EAP 3025: HIV AND AIDS ISSUES IN EDUCATION

• HARRISON DAKA 0974 765442 AND 0964

104479 ; ROOM 311
• bhamudak@yahoo.com
• harrison.daka@unza.zm
 COURSE OUTLINE
• OVERVIEW OF HIV AND AIDS PANDEMIC
• THE SPREAD AND PREVENTION
• STIGMA,DISCRIMINATION AND POLICIES
• VCT AND ART
• IMPACT OF HIV AND AIDS ON EDUCATION AND
SUSTAINABLE DEVELOPMENT GOALS .
• EDUCATION AS A SOCIAL VACCINE
• THE ROLE OF LEADERS AND MANAGERS IN THE
FIGHT
 RATIONALE OF THE COURSE
• BUILD CAPACITY IN STUDENTS
• OVERCOME THE EPIDEMIC OF SILENCE
• DISCOVER CHALLENGES INSTITUTIONS FACE
• PROVIDE LEADERSHIP AND FIGHT STIGMA
AND DISCRIMINATION
• IMPLEMENT THE STRATEGIES OF MOE TODATE
 OUTCOMES
• PROVIDE AN UNDERSTANDING OF THE
BIOCHEMISTRY OF THE BODY
• ANALYSE THE MYTH AND CURE OF HIV
• HAVE COUNSELLING BASICS
• UNDERSTANDING HOW ARVs WORK
• APPECIATE THE ROLE OF EDUCATION AND
LEADERSHIP IN MITIGATING THE SPREAD OF HIV
• IMPACT OF HIV AND HIV ON SUSTAINABLE
DEVELOPMENT GOALS
 MOE Intervention Objectives
• To promote a conducive environment in which
learners actively participate in acquiring relevant
information, knowledge and skills and form
positive behaviour and attitudes that protect
them from contracting HIV or living positively and
to meet other everyday challenges (LEARNERS).
• To provide training to all teacher trainers and pre-
service students in comprehensive, evidence-
based SRH, life skills and HIV and AIDS interactive
methodologies (EDUCATORS).
 OVERVIEW OF THE PANDEMIC
• HIV –Human Immunodeficiency Virus( HIV-1
and HIV-2)
• AIDS- Acquired Immune Deficiency Syndrome
• SIV- Simian Immunodeficiency Virus
• EPIDEMIOLOGY-scientific study of the spread
and control of the disease
• EPIDEMIC-large number of cases of a
particular disease happening at the same time
in a community ie flu, cholera
 CONT’N
• PANDEMIC-a disease spread over the whole
area eg HIV and AIDS
• ENDEMIC- a situation regularly found in a
place among particular people and difficult to
get rid eg malaria in Sub-Saharan Africa
• INFECTION- the act of causing a disease
• LENTVIRUS- slow acting
• STIs-Sexually Transmitted Infections
 CONTN’
• PrEP - Pre-exposure prophylaxis:. Truvada is
currently used which is a single pill that is a
combination of two anti-HIV drugs, tenofovir and
emtricitabine.
• PrEP is taken 7 days in men and 21 days in women
before engaging in high risk sexual exposure to
achieve maximal protection from HIV acquisition.
• PEP - post-exposure prophylaxis: involves taking a
28-day course of ARVs within 72 hours.
 THEORIES ABOUT ORIGIN OF HIV
• HUNTER/MONKEY/CHIMPAZEE THEORY
• CONSPIRACY THEORY
• LABORATORY DISFUNCTION/EMERGENCY
• GOD’S PUNISHMENT
• COLONIALISM
• ORAL POLIO VACCINE
 HUNTER/MONKEY/CHIMPANZEE THEORY

• Research carried out in the USA alleged that

the HIV originated from the monkeys known
red-capped mangabeys and spot-nosed
guenons.
• It is believed that these monkeys are found in
West Central Africa.
• It is stated that a Chimpanzee ate from the
two monkeys and was infected of Simian
Immunodeficiency Virus (SIV).
 CONTN’
• The a Human Hunter got this from the
infected Chimpanzee and the virus under
went mutation to in a human to become
Human Immunodeficiency Virus (HIV) and
infected many women.
• Due to slave trade, some of these were taken
to America and that’s how the virus was
discovered in one of the Americans
 CONSPIRACY THEORY/ COLONIALISM
• This theory is mostly propagated by Africans in
response to the first theory.
• It is alleged that Chemical and Biological
Warfare Board in America deals with
experiments to deal with unwanted species.
• These Europeans wanted to eliminate the
natives in America
• The following are some of the allegations:
 CONTN’
HIV and AIDS is a man-made virus that the
federal government made to kill and wipe out
black people.
In early 1960s, the USA Army released some
chemicals in highly populated African
communities.
Americans also produced a birth pill which
gave people in Haiti a lot of health problems.
LABORATORY DISFUNCTION/EMERGENCY
OR ORAL POLIO VACCINE
This is also known as ‘cut hunter theory’.
The most highly respected scientists and
academicians debated that HIV-1, the most
widespread and deadly human AIDS virus,
evolved from accidental vaccine
contaminations and subsequent transmissions
to mostly African villagers from the Oral Polio
Vaccine (OPV) given to them.
 CONTN’
It is believed that in the Laboratory, they were
in search for the cure of cancer.
Instead of the cure for cancer, HIV was made
and tests were done on small communities
like gays, prisoners etc.
 GOD’S PUNISHMENT
 Fundamentally, all disease is a judgment from God.
 When God pronounced judgment on Adam, death
entered the world (Genesis 3:19; Romans 5:12)
 God designed man and woman to marry but because
of homosexuality and lesbianism God has punished
humanity (Leviticus 26: 13-35).
 They believe that HIV is a spirit.
 Condom as a false solution.
 HIV KNOWLEDGE, TRANSMISSION
AND PREVETION (ZDHS REPORT, 2018)
• 99% of men said they have heard about HIV
and 98% of women.
• Knowledge of HIV prevention methods is
higher among urban women (83%) than
among rural women (77%).
• More men (33%) had sex outside marriage
than women (19%).
• More women (22%) in urban had sex outside
marriage than those in the rural (17%).
 CONTN’
• Western has the highest percentage of women (34%) and
men (47%) who had sex outside marriage as compared to
Northern and Muchinga with women (10%) and men
(21%).
• The percentage of women who had sex outside marriage
11% of those without education to 25% among those with
a higher education. No such pattern is observed among
men.
• Among both women and men, condom use outside
marriage increases with increasing education, from 20%
and 37%, respectively, among those with no education to
52% and 65%, respectively, among those with a higher
education.
 CONTN’
• More women (85%) go for HIV testing than men
(75%).
• The percentage of men who are circumcised is
highest among those age 20-24 (39%) and
lowest among those age 40-49 (23%).
• 14% of young women and 15% of young men
had sex before age 15.
• Twice as many young women in rural areas have
sex before age 15 than their urban counterparts
(18% and 9%, respectively). A similar pattern is
observed among young men (19% and 10%,
respectively).
 WORLD SITUATIONAL ANALYSIS
• World Health Organization (WHO) show that
there are annually nearly 2 million new people
infected with HIV.
• 36.9 million people living with this chronic
infection in 2020.
ZAMBIAN SITUATION
ANALYSIS-BY PROVINCE
 2007 ZDHS showed prevalence rate as 14.3%
 Top three provinces are; Lusaka- 20.8%,
Central- 17.5% and Copperbelt- 17.0%
 Followed by; Western- 15.2%, Southern-
14.5% and Luapula- 13.2%
 Last three are; Eastern- 10.3%, North
Western- 6.9% and Northern- 6.8%
 ZAMBIAN SITUATION
ANALYSIS-BY PROVINCE
 2013-2014 ZDHS showed prevalence rate as 13%.
 Top three provinces are; Copperbelt- 18.2%,
Lusaka- 16.3% and Western - 15.4%
 Followed by; Southern- 12.8%, Central-12.5%
and Luapula- 11.0%
 Last Four are; Northern- 10.5%, Eastern-9.3%,
North Western- 7.2% and Muchinga- 6.4%
 ZAMBIAN SITUATION
ANALYSIS-BY PROVINCE
 2018 ZDHS showed prevalence rate as 11%
with men (7.5%) and women (14.2%).
 Top three provinces are; Copper belt-
15.4%, Lusaka- 15.1% and Southern and
Central - 12.4%
 Followed by; Western-10.6%, Luapula- 7.9%
and Eastern- 7.4%
 Last three are; North Western- 6.1%,
Northern – 5.6% and Muchinga- 5.4%
ZAMBIAN SITUATION ANALYSIS-
BY AGE 2013 - 2014
AGE IN YEARS HIV PREVALENCE(%)
15-19 4.4
20-24 9.4
25-29 12.9
30-34 17.6
35-39 21.0
40-44 22.5
45-49 19.4
ZAMBIAN SITUATION ANALYSIS-
BY AGE 2018
AGE IN YEARS HIV PREVALENCE(%)
15-19 1.9
20-24 6.1
25-29 10.4
30-34 16.7
35-39 18.5
40-44 22.3
45-49 19.6
ZAMBIAN SITUATION
ANALYSIS 2013 - 2014
 1. RELIGION
 Catholics-14.2%
 Protestant-13.0%
 Muslims-15.0%
 2. Geographical
 Urban-18.2%
 Rural-9.1%
ZAMBIAN SITUATION
ANALYSIS 2018
 1. RELIGION
 Catholics-10.8%
 Protestant-11.0%
 Muslims-12.9%
 2. Geographical
 Urban-15.9%
 Rural-7.1%
ZAMBIAN SITUATION
ANALYSIS 2018
 3. Education level
 No education-9.3%
 Primary-10.8%
 Secondary-11.2%
 Tertiary-14.0%
 4. Employment
 Employed-12.7%
 Non employed-8.4%
ZAMBIAN SITUATION
ANALYSIS 2018
 5. Marital status
 Never married-4.6%
 Married-12.6%
 Divorced-27.5%
 Widowed-42.8%
 Polygynous union-10.6%
 Non Polygynous union-12.7%
DRIVERS OF HIV IN ZAMBIA

 A study on the drivers of the epidemic

in Zambia was carried out and the key
drivers identified through these works
were :-
DRIVERS OF HIV EPIDEMIC
 Mother to child
 Vulnerability and marginalized
 Mobility and migrant labour
 Low rates of male circumcision
 Low and inconsistent condom use
 Multiple concurrent partners
 Harmful cultural practices
 MULTIPLE AND CONCURRENT SEXUAL
PARTNERS

 Multiple & concurrent sexual partners is a key

driver of HIV infection in Zambia.
 Separation from regular partners & social
norms can lead migrants to engage in
behavior which increase vulnerability to HIV
(e.g. alcohol abuse, unsafe casual or
commercial sex).
 LOW PREVALENCE OF MALE
CIRCUMCISION

 Zambia is one of the countries leading in

promoting adult male circumcision.
 Circumcision is recommended if scientifically/
medically done.
 A number of doctors have been trained to
carry out medical male circumcision.
 Some men feel that after circumcision they
can not be infected.
 STIGMA, DISCRIMINATION
AND DENIAL

 A person at high risk of being HIV positive may

deny such risk as the individual is unable to
cope with the ‘associated stigma’.
 Fear of being stigmatized and discriminated
against may prevent people from knowing their
status.
Harmful Cultural practices
1. Some Polygamy marriages
2. Cross-generational sex.
3. Transactional sex and dry sex.
4. Early marriages.
5. Traditional practice of sexual cleansing,
including wife inheritance.
6. Some initiation ceremonies facilitate
the transmission of HIV.
CONTN’
7.Myth about passing the ghost of the
dead spouse to a stranger among some
Zambian tribes to rid themselves of their
spouse’s ghost.
8. Multiple sexual partners is common in
both urban and rural areas.
9.Wife swapping among friends in some
cultural groups.
GENDER AND SEXUAL
VIOLENCE
 Women are socialised into becoming mainly
wives and mothers.
 The socialization process influences women to
a situation where they are unable to
negotiate for safer sex.
 Social norms that perpetuate the dominance
of male interests and lack of self –
assertiveness on the part of women.
Poverty
 HIV and AIDS, like all communicable
diseases, is linked to poverty.
 The link between HIV and those with high
income or high education level is more
among men.
HIV Related Poverty
• Poverty created by war: civil unrest and social
disruption which leads to high levels of rape
and the breakdown of traditional sexual
mores, and the refugee problem)
 CONTN’

• Deep-rooted structural poverty -arising from such

things as gender imbalance, land ownership
inequality, ethnic and geographical isolation, and lack
of access to services.
• Developmental poverty -created by unregulated
socio-economic and demographic changes such as
rapid population growth, environmental degradation,
rural-urban migration, community dislocation, slums
and marginal agriculture.
 LOW RISK PERCEPTION
 Some believe that they are at no risk of
getting HIV infection although they practice
high risk behavior.
 Although awareness of HIV and AIDS and
risk perception is high, this knowledge did
not translate into positive result (change of
attitudes and behavior e.g. use of condoms)
 EXAMPLES
 2001/2002 research result:
 64% female and 70% male think they
are at no risk of contracting HIV
because;
 73% trust their partners,
 34% used condoms always, 9 % were
mutually faithful,
 8 % the partners looked health.
The Religious Factor

 Some scholars have attributed religious

factors to be key in the spread of the HIV
virus.
 Some religious groups are told that they
shouldn't use condoms or any artificial form
of birth control.
MODES OF TRANSMISSION
 Blood
 Breast milk
 Semen
 Vaginal fluid
 Injectible needles
BODY FLUIDS WITH LESS HIV
QUANTITIES
 Saliva
 Sweat
 Tears and Urine
 Sufficient quantities of the virus,
Access to the bloodstream and
Duration of exposure (SAD) OR
Quantity, Quality and Route (QQR)
are used.
GENERAL PREVENTION OF
THE SPREAD
 Prevention of Mother-to-Child Transmission
(PMTCT)
 Post-exposure prophylaxis (PEP)
 Microbicides/Truvada
 Circumcision
 Condom use
 Education about sex
 Vaccine/ARVs
CONTN’
 There are two major ways of
prevention:
 1. Criminal law
 2. Public health
 Zambia uses # 2
Sexual Intercourse
 Abstinence/Sex education
 Be faithful
 Condom use- Circumcision
CHALLENGES OF ABSTINENCE
 Over nights
 Youth camps
 Zonal games
 Boarding Schools
 Workshops
 Dress code
 Traditional beliefs
 Lack of sex education
 Social networking
CHALLENGES OF
FAITHFULNEES
 Workshops
 Cultural context
 Counseling
 Marriage openness
 Poverty
 Lack of sex education
 Social networking
CHALLENGES OF CONDOM
USE
 Availability
 Correct use
 Consistency
 Consent
 Affordability
 Packaging
 Information (Male Circumcision)
 Social networking
WHY PEOPLE DO NOT LIKE
CONDOMS
 Interference with the flow of the sexual act
 Difficulties in opening the pack
 Difficulties in unrolling the condom
 Discomfort
 Decrease in sensation
 Removal and disposal
 Implied distrust.
 In some cultures, spiritual issues
Condom effectiveness the 4 A’s

 •Availability
 Affordability
 Acceptability –dependant on
marketing, perception and design
 Adequacy (Safety)
 Ease of use

 Adherence to appropriate standards

DETERMINANTS OF HIV INFECTION
• Ro = βcD
• Ro = reproductive rate
• β = probability of transmission
• c = rate of new partners
• D = duration of infectiousness
 STI of β
Each STI has a different
• Gonorrhoea ----------------------50%
• Chlamydia trachomatis .……….20%
• Syphilis ……………………………… 60%
• Chancroid …………………………. 80%
• HIV-1 HIV infection …………… 10%
Reduce transmission efficiency (β )
• Condoms: male & female
• Withdrawal and ‘non-penetrative’ sex
• Circumcision
• Antiretroviral treatment for HIV positive people
to reduce viral load to undetectable levels
• Pre-exposure prophylaxis of HIV (PrEP) and
possibly vaccination
• Post-exposure prophylaxis (PEP)
 Reduce frequency of exposure (c)

• ABC approach (abstinence, being faithful,

condom use)
Reduce duration of infectiousness (D)

• Contact tracing & partner notification

• Routine (eg antenatal) & selective screening
• Antiretroviral treatment as prevention (earlier
treatment initiation)
• Educating the public and professionals to respond
to early symptoms
• Providing accessible, affordable & acceptable
clinical services
• Better tests & treatments
 Per sex act

Vaginal sex
• receptive partner 1-2/1,000 per act
• insertive partner 0.3-0.9/1,000 per act
Anal sex
• receptive partner 5-30/1,000 per act
• insertive partner 0.3-0.9/1,000 per act
Oral sex
• Transmission occurs rarely, only when there is a
breach of the mucous membrane
• Risk is unquantifiably low
 Receptive versus insertive role

• Receptive partner is more susceptible than the male:

• The area susceptible to infection (vagina, cervix and
uterus) is much larger in women than in men (head
of the penis, exposed urethra)
• Women are exposed to a larger quantity of infectious
fluid (semen) than men (vaginal fluids)
• Vaginal fluids contain less HIV on the average than semen
• Women retain the secretions within the body while
men are only exposed during the sex act
 BEHAVIOURAL FACTORS
• Withdrawal before ejaculation (↓)
• Fisting and other stimulating sexual
practices(↑)
• Douching (↑)
• Illegal drug and alcohol use (↑)
• Condom use (↓)
• Number and selection of sexual partners
(whether concurrent or consecutive)
 HIV LIFE SPAN
• After someone becomes infected with HIV, the
virus begins to replicate very quickly and the
amount of virus in the body and bodily fluids
(blood, semen, vaginal fluid) rapidly rises.
• Once antibodies to HIV have been produced,
HIV replication begins to slow down and the
amount of virus in the body.
• Then the viral load gradually reduces but later
rises if no measures are taken (ARVs, nutrition
and life style, re – infections).
 CONTN’
• Antibodies are not produced immediately
after infection.
• The amount of time it takes for the body’s
immune system to produce them varies from
person to person.
• Most studies have shown that after 3 weeks
up to 3 months (this is why they call this
window period).
• The amount of virus in the bodily fluids is
highest during the acute HIV infection stage.
 CONTN’
• The period from infection to infect others
depend on levels of virus (viral load) and other
underlining factors like TB, Sugar etc.
• The highest chances has been in the first 3
weeks before the production of the antibodies
(this period the infected does not present any
symptoms so it is difficult to tell).
• The higher the viral load, the greater the risk is
of transmitting HIV to others through
unprotected sex.
 CONTN’
• Researchers estimate that the risk of
transmitting HIV to another person sexually
with unprotected sex is 26 times higher during
the first three months after infection than
during the months and years that follow.
• HIV survives within an organism but dies
outside the organism within seconds to 4
minutes if on the surface.
• Precautions need to be taken in fresh blood
for time can be longer.
 CONTN’
• The virus can stay 2 to 3 days inside the body
(cervix to the oviduct) and die later if it does
not find route into the blood stream (72 hours
maximum just as the period for PEP).
• The HIV virus can only survive outside the
body if the temperature is below 39 degree.
• The virus can also only survive in a pH level
between 7.0 and 8.0.
• The HIV virus dies instantly if it comes into
contact with oxygen.
• HIV can survive in the lab conditions, and even
then, it can last for a maximum of six days with
very low concentrations.
• The HIV virus may be an actual risk once it’s
outside the body under four conditions.
1. First, HIV can only thrive in certain body fluids,
which include semen, blood, vaginal fluid, and
breast milk.
2. Second, in order to get infected, there must be
an entry point for the virus to get into the
bloodstream.
• 3. This can happen either through sex, blood
transfusions , sharing needles, etc. (Unlike
common perception, HIV can’t get through
unbroken skin. Also, a scrape, abrasion, or
prick will not penetrate deep enough to allow
infection).
4. There also must be a large enough quantity of
the virus in the right body fluid to get infected.
 BASIC CLINICAL FACTS ABOUT HIV
1. BIOSYNTHESIS OF THE BODY
• PRIMARY INFECTION (RECEPTOR)
• ASSYMPTOMATIC PHASE
• SYMPTOMATIC PHASE
 BIOSYNTHESIS OF THE BODY
• HIV is a lent virus-a slow acting virus
• It binds to the CD4 cells or Helper-T cells and attacks
them destroying the immune system
• A normal person has btn 500 to 1600 CD4 cells
• In the first 4-8 weeks a newly infected body will feel
flu like, fever, sore throat, headache, skin rush and
general body discomfort due to the fight in the
body(viral load increase)
 CONTN’
SHOW VIDEO ON HIV INFECTION
 HIV particle and genome

gp120 MHC
envelope gp41

matrix p17 lipid bilayer

core p24
RT

RNA
 CONT’N
• In 6 months there will be enough antibodies
to show in the test(rapid) and the viral load
will start decreasing
• This is known as ASSYMPTOMATIC PHASE(
symptom free)
• This can take upto 10 years depending on the
immunity and life style of a person.
• It should be noted that the viral load will again
steadily be increasing while the CD4 cells will
continue to reduce
• When the CD4 cells reduces to 250 or less a person
will start experiencing; extensive weight loss, fatigue,
periodic fever, recurring diarrhea, fungal infections
(symptomatic phase)
 CONT’N
• The Opportunistic Infections start occurring ie
• Kaposis sarcoma, Pneumonia, Cryptococcal
Meningitis, T.B., Herpes zoster, Candidiasis etc
• People die as a result of OIs
• When the body fails to fight back the an AIDS stage is
reached where all the OIs are experienced
3. Opportunistic Infections
 HIGH RISK SITUATIONS
• The first 3 weeks as viral is very high
• Those with STIs
• Those in AIDS stage
 HIV TESTING
1. Detecting the antibodies;
• Rapid test ( blood, saliva and urine) takes
few minutes
• ELISA (Enzyme-Linked Immunosorbent
Assay)-blood is used
• Western Blot- can confirm a positive ELISA
result
 CONT’N
1. OTHER DETECTIONS;
• P24 Antigen detect pieces of HIV within 3
weeks of infection
• Quantitative Polymerase Chain Reaction
(PCR) can detect quantity of virus within 48
hours.
• Quality Polymerase Chain Reaction (PCR-
DNA) can detect presence of HIV
 MEANING OF THE RESULTS

1. HIV- negative or Non reactive shows;

• At that time antibodies can not be detected/
there are no antibodies but does not mean that
you are immune to HIV.
2.HIV-positive or reactive shows;
• Has antibodies fighting the virus/ will be positive
for life but does not mean that you are in AIDS
stage. You need to do CD4 count to see if you
need ARVs.
ANTIRETROVIRAL DRUGS
 These suppresses the virus to below the
limit of detection but does not mean
that someone has no Virus. The same is
applied to herbal medicine.
 All the drugs are combined so that they work
well (trimune). Some examples are ;
Stavudine, Lamivudine, Nevirapine,
Zidovudine, Abacavir, Didanosine etc
ARVs RECOMMENDED DOSES
1. Zidovudine (AZT) +Lamivudine(3TC)
+Nevirapine(NVP)-Child bearing age
and not anaemic patients due to AZT(
causes bone marrow suppression).
2. Stavudine(d4t)+ Lamivudine(3TC)
+Nevirapine(NVP)- both above not for
TB patients because NVP reacts with
Rifamicin
CONTN
3. Stavudine(d4t)+ Lamivudine(3TC)
+Efavirenz(EFV).
4. Zidovudine (AZT) +Lamivudine(3TC) +
Efavirenz(EFV).
5. 2ND LINE

Zidovudine + Lamivudine + Lapinavir +

Litonavir
 Use of ARVs
Attachment, Viral Zinc-finger
fusion and entry Nucleocapsid proteins

Viral protease

RNA RNA
RNA Proteins

Reverse
RNA
transcriptase
RNA

DNA
Viral regulatory
RT proteins
DNA
DNA

DNA Provirus

Viral Integrase 83
WHEN TO START TREATMENT
1. TEST AND TREAT
2. Advanced stage disease (severe symptoms)
with any CD4 level
3. No symptom of HIV but CD4 level below 500
4. No symptoms with any CD4 level but has
cancer
5. Symptoms with CD4 count 500
AREAS OF CONCERN IN HIV
COUNSELLING
 PRE-TEST
 POST TEST (HIV +VE AND –VE) AND
OTHER INFECTIONS
 ADHERENCE
 DISCLOSURE
 POSITIVE LIVING
VCT PROCESS
 Room need to be set up (clean and sit
squarely with your client).
 Consent documents present
 Lab consumables ready for testing
 Conducive environment (less or no noise).
 Three steps: Pre-test, the test and Post-test
PRE-TEST
 Correct information of HIV test
 Benefits of testing
 Information of the HIV transmission
 Confidentiallity
 Meaning of results
THE TEST
 Take a drop of blood
 Results are available within 5 – 15
minutes
 If positive need for a second test to
confirm
 Take note of window period
POST TEST
 The client is given the results
 In case of couples the results are given
to spouse.
 Time is given to counselee for
understand the results
 Consider available support available or
options.
CONSEQUENCES
 Some negatives of VCT includes:
Stigma, Discrimination, disclosure
CLIENTS RIGHTS
 Consent
 If a child under 16, a parent to give
consent.
 Confidentiality and privacy
 Results not to be used for
discrimination
 Medical treatment
ARV COUNSELLING
 Treatment adherence helps prevent
drug resistance. The following can be
done: Keep time, inform a relative so as
to avoid missing.
CHALLENGES OF TAKING
ARVS
 Stigma and Discrimination
 Drugs
 Disclosure and support
 Denial
 Pill burden
 Side effects
 Poor diet
 Lack of adequate information
TREATMENT ADHERENCE
 Taking the drugs when and how you
are supposed to take.
 This affects how well the ARVs can
reduce the viral load and when this
happens the better the health.
BENEFITS OF ADHERENCE
 Helps prevents drug resistance
 Helps stops the virus to replicate
 Stops new strains to develop which
might be resistant to ARVs
 A VIDEO ON ADHERENCE
HIV AND AIDS RELATED STIGMA
AND DISCRIMINATION
 Stigma- the holding of derogatory social
attitudes or cognitive beliefs OR a powerful
and discrediting social label that radically
changes the way individuals view themselves
or the way they are viewed by others.
 Discrimination- an action based on pre-
existing stigma, a display of hostile or
discriminatory behavior towards members of
the group, on account of their membership to
that group.
 AIDS RELATED STIGMA AND
DISCRIMINATION

 Refers to prejudice, negative attitudes,

abuse and maltreatment directed at
people living with HIV and AIDS.
 It refers to prejudice, discrediting,
disregarding, underrating and
discrimination directed at persons
perceived to have HIV and AIDS as well
as their partners, friends, families and
communities.
ROOT CAUSES OF HIV/AIDS
RELATED STIGMA
a) Insufficient knowledge, as well as disbeliefs
and fears about HIV/AIDS.
b) Fear of death and the disease itself.
c) Moral judgment about people and
assumptions about their sexual behavior.
d)Associations with “unlawful” sex and/or
drugs.
e) Links with religion and the belief that AIDS is
a punishment from GOD.
Effects of stigma &
discrimination
• They can result in being shunned by family,
peers and the wider community.
• Can result into poor treatment in healthcare
and education settings.
• Violation of rights; psychological damage.
• Affect the success of testing and treatment
done by health care providers.
• Stigma changes the way people view
themselves.
CONTN’
• The stigmatized person becomes laden
with intense disabling feelings of
anguish, shame, self doubt, guilt, self
blame and inferiority.
• Stigma arising from HIV is a major
cause of personal suffering and a
principal obstacle to effective responses
to the AIDS epidemic
CONTN’
• Makes difficult for people to come to terms
with HIV
• Interferers with attempts to fight the AIDS
epidemic as a whole.
• Contributes to maintaining the AIDS
epidemic: People do not go for testing; they
do not disclose their positive HIV status.
• Excluding people from society may push them
to engage in high- risk behavior
 WHAT HIV/AIDS RELATED STIGMA CAN DO?

 Shatters self-esteem.
 Destroys families.
 Disrupts communities and reduces hope for
future generations.
 It violates basic human rights.
 It cripples efforts for prevention and cure.
 FORMS OF STIGMA &
DISCRIMINATION
 They occur alongside other forms of stigma
and discrimination, such as racism and
Xenophobia
 Among the forms of HIV/AIDS stigmas are:
SELF-STIGMA, FELT-STIGMA and ENACTED
STIGMA.
 1. SELF-STIGMA
a. Self-stigma refers to the process
whereby people living with HIV impose
feelings of deference, inferiority and
unworthiness on themselves.
EXAMPLE: Self hatred, shame, blame,
etc. Feelings of shame, dejection, self
doubt, guilt, self blame, Loss of self-
esteem, Social withdraw, Self-exclusion
from services & opportunities. High
levels of stress and anxiety with Fear of
disclosure.
HOW TO OVERCOME SELF-
STIGMA
1) Early referral to peer support
2) Good quality pre/post counseling.
3) Disclosure of HIV status to loved ones.
4) Encouragement to remain productive
5) Providing Information about HIV/AIDS.
6) Access to antiretroviral treatment
7) Respect for the right of all people diagnosed
as being HIV positive.
2. FELT STIGMA
 These are perceptions or feelings
towards a group (such as people living
with HIV) who are different in some
respect.
 ***hepatitis A, B and C
EFFECTS OF FELT STIGMA
1) Compromises the human rights.
2) Leads to denial, ignorance and fear.
3) Labels others“they are different from us”.
4) Separating “us” from “them” – leading to
avoidance, shunning, isolation and
rejection.
5) Attributing differences to negative behavior
“his sickness is caused by sinful or
promiscuous behavior”
6) Loss of status.
3. ENACTED STIGMA
 These are actions fueled by stigma,
which are commonly referred to as
discrimination.
EFFECTS OF ENACTED
STIGMA
a. Physical and social isolation ie removed
from family, house, group, school etc.
b. Gossip, name calling and insults.
c. Judging , blaming and condemnation.
d. Loss of rights and decision making power.
e. Loss of employment.
f. Reduced access to treatment and care.
g. Depression, suicide, alcoholism, Violence.
h. Avoiding getting tested for HIV.
i. Breaking up of relationships.
STIGMA & THE LANGUAGE
USED
 The metaphors related to HIV and AIDS
reinforce stigma and re-affirm social
inequalities. This makes the already
stigmatized groups, even more stigmatized.
1.Words such as ‘victim’, AIDS ‘carrier’,
‘sufferer’, ‘kanayaka’ stigmatize people with
HIV and create images of powerlessness.
2. In many cultures, “AIDS is seen as a
woman’s disease.
CONFRONTING STIGMA &
DISCRIMINATION IN THE
EDUCATION SECTOR
There are many forms of AIDS-related stigma
and discrimination occurring in education.
Examples:-
 Termination of employment.
 Refusal to offer employment.
 Unequal training or promotion
opportunities
 Breaches of confidentiality regarding
an employee’s HIV status.
EFFECTS OF STIGMA &
DISCRIMINATION IN THE
EDUCATION SECTOR
1) They can negatively affect teacher morale.
2) They can compromise employee health, in
instances where stigma constitutes a barrier
to access to treatment and cure
3) They can result in the loss of human
resources if infected employee leave.
4) They will undermine HIV prevention
programs.
ENABLING & PROTECTIVE
POLICIES AND LAWS
 Most countries have now enacted
policies and laws to protect the rights
and freedoms of people living with HIV
& AIDS.
 This legislation has sought to ensure: -
their rights to education, employment,
privacy & confidentiality as well as right
to information, treatment and support
are protected.
DISCRIMINATORY/
STIGMATIZING LAWS &
POLICIES
 Some countries, stigmatization is expressed
through laws and policies directed at those
living with HIV that claims to protect the
“general population”. Examples:-
• Limitation on international travel and
migration e.g. USA, China, Australia.
• Compulsory screening and testing for HIV
• Compulsory notification of AIDS cases.
• Prohibition of people living with HIV from
certain occupations ie food handling.
CONTN’
• Isolating of people living with HIV from the
general population
• Compulsory HIV testing for international
students studying in those countries
• National and international subsidies and
support program to support orphans’
education e.g. in Zambia, Uganda, etc
(HIV orphans are unhappy being singled out as
orphans as this support made their status easily
recognized)
END!!!

KNOWLEDGE IS POWER SO GET

TESTED!!!!!