MANAGEMENT OF COMMUNICABLE

DISEASE
CONCEPTS OF HIV AND AIDS AND KEY
POPULATION
Learning objectives
At the end of this session each student is expected to be able to:
• Define HIV and AIDS
• Identify key population
• Explain the magnitude of HIV and AIDS with regards to
prevalence to general and key population
• Identify factors for HIV transmission
• Explain the transmission cycle of HIV
• Outline mode of transmission of HIV
• Explain the impact of HIV (clinically, social/psychologically and
economically)
• Explain the WHO stages of HIV and AIDS
Definition of HIV and AIDS

 HIV (Human Immunodeficiency Virus) is a virus that

attacks the immune system, our body's natural
defence against illness.
Definition of HIV and AIDS cont..

 AIDS (Acquired Immunodeficiency Syndrome) is a

chronic, potentially life-threatening condition caused
by the human immunodeficiency virus (HIV).
By damaging immune system, HIV interferes with
the body's ability to fight the organisms that cause
diseases.
Identification of Key Population

• Key Population (KPs) are defined groups who, due to

specific higher-risk behaviors, are at increased risk of
HIV irrespective of the epidemic type or local context.
• KPs have legal and social issues related to their
behaviours that increase their vulnerability to HIV.
Identification of Key Population cont..

•WHO guidelines focus on five key populations:

1) men who have sex with men,
2) people who inject drugs,
3) people in prisons and other closed settings,
4) sex workers and
5) transgender people.
Identification of Key Population cont..

• The key populations are important to the dynamics of

HIV transmission. They also essential partners in an
effective response to the epidemic.
Magnitude of HIV and AIDS with Regards to
Prevalence to General and Key Population
• It is estimated that by 2015 there were about 36.7
million people living with HIV (PLHIV) globally.
• In Tanzania by 2016, it was estimated that around
1.35 million people were infected with HIV in the
country.
• Tanzania mainland is experiencing a generalized HIV
epidemic, with an HIV prevalence of 5.3% in the
general population.
Magnitude of HIV and AIDS with Regards to
Prevalence to General and Key Population cont..
• Heterosexual sex is the most common route
(attributing up to 80%) of all new HIV infections in
Tanzania Mainland.
• HIV prevalence is higher in sub-groups such as people
who inject drugs (PWID) (16-51%)3, men who have
sex with men (MSM) (22-42%)4, and mobile
populations and sex workers (14-35%)5.
• Women are disproportionally more affected, with an
HIV prevalence of 6.3% versus 3.9% among men.
Magnitude of HIV and AIDS with Regards to
Prevalence to General and Key Population cont..
• The prevalence of HIV among young people aged 15-
19 years was 1% (1.3% among girls, and 0.8% among
boys).
• Furthermore, the percentage of women aged 20-24
infected with HIV is higher (4.4%) than that of men
(1.7%) in the same age group
Mode of Transmission and Factors Influencing HIV
transmission
Mode of Transmission
Sexual transmission
Injection drug use
Blood and blood products
Perinatal
Mode of Transmission and Factors Influencing HIV
transmission cont..
Factors Influencing HIV transmission
 Infectiousness of host
High viral load
Advanced stages
 Susceptibility of recipient
STIs
Lack of circumcision
Mode of Transmission and Factors Influencing HIV
transmission cont..
• Gender (woman are more susceptible)

Socio-economic factors
Gender inequality
Social mobility
Poverty
Cultural factors
People in conflict
Drug use
Alcohol consumption
Replication cycle of HIV

 HIV is a special family of virus known as retroviruses

 A retrovirus is any virus belonging to the viral family
Retroviridae.
 They are enveloped viruses possessing a RNA
genome, and replicate via a DNA intermediate.
Replication cycle of HIV cont..

 Retroviruses rely on the enzyme reverse

transcriptase to perform the reverse transcription of
its genome from RNA into DNA, which can then be
integrated into the host's genome with an integrase
enzyme.
 The virus then replicates as part of the cell's DNA
Replication cycle of HIV cont..
Steps
A= Attachment to host CD4 cell
R= Reverse transcription, enzyme makes viral DNA from
viral RNA
I= DNA Integration, viral DNA integrates to cell nucleus
material by integrase enzyme
R= Reproduction of HIV within CD4 cell
A= Assembly of viral components to make new HIV by
protease enzyme
R= Release of new HIV viruses
Replication cycle of HIV cont..
The impact of HIV

Health Impact
• HIV and AIDS pandemic predisposes people to other
infections such as tuberculosis (TB) and non-
communicable diseases (NCDs), which are among the
leading causes of morbidity and mortality among the
PLHIV with HIV.
The impact of HIV cont…

• In Tanzania Mainland, where human and financial

resources for the health system are constrained, the
implementation of additional care and management
services for HIV infection has added challenges to
overall health system.
• Since HIV infection also affects health care personnel,
an additional burden to the human resource crisis
has been noted.
The impact of HIV cont…

Economic Impact
• There is a close relationship between HIV and AIDS
and economic development. Poverty is a powerful co-
factor in the spread of HIV infections.
• Economically and socially disadvantaged segments of
the population, including women, youth, and other
marginalized groups, are disproportionately affected
by the epidemic.
The impact of HIV cont…

• Health status and death caused by AIDS are reported

to have reduced the work force, productivity, and
disposable incomes in many communities.
The impact of HIV cont…

Social Impact
• HIV and AIDS-related deaths among youths and
middleaged adults has resulted in thousands of
orphans. AIDS is widespread in both urban and rural
communities and mostly affects persons at the peak
of their sexual and productive lives.
• The death of a young adult often means loss of a
family’s primary income earner.
The impact of HIV cont…

• The HIV and AIDS epidemic has caused breakdown of

social networks in African societies.
• Stigma associated with HIV continues to prevail.
Orphans are not only subjected to material, social,
and emotional deprivation, but also lack of
opportunity for education and health care.
• Widows and orphans are deprived of their
inheritance rights.
WHO Stages of HIV and AIDS

• WHO developed a clinical classification system for

predicting morbidity and mortality of infected adults
based on both clinical symptoms and lab markers and
also incorporates a patient performance scale.
• It has FOUR stages.
• It is a clinical classification tool for patients with HIV.
WHO Stages of HIV and AIDS cont...

 Stage 1
o Asymptomatic and persistent generalized
lymphadenopathy
o Performance scale 1: normal activity
WHO Stages of HIV and AIDS cont...
• Stage 2 (CD4< 350)
oWeight loss < 10% body weight (wt)
oMinor mucocutaneous manifestations
oHerpes zoster
oRecurrent upper respiratory tract infections
oRecurrent oral ulcerations
Performance scale 2:
 symptomatic, normal activity
WHO Stages of HIV and AIDS cont...

 Stage 3
oWt loss > 10% body wt
oUnexplained chronic diarrhea
oUnexplained prolonged fever
oOral Candidiasis
WHO Stages of HIV and AIDS cont...
oPulmonary TB
oSevere bacterial infections
oPerformance scale 3: bedridden <50% of day
WHO Stages of HIV and AIDS cont...
• Stage 4
o HIV wasting syndrome
o Pneumocystis jerovic Pneumonia (PJP)
o Toxoplasmosis of brain
o Cryptosporidiosis with diarrhea
o Cytomegalovirus (CMV)
o Oesophageal Candidiasis
WHO Stages of HIV and AIDS cont...

o Extrapulmonary TB
o Lymphoma
o Kaposi’s sarcoma
o Progressive Multifocal Leukoencephalopathy
(PML)
o HIV Dementia
o Performance scale 4, bedridden >50 %
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