Page 44 - AIDSBK23C

Page 44

PREVENTION OF HIV TRANSMISSION

The transmission of HIV in definable risk groups allows control measures to be taken that
prevent the spread of AIDS. Since HIV is primarily spread as a sexually transmissible disease,
then educational efforts must be aimed at sexually active persons and must be explicit regarding
the behaviors that lead to the spread of HIV. A significant number of both boys and girls
become sexually active as teenagers and must be included in prevention strategies. Given that
the level of promiscuity will often be difficult to modify within a population, then educational
campaigns are best focused upon the use of barrier precautions, particularly condom use. All
sexually active persons with more than one sexual partner, or whose partner is a member of a
risk group for AIDS, should use condoms. Persons who know that they are infected with HIV
should inform their sexual partners.[243,244,245] Sexual activity does not appear to increase
with condom use.[127]
Socioeconomically disadvantaged persons, and women in particular, are at increased risk
for HIV infection. They have more limited educational opportunities. They may not have access
to treatment for sexually transmitted infections and for HIV testing. They often lack access to
antiretroviral therapy following infection.[246,247,248]
The spread of HIV by injection drug use creates a major reservoir for HIV infection that
can then be transmitted to other segments of the population, particularly heterosexual adults,
including the sexual partners of injection drug users. Drug users must be educated about the
risks of needle sharing. Cleaning of needles with undiluted bleach appears effective in
preventing HIV transmission.[249] They can be provided with clean needles to prevent the

spread of HIV, and can be advised to use condoms.[250] Congenital AIDS can be prevented by
efforts to educate women of childbearing age about the hazards to the fetus if they are HIV-
infected. Potential mothers can be provided with means of contraception. Antiretroviral therapy
for mothers can reduce perinatal HIV transmission. Confidential HIV testing should be made
available along with counseling services to persons in all risk groups to encourage voluntary
testing and prevent unknowing transmission of HIV.[251]
Transmission of HIV through blood product therapy has become vanishingly rare when
screening and testing of donors is applied. Such screening is costly. Since HIV infection is not
spread by casual contact in public places, households, or in the workplace, no modifications of
routine activities of daily living or work practices is necessary. Insect vectors do not spread
HIV, and insect control programs will have no effect upon HIV transmission in a population.
HIV/AIDS prevention programs have successfully produced long-term behavior change
with reduction in incidence of HIV infection.[252] In order for such programs to be effective,
several principles must be applied: sustained interventions are more likely to lead to sustained
behavior change; more intense interventions are more likely to result in greater risk reduction;
accessibility to devices (such as clean needles and condoms) that are necessary to safer practices
reduces the risk for HIV infection; modification of community norms appears to enhance
behavior change; and explicit HIV prevention programs must be provided prior to the time that
adolescents become sexually active.[16]
A summary of AIDS prevention strategies is given below: