HIV PREVENTION

HIV Prevention
•   Prevention is the cornerstone of public-health practice and HIV control
•   Prevention includes:
  o Activities directed at those who are HIV-negative to prevent them from getting infected
  o Activities directed at those who are HIV-positive to prevent them from being
re-infected and infecting others

The Goals of HIV Prevention
• The goals of HIV prevention are:

   o Preventing a person from becoming HIV-positive by promoting ABC: abstinence, being faithful, condom use and safer sex, and use of clean needles
   o Enabling those who are unaware of their HIV status to find out their status and stay healthy

o Preventing those who are already HIV positive from infecting others and from
becoming re-infected

      Populations Vulnerable to HIV Infection Vulnerable Populations and HIV
•     Specific population groups are much more vulnerable to HIV because of a combination of risk factors
•     Social and cultural marginalization or lacks of stable social environment are important risk factors
•     These populations are highly vulnerable to HIV
o Orphans and vulnerable children
More than 13 million children under 15 have lost one or both parents to AIDS
       Orphans have less social and economic support to protect themselves from HIV
     =  May leave school early
     =   Girls may have to sell sex for income
     =  Orphans often become caretakers of younger siblings or care for relatives living with HIV
     These children need education, support, and should be part of HIV prevention programmes

o Men who have sex with men (MSM)
o Injection drug users (IDU)
o Sex workers
o Refugees
o People whose jobs bring them in environment with high risk behaviors i.e. barmaids
o People who experience long periods of separation from families for example
prisoners, migrant workers (miners, military servicemen, victims of human
trafficking), frequent travelling, forest workers or loggers and long truck drivers.
o Health care workers e.g. nurses, doctors, mortuary attendants
IDUs, Sex Workers, and MSM
•    Injection drug users (IDUs), sex workers, and men who have sex with men (MSM) are more vulnerable to HIV infection
•     They are less likely to seek care and treatment because they are socially marginalized and fear violence and arrest
•     Common needs include:
  o Access to safe, confidential, comfortable services, and programmes
  o Tolerant and non-judgmental treatment by health-care workers
•    Each of these groups faces unique challenges
    o IDUs
√Need programmes to treat their addiction
√ Need access to peer outreach, sterile needle exchange, peer counselling
     o Sex workers
ƒ Need access to male and female condoms, peer education, treatment for STIs
     o MSM Can be especially high-risk for HIV due to high-risk acquisition from anal sex
May have female partners who also need protection

Major HIV Prevention Interventions in Tanzania
Behaviour-Change Communication
•   Behaviour-change communication reduces unsafe behaviours through:
   o Social mobilization
Bringing together allies
   o Communication
Information education communication (IEC) using multiple media to educate on
HIV
    o Advocacy
Engaging and empowering the community
Use of condoms at every sexual Act

Development/Empowerment Interventions
•   Development/empowerment interventions improve general living conditions through:
o Poverty-alleviation and income-generation programmes e.g. MKUKUTA
o Improvements to infrastructure
o Workshops and training to address gender inequality or to empower youth

Health-Services Interventions
•    Improve health-services issues:
o Provider-initiated testing and counselling (PITC) or voluntary counselling and testing (VCT)
o Provision of ART and care of PLHIV
o Prevention for PLHIV (positive prevention)
o Strengthening management of STIs
o Strengthening prevention of mother-to-child-transmission services (PMTCT) and
provision of ART
o Strengthening training for health-care providers
o Integrating HIV prevention into care and treatment services
o Safe medical practices
o Male circumcision

Management of STIs
•    All patients should be assessed by clinicians for STIs because:
    o STIs share similar risk factors with HIV infection
    o STIs increase the risk of HIV acquisition or HIV transmission
    o STIs can often be treated and cured
•    Syndromic management is necessary for STIs

The Roles of HIV Testing in Prevention of HIV in Tanzania
HIV Testing Strategies in Tanzania
•   Voluntary Counselling & Testing (VCT):
   o Initiated by client seeking to know his/her HIV status
•    Provider-Initiated Testing and Counselling (PITC):
   o Initiated/recommended by health care provider to all persons attending health care facilities as a standard component of medical care to patients with or without HIV symptoms
    o Diagnostic Counselling and Testing (DCT): Initiated/recommended by health care Provider to all persons attending health care facilities as a standard component of medical Care to patients with HIV symptoms

Roles of HIV Testing
•   Surveillance: To measure prevalence of HIV in the population
•   Improves diagnosis and management of HIV
•   It helps screening of donors’ blood for transfusion
•   As a prevention tool (HIV negative are counselled on how to remain negative and HIV positive on how to live positively)
Potential Benefits to those who Test Positive
    Benefits may include:
   o Gaining access to HIV care, treatment and support ART, home based care, palliative care
   Gaining access to support services such as post-test clubs
    o Starting cotrimoxazole prophylaxis-CPT (if symptomatic or CD4 less than
350cells/µl)
    o Changing behavior to prevent further transmission

Reviewing risk taking behavior
    Adopting healthier lifestyle
Changing reproductive health decisions
    Encouraging their partners to get tested
Using condoms to prevent infecting others
Potential Benefits to those who Test Negative
Benefits may include:
   o Becoming motivated to change current behaviors to prevent acquisition of HIV e.g. reducing number of sex partners, abstaining, or remaining faithful to one partner who is HIV negative.
    o Being reminded of the importance of sustaining current safe behavior
Benefits of HIV Testing for Community Overall
•    The community may gain resources:
o Support plan for HIV positive individuals
o Hospital resources
o Community resources
o Treatment of HIV+ so that they can continue to work
•    Determine prevalence of HIV
o Identify at risk groups

Pregnant women, TB patients, discordant couples
o Identify high risk groups
Patients with STI, Commercial sex workers, IDU and MSM
o Help MOHSW to develop national policies
o Help MOHSW in planning resources (ART, Cotrimoxazole)

Importance of Effective Counselling
•    High-quality counseling and testing leads to effective HIV care and treatment by:
o Reducing the risk of transmission to others
o Promoting disclosure and encouraging partner testing
o Helping PLHIV seek care to preserve health and access ART (a range of services that the PLHIV gets including ARV drugs)
o Allowing clinicians to provide the most effective care and treatment
o Improving the patient’s health and affirming the decision to be tested
Targeting Interventions for HIV Prevention
•   All prevention interventions should:
o Consider the context of the individual
o Recognize areas of vulnerability
o Focus on risk reduction by promoting behaviour change
o Ensure that consistent HIV prevention messages are used at individual, community, and Societal levels
HIV-Discordant Couples
•   Discordant couples: A couple in which one member is HIV-positive and the other HIV-negative
o Strong counselling skills are needed to give each member equal attention and to prevent one member from being victimized
o Couples counseling is important for disclosure and for planning safer sex or
abstinence to prevent infecting the negative partner

HIV and Youth
•    Youth are still developing physically and psychologically, which makes them at-risk on several levels

Youth need tools for HIV prevention, including:
o Evidence-based sexual education
o Youth-friendly services
o Access to condoms and other forms of family planning

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