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Effective Methods of Prevention

What are the Evidence-Based1 Methods to Prevent the Transmission of HIV?

Sexual Transmission

Studies have shown that the most effective approach to HIV prevention is comprehensive, holistic, and sensitive to the culture and context. Elements of HIV prevention can include the following:

  • Abstinence: not having any sexual intercourse (vaginal, anal, oral) and /or delaying sexual debut; it is 100% effective in preventing sexually transmitted infections.
  • Mutual fidelity between partners who know (through testing) that they are not HIV positive; this is 100% effective in preventing sexually transmitted infections.
  • Correct and consistent condom use (male and female condoms): Creates barrier so virus is not passed between sexual partners; reduces the risk of transmission by 80-90%.
  • Microbicides: a gel or cream that can be applied topically to the vagina that would act against the virus; unfortunately no safe and effective microbicide is currently available and research is still being carried out to develop such a product.
  • Male Circumcision: the procedure involves removing the foreskin from the head of the penis; it has been said to reduce the risk of acquiring HIV infection by approximately 60%. Male circumcision does not prevent HIV transmission, it just reduces the risk. If high-risk behavior is not altered, by either circumcised or uncircumcised men, transmission will continue to take place for both circumcised and uncircumcised men.

NOTE: Female "circumcision", also known as female genital mutilation, increases the risk of contracting HIV in women and girls.

Harm Reduction

Harm reduction refers to services and approaches that seek to minimize the harm caused by drug use and preventing HIV transmission without condoning or prohibiting continued drug use. A harm reduction approach can include:

  • Needle exchange programs where drug users can exchange used needles and syringes for new, clean ones.
  • Rehabilitation clinics that provide counseling and detoxification treatment.
  • Outreach programs to reach injecting drug users with clean equipment, condoms, and information.

Studies of harm reduction programs have shown significant drops in HIV prevalence among injecting drug users. Successful harm reduction is based on a policy, legislative and social environment that minimizes the vulnerability of injecting drug users. Harm reduction for injecting drug users primarily aims to help them avoid the negative health consequences of drug injecting and improve their health and social status. To this end, harm reduction approaches recognize that for many drug users total abstinence from psychoactive substances is not a feasible option in the short term, and aim to help drug users reduce their injection frequency and increase injection safety. What is listed above are components that have a significant potential to reduce individual risk behaviors.

Clean Blood Supply

Ensuring that all blood for transfusions has gone through a screening process. In most counties, steps have been put into place so that the risk is extremely low, but in some parts of the developing world it has been more difficult to ensure the services, staff and funds for effective screening of the entire blood supply.

Safety Protocol for Healthcare Workers

Universal precautions are advised by the World Health Organization to protect health care workers and their patients from blood-borne infections. This includes washing hands with soap and water before and after procedures, disinfecting instruments, using protective clothing, using disposable injection equipment, properly handling soiled linen and discarding contaminated sharps.

Education

Education that helps people make informed choices

  • Sex/Sexuality Education: contrary to common fears, extensive research has shown that sex education does not increase sexual activity. Rather it contributes to delaying a young person's first sexual encounter and leads to further efforts at protection.
  • Addiction programs and drug/alcohol addiction education: substance use and abuse decreases mental ability for making choices of safety. Addiction increases chances of trading sex for drugs or alcohol. Addiction programs such as twelve step programs empower people to recover from addiction and the risk behavior involved.

Treatment

Anti-retroviral treatment: medications formulated to disrupt the different stages of HIV can reduce the viral load in patients and reduce the risk of passing on the virus.

Early treatment of sexually transmitted infections is necessary to reduce the risk of transmitting or contracting HIV. Post-exposure prophylaxis: in the case of an injury (such as being accidentally stuck by a contaminated needle) or rape, there is some evidence that the immediate use of a combination of anti-HIV drugs can reduce the rate of transmission.

Post-exposure prophylaxis (PEP)

Post-exposure prophylaxis (PEP) is an emergency medical response that can be used to protect individuals exposed to HIV through an accident at work or to women who have been raped. PEP consists of HIV antiretroviral medication, laboratory tests and counseling. Ideally PEP should be initiated within 2 to 24 hours (and no later than 48 to 72 hours) of possible exposure to HIV, and must continue for approximately four weeks. Although PEP has not been conclusively proven to prevent the transmission of HIV infection, research studies suggest that if medication is initiated quickly after the possible exposure it may be beneficial. After 48 to 72 hours, the benefits are probably minimal (or non-existent) and the risk of intolerance and side-effects associated with antiretroviral treatments will outweigh any potential preventive benefit.

PEP has routinely been used in occupational settings such as for exposed healthcare workers however its use is being extended to non-occupational settings such as refugee camps to treat survivors of sexual assault and rape.

1 'Evidence-based' refers to methods that have been evaluated through scientific processes.