Hygiene is the practice of following certain health rules. In the age of AIDS, sexual hygiene means avoiding the exchange of bodily fluids and secretions during sexual activity.
Strictly speaking, semen, vaginal and cervical secretions, blood, urine, feces, saliva, tears, and mother's milk from one person should not be placed into the mouth, nose, eyes, ears, vagina, anus, or open wounds (even microscopic) of another person. As mentioned previously, the hands often have microscopic lesions (wounds) around the fingernail cuticles.
This chapter outlines the physical and behavioral barriers used to prevent catching HIV infection sexually, as well as discussing other important concerns.
Semen is a potentially contaminated substance. If contaminated, it is highly infectious. Neither semen nor pre-ejaculate fluid should come into contact with mucous membrane surfaces. Ideally, semen should not come into contact with a person's hands either, since microscopic lesions (wounds) often exist in the vicinity of the fingernail cuticles. Ideally, latex gloves should be worn to prevent hand-to-semen contact.
Be prepared in advance. Sexual passion often interferes with clear thinking. In order to provide adequate protection, condoms must be used correctly. See Figure 7 regarding condom use, and then practice.
Condoms are a physical barrier against HIV transmission but they are not perfect barriers. Condoms can have invisible pinholes or cracks. Condoms can break open or slip off. When condoms break, it is usually because of the lack of lubrication. Condom lubrication is very important in the preventing of condom breakage. Ideally, spermicide or contraceptive jelly should accompany condom use.
Most condoms are made of latex, basically a form of rubber. Approximately I percent of all condoms sold are natural, made of the "skin" of lamb's intestines. The membrane surfaces in intestines are permeable, meaning that some large biological molecules are able to pass through the material. In laboratory experiments, some viruses are able to pass through natural membrane condoms. Thus, natural membrane condoms are not considered adequate for preventing HIV infection.
Condoms vary in size and width, and generally these factors vary slightly from nation to nation. When going on vacation, bring your own condoms along.
All commercially manufactured condoms obtain the approval of the Food and Drug Administration (FDA), but there is a wide variety in quality. Researchers suggest avoiding "boutique" brands because quality control techniques may not be on par with those of major condom manufacturers.
With the advent of AIDS, many new types of condoms, supposedly designed for anal intercourse, have been marketed. Most claims are not backed by scientific experiment.
While condoms prevent contact between the sexual partners, diaphragms offer no protection for the mucous membrane surfaces within the female's vagina. Diaphragms only prevent semen from getting into the cervix, the doorway to the womb. If HIV is present in the semen, the whole vagina is still exposed.
Ideally, contraceptive jellies or spermicides should always be used along with condoms. By using both condoms and contraceptive chemicals, pregnancy risk approaches zero. Proper use of both should reduce greatly the risk of catching HIV. Used by themselves, contraceptive jellies and spermicides ARE NOT EFFECTIVE against pregnancy and probably are not effective in preventing HIV transmission.
Some chemicals are known to inactivate HIV. In the United States, nonoxynol-9 and benzalkonium chloride are two chemicals which inactivate (kill) HIV and are available in spermicidal jellies and foams, some condom lubricants, and on the tips of some condoms. Brands differ. If itching or irritation results from use, try another brand.
Ideally, latex gloves should be worn if the hands are to come into contact with semen, vaginal and cervical secretions, blood, urine, feces, saliva, tears, or mother's milk. That is, latex gloves should be worn to prevent hand-to-semen contact, hand-to-anus contact, hand-to-vagina contact, etc.
Among homosexual male AIDS patients, a slight statistical risk for hand-to-anal contact has been established.
In at least one instance, HIV transmission has occurred in a medical setting when a nurse's hands came into contact with blood (she did not wash her hands immediately as she should have). In another instance, a mother nursing an HIV-infected infant had frequent and prolonged contact with the baby's blood, feces, saliva, and nasal excretions and did not wash her hands immediately afterwards. The mother became infected.
The most dangerous substances, or course, are blood, semen, vaginal and cervical secretions, and feces. Saliva and tears do not seem capable of transmitting HIV due to their low concentration of HIV.
Put on condom as soon as erection occurs or before pre-ejaculatory fluid appear on tip of penis.
Be prepared in advance; sexual passion often interferes with clear thinking.
Practice condom use beforehand. Practice makes perfect.
With thumb and finger of one hand, gently squeeze condom tip together. (Squeezing condom tip ensures that no air remains in condom and leaves room for semen.) Place condom over tip of penis, then unroll condom over full length of penis with other hand. When unrolling condom down penis, be sure to expel all air. Unroll condom to base of penis.
Water-based lubricants, non-allergenic surgical lubricants (such as K-Y jelly), and contraceptive jellies and foams are OK to use. Available in pharmacies and sex specialty shops. Read the label. DO NOT use petroleum jelly or any petroleum-based lubricant (they dissolve latex). DO NOT use saliva (may contain germs or blood).
Avoid over-long exposure of condom to spermicides and contraceptive foams or creams. No problem should develop during the time-span of normal use.
Removing condom, roll condom up shaft of penis, then slide condom off without spilling contents.
DO NOT store condoms in sunlight. If the condom package has a window in it, DO NOT store condom package under fluorescent light. DO NOT store condoms in gloveboxes of cars: it gets too hot. Coolest place in auto is under front seats. Discard and replace condoms frequently if carried in wallet, or find better place.
Abstinence has other benefits: the lack of risk of pregnancy, and the lack of exposure to spermicides and contraceptive jellies (exposure to any chemical carries some degree of health risk), and the avoidance of the emotional ravages of premature sex. As many adults will testify, sexual activity can be emotionally hazardous.
Unfortunately, as a society, we are living a big lie. While many concerned individuals promote abstinence, our visual world is saturated with sexual images that relate success, maturity, and popularity to sexually active behavior.
Although touted as the historically successful approach, abstinence has never been fully successful as a way of controlling unwanted pregnancies nor STDs. Perhaps when most people lived in small villages and there were only a few dozen potential sexual mates in the vicinity, and social censure was very strong, abstinence was a realistic behavior. However in the modern western world, individualism overcomes social censure, in fact sexuality becomes a measure of success. Also, especially for young people, the number of potential sexual partners one sees daily, say just walking to work, may number in the hundreds.
Embarrassment is also a key issue, beginning with the purchase of the condom and ending with a reluctance to insist on their use.
The responsibility for purchasing and using condoms and other physical barriers should be shared by sexual partners. Each partner should be instructed how to place the barrier on the other partner and partners should practice doing so. By making eroticism part of this exercise, condom and barrier use can become part of relaxed, satisfying sexual behavior.
Avoid having sex with partners who: have sex with numerous people, with HIV-infected people, with IV drug users (including steroid users), with people who have sex with HIV-infected people, with people whose HIV status is unknown, and so on.
Negotiation of sexual activity is a new, necessary skill.
HIV infection and AIDS are not the only dangers associated with re-using IV needles. In populations who share and/or re-use IV needles, the following conditions are common: I ) HIV infection; 2) hepatitis B infection; 3) bacterial infections ("staph" and "strep"); 4) endocarditis (the inflammation of membrane lining the heart); 5) tetanus (poisoning by bacterial poisons); and, 6) embolisms, wherein air bubbles introduced by the needle into the bloodstream become lodged in blood vessels, blocking blood flow and perhaps resulting in the death of tissues downstream and/or the death of the person.
If needles are re-used, proper cleaning can help reduce the risk of these conditions occurring. Two cleaning agents are generally available: bleach, and ethanol (drinking alcohol). Isopropyl alcohol (rubbing alcohol) does not seem effective against HIV in this setting. DO NOT USE RUBBING ALCOHOL.
Bleach is inexpensive and very effective, but it slowly corrodes plastic and metal. Bleach is poisonous to living tissue. Pure bleach spilled on skin can cause burns. To make a cleaning solution of bleach, add I part bleach to 9 parts water. "Parts" just means any unit of measure, a part can be a cupful or a bucketful, just keep the "parts" the same.
Ethanol is drinking alcohol. Ethanol is very expensive. Ethanol can be purchased at liquor stores or at chemical supply stores. If purchased at a liquor store, the liquor must be "150 proof' or more. Ethanol does not harm metal but it will eventually damage plastic. Purchased from a chemical supply store, the ethanol will be "denatured:" poison is added to make it undrinkable. Denatured alcohol is still useful for cleaning equipment.
To clean equipment: I ) fill a container with cleaning solution, 2) stick the needle point into the solution and slowly fill the syringe by drawing the plunger back. Keep the needle point below the surface of the liquid, do not let air bubbles into the syringe. 3) Tap the syringe up and down its length to dislodge air bubbles. 4) After filling the syringe, slowly push the plunger all the way to the bottom, expelling all fluid from the syringe. 5) Repeat this several times. 6) Disassemble the equipment and leave them soaking in the solution for at least 10 minutes. Preferably, soak the equipment in alcohol until the next use.
Before using equipment again, fill a glass with water and carefully flush the needle and syringe by pumping water in and out of the equipment. Change the water and wash both the inside and outside of the equipment. Remove all smell of bleach or alcohol.
Discard cleaning solutions after use. Discard any cleaning solutions left out over night.
If the syringe contains blood, stronger mixtures of cleaning solution may be used. If time is short, fill a glass with bleach; pump bleach in and out of the syringe several times, then fill the glass with water, and pump some more.
Or, the needles and syringe can be boiled in water for 10 minutes. This heat should kill HIV, but not the stronger bacteria.
To clean up such spills, use a 10 percent bleach solution ( I part bleach, 9 parts water). Surround the spill with bleach solution, work inward with the mop, working slowly and carefully to avoid splashes or creating aerosols (airborne particles). Stronger bleach solutions should be used if excessive amounts of blood/substance is present. Afterwards, the mop head should be soaked in 10 percent bleach solution. Agitate (stir up) the mop head carefully to ensure that all mop surfaces are exposed to the cleaning fluid.
If an open wound is exposed to an HIV-contaminated substance, it should be immediately flushed with large amounts of hydrogen peroxide or a 10 percent bleach solution (I part bleach, 9 parts water). DO NOT place hydrogen peroxide on mucous membrane surfaces. DO NOT pour hydrogen peroxide into mouth, vagina, anus, eyes, urethra, etc.
While not all medical authorities agree with the procedure, more and more hospitals are offering autologous transfusions (a patient receives his or her own blood collected in the weeks before surgery). Besides preventing possible HIV infection, autologous transfusions prevent many other transfusion-related problems. Most negative reactions associated with transfusions are caused by foreign proteins (antigens) in the donor blood which the patient's immune system attacks as invaders.
Anyone planning elective surgery (surgery by choice) should consult his or her physician regarding autologous transfusions.
Bleach is the preferred cleaning agent of research labs. Mix I part bleach with 9 parts water to make a 10 percent bleach solution. If blood or bodily secretions are plentiful, then use a stronger mixture.
Ethanol (drinking alcohol) at 50 percent solution (100 proof) kills HIV. Isopropyl alcohol in a 35 percent solution kills HIV in most settings, but not for cleaning IV or hypodermic needles. Most drug store alcohol is 70 percent. Read the label. (Alcohols are not as effective in killing HIV in the presence of blood. If blood or other substances are plentiful, use stronger mixtures or lots of alcohol.)
Lysol at 0.5 percent solution inactivates HIV. In stores, Lysol is available at 3 percent solution, read the label.
In the hospital, Nonidet P-40 at 1 percent killed HIV. Paraformaldehyes and phenols are effective. Formalin was effective but too slow for common use. Tween-20 was ineffective, but its stronger version was effective.