Preventing HIV with Condoms. The Basics of STD and AIDS Prevention

The Basics of STD and AIDS Prevention
AIDS Prevention and the Role of Condom Use

With nearly 1 million Americans infected with HIV, AIDS prevention is more important than ever before. Most HIV infection is a result of sexual transmission. That combined with an estimated 15 million cases of other sexually transmitted diseases (STDs) occurring each year effective strategies for preventing these diseases are critical. AIDS prevention is not the only reason for condom use. STD prevention as well as AIDS prevention are important reasons for condom use. Refraining from having unprotected sexual intercourse with an infected partner is the best way to achieve AIDS prevention and other STD prevention. Latex condoms are highly effective when used consistently and correctly. The Centers for Disease Control (CDC) offers the following recommendation with regard to STD and AIDS prevention:

"Condoms are effective in preventing HIV and other STDs."

Facts About Condom Use and STD, HIV, and AIDS Prevention

• The correct and consistent use of latex condoms during sexual intercourse- vaginal, anal, or oral-can greatly reduce a person’ s risk of acquiring or transmitting most STDs, including HIV infection, gonorrhea, chlamydia, trichomonas, human papilloma virus infection (HPV), and hepatitis B.

• Protecting yourself and others against STDs is important because many of these diseases have serious complications. AIDS prevention is important because HIV is life threatening disease that can cause serious illness throughout life.

• Laboratory studies show that latex condoms are effective barriers to HIV and other STDs. In addition, several studies provide compelling evidence that latex condoms are highly effective in AIDS prevention when used for every act of intercourse. This protection is most evident in studies of serodiscordant couples; those couples with one positive and one negative partner.

• Several studies clearly show that condom breakage rates in this country are less than 2%. Most of the breakage and slippage likely is due to incorrect use rather than poor condom quality. Using oil-based lubricants can weaken latex, causing the condom to break. In addition, condoms can be weakened by exposure to heat or sunlight or by age, or they can be torn by teeth or fingernails. Studies also indicate that condoms slip off the penis in about 1-5% of acts of vaginal intercourse and slip down (but not off) about 3-13% of the time.

• Some persons have expressed concern about studies that report higher failure rates among couples using condoms for pregnancy prevention. Analysis of these studies indicates that the large range of efficacy rates is related to incorrect or inconsistent use. In fact, latex condoms are highly effective for pregnancy prevention and AIDS prevention, but only when they are used properly. Research indicates that only 30-60% of men who claim to use condoms for contraception actually use them for every act of intercourse. Further, even people who use condoms every time may not use them correctly from start to finish. Incorrect use contributes to the possibility that the condom could leak at the base or break. AIDS prevention and STD prevention depends on the proper use of condoms each and every time.

Barebacking.....a Right of Passage. HIV and Barebacking

HIV and Barebacking
Is Deliberate HIV Exposure a Rite of Passage

The term barebacking originated in the gay community as a slang for unprotected anal intercourse. The term is also used but not as frequently in the heterosexual community as a reference to unprotected sexual intercourse. Who uses the term is not important. What is important is the link between HIV and barebacking. And as unlikely as it would seem, Health professionals and HIV prevention specialists are seeing an unbelievable phenomenon among a small group of gay men. These gay men have expressed the desire to to get exposed and in some cases hope for HIV infection.

Can This Be True?
Often called "bug chasers" among the gay community, these men seek out other gay men who are infected, in hopes of having unprotected sex, barebacking, in an effort to become infected with HIV. Across the Internet, chat rooms and newsgroups are advertising "conversion parties" where negative men seek out those who are positive in hopes of getting infected. This practice of having deliberate unprotected anal sex has the potential to cause widespread HIV infection, especially among gay men and men who seek out anonymous sexual partners on the Internet

How Common is This Practice
The number of gay men looking to become positive seems to be growing. In fact, the Centers for Disease Control (The CDC) reports a new surge in the incidence of HIV among gay males, in part due to this unthinkable practice. But what can drive such a desire? Why would a life with HIV be desirable to some?

Why Do Healthy Men Want To Be Infected?
There are some very strong beliefs at work among men who bareback looking for HIV infection.

• No More Isolation
For some men, being infected is a way out of their isolation and loneliness. Social stigmas and prejudices add to an already strong feeling of isolation. The belief is that once infected, they will be welcomed into a supportive community where prejudice and stigma does not exist. For these men, HIV is a rite of passage into the gay community. Being positive gets you into the "family."

• A Different Perspective
When asked about being infected, men who are seeking out HIV infection show little fear. These feel HIV is simply a nuisance that can be treated with a few pills; a small price to pay to be a member of such a close knit group. One gay man reported an incredible feeling of belonging when he learned of his positive HIV status. Just as a teen-age boy joins a gang to belong to a family, so does the gay man who practice barebacking in hopes of becoming HIV positive.

• A Sense of Relief
Others who become infected feel a profound sense of relief. Some sexually active gay men grow tired of living with the uncertainty of if and when they will become HIV positive. Some are so troubled by that uncertainty that multiple HIV tests become the only means of dealing with what they feel is the inevitable. One man's face glowed with a sense of relief after his doctor told him he had been infected. He would never again have to worry if he had been infected because now he knew he had.

• A Sense of Intimacy
Still others are longing for a sense of intimacy. To these men, anal sex feels better and more intimate without condoms. They feel condoms decrease sensitivity and spontaniety. Others feel barebacking is a type of sexual intimacy they equate with mating and infection is equated with impregnating. Some even go as far as choosing the man who will "father" their infection. One gay man reported the most incredible feeling of intimacy being united with other gay men through HIV. Another allowed his positive partner to infect him as a way to show how deep his commitment was. Oddly enough, as soon as he found out he was positive, the man and his partner began using condoms.

• What Drives the Gift Giver?
But what of the positive man who infects the willing. What drives them to knowingly give an illness to an otherwise healthy man? One "gift giver", as positive men are often called, reported,

"It was the most incredible feeling of power. I was going to take something from him, and that power gave me a rush I'd never known."

Among this population of barebackers there is a distinct connection between masculinity, sexual prowess, and intentional unprotected anal sex.

Deliberatly seeking out HIV is a practice few of us would understand. Is such a practice a cry for help, a sign of depression or just a symptom of social stigmas and prejudices? Whatever drives this practice, one thing is for certain; it helps drive the epidemic. But before we can address the issue we have to understand it. As one gay man stated soon after he found out he had become HIV positive, "It's impossible to know how great it feels unless you have been where I have."

Source:
Halkitis, PN. "Intentional unsafe sex (barebacking) among hiv-positive gay men who seek sexual partners on the internet."; AIDS Care 2003 Jun;15(3):367-78.

Should Needle Exchange be Funded?

Should Needle Exchange Be Funded By The Federal Government?

The key to slowing the HIV epidemic is HIV prevention. There are several prevention techniques that slow the transmission of HIV from one person to another. One such prevention method is needle exchange.

Needle exchange involves providing clean, sterile needles and syringes to IV drug users in exchange for their used syringes and needles. If IV drug users can't stop injecting recreational drugs, then providing them with sterile needles and syringes should decrease the incidence of sharing needles. As we know, sharing needles is a source of HIV infection. Decrease needle sharing and HIV transmission will decrease. But how should needle exchange programs be funded? Right now, it's illegal to use federal monies to fund needle exchange programs. Because of this, funding is difficult and programs struggle to survive. Should needle exchange programs be funded by the federal government? There are two schools of thought.

Current Status
Globally, sex between men and women is by far the most common way of passing on HIV. But a second transmission route drives the epidemic in many countries outside Africa; transmission among men and women who inject drugs. Injection of any sort is a more efficient way of spreading HIV than sexual intercourse. Since injecting drug users are often linked in tight networks, sharing injection equipment is common. But because the injection equipment is rarely disinfected, HIV infection among this population is common.

Also, people who inject drugs may acquire HIV infection through their sexual partners while having unprotected sex. In the United States, it's estimated that 9 out of 10 cases of heterosexual transmission of HIV occurring in New York City is related to sex with a drug user. In some places, including much of China and parts of India and Myanmar, more women are infected through sex with drug users than any other way. Injecting drug use also contributes to mother-to-child transmission of HIV. In Uruguay, 40 percent of babies with HIV are born to mothers who inject drugs.

So it's clearly obvious that transmission of HIV by way of sharing dirty needles must be addressed. The way to address the issue is through needle exchange. But how do we pay for exchange programs?

What's all the Fuss About?
If needle exchange is the answer, then why all the fuss? Programs should be funded and put in place across the country. If only it were that easy. The fact of the matter is, needle exchange is a politically charged issue that few want to take on. It's because of the controversial nature of needle exchange that programs are not federally funded. In fact, the law states that needle exchange programs can't be paid for with federal monies. And because of the politics involved, few government leaders are willing to risk their careers by fighting for change.

Arguments For
Proponents of needle exchange site several reasons why the federal government should get involved and offer funding for such programs.

• Data shows that upwards of 90 percent of heterosexually transmitted HIV is related to IV drug use and the sharing of dirty needles.
• Data shows that in several communities in the US and around the world, HIV transmission has increased where needle sharing and injecting drug use is common.
• Many studies have proven that needle exchange programs lead to decreased rate of HIV transmission among IV drug users.
• Studies have concluded that needle exchange does not increase the incidence of IV drug use.
• Some studies have shown that entrance into drug treatment programs are increased in the presence of needle exchange programs.

Arguments Against
Opponents of federally funded needle exchange point out several concerns.

• Funding needle exchange programs sends the "wrong message" to children.
• Clean needle exchange will lead to an increase in IV drug use among populations already ravaged by recreational drug use.
• Federal funding of exchange programs would allow tax dollars to be used to increase the amount of drug paraphernalia in areas already overburdened with IV drug use.
• Distributing drug paraphernalia is in stark contrast to the accepted morals of our culture.

Where it Stands
While acceptance and funding of needle exchange programs has continued in the private sector as well as the state and local level, the federal government continues to balk at offering funding of any sort. Yet, studies continue to show that needle exchange programs are successful in decreasing HIV transmission. So the debate continues.

Does Needle Exchange Reduce HIV? Needle Exchange Programs

Needle Exchange Programs
Do They Help Prevent HIV Infection?

Why Do We Need Needle Exchange?
More than a million people in the United States inject drugs, at a cost to society (in health care, lost productivity, accidents, and crime) of more than $50 billion a year. Obviously, people who inject drugs imperil their health. But if they become infected with HIV or Hepatitis C they also imperil their needle sharing partners, sexual partners and offspring as well.

One-third of all AIDS cases are linked to injection drug use. For women, 64 percent of all AIDS cases are due to injection drug use or sex with partners who inject drugs. Injection drug use is the source of infection for more than half of all children born with HIV.

Around the world and in more than sixty locations in the United States, needle exchange programs have sprung up to address drug injection risks. These programs:

• distribute clean needles
• safely dispose of used needles
• offer referrals to drug treatment
• offer HIV counseling and testing

Why Do Drug Users Share Needles?
The answer is as simple as supply and demand. Needle sharing is common in part because there are not enough needles and syringes to go around. The overwhelming majority of intravenous drug users (IVDUs) are aware of the HIV risk associated with sharing contaminated equipment. However, sterile needles are not always available or affordable and their physical and emotional need for injectable drugs clouds their better judgement.

Most US states have paraphernalia (items used to inject or use drugs) laws that make it a crime to possess or distribute drug paraphernalia not for a "legitimate medical purpose". If caught those that break these laws are subject to prosecution. In addition, ten states and the District of Columbia have laws that require a prescription to buy a needle and syringe. Even where over-the-counter sales of syringes are permitted by law, pharmacists are often unwilling to sell to IVDUs.

In July of 1992, the state of Connecticut passed a law permitting the purchase and possession of up to ten syringes without a prescription. After the new law went into effect, the sharing of needles among IVDUs decreased, indicating a shift from street needle and syringe purchasing to pharmacy purchasing. It's believed that such a shift could decrease HIV infection due to needle sharing.

How Can Injection Risks Be Reduced?
Getting drug injectors into treatment and off drugs is the best answer. Unfortunately, not all drug injectors are ready to quit. Even those who are highly motivated may find few drug treatment services available. Drug treatment centers frequently have long waiting lists and fewer than 15 percent of IVDUs are in treatment at any given time.

For those who cannot or will not stop injecting drugs, the best way to avoid spreading HIV is to use a sterile needle for each injection, or at the very least not to share needles. Users who share should disinfect their injection equipment thoroughly with bleach, although this is not as safe as always using a sterile needle and syringe.

Does Needle Exchange Encourage Drug Use?
There is no evidence that needle exchange programs increase the amount of drug use by needle exchange clients in the community in general. A study of a San Francisco needle exchange program that opened in 1988 found that from 1987 to 1992, frequency of injecting drugs among street-recruited IVDUs declined from 1.9 to 0.7 injections per day. The mean age of IVDUs increased from 36 to 42 years, and the percentage of new initiates into injection drug use dropped from three percent to one percent. Drug abuse and the recruitment of new or younger users did not increase in the presence of the exchange; in fact, the exchange may have helped decrease the amount of drug abuse in the area.

Does Needle Exchange Reduce the Spread of HIV?
Simply put, the answer is yes, almost certainly. Needle exchange programs are based on a sound public health principle; the principle of eliminating the item that helps transmit infection from one person to another, just as, for example, reducing the number of mosquitoes helps prevent malaria.

Needle exchange programs have also achieved reductions in the rate of hepatitis infection, which can also be spread through sharing needles. In Tacoma, WA, clients of a needle exchange program were up to eight times less likely to contract Hepatitis B or C than non-client IVDUs.

Finally, needle exchange programs can act as a bridge to:

• drug treatment
• HIV testing and counseling
• primary medical care
• tuberculosis and sexually transmitted disease screening

Source: Lurie, P. and DeCarlo, P., The Center for AIDS Prevention Studies at the University of California San Franciso, 2005.

The Riskiest Activities. What Activities are Riskiest?

What Activities are Riskiest?

HIV can be transmitted from person to person in many different ways. But which activities are the riskiest? Which activities carry the highest risk of HIV infection? Here are the most risky:

1. Sharing needles to inject drugs
• Does Needle Exchange Reduce HIV?
• Should Needle Exchange be Funded?

2. Receptive Anal Intercourse
• Barebacking...a Right of Passage
• Preventing HIV with Condoms

3. Vaginal Intercourse
• HIV from Vaginal Sex
• What is My HIV Risk?

Source:
AIDS Infonet; "How Risky is It?; October 25, 2005.