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PREVENTION
In the U.S. overall, HIV is most commonly acquired from homosexual sex; among women, it is most commonly acquired through heterosexual sex. The primary means of prevention and the primary focus of public health officials throughout the epidemic have been on the use of barrier contraceptives-condoms, male or female.
Yet despite all the information presented to the public on the benefits of condoms, rates of HIV infection are still escalating. Additionally, repeated studies show that the overwhelming majority of people fail to use condoms consistently and correctly despite appropriate knowledge and education.
More recently, however, the medical community has begun shifting from the condom approach and placing a greater emphasis on risk-avoidance techniques. As David Wilson, PhD, a senior monitoring and education specialist for global HIV/AIDS wrote in the British Medical Journal in 2004: "As AIDS educators, we often publicly promote approaches that we would not countenance in our personal lives, such as the notion that it is acceptable for our spouses or children to have multiple partners, provided condoms are used."
One approach gaining support is called the "ABC" approach, in which A stands for abstinence or delay of sexual activity, B for being faithful, and C for condom use. This idea implies not only monogamy, but also reductions in casual sex and multiple sexual partnerships.
This approach is the primary reason behind the ability of Uganda and Thailand to reverse their HIV epidemics, with the partner reduction element cited as most critical.
In other words, to reduce their risk of HIV women need to stop having sex with multiple partners, stop having casual sex and engage in intercourse only as part of a committed, monogamous relationship whenever possible.
Other preventive behaviors include:
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Always use a condom (male or female) from start to finish during any type of sex (vaginal, anal and oral). Use latex or polyurethane condoms rather than natural membrane condoms. If used properly and consistently, these condoms offer protection against other sexually transmitted disease agents as well as HIV.
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Use only water-based lubricants with latex condoms, although you can use non-water-based lubricants with polyurethane condoms. Do not use oil-based lubricants such as petroleum jelly or vegetable shortening. If you decide to use a spermicide along with a condom, use the spermicide in the vagina according to the manufacturer's instructions. Spermicides have not been shown to protect against HIV in clinical trials.
If possible, avoid contraceptives containing the spermicide nonoxynol-9. Over-the-counter contraceptives that include contraceptive foams, creams, gels, films, suppositories, diaphragms, female condoms and cervical caps) that contain the spermicide nonoxynol-9 do not protect against HIV infection or other STDs. In fact, vaginal contraceptive products containing nonoxynol-9 can promote vaginal irritation, which may actually increase the possibility of HIV transmission and other sexually transmitted infections.
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Don't do anything that could tear the skin or moist lining of the genitals, anus or mouth and cause bleeding. For instance, trauma to the mouth caused by rough kissing or other intimate activities could lead to an exchange of blood.
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Avoid alcohol and illicit drugs. Alcohol and drugs can impair your immune system and your judgment. If you use drugs, do not share "injecting drug works" such as needles, syringes or cookers.
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Do not share personal items such as toothbrushes, razors and devices used during sex that may be contaminated with blood, semen, or vaginal fluids.
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Seek early diagnosis and treatment if you have any symptoms of sexually transmitted diseases. Other sexually transmitted diseases may increase your risk of HIV infection.
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Realize that you cannot tell by looking who is HIV-infected. In fact, a person can be infected and go years without any symptoms. During this time, however, they are still infectious.
For those already infected, combinations of antiviral drugs may reduce the ability to transmit the virus to a partner, with research finding that the drugs reduce the amount of virus in bodily secretions. Until the impact of treatment on transmission has been determined by large studies, however, this should not be considered a form of prevention.
For women who have sex with other women (WSW), the risk of HIV transmission is small. However, surveys of risk behaviors within some WSW groups indicate relatively high rates of high-risk behaviors, such as injection drug use and unprotected vaginal sex with gay/bisexual men and injection drug users. To minimize risk, you should:
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Understand that exposure of a mucous membrane, such as the mouth, (especially non-intact tissue) to vaginal secretions and menstrual blood is potentially infectious, particularly during very early and late-stage HIV infection when the amount of virus in the blood tends to be highest.
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Use dental dams, cut-open condoms or plastic wrap to help protect yourself from contact with body fluids during female-to-female oral sex.
Researchers are working hard to find other ways to prevent HIV transmission. Two of the most promising are vaccines and anti-microbials. Neither, however, is expected to reach the market for many years.
