Hiv and Aids Awareness and Management Book

HIV AND AIDS AWARENESS AND MANAGEMENT BOOK https://elearning.tum.ac.ke/mod/book/tool/print/index.php?
id=30155
HIV AND AIDS AWARENESS AND MANAGEMENT BOOK
Site: TUM E-Learning Portal Printed by: Agnes Kibira

Course: HIV AND AIDS AWARENESS AND MANAGEMENT Date: Thursday, 1 December 2022, 10:29 AM
Book: HIV AND AIDS AWARENESS AND MANAGEMENT BOOK
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HIV AND AIDS AWARENESS AND MANAGEMENT BOOK https://elearning.tum.ac.ke/mod/book/tool/print/index.php?id=30155
Table of contents
1. Introduction to the course

1.1. Getting to know each other
1.2. Course outline
1.3. Learning outcomes for the course Unit
1.4. Introduction
1.5. Learning Outcomes for session 1
1.6. Concepts of HIV/AIDS
1.7. Types of HIV Virus
1.8. Overview of STIs/STDs
1.9. Gonorrhoea
1.10. Syphilis
1.11. Candidiasis (thrush)
1.12. Trichomoniasis
1.13. Chlamydia
1.14. Genital warts
1.15. Relationship between HIV/AIDS and STISs/ STDs
1.16. Role of public health and hygiene in HIV/AIDS issues
1.17. Summary
1.18. Session 1 Quiz
1.19. References and Further Readings
2. ORIGIN, CLASSIFICATION AND BIOLOGY OF HIV

2.1. Introduction
2.2. Origin and history of HIV
2.3. 2.3.1 Origin of HIV-1
2.4. 2.3.2 Origin of SIVcpz
2.5. 2.3.3 Theories on the origin of HIV/AIDS
2.6. Structure of HIV
2.7. 2.4 HIV Life Cycle
2.8. Disease progression
2.9. Stage 1: Initial infection
2.10. Summary
2.13. Window period (incubation period)
2.14. Sero conversion
2.15. Asymptomatic (HIV infection)
2.16. HIV related illness (AIDS)
2.17. Summary
3. HUMAN REPRODUCTIVE SYSTEM, IMMUNE SYSTEM

3.1. Lecture Outline
3.2. Introduction
3.3. Learning Outcomes
3.4. Structure and function of Human Reproductive system
3.5. How reproductive systems work
3.6. Why does the immune system fail to fight the HIV virus
3.7. Overview of immune system
3.8. Common Opportunistic infections
3.9. Summary
4. FACTORS CONTRIBUTING TO HIGH INCIDENCES OF HIV/AIDS

4.1. Introduction
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4.3. Socio-cultural and economic factors

4.4. Socio-cultural factors
4.5. Socio-economic factors
4.6. Political factors
4.7. Myths
4.8. Factors influencing gender disparity in HIV/AIDS infection
4.9. Gender inequality threatens prevention and treatment of HIV
4.10. Religion has a role to play
4.11. Intimate partner violence and HIV
4.12. Cultural and social norms
4.13. Educational factors
4.14. Legal factors
4.15. Poverty and gender inequality
4.16. Biological Factors
4.17. Summary
5. TRANSMISSION AND DIAGNOSIS OF HIV/AIDS

5.2. Introduction
5.3. Modes of HIV transmission
5.4. Sexual transmission
5.5. Mother to Child Transmission (MTCT)
5.6. Blood-to-blood transmission
5.7. Sharing needles/syringes and sticks
5.8. Rare forms of HIV transmission
5.9. HIV/AIDS diagnostic techniques
5.10. Summary
6. PREVENTION AND CONTROL OF HIV/AIDS

6.1. Introduction
6.3. ABCDEF Approach
6.4. Condoms
6.5. Obstacles to condom Use
6.6. Antiretroviral Therapy
6.7. Counselling
6.8. Types of testing
6.9. Purpose of VCT
6.10. Role of VCT
6.11. Pre-testing counselling
6.12. Post-test counselling
6.13. How to live positively
6.14. The importance of going to a VCT
6.15. Role of Nutrition in HIV/AIDS management
6.16. Advantages of Good Nutrients
6.17. Home Based HIV/AIDS care
6.18. Objectives of Home-Based Care
6.19. Principles of Home-Based Care
6.20. HIV prevention medicine
6.21. Summary
7. THE ROLE OF DRUGS IN THE SPREAD OF HIV/AIDS

7.1. Introduction
7.3. Definition of terms
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7.4. Classification of drugs

7.5. Mode of drug administration and action
7.6. Factors governing choice of route
7.7. Role of drugs abuse in the spread of HIV/AIDS
7.8. The impact of drug abuse may include;
7.9. Relationship between drug use and HIV/AIDS may include;
7.10. Summary
8. Learning Outcomes
8.2. Factors leading to high incidences of premarital activity
8.8. Summary
8.9. Session 8 Quiz
8.10. 7.9 References and Further Readings
9. YOUTH SEXUALITY AND HIV/AIDS

9.2. Definition of key terms
9.3. HIV/AIDS and Youth
9.4. Challenges youth face on sexuality and HIV
9.5. Summary
9.6. Session 9 Quiz
10. GOVERNMENT POLICIES AND RESPONSES TO HIV/AIDS PANDEMIC

10.2. Global policies on HIV/AIDS
10.3. The Guidelines
10.4. Human rights principle relevant to HIV/AIDs
10.5. International responses to the HIV/AIDS pandemic
10.6. Kenya’s response to the pandemic
10.7. Objectives of HIV/AIDs Prevention and Control ACT
10.8. Summary
11. PREGNANCY AND HIV/AIDS

11.1. Learning Outcome
11.2. Effects of HIV/AIDS in pregnancy
11.3. Factors affecting mother-to-child transmission of HIV
11.4. Interventions to prevent mother-to-child transmission of HIV
11.5. Summary
12. DISCRIMINATIONS & STIGMATIZATION ON HIV/AIDS, AND LEGAL RIGHTS OF AIDS PATIENTS
12.3. Discriminations & stigmatization on HIV/AIDS
12.4. Factors contributing to HIV/AIDS related stigma
12.5. Legal rights of HIV/AIDS patients
12.6. Summary
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1. Introduction to the course
A huge welcome to HIV/AIDS Awareness and Management course! I'm excited to have you in the class and look forward to meeting most of your
expectations.
First, let’s take a moment to explore the unit.
HIV/AIDS Awareness and Management is taught as an undergraduate unit. It provides knowledge and awareness on HIV/AIDS. Inadequate
knowledge and risky practices are major hindrances in preventing the spread of HIV.
The main objective of the course is to enhance your knowledge and awareness about HIV as one of the key strategies utilized in the prevention
and control of HIV/AIDS worldwide.
The course content is divided into Lecture sessions and include interactive sessions such as forums and chats that allows you to interact with
fellow learners in the class as well as interactions with the unit lecturer.
In case you have questions about course content, feel free to post them in the forums for discussion or contact the lecturer. Good luck as you get
started, and I hope you enjoy the course!
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1.1. Getting to know each other
As you study on this course, one of the most valuable resources available to you are the experiences and insights offered by your fellow learners.
Your task: Introduce yourself
Estimated study time: 10 minutes
1. Open the 'Getting to know each other' forum below the Lecture Material Book.
2. Click the Reply link at the bottom-right section.
3. Using the forum link below, share a message introducing yourself to your fellow learners and explaining why you’re studying this course.
4. Look through the discussions from other learners introducing themselves and reply to anyone who has similar interests to you.
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1.2. Course outline
This unit is basically on the awareness, prevention and management of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency
Syndrome (AIDS). HIV infection is a global public health concern and it is most prevalent in less developed countries in the world. The increasing
access to effective HIV prevention, diagnosis, treatment and care, has made HIV infection to be manageable chronic health condition, enabling
people living with HIV to lead long and healthy lives. The unit intends to enlighten the learners and impart knowledge on various aspects of
HIV/AIDS in accordance with the recommendations by the Association of African Universities.
Lecture One focuses on the general overview of HIV/AIDS, STIs/STDs and public health hygiene by given their meaning and relationship.
In Lecture Two, an in depth review of the origin and evolution of HIV, biology of HIV and the progression of the HIV virus to AIDS.
Lecture Three covers the structure and function of both human reproductive system and human immune system. It is also important to note that
the lecture looks at the common opportunistic infections.
Factors contributing to the high incidences of HIV/AIDS are well covered in Lecture Four. The lecture has highlighted varied factors such as
socio-economic, socio-cultural, political factors and myths that plays a major role in the spread of HIV/AIDS.
Lecture Five covers modes of HIV transmission and the various HIV/AIDS diagnostic techniques.
In Lecture Six, prevention and control strategies for HIV/AIDS is in-depthly covered. It is worth noting that some of the prevention and control
strategies includes counselling, nutritional approach, home based care among others.
Lecture Seven covers the role of drugs in the spread of HIV/AIDS. This session basically highlights the various classes of drugs, their mode of
administration and their contributions to the spread of HIV/AIDS.
In Lecture Eight, youth and sexuality is profoundly looked at in relation to their implications on the spread of HIV/AIDS.
Lecture Nine looked at the government policies and response to HIV/AIDS. The session highlights the various policies and responses adopted
by the Kenyan government and global community.
Lecture Ten comprehensively covers HIV/AIDS during pregnancy. The session describes the effects of HIV/AIDs in pregnancy, factors affecting
mother-to-child transmission and interventions laid down to prevent this transmission.
In our Lecture Eleven, stigma and discrimination on HIV/AIDS is well captured. The session has also provided a comprehensive legal/human
rights of HIV/AIDS patients.
In our last lecture, Lecture Twelve, impacts of HIV/AIDS in the various sectors have been profoundly covered.
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1.3. Learning outcomes for the course Unit
HIV/AIDS is one of the world’s most serious health and development challenges. A vast majority of people worldwide are currently living with the
infection, and millions of people have died of the disease since the beginning of the pandemic. Major global efforts have been mounted to
address the pandemic, and despite challenges, significant progress has been made in addressing it.
By the end of this course, you should be able to: -
i) Explain the ways of acquisition and spread of HIV and AIDS
ii) Disseminate correct and accurate information on HIV and AIDS
iii) Assess the impact of HIV and AIDS in Kenya
MODE OF STUDY
This course will adopt a blended learning format which essentially consists of online learning modules where a portion of the lecture and reading
material will be presented through videos (and or web conferences), text, and other interactive programming formats.
COURSE ASSESSMENT
Continuous Assessments 30%
Examination 70%
Total 100%
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1.4. Introduction
Welcome to the first lecture session in HIV/AIDS awareness and management. In this session, we shall cover the concepts of HIV/AIDS,
STIs/STDs, have an overviews of STIs/STDs. Additionally, the session will cover the relationship between HIV/AIDS and STIs and expound on
the role of public health and hygiene.
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1.5. Learning Outcomes for session 1
At the end of this course unit, you should be able to:
1. Explain the concept of HIV/AIDS

2. Identify the various STIs/STDs
3. Explain the relationship between HIV/AIDS and STIs
4. Understand the role of public health and hygiene in HIV/AIDS issues.
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1.6. Concepts of HIV/AIDS
Let us start our discussion by asking ourselves this question.
Question
What is the meaning of the initials HIV/AIDs?
HIV stands for Human-Immunodeficiency Virus, the virus that causes AIDS. AIDS stands for Acquired Immunodeficiency Syndrome.
The AIDS virus enters the body through the mucus membrane or through broken skin. Once inside the body, the virus attacks the body defence
cells which are mainly the white blood cells and eventually killing them. White blood cells are a collection of different kinds of cells that work
together to gourd the body against microorganisms.
The virus targets particularly the white blood cells, the T-cells of the body’s immune system. T-cells are clustered into different categories using
protein receptors on their surface. HIV attacks differential 4 (CD4) clusters of T-cells. Once this happens HIV starts to reproduce other viruses
eventually, destroying other CD4 cells. Normal range of CD4 cells in an adult is about 400-1800 per millilitre of blood volume. If the number falls
below 200, the person is said to have developed Immuno-deficiency syndrome (AIDS)
Take Note
AIDS is specifically acquired and not inherited.
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1.7. Types of HIV Virus
Many people see HIV and AIDS as being the same thing, this is not true; HIV and AIDS are not the same thing and people who get HIV infection
do not automatically develop AIDS.
There are two types of HIV virus:
i. HIV-1 and HIV-2 are types of HIV. HIV-1 and HIV-2 have the same modes of transmission and are associated with similar
opportunistic infections when a patient’s immune system is compromised.
ii. HIV-2 is less easily transmitted than is HIV-1, and it is less pathogenic, meaning that the period between initial infection and illness is
longer. In some areas, a person may be infected with both HIV-1 and HIV-2.
iii. Mother to child transmission (MTCT) is common in the case of HIV-1 but relatively rare with HIV-2.
iv. HIV-1 is more common worldwide. HIV-2 is found predominantly in West Africa, Angola, and Mozambique.
v. There is large genetic difference between HIV-1 and HIV-2 meaning that test keyed to one will not reliably detect the other.
HIV is in a family of viruses called retrovirus. Specific test methods are used to detect and measure certain parts of the virus. For example, a test
to detect the core of the virus called p24 is used to detect early or pediatric infections.
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1.8. Overview of STIs/STDs
Now you have looked at the meaning and types of HIV/AIDs. You can now have an overview of common STIs/STDs.
The initials STIs/STDs stands for: STIS stands for Sexually Transmitted Infections / STDS stands for Sexually Transmitted Diseases.
WHO defines STIS as communicable diseases mainly transmitted through sexual intercourse with an infected person. STIs are also sometimes
called sexually transmitted diseases (STDs). While "STD" is often used interchangeably with "STI," they are not exactly the same. A "disease" is
usually an obvious medical problem with clear signs and symptoms. "Infection" with an STI may or may not result in disease. This is why many
individuals and organizations working in health are moving toward using the term "sexually transmitted infection" rather than "sexually
transmitted disease." Most people with STIs do not have any symptoms and therefore often do not know that they can pass the infection on to
their sexual partner(s). In addition to AIDS, there are other types of STIs/STDs as described below.
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1.9. Gonorrhoea
Gonorrhoea is a sexually transmitted bacterial infection in adults, and in children infection is accidental. In women symptoms are mild compared
to men. Many women have no symptoms. Symptoms may include a yellowish or greenish vaginal discharge and a burning feeling when urinating.
Infection occurs in the cervix, urethra, rectum, anus and throat. In females there is urethritis, endocervicitis and salpingitis which may be
symptomless and later vaginal discharge. Chief manifestations of the infection in males are purulent urethritis with dysuria (painful urination).
Men are far more likely to notice symptoms than women. Tetracycline and penicillin are among the drugs for treatment. If left untreated,
gonorrhoea can cause Pelvic Inflammatory Disease (PID) and infertility. All sexually active women should be screened for gonorrhea.
Take Note
It is possible to be infected with gonorrhoea and have no symptoms.
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1.10. Syphilis
It is a bacterial infection whose causative agent is Treponema Pallidum. It is usually sexually transmitted, but may also be passed from an
infected mother to her unborn child. The signs and symptoms of syphilis are the same in both men and women. Signs and Symptoms can be
difficult to recognize and may take up to 3 months to show after sexual contact with an infected person.
Syphilis has three stages. The primary and secondary stages are infectious. The primary stage appears 4-5 weeks after infection when a primary
chancre (a corruption of cancer) associated with swelling of lymph glands, pyrexia (fever) and malaise appears (Govan et al, 1985). The chancre
is the point at which the bacterium enters the body. The chancre starts as a reddish papule measuring about 1 cm in diameter which then
becomes ulcerated. It is painless and highly infective. The secondary stage is when the skin eruption (syphilidae) appears as ulcerations on
mucosal surfaces like the vulva in women and the skin develops a wide variety of popular rashes. The third stage occurs 15-30 years after the
initial infections when there may be nervous system involvement with general paralysis, (defective muscular control) resulting in irregular and
jerky movements. Cardiovascular involvement may result in aortic aneurysm and impairment or and destruction of the aortic valve.
Syphilis may be treated with antibiotics like penicillin and tetracyclines. Pregnant women can pass syphilis to their babies during pregnancy and
childbirth, so it is important that pregnant women get tested for syphilis.
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1.11. Candidiasis (thrush)
The causative agent is yeast, Candida albicans which is a commensal of the alimentary canal and the vaginal. Males are infected by females
during sexual intercourse and also from the patient’s own commensal especially the rectum and finger nails. The yeast generally lives on the skin
and is normally kept in check by harmless bacteria. Under favorable conditions, that is, warm moist environment, the yeast multiplies and can
cause itching, swelling, soreness, and discharge in both men and women. Women may experience a thick white discharge and pain when
passing urine. Men may experience the same discharge in the penis and difficult pulling back the foreskin. Thrush can be passed on when having
sex with someone who is infected, but also if one wears too tight nylon or lycra clothes or if one is taking certain antibiotics.
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1.12. Trichomoniasis
Trichomoniasis is also known as “Trich” and is caused by a parasite (Trichomoniasis vaginalis) a protozoan organism which is found in vagina in
females and the urethra, prepuce and prostate in males. Often there are no symptoms. When present, symptoms include local irritation or a
burning and itchy sensation in the vulva, urethritis, cervicitis and a foul smelling vaginal discharge. In males there may be itching and discomfort
in the urethra during urination, urethritis and epididymitis. There may also be some discharge as well. Transmission normally occurs through oral,
anal or vaginal sex with an infected person. Antibiotics are used for treatment.
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1.13. Chlamydia
Affect cervix and urethra. It is one of the most common treatable bacterial STIs. Infection includes trachoma, conjunctivitis, non-gonococcal
urethritis and cervicitis. It is caused by a bacterium that exists in vaginal secretions and semen. Chlamydia trachoma is the most common found
in cervix and urethra in women. The urethra, rectum and eyes can be infected in both sexes and can cause serious problems later in in life if it is
not treated. If left untreated, it can spread to a woman's upper, internal reproductive organs (ovaries and fallopian tubes) and cause pelvic
inflammatory disease (PID). PID can lead to infertility, meaning that it may be difficult or impossible to become pregnant.
1.4.6 Chancroid (soft sores)
Chancroid is a genital ulcer caused by an infection due to Haemophilus ducreyi. The incubation period is a week, and the ulcers are normally
multiple. Symptoms may include genital sores, vaginal discharge, a burning feeling when urinating, and swollen lymph nodes in the groin. It can
be spread by vaginal or anal sex or skin-to-skin contact with sores. They are painful ulcers which respond to treatment with sulphonamides.
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1.14. Genital warts
Genital warts are small fleshy growth which may appear anywhere on a man or woman’s genial area. They are caused by a virus called the
Human Papilloma Virus (HPV). Warts can grow on the genitals, or on different parts of the body, such as the hands. After one has been infected
with the genital wart virus, it usually takes between 1 and 3 months for warts to appear on one’s genitals, they appear as pinkish/white small
lumps or large cauliflower-shaped lumps on the genital area. Warts can appear around the vulva, the penis, the scrotum or the anus. They may
occur singly or in groups. They may itch, but are usually painless. Often there no other symptoms and the warts may be difficult to see. If a
woman has warts on her cervix, this may cause light bleeding or, very rarely, an unusual coloured vaginal discharge.
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1.15. Relationship between HIV/AIDS and STISs/ STDs
It is generally accepted that having a STIs/STDs increases in a person's risk of getting HIV, both for biological and behavioural reasons.
STIs/STDs (such as syphilis) enhance HIV transmission by causing open sores and skin injuries in sex organs through which the HIV enters. A
lot of T-lymphocytes are mobilized to fight the STD infections and since these are the targets of HIV, a lot of them are destroyed and the person
or individual goes down faster with the HIV. The mode of transmission for the STDs is also the same as the mode of transmission of HIV. People
infected with an STIs/STDs also have increased concentrations of HIV in their seminal and vaginal fluids, increasing the possibility of HIV
transmission.
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1.16. Role of public health and hygiene in HIV/AIDS issues
Public health is the science and art of preventing diseases, prolong life and promoting health through the organized and informed choices of
society /organizations /public and private, communities and individuals.
Public health can also be defined as the protection and the improvement of health of the entire populations through community-wide action,
primarily by governmental agencies. Public health work deals with the assessment of health status of the community. The goals of public health
are comparable to those of HIV/AIDS education and they include:
i. To prevent human disease, injury, and disability.
ii. Protect people from environmental hazards.
iii. Promote behaviors that lead to good physical and mental health.
iv. Educate the public about health; and assure availability of high-quality health services.
Therefore, public health programs and HIV/AIDS education complement one another. Most people think of public health workers as physicians
and nurses, but a wide variety of other professionals work in the public health sector including, veterinarians, sanitary engineers, microbiologists,
laboratory technicians, statisticians, economists, administrators, attorneys, industrial safety and hygiene specialists, psychologists, sociologists
and educators.
Public health workers may engage in activities such as inspecting and licensing restaurants; conducting rodent and insect control programs and
checking the safety of housing, water, and food supplies. In assuring, overall community health, public health officials also act as advocates for
laws and regulations such as, drug licensing, or product labelling requirements. Some public health officials are epidemiologists, who use
sophisticated computer and mathematical models to track the incidence of communicable diseases including HIV/AIDS and to identify new
diseases and health trends. Others conduct state-of-the-art medical research to find new prevention and treatment methods.
Hygiene is defined as the science of dealing with the preservation of health or the practice or principles of cleanliness. In the public domain,
public health officers mainly manage this practice.
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1.17. Summary
This session provided an overview of HIV, AIDS, STIs/STDs, by giving their meaning, and their relationships. The session also covered the in-
depth review of public health and hygiene in relation to HIV/AIDS.
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This end of session quiz will enable you to check your understanding of what you have learned in Session 1. You must obtain a score of at least
50% to be allowed to proceed to the next session.
• Aim to answer all the questions.
• If you are not successful in getting 50% or more questions correct the first time, you can attempt the whole quiz again. There is no limit to the
number of attempts at the whole quiz.
When you have finished the quiz, click on ‘Finish attempt and submit..’ to review your ‘Summary of attempt’.
Grading method: Highest grade
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1. Avert (2019). The science of HIV and AIDS-Overview. https://www.avert.org/professionals/hiv-science/overview

2. onathan Engel. (2015). The Epidemic: A Global History of AIDS. ISBN: 10: 0061144886
3. International Journal of STD & AIDS. ISSN 1758-1052
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2. ORIGIN, CLASSIFICATION AND BIOLOGY OF HIV
2.1 Introduction
2.2 Learning outcomes
2.3 Origin and history of HIV
2.4 Structure of HIV
2.5 HIV life cycle
2.6 Disease progression
2.7 Summary
2.8 Review Activity
References and Further Reading
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2.1. Introduction
Hello!! Welcome to the second lecture session in HIV/AIDS awareness, prevention and management. The session shall cover the origin and
history of HIV, structure of HIV, HIV life cycle and lastly the disease progression.
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2.2. Origin and history of HIV
Let's begin with a question that has varied answers.
In your opinion, where did HIV come from.
I am certain that each one of you have their own opinion on where HIV might have originated from. Let us now review some of the concepts that
have been fronted to explain the origin of HIV.
When the first cases of AIDS were reported in the early 1980s, the cause of the disease was mystery. The discovery of HIV in 1983 led to
considerable speculation about the origin of the virus. Many ideas were suggested, some of them fanciful, including curse from Tutenkhamen’s
tomb and the deliberate creation of the virus by genetic modification.
Recent genetic research shows that the truth is less dramatic. Most estimates suggest that HIV evolved from SIV in the 1930s, although a 2008
study placed the origin of HIV between 1884 and 1924. It is widely believed that HIV originated in Kinshasa, in the Democratic Republic of Congo
around 1920 when HIV crossed species from chimpanzees to humans. Up until the 1980s, we do not know how many people developed HIV or
AIDS. HIV was unknown and transmission was not accompanied by noticeable signs or symptoms.
The earliest known case of AIDS occurred in 1959 in the Belgian Congo (today, the ‘Democratic Republic of Congo’). Several cases have been
confirmed from the 1960s and ’70s. Several factors, including a population boom, new transportation networks (HIV grew along with train routes),
changing practices of sex workers, decolonization, and growth of using injectable medicine (and reuse of the needles) all contributed to the
spread into the larger population (spread from Africa to the USA, Europe and rest of the world) during the 1960s. By 1980, HIV may have already
spread to five continents (North America, South America, Europe, Africa and Australia). In this period, between 100,000 and 300,000 people
could have already been infected.
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2.3. 2.3.1 Origin of HIV-1
1. The origin of HIV-1 has proved more elusive. In 1999, an international group of researchers announced that they had found a SIVcpz that
was almost identical to HIV-1. The SIVcpz came from a frozen sample taken from a captive chimpanzee (subspecies Pan troglodytes
troglodytes).
Later, it became possible to extract SIVcpz from faecal samples collected from wild chimpanzees, and this confirmed that they were indeed a
reservoir of SIVcpz. Later that year, members of these same team suggested that one form of HIV-1 (Group O) might be derived from gorilla SIV
(SIVgor).
There are three strains/groups of the virus (Figure 1) that have been defined: M, N and O. More than 90% of HIV infections worldwide are of the
HIV-1 M group (M stands for ‘main’); Group O is restricted to west-central Africa and Group N is very rare and is found only in Cameroon. Each of
these groups represents a separate transfer of SIV from apes into the human population. (Similarly, there are several groups of HIV-2 which are
thought to have been derived from separate ‘jumps’ of SIVs into humans.)
A new subgroup of HIV-1, P, has recently been proposed, and it is thought that this strain was derived from a gorilla SIV.
Figure 1: HIV “family tree”
HIV-1 group M, which is the most prevalent HIV strain, jumped from chimpanzees into humans. New viruses are still being transferred from
primates to humans, and have the potential to cause new diseases and epidemics.
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2.4. 2.3.2 Origin of SIVcpz
A few years after they had proposed that SIVcpz was the source of HIV-1, some of these researchers suggested that SIVcpz was a hybrid of two
monkey SIVs. Their suggestion was based on an analysis of the sequences of the viruses. They proposed that a chimp had become infected
simultaneously with two monkey SIVs which had recombined within the host to form a new virus. Since chimpanzees are known to hunt and kill
monkeys for food, transmission of the viruses to chimps could have occurred in a similar manner to that in which SIVs are thought to have
transferred to humans.
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2.5. 2.3.3 Theories on the origin of HIV/AIDS
Several theories have been proposed over the years to explain the origin and spread of HIV. Some of the theories that try to explain the origin of
HIV/AIDS are discussed as follows;
i. The Heavenly Theory: Many religious groups believe that HIV came from an angry God who was unhappy with gays, intravenous
drug users (IVDUs) and promiscuity. There are others who believed that HIV came as a Cosmic debris as part of the tail of a comet.
ii. Conspiracy theory: Many believe that HIV was developed by the US army as a weapon of germ warfare, whereas right wing American
groups blamed the Soviets for the AIDS epidemic.
iii. The contaminated Oral Polio Vaccine (OPV) theory: Contaminated OPV theory is the most controversial and also the most thought
provoking theory. In this it is said that the virus was transmitted via various medical experiments especially through the polio vaccines. The oral
polio vaccine called Chat was given to millions of people in the Belgian Congo, Ruanda and Burundi in the late 1950s. Then it was cultivated on
kidney cells taken from the chimps infected with SIV in order to reproduce the vaccine. This is the main source of contamination, which later
affected large number of people with HIV. But it was rejected as it was proved that only macaque monkey kidney cells, which cannot be infected
with SIV or HIV, were used to make Chat. Another reason is that HIV existed in humans before the vaccine trials were carried out.
iv. The cut hunter theory: The process of viral transfer from animals to humans is known as zoonosis. It is now generally accepted that HIV
is a descendant of the SIV because certain strains of SIVs have a homology to HIV-1 and -2. The virulent HIV-1 has its closest counterpart in SIV
of the chimpanzees (SIV-cpz) and the more benign HIV-2 in the SIV of the sooty mangabeys (SIV-sm). The basis of this theory is that SIV-cpz
and SIV-sm were transferred to humans as a result of these primates being killed and eaten, a practice known as "bushmeat hunting".
v. The contaminated needle theory: The lead role in this theory was played by Preston Marx, a virologist in primate research, who had
worked extensively on SIV. During a number of trips in the northern and eastern parts of Sierra Leone, Marx collected blood samples from sooty
mangabeys and also from the villagers who hunted the primates.
In his laboratory in the United States, he found that the mangabey blood samples tested positive for SIV and that the blood samples from a few of
the villagers contained both HIV and SIV genes. He was convinced that retroviral zoonosis must have been going on for centuries but he was not
sure of what "kick started" the epidemic of HIV and the timing of the epidemic in the mid-70s. Marx was captivated by this theory and felt that
retroviral zoonosis and the re-use of unsterile needles, as practiced in Africa in the mid-50s could have spread HIV from person to person and
ignited the epidemic. Hence, he proposed the theory of serial passage.
vi. The theory of serial passage: The process of serial passage commences when a person exposed to SIV, through retroviral zoonosis,
receives an injection. When the same needle is used to inject another individual, the SIV gets transferred and infects the second person. This
person then receives another injection with a new needle which is re-used on a third patient. This procedure gets repeated and with each
passage the SIV adapts and grows stronger to the human immune system.
vii. The colonialism theory: The colonial rule in Africa was particularly harsh and the locals were forced into labor camps where sanitation
was poor and food was scare. SIV could easily have infiltrated the labor force and taken advantage of their weakened immune systems. Laborers
were being inoculated with unsterile needles against diseases such as smallpox to keep them alive and working. Also many of the camps actively
employed prostitutes to keep the workers happy. All these factors may have led to the transmission and development of AIDS as a disease.
To know more on the history of HIV/AIDS, follow this link;

https://www.avert.org/professionals/history-hiv-aids/overview
Take Note
From all the theories, an obvious general conclusion is that for some puzzling reason, the origin of HIV was not natural. Something spurred the
conversion of the benign SIV into the virulent HIV, although humans have been exposed to SIV for thousands of years.
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2.6. Structure of HIV
You have already looked at the origin and history of HIV. You can now consider the structure of HIV.
In order to understand how HIV affects the body, it would be vital to first imagine what HIV looks like. Figure 2, shows the structure of HIV.
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2.7. 2.4 HIV Life Cycle
Having looked at the structure of HIV, You now need to describe HIV life cycle.
Let's begin with a question.
Question
What do you understand by the term life cycle?
Good attempt!! I am certain that you have responded that a life cycle is a series of stages a living thing goes through during its life. In our case
HIV life cycle refers to a series of steps that HIV follows to multiply in the body.
The seven stages/steps of the HIV life cycle are: 1) binding, 2) fusion, 3) reverse transcription, 4) integration, 5) replication, 6) assembly, and 7)
budding. Using Figure 3, now follow each stage in the HIV life cycle, as HIV attacks a CD4 cell and uses the machinery of the cell to multiply.
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2.8. Disease progression
Now you have looked at the deferent stages/steps of HIV life cycle. Let us now look at disease progression or clinical stages of HIV development
Once a person is infected with HIV, he/she should understand the progression of the disease from initial infection, through the latency period,
symptomatic infections, and finally AIDS. The course of untreated HIV is not known but may go on for 10 years or longer in many people.
Several years into HIV infection, mild symptoms begin to develop, then later severe infections that define AIDS occur. Treatment appears to
greatly extend the life and improve the quality of life of most patients, although estimating survival after an AIDS diagnosis is inexact.
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2.9. Stage 1: Initial infection
Stage 1: Initial infection
Primary HIV infection can cause an acute retroviral syndrome that often is mistaken for influenza (the flu), mononucleosis, or a bad cold. This
syndrome is reported by roughly half of those who contract HIV and generally occurs between 2 and 6 weeks after infection.
Symptoms may include fever, headache, sore throat, fatigue, body aches, weight loss, and swollen lymph nodes. Other symptoms are a rash,
mouth or genital ulcers, diarrhea, nausea and vomiting, and thrush.
The CD4+ T cell count can drop very low during the early weeks, although it usually returns to a normal level after the initial illness is over. The
initial illness can last several days or even weeks.
The greatest spread of HIV occurs throughout the body early in the disease. Approximately 6 months after infection, the level of virions produced
every day may reach a “set point.” A higher set point usually means a more rapid progression of HIV disease.
Early treatment may be recommended to reduce the set point, potentially leading to a better chance of controlling the infection.
Stage 2: Window period (incubation period)
This stage usually stays for three months. In the window period the body has resisted the HIV infection even after a high exposure to HIV virus.
They normally have a genetic resistance (cytolytic) where lymphocyte cells destroy microorganisms on contact.
HIV cannot be detected in the blood screening. Hence blood cannot be free from HIV. If this blood is injected to a healthy person, he/she will turn
positive after three months. During this time a person can transmit the virus to another person.
Stage 3: Sero conversion
This is the development of antibodies. In this stage, a person may have flue like illness, some will not experience illness at this stage.
Take Note
Cytolytic T lymphocyte cells or CD8+ T-cell or killer T cell) prevent some people from acquiring HIV infection. The victim may sero
convert or remain sero negative. This is where we have discordant couples: one is positive while the other is negative.
Stage 4: Asymptomatic (HIV infection)
Asymptomatic means a person is infected with HIV but does not have signs of being sick. A person can remain without symptoms from 6 months
to about ten years. The amount of HIV in the blood initially begins to drop but then continues to replicate. There isn’t enough HIV in the blood yet
to cause opportunistic illness.
Stage 5: HIV related illness (AIDS)
In this stage, there are signs and symptoms. The body immune system is damaged. Symptoms can be life threatening due to human immune
system being weakened. Concerned may develop, Tuberculosis, pneumonia, swollen glands etc. A person can die any moment at this stage.
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2.10. Summary
This session has provided in depth review on the origin of HIV where it’s noted that the origin of HIV of HIV is a mystery. The session also
illustrated the structure of HIV and how it gains access to the body. Finally, the progression of the HIV virus to AIDS has also been
comprehensively covered. There are two types of HIV namely: HIV-1 & HIV-2. More than 90% of HIV infections worldwide are of the HIV-1. Some
of the theories of origin of HIV include Hunter’s theory, The Oral Polio Vaccine Theory and contaminated needle theory.
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Session 1 Quiz
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2. Sharp PM, Hahn BH (2011). "Origins of HIV and the AIDS Pandemic". Cold Spring Harbor Perspectives in Medicine. 1 (1): a006841.
doi:10.1101/cshperspect.a006841. PMC 3234451. PMID 22229120.
3. Faria NR, Rambaut A, Suchard MA, Baele G, Bedford T, Ward MJ, Tatem AJ, Sousa JD, Arinaminpathy N, Pépin J, Posada D, Peeters M,
Pybus OG, Lemey P (2014). "The early spread and epidemic ignition of HIV-1 in human populations". Science. 346 (6205): 56–61.
Bibcode:2014Sci...346...56F. doi:10.1126/science.1256739. PMC 4254776. PMID 25278604.
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2.13. Window period (incubation period)
This stage usually stays for three months. In the window period the body has resisted the HIV infection even after a high exposure to HIV virus.
They normally have a genetic resistance (cytolytic) where lymphocyte cells destroy microorganisms on contact.
HIV cannot be detected in the blood screening. Hence blood cannot be free from HIV. If this blood is injected to a healthy person, he/she will turn
positive after three months. During this time a person can transmit the virus to another person.
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2.14. Sero conversion
This is the development of antibodies. In this stage, a person may have flue like illness, some will not experience illness at this stage.
Take Note
Cytolytic T lymphocyte cells or CD8+ T-cell or killer T cell) prevent some people from acquiring HIV infection. The victim may sero convert or
remain sero negative. This is where we have discordant couples: one is positive while the other is negative.
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2.15. Asymptomatic (HIV infection)
Asymptomatic means a person is infected with HIV but does not have signs of being sick. A person can remain without symptoms from 6 months
to about ten years. The amount of HIV in the blood initially begins to drop but then continues to replicate. There isn’t enough HIV in the blood yet
to cause opportunistic illness.
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2.16. HIV related illness (AIDS)
In this stage, there are signs and symptoms. The body immune system is damaged. Symptoms can be life threatening due to human immune
system being weakened. Concerned may develop, Tuberculosis, pneumonia, swollen glands etc. A person can die any moment at this stage.
Summary
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2.17. Summary
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Session 2 Quiz
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2. Jonathan Engel. (2015). The Epidemic: A Global History of AIDS. ISBN: 10: 0061144886
3. International Journal of STD & AIDS. ISSN 1758-1052
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3. HUMAN REPRODUCTIVE SYSTEM, IMMUNE SYSTEM
3.1 Introduction
3.3 Structure and function of human reproductive system
3.4 How reproductive systems work
3.5 Overview of immune system
3.6 Common opportunistic infections
3.7 Summary
3.8 Review Activity
3.9 References and Further Reading
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3.1. Lecture Outline
3.1 Introduction
3.3 Structure and function of human reproductive system
3.4 How reproductive systems work
3.5 Overview of immune system
3.6 Common opportunistic infections
3.7 Summary
3.8 Review Activity
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3.2. Introduction
Hello and welcome to the third lecture session in HIV/AIDS awareness, prevention and management. Today, we’re going to begin focusing on the
structure and function of human reproductive system, overview of human immune system and finally the various common opportunistic infections.
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At the end of this lecture, you should be able to:
1. Describe the structure and function of human reproductive system

2. Describe the overview of human immune system
3. Identify the common opportunistic infections
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3.4. Structure and function of Human Reproductive system
Let's us start with this question
Question
Define the term human reproductive system
Good attempt!! To begin, we’re going to think about a definition of the word reproductive system. The reproductive system is defined as a
collection of internal and external organs in both human males and females that work together for the purpose of procreating. Due to its vital role
in the survival of the species, many scientists argue that the reproductive system is among the most important systems in the entire body.
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3.5. How reproductive systems work
After defining the term human reproductive system let us now look at how this system functions
Male Reproductive System
The male reproductive system is a grouping of organs that make up a man’s reproductive and urinary systems. The male reproductive system is
responsible for sexual function, as well as urination. The male sex organs comprise a complex arrangement of internal and external genital
organs. The external organs include the penis, scrotum and testicles. Internal organs include the vas deferens, prostate and urethra. These
organs produce, maintain and transport sperm (the male reproductive cells) and semen (the protective fluid around the sperm). They also
discharge sperm into the female reproductive tract as well as produce and secrete male sex hormones. A man's fertility and sexual traits depend
on the normal functioning of the male reproductive system, as well as hormones released from the brain.
Figure 5: Cross-sectional diagram of the male reproductive organs (Adapted from https://my.clevelandclinic.org)
Female Reproductive System
The female reproductive system is largely internal. Female reproductive system consists of ovaries (produce the female's ova), fallopian tubes,
uterus (the receptacle for the ovaries), cervix, vagina (act as the receptacle for semen), glands and external genitalia. The vagina is attached to
the uterus through the cervix, while the fallopian tubes connect the uterus to the ovaries. In response to hormonal changes, one ovum, or egg, or
more in the case of multiple births, is released and sent down the fallopian tube during ovulation. If not fertilized, this egg is eliminated during
menstruation. The basic functions of female reproductive system include production of female sex hormones, production of gametes (eggs),
protection and supporting developing embryo and nourishment of the new-born infant.
Figure 6: Cross-sectional diagram of the female reproductive organs (Adapted from https://www.ck12.org)
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3.6. Why does the immune system fail to fight the HIV virus
There are various reasons which can contribute to the failure of the immune system to control HIV infection and prevent AIDS development. HIV
destroys cells in the body, called CD4 T cells. CD4 T cells are a type of white blood cell (a lymphocyte). These are important cells involved in
protecting the body against various bacteria, viruses and other germs. HIV actually multiplies within CD4 cells. HIV cannot be destroyed by white
blood cells, as it keeps on changing its outer coat, so protecting itself. By infecting CD4 T cells, HIV is able to replicate predominantly in activated
T cells and paralyze one of the main components of adaptive immune system. HIV can also establish latent infection in CD4+ T cells and remain
invisible to CD4 T cells and therefore replication can occur later in the infection and generate new virions.
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3.7. Overview of immune system
You now have looked at the structure and functioning of human reproductive system. You can now consider the overview of the immune system.
Let us start by trying to understand the meaning of immune system
Question
How do you define immune system?

Great!! I believe that all of you have made excellent attempt in defining the immune system. The immune system is a system of biological
structures and processes within an organism that protects against disease. To function properly, an immune system must detect a wide variety of
agents, from viruses to parasitic worms, and distinguish them from the organism’s own healthy tissue. Lack of immune system response indicates
immunodeficiency.
Types of Immune system
Innate immunity: The natural resistance with which a person is born. It provides resistance through several physical, chemical, and
cellular approaches.
Adaptive (acquired) immunity: The creation of immunological memory after an initial response to a specific pathogen, leading to
an enhanced response to subsequent encounters with that same pathogen. This process of acquired immunity is the basis of
vaccination.
Figure 8: A typical immune response

Why does the immune system fail to fight the HIV virus
There are various reasons which can contribute to the failure of the immune system to control HIV infection and prevent AIDS development. HIV
destroys cells in the body, called CD4 T cells. CD4 T cells are a type of white blood cell (a lymphocyte). These are important cells involved in
protecting the body against various bacteria, viruses and other germs. HIV actually multiplies within CD4 cells. HIV cannot be destroyed by white
blood cells, as it keeps on changing its outer coat, so protecting itself. By infecting CD4 T cells, HIV is able to replicate predominantly in activated
T cells and paralyze one of the main components of adaptive immune system. HIV can also establish latent infection in CD4+ T cells and remain
invisible to CD4 T cells and therefore replication can occur later in the infection and generate new virions.
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Figure 9: Events that happens in an HIV infection
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3.8. Common Opportunistic infections
Having looked at the meaning of the immune system, you will now identify common opportunistic infections associated with HIV/AIDs
When someone living with HIV has weakened immune system (shown by a low CD4 count), they are at risk of other illness. These are known as
opportunistic infections or OIs because they take the opportunity of the immune system being weak or compromised.
When a person living with HIV gets opportunistic infections, or OIs, he or she will get a diagnosis of AIDS, the most serious stage of HIV infection.
AIDS is also diagnosed if a type of blood cell that fights infection (known as CD4 cells) falls below a certain level in persons with HIV. These blood
cells are a critical part of a person’s immune system.
CDC has developed a list of OIs that indicate a person has AIDS. It does not matter how many CD4 cells a person has, receiving a diagnosis with
any of these OIs means HIV infection has progressed to AIDS. HIV treatment can help restore the person’s immune system. Some of the most
common OIs include:
i. Tuberculosis (TB) : Tuberculosis (TB) infection is caused by the bacteria Mycobacterium tuberculosis. TB can be spread through the air
when a person with active TB coughs, sneezes, or speaks. Breathing in the bacteria can lead to infection in the lungs. Symptoms of TB in the
lungs include cough, tiredness, weight loss, fever, and night sweats. Although the disease usually occurs in the lungs, it may also affect other
parts of the body, most often the larynx, lymph nodes, brain, kidneys, or bones.
ii. Pneumonia, recurrent: Pneumonia is an infection in one or both of the lungs. Many germs, including bacteria, viruses, and fungi can
cause pneumonia, with symptoms such as a cough (with mucous), fever, chills, and trouble breathing. In people with immune systems severely
damaged by HIV, one of the most common and life-threatening causes of pneumonia is infection with the bacteria Streptococcus pneumoniae,
also called Pneumococcus. There are now effective vaccines that can prevent infection with Streptococcus pneumoniae and all persons with HIV
infection should be vaccinated.
iii. Pneumocystis carinii pneumonia (PCP): This lung infection, also called PCP, is caused by a fungus, which used to be called
Pneumocystis carinii, but now is named Pneumocystis jirovecii. PCP occurs in people with weakened immune systems, including people with
HIV. The first signs of infection are difficulty breathing, high fever, and dry cough.
iv. Kaposi's sarcoma (KS): This cancer, also known as KS, is caused by a virus called Kaposi's sarcoma herpesvirus (KSHV) or human
herpesvirus 8 (HHV-8). KS causes small blood vessels, called capillaries, to grow abnormally. Because capillaries are located throughout the
body, KS can occur anywhere. KS appears as firm pink or purple spots on the skin that can be raised or flat. KS can be life-threatening when it
affects organs inside the body, such the lung, lymph nodes or intestines.
v. Candidiasis of bronchi, trachea, esophagus, or lungs: This illness is caused by infection with a common (and usually harmless) type
of fungus called Candida. Candidiasis, or infection with Candida, can affect the skin, nails, and mucous membranes throughout the body. Persons
with HIV infection often have trouble with Candida, especially in the mouth and vagina. However, candidiasis is only considered an OI when it
infects the esophagus (swallowing tube) or lower respiratory tract, such as the trachea and bronchi (breathing tube), or deeper lung tissue.
vi. Histoplasmosis: This illness is caused by the fungus Histoplasma capsulatum. Histoplasma most often infects the lungs and produces
symptoms that are similar to those of influenza or pneumonia. People with severely damaged immune systems can get a very serious form of the
disease called progressive disseminated histoplasmosis. This form of histoplasmosis can last a long time and involves organs other than the
lungs.
Cryptococcosis: This illness is caused by infection with the fungus Cryptococcus neoformans. The fungus typically enters the body through the
lungs and can cause pneumonia. It can also spread to the brain, causing swelling of the brain. It can infect any part of the body, but (after the
brain and lungs) infections of skin, bones, or urinary tract are most common.
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3.9. Summary
The structure of both the male and female human reproductive systems varies and each of them plays a unique role in the reproduction process
among other functions. The human immune system plays a vital role in defending the body against pathogenic materials that gains access to the
body. Additionally, it is worth noting that the common opportunistic (such as tuberculosis and pneumonia) infections further weakens the already
compromised immune system by the HIV which in turn leads to AIDS.
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Session 3 Quiz
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1. Mor G (2021). Reproductive Immunology: Basic Concepts 1st Edition. Academic Press. ISBN-13: 978-0128185087.
2. Barresi MJF, Gilbert SF. (2019). Developmental Biology 12th Edition. Sinauer Associates is an imprint of Oxford University Press. ISBN-13:
978-1605358222.
3. Sompayrac LM (2019). How the Immune System Works (The How it Works Series) 6th Edition. Wiley-Blackwell. ISBN-13 :
978-1119542124
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4. FACTORS CONTRIBUTING TO HIGH INCIDENCES OF HIV/AIDS
Lecture Outline
4.1 Introduction
4.3 Socio-cultural and economic factors
4.4 Political factors
4.5 Myth
4.6 Factors influencing gender disparity in HIV/AIDS infection
4.7 Summary
4.8 Review Activity
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4.1. Introduction
Welcome to the fourth lecture session in HIV/AIDS awareness, prevention and management. The session shall cover the various factors
contributing to high incidences of HIV/AIDS.
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1. 1Discuss the socio-cultural and economic factors causing the high incidences of HIV/AIDS
2. Describe the political factors causing the high incidences of HIV/AIDS
3. Explain myth on sexuality and link them to the high incidences of HIV/AIDS
4. Describe the factors influencing gender disparity in HIV/AIDS infection
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4.3. Socio-cultural and economic factors
Both the socio-cultural and socio-economic aspects play a major role in contributing to the high incidences of HIV/AIDS in the society. We shall
cover each aspect separately but first we shall start with socio-cultural factors.
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4.4. Socio-cultural factors
Various socio-cultural factors have contributed immensely to the high incidences of HIV/AIDS in the society. Some of these factors have been
tackled below.
1. Deeply rooted traditions such as;
i. Wife inheritance
ii. Polygamy
iii. Circumcision
iv. Medicine men/witch doctors
v. Sharing wives
vi. Female genital mutilation etc.
2. Belief system such as;
i. AIDS is a disease like any other
ii. AIDS is a curse like chira in Luo
iii. Belief that young people do not have AIDS
iv. Belief that only poor people can have AIDS
v. Belief that death is certain
3. Poor parental skills
i.Lack of advice to the children by the parents
ii.No role models
iii.Lack of religious morals
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4.5. Socio-economic factors
Similarly, socio-economic factors have also contributed to the high incidences of HIV/AIDS in the society. Some of these factors have been
tackled below
1. The rich or wealth such as;
i. Buying sexual services
ii. Care free attitudes
iii. Concubines
iv. Leisure among the rich since money is available
v. Marrying and remarrying
vi. Frequent parties
2. Growth of shantytowns around towns and cities
3. Land reform measures and worker relocation.
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4.6. Political factors
Politics has been the main driver of action as well as inaction and denial regarding AIDs. Positive political action at both the grassroots and
governmental levels has greatly enhanced the global response to AIDs. Political action on AIDs has also been an opportunity to correct
underlying practices and mobilize positive political momentum. On the other hand, politics has been a negative force at times blocking important
policy developments and evidence informed action on AIDS, particularly access to antiretroviral treatment, prevention of sexually transmitted of
HIV, and harm reduction in injection drug users. There is decreased allocation of resources and most funds are from external donors. Corruption
is rampant especially in developing countries like Kenya.
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4.7. Myths
A myth is a widely held but false belief or idea. The following are examples of myths surrounding HIV/AIDs which need to be demystified
1. Having multiple sex partners boosts men’s prestige and status among the peers
2. Abstinence causes males sexual impotence
3. Teaching young people about sex encourages them to practice it
4. For a man infected with HIV/AIDS, sex with a virgin provides a cure.
5. Ignorance about sex is a sign of innocence and purity, while too much knowledge is a sign of immorality
6. Condom have pores thus it is wise to use two or more
7. Knowing your sero-status means an early death.
8. ARVs provides cure for AIDs
People living with HIV/AIDs need not use the condom during sex
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4.8. Factors influencing gender disparity in HIV/AIDS infection
HIV disproportionately affects women and adolescent girls because of their unequal cultural, social and economic status in society. This means
that gender inequality must be tackled in order to end the global HIV epidemic, and achieve other, broader development outcomes.
Intimate partner violence, inequitable laws and harmful traditional practices reinforce unequal power dynamics between men and women. These
dynamics limit women’s choices, opportunities and access to information, health and social services, education and employment.
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4.9. Gender inequality threatens prevention and treatment of HIV
Women in marginalized communities are more vulnerable to HIV infection because of the role they play in the family setting. Women who
economically depend on men, often older men, are at high risk of infection.
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4.10. Religion has a role to play
Religious laws that inflict on women’s rights have a part to play in the spread of HIV infection. In the northern parts of Nigeria where it’s
predominantly Muslim, women are at higher risk of getting infected because of some of the sharia laws implemented.
The laws encourage dependence on men and make it difficult for the women to insist on safer sex relations. In some cases, women are not even
able to confront their husband if they discover he’s having relations outside marriage.
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4.11. Intimate partner violence and HIV
Although the prevalence of intimate partner violence among married or partnered women decreased between 2000 and 2014, it still remains high
across the world, affecting one in three women globally and is particularly common in certain regions.
The fear of intimate partner violence has been shown to be an important barrier to the uptake of HIV testing and counselling, to the disclosure of
HIV-positive status, and to treatment uptake and adherence, including among pregnant women who are receiving antiretroviral treatment (ART)
as part of services to prevent mother-to-child transmission (PMTCT).
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4.12. Cultural and social norms
Intimate partner violence is typically underpinned by dominant cultural and social norms about masculinity, femininity, and sexuality. Research
shows that gender inequality results from the patriarchal nature of many societies, especially where control of women and male strength and
power is highly valued.
Violence against women, including intimate partner violence and rape, is one consequence of gender inequality. However, such violence also
reinforces and perpetuates gender inequality at both societal and relationship levels.
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4.13. Educational factors
Studies have shown that increasing educational achievement among women and girls is linked to better sexual and reproductive health (SRH)
outcomes, including lower rates of HIV infection, delayed childbearing, safer births and safer abortions.
In many settings, cultural and social norms mean that girls in families affected by HIV are the ones who drop out of school to care for sick parents
or generate income for the family. The education and empowerment of women and girls is also fundamental to preventing intimate partner and
gender-based violence
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4.14. Legal factors
In many places, discriminatory social and cultural norms are translated into laws which act as barriers to HIV services for women, increasing their
vulnerability to HIV. Nine countries in 2014 reported laws that obstruct women and girls from accessing HIV services.
Mandatory parental consent has been shown to deter young women from accessing vital HIV and sexual and reproductive health (SRH) services
due to fear of disclosure or violence. A 2017 study on sexual and reproductive health and rights among young people in Kenya, Uganda,
Myanmar, Bangladesh and Ethiopia found young women frequently lacked the freedom to access contraceptives, particularly when parental or
spousal consent was required due to their being under the legal age of consent.
Age-restrictive laws, such as those that ban contraception under a certain age, act as barriers to healthcare for young women, while women
belonging to other key affected populations are negatively affected by laws that ban drug use, sex work and homosexuality.
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4.15. Poverty and gender inequality
Poverty is an overarching factor that increases vulnerability to HIV and is further complicated by gender inequalities.
Poor women are often economically dependent on men. The need for economic support may partly drive earlier marriage and existing gender
inequalities may make it difficult for young women to insist on safer sexual practices.
The poorest women may have little choice but to adopt behaviours that put them at risk of infection, including transactional and intergenerational
sex, earlier marriage, and relationships that expose them to violence and abuse.
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4.16. Biological Factors
Biological make up and reproductive anatomy of the female body makes her more vulnerable to contract HIV than men. Sex takes place inside
the body of the woman and the female genitalia is prone to tear and wear. These tears and wears and/or sores provide entry route for the virus.
The female reproductive system is also in direct and longer contact with the male semen deposited during sexual intercourse. If the semen has
HIV, then it becomes easier for her to contract the virus. Changes associated with female reproduction explain to a larger extent the differential
infections.
As seen, gender inequality contributes greatly to the spread of HIV. It’s important to find ways to make information about spread of the disease
available to women and ensure treatment is accessible for those women living with HIV
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4.17. Summary
This session covers factors contributing to high incidence of HIV/AIDs. These include socio-economic, cultural, biological and political factors.
The session also gives some myth on sexuality and link them to the rapid spread of HIV/AIDs. Examples of some myths are; “Abstinence causes
males sexual impotence which is not true”, “For a man infected with HIV/AIDs, sex with a virgin provides a cure” which is also not true.
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Session 4 Quiz
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1. WHO (2020). HIV/AIDS. https://www.who.int/news-room/fact-sheets/detail/hiv-aids
2. International Journal of Maternal and Child Health (MCH) and AIDS (IJMA). ISSN: 2161-864X
Journal of HIV and AIDS Research. ISSN: 2141-2359
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5. TRANSMISSION AND DIAGNOSIS OF HIV/AIDS
Introduction
Welcome to the fifth lecture session in HIV/AIDS awareness, prevention and management. In this session, we shall cover the various
modes of HIV transmission. The session will also describe the various techniques used to diagnose HIV/AIDS.
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1. Describe the various modes of HIV transmission

2. Explain the various diagnostic techniques for HIV/AIDS
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5.2. Introduction
Welcome to the fifth lecture session in HIV/AIDS awareness, prevention and management. In this session, we shall cover the various modes of
HIV transmission. The session will also describe the various techniques used to diagnose HIV/AIDS.
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5.3. Modes of HIV transmission
Let us start our discussion by engaging in the following activity.
Activity
List the major ways through which HIV can be transmitted
Bravo!!!, I trust that you have responded that HIV can be transmitted through blood, sexual contact, or injection drug use, and from
mother-to-child (also known as perinatal or vertical transmission). The most common route of HIV transmission is through sexual
contact, especially heterosexual intercourse.
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5.4. Sexual transmission
Unprotected sexual intercourse (vaginal, oral, or anal); Sexual contact by far is the most common mode of transmitting HIV. Anal sex is the
most efficient sexual manner of transmitting the virus. Vaginal intercourse poses the next highest risk, but more to the female than the male. In
other words, it is much easier for an infected man to infect a woman through penile-vaginal intercourse than the other way around, especially if
the man is circumcised and has no sores or ulcers on his penis. Women of childbearing age are at particular risk for acquiring HIV; The main
behavior that places them at risk is unprotected sex with an infected male partner.
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5.5. Mother to Child Transmission (MTCT)
This is from mothers who are HIV-positive to their infants during pregnancy, labour, delivery, and breastfeeding
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5.6. Blood-to-blood transmission
Blood-to-blood transmission of HIV/AIDS can occur in the following ways;
i. Transfusion with HIV-infected blood

ii. Organ transplant
iii. Direct contact with HIV-infected blood
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5.7. Sharing needles/syringes and sticks
Injection of drugs with needles or syringes contaminated with HIV can contribute to HIV/AIDS infection.
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5.8. Rare forms of HIV transmission
It’s theoretically possible, but considered extremely rare, for HIV to be transmitted through oral sex (only if there are bleeding gums or open sores
in the person’s mouth), being bitten by a person with HIV (only if the saliva is bloody or there are open sores in the person’s mouth), and also
contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV
Take Note
HIV/AIDS CANNOT be transmitted through the following ways; Coughing or sneezing, insect bites, public bath/pool, public toilet, shaking hands,
sharing cups, glasses, plates, or other utensils, touching or hugging, sharing a toilet, towels, or bedding, etc
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5.9. HIV/AIDS diagnostic techniques
Let us recall the various modes of HIV transmission after which you can now look at HIV diagnostic techniques.
Given that we have gone through the various ways on how HIV can be transmitted, let us now review the various ways through which HIV/AIDS
can be diagnosed. There are several tests available to detect if someone has been infected with HIV. The most commonly used are tests for
antibodies to the virus rather than the virus itself. If our bodies are infected with any virus, they produce antibodies that fight the virus after some
weeks; these antibodies can be detected in the blood with an HIV antibody test.
1. The enzyme linked immune-sorbent assay (ELISA) test – This is the most common test used to detect antibodies against HIV. When
the body is exposed to HIV, the immune system mounts an attack against it and produces antibodies to fight it off. The presence of these
antibodies show there is HIV infection. The Elisa test is an indirect test because it does not test for HIV itself but for the antibodies.
2. Unigold and determine – These are rapid tests recommended for VCT centers in Kenya and gives results within 15 minutes and are
simple, free and require no laboratory.
3. Antigen test – This test directly for the virus itself and sometimes is used in babies.
4. Viral load test – All tests for the virus itself.
5. CD4 count – this test is able to count the CD4 cells remaining in the blood as an indicator of the strength of the immune system.
6. Western blot test – the western blot test involves putting the blood sample on a string of paper, which is embedded with HIV antigens.
The blood moves along the paper and visible bands appear in places where HIV antibodies from the patient bind with the antigens., I f no
band appear, then the person is HIV negative. If three bands appear then that person is considered HIV positive. If one or two bands
appear, then the result is considered indeterminate. Although west blot test is too accurate, it’s also very expensive.
7. Polymerase chain reaction test (PCR) – The test works by amplifying segments of genetic DNA or RNA of known composition with
premiers in sequential repeated steps. The PCR detects HIV itself.
8. Genotype test – Tests for HIV genes
9. Other tests include saliva and urine test, aplicor’s branched DNA test, immune florescent antibody assay.
Figure 11: HIV test kit
Learn how HIV testing is conducted by following this link;
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5.10. Summary
In this session we have learned that unprotected sex is the main method of HIV/AIDS transmission. Body fluid that contain high amount of HIV
includes blood, semen, vaginal and rectal fluids, and breast milk. The session also looked at various HIV/AIDS diagnostic techniques which
includes enzyme linked immune-sorbent assay (ELISA) test, Western blot test, Polymerase chain reaction test (PCR) among other techniques.
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Session 5 Quiz
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1. Mostafa R (2016). HIV/AIDS: Advanced Diagnosis and Treatment. Callisto Reference. ISBN-13: 978-1632397300
2. Tony Barnett and Alan Whiteside. (2015). AIDS in the Twenty-First Century. ISBN: 1403997683.
Journal of HIV/AIDS Prevention & Education for Adolescents & Children. ISSN 1069-837X.
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6. PREVENTION AND CONTROL OF HIV/AIDS
6.1 Introduction
Lecture Outline
6.3 ABCDEF approach
6.4 Counselling
6.4.1 Voluntary Counselling and Testing Services (VCT)
6.5 Role of Nutrition in HIV/AIDS management
6.6 Home Based HIV/AIDS care
6.7 HIV prevention medicines
6.8 Summary
6.9 Review Activity
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6.1. Introduction
Welcome to our sixth lecture session in HIV/AIDS awareness, prevention and management. This section shall cover in details HIV/AIDS
prevention and control methods.
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1. Explain the ABCDEF approach of HIV/AIDS prevention and control strategy.

2. Describe the role of Voluntary Counselling and Testing Services (VCT) in HIV/AIDS management
3. Describe the role of Nutrition in HIV/AIDS management
4. Explain how Home Based HIV/AIDS care helps in HIV/AIDS management
5. Describe the medicines used to prevent HIV
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6.3. ABCDEF Approach
ABCDEF stands for;
A: Abstinence,
B: Be Faithful,
C: Correct and Consistent Condom Use and Circumcision,
D: Diaphragm for HIV Prevention,
E: Exposure Prophylaxis,
F: Female-Controlled Microbicides (approach to prevention of AIDS virus)
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6.4. Condoms
Both male condoms (Figure 13) and female condoms (Figure 14) are available. They come in a variety of colours, textures, materials and
flavours. A condom is the most effective form of protection against HIV and other STIs. It can be used for vaginal and anal sex, and for oral sex
performed on men. HIV can be passed on before ejaculation through pre-come and vaginal secretions, and from the anus. It's very important
condoms are put on before any sexual contact occurs between the penis, vagina, mouth or anus.
Condoms in good conditions
Before using a condom, it’s always important to ensure that it adheres to the followings;
i. It is well lubricated, soft and flexible

ii. Has uniform colour and thickness
iii. Have no holes, cracks or tears
iv. Has not expired
v. Is stored away from heat
Advantages of using a condom
1. They are recognized by the World Health Organization and other leading health agencies as one of the best forms of protection against HIV
2. Research studies designed to crate public doubt about the effectiveness of condoms are unfounded
3. Condoms can provide up to 98% protection against unplanned pregnancies and most STIS.
1. Condoms are effective ways of preventing unplanned pregnancies. Condoms can also help to protect fertility by forming a barrier
against STDS that causes infections e.g. Chlamydia, gonorrhea as well as protecting other STIS e.g. syphilis.
2. Condoms have been proven to provide a barrier against virus such as herpes simplex and HIV virus that causes AIDS.
3. Condoms are useful for couples with HIV infections to reduce infections
4. Man can be able to maintain a longer erecting time during sex with a condom
5.
i. Condom can also reduce the bad virginal odour that follows sex.
Condom use is less messy especially to those who dislike the wetness sipping or oozing of semen after sex.
6.
7.
Despite the numerous advantages associated with the use of condom, it also has some setback in its usage as listed below;
i. It can burst, slip or tear during sexual intercourse

ii. It can also tear when using sharp object while opening the package
iii. The latex rubber is easily damaged on exposure to heat
iv. If not correctly used it serves no purpose.
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Condom can also reduce the bad virginal odour that follows sex.
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6.5. Obstacles to condom Use
1. Cultural beliefs
Sometimes cultural believes make some people not to use condoms. There are false believes that hinder some people to use condoms e.g.
i. You will become impotent
ii. Free condoms are not safe
iii. They have been stored for too long
iv. Condoms are filled up with viruses so that they spread AIDS
v. Condoms from overseas bring the disease with them
vi. Foreign governments that donate condoms put holes in them so that Africans can die.
2. Negative religious Attitudes
Some religious leaders are outspoken against the distribution of condoms. They see condoms as moral evil. They say:-
i. Condoms encourage promiscus living (bad morals)
ii. They increase rather than decrease the incident of HIV/AIDS
iii. They are an incentive to prostitution
iv. They increase teenage pregnancies, abortion
v. They give people a false security.
3. A woman may be powerless to suggest condom use
Women may lack the power, to request their partners to use a condom. A man may think that this is a sign of her being unfaithful, even though
he may be the one who has had numerous partners. Sex workers may not be in a position to decide on the use of a condom. This may be
controlled by their client, brothel owners.
4. As a means of birth control
If a couple is married how can they get children if they are using a condom?
5. Accessing condoms
Condoms may not be readily available or may be too expensive
6. Lack of knowledge or skills in condom use
People may not know about the correct use of condoms and the purpose of using them. If condoms are not used correctly or with the right kind
of lubricant, they may burst.
7. Reluctance to use condoms
People are often reluctant to use condoms for a variety of reasons, they may feel that they are not at risk of contracting HIV or other sexually
transmitted infections or may find condoms uncomfortable and inhibiting. Some people can develop allergic reaction to the latex rubber or to the
lubricant used.
8. Poor quality design
Some condoms may be of poor quality for a number of reasons e.g. Manufacturing standards may not be enforced, not stored properly, etc. This
can lead to breakage, leakage or spillage during use.
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6.6. Antiretroviral Therapy
Antiretroviral therapy (ART) is a combination of medicines that slows down the effects of HIV in your body and can help you stay healthy for many
years. It can also lower or even stop your chances of giving HIV to anyone else. ART lowers the amount of HIV in your body (called your viral
load) — sometimes to the point where HIV won’t show up on standard blood tests. If your HIV viral load is so low that certain tests can’t see it, it’s
called “undetectable.” Having an undetectable viral load for 6 months or more means it is not possible to pass the virus on during sex. This is
called undetectable=untransmittable (U=U), which can also be referred to as "treatment as prevention"
It’s important to remember that even with an undetectable viral load, HIV is still present in your body. If you stop treatment your viral load can go
up, making it possible to pass HIV to others you have sex with.
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6.7. Counselling
Counselling is a process that helps people understand and deal with their problems and communicate better with those whom they are
emotionally involved. Counselling is a therapeutic relationship through which individual are helped to define goals, make decisions and resolve
problems related to personal, social, educational, health and psychological concerns. Here the counsellor discusses and explores feelings,
worries and concerns of the client. Together, they look for the best ways possible of dealing and coping with these feelings and concerns. The
relationship between a counsellor and a client is a professional one and not friendly, it must be confidential, professional and non-judgmental.
Counselling means you encourage the client to find his or her own solutions and this helps him or her to become confident and independent
person.
There are two types of counselling, namely;
i. Pre-test counselling (counselling before testing)

ii. Post-test counselling (counselling after testing)
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6.8. Types of testing
There are Four types of testing. These includes;
1. Voluntary Counselling and testing (VCT); is a client initiated HIV testing to learn HIV status provided through voluntary counselling and
testing.
2. Diagnostic HIV testing; When a person shows signs, or symptoms that are consistent with HIV related diseases or AIDS, they may be
tested. This is to aid the health workers in treatment.
3. Offer of HIV testing by health care provider; Health care providers should offer HIV testing to;
(a) Those being tested or treated for sexually transmitted diseases
(b) Pregnant women in order to offer antiretroviral therapy to prevent mother to child transmission
(c) Those in areas where HIV is prevalent and retroviral treatment is available.
4. Mandatory HIV screening; Mandatory screening for HIV and other blood borne virus is necessary for blood that is to be used for
transfusion. It is also required for all procedures involving transfers of body fluids or body parts.
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6.9. Purpose of VCT
The main purpose of the VCT are;
i. To help a client make a decision about whether to take the test or not
ii. Evaluate personal risk of HIV transmission
iii. Facilitate behaviour change
iv. Prevent transmission of HIV
v. Emotional support for client.
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6.10. Role of VCT
VCT plays a vital role in the prevention and control of HIV/AIDS. Some of the key roles in which the VCT plays a fore front role includes;
i. Enlightens and guides people on issues relating to HIV/AIDs

ii. Contributes in the control of HIV/AIDs by offering counseling services, free condoms.
iii. They enable the public who include the relatives of the infected to stop him/stigmatizing those infected to be able to live normal lives
knowing that someone cares for them.
iv. They also help the government to keep statistics on the prevalence of the disease hence policy development or strategic planning.
v. They enhance peer counseling –which is a more effective tool as it applies peer pressure. The clients are prepared for both positive and
negative results before and after testing then allowed to know their HIV status
vi. . Offer testing and avail the results to people within short period
vii. Through counseling, infected people, majority of who have lost hope are offered an opportunity for positive living
viii. They reduce the revenge attitude for those innocently infected and may opt to die with many or commit suicide.
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6.11. Pre-testing counselling
An HIV test is a very serious matter and therefore pre-test counselling is very important in order to prepare the client psychologically. The
government has established three requirements in HIV counselling;
1. Every person who requests for a test or advised to take one must be counselled and educated before (pre-test), about the meaning of the
test and its implications.
2. No one will be tested without his or her consent. Testing should only be conducted with informed consent, meaning it is both informed and
voluntary.
3. Test results are confidential – test result must be revealed only to the person being tested and everything discussed before pre-testing and
post-testing must be confidential unless the client decides otherwise.
Reasons for HIV pre-test counselling
Some of the reasons for pre-test counselling includes;
i. Provide a person with accurate information about HIV
ii. Assist the client to consider the implications
iii. Assess the client’s ability to cope with positive results
iv. To help the client make a reformed position on whether to take the result of not
To help the client manage fear, anxiety while waiting for the results.
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6.12. Post-test counselling
(a) Counselling after positive results
(i) Review what the positive result means and how the client can be able to cope with the positive results.
(ii) Let the clients express their feelings and thoughts.
(iii) Assess the psychological state of the client especially thoughts of vengeance or suicide, such expressions should never be ignored even
if said jokingly.
(iv) Explain ways of positive living and reducing risks.
(v) Offer empathy and find out how the client will behave in the next hours or days.
(vi) Encourage the client to discuss any other concerns
(vii) You may refer to a client to a supportive group.
(b) Counselling after negative results
(i) The client may shout with happiness and joy and even become angry
(ii) Ask open-ended questions to establish the understanding of the client’s negative results.
(iii) Remind the client of the window period and recommend the repeat of the test after three months, meanwhile reduce risks.
(iv) Discuss with the client how to prevent and protect themselves from the infections.
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6.13. How to live positively
An HIV person can live positively by observing the following: -
1. Eat a well-balanced diet i.e. protein, vitamins and carbohydrates in order to keep ones body well from infections
2. Do exercise and remain as active as possible to keep fit and keep off depression and anxiety.
3. Get regular sleep for better health and stamina
4. Continue to work if possible to avoid stress
5. Keep busy in meaningful activities
6. Socialize with friends and families
7. Seek medical attention immediately the body gets attacks of the diseases
8. Use condoms for safer sex
9. Avoid exposure to other infections
10. Avoid smoking and alcohol due to opportunistic diseases or infections
11. Do not use un-prescribed drugs for effective control of diseases
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6.14. The importance of going to a VCT
1. To prevent the transmission of HIV
When a person knows what their sero-status is, they can act accordingly. If a person tests positive for HIV, they can change their sexual
behaviour to avoid transmission to sexual partners. If a mother knows she is HIV positive she can take preventive measures to ensure her child
will not be infected.
2. To protect one from becoming infected with HIV
Once you go for voluntary counselling and testing, you are given information about HIV/AIDS. This information can help a person to take the
appropriate steps to avoid being infected with HIV.
3. To receive available services
If a person tests HIV positive, he/she can seek appropriate medical care. This includes antiretroviral therapy, treatment of opportunistic infection
as well as testing for other infections that are associated with HIV. If a person tests negative for HIV, He or she can take the appropriate steps to
avoid being infected with HIV because a person is given information at the VCT centre.
4. Benefits in Society
When more people go for voluntary counselling and testing it will become the norm in society (everyone is going it). This will challenge the
stigma that is often associated with testing. It will spread awareness on issues related to HIV/AIDS.
5. Counselling for adherence
Adherence to antiretroviral and preventive therapies, coping adverse effects and counselling about adherence in mother to child transmission
interventions.
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6.15. Role of Nutrition in HIV/AIDS management
Nutrition implies the process of absorbing nutrients from food and processing them in the body in order to keep healthy and or to grow. Adequate
food security in the household is requisite for optimum nutrition, health and survival. However, HIV/AIDs reduce the household’s ability to produce
and buy food by taking away the adult labour that would otherwise be engaged in agricultural production or in earning an income.
At the same time HIV/AIDs increases health expenditure. The capacity of an infected household to obtain an adequate amount of and variety of
food, and to adopt appropriate health and nutritional responses to HIV/AIDs, especially for the already vulnerable ones, is grossly reduced.
On the other hand, both HIV/AIDs and malnutrition compromise the immune system, resulting in increased susceptibility to severe illnesses,
which reduce the quality of life and shortens life expectancy.
Malnutrition due to HIV/AIDs is linked to inadequate food intake, poor uptake of food into body, and poor use and storage of nutrients.
Each of these factors must be considered in providing the most appropriate nutritional care for the HIV-positive person.
Reduced food intake
Ø Reduce food intake in persons with HIV may be due to painful sores in the mouth the throat, loss of appetite or fatigue. The main causes of
loss of appetite are infections and depression. Other causes include side effects of medications such as nausea and vomiting, and inadequate
access to and availability of appealing foods.
Poor nutrient absorption
Ø Poor absorption of nutrients results when HIV damages the small intestines and alters the healthy bacteria of the digestive system, causing
malabsorption of fats and carbohydrates and frequent episodes of diarrhea. Intestinal infections also cause diarrhea, with loss and waste of
nutrients.
Increased Metabolism
Ø Infections, including HIV itself, lead to increased requirement for energy and proteins, inefficient use of nutrients, and loss of nutrients. Energy
requirements are likely to increase by 10% to maintain body wait and physical activity in adults and growth in symptomatic children.
Ø HIV patients require the following nutrients in a well-balanced diet:
Ø Vitamins: A good multivitamin should be considered.
Ø Proteins: Sources of proteins are red meat, fish, poultry eggs, nuts, beans, peas, and other pulses.
Ø Carbohydrates: are required for energy and for the purpose of PLWAs, they may be categorized into insoluble and soluble dietary fibers
Ø Fats: Fats are high in calories (energy). They are needed for many membranes in the body. Fish, beef, and vegetables all supply fats.
Ø Vitamins and minerals: Vitamins and minerals are also needed by the immune system. While our foods contain vitamins and minerals it is
important to recognize that available data indicate food alone does note supply enough in the presence of HIV, and that supplementation is very
important.
Ø Water is also very important.
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6.16. Advantages of Good Nutrients
Ø Good nutrition entails eating a well-balanced diet that contains all the nutrients the body needs for growth and proper functioning.
Balanced nutrition helps the body to:
Ø Increase resistance to infection and disease and improve the energy supply.
Ø Boost the immune system and therefore reduce the frequency of episode of morbidity.
Ø Lessen severity of infection, improve response to treatment for opportunistic infections such as TB, and speed the rate of recovery.
Ø Replace lost micronutrient and provide the body with all essential nutrient required for good health.
Ø Preserve muscle mass, slow or stop the loss of lean tissue, prevent weight loss, and improve body strength and energy.
Ø Delay the rate of progression of HIV to AIDS and the further advance of the AIDs itself.
Ø Keep PLWAs alive and able to lead an active life; this in turn reduces their dependence, thus allowing them to take care of themselves and too
delay early orphan hood of their children.
Ø Studies show that nutrition interventions can positively affect nutritional status (FAQ, 2002), THE immune system and even personal esteem,
by maintaining body weight, improving effectiveness of medication and prolonging life.
Ø Supplementing micronutrient has been shown to increase the expectancy of subjects with fewer than 200 CD4 cells per milliliter.
Ø A number of micronutrient supplements including vitamin A, zinc and iron have been found to boost the immune system in a person with HIV
infections. Multivitamins can reduce the risk of death and improve immune functions.
Ø Good nutrition can therefore play an important role in the comprehensive management of HIV/AIDs, as it improves the immune system, boost
energy, and helps recovery from opportunistic infections.
The following basic principles are being advocated for all programmes of HIV/AIDs patient management, counseling or education.
Ø Nutritional educational and counseling
Ø Water and food safety intervention to prevent diarhoea.
Ø Income-generating activities to enhance food security.
Ø Nutritional supplementation
Ø Meal designing and planning using locally available food staffs.
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6.17. Home Based HIV/AIDS care
Home-based care is the care of persons infected and affected by HIV/AIDS that is extended from the health facility to the patient’s home through
family participation and community involvement within available resources and in collaboration with health care workers.
Home-based care is a holistic, collaborative effort by the hospital, the family of the patient, and the community to enhance the quality of life of
people living with HIV/AIDS (PLWHAs) and their families. It is comprehensive care across the continuum of care from the health facility through to
community/home level. It encompasses clinical care, nursing care, counselling and psycho-spiritual care, and social support.
1. Clinical care: Includes early diagnosis, rational treatment, and planning for follow-up care of HIV related illness.
2. Nursing care: Includes care to promote and maintain good health, hygiene, and nutrition.
3. Counselling and psycho-spiritual care: Includes reducing stress and anxiety for both PLWHAs and families, promoting positive living, and
helping individuals to make informed decisions on HIV testing, plan for the future and behavioural change, make risk reduction plans, and involve
sexual partner(s) in such decisions.
4. Social support: Includes information and referral to support groups, welfare services, and legal advice for individuals and families, including
surviving family members, and where feasible provision of material assistance.
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6.18. Objectives of Home-Based Care
i. To facilitate the continuity of the patients care from the health facility to the home and community.
ii. To promote family and community awareness of HIV/AIDS prevention and care.
iii. To empower the PLWHA, the family, and the community with the knowledge needed to ensure long-term care and support.
iv. To raise the acceptability of PLWHAs by the family/community, hence reducing the stigma associated with AIDS.
v. To streamline the patient/client referral from the institutions into the community and from the community to appropriate health and social
facilities.
vi. To facilitate quality community care for the infected and affected.
To mobilize the resources necessary for sustainability of the service
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6.19. Principles of Home-Based Care
i. To ensure that the foregoing benefits are realized, home-based care should be regarded as a holistic system of care with provisions
for:
ii. Ensuring appropriate, cost-effective access to quality health care and support to enable persons living with HIV/AIDS to retain their self-
sufficiency and maintain quality of life.
iii. Encouraging the active participation and involvement of those most affected, the persons living with HIV/AIDS.
iv. Fostering the active participation and involvement of those are able to provide support the community at all levels.
v. Targeting social assistance to all affected families, especially children.
vi. Caring for caregivers, in order to minimize the physical and spiritual exhaustion that can come with the prolonged care of the terminally
ill.
vii. Ensuring respect for the basic human rights of PLWHAs.
viii. Developing the vital role of home-based care as the link between prevention and care.
ix. Taking a multi-sector approach to care and support.
x. Addressing the reproductive health and family planning needs of persons living with
xi. HIV/AIDS.
xii. Instituting measures to ensure the economic sustainability of home care support.
xiii. Building and supporting referral networks/linkages and collaboration among participating entities
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6.20. HIV prevention medicine
What is PrEP and how does it prevent HIV?
PrEP stands for pre-exposure prophylaxis. If you're HIV negative, you may be able to take pre-exposure prophylaxis (PrEP) medicine to reduce
your risk of getting the virus. PrEP is available for some people who are at high risk of HIV infection – for example, those whose partner is HIV
positive. It's available as a tablet, and is to be taken before you have sex and are exposed to HIV.
What is PEP and how does it prevent HIV?
PEP stands for post-exposure prophylaxis. It’s a series of pills you start taking after you’ve been exposed to HIV that lowers your chances of
getting HIV. You have to start PEP within 72 hours (3 days), after you were exposed to HIV for it to work. The sooner you start it, the better. PEP
is only for emergencies and it doesn’t take the place of using condoms or PrEP. It is not meant for regular use by people who may be exposed to
HIV frequently.
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6.21. Summary
There are many effective ways to prevent or reduce the risk of HIV infection. HIV prevention programmes are interventions that aim to halt the
transmission of HIV. They are implemented to either protect an individual and their community, or are rolled out as public health policies.
Initially, HIV prevention programmes focused primarily on preventing the sexual transmission of HIV through behaviour change. However, by the
mid-2000s, it became evident that effective HIV prevention needs to take into account underlying socio-cultural, economic, political, legal and
other contextual factors.
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Session 6 Quiz
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1. American Academy of HIV Medicine and Hardy WD (2019). Fundamentals of HIV Medicine 2019: CME Edition 1st Edition. Oxford University
Press. ISBN-13: 978-0190936044.
2. Bartlett JG, Pham PA, Shah M (2019). he Bartlett Pocket Guide to HIV/AIDS Treatment. PPham and JBriggs LLC. ISBN-13:
978-0996733373.
Journal of HIV/AIDS Prevention & Education for Adolescents & Children. ISSN 1069-837X.
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7. THE ROLE OF DRUGS IN THE SPREAD OF HIV/AIDS
Lecture Outline
7.1 Introduction
7.3 Definition of terms
7.4 Classification of drugs
7.5 Mode of drug administration
7.6 Role of drugs abuse in the spread of HIV/AIDS
7.7 Summary
7.8 Session Quiz
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7.1. Introduction
Welcome to our seventh lecture session in HIV/AIDS awareness, prevention and management. This session aims at introducing you to drugs and
drugs abuse by giving their meaning, classification, mode of administration, and then expound on their role in the spread of HIV/AIDS
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1. Define the term drug and drug abuse

2. Describe the classification of drugs
3. Describe the mode of drug administration
4. Explain the role of drugs abuse in the spread of HIV/AIDS
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7.3. Definition of terms
Let us commence this discussion by asking ourselves this question.
Question
Differentiate between drugs and drug abuse.

Great!!!, I trust that you have differentiated the two by stating that a drug is any substance that affects the functioning of living cells, used in
medicine to diagnose, cure, prevent the occurrence of diseases and disorders, and/ or prolong the life of patients with incurable conditions. On
the other hand, drug abuse is the use of illegal drugs or the use of prescription or over-the-counter drugs for purposes other than those for which
they are meant to be used, or in large amounts. Drug abuse may lead to social, physical, emotional, and job-related problems.
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Drugs can be classified in many ways:
i. The way they are dispensed, e.g., Over –The –Counter (OTC) or By prescription
ii. The substance from which they are found e.g., Plants, Animals, Microrganisms, Minerals
iii. The form they take e.g., Tablet, Capsule, Liquid, Gas
iv. The way they are administered e.g., By mouth, Injection, Inhalation, Direct application to the skin (absorption)
v. The way they act against diseases or disorders e.g., Chemotherapeutic drugs (attack specific organisms that cause a disease
without harming the host) or Pharmacodynamic drugs (alter the function of the bodily systems by stimulating or depressing normal cell activity
in a given system).
vi. Its effect on a particular area of the body or a particular condition (most common way to categorize drugs) e.g., Endocrine
drugs (drugs that correct the overproduction or underproduction of body’s natural hormones), Anti-infection drugs (include drugs which are
classified as antibacterial, antiviral, or antifungal depending on type of micro-organism they combat. Anti-infection drugs interfere selectively with
the functioning of a micro-organism while leaving the human host unharmed), Cardiovascular drugs (drugs that affect the heart and blood
vessels and are divided into categories according to function, e.g., Antihypertensive drugs reduce blood pressure by dilating blood vessels and
reducing the amount of blood pumped by the heart into the vascular system. Anti-arythmic drugs normalize irregular heartbeats and prevent
cardiac malfunction and arrest).
Drugs that affect the blood-e.g. antianemic such as vitamins or iron, enhance the formation of red blood cells. Anticoagulants like heaparin
reduce blood-clot formation and ensure free blood flow through major organs in the body. Thrombolytic drugs dissolve blood clots which can
block blood vesels and deprive the heart or brain of blood and oxygen, possibly leading to heart attack or stroke.
Central nervous system drugs-Affect the spinal cord and the brain and are used to treat several neurological (nervous system) and psychiatric
problems. For example;
a) Antiepileptic Drugs-Acetazolamide, carbamazepine
b) Antipsychotic Drugs -alleviate hallucinations and other abnormal behavior).
c) Antidepressants drugs -reduce mental depression.
d) Antimantic Drugs-reduce excessive mood swings in people with manic depressive illness.
e) Antianxiet drugs- (also referred to as tranquillizers)-treat anxiety by depressing the activity in the activity centres of the brain.
f) Sedative-hypnotic drugs are used both as sedatives to reduce anxiety and as hypnotic to induce sleep. Sedative-hypnotic drugs act by
reducing brain-cell activity.
g) Stimulatory drugs-Increase neuronal (nerve) activity and reduces fatigue and appetite.
h) Analgesic drugs-reduce pain and are generally categorized as narcotics and non-narcotics. Narcotic analgesics (opioids) include opium and
the natural opium derivatives codeine and morphine, synthetic derivatives of morphine such as heroin and synthetic drugs such as meperidine
and propoxyphene hydrochloride. Narcotics relieve pain by acting on specific structures, called receptors, located on the nerve cells of the spinal
cord or brain. Non-narcotic analgesic such aspirin, acetaminophen and ibuprofen reduce pain by inhibiting the formation of nerve impulses at the
site of pain. Some of these drugs can also reduce fever and inflammation.
i) General anaesthetics- used for surgery or painful procedures, depress brain activity, causing a loss of sensation throughout the body and
unconsciousness. Local anaesthetics are directly applied to or injected in a specific area of the body, causing a loss of sensation without
unconsciousness; they prevent nerves from transmitting impulses signalling pain.
j) Anticancer drugs-eliminate some cancers or reduce their rapid growth and spread and are specific to certain cancers.
vii. Drugs are also classified by their names. All drugs have three names:
a) A chemical name-which describes the exact structure of the drug.
b) A generic or proprietary name- which is the official medical name assigned by regulatory bodies, e.g., paracetamol
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c) A brand or trade name-given by the particular manufacturer that sells the drug, e.g. Panadol
7.5 Mode of drug administration and action (VIDEO)
The effect of the drug on the body depends on a number of processes that the drug undergoes as it moves through the body. All these processes
together are called Pharmakinetics (Aldridge, 1998)-literally, -motion of the drug.
7.5.1 Factors governing choice of route
a) Physical and chemical properties of the drug (solid/ liquid/gas; solubility, stability, pH, irritancy).
b) Site of desired action—localized or generalized.
c) Rate and extent of absorption of the drug from different routes.
d) Effect of digestive juices and first pass metabolism on the drug.
e) Rapidity with which the response is desired (routine treatment or emergency).
f) Accuracy of dosage required (intravenous and inhalational can provide fine tuning).
g) Condition of the patient (unconscious, vomiting).
Drugs can be administered by the following routes
1. Oral administration (by swallowing)
This is done through the mouth. Only the drugs that will not be destroyed by digestive processes of the stomach or intestine can be given orally.
2. Administration by injections
a) Intradermal- the drug is injected into the outer layers of the skin. The amount of drug is small and absorption is slow. This route is used for
diagnostic tests and for injecting BCG vaccine.
b) Subcutaneous (under the skin) - injections are made into the loose subcutaneous tissue under the skin. This route is used to inject small
amount of drug (2 ml or lesser).
c) Intramuscular (in a muscle) -are given with a longer and heavier needle that penetrates the subcutaneous tissues and the drug is
deposited deep between layers of muscle mass. The route is suitable for administration of solution and suspensions.
Intravenous (in a vein) -drug given directly into the vein. This route assures quick distribution through the blood stream and a rapid effect.
d) Intrathecal (around the spinal cord) -drugs injected into subarachnoid space
e) Intra-arterial-drug injected into the arteries
f) Intra-medullary-drugs injected into the bone marrow.
g) Intraarticular-drug administered into the joint cavity.
3. General anaesthetics may be given through inhalation.

4. Some drugs are administered through drug-filled patches that stick to the skin. The drug is then slowly released from the patch and
enters the body through the skin.
5. Administered topically that is, applied directly to the skin; or rectally absorbed through an enema (an injection of liquid into the rectum) or
a rectal suppository (a pellet of medication that melts when inserted in the rectum.
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f) Accuracy of dosage required (intravenous and inhalational can provide fine tuning).
g) Condition of the patient (unconscious, vomiting).
Intravenous (in a vein) -drug given directly into the vein. This route assures quick distribution through the blood stream and a rapid effect.
d) Intrathecal (around the spinal cord) -drugs injected into subarachnoid space
e) Intra-arterial-drug injected into the arteries
f) Intra-medullary-drugs injected into the bone marrow.
g) Intraarticular-drug administered into the joint cavity.

Take Note
From its site of administration, drugs are absorbed into the bloodstream and distributed throughout the body to various tissues and organs. As the
drug is metabolized, or broken down and used by the body, it goes through chemical changes that produce metabolites, and its metabolites are
eliminated by the body.
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Drug abuse is characterized by:
a) Taking more than recommended dose of prescription drug such as depressants without medical supervision, or using government-controlled
substances such as marijuana, cocaine, heroin, or other illegal substances.
b) Abusing Legal substances such as alcohol and nicotine.
c) Abuse of drugs and other substances can lead to physical and psychological dependence.
Drug abuse can cause a wide variety of adverse physical reactions;
i. Long term drug use may damage the heart, liver, heart and brain.
ii. Drug abusers may suffer from malnutrition if they habitually forget to eat, cannot afford to buy food or eat foods lacking the proper vitamins
and minerals.
iii. Individuals who abuse injectable drugs risk contracting infections such as hepatitis and HIV from contaminated needles shared with other
infected abusers.
iv. One of the most dangerous effects of illegal drugs use is the potential for overdosing. A drug overdose may cause an individual to lose
consciousness and to breathe inadequately.
v. Without treatment the individual may die
Successful treatment methods may vary and include psychological counselling, or psychotherapy, and detoxification programs which are
medically supervised to gradually wean an individual from a drug over a period of days or weeks. Detoxification and psychotherapy are often
used together.
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i. Irresponsible behaviour
ii. Mental illness
iii. Addiction
iv. School dropouts
v. Pregnancy
vi. Increase in crime.
vii. Lack of social interaction
viii. Abortions
ix. Spread of HIV and other STDs/STIs through casual sex.
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i. Shared needles/syringes for use in drug application can carry HIV and hepatitis viruses. Infected blood drawn into the needle is injected
along with the drug by the next user.
ii. Drug use is linked with unsafe sexual activity.
iii. A lot of people believe that sex and drugs (e.g. alcohol) should go together.
iv. Others claim that sexual activity is more enjoyable when they are using drugs.
v. Drug use including alcohol increases the chance of not using protection during sex, leading to acquiring/ transmitting HIV/AIDS.
vi. A lot of drugs interfere with the proper functioning of the antiviral drugs.
vii. One who is a drug addict might forget to take his/her ARV therapy- leading to delay in treatment and increment of viral load.
viii. There may be overload which may be fatal.
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7.10. Summary
Drugs are as old as mankind. We come to this world with the help of drugs and we also die with the help of drugs too. The sources of drugs
include plants, animals, minerals, microorganisms and some drugs are obtained from genetic engineering. Drugs are administered into our
bodies through various routes, such as oral (swallowing) and parenteral routes (e.g. injections). Drugs are used for various reasons among then
curative, alleviation pain, diagnostic and pleasure. Drugs can also be abused and have far reaching effects.
129 of 180 01/12/2022, 10:29

Session 7 Quiz
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1. Bartlett JG, Redfield RR, Pham PA (2019). Bartlett's Medical Management of HIV Infection 17th Edition. Oxford University Press. ISBN-13:
978-0190924775.
2. Richard Wilson, Cheryl Kolander (2013). Drug Abuse Prevention: A School and Community Partnership. ISBN-10: 1285070275 and
ISBN-13: 978-1285070278
3. Substance Abuse and Mental Health Services Administration (U.S.) (Center for Substance Abuse Treatment (U.S.) (2012). Substance
Abuse Treatment for Persons with HIV/AIDS (Treatment Improvement Protocol (Tip)). ISBN-13: 978-0160915154.
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8. Learning Outcomes
1. Define the term drug and drug abuse
2. Describe the classification of drugs
3. Describe the mode of drug administration
Explain the role of drugs abuse in the spread of HIV/AIDS
Definition of terms
Let us commence this discussion by asking ourselves this question.
Question
Differentiate between drugs and drug abuse.
Great!!!, I trust that you have differentiated the two by stating that a drug is any substance that affects the functioning of living cells,
used in medicine to diagnose, cure, prevent the occurrence of diseases and disorders, and/ or prolong the life of patients with
incurable conditions. On the other hand, drug abuse is the use of illegal drugs or the use of prescription or over-the-counter drugs for
purposes other than those for which they are meant to be used, or in large amounts. Drug abuse may lead to social, physical,
emotional, and job-related problems.
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Drugs can be classified in many ways:
i. The way they are dispensed, e.g., Over –The –Counter (OTC) or By prescription
ii. The substance from which they are found e.g., Plants, Animals, Microrganisms, Minerals
iii. The form they take e.g., Tablet, Capsule, Liquid, Gas
iv. The way they are administered e.g., By mouth, Injection, Inhalation, Direct application to the skin (absorption)
v. The way they act against diseases or disorders e.g., Chemotherapeutic drugs (attack specific organisms that cause a disease
without harming the host) or Pharmacodynamic drugs (alter the function of the bodily systems by stimulating or depressing normal cell activity
in a given system).
vi. Its effect on a particular area of the body or a particular condition (most common way to categorize drugs) e.g., Endocrine
drugs (drugs that correct the overproduction or underproduction of body’s natural hormones), Anti-infection drugs (include drugs which are
classified as antibacterial, antiviral, or antifungal depending on type of micro-organism they combat. Anti-infection drugs interfere selectively with
the functioning of a micro-organism while leaving the human host unharmed), Cardiovascular drugs (drugs that affect the heart and blood
vessels and are divided into categories according to function, e.g., Antihypertensive drugs reduce blood pressure by dilating blood vessels and
reducing the amount of blood pumped by the heart into the vascular system. Anti-arythmic drugs normalize irregular heartbeats and prevent
cardiac malfunction and arrest).
Drugs that affect the blood-e.g. antianemic such as vitamins or iron, enhance the formation of red blood cells. Anticoagulants like heaparin
reduce blood-clot formation and ensure free blood flow through major organs in the body. Thrombolytic drugs dissolve blood clots which can
block blood vesels and deprive the heart or brain of blood and oxygen, possibly leading to heart attack or stroke.
Central nervous system drugs-Affect the spinal cord and the brain and are used to treat several neurological (nervous system) and psychiatric
problems. For example;
a) Antiepileptic Drugs-Acetazolamide, carbamazepine
b) Antipsychotic Drugs -alleviate hallucinations and other abnormal behavior).
c) Antidepressants drugs -reduce mental depression.
d) Antimantic Drugs-reduce excessive mood swings in people with manic depressive illness.
e) Antianxiet drugs- (also referred to as tranquillizers)-treat anxiety by depressing the activity in the activity centres of the brain.
f) Sedative-hypnotic drugs are used both as sedatives to reduce anxiety and as hypnotic to induce sleep. Sedative-hypnotic drugs act by
reducing brain-cell activity.
g) Stimulatory drugs-Increase neuronal (nerve) activity and reduces fatigue and appetite.
h) Analgesic drugs-reduce pain and are generally categorized as narcotics and non-narcotics. Narcotic analgesics (opioids) include opium and
the natural opium derivatives codeine and morphine, synthetic derivatives of morphine such as heroin and synthetic drugs such as meperidine
and propoxyphene hydrochloride. Narcotics relieve pain by acting on specific structures, called receptors, located on the nerve cells of the spinal
cord or brain. Non-narcotic analgesic such aspirin, acetaminophen and ibuprofen reduce pain by inhibiting the formation of nerve impulses at the
site of pain. Some of these drugs can also reduce fever and inflammation.
i) General anaesthetics- used for surgery or painful procedures, depress brain activity, causing a loss of sensation throughout the body and
unconsciousness. Local anaesthetics are directly applied to or injected in a specific area of the body, causing a loss of sensation without
unconsciousness; they prevent nerves from transmitting impulses signalling pain.
j) Anticancer drugs-eliminate some cancers or reduce their rapid growth and spread and are specific to certain cancers.
vii. Drugs are also classified by their names. All drugs have three names:
a) A chemical name-which describes the exact structure of the drug.
b) A generic or proprietary name- which is the official medical name assigned by regulatory bodies, e.g., paracetamol
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c) A brand or trade name-given by the particular manufacturer that sells the drug, e.g. Panadol
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8.2. Factors leading to high incidences of premarital activity
Some of the factors that lead to high incidences of premarital activity includes;
1. Peer pressure among the youth
i. You will become sterile if you don’t play sex
ii. A woman will get problems when giving births later in her life if she does not start having sex early
iii. Everyone is doing it, why not me.
iv. You prove that you are normal through sex
v. Competition
vi. Influence of alcohol and drugs
vii. Commercial sex workers
viii. Ignorance.
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f) Accuracy of dosage required (intravenous and inhalational can provide fine g) Condition of the patient (unconscious, vomiting).uning).
d) Intravenous (in a vein) -drug given directly into the vein. This route assures quick distribution through the blood stream and a rapid effect.
e) Intrathecal (around the spinal cord) -drugs injected into subarachnoid space
f) Intra-arterial-drug injected into the arteries
g) Intra-medullary-drugs injected into the bone marrow.
h) Intraarticular-drug administered into the joint cavity.

Take Note
From its site of administration, drugs are absorbed into the bloodstream and distributed throughout the body to various tissues and organs. As the
drug is metabolized, or broken down and used by the body, it goes through chemical changes that produce metabolites, and its metabolites are
eliminated by the body.
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Drug abuse is characterized by:
a) Taking more than recommended dose of prescription drug such as depressants without medical supervision, or using government-controlled
substances such as marijuana, cocaine, heroin, or other illegal substances.
b) Abusing Legal substances such as alcohol and nicotine.
c) Abuse of drugs and other substances can lead to physical and psychological dependence.
Drug abuse can cause a wide variety of adverse physical reactions;
i. Long term drug use may damage the heart, liver, heart and brain.
ii. Drug abusers may suffer from malnutrition if they habitually forget to eat, cannot afford to buy food or eat foods lacking the proper vitamins
and minerals.
iii. Individuals who abuse injectable drugs risk contracting infections such as hepatitis and HIV from contaminated needles shared with other
infected abusers.
iv. One of the most dangerous effects of illegal drugs use is the potential for overdosing. A drug overdose may cause an individual to lose
consciousness and to breathe inadequately.
v. Without treatment the individual may die
Successful treatment methods may vary and include psychological counselling, or psychotherapy, and detoxification programs which are
medically supervised to gradually wean an individual from a drug over a period of days or weeks. Detoxification and psychotherapy are often
used together.
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i. Irresponsible behaviour
ii. Mental illness
iii. Addiction
iv. School dropouts
v. Pregnancy
vi. Increase in crime.
vii. Lack of social interaction
viii. Abortions
Spread of HIV and other STDs/STIs through casual sex.
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i. Shared needles/syringes for use in drug application can carry HIV and hepatitis viruses. Infected blood drawn into the needle is injected
along with the drug by the next user.
ii. Drug use is linked with unsafe sexual activity.
iii. A lot of people believe that sex and drugs (e.g. alcohol) should go together.
iv. Others claim that sexual activity is more enjoyable when they are using drugs.
v. Drug use including alcohol increases the chance of not using protection during sex, leading to acquiring/ transmitting HIV/AIDS.
vi. A lot of drugs interfere with the proper functioning of the antiviral drugs.
vii. One who is a drug addict might forget to take his/her ARV therapy- leading to delay in treatment and increment of viral load.
viii. There may be overload which may be fatal.
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8.8. Summary
Drugs are as old as mankind. We come to this world with the help of drugs and we also die with the help of drugs too. The sources of drugs
include plants, animals, minerals, microorganisms and some drugs are obtained from genetic engineering. Drugs are administered into our
bodies through various routes, such as oral (swallowing) and parenteral routes (e.g. injections). Drugs are used for various reasons among then
curative, alleviation pain, diagnostic and pleasure. Drugs can also be abused and have far reaching effects.
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8.9. Session 8 Quiz
Session 8 Quiz
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8.10. 7.9 References and Further Readings
1. Bartlett JG, Redfield RR, Pham PA (2019). Bartlett's Medical Management of HIV Infection 17th Edition. Oxford University Press. ISBN-13:
978-0190924775.
2. Richard Wilson, Cheryl Kolander (2013). Drug Abuse Prevention: A School and Community Partnership. ISBN-10: 1285070275 and
ISBN-13: 978-1285070278
Substance Abuse and Mental Health Services Administration (U.S.) (Center for Substance Abuse Treatment (U.S.) (2012). Substance Abuse
Treatment for Persons with HIV/AIDS (Treatment Improvement Protocol (Tip)). ISBN-13: 978-0160915154.
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9. YOUTH SEXUALITY AND HIV/AIDS
Introduction
Welcome to the eighth lecture session in HIV/AIDS awareness, prevention and management. In this session, we shall differentiate
between sex and sexuality, explore the reasons why we focus on the youths, describe the challenges that youths face on sexuality and
HIV. Finally, the session will explore on the factors leading to high incidences of premarital activity
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1. Explain the differences between sex and sexuality.
2. Explain reasons why we focus on the youths
3. Describe the challenges that youths face on sexuality and HIV
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9.2. Definition of key terms
Sex: It is biologically determined state of being female or male. On the other hand, sexuality is a condition of having sex or sexual activity or
interest especially when it is excessive.
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9.3. HIV/AIDS and Youth
Young people’s risk of becoming newly infected with HIV is closely correlated with age of sexual debut. Abstinence from sexual intercourse and
delayed initiation of sexual behavior are among the central aims of HIV prevention efforts for young people. Decreasing the number of sexual
partners and increasing access to, and utilization of comprehensive prevention services, including prevention education and increasing access to
condoms are essential for young people who are sexually active.
Take Note
The vulnerability of youth to HIV infection, defined by the United Nations and the World Bank as persons between the ages of 15 and 24 years
(World Bank 2011), has been receiving greater attention recently after years of neglect (UNAIDS 2012). The fact that nearly half of all new HIV
infections worldwide occur in this age group indicates that youth may be central to the dynamics of the epidemic.
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9.4. Challenges youth face on sexuality and HIV
Some of the challenges that youths face on sexuality and HIV includes;
i. Premarital Sex- Incidences of premarital sex have increased in the few days.
ii. Number of partners- Nearly one-quarter (24%) of male students who had sexual contact with other males reported sexual intercourse
with 4 or more persons during their life, compared to 10% of all students. The more sexual partners you have, the more likely you are to have sex
with someone who has HIV and doesn’t know it.
iii. Limited access to health care and services-Youth are marginalized duet lack of resources, lack of confidentiality, youth not to focus
on HIV, until after school.
iv. Low rates of condom use- There’s low condom usage among the youths. Using condoms, the right way can protect from HIV and
some sexually transmitted diseases (STDs).
v. Low rates of testing- Among male students who had sexual contact with other males, only 15% have ever been tested for HIV. Low
rates of testing mean more young people have undiagnosed HIV. People who do not know they have HIV cannot take advantage of HIV care and
treatment and may unknowingly transmit HIV to others
vi. Drug and substance abuse-Promiscuity, rape and coerced sex is increased with drugs and alcohol use
vii. Abortion-We are concerned with unhygienic abortion, use of unsafe instruments resulting to death, infertility, chronic ill-health, e.g.,
HIV/AIDs
viii. Adolescent pregnancy and childbearing- Pregnancy and HIV/AIDs are consequences of sexual activity.
ix. Sexual abuse and coercion- pressure and dangers for young girls are many
x. Female genital mutilation-The concern is when it is done in unhygienic conditions it increases the chances of infection.
xi. Male circumcision- Tradition way of doing it should be discouraged as it predisposes some to HIV infection
xii. Sexual education-education seeks to reduce the risks of potentially negative outcomes from sexual behavior by developing young
people’s ability to make decisions over their entire life.
xiii. High rates of STDs/STIs- Some of the highest STD rates are among youth aged 20 to 24, especially youth. Having another STD can
greatly increase the chance of getting or transmitting HIV
xiv. Stigma and misperceptions about HIV- Stigma and misperceptions about HIV negatively affect the health and well-being of young
people, and may prevent them from testing, disclosing their HIV status, and seeking HIV care.
xv. Feelings of isolation- High school students may engage in risky sexual behaviors and substance misuse because they feel isolated
from family or peers and lack support. This is especially true for gay and bisexual students who are more likely than heterosexual youth to
experience rejection, bullying, and other forms of violence, which also can lead to mental distress and engagement in risk behaviors that are
associated with getting HIV.
xvi. Low rates of pre-exposure prophylaxis (PrEP) use- A 2018 study found that young people are less likely than adults to use medicine
to prevent HIV. Barriers include cost, access, perceived stigma, and privacy concerns.
xvii. Socioeconomic challenges for young people with HIV-. Among people with HIV who are receiving medical care, young people aged
18 to 24 are more likely than older people to be living in households with low income levels, to have been recently homeless, recently
incarcerated, or uninsured. All of these factors pose barriers to achieving viral suppression and highlight the need for youth-specific support for
HIV care retention and medication adherence.
xviii. Older partners- Research has also shown that young gay and bisexual men who have sex with older partners are at greater risk for
HIV infection. This is because an older partner is more likely to have had more sexual partners or other risks and is more likely to have HIV
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9.5. Summary
Young people represent a growing share of people living with HIV worldwide. There are many factors that put young people at an elevated risk of
HIV. Adolescence and early adulthood is a critical period of development when significant physical and emotional changes occur. Adolescents
and young people have growing personal autonomy and responsibility for their individual health. The transition from childhood to adulthood is
also a time for exploring and navigating peer relationships, gender norms, sexuality and economic responsibility.
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9.6. Session 9 Quiz
Session 9 Quiz
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1. Avert (2020). Young people, HIV and AIDS. https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/young-people
2. Ross MW (2012). HIV/AIDS and Sexuality 1st Edition. Routledge. ISBN-13: 978-1560247302.
Mohammed SA (2011). Gender Differentials in Youth Sexuality and Vulnerability to HIV/AIDS: In the Case of Burayu Zone, Oromia Regional
States, Ethiopia. LAP LAMBERT Academic Publishing. ISBN-13: 978-3846512654
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10. GOVERNMENT POLICIES AND RESPONSES TO HIV/AIDS PANDEMIC
Introduction
Welcome to the ninth lecture session in HIV/AIDS awareness, prevention and management. In this session, we shall cover the government
policies and the responses to HIV/AIDS pandemic.
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1. Describe the global policies on HIV/AIDS
2. Explain the international responses to the HIV/AIDS pandemic
Discuss Kenya’s response to the pandemic
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10.2. Global policies on HIV/AIDS
Let u
Activity
1: Identify the various policies that have been enacted worldwide in relation to HIV/AIDS.
A policy is a progam of actions adopted by an individual group or government or the set of principles on which actions are based.
The United Nations AIDS (UNAIDS) and United Nation High Commission for Human Rights (UNHCHR) have set policies to assist states in
translating human right values into practical observation in the context of HIV/AIDs. The policies are in two parts as follows:
1. Guidelines on action oriented measures to be employed by governments in the areas of law, administrative policy and practice that will
protect human rights and achieve HIV related public goals.
2. Principles of human rights underlying the positive response to the pandemic.
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10.3. The Guidelines
That there will be:
i. National frameworks in response to HIV/AIDs
ii. Political and financial support in consultation with communities in response to HIV/AIDs
iii. Address on public health issues related to HIV/AIDs, e.g., tuberculosis
iv. No criminal law violations in the context of HIV/AIDs
v. No discrimination/vulnerability to discrimination in both public/ private sectors based on HIV/AIDs.
vi. Availability of qualitative preventive measures and services at an affordable price.
vii. Education of people affected by HIV/AIDs- about their rights, including free legal services.
viii. Supporting and enabling environment for women, children and other vulnerable groups.
ix. Wide spread education through training and media programmes designed to change stigmatization associated with HIV/AIDs.
x. Translation of human rights to code of conduct regarding HIV/AIDS issues.
xi. Guaranteed protection to HIV/AIDs infected people, families and communities.
xii. That are most relevant to HIV/AID
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10.4. Human rights principle relevant to HIV/AIDs
i. Countries have an obligation to respect, protect and fulfil all human rights including HIV/AIDs related human rights (NACC, 2002
ii. Human right principles that are most relevant to HIV/AIDs include the right to :
a) Non-discriminative, equal protection and equality before the law
b) Life
c) The highest attainable standard of physical and mental health.
d) Liberty and security of all persons
e) Freedom of movement
f) Freedom of association
g) Seek and enjoy asylum
h) Privacy
i) Freedom of opinion and expression and the right to freely receive and impart information.
j) Freedom of association
k) Marry and find a family
l) Work
m) Equal access to education
n) Share in scientific advancement and its benefits
o) Be free from torture and cruelty, inhuman and degrading treatment or punishment among others
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10.5. International responses to the HIV/AIDS pandemic
International efforts to combat HIV began in the first decade of the epidemic with the creation of the WHO’s Global Programme on AIDS in 1987.
The initial global response to HIV focussed on prevention through behaviour change and research into a vaccine. However, it became clear that
knowledge of transmission was not enough to stop the epidemic. Over time, new initiatives and financing mechanisms have helped increase
attention to HIV and contributed to efforts to achieve global goals; these include:
i. The Joint United Nations Programme on HIV/AIDS (UNAIDS), which was formed in 1996 to serve as the U.N. system’s coordinating
body and to help galvanize worldwide attention to HIV/AIDS; and
ii. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), which was established in 2001 by a U.N. General Assembly
Special Session (UNGASS) on HIV/AIDS as an independent, international financing institution that provides grants to countries to address HIV,
TB, and malaria.
The contributions of affected country governments and civil society have also been critical to the response. These and other efforts work toward
achieving major global HIV/AIDS goals that have been set through:
i. Activism and Innovation: In 2000, civil society groups, activists and people living with HIV (PLHIV) protested high HIV drug prices. The
worldwide activism led to the availability of generic quality ART at about 350 USD/year/person. At the same time the Global Fund for AIDS,
malaria and tuberculosis was created to combat these three deadly diseases.
ii. The Sustainable Development Goals (SDGs). Adopted in 2015, the SDGs aim to end the AIDS epidemic by 2030 under SDG Goal 3,
which is to “ensure healthy lives and promote well-being for all at all ages.” The SDGs are the successor to the Millennium Development Goals
(MDGs), which included an HIV target under MDG 6: to halt and begin to reverse the spread of HIV/AIDS by 2015 and achieve universal access
to treatment for HIV/AIDS by 2010. As of 2015, the AIDS-related targets of MDGs were met.
iii. UNAIDS targets to end the epidemic by 2030. On World AIDS Day 2014, UNAIDS set targets aimed at ending the AIDS epidemic by
2030. To achieve this, countries had been working toward reaching the interim “90-90-90” targets – 90% of people living with HIV knowing their
HIV status; 90% of people who know their HIV positive status on treatment; and 90% of people on treatment with suppressed viral loads—by
2020. However, gains that were achieved in some countries and regions were unequal, and these targets were missed. Based on the 2019 data
and trends, 25 81% of people living with HIV knew their status; among those who knew their status, 82% were accessing treatment; and among
those accessing treatment, 88% were virally suppressed. The focus now is on reaching “95-95-95” (or, 95% of people living with HIV knowing
their HIV status; 95% of people who know their HIV positive status on treatment; and 95% of people on treatment with suppressed viral loads).
Additional interim targets have also been set for 2025, which place a greater emphasis on societal aspects and social services to address the
inequalities of HIV.
At the June 2016 U.N. General Assembly High-Level Meeting on Ending AIDS, world leaders adopted a new Political Declaration that reaffirmed
commitments and called for an intensification of efforts to end AIDS by 2030. In 2017, a report of the U.N. Secretary-General emphasized these
commitments, calling for the global community to reinvigorate global efforts to respond to AIDS
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10.6. Kenya’s response to the pandemic
The Kenya Government is responding on controlling the spread of HIV/AIDS (strategies the government has taken to reduce spread of HIV/AIDs
1. Organizing HIV/AIDS seminars and workshops where people discuss and come up with solutions.
2. Mainstreaming HIV/AIDs lesson in the formal education system, i.e. introducing HIV/AIDS in the syllabus.
3. De-stigmatization campaigns by creating awareness about HIV i.e. how it spreads and cannot spread
4. Free distribution of condoms.
5. Provision of treatments to HIV/AIDS patients i.e., give ARVs and drugs
6. Provision of VCT centers which are easy to reach.
7. Discouragement of detrimental social cultural practices e.g. FGM and unsafe male circumcision, early marriages and forced marriages
8. Gender advocacy on female gender so that they become empowered
9. Poverty eradication-the government has introduced Constituency Development Fund (CDF), Youth Enterprise Funds (YEF).
Public Education campaigns e.g., using media e.g., “Mpango wa kando
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10.7. Objectives of HIV/AIDs Prevention and Control ACT
1. Promote public awareness about the causes, mode of transmission, consequences, means of prevention and control of HIV/AIDS.
2. Extend full protection of human rights and civil liberties to every person suspected or known to be with HIV/AIDS.
3. Prohibiting compulsory HIV testing save as provided in the ACT.
4. Guaranteeing the right to privacy of the individual.
5. Outlawing discrimination in all its forms against persons with or persons perceived or suspected of having HIV/AIDS.
6. Ensuring the provision of basic health and social services for people infected with HIV/AIDS.
7. Promote utmost safety and universal precaution in practices and procedures that carry the risk of HIV transmission.
8. Positively address and seek to eradicate conditions that aggravate the spread of HIV infection
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10.8. Summary
Laws and policies that protect against discrimination based upon HIV status or health status more generally have been widely enacted. These
laws are embodied in antidiscrimination provisions found in international conventions and agreements, national constitutions and laws, and
multiple court decisions affirming that arbitrary discrimination is wrong and damaging to society. Additionally, over the years, major global efforts
have been mounted to address the epidemic, and significant progress has been made.
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Session 10 Quiz
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1. Mhlanga SSG (2021). HIV/AIDS Dilemma!: Christian Response to HIV/AIDS. Westbow Press. ISBN-13: 978-1664218192
2. HIV.gov (2017). Activities Combating HIV Stigma and Discrimination.
https://www.hiv.gov/federal-response/federal-activities-agencies/activities-combating-hiv-stigma-and-discrimination
Liamputtong P (2015). Stigma, Discrimination and Living with HIV/AIDS: A Cross-Cultural Perspective. Springer. ISBN-13: 978-9400793316.
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11. PREGNANCY AND HIV/AIDS
Introduction
Hello, welcome to the tenth lecture session in HIV/AIDS awareness, prevention and management. This session, shall cover the effects
of HIV/AIDS in pregnancy, factors affecting mother-to-child transmission of HIV and the interventions laid down in order to prevent
mother-to-child transmission of HIV
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11.1. Learning Outcome
1. Describe the effects of HIV/AIDS in pregnancy
2. Identify the factors affecting mother-to-child transmission of HIV
Explain interventions to prevent mother-to-child transmission of HIV
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11.2. Effects of HIV/AIDS in pregnancy
In pregnancy, immune function is suppressed in both HIV-infected and uninfected women. There is a decrease in immunoglobulin, reduced
complement levels in early pregnancy and a more significant decrease in cell-mediated immunity during pregnancy. These normal changes
during pregnancy have led to concern that the effect of pregnancy in HIV disease could be to accelerate the progression of the infection.
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11.3. Factors affecting mother-to-child transmission of HIV
Viral factors
Viral load Transmission is increased in the presence of high levels of maternal viraemia. An association has been shown between the
maternal viral load and the risk of transmission from mother to child. More than half of the women with viral loads of >50 000 RNA
copies per ml at the time of delivery have been shown to transmit the virus. Few studies have shown a threshold viral load for
transmission and it appears that it can occur at low viral levels, for reasons which are not well understood, but which probably reflect
the multiple influences acting on mother-to-child transmission. The local viral load in cervico-vaginal secretions and in breast milk may
also be an important determinant of transmission risk intrapartum and through breastfeeding.
Maternal Factors
Maternal antiretroviral therapy during pregnancy is thought to reduce transmission partly through the reduction of
viral load. Maternal immunological status Transmission from mother to child is more likely with decreased maternal
immune status, reflected by low CD4+ counts, low CD4+ percentages. Maternal nutritional factors Serum Vitamin A
levels in HIV positive mothers have been correlated with the risk of transmission. Several behavioural factors have
been associated with an increased rate of transmission from mother to child. These include cigarette smoking and
maternal hard drug use.
Unprotected sexual intercourse during pregnancy has been linked to an increased risk of mother to-child
transmission. Placental factors have also been implicated in transmission of the virus from mother to child.
Placental infection with HIV-1 has been reported and Hofbauer cells and possibly trophoblasts express CD4+ and are
thus susceptible to infection.
Obstetrical factors
The majority of mother-to-child transmission occurs at the time of labour and delivery and therefore obstetric factors
are important determinants of transmission. Suggested mechanisms for intrapartum transmission of HIV include
direct skin and mucous membrane contact between the infant and maternal cervico-vaginal secretions during
labour, ingestion of virus from these secretions, and ascending infection to the amniotic fluid. HIV in cervico-vaginal
secretions may be raised four-fold during pregnancy. The higher rate of infection in firstborn twins may be due to
longer exposure of the infants to infected secretions. Several obstetric factors are related to transmission risk and
these include preterm delivery, intrapartum haemorrhage and obstetric procedures.
Other factors such as the use of fetal scalp electrodes, episiotomy, vaginal tears and operative delivery have also
been implicated. The duration of labour does not appear to be as important as the duration of rupture of membranes.
Prolonged rupture of membranes has been associated with increased risk of transmission. Duration of ruptured
membranes of over four hours nearly doubled the risk of infection, regardless of the eventual mode of delivery.
Delivery by caesarean section has been shown to be protective
Fetal factors
Fetal genetic factors may play a part in transmission. Little is known yet about the role of genetic factors. Preterm
infants have higher reported rates of transmission. Women with low CD4+ counts are more likely to have preterm
deliveries. The higher rates of infection seen in first-born twins have been widely reported and have formed part of
the evidence for the role of intrapartum transmission. This effect is more pronounced in vaginally delivered twins,
where a two-fold increase in infection is seen in first born twins than second born, but is also present in twins
delivered by caesarean section. Other fetal factors may include co-infection with other pathogens, fetal nutrition
and fetal immune status.
Infant factors
Mixed breastfeeding is responsible for a high proportion of mother-to-child transmission in developing countries
where 30% or more of perinatal HIV infections will occur through breast milk. This is less common in the developed
world, where most HIV-positive women will not breast feed. Breast milk contains both cell associated and free virus,
the amount of which may be related to the immune suppression of the mother and vitamin A levels. Late postnatal
transmission, after the age of six months, has been described in a number of studies. The risks of postnatal
transmission may also be related to other factors in the newborn. HIV entry may occur through the gastro-intestinal
tract following ingestion of virus in utero or at birth. There is decreased acidity, decreased mucus, and thinned
mucosa in the newborn gastro-intestinal tract, which may facilitate transmission. The newborn immune system may
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also be deficient in macrophage and T cell immune response increasing the susceptibility to infection.
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11.4. Interventions to prevent mother-to-child transmission of HIV
With increasing knowledge about the underlying mechanisms of mother-to-child transmission of HIV has come as an increased emphasis on the
search for interventions to prevent or reduce the risk of transmission. A number of possible intervention strategies that have been proposed or are
under investigation include the following:
i. Behavioural interventions: Avoid being infected by other HIV strains, avoidance of drug use and smoking in pregnancy
ii. Therapeutic interventions: Antiretroviral therapy: e.g. use of HAART, niverapine or short-course Vitamin A and other micronutrients
Treatment of STD
iii. Obstetric interventions: Caesarean section delivery, Avoidance of assisted delivery & Birth canal cleansing
iv. Modification of infant feeding practice Avoidance of mixed feeding
v. Nutritional interventions: A health balanced diet; Exclusive breast feeding; Avoidance of mixed feeding.
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11.5. Summary
In this session we have covered that in pregnancy, immune function is suppressed in HIV-infected women. We have also looked at the factors
affecting mother-to-child transmission of HIV. These factors include viral, maternal, infant and fetal factors. A number of intervention strategies
were also covered among them behavioural interventions, antiretroviral therapy obstetric interventions and modification of infant feeding
practices.
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Session 11 Quiz
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1. CDC (2021). HIV and Pregnant Women, Infants, and Children. https://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html
2. Cader R (2015). HIV/AIDS During Pregnancy with Parenting a Child with HIV/AIDS Box Set Collection Kindle Edition
Hollen CV (2013). Birth in the Age of AIDS: Women, Reproduction, and HIV/AIDS in India 1st Edition. Stanford University Press. ISBN-13:
978-0804784238
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12. DISCRIMINATIONS & STIGMATIZATION ON HIV/AIDS, AND LEGAL RIGHTS OF AIDS PATIENTS
Introduction
Welcome to the eleventh lecture session in HIV/AIDS awareness, prevention and management. The session, shall cover in detail types
of discrimination and stigmatization the persons living with HIV/AIDS experiences and also it would provide an in-depth analysis of the
legal rights for persons living with HIV/AIDS.
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Session 12 Quiz
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1. Discuss the discrimination and stigmatization associated with HIV/AIDS
2. Explain the factors that contribute to HIV/AIDS related stigma
Describe the legal rights of a person living with HIV/AIDS
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12.3. Discriminations & stigmatization on HIV/AIDS
The London Declaration on AIDS Prevention following the World Summit of Ministers of Health on Programmes for HIV Prevention in January
1988 was one of the first international statements to recognize that discrimination against, and stigmatization of, HIV-infected people and people
with AIDS and population groups undermine public health and must be avoided. Discrimination and stigmatization of persons infected with
HIV/AIDS can take different forms, some of these forms are outlined below
Forms of discriminations & stigmatization on HIV/AIDS
Self stigma on HIV/AIDS
Self-stigma, or internalized stigma, has an equally damaging effect on the mental wellbeing of people living with HIV or from key affected
populations. This fear of discrimination breaks down confidence to seek help and medical care. Self-stigma and fear of a negative community
reaction can hinder efforts to address the HIV epidemic by continuing the wall of silence and shame surrounding the virus. Negative self-
judgement resulting in shame, worthlessness and blame represents an important but neglected aspect of living with HIV. Self-stigma affected a
person's ability to live positively, limits meaningful self-agency, quality of life, adherence to treatment and access to health services.
Social stigma on HIV/AIDS
Community-level stigma and discrimination towards people living with HIV can force people to leave their home and change their daily activities.
In many contexts, women and girls often fear stigma and rejection from their families, not only because they stand to lose their social place of
belonging, but also because they could lose their shelter, their children, and their ability to survive. The isolation that social rejection brings can
lead to low self-esteem, depression, and even thoughts or acts of suicide
In the workplace, people living with HIV may suffer stigma from their co-workers and employers, such as social isolation and ridicule, or
experience discriminatory practices, such as termination or refusal of employment. Evidence from the People Living with HIV Stigma Index
suggests that, in many countries, HIV-related stigma and discrimination are as frequently or more frequently a cause of unemployment or a denial
of work opportunity as ill health.
Healthcare stigma on HIV/AIDS
Healthcare professionals can medically assist someone infected or affected by HIV, and also provide life-saving information on how to prevent it.
However, HIV-related discrimination in healthcare remains an issue and is particularly prevalent in some countries. It can take many forms,
including mandatory HIV testing without consent or appropriate counselling. Health providers may minimize contact with, or care of, patients living
with HIV, delay or deny treatment, demand additional payment for services and isolate people living with HIV from other patients.
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12.4. Factors contributing to HIV/AIDS related stigma
There are several factors contributing to HIV/AIDS-related stigma. These factors include:
i. The fact that HIV/AIDS is a life-threatening disease
ii. The fact that people are afraid of contracting HIV
iii. The disease’s association with behaviours (such as sex between men and injecting drug use) that are already stigmatized in many
societies
iv. The fact that people living with HIV/AIDS are often thought of as being responsible for having contracted the disease;
v. Religious or moral beliefs that lead some people to conclude that having HIV/AIDS is the result of a moral fault (such as
promiscuity or “deviant” sex) that deserves punishment.
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12.5. Legal rights of HIV/AIDS patients
Do persons living with HIV/AIDS have any legal rights? Let us review this question by first going through the following case study.
Case study
Kiongos lost his job as a truck driver because he could not keep awake during long journeys. His boss had noted that he had lost weight and said
that he coughed a lot. The boss requested that he visits a company doctor who tested him for HIV/AIDS without his knowledge and passed on
the results to the boss
i. Does Kiongos have any human rights and if so, which ones?
ii. Was the doctor assisting Kiongos in doing the HIV/AIDS test without his knowledge?
iii. In which ways would the boss and the doctor have assisted Kiongos ?
A persons living with HIV/AIDS are entitled to all the legal rights enjoyed by every human being. Under international human rights laws and
treaties, and international obligations such as the Universal Declaration of Human Rights and the 2030 Agenda for Sustainable Development,
every person has a right to health and to access HIV, and other healthcare services. People also have a right to equal treatment before the law
and a right to dignity.
The protection of human rights is essential to safeguard human dignity in the context of HIV/AIDS and to ensure an effective, rights-based
response. When human rights are protected, fewer people become infected and those living with HIV/AIDS and their families can better cope with
HIV/AIDS.
The Kenyan Bill of Rights lists fundamental rights of all people living in Kenya. Table 1 below explains some of the provisions particularly
important in the context of HIV/AIDS.
A Link to be Provided
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12.6. Summary
Myths and misinformation increase the stigma and discrimination surrounding HIV and AIDS. There is a cyclical relationship between stigma and
HIV; people who experience stigma and discrimination are marginalised and made more vulnerable to HIV, while those living with HIV are more
vulnerable to experiencing stigma and discrimination.
People living with HIV or AIDS have the same rights as the rest of the population The protection and promotion of human rights are essential in
preventing the spread of HIV and to mitigating the social and economic impact of the pandemic.
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Session 12 Quiz
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1. UNAIDS (2017). Make some noise for zero discrimination. https://www.unaids.org
2. Avert (2019). https://www.avert.org/human-rights-and-hiv
Republic of Kenya 2010 constitution.
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HIV AND AIDS AWARENESS AND MANAGEMENT BOOK https://elearning.tum.ac.ke/mod/book/tool/print/index.php?

HIV AND AIDS AWARENESS AND MANAGEMENT BOOK

Site: TUM E-Learning Portal Printed by: Agnes Kibira

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1. Introduction to the course

2. ORIGIN, CLASSIFICATION AND BIOLOGY OF HIV

3. HUMAN REPRODUCTIVE SYSTEM, IMMUNE SYSTEM

4. FACTORS CONTRIBUTING TO HIGH INCIDENCES OF HIV/AIDS

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4.3. Socio-cultural and economic factors

5. TRANSMISSION AND DIAGNOSIS OF HIV/AIDS

6. PREVENTION AND CONTROL OF HIV/AIDS

7. THE ROLE OF DRUGS IN THE SPREAD OF HIV/AIDS

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7.4. Classification of drugs

9. YOUTH SEXUALITY AND HIV/AIDS

10. GOVERNMENT POLICIES AND RESPONSES TO HIV/AIDS PANDEMIC

11. PREGNANCY AND HIV/AIDS

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1. Introduction to the course

First, let’s take a moment to explore the unit.

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1.1. Getting to know each other

Your task: Introduce yourself

Estimated study time: 10 minutes

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1.2. Course outline

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1.3. Learning outcomes for the course Unit

By the end of this course, you should be able to: -

i) Explain the ways of acquisition and spread of HIV and AIDS

ii) Disseminate correct and accurate information on HIV and AIDS

iii) Assess the impact of HIV and AIDS in Kenya

Continuous Assessments 30%

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1.5. Learning Outcomes for session 1

At the end of this course unit, you should be able to:

1. Explain the concept of HIV/AIDS

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1.6. Concepts of HIV/AIDS

Let us start our discussion by asking ourselves this question.

What is the meaning of the initials HIV/AIDs?

AIDS is specifically acquired and not inherited.

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1.7. Types of HIV Virus

There are two types of HIV virus:

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1.8. Overview of STIs/STDs

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It is possible to be infected with gonorrhoea and have no symptoms.

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1.11. Candidiasis (thrush)

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1.4.6 Chancroid (soft sores)

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