ZOOL 143: HIV/AIDS AND SOCIETY

Course instructor: Abasi Edna

Lecture hours: 2.0

COURSE OBJECTIVES
At the end of the course, the students should be able to;
Give an account of the practical knowledge and information about HIV/AIDS in the society
Address emerging trends of HIV/AIDS nationally and globally
Discuss HIV/AIDS prevention and control measures leading to behaviour change.
Describe the skills that can be used to solve complex community problems relating to HIV/AIDS
Describe how interdisciplinary approach can be used to solve problems in the society for civic
engagement.

Course outline

1. Introduction to HIV/AIDS and society

 History of HIV/AIDS
 Models of HIV/AIDS
 Theories of origin of HIV/AIDS

2. Microbial pathogens

 Types of microbial pathogens

 Sexually transmitted diseases

3. HIV structure and lifecycle

 HIV structure
 HIV lifecycle
 Phases of infection
 Factors that lead to faster progression of HIV to AIDS

4. The immune system

 How HIV damages the immune system

 Strains of HIV

5. Modes of transmission of HIV and preventive strategies

 Transmission of HIV at the cellular level

 Drug use and HIV transmission
6. Voluntary counselling testing (VCT)

 HIV counselling
 HIV detection

7. HIV management

 HIV treatment
 Home-based care
 Principles of long term survivors (positive living)

8. HIV and gender

 Female genital mutilation

 Strategies to decrease the transmission of hiv in women

9. HIV/AIDS stigma

 Types of stigma
 Human rights issues and HIV/AIDS

10. The role of government and other stakeholders in the fight against hiv/aids

 General role of government in fighting hiv/aids

 The role of NGOs
 The role of community based organisations

11. HIV transmission facts and myths

 Fact sheet to correct misperceptions about HIV

 Socioeconomic impact of HIV/AIDS

COURSE CONTENTS
Introduction to HIV/AIDS and definition of terms: prevalence, incidence and pandemic (2 Hours)
Relationship between HIV/AIDS; History of HIV/AIDS, theories of origin and epidemiology of
HIV/AIDS (5 Hours)
Introduction to human microbial pathogens: viruses, bacteria, fungi and parasites (2 hours)
STDs and the relationship between STDs and HIV/AIDS, opportunistic infections; cancers and their
relationship with HIV/AIDS (4 Hours)
HIV viral structure, strains of HIV and the life cycle of HIV (4 Hours)
The immune system in relation to HIV infection (4 Hours)
HIV transmission, symptoms, diagnosis, treatment and prevention measures of HIV/AIDS (6 Hours)
CAT 1 (1 HOUR)
Roles and impact of FGM and male circumcision in HIV/AIDS pandemic (3 Hours)
Gender issues and their implications in relation to HIV/AIDS (4 Hours)

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The role of government, NGOs and human rights issues in relation to HIV/AIDS pandemic (3 hours)
Counseling, V.C.Ts, community outreach programmes and care of HIV/AIDS affected and infected
individuals (2 hours)
The myths, cultural beliefs and misconceptions pertaining to HIV/AIDS in the society (2 hours)
Social and economic impacts of HIV/AIDS in the society (2 hours)
CAT 2 (1 HOUR)
Teaching Methodology
The course will be taught using lectures, group discussions and class presentations.
Course evaluation
Continuous Assessments 30%
End of Semester Examination 70%
Total 100%

REFERENCES
Edward Alcano (2002). AIDS in the Modern World. 1st Ed.
Hung R. and Ross F. C (2004). The Biology of AIDS. 4th ED.
Hung R. and Ross F. C (2006). Aids, Science and Society. 2nd Ed
Benson S. A (2004). Control of Communicable Diseases Manual.
Burns D. (2002). Learning for our Common Health. How an Academic Focus on/AIDS will Improve
Education and Health.
The World Bank (April 1992). Overhead “The Macro-economic Impact of AIDS in sub-Saharan
Africa Population and Human Resource Department.” Washington DC.
UNICEF (2002). Children and Women in Kenya: A Situation Analysis.
NASCOP (2007). AIDS in Kenya. Background and Projections, Impacts and Interventions.

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 INTRODUCTION TO HIV/AIDS AND SOCIETY
INTRODUCTION TO HIV/AIDS AND SOCIETY
HIV (Human Immunodeficiency Virus) is a tiny microorganism that belongs to the larger group of
organisms called viruses. Viruses cause diseases in humans, animals and even plants. There are
numerous types of viruses.
Viruses cannot multiply on their own. They can only reproduce by using the genetic material of the
cell of the host animal or plant. In order to reproduce HIV attaches itself to the genetic material of
the cell it has infested. This makes it very hard for either the body or the plant to destroy it without at
the same time destroying the cell itself. HIV is also capable of resembling the host cell through
mutation. This is why it is difficult to develop a cure for HIV. The destruction of the immune system
by the virus means that infectious organisms can invade the body unchallenged and multiply to cause
a disease.
AIDS (Acquired Immune Deficiency Syndrome) the disease caused by (HIV) is a global health issue
that affects nearly everyone living on planet today. It is estimated that between 35–49 million people
are living with HIV/AIDS today.
ACQUIRED means that this disease can spreads from one person to another. Every person who has
AIDS has received from someone else who has the diseases
IMMUNE means protection; the body is normally protected from sickness by its ability to fight
germs/pathogens
DEFICIENCY means lacking; the body is lacking the normal immune system for fighting germs
SYNDROME means a group of signs and symptoms which result form a common cause. Because a
person with AIDS cannot fight germs, the AIDS patient may have several different sicknesses in his
body at the same time. All this simply means, that is the disease that destroys a person’s immune
system.

Why is it important to learn about HIV/AIDS?

Learning about HIV/AIDS can empower people to make decisions that can minimize the risk of
exposure to HIV/AIDS and help prevent its spread.
Education is the first step to self-protection, community improvement and empowerment.
It helps those individuals already living with HIV/AIDS to be empowered
It is a resource for everyone to learn how to support friends, family members and community
members already living with HIV/AIDS.

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HISTORY OF HIV/AIDS
AIDS has been around for several decades. It is estimated to have first infected humans in the 1910’s
and 1920’s.
1981 to 1991
In 1981, scientists first identified AIDS in the United States when researchers observed a sudden
increase in opportunistic infections (disease that do not cause major problems in healthy individuals
but flourish in the absence of a functional immune system) among homosexuals. Most of them were
going down with a lung disease (Pneumocystis carinii) characterized by progressive suffocation of
the lungs as they fill with fluid. This was attributed to pleasure stimulants used by the gay
community; others attributed it to many disease causing organisms prevalent among the gay
community e.g. cytomegalovirus; while others thought that homosexual patients immune system had
been compromised due to frequent sexually transmitted diseases. As more cases were reported,
mostly from the gay community, the disease was coined GRID – Gay Related Immune Disease.
When the researchers further examined the patients, they found that their immune system was
damaged and it was given the name AIDS (Acquired Immunodeficiency Syndrome). Doctors later
came to the conclusion that it was caused by a virus. In 1982, two cancer research laboratories were
in the hunt for the causative agent of AIDS. In 1984, a team from Washington DC led by Robert
Gallo reported the discovery of AIDS as Human T-Cell Lymphotrophic Virus Type III (HTLV-III)
while the French team led by monsieur Luc Montagnier named the virus Lymphadenopathy-
Associated Virus (LAV). In 1984 the virus was isolated by French and American scientists. In 1986,
an International Commission of prominent Virologist and molecular biologists recommended that the
virus’ name be changed to HIV to follow the nomenclature for virus classification.
In 1983, HIV was discovered in Africa among heterosexuals and this led to the realization that this
disease had the capability of affecting everyone, everywhere. By 1985, at least one case of AIDS had
been reported in every region of the world. This led to the growth of HIV/AIDS awareness on a
global scale e.g. the World Health Organization started its Special Program on AIDS. In 1987, the
first AIDS therapy, AZT (Azidothymidine) was introduced in the United States.
1991 to present
After the first decade, 15 million people were living with the disease. The first success in reducing
the number of cases was observed in Uganda in 1993. This was also observed in Thailand and Brazil.
In 1993, the first regimen to prevent mother-to-child transmission was developed. In 1995, HAART
(Highly Active Antiretroviral Therapy) was introduced. In the same year, UNAIDS was created
specifically to deal with HIV/AIDS. In 2001, 37 million people were living with HIV/AIDS and
currently this figure is much higher (approximately 42 – 45 million). In 2000, Kenya established 3

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VCTs nationwide and in 2011 VMMC was introduced to deal with the disease among uncircumcised
males. More and more therapies are being developed but there’s still no cure for the disease. The
epidemic is far from over.

EPIDEMIOLOGY OF HIV/AIDS

Epidemiology is the study of patterns of disease occurrence in a population and the factors affecting
them. By epidemiological classification, HIV/AIDS is a pandemic, which is an epidemic that
includes all parts of the world.
Epidemic is a disease outbreak characterized by the sudden increase in number of infections within a
short period of time.
Prevalence is the total number of people infected within a given period of time in a certain
population and incidence is the total number of new cases within a given period of time in a certain
population.
Epidemiology of HIV/AIDS varies from region to region due to various factors e.g. human
migration, urbanization, civil war, poverty e.t.c.
Epidemiology in United States

US has the lowest prevalence of HIV. However, the population with the highest infection rate is the
homosexual and bisexual men, followed by injection drug users and blood transfusion recipients.
The fastest growing HIV infection rate is in the African American population and this could be due
to racism and social marginalization.
Epidemiology in Asia

Asia has the most rapidly increasing number of HIV-infected people with 3.8 million people living
with HIV/AIDS and 355,000 new infections in 2008. If the trends continue, the number of will
surpass that in Africa. Commercial sex workers and injection drug users are the two primary vehicles
for HIV transmission in Asia. India now has the most number of infections in the world (though
some countries in Africa have a higher proportion of AIDS i.e. South Africa and Nigeria). Deaths
due to AIDS is 329000.
Epidemiology in Africa

Africa has the highest number of HIV infected people. Unlike other areas of the world where
HIV/AIDS affects men and women equally, women have a much higher infection rate than men in
most parts of Africa. They are twice as likely to become infected with HIV than men of the same

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ages. Commercial sex workers are the most highly infected groups with at least 90% of them being
infected.
Global statistics in Africa can be broadly divided into two regions:
The Sub Saharan Africa
Hosts nearly 67% of all PLWA globally and it accounted for 70% of AIDS deaths in 2008. The
number of people living with HIV is 22,000,000. Newly infected in 2008 was 3,800,000 while deaths
due to AIDS is 1,500,000. Women living with HIV is 12,000,000 and children living with
HIV1,800,000.
The Southern Part of Africa
The number of people living with HIV is 4.8 million. Newly infected in 2008 was 2,900,000 and
deaths due to AIDS was 705,480. Women living with HIV are 2.4 million while children living with
HIV is 243,000.

1.3.3.7.1 REASONS WHY AFRICA IS HARDEST HIT BY HIV/AIDS

All the continents are affected by HIV/AIDS but the most is Africa. In the world, 10 people are being
infected every second. Mobility, ignorance and poverty are some of the main factors associated with
spread of AIDS in Africa. In Kenya 164 people are being infected by HIV every day which translates
to 60,000 new infections annually. Many factors have contributed to this phenomenon including:
Poverty: due to this, the Africans have been rendered vulnerable to the virus. It may lead one to
prostitution which is a main source of infection. Nutrition will also be a problem to those infected
and most victims will not be able to respond to any attack.
Conflict/disasters: during conflicts displaced population is more vulnerable to such atrocities like
rape/defilement. War has led to under-development hence to stagnation of economic growth leading
to wide spread poverty. Displaced people are likely to engage in casual and unprotected sex and in
many cases it may be hard to reach the affected people with material or medical help.
Wide spread ignorance and illiteracy: lack of proper information about HIV/AIDS has accelerated
the spread of the virus in Africa. Majority may not know the epidemiology of the disease, how to
protect themselves or how to manage the pandemic. Ignorance may have led to very many new
infections because it may be accompanied by false beliefs e.g. a false belief that having sex with a
virgin cures HIV/AIDS
Culture: Some African cultures and myths fuel spread of HIV practices like wife inheritance,
polygamy, female genital mutilation, tattooing etc. may spread the virus to healthy people.
Mismanagement of health facilities and resources: African countries are known to be corrupt.
Almost every aspect in an African country has been politicized e.g. money intended for HIV/AIDS

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management may be diverted to political campaign funding. Africa therefore lacks missionary and
focused leadership.
Poor access to health facilities: in many cases the rural population and the urban poor may not have
access to health facilities. This may fuel the spread of HIV due to lack of information on personal
health and other areas concerning the pandemic.
Large population of the youth: Youth form the majority of the population in any African country
e.g. in Kenya the youth form 60% of the population. They are known to involve themselves in risky
behaviors. They may carry the big load of STDs infections which act as avenues to contracting HIV.
The youth are sexually active because they are getting into the reproductive age and they like
experimenting. They are also daring and are willing to take risks. The youth are easily influenced by
peer, mass media, current trends and are likely to fall into drug abuse.
HIGH RISK BEHAVIORS
These are practices that increase the risk of acquiring the virus. Some behaviors expose a person to
the virus or to areas where there is likelihood of the virus being there. However, a person’s actions
and behavior may increase the risk of getting HIV.
Some of the high risk behaviours include:
Having multiple partners; Having sex when one has an STD; Having sex which causes tear or
bleeding e.g. when the vagina is too dry ; Rape; Homosexuality; Having sex with someone who has a
history of STD’s; Having sex without a condom; Having sex with an unknown person; Drugs and
substance abuse; Blood transfusion; Sharing of needles; Having a partner who uses drugs; Use of
unsterilized equipments in hospitals; Use of same cutting instruments (not sterilized); Prostitution;
Some careers e.g. long distance transport and Bar tending.
Inaccessibility of modern HIV management resources: due to poverty most African countries are
not able to embrace the modern management development in HIV/AIDS management field. Most of
the victims may not access modern ARVs
Un-acceptance of the victim: in Africa there is still a burden of stigma. The victims may be
unaccepted, others will be bitter and they are likely to seek revenge

Epidemiology in Kenya

HIV was first recorded among CSWs between 1983 and 1985. Towards the end of 1986 there were
an average of four new AIDS cases being reported to the World Health Organization each month.
This totalled 286 cases by the beginning of 1987, 38 of which had been fatal. By 1987 HIV appeared
to be spreading rapidly among the population – an estimated 1-2% of adults in Nairobi were infected
with the virus, and HIV prevalence among pregnant women in the capital had increased from 6.5%
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to a staggering 13% between 1989 and 1991. By 1994 an estimated 100,000 people had already died
from AIDS and around 1 in 10 adults were infected with HIV. In 1999, Former Kenyan President
declared the AIDS epidemic a national disaster. HIV prevalence began to decline from its peak of
13.4% in 2000 and continued to decrease steadily to 6.9% in 2006.
Kenya’s HIV epidemic has been categorised as generalised – meaning that HIV affects all sectors of
the population, although HIV prevalence tends to differ according to location, gender and age.
Various studies have revealed a high HIV prevalence amongst a number of key affected groups,
including sex workers, injecting drug users (IDUs), men who have sex with men (MSM), truck
drivers and cross-border mobile populations.
By 2011, 1.6 million people were living with HIV/AIDS and 1.1 million children were orphaned by
AIDS. 62,000 people died of AIDS-related illnesses in the same year. In 1990, prevalence was
reduced to 6.2% due to increase in education and awareness and high death rates. Currently the
prevalence is at 4.3%. Prevalence in women is twice as high that in men (8.4% and 5.4%
respectively). The age group 15 – 24 years is most affected (7.4%) and younger women are four
times more likely to be infected with HIV than men of the same age. HIV prevalence is greater in
urban than rural settings. It is on trucking and migration routes and border towns. Children <15 years
are also highly infected accounting for 16% of all new infections mainly due to MTCT.

NB: Despite the fact that treatments that prolong life and improve quality of life have been
discovered, only around 2% of all people living with HIV/AIDS in Africa receive treatment.
However, 72% of adults in Kenya are receiving treatment

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Figure 1: HIV PREVALENCE IN KENYA - KAIS 2007

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MODELS OF HIV/AIDS
There are two types of models: - Biomedical model
- Traditional model

BIOMEDICAL MODEL

At least a good number of people understand the biomedical model which gives the scientific facts
about HIV/AIDS. This model makes us understand that AIDS is a viral infection caused by HIV
which affects the immune system. This model gives us facts on the modes of transmission and how
to manage the disease. This model therefore gives us the true facts about the virus, AIDS
transmission, prevention, management etc. This is the model that should be passed to all members in
the community because it is about the reality.

TRADITIONAL AFRICAN MODEL

Every community has its own way of explaining HIV/AIDS. Traditionally, most Africans view the
disease as a curse. There is even religious explanation that HIV/AIDS is a curse from God for the
evils that people are doing in the world. The names used by some African communities to refer to
some illnesses suggest supernatural causes of HIV infection. Among the Tonga of Zambia, Lukanko
is the word used to describe “thinning” and persisted coughing that manifest in a man who has
engaged in sexual intercourse with a woman who has procured abortion or it may happen if a man
had sex with someone who had taken traditional medicine restraining her from having sex. Among
the Luo of Kenya, HIV/AIDS is attributed to Chira, a condition associated with one’s failure to
observe traditional cultural norms e.g. refusal of a widow to be inherited. When a woman whose
husband died of AIDS refuses to be inherited only to die soon because she too had AIDS, people
may ironically conclude that she died because of her refusal to be inherited. People in many cultures
of Africa have strong beliefs in curses and witchcraft as the main causes of death. Many
communities including Kenyans are still concealing the AIDS related illnesses bravely born or
saying that someone has died of malaria, meningitis, typhoid e.t.c. It is no wonder then that the
misconception and traditional beliefs associated with curses and witchcraft have enhanced the spread
of HIV/AIDS in Africa.

THEORIES OF ORIGIN OF HIV/AIDS

These are meant to reflect the assertions of speculators about the origin of HIV. In truth nobody yet
knows the origin of this virus although there are a number of theories purporting to account for it.

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HIV spread to humans from primates as in the case of many diseases. These types of diseases are
known as zoonoses (singular form is zoonosis) i.e. animal diseases that can be transmitted to humans
e.g. rabies, bird flu, swine flu, SARS (Severe Acute Respiratory Syndrome) e.t.c.
HIV probably originated from chimpanzees and mutated in humans to Human Immunodeficiency
Virus (HIV).
It is now generally accepted that HIV is a descendant of a Simian Immunodeficiency Virus because
certain strains of SIVs bear a very close resemblance to HIV. Many theories have been postulated on
how HIV originates and the most common theories describe how the viral transfer between animals
and humans takes place and how SIV became HIV in humans.
These theories include:
The Cut Hunter Theory (Natural Transfer Theory): It is the most commonly accepted theory. It
is said that the virus (SIV) was transferred to humans as a result of chimps being killed and eaten or
their blood getting into cuts or wounds on the hunter. SIV on a few occasions adapted itself within its
new human host and become HIV. Every time it passed from a chimpanzee to a man, it would have
developed in a slightly different way within his body, and thus produced a slightly different strain.
The Oral Polio Vaccine Theory: In this it is said that the virus was transmitted via various medical
experiments (iatrogenically) especially through the polio vaccines. The oral polio vaccine called
Chat was given to millions of people in the Belgian Congo, Ruanda and Urundi in the late 1950s.
Then it was cultivated on kidney cells taken from the chimps infected with SIV in order to reproduce
the vaccine. This is the main source of contamination, which later affected large number of people
with HIV. But it was rejected as it was proved that only macaque monkey kidney cells, which cannot
be infected with SIV or HIV were used to make Chat. Another reason is that HIV existed in humans
before the vaccine trials were carried out.
The Contaminated Needle Theory: African healthcare professionals were using one single syringe
to inject multiple patients without any sterilization in between. This could have rapidly have
transferred infection from one individual to another resulting in mutation from SIV to HIV.

The Colonialism Theory: The colonial rule in Africa was particularly harsh and the locals were
forced into labor camps where sanitation was poor and food was scare. SIV could easily have
infiltrated the labor force and taken advantage of their weakened immune systems. Laborers were
being inoculated with unsterile needles against diseases such as smallpox to keep them alive and
working. Also many of the camps actively employed prostitutes to keep the workers happy. All these
factors may have led to the transmission and development of AIDS as a disease.
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The Conspiracy Theory: According to a survey, which was carried among African Americans it
was found that HIV was manufactured as part of a biological warfare programme, designed to wipe
out large numbers of black and homosexual people. There is no evidence to disprove it, cannot be
accepted as there were no genetic engineering techniques at that time of emergence of AIDS.

TOPIC ACTIVITIES
1. This chapter gives an overview of the first two decades of the AIDS pandemic. What are your
expectations of the decade we are currently living in? What are your hopes?
2. Do you believe the data on the origins of HIV? What data would convince you?

FURTHER READING
Benson S. A (2004). Control of Communicable Diseases Manual.
Edward Alcano (2002). AIDS in the Modern World. 1st Ed.
Hung R. and Ross F. C (2004). The Biology of AIDS. 4th ED.
Hung R. and Ross F. C (2006). Aids, Science and Society. 2nd Ed

SELF ASSESSMENT
1. Why would Nyanza region have higher prevalence than other regions elsewhere in Kenya?
2. How can the HIV/AIDS pandemic be addressed globally when the nature of HIV/AIDS
differs in different regions?
3. How can the knowledge that HIV is a zoonosis be used to educate people to reduce bushmeat
hunting or their risk of infection during butchering?

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 MICROBIAL PATHOGENS
MICROBIAL PATHOGENS
A microbial pathogen is any microscopic organism that causes disease. Microbes are responsible for
many commonly found infections. There are various types of microbial pathogens.

Types of Microbial Pathogens

Viruses
These are sub-cellular agents which require a host cell to multiply. After passing through the host
membrane of the host cell, the virus depends on the host machinery for energy and synthesis of new
viruses. Viral diseases e.g. polio, ebola, influenza and Severe Acute Respiratory Syndrome (SARS)
account for 25% of deaths worldwide and 45% of deaths in Asia and Africa. Viruses are responsible
for four of the six leading global infectious killers. Viral infections cannot be treated but can be
prevented using vaccines. They can cause permanent disability and death, especially among children.

Bacteria
These are independent cellular organisms which reproduce by splitting in half and do not use a host
cell. Bacteria multiply rapidly and exist in all types of organisms. Bacterial infections e.g. typhoid,
cholera, tuberculosis and pneumonia can be treated using antibiotics. Malnutrition, parasitic
infections and poor sanitation contribute to increased susceptibility to bacterial infections which
account for 5 million deaths annually.
Parasites
A parasite is any protozoan, worm or arthropod that simultaneously injures and derives sustenance
from its host. Parasites cause diseases which are becoming more prevalent due to ecologic changes
and the AIDS pandemic. Parasitic opportunistic infections are flourishing in AIDS patients with
weakened immune systems e.g. cryptosporidiosis, strongyloidiasis, schistosomiasis.
Fungi
These are eukaryotes which usually cause mild diseases but a few can be very dangerous and life
threatening. As parasitic infections, AIDS patients are susceptible to fungal opportunistic infections
e.g. candidiasis, cryptococcal meningitis.
Relationship between HIV and Malaria
Malaria is a parasitic disease caused by Plasmodium parasite. Mosquitoes serve as vectors for the
spread of malaria to humans. Once infected, people with malaria suffer from anaemia and disorder of
the liver, lungs, kidneys and nervous system.
HIV/AIDS and malaria are two of the leading infectious killers worldwide, responsible for 2.7 and
1.1 million deaths respectively in 1999. According to a recent study, HIV and malaria can interact to

14
worsen symptoms in those who have contracted both pathogens. HIV infection has been correlated
with an increase in malaria infections and parasite density in adults, particularly in pregnant women.
A 2000 study on Kenyan mothers also found that women with HIV have lower levels of antibodies
against malaria. Malaria, in turn, allows for an increased HIV viral load in people with both
infections. In light of these infections, health workers are encouraged to emphasize preventive
measures against malaria in HIV-positive patients.

SEXUALLY TRANSMITTED DISEASES

Sexually Transmitted Diseases (STDs) also known as Sexually Transmitted Infections (STIs) are
infections spread from person to person through sexual activity or close sexual activity. The contact
could be vaginal, oral or anal sex or even touching infected areas of somebody and then touching
one’s own genitals. Bacteria, viruses, insects or parasites can cause STIs.
STIS are cases where the pathogen passed to an individual may not cause clinical signs and
symptoms while STDs are cases where the pathogen passed to an individual manifest in form of
clinical signs and symptoms.
STDs can be transmitted from person to person through unprotected anal, oral, or vaginal sex. Many
STIs do not have visible symptoms, and so people can be at risk and not know it if they do not use
protection every time they have sex. Even if an individual does not have any visible symptoms of an
STI, it is still advisable to use latex condoms or other barriers to prevent inadvertent transmission
(transmission without one’s knowledge due to absence of signs and symptoms).
STDs can be classified in two categories:
Depending on signs and symptoms manifested
Depending on the causative agent
Depending to signs and symptoms manifested
Ulcerative STDs which cause ulcers, sores, blisters, bumps or rashes on the genitalia.
Inflammatory STDs which damage the epidermal layer of cells lining the genitals and urinary tract
resulting to production of profuse discharge or pus from the genitalia
Depending on the causative agent
Bacterial STDS e.g. Chlamydia, Chancroid, Syphilis, Gonorrhea, Pelvic Inflammatory Disease (PID)
Viral STDS e.g. Genital herpes, Genital warts (Human papilomavirus), Hepatitis B
Parasitic STDS e.g. Pubic lice, Scabies, Trichomoniasis
Fungal STDs e.g. Candidiasis

General Signs and Symptoms of STDs

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  Any of these symptoms can mean, but does not necessarily mean that one has an STD:
 Skin changes include sores, blisters, bumps and rashes around private parts, genital area.
 The need to urinate or defecate frequently
 Irritation and/or a burning sensation when one urinates, sometimes with pain during urination
and defecation
 Genital and private part itching, burning sensation
 Noticeable pelvic pain (in females)
 Discharge from sex organs and unpleasant odour from the sex organs
 Swollen glands and fever

General Complications of STDs

 The germs may cause mental illness after some time

 The germs may hide in the body and can be passed on to one’s sexual partner during sexual
contact (inadvertent transmission)
 Can damage different organs in the body like the nerves, heart, brain, and may lead to death.
 Can cause a man to be infertile and cause a woman not to fall pregnant

Relationship between HIV and STDs

There are strong links between the transmission of STDs and HIV and therefore an understanding of
both of them is important for preventing their transmission.
The presence of an STD has been shown to increase the individual’s susceptibility to HIV in the
following ways:
The presence of genital ulcers that accompany STDs like syphilis, herpes or chancroid can result in
breakages in skin or around the genitals. These small openings are “gateways” for HIV entrance into
the human body. Close sexual contact with an individual who has HIV may allow the virus to enter
the body through these sores.
Inflammatory STDs like gonorrhea, Chlamydia and trichomoniasis lead to increased concentration of
cells targeted by HIV in genital secretions. Increased concentration of CD 4+ cells in genital secretions
can increase an individual’s susceptibility to HIV by providing HIV with more targets and potential
ways to infect the body. These increased CD 4+ cell concentrations occur because these white blood
cells all cluster in the area of the STI as part of the body’s natural immune response.
The presence of an STD increases the viral load present in a man’s semen or a woman’s vaginal
fluids. These increased viral loads increase the individual’s infectiousness and increase their chances
of transmitting the virus to a partner during close sexual contact.
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The presence of an STD in an individual may increase the gaps between the epithelial cells that line
the genital and urinary tracts. These increased gaps make it easier for HIV to enter the body so an
HIV negative individual with an STD will be more susceptible to contracting HIV because of the
presence of an STI.
The damage HIV cause to the immune system makes the symptoms of STIs more severe, longer
lasting, and more difficult to treat. Further, some STIs that are asymptomatic in HIV negative
individuals can have symptoms in HIV positive individuals. These symptoms may result in more
lesions or sores, which can contribute to the spread of HIV for the reasons mentioned above.
Individuals who receive treatment for STDs actually shed smaller amounts of HIV less often than
those who receive no treatment for their STDs. For this reason, infected individuals should seek
intervention and treatment if they know they are infected with an STI, and individuals who are
unsure should seek to be tested.

TOPIC ACTIVITIES
Keeping in mind the relationship between HIV and malaria, what public health measures can be
taken to fight coinfection?

SELF ASSESSMENT
1. Why is there stigma attached to STDs and seeking treatment for them?
2. Do you think HIV can be spread through mosquitoes? Why or why not?

HIV STRUCTURE AND LIFECYCLE

HIV STRUCTURE
Viruses depend on healthy cells in the human body in order to reproduce copies of themselves and
sustain their existence. They can be rod-shaped or spherical and can range from 20 to 200
nanometers (one nanometer is one billionth of a meter) in size. Viruses are made up of a nucleic acid,
either DNA or RNA, and a caspid, which is protective coat made of protein. Some viruses also
include external membranes.
The virus goes through a complex process to replicate:
After the viruses pass through the host cell’s membrane, the virus takes control over the host cell’s
machinery in order to produce copies of itself.
The components of the virus are created separately within the cell and then assembled to form a
functional viral unit, a process unique to viral replication.

17
During the assembly process, the new viruses that are created either destroy the host cell or bud off
from it.

Specific Parts of HIV

Not all viruses contain the same structural elements. Specific elements that are specific to HIV are:
Genetic Material: RNA provides the genetic information necessary for the virus to exist. It serves as
a blueprint to provide the instructions necessary for the virus to make copies of itself.
Enzymes: These are complex proteins that are located in the HIV. There are multiple types of
enzymes each serving specific functions. They are responsible for helping HIV replicate itself along
specific steps in the process. Three of the most important enzymes in the HIVare:
Reverse transcriptase: This enzyme reads the genetic material of the HIV, RNA, and processes it to
create a template of DNA that will be used as the specific blueprint for assembling the new viruses.
HIV is therefore referred to as a retrovirus whose genetic material, RNA, has to be converted to
DNA before the genetic information can be integrated into the host cell’s genome.
Protease: This enzyme helps the HIV mature into a full virus as it assembles itself
Integrase: This enzyme cuts the human host DNA and attaches a copy of the HIV DNA
Protective Coat (Viral envelope/ Caspid): The exterior of the HIV molecule includes protective
proteins to prevent damage to the genetic material on the inside. HIV needs to keep all their parts
together, especially when they are entering or exiting cells.
Surface Proteins: In addition to the protective coat, the surface of the HIV has special proteins to
help them bind to the cells they are going to infect. gp120 and gp41 are two important surface
proteins on HIV that help the virus grab onto the human cells it is going to infect.

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Figure 2: Structure of Human Immunodeficiency Virus

HIV LIFE CYCLE

HIV is classified as a retrovirus whose genetic material is RNA (Ribonucleic acid). RNA is single
stranded unlike the double stranded DNA (Deoxyribonucleic acid) found on the human bodies. In
addition to RNA, HIV is composed of a protein coat and a membrane envelope with viral proteins
gp120 and gp41. Each of these components has a function within the HIV life cycle. The life cycle
consists of the following 10 stages:
After infection, a free virus particle exists in the body and it cannot replicate unless it successfully
parasitizes a cell.
HIV comes into contact with a T-Helper cell and binds to specific cellular proteins that act as viral
receptors found on the membrane of that cell. These receptors normally function to communicate
with other cells, but have been exploited by HIV in order to initiate infection. The receptors are CD 4
and CCR5 or CXCR4. The initial contact and binding to the cell occurs when the viral protein gp120
binds to the cellular receptor CD 4. Fusion between the viral and host cell membranes occur when
gp41 binds to either CCR5 or CXCR4.
Following binding and fusion, infection of T-cell by HIV occurs. During this stage, the viral and
cellular membranes “melt” together and release the viral RNA genome and associated proteins, such
as reverse transcriptase.

19
In order to successfully infect a cell, the viral genome must become integrated into the host’s DNA.
For this to happen, the single stranded RNA must be converted into double stranded DNA. This
process is called reverse transcription and is performed by the enzyme reverse transcriptase.
NB
The word “reverse” is used to indicate that in all life forms other than retroviruses (“backwards”
viruses), transcription is the process of converting DNA to RNA. HIV however uses reverse
transcriptase to synthesize a double stranded DNA from RNA, instead of RNA from DNA like all
other life forms. Because of the uniqueness of reverse transcriptase, it was the first target for
antiretrovirals and the majority of drugs available target this step.
Once the double stranded DNA copy of the HIV genome has been produces, it must integrate into
the host cell’s DNA in the nucleus. The viral enzyme integrase cuts the host DNA and pastes the
viral DNA. The viral genes are now a permanent part of that cell’s DNA. The only way to remove
the viral genes is to destroy the infected cell.
After the integration process is complete, the cell is latently infected with HIV, which is now called a
provirus. If activated, the provirus begins transcription of RNA copies of its genes. Some of these
copies are used to produce viral proteins that build the new viruses, while others serve as new viral
genomes that will be packaged into those viruses.
When viral proteins are produced they are connected to each other like beads on a string. However in
order to function correctly and build the new viral components they must be cut apart. This
separation or cleavage is accomplished by the viral protease enzyme. Drugs called protease inhibitors
prevent this separation, thus preventing the final creation of new viral particles. After separation
occurs, the structural subunits of HIV mesh with the cell’s membranes and begin to deform a section
of the membrane. Through this process, the nucleocaspid is formed and wound tightly inside.
During budding, this nucleocaspid merges with the deformed cell membrane to form the viral
membrane.
The newly created viral particle is released from the cell, taking with it a piece of the cellular
membrane that now has gp120 and gp41 inserted into it.
The virus finishes protease processing of structural proteins and is ready to infect another cell.
This entire process takes about 14 hours and millions of new viruses are produced every day. ‘Viral
load’ is a measurement of the rate of virus production and indicates how actively HIV is being
produced. Scientists are not sure exactly how the infected T-cell finally dies after producing virus
particles, though several mechanisms are likely. However, after being used as a factory for making
new viruses for a period of time, the T-cells that have been hijacked by HIV eventually die. As more
T-cells die, the immune system becomes less capable of responding effectively to disease. One
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definition of AIDS is having less than 200 T-cells per milliliter of blood, even if the person is
symptom free. This person now has no defense against opportunistic diseases. As the viral load in an
individual increases, their T-cell count decreases.

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Figure 3: HIV lifecycle

PHASES OF INFECTION
It is important to note the special characteristics of the HIV lifecycle that allow it to evade attacks by
the body’s immune system. First, little virus is found free in the blood where it can be destroyed by
the immune system. Secondly viruses integrate their genetic material into the host chromosomes,
thereby establishing a stable carrying state within the infected cell. Thus, once cells are infected with
HIV, they continually produce viruses. Also noteworthy, is the latent stage that develops in many
cell directly after integration of the viral DNA into the cell’s DNA. In this latent stage, infected cells
replicate without being programmed to produce new viral particles. Later (usually years later), the

22
latent virus in these now widely infected cells become activated by some means and the process of
transcription begins to produce more viral particles. This activation of the latency stage creates a
dramatic spike in the viral load in the body as infected cells that have been produced over years of
latency are suddenly producing HIV. The end of this latency period is most likely closely linked to
the onset of AIDS, indicated by a lowering of the T-cell count below 200.

Figure 4: Graph of interplay between CD4 count and Viral Load in time

HIV/AIDS infection is divided into 5 stages. WHO classification is based on the presence of specific
signs and symptoms while CDC classification is based on CD4 T-cell count.
1. PRIMARY INFECTION PHASE (ACUTE SERO-CONVERSION ILLNESS) (Invasion of
the HIV Virus)
Characterized by the following:
A person HIV status changes from HIV – to HIV+ and it occurs 4-8 weeks after HIV infection.
Approximately 30%-60%of people infected with HIV will develop a glandular fever-like illness.
The viral load is very high during this phase because of the rapid and unchecked spread of the virus.

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There is significant drop in CD4 cells
Window period – this is the period from infection to seroconversion
Seroconversion – it is the development of detectable specific antibodies to microorganisms in the
serum as a result of infection
Prior to seroconversion, the blood tests seronegative for the antibody; after seroconversion, the blood
tests seropositive for the antibody
Incubation period - this is the period from infection to development of detectable signs and
symptoms.

2. THE ASYMPTOMATIC LATENT PHASE (SILENT PHASE)

Infected person shows no symptoms and may unwillingly infect new sex partners.
Virus still active in the body and continues to damage the immune system.
HIV test is the only way to know if one is infected.
Usually associated with a CD4 count of between 500 and 800 cells/mm3

3. THE MINOR SYMPTOMATIC PHASE

The body begins to loose ground and its capacity to replace CD4 cells. Virus level begins to rise.
This stage begins when the person infected begins to displays herpes zoster, skin rashes, 10%weight
loss.
CD4 cell count here is between 350 and 500 cells/mm3

4. THE MAJOR SYMPTOMATIC PHASE OF HIV INFECTION AND OPPORTUNISTIC

DISEASES
The CD4 counts decline while the viral load increases.
More and more HIV/AIDS symptoms begin to manifest
Major symptoms and opportunistic diseases begin to appear as the system continues to deteriorate.
Person is usually bedridden for up to 50% of the day during the last month.
CD4 count here is 150-350 cells/mm3
5. AIDS DEFINING CONDITIONS: THE SEVERE SYMPTOMATUC PHASE
Patients said to have full-blown ids.
Symptoms become more acute.
Patients bed-ridden for more than 50% of the day.
CD4 cell count here is below 200m.

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FACTORS THAT LEAD TO FASTER PROGRESSION OF HIV TO AIDSz
The length of time it takes for people with HIV to develop to AIDS varies from one person to
another. The following factors are thought to contribute to faster progression of HIV to AIDS:
1. Age
A person who gets infected after the age of 35 moves faster from HIV infection to full blown illness
than those who get infected in their mid 20’s. This is due to the strength of the immune system.
2. Types of HIV contacted by the person
HIV-1 is more dangerous (virulent) than HIV-2.
3. Mode of transmission
HIV got through blood transfusion kills faster than one got through sexual contact. This is due to the
fact that the amount of virus channeled into blood stream is in larger quantities.
4. Health and malnutrition
People who are sick move from HIV to full blown AIDS faster
5. Other types of infection
Tropical diseases such as malaria, typhoid and intestinal worms make the patient move faster from
HIV to AIDS.
Once one is confirmed to have full blown AIDS, if no effective treatment is given the patient
progresses to death within two years. Poor information on tropical diseases makes the two years
period even shorter in Africa.
6. Opportunistic infections
When white blood cells drop to 700 cells/ml of blood, the person is likely to develop opportunistic
infections because the immune system is very weak. The person eventually suffers the following:
weight loss, fever, diarrhea, fatigue, night sweats, open wounds around the penis and vagina.

25
 7. Other complications
When HIV infection matures to AIDS, the immune system gets destroyed by the virus. The patient
develops more opportunistic infections like meningitis, TB, pneumonia, skin cancer (KS) or cervical
cancer, candidiasis. These conditions tend to persist and they are difficult to treat in most cases.
8. The amount or concentration of the virus in the blood (viral load)
9. Infection with different strains of the virus (superinfection)
10. Individual difference in immune system
11. Stress of the immune system because of general lack of fitness and exposure to repeated
or severe infection
12. State of the mind e.g. anxiety, depression, stress etc.

TOPIC ACTIVITIES
Discuss in groups when someone infected with HIV is most infectious to others.

SELF ASSESSMENT
How does the existence of latency affect the ability of the immune system to control HIV?

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 THE IMMUNE SYSTEM
THE IMMUNE SYSTEM
The immune system is a collection of cells and processes dedicated to keeping the body functioning
and healthy. Upon the entry of a foreign agent (antigen/pathogen) into the body, the immune system
is activated.
The immune system works to protect the body from disease-causing organisms and cancers.
The first part of the immune system to be activated upon entry of a micro-organism is the innate/non-
specific immune response. It’s made up of several processes that occur in the body and tissue, and
physical barriers outside the body. Its made up of different types of white blood cells.
The phagocytes
These are white blood cells that specialize in destroying antigens by engulfing them. They are broken
down into 4 more groups:
Neutrophils – attack cells that have been infected with bacteria
Macrophages – attack cells that have been infected with a virus
Natural killer cells – attack cells that been infected with a virus and cancer cells
The second part of the immune system is the specific immune response which is tailored to attack a
specific antigen. It is comprised of the lymphatic system (lymph nodes). It can be grouped into two
responses known as humoral/antibody-mediated and cell-mediated immune response.
The Lymphocytes
Lymphocytes are white blood cells that respond specifically to a particular antigen. Lymphocytes are
divided into two types: B-lymphocytes and T-lymphocytes. The B-cell response is called the
humoral response and the T-Killer cells response is called the cell-mediated response.
Types of T-cells
Two main types of T-cells important for the immune system to function properly are: T-Helper cells
and T-Killer cells.
T-Killer cells (CD8 T-cells) attack and destroy virus infected cells and cancer cells.
T-Helper cells (CD4 T-cells) do not directly kill viruses or infected cells. Instead, they interact with
both B-cells and T-Killer cells and assist them in their defense.
B-cells
B-cells produce antibodies which are Y-shaped protein molecules that bind to specific antigens.
Antibodies can interfere with antigen function in several ways:
Antibodies can bind to the HIV and physically block the active site of the protein.
Antibodies can also bind to the antigen and signal destruction by macrophages
27
Antibodies can combine with antigens and activate outflow of complement which destroy the
antigen.
Other antibodies block viruses from entering cells

HOW HIV DAMAGES THE IMMUNE SYSTEM

Once HIV enters the body, it attaches itself to T-Helper cells which contain CD 4 (Cluster of
Differentiation) protein on their surface. T-Helper cells are important in coordinating the other
immune cells (Natural Killer cells, T-Killer cells and macrophages). The average count of CD 4 is
about 1000/ml of blood. However, with HIV infection, the number starts going down. Once the body
is infected, the immune cells respond by forming antibodies against HIV. It takes about 2-3 weeks
for the body to make antibodies against HIV. The antibodies start fighting the HIV and consequently
the number of viruses (viral load) declines. Unfortunately, HIV “detects” the fight and virus keeps
multiplying unchallenged and eventually overcomes the immune system which protects and defends
against diseases. During this time, the virus continues to multiply while the body attempts to create
antibodies, eventually exhausting the immune system’s ability to create antibodies against HIV. This
time when the body can no longer create antibodies is the immunity threshold, beyond which,
without the help of antiretrovirals, the immune system has exhausted its resources. This renders it
dysfunctional as it gets weaker giving way to other diseases.
Collapsing of the immune system is characterized by the onset of opportunistic infections (disease
which take advantage of a weakened immune system). This stage marks the onset of AIDS. AIDS
can also be defined as having less than 200 CD 4 T-cells/ml of blood even if the person is symptom-
free.
B-cells and T-cells contain the capacity to remember previous exposure to antigens which help
produce higher levels of antibodies faster after a second exposure. However, if there is mutation
causing the antigen to change, then all previous antibodies are rendered useless since their “target” is
no longer recognizable. HIV has one of the highest mutation rates ever recorded causing constant
and rapid change in its antigens. This mutation enables HIV escape destruction by the immune
system.
Another reason why HIV is able to disable the human immune system so thoroughly is due to the
fact that HIV specifically infects and kills T-Helper cells, vital and central players in the immune
system functioning. By reducing the function of T-Helper cells, HIV reduces the function of both the
humoral and cell mediated responses.
Whereas the major effect is on mature peripheral T-cells, HIV can also infect developing thymocytes
in the thymus which also express CD4 protein.

28
The rate at which the immune system gets weakened depends on many factors including individual
immune status. There are 3 categories of individuals classified according to how long or how fast it
takes between the time of infection and the body immune system getting overpowered by HIV.
Fast developers (0 – 5 years to develop AIDS)
Moderate developers (5 - 10 years to develop AIDS)
Slow developers (over 15 years to develop AIDS)

STRAINS OF HIV
There are two types of HIV: HIV-1 and HIV-2. Both types are transmitted by sexual contact, through
blood, and from mother to child, and they appear to cause clinically indistinguishable AIDS.
HIV-1 is common worldwide, is more virulent/aggressive and has a short incubation period. It also
has a high mutation rate (has several subtypes). HIV-2 is common in West Africa and rare elsewhere.
It is less aggressive and has a long incubation period.
The strains of HIV-1 can be classified into four groups: group M, group O, group N and group P.
These four groups may represent four separate introductions of simian immunodeficiency virus into
humans.

Figure 4: The different levels of HIV classification

Within group M there are known to be at least nine genetically distinct subtypes (or clades) of HIV-
1. These are subtypes A, B, C, D, F, G, H, J and K.
Occasionally, two viruses of different subtypes can meet in the cell of an infected person and mix
together their genetic material to create a new hybrid virus. Many of these new strains do not survive
for long, but those that infect more than one person are known as "circulating recombinant forms" or
CRFs. For example, the CRF A/B is a mixture of subtypes A and B.
Some sub-subtypes have also been identified: A1, A2, A3, F1 and F2.

However, no one has ever found a pure form of subtype E and I and its assumed that most of them
exist as CRFs.

29
The HIV-1 subtypes and CRFs are typically associated with certain geographical regions, with the
most widespread being subtypes A and C. Subtype A and CRF A/G predominate in West and Central
Africa, with subtype A possibly also causing much of the Russian epidemic.
Subtype B has been the most common subtype/CRF in Europe, the Americas, Japan and Australia
and is the predominant sub-type found among MSM infected in Europe.
Subtype C is predominant in Southern and East Africa, India and Nepal. It has caused the world's
worst HIV epidemics and is responsible for around half of all infections.
Subtype D is generally limited to East and Central Africa. CRF A/E is prevalent in South-East Asia,
but originated in Central Africa. Subtype F has been found in Central Africa, South America and
Eastern Europe. Subtype G and CRF A/G have been observed in West and East Africa and Central
Europe.
Subtype H has only been found in Central Africa; J only in Central America; and K only in the
Democratic Republic of Congo and Cameroon.
As virus mutation continue to occur, it is almost certain that new HIV genetic subtypes and CRFs
will be discovered in the future, and indeed that new ones will develop. The current subtypes and
CRFs will also continue to spread to new areas as the global epidemic continues.
It is possible for individuals to be infected with two or more strains if the body's immune response to
the first virus is not enough to prevent infection with a second strain.
Coinfection is dual infection during the acute phase; or infection with more than one subtype
simultaneously or before seroconversion.
Superinfection is infection with a second or more subtype after seroconversion.

NOTE
The high mutation rate of HIV makes antiretroviral and vaccine development difficult as vaccines
are dependent on creating effective memory cells.
TOPIC ACTIVITIES
Q. If both partners are HIV+ and the woman gets sick (AIDS) first, then who was infected first?
SELF ASSESSMENT
1. How does the body work to combat pathogens and how does the HIV evade those systems?
2. How does HIV destroy the immune system?
3. What problems do mutations of the HIV virus cause in vaccine research?

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 HIV TRANSMISSION

MODES OF TRANSMISSION OF HIV AND PREVENTIVE STRATEGIES

HIV can only be transmitted from one person to another via infected body fluids (blood, semen,
vaginal fluid and breast milk).
There are five modes of transmission:
1. Sexual intercourse with an infected person
This is the most common way of transmitting the virus from one person to another. There are two
important factors that influence the probability that an individual will contract the virus:
i. The person’s sexual behavior
ii. The prevalence of HIV in the individual’s community
Biological factors affecting HIV transmission through sexual intercourse:
Transmission of HIV is two to three times more likely in women than in men due to the following
reasons:
The surface area of the woman’s anatomy is larger, thus making it easier for HIV to enter an opening
The lining of the vagina is more fragile and porous than the skin of the penis, making HIV uptake
easier.
The lining of the vagina had more cells capable of becoming infected with HIV.
The presence of untreated STDs greatly increases the chance of HIV transmission
Another biological factor affecting HIV transmission is viral load. Studies have shown that people in
the very early stages of HIV and very late stages of AIDS have the highest viral loads and therefore
pose the most risk to their partners. However, no matter what stage of HIV/AIDS, it is still possible
to transmit HIV during unprotected sex.
The use of antiretrovirals (ARVs) can reduce a partner’s viral load and infectiousness, but does not
completely eliminate the virus from the body.
PREVENTION STRATEGIES
- Behavior change which entails Abstinence; Faithfulness; Reduction in number of sexual
partners someone has during his/her lifetime and Delaying onset of sexual activity
- Using latex condoms – properly and consistently
2. From mother to child
Transmission of HIV from mother to child can occur in two ways:
During delivery, which accounts for 75% of mother-to-child transmission, and
During breast feeding which accounts for 25% of mother-to-child transmission.

31
If babies are born with HIV, they may die within a year or two. However, some may live longer even
up to 8 years.
PREVENTION STRATEGIES
Treating the mother with an ARV during labour and giving the baby one dose after birth.
Exclusive breastfeeding of the baby for 6 months or not breast feeding the baby at all and feeding
them bottled formula.
3. Blood to blood contact
This is mainly spread when a person receives blood or organs from an infected person with HIV.
It can also occur during direct contact of blood and other bodily fluids in case of emergencies
PREVENTION STRATEGIES
Screening blood used for transfusion and organs used for transplanting. Since there is no 100%
surety with screening (due to the window period), blood transfusion should be limited to life
threatening cases only.
Selecting people of low risk of HIV infection to donate blood.
4. Blood to blood contact by using unsterilized needles or surgical equipments (medical
setup)
Infections occur when a person is injected with unsterilized needles in medical centres and if that
needle had been used on a person infected with HIV. Instruments used in surgery can come in
contact with blood, vaginal or seminal fluids and spread HIV.
PREVENTION STRATEGIES
Sterilization of medical equipment between procedures.
5. Blood to blood contact through unsterilized equipments used in any practices that cut a
skin
Unsterilized equipment include knives used for circumcision, tattooing instruments, razors for
shaving, drug users needles and silages. The virus can enter the mucus membrane or a break in the
skin or directly into the blood stream.
PREVENTION STRATEGIES
Sterilization of medical equipment between procedures.
Avoid sharing cutting equipment

TRANSMISSION OF HIV AT THE CELLULAR LEVEL

HIV exists predominantly within cells. Both virus and virus infected cells are not active for long
after exposure to air and light. A drop of HIV + blood is no longer infectious once it has dried.
Sexual activity and intravenous drug use are the most effective forms of transmission because blood,

32
semen and vaginal/cervical fluid have the most live cells and have minimal exposure of cells to light
and air.
Additionally, in order for HIV to be transmitted, HIV receptors (CD 4 surface proteins found in T
lymphocytes, macrophages and Langerhans cells) must be present. These receptors are found in the
highest number in cells in blood, so tears in the genitals made prior to or during sexual intercourse
makes a person more susceptible to HIV infection.
HIV can be transmitted via oral sex because macrophages and Langerhans cells are present in the
mucosal lining of the throat and oral cavity.

DRUG USE AND HIV TRANSMISSION

HOW DRUG USE RELATES TO HIV

Drug use is a major factor in the spread of HIV infection. Shared equipment for using drugs can
carry HIV and Hepatitis, and drug use is linked with unsafe sexual activity .Drug and alcohol use can
also be dangerous for people who are taking anti-HIV medications. Drug users are less likely to take
all of their medications, and street drugs may have dangerous interactions with HIV medications.

INJECTION AND INFECTION.

HIV infection spreads easily when people share equipment to use drugs. Sharing equipment also
spreads Hepatitis B, Hepatitis C, and other serious diseases .Infected blood can be drawn up into a
syringe and then get injected along with the drug by the next user of the syringe. This is the easiest
way to transmit during drug use because infected blood goes directly into someone’s bloodstream.
Even small amounts of blood on your hands, cookers, filters, tourniquets, or in rinse water can be
enough to infect another user. To reduce the risk of HIV and Hepatitis infection, never share any
equipment used with drugs, and keep washing your hands. Carefully clean your cookers and site you
will use for injection. A recent study showed that HIV can survive in a used syringe for at least 4
weeks. If you have to re-use equipment, you can reduce the risk of infection by cleaning it between
users. If possible, reuse your own syringe. It still should be cleaned because bacteria can grow in it.
The most effective way to clean a syringe is to use water first, then bleach and a final water rinse.
Try to get all blood out of the syringe by shaking vigorously for 30 seconds. Use cold water because
hot water can make the blood form clots. To kill most HIV and Hepatitis C virus, leave bleach in the
syringe for two full minutes. Cleaning does not always kill HIV or Hepatitis. Always use a new
syringe if possible.

DRUG USE AND UNSAFE SEX

33
For a lot of people, drugs and sex go together. Drug users might trades sex for drugs or for money to
buy drugs. Some people connect having unsafe sex with their drug use. Drug use, including
methamphetamine or alcohol, increases the chance that people will not protect themselves during
sexual activity. Someone who is trading sex for drugs might find it difficult to set limits on what they
are willing to do. Drug use can reduce a person’s commitment to use condoms and practice safer sex.

TOPIC ACTIVITIES
Q. Can HIV be transmitted through sweat, mucus, urine, faeces or saliva?
Q. Can HIV be transmitted through social activities like hugging, shaking hands, kissing, sharing
utensils or caring for an AIDS patient?
Q. Can mosquitoes transmit HIV?

SELF ASSESSMENT
1. What do you think are the biggest misunderstandings about how HIV is transmitted? How
might these misunderstandings be addressed?
2. Why do you think stigma exists about being near an HIV-positive person, shaking hands with
them, hugging them etc when HIV cannot be transmitted in these ways?
3. Do you think educating people about how HIV is transmitted will make them less likely to
engage in high risk activities like unprotected sex?

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 VOLUNTARY COUNSELLING TESTING (VCT)
A VCT is a confidential, free, voluntary and anonymous service located within specific NGOs,
healthcare and social services and referrals where high risk individuals can speak to qualified
professionals.
VCT offers information about HIV/AIDS, STIs and HIV testing.
Goals of VCT
1. Prevention of HIV/AIDS transmission through education, awareness and empowerment
2. Decreasing HIV related stigma and discrimination
3. Case finding

HIV CONSELLING
This occurs before and after HIV testing and even after knowing one’s status.
Counseling is important because HIV is an important part of a person’s life.
Testing allows a person to know his/her status and enables them make choices about his/her health,
behaviors; allows someone to discuss personal risks, safety, sexual partners and other behaviors.
When someone knows his/her status, there’s potential for HIV treatment with antiretrovirals (ARVs)
and for prevention of mother-to-child transmission of HIV.

Pre-test counselling

The counselor helps the client to assess behavioral/social risk factors that the client may have been
exposed to.
The counselor will inquire about the time of exposure to the virus since window period is important
in assessing accuracy of HIV results.
The counselor explains the meaning of positive and negative test for HIV/AIDS so that the client can
make an informed decision
The counselor provides adequate information and presents a harm reduction plan to the client.

HIV test/HIV detection

A rapid test is performed to detect the presence of HIV antibodies in blood.

Post-test counseling

The client is informed of his/her status

The client decides on a harm reduction plan and where he/she needs to be referred to (if required).

35
Follow-up counselling

Involves referral for treatment.

Disclosure counselling

Q. To tell or not to tell?

Q. Who do you tell? Immediate family? Sexual partners? Friends?
Advantages of Disclosure
1. Helps prevent transmission (protects partners).
2. Psychological benefits.
3. Increases social support, greater self-esteem and low levels of depression.
4. Helps in compliance and adherence to HIV treatment.
Disadvantages of Disclosure
1. Fear of discrimination, violence.
2. Fear of rejection/harm/shame.
Challenges to Disclosure
Desire to maintain secrecy and one feels that with safe sex there’s no need for disclosure and that one
has to protect themselves.

HIV DETECTION
During the initial weeks of infection with HIV, there are high levels of virus in the body making one
highly infectious. However, it is difficult to be diagnosed with HIV during this window of time as
majority of tests so not screen for the virus itself but for antibodies produces by your body against
HIV. It takes about 6 weeks to 6 months to generate antibodies that are detectable by most HIV tests
(seroconversion).
Different parts of the world use different HIV tests. These differ on how long they take to get results;
how expensive and the equipment used.
There are two types of tests: Direct and Indirect tests.
Direst tests detect the presence of the virus in blood or plasma but Indirect tests detect the presence
of antibodies against HIV in blood or plasma. For accuracy, indirect tests should be done after
seroconversion.
Direct tests: Western Blot, Polymerase Chain Reaction (PCR)
Indirect tests: Rapid tests, Enzyme-Linked Immunosorbent Assay (ELISA)
A good diagnostic test should be both sensitive and specific.

36
Sensitivity and specificity describes how well a test discriminates between patients with and without
disease.
Specificity is the proportion of patients without disease who test negative while sensitivity is the
proportion of patients with disease who test positive.

RAPID TESTS

The three most common rapid assay formats are immunochromatographic (lateral flow) strips,
particle agglutination, and membrane immunoconcentration. These tests require only one step.

Immunochromatographic (lateral flow) strips

The two most common kits in Kenya, Unigold and Determine, employ this technique.
A finger prick blood is applied to an absorbent pad at one end of the test kit. The blood diffuses
along the test strip and combines with chemicals embedded in the strip. If antibodies against HIV-1
or HIV-2 are present in the sample. Then a chemical reaction produces a colored line. This whole
process takes about 20 minutes and costs less than Kshs. 200.

Particle agglutination assay

It involves mixing plasma or serum with HIV antigen coated latex particles. If HIV antibodies are
present in the plasma or serum, crosslinking and agglutination will appear, which is visible to the
human eye. The test takes 10 to 60 minutes, it requires refrigeration and costs Kshs. 350 to 650.

Membrane immunoconcentration
This assay immobilizes HIV antigens on a porous membrane. Serum or plasma is poured over the
membrane, and then the membrane developed with a reagent/stain. A dot or line on the membrane
shows seroconversion. This test takes 5 to 15 minutes, does not require refrigeration and costs Kshs.
350 to 630.
ELISA TEST
It involves placing serum on a laboratory dish covered with virus protein. The antibodies in the
serum of a HIV-infected person will bind to the virus protein and will be picked up by a stain uses to
detect antibodies. If the person is not HIV-infected, no antibodies will bind and the dish will not be
staines because there are no antibodies present to bind to. ELISA is more that 99.9% accurate in
detecting HIV antibodies.
Western Blot
To guard against the stress of receiving a false-positive result (receiving a positive result, when a
person is in fact HIV-negative), in the US HIV-positive results are not given until they are confirmed
by a western blot analysis. HIV proteins are separated out using electrophoresis, which separates
molecules by size using an electric field, and then the proteins are transferred onto a paper substrate.

37
Serum of the possibly HIV positive person is added to the paper. If HIV antibodies are present in the
serum, they bind to complementary viral proteins e.g. gp41 antibody will bind to gp41 protein. This
can be seen using a stain. At least three specified HIV antigens must be bound by HIV antibodies for
the test to be positive. In this way, the western blot is more specific than ELISA.

NOTE
In HIV detection, the choice of test kit depends on the sensitivity and specificity of the test to prevent
chances of giving an individual false-positive or false-negative results.

TOPIC ACTIVITIES
Discuss with your friends the test kit you think is most appropriate. Is it appropriate to use more than
one test kit at the same time?

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 HIV MANAGEMENT
HIV management involves treatment and follow-up care provided to the People Living With
HIV/AIDS (PLWHA).
HIV TREATMENT
Understanding the life cycle of HIV, its functions and how it reproduces within the body, is crucial
for the development of effective drugs and a possible vaccine. By identifying the mechanisms by
which HIV replicates, scientists can pinpoint its vulnerabilities to target with drugs. Antiretrovirals
are drugs that target specific points in the HIV life cycle to disable the virus’ replication.
There currently exists no treatment for HIV or HIV infection. Thus prevention is a crucial step in
slowing the pandemic. All drugs currently being used to manage HIV infection and improve the
quality of life for those already living with the disease target specific parts of the virus’ lifecycle. A
common name for medications that help manage HIV is antiretrovirals (ARVs) or Antiretroviral
therapy (ART). The goal of these drugs is to decrease the amount of HIV in the body (viral load) so
that the immune system can function adequately.
Classes of ARVs
Reverse transcriptase inhibitors
These blocking or stop the function of reverse transcriptase (which uses HIV genetic material RNA
as a template for making a double stranded DNA copy to initiate its life cycle) by acting as a
“poison”.
E.G. Azidothymidine, Nevirapine, Viramune and Abacavire.
Protease inhibitors
These drugs bind to the functional region of protease enzyme and block its function.
E.G. Saquinavir, Indinavir and Ritonavir
Entry and Fusion inhibitors
These block the virus entrance into a cell thereby slowing progression from HIV to AIDS.
Entry inhibitors attach themselves to proteins on the surface of CD4 cells or viral proteins thus
blocking binding, fusion and entry of HIV into a cell.
They are normally used in combination therapy for the treatment of HIV infection especially in HIV-
positive people who have become resistant to protease inhibitors and reverse transcriptase inhibitors.
E.G. Albuvirtide, Fuzeon, Selzentry
Integrase inhibitors
These block the action of integrase enzyme. It’s usually taken in combination with other HIV drugs
to minimize adaptation by the virus.

39
 It’s also useful in SALVAGE THERAPY for patients whose virus has mutated and acquired
resistance to other drugs.
E.G. Raltegravir

HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)

This is a combination of more than one ARV in a cocktail to interrupt different phases in the virus’
lifecycle. In order to combat evolution of resistance and to suppress viral reproduction more
effectively, drug combination was developed in the 1990s and is now the recommended method of
treatment for all HIV-positive patients.
When HAART was first developed, it was a very complicated regimen of medications. Some people
had to take up to 70 drugs a day at different times with food/water/an empty stomach. Because of the
extreme difficulty in taking the medications correctly, some people missed doses, others suffered
side effects. This posed a major public health risk due to development of resistance if HAART
regimen is not followed.
Unfortunately, the complexity of the regimen had been used as a justification for denying HAART
therapy to people in poor, marginalized communities and developing countries.
Treatment allows the immune system to strengthen and fight infections effectively. To get the most
benefit from HIV treatment, one needs to take it as prescribed. This is known as adherence or
compliance.

Changing therapy
Side effects – when a drug affects the body in ways other than those that is intended. If the side
effects are so severe, an alternative drug is considered.
Treatment failure – when drugs fail to work and are not slowing the reproduction of the virus in the
body. This can be detected by fall in CD 4 count by more than 50% while the person is on treatment
or occurrence of new opportunistic infections or cancers.

HOME-BASED CARE
The increasing number of people developing AIDS calls for partnership among family members,
health care givers, local community based organizations and the persons themselves in providing
care and support to those infected and affected by HIV. Home based programs are being developed
as best options for caring for people with HIV.
What is Home Based Care (HBC)?
According to the World Health Organization, any form of care given to sick people in their homes is
considered home based care. It could mean the things people might do to take care of themselves or

40
the care given to them by the family or Health care workers. It includes physical, psychological and
spiritual activities.
It is the care of persons infected or affected by HIV that is extended from the health facility to the
patients’ home through family participation and community involvement with available resources
and in collaboration with health care workers.
It is the collaborative, holistic effort by the hospital, the family of the patient and the community to
enhance the quality of life of people living with HIV and their families. National Home Based Care
Programme and service guidelines, NASCOP Kenya 2002.

Objectives of Home Based Care

To facilitate the continuity of the client’s care from the health facility to the home and community.
To promote family and community awareness of HIV prevention and care.
To empower the family and the community with the knowledge needed to ensure long term care and
support.
To raise acceptability of being HIV positive by the family and community hence reducing stigma
associated with HIV.
To streamline referrals from the institutions into the community and from the community to
appropriate health and social facilities.
To facilitate quality community care to the infected and affected.

Components of Home Based Care

Home Based Care is comprehensive care across the continuum of care from the health facility
through to community/home level. It encompasses Clinical Care, Nursing Care, Counseling and
psycho spiritual care and Social support.
Clinical Care
This includes early diagnosis, rational treatment and planning for follow-up care of HIV related
illness, all referred to as clinical management of HIV.
Nursing Care
Nursing is the art of assisting individuals, sick or well, to do those things they would do if they had
the strength, knowledge or will or to a peaceful death.
Nursing care is aimed at alleviating physical or psychological symptoms as well as maximizing the
level of function of the affected person. Systematic assessment of the needs of the sick individual
and provision of care to meet those needs is important in achieving the nursing aims.
Counseling and Psycho-spiritual care
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Counseling is a professional helping relationship that assists people understand and deal with their
problems. It includes emotional support, promotion of positive living and helping with making of
informed choices/decisions.
Social Support
Social support for PLWHA is the creation of an enabling environment for all those involved in
providing care. It involves information dissemination and referral to support groups and welfare,
economic and legal services.

PRINCIPLES OF LONG TERM SURVIVORS (POSITIVE LIVING)

- Long-Term Survivors understand and accept that the reality of AIDS diagnosis, but also
refuse to believe that the syndrome is an automatic, imminent death sentence.
- Long-Term Survivors believe that they cope actively with the disease, and refuse to succumb
to a “helpless-hopeless” state.
- Long-Term Survivors make appropriate, individualized adjustments in personal habits and
behavior in order to accommodate living with the disease.
- Long-Term Survivors see the physician as a collaborator and take an active part in decisions
related to their own treatment. There is a sense of personal responsibility for health, and a
belief that they personally can influence the outcome of the disease.
- Long-Term Survivors show a “commitment to life”, there are unfulfilled goals, dreams and
unfinished business that they commit themselves to.
- Long-Term Survivors find meaning and purpose in life and even in the disease itself.
- Long-Term Survivors have usually had a previous experience with overcoming a life-
threatening illness or overcoming previous difficult situations and events.
- Long-Term Survivors report the importance of support and information from other persons
with HIV, and furthermore, are usually involved in active service to other persons with HIV.
- Long-Term Survivors are assertive, can say “NO” and withdraw from self-detrimental
involvements when self-care becomes necessary.
- Long-Term Survivors develop an ability to listen to their own body, and to sensitively care
for it, and to communicate openly about their concerns without feeling selfish.

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 HIV AND GENDER
Gender is the maleness or femaleness of an organism. Their roles are mainly determined by the
society. HIV and gender are correlated and studies have shown that women have a higher prevalence
of HIV than men due to biological, sociocultural and economic factors. We will learn how these
factors increase the vulnerability of women to HIV/AIDS.

Why is the infection rate for HIV higher for women than for men?
The infection rate of HIV/AIDS is higher for women than for men because women are more
vulnerable to contracting HIV for biological, sociological, cultural and economic reasons. This
means that there are certain aspects of a woman’s anatomy that make her more vulnerable to the
infection, and at the same time there are certain practices in society that make her more vulnerable as
well.

Biological factors

These factors include the following:

a. The surface area of the woman’s anatomy is larger, thus making it easier for HIV to enter an
opening
b. The lining of the vagina is more fragile and porous than the skin of the penis, making HIV
uptake easier.
c. The lining of the vagina had more cells capable of becoming infected with HIV.
d. The presence of untreated STDs in women greatly increases the chance of HIV transmission

Sociocultural factors increasing susceptibility of HIV in women

In addition to the fact that women are more susceptible to HIV infection because of their anatomy,
there are some sociological reasons that women are becoming infected with HIV at higher rates than
their male counterparts.
Current data estimates that around two-thirds of all HIV cases are transmitted through heterosexual
activity, but women are still being infected at higher rates than men.
1. Sex with Older Men
a. Marriage
There are economic pressures in Kenya that encourage families to marry off their daughters while
they are still relatively young.

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-Providing for children is expensive because children need food, shelter, school fees and clothing.
Parents may believe that they can reduce their own financial burdens by marrying off their daughters
to other families.
-A man who marries several wives during his lifetime may seek to marry a young girl because it is
believed that she (in her early to late adolescence) will have had less of a chance of contracting HIV
during her lifetime. A very young girl is unlikely to be sexually active before this marriage, and so it
is perceived that she has little chance of being HIV positive.
b. “Sugar Daddy Sex”
Some young girls who have no opportunities to get jobs or pursue their education may have sex with
older, richer men in exchange for school fees ,food, clothing or other types of valuable gifts.
This practice exploits young girls who are economically vulnerable and have no other options to get
the things they need to survive, attend school, and support their families. This practice increases a
young girl’s chance of contracting HIV because it is likely that this older man has had multiple
sexual partners in his lifetime.
Further when a young girl has sex with an older man who is pressuring her and giving her gifts or
money at the same time, it is unlikely that she will be able to convince him to use a condom if he
does not want to. The age difference and his power over her make it difficult for her to protect
herself.
c. Commercial Sex Work
Young girls who are economically vulnerable may engage in commercial sex-sex in exchange for
money-in order to secure their own basic necessities or the things they need for their families’
members. Girls who are especially at risk for this type of work are: orphans, girls who have been
abandoned by their families, or girls who do not receive support from their parents.
Aside from the fact that a commercial sex-worker may have little power to negotiate condom use
with her partner, it is a known fact that some men deliberately try to have sex with the youngest
commercial sex workers they can find. This is because the men believe that young girls do not have
HIV.
2. Difficulty to Negotiate Condoms
There are strong ideas about masculinity and sexuality in Kenyan culture. It is often believed that a
man cannot control his desire for sex. It is believed that he is driven by instinct and cannot control
his own behavior. This belief is sometimes used as a way for men to justify not using a condom.
They say that in the heat of the moment there is no time to get a condom or that it will ruin the sexual
experience for them. It is also difficult for women to negotiate condom use, because females who
buy condoms or keep them with them are often accused of “inviting sex” or being “seductive”.
44
Sometimes it is also difficult for partners to negotiate about condoms and protection because the man
makes the woman feel guilty or accuses her of being untrusting. Sometimes men will say, “Why
should we use condoms if we love each other?” Men sometimes also complain that a condom makes
the sex worse. They say things like, “Using a condom is like eating the candy with the wrapper still
on.” However, self-protection for a lifetime is more important than an isolated sexual experience.
3. Pressure to Have Children
There is often a lot of pressure on Kenyan women to have children –and especially male children -
because children and families are celebrated in Kenyan culture. Although children can be a real
blessing, sometimes women feel especially pressured to have male children, which may pressure
them into having large families in order to produce males. Male children carry special prestige that
female children do not because there are certain benefits the family receives form them. For
example, male children are expected to care for their elderly parents and support them later in life.
This is not expected of female children, who generally marry into another family and move to live
with their husbands. Male children are also highly valued in Kenyan culture because a wife’s
inability to produce male heirs for her husband may result in the husband taking other wives- a
practice which also puts the first wife at risk of contracting HIV or other STIs. For this reason,
Kenyan women may have little control over their sexuality and sexual activity.
Women who feel pressured to have many children have little bargaining power in their relationships
about when they want to have sex and when they do not. Also, women who are trying to have
children will not use protection –like condoms-and so if her husband becomes infected with HIV
over his lifetime, she will not be able to protect herself.
4. Numbers of Partners/Polygamy
A man’s sexual behavior is shaped by the culture and the ideas of masculinity that he sees around
him. It can be considered very “masculine” to have frequent sex and to have numerous sexual
partners. For this reason, women are often at higher risk for contracting HIV because their partner
may have been infected by another woman. The same idea is true for a man with multiple wives. It is
possible that a man with multiple wives could get HIV and then give it to all of his wives. In this
situation, when the man and woman are married, it is especially difficult for a woman to ask her
husband to use protection.
Polygamy involves multiple sexual partners and therefore can lead to increased transmission of HIV.
This situation most often occurs when a man takes on multiple wives. This custom can spread HIV
through entire families and leave many children without parents. Once the virus enters a family
where there is a husband with multiple wives, it is highly likely that the virus will be transmitted to
multiple members of the family over time.
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Other Issues Contribute to the Spread of HIV
In Kenyan society, there are some traditional practices used throughout the country by various tribal
groups that may contribute to the spread of HIV. These practices are wife inheritance, polygamy and
male and female circumcision if the tools are not properly cleaned.
5. Wife inheritance and Village Cleansing
When a married woman’s husband dies, she is inherited by a brother –in-law or another male family
member. The family members who inherits her, an act which is solidified through sexual intercourse,
then pledge to care for her and her children. Although a woman can sometimes choose not to be
inherited, she risks being ostracized from her community and is often cut off from the financial
support of her family members. In some communities this practice varies so that the widowed
woman is inherited by a “village cleanser”, a local man who is responsible for inheriting all widowed
women in the community. Although this practice is not very widespread in Kenya, it is still practiced
in some areas of the country.
This practice has contributed to the spread of HIV in Kenya because when a woman’s husband dies
of AIDS, she has often already been infected and is then forced to have sexual intercourse with
another family member who will then get the virus from her. This cycle continues and has been
devastating for many communities.
For many women, the choice to be inherited is really not a choice at all. Gender inequality in Kenya
makes it hard so that few women have the education or possess the skills necessary to support
themselves and their families on their own.

Economic factors
Women are dependent on men for multiple household and community roles, but they have very
limited access to autonomy and their own economic opportunities.
The lack of empowerment in women to negotiate monogamous relationship is because of economic
dependence, cultural taboos, and fear of rejection and even violence.
Of the 1.3 billion living in abject poverty in the world, 70% are women. Kenya’s areas of extreme
poverty are characterized by high infection rates in women who hold little or no legal rights. A sharp
correlation exists between poverty and prostitution as well as declined overall immunohealth.
Further increasing female vulnerability to HIV are girls’ tendencies to start sexual activity earlier
than boys, to have large numbers of sexual partners, to have high prevalence of sexually transmitted
diseases, and to be victims of violent sexual contact. The Kenyan Ministry of Health reported that
18% of women and girls become HIV-positive within two years of becoming sexually active (IRIN
Plus News,2003). Rape is also widespread, both within communities and inside marital relationships.
46
All these factors (biological, sociocultural and economic) fuel the overall HIV transmission in many
areas of Kenya.

FEMALE GENITAL MUTILATION AND MALE CIRCUMCISION

Female genital mutilation and male circumcision can be major sources of HIV transmission
especially in Africa where the two practices are often considered to be rites of passage into adulthood

MALE CIRCUMCISION

This is the surgical removal of the foreskin (prepuce) from the human penis.

a. Benefits
United Nations indicates that HIV spreads more quickly in places where male circumcision is
uncommon leaving men at a greater risk of contracting the disease during unprotected sex. Up to
97% of circumcised men have lower rates of HIV infection. Circumcision both removes tissue that is
susceptible to HIV infection and creates scar tissue which makes the tip of the penis less likely to be
abraded or torn during sexual activity.
Circumcision reduces the rate of infection, but does not abolish it. It reduces female to male
transmission by 33% to 68% in heterosexual men. WHO recommends including Voluntary Medical
Male Circumcision (VMMC) in comprehensive programs for prevention of HIV/AIDS transmission.
A latex condom is still the best protection for both circumcised and non-circumcised males.

b. Controversy
Recent research indicates that a lack of circumcision increases a male’s chance of contracting the
disease. Uncircumcised men are anywhere from twice to eight times at greater risk to HIV infection.
In spite of this, some scientists from the University of Illinois believe more studies need to be
conducted regarding the pros and cons of the practice.

c. Risks
The greatest problem with promoting male circumcision is that it is often done in an unsafe manner.
In many cases, especially in Africa, males are not circumcised until they are young adults and are
already sexually active. The same knife which is easily contaminated is then often used since the
exchange of blood is symbolic of brotherhood. Thus males who are already infected can easily pass
the virus onto other individuals involved in the ceremony.

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 d. Cultural Obstacles
Changing cultural practices proves difficult, though. In some tribes in Kenya, a sterilized procedure
would signify weakness and prevent the male from joining the rest of the men in the community. For
other tribes, who do not practice circumcision and feel that the foreskin is one of the defining
characteristics of their tribe, it is even more difficult to convince them adopt an entirely new practice
that they feel would decrease their uniqueness.

FEMALE GENITAL MUTILATION (FEMALE CIRCUMCISION)

This is the partial or total removal of the external female genitalia. FGM is almost always a
dangerous procedure.

Risks
Preservation of the intact surface of the female genital tract is an important defense against HIV.
Circumcision can lead to long term infection and ulcers which facilitate HIV transmission during
unprotected sex. According to WHO, consequences of inflammation of the genital area and partial
closure of the vagina may increase susceptibility to HIV. It can lead to enhanced tearing of the
vaginal lining during sex. An HIV positive woman who undergoes female genital mutilation can
easily pass the infection to other initiates since most of the traditional circumcisers use only one
blade to circumcise several girls. In addition to increased susceptibility to the virus, women are often
subjected to chronic urinary tract infections and vaginal obstruction.

CURRENT STATUS
Even though there is a presidential ban on FGM, it is still widely practiced throughout Kenya. Many
women are pressured are pressured into accepting the process by older women who inform them that
it is tradition that will welcome them into womanhood as well as make them attractive to future
husbands. Some believe that FGM will prevent promiscuity, promote virginity and make childbirth
easier.

STRATEGIES TO DECREASE THE TRANSMISSION OF HIV IN WOMEN

Education
Education for young girls is a strategy that will benefit the individuals and the society as a whole.
Education and schooling provide women with access to the knowledge and skills they need to make
informed choices about their lives .Research has shown that education allows girls and women to
make more informed choices about their health, families, and work activities. Even though education

48
is now free in Kenya, some girls are still forced to drop out because they cannot pay school fees or
because they need to care for younger siblings or help with chores.
The Kenyan Government also needs to work aggressively to make school a better environment for
girls. This would mean things like:
-building schools in villages where there are none so girls (and boys) do not have to travel long
distances: sometimes the travelling is difficult and becomes a barrier for girls and boys who want to
attend school.
-having more female teachers to support girls in school.
-designing curricula to encourage less sex-discrimination and start changing attitudes about
inequality between men and women.
Other Ideas
There are several other strategies that the government and individual villages should consider
undertaking in order to help girls and women reduce the risks of getting HIV/AIDS:
-Health education: teach young women and girls about how HIV is spread
-Transportation: allow women and children to have access to transportation so they get to visit
health clinics, VCTs, or hospitals. Women and children often do not drive cars and do not have
access to other means of transportation, so they are unable to get themselves to the places where they
can learn about health and take care of themselves.
-Property rights: Allow women and children to rightfully inherit property when their male family
members die so that they do not have to live on the streets, engage in commercial sex, or beg in order
to provide for themselves and their families.

NOTE
Most studies reveal that male circumcision, when done properly with sterile equipment, can reduce
the spread of the virus, while FGM is almost always hazardous to a woman’s health. The issue
remains how and if a balance between traditional practices and prevention of HIV transmission can
be accomplishes.

SELF ASSESSMENT
1. Should FGM be eliminated? If so, what would it take to stop it? What role should local health
officials and the government play?
2. Is it preferable to attempt to eliminate FGM or should officials focus on creating safer and
healthier methods of performing FGM?

49
3. To what extent is poverty, in terms of access to medical personnel, a possible hindrance to
safely performing male circumcision?

50
 AIDS -RELATED STIGMA AND DISCRIMINATION
Stigma is prejudice, negative attitude, abuse and maltreatment directed to people living with HIV and
AIDS. They manifest themselves differently across countries, communities, religious groups and
individuals and changes from time to time as information of the disease and availability of treatment
vary. Fear of transmission and value- based assumptions about people who are infected leads to high
levels of stigma surrounding HIV and AIDS.

HIV/AIDS STIGMA
Factors contributing to HIV and AIDS stigma
1. HIV is a life threatening- disease and therefore people react to it in strong ways.
2. HIV infection is associated with behaviors {e.g. homosexuality, drug addiction, prostitution
or promiscuity} that are already stigmatized in many societies.
3. Most people become infected with HIV through sex which often carries emotional
baggage/restrictions.
4. There is a lot of inaccurate information about how HIV is transmitted, creating irrational
behavior and misperception of personal risk.
5. Religious/moral beliefs lead some people to believe that being infected with HIV is the result
of moral fault and personal irresponsibility that deserve to be punished.
6. The effect of ART on people’s physical appearance can result in forced disclosure and
discrimination based on appearance.
TYPES OF STIGMA
a) Self stigma/ internal stigma: This refers to how people living with HIV/AIDS (PLWHA) regard
themselves and how they see the public perception of PLWHA. They are beliefs and actions imposed
by PLWHA themselves. This creates a wall of silence and shame around them.
e.g. In Vietnam - A HIV positive woman was afraid to handle her kid brother for fear of infecting
him.
b) Social stigma/ fear- based stigma
Refers to how the community/society perceives PLWHA. It is difficult to differentiate between
people infected with HIV and those not by the community.
Social stigma falls into various categories:
a. Government
61% of countries have legislation in place to protect PLWHA from discrimination.

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However 78% countries still criminalize vulnerable groups [MSMs and CSWs] and this presents
obstacles to providing effective HIV prevention, treatment, care and support.
e.g. Uganda doesn’t employ people with HIV in the armed forces;
China denies infected people with study/work visa;
United Kingdom prosecute people who pass the virus to someone else even if it was unintentionally.
b. Healthcare
- Most HIV positive patients are being refused medicine or access to facilities, receiving HIV testing
without consent and lack of confidentiality [73% breach of confidentiality by health workers]
- Lack of options for treatment of AIDS patients in resource-poor areas. They are therefore not
prioritized or are actively discriminated against.
- Fear of exposure to HIV due to lack of protective equipment fuels discrimination among doctors
and nurses in under resourced clinics and hospitals
e.g. In UK a dentist gave a HIV positive patient the last appointment despite the fact that she arrived
in the facility early enough. He then wore three gloves to prevent transmission.
c. Employment
Most HIV positive patients suffer social isolation, ridicule, termination or refusal of employment
from their co-workers.
e.g. China- disqualifies those infected with Human PapillomaVirus, Genital herpes or HIV from
employment
d. Restriction on travel and stay [study]
Many countries have laws that restrict entry, stay and residence of PLWHA. Deportation of PLWHA
has life threatening consequences if they’ve been taking HIV treatment. If deported to a country with
limited treatment provision, this could lead to drug resistance and death.
e. Community
Community level stigma manifest as banishment, rejection, verbal and physical abuse even murder.
Segregation leads to depression, anxiety and loneliness.
e.g. HIV positive patients face murder in Brazil, Colombia, Ethiopia, India, South Africa
Community level stigma causes people to leave their homes, change daily activities like Shopping,
schooling, socializing e.g. in a British school a pupil suffered discrimination and was not allowed to
have any playmates. Other parents demanded his transfer from the school to a foster home or they
would all transfer their children from the school.
f. Family

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The family is the first caregiver when someone falls ill but not all are supportive. However women
and gay family members are more likely than children and men to be mistreated. This leads to
psychological distress and emotional burden on those left behind and denial of its existence.

CONSEQUENCES
Being shunned by family, peers, and with the wider community; loss of income
Poor treatment in healthcare and education settings-denied opportunities
An erosion of human rights - loss of reputation
Psychological damage-[difficulty in acceptance]- denial and feelings of worthlessness
Negative effect on the success of HIV testing, treatment and disclosure
Loss of marriage/ childbearing option
NB: People who reported high levels of stigma were four times more likely to report poor access to
care. Unwillingness to take HIV test means that people are diagnosed late when the virus has already
progressed to AIDS making treatment less effective causing early death.

HUMAN RIGHTS ISSUES AND HIV/AIDS

Human rights are fundamental rights possessed by all human beings and which must be honored and
respected at all times by other people and enforced by governments. These rights are meant to
provide for the protection of the rights of women, children and all civil, political, economical, social,
racial and cultural rights of all people. Governments are required to uphold the rights on three
different levels: respecting the right, protecting the right and fulfilling the right.

THE HUMAN RIGHTS AND ETHICS OF HIV/AIDS

Human rights cannot be upheld when basic needs are not met and this greatly magnifies the problem
of HIV/AIDS. Issues of human rights as they relate to HIV/AIDS include the following:
1. Access to Antiretrovirals and Highly Active Antiretroviral Therapy
For those infected, access to drugs and better health care systems can help reduce one’s pain and
suffering while promoting a longer and higher quality of life. Unfortunately, very few people,
especially in developing countries, have access to antiretrovirals (ARVs) or highly active
antiretroviral therapy (HAART). Only 1% of HIV-infected people in Africa have access to
antiretroviral therapy.
Providing access to these drugs is a point of controversy especially when western pharmaceutical
companies are not willing to reduce the price of these products to meet the demands of developing
countries. Pharmaceutical companies argue that the quality of their research and their capacity to
continue producing new drugs would be significantly reduced if they distributed drugs for free or at a

53
reduced price. Others argue that pharmaceutical companies are the most profitable companies in the
world.
This raises some difficult ethical questions:
Should companies receive compensation for their work or does the suffering of HIV-positive people
demand that prices of ARVs or HAART be reduced so that they enjoy better health and their right to
life?
Whose responsibility is it to provide affordable medication? The industry? National governments?
The World Health Organization? The United Nations?
2. Reduction of stigma
The stigma of HIV causes people to lose their jobs, to be ostracized by the community or family or
be denied medical treatment. Some people are infected through no fault of their own and they should
not be considered as bad or cursed or promiscuous people. Empathy with infected people reaffirms
their dignity. Lessening stigma through recognition of human rights creates an environment where it
is not important how one contracted HIV and blaming others for the infection. In this kind of
environment, HIV-positive people are more likely to access VCTs, care and treatment services
leading to an increased quality of life and a reduced risk of them transmitting the virus to other
people.
3. Right to privacy
Considering the lethal nature of HIV and the mechanism of transmission, should HIV-positive
people have the right to privacy or should they be forced to disclose their HIV status? Currently the
right to privacy is upheld, in large part, due to stigma attached to HIV. However, some churches
require an HIV-test before marrying people. Mandatory testing has been discussed for people of
child-bearing age or those in high risk situations, but it is in many ways a violation of individual
rights.
Q. Whose rights should have priority – those of the HIV-positive person or those of the people who
could be infected by the HIV-positive people?
4. Right to healthcare
Many people consider health care a fundamental right and therefore treatment for AIDS and AIDS-
related infections should be made available to all. The inability to access effective AIDS prevention
and treatment violates the basic rights of millions of people in the developing world.

SUMMARY
HIV/AIDS related stigma has been a major challenge in the fight against HIV/AIDS. There are two
types of stigma: self and community stigma which manifest differently in different regions. On the

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other hand there are human rights meant to protect those living with HIV/AIDS. Understanding both
will go a long way in reducing the prevalence of HIV.

NOTE
By 2011 – 34 million people were living with HIV and AIDS, and 1.7 million deaths. Preventing this
epidemic goes hand in hand with combating stigma and discrimination; and educating PLWHA on
their human rights and ethics.

How do we change people’s attitudes to AIDS?

By:
Enforcing rights of people living with HIV by education to communities and patients
Teaching respect, understanding, tolerance to condemn prejudice and enhance social existence
Empowering people living with HIV to take action if their rights are violated.

SELF ASSESSMENT
1. Where should the bulk of the responsibility lie in ensuring the human rights are upheld?
(International/National/Regional/Local)? And what types of organizations
(governmental/religious/independent) should have the biggest role?
2. Who discriminates against HIV positive people the most?

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 THE ROLE OF GOVERNMENT AND OTHER STAKEHOLDERS IN THE FIGHT
AGAINST HIV/AIDS

INTRODUCTION
The government is the most important stakeholder in the fight against HIV/AIDS because of the
magnitude involved. It has shown goodwill especially at policy level which has made the country to
achieve some milestones in the fight against HIV/AIDS.

GENERAL ROLE OF GOVERNMENT IN FIGHTING HIV/AIDS

1. Provision of funds and other resources
2. Training of personnel involved in HIV/AIDS
3. Providing leadership and political goodwill
4. Provision of VCT services
5. Providing a conducive environment for other stake holders to participate
6. Awareness creation through provision of information and materials on HIV/AIDS
7. Playing a regulatory role in controlling all activities from all the stakeholders
8. Provision of ARV’s
9. Establishment of government organs to fight HIV/AIDS
10. Providing a legal framework on matters concerning HIV/AIDS

THE KENYAN GOVERNMENT RESPONSE TO HIV/AIDS

Kenyan government has done quite a lot in HIV/AIDS management. After reporting the first cases in
1980’s the governments throughout the continent reluctantly addressed the issue of HIV/AIDS. In
1997 World Health Organization facilitated setting up of National Aids Control Programmes
(NASCOP) in various countries with major aim of saving blood supply, monitoring confession of the
disease and creating awareness on HIV prevention.
With excavation of HIV/AIDS cases, the government realized the need for clinical care, home based
care and currently VCT and ARTs. Between 1980 and 1989 the Kenyan government did not take
HIV/AIDS seriously. There were many rumours and myths surrounding the plan with a few activities
on prevention and awareness.
Between 1992–1994, NASCOP was established in the Ministry of Health to coordinate awareness,
prevention and blood screening.

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In 1997, sessional paper number 4 on importance of advocacy and policy on HIV/AIDS was
developed. The goal of this paper was to provide policy frame work in which AIDS prevention and
control was to be undertaken by government in the next 15 years.
This proved the recognition of the disease and commitment of the government to fight HIV/AIDS.

NATIONAL AIDS CONTROL COUNCIL (NACC)

After HIV/AIDS was declared a national disaster NACC was established under office of the
president and made operational on 26th Nov 1999.
This body was made to provide strong leadership to coordinate all HIV/AIDS programmes nationally
through multisectoral approach and to mobilize resources for prevention, care and support of the
infected and affected.
FUNCTIONS OF NACC
1. To develop policies and guidelines relevant to prevention, control and management of
HIV/AIDS
2. To mobilize resources for HIV/AIDS prevention, control and management.
3. To coordinate and supervise the implementation of HIV/AIDS programmes at various levels
by all stakeholders in the country.
4. To collaborate with local and international agencies towards prevention, control and
management of HIV/AIDS.
5. To facilitate the setting up of sectoral programmes of HIV/AIDS
6. To mobilize all stakeholders to participate in prevention, control and management of
HIV/AIDS.
7. To develop strategies to deal with all aspects of HIV/AIDS pandemic

AIDS CONTROL UNITS (ACUs)

They were first established in government ministries and department to provide leadership and
advocating of NACC policy. Later they were extended to state operations parastatals, local authority,
private sectors, NGOs and other stake holders.
FUNCTIONS OF ACUs
1. To adopt infrastructure and human resource planning
2. To address the change in size and structure of Kenya population in relation to HIV/AIDS
3. To introduce new services and change mode of service delivery in HIV/AIDS matters
4. To bring reforms that protects rights of people living with HIV/AIDS

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 5. Encourage effective roles in prevention and care by all stakeholders
6. Make proposals to NACC on best ways of HIV/AIDS intervention
7. Coordinate implementation of inter-sector commitment on HIV/AIDS reduction
8. To ensure implementation of NACC policy, promote culture and behavior change among the
staff
9. To develop guidelines on how to use the allocated resources
10. To build network with other ACUs
11. To conduct statistical analysis and compile data according to NACC requirements

PROVINCIAL AIDS CONTROL

The NACC secretariat cannot supervise all the districts in Kenya and provincial AIDS control
committee were established in the eight provinces to supervise, support and coordinate the
implementation of NACC activities. PACC membership is drawn from Ministry of health at
provincial level and civil society.

DISTRICT AND CONTROL COMMITTEE

DACC are designed to contribute to the coordination and implementation of NACC strategic plan at
District level. Membership is drawn from ministries at district level, civil society and private sector
and from people living with AIDS.
FUNCTIONS
- To communicate and implement policies in institutions in the district
- To monitor implementation of the NACC policy
- To cost potential intervention at district level and forward recommendation to PACC
- To prioritize various intervention according to resources available
- To collect information on NACC intervention strategic activity
NB: DACC recommends to NACC through PACC the exact requirements at district level after the
assessment.

CONSTITUENCY AIDS CONTROL COMMITTEE (CACC)

The smallest unit of NACC is CACC which operates at constituency level. They work closely with
DACC to plan and to prioritize interventions at community level. Selection to CACC is guided by
geographical representation in the constituency, gender, technical capacity, people living with
HIV/AIDS in the constituency, knowledge of accounts and any other key resource person.

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FUNCTIONS OF CACC
- To mobilize community
- To take active roles in fighting HIV/AIDS
- To operate as agents within the respective communities
- To form elders committee on cultural issues related to HIV/AIDS
- To promote behavior change with emphasis to STDs, VCT management etc
- To facilitate participation of youth in fighting HIV/AIDS
- To provide leadership on local resources and utilization
- To develop sustainable community owned mechanisms on HIV/AIDS prevention, control and
management.
- To provide and strengthen income generating activities to eradicate poverty especially among
the youth and women
- To develop and to design community based programmes to care for the infected, orphans and
others affected.
- To identify and prioritize needs of those affected by HIV/AIDS
- To develop network for collaboration with other organizations in the district.
- To establish monitoring and evaluation system and to submit quarterly and annual reports to
NACC

KENYA NATIONAL HIV/AIDS STRATEGIC PLAN 2000-2005

The plan was launched in 2000 with the principal objective of stopping the pandemic and reducing
the impact on Kenyan society and the economy by:
- Reducing HIV/AIDS prevalence by 20 – 30% by year 2005
- Accessing health care and counseling to the infected and the affected
- Enhancing response capacity and coordination at all levels
This strategic plan addresses five key priority areas:
1. Prevention and advocacy
This is to be done through:
- Promotion of behavior change
- Awareness of HIV/AIDS in schools and colleges
- Protecting children and youths from HIV/AIDS
- Promotion of VCTs
2. Treatment

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This is to be done through availing ARVs and other useful therapies including home-based care
(HBC) and social support.
3. Monitoring and evaluation and research of infrastructure of fighting HIV/AIDS
4. Management and coordination
5. Gender and HIV/AIDS

THE ROLE OF NGOs (CHARITABLE ORGANIZATIONS)

They were the first ones to help initiate HIV/AIDS programmes especially the international NGOs.
They worked in collaboration with community based organizations to create awareness which was
the main aim. They later started prevention campaign and currently they are involved in all areas
concerning HIV/AIDS.

ROLE OF NGOs

- Provision of funds even to government bodies like NACC

- Conducting training and education on HIV/AIDS through seminars, conferences, workshops,
open meetings etc.
- Provision of drugs and other medical services to the infected.
- Providing for the socio-economic needs of the infected and the affected e.g. providing food,
shelter, small loans etc.
- Establishment of care centers for the infected, the affected and the community in general.
- Strengthening the capacities of the communities in fighting HIV/AIDS especially through
empowerment of the disadvantaged in the community.

FAITH BASED ORGANISATIONS (RELIGIOUS)

Initially FBOs were reluctant in the fight against HIV/AIDS because people were viewing them as
people of God and were therefore not to be associated with HIV/AIDS, a disease they considered
belonging to the immoral people. Later on even religious leaders started suffering and dying of
HIV/AIDS.
This changed religious people perception towards HIV/AIDS and agreed that it affects every person
in the world. Religious based organizations have some strengths which helps them in this fight in the
following ways:
They are basically healing organizations especially due to faith based counseling which makes it
easier to deal with the infected people

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They reach out to large numbers of people
They have good network that enables them to implement HIV project within the community level
They are leaders who command a lot of respect
They already have other projects which can be expanded to accommodate HIV/AIDS

ROLES OF FAITH BASED ORGANISATIONS IN THE FIGHT AGAINST HIV/AIDS

- They open, run and offer counseling services and testing centers
- Their teachings are part of the campaign especially on youth who are taught to abstain from
sex until marriage
- They have care centers for the infected and the affected where they are involved in
empowering people
- Some have been directly involved in vigorous campaigns on HIV prevention
- They train and disseminate information on HIV/AIDS e.g. they train social workers,
counselors, care takers etc
- They advocate and lobby on behalf of the vulnerable group
- Some of them provide funds to CBO (Community Based Organization)
- They are involved in fighting out stigma and discrimination

THE PRIVATE SECTOR

Initially most employers discriminated the infected people. Once an employee was found positive
he/she was immediately terminated. This affected the fight negatively because the infected decided
to keep it secret.
As time went by employers were forced to change their policies but some employers still insist on a
medical test before employing somebody. This was to avoid employing people who are already
infected. With time the employers themselves started being affected; this changed their perception
and most stopped discrimination. The government policies were put in place against discriminating
people with HIV/AIDS. Currently the private sector is actively involved in fighting against
HIV/AIDS.

THE ROLES OF PRIVATE SECTORS

- Giving funds that help in financing ARTs programmes for their works and families
- Initiating AIDS control units within their organizations to educate their staffs on HIV/AIDS
- Giving assistance to the dependant of the sick and those who have died

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 - Many have started training programmes for part of their workforce who in turn bring their
colleagues
- They provide funds and other materials to the government agencies, NGOs and CBOs
involved in HIV activity

THE ROLE OF COMMUNITY BASED ORGANISATIONS

The CBOs have played a major role in the fight against HIV/AIDS
They have initiated projects on awareness creation, HBC and they have contributed in changing
perception of HIV/AIDS
They have contributed a lot in promoting acceptance of people living with HIV/AIDS
CBOs are easy to initiate because they mostly rely on locally available resources
The government, NGOs and religious organizations have given a lot of support to CBOs since they
have realized participation at community level is the best strategy in the fight against HIV/AIDS.
Change at community level will translate into change in all other levels in the society

NOTE
Each government has its own way of allocating resources and different stakeholders with various
roles to help fight HIV.

TOPIC ACTIVITIES
1. Discuss in groups why the governments should be involved in the fight against HIV.
2. Discuss the successful responses to the AIDS pandemic by the Kenyan government.
Brainstorm ways in which the Kenyan government been unsuccessful and how could these
efforts have been more effective.

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 HIV TRANSMISSION FACTS AND MYTHS
Myths are false information or statements that are not supported by scientific findings but continue to
be shared widely through the Internet or popular press. Below is a fact sheet to correct a few
misperceptions about HIV.

Fact Sheet to Correct Misperceptions About HIV

Myth No. 1: I can get HIV by being around people who are HIV-positive.
HIV is not spread through touch, tears, sweat, or saliva. One cannot get HIV by: breathing the same
air as someone who is HIV-positive; touching a toilet seat or doorknob handle after an HIV-positive
person; hugging, kissing, or shaking hands with one who is HIV-positive; sharing eating utensils
with an HIV-positive person; using exercise equipment at a gym
You can get it from infected blood, semen, vaginal fluid, or mother's milk.
Myth No. 2: I don't need to worry about becoming HIV positive – ARVs will keep me well.
Yes, ARVs are improving and extending the lives of many people who are HIV-positive. However,
many of these drugs are expensive and produce serious side effects. None yet provides a cure. Also,
drug-resistant strains of HIV make treatment an increasing challenge.
Myth No. 3: I can get HIV from mosquitoes.
Because HIV is spread through blood, people have worried that biting or bloodsucking insects might
spread HIV. Several studies, however, show no evidence to support this -- even in areas with lots of
mosquitoes and cases of HIV. When insects bite, they do not inject the blood of the person or animal
they have last bitten. Also, HIV lives for only a short time inside an insect.
Myth No. 4: I'm HIV-positive -- my life is over.
In the early years of HIV epidemic, the death rate from AIDS was very high. But today, ARVs allow
HIV-positive people and AIDS patients to live much longer, normal, and productive lives.
Myth No. 5: AIDS is genocide.
In one study, as many as 30% of African-Americans and Latinos expressed the view that HIV was a
government conspiracy to kill minorities. Instead, higher rates of infection in these populations may
be due to a lower level of health care.
Myth No. 6: I'm straight and don't use IV drugs -- I won't become HIV-positive.
Most men become HIV-positive through sexual contact with other men or through injection drug
use. However, about 16% of men and 78% of women become HIV-positive through heterosexual
sex.
Myth No. 7: If I'm receiving treatment, I can't spread the HIV virus.

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When HIV treatments work well, they can reduce the amount of virus in your blood to a level so low
that it doesn't show up in blood tests. Research shows, however, that the virus is still "hiding" in
other areas of the body. It is still essential to practice safe sex so you won't make someone else
become HIV-positive.
Myth No. 8: My partner and I are both HIV positive -- there's no reason for us to practice safer sex.
Practicing safer sex can protect you both from becoming exposed to other (potentially drug resistant)
strains of HIV.
Myth No. 9: I could tell if my partner was HIV-positive.
You can be HIV-positive and not have any symptoms for years. The only way for you or your
partner to know if you're HIV-positive is to get tested.
Myth No. 10: You can't get HIV from oral sex.
It's true that oral sex is less risky than some other types of sex. But one can get HIV by having oral
sex with either a man or a woman who is HIV-positive. Always use a latex barrier during oral sex.

NOTE
Misconceptions about HIV has contributed a lot to the spread of HIV. Understanding the facts about
HIV will go a long way in preventing HIV transmission.

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 SOCIOECONOMIC IMPACT OF HIV/AIDS
HIV/AIDS is a threat to the socio economic development and community stability influencing the
productivity of Kenyan citizens for years to come.

SOCIOECONOMIC IMPACTS
1. Socioeconomic status (SES) affects HIV infection
A lack of socioeconomic resources is linked to the practice of riskier health behaviors, which can
lead to contraction of HIV e.g. early debut of sexual activity and less frequent use of condoms.
Unstable housing arrangement and being homeless has been linked to risk for HIV infection
including IDUs and unsafe sexual behaviors
2. HIV Status Affects SES
HIV has a negative impact on SES by constraining an individual’s ability to work and earn income.
Up to 45% of people living with HIV are unemployed.
The effects of HIV on physical and mental functioning can make maintaining regular employment
difficult.
HIV patients find that their work responsibilities compete with their health care needs.
Some HIV patients are discriminated against in their work place, leading to their termination or
forced resignation.
Children infected with HIV have mental/cognitive deficits compared to their uninfected peers. These
deficits can affect learning and earning ability later in life
3. SES Affects HIV Treatment
Treatment of HIV/AIDS patients must be accompanied with other social measures to enhance their
physical, mental and social wellbeing
SES determines access to HIV treatment. Individuals of low SES have delayed treatment reducing
their chances of survival.
Patients of lower SES have more HIV-related diseases and early death from HIV/AIDS (faster
progression of HIV infection to AIDS).
Decreased access to health insurance and preventive services is a major contributor to health
disparities between high and low income individuals. Low income individuals are less likely to have
health coverage or receive optional treatment and care for HIV/AIDS, such as Highly Active
Antiretroviral Therapy (HAART).

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4. HIV/AIDS affects economic growth by reducing the availability of human capital. HIV/AIDS
infects people at the peak of their productive and income generating years leading to poverty,
affecting particularly women and young people.
It weakens family and societal support systems, decreased participation in formal education of young
people as a result of AIDS in the family, along with depleted family income due to loss of work, and
poor disease management present additional vulnerabilities.
Increases HIV/AIDS related deaths (mortality) result in a smaller skilled population and labor force
who are predominantly young people, with reduced knowledge and work experience leading to
reduced productivity.
An increase in worker’s time off to look after sick family members or sick leave also lowers
productivity. This has mainly affected the agricultural sector which involves the largest share of
Kenyan labor force.
Increased mortality weakens the mechanisms that generate human capital and investment in people,
through loss of income and death of parents.
By killing off mainly young people, AIDS weakens the taxable population, reducing the resources
available for public expenditure e.g. education and health services. This increases pressure for the
state’s finances and slower growth of the economy.
5. AIDS slows economic growth in developing countries thus lowering gross national product.
For individual families, HIV infection is often accompanied by loss of income, increased medical
expenditures and ultimately high funeral rates. This leaves millions of AIDS orphans without proper
access to food, education or medical services. The instability in the orphans’ lives affects their
opportunities for education and social development.
6. Hospitals are running out of beds to take care of AIDS patients.

NOTE
Increased HIV prevalence weakens the GDP of a country and investment in people, through loss of
income and death of parents. It is therefore of paramount importance to reduce HIV transmission.

TOPIC ACTIVITIES
1. Explain the measures taken by financial institution to minimize the risks of HIV/AIDS.
2. Find out the requirements that are needed to minimize the impacts of HIV/AIDS

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