LECTURE ONE: INTRODUCTION TO HIV/AIDS

This lesson will enable the learner to understand the foundational aspects of HIV/AIDS,
including its origin, key theories that explain its emergence, and the historical development
of the pandemic. Students will explore the discovery of HIV, the progression of the disease,
and the global trends in its distribution, emphasizing how different regions are impacted. The
topic also examines the factors influencing the spread of HIV, such as behavioral, social, and
economic elements, alongside international responses to the pandemic

1.0 Brief overview of the lesson

General course description
This course provides an in-depth understanding of HIV/AIDS, focusing on its historical
background, transmission, prevention, and the social, economic, and cultural impact on
communities. Students will explore the
biology of HIV, the immune system’s response, treatment options, and the global strategies
employed to combat the pandemic.

1.1 What is HIV?

HIV stands for Human Immuno Defficeincy Virus which causes AIDS.

A blood test is carried out to find out whether a person is infected with HIV but tests positive
for HIV it does not necessary means that person has AIDS

AIDS diagnosis is made by a physician based on the definition case made CDC AIDS. A
person who is infected with HIV might receive an AIDS diagnosis after developing one of
CDC defined AIDS indicator illness

HIV infected persons could receive an AIDS diagnosis on the basis of specific blood test
(CD4 count) and might not the basis of certain blood test (CD4) and might not have
experienced any illness that is serious

Infection of HIV virus occurs when the virus attaches and penetrate the cells

The HIV virus targets specific cell types which are identified and is differentiated by the
protein found on the surface of the cell. The different cell indicates different proteins which
are attractive to different viruses. For HIV virus-helper cells and macrophages are the main
cell types targeted by the virus. T-helper cells and macrophages are the main players in the
immune system of human.

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Made with eXeLearning1.2 What is AIDS?

AIDS means Acquired Immunodeficiency Syndrome. Over the time HIV infection have been
seen to weaken the immune system to the extend it have difficult in fighting off infections.
These infections are normally regulated by immune systems that are healthy, but they cause
problems or even become life threatening in an individual with AIDS. The immune system of
an individual with HIV/AIDS has become weak the point that medical intervention might be
necessary to prevent serious illness.

AIDS is caused by HIV which is characterized by the weakening of the immune system
which leaves the body unprepared to fight the diseases. An individual might live with HIV for
up to 10 years before developing AIDS
Definition of AIDS is determined when CD4 cells are less than 200 cells per cubic millimeters
AIDS eventually results to death because of opportunistic infection (viral, fungal, and
bacterial infection) since the immune system is weak
Lack of treatment of AIDS could enhance rapid progression of diseases in one year of
diagnosis
Update there is no cure or complete remedy for AIDS, although diseases could be managed
by antiretroviral treatment
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Made with eXeLearning1.3 History of HIV

The origin of the Human Immunodeficiency Virus (HIV) has been a subject of scientific
research and debate since the virus was identified in the 1980s. There is now a wealth of
evidence on how, when and where HIV first began to cause illness in humans.

HIV is a type of lentivirus, which means it attacks the immune system. In a similar way, the
Simian Immunodeficiency Virus (SIV) attacks the immune systems of monkeys and apes.1

Research found that HIV is related to SIV and there are many similarities between the two
viruses. HIV-1 is closely related to a strain of SIV found in chimpanzees, and HIV-2 is closely
related to a strain of SIV found in sooty mangabeys

In 1999, studies carried out found a strain of SIV (called SIVcpz) in a chimpanzee that was
almost identical to HIV in humans.

The scientist who discovered this connection concluded that it proved chimpanzees were the
source of HIV-1, and that the virus had at some point crossed species from chimps to
humans

HIV-2 comes from SIVs in sooty mangabey monkeys rather than chimpanzees. The
crossover to humans is believed to have happened in a similar way (through the butchering
and consumption of monkey meat).

HIV-2 is far rarer, and less infectious than HIV-1. As a result, it infects far fewer people, and
is mainly found in a few countries in West Africa like Mali, Mauritania, Nigeria and Sierra
Leone.

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Multi-choice
What is the main difference between HIV and AIDS?
HIV is a bacterial infection, while AIDS is viral

HIV is curable, while AIDS is not

HIV affects only the immune system, while AIDS affects all body systems

HIV can only be transmitted through casual contact

AIDS occurs when HIV is untreated and the immune system is severely damaged

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Made with eXeLearning2.0 Theories of HIV/AIDS

A theory is a structured set of ideas that explains, predicts, or interprets various phenomena
by identifying relationships between different factors. In the context of HIV/AIDS, theories
offer frameworks to understand the origins, spread, and impact of the virus on individuals
and communities. Biomedical theories, for instance, explain HIV as a viral infection that
weakens the immune system, while behavioral theories examine how human actions

image describing the theories of HIV/AIDS

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Made with eXeLearning2.1 Contaminated polio vaccine theory

The speculation continues that the AIDS virus, human immunodeficiency virus type 1 (HIV-
1), may have crossed into humans as a result of contamination of the oral polio vaccine
(OPV). This 'OPV/AIDS theory' claims that chimpanzees from the vicinity of Stanleyville--
now Kisangani in the Democratic Republic of Congo--were the source of a simian
immunodeficiency virus (SIVcpz) that was transmitted to humans when chimpanzee tissues
were allegedly used in the preparation of OPV.

https://en.wikipedia.org/wiki/Oral_polio_vaccine_AIDS_hypothesis#:~:text=The%20oral%20p
olio%20vaccine%20(OPV,between%201957%20and%201960%20in

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Made with eXeLearning2.2 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 (SIVcpz) 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 know as "bushmeat hunting".
While being butchered, their blood got into the cuts and wounds of the hunter. These SIVs
then adapted to the hunter's body and then over a period of time transformed into HIV-1 or
-2. Every time a SIV passed from a chimpanzee to man, it would develop in a slightly
different way and produce a slightly different strain. The fact that there are several different
early strains of HIV, each with a slightly different genetic makeup, would support this theory.
Secondly, in Africa, retroviral zoonosis is still occurring, as postulated in the article by Wolfe
et al.[20] Discoveries such as this, have led to a call for an outright ban on bushmeat
hunting. The timing of the AIDS epidemic, according to this theory is attributed to
urbanization and regional commerce, which facilitated conditions for sexually transmitted
diseases. However, the emergence of the AIDS epidemic in the mid-70s could not be
explained by this theory alone as bushmeat hunting and hence SIV zoonosis has been going
on for centuries.

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Made with eXeLearning2.3 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.

Now serendipity plays a hand. On a flight from New York to New Orleans, he noticed a
passenger reading an article by one of his colleagues in Manhattan. 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.

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Made with eXeLearning2.4 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.
The virus is thus serially passed through several persons by contaminated needles and this
process eventually transforms the benign SIV into the virulent HIV. This transformed HIV is
virulent enough to be transmitted through sexual contact and thus started an epidemic.

The history of the hypodermic syringe and needle in Africa bears testimony to this theory.
Post World War II, penicillin was introduced as an antibiotic. In 1943, 21 million units, were
produced which increased to 120 million units in 1949. In the 1950s, WHO and other
agencies launched massive health programs in Africa. Poverty and limited resources
compelled the reuse of syringe and needles. Marx demonstrated experimentally that the SIV
became 1000 times more pathogenic when serially passed through just three monkeys. This
theory is less flawed than the contaminated OPV and the cut hunter theories. The only
explanation it lacked was the latent interval between the use of unsterile needles.

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Made with eXeLearning2.5 The colonialism theory

The colonialism theory is based on the cut hunter theory premise but is more thorough and
specific. Joseph Conrads' novel regarding the colonial rule in Belgian Congo, "Heart of
Darkness", was as much fact as fiction and described the horror of the official policies in the
Congo. The Belgian colonial rule under King Leopold was very harsh and cruel. It is
estimated that more Africans died as a result of colonial practice in French Equatorial Africa
and Belgian Congo between 1880 and onset of World War II, then had been taken from
Africa as slaves in the preceding 400 years. The first census in 1920s estimated that the
population in the two colonies, at that stage was 15 million. Census recorders reported that
about another 15 million had died in the preceding two decades. A fatality of 50% far
exceeds even the 35% fatality rate of the plague in Europe. The state of the colonies was
such that they had a poor diet, poor sanitation and exhausting labor demands. The
well-meaning but ill equipped doctors, trying to protect workers from various rampant
diseases, faced an uphill task. Re-use of syringes and unsterile needles was rampant and to
appease the laborers, sex workers were officially encouraged. The transfer of pathogens
under such circumstances was inevitable emergence of the HIV epidemic.

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Cloze Activity
Read the paragraph below and fill in the missing words.
The
vaccine theory suggests that the AIDS virus (HIV-1) may have crossed into humans due to
contamination of the oral polio vaccine (OPV). This theory claims that chimpanzees from the
vicinity of Stanleyville were the source of a simian immunodeficiency virus (SIVcpz) that was
transmitted to humans when chimpanzee tissues were allegedly used in the preparation of
vaccines.

The
states that HIV is a descendant of SIV because certain strains of these viruses closely
resemble HIV-1 and HIV-2. The process of viral transfer from animals to humans is known as
. The theory explains that SIVcpz and SIVsm were transferred to humans through bushmeat
hunting, where the blood of the animal came into contact with cuts and wounds of the hunter.

The
 argues that the re-use of unsterile syringes in medical practices in Africa, especially during
health campaigns in the 1950s, contributed to the spread of HIV. This theory suggests that
SIV was passed from person to person through contaminated needles, accelerating the viral
serial passage of HIV.

The
builds on the idea that with each passage through a different individual via unsterile
needles, the virus adapts and grows stronger, eventually transforming from SIV into a more
virulent form of HIV. This transformed HIV was then capable of being transmitted through
sexual contact.

The
is based on the cut hunter theory but provides a more specific explanation. During the harsh
colonial rule in the Belgian Congo, factors such as poor sanitation, re-use of syringes, and
official encouragement of sex workers contributed to the spread of HIV. According to this
theory, the social and economic conditions created a perfect environment for the emergence
of the HIV epidemic.

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Made with eXeLearning3.0 Global trends of HIV/AIDS

In 2022, around 130,000 [90,000-210,000] children aged 0-9 were newly infected with HIV,
bringing the total number of children aged 0-9 living with HIV to 930,000 [730,000-1.28
million]. Nearly 85 per cent of these children live in sub-Saharan Africa. One bright spot on
the global horizon is the rapid decline of approximately 58 per cent in new HIV infections
among children aged 0-9 since 2010 due to stepped-up efforts to prevent mother-to-child
transmission of HIV. However, the number of new HIV infections among adolescents (aged
10-19) has declined at a slower rate of about 47 per cent.

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Made with eXeLearning3.1 The number of new HIV infections has plateaued in recent years

Number of annual new HIV infections among children aged 0–9 years and adolescents aged
10–19 years, 2000–2022

Image of the global trends in the whole world

An estimated 100,000 [67,000-146,000] children and adolescents died from AIDS-related

causes in 2022. About 73 per cent of these preventable deaths occurred among children
under 10 years old. The number of annual AIDS-related deaths among children has declined
by about 80 per cent since its peak in 2002, while the number of annual AIDS-related deaths
among those aged 10-19 has only decreased by 27 per cent since 2002.

While tremendous strides have been made in early childhood survival for children living with
HIV, adolescents are being left behind
Number of AIDS-related deaths among children aged 0–9 years and adolescents aged
10–19 years, 2000–2022

People in sub-Saharan Africa are disproportionately affected by the HIV epidemic, especially
children

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Made with eXeLearning3.2 Geographic disparity of HIV/AIDS Distribution

Sub-Saharan Africa, particularly Southern Africa, remains the region most heavily affected
by the epidemic. In 2022, sub-Saharan Africa accounted for approximately 66 per cent of
people of all ages living with HIV and 85 per cent of children and adolescents living with HIV
worldwide. The spread of HIV in sub-Saharan Africa is mostly through heterosexual
relationships, both in the context of transactional and commercial sex and in longer-term
relationships, including marriage. Current evidence in Southern Africa has identified sexual
relationships between adolescent girls or young women and older men as a common HIV
transmission route. In addition, infants born to mothers living with HIV are at risk of
becoming infected if their mothers are not on effective treatment or retained in care.

People in sub-Saharan Africa are disproportionately affected by the HIV epidemic, especially
children
In most other regions of the world, HIV disproportionately affects persons who inject drugs,
men who have sex with men and sex workers. The epidemic is evolving, however, and
transmission patterns are changing throughout the world. In Eastern Europe and Central
Asia, HIV epidemics that were once distinguished largely by transmission among persons
who inject drugs are now increasingly characterized by significant sexual transmission. In
parts of Asia, HIV is transmitted more and more among heterosexual couples. In Asia as a
whole, HIV epidemics have long been concentrated in persons who inject drugs, sex
workers and their clients, and men who have sex with men. Now, HIV infections are steadily
spreading into lower-risk populations through transmission to the sexual partners of those
most at risk.

Number of children aged 0–19 years living with HIV, 2022

Number of children aged 0–19 years living with HIV, 2022

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DropDown Activity
Read and complete
Sub-Saharan Africa, particularly Southern Africa, remains the region most heavily affected
by the HIV epidemic. In 2022, approximately
of people of all ages living with HIV and
of children and adolescents living with HIV worldwide were from sub-Saharan Africa. The
spread of HIV in this region is predominantly through
 , including transactional and commercial sex as well as longer-term relationships like
marriage. In Southern Africa,
between adolescent girls or young women and older men are a significant transmission
route. Additionally, infants born to mothers living with HIV are at risk of infection if their
mothers are not on effective treatment or are not retained in care.

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