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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 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 SODeL JKUAT 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 JJ II J I J DocDoc I Back Close 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 Course Description General introduction: Public health and hygiene, human reproductive system, sex and sexuality. History of sexually transmit- SODeL JKUAT ted 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; JJ II J I J DocDoc I Back Close nutrition, prevention and control; Abstain, Be faithful, Condom use, Destigmatize HIV/AIDS (ABCD) methods and antiretro4 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. SODeL JKUAT 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 3. To promote HIV/AIDS education as a means of producing better and more integrated sense of health education in the SODeL JKUAT 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 additional 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 administered 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 Concept of positive living 11 1.1 Introduction . . . . . . . . . . . . . . . . . . . . . 12 1.2 Home Based Care . . . . . . . . . . . . . . . . . . 17 1.2.1 Rationale for Home Based care . . . . . . 20 1.2.2 Advantages of organized home based care 1.2.3 Components of home based care 9 21 . . . . . 22 SZL2111 HIV/AIDs ˆ Advantages of good nutrition to PLWA . . . . . . . . . . . . . . . 26 ˆ Principles of nutrition support for PLWA . . . . . . . . . . . . . . . 28 SODeL JKUAT 1.3 JJ II J I J DocDoc I Back Close Management of pregnancy in HIV/AIDS . . . . . 31 1.3.1 Reducing the risk of transmission during pregnancy . . . . . . . . . . . . . . . . . . 32 ˆ Conception . . . . . . . . . . . . 34 ˆ The pregnancy . . . . . . . . . . 35 ˆ Delivery . . . . . . . . . . . . . . 36 ˆ Breastfeeding . . . . . . . . . . . 37 ˆ Testing babies for HIV . . . . . . 37 Solutions to Exercises . . . . . . . . . . . . . . . . 42 10 SZL2111 HIV/AIDs LESSON 1 Concept of positive living Learning outcomes SODeL JKUAT Upon completing this topic, you should be able to understand the following: ˆ Components of home based care ˆ Relationship between good nutrition and management of HIV ˆ Reducing the risk of transmission during pregnancy JJ II J I J DocDoc I Back Close 11 SZL2111 HIV/AIDs 1.1. Introduction The rst stage of positive living is accepting wholly HIV is part of you and this cannot be changed and start taking good care of yourself:  SODeL JKUAT 1. Breath - When you get overwhelmed, take three deep breaths. Breathing better is one of the most important things you can do to maintain your health. It improves everything from chronic health problems, stress related disorders to our sporting performance. Whether you want to boost your workout, ease stress or improve your health, learning to breathe properly can enhance your quality of life. Look for fresh air, like the around lakes, forests, near rivers and JJ II J I J DocDoc I Back Close water falls, at the seashore and after a rainstorm that is know to contain abundant negatively charged ions.. This 12 SZL2111 HIV/AIDs kind of air is refreshing and gives people a lift. House plants also do more than enhance the appearance of the home and oces. They enrich the air with oxygen and absorb carbon dioxide. Some even remove toxic pollutant SODeL JKUAT from the air we breathe (Ang'awa 2005). ˆ Bad air and poor breathing habits interfere with breathing, reducing the oxygen delivered to the blood and impairing performance and mood and promotes negative emotions like depression, irritability, headaches and feelings of fatigue and exhaustion because the body is robbed of this vital element (Ang'awa 2005) 2. Refuse to be a victim - Focus on what you can do. Focus JJ II J I J DocDoc I Back Close on living with HIV and not dying of AIDS. Live one day at a time. Seek support not pity 13 SZL2111 HIV/AIDs 3. Educate yourself about HIV: (a) Attend HIV/AIDS seminars, workshops or any education forum 4. Physical exercise(b) Necessary for all parts of the body SODeL JKUAT 4. Reduces stress (a) (b) (c) (d) Keep busy Do not concentrate on self. No self pity, concentrate on development Do not overwork. 5. Express yourself, ask for support - JJ II J I J DocDoc I Back Close (a) Talk to your friends (b) Share feelings with your partner, friends and family (c) Professional counselor, therapists and clergy can oer support 14 SZL2111 HIV/AIDs 6. Embrace your own spirituality (a) Faith based organizations have ministers who support HIV + ve people (b) If you feel angry with God, acknowledge it. HIV is a SODeL JKUAT virus not a punishment. 7. Think and act positively 8. Seek out people who are honest, trustworthy and supportive 9. Cry when you need to let it out, as it creates room for positive feelings 10. Accept responsibility (a) Pledge that HIV stops with you. Do not deliberately JJ II J I J DocDoc I Back Close seek to infect others. Use condoms to pr others and avoid re-infection. 15 SZL2111 HIV/AIDs 11. Talk to other people with HIV - group therapy works. Join support groups 12. Healthy and diet - eat well balanced diet with lots of proteins and vitamins Avoid food poisoning as much as pos- SODeL JKUAT sible Avoid alcohol, drug and substance abuse 13. Attend to opportunistic infections immediately 14. Have hope about many things. For example: It is important to have hope. Hope lifts spirits and gives strength to face each situation. Hope can help each person to ght HIV and AIDS - to live positively and to live longer. Remember, even if a person has hope today, it is possible to feel angry or depressed tomorrow. This is normal. Even people without HIV JJ II J I J DocDoc I Back Close or AIDS go up and down emotionally every day. The important thing is to try to instill the feelings of hope again and again. 16 SZL2111 HIV/AIDs 1.2. Home Based Care Home based care means - any form of concern given to sick people in their own dwellings. It can mean the things people might do to take care of themselves or the care given to them by the SODeL JKUAT family or it can be extended from the hospital or health facility to the patient's home through family participation and community support (Gilks et al. 1998., MOH 2002c). Care includes physical, psychosocial and spiritual activities. The term family here refers to the person (or people) with the main responsibility for caring for a person with AIDS in the home. In fact, the person providing such care may be a blood relative, a relative by marriage (a spouse for example), a friend, a neighbour or some JJ II J I J DocDoc I Back Close other person. The overall goal of home based care is - to ensure a high 17 SZL2111 HIV/AIDs standard of human, holistic care that meets the needs of People living with HIV/AIDS (PLWA's). PLWA's have basic, physical, economic and psychosocial needs. These can be met at the familiar home environment and may lead to an improvement of SODeL JKUAT the quality of life for PLWA's. Home based care establishes an important link between health professionals and the caregivers at home. HIV /AIDS aect all aspects of social and economic life in Kenya. The health sector is aected by an increased burden of caring for those infected. It is responsible for delivering eective treatment of opportunistic infections, providing compassionate care and implementing many prevention programs such as STD JJ II J I control, condom promotion and distribution and health educa- J DocDoc I 18 Back Close tion and provision of Anti retroviral drugs (ARVs). SZL2111 HIV/AIDs It is estimated that 51 % of the bed occupancy in public hospitals in Kenya is by AIDS patients1. The national health systems cannot cope with the accelerating demand as increasing number of people with full blown AIDS develop opportunistic SODeL JKUAT infections. The nancial investments required to treat AIDS are beyond national budgets. Not only is the cost of care beyond health care systems, but it is beyond the reach for the individual and the family. Family, friends and the community must ll the "care gap" at large. This group of care givers has the capacity and resources to do more than the national health care systems: they take care of the sick, replace their labor/income, care for their JJ II J I dependants, and help defray costs associated with the illness, J DocDoc I 19 Back Close provide palliative care of PLWA's and quality life in death. The SZL2111 HIV/AIDs use of caregiver is instrumental in reducing the stigma associated with HIV/AIDS. Thus, the concept of home based care. 1.2.1. Rationale for Home Based care SODeL JKUAT ˆ The people living with HIV/AIDS are discharged from hospital where trained professionals are and sent home where they are usually cared for by untrained relatives ˆ PLWA's need continued quality care to prolong lives and reduce suering ˆ There are limitations on hospital care, including limited resources that aect the care that can be given to PLWA's. JJ II J I J DocDoc I Back Close Continued hospitalization of PLWA's may lead to depletion of family and community savings and investments. 20 SZL2111 HIV/AIDs 1.2.2. Advantages of organized home based care ˆ It aects the socioeconomic, psychosocial and medical well being of the patient, the family, the community and the health care system. SODeL JKUAT ˆ It provides comfort of a familiar environment to the PLWA, ˆ It is less expensive for families ˆ It helps counteract the myths and mistaken beliefs about HIV/AIDS ˆ It encourages people to take steps to prevent infection. ˆ It encourages community participation in the care of PLWA's and thus maintains community cohesiveness in responding JJ II J I J DocDoc I Back Close to community members' needs. 21 SZL2111 HIV/AIDs ˆ It eases the demand on the national health system by reducing crowding in hospitals, thus better care is given to those who really need to be in hospital. SODeL JKUAT 1.2.3. Components of home based care ˆ Clinical management - which includes early diagnosis, rational treatment and planning for follow up care of HIV related illness ˆ Nursing care - which includes care to promote and maintain good health, hygiene and nutrition ˆ Counseling and psycho social care - which includes reducing stress and anxiety, promoting positive living, and help- JJ II J I J DocDoc I Back Close ing individuals to make informed decisions on HIV testing, plan for the future and behavior change 22 SZL2111 HIV/AIDs ˆ Social support - which includes information and referral to support groups, welfare services and legal advice for individuals and families and where possible provision of material assistance SODeL JKUAT ˆ Aspects of nutrition in comprehensive care of HIV/AIDS patients Nutrition implies the process of absorbing nutrients from food and processing them in the body in order to keep healthy or to grow. Adequate food security in the household is requisite for optimum nutrition, health and survival (FAO 2002). But HIV/AIDS reduces the household's ability to produce and buy food by taking away the adult labour that would otherwise be JJ II J I J DocDoc I Back Close engaged in agricultural production or in earning an income. At the same time, HIV disease increases health expenditure. 23 SZL2111 HIV/AIDs The capacity of an aected household to obtain an adequate amount and variety of food, and to adopt appropriate health and nutritional responses to HIV/AIDS, especially for the already vulnerable ones, is grossly reduced. On the other hand both SODeL JKUAT HIV/AIDS and malnutrition compromise the immune system, resulting in increased susceptibility to severe illnesses, which reduce the quality of life and shorten life expectancy. Malnutrition due to HIV/AIDS is linked to inadequate food intake, poor uptake of food into the body, and poor use and storage of nutrients. Each of these factors must be considered in providing the most appropriate nutritional care for the HIV-positive person. Reduced food intake in persons with HIV may be due to painful JJ II J I sores in the mouth and throat, loss of appetite, or fatigue. The J DocDoc I 24 Back Close main causes of loss of appetite are infections and depression. SZL2111 HIV/AIDs Other causes include side eects of medication such as nausea and vomiting, and inadequate access to and availability of appealing foods. Poor absorption of nutrients results when HIV damages the small intestine and alters the healthy bacteria of SODeL JKUAT the digestive system, causing malabsorption of fats and carbohydrates and frequent episodes of diarrhea. Intestinal infections also cause diarrhea, with loss and waste of nutrients. Infections, including HIV itself, lead to increased requirements for energy and protein, inecient use of nutrients, and loss of nutrients. Energy requirements are likely to increase by 10% to maintain body weight and physical activity in adults and growth in symptomatic children. JJ II J I J DocDoc I Back Close 25 SZL2111 HIV/AIDs • Advantages of good nutrition to PLWA ˆ Good nutrition entails eating a well-balanced diet that contains all the nutrients the body needs for growth and proper functioning. Balanced nutrition helps the body to: SODeL JKUAT ˆ Increase resistance to infection and disease and improve the energy supply. ˆ Boost the immune system and therefore reduce the frequency of episode of morbidity. ˆ Lessen severity of infection, improve the response to treatment for opportunistic infections such as TB, and speed the rate of recovery. JJ II J I J DocDoc I Back Close ˆ Replace lost micronutrient and provide the body with all essential nutrient required for good health. 26 SZL2111 HIV/AIDs ˆ Preserve muscle mass, slow or stop the loss of lean tissue, prevent weight loss, and improve body strength and energy. ˆ Delay the rate of progression of HIV to AIDS and the SODeL JKUAT further advance of AIDS itself. ˆ Keep PLWAs alive and able them to lead an active life; this in turn reduces their dependence, thus allowing them to take care of themselves and to delay early orphan hood of their children. Studies show that nutrition interventions can positively aect nutrition status (FAO 2002), the immune system and even personal esteem, by maintaining body weight, improving eective- JJ II J I J DocDoc I Back Close ness of medication and prolonging life. Supplementing micronutrients has been shown to increase life expectancy of subjects 27 SZL2111 HIV/AIDs with fewer than 200 CD4 cells per millilitre1. A number of micronutrient supplements including vitamin A, zinc and iron have been found to boost the immune system in a person with HIV infection. Multivitamins can reduce the risk of death and SODeL JKUAT improve immune function. • Principles of nutrition support for PLWA Good nutrition can therefore play an important role in the comprehensive management of HIV/AIDS, as it improves the immune system, boosts energy, and helps recovery from opportunistic infections. The following basic principles are being advocated for all programmes of HIV/ AIDS patient management, JJ II J I J DocDoc I Back Close counselling or education:  ˆ Nutritional education and counselling 28 SZL2111 HIV/AIDs ˆ Water and food safety intervention to prevent diarrhoea ˆ Income-generating activities to enhance food security ˆ Nutritional supplementation ˆ Meal designing and planning using locally available food- SODeL JKUAT stus ˆ To avoid malnutrition and wasting away HIV infected persons should always ensure that they take highly nutritive foods that are well balanced. ˆ High protein diet to build up infected cells and tissues/strengthen them. They include Soya beans, lean meat, milk, beef, eggs. JJ II J I J DocDoc I Back Close ˆ Carbohydrate foods are required in large quantities to provide the much required energy to strengthen patients who 29 SZL2111 HIV/AIDs are weak. They include Whole meal cereals, cassava, potatoes, and cooked bananas. ˆ Vitamins and minerals help bodies' in ghting diseases and keep opportunistic infections checked. They also help in SODeL JKUAT a quick recovery and disease management. Vitamins are obtained from fresh vegetables, fruits, fresh juices. ˆ Fluids help in cleaning the immune system, blood purication and to improve the appetite (anorexia). ˆ Frequency of food intake should be high to avoid or replace weight loss JJ II J I J DocDoc I Back Close 30 SZL2111 HIV/AIDs 1.3. Management of pregnancy in HIV/AIDS The introduction of combination therapy and the impact it has had on improving the health of HIV-positive women, together with the enormous strides made in reducing the risk of trans- SODeL JKUAT mission from mother to baby has led more HIV positive women contemplating having children. It is advisable to plan a pregnancy well in advance, more so for HIV positive women. Unfortunately, prior planning is not possible for all HIV positive women some will learn of their HIV diagnosis at routine antenatal visit. The women will be promptly referred for additional costs and informed of treatment options to safeguard their own health and the health of their unborn child. Ideally HIV posi- JJ I...
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