Features of HIV infection: prevention, etiology and treatment. HIV prevention and treatment Specific prevention of HIV infection
Specific immunoprophylaxis of HIV infection has not been developed. WHO (according to documents) indicates 4 main areas of prevention:
^ prevention of sexual transmission of HIV through medical and moral education of the population, including older schoolchildren;
2) prevention of HIV transmission through the blood by ensuring the safety of blood products, aseptic conditions during invasive therapy (surgical and dental procedures that violate the integrity of the skin);
3) prevention of perinatal transmission of HIV by disseminating information on methods for preventing perinatal transmission of HIV in family planning, as well as providing medical care (including counseling) to women infected with HIV;
4) organization of medical care and social support for HIV patients, their families and others.
Unfortunately, as can be seen from the introductory remarks to the chapter, it turned out to be impossible to achieve 100% effectiveness of each of the directions, and by the mid-1990s, WHO stated the presence of an HIV pandemic in a number of regions of the world. Without touching on the reasons for this, we will only point out that (in the second direction) so far only a serological examination of blood donors is being carried out. “False-negative” results of such an examination may be due not only to technical errors, but also to the fact that the donor is in the “seronegative” period of the disease. PCR with donated blood is not yet performed in any country in the world. It follows from the above that an important link in the prevention of transmission of HIV (as well as cytomegalovirus, hepatitis, etc.) with blood and its preparations is a sharp restriction of indications for blood transfusions. With regard to perinatal transmission, an HIV-infected woman must decide whether to prevent or terminate a pregnancy, and forced termination of pregnancy is unacceptable, as this violates human rights.
Specific prevention of HIV infection in a child born to an HIV-infected mother is described in our textbook Neonatology [M.: MEDpress, 2004].
Prevention of infection in medical institutions is ensured by strict observance of the sanitary and epidemic regime. In doing so, you must remember:
The greatest danger of spreading HIV is blood and saliva.
The maximum risk is the penetration of infected material through damaged skin and mucous membranes. In this regard, it is necessary to carefully avoid accidental damage to the skin with sharp instruments.
All manipulations with patients, as well as work with biological materials from the patient, are carried out by medical workers in disposable rubber gloves and masks. In addition, it is necessary to observe all precautions provided for when working with patients with viral hepatitis B.
All healthcare workers who come into contact with HIV-infected patients should be vaccinated against hepatitis B.
If the skin is damaged, it is necessary to immediately treat the gloves (70% alcohol, 3% chloramine, chlorhexidine alcohol solution) and remove them, squeeze the blood out of the wound, then thoroughly wash your hands with soap and water under running water, treat them with 70% alcohol and lubricate the wound with 5% iodine solution. If hands are contaminated with blood, immediately treat them with a swab moistened with a 3% solution of chloramine or 70% alcohol, wash them twice with running water and soap and dry them with a disposable towel. It is necessary to immediately consult with a specialist in HIV infection and resolve the issue of chemoprophylaxis (Table 299).
Prevention of HIV infection at the risk of parenteral infection (Rakhmanova A. G., 2000)
Table 299
|
* Take into account the HIV status of the patient whose blood was in contact:
In case of trauma from an asymptomatic patient with a high level of CD4+ T-helpers and a low viral load (the number of copies of HIV RNA in 1 ml of blood plasma), type 3 chemotherapy is performed;
With an advanced clinical picture of the disease, the level of CD4+ T-helpers is below 500 in 1 µl and / or viral load, type 1 chemoprophylaxis is performed.
* * If a patient does not have a positive serology prior to exposure and there is no evidence of a negative serological test, a rapid test is preferred, as results will be available within 1 hour. Standard serological tests may take 3 to 7 days, but a negative ELISA usually available within 24-48 hours. If the patient has an illness with an acute HIV infection syndrome, then testing should also include measuring the level of HIV RNA and HIV DNA.
If blood gets on the mucous membranes of the eyes, they should be immediately washed with water or a 1% solution of boric acid.
If blood, saliva of the patient gets on the nasal mucosa, it is necessary to treat it with a 1% solution of protargol; on the mucous membrane of the mouth - rinse your mouth with 70% alcohol solution or 0.05% potassium permanganate solution or 1% boric acid solution.
Health care workers with wounds on their hands, exudative skin lesions or oozing dermatitis are temporarily suspended from caring for HIV-infected patients and from contact with care items.
Be sure to thoroughly wash hands after removing gloves and personal clothing before leaving the area where potentially infectious material is being handled.
Hospitalization of AIDS patients and HIV-infected patients should be carried out in such a way as to prevent the spread of infections, as well as taking into account the requirements for the maintenance of patients with altered behavior in case of CNS damage.
When treating children with HIV infection, only disposable instruments and syringes should be used.
If household items, bedding, environmental objects are contaminated with the discharge of the patient, it is necessary to treat with disinfectants (5.25% sodium hyposulfite solution, 0.2% sodium hypochlorite solution, ethyl alcohol).
The necessary measures to combat infection include the timely recognition and hospitalization of infected patients in specialized institutions. However, as the number of HIV-infected people increases, their hospitalization for any intercurrent diseases only in specialized hospitals becomes unrealistic. If elementary precautions are followed, communication with HIV-infected and even AIDS patients is safe. HIV-infected children and even sick children can attend children's institutions and school during the period of remission. The family must decide for itself who to tell about the child's diagnosis. Many families are afraid of what will become known about the HIV infection of their children and themselves. It is important to discuss with them who should know about the diagnosis. The medical staff of the hospital must carefully maintain confidentiality. It may be beneficial for the child if a teacher who is sympathetic to him and knows about the diagnosis pays him increased attention in case of lagging behind or missing school classes due to illness. Some families want no one to know about the diagnosis, and a conflict with a doctor about this can lead to a complete refusal of the parents to help the hospital. Medical assistance to the child in case of deterioration is the most important, and the parents themselves will later come to the conclusion that it is necessary to disclose the diagnosis to some circle of people. Parents also tend to be concerned about information that may be on a child's card given to a school where secrecy may not be kept. Parents always face the problem of when to tell their child about his illness. There are no unambiguous answers to all these complex questions, and in each case the solution is individual. Such parents can be helped by connecting them with families in a similar situation.
slide 2
Prevention of the spread of HIV infection is a consistent activity of organizations, structures and individuals aimed at informing the population about the danger of HIV infection and the formation of safer forms of behavior to reduce the risk of HIV infection.
slide 3
Types of prevention
Non-specific prevention is a field of activity that does not directly affect the problem, but affects it indirectly. Specific prevention is an activity aimed directly at certain manifestations of a problem.
slide 4
Priority actions for HIV prevention
Implementation of programs to prevent sexual transmission of HIV Implementation of programs to prevent transmission of HIV through injecting drug use Implementation of programs to prevent mother-to-child transmission of HIV.
slide 5
Implementation of programs to prevent sexual transmission of HIV
a) Providing accurate and complete information on less hazardous sexual behavior, from information on abstinence to less hazardous sexual practices; b) information on abstinence, delayed onset of sexual activity, mutual fidelity, reduction in the number of sexual partners, comprehensive and correct sexual education; c) information on early and effective treatment of sexually transmitted infections.
slide 6
Implementation of programs to prevent HIV transmission through injecting drug use
a) prevention of drug use (reducing the demand for drugs, reducing the number of drug users); (b) A necessary set of effective treatment and rehabilitation options for drug dependence; c) harm reduction measures;
Slide 7
Implementation of programs to prevent mother-to-child transmission of HIV.
a) primary prevention of HIV infection among women; b) prevention of unwanted pregnancies among HIV-positive women; c) prevention of HIV transmission from infected pregnant women to infants, including providing access to ARV therapy and quality breast-milk substitutes; d) providing care, treatment and support to HIV positive women and their families.
Slide 8
Other HIV prevention measures
Measures for susceptible populations; Prevention of nosocomial infection; Prevention of occupational infection; Prevention of infection during transfusion of donor blood and its components, organ transplantation and IVF.
Slide 9
HIV vaccination
At present, the first phase of clinical trials of the anti-HIV/AIDS vaccine "VICHREPOL", created at the Institute of Immunology, has been successfully completed. This vaccine is a new generation drug that has no analogues in world practice. The test results confirm that the VICHREPOL vaccine is safe and does not cause side effects.
Slide 10
Components of HIVREPOL
a synthetic protein that copies conserved (permanent) HIV antigens; polyoxidonium, a synthetic immunostimulant that greatly enhances the immune response to the vaccine antigen.
slide 11
Other vaccines under development
Recombinant subunit vaccines. The classic representative is AIDSVAX (Vaxgen Inc., USA), which contains the surface protein of the virus (gp120). Aventis Pasteur, France and Chiron, USA) p24 (major core coat protein of the virus) - phase I
slide 12
Inactivated subunit vaccines. When creating inactivated vaccines for the prevention of HIV infection, an inactivated Tat toxin of the virus is currently used. DNA vaccines. The preparations are purified nucleotide sequences of the DNA of the virus. Current status of DNA vaccine development: Phase I. Live recombinant vaccines based on viral vectors. Variola virus vaccine (ALVAC (Aventis Pasteur, France and Chiron, USA) - phase II. Variola virus vaccine - phase I
slide 13
Live recombinant vaccines based on bacterial vectors. Current status of vaccine development based on bacterial vectors: Salmonella - Phase I. Synthetic peptide vaccines. Current developments of synthetic peptide vaccines in clinical trials: p17 (one of the core proteins of the virus): Phase I Lipopeptides: Phase I V3-based (one of the gp120 protein fractions): Phase I Combination vaccines. Current development of combination vaccine candidates in clinical trials: avian pox virus + gp120 vector vaccine.
Slide 14
Thank you for your attention!
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MODERN METHODS OF NON-SPECIFIC HIV/STI PREVENTION
Nonspecific (barrier) prevention of HIV/STIs is currently the main method of preventing these diseases. The domestic antiseptic miramistin, used for 10 years as a means of preventing sexually transmitted diseases, has shown high efficiency and safety. Candles and Miramistin gel also have a pronounced spermicidal and contraceptive effect. The fight against HIV infection and STIs is one of the most urgent problems currently facing humanity. According to official statistics, about 40 million HIV-infected people are currently registered in the world, 200 thousand in Russia, of which about 2.5 thousand are children. Every day this figure increases in the Russian Federation by 100 people, of which 70 are in Moscow and the Moscow region. In recent years, the incidence of STIs has increased dozens of times, in the Russian Federation it is 85.5 cases of syphilis and 200 cases of gonorrhea per 100,000 population. The number of patients with trichomoniasis, gardnerellosis, urogenital chlamydia, herpes and candidiasis, mycoureaplasmosis and other STIs has sharply increased. It should be noted that official statistics do not fully reflect the true picture of HIV/STI prevalence. According to WHO experts, in order to get the real number of infected people, it is necessary to multiply the official statistics by 10. HIV / STI prevention is divided into general (sanitary education, work, social events, etc.), specific (vaccination) and non-specific chemical). Several types of vaccines are currently being developed. According to WHO estimates, effective and widely available vaccines are likely to be created only in the 2nd decade of the 21st century. No less difficult is the problem of specific prevention of STIs.
20. Epidemiology, specific and non-specific prevention of rabies. Rabies vaccine and gamma globulin. Pasteur's work.
Epidemiology. The reservoir of the virus in nature are various warm-blooded animals. Bats can develop chronic asymptomatic infections. Dogs, foxes, wolves, jackals, as well as cats and lynxes are most sensitive to the causative agent of rabies. Most often, a person becomes infected from sick foxes and cats with rabies, less often from dogs and other animals in which the virus is contained in the salivary glands and excreted into the external environment with saliva. The virus is transmitted by bites and saliva on damaged skin and mucous membranes.
A person is a dead end in the circulation of the virus, the transmission of the pathogen from person to person is extremely rare.
The rabies virus is sensitive to heat. At 56°C, inactivation occurs in 60 minutes, at 80-100°C - in 1 minute. It is quickly inactivated in solutions of alkalis, iodine, detergents and UV radiation. Slow drying leads to inactivation of the pathogen in the material in a few days, and under lyophilization conditions, the virus persists for years.
Prevention. Currently live and inactivated vaccines are used.
Long before the isolation of the virus, L. Pasteur developed a method of attenuation by multiple passages of the "street" virus through the brain of rabbits. As the passage progressed, the incubation period of the infection decreased to 5 days and then remained stable. Therefore, Pasteur called the virus he received fixed (virus fix). It multiplied only in the brain of rabbits and was not detected in the saliva of infected animals, and also lost its pathogenicity for humans and dogs. After drying the brain suspension, Pasteur used it as a vaccine to prevent rabies in humans.
Currently, a live anti-rabies vaccine is prepared from a virus grown on diploid human cells. The anti-rabies vaccine can be considered as a therapeutic and prophylactic drug, since specific protective reactions develop during the incubation period.
With multiple bites of dangerous localization (head and neck area), when the incubation period may be short, a specific immunoglobulin is administered in parallel with the vaccine. It is obtained from the blood serum of hyperimmunized horses.
21, 22. Retroviruses. Human immunodeficiency virus (HIV), characteristics. Epidemiology, pathogenesis, methods of laboratory diagnostics, prevention of HIV infection. AIDS, definition, stages of development. The role of CD4+ and CD8+ T cells. AIDS-associated diseases.
[lecture on HIV + training manual on viruses]
1981 - first discovered.
4 risk groups: homosexuals, drug addicts, hemophiliacs, persons who have visited Haiti.
The study showed the development of ID → the name AIDS.
Cultivation of E-lymphocytes, stimulation of IL-2, studying human leukemia → HTLV - I, II.
Moncagnier '83 - Poster Institute - LAV
86. Given the name of HIV (HIV - I)
85-86 - HIV-II is isolated.
Family Retroviridae, genera: p. Onkovirinae, p. Pumovirinae (only in animals), p. Lentovirinae (relative to HIV). These viral infections are called slow → long-term incubation and the course of the disease, leading, as a rule, to a fatal outcome (nj, that is, DEATH). The name of the family was obtained due to the presence of enzymatic reversetase (RNA-dependent DNA polymerase or reverse transferase).
RNA genomic viruses (2nd RNA)
Genes are arranged linearly
Integrability - the ability to integrate into the genome as a provirus
Activation of the genome - the synthesis of proteins and NK, the formation of a mature virion during penetration through the cytoplasmic membrane of the informing cell.
The supercapsid is a two-layer membrane; it acquires, during budding, a three-membrane protein with M = 17-18 kDa.
The bilipid layer pierces the receptors GP-41 (glycoprotein) and GP-120 (virion spine) - surface proteins and AT are produced for them, GP-120 is a T-lymphocyte receptor carrying CD-4.
Features of the HIV genome - 9749 nucleotides (100,000 times shorter than the human genome). There are 3 reading frames LTR (long terminal repeat), There are genes:
1. gag gene (internal proteins),
2
.pol (reverse transcriptase),
3. env (outer shell protein),
6 additional genes:
1. rev (selectivity of action, thanks to it, the synthesis of virion proteins is regulated)
2. vif (infectivity factor)
3. nef (the ability of the virus to stop reproducing, to go into a dormant stage)
4. tat (for replication)
5-6. vpr and vpu - the function is different, not decoded
No onc virus - does not form malignant formations. Tumors arise due to the most powerful repayment of immunity.
Features of the genome. High variability (100 times higher than influenza). The reason for the variability is reverse transcriptase, which makes many errors when reading. The virus at the beginning and at the end of the disease is different.
Life cycle of HIV.
adsorption from the target cell (macrophages, monocytes, neurons, E-helpers, intestinal cells) - GP-120, where there is CD-4 R.
Stages of interaction of the virus.
RR CD-4 interact with GP-120
Penetration into the cell by fusion with the cell membrane
The inclusion of reverse transcriptase in the work and synthesis of DNA copies.
DNA polymerase activity that catalyzes the synthesis of 1 strand DNA complementary to viral DNA.
Ribonuclease activity, cleaves original DNA
Reverse transcriptase synthesizes the 2nd strand of DNA using the 1st as a template.
Integral activity, DNA insertion into the host chromosome, provirus formation.
The infection is permanent, long-term - the cell carries information until the end of the host's life.
The production of new virions, with the activity of the tat genes, the synthesis of new proteins and NA, the assembly of virions and exit from the cell by budding → a lattice is formed in the cell membrane → cell fusion → the formation of symplasts.
Damage to the immune system
The development of apostasy. infections
Affects T-helpers → malfunction of T-killers → lymphopenia → T-suppressors actively proliferate → suppression of activity (T-helpers / T-suppressors = 0.5 (normal 2 or more)) HLD is negative, non-serum IgA, IgM. Kidney damage, ID.
The incubation period (from infection to the appearance of AT) - 6 months - 2 years.
Acute HIV infection caused by a retrovirus (t 0 , pneumonia, increase in blood pressure, sweating, cardiomediastinal syndrome, stool disorder, thrombocytopenia, bleeding, neurological syndrome.
Asymptomatic latent carriage (2-4 - 10-20 years)
L.s. systemic increases, tongue plaque
Laboratory diagnostics: immune system analysis, immune blot, GWH? Specific changes in the immune system.
In the world: RB > 5,000, RF - 250,000, 20 million died.
Antiviral therapy: azidotherapy, thymosin, thymus, bone marrow transplantation, etc., intensive search for the virus.
What methods are used to prevent HIV infection
Acquired Immunodeficiency Syndrome AIDS is an infectious disease that can lead to the death of the patient. AIDS develops rapidly and within a few years the patient may die from concomitant diseases. Since there are no specific treatments, HIV prevention remains relevant to prevent the spread of the disease.
What is the danger of the virus
The human immunodeficiency virus belongs to retroviruses and its effect on the body is to suppress human cellular immunity. By affecting CD4 receptors, which are located on the surface of T-lymphocytes, macrophages and dendritic cells, the virus reduces the body's immune defenses. This depresses the immune system and increases the risk of developing infectious diseases, oncological neoplasms, which ultimately lead to the death of the patient.
The virus is constantly undergoing changes, this causes differences in the course of the disease, and is the reason that there are no methods of specific prevention (vaccination) against it. Nonspecific prevention of HIV infections is aimed at preventing infection. An important role in this is played by the awareness of the population about the ways of transmission of HIV infection. Measures taken by the media and medical institutions have helped reduce the spread of HIV.
How can you get infected
Infection occurs when the virus enters the internal environment of the human body. The source of infection is a patient or carrier of the virus. Moreover, there are a lot of seropositive carriers of HIV. Not everyone who is infected develops AIDS, as some have resistance to the virus at the gene level.
The infectious agent can be found in body fluids such as:
Other biological fluids may also contain it (urine, saliva, sweat), but its concentration in them is so low that it cannot cause infection in a healthy person. Based on this, measures have been developed to prevent infection, the observance of which allows avoiding such a serious disease as AIDS.
Transmission routes can be divided into several groups:
- contact infection or sexual;
- vertical path or from mother to child;
- artificial infection (medical, cosmetic manipulations).
Methods of prevention in adults
The most common route of infection in adults is the penetration of the virus into the body during sexual intercourse, and the semen and vaginal mucus of the patient or the virus carrier contain HIV in high concentrations.
But there is a high risk of infection in drug addicts and with various manipulations associated with damage to the skin. There is no data on the possibility of penetration of the virus through the contact-household route with a kiss, handshake, food, water, and bites of blood-sucking insects.
Prevention during sexual intercourse
Infection during sex can occur even with interrupted intercourse, since the infectious agent is also found in the pre-ejaculatory fluid. The risk of contracting HIV increases many times with an increase in the number of sexual partners and the use of unprotected sex.
The risk of infection is especially high in the youth environment, in adolescents, since during this period there is a sexual surge in the body, which reduces the sense of danger. And even awareness of the risk of unprotected sex does not always stop.
Using condoms during intercourse reduces the risk of infection by almost 95-98%, but they must be used correctly.
- Choose condoms from large manufacturers, preferably in opaque packaging.
- Use condoms without various aromatic lubricants, as they can cause irritation, allergies, which means that the likelihood of microdamage to the mucosa increases.
- Do not use creams, Vaseline for lubrication, they can damage the latex.
- Check condom expiration date.
- Storage conditions play an important role, so it is better to purchase them in pharmacies.
- Do not store condoms for a long time in the light or at elevated temperatures, for example, in pockets, this leads to a violation of their integrity.
- You can not put one condom on another, the likelihood of damage increases due to friction.
- One should not be shy about offering protected sex to a partner, this does not indicate distrust, but indicates awareness, care for one's own and his health.
Sanitary and educational work on awareness of the population begins at school. Adolescents are introduced to the ways in which HIV is transmitted and how to prevent diseases such as AIDS. In some countries, free condoms are distributed to schoolchildren and warned that the best prevention measure is to abstain from promiscuity, to test partners for HIV before marriage.
Prevention for drug addicts
Another problem inherent in the youth environment is drug addiction. The introduction of narcotic substances with one syringe can lead to infection. Educational work on the dangers of drug addiction with different age groups, compulsory treatment and the fight against the production and distribution of drugs are measures to prevent acquired immunodeficiency syndrome.
Prevention in medical and cosmetic procedures
There is a risk of infection during medical, cosmetic procedures. You can get infected by shaving, nail polishing, tattooing. Compliance with the rules of personal hygiene and careful sterilization of instruments in beauty salons can reduce it.
With regard to medical interventions, procedures, the use of sterile or disposable instruments prevents infection. Compliance with the norms of their processing is carried out at several levels in each medical institution.
There have been cases when HIV infection occurred as a result of transfusion of infected blood products. This has led to the development of rules for manufacturing, processing and proper use, which have significantly reduced the risk of infection.
Medical workers are also at risk, since during the care of patients there is a possibility of infection through contaminated blood with cuts and injuries. In such cases, they undergo emergency medical post-exposure prophylaxis, which consists in providing first aid (treatment of the wound) and prescribing antiretroviral drugs.
Methods of prevention in newborns
AIDS infection of a child can occur in early pregnancy, during childbirth and while breastfeeding. HIV-infected pregnant women are prescribed antiviral drugs. Childbirth is more often carried out by caesarean section in order to shorten their duration. To exclude infection when feeding a child, they are transferred to artificial nutrition.
HIV prevention is necessary to prevent the development of AIDS and virus transmission. Everyone should understand that AIDS is a serious disease with a high mortality rate, and its prevention is the only way to preserve the health of oneself and loved ones.
receptdolgolet.ru
Presentation on the topic: Non-specific prevention of HIV infection. HIV vaccination
Prevention of the spread of HIV infection is a consistent activity of organizations, structures and individuals aimed at informing the population about the danger of HIV infection and the formation of safer forms of behavior to reduce the risk of HIV infection. Prevention of the spread of HIV infection is a consistent activity of organizations, structures and individuals aimed at informing the population about the danger of HIV infection and the formation of safer forms of behavior to reduce the risk of HIV infection.
Non-specific prevention is a field of activity that does not directly affect the problem, but affects it indirectly. Non-specific prevention is a field of activity that does not directly affect the problem, but affects it indirectly. Specific prevention is an activity aimed directly at certain manifestations of a problem.
Implementation of programs to prevent sexual transmission of HIV Implementation of programs to prevent sexual transmission of HIV Implementation of programs to prevent transmission of HIV through injecting drug use Implementation of programs to prevent mother-to-child transmission of HIV.
a) Providing accurate and complete information on less hazardous sexual behavior, from information on abstinence to less hazardous sexual practices; a) Providing accurate and complete information on less hazardous sexual behavior, from information on abstinence to less hazardous sexual practices; b) information on abstinence, delayed onset of sexual activity, mutual fidelity, reduction in the number of sexual partners, comprehensive and correct sexual education; c) information on early and effective treatment of sexually transmitted infections.
a) prevention of drug use (reducing the demand for drugs, reducing the number of drug users); a) prevention of drug use (reducing the demand for drugs, reducing the number of drug users); (b) A necessary set of effective treatment and rehabilitation options for drug dependence; c) harm reduction measures;
a) Primary prevention of HIV infection a) Primary prevention of HIV infection among women; b) prevention of unwanted pregnancies among HIV-positive women; c) prevention of HIV transmission from infected pregnant women to infants, including providing access to ARV therapy and quality breast-milk substitutes; d) providing care, treatment and support to HIV positive women and their families.
Measures for susceptible populations; Measures for susceptible populations; Prevention of nosocomial infection; Prevention of occupational infection; Prevention of infection during transfusion of donor blood and its components, organ transplantation and IVF.
At present, the first phase of clinical trials of the anti-HIV/AIDS vaccine "VICHREPOL", created at the Institute of Immunology, has been successfully completed. This vaccine is a new generation drug that has no analogues in world practice. The test results confirm that the VICHREPOL vaccine is safe and does not cause side effects. At present, the first phase of clinical trials of the anti-HIV/AIDS vaccine "VICHREPOL", created at the Institute of Immunology, has been successfully completed. This vaccine is a new generation drug that has no analogues in world practice. The test results confirm that the VICHREPOL vaccine is safe and does not cause side effects.
a synthetic protein that copies conserved (permanent) HIV antigens; a synthetic protein that copies conserved (permanent) HIV antigens; polyoxidonium, a synthetic immunostimulant that greatly enhances the immune response to the vaccine antigen.
Recombinant subunit vaccines. The classic representative is AIDSVAX (Vaxgen Inc., USA) containing the surface protein of the virus (gp120). Current state of development of subunit recombinant vaccines: Recombinant subunit vaccines. The classic representative is AIDSVAX (Vaxgen Inc., USA), which contains the surface protein of the virus (gp120). Aventis Pasteur, France and Chiron, USA) p24 (major core coat protein of the virus) - phase I
Inactivated subunit vaccines. When creating inactivated vaccines for the prevention of HIV infection, an inactivated Tat toxin of the virus is currently used. Inactivated subunit vaccines. When creating inactivated vaccines for the prevention of HIV infection, an inactivated Tat toxin of the virus is currently used. DNA vaccines. The preparations are purified nucleotide sequences of the DNA of the virus. Current status of DNA vaccine development: Phase I. Live recombinant vaccines based on viral vectors. Avian pox virus vaccine (ALVAC (Aventis Pasteur, France and Chiron, USA) - phase II. Variola vaccine product - phase I
Live recombinant vaccines based on bacterial vectors. Current status of vaccine development based on bacterial vectors: Salmonella - Phase I. Live recombinant vaccines based on bacterial vectors. Current status of vaccine development based on bacterial vectors: Salmonella - Phase I. Synthetic peptide vaccines. Current developments of synthetic peptide vaccines in clinical trials: p17 (one of the core proteins of the virus): Phase I Lipopeptides: Phase I V3-based (one of the gp120 protein fractions): Phase I Combination vaccines. Current development of combination vaccine candidates in clinical trials: avian pox virus + gp120 vector vaccine.
Modern methods of non-specific HIV / STI prevention
Russian Journal of Skin and Venereal Diseases, 2004. - No. 2. - P. 56-58.
V. A. Molochkov, I. M. Kirichenko, Yu. S. Krivoshein
MMA them. I. M. Sechenov, Moscow
MODERN METHODS OF NON-SPECIFIC HIV/STI PREVENTION
SUMMARY Non-specific (barrier) HIV prevention / STI is currently the main method of preventing these diseases. The domestic antiseptic Miramistin®, used for 10 years as a means of preventing sexually transmitted diseases, has shown high efficiency and safety. Candles and Miramistin® gel also have a pronounced spermicidal and contraceptive effect.
Fight against HIV infection and STI is one of the most urgent problems facing humanity today.
According to official statistics, about 40 million HIV-infected people are currently registered in the world, and 200,000 in Russia, of which about 2,500 are children. Every day this figure increases in the Russian Federation by 100 people, of which 70 are in Moscow and the Moscow region.
In recent years, the incidence of STIs has increased dozens of times, in the Russian Federation it is 85.5 cases of syphilis and 200 cases of gonorrhea per 100,000 population. The number of patients with trichomoniasis, gardnerellosis, urogenital chlamydia, herpes and candidiasis, mycoureaplasmosis and other STIs has sharply increased. It should be noted that official statistics do not fully reflect the true picture of HIV/STI prevalence. According to WHO experts, in order to get the real number of infected, it is necessary to multiply the official statistics by 10.
Prevention of HIV / STIs is divided into general (sanitary clearance, social activities, etc.), specific (vaccination) and non-specific (barrier, mechanical and chemical) (see diagram).
Several types of vaccines are currently being developed. According to WHO estimates, effective and widely available vaccines are likely to be created only in the 2nd decade of the 21st century. No less difficult is the problem of specific prevention of STIs.
Due to the current lack of anti-HIV/STI vaccines, the main way to prevent these infections is an alternative (non-specific) one - with the help of condoms and chemicals. The same funds form the basis of modern contraception, providing both prevention of pregnancy and prevention of HIV / STIs.
The main means of non-specific barrier individual prevention of HIV / STIs are condoms (male and female), which create a mechanical obstacle to the penetration of the pathogen into the human body.
Their effectiveness is limited by the risk of the pathogen passing through the barriers created by polymeric materials, as well as by mechanical damage during use. Certain brands of condoms are estimated to provide only 30% protection against sexual transmission of HIV. It has been proven that when using condoms, in a significant percentage of cases, they break, slip during intercourse, which leads to infection with bacterial infections (syphilis, gonorrhea, trichomoniasis, chlamydia, etc.) and viral (HIV, herpes) nature, as well as pregnancy . Data from surveys of sexual partners who regularly use condoms showed that during the observed period, 62% of couples did not break a condom even once, 29% broke 1-3 times, and 9% more than 4 times. In addition, about 30% of men do not use condoms for physiological reasons (weak erection), because of the occurrence of allergic reactions to latex or condom lubricant, for religious or other beliefs. Therefore, condoms are not a universal prophylactic and cannot guarantee complete protection against HIV/STI infection and prevention of pregnancy.
This stimulated the creation of programs for the development and distribution of individual means of preventing HIV / STIs and contraception using chemical agents - microbicides. For this purpose, preparations have been developed that are intended for treating the genitals of sexual partners before and after sexual contact.
Currently, external microbicides have been created for the prevention of STIs and HIV infection: PRO 2000 (naphthalenesulfonate polymer); buffer gel, negatively charged, non-absorbable high molecular weight polymer gel for maintenance in the vagina in the presence of sperm pH below 5.0; F5 gel. containing 3 spermicides (Nonoxynol9. benzalkonium chloride and sodium cholate); combined preparation C31G, consisting of C14 alkylamine oxide and C16 alkyl betaine, and others. The drug Nonoxynol9 (H9), which has been officially used in the United States as a chemical contraceptive for more than 30 years, has received the greatest distribution in various countries of the world.
Numerous studies on the use of H9 as a contraceptive, as well as for the prevention of HIV infection, conducted under the auspices of WHO in various countries of the world, have confirmed that intravaginal applications of H9 can prevent pregnancy and protect women from HIV and other STI pathogens. At the same time, it has been proven that H9, like other non-ionic surfactants, are weak microbicides and have an effect only at high concentrations of the drug, which is associated with more pronounced manifestations of their toxic properties. So, when using surfactants, there are signs of allergic reactions (erythema of the vulva, irritation of the vaginal mucosa with the appearance of copious secretions and an unpleasant odor), as well as more serious consequences (development of ulcers, and sometimes - when using sponges, films, caps - the occurrence of toxic shock).
In the study of systemic effects on the fetus as a result of the penetration of H9 through the vaginal mucosa, an almost twofold increase in the risk of limb shortening, malignant neoplasms, urethral hypospadias, Down syndrome and other severe chromosomal abnormalities was established.
There are reports that the use of certain dosage forms of H9 increases the risk of HIV infection. Scientists see the explanation for this phenomenon in the fact that the frequent use of H9 causes irritation of the vaginal wall, which leads to the formation of microcracks that open the way for HIV. However, it should be noted that in most cases we are talking about experiments involving prostitutes who used the drug up to 20 times a day, and there is no evidence that its use 2-3 times a day leads to negative consequences.
Nevertheless, scientists are constantly calling for a more detailed study of the long-term use of H9, since it is a very common drug: in the US alone, it covers up to a third of condoms sold.
In addition, WHO, stating the prospect of using H9 as a prophylactic agent, constantly points out the need to search for and develop new surfactants, more effective microbicides with minimal irritant and other side effects on the human body, which could be used as contraceptives by women, as well as for individual HIV / STI prevention not only by women, but also by men.
These drugs include the antiseptic Miramistin® produced in Russia, widely used by sexually active groups of the population and persons belonging to risk groups, as an individual means of preventing syphilis, gonorrhea, trichomoniasis, chlamydia, herpes and other STIs.
Miramistin® was developed by prof. Yu. S. Krivoshein and Ph.D. chem. Sciences A. P. Rudko and approved by the USSR Ministry of Health for medical use in 1991 as an antiseptic for individual prevention of sexually transmitted diseases, and in 1993 as a broad-spectrum antiseptic. The exclusive manufacturer of the drug in Russia is Infamed CJSC.
Miramistin® is a cationic surfactant that has pronounced antimicrobial properties and does not have a local irritant, mutagenic and carcinogenic effect. The effectiveness of the prevention of STIs by treating the genitals of sexual partners with a 0.01% solution of Miramistin® after sexual contact has been demonstrated. In addition, instillations of Miramistin® solution are included in the complex treatment of chronic urethritis in gonorrhea, trichomoniasis, mixed trichomonadal nococcal and chlamydial infections. This addition to traditional therapy led to a significant increase in the effectiveness of treatment.
Multifaceted studies of the anti-HIV activity of Miramistin®, conducted in leading laboratories in Russia, Ukraine, Sweden, Germany, made it possible to prove that Miramistin® at working concentrations is effective for the destruction of extracellular and intracellular HIV. It turned out to be a more active agent for the destruction of HIV compared to other disinfectants (see table). Based on these data, the Pharmacological State Committee of the Ministry of Health of the Russian Federation decided to include in the instructions for the use of Miramistin® information that the drug has anti-HIV activity.
Minimum concentrations at which various disinfectants inactivate HIV
RUSSIAN FEDERATION
FEDERAL STATE BUDGETARY INSTITUTION "RUSSIAN CENTER FOR FORENSIC MEDICAL EXAMINATION"
"APPROVE"
chief freelance specialist
forensic medical examination
Ministry of Health of Russia,
Director of FGBU "RCSME"
Ministry of Health of Russia,
Doctor of Medical Sciences
____________ A.V. Kovalev
"___" ___________ 2013
PREVENTION OF HIV INFECTION IN PUBLIC
^ FORENSIC MEDICAL EXPERT INSTITUTIONS
Moscow
The methodological recommendations were developed by Doctor of Medical Sciences V.N. Kildyushov, Doctor of Medical Sciences A.V. Kovalev (Chief Freelance Specialist in Forensic Medical Examination of the Ministry of Health of Russia), Candidate of Medical Sciences A.L. Kochoyan, Candidate of Medical Sciences E.S. Orlova, Doctor of Medical Sciences, Professor A.I. Mazus (chief freelance specialist in the problems of treatment and diagnosis of HIV infection of the Ministry of Health of Russia), intern P.V. Minaeva.
Bolekhan V.N., Dzhuvalyakov P.G., Zigalenko D.G., Kadochnikov D.S., Kildyushov E.M., Kovalev A.V., Kochoyan A.L., Orlova E.S., Mazus A .I., Minaeva P.V. Prevention of HIV infection in state forensic medical institutions: guidelines. - M., 2013. - 38 p.
The guidelines present - the system of HIV prevention in the state forensic medical institution (GSMEU), the organization of sectional and laboratory work with HIV-infected material, risk factors for infection, accidents during medical manipulations and injuries of medical workers, recommendations are given for post-contact prevention at the risk of occupational infection.
The guidelines are intended for heads of state forensic medical institutions (GSMEU), as well as forensic doctors (forensic experts), middle and junior medical staff of the SMEU, students, residents, postgraduate students and teachers of state educational institutions of higher and additional professional education.
INTRODUCTION
The HIV epidemic in Russia is characterized by a further increase in the number of new infections. In recent years, there has been an increase in the death rate among HIV-infected people. A manifestation of the current epidemic situation is an increase in the frequency of detection of HIV infections in medical organizations of various profiles, as well as an increase in the number of sectional studies of HIV-infected people. This indicates a growing threat of bringing HIV infection into state forensic medical institutions (GSMEU) and, accordingly, the risk of infection of employees of these institutions as a result of their professional activities.
In the SMEU, employees of thanatological units have the greatest risk of infection, since they are in direct contact with the corpses. An analysis of injuries during sectional studies showed that annually up to 65% of forensic experts and support staff are at risk of contracting HIV, bloodborne hepatitis viruses as a result of infected blood getting on damaged skin and mucous membranes during the section. In addition, at the time of the emergency, less than 1% of the examined corpses are accompanied by lifetime medical documentation of HIV status and viral pathology of the liver.
Informing employees of the risk associated with their activities and preventive measures is a major component of the preventive work of health services. If healthcare workers do not feel supported if they are at risk of exposure to HIV, it will be extremely difficult for them to do their job with due confidence. Therefore, the most important task of medical science and practice is the development and creation of safe working conditions for medical personnel.
In this regard, the primary importance in the SMES should be given to the issues of training and protection of medical personnel in the event of a risk of occupational exposure to HIV and other infections with parenteral transmission.
^ 1. RISK FACTORS FOR INFECTION
MEDICAL WORKERS
Currently, HIV infection is an incurable infectious disease. Despite prevention efforts, the number of new HIV infections is increasing every year. The epidemic of this infectious disease has become an additional factor that creates an excessive burden on public health.
Risk factors for infection are multiple, frequent, associated with the risk of infectious complications in the patient and injuries to medical personnel, parenteral interventions, especially those carried out in violation of anti-epidemic rules. The probability of infection of a medical worker with infections with parenteral transmission as a result of the performance of his professional duties consists of three components:
the occurrence of conditions for the transmission of infection (accident or injury);
the presence of a risk of transmission of the pathogen (contagiousness of the pathogen and the dose of infected material are taken into account);
determination of the potential infectivity of the material with which contact occurred.
In HIV-infected persons, markers of parenteral viral hepatitis are detected in 66% of cases. In this regard, medical workers are also at risk of contracting hepatitis B and C, and a higher risk than with HIV infection. The incidence rate of hepatitis B and C of medical workers in clinical specialties with these infections exceeds the incidence rates of the population of Russia by 1.5-6.5 times, and for the staff of the SMEU this figure increases already by 20-50. In connection with this, parenteral viral hepatitis in medical workers should be considered occupational diseases, especially if a direct causal relationship with their occurrence and professional activity has been proven (Order of the Ministry of Health and Social Development of Russia dated April 27, 2012 No. 417n “On approval of the list of occupational diseases”).
The frequency of detection of markers of viral hepatitis B and C in medical workers of various specialties varies significantly. This allows us to talk about groups of different levels of occupational risk of infection. These include employees of the departments of laboratory diagnostics, surgery, resuscitation, dentistry, gynecology, thanatology departments of the SMEU. Infection with viral hepatitis B can currently be prevented by specific prophylaxis - vaccination, followed by regular determination of the titer of protective antibodies. There are currently no specific preventive measures against HIV infection and viral hepatitis C.
The factors of transmission of infections with a parenteral transmission mechanism are blood and objects contaminated with it. With viral hepatitis B, 1 ml of blood can contain from 1.5 to 150 million infectious doses, with viral hepatitis C - from 1 to 100 thousand, with HIV infection - from 10 to 1 thousand. According to a number of researchers, the probability of infection of a healthcare worker when performing manipulations on a patient with HIV infection with a single skin puncture varies from 0.1-0.2% to 0.3-0.5%, and when performing manipulations on patients with viral hepatitis B and C - 30-43% and 1.8-2%, respectively.
^ 2. ACCIDENTS DURING MEDICAL MANIPULATIONS
AND INJURIES OF HEALTHCARE WORKERS
A detailed analysis of the frequency of injuries and accidents associated with the risk of occupational HIV infection is complicated by the system of their registration. Every month, 65% of medical workers receive microtraumas of the skin, however, no more than 10% of injuries and emergencies are officially registered. Based on the registration data, the frequency of injuries with sharp medical instruments has been established, which ranges from 0.75 to 5.15 per year per employee, and it is also possible for blood to get on the skin and mucous membranes. Of the emergencies during the sectional study, the most common are cuts and “scratching” of the skin - 63.5%, needle prick - 18%. Less often, blood gets on the skin - 12.5% and the mucous membrane of the eyes - 6%.
In one study, the injury rate for nursing staff was 0.61 per 1000 people per day (equivalent to 22.3 per 100 people per year), with only 4.3% of nurses and 3.9% of physicians reporting an injury. Nearly a third of all healthcare workers have had at least one needle stick injury within 12 months. The smallest number of injuries was described in pediatrics - 18.7%, and the largest - in surgery - 46.9%.
The ratio of the frequency of emergencies among medical personnel in surgical and therapeutic hospitals is 3:1. It is generally accepted that the frequency of safety violations during surgery and microtraumatization of the hands among surgeons during the year is 10-30%.
The risk of HIV infection of a medical worker directly depends on the conditions of injury and the nature of the injury itself. So injections are more dangerous than incised wounds due to the fact that bleeding from an open incised wound greatly reduces the risk of infection. In addition to damage from sharp objects, contamination of damaged skin (abrasions, eczema, etc.) and mucous membranes with biological material contaminated with HIV poses a minor danger.
The first case of a healthcare worker becoming infected with HIV as a result of a needle stick was described in 1984. Currently, 344 cases of professional infection of health workers with HIV infection have been described in the world. Among them, 106 are classified as proven cases, and 238 are cases in which occupational contact as the cause of infection is presumptive. The largest number of cases of HIV infection (48.2%) was noted among nurses, in second place (39.3%) were employees of clinical laboratories, in third (12.5%) - doctors of surgical specialties (surgeons, obstetricians-gynecologists, etc.). .d.) .
^ 3. GENERAL ISSUES IN HIV PREVENTION
AT THE RISK OF OCCUPATIONAL INFECTION
The main way to prevent occupational exposure is to follow standard precautions when working with blood and biological material. According to WHO recommendations, these are:
maximum prevention of the possibility of contamination of the skin and mucous membranes with blood and biological fluids as a result of the use of personal protective equipment (overalls, gloves, goggles, screens, shields);
observance of sterilization, disinfection regimes and algorithms for performing invasive procedures.
The use of latex gloves reduces the risk of infection by several times.
However, a study by Danish scientists showed that 28% of accidents could not be prevented using universal precautions. In the United States, 20% of emergencies were associated with unexpected, difficult to predict events, the rest were the result of insufficient implementation of anti-epidemic measures. Only 13.2% of all injuries could be prevented through organizational measures, and 34% through the use of safer tools.
In the event of an emergency with the risk of HIV infection, medical personnel should reduce the likelihood of infection by reducing the infectious dose that has entered the body (for example, by allowing blood to flow freely from the wound or by gently washing the wound or mucous membranes with water, treating the injury site with disinfectants), and by exposure to the pathogen by means of post-exposure chemoprophylaxis.
In accordance with the recommendations set out in the clinical protocol of the WHO European Bureau (2006), and in a number of other methodological documents, all workplaces for performing invasive procedures should be provided with first aid kits for partial sanitization in case of an accident or injury (first aid kit "Anti-AIDS ""). Wounds and skin areas, after contact with blood or other biological fluids, should be washed with soap and water, mucous membranes should be washed with water. The use of antiseptics for wound treatment does not significantly reduce the risk of HIV transmission. However, the use of antiseptics is recommended by most methodological guidelines for emergency chemoprophylaxis of HIV infection. Invasive manipulation of an HIV-infected patient is prescribed to be performed in the presence of a second specialist, who, in the event of an emergency or injury, will be able to continue its implementation, and the injured medical worker to receive first aid.
When a patient with HIV infection is admitted to a medical organization, medical workers, in most cases, do not know about the patient's HIV status. Therefore, in the event of an emergency, rapid tests must be used to quickly determine the patient's HIV status. In the event of an emergency, a medical worker of the SMEU is also shown to conduct an HIV test on the blood of a corpse, regardless of the presence or absence of intravital medical documentation.
Data on the development of the initial stage of HIV infection indicate that full-scale general infection does not develop immediately, leaving a chance for antiviral measures after dangerous contact (up to 36 hours!), which may affect virus replication. Experimental studies on animals and humans have provided direct and indirect evidence of the effectiveness of antiretroviral drugs as a means of emergency post-exposure prevention of HIV infection.
Currently, three classes of drugs can be used for post-exposure emergency chemoprophylaxis: nucleoside (nucleotide) reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs).
The volume of post-exposure emergency prophylaxis, that is, the appointment of antiretroviral drugs, is determined by the infectious disease doctor, taking into account the nature of the traumatic effect, the amount of biological fluid that has entered the wound or mucous membranes, and the possible amount of HIV in this substrate. In accordance with the methodological recommendations of the Ministry of Health and Social Development of Russia (2007) for emergency post-exposure prophylaxis of HIV infection, during prophylactic administration of antiretroviral drugs, it is necessary to monitor toxicity at the time of the start of the course and two weeks after its start. At a minimum, it should include a general clinical blood test with the definition of its formula, as well as a study of blood biochemical parameters.
A number of methodological documents of the Ministry of Health and Social Development of Russia and the Ministry of Labor of Russia require mandatory registration and investigation of emergency situations and injuries among medical workers performing professional duties. For each case associated with the risk of nosocomial infection of a medical worker with HIV infection at the workplace, based on the explanations of the victim and eyewitnesses, an entry is immediately made in the register of injuries and accidents among medical workers (Appendix 2) and an act of medical injury is drawn up (“Act about an accident at work "- Appendix 5).
The fact of HIV infection, as well as the cause of infection, its connection with the performance of official duties by a medical worker, is established by a specialized medical organization of the state or municipal health care system dealing with HIV infection prevention, together with the territorial center of state sanitary and epidemiological surveillance.
In the event that HIV infection is detected in employees of certain professions, industries, enterprises, institutions and organizations, the list of which is approved by the Government of the Russian Federation, these employees are subject to transfer in accordance with the legislation of the Russian Federation to another job that excludes the conditions for the spread of HIV infection.
^ 4. SYSTEM OF PREVENTION OF HIV INFECTION IN GSMEU
The HIV prevention system in the SMES includes a set of sanitary and anti-epidemic (preventive) measures and a set of forces and means of the institution for its implementation. Activities within the system are carried out in the following areas: ensuring sanitary and epidemiological well-being in the SMES, organizing and conducting laboratory diagnostics of HIV infection, ensuring a sanitary and anti-epidemic regime (SER), improving the professional training of medical personnel on the problem of HIV infection.
^ 4.1. Ensuring sanitary and epidemiological
well-being on HIV infection in GSMEU
The organization of work on the prevention of HIV infection in the SMES provides for: constant monitoring and identification of risks of occupational infection in the workplace, determination of priorities and the nature of preventive measures, taking into account emerging risks of infection, the application of safety standards when performing medical procedures, ensuring the optimal workload for staff, analysis of cases of occupational injuries, emergency prevention of HIV infection at the risk of occupational infection, training of medical staff in safety rules when handling traumatic instruments and infectious substrates, including their disinfection and disposal.
There are two main areas of sanitary and anti-epidemic (preventive) measures to ensure sanitary and epidemiological well-being for HIV infection in the SMEU:
prevention of the emergence and localization of foci of HIV infection among medical workers,
Prevention of "uncontrolled removal" of HIV infection outside the SMEU.
^ Prevention of the emergence and localization of foci of HIV infection among medical workers is ensured by strict compliance with the requirements of the SPEP, and is also achieved by carrying out the following groups of measures: restrictive, disinfection, laboratory studies, including the use of rapid tests for examining corpses with unknown HIV status; emergency post-exposure chemoprophylaxis at risk of infection to healthcare workers. Methodological work and special training on HIV prevention are being carried out with the medical staff.
When a body with unknown HIV status is admitted to the SMES recommended perform a laboratory express test of his blood for HIV infection by the forensic biology department in the following cases:
murders and suspicions of murder;
suicides of people under 40;
Suspicion of death from drug poisoning;
deaths from various causes of persons who have previously used drugs;
availability of data on lifetime HIV infection or suspicion of it;
deaths of people aged 18 to 50 from tuberculosis, pneumonia, hepatitis, cirrhosis of the liver;
violent and non-violent death of asocial persons (homeless people, etc.).
If HIV infection is detected in the cadaveric material, the result of the study must be entered in the "Journal of Hospital Infections" (f.060-U). If epidemiological signs of possible infection and clinical manifestations of HIV infection are identified during a forensic medical examination of living persons, they should be referred for a consultation to the territorial Center for the Prevention and Control of AIDS and Infectious Diseases.
^ Prevention of "uncontrolled removal" of HIV infection outside the SMEU can be ensured by the timely transmission of information on the detection of HIV infection in a corpse to the territorial center of the State Sanitary and Epidemiological Supervision, the Center for the Prevention and Control of AIDS and Infectious Diseases (city, regional) and the relatives of the deceased.
^ 4.2. Ensuring sanitary and anti-epidemic
regime in GSMEU
The heads of bureaus (centers) of forensic medical examination, full-time and non-staff epidemiologists, medical personnel of the State Medical Service, the logistics service of the State Committee for Sanitary and Epidemiological Supervision, specialists of the centers of the State Sanitary and Epidemiological Supervision, etc.
Responsibility for the organization of SPED in GSMEU rests with the head of the institution. The head of the bureau (center) of the forensic medical examination organizes the fulfillment of the requirements of the legislation of the Russian Federation in the field of ensuring the sanitary and epidemiological well-being of personnel. The Deputy Head of the Bureau (Center) of the Forensic Medical Examination for Organizational and Methodological Work provides general guidance on the organization of the SPEE and preventive measures. The heads of the departments organize the fulfillment of the requirements of the SPEP by the personnel, the collection, recording and analysis of cases of detection of HIV infection and viral hepatitis B and C among employees, among the living examined persons and the deceased who were admitted for forensic medical examination, conduct classes for medical personnel on the prevention of parenteral infections, take part in the investigation of cases of injuries and accidents among medical workers, provide measures for their prevention. The chief (senior) nurse of the bureau (center) of the forensic medical examination directly organizes the implementation and is personally responsible for compliance with the SEP. Nursing and paramedical personnel are required to carry out the SEP in their daily work.
Heads of subdivisions of the SMES provide briefings on the requirements of the sanitary and anti-epidemic regime, the need to observe medical secrecy and responsibility for disclosing information with the signature of a medical worker in a special journal.
^ 4.3. Improving the professional training of medical personnel on the problem of HIV infection
Increasing the professional competence of medical workers of the State Medical University on topical issues of epidemiology, clinic, diagnosis and prevention of HIV infection is carried out as part of special training. To assess the level of knowledge of medical workers on the problem of HIV / AIDS in the SMEU, it is necessary to have control tests, according to which personnel should be periodically tested to assess their readiness to work in conditions of professional contact with HIV-infected corpses. Such testing objectively reflects the level of professional knowledge of medical specialists of the SMEU and allows you to properly plan work to improve it.
^ 5. ORGANIZATION OF SECTIONAL WORK WITH
HIV-INFECTED MATERIAL
5.1. Ensuring safety during the sectional
studies of a corpse infected with HIV and activities
in case of an accident
The working conditions of forensic medical experts (forensic experts), the procedure for organizing and carrying out forensic medical examinations (forensic examinations) at the SMEU, the requirements for ensuring safety when working with HIV-infected material are regulated by the legislation of the Russian Federation.
In order to protect the expert from HIV infection during the sectional examination of the corpse, it is necessary to use protective clothing: a gown, a cap, a disposable surgical mask, goggles or a face shield, two pairs of rubber anatomical gloves, disposable sleeves and an apron. Protective clothing can be supplemented with rubber shoes or boots. If there are microtraumas, scratches, cuts on the hands, the damaged areas should be sealed in advance with adhesive tape or covered with a fingertip.
All instruments and materials used in laboratory and sectional studies and having contact with HIV-infected material must be decontaminated.
The sectional instruments used in the study of a corpse infected with HIV are placed in a special hermetically sealed container, and objects contaminated with blood are placed in a plastic bag.
The waste of the SMES is epidemiologically dangerous and is classified as class B medical waste. Containers and bags for waste collection in these institutions should be yellow or have a yellow label “Waste. Class B. If sectional material, tools or objects have been in contact with infectious agents of the 1-2nd pathogenicity groups or tuberculosis, then they represent an extreme epidemiological hazard and should, like medical waste, be collected in an appropriate red container or have a red marking “Waste. Class B.
Methods and methods of collection, neutralization (decontamination), transportation and disposal of medical waste of classes "B" and "C" are described in the relevant sanitary norms and rules.
On referral forms, jars or other utensils with sectional HIV material sent for research, a red marking is made in the form of a triangle, as in hepatitis B. The diagnosis of HIV infection in all medical documents is indicated by the code "B.23".
Upon completion of work with material containing HIV, and after removing protective clothing, all medical personnel thoroughly wash their hands with soap and treat them with an antiseptic.
In the event of an emergency and the ingress of blood or other biological fluids (substrates) on the surface of objects, it is necessary to wipe the contaminated surface twice (immediately and with an interval of 15 minutes) with a rag, cotton or gauze swab, abundantly moistened with a disinfectant solution. All work should be done with gloves. It is undesirable to use compositions based on chlorine as disinfectants, since formaldehyde is often present in the premises of the SMES, which forms a strong carcinogen with hypochlorite - bis (chloromethyl) - ether. Used rags, tampons are thrown into a container with a disinfectant solution or into a tank for subsequent autoclaving.
When parts of the body of medical personnel that are not protected by gowns and gloves come into contact with blood or other biological material from a corpse infected with HIV, the contaminated surface is quickly treated with a disinfectant solution. Before removing the apron, thoroughly wipe it with a gauze cloth moistened with a disinfectant, after which it is removed and folded with the outer side inward. Separate wipes, abundantly moistened with a disinfectant solution, wipe the sleeves and rubber gloves.
Used and contaminated during the study of a corpse infected with HIV, a gown and a cap are placed in a waterproof sealed bag and sent for autoclaving, or soaked in a container with a disinfectant directly in the sectional room. After the recommended exposure specified in the instructions for the disinfectant, the soaked elements of the protective suit are washed with running water and transferred to the wash. Shoes are treated with a double wipe with a rag soaked in a solution of one of the disinfectants. The skin of the hands and other parts of the body under contaminated clothing is wiped with a 70% solution of ethyl alcohol.
^ 5.2. Measures of non-specific prevention
HIV infections
Any equipment or linen contaminated with cadaver secretions must be considered as potentially infected with HIV. It should be handled in such a way as to avoid contact between skin and mucous membranes. If, nevertheless, such contact has occurred, it is necessary to carry out partial sanitization (Appendix 1):
- if such potentially infectious material comes into contact with the skin: treat with 70% ethanol solution, wash thoroughly with soap and water and re-treat with 70% ethanol solution;
if such potentially infected material gets on the mucous membrane of the eyes, nose and oral cavity: rinse the mouth with plenty of water and rinse with 70% ethyl alcohol solution, rinse the mucous membrane of the nose and eyes with plenty of water.
In case of skin damage (cut, injection), it is necessary: immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% ethyl alcohol solution and 5% iodine alcohol solution.
All cases of possible infection of employees as a result of accidents or injuries at the workplace must be immediately reported to the head of the unit and the epidemiologist or person responsible for the prevention of HIV infection, as well as the head of the SMEU. Data on the examined corpse, the injured medical worker are entered in the register of injuries and accidents among medical workers, which is stored in a place established by a special order for the SIEM. The registration form is given in Annex 2.
In the event of an accident, as a result of which a medical worker was injured, the head of the unit ensures that this accident is recorded and investigated (makes an entry in the register of injuries and accidents for medical workers - see Appendix 2). For each case associated with the risk of occupational exposure of a medical worker to HIV infection, it is necessary to issue an injury report (“Act on an industrial accident”, see Appendix 5) . An injury (accident) act must be drawn up in the unit immediately after the injury (accident) has occurred, based on the explanations of the victim and eyewitnesses. The act is signed by the head of the unit, the person responsible for labor protection in the institution and the safety of personnel (at night, weekends and holidays - by the administrator on duty), and eyewitnesses from among medical workers.
^ 6. EXPRESS DIAGNOSTICS OF HIV INFECTION IN SMES AT THE RISK OF INFECTION OF MEDICAL WORKERS
In the absence of data on the HIV status of a corpse, it is required to perform an express blood test, based on the results of which a decision will be made on conducting emergency post-exposure prophylaxis of HIV infection for a medical worker and organizing anti-epidemic measures in a potential focus of HIV infection.
Cadaveric blood is taken from the heart before the brain is removed. To do this, it is necessary to make a median incision of the anterior surface of the trunk and separate the musculoskeletal flap. The surface of the sternum should be wiped with gauze moistened with 70% ethyl alcohol and burned with a hot spatula. Then the sternum and pericardium are dissected, the anterior surface of the right ventricle of the heart is cauterized with a spatula, through which a sterile syringe needle is inserted into the cavity. At least 5-10 ml of blood should be drawn into the syringe. If blood has coagulated or is absent in the cavity of the heart, it should be taken under the same conditions from the vena cava, femoral or jugular veins.
To conduct rapid testing for HIV infection, the SMES should be provided with appropriate diagnostic enzyme immunoassay test systems. The result of the express test will be known within 1 hour, which will ensure the timely appointment of emergency chemoprophylaxis to the injured medical worker. The result of the study must be entered in the register of injuries and accidents among medical workers.
A referral form with a negative result of an express test for HIV infection from the SMES must be transferred to the unit where the injury occurred to the medical worker and attached to the autopsy report.
In case of a positive result of a rapid test for HIV infection, in order to assess the risk of occupational infection and determine the indications for prescribing emergency post-exposure prophylaxis for HIV infection of the appropriate volume, the injured medical worker with an injury report (accident) and the result of express diagnostics must be referred to the doctor on duty - an infectious disease specialist of a medical organization. When choosing such a medical organization, it is advisable to proceed from the principle of its maximum proximity to the SMEU.
In the absence of the possibility of express testing for HIV by the SMES, the blood taken from a corpse (probable source of HIV infection) with a referral and an act of medical injury (accident) should be sent to the nearest medical organization that has a diagnostic laboratory that performs express research on HIV.
However, the rapid test does not replace the HIV test in the standard test, which is more specific. Such a study is carried out in the above-mentioned laboratory of a medical organization, where a blood sample from a corpse must be received within the first day after the risk of infection of a medical worker arises. Obtaining a negative result in a standard test (after 1-3 days) will allow you to cancel the emergency chemoprophylaxis that has been started and stop further anti-epidemic measures to localize the epidemic focus of HIV infection.
It should be noted that the average cost of one rapid test is approximately 13 times higher than a standard serological test, but 11 times cheaper than a weekly course of emergency post-exposure chemoprophylaxis with only one antiretroviral drug (for example, azidothymidine) prescribed before receiving the result of an HIV serological test, and about 27 times cheaper than a week's course of extended "regime" antiretroviral therapy given for high-risk injuries.
Therefore, the organization and conduct of express diagnostics of HIV infection at the risk of occupational infection at the SMEU is an economically feasible measure. This allows, in case of a positive result for HIV infection, timely start of emergency chemoprophylaxis of HIV infection for a healthcare worker, and in case of a negative result, to avoid the unreasonable use of toxic antiretroviral drugs and relieve psycho-emotional stress from an injured medical worker.
^ 7. ORGANIZATION OF SPECIFIC PREVENTION OF HIV INFECTION AT THE RISK OF OCCUPATIONAL INFECTION
Each medical organization, including SMES, should be provided or have access, if necessary, to rapid HIV tests and antiretroviral drugs. A stock of antiretroviral drugs should be stored in any medical organization at the choice of the health authorities of the constituent entities of the Russian Federation, but in such a way that examination and treatment can be organized within 2 hours after the emergency.
After the implementation of non-specific prophylaxis measures and rapid testing of cadaveric blood from a probable source of infection, indications for emergency (specific) chemoprophylaxis should be determined for a person who has received damage to the skin and / or mucous membranes during examination of a corpse or in the process of working with infected biological material.
Emergency post-exposure chemoprophylaxis for HIV infection should be prescribed to a healthcare worker within the first 2 hours after an injury (accident). The effectiveness of prevention, started later than 36 hours from the moment of the accident, is sharply reduced, and later than 72 hours is considered inappropriate.
An epidemiologist, based on a positive result of a laboratory study of the blood of a corpse and a study of the circumstances of the occurrence of an injury, determines the risk of infection, an infectious disease specialist, if indicated, prescribes emergency chemoprophylaxis for occupational HIV infection of the appropriate volume (Table 1.)
Table 1
Indications for emergency chemoprophylaxis of HIV infection
| № | Risk of infection | Indications |
| 1 | High: deep wounds, mucosal contact or other cases of contact with large volumes of blood that contains a significant amount of virus | Recommended |
| 2 | Short: contact of the mucous membrane or damaged skin with blood, other fluids containing a small amount of the virus | Recommended |
| 3 | Minimum(no risk): contact with a liquid that does not show visible signs of blood | Not offered |
Before starting emergency prophylaxis, an infectious disease specialist consults a medical worker who has been injured with a risk of contracting HIV infection, informs the victim that he has the right to refuse chemoprophylaxis, and provides objective information about possible complications. An infectious disease doctor must obtain from a medical worker voluntary informed consent for emergency prophylaxis (Appendix 4). Then he should make recommendations regarding the need for: preventing pregnancy, breastfeeding a child, donating blood, tissues or sperm; use of condoms during sexual contacts for the period of dispensary observation; compliance with standard precautions in the workplace when there is a risk of professional contact, clinical and laboratory monitoring, strict adherence to the regimen for taking antiretroviral drugs.
damage treatment
1. Cotton and gauze swabs - 5 pieces each (treatment of the skin, mucous membranes).
2. 70% solution of ethyl alcohol - 100 ml (treatment of the skin, rinsing the mouth).
3. 5% alcohol solution of iodine - 1 bottle (treatment of the wound surface).
4. Antiseptic adhesive plaster - 1 pack (closure of microtraumas).
5. Fingertips - 5 pieces (closure of microtraumas).
6. Metal scissors.
7. Glass pipettes - 5 pieces.
Note:
The first aid kit must be stored in a labeled metal box. Responsibilities for monitoring the storage and replenishment of the mini-package are assigned to the main (senior) nurse of the GSMEU and responsible for the prevention of HIV infection.
accidents with healthcare workers
Date ___/___/____/, time _____ h. _____ min.
FULL NAME. health worker _______________________________________________
Health worker position ____________________________________________
Conducted manipulation _________________________________________________
The nature of the injuries received ___________________________________
Brief description of the circumstances of the emergency ____________________
__________________________________________________________________
Measures taken ________________________________________________
Head's signature subdivision ____________________________________________
Signature of person responsible for HIV prevention ________________
Signature of the head (senior) nurse _________________________________
Zidovudine (azidothymidine) 2 (or its analogues) - 54 caps. 100 mg
Lamivudine (or its analogues) - 18 caps. 150 mg
Lopinavir / ritonavir (kaletra) 2 (or its analogues) - 36 tab. 200/50 mg each
Lamivudine + Zidovudine (combivir) 2 (or its analogues) - 18 caps.
Note:
1 - use strictly as directed by an infectious disease specialist;
2 - laying is designed for 3 emergency cases and taking medications for 3 days;
3 - drugs that are part of the styling can be replaced by their analogues from the same pharmacological groups.
I, ______________________________________________________, 19 ____ year of birth,
(last name, first name, patronymic in full)
I hereby confirm my voluntary consent to conduct chemoprophylaxis of HIV infection and / or chemoprophylaxis of secondary diseases for me (represented) with the following drugs:
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
^ I confirm that I (represented) were given full and comprehensive explanations:
That the treatment prescribed to me (represented) is aimed at suppressing the reproduction of the human immunodeficiency virus (HIV) in the body and at preventing the development of secondary diseases associated with HIV infection; that the therapy will not lead to a complete cure for my HIV infection and will not completely prevent me from infecting others;
Why therapy is necessary, the effect of the drugs prescribed to me (represented) and the adverse reactions that they can cause are explained;
I have been given a contact phone number by which, if necessary, I can contact the attending physician or the person replacing him (tel.: ____________________).
^ I put (put) informing the attending physician about all health-related problems, including allergic manifestations or individual intolerance to medicines, about all the diseases I (represented) have suffered, about the medicines I take. I reported (reported) truthful information about heredity, as well as about the use of alcohol, narcotic and toxic drugs.
^ I undertake (I give my voluntary consent to the represented) strictly in accordance with the instructions of the attending physician or the person replacing him:
Undergo the necessary diagnostic tests: general and biochemical blood tests, blood tests to determine the viral load and immune status, viral hepatitis, X-ray, ultrasound and endoscopic studies;
Take prescribed medications; do not take, without consulting your doctor, any drugs not prescribed by him (even if they are prescribed by another doctor not on an emergency basis). If taking these drugs is unavoidable (for example, in emergency cases), inform your doctor as soon as possible;
Report immediately (within 24 hours) to the attending physician about all changes in the state of my (represented) health during treatment, if I believe that these changes are associated with the intake of drugs prescribed to me (represented).
^ I'm familiar (familiar) that refusal of treatment, non-compliance with the regimen of taking drugs, the regimen established in this medical institution, uncontrolled self-medication can complicate the treatment process and adversely affect the state of health; The treatment prescribed for me may be terminated at my own request or at the discretion of the attending physician, including due to my non-compliance with the regimen of medication or examination. In the event that I fail to comply with the prescriptions and recommendations of the doctor, as well as other disagreements regarding my (represented) treatment, a decision may be made in relation to me (represented) to be transferred for dispensary observation and treatment to another attending physician.
^ I'm familiar (familiar) and I agree (agree) with all the clauses of this document, the provisions of which were explained to me, I understood and voluntarily give my consent to the examination and treatment in the proposed volume.
I allow, if necessary, provide information about my diagnosis, severity and nature of the disease to my relatives, legal representatives, citizens:
__________________________________________________________________________________________________________________________________________________________
(last name, first name, patronymic in full, passport data / place of registration, date of birth)
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Additional Information:
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Date of completion: "____" ________________20___.
Signature ________________________________
(signature)
Signed in my presence:
________________________________
Doctor __________________________________ (signature)
(position, full name)
Annex 5
^
Form H-1
(approved by the Decree of the Ministry of Labor of the Russian Federation
dated October 24, 2002 No. 73)
One copy is sent
the victim or his authorized representative
I approve
____________________________________
(signature, full name of the employer)
ACT No. ____
^
about an accident at work
Date and time of the accident ______________________________________________
(day, month, year and time, number of full hours from start of work)
Organization (employer) of which the victim is (was)
_____________________________________________________________________________ (name, location, legal address, departmental and industry affiliation (OKONH main activity))
(surname, initials of the employer - natural person)
Name of the structural subdivision _______________________________________
The organization that sent the employee _______________________________________________
_______________________________________________________________________________
(name, location, legal address, industry affiliation)
The person who conducted the investigation of the accident: __________________________
(surname, initials, position and place of work)
Information about the victim:
Full Name ________________________________________________________
______________________________________________________________________________
Gender (male, female)
Date of Birth __________________________________________________________________
professional status ___________________________________________________________
profession (position) _______________________________________________________________
work experience during which the accident occurred _________________
(number of completed years and months)
including in this organization ________________________________________________
(number of completed years and months)
Information on briefings and training in labor protection
Introductory briefing / primary, repeated ______________________________________
(day month Year)
Briefing at the workplace (unscheduled, targeted / underline as necessary) by profession or type of work during which the accident occurred, if not carried out, indicate ____________________________________________________________
(day month Year)
Internship: from "_____" _________________20___ to "_____" __________________20___
(if not done, please specify)
Training in labor protection in the profession or type of work in the performance of which the accident occurred: from "___" ___________ 20___ to "___" ___________ 20___
(if not done, please specify)
Checking knowledge on labor protection by profession or type of work during which the accident occurred ___________________________________________
(day, month, year, protocol number)
Brief description of the place (object) where the accident occurred
(brief description of the scene of the incident with an indication of hazardous and (or) harmful production
______________________________________________________________________________
equipment that caused the accident
(name, type, brand, year of manufacture, manufacturer)
8. Circumstances of the accident ______________________________________
(a brief summary of the circumstances preceding the accident, a description of the events
and actions of the victim and other persons related to the accident, the availability of funds
Protection, other information established during the investigation)
8. 1. Type of incident _________________________________________________________
______________________________________________________________________________
(puncture wound, superficial or deep abrasion, puncture with a contaminated needle, contamination of damaged skin and mucous membranes with infected blood or other biological fluids, etc.)
8. 2. The nature of the injuries received and the organ that was damaged, a medical report on the severity of the damage to health
______________________________________________________________________________
3. Finding the victim in a state of alcoholic or drug intoxication _____________________________________________________________________
4. Eyewitnesses of the accident ______________________________________________
______________________________________________________________________________
(last name, initials, permanent place of residence, home phone)
Causes of the accident _________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(indicate the main and concomitant causes of the accident with references to the violated requirements of legislative and other regulatory legal acts, local regulations)
Persons who violated labor protection requirements: _________________________
______________________________________________________________________________
(last name, initials, position (profession) indicating the requirements of legislative, other regulatory, legal and local regulations providing for liability for violations that caused the accident specified in paragraph 9 of this act, when establishing the fact of gross negligence of the victim, indicate the degree of his guilt as a percentage)
Organization (employer), whose employees are these persons _______
__________________________________________________________________
_____________________________________________________________________________
(name, address)
Measures to eliminate the causes of the accident, terms
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Signatures of persons conducting
Accident investigation
_____________________________________________________________________________
"______" ___________________ 20____
Preventing infection with immunodeficiency is much easier than maintaining life after the disease is detected. An effective vaccine that completely cures the patient has not been invented. HIV prevention is becoming the main line of all healthcare, educational and social institutions. Health education, especially schoolchildren and students, is an integral part of the work of all subjects of the prevention system. The epidemiology of HIV infection is becoming more informative every year. Medical scientists are striving to pass on this knowledge so that the prevention of the spread of infection is more effective.
Prevention of HIV, first of all, is aimed at informing people about the ways of transmission of infection and precautions. Everyone should have an idea of how to protect themselves from AIDS. 
The right way to prevent HIV infection is to refuse.
Trying light psychotropic drugs, a person exposes himself to the delusion that at any moment he can stop and stop taking drugs. This is not true. In the later stages, the likelihood of the virus entering the body is especially high. The use of one syringe per group of people exposes a weakened body to mortal danger. The best defense option is not to try any substances that can affect consciousness.
Precautions are not superfluous in the life of every person. If you follow fairly simple rules, it becomes more difficult to get an infection. Contraceptives will help protect against the immunodeficiency virus.
Secondary measures to prevent HIV infection
The purpose of secondary prevention measures is to prevent diseases that provoke the development of immunodeficiency. Work is carried out with people who are at risk for HIV disease. These include injection drug addicts, gay couples, children from antisocial families, and prostitutes.
Secondary prevention of HIV is also carried out with persons who have confirmed the presence of the virus in the body. The person is already aware of his status. The main task is to minimize the risk of transmission of the virus to healthy people. This does not mean that the infected person is isolated. He needs to be given all the information on how to prevent the infection of other people.
Diabetes mellitus, chronic obstructive pulmonary disease, types of hepatitis, diseases of the lymphatic system put an infected person at great risk. Knowing how these diseases occur and how not to get infected is an important stage in the system of secondary prevention measures.
The postoperative period carries the risk of complications. Especially if the immune system is subject to destruction from the inside. Effective preventive care will be the use of antibiotics and antiviral drugs.
Post-exposure prophylaxis for HIV is aimed at a person who has been confirmed to have the virus in their body. Reception of antiretroviral agents begins no later than two hours from the estimated moment of risk. Later than 72 hours, the drug will not bring effectiveness. The duration of the prophylactic course is 4 weeks. Such preventive measures are shown mainly to persons who are in contact with patients or are at risk. The drugs are complex in the regimen. Many drugs have a wide range of side effects that require their use only under the supervision of a physician.
Pregnancy is a stress factor for the body. The body is rebuilt in such a way as to preserve the fetus. Pregnant women are required to donate blood for analysis several times. Perhaps the partner was infected and did not know about it. Then the virus will reveal itself in a woman during re-analysis. If HIV is detected, then a caesarean section will be used at the time of delivery. This will reduce the risk of transmission from mother to child. In the future, highly active therapy of the newborn will block the virus in his body.
The tertiary level of protection of the population.
Tertiary prevention aims to motivate the already infected population for medical support and antiretroviral therapy. Confirmation of the diagnosis is not a reason to panic. Measures to prevent HIV infection at this stage are limited to supporting patients who are undergoing therapy. Medical intervention reduces the risk of secondary diseases and reduces the viral load on the body. The psychological support of those people who have recently been given a disappointing diagnosis is also important. Non-specific prophylaxis will allow you to convey the necessary and important information for the patient himself and people from the immediate environment. The life of patients is not limited to limiting their vital activity. Her character is changing. It is important to convey to the patient that the lack of medical care leads to the development of acquired immunodeficiency syndrome. Visiting AIDS centers will allow timely and accurate assessment of the viral load. This will allow adjusting antiretroviral therapy.
The role of the state in the fight against HIV infection.
The main role in the prevention of HIV infection belongs to the state. In our country, there is a state program for the prevention of HIV infection. It is supported by all media. Special ones travel regularly to the cities of Russia. Booklets and leaflets are distributed in health care institutions, telling about the ways of HIV infection.
In addition to the above, the tasks of the state include the fight against drug trafficking. This is directly related to the spread of HIV infection.
The fight against prostitution is aimed not only at supporting the moral side of the development of a citizen. Numerous partners of women of easy virtue do not always spread about the presence of sexual and viral diseases, so the risk of infection is high. The lack of contact with representatives of the ancient profession will greatly facilitate the life of a man.