Lecture Eleven

Prevention of HIV Infection

Introduction

HIV being an incurable disease with long term consequences to the health and life of an
individual, prevention is the most important measure in the fight against the pandemic.
Prevention strategies must identify and minimize the risk associated with the various routes of
transmission while at the same time addressing the many factors that increase the chances of
infection occurring. These factors are complex and relate to biological, socio-cultural, economic
and even political factors.

Risk factors that apply in one community or risk group are not necessarily the ones that will
apply to another group. By the same token measures of prevention that will work with one
group are not necessarily the ones that will apply to another. For this reason any behavior
change initiative aimed at prevention must take into consideration all of these factors and offer
what is appropriate and effective for each situation.

This lecture aims at giving you a comprehensive picture of HIV prevention strategies which can
be applied by the individual as well as at the community level to ensure that new infections are
minimized and infection rates brought down to the lowest levels possible.

By the end of this lecture you should be able to:

1.2 UNIT OBJECTIVES
 Demonstrate knowledge of the various strategies applied in the prevention of HIV.
 Discuss the essential nature of the Behaviour Change Communication approach
 Demonstrate ability to plan a HIV prevention program
PREVENTION OF HIV

The various strategies are applied as explained and where appropriate:

1. Health Education and awareness creation- HIV prevention starts with Health Education and
awareness creation to as many members of a community as possible. People need to have accurate
information on the cause, mode of transmission, symptoms, and ways of identifying the infection, treatment
options and preventive measures. Where accurate information is lacking it is myths and misconceptions
that abound leading to a continuation of risky behaviours and worsening of stigma. Preventive measures
such as Safe Sex practices-Abstinence, Being Faithful to one uninfected partner, Correct and consistent
use of Condoms and De-stigmatization (stigma reduction) which is the “ABCD” of prevention should be
promoted and supported.

2. Behaviour Change Communication ( BCC) initiatives

BCC is defined as “an intervention that works with communities to develop tailored messages
and approaches using a variety of communication channels, to produce sustainable positive
behaviour change in order to achieve health goals such as prevention of HIV.” It is
participatory and involves the target groups in developing and implementing interventions,

BCC has some unique features in its approach that improve the effectiveness of the intervention
undertaken. These features are explained next.

Features of BCC

 Interventions are guided by formative research which helps to identify relevant risk
factors that will need to be modified. By understanding the risk factors affecting a
community the measures that need to taken become clearer
 Uses audience segmentation so that interventions are appropriate for the target group.
This means that in a target community measures to be taken can vary from one category
of member to another. For example married couples may require a different approach
from the one used with teenagers or single young adults
 It goes hand in hand with service provision and provides a supportive environment for
sustained positive behaviour change. This means that if a group is targeted with condom
use as a preferred intervention then there has to be access to condoms for the intervention
to work. Likewise if a group is targeted to increase knowledge of HIV status then there
must be access to HIV testing services such as VCT clinics

Examples of BCC interventions in mass media include“Tumechill”, “Tuwache mipango ya

kando la sivyo weka condom mpangoni.

Page 2 of 8
Voluntary Counselling and Testing

This is a user friendly service, free and widely available –pre-test counselling, testing and post -test
counselling form part of the process. Counselling provides accurate information about HIV, helps to
reduce anxiety about the testing process, prepares the client for the outcome of the test and is an
opportunity to empower the client with information on safe sex practices. After the test, post-test
counselling helps the client to deal with the results and for those found to be infected referral to
Comprehensive Care Centres is arranged. VCT services are organized in various setting as: Integrated
clinics which are based within established health facilities such as hospitals and health centers, Stand-
alone sites which are operated independent of other health facilities , Community- based clinics and
Outreach or Mobile Clinics which are offered at chosen sites where there are potential clients in need of
the services.

Offering of VCT Services is moving towards door to door campaigns where people can be reached and
tested in their homes and moonlighting where testing of clients is carried out in selected sites at night.

Promotion of condom use. By educating people on how to use them, availing condoms conveniently
through dispensers. Social marketing of condom, free in government hospital.

NB- opposed by churches especially Catholic.

Blood safety- This is meant to ensure that HIV transmission through contaminated blood does not occur.
Blood meant for transfusion is properly screened and confirmed safe. Some small element of risk remains
due to the few donors who may be in the Window Period. Measures should also be put in place to reduce
risk associated with use of contaminated needles especially by those who abuse intravenous drugs. This
can be done through rehabilitation of those addicted to drugs, education on safe practices and at times
needle exchange programs which provide sterile needles and syringes for those who are still in addiction
can be put in place. This is a risk reduction measure, It is also important to education people on the
dangers of sharing skin piercing instruments such as during traditional circumcisions and other practices
that lead to bleeding.

Prevention of Mother to Child Transmission (PMTCT). This is achieved through screening of expectant
mothers when they attend antenatal clinics. Those found positive are given appropriate care which include
use of preventive Anti-retroviral medicines, Caesarean Section delivery, and breastfeeding advice.

Post Exposure Prophylaxis (Prevention) or “PEP” is provided for health workers who may be
accidentally injured by contaminated sharp instruments and also to victims of sexual abuse. It involves
provision of Antiretroviral Medicines to those exposed to risk of infection within 72 hours of the exposure.
Screening for HIV is done before such medication is given.

The client who needs PEP should undergo counselling and then tested for HIV. If they are HIV negative
then they are given suitable Antiretroviral Medicine to use for one month.

Page 3 of 8
For cases of sexual assault the client is further counselled to reduce psychological trauma, given antibiotics
to prevent other Sexually Transmitted Medicines and in case of females they should also be given
emergency contraceptives to prevent unwanted pregnancy.

Substance abuse Prevention- Substance abuse contributes to infection directly or indirectly. Those who
inject substances with contaminated needles can be assisted through rehabilitation and in some countries
even needle exchange programs are in place to encourage use of sterile items. Unsafe sex practices are
more likely when people are intoxicated and these can be reduced through behaviour change interventions
and substance abuse prevention.

Early detection and treatment of STIs- The presence of untreated Sexually Transmitted Diseases
increase the risk of HIV transmission as discussed in an earlier lecture. This being the case, it is important
to provide services for the early diagnosis of STIs and prompt treatment of these infections. Prevention of
STIs through promotion of safe sex practices also helps to reduce risk.

Male circumcision campaign- In areas where male circumcision is not practiced widely, this surgical
procedure can be offered as one of the strategies of risk reduction. Offered as Voluntary Medical Male
Circumcision this procedure provides up to 60 percent protection. It must go hand in hand with other well
established HIV prevention measures.

Stigma reduction Stigma contributes to the spread of HIV infection as people fail to seek proper care and
adopt safe sex practices. By providing accurate information about HIV and quality care for those who are
infected; as well as putting in place policies that help to reduce stigma, preventive measures are likely to be
more effective as people are more willing to seek care and adopt safe sex practices in an environment that
is free from stigma.

The 90-90-90 strategy- The UN AIDS has come up with this strategy with a view to controlling the HIV
AIDS pandemic by the year 2030. The key provisions of this strategy is to ensure that 90% of all those
infected with HIV know their status, and that 90 % of all those who are HIV positive are on treatment and 90
percent of all those on treatment are viral suppressed( ie they have undetectable viral loads). This strategy
recognize that if most of those with HIV are on treatment and are viral suppressed the rates of new
infection will drop drastically because those who are viral suppressed are much less likely to infect others
compared to those who are not viral suppressed.

Working with Most at Risk Population- This approach aims at involving those most at risk of contracting
the HIV virus in prevention efforts. Such groups include the men who have Sex with Men, Commercial sex
workers and Intravenous Drug users. By working with such populations to reduce transmission of the HIV
virus, news cases of infection among them and by extension to the rest of the community can be
minimised.

HIV POLICIES

Policies-Policy support for these initiatives is important. Policies are statements of ideals to be pursued as
well as plans of action issued usually by public authorities or other organisations. Policy directives require
Page 4 of 8
that certain actions be taken to achieve set goals and objectives.HIV/AIDS policies have been developed to
respond to the pandemic and ensure that action is taken to address all the various issues arising as a result
of the panendemic such as treatment, prevention, protecting the interests of those infected, mobilizing
resources , fighting stigma and gender inequalities.

Examples of policies that have been put in place are outlined below.

Global Policies

JUNE 2001, UN General Assembly Special Session of HIV/AIDS was held 189 world governments
adopted the declaration of commitment on HIV/AIDS. They undertook to improve responses to HIV/AIDS
and include Civil Society and People Living With HIV/AIDS (PLWHA’S) in their efforts.

1994 – The Paris AIDS Summit adopted a policy of greater involvement of PLWHA’S as critical to ethical
and effective national response to the epidemic.

International Labour Organisation (ILO)- The ILO has a code of practice on HIV/AIDS and the World of
Work.

USA –Besides their domestic policies the USA has programs that undertake international projects. One of
them is the Presidents Emergency Plan for AIDS Relief (PEPFAR) which provide support to HIV/AIDS
projects in other countries.

2006 – High Level United Nations meeting in which member states pledged to eliminate gender
inequalities, gender based abuse and violence and to increase capacity of women and girls to protect
themselves from the risk of HIV infection.

Local Policies

Sessional Paper NO.4 1997 put in place a National Policy, defined an instrumental framework and
intensified intervention measures for the control and mitigation of the HIV/AIDS impact.

Presidential Order in Legal Notice NO. 170 of the 26th of September 1999-Established the National
AIDS Control Council-NACC after AIDS was declared a national disaster.

HIV/AIDS Prevention and Control Bill 2004(gazetted in August 2004 and enacted as the HIV/AIDS
Prevention and Control Act 2006) The bill made provisions such as:

 No person should be forced to undergo a HIV test unless charged with a sexual offence.
 Prohibiting disclosure of HIV status unless written consent is given
 Prohibits discrimination on the basis of actual, perceived or suspected HIV status/

These are just a few highlights and you can read more on them.

PUBLIC SECTOR WORK PLACE POLICY- APRIL 2005

Page 5 of 8
Prepared by the Directorate of Personnel Management (DPM)

Recommends:

 Mainstreaming of HIV/AIDS Policy into all core activities of public sector organisation This means
that every organisation is expected to include HIV prevention in whatever other activities they
conduct. For universities this meant that HIV/AIDS education became integrated into the academic
programs of the university to ensure that all students are reached with the HIV prevention
message. Also other HIV prevention activities such as VCT services, Condom distribution and
stigma reduction are required to be undertaken.
 Budgetary allocations for HIV/AIDS programs- this is to ensure that HIV related activities
 Set minimum internal requirements for managing HIV/AIDS in the public Sector
 Ensure non-discrimination and non-stigmatisation of the infected.
 Contribute to national effort to minimise spread of HIV. Establish AIDS Control Units (ACUs) and
Sub-ACUs.
 The policy takes note that there are other legal and regulatory instruments that underpin the policy
provisions. For example the Constitution of Kenya gives every person the right to non-
discrimination. Also the Service Commission Act provide that issues such as appointment to office
and promotions should be decided on merit, ability, qualification, experience and seniority and NOT
on ones HIV status.
 There are also policies dealing with special areas of prevention such as Voluntary Counselling and
Testing Services, Home based care, Voluntary Medical Male Circumcision among others.

All these policies have an important role to play in ensuring that HIV prevention, care of those infected and
reduction of stigma towards those who are living with the HIV virus are undertaken effectively.

SUMMARY

This lecture highlights the various HIV prevention measures that are in place to prevent new
infections. These measures can be applied in a suitable work plan that is appropriate for the context
in which they are being applied. Prevention of new infections remains the most important measure
in dealing with what has remained an incurable though treatable infection.
Page 6 of 8
Prevention of new HIV infections remains an important priority in
dealing with the threat posed by the HIV/AIDS pandemic. The effort that
has been shown in the preceding period has borne fruit in reducing HIV
prevalence in many countries including Kenya where infection rate has
dropped from highs of 13 per cent in the 90s to the current of around 6
percent. Much remains to be done in order to eliminate new infections
altogether.

References and Further Reading.

1. AIDS in the Work Place Policy Government of Kenya DPM 2005

2. Davidson’s Principals of Medicine 1996 Edition.

Page 7 of 8
3. Kenya AIDS Indicator SURVEY 2007, 2012 Ministry of Health Kenya

4. UNAIDS Website www.unaids.org

Page 8 of 8