Comprehensive HIV/AIDS prevention strategies, identification of high-risk groups, and guidelines for safe contraception during the preconception period.

131. Prevention of AIDS Currently, there are many ways to prevent AIDS. The following points can effectively prevent AIDS infection: (1) Fidelity: Maintaining a monogamous sexual relationship with only women who test negative for HIV is the only effective way to avoid HIV infection through sexual intercourse. (2) Using condoms: Correct use of condoms can not only prevent but also reduce the risk of AIDS and sexually transmitted diseases. Lubricated latex condoms are the most effective because lubrication prevents breakage, and latex is also an effective barrier against HIV. For an even stronger layer of prevention, latex condoms coated with a special substance can be used. This coating can kill sperm and also kill the HIV virus. If using a condom, the outer layer must be lubricated. Choose water-based products such as KY acetone or general spermicide. Oily lubricants, such as baby oil, cold liquid, or gasoline, can break down condoms. Also, avoid using condoms made of sheepskin, as these have tiny pores that the HIV virus can pass through. (3) Be cautious when kissing: Theoretically, a light kiss on the cheek is safe, but a deep kiss on the lips can be dangerous. If the person you are kissing is infected with HIV and there is bleeding in their mouth, the virus can potentially enter your body through the mucous membrane of their mouth. (4) Avoid anal sex: Unprotected anal sex is one of the most dangerous forms of intercourse. Especially when you are the recipient, the anus is not protected by a sheath, so intercourse can easily damage the anal mucosa, allowing the virus to enter the bloodstream. Even if a condom is used during anal sex, it is not very effective because the condom can easily break through the anal wall. (5) Be aware of the source of blood transfusions: HIV testing and sterilization in the United States have largely prevented HIV transmission through blood transfusions, but this is not the case in other parts of the world. Therefore, if you must receive a blood transfusion for any reason, be sure to ascertain the safety of the blood source before consenting. (6) Avoid sharing needles: Because HIV is transmitted through blood, it is easy to get infected by sharing a needle with someone else during injections. This is something you should never overlook. (7) Get a checkup: If you are worried that you have been infected with HIV, you can get tested by a doctor 6 months after sexual intercourse (antibodies will not appear in the blood until 6 months after the initial infection). This HIV antibody test can be done at many health institutions and hospitals.

The following groups are at high risk of HIV infection: (1) Drug users: especially those who use unsterilized syringes for intravenous drug use. (2) Prostitutes: the more sexual partners they have, the greater their chance of infection. (3) Male homosexuals: anal intercourse among male homosexuals can easily damage the rectal or genital mucosa, creating favorable conditions for HIV invasion and increasing the chance of infection. (4) Patients with sexually transmitted diseases: especially those with gonorrhea, syphilis, genital herpes, etc., who have ulcers in the genital area and multiple sexual partners, are more susceptible to HIV infection. (5) Infants whose mothers are HIV-positive: if the mother is an HIV patient or infected with HIV, she may transmit the virus to her offspring. Therefore, these women should avoid pregnancy. (6) Spouses of HIV patients or infected individuals: they are more susceptible to infection during sexual intercourse. Therefore, they should use condoms during sexual intercourse to protect themselves from infection.

The causes of male infertility: Generally, 80%–85% of couples conceive in the first year of marriage, and 10%–15% in the second year. If infertility persists for more than 3 years, it should be taken seriously. According to the World Health Organization, male infertility is defined as one year, meaning at least 12 months of unprotected sexual intercourse without the woman conceiving. Primary male infertility refers to a man never having conceived a woman. Secondary male infertility refers to a man having previously conceived a woman, regardless of whether she is his current partner or the outcome of the pregnancy. Generally, the chances of restoring fertility are higher for men with secondary infertility than for those with primary infertility. Currently, infertility has become a common condition. The normal sperm count has been lowered from over 60 million per milliliter to over 20 million per milliliter. The causes of male infertility are very complex, mainly including the following aspects: (1) Infection of reproductive organs: After the male reproductive organs are infected with pathogens, the presence of inflammation will affect the normal secretion of the gonads and the decline of spermatogenesis, and will cause changes in sperm morphology, motility and survival time, thus losing the ability to fertilize, resulting in infertility. The vast majority of patients have no other symptoms except infertility, and only a very small number of patients will have symptoms such as acute orchitis, epididymitis, prostatitis, urethritis and abnormalities in the structure of reproductive organs. In severe cases, it can cause stenosis or even obstruction of the vas deferens and epididymis, so that sperm cannot pass through smoothly and enter the female body to combine with the egg. (2) Varicocele: refers to the dilation of the pampiniform plexus of veins in the spermatic cord, which will obstruct the blood return of the testes, increase the temperature, and cause metabolic disorders. In addition, the harmful substances cannot be excreted in time, which will cause testicular spermatogenesis disorders, resulting in oligospermia, sperm malformation and decreased motility, leading to infertility. (3) Immune dysfunction: that is, the male produces antisperm autoimmunity. Human semen contains a variety of antigens. If a person suffers from urethritis, prostatitis, epididymitis, orchitis, the blood-testis barrier is damaged, which will cause an immune response and produce antisperm antibodies. Antisperm antibodies can inactivate sperm, causing oligospermia and azoospermia, and prevent sperm and egg from combining. (4) Endocrine dysfunction: abnormalities in hypothalamus, pituitary function, and hypothyroidism can all cause abnormal secretion of gonadotropins, affecting testicular function and leading to infertility. (5) Sexual dysfunction: including erectile dysfunction, premature ejaculation, decreased libido, and ejaculatory dysfunction, are important causes of infertility. Erectile dysfunction refers to the inability to erect or maintain an erection, making it impossible to insert the penis into the vagina to complete sexual intercourse. As for non-ejaculation or retrograde ejaculation, even if intercourse occurs, there is not enough semen to enter the vagina, and the sperm and egg cannot meet and combine. (6) Abnormal development of reproductive organs: causing difficulty in penile insertion into the vagina, and semen cannot be ejaculated normally into the vagina, thus leading to infertility. Common examples include penile defects, micropenis, macropenis, and severe hypospadias. In addition, abnormal testicular development can lead to impaired sperm production, resulting in infertility. (7) Hereditary diseases: such as congenital seminiferous tubule dysplasia, mixed gonadal dysplasia, etc., can prevent spermatogenic cells from growing into mature sperm with normal morphology and motility. The causes of these congenital diseases are complex, mainly including genetic factors, environmental factors, radiation, chemical substances, endocrine disorders, rubella virus infection in early pregnancy, etc. These pathogenic factors mainly affect embryonic development in the first 3 months of pregnancy. (8) Environmental physical and chemical factors: The lack of certain vitamins and trace elements can cause malnutrition in sperm development. Smoking, alcoholism, and mental stress can also cause incomplete sperm development or weak motility. Radiation in the environment, etc., can all have adverse effects on reproductive function. (9) Long-term use of certain drugs: In recent years, the widespread use of chemical reagents, food additives, and pesticides has also been an important reason for the continuous increase in the incidence of infertility.