Currently, no means exist that have been proven to effectively prevent transmission of all STIs, other than • Abstinence or • Mutual monogamy among uninfected partners
STD & HIV Spread the WordNot the Disease !!! Why ? How ? Do we have an answer?
Why ? • Every individual and couple has the Reproductive Right to enjoy healthy sexual lives free of unplanned pregnancy and sexually transmitted infections (STIs), including HIV.
Why ? • Complications of unintended pregnancy and unsafe abortion are leading causes of reproductive mortality and morbidity among reproductive age females worldwide. • In addition, women and girls are biologically, socially and economically more vulnerable than are their male partners to HIV and other STIs.
How ? • Dual protection is one of the means through which this goal can be achieved • It is defined as simultaneous protection from both pregnancy and HIV / STIs.
Transmission Risks • The probability of an infected person transmitting gonorrhea or syphilis is about 50 percentforeachcoital act with an uninfected person. • The probability of acquiring Chlamydia or viral STIs, especially HIV, during each coital act may be somewhat lower. • A woman's risk of acquiring gonorrhea from an infected partner is aboutdouble that of her becoming pregnant during a single act of unprotected sexual intercourse, even when she is most fertile.
Who needs Dual Protection? • Youth • Men and women who practice "risky" sexual behavior • Sexually active people in areas where STIs and HIV are highly prevalent • Sex workers and clients • Infected people with STIs (including HIV) and their partners
Dual protection programs will only be successful if . . . • STI / HIV / AIDS prevention, testing and treatment services are integrated into sexual and reproductive health (SRH) programs • Service providers are trained to promote dual protection • Condom access and availability is assured • Female condom is introduced and promoted • Dual Protection is incorporated into Preventing Parent to Child Transmission (PPTCT) programs.
STI Protection • In addition to preventing pregnancy, latex condoms are effective in protection against sexually transmitted infections (STIs). • Male condoms may be less effective in protecting against those STIs that are transmitted by skin-to-skin contact, since the infected areas may not be covered by the condom
Failure Rate • The most important factor affecting condom failure isnon-use — not breakage or slippage. • Consistent use reducesHIV incidence by at least 80 percent and perhaps as much as 97 percent. • For protection against unintended pregnancy, condoms are 86percent to 97 percent effective, depending on whether use is typical or ideal, respectively.
"ABC strategy": • In Uganda, these approaches, together with condoms, have been labeled the "ABCstrategy": • Abstinence • Be faithful to one partner or — if "A" or "B" cannot be achieved — use • Condoms. • This ABC approach defines an appropriate role for condoms as an essential part of a larger armamentarium for HIV prevention.
Factors Affecting Use Slippage of condom is related to: (1) Young age (2) Having less lifetime condom experience (3) Being circumcised (4) The donning technique Therefore condom counseling protocols should acknowledge the complexity of condom use. This highlights the need for condoms in various sizes
What is a Female Condom? • It is a thin, soft, loose-fitting polyurethane plastic pouch that lines the vagina. • It has two flexible rings: an inner ring at the closed end, and an outer ring which remains outside the vagina and covers the external genitalia. • Because the device is made from polyurethane, the female condom can be used with any type of lubricant without compromising the integrity of the device.
Female Condom: Advantages • Female-controlled • More comfortable to men, less decrease in sensation than with the male latex condom • Offers greater protection (covers both internal and external genitalia) • More convenient (can be inserted pre-coitus) • Stronger (polyurethane is 40% stronger than latex)
What is a Microbicide ? • These are compounds that can be applied inside the vagina or rectum to protect against sexually transmitted infections (STIs) including HIV. They can be formulated as • gels • creams • films • suppositories • Microbicides may or may not have spermicidal activity (contraceptive effect)
How do they Work ? There aredifferent waysin which microbicides act to prevent infection with genital pathogens. Microbicides may . . . • provide a barrier that keeps HIV from reaching the target cells • act by enhancing the natural vaginal defense • prevent replication of the virus
Why is there a need for methods of disease prevention that women initiate? • Many women lack the power within relationships to negotiate condom use and the social and economic resources to abandon partnerships that put them at risk • Anatomical differences place women at a greater risk of contracting STIs than men • Age-related changes in the cervix make risk of infection even higher for adolescent women • Heterosexual sex, once the source of only a small fraction of HIV infections, now accounts for three out of four new infections in women
Triple Protection? This is a concept that would add the safeguarding of fertilityto protection from unwanted pregnancy and sexually transmitted infections
Concept – Dr. Duru Shah • Contributors Dr. Suchitra Dalvie • Editors Dr. Sangeeta Agrawal Dr. Reena Wani
We acknowledge the efforts of our : Coordinators : Dr. Sangeeta Agrawal - Central Dr. Narendra Malhotra - North Dr. Hema Divakar - South Dr. P. C. Mahapatra - East Dr. Uday Thanawala - West In bringing the FOGSI YOUTH EXPRESS to your city.
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