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Protection Against HIV Offered by Other Contraceptive Methods. Spermicides May have activity against gonorrhea, chlamydia Possible increase in mucosal irritation and genital ulcers, especially with frequent use

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Protection against hiv offered by other contraceptive methods
Protection Against HIV Offered by Other Contraceptive Methods

  • Spermicides

    • May have activity against gonorrhea, chlamydia

    • Possible increase in mucosal irritation and genital ulcers, especially with frequent use

    • Recent UNAIDS clinical trial of sex workers in Africa and Thailand found significantly higher HIV seroconversion rates in nonoxynol-9 users as compared to a placebo vaginal lubricant


Protection against hiv offered by other contraceptive methods continued
Protection Against HIV Offered by Other Contraceptive Methods continued

  • Diaphragm

    • No significant protection against HIV transmission

    • Limited STI protection


Protection against hiv offered by other contraceptive methods continued1
Protection Against HIV Offered by Other Contraceptive Methods continued

  • IUD

    • No STI or HIV protection

    • Increased menstrual flow and duration with nonprogesterone containing IUDs may increase transmission risk and risk of anemia

    • No increase in cervical HIV shedding four months after insertion.

Source: Richardson 1999.


Contraception and prevention of hiv infection continued
Contraception and Prevention of Methods HIV Infection continued

  • Hormonal methods: oral contraceptive pills, DMPA, Norplant implants

    • No significant STI or HIV protection

    • May increase genital tract HIV shedding

  • Voluntary sterilization

    • No STI or HIV protection

    • Decreased risk of PID


Stis prevention and treatment
STIs Methods — Prevention and Treatment

STIs, both ulcerative and nonulcerative, facilitate HIV transmission 2–5 fold

  • Condoms

  • Sexual behavior change

  • Recognition of risk factors and early symptoms

  • Syndromic management

    • Genital ulcer disease

    • Urethral discharge in men

    • Vaginal discharge – limitations


Stis prevention and treatment continued
STIs Methods – Prevention and Treatment continued

  • Antenatal screening for syphilis

  • Linkage to programs treating symptomatic men

  • Target high-risk individuals

    • Sex workers and clients

    • Drug users

    • Military personnel

    • Truck drivers



Comparison of Increase in Condom Use with Decline in Reported Male STIs on a National Scale, Thailand, 1989–1994

Source: UNAIDS 2001.


Ways to reduce risk of transmission
Ways to Reduce Risk of Transmission Reported Male STIs on a National Scale, Thailand, 1989

  • Injection drug use

    • Offer drug treatment

    • Avoid sharing or reusing needles or other injection equipment or supplies

    • Offer needle exchange programs

      OR

    • Clean injection equipment with high-level disinfection of needles and syringes by soaking in 0.5% bleach or boiling for 10 minutes

    • Use boiled water to prepare drugs or equipment

    • Clean injection site before injection

    • Safely dispose of syringes after use


Ways to reduce risk of transmission1
Ways to Reduce Risk of Transmission Reported Male STIs on a National Scale, Thailand, 1989

  • Traditional Practices

    • Avoid female circumcision – may increase risk of trauma or bleeding with intercourse

    • Do not share sharp instruments used in ritual cutting, tattooing practices OR

    • High-level disinfect instruments after each use


Mtct transmission with short course oral arv regimens
MTCT Transmission with Short Course Oral ARV Regimens Reported Male STIs on a National Scale, Thailand, 1989


Preventing mtct in low resource settings breastfeeding
Preventing MTCT in Low-Resource Settings Reported Male STIs on a National Scale, Thailand, 1989— Breastfeeding

  • HIV-negative women or women with unknown HIV status

    • Breastfeed exclusively for 6 months

    • Reinforce use of condoms during breastfeeding

  • HIV-positive women

    • Avoid if safe and affordable alternatives available

    • Teach proper attachment of newborn to nipples and frequent breast emptying

    • Seek prompt treatment of mastitis or breast abscess and oral thrush in newborns

    • Breastfeed exclusively for up to 6 months

Photo by: Hugh Rigby, Kenya, 1982


Prevention transfusion related
Prevention Reported Male STIs on a National Scale, Thailand, 1989— Transfusion-Related

  • Prevent or treat causes of anemia and blood loss

    • Malnutrition

    • Malaria

    • Parasitic infestation

    • Pregnancy (repeated pregnancies at short intervals, postpartum hemorrhage)

  • Minimize unnecessary transfusions: Use blood substitutes (crystalloid /colloid) for volume replacement when possible


Prevention transfusion related continued
Prevention Reported Male STIs on a National Scale, Thailand, 1989— Transfusion-Related continued

  • Select donors carefully: Family replacement and paid or professional donors higher risk

  • Screen blood supply


Barriers to prevention for women
Barriers to Prevention for Women Reported Male STIs on a National Scale, Thailand, 1989

  • Stigma of HIV

  • Women often unaware of partner’s infection status or level of risk

  • Women may be unable to negotiate safer sex practices

    • Sexual coercion

    • Domestic violence

    • Economic vulnerability


Prevention lessons learned
Prevention Lessons Learned Reported Male STIs on a National Scale, Thailand, 1989

  • Focusing on high-risk groups is not enough

  • Risk behavior and vulnerability should be emphasized

  • Knowledge and awareness are important but not sufficient

    • Life skills training (sexual negotiation)

    • Condom promotion

    • Long-term change in social norms


Prevention lessons learned continued
Prevention Lessons Learned Reported Male STIs on a National Scale, Thailand, 1989continued

  • Socioeconomic interventions to reduce vulnerability are needed

    • Education of girls

    • Protection of human rights

    • Reduction of stigma


Antiretroviral therapy and prevention
Antiretroviral Therapy and Prevention Reported Male STIs on a National Scale, Thailand, 1989

  • ARV for HIV-infected persons:

    • Reduces risk of sexual transmission

    • Reduces incidence of TB

    • Promotes HIV testing

  • Barriers

    • Complex regimens

    • Resistance issues

    • Side effects and toxicity

    • Cost


Hiv prevention future research
HIV Prevention Reported Male STIs on a National Scale, Thailand, 1989— Future Research

  • Microbicides

  • Postexposure prophylaxis

  • Vaccines


References
References Reported Male STIs on a National Scale, Thailand, 1989

  • Anderson J. HIV and reproduction. In Anderson J (ed): A Guide to the Clinical Care of Women with HIV. HRSA/DHHS, 2001.

  • Armed Forces Research Institute of Medical Sciences. Thailand.

  • Chamratrithirong et al. Review of the 100% Condom Programme, Mahidol University. 2001.

  • Compendium of HIV prevention interventions with evidence of effectiveness. Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia. November 1999.

  • Consultation on STD interventions for preventing HIV: What is the evidence?UNAIDS. May 2000.

  • Female condom-guide for planning and programming. UNAIDS. August 2000.


References continued
References Reported Male STIs on a National Scale, Thailand, 1989continued

  • HIV prevention needs and successes: a tale of three countries. UNAIDS. May 2001.

  • HIV prevention strategic plan through 2005. Centers for Disease Control and Prevention. January 2001. Institute of Medicine. No time to lose: getting more from HIV prevention. September, 2000

  • Male condom technical update. UNAIDS. September 2000. National STD/AIDS Control Programmes. Senegal and Uganda.

  • Richardson BA, Morrison CS, Sekadde-Kigondu C, et al. Effect of intrauterine device use on cervical shedding of HIV-1 DNA. AIDS 13:2091-7, 1999.

  • Royce RA, Sena A, Cates W Jr, and Cohen MS. Sexual transmission of HIV. N Engl J Med 336:1072-8, 1997.

  • Sex and youth: Contextual factors affecting risk for HIV/AIDS. UNAIDS. May 1999.  


References continued1
References Reported Male STIs on a National Scale, Thailand, 1989continued

  • Sittitrai W, Phanuphak P, Barry J, et al. A survey of Thai sexual behaviour and risk of HIV infection. Int J STD AIDS (England), Sep-Oct 1994, 5(5) p377-8.

  • Sweat M, Gregorich S, Sangiwa G, et al. Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania. Lancet 2000;356:113-121.

  • Thongthai et al. Media Effectiveness Survey. Mahidol University. 2001

  • UNICEF, DHS surveys, 1994-1999.

  • The voluntary HIV-1 Counseling and Testing Efficacy Study Group. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomized trial. Lancet 2000;356:103-112.

  • Wang C and Celum C. Prevention of HIV. In Anderson JR (ed): A Guide to the Clinical Care of Women with HIV. DHHS, HRSA, HAB. Washington, D.C. 2001. 


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