**4. Prevention**

Perhaps the most important fact about AIDS is that it is a preventable disease. Ideally, this can be achieved by development of a vaccine, although much effort and money have been directed towards production of a vaccine. However, presently, there is none yet, and, it is unlikely that one will be available within the next five years (National Institute of Allergy and Infections Diseases (NIAID) 2009). In the absence of a vaccine, health education and counselling to create a sense of awareness and to reduce the risk of transmission by employing safe sex practices and other high risk behaviours, should become imperative (Centers for Disease Control & Prevention (CDCP), 2002). Other factors that may prevent the spread of AIDS includes ensuring a supply of safe blood and blood products, no sharing of needles and syringes and deferment of pregnancy among high risk subjects. Surveillance to monitor the size of the problem and how it changes, is an important component of prevention (ibid).

#### **4.1 HIV test**

In most developing countries, many people are not aware of their HIV status. Less than 1% of sexually active persons in urban Nigeria have been tested for HIV and this proportion is even lower within rural populations (Akande, 2001). Furthermore, a mere 0.5% of pregnant women who attend urban health facilities are counselled, tested or receive their test results. In fact, this proportion is even lower in rural health facilities. Hence, donor blood and blood products that are used in medicine and medical research, are screened for HIV (Nunn, *et al.*, 2004). A typical HIV test, including the HIV Enzyme Immunoassay (EI) and the Western Blot Assay (WBA), detects HIV antibodies in serum, plasma, oral fluid, dried blood spot and urine of patients. However, the window period (the time between initial infection and the development of detectable antibodies against the infection), can vary. This is why it can take 3-6 months to seroconvert, test and detect other HIV antigens, HIV-RNA, and HIV-DNA (Scripps Research Institute, n.d). In order to detect HIV infection these assays are not officially approved, but are nonetheless routinely used in some countries.

#### **4.2 Transmission**

Three main transmission routes of HIV include sexual contact, exposure to infected body fluids or tissues and from mother to child during the prenatal period. It is possible to find HIV in the saliva, tears and urine of individuals but there have not been recorded cases of infection from these secretions (WHO, 2006). Therefore, the risk of infection through saliva, tears and urine is negligible.

#### **4.3 Sexual contact**

A majority of HIV infections are acquired through unprotected sexual contact between partners, one of whom has HIV (UNAID, 2004; Ojukwu, 2004). Sexual intercourse is a primary mode of HIV infection worldwide. Sexual transmission occurs with contact between sexual secretions from one partner with the rectal, genital or oral mucous membranes of another. Unprotected receptive sexual acts have a greater risk of transmitting HIV from an infected partner to an uninfected partner through unprotected anal and vaginal intercourse/sex (Nomcebo, 2005). Oral sex is not without its risks as HIV may be transmissible through both assertive and receptive oral sex (HIV InSite, 2003). The WHO (2006) reported that the risk of HIV transmission from exposure to saliva is considerably smaller than the risk from exposure to semen. Contrary to popular belief, one would have to swallow gallons of saliva, for a person to run a significant risk of becoming infected. About 30% of women in ten countries representing 'diverse cultural, geographical and urban/ rural settings', reported that their first sexual experiences were either forced or coerced, which makes sexual violence a key driver of the HIV/AIDS pandemic. Frequent sexual assaults result in physical trauma to the vaginal cavity, which facilitates transmission of HIV. During a sexual act, male/female condoms can reduce the chances of infection with HIV and other STDs, and of course the chances of becoming pregnant (Rutter & Quine, 2002; Nomcebo, 2005). The best evidence, to date, indicates that proper condom use reduces the risk of heterosexual HIV transmission by about 80% over the long-term. The benefit is higher if condoms are used correctly on every occasion. Promoting condom use, however, has often proven controversial and difficult. Several religious groups, particularly the Roman Catholic Church, have opposed the use of condoms on religious grounds and have sometimes perceived condom promotion as an affront to the promotion of marriage, monogamy and sexual morality (BBC News, 2009).
