HIV/AIDS (UNIT 2)

PRESENTER
HACHIBALA PM (MRS.)
LEARNING OBJECTIVES

•Define: HIV/AIDS
•Describe the historical background
of HIV/AIDS.
•State the mode of spread of
HIV/AIDS.
•Outline the prevention strategies of
HIV/AIDS.
DEFINITION OF TERMS
•HIV – Human Immunodeficiency
virus.
•AIDS – Acquired Immuno-deficiency
Syndrome.
•Immunity – The body’s ability to
defend itself against infections.
•Syndrome – a group of complex
signs and symptoms that occur
together in a given condition.
HISTORICAL BACKGROUND

•Acquired Immune Deficiency

Syndrome (AIDS) is an end
stage of an infection caused by
the Human Immune-deficiency
Virus (HIV).
•AIDS is now in serious epidemic
proportion in most parts of the
world especially in environments
compounded by social economic
problems as well.
HISTORICAL BACKGROUND……..

•Two types of HIV virus are now

recognised, HIV-1 and HIV-2.
The later is more common in
west part of Africa and does not
cause wasting or weight loss,
which is common feature among
those, infected with HIV -1.
WORLD HISTORY

•The first cases of AIDS were first

reported in New York and
California in 1981 in male
homosexuals who presented with
opportunistic infections and
Kaposis'sarcoma.
•The term AIDS was officially
adopted in 1982.
WORLD HISTORY…………

•The causative agent of AIDS is a

retrovirus and was first identified
in 1983 by a group of scientist
lead by Professor Montagner in
Paris who called it
Lymphadenopathy -associated
virus (LAV).
WORLD HISTORY…………

•Almost at the same time another

group of scientists in USA working
with Professor Galla reported
isolation of a virus from patients
which they called Human T – cell
lymphotropic virus type 111 (HTL V-
111).
•Investigations confirmed the identity
of LA V and HTL V-111.
WORLD HISTORY…………

•By international agreement this

virus is now referred to as the
Human Immuno-deficiency Virus
type 1 (HIV -1).
 THE ZAMBIAN SITUATION
•The HIV / AIDS epidemic is a
serious health problem in
Zambia.
•The virus has already and
continues to infect and affect
many people every day.
IN ZAMBIA CONTINUES…

•The first HIV case in Zambia was

reported in 1984 since then it has
spread rapidly with cases
reported in all districts.
HISTORICAL BACKGROUND …………………

•The estimated prevalence rate

stands at 14% and more than
1million people are living with
HIV/AIDS.
•There has been a decline in the
prevalence rate from 20% in
1998, 16% in 2004and now is at
13.9% among women and 8.0%
among men.
In Zambia cont’

•AIDS is now a major contributor

to under 5 mortality.
HISTORICAL BACKGROUND …………………

•In 2001, an estimated 120,000

Zambians died of AIDS and there
were approximately 570,000
children under the age of 15 in
Zambia who have been
orphaned by the death of one or
both Parents due to AIDS.
HISTORICAL BACKGROUND …………………

•By 2050, 6.2 million Zambians will

have died because of the epidemic.
•The proportion of the population
infected in urban areas ranges from
25-32percent between the ages of
15 and 44 years.
HISTORICAL BACKGROUND …………………

•In rural areas, infection rates range

from 8 to 16 percent.
•Studies in sentinel populations show
significant increases in infection
rates over time.
•In Lusaka and Ndola, HIV
prevalance among women attending
antenatal care clinics increased from
5% in 1985 to 27% in 1994.
HISTORICAL BACKGROUND …………………

•The total percentage of HIV positive

women from 15-46 years was 17.8,
of the 2,073 that had been tested
and the total percentage of men was
12.9% of the 1,734 that had been
tested.
HISTORICAL BACKGROUND …………………

•Over 60% of adults aged 15-49

years suffering from TB are HIV
positive. (WHO, 2004).
•The socio-economic impact of
HIV/AIDS in Zambia is enormous
because the most affected are
individuals at the peak of their
productive and reproductive period.
HISTORICAL BACKGROUND …………………

•HIV/AIDS has resulted in

reduced productivity because of
illness and premature mortality
due to HIV related opportunistic
infections and malignancies.
HISTORICAL BACKGROUND …………………

•The most common opportunistic

illnesses seen in Zambia include
Tuberculosis, bacterial meningitis,
bacterial pneumonia and oral thrush.
•Furthermore, the high prevalence of
HIV related illness in Zambia has
seriously overburdened the
healthcare system at all levels.
•In major hospitals, HIV/AIDS patients
used to occupy more than half of the
beds.
HIV NATURAL HISTORY
•It is difficult to determine how
long a person will live with HIV
before developing AIDS.
•The average length of time is about
10 years or more.
•However, each person is different,
and many factors such as
malnutrition, stress levels and
emotional support influence a
person’s ability to remain healthy.
HIV NATURAL HISTORY…..

Infection
•May experience vague flu-like
symptoms for 1or 2 weeks such as
sore throat, muscle and joint pain and
swollen lymph nodes.
•These symptoms may go unnoticed.
HIV NATURAL HISTORY…..

•Asymptomatic.
•May live without any symptoms
of HIV for 10 years or more.
HIV NATURAL HISTORY…..

•Non-specific symptoms.
•Begins to develop more severe
infections such as candidiasis,
pneumocystis, pneumonia,
tuberculosis and severe weight loss
and wasting.
•When the CD4 drops below 200 per
cubic millilitre, the individual is
classified as having AIDS.
HIV NATURAL HISTORY…..

•Death – is the inevitable end result of

HIV infection and AIDS.
•NB: CD4 count is used to measure
immune system damage.
Measurement of viral load in the
plasma reflects the activity of the
virus and measures the strength of
the infection.
HIV NATURAL HISTORY…..

•Because the infection is present

in the blood and genital
secretions throughout the course
of HIV infection, HIV infected
individuals are infectious even
when they have no symptoms or
physical signs of infections.
 MODE OF
TRANSMISSION
•HIV can be transmitted in the
following ways:
•Sexually: vaginal (most
transmission), anal or oral sex.
•Parenterally: through transfusion of
infected blood or blood products,
donated organs, exposure of
infected blood through injection drug
use or needle stick.
MODE OF TRANSMISSION…

•Perinatally: mother to child

transfusion (MTCT) occurs
during pregnancy, child birth or
breast-feeding.
SIGNS AND SYMPTOMS SUGGESTIVE
OF HIV INFECTION
•The occurrence of the following
symptoms and signs may indicate an
HIV infection in an area of high HIV
prevalence and should be an
indication for counselling patients
about HIV testing:
•Acute or chronic cough
•Anaemia
•Weight loss
SIGNS AND SYMPTOMS SUGGESTIVE
OF HIV INFECTION……………

•Failure to thrive (in children)

•Mouth and/ or throat problems
•Acute or chronic fever
•Acute or chronic diarrhoea
•Genito-urinary symptoms
•Skin problem or lumps
SIGNS AND SYMPTOMS SUGGESTIVE
OF HIV INFECTION……………
• Genital or anal sores or ulcers
• Headaches or other neurological
problems
• Mental illness
HIV IS NOT SPREAD THROUGH:

•Germs on hands
•Food
•Cups or utensils
•Saliva
•Coughing
•Use of the same utensils
•Sharing toliets
•NB:When these complaints are
recurrent or chronic, the index or
suspicion should be raised and
the patient (or caregivers, if child)
should be counselled about HIV
testing and about the available
interventions to mitigate the
disease.
PREVENTION STRATEGIES

•A – Abstinence ‘ILICHE’
•B – Be faithful to one uninfected
sexual partner.
•C – Condom: correct and
consistent use of condoms.
COUNCELLING TESTING AND
CARE(CTC)
• This is Voluntary Counselling and
Testing.
• Knowing one’s status is the first key step
towards accessing available care
interventions.
•Counselling is a process that
assists individuals to reach their
own informed decisions about
what they should do, or come to
terms with a problem that is
facing them.
VCT……………….

•VCT services enable people to

determine their own HIV status and
to take measures to keep
themselves healthy and reduce the
risk of transmission of HIV to others.
•VCT is important in behavioural
change.
•It helps to maintain healthy lifestyles
among those who test positive and
thus enhance positive living.
VCT……………….

•VCT is optional, not mandatory,

and is confidential.
•There are 3 main types of
counselling:
•Pre-test counselling.
•Post-test counselling
•Crisis counselling.
VCT……………….

• Clients in communities should be

encouraged to undergo HIV test in
specific circumstances such as:
• Individuals with STI’s
• Couples considering marriage
• Couples considering having a child
• Cases of sexual abuse
• Patients with HIV –related signs and
symptoms.
VTC……………….

•The VCT services should be

youth friendly.
•Treat youth with respect and
maintain confidentiality.
•Make young people feel free at
the heath facility.
ELIMINATION OF MOTHER TO CHILD
TRANSMISSION

•This Prevention of Mother To

Child Transmission.
•MTCT is the transmission of HIV
from an infected woman during
pregnancy, delivery, or
breastfeeding to a child.
•MTCT is by far the largest source
of infection in children below the
age of 15 years.
•There are 3 ways in which the
baby may get infected:
PMTCT……………..

•During pregnancy, (in utero);

infection rate is about 21%.
•During labour and delivery
(intrapartum)- the infection rate is
about 65%.
•Through breast feeding (post-natal):
infection rate is about 14% (risk
increases with duration of breast
feeding).
PMTCT……………..

•In Zambia, the risk of an HIV

positive woman transmitting HIV
to her infant is about 40%.
•Risk of transmission is increased
when the mother has a higher
concentration of HIV in the body.
INFANT FEEDING OPTIONS
FOR AN HIV POSITIVE
MOTHER
•Counsel mother on feeding
option and support her in making
an informed choice.
•Three (3) different feeding
methods can be used’
1. BREAST MILK
SUBSTITUTES
•A) Commercial Infant formula
•Feeding an infant for six months
requires on average 40x 500gms
(44x450gm tins) of formula.
INFANT FEEDING OPTIONS FOR
AN HIV POSITIVE MOTHER………

•Infants who are fed on commercial

foods do not need complementary
foods if they are gaining weight
adequately.
•B) Home prepared formula
•Can be made with modified animal
milks, dried milk powder or
evaporated milk.
•C) Unmodified cow’s milk.
INFANT FEEDING OPTIONS FOR
AN HIV POSITIVE MOTHER………

2. Modified Breast feeding.

A. Early cessation of breastfeeding –
reduces risk of HIV transmission.
B. Expresed and heat-treated breast
milk.
•Heat treatment of expressed breast
milk from an HIV positive mother kills
the virus in the breast milk.
INFANT FEEDING OPTIONS FOR
AN HIV POSITIVE MOTHER………

•3. Wet nursing

•In some parts of Zambia, there is a
tradition of wet nursing in the family
context, where a relative breastfeeds
an infant.
•This has a high risk of HIV
transmission to the infant through
breast milk.
•There is also a risk of
transmission of HIV from the
infant to the wet nurse especially
if she has cracked nipples.
 MALE CIRCUMCISION
Voluntary Medical Male
Circumcision (VMMC) has
been performed on boys and
men in Zambia since 2007
following the joint announcement
by the WHO and UNAIDS that
male circumcision should be included
as part of a comprehensive
HIV prevention program.
• Male circumcision is
considered a highly cost-
effective strategy for HIV
prevention for the Zambian
context.
•Evidence suggests that Zambia’s
National MC Programme would
have the greatest and most
immediate impact by focusing on
HIV negative adult males age 15-
49.
 MALE CIRCUMCISION
DEFINITION

Circumcision is a Surgical
procedure to remove the foreskin,
the skin that covers the tip of the
penis.
•Evidence suggests that Zambia’s
National MC Programme would
have the greatest and most
immediate impact by focusing on
HIV negative adult males age 15-
49.
BENEFITS

A lower risk of HIV

A slightly lower risk of other sexually
transmitted diseases
A slightly lower risk of urinary tract
infections and penile cancer.
However, these are both rare in all
males.
COMPLICATIONS

Excessive bleeding:
Some people may bleed more than is
normal or safe during the procedure.
They may also notice bleeding
around the incision for a few hours or
days after the procedure.
Infection:
Any injury to the skin can provide
a site for bacteria to grow.

A circumcision creates a wound,

which may become infected.
Anesthesia complications: As with
any surgery, a person may
experience anesthesia-related
complications, such as allergic
reactions, nausea, vomiting, or
difficulties waking up from general
anesthesia
•Pain: It is normal to feel pain after
the procedure. For some people, the
pain is intense or lasts weeks or
months.
•Very rarely, injuries to the penis or
surrounding nerves may cause
chronic pain or make sex painful
The surgery itself takes about 30 minutes,
but the whole procedure, including
delivering anesthesia and waking up, may
take longer.
After surgery, a doctor applies a dressing to
the site of surgery, which usually stays on
for about 2 days. They may also give the
person some pain medication. Some
swelling and bruising will likely last for
several days.
Recovery from an adult circumcision may
take up to 6 weeks.
The penis may feel very sensitive for the
first 2 weeks, and dissolvable stitches may
last for 2–3 weeks.
It is also advisable to keep the area dry for
48 hours and avoid swimming for up to 2
weeks.
A person should wear loose-fitting
clothing for the first few days after the
procedure and refrain from any
sexual activity for 4 weeks. It is
common to experience pain during an
erection while recovering.
Applying petroleum jelly may help
ease itching and pain, and it can help
prevent stitches from sticking to
clothing. Nonsteroidal anti-
inflammatory drugs (NSAIDs) may
help if a person experiences any
discomfort.
PRE- EXPOSURE
PROPHYLAXIS
•Pre-exposure prophylaxis (or
PrEP) is medicine taken to
prevent getting HIV. PrEP is
highly effective for preventing
HIV when taken as prescribed.
•PrEP reduces the risk of getting
HIV from sex by about 99%.
PrEP reduces the risk of getting
HIV from injection drug use by at
…
●
TDF{TENOFOVIR AND EMITRISTABINE
FEMULATE)/EMITRISTABINE,
To be taken 2 weeks before exposure and
to be continued 2 weeks after exposure.
POST- EXPOSURE PROPHYLAXIS

PEP is the use of antiretroviral drugs

after a single high-risk event to stop
HIV seroconversion.
PEP must be started as soon as
possible to be effective—and always
within 72 hours of a possible
exposure.
Post exposure…

•PEP may be right for you if you are

HIV-negative or don’t know your HIV
status, AND you think you may have
been exposed to HIV in the last 72
hours:
1. During sex (for example, you had a
condom break with a partner of …
●
GIVE PEP
TLD(TENOFOVIR,LAMIVUDINE AND
DOLUTEGRAVIR FOR 28 DAYS,
●
Do anothr test at 6 wks,3 months and
then normal HIV testing.
Prio to taking pep do HIV TESTING.
●
THE END