December 1 is “WORLD AIDS DAY”, a day to spread awareness about AIDS. The theme for 2019 is ‘Know Your Status’. This implies broadly, whether one is positive or not, if positive, what is the stage and the effort an individual makes in preventing further transmission of the disease.
UNAIDS/WHO estimates that 42 million people are living with HIV/AIDS worldwide and 50 per cent of all adults with HIV infection are women predominantly infected via heterosexual transmission. Acquiring and transmitting HIV infection can be prevented to a great extent by use of condoms.
Infected men can infect their sexual partners if no protection is used. Infected women carry risk of transmitting infection to their in-womb baby. The baby is also at risk of acquiring infection during vaginal delivery and even during breastfeeding. Condom use stops this vicious cycle of transmission and also prevents unwanted pregnancy.
Consistent use of condoms is known to reduce risk of acquiring/transmitting HIV by 90 to 95 per cent. Only thing needed is the condom should be of good quality, which does not rupture during the act. Condoms should be discarded after single use, otherwise there is risk of infection and condom failure.
It is important that men take the issue of using condoms seriously. Women mostly have no say regarding limiting their family size. There are many reasons why people hesitate to use contraception. Religion, being one of them. The Pope commented a few years ago that use of condoms is acceptable in certain situations to prevent HIV/AIDS. Reduced ‘masculinity’ is another myth which prevents use of condoms. But men have to be counselled that condoms in no way reduce the sexual prowess of a man.
Since 2005, female condoms have been promoted for prevention of HIV/AIDS in countries like South Africa, Zimbabwe where there is a high prevalence of HIV. They are equally useful in prevention of HIV and sexually transmitted diseases, but are not as easy to use as a male condom. Moreover, they are not readily available and are more expensive. Both partners should not use condoms at the same time, as the friction can cause the condom to rupture.
Hormonal contraceptives carry risk of side effects if used for long. Moreover, if a woman is on antiretroviral drugs and takes hormonal contraceptives, there is risk of drug interaction, due to which efficacy of one drug is reduced or concentration in blood reaches toxic levels.
Best course for a seropositive couple after they have completed their family would be to get sterilisation done. This way, they would be totally carefree about unwanted future pregnancies. But this should be done only after their youngest child is at least five years or more to cover the risk for a child dying due to childhood infections.
Intra uterine device (IUD) use is good for spacing between children. But immune depressed women should be vigilant to use it only in absence of pelvic infections, as they are more vulnerable to acquire pelvic infections due to multiple reasons.
A small family with planned number of children and proper adequate spacing between each child is beneficial for all couples, more so for couples who are HIV positive or where one of the partners is HIV positive. By planning their family, they can make best use of available resources and ensure good health for themselves and their children. Limiting the family size with few children is useful for HIV positive couples, whether concordant or discordant. Therefore, contraception is important.
In this context, efforts done by MOH Rwanda are laudable. Due to this, there is a slow but increasing use of contraceptives by HIV positive women. Due to multiple measures undertaken by Ministry pf Health, HIV prevalence has been brought down and is maintained on 2.9 per cent. It included contraceptive advice and free access to contraceptives for HIV positive individuals, mass distribution of condoms, circumcision programmes and measures for preventing mother-to-child HIV infection (PMTCT).
Dr. Rachna Pande is specialist in internal medicine.