HIV prevention strategies and approaches

HIV Prevention

It is a myth that only homosexual men and promiscuous women are susceptible to contracting HIV, or Human Immunodeficiency Virus. This very serious disease does not discriminate. In fact, HIV can be contracted by anyone. Because it can happen to anyone, HIV should be understood by everyone. Everyone can do something to help stop the spread of HIV.

HIV is a wide-spread disease that continues to spread rapidly, with statistics in the millions. It has killed twenty-five million people from all over the world, and over forty million people currently have HIV or AIDS. In the past few years, millions of people have contracted the disease. Of the forty million that are infected, about seventy percent live in Sub-Saharan Africa. While the majority of those infected are located in areas of Africa, HIV is present and spreading throughout all areas of the world. In 2001, approximately 940,000 people in North America were infected with HIV or AIDS. Developing countries, however, seem to be affected the most, as HIV has spread from high-risk groups to the general population (World Bank 2).

HIV and AIDS

It is common to associate AIDS (Acquired Immune Deficiency Syndrome) with HIV. This is because HIV is the virus that causes AIDS. However, just because a person is infected with HIV does not mean that they have or will ever have AIDS. but, HIV can weaken a person's immune system, allowing HIV to progress to AIDS. This progression can be prevented or slowed with early and on-going treatment of HIV. Because it can lead to AIDS, treatment of HIV is extremely important, as AIDS is the most severe stage of HIV. Also, a weakened immune system caused by HIV can rob they body of its ability to fight off other life-threatening infections and cancer (AIDSinfo).

Contraction of HIV

HIV is transmitted from one person to another through blood and certain other bodily fluids, such as semen, breast milk, and women's genital secretions. Bodily fluids such as saliva, tears, urine and feces generally do not have enough blood cells in them to be able to transmit HIV. HIV cannot be transmitted through "casual contact," such as shaking hands, closed-mouth kissing, drinking from the same glass, sharing kitchen utensils, hugging, sharing a toilet, etc. There are, however, some common ways that blood or other bodily fluids are passed from one person into the body of another (Bartlett and Finkbeiner 33).

It is generally well-known that HIV can be contracted through unprotected sexual contact, but there are some other common ways of contracting the disease. Another way HIV is commonly contracted is needle sharing in drug use and tattoos. HIV infected blood can be introduced into a person's body through transfusions, although this blood is now screened for HIV in the U.S. Also, pregnant mothers can pass HIV to their children. A few other types of contact that rarely transmit HIV are breast-feeding, organ transplantation, artificial insemination, and needle accidents involving health care professionals. Although these instances are rare, it is still possible to contract HIV with these types of contact, so it is best to be careful in those situations (Bartlett and Finkbeiner 33).

There are certain risk factors that make a person more susceptible to contracting HIV. Practicing unsafe sex is the most common risk factor. Unsafe sex is defined as any sexual contact, including oral and anal sex, that does not use a condom or other barrier which prevents bodily secretions from entering another person. Having unsafe sex with multiple partners increases this risk greatly. Homosexual and bisexual men have an increased risk of contracting HIV, since a condom is more likely to break during anal sex than it is to break during vaginal sex. Sharing needles, syringes, cotton, drugs, or other drug paraphernalia is also another common risk factor. Having had a recent episode of a sexually transmitted disease such as syphilis puts one at increased risk of contracting HIV. In addition, having a sex partner that has any of the previous risk factors for HIV puts one at an increased risk for contracting HIV. A person with multiple risk factors has an extremely high risk of contracting HIV (U.S. Centers for Disease Control).

Prevention of HIV

Education about HIV and prevention of the HIV is vital in an effort to prevent the disease from spreading. In fact, education has been proven to provide protection against HIV infection. People without HIV need to be educated about how to avoid getting the disease, and those that are already infected with HIV need to be educated about how to prevent spreading the disease to others. It may sound simple, but millions of people know nothing about HIV or have false impressions about the disease. This is true even among young people and those living in countries that are badly affected by the disease. It is especially important that very young people be educated about HIV, since they are the least likely group to be infected with HIV. Prevention education at a young age will usually follow children into their teenage years when they are at the highest risk for contracting HIV (World Bank 4).

Prevention of Sexually Transmitted HIV

Because HIV is a sexually transmitted disease, abstinence from sex of any kind is the only way to be sure that HIV is not transmitted by engaging in sex. If abstinence, completely refraining from sex, is not an option, then it is extremely important to practice safe sex. Practicing safe sex means using a new latex barrier such as a condom or dental dam for every sexual act. Sexual acts include oral, anal, and vaginal sex. Only water-based lubricants can safely be used with condoms. Oil-based lubricants such as baby oil and Vaseline may cause holes in the condom or even cause the condom to break, rendering it ineffective in protecting against HIV. Check all contraceptive products such as contraceptive creams, gels, suppositories, foams, films, and sponges to see if they contain the spermicide nonoxyono-9. Nonoxyono-9 does help to prevent pregnancy by killing sperm, but it may also increase the risk of contracting HIV. Sexual paraphernalia such as vibrators or other sex toys should never be shared with anyone. One must even be careful even when having a sexual relationship with someone who does not have HIV, as one must also be certain that this partner is monogamous (U.S. Centers for Disease Control).

Prevention of HIV Transmitted by Blood and Needles

To prevent HIV transmitted by blood and needles, it is important to use sterile equipment and supplies. Also, the equipment must not be shared. Needles used for piercing, tattooing, and drug use should not be shared or reused. They should be disposed of properly and immediately. One should not attempt to clean needles using bleach or heat, as this is not as safe as using a new, sterile needle. Again, a new, sterile needle should be used every time. In addition to needles, personal care items such as floss, toothbrushes, and razors should not be shared. People infected with HIV should not donate blood, plasma, sperm, or organs. When aiding people who may be hurt and bleeding, be careful to not make contact with the bleeding individual's blood (U.S. Centers for Disease Control).

Prevention of HIV Transmission from Mother to Child

Pregnant women should get tested for HIV as soon as possible after becoming pregnant. Pregnant women who are HIV positive should take appropriate measures to prevent transmitting the disease to her baby. Certain drugs such as zidovudine (ast or ZDV) or nevirapine can be taken during both pregnancy and labor. These drugs reduce the chance of an HIV positive mother passing the disease on to her child. HIV positive mothers may want to consider delivering their babies by cesarean section rather than having a vaginal delivery, because doing so can reduce the babies' chance of being exposed to HIV. After the baby is born, if possible, babies should be fed using baby formula rather than breast milk. This is because HIV can be transmitted from mother to child through breast milk. Most importantly, women should discuss these options with their doctor to decide what is best for them and their babies (U.S. Centers for Disease Control).

Prevention of Transmission of HIV

Testing for HIV is an important measure in preventing the spread of the disease. Testing for HIV should be added to the regular tests run during normal doctor visits. Sex partners should share their HIV status with each other. In order to prevent HIV transmission between mother and child, HIV testing should also be part of routine pregnancy care. The first test should be done during the beginning of the pregnancy and another test should be performed during the third trimester. Even when a person tests negative for HIV, this does not necessarily mean that he or she does not have HIV. The test must be given three to six months after possible exposure in order to be sure that the individual does not have HIV (Campos-Outcalt).

A person infected with HIV is able to transmit the virus to others at any time, as it is impossible to totally rid the body of the virus. There is currently no cure for HIV. Drugs used to treat HIV may be able to decrease the number of the virus by 99.9%, but they are unable to get rid of it completely. Even though it is less likely, with a low number of the virus it is still possible to transmit HIV to others. For this reason, those already infected with HIV should take measures to prevent spreading the disease to others (Bartlett and Finkbeiner 3).

Individuals infected with HIV should follow all prevention measures listed above. These individuals should also notify anyone they may have exposed to HIV. This way, anyone who may have been exposed to HIV can get tested for it. Notifying those who may have been exposed is a very important moral obligation. Also, in some states, it is a legal obligation. Notification can be done by the HIV infected person or by public health authorities. Public health authorities will contact those who may have been infected while keeping the individual infected with HIV anonymous (Bartlett and Finkbeiner 14).

Prevention of HIV in Developing Countries

As mentioned earlier, developing countries have the highest number of HIV infected people. Generally, these countries utilize small, localized efforts to educate the population about HIV and AIDS prevention. Unfortunately, these efforts are not large enough to reach everyone. Instead, mass media such as television and radio should be used in an effort to educate the public in developing countries about HIV. Mass media information and education programs can improve knowledge and awareness of HIV. Misconceptions are also reduced through these programs. Most importantly, these programs have been shown to promote safer sexual behavior (Gibney, DiClemente, and Vermund 334).

HIV Prevention Education for Adolescents (Industrialized Nations)

Education programs that work well with adolescents are not based on abstinence only. Instead, they focus on safe sexual practices. Contrary to popular belief, these programs do not encourage adolescents to have sex. In fact, these programs have been proven to delay the age of first coitus. Teaching adolescents safe sexual practices is important, as it may prevent them from falling into a habit of risky sexual behaviors. Schools and colleges are the most appropriate place to implement these programs, as this is where the largest concentration of adolescents and young adults is to be found (Gibney, DiClemente, and Vermund 161).

HIV Prevention Education for Homosexual Males (Industrialized Nations)

Because the majority of AIDS cases are found in homosexual men, this is an especially important group to educate in the prevention of transmitting HIV. Men who frequent gay bars have been found to be even more likely to engage in particularly risky sexual activities. The best way to reach out to this group is to use trained spokesmen to visit gay bars to communicate HIV risk reduction information and endorse safer sex behaviors. This method of prevention has been proven to decrease unprotected anal sex and increased condom use in gay men (Gibney, DiClemente, and Vermund 165).

HIV Prevention Education for Female Commercial Sex Workers (Industrialized Nations)

Commercial sex workers have an unusually high risk of contracting HIV because of the nature of their work. Government-run programs have had some success in educating commercial sex workers about HIV and risk behaviors related to the virus. Clinic drop-in centers that provide medical and health services, HIV testing and counseling, STD treatment, a needle and syringe exchange program, and condoms are effective in educating commercial sex workers. These programs were effective in addressing injecting drug use behavior and condom use with clients (Gibney, DiClemente, and Vermund169).

HIV Prevention for Intravenous Drug Users

Intravenous drug users present a special problem as they may transmit HIV through both drug use and sexual activity. The most effective prevention method of HIV in intravenous drug users is syringe exchange. Programs for exchanging needles and syringes in the United States are very controversial; however, these programs offer the most effective means of controlling the transmission of HIV through needle sharing. Also, drug use does not appear to increase in the presence of syringe exchange programs (Gibney, DiClemente, and Vermund 170).

Treatment of HIV

Without treatment of HIV, the disease is likely to lead to AIDS and soon thereafter, death. On the other hand, the prognosis with treatment is relatively good. In fact, with treatment, usually ninety-nine percent of the virus is eliminated from the body in about a month. Even when doing well with treatment, people infected with HIV should seek regular medical care, which usually includes a medical evaluation every three or four months (Bartlett and Finkbeiner 67).

Tests for resistance can help a physician to determine which types of drugs are resistant to each individual's specific strain of HIV. Other tests one might expect during medical visits are kidney and liver function, a blood test for syphilis, a complete blood count, and a test for the hepatitis virus. The complete blood count will measure the number of red blood cells, white blood cells, and platelets. Each of these is at risk for being low because of HIV itself, complications related to HIV, or various drugs used to treat HIV (Bartlett and Finkbeiner 71).

Drugs used to fight HIV are called antiviral or antiretroviral drugs. AZT was the first drug approved by the FDA for treatment of HIV infection. AZT worked for a short time, but then HIV became resistant to the drug. HIV multiplies and mutates, which changes its genetic structure. Because of this, it became difficult to create a drug to treat HIV. Several other drugs were later approved by the FDA to treat HIV. Soon thereafter, it was discovered that the best way to fight HIV was to combine drugs, which is called combination therapy. Combination therapy entails giving patients two or more drugs so that the mutations required of the virus are not just a few, but many. The best treatment of HIV requires a combination of three drugs, or triple therapy (Bartlett and Finkbeiner 74).

With modern drugs, HIV can almost be completely suppressed. Suppression of HIV provides the following benefits: HIV mutations are limited, the virus numbers are low, the complications of HIV are reduced or eliminated completely, patients live longer, the death rate due to AIDS declined, and amazing recoveries are quite common. Since there is currently no cure for HIV, eradicating the virus completely is impossible. Therefore, the goal of therapy is to limit the virus numbers as much as possible. There are now fifteen drugs, given three at a time, that are used in the treatment of HIV. The best outcome for a patient is "no detectable virus." This means that the virus cannot be found during routing laboratory tests. Not all patients get this result, but most people do well even when HIV is somewhat suppressed. Results can only be maintained while on medication, so HIV patients must continue treatment for the foreseeable future. Also, these drugs must be taken accurately every day (Bartlett and Finkbeiner 75).