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PREVENTION OF HIV

People who do not have HIV need to protect themselves from becoming infected. You can do this by:

1. Abstaining from sex
HIV is mainly spread by sex. The safest way to stop the spread is to abstain from sex. Having sex is a very serious decision, especially for young people. It is important to know that you can have a relationship without sex.

2. Remaining faithful to one sexual partner
Only an HIV test can confirm that you are HIV negative. If you and your partner both test negative and you remain faithful to each other, this will ensure that you remain safe. However, you should continue to use condoms for three months after testing HIV negative, and then, together with your partner, get re-tested for HIV. If the repeat test is negative, you may stop using condoms if you and your partner only have sex with each other. Remember to use a condom each time you start a new sexual relationship. You cannot tell by looking at a person what their HIV status is.

3. Using protection (a condom)

Female condoms
This condom can be used by women to help prevent pregnancy, sexually transmitted infections (STIs) and HIV. Female condoms can be inserted long before having intercourse. They give the best protection if used correctly every time you have sex. You may even use a female condom if you are menstruating. Female condoms are not readily available at all clinics and therefore need to be bought.

How to use a female condom:

• Open the packaging carefully to ensure that the condom is not damaged. The female condom has a thin outer ring and a loose inner ring.
• Rub the condom between your fingers to spread the lubrication. Twist the inner ring into a ‘figure 8' and hold it between your fingers.
• You may squat with your knees apart, stand with one leg raised or sit with your legs apart to relax the vagina.
• Push the inner ring into the vagina. Put your finger in the condom and gently push the inner ring up into your vagina so that it sits behind the pubic bone.
• The outer ring will hang outside your vagina. Make sure that the condom is not twisted.
• During intercourse, guide your partner's erect penis into the condom, making sure that the penis does not penetrate next to the condom.
• Do not use male and female condoms simultaneously as the friction between the two condoms may cause the condoms to break.
• Remove the condom after ejaculation. Twist the outer ring and gently pull the condom from the vagina. Dispose of it safely.

Male condoms
Male condoms are freely available at clinics. If used consistently and correctly, it can protect you and your partner from STIs and HIV.

How to use a male condom:

IMPORTANT INFORMATION:
Do not use Vaseline or baby oil for lubrication during intercourse as this weakens the condom. Remove the condom immediately after ejaculation to prevent the fluid from leaking. Hold the base of the condom and withdraw from the vagina. Slide the condom off the penis, tie a knot and dispose of it safely.

4. Circumcision
It has been proven in three good research projects conducted in South Africa that circumcision at ages between 18 and 24 years gives some added protection against HIV infection. The added protection means that fewer men will get infected. But the procedure will not protect totally against HIV infection. Circumcised men must still practice safe sex and use condoms at all times.

What do I do if I have been raped?
Victims of rape or sexual assault are at higher risk of HIV infection because rape is violent and there is often tearing and bleeding. The worry of HIV infection adds more stress to an already traumatic event.

If you have been raped, you will need to do the following:

• It is vital to see a doctor as soon as possible. The doctor will supply you with PEP (post-exposure prophylaxis) medication. This is antiretroviral (ARV) medication that will reduce your risk of getting HIV.
• You need to start taking this medication as soon as possible after the rape; if taken after more than 72 hours, it is too late.
• You should be counselled and have an HIV test.
• While waiting for the results you will be given a starter-pack treatment kit that you should take immediately.
• If you test HIV positive, the PEP medication will be discontinued and the healthcare worker should refer you for the appropriate treatment.
• If you test negative, you need to complete 28 days of treatment.
• You may experience side-effects such as headache, nausea, tiredness, skin rash or runny stomach, but these side effects usually do not last long.
• You need to go for follow-up HIV tests at six weeks, three months and six months after the rape.

How do I protect myself from HIV when taking care of a person living with HIV?

• Do not touch the patient's body fluids (blood, urine or stool) without wearing gloves.
• Wash the gloves with warm water after each use.
• Do not share razors, needles or toothbrushes.
• Keep clothes or bedding soiled with blood or diarrhoea away from other washing and wear gloves when working with them.
• Wash the bedding and clothes in warm soapy water and hang them in direct sunlight.
• Burn any bandages that cannot be rewashed.
• Cover the patient's mattress with a plastic sheet.
• Always wear protective clothing when working with the patient's wounds or body fluids.

References
1. Metropolitan Foundation. 2009. B the Future cellbook. South Africa.
2. ORANGE FARM STUDY. Research on protective effect of circumcision done in Orange Farm area in South Africa, Kenya and Uganda amongst young males: several references.