Lesson1 - SODeL JKUAT JOMO KENYATTA UNIVERSITY OF...

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Unformatted text preview: SODeL JKUAT JOMO KENYATTA UNIVERSITY OF AGRICULTURE & TECHNOLOGY SCHOOL OF OPEN, DISTANCE AND eLEARNING P.O. Box 62000, 00200 Nairobi, Kenya E-mail: [email protected] SZL 2111: HIV/AIDs JJ II J I J DocDoc I Back Close LAST REVISION ON March 27, 2013 SODeL JKUAT JJ II J I J DocDoc I Back Close SZL2111 HIV/AIDs This presentation is intended to covered within one week. The notes, examples and exercises should be supplemented with a good textbook. Most of the exercises have solutions/answers appearing elsewhere and accessible by clicking the green Exercise tag. To move back to the same page click the same tag appearing at the end of the solution/answer. Errors and omissions in these notes are entirely the responsibility of the author who should only be contacted through the Department of Curricula & Delivery (SODeL) and suggested corrections may be e-mailed to [email protected] 2 SODeL JKUAT SZL2111 HIV/AIDs JJ II J I J DocDoc I Back Close 3 SZL2111 HIV/AIDs SZL 2111: HIV/AIDs SODeL JKUAT Course Description JJ II J I J DocDoc I Back Close General introduction: Public health and hygiene, human reproductive system, sex and sexuality. History of sexually transmitted diseases (STDs); History of Human Immunodeciency virus/ Acquired Immune deciency Syndrome (HIV/AIDS), Comparative information on trends, global and local distribution, Justication of importance of course. Biology of HIV/AIDS; Overview of immune system, natural immunity to HIV/AIDS. The AIDS virus and its life cycle, disease progression, transmission and diagnosis. Discordant couples. Treatment and Management; nutrition, prevention and control; Abstain, Be faithful, Condom use, Destigmatize HIV/AIDS (ABCD) methods and antiretro4 SODeL JKUAT SZL2111 HIV/AIDs viral drugs and vaccines. Pregnancy and AIDS. Management of HIV/ AIDS patients. Social and cultural practices: Religion and AIDS. Social stigma on HIV/AIDS. Behavioral change. Voluntary Counseling and Testing Services. Gender and HIV/AIDS. Drug and alcohol abuse and HIV/AIDS. Poverty and AIDS. Families and AIDS orphans. Government policies: Global policies of AIDS. Legal rights of AIDS patients. AIDS Impact: Family /society setup, population, agriculture, education, health, industry, development, economy and other sectors. Prerequisite: none JJ II J I J DocDoc I Back Close Course aims 1. To bring about behavioral change 5 SZL2111 HIV/AIDs 2. To prevent HIV/AIDS and reduce the threat it poses to youth/students SODeL JKUAT 3. To promote HIV/AIDS education as a means of producing better and more integrated sense of health education in the student Learning outcomes Upon completion of this course you should be able to know; 1. Biology of HIV 2. Transmission of HIV 3. Disease progression and symptoms JJ II J I J DocDoc I Back Close 4. Treatment of HIV/AIDs Various strategies of managing of HIV/AIDs 6 SZL2111 HIV/AIDs 5. How to prevent and control of HIV/AIDs 6. Social and cultural practices that contribute to spread of HIV/AIDs 7. Policies and rights of people living with HIV/AIDs SODeL JKUAT 8. Implications of HIV/AIDs on various sectors Instruction methodology ˆ Lectures: oral presentation generally incorporating addi- tional activities e.g writing on chalk board, exercises, class questions and discussions or student presentation. ˆ Tutorials to give the students more attention. JJ II J I J DocDoc I Back Close ˆ Assignments and Demonstrations. 7 SZL2111 HIV/AIDs Assessment information The module will be assessed as follows; ˆ 10% of marks from two (2) assignments to be submitted online SODeL JKUAT ˆ 20% of marks from two written CAT to be administered at JKUAT main campus or one of the approved centres ˆ 70% of marks from written Examination to be adminis- tered at JKUAT main campus or one of the approved centres JJ II J I J DocDoc I Back Close 8 SODeL JKUAT Contents JJ II J I J DocDoc I Back Close 1 GENERAL INTRODUCTION 1.1 Introduction . . . . . . . . . . . . . . . . . . . . 1.2 Justication of the course . . . . . . . . . . . . 1.2.1 Reasons for HIV/AIDS education/ why train in HIV/AIDS . . . . . . . . . . . . 1.3 Denition of Terminologies . . . . . . . . . . . . 9 12 . 13 . 15 . 17 . 19 SODeL JKUAT JJ II J I J DocDoc I Back Close SZL2111 HIV/AIDs 1.4 Public Health and Hygiene . . . . . . . . . . . . 1.4.1 Public health programs may include: . . . ˆ Vaccination . . . . . . . . . . . . ˆ Rural and Urban Health Clinics ˆ Disease Tracking and Epidemiology . . . . . . . . . . . . . . . ˆ Sanitation and Pollution Control . . . . . . . . . . . . . . . . . . ˆ Medical Research . . . . . . . . ˆ Public Education Campaigns . . 1.5 Types of HIV . . . . . . . . . . . . . . . . . . . . 1.6 Origin, Theories and History of HIV/AIDS . . . 1.6.1 Mysterious origins . . . . . . . . . . . . . 10 24 25 25 26 27 28 28 29 30 33 36 SODeL JKUAT SZL2111 HIV/AIDs 1.6.2 Religious Theories (God's wrath and witch craft) . . . . . . . . . . . . . . . . . . . . 1.6.3 Monkey origin theories . . . . . . . . . . . ˆ Hunter theory . . . . . . . . . . ˆ Oral Polio Vaccine (OPV) theory . . . . . . . . . . . . . . . . ˆ The contaminated needle vaccine . . . . . . . . . . . . . . . . . . ˆ The colonialism theory . . . . . 1.6.4 The conspiracy theory . . . . . . . . . . . 1.6.5 The calculated theory . . . . . . . . . . . Solutions to Exercises . . . . . . . . . . . . . . . . JJ II J I J DocDoc I Back Close 11 37 39 41 41 43 44 46 47 53 SZL2111 HIV/AIDs LESSON 1 GENERAL INTRODUCTION SODeL JKUAT Learning outcomes Upon completing this topic, a student should be able to: ˆ Dene of terms related to HIV/AIDS ˆ Understand the meaning of public health and its role in disease infection ˆ Understand origins, theories and history of HIV/AIDS ˆ Know various types of HIV ˆ Global distribution and trends of HIV/AIDS JJ II J I J DocDoc I Back Close 12 SODeL JKUAT SZL2111 HIV/AIDs 1.1. Introduction JJ II J I J DocDoc I Back Close HIV/AIDS is the worst pandemic the world has experienced in the last half of the 20th century. It has decimated whole population of people in certain region. If one becomes infected with HIV, the virus begins to attach the immune system. A person infected with HIV can look and feel perfectly well for many years and may not even know they are infected. Over a period of time, it is highly likely that HIV will damage the immune system and when this happens, one become vulnerable to illness often referred to as opportunistic infections that a healthy immune system would usually be able to ght o, and this leads to a condition known as AIDS - Acquired Immunodeciency Syndrome. AIDS is a collection of infections (usually severe) and cancers that may develop in people who are HIV positive. A per13 SODeL JKUAT SZL2111 HIV/AIDs son is said to have AIDS when they have developed one of these specic illness, this is usually after a signicant period of time often many years. Some people will receive an AIDS diagnosis when their T-cell count drops below 200 copies per cubic ml of blood. The eects that HIV infection may have on an individual vary dramatically. At one end of the spectrum a person may remain very well with virtually no ill eects. At the other end of the spectrum a person may have an AIDS diagnosis and develop a life threatening opportunistic infection. Currently there is no cure or vaccine for HIV/AIDS. Once a person contracts HIV, they will remain infected with the virus for life and are able to transmit the virus to others. JJ II J I J DocDoc I Back Close 14 SZL2111 HIV/AIDs 1.2. Justication of the course SODeL JKUAT Education is an important component of preventing the spread of HIV. Aims of HIV/AIDS training, ˆ To prevent new infections from taking place. i.e. JJ II J I J DocDoc I Back Close  By giving people information about HIV - what HIV and AIDS are, how they are transmitted, and how people can protect themselves from infection.  Teaching people how to put this information to use and act on it practically for e.g. how to get and use condoms, how to suggest and practice safer sex, how to prevent infection in a medical environment or when injecting drugs. ˆ To improve quality of life for HIV positive people i.e. by - 15 SODeL JKUAT SZL2111 HIV/AIDs  Enabling and empowering them to improve their quality of life.  To be able to access medical services and drug provision  To be able to nd appropriate emotional and practical support and help  Teaching them about the importance of not passing on the virus ˆ To reduce stigma and discrimination.- Discrimination against positive people can help the AIDS epidemic to spread ˆ To help people focus upon the person than the disease and be more caring to the person. JJ II J I J DocDoc I Back Close ˆ To provide knowledge on modes of transmission especially to those aected and how to cope with the infected. 16 SZL2111 HIV/AIDs ˆ To initiate and sustain behavior changes necessary to reduce the rate of developing infections through safer sex practices. SODeL JKUAT 1.2.1. Reasons for HIV/AIDS education/ why train in HIV/AIDS JJ II J I J DocDoc I Back Close ˆ HIV infection is lifelong and there is no cure ˆ HIV is infectious, and those infected will remain infectious throughout their lives. ˆ Fear arises from uncertainty of unpredictable medical conditions and reactions of people especially of those close to them. ˆ Information and knowledge is incomplete about HIV care and prevention and at times even conicting. 17 SZL2111 HIV/AIDs ˆ The infected and aected are likely to have abroad of physical, psychological and social needs which may need adjustments e.g. nances. ˆ Good management can contain some of these problems, SODeL JKUAT early identication and intervention. ˆ It provides knowledge needed to initiate and sustain change in risky behavior. ˆ It helps the infected nd a new or perhaps dierent ap- proach to using safer sex and responsible social relationships. ˆ It helps those who are infected to leave with the infection. JJ II J I J DocDoc I Back Close 18 SODeL JKUAT SZL2111 HIV/AIDs 1.3. Denition of Terminologies JJ II J I J DocDoc I Back Close Any specialized eld of study has some terms (jargon) that only professional in that eld comprehend clearly their meaning with reference to the subject. HIV/AIDS education is a subject that has borrowed heavily from medical sciences and therefore learners need to familiarize themselves with some terms that are commonly used in the subject 1. Rate - This is the amount of something in relation to something else shown as a proportion or percentage. Often it reects the idea of specic time. For example, imagine that 10,000 cases of AIDS have been reported to the ministry of health over the past ten years. You could tell someone this information alone, or you could say that the country only has a population of 100,000 people, and the rate of AIDS 19 SODeL JKUAT SZL2111 HIV/AIDs is 0.1, or 10% (10,000 cases divided by 100,000 people). JJ II J I J DocDoc I Back Close 2. Incidence-This is how often new cases of a disease appear in a population during a set period of time, usually one year. For example, if you wanted to know the incidence of HIV in a village, you could test all the people in the village and record that information as your baseline. Then test all of the same people one year later. Count the number of people who did not have HIV during the rst test but did have the virus during the second test. Divide this number by the total number of uninfected people in the village. The result is the incidence of HIV in this village (the number of new infections per person per year). 3. Prevalence - This is the proportion of people who have a disease in a community at any one point in time. In 20 SODeL JKUAT SZL2111 HIV/AIDs the example above, the prevalence of HIV would be 10% the rst year (100 cases among 1,000 people living in the village) and 15% the second year (150 cases among 1,000 people living in the village). JJ II J I J DocDoc I Back Close 4. Bias-This occurs when an unexpected factor aects the results of a study. For example, imagine you want to nd out how many pregnant women in your town have HIV. You test all the pregnant women who come to your medical clinic over a three-month period. Since people with HIV are more likely to be sick and come to the clinic, and you tested all pregnant women who came to the clinic, you will nd more women with HIV than if you tested every pregnant woman in the town. Testing only sick pregnant women inuenced your results. Your study was aected by 21 SODeL JKUAT JJ II J I J DocDoc I Back Close SZL2111 HIV/AIDs bias. Bias can happen even when you are trying to avoid it. If you ask questions with a tone that tells people that you want them to answer in a certain way, you can bias your results. For example, if you want to know how many people inject drugs but ask, You do not use those illegal, deadly drugs do you? then fewer people will answer yes than really do use drugs. Your results will be biased. 5. Endemic - This term describes characteristic of a particular place or among a particular group or area of interest or activity. From disease point of view, the term is used to describe a disease occurring within a specic area, region, or locale e.g. Malaria is endemic in a lot of Africa countries. The term can also be used to describe a species of organism that is conned to a particular geographical 22 SODeL JKUAT SZL2111 HIV/AIDs region, for example, an island or river basin. JJ II J I J DocDoc I Back Close 6. Epidemic - This is an outbreak of a disease that spreads more quickly and more extensively among a group of people than would normally be expected. Among the diseases that have occurred in epidemic proportions throughout history are bubonic plague, inuenza, smallpox, typhoid fever, tuberculosis, cholera, bacterial meningitis, and diphtheria. Occasionally, childhood diseases such as mumps and German measles become epidemics. 7. Epidemiology-This is the study of the incidence and distribution of diseases in large populations, and the conditions inuencing the spread and severity of disease. For example in the study of the acquired immunodeciency syndrome (AIDS) epidemic in the early 1980s, both the National 23 SODeL JKUAT SZL2111 HIV/AIDs Cancer Institute (U.S.) and the Pasteur Institute (France) reported discovering that a retrovirus which came to be known as the human immunodeciency virus (HIV) was the main cause of the disease. JJ II J I J DocDoc I Back Close 8. Pandemic - a widespread epidemic that aects people in many dierent countries, across several continents e.g. HIV/AID 1.4. Public Health and Hygiene Public Health is the protection and improvement of the health of entire populations through community wide action, primarily by governmental agencies. Most people think of public health workers as physicians and nurses, but a wide variety of other professionals work in public health, including veterinarians, sanitary engineers, microbiologists, laboratory technicians, statisti24 SODeL JKUAT SZL2111 HIV/AIDs cians, economists, administrators, attorneys, industrial safety and hygiene specialists, psychologists, sociologists, and educators. Public health workers engage in activities outside the scope of ordinary medical practice and these include inspecting and licensing restaurants; conducting rodent and insect control programs; and checking the safety of housing, water, and food supplies etc. Hygiene is the science dealing with the preservation of health or the practice or principles of cleanliness. In the public domain, Public health ocers mainly manage this practice. 1.4.1. Public health programs may include: JJ II J I J DocDoc I Back Close • Vaccination This is the process of making the body resistant to a specic disease by using a vaccine (a chemical that stimulates the body to 25 SODeL JKUAT JJ II J I J DocDoc I Back Close SZL2111 HIV/AIDs create antibodies to ght a specic infectious organism). Vaccination programs protect people against disease such as measles, mumps, diphtheria, and other childhood infectious diseases. When small outbreaks of infectious disease threaten to grow into epidemics, public health ocials may initiate new vaccination programs. • Rural and Urban Health Clinics Public health agencies operate local clinics that provide free or reduced-cost medical services to individuals, especially infants and children, pregnant and nursing women, people with drug abuse problems, physical disabilities, and other conditions. Public health clinics routinely screen patients for a number of infectious diseases and may provide free treatment if patients test 26 SODeL JKUAT SZL2111 HIV/AIDs positive. Each clinic tracks the incidence of certain communicable diseases in its area, and reports this information to national and international public health oces. JJ II J I J DocDoc I Back Close • Disease Tracking and Epidemiology Threats to public health concerns change over time and epidemiologists and other ocials continuously evaluate epidemiological trends to determine how best to meet future public health needs. Epidemiologists and other public health ocials attempt to break the chain of disease transmission by notifying people who may be at risk for contracting an infectious disease. Public health ocials may also ensure that infected people complete treatment programs, so that the diseases are completely eliminated and the patients are no longer carriers of the infection. 27 SODeL JKUAT SZL2111 HIV/AIDs • Sanitation and Pollution Control Disease-causing organisms are often transmitted through contaminated drinking water. The single most eective way to limit water-borne diseases is to ensure that drinking water is clean and not contaminated by sewage. Public health ocials establish sewage disposal and solid waste disposal systems, and regularly test water supplies to ensure they are safe. Public health programs establish and enforce laws for safe food storage and preparation;food-safety guidelines established by public health ocials. JJ II J I • Medical Research Another component of public health is scientic and medical research. Cadres of doctors and scientists work in laboratories to J DocDoc I 28 Back Close SODeL JKUAT SZL2111 HIV/AIDs establish new ways to prevent, diagnose, treat, and cure disease and disability. Scientists and doctors employed by the government conduct some biomedical research in public health facilities to nd better ways to protect human health. JJ II J I J DocDoc I Back Close • Public Education Campaigns Many diseases are preventable through healthy living, and a primary public health goal is to educate the general public about how to prevent non-infectious diseases. Health promotion also encourages people to take advantage of early diagnostic tests that can make the outcome of disease more favourable e.g. early detection of breast cancer, for instance, increasing the chances of a cure. Detection and proper treatment of high blood pressure reduces the risk of a stroke, the leading cause of permanent 29 SZL2111 HIV/AIDs disability in older people. SODeL JKUAT 1.5. Types of HIV JJ II J I J DocDoc I Back Close There are 2 main types of HIV: - HIV-1 &HIV-2. Both types are transmitted by sexual contact, through blood & from motherto-child. They both appear to cause clinically indistinguishable AIDS. HIV-2 is less easily transmitted & the period between initial infection & illness is longer. Its uncommon & conic. in W.Africa. E.g. Senegal, Ghana, Mali, Burkina Faso, Ivory Coast. Most HIV-2 reported in Brazil, Angola, Mozambique and Portugal can be traced back to W. African contact. HIV-1 is the predominant virus world wide & generally when people refer to HIV without specifying the type they refer to HIV-1. 30 SZL2111 HIV/AIDs HIV-1 subtypes 1. Group M (major) 2. Group N (new) SODeL JKUAT 3. Group O (outlier) The 3 groups may rep separate introduction of SIV into humans ˆ Group O appears to b...
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