• casual contact such as shaking hands, or lavatory seats;

• through food, water or the respiratory route.

control programmes The main method of control is health promotion and should involve community leaders, religious organizations and NGOs. This can be to the general public to supply them with the correct information or to specific groups. The most cost-effective health education will be to high-risk groups, such as commercial sex workers, homosexuals, single workers, etc. However, they are difficult to motivate and it is probably better to concentrate effort on school children. Girls should have equal opportunity for education, whereas sex education should be an integral part of the school curriculum. Counselling and testing facilities need to be readily available as well as programmes on mother-to-child transmission. Improved diagnosis and treatment facilities for STIs need to be made available, providing early and adequate treatment. Condoms can be dispensed at clinics, markets or at any suitable social marketing opportunity (see Box 14.1).

All persons with HIV infection, including those under treatment, are at risk of passing on infection to others and should be counselled about preventive measures to be taken.

Treatment is largely unavailable in most developing countries, but efforts are being made to rectify the situation. Individual treatment is a highly specialized subject, but will probably consist of two nucleoside analogues, a non-nucleoside reverse transcriptase inhibitor and/or a protease inhibitor, a three- or four-drug regime being found to be more effective than a two-drug regime. A second-line regimen should be available in case of toxicity or treatment failure. Any opportunistic infection must receive specific treatment for the condition.

Surveillance The prevalence of HIV infection can be estimated by testing anonymously blood that has been obtained for other purposes, such as in ante-natal or STI clinics. Population-based surveys have been conducted in Zambia, South Africa and some other countries. Numbers of cases of AIDS are reported to WHO using the case definitions outlined above.

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