The Prevention Toolbox
There isn’t one all-inclusive method of preventing HIV. HIV transmission is a many-layered problem that requires an entire toolbox of solutions. This includes strategies, equipment and medication for safe sex, and societal intervention.
What’s in our Toolbox?
|I have HIV||My partner has HIV||I have HIV, and I am pregnant/breastfeeding|
HIV can be found in the following bodily fluids: blood, semen, vaginal fluids and breast milk.
HIV cannot be found in these bodily fluids: saliva, tears, sweat, urine, faeces.
Stands for Pre-Exposure Prophylaxis. It is a pill that needs to be taken every day by people who are HIV-negative and at high risk of being infected with HIV. If you have taken PrEP, then it will protect you from HIV even if the virus is sexually transmitted in your body or injected into your bloodstream.
It is most effective with condom use. PrEP-users should see their healthcare provider every three months for follow-ups. For information on where to get free PrEP, phone the FREE AIDS Helpline on 0800 012 322
Stands for Post-Exposure Prophylaxis. It is a twice-a-day medication for people who have had a single high-risk encounter with HIV. If PEP is taken within 72 hours of first HIV exposure, then there is a chance that the patient will not be infected with HIV. PEP needs to be taken for 28 days after exposure, and the sooner the patient starts PEP, the better.
Someone who needs to take PEP should request treatment at the GP or casualty at a hospital. Find out where your nearest free PEP is using the FREE AIDS Helpline on 0800 012 322
High-risk encounters include sex without a condom, sexual assault and sharing needles.
There are currently no effective microbicides available, but there are ongoing trials in this field. A microbicide is a gel, cream or film that can be applied to the anus or vagina before sex. The gel contains compounds that prevent HIV infection: for example, some create a barrier that blocks the virus from entering the body’s cells, others alter the vaginal pH creating an HIV-unfriendly environment.
Structural – GBV, keeping girls in school, economic empowerment. Launch of the Zimele Project
Gender Based Violence
Women experience a disproportionate amount of HIV to men in Sub-Saharan Africa. Women between the ages of 15-24 are four-times more likely to be infected with HIV than men the same age. Gender-based violence has been identified as a significant driver for HIV infections in women. The occurrence of forced sex makes women more vulnerable to HIV infection, as this can cause tears and lacerations in the vaginal walls.
Women who are at risk of GBV are unable to negotiate condom-use and safe sex or refuse unwanted sex. Social stigma also prevents these women from getting treatment for HIV – many women fear disownment from their family or community if they are thought to have HIV.
These social constraints need to be demolished for any hope of preventing the further spread of HIV.
Keeping Girls in School
In areas with strong gender-role expectations, girls are likely to drop out of school. However, school provides an environment to empower and educate women and ultimately reduce the spread of HIV.
Comprehensive sexual education reduces women’s risk of unwanted pregnancy and unsafe sex. Women who complete their education also have more opportunities when seeking employment. They may also marry later and have children at a later age when they are better equipped to support a family.
It is argued that women’s economic dependence on men makes them vulnerable to HIV, GBV and dissolves their power to negotiate safe sex. HIV risk and poverty has a complex relationship; however, there is evidence that dependent women are at greater chance of being infected with HIV.
Economic empowerment strategies will liberate women so that they do not have the additional risk of male dependence and HIV infection.
The Zimele Project is a health and social intervention scheme that targets youth aged 10-24 years. This age range, especially for women, is vulnerable to dropping out of school and teen pregnancy. The project hopes to encourage girls to stay in school and teach them life skills during workshops, empowerment sessions and health sessions.
Not to forget
Abstinence and Safe Sex
Sex is the number one way that HIV spreads. Abstinence is the most effective form of HIV prevention, however, there are plenty of ways to safeguard yourself and your partner from HIV in the bedroom. Safe sex is the next best way to prevent new HIV cases.
Anal sex has the highest risk of HIV transmission, whereas oral sex has a small risk of infection. Vaginal sex has a lower risk than anal. However, there is still a significant chance of contracting the virus. The risk is greatly reduced with consistent and correct usage of condoms.
Condoms come in both ‘male’ and ‘female’ options. Using one can significantly reduce your chance of spreading Sexually Transmitted Infections, including HIV and of getting pregnant. Male and female condoms should not be used together since they can break.
The male condom is a thin sheath worn over the penis during vaginal and anal sex. It prevents seminal fluid from coming into contact with the partner’s body.
The female condom is a thin bag that lines the vagina during sex. It prevents vaginal fluid from coming into contact with the penis.
Female condoms are sometimes used for anal sex. It is not known how effective this is at preventing HIV but the virus cannot penetrate the condom wall.
The South African government provides free condoms, you can find your nearest dispenser by phoning the FREE AIDS Helpline on 0800 012 322.
Medical Male Circumcision
There is evidence that a medially-performed male circumcision can reduce a man’s risk of being infected with HIV. The foreskin tissue is more susceptible to the virus than the rest of the penis. A circumcision only provides partial prevention – studies have shown a 60% decrease in incidences of HIV in the men who were circumcised. There is no information on whether male circumcision provides lifelong protection.
Circumcision reduces HIV infection risk for men when having vaginal sex with an HIV-positive woman.
Circumcision does not reduce the possibility of infection for women having sex with men, or for men having sex with men.
We are working towards a vaccine – both active and passive
Currently, there is no vaccine for HIV.
However, there is a frenzy of research to make one. At DTHF, the prevention division at the Emavundleni research site is working on trials to develop HIV vaccines. These include both active vaccines (which protect the host from being infected with HIV) and passive (which protects unborn children via inherited immunity from the mother’s vaccine).
There is hope that we will develop a working vaccine after a trial in Thailand in 2006 showed a 31.2% efficacy.
Groote Schuur Hospital-Clinical Research Sites – passive vaccine research
The Treatment and Key Populations teams are recruiting young women and female sex workers (FSW) for an antimicrobial peptide study. This is an infusion of antibodies that provide short-term resistance to the virus for HIV-negative people who are at risk of infection. This research is part of the AMP (antibody mediated prevention) study. Tests have already begun and are predicted to finish in 2020.
Ema Research Site – active vaccine research
This research site is working on trials to develop HIV vaccines. These include both active vaccines (which protect the host from being infected with HIV) and passive (which protects unborn children via inherited immunity from the mother’s vaccine).
The study began in 2016 and is predicted to run for approximately five years. The vaccine is designed to protect HIV-negative people by enabling them to resist infection if they ever come in contact with the virus. Each patient receives a series of injections at five different time points. These include DNA vaccines that rally the body’s defences against the virus and injections where a protein is added that gives the immune system an extra boost.
The team at Emavundleni undertake many research studies on vaccinations for HIV, HPV and TB. Additionally, there is research being undertaken in a long-term PrEP injection as well as a vaginal ring.
Masi Research Site – 3Ps and CHAMPS
The division conducted critical formative research in both:
The 3P’s for Prevention study (Push for funding, Pull in adherence with incentives and Pool data) is a program that is developing affordable, effective new drug regimens to treat TB.
CHAMP (Tuberculosis CHild Multidrug-resistant Preventive therapy) is a study that assesses a child’s risk of developing TB while living with someone who has recently had MDR-TB. This study has to main questions: Will treating children living with an adult who had or has MDR-TB with levofloxacin tablets reduce their risk of developing TB compared to treatment with a placebo (inactive “dummy” tablets)? As well as, Is it safe to treat children living with an adult who had or has MDR-TB with levofloxacin?