What measures are needed for someone to protect themselves against HIV?

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OPINION

By Dr Nelson Musoba

Yes, it is possible to prevent oneself from getting infected with the HIV virus.

In order to be able to do, one needs to know how HIV is transmitted and what the risks factors are.

There are several ways of getting infected with HIV as follows:

i) Having sex with someone who is infected with HIV without using any protection. Other risk factors include concurrent multiple sexual partnerships, sero-discordance especially if accompanied by non-disclosure, transactional sex, incorrect and inconsistent condom use, low male circumcision and alcohol and drug abuse.

ii) Mother-to-child transmission, which can happen during pregnancy, at birth or after birth especially through breastfeeding. Mother-to-child transmission is especially common if the mother is not on ARV treatment or she may be on treatment but the ARVs are not effectively suppressing the virus due to various reasons.

iii) Sharing contaminated instruments (such as needles/syringes as may be the case for people who inject drugs into their veins, razor blades as has been narrated in prison settings, sex toys, etc).

iv) Being transfused with blood or blood products that are from someone who has the HIV virus without following the necessary approved protocols of the Ministry of Health. Getting transfused with contaminated blood is extremely rare in Uganda, especially if blood transfusion is done following the protocols approved by the Ministry of Health.

What has been observed is that the levels of comprehensive knowledge and risk perception about HIV transmission and, therefore, measures of protection remain very low amongst those getting infected. Despite the great strides made in the HIV response in Uganda, there still exist some structural barriers that hamper progress such domestic violence, widow inheritance and unemployment leading to poverty.

The effective prevention method for each of the risks enumerated above depends on the circumstances surrounding those at risk which in most cases require the combining of the prevention interventions. For example, a young person below 18 years at risk of acquiring HIV will need an assessment of what the other predisposing factors are including retention in school, increasing their knowledge about the danger of HIV and how they can protect themselves, vulnerability due to poverty, cultural practices such as child marriages, domestic violence among others.

Therefore, consistent behavioural change communication on HIV prevention, targeting each risk group with the appropriate messages which worked well in the early 90s and enabled Uganda to make significant progress in HIV prevention need to be revisited. However, the scare factor of HIV diagnosis being a death sentence worked well to communicate this message and may need to revisited with an appropriate replacement, especially if we work with the people to identify what works for them in the current circumstances. With life-saving ARVs, the messages need to be appropriately tailored, especially if they are to make sense and draw the attention of young people, thankfully, who do not have the benefit of seeing advanced HIV disease because of ARVs.

There are other measures that are now available such as the use of pre-exposure prophylaxis (PrEP). This is an effective preventive measure especially for discordant couples (when one sexual partner is HIV-negative and the other is HIV-positive) as well others at risk of being infected with HIV because they do not know the HIV status of their sexual partners. Included in this category are others at high risk such as HIV-negative sexual partners of long-distance truck drivers, HIV-negative sex workers, those involved in multiple sexual encounters with partners whose serostatus they do not know, etc.

Additionally, getting knowledgeable about HIV, getting tested and knowing the HIV status of sexual partners can contribute to the prevention of acquiring new HIV infections. The key guidance here is that do not have sex with anyone whose HIV status you do not know, and if you must then use a condom. Testing for HIV is an act of love, care and responsibility. Knowing your status demonstrates that you care enough about yourself and the person and, therefore, would not like to put their life at risk.

The writer is the director general, Uganda AIDS Commission