HIV Prevention

Understanding HIV, Prevention, Care, and Treatment

HIV Prevention Works!

The United States’ HIV prevention investments have paid off. Prevention has helped slow the rate of new HIV infections in the United States from over 150,000 in the mid 1980s to around 40,000 per year now – a remarkable decline, but new infections are still unacceptably high. AIDS remains a crisis in the U.S.ⁱ

But prevention’s successes have not been as evident among the populations now at greatest risk, particularly people of color, younger MSM and women. The challenge now is to continue to develop targeted, effective, sustained prevention efforts that build community capacity to deliver ongoing, lifelong prevention programming for those at risk and those already infected.ⁱⁱ

Successful prevention efforts avert HIV infection. The most effective prevention works at multiple levels simultaneously – at individual, social network and community levels, as well as at the structural level – addressing the sometimes hidden societal barriers to effective prevention (i.e. stigma and complacency). Successful prevention provides support for healthy decision-making for people at risk for HIV infection and for those who are already infected, to help them avoid spreading the virus to others.ⁱⁱⁱ

The Center for Disease Control and Prevention (CDC)’s: HIV Prevention Strategic Plan Through 2005, outlines the following continuum of HIV prevention and treatment:

• Individuals use the full array of existing prevention interventions and services to adopt and maintain HIV risk reduction behaviors.
• Individuals determine their HIV status through voluntary counseling and testing as early as possible after their exposure to HIV.
• If they test negative for HIV, they use the full array of existing prevention interventions and services to adopt and maintain HIV risk reduction.
• If they test positive for HIV, they use quality prevention services to and work to adopt and sustain lifelong protective barriers to avoid transmitting the virus to others.
• If they are HIV-infected, they enter the care system as soon as possible to reap the benefits of ongoing care and treatment.
• Once in the care system, they benefit from comprehensive, high quality services, including mental health and substance abuse treatment services; treatment for HVI infection; prevention, prophylaxis (preventative treatment) and treatment of opportunistic infections and other infections, such as STDs and TB.
• In conjunction with their providers and support networks, they work to develop strategies to optimize adherence to their prescribed therapies.

For more information about CDC’s HIV Prevention Strategic Plan Through 2005 go to: http://www.cdc.gov/hiv/resources/reports/psp/index.htm

ABC’s of HIV Prevention

HIV prevention requires the work of individuals, groups, communities, and institutions. The following “alphabet soup” may assist individuals, groups, communities, and institutions understand their potential roles in HIV prevention.

Safer Sex

Safer sex is the term describing sexual practices that minimize the exchange of blood, semen, and vaginal fluids. Safer sex is achieved by incorporating latex or polyurethane condoms and water-based lubrication into every sexual activity, be it vaginal, anal, or oral.

Why Safer Sex?

The risk of HIV, STDs, and unplanned pregnancy is real. For those individuals that choose not to abstain from sex, safer sex practices provide a good method of reducing one’s risk.

Condoms…aren’t they ineffective?

• Many people argue that condoms are ineffective, inconvenient, unreliable, and prone to breaking. Condoms can be ineffective, inconvenient, unreliable, and prone to breaking…WHEN USED INCORRECTLY! Condoms are not inherently ineffective, unreliable, or prone to breaking but are at risk of human error. Common examples of human error included the following:
  Not Checking the Expiration Date
• Leaving condoms in wallets, glove compartments, and other hot and humid places
• Using oil-based lubricants (i.e. body lotion, petroleum jelly, baby oil, etc)
• Storing condoms in places where they can be poked by pens, pins, pocketknives, etc
• Putting the condom on incorrectly – Not pinching the tip; Not rolling the condom down the to the base of the penis; Putting the condom on inside out.
• Inconsistent or occasional condom use.

In a June 2000, the National Institute of Health (NIH) in collaboration with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the United States Agency for International Development (USAID), released a report discussing efficacy of correct and consistent condom usage for the prevention of HIV, the virus that causes AIDS, and other sexually transmitted diseases (STDs), specifically Chlamydia, Gonorrhea, Trichomoniasis, Syphilis, and other genital ulcer diseases. That full report, entitled Scientific Evidence on Condom Effectiveness in Sexually Transmitted Disease Prevention is available at: http://www.niaid.nih.gov/dmid/stds/condomreport.pdf

10 Steps to Using a Condom
See how much effort goes into proper condom use before sex even begins.

1. Buy/Obtain Latex or Polyurethane Condoms
2. Store properly (not in extreme temperatures, no in places where easily and continually bent)
3. Check Packaging – Expiration Date and Damage to the Condom
4. Open Condom Package – Avoid using teeth
5. Squeeze tip of condom and place on the head of an erect penis
6. Hold tip of condom and unroll condom down to the base of the penis. Note: If condom does not roll it has probably been put on inside out.
7. Enjoy Safer Sex
8. After ejaculation, while penis is still erect, hold the base of the condom and withdraw from partner.
9. Remove condom from penis.
10. Wrap condom in tissue and throw away. (Don’t flush condom down toilet.)

Practicing Abstinence and/or Safer Sex

Many people attribute HIV/STD risk factors to low self-esteem, lack of community, psychological distress, challenges surrounding physical and emotional intimacy, and lack of education. In addition to these factors people also need to examine the circumstances, motivations, and relationship status of the individuals they may be attracted to or choice to have sex with. To manage these complex issues quality programs that promote abstinence or safer sex practices seek to increase the participant’s HIV, STD, and general sexual health knowledge, assertiveness in sexual communications, promote self-esteem and self-efficacy, and delay the onset of sexual intercourse. Programs that also discuss safer sex will seek also to promote consistent and correct condom usage and decreasing the number of sexual partners.

Assertiveness Training

The complex issues discussed cannot be adequately examined without direct contact with a HIV prevention specialist, Prevention Case Manager (PCM), mental health counselor, or substance abuse counselor, or other trained professional. Here, however, basic skills surrounding assertiveness training will be discussed.

Assertiveness is the ability to tell someone how you feel, what you want or need in a way that doesn’t threaten, punish, or put him or her down. Being able to express yourself without anxiety or fear. Assertiveness is frequently confused with aggression (both direct and indirect), the following differentiates between assertiveness, aggressiveness, non-assertiveness.

• Being assertive is a learned skill that ensures that we communicate directly and honestly with one another rather than hoping the other person will figure out what’s on our mind.
• Being aggressive means expressing yourself in a way that is punishing, demanding or threatening to the other person. The person who responds aggressively fails to consider the feelings of the other person. Aggression can be expressed directly or indirectly.
  • Direct Aggression: Name calling and threats
  • Indirect Aggression: Aggressive body language, such as stares, eye-rolling, etc.
• Being non-assertive means that you fail to express yourself in a situation. When being non-assertive, one may not provide direct eye contact, have nervous body language, or hesitant speech.
  
  When it comes to sexual situations assertiveness is extremely important. The Missouri Statewide HIV/STD Prevention Community Planning Group developed the following core elements that aim to increase an individuals risk reduction skills. Assertiveness implies that an individual will be able to successfully negotiate or refuse in sexual situations.

Core Elements for Comprehensive Risk Reduction Negotiation

The above description of assertiveness, does not presume that in situation were one’s safety may at risk (i.e. domestic violence, sexual assault, or aggressive relationships) that these skills alone will be able to prevent or stop violence. To contact a domestic violence counselor, call the National Domestic Violence Hotline at (800) 799-7233 or http://www.ndvh.org. For Missouri specific information go to Missouri Coalition Against Domestic Violence website at http://www.mocadv.org, for domestic violence services (i.e. crisis counseling, shelter, etc.) near you.

What resources are available?

In the State of Missouri there a number of HIV/AIDS service organizations that work specifically with individuals, groups, and institutions to increase understanding surrounding HIV/AIDS.

Awareness Education
The American Red Cross has chapters throughout the State of Missouri, which offer HIV/AIDS Instructor Training Courses. Information about these services can be accessed at the National American Red Cross website at http://www.redcross.org

Prevention Education, Risk/Reduction and Prevention Case Management Services
The Department of Health and Human Services - The Center of Disease Control and Prevention and the Missouri Department of Health and Senior Services contracts with agencies throughout the state to provide prevention education and risk reduction counseling. To discover which organizations are receiving funds from the Center for Disease Control and Prevention or the Missouri Department of Health and Senior Services go to http://www.communityconnection.org, call (573) 751-6475 or fax (573) 751-6447.

What youth specific resources are available?

Abstinence Only Education
The Department Health and Human Services – Health Resources and Services Administration, under Title V, Section 510 and the Missouri Department of Health and Senior Services contracts with agencies throughout to the state to abstinence only education to youth throughout the state.

To discover with organizations are receiving Title V funds in your community go to http://www.communityconnection.org, call (573) 751-6215 or fax (573) 526-5347.

Comprehensive Sexual Health Education
The Department of Health and Human Services – The Center for Disease Control and Prevention and the Missouri Department of Health and Senior Services contracts with agencies throughout the state to provide comprehensive education specifically targeting youth. To discover which organizations are receiving funding go to http://www.communityconnection.org, or contact:

Statewide Prevention Planner
Telephone: (573) 751-6475
Fax: (573) 751-6447
Email: info@dhss.mo.gov

The following organizations are national resources surrounding issues of youth and sexual health.

AIDS Alliance for Children, Youth, and Families
AIDS Alliance for Children, Youth & Families is the only national organization focused solely on the needs of children, youth, and families living with, affected by, or at risk for HIV and AIDS. (See HOPE Campaign)
http://www.aids-alliance.org

Advocates for Youth
Advocates for Youth is dedicated to creating programs and advocating for policies that help young people make informed and responsible decisions about their reproductive and sexual health. Advocates provides information, training, and strategic assistance to youth-serving organizations, policy makers, youth activists, and the media in the United States and the developing world.

www.advocatesforyouth.org—for youth, parents, and education, health, and other professionals who work with youth
www.youthresource.com—by and for gay, lesbian, bisexual, transgender, and questioning (GLBTQ) youth
www.themediaproject.com—for the entertainment industry
www.youthshakers.org—by and for international youth activists
www.ambientejoven.org—by and for Latino GLBTQ youth
www.youthHIV.org—by and for HIV-positive youth and HIV peer educators
www.mysistahs.org—by and for young women of color

Gay, Lesbian, Straight Education Network (GLSEN)
GLSEN envisions a world in which every child learns to respect and accept all people, regardless of sexual orientation or gender identity/expression.
http://www.glsen.org

National Youth Advocacy Coalition (NYAC)
The National Youth Advocacy Coalition is a social justice organization that advocates for and with young people who are lesbian, gay, bisexual, transgender, or questioning (LGBTQ) in an effort to end discrimination against these youth and to ensure their physical and emotional well being.
http://www.nyacyouth.org

National Network for Youth
The National Network for Youth is dedicated to ensuring that young people can be safe and lead healthy and productive lives.
http://www.nn4youth.org/

Planned Parenthood
Planned Parenthood believes in the fundamental right of each individual, throughout the world, to manage his or her fertility, regardless of the individual's income, marital status, race, ethnicity, sexual orientation, age, national origin, or residence. We believe that respect and value for diversity in all aspects of our organization are essential to our well-being. We believe that reproductive self-determination must be voluntary and preserve the individual's right to privacy. We further believe that such self-determination will contribute to an enhancement of the quality of life, strong family relationships, and population stability.
Based on these beliefs, and reflecting the diverse communities within which we operate, the mission of Planned Parenthood is:

• to provide comprehensive reproductive and complementary health care services in settings which preserve and protect the essential privacy and rights of each individual;
• to advocate public policies which guarantee these rights and ensure access to such services;
• to provide educational programs which enhance understanding of individual and societal implications of human sexuality;
• to promote research and the advancement of technology in reproductive health care and encourage understanding of their inherent bioethical, behavioral, and social implications.
  http://www.ppfa.org

Sexuality Information and Education Council of the United States (SEICUS)
The Sexuality Information and Education Council of the U.S. (SIECUS) is a national, nonprofit organization, which affirms that sexuality is a natural and healthy part of living. Incorporated in 1964, SIECUS develops, collects, and disseminates information, promotes comprehensive education about sexuality, and advocates the right of individuals to make responsible sexual choices.
http://www.siecus.org

Is there a vaccine available for HIV?

There is currently no approved vaccination against HIV infection. Clinical trials are currently taking place around the world to try and develop a vaccine against HIV. As there is no vaccine against HIV it is important that we all protect ourselves from HIV infection, through abstinence and risk reduction (e.g. safer sex, not sharing needles, etc.)

How can I get involved in an HIV vaccine study?

The HIV Vaccine Trials Unit at St. Louis University School of Medicine is currently conducting vaccine trials in Missouri. To learn more about vaccines and the trials go to: http://medschool.slu.edu/hvtu/index.phtml.

ⁱhttp://www.cdc.gov/hiv
ⁱⁱIbid
ⁱⁱⁱIbid