Lecture | Quiz | Learning Exercise | Answer Key

Developed by JHPIEGO’s Training in Reproductive Health Project with funding from USAID.

Lesson 3: Prevention of Sexual Transmission of HIV
Instructor: Jean Anderson, MD

Answer Key

Quiz

1. Protection against pregnancy, HIV and other sexually transmitted infections can be achieved by:
   1. Use of hormonal contraception 
   2. Use of spermicides containing nonoxynol-9 
   3. Use of natural skin condoms 
   4. Use of female condoms
   5. Withdrawing before ejaculation
2. Which of the following factors increases the risk of sexual transmission?
   1. Use of antiretroviral drugs 
   2. The female partner has a trichomonas infection 
   3. Use of a diaphragm for contraception 
   4. Male circumcision 
   5. Use of condoms
3. Which of the following is true about spermicides containing nonoxynol-9?
   1. Decrease likelihood of mucosal irritation 
   2. May increase HIV transmission, especially in women with high rates of sexual activity 
   3. Decrease vaginal lubrication 
   4. Protect against infection with human papillomavirus (HPV) 
   5. Provide no protection against pregnancy
4. Which of the following are true statements about the female condom?
   1. Made of latex 
   2. Is associated with irritation in most users 
   3. Can be safely reused if washed, rinsed and air dried after initial use 
   4. Should be used only with water-based lubricants 
   5. Must be disposed of after one use

Learning Exercise

The task for these learning exercises was to assess risk of HIV transmission in three different scenarios and think about how to counsel each individual.

1. The first case is a 16 year-old girl who presents at the family planning clinic requesting birth control pills. She has recently become sexually active with a 22 year-old man.
   
   She is at risk for HIV because she is sexually active. Furthermore, she is sexually active with an older man who has probably had more sexual experience and may have other sexual partners; therefore, he is more likely to have already been exposed to HIV. She should be asked about use of condoms and about other sexual partners that she may have or that she knows her boyfriend has. She should also be asked about any symptoms that might suggest the presence of a sexually transmitted infection. 
   
   She should be counseled about using condoms with each sexual act and taught how to use these correctly, even if she is using another method, like the birth control pills. She should also be taught the symptoms of STI and told to come in for evaluation if she develops any of these.
2. The second case is a 23 year-old woman in her first trimester of pregnancy. She is also at risk for HIV, since she is sexually active and has had unprotected sex (since she became pregnant). She may also be at risk of becoming HIV-infected during pregnancy if condoms are not used. It is easy to forget about using condoms during pregnancy because many people (and many health care providers!) still think of condoms primarily as a means of contraception. She should be counseled about using condoms with all sexual activity. If she becomes HIV-infected during pregnancy, her risk of transmission to her fetus or infant is increased.
3. The third case is a 16 year-old boy who presents with penile itching and has recently become sexually active. He is at risk for HIV because he is sexually active. His symptoms may also indicate the presence of an STI, which will increase his risk of HIV transmission if he is exposed. He should be evaluated for STIs and taught about their symptoms. He should be counseled to use condoms with all sexual activity and taught how to use them correctly.