# Presentation: 079404

## PUBLIC HEALTH EMERGENCY!

**  ****HIV AND SYPHILIS EPIDEMIOLOGY**
**                         ****2001 -  2003**

-                  **A REPORT TO THE NAVAJO NATION**
**     ****HEALTH AND SOCIAL SERVICES COMMITTEE**
**                                     ****FROM **
**     ****THE NAVAJO AREA INDIAN HEALTH SERVICE **
**                             ****MARCH 11, 2003**

## THE PROBLEM

**I. SYPHILIS**
**    **_**NATIONAL RATE**_
-     ***2.2 CASES PER 100,000 PEOPLE***
-      _**NAVAJO RATE**_
-     ***14.7 CASES PER 100,000 PEOPLE***
*****This is a 7-fold increased rate*****

## THE PROBLEM

_**SYPHILIS**_
**75 CASES SINCE 1/01**
**SEVEN NEW CASES SO FAR IN 2003 AT GALLUP SU ALONE  (2 with brain damage)**
**THREE INNOCENT BABIES  HAVE BEEN BORN WITH CONGENITAL SYPHILIS****      **

## New Syphilis Cases Navajo Area IHS 1999 - 2002

- *Includes data from January1, 2002 - September 8, 2002

## Geographic Distribution of Adult Syphilis Cases By Test Site

**8**

**6                  **

**1**

**Geographic Distribution of Adult Syphilis Cases By Test Site**
**All Stages, Navajo IHS Area, 2002 (Jan 1 - September 8)**

**1**

**2**

**4       **

**1**

**3**

**1       **

**6                  **

**2**

**4       **

**1**

**4**

**1       **

##           Syphilis Leap Brings 
            Pima Health Alert
      Nation seemed on the cusp of         	           wiping it out
                By Carla McClain           ARIZONA DAILY STAR 

**            ****Pima Health Alert**
**      ****Nation seemed on the cusp of         ****	****           wiping it out**
**                ****By Carla McClain **          ARIZONA DAILY STAR

**MARCH 7,2003**

## Syphilis-  the disease

_***First stage***_
- Painless genital ulcer and swollen glands
_***Second stage***_
- Rash on hands, feet and body, genital warts
_***Latent stage***_
- Nothing except positive blood test
_***Third stage***_
- Brain damage, blindness, heart failure

## Syphilis- the disease

- _Congenital syphilis in babies_
- Nasal discharge
- Jaundice (yellow skin and eyes) or blisters
- Swelling
- Meningitis leading to brain damage
- Permanently deformed bones

## THE PROBLEM:    HIV / AIDS 

**II. **_**ACUTE RETROVIRAL SYNDROME**_
**	****new infection with AIDS virus**
** ****6 cases seen since Jan 2000**
**3 men, 2 women  (one additional man)**
**60 % men who have sex with men**
**60% had known alcohol abuse **

## The Disease:   Acute Retroviral Syndrome

- Starts 6 weeks after sexual exposure or injection of drugs with infected needle.
- Patients get high fever, muscle ache, and total body rash.
- Brain damage is seen in 10%  (paralysis, spasticity, abnormal movements)

## THE PROBLEM:    HIV / AIDS

- 151 people have been treated since 1987 for _*chronic*_ HIV infection.
- 49 people now get their care at IHS hospitals for chronic HIV
- 3 people were diagnosed with HIV at GIMC last week!

## NAIHS 2002 HIV Epidemiology          New Cases 2002

_**Mental Illness**_
**Total ****	****	****	****29****	****	****(37%)**
- Alcohol abuse	15		(31%)
- IDU			4		(8%)
- Depression		11		(22%)

## The Problem: HIV AIDS

***HIV / AIDS IS BEING SPREAD LOCALLY WITHIN  the NAVAJO NATION***

## THE PROBLEM

**BOTH SYPHILIS AND HIV / AIDS:**
**CAN BE FATAL**
**ARE SPREAD SEXUALLY**
**AFFECT “INNOCENT BYSTANDERS”  **
**Pregnant women, babies,  unsuspecting spouses**
**ARE PROMOTED BY SUBSTANCE ABUSE**
**ARE EASILY PREVENTED**

## The Solution- our suggestions

- Notify the Navajo people through the news papers, radio, and TV as soon as possible.
- Community presentations at Chapter house level by CHR, health educators, Navajo Nation AIDS Office and Social Hygiene as soon as possible.

## The Solution- our suggestions

- Call in the CDC for an emergency intervention. Ask for:
- A field manager under the STD director to assist him and help supervise the field work.
- A clinical manager (nurse) to assist IHS clinicians with management of cases.
- Funding to hire more staff (see next)
- Support of syphilis education (public/providers)

## The Solution- our suggestions

- Double the size of social hygiene ASAP
- Need more techs to do all the work
- Need up to date computer data management
- _Let social hygiene concentrate on treatment_
- Double the size of the AIDS Office  ASAP
- Need prevention of both HIV and Syphilis
- _Let the AIDS Office concentrate on prevention_

## The Solution- our suggestions

- Mobilize DBHS to assist with all of the above efforts since substance abuse is so closely linked to transmission in these two epidemics.

##   BUILDING PUBLIC HEALTH CAPACITY
PARTNERSHIP:
      NAVAJO NATION
         DIVISION OF HEALTH                  	 	 	           	    EMERGENCY MANAGEMENT
                JUDICIAL AND LAW ENFORCEMENT
                   PUBLIC SAFETY
        IHS
      CDC
      STATES / COUNTIES

**PARTNERSHIP:**
**      ****NAVAJO NATION**
**         ****DIVISION OF HEALTH                  ****	**** ****	**** ****	****           ****	****    EMERGENCY MANAGEMENT**
**                ****JUDICIAL AND LAW ENFORCEMENT**
**                   ****PUBLIC SAFETY**
**        ****IHS**
**      ****CDC**
**      ****STATES / COUNTIES**
**           **

**THE FUTURE**