TOPIC 1: MEANING AND CURRENT STATUS OF HIV/AIDS

By the end of this section, you should be able to:

(a). Explain the meaning of HIV/AIDS and their relationship
(b). Explain the origin and classification of HIV/AIDs.
(c). Explain the relationship between HIV and Sexually Transmitted Infections (STIs).
(d). Explain the current status in the spread of HIV/AIDs from a global, African and Kenyan
perspectives.
(e). Identify factors that contribute to the spread of HIV/AIDS in Kenya

Definitions
HIV stands for Human Immuno-deficiency Virus, the virus that causes AIDS. This virus enters
the body through the mucus membrane or through broken skin. It attacks and eventually kills the
body defense cells. The virus particularly targets the T cells, a type of white cells that are essential
to the functioning of the body’s immune system. Although all the body fluids contain T cells, the
concentration is higher in blood, semen and vaginal secretions.
The virus reproduces inside the defense cells and other viruses are released into the blood stream.
When a substantial number of defense cells have been killed the body lacks protection against
common infections.
AIDS
This stands for Acquired Immune Deficiency Syndrome. HIV causes AIDs through progressive
destruction of the body’s immune system. Due to inability to defend itself against other infections,
the person’s health deteriorates until death occurs.

Origin and Classification of HIV/AIDS

HIV is believed to have evolved from the simian immunodeficiency virus (SIV), which crossed
the species barrier from primates in Central Africa on at least two occasions, most likely when
human hunters came into contact with an infected primate’s blood, and evolved into HIV.
The primary HIV strain, HIV-1, has been traced to chimpanzees in Cameroon. The less virulent
HIV-2 strain has been traced to sooty mangabey, which lives in several countries along Africa’s
west coast, from Senegal to Ivory Coast. Researchers believe HIV first manifested in the 1900s
and spread slowly across Africa before expanding into the rest of the world. The transmission of
HIV was driven through war, migration, housing, travel, sexual practices, drug use and economics
that affect both Africa and to the entire world.
AIDS was first recognised as a new entity in 1981 in USA among male homosexuals who
succumbed to unusual opportunistic infections and rare malignancies. In 1983 the cause of the
syndrome was discovered to be a virus, which was given the title of Human Immuno-deficiency
Virus because of its role in lowering the immunity of those infected. This was named as HIV-1
and is the predominant strain of HIV in the developed world. In 1986, a second type of HIV was
discovered in West Africa and was named HIV-2. It is rarely found elsewhere. Both HIV-1 and
HIV-2 have several subtypes because HIV is a virus that easily mutates. There may be many
different strains of HIV, even within the body of a single infected person.

Ways through Which HIV Spreads:

 Sexual contact with a person infected with the virus.
 From an infected mother to her unborn child in the womb, during birth or soon after birth.
 Transfusion with infected blood of blood products.
 HIV contaminated and skin piercing instruments e.g. needles, razors and knives during
circumcision.
 Occupational exposures like for medical personnel.

HIV is not spread through:

 Shaking hands
 Living together
 Working together
 Eating and cooking utensils
 Insect bites e.g. mosquitoes
 Toilet seats
 Coughing and sneezing
Relationship between HIV/AIDS and STIs
 STIs such as gonorrhea and syphilis not only provide HIV easier access to vulnerable cells
and tissues of the body, but they also increase the likelihood of a person with the virus to
transmit it to others.
 Some STIs such as syphilis, herpes and chancroid cause open wounds in the genital area
which provide HIV a direct route into the bloodstream.
 Some STIs such as gonorrhea cause an increase in the concentration of CD4 T-cells in the
genital area, and these provide a favourable target for infection.
 People infected with an STI have increased concentrations of HIV in their seminal and
vaginal fluids, increasing the possibility of HIV transmission.
 STIs and HIV are both spread in the same ways e.g. unsafe sex, from mother to her unborn
baby in the womb, during birth or breastfeeding or sharing drugs.
HIV/AIDS PROGRESSION STAGES
 Acute Primary Infection
It is the earliest stage of HIV infection. HIV cells multiply rapidly in the body and begin to
destroy the host’s CD4 T cells. About one or two weeks after getting the virus, a person may
experience flu-like symptoms such as:
 Fever
 Rash
 Sore throat
 Swollen glands
 Headache
 Joint aches and pains
 Muscle pains
The symptoms occur as a result of the immune system trying to produce antibodies to attack the
virus. This process is called seroconversion where the person moves from HIV negative to
positive. The risk of infecting others, through sexually contact, is very high.
However, the HIV Antibodies, can only be detected in blood after three months from the time of
exposure. This period is called Window period

 Asymptomatic Stage
Once a person has been through the acute primary stage and the seroconversion process, they
may often start to feel better. It is also called chronic HIV infection or clinical latency. There are
no symptoms during this stage and the virus can only be detected through a clinical test. Risk of
transmission to others is greatly diminished.

During this stage the virus keeps on multiplying in the body and the immune system slowly
weakens but the person has no symptoms. The stage may last up to 10 or 15 years depending on
how quickly the HIV virus copies itself and how a person’s genes affect the way the body handles
the virus.

 Symptomatic HIV infection

The person’s immune system is severely damaged. They are more likely to get serious infections
that the body would otherwise be able to fight off. These infections are known as ‘opportunistic
infections’ e.g. malaria, TB, oral thrush, herpes simplex virus.

Opportunistic infections are diseases that attack the human body, and they get cured with
medicine and the help of natural immune system in a person with strong immune system. But
when immune system is weak due to its destruction by the HIV, they take an opportunity (hence
the name) to attack the body successfully and it take time for them to get cured.
Some of the symptoms at this stage include:
 Weight loss
 High fever
  Diarrhea
 Night sweat
 Persistent cough
 Mouth and skin problems
 Regular infections

 AIDS full-blown Stage

The person develops certain serious opportunistic infections or diseases as a result of damage
to their immune system from the advanced stage 3 HIV infection.
Symptoms include:
 Rapid weight loss
 Memory loss, poor concentration, tremor, headaches, confusion, loss of vision and
seizures
 Pain, numbness or pins sensation in the hands and feet
 Tuberculosis
 Other sexually transmitted infections
 Chronic diarrhea
 Recurring fever
 Pronounced weakness and fatigue
 Sores that develop in the mucous membranes of the mouth, anus or genitals.

THE CURRENT STATUS OF HIV/AIDS

In 2021, there were approximately 38.4 million people across the globe with HIV, up from 37.7
million in 2020. 650,000 people died from HIV-related causes and 1.5 million people acquired
HIV. Out of the 38.4 million people living with the virus, 2.73 million were children aged 0-19
years. 53% of these were women and girls. Over 90% of the children were born to mothers with
HIV and get it either through birth, pregnancy or breastfeeding.
Two-thirds (25.6 million) of these (PLWHA) are found in sub-Saharan Africa. Half of these people
are found in eastern Africa. In West Africa, Nigeria has the highest number of people living with
HIV (1.9 million). Women and girls accounted for 63% of all new HIV infections in 2020. 80%
of children living with HIV/AIDS in the world are found in sub-Saharan Africa.

In 2020, key populations (sex workers and their clients, gay men and other money who have sex
with men, people who inject drugs, transgender people) and their sexual partners accounted for
65% of HIV infections globally.
Factors Accounting for this State of Affairs
 Behavioural and social factors
 Little, wrong or no use of condoms
 Large proportion of adult population has multiple sexual partners
  Overlapping (as opposed to serial) sexual partners
 Large sexual networks often seen in individuals who move back and forth
between home and far off work places
 ‘Age mixing’ typically between older men and younger women or girls.

 Biological factors
 High rates of STIs, especially those causing genital ulcers
 Low rates of male circumcision

HIV/AIDS in Kenya
 Kenya ranks position 8 out of the top ten countries globally with high HIV infections.
 The first case of AIDS was detected in 1984
 Over 1.5 million people are living with HIV/AIDS
 The prevalence rate now stands at 4.9%
 The top 5 counties with a prevalence of more than 9% are Homa Bay, Kisumu, Siaya,
Migori and Busia while the lowest prevalence are in Samburu, Tana River, Garissa,
Mandera, Marsabit, Kiambu, West Pokot and Baringo
 The main mode of transmission is sexual contact
 Infection affects all sections of the population including children, young people, adults,
women and men.
 Groups most affected by HIV in Kenya are sex workers, men who have sex with men,
people who inject drugs, young people and women.

Factors Responsible for the Spread of HIV/AIDS in Kenya

The widespread of HIV/AIDS has been due to the following factors:
 Lack of early recognition of the disastrous nature of AIDS
 Poverty
 Lack of sex education
 Misuse of drugs
 High risk activities of men
 Urbanization
 Enforced idleness among unemployed youth
 Socio-cultural practices
o Patriarchy (Male dominance)-men have power to determine when, where and how
sex takes place.
o Circumcision-sharing of knives
o Tattooing
o Scarification
o Wife inheritance
 o Early marriages
o Burial ceremonies e.g. disco matanga
o Denial of vulnerability
o Sexual adventure by adolescents
o Loss of moral authority over children by parents
o Deliberate infection as revenge
o Deviant behaviour such as rape, incest
o Cultural permissiveness
Kenya’s Response to the Epidemic
 Declaring it a national disaster in 1999
 HIV education and awareness has been part of the curriculum since 2003
 Increased availability of condoms
 Preventing mother-to-child transmission (PMTCT)
 Encouraging voluntary medical male circumcision (VMMC)