HIV: Prevention, sexual transmission

on 26.9.09 with 3 comments

Information for the general population and for particular risk groups, counselling of seropositive persons, condom distribution (prostitutes), promotion of use and availability of condoms, counselling prostitutes, detection and treatment of other sexually transmitted diseases (STDs). In a number of countries it is the custom that after the death of the husband, the wife marries a brother or another member of the deceased’s family. This of course promotes transmission. In many countries the condom is still a very sensitive topic (taboo in public debates or even in private conversations within couples or family). One of the first actions to be taken in the campaign against AIDS in Thailand was the demystifying of the condom by all kinds of educational and promotional campaigns. In contrast to what is sometimes said, the promotion of condom use in tropical countries is not a hopeless task. It is being investigated whether a virocidal cream applied to the vagina offers some protection (so that women no longer have to depend on the good-will of their male partners). Circumcision of the man brings about a 2.5-fold decrease in the risk of HIV transmission from woman to man. It must be emphasised that circumcision does not give absolute protection.

Category: Medical Subject Notes , Medicine Notes , Microbiology Notes , PSM Notes



Caroline said...
September 27, 2009 at 5:40 AM

Circumcision does virtually nothing to stop HIV transmission. If a man is going to have unprotected sex with an infected woman, he still has a 50% chance of acquiring the virus. How is that "protection"?

Furthermore, circumcision has the opposite effect in male to female transmission, making a circumcised man MORE likely to transmit the virus to a woman. And circumcision has zero affect on male to male transmission.

Condoms and testing are so far the most reliable ways we have to prevent the spread of HIV. Anything less than that is a dangerous and irresponsible distraction. There are already people in Africa who think circumcision is an "invisible condom". All promoting it is going to do is waste funds and spread confusion, most likely resulting in a rise in new infections.

Dave T said...
September 27, 2009 at 7:52 PM

While the relative reduction of HIV from circumcision is around 50%, the absolute reduction is closer to 1.4% - this is assuming you actually believe the highly criticized African study. This number is not even close to the 2.5 times reduction mentioned in this article.

TD said...
September 27, 2009 at 9:55 PM

Treating the African studies with so much legitimacy is highly suspect. They failed to control for the HIV status of the female partners prior to commencing, and the circumcised men were instructed in condom use and told to abstain from sex for six weeks, while the intact group was not. Too many confounding factors to take seriously.

Another factor circ-happy researchers fail to consider is that the intact prepuce is rich in Langerhans cells which secrete Langerin, the hormone most effective in fighting HIV.

"Langerin is produced by Langerhans cells, which form a web-like network in skin and mucosa. This network is one of the first structures HIV confronts as it attempts to infect its host."

However, "we observed that Langerin is able to scavenge viruses from the surrounding environment, thereby preventing infection," said lead researcher Teunis Geijtenbeek, an immunologist researcher at Vrije University Medical Center in Amsterdam.

In essence, Geijtenbeek said, "Langerhans cells act more like a virus vacuum cleaner."

SOURCES: Teunis Geijtenbeek, Ph.D., department of molecular cell biology and immunology, Vrije University Medical Center, Amsterdam, The Netherlands; Jeffrey Laurence, M.D., professor, medicine and director, Laboratory for AIDS Virus Research, Weill Cornell Medical College, New York City; March 4, 2007, Nature Medicine online

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