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Prevention of Sexual Transmission HIV "Knowing your epidemic in a particular region or country is the first, essential step in identifying

, selecting and funding the most appropriate and effective HIV prevention measures for that country or region." UNAIDS guidelines for HIV prevention HIV counselling and testing are fundamental for HIV prevention. People living with HIV are less likely to transmit the virus to others if they know they are infected and if they have received counselling about safer behaviour. For example, a pregnant woman who has HIV will not be able to benefit from interventions to protect her child unless her infection is diagnosed. Those who discover they are not infected can also benefit, by receiving counselling on how to remain uninfected. The availability and accessibility of antiretroviral treatment is crucial; it enables people living with HIV to enjoy longer, healthier lives, and as such acts as an incentive for HIV testing. Continued contact with health care workers also provides further opportunities for prevention messages and interventions. Studies suggest that HIV-positive people may be less likely to engage in risky behaviour if they are enrolled in treatment programmes.10 11 The preventative effect of antiretroviral treatment is another reason for scaling up access to HIV treatment. Since 2008 and the Swiss Statement (for more information read AVERT's HIV transmission and antiretroviral therapy briefing sheet), a number of studies have shown that an HIV positive person on antiretroviral treatment with an undetectable viral load has a very low risk of transmitting HIV to someone else.
   Abstain from sex Be faithful if you do not abstain Use a condom if you are not faithful

If young people delay sex in areas with a high HIV prevalence, then this risk avoidance will indeed result in them avoiding infection whilst they are adopting this approach. However, abstinence until marriage does not always ensure safety, because marriage in itself provides no protection from infection. Many people are unsure of the HIV status of their partners, and those who are faithful cannot be certain that their partner is maintaining the same commitment. Abstinence is not a realistic option for the millions of women and girls who are in abusive relationships, or those who have been taught always to obey men. People who do not abstain should do everything possible to reduce risk, including using condoms. “Condoms, when distributed with educational materials as part of a comprehensive prevention package, have been shown to significantly lower sexual risk and activity, both among those already sexually active and those who are not." UNAIDS

Moreover. circumcision requires medical intervention. there are also disadvantages to circumcision as a universal HIV prevention approach which is why on its own. However. he must still abstain.  Withdraw from the partner immediately after ejaculation. when used consistently and correctly. yet ensuring that no air is trapped in the condom's tip. Consistent use of condoms means using a condom from start to finish with each act of intercourse. Effectiveness: Circumcision is much less effective than condom use at preventing HIV transmission. Correct condom use should include  Use a new condom for each act of intercourse  Put on the condom as soon as erection occurs and before any sexual contact (vaginal. be faithful or use condoms to substantially cut his risk of infection. In the laboratory.  Hold the tip of the condom and unroll it onto the erect penis. unlike condoms. whereas circumcision only prevents around 50 percent of infections. Oil-based lubricants such as petroleum jelly (vaseline). but use only water-based lubricants on latex condoms. To carry out the procedure safely requires considerable . cold cream. Hazards of the procedure: Unlike other methods of preventing HIV transmission during sex. holding the condom firmly to keep it from slipping off. If used properly. circumcision does not prevent pregnancy. condoms provide highly effective protection against HIV infection. hand lotion or baby oil can weaken the latex condom and are not recommended. However. Once a boy or man has undergone the procedure he will benefit from the preventive effect for the rest of his life. anal or oral). are the only form of protection that can help stop the transmission of sexually transmitted diseases (STDs) such asHIV. Using a condom also provides protection against other sexually transmitted diseases.  Adequate lubrication is important. and protection against pregnancy. a condom is very effective at reducing the risk of HIV infection during sexual intercourse. If used correctly every time a person has sex. latex condoms are very effective at blocking transmission of HIV because the pores in latex condoms are too small to allow the virus to pass through. “The main reason that condoms sometimes fail is incorrect or inconsistent use. Even if a man has been circumcised. Condoms must be used consistently and correctly to provide maximum protection.Condoms. outside of the laboratory condoms are less effective because people do not always use condoms properly. with no ongoing costs or supply issues to worry about. it is not a solution to the global HIV epidemic. not the failure of the condom itself” The greatest advantage of circumcision is that it is a one-off procedure. leaving space at the tip of the condom.

Effects on transmission of other STDs: Some studies show that circumcision has an effect on the transmission of other sexually transmitted diseases. helping sex workers to group together. and Americans. however. In June 2010 it was reported that 20 fatalities were linked to unregulated circumcisions performed by unqualified surgeons in Eastern Cape Province. newly circumcised men must wait a few weeks for their wounds to heal before having sex. and would struggle to provide widespread access to circumcision. In many of the regions worst affected by HIV. infection or excessive pain. South Africa. demands considerable resources including trained staff. if they don't they are likely to face an increased risk of HIV infection through their broken skin. male circumcision also reduced the incidence of herpes simplex virus type 2 (HSV-2) and the prevalence of human papillomavirus (HPV) among men and adolescent boys. encouraging peer education (where sex workers inform one another about HIV). it has been calculated that rapid roll out of circumcision in high-prevalence African countries would save billions of dollars in the long term by reducing the number of people needing HIV treatment. Many cultures. some may be led to believe that FGC could also reduce the risk of HIV infection. some men will have personal reasons for rejecting circumcision.  Increased sex worker involvement and control over their working and social conditions. In addition. have no tradition of circumcision. Estimated costs vary between $25 and $500 per person in Africa. and some (including Hindus and Sikhs) are strongly opposed to it. in areas where circumcision is already widespread. Acceptability: Circumcision is normal in some communities. Uganda. as performed in the clinical trials. found that in addition to reducing the incidence of HIV infection. Nevertheless. Therefore it is unlikely that this intervention will be able to benefit all parts of the world. Effects on risk taking: If people become too confident about the protective effects of circumcision. and ensuring that laws and policies respect sex workers’ human and citizen rights. . it is a common practise for many Jews.Results from the trial also showed a reduced prevalence and incidence of HPV infections among the female partners of the circumcised adolescent and adult men Experts recommend that campaigns aiming to prevent HIV amongst sex workers should initially focus on achieving three main outcome:  An increased level of condom use and safer sex amongst sex workers and their clients. a clean clinic and sterile tools. Resources required: Safe circumcision. for example excessive bleeding. Side effects of poorly performed circumcision can include serious bleeding and damage to the rest of the penis. Perceptions of female genital cutting (FGC): It has been identified that in communities where FGC is practised and male circumcision for HIV prevention is promoted. educating sex workers and their clients about HIV. the HIV transmission and male circumcision trial conducted in Rakai. For example. reducing the stigma that communities attach to sex work. Women might find it harder to insist on condom use by circumcised partners. If tools are not sterilised before each use then they can transmit infections: there is a real risk that circumcision could actually spread HIV if not performed properly. There are several steps that can be taken towards achieving these goals. A study of a thousand men in Western Kenya found that 25 percent of circumcised males (35 percent in traditional circumcision and 18 percent in a clinical setting) experienced an adverse event. or be keener to visit sex workers. Effective measures include the provision of condoms. even if their culture allows it. publicity of the scientific findings could increase transmission of HIV. It is even possible that. Men who have been circumcised might stop using condoms. Muslims.resources. otherwise it can be very risky. Also.  A reduction in the number of sexually transmitted infections occurring amongst sex workers. they may engage in more high-risk sexual behaviour. health care infrastructure is extremely weak.

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