4-1. How can HIV infection be prevented?


Sexual transmission of HIV can be prevented by: abstinence

monogamous relations between uninfected partners

non-penetrative sex

consistent and correct use of male or female condoms

Additional ways of avoiding infection:

If you are an injecting drug user, always use new needles and syringes that are disposable or those that are properly sterilized before reuse.

Ensure that blood and blood products are tested for HIV and that blood safety standards are implemented.


4-2. What is 'safer' sex?


No sexual act is 100% safe.


Safer sex involves taking precautions that decrease the potential of transmitting or acquiring sexually transmitted infections (STIs), including HIV, while having sex. Using condoms correctly and consistently during sex is considered safer sex.


4-3. How effective are condoms in preventing HIV?


Quality-assured condoms are the only products currently available to protect against sexual infection by HIV and other sexually transmitted infections (STIs). When used properly, condoms are a proven and effective means of preventing HIV infection in women and men.


However, no protective method is 100% effective, and condom use cannot guarantee absolute protection against any STI. In order to achieve the protective effect of condoms, they must be used correctly and consistently. Incorrect use can lead to condom slippage or breakage, thus diminishing their protective effect.


4-4. How do you use a male condom?


Condoms with lubrication are less likely to tear during handling or use. Oil-based lubricants, such as Vaseline, should not be used, as they can damage the condom.


Only open the package containing the condom when you are ready to use it. Otherwise, the condom will dry out. Be careful not to tear or damage the condom when you open the package. If it does get torn, throw it away and open a new package.


Condoms come rolled up into a flat circle. Place the rolled-up condom, right side up, on the end of the penis. Hold the tip of the condom between your thumb and first finger to squeeze the air out of the tip. This leaves room for the semen to collect after ejaculation. Keep holding the top of the condom with one hand. With the other hand, unroll the condom all the way down the length of the erect penis to the pubic hair. If the man is uncircumcized, he should first pull back the foreskin before unrolling the condom.


If the condom is not lubricated enough, a water-based lubricant (such as silicone, glycerin, or K-Y jelly) can be added. Even saliva works well for this. Lubricants made from oil?cooking oil or shortening, mineral or baby oil, petroleum jellies such as Vaseline, and most lotions?should never be used because they can damage the condom.


After sex, the condom needs to be removed the right way.


Right after the man ejaculates ('cums'), he must hold onto the condom at the base, to be sure the condom does not slip off.


Then, the man must pull out while the penis is still erect.


When the penis is completely withdrawn, remove the condom from the penis and throw away the condom. Do not flush it down the toilet.


If you are going to have sex again, use a new condom and repeat the whole process.


4-5. What is a female condom?


The female condom is the first and only female-controlled contraceptive barrier method. The female condom is a strong, soft, transparent polyurethane sheath inserted in the vagina before sexual intercourse.  It entirely lines the vagina and, therefore, with correct and consistent use, provides protection against both pregnancy and STIs. The female condom has no known side-effects or risks and does not require a prescription or the intervention of a health-care provider.


4-6. How do you use a female condom?


Carefully remove the condom from its protective pouch. Add extra lubricant, if desired, to the inner and outer rings of the condom.


To insert the condom, squat down, sit with your knees apart, or stand with one foot on a stool or low chair. Hold the condom with the open end hanging down. While holding the top ring of the pouch (the closed end of the condom) squeeze the ring between your thumb and middle finger.


Now place your index finger between your thumb and middle fingers. With your fingers in this position, keep the top of the condom squeezed in a flat oval. Use your other hand to spread the lips of your vagina and insert the closed end of the pouch.


Once you have inserted the closed end of the pouch, use your index finger to push the pouch the rest of the way up into your vagina. Check to be certain that the top of the pouch is up past your pubic bone, which you can feel by curving your index finger upwards once it is a few inches inside your vagina. You can insert the pouch up to eight hours before your have intercourse.


Make sure that the condom is not twisted inside your vagina. If it is, remove it, add a drop or two of lubricant, and re-insert. Note: About one inch of the open end of the condom will remain outside your body. If your partner inserts his penis underneath or alongside the pouch, ask him to withdraw immediately. Remove the condom, discard it, and use a new pouch. Until you and your partner become familiar with the female condom, it will be helpful if you use your hand to guide his penis into your vagina.


After your partner ejaculates and withdraws, squeeze and twist the open end of the pouch to keep the sperm inside. Pull out gently. Dispose of the used condom (but do not throw it down the toilet).


The re-use of female condoms is not recommended (See WHO information update: Considerations regarding reuse of the female condom (July 2002) for more information)


See also: WHO: Explaining the female condom to potential users


4-7. How can injecting drug users reduce their risk of contracting HIV?


For injecting drug users, certain steps can be taken to reduce personal and public health risks:


Take drugs orally (changing from injecting to non-injecting drug use).


Never re-use or share syringes, water or drug-preparation equipment.


Use a new syringe (obtained from a reliable source, e.g. a chemist or via a needle-exchange programme) to prepare and inject drugs each time.


When preparing drugs, use sterile water or clean water from a reliable source.


Using a fresh alcohol swab, clean the injection site prior to injection.


4-8. How can mother-to-child transmission (MTCT) be prevented?


Transmission of HIV from an infected mother can occur during pregnancy, during labour or after delivery through breastfeeding. In the absence of any intervention, an estimated 15?30% of mothers with HIV infection will transmit the infection during pregnancy and delivery. Breastfeeding increases the risk of transmission by 10?15%. This risk depends on clinical factors and may vary according to the pattern and duration of breastfeeding.


Mother-to-child transmission can be reduced by the following:


Treatments


It is clear that short-term antiretroviral preventative treatment is an effective and feasible method of preventing mother-to-child transmission of HIV. When combined with infant-feeding counselling and support, and the use of safer infant-feeding methods, it can halve the risk of infant infection. ARV regimens are mainly based on the use of nevirapine or zidovudine. Nevirapine is administered in one dose to the mother at delivery, and in one dose to the child within 72 hours of birth. Zidovudine has been shown to decrease the risk of transmission when administered to the mother during the last six months of pregnancy and intravenously during labour and to the baby for six weeks after birth.  Even if zidovudine is administered later in pregnancy, or around the time of delivery, the risk of transmission can be halved. Overall, the efficacy of the various drug regimens is diminished if babies continue to be exposed to HIV through breastfeeding.


Antiretroviral drugs should only be taken under medical supervision.


Caesarian section


A Caesarian section is a surgical procedure whereby the baby is delivered through an incision in the mother's abdominal wall and uterus. Of the babies who are infected through mother-to-child transmission, it is believed that about two-thirds are infected during pregnancy and around the time of delivery. Vaginal deliveries are more likely to increase the risk of mother-to-child transmission, while elective Caesarian sections have been shown to reduce the risk. However, the potential benefits have to be balanced against the risk to the mother.


Avoiding breastfeeding


The risk of transmission from mother to child is increased when the child is breastfed. Although breast milk is considered the best nutrition for a child, it is recommended that HIV-positive mothers replace breast milk with infant formula to reduce the risk of transmission to the child. However, this is advisable only if it covers the child's nutritional requirements, if it can be prepared under hygienic conditions and if it is affordable for the families.


WHO makes the following recommendations:


? When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoiding breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life and should be discontinued as soon as possible.


For more detailed information, see: WHO: Conclusions and recommendations regarding infant feeding


4-9. What procedures should health-care workers follow to prevent transmission in health-care settings?


Health-care workers should follow Universal Precautions. Universal Precautions are infection-control guidelines, developed to protect health workers and their patients from exposure to diseases spread by blood and certain body fluids.


Universal Precautions include:


careful handling and disposal of 'sharps'(items that could cause cuts or puncture wounds, including needles, hypodermic needles, scalpel and other blades, knives, infusion sets, saws, broken glass, and nails) 


hand-washing with soap and water before and after all procedures;


use of protective barriers such as gloves, gowns, aprons, masks and goggles when in direct contact with blood and other body fluids;


safe disposal of waste contaminated with blood or body fluids;


proper disinfection of instruments and other contaminated equipment; and


proper handling of soiled linen.


In addition, it is recommended that all health-care workers take precautions to prevent injuries caused by needles, scalpels and other sharp instruments or devices. In accordance with universal precautions, blood and body fluids from all persons are considered as infected with HIV, regardless of the known or supposed status of the person.


For more information, see: WHO: Universal Precautions, Including Injection Safety


4-10. What should you do if you think you have exposed yourself to HIV?


If you think you've been exposed to HIV, you should get counseling and testing for HIV . Precautions should be taken to prevent to spread of HIV to others, in case you are infected with HIV.