Protection against hiv offered by other contraceptive methods
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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

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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 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 — 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 – 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


Rates of stis among pregnant women in dakar senegal 1991 1996

Rates of STIs Among Pregnant Women in Dakar, Senegal, 1991–1996

Source: UNAIDS 2001.


Protection against hiv offered by other contraceptive methods

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

  • 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

  • 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


Preventing mtct in low resource settings breastfeeding

Preventing MTCT in Low-Resource Settings — 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 — 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 — 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

  • 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

  • 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 continued

  • 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

  • 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 — Future Research

  • Microbicides

  • Postexposure prophylaxis

  • Vaccines


References

References

  • 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 continued

  • 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 continued

  • 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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