Prevention of HIV/AIDS
HIV prevention refers to practices done to prevent the spread of HIV/AIDS. HIV prevention practices may be done by individuals to protect their own health and the health of those in their community, or may be instituted by governments or other organizations as public health policies.
Some commonly considered pharmaceutical interventions for the prevention of HIV include the use of the following:
Of these, the only universally medically proven method for preventing the spread of HIV during sexual intercourse is the correct use of condoms, and condoms are also the only method promoted by health authorities worldwide. For HIV positive mothers wishing to prevent the spread of HIV to their child during birth, antiretroviral drugs have been medically proven to reduce the likelihood of the spread of the infection. Scientists worldwide are currently researching other prevention systems.
Increased risk of contracting HIV often correlates with infection by other diseases, particularly other sexually transmitted infections. Medical professionals and scientists recommend treatment or prevention of other infections such as herpes, hepatitis A, hepatitis B, hepatitis C, human papillomavirus, syphilis, gonorrhea, and tuberculosis as an indirect way to prevent the spread of HIV infection. Often doctors treat these conditions with pharmaceutical interventions.
As of September 2013, condoms are available inside prisons in Canada, most of the European Union, Australia, Brazil, Indonesia, South Africa, and the US state of Vermont (on September 17, 2013, the Californian Senate approved a bill for condom distribution inside the state's prisons, but the bill was not yet law at the time of approval).
Social strategies do not require any drug or object to be effective, but rather require persons to change their behavior in order to gain protection from HIV. Some social strategies which people consider include the following
These strategies have widely differing levels of efficacy, social acceptance and acceptance in the medical and scientific communities. An example of an intervention employing these social strategies is the Women's Health Co-Op (WHC), which is on the CDC's best evidence based practice list for HIV prevention.
Populations which receive HIV testing are less likely to engage in behaviors with high risk of contracting HIV, so HIV testing is almost always a part of any strategy to encourage people to change their behavior to become less likely to contract HIV.
Over 60 countries impose some form of travel restriction, either for short or long term stays, for people infected with HIV.
Consistent condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term. Where one partner of a couple is infected, consistent condom use results in rates of HIV infection for the uninfected person of below 1% per year. Some data supports the equivalence of female condoms to latex condoms however the evidence is not definitive. The use of the spermicide nonoxynol-9 may increase the risk of transmission due to the fact that it causes vaginal and rectal irritation. A vaginal gel containing tenofovir, a reverse transcriptase inhibitor, when used immediately before sex, reduce infection rates by approximately 40% among African women.
Circumcision in sub-Saharan Africa reduces the risk of HIV infection in heterosexual men by between 38 percent and 66 percent over two years. Based on these studies, the World Health Organization and UNAIDS both recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007. Whether it protects against male-to-female transmission is disputed and whether it is of benefit in developed countries and among men who have sex with men is undetermined. Some experts fear that a lower perception of vulnerability among circumcised men may result in more sexual risk-taking behavior, thus negating its preventive effects. Women who have undergone female genital cutting have an increased risk of HIV.
Programs encouraging sexual abstinence do not appear to effect subsequent HIV risk. Evidence for a benefit from peer education is equally poor. Comprehensive sexual education provided at school may decrease high risk behavior. A substantial minority of young people continue to engage in high-risk practices despite HIV/AIDS knowledge, underestimating their own risk of becoming infected with HIV. It is not known if treating other sexually transmitted infections is effective in preventing HIV.
Early treatment of HIV-infected people with antiretrovirals protected 96% of partners from infection. Pre-exposure prophylaxis with a daily dose of the medications tenofovir with or without emtricitabine is effective in a number of groups including: men who have sex with men, by couples where one is HIV positive, and by young heterosexuals in Africa.
Universal precautions within the health care environment are believed to be effective in decreasing the risk of HIV. Intravenous drug use is an important risk factor and harm reduction strategies such as needle-exchange programmes and opioid substitution therapy appear effective in decreasing this risk.
Needle exchange programs (also known as syringe exchange programs) are effective in preventing HIV among IDUs as well as in the broader community. Pharmacy sales of syringes and physician prescription of syringes have been also found to reduce HIV risk. Supervised injection facilities are also understood to address HIV risk in the most-at-risk populations. Multiple legal and attitudinal barriers limit the scale and coverage of these "harm reduction" programs in the United States as well as elsewhere around the world.
The American Centers for Disease Control and Prevention (CDC) conducted a study in partnership with the Thailand Ministry of Public Health to ascertain the effectiveness of providing people who inject drugs illicitly with daily doses of the anti-retroviral drug Tenofovir as a prevention measure. The results of the study were released in mid-June 2013 and revealed a 48.9% reduced incidence of the virus among the group of subjects who received the drug, in comparison to the control group who received a placebo. The Principal Investigator of the study stated in the Lancet medical journal: “We now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use.”
A course of antiretrovirals administered within 48 to 72 hours after exposure to HIV positive blood or genital secretions is referred to as post-exposure prophylaxis. The use of the single agent zidovudine reduces the risk of subsequent HIV infection fivefold following a needle stick injury. Treatment is recommended after sexual assault when the perpetrators is known to be HIV positive but is controversial when their HIV status is unknown. Current treatment regimes typical use lopinavir/ritonavir and lamivudine/zidovudine or emtricitabine/tenofovir and may decrease the risk further. The duration of treatment is usually four weeks and is associated with significant rates of adverse effects (for zidovudine ~70% including: nausea 24%, fatigue 22%, emotional distress 13%, headaches 9%).
Programs to prevent the transmission of HIV from mothers to children can reduce rates of transmission by 92-99%. This primarily involves the use of a combination of antivirals during pregnancy and after birth in the infant but also potentially include bottle feeding rather than breastfeeding. If replacement feeding is acceptable, feasible, affordable, sustainable and safe mothers should avoid breast-feeding their infants however exclusive breast-feeding is recommended during the first months of life if this is not the case. If exclusive breast feeding is carried out the provision of extended antiretroviral prophylaxis to the infant decreases the risk of transmission.
As of 2012 there is no effective vaccine for HIV or AIDS. A single trial of the vaccine RV 144 published in 2009 found a partial efficacy rate of ~30% and has stimulated optimism in the research community regarding developing a truly effective vaccine. Further trials of the vaccine are ongoing.
Laws criminalizing HIV transmission have not been found an effective way to reduce HIV risk behavior, and may actually do more harm than good. In the past, many U.S. states criminalized the possession of needles without a prescription, even going so far as to arrest people as they leave private needle-exchange facilities. In jurisdictions where syringe prescription status presented a legal barrier to access, physician prescription programs had shown promise in addressing risky injection behaviors. Epidemiological research demonstrating that syringe access programs are both effective and cost-effective helped change state and local laws relating to needle-exchange program (NEP) operation as well as the status of syringe possession more broadly. As of 2006, 48 states in the United States authorized needle exchange in some form or allowed the purchase of sterile syringes without a prescription at pharmacies.
Removal of legal barriers to operation of NEPs and other syringe access initiatives has been identified as an important part of a comprehensive approach to reducing HIV transmission among injection drug users (IDUs). Legal barriers include both "law on the books" and "law on the streets," i.e., the actual practices of law enforcement officers, which may or may not reflect the formal law. Changes in syringe and drug control policy can be ineffective in reducing such barriers if police continue to treat syringe possession as a crime or participation in NEP as evidence of criminal activity.  Although most NEPs in the US are now operating legally, many report some form of police interference.
Research elsewhere has shown similar misalignment between “law on the books” and “law on the streets.” For example in Kyrgyzstan, although sex work, syringe sales, and possession of syringes are not criminalized and possession of a small amount of drug has been decriminalized, gaps remain between these policies and law enforcement knowledge and practice. To optimize public health efforts targeting vulnerable groups, law enforcement personnel and public health policies and practices should be closely aligned. Such alignment can be improved through policy, training, and coordination efforts.
The Centers for Disease Control was the first organization to recognize the pandemic which came to be called AIDS. Their announcement came on June 5, 1981 when one of their journals published an article reporting five cases of pneumonia caused by Pneumocystis jirovecii, all in gay men living in Los Angeles.
In May 1983, scientists isolated a retrovirus which was later called HIV from an AIDS patient in France. At this point the disease caused AIDS was proposed to be caused by HIV, and people began to consider prevention of HIV as a strategy for preventing AIDS.
In the 1980s public policy makers and most of the public could not understand that the overlap of sexual and needle-sharing networks with the general community had somehow lead to many thousands of people worldwide becoming infected with HIV. In many countries leaders and most of the general public denied both that AIDS and the risk behaviors which spread HIV existed were present outside of concentrated populations.
In 1987 the United States FDA approved AZT as the first pharmaceutical treatment for AIDS. Around the same time ACT UP was formed, with one of the group's first goals being to find a way to get access to pharmaceutical drugs to treat HIV. When AZT was made publicly available, it was extremely expensive and unaffordable to all but the most wealthy AIDS patients. The availability of medicine but the lack of access to it sparked large protests around FDA offices.
In 2003 there were reports that in Swaziland and Botswana nearly 4 out of 10 people were HIV positive. Festus Mogae, president of Botswana, admitted huge infrastructure problems to the international community and requested foreign intervention in the form of consulting in health care setup and anti-retroviral drug distribution programs. and from this began to be personally involved in HIV issues worldwide. In Swaziland the government chose not to immediately address the problem in the way that international health agencies advised and many people died. In world media, the governments of African countries began to similarly be described as participating in the effort to prevent HIV actively or less actively.
There came to be international discussion about why HIV rates in Africa were so high, because if the cause were known then prevention strategies could be developed. Previously some researchers had suggested that HIV in Africa was widespread because of unsafe medical practices which somehow transferred blood to patients through procedures such as vaccination, injection, or reuse of equipment. In March 2003 the WHO released a statement that almost all infections were, in fact, the result of unsafe practices in heterosexual intercourse.
In response to the rising HIV rates, Cardinal Alfonso López Trujillo, speaking on behalf of the Vatican, said that not only was the use of condoms immoral, but also that condoms were ineffective in preventing HIV. The cardinal was highly criticized by the world health community, who were trying to promote condom use as a way to prevent the spread of HIV.
In 2001 the United States began a War in Afghanistan related to fighting the Taliban. The Taliban, however, had opposed local opium growers and the heroin trade; when the government of Afghanistan fell during the war, opium production was unchecked. By 2003, the world market saw an increase in the available heroin supply, and in former Soviet states especially, there was an increase in HIV infection due to injection drug use. Efforts were renewed to prevent HIV related to sharing needles.
In July 2011, it was announced by the WHO and UNAIDS that a once-daily antiretroviral tablet could significantly reduce the risk of HIV transmission in heterosexual couples. These findings were based on the results of two trials conducted in Kenya and Uganda, and Botswana.
The Partners PrEP (pre-exposure prophylaxis) trial was funded by the Bill and Melinda Gates Foundation and conducted by the International Clinical Research Center at the University of Washington. The trial followed 4758 heterosexual couples in Kenya and Uganda, in which one individual was HIV positive and the other was HIV negative. The uninfected (HIV negative) partner was given either a once-daily tenofovir tablet, a once-daily combination tablet of tenofovir and emtricitabine, or a placebo tablet containing no antiretroviral drug. These couples also received counselling and had access to free male and female condoms. In couples taking tenofovir and tenofovir/emtricitabine, there was a 62% and 73% decrease, respectively, in the number of HIV infections as compared to couples who were receiving the placebo.
A similar result was observed with the TDF2 trial, conducted by the United States Centers for Disease Control in partnership with the Botswana Ministry of Health. The trial followed 1200 HIV negative men and women in Francistown, Botswana, a city known to have one of the world's highest HIV infection rates. Participants received either a once-daily tenofovir/emtricitabine combination tablet or a placebo. In those taking the antiretroviral treatment, there was found to be a 63% decrease in the risk of acquiring HIV, as compared to those receiving the placebo.
- Nandra, Iqbal (28 March 2008). "WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention". who.int. Retrieved 3 July 2011.
- Holly Richmond (18 September 2013). "Everybody wants condom vending machines". Grist Magazine. Grist Magazine, Inc. Retrieved 19 September 2013.
- Weinhardt LS, Carey MP, Johnson BT, Bickham NL (1999). "Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997". American Journal of Public Health 89 (9): 1397–1405. doi:10.2105/ajph.89.9.1397.
- "HIVTravel - Regulations on Entry, Stay, and Residence for PLHIV". Retrieved 2012-02-26.
- Crosby, R; Bounse, S (March 2012). "Condom effectiveness: where are we now?". Sexual health 9 (1): 10–7. doi:10.1071/SH11036. PMID 22348628.
- "Condom Facts and Figures". WHO. August 2003. Retrieved January 17, 2006.
- Gallo, MF; Kilbourne-Brook, M; Coffey, PS (March 2012). "A review of the effectiveness and acceptability of the female condom for dual protection.". Sexual health 9 (1): 18–26. doi:10.1071/SH11037. PMID 22348629.
- Baptista, M; Ramalho-Santos, J (2009-11-01). "Spermicides, microbicides and antiviral agents: recent advances in the development of novel multi-functional compounds.". Mini reviews in medicinal chemistry 9 (13): 1556–67. doi:10.2174/138955709790361548. PMID 20205637.
- Celum, C; Baeten, JM (February 2012). "Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence.". Current Opinion in Infectious Diseases 25 (1): 51–7. doi:10.1097/QCO.0b013e32834ef5ef. PMC 3266126. PMID 22156901.
- Siegfried, N; Muller, M; Deeks, JJ; Volmink, J (2009-04-15). "Male circumcision for prevention of heterosexual acquisition of HIV in men.". Cochrane database of systematic reviews (Online) (2): CD003362. doi:10.1002/14651858.CD003362.pub2. PMID 19370585.
- "WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention". World Health Organization. Mar 28, 2007.
- Larke, N (2010 May 27 – Jun 9). "Male circumcision, HIV and sexually transmitted infections: a review". British journal of nursing (Mark Allen Publishing) 19 (10): 629–34. PMID 20622758.
- Eaton, L; Kalichman, SC (November 2009). "Behavioral aspects of male circumcision for the prevention of HIV infection". Current HIV/AIDS reports 6 (4): 187–93. doi:10.1007/s11904-009-0025-9. PMC 3557929. PMID 19849961.
- Kim, HH; Li, PS, Goldstein, M (November 2010). "Male circumcision: Africa and beyond?". Current Opinion in Urology 20 (6): 515–9. doi:10.1097/MOU.0b013e32833f1b21. PMID 20844437.
- Templeton, DJ; Millett, GA, Grulich, AE (February 2010). "Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men". Current Opinion in Infectious Diseases 23 (1): 45–52. doi:10.1097/QCO.0b013e328334e54d. PMID 19935420.
- Wiysonge, CS.; Kongnyuy, EJ.; Shey, M.; Muula, AS.; Navti, OB.; Akl, EA.; Lo, YR. (2011). "Male circumcision for prevention of homosexual acquisition of HIV in men". In Wiysonge, Charles Shey. Cochrane Database Syst Rev (6): CD007496. doi:10.1002/14651858.CD007496.pub2. PMID 21678366.
- Eaton LA, Kalichman S (December 2007). "Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies". Curr HIV/AIDS Rep 4 (4): 165–72. doi:10.1007/s11904-007-0024-7. PMC 2937204. PMID 18366947.
- Utz-Billing I, Kentenich H (December 2008). "Female genital mutilation: an injury, physical and mental harm". J Psychosom Obstet Gynaecol 29 (4): 225–9. doi:10.1080/01674820802547087. PMID 19065392.
- Underhill K, Operario D, Montgomery P (2008). "Abstinence-only programs for HIV infection prevention in high-income countries". In Operario, Don. Cochrane Database of Systematic Reviews (4): CD005421. doi:10.1002/14651858.CD005421.pub2. PMID 17943855.
- Tolli, MV (2012-05-28). "Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: a systematic review of European studies.". Health education research. doi:10.1093/her/cys055. PMID 22641791.
- Ljubojević, S; Lipozenčić, J (2010). "Sexually transmitted infections and adolescence.". Acta dermatovenerologica Croatica : ADC 18 (4): 305–10. PMID 21251451.
- Patel VL, Yoskowitz NA, Kaufman DR, Shortliffe EH (2008). "Discerning patterns of human immunodeficiency virus risk in healthy young adults". Am J Med 121 (4): 758–764. doi:10.1016/j.amjmed.2008.04.022. PMC 2597652. PMID 18724961.
- Ng, BE; Butler, LM; Horvath, T; Rutherford, GW (2011-03-16). "Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection.". Cochrane database of systematic reviews (Online) (3): CD001220. doi:10.1002/14651858.CD001220.pub3. PMID 21412869.
- National Institute of Allergy and Infectious Diseases (NIAID), "Treating HIV-infected People with Antiretrovirals Protects Partners from Infection", NIH News, 2011 May
- Anglemyer, A; Rutherford, GW; Baggaley, RC; Egger, M; Siegfried, N (2011-08-10). "Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples.". Cochrane database of systematic reviews (Online) (8): CD009153. doi:10.1002/14651858.CD009153.pub2. PMID 21833973.
- Centers for Disease Control (CDC) (August 1987). "Recommendations for prevention of HIV transmission in health-care settings". MMWR 36 (Suppl 2): 1S–18S. PMID 3112554.
- Kurth, AE; Celum, C; Baeten, JM; Vermund, SH; Wasserheit, JN (March 2011). "Combination HIV prevention: significance, challenges, and opportunities.". Current HIV/AIDS reports 8 (1): 62–72. doi:10.1007/s11904-010-0063-3. PMC 3036787. PMID 20941553.
- World Health Organization. "Effectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS Among Injecting Drug Users". Evidence for Action Technical Papers. Retrieved 7 January 2012.
- E Macalino, D Dhawan Sachdev, JD Rich, C Becker, LJ Tan, L Beletsky and S Burris (2009). "A national physician survey on prescribing syringes as an HIV prevention measure". Subst. Abuse Treatm’t., Prev. & Pol’y. 36 Suppl 2: 1S–18S. PMID 3112554.
- L Beletsky, CS Davis, ED Anderson, S Burris (2008). "The Law (and Politics) of Safe Injection Facilities in the United States". American Journal of Public Health.
- Emma Bourke (14 June 2013). "Preventive drug could reduce HIV transmission among injecting drug users". The Conversation Australia. The Conversation Media Group. Retrieved 17 June 2013.
- Linden, JA (2011-09-01). "Clinical practice. Care of the adult patient after sexual assault.". The New England Journal of Medicine 365 (9): 834–41. doi:10.1056/NEJMcp1102869. PMID 21879901.
- Young, TN; Arens, FJ; Kennedy, GE; Laurie, JW; Rutherford, G (2007-01-24). "Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure.". Cochrane database of systematic reviews (Online) (1): CD002835. doi:10.1002/14651858.CD002835.pub3. PMID 17253483.
- Kripke, C (2007-08-01). "Antiretroviral prophylaxis for occupational exposure to HIV.". American family physician 76 (3): 375–6. PMID 17708137.
- Coutsoudis, A; Kwaan, L; Thomson, M (October 2010). "Prevention of vertical transmission of HIV-1 in resource-limited settings.". Expert review of anti-infective therapy 8 (10): 1163–75. doi:10.1586/eri.10.94. PMID 20954881.
- Siegfried, N; van der Merwe, L; Brocklehurst, P; Sint, TT (2011-07-06). "Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection.". Cochrane database of systematic reviews (Online) (7): CD003510. doi:10.1002/14651858.CD003510.pub3. PMID 21735394.
- "WHO HIV and Infant Feeding Technical Consultation Held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV – Infections in Pregnant Women, Mothers and their Infants – Consensus statement" (PDF). October 25–27, 2006. Archived from the original on April 9, 2008. Retrieved March 12, 2008.
- Horvath, T; Madi, BC; Iuppa, IM; Kennedy, GE; Rutherford, G; Read, JS (2009-01-21). "Interventions for preventing late postnatal mother-to-child transmission of HIV.". Cochrane database of systematic reviews (Online) (1): CD006734. doi:10.1002/14651858.CD006734.pub2. PMID 19160297.
- UNAIDS (May 18, 2012). "The quest for an HIV vaccine".
- Reynell, L; Trkola, A (2012-03-02). "HIV vaccines: an attainable goal?". Swiss medical weekly 142: w13535. doi:10.4414/smw.2012.13535. PMID 22389197.
- U.S. Army Office of the Surgeon General (March 21, 2011). "HIV Vaccine Trial in Thai Adults". ClinicalTrials.gov. Retrieved June 28, 2011.
- U.S. Army Office of the Surgeon General (June 2, 2010). "Follow up of Thai Adult Volunteers With Breakthrough HIV Infection After Participation in a Preventive HIV Vaccine Trial". ClinicalTrials.gov.
- Case P, Meehan T, Jones TS (1998). "Arrests and incarceration of injection drug users for syringe possession in Massachusetts: implications for HIV prevention". J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 18 Suppl 1: S71–5. doi:10.1097/00042560-199802001-00013. PMID 9663627.
- GE Macalino, D Dhawan Sachdev, JD Rich, C Becker, LJ Tan, L Beletsky and S Burris. (2009). "A national physician survey on prescribing syringes as an HIV prevention measure.". Subst. Abuse Treatm’t., Prev. & Pol’y 4 (1). Retrieved 2012-07-05.
- S Burris, D Finucane, H Gallagher, and J Grace (1996). "The legal strategies used in operating syringe exchange programs in the United States.". Am J Public Health 86 (8): 1161–6. doi:10.2105/ajph.86.8_pt_1.1161. PMC 1380633. PMID 8712281. Retrieved 2012-07-05.
- Chris Barrish (10 June 2006). "To stop AIDS 'breeding ground' needle exchange a must, many say". The News Journal. pp. A1, A5. Archived from the original on 2 September 2006. Retrieved 2006-06-10. Note: this article contains a picture of the interior of a "shooting gallery"
- Burris, S., Blankenship, K. M., Donoghoe, M., Sherman, S., Vernick, J. S., Case, P., et al. (2004). "Addressing the 'Risk Environment' for Injection Drug Users: The Mysterious Case of the Missing Cop.". Milbank Quarterly 82: 125–156. doi:10.1111/j.0887-378x.2004.00304.x. Retrieved 2012-07-05.
- Beletsky L, Burris S, Macalino GE. (2005). "Attitudes of Police Officers Towards Syringe Access, Occupational Needle-Sticks, and Drug Use: A Qualitative Study of One City Police Department in the United States.". Int’l. J. Drug Pol’y 16 (4): 267–274. doi:10.1016/j.drugpo.2005.01.009. Retrieved 2012-07-05.
- Beletsky L, Grau LE, White E, Bowman S, Heimer R. (2011). "The roles of law, client race and program visibility in shaping police interference with the operation of US syringe exchange programs.". Addiction 106 (2). doi:10.1111/j.1360-0443.2010.03149.x. PMC 3088513. PMID 21054615. Retrieved 2012-07-05.
- Beletsky L, Grau LE, White E, Bowman S, Heimer R. (2011). "The roles of law, client race and program visibility in shaping police interference with the operation of US syringe exchange programs.". Addiction 106 (2). doi:10.1111/j.1360-0443.2010.03149.x. PMC 3088513. PMID 21054615. Retrieved 2012-07-05.
- CIS News (2009). Kyrgyzstan takes an official course towards humanization of its policy towards drug users.
- Eurasian Harm Reduction Network (2011). "Implementation of the political declaration and plan of action on international cooperation towards an integrated and balanced strategy to counter the world drug problem". Eurasian Harm Reduction Network.
- Beletsky L, Thomas R, Smelyanskaya M, et al. (2012). "Policy reform to shift the health and human rights environment for vulnerable groups: the case of Kyrgyzstan’s Instruction 417". Journal of Health and Human Rights 14 (2): e1–e15. PMID 23568946.
- Michael H Merson, Jeffrey O’Malley, David Serwadda, Chantawipa Apisuk (6 August 2007). "The history and challenge of HIV prevention". The Lancet. online: 7. doi:10.1016/S0140-6736(08)60884-3. Retrieved 31 March 2011.
- Anonymous (1981). "Pneumocystis pneumonia—Los Angeles". Morbidity and Mortality Weekly Report (30): 250–52.
- Sepkowitz, Kent A. (7 June 2001). "AIDS — The First 20 Years". NEJM (Massachusetts Medical Society) 344 (23): 1764–72. doi:10.1056/NEJM200106073442306. PMID 11396444. Retrieved 19 April 2011.
- F. Barré-Sinoussi; J. C. Chermann; F. Rey; M. T. Nugeyre (20 May 1983). "Isolation of a T-Lymphotropic Retrovirus from a Patient at Risk for Acquired Immune Deficiency Syndrome (AIDS)". Science (American Association for the Advancement of Science) 220 (4599): 868–871. doi:10.1126/science.6189183. JSTOR 1690359. PMID 6189183.
- Brown, James (20 March 1987). "AEGiS-FDA: Approval of AZT". aegis.com. AIDS Education Global Information System. Retrieved 2 July 2011.
- "ACT UP 1987 Wall Street Action - List of Demands". actupny.org. March 1987. Retrieved 2 July 2011.
- "ACT UP/ NY Chronology 1989". actupny.org. 2003. Retrieved 2 July 2011.
- "Police Arrest AIDS Protesters Blocking Access to FDA Offices". Los Angeles Times. 11 Oct 1988.
- Loth, Renee (12 October 1988). "AIDS Protests close FDA Headquarters". Boston Globe.
- Carroll, Rory (3 January 2003). "Swaziland has world's highest Aids rate". The Guardian (London: GMG). ISSN 0261-3077. OCLC 60623878. Retrieved 2 July 2011.
- Boseley, Sarah (11 July 2003). "Bush vows to join Africa's war on Aids". The Guardian (London: GMG). ISSN 0261-3077. OCLC 60623878. Retrieved 2 July 2011.
- "Bogus Aids cures flood Swaziland - News - Mail & Guardian Online". mg.co.za. Mail & Guardian. 30 December 2003. Retrieved 2 July 2011.
- de Santis, Dominique (14 March 2003). "Expert group stresses that unsafe sex is primary mode of transmission of HIV in Africa". who.int. World Health Organization. Retrieved 2 July 2011.
- Johnston, B (14 October 2003). "Cardinal wants health warnings on 'unreliable' condoms". The Daily Telegraph. "I simply wished to remind the public, seconding the opinion of a good number of experts, that when the condom is employed as a contraceptive, it is not totally dependable, and that the cases of pregnancy are not rare. In the case of the AIDS virus, which is around 450 times smaller than the sperm cell, the condom's latex material obviously gives much less security."
- Stanford, Peter (22 April 2008). "Obituary: Cardinal Alfonso López Trujillo". The Guardian (London: GMG). ISSN 0261-3077. OCLC 60623878. Retrieved 2 July 2011.
- Parfitt, T. (2003). "Drug addiction and HIV infection on rise in Tajikistan". The Lancet 362 (9391): 1206–1211. doi:10.1016/S0140-6736(03)14560-6. PMID 14570036.
- Griffin, N.; Khoshnood, K. (2010). "Opium Trade, Insurgency, and HIV/AIDS in Afghanistan: Relationships and Regional Consequences". Asia-Pacific Journal of Public Health 22 (3 Suppl): 159S–167S. doi:10.1177/1010539510374524. PMID 20566549.
- Catherine A. Hankins , Samuel R. Friedman, Tariq Zafar and Steffanie A. Strathdee (2002). "Transmission and prevention of HIV and sexually transmitted infections in war settings: implications for current and future armed conﬂicts". AIDS (Lippincott Williams & Wilkins) (16): 2245–2252. ISSN 0269-9370.
- Todd, C. S.; Abed, A. M. S.; Strathdee, S. A.; Scott, P. T.; Botros, B. A.; Safi, N.; Earhart, K. C. (2007). "HIV, Hepatitis C, and Hepatitis B Infections and Associated Risk Behavior in Injection Drug Users, Kabul, Afghanistan". Emerging Infectious Diseases 13 (9): 1327–1331. doi:10.3201/eid1309.070036. PMC 2857281. PMID 18252103.
- "UNAIDS and WHO hail new results showing that a once-daily pill for HIV-negative people can prevent them from acquiring HIV". unaids.org. 13 July 2011. Retrieved 4 March 2012.
- "HIV & AIDS Information :: The efficacy of PrEP - The Partners PrEP trial". aidsmap.com. Retrieved 4 March 2012.
- "HIV & AIDS Information :: The efficacy of PrEP - The TDF2 trial". aidsmap.com. 2012. Retrieved 4 March 2012.
- AVERT's layman guide to HIV prevention
- UNAIDS operational guidelines for organizations promoting HIV prevention
- The US government's Centers for Disease Control's Division of HIV and AIDS Prevention
- CDC 2009 Compendium of Evidence-Based HIV Prevention Interventions