The most effective way to prevent HIV disease is to avoid exposure to HIV.
Globally, the most significant measures to prevent the spread of HIV are the reduction in the number of sexual partners and the adoption of safe-sex. Vertical transmission may be reduced if viral load is reduced by combination anti-viral therapy.
Risk factors for HIV infection are well characterised and should be avoided:
- unprotected anal sex
- sharing of needles by intravenous drug abusers
- sex with high-risk partners e.g. prostitutes
In the developed world, nosocomial HIV infection is rare now that blood products are screened. In the developing world nosocomial HIV infection is common.
Prevention strategies include:
- in sexually transmitted HIV – advice about
- abstinence
- monogamy
- promoting safe sexual practice e.g. – use of condoms in vaginal, anal and oral sex, use of water-based lubricant instead of oil-based lubricants since they degrade latex, use of dental dams during oral sex (latex sheets which cover womens genitalia during oral sex) (2), reduced numbers of sex partners (1)
- in mother to child transmission - with proper interventions the rate of vertical transmission can be reduced from 20% to about 1%. Preventing methods include:
- antiretroviral therapy in pregnancy
- antiretroviral treatment at delivery plus a short course for the baby
- elective caesarian section – although this might not be useful in women with low viral loads
- avoidance of breastfeeding
- in parenteral transmission of HIV
- preventing people from using injected drugs by educating them
- people already using injected drugs – provide support to give up drugs, recommend safer alternatives such as methadone or buprenorphine, educate them about safer injecting practice, exchange of needles and syringes for new ones on an anonymous basis
- in blood-borne transmission of HIV
- taking necessary precautions when handling blood and body fluids
- screening all blood and organ donors (3)
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