Combined HIV Prevention

The Combined Prevention is an strategy that simultaneously uses different prevention approaches (biomedical, behavioral, and structural) applied at several levels (individual, in the partnerships/relationships, community, social) to answer to specific needs of certain population segments and of certain forms of transmission of HIV.

The Biomedical Interventions are actions towards the reduction of the exposure risk upon intervention in the interaction between HIV and the person susceptible to infection. Such strategies may be divided into two groups: classic biomedical interventions, which deploy methods of physical barrier to the virus, already widely deployed in Brazil; and Biomedical Interventions based on the use of antiretroviral (ARV).

As example of the first group, there is the distribution of male and female preservatives and lubricating gel. The examples of the second group include the Treatment to All People – TTP; the Post-Exposure Prophylaxis – PEP; and the Pre-Exposure Prophylaxis – PrEP.

The Behavioral Interventions are actions that contribute to the increase of information and perception of the risk of exposure to HIV and to its consequent reduction, upon incentives to changes of behavior of the individual and community or social group he/she is inserted in.

As examples, the following may be mentioned: incentive to the use of make and female preservatives; advisory about HIV/aids and other IST; incentive to the testing; adhesion to the biomedical interventions; bond and retention in the health services; reduction of damages to people that make use of alcohol and other drugs; and strategies of communication and instruction between pairs.

The Structural Interventions are actions towards social-cultural factors and conditions that directly influence the vulnerability of individuals or specific social groups to HIV, involving prejudice, stigma, discrimination, or any other form of disposal of the rights and fundamental guarantees to human dignity.

As examples, the following may be mentioned: actions of handling of racism, sexism, LGBT phobia, and other prejudices; promotion and defense of human rights; educational and awareness campaigns.

Use of preservative

Condom is the most efficient method to get prevented against many sexually transmitted infections, such as aids, some types of hepatitis, and syphilis, for example. Additionally, it avoids an unplanned pregnancy. So, always use condom.

However, the preservative shall not be an option only to who did not get infected with HIV. In addition to avoid the transmission of other diseases, which may even more harm the immunologic system, it prevents against re-infection by the virus causing aids, which may worsen the person’s health even more.

Keep and handle the condom is very easy. Train before – so you do not make a mistake at the time. In the preliminaries, putting the condom on the partner may become a pleasant time. It is only required to follow the correct mode of use. But attention: never use two condoms at the same time. This way, it may rupture or blow.

Circumcision

Male circumcision helps to protect man from infection by HIV from his female partners. However, most of gay men and other HSH contracts HIV through receptive anal sex, and, in such case, the circumcision does not offer protection to the passive partner.

There are researches that show that the circumcision may reduce the risk of the anal sex with no protection to the active partner. When the HIV-negative man is active in anal sex, the risk is reduced at around six times if he is circumcised. However, being circumcised does not offer full protection to a negative-HIV man when the penetrates a positive-HIV man. The risk is reduced, but it is not eliminated, and circumcised men shall always use the preservative to get prevented from infection by HIV, even if they are only active.

Removal of penis before ejaculation

Removing the penis from anus before ejaculating may be a very difficult strategy, because the negative-HIV man that is being penetrated does not have when (and if) the partner that is penetrating him will remove the penis. It is also difficult to the partner that is penetrating to exactly assess when removing the penis, especially in the heat of the moment. Another problem is that HIV is present even before the ejaculation in the pre-semen, and may men secrete such fluid when they are stimulated. Ejaculating outside is five times more risky than not to have anal sex unprotected.

Post-Exposure Prophylaxis (PEP)

The Post-Exposure Prophylaxis, or simply PEP, is a treatment with antiretroviral therapy (TARV) for 28 days to avoid the survival and multiplication of HIV in a person’s body. It is indicated to people that may have had contact with the virus in any situation, such as:

• Sexual violence;
• Unprotected sexual intercourse (without the use of condom or with rupture of the condom);
• Occupational accident (with sharp instruments or in direct contact with biological material).

To work, PEP shall be started right after the risk exposure, within 72 hours. You shall immediately look for a health service that carries out PEP service as soon as you deem to have been in a situation of contact with HIV. It is important to observe that PEP does not serve as substitute to condom. To the contrary: the use of male and female preservatives still is the main and more efficient manner of avoiding HIV. Never fail to use condom and protect yourself in every sexual intercourse.

How does it work?

PEP consists of the ingestion of a pill in a single daily dose, but, depending on the assessment of the health care professional that assists you, you may be then guided to follow another combination of medicines, which means that you maybe needs to take more than one medicine a day. The most important is to have in mind that the treatment, regardless the daily quantity of pills, may not be discontinued during the 28 days of duration, having to be taken as prescribed by the doctor.

It is very important, since, if you do not follow the orientations you received from your doctor, the treatment may fail and, thus, will not prevent that the virus survives and is reproduced in your body, which will make you to contract HIV.

For such, strictly observe the doses, the intervals of use and the duration of PEP, as guided by the professional that carried out the service. As every medicine, the antiretroviral drugs used in PEP may also cause undesired effects. The most common are: headache, sickness, and diarrhea. If you develop any of such symptoms, never interrupt the treatment. Immediately look for the service that assisted you and prescribed PEP to search for orientations regarding such effects. Your doctor will orientate you on how to proceed.

What are IST (Sexually Transmitted Infections)?

The Sexually Transmitted Infections (IST) are caused by virus, bacteria, or other microorganisms.

They are especially transmitted through the sexual contact (oral, vaginal, anal) without the use of male or female condom, with a person that is infected. The transmission of an IST may also occur from the mother to the child during the pregnancy, delivery, or breast feeding.

The treatment of people with IST improves the life quality and interrupts the chain of transmission of such infections. The service and treatment are free in the health services of SUS.

The terminology Sexually Transmitted Infections (IST) becomes to be adopted in replacement to the expression Sexually Transmitted Diseases (DST), because it highlights the possibility of a person having and transmitting an infection, even with no signals and symptoms.

Oral Sex

The risk of transmission of HIV through oral sex is very low. However, there were some cases of infection by HIV, where the only factor of risk was the receptive oral sex with no condom (that is, make oral sex on a man). In such cases, HIV may be transmitted if the negative-HIV man makes oral sex on a positive-HIV man, the positive-HIV man ejaculates inside the mouth and the negative-HIV man has cuts, wounds, or bleeding in the mouth, or has gone through recent dental treatment. Although very rare, all of that may serve as a way to the HIV present in the sperm to enter the body of the negative-HIV partner.