Professional Documents
Culture Documents
BUCU005 HIVAIDS and DRUG ABUSE
BUCU005 HIVAIDS and DRUG ABUSE
BUCU005 HIVAIDS and DRUG ABUSE
CHAPTER 1 .................................................................................................................................................................8
CHAPTER 2 ............................................................................................................................................................... 31
CHAPTER 3 ............................................................................................................................................................... 37
3.5.1 DRUG ABUSE CAN CAUSE A WIDE VARIETY OF ADVERSE PHYSICAL REACTIONS. ...... 42
CHAPTER 4 ............................................................................................................................................................... 45
CHAPTER 5 ............................................................................................................................................................... 53
6.3.2 KENYA NATIONAL AIDS STRATEGIC PLAN (KNASP) 2005/6 – 2009/10 ............................... 66
6.3.3 KENYA NATIONAL AIDS STRATEGIC PLAN (KNASP) 2009/10 – 2012/13 ............................. 67
6.4 SOME OF THE STRATEGIES ADOPTED BY THE KENYAN GOVERNMENT TO FIGHT THE
SPREAD OF HIV/AIDS ...................................................................................................................................... 69
CHAPTER 7 ............................................................................................................................................................... 72
CHAPTER 8 ............................................................................................................................................................... 89
General introduction: public health and hygiene, human physiology, sex and sexuality.
History of STDs, History of HIV/AIDS, comparative information on the trends global and
local distribution. Treatment and management: Ant-retroviral drugs and vaccines,
nutrition and home based care. Prevention and control: Abstain, be faithful, condom use,
destigmatise HIV/AIDS (ABCD) method. Pregnancy and AIDS. Social and cultural
practices: religion and AIDS. Behavioural change. VCT services. Drugs abuse and AIDS,
Alcohol and hard drugs. Government policies: global policies of AIDS. Legal rights of
AIDS patients. AIDS impact: family set-up/society, population, agriculture, education,
development and economy and other sectors.
Objectives
Mode of Assessment
CATs 30%
Examination 70%
CHAPTER 1
GENERAL INTRODUCTION
1.0 INTRODUCTION
This section aims at introducing you to public health & hygiene, and HIV/AIDS by
giving their meaning, relationship, origin and classification. The section will also
discuss the relationship between the spread of HIV and Sexually Transmitted Infections
(STIs). The section also brings out the current status of HIV/AIDS At global, African
and Kenyan perspectives. The factors leading to the spread of the virus also form part
of the discussion in the unit.
Objectives
Explain the relationship between HIV and Sexually Transmitted Infections (STIs)
Explain the current status in the spread of HIV/AIDS from global, African and
Kenyan perspectives
Therefore public health programs and HIV/AIDS education compliment one another.
Most people think of public health workers as physicians and nurses, but a wide variety
of other professional work in the public health sector including; veterinarians, sanitary
engineers, microbiologists, laboratory technicians, statisticians, economists,
administrators, attorneys, industrial safety and hygiene specialists, psychologists,
sociologists, and educators.
Public health workers may engage in activities such as inspecting and licensing
restaurants; conducting rodent and insect control programs; and checking the safety of
housing, water, and food supplies. In assuring overall community health, public health
officials also act as advocates for laws and regulations such as drug licensing or product
labeling requirements. Some public health officials are epidemiologists, who use
sophisticated computer and mathematical models to track the incidence of
communicable diseases and to identify new diseases and health trends. Others conduct
state-of-the-art medical research to find new prevention and treatment methods.
Hygiene is defined as the science dealing with the preservation of health or the practice
or principles of cleanliness. In the public domain, public health officers mainly manage
this practice.
Vaccination:
This is the deliberate process of making the body resistant to a specific disease by using
a vaccine (a suspension or a product of an infectious agent that is used to produce
active immunity). Vaccination programs [protect people against diseases such as
measles, mumps, polio, diphtheria and other childhood infectious diseases. When small
outbreaks of infectious disease threaten to grow into epidemics, public health officials
may initiate new vaccination programs.
Public health agencies operate local; clinics that provide free or reduced – cost medical
services to individuals, especially infants and children, pregnant and nursing women,
people with drug abuse problems, physical disabilities, and other conditions. These
clinics provide prenatal and pediatric care for children who have no regular access to
medical care.
Public health clinics routinely screen for a number of infectious diseases, such as
sexually transmitted infections (STI) and diseases (STD), and may provide free
treatment if patients test positive. Each clinic tracks the incidence of certain
communicable diseases in this area, and reports this information to national and
international public health offices. Public health clinics may also track down past sexual
partners of STD patients, inform them that they may have been infected with an STD,
and urge them to come in to a clinic to be tested.
Public health officers are also involved in epidemiology. Threats to public health
concerns change over time and epidemiologists and other officials continuously
evaluate epidemiological trends to determine how best to meet future public health
needs. For example, recent epidemiological reports show that tuberculosis, an infectious
disease believed to be under control just 30 years ago, is now responsible for more
deaths worldwide than any other infectious disease, killing more people per year than
AIDS and malaria combined. This resurgence is due to new drug-resistance strains of
the bacterium that cause tuberculosis. The tuberculosis epidemic, or pandemic, has been
declared a global public health emergency, promoting intensive international public
health efforts to curb its spread.
Epidemiologists and other public health officials attempt to break the chain of disease
transmission by notifying people who may be at risk of contracting an infectious
disease. For example, when epidemiologists learn that a restaurant worker has
infectious hepatitis, they place announcement in local media, such as radio and
newspaper, urging people who ate at the restaurant in recent weeks to be checked for
the disease and to seek treatment so that they will no longer risk infecting others. Public
health officials may also ensure that infected people complete treatment programs, so
that the diseases are completely eliminated and the patients are no longer carriers of the
infection.
Disease causing organisms are often transmitted through contaminated drinking water.
The single most effective way to limit water-borne diseases is to ensure that drinking
water is clean and not contaminated by sewage. In many parts of the world, public
health official establish sewage disposal and solid waste disposal systems, and regularly
test water supplies to ensure they are safe.
Many diseases such as hepatitis A and these caused by bacteria are transmitted through
food. When food is not washed or thoroughly cooked, or when food is stored at
temperatures that are hospitable to disease-causing organisms, people who eat the food
are subject to infection. Public health programs establish and enforce laws for safe food
storage and preparation. For example, in most nations, food processing plants
restaurants and grocery stores are legally required to follow strict food-safety
guidelines established by public health officials.
Public health officials also establish and oversee programs to control flies, rodents, and
other animals that spread disease-causing microbes.
Medical research
Many diseases are preventable through health living, and a primary public health goal
is to educate the general public on how to prevent the noninfectious diseases. Public
health campaigns teach people about the value of avoiding smoking, getting treatment
for high blood pressure, avoiding foods high in cholesterol and fat, and maintaining a
healthy body weight. Other campaigns educate the public on ways to prevent birth
defects, such as abstaining from alcohol during pregnancy to prevent fetal alcohol
syndrome.
Health promotion also encourages people to take advantage of early diagnostic tests
that can make the outcome of disease more favorable (Bres, 1986). Regular
mammograms encourage early detection of breast cancer, for instance, increasing the
chances of cure. Detection and proper treatment of high blood pressure reduces the risk
of stroke, the leading cause of permanent disability in older people.
Accidents, particularly automobile accidents, pose a major threat to public health, and
official have undertaken campaigns to reduce the number of automobile accidents by
encouraging seat belt use and discouraging drinking and driving.
1.2 CONCEPTS OF HIV, AIDS AND STIS
1.2.1 HIV:
HIV stands for Human Immuno-deficiency Virus, the virus that causes AIDS.
The aids virus enters the body through the mucus membrane or through broken
skin.
Once inside the body, the virus attacks the body defense cells eventually killing
them.
White blood cells are a collection of different kinds of cells that work together to
gourd the body against micro-organisms.
The virus targets particularly the white blood cells, the T cells of the body’s
immune system and all the body fluids contain the T cells.
T- Cells are clustered into different categories using protein receptor on their
surface.
Once this happens HIV starts to reproduce other viruses, eventually destroying
other CD4 cells
Normal range of CD4 cells in an adult is about 400-1800 per milliter of blood
volume.
If the no. falls to below 200, the person is said to have developed Immuno-
deficiency syndrome (AIDS).
1.2.2 AIDS:
This stands for Acquired Immune Deficiency Syndrome. HIV causes AIDS through
progressive destruction of the body defense system. After infection the body defense is
progressively weakened making it liable to get common infections, which are also
recurrent. Due to its inability to defend itself against other infection, the person’s health
deteriorates until death.
1.2.3 STIs/STDs
Stands for sexually Transmitted Infections/Diseases
II. Balanitis:
The urethra, rectum and eyes can be infected in both sexes can cause
serious problems later in life if it is not treated.
These are small, crab shaped parasites that live on hair and which draw
blood.
They live predominantly on pubic hair, but can also be found in hair in
the armpits, on the body and even in facial hair such as eyebrows
They can live away from the body too, and therefore can be found in
clothes, bedding and towels.
One can have crabs and not know about it, but after 2 to 3 weeks, one
would expect to experience some itching.
Crabs are mainly passed on through body contact during sex, but they can
also be passed on through sharing clothes, towels or bedding with an
infected person.
V. Epididymitis
It is not always the result of an STD, but if it is, it is usually due to the
presence of can chlamydial infection or gonorrhoea.
This is caused by the Herpes Simplex Virus (HSV). The virus can affect the
mouth, the genital area, the skin around the anus and the fingers.
Once the first outbreak of herpes is over, the virus hides away in the nerve
fibres, where it remains totally undetected and causes no symptoms.
Symptoms of the first infection usually appear after 26 days after exposure
and last two to three weeks.
Both men and women may have one or more symptoms, including an
itching or tingling sensation in the genital or anal area, small fluid-filled
blisters that can lion burst and leave small sores which can be very
painful, pain when passing urine if it passes be over any of the open sores,
flu-like illness, backache, headache, swollen glands or fever. In females,
there are ulcers and vesicles on the cervix, vagina, vulva and labia while
in males, there are similar effects on the glans, prepuce, penal shaft and
less commonly on the scrotum.
The affected areas should be kept clean by frequent bathing and applying
barrier creams can protect against the irritative effects of urine.
They are small fleshy growths which may appear anywhere on a man or
woman’s genital area.
They are caused by a virus called the Human Papilloma Virus (HPV).
Warts can grow on the genitals, or on different parts of the body, such as
the hands. After one been infected with the genital wart virus, it usually
takes between 1 and 3 months for warts to appear on one’s genitals, they
appear as pinkish/white small lumps or larger cauliflower-shaped lumps
on the genital area.
Warts can appear around the vulva, the penis, the scrotum or the anus.
They may itch, but are usually painless. Often there are no other
symptoms, and the warts may be difficult to see.
If a woman has warts on her cervix, this may cause light bleeding or, very
rarely, an unusual coloured vaginal discharge.
VIII. Gonorrhoea:
Two of the most common infections are amoebiasis and giardiasis. They
are protozoan infections, and when they reach one’s gut they can cause
diarrhoea and stomach pains.
Gut infections can be passed on when having sex with someone who is
infected, especially during activities that involve contact with faeces, such
as rimming and anal sex.
Sex toys should be thoroughly cleaned after use and hands washed after
any contact with faeces.
Anti- diarrhoea treatments should be enough to treat most infections.
X. Molluscum:
They are passed on through body contact during sex and through skin- to-
skin contact.
In most cases molluscum do not need treatment and will disappear over
time.
Often there may be no symptoms, but this does not mean that one cannot
r on pass the infection on to sexual partner(s).
XII. Scabies:
Scabies caused by a parasitic mite can get under the skin and cause
itching.
The mites are very small and cannot be seen by the naked eye, and many
people do not now they have them.
They can cause itching, and this can start between 2 to 6 weeks after
infection.
Signs of infection can be red lines under the skin of the hands, buttocks
and genitals.
Lotions can be bought from pharmacies and ales applied to the body to
kill off the parasites.
XIII. Syphilis:
The signs and symptoms of syphilis are the same in both men and
women.
The primary and secondary stages are very infectious. 3ins. The primary
stage appears 4-5 weeks after infection when a primary chancre (a
corruption of cancer) associated with swelling of lymph glands, Pyrexia
(fever) and malaise appears (Govan et aL, 1985).
The chancre is the point at which the bacterium enters the body.
The third stage occurs 15-30 years after the initial infection when there
may be nervous system involvement with general paralysis of mall the
insane and locomotor ataxia (defective muscular control) resulting in
irregular and jerky movements.
Cardiovascular involvement may result in aortic aneurysm and
impairment or and destruction of the aortic valve. Syphilis may be treated
with antibiotics like penicillin and kin- tetracyclines
Males are infected by females during sexual intercourse and also from the
patient’s own commensals especially the rectum and finger nails.
The yeast generally lives on the skin and is normally kept in check by
harmless bacteria. Under favourable conditions i.e warm moist
environment, the yeast multiplies and can cause itching, swelling,
soreness and discharge in both men and women.
Women may experience a thick white discharge and pain when passing
urine.
Men may experience the same discharge in the penis and difficulty
pulling back the foreskin.
Thrush can be passed on when having sex with someone who is infected,
but also if one wears too tight nylon or lycra clothes or if one is taking
certain antibiotics
XV. Trichomoniasis:.
The incubation period is week, and the ulcers are normally multiple.
This is a fatal disease that, once symptoms and signs develop, causes
death in less than 2 years (Porth, 1998).
A lot of T-lymphocytes are mobilized to fight the STD infections and since these
are the targets of HIV, a lot of them are destroyed and the person or individual
goes down faster with the HIV.
The mode of transmission for the STDs is also the same as the mode of
transmission of HIV.
This has been reinforced repeatedly by the many conflicts, which have occurred in
many parts of the world. One of the most important activities, which these wars have
facilitated, has been the increase of prostitution, which in turn has been closely
associated with the spread of sexually transmitted diseases. Prostitution and sexually
transmitted diseases are now known to be closely associated with the spread of AIDS. It
also now appears that these were the very conditions that were needed for the
evolution of the AIDS war to occur. The 1960s brought with them independence in
various African countries. There was large scale migration of school leavers from rural
to urban areas where jobs were easily available then. A new community of urban
workers was thus created and was to become very important in the spread of AIDS
later. They were the perfect targets for tourism, prostitution, including international
prostitution, sexually transmitted diseases and decontrolled sex.
Today, AIDS is the most prominent and catastrophic example of the process of
globalization to Africa in general and Kenya in particular. Sex tourism in Kenya is a
significant component in this global catastrophe.
While globalization has been understood in such economic term as privatization, free
market and removal of subsidies, AIDS epidemic is itself a global health crisis. It offers
both a threat to survival and an opportunity to revive, renovate, revitalize and relocate
our values and ethics of survival.
In 1983, the cause of the syndrome was discovered to be a virus, which was given the
title of Human Immune-Deficiency Virus (HIV) because of its role in lowering the
immunity of those infected. This was named as HIV type 1.
In 1986, a second type of virus was discovered in West Africa and was named HIV type
2.
Two types of viruses thus cause AIDS: HIV-1 and HIV-2. The main characteristic is the
long period (6-12 years) they stay in the body of the infected person before the full-
blown condition is developed.
HIV-1 and HIV-2 are thus brothers. They come from a family of other viruses, which are
known as retroviruses. They have a peculiar enzyme, which enables them to change
their genetic or inheritance mechanism, when they get into the human body. When the
viruses get into the body they enter only the cells called T lymphocytes. These are
responsible for the manufacture of immune substances.
Origin of H1V
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 acknowledged theories about the origin of HIV include the
following:
- Conspiracy theories
This theory tries to account for the seemingly mysterious origin of HIV by
locating it out of this world.
It suggests that viral material was carried in the tail gases of a comet passing
close to the earth and that this 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 extraterrestrial phenomena and any personal connection to the theory.
Certain segments of the population have openly stated that AIDS is God’s wrath
since the Scriptures condemn the homosexual practice in which AIDS was first
observed in the 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.
HIV is a lentivirus, and like all viruses of this type, it attacks the immune system.
Lentiviruses are in turn part of a larger group of viruses known as retroviruses.
The name ‘lentivirus’ literally means ‘slow virus’ because they take such a long
time to produce any adverse effects in the body.
They have been found in a number of different animals, including cats, sheep,
horses and cattle.
The most interesting lentivirus in terms of the investigation into the origin of
HIV is the Simian lmmunodeficiency Virus (S IV) that affects monkeys.
The researchers led by Paul Sharp of Nottingham University and Beatrice Hahn
of the University of Alabama made the discovery during the course of a 10-year
long study into the origins of the virus.
They claimed that this sample proved that chimpanzees were the source of HIV-
1, and that the virus had at some point crossed species from chimps to humans.
Some of the most common theories about how this ‘zoonosis’ took place, and how SIV
sheep, became HIV in humans include:
- Colonialism theory
In his book, The River, the journalist Edward Hooper suggested that HIV could
be traced to the testing of an oral polio vaccine called Chat, given to about a
million people in the Belgian that Congo, Rwanda and Burundi in the late 1950s.
This, he claims, would have resulted in the contamination of the vaccine with
chimp Sly, and a large number of people subsequently becoming infected with
HIV-1.
The most commonly accepted theory is that of the ‘hunter’. In this theory, SlVcpz
was transferred to humans as a result of chimps being killed and eaten or their
blood getting into cuts or wounds on the hunter. Normally the hunter’s body
would have fought off Sly, but on a few occasions it adapted itself within its new
human host and become HIV-1.
The fact that there were several different early strains of HIV, each with a slightly
different genetic makeup (the most common of which was HIV-1 group M),
would support this theory: every time it passed from a chimpanzee to a man, it
would have developed in a slightly different way within his body, and thus
produced a slightly different strain.
An article published in The Lancet in 2004 (Nathan et al., 2004), also shows how
retroviral transfer from primates to hunters is still occurring even today.
All these infections were believed to have been acquired through the butchering
and consumption of monkey and ape meat.
Discoveries such as this have lead to calls for an outright ban on bush meat
hunting to prevent simian viruses being passed to humans.
This is an extension of the original ‘hunter’ theory. In the 1 950s, the use of
disposable plastic syringes became commonplace around the world as a cheap,
sterile way to administer medicines.
It is therefore likely that one single syringe would have been used to inject
multiple patients without any sterilisation in between.
This would rapidly have transferred any viral particles (within a hunter’s blood
for example) from one person to another, creating huge potential for the virus to
mutate and replicate in each new individual it entered, even if the SIV within the
original person infected had not yet converted to HIV
It was first proposed in the year 2000, by Jim Moore, an American specialist in
primate behaviour, who published his findings in the journal AIDS Research
and Human Retroviruses.
During the late 19th and early 20th century, much of Africa was ruled by
colonial forces.
In areas such as French Equatorial Africa and the Belgian Congo, colonial
rule was particularly harsh and many Africans were forced into labour camps
where sanitation was poor, food was scare and physical demands were
extreme.
These factors alone would have been sufficient to create poor health in
anyone, so SIV could easily have infiltrated the labour force and taken
advantage of their weakened immune systems to become HIV.
A stray and perhaps sick chimpanzee with SIV would have made a welcome
extra source of food for the workers.
Moore also believes that many of the labourers would have been inoculated
with unsterile needles against diseases such as smallpox (to keep them alive
and working), and that many of the camps actively employed prostitutes to
keep the workers happy, creating numerous possibilities for onward
transmission.
One final factor Moore uses to support his theory, is the fact that the labour
camps were set up around the time that HIV was first believed to have
passed into humans - the early part of the 20th century.
Conspiracy administer theorists have blamed German biological warfare all the
way back to the days of Nazi and other dominance in Germany for the escape of
HIV-infecting agents.
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.
The virus probably did not spread because members of these rural communities
had limited contact with people from other areas.
But in the 1 960s and 1 970s, 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 global spread of the 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 twentieth century.
They include:
a) International travel,
From an infected mother to her unborn child in the womb, during birth or soon
after birth.
HIV contaminated cutting and skin piercing instruments e.g. needles, razors,
knives (e.g. during circumcision).
Shaking hands
Living together
Playing together
Eating together
Working together
Toilet seats
Asymptomatic stage
During this stage there are no symptoms. The virus can only be detected through
clinical test.
The stage is complex because there are many problems evident at the same time. These
are as follows:
Weight loss
High fever
Night sweat
AIDS related complex are mainly due to the antibodies (B cells) fighting the AIDS virus
and other virus, especially the herpes virus group which normally attacks the body as
soon as the immune system goes down.
The ARC stage is therefore characterized by a win or loses battles between the B cells
and the AIDS virus until finally the body becomes overwhelmed when the few
remaining B cells give up.
TB
Kapsosi sarcoma (cancer of the blood vessels) especially in the mouth region
The patient is hospitalized on and off with total weight loss and sick looking
Death
During the process from infection to death is 4 – 8 years. Most of the children present
the symptoms within the first two years. This is because their immune system is
immature.
The challenge and the causes of the fast spread of the virus vary from place to place,
depending on among other things, the national response.
However: People of all ages are affected. (Indeed we are all either infected or affected
by HIV/AIDS).rates of new infection in 2000 were 4.7 million adults, 2.3 females and
0.620 million children. About half of all people who contracted AIDS are under the age
25. Over 90% of the children under age 15 who contract HIV are born to mothers with
HIV and get it through, either birth; pregnancy or breastfeeding.
In all parts of the world, except sub Saharan Africa, there are more men infected with
HIV and dying of AIDS than women. Sub-Saharan Africa seems to bear the brunt of the
epidemic. HIV seems to be high in the Black populated areas.
UNAIDS observes that in Africa, there are signs that the HIV incidence (i.e the number
of new infections) may have established in Sub Saharan Africa. Two factors explain this:
The epidemic in many countries has gone for so long that it has already affected
many people in the sexually active population, leaving a smaller pool of people
still able to acquire the infection
Large sexual networks often seen in individuals who move back and forth
between home and far off work places
Age mixing typically between older men and younger women or girls
2. Biological factors
SSA is a home of 70% of adults and 80% of children living with HIV/AIDS in the
world (25.8 M)
In countries worst affected by the pandemic, rising sickness and death take place
agaist a backdrop of ;
c) Endemic poverty
Overall prevalence, 7.1% of adults (aged 15-64 years) were infected with HIV,
representing an estimated 1417000 people.
Women were more likely to be infected (8.4%) than men (5.4%). In particular,
young women aged 15-24 years were four times more likely to be infected than
young men in the same aged group (5.6% Vs 1.4% respectively)
There was a wide regional variation in adult HIV prevalence, ranging from
14.9% in Nyanza province to 0.8% in North Eastern province. Other provinces
include Nairobi 8.8%, Coast 8.1%, Rift valley 6.3% Western 5.4%, and Eastern
4.6%.
An estimated 1027000 adults in rural areas (6.7%) were infected with HIV
compared with an estimated 390000 adults in urban areas (8.4%)
Uncircumcised men were three times more likely to be infected with HIV than
circumcised men (13.2% Vs 3.9% respectively).
Women who reported secondary education or more had significantly lower HIV
prevalence(6.2%) than women who reported less education (7.7%- 9.8%)
80- 90% of infections are in the 15- 49 year age group, while 5-10% occurs in
children less than 5 years old.
Most AIDS deaths occur between the ages 25-35 years for men and 20-30 years
for women. Thus assuming an incubation period of 9-10 years, it suggests that
most infections occur in the teens and early 20s.
Thika and Busia are leading with 33% and 34% respectively. Though latest data
shows that Thika is leading with 34%. Mombasa and Nairobi have prevalence at
approximately at approximately 15%.
REVISION QUESTIONS
1. Explain the strategies used by the public health officers to curb the spread of
infectious diseases
4. Account for the rapid global spread of HIV/AIDS in the late 20th century
2.0 Introduction
This section aims at introducing you to factors fueling the spread of HIV/AIDS. This
section explains African traditional beliefs and practices which may be major factors in
the spread of the virus that causes AIDS. It gives some myths on sexuality and links
them to the rapid spread of HIV/AIDS. The section discusses socio-economic and
cultural factors fueling HIV/AIDS. Finally this section explains political factors
influencing the spread of HIV/AIDS
Objectives
1. Explain African traditional beliefs and practices may be major factors in the
spread of the virus that causes AIDS.
2. Explain myths on sexuality and link them to the rapid spread of HIV/AIDS.
Witchcraft
Laboratory mistakes
1) Having multiple sex partners boosts men’s prestige and status among the peers
(not true)
2) Abstinence causes males sexual impotence (not true)
3) For a man infected with HIV/AIDS, sex with a virgin provides a cure (not true)
4) Teaching young people about sex encourages them to practice it (not true –
informed consent/ negotiate for safe sex)
5) Ignorance about sex is a sign of innocence and purity, while too much
knowledge is a sign of immorality (information is power)
6) Condoms have pores thus it is wise to use two or more (not true- effective
protection against HIV, STIs and pregnancy)
7) Knowing your sero-status means an early death (not true – it is the first step in
counseling services, medical intervention, care and support)
8) ARVs provide cure for AIDS. (ARVs helps in restoring immune system, reduce
the viral load and prolong life)
9) People living with HIV/AIDS need not use the condom during sex (re-infection
increase the viral load)
Premarital sex
- Ritual that encourage sexual activities, related to seasons and events e.g. a man
has to have sex with his wife to mark various stages in farming process i.e.
cultivating, harvesting, newly constructed home e.t.c.
Cultural practices
- Ear piercing
- Circumcision
- Tattooing
- Teeth extraction
- Forced marriages
Cultural taboos
- Means commercial sex work, which involves exchange for money – prostitution
- Unable to access antiretroviral therapy due to cost of transport and buying other
drugs
- Poverty leads to deprivation which results in poor diet, lack of clean water and
medical care, and support to manage opportunistic infections
- Especially truck drivers – away from home for a long period of time
Tourism
- Poverty makes men and women flock beaches to seek for money from tourists
- Women and girls loose male protection and therefore become victims of sexual
harassment, rape and other sexual exploitations
- Women and girls forced trafficked for sexual services (especially to military
camps)
Cohabitation
- A relationship for the purpose of material gain of one kind or another and is
usually with several partners
- Culturally unknown
Social stigma
Polygamy
C. Political factors
- Corruption
REVISION QUESTIONS
1. African traditional beliefs and practices may be major factors in the spread of the
virus that causes AIDS. Discuss giving examples
2. Explain some myths on sexuality and link them to the rapid spread of HIV/AIDS
among the youth.
4. How has political factors influenced the spread of HIV/AIDS in your country?
CHAPTER 3
3.1 INTRODUCTION
This section aims at introducing you to drugs and substance abuse by giving their
meaning, classification, mode of administration, reasons for using drugs, impact and
their relationship with HIV/AIDS.
Objectives:
3.1 DEFINITION
A drug can be defined as any substance that affects the function of living cells, used in
medicine to diagnose, cure, prevent the occurrence of diseases and disorders, and/or
prolong the life of patients with incurable conditions. Since 1900 the availability of new
and more effective drugs such as antibiotics which fight bacterial infections, and
vaccines which prevent diseases caused by bacteria and viruses, has increased the
average life span of many people. Drugs have vastly improved the quality of life.
Today, drugs have contributed to the eradication of once widespread and sometimes
fatal diseases such as poliomyelitis and smallpox.
- by prescription
- plant,
- mineral, or
- animal
- capsule,
- liquid, or
- gas.
- by mouth,
- injection,
- inhalation, or
6. Its effect on a particular area of the body or a particular condition (most common
way to categorize drugs) e.g.
c) Cardiovascular drugs - drugs that affect the heart and blood vessels and are
divided into categories according to function. Antihypertensive drugs reduce
blood pressure by dilating blood vessels and reducing the amount of blood
pumped by the heart into the vascular system. Ant-arrhythmic drugs
normalize irregular heartbeats and prevent cardiac malfunction and arrest
d) Drugs that affect the blood - e.g. antianemic drugs, such as certain vitamins or
iron, enhance the formation of red blood cells. Anticoagulants like heparin,
reduce blood-clot formation and ensure free blood flow through major organs
in the body. Thrombolytic drugs dissolve blood clots, which can block blood
vessels and deprive the heart or brain of blood and oxygen, possibly leading
to heart attack or stroke.
e) Central nervous system drugs - Affect the spinal cord and the brain and are
used to treat several neurological (nervous system) and psychiatric problems.
For instance, antiepileptic drugs, antipsychotic drugs (alleviate hallucinations
and other abnormal behaviors), antidepressant drugs (reduce mental
depression). Anti- manic drugs (reduce excessive mood swings in people
with manic- depressive illness), Anti-anxiety drugs, also referred to as
tranquilizers, treat anxiety by decreasing the activity in the anxiety centers of
the brain. Sedative - hypnotic drugs are used both as sedatives to reduce
anxiety and as hypnotics to induce sleep. Sedative-hypnotic drugs act by
reducing brain-cell activity. Stimulatory drugs, on the other hand, increase
neuronal (nerve cell) activity and reduce fatigue and appetite. Analgesic
drugs reduce pain and are generally categorized as narcotics and non-
narcotics. Narcotic analgesics, also known as opioids, include opium and the
natural opium derivatives codeine and morphine; synthetic derivatives of
morphine such as heroin; and synthetic drugs such as meperidine and
propoxyphene hydrochloride. Narcotics relieve pain by acting on specific
structures, called receptors, located on the nerve cells of the spinal cord or
brain. Non-narcotic analgesics such as aspirin, acetaminophen, and ibuprofen
reduce pain by inhibiting the formation of nerve impulses at the site of pain.
Some of these drugs can also reduce fever and inflammation. General
anesthetics, used for surgery or painful procedures, depress brain activity,
causing a loss of sensation throughout the body and unconsciousness. Local
anesthetics are directly applied to or injected in a specific area of the body,
causing a loss of sensation without unconsciousness; they prevent nerves
from transmitting impulses signaling pain.
f) Anticancer drugs - eliminate some cancers or reduce their rapid growth and
spread and are specific to certain cancers.
7. Drugs are also classified by their names. All drugs have three names:
- A brand or trade name given by the particular manufacturer that sells the
drug.
3.3 MODES OF DRUG ADMINISTRATION AND ACTION
The effect of a drug on the body depends on a number of processes that the drug
undergoes as it moves through the body. All these processes together are known as
pharmacokinetics (Aldridge, 1998) - literally, - motion of the drug.
Administered orally - that is, through the mouth. Only drugs that will not be
destroyed by the digestive processes of the stomach or intestines can be given
orally.
Administered by injection
- under the skin (subcutaneously) into the tissues, which results in localized
action at a particular site as with local anesthetics; or
Some drugs are administered through drug-filled patches that stick to the skin.
The drug is then slowly released from the patch and enters the body through the
skin.
Administered topically that is, applied directly to the skin; or rectally absorbed
through an enema (an injection of liquid into the rectum) or a rectal suppository
(a pellet of medication that melts when inserted in the rectum)
N.B From its site of administration, drugs are absorbed into the bloodstream and
distributed throughout the body to various tissues and organs. As the drug is
metabolized, or broken down and used by the body, it goes through chemical changes
that produce metabolites, or altered forms of the drug, most of which have no effect on
the body. Finally, the drug and its metabolites are eliminated from the body.
3.4 DRUG INTERACTIONS
When taken together, drugs can interact with one another and produce desirable or
undesirable results.
Some drugs have an additive or synergistic effect - that is, they increase the eftect
of other drugs. For example, alcoholic beverages intensify the drowsiness-
producing effect of some sedatives. A drug that displaces, or takes the place of
other drugs present in blood proteins, makes the displaced drugs more active in
the body, increasing their effect.
Other drugs have a reducing effect that is, they interfere with the action of drugs
already present in the body. For example, antacids prevent antibiotics from being
absorbed by the stomach.
Some drugs combine with other drugs to create a substance that has no medical
benefit.
In some cases, however, drug interactions can produce desirable results. For instance, it
has been found that using three drugs to fight AIDS is more effective than one drug
used alone.
Control emotion
Abuse of drugs and other substances can lead to physical and psychological
dependence
3.5.1 Drug abuse can cause a wide variety of adverse physical reactions.
Long-term drug use may damage the heart, liver, and brain.
Drug abusers may suffer from malnutrition if they habitually forget to eat,
cannot afford to buy food, or eat foods lacking the proper vitamins and minerals.
Individuals who abuse inject able drugs risk contracting infections such as
hepatitis and HIV from contaminated needles shared with other infected
abusers.
One of the most dangerous effects of illegal drug use is the potential for
overdosing. A drug overdose may cause an individual to lose consciousness and
to breathe inadequately
Mental illness
Addiction
School dropouts
Pregnancy
Increase in crime
Abortions
Others claim that sexual activity is more enjoyable when they are using drugs
Drug use including alcohol increases the chance of not using protection during
sex, leading to acquiring/transmitting HIV/AIDS
A lot of drugs interfere with the proper functioning of the antiretroviral drugs
One who is a drug addict might forget to take his ARV therapy — leading to
delay in treatment and increment of viral load
Similarly people with HIV are more likely to abuse alcohol in their life time. In
persons already infected, the combination of heavy drinking and HIV has been
associated with increased medical and psychiatric complications, delay in
seeking treatment and poor HIV treatment outcome.
Heavy alcohol use has been correlated with a high risk sexual behaviours
including
REVISION QUESTIONS
2. Individual behaviour change can drastically reduce HIV/AIDS prevalence. Explain.
Define the term drug and describe how drug abuse may lead to high levels of HIV
3.
infections.
5. Explain why women are at higher risk of acquiring HIV infections than men.
4.0 INTRODUCTION
This section aims at introducing you to youth sexuality and HIV/AIDS. This section
highlights the differences between sex and sexuality and gives reasons why focus is on
the youth. This section explains youths’ problems and challenges. Finally this section
gives factors leading to high incidences of premarital activities and hence HIV infection.
Objectives:
4.1 DEFINITION
Terms “youth”, “adolescents” and young people are define variously.
WHO refers:
- 10 – 24 years as youth
Youth constitute 30% of world population (in the start of the 21 st century, it was
1.7 billion and by 2025 it will be 1.8 billion people)
Size continue to grow across regions, countries, urban and rural areas
Kenya is among those countries with the highest number of young people in
Africa
- Others include:-
Algeria 34%
Rwanda 34%
Zambia 34%
Swaziland 34%
It is estimated that 6000 youth get infected in a day and one in every 14 seconds,
majority of them young women (UNAID, 2006)
Among 20 years and over, 60M half (1/2) have been infected with HIV/AIDS
and half of them get infected between the age of 15 – 24 years
Many parents and religious communities fear if exposed to the youth will
encourage promiscuity among them e.g. resistance shown to the sexual offence
bill of 2006
Sometimes the term ‘sex’ is used ambiguously to refer to being male or female
and other times sexual behavior or reproduction
4.3.1 SEX
refers to biological attributes (characteristics of a person)
4.3.2 SEXUALITY
It is a condition of having sex or sexual activity or interest especially when it is
excessive
Continued lack of information has led them to seek it elsewhere (peers, media,
pornography)
Sexual experimentation
Early sexual activity (as early as 6 years) – lengthening of the time between
biological readiness and marriage the gap is between 12 – 14 years
NB// young people 15 – 24 years account for ½ of all new infections worldwide
In south Africa and Zimbabwe – ½ of all 15years are likely to die of AIDS
In Kenya – 20% of all reported AIDS patients are young people in the age range
of 15-24years
Challenge: - young people present the greatest challenge for the prevention of
new HIV infections
Safeguarding the health and wellbeing of the future generations and their
potential parents
Young people as “hope of the future” need to be the major beneficiaries of efforts
to prevent and respond to HIV/AIDS
Youth are every nation’s future – first as an important resource whose capacities
must be tapped for development, and secondly a major potential resource for
economic development, labour force and future leaders.
10 – 25 youths – form the bulk of the future human resource pool for any country
- Studies indicate that adolescents who had initiated early sexual activity, 58.4%
were in age bracket (15 – 19 years)
- The effect of early initiation of sex is the substantial lengthening of the time
between biological readiness and marriage
- Sexual experimentation
i. Bodily changes
For boys
b) 4% married by 18 tears
Health care and services are not available, accessible, affordable and acceptable
to the youths
- Lack of resources
- Inaccessibility to services
IV. Abortion
Involve rape, sexual assault, money for sex, sex trafficking, partner violence
It is about developing young people’s skill so that they make informed choice
about their behavior and feel confident and competence about acting on their
choices.
- Sexual taboos, myths and silence surrounds sex are all offshoots of
traditional, culture and religious beliefs, attitudes and practices.
- It leaves youth to be curious and need to find out about sexual activities
and intimacy from the media- internet, moies, TV, Videos, tape, films.
REVISION QUESTIONS
1. Highlights the differences between sex and sexuality.
3. Describe the problems and challenges youth face in relation with HIV/AIDS.
5.0 INTRODUCTION
This section aims at introducing you to gender issues in HIV/AIDS. This section
identifies and explains some cultural, social, biological and economic factors that make
women more vulnerable to HIV/AIDS. This section also discusses some ways we can
redress gender issues in HIV/AIDS.
Objectives:
a) Explain cultural, social, biological and economic factors that make women
more vulnerable to HIV/AIDS.
Biological makeup and reproductive anatomy of the female body makes her more
vulnerable to contract HIV than men. Sex takes place inside the body of the woman and
the female genitalia is prone to tear and wear. These tears and wears and/or sores
provide entry route for the virus. The female reproductive system is also in direct and
longer contact with the male semen deposited during sexual intercourse. If the semen
has HIV, then it becomes easier for her to contract the virus Changes associated with
female reproduction explain to a larger extent the differential infections.
Men dictate matters regarding sex irrespective if a woman wants sex or not in
some societies and countries.
Male predominance – here male are left with matters about the house (sex) and
they are allowed to have multiple sexual partners.
Cultural practices – wife inheritance, polygamy, early marriages and resistance
to use of condom are some gender inequalities making women vulnerable to
HIV/AIDS.
3. Economic factors
Women have limited access to family resources and security e.g. land for
financial negotiations
Are not able to meet health needs e.g. drugs for opportunistic infections
Family property inheritance – some society do not pass them e.g. land to women.
In some societies, when husband dies, relatives of deceased are to be in charge of
property and not wives.
In such cases that women cannot provide for family, they resort to commercial
sex working.
Poverty has lead to men abandoning family and resort into drugs/alcohol and in
event contract HIV exposing self and family to HIV.
Poverty leads women not to question even when asked for sex without condom.
Manifested in:
- Rape
- Sodomy
- Coerced sex
- Sexual assault
Although both sex suffer the same, women are more vulnerable
Is a global issue
Problem acute in conflict, post conflict and refugee settings where women are
subjected to increased rates of sexual harassment that expose them to HIV/AIDS.
2. Combating ignorance
o Ensure they have information on their bodies, HIV/AIDS and other STDs
o Cultural believe that ‘NO’ to sex means ‘YES’ and therefore must be forced to
have sex since they in any case will say ‘YES’
o Girls and women should have access to appropriate health care and
HIV/STD prevention services
o Make condoms and STDs care available where women don’t feel embarrassed
REVISION QUESTIONS
1. Identify and explains cultural, social, biological and economic factors that make
women more vulnerable to HIV/AIDS.
6.0 INTRODUCTION
This aims to introduce to you the various global policies and responses to HIV/AIDS.
The section gives guidelines on action oriented measures to be employed by
governments in the areas of law, administrative policy and practice that will protect
human rights and achieve HIV related public goals. It also gives principles of human
rights underlying the positive response to the pandemic. This section also explains the
Kenyan response to HIV/AIDS.
Objectives
f) Explain some of the strategies adopted by the Kenyan government to fight the
spread of HIV/AIDS
The United Nation AIDS (UNAIDS) and United Nation High Commission for
Human Rights (UNHCHR) have set policies to assist states in translating human
rights values into practical observation in the context of HIV/AIDS.
Supportive and enabling environment for women, children and other vulnerable
groups
Human right principles that are most relevant to HIV/AIDS include the right to:
- Non discrimination, equal protection and equality before law
- Life
- Freedom of movement
- Privacy
- Freedom of opinion and expression and the right to freely receive and
impart information
- Freedom of association
- Work
The initial reaction of many countries to the pandemic was to try to persuade
individuals and selected groups to change their behaviour by providing
information about HIV/AIDS. However,
Behavior change was later understood to require more than mere information
and the importance of decision-making and negotiation skills, accessibility of
commodities and services, and supportive peer norms became increasingly
apparent.
It was well appreciated that individuals do not always control their own risk
situations. This led to the development of prevention programmes aimed at
enabling particular groups or communities such as sex workers and men who
have sex with men to adopt safer sexual behaviour.
At the same time, as individuals infected with HIV earlier in the epidemic
gradually fell ill and died, challenging family and community structures alike,
the need to provide health care and cushion the epidemic’s impact became
increasingly obvious.
- Political will expresses the national commitment and provides overall leadership
to the nation in response to AIDS.
- To be effective, programmes need to make HIV visible and the factors leading to
its spread, discussible.
- Programmes need to make people aware of the existence of HIV and how it is
spread, without stigmatizing the behaviours that lead to its transmission.
- This involves dissipating fear and prejudice against people who are already
living with HIV/AIDS
- Successful prograrimes impart knowledge, counter stigma and discrimination,
create social consensus on safer behaviour, and boost AIDS prevention and care
skills.
Strategic response
- Powerful national AIDS plan involving a wide range of actors - government, civil
society, the private sector and donors (where appropriate), is a highly valuable
starting point.
- It is essential to find out where people in the country are already infected, where
they are most vulnerable, and why.
- Effective strategies offer both prevention and care. As illness mounts in the
epidemic, so does the need for health care and social support. Care services have
benefits that extend beyond caring for sick individuals. They help convince
others that the threat of HIV is real and they therefore make prevention messages
more credible.
- Responses to HIV are in the first instance local: they imply the
involvement of people in their homes, neighbourhoods and their
workplaces.
The last 26 years of HIV prevention and care have led to the development
of a rich body of experience and expertise.
Adequate resources
- It has not kept pace with the spread of the epidemic - or even the most
basic requirements for HIV programmes of the most affected countries
Phase 1 (1984-1993)
Government lost valuable time and missed opportunity to deal with the
HIV/AIDS before it would spread
If it would have sounded alarm measures would have been put in place.
Phase 3 (1999-date)
Started on the 25th Nov. 1999 when the president of Kenya declared HIV/AIDS a
National disaster.
National AIDS control council (NACC) was established under legal notice No.
170 of 1999.
Functions included:
- Mobilize resources
Structure were put in place to operationalize the responses from the National
level to the grassroots
At the District level a technical team was put in place to offer or provide
guidance on the operations of CACCs.
Planned activities were coordinated under Kenya HIV and AIDS disaster
response project (KHADREP)
Each ministry within the government had to establish an AIDS control Unit
(ACU) to undertake the mainstreaming of HIV/AIDS activities in all its core
functions.
In the new structure, constituency AIDS control committees were the focal points
for spear leading the fight against the pandemic at grassroots level
According to the strategic plan CACCs were to operate under five components
namely
Goal was to reduce the spread of HIV, improve the quality of life the infected
and the affected and mitigate the social economic impact of the pandemic.
TOWA build on the Kenya HIV/AIDS Disaster Response Project (KHADREP)
which came to an end in Dec. 2005.
- Sexual workers
- Migrants workers
- Micro enterprises
- Informal sector
Strategic plan estimated that approximately 65000 Kenyan adults and 25000
children became infected with HIV/AIDS related diseases annually.
The aim of the plan was to ‘reduce the no. of new infection among the vulnerable
groups and general population by improving in treatment and care of the
infected and affected as well as ensuring access to effective services
Under KNASP III, by 2013, the following four impact results will be achieved:
vi. KNASP III stakeholders aligned and held accountable for results.
KNASP III will achieve the above impact results and outcome through
implementation of the following four strategies:
- The government through its state owned media has set up sensitization
programmes to try and educate the public on the dangers of the disease
and also advise them to stay healthy.
- This is done through plays; poetry and reality show programs where
HIV/AIDS individuals take the opportunity to air their views and
encourage others to take measures to avoid contracting the virus.
- This has helped in the reduction of spread of HIV since most sexually
active Kenyans, the youths are taught about the dangers of casual sexual
behaviour and unprotected sexual relations.
Destigmatization campaigns
- This has encouraged free talk about AIDS and thus created awareness
amongst Kenyans.
- The government has established and opened VCT centers all over the
country. VCT services are offered free in most government health
facilities.
Gender advocacy
- It has also allowed formation and operation of NGOs which help people
at the grass root fight poverty.
REVISION QUESTIONS
1. Debt relief for poor countries can be a strategy to fight HIV/AIDS pandemic.
Justify.
7.0 INTRODUCTION
This section aims to introduce you to the transmission of HIV/AIDS and the prevention
and control strategies. This sections deals with various ways on how HIV is transmitted
and various ways through which HIV cannot be transmitted. The section also describes
ways to diagnose HIV/AIDS. This section also gives various prevention and control
strategies.
Objectives
The most important factors that will influence the risk of HIV transmission are
the type of body fluids that contain the virus and the entry route of infection.
Undoubtedly blood contains the highest concentration of HIV virus. For this
reason the risk of acquiring the virus through direct contact with an infected
person’s blood posses a much higher risk of infection than contact with other
body fluids.
Similarly, the risk of infection is dependent on the route through which the virus
enters the body. For example, if the virus enters directly into the blood stream i.e.
the vein, the risk is much higher than if it enters the body via the digestive tract
e.g. in breast fed babies.
ii. Sharing needles, syringes or other drug infecting equipment with someone who
is infected with HIV.
iii. An HIV positive mother to her baby during pregnancy, delivery or while breast-
feeding.
And HIV positive person could pass the virus on another person if they have
vaginal or anal sex without a condom or oral sex without the use of a barrier.
Some sexual activities appear to be more risky than others, e.g. unprotected anal
intercourse posses a greater risk of transmission than any other sexual activity.
The tissue inside the anus is much softer than vaginal tissue; it is also less elastic
and less lubricated. Thus this tissue is more prone to tearing during intercourse;
this increases the risk of bleeding and therefore provides more opportunity for
viral transmission.
However, where there is a risk of vaginal tears or sores e.g. in the presence of
sexually transmitted infection, the risk of transmission is increased significantly.
HIV transmission through oral sex is a much debated subject. However, the virus
is present in blood and semen that means that in theory, this is a possible
transmission route.
Using syringes that have previously been used by someone else can easily lead to
infection with HIV
If a group is sharing the same cup of water to clean out (flush) syringes or other
equipment, there is also a risk that infected blood may be present.
In developing countries, blood screening is often not common place and there is
risk of one receiving contaminated blood in case of blood transfusion or surgery.
This includes needles used for ear and body piercing, acupuncture, tattooing.
Jewelry used for body and ear piercing should not be shared as this can transmit
the virus
Some have become infected with HIV as a result of being injured by a needle in
the course of their work.
Although an area of concern, the risk of contracting virus this way is less than
1%.
Certain specific factors mean a needle stick injury carries a higher risk e.g.
i. A deep injury
Treatment with anti-HIV drugs as soon as possible after an injury has occurred
can reduce the rate of transmission (often referred to as a post exposure
prophylaxis or PEP)
There is also a risk of infection from a splash injury. This is when blood splatters
and some enters a person’s eyes. The eyes should be washed out thoroughly
using an eye bath should this happen after which, one may seek medical
attention.
Laboratory findings reveal that saliva has natural properties that limit the power
of HIV to infect.
Studies involving HIV infected people have found no evidence of HIV
transmission through saliva.
ii. Person who received blood transfusion or pooled blood products between 1978
to 1995
iv. Person having unprotected sex with people of unknown HIV status
vi. People having sexually transmitted diseases are highly susceptible to HIV
infection during sex with infected persons. Diseases include syphilis, gonorrhea,
genifal herpes, chiamydial infection, herpes zoaster.
A high viral load is an indication of high levels of HIV in body fluids while
undetectable viral load indicates a reduction in levels of HIV in these fluids, but the risk
of transmitting the virus is still present.
NB:
Viral load and CD4 tests should always be carried out at the same time.
7.2 DIAGNOSIS
Some of the blood sample is poured into an HIV antigen-coated vial and a
binding enzyme added. Any antibodies present in the blood migrate to the lining
surface of the vial.
Excess antigen is flushed out by rinsing, and a chemical which can produce a
color reaction is poured in.
The color reaction only takes place if there are HIV antibodies present, in which
case the individual is said to be IIIV positive.
Conversely, if the reaction is not present the person is regarded as being HIV
negative.
HIV antibodies do not reach detectable levels in the blood for one to three
months.
Window period is the time during which antibody detection using ELISA is
negative.
In some cases it may take even six months for the antibody levels to get high
enough for detection.
It does this by separating light and heavy chain proteins in an electric field into
their constituent parts.
These separated proteins are graded by size and placed on the surface of a
specially prepared gel.
The density of the separated proteins determine, to what level they sink into the
gel layers, with the heaviest sinking lowest.
Since the molecular weight of each protein is known, they can be identified. Once
identified, the proteins are relocated to nitrocellulose sheets which are cut into
strips to which blood from the ELISA- determined HI V-positive person is
added.
The strips are washed, and an anti-human antibody enzyme label introduced. A
visible enzyme marker, following this procedure, indicates an HI V-positive
result, thus confirming the EL1SA test.
This is a method that detects very low viral antigen levels such that one may test
HIV negative by ELISA but test positive through Western blot (V/B).
Babies born of HIV mothers have antibodies to IITV that were passed on during
pregnancy through the placenta.
However, these antibodies diminish with time such that by 15 months the child
may test negative.
Use of Western blot confirms presence of HIV antigen and this rules out whether
babies are positive due to HIV itself or because of maternal antibodies.
It involves combining a DNA an1e (taken from the suspected HIV infected
person), some short strands of DNA (primers), four nucleotides (adenosine,
cytosine, guanine and thyrnine), an enzyme, and a buffer solution.
These items are heated to separate double-stranded DNA into single strands
which when cooled adhere to the single strand primers.
Reheating allows the enzyme to make new double-stranded DNA using the
ingredients already present.
The resultant DNA is stretched over repeated similar processing, amplifying the
material over one million times.
Sequencing of the DNA identifies any HIV isolate present in the strands.
A draw back to the use of PCR s that samples may be easily contaminated.
IFA (immuno fluorescence assay): Similar to the above but using a fluorescent
medium
RIPA (radloimmunoprecipitation): Rather like the ETA and IFA but using a
radioactive medium
Orasure: Analyses a sample of saliva. While antibodies are only found insmal1
amounts in thè aflvathe infected people, an American Association report says
that the test is 99.9% accurate.
7.2.5 CD4+ Cell Count
Once a patient is diagnosed positive, the extent of damage to the immune system
is determined by CD4 cell count (T-helper cell count).
The number of CD4 cells present is direct indicator of the immune system’s
ability to fight off opportunistic infections.
The test to measure your CD4 count requires a sample of blood to be taken.
The CD4 count of a person who is not infected with HIV may lie anywhere
between 500 and 1200.
A drop in an HIV positive persons CD4 count usually occurs over a number of
years.
A CD4 count between 500 and 200 indicates that some damage to the immune
system has occurred and a count below 350 or rapid decline is an indication that
one should consider anti-HIV treatment.
Since your CD4 count will fluctuate in response to infection, stress, smoking,
exercise, the menstrual cycle, the contraceptive pill, the time of day and even
seasons of the year. it is necessary to monitor it over time to identify trends,
The viral load test requires the collection of a blood sample ‘and estimates the
number of HJV particles in the sample by looking for HIV genes.
The level of viral load is generally seen as a good indicator of whether to start
anti-HIV treatment.
Effective anti-HIV treatment will result in a reduction in viral load and one may
even attain an undetectable viral load. This does not mean that the virus is no
longer present, but merely that the sensitivity of the test performed can no longer
detect the virus.
An undetectable viral load is an indication that both the risk of developing AIDS
and the risk of developing drug resistance has been reduced.
7.3 PREVENTION AND CONTROL STRATEGIES
Prevention involves tackling the most important modes of transmission i.e.
prevent sexual transmission, mother to child transmission and blood/blood
products transmission.
This method has been advocated for, as the best means of preventing and
controlling HIV infections.
A - Abstinence
B - Be faithful
C - Condom
D - Destigmatization
A - Abstaining (Abstinence)
Abstinence means not engaging in any sexual activity in which there is direct or
theoretical risk of exposure to blood, semen, and vaginal fluid.
B - Be Faithful
If two partners are tested negative then they should enter into strictly
monogamous sexual relationship.
It only works if both partners are known to be uninfected when their sexual
relationship begins; neither partner had sex even one time outside the primary
relationship.
C - Condom use
Consistence and correct use of latex condoms during intercourse can greatly
reduce the chances of acquiring or transmitting HIV and other STDs.
Correct use means that you should use a new condom every time you have
sexual intercourse.
Condom is not totally safe some of its weaknesses include bursting, leaking and
slipping off inside the women; this exposes both male and female partners to the
AIDS virus.
Although leaking was not always noticed even after sex, cases of condoms
slipping had become frequent and they reached the attention of the health
officials because sometimes they had to be removed by th doctor.
Where a condom is used and the stronger the latex the better - it is firmly urged
that a spermicide also be used.
D- Destigmatization
Remove the stigma such that infected people are not neglected
Irresponsible
- Mothers who are HIV positive should not donate breast milk to breast
milk banks, neither should they express milk to be bottle-fed to their
baby
N.B
- It is known that breast milk contains growth factors that may help the infant’s
gut mature, thus maintaining the integrity of the gut and hindering infections by
virus.
At community level
Education – facts around HIV increase knowledge, risks infection and re-
infections.
Post-test – explains test results and how to cope with implications, positive or
negative.
confidentiality – fear that counselor may tell out and fear of positive face –
rejection, divorced, e.t.c.
Some do not themselves as at risk – is for those others (commercial sex workers,
homosexuals, town dwellers)
Lack of where to find VCTs in rural areas with low information and
infrastructure.
Some facilities have stock out of testing kits – donor driven and attached to
corruption.
7.3.6 PPTCT/PMTCT
Both are parents responsible for MTCT.
Increase ANC with increased information about HIV and give AZT and
Nevirapine drugs in pregnancy and in labour
Increase policy guidelines in protecting and promoting the health of both blood
donors and recipients by establishing efficient, self-sustaining and safe blood
transfusion services
The ARV drugs tenofovir disoproxil fumarate (TDF) and a combination of TDF
and emtricitabine (FTC) are currently being tested in clinical trials for use as
PrEP.
Verbal/Nonverbal communication
Active listening
Expressing feelings; giving feedback (without blaming) and receiving feedback
Negotiation/refusal skills
Empathy
Ability to listen and understand another's needs and circumstances and express
that understanding
Advocacy Skills
Influencing skills & persuasion
Networking and motivation skills
Anger management
Dealing with grief and anxiety
Coping skills for dealing with loss, abuse, trauma
Time management
Positive thinking
Relaxation techniques
Revision Questions
1. Explain various ways on how HIV can be transmitted.
8.0 INTRODUCTION
Objectives
Introduction
Preventive efforts have reduced the number of new cases of the disease, and for
people already living with HIV/AIDS; the survival rate is increasing because of
advances in drug therapy.
However, the majority of those affected by the disease are unable to afford the
latest drug therapies and their lives are still seriously threatened by the disease.
While no medical treatment cures AIDS, in the relatively short time since the
disease was first recognized, new methods of treating the disease have
developed rapidly.
Health-care professionals focus on three areas of therapy for people living with
HIV infection or AIDS:
8.1 TREATMENT
The three main classes of drugs developed so far and are used against HIV are:-
- Protease inhibitors
- Entry inhibitors
a) Nucleoside analogues
- These impede the action of reverse transcriptase, the HIV enzyme that
converts the virus’s genetic material into DNA.
b) Protease inhibitors
- These drugs block protease, hence defective HIV forms are unable to
infect new cells.
- They target the first stage of the entry stage of the HIV replication cycle
- This drug is specifically designed to fit between the HIV particle and the
point of the CD4+ cell to which it needs to bind to gain entry and
therefore preventing the HIV from entering the CD4+ cell.
- Best known drug in this class is T-20, which is given as an injection into a
muscular part of the body.
i. Drug resistance.
Benefits are short-lived when a single drug is used alone. This short-term
effectiveness results when HIV mutates, or changes its genetic structure,
becoming resistant to the drug. The genetic material in HIV provides instructions
for the manufacture of critical enzymes needed to replicate the virus. Scientists
have designed current antiretroviral drugs to impede the activity of these
enzymes. The structure of the virus’s enzymes changes if the virus mutates and
the drugs no longer work against the enzymes, making the drugs ineffective
against viral infection and resistance sets in. Since gene mutation occurs during
the course of viral replication, the best way to prevent mutation is to halt
replication. Studies have shown that the most effective treatment to halt HIV
replication employs a combination of three drugs taken together for instance, a
combination of two nucleoside analogues with a protease inhibitor. This
regimen, called triple therapy (also known as Highly Active Antiretroviral
Therapy- (HAART)), maximizes drug potency while reducing the chance for
drug resistance.
The greatest drawback to triple therapy is its high cost, which is well beyond the
means of people with low incomes or those with limited healthcare facilities. As
a result, the most effective therapies currently available remain beyond the reach
of the majority of HIV-infected people worldwide.
iv. Stigma.
Doctors try to Doctors usually prescribe more than one drug to forestall
infections.
There are many challenges faced by people living with HIV and AIDS,
including choosing the best course of treatment, paying for health care,
and providing for the needs of children in the family while ill.
Stand-alone sites: These are not associated with any existing medical
institution and usually have staff fully devoted to VCT. Their main
advantages are that the staff can work full time on VCT services, and they
may have donor funds that facilitate their work.
Voluntary testing
HIV testing
i. Pretest counseling
- Help to identify risk factors and symptoms that may indicate that the client is
HIV infected.
- Help the client to identify one with whom he/she will share the results with.
- To ensure the client has a full understanding of the implications of the test
and is able to make an informed decision whether to take the test or not
- Ensure informed consent to carry out the test is obtained from the client
- Discuss the implications and support needs that may follow either a positive
or negative test result.
- Encourage the client to consider and evaluate the impact the result may have
on him/her, emotionally, physically and in relation to his/her lifestyle.
Advantages of testing
They include:
iii. Making healthy life style changes; (e.g. eating a balanced diet and regular
exercising).
If results are negative benefits include: Increased self confidence by knowing that one
is not HIV positive. However, this self confidence if not well handled may lead to risky
behaviour.
N.B:
- Positive test mean the person is HIV infected except for infants who may carry
the mother’s antibodies and may test positive even when they don’t carry the
HIV.
- There is a period of 3-6 months during which antibodies may not show up in the
blood and test will reveal the person to be negative.
- This is the ‘window period’. Western blot is used to confirm the positive results.
- Because of the window period, tests giving negative results should be repeated
again after 3 and 6 months respectively.
If the person tests positive, the counselor should explain to him/her that there is a
chance of not developing full blown AIDS through medical intervention by ARVs,
antibiotics and antifungal drugs, good nutrition and reducing stress, and change of
lifestyle through positive living.
- Clarify that the test did not yield positive results but this does not means that
the person does not have the HIV since one may be in the window period.
- Let the person know that there is need to repeat the test after 3 months.
However don’t forget to congratulate the person.
iii. Offer testing and avail the results to people within short period.
iv. The clients are prepared for both positive and negative results before and after
testing then allowed to know their HIV status.
v. Through counseling, infected people, majority of who have lost hope are with
offered an opportunity for positive living
vi. They reduce the revenge attitude for those innocently infected and may opt to
die with many or commit suicide
vii. They enable the public who include the relatives of the infected to stop him/
stigmatizating those infected to be able to live normal lives knowing that
someone cares for them
viii. They also help the government to keep statistics on the prevalence of the
disease hence policy development or strategic planning.
ix. They enhance peer counselling - which is a more effective tool as it applies peer
pressure.
Shock
Denial
Anger
Bargaining
Fear
Loneliness
Self-consciousness
Depression
Acceptance
i) Breath
When one gets overwhelmed, he/she should take three deep breaths. Body
ventilation improves everything from chronic health problems, stress related
disorders to sporting performance. Whether one wants to boost one’s workout, ease
stress or improve one’s health, learning to breathe properly can enhance one’s
quality of life.
- Focusing on positive thoughts like living with HIV and not dying
iii. Educate one’s self about HIV by attending HIV/AIDS seminars, workshops or
any education forum
iv. Physical exercise — exercise regularly to keep muscle tone and reduce stress
v. Keep busy and avoid self pity by concentrating on development but one must be
careful not to overwork
- Talking to friends
vii. Embrace one’s own spirituality - Faith based organizations have ministers who
support HIV positive people these should be consulted for spiritual support.
x. Cry when one needs to let it out, as it creates room for positive feelings
xi. Accept responsibility: Pledge that HIV stops with me. Do not deliberately seek to
infect others. Use condoms to protect others and to avoid re-infection.
xii. Join HIV/AIDS support groups that over group therapy as infected people share
experiences.
xiii. Eat a well balanced diet with lots of proteins and vitamins. Avoid alcohol, drug
and substance abuse
The needs can be met at familiar home environment and may lead to an
improvement of the quality of life for PLWA’s.
Family, friends and the community must fill the “care gap” at home.
Home based care simply means the care given to HIV/AIDS patients at
home.
It means that the things people might do to take care of themselves or the
care given to them by the family and community.
Nursing care; which includes care to promote and maintain good health, hygiene
and nutrition
Counseling and psycho social care; which includes reducing stress and anxiety,
promoting positive living, and helping individuals to make informed decisions
on HIV testing, plan for the future and behavior change
i. It affects the socio economic, psychosocial and medical well being of the patient,
the family, the community and the health care system
iv. It helps counteract the myths and mistaken beliefs about HIV/AIDS
vi. It encourages community participation in the care of PLWA’s and thus maintains
community cohesiveness in responding to community members’ needs.
vii. It eases the demand on the national health system by reducing crowding in
hospitals, thus better care is given to those who really need to be in hospital.
Reduced food intake in persons with HIV may be due to painful sores in the mouth and
throat, loss of appetite, or fatigue. The main causes of loss of appetite are infections and
depression. Other causes include side effects of medication such as nausea and
vomiting, and inadequate access to and availability of appealing foods.
Poor absorption of nutrients results when HIV damages the small intestine and alters
the healthy bacteria of the digestive system, causing malabsorption of fats and
carbohydrates and frequent episodes of diarrhea. Intestinal infections also cause
diarrhoea, with loss and waste of nutrients.
Increased metabolism
Infections, including HIV itself, lead to increased requirements for energy and protein,
inefficient use of nutrients, and loss of nutrients. Energy requirements are likely to
increase by 10% to maintain body weight and physical activity in adults and growth in
symptomatic children.
- Proteins: Sources of protein are red meat, fish, poultry, eggs, nuts, beans, peas
and other pulses.
- Carbohydrates: are required for energy and for the purpose of PLWAs, they may
be categorized into insoluble and soluble dietry fibres.
- Fats: Fats are high in calories (energy). They are needed for many membranes in
the body. Fish, beef, and vegetables all supply fats.
- Vitamins and minerals: Vitamins and minerals are also needed by the immune
system. While our foods contain vitamins and minerals, it is important to
recognize that available data indicate food alone does not supply enough in the
presence of HIV, and that supplementation is very important.
Good nutrition entails eating a well-balanced diet that contains all the nutrients the
body needs for growth and proper functioning
Increase resistance to infection and disease and improve the energy supply
Boost the immune system and therefore reduce the frequency of episode of
morbidity.
Replace lost micronutrient and provide the body with all essential nutrient
required for good health.
Preserve muscle mass, slow or stop the loss of lean tissue, prevent weight loss,
and improve body strength and energy.
Delay the rate of progression of HIV to AIDS and the further advance of AIDS
itself.
Keep PLWAs alive and able to lead an active life; this in turn reduces their
dependence, thus allowing them to take care of themselves and to delay early
orphan hood of their children.
N.B:
Studies show that nutrition interventions can positively affect nutrition status
(FAQ, 2002), the immune system and even personal esteem, by maintaining body
weight, improving effectiveness of medication and prolonging life.
The following basic principles are being advocated for all programmes of HIV/AIDS
patient management, counselling or education;
- Nutritional supplementation
REVISION QUESTIONS
1. 21-year-old college student who has been sexually active for years asks if it’s a
good idea for her to be tested for HIV infection. How would you respond to her
and what recommendation would you give and why?
11. During a home care visit to a patient who is immune-compromised, you note
spoiled food in the kitchen, dirty dishes, unclean bathroom and the presence of
several cats and dogs. Explain the cause of action you would take.
CHAPTER 9
9.0 INTRODUCTION
This section aims to introduce to you the impact of HIV/AIDS. This section gives the
impact of HIV/AIDS on demography, agriculture, education, health, industry and the
business, and economic growth.
Objectives
- These orphans in some cases are taken care of by the older generation,
whose level of income is low, and in other cases are in child-headed
households, which may not be able to provide essential requirements,
including education and health services.
- They do not have the basic material needs that their family would supply
i.e food security, shelter, clothing, schooling, access to health and medical
services (including psychological support services), and parental love and
the feeling of belonging.
- They form the basis for production and supply of goods and services in an
economy.
- The end results are declines in agricultural income and food production
and increased food insecurity.
- HIV/AIDS has increased demand for health services due to the number of
infected persons.
- HIV - infected health workers also may have low productivity and morale.
- HIV/AIDS takes about 15% of the resource requirements for the entire
health sector.
- The most critical factors that determine economic growth are labour,
capital and technical progress.
- HIV and AIDS slow economic growth by their effect on labour and capital
investment.
REVISION QUESTIONS
1. HIV/AIDS results in a vicious cycle of poverty amongst the infected and the
affected. Justify this statement.
a) Education,
b) Agriculture,
c) Health,
d) Industry
UNIVERSITY EXAMINATION
Instructions
1. Identify and Discuss factors influencing condom use among the youth (10
marks)
2. In your view, what should be done to ensure that the married couples protect
themselves and their children from HIV/AIDS (10marks)
3. Clearly outline the relationship between drug, substance abuse and HIV and
AIDS (10 marks).
4. ‘’The youth are scared of pregnancy more than HIV and AIDS’’ Discuss
(20marks)
5. Discuss the impact of HIV/AIDS on any two of the following sectors (20marks)
6. Discuss the factors that explain the differential infection rates between men,
women, boys and girls (20marks)
7. Assess the impact of Drugs and Substance Abuse on individual and society
(20marks)
UNIVERSITY EXAMINATION
Instructions
2. Women are the most affected by HIV/AIDS pandemic. Discuss the factors for
this gender disparity (10 marks).
3. Discuss five most effective HIV/AIDS prevention and control strategies (10
marks).
Instructions
3. Explain how the rampant spread of HIV could be controlled among married
couples. (10marks)
4. During the Mt Kenya University HIV/Aids awareness week, you tested positive.
Explain the measures you would undertake to ensure that you continue to live
long despite the infection. (20marks)
6. Discuss any four gender related factors that explain the differential HIV/Aids
infection rates between young men and women in Kenya (20marks).
7. Identify and discuss three ways of managing the spread of HIV/Aids among
drug abusers (20marks).
UNIVERSITY EXAMINATION
Instructions
3. Giving relevant examples, explain the factors fueling the spread of HIV/AIDS.
4. Recent studies have shown that marriage and regular unions are at more risk of
HIV/AIDS spread. Discuss the statement.