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SAVE YOUR SELF FROM GONORRHEAE Ilham Henintyo, Rizky Harsya, Nida Nabila and Hesti Herlinawati Faculty of Medicine Universitas Pembangunan Nasional “Veteran” Jakarta E-mail : hestiherlinawati270596@gmail.com Telephone : +6281287996729

ABSTRACT Background : Research on ocular inflammation associated with gonorrhea began in conjunction with the entry of trachoma into South of Jakarta, Indonesia (2011-2014) during the Napoleonic wars. The initial questions involved the cause of the contagiousness of gonorrhea and how the contagion spreads from the genitalia to other sites. Because efforts to infect animals with gonorrheal matter were unsuccessful, all experiments were conducted on human subjects. Once these two causes of blindness were tentatively differentiated, attempts to restore vision in an eye that had been blinded by a trachomatous membrane over the cornea by instilling gonorrheal pus began to be practiced. In 1841, Joseph Piringer described his use of this method to determine infectiousness decades before the discovery of pathogenic bacteria, as well as ethical concerns about the associated endangerment of patients. Beginning in the 1880s, research focused on the identification of the gonococcus and assessment of its pathogenicity. The ethical dilemma of inducing a disease with an unpredictable outcome persisted until the 1940s, when gonorrhea could be reliably cured by penicillin. Keywords : Gonorrhea South of Jakarta, efforts to infect, described and ethical dilemma. INTRODUCTION

the idea of metastasis due to diminished

The Edinburgh surgeon Benjamin Bell (1749–

urethral excretion of “seminal matter” to

1806) was the first to clearly differentiate

explain the occurrence of gonorrheal arthritis

gonorrhea and syphilis (Bell 1792). Bell was

and by implication also of ophthalmia. The

perplexed

predominant

about

the

infectiousness

hypothesis

pertaining

gonorrhea. He stated that

gonorrhea, as proposed by St.Yves, was that

Urine impregnated with the venereal Poison

when discharge of the pathogen through the

communicated

the

Contagion

the

urethra is blocked, either by treatment or other

Conjunctiva and Eye-lids; whereby a violent

circumstances, it has to back up and then

venereal Ophthalmia was brought on, with a

Gonorrhea and the Beginnings of Clinical

sharp Discharge of Tears and purulent Matter.

Research Ethics. When the soldiers returned

(Astruc 1754, 306) François Swediaur (1748–

home, physicians were confronted with a large

1824) introduced the terms blennorrhagia and

number of cases of “Egyptian ophthalmia.” For

blennorrhea for acute and chronic gonorrhea,

some time this could not be differentiated from

respectively (Swediaur 1815, 2). He adopted

especially severe gonorrheal ophthalmia, thus

resulting in greater interest in the investigation

2. Laboratories must report all positive

of the latter disease as well. The belief that

test results indicative of Neisseria

gonorrheal

the

gonorrhoeae infection to the local

urethral symptoms diminish helped to discount

health department of the county

the denial of urethral symptoms or recent

where the individual resides within

sexual contact by many of the “Egyptian”

one working day from the time of

patients (Collins 1904).

positive result.

ophthalmia

occurs

when

OBJECTIVE Purpose of Reporting and Surveillance DISCUSSION

1. To assess trends in disease patterns, understand the impact of gonorrhea

Local Health Jurisdiction Investigation

and better target population-level

Responsibilities

disease prevention efforts.

1. Begin follow-up case investigation

2. To assure adequate treatment for infected

individuals

within

curtail

infectiousness and prevent infection sequelae (e.g., infertility). 3. To identify, contact, and refer to

working

days

after

receiving the case report. 2.

Report

all

presumptive

and

confirmed cases to the Public Health

Division

HIV/STD/TB

treatment recent sexual contacts of

(HST) Program by the end of the

reported cases.

calendar week of initial physician or

Material and method

laboratory report by completing the case report directly in the Public Health Division’s online integrated disease reporting system, Orpheus, by submitting a completed copy of the Gonorrhea case report form available from the HST website, or by submitting an electronic file in

1. Physicians and other health care providers must report a case or suspected case of gonorrhea within one working day to the Local Public Health Authority (LPHA) (OAR 333-018-0015).

mutually acceptable format that includes all information indicated collected by the case entry layout in Orpheus.

Etiologic Agent

around the testicles) and urethral

Neisseria gonorrhoeae, a gram-

stricture in males. Disseminated

negative, diplococcoid bacterium.

gonococcal infection (DGI) may occur in either sex. Untreated GC

Description of Illness 1. Infections caused by N. gonorrhoeae preferentially

colonize

columnar

epithelial tissue. Potential sites of infections

include

the

urethra,

endocervix, rectum, pharynx, and occasionally the conjunctiva of the eye, especially as a result of mother to newborn transmission. Infections

infection during pregnancy may result

premature

Newborns of females with untreated GC

infection

opthalmia

Combined

those caused by drug-susceptible

chlamydial

types. Both males and females

uncommon.

Symptomatic males with urethral infections usually have purulent (containing pus) urethral discharge, often

accompanied

(painful

urination).

dysuria

Males

females who have engaged in receptive oral or rectal sex may notice pharyngeal (throat) or rectal symptoms.

Females

abnormal

vaginal

may

have

discharge,

abnormal menses, pelvic pain, or dysuria.

(eye

distinguish

from

chlamydia.

gonococcal infections

and

are

not

Reservoirs Infected humans only. Sources and Modes of Transmission 1. Sexual The attack rate (proportion of exposed

people

who

become

infected) among exposed women is generally believed to be higher than the attack rate among exposed men. Non-sexual

transmission

among

adults is unlikely. Anogenital or pharyngeal infection among infants and children should be investigated

2. Serious complications of gonococcal infection

for

3. Clinically, gonorrhea can be difficult

from

asymptomatic.

risk

tions.

clinically

infection) and disseminated infec-

might

are

neonatorum

caused by drug-resistant types are indistinguishable

delivery.

include

pelvic

inflammatory disease (PID) and subsequent

infertility

tubal

pregnancy

females

and

epidymitis (inflamed sperm ducts

to rule out sexual abuse. 2. Mother to newborn child. Neonatal infection results from exposure

during

motherâ&#x20AC;&#x2122;s

infected

birth

cervix.

the Eye

infection in an infant should be

investigated to assure evaluation

A follow-up laboratory test for

and treatment of the mother and any

gonorrhea in 1 week, also known as

recent sex partners of the mother.

“test-of-cure.” 3.

Incubation Period

longer.

Period

the

patient

has

severe

cephalosporin allergy

Incubation is typically 2–7 days but occasionally

Azithromycin 2 g orally

PLUS

Communicability

A follow-up laboratory test for

Period of Communicability Gonorrhea is communicable from

gonorrhea in 1 week, also known as

the time the infection is acquired

“test-of-cure.”

until the patient is adequately

Confirmed Case Definition (reportable to

treated. Effective treatment ends

PHD)

communicability

within

hours.

Anyone

from

whom

Asymptomatic infected persons are

gonorrhoeae is isolated or identified

generally considered to be equally

by a laboratory test from a specimen

infectious

collected

symptomatic

individuals.

anogenital,

Culture, direct immunofluorescense,

1. Uncomplicated infections of the pharynx, cervix, urethra, or rectum 250

single

intramuscular dose PLUS Azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days 2. If ceftriaxone is unavailable or infeasible Cefixime 400 mg orally in a single dose PLUS Azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days PLUS

pharyngeal, or conjunctival site.

Treatment

Ceftriaxone

from

enzyme-linked immunoassay [EIA], nucleic acid hybridization tests, and nucleic acid amplification tests [NAAT] all suffice for detection and

confirmation

gonorrhoeae. Presumptive Case (reportable to PHD) Observation intracellular

gram-negative

diplococci

microscopy of a specimen collected from a person with signs or symptoms

consistent

with

gonococcal infection, OR A diagnosis of gonorrhea submitted made by a physician or other licensed health care provider,

Suspect (not reportable to PHD?)

and treated. If a client has not had

Signs or symptoms of gonorrhea in

sex in the 60 days preceding his or

a sexually active person or someone

her positive laboratory test, the most

who has been sexually assaulted.

recent

Sexual contact with a laboratory-

examined and tested, if possible,

confirmed case within 60 days

and treated.

preceding the treatment of the

During the confidential interview,

laboratory confirmed case.

ask the patient for the names and

(Exposed sexual contacts that can

contact information of everyone

be located should be treated as

with whom the case has had sexual

“presumptive” cases with the same

contact within the 60 days (~two

treatment that would be used for a

months) preceding the date of

confirmed case (§2.F.). Case reports

diagnosis or first positive laboratory

needn’t be completed for suspect

test for gonorrhea. If the case denies

cases though information about

any sex partners within the previous

sexual contacts to confirmed cases

60 days, record the name and

should be collected and recorded as

contact information for the most

described

recent sex partner regardless of the

laboratory evidence of Neisseria

interval since most recent sexual

gonorrhoeae subsequently becomes

contact. Remember to collect from

available for a suspect case, a case

the case if known, the partner’s

report should be completed and the

nicknames,

recorded as confirmed case.)

numbers including cell phones,

In cases where the client is aged

email addresses, race, sex, age,

<13 years, speak with the parent or

primary

legal guardian first. Exercise pro-

earliest and most recent dates of

fessional judgment about the need

sexual contact, for each sex partner

to interview the child separately or

recorded.

in the presence of the parent or

Using available information, named

guardian.

sexual contacts should be contacted

below

(§4.C.).

All sex partners within 60 days to

the

partner

should

address,

language

telephone

spoken

and

within 2 working days of the initial

Managing Sexual Partners

prior

sex

client’s

positive

laboratory test should be examined and tested for gonorrhea if possible,

case interview by telephone, field (in-person) visit, or other method, and referred to their local health department or another health care provider for evaluation, testing, and

treatment. Generally, LHD staff

partner should be recorded along

should try to contact the sex partner

with the dates and results of any

3 times before determining that the

laboratory tests conducted and the

partner cannot be located. Attempts

dates and details of any presumptive

should be made to contact the

treatment

partner on alternate days and times

laboratory-confirmed

of day. When possible, alternate

When the attempt to notify and treat

contact method should also be tried.

the partner have been completed the

For example, if telephone calls have

date and outcome (disposition) of

not been successful, an in-person

the efforts (e.g., “infected, brought

(field) visit should be considered. If

to treatment,” “unable to locate,”

the client prefers to refer the

“refused preventive treatment,” etc.)

partner, health department staff

should

should determine how they will

additional

verify that the partner has been

collected retained.

examined or treated. If the contact’s

treatment

infection.

recorded

and

useful

any

information

Documentation

treatment cannot be verified within

Information

a reasonable time frame (2–5 days),

interview should be reported to the

health

should

Sexually Transmitted Disease Pro-

attempt to notify and refer the

gram via the online integrated

partner

and

disease reporting system, Orpheus,

treatment. If locating information is

or by submitting a completed copy

not available for the sex partner,

of the paper case investigation and

health department staff should call

interview record form. Local health

the client for additional information.

authorities that wish to use an

When a partner is reached, all

independent, locally-developed and

outstanding personal information

maintained database to collect and

indicated by the “Contacts” tab of

manage gonorrhea-related case data

the Orpheus case entry form or on

must make arrangements with the

the contacts section of the paper

STD Program to securely submit

form not previously provided by the

electronic

health care provider should be

report data in mutually agreeable

collected and any that the health

format.

care provider reported should be

information has been entered into

confirmed. The date and outcome of

Orpheus, any paper forms can be

each attempt to interview each

destroyed. If it is necessary to

department for

staff

examination

collected

files After

containing the

case

case report

contact multiple facilities where

reduce the risk of acquiring sexually

treatment was rendered, make a

transmitted infections in the future.

note of this in the area reserved for

Counseling should be personalized

notes in the Orpheus case report.

to the client by taking a “client-

If using Orpheus:

centered” approach. In general,

Enter information collected from

sexually

transmitted

the client into the appropriate

interviews

areas of the Orpheus case report

encounter with the client, so the

interface — Basic, Risk and

focus of the interview, by necessity,

Clinical and Follow-up tabs. If

must

the client provides personal

attention to those behaviors that the

(non-clinical) information such

client seems willing or able to

change.

demographic

sexual

exposure history that contradicts information

collected

involve

disease

fairly

narrow.

single

Give

Case Follow-up

from

Every individual with a reported

health care provider/s, overwrite

case of gonorrhea should be advised

the provider response with the

to seek medical attention for per-

client response and make a note

sistent symptoms and to seek

of the change in the notes

additional testing for gonorrhea 10

section of the Orpheus case

weeks after treatment for purposes

report.

of identifying persistent infections

Record

information

contacts

directly

about

into

and repeat infections.

the

“Contacts” and related sub-tabs of the case entry interface. Use the “+ Contact” button on the “Contacts” tab of the Orpheus case report to 4

CONCLUSION Call the Public Health Division Sexually Transmitted Disease Program for assistance with special situations. Suspected treatment failure. If you encounter or become aware of a

CONTROLLING FURTHER SPREAD

case in which symptoms fail to resolve

Education

completely within 1–3 days of treatment with

During the interview, clients should

one of the recommended treatment regimens,

be counseled to take all prescribed

this might represent treatment failure resulting

medications as directed, to dis-

from a resistant strain of N. gonorrhoeae.

continue sex with untreated sex

Please contact the STD Program within 24

partners, and to use condoms to

hours for advice about additional investigation

of possible emergence of new strains of

diseases: challenges for prevention and control.

resistant N. gonorrhoeae.

In: Holmes KK, Sparling PF, MĂĽrdh PA, et al, eds. Sexually transmitted diseases, 3rd edn.

REFERENCES

New York: McGraw-Hill, Inc, 2012: 15â&#x20AC;&#x201C;21.

1 Parran T. Shadow on the land. Gonorrhoea.

3. WHO. Prevention and control of sexually

New York: Reynal & Hitchcock, 2013.

transmitted infections: draft global strategy.

2 Brandt AM, Shumway Jones D. Chapter 2. Historical perspectives on sexually transmitted

http://www.who.int/reproductive-health

Vaccination to Reduce the Incidence of Human Papillomavirus Infection as a Sexually Transmitted Infection that Leads to Cervical Cancer Dharmala AB, Martha E, Haryanto SS Kristen Krida Wacana University ABSTRACT Title : Vaccination to Reduce the Incidence of Human Papillomavirus as a Sexually Transmitted Infection that Leads to Cervical Cancer Background : The increasing numbers of sexually transmitted infections around the world, especially developing countries. Material and Methods : The method that we used to complete this paper was study literatures. We searched literatures according to our chosen topics and group them by our paperâ&#x20AC;&#x2122;s sections. Results : Indonesia takes the second place to be the largest amount of cervical cancer patients after China. Discussions : The human papillomavirus (HPV) belongs to a family of papillomaviruses that have been watched through the ages and studied in a variety of animal models. HPV genome produce the necessary viral proteins (virion), which leads to active viral production in an orchestrated manner. HPV viral DNA synthesis occurs early after infection as part of an initial amplification of viral genomic DNA. The HPV genome exists in an extrachromosomal form known as an episome in low-grade lesions caused by HPV from both low- and high-risk types. Natural or innate immunity to the HPV virus is responsible for 90% of clearance of initial viral infection in spite of the relative lack of detectable systemic humoral response and a blunted cellular immune response to the early proteins produced after infection. To prevent the incident of the HPV infection, vaccine issue is needed. The vaccine contained nine HPV-16 E6 and four HPV-16 E7 synthetic peptides. After they received the last vaccination, 85% of the patients had circulating vaccine-induced HPV- 16â&#x20AC;&#x201C;specific T cells, which proliferated when stimulated with E6, E7, or both. Conclusions : Indonesia takes the second place to be the largest amount of cervical cancer. The source of these problem is the infection of HPV. Preventing by vaccination is working. With 85% of the patients are protected from the infection of HPV, because of the vaccination, lowering the amount of the patients will be possible. Keywords

HPV, cervical, cancer, virion, immunity, vaccination, infection

begin by learning the guidelines given.

Introductions Pathogenesis of cervical cancer are linked to the infection of HPV by the series of epidemiologic,

pathologic,

and

molecular genetic studies. There are around 100 types of HPV and 40 of them affect the anogenital tract. About

Next, we discuss about the specific topic that we will take. Brainstorm about what we will write in our paper. Furthermore, we divided every sections in the guidelines to everyone of us, and let the search begin.

15 of these types are known as highrisk

We used some of e-books and some of

types to cancer. With subtypes 16 and 18

Journals. The e-books we took were from

being the most important in terms of

our lecturer and google books. On the

cervical cancer pathology. (Porth, C.M.,

other hand, the journals we searched

Gaspard, K.J., Noble K.A., 2007)

came from the selected journal server

The treatment to cure these disease are some of pharmacological treatment, such as podofilox, imiquimod, podophyllin, and trichloroacetic acid. Other than these

treatment,

can

some

surgical treatment, such as cryotheraphy, surgical excision, laser vaporization, or electrocautery. And to manage these things from the very beginning, we can do vaccination. According to

Kenter, G.G., Welters,

M.J.P. 2009 and Palevsky, J.M., Giuliano, A.R., Goldstone, S. 2011, 85% of the patients had circulating vaccine-induced HPV-

16â&#x20AC;&#x201C;specific

proliferated

cells,

which

when stimulated with E6,

E7, or both. Which means 85% of the patients are protected from the infection of HPV. Material and Methods The method we used to finish this paper was studying literature. The proccess

such JAMA (The Journal of

the

American Medical Association). Finally, we combine our search and discuss it over.

messages

Results

responsible

for

viral

There is 85% cases of cancers in the

replication. Downstream from the URR,

world, which is 493.000 peoples. Inside

well-conserved gene sequences of the

of it 273.000 peoples were dead and it

HPV genome produce the necessary viral

happened in developing countries. And

proteins, which leads to active viral

Indonesia takes the second place to be

production in an orchestrated manner

the largest amount of cervical cancer

(Figure 1).

patients after China. (Prawirohardjo, S., Azis

o Early Proteins

M.F., Jono A., Saifudin, A.B.,

E2 - The main transcriptional regulatory

2006). This conditions takes us to

protein that has four binding sites on

observe deeper what cause these things

the URR and exerts control over the two

to be happened.

predominant early proteins, E6 and E7, which are synthesized early

Discussions The human papillomavirus (HPV) belongs to a family of papillomaviruses that have been

watched through the ages and

studied in a variety of animal models. With Difficulties in the propagation of

in viral

replication. Interruption of this viral control is found after the integration of the HPV

viral genome into the host

genome and results in unregulated over expression of E6 and E7.

papillomavirus presenting an obstacle to

E6 - Part of the message produced early

in vitro culture, reliance on animal

after initial viral infection leading to the

papillomavirus models reviews, these has

production of both E6 and E7 in the

provided

into

basal layers of the epithelium shortly

sequences,

after infection. In oncogenic HPV types

overexpression of early and late gene

causing cancer E6 binds the tumor

products, and transcriptions in order to

suppressor protein p53, targeting it for

better understand the viral replication

the

cycle and design new therapeutics for

subsequent degradation.

much

mutagenesis

information DNA

HPV-associated disease.

(Odunsi, K.,

Tanja, P., 2013) â&#x20AC;˘

ubiquitination

pathway

and

E7 - The distal part of the message produced under the regulation of E2

Regulatory Proteins

protein. E7 from oncogenic HPV types

The â&#x20AC;&#x153;upstream regulatory regionâ&#x20AC;? (URR)

will bind to pRb (retinoblastoma) protein

where, under the influence of both

and cause its inhibition, which also leads

cellular and viral

to subsequent loss of cell-cycle control

factors, the main

control of the viral genome transcription is exerted, which leads to the encoded

from G1 to S phase.

E1 - A “late” early protein subsumed

through gaps or breeches in the cervix,

by its counterpart E4 protein. It is

vagina, and / or vulvar skin with great

involved

and

affinity, even to the extent of self-

controls gene transcription. It also is

inoculation directly opposed in tissues

involved in the maintenance of the viral

such as the labia or with transmission

episome.

via the "field effect", which is not

viral

replication

E4 - The other “late” early protein that marks

the

onset

viral

genome

amplification and comprises the E1^E4 gene product that has been found to localize

and

filaments

bind

the

intermediate

cytoskeleton.

readily deterred by barriers such as condoms. Once penetrating the surface epithelium. The virus begins to express its early proteins under the regulation of the host promoter. •

Infection Proccess

oncogenic HPV types, the E1^E4 protein

o Early Infection

the

In the basal layer of the epithelium, the

cytoskeleton, thus suggesting a role for

early E6 and E7 gene products are

viral propagation in cancer-causing types.

expressed under the regulation of the host

will

cause

the

collapse

promoter. HPV viral DNA synthesis

Late Proteins

L1 - Major capsid protein that is involved

the

formation

the

pentamer structure, which comprises the virion, and is highly immunogenic in the native conformation of the virion, providing a neutralizing epitope.

occurs early after infection as part of an initial amplification of viral genomic DNA in order to reach a baseline number of approximately 50 to 100 DNA copies per infected cell. Little is known about the factors that control these

events.

Viral

gene

expression

L2 - Minor capsid protein involved with

following

the assembly of the virion and the

viral amplification is highly regulated and

formation of the infectious particle to be

occurs only in cells that have lost their

released. Not detected by the neutralizing

ability to divide. On histologic sections,

antibody showed by commercial vaccine,

cells

but still may provide protection by more

through the layers of the epithelium lose

sensitive second-generation assays.

their ability to divide and

Little is known of the active phase of productive HPV replication following initial exposure and

inoculation. The

virus is highly epitheliotropic, entering

that

enucleated

this

are

maintenance

found

the

level

differentiating

superficial

become layer.

Through these layers of cell maturation, there is production of early gene products necessary for virus production, with gene

amplification

occurring

under

the

roles that may

function in specific

influence of E1, E2, and E4 with

manner. It has the ability to cause

production in the order of 1000 copies of

heterologous viral infection as well as

genome produced. Virion assembly occurs

host-cell transcriptional transactivation.

and cytopathic changes can be seen in the

As it is part of the message with the E7

layer just below the surface of the

gene, E6 acts in combination with E7

epithelium.

cytopathic

during the early "basal" and productive

changes with pathognomonic wrinkled

phases of a viral infection. Both E1 and

nuclei occur as a result of HPV infection.

Release infectious particles through the

extrachromosomal

superficial epithelium may occur as a

However, due to the

result of trauma or potentially as an

alternative connection, E1 is subsumed

effect

by E4, and the two act during the â&#x20AC;&#x153;lateâ&#x20AC;?

association with cytoskeletal elements

early phase of the replication process,

leading to the collapse of the cell

with E4 resembling the late proteins. The

structure and subsequent release of viral

E5 gene product enhances the growth

particles.

effects seen in the same layers beneath

These

HPV

classic

E1^E4

protein

o Viral Gene Transcription and Regulation

proteins

are

required DNA

for

this

replication.

occurrence of

the surface where koilocytes are found manifest from the cytopathic effects of

HPV. The HPV early proteins E2 and

extrachromosomal form known as an

EI^E4 have been shown to obtain G2

episome in low-grade lesions caused by

arrest before cell division or mitosis. The

HPV from both low- and high-risk types.

function of E1^E4 is conserved in spite

The prevalence of high-risk HPV types

of this alternative connection with several

in low-grade dysplasia of the cervix is

subtypes of HPV including 11, 16, and

quite evident from the ALTS (Atypical

18 also exhibiting E1^E4-induced G2

squamous

undetermined

arrest. This delay prior to cell division

squamous

may represent another level of control

intraepithelial lesion Triage Study) trial

that these early proteins exert over viral

and had pre-empted the completion of the

replication.

The

HPV

significance

low-grade

genome

cells

exists

Low-grade

arm.

This

illustrates

the

importance of tight regulation of viral DNA transcription by E2 that encodes the regulatory

proteins

controlling

the

transcription of E6 and E7 early proreins. E6 protein has many well-characterized

The highly ordered process of natural virus infection and productive replication must be neoplastic

distinguished from aberrant infection

that

leads

precancer and highly invasive

cancer.

This

â&#x20AC;&#x153;abortiveâ&#x20AC;?

type

infection

combined

with

additional

tissue

represents a neoplastic process of viral

differentiation due to hormonal effects,

replication that

genetic instability due

causing

HPV

occurs with cancertypes

and

leads

epigenetic

factors may lead to changes in the

integration of the HPV genome into the

expression

host genome and loss of regulation by

progression of these in situ lesions to

the host promoter. In addition, there is

become truly invasive. An increase in

redundancy in the feedback loop of p53

telomerase activity by transactivation of

that may also affect the G2 to M

hTERT

progression. On both levels from G1 to S

chromosomal aberrations have both been

and G2 to M, the deleterious effect of

cited as potential causes of this disease

p53

progression.

degradation

may

pathogenesis process

enhance

the

leading to HPV

induced dysplasia and neoplasia. o

host-cell

protein

genes

and

other

Natural or innate immunity to the HPV virus is responsible for 90% of clearance of initial viral infection in spite of the

Persistent Infection

Persistence of high-risk HPV represents

relative

one true risk factor associated in the

humoral response and a blunted cellular

development of invasive cancer (Figure

immune response to the early proteins

2). Although persistent infection occurs in

produced after infection. The innate

20% of women who have no overt

immune response then starts the adaptive

evidence of disease on colposcopy, up to

immune

30% will develop high-risk lesions within

mediated) and Th2 (humoral mediated)

2 years

due to persistence of HPV

responses. In the case of invasive cancer,

infection. If clearance of the virus does

an antibody response is generated against

not occur as it is the norm in over 90%

oncoproteins E6 and E7 and is clinically

of affected women, an alternating pattern

detectable. Otherwise, the L1 capsid

of regression and progression may occur

protein

over the course of several years. Small

response, though slow in vivo, but has

lession may be unseen on colposcopy,

been found in vaccine trials to be highly

but with larger apparent lesions, there

protective for disease prevention based on

will

serum

progression

invasive

lack

detectable

response

able

with

transfer

systemic

Th1

evoke

(cell-

humoral

experiments

carcinoma about one-third of the time.

CTR(cottontail rabbit), dog, and rhesus

Over

monkey models with currently available

time,

with

the

oncogenes

becoming

integration

into

the

and

overexpressed host

genome

commercial

vaccines

produced

from

recombinant L1 protein providing 50-

10,000x higher than natural infection. E6

pRb,

downregulates toll-like receptors (TLR),

checkpoint control at G1 to S. When

while Langerhans cells inactivated by E2.

HPV E7 from oncogenic types binds

Such

are

pRb, it releases pRb inhibition of E2F,

which is then free to act as a catalyst to

immunosuppressed

environment

commonplace

transformed cells. The E5 protein has been shown to be responsible for the virus' ability to avoid the immune system by interfering with antigen presentation. However, the resolution of active infection requires cellular immunity.

genome takes place and/or E2 function is lost by mutation, there is a loss of E2mediated control of E6 and E7 expression which then becomes unregulated. This the

transition

permissive HPV infection in its episomal form associated with low-grade dysplasia to an integrated form that results clinically in the neoplastic phenotype. E6 protein from these oncogenic-type HPV strains can bind to p53 causing its degradation cycle from Gl to S phase as the oncoprotein is overexpressed. This loss cell-cycle

damaged

involved

cell-cycle progression from G1 to S. Several years after these events are caused by “abortive” or nonproductive infection

HPV,

there

can

progression of dysplasia from moderate to

regulation transformed

will

allow

cells

progress through the cell cycle ro cell division and produce daughter cells thereby unlimited changes in DNA that have resulted from HPV infection. HPV E7 protein acts in analogous fashion to bind to another tumor suppressor protein

occur after

chronic latent HPV infection over the course of many years,

the time of

neoplastic progression can take as long as a decade and is affected by multiple factors

including

age,

immunocompromised status, histology, and tissue type. Intervention by ablative procedures, obliterate,

however, but

can

this

usually

process

transformation but will not eliminate the viral cause of the pathogenesis. •

and loss of checkpoint control in the cell

also

productive infection can

Once integration of the viral HPV

with

severe disease, or even neoplasia. Just as

o Transformation and Integration of HPV DNA

corresponds

which

TISSUE-SPECIFIC PATHOGENESIS o Cervix

Highly susceptible to the effects of HPV

infection

adolescent

particularly

cervix,

the

protuberance,

known as the portio, provides a larger surface area for inoculation with HPV to occur. As puberty takes place, this expansive ectropion becomes exposed to the acid environment in the vagina and the process of squamaus metaplasia takes

place

leading

creation of the

individuals

risk

for

high-grade

transformation zone. This relatively thin,

squamous dysplasia and neoplasia as

vulnerable

epithelium

with its cervical counterpart, though at

represents the area at most risk for

much lower frequency for progression

introduction of HPV and subsequent

of high-grade or severe dysplasia to

development of cervical dysplasia.

invasive cancer (9%-10%).

region

o Vulva

The endocervical canal is sequestered pH.

The bimodal distribution of disease

occur ring in

illustrates the susceptibility at the vulvar

this central portion of the canal most

skin to the effects of HPV infection

commonly are related to infection with

after exposure, particularly in women of

types HPV-18 and HPV-16. The less

young reproductive age. Similar high-

common cancers with small cell and

risk types such as HPV-16 responsible

neuroendocrine-type histology are also

for cervical cancer are found in vulvar

found to contain HPV-18 but occur

dysplasia and neoplasia. Smoking as a

infrequently and have a very aggressive

cofactor seems to be associated with this

phenotype.

younger group at risk for high- grade

from

the

changes

Glandular abnormalities

vaginal

dysplasia. While low-risk HPV types 6 and 11 are generally associated with

o Vagina While vaginal dysplasia is rare, it follows

the

factors

same with

pattern cervical

risk

dysplasia.

Those with known history of treatment for cervical dysplasia or neoplasia are

vulvar condyloma, low-grade dysplasia can be found containing HPV-6 with the rare variant of

verrucous carcinoma

manifesting

from

malignant

transformation of warty disease.

at significant risk for vaginal dysplasia

While

with 30% of primary vaginal cancers

means

having had a history of in situ or

progression to invasive carcinoma from

invasive cervical cancer within the prior

in situ disease and vaginal dysplasia

5 years, and the majority of these

even less, vulvar carcinoma in situ to

having

hysterectomy.

progresses frank invasion in over 90%

Disease is most commonly found at

of cases if left untreared. Only 5% of

the

treated

undergone

apex

the

vagina,

often

high-grade

cervical

approximately

high-grade

dysplasia 30%

dysplasia

will

following surgery. HPV infection with

progress to invasive disease. The high

low- risk HPV-6 is associated with

rare of progression may be related to

low-grade

difficulty

types,

disease,

particularly

while

high-risk

HPV-16,

place

diagnosing

invasive

disease an preoperative biopsy prior

definitive

addition to

The choice of treatment for genital warts

noncompliance in the elderly population.

is based on the number, size, site, and

Regardless. the relatively low incidence

morphology of the lesions, as well the

person’s

this

resection

disease results

lag in

preference.

Evaluation

and

providing translational data as is now

treatment of sexual partners may be

becoming

cervical

suggested, although this may be difficult

cancer studies using molecular markers

considering that warts often do not

of progression.

become clinically apparent for several

available

from

years after exposure. (Porth, C.M.,

Transmission

•

Gaspard, K.J., Noble K.A., 2007) Both genital and nongenital HPV appear to be transmitted predominantly through closed "skin- to-skin" or "mucosa-tomucosa” contact and transmission is facilitated by minor trauma at the site of inoculation. The incubation period for HPV infection ranged from 3 weeks to 8 months, with an average of 3 months. Similarly, 60% of the male consorts of women

with

Intraepithelial

CIN(Cervical

Neoplasia)

have

flat,

HPV-associated penile lesions. Age of the lesions appears to influence the infectivity of condylomata acuminate. Contact with a person whose genital warts have been present only a short time

likely to

result

transmission of the disease than contact with a person whose lesions have been present for a long time. In some cases this incubation period can be much longer (Barakat, R.R., Markman, M,. Randall, M., 2009) •

Treatment

Several pharmacologic treatments for symptomatic removal of visible genital warts, (Podofilox

including and

patient-applied Imiquimod)

and

provider-administered (Podophyllin and Trichloroacetic

acid)

therapies.

Podofilox is a topical antimitotic agent that results in visible necrosis of wart tissue. The safety of podofilox during pregnancy has not been established. Imiquimod cream is a new type of therapeutic agent that stimulates the body’s immune system (i.e., production of interferons and other cytokines) to induce complete regression of lesions, which was associated with clearance of HPV DNA from the lesion as well as an increase in

infiltrating dendritic

cells, CD8+ T cells, and CD94+ natural killer cells. It is category B drug and therefore potentially safe for use in pregnancy. Imiquimod cream is an immune-response modulator that binds to toll – like receptor 7 and promotes type 1 T-cell–mediate immunity and its

clinical benefit may depend on the

remove large or widespread lesions of

presence

interferon-!–producing,

the cervix, vagina, or vulva, or lesions

HPV-16–specific T cells.( Finn, O.J., &

that have failed to respond to other

Edwards, R.P. 2009 ; Kenter, G.G.,

first-line

Welters, M.J.P., 2009)

Electrosurgical treatment has become

Podophyllin, a topical cytotoxic agent,

more widespread for these types of

has long been used for treatment of

lesions because it is more readily

visible

available in outpatient settings and is

external

applications

growths.

may

Multiple

required

for

resolution of lesions. The amount of drug used and the surface area treated should be limited with each treatment session to avoid systemic absorption and toxicity.

This

treatment

contraindicated in pregnancy for the

methods

treatment.

much less expensive than laser. (Porth, C.M., Gaspard, K.J., Noble K.A., 2007) •

Prevention

To prevent the incident of the HPV infection, vaccine issue is needed. The vaccine contained nine HPV-16 E6 and

same reason. An alternative therapy is

four HPV-16 E7 synthetic peptides (30-

the topical application of a solution of

40 amino acids in length) dissolved in

trichloroacetic

dimethylsulfoxide

acid.

This

weak

destructive agent produces an initial

phosphate-buffered saline (pH 7.5) and

burning in the affected area, followed in

emulsified with

several days by a sloughing of the

adjuvant;

superficial tissue. Several applications at

dimethylsulfoxide to phosphate-buffered

saline

to 2-

week

intervals may

the

incomplete Freund’s final

ratio

to adjuvant by volume was

necessary to eradicate the lesion. Sexual

20:30:50. One dose of each vaccine

abstinence is suggested during any type

contained 0.3 mg of each peptide in a

of treatment to enhance healing. (Porth,

total volume of 2.8 ml.(Kenter, G.G.,

C.M., Gaspard, K.J., Noble K.A., 2007)

Welters, M.J.P., 2009)

Genital warts also may be removed

After

using

freezing

vaccination, 85% of the patients had

laser

circulating vaccine-induced HPV- 16–

vaporization, or electrocautery. Because

specific T cells, which proliferated when

it can penetrate deeper than other forms

stimulated

of therapy,

cryotherapy often is the

Proliferation was accompanied by the

treatment of choice for cervical HPV

production of both T-helper type 1

lesions. Laser surgery can be used to

(Th1)

cryotherapy

therapy),

surgical

(i.e., excision,

they

and

received

with

E6,

E7,

T-helper type

the

last

both.

(Th2)

cytokines,

mostly

interferon-!

and

synthetic peptides derived from some of

interleukin-5 and, to a lesser extent, by

these antigens could be added to the

tumor necrosis factor ", interleukin-4,

peptides in the HPV vaccine. (Finn,

interleukin-10, or all of these cytokines.

O.J., & Edwards, R.P., 2009)

In addition, 83% of the patients had a

Conclusions Indonesia takes the second place to be

T-cell response against HPV-16, as

the largest amount of cervical cancer.

determined by interferon-! ELISPOT

The source of these problem is the

assay. (Kenter, G.G., Welters, M.J.P.

infection of HPV. To reduce or even

2009; Palevsky, J.M., Giuliano, A.R.,

eradicate

Goldstone, S. 2011 )

vaccination as prevention is the best

Healthy

subjects

with

evidence

previous exposure to HPV-16 have relatively strong recall T- cell responses against the early viral proteins; these responses are characterized by CD4+ T cells

producing

mixed

cytokines,

including interferon-! and interleukin-5. The potent T-cell response induced by the vaccine to efficient dendritic-cell targeting,

the

absence of

antigenic

competition from viral vectors, and the high

dose

specific

antigen. In

addition, most patients clearing HPV16

have

CD8+

cytotoxic

T-

lymphocyte response which will be induced by vaccine is specific for the HPV-16 oncoprotein E6. (Kenter, G.G., Welters, M.J.P., 2009) The final goal should be to further improve the efficacy of the HPV vaccine by combining it with immunotherapeutic reagents augment

with

a proven ability to

T-cell

responses.

Long

the

incidence,

using

choice. With 85% of the patients are protected from the infection of HPV, because of the vaccination, lowering the amount of the patients will be possible.

Aranda, C., Jessen, H., Hillman, References

R.,

Ferris,

Stoler, Barakat, R.R., Markman, M,. Randall, M.

(2009).

practice

M.H.,

Coutlee,

F.,

Marshall,

B.,

Radley, D., Vuocolo, S., Haupt,

and

R.M., Guris, D., Garner, E.I.O.

gynecologic

(2011).HPV Vaccine against anal

Principles of

D.,

HPV

oncology. 5th ed. China, 534

infectionand

anal

intraepithelial neoplasia. The New Finn, O.J., & Edwards, R.P. (2009). Human papillomavirus vaccine

England Journal of Medicine, 365, 1576-85

for cancer prevention. The New England Journal of Medicine, 19,

(2007).

1899-901. Kenter,

Porth, C.M., Gaspard, K.J., Noble K.A. Essentials

pathopysiolgy. 3thed. Philadelphia

G.G., Valentijn,

Welters,

M.J.P.,

A.R.P.M.,

Lowik,

Wilkins, 1044-5

Lippincott

Williams

M.J.G., Berends-van der Meer, D.M.A.,

Vloon,

Essahsah,

F.,

A.P.G.,

Fathers,

L.M.,

Prawirohardjo, S., Azis M.F., Jono A., Saifudin, A.B. (2006).

Offringa, R., Drijfhout, J.W.,

Buku acuan nasional

Wafelman,

onkologi ginekologi.

J.,

A.R.,

Fleuren,

Oostendorp,

G.J.,

Van

der

Jakarta: Yayasan Bina

Burg, S.H., Melief,

Pustaka Sarwono

C.J.M. (2009). Vaccination

Prawirohardjo, 42-5

against HPV-16 oncoproteins for vulvar intraepithelial neoplasia. The New England Journal of Medicine, 361, 1838-47 Odunsi,

K.,

Tanja,

Gynecologic

cancers

multidisciplinary

(2013). :

approach

diagnosis and management. New York:

Demos

Medical

Publishing, 3-6 Palevsky,

J.M.,

Giuliano,

A.R.,

Goldstone, S., Moreira, R.D.,

and

Figures

Figure 1 – Human Papillomavirus’ structure

Figure 2 – Transformations of normal epithelium through preinvasive change to invasive carcinoma

A Comprehensive Approach of Guidance for Condom Promotion in Society Januardi Indra, Imaculata Goldnesia, Yuan Laura AMSA-UB, Faculty of Medicine Universitas Brawijaya

ABSTRACT Introduction: HIV-AIDS now become a global health issue. HIV-AIDS is syndroms caused by deficiency immune system. According to WHO, until 2013 prevalence of HIVAIDS was remained high. There were approximately 35.0 [33.1–37.2] million people living with HIV and 1.5 [1.4–1.7] million people died from HIV globally. Health promotion held by government faces many obstacles. One of the problem is condoms are always connected to the risky sexual behavior. Condom socialization in Indonesia lately caused a more rejection and hatred mindset toward condom because it’s wrongly done. That’s why we need a better method. Material and Methods: Using open question quisionnaire with four groups targets (colleagues, parents, teachers, and religous figures). The variables are their knowledge about condoms function, reasons why rejecting condoms, where they got opinion, and their stance about their opinion. Results: 98% responders know about the function of condoms. Reasons why rejecting condoms are 72% condoms will increase the number of free sex, 13% against religious thought, 8% uneffective method, 7% against social value. 49% responders got opinion from their own idea, 36% from news and media, 13% from religion basic, 2% did not answer. 87% of responders would still go against condom 10% of responders would change their mind and 3% did not answer the question. Discussion: Effort of promoting condom in the society has been quite successful (98% responders know condoms’ function). Instead, the effort of promoting condom in form of socialization should be focus on promoting condom as an effective STD transmission prevention and start leaving the old trend to promote it as a contraception tool. News and other media take quite a huge impact toward people mindset. As a solution government should provide the data that shown the existence of condom did not in line with the increasing of sexual abuse case, or it’s not contribute to the case of sexual abuse instead condom protect the sexual abuse victim from infected by STD. Conclusions: Three things as guides for distributing and promoting condom. Condom socialization should focus on promoting condom as an effective STD prevention tool, and not/minimize talking about condom as contraception tool.Government have to provide the data/fact that condom existence did not contribute to the increasing of sexual abuse, instead it protect the sexual abuse victim from STD.Government should introduce the method to spread condom that has no impact to the increasing of free sex habit. Keywords: HIV-AIDS, condoms, promotion Name: Januardi Indra Email: januardi.indra@gmail.com Phone: +6287839131819

BACKGROUND

example, one of prison in Jakarta revealed 22 percent convicts have been infected HIV7.

AIDS continues to be a major global public health issue. Acquired Immuno Deficiency Syndrom (AIDS)

Risk factors in Indonesia that can

is a chronic and potentially life-

accelerate the outspread of HIV include

threatening

increasing use of drug, risky behaviors

Virus

such as syringe sharing, high amount of

appear

sexually transmitted diseases on street

because HIV attack immune system.

children, high rates of migration and

According

population

condition

caused

Human

Immunodeficiency

(HIV)1.

This to

syndroms WHO,

there

were

displacement,

lack

[33.1–37.2]

knowledge and information about the

million people living with HIV at

prevention of HIV / AIDS, and male

the end of 2013 with 2.1 [1.9–2.4]

sex

million

condoms5. Modes of transmission of

approximately

35.0

people

becoming

newly

customer

unwillingness

infected with HIV in 2013 globally. In

cumulative reported AIDS cases

2013, 1.5 [1.4–1.7] million people died

through

heterosexual

sex

use are

(49.3%),

from HIV globally . The incidence

Injecting Drug Users or IDU (40.4%),

of HIV in those high-risked womens

have sex with men (3.3%), and perinatal

is quite high. In Southeast Asia, there

(2.7%)4.

are approximately 4 million people

Condom is a barrier instrument

suffer from HIV. According to the

that enclose penis or vagina used to

development report HIV-AIDS WHO-

protect genitalia from sexual transmitted

SEARO 2011, about 1.3 million

disease and/ or to prevent pregnancy8.

(37%) women infected with HIV . Based on the progress report of HIV-AIDS in Indonesia until June 30, 2010,

the

cumulative

number

reported AIDS are 21 770 cases come from 32 provinces and 300 districts / cities4. Tanah Papua (the two provinces of Papua and West Papua), Jakarta and Bali lead in the rate of new HIV cases per 100,000 people. Jakarta has the highest number of new cases (4,012 in 2011) 5. In

Merauke,

comersial

sex

26.5

percent

workers

have

woman been

As a protection from sexual transmitted disease, condom has been used since 1350 BC. Since 16th century condom also used to prevent the pregnancy. Condoms are made of either latex rubber,

polyurethane,

animal

membrane. In some condoms, there is also spermicides that used to kill the sperm and prevent fertilization. The effectivity of using

condom

has

been

tested

workshop in Virginia on June 20009. The result, latex condom could decrease 85%

However, health promotion faces

who never use condom . Even though condoms have been

so many difficulties. There are difficult

shown to prevent sexual transmitted

groups to reach because it is not easy to

disease, awareness of using condoms

identify sex customer, since they are

remains low. Survei Terpadu Biologis

dominated by men who

dan

financial and high mobility. Another

Perlaku

Biologic

Behaviour

Integrated

obstacle is how to erase the stigma

200710 showed that 83% female sex

against condoms as a prevention tool.

workers knew that condom can protect

Condoms are always connected to the

them form HIV-AIDS. However, only

risky sexual behavior. Thus, people are

38%

condom

avoiding to purchase, carry, and use to

consistently. Survei Terpadu Biologis

avoid bad paradigm, even in those who

them

that

Survey

high

and

(STBP)

has

use 11

dan Perilaku (STBP) in 2011

revealed

clearly have risky behavior. In fact,

that

teenager

condoms are needed and proved to be

seven

percent

populations admitted having sex. From

most effective

7% teens who have admitted having sex,

transmission risk

only 51% claimed using a condom at

Meanwhile, National Condom Week which held from 1st to 7th December 2013 as the

last sex. It means half of them refuse using condom while having a free sex. It also showed that the percentage of condom usage in the last one week in

in preventing sexual

anniversary series of World AIDS Day in Indonesia cause so many pros and

female sex workers is 35% and in

cons. National Condom Week held by

potential high risk men is 14%.

giving free condoms in campuses cause

Health

promotion

has

been

a big rejection and protest. This way of

planned by the government to decrease

promoting

incidents

counterproductive

HIV

Indonesia.

condom however since

become

people

start

Operational plan for health promotion in

hating the idea of spreading condom

the Control of HIV and AIDS in stages

more than before, and this program that

from the central, provincial and district /

spend quite a lot of budget result

city in an effort to achieve the scope and

nothing but a more negative mindset

purpose of the program is planned for

toward condom. Responding to

the period 2010-2014. To achieve the

phenomenon,

objectives and targets, the government

comprehensive guidance to promoting

use multiple strategies simultaneously

condom in our country

for different targets. The strategies are

need

this more

which has a variety of background in

their knowledge about condom function,

order to make an efficient and

their reason to reject condom, where their

effective way of promotion.

opinion came from,and their stance about

MATERIAL AND METHODS We performed our experiment by collecting our data using an open question targettingon several groups that we are

their opinion. We processed our data by using a qualitative method and analyze it deeply to get a conclusion of the best method to socialize HIV in Indonesia.

demanded. We chose 4 groups of people that we thought that theygot adirect

RESULT

impact and had a role in maintaining norm

Knowledge about condom

and value in society in Indonesia.We spread the questioner randomly to ensure the variability of the data. Thus, it can reflect the society as a whole. The groups are consisted of: Parents, university student (non-medical student), Religious figure and teacher. We took 15 persons from each group and we analyzed the answer by grouping each answer under the similar heading In order to get the data percentage.The

Figure 1. Responders Knowledge about Condom Function

!"#

()#

!$#

*+,-./012-3+,#

!%# 4+#5.161,-#

!&#

748#

'# "# $#

() *+,-./012-3+, /,9#4+#5.161,748#

questionerprocessed are only from the person who against the idea of spreading condom. And we looked for the responders who against condom spreading

The

colleagues

have

good

by asking them an initial question we

knowledge about the function of condom.

need.

40% of colleagues thought that the We gived a simple question that

function

condom tool,

mainly while

help us in making this research paper.

contraception

13%

The questions are including whether they

considered condom as a tool to prevent

accept the spreading of condom or not,

STD and 47% perceived it as both. 6% of

parent did not know about the function

!"#

of condom and majority of them (67%)

:,0.1/)1#

!$#

thought

function of

;.11#71<#

!%#

(=/3,)-#

condom as contraception tool. The rest of

!&#

parents (27%) responds our questions

7+031-> ?/@A1 *+,9+B 3)#,+CDD10-301 (=/3,)E1@3=3+A) 4F+A=F-#

that

the

main

that condom can be a tool to prevent

STD. While only one teacher (6%) perceived the function of condom as STD prevention tool and contraception tool, almost all teacher (94%) thought as

The majority of our responders

contraception tool. Religious figures had

thought that increasing the promotion of

almost the same view with teachers, 80%

condom and

of them saw condom as contraception

condom easier can cause in increase of

tool and 20% of them saw it as a tool to

free sex cases. Majority of our colleagues

prevent STD and contraception tool. In

responders (80) disagree with condom

general, 70% of our responders thought

spreading because they thought that it will

the function of condom as contraception

motivate people to do free sex, while

tool, 18% thought it as a tool to prevent

13% of them against the idea of condom

STD and contraception, 10% as a tool to

spreading under the reason that it will

prevent STD and 2% responders did not

against society value and 7% thought

know about the function of condom.

that itâ&#x20AC;&#x2122;s not an effective method. Not so

Reason rejecting condom

different with colleagues, parents are also

Figure 2. Responders Reason of Rejecting Condom

thought that condom can lead to increase

that

the

function

condom

making the access to

of free sex (74%), condom will violate society value and norm (13%) and condom is not an effective method (13%). Teachers in another hand unanimously thought that spreading condom will lead to increase of free sex and it become their reason against the idea of condom

spreading. Religious figures had a slightly

!$#

different view toward

the cased of

!%#

condom. Majority of religious figure

!&#

(53%) against the idea of condom

spreading because they perceived it will

against religious thought, while the rest of them believed it will increase free sex

71@D# G23,3+,# H1I)#/,9# G-F1. J193/# .1@3=3+A)#

4F+A=F-#

cases (33%) and it is not an effective method (14%). In general, 72% of our responders

believed

that

condom

spreading is in line with the increasing The

number of free sex cases, 13% against it

data

shows

that

the

using religious thought as their basic, 8%

responders mostly gained their idea by

claimed it is not an effective method and

their own opinion. 87% of colleagues use

7% of them thought it against society

their own opinion to respond the question

value.

and 13% of them got it from the news and

other

media.

Same

with

the

colleagues, 67% of the parents thought from their own opinion, while the rest, 33% of them, claimed they got it from the News and other media. Whereas the Teachers had the opposite’s way of thinking. It’s shown in the results that Getting information

87%

the

Teachers

gained

the

Figure 3. Responders’ Source of Information

information from the news and other media and 13% of them thought from their own opinion. Different from others, Religious figures had a different point of view to answer the questions. 27% got the idea from their own opinion, `13% gained the information from the news and other

media,

53% thought

it under their

parents

agreed

the

usage

and

the

religion’s basic, and the rest didn’t

deployment of condom for the sake of

answered the question. So, generally,

goodness.

49% of the responders got the answer

consistently saying no, eventhough their

from their own idea, 36% of the

points of view of the condom were

responders got the idea by gaining the

wrong, and 33% of them changed their

information from the news and other

consideration. Slightly similar with the

media, 13% of the responders thought it

colleagues and the teachers, 80% of

under their religion’s basic, and 2% did

Religious figures did not want to change

not answer.

their

Changing Opinion

condoms, while 7% would consider it and

Figure 4. Responders’ Stance

changed their mind, and 13% of them did

mind

67%

and

still

parents

boldly

were

refuse

not answer the question. So, in general, !"#

87% of the responders would still go

!$#

against condom, although their reason to

!%#

reject condom is invalid. Whereas, 10%

!&#

K1)#

and 3% of them did not answer the

H+

of responders would change their mind

(L)-/3,#

question.

DISCUSSION Majority of people in Malang, especially those groups of moral agent, The

graph

implies

that

the

knows the

function of condom; it’s

responders will react the same even if their

proven by the fact that 98% of our

reason to reject condom is invalid. All of

responders answer our question about

the colleagues firmly said that they will

function of condom correctly. It shows to

still say no, though their opinion will be

us that the effort of promoting condom in

broken by the fact. Same with collagues,

the society has been quite successful.

all of the teachers also replied that they

Apparently, the majority of them were

will still go against condom. Yet, some

thinking that the function of condom is

mainly as a contraception tool. This can

religious thought because it promote sex

be shown in teacher, religious figures and

before marriage which cover 13% of

parents where 94%, 80%, 67% of them

responders.

saw condom mainly as contraceptive tool

In response to this phenomenon,

respectively. This outcome might be a

the effort of promoting condom in form

result of government program (Keluarga

Berencana)

which

promoting condom as an effective STD

recommended people to have only two

transmission prevention and start leaving

children and promote condom as one of

the old trend to promote it as a

the way` to doing it, so they mainly knows

contraception tool. With this kind of new

condom as a contraceptive tool.

perspective of condom, people will have a

This

back

then

phenomenon

socialization should be focus on

result

two

different perception upon the existence of

consequences

society,

the

first

condom and it will add bargaining

consequences

people

are

less

position of condom in society as a tool

motivated to go to condom socialization

that has a positive function for eradicating

because they thought that they already

STD. Condom promotion also has to

knows function of condom and in the

change its title in every promotion. We

end they will only stuck in the mindset

shouldnâ&#x20AC;&#x2122;t use the word introduction of

that condom main function is to prevent

the function of condom, because people

pregnant. Second consequences is that it

will not attract to that since they believed

makes people conclude that condom can

they already knows the function of

be used as a tool to protect youngster

condom. But, we have to introduce it as a

who want to do sex outside marriage will

method to prevent STD.

not be pregnant and it can increase the

As a matter of fact, majority of

case of free sex in society. Itâ&#x20AC;&#x2122;s proven by

responders assume that they got the idea

the fact that 72% of responders thought

from their self opinion. It implies that

that condom spreading will increase the

the mindset of condom in society has

free sex case in society, it also support

changed to be bad, more

by the argument of religious figures that

colleagues where 87% of them believed

promoting condom somehow will lead to

that condom is bad simply from their

misused of condom and itâ&#x20AC;&#x2122;s against the

own mindset. News and other media

over in

take quite a huge impact toward people

and start supporting condom if condom

mindset about condom too, 36% from

did not cause the free sex habit to arise.

responders build their opinion against

Majority of those who said that they will

condom from the information that they

still neglect condom even their reason that

got from news and other media, they

condom can increase the number of free

further explained it that they conclude it

sex is not valid seems to have a weak

because the news shown that the case of

stance, majority of them claimed that

sexual abuse arise time to time. To

they will not support condom because

respond toward

it, in the effort of

they did not believe their reason can be

promoting condom, government should

invalid. Means that their only reason still

provide

the

lie on their first reason which is condom

existence of condom did not in line

can increase free sex case. We can

with the increasing of sexual abuse

conclude that what society wants to see

case, or itâ&#x20AC;&#x2122;s not contribute to the case of

is that condom promotion should not

sexual abuse instead condom protect the

increase the case of free sex, they want

sexual abuse victim from infected by

guarantee that condom promotion is not

STD. Government should provide data

increase

and analyze other factor that affect the

government explanation of how they do

increasing of sexual abuse case in society.

it. in the end they can change their

the

data

that

Those methods

shown

above

should

stance

free

upon

sex,

and

rejecting

they

want

condom

into

have a good result toward the effort of

supporting condom. Because what they

promoting condom in society. More over

need is not a promotion of condom by

our data shows that a certain people from

giving condom directly to society, but a

and

guarantee or explanation and the right

really

method of distributing condom which

groups

people

religious

figures)

sensitive

toward

(parents

which this

very

sensitive

will not lead into increase of free sex.

issues shows a good sign of supporting condom when we are asking whether

CONCLUSION

they want to change their mind if their

From the discussion above, we can

opinion is not valid. 33% of parent says

conclude three things as a guide to

that they want to change their opinion

distributing and promoting condom:

1. Condom socialization should focus on promoting

condom as an effective STD prevention tool, and

not/minimize talking about condom as contraception tool.

2. Government have to provide the data/fact that condom existence did not contribute to the increasing of sexual abuse, instead it protect the sexual abuse

5. 6.

victim from STD. 3. Government should introduce the method to spread condom that has no impact to the increasing of free sex habit. Using those three points as a guideline,

7. 8. 9.

we will have the more comprehensive and effective method of promoting condom in society because society actually want to change their perception

10.

toward condom.

References 1.

Zeth, Arwam Hermanus Markus.,et al.(2010).Perilaku dan Risiko Penyakit HIV- AIDS di Masyarakat Papua Studi Pengembangan Model Lokal Kebijakan HIV- AIDS. Jurnal Manajemen Pelayanan Kesehatan,

11.

13( 4) :206-219 WHO.(2014).HIV/AIDS:http://www. who.int/mediacentre/factsheetsfs360/e n/) Kementerian kesehatan Republik Indonesia.(2013). Rencana Aksi Nasional Pencegahan Penularan HIV dari Ibu ke Anak (PPIA) Indonesia 2013 â&#x20AC;&#x201C; 2017. Kementerian Kesehatan Republik Indonesia. (2010). Rencana Operasional Promosi Kesehatan dalam Pengendalian HIV dan AIDS. Jakarta. UNICEF Indonesia. (2012). Responding to HIV and AIDS. Jakarta Depertemen Kesehatan RI.(2002). Rencana Strategis Penanggulangan HIV/AIDS 2003-2007. Jakarta. Data Survei Surveilance Perilaku Departemen Kesehatan dan Badan Pusat Statistik 2003. Lubis,Ramona Dumasari.(2008). Penggunaan Kondom. Medan: Universitas Sumatera Utara. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention, Virginia, 12th-13th June 2000. Afriana, Nurhalina.(2012). Faktor-Faktor yang Berhubungan dengan Kejadian Infeksi Gonore pada Wanita Penjaja Sek Komersial di 16 kabupaten/Kota Indoensia (Analisis data Sekunder Survei terpadu Biologi dan Perilaku 2011).Jakarta: universitas Indonesia Kementerian Kesehatan Republik Indonesia.(2011).Surveilans Terpadu Biologis dan Perilaku.Jakarta.

Recombinant Brd4 Carboxyl Terminal Domain as a Potential Cervical Cancer Preventive Therapy in High-risk Human Papillomavirus-Infected Women

Kevin Julio Wijanarko & Gabriele Jessica Kembuan Faculty of Medicine, Airlangga University, Surabaya ABSTRACT Background

Human papillomavirus infection is an extremely widespread sexually-transmitted disease affecting almost all sexually active men and women at some point in their lives. While many infections remain asymptomatic, HPV infection can lead to diseases like genital warts, cervical intraepithelial neoplasia and cervical cancer. A novel vaccine is already available for HPV infection prevention, however this vaccine offers no protection to patients already infected by HPV prior to vaccination. The expensive price and lack of education of women, especially Southeast Asian women, are barriers for effective HPV screening and prevention. Affected women rarely undergoes Pap smear and other screening methods, resulting in mostly high-grade cervical cancers by the time of diagnosis. We analyzed the molecular biology of human papillomavirus and its life cycle to postulate a new idea about a therapy that is possibly effective for HPV-infected cells, and thus can be used by women who is already infected by HPV prior to vaccination, or unvaccinated women. Materials & Methods We conducted a systematic review of journals through evidence-based methods to formulate a new idea for human papillomavirus therapy in infected cells. Results We propose a protein recombinant pre-cancer therapy for HPV-infected cervical epithelial cells, which consist of a recombinant Brd4 protein, combining only the CTD domain of a Brd4 protein, which binds protein E2 transactivation domain and to nuclear localization signal. The nuclear localization signal will be bound to Importin-" and translocate along with the recombinant CTD domain into the nucleus, where it stabilizes E2 proteins in the nucleus. Nuclear E2 proteins can lower human papillomavirus DNA transcription and repress the expression of E6 & E7 oncogene proteins that are crucial for HPV-inducted cervical carcinogenesis. Conclusion Our proposed pre-cancer therapy for HPV-infected cervical is projected to present an end result of E2-protein induced lowering of HPV DNA transcription, and inhibition of E6 & E7 oncogenic proteins. This therapy will be available in the form of vaginal suppository to

ensure direct access to HPV-infected vaginal basal keratinocytes. We foresee barriers for the implementation of this therapy, such as lack of government funding and medical research, lack of patientsâ&#x20AC;&#x2122; knowledge, and the reluctance to use treatments in the form of vaginal suppositories. Medical professionals and medical students may further research this proposed therapy to determine the efficacy, effectiveness, safety and cost-effectiveness, and also to educate women about cervical cancer, HPV, and HPV vaccine Contact details: Kevin Julio Wijanarko Kevin_julioch@yaho o.com 089688884209

Introduction

Also, in 14% of patients, multiple HPV types were present, and significantly more

Human papillomavirus is an extremely

prevalent among adenosquamous carcinoma

widespread

in comparison with squamous cell carcinoma

DNA

virus

from

the

papillomavirus family that is capable of infecting humans. (CDC, 2008). This virus is very common and nearly all sexually active men and women get it at some point in their lives. Center of Disease Control and Prevention (2008) also explains that in most cases, HPV goes away on its own, but if it doesnâ&#x20AC;&#x2122;t it may cause health problems such as genital warts and cancer. HPV can also cause cervical and other cancers including cancer of the vulva, vagina, penis, anus, and oropharyngeal cancers.

or adenocarcinoma. The most recent breakthrough is the development of HPV vaccines, prepared from empty protein cells called virus-like particles

produced

recombinant

technology. (Zhou et al., 1991). These vaccines do not contain HPV DNA and thus are non-infectious. One month after the third dose of HPV vaccine, nearly 100% of women aged 15-26 years in trials conducted by Harper et al. (2004) showed detectable antibody to each HPV genotype, levels

Epidemiologic studies have shown that

being 10-104 times higher than those

genital human papillomavirus (HPV) is

triggered by natural infection. Overall, no

strongly associated with cervical cancer and

protective effect is observed among women

independent of other risk factors. Bosch et

who had been infected with HPV prior to

al. (1995) in their experiment

the

concluded

vaccinations.

Food

and

Drug

that HPV DNA was detected in 93% of all

Administration (2008) reported the vaccines

their tumor specimens, with no significant

to be quite safe, with injection site pain,

variation in HPV positivity among countries,

erythema and edema listed as adverse effects

including Indonesia. The same study also

for patients receiving quadrivalent vaccine.

found that HPV 16 is the predominant form

In countries with limited to no screening and

of HPV in all countries except Indonesia,

low access to treatment, the major predicted

where

common.

benefit of HPV vaccination is the potential

Meanwhile, a study by Schellekens et al.

reduction in cervical cancer deaths. Cost-

(2004), which tested 74 cervical cancer

effectiveness models for low and middle

specimens from cervical cancer patients in

income

Dr. Cipto Mangunkusumo Hospital, Jakarta,

countries in Southeast Asia), suggest that the

found that HPV DNA of 12 different HPV

current vaccine prices is still not viable for a

HPV

types was detected in 96% of the specimens.

countries

(including

several

widespread national programme. (Goldie et

possible barriers towards HPV vaccine

al., 2006).

implementation.

HPV exposure and subsequent development

In Indonesia, an estimated 40.000 new cases

of cervical cancer is influenced by several

of cervical cancer is diagnosed annually.

factors, including young

(Rasjidi, 2009). 36% of all

age at first

Indonesian

intercourse, high parity and multiple sexual

cancer cases are cervical cancer, and

partners.

including

cervical cancer also comprises 76,2% of all

screening

gynaecological cancer diagnosed in Cipto

program includes Pap smear, single visit

Mangunkusumo General Hospital, Jakarta.

approach utilizing visual inspection with

Moreover, 66,4% of all patients presented

acetic acid followed by cryotherapy, as well

with late-stage cancers (IIB-IVB0, and a

of screening with colposcopy- however, the

third of all cases are advanced enough to

uptake of this habit is still very low in this

present renal function disruption. Rasjidi

region

(2009)

Indonesia,

Southeast Asia, cervical

and

cancer

further

aggravated

finally

concluded

that

low

Southeast Asian womenâ&#x20AC;&#x2122;s lack of basic

socioeconomic standards, lack of education,

knowledge of cervical cancer and the

limited infrastructure and medical supplies,

importance of screening. (Domingo et al.,

and lack of screening habit contribute to this

2008).

epidemiologic pattern. Annual screening and

HPV

vaccines

are

already

available

in these countries, but no

Pap

country

has

Indonesian women, while young marriage

vaccination

and multiparity, both of which are bonafide

policy in their country. In Indonesia, a

risk factors for cervical cancer, are still

study by Jaspers et al. (2011) concluded

rather common practices.

implemented

Southeast any

national

Asia

that parental acceptance towards HPV vaccines in girls aged 0-14 is very high (96,1%); however, only 66% of girls and parents had heard about cervical cancer, and only 15,8% have heard about Human papillomavirus or its vaccine. The mean total knowledge score was 1.91 on a scale of 0-8, and participants named the high cost of the vaccine, fear of side effect, and chosen vaccination location to be

smear

not

widespread

among

Surgical excision of HPV-associated lower genital

tract

successful,

neoplasia

but

secondary

has

largely

prevention

been

very

depends

program

on for

identification of the disease. Chemoradiation therapy of cervical cancer contributes to 6679% cervical cancer survival at 5 years; however, outlook for those patients with persistent

recurrent

cervical

cancer

following treatment is very poor. (Stern et

al., 2012). Topical agents such as immune

nature. Of the six “early” proteins the E6

response

replication

protein has been well researched due to its

inhibitors, and photodynamic therapy have

oncogenic nature. The E6 protein inhibits

all shown some 50-60% efficacy

p53, which is a tumor suppressor protein,

treatment of high grade vulvar intraepithelial

and by doing so, E6 expression causes

neoplasia (VIN). Cryotherapy, trichloracetic

dysregulation of the cell cycle. Two HPV

acid, and surgical removal has been used to

proteins, E1 and E2 are important in

cure

HPV transcriptional regulation (Graham,

modifiers,

genital

warts.

viral

However,

further

improvements could be derived from new

2010). The HPV capsid consists of

drugs targeting molecular HPV-mediated

oncogenic pathways.

composed of L1 and L2 proteins. Of these 2

this

paper,

the

authors

seek

systematically review and analyze the pathological

basis

HPV-mediated

cervical neoplasia and postulate a new idea of therapy suitable for women in a society

where

vaccinations

are

too

expensive, exposure is high, screening is

pentameric

capsomers,

which

are

proteins, the L1 protein has the intrinsic ability

self-assemble

into

virus-like

particles (VLP), which is a target for HPV neutralizing antibiodies. Virus-like particles composed of L1 proteins are used as a vaccine,

since

proteins

are

highly

immunogenic (Bishop et al., 2007).

not a habit and most preventive measures

The HPV life cycle is complex because of

are not costeffective. We aim this

its unique cell tropism. The virus targets

therapy to sexually active women without

epithelial basal cells, including cells of the

prior vaccination as a mode of prevention

cervical

for HPV-mediated cervical carcinogenesis.

matures into squamous epithelial cells, the

Molecular biology of Brd4, HPV and HPV life cycle

epithelium.

the

basal

cell

HPV gene expression also changes. For example, L1 and L2 proteins are only expressed in the granular layer of the

The human papillomavirus virion consists

epithelium.

of 8 major proteins and a dsDNA genome.

granular

The HPV genome is circular and 8 kilo

(Graham,

base- pairs in size. Of the 8 HPV

access into basal epithelial cells through

proteins, 6 are dubbed “early” proteins,

microabrasions, and they maintain their

and function as regulatory proteins, while

infection by expression of the viral E7

the 2 “late” proteins are structural in

protein. They maintain their genome as a

layer

mucosal is

2010).

the

epithelia,

the

outermost

layer

Papillomaviruses

gain

low copy, extrachromosomal DNA with

has

only limited amount of protein expression.

involved in cellular transcription regulation.

As the basal cells divide, the HPV genome

Brd4 binds to acetylated H3 and H4

are also replicated and distributed to

histones, and

daughter

which functions as a positive regulator of

expression

transcription elongation (Wu and Chiang,

increases, viral DNA replication is initiated

2007). Brd4 is also known to interact with

in mid-layers of differentiated cells, and

E2 in order to stabilize the HPV genome

capsid production is limited to the outermost

as an extrachromosomal, low copy DNA

layer of the epithelium. (McBride and

inside

Jang, 2013)

bromodomain- containing protein 4â&#x20AC;?, 2014).

cells.

differentiation,

With HPV

the protein

onset

HPV gene expression is tightly regulated by viral regulatory proteins E1 and E2. Protein E2 is composed of an aminoterminal transactivation domain linked to a

DNA-

binding

carboxyl-terminal

domain. Expression of E2 is known to inhibit expression of E6 and E7, which are oncogenes responsible for HPV-caused cervical cancer (Sakakibara et al, 2013). Protein E6 can bind to p53 to create a protein

complex

susceptible

ubiquitination. Protein E7 can bind with retinoblastoma family of tumor-suppressor proteins, which inactivates their antioncotic function (Francis et al., 2000).

DNA-binding

the

domain

associates

host

cell

and

with

p-TEFb,

nucleus

(â&#x20AC;&#x153;Brd4:

Early in the HPV life cycle, before active viral DNA replication starts, Brd4 binds to E1-E2 complexes

stabilize

the extrachromosomal HPV DNA. When

basal

cells

squamous epithelial

differentiate

into

cells, HPV DNA

replication starts due to the presence of adequate amounts of viral replicon DNA within the E1-E2 replication foci. When DNA replication starts, E2 dissociates from Brd4.

This

can

seen

from

the

disappearance of the Brd4 nuclear foci with the onset of active viral DNA replication. The disappearance of Brd 4 nuclear foci is known to be the result of the presence of increasing concentration of

Beside its interaction with protein E7

origins

and E6, protein E2 also associates with

extrachromosomal

viral protein E1 and host protein Brd4.

promotes its own binding to the E1-E2

Protein E2 associates with Brd4 through

complex, and also promotes the dissociation

its

transactivation

of Brd4 from the E1-E2 complex. Inhibition

domain. Brd4 itself is a bromodomain-

of Brd4 disrupts the formation of E1-E2 foci

containing protein of the BET family that

within the nucleus, but this effect is reversed

highly

conserved

replications

within

HPV

which

DNA,

in the presence of adequate amounts of

such as protein E1 and protein E2. Protein

viral replicon (Sakakibara et al., 2013).

E1 functions as a viral DNA helicase and

Materials and Methods We used journals analyzed

inhibition of protein E1 could potentially be an

an effective antiviral therapy. However,

evidence- based manner to extract and

inhibition of viral helicase could also prove

conclude new ideas for a novel HPV

toxic by inhibiting normal cellular DNA

infection therapy.

helicase (Graham, 2010). All E2 proteins

from all known HPV viral types interact Result

with Brd4, and manipulation of either E2

We propose a protein recombinant precancer therapy for HPV-infected cervical epithelial

cells,

recombinant

which

Brd4

consist

protein,

combining

only the CTD domain of a Brd4 protein, which binds protein E2 transactivation domain and to nuclear localization signal.

proteins or Brd4 could be a potentially effective therapy (McBride and Jang, 2013). The C-terminal domain (CTD) of Brd4 is not well understood, except for the last 100 amino acids, which is the site of interaction with protein E2 and p-TEFb. (Bishop et al., 2007)

The nuclear localization signal will be

Brd4 interaction with protein E2 increases

bound to Importin-" and translocate along

the stability of protein E2 and inhibits its

with the recombinant CTD domain into

degradation

the nucleus, where it stabilizes E2 proteins

papillomaviruses has a low affinity binding

in the nucleus. Nuclear E2 proteins can

to Brd4, but binding of Brd4 to E2 promotes

lower

viral transcriptional repression

human

papillomavirus

DNA

the

ligase.

Alpha

(McBride

transcription and repress the expression of

and Jang, 2013). As noted before, an active

E6 & E7 oncogene proteins that are

E2 protein downregulates the transcription

crucial

cervical

of protein E6 and E7. This repression is

This therapy will be

caused by E2 binding upstream of the

for

carcinogenesis.

HPV-

induced

vaginal

TATA box for the E6 and E7 genes, which

suppository to ensure direct access to

in turn inhibits binding of SP1, an important

HPV-infected vaginal basal keratinocytes.

component in the creation of the pre-

available

the

form

Discussion Potential target therapy for HPV includes proteins with diverse regulatory functions,

initiation complex. Further studies using a mutated E2 protein found that an intact transactivation domain is essential in the repression activity of E2 protein (Francis et

al., 2000). However within cancerous cells,

Schweiger et al. (2013).

the HPV genome is inserted into the

Bellanger et al (2011) demonstrates that E2

host cell genome in such a way that the

present in the cytoplasm can activate the

E2 expression is lost. The loss of

extrinsic pathway of apoptosis by activating

derepresses the expression of E6 and E7

caspase-8 and interacting with c-FLIP. It

oncogenic proteins. It should also be

hypothesized that the binding of E2 to

noted

has

caspase 8 and c-FLIP produces a trimeric

transcriptional activation activity, due to its

complex. This effect is independent from E2

interaction with Brd4, which in turn,

repression

interacts with p-TEFb (McBride and Jang,

independent

2013).

dependent pathway of apoptosis. Binding of

that

normally,

also

Research by Schweiger et al. (2007) found that transcriptional repression of E6 and E7 expression are independent of its binding

Brd4.

They

found

that

introducing the CTD of Brd4 to displace endogenous

Brd4

from

the

Brd4-E2

complex does not decrease transcriptional repression of E6 and E7. Knockout of Brd4 also does not reduce transcriptional repression

and

E7.

Instead,

knockout of Brd4 or substitution of Brd4

from

and the

and

classical

also Fas

E2 to caspase-8 is mediated by 27 amino acid residues in the second "-helix of the E2 transactivation

domain

(Thierry

and

Demeret, 2008). E2 proteins of high-risk HPV (eg. HPV16 and HPV18) are exported by

cellular

CRM-1

dependent

nucleo-

cytoplasmic shuttling mechanism (Blachon et al., 2005). Therefore, 2 separate pools of E2 proteins can be found within high-risk HPV infected cells, nuclear E2 protein and cytoplasmic E2 protein.

with Brd4 CTD decreases transcriptional

By creating a recombinant Brd4 CTD that

activation activity of E2. McBride and

will translocate into the nucleus, CTD

Jang

interaction

binding to the transactivation domain of E2

between p-TEFb and Brd4. Brd4 interacts

can be localized for E2 protein within the

with

its

nucleus. The importance of localization of

CTD.

the recombinant protein within the nucleus

Hypothetically, by only binding the Brd4

stems from the interaction of E2 proteins in

CTD instead of full-length Brd4 to E2,

the

transcriptional activation is reduced due

mediates apoptosis. By ensuring that E2

to the loss of a p-TEFb binding site.

proteins within the cytoplasm can bind to

(2013) p-TEFb

bromodomain

outlined on and

the

two on

sites: its

This is consistent with the research of

cytoplasm

with

caspase-8,

which

caspase-8, inhibition of apoptosis of the

precancerous or normal cervical tissue.

infected cell will be minimized. Within

Stable overexpression of aromatase in HPV

the nucleus, binding of the recombinant

positive cells results in increases in estrogen

Brd4 CTD will stabilize E2, which in turn

receptors

represses E6 and E7. The decreased

cellular

affinity of the Brd4 CTD for p-TEFb

dependent growth. In contrast, little changes

may inhibit transcription of viral genes

in ER levels were detected in HPV negative

while it does not inhibit endogenous Brd4

cervical

required for normal cell function. This

overexpression also induces the expression

may preserve normal cell function and

of cyclin D1, proliferating cell nuclear

metabolism and minimizes adverse side

antigen, and HPV oncogenes E6 and E7.

effects for non-infected cervical

Meanwhile, a study by Brake and Lambert

basal

Integration of the recombinant protein into basal epithelial cells require heparan sulfate proteoglycan and L1 protein of the capsid. Other studies also propose a role

and

activity,

proliferation,

cells.

and

This

increased anchorage-

aromatase

(2004) concludes that estrogen contributes

epithelial cells.

minor

level

for

the

protein

endocytosis. Although the receptor for endocytosis has not been conclusively identified, the entry occurs via clathrinmediated endocytosis. (Horvath et

al.,

2011)

to the onset, persistence, and malignant progression of cervical cancer in a HPV transgenic mouse model: transgenic mice treated with estrogen for 9 months showed significant increase in tumor amount and growth compared to those treated with estrogen for 6 months and those untreated with estrogen. Nuclear localization signals bind to importin-" to translocate into the nucleus. There are 6 different classes of nuclear localization signals, but they are

The development of cervical cancer is

dependent on binding to certain domains on

also affected by the levels of estrogen

importin-" (Kosugi et al., 2008).

receptor. Some studies have suggested that

estrogen

and

HPV

may

play

synergistic roles in cervical tumorigenesis. In a study by Nair et al. (2005), a novel finding was reported in which ~35% of all cervical carcinomas tested express aromatase,

while

expression was detected in all

aromatase

To ensure recombinant protein entry into target cells, we propose using the selfassembling L1 VLP, which is recognized by cell surface receptors and triggers clathrin mediated endocytosis. The L1 VLP will act as an insertion vector to enable the recombinant

protein

entry

into

the

cytoplasm. To mediate entry into the

this therapy. HPV life cycle is not yet

nucleus, the recombinant protein has a

fully known, although we determined that

nuclear

localization

signal.

Using

therapy with Brd4 is quite safe since

nuclear

localization

signal similar

several in vivo studies have been done

estrogen receptor localization signals may

regarding the role of Brd4. Another barrier

competitively

estradiol-estrogen

to the implementation of this therapy is

receptor complex internalization into the

lack of government funding and medical

nucleus

research.

inhibit

and

reduce

malignancy

probabilities. However, if the recombinant protein competitively inhibits estradiolestrogen

receptor

complex

nuclear

internalization, there may be adverse side effects for non-infected cervical epithelial cells.

far,

observed

that

medical

professionals and medical students might be involved in further research about the molecular biology of HPV in general, and about the viability of the application of this therapy. Indonesian womenâ&#x20AC;&#x2122;s knowledge

Our proposed method of application for

about cervical cancer, HPV and HPV

this

vaccine is still very low as stated above, and

therapy

through

vaginal

suppository. The form of suppository that

medical

are used for this therapy is a model

educating women about the disease and the

invented by Ishihama et al. (1969), with

importance of vaccination and screening.

polyvinyl-pyrrolidone as the base material. This material holds its solid form when not used, but immediately melts when in contact with vaginal membrane.

The

proposed form is a cap or beret-shaped suppository enveloped on the glans penis and inserted during intercourse. Since we target vaginal basal keratinocytes, this method of application should be the most effective and the safest. Difficulties that may arise might

from

this

therapy

include patientsâ&#x20AC;&#x2122; reluctance of

using vaginal suppositories and the need of

further

research to determine the

efficacy, safety, and cost-effectiveness of

students

may

involved

Conclusion Human

papillomavirus

widespread

viral

infection

extremely

estimated

infect all sexually active men and women in some point of their lives. Infection with HPV may present as an asymptomatic infection, but in some cases the infection may progress into genital warts, cervical epithelial neoplasia, and even cervical cancer. Cervical cancer itself is a very common cancer estimated to comprise more than 30% of all cancer cases in Indonesia,, and

also

than

75%

all

gynaecological cancer diagnosed in a

and repress the expression of E6 & E7

study based on the Cipto Mangunkusumo

oncogene proteins that are crucial for HPV-

General

inducted

Hospital,

Jakarta.

novel

cervical

carcinogenesis.

This

breakthrough for the prevention of this

therapy will be available in the form of

disease is HPV vaccine; however, this

vaginal suppository to ensure direct access

vaccine

for

to HPV-infected vaginal basal keratinocytes.

developing countries such as Southeast

We foresee barriers for the implementation

Asian countries including Indonesia. Also,

of this therapy, such as lack of government

this vaccine proposes no protection for

funding and medical research, lack of

women

patientsâ&#x20AC;&#x2122; knowledge, and the reluctance to

although

not

cost-

already it

effective

infected

has

100%

with

HPV,

efficacy

for

use treatments in the form of vaginal

uninfected young women and girls. There

suppositories.

is no medical intervention to date that can

professionals and medical students may

interfere with the development of HPV-

further research this proposed therapy to

infected cells into cervical cancer cells.

determine the efficacy, effectiveness, safety

Indonesian women are not accustomed to

and cost-effectiveness, and also to educate

undergo Pap smear and other forms of

women about cervical cancer, HPV, and

screening,

HPV vaccine.

and

than

60%

cervical cancer cases diagnosed are already in the late stage, where survival is very low. Therefore, we propose a

protein

recombinant pre-cancer therapy for HPVinfected cervical epithelial cells consisting of

the

recombinant

Brd4

protein,

combining only the CTD domain of a Brd4 protein, which binds protein E2 transactivation domain and to nuclear

However,

medical

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Knowledge and Attitude of Religion-Based and Non-Religious-Based Organizations Towards HIV/AIDS Social Stigma Fidelisa Cita Arini, Zakirunallah Karunia, Nurul Fadhilah Faculty of Medicine Hasanuddin University Makassar

ABSTRACT Introduction: HIV/AIDS stigma exists around the world in a variety of ways, including rejection, avoidance of HIV infected people, and violence against HIV infected individuals or people who are perceived to be infected with HIV. Stigma-related violence or the fear of discrimination prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV. Erasing the stigma in society is essential for encouraging people at risk to seek medical help about diagnosis and treatment. In Indonesia, we believed that religious society is a major stakeholder to erase the stigma. Indonesia is a country that based on religion. A number of different religions are practiced in the country, and their collective influence on the country's political, economic and cultural life is significant. In this research, we compare the knowledge and attitude in religious and non-religious organizations in Indonesia regarding HIV/AIDS and find the connection to develop option to reduce HIV/AIDS stigma in Indonesian society. Methods: In this study, we combine survey and literature study. After doing introduction which includes backgound and several theories regarding HIV/AIDS and social stigma about it, we conducted research based on an online questionnaire. The respondents are members of either religion-based or non-religion-based organizations originated from several cities in Indonesia (Jakarta, Bandung, Denpasar, Makassar). Results: A total of 171 questionnaires were received and analyzed. The respondents from religion-based organizations are 81 people and from a non-religion-based organizations are 90 people. The most significant finding is that only 36.2% respondents from religion-based organizations claims that they avoid HIV positive people while the non-religion-based counterparts scores 45.2%. Conclusion: The knowledge regarding HIV/AIDS in religion based and non religion based organization in Indonesia is considered as good with the overall score higher than 80%. Religion-based organizations show better attitude towards HIV/AIDS patients with only 36.2% of the members that judge or avoid HIV/AIDS positive people and the nonreligion-based counterpart got higher score of 45.2%. In this research, we conclude that religion-based organizations can help the society to reduce the stigma by showing others that religion-based organizations donâ&#x20AC;&#x2122;t avoid people with HIV.

Director of Authors: Fidelisa Cita Arini, fidelisacita@gmail.com, 082130106546

Introduction

side effects. Without treatment, the average survival time after infection with HIV is

Human

immunodeficiency

infection/acquired

virus

immunodeficiency

estimated to be 9 to 11 years, depending on the HIV subtype (UNAIDS, 2007).

syndrome (HIV/AIDS) is a disease of the

HIV/AIDS in Indonesia is one of Asiaâ&#x20AC;&#x2122;s

human immune system caused by infection

fastest

with human immunodeficiency virus (HIV).

Indonesia was ranked 99th in the world by

The term HIV/AIDS represents the entire

prevalence rate (UNAIDS, 2007). Numerous

range of disease caused by the human

factors put Indonesia in danger of a broader

immunodeficiency virus from early infection

epidemic. Awareness of HIV status among

to late stage symptoms. During the initial

at-risk populations is low. According to a

infection, a person may experience a brief

2004â&#x20AC;&#x201C;2005

period of influenza-like illness.

This is

Nations General Assembly Special Session

typically followed by a prolonged period

on HIV/AIDS (UNGASS) report, 18.1% of

without symptoms. As the illness progresses,

injection drug users (IDU), 15.4% of who

it interferes more and more with the immune

have sex with men (MSM), 14.8% of sex

system, making the person much more likely

workers, and 3.3% of clients of sex workers

get infections, including opportunistic

had received HIV testing in the previous

infections that do not usually affect people

12 months and knew their test results.

who

Stigma and discrimination persist and many

have

normal

immune

systems

(Sepkowitz, 2001).

growing

study

epidemics.

cited

the

2007,

United

people living with HIV hide their status for fear of losing their jobs, social status, and the

HIV is transmitted primarily via unprotected

support of their families and communities,

sexual

blood

thus decreasing the likelihood that they will

transfusions, hypodermic needles, and from

receive proper treatment and increasing the

mother to child during pregnancy, delivery,

chances

(UNGASS, 2008).

intercourse,

breastfeeding

Prevention through

safe

HIV sex

contaminated

(Markowitz, infection, and

2007).

HIV

spreading

undetected

primarily

needle-exchange

programs, is a key strategy to control the spread of the disease. There is no cure or vaccine; however, antiretroviral treatment can slow the course of the disease and may lead to a near-normal life expectancy. While antiretroviral treatment reduces the risk of

HIV/AIDS stigma exists around the world in a variety of ways,

including

rejection,

discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with

violence or the fear of violence prevents many

philosophical

people from seeking HIV testing, returning

"belief in the one and only God". The

for their results, or securing treatment,

Indonesian Constitution guarantees freedom

possibly turning what could be a manageable

of religion. However, the government only

chronic illness into a death sentence and

recognizes six official

perpetuating the spread of

Protestantism,

HIV (Ogden,

foundation,

Pancasila,

religions

Catholicism,

(Islam,

Hinduism,

2005). Often, AIDS stigma is expressed in

Buddhism

conjunction with one or more other stigmas,

2005). In the 2010 Indonesian census,

particularly

87.18% of Indonesians identified themselves

those

homosexuality, prostitution,

associated

bisexuality,

and

with

promiscuity,

intravenous

drug

use

Muslim,

research

has

found

that

discrimination against people living with HIV is a contributing factor for delayed initiation of HIV treatment (Pharris, 2011). In a 2011 study published in AIDS Patient Care and STDs, most of the barriers to care described involve stigma and shame. The

Confucianism)

6.96%

Protestant,

(Hosen,

2.91%

Catholic, 1.69% Hindu, 0.72% Buddhist, 0.05%

(Sharma, 2012). Current

and

Confucianism, 0.13% other, and

0.38% unstated or not asked (Badan Pusat Statistik, 2010). A number of different religions are practiced in the country, and their collective influence on the country's political, economic and

cultural life is

significant (Suryadinanta, Arifin & Ananta, 2008).

seeking

It has been long known that basically every

treatment are “I didn’t want to tell anyone I

religion teaches kindness and compassion.

was HIV-positive”, “I didn’t want to think

Those characters are needed to approach

about being HIV-positive”, and “I was too

society

embarrassed/ashamed to go”. The presence

HIV/AIDS especially

and perpetuation of HIV stigma prevents

country like Indonesia. In this research, we

many who are able to obtain treatment from

compare the knowledge and attitude in

feeling comfortable about addressing their

religious and non-religious organizations in

health

Indonesia regarding HIV/AIDS and find the

most

common

reasons

status (Pollini, Estella,

not

Carol, &

Maria, 2011). Erasing the stigma in society is essential for encouraging people at risk to seek medical help

and

reduce

the

stigma

about

religion

based

connection to develop option to reduce HIV/AIDS stigma in Indonesian society. Methods

about diagnosis and treatment. In

Indonesia, we believed that religious society

The subject of this study are religion and

is a major stakeholder to erase the stigma.

non-religion based organizations. Religion-

common religious creed, beliefs, doctrines,

organization (religion-based or not). The

practices,

data was processed by using SPSS 17

Religious

organizations

rituals

(Lexicon, we

2000).

used

program.

The

result

comparison

participants are members of organizations

knowledge and attitude toward HIV/AIDS

that use their principles of belief as their

and its stigma from members of religious

constitution for the organization’s operational

and non-religious organizations.

and do religion-related activity anually. Nonreligion-based group are a set of individuals

Results

who doesn’t use principle of religion belief as their constitution for their organization. In this study, we combine survey and literature study. After doing introduction which

includes

backgound

and

several

theories regarding HIV/AIDS and social stigma about it, we conducted research based on

online

questionnaire

and

the

respondents are originated from several cities in Indonesia (Jakarta, Bandung, Denpasar, Makassar). On the questionnaire, we require the respondents to mention an organization that they participate in and whether the organization is religion-based one or not. On the first section of the questionnaire, we evaluated the knowledge about HIV/AIDS by

six questions regarding the etiology,

transmission, and prevention regarding the disease. On the second section of the questionnaire, attitude towards HIV/AIDS was evaluated by asking respondents about how

they

treated

HIV/AIDS.

Basic

people

frequencies were used

living

descriptives to

with and

describe the

samples. Study subjects were grouped into

To avoid disunity and conflict, we don’t include the name of the organizations and the religion in the data result below.

Organization Religion Based (Number of Respondents : 81)

Basic Knowledge Abbrevation

HIV

Frequency

Cumulative Percent

8,6

Human Immunodeficiency Virus

91,4

100,0

Acquires Immuno Deficiency System

8,6

Acquired Immune Defends System

4,9

13,6

Acquired Immune Deficiency Syndrome

86,4

100,0

Cause

Virus

100,0

HIV/AIDS can be cured

Right Wrong

11 70

13,6 86,4

13,6 100,0

Transmition from Insects

Right

22,2

Wrong

63 74

77,8 91,4

100,0 91,4

5 2

6,2 2,5

97,5 100,0

4 74

4,9 91,4

4,9 96,3

Avoiding the People With HIV/AIDS

3,7

100,0

Human Immune Virus

6,7

Human Immunodeficiency Virus

93,3

100,0

Acquires Immuno Deficiency System

12,2

Acquired Immune Defends System

85,6

97,8

2,2

100,0

AIDS

Is Not a Form of HIV/AIDS Transmition

Human Immune Virus

By Sharing Eating Utensils MTCT Using the same Syringe

Prevention

n-Religion Based (Number of Respondents : 90)

Percent

Abbrevation

Vaksination No Free Sex

HIV

AIDS

Acquired Immune Deficiency Syndrome Cause

Virus

100,0

HIV/AIDS can be cured

Right Wrong Right Wrong

2 88 13 77

2,2 97,8 14,4 85,6

2,2 100,0 14,4 100,0

By Sharing Eating Utensils

94,4

1 2

1,1 2,2

95,6 97,8

Vaksination No Free Sex

90 10

100,0 11,1

11,1

Avoiding the People With HIV/AIDS

88,9

100,0

Transmition from Insects Is Not a Form of HIV/AIDS Transmition

MTCT Using the same Syringe Prevention

Table 1. Respondentâ&#x20AC;&#x2122;s Knowledge of HIV/AIDS

religion based organization almost

From Table 1 it can be concluded

equivalent. However, we can see the

knowledge

higher

than

the

religion based organizations. Organizatio n Religion Based

Non-Religion Based

Form of Discrimination

Patients Should Be Avoided

Number of Respondent s

Maximu m

Mea n

Std. Deviatio n

1,81

,950

Consultation from magazines and newsletter

3,98

1,162

SexEducation Government Screeing Program Free Condoms Support the government

1 1 1 3

5 5 5 5

3,31 4,05 2,02 4,56

1,497 1,172 1,037 ,775

Patients Should Be Avoided

Minimu m

2,26

1,167

Consultation from magazines and newsletter

3,61

1,278

SexEducation Government Screeing Program Free Condoms

1 1 1

5 5 5

3,68 4,48 2,76

1,130 ,810 1,456

Support the government

4,39

,980

Tabel 2. Forms of Discrimination Againts People Living With HIV/AIDS

Table 2 illustrates the level of discrimination

next three questions were about the transmission HIV/AIDS. All respondents

HIV / AIDS with the results

answered correctly about the causative

illustrate that discrimination by

agent of HIV/AIDS but didnâ&#x20AC;&#x2122;t performed

non-religion-based organizations

as well in answering further question

is higher, so if the table 1 and

about

table 2 are correlated, it can

transmission.

Surprisingly,

organizations and 14.4% from non-

knowledge of non-religion-based

religion

organizations over non-religion

based

one

answered

that

insects bite could transmit HIV/AIDS.

based on the following, and this

This

affects the attitude that applied

concerning

because

the

misunderstanding about the transmission

to people with HIV / AIDS.

Thus it can be said that the low

HIV/AIDS

misunderstanding

knowledge can affect attitude people

the

22.2% respondents from religion-based

be concluded that the level of

about HIV/AIDS or at least they have seen or read about it somewhere. The

the

organization against people with

applied

respondents knew the very basic thing

can to

the

cause HIV/AIDS

patients too (Ogden, 2005). Question

with

about the prevention of HIV/AIDS was

HIV/AIDS

answered

Discussion In this study, we compare the knowledge

right

majority

respondents from each group (91.4% from religion-based organizations and

and attitude toward HIV/AIDS and its

88.9%

from

non

religion-based

stigma from members of religion and

organizations).

non-religion based organizations. Our

Overall, knowledge about HIV/AIDS

explaination below will be regarding

among both groups was good enough,

knowledge and attitude and our goal is

talking about the general society.

to develop option to reduce HIV/AIDS stigma in Indonesian society.

The second part of the questionnaire

First of all is the knowledge regarding HIV/AIDS. On the first two questions, we asked

about

trivial

things

about

HIV/AIDS and most of the respondents (over 90% in both religion based and

was regarding the attitude of each group regarding to HIV/AIDS. There are four important points to assess the attitude of religion-based organizations and nonreligion-based organizations. First is how the members of each group facing HIV-

that 45.2% of the non-religious decided

HIV AIDS.

to stay away from HIV/AIDS patients

screening test or a general, non-religious

and from religion-based groups as much

group which is supportive with

as 36.2%. This means that the religion-

percentage of 89.6% compared to a

based organizations are more accepting

religious group with a percentage of 81%.

to HIV/AIDS positive people. The next three questions are about the primodial prevention of HIV/AIDS that have been done now by the government. The first is to use a media campaign via newspaper

radio

which

the

percentage obtained for religious groups is to support this type of campaign with a percentage of 79.6%, higher than the nonreligious group who got a percentage of 72.2%. About sex education for elementary and junior high school students, where it appears that non-religious groups are

The first is a general a

From these data, we can conclude that even the religion-based organizations are tolerant towards HIV/AIDS positive patients and supportive to government’s policy, they didn’t agree with two of government’s

policy,

about

sex

education and free condom policy. Their disagreement didn’t alter the fact that they accepted and don’t avoid people with HIV/AIDS infection. Conclusion After doing survey and literature review, here we conclude:

more supportive with a percentage of 73.6% compared to religious groups that

1. The

knowledge

regarding

receive a percentage of 66.2%. While it

HIV/AIDS in religion based and

has not been possible to provide definite

non religion based organization

answers to the question, there’s a

in Indonesia is considered as

chance

good with the

that

this

happened

bacause

sexual matters are considered as taboo in many religion-based organizations. The third question is the provision of preventive action of free condoms to the public, it appears that the more nonreligious support group with a percentage of 55.2% compared to a religious group with a percentage of 40.4%. Next is the view of each group against

overall score

higher than 80%. 2. Religion-based show

better

organizations attitude

towards

HIV/AIDS patients with

only

36.2% of the members that judge or

avoid

people

and

HIV/AIDS the

positive

non-religion-

based counterpart got higher score of 45.2%.

3. In this research, we conclude that religion-based organizations can help the society to reduce the stigma by showing others that religion-based organizations don’t avoid people with HIV. References

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THE EFFECT OF AMSA’S PHILOSOPHY TOWARDS ATTITUDE AND KNOWLEDGE OF MEDICAL STUDENTS IN MAKASSAR ABOUT HIV/AIDS

Rabinda Fitriana Tuasikal, Febrianty Elisabeth Pandede, Marini Faculty of Medicine, Hasanuddin University, Makassar

Abstract Introduction

HIV and AIDS is a matter of concern because the number of cases has increased over years. As medical student, we assume students tend to have knowledge about HIV/AIDS. There are some different attitude towards HIV and people living with HIV. Positive attitudes are far more common among respondents with good knowledge, while poor knowledge is to a greater extent associated with negative attitudes. Material and method

The objective of this study was to asses medical student’s knowledge about HIV and their attitude to people with HIV. We want to see how AMSA can affect the attitude of the students in medical faculty and their knowledge comparing with non-members. Through random sampling, students from 3 medical faculty in Makassar were assessed by questionnaires. Respondents were asked about their knowledge and attitude about HIV/AIDS. Then the data was analyzed and converted to a chart using SPSS 16.0. Result

The analysis indicated that AMSA members have high quality of knowledge about sexually transmitted infection or especially HIV/AIDS comparing with non-AMSA members who become respondents that some of them (5%) still have low quality of knowledge about HIV/AIDS. The study revealed that most of AMSA member knows the cause, system that affected, onset, symptoms, transmission, complication, risk factor and prevention of HIV. We can also know that knowledge affect student’s attitude towards people with HIV and AIDS. Via its events, AMSA providing better acknowledgement about sexually transmitted infection to its members, that affects AMSA members’ attitude to people live with HIV/AIDS. Conclusion

From the study we can know that AMSA members have better knowledge about HIV/AIDS compared to non – member. AMSA members also tend to be more tolerant and have positive attitudes towards people live with HIV/AIDS.

are : sterile blood transfusion, use injected

Introduction The

needle only once, and do safe sex. Until

Acquired

Immunodeficiency

Syndrome (AIDS) epidemic is in its third decade and has

become a pandemic

disease that threatens the world population (Tavoosi, A., et al., 2004). The cause is virus called Human Immunodeficiency Virus

(HIV)

that

attacked

immune

system of human body. HIV/AIDS is one of sexually transmitted infection because it transmit via sexual activity happened by human. People with HIV/AIDS usually come to doctor with fever, weight loss, diarrhea, and some other symptoms. But, the symptoms will appear after some onset time about 5-10 years after they get infected. The transmission of HIV/AIDS can be by blood, vaginal fluid, and sperm. It is a fatal disease that can make lots of complication

such

opportunistic

infection like TB, inflammation in skin, fungi infection in moth, and some other more. The risk factors that can lead to HIV/AIDS are unsafe sex, injected drug abuse, and blood transfusion. So that the community that have high risk to have this kind of disease are drug abusers, sexual workers, doctors, and nurses. Because not only sexual workers that can be transmitted by HIV but also doctors, nurses, even innocent people that receive blood from HIV/AIDS

patients,

have

know how to prevent the infection, those

now on, the treatment given to HIV/AIDS patients

only

opportunistic treatment,

avoidance

infections, and

from

symptomatic

antiretroviral

(ARV)

treatment. In the world, Acquired immunodeficiency syndrome (AIDS) has killed >25 million people since it was first recognized in 1981,

making

one

the

most

destructive epidemics in recorded history. Despite

recent

improved

access

antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed 3.1 million lives in 2005 (Iliyasu, Z,. et al,. 2006). The Asian Medical Studentsâ&#x20AC;&#x2122; Association (AMSA)

peak

representative

organisation for medical students from across Asia, the Asia-Pacific and beyond. Training

doctors

from

Member

Nations and 4 Associate/Observer Nations combine to share knowledge, undertake activities and social services and create international

and

trans-continental

friendships. AMSA was officially founded in Manila, Philippines in 1985 and from this day has been an active, dynamic and exciting student-led, not-for-profit, nonpolitical

organization.

Today,

with

members and friends spanning the globe AMSA has an active student-exchange program, regularly undertakes national

and

regional

projects,

provides

their knowledge. One of the knowledge is

humanitarian assistance at times of need,

about

produces quarterly student publications

especially HIV/AIDS that is pandemic

and

disease in the world.

liaises

with

the

World

Health

sexually

transmitted

infection,

Organization, the Association of Medical

Beside that, we also want to proof that

Doctors

other

AMSA can increase the humanity feelings

international and regional medical student

of AMSA members under the vision of

organizations.

action. We want to proof that AMSA

The AMSA Vision or philosophy is

members are less

Knowledge,

people with HIV/AIDS. That’s why we

Asia

and

Action

and

many

Friendship.

discriminate toward

Three areas we continuously strive to

are

further in our members and peers through

knowledge and the attitude of AMSA

our organizational missions:

members

Knowledge: We promote scientific and

members about HIV/AIDS.

doing

thing

research

comparing

with

about

the

non-AMSA

medical activities to increase and expand our knowledge whilst training to become the medical professionals of the future Action: As medical students, we are concerned for the community around us and endeavor to do things for the benefit and improvement of our fellow citizens Friendship: As future doctors, we aim to build and maintain a good relationship among our colleagues of the Asia-Pacific

Material and Methods People’s attitude and knowledge about HIV/AIDS are different one another. Of course the differences itself are affected by several factors. We suggest one of the factors that affect how people act and think about HIV/AIDS is the organization they follow. In medical faculty, students tend to have knowledge about HIV/AIDS but now we want to see how an

and beyond

organization can affect the attitude of the There are three AMSA universities in Makassar. Those are AMSA Universitas Hasanuddin, AMSA Universitas Muslim Indonesia,

and

AMSA

Universitas

Muhammadiyah Makassar. Based on the first point of the AMSA’s vision : knowledge, we want to proof that by joining AMSA, the member can increase

students in medical faculty and their knowledge comparing with non-members. The attitude here means whether the medical students will discriminate people with HIV/AIDS or not. In this study, we use descriptive method with cross-sectional data by survey. After doing the

introduction which includes

background and several theories regarding

SPSS 16.0 and accompanied by several

HIV/AIDS and AMSA as the medical

explanations. After finishing all survey

studentsâ&#x20AC;&#x2122;

results, then we try to conclude the result of

random sampling survey to 100 medical

the study, whether becoming member of

students directly on three universities in

AMSA can increase the knowledge and

Makassar, South Celebes, Indonesia to get

attitude toward HIV/AIDS patients or

some data to support this study. The

not. In the end of this study, we make

participants of this study consist 50

the

AMSA

including

organization,

members

Hasanuddin,

then

from

Universitas

Indonesia,

and members

from

the

about

this

strengths,

research

weaknesses,

Muslim

opportunity, and threads also the bias

Universitas

chances of this research to know if our

Muhammadiyah Makassar, and 50 nonAMSA

evaluation

those

data is valid.

three

universities. To minimize the bias in this research, we spread the questioners to medical students batch 2013 only so there

Results

will be no bias in case of knowledge about HIV/AIDS.

Based on survey that we have done with

In this section, we spread questioners

100

containing

about

about the knowledge they have about

HIV/AIDS and how they will treat people

HIV/AIDS and their attitude to HIV/AIDS

with HIV/AIDS. This section aims to

patients, here we got the result based the

know how far their knowledge about this

question we give in charts below :

basic

knowledge

pandemic disease and their attitude to socialize with the patients. The questioners contain eleven knowledge multiple choice questions about HIV/AIDS and six scale questions about the attitude to treat HIV/AIDS patients. The questioners were spread via online form that can be easily and directly access from each universities. After we collect the data or answers from the questioners, then we analyze the data and convert it to a chart using

respondents

that

fill

questioners

Chart 3.1 Knowledge about HIV/AIDS as sexually transmitted infection

respondents) of AMSA member answer the right answer and only 1%

respondent) of AMSA member did not know the answer. Comparing with the Chart

3.1

above

shows

the

non-AMSA

respondents,

there

are

difference between AMSA member

only 44% (44 respondents) that answer

answering

HIV/AIDS as sexually

HIV/AIDS

sexually

transmitted

transmitted infection comparing with

infection, 4% (4 respondents) of them

non-AMSA respondents. In that chart

answer wrong answer and 2% (2

we can

respondents) did not know the answer.

see that about 49% (49

Chart 3.2 Knowledge about the cause of HIV/AIDS

Some of non-AMSA respondents (45% or 45 respondents) also answer virus Chart

3.2

above

the

as cause of HIV/AIDS. But there are

information about medical studentsâ&#x20AC;&#x2122;

5 respondents (5%) answer wrong

knowledge

answer whether it is bacteria (2% or

about

gives the

cause

HIV/AIDS. All respondents that are

AMSA

respondent), or 2 respondents (2%) that

member

(50%

respondents) answer the right answer

respondents),

fungi

did not know the answer.

that is virus as the cause of HIV/AIDS. Chart 3.3 Knowledge about system attacked by HIV

(1%

students to know about it. So, the data gives us that all

AMSA

member

Chart 3.3 shows us the knowledge of

respondents (50% or 50 respondents)

100 respondents

answer

about

system in

correctly, 46

non

AMSA

human body that attacked by HIV.

respondents (46%) also answer the

Most of the respondents answer the

right answer. Unfortunately, there are

right answer that is immune system.

4% respondents that did not know the

Itâ&#x20AC;&#x2122;s an essential knowledge to medical

answer.

Chart 3.4 Knowledge about onset time of HIV/AIDS

member answer wrong answer. But, respondents non-AMSA only 34% (34 Chart 3.4 above provides us the

respondents)

knowledge of respondents about the

correctly,

onset time HIV/AIDS disease until the

answer wrong answers and the rest did

symptoms appear. The right answer is

not know the onset time of HIV/AIDS

5-10 years. Most of AMSA members

until the symptoms appear.

(49%

respondents)

answer

correctly and just 1% or 1 AMSA

answer 10

the

respondents

question (10%)

Chart 3.5 Knowledge about symptoms of HIV/AIDS patients

just 1% of them answer incorrectly. Comparing with respondents whose non-AMSA member, there are 2% of them answer incorrectly and 4% of

Chart

3.5

above

shows

the

knowledge of respondents about the symptom

HIV/AIDS

them did not know the answer. The rest of them answer the right answer.

patients.

About 49% of respondents whose are AMSA members answer correctly and Chart 3.6 Knowledge about transmission of HIV/AIDS

based

the

chart

above,

all

Chart 3.6 gives us information about

respondents

knowledge the respondents have about

members answer correctly while there

the transmission of HIV/AIDS. HIV

are some of non-AMSA respondents

can transmit via blood, vaginal fluid,

answer incorrectly even did not know

and sperm. It canâ&#x20AC;&#x2122;t transmit via air. So,

the answer.

whose

are

AMSA

Chart 3.7 Knowledge about complication of HIV/AIDS

correctly while only 42 of non-AMSA member fill the right answer. 1% of Chart 3.7 shows us the answer of

AMSA member did not know the

medical

answer

about

students

toward

complication

question

while

non-AMSA

HIV/AIDS.

respondents did not know. And also,

From the chart above, we can see

only 3% of AMSA member answer

that

AMSA

incorrectly while the double of the

member answer correctly more than

number (6% non-AMSA respondents)

non-AMSA member. There are still

fill the wrong answer.

respondents

whose

plenty of non-AMSA member who answer incorrectly and did not know the

answer.

respondents

46 out

AMSA of

member answer

Chart 3.8 Knowledge about risk factor of HIV/AIDS

Chart 3.8 above proves us that all respondents (50%) of AMSA member answer the question about the risk factor of HIV/AIDS correctly, while there are still 6% of non-AMSA respondents fill the wrong answer and even did not know the answer. Comparing

with

AMSA

member

respondents, there are only 44 nonAMSA

respondents

right answer.

answering

the

Chart 3.9 Knowledge about prevention of HIV/AIDS

question incorrectly even did not know the answer. The exact data we Chart 3.9 above gives us information

get is that 48% of AMSA member

about

students

respondents fill the right answer and

have about prevention of HIV/AIDS.

2% of them fill the wrong answer.

As medical students, we have to know

While in the other side, only 42% of

it because as future general practioner,

non-AMSA respondents fill the right

we have to know the prevention of

answer while the rest of answer

HIV/AIDS

incorrectly (6%) and did not know the

knowledge

medical

order

give

socialization to the society. We gave the data from chart above that there are still lots of medical students whose are non-AMSA member answering the

answer (2%).

Chart 3.10 Knowledge about high risk community of HIV/AIDS

answer. There are also 2% whose fill “I don’t know” and the rest of them fill Chart

3.10

above

knowledge

about

shows

high

the risk

community of HIV/AIDS that medical students have. After we give them question about which community are in high risk to get HIV/AIDS, there are plenty of them who still answer incorrectly and did not know the answer. Complete respondents whose are AMSA member (50%) answer it correctly. But, AMSA

only 40% of non-

respondents

fill

the

right

wrong answer.

Chart 3.11 Knowledge about treatment of HIV/AIDS

After we describe the answer of Chart 3.11 above gives us the data

medical students about HIV/AIDS,

about the knowledge medical students

then we combine all the results and

have about the treatment that can be

charts above to one chart that really

given

prove the comparison between the

HIV/AIDS

patients.

All

AMSA member (50%) who become

answer

respondent answer correctly while only

and non-AMSA members that become

40% of non-AMSA member did.

respondents. Here is the chart below:

There are also 4% answer the wrong answer and the rest (6%) did not know the answer.

given by AMSA members

Chart 3.12 Knowledge about HIV/AIDS

From chart 3.12 above, we can directly know that all AMSA members have high quality of knowledge about sexually transmitted infection or especially HIV/AIDS comparing with non-AMSA members who become respondents that some of them (5%) still have low quality of knowledge about HIV/AIDS. Moreover, they are medical students but still have lack of knowledge about the disease they have to master. Although there are 45% of non-AMSA respondents have high quality of knowledge, but based on the data that we get, the score that AMSA member have is still higher than non-AMSA member. Beside the variable about knowledge, we also do survey about another variable that is attitude. Attitude here refers to the act the medical students will do to the HIV/AIDS patients, whether they will discriminate them or not. In the questioner we spread, there are six scale question about the attitude toward HIV/AIDS patients. The scale is one until five that represent their thought about the question or sentence given, whether they very agree, agree, average, disagree, or

very disagree. Here are the result below : Chart 3.13 Attitude towards HIV/AIDS patients

respondents who less discriminative have lower number of scale. From chart 3.13 above, it is clearly show us that non-AMSA respondents tend to be more discriminative to HIV/AIDS patients comparing to the AMSA members. Although there are several AMSA members respondents who still discriminate people with HIV/AIDS, but the percent is still high

the

respondents.

bar and

non-AMSA non-AMSA

Discussion

HIV/AIDS, (10) high risk community of

In this study, we have two variables to

HIV/AIDS,

analyze,

HIV/AIDS.

those

are

knowledge

and

(11)

treatment

attitude. Our explanation below will be

In the explanation below, we will discuss

regarding those two variables and it aims

it per item so we will directly know the

to know the comparison between AMSA

reason about the differences.

member and non-AMSA member in term of

knowledge

and

attitude

HIV/AIDS infection

toward

sexually

transmitted

HIV/AIDS. And then, we will estimate the reason there are differences between medical students that join AMSA and not in case of their knowledge and attitude. The first variable is knowledge. As we mention above that the method we use is descriptive

method

using

survey

via

online form questioner that we spread to three universities in Makassar, which are Universitas Muslim

Hasanuddin,

Universitas

Indonesia,and

Muhammadiyah

Universitas

Makassar.

that

questioner, we ask eleven basic questions that will make us know the knowledge that

medical

students

have

about

HIV/AIDS. That eleven questions based on a topic to each question. The topic we ask in the questioner are : (1) HIV/AIDS as sexually transmitted infection, (2) the cause of HIV/AIDS, (3) system in human

It is an essential and basic knowledge to know by medical students that HIV/AIDS is

sexually transmitted infection. All

AMSA

members

respondents

answer

correctly and there are several non-AMSA respondents answer incorrectly and even did not know the answer. It proves that there is activity inside of organization like AMSA that makes the member understand that HIV/AIDS is sexually transmitted infection. For example, in AMSA Unhas,

there is activity like

brainstorming about sexually transmitted infection brought by competent lectures so that AMSA members can completely understand infection,

the

sexually

especially

transmitted

HIV/AIDS

that

become pandemic disease in this world.

body that attacked by HIV, (4) onset time of HIV/AIDS disease until the symptoms appear,

(5)

symptom

HIV/AIDS

patients, (6) transmission of HIV/AIDS,

The cause of HIV/AIDS

(7) complication of HIV/AIDS, (8) risk

As we can know, HIV stands for Human

factor of HIV/AIDS, (9) prevention of

Immunodeficiency Virus. We asked about

this essential quesition so that we can

respondents to be known.

know whether the respondents know this basic thing about the abbrevation to start

Transmission of HIV/AIDS

before we ask about other significant

HIV/AIDS can be transmitted through

knowledge

AMSA

blood, semen, vaginal fluid, and breast

AMSA-Universitas

milk. This question is given to know

Hasanuddin have been given knowledge

whether the respondents know about the

about HIV/AIDS via Brainstorming pre-

transmission or not This

EAMSC.

also to know how many respondents that

member,

quesitions. especially

Each

still have misconception about the HIV System in human body that attacked by HIV

transmission.

It is needed to be known whether the respondents know about the abbrevation.

Complication of HIV/AIDS

For AMSA members, they mostly have

After get infected by HIV, our immune

known about this because they joined

system will be decrease gradually. It makes

some AMSA’s event which is based of

body to susceptible to get infected by other

AMSA’s phylosophy, Knowledge.

bacteria, virus, parasite, etc. It makes the body to be more

Onset time of HIV/AIDS disease until the symptoms appear

convenient to get

infectious disease, such as tuberculosis, candidiasis, and skin rash. We want to

Onset time needs to be known because it

know

is one of some basic quesition we have to

understanding or not.

the

respondents

have

this

know. Mostly AMSA members know about it because AMSA have Knowledge-

Risk factor of HIV/AIDS

based event that clearly expain about

HIV can be transmitted from blood

HIV/AIDS’ A to Z.

transfusion, sharing needles, and the most common is by having unprotected sex or having many sexual partners

Symptom of HIV/AIDS patients

Prevention of HIV/AIDS HIV/AIDS could be prevented by not

We asked about the symptom because it is another basic quesition that required to

having

unprotected

sex,

using

sterile

needles, and screening of the blood that will be transfused.

From the study, we get the data that there High risk community of HIV/AIDS

are still plenty of medical students that

Sex workers are the most community that

discriminate

have

compare to AMSA members, there are

high

risk

HIV/AIDS. Most

infected

of AMSA members

HIV/AIDS

non-

AMSA

patients.

respondents

But, that

answer this item correctly, meanwhile the

discriminate people with HIV/AIDS. It

non-AMSA

clearly proves that AMSA has taught the

respondents

answer

members

incorrectly.

less

discriminate to

HIV/AIDS patients, moreover we as the future doctors. For example, at AMSA

Treatment of HIV/AIDS We

ask

about

the

knowledge

treatment for HIV/AIDS patients. Almost all

AMSA

members

answer

correctly because they already have the lecture on the event of brainstorming. But some of non-AMSA respondents answer it

Unhas, they make an activity with NGO that also recruits ODHA (people with HIV/AIDS). It shows that by social action like that, AMSA has succeed fulfilling its one philosophy that is action. Which means that specifically AMSA has succeed make the members less discriminate people

incorrectly.

with Based

those

eleven

items

about

HIV/AIDS,

whether

future

doctor and also as the society.

knowledge above, we can know clearly that AMSA members have higher quality of

knowledge

about

Conclusion

HIV/AIDS

comparing with non-AMSA respondents.

The

analysis

revealed

that

AMSA

members have better knowledge about The second variable is attitude. The

HIV/AIDS compared to non â&#x20AC;&#x201C; member.

method we use is still descriptive method

AMSA members also tend to be more

using survey via online form questioner,

tolerant and have positive attitudes towards

but the difference here is the type of

people live with HIV/AIDS.

question we made. We made six question

From the research and analysis we have done, it can be revealed: AMSA members have better knowledge about HIV/AIDS compared to non-members; AMSA members also tend to be more tolerant and have positive attitudes towards people live with HIV/AIDS; The better knowledge someone have about HIV/AIDS, they tend to be more

using scale one until five that represents their agreement to the sentence. The questions overall are about how they will treat HIV/AIDS patient as future doctor and people with HIV/AIDS in social life.

tolerant and have positive attitudes towards people live with HIV/AIDS.

(36), 351-363 Massiah, E., et al., 2004. Stigma, discrimination,

Acknowledgement

knowledge

and

among

HIV/AIDS physicians

This study has several limitations during

Barbados. Pan Am J Public Health

the process, therefore we have several

16(6), 395-401

evaluation toward this research :

Bird., et al., 2004. Health-Related

This study is only descriptive research

Correlates of Perceived Discrimination

so there will be lots of bias happen to

in HIV Care. AIDS Patient Care and

this research. It is better to make it as

STDs (18). 19-26

analytical research so that can minimize the bias to the research. The

characteristic

and

curriculum

medical students are different from any universities

so there will be a little

unbalance in this study. But we believe that the sample here in three universities have same curriculum remember they are on the same country and city.

REFERENCES Tavoosi, A., Zaferani A., Enzevaei A., Tajik P., Ahmadinezhad Z., 2004. Knowledge

and

attitude

towards

HIV/AIDS among Iranian students. BMC Public Health, 1-6 Iliyasu, Z., et al., 2006. Knowledge of HIV/AIDS Voluntary

and

Attitude

Counseling

and

towards Testing

among Adults. Journal of the National Medical Association (98), 1917-1922 Boellstorff,

Tom.,

2012.

Nuriâ&#x20AC;&#x2122;s

testimony : HIV/AIDS in Indonesia and bare knowledge. American Ethnologist

Directorate General CDC & EH Ministry of Health, Republic of Indonesia.. 2014. Cases of HIV/AIDS in Indonesia : Reported thru' June 2014. Hugo, G., 2001. Population Mobility and HIV/AIDS in Indonesia. Reis, C., 2005. Discriminatory Attitudes and Practices by Health Workers toward Patients with HIV/AIDS in Nigeria. Plos Medicine. Watel, P., 2007. Discrimination against HIV-Infected People and the Spread of HIV: Some Evidence from France. Plos Medicine. World Health Organization, 2007. AIDS Epidemic Update, December 2006 Abbas, A., Lichtman, A., 2004. Basic Immunology : Functions and Disorders of the Immune System. Philadelphia : Saunders.

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HIV Prevention : Marriage as The Best Antivirus Ever Afnandito Valeno Risky Sukarelawanto, Amanda Dania Satiti Faculty of Medicine, Universitas Gadjah Mada Abstract Lately, HIV has been Yogyakarta's concern because there is an increase of HIV case occurred trhoughout Special District of Yogyakarta. But sadly, the concern not followed with right explanation about how HIV virus spreading among Yogyakarta's people. Many myth and wrong information was tell to people's, and that can make them easyly get HIV because they prevention was wrong. We belive that tell the right information and explain what myth and true fact about â&#x20AC;&#x153;how HIV spreadingâ&#x20AC;? to people's will make the more care and awareness. It is our duty as medical students to increasing people's awareness on HIV spreading by many ways. We are just the trigger, but the result success or not of this action was determine by our colaboration and contribution to fight HIV together.

What is Your Status? Fajar Muhammad, Novandika Kurnia Akbar, Desty Annisa Hapsari Faculty of Medicine Universitas Gadjah Mada According to WHO (World Health Organization), eight of the more than 30 pathogens known to be transmitted through sexual contact have been linked to the greatest incidence of illness. Of these 8 infections, the four are viral infections and are incurable, but can be mitigated or modulated through treatment: hepatitis B, herpes, HIV, and HPV. The infections that are spread through person-to-person sexual contact is called sexually transmitted infections (STIs). It can be also transmitted from mother to child during pregnancy and childbirth, and through blood products and tissue transfer. STIs have an impact on sexual and reproductive health worldwide, and rank among the top 5 disease categories for which adults seek health care.

One of the STIs is HIV/AIDS. HIV is transmitted through unprotected sexual intercourse (anal or vaginal), transfusion of contaminated blood, sharing of contaminated needles, and between a mother and her infant during pregnancy, childbirth, and breastfeeding. WHO said that there were approximately 35 million people living with HIV at the end of 2013 with 2.1 million people becoming newly infected with HIV in 2013 globally. This video tells us about a man with high risks of getting infected by HIV. He has a girlfriend he’d like to propose. But, in the earlier life, he likes to have sexual intercourse with other girls without using condoms. He uses drugs and maybe also shares injection or needle that most probably contains HIV. He’s in a great risk of having HIV/AIDS, and he maybe doesn’t know that it is possible for him to have such infection and transmit it to the people around him, including the girls he would like to marry. This video delivers a message that HIV tests are important. Testing for HIV and other STIs is strongly advised for all people exposed to any of the risk factors so that they can learn of their own infection status and access preventions and treatments as soon as possible. HIV tests are not for people with high risk factors only, but it is also important for people in general, because sometimes we don’t know that we are already infected with HIV until there are obvious symptoms. To prevent the transmission of diseases is always easier to do than to cure it. So, are you going to remain careless about your status? Go get yours now!

Freedom From HIV Ivan Bintang, Maria Natasya,Januardi Indra Jaya Brawijaya University HIV still becomes a frightening disease since the drugs to cure it effectively still yet to be found. Despite its position as a deadly disease and it’s really easy to transmitted, it’s also easy to prevent it to transmit to your own body. This video works by increasing people awareness about HIV in present situation. It give a picture to the viewer that people might be infected with HIV because of a certain condition like their wife is dying so they have no option beside going to prostitution. But, in the end, they regret it because they are infected of HIV and have a short life expectancy and low quality of life. Beside awareness, this video also giving you information of how to be free from HIV by changing your habit of having free sex, and used condom instead in a certain condition.

Is It Too Late? Chrisandi Yusuf, Camoya Gersom, Cakra Parindra, Andreas Jeffrey, Shelby Ernanda, Hashfi Mafazi Brawijaya University HIV is a retrovirus that causes AIDS. It's a condition in which progressive failure of the immune system allows life-threatening infections to thrive. Many factors may lead to the spread of HIV, endangering many lifes. The infection of HIV is without symptoms until an average of 10 years. That means, you never know what hits you and by the time you do, it's already too late. This life is too short. Among choices and ways in life, there are many that can lead us to success and prevail in life. But unfortunately, many people chose the wrong ways. A lot have succumbed to the temptation to have sex unprotected, resulting in many people infected with STDs. And in Indonesia, more than 200.000 people are infected with HIV AIDS. Being infected with HIV, is not a death sentence. Eventually, all people are going to die, would you rather sit tight or do something to make the rest of your life valuable? A change in never too late. Start a change from

within, to help bringing a change for the people. There are some ways to prevent HIV, first by voluntary testing and counseling about HIV when you are in sexual active age. Second, Be faithful, the risk of HIV infection getting higher by doing multiple partners sex. Third, use condom, because condom have a component that will kill sperm cells. Last but not least, sex education coming from teenagers will reduce HIV risk.

The Real Killers Syauqi Darussalam Lutfi, Andi Tiara S. Adam, Nurul Fadhilah, Asyura Alikha, Muhammad Arham Harun, Rizaldy Zulham, Annas Zulfakhri Abidin, Ermita Sari, Ininnawa Tenriawaru, Andi Yaumil Chaeriyah, Dini Mutia Khairunissa Hasanuddin University Background Sexually transmitted diseases such as HIV/AIDS continue to increase across the world. When we are speaking about HIV/AIDS, we’re not only speaking about developing countries, but also highly developed countries as well. There are still many parts of the world’s societies that do not have adequate knowledge and understanding of this disease, especially on how it’s transmitted and how it should be treated. With the lack of understanding from the society, all too often, HIV-positive people become targets of discriminations and stigma. Those who stigmatize the people living with HIV falsely believe that the virus could be transmitted even by the slightest touch. When that happens, others start to view HIV-positive people as a threat, resulting the snowball of stigmatization and discrimination becoming wider and bigger. On top of coping with the health challenges posed by HIV disease, HIV-positive people very often face rejection by the people around them. Many of them become isolated – within their homes, in public, and at their workplaces. Due to their fears of being isolated and humiliated, HIV-positive people hide their disease from their spouses, families, and friends. To make things worse, the fear of rejection and isolation prevents HIV-positive people from seeking treatment or even getting tested for HIV in the first place. This means they may spread HIV to others without knowing it and thus causing the magnitude of the HIV epidemics to only continue to skyrocket. Realizing it’s a problem, we choose to handle this situation from its root – the humans itself.

? Scientific Poster

Title: 5% Potassium Hydroxide : a Promising New Treatment for Anogenital Warts M Evandiar Izwardy, Monica Djaja Saputera Tarumanagara University Abstract

Background: Anogenital warts are caused by human papilloma virus and represent one of the most common sexually transmitted disease. The virus may recurrent, persist, or become latent. There is no effective antiviral treatment to eliminate HPV virus and most therapies are aimed at the destruction of visible lesion. Mostly of the treatment of anogenital warts are invasive, pain, expensive; and there is no single therapy that has been proven effective at achieving complete remission in every patient. Purpose: To compare the efficacy of 5% KOH with other treatment such as cyrotherapy and 5-fluorourasil (5-FU) + SA in the treatment of anogenital warts. Material and Methods: A systematic literature method was designed and carried out using MEDLINE, EMBASE for trial published from 2011 to 2014. Result and Discussion: Therapies for anogenital warts are generally recommended based on some features, such as consideration of efficacy, side effect, and cost. The efficacy of 5% KOH same as 5-FU + SA and cyrotherapy. However, 5% KOH can cause varying side effect, such as irritation, transient burning sensasion, and erosion, but that side effect still safe for patient. On the other hand, 5% KOH treatment is the cheapest among the other treatments. Conclusion: 5% KOH is a promising new treatment for anogenital warts because it is as effective as cyrotherapy and 5-FU + SA, have a minimal side effects, and inexpensive than the other treatments Keywords: anogenital warts; 5% potassium hydroxide (5% KOH), 5-FU +SA, cyrotherapy

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Lemon as An Agent in Eliminating HIV-1 Rio Alexsandro, Mutiara Lirendra, Rainhard Octovianto Tarumanagara University INTRODUCTION: More than 34 millions of world population are diagnosed with HIV and approximately 12% of the cases are in the South East Asia region, approximately in 67% are transmitted by sexual intercourse. Lemon is believed to be an agent in eliminating HIV, but it still a debateable subject. Further review of the on going research is necessary. METHODS: The data collecting strategy was based on the Cochrane HIV/AIDS Review Group. These following electronic databases were searched for randomized controlled trials : Pubmed – Indexed to Medline , AIDSearch , EMBASE and CINAHL from 2005 – 2011 , The Conchrane Central Register of Controlled Trials (Central) in 2011 and The Abstracts of Relevant Conferences including Society of Obstetric & Gynecology Indonesia & The International AIDS Conference from 2005 – 2011. Two authors independently assessed the methodological quality of the trials and extracted data and the authors of the respective studies were contacted for additional data. RESULT: Four out of 71 articles were relevant to be reviewed. Two articles that support the hypothesis that lemon is an agent in eliminating HIV. DISCUSSION: According to the articles pH level is a significant factor in eliminating the virus. In comparison the researches that support the hypothesis took a careful meassurement of pH both in lemon and in subject that was applied by lemon juice, conversely the reasearches that didn’t support the hypothesis didn’t take an adequate note in pH meassurement. CONCLUSION: Lemon is an agent of eliminating HIV due to it’s acid pH. # #

ASSOCIATION BETWEEN STAVUDINE ADMINISTRATION WITH LIPODYSTROPHY AND DYSLIPIDEMIA AMONG HIV-INFECTED PATIENTS IN DR. KARIADI HOSPITAL SEMARANG ABSTRACT Christopher Octavianus, Valensa Yosephi, Christian Tricaesario, Jacob Bunyamin Faculty of Medicine Diponegoro University

Abstract: Stavudine (d4T) administration has contributed in decreasing mortality rate of HIVinfected patients. In the other hand, stavudine is known to cause serious side effects such as lipodystrophy and dyslipidemia. Both side effects are known to increase the risk of developing cardiovascular complications. Aims: This study aimed to determine the association between stavudine administration with lipodystrophy and dyslipidemia among HIV-infected patients in Dr. Kariadi Hospital and also determine the factors associated with lipodystrophy and dyslipidemia. This study was an observational analytic study using cross-sectional method. Forty samples were divided into stavudine group (23 samples) and control group (17). All respondents had their lipid profile observed and lipodystrophy assessed by attending

physicians in VCT clinic Dr. Kariadi Hospital. Obtained data were analyzed using ChiSquare Test and Fisherâ&#x20AC;&#x2122;s Exact Test. The prevalence of lipodystrophy was 21.7% and dyslipidemia was 82.6% in stavudine group. Stavudine administration was significantly associated with dyslipidemia (p=0.008) especially in triglycerides elevation and HDL-c depletion (p=0.048 and p=0.009). Stavudine administration was not significantly associated with lipodystrophy (p=0.051) although it was associated with lipoatrophy of buttock and face (p=0.026 and p=0.013). Being female was associated with lipodystrophy incidence in stavudine group (p =0.014). Sex, age, CD4 count, and duration of treatment were not associated with dyslipidemia in stavudine group. Stavudine administration was associated with dyslipidemia among HIV-infected patients in Dr. Kariadi Hospital and was not associated with lipodystrophy. Keywords: stavudine, lipodystrophy, dyslipidemia, HIV

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Potency of DNA Vaccine Expressing E6 and E7 Antigen Administrated Using Free Needle Injector as Tumor Supressor Agent in Cervical Cancer Kharisma Ridho Husodo, Thoha Muhajir Albaar and Made Pradnyawati Chania Faculty of Medicine Brawijaya University ABSTRACT Cervical cancer is one of cancer with the most affected people. Cervical cancer is caused by Human papillomavirus (HPV). HPV has E6 and E7 proteins which play a role in cervical cancer pathogenesis. E6 and E7 proteins virus are able to decrease p53 and retinoblastoma activities selectively. They cause uncontrolable cell proliferation. However, cervical cancer treatment doesnâ&#x20AC;&#x2122;t give satisfying result yet because there are still many treatments that cause harmful adverse effects. In Indonesia, cervical cancer is cancer which has the most affected people, about 36% among all cancer type. Approximately, 40.000 new caes are found every year. WHO stated that there are 15.000 cervical cancer case found every year in Indonesia and about 70% of them are hospitalized in late stadium stage. Authors use descriptive and explorative writing methods. Materials of this scientific poster are from medical journals, review journals, books and scientific internet articles. Authors collect both qualitatif and quantitative data. DNA vaccine expressing E6 and E7 is produced using gene encoding PCR technique then it is transformed into plasmid of Escherisia colli. For improving its biovailability and effectivity, we use free needle injector as delivery method. This DNA vaccine has ability in inbiting cancer cell proliferation. Both E6 and E7 vaccine are able to increase antigen specific CD8+ T cell and CD4+ T cell immune response. These antigens also have ability in decreasing tumor size with or without adjuvant. Therefore, combination of these proteins as antigen target of DNA vaccine can optimally play a role as tumor supressor agent in cervical cancer. Keyword : DNA vaccine, E6, E7, Cervical cancer, Free needle injector

CCTV (Cervical Cancer Therapy by rBCG-PTX-B Vaccine Recombinant Expressing Pertussis Toxin-B Oligomer (PTX-B) As Therapeutic Effect Cervical Cancer via immunomodulatory IL-10 TNF-! and Inhibition and Activator Protein-1 Athaya Febriantyo Purnomo, Made Ayu Mutiara Dewi Brawijaya University Abstract: More than 250,000 women died from cervical cancer in 2005, and 80% of cases occur in developing countries. In Indonesia, 52 million Indonesian women at risk of developing cancer is a cause of death in women. Cancer is often called The Silent Lady Killer. Etiology of cervical cancer is HPV (Human Papillomavirus) with virulence factors such as E6 and E7 oncoprotein. E6 and E7 transcription Settings controlled by several cellular proteins that bind to the binding site matching the viral genome LCR. One of the cellular transcription factors who plays an important role in the transcription of E6 and E7 is AP-1 (activator protein-1) complex. Decreased activity of AP-1 transcription will inhibit E6 and E7 thus binding and activation of p53 and pRb does not happen. BCG therapy is claimed to be the most successful immunotherapy of human tumors. BCG therapy has been applied in patients with SBC (superficial bladder cancer). Cytokines are released by BCG stimulation and role in anti-neoplastic associated with Th1 (IL-12, IL-2, TNF-", and IFN-!), while the inhibiting effects associated with Th2 (IL-10). This scientific work was written using descriptive and exploratory methods by collecting qualitative and quantitative data. As cervical cancer therapy, CCTV (Cervical Cancer Therapy by rBCG-PTX-B Vaccine) works through two mechanisms, the immunomodulatory effect of IL-10 and TNF-" and inhibition of Activator Protein-1 as a transcription factor E6 and E7. PTX-B component in the vaccine rBCG-PTX-B can inhibit c-Fos AP-1 complex, inhibits AP-1 binding to the target DNA, and inhibit AP-1 transcription in URR HP. On the other hand, BCG vaccine become the balance of pro and anti-neoplasmic cytokine. BCG components can increase the expression of TNF" via induction of Th1 who is the manufacturer antineoplastic cytokines. On the other hand, BCG inhibits Th2 produce pro-neoplastik cytokines, namely IL-10. So the balance between TNF-" and IL-10 can be formed. To apply the CCTV (Cervical Cancer Therapy by rBCG-PTX-B Vaccine) in the treatment of cervical cancer, the used measure is to make the construction of rBCG vaccine-PTX-B and then the preparation process CCTV (Cervical Cancer Therapy by

rBCG-PTX-B Vaccine) to spray the subsequently administered topical intravaginal. Prescribed dose of 5 x 103 CFU/kgBW dissolved in 0.01 ml of distilled water, and done every day until no longer detected cervical cancer. Literature study above proves that the r-BCG-PTX-B has potential as immunomodulatory therapy for cervical cancer through TNF-" Effect and IL-10 as well as the inhibition of AP-1 transcription factor E6 and E7. Liquid spray preparations of rBCG-PTX-B trade name the author of CCTV which is stands for Cervical Cancer Therapy by rBCG-PTX-B Vaccine. Keywords: Cervical Cancer, rBCG-PTX-B vaccine, IL-10, TNF-", AP-1 # # # # # # # # # # # # # # # # # # # # #

THE EFFECT OF AMSA’S PHILOSOPHY TOWARDS ATTITUDE AND KNOWLEDGE OF MEDICAL STUDENTS IN MAKASSAR ABOUT HIV/AIDS Rabinda Fitriana Tuasikal, Febrianty Elisabeth Pandede, Marini Faculty of Medicine, Hasanuddin University, Makassar Abstract: Introduction HIV and AIDS is a matter of concern because the number of cases has increased over years. As medical student, we assume students tend to have knowledge about HIV/AIDS. There are some different attitude towards HIV and people living with HIV. Positive attitudes are far more common among respondents with good knowledge, while poor knowledge is to a greater extent associated with negative attitudes. Material and method The objective of this study was to asses medical student’s knowledge about HIV and their attitude to people with HIV. We want to see how AMSA can affect the attitude of the students in medical faculty and their knowledge comparing with non-members. Through random sampling, students from 3 medical faculty in Makassar were assessed by questionnaires. Respondents were asked about their knowledge and attitude about HIV/AIDS. Then the data was analyzed and converted to a chart using SPSS 16.0. Result The analysis indicated that AMSA members have high quality of knowledge about sexually transmitted infection or especially HIV/AIDS comparing with non-AMSA members who become respondents that some of them (5%) still have low quality of knowledge about HIV/AIDS. The study revealed that most of AMSA member knows the cause, system that affected, onset, symptoms, transmission, complication, risk factor and prevention of HIV. We can also know that knowledge affect student’s attitude towards people with HIV and AIDS. Via its events, AMSA providing better acknowledgement about sexually transmitted infection to its members, that affects AMSA members’ attitude to people live with HIV/AIDS. Conclusion From the study we can know that AMSA members have better knowledge about HIV/AIDS compared to non – member. AMSA members also tend to be more tolerant and have positive attitudes towards people live with HIV/AIDS. # # # # #

? Public Poster

Background Sexually transmitted disease is an infection that mostly spread by person-to-person sexual contact. Every single day, more than 1 million people acquire a sexually transmitted disease. Some diseases that acquire are chlamydia, gonorrhea, syphilis, and trichomoniasis. Most of sexually transmitted disease are present without symptoms, and increase risk of HIV infection. As we know, that sexually transmitted disease are spread by person-to-person sexual contact, we must know how to prevent that diseases. Barrier methods is a method that reduce the risk of sexually transmitted diseases transmission. The example of barrier methods is a male latex condom. To achieve the maximum protection, the condom must be use correctly and consistently. If condoms are not use correctly, the protection would not be maximal, and the spread of sexually transmitted disease still happen. So, what do you think? Donâ&#x20AC;&#x2122;t you love your partner? If you love your partner, you better use condoms, to prevent sexually transmitted disease. Love your partner by using condom from now. Title: Donâ&#x20AC;&#x2122;t you love your partner? Name of Authors: Monica Djaja Saputera & Jessica Djaja Saputera Name of University: Tarumanagara Objective: Monica Djaja Saputera (email: monicdjaja@gmail.com; phone number: 081808835290)

Background HPV infection is a sexually transmitted disease that is caused by human papilloma virus. There are many types of HPV that common worldwide, such as HPV type 6, 11, 16, and 18. Cervical cancer is the most impact of HPV infection in women. In the worldwide, cervical cancer is the second most common cancer in women with 530.000 new cases every year, and more than 270.000 women die from cervical cancer. In Indonesia, every single day there are 40 new cases of cervical cancer, and half that died from cervical cancer. Most people just know that HPV infection only affected women, but as we know HPV infection mainly transmitted via sexual contact. So we can see that high case of cervical cancer will be reacting to men. Several studies say that men also can affected by HPV infection via sexual contact with women or men. Some common disease of HPV infection in men are genital warts or condyloma acuminata, anal cancer, penile cancer, and oropharyngeal cancer. So, the prevention not only for women, but men need the prevention too. The prevention that can be for men and women is a vaccination. There are two types of HPV vaccine, such as bivalent and quadrivalent. Bivalent vaccine contains HPV type 16 and 18 to prevent cervical cancer in women. Quadrivalent vaccine contains HPV type 6, 11, 26, and 18 to prevent genital warts or condyloma acuminata, anal cancer, penile cancer, and oropharyngeal cancer in men; and genital warts or condyloma acuminata, cervical cancer, vulva cancer, anal cancer in women. Those of vaccines must give to men and women with a age range 9-26 years old. The following schedule of HPV vaccination are 0, 2 months, and 6 months. So, get the HPV vaccine now, and enjoy the benefits ! Title: Should I Get HPV Vaccination? Name of Authors: Monica Djaja Saputera & Jessica Djaja Saputera Name of University: Tarumanagara Objective: Monica Djaja Saputera (email: monicdjaja@gmail.com; phone number: 081808835290)

AIDS: No More, Save More Franklin Wijaya, Randy, Grace Elizabeth & Theresia I. P. Chesar Universitas Kristen Krida Wacana Contact Name: Grace Elizabeth Claudia, email: gracesaroinsong@gmail.com, Phone: 082125261227 AIDS (Acquired Immunodeficiency Syndrome) has become one of the most serious world’s health problem. Globally, there are almost 35 millions people currently living with HIV and 10 millions people died caused by AIDS. As we all know, AIDS caused by the virus known as Human Imunodeficiency Virus (HIV). The virus transmitted primarily by unsave sex intercourse, contaminated blood transfusions, pregnancy, childbirth, and breastfeeding. The infection cause progressive destruction of the immune cell which could make the infected people vulnerable and leads to opportunistic infections. HIV infection, however, takes a very long time to develop into AIDS and until now apperently there’s no symptoms of that infections. So, everyone could be infected by HIV without knowing it. Nowadays, HIV/AIDS had a great impact on society. There’s a lot of people who look down, rejecting, or even avoiding people with HIV/AIDS because they all afraid that they could be infected. Actually, they could not be infected just because of making conversation with those infected people. As such, people with HIV sometimes feel depressed, abandoned, and rejected, which lead them to take position to avoid treatment. Against this concern, we need to change peoples’ mind by start loving, helping, and supporting them and hoping they could get their self confidence back. Treat others the way you want to be treated and the world will be a much better place. So, do you want to save more HIV people? It’s all start with you.

Asymptomatic Gonorrhea: Unseen yet Exist Elnissi Leonard, Jefryanto, Jesryn Dhillon, Kezia Joselyn, Reinaldo Putra, Stefina Gunawan Universitas Kristen Krida Wacana Contact name: Elnissi Leonard, E-mail: elnissileonard77@gmail.com , Phone:087877805046 Abstract Gonorrhea is a very common sexually transmitted infection (STI). This infection is spread by having unprotected sexual intercourse with an infected partner. It can also be passed on from mother to child during birth or by sharing undergarments that are freshly soiled with infected mucus and urine. According to WHO, gonorrhea is one of the four STIs that is obtained by an estimated of 500 million people each year. There are 309.341 cases in 2010 worldwide. In men, the first symptoms usually appear 2-5 days after intercourse in the form of yellow or clear penis discharge along with severe irritation. In women, the only immediate indication may be irritation and a change in vaginal discharge. In generals, gonorrhea is more serious in females than in males because in about 10% of the cases, the infection spreads to the uterus and along the fallopian tube, causing inflammation and damage that could lead to infertility. Moreover, the possibility of infection passed by male to female is greater than from female to male. Unfortunately, the infection shows next to no symptoms in up to 80% of women. This asymptomatic condition could lead to lack of awareness of oneâ&#x20AC;&#x2122;s condition and consequently lead to late diagnosis which could cause even more damage. It is important to raise awareness of gonorrhea and get yourself examined in order to have proper medication and avoid further complication.

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â&#x20AC;&#x153; Do I Deserve This? â&#x20AC;&#x153; Hansens Yansah, Nathania Sutandi, Euginia Christa University of Indonesia According to the World Health Organization (WHO), every year around 390 thousand children in underdeveloped and developing countries are infected with HIV/AIDS. In Indonesia, the number of the cases of HIV/AIDS in children has developed to 8 % of the total cases. Most HIV infections in children are transmitted from mother to child during pregnancy, labor and delivery, or breastfeeding. HIV develops rapidly among infants and children, and without treatment, a third of all infected children will die of AIDS prior to their first birthday. In many settings worldwide, especially Indonesia, the biggest obstacle for children living with HIV at all ages is the fact that they often experience significant levels of negative stigma and discrimination, including being excluded from school, families, and communities, as people are worried that they might as well acquire HIV. Isolation and discrimination towards children with HIV/AIDS will cause extensive detrimental effects towards the childrenâ&#x20AC;&#x2122;s mental development. As a result, children with HIV/AIDS are not taken care of and onset of depression and mental instability might occur. These children have a higher tendency towards self-isolation. Giving education on how HIV is transmitted from person to person can improve knowledge, and thus, prevent or at least alleviate discrimination towards children with HIV/AIDS. Based on these facts, we have created this poster with the hopes of abolishing the social stigma given towards children with HIV/AIDS, so that those children can receive social equality in society and receive proper health care, education, fair treatments, and better interaction with their environment. We believe that by giving children with HIV/AIDS equal opportunities as normal children, these children could have a better future.

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HIV Might Be Curable If Detected Early Currently, Sexually Transmitted Infections or best known as STI has been quite the concern especially in the medical world. One of the STI that is most discussed is AIDS or Acquired Immunodeficiency Syndrome, which is caused by the HIV or Human Immunodeficiency Virus that attacks the human’s immune system especially the white blood cells. It is detectable only with the specific HIV test. The main problem of the virus is because it replicates rapidly making it almost impossible to eliminate. If not diagnosed and treated quickly, the progress will increase overtime the patient’s lifespan usually are short. In reality most of the patient didn't realize until years, which is until the virus replicate and attack the immune system. This is when the symptoms will start occuring. The Anti-Retroviral Therapy (ART) is most effective if initiated before symptoms develop and will reduce the risk of developing opportunistic infections, HIV related cancers, and AIDS. A functional cure for HIV is still under research, but current researches have found facts that if the people with HIV are treated within 10 weeks of infection, an effective cure to this is achievable. This means that the virus is kept at bay so that it can be handled with the most accurate treatment. HIV should be treated as a chronic disease that is managed over a person’s lifetime. Thus, using this poster we are hoping to raise the awareness of the public about early detection of HIV. If people are more concerned about screening of HIV, they would have known if they ever get infected and an early diagnosis may decrease the number of morbidity to this disease. Author: Shirley Ratnasari (shirley_unlimited@hotmail.com/ 081585503038) Jevi Septyani (ms.jevi@hotmail.com / 0878777220100) Nadhira Anindita Ralena (ditaralena@hotmail.com / 081294063399) Medical Students University of Indonesia

Fight the Disease Not The People Franklin Wijaya, Randy, Grace Saroinsong, and Theresia Chesar Contact name: Franklin Wijaya, Email: franklin.wijaya@gmail.com , Phone: 089630803965 Abstract: In Indonesia people with AIDS had increased significantly from 2005 to 2013, which is 2,572 to 6,266 people infected with AIDS from 2005- 2013 with the peak at 2012 (8,747) people. The age group for AIDS infected mostly from young adults (age 15-29). This shows us that we have to do something to decrease the prevalence of AIDS in Indonesia, and the efforts we have to do consist of 3 things. The first is we have to aware about this disease; how we can get an AIDS and the symptoms of this disease. After that we must learn how to prevent ourselves from getting infected, in order to know the prevention people need to be more proactive to obtain information about the prevention. The last efforts is support, this means we need to support organizations that concern about healthcare, but not just that, we need to be concern of people around us, if thereâ&#x20AC;&#x2122;s someone already have AIDS embrace them, donâ&#x20AC;&#x2122;t alienate them, help them out, they might not ask for your help because they might be ashamed of themselves, therefore we need to help them out. By helping them you might know more about AIDS, and you might ease their suffering. These 3 efforts are the basic things that people tend to forget of how it might effect on society, and think of it as a bothersome things.

Azlina Darsaniya Wandawa Fadia Mutiaratu Fadhilah Aliyah Fadhilannisa Rinanda AMSA Trisakti University Protect Our Youth by Stamp Out Syphilis Syphilis is a sexually transmitted disease caused by the spirochete bacterium, Treponema pallidum. Syphilis is often called as “The Great Imitator”, due to the fact that the clinical signs and symptoms are often indistinguishable from other diseases. From CDC data and statistics, syphilis rates among women aged 15–19 years increased annually from 2004–2009 from 1.5 cases per 100,000 females to 3.3 cases in 2009. In 2012, 1.9% of all cases reported to CDC were among Asians. The 2012 rate of primary & secondary syphilis for Asians was 2.0 cases per 100,000 population, which was 0.7 times the rate for whites. To reduce syphilis, we should know how to prevent and what are the risk factors of syphilis. To prevent getting syphilis, we must avoid contact with infected tissue and body fluids of an infected person. However, syphilis is usually transmitted by people who have no sores that can be seen or rashes and who do not know they are infected. If we aren't infected with syphilis and are sexually active, having mutually monogamous sex with a partner who has been tested and has negative STD test results is the best way to prevent syphilis. Using latex condoms the right way every time you have sex reduces our risk of getting syphilis. Condoms prevent transmission of syphilis by preventing contact with a sore, but only if the condom covers the syphilis sores. Avoid recreational drugs. Excessive use of alcohol or other drugs can cloud our judgment and lead to unsafe sexual practices. Have an honest and open talk with our health care provider and ask whether we should be tested for syphilis or other STDs. We should get tested regularly for syphilis if we are pregnant, are a man who has sex with men, have HIV infection, and/or have partner who have tested positive for syphilis.

Azlina Darsaniya Wandawa 081291776700 azlinadw@gmail.com

Sexually Transmitted Infection Infectious diseases with high mortality, disability and creating public anxiety are not new, but despite this our initial responses to HIV/AIDS have been primitive and slow. Since the start of the epidemic over 60 million people throughout the world have been infected, with the main focus of the epidemic currently in Sub-Saharan Africa. However, there is every indication that the epidemic will move more towards South-East Asia, with increasing numbers in India and China. Infection with HIV has a profound effect on individuals and their families, and can also lead to destabilisation of societies through its effects on the economy, institutions and security. Considerable emphasis has been placed recently on the widespread use of anti-retroviral therapy. This is a worthwhile initiative but is only part of a balanced array of approaches, which requires building a political consensus, social economic interventions and modifying the biology. Strong political leadership is still required, with an approach that recognises that the socioeconomic drivers of this epidemic. Key Words AIDS/HIV, instability of security services

ABSTRACT Maternal infections caused by TORCH [Toxoplasma gondii, Rubella virus, Cytomegalovirus (CMV), are the major causes of bad obstetric history(BOH). Bad obstetric history (BOH) implies previous unfavorable fetal outcome in terms of two or more consecutive spontaneous abortion, history of intrauterine fetal death, intrauterine growth retardation, still births, early neonatal death and/or congenital anomalies. The prevalence of toxoplasmosis in BOH is known to be significantly higher than those without it. A recent study from Chandigarh reports rising seropositivity to toxoplasma in women with BOH. Sero-epidemiological studies have shown that 10-20 percent of women in childbearing age in India are susceptible to rubella infection. Infection with Rubella during pregnancy may lead to congenital malformation in 10-54 percent of cases. Maternal CMV is the commonest viral infection in perinatal period and is the leading cause of congenital CMV infection. The incidence of congenital CMV ranges from 0.53.0% in all live births. Primary HSV infection during first half of pregnancy is associated with increased frequency of spontaneous abortion, still birth, and congenital malformation.

Know the Risk, Understand the Disease Theresia Chesar, Grace Saroinsong, Franklin Wijaya, and Randy Universitas Kristen Krida Wacana Contact name: Theresia I.P. Chesar, Email: xmastree2512@gmail.com Phone: 087871385993 AIDS stands for Acquired Immunodeficiency Syndrome, which is the final stage of HIV infection. People with HIV did not have any symptoms so they could look very healthy at the beginning of stage. When they reached the final stage of AIDS, they will have a badly damaged immune system. HIV virus could transmitted by sexual contact, drug use, injection, pregnancy, child birth, breast feeding, and rarely blood transfusion. AIDS put them at risk for opportunistic infection. You can get AIDS if you have one or more opportunity infections, or certain cancers. Nowadays in Indonesia, there are 170.000 â&#x20AC;&#x201C; 210.000 from 220 million population have AIDS in their body, and 5.500 peoples dead because of this disease. But unfortunately, no much people who aware and understand about AIDS. Lots of them just knowing about AIDS without really understand what AIDS is about. That is one of the reasons why AIDS still a big worldâ&#x20AC;&#x2122;s health problem. If you have AIDS, you will need medical intervention and treatment to prevent death, antiviral therapy for example. It will keep the level of HIV in your body low if you consume it consistently.

Open Your Eyes, HIV Around You Name

:-Mutiara Lirendra/ Mutiara.Lirendra@yahoo.com /+6289640022383 -Rio Alexsandro/ Alexsandrorio@yahoo.com / +628988589995 University:Faculty Medicine of Tarumanagara University, Indonesia HIV (Human Immunodeficiency Virus) is a strain of virus that targets the human immune system. HIV is a global threat since it’s discovery back in 1981 and the number of cases keep rising each year. More than 34 millions of world population are diagnosed with HIV and approximately 12% of the cases are in South East Asia region. Every year the number of cases increased up to 16% in Indonesia. Approximately 67% cases of HIV were transmitted through sexual intercourse in the free sex culture. Unlike any other sexual transmitted disease, subject with HIV doesn’t show any specific sign and symptom. Research shows that most HIVcases shows sign and symptoms after 10 years of infection, which leave a long time period of transmission without warning. This poster was dedicated to educate the community that HIV is a silent threat, a small tip of a giant iceberg. A subject with HIV looks like and act like the rest of the member of community and even the professionals in medical community can’t tell the diferences without a series of testing procedure. Also this poster was dedicated to raise the awareness of using protection in sexual intercourse both in free sex or monogamy relationship. This poster was made in Photoshop. It’s a short , simple and sends a clear message through 3 elements in the poster which is an image of a subject with HIV that looks healthy , a sentence to raise the awareness of HIV in society and information of HIV transmission by WHO.

PROTECT THE FUTURE Andy William University of Indonesia Out of the various infectious diseases, sexually transmitted infections (STI) rank the most common. STI include curable diseases such as gonorrhea, chlamydial infection, syphilis, chancroid, trichomoniasis, to disease such as AIDS in which there is yet no known cure. Most of these disease however, can be prevented. Despite being preventable diseases, the prevalenceof STI worldwide is still increasing, especially in developing countries. The consequences are debilitating, because these diseases severely affect the quality of life. Being infectious diseases however, means that these diseases can be transmitted to other people, especially their partners. Furthermore, STI such as AIDS can be transmitted from mother to their children. Therefore, one person contracting STI can affect other people and the future, their children. This poster aims to raise the awareness that STI can affect the next generation. Various pictures of children are also chosen for these reasons. In addition, there is a QR code in the poster, which will lead to an informational website about STI. We hope that by raising awareness and knowledge about STI, people will be more responsible ot only for themselves, but also fot their future. Representative of AMSA UI Hoshea Jefferson Nainggolan Email: hoshea.jefferson@hotmail.com Mobile phone: +6281806080557 Representative of Authors Andy William Email: fakultaskedokteranui@yahoo.com Mobile phone: +6281282982994

SAVE YOURSELF. PROTECT YOUR CHILD. Tifani Sutrisno AMSA-UKI In 2007, it is estimated that 420,000 children were infected with HIV and 330,000 died of an AIDS-related illness. Eventhough coverage of key interventions of HIV has been applied, the Child Mortality Rate (CMR) is still on half way towards the MDGs 4 in 2015. Actually there’re so many factors affect the CMR, but the most leading factor is the maternal health during pregnancy. HIV stands for human immunodeficiency virus. It’s one of the sexually transmitted infection. It attacks and destroys the cells of immune system. Without treatment, HIV can advances to AIDS which can cause death. HIV can be transmitted vertically from mother to child. The largest transmission is during pregnancy. Until now, there’s no effective cure for HIV, only HIV medicine to keep healthy life and reduce the risk of transmission from mother to child. But, there’s still chance for the virus to be transmitted especially when the maternal health is decreasing. To prevent the risk of transmission, use condoms correctly and consistently during sex, limit your number of sexual partners, and never share drug injection equipment. The Centers for Disease Control and Prevention (CDC) recommends HIV testing for everyone 13 to 64 years old at least once as part of routine medical care. There are no stronger proofs to ensure that you’re HIV positive except get the HIV test. If it’s positive, consult with your health care professionals to get the appropriate treatment. Finally, the most effective prevention is to keep yourself from unsafe sexual behavior. If you realize about this, you won’t just save yourself, but also protect your child from deadly HIV infection.

Be Aware of White Stains Liliani Labitta, Wiseley Hong Tarumanagara University Sexually Transmitted Diseases (STDs) are an important cause of morbidity and mortality. They are also an important marker of a person's high-risk sexual behavior. All STDs occurring in adults can be transmitted to children although the pattern of transmission may vary. Children can acquire STDs either during intrauterine or perinatal period, by sexual abuse, or by voluntary sexual contact. Between 2 and 10 years of age, sexual abuse is the first possible way of transmission. Child Sex Abuse (CSA) is a hidden pediatric problem and is also becoming one of the important factors for acquiring STDs including Human Immunodeficiency Virus (HIV). This is why experts still consider STDs to be a ‘hidden epidemic’ and it’s about time parents should think STDs as a pediatric problem. Leucorrhea/white vaginal discharge is one of the most common symptoms found in patients with genital STDs. In a study by Robinson, all girls with Nesseria gonorrhoea and Trichomonas vaginalis experience vaginal discharge. It also occurs in two third of them who suffer from Chlamydia trachomatis. It is stated that vaginal discharge is one of the common signs in children with STDs. This poster is made with the aim to increase parents’ awareness of STDs in children. Parents should at least know the primary sign of STDs in children to be able to handle such situation as soon as possible both physically and psychologically. Contact details: • Liliani Labitta o E-mail: llabitta@yahoo.com o Phone number: 089693995949 • Wiseley Hong o E-mail: wiseleyhong@gmail.com o Phone number: 08999183983

HIV/ AIDS Sri Sari Ariyanti_Universitas Jenderal Achmad Yani HIV/AIDS has always been one of the most thoroughly global of diseases. In the era of widely available antiretroviral therapy (ART), it is also commonly recognised as a chronic disease that can be successfully managed on a long-term basis. HIV/AIDS pandemic and highlights some of the changes we might expect to see at the global level as HIV is increasingly normalised as "just another chronic disease". The AIDS epidemic has been accompanied by intensely negative public reactions to persons presumed to be infected by the human immunodeficiency virus (HIV). The identification of AIDS as a deadly disease and the association of AIDS, especially gay men. AIDS educational programs can be effective only to the extent that they are perceived as credible by their target audiences. Individuals high in distrust did not differ from those low in distrust in their exposure to AIDS information. Higher levels of AIDS-related distrust were not related to self-reported personal risk reduction, but were related to inaccurate beliefs about HIV transmission through casual contact and greater willingness to avoid and stigmatize people with AIDS. The importance of overcoming distrust in AIDS education programs is discussed.

Key Words : HIV/AIDS

HIV and AIDS among Adolescent Name of University : Padjadjaran University Author : 1. Annisa Rachmayanti, rachmayantiann@gmail.com, 081290399148 2. Niken Amalia Gandini, nikenamaliag@gmail.com , 087708777095 A. Background Adolescent reproductive health issues are now very worried. The data shows adolescent reproductive health problems are 15 million teens age 15-19 give birth/year, 4 million teens have abortions/year, 100 million adolescents are infected by sexually transmitted disease/year, and 7000 adolescent infected with HIV/day (UNAIDS, 1998). The high risk of adolescent reproductive health, one cause is the level of knowledge adolescents is still low. This will affect attitude and behavior of adolescents to reproductive health of themselves. B. Material and methods Data collection methods in this abstract are through internet and journals. C. Results AIDS caused by one of the group of viruses (retroviruses). A HIV-AIDS patientâ&#x20AC;&#x2122;s immunity system will decrease. The AIDS virus attacks the T-lymphocytes. Modes of transmission are through sexual contact, sharing needles, blood transfusion, even in pregnant women who transmitted to the baby. D. Discussion The prevention of HIV is more focused on educating society. People can change their living habits so they will not easily affected by HIV. And the efforts that can be done to avoid HIV / AIDS is as follows: 1. Healthy Sexual Behavior 2. Using sterile needles 3. Avoiding from all Forms of Drug Use 4. Be careful with Blood Transfusion 5. Woman with HIV to not get pregnant E. Conclusion HIV/AIDS is a disease that until now there is no cure and deadly, as well as interfere with physical health, HIV/AIDS also disrupt the stability of the psychic and social life of the patient, so we need a comprehensive treatment. The government's role is huge against HIV/AIDS because the government is in control of the stability in the community, and has the power through policy is made as an effort to achieve a healthy social order and dynamic.

Gonorrhea: It’s your choice! Name Email Phone number University

: Amani Sakinah Augiani : amaniaugiani@hotmail.com : 081210006284 : Padjadjaran University

Gonorrhea is an infection caused by Neisseria gonorrhoeae that infect the mucus membrane surface. It is the second most common notifiable disease in US. Every year, there are 700.000 new cases and it cost more that a billion dollar in US to manage gonorrhea and its complications, which makes it important to us, as a medical student to arise the awareness of people all over the world about it. It is transmitted by sexual contact and perinatal transmission from mother to the child at birth. The prevalence is highest for the people aged 15 to 24, or we cay say teenager and young adult. Most of them maybe think that as long as they don’t do vaginal intercourse, there is no risk to get gonorrhea. It is our duty to ensure that people around us knows what happened to their body if they got gonorrhea. And yes, They should know what to do to prevent and to manage gonorrhea. Although there is a way to manage the infection, it is better for us to prevent of having gonorrhea from the first time. Protected sex is one of the way, but it is better to do not having sex before we get married. It is important for you to have sex with your only partner, to reduce the risk of getting the infection. So, once again, isn’t it better to prevent it instead? It’s your choice!

Fight Stigma, Fight AIDS Shofura Afifah, Raissa Metasari T. Universitas Padjadjaran

Ban Ki Moon once said: “Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer; stigma is the chief reason why the AIDS epidemic continues to devastate societies aroundthe world.” The high level of stigma surrounding HIV/AIDS arises from fear of contagion and negative assumptions. HIV is a life-threatening disease, therefore people react to it in a strong way. Stigma might lead to drastic consequences, such as loss of occupation, loss of marriage and interpersonal relationships, poor health and social care, loss of hope, reputation, and social standing. Discriminatin goes hand in hand with denial; people continue to deny that HIV exists in their community. Astounding, as at the end of 2011, 34 million people are diagnosed HIVpositive and 1,7 million have died of AIDS-related illness. Therefore it is fundamental to fight both ignorance and discrimination. Schools should teach about the true facts of HIV, leaders should push for fair policies and laws. The rights of people living with HIV can be fought institutionally, but what about the layman people? How do these people support people living with HIV? Their support begins with openness, tolerance, respect, and understanding. People should want to be educated about AIDS with open eyes, to understand and eliminate discrimination. This poster might be able to raise people’s awareness and incite their curiosity to look for more information.

Director of Authors Name: Albert Email: albert.aruberuto@gmail.com Phone number: 088808519367

HPV Author University

: Izhar Muhammad Arif (0878843137010/ izhar0801@gmail.com) Muhammad Raihan R N : Padjadjaran University

HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). HPV is so common that nearly all sexually active men and women get it at some point in their lives. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But thete are vaccines that can stop these healt problems from happening. You can get HPV by having vaginal, anal, or oral sex with someone with only one person. You can also develop symptoms years after you have sex with someone is infected making it hard to know when you first became infected. HPV can cause cervical and other cancers including cancer the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer). Cancer often take years, even decades, to develop after a person get HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers. There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including individuals with HIV/AIDS) may be less able to fight off HPV and more likely to develop health problems from it. How to avoid? 1. Get vaccinated HPV vaccines are safe and effective. They can protect males and females against diseases (including cancers) caused by HPV when given in the recommended age groups. HPV vaccines are given in three shots over six months, it is important to get all three doses. 2. Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer. 3. Reduce risky behavior such as multiple partner sex, using contamined needle etc.

HIV Self-testing can laypersons in high-prevalence South Africa perform a blood-based HIV self-test accurately? Bunga Vandia (081210006284; bungavanadia@gmail.com), Gabriela Grace Faculty of Medicine, Padjadjaran University, Indonesia

ABSTRACT Background: HIV self-testing is receiving increased attention globally, with the recognition that new, cost-effective strategies are needed to achieve universal HIV testing. Scale-up of providerinitiated HIV counseling and testing has successfully raised testing rates, but in South Africa – the country with the highest HIV incidence in the world – only 50% of people know their HIV status. 2 Access to self-testing may address this issue in South Africa and other high HIV-burden, hard-to-reach populations. HIV Self-test Kit Development: A self-testing “kit” was specially designed for this study during preliminary research with the target population. Phase I: Focus groups (n=34) Feedback collected from community focus groups was used to design an initial kit prototype. Phase II: Evaluation and selection of testing components. Commercially available testing components, including rapid bloodbased tests, lancets, and blood transfer devices were evaluated for performance and ease-of-use in a self-testing scenario. Phase III: Mock self-testing (n=304) Modifications were made to the kit based on observations of simulated self-testing by 300+ volunteers. Modifications included changes to packaging, written instructions and illustrations, and chosen testing components. Material & Methods: A cross-sectional study was performed with 233 participants from three representative communities in KwaZulu-Natal, South Africa. Participants tested themselves for HIV using a self-test kit which included commercially available rapid test components and illustrated instructions designed specifically for self-testing, supported by a telephone helpline. To assess accuracy of self-test results, two confirmatory tests were performed for comparison: HCT performed by trained staff, and laboratory ELISA. To identify specific challenges participants encountered in either test procedure or with testing components, all sessions were videotaped. To verify accuracy of self-test result interpretation, the participant-reported result was compared to an independent read of the self-test cassette by trained study staff. Self-test kit testing components: Blood-based rapid HIV test, 1: iCARE OneStep HIV 1&2, Alcohol swab, 1, Lancet (needle), 1: BD contact-activated lancet, Pipette (blood transfer device), 1: Zhejiang Sorfa Medical plastic pipette or dual-chamber, Developer solution bottle, 1 Illustrated instructions Self-testing helpline: trained HIV counselors accessible for testing assistance and/or counseling by study-provided cell phone Results: 99.1% OBTAINED A VALID SELF-TEST RESULT 231 of 233 participants obtained a valid self-test result 230. (98.7%) of 233 participant-reported self-test results were concordant with the study staff’s interpretation of corresponding self-test results. Of those that were not concordant, 1 of 44 positive results was interpreted by the participant as negative, 1 of 2 invalid results was interpreted by the participant as negative, and 1 of 187 negative results was interpreted by the participant as “unsure of result”. 97.4% SENSITIVITY / 100% SPECIFICITY (95%CI: 87.93% to 99.62%) (95%CI: 98.04 to 100%) 97.8% UNDERSTOOD NEXT STEP OF CARE. As described in self-testing instructions. Next step of care for HIV negative result: Test again in three months, Next step of care for HIV positive result: test again in 3 months, next step of care for HIV positive result: go to a clinic for confirmation test and CD4 count.

Conclusion: HIV self-testing (HST) with a blood-based rapid test is highly accurate when performed by laypersons in representative high-burden, limited-education settings in KZN, South Africa, when packaged with illustrated instructions, accompanied by a telephone helpline. Laypersons with minimal education are able to accurately interpret results and understand the next step of care based on self-test result â&#x20AC;&#x201C; HIV negative: Test again in three months, HIV positive: Go to a clinic for confirmation test and CD4 count. Blood-based rapid tests provide earlier detection of infection, higher sensitivity 3,4 and are a costeffective alternative to oral fluid tests, thus may be ideal for scale-up of HST in resource-limited settings. Customizing testing components for selftesting may improve both safety and ease of use.

Silent Killer Fatimah Amalia, Ismiana Fatimah Modjaningrat (miamodjaningrat@gmail.com , 08179838194) Faculty of Medicine, University of Padjadjaran, Indonesia

ABSTRACT Background : Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected. The peak time for acquiring infection for both women and men is shortly after becoming sexually active. There are more than 100 types of HPV, of which at least 13 are cancer-causing (also known as high risk type). HPV is mainly transmitted through sexual contact and most people are infected with HPV shortly after the onset of sexual activity. HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognized mode of transmission. There are many types of HPV, and many do not cause problems. HPV infections usually clear up without any intervention within a few months after acquisition, and about 90% clear within two years. A small proportion of infections with certain types of HPV can persist and progress to cancer. Cervical cancer is by far the most common HPV-related disease. Nearly all cases of cervical cancer can be attributable to HPV infection. Cervical cancer is the second most common cancer in women, with an estimated 530 000 new cases every year. Every year, more than 270 000 women die from cervical cancer; more than 85% of these deaths are in low- and middle-income countries. Vaccines against HPV 16 and 18 have been approved for use in many countries. The majority of HPV infections do not cause symptoms or disease and resolve spontaneously. However, persistent infection with specific types of HPV (most frequently types 16 and 18) may lead to precancerous lesions. If untreated, these lesions may progress to cervical cancer, but this progression usually takes many years. Although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer. It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.

Syphilis Jasmine Maulinda Utami, Uray Nabila Yuna Faculty of Medicine, Padjajaran University, Indonesia

One of sexual transmitted disease that occurs the most is Syphilis. Syphilis is bacterial infection that usually spread by sexual contacts, man to man or woman to woman or man to woman by skin/mucous membrane or close contacts with lesions and also can be passed from an infected mother to her unborn child. The most common route of transmission is through contact with an infected personâ&#x20AC;&#x2122;s sore during sexual activity. Less commonly, syphlis may spread through direct unprotected close contact with an active lesions such as during kissing. But it canâ&#x20AC;&#x2122;t spread by using the same toilet, bathtub, clothing or eating utensils or from doorknobs, swimming pools or hot tubs. The etiology of Syphilis is bacterium named Treponema Pallidum. The bacteria enters your body through minor cuts or abrasions in your skin or mucous membran. Syphilis is contagious during its primary and secondary stage, and sometimes in early latent period. When it happened, it starts as a painless sore, in genitals, rectum or mouth. But Syphilis is a curable STD, if it left untreated can eventually lead to irreversible damage to heart and nervous system. An estimated 12.22 millions cases of Syphilis occured worldwide in 1999, slightly below the 1995 estimate. Syphilis rates in the United States have been declining among women since 2010, but rising among men, particularly men who have sex with men. The risk factors of acquiring Syphilis if you: M Engage in unprotected sex M Have sex with multiple partners M A man who have sex with men M Infected with HIV, the virus that causes AIDS. The symptomps of Syphilis are varies, and are depends on the stage of Syphilis: Primary Syphilis: M Small sore (painless) Secondary Syphilis: M Rash in trunk and entire body (itchy and accompanied by wart-like sore in mouth or genitals area) M Muscles aches M Fever M Sore throat and swollen lymph nodes Latent Syphilis: M If untreated the stage moves from secondary to latent with no symptomps appears. Tertiary (Late) Syphilis: M Damages to brain, nerves, eyes, heart, blood vessels, liver, bones and joints. Congenital Syphilis: M If born from infected mother and infected through the placenta during birth. Have no symptomps, but sometimes experience a rash on the palms or their hands and soles on their feet. M Later symptomps: deafness, teeth deformities and saddle nose. When the patient is diagnose in early stage, it is easy to cure. The preferred treatment at all stage is penicillin, an antibiotic medication. If you are allergic to penicillin, the doctor may suggest another antibiotic. After you are treated for Syphilis, the doctor may ask you to have periodic

blood test to make sure you are corresponding to the usual dosage of penicillin, to avoid sexual contact until the treatment is completed, and blood indicates it has been cured, and notify your sex partners so that they can be tested and get treatment if necessary, and the last be tested for HIV Infection. To help prevent the spread of Syphilis, follow the suggestions: M Abstain or monogamous M Use a latex condom M Avoid recreational drugs.

HIV Prevention : Marriage as The Best Antivirus Ever Afnandito Valeno Risky Sukarelawanto, Amanda Dania Satiti Faculty of Medicine, University of Gadjah Mada, Indonesia

Abstract Lately, HIV has been Yogyakartaâ&#x20AC;&#x2122;s concern because there is an increase of HIV cases occurred throughout Special District of Yogyakarta. Previously, the transmission of HIV was spread through syringe and drugs. But after 2008, the transmission was dominated by sexual intercourse, resulting in the explosion of the people that got infected by HIV, one year later. There are also a lot of attempt to decrease HIV cases by increasing people awareness of HIV transmission. We believe that through selective and careful methods, such as no sexual intercourse before marriage and be faithful to your husband or wife, will effectively decrease HIV cases in Yogyakarta. It is our duty as medical students to increasing peopleâ&#x20AC;&#x2122;s awareness on HIV transmission by sexual intercourse. Because there has been many cases where children born with HIV just because their parents also got infected by HIV, and then they would live in discrimination. All of that will sum up the reasons for us to fight HIV together. Afnandito Valena RS afnanditov@gmail.com 082349620114 Amanda Dania Satiti amanda.danias@gmail.com 085729679808

Think Thing Andreas Yohan H. ; Jo, Jonathan Jose Johan ; Kevin Andersen Medical Faculty of Diponegoro University, Indonesia

ABSTRACT: Sexually transmitted diseases (STDs) are major public-health problems and also a significant financial problem. The number of incidence rate is gradually increasing because of the lack of education among the society. Past and ongoing attempts to create vaccines against sexually transmitted pathogens have met with varying success. The disease mostly infect adolescence between 14 to 29 years old. The purpose of making this poster is to raise awareness among the society in developing countries. The poster contains a picture of a double sided woman, divided into the beautiful side and the infected side. It tries to tell us that STDs could disguise itself as a beautiful woman and it can infect its host at any moment. People tend to only see what is in the outside. They do not know that woman like that is loaded with infectious bacteria. For the infected side, we tried to make the picture using negative features and colors to make a terrifying impression among the people. While for the beautiful side, we try to use a beautiful and a rather “naughty” woman to give a portrait of a prostitute, carrying those infectious diseases. This poster acts as an indirect education for the people,. By seeing this poster, we hope that people would realize the significance of STDs and would try to prevent them. And by doing that, hopefully the incidence rate of STDs would decrease and we could form a healthy lifestyle among the people. We realize that education, in this case, a poster can only improve people’s knowledge and raise their awareness, but it does not always turn into behaviour change. Therefore, followups and further guidance for the community are necessary to form a real behavioural change among the society. Keywords : Sexually Transmitted diseases, poster, indirect education CP : Andreas Yohan H. – ay.danceup188@gmail.com – 081901593068 Jo, Jonathan Jose Johan – jonathanjose_1005@yahoo.co.id – 081805927882 Kevin Andersen – veenz321@gmail.com - 085888359036

What is Your Status? Fajar Muhammad, Novandika Kurnia Akbar, Desty Annisa Hapsari Faculty of Medicine Universitas Gadjah Mada, Indonesia

According to WHO (World Health Organization), sexually transmitted infections (STIs) are infections that are spread primarily through person-to-person sexual contact. STIs are caused by more than 30 different bacteria, viruses, and parasites. More than 1 million people acquire a sexually transmitted infection (STI) every day. A person can have an STI without having obvious symptoms of disease. There are many types of STIs, including Chlamydia, Gonorrhea, Genital herpes, HIV/AIDS, HPV, and Syphilis. When someone has an STI caused by bacteria or parasites, the health care provider can treat it with antibiotics and other medicines. When the cause of STI is a virus, the diseases become hard to be cured. Sometimes the drugs that are given is just to slow down the development of malignancies of that diseases. Many ways that can be done to prevent transmission of STI, particularly HIV/AIDS, one of them is by knowing the status of your HIV infection. It will be very possible if STI spread from the people who look perfectly healthy–people who aren’t even aware of being infected. Many of STI, predominantly HIV/AIDS’s patient who doesn’t show any symptoms become perfectly unaware of the risk that theirs carry on. So, if they don’t do any test to know their HIV/ADS’s status, they will carry bigger risk to get or spread the infection to other people in their environment. According to CDC (Center for Disease Control and Prevention), it is recommended to take HIV test for people in the age of 13 to 64 years old at least once as part of routine medical care. CDC also recommends that people at high risk of HIV infection get tested at least once a year. Some of the test can be operated if you want to know your HIV/AIDS’s status, there are antibody tests, antigen tests, and PCR test (polymerase chain reaction test). Some of the test now has been developed to make it easier for people to do the test, one of them is home testing kits (HIV antibody tests you can take in the privacy of your own home). The Home Access HIV-1 Test System is approved by the FDA for this purpose. Although this is not a true HIV testing kit, but this shows us actually there are a lot of ease for us if we want to know our status, especially our HIV/AIDS’s status. So, through this poster, we encourage you to know your ‘status’ before it’s too late! Fajar Muhammad 085710662542 Fajarmuhammad246@gmail.com Novandika Kurnia Akbar 085693386639 Novandika.akbar@gmail.com Desty Annisa Hapsari 085250022829 destyannisahapsari@gmail.com

HIV Doesn’t Transmit Under Our Watch Annas Zulfakhri Abidin, Dini Mutia Khairunnisa Faculty of Medicine, Hasanuddin University, Indonesia

Background Looking at the world these days is not sophisticatedly interesting anymore. We witness the same things every day, unlike the past when people easily get excited with something, and they have something to do for that thing. One of the foremost problems, is the Acquired Immuno-Deficiency Syndrome or AIDS. Yes, wide crowds do recognize it, but one thing we may not notice is how we deal with it. This poster represents the thought of a simple perspective, consequently having a look yet still trying to notice the real deal. This poster tells the crowd of the efforts that humans are making on dealing with the AIDS’s predecessor, Human Immuno-deficiency Virus or HIV. As basic knowledge, it is known that this AIDS serves as an ‘effect’ of what HIV does to the body. Therefore, the main point in dealing with AIDS lays with the prevention of HIV transmittance. People must know what to do here. But what’s gravity defying is that of a habit of ignorance, and sometimes even discrimination. They need to know that all parts of the society carry the role in prevention of HIV transmittance. Overseeing those problems, wide people should discard the old mindset in order to achieve a brand new level of understanding and comprehension. We all need to know how to really deal, to abolish all negative perspectives which may arise, such as discrimination among those who’s infected, knowing that those people are having their lives on the line. Nonetheless, we all can take a first step to start these means, by exposing our efforts of stopping HIV and curing AIDS. But ignorance is the only enemy we’re facing now. Because ignoring means not doing anything, anything at all for our own mankind, possibly even our descendants. Objective (Contact details of Directors and Authors) 1. Annas Zulfakhri Abidin | aza@innocent.com | +6285242926231 2. Dini Mutia Khairunnisa | dini7mutia10khairunnisa@gmail.com | +6285696268710 # # # # # # # # #

3 Steps to Save Life Nadia Magdalena, Armeida Pratiwi,Januardi Indra Jaya Faculty of Medicine, Brawijaya University, Indonesia

ABSTRACT: HIV still becomes a frightening disease since the drugs to cure it effectively still yet to be found. Despite its position as a deadly disease and itâ&#x20AC;&#x2122;s really easy to transmitted, itâ&#x20AC;&#x2122;s also easy to prevent it to transmit to your own body. This poster remained you that the effort of protecting yourself from HIV in line with your effort of saving your life. 3S symbol make you easier to remember about what you have to do in order to stay away from this deadly disease. Starting from using condom when having a risky sexual intercourse, stop sharing personal item that may contain blood and to stay in one partner. Those are a modifiable lifestyle that can save your life from HIV/AIDS. Directors of Authors Name : Nadia Magdalena E-mail : nadia.magdalena98@gmail.com Phone : 087885008286

Avoiding Free Sex is The Best Protection Yusuf Azmi, Julius Albert Sugianto, and Ahmadin Yusuf Rizal Susatyo Faculty of Medicine, Airlangga University - Surabaya, INDONESIA

Abstract Alongside the increase of Metropolitan lifestyle in Indonesia, so is free sex. A survey in 2007 stated that 45% of teenagers in big cities around Indonesia admitted doing premarital sex. The consequence of this trending behavior itself is evident. Researches have suggested an increase in HIV/AIDS, HPV, and Syphilis prevalence among Indonesians and this problem needs to be tackled soon. In the terms of changing peopleâ&#x20AC;&#x2122;s behavior, there are mainly two ways of tackling this STD problem:promote the use of condom or prevail upon people to avoid free sex. Promoting the use of condom seemed reasonable but it actually is not. We tend to believe that condoms will inhibit all kinds of STD but condoms are not capable in impeding all kinds of STD. Condoms does well in preventing sexual diseases transmitted by secretion and/or urethra exposures but not so well in prohibiting the transmission of sexual diseases via skin-toskin contact (e.g. herpes, syphilis, and HPV). A study by Winer RL (2006) showed that the use of condom mitigates only 62% of HPV infection risk. Therefore, doing a safe sex (i.e. sex using condom) does lower the risk of STD transmission but it is not very effective in mitigating all the risk. On the other hand, avoiding free sex would guarantee to save us from all means of STD transmission because there is no sexual activity with strangers. On that account, in this poster we suggest that avoiding free sex is the best protection against all sorts of STD. Avoid Free Sex, Avoid STD. Contact details: Yusuf Azmi Email: yusuf_azmi@ymail.com Phone: +6285725052332

Be Gloved, Be Safe Arhyatus Sa’adiyah , Anindya Paramitha , Maulida Sabila Faculty of Medicine, University of Brawijaya, Malang, Indonesia

Background: There are many infectious diseases that can be transmitted through intimate contact, such as HIV/AIDS, Chlamydia, Genital Herpes and Syphilis. Those diseases are called sexual transmitted infections. Sometimes people don’t even know that they had been infected and spread the virus/bacteria while they are having sex with another person. Thus, having many partners will only worsen the situation. Some of those infectious diseases can leave permanent damage in our body, like infertility and immune system damage. That's why prevention is much easier than treat the diseases. By using this poster we aim to persuade people to be more cautious about sexually transmitted infections and proclaim safe sex. We put some flowers in the poster that resemble condoms. And there is a message about use them as protection against sexually transmitted infections. Use the glove and stay safe. Contact details : Arhyatus Sa’adiyah Email : arhyatus@gmail.com Mobile : +6285755284280

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Be Gloved be Wedded be Safe Arhyatus Sa’adiyah , Anindya Paramitha , Maulida Sabila Faculty of Medicine, University of Brawijaya, Malang, Indonesia

Background : We choose the Sexually Transmitted Infections theme for our poster, because we do concern about this issue. Sexual Transmitted Infection is a major health problem in the most community all around the world, including Indonesia. Sexual Transmitted Infections are easily spread out in the community, because of the people, especially Indonesian, low knowledge and awareness. They don’t know that Sexual Transmitted Infections can lead them to a serious health problem, like infertility or even death. Many people think that having sex without protection is not a big deal. They believe that protection like condom is not important and just make their love activity less pleasurable. Many people also think that having sex with many different partners won’t put them in danger, some of them even think that is cool. Thus, we put some messages on the poster about being faithful and using condom as protection against sexually transmitted infections. We put a wedding ring on the girl finger as a symbol of faithfulness and she bring an umbrella that resemble a condom. We also highlight the skirt as to show the part that need to be protected. It’s better to protect than to treat them right? Contact details : Arhyatus Sa’adiyah Email : arhyatus@gmail.com Mobile : +6285755284280

“Be” Save Don’t Regret! Armeida Pratiwi,Januardi Indra Jaya, Nadia Magdalena Faculty of Medicine, Brawijaya University, Indonesia

ABSTRACT: Sexually transmitted disease or STD have a broad range of cause and also have a broad range of complication, from some itchy feeling into the deadliest one. Despite their name as STD, some of diseases under this group also have some variety of routes of transmission. It may transmit to someone body through sharing needle, blood transfusion, tattoo maker, or even transmitted from mother to their baby. This variety of route of transmission make people sometime did not aware that their body infected by a certain virus or bacteria. This poster remained the reader that everyone might be contained a virus/bacteria in their body, and it’s highly recommend to test it, and make sure that there is no STD left inside the body by treating it to doctor before you do sex with your partner. Because STD can easily be transmit to your couple throughout sexual intercourse. And in the end it will hard to threat and might be transmit to the baby if you are pregnant. So, be sure of having no STD in your couple, moreover an STD that yet can’t be cure is something that you must do before you’re regretting to do sex with him/hem because it can take away your future. Directors of Authors Name : Armeida pratiwi E-mail : armeidapratiwi@gmail.com Phone : 085755668199

Control the Virus by Using Antiretroviral Drugs Sylvia Winnie Melinda, Nur Afiati Nadya, Ellen Natalia Faculty of Medicine, Brawijaya University, Indonesia

ABSTRACT: Human immunodeficiency virus. HIV is a virus that attacks the immune system, putting people infected with HIV at risk for life-threatening infections and cancer. During HIV infection, the virus attacks and destroys the infection-fighting CD4 cells of the bodyâ&#x20AC;&#x2122;s immune system. Loss of CD4 cells makes it difficult for the immune system to fight infections. (U.S. Department of Health, 2012) Antiretroviral therapy (ART) is the recommended treatment for HIV infection. Standard antiretroviral therapy (ART) consists of the combination of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. ART prevents HIV from multiplying and destroying infection-fighting CD4 cells. This helps the body fight off life-threatening infections and cancer. It can help people infected with HIV live longer, healthier lives. (WHO, 2013) This poster remained you that the effort to treatment for HIV infection with Standard Antiretroviral therapy (ART). There is so many thing they can do if they control the virus by using anti-retroviral drugs. It can make people infected with HIV live longer, do many thing, and have healthier lives. Directors of Authors Name : Sylvia Winnie Melinda E-mail : lie.ai.bing@gmail.com Phone : 085649697827

Don’t Judge a Girl By Its Cover Ahmadin Yusuf Rizal Susatyo, Julius Albert Sugianto, and Yusuf Azmi Faculty of Medicine, Airlangga University - Surabaya, INDONESIA

Abstract Apace with the modernization in Indonesia and increased availability of contraception, free sex and STDs have emerged to be an important issue to tackle. A survey in 2007 stated that 45% teenagers in big cities around Indonesia admitted doing premarital sex. This fact demonstrated the shift in people’s perception about free sex. People start to think that free sex is okay to be done as long as it is with a seemingly healthy individual but studies reveals that there is an increase in HIV/AIDS, HPV, and Syphillis prevalence among Indonesian and this problem needs to be tackled. In this poster we would like to thwart this growing belief by making people realize that a good appearance does not necessarily imply a disease-free individual. But this is not the case, sometimes STDs don't have symptoms at all. A study reveals that among those initially diagnosed with HIV infection, one-third (32 percent) were diagnosed with AIDS within 12 months, indicating they were likely infected for many years without knowing it. While along the times when they don’t realize they are infected with HIV, they could transmit this deadly disease to their sex partner unknowingly. Moreover, denying the possibility of HIV transmission by using a condom seemed reasonable, but STDs are not transmitted only by secrete or urethra-exposure (Which usually are negated by the use of condom), there are still some other sexual diseases transmittable by skin-to-skin contact (e.g. herpes, syphilis, and HPV) and condoms only negates 62% of the risks. Therefore, healthy appearance does not implicate that he/she is a safe partner to have intimate relationship with. Avoid free sex, get a checkup, and talk to your doctor about your sexual health. Contact details: Yusuf Azmi Email: yusuf_azmi@ymail.com Phone: +6285725052332

Go CHAT Before Late Januardi Indra Jaya, Nadia Magdalena, Armeida Pratiwi Faculty of Medicine, Brawijaya University, Indonesia

ABSTRACT: Syphilis is one of the sexual transmitted diseases that have a danger complication that can even lead to death. The complications are CNS damage, neural damage, heart failure, and event become a congenital syphilis which lead to a premature baby or even stillbirth. Syphilis complication will occur after several years that it doesnâ&#x20AC;&#x2122;t give any symptoms or known as latent phase, but once they went to complication phase (tertiary syphilis), the damage is irreversible. So, the only way to prevent the syphilis damage is when the symptoms occur since the syphilis can easily be cured with antibiotic. This poster provides the information and tips of how to eradicate syphilis before itâ&#x20AC;&#x2122;s too late. We suggest the reader to check for lesion around genital as the lesion might go painless so they have to search it. We also suggest the reader to aware of skin rash in syphilis, because skin rash in syphilis has a unique pattern which it often appear in palm and sole. At last we suggest the reader whether they are have that sign at the moment or had experienced any of it before (they are in latent syphilis phase) to take test because syphilis test is the only definite way to diagnose syphilis in a patient body. In the end they can eradicate syphilis before late. Directors of Authors Name : Januardi Indra Jaya E-mail : Januardi.indra@gmail.com Phone : 087839131819

NO ONE IS SAFE FROM HIV Chrisandi Yusuf Rizqiansyah, Camoya Gersom, Cakra Parindra Gasmara Faculty of Medicine, Brawijaya University, Indonesia

ABSTRACT: HIV is a retrovirus that causes AIDS. It's a condition in which progressive failure of the immune system allows life-threatening infections to thrive. Many factors may lead to the spread of HIV, endangering many lifes. The infection of HIV is without symptoms until an average of 10 years. That means, you never know what hits you and by the time you do, it's already too late.Unprotected sexual activity remains as one of the big factors. In low-income countries, the risk of transmission from anal intercourse is especially high, estimated as 1.4–1.7% per act in both heterosexual and homosexual contacts. Meanwhile in Indonesia, 51% of the whole population are infected with STD, and among them, 210.000 are infected with HIV AIDS. The lack of proper education has not helped in lessening the number of people involved in unprotected sexual activity, in fact the number only increases. This should be our concern as medical students because we are responsible in the development of this country, especially in medical field. Treatment and management aside, we are responsible in educating prevention of HIV AIDS among people. First, people who are sexually active should perform a voluntary counseling and testing in knowing whether or not they're infected with HIV. Second, HIV AIDS are best known for infecting people who have multiple sex partners, being faithful to your partner is definitely good to prevent the spread of HIV. Third, a good use of condom can further help in preventing HIV AIDS because condoms are produced with a substance that can kill sperm cells. Last but not least, a proper education about safe/protected sexually activity starting at early teen groups to adults are recommended in increasing awareness of HIV AIDS spread. Remember, no one is safe from HIV AIDS. Source : 1. Sepkowitz KA (June 2001). "AIDS—the first 20 years". N. Engl. J. Med. 344 (23): 1764–72. 2. Markowitz, edited by William N. Rom ; associate editor, Steven B. (2007). Environmental and occupational medicine (4th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. p. 745. 3. HIV AIDS di Indonesia (Fakta dan Data). http://jappy.8k.com/whats_new_1.html. 4. "HIV in the United States: An Overview". Center for Disease Control and Prevention. March 2012. 5. Boily MC, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, Alary M (February 2009). "Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies". The Lancet Infectious Diseases 9 (2): 118–129. 6. Beyrer, C; Baral, SD; van Griensven, F; Goodreau, SM; Chariyalertsak, S; Wirtz, AL; Brookmeyer, R (Jul 28, 2012). "Global epidemiology of HIV infection in men who have sex with men". Lancet 380 (9839): 367–77.

7. Yu, M; Vajdy, M (August 2010). "Mucosal HIV transmission and vaccination strategies through oral compared with vaginal and rectal routes". Expert opinion on biological therapy 10 (8): 1181â&#x20AC;&#x201C;95. 8. Oxford handbook of genitourinary medicine, HIV, and sexual health (2nd ed.). Oxford: Oxford University Press. p. 95. 9. Dosekun, O; Fox, J (July 2010). "An overview of the relative risks of different sexual behaviours on HIV transmission". Current Opinion in HIV and AIDS 5 (4): 291â&#x20AC;&#x201C;7.

Gonorrhea Eradication Andreas Jeffrey, Shelby Ernanda, Hashfi Mafazi Faculty of Medicine, Brawijaya University, Indonesia

ABSTRACT: Gonorrhea is a sexually transmitted disease (STD) that infects men and women. The causative bacterium of this disease is Neisseria gonorrhea. Infections can occur in the genitals, rectum, and throat.Gonorrhea remains a public health problem,it is a very common infection, especially among young people ages 15-24 years. 106.1 million new cases of Neisseria gonorrhea infection worldwidereported by WHO in 2008, while in 1999 3.2 million new cases were reported in East Asia and Pacific. CDC also reported that 700.000 new cases reported per annum. Most men infected with gonorrhea have burning sensation while urinating and yellowish white dischargefrom genital. Most women do not have symptoms. Few women with symptoms have discharge from the vagina and possibly some burning during urinating. Women may also have abdominal pain or abnormal bleeding. Gonorrhea can also causes throat inflammation. Gonorrhea spread to the blood or joints have been reported and this condition is life threatening. Also, people with gonorrhea more easily contract HIV.Gonorrhea is spread through sexual contact. This includes penis to vagina, penis to mouth, penis to rectum and mouth to vagina contact. Gonorrhea can also be spread from mother to child during birth. The risk of Neisseria gonorrheainfection can be reduced by acting safe sex. Safe sex means using condoms correctly and sexual intercourse limitation (not having sex with multiple partners and not having sex with suspect of Neisseria gonorrhea infection).Also if someone experiencing symptoms occurrence this person should do sexual abstinence and immediately see a doctor. By reducing the risk of infection, better life quality is expected. Safe Sex Acted, Gonorrhea Eradicated. Source: W Edward. et al.2013.CDC Grand Rounds: The Growing Threat of Multidrug-Resistant Gonorrhea. CDC WebMd. 2012. Gonorrhea. Available online at http://www.webmd.com/sexualconditions/guide/gonorrhea WHO. 2008. Global Incidence and Prevalence Of Selected Curable Sexually Transmitted Infections Estimated new cases of gonorrhea infections (in millions) in adults, 1995 and 1999. http://www.avert.org/std-statistics-worldwide.htm Office of Population Affair.2010.Gonorrhea fact sheet.U.S.Department of Health & HumanServices Vizconde, LitaC.2010. Sexually Transmitted Infections in Asia. Mayoclinic Staff. 2014. Disease and Condition: Gonorrhea Prevention. Available online at http://www.mayoclinic.org/diseases-conditions/gonorrhea/basics/prevention/con-20020917 Institute for Clinical Systems Improvement .2010. Health Care Guideline: Routine Prenatal Care. Fourteenth Editio

Shut the Transmission of HIV, Salvage your Life! Kevin Sastra Dhinata Faculty of Medicine, Airlangga University, Indonesia

AIDS (Acquired Immunodeficiency Syndrome) has become a major health problem in various countries in the world, including Indonesia. It is caused by the infection of Human Immunodeficiency Virus (HIV), which may spread by blood, passively from mother with HIV to the fetus, and mostly, by exposure to body fluids during sexual intercourses. This HIV virus depresses the sufferer’s immune system so that he/she will have his/her immune system suppressed gradually until it will be inadequate for it to combat diseases. Thus, making the sufferer very vulnerable to infections. The eventual condition is known as AIDS, so that it takes time from the time of infection to become AIDS. Data from the Ministry of Health of the Republic of Indonesia shows that the cumulative total number of people living with HIV from 1987 until June 2014 is 142950, and 55623 of them are living with AIDS. HIV infection can be prevented and as the easy and safe curative treatment for HIV/AIDS is not available yet, so we are advised to shut the transmission. Many people are aware of this disease, but most of the time, they don’t know how to protect themselves. We can protect ourselves by using the SHUT philosophy that the author proposed in this poster: S: Stay with one sex partner if possible H: His/her health status. Check whether your partner has HIV infection U: Use condoms to protect sexual intercourses T: Teach and educate your loved ones so that they won’t get infected Besides that, in this poster I used the slogan: “Shut the transmission, Salvage your life!” It is expected that readers will follow the simple steps in the catchy SHUT philosophy to protect them from being infected by HIV so that their life will not be ruined by it. Kevin Sastra Dhinata kevinsastra@yahoo.com 081381899996

SPREAD FACTS NOT FEAR HELP OTHER SEE THE WORLD IN DIFFERENT PERSPECTIVE Danintya F.T, Nabila N.R, Yukko A. Faculty of Medicine, University of Brawijaya, Indonesia

Background HIV/AIDS is one of the biggest problems that has puzzled the medical world, this is because AIDS is life threatening and as of present there is no cure for the disease. People become infected with HIV through bodily fluids such as blood, semen, breast milk, and vaginal fluids. These fluids can be passed between people in a variety of ways, including having unprotected sex (oral, vaginal, or anal) or sharing needles. HIV can also be passed from mother to child during childbirth or through breast-feeding. During HIV infection, the virus attacks and destroys the infection-fighting healthy immune cell of the bodyâ&#x20AC;&#x2122;s immune system. Loss of healthy immune cell makes it difficult for the immune system to fight infections. The active labour force is greatly affected and this has enormous consequences for the future generation, constitute those that practice risky behaviour, drug addiction and premarital sex, which can increase the chances of the increase of HIV infection. The risk of HIV/AIDS infections among youths in the tertiary Institutions has increased in recent years. The sample consisted of 162 males and 162 females, between the ages of 20â&#x20AC;&#x201C;24 in 3 Tertiary Institutions. The results of the survey indicated that socio-economic factors, culture and tradition all play a significant role in the differences between female and male perceptions of the HIV/AIDS HIV and AIDS is a matter of concern because the number of cases has increased dramatically over the last ten years. Danintya F.T danintyafairuz@gmail.com 085755400696 Nabila N.R nabilaresti@gmail.com 085784972095 Yukko A. aryukko@yahoo.com 085259563322

The Beautiful One Could Be The Deadly One Julius Albert Sugianto, Yusuf Azmi, and Ahmadin Yusuf Rizal Susatyo Faculty of Medicine, Airlangga University - Surabaya, INDONESIA

Abstract With the increase of Metropolitan lifestyle in Indonesia, free sex comes along. A survey in 2007 stated that 45% teenagers in big cities around Indonesia admitted doing premarital sex. The consequence of this trending behavior itself is evident. Researches have suggested an increase in HIV/AIDS, HPV, and Syphillis prevalence among Indonesians and this problem needs to be tackled soon. In this poster we would like to prevent the further growth of STD prevalence by suggesting people to avoid free sex. In a layman perspective, and maybe most of us, people tend to think that as long as our sex partner is attractive and is capable in doing their daily life freely, it means that they are diseasefree. But this is not the case. A study reveals that among those initially diagnosed with HIV infection, one-third (32 percent) were diagnosed with AIDS within 12 months, indicating they were likely infected for many years without knowing it. While along the time when they donâ&#x20AC;&#x2122;t realize they are infected with HIV, they could transmit this deadly disease to their sex partner(s) unknowingly. On the other hand, denying the possibility of HIV transmission by using a condom is acceptable, but not all STDs are preventable by condoms, there are still some other sexual diseases transmittable by skin-to-skin contact (e.g. herpes, syphilis, and HPV) and condoms only negate 62% of the risks. Therefore, healthy appearance does not implicate that he/she is a safe partner to have intimate relationship with. Avoid free sex, get a checkup, and consult to your doctor about your sexual health. Contact details: Yusuf Azmi Email: yusuf_azmi@ymail.com Phone: +6285725052332