Methods of Protection Agaist Sexual Transmission of HIV

Condoms

A condom is an effective protection barrier and is one of the most important tools in preventing HIV transmission through sexual activity.

Quality control

In Canada, condoms as contraceptive devices are classified as medical devices, and are subject to regulatory control under the Food and Drugs Act and Medical Devices Regulations. Some requirements apply to all condoms. For example, all condoms must be packaged and labelled, and all manufacturers must notify Health Canada regarding the sale of condoms.

In addition, latex condoms must meet design, length and width requirements as well as specific tests for water leakage, bursting volume and bursting pressure. Condoms are tested and must achieve safety levels of 99.9%; otherwise, they must be withdrawn from the market and re-evaluated.

Lambskin condoms

Lambskin condoms are manufactured from a natural membrane. Used alone (without another product), they are not considered effective in the prevention of HIV, because the virus is easily able to pass through the membrane. However, lambskin membrane condoms are made available for people who have an allergy to latex, and can be “double-bagged” (i.e. a latex condom is placed closer to the non-allergic person).

Polyurethane condoms (synthetic condoms)

Polyurethane has been shown to be an effective barrier against HIV. Female condoms are currently made of polyurethane, and male condoms are also available in polyurethane, although they may be more difficult to find. Also, polyurethane conducts heat better than latex, providing users with a more “natural” feel. People who are allergic to latex can use polyurethane.

Male condom use

Condoms require getting used to. Men who are first-time condom users should practise using them by themselves before they use one with a partner. If condoms are used properly, they have been shown to substantially reduce risk of HIV transmission.

Buying and storing

There are many different brands of condoms and preferences are personal. Try several brands to find the most comfortable. When using condoms, follow these guidelines:

Always use before the expiry date on the package. If in doubt, get a fresh supply.
Store condoms in a cool, dry place Exposure to heat can break down latex. Polyurethane condoms are not affected by heat or light and may be stored for up to five years.
Carefully open the condom package; teeth or fingernails can tear the condom.
Put the condom on by pinching the tip to remove air bubbles, and unrolling it all the way down the shaft of the penis from head to base.
Use only water- or silicone-based lubricants. (Oil-based lubricants, such as cooking or vegetable oil, baby oil, hand lotion or petroleum jelly (Vaseline) will cause the latex condom to deteriorate and break.)
Withdraw the penis from the vagina or the anus after ejaculation while still erect. Grasp the rim of the condom between the fingers and slowly withdraw the penis (with the condom still on) so that no semen is spilled.
Remove the condom, making certain that no semen is spilled.
Carefully dispose of the condom. Do not reuse it.

Female condom use

The female condom is now available in several retail outlets. The female condom offers the potential of giving women the chance of more control over their own protection. Like the male condom, proper use is crucial to its effectiveness.

The female condom is a sheath that lines the vagina, with two flexible plastic rings at either end. The closed end is inserted in the vagina and the open end hangs outside the body against the outer lips of the vagina. The condom comes with a water-based lubricant to make insertion easier and to allow comfortable movement during sex. It may be inserted into the vagina up to eight hours before intercourse.

Do not use damaged, discoloured, brittle, or sticky condoms.
Check the expiration date.
Carefully open the condom package; teeth or fingernails can tear the condom.
First, inspect the condom and make certain it is completely lubricated on the outside and the inside.
The female condom is inserted into the vagina with fingers, much like a tampon that has no applicator. To do so: hold the condom at the closed end and squeeze the flexible inner ring with thumb and middle finger so it becomes long and narrow. With the other hand, separate the outer lips of the vulva.
Gently insert the inner ring end as far into the vagina as possible, using the index finger to push up the inner ring until the finger reaches the cervix (similar to how a diaphragm would be inserted).
Before intercourse, make certain the condom is in place.
Add a water-based lubricant onto the penis and/or the inside of the female condom. Be sure that the penis is not entering the vaginal canal outside of the condom.
To remove the condom, twist the outer ring and gently pull the condom out to avoid any spillage.
Dispose of the condom.
Do not use a male condom along with a female condom. If the two condoms rub together, the friction between them can cause the male condom to be pulled off or the female condom to be pushed in.

Female condom for anal intercourse?

The female condom has not been designed or approved for use during anal intercourse. However, it is being used by many people for this purpose. One study that examined the use of the female condom by men who have sex with men (MSM) found that 57% of the men reported problems that included rectal bleeding by the receptive partner. The use of lubricant inside, removing the inner ring and placing the condom on an erect penis can help eliminate some injury and discomfort.

Dental dams

Dental dams are relatively thick sheets of latex squares. Although cunnilingus and anilingus carry a negligible-to-low risk of HIV transmission, dental dams have been recommended for people who wish to further reduce risk.

Dams are often available only from medical supply stores. An alternative is to use a latex glove or finger cot.

Latex Gloves and Finger Cots

Latex gloves and finger cots reduce the risk of HIV transmission via open cuts, sores, lesions, burns or rashes on the hands or fingers during fingering and fisting penetration in the vagina or anus. Care should be taken to prevent holes being made in the glove by fingernails during vigorous activity. Rings should be removed before putting on the glove. Finger cots and gloves made of polyurethane are also available.

Cervical barriers

Cervical barriers (diaphragms and cervical caps) are soft latex or silicone cups that fit at the upper end of the vagina, covering the cervix. They are currently used to prevent pregnancy, but research is underway to see if their use may also reduce the transmission of HIV and other STIs.