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Campaign Leaflet

All of us are aware of the existence of sexually transmitted infections (STIs) and HIV/AIDS. Many of us also know that it is possible to avoid infection and unwanted pregnancy by using a condom. But are we certain that a condom is reliable? Do we correctly rate our own risk of becoming infected? Sometimes we think that issues related to HIV/AIDS and other STIs are of no concern to us. But, is this really true?

This leaflet will help you to understand what HIV and AIDS are, how dangerous these diseases are, and how to avoid infection. This leaflet contains reliable information regarding STIs, condoms and safer sex practices, which may be helpful in making the right decision for protecting one's health and allowing one to avoid thoughtless actions.

HIV and AIDS. What is the difference?
A disease which damages the immune system

The Human Immunodeficiency Virus (HIV) was identified in 1981. Today, the scientific and medical world focuses much attention on the study of HIV. The nature and structure of the virus has been defined, and its strengths and weaknesses have been well documented.

HIV belongs to the retrovirus family (also known as the 'slow virus' group). It has a spherical shape and a cover protects its 'core', which is fully adapted to surviving within the human body. However, outside the human body, it is very unstable. That is why beyond its own habitat, HIV quickly perishes and cannot travel by air or water.

Once in the human body, HIV penetrates certain blood cells called T-lymphocytes, which are designed to fight infections. Once inside a T-lymphocyte cell, HIV changes its structure such that the cell serves as a 'factory' for HIV virus reproduction. At a certain point, the cell fills to capacity with virus particles, explodes, and dies. When this happens on a larger scale, the number of T-lymphocytes in the blood sharply decreases and the human immune system has more difficulty warding off infections. It is at this point that a person is diagnosed as having developed Acquired Immune Deficiency Syndrome (AIDS).

HIV can be detected in the body through a special blood test, which reveals antibodies to the virus, approximately three to six months after infection. The period after infection and before HIV antibodies start to appear is called the 'window period'. It is dangerous primarily because a person usually cannot find out that s/he has been infected although they can transmit the virus to other people.

Usually, HIV infection is asymptomatic for long periods of time. However, the virus continues replicating in the body. The majority of those infected feel well for many years. Due to the development of the virus, the health status of an infected person goes from bad to worse. A high temperature, diarrhoea and sweats become habitual symptoms. A general feeling of weakness increases, swollen lymph nodes in the neck, armpits and subclavian areas appear.

The viral stage known as AIDS, begins when the immune system can no longer cope with various infections, which previously did not represent a threat to a person's health, and consequently the person becomes ill. Usually infections appear, which target the lungs, intestinal tract, and the central nervous system.

The time at which symptoms associated with AIDS appear is individual and depends mostly upon the presence or absence of other infections. The presence of other STIs not only increases the risk of HIV infection, but also aggravates HIV/AIDS.

AIDS develops quicker among those who already have a poor health status. Smoking, alcohol abuse, drug use, and malnutrition contribute to poor health.

At the same time, in a very small group of people, the AIDS stage is never reached and they seem able to live with the virus indefinitely.

Therefore, you can see that HIV and AIDS are not the same. HIV is a virus, which leads to suppression of the immune system, while AIDS is a mixture of health problems caused by lowered immunity.

During the AIDS stage, the viral load produced by T-lymphocytes 'occupied' by HIV increases. At this stage, treatment is urgently needed to slow down HIV replication activity, and to stop the virus from multiplying in the body. Treatment does not result in the elimination of the virus from the blood stream, but does help to prolong a person's life and allows the human body to function more or less normally.

Unfortunately, the cost of the treatment, which allows people living with HIV/AIDS (PLWHA) to lead normal lives, is very high. A federal programme in Russia focused fighting the disease and finding a cure for those already infected does not allow for the provision of medicines and the necessary care for all AIDS patients. This is especially the case given that the prevalence of this incurable disease has reached epidemic proportions in Russia. The only way to limit the spread of infection is through prevention. Therefore, every person is able and must take responsibility for protecting her/his own health.

Thus, how is it possible to avoid becoming infected with HIV? In what situations is it possible to become infected, and what types of contact with HIV-infected people are safe?

Topics related to HIV and AIDS cause fear and concern. However, in the majority of cases these fears are unfounded and exaggerated. In reality, most forms of contact with HIV-infected people are absolutely safe. All routes of HIV transmission have been scientifically proven and well researched.

How do you become infected with HIV?

It is possible to become infected in three ways:
· Unsafe sexual intercourse through sperm, vaginal discharge, and blood (which may be due to micro-trauma to the genitals and/or the rectum mucous membranes);
· Via blood, for example, through the sharing infected needles and syringes used when injecting drugs, tattooing and piercing; and,
· From a mother to an (unborn child), either by passing the virus through the placenta, when the foetus passes through the infected birth canal, or when passed through the mother's milk during breastfeeding.

Thus, HIV is spread via blood, sperm, vaginal fluid and breast milk, but not through other bodily fluids such as saliva, sweat, tears, urine and faeces).

How is HIV not transmitted?

People are afraid that they will contract HIV through normal social contact. This fear is unfounded.

HIV is not transmitted:
*through shaking hands with or by hugging an HIV infected person;
*through sweat or tears;
*through sneezing or coughing;
*by using the same plates or bed linens;
*by using the same toilet and/or bathe as an infected person;
*when travelling by public transport; nor,
*through animal or insect bites.

HIV is also not transmitted through kissing. This is because there is the viral concentration in saliva is too low to foster transmission. It is impossible to get infected through the absence of deep bleeding wounds in the mouth and following proper oral hygiene. Throughout all HIV/AIDS studies, there has been no document and/or reported case of transmission occurring in these ways.

Taking precautions
It is possible to avoid HIV infection. There is an accessible way to protect your own health and the health of your partner - that is, through safer sex practices, so that blood, semen and vaginal fluid do not pass between bodies. Safe sex and condom use solve one more important problem: unwanted pregnancy prevention. Safe sex is the most reliable method of preventing HIV/AIDS and other STIs, and it is also a convenient and safe method of family planning.

Safe sex means that you can:
*kiss and even deep kiss (i.e., 'French kiss')
*lie close together, cuddle
*caress or massage one other
* have penetrative sexual intercourse always using a condom.

Knowledge of the routes of HIV transmission affords the opportunity to rate our risk of infection correctly, and to take the necessary precautions. Always practicing safe sex and using a condom allows one to avoid HIV infection, and leading a healthy lifestyle and maintaining normal personal hygiene strengthens immunity and increases disease resistance.

If there are some concerns regarding the possibility of being infected with HIV, it is necessary to see a doctor immediately. Reliable information provided by an experienced specialist during a consultation will help to make the situation clear and will dispel any groundless apprehensions.

Sexually transmitted infections (STIs)
In addition to HIV, other sexually transmitted infections (STIs) can be transmitted through unsafe (without a condom) sexual contact. Unfortunately, these infections are very common. Some of them represent inconveniences, while others may cause infertility or lead to more serious health problems if not treated in a timely manner. Moreover, persons suffering from an STI may be more easily infected with HIV. It is easier for the virus to enter the bloodstream through sores, warts and other skin injuries associated with STIs.

The symptoms and consequences, their routes of transmission, and the main methods of prevention for the most widespread STIs are described in this leaflet. The information provided here will help you to behave appropriately in situations related to sexual health, and to avoid problems as well. Descriptions of other STIs not included in this leaflet can be found on our web site: www.fondfocus.org.

Do not delay a visit to a doctor
Do not delay a visit to a doctor if you notice any of the following symptoms:
*a mucus or purulent discharge or pus from the penis, vagina, or anus;
*a burning sensation when urinating;
*sores, warts or blisters on the penis, vagina, anus or mouth; or,
*an irritation in or around the genital area.

Do not panic if you notice any of the symptoms listed above. Most STIs can be treated and/or cured. It is, however, necessary to see a doctor immediately, who will prescribe the proper treatment and will advise you regarding how to avoid any further consequences. Knowing the main symptoms of STIs will help to prevent infection or, if it has already happened, initiating treatment during the early stages of infection will usually improve results.

Syphilis
Syphilis is an STI characterized by skin and mucous membranes and nervous system lesions. Without treatment, syphilis lasts for many years and can lead to a lethal outcome.

Pathogen: Treponema pallidum.

Routes of transmission:
· During unsafe sexual intercourse with a partner who was infected by someone else;
· From mother to (unborn) child during pregnancy or during childbirth as the foetus passes through the birth canal.

Symptoms:
The infection progresses very slowly, and the primary symptoms often go unnoticed, especially among women.

The bacteria (Treponema pallidum) can settle anywhere in different areas of the body. Where you are infected depends upon how you had sex. Infection may occur in the genital region, or in mucous membrane of the mouth, tongue, anus, etc. Between three and four weeks after infection with syphilis, the primary symptoms of infection are chancre - a small, round, painless sore, which feels hard to the touch may appear in places where you have been infected. The lymph node glands near the sore are swollen (usually in the groin or submaxillary area), often only on one side only. On the surface of the sore, a large deposit of spirochaetes may be visible. The sore will usually clear up by itself within three or four weeks. From the moment the primary signs appear, the person is infected.

Two to four months after infection, the second stage of infection sets in, whereby the roseola rash appears commonly appears. The rash is a symmetric eruption on the surface of the body, palm of the hands, and soles of the feet, or mucous membranes. The rash is accompanied by fever, headache, fatigue, enlarged lymph nodes, and localised tonsillitis. Papulation/papule formations -red, round formations, which peel around the edges and tower over the skin surface -- on the body, palms and soles, syphilitic condylomas, hair loss, loss of vision, and changes in the voice are also possible. All of these symptoms may disappear by themselves within two to six weeks after their onset. At this point, syphilis enters the 'latent' (or asymptomatic) stage. The latent stage alternates with relapses - periodically, reoccurring symptoms of secondary syphilis erupt. Reoccurring symptoms are usually less visible, and are present as papules, which are often located on the palms and soles, in skin folds, and in the genital region.

If left untreated, syphilis can reach the third stage, and cause damage to the nervous system, bones and viscera. Infection of the spinal fluid and brain may occur.

Diagnosis:
The incubation period usually lasts 3 to 4 weeks after al sexual contact with an infected partner.

Diagnosis requires laboratory testing of blood samples (a blood test will be accurate on average within 3 to 4 weeks of infection), or though examination of the discharge produced by sores which reveal Treponema pallidum (examined by dark-field microscope).

Treatment:
Syphilis can be treated and cured easily, especially during the earlier stages, through injections of long-lasting penicillin.

The success of the treatment depends upon when treatment began after the initial infection. Sero-reactivity during the later stages of syphilis may last throughout the rest of your life.

The sexual partner must also be treated.

Possible complications:
· A woman infected with syphilis is at high risk of giving birth to an infected child. Receiving timely treatment allows the child a healthy birth;
· Untreated syphilis will cause severe heart, liver, bone, brain and spinal cord damage, which may lead to death; and,
· Syphilis infection increases the possibility to contracting HIV and other STIs.

How to avoid infection:
Use a condom every time you have sexual intercourse!

Refrain from kissing and engaging in oral sex if you notice any chancre and/or sores in your partner's mouth. Using a latex tissue (which can be replaced with a slit condom or food pellicle) during oral sex reduces the risk of infection.

Gonorrhea

Gonorrhea (or 'clap') is an STI caused by a bacterium. Men, women and children can be infected.

Pathogen: Neisseria gonorrhoea, gonococcus.

Routes of transmission:
Gonorrhoea can be transmitted through:
· Sexual intercourse (vaginal, oral or anal) without using a condom;
· From an infected mother to a child during childbirth.
· Through hands the infection can be spread to the eyes.

Well-marked symptoms among men can be slight, and may go unnoticed in women. The primary symptoms usually appear within two to seven days after sexual contact with an infected partner.

Women may notice:
· A thick discharge from the vagina;
· Pain, burning or discomfort when urinating;
· Abdominal pain or fever, which may indicate spreading to the ovaries;
· Itching or a discharge from the anus.

If infection occurs through oral sex, a sore throat may be noticed.

Men may notice:
· A white or yellow discharge oozing from urethra. This is sometimes enough to stain underpants;
· Pain, burning or discomfort when urinating;
· A painful erection;
· Itching or a discharge from the anus;
· A sore throat.

However, there may be no symptoms for one to two weeks, especially when gonorrhoea is in the throat or rectum.

Symptoms may disappear without any treatment, which means that the disease enters the chronic stage. Symptoms may appear again exacerbated.

It is important to remember that gonorrhoea may be present with other STIs. Therefore, it is better to have tests for trichomoniasis, Chlamydia and herpes.

Diagnosis:
The incubation period usually lasts two to seven days after initial sexual contact with an infected partner.

Diagnosis of gonorrhoea is based on the presence of Neisseria gonorrhoea in the discharge.

Treatment:
Gonorrhoea is easily treated with a course of antibiotics - either via injections or pills -- especially during the earlier stage.

It is important to have a follow up examination and testing to ensure that it has completely cleared up.

Partners with whom you have had sexual contact must also be treated.

Possible complications:
· Pelvic inflammatory disease, which can lead to infertility in women;
· Inflammation of the testes and prostate gland, which sometimes can lead to infertility in men;
· A mother with gonorrhoea can infect her baby during childbirth. Consequentially, the newborn child may become blind because of an associated eye infection. Immediate treatment prevents this from happening; and,
· Gonorrhoea increases the possibility of contracting HIV and other STIs.

How to avoid infection:
Use a condom during each sexual intercourse!

Chlamydia

Urogenital (urinogenital) Chlamydia is one of the most common STIs.

Pathogen: a germ of an intermediate form between viruses and microbes, an intracellular parasite (Chlamydia trachomatis).

Routes of transmission:
· The primary route of transmission is penetrative sex without using a condom.
· Chlamydia can be passed from an infected mother to a baby during child birth.

Symptoms:
Women often do not notice any symptoms.

Symptoms which indicate that an individual has been infected with Chlamydia include:
· A slight, thin discharge from the vagina which resembles glue;
· Itching and burning when urinating, or pain in the abdomen or in the sacrum area;
· Bleeding from the vagina between periods or after sex; and,
· In the case of rectum inflammation, there may be a slight blood and mucus secretion.

When Chlamydia infects the urethra, it causes similar symptoms of urethritis in men. Chlamydia in the rectum is passed on during anal sex. It often causes no symptoms and can be missed.

Diagnosis:
The incubation period usually lasts between seven and 21 days after sexual contact with an infected partner.

For a precise diagnosis, a swab of the vagina, urethra or anus is needed.

Treatment:
Chlamydia is easy to treat, and is usually includes a course of antibiotics, which should be taken for between seven and 14 days. Your sexual partners must also be treated to avoid re-infection.

A repeat test no earlier than two to three weeks after initial treatment is needed in order to ascertain how well you are recovering.

Possible complications:
For women:
· Pelvic inflammatory disease, i.e., inflammation of the Fallopian tubes (oviduct);
· Infertility, even when the infection is asymptomatic;
· An increased risk of ectopic pregnancy;
· Pain in the joints;
· Commissures, which appear as a result of inflammation, causing pain in the lower abdomen; and,
· Chlamydia may be passed from an infected mother to her baby during birth, giving it an eye or lung infection, or Chlamydia of a female child's urogenital organs.

Timely treatment with antibiotics can clear up the infection in the mother without harming an unborn child.

In men, the infection may be the cause of some painful inflammatory symptoms in the urinary tract, which occasionally lead to the impotence or even sterility.

Chlamydia increases the risk of contracting HIV and other STIs.

How to avoid infection:
Use a condom during each sexual intercourse!

Genital herpes

Herpes is one of the most common STIs. Around 90% of people globally are infected with herpes, and only 20% have different types of it.

Pathogen: a viral infection (Herpes simplex virus (HSV), types I and/or II).

Routes of transmission:
The primary route of transmission is penetrative sex without using a condom.

It is possible to transmit herpes from kissing or through any contact with infected organs, as well as from mother to child during pregnancy or during childbirth.

According to recent research, genital herpes infection depends upon:
· Sex -- women are more susceptible to infection;
· The age of the woman -- the mucous membranes of the vagina and the cervix in younger women are very susceptible to the viral infections. Young women who have started their sexual life as teenagers are particularly at risk; and,
· The number of sexual partners during the course of one's -- genital herpes is wide spread among sex workers and teenagers).

Symptoms:
Symptoms usually appear within two to 10 days after getting infected. The primary symptoms of herpes infection are:
· Burning, painful, and swollen infected areas. These signs can be accompanied by a fever, headache, and/or indisposition.
· Small blisters which have a clear, viral load inside appear within two days. These burst and leave small ulcers which may be painful. They usually heal within a week or two and leave scabs.
· Swollen lymph nodes in infected areas.

Men usually have eruptions on the tip and on the body of the penis, coronal sulcus, urethra, and/or the peri-anal region. In rare cases, the eruptions appear on the scrotum, perineum, hips, and buttocks.

Among women, the blisters may appear on the genital lips, the membrane of the vagina, the cervix, the ostium of the urethra, the mouth (via oral transmission), infection of the perineum, peri-anal region, hips and buttocks as well.

After primary infection, the herpes virus penetrates into the neuronal cells, where it can stay in an inert (latent) state.

It is impossible to completely destroy the virus, and it will remain in the organism infection symptoms reoccur. Other STIs, stress, and mechanical irritation such as rigorous sexual intercourse, super-cooling, and over-isolation contribute to relapses in symptoms. Frequently, relapses in women are connected with the menstrual cycle.

Diagnosis:

Diagnosis may be confirmed through laboratory analysis (IFA, PCR-test).

Treatment:
Receiving treatment during the primary herpes symptoms is most effective.

Treatment includes prescribing antiviral medication ingested or applied to the skin surface, and also corroborative of the immune system.

Currently, there is no available cure for herpes infection.

Possible complications:
· People with recurring genital herpes often have pathology of the reproductive function, such as miscarriage or premature birth, and lower counts of spermatogenesis.
· Herpes infection increases the likelihood of contracting HIV and other STIs.

How to avoid infection:
· If there are some indications of herpes lips or mouth, you should refrain from kissing and from oral sex. Using a latex tissue (which may be replaced with a slit condom or food pellicle) during oral sex reduces the risk of infection.
· Use a condom during each sexual intercourse!

Taking drugs is also taking a risk
Drugs threaten your health and increase the risk of becoming infected with HIV and Hepatitis B and C.
Moreover, drugs themselves kill, and contribute to the spread of many dangerous diseases.

HIV and Hepatitis B and C may enter the blood stream through sharing a needle which has been contaminated with infected blood. Other injecting equipment (i.e., syringes, cotton filters, spoons, plates, and even water) and sharing the same vile also pose risks. Sometimes even the drug itself contains the virus, if infected blood was used during the manufacturing process.

It goes without saying that drug users must also always practice safer sex. It is necessary to remember that alcohol is also a drug, and under the influence of alcohol, you may lose control of a situation, which could lead to hasty actions.

Talk to your partner about it
How do you start talking about it?
We easily can talk about sex with our friends, but for some reason are hesitant when it comes to talking about it with our partner. Regardless of the type of sexual relationship you have, you should always use condoms. If you have already met a person with whom you are going to live with for a long time, then condom use will help you to prevent an unwanted pregnancy. And, if you have not made your choice yet, and do not yet have a permanent partner, safe sex must become a part of your life.

It is natural and easy to practice safe sex. Make it clear to your partner that you want to use a condom. If you still find it difficult to start talking about it, just take out a condom. You can make a joke out of it. Telling someone you want to use condoms does not mean that you do not trust him/her. On the contrary, it means that you want to protect one other, and that you have a sense of responsibility. If your partner still refuses to use a condom, suggest that you read this leaflet together. Remember that it is better to refuse to have sexual contact without a condom than to expose yourself and your partner to risk. Once you have made your attitude towards safe sex clear, you and your partner will feel much better.

Condoms
A condom is a very strong thin latex sheath that is put over the penis. A condom prevents infection with HIV and other STIs, as well as unwanted pregnancy. If used correctly (see the chapter 'How to use a condom'), condoms provide 100% protection from HIV/AIDS and many other STIs. In contrast to many other methods of prevention, such as suppositories, sprays, etc., condoms are unique and provide a high level of protection without any side effects. Misconceptions that condoms have some small openings, which allow the HIV virus to pass through them, have been refuted through many research studies. To guarantee protection against, it is necessary to make sure that the expiration date has not yet passed.

How to use a condom
· Avoid any contact between the penis and the vagina or anus before the condom has been put on;
· Open the packet carefully. Be sure not to damage the condom with sharp nails or jewellery;
· Put the condom on only when the penis is completely erect;
· There must be some space at the tip of the condom to hold the semen. That is why most condoms have a teat. Squeeze either the tip of the condom (about one centimetre) or the teat tightly so that there is no air in it, and unroll the condom;
· Never use oil, Vaseline, or other creams, because these damage the latex. If you want to use a lubricant, make sure that it is water-based;
· After ejaculation, withdraw the penis immediately. Hold on to the condom while you are doing so. If you wait too long and the penis becomes limp, the condom could slip off;
· Throw away the used condom in a rubbish;
· Use a condom only once;
· Two condoms on top of each other may seem even safer, but the friction causes them to tear.

Buying condoms
If you are a modern, civilized person, buying condoms for you is as natural as buying chewing gum or aspirin. Buy only high quality condoms produced by well known companies in pharmacies and supermarkets, paying attention to the expiration date and the label which states that the brand meets international standards. These types of condoms may be more expensive, but they will not let you down during an important moment. Moreover, high quality condoms do not reduce sexual pleasure. Various forms and colours of condoms can add variety to your sexual life. In order to decrease the friction between the condom and the vagina, lubricants may be used. These make the usage of condoms more comfortable and improve feelings and intensify pleasure. Every pack contains an instructions regarding how to use a condom, and information on where, when and how these condoms have been produced, if they have been treated with lubricants, and how to best store them.

Life is full of joy and pleasure. By protecting our health, we save the joy of life!

Want to know more?
If you would like to know more about AIDS or STIs, consider contacting the following organisations or institutes:
- Non-profit partnership organisation for civic initiatives support 'Focus'. Literature distribution regarding safe sex and HIV/AIDS prevention. E-mail: foundfocus@mtu-net.ru

- Russian Association for sexually transmitted infections prevention 'SANAM'. Free consultations. Address: 119048, Moscow, Dovatora str., 13. Tel./fax: 245-54-70.

- Information Centre 'GERA', working in the field of sexual and reproductive health with professional audiences. Tel. (095) 916-3966

- Non-profit nongovernmental organisation 'AIDS-Infoshare'. Library and resource Centre. Information and technical support to NGOs, investigations in the field of human rights and health protection. Tel. (095) 119-3316. Address: Moscow, 105037, box 51. Hot line - tel. (095) 250-6341 (from 3 p.m. to 9 p.m.)

- Charity Foundation 'Ogonjok-VID-AntiAIDS', educational activity in the field of AIDS prevention. Tel.: (095) 203-03-96

- Inter-regional public organisation 'ACCENT, Support and assistance centre for public health development'. Tel.: (095) 178-27-43.
Free consultations for the teenagers, address: 103160, Moscow, Komsomol'skiy pr. 13A, app. 104, Tel./Fax: (095) 247-50-36

- Anonymous HIV- and Hepatitis-testing service at polyclinic №211. Address: Varshavskoje shosse, 148, tel.: (095) 389-6018

The text included in this booklet was written by the Foundation for civic initiatives support 'Focus' with the support of the Ministry of Health of the Russian Federation and was approved by the Centre for sanitary epidemiological surveillance in Moscow. The materials for the creation of this leaflet were provided by the international organisation MSF-Holland, Inter-regional public organisation 'ACCENT, Support and assistance centre for public health development', and 'SANAM' Association.