Topic: Objectives

Objectives:

• Describe the basic concepts of HIV and AIDS.
• Appreciate global and national HIV statistics and epidemiology.
• Explain HIV combination prevention intervention.
• Describe HIV positive living.

Topic One: Definition of Terms

HIV (Human Immunodeficiency Virus):

• Virus causing HIV infection and AIDS.
• Weakens the immune system by destroying disease-fighting cells.
• Preventable and manageable, but not curable.
• Transmitted via body fluids (blood, breast milk, semen, vaginal secretions).
• Not transmitted through kissing, hugging, shaking hands, sharing personal objects, food, or water.
• Invades helper T cells (CD4+ cells) in the body.
• No signs or symptoms in the initial stages, but still infectious.
• Body can’t fight off infections, leading to AIDS.

AIDS (Acquired Immune Deficiency Syndrome):

• Disease caused by a confirmed positive test for HIV.
• Predisposes patients to multiple opportunistic infections, leading to death.

Risk Factors of HIV Infection

• Unprotected sex (anal or vaginal).
• Having STIs (e.g., syphilis, herpes, Chlamydia, gonorrhea, bacterial vaginosis).
• Sharing injecting needles.
• Receiving unsafe injections, tissue transplantation, or medical procedures involving unsterile cutting or piercing.
• Accidental needle stick injuries (healthcare workers).
• Mother-to-child transmission during pregnancy, birth, or breastfeeding.

HIV Prevention Key Approaches

• Biomedical Prevention:
• Condom use promotion and distribution.
• Elimination of mother-to-child transmission (EMTCT).
• Voluntary medical male circumcision (VMMC).
• Methadone replacement therapy.
• STI treatment.
• Blood safety.
• Behavioral Interventions:
• HIV testing.
• Behavior change communication.
• Social/Structural Interventions:
• Social Protection (e.g., Cash Transfers for Orphans and Vulnerable Children – CT-OVC).
• Building resilience of women and girls.
• Girls enrolled in secondary school.

HIV Positive Living

• Antiretroviral (ARV) drugs control the virus and prevent transmission for healthy, long, and productive lives.
• Antiretroviral therapy (ART) should be taken daily and right away to reduce viral load.
• Use condoms correctly every time you have sex.
• Choose less risky sexual behaviors.
• Not sharing needles for drug use.
• Pre-exposure prophylaxis (PrEP).
• Adherence to treatment.
• Get tested and treated for other STIs.
• Encourage partners to get tested for HIV.

Topic Two: Modes of HIV Transmission and Key Risk Factors

Modes of Transmission:

• Heterosexual (male-female) and homosexual (men having sex with men).
• Non-consensual sexual exposures (assault).
• Parenteral: transfusion of infected blood or blood products, exposure to infected blood/body fluids through contaminated sharps, IDU needle sharing or needle stick accidents, donated organs.
• Perinatal/Vertical: transplacental, during labor/delivery, breastfeeding.
• HIV is not transmitted by casual contact, surface contact, or insect bites.

Biological Factors Influencing HIV Transmission:

• Disease status of the source patient (related to immunosuppression and viral load).
• Presence of untreated STIs in the source and person at risk.
• Circumcision status: uncircumcised men are more likely to acquire HIV than circumcised.
• Gender differences: females are more susceptible due to genital anatomy.

Socio-economic Factors Facilitating HIV Transmission:

• Social mobility: partners living apart.
• Stigma and denial.
• People in conflict: war and struggle for power.
• Cultural factors: traditions, beliefs, and practices.
• Gender: acceptance of men having multiple sexual partners, gender inequalities, inability of women to negotiate condom use.
• Poverty: lack of information needed to understand and prevent HIV.
• Drug use and alcohol consumption: impaired judgment, sharing of needles and equipment.

Key Populations (KP):

• Groups at increased risk of HIV due to specific high-risk behaviors.
• Include sex workers, men who have sex with men, people who inject drugs, and transgender people.
• Should receive routine HIV testing every 3 months and retesting at least annually.

Vulnerable Populations:

• Persons at high risk due to situations beyond their control.
• Include widows and widowers, orphans and vulnerable children (OVCs), families and children living on the streets, young women aged 15-24 years, servicemen and women, refugees, displaced persons and migrants, people who abuse alcohol, survivors of sexual and gender-based violence.

Survivors of Sexual and Gender-Based Violence:

• Should receive HIV testing services (HTS) at first contact.
• Immediate referral for clinical evaluation, documentation and treatment, trauma counseling, and post-exposure prophylaxis (PEP).
• Retesting recommended after 4 weeks, and if still negative or in a discordant relationship, retesting at 12 weeks.

Topic Three: Global HIV Statistics

Global HIV Statistics (2016):

• People living with HIV: 36.7 million.
• People accessing antiretroviral therapy: 19.5 million.
• Newly infected with HIV: 1.8 million.
• Deaths from AIDS-related illnesses: 1 million.
• Total people infected since the epidemic began: 76.1 million.
• Total deaths by AIDS: 35 million.

HIV/Tuberculosis (TB) Co-infection:

• Leading cause of death among people living with HIV.
• Around one in three AIDS-related deaths due to TB.
• Global TB cases (2015): 10.4 million; 1.2 million among people living with HIV.
• TB-related deaths among people living with HIV fell by 33% between 2005 and 2015.
• 60% of TB cases among people living with HIV were not diagnosed or treated, resulting in 390,000 TB-related deaths among people living with HIV in 2015.

HIV is not transmitted by:

• Touching/hugging.
• Mutual masturbation, kissing, oral sex.
• Insect bites.
• Water, food, air.
• Sharing toilet seats, tables, door handles, cutlery, towels.

Myths and Misconceptions of HIV and AIDS

• Common myths and misconceptions should be addressed to improve understanding and reduce stigma.

Topic Two: The Immune System

The Immune System:

• A system of special cells (lymphocytes, monocytes), proteins (antibodies), tissues, and organs that defend the body against foreign substances (antigens).

Antigen:

• A foreign substance which stimulates the immune system to respond by producing antibodies.

Antibody:

• A protein produced by lymphocytes, binding to specific antigens.

Immune System Organization:

• The immune system is organized into innate, cellular, and humoral responses.
• Organs involved are categorized into primary (thymus and bone marrow) and secondary (lymph nodes and spleen) lymphoid organs.

Cellular Responses to HIV Infection:

• HIV enters the body, triggering anti-HIV antibody and cytotoxic T cell production.
• Macrophages and dendritic cells present the virus to CD4 cells.
• CD4 T lymphocytes are the main target for HIV attack.
• CD8+ cytotoxic cells lyse HIV-infected cells and secrete cytokines and chemokines to inhibit virus replication.

Humoral Response to HIV:

• Production of specific antibodies in response to HIV infection.
• Non-neutralizing antibodies target HIV structural proteins (P17 and P24).
• Neutralizing antibodies target gp120, CD4 binding sites, chemokine receptors, and gp41.

Combined Cellular and Humoral Response:

• Both responses play important roles in HIV infection.
• Cellular responses are initiated first, followed by antibody responses 4-8 weeks after infection.
• B cells produce antibodies, but mutations in HIV glycoproteins render them ineffective.

Summary

• HIV has become a pandemic since the first cases were identified.
• It is a major cause of morbidity and mortality, especially in sub-Saharan Africa (SSA).
• Multiple factors contribute to HIV transmission in society.
• Effective prevention requires a combination of biomedical, behavioral, and social/structural interventions.