Prevention

Technically, the best way to avoid being exposed to HIV infection through sexual intercourse is to abstain from having sex. This can mean delaying the onset of sexual debut (initiation) or, once sexually active, refraining from having sex.

Some of us may be in a position to completely trust our partner within a relationship founded on love and affection. If both partners are HIV- negative, HIV prevention may consist of an express agreement to remain absolutely faithful to each other. For some people, this approach is not without risks. Many people, especially women, have become infected in relationships in which they loved and trusted their partner.

For other sexually-active individuals who engage in penetrative sex, the male latex condom and the female condom offer the most effective and accessible means of preventing HIV transmission. As UN employees, we all have the right to have ready access to condoms.

No. We now know that it is possible for an HIV-positive person to become infected with another strain of HIV. Contracting a more virulent strain of the virus or a strain that is resistant to one or more available drugs may complicate effective treatment and cause HIV disease to progress faster than it otherwise would. As a result, HIV-positive individuals should always use a condom during sex to protect themselves and their partner.

Yes. In addition to HIV, there are more than a dozen other STIs, which can cause much more than discomfort. They are the main cause of infertility in women and, when left untreated, can lead to complications during pregnancy and for the newborn. The sexually transmissible human papillomavirus (HPV) can also cause cervical cancer.

Blood supplies in most (but not all) parts of the world are now screened for HIV antibodies. Where blood screening takes place, units of blood that are found to be infected with HIV are removed from the blood supply, virtually eliminating the risk of transmission. As employees of the UN system, we are entitled to information from UN system medical services about local sources of safe blood. If we receive a blood transfusion while obtaining care through the UN system medical services or from a UN-affiliated health-care provider, we can be confident that every effort has been made to ensure that the blood is safe. Unfortunately, in some parts of the world, blood is not always screened. Especially when you receive a blood transfusion administered by a health-care provider who is not affiliated with the UN, there can be a risk of exposure to HIV or other bloodborne diseases.

UN employees engage in many activities that could conceivably lead to exposure to another person's blood. Accidents on the road, at home, or at work are not only health risks themselves, but might conceivably result in blood exposures.

Fortunately, we know from more than 20 years' experience with HIV that the virus is hard to transmit. Because HIV cannot be transmitted through intact skin, our first defence is to avoid accidents that might lead to blood exposure. The UN System Personnel Policy, for example, emphasizes prevention of road accidents. It is a requirement, of course, that all UN staff members and others in UN official vehicles wear seat belts at all times.

When accidents do occur, the best approach is to follow what are known as universal precautions. This strategy assumes that everyone is potentially infectious-either with HIV or with another bloodborne disease, such as hepatitis. With universal precautions, no blood exposure is regarded as safe.

Following universal precautions requires advance planning and preparation. UN first-aid kits, which must be available in all UN workplaces and in all UN cars, include gloves, which should be worn before you touch another person's blood or open wound. The first-aid kits also include bleach, which can be mixed with water to clean up spills of blood or other body fluids. Because accidents can occur at home as well as at work, you should have a readily accessible first-aid kit in the home, as well.

None of us should ever share with another person a needle, syringe or equipment used for injection. If we receive medical care from the UN system medical services or from a UN-affiliated health-care provider, we can be confident that every effort has been made to ensure that injecting devices used to administer a shot are sterile and will not expose us to HIV. If we need to give ourselves a shot outside a UN health-care setting, we should only use disposable needles and syringes and we should use them only once.

Because safe injection practices are not followed in all health-care settings and it may not always be possible to purchase sterile injection devices, the WHO medical kit that is made available to all UN agencies includes disposable syringes and needles.

If no other access to sterile injecting devices exists, we can reduce the risk of being exposed to HIV from previously-used syringes and needles by boiling them or by washing them repeatedly, at least three times, with full strength household bleach, followed by thorough rinsing three times with water (ideally sterile). Studies indicate that such measures may not be 100% effective so they should only be used as a last resort.

While unprotected sexual intercourse accounts for most new HIV infections, the second-most important source of transmission is the use of contaminated needles or syringes during injecting drug use.

Undergoing a successful drug rehabilitation programme represents the most effective long-term strategy for avoiding HIV infection through injecting drug use. UN medical insurance plans cover costs relating to such treatment programmes. We recommend that you speak to the UN system medical services or to a UN-affiliated health-care provider to find out about possible treatment plans.

Until drug rehabilitation is successfully completed and recovery is sustained, individuals who use drugs should take steps to prevent their exposure to HIV. In many parts of the world where injecting drug use is known to be prevalent, there are needle/syringe-exchange programmes for injecting drug users, to ensure that they can use only sterile injecting equipment. Studies show that such programmes reduce the risk of HIV transmission without contributing to an increase in drug use.

For more information on the transmission and prevention of HIV / AIDS, visit the following sites (links will open in a new window):

• Can you get AIDS from…?
  A comprehensive, user friendly site about the transmission of HIV by AVERT, a UK based charity
• AIDS Education Global Information System (Aegis)
  An excellent information resource for a global audience.
• About Sexually Transmitted Infections
  Information provided by Planned Parenthood Federation of America, Inc.
• Reducing the Risk of Getting HIV from Sexual Activities
  An excellent site by the Body, a Western based AIDS and Information Resource