ABCs Of Aids Prevention


Published on

The first behavioral interventions designed to stem the spread of HIV were tested over 25 years ago, within just a few years of the first reported cases of AIDS. Interventions grounded in sound theories of behavior change have since been demonstrated effective at reducing high-risk injection and sexual practices in nearly every population with known risks for HIV/AIDS. Yet the epidemic continues thus it has forced everybody to think of a practicable behavioral interventions.

Published in: Education, Health & Medicine

ABCs Of Aids Prevention

  1. 1. Dr.Sujnanendra Mishra MD (O&G) The ABC’s of AIDS Prevention
  2. 2. HIV prevention Traditionally, prevention is described as being at three levels: -----primary, ------secondary and ---------tertiary.
  3. 3. Primary HIV prevention refers to activity focused on preventing uninfected people becoming infected. Secondary HIV prevention aimed at enabling people with HIV to stay well (e.g. testing to allow people to know their status; welfare rights advice; lifestyle behaviour ; anti–discriminatory lobbying). Tertiary HIV prevention aims to minimise the effects of ill–health experienced by someone who is symptomatic with HIV disease (e.g. the prophylactic use of drugs and complementary therapies )
  4. 4. Two approaches to disease prevention 1. Risk avoidance (abstinence or delay of age of first sex; mutual monogamy. Not injecting drugs, or stopping if already started). 2. Risk- reduction or “remedies” interventions (condoms, treating STIs with drugs, providing clean needles) Some refer to the latter as “Primary Prevention” or “Primary Behavior Change”
  5. 5. Risk avoidance & risk reduction BLOOD Approaches Sex Injection Transfusion Pregnancy RISK AVOIDANCE Abstinence, mutual monogamy safe and appropriate use of injections reducing unnecessary transfusions Routine HIV antibody screening interventions RISK REDUCTION Condoms, STI Rx Sterile syringes quality blood for transfusions Short-course monotherapy Zidovudine ,Nevirapine to mothers and babies Elective Caesarean delivery and breastmilk replacement
  6. 7. PRIMARY PREVENTION Prevention of New Infections • A = abstinence, i.e., delaying sexual debut • B = be faithful, i.e., avoid, or reduce multiple (concurrent) sexual partners • C = condoms, i.e., consistent*condom use if one (or one’s partner) has multiple concurrent sexual partners (assuming one does not increase multiple partnering with the use of condoms) * Consistent condom use is only 80% (or less) protective; inconsistent use has minimal or no protection.
  7. 8. What is the ABC Approach? <ul><li>A= Abstain </li></ul><ul><li>B= Be faithful </li></ul><ul><li>C= use Condoms </li></ul><ul><li>Population specific approach , emphasizing different options for different populations depending on level of risk (risk avoidance as well as risk reduction) </li></ul>
  8. 9. ABC Strategy A Avoid exposure   A bstinence Mutual faithfulness B Reduce exposure B e faithful (Partner reduction) C Block exposure efficiency   C ondom use And D for Drugs, for treating STDs, another prevention method
  9. 10. Abstinence for youth. Abstinence until marriage for those who have not yet initiated sexual activity . “ Secondary abstinence” for unmarried youth who have already engaged in intercourse.
  10. 11. Advantages of Abstinence <ul><li>Abstinence is free and available to all. </li></ul><ul><li>It is extremely effective at preventing both infection and pregnancy. </li></ul><ul><li>It can be started or returned to at any time in one's life. </li></ul><ul><li>Abstinence may encourage people to build relationships in other ways. </li></ul><ul><li>Abstinence may increase the creativity in a relationship as partners find new ways to express intimacy with each other. </li></ul><ul><li>Abstinence may be boost your self-esteem as you are choosing what you consider to be right for yourself. </li></ul><ul><li>Abstinence contributed to a fall in teen pregnancy rates in the '90s along with increase use of Depo-Provera and Norplant. In the near future, Implanon may be an important new option for teens. </li></ul><ul><li>It has no medical side effects. </li></ul><ul><li>It is cost-effective because there's nothing to buy! </li></ul>
  11. 12. Disadvantages of Abstinence <ul><li>Difficult to adhere strictly change of mind in the heat of the moment, one might not have birth control handy. </li></ul><ul><li>It may be very difficult to communicate clearly with a partner about abstinence </li></ul><ul><li>Some people find not having sex too frustrating, and may feel as though they are &quot;missing out&quot;. </li></ul><ul><li>If only abstaining from penis-in-vagina intercourse, there may be no protection against infections transmitted through other activities such as oral and anal intercourse, including herpes, genital warts, gonorrhea, and HIV/AIDS. </li></ul><ul><li>Some who choose to no longer abstain may have little knowledge about other methods. </li></ul>
  12. 13. Poster from Uganda’s AIDS Control Programme in the late1980s B = be faithful “… another loves another.. It’s a circle of love…” Look, listen and decide, Ray Phiri
  13. 14. Faithfulness… <ul><li>Means only 1 partner before marriage </li></ul><ul><li>Means only your spouse in monogamous marriage </li></ul><ul><li>Mixed opinions about how easy or hard it is to be </li></ul><ul><li>faithful, whether it’s a premarital or marital relationship </li></ul><ul><li>For women vs. men: expectations are/should be the same </li></ul><ul><li>Discussing faithfulness with partners is common, but </li></ul><ul><li>mixed opinions about whether it is easy to talk about </li></ul><ul><li>Majority of groups said no way to tell if your partner isfaithful </li></ul>
  14. 15. What supports faithfulness • Love, respect and communication important • Being married can help set the expectation • Religion helps set some rules--- – Faithfulness, --respect, --do not commit adultery. • Sexual satisfaction, harmonious households, education/fear of diseases as reasons for being faithful.
  15. 16. What does not support faithfulness <ul><li>– Money (exchanged or unequal access to or between partners) </li></ul><ul><li>– Coercion or force in relationships, including arranged marriages </li></ul><ul><li>– Inequality in decision‐making between partners </li></ul>
  16. 17. Faithful relationships seen as ideal in terms of romantic expectations and HIV prevention, yet many recognize that the application of “B” is complex and they are not sure how to negotiate this in their relationships. “B” is particularly difficult if relationships are unequal .
  17. 18. C = condoms , What is a Condom? <ul><li>It is a barrier method of birth control </li></ul><ul><li>Prevents pregnancy </li></ul><ul><li>Protects against sexually transmitted infections including HIV Types: </li></ul><ul><ul><li>Male condom </li></ul></ul><ul><ul><li>Female condom </li></ul></ul>
  18. 19. How Does a Condom Work? <ul><li>A condom acts as a barrier, or wall, to prevent semen (cum), vaginal fluid, or blood from being passed between sexual partners during oral, vaginal, or anal sex. </li></ul>
  19. 20. What are the Advantages of Using a Condom? <ul><li>Low cost birth control. </li></ul><ul><li>Easy to find. </li></ul><ul><li>Provide BEST protection against STI. </li></ul><ul><li>Offer extra protection when using another birth control method. </li></ul><ul><li>Men and women share the responsibility. </li></ul><ul><li>Condoms are made from latex and non-latex materials. </li></ul>
  20. 21. How to Take Care of Condom? <ul><li>Store the condom at room temperature. </li></ul><ul><li>Store the condom out of direct sunlight </li></ul><ul><li>Check the expiry date. </li></ul><ul><li>Avoid tearing or putting a hole in the condom. </li></ul><ul><li>Use only water based lubricants. </li></ul><ul><li>Do not use a male and female condom at the same time. </li></ul>
  21. 22. How Do to Use a Condom? <ul><li>Male Condom </li></ul><ul><ul><li>Pinch the top of the condom to squeeze out the air. </li></ul></ul><ul><ul><li>Put the condom on the erect penis before any genital contact. </li></ul></ul><ul><ul><li>Unroll to base of erect penis. </li></ul></ul><ul><ul><li>Right after ejaculation, before the penis is soft – hold the rim of the condom while pulling out. </li></ul></ul><ul><li>Female Condom </li></ul><ul><ul><li>Insert the condom. </li></ul></ul><ul><ul><li>The outside rim will be against the outer labia (lips). </li></ul></ul><ul><ul><li>Remove before standing up. </li></ul></ul><ul><li>Use a new condom every time you have sex. </li></ul>
  22. 23. Important Things to Remember About Condoms <ul><li>Condoms may feel awkward at first. </li></ul><ul><li>If the condom breaks you may want to consider emergency contraception. </li></ul><ul><li>Non-spermicidal condoms are recommended. </li></ul><ul><li>There may be a slight decrease in sensation for the male. </li></ul><ul><li>Do not Put condoms in the garbage . </li></ul><ul><li>Application of ointments may damage the latex condom. </li></ul>
  23. 24. Are condoms effective against HIV/AIDS? <ul><li>Condoms are 80-90% effective in reducing risk of HIV transmission (compared to non-use) when used consistently and correctly </li></ul><ul><li>Inconsistent condom use produces little or no reduced risk </li></ul><ul><ul><li>Inconsistent use IRR = 0.96 </li></ul></ul><ul><ul><li>Consistent use IRR = 0.37 </li></ul></ul><ul><ul><li>(Ahmed et al., AIDS 2001) (also Hearst & Chen ‘03) </li></ul></ul>
  24. 25. Many assume that “ABC misses the point” Nancy Padian, presentation to NIH, 2005 Message Reality Abstain from sex Rape & forced sex Be faithful Infection by partners Wear a condom Coercion & financial dependency Defense of women! for whom ABCs do not apply
  25. 26. Realistic Approach *Consistent condom use is only 80% (or less) protective; inconsistent use has minimal or no protection. D delaying sexual debut R reduce multiple (concurrent) sexual partners C Consistent and correct condom use *
  26. 27. STUDY BASED EFFECTIVE Approach A Abstinence, i.e., delaying sexual debut . B be faithful, i.e., avoid, or reduce multiple (concurrent) sexual partners . C consistent and correct use of CONDOM c CIRCUMCISION c CONTRACEPTION
  27. 28. Has ABC been superceded by SAVE? ANERELA+ (the African Network of Religious Leaders Living with or personally affected by HIV and AIDS) has developed a new model for a comprehensive HIV response, called SAVE . • S afer practices • A vailable medications • V oluntary counseling and testing (VCT) • E mpowerment through education Translation: condoms, pills, testing and “empowerment” (Notice removal of A&B)