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The Prevention of AIDS

Written by: Francis, Donald P., MD/ Chin, James, MD    Posted on: 04/10/2003

Category: Educational

Source: CCN

  The Prevention of Acquired Immunodeficiency Syndrome in The U.S. (This is an Excerpt of a very EXTENSIVE and well documented report by Donald P. Francis, MD, DSc, & James Chin, MD, MPH)

                      TRANSMISSION OF AIDS

  "AIDS is one of the most viruent infectious agents ever encountered. This virus, esitmated to kill up to half of those infected, has spread to more than 1 million Americans.  There is no safe and effective treatment.  Nor is there a vaccine.

  AIDS has been isolated from fluids obtained from a variety of body sites, including blood, semem, vaginal fluid, tears and saliva. Epidomiologic studies have established that those fluids that provide sufficent virus for transmission seem to be limited to blood, semen, and vaginal secredtions.  Presumably, the presence of lymphocytes in these fluids increases the concentration of infectious virus and may be important, or even essential, for transmission.

  The exact risk of infection for a suspectible person having a single sexual encounter with an infected partner is unknown.  Yet there are those who report having only one sexual encounter and have then developed AIDS.  In addition, a report from Australia that four of eight women developed an infection after they were inseminated with semen from an infected sperm donor, and a report of infection of a female chimpanzee by intravaginal inoculation, suggest that a single encounter with AIDS is sufficient in some situations to infect.

  The major determinant of outcome of exposure appears to be the amount of virus inoculated.  Large inocula given in the form of transfused blood almost universally result in infection.

  A single episode of possible intrahousehold transmission between two brothers has been reported.

  Two out-of-hospital instances of AIDS transmission to individuals who performed duties similar to hospital nurses.

                    PREVENTION OF TRANSMISSION

  At the present time, there are no effective vaccines or chemoprophylatic drugs for the prevention of AIDS infections.  Likewise, no effective treatment exists for AIDS infection once established. Since there are no know animal or insect vectors and the virus is not transmitted by the respiratory or fecal-oral route, prevention of AIDS transmission must be directed at person-to-person spread via sexual, blood-borne, and perinatal routes.

  THERE IS NO RISK OF SEXUAL TRANSMISSION OF AIDS FOR THOSE WHO PRACTICE SEXUAL ABSTINENCE.  Furthermore, there is no risk of infection if neither partner is infected.  This would be the case for couples who have been mutually monogamous since the introduction of AIDS in the United States (presumably in the mid-1970's).

  However, as with the use of condoms for pregnancy prevention, failures can be expected, espically if the condoms are not used consistently and continuously with all sexual partners.

  Transmission among homosexual men appears to be due almost exclusively to receptive anal intercourse.  The prevalence of infection in this group today is extermely high in most urban areas.  Even with profound decreases in the number of sexual partners, the risk of infection in this community remains high because of the present high chance that any single sexual partner is infectious.

  Controversy has surrounded the issue of homosexual bathhouses.  Any setting that encourages unsafe sexual practices between individuals will increase the transmission of AIDS.  As such, those bathhouses that encourage such practices adversly affect AIDS prevention.

  The current risk of infection of a given heterosexual contact in the United States is low, but infections and AIDS cases art certainly being acquired by heterosexual contact.  Logic would dictate that those outside of mutually monogamous relationships who wish to minimize their risk should limit their total number of partners and practice protective sex all the the time.

  Infection with this virus has potentially dire consequences; therefore, sexual partners should carefully weigh the risks of unprotected sexual encounters outside of mutually monogamous relationships.

  Prostitutes are a major source of infection in central Africa and probably in some European countires.

                      INTRAVENOUS TRANSMISSION

  The message for AIDS prevention is obvious: stop the use of IV drugs, or, at a minimum, eliminate sharing of unsterilized injection paraphernalia.

  Intravenous drug abusers, if AIDS transmission persists, will likely serve as a major entree of the virus into a segment of the heterosexual community, most prominently in the urban poor communities.

  The use of drugs in association with sexual practices is prevalent in many communities, including the homosexual community.

                            OTHER DATA

  Of surveys conducted 1985-1986, 72% of Homosexual men in STD clinics in San Francisco are reported as having AIDS.  49% of Homosexual men in San Francisco had AIDS,  59% of IV drug users surveyed in New York and 40% of the homosexuasls.

(For the sake of easier reading, AIDS was subsitiuted in-place of Human immunodeficiency Virus (HIV) and inserted sub-headings)





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