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HIV/STD Prevention and
Intervention Program
June 2009 CNMI
Department of Public Health
HIV/STD Resource & Treatment Center
Building N-29 Navy Hill, Saipan
STDs
• STDs remain a significant public health
concern in the CNMI
• CNMI notifiable disease reports
– STDs remain the highest
• Chlamydia remains the most commonly
reported infectious disease in the CNMI
• STDs are under reported
Reported STD Cases by Sex and Year
2004 2005 2006 2007 2008
Male Female Male Female Male Female Male Female Male Female
Chlamydia 16 171 14 189 13 95 3 97 13 100
Gonorrhea 3 10 2 6 7 8 1 5 3 6
Syphilis 3 6 2 2 13 8 19 10 17 9
Hepatitis B 5 7 0 5 2 5 5 22 30 47
HIV 0 0 0 0 2 0 1 1 1 0
Total 27 194 18 202 37 116 32 136 64 162
Annual Total 221 220 153 168 226
Total cases of Chlamydia by age, gender & sentinel site for 2008
STI Assessed Chlamydia
No.
Sentinel site patients Female Male Total
ER/Triage 1 1 2
CDC 3 8 11
AHC 1 - 1
SWC 34 2 36
WC 49 - 49
THC 5 2 7
RHC 7 - 7
TOTAL 100 13 113
15-19
years 22 3 25
20-24
years 32 8 40
25-29
years 22 - 22
30-34
years 10 2 12
35+
years 14 - 14
unkno
wn - - -
TOTAL 100 13 113
Total cases of Chlamydia by ethnicity & gender in 2008
Female Male Total
Ethnicity Detected
Chamorro 49 6 55
Filipino 19 5 24
Carolinian 10 1 11
Chinese 9 - 9
Thai 3 - 3
Yapese 3 - 3
Palauan 5 - 5
Caucasian 2 - 2
Bangladeshi - 1 1
TOTAL 100 13 113
2009 HIV Epidemiology for the CNMI
•Cumulative number - since 1997:
•29 cases diagnosed in CNMI since 1997
•1 new male case in late 2008; 1 female partner tested positive
early 2009
•8 clients with HIV known to the HIV Program:
•5 are adult males and 3 adult females
•4 on ART
•Gender:
•13 Females
•16 Males
•Reported Mode of Transmission:
•18 Heterosexual (5 men, 13 women)
•5 MSM
•2 Mother to Infant
•4 Unknown mode
•0 Intravenous drug use
2009 HIV Epidemiology for the CNMI
Ethnicity:
Ethnicity Males Females Total
Chamorro 3 1 4
Chinese 1 2 3
Chuukese 2 3 5
Filipino 2 5 7
Japanese 1 0 1
Palauan 1 0 1
Pohnapean 0 1 1
Thai 1 6 7
Cumulative HIV Cases in the CNMI
12
10
6
8
Female
6
Male
4 2
6
2
3 3 1 1
2
1 1 1 1
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Vertical Transmission – Mother
to Infant
• 2 cases – late 1990’s (Chuckese).
• Since 2000, 4 deliveries; no positive
infants; 5th case to delivery 2009.
• ART during pregnancy; CDC guidelines for
prevention of perinatal transmission -
peripartum (AZT)
• Collaborative effort – physicians
(OB,Ped,IM), nurses, pharmacist,
prevention staff, clients
2009 HIV Screening – CNMI
Who do we screen ?
• Positive STD clients (referrals from government & private
clinics)
• Prenatal clients – routine testing, unless opts-out
• Non-resident Workers Health Program (HIV, RPR, CXR
for Tb) – 30,000/yr (private sector)
• All blood products – procured through American Red
Cross
• Correctional clients
• Self-referred clients
• Active Tuberculosis clients (DPH Chest Clinic)
• Family Planning Program clients - Oraquick™ HIV Rapid
Test
• Adolescent Clinic (high school) & NMC (community
college)
2008 HIV Screening
• 942 HIV total tests conducted through Public
Health in 2008
• Mostly prenatal cases
• 1,384 live births at CHC in 2007
• Not including private clinic testing
• 306 HIV tests conducted at the HIV/STD
Resource and Treatment Center in 2008.
• 2008, Oraquick™ HIV Rapid Test introduced in
November, testing about 30/month
• Family Planning clients; contraception control
Client Services
• Ryan White CARE Act Part B
– Discretionary funds that is payer of “last
resort” for Core Services
• Core Services
– Medications & AIDS Drug Assistance Program (ADAP)
– Out-patient care
– Laboratory services
– Inter-island transportation
– Dental & eye care
– Health Insurance Continuum of Coverage Programs
(HICCPs)
Private insurance co-payments
• HIV/STD Prevention Staff
– MD
• shared IM with CHC during clinic days
– RN
• shared RN with DPH during clinic days
– Program Manager
• Manages CDC’s HIV and STD Prevention Grant, HIV Surveillance
Grant, and HRSA’s RWCA Part B
• Counseling, Testing & Referral Services (CTR) certified
– STD Case Worker
• Case managers positive STD referrals
• Contact tracing
• CTR certified
– HIV Case Worker
• Same as STD Case Worker but for HIV (+) clients & partners
• Vacant at the moment
– HIV Community Worker
• Outreach & education
• Alien Health Screening Program client management
– HIV Clinical Attendant
• Clerical duties (appointments, follow-ups, procurement, etc.)
Some Training Outcomes since 2000
• HIV demystified - less stigma/fear about HIV (clinical
staff more informed – nurses, lab, support)- positive,
caring attitude
• Improved awareness –barriers to care, universal
precautions, guidelines PEP, ART, and prevention of
vertical transmission
• Importance - STD risk assessment, HIV testing, POS
rapid testing, client support and services
• Much better understanding – HAART & complicatons,
monitoring CD4 & VL, adherence, secondary prevention
• Appreciation of challenges faced by PIC’s
• Access to consultants
Needs Strengthening
•MONITORING & EVALUATION:
• Improvement of data collection, analysis & reporting
• Improve reporting, data-sharing and case
management with private providers
•DIAGNOSIS, TREATMENT & CARE:
• Increase in certified Counselors, training of new staff
– constant turnover
• Improved contact tracing & partner services
• More HIV testing in primary care clinics (private)
•? Dedicated medical provider for HIV/STD Clinic
• ? On site STD laboratory testing/processing
•EDUCATION & OUTREACH:
• Enhance screening activities & outreach (at-risk
population e.g. MSMs, sex workers, etc.)
CNMI HIV/STD Contacts
James U. Hofschneider, MD, HIV/STD Physician (MAP)
Laura Shevy, MD, HIV/STD Physician (CHC)
John Dax Moreno, DPH Communicable Disease Manager
Carol Paez, RN, STD/HIV Nurse (Part-time)
Alingmar Uludong-Ogumoro, HIV Community Worker
Delma Dela Cruz, HIV Administrative Assistant
Tenta Tenorio, STD Caseworker
Telephone #: 664-4050
Fax #: 664-4051
E-mail:
juhofschneider@gmail.com
johndax.moreno@gmail.com
Si Yuus Maa’se.
Olomwaay.
Outreach Activities
Street Market outreach in Garapan with Guahan Project’s Barbara Bernardo
and JoBeth Aquino
Outreach Activities
World AIDS Day & Street Market
outreach with Napu Life Foundation
