please take this moment to update yourself here.) It’s easy to turn a blind eye to the barrage of emails we get describing the issue, but this unprecedented rise in syphilis cases should grab our attention. It’s not uncommon for a spike in new HIV cases to occur after an outbreak of another illness that shares similar risk factors. Individuals with syphilis are more likely to contract HIV than their peers without syphilis or other sexually transmitted illnesses. Simply put, when a person has urethritis or a genital sore, they are more likely to contract HIV if they are exposed. They’re also more likely to transmit HIV if they have an open sore and a detectable viral load. Guess what prevents both HIV and syphilis? You got it! Condoms.

We have a lot of amazing tools in our HIV prevention kit. Pre and Post Exposure Prophylaxis (PrEP and PEP) have greatly improved our ability to prevent new HIV infections, and we know virally suppressed patients living with HIV cannot transmit the virus. Yet, PrEP, PEP, and HIV treatment should not be reviewed as replacements for condoms as they do not protect against other STIs. All patients, including those living with HIV, need protection from sexually transmitted illnesses, and it is not realistic to assume people will practice abstinence. The answer? Condoms.

I will spare you the graphic 1980s-era presentation of how to apply a condom. (Hint: They come with directions if needed, and most have access to Google.) The critical point here is that condoms work well if people use them. Condoms are an affordable, effective defense in the fight against sexually transmitted illnesses. Yet, many don’t use them. Patients tell me many reasons why they don’t use condoms, but the most common barrier is that they don’t have any on hand. It makes sense. Did you know the condoms at some big box stores are locked in cabinets where customers need to ask a store associate to access them? Can you imagine being an embarrassed newcomer, trying to protect yourself, and then having to notify a stranger you need condoms… in front of other strangers? No wonder people don’t use condoms as often as we’d like.

So what do we do? How are we supposed to keep patients safe? We need to give them condoms in a setting where they feel safe and comfortable. We could have an entire lecture on this topic alone, but for today, we will keep it basic. If we are comfortable asking about sex, our patients will be more comfortable talking about it. We need to ask them about who they are having sex with, what type of sex they are having, and if they are using condoms. Try to avoid stigmatizing language and questions that imply judgment. For example, avoid saying “unprotected sex” and say “sex without condoms or condomless sex” instead. If they say they aren’t using condoms, don’t gasp or act disappointed. Explain why they are important and give them some condoms.

Condoms should not only encouraged but should be readily available in any space where discussions about sexual health and HIV/STI testing take place. At Complete Health STI Clinic, we have an “open drawer condom” policy. After I visit with patients about condom use, they are shown a drawer with ample supply. They’re allowed to take as many condoms as they’d like. We tell them they may return anytime for more and encourage them to take some for partners and friends. We wouldn’t tell someone to check their blood sugar without giving them testing supplies. We need to provide people with condoms when we tell them to use them.

Recommendations for Providing Quality STD Clinical Services (or STD QCS) highlights the services healthcare settings can offer to provide the highest-quality STD care to their patients. The recommendations are designed to go hand-in-hand with the STI Treatment Guidelines – STD QCS can help guide clinical operations, while the Treatment Guidelines focus on the clinical management of patients. Healthcare professionals can use the recommendations to identify opportunities to build, maintain, or enhance the delivery of their services.

HIV/STI/TB/Viral Hepatitis Lunch and Learn
Human Papilloma Virus and Disease
February 28, 2024 | 12:00 pm CT/11:00 am MT

Please join the Dakotas AIDS Education and Training Center (DAETC) and North Dakota Department of Health & Human Services (NDHHS) in enjoying our monthly lunch and learn webinar Human Papilloma Virus and Disease on Wednesday, February 28 at 12:00 pm CT/11:00 am MT.

Objectives:
Following this presentation, attendees will be able to:

Describe the epidemiology of HPV in the USA;
Appreciate the risks of HPV infection;
Understand the disease manifestations of HPV;
Implement screening guidelines for anal & cervical cancer;
Explain the role of vaccines in the prevention of HPV disease.

Presented by: Dr. Christopher Evans, MD, MPH, AAHIVS

Dr. Christopher Evans is an internal medicine and geriatrics doctor. He is board-certified in internal medicine and infectious diseases. He has an additional certification as an HIV specialist from the Academy of HIV Medicine and has a strong interest in HIV primary care and hepatitis C treatment. Dr. Evans also enjoys teaching medical residents and medical fellows in both inpatient and outpatient settings.

Register Here.

Congenital Syphilis Informational Webinar
February 28, 2024 | 11:00 am CT/10:00 am MT

Please join the Bureau of Primary Health Care (BPHC) in collaboration with Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention for this webinar developed for clinicians and other health care providers.

Congenital syphilis occurs when pregnant people with syphilis pass the infection to their babies. According to the CDC, cases of congenital syphilis in the U.S. increased 15% from 2019 to 2020, and by 32% from 2020 to 2021. Syphilis and congenital syphilis are a public health issues that require urgent attention and action. Congenital syphilis is preventable, and this requires early screening, diagnosis, and treatment, to prevent potential lifelong consequences for affected families and communities.

This webinar will provide an overview of congenital syphilis and explore missed opportunities for preventing congenital syphilis as well as interventions for prevention. Objectives of this presentation: 1) Understand the epidemiology of syphilis and congenital syphilis in the United States. 2) Diagnosis and counsel about syphilis and congenital syphilis. 3) Practical implementation of syphilis screening and treatment in the clinical setting. 4) Discuss missed opportunities to prevent congenital syphilis in the US and possible interventions.

Register Here.