An Ounce of Prevention is Worth A Pound of Cure

Henry de Bracton

Condoms and Water Based Lube

A condom is a tight-fitting penis-shaped rubber sheath, usually made of latex or, more recently, polyurethane, that is worn on a man’s penis during sexual intercourse. It is put on a man’s erect penis and physically blocks and captures ejaculated semen, preventing it from entering the body of a sexual partner. Condoms are used to prevent unintended pregnancies and transmission of STIs (such as gonorrhoea, syphilis, hepatitis B and C and HIV). Condoms can be used for vaginal, anal or oral sex. From an HIV-prevention perspective, using condoms for anal and vaginal sex is more crucial than using them during oral sex.

Lubricants are usually divided into two types: water-based and oil-based lubricants. Only water-based lubricants (including ‘Durex’ and ‘K-Y Jelly’) are safe to use with latex condoms. Oil-based lubricants (this can be ‘Vaseline’ or any type of cream, including Nivea or sun lotion) are not safe to use with latex condoms but they can be used with female condoms or with polyurethane condoms (which are not widely available in Malaysia). Water-based lubricants can be used for any vaginal or anal sex.

PEP

Post-exposure prophylaxis (PEP) means taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent becoming infected. PEP should be only used in emergency situations and must be started within 72 hours after a recent possible exposure to HIV. PEP should be taken for 28 days. PEP is available in selected MOH hospitals, at the infectious disease department, university hospitals and private clinics. PEP may be made available for free to women who were sexually assaulted.

Treatment as Prevention

Treatment as Prevention (TasP) is the use of antiretroviral medication to prevent the transmission of HIV to sexual partners.

HIV treatments ensures that an HIV positive person’s immune system is healthy and reduces the risk of disease advancement associated with HIV. These treatments suppress the levels of HIV (viral load) in a person’s blood and other bodily fluids to ‘undetectable’ levels.

It is critical that access to treatment is equitable and affordable for all people with HIV and that immediate access to treatment is available for people diagnosed with HIV.

PrEP

PrEP stands for pre-exposure prophylaxis. The word “prophylaxis” means to prevent infection or disease. PrEP is when people at a righ risk of contracting HIV take HIV medication daily to lower their chances of getting infected. This pill, called Truvada, contains two medicines that are also used to treat HIV. This pill can stop HIV from taking hold and spreading throughout the body. Therefore it is highly effective for preventing HIV if used as prescribed, but it is much less effective when not taken consistently.

Low / No Risk Sexual Practices

There are a number of sexual practices that present no or low risk for HIV transmission that you and your partners can enjoy. These include the following:

NO RISK

LOW RISK

Oral Sex and HIV Transmission

Oral sex is considered to be a very low risk sexual practice in regard to HIV transmission.

In the case of oral sex with a HIV positive partner, the risk of transmission is lowered even further if the HIV-positive partner is on treatment and has a low viral load, and/or the HIV-negative partner is using pre-exposure prophylaxis (PrEP).

However the risk can increase if there is cumming in the mouth, and if there are cuts or ulcers in the mouth, or the presence on another STI. Even in these instances it is still considered as low risk.

Caution should be taken with this in mind, particularly directly after dental surgery or immediately

HIV Transmission in Malaysia in 2020

HIV Transmission by Risk Factor in 2020

HIV Transmission by Age in 2020

Pulling Out

Although not a particularly successful method of HIV prevention, pulling out has been an option to reduce HIV transmission in situations where condoms are not used. Pulling out involves removing the penis before ejaculating during vaginal or anal sex to reduce the risk of transmitting HIV. HIV can still be transmitted through pre-cum (pre-seminal fluid), rectal and vaginal fluids. Using pulling out also runs the risk of not pulling out in time before ejaculation or getting caught up in the moment and not pulling out at all.

Serosorting

Serosorting is an HIV prevention strategy that involves choosing a sexual partner or prevention method based on a person’s HIV status. For example, by choosing a sexual partner with the same serostatus, an HIV-negative person can reduce their risk of HIV infection, and an HIV-positive person can reduce their risk of transmitting HIV to others.

Relationship Agreement

A relationship agreement (or safety agreement) is an agreement between you and your partner to protect against HIV. Some people in relationships decide not to use condoms with each other. This type of agreement is not for everyone, but it can work well. It can be safe but only if you are sure you are both still HIV negative. The most common form of agreement is whether you are allowed to have sex with other partners outside the relationship, and if you are what kind of sex you are allowed to have.

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Mother-To-Child-Transmission

The transmission of HIV from a HIV-positive mother to her child during pregnancy, labour, delivery or breastfeeding is called mother-to-child transmission. With effective interventions during the periods of pregnancy, labour, delivery and breastfeeding infection rate can be reduced to below 5%. These interventions primarily involve antiretroviral treatment for the mother and a short course of antiretroviral drugs for the baby. It also includes measures to prevent HIV acquisition in the pregnant woman and appropriate breastfeeding practices.

Safe Drug Use

Sharing, lending or borrowing equipment for using drugs can spread Hep C and HIV. This is because used equipment could have blood on it, and even invisible amounts of blood carrying Hep C or HIV can spread these viruses when they enter another person’s bloodstream. There are things you can do to lower the chance of passing on Hep C and HIV when using drugs like; if you inject drugs, you can lower the risk by using new needles, syringes, cookers, filters, water, swabs and ties (tourniquets) and after you shoot, recap the needle and put it in a sealed container.

Strategic Positioning

Strategic positioning, also known as sero-positioning, is the act of choosing a different sexual position or practice depending on the serostatus of one’s partner. Typically, a person living with HIV chooses to take the receptive position (“bottom”) during unprotected anal sex with a partner believed to be HIV-negative. The practice is based on the belief that it is less likely for HIV to be transmitted from a receptive partner to an insertive partner (“top”) during unprotected anal sex. While strategic positioning does not eliminate the risk of HIV transmission, it is practiced based on evidence that there is a lower relative risk for HIV acquisition per-contact when HIV-negative men engage in insertive anal sex, compared to receptive anal sex, with an HIV-positive partner.