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safe sex (prevention of HIV1 & other STDs)

Management: 1) activities with no risk of HIV transmission - abstinence - dry kissing - hugging - massage - clothed body rubbing - fantasy 2) very low risk of HIV transmission - external water sports - sexual activities involving urine - oral sex with a condom - oral sex with a dental dam - deep kissing - masturbation on healthy, dry skin 3) low risk of HIV transmission - insertive vaginal intercourse with a condom - insertive anal intercourse with a condom - receiving oral sex without a latex barrier 4) medium risk of HIV transmission - receptive vaginal intercourse with a condom - receptive anal intercourse with a condom - giving oral sex without a latex barrier - masturbation on open or broken skin - inserting finger or hand into vagina or anus without latex barrier - sharing sex toys without a condom or disinfecting toys 5) high risk of HIV transmission - anal stimulation with tongue (rimming) - insertion of entire hand into vagina or anus (fisting) - inserting anal intercourse without a condom - insertive vaginal intercourse without a condom 6) very high risk of HIV transmission - receptive anal intercourse without a condom - receptive vaginal intercourse without a condom Notes: 1) condoms are 98% effective in preventing sexual transmission of HIV1 & other STD 2) male circumcision protects against heterosexual transmission of HIV1 (RR 0.4) [3] 3) 1% tenofovir gel used intravaginally before & after sex reduces incidence of HIV1 by up to 54% 4) oral tenofovir/emtricitabine reduces HIV1 transmission in serodiscordant heterosexual couples by 62-73% [5] 5) contraception safe for women with HIV1 [6]

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Veterans Administration, Mather, CA
  3. AIDS Clinical Care December 28, 2005
  4. Abdool KQ et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science 2010 Jul 19 PMID: 20643915 http://www.sciencemag.org/cgi/content/abstract/science.1193748v1
  5. University of Washington - Health Sciences/UW News, Community Relations & Marketing; Public release date: 13-Jul-2011 Pivotal study in Africa finds that HIV medications prevent HIV infection http://www.eurekalert.org/pub_releases/2011-07/uow--psi071211.php - CDC Press release: July 13, 2011 CDC Trial and Another Major Study Find PrEP Can Reduce Risk of HIV Infection among Heterosexuals http://www.cdc.gov/nchhstp/newsroom/PrEPHeterosexuals.html
  6. Centers for Disease Control and Prevention Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Hormonal Contraception Among Women at High Risk for HIV Infection or Infected with HIV MMWR June 22, 2012 / 61(24);449-452