Unformatted text preview: SZL2111 HIV/AIDs LESSON 2
Sex education and Human sexuality
Learning outcomes SODeL JKUAT By the end of this topic you should be able to; To know what sex education entails Describe the some of the common STIs Understand the Myths surrounding sexuality Understand the relationship between STIs and HIV Role of sex education as HIV control and management
strategy JJ II
J DocDoc I Back Close 1 SZL2111 HIV/AIDs 2.1. What is sex education?
Sex education, also called sexuality education or sex and relationships education. It's the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, SODeL JKUAT relationships and intimacy. It is also about developing young people's skills so that they make informed choices about their
behavior, and feel condent and competent about acting on
these choices. It is widely accepted that young people have a right to sex education, partly because it is a means by which
they are helped to protect themselves against abuse, exploitation, unintended pregnancies, sexually transmitted diseases and
HIV/AIDS. JJ II
J DocDoc I Back Close 2 SZL2111 HIV/AIDs 2.1.1. Aims of sex education To reduce the risks of potentially negative outcomes from
sexual behavior like unwanted or unplanned pregnancies SODeL JKUAT and infection with STDs To enhance the quality of relationships. To develop young people's ability to make decisions over
their entire lifetime. 2.1.2. Myths surrounding sexuality
Myths are commonly held believes that are untrue or without
foundations. Myths are universal; occurring in almost all cul- JJ II
J DocDoc I Back Close tures and attempts to explain assorted topics on humanity, and
may have both religious and non religious dimensions. The con3 SZL2111 HIV/AIDs
cepts of sex being a necessary evil and the less said about it
the better have led to many misconceptions about sex. Most
common sexual myths arise out of ignorance and these circulate
more in adolescents and with lack of information they internalize SODeL JKUAT this and practice and this may lead to exposure to HIV/AIDS. 2.2. Sexually Transmitted Diseases
Sexually transmitted diseases (STD) are caused by communicable agents (viruses, bacteria, parasites etc) that are principally
transmitted during sexual intercourse resulting in clinical illness.
How, sometimes infection with these agents does not result in
clinical disease but the agents can be transmitted from the host JJ II
J DocDoc I Back Close organism to their sexual partners. This has given rise to the term sexually transmitted infections (STI). Some persons are
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thus healthy carriers. There are at least 25 dierent sexually transmitted diseases. What they all have in common is that they can be spread by sexual contact, including vagina, anal
and oral sex. SODeL JKUAT 2.2.1. How do you know that you have an STD?
Anyone who is sexually active can be at risk from STDs. Some
STDs can have symptoms, such as genital discharge, pain when
urinating and genital swelling and inammation. Many STDs,
such as Chlamydia, can frequently be symptom less. This is why it is advisable to have a sexual health check-up, to screen
for STDs, if you think you have been at risk. It can sometimes JJ II
J DocDoc I Back Close take a long time for STDs to display any symptoms, and you can
pass on any infections during this time, further demonstrating
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the need to be tested and treated. If you are in a relationship,
and are diagnosed with an STD, it does not necessarily mean
that your partner has been unfaithful. Symptoms of STDs can
present themselves months after infection. Many STDs are very SODeL JKUAT infectious and can cause long-term or permanent damage, including infertility if left untreated. Many STDs can be easily passed onto sexual partners, and some STDs can be passed from
a mother to her unborn child too. STDs can also aid the transmission of HIV. 2.2.2. How STDs are transmitted
STDs are transmitted by infectious agent microscopic bacteria, JJ II
J DocDoc I Back Close viruses, parasites, fungi, and single-celled organisms called protozoa - that thrive in warm, moist environments in the body,
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such as the genital area, mouth, and throat Most STDs are
spread during sexual intercourse (vaginal or anal), but other
forms of sexual contact, such as oral sex, can also spread disease. Some STDs are passed from an infected mother to her child SODeL JKUAT before birth, when the infection crosses the placenta and enters
the baby's bloodstream; during childbirth, as the baby passes
through the birth canal; or after birth, when the baby consumes
infected breast milk. Some viral STDs, especially AIDS, may be
transmitted by blood. Such STDs may be passed between people who share infected needles or received through a transfusion
of infected blood. Some people mistakenly believe that STDs can be transmitted through shaking hands or other casual con- JJ II
J DocDoc I Back Close tact, or through contact with inanimate objects such as clothing
or toilet seats. Such transmissions are extremely rare.
7 SZL2111 HIV/AIDs • Factors that enhance chances of getting infected with
1. The potential for sexual activity is greatest from adolescence to the third decade: 15 years and older. The greatest SODeL JKUAT risk occurs in the age group 18-35. However, the trend is
towards very early sexual debut, among teenagers below
15 years of age, as society changes and liberal attitudes
become the norm in formerly traditional societies .
2. Marital status and occupation aect exposure to STDs.
Due to industrialization and consequent urbanization; there
is usually a large group of single, poorly paid and unemployed young people who live in shanties in towns. Sexual JJ II
J DocDoc I Back Close intercourse, for pleasure and for gain, assumes an important role in such circumstances. Prostitution and promis8 SZL2111 HIV/AIDs
cuity ourish under these conditions and so do STDs.
Promiscuous sexual behaviour is closely associated with
the acquisition and spread of STDs in any group of people.
There are certain factors that may reduce promiscuous be- SODeL JKUAT haviour in individuals. The more of these factors exist in
an individual's life, the less the risk of STDs .
3. Ethnicity is not a risk factor for STDs, but it is closely
associated with specic cultural practices that may predispose to transmission of STDs. In some groups, certain
celebrations and rituals (e.g., cleansing after the death of
a family member) may involve high-risk sexual practices
that predispose individuals to transmission of STIs, such JJ II
J DocDoc I Back Close as infection with human immunodeciency virus (HIV),
the cause of acquired immunodeciency syndrome (AIDS).
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A surviving HIV-positive spouse may have to have sex with
someone else as part of a ritual . Alternatively, "professional hired cleansers" may infect healthy widows and widowers. Many such funeral events are also associated with SODeL JKUAT much promiscuity as celebrations are held over a week or
so with men and women having many opportunities for
casual sex. Conversely, societies with strict moral codes regarding sex and marriage have a much lower prevalence
of STDs . 2.2.3. Prevention and Control of STIs
One can minimize the risk of getting infected with STIs by hav- JJ II
J DocDoc I Back Close ing protected sex with condoms and getting tested together with
sexual partner(s). The more partners one has, the greater the
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risk of acquiring an STD. Other ways to reduce the risk include
using dental dams and condoms during oral sex, clean sex toys
after use, clean your hands after having sex, and improving genital hygiene routines. SODeL JKUAT • Importance of early diagnosis and treatment In many resource poor countries, the approach to diagnosis and
treatment of STDs has changed radically in the last few years.
The emphasis is now on recognition of groups of signs and symptoms, or syndromes, rather than strict etiologic diagnosis based
on laboratory ndings as a basis for patient management. Syndromes are based on the clinical presentation of the commonest JJ II
J DocDoc I Back Close STDs in the particular country, or region within a country, and
patients are treated for the likely STDs that commonly cause
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that particular combination of signs and symptoms. The commonest cause of urethral discharge in males in Africa, for example, is gonorrhea and Chlamydia urethritis, either individually
or in combination. In the new approach, the patient is treated SODeL JKUAT for both infections. Other causes are considered if there is no improvement (Adler, 1996., Holmes, 1990). The advantage of this
approach is that even the lowest cadres in the health service can
treat patients eectively with a minimum of retraining, without
requiring the assistance of a laboratory. The main disadvantage
is a certain amount of over-treatment for diseases that are not
present, but this is a small price to pay for increased access to
STD treatment services for the whole community. JJ II
J DocDoc I Back Close 12 SZL2111 HIV/AIDs 2.2.4. Basic information on some common STDs
1. Bacterial Vaginosis - (BV) is not strictly an STD as it is
not transmitted via sexual intercourse. However, it can be
exacerbated by sex and is more frequently found in sexu- SODeL JKUAT ally active women than those who have never had intercourse. It is caused by an imbalance in the normal healthy
bacteria found in the vagina and although it is relatively
harmless and may pass unnoticed, it can sometimes produce an abundance of unpleasant shy smelling discharge.
Whilst there is no clear explanation as to why BV occurs,
there have been suggestions that the alkaline nature of semen could be one cause, as it may upset the acidic nature JJ II
J DocDoc I Back Close of the vaginal bacteria. Another cause can be the use of an
intrauterine contraceptive device (coil). A woman cannot
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pass BV to a man, but it is important she receives treatment as BV can occasionally travel up into the uterus and
fallopian tubes and cause a more serious infection. Treatment for BV consists of applying a cream to the vagina or SODeL JKUAT taking antibiotics.
2. Balanitis - is often referred to as a symptom of infection,
and not necessarily an infection in its own right. It is not
strictly an STD, more a consequence of sexual activity. It
only aects men and usually presents itself as an inammation of the head of the penis, and is more common in
men who are not circumcised. It can be caused through
poor hygiene, irritation due to condoms and spermicides, JJ II
J DocDoc I Back Close using perfumed toiletries and by having thrush. It can be
prevented through not using certain toiletries and by wash14 SZL2111 HIV/AIDs
ing under the foreskin. Treatment can consist of creams
to reduce inammation and antibiotics if necessary.
3. Chlamydia - is the most common treatable bacterial STD.
It can cause serious problems later in life if it is not treated. SODeL JKUAT Chlamydia infects the cervix in women. The urethra, rectum and eyes can be infected in both sexes. Symptoms of
infection may show up at anytime. Often this is between
1 to 3 weeks after exposure. However, symptoms may not
emerge until a long way down the line.
4. Crabs or Pubic Lice - are small, crab shaped parasites that
live on hair and which draw blood. They live predomi- nantly on pubic hair, but can also be found in hair in the JJ II
J DocDoc I Back Close armpits, on the body and even in facial hair such as eyebrows. They can live away from the body too, and there15 SZL2111 HIV/AIDs
fore can be found in clothes, bedding and towels. You can
have crabs and not know about it, but after 2 to 3 weeks,
you would expect to experience some itching. Crabs are
mainly passed on through body contact during sex, but SODeL JKUAT they can also be passed on through sharing clothes, towels
or bedding with someone who has them. There is no eective way to prevent yourself becoming infected, though you
can prevent others becoming infected by washing clothes
and bedding on a hot wash. Lotions can be bought from
pharmacies and applied to the body to kill o the parasites. Shaving o pubic hair will not necessarily get rid of
crabs. JJ II
J DocDoc I Back Close 5. Epididymitis - refers to inammation of the epididymitis, a
tube system above the testicles where sperm are stored. It
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is not always the result of an STD, but if it is, it is usually
due to the presence of Chlamydia or Gonorrhoea. Symptoms will present themselves in the form of swollen and
painful testicles and scrotum. The best way of preventing SODeL JKUAT it is to use condoms during sex, as this is the most eective
way to prevent Chlamydia and Gonorrhoea. Epididymi- tis itself cannot be passed on, though any other infections
that may have caused epididymitis can be passed on (see
Chlamydia and Gonorrhoea sections). Treatment usually
involves treating the underlying infection with antibiotics.
6. Genital herpes - is caused by the herpes simplex virus.
The virus can aect the mouth, the genital area, the skin JJ II
J DocDoc I Back Close around the anus and the ngers. Once the rst outbreak
of herpes is over, the virus hides away in the nerve bres,
17 SZL2111 HIV/AIDs
where it remains totally undetected and causes no symptoms. Symptoms of the rst infection usually appear one
to 26 days after exposure and last two to three weeks.
Both men and women may have one or more symptoms, SODeL JKUAT including an itching or tingling sensation in the genital or
anal area, small uid-lled blisters that can burst and leave
small sores which can be very painful, pain when passing
urine, if it passes over any of the open sores and a u-like
illness, backache, headache, swollen glands or fever. Find
out more about genital herpes.
7. Genital warts - are small eshy growths which may appear anywhere on a man or woman's genital area. They JJ II
J DocDoc I Back Close are caused by a virus called the Human Papilloma Virus
(HPV). Warts can grow on the genitals, or on dierent
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parts of the body, such as the hands. After you have been
infected with the genital wart virus it usually takes between 1 and 3 months for warts to appear on your genitals. You or your partner may notice pinkish/white small SODeL JKUAT lumps or larger cauliower-shaped lumps on the genital
area. Warts can appear around the vulva, the penis, the
scrotum or the anus. They may occur singly or in groups.
They may itch, but are usually painless. Often there are
no other symptoms, and the warts may be dicult to see.
If a woman has warts on her cervix, this may cause slight
bleeding or, very rarely, an unusual coloured vaginal discharge. Find out more about genital warts. JJ II
J DocDoc I Back Close 8. Gonorrhoea - is a bacterial infection. It is sexually transmitted and can infect the cervix, urethra, rectum, anus
19 SZL2111 HIV/AIDs
and throat. Symptoms of infection may show up at anytime between 1 and 14 days after exposure. It is possible
to be infected with gonorrhoea and have no symptoms.
Men are far more likely to notice symptoms than women. SODeL JKUAT 9. Gut Infections - can be passed on during sex. Two of the
most common infections are Amoebiasis and Giardiasis.
They are bacterial infections, and when they reach your
gut they can cause diarrhoea and stomach pains. Gut infections can be passed on when having sex with someone
who is infected, especially during activities that involve
contact with faeces, such as rimming and anal sex. Infection can be prevented through using condoms, dental dams JJ II
J DocDoc I Back Close or latex gloves. Sex toys should be thoroughly cleaned after use and hands washed after any contact with faeces.
20 SZL2111 HIV/AIDs
Anti-diarrhoea treatments should be enough to treat most
infections, but antibiotics can also be used.
10. Hepatitis - causes the liver to become inamed. There are various dierent types of hepatitis, the most common SODeL JKUAT being hepatitis A, B and C. Each of these viruses acts
dierently. Hepatitis can be caused by alcohol and some
drugs, but usually it is the result of a viral infection. Find
out more about hepatitis.
11. Molluscum - is a skin disease caused by the Molluscum
Contagiosum Virus. It appears as small bumps on the skin, and can last from a couple of weeks to a few years.
Molluscum cause small, pearl-shaped bumps the size of a JJ II
J DocDoc I Back Close freckle on the thighs, buttocks, genitalia and sometimes
the face. They are passed on through body contact during
21 SZL2111 HIV/AIDs
sex and through skin-to-skin contact. Transmission can be prevented by using condoms, by avoiding skin-to-skin
contact with someone who is infected and by not having
sex until they have been treated. In most cases molluscum SODeL JKUAT do not need treatment and will disappear over time. However, they can be frozen o or a chemical can be painted
12. Non-Specic Urethritis (NSU) - is an inammation of a
man's urethra. This inammation can be caused by several dierent types of infection, the most common being
Chlamydia. NSU may be experienced months or even in
some cases years into a relationship. JJ II
J DocDoc I Back Close The symptoms of NSU may include pain or a burning sensation when passing urine, a white/cloudy uid from the tip of the penis
22 SZL2111 HIV/AIDs
that may be more noticeable rst thing in the morning,
feeling that you need to pass urine frequently. Often there
may be no symptoms, but this does not mean that you
cannot pass the infection on to your partner(s). SODeL JKUAT 13. Scabies - is caused by a parasitic mite that can get under
the skin and cause itching. The mites are very small and
cannot be seen, and many people do not now they have
them. They can cause itching, and this can start between
2 to 6 weeks after infection. Signs of infection can be red
lines under the skin of the hands, buttocks and genitals.
The most common way of becoming infected is through
body contact during sex, though it is also possible to be JJ II
J DocDoc I Back Close infected through sharing towels and clothes with someone
who is infected. This route however is uncommon. There
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is no eective way to prevent yourself becoming infected,
though you can prevent others becoming infected by washing clothes and bedding on a hot wash. Lotions can be bought from pharmacies and applied to the body to kill SODeL JKUAT o the parasites.
14. Syphilis - is not a common infection in the UK but it is
more common in some other countries. It is a bacterial infection. It is usually sexually transmitted, but may also be
passed from an infected mother to her unborn child. The
signs and symptoms of syphilis are the same in both men
and women. They can be dicult to recognise and may
take up to 3 months to show after having sexual contact JJ II
J DocDoc I Back Close with an infected person. Syphilis has several stages. The
primary and secondary stages are very infectious.
24 SZL2111 HIV/AIDs
15. Thrush, also known as Candidiasis - is yeast which lives
on the skin and is normally kept in check by harmless
bacteria. If this yeast multiplies however, it can cause itching, swelling, soreness and discharge in both men and SODeL JKUAT women. Women may experience a thick white discharge and pain when passing urine. Men may experience the same discharge in the penis and diculty pulling back the
foreskin. Thrush can be passed on when having sex with
someone who is infected, but also if you wear too tight nylon or lycra clothes or if you are taking certain antibiotics.
Sometimes the cause may be unclear however. Transmission can be prevented by using condoms during sex and JJ II
J DocDoc I Back Close by men washing underneath their foreskin. Treatment for
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