SZL2111 PDF
SZL2111 PDF
SZL2111 PDF
OF
AGRICULTURE & TECHNOLOGY
IN COLLABORATION WITH
FACULTY OF SCIENCE
DEPARTMENT OF ZOOLOGY
Nairobi, Kenya
K. O. OGILA
([email protected])
JOMO KENYATTA UNIVERSITY
OF
AGRICULTURE & TECHNOLOGY
Nairobi, Kenya
E-mail: [email protected]
accessible by clicking the green Exercise tag. To move back to the same
page click the same tag appearing at the end of the solution/answer.
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SZL2111 HIV/AIDs
of immune system, natural immunity to HIV/AIDS. The AIDS virus and its
AIDS patients. Social and cultural practices: Religion and AIDS. Social stigma
Gender and HIV/AIDS. Drug and alcohol abuse and HIV/AIDS. Poverty and
AIDS. Legal rights of AIDS patients. AIDS Impact: Family /society setup,
Prerequisite: none
Course aims
1. To bring about behavioral change
Learning outcomes
Upon completion of this course you should be able to know;
1. Biology of HIV
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2. Transmission of HIV
Instruction methodology
Lectures: oral presentation generally incorporating additional activities
student presentation.
Assessment information
The module will be assessed as follows;
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Contents
1 General introduction 2
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Vaccination . . . . . . . . . . . . . . . . . . . 7
Medical Research . . . . . . . . . . . . . . . 8
Hunter theory . . . . . . . . . . . . . . . . . 13
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with STD . . . . . . . . . . . . . . . . . . . . 22
fections . . . . . . . . . . . . . . . . . . . . . . . . . . 28
. . . . . . . . . . . . . . . . . . . . . . . . . 33
Recognition stage . . . . . . . . . . . . . . . . 38
Proliferation stage . . . . . . . . . . . . . . . 39
Response stage . . . . . . . . . . . . . . . . . 40
Eector stage . . . . . . . . . . . . . . . . . . 40
Role of T lymphocytes . . . . . . . . . . . . . 43
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3.2 Immunodeciency . . . . . . . . . . . . . . . . . . . . . . . . 45
4 Biology of HIV 53
4.1 Nature of HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
phase . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
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6.2.3 PCR . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Types of FGM . . . . . . . . . . . . . . . . . 81
HIV survival . . . . . . . . . . . . . . . . . . 81
blood products . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Drug resistance . . . . . . . . . . . . . . . . 88
Cost of treatment . . . . . . . . . . . . . . . . 89
Support mechanisms . . . . . . . . . . . . . . 91
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Pretest counseling . . . . . . . . . . . . . . . 93
Advantages of testing . . . . . . . . . . . . . 93
Disadvantages . . . . . . . . . . . . . . . . . . 94
patients . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Conception . . . . . . . . . . . . . . . . . . . 109
Delivery . . . . . . . . . . . . . . . . . . . . . 110
Breastfeeding . . . . . . . . . . . . . . . . . . 110
9.3 Drug/Alcohol Use and Abuse and the Spread of HIV/AIDS . 118
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pandemic . . . . . . . . . . . . . . . . . . . . . . . . . 129
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LESSON 1
General introduction
Learning outcomes
Upon completing this topic, a student should be able to:
Understand the meaning of public health and its role in disease infection
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1.1. Introduction
HIV/AIDS is the worst pandemic the world has experienced in the last half
region. If one becomes infected with HIV, the virus begins to attach the
immune system. A person infected with HIV can look and feel perfectly well
for many years and may not even know they are infected. Over a period of
time, it is highly likely that HIV will damage the immune system and when this
infections that a healthy immune system would usually be able to ght o,
may develop in people who are HIV positive. A person is said to have AIDS
when they have developed one of these specic illness, this is usually after a
signicant period of time often many years. Some people will receive an AIDS
diagnosis when their T-cell count drops below 200 copies per cubic ml of blood.
The eects that HIV infection may have on an individual vary dramatically.
At one end of the spectrum a person may remain very well with virtually no ill
eects. At the other end of the spectrum a person may have an AIDS diagnosis
cure or vaccine for HIV/AIDS. Once a person contracts HIV, they will remain
infected with the virus for life and are able to transmit the virus to others.
of HIV/AIDS training,
By giving people information about HIV - what HIV and AIDS are,
how they are transmitted, and how people can protect themselves
from infection.
practically for e.g. how to get and use condoms, how to suggest and
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help
To help people focus upon the person than the disease and be more
their lives.
The infected and aected are likely to have abroad of physical, psycho-
logical and social needs which may need adjustments e.g. nances.
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behavior.
in that eld comprehend clearly their meaning with reference to the subject.
sciences and therefore learners need to familiarize themselves with some terms
time. For example, imagine that 10,000 cases of AIDS have been reported
to the ministry of health over the past ten years. You could tell someone
this information alone, or you could say that the country only has a
population of 100,000 people, and the rate of AIDS is 0.1, or 10% (10,000
during a set period of time, usually one year. For example, if you wanted
to know the incidence of HIV in a village, you could test all the people in
the village and record that information as your baseline. Then test all of
the same people one year later. Count the number of people who did not
have HIV during the rst test but did have the virus during the second
test. Divide this number by the total number of uninfected people in the
village. The result is the incidence of HIV in this village (the number of
community at any one point in time. In the example above, the preva-
lence of HIV would be 10% the rst year (100 cases among 1,000 people
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living in the village) and 15% the second year (150 cases among 1,000
For example, imagine you want to nd out how many pregnant women
in your town have HIV. You test all the pregnant women who come to
your medical clinic over a three-month period. Since people with HIV
are more likely to be sick and come to the clinic, and you tested all
pregnant women who came to the clinic, you will nd more women with
HIV than if you tested every pregnant woman in the town. Testing only
sick pregnant women inuenced your results. Your study was aected
by bias. Bias can happen even when you are trying to avoid it. If you
ask questions with a tone that tells people that you want them to answer
in a certain way, you can bias your results. For example, if you want
to know how many people inject drugs but ask, "You do not use those
illegal, deadly drugs do you?" then fewer people will answer yes than
become epidemics.
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and severity of disease. For example in the study of the acquired im-
National Cancer Institute (U.S.) and the Pasteur Institute (France) re-
human immunodeciency virus (HIV) was the main cause of the disease.
Most people think of public health workers as physicians and nurses, but a
in activities outside the scope of ordinary medical practice and these include
inspecting and licensing restaurants; conducting rodent and insect control pro-
grams; and checking the safety of housing, water, and food supplies etc. Hy-
giene is the science dealing with the preservation of health or the practice or
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nursing women, people with drug abuse problems, physical disabilities, and
other conditions. Public health clinics routinely screen patients for a number
of infectious diseases and may provide free treatment if patients test positive.
Each clinic tracks the incidence of certain communicable diseases in its area,
and reports this information to national and international public health oces.
best to meet future public health needs. Epidemiologists and other public
people who may be at risk for contracting an infectious disease. Public health
ocials may also ensure that infected people complete treatment programs,
so that the diseases are completely eliminated and the patients are no longer
ing water. The single most eective way to limit water-borne diseases is to
ensure that drinking water is clean and not contaminated by sewage. Public
health ocials establish sewage disposal and solid waste disposal systems, and
regularly test water supplies to ensure they are safe. Public health programs
establish and enforce laws for safe food storage and preparation;food-safety
• Medical Research
Another component of public health is scientic and medical research. Cadres
diagnose, treat, and cure disease and disability. Scientists and doctors em-
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health goal is to educate the general public about how to prevent non-infectious
diagnostic tests that can make the outcome of disease more favourable e.g.
early detection of breast cancer, for instance, increasing the chances of a cure.
Detection and proper treatment of high blood pressure reduces the risk of a
by sexual contact, through blood & from mother-to-child. They both appear
the period between initial infection & illness is longer. Its uncommon and
Burkina Faso, Ivory Coast. Most HIV-2 reported in Brazil, Angola, Mozam-
bique and Portugal can be traced back to West African contact. HIV-1 is the
predominant virus world wide & generally when people refer to HIV without
Group M (major)
Group N (new)
Group O (outlier)
F, G, H, J, and K.
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HIV1A found across west east axis from Ivory Coast to Djibouti
via Kenya
Uganda
and Congo
be ranked amongst the leading countries with the highest HIV infections.
ent subtypes can meet in the cell of an infected person and mix together its
genetic material to create a new hybrid virus in a process similar to sexual re-
production and sometime called viral sex. Many of these strains don't survive
for long but those that infect more than one person are known as CRFs. E.g.
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came to light in the early 1980s. For over twenty years it has been the subject
of debate and the cause of countless arguments, with everything from a promis-
cuous ight attendant to a suspect vaccine program being blamed. The rst
recognized cases of AIDS occurred in the USA in the early 1980s In 1981. The
virus was discovered among homosexuals in the USA. A number of gay men in
New York and San Francisco suddenly began to develop rare opportunistic in-
fections and cancers that seemed stubbornly resistant to any treatment. They
presented with a syndrome which included mouth rash, skin problems e.t.c. At
this time, AIDS did not yet have a name, but it quickly became obvious that
all the men were suering from a common syndrome. Their bodies' immunity
in a journal.
In 1983, it was discovered that the symptoms that were earlier observed
were caused by a certain virus called immunodeciency virus and it was sup-
pressing the immune system. In 1986, it became clear that the virus discovered
in 1981 was spreading fast and many people suered from the same condition.
In 1986, in West Africa, another virus was discovered & they called it immun-
odeciency virus type2. The discovery of HIV, the Virus that causes AIDS
was made soon after. In Kenya, the 1st case was noted in 1983 in KNH &
it was noted that the body of the patient had low immunity. From 1981 to
date the disease has claimed 22m lives & is still spreading. There is now clear
evidence to prove that HIV does cause AIDS. So, in order to nd the source
of AIDS, it is necessary to look for the origin of HIV, and nd out how, when
When and where the HIV virus rst emerged is probably going to remain a
mystery for many years to come. While several theories have been put forward,
Mysterious origins .
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Conspiracy theories
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 de-
names have been linked to this theory in the popular press, these scientists
deny the possibility of this extraterrestrial phenomena and any personal con-
AIDS is God's wrath since the Scriptures condemn the homosexual practice in
which AIDS was rst observed in the Western world. If one adds to this belief
the mysterious origin of the virus, and the apparently hopeless prospects for
a cure, it will readily be understood how many have come to believe in Divine
intervention, with AIDS being God's way of destroying sinners. If this were
so, it would be dicult to see why God, after watching over thousands of
years of vastly diering "sins', should suddenly decide to settle His score with
homosexuals and drug addicts rather than any other 'sinners'. The Bible
clearly speaks of a future (and imminent) judgment time when all sinners -
no matter what their specic practice will have to pay the penalty for their
sins. It does not tell, however, of a God who prejudges particular situations
and who picks out special groups for early condemnation. Clearly, there are
God-given laws which govern the harmonious interaction of body, mind and
and the presence of sin in the world. It should be recognized that once the
process has started, 'guilty' and `innocent' suer alike nowhere is this more
obvious or more poignant than in the AIDS pandemic. Rather than its being
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considered a visitation from God, many Africans believe that AIDS is caused
virus' because they take such a long time to produce any adverse eects in the
body and have been found in a number of dierent animals, including cats,
sheep, horses and cattle. The lentivirus of interest in terms of the investiga-
tion into the origins of HIV is the Simian Immunodeciency Virus (SIV) that
Immunodeciency Virus because certain strains of SIVs bear a very close re-
semblance to HIV-1 and HIV-2, the two types of HIV For example, HIV-2
in the sooty mangabey (also known as the green monkey), which is indigenous
to western Africa. HIV-1, was until recently more dicult to place. Until
1999, the closest counterpart that had been identied was SIVcpz, found in
chimpanzees, but this virus still had certain signicant dierences from HIV-1.
Below are some of the most common theories about how this 'zoonosis' took
place, and how SIV became HIV in humans. Zoonosis- viral transfer between
• Hunter theory
The most commonly accepted theory is that of the 'hunter'. In this scenario,
SIVcpz 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 o SIV, but on a few occasions it adapted itself within
its new human host and become HIV-1. Discoveries such as this have lead to
calls for an outright ban on bush meat hunting to prevent simian viruses being
passed to humans.
to the testing of an oral polio vaccine called Chat, given to about a million peo-
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ple in the Belgian Congo, Ruanda and Urundi in the late 1950s. To be repro-
duced, live polio vaccine needs to be cultivated in living tissue, and Hooper's
belief is that Chat was grown in kidney cells taken from local chimps infected
the vaccine with chimp SIV, and a large number of people subsequently be-
coming infected with HIV-1. However, in February 2000 the Wistar Institute
in Philadelphia (one of the original places that developed the Chat vaccine)
announced that it had discovered in its stores a phial of polio vaccine that had
been used as part of the program. The vaccine was subsequently analysed and
in April 2001 it was announced that no trace had been found of either HIV
kidney cells, which cannot be infected with SIV or HIV, were used to make
Chat. While this is just one phial of many, most have taken its existence to
mean that the OPV vaccine theory is not possible. The fact that the OPV
theory accounts for just one (group M) of several dierent groups of HIV also
suggests that transferral must have happened in other ways too. The nal
element that suggests that the OPV theory is not credible as the sole method
of transmission is the argument that HIV existed in humans before the vaccine
likely that one single syringe would have been used to inject multiple patients
any viral particles (within a hunter's blood for example) from one person to
another, creating huge potential for the virus to multiply in each new individual
it entered, even if the SIV within the original person infected had not yet
converted to HIV.
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to have entered into the debate. It is again based on the basic 'hunter' premise,
but more thoroughly explains how this original infection could have lead to
an epidemic. During the late 19th and early 20 th 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 sucient
to create poor health in anyone, so SIV could easily have inltrated 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
warfare program, designed to wipe out large numbers of black and homosexual
people. Many say this was done under the auspices of the US federal 'Special
Cancer Virus Program' (SCVP), possibly with the help of the CIA. Some
even believe that the virus was spread (either deliberately or inadvertently)
to thousands of people all over the world through the smallpox inoculation
indicate that HIV has been around probably for hundreds of years. This is
latest theory on the origin of HIV when a team of scientists using computer
technology to study the structure of HIV calculated the rate at which the virus
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mutates for the HIV viral sub-bytes to have a common ancestor. This process
revealed that 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 1960s and 1970s,
political upheaval, wars, drought, and famine forced many people from these
rural areas to migrate to cities to nd jobs. During this time, the incidence
from the United States suggest that HIV infection was well established there
by 1978. Rather than acquiring HIV from SIV it is thought that HIV mutated
to become ever more infectious. We will probably never know exactly when
and where the virus rst emerged, but what is clear is that sometime in the
middle of the 20th century, HIV infection in humans develop and into the
Solution : HIV is the human immunodeciency virus that causes AIDS (ac-
enters the body and begins to multiply and attack immune cells that normally
protect us from disease. It's only when someone with HIV begins to infections
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Learning Activities
Read more papers and journal articles on current advances in HIV/AIDs re-
search. Visit the reproductive health clinic/ section in a hospital around you
and get to learn various methods used to control HIV/AIDs and other STIs.
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Assignments
1. Comprehensively discuss the global distribution and trends of HIV/AIDs.
Narrow down specically to Kenya and use current data and information.
9780521627665
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LESSON 2
Sex education and Human sexuality
Learning outcomes
By the end of this topic you should be able to;
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cation. It's the process of acquiring information and forming attitudes and
beliefs about sex, sexual identity, relationships and intimacy. It is also about
developing young people's skills so that they make informed choices about their
behavior, and feel condent and competent about acting on these choices. It
is widely accepted that young people have a right to sex education, partly
HIV/AIDS.
lifetime.
Myths are universal; occurring in almost all cultures and attempts to explain
assorted topics on humanity, and may have both religious and non religious
dimensions. The concepts of sex being a necessary evil and the less said
about it the better have led to many misconceptions about sex. Most common
sexual myths arise out of ignorance and these circulate more in adolescents and
with lack of information they internalize this and practice and this may lead
to exposure to HIV/AIDS.
bacteria, parasites etc) that are principally transmitted during sexual inter-
course resulting in clinical illness. How, sometimes infection with these agents
does not result in clinical disease but the agents can be transmitted from the
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host organism to their sexual partners. This has given rise to the term sexually
transmitted infections (STI). Some persons are thus healthy carriers. There
are at least 25 dierent sexually transmitted diseases. What they all have in
common is that they can be spread by sexual contact, including vagina, anal
have symptoms, such as genital discharge, pain when urinating and genital
up, to screen for STDs, if you think you have been at risk. It can sometimes
take a long time for STDs to display any symptoms, and you can pass on
any infections during this time, further demonstrating the need to be tested
and treated. If you are in a relationship, and are diagnosed with an STD, it
does not necessarily mean that your partner has been unfaithful. Symptoms
of STDs can present themselves months after infection. Many STDs are very
if left untreated. Many STDs can be easily passed onto sexual partners, and
some STDs can be passed from a mother to her unborn child too. STDs can
sites, fungi, and single-celled organisms called protozoa - that thrive in warm,
moist environments in the body, such as the genital area, mouth, and throat
Most STDs are spread during sexual intercourse (vaginal or anal), but other
forms of sexual contact, such as oral sex, can also spread disease. Some STDs
are passed from an infected mother to her child before birth, when the infec-
tion crosses the placenta and enters the baby's bloodstream; during childbirth,
as the baby passes through the birth canal; or after birth, when the baby
consumes infected breast milk. Some viral STDs, especially AIDS, may be
transmitted by blood. Such STDs may be passed between people who share
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ple mistakenly believe that STDs can be transmitted through shaking hands
decade: 15 years and older. The greatest risk occurs in the age group
18-35. However, the trend is towards very early sexual debut, among
single, poorly paid and unemployed young people who live in shanties in
towns. Sexual intercourse, for pleasure and for gain, assumes an impor-
closely associated with the acquisition and spread of STDs in any group
of people. There are certain factors that may reduce promiscuous be-
3. Ethnicity is not a risk factor for STDs, but it is closely associated with
In some groups, certain celebrations and rituals (e.g., cleansing after the
sional hired cleansers" may infect healthy widows and widowers. Many
such funeral events are also associated with much promiscuity as cele-
brations are held over a week or so with men and women having many
opportunities for casual sex. Conversely, societies with strict moral codes
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sex with condoms and getting tested together with sexual partner(s). The
more partners one has, the greater the risk of acquiring an STD. Other ways
to reduce the risk include using dental dams and condoms during oral sex,
clean sex toys after use, clean your hands after having sex, and improving
STDs has changed radically in the last few years. The emphasis is now on
STDs in the particular country, or region within a country, and patients are
treated for the likely STDs that commonly cause that particular combination
or in combination. In the new approach, the patient is treated for both infec-
Holmes, 1990). The advantage of this approach is that even the lowest cadres
in the health service can treat patients eectively with a minimum of retrain-
is a certain amount of over-treatment for diseases that are not present, but
this is a small price to pay for increased access to STD treatment services for
frequently found in sexually active women than those who have never had
found in the vagina and although it is relatively harmless and may pass
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occurs, there have been suggestions that the alkaline nature of semen
could be one cause, as it may upset the acidic nature of the vaginal
and fallopian tubes and cause a more serious infection. Treatment for
in men who are not circumcised. It can be caused through poor hygiene,
cervix in women. The urethra, rectum and eyes can be infected in both
4. Crabs or Pubic Lice - 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. You can have crabs and not
know about it, but after 2 to 3 weeks, you 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 someone who has them. There is no eective way to prevent
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bought from pharmacies and applied to the body to kill o the parasites.
above the testicles where sperm are stored. It is not always the result
use condoms during sex, as this is the most eective way to prevent
though any other infections that may have caused epididymitis can be
6. Genital herpes - is caused by the herpes simplex virus. The virus can
aect the mouth, the genital area, the skin around the anus and the
ngers. Once the rst outbreak of herpes is over, the virus hides away
after exposure and last two to three weeks. Both men and women may
in the genital or anal area, small uid-lled blisters that can burst and
leave small sores which can be very painful, pain when passing urine,
if it passes over any of the open sores and a u-like illness, backache,
headache, swollen glands or fever. Find out more about genital herpes.
7. Genital warts - are small eshy growths which may appear anywhere
the Human Papilloma Virus (HPV). Warts can grow on the genitals, or
on dierent parts of the body, such as the hands. After you have been
infected with the genital wart virus it usually takes between 1 and 3
months for warts to appear on your genitals. You or your partner may
the genital area. Warts can appear around the vulva, the penis, the
scrotum or the anus. They may occur singly or in groups. They may
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itch, but are usually painless. Often there are no other symptoms, and
the warts may be dicult to see. If a woman has warts on her cervix,
this may cause slight bleeding or, very rarely, an unusual coloured vaginal
can infect the cervix, urethra, rectum, anus and throat. Symptoms of
9. Gut Infections - can be passed on during sex. Two of the most common
and when they reach your 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 fae-
ces, such as rimming and anal sex. Infection can be prevented through
using condoms, dental dams or latex gloves. Sex toys should be thor-
oughly cleaned after use and hands washed after any contact with faeces.
10. Hepatitis - causes the liver to become inamed. There are various dif-
and some drugs, but usually it is the result of a viral infection. Find out
Virus. It appears as small bumps on the skin, and can last from a couple
the size of a freckle on the thighs, buttocks, genitalia and sometimes the
face. They are passed on through body contact during sex and through
not having sex until they have been treated. In most cases molluscum
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do not need treatment and will disappear over time. However, they can
even in some cases years into a relationship. The symptoms of NSU may
uid from the tip of the penis that may be more noticeable rst thing in
the morning, feeling that you need to pass urine frequently. Often there
may be no symptoms, but this does not mean that you cannot pass the
13. Scabies - is caused by a parasitic mite that can get under the skin and
cause itching. The mites are very small and cannot be seen, and many
people do not now they have them. They can cause itching, and this
be red lines under the skin of the hands, buttocks and genitals. The
you can prevent others becoming infected by washing clothes and bed-
ding on a hot wash. Lotions can be bought from pharmacies and applied
unborn child. The signs and symptoms of syphilis are the same in both
men and women. They can be dicult to recognise and may take up to
Syphilis has several stages. The primary and secondary stages are very
infectious.
15. Thrush, also known as Candidiasis - is yeast which lives on the skin and
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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 diculty pulling back the foreskin. Thrush can be passed
on when having sex with someone who is infected, but also if you wear
too tight nylon or lycra clothes or if you are taking certain antibiotics.
is found in women's vagina's and men's urethra's. Often there are not
any symptoms. If symptoms are present, they can include pain when
urinating and discharge in men and discharge, soreness when having sex
mission normally occurs through having oral, anal or vaginal sex with
17. AIDS - this is a fatal disease that, once symptoms and signs develop,
causes death in less than 2 years (Porth 1998). The virus causing this
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tissues that ght infections) are mobilized to ght the STD infections
and since these are the targets of HIV, a lot of them are infected by HIV
and destroyed and the patient goes down faster with the HIV.
The mode of transmission for the STDs is also the same as mode of
transmission of HIV.
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to be lower than anal sex, though still highly signicant. However, where there
through oral sex is a much debated subjected. However, the virus is present in
blood and semen, which means that in theory, this is a possible transmission
toys also carries a risk of HIV transmission. If more than one person is going
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LESSON 3
The Immune system
Learning outcomes
Upon completing this topic, you should be able to :
What is immunodeciency?
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and tumor cells. The immune system is made up of organs that are involved
then enter the circulation. T lymphocytes move from the bone marrow to
the thymus, where they mature into several kinds of cells capable of dierent
functions Lymphoid organs The Lymphoid tissues include the thymus gland,
the spleen, the lymph nodes, the tonsils and adenoids, and similar tissues in
are distributed throughout the body. They are connected by lymph channels
and capillaries, which remove foreign material from the lymph before it enters
the bloodstream. The lymph nodes also serve as centers for immune cell
proliferation. The remaining lymphoid tissues, such as the tonsils and adenoids
and other mucoid lymphatic tissues, contain immune cells that defend the body
against microorganisms
Physical/mechanical barrier
Respiratory tracts- the hairs /cilia along the tract leads to coughing
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the body.
responses. The cells ght invading foreign bodies by releasing cell medi-
injured tissue.
contracting a disease i.e. weeks or months after exposure to the disease, the
immunologic defenses are developed by the person's own body. This immu-
nity generally lasts many years or even a lifetime. Passive acquired immunity
globulin and antiserum, obtained from the blood plasma of people with ac-
the risk for contracting a specic disease is great and there is not enough time
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antibodies recognize & bind specically to foreign antigens & may cause
dierent).
(a) The T helper subset, (CD4+ T cell) - The main function is to aug-
teract with B cells or T killer cells & help them respond to foreign
They directly bind to foreign agents, attack & kill those cells thus
eliminating them from the body. The CD8+ T cells are also im-
NB: Both types of T cells can be found throughout the body. They often
depend on the secondary lymphoid organs (the lymph nodes and spleen)
as sites where activation occurs, but they are also found in other tissues
of the body, most conspicuously the liver, lung, blood, and intestinal and
reproductive tracts.
2. Natural Killer Cells (NK) Are similar to the killer T cell subset (CD8+
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infected cells. NK cells, unlike the CD8+ (killer) T cells, kill their targets
by T h cell.
teristics with certain dyes. These cells are important in the removal of
bacteria and parasites from the body. They engulf these foreign bodies
remain incirculation for 10hours - leave thro capillary wall & enter
presenting cells (APC). This is because they pick up and ingest foreign
materials and present these antigens to other cells of the immune system
such as T cells and B cells. This is one of the important rst steps in
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more ecient APCs than macrophages. These cells are usually found in
lymph nodes and spleen. They are also found in the bloodstream and
other tissues of the body. It is believed that they capture antigen or bring
are extremely hard to isolate. Recent nding is that dendritic cells bind
markers include:
T helper cells
Macrophages
Monocytes
Colon cells
Dendritic cells
Retinal cells
When bacteria, viruses or other pathogens overcome the body's natural immu-
nity and gain entry into the blood system, three specic mechanism of acquired
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3. Antigen recognition
is the initiating event in any immune response (g 2.2). The body must
rst recognize invaders as foreign before it can react to them. The body
lance. Lymph nodes are widely distributed internally and externally near
the bloodstream. These lymphocytes patrol the tissues and vessels that
Lymphocytes are found in the lymph nodes and in the circulating blood.
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cytes recirculate from the blood to lymph nodes and from the lymph
small, hardy cells maintain their solitary circuits for the lifetime of the
person.
cytes process the antigens. When foreign materials enter the body, a
way picks up an imprint of its structure, which comes into play with
lymphocyte moving through the tissues of the neck comes in contact with
the organism. The lymphocyte, familiar with the surface markers on the
cells of its own body, recognizes the antigens on the microbe as dierent
• Proliferation stage
The circulating lymphocyte containing the antigenic message returns
to the nearest lymph node. Once in the node, the sensitized lympho-
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• Response stage
In the response stage, the changed lymphocytes function either in a
sponse. Humoral refers to the fact that the antibodies are released into
the bloodstream and so reside in the plasma (uid fraction of the blood).
migrate to areas of the lymph node (other than those areas containing
the residing lymphocytes to become cells that will attack microbes di-
cleosis.
Most immune responses to antigens involve both humoral and cellular re-
bacterial pneumonias and sepsis, the humoral response plays the domi-
• Eector stage
In the eector stage, either the antibody of the humoral response or the
cytotoxic (killer) T cell of the cellular response reaches and couples with
the antigen on the surface of the foreign invader. The coupling initiates
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Production of B-Lymphocytes
B-lymphocytes stored in the lymph nodes are subdivided into thousands
memory cells are responsible for the more exaggerated and rapid immune
heavy peptide chain. The sub-units are held together by a chemical link
binding site for a specic antigen referred to as the Fab fragment. This
site provides the "lock" portion that is highly specic for an antigen.
Antibodies defend against foreign invaders in several ways, and the type
the antigen and the immunoglobulin. The antibody molecule has at least
two combining sites, or Fab fragments. One antibody can act as a cross-
link between two antigens, causing them to bind or clump together. This
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ulins are commonly designated by the abbreviation Ig.) Each of the ve types,
or classes, is identied by a specic letter of the alphabet (IgA, IgD, IgE, IgG,
and IgM). Classication is based on the chemical structure and biologic role
(interstitial uid) Assumes major role in blood borne and tissue infec-
clear role
fections
phocytes (or T cells) that are primarily responsible for cellular immu-
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nity. These lymphocytes spend time in the thymus, where they are pro-
(Figure 2.3). Several types of T cells exist, each with designated roles
antibodies.
gen receptor located on the surface of a T cell. This may occur with or
without the assistance of macrophages. The T cells then carry the anti-
and retain a memory for the antigen. Other T cells migrate from the
lymph nodes into the general circulatory system and ultimately to the
tissues, where they remain until they either come in contact with their
• Role of T lymphocytes
Two major categories of eector T cells are helper T cells and cytotoxic T
include suppressor T cells and memory T cells. T cells interact closely with-
cells, indicating that humoral and cellular immune responses are not separate,
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unrelated processes but rather branches of the immune response that can and
1. Helper T cells (helper CD4 cells) are activated upon recognition of anti-
gens and stimulate the rest of the immune system. When activated,
T cells, natural killer cells, macrophages, and other cells of the immune
(tumor necrosis factor). Helper T2 cells produce IL-4 and IL-5, lym-
Roit I; et al 1989)).
the cell membrane and causing cell lysis (disintegration) and releasing
and regulate other lymphocytes and WBCs. These cells then assist in
assist in combating organisms. These are distinct from-cells and T cells and
ready coated with antibody. These cells have special Fc receptor sites on
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their surfaces that allow them to couple with the Fc end of antibodies
rence J. 1995).
"falling domino" eect. This complement cascade alters the cell mem-
enter the cell and leading eventually to cell lysis and death. In addition,
terial agents.
macrophages.
3.2. Immunodeciency
When some or one of the components of the immune system is lacking,
a number of factors
Old age
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Nutrition
Autoimmune disorder
Neoplastic disease
Medication
Stress
1. Age - People at the extremes of the lifespan are more likely to develop
and motility allow normal intestinal ora to proliferate and produce in-
decreases the elasticity of lung tissue, the eectiveness of cilia, and the
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skin becomes thinner and less elastic. Peripheral neuropathy and the
predisposes the aging person to infection from organisms that are part
immune system. Vitamin intake, essential for DNA and protein synthe-
diet generally suppresses immune function. Fatty acids are the build-
Both excess and deciency of fatty acids have been found to suppress
immune function.
ments and an even greater risk of impaired immune response and sepsis.
This is believed to be the result of the activity of the sex hormones. The ability
of sex hormones to modulate immunity has been well established. There is ev-
pressor cells), whereas androgens act to preserve IL-2 production and suppres-
sor cell activity. The eects of sex hormones on B -cells are less pronounced.
the CD5 marker (an antigenic marker on the-cell). Estrogen tends to enhance
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cer itself is immunosuppressive. Large tumors can release antigens into the
blood, and these antigens combine with circulating antibodies and prevent
them from attacking the tumor cells. Furthermore, tumor cells may possess
special blocking factors that coat tumor cells and prevent destruction by killer
T lymphocytes. During the early development of tumors, the body may fail
lymphoma, are associated with altered production and function of WBCs and
phocytes and decreases the population of cells required to replace them. The
function.
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factors cause impaired skin integrity and compromise the body's rst line
of defense. Loss of large amounts of serum with burn injuries depletes the
cortisol release from the adrenal cortex; increased serum cortisol also
1. Medications
Like any other body system, the immune system functions de-
pathogenesis
lymphocytes.
T-helper lymphocytes have a CD4+ marker that the HIV use for entry
they are activated they recruit other immune cell involved in immune
responses.
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HIV uses the CD4+ cells to replicate and produce more viral particles.
Macrophages which have a CD4+ marker too act as reservoir and are
to be lower than anal sex, though still highly signicant. However, where there
through oral sex is a much debated subjected. However, the virus is present in
blood and semen, which means that in theory, this is a possible transmission
toys also carries a risk of HIV transmission. If more than one person is going
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LESSON 4
Biology of HIV
Learning outcomes
By the end of this topic you should be able to;
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to infect & reproduce. HIV is specic to CD4+ cells in the human body i.e.
ing this molecule are called CD4+ cells. Therefore HIV cant survive in the
animal blood, because its only human blood that contains CD4+cells. HIV
is a lentivirus. Like all viruses in this group it attacks the immune system.
The term "retrovirus" stems from the fact that these kinds of viruses are capa-
ble of copying RNA into DNA. The name lentivirus means slow virus. This is
because they take such a longtime to produce any adverse eects in the body.
called virions). The surface of each particle is studded with lots of little spikes.
of the diameter of a human CD4+ white blood cell. Unlike most bacteria,
HIV particles are much too small to be seen through an ordinary microscope.
NB: The proteins gp120 and gp41 together make up the spikes that project
from HIV particles, while p17 forms the matrix and p24 forms the core.
and is spherical in shape. The outer coat of the virus, known as the
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taken from the membrane of a human cell when a newly formed virus
particle buds from the cell. Embedded in the viral envelope are proteins
from the host cell as well as 72 copies (on average) of a complex HIV
a cap made of three molecules called glycoprotein (gp) 120, and a stem
consisting of three gp41 molecules that anchor the structure in the viral
ii. Retroviruses are the exception because their genes are com-
iii. RNA has a very similar structure to DNA. However, small dif-
viruses.
3. Matrix - Just below the viral envelope is a layer called the matrix, which
is made from the protein p17 which maintains the integrity of the virus
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Projecting from this are around 72 little spikes, which are formed
from the proteins gp120 which protrudes from the surface & binds
CD4+ cells and gp41. which is embedded within the envelope & is
for entry/fusion.
the CD4 receptor on the surface of human T cell and the viral envelope
2. Entry - The contents of the HIV particle are then released into the cell,
leaving the envelope behind.
3. Reverse Transcription - Once inside the cell, the HIV enzyme reverse
transciptase converts the viral RNA into DNA, which is compatible with
is spliced into the human DNA by the HIV enzyme integrase. Once
5. Transcription - HIV provirus may lie dormant within a cell for a long
time. But when the cell becomes activated, it treats HIV genes in the
same way as human genes. First it converts them into messenger RNA
enzymes.
duced by the cell are complete copies of HIV genetic material. These
gather together with newly made HIV proteins and enzymes to form
new viral particles, which are then released from the cell. The enzyme
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protease plays a vital role at this stage of HIV's life cycle by chopping up
long strands of protein into smaller pieces, which are used to construct
8. Maturation & release - The newly matured HIV particles are ready
to infect another cell and begin the replication process all over again. In
this way the virus quickly spreads through the human body. And once a
person is infected, they can pass HIV on to others in their bodily uids.
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Example . Are there other ways to avoid getting HIV through sex?
Solution : The male condom is the only widely available barrier against sexual
transmission of HIV. Female condoms are fairly unpopular in the U.S. and
still relatively expensive, but they are gaining acceptance in some developing
countries. Eorts are also under way to develop topical creams or gels called
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LESSON 5
Disease progression and symptoms
Learning outcomes
Upon completing this topic, you should be able to understand:
Factors that leads to faster progression fro HIV to full blown AIDs
Opportunistic infections
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5.1. Introduction
HIV infects cells of the immune system and the central nervous system. The
main cell HIV infects is T helper cell which is a crucial part of the immune
system, because it co-ordinates the actions of other cells of the immune system.
A large reduction in the number of T helper cells seriously weakens the immune
system.
Those who are exposed & become infected do not show sign of illnesses right
away.
physical symptoms. Most viral infections don't show physical symptoms, but
most people infected with HIV ultimately develop some disease symptoms.
These disease symptoms are caused by damage or destruction of cells & tissues
in the infected person. In some cases the damage may result from direct
killing of cells by virus. In the case of AIDS, most of physical symptoms are
the indirect result of damage to the immune system by HIV. Factors such as
other infectious agents can inuence the exact nature of the symptoms in a
particular individual.
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1. Window period - This stage of infection lasts for a few weeks to about
3 months and is often accompanied by a short u-like illness or no signs.
blood & the blood in not 100% free of HIV. The virus cannot be seen in
the rst 21 days. During this time a person can still transmit the virus
person may have u like illnesses, fever, fatigue, sore throat, joint pains
& lymphadenopathy Some will not experience any illnesses at this stage.
glands. The level of HIV in the peripheral blood drops to very low levels
but people remain infectious. HIV antibodies are detectable in the blood, so
antibody tests will show a positive result. HIV is not dormant during this
stage, but is very active in the lymph nodes. Large amounts of T helper cells
are infected and die and a large amount of virus is produced. This period can
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NB: Asymptomatic period some type of balance exist between HIV infection
& the immune system in the infected person
2. HIV mutates and becomes more pathogenic, i.e. stronger and more
3. The body fails to keep up with replacing the T helper cells that are
of the symptoms are mild, but as the immune system deteriorates the
symptoms worsen. When the viral load reaches a critical amounts, the
tage of the impairment of the immune system & sometimes are caused
Chronic fever
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Lymphadenopathy
Night sweats
of factors
present become more and more severe leading eventually to an AIDS diagnosis.
It's the most advanced stage of HIV infection. At this time when CD4 cell
count has gone down below 200 CD4 cells/ml, HIV develops to one or more
classes;
causes night sweats (>1 month) and brain damage due to high temp
armpits, head & neck but are not painful. Some infected people may ex-
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Damage of parts of the nervous system can also cause dierent neurologic
and Coma. HIV+ patient can die any moment at this stage.
They can cause Headache & confusion, Poor coordination of feet, Blind-
tients the skin conditions tend to persist more & they become dicult
or fungi.
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mid 20s. Children who get infected at birth die faster simply because
2. Type of HIV contracted - There are two well known types: HIV1
and HIV2. HIV1 is harsher on people hence kills faster than HIV2.
4. Ill - health & other types of infections - People who are already
sick & then get infected move faster than those infected when healthy.
5. Nutritional status - Those infected & are not eating enough of well-
strains of HIV or STIs / STDs and other illnesses move faster from
HIV to AIDS
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spots in x-rays. It's the leading cause of death in AIDS patients i.e.
(c) Systemic mycosis - Soil fungus that can cause generalized infections
in AIDS patients. Exist in either mold like or yeast like form & are
patients. In AIDS patients, the brain, skin, bone, liver & lymphatic
trolling the common bacteria are less aected by HIV infection, thus
adult AIDS patients do not generally suer infections with common bac-
teria
blood at high levels. Patients will have fevers & low no. of white
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patients CMV infect retinas of the eyes causing blindness & also
convulsions, dementias).
5. Examples of Cancers:
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into cancer cell. Unusual lymphoma that spread to the brain also
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opments. Discuss
- blown AIDS
Solution : Age - Persons who get infected after the age of 35years move faster
from HIV infection to full blown AIDS than those who get infected in their mid
20s. Children who get infected at birth die faster simply because their immune
system is not well developed at their tender age. Type of HIV contracted -
There are two well known types: HIV1 and HIV2. HIV1 is harsher on people
hence kills faster than HIV2. Mode of transmission - HIV got through blood
transfusion kills faster than one got through sexual contact. This is because
the amount of virus channeled into the bloodstream is in large quantity. Ill
- health & other types of infections - People who are already sick & then get
infected move faster than those infected when healthy - Tropical diseases such
as malaria, typhoid & intestinal worms makes patients to develop AIDS faster
Nutritional status - Those infected & are not eating enough of will balanced
foods are more likely to develop AIDS faster. Lifestyle - People who expose
illnesses move faster from HIV to AIDS. Opportunistic infections - If they are
not competently treated, then the HIV+ person develops AIDS faster.
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LESSON 6
Transmission and diagnosis of HIV
Learning outcomes
Upon completing this topic, you should be able to understand:
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sneezing or coughing
insect bites e.g. mosquitoes - HIV only lives for a short time and
risk of HIV transmission. There are myths saying that 'some very
(a) Heterosexual contact (man &woman) a/c 70%-80% of all HIV trans-
mission.
(c) Oral sex is low risk but oral ulcers, bleeding gums, genital sores &
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(d) Rape, & sodomy victims could get infected if the attacker is HIV+.
The victims should seek prompt medical attn because early treat-
ment with ARVs can greatly reduce chances of HIV infection. They
by a number of factors:
iv. age
v. STDs/STIs
I.V. drug use is the administration of drugs of addiction e.g heroin into
the blood stream by injecting into the veins. Most drug users tend to
shoot in groups & often share needles. It therefore becomes very easy
for 5-10% of HIV infections. Procedures such as ear piercing & circum-
cisions when done with poorly cleaned & unsterile instruments can lead
to HIV transmission.
care. This is most frequently due to needle pricks or cuts with surgical
instruments. Infection can also occur due to contact with infected blood,
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(a) During pregnancy- The virus crosses from mother's blood to child
tween mother & child, researchers believe that the foetus can get
(b) During birth Through exposure to mother's blood & other secre-
(c) After birth- through breast feeding. Breast milk contains minimal
load)
inadequate nutrition
foetal cells
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Reduce the number of HIV exposed pregnancies i.e. Women who are
Nov `94) is taken in the last week of pregnancy and nevirapine is given
at the onset of labour & to the HIV exposed babies within 3 days after
birth
of preventing MTCT
Reducing trauma and shortening exposure of the baby to the virus during
make sure that the mother gives birth within 4 hours after mem-
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test does not establish a diagnosis of AIDS. Rather, it indicates that the
person has been exposed to or infected with HIV. People whose blood
do not reach detectable levels in the blood for one to three months. This
to viral proteins take place. Window period is the time during which
even 6 months for the antibody levels to get high enough for detection.
very low antigen levels such that one may test HIV negative by ELISA
but test positive through western blot. Babies born of HIV mother have
15 months the child may test negative. Use of Western, blot conrms
presence of HIV antigen and this rules out whether babies are positive
6.2.3. PCR
It is also used to detect HIV in high-risk seronegative people before
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made of the number of CD4 cells in a cubic milliliter of blood and will
ing or declining. 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 indicate that some damage to the immune system
has occurred and a count below 350 or rapid decline is an indication that
viral load test requires the collection of a blood sample and estimates
the number of HIV particles in the sample by looking for HIV genes.
that both the risk of developing AIDS and the risk of developing drug
reduction in levels of HIV in these uids but the risk of transmitting the
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through sexual intercourse. STIs is a term applied to infections that are trans-
They don't necessarily involve sexual activity but the organisms that cause
STIs enters mostly through the soft & thin skin that cover the inner surfaces
i.e. mucus membrane of the vagina, urethra, anus & mouth. However, in
some instances exposure to sores or other types of skin to skin contact may be
Gonorrhea
Candidacies
Hepatitis B & C.
Bacterial vaginosis.
Trichomoniasis
of T cells to ght the STI/STD. Since the T cells are the target cells for
attack by HIV, such a large population will inevitably provide breeding ground
for HIV. STDs/STIs also increase the risk of acquiring or transmitting the
virus. Both are transmitted through sexual contact & to unborn baby during
pregnancy or at birth.
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son who has contracted STD/STI & is receiving treatment should also:
future infections
tions
Inform all sexual partners of the need to get examined & treated
Financial constraints for the youth who are unemployed e.g. anti-fungal
per tablet
to the youth
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It involves surgically removal of part or the whole clitoris using razor blades,
knives, and scissors. Since the victims are young they are unable to give
world wide. Because of poverty & lack of medical facilities the procedure is
frequently done under less hygienic conditions & often without anaesthesia. A
person who is not medically trained usually circumcises about 20 girls of same
age group.
• Types of FGM
1. Sunna - its most widely practiced in sub-Saharan and middle east. It
3. Pharoic - it's the total removal of the clitoris, labia minor, labia major
and where the two sides of the vulva are drawn together and then fas-
especially in Somalia.
from urine
Chronic urinary retention - urine is broken down to urea & uric acid
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transmission of HIV?
Solution :
Know your HIV status-get tested: Knowing whether or not you have HIV
is the rst step toward keeping yourself healthy and avoiding passing infection
behavior.
If you are HIV infected, know about ART: See a healthcare provider and
nd out if you should be on ART. Even if you do not need ART at rst, keep
your appointments for check-ups so that you will be able to start when you
do need it. Current guidelines suggest that ART be started when the CD4
cell count is between 350-500. However, it may be started when CD4 counts
are greater than 500, depending upon your situation. For example, pregnant
women and people with certain medical conditions should start earlier, at
higher CD4 counts. ART can also be started earlier to help prevent HIV
If you are on ART, take it correctly and consistently: ART drugs work best
when the right doses are taken at the right times. Not taking them properly
gives the virus a chance to multiply and sometimes become resistant to the
medications. Taking ART as recommended will give you the best chance of
staying healthy, and will probably help lessen the chance of infecting others.
of HIV: Eective ART and an undetectable viral load will probably decrease
the risk of transmission, but ART alone will not prevent all new infections. For
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positive individual.
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LESSON 7
Prevention and treatment of Hiv/Aids
Learning outcomes
Upon completing this topic, you should be able to understand:
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Taking anti-HIV therapy during pregnancy and delivery e.g. AZT which
Not breast feeding where there is access to safe, adequate milk sub-
Mothers who are HIV positive should not donate breast milk to breast
milk barks, neither should they express milk to be bottle fed to their
baby.
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drugs within 24 hours (preferably within one to two hours) after exposure to
HIV can protect a person from becoming infected with the virus. Although the
to HIV remains uncertain, the Center for Disease Control, USA, recommends
Coughing or sneezing
Swimming pools
Protease Inhibitors
Entry Inhibitors
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verts the virus's genetic material into DNA. During this conversion process,
these drugs incorporate themselves into the structure of the viral DNA, ren-
dering the DNA useless and preventing it from instructing the infected cell to
make additional HIV. Examples include AZT, didanosine (sold under the trade
abacavir (Ziagen)
these drugs block protease, defective HIV forms that is unable to infect new
cells. These drugs are taken orally and act against HIV directly. As the chem-
icals produced by the new DNA attempts to make copies of HIV, the protease
inhibitors act against them and prevent them from working correctly. New
whereby HIV enters a CD4 cell is the binding or fusion of the HI virus with a
particular part of outer wall of the CD4. The entry inhibitor is a drug speci-
cally designed to t between the HIV particle and the point of the CD4 cell to
which it needs to bind to gain entry and therefore prevent this happening.This
is the newest class of anti-HIV drug. The best known drug in this class is T-20,
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• Drug resistance
Clinical studies of treatment with antiretroviral drugs have showed that
their benets are short-lived when a single drug is used alone. This
pede the activity of these enzymes. The structure of the virus's enzymes
changes if the virus mutates. Drugs no longer work against the enzymes,
making the drugs ineective against viral infection, and resistance sets.
Genes mutate during the course of viral replication, so the best way to
and it maximizes drug potency while reducing the chance for drug resis-
be taken with food, while others cannot be taken at the same time as
certain other pills. Even the most organized people nd it dicult to
take pills correctly. Yet, just one or two lapses in treatment may cause
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tingling or numbness in the hands and feet. Some patients may develop
placing a patient at risk for heart attack or stroke. Some patients suer
more misery from the drug treatment than they do from the illnesses
no symptoms and who have been infected with HIV for more than six
months. The new guidelines call for delaying treatment until an infected
person's CD4 cells fall below 350 cells per microliter of blood or the
HIV viral load exceeds 30,000 per microliter of blood. Evidence suggests
• Cost of treatment
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
worldwide.
fewer side eects and fewer resistance problems. Some drugs under in-
vestigation block the HIV enzyme integrase from inserting viral DNA
into the infected cell. Other drugs prevent HIV from binding with a
CD4 cell in the rst place, thereby barring HIV entry into cells.
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production of CD4 cells. If enough CD4 cells can be created, they may
trigger other immune cell responses that can overpower HIV infection.
In other research, doctors hope to bolster the immune system with a vac-
cine. Most vaccines available today, including those that prevent measles
vaccines mark specic infectious agents, such as the measles and polio
viruses, for destruction. But many experts believe that an eective HIV
Studies are underway to develop vaccines that also elevate the produc-
tion of T cells in the immune system. Scientists hope that this dual
approach will prime the immune system to attack HIV as soon as it ap-
pears in the body, perhaps containing the virus before it spreads through
would need to protect the person against many strains of the virus. Vac-
cines against other viruses have only had to protect the person against
HIV infects helper T cells, the immune cells that orchestrate the immune
to activate the very cells the virus infects. HIV can be transmitted as
both free virus and in infected cells. This may mean that both arms
stimulated.
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that result from HIV infection. Doctors try to prevent infections before
scribe more than one drug to forestall infections. For example, for those
less than 200 cells per microliter, doctors may prescribe the antibiotics
nia. Patients suering from recurring thrush may be given the antifungal
drug uconazole for prolonged periods. For people with CD4 cell counts
of less than 100 cells per microliter, doctors may prescribe clarithromycin
• Support mechanisms
A person diagnosed with HIV infection faces many challenges, includ-
ing choosing the best course of treatment, paying for health care, and
providing for the needs of children in the family while ill. In addition
AIDS because of the disease's prevalence among gay men or drug users
causes many people to avoid telling family or friends about their illness.
People with AIDS often feel incredibly lonely as they try to cope with
to help people with HIV infection or AIDS share their feelings, problems,
and coping mechanisms with others. Family counseling can address the
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Counselors are people who are trained to help others to understand their
problems, identify and develop solutions, and make their own decisions
them talk about their problems and fears, helping them to increase their
own self-esteem, and when necessary giving correct and useful informa-
tion based on what they need to know at that point in time. Voluntary
sion and serves as a point of entry into care for those testing.
integrated,
stand-alone,
community-based
and mobile.
alone sites are usually not associated with any existing medical institu-
tion and usually have sta fully devoted to VCT. They are largely op-
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There may be any number of reasons why a person may want to undergo
* Pregnancy
* STDs
* Legal insurance,
* visas, s
* cholarships
Voluntary testing
the health of HIV infected persons and plays a role in reducing HIV transmis-
sion. Aims of a pretest counseling Ensure you have a full understanding of the
implications of the test and are able to make an informed decision whether
to test. Ensure informed consent (to carry out the test) is gained from you.
Give you the opportunity to discuss routes of HIV transmission Discuss the
implications and support needs that may follow either appositive or negative
the future. Encourage you to consider and evaluate the impact the result may
identify risk factors and symptoms that may indicate that the patient is HIV
infected. During the pretest counseling the person thinks of someone to share
• Advantages of testing
1. Ability to seek medical intervention when one tests positive and this
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• Disadvantages
1. Increased fear of illness and death
The patient should be helped to understand the antibody test. Body produces
antibodies to HIV that are found in the blood. Positive test mean the person
is HIV infected. 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. Tests giving negative results should be repeated again
Explain to them that there is chance of not developing full blown AIDS
Clarify that the test did not yield positive results does not means that
the person does not have HIV or has not developed HIV.
Let the person know that there is need to repeat test after 3 months
haviours.
Discuss the current risk situations of the patient and help to develop
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disease.
4. Before testing the people are prepared rst for both positive and negative
(b) Enhancing abstinence for the infected helps in controlling the dis-
people who have been infected but had not shown symptoms.
7. Help to reduce the revenge attitude for those innocently infected and
8. Counseling enables the public who includes the relatives of the infected to
of great stress.
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feelings will keep changing. One day they might feel rejected and lonely
- the next day hopeful and energetic. One day depressed, another day
angry.
that one has HIV infection or AIDS. A person might feel confused and
not know what to do. It is good for people to be with someone they
Denial - At rst they might not be able to believe that they really have
HIV or AIDS They might think 'The doctor must be wrong' or "It can't
posed by AIDS.
Anger - People might become very angry when they learn that they have
HIV or AIDS This is a common feeling and can come when they blame
themselves or the person they think gave them HIV. Some may even
God will cure me if I stop having sex or the ancestors will make me
People with HIV or AIDS need to be helped to get through the feeling
of bargaining.
Fear - People with HIV or AIDS fear many things, for example:
Rejection
Death.
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Loneliness - A person with AIDS might often feel lonely. This feeling
may come and go for a long time and depends on the support given by
family and friends. Anyone who has AIDS must be helped to remember
that they are not alone; that they are surrounded by family, friends and
a community that cares about them. Many other people have HIV or
AIDS.
them want to hide. Sometimes a person with AIDS may feel unworthy
of friendship.
Depression - If a person nds out that they have HIV or AIDS they may
feel there is no good reason for living. They may feel useless, and want
to stay at home, not eat, and not talk to anyone. Depression can make
Acceptance - After some time, a person with HIV or AIDS will usually
begin to accept their situation. This will help the person to feel better.
Such a person will feel more peaceful in their mind, and will begin to
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Revision Questions
Solution : Taking anti-HIV therapy during pregnancy and delivery e.g. AZT
which reduces the viral load. HIV positive mothers to choose an elected cae-
sarean section instead of normal delivery. Not breast feeding where there is
because the HIV virus is present in breast milk. Also it is not uncommon for
fore increase the risk of viral transmission. Mothers w ho are HIV positive
should not donate breast milk to breast milk barks, neither should they ex-
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2. Explain the factors that account for the continued rise in women infected
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LESSON 8
Concept of positive living
Learning outcomes
Upon completing this topic, you should be able to understand the following:
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8.1. Introduction
The rst stage of positive living is accepting wholly HIV is part of you and
1. Breath - When you get overwhelmed, take three deep breaths. Breathing
better is one of the most important things you can do to maintain your
properly can enhance your quality of life. Look for fresh air, like the
around lakes, forests, near rivers and water falls, at the seashore and
ions.. This kind of air is refreshing and gives people a lift. House plants
also do more than enhance the appearance of the home and oces. They
enrich the air with oxygen and absorb carbon dioxide. Some even remove
toxic pollutant from the air we breathe (Ang'awa 2005). Bad air and
poor breathing habits interfere with breathing, reducing the oxygen de-
livered to the blood and impairing performance and mood and promotes
fatigue and exhaustion because the body is robbed of this vital element
(Ang'awa 2005)
2. Refuse to be a victim - Focus on what you can do. Focus on living with
HIV and not dying of AIDS. Live one day at a time. Seek support not
pity
5. Reduces stress
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(a) Faith based organizations have ministers who support HIV positive
people
(b) If you feel angry with God, acknowledge it. HIV is a virus not a
punishment.
10. Cry when you need to let it out, as it creates room for positive feelings
11. Accept responsibility - Pledge that HIV stops with you. Do not de-
re-infection.
12. Talk to other people with HIV - group therapy works. Join support
groups
13. Healthy and diet - eat well balanced diet with lots of proteins and vita-
mins Avoid food poisoning as much as possible Avoid alcohol, drug and
substance abuse
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It is important to have hope. Hope lifts spirits and gives strength to face
each situation. Hope can help each person to ght HIV and AIDS - to live
positively and to live longer. Remember, even if a person has hope today, it
without HIV or AIDS go up and down emotionally every day. The important
dwellings. It can mean the things people might do to take care of themselves
or the care given to them by the family or it can be extended from the hos-
pital or health facility to the patient's home through family participation and
community support (Gilks et al. 1998., MOH 2002c). Care includes physical,
psychosocial and spiritual activities. The term family here refers to the person
(or people) with the main responsibility for caring for a person with AIDS in
the home. In fact, the person providing such care may be a blood relative,
other person.
The overall goal of home based care is - to ensure a high standard of human,
holistic care that meets the needs of People living with HIV/AIDS (PLWA's).
PLWA's have basic, physical, economic and psychosocial needs. These can be
the quality of life for PLWA's. Home based care establishes an important link
HIV /AIDS aect all aspects of social and economic life in Kenya. The
such as STD control, condom promotion and distribution and health education
is by AIDS patients1. The national health systems cannot cope with the
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AIDS are beyond national budgets. Not only is the cost of care beyond health
care systems, but it is beyond the reach for the individual and the family.
Family, friends and the community must ll the "care gap" at large. This
group of care givers has the capacity and resources to do more than the national
health care systems: they take care of the sick, replace their labor/income, care
for their dependants, and help defray costs associated with the illness, provide
palliative care of PLWA's and quality life in death. The use of caregiver is
trained professionals are and sent home where they are usually cared for
by untrained relatives
PLWA's need continued quality care to prolong lives and reduce suering
investments.
patient, the family, the community and the health care system.
bers' needs.
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hospital.
Nursing care - which includes care to promote and maintain good health,
Counseling and psycho social care - which includes reducing stress and
formed decisions on HIV testing, plan for the future and behavior change
welfare services and legal advice for individuals and families and where
them in the body in order to keep healthy or to grow. Adequate food security
in the household is requisite for optimum nutrition, health and survival (FAO
2002). But HIV/AIDS reduces the household's ability to produce and buy food
by taking away the adult labour that would otherwise be engaged in agricul-
tain an adequate amount and variety of food, and to adopt appropriate health
ones, is grossly reduced. On the other hand both HIV/AIDS and malnutrition
illnesses, which reduce the quality of life and shorten life expectancy. Mal-
of food into the body, and poor use and storage of nutrients. Each of these
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for the HIV-positive person. 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 eects of medication such as nausea and vomiting, and inadequate
sults when HIV damages the small intestine and alters the healthy bacteria
loss and waste of nutrients. Infections, including HIV itself, lead to increased
requirements for energy and protein, inecient use of nutrients, and loss of
nutrients the body needs for growth and proper functioning. Balanced
Increase resistance to infection and disease and improve the energy sup-
ply.
Boost the immune system and therefore reduce the frequency of episode
of morbidity.
Replace lost micronutrient and provide the body with all essential nu-
Preserve muscle mass, slow or stop the loss of lean tissue, prevent weight
Delay the rate of progression of HIV to AIDS and the further advance
of AIDS itself.
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Keep PLWAs alive and able them to lead an active life; this in turn
Studies show that nutrition interventions can positively aect nutrition status
(FAO 2002), the immune system and even personal esteem, by maintaining
jects with fewer than 200 CD4 cells per millilitre1. A number of micronutrient
supplements including vitamin A, zinc and iron have been found to boost the
immune system in a person with HIV infection. Multivitamins can reduce the
are being advocated for all programmes of HIV/ AIDS patient management,
counselling or education:
Nutritional supplementation
To avoid malnutrition and wasting away HIV infected persons should al-
ways ensure that they take highly nutritive foods that are well balanced.
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Vitamins and minerals help bodies' in ghting diseases and keep oppor-
tunistic infections checked. They also help in a quick recovery and disease
juices.
proving the health of HIV-positive women, together with the enormous strides
made in reducing the risk of transmission from mother to baby has led more
prior planning is not possible for all HIV positive women some will learn of
their HIV diagnosis at routine antenatal visit. The women will be promptly
their own health and the health of their unborn child. Ideally HIV positive
their pregnancy. This will ensure that both the pregnancy and their HIV can
made available. HIV positive women should discuss the prospect of pregnancy
before hand, ensuring they have the information to ensure the best possible
She is old
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SZL2111 HIV/AIDs
Primarily, viral load is the most important factor to inuence the risk of trans-
either a negative partner or unborn child. For this reason, the control of viral
load from conception, throughout the pregnancy and during delivery by use
• Conception
Conceiving a child in relationship where one partner is HIV positive and the
other HIV negative presents unique challenges. If the woman is the HIV
For some couples, assisted conception is not an option and they may choose
not to use a condom while trying to conceive a child naturally, this of course
increases the risk of HIV transmission to the negative partner. In these in-
stances it may be wise to restrict unprotected sex to the fertile period of the
woman's cycle.
• The pregnancy
Optimum health, which for an HIV-positive woman means a low viral load
and a healthy CD4 count in addition to good general health, oers the best
chance for a healthy pregnancy and baby. There is no evidence to suggest that
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pregnancy accelerates HIV progression. It has been observed that CD4 counts
drop in pregnancy, but this is also seen in HIV-negative women. CD4 count
ARVs such as AZT are used to reduce the risk of transmission during
pregnancy. AZT is taken orally after the 14th week of pregnancy and intra-
venously during labour. Administering AZT syrup to newborns for the rst
six weeks can further reduce transmission. AZT reduces the risk of mother to
child transmission by lowering the mother's viral load during pregnancy and
delivery and may act as a post exposure treatment for newborns. It is the
only antiretroviral that has been thoroughly tested for use in pregnancy. For
women who are already taking antiretroviral therapy and other discover they
are pregnant after 14 weeks, it is usually advisable that they continue with the
• Delivery
There are conicting opinions regarding whether HIV positive mothers should
transmission to their baby. Until recently all HIV positive mothers were urged
that should be reached after all factors have been considered by the mother
• Breastfeeding
HIV- positive mothers should not breastfeed their babies as this increases the
the virus has been transmitted. Initial testing is undertaken when the child
is 48 hours old. Negative children are tested again at day 14 when PCR will
negative, then the test is repeated again at 4-8 weeks and then again at 16-26
weeks of age. If they return two negative results, when they are over 6 month
of age, it can be conrmed that the virus has not been transmitted.
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Exercise 10. Explain if one might have been exposed to HIV is there
Solution : More than 90% of people infected with HIV do not know their
public health strategy as they result in reduced risk behaviours and increased
condom use. Testing and counselling serve as entry points to HIV/AIDS care
and support.
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of HIV/AIDs.
of HIV/AIDS. Discuss.
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LESSON 9
Behavioral patterns and the spread of Hiv /Aids
Learning outcomes
Upon completing this topic, you should be able to know policies and rights of
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external world and the internal state of its body and responds to changes which
perceives. Many of such process will take place inside the nervous system and
violent activity or incomplete inactivity, but all are equally behaviour. The
often men and women have sex and who they have sex with. Not everyone's
sex life is the same and patterns of sexual behaviour are strongly inuenced by
social, cultural and psychological factors over which men and women have little
their families and societies from aggressors. Virility-the ability to perform sex
people are expected to prove their sexual prowess and there is under spread
belief that a man's need for sex is beyond control. For men anything that
appears to interfere with their sex lives such as appeal to abstinence or use of
average report more sexual partners than women. The implication of this are
that women are likely to contract HIV but less likely to transmit the virus to
other sexual partners while men are more likely to contract and transmit the
virus. In the long term this means that more women than men will contract
HIV. Compounding this situation is the fact that many men do not consider sex
as a consensual activity. Sex has to take place when man decides and without
a condom if he chooses. Wives are often beaten or ejected from their home. If
they refuse to submit to their husbands and many women are at risk outside
the home if they refuse to submit to their husbands and many women are at
risk outside the home. In such instances, women nd it impossible to protect
themselves from infection with HIV or other STI's. In prisons or other single
sex environments some men rape other men either as a substitute for sex with
sex between men may be an expression of mutual desire or the result of ones
desire and other's nancial need. There is need to change men attitudes and
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tell them not to; while women do not protect themselves because men do not
Always use dental dams for oral female genital or anal stimulation.
Avoid having sex with people who are injecting drug users.
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itive.
Notify previous and present sexual partners if you learn that you are
HIV seropositive.
contaminated articles.
still do not have control over their lives especially their bodies.
2. Girls have been taught to leave decision making on sex matters to males
3. Male predominance often comes with intolerance for predatory and vio-
lent sexuality - this carries double standards whereby women are blamed
or thrown out for indelity whether real or suspected while men are
her to be more vulnerable to contract HIV than men - sex takes place
inside the body of the woman and the female genitalia is prone to tears
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and wear. These tears and wears and/or sores provide entry route for
the virus.
5. The female reproductive system is also in direct and longer contact with
the male semen deposited during sexual intercourse. If the semen has
dize his support even when she suspects that he is HIV positive. If she
reacts violently.
into it to exchange sex for basic necessities of life for themselves and
their children.
10. Ignorance - majority of women are poorly educated and lack informa-
A vulnerable woman is one who is lacking in power or control over her risk of
HIV infection.
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(b) ensure they have information on their bodies, HIV/AIDS and other
STD's, and
(a) girls and women should have access to appropriate health care and
(b) make condoms and STD care are available where women don't feel
embarrassed.
be made available.
traditions which have become deadly with the advent of HIV/AIDS e.g.
5. Educate boys and men to respect girls and women - this enables them to
and STDs.
schemes and women's cooperatives and link them with AIDS prevention
activities.
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and disorders, and/or prolong the life of patients with incurable conditions
heroin, or other illegal substances. Legal substances, such as alcohol and nico-
tine, are also abused by many people. Abuse of drugs and other substances
can lead to physical and psychological dependence. 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 suer from malnutrition if they
habitually forget to eat, cannot aord to buy food, or eat foods lacking the
proper vitamins and minerals. Individuals who abuse injectable drugs risk
contracting infections such as hepatitis and HIV from dirty needles or needles
shared with other infected abusers. One of the most dangerous eects of illegal
drug use is the potential for overdosing that is, taking too large or too strong
a dose for the body's systems to handle. A drug overdose may cause an indi-
compulsive craving for a substance. Successful treatment methods vary and in-
used together. The illegal use of drugs was once considered a problem unique
economic levels, in both cities and suburbs, abuse drugs. Some people use
drugs to relieve stress and to forget about their problems. Genetic factors
such as peer pressure, especially in young people, and the availability of drugs,
also inuence people to abuse drugs. People with alcohol use disorders are
more likely to contract HIV than the general population. 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
poor HIV treatment outcome. People who abuse alcohol are more likely to
engage in behaviors that place them at risk of contracting HIV. Heavy alcohol
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use has been correlated with a high risk sexual behaviors including:
Unprotected intercourse
hepatitis viruses.
Infected blood drawn into the needle is infected along with the drug by
A recent study has shown that HIV can survive in a used syringe for at
least 4 weeks.
A lot of people believe that sex and drugs should go together. Drug users
Others think that sexual activity is more enjoyable when they are using
drugs.
Drug use including alcohol increases the chance of not using protection
drugs.
One who is a drug addict might forget to take his ARV therapy - delay
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counterparts
of HIV/AIDS
is used to separate the aected persons or groups apart from the normalized
targeted towards those who are perceived as being shamefully dierent and
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SZL2111 HIV/AIDs
2. During Volutary Conselling and Testing explain how the health worker
3. Sex education is a right for every youth. Discuss in detail what this
entails.
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LESSON 10
Implications of Hiv/Aids And International Responses
to the Hiv/Aids Pandemic
Learning outcomes
Upon completing this topic, you should be able to know:
HIV/AIDS
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SZL2111 HIV/AIDs
Self pity
Depression
Suicidal thoughts
Shame
Anger
Denial
Revenge
Fear of death
Opportunistic infections
Inability to work
Loss of job
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Strained nances
Orphans & vulnerable children have their growth aected, reduced ac-
cess to basic education & increased risk of acquiring HIV due to lack of
parental guidance
Development retardation
Expensive funerals
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Destigmatization
prots
sector
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Loss of household and farm assets - this is due to diverted time of family
insecurity
tence farming.
education system.
related needs
Children from aected families absent themselves because they take care
of the sick
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SZL2111 HIV/AIDs
sons
ment
to treatment or die
HIV infected health workers may have low productivity and morale
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and the National STDs control programme (NSTDCP) were merged in 1994 to
form the National HIV/AIDS and STD programme (NASCOP) which assumed
launch of the Kenya National HIV/AIDS plan in December 2000 was the ad-
ing the launch of constituency AIDS control committees (CACC) by his Excel-
lency President Mwai Kibaki. The launching was done during the worlds AIDS
Behavior change communication strategy phase one campaign was also done
the same day by the President. The strategy focuses on supporting people who
campaign slogan.
In March 2004, the President launched the country total war on HIV/AIDS
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the AIDS pandemic. The committee discussions revealed the need to include
care for those orphaned by AIDS and the provision of drugs for those infected.
media has set up sensitization programme to try and educate the public
on the dangers of the disease and also advise them to stay healthy with-
out contracting the disease. This is done through plays; poetry and real-
air their views and encourage others to take measures to avoid contract-
ing the disease. The government has also gone step ahead in creating
groups etc. The government has also through its ocials advocated the
ocials get the chance to give out the much needed information on the
prevention of AIDS.
Through these seminars and workshops, people are educated and en-
which are answered frankly and elaborated. These are also supplemented
the reduction of spread of HIV since the most sexually active Kenyans,
the youths are taught about the dangers of casual behaviors and unpro-
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this as any other disease. This has helped to remove stigma label on
those infected and hence are no neglected. This has encouraged free talk
encourages correct and consistent use of latex condoms during sexual in-
tercourse. In this regard the government has zero rated tax on condoms
and other preventive devices to ensure that its citizen can all have access
subsidizes ARV drugs and other health services to people suering from
viral drugs during pregnancy and delivery. This includes AZT which
helps in the reduction of the viral load. HIV positive mothers are also
donate breast milk to milk banks nor to express their breast milk to be
7. Provision of VCT centers all over the country: The government has es-
tablished and opened VCT centers all over the country. VCT services
are oered free of charge in most government health facilities. This has
enabled most Kenyans to know their HIV status and through guidance
and counseling, they have been taught on how to live positively for those
aected and how to stay negative for those who are HIV negative. In
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tices that have become deadly with the advent of HIV/AIDS. They have
FGM, circumcision done the traditional way, wife inheritance and early
marriages.
and thus is teaching women on their basic rights and more so not to
the current world where they are recognized and respected equally as
men. The government has enhanced laws against violence on women and
to protect them from victimization. Tough laws have been enacted for
10. Poverty eradication: The government has been at the forefront of try-
the central government and channel them to projects that help elevate
are that help people at grass root ght poverty. Some of these NGO's
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Solution : Premarital sex - sex before marriage, involves both fornication and
adultery. Extra marital sex - involves having sex besides the matrimonial
body parts such as ear, nose, tattooing portions of the body etc. Cohabitation
- trial marriage. Sex for ritual purposes - these arise from the belief in the
powers of an external force, usually in the form of a spirit which can befall
a person if some prescribed traditional rituals are not carried out. Festival
seasons - during certain occasions such as Christmas, valentine day etc, there
a relationship for the purpose of material gain of one kind of another. Sex
for livelihood - this means commercial sex work, and involves exchange sex
for money. Prostitution is the old name given to this kind of activity. Sexual
have emerged in urban centers even though they are conducted clandestinely
and are strongly disproved. Resistance to condom use - the use of condom
the suggestion of its use suggests sign of mistrust. Drug and alcohol use
and abuse - use of hard drugs and alcohol predisposes those involved to risky
are stimulating sexually to the mind and individuals especially the youngster
may be tempted to copy and put into practice what they view thus becoming
other recreational facilities. The youth become idle and to reduce idleness they
stigma - because of this, HIV positive individual hide their status and behave
normally while they go on infecting other people. Male and female circumcision
- the same knife is used repeatedly without sterilization this leading to risk of
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of communities. Given the evidence that many sexual partner increases one
which are culturally tolerated play a part in the spread of HIV/AIDS. Spouse
the surviving partner to a relative of the deceased. Given the fact that most
AIDS as the cause of death is usually not disclosed to the relatives, inheritance
of spouses has pose high risk of exchanging the HIV virus, thus feeling the HIV
curse arising from violating some cultural taboos. Most people tend to believe
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initiate various programs to reduce the spread of HIV among its citizens.
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Solutions to Exercises
Exercise 1. The vaccine used in the program then was discovered in the
stores of the original place that developed it. This was subsequently analyzed.
It was announced that no trace had been found of either HIV or chimpanzee
SIV. A second analysis conrmed that only macaque monkey kidney cells,
which cannot be infected with SIV or HIV, were used to make Chat and not
chimpanzee's as earlier suggested. While this is just one phial of many, most
have taken its existence to mean that the OPV vaccine theory is not possible.
The fact that the OPV theory accounts for just one (group M) of several
dierent groups of HIV also suggests that transferal must have happened in
other ways too. The nal element that suggests that the OPV theory is not
credible as the sole method of transmission is the argument that HIV existed
in humans before the vaccine trials were ever carried out. Exercise 1
enters the body and begins to multiply and attack immune cells that normally
protect us from disease. It's only when someone with HIV begins to infections
Exercise 3. Fertility myth - Common belief that one engage in sex to enhance
fertility in future. This not true. People have to multiply to ll the earth, a
spiritual sense. This is a corruption of the bible. Health Myth - abstaining from
sex leads to sickness and madness, nobody has ever fallen sick or become mad
to any man. Venereal disease is cured if the man has sex with a virgin. This
is not true. On the contrary the Venereal disease suerer will transmit the
disease to the virgin. Special food and exercise will make the penis grow big.
This is not true. Whatever that is good for other body parts is also good for
sex organs. Men have stronger sexual urges than women. Men sex drive is
equal in both the sexes. It is generally said that Africans are promiscuous This
is not true. Promiscuity is not necessary an African trait has other races have
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promiscuous people too. A man cannot be satised by one woman. This not
true. One can't get pregnant during the rst sex intercourse. Common believe
that there is a grace period between the rst sexual encounter and getting
pregnant - like the payment schedule on credit card. This one isn't true.
One can't get pregnant during unprotected sex if the man pulls out before he
ejaculates. This is not true. Some small amounts of sperm containing semen
may be deposited in the vagina before ejaculation. Other remain in the urethra
by the ability to conceive a child. There are other criteria. Common belief
that virginity brings problems during birth. This is not true. Imparting sex
on sex and sexual behaviour helps them to develop a healthy and positive
Exercise 4. The immune system is responsible for body defense against attack
lymphocytes. T-helper lymphocytes have a CD4+ marker that the HIV uses
for entry into the cell and replicates. T-helper lymphocytes are important in
immune regulation because when they are activated they recruit other immune
cell involved in immune responses. HIV uses the CD4+ cells to replicate and
produce more viral particles. CD4 are killed and destroyed as viral production
infected CD4+ cells and kills them. Macrophages which have a CD4+ marker
too act as reservoir and are also killed by cytotoxic. As virtually infected cells
are killed by cytotoxic T-lymphocytes and more of the CD4+ cells destroyed as
a result of viral replication, their numbers goes down. The immune system is
depleted of these crucial cells involved in body defense and becomes vulnerable
Integration - Viral DNA moved into cell nucleus where it is integrated with
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sembly and budding - Newly made HIV core proteins enzymes and genome
RNA gather inside cell and they bud o. Maturation - The core of the virus
is immature and therefore un-infectious protease breaks the long protein chains
Exercise 6. Primary HIV infection - This is the initial stage where one
obtains the virus through the various modes of transmission. Window period
- This stage of infection lasts for a few weeks to about 3 months and is often
in blood screening although HIV is present in blood & the blood in not 100%
free of HIV. During this time a person can still transmit the virus to another
person. It's the most crucial stage. Sero conversion - This is the development
a person may have u like illnesses, fever, fatigue, sore throat, joint pains
& lymphadenopathy. Some will not experience any illnesses at this stage.
without major symptoms. Although there may be swollen glands. The level
of HIV in the peripheral blood drops to very low levels but people remain
infectious and HIV antibodies are detectable in the blood, so antibody tests
will show a positive result. HIV is not dormant during this stage, but is very
active in the lymph nodes. Large amounts of T helper cells are infected and die
and a large amount of virus is produced. This period can last for many years
phase - Over time the immune system loses the struggle to contain HIV due
to the following main reasons: The lymph nodes and tissues become damaged
or 'burnt out' because of the years of activity; HIV mutates and becomes
more pathogenic, i.e. stronger and more varied, leading to more T helper cell
destruction; The body fails to keep up with replacing the T helper cells that
are lost. It varies between people & depends on a length of factors. Progression
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of HIV to AIDS - As the immune system becomes more and more damaged the
illnesses that present become more and more severe leading eventually to an
AIDS diagnosis. It's the most advanced stage of HIV infection. At this time
when CD4 cell count has gone down below 200CD4 cells/ml, HIV develops to
Identies antibodies directed specically against HIV. ELISA test does not
establish a diagnosis of AIDS, rather it indicates that the person has been
exposed to or infected with HIV. People whose blood contains antibodies for
HIV are said to be sero positive. 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 6 months for the antibody levels to get high enough for detection.
The Western blot assay is another test that can identify HIV antigens and
that detects very low antigen levels such that one may test HIV negative by
ELISA but test positive through western blot. Babies born of HIV mother
have antibodies to HIV 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 conrms presence of HIV
antigen and this rules out whether babies are positive because of HIV itself or
ELISA, to screen neonates, and to determine the exact strain of virus that is
count). The number of CD4 cells present is a direct indicator of the immune
number of CD4 cells in a cubic milliliter of blood and will give a picture of the
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 indicate that
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some damage to the immune system has occurred and a count below 350 or
The viral load test requires the collection of a blood sample and estimates the
number of HIV particles in the sample by looking for HIV genes. The level
developing AIDS and the risk of developing drug resistance has been reduced.
A high viral load is an indication of high levels of HIV in body uids while
HIV/AIDS disease. Involve testing and availing the results to people in min-
utes. Before testing the people are prepared rst for both positive and negative
results before allowed to know their status. Importance of knowing one's HIV
status includes: Preventing the uninfected person from contracting the dis-
ease. Enhancing abstinence for the infected helps in controlling the disease
through self awareness and putting up ways on how to abstain or get involved
in safe sex. Counseling also helps in ensuring reduced spread of the virus by
those people who have been infected but had not shown symptoms. Counsel-
ing infected people, majority of who have lost hope, helps in ensuring positive
living. Help to reduce the revenge attitude for those innocently infected and
may opt to die with many or commit suicide. Counseling enables the public
who includes the relatives of the infected to stop stigmatizing those infected
to be able to live normal lives knowing that someone cares for them. Testing
also helps the government to keep statistics on the prevalence of the disease
HIV in genital secretions and reduces the risk of its spread to other sexual part-
ners. Early treatment also reduces the risk of contracting HIV from infected
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pregnancy, genital cancer, blinding eye disease, and major nervous system in-
Exercise 9
for HIV. PEP is a month-long course of drugs that may prevent a person
from becoming infected with HIV if they begin treatment within three days
of exposure to HIV. If you may have been exposed, contact a health service
as soon as possible for treatment. See the `Further Information' section at the
Exercise 11. Men still dictate matters regarding sex - for example, when to
use of condom relies on the man. Girls have been taught to leave decision
making on sex matters to males whose needs and demands are expected to
dominate. Male predominance often comes with intolerance for predatory and
violent sexuality - this carries double standards whereby women are blamed or
thrown out for indelity whether real or suspected while men are allowed to
of the female body makes her to be more vulnerable to contract HIV than
men - sex takes place inside the body of the woman and the female genitalia
is prone to tears and wear. These tears and wears and/or sores provide en-
try 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. Poverty -
failure to respect the human rights of girls in terms of equal access to school,
dent on her husband cannot aord to jeopardize his support even when she
suspects that he is HIV positive. If she insists on a condom use she is accused
others are forced by circumstances into it to exchange sex for basic necessities
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of life for themselves and their children. Cultural practices-a number of cul-
condom use. Social evils - they include rape, sodomy, homosexuality, premar-
ital, extramarital sex, and drug and alcohol abuse. Ignorance - majority of
women are poorly educated and lack information on their bodies, HIV/AIDS
and other sexually transmitted diseases. They are therefore unable to protect
themselves. Exercise 11
Exercise 12. Vaccination - This is the process of making the body resistant
into epidemics, public health ocials may initiate new vaccination programs.
Rural and Urban Health Clinics - Public health agencies operate local clinics
infants and children, pregnant and nursing women, people with drug abuse
routinely screen patients for a number of infectious diseases Each clinic tracks
the incidence of certain communicable diseases in its area, and reports this
ing and Epidemiology - Threats to public health concerns change over time
trends to determine how best to meet future public health needs. Epidemiol-
ogists and other public health ocials attempt to break the chain of disease
fectious disease Public health ocials ensure that infected people complete
treatment programs, so that the diseases are completely eliminated and the
patients are no longer carriers of the infection. Sanitation and Pollution Con-
drinking water. The single most eective way to limit water-borne diseases
In many parts of the world, public health ocials establish sewage disposal
and solid waste disposal systems, and regularly test water supplies to ensure
and disability, and in most countries public health ocials address the adverse
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health eects of air pollution and water pollution. Public health ocials may
force pollution limits and advise the general population when pollution levels
exceed safe limits. Medical Research Cadres of doctors and scientists work
treat, and cure disease and disability. Scientists and doctors employed by the
better ways to protect human health. Public Education Campaigns Many dis-
eases are preventable through healthy living, and a primary public health goal
that can make the outcome of disease more favourable e.g. early breast cancer
detection . Exercise 12
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