HIV,AIDS & STI

BY
VICTORIA KIMANI
29/9/2017
 MODULE COMPETENCE
• To equip learner with the appropriate
knowledge, skills and attitude to enable them
effectively contribute to the national HIV
response.
 MODULE UNITS
1. Fundamentals of HIV/AIDS
2. Prevention of HIV/AIDS
3. Management of HIV/AIDS
4. Strategic BCC (Behaviour change
communication)
5. Home and Community based care(HCBC)
6. STI’S
 MODULE LEARNING OUTCOMES
• By the end of the course the learner shall be
able to:
1. Demonstrate understanding of the
epidemiology of HIV/AIDS
2. Apply knowledge of prevention of curbing the
spread of HIV/AIDS
3. Apply the knowledge in management of HIV/
AIDS and related diseases in the community
4. Conduct strategic behaviour change
communication
5. Apply principles of HCBC in prevention and
management of HIV/AIDS and related diseases
6. Apply knowledge in prevention and
management of various on STI’S.
 FUNDAMENTALS OF HIV/AIDS
DEFINATION OF TERMS
HIV-Stands for human immuno deficiency virus.
H=Human(refer to us)
I=Immunodeficiency(lack of protection from
getting sick)
V=Virus(a type of germ in the body that can be
cured)
This is the virus that causes Aids
AIDS-Stands for acquired immune deficiency
sydrome.
A=Acquired(to get something)
I=Immune(the way the body fights disease)
D=Deficiency(not enough of something-in this
case lack of protection from getting sick)
S=Sydrome(a group of symtoms or illness)
AIDS:This is state when a person gets a group of
serious illnesss and opportunistic infection
that develop after speedy multiplication of
HIV virus in the body with consequent
reduction of CD4.This results into the body’s
inability to fight other invading germs thus
making the person very prone to diseases
that take advantage of the lowered immunity.
HIV INFECTED;is when hiv virus has entered a
persons body.A person who is hiv-infected might
be very healthy and not have any signs of illness
for a very long time but they can pass the virus
to others.
STI’S stands for sexually transmitted infections/
diseases
WHO define STI as communicable disease mainly
trasmitted through sexual intercourse with an
infected person.They are caused by a number of
micro-organisms eg virus,bacteria etc
How does a person know they have HIV or AIDS?
HIV infection can be diagosed with a simple blood test.This
is usually done in VCT(Voluntary counselling and testing)
clinics or through PITC(Patient initiated testing and
counselling)Hiv test is conducted to pregnant mothers as
a routine part of antenatal care.
AIDS is diagonised by clinical and lab tests,usually with
blood samples,done at the hospital.Where these tests
are not available,AIDS can be diagnosed by a doctor
after examining a person’s health and taking a history
from the patient on their illness
ORIGIN & HISTORY OF HIV/AIDS:
ORIGIN
When and where the Hiv virus first emerged is
probably going to remain a mystery for many
years to come.
While several theories have been put forward,
there is no conclusive single agreement on the
origin of HIV/AIDS.
Some of the mostly acknowledge theories about
the origin of HIV include the following
• Mysterious origins e.g the tail of the comet
theory
• Religious theories(Gods wrath and witchcraft)
• Monkey origin theories (with four theories)
• Conspiracy theories
• The calculation theory
1.Mysterious origin theory
Tries to account for the seemingly mysterious
origin of HIV by locating it out of this world.
Suggest that viral materials was carried in the tail
gases of a comet passing close to the earth and
its material was deposited,subsequently
infecting nearby sate in people .Although one or
two famous astronomers have been linked to
this theory,in the popular press,these scientists
deny the possibility of this extraterrstial
phenomena and any personal connection to the
theory.1
2.Religious theories(Gods wrath and witch craft)
Certain segments of the population have openly
stated that AIDS is Gods wrath since the scripture
condemn the homosexual practice in which AIDS
was 1st observed in western world
Rather than its being considered a visitation from
God; many Africans believe that AIDS is any caused
by another supernatural power-witchcraft and
they use anti-witchcraft rituals and objects to
counteract the infection.
3.Monkey origin theories(has 4 theories)
Hiv is a lentivirus called simian immunodeficiency virus(SIV).
The research done claimed that chimpanzes were the source of
HIV 1,and that the virus had at some point crossed species
from chimps to humans.
How HIV crossed species is explained by theories such as ;
-The oral polio vaccine( OPV)Theory
-The hunters theory
-The contaminated neddle theory
-Colonisation theory.
4.Conspiracy theories
Americans believed HIV was manufuctured as part of a
biological warfare programme,designed to wipe out
large numbers of black and homosexual people
5.The calculation theory
The latest in the origin of HIV.
Opponents of SIV-human transmission remain unimpressed
by the evidence in the monkey theories and argue that
viral sequencing of HIV strains indicate that HIV has been
around probably for hundred of years
 ct
In 2000 when a team of scientist using
computer technology to study the structure
of HIV calculated the rate at which the virus
mutates for the HIV viral sub-types to have a
common ancestors.
This process revealed HIV originated around
1930 in rural areas of central africa ,where
the virus may have been present for many
years in isolated communities
 ct
The virus probably did not spread because members of
these rural communities had limited contact with
people from other areas.
But in 1960s and 1970s ,political upheaval,wars ,
drought, and famine forced many people from these
rural areas to migrate to cities to find jobs.
During this time, the incidence of sexually transmitted
infections,including HIV infection ,accelerated and
quickly spread throughout africa.
What caused the rapid spread of the HIV
epidemic in the latter half of the 20th century:
There are a number of factors that may have
contributed to the sudden global spread of HIV
in the latter half of the 20th century and they
include
a.international travel,
b. The blood industry
c.Widespread drug use
History in USA:HIV virus began to emerge in the
united states in the 1980s,the HIV epidemic has
frequently been linked to gay,bisexul and men
who have sex with men(MSM).The 1st official
report on the virus was published by centre for
disease control(cdc) in 1981 and detailed a case
of 5 young gay men who were hospitalised with
serious infections later the New York times
reported 41 homosexual had been dx with
kaposi sarcoma and 8 had died less than 24
months after dx made.
HIV histoy in kenya;
It began between 1983 and 1985 when 26 cases
of Aids were reported in kenya.sex workers
were the first group affected,A study from
1985 reported a HIV prevalence of 59%
amongest a group of sex workers in Nairobi.
Epidemiology of HIV:
Global overview : HIV ,the virus that causes
AIDS, is one of the world most serious health
and development challenges. According to
UNAIDS
There are apprx. 36.7m people worldwide living
with HIV/AIDS at the end of 2015.of
these,1.8m were children(<15 years old )
An estimated 2.1m worldwide became newly
infected with HIV in 2015.
This includes 150,000 children(<15 years)most
of these children live in sub-saharan africa
and were infected by HIV positive mothers
during pregnancy,childbirth or breastfeeding
Currently only 60% of people with HIV know
their status.The remaining 40%(>14M people)
still need to access hiv testing services.
As of june 2016,18.2m people living with HIV
were accesing ART globally up from15.8 in
june 2015,7.5m in 2010, and less than 1m in
2000.
HIV/AIDS IN SUB SAHARAN AFRICA:
SSA has only 10% of the world population
Adult HIV prevalence is 1.2% worldwide(0.6% in north
america ),but 9% in sub saharan africa.
UNAIDS estimate that at the end of 2001 there were 40m
people living with HIV/AIDS,28.5m of them from sub
saharan africa.5m adult and children become newly
infected with HIV in 2001,3.5m of them from sub
saharan africa.3m people died from AIDS related causes
2001, and 2.2m of these were from subsaharan africa.
AIDS is the leading cause of death in SSA.
HIV/AIDS IN KENYA:
Kenya has an average hiv prevalence rate of 6%
and with about 1.6m people living with hiv
infection,it is one of the six hiv ‘high burden’
countries in Africa.The western part of the
country through Homabay,siaya and kisumu
are the most affected with HIV with rates of
25.7%,23.7% and 19.3% respectively
In Kenya women were more likely to be
infected(8.4%) than men (5.4%).In particular
young women aged 15-24 years were 4 times
more likely to be infected than young men in
the same age group(5.6% vs 1.4%)
An estimated 6.7% adult in rural areas are
infected with HIV compared to estimated
8.4% in urban areas
Uncircumcised men were 3 times more likely to
be infected with HIV than circumcised
men(13.2% vs 3.9%)respectively.
80-90% of infections are in the 15-49 years age
group,while 5-10% occurs in children less
than 5 years old.
TRANSMISSION OF HIV:
HIV can be transmitted in the following body
fluids;
Semen
Vaginal fluids
Blood
Birth fluids
breastmilk
Hiv is not transmitted in these fluids unless
there is also blood present;
Urine
Faeces
Saliva
Sweat
Mucus
How is HIV transmitted?
HIV/AIDS is transmitted through the following ways:
Sexual contact with a person infected with the
virus(unprotected sexual intercourse with infected
person)
NB: sexual transmission accounts for 87% of HIV
transmission world wide.
From infected mother to her unborn child in the womb,
during birth and after birth.
Transfusion with infected blood or blood products
 ct
Cutting and skin piercing instruments e.g needles,
razors, knives(e.g during circumcision)
Occupational exposure like for medical personnel
Sharing tooth brushes if one has a bleeding gums
Deep kissing if one has open wounds in the
mouth
Ways hiv is not trasmitted:
Sharing food or a drinking cup
Hugging
Kissing
Shaking hands
Coughing or sneezing
Being near a person with aids
Sharing a latrine or toilet
Mosquito or insect bite
HIV TYPES AND SUBTYPES:
One of the obstacles to treatment of the human
immunodeficiency virus is its high genetic
variability.HIV can be divided into two major
types,HIV type 1(HIV-1) and HIV type 2(HIV-2)
HIV-1 is related to viruses found in chimpanzees
and gorillas living in western africa,while HIV-2
viruses are related to viruses found in the
endangered west africa primate sooty
mangabey.
HIV-1 viruses may be further divided into groups.
Hiv-1 group M viruses predominate and are
responsible for the aids pademic.Group M can be
further subdivided into subtypes based on
genetic sequence data.Some of the subtypes are
known to be more virulent or are resistance to
different medications. Likewise HIV-2 viruses are
thought to be less virulent and transmissible
than HIV-1 M group viruses although HIV-2 is
known to cause AIDS
KEY RISK FACTORS FUELLING THE SPREAD OF HIV/
AIDS
INTRODUCTION: It explains African traditional
beliefs and practices which may be major factors
in the spread of the virus causing AIDS.
It gives myths on sexuality and links them to the
rapid spread of HIV/AIDS.
Also discusses socio-economic and cultural factors
and also political factors influencing the spread of
HIV/AIDS.
a .Myths /mysteries surrounding HIV/AIDS
People lack information about HIV/AIDS
They think it is a curse from God, witch craft,
originated from monkeys, lab mistakes, blame
Americans who might have introduced it to
African sex or controlling population.
 ct
Some of the myths which need to be
demystified include;
Having multiple sex partners boosts men
prestige and status among the peers(not true)
Abstinence causes male impotence(not true)
Sex with a virgin provides a cure for a man
infected with HIV/AIDS
 ct
Teaching young people about sex encourages
them to practice”(not true)
Ignorance about sex is a sign of innocence and
purity while too much knowledge is a sign of
immorality(information is power)
Knowing your status means early death(not
true)
ARVS provide cure for aids(not true)
b.Socio-economic and cultural factors
Pre marital sex-before marriage involve
fornication and adultery
Age at 1st sexual encounter-women aged
between 14-25 majority infected
Drug and substance abuse common among youth
in institution of higher learning
Lack of control over sexual urge thus going for
risk sex
 ct
Inequality in making decisions
In access and control over assets/resources at
family community and national level
Women obliged/compelled/required to have sex
when she is aware that partner is infected
Having sex besides the matrimonial spouse
African traditional ceremonies-long duration,
social gathering and festivities
 ct
Wife inheritance and window cleansing especially
through sexual performance
Ear piercing
Circumcision
Female genital mutilation(FGM)
Tattooing
Teeth extraction
Forced marriage
poverty
 ct
Illiteracy
Unwillingness to know ones HIV status
Trial marriages
Sex expediency
Sexual orientation
Resistance to condom use
Media and pornography
Tendency to copy and put to practice
Youth idle and engage in risk behavior
c.Political factors
Decreased allocation of resources and
commitment to the implementation of policies
that exist from external donors
Sustainability –mobilization of locally generated
resources
Most of the intentioned policies which have been
formulated,have not been fully implemented
Corruption
MOST AT RISK POPULATION(MARPS)
BY

VICTORIA KIMANI
6/10/2017
Anyone can contract HIV , but there are certain
groups of people that are more affected than
others:
1.Men who have sex with men(MSM)
Gay or bisexual MSM are most severely affected
population
This is because they have sex on the anus which is
prone to tearing due to lack of lubrication thus
increasing the risk of HIV transmission
In order to prevent transmission of HIV/AIDS there is
need for them to use condoms and lubrications
such as ky jelly every time they have sex.Also get to
know their HIV status often .
2.Injecting drug users(IDU’S)
These are people who abuse drugs and mostly they
share syringes and needles .
Also by abusing drugs it make them vulnerable to
having unprotected sex which put them at a higher
risk of contracting HIV/AIDS.
In order to protect themselves they should avoid sharing
of syringes and needles and also use condoms when
they engage in sexual activities.
3.Track drivers.
They travel for long distance i.e from one town to
another leaving their spouses behind .they get
involved sexually with multiple partners which put
them at a risk of getting infected with HIV/AIDS
In order to avoid this they should know their HIV status
often,use condoms and practice faithfulness.
4.Prisoners
They are most at risk because they practice
homosexuality which is illegal in our country.
use of condoms in the prison is illegal which
put them at a greater risk
In order to reduce the risk of transmission there
should be provision of condoms, ARVS and
also HIVtesting and counselling.
5.Fish forks/mongers
Another most at risk group they leave their
families to do fish business at the lakes and
involve themselves with multiple sex partners.
In order to prevent transmission there is need
to do HIV testing regulary,use of condoms and
faithfulness.
6.Sex commercial worker both men and women
They are at risk because of mutiple sex partners.
In order to prevent the risk of HIV transmission there
is need to regulary know their hiv status, use of
condoms and treatment of STI’S.
7.Young people
They are most at risk because of peer influence,
hormonal changes, experimenting and many more
they have mutiple sex partners without using
protection.
• In order to prevent the risk of transmission
they should use condoms, know their HIV
status, avoid negative peer influence.
Opportunistic infection
Also called OI’S
They are the infections that make PLWHA because
the body immune system is weakened and it can
not fight back
When the HIV attacks the CD4 cells,the person has
trouble fighting back when a virus or germ
enters their body.PLWHA,especially people not
on ART,can get a lot of OIS
One of the best ways to live positively with HIV/
AIDS whether you are on ART or not,is to
prevent opportunistic infections from
happening in the first place or treating them
right away if they do happen.
The most common OIS are;
Tuberculosis (usually in the lungs;the person will
have a bad cough,fever and will loose weight;
easily trasmitted from person to person)
2.Malaria (given to people by mosquitoes cause
high fever and weakness)
3.Pneumonia or pcp(a very bad infection in the
lungs that can develop quickly.causes coughing,
weakness,shortness of breath;is what can kill a
person with HIV if its not treated.)
4.Menengitis (a deadly disease in the brain,can
cause bad headache)
5.Sexally transmitted infections(STI’S) can cause
infected sores in the the genital area of men
and women;can cause unusual discharge,or
sometimes have no symtoms;easy to spread
through sex and need to be treated right
away;PLWHA are more likely to get STI’S than
people without HIV.
6.Diarrhea(that lasts more than few days and
causes dehydration and weight loss;especialy
dangerous if there is also fever)
7.Vomitting (often a sign of other problem,
especially if there is also fever and it doesn’t
go away after a couple of days;causes
dehydration)
8.Skin problems(like rashes or shingles,warts,or
sore lesions;can be caused by funfus and very
uncomfortable)
9. Oral sores(very common among PLWHA ;can
be very painful)
More about TB
TB is the most common OI among PLWHA .
TB and HIV are like brother and sister-about 50%
of PLWHA in kenya also have TB and about 70%
of people with TB also have HIV
Because TB and HIV are so closely linked,services
to prevent and treat both also need to be
linked.
TB is spread through the air ,especially from
coughing,sneezing and being in close quarters with
a person with TB.
It’s made worse when there is not good air
circulation like if there are no open windows.
Its very easy to spread TB from person to person,and
PLWHA are especially likely to get it if they are in
contact with a person with TB.
Little children are at high risk for TB when they live
with adult who have TB.
Assignment
myths and misconceptions about HIV/AIDS
 PREVENTION OF HIV INFECTION
INTRODUCTION: The so-called ABC of HIV
Prevention was developed by governments
and their partners as the key approaching the
fight against HIV/AIDS. The ABC messages
standing for Abstain from sex, Be faithful to
one partner and use a Condom, have been
accepted and applied globally and are the
dominant prevention messages.
The approach consists of mutually reinforcing
messages encouraging behaviour change with
regards to sexual activities and should not be
seen as stand alone package in HIV
prevention programming. The messages are
targeting the overall population and
particularly sexual active age groups, both
adults and youth.
Abstain from sex:The core message in the A
is to stay abstinent until marriage. Abstinence
is the most effective means of protection
against both pregnancy and HIV. With sex
being the primary cause of HIV transmission ,
it is unlikely for a person to contract the
disease if he or she does not have sex.
• However, A of prevention appears not to be
widely practiced – even though young people
have positive attitudes towards the idea itself.
The almost constant teenage pregnancy rates
of about 19-20% of 15-19 year old girls
between 1998 and 2002 are also a clear
indicator that young people indeed are having
sex.
Be faithful to one partner: The message contained
in B is to be faithful to a mutually faithful and
uninfected partner and reduce the number of
sexual partners if possible to one. This is a rather
complex concept since it requires commitment,
honest y and trust among partners, without those
this prevention strategy does not work. It is
difficult to know for sure if your partner is being
faithful, and it is clear that many partners are not.
This is also true for youth, who are in an
experimental stage sexually and emotionally.
Condom use:
Consistent and correct use of condoms during
intercourse can greatly reduce the chances of
acquiring or transmitting HIV.
Consistent use means using a condom each act
of intercourse
Correct use means that you should use anew
condom every time you have sexual intercourse
Never use the same condom twice
Put a condom before any contact is made between the
penis and any part of your partners body
Leave a space at the tip
Withdraw immediately after ejaculation
Condoms is not totally safe because it has some
weakness which includes;
Bursting
Leaking
Slipping off inside the woman-which exposes
both male and female to hiv virus
In addition, the application of the C message is
challenged by social norms and gender relations
making it difficult for girls and women to negotiate
condom use. Also, insecurities about the
effectiveness of condoms have begun to
undermine the status of condoms as a tool for HIV-
prevention among young people. Having
experienced that condoms do not provide 100%
protection from HIV-prevention if not used
correctly or taken off early, some people don’t feel
secure even when condoms are being used.
• Surveys undertaken in different parts suggest
that there are instances of young girls having
unprotected sex in exchange for much-needed
material support to the girls and their families
including money for school fees, transportation
and groceries or for luxury goods such as cell
phones, toiletries etc. Poverty and inequality
contribute to the rising numbers of young girls
and boys having unprotected sex with partners
that are much older, also popularly known as
sugar daddies or sugar mummies
• Considering that studies demonstrate a
strong correlation between high incidence of
HIV and the age difference between partners,
the sugar daddy phenomenon places young
girls at high risk with regards to HIV. Older
men are more likely to be infected with HIV
than younger men, posing a greater risk of
transmission to their younger partners.
• Giving ‘gifts’ or money to the girls may also
make men feel as being in power and having
the right to control the terms of the
relationship. Also for women who find
themselves in an abusive relationship or who
are economically or otherwise dependent on a
partner it is often difficult to negotiate sex and
condom use. As a consequence,they are at high
risk of contracting HIV/AIDS.
• Based on these communication messages and as
part of the overall ABC approach, the
Government together with its partners and
young people concerned developed and adapted
a variety of programmes in education,
awareness-raising and life skills training. These
programmes are going hand in hand with the
ABC messages and are all geared towards
encouraging behaviour change with regards to
sexual activities aiming to stop the HIV/AIDS
epidemic.
• D – Delaying: Youth who begin sexual activity early
appear more likely to have sex with high-risk
partners or multiple partners and are less likely to
use condoms. Thus early sexual debut can place
adolescents at increased risk of unintended
pregnancy, HIV, and other sexually transmitted
infections. Positive relationships with parents,
teachers, and spiritual beliefs decrease the
likelihood of early sex, while engaging in other
hazardous behaviours and having friends who are
sexually active can be considered as risk factors.
• Therefore, encouraging youth to start engaging
in sexual activities only when getting married or
being mature enough to take responsible
decisions need to go hand in hand with revisiting
the important function parents, teachers and
influential community members have as role
models. Delaying is an important, practicable
prevention message reflecting and responding to
the realities of many youth and therefore needs
to be added to the so-called ABC of HIV
prevention.
 2.Prevention of mother to child
transmission(PMTCT)
Having a HIV test done before getting pregnant
and during pregnancy
Taking ARVS during pregnancy and delivery and
breastfeeding and for life.
Having a caesarean section instead of normal
delivery i.e to avoid hurting the baby
Avoiding episiotomy during derivery
Giving the baby arvs after derivery
3.Prevention of transmission through blood and
other blood product
Screening all donated blood/all donated blood
must be screened
Careful handling of blood and blood fluids
Other methods of prevention are;
Avoidance of sharp injuries-neddles,knives,clips,
sharp objects in hospital working situation.
All used sharp objects e.g neddles and blades
should be disposed in the right way
Never pick a sharp object without looking/
careful handling of sharp objects
Use of protective gear such as gloves(heavy duty gloves
Avoid skin/mucous membrane contamination
Equipment should be thoroughly and properly sterilized
Avoid sharing nedddles and syringes
Use of PEP taken after exposure to HIV
Use of Prep taken before exposure by HIV NEGATIVE people.
Vmmc(voluntary medical male circumcision)
Sex without penetration e.g masturbation ,massage etc
 VOLUNTARY MEDICAL MALE
CIRCUMCISION(VMMC)
Key facts
Medical male circumcision reduces the risk of female-
to-male sexual transmission of HIV by approximately
60%.
Since 2007, WHO and UNAIDS have recommended
voluntary medical male circumcision as an additional
important strategy for HIV prevention, particularly in
settings with high HIV prevalence and low levels of
male circumcision, where the public health benefits
will be maximized. Fourteen countries in eastern and
southern Africa with this profile have initiated
programmes to expand male circumcision.
• Medical male circumcision offers excellent value
for money in such settings. It saves costs by
averting new HIV infections and reducing the
number of people needing HIV treatment and care.
A one-time intervention, medical male
circumcision provides men life-long partial
protection against HIV as well as other sexually
transmitted infections. It should always be
considered as part of a comprehensive HIV
prevention package of services and be used in
conjunction with other methods of prevention,
such as female and male condoms.
Overview
Male circumcision is surgical removal of the
foreskin - the retractable fold of tissue that
covers the head of the penis. The inner aspect
of the foreskin is highly susceptible to HIV
infections. Trained health professionals can
safely remove the foreskin of infants,
adolescents and adults (medical male
circumcision).
Compelling evidence for recommendations
In 2007, WHO and UNAIDS issued
recommendations on medical male circumcision
as an additional HIV prevention strategy based
on strong and consistent scientific evidence.
Three randomized controlled trials undertaken in
Kisumu, Kenya, Rakai District, Uganda, and
Orange Farm, South Africa have shown that
medical male circumcision reduces the risk of
sexual transmission of HIV from women to men
by approximately 60%.
• The most recent data from Uganda show that
in the five years since the Uganda trial was
completed, high effectiveness has been
maintained among the men who were
circumcised, with a 73% protective effect
against HIV infection.
What are the benefits of Voluntary Medical
Male Circumcision?
Medical male circumcision is a one-time health
intervention that provides men with life-
long partial protectionn against HIV. Apart from
reducing HIV infection, male circumcision
decreases the risk of urinary tract infections;
reduces risk of sexually transmitted diseases in
men; protects against cancer of the penis and
prevents inflammation of the glands and foreskin
altogether.
• Moreover, Male Circumcision also benefits women:
improving hygiene, reducing STI’s, and reducing the risk
of cervical cancer (Human Papilloma Virus – HPV). Men’s
health is as much about women’s health when it comes
to sexually transmitted diseases.
• Most recently, results from a 5-year follow up study in
Uganda showed that men who chose surgical VMMC
were 70% less likely to be infected with HIV than men
who were not circumcised. Similar results were reported
from extensive follow-up studies in Kenya and South
Africa.
Five Facts about Voluntary Medical Male
Circumcision (VMMC)
1. A circumcised man is up to 60% less likely to get
infected with HIV.
2. It does not affect the size of your penis.
3. There is some pain, but not much.
4. After VMMC, you can do most things after just 2
or 3 days.
5. There is no proven effect on sexual pleasure.
How male circumcision protects you against
HIV:
Before circumcision:
The inside of the foreskin is soft and moist and
is more likely to get a tiny tear or sore that
allows HIV to enter the body more easily. The
foreskin itself contains many ‘target cells’ that
allow HIV to enter the body easily.
 FREQUENTLY ASKED QUESTIONS ON
VMMC
1. What is Voluntary Medical Male Circumcision
(VMMC)?VMMC is the removal of a man’s
foreskin. It is a widely used, simple and safe
procedure. Men can be circumcised at any age.
While many men in Kenya have already
undergone the procedure, only 10% of Luo men
in Nyanza are circumcised today.
2. Why should men get circumcised?VMMC can
provide protection against HIV infection. A
circumcised man is up to 60% less likely to get
infected with HIV than an uncircumcised man.
3. What are other benefits of VMMC? VMMC
reduces the man’s chances of getting other
infections like syphilis and herpes. VMMC also
gives some protection against penile cancer in
men and cervical cancer in women.
4. How does being circumcised protect men from
HIV?
The inside of the foreskin is soft and moist and
is more likely to get a tiny tear or sore that
allows HIV to enter the body more easily. The
foreskin itself contains many ‘target cells’ that
allow HIV to enter the body easily. After
circumcision, the skin on the head of the penis
becomes thicker and is less likely to tear
5. Why is it important to know your HIV status
prior to VMMC?Someone considering VMMC
should know their HIV status in order to get
the health benefits that VMMC provides.
Clients who decline the test but still want to
get circumcised must be respected for their
decision. VMMC is not recommended for HIV
positive men.
6. How is VMMC done?
The procedure takes a short time. An injection
is given at the base of the penis to make it go
numb, so that no pain is felt while the
foreskin is cut off. The wound is then stitched,
cleaned and bandaged
7. What happens after the operation?
The man rests a short while, and then goes
home.
After 3 days the bandage is removed. He
cannot have sex for the next 6 weeks.
For the next 7 days, it is important to keep
the wound clean, and avoid heavy exercise.
• After 7 days, the man needs to return to the
health facility for a check-up. If men
experience any complications after surgery
(like prolonged pain or bleeding), they should
seek assistance at the clinic
8. Does VMMC affect sexual intercourse?Yes,
because men cannot have sexual intercourse for
6 weeks after VMMC. The wound needs enough
time to heal properly. VMMC does not affect
sexual performance.
9. Why should I talk to my partner about
VMMC?VMMC has many benefits for both
partners and both need to understand the
procedure. It is best to openly discuss why you
want VMMC. You can also visit a counselor or
health worker together to discuss the matter
 DRUGS USED IN HIV
Hiv medication can help lower your viral load,
fight infections, and improve your quality of life.
But even if you take them, you can still give HIV
to others. They're not a cure for HIV.
The goals for these medicines are to : Control
the growth of the virus Improve how well your
immune system works Slow or stop symptoms
Cause as few side effects as possible
• The FDA has approved more than two dozen
antiretroviral drugs to treat HIV infection.
They're often broken into six groups because
they work in different ways. Doctors
recommend taking a combination or
"cocktail" of at least two of them. This is
called antiretroviral therapy, or ART.
• Your doctor will let you know specifically how
you should take your medications. You need
to follow the directions exactly, and you
shouldn't miss even one dose. Or you could
develop drug-resistant strains of HIV, and
your medication may stop working.
• Some other medicines and supplements don't
mix well with HIV drugs, so make sure you tell
your doctor about everything you're taking.
 VIRUS LIFE CYCLE
HIV enter cell through interaction of an envelope
glycoprotein (gp120) and the cellular receptor,CD4, and
other co-receptor such as CCR5 and CXCR4.These receptors
are expressed on T-helper lymphocytes(CD4 lympocytes),
macrophages,dentritic cells(in lymph nodes and mucosal
surfaces) and microglial cells in the brain,Viruses that
utilize the CCR5 co-receptors to gain entry into cells are
referred to as R5 tropic;whereas those that use CXCR4 co-
receptor are x4 tropic.Most primary HIV infection are R5
tropic;the x4 tropic virus appear late in the course of HIV
infection.The virus life cycle can be divided into a number
of distinct steps,each of which is a current or potential
therapeutic drug target.
Stages of replication cycle;
1.Binding ,fusion and entry;
During this step,viral gp 120 binds to the CD4 receptor and
CCR5 or CXCR4 co-receptor on host cell surface.The binding
facilitates fusion of viral and host cell membrane thereby
facilitating the entry of viral nuclears material into the host
cell.
2.Reverse transcription;
Viral RNA is reverse transcribed into viral DNA .This process
is madiated by the enzymes reverse transcriptase (RT).This
enzymes has no proof-reading function,and therefore the
process is error prone and responsible for rapid
development of drugs resistant mutation.
3.integration;
The pro –viral DNA is inserted into host cell
chromosomal DNA using the viral enzyme
intergrase.This is the step that establishes
replication competent virus in the body and
makes HIV incurable even with effective ART.
Further,drug resistant virus that occurs in
patient on ART may also be archived in the
same way,establishing a permanent pool of
resistant viruses.
4.Transcription and translation;
Host cell enzymes transcribe viral DNA into viral
RNA uses host cell energy and synthetic
pathways to make viral protein
5.assembly,budding and maturation;
Viral protein and RNA aggregate on the cell
surface for assembly into a mature viral particle
by budding through host cell membrane.
NATURAL HISTORY AND STAGING OF HIV
INFECTION;
Following HIV infection there is initial rapid rise in
viral load,which may be associated with flue
like symtoms(primary hiv infection).
A vigorous immune response occurs within weeks
of infection,with production of both antibodies
and cellular mediated response.
Thus antibodies to HIV can be detected within 2
week of infection.The immune response
inhibits HIV replication with the results that the
viral load declines and stabilises within the first
6-12 months after infection.Thereafter the
patient remains asymtomatic for an average
6-10 years in the majority of patients,before
the ongoing immune destruction begin to
manifest in symtomatic HIV related disease
At the time of initial infection with HIV ,patient have large
number of susceptible CD4+ T-lymphocytes and no HIV
specific response.Thus ,there is rapid HIV replication that
causes rapid destruction of CD4+ T lympocytes over the
first weeks and months after infection.Through the
induction of HIV specific immune response,there is
stabilization of CD4 cells level and containment of viral
replication,which is marked by a very slow decline of
CD4+ T-cells over 6-10 years.Eventually ,in the absence
of effective arvs CD4 cell level decline further
culminating in progressive immune deficiency
accompanied by the development of HIV associated
complication(e.g.OIS,malignancies )
While immunologic decline after primary
infection usually occur slowly over many
years, it is `worth noting that many patients
will not be diagnosed until late in the course
of infection, when symptoms are present and
CD4 count is low.
 WHO Clinical staging of HIV/AIDS
Clinical stage1;
1.Asymtomatic
2.Persistent generalized lympadenopathy(PGL)
Clinical stage 2;
1.Moderate unexplained weight loss(<10% of pressumed or
measured BW)
2.Minor mucocutanous manifestation(seborrheic dermatitis,
popular pruritic eruption,fungal nail infection,recurrent oral
ulcerations,angular cheilitis)
3.Herpes zoster
4.Reccurent URTI(sinusitis,tonsilitis,bronchitis,otitis media,
pharyngitis)
Clinical stage 3;
1.Unexplained severe weight loss(over 10% of
presumed or measured BW)
2.Unexplained diarhoea for more than one
month
3.Unexplained persistent fever
4.Persistent oral candidiasis
5.Oral hairly leukoplakia
6.Pulmonary tuberculosis
7.Severe bacterial infection (e.g pneumonia,
empyema,pyomyositis,bone and joint
infection,menengitis,bacterimia.)
8unexplained anemia(below 8 g/dl)
Clinical stage 4
1.Hiv wasting sydrome
2.Pneumocystic jiroveci pneumonia(pcp)
3.Recurrent severe bacteria pneumonia(2 episodes
within 1 year)
4.Cryptococcal menengitis
5.Toxoplasmosis of the brain
6.Kaposi sarcoma(ks)
7.Hiv encephalopathy
8.Etra pulmonary tuberculosis
CLASSIFICATION OF DRUGS
AGAINIST HIV
BY
VICTORIA
 CLASSIFICATION OF DRUGS ACTIVE
AGAINST HIV
Currently ,there are 5 classes of drugs active against HIV.ARV
agents act by interfering with important functions in the viral
life-cycle.
1.Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
(NRTIs)They work by prematurely terminating DNA chain
formation as the enzyme reverse transcriptase copies viral RNA
into DNA.Examples are
Abacavir, or ABC (Ziagen)
• Didanosine, or ddl (Videx)
• Emtricitabine, or FTC (Emtriva)
• Lamivudine, or 3TC (Epivir)
• Stavudine, or d4T (Zerit)
• Tenofovir, or TDF (Viread)
• Zidovudine, or AZT or ZDV (Retrovir)
2.Non-nucleoside Reverse Transcriptase Inhibitors
(NNRTIs)
Inhibit the formation of viral DNA from viral RNA
by tightly binding to the reverse trascriptase
enzyme.Example are
• Delavirdine (Rescriptor)
• Efavirenz (Sustiva)
• Etravirine (Intelence)
• Nevirapine (Viramune)
• Rilpivirine (Edurant)
3.Protease Inhibitors (PIs)
They bind to the viral protease enzyme and block the
formation of viral proteins.
• Atazanavir, or ATV (Reyataz)
• Darunavir, or DRV (Prezista)
• Fosamprenavir, or FPV (Lexiva)
• Indinavir, or IDV (Crixivan)
• Lopinavir + ritonavir, or LPV/r (Kaletra)
• Nelfinavir, or NFV (Viracept)
• Ritonavir, or RTV (Norvir)
• Saquinavir, or SQV (Invirase)
• Tipranavir, or TPV (Aptivus)
• Cobicistat (Tybost) is a drug that helps
atazanavir and darunavir work better, but it
can cause life-threatening kidney problems if
you take it with certain other medicines.
• Atazanavir + cobicistat, or ATV/COBI (Evotaz)
• Darunavir + cobicistat, or DRV/COBI
(Prezcobix)
4.Entry inhibitors;they prevent entry of the
virus into the host cell i.e CD4.Example
include enfuvirtide
CCR5 antagonist Maraviroc
5.Integrase strand trasfer inhibitors(INSTI);they
block the integrase enzyme which
incorporates/integrates pro viral DNA into the
host cell DNA.Example are;Raltegravir,
Elvitegravir,Dolutegravir
 SIDE EFFECTS OF ARVS
• HIV medications help many people lead
longer, healthier lives. However, AIDS and HIV
drug side effects are also common. These side
effects range from mild to life threatening.
Here is an overview of some of the common
and more severe HIV drug side effects.
 P.E.P(post exposure prophylaxis)
• Prophylaxis is a treatment that helps you
ward off an infection from bacteria, fungus, a
virus, or a parasite. Post-exposure prophylaxis,
or PEP, means you take it after you may have
come into contact with one of those bugs.
• If you've been exposed to HIV (the virus that
causes AIDS), PEP is a course of two or three
drugs that will make you less likely to be
infected.
• With the right treatment, there's an 80%
chance the virus will be stopped. But you
have to take the full course of drugs, and not
everyone follows through. Only 57% of
people who start the treatment typically
finish it. This may be because you have to
take the medication for 28 days, and it can
cause side effects. It also can be expensive.
Who Might Need PEP?
PEP may help:
People who think they might have been exposed to HIV
during sex
Drug users who have recently shared needles or other
related items
Health-care workers who think they've been exposed to
HIV on the job
PEP is for emergency situations only. It should not be
used as a substitute for safe sex or new sterile needles.
 If you're frequently exposed to HIV -- through
your partner or shared needles, for example --
talk with your doctor about pre-exposure
prophylaxis (PrEP) instead. PEP uses higher doses
of more drugs than PrEP.
Timing
You have to start PEP within 72 hours of possible
exposure. After that, the treatment won't work. If
you think you may have been exposed to HIV, get
medical attention as soon as possible.
Pep should be discouraged after 72 hrs of exposure as
there is no benefit(ensure early referral to nearest
centre offering PEP if there are no local services.
Pre-exsisting medical condition and any current
medications being used by an exposed individual.
Choice of an efficacious simplified regimen preferably in
a fixed dose combination whenever possible to
increase adherence by reducing number of pills and
frequency of dosing.
Provide on going counselling due to adherence and
adverse reaction
Note: pep may be considered following RTA
where there has been exposure to other
peoples blood ; among police and prison staff
who may be injured in the course of their
work and in discordant couples following
condom accident.
Risk assessment following exposure to various body
fluids;
low risk-type of exposure ;intact skin-source HIV
negative ; material; saliva, tears,sweat, faeces,
urine ,sputum and vomitus
High risk;type of exposure; mucus membrane/non
intact skin, percutaneous injury, material; semen,
vaginalsecretions, synovial, pleural, pericardial,
peritoneal, amniotic fluids, blood and bloody
bodily fluids, viral culture in laboratory.
Of particular high risk are deep injuries,those involving
hollow neddles with visible blood and those involving
patients with high viral loads (recent HIV infection,late
stage HIV disease.
Note;the transmission of HIV is probably significantly
higher in rape because of trauma forceful penetration.
Other factors that increase transmission risk include
disease status of rapists(risk increase with viral load)
and presence of STI’S in the source or the person
assulted.In high prevalence population rapists should
be assumed to be HIV-positive unless proven
otherwise.
Additional service for sexual assault;
Emergency contraceptives for a child bearing non-
pregnant women
STI prophylaxis rx to all
Adult non pregnant
Po Doxycline 100mg bd x7 days = po norfloxacin
800mg stat
Adult pregnant
Im inj spectinomycin 2gm stat +po erythromycin
500mg qid x 7 days
Children ;
Po amoxyllin 15mg/kg/dose TDS X7 days +
Po erythromycin 10 mg/kg/dose qid x7 days
Post-exposure management;
In occupational exposure;
Immediate care to exposure site;encourage
bleeding from the site but do not scrub or cut the
site,washing it with soap and running water
Determine risk associated with exposure;evaluate
the source and exposed person
Asses the potential risk of infection
Both the source and exposed person need to be
counselled for hiv testing
A known source should be tested for hiv;if the
source person is not willing to be tested he/she
should not be coerced into having the test
Discarded sharps/neddles should not be tested
The exposed person should not receive ARVS drugs
without being tested.However where immediate
testing is not feasible,rx should be delayed since
hiv testing can be carried out the following day
or soon thereafter
Hiv test should be done at baseline,at 3 months and
6 months for a person exposed.
Offer PEP;Used FDC if available,to reduce pill
burden and increase adherence.
TDF/AZT +3TC +LPV/r
ARV prophylaxis in sexual assault is different;
TDF +3TC +LPV/r(adult only)
Or
AZT +3TC +LPV/r(for adult and children)
How It Works
The idea behind PEP is that the same drugs that
treat HIV can help you fight the virus as it tries to
infect you.
That involves a combination of two or three drugs
called anti-retrovirals. The process is called anti-
retroviral therapy, or ART. The medications help
keep HIV from making copies of itself.
You'll take them once or twice a day for 28 days:
• For adults, the World Health Organization (WHO)
recommends a drug called tenofovir, combined
with either lamivudine, also called 3TC, or
emtricitabine, commonly known as FTC. You
might also be prescribed lopinavir, which is
sometimes called LPV/r.
• If a child under 10 needs PEP, the WHO
recommends zidovudine, commonly known as
AZT, and 3TC. If a third drug is needed, it
recommends LPV/r.
• If you're on PEP, use condoms if you have sex
to lower the chances that you'll be exposed to
HIV again or that you'll pass the virus to
others if you are infected.
 PMTCT (emtc)
Means prevention of mother to child transmission of HIV.
emtc means elimination of mother to child transmission
of HIV.
More than 90% of paediatric HIV infections are as a
result of MTCT
In absence of any intervention,the risk of MTCT is
15-30% in a non-breastfeeding population and
20-40% among women who practice prolonged
breastfeeding without ARVS prophylaxis.The greatest
risk of transmission is during labour and delivery due
to the increased exposure of the newborn to HIV
contaminated blood and body fluids.
Higher viral load(>=1000 copies/ml),lower CD4
counts(,=350 cells/mm3),rupture of amniotic
membranes for more than 4 hours before
delivery and prolonged breastfeeding all
increases the risk of MTCT.
Prematurity ,low birth weight,mastitis and
genital tract infection are some additional
factors that may further increase the risk
 The four prongs of comprehensive
MTCT
1.Primary prevention
2.Prevention of unintended pregnancies
3.Chronic care and support for HIV+women,
their infant and families
4.Interventions to reduce HIV trasmission to
infant during pregnancy,labour and derivery
 Recommended care of a HIV-
POSITIVE woman
1.All HIV infected women who desire pregnancy
should receive preconception care to
optimize their health status prior to pregnancy
2.All pregnant women should be encouraged to
start attending antenatal care (ANC) as soon
as they know that they are pregnant,
st
preferably in the 1 trimester
3.All pregnant women should be offered HIV
counselling and testing during their 1st ANC
visit.Those negative should be re-tested after
3 months
4.All those pregnant who are not tested or opt
out or decline HIV testing during the 1st ANC
should be offered continued counselling and
testing in subsequent visit
5.Health care workers should offer counselling
and testing to all sexual partners of the ANC
clients and children of all HIV infected.HIV
+partner in doscordant relationship should be
evaluated for ARVS eligibility.
6.If a HIV + at the time of enrolment into ANC
or becomes pregnant while in care;a full
baseline assessment should be performed
including clinical psychosocial and laboratory
assessment including Cd4 cell count and
eligibility for ART initiation is determined
7.Where available,all HIV –infected pregnant
women should be screaned for hepatitis B
virus infection and managed accordingly
8.Labour and derivery should be follow optimal
obstetrics management guidelines
9.All HIV + pregnant women should be started
on ART.By enrolling them in care.
 st
Prefered 1 line ART regimen in pregnant
women is;
TDF+3TC+EFV
Infant nevirapine prophylaxis;
HIV exposed infants of women on ART should
receive 6 week of daily nevirapine
irrespective of breastfeeding practices
Infant who are breastfeeding whose mothers are
not on ART should receive daily nevirapine until
one week after complete ceasation of
breastfeeding
Infant who are not breastfeeding should receive 6
weeks of daily nevirapine.
NB;AZT 15 mg/kg twice daily for 6 weeks is an
alternative for infants who are not breast fed or
whose mothers are on ART/T riple prophylaxis
3TC is an alternative for infants with severe NVP
toxicity(grade 3 or 4) or if baby is on TB
treatment with rimfapicin containing regimen.
Dosage;2-4 mg/kg twice daily
MANAGEMENT OF HIV INFECTION
INTRODUCTION;
Knowledge about HIV status remains a mojor
limiting factor to accessing HIV prevention,
care and treatment services ,therefore at all
HIV testing sites.
VCT services should refer patients to HIV /
comprehensive care clinic(ccc) as soon after
diagnosis is made
PICT(provider initiated counselling and testing)
should be carried out aggressively in and out
patient service points (ANC,TB,STI,FP,MCH etc
clinics)
All patients with children under 15 years
attending CCC should be encouraged to bring
their children for hiv testing in additional to
sexual partners
All community based organizations and families
supporting orphans and vulnerable children
should arrange to have those children whose
parents may have died of HIV infection tested
All people living with HIV ,whether on ART or not,
should have access to a set of core interventions
known to promote health,improve the quality of
life ,prevent further HIV transmission ;and for
some delay HIV disease progression and prevent
mortality.
Counselling and psychosocial support;
1. All people living with HIV should be provided
with counselling and psychosocial support
intervention including individual and group
counselling ,peer support groups ,family and
couple counseling and support
Counseling and psychosocial support should
focus on ;
• Mitigation of fear,anger,self-stigma and
discrimination
• Alleviation of grief,bewilderment and stress
among partners and family members
• Behaviour change in support of healthy living
and prevention of further HIV transmission
• Disclosure and partner notification
• Family/partner counselling to identify family
members who may need care and treatment
• Skills –bulding on how to live a healthy and
productive life
• Identification and treatment of depression and
substance abuse.Mental illness and substance
and alcohol dependence are common conditions
among PLWHIV.These conditions ,besides
affectingthe quality of life of patient can cause
non adherence to prophylaxis and ART regimens
as well as underminesafer sex practices and
youth and adolescence issues
2.People living with HIV should be offered
counselling and support to promote adherence to
prevention interventions and treatment
recommended for their care including ART
3.PWHIV who choose to be sexually active should
be counseled on safer sexual practices to prevent
HIV transmission to their sexual partners and
avoid acquisition of STIs and HIV reinfection;and
should be provided with condoms and
appropriate contraceptive services and
counseling
 Prevention with positives;People living with HIV
should be support and encouraged to disclose their
HIV status to those who need to know ;particularly
sexual partner.
In Kenya,upto 7-11% of couples in stable long –term
parnership are sero discordant
HIV negative partners in a sero –discordant relationship
are at high risk of HIV infection
Disclosure of HIV status encourages couple counselling
and testing the discussion of reproductive health
issues such as desired to have children, better couple
communication and condom use.
Accumlating evidence has shown that
treatment of HIV positive partners in a sero
–discordant relationship markedly reduces
the risk of HIV transmission to the HIV
negative partner.
Sero –concordant couples also benefit from
disclosure;thus facilitating couple counseling
and testing ;provision of condoms to avoid
STIs and unintended pregnancies and
discussion of reproductive health matters.
Cotrimoxazole prophylaxis (CPT);
All HIV positive patients should be given
lifelong CPT unless contraindicated.
Cotrimozole is an effective prophylaxis agent
against a broad range of conditions and
organisms including; toxoplasmosis,PCP,
common bacterial infections,sepsis,
diarrhoea and malaria
In pregnancy CPT has additional benefit of
reducing chorioamnionitis ,prematurity and
neonatal mortality,particulary in patient with
CD4 cell count of <-200 cells/mm3.During
pregnancy ,CPT should be initiated
irrespective of the gestation age.Additional
intermittent preventive therapy for malaria is
not required in women already on CPT.HIV
infected breastfeeding women should
continue with CPT.
A rash may occasionally develop, usually about
7-14 days following initiation of CTX(SEPRIN)
It is often relatively mild maculopapular rash
with or without pruritis.Infrequently a more
severe rash may develop with exfoliation of
the skin and steven –johnson syndrome.
Patient with mild to moderate rash should stop
the CTX and once recovered should undergo
desentization
Patient with severe rash (edema,vesiculation ,
mucosal involvement) should not be
desentised,CTX should be stopped and never
be re-used
Desentisization is effective in majority of
patients but is not recommended in children
Management of patient with cotrimoxazole allergy;
Desentisation is effective in majority of patient
Dapson is recommended for use in patient unable
to use CTX ;unfortunately dapson is not as
effective a chemoprophylatic agent as CTX and is
effective against only PCP when used
alone(ideally ,pyremythamine should be used in
addition ,to provide effective prevention against
toxoplasmosis
 day Dose of TMP/SMX
Standard desentization regimen (days);
suspension 40/200 per 5 ml

1 0.5ml

2 1 ml

3 2ml

4 3 ml

5 4 ml

6 5 ml

7 1ss tablet

8 2 ss tablets/1ds tablet per day

Dose of dapson;
Available as 25 mg and 100 mg tabs
Children 4 mg /kg per week or 2 mg once daily;
maximum dose is 100 mg
Adult 100 mg daily
Tuberculosis prevention and treatment among
PWHIV ;
Is most frequent serious opportunistic infection
and a leading cause of death
Hiv infection increase the risk of TB disease ten
fold;together with a higher risk of death ,
reccurence and re-infection.ART substantially
decreases the risk of TB disease,
1. PWHIV should receive counselling about
the risk of acquiring TB ,strategies for
reducing exposure to TB ,recognizing clinical
manifestation of TB and seeking care
promptly ,the risk of transmission of TB to
others and TB preventive therapy.
2.PWHIV should be screened for TB at each visit
3.TB preventive therapy should be provided to all
PWHIV after thourough exclusion of TB disease
Indication of IPT; (isonizide preventive therapy)
1.All children regardless of HIV sero status < 5
years exposed to open ‘PTB’ in a close contact,
with a negative TB screen should be given IPT.
Given isoniazide 10mg /kg bw daily for 6/12.
ii.All children living with HIV with more than 1
year of age in whom TB has been excluded.
iii.All HIV –positive adults patient in whom TB
has been excluded
4.All health care setting should develop and
implement TB infection control strategies to
reduce the risk of transmission of TB among
patients ,visitors and staff.
 NUTRITION
Nutrition Defination;is the process of taking food
into the body and absorbing the nutrients in
those foods.
HIV infection is often associated with poor nutrition
due to a number of reasons including;
Increasing energy requirements
Decreased appetite
Reduced intake due to painful oral and
oesophangeal OIs
Malabsorption
Unavailability of sufficient food due to household
food insecurity and poverty
Low body mass index is an independent predictor of
mortality in PWHIV;
i.At the initial assessment and at regular interval
thereafter,all PWHIV should receive full
nutritional assessment(weight,height,BMI,MUAC.
Symtoms related to appetite,nausea,difficulty
swallowing,dirrhoea,food drug interaction and
adequacy of food intake)
ii.Clinically malnourished adults(BMI<18.5 kg/
m2) need therapeutic and supplementary
feeding support until their BMI is above 18.5
kg/m2
iii.Care and treatment programmes should link
patients to community organizations and
programmes that will assist them to achieve
household food security
iv.PLHIV should be provided with daily
micronutrient supplement(appropiate
multivitamin preparation);unless their diets
are determined to be adequate and
diversified.
v.The standard recommendation for nutrient
intake and nutritional support for pregnant
and lactating women should be followed,
regardless of the women’s HIV status