HIV prevention refers to practices done to prevent the spread of HIV. HIV prevention practices may be done by individuals to protect their own health and the health of those in their community, or may be instituted by governments or other organizations as public health policies.
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The Centers for Disease Control was the first organization to recognize the pandemic which came to be called AIDS.[1] Their announcement came on June 5, 1981 when one of their journals published an article reporting five cases of pneumonia cased by Pneumocystis jirovecii, all in in gay men living in Los Angeles.[2][3]
In May 1983, scientists isolated a retrovirus which was later called HIV from an AIDS patient in France.[4] At this point the disease caused AIDS was proposed to be caused by HIV, and people began to consider prevention of HIV as a strategy for preventing AIDS.
In the 1980s public policy makers and most of the public could not understand that the overlap of sexual and needle-sharing networks with the general community had somehow lead to many thousands of people worldwide becoming infected with HIV.[1] In many countries leaders and most of the general public denied both that AIDS and the risk behaviors which spread HIV existed were present outside of concentrated populations.[1]
In 1987 the United States FDA approved AZT as the first pharmaceutical treatment for AIDS.[5] Around the same time ACT UP was formed, with one of the group's first goals being to find a way to get access to pharmaceutical drugs to treat HIV.[6] When AZT was made publicly available, it was extremely expensive and unaffordable to all but the most wealthy AIDS patients.[7] The availability of medicine but the lack of access to it sparked large protests around FDA offices.[8][9]
In 2003 there were reports that in Swaziland and Botswana nearly 4 out of 10 people were HIV positive.[10] 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 anti-retroviral drug distribution programs.[11] and from this began to be personally involved in HIV issues worldwide. In Swaziland the government chose not to immediately address the problem in the way that international health agencies advised and many people died.[12] In world media, the governments of African countries began to similarly be described as participating in the effort to prevent HIV actively or less actively.
There came to be international discussion about why HIV rates in Africa were so high, because if the cause were known then prevention strategies could be developed. 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. In March 2003 the WHO released a statement that almost all infections were, in fact, the result of unsafe practices in heterosexual intercourse.[13]
In response to the rising HIV rates, Cardinal Alfonso López Trujillo speaking on behalf of the Vatican said that not only is the use of condoms immoral, but also that condoms were ineffective in preventing HIV.[14] The cardinal was highly criticized by the world health community, who were trying to promote condom use as a way to prevent the spread of HIV.[15]
In 2001 the United States began a War in Afghanistan related to fighting the Taliban. The Taliban, however, had opposed local opium growers and the heroin trade; when the government of Afghanistan fell during the war, opium production was unchecked. By 2003, the world market saw an increase in the available heroin supply, and in former Soviet states especially, there was an increase in HIV infection due to injection drug use. Efforts were renewed to prevent HIV related to sharing needles.[16]
Some commonly considered pharmaceutical interventions for the prevention of HIV include the use of the following:
Of these, the only universally medically proven method for preventing the spread of HIV during sexual intercourse is the correct use of condoms, and condoms are also the only method promoted by health authorities worldwide. For HIV positive mothers wishing to prevent the spread of HIV to their child during birth, antiretroviral drugs have been medically proven to reduce the likelihood of the spread of the infection. Scientists worldwide are currently researching other prevention systems.
Increased risk of contracting HIV often correlates with infection by other diseases, particularly other sexually transmitted infections. Medical professionals and scientists recommend treatment or prevention of other infections such as herpes, hepatitis A, hepatitis B, hepatitis C, human papillomavirus, syphilis, gonorrhea, and tuberculosis as an indirect way to prevent the spread of HIV infection. Often doctors treat these conditions with pharmaceutical interventions.
Social strategies do not require any drug or object to be effective, but rather require persons to change their behavior in order to gain protection from HIV. Some social strategies which people consider include the following
These strategies have widely differing levels of efficacy, social acceptance, and acceptance in the medical and scientific communities.
Populations which receive HIV testing are less likely to engage in behaviors with high risk of contracting HIV[18], so HIV testing is almost always a part of any strategy to encourage people to change their behavior to become less likely to contract HIV.