HIV/AIDS Warning: You are not logged in. Your IP address will be publicly visible if you make any edits. If you log in or create an account, your edits will be attributed to your username, along with other benefits.Anti-spam check. Do not fill this in! == Prevention == {{Main|Prevention of HIV/AIDS}} [[File:AIDS Clinic, McLeod Ganj, 2010.jpg|thumb|alt=A run down a two-story building with several signs related to AIDS prevention|AIDS clinic, [[McLeod Ganj]], Himachal Pradesh, India, 2010]] === Sexual contact === <!--Condoms --> [[File:FACING AIDS a condom and a pill at a time - I am FACING AIDS because people I -3 are infected. (5202985364).jpg|thumb|People wearing AIDS awareness signs. On the left: "Facing AIDS a condom and a pill at a time"; on the right: "I am Facing AIDS because people I ♥ are infected"]] Consistent [[condom]] use reduces the risk of HIV transmission by approximately 80% over the long term.<ref>{{cite journal |vauthors=Crosby R, Bounse S |title=Condom effectiveness: where are we now? |journal=Sexual Health |volume=9 |issue=1 |pages=10–17 |date=March 2012 |pmid=22348628 |doi=10.1071/SH11036|doi-access=free }}</ref> When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year.<ref name=WHOCondoms>{{cite web |publisher=World Health Organization |date=August 2003 |url=http://www.wpro.who.int/mediacentre/factsheets/fs_200308_Condoms/en/index.html |title=Condom Facts and Figures |access-date=January 17, 2006 |url-status=dead |archive-url=https://web.archive.org/web/20121018145513/http://www.wpro.who.int/mediacentre/factsheets/fs_200308_Condoms/en/index.html |archive-date=October 18, 2012 }}</ref> There is some evidence to suggest that [[female condom]]s may provide an equivalent level of protection.<ref>{{cite journal |vauthors=Gallo MF, Kilbourne-Brook M, Coffey PS |title=A review of the effectiveness and acceptability of the female condom for dual protection |journal=Sexual Health |volume=9 |issue=1 |pages=18–26 |date=March 2012 |pmid=22348629 |doi=10.1071/SH11037 |url=https://zenodo.org/record/1236046 |access-date=September 4, 2020 |archive-date=October 28, 2021 |archive-url=https://web.archive.org/web/20211028225037/https://zenodo.org/record/1236046 |url-status=live }}</ref> Application of a vaginal gel containing [[tenofovir]] (a [[reverse transcriptase inhibitor]]) immediately before sex seems to reduce infection rates by approximately 40% among African women.<ref name=VagGel2012>{{cite journal |vauthors=Celum C, Baeten JM |title=Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence |journal=Current Opinion in Infectious Diseases |volume=25 |issue=1 |pages=51–57 |date=February 2012 |pmid=22156901 |pmc=3266126 |doi=10.1097/QCO.0b013e32834ef5ef}}</ref> By contrast, use of the [[spermicide]] [[nonoxynol-9]] may increase the risk of transmission due to its tendency to cause vaginal and rectal irritation.<ref>{{cite journal |vauthors=Baptista M, Ramalho-Santos J |title=Spermicides, microbicides and antiviral agents: recent advances in the development of novel multi-functional compounds |journal=Mini Reviews in Medicinal Chemistry |volume=9 |issue=13 |pages=1556–67 |date=November 2009 |pmid=20205637 |doi=10.2174/138955709790361548}}</ref> <!--Circumcision --> [[Circumcision]] in [[sub-Saharan Africa]] "reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months".<ref>{{cite journal |vauthors=Siegfried N, Muller M, Deeks JJ, Volmink J |title=Male circumcision for prevention of heterosexual acquisition of HIV in men |journal=The Cochrane Database of Systematic Reviews |issue=2 |page=CD003362 |date=April 2009 |pmid=19370585 |doi=10.1002/14651858.CD003362.pub2 |editor1-last=Siegfried |editor1-first=Nandi}}</ref> Owing to these studies, both the World Health Organization and [[UNAIDS]] recommended male circumcision in 2007 as a method of preventing female-to-male HIV transmission in areas with high rates of HIV.<ref>{{cite web |title=WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention |publisher=World Health Organization |date=March 28, 2007 |url=https://www.who.int/mediacentre/news/releases/2007/pr10/en/index.html |url-status=dead |archive-url=https://web.archive.org/web/20110703140439/http://www.who.int/mediacentre/news/releases/2007/pr10/en/index.html |archive-date=July 3, 2011 }}</ref> However, whether it protects against male-to-female transmission is disputed,<ref>{{cite journal |vauthors=Larke N |title=Male circumcision, HIV and sexually transmitted infections: a review |journal=British Journal of Nursing |volume=19 |issue=10 |pages=629–34 |date=May 27, 2010 |pmid=20622758 |pmc=3836228 |doi=10.12968/bjon.2010.19.10.48201}}</ref><ref name="pmid19849961">{{cite journal |vauthors=Eaton L, Kalichman SC |title=Behavioral aspects of male circumcision for the prevention of HIV infection |journal=Current HIV/AIDS Reports |volume=6 |issue=4 |pages=187–93 |date=November 2009 |pmid=19849961 |pmc=3557929 |doi=10.1007/s11904-009-0025-9}}(subscription required)</ref> and whether it is of benefit in [[developed countries]] and among [[men who have sex with men]] is undetermined.<ref>{{cite journal |vauthors=Kim HH, Li PS, Goldstein M |title=Male circumcision: Africa and beyond? |journal=Current Opinion in Urology |volume=20 |issue=6 |pages=515–19 |date=November 2010 |pmid=20844437 |doi=10.1097/MOU.0b013e32833f1b21|s2cid=2158164 }}</ref><ref>{{cite journal |vauthors=Templeton DJ, Millett GA, Grulich AE |title=Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men |journal=Current Opinion in Infectious Diseases |volume=23 |issue=1 |pages=45–52 |date=February 2010 |pmid=19935420 |doi=10.1097/QCO.0b013e328334e54d|s2cid=43878584 }}</ref><ref>{{cite journal |vauthors=Wiysonge CS, Kongnyuy EJ, Shey M, Muula AS, Navti OB, Akl EA, Lo YR |title=Male circumcision for prevention of homosexual acquisition of HIV in men |journal=The Cochrane Database of Systematic Reviews |issue=6 |page=CD007496 |date=June 2011 |pmid=21678366 |doi=10.1002/14651858.CD007496.pub2 |editor1-last=Wiysonge |editor1-first=Charles Shey}}</ref> <!--Education --> Programs encouraging [[Abstinence-only sex education|sexual abstinence]] do not appear to affect subsequent HIV risk.<ref>{{cite journal |vauthors=Underhill K, Operario D, Montgomery P |title=Abstinence-only programs for HIV infection prevention in high-income countries |journal=The Cochrane Database of Systematic Reviews |issue=4 |page=CD005421 |date=October 2007 |pmid=17943855 |doi=10.1002/14651858.CD005421.pub2 |url=http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005421/frame.html |editor1-last=Operario |archive-url=https://web.archive.org/web/20101125105707/http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005421/frame.html |url-status=dead |editor1-first=Don |archive-date=November 25, 2010 |access-date=May 31, 2012 }}</ref> Evidence of any benefit from [[peer education]] is equally poor.<ref name="pmid22641791">{{cite journal |vauthors=Tolli MV |title=Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: a systematic review of European studies |journal=[[Health Education Research]] |volume=27 |issue=5 |pages=904–13 |date=October 2012 |pmid=22641791 |doi=10.1093/her/cys055|doi-access=free }}</ref> Comprehensive [[Sex education|sexual education]] provided at school may decrease high-risk behavior.<ref>{{cite journal |vauthors=Ljubojević S, Lipozenčić J |title=Sexually transmitted infections and adolescence |journal=Acta Dermatovenerologica Croatica |volume=18 |issue=4 |pages=305–10 |year=2010 |pmid=21251451}}</ref><ref>{{cite book |url=http://unesdoc.unesco.org/images/0026/002607/260770e.pdf |title=International technical guidance on sexuality education: an evidence-informed approach |publisher=UNESCO |year=2018 |isbn=978-92-3-100259-5 |location=Paris |page=12 |access-date=February 22, 2018 |archive-url=https://web.archive.org/web/20181113072101/http://unesdoc.unesco.org/images/0026/002607/260770e.pdf |archive-date=November 13, 2018 |url-status=live }}</ref> A substantial minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV.<ref name="Patel2008">{{cite journal |vauthors=Patel VL, Yoskowitz NA, Kaufman DR, Shortliffe EH |title=Discerning patterns of human immunodeficiency virus risk in healthy young adults |journal=[[The American Journal of Medicine]] |volume=121 |issue=9 |pages=758–64 |date=September 2008 |pmid=18724961 |pmc=2597652 |doi=10.1016/j.amjmed.2008.04.022}}</ref> Voluntary counseling and testing people for HIV does not affect risky behavior in those who test negative but does increase condom use in those who test positive.<ref>{{cite journal |vauthors=Fonner VA, Denison J, Kennedy CE, O'Reilly K, Sweat M |title=Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries |journal=The Cochrane Database of Systematic Reviews |volume=9 |issue=9 |page=CD001224 |date=September 2012 |pmid=22972050 |pmc=3931252 |doi=10.1002/14651858.CD001224.pub4}}</ref> Enhanced family planning services appear to increase the likelihood of women with HIV using contraception, compared to basic services.<ref>{{cite journal |last1=Lopez |first1=LM |last2=Grey |first2=TW |last3=Chen |first3=M |last4=Denison |first4=J |last5=Stuart |first5=G |title=Behavioral interventions for improving contraceptive use among women living with HIV. |journal=The Cochrane Database of Systematic Reviews |date=August 9, 2016 |volume=2016 |issue=8 |pages=CD010243 |doi=10.1002/14651858.CD010243.pub3 |pmid=27505053|pmc=7092487 }}</ref> It is not known whether treating other sexually transmitted infections is effective in preventing HIV.<ref name=CochraneSTI2012/> === Pre-exposure === Antiretroviral treatment among people with HIV whose CD4 count ≤ 550 cells/µL is a very effective way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP).<ref name=Anglemyer2013>{{cite journal |vauthors=Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N |title=Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |page=CD009153 |date=April 2013 |pmid=23633367 |pmc=4026368 |doi=10.1002/14651858.CD009153.pub3}}</ref> TASP is associated with a 10- to 20-fold reduction in transmission risk.<ref name=Anglemyer2013/><ref name=Chou2012>{{cite journal |vauthors=Chou R, Selph S, Dana T, Bougatsos C, Zakher B, Blazina I, Korthuis PT |title=Screening for HIV: systematic review to update the 2005 U.S. Preventive Services Task Force recommendation |journal=Annals of Internal Medicine |volume=157 |issue=10 |pages=706–18 |date=November 2012 |pmid=23165662 |doi=10.7326/0003-4819-157-10-201211200-00007|s2cid=27494096 }}</ref> [[Pre-exposure prophylaxis]] (PrEP) with a daily dose of the medications [[tenofovir]], with or without [[emtricitabine]], is effective in people at high risk including men who have sex with men, couples where one is HIV-positive, and young heterosexuals in Africa.<ref name=VagGel2012/><ref>{{cite journal |last1=Owens |first1=Douglas K. |last2=Davidson |first2=Karina W. |last3=Krist |first3=Alex H. |last4=Barry |first4=Michael J. |last5=Cabana |first5=Michael |last6=Caughey |first6=Aaron B. |last7=Curry |first7=Susan J. |last8=Doubeni |first8=Chyke A. |last9=Epling |first9=John W. |last10=Kubik |first10=Martha |last11=Landefeld |first11=C. Seth |last12=Mangione |first12=Carol M. |last13=Pbert |first13=Lori |last14=Silverstein |first14=Michael |last15=Simon |first15=Melissa A. |last16=Tseng |first16=Chien-Wen |last17=Wong |first17=John B. |title=Preexposure Prophylaxis for the Prevention of HIV Infection |journal=JAMA |date=June 11, 2019 |volume=321 |issue=22 |pages=2203–2213 |doi=10.1001/jama.2019.6390 |pmid=31184747|doi-access=free }}</ref> It may also be effective in intravenous drug users, with a study finding a decrease in risk of 0.7 to 0.4 per 100 person years.<ref>{{cite journal |vauthors=Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, Chiamwongpaet S, Kitisin P, Natrujirote P, Kittimunkong S, Chuachoowong R, Gvetadze RJ, McNicholl JM, Paxton LA, Curlin ME, Hendrix CW, Vanichseni S |title=Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial |journal=The Lancet |volume=381 |issue=9883 |pages=2083–90 |date=June 2013 |pmid=23769234 |doi=10.1016/S0140-6736(13)61127-7|s2cid=5831642 }}</ref> The [[USPSTF]], in 2019, recommended PrEP in those who are at high risk.<ref>{{cite journal |last1=US Preventive Services Task |first1=Force |last2=Owens |first2=DK |last3=Davidson |first3=KW |last4=Krist |first4=AH |last5=Barry |first5=MJ |last6=Cabana |first6=M |last7=Caughey |first7=AB |last8=Curry |first8=SJ |last9=Doubeni |first9=CA |last10=Epling JW |first10=Jr |last11=Kubik |first11=M |last12=Landefeld |first12=CS |last13=Mangione |first13=CM |last14=Pbert |first14=L |last15=Silverstein |first15=M |last16=Simon |first16=MA |last17=Tseng |first17=CW |last18=Wong |first18=JB |title=Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement. |journal=JAMA |date=June 11, 2019 |volume=321 |issue=22 |pages=2203–2213 |doi=10.1001/jama.2019.6390 |pmid=31184747|doi-access=free }}</ref> [[Universal precautions]] within the health care environment are believed to be effective in decreasing the risk of HIV.<ref>{{cite journal |title=Recommendations for prevention of HIV transmission in health-care settings |journal=MMWR Supplements |volume=36 |issue=2 |pages=1S–18S |date=August 1987 |pmid=3112554 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00023587.htm |archive-url=https://web.archive.org/web/20170709181703/https://www.cdc.gov/MMWR/PREVIEW/MMWRHTML/00023587.htm |url-status=live |archive-date=July 9, 2017 |author1=Centers for Disease Control (CDC)}}</ref> [[Intravenous drug use]] is an important risk factor, and [[harm reduction]] strategies such as [[needle-exchange program]]s and [[Opioid replacement therapy|opioid substitution therapy]] appear effective in decreasing this risk.<ref name=Kurth2011>{{cite journal|author4-link=Sten H. Vermund |vauthors=Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN |title=Combination HIV prevention: significance, challenges, and opportunities |journal=Current HIV/AIDS Reports |volume=8 |issue=1 |pages=62–72 |date=March 2011 |pmid=20941553 |pmc=3036787 |doi=10.1007/s11904-010-0063-3}}</ref><ref>{{cite journal |vauthors=MacArthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, Degenhardt L, Hickman M |title=Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis |journal=BMJ |volume=345 |issue=oct03 3 |page=e5945 |date=October 2012 |pmid=23038795 |pmc=3489107 |doi=10.1136/bmj.e5945}}</ref> === 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]] (PEP).<ref name=Prevention2012/> The use of the single agent [[zidovudine]] reduces the risk of an HIV infection five-fold following a needle-stick injury.<ref name=Prevention2012>{{cite journal |title=HIV exposure through contact with body fluids |journal=Prescrire International |volume=21 |issue=126 |pages=100–01, 103–05 |date=April 2012 |pmid=22515138 }}</ref> {{As of|2013}}, the prevention regimen recommended in the United States consists of three medications—[[tenofovir]], [[emtricitabine]] and [[raltegravir]]—as this may reduce the risk further.<ref>{{cite journal |vauthors=Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, Gomaa A, Panlilio AL |title=Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis |journal=[[Infection Control and Hospital Epidemiology]] |volume=34 |issue=9 |pages=875–92 |date=September 2013 |pmid=23917901 |doi=10.1086/672271 |s2cid=17032413 |url=https://zenodo.org/record/1235708 |access-date=October 20, 2020 |archive-date=June 23, 2019 |archive-url=https://web.archive.org/web/20190623220711/https://zenodo.org/record/1235708 |url-status=live }}</ref> PEP treatment is recommended after a [[sexual assault]] when the perpetrator is known to be HIV-positive, but is controversial when their HIV status is unknown.<ref name=NEJM2011Sex>{{cite journal |vauthors=Linden JA |title=Clinical practice. Care of the adult patient after sexual assault |journal=The New England Journal of Medicine |volume=365 |issue=9 |pages=834–41 |date=September 2011 |pmid=21879901 |doi=10.1056/NEJMcp1102869|s2cid=8388126 |doi-access=free }}</ref> The duration of treatment is usually four weeks<ref name=CochranePEP2007>{{cite journal |vauthors=Young TN, Arens FJ, Kennedy GE, Laurie JW, Rutherford GW |title=Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure |journal=The Cochrane Database of Systematic Reviews |issue=1 |page=CD002835 |date=January 2007 |volume=2012 |pmid=17253483 |doi=10.1002/14651858.CD002835.pub3 |pmc=8989146 |editor1-last=Young |editor1-first=Taryn }}</ref> and is frequently associated with adverse effects—where zidovudine is used, about 70% of cases result in adverse effects such as nausea (24%), fatigue (22%), emotional distress (13%) and headaches (9%).<ref name=AFP2007k/> === Mother-to-child === {{Main|HIV and pregnancy}} Programs to prevent the [[vertical transmission]] of HIV (from mothers to children) can reduce rates of transmission by 92–99%.<ref name=Mother2010>{{cite journal |vauthors=Coutsoudis A, Kwaan L, Thomson M |title=Prevention of vertical transmission of HIV-1 in resource-limited settings |journal=Expert Review of Anti-Infective Therapy |volume=8 |issue=10 |pages=1163–75 |date=October 2010 |pmid=20954881 |doi=10.1586/eri.10.94|s2cid=46624541 }}</ref><ref name=Kurth2011/> This primarily involves the use of a combination of antiviral medications during pregnancy and after birth in the infant, and potentially includes [[bottle feeding]] rather than [[breastfeeding]].<ref name=Mother2010/><ref>{{cite journal |vauthors=Siegfried N, van der Merwe L, Brocklehurst P, Sint TT |title=Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection |journal=The Cochrane Database of Systematic Reviews |issue=7 |page=CD003510 |date=July 2011 |pmid=21735394 |doi=10.1002/14651858.CD003510.pub3 |editor1-last=Siegfried |editor1-first=Nandi}}</ref> If replacement feeding is acceptable, feasible, affordable, sustainable and safe, mothers should avoid breastfeeding their infants; however, exclusive breastfeeding is recommended during the first months of life if this is not the case.<ref>{{cite web |url=https://www.who.int/hiv/mediacentre/Infantfeedingconsensusstatement.pf.pdf |access-date=March 12, 2008 |title=WHO HIV and Infant Feeding Technical Consultation Held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV – Infections in Pregnant Women, Mothers and their Infants – Consensus statement |date=October 25–27, 2006 |archive-url=https://web.archive.org/web/20080409065845/http://www.who.int/hiv/mediacentre/Infantfeedingconsensusstatement.pf.pdf |archive-date=April 9, 2008 |url-status=live}}</ref> If exclusive breastfeeding is carried out, the provision of extended antiretroviral prophylaxis to the infant decreases the risk of transmission.<ref>{{cite journal |vauthors=Horvath T, Madi BC, Iuppa IM, Kennedy GE, Rutherford G, Read JS |title=Interventions for preventing late postnatal mother-to-child transmission of HIV |journal=The Cochrane Database of Systematic Reviews |issue=1 |pages=CD006734 |date=January 2009 |volume=2009 |pmid=19160297 |doi=10.1002/14651858.CD006734.pub2 |editor1-last=Horvath |editor1-first=Tara|pmc=7389566 }}</ref> In 2015, [[Cuba]] became the first country in the world to eradicate mother-to-child transmission of HIV.<ref>{{cite web |url=https://www.who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/ |title=WHO validates elimination of mother-to-child transmission of HIV and syphilis in Cuba |publisher=World Health Organization |date=June 30, 2015 |access-date=August 30, 2015 |url-status=dead |archive-url=https://web.archive.org/web/20150904154356/http://who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/ |archive-date=September 4, 2015 }}</ref> === Vaccination === {{main|HIV vaccine development}} Currently there is no licensed [[HIV vaccine development|vaccine for HIV or AIDS]].<ref name="UN2012Vac" /> The most effective vaccine trial to date, [[RV 144]], was published in 2009; it found a partial reduction in the risk of transmission of roughly 30%, stimulating some hope in the research community of developing a truly effective vaccine.<ref>{{cite journal |vauthors=Reynell L, Trkola A |title=HIV vaccines: an attainable goal? |journal=Swiss Medical Weekly |volume=142 |page=w13535 |date=March 2012 |pmid=22389197 |doi=10.4414/smw.2012.13535|doi-access=free }}</ref> Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. 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