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One-size does not fit all: Importance of allinclusive HIV prevention
HIV-Prevention:update on global and Finnish HIV situation and new preventive
technologies
Seminar in Parliament 24 October 2007
Devlopment Cooperation Unit
HIV TRANSMISSION
• Sexual transmission
• Transmission through blood
• Mother-to-child transmission
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
TO BE SUCCESSFUL AN HIV PREVENTION
PROGRAMME MUST MAKE USE OF ALL
APPROACHES KNOWN TO BE EFFECTIVE,
RATHER THAN JUST IMPLEMENTING ONE
OR A FEW SELECT ACTIONS IN ISOLATION
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
Requirements for prevention of all forms of
HIV transmission
• Comprehensive awareness of HIV and how it
can be spread
• Provision of services and necessary
prevention methods
• HIV counselling and testing
• Provision of antiretroviral treatment
• Protecting and promoting human rights
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
Comprehensive sexuality education
• Provision of sufficient and reliable
information
• Encourage abstinence
• Promotion of condom use
• Encourage fewer sexual partners
• Early identification and treatment of
STIs
• Teaching sexual communication
skills
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
Obstacles
• Women and young people unable to negotiate condom use or
abstinence
• Couples compelled to have unprotected sex to have children
• Condoms often associated with promiscuity and lack of trust
• Authorities restrict what subjects can be discussed in schools or in
public campigns for moral and religious reasons
• Marginalisation of groups at high risk
• Lack of condoms and services
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
Abstinence-only programmes
• Focus on abstaining from sex until marriage
• Religious and/or moral approach
• Strong opposition to same-sex relationships
and abortions
• Encourage young people to refuse or avoid
sex altogether
• Exclude any other information, which conflicts
with this view
• Increases the risk of young people for
pregnancy and STIs including HIV
• Ineffective and dangerous
• PEPFAR
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
Male circumcision
• Strong evidence that male circumcision reduces HIV transmission
from woman-to-man by 60 %
• Not known if affects likelihood of male-to-female or male-to-male
transmission
• Research is still ongoing
• Needs to be considered as just one part of comprehensive HIV
prevention package
• Sexual partners need to avoid false sense of security
• Other forms of protection needs to be used simultaneously
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
Mother-to-child transmission
Transmission
• Pregnancy, labour, delivery
• Breast feeding
Prevention
• Testing
• Antiretroviral drugs
• Caeserean section
• Avoiding breast feeding
Obstacles
• Lack of drugs and medical services
• Caeserean section impractical
• No resources to avoid breastfeeding
• Stigma
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
Transmission through blood
IV drug users
• Needle exchange programmes
• Necessary part of HIV prevention
Transfusion of infected blood or blood products
• Screening all blood supplies
• Heat-treating blood products
• Restrictions to blood donations
Medical procedures/other activities involving contact w. blood
• Sterilisation or disposal of equipment after each use
Health care workers safety
• Practicing universal precautions
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
Integrating SRHR with HIV prevention and
treatment
• HIV and AIDS education programs restricted to factual info on HIV
transmission and AIDS prevention
• Broader rh needs are rarely met
• SRHR programmes although broader usually do not include
strategies for HIV and AIDS prevention, care or stigma
• Both address human sexuality, serve similar target groups, promote
safe responsible sexual behaviour etc.
• Integration beneficial to both
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
Policy measures
• Strong political leadership and commitment necessary
• All leaders in all sectors must speak out openly
• Protecting and promoting human rights
• Awareness raising, attitude change
• Legislating against any forms of stigma and discrimination
• Strategic planning based on good quality science
• Consideration of local society and culture
• All sectors of the population actively involved: employers, religious
groups, NGOs, HIV positive people, young people
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Hilkka Vuorenmaa 24.10.2007
Devlopment Cooperation Unit
THANK YOU!
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Hilkka Vuorenmaa 24.10.2007