PREVENTION OF
HIV/AIDS
MS SALUBWE
Definition of key terms
HIV-Human Immunodefiency Virus - retrovirus that
causes AIDS by infecting helper T cells of the immune
system.
AIDS- Acquired Immune Defiency Syndrome- the
occurrence of specific diseases in association with an HIV
infection.
Adherence - accepting, agreeing and following correctly,
a prescribed treatment.
Antiretroviral drug resistance-Virus that is no longer
sensitive to one or more of the antiretroviral drugs being
taken.
CONTI’
Antiretroviral drugs (ARVs)-Drugs that
specifically work to suppress HIV viral replication.
Antiretroviral Therapy (ART)-Management of
the HIV disease including provision of ARVs.
HighlyActiveAntiretroviralTherapy(HAART) -
This is the use of effective combinations of three
or more ARVs usually from two or more drug
classes in order to achieve the greatest suppression
of viral load for the most sustained period of time.
CD4cell -A specialized lymphocyte that is an important
component of the immune system targeted by HIV.
HIV Prevalence - is the total number of people living
with HIV infection (including those with AIDS) at a
given time in a specified risk population (15-49 years).
HIV incidence - is rate at which new infections are seen
in a specified time period (usually a month, quarter or
year) in a defined population that is “at risk” of
contracting HIV.
Opportunistic infections (OIs) in HIV -Infections
that occur in immune suppressed individuals as a result
of HIV infection. E.g. Tuberculosis, Cryptococcal
Meningitis, Pneumonias, Oral candidiasis.
Post-Exposure Prophylaxis (PEP) - Providing short
course ARVs after exposure to the virus to prevent
infection.
Treatment failure - This is when a treatment regimen
is no longer able to sustain viral suppression and
consequently is unable to control the HIV disease.
Window period-This is time from
infection with the HIV to the time when
the antibodies are produced.
Eclipse period-This is the time period
during which no existing diagnostic test
is capable of detecting HIV. It
rangesfrom10to14days.
Viral load This is the number
(copies/ml) of HIV RNA particles in
the blood.
Viraemia-The presence of virus in
the blood stream.
Sero conversion - Turning from
HIV negative to HIV positive due to
production of antibodies.
Historical background of HIV and AIDS
HIV originallycame from a virus particular to
chimpanzees in West Africa during the 1930s.
And it originally transmitted to humans through the
transfer of blood through hunting.
Over the decades, the virus spread through Africa, and
to other parts of the world.
Acquired Immune Deficiency Syndrome (AIDS) was
first recognized as a new disease in 1981 when
increasing numbers of young homosexual men
succumbed to unusual opportunistic infections and rare
malignancies.
In 2014, UNAIDS launched the 90-90-90 targets, which
aim for 90% of people living with HIV to be diagnosed,
90% of those diagnosed to be accessing medical
treatment, and 90% of those accessing treatment to
achieve viral suppression by 2020 (CANFAR).
Note that the 90% target its now 95%
Stages of HIV infection progression
1. INFECTION/SEROCONVERSION STAGE
At this stage:
Some people have flu-like symptoms such as fever,
muscle and joint pains, swollen lymph nodes, skin rash
for 1-2 weeks. Some people do not have any symptoms
at all
Lasts several weeks to 3 months
Even during this period the infected person can transmit
the virus.
2. ASYMPTOMATIC STAGE
At this stage:
The infected person has no symptoms. the
immune system (determined by CD4+ cell
count) manages to keep HIV viral load at
relatively low levels and may last up to 8 years.
3. SYMPTOMATIC STAGE
At this stage:
The immune system (CD4+cell count) falls to
very low levels and the viral load rises.
Theinfected person begins to have symptoms, it
may last 1-3 years.
ARVs may slow progression
[Link] STAGE
At this stage:
Theimmune system (CD4+ cell count) has been
severely weakened
The viral load rises
•The infected person develops OIs and HIV-related
cancers like kaposi’s sarcoma
•It may last 1-3 years
•ARVs may slow progression of HIV
Types of HIV
HIV-1 and HIV-2.
Both types are transmitted by sexual contact,
through blood, and from mother to child, and they
appear to cause clinically indistinguishable AIDS.
However, it seems that HIV-2 is less easily
transmitted, and the period between initial
infection and illness is longer in the case of HIV-2.
Myths about HIV
People who look healthy cannot have HIV
HIV cannot be transmitted from a woman to a man
Having sex with a virgin will cure HIV
Condoms do nothing to prevent HIV transmission
Religious rituals, like holy waters, cure HIV
Impact of HIV/AIDS pandemic
2. The socioeconomic impact of HIV/AIDS in
Zambia
AIDS reduces the taxable population, in turn
reducing the resources available for public
expenditures such as education and health services
not related to AIDS resulting in increasing pressure
for the state's finances and slower growth of the
economy.
This results in a slower growth of the tax base
Most affected individuals are at the peak of their
productive and reproductive period.
And as a result there is reduced productivity due to
the illness and death.
Opportunistic infections in Zambia include
tuberculosis, bacterial meningitis, bacterial
pneumonia and oral thrush.
Healthcare systems are seriously overburdened at
all levels.
More than half of hospital beds are
occupied by HIV/AIDS patients.
3. On the health sector
This epidemic has an extraordinary burden on
already troubled health sector.
As the epidemic matures, the demand
for care for those living with HIV
rises.
In sub-Saharan, Africa, people with HIV-related
disease occupies more than half of the hospital
beds.
HIV positive patients stay in the hospital four times
longer than other patients.
Therehas been an increased shortage of healthcare
professionals due to infection and death, as well as
excessive workloads, poor pay, and the temptation
to migrate to richer countries once trained.
On the households and society
Often the poorest sectors of society are most
vulnerable to the epidemic and for whom the
consequences are most severe.
In many cases, households dissolve because of AIDS,
because parents die and children are sent to relatives
for care and upbringing.
Every income earner will be likely to acquire
one additional dependent over the next ten years
due to the AIDS epidemic.
A dramatic increase in destitute households,
those with no income earners, is also expected.
Children may be forced to abandon their education and
in some cases women may be forced to turn to
prostitution which can in turn lead to a higher risk of
HIV transmission.
On culture
Somereligious organizations have stated that prayer can cure
HIV/AIDS; this has led several people to stop taking their
medication resulting in a number of deaths.
Women in most parts of the developing world, due to the
repressive cultural practices, have no power to make
decisions and hence they are not allowed to decide on certain
protective measures’ use such as condoms if the partner does
not want regardless of the known status.
Furthermore women continue to be betrayed by
out-dated traditional norms such as widow
inheritance, widow cleansing, polygamy and gender
inequality in certain parts of societies which puts
them at risk.
The Impact on Children
As parents and family members fall ill, children take on
more responsibility to earn an income, produce food, and
provide care for family members.
It is harder for these children to access adequate
nutrition, basic health care, housing, and clothing.
Consequently more children have been orphaned by
AIDS in Africa than anywhere else.
One of the more unfortunate responses to a death in
poorer households is removing the children (especially
girls) from school, as uniforms and fees become
unaffordable.
There is an increase in numbers of child rape cases
which are being fuelled by the "virgin cure" myth
(which wrongly claims that sex with a virgin can cure
AIDS) (Kalundu).
HIV TRANSMISION
Sexually: vaginal (99% of sexual transmissions), anal or oral
sex.
Parenterally: this type of transmission is through transfusion
of infected blood or blood products, donated organs, exposure to
infected blood though injection, drug use or needle stick.
Perinatally: Mother to child transmission
(MTCT) occurs during pregnancy,
childbirth or through breastfeeding.
Prevention strategies
Abstinence, Be faithful, Condom use (ABC)
Prevention of Parent to Child transmission of HIV
(PPTCT) or Prevention of Mother to Child
transmission of HIV (PMTCT).
Counseling Testing and Care (CTC)
Pre and Post exposure prophylaxis; Early treatment of
HIV-infected people with antiretroviral drugs
protected 96% of partners from infection (Kalundu).
STAKEHOLDERS IN THE MANAGEMENT
OF HIV/AIDS
According to the World Health Organisation
(2013), the following are the stakeholders
involved in the management of HIV/AIDS:
People with HIV
Local community and traditional leaders
Health-care workers
Governments
Non-governmental organisations (NGOs)
Community-based organisations (CBOs)
Faith-based organisations (FBOs)
Medical associations
Drug regulatory authorities
The private sector, i.e. employers, unions, etc.
Donors / cooperating partners
Academic institutions
Role of stakeholders in management of HIV/AIDS
Stakeholder is a party that has an interest in an enterprise
or project.
1. Governance and coordination at national and sub-
national levels - the government through the
responsible ministries they put in place activity outline
how the programmes are going to be managed so that
all the areas are covered.
They provide guidance to other stake holders
according to identified needs of different
societies.
[Link] mobilization - Resource mobilization
means identifying possible sources and
opportunities, finding appropriate personnel and
funding, setting clear priorities, Provision of
general policy and programme direction for the
management of activities.
Theydevelop strategic plans and policies that are
prepared for the needs of persons with HIV in the
country and how these will be managed.
3. Capacity-building including training
Theyprovide training to health workers and other
community volunteers on how to provide ART,
counseling, testing and how to care for the sick.
Ensuring coherence of communications about
TB and HIV, they ensure there is an
appropriate network of communication on
issues related to HIV/ AIDS.
This is where the media may also be involved.
Ensuring the involvement of civil society,
nongovernmental and community
organizations, and individuals.
4. Building and maintaining political commitment-
Active involvement and leadership by
people in positions of authority are
vital for the implementation of
successful HIV testing and
counseling services and care,
treatment and prevention
programmes, as well as for
combating stigma and discrimination.
The term 'political' is used here in its
broadest sense, meaning the
involvement of people who have
influence and decision-making capacity
in respect of the lives of people and
communities affected by HIV.
[Link] a monitoring and evaluation
system that promotes an enabling
environment
The government provides the tools for
evaluating HIV/ AIDS programs in conjunction
with cooperating partners.
This may be achieved through the involvement
of provincial departments throughout the
country.
They monitor the programs and
initiatives within their catchment areas
(Kalundu).
