CHAPTER TWO

BASICS OF HIV/AIDS

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 objective

At the end of this chapter students will be able to :

• Identify magnitude of HIV/AIDS
• Distinguish the differences between HIV and AIDS.
• Describe Risk and Vulnerability factors related to HIV/AIDS
• Explain the modes of HIV/AIDS transmissions and Preventions
• Explain the impact of HIV/AIDS at different levels( quality of education,
development, etc.)
• Participate in community based HIV/AIDS prevention, care and support
activities
•
•
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 What does HIV mean?
HIV stands for:
• HUMAN: it affects human beings.
IMMUNODEFICIENCY: is a condition
in which the immune system, consisting
of white blood cells, is not working and
the body cannot fight disease germs.
VIRUS: an organism that causes infection.
HIV is the name of the virus. When
somebody is HIVpositive,it means the virus is
present in his/her body and blood. It does not
necessarily mean that the person is ill
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 What does AIDS mean?
AIDS stands for
ACQUIRED: you get it from somebody else.
IMMUNE: it affects the immunesystem, the
white blood cells of our body that fight disease.
DEFICIENCY: the immune system no longer
works well.
SYNDROME: not just a single illness,but many
different symptoms and infections develop
because the immune system cannot fight off
other diseases.

4
 History of AIDS

1999: Origin of HIV-1 Discovered. A research

team from UAB lead by Dr Beatrice Hahn
identified a subspecies of chimpanzee native to
West-Central Africa as the natural reservoir for
HIV-1. Viruses related to HIV-1 had previously
been found in chimpanzees and were given the
designation SIVcpz (for Simian Immunodeficiency
Virus).

Both HIV-1 (chimpanzees) and HIV-2 (sooty

mangabeys) originated in Africa.
Why the epidemic arose in the mid-20th century
is not clear. 5
People in some African nations contract
the virus by eating 'bushmeat'

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• 1981: PCP and Kaposi’s sarcoma reported by doctors in
NY and Los Angeles. CDC reports in MMW a strange killer
pneumonia spreading among gay men. Is was designated
as GRID (Gay-Related Immune Deficiency). Referred to as
“Gay Cancer.”
• 1982-1985: Cases of AIDS in 1982 began to be reported
by fourteen nations. In 1982 CDC received its first report
of "AIDS in a person with hemophilia (from a blood
transfusion), and in
infants born to mothers with AIDS.” N.S.-Janet and Randy
Conners
• 1983: Dr. Montagnier announced the
isolation of LAV retrovirus
(lymphadenopathy-associated virus),
which later was identified as the cause
of AIDS. 33 countries reported cases.
• 1984: Dr. Robert Gallo of the NCI
isolated HTLV-III retrovirus ( Human Hollywood leading man Rock Hudson, died of
T-cell lymphotropic virus III). It was later AIDS shortly after making it public thus
becoming the first major public figure to
determined that LAV and HTLV-III were the same virus
• 1985: AIDS awareness was brought to the public's announce that he had AIDS. An HIV blood test
was brought to large companies to make it
consciousness, available in large scale. 7
 Facts about HIV/AIDS

• Key Points
• HIV is the virus that causes HIV infection. AIDS is the most advanced
stage of HIV infection.
• HIV is spread through contact with the blood, semen, pre-seminal
fluid, rectal fluids, vaginal fluids, or breast milk of a person infected
with HIV. In the United States, HIV is spread mainly by having anal or
vaginal sex or sharing drug injection equipment with a person infected
with HIV.
• The use of HIV medicines to treat HIV infection is called antiretroviral
therapy (ART). ART involves taking a combination of HIV medicines
(called an HIV regimen) every day.
• ART can’t cure HIV infection, but it can help people infected with HIV
live longer, healthier lives. HIV medicines can also reduce the risk of
transmission of HIV.
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 Magnitude and curreny status of HID/AIDS
Introduction
The fact that the HIV/AIDS epidemic severely affects Sub
Saharan Africa is now well documented (Caldwelk J.C.,
1993 ; UNAIDS, 2000). According to UNAIDS statistics,
Sub-Saharan Africa alone accommodates 70 % of people
living with HIV/AIDS in the world. For year 2000 alone,
3,200,000 persons were newly infected in Sub-Saharan
Africa and 2,400,000 died of AIDS. The average infection
ratio for Sub-Saharan African countries was estimated at
8.57 % and the figures were particularly higher in
countries such as South Africa,Zimbabwe, Botswana and
Côt d'Ivoire rica, (UNAIDS, 2000). e

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10
11
 Global summary of the AIDS
epidemic2013
About 6,000 new HIV infections a day in 2013
 About 68% are in Sub Saharan Africa

 About 700 are in children under 15 years of age

 About 5,200 are in adults aged 15 years and older, of whom:

─ almost 47% are among women
─ about 33% are among young people (15-24)

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13
14
Treatment coverage in Eastern and
Southern Africa
18.5 million people living with HIV
in ESA in 2013
7.7 million people receiving ART
in 2013

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 Ethiopian Prevalence
National prevalence for 2003 ......... 4.4%
National Prevalence for 2005 ........... 4.7%
Women….5.0%
Men….3.8%

Urban prevalence in 2003...................12.6%

Urban prevalence in 2005...................12.5%

Rural prevalence in 2003 .................. .2.6%

Rural prevalence in 2005................... .3.0%

Addis Ababa prevalence in 2003 ........14.6%

Addis Ababa prevalence in 2005 ........14.5%

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 IMPACTS OF HIV/AIDS
AIDS on Agricultural Production
Agric. Production is express as a% change in
production.
This impact is felt through:
Fall in labour productivity
Reduction in income which in turn can cut
crop yields and
agricultural output
The changes may be in two folds
Smallholder farming
Commercial farms
E.g. in Africa, depend on smallholder agriculture
sector for their livelihood,
Thus; observed negative impact on HIV/AIDS WILL
EVENTUALLY DOWN PLAY FOOD SECURITY
It will also undermine economic basis of a country and
thus retard development
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 Impact cont….
Business Sector
Is measured in the profile of a % change in the enterprise
profit or as an increase in cost to firm
A number of studies have examined the cost of AIDS
and in terms of
-Higher absenteeism
-Increased payments for medical care and funerals
-Cost on worker replacement and training.

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 Impact cont….
Health
Hospital bed occupancies is high
Public Health spending to AIDS prevention
and care is increased Low standard of care
due to lack of skill staff Fund to be used for
other developmental purposed will be
utilized to care PLWHA

[Link] AND HEALTHCARE

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 POVERTY AND HEALTHCARE
Hence poverty implies deprivation or human needs
that are not met .It is generally understood to arise
from lack of income or assets. This may be :
Absolute or Relative
The absolute poverty line remains and seeks to identify
people who are destitute for instance lack of an income
or assets base and the access to social services that mean
that individuals or household cannot obtain sufficient
food to eat, shelter and health care.
Relative
This define the minimum ‘basket’ of goods and services
about which there is some agreement within a society
that all citizens should have. People are relatively
deprived if they cannot obtain the condition of life,that is
the diet ,amenities ,standards and services which allow
them to play their roles.
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 IMPACT ON............

Economic
AIDS epidemic has the greatest impact on the most
productive :thus
The spread of the disease having devastating
effect at the
household
Community
Sectoral level
Significant negative consequence for the
national economy.

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 IMPACT ON............

Development:
It hinders all parameters developments
•Economic
•Impact On Household
•Agricultural Production
•Business Sector
•Education
•Health

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 IMPACT ON............

Demography:

With high infective rate

-Life expectancy become
shorter
-The population distribution
become sparse .More active
segment of the society is
gradually lost etc.

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 Culture and HIV/AIDS…..
Culture
Beliefs, traditions, values, ways of life

[Link] References Potentially Risky

Cultural Traditions Cultural Customs
•Widow inheritance •Forced marriages
•Polygamy •Sexual experiments
•Funeral Rites
among the youth
•Reproductive Value systems •Commercial sex
•circumcision/excision •Sugar daddies/mummies
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 Impact Cont...........
Education
Is portrayed in terms of a reduction in
school enrolment as a result of
-Infant and child death
-Decreased fertility
-In terms of # of teachers ill or dying of
AIDS
-Or mortality rate amongst education
professional
-Thus this have direct effect on national
development.
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Global response towards HIV/AIDS

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Global response……….

BY HUNDUMA D 27
 Purpose of the Strategy
 Builds on our new vision and mission – providing a
pathway towards long-term vision of getting to zero
 Responds to a changing world – the HIV response is at a
pivotal juncture, we need to face threats and take
advantage of opportunities
 Presents a transformative agenda to help break the
trajectory and sustain support

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 Transformation agenda
Focus and efficiency to radically reduce new infections

Focus – Directing resources to where they have most impact on the

epidemic—to hotspots, interventions, countries
Efficiency – Reducing unit cost, innovative delivery systems, involving
communities, integrating services
Partnership – Supporting country ownership and south-south
cooperation, engaging communities and emerging economies
Enhancing mutual accountability through shared ownership
 People
 Countries
 Synergies

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 Strategic Directions
Revolutionising HIV prevention Catalysing the next phase
 Political commitment to why of treatment, care & support
people are getting infected  Access to effective treatment
 Communities demand when people need it
transformative change  Strong national & community
 Resources directed to hotspots and systems
what works  Access to care, support & social
protection

Advancing human rights & gender equality

 Protective social & legal environments
enable access
 Equitable service provision reaches
people most in need
 HIV-related needs and rights women
and girls addressed
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 Natural history of HIV/AIDS
Four Stages of HIV:
Ones aperson acquire HIV
virus it passes
four sges to develop syptomes of
Stage 1 -
the disease.
Primary
Short, flu-like illness - occurs one to six weeks after infection
no symptoms at all
Infected person can infect other people

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 Natural history of HIV/AIDS…
Stage 2 - Asymptomatic
Lasts for an average of ten years
This stage is free from symptoms
There may be swollen glands
The level of HIV in the blood drops to very low
levels
HIV antibodies are detectable in the blood

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 Stage 3 - Symptomatic
The symptoms are mild
The immune system deteriorates
emergence of opportunistic infections and cancers

•Mouth
infections
•Fever
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 Natural history of HIV/AIDS…
Stage 4 - HIV 
AIDS

The immune system weakens

The illnesses become more severe
leading to an AIDS diagnosis.
The 4th stage is known as the stage
Of kaposis sarcoma and PCP.

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 Transmission of HIV/AIDS
HIV is the name of the virus. When somebody is HIVpositive,
it means the virus is present in his/her body and
blood. It does not necessarily mean that the person is ill .
What is the difference between HIV and AIDS?
HIV: is the name of the virus.
AIDS: is the name of the disease that people infected
with HIV develop.
When a person becomes HIV-infected, it
takes usually about 5 to 10 years before
symptoms of AIDS develop. Babies and
children often develop the disease faster.
During those first years, an HIV-infected
person can look totally healthy, and can
still transmit the virus to others!

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 Transmission of HIV/AIDS
Routes of transmission of HIV
Unprotected sexual intercourse with an infected
person
Both men and women at risk
Women more at risk
Risk increases further in the presence of STIs
Anal intercourse- higher risk

Transfusion of infected blood/blood products

Fastest rate of transmission Can happen through
blood transfused or use of unsterilized infected
needles / syringe
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 Routes of transmission of HIV
contd…………..
Sharing of Infected needles/syringes
Small amounts of contaminated blood left in needles or
syringes can carry the HIV virus from user to user.
Among IDUs, transmission occurs by sharing drug
paraphernalia.

From infected mother to the baby

During pregnancy in womb;
During birth; and
Post- delivery through breast milk

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 Progression from HIV infection to stage of
AIDS

Normal Healthy Individual

Gets infected with HIV
WINDOW PERIOD (3-12 weeks or even 6 months)
(Antibodies to HIV not yet developed, test does not capture
the real status but person can infect others)
HIV Positive
(Development of antibodies, can be detected in test)
No exclusive symptoms (mild fever or flu like features in
somecases)
May take up to 10 to 12 years to reach the stage of AIDS, the
period can be prolonged through available treatment 38
 Major Signs / Symptoms of AIDS:
(A) Major Signs:
Weight loss (> 10% of body weight)
Fever for longer than a month
Diarrhea for longer than a month
(B) Minor Signs:
Persistent cough
General itchy skin diseases
Thrush in mouth and throat
Recurring shingles (herpes zoster)
Long lasting, spreading and severe cold sores
Long lasting swelling of the lymph glands
Loss of memory
Loss of intellectual capacity
Peripheral nerve damage

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 How HIV does not spread?
HIV does not spread by normal social contact
- Shaking hands
Living together in the same house / hostel
Sharing clothes/towels
Sharing toilets
Eating together
Through mosquitoes bite
Sharing equipment (telephone, computers, machines etc.)
Kissing Does not spread by social kissing as viral load in
saliva is low in the presence of ulcers in the mouth or
bleeding gums - deep kissing or French kissing may be risky

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Risk and vulnerablity to HIV/AIDS…
Risk:High possiblity to aquire the Hiv virus.
Vulnerablity:Most likely to be exposed to the
virus
Risk and Vulnerabe groups to Hiv/Aids
prostitutes work finders
• Gay man lesbians
• poverty countries Women
• Peoples who inject the drugs Bisexual
• IV drug users and Surgeons
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 Risk and vulnerablity to HIV/AIDS…
Vulnerability Factors
Biological Infected person with
Economic other STIs
Social
Cultural
“Women are most vulnerable to
HIV infection, given the social and
economic disadvantages they
face in their day to day lives.”

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 Common misconceptions on Hiv/Aids
HIV is the same as AIDS.
Sex with animals is ameans of preventing HIV/AIDS:

In 2002, the National Council of

Societies for the Prevention of Cruelty to Anim
als
(NSPCA) in Johannesburg, South Africa,
recorded beliefs amongst youths that
sex with animals is a means to avoid AIDS or
cure it if infected.[11] As with "virgin cure"
beliefs, there is no scientific evidence
suggesting a sexual act can actually cure AIDS,
and no plausible mechanism by which it could
do so has ever been proposed. The risk of 43
contracting HIV via sex with animals is small,
 Common misconceptions on…
• Sexual intercourse with a virgin will cure
AIDS. The myth that sex with a virgin will cure
AIDS is prevalent in sub-Saharan Africa.
[8][9][10]
Sex with an uninfected virgin does
not cure an HIV-infected person, and
such contact will expose the uninfected
individual to HIV, potentially further
spreading the disease. This myth has
gained considerable notoriety as the
perceived reason for certain sexual abuse
and child molestationoccurrences,
including the rape of infants, in Africa.
44
 Common misconceptions on…
• HIV antibody testing is unreliable
• Progress in testing methodology has enabled detection
of viral genetic material, antigens, and the virus itself in
bodily fluids and cells. While not widely used for routine
testing due to high cost and requirements in laboratory
equipment, these direct testing techniques have
confirmed the validity of the antibody tests.
• Positive HIV antibody tests are usually followed up by
retests and tests for antigens, viral genetic material and
the virus itself, providing confirmation of actual
infection.
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 Common misconceptions on…
• HIV-positive individuals can be detected by their
appearance
Due to media images of the effects of AIDS, many
people believe that individuals infected with HIV
always appear a certain way, or at least appear
different from an uninfected, healthy person. In
fact, disease progression can occur over a long
period of time before the onset of symptoms, and
as such, HIV infections cannot be detected based
on appearance.
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 Common misconceptions on…
• HIV is transmitted by mosquitoes
When mosquitoes bite a person, they do not inject the blood of
a previous victim into the person they bite next. Mosquitoes do,
however, inject their saliva into their victims, which may carry
diseases such as dengue fever, malaria, yellow fever, orWest
Nile virus and can infect a bitten person with these diseases.
HIV is not transmitted in this manner. On the other hand, a
mosquito may have HIV-infected blood in its gut, and if swatted
on the skin of a human who then scratches it, transmission is
hypothetically possible, though this risk is extremely small, and
no cases have yet been identified through this route

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 Common misconceptions on…
• HIV survives for only a short time outside the
body
HIV can survive at room temperature outside the body for hours if
dry (provided that initial concentrations are high), and for weeks
if wet (in used syringes/needles). However, the amounts typically
present in bodily fluids do not survive nearly as long outside the
body—generally no more than a few minutes if dry. Again, the
amount of time is longer if wet, especially in syringes/needles and
related equipment.
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 Common misconceptions on…
• HIV/AIDS is a disease of curse launched from
GOD for those did sex.
• But those who didn’t do sex can acquire sex
• other modes of transmissions.
An HIV-infected mother cannot have children.
But they can have until thet are in reproductive
ages.

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 How we can correct misconception on
HIV/AIDS?
The ony means of correcting misconceptions
is creating social [Link]:
• Raising the issues of HIV/AIDS on social
medias.
• Teaching the students at any level of
educations.
• Encouraging health Education programes

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 Prevention methods of HIV/AIDS
• Pevention of HIV/AIDS is based up on the level
of infection e,I after or before that person
acquire the disease.
1 ,primary preventions:Are the methodes we
use before acquiring the viruse. It is abreviated
as ABC [Link] systeme is used as dual
protections e,i protects from HIV/AIDS and
other sexual transmitting diseases.

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 Prevention methods of HIV/AIDS
• 1. A bstaining from sex
• 2. Being faithful to a partner who
is faithful to you.
3. Condom use
Abstinence :Don’t be afraid to say
No to do sex.
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 Prevention…………
• Do not have sex until you are
married. You can enjoy your
relationship and love in nonsexual
ways, which do not spread HIV, such
as kissing and hugging.

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 Prevention…………
• “Hey, that’s easier said then done...But how
do I deal with my sexual urges?”
MASTURBATION: (selfsatisfaction through
stimulation of one’s own genitals) is a healthy
way to release sexual urges without a partner.
Although most people won’t admit it, many
do it regularly. Contrary to many beliefs, it is
safe. It does NOT lead to any physical or
mental weakness, and does not give disease
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 Prevention…………

Be faithful to your partner!

• If you can’t abstain from sex, then be faithful to one partner, who
is not infected and who is also faithful to you! Avoid many sexual
[Link] will decrease the risk of you catching HIV.

HIV & Marriage

Both partners should get an HIV test before marriage. Inform your partner of your
status, so you can both make informed decisions about whether or
not to continue with the marriage. If you marry an HIV+ person,
then you can still enjoy sex, but always using a condom is a must.

55
 Prevention…………
• IF you don’t want to abstain, or IF you or your
partner or not faithful, or IF you are not sure if
your partner has HIV, then don’t take any
risks. Always use a condom

SAY NO !to wards unprotected

sex and un faith full
sex.
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 How to use a condom?
• You can use a condom to avoid getting infected
with HIV or other sexually transmitted
infections (STIs). It is very risky for you to be
exposed to other sexually transmitted
infections if you already have HIV. It is also
important that you use the condom correctly.
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 How to use a condom….?
1 Check the expiration date.
2 Open the package carefully without
damaging
3 Put the condom on only after the penis is fully
erect
4 Always hold the space at the end of the condom to
squeeze out air, and then gently roll it on the penis
5 Check to make sure there is space at the tip and
that the condom is not broken.g the condom
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 How to use a condom….?
6 With the condom on, insert the penis for
intercourse. The condom must be on during the
whole time of penetrative sex. If it slides off or
breaks, put on a new condom.
If you use lubricant, use only water-based lubricants
(not oil-based, which may dissolve the condom).
7 After you have finished, hold onto the condom at
the base of the penis. Keeping the condom on, pull
the penis out before it gets soft. Remove the
condom carefully without spilling the semen.
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 How to use a condom….?
8 Tie a knot in the used condom and dispose
of it in a safe place such as an enclosed
trash container or in a pit latrine or toilet
Always use the condom only once for
every sex act.

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 Screening Blood transfusion
SCREENING:Is the process of checking OR
filtering weither the blood is free
from pathogenes or infected.
Before any blood transfusion screening is a
precondition for any pationts .
HIV cannot penetrate through intact skin.
People get HIV when HIV-infected blood mixes with
their blood. Infected blood can come from blood
transfusion. If you need a blood transfusion, then
insist on blood which has been tested for HIV.
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HIV, Pregnancy and Preventing Maternal to
Child Transmission

62
 PMTCT…..
• Introduction:
• HIV is a family infection
• Mothers and fathers have an impact on
transmission of HIV to the baby
• There is increased chance of transmission
to the baby when a woman becomes
infected with HIV when she is pregnant or
breastfeeding
• Partners should have safer sex
throughout pregnancy and while
breastfeeding
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 PMTCT…..
Pregnancy Outcome: Goals

• Uncomplicated pregnancy
• Healthy, uninfected infant
• Healthy mother who has not
compromised her future options
for HIV therapy

64
 PMTCT…..
HIV and Pregnancy

Pregnancy does not accelerate the

progression of HIV disease to AIDS
Patients with AIDS are more likely
to suffer from pregnancy-related
complications

65
 PMTCT…..
Effect of Advanced HIV on
Pregnancy Decreased fertility:
• Spontaneous abortion
• Infections (opportunistic, GU,
postpartum, post-surgical)
• Preterm labor
• Premature rupture of membranes
• Low birth weight babies
• Stillbirths
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 PMTCT…..
Estimated Risk of MTCT
Transmission Rate
Without Any
Timing Interventions

During pregnancy 5-10%

During labor and delivery 10-15%
During breastfeeding 5-20%
Overall without breastfeeding 15-25%
Overall with breastfeeding to six months 20-35%
Overall with breastfeeding to 18-24 months 30-45%
Note: Rates vary because of differences in population characteristics such as maternal CD4+
cell counts, RNA viral load and duration of breastfeeding.

67
 Factors Influencing MTCT
• Viral Load
– The higher the viral load, the higher the
risk of MTCT
• Lower risk through:
– Use of ART during pregnancy and
postpartum to mother and newborn
– Adequate nutrition, particularly vitamin
A

68
Factors Influencing MTCT (2)….

Maternal factors increasing risk:

• Viral or parasitic placental infection
(especially malaria)
• Becoming infected with HIV during
pregnancy
• Severe immune deficiency
• Advanced clinical and immunological
state
• Maternal malnutrition

69
 Factors Influencing MTCT (2)….

Fetal Conditions increasing risk:

Premature delivery
Low birth weight
Immature immune status
First infant in a multiple birth
Oral diseases

70
 National Strategies for PMTCT
•Primary prevention of HIv in
childbearing women
•Prevention of unintended pregnancy in
HIV-positive women
•Prevention of transmission fromHIV+
women to their infants
•Treatment, care and support of women
infected with HIV, their infants and their
families

71
 Antenatal Care
Primary prevention during
pregnancy
• Education about safer sex with
use ofcondoms for mother and
father
• Early treatment of STIs
• Safer sex during pregnancy
andlactation
•Offer VCT to all pregnant women
Antenatal visits are vital
opportunities for PMTCT for both
HIV-positive and HIV-negative 72
Care of the HIV+ Pregnant Woman
Treatment: Prophylaxis:
• OIs • Anemia
• STI • Tetanus (Toxic-TT)
• UTI • Vitamin deficiency
• Vaginal candidiasis • Malaria
• ARV • Pneumonia (PCP)
• Vitamin supplements • TB

73
 National PMTCT
Drug Regimen to the Mother Regimen to the Baby

Antepartu Intrapartum
m

1) 200 mg po at ^^2 mg/kg po single

Nevirapine onset of labor dose within 72 hours
postpartum x1

2) 300 mg po 300 mg po 4 mg/kg BID po for 7

Zidovudine BID from every 3 hours days beginning at 8-
36 weeks 12 hours postpartum
onwards

600 mg at Same as above

onset of labor
then 300 mg
every 3 hours**

3) Combination of zidovudine and nevirapine as above

74
 Intrapartum Nevirapine
Single dose (200 mg) to
mother in labor:
• Rapidly absorbed
• May rapidly reduce mother’s
viral load in blood and birth
canal
• NVP crosses placenta and enters
baby
• NVP provides prophylaxis to the
baby during the birth
• No side effects with single dose
(hepatotoxicity or rash) 75
 Postpartum Nevirapine
Single dose (2 mg/kg, 0.2 ml/kg)
to newborn 48-72 hours after
birth:
• Maintains therapeutic levels in
baby’s bloodstream for the first
week of life
• Acts as post-exposure
prophylaxis
• No side effects with single dose
• If mother received her dose of
NVP less than 2 hours prior to
delivery, give one dose of NVP 76
 Infant Follow-up Schedule

•Infant Follow-up ScheduleFollow-up

at 6 hours, 6 days, 6 weeks, and
every 3 months
•Do full reassessment, and
reclassification for HIV at each visit
•Virological testing after 6 weeks
•Cotrimoxazole prophylaxis to all
exposed infants

77
 Primary Preventive measures:….
some of the safer sexual practices include:
• Correct and consistent use of condoms

• Intimate romance

• Sex with clothes on (romance )

• Sex with other parts of the body that

don’t produce body fluids.

78
 Secondary Prevention.
• Is known as posetive prevention.
• It is the Stage in wich already
HIV/AIDS infected individuals starts
the drugs wich can prolong the age of
infected person.
• The drugs are known as Anti
retroviral [Link] infected
person requires progressive
counselling and taking the drugs by
following the physicians order.
79
 Tertiary pevention of
HIV/AIDS.
• Tertiary prevention is the last steps of
HIV/AIDS [Link] is the stages in
wich infected person developes
opportunistic infections(additional diseases
those causes a death of the person,
like:TB,Diarrhea,anemia,malaria,skin
rash,mouth infection…………)
• On this stages the person cuts his/her
hopes to life,so they need psychological
and economical supprts.

80
Tertiary pevention of HIV/AIDS……..

Those supports are :

Encouraging the families of infected
Persons.
Eating nutritious foods. Looking
after their mental and spiritual
health.

81
Tertiary pevention of HIV/AIDS……..

AIDS and Nutrition

A person with HIV or AIDS needs to
eat nutritious foods
These include:
Energy-building foods
Body-building foods
Foods that protect the body from
infections (vitamins)
82
Tertiary pevention of HIV/AIDS……..

• Caring for a child with HIV or AIDS.

Make sure the child gets regular
medical care and early treatment
for opportunistic infections
•Caring for a child with HIV infection.
Have the child immunized against all
immunizable diseases. Consult with
an expert HIV doctor which vaccines
are safe

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Caring for healthy children whose parents have
HIV or AIDS

Show a lot of love by giving them care and

guidance. Plan to spend more time with them

Caring for healthy children whose parents

have HIV or AIDS

Make arrangements to have them looked

after by relatives and plan for their education
if possible.
Make a will which will protect their family
and their property

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 AIDS: making a difference
We can all make a difference by:
•Educating family members about the prevention
of HIV
•Being good examples and role models.
•Speaking about HIV testing, good hygiene
and health, and positive living for both men
and women
•Caring for our partners, children, family
members and friends

85
Stigma and Discrimination Related to
HIV/AIDS

Do not point fingers.

Anyone can get HIV. Even you!
86
 Stigma and Discrimination.....
• Lesson Objectives:-
• Define and identify HIV/AIDS-related stigma
and discrimination
• Better understand international and national
human right issues
• Clarify personal values and attitudes with
regard to HIV/AIDS prevention and care
• Know how to address stigma and discrimination
in the context of providing HIV services 87
 Definition
• Stigma: refers to unfavourable
attitudes and beliefs directed toward
someone or something

• Discrimination: is the treatment of an

individual or group with partiality or
prejudice

• Stigmatization reflects an attitude

• Discrimination is an act or behavior 88

 Root Causes
• [Link] role of knowledge about HIV
and AIDS and fear surrounding it
– Ogden and Nyblade believe that the
fear of transmission from casual
transmission, and the various "what
if scenarios" are the result of
– 1) the lack of specific, in-depth
information about HIV transmission,
– 2) fear-based public messaging,
and
– 3) the evolving nature of knowledge
about HIV and AIDS.
89
 Root Causes…….
• [Link] role of values, norms, and moral judgment
– This stigma is exacerbated by the
seriousness of the illness, its
mysterious nature, and its
association with behaviours that
are either illegal or socially
sensitive (e.g., sex, prostitution,
and drug use). Also relevant is the
perception that HIV infection is the
product of personal choice: that
one chooses to engage in "bad"
behaviours that put one at risk and
so it is "one's own fault" if HIV 90
 Root Causes…….
• Ogden and Nyblade divide stigma into four
loosely defined groups: physical, social,
verbal and institutional.
– Social stigma
– Isolated from community
– Voyeurism: any interest may be morbid
curiosity or mockery rather than genuine
concern
– Loss of social role/identity: social `death`,
loss of standing and respect
– Physical stigma
– Isolated, shunned, abandoned
– Separate living space, eating utensils
– Violence
91
 Forms of stigma (contd.)
– Gossip, taunting, scolding
– Labelling: in Africa: "moving
skeleton," "walking corpse," and
"keys to the mortuary." In Vietnam:
"social evils," and "scum of society."

– Institutionalised stigma
– Barred from jobs, scholarships,
visas
– Denial of health services
– Police harrassment (eg of sex
workers, HIV-positive actvists in
China, outreach workers in India)
92
 Challenge
 HIV-related stigma is increasingly
recognized as the single greatest
challenge to slowing the spread of
HIV/AIDS
 HIV/AIDS – a threefold epidemic
• HIV
• AIDS
• Stigma, discrimination, and denial

93
 Human rights
• Freedom from discrimination is a
fundamental human right

• Discrimination on the basis of

HIV/AIDS status, actual or
presumed, is prohibited by existing
human rights standards

• Discrimination against persons

living with HIV/AIDS (PLWHA), or
those thought to be infected, is a
94
clear human rights violation
 Effects of stigma
• Social isolation
• Limited rights and reduced access
to
services
• HIV/AIDS related stigma fuels new
HIV
infections
• Secondary stigma (stigma by 95
 Stigma in service delivery
• Prevents access to counselling , HIV
testing and MTCT services
• Discourages disclosure of HIV test
results to partner(s)
• Discourages acceptance of MTCT
interventions
• Inhibits use of safer infant-feeding
practices
• Confers secondary stigmatisation 96
 Addressing stigma
• Interventions addressing HIV-
related
stigma can take place at all
levels:
• National
• Community and
social/cultural
97
 National Level Interventions to
Address Stigma
– Support
• Human rights legislation
• National efforts to scale up ARV
treatment
• Funding for PPTCT services, and
training
– Share
• MTCT success stories
98
 Community Level Interventions
• In the community, promote
• HIV awareness and knowledge
• MTCT activities as integral to health
care and HIV/AIDS prevention and
treatment
• Referrals to and from MTCT services
• Awareness of MTCT interventions

99
Community level interventions (contd.)

Support
• Partnership with schools, social and
community organizations
• PLWHA ( people living with
HIV/AIDS) in implementing
initiatives
• Networking with needed linkages
• Ongoing training
100
Programme level interventions
• Integrate MTCT into antenatal
services
• Encourage partner involvement
• Enlist partner and family
support to decrease HIV
transmission

101
 Addressing stigma

• Educate and train healthcare providers in

• HIV transmission
• Activities to address stigma
• Awareness of language that
describes PLWHA
• MTCT-related policies
• Counselling and safer infant
feeding practices
102
 Addressing stigma……
Enlist manager’s help to ensure policies and
procedures are in place and implemented for:

• Non-discrimination policies
• Confidentiality
• Universal precautions
• Post-exposure prophylaxis (PEP)

103
 Summary
• Stigmatisation reflects an attitude

• Discrimination is an act or behaviour

• Stigma and discrimination are often linked

to violations of human rights
• Human rights declarations affirm all
peoples’ rights to be free from
discrimination, including discrimination
based on HIV/AIDS status.
• HIV/AIDS-related stigmatisation and
discrimination can discourage access to key
HIV services, including:
• Testing
• MTCT services
104
• Antenatal care
 Summary contd
• Stigma discourages
-Disclosure of HIV status
-Acceptance of safer infant-feeding practices
-Access to education, counselling, and treatment even
when such services are available and affordable
• The MTCT programs and staff can help reduce stigma and
discrimination in the healthcare setting, in the
community, and at the national level
• Encourage MTCT staff to serve as role models
• Involve PLWHA
• Promote partner participation and community support
105
 How You DON’T Get HIV
 You CANNOT get HIV by
hugging, touching, living with
or caring for someone with HIV,
shaking hands or kissing.
 You CANNOT get HIV from
eating out of the same plate or
cup or utensils that an HIV
positive person uses.

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Can YOU support someone living with HIV?

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 END THE STIGMA!

N K
•

H A !
T OU
Y
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