HIV prevention

To date, the prevention of HIV infection is one of the most effective ways to combat a dangerous disease. Scientists around the world are doing everything possible to develop an effective remedy for HIV in the near future. And although there are some successes in this area, a vaccine against infection has not yet been invented. Therefore, HIV prevention is a reliable and guaranteed way to protect against infection, and its results depend on the behavior of each person.

One of the most important areas of HIV prevention can be considered the prevention of vertical transmission of HIV infection, that is, the passage of a preventive course of treatment for pregnant women who are carriers of the human immunodeficiency virus (HIV). This therapy is aimed at minimizing the risk of infection of the child in utero. Caesarean section replacing natural childbirth, artificial feeding of a baby born from an infected mother are also ways to prevent HIV.

Factors affecting the risk of vertical HIV transmission:

The state of the mother's health. The higher the level of the virus in the mother's blood or vaginal secretions and the lower her immune status, the higher the risk of transmitting the virus to the child. If the mother has painful symptoms— the risk is higher.

The mother's living conditions: nutrition, rest, vitamins and others are a very important factor. It is characteristic that the average risk of having a child with HIV in the industrialized countries of Europe and the United States is about half as low as in the third world countries.

The presence of previous pregnancies: the more of them— the higher the risk.

Full-term pregnancy of the child: both premature and transferred children are more likely to be infected.

Duration of the second stage of labor: the risk is less, the shorter the period of time before the baby is born.

Inflammation or premature rupture of amniotic membranes: increased risk of HIV transmission to the newborn.

Cesarean section: Many studies have shown that with a cesarean section, especially if it is performed before the rupture of the amniotic membranes, the risk of having a child with HIV is reduced.

Ulcers and cracks in the vaginal mucosa (usually they occur as a result of infections) increase the risk of having a child with HIV.

Breastfeeding: Mothers with HIV are not recommended to breastfeed their children, as this increases the risk of HIV transmission.

Studies show that the fetus can be infected with HIV as early as 8-12 weeks of pregnancy. However, in most cases, infection of infants occurs during childbirth.

In order to identify HIV-infected pregnant women in a timely manner and take preventive measures to prevent infection of the child, mandatory HIV testing has been introduced for them upon registration and within 28-30 weeks, those who have been admitted to maternity hospitals without the results of a 2-fold HIV infection examination or examined once more than 3 weeks before admission to childbirth are also examined.

Prevention of HIV infection in people who inject drugs (LUIN)

LUIN must be given a choice: either stop consuming, or switch to safe forms (smoking, sniffing, swallowing), or inject with sterile instruments. This is called the strategy of "reducing the risk of drug use" or "reducing the harm caused by drugs." The main principles of effective prevention of HIV infection among PWID are the following:

Informational and educational work on HIV infection prevention

Ensuring the availability of social services and health protection services

Active work among injecting drug users

Providing access to needle and syringe exchange programs

Ensuring access to antiretroviral and substitution therapy

Prevention of sexual infection is of particular importance. According to the World Health Organization, untreated sexually transmitted diseases (STDs) increase the risk of HIV infection by 5-10 times.

Worldwide, about half of all infections with HIV and other STDs occur among young people aged 10 to 25 years. In this regard, it is especially important to teach young people responsible and safe sexual behavior.

In fact, sex education is aimed at forming the ability of a growing person to make sound decisions, develop psychological "immunity" in the face of a huge variety of risk factors, including the adolescent need to experiment, self-affirmation, peer pressure, the activity of drug dealers. Since modern youth face a wide range of diverse and interrelated problems, sex education and the promotion of safe behavior should become part of the overall complex of life skills training in the modern world.

In a survey conducted in the United States, it was found that teenagers with whom their mothers talked about condoms at least a year before the teenager started having sex are significantly more likely to use condoms during the first sexual contact. In addition, those who used a condom at the first contact are 20 times more likely to continue to use a condom constantly afterwards.

Today, HIV prevention consists in carrying out information work with young people, explaining the importance of using a condom to protect against possible infection. The younger generation should know everything about the ways of transmission of the disease and how to safely avoid HIV infection.

When preventing infection through the blood, it is necessary to remember the rules of personal hygiene when using toiletries. First of all, this applies to objects that can be cut, and on which traces of fresh blood can remain (scissors, forceps, shaving machines, etc.).

In medical institutions, the use of a sterile instrument is mandatory.

The task of prevention is to convince people to change their behavior voluntarily and for a long time, making it safer.

Prevention of HIV infection in modern conditions

More than 40 years have passed since the publication of the first scientific report on pneumocystis pneumonia, which later became known as acquired immunodeficiency syndrome (AIDS) , the last stage of HIV infection.

Human Immunodeficiency Virus (HIV) - causes an infection that is transmitted: sexually, through contact with infected blood, semen, or vaginal secretions. The virus can be transmitted by sharing drug needles and syringes and from mother to child.

The diagnosis of HIV and AIDS has a different meaning now than it did two decades ago. It has gone from people taking multiple drugs with many side effects to one tablet a day, a drug combination that is well tolerated and completely suppresses the virus.

Different ways of delivering drugs are now being researched: for example, injections that last several months or implantable drug delivery mechanisms that allow people not to take pills every day which increases adherence.

In July 2022, the World Health Organization (WHO) published new recommendations for the use of long-acting injectable cabotegravir (CAB-LA) as a pre-exposure prophylaxis for HIV infection in key populations at high risk of HIV infection.

At the current stage, universal screening for HIV is very important: many people who have HIV are not aware of it, timely diagnosis, effective treatment with viral load suppression can help maintain their health for many years and prevent the transmission of the virus to others.

According to UNAIDS (Joint United Nations Program on HIV/AIDS) in 2021, out of all people living with HIV worldwide: 85% knew their HIV status, 75% were on ART, and 68% had a suppressed viral load. In Kazakhstan, these figures are respectively: 81%/79%/86%. Targets indicators for 2030, according to the UNAIDS strategy are: 95% / 95% / 95%.

Kazakhstan maintains a high standard of data on HIV and implements measures in accordance with the international recommendations of WHO and UNAIDS. As a result of ongoing systemic preventive measures, the situation with the prevalence of HIV infection in Kazakhstan is kept at a concentrated stage (0.2% of the population against the world average of 1.1%). A significant decrease in perinatal transmission has been noted, from 8.4% in 2007 to 1.4% in 2021.

A comprehensive approach to HIV prevention aims to achieve maximum impact in preventing HIV infection through a combination of behavioral, biomedical and constructive strategies based on human rights and evidence-based information in a researched epidemic.

Behavioral interventions are mainly informational work aimed at changing behavioral patterns. To reduce the risk of contracting an STI or HIV, people must understand the level of risk they are exposed to and have the knowledge, skills and abilities necessary reduce that risk. They incorporate a range of communication programs using various channels (eg, mass media, community and interpersonal) to disseminate messages aimed at, for example, comprehensive sexual education in schools.

But as far as HIV is concerned, the statement of Dr. Stacey Rizza of the world-renowned Mayo Clinic remains valid: “We know that if every person on the planet with HIV were diagnosed, linked to care, and effective antiretroviral therapy, the HIV virus would be eliminated from the human race within one generation. We know we can achieve it with the given measures."

Zhannat Musina,

Epidemiologist, Head of the HIV Prevention Department, KSCDID, Ministry of Health of the Republic of Kazakhstan