Ways of Reducing the Risk of STI and HIV Infection

1Why this matters

There is still no vaccine against HIV, and no cure. Yet the number of new infections in Rwanda has fallen greatly since the 1990s. That fall came from prevention: people learning their status, choosing safer behaviour, and using the tools that medicine now offers. Every one of those tools depends on the transmission routes you learned in the last two lessons. Block the route and you block the infection.

2Prevention through behaviour: A, B and C

• A: Abstain. Not having sexual intercourse removes the sexual route completely. For young people it is the safest choice, and delaying your first sexual experience greatly reduces your lifetime risk.
• B: Be faithful. Adults in a relationship reduce their risk by staying with one partner who has tested HIV-negative and is also faithful. Having several partners, especially at the same time, multiplies the risk.
• C: Condoms. Male and female condoms, used correctly every time, block contact with semen and vaginal fluids.

3Prevention through testing and health services

• Know your status. HIV testing is available at every health centre in Rwanda. Couples should test together before they begin a sexual relationship and before trying for a baby.
• Treat STIs early. Sores and inflammation from other STIs make HIV infection much more likely, so prompt treatment also protects against HIV.
• Prevention of mother-to-child transmission (PMTCT). Pregnant women are tested at antenatal care. A mother with HIV who takes ART, and whose baby receives preventive medicine and is fed safely, greatly lowers the risk to her baby. Without any treatment, 15 to 45 of every 100 babies born to mothers with HIV become infected; with treatment, fewer than 5 do.
• Voluntary medical male circumcision (VMMC). Removal of the foreskin by a trained health worker reduces a man's risk of getting HIV from a female partner by about 60%. It gives only partial protection, so condoms are still needed.
• PrEP (pre-exposure prophylaxis): a daily medicine for HIV-negative people at high risk, which prevents infection if they are exposed.
• PEP (post-exposure prophylaxis): ART taken for 28 days, starting within 72 hours of possible exposure, for example after sexual assault or a needle injury.
• ART for people living with HIV keeps their viral load undetectable, so they do not pass HIV to partners (undetectable = untransmittable).

4Prevention in daily life

• Never share needles, syringes, razor blades, toothbrushes, or instruments for piercing or tattooing. Insist on new or sterilised instruments.
• When helping someone who is bleeding, protect your hands, with gloves or a plastic bag, and wash afterwards.
• Avoid alcohol and drugs, which weaken judgement and lead to unplanned, unprotected sex.
• Avoid transactional and cross-generational relationships (unit 12), where unequal power makes safer choices hard.

Worked example: ranking the risk

Rank these situations from no risk to highest risk of HIV infection, giving a reason for each.

The method: ask two questions. Is one of the four fluids (blood, semen, vaginal fluid, breast milk) involved? and Can it reach the other person's bloodstream or mucous membranes? If the answer to either is no, there is no risk.

Practice