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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 2 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 3 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 4 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 5 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 6 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 7 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 8 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 9 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 10 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 11 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 12 Hilkka Vuorenmaa 24.10.2007 Devlopment Cooperation Unit THANK YOU! 13 Hilkka Vuorenmaa 24.10.2007