DS 113

Topic 5: HIV/AIDS and Its

Implications for
Development
 Objectives

By the end of this topic, the following sub-topic has to be

covered
Modes of transmission of HIV/AIDS
The link between HIV/AIDS and development
 The effect of HIV/AIDS on development
Examine factors which contribute to the spread of HIV/AIDS.
The strategies to alleviate HIV/AIDS
Introduction
 Introduction

 HIV/AIDS is a global health  HIV/AIDS affects

problem. East and Southen development issue as it:
Africa, the infection rate is Primarily affect most
approximated at 7% among productive people between
people of age group 15-49 15-49 years
years. This is the highest Erode human and
infection rate in the global. institutional capacities
Over 54% of the global Jeopardise/threaten the
infections are from SSA productive base of entire
countries. societies
The new HIV infections rate Leaving the very young and
estimated at 800,000/year, just elderly to feed for
under half of the global themselves
 Diagnosis and Symptoms
The first case of HIV/AIDS reported in the early 1981, Los
Angeles and New York-USA.
The reported in many palces of USA, Western Europe and
Africa
In 1983, it was described that the virus that causes AIDS
(acquired immunodeficiency syndrome) is HIV (human
immunodeficiency virus) (USA and France researcher's )
A person with AIDS is characterized with severe reduction in
CD4 cells, blood cell, important part of the immune system fight
against infections of the body.
When the immune system no longer functions effectively: a
person’s health fails, and a range of opportunistic infections
emerge, finally overwhelming the system.
 Diagnosis and Symptoms

In Tanzania, the first case was reported in Kagera region in

1983. since then, the diseases have spread all over the
country
The most common symptoms include rapid weight loss,
periodic fever, extreme and unexplained tiredness,
prolonged swelling of the lymph glands in the armpits,
groin, or neck, diarrhoea, sores of the mouth, anus, or
genitals, pneumonia and others
HIV/AIDS in Tanzania
 HIV/AIDS in Tanzania
The HIV affects all section of 72,000 are new infections
society- men, women, young,  24,000 deaths due to
elderly, etc. HIV/AIDS
The HIV prevalence is high 72% of adults and 65% of
among adult people aged children with HIV are in
between15-49 years. treatment (using ARV)
In Tanzania, the infection rate HIV affects all section of
estimated at 4.6%. society- men, women, young,
The highest prevalence rate elderly, etc. However, women
reported in Njombe with 11.4% group are the most vulnerable
and lowest in Kusini Unguja to HIV infections than their
and Kaskazini Pemba with less counterparts men
than 0.3%.
 HIV/AIDS in Tanzania
Why women are more vulnerable to HIV infections?
Women suffer the effects of gender inequality. In most
LMICs, about 30% of married women or in a long-term
relationship experiences physical or sexual violence from
a male intimate partner. This reduces women’s ability to
prevent their partner from having other sexual
relationships or negotiate condoms in relationship.
Women get married earlier to older male partners. Young
women are often unable to negotiate condom use due to
the unequal power balance in the relationships.
 Transmission of HIV/AIDS
HIV is present in blood andThe common ways in which
genital discharges of all HIV/AIDS is spreed include:
individuals infected with HIV Sexual Transmisson
regardless of whether or not Sharing needles and other
they have symptoms. sharp instruments
The spread of HIV can occur Transmisson from infected
when blood & genital mothers to newborn during
discharges come in contact pregnancy, labour (delivery
with tissues lining the vigina, process) or breastfeeding
anal areas, mouth or eyes Blood transfusion, the risk
(mucus membranes); a break is very low
in the skin such as from a cut
or puncture by a needle
 Sexual Transmission of HIV/AIDS
 Sexual transmission remains periods of:
the major mode of HIV  Physiological,
transmission where psychological and social
heterosexual and homosexual change
transmission is rapidly  Time related to
increasing in developing bahavioural
countries experimentation (including
Heterosexual sex accounts for sexuality & drug abuse)
the vast majority (80%) of HIV Sexual transmission of HIV
infections occurs through vaginal, anal
Half of those infected with and oral sex and can be
HIV worldwide are under transmitted from
the age of 25 (youths & Men to men
adolescents) Men to women
 Sexual transmission of HIV/AIDS
Sexual intercourse between The use of illegal drugs
adolescents bring about a /alcoholic may expose young
potential risk to HIV infections people to hazardous
A large number o adolescents intravenous drug abuse
do not protect themselves The best way to avoid sexual
during intercourse transmission
They do not protect their Self-denial from sex
sexual partners either The use of latex barriers
Sexually active men & women (involving condom use),
often change partners before Having single faithfull partner
the establish a family or long- relation
term relationships
Other modes of HIV/AIDS Transmission
Sharing needles or sharp However, in the household
instruments: context risks are asociated
Illegal drugs uses with sharing of toothbrushes &
Anabolic steroids to increase shaving razors. These can
muscles, tattooing and body cause bleeding and blood can
piercing contain large amounts of HIV
Traditional circumcision and Blood transfusion, however,
Female Genital Mutilations the risk is small because blood
(FGMs) is tested before transfusion
Casual exposure as might To prevent spread of HIV &
occur in household setting like other diseases
kissing (risky is very minimal
because of little HIV found in Stop sharing of needles and
saliva) sharp instruments
Health and Development
 Contribution of Health to Development
 Ill-health, due to infectious and chronic diseases, leads to
suffering, disability and premature death, affecting social and
economic development of a nation.
 The productivity of an individual depends greatly on his or her
health status. Therefore improving the health status of population
will contribute greatly towards achieving its development goals.
Proper investment in human resources largely depend on health
status of people. Healthier people are more likely to be capable in
acquiring knowledge and skills which had to be integrated well in
the course of production of goods and services.
 A country with great number of people with ill-health incur much
cost for medical treatment and other associated repercussions.
 Impact of HIV/AIDS in Development
 Reduction of labour power
 Increase of dependent ratio e.g. orphans and sick people who can
hardly engage in production activities. For example, in 2004 about 48%
of all orphans in Kenya were due to AIDS (Boutayeb, 2009)
 Treatment cost for HIV/AIDS infected people e.g. free provision of ARV
Reduced working time on production activities due to taking care of
people who are suffering from AIDS.
 Reduced labour productivity level of the HIV-infected people. For
example, according to Bollinger & Stover (1999) the annual costs
associated with sickness and reduced productivity due to HIV/AIDS
ranged from US Dollar 17 per employee in Kenya and US $ 300 in
Uganda.
 Impact of HIV/AIDS in Development
 Cost associated with disseminating of HIV/AIDS information e.g.
via TV programmes, radio etc.
 Costs associated with free provision of condoms
 HIV/AIDS lowers or reduces life expectancy among the African
countries. For example, between 2000 and 2005 HIV/AIDS
lowered life expectancy by 28 years in Botswana and Swaziland;
35 years in Zimbabwe and 24 years in Lesotho
Driving Forces for HIV/AIDS
 Driving Forces for HIV/AIDS
Sexual transmission account for over 80% of HIV/AIDS
infections.
The key factors which exacerbate the spread of HIV/AIDS
The economic factors
Social factors
Cultural factors
Political factors
Biological factors
Psychological factors
 Driving Forces for HIV/AIDS....1
1. Social-cultural factors: is unclean after burial ceremony
Inheriting widows e.g. among of her late husband.
the Kurya, Sukuma etc.  According to this ritual, in Malawi
widows are sexually unclean and won’t
 Sharing wives as it is practiced be re-married unless they are being
among the Maasai. cleaned by the so-called sex cleaners or
namandwa (Loosli, 2004)
 Forced marriage doesn’t give Malawi girls they are being cleansed
chance for HIV/AIDS testing. through sexual intercourse by the
traditionally selected men.
Initiation rites which are mainly This type of cleanliness prepares girls
centred on sexual orientations for adolescent stage i.e. from
like cleansing widows, girls e.g. childhood to adolescent stage
among the Sambaa, Ukara,
malawi etc.They believe, a widow
 Social-cultural factors...
Arranged sexual intercourse on the religious or leisure grounds.
basis of cultural practices so as to Home delivery among women.
get rid of problems or to prevent
recurrence of problems. Refer to Female Genital Mutilation (FGM)
BBC research report after the M.V. especially when a single unsterilized
Nyerere accident. tool (e.g. razorblade ) is used to
mutilate two or more girls.
Traditional dances which stimulate
sexual desires e.g. Kigodoro and
Chagulaga.
Negligence of undertaking
circumcision among men on cultural
grounds
Refusal of using condoms on
 Social-cultural factors...
Illiteracy and ignorance: SomeRaping of virgins as a cultural belief
people especially in the African for curing HIV/AIDS among societies in
societies they are not well informed some African countries such as Zambia,
about HIV/AIDS due to their inability to Zimbabwe, Nigeria, and mainly in South
grasp HIV/AIDS information conveyed Africa
via TV, newspapers, leaflets/brochuresHaving many sexual partners as
etc. For instance, The AIDS Foundation
(2001)reported that about 30% South
prestige among people especially
African women believe that if a man youths.
looks healthy he could not have HIVPolygamy marriages with some
infection. On the other hand, some couples who are not sexually
people including the educated ones, faithful
they just ignore useful information of
which can enable them to avoid HIV
infections.
Sexual cleansing custom in Malawi on spotlight
Utakaso kupitia tendo la ndoa kwa waliofiwa
 Driving Forces for HIV/AIDS....2
2. Economic factors as driving force Household poverty can to
to HIV/AIDS infection. engage in sex in exchange of
Mobile populations: for example, money. Some women engage in
long-distance truck drivers, commercial sex as wives and not
agricultural plantation workers, sex workers. Likewise, young girls
mining sector and fishermen. get involved in sexual activity
Sex workers: mainly women, sell because of money and gifts
sex. if a man pays for sex, he
feels more empowered to dictate
using a condom or not. Likewise,
woman who has sex because of
money may feel she has no
choice. However, a woman doing
it for leisure might disagre
 Driving Forces for HIV/AIDS...3
3. Political factors
Political instability expressed in
form of civil wars. E.g. DRC, Sudan,
Rwanda, Sierra Leone etc.
For example, during the genocide in
Rwanda, the United Nations
reported that the deliberately
selected HIV-infected Hutu raped
about 250,000 women (UN, 2004)
During civil war a ruling regime on
the other hand, can hardly allocate
fund to health services including
fund for fighting against HIV/AIDS
 Driving Forces for HIV/AIDS....4
4. Biological and Psychological factors Existence of other Sexually
 Excessive sexual desires among Transmitted Diseases (STDs).
women and men. Evidence show that persons with STDs
(such as Gonorrhoea, Syphilis etc.) have
Refusing from using condoms so as three to five fold increase in risk of
to achieve sexual satisfaction being infected with HIV than those who
Intentional spread of HIV by some are not having sexually transmitted
diseases.
HIV-infected people due to aggressive
behaviour or psychological trauma led Homosexuality which increases the
by HIV which is justified by probability of one to get infected
expression/statement like “let me die due to high friction.
with many other people”
Sexual violence e.g. raping due to
uncontrolled sexual desires by some
boys and men.
 STRATEGIES TO ADDRESS HIV/AIDS
Strategies to address HIV/AIDS change
are interventions aiming to The ABC approach: “Abstinence,
alleviate the prevalence of Be faithful, Use a Condom” was
HIV/AIDS. highly encouraged by the
They are put in place to protect international community to curb
individuals or community, or the growing diseases in sub-
They are rolled out as public Saharan Africa.
health Policy By the mid-2000s the ABC
Approach was no longer
Historically the focus to alleviate effective, therefore wider
the prevalence of HIV/AIDS was perspectives were sought, and
primarily on preventing sexual this is what called Combination
transmission through behaviour Prevention Approach
 Strategies to address HIV/AIDS....
 Combination Prevention Effective implementation of
Approach replaced the ABC Combination Prevention
Approach by taking into account Approach depends on:
the underlying socio-cultural, a) a clear and evidence-
economic, political, and other informed strategy
contextual factors as drivers to b) Participation of relevant
HIV/AIDS infections. stakeholders: government,
Effective HIV/AIDS prevention cultural leaders, CSOs,
programmes require a donors, and individuals &
combination of behavioural, communities affected by
biomedical and structural HIV/AIDS
intervention.
 1. Behavioural Interventions
This focus on imparting useful They seek to reduce the risk of
information that may lead to HIV transmission by reducing risk
behavioural changes. The behaviours like
useful information include: Reduce the number of sexual
Information provision (eg. Sex, partners
gender, education) Improve treatment adherence
Counselling and other psycho- among PLW HIV
social support Increase the use of clean
Safe infant feeding guidelines syringes among drug users
Stigma and discrimination Increase consistent and correct
reduction programmes use of condom
Cash transfer programmes
(TASAF, etc)
 2. Structural Interventions
Structural interventions include;
Interventions addressing social, economic and social inequality
Policies/Laws protecting PLW HIV/AIDS
Combating all unconstructive cultural practices which exacerbate the
spread of HIV/AIDS.
They seek to address social, economic, political or environmental factors
that make individuals or groups vulnerable to HIV infection.
Structural interventions are the most difficult to implement as they
attempt to challenge deep-rooted socio-economic issues such as poverty
and gender inequality.
Therefore, the success of this kind of interventions depends much on
cooperation of stakeholders, with the central coordination of governments
 3. Biomedical Interventions
Biomedical interventions include:
Male and female condoms
Sex and reproductive health services
Voluntary medical male circumcision
Promote the use of PMTCT services, pre and post-exposure prophylaxis
and treatment as prevention, etc.
Biomedical interventions use a mix of clinical and medical
approaches to reduce HIV transmission, eg. male circumcision policy
reduces the risk of HIV transmission up to 60% during unprotected
heterosexual sex.
For more effectiveness, biomedical interventions must be combined
with behavioural and structural interventions.
 Public Health Approach to combination prevention
There have been some recent evolution b) Fast-tracking Combination Prevention
and improvements in combination launched in 2014 by UNAIDS, aiming to
prevention. end the HIV/AIDS epidemic as a global
a) This involves a combination of public health threat by 2030 focusing
behavioural, biomedical and structural on the low- and middle-income
strategies using available resources to countries. It consists of:
tackle HIV/AIDS problems at high Increasing political and financial
prevalence regions “hot spots” like commitment in order to reduce new
Mbeya, Iringa and Njombe in Tanzania infections by 75%
and high-risk groups such as Using new tools and technology like
homosexuals and transactional sex mobile phones and internet in raising
workers. awareness and influencing norms
The effectiveness of this kind of regarding HIV prevention.
interventions is limited as they Achieving full coverage especially in
concentrate on some areas and provision of condoms and ARVs
population groups
 National strategies for
Addressing
HIV/AIDS Pandemic: Tanzania
1. Establishment of the Tanzania Commission for
AIDS (TACAIDS) in 2001.
TACAIDS was created to strengthen response to the HIV epidemic. At
this time, it was upgraded to a national programme from being a unit
in the Ministry of Health.
It has mandated to provide strategic leadership and coordination of
the HIV/AIDS national response through development of a strategic
framework and national guidelines for HIV.
TACAIDS resulted in the development of the National Guidelines on
HIV Prevention Strategy (2010), the National Stigma and
Discrimination Reduction Strategy (2012).
2. National Policy on HIV/AIDS, 2001...
Progress made by the Government national response to HIV/AIDS in its
a) Formulation of National AIDS annual budget and through
Control Programme (NACP), 2006. collaboration with national and
This comprised strategies to prevent, international communities (Global
control and mitigate the impact of the Fund, PSI, etc),
HIV/AIDS epidemic through health
education, multi-sectoral responses
and community b) The Government
has made progress in resource
mobilization, communication,
advocacy, and community
participation,
c) The government continues to
increase the level of funding for the
 Progress made by the Government....
d) In 2007 and 2013 the 2nd and 3rd g) Free provision of condoms as
National Multisectoral Strategic prevention strategy (2017-2022)
Framework on HIV/AIDS were aiming to reach 85% of people
launched in order to guide the engaged in multiple sexual
government’s response to the partnerships- use condoms correctly
HIV/AIDS related issues, and consistently,
e) In 2008, the government created h) Integration of HIV/AIDS education
legal framework by enacting the HIV in curricula from primary to university
and AIDS (Prevention and Control) level,
Act, 2008 which addresses issues i) HIV/AIDS in mass campaign is
related to prevention, care and disseminated via different means
control of HIV and AIDS in Tanzania including community theatre, songs,
Mainland, leaflets/brochures etc
f) Free Provision of ARV for the HIV-
infected people,
2. National Policy on HIV/AIDS, 2001
 The first multi-sectoral policy was issued in November 2001 with its
implementation and coordination being entrusted to TACAIDS. The policy
aims is freeing the country from the epidemic and having a generation live
without fear of HIV and AIDS.
The Government vision is commited to reach UNAIDS vision of three zeros:
zero new HIV infections, zero discrimination, and zero AIDS-related
deaths.
Again, the government is committed to achieve a 90-90-90 global
target set by UNAIDS by 2020:
90% of all people living with HIV (PLHIV) will know their HIV status;
 90% of all people with diagnosed HIV infection will receive sustained ART;
90% of all people receiving ART will have HIV viral load Suppression (the
concentration of HIV in the blood less than 1,000 copies/mL).
Challenges of achieving three zeros and 90-90-90 target
a) Inadequate human and financial resources
b) Ineffective coordination mechanisms
c) Inadequate political commitment and leadership
d) Lowly attitude to condom use
e) Weak supply lines and inadequate of funding, e.g.
In 2017, just 30% of women and 46% of men reported to use condom in
the last time they had a sex with a non-marital, non-cohabiting partner.
In 2018 around 260 million free condoms were needed, however, there
were a shortfall of around 100 million condoms
The End.