peripheries

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.

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?“

HIV Prevention: Condoms work!

Despite an increase in intergenerational sex amongst female teenagers, despite an increase in the number of multiple partners amongst men age 15-24, despite a decrease in HIV prevention knowledge, the third South African National HIV survey conducted in 2008 showed a promising decline in the number of HIV infections amongst the 15-24 years old.

“HIV prevalence among adults aged 15-49 has declined between 2002 and 2008 in the Western Cape, Gauteng, Northern Cape and the Free State, with the largest decline of 7.9 percentage points in the Western Cape.”

This may well be explained by an increase in condom use:

“The proportion of the population who reported using a condom at their last sexual encounter was particularly high among young people aged 15-24 years: from 57% in 2002 to 87% in 2008 among young males, and from 46% to 73% among young females. This trend was also obvious in condom use among people in the 25-49 age group, where condom use among males aged 25-49 at last sex has nearly doubled, while among females in the same age group it has tripled.”

The survey conducted by by the Human Sciences Research Council (HSRC), in conjunction with the Medical Research Council (MRC) and the Centre for AIDS Development, Research and Evaluation (CADRE), sends a clear message:

Condoms work!

It also hints at a very different kind of HIV prevention intervention as suggested by another observation:

“The good news is that the change in HIV prevalence in children is most likely attributable to the successful implementation of several HIV-prevention interventions,” said Dr Olive Shisana, CEO of the Human Sciences Research Council (HSRC) and one of the two principal investigators of the study. “These interventions are related to addressing HIV in early childhood, particularly programmes to prevent mother-to-child transmission in the Western Cape, where the largest decline of 6 percentage points occurred.”

This is a completely different way of tackling the HIV epidemic with a dramatic shift from prevention to treatment and a focus on addressing sexual behaviours that most contribute to the spread of the epidemic such as multiple partnership and intergenerational sex.

The survey also confirmed that drug users and Men who have Sex with Men (MSM) are amongst those most vulnerable to HIV infection and that specific interventions are needed to reach these groups.

“For the first time, the report provides information on high-risk groups, defined in this study as people who drink excessively, those who take drugs, men who have sex with men and people with disabilities as well as women aged 20-34 and men aged 25-49. More attention should be paid to these categories in the NSP” said Shisana.

Evidences are piling up, action is urgently needed, starting by knowing your status (if the South African can do it and they did – “The percentage of people in the age group 15-49 who reported awareness of their HIV status has doubled from 2005 to 2008”, we can do it too) and by insuring human rights for those most vulnerable.