HIV/AIDS Prevention and Cure

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.