Comprehensive Overview of HIV/AIDS:
State of Kentucky Mandatory Training

HIV Prevention

HIV Vaccine

The development of an effective HIV vaccine has eluded scientists since the beginning of the pandemic. Traditionally vaccines have been developed from live or attenuated organisms that stimulate the development of antibodies to the organism when injected into a healthy person. In this way, the immune system develops a "memory" of the invading organism and is able to mount a rapid response to prevent the organism from causing serious illness. HIV vaccine development has been complicated by the number of different viral strains and mutations. HIV mutation is encouraged by non-adherence to medication, and also by natural processes that occur during viral replication. A person may start with a virus with several mutations and within years develop a virus that is "wild type," meaning that it has changed characteristics from the original virus. None of the vaccines currently under development use live HIV or any organisms that could cause HIV/AIDS in humans.

Several vaccines are being tested in the U.S. and developing countries but further testing will be needed before any product will be available for use.

Risk Reduction Methods

Methods for reducing the risk of sexual and drug-related transmission of HIV include:

• Abstinence from sex;
• Monogamous relationships or limiting the number of partners;
• Safer sex practices;
• Avoidance of injecting drug use;
• Needle exchange programs;
• Cleaning drug works.
• Standard/Universal precautions and barrier protection.

Sexual abstinence means not engaging in anal, vaginal or oral intercourse or other sexual activities where blood, semen or vaginal fluid can enter the body. It is a completely safe and 100% effective method for preventing the sexual transmission of HIV.

Some people may choose to have non-penetrative sexual contact instead of penetrative intercourse (oral, anal or vaginal). This practice will not transmit HIV, provided that there is no exchange of blood, semen, vaginal fluids or breast milk in the sexual contact. However, non-penetrative sexual intercourse may still be a risk factor for the transmission of other sexually transmitted diseases.

Monogamous long-term relationships, that is having sex with only one person who only has sex with you, is another choice to prevent/reduce the risk of HIV infection. If neither partner is infected with HIV or other STDs, and neither has other sexual or injection equipment-sharing contacts, then neither partner is at risk of exposure to HIV or other STDs. It is crucial that both partners be tested for HIV and STDs and remain monogamous.

The decision to limit the number of sexual or drug-injecting partners may reduce the risk of HIV transmission, but is not a guarantee of safety. The fewer the partners, the greater the reduction of risk.

Safer sexual practices include the use of latex barriers such as male and female condoms or dental dams. When used correctly and consistently during sexual activity (anal, vaginal and oral), they are highly effective in preventing the transmission of HIV.

Instructions for Using a Male Condom

• Check the expiration date of the condom, which is on the package. The condom package should look like a small inflated pillow. Look at the corners of the package and notice how they are filled with air. A condom with a broken seal will not do this. Open the package at the end so that you don't damage the condom. Many condom packages have a notch in the edge of the packaging as a place to begin tearing.
• Condoms may stick to skin and hair so it is recommended to use them with only water-based lubricant-do not use condoms with spermicide, also known as nonoxynol-9. In people with an allergic reaction to the spermicide, nonoxynol-9 can result in little sores that make the transmission of HIV and sexually transmitted diseases (STDs) more likely. Be sure to check the label of any lubricant before using it.
• Put on the condom as soon as the penis is hard. Be sure the roll-up ring is on the outside facing away from the penis. Hold the tip while you unroll the condom along the length of the penis to the hair. Because a condom rolls down the penis, it can only go on one way. If you ever try to put a condom on with the wrong side onto the penis, throw it away and start with a new, unopened condom. Never unroll the condom before putting it on the penis.
• While unrolling the condom, be sure to leave some space at the tip to hold the semen---about one-half to one inch at the tip of the condom. Some condoms have reservoir tips. (If there is not enough room at the tip, the semen could break the condom.) Squeeze the tip gently so that no air is trapped inside.
• When putting the condom on, avoid tearing it with fingernails, jewelry, or anything else sharp or metallic.
• A condom fits rather snuggly on a penis, so rolling it down can be difficult. Be gentle, so as not to injure the penis or cause discomfort. It is important that the penis stay erect in order to apply the condom.
• Right after ejaculation the penis should be pulled out slowly while it is still hard. Hold the condom in place on the penis to avoid spilling semen. While holding the tip, roll the condom up only a portion of the way and then gently pull it off of the penis.
• You need to use a new condom every time that you have sexual intercourse. Never use the same condom twice.
• Dispose of used condoms properly. If possible, wrap them in something like a paper towel or tissue and dispose of them in a trash container. Do not flush condoms as they can easily clog plumbing. Do not throw them away on the ground where they can present a hazard to children and a litter problem.

The female/insertive condom fits inside the vagina or anus. It is made of polyurethane, which blocks sperm and viruses (like HIV). These condoms may be inserted several hours before intercourse.

Instructions for Using a Female Condom

• Check the expiration date. Do not use if the package is broken, the female condom is brittle or dried out, the color is uneven or has changed, or it is unusually sticky.
• Use a new female condom each time you have sex. Use each female condom only once.
• Open the package carefully. Avoid tearing the condom with fingernails or using the condom with jewelry or anything else sharp or metallic.
• Use only water-based lubricants with female condoms.
• Make sure the inner ring is at the bottom closed end of the sheath, and hold the sheath with the open end hanging down.
• Find a comfortable position to insert the ring. Most women will do it lying on their back, squatting, or standing with one foot on a chair.
• With your free hand, spread open the outer vaginal lips. Squeeze the inner ring with thumb and middle finger (so it becomes long and narrow), and then insert the inner ring and sheath into the vaginal opening. Gently insert the inner ring into the vagina and feel it go up. Place the index finger inside of the condom and push the inner ring as far as it will go. Do not worry, it can't go too far. Make sure the condom is inserted straight, and is not twisted inside the vagina.
• The ring at the open end of the female condom should stay outside the vagina and rest against the labia (the outer lip of the vagina).
• Once you begin to engage in intercourse, you may have to guide the penis into the female condom. If you do not, be aware that the penis could enter the vagina outside of the condom's sheath. If this happens, you will not be protected.
• If the condom slips during intercourse, or if it enters the vagina, then you should stop immediately and take the female condom out. Then insert a new one and add extra lubricant to the opening of the sheath or on the penis.
• To remove the condom, twist the outer ring gently and then pull the condom out, keeping the sperm inside. Dispose of used condoms properly. Wrap the condom in the package or in tissue and throw it away. Do not put it into the toilet, since it can clog the plumbing. Do not throw used condoms away on the ground where they can present a hazard to children and become a litter problem.

Only water-based lubricants, not oil-based lubricants like petroleum jelly or cooking oils, should be used to prevent tearing of latex condoms. The use of polyurethane condoms also provides safer sex. These polyurethane male condoms are made of a soft plastic. They look like latex condoms but are thinner. Lab tests show that sperm and viruses (like HIV) cannot pass through polyurethane.

Dental dams, large pieces of new, unused, clear, non-microwaveable plastic wrap, and latex condoms may be used to provide a barrier to reduce the risk of HIV transmission during oral sexual activity with the vagina or rectum. The latex condom should have the tip cut off, then cut down one side, before use. This results in a latex square. Water-based lubricant may be used with the dental dams, plastic wrap or cut-open condoms to enhance sensitivity and reduce friction.

Natural membrane condoms ("skins") are useful for preventing pregnancies and some STDs, such as syphilis. They do not provide protection from HIV, HBV and some other STDs.

Many people believe it's safe for two people who are both infected with HIV to have unprotected sex with each other. Using latex condoms even when both partners are HIV-positive is still advised. Each additional exposure to the virus may further weaken an immune system already damaged by HIV. There is also the possibility of passing other STDs through unprotected sex.

The avoidance of injecting drugs is another way to avoid the risk of transmission of HIV. If entering drug treatment or abstaining from using injecting drugs is not possible, then using a clean needle each time and not sharing injection equipment is better than sharing needles. This includes people who use needles to inject insulin, vitamins, steroids or prescription or non-prescription drugs.

Public support for needle or syringe exchange, has grown in recent years. People who trade in their used syringes/needles for clean syringes/needles significantly reduce their risk for sharing needles and becoming infected with HIV or hepatitis. Syringe exchanges are also referral sources for drug treatment. Many people who began trading syringes were able to access drug treatment through the intervention of the syringe exchange staff and are now no longer using drugs. The state of Kentucky has not legislated a needle exchange program.

If a drug user cannot avoid sharing syringes and needles, than thorough cleaning of works with full strength bleach and clean water has been recommended to kill HIV in syringes/needles. This method is not likely to prevent the transmission of HBV or HCV. These viruses are much stronger and are unlikely to be killed by a brief exposure to bleach.

Because the prevalence of HBV and HCV infection is high among injecting drug users, it is safest to always use new, sterile needles and syringes. They should also avoid sharing the cotton, cooker, water, spoons and other "works," which may also be contaminated with blood.

If there is no possible way to obtain new needles and syringes, the directions for using bleach to clean needles and syringes follows:

• Fill the syringe completely with water. Shake and tap it vigorously to loosen any blood clots. Shoot out the bloody water. Continue this rinsing procedure until there is no "pinkness" or visible blood inside the syringe.
• Completely fill the syringe with fresh bleach. Make certain that the bleach touches all the inside surface of the syringe. Keep the bleach inside the syringe for a minimum of 30 seconds. Shake the syringe, then squirt out the used bleach.
• Repeating Step 2 may provide additional benefit.
• Rinse out the syringe with clean water. Shake the syringe, then squirt out the water.

It is important to follow these steps exactly, because inadequate cleaning can result in the possibility of HIV infection. Always do the final rinse with water!

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