Unformatted text preview: SODeL JKUAT JOMO KENYATTA UNIVERSITY
AGRICULTURE & TECHNOLOGY SCHOOL OF OPEN, DISTANCE AND eLEARNING
P.O. Box 62000, 00200
E-mail: [email protected]
SZL 2111: HIV/AIDs JJ II
J DocDoc I Back Close LAST REVISION ON March 27, 2013 SODeL JKUAT JJ II
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
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SZL 2111: HIV/AIDs SODeL JKUAT Course Description JJ II
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 DocDoc I Back Close Course aims 1. To bring about behavioral change
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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
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 DocDoc I Back Close 4. Treatment of HIV/AIDs Various strategies of managing of
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5. How to prevent and control of HIV/AIDs
6. Social and cultural practices that contribute to spread of
7. Policies and rights of people living with HIV/AIDs SODeL JKUAT 8. Implications of HIV/AIDs on various sectors
Lectures: oral presentation generally incorporating addi- tional activities e.g writing on chalk board, exercises, class
questions and discussions or student presentation.
Tutorials to give the students more attention. JJ II
J DocDoc I Back Close Assignments and Demonstrations. 7 SZL2111 HIV/AIDs
The module will be assessed as follows;
10% of marks from two (2) assignments to be submitted
online SODeL JKUAT 20% of marks from two written CAT to be administered at JKUAT main campus or one of the approved centres
70% of marks from written Examination to be adminis- tered at JKUAT main campus or one of the approved centres JJ II
J DocDoc I Back Close 8 SODeL JKUAT Contents JJ II
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
. 15 . 17
. 19 SODeL JKUAT JJ II
J DocDoc I Back Close SZL2111 HIV/AIDs
1.4 Public Health and Hygiene . . . . . . . . . . . .
1.4.1 Public health programs may include: . . .
Vaccination . . . . . . . . . . . .
Rural and Urban Health Clinics
Disease Tracking and Epidemiology . . . . . . . . . . . . . . .
Sanitation and Pollution Control
. . . . . . . . . . . . . . . . . .
Medical Research . . . . . . . .
Public Education Campaigns . .
1.5 Types of HIV . . . . . . . . . . . . . . . . . . . .
1.6 Origin, Theories and History of HIV/AIDS . . .
1.6.1 Mysterious origins . . . . . . . . . . . . .
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1.6.2 Religious Theories (God's wrath and witch
craft) . . . . . . . . . . . . . . . . . . . .
1.6.3 Monkey origin theories . . . . . . . . . . .
Hunter theory . . . . . . . . . .
Oral Polio Vaccine (OPV) theory . . . . . . . . . . . . . . . .
The contaminated needle vaccine
. . . . . . . . . . . . . . . . . .
The colonialism theory . . . . .
1.6.4 The conspiracy theory . . . . . . . . . . .
1.6.5 The calculated theory . . . . . . . . . . .
Solutions to Exercises . . . . . . . . . . . . . . . . JJ II
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53 SZL2111 HIV/AIDs LESSON 1
GENERAL INTRODUCTION SODeL JKUAT Learning outcomes Upon completing this topic, a student should be able to:
Dene of terms related to HIV/AIDS
Understand the meaning of public health and its role in disease infection
Understand origins, theories and history of HIV/AIDS
Know various types of HIV
Global distribution and trends of HIV/AIDS JJ II
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1.1. Introduction JJ II
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
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1.2. Justication of the course SODeL JKUAT Education is an important component of preventing the spread
of HIV. Aims of HIV/AIDS training,
To prevent new infections from taking place. i.e. JJ II
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
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
To reduce stigma and discrimination.- Discrimination against positive people can help the AIDS epidemic to spread
To help people focus upon the person than the disease and be more caring to the person.
J DocDoc I Back Close To provide knowledge on modes of transmission especially to those aected and how to cope with the infected.
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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 DocDoc I Back Close HIV infection is lifelong and there is no cure
HIV is infectious, and those infected will remain infectious throughout their lives.
Fear arises from uncertainty of unpredictable medical conditions and reactions of people especially of those close to
Information and knowledge is incomplete about HIV care
and prevention and at times even conicting.
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The infected and aected are likely to have abroad of physical, psychological and social needs which may need adjustments e.g. nances.
Good management can contain some of these problems, SODeL JKUAT early identication and intervention.
It provides knowledge needed to initiate and sustain change in risky behavior.
It helps the infected nd a new or perhaps dierent ap- proach to using safer sex and responsible social relationships.
It helps those who are infected to leave with the infection. JJ II
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1.3. Denition of Terminologies JJ II
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
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is 0.1, or 10% (10,000 cases divided by 100,000 people). JJ II
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
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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 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
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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
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region, for example, an island or river basin. JJ II
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 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 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
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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 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
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 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 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.
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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
Group O appears to b...
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