HIV Information
What are the main ways of Preventing HIV and Sexually Transmitted Infections (STIs)?
ABCD is the commonly used terminology to remember HIV prevention.
- A: Abstinence from unsafe sex
- B: Being faithful to your spouse or the regular partner
- C: Correct and consistent use of a condom
- D: Do not use drugs
What is treatment as prevention (TASP) for HIV?
HIV medicine is commonly called antiretroviral therapy (ART) and is a lifelong medication to treat HIV infection. ART prevents HIV from multiplying and reduces the amount of HIV in the body (Viral load).
Having less HIV in the body protects the immune system and prevents HIV infection from advancing to AIDS resulting in quality life.
When the HIV infected person achieves a low level of viral load in the body then we called it viral suppression which is defined as having less than or equal to 1000 copies of HIV per milliliter of blood.
A timely medication with good adherence is the only means to achieve a low level of HIV in an individual’s blood, semen, vaginal fluid and rectal fluid that the test can’t even detect the HIV in the blood. This is called undetectable viral load.
Viral suppression can only be confirmed if a person is accessing regular treatment support, monitoring and viral load testing from a health district hospital.
The benefit of keeping the low level of HIV in blood by the people living with HIV is that it helps prevent further transmission from the source to other through sex, sharing syringes/needles and from mother to child during pregnancy, delivery and breastfeeding. This we called treatment prevention.
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It is very important for those diagnosed with HIV to initiate HIV treatment immediately or as soon as possible.
The paramount importance is to take the ART medicine regularly and on time to keep the HIV virus low, overcome drug resistance, improve overall health and enhance quality of life and survival. ART also reduces the risk of HIV transmission.
How can you prevent acquisition and transmission of HIV through sex?
About 94% of the HIV transmission in Bhutan is through unsafe heterosexual practice and then 3% through mother to child transmission (MTCT) and 1% from injecting drug use (IDU). The following are the different sexual practices that are associated with HIV and STIs.
- Vaginal sex
- Oral sex
- Anal sex
Vaginal sex
carries a risk of getting HIV, though it is less risky than anal sex. Most women who get HIV is from vaginal sex, but men can also get HIV from vaginal sex.
Oral sex
carries little to no risk for getting or transmitting HIV and other STIs. Theoretically, the transmission of HIV is possible if an HIV-positive man ejaculates in his partner’s mouth during oral sex. Factors that may increase the risk of transmitting HIV through oral sex are oral ulcers, bleeding gums, genital sores, and the presence of other sexually transmitted infections (STIs), which may or may not be visible. However, the risk is still very low as compared to anal and vaginal sex.
Anal sex
among the three different sexual practices the anal sex has the highest risk, which includes penetrating the anus with a penis, finger/sex toys and stimulating the anus with the mouth or tongue. Penetrative anal sex has a higher risk of spreading STIs like chlamydia, genital herpes, genital warts, gonorrhea and syphilis than other sexual practice because inner lining of the anal tissues are thin and can easily break during the sexual act thus creating and entry point for the HIV if the penetrator is HIV infected. Therefore, between the two, the penetrator and receiver, the latter is at much higher risk of getting infected with HIV and other STIs. In general, both the penetrator and receptor are vulnerable to infection if either of them is infected.
Key points
The most effective means for preventing HIV and other STIs through sex is by using the condoms. For anal sex, one has to use only water-based lubricants besides the condom. The use of lubricant is important because, unlike the vagina, the anus doesn’t produce lubrication, so it’s important to use a good lube to make sex more comfortable and to prevent anal musical tears and damages. Those engaged in anal sex should clean their anus by cleaning gently with water.
What is risk associated with alcohol and substance abuse for HIV and other STIs?
Alcohol and HIV
Drinking alcohol can cause serious health conditions in the long run. When you are intoxicated with alcohol, it will result in poor coordination, reactions and judgment, inappropriate decisions that will ultimately increase your risk behaviour such as having unprotected sex.
The evidence from the study in Bhutan showed that about 57 high-risk women had engaged in sex under the influence of alcohol and only 21% of them had used condoms.
It is important to undertake the following precaution if you decide to drink as stated below.
- Limit your drink
- Don’t have sex if you’re drunk or high from other drugs
- Use a condom every time you have sex
- Do not drink alcohol if you are living with HIV because it can affect your brain and body and affect your ability to adhere to the treatment schedules
Drug Users (DUs)/Injecting Drug Users (IDUs) and HIV
Using drugs affects your brain, alters your judgment, and lowers your inhibitions. When you’re high, you may be more likely to make poor decisions that put you at risk of getting HIV by not having safe sex. Or, if you have HIV, they can increase your risk of spreading HIV to others.
Injecting drugs use is one of the major modes of HIV transmission across the globe including hepatitis C. It is the highest risk as compared to vaginal and anal sex. This is because the needles will have blood in them, and blood can carry HIV. You should not share needles or works for injecting silicone, hormones, or steroids for the same reason.
Why is Prevention of Mother-to-Child Transmission (PMTCT) of HIV and STIs important?
Benefits of PMTCT
- All pregnant mothers should avail themselves of HIV testing services twice from the nearest health centers to know their HIV status
- Knowing your HIV status and treatment on time will help
- To prevent mother to child transmission of HIV, Hepatitis B and Syphilis
- To maintain the quality of life of the mother.
- The level of risk of mother to child transmission of HIV is shown in the table below.
Pregnancy stages and factors for MTCT and level of risk
| Factors that can potentially increase the risk for MTCT at different stages of pregnancy | ||
|---|---|---|
| Pregnancy / postpartum stage | Factors | Risk of transmission* |
| Pregnancy |
|
5-10% |
| Labor & Delivery |
|
10-20% |
| Breastfeeding |
|
10-20% |
Prevention of other STIs
What is STI/STD and what are the common forms of STI/STDs in Bhutan?
Sexually transmitted infections (STI), also referred to as sexually transmitted diseases (STD) are infections that are commonly spread by sex, especially vaginal intercourse, anal sex or oral sex. In short, the route of transmission is the same as that of HIV. HIV itself is one form of STIs.
The most common form of STIs are as follows
Curable STI/STDs
Chlamydia
Signs and symptoms
- Burning sensation during urination and an abnormal vaginal/penis discharge
- Abdominal or pelvic pain is sometimes present in females
- Blood in the urine, urinary urgency (feeling an urgent need to urinate), and increased urinary frequency can occur if the urethra is infected/involved.
- Inflammation, tenderness and pain in and around the testicles (orchitis)
Gonorrhoea
Signs and Symptoms in male
- Increased frequency or urgency of urination
- A pus-like discharge (or drip) from the penis (white, yellow, beige, or greenish)
- Swelling or redness at the opening of the penis/meatus
- Burning sensation while urinating
- Swelling or pain in the testicles
- Sharp pain in the lower abdomen
- A persistent sore throat
Signs and symptoms in females
- Discharge from the vagina (watery, creamy, or slightly green)
- A persistent sore throat
- Burning sensation while urinating
- Pain upon engaging in sexual intercourse
- Sharp pain in the lower abdomen
- Fever
- Heavier periods or spotting
Syphilis
Common signs and symptoms
- Sore throat
- Fever
- Headaches
- Fatigue
- Joints pain
- Muscle aches
- Loss of appetite
- Swollen lymph glands
- Wart-like patches around skin folds or genitals
- Enlarged lymph nodes
Trichomoniasis
Signs and Symptoms
- Irritation and itching in the genital area
- Thin or frothy discharge with an unusually foul odor that can be clear, white, yellowish, or greenish in colour
- Discomfort during sex and when urinating
- Lower abdominal pain (this is rare)
Non-curable STI/STDs
Viral Hepatitis B
Signs and Symptoms
- Abdominal pain
- Dark urine
- Fever
- Joint pain
- Loss of appetite
- Nausea and vomiting
- Weakness and fatigue
- Yellowing of your skin and the whites of your eyes (jaundice)
Herpes simplex
Signs and symptoms
- Blistering sores (in the mouth or on the genitals)
- Pain during urination (genital herpes)
- Itching
Human papillomavirus (HPV)
Signs and symptoms
Genital warts: The small cauliflower flat lesions and in women it usually occurs on the vulva, near the anus and on the cervix or in the vagina. While in men it appears on the penis and scrotum or around the anus. Genital warts rarely cause discomfort or pain, though they may itch.
Common warts: Appear on the hands, fingers and elbows. It looks unpleasant and it’s painful or susceptible to injury or bleeding.
Plantar warts: They are hard and usually appear on the heels or balls of your feet. Causes discomfort.
Flat warts: It looks a little darker than your skin and appears anywhere. However, children usually appear on the face and men tend to get them in the beard area while women get them on the legs.
Human Immunodeficiency Virus (HIV)
Signs and symptoms
- Rapid weight loss
- Dry cough
- Recurring fever or profuse night sweats
- Profound and unexplained fatigue
- Swollen lymph glands in the armpits, groin, or neck
- Diarrhoea that lasts for more than a week
- White spots or unusual blemishes on the tongue, in the mouth, or the throat
- Pneumonia
- Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
- Memory loss, depression, and other neurological disorders
Key points
It is important to understand that most people with STIs are still not aware that they are infected because at many instances, the infection remains without signs and symptoms (asymptomatic). In terms of gender, women are more affected by asymptomatic STIs as compared to men and then men are more likely to have symptomatic STIs than women.
