STRATEGY FOR CONTROL OF HIV AND AIDS
Both HIV infection and other traditional sexually transmitteddiseases (STDs) share similar risk factors in relationto their spread, but in addition they can potentate eachother. Both of these facts need to be understood if effectivecontrol programmes are to be developed. The presenceof an STD, particularly genital ulcers, can enhanceboth the acquisition and transmission of HIV by increasedshedding of the virus within and from the genital tract.Several studies have shown that the risk of acquiring HIVin the presence of an ulcerative or non-ulcerative STD isincreased 2-6-fold. The shared risk factors for the acquisition of HIV and other STDs, and the interaction betweenthem, has led to the setting up of integrated control programmesin the hope of reducing STDs and slowing thespread of HIV. This strategy was reinforced by the resultsof one study in Africa which showed a significant reductionof HIV transmission rates with the provision of STDtreatment services.Control of HIV has two elements, primary and secondary. Primary prevention is aimed at stopping infectionoccurring in the first place. This is achieved through healtheducation and programmes to market and encourage theuse of condoms. In the UK, initial health education campaignsresulted in homosexual men, in particular, adoptingsafe sex practices. However, such changes are not alwayseasy to sustain, and repeated reinforcement and monitoringis required. Secondary prevention is aimed at promotinghealth-care seeking behaviour, so that those who couldbe infected recognize this, regardless of symptoms, and asa result come forward for HIV testing and care if required.This is particularly important, as primary prophylaxis canbe offered for PCP, and combination antiviral therapy canhave an effect on morbidity and mortality.
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