Prevention

How can I avoid sexual transmission of HIV?

Use condoms:when correctly and consistently used, the female condom and the male latex condom are the most effective available tools to reduce the sexual transmission of HIV and other sexually transmitted infections for people having sexual intercourse.

Take prophylactic medication(PrEP):pre-exposure prophylaxis or PrEP is the use of a combination of 2 antiretroviral drugs to prevent the acquisition of HIV infection by uninfected persons. The PrEP drug combination are antiretroviral drugs available for treatment of HIV infection (tenofovir plus emtricitabine).

The World Health Organization (WHO) now recommends that people at substantial risk of HIV should be offered PrEP. In 2014 WHO recommended offering PrEP to men who have sex with men (MSM). On the basis of further evidence of the effectiveness and acceptability of PrEP, WHO has now broadened the recommendation to include all population groups at substantial risk of HIV infection.(As listed in WHO website). This should not be confused with Post-Exposure Prophylaxis which is intended as an emergency measure after a possible exposure to HIV.

PrEP should be an additional prevention choice in a comprehensive package of services that also includes HIV testing, counselling, male and female condoms, lubricants, ARV treatment for partners with HIV infection, voluntary medical male circumcision and harm reduction interventions for people who use drugs.

Be faithful with another HIV-negative partner*: some of us may be in a relationship where we can discuss the need either to be mutually faithful (*if you both know you are HIV-negative) or to practice safer sex within or outside of the relationship (avoiding penetrative sex, using male or female condoms consistently and correctly). This approach is not without risks. For example, a significant proportion of women living with HIV became infected by their husbands/partners, whom they trusted and to whom they were sexually faithful. You may find specific information on condom negotiation and condom misconceptions.

Engage only in non-penetrative sex: another prevention approach is to engage only in non-penetrative sex. Because such activities involve no vaginal or anal penetration, they present no risk of HIV transmission. Oral sex presents an extremely low risk of transmission, although the risk is likely increased if ejaculate is taken into the mouth during penile oral sex or there are genital sores on the partner receiving oral sex, and if the mouth has cuts and/or sores.

Abstain from sex: the safest way to avoid being exposed to HIV infection sexually is to abstain from having penetrative sex. This can mean delaying sexual initiation or, once sexually active, refraining from having penetrative sex.

Is it safe for me and my partner to have unprotected sex if we are both living with HIV?

No. It is possible that unprotected sex between two HIV-infected people will result in transmission of a more virulent or drug-resistant strain of the virus.

Are there other sexually transmitted infections that I should be concerned about?

Yes. In addition to HIV, there are more than a dozen other sexually transmitted infections. They are the main cause of infertility in women and, when left untreated, can lead to complications during pregnancy, for both the mother and the newborn child. In addition, having an untreated sexually transmitted infection increases your vulnerability towards HIV The sexually transmissible human papillomavirus (HPV) can also cause penile and cervical cancer.

Condoms significantly reduce the risk of infection for most sexually transmitted infections. Some infections, however, especially those that cause genital ulcers, may not be prevented if the condom does not cover the infected area. It is therefore very important to be screened regularly for sexually transmitted infections if you have been at risk of acquiring one.

Signs of a sexually transmitted infection can include an unusual discharge from the penis or vagina, burning or pain during urination, and sores or blisters in or around the genitals or mouth. In women, sexually transmitted infections can also cause unusual bleeding (distinct from the menstrual cycle), as well as vaginal pain during sex.

Unlike HIV, which has no cure, most sexually transmitted infections can be cured with relatively simple treatments, which not only eliminate the disease but also ensure that the individual can no longer infect others. The fact that sexually transmitted infections significantly increase the risk of HIV transmission is an important additional reason why it is crucial to obtain immediate treatment for any kind of sexually transmitted infection.

In the event that you have a sexually transmitted infection, you might initially feel ashamed and want to avoid seeing a nurse or doctor. You might even be tempted to try dubious home remedies, take an over-the-counter medication that may not be correct for the infection you have, or even ask your friends for antibiotics. Do not take this approach. Improperly treated sexually transmitted infections will only worsen and may become resistant to available medication. Going for treatment when you have a sexually transmitted infection is not only a sign of self-respect, but also a reflection of your respect for your sexual partner(s). If you have a sexually transmitted infection, alert your partner and advise her/him to seek treatment.

What about male circumcision?

In combination with safer sex practices, male circumcision reduces the possibility of transmission of HIV infection from female to male. The evidence is compelling: a remarkably consistent, partially protective effect (approximately 60% reduction in risk of heterosexually acquired HIV infection for men) has been found across observational studies and in controlled trials conducted in diverse settings. It is emphasized that male circumcision does not provide complete protection against HIV infection. It should never replace other known effective prevention methods but should be considered as part of a comprehensive prevention package, which includes abstaining from penetrative sex, correct and consistent use of male or female condoms, reduction in the number of sexual partners, delaying the onset of sexual relations, and HIV testing and counselling. Given that male circumcision partially reduces HIV risk for men, WHO, UNAIDS and their partners have developed specific policy recommendations for expanding and promoting male circumcision as a method of HIV prevention in countries with high HIV prevalence and low rates of male circumcision, along with operational guidance and tools. Male circumcision is one of the oldest and most common surgical procedures known. It is undertaken for cultural, religious, social and medical reasons. For more information, please refer to www.uncares.org or www.malecircumcision.org.

EXPOSURE TO BLOOD

How do I avoid receiving an HIV-infected blood transfusion?

Blood supplies in most parts of the world are now screened for HIV antibodies. Where blood screening takes place, units of blood infected with HIV are removed from the blood supply, virtually eliminating the risk of transmission. Blood that has not been obtained from appropriately selected donors and that has not been screened for transfusion-transmissible infectious agents such as HIV, in accordance with national requirements, should not be issued for transfusion, other than in the most exceptional life-threatening situations. As personnel of the UN system, we are entitled to information from UN Medical Services about local sources of safe blood. If we receive a blood transfusion while obtaining care through the UN Medical Services or from a UN-affiliated health-care provider, we can be confident that every effort has been made to ensure that the blood is safe.

Unfortunately, in some parts of the world, blood is not always screened. In such places, especially when a blood transfusion is administered by a health-care provider not affiliated with the UN, there can be a risk of exposure to HIV or other blood-borne diseases. If you have any concerns relating to the safety of blood available at your duty station or country, please contact the designated UN official for Security or check the UN Cares Global Medical Database on HIV.

How can I avoid being exposed to HIV-infected blood in the course of my work or in daily life?

Many people engage in activities that could conceivably lead to exposure to another person's blood. Accidents on the road, at home, or at work are not only health risks in their own right, but might conceivably result in blood exposures.

Because HIV cannot be transmitted through intact skin, our first defence is to avoid accidents that might lead to blood exposure. The United Nations HIV/AIDS Personnel Policy emphasizes prevention of road accidents. It is a requirement that all UN personnel and others in UN vehicles wear seat belts at all times. Those of us who are drivers or supervise drivers have an extra responsibility to make sure that seat belts are worn by passengers at all times--whether sitting in the front of the vehicle or in back seats. Outside of UN vehicles, it is recommended that all passengers wear seat belts at all times, regardless of whether or not it is the law.

When accidents do occur, the best approach is to follow what are known as standard precautions. This strategy assumes that everyone is potentially infectious--either with HIV or with another disease, such as hepatitis. Under the approach of universal precautions, no blood exposure is regarded as safe. It is recommended that everyone--not only UN personnel--know and follow standard precautions during first aid and at other times of possible contact with blood.

Following standard precautions requires advance planning and preparation. Because accidents can occur at home as well as at work, be sure that you have ready access to first-aid kits in both locations. According to the standard UN recommendation for first-aid kits, all kits should include latex gloves, to be worn before touching another person's blood or open wound. To clean up spills of blood or other body fluids, use a solution of bleach mixed with water. Bleach is widely available in local markets.

The safest way to avoid being exposed to HIV infection sexually is to abstain from having penetrative sex.

SAFE INJECTION PRACTICES

Is it safe for me to have an injection?

Nobody (including injecting drug users) should ever re-use a needle, syringe, or equipment used for injecting of any kind that has already been used by another person. If you receive medical care from the UN Medical Services or from a UN-affiliated health-care provider, you can be confident that every effort has been made to ensure that injecting devices have not been used before and will not expose you to HIV. If you need to give yourself an injection outside a UN health-care setting, only use single-use disposable needles and syringes. Since safe injection practices are not followed in all health-care settings and since it may not always be possible to purchase sterile injection devices, all medical kits given to travellers in all UN agencies include disposable syringes and needles.

How can injecting drug users protect themselves from HIV?

Unprotected sexual intercourse and the use of contaminated needles or syringes for the purpose of injecting drugs account for the top two sources of new HIV infections. Individuals who use drugs should take steps to prevent their exposure to HIV, in particular, by ensuring that if drugs are injected, a clean needle/syringe is used every time. In many parts of the world where injecting drug use is known to be prevalent, needle/syringe-exchange programmes for injecting drug users, to ensure access to sterile injecting equipment. Studies show that such programmes reduce the risk of HIV transmission without contributing to an increase in drug use. Drug treatment is also an important means of reducing the harm associated with drug use. Opioid substitution therapy, with the use of prescribed methadone or buprenorphine, is available in many countries and has been shown to successfully reduce the harm caused by drug injecting, including the risk of becoming infected with HIV. Undergoing a successful drug rehabilitation programme can also contribute to avoiding HIV infection through injecting drugs. UN medical insurance plans cover the costs of such treatment programmes. To find out about possible treatment plans, speak to the UN Medical Services or to a UN-affiliated health-care provider.

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