Prevention
of HIV/AIDS and Cure
HIV prevention refers to practices done to
prevent the spread of HIV/AIDS. HIV prevention practices may be done by
individuals to protect their own health and the health of those in their
community, or may be instituted by governments or other organizations as public
health policies.
Pharmaceutical
Some
commonly considered pharmaceutical interventions for the prevention of HIV
include the use of the following:
- Microbicides for sexually transmitted diseases
- pre-exposure prophylaxis
- post-exposure prophylaxis
- hiv vaccines
- circumcision (see also circumcision and hiv)[1]
- antiretroviral drugs to reduce viral load in the infected, and
- condoms
Of these,
the only universally medically proven method for preventing the spread of HIV
during sexual intercourse is the correct use of condoms, and condoms are also
the only method promoted by health authorities worldwide. For HIV positive
mothers wishing to prevent the spread of HIV to their child during birth,
antiretroviral drugs have been medically proven to reduce the likelihood of the
spread of the infection. Scientists worldwide are currently researching other
prevention systems.
Increased
risk of contracting HIV often correlates with infection by other diseases,
particularly other sexually transmitted infections. Medical professionals and
scientists recommend treatment or prevention of other infections such as herpes, hepatitis A, hepatitis B, hepatitis C, human papillomavirus, syphilis, gonorrhea, and tuberculosis as an
indirect way to prevent the spread of HIV infection. Often doctors treat these
conditions with pharmaceutical interventions.
Social
strategies
Social
strategies do not require any drug or object to be effective, but rather
require persons to change their behavior in order to gain protection from HIV. Some
social strategies which people consider include the following
- Sex education
- Lgbt sex education
- Needle-exchange programmes
- Safe injection sites
- Safe sex
- Serosorting
- Sexual abstinence
- Immigration regulation
These
strategies have widely differing levels of efficacy, social acceptance, and
acceptance in the medical and scientific communities.
Populations
which receive HIV testing are less
likely to engage in behaviors with high risk of contracting HIV, so HIV testing
is almost always a part of any strategy to encourage people to change their
behavior to become less likely to contract HIV.
Over 60
countries impose some form of travel restriction, either for short or long term
stays, for people infected with HIV.
Sexual
contact
Consistent condom use reduces the risk of heterosexual HIV
transmission by approximately 80% over the long-term. Where one partner of a
couple is infected, consistent condom use results in rates of HIV infection for
the uninfected person of below 1% per year. Some data supports the equivalence
of female condoms to latex condoms however the evidence is not
definitive. The use of the spermicide nonoxynol-9 may
increase the risk of transmission due to the fact that it causes vaginal and
rectal irritation. A vaginal gel containing tenofovir, a reverse transcriptase inhibitor, when used
immediately before sex, reduce infection rates by approximately 40% among
Africa women.
Pre
exposure
Early treatment of HIV-infected people with
antiretrovirals protected 96% of partners from infection. Pre-exposure
prophylaxis with a daily dose of the medications tenofovir with or without
emtricitabine is effective in a number of groups including: men who have sex
with men, by couples where one is HIV positive, and by young heterosexuals in
Africa.
Needle exchange programs (also known as syringe
exchange programs) are effective in preventing HIV among IDUs as well as in the
broader community. Pharmacy sales of syringes and physician prescription of
syringes have been also found to reduce HIV risk. Supervised injection
facilities are also understood to address HIV risk in the most-at-risk
populations. Multiple legal and attitudinal barriers limit the scale and
coverage of these “harm reduction” programs in the United States as well as
elsewhere around the world.
Post
exposure
A course of antiretrovirals administered within
48 to 72 hours after exposure to HIV positive blood or genital secretions is
referred to as post-exposure prophylaxis. The use of the single agent
zidovudine reduces the risk of subsequent HIV infection fivefold following a
needle stick injury.[8] Treatment is recommended after sexual assault when the
perpetrators is known to be HIV positive but is controversial when their HIV
status is unknown. Current treatment regimes typical use lopinavir/ritonavir
and lamivudine/zidovudine or emtricitabine/tenofovir and may decrease the risk
further. The duration of treatment is usually four week and is associated with
significant rates of adverse effects (for zidovudine ~70% including: nausea
24%, fatigue 22%, emotional distress 13%, headaches 9%).
Mother-to-child
As of 2012 there is no effective vaccine for HIV
or AIDS. A single trial of the vaccine RV 144 published in 2009 found a partial
efficacy rate of ~30% and has stimulated optimism in the research community
regarding developing a truly effective vaccine. Further trials of the vaccine
are ongoing.
Law and Law
Enforcement
Laws criminalizing HIV transmission have not
been found an effective way to reduce HIV risk behavior, and may actually do
more harm than good. In the past, many U.S. states criminalized the possession
of needles without a prescription, even going so far as to arrest people as
they leave private needle-exchange facilities. In jurisdictions where syringe
prescription status presented a legal barrier to access, physician prescription
programs had shown promise in addressing risky injection behaviors.
Epidemiological research demonstrating that syringe access programs are both
effective and cost-effective helped change state and local laws relating to NEP
operation as well as the status of syringe possession more broadly. As of 2006,
48 states in the United States authorized needle exchange in some form or
allowed the purchase of sterile syringes without a prescription at pharmacies.
Removal of legal barriers to operation of NEPs and
other syringe access initiatives has been identified as an important part of a
comprehensive approach to reducing HIV transmission among IDUs. Legal barriers
include both “law on the books” and “law on the streets,” i.e., the actual
practices of law enforcement officers,[which may or may not reflect the formal
law. Changes in syringe and drug control policy can be ineffective in reducing
such barriers if police continue to treat syringe possession as a crime or
participation in NEP as evidence of criminal activity. Although most NEPs in the US are now operating
legally, many report some form of police interference.
