Primary prevention
There are many ways in which the likelihood of HIV transmission, in both the occupational and non-occupational setting, can be reduced.
In the occupational setting, basic infection-control measures such as wearing gloves, using self-sheathing needles, and access to sharps bins should be utilised.[34]
In the non-occupational setting, intravenous drug users should be encouraged not to share needles or other drug paraphernalia and to use needle exchange programmes, where such programmes are available.[35] The risk of HIV transmission sexually can be reduced through prevention strategies such as consistent condom use, treatment as prevention, and the use of HIV pre-exposure prophylaxis. The evidence shows that men who have sex with men who have used post-exposure prophylaxis (PEP) do not increase their risky behaviour following PEP.[36]
In most countries, blood is screened for HIV prior to transfusion, reducing the risk of HIV transmission from transfusion.
Secondary prevention
An ultra-rapid course of hepatitis B vaccination should be offered to people presenting for post-exposure prophylaxis depending on the type of exposure and their history of vaccination or previous infection, with the possible addition of hepatitis B immunoglobulin (HBIG) if the source is known to have hepatitis B or is high risk for hepatitis B.[3]
Vaccinations for hepatitis A and human papilloma virus may be indicated for high-risk groups, such as men who have sex with men and victims of sexual assault.[4][63]
Screening for STIs including syphilis, gonorrhoea, and chlamydia should be offered at baseline and at follow-up visits; the frequency of screening depends on local guidelines.[3][4]
The US Centers for Disease Control and Prevention guidelines recommend STI prophylaxis in all adults and adolescents with exposures from sexual assault.[64]
Emergency contraception should also be considered for women following sexual exposure who are not currently using contraception.
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