HIV prevention: invisible work with visible results.

21265 is the total population of the cities of Kosovo, Vysokoe, David-Gorodok, and Kamenets.
21805 is the total number of registered cases of HIV infection in the Republic of Belarus as of November 1, 2016.

Compare the figures.

For 10 months of 2016, 1978 HIV-infected individuals were identified in the Republic of Belarus, which is more than the population of the same city of Kosovo in the Brest region.

Impressive real figures that make you think. The leader of this important rating is the Gomel region with a huge gap — 9478 cases of infection, followed by the Minsk region — 3177, Minsk — 3969, Mogilev region — 1361, Brest region — 1682, Vitebsk region — 1177, and the list is completed by the Grodnenskay region, which is not prestigious to lead — Grodno region — 961 registered case of HIV infection.

As we can see, despite the technological nature of the century in which we live, the abundance of propaganda for a healthy lifestyle and the availability of various methods of prevention, the number of infections is unpleasantly impressive. Our Public Association "Club of Business Women" has been working on the prevention of HIV/STIs (sexually transmitted infections) since 1999. Within the framework of various projects, we work with those who are most at risk of infection — with risk groups. According to statistics, according to which the sexual transmission of HIV infection in the Brest region over the past 4 years is at the level of as much as 77.8%, we work with a vulnerable group of women practicing risky sexual behavior.

The main advantages of working with us are anonymity and accessibility. Interaction in this area requires delicacy and a non-judgmental approach to the target group with which we work. Our main task is to contain the prevalence of HIV/STIs and reduce the level of disease among the target group, not moralizing. Thanks to anonymous methods of work, it is possible to find contact with representatives of the group. We have an anonymous advisory point, a hotline, and visits to the locations of such women, as a rule, these are roadside service establishments or city hotels, bars, restaurants. We also involve the environment of our group — long-distance drivers, taxi drivers, hotel and roadside service employees. Actions are aimed at creating an image of the openness of our organization, its readiness to help in a difficult, non-standard situation. Only through a trusting attitude can we influence women at risk, help change their dangerous behavior to safe behavior, and teach them responsible attitude towards their health. This has yielded results — over 17 years of working on the prevention of HIV/STIs, the level of awareness among our target group has increased from 14% to 89%, which is confirmed by questionnaires during sentinel epidemiological surveillance and personal consultations. The results on reducing the incidence of STIs are also impressive — from 95% to 46%.

January 2016 was the starting point for us in implementing a new project "Containing the HIV epidemic and reducing morbidity and mortality from HIV in Belarus". Within its framework, we provide a comprehensive package of services to women practicing risky sexual behavior. Counseling is provided on a number of topics and issues: social, medical, psychological, legal. Telephone counseling is constantly available through the hotline (number +375 29 790 90 90). We distribute information and handout materials with up-to-date information to as many people as possible, and educate on the prevention of HIV infection and sexually transmitted infections. Our support also includes the provision of personal protective equipment (condoms, lubricants, hygiene wipes). Staff conduct rapid HIV testing using saliva, refer for free diagnostics of infections, and, we repeat, all this is based on conditions of mutual trust and anonymity.

It is worth noting separately the opportunity to ask any question to specialized specialists through the online service malina-center.by and receive free consultations and explanations from a psychologist, lawyer, dermatovenerologist, sexologist, and gynecologist.

In our work, we should not underestimate the importance of information. Despite general awareness of the routes of infection transmission, there are nuances that are not taken into account by everyone. With all types of sexual relations, there is a risk of HIV transmission. Each unprotected sexual contact (without a condom) with an HIV-infected person puts the uninfected partner at risk of infection. Women are more vulnerable to HIV infection due to greater surface contact with infected fluid, such as the high concentration of HIV in semen. Age also plays a role; women under 20 and over 45 years of age are most susceptible. It is important to consider the type of sexual contact. Anal sexual contact carries a higher risk of transmission (due to a greater likelihood of tissue damage, which significantly facilitates the penetration of the virus). The stage of the disease of the infected partner is another factor. The risk of HIV transmission at the earliest stages, before antibodies appear in the blood, i.e., during the "seroconversion window", and at a later stage of the disease when there are clinical manifestations of AIDS, is highest. Another important factor that significantly increases the risk of HIV transmission is the presence of sexually transmitted diseases. This is due to the fact that the entry of STI pathogens causes an inflammatory process, in addition, many STIs (syphilis, herpes, etc.) cause lesions in the genital area, which significantly facilitates the penetration of the HIV virus.

Note that if previously the leading route of HIV transmission was through the intravenous injection of drugs, now the situation is characterized by an increase in the number of infections through sexual contact up to 70%. It is important to remember that a woman's responsible attitude towards her health is the most important factor that minimizes the risk of HIV infection. We are ready to provide any advisory support, assistance with examinations and tests, but only you can guarantee safe behavior, including sexual behavior!

The publication is based on materials prepared by Pukhteeva V.V., coordinator of the Brest project "Containing the HIV epidemic and reducing morbidity and mortality from HIV in Belarus".