Prevention of HIV/AIDS
[6] In high income countries, Prevention of Mother to Child Transmission Programs (PMTC) including HIV testing of pregnant women, antiretroviral treatment,[7] counselling about infant feeding, and safe obstetric practices (avoiding invasive procedures) have reduced mother-to-child transmission to less than 1%.
[18][19] A 2020 systematic review of 16 studies found that financial education improved self-efficacy and lowered vulnerability to HIV in young people in low and middle income countries.
[25] A vaginal gel containing tenofovir, a reverse transcriptase inhibitor, when used immediately before sex, was shown to reduce infection rates by roughly 40% among African women.
[26] Studies conducted in sub-Saharan Africa have found that circumcision reduces the risk of HIV infection in heterosexual men between 38 and 66% over two years.
[27] Based on these studies, the World Health Organization and UNAIDS both recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007.
[34] Some experts fear that a lower perception of vulnerability among circumcised men may result in more sexual risk-taking behavior, thus negating its preventive effects.
They also point out that the United States has both the highest rates of circumcision and HIV/STD infections in the industrialized world, casting serious doubt that the former prevents the latter.
[41] A substantial minority of young people continue to engage in high-risk practices despite HIV/AIDS knowledge, underestimating their own risk of becoming infected with HIV.
[50] Multiple legal and attitudinal barriers limit the scale and coverage of these "harm reduction" programs in the United States and elsewhere around the world.
[50] The American Centers for Disease Control and Prevention (CDC) conducted a study in partnership with the Thailand Ministry of Public Health to ascertain the effectiveness of providing people who inject drugs illicitly with daily doses of the antiretroviral drug tenofovir as a prevention measure.
The principal investigator of the study stated in the Lancet medical journal: "We now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use.
[52] The use of the single agent zidovudine reduces the risk of subsequent HIV infection fivefold following a needle stick injury.
[52] The duration of treatment is usually four weeks[54] and is associated with significant rates of adverse effects (for zidovudine about 70% including: nausea 24%, fatigue 22%, emotional distress 13%, and headaches 9%).
[47][57] This primarily involves the use of a combination of antivirals during pregnancy and after birth in the infant but also potentially include bottle feeding rather than breastfeeding.
[59] If exclusive breast feeding is carried out the provision of extended antiretroviral prophylaxis to the infant decreases the risk of transmission.
In the past, many U.S. states criminalized the possession of needles without a prescription, even going so far as to arrest people as they leave private needle-exchange facilities.
[70] Removal of legal barriers to operation of NEPs and other syringe access initiatives has been identified as an important part of a comprehensive approach to reducing HIV transmission among injection drug users (IDUs).
[77] Their announcement came on June 5, 1981, when one of their journals published an article reporting five cases of pneumonia, caused by Pneumocystis jirovecii, all in gay men living in Los Angeles.
[77] In many countries, leaders and most of the general public denied both that AIDS and the risk behaviors which spread HIV existed outside of concentrated populations.
[86] Festus Mogae, president of Botswana, admitted huge infrastructure problems to the international community and requested foreign intervention in the form of consulting in health care setup and antiretroviral drug distribution programs.
[87] In Swaziland, the government chose not to immediately address the problem in the way that international health agencies advised, so many people died.
Previously, some researchers had suggested that HIV in Africa was widespread because of unsafe medical practices which somehow transferred blood to patients through procedures such as vaccination, injection, or reuse of equipment.
[93][94][95][96] In July 2011, it was announced by the WHO and UNAIDS that a once-daily antiretroviral tablet could significantly reduce the risk of HIV transmission in heterosexual couples.
The Partners PrEP (pre-exposure prophylaxis) trial was funded by the Bill & Melinda Gates Foundation[98] and conducted by the International Clinical Research Center at the University of Washington.
[97] A similar result was observed with the TDF2 trial, conducted by the United States Centers for Disease Control in partnership with the Botswana Ministry of Health.
In a study published by the Proceedings of the National Academy of Sciences (PNAS), Khalili and colleagues detail how they created molecular tools to delete the HIV-1 proviral DNA.
The research shows that these molecular tools also hold promise as a therapeutic vaccine; cells armed with the nuclease-RNA combination proved impervious to HIV infection.
