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Master Class: HIV Transmission

Several factors are important in determining if the HIV virus can be passed from an infected person to another person. These include biological and social factors and they relate to both the exposed and the “infector” individuals.

This conceptual framework summarises only the biological factors that influence HIV transmission. When assessing the risk of infection, each of them should be considered in turn and as a whole.

Exposure alone is not enough to predict a risk of infection, viral load maters and though there is no direct correlation between viral load and infectiousness, a high viral load has been associated with higher infectiousness. However, a low viral load may not be underrated if exposure is direct through blood, like with IDUs.

When it comes to sex with an HIV-infected person or a person of unknown status, different levels of risk have been attributed to different sexual practices. But this does not mean that the risk is always the same for the same practice. Oral sex may be overall much safer than unprotected anal sex, but oral sex with bleeding teeth and rotten gum isn’t certainly safe!

By and large, there is no clear cut or definitive risk factor and often risk is what we estimate it to be and how we relativise it. The risk of HIV infection is dynamic and depends on many factors who weight differently in the scale. Though there is an agreement that some factors weight more than other this cartoon does not give a weight to each factor identified as this is open to debate and only add to the existing confusion around risk.

Knowing and understanding what these factors are and how they interact one with another to determine the overall level of risk of HIV infection when exposed to the virus, particularly during sexual intercourse, will help individual to assess the risk of being infected.

Thinking inside the Box: You Are the Man!

The expression “thinking outside the box” is one of the most ridiculous fad (common amongst idealist) I have ever heard and I uncontrollably cringe each time I hear it. Thinking outside the box is leading nowhere. Imagine you are lost in the middle of the Sahara with no water and no food, no amount of thinking outside the box if going to help you…

Great discovery and progress were made because people were thinking within the box. They knew the box very well and that’s why they could come up with something innovative. Think about the bankers behind the credit crunch, think about Bill Gates who revolutionised the personal computer. As much as bankers are despised or Bil Gates is despised, they knew the box very well and that’s why they found ways out of it and in the case of Bill, we are nowadays all enjoying the pleasure of endless digression and online nonsense.

Back to business, Orange Cambodia is showing how well they know the “box”, and in this case the TV box. Indeed Orange partnered with USAID to promote HIV awareness through a TV programme they sponsor and called You Are The Man.

Over a two-month period, six Cambodian men between the ages of 18 and 35 will undergo numerous challenges to compete for the title of “real man”.

“This program is very important for men in our country because it will challenge the perception that Cambodian men usually look down on women and go out to drink alcohol,” said Ben L Cheav, brand consultant and media manager of the Orange Brand Elements production company, adding that the program will also educate contestants and viewers about the issue of HIV/AIDS.

The six competitors will be given mark and the winner of the show will receive a grand prize of, hold your breath, US$3,000 and a “cool” motorbike!

How cool, and clever, is that! So, how cool it would be if HIV prevention would start “thinking inside the box” and come up witth some innovative campaign?

INTERMEZZO: (not-) Travelling with HIV

“In early 2005, a small but determined group of Korean vigilantes began stalking foreign English teachers (sometimes for months at a time) and feeding the press with sordid stories of their relations with Korean women. Their goal was to influence public opinion and push the government for the means to deport “illegal English teachers” from the country.”

Abandon discriminatory HIV policy
By Ben Wagner
The Korea Herald

There are currently 14 countries which either categorically refuse entry of PLWHA or also require disclosure of HIV infection even for entry for short term stays. These countries are:

Countries which force HIV positive foreigners to leave include (2008-2009 update)

Mumbai’s NGO Campaigns to Normalise Condoms

As I was complaining that lateral thinking was dearly missing when it comes to condom promotion and sale, The National AIDS Control Organisation (NACO) and the Hindustan Latex Family Planning Promotion Trust (HLFPPT) installed two “camouflaged” vending machines in Mumbai as part of a ‘condom normalisation campaign’.

The originality of these Condom Vending Machines (CVM) is that they provide other general products like soaps and snacks too. “When we installed 3000 CVMs in Mumbai and Thane, we observed that people were still apprehensive about being noticed while operating the machine. So this is an attempt to camouflage the process of buying a condom by providing other things too,” said Rajesh Nainakwal, partnership manager for HLFPPT.

The closest picture available on the web comes from Japan and with a bit of imagination the real multi-convenience CVM could easily be pictured.

Interestingly the launch of the campaign coincides with the monsoon as it is believed that “commercial sex sees a spurt during rainy season”.

Let’s hope Mumbai’s men cover themselves before going out…

Protecting the Protection

Condoms sold in safety box at Tesco, London. (C) peripheries

A coalition of labor unions started a campaign to free condom from bondage in a major drug store chain in the US. The “Cure CVS: Unlock the Condoms Initiative” is concerned “that young people are less likely to ask a store associate for access to the condoms, exposing them to a greater chance of contracting HIV/AIDS or becoming pregnant if they don’t use such contraceptives.”

According to The Tennessean, a spokesman for the chain explained that the practice aims at preventing shoplifting in situation where it has reached such a degree that “the product is becoming unavailable for our customers to purchase, we take additional product protection measures.”

Interestingly it seems that not all stores enforce a condom protection policy, but that “in nine of 19 markets where the company locks up condoms, CVS was at least three times more likely to do so in communities of color than in majority white ZIP codes.”

Condom’s theft do happen all over the world. Such thefts could lead to extreme situations where the thief end up being arrested at gun point or face a lengthy jail sentence. Likewise, condom’s protection is not limited to the US (see picture).

What is most deplorable is that condoms being the best prevention method against HIV infection, people are resolved to steal them rather than buy them. It say a lot about how much more work is needed to de-stigmatize sex and if we can’t “decriminalise” sex (from a moral perspective) we won’t be able to do much when it comes to stigma surrounding HIV. It is even more discouraging when epidemiological evidences show that African American are more vulnerable to HIV infection.

Understandably, CVS is here to do business, not to run an HIV prevention programme, though with a bit of lateral thinking – dearly missed when it comes to HIV prevention, it could be possible to both make condoms more accessible whilst preventing them being stolen. Anyone who regularly get his morning coffee shot in a Costa or Starbucks will have noticed the robotic way with which shop assistants ask customers if they would like any cake with their coffee. What about CVS store employees doing the same?

“Any condom with this?“