Ses Affects Our Society
SES affects overall human functioning, including our physical and mental health. Low SES and its correlates, such as lower educational achievement, poverty and poor health, ultimately affect our society. Inequities in health distribution, resource distribution, and quality of life are increasing in the United States and globally. Society benefits from an increased focus on the foundations of socioeconomic inequities and efforts to reduce the deep gaps in socioeconomic status in the United States and abroad.
What Medication Is Available
There are currently two medications approved by the FDA for PrEP: Truvada and Descovy.
Both of these medications can be up to 99% effective at HIV prevention when taken correctly. However, the notable difference between these medications is that Descovy is currently only approved for use in cisgender males and transgender females, while Truvada is approved for all genders.
PrEP does not have any significant health effects even with long-term use, but you may experience some side effects, such as:
- Rash
- Abdominal pain
- Changes in weight
Some more severe side effects that may occur can be kidney issues, liver problems, or bone density loss. But these often occur in people who had health issues prior to taking PrEP. Ultimately, it is between you and your doctor to determine whether or not PrEP is the best choice for you.
What Is The Risk Of Hiv From Anal Sex
The risk of HIV through unprotected anal intercourse is seen to be extremely high, as much 18 times greater than vaginal intercourse. The reasons for the increased risk are well known and include such factors as:
- The fragility of rectal tissues, which allow the virus direct access into the bloodstream through tiny tears or abrasions
- The porousness of rectal tissues, providing access even when undamaged
- The high concentration of HIV in semen and pre-seminal fluid , which doubles the risk of infection with every one-log rise in the person’s viral load.
Furthermore, the secretion of blood from damaged rectal tissues can increase the risk for the insertive partner, providing the virus a route of transmission through the urethra and tissues that line the head of the penis .
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Are There Any Issues That Affect Hiv Treatment In Women
Treatment with HIV medicines is recommended for everyone with HIV. Treatment with HIV medicines helps people with HIV live longer, healthier lives. ART also reduces the risk of HIV transmission.
People should start taking HIV medicines as soon as possible after HIV is diagnosed. However, birth control and pregnancy are two issues that can affect HIV treatment in women.
Birth control
Some HIV medicines may reduce the effectiveness of hormonal contraceptives, such as birth control pills, patches, rings, or implants. Women taking certain HIV medicines may have to use an additional or different form of birth control. For more information, view the HIV and Birth Control infographic from HIVinfo.
Pregnancy
Women with HIV take HIV medicines during pregnancy and childbirth to reduce the risk of perinatal transmission of HIV and to protect their own health.
The choice of an HIV treatment regimen to use during pregnancy depends on several factors, including a womans current or past use of HIV medicines, other medical conditions she may have, and the results of drug-resistance testing. In general, pregnant women with HIV can use the same HIV treatment regimens recommended for non-pregnant adultsunless the risk of any known side effects to a pregnant woman or her baby outweighs the benefits of a regimen.
Ses Impacts The Lives Of People With Hiv/aids
Both domestically and internationally, HIV is a disease that is embedded in social and economic inequity , as it affects those of lower socioeconomic status and impoverished neighborhoods at a disproportionately high rate. Research on SES and HIV/AIDS suggests that a persons socioeconomic standing may affect his or her likelihood of contracting HIV and developing AIDS. Furthermore, SES is a key factor in determining the quality of life for individuals after they are affected by the virus.
SES Affects HIV Infection
A lack of socioeconomic resources is linked to the practice of riskier health behaviors, which can lead to the contraction of HIV. These behaviors include substance use, which reduces the likelihood of using condoms .
HIV Status Affects SES
HIV status often has a negative impact on socioeconomic status by constraining an individuals ability to work and earn income.
SES Affects HIV Treatment
Get Involved
- Consider SES in your education, practice and research efforts.
- Stay up to date on legislation and policies that explore and work to eliminate socioeconomic disparities . Visit the Office on Government Relations for more details.
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Challenges In Calculating A Number
It isn’t easy for researchers to calculate the risk of transmission from an exposure to HIV through sex. To do this effectively, a group of HIV-negative individuals need to be followed over time and their exposures to HIVboth the number of times they are exposed and the types of exposureneed to be tracked.
As you can imagine, accurately tracking the number of times a person is exposed to HIV is very difficult. Researchers ask HIV-negative individuals enrolled in these studies to report how many times they have had sex in a given period of time, what type of sex they had, how often they used condoms and the HIV status of their partner. Because a person may have trouble remembering their sexual behaviour or may not want to tell the whole truth, this reporting is often inaccurate.
Furthermore, a person does not always know the HIV status of their partner. For this reason, researchers usually enroll HIV-negative individuals who are in stable relationships with an HIV-positive partner . Researchers can then conclude that any unprotected sex reported by a study participant counts as an exposure to HIV.
Men Who Have Sex With Men
Gay or bisexual MSM are the most severely affected population. MSM account for just a small fraction of the total U.S. population, yet nearly two-thirds of all new infections occurred within this group in 2009, and one-half of all people living with HIV in 2008 were MSM. MSM within ethnic minority populations are at greatest risk .
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All Exposures Are Not Equal
The results of several meta-analyses suggest that some types of sex carry on average a higher risk of HIV transmission than others. Below are estimates from meta-analyses that have combined the results of studies conducted in high-income countries. For types of sex where meta-analysis estimates do not exist, numbers from individual studies are provided.
Anal sex
A meta-analysis exploring the risk of HIV transmission through unprotected anal sex was published in 2010.1 The analysis, based on the results of four studies, estimated the risk through receptive anal sex to be 1.4%. This risk was similar regardless of whether the receptive partner was a man or woman.
No meta-analysis estimates currently exist for insertive anal sex but two individual studies were conducted to calculate this risk. The first, published in 1999, calculated the risk to be 0.06% .2 However, due to the design of the study, this number likely underestimated the risk of HIV transmission. The second study, published in 2010, was better designed and estimated the risk to be 0.11% for circumcised men and 0.62% for uncircumcised men.3
Vaginal sex
A meta-analysis of 10 studies exploring the risk of transmission through vaginal sex was published in 2009.4 It is estimated the risk of HIV transmission through receptive vaginal sex to be 0.08% .
A meta-analysis of three studies exploring the risk from insertive vaginal sex was estimated to be 0.04% .4
Oral sex
Why People Living With Hiv May Have Worse Covid
While several studies have observed worse outcomes in people with HIV, understanding of the reasons for these is incomplete. Possible explanations include:
- HIV-specific factors. It is possible that chronic inflammation in response to HIV infection may raise the risk of severe COVID-19 outcomes. Excess inflammation is most pronounced in individuals who have had a very low CD4 count in the past or with incomplete reconstitution of their immune system.
- Underlying health conditions. If people with HIV have higher rates of underlying health conditions that are risk factors for severe COVID-19, this will affect outcomes. Researchers try to take these into account in their analyses, but studies may not collect enough information on all relevant conditions.
- Social determinants of health. In many places, significant numbers of people with HIV are economically disadvantaged, live in overcrowded housing, work in frontline jobs or belong to ethnic minorities. However, studies do not usually collect data on many of these factors.
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Risks To Insertive And Receptive Partners
There is a widespread belief among gay men that the insertive partner is at very low risk of HIV infection. It is true that HIV infection occurs less frequently in men who solely take the insertive role than in men who engage in both roles, or men who practise receptive anal intercourse only .
However, being the insertive partner in condomless sex remains a high-risk activity. The per-act risk for the insertive partner in anal sex is comparable to the per-act risk for the male partner in vaginal sex.
The receptive partner is at risk of infection from HIV in the semen and pre-seminal fluids of the infected partner. Rectal tissue is delicate and easily damaged, which can give the virus direct access to the bloodstream. However, such tissue damage is not necessary for infection to occur: the rectal tissue itself is rich in cells which are directly susceptible to infection.
The insertive partner is also at risk of infection, as there are high levels of HIV in rectal secretions, as well as blood from the rectal tissues . This creates a risk of transmission to the insertive partner through the tissue in the urethra and on the head of the penis particularly underneath the foreskin.
Several systematic reviews of studies have calculated that condomless receptive anal intercourse posed approximately ten to twelve times greater risk of infection than insertive anal intercourse.
receptive
Women At Greater Risk Of Getting Hiv/aids
More women than men are now HIV-positive. In South Africa, HIV prevalence in women aged 15-24 is nearly four times greater than men of that age.
This is partly because women usually become infected at a younger age than men. In Africa, many young women have sexual relations with older men who are more likely to be HIV-positive, with the result that far more young women than young men get infected.
HIV is also more common in women because theyre at higher risk of infection. The reasons are both physical and socio-cultural.
Sex carries a higher infection risk
Heterosexual intercourse carries a higher risk of infection for women.
During sex, semen enters the vagina, where it can stay for several hours, increasing the risk of infection. The virus enters the bloodstream via tiny sores that form in the sensitive lining of the vagina during intercourse.
Certain sexual practices between men and women, such as dry sex and anal sex, carry an even greater risk of HIV because they cause more severe vaginal or anal abrasions.
Unequal power relations
Unequal power relations between men and women, particularly when negotiating sexual relations, increases womens vulnerability.
In South Africa, and throughout Africa, male-dominated culture socialises men to feel that theyre superior to women, that they should control them, and that women should be submissive. Womens inferior status means that they often have little or no power to negotiate safer sex.
Lack of economic power
R75 per month
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Antiretroviral Treatment For Women
Globally, adult women are more likely to be accessing antiretroviral treatment than men. In 2017, 65% of women living with HIV had access to treatment compared with just 53% of HIV-positive men71 This means that, despite women being more affected by HIV globally, the AIDS-related death rate is around a third lower among women than among men, and has decreased by 33% since 2010, compared to a 15% reduction for men.7273
Despite this, AIDS-related illness remains the leading cause of death among women of reproductive age.74
Coverage is higher among pregnant women attending clinics that provide prevention of mother-to-child transmission services. In South Africa, for example, while ART coverage is only 53% for women over the age of 15, PMTCT coverage is over 95%. Similarly, in Uganda, ART coverage is 65% in women over the age of 15, yet PMTCT service coverage is over 95%.75
Clearly PMTCT services are proving effective. However, despite considerable progress, 20% of pregnant women living with HIV in 2017 did not access antiretroviral drugs for PMTCT and there is still not enough focus on reaching young women who are not pregnant.76 For more information on PMTCT see our.
Putting A Number On It: The Risk From An Exposure To Hiv
This information was provided by CATIE . For more information, contact CATIE at 1-800-263-1638.
Author: James Wilton
Service providers working in HIV prevention are often asked by their patients and clients about the risk of HIV transmission from an exposure to HIV through sex. What do the latest studies tell us about this risk? And how should we interpret and communicate the results?
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Lack Of Access To Education
Studies have shown that increasing educational achievement among women and girls is linked to better SRH outcomes, including delayed childbearing, safer births and safer abortions, lower rates of sexually transmitted infections and unintended pregnancies.35
Women with more education tend to marry later, bear children later and exercise greater control over their fertility. 36, DeNeve, JW et al. Length of secondary schooling and risk of HIV infection in Botswana: evidence from a natural experiment, Lancet Glob Health, Volume 3, No.8, p.e470e477 It has also been shown to be linked to reduced risk of partner violence, another factor that makes women and girls vulnerable to HIV.37 Despite this, in the least developed countries in the world, 60% of girls do not attend secondary school.38
Research has shown a direct correlation between girls educational attainment and HIV risk: uneducated girls are twice as likely to acquire HIV as those who have attended school.39 In Botswana, UNAIDS reports that every additional year of school a girl completes reduces her risk of acquiring HIV by 11.6%.40
Research Findings About Higher Incidence Of Heart Failure Among People With Hiv
Silverberg and his colleagues identified 38,868 people with HIV who were Kaiser Permanente members between 2000 and 2016 in one of 3 regions: Northern California, Southern California, and the Mid-Atlantic States. Next, they matched each person with up to 10 Kaiser Permanente members from the corresponding region who were the same age, gender, and race but did not have HIV this group included 386,586 people. Lastly, they identified the people in both groups who had developed heart failure during follow-up.
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Should You Get Tested For Hiv
Everyone between the ages of 13 and 64 should get tested for HIV at least once. If your behavior puts you at risk after you are tested, you should think about being tested again. Some people at higher risk should get tested more often.
If your last HIV test result was negative, you should get an HIV test if you answer “yes” to any of the questions below about your risk since that test:
- Are you a man who has had sex with another man?
- Have you had sexanal or vaginalwith an HIV-positive partner?
- Have you had more than one sex partner?
- Have you injected drugs and shared needles or works with others?
- Have you exchanged sex for drugs or money?
- Have you been diagnosed with, or sought treatment for, another sexually transmitted disease?
- Have you been diagnosed with or treated for hepatitis or tuberculosis ?
- Have you had sex with someone who could answer “yes” to any of the above questions or someone whose sexual history you don’t know?
Sexually active gay and bisexual men may benefit from more frequent testing .
If you’re pregnant, talk to your health care provider about getting tested for HIV and other ways to protect you and your child from getting HIV.
How Can Testing Help You
The only way to know for sure whether you have HIV is to get tested.
Knowing your HIV status gives you powerful information to help you take steps to keep you and your partner healthy.
- If you test positive, you can take medicine to treat HIV . People with HIV who take HIV medicine as prescribed can live long and healthy lives. Theres also an important prevention benefit. If you take HIV medicine daily as prescribed and get and keep an undetectable viral load, you have effectively no risk of transmitting HIV to an HIV-negative partner through sex.
- If you test negative, you have more prevention tools available today to prevent HIV than ever before.
- If you are pregnant, you should be tested for HIV so that you can begin treatment if you’re HIV-positive. If an HIV-positive woman is treated for HIV early in her pregnancy, the risk of transmitting HIV to her baby can be very low.
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Estimating Transmission Risk By Exposure Type
When discussing HIV risk, it’s important to first establish the four conditions that must take place in order for HIV transmission to occur:
Determining whether an activity is “high risk” or “low risk” is, therefore, dependent upon how efficiently an activity satisfies each of these four conditions.