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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 supple- mented 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 (SODeL) Department of Curricula & Delivery 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. JJ II J I J DocDoc I Back Close Discordant couples. Treatment and Management; 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: JJ II J I J DocDoc I Back Close none 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. JJ II J I J DocDoc I Back Close ˆ Tutorials to give the students more attention. 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 1 BEHAVIORAL PATTERNS AND THE SPREAD OF HIV /AIDS 11 1.1 Individual Behavioral Patterns and the spread of HIV /AIDS JJ II J I J DocDoc I Back Close 1.1.1 . . . . . . . . . . . . . . . . . . . . . 12 Behaviour change could play a greater role in reducing HIV infection 9 . . . . . . . . . 15 SZL2111 HIV/AIDs 1.1.2 1.2 . . . . . . . . 16 Role of Gender in HIV/AIDS Transmission . . . . 18 1.2.1 Safe sex and safer behaviors Cultural, social, biological and economic pressures make women more vulnerable SODeL JKUAT HIV that men. 1.2.2 1.3 Remedy to above problem Back Close . . . . . . . . . 19 22 Drug/Alcohol Use and Abuse and the Spread of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . 25 1.3.1 . 28 Solutions to Exercises . . . . . . . . . . . . . . . . 34 Relationship between drug use and HIV JJ II J I J DocDoc I . . . . . . . . . . . . . . . 10 SZL2111 HIV/AIDs LESSON 1 BEHAVIORAL PATTERNS AND THE SPREAD OF HIV /AIDS SODeL JKUAT Learning outcomes Upon completing this topic, you should be able to know policies and rights of PLWHAs with relation to: ˆ Individual Behavioral Patterns and the spread of HIV /AIDS ˆ Role of gender in transmission of HIV /AIDS ˆ Drug/Alcohol use and use and the spread of HIV/AIDS JJ II J I J DocDoc I Back Close 11 SZL2111 HIV/AIDs 1.1. Individual Behavioral Patterns and the spread of HIV /AIDS Behaviour can be dened as all those process by which an organism senses the external world and the internal state of its SODeL JKUAT body and responds to changes which perceives. Many of such process will take place inside the nervous system and may not be directly observable. An organism may respond by involving in a violent activity or incomplete inactivity, but all are equally behaviour. The spread of HIV primarily depends on individ- ual's sexual behaviour patterns how often men and women have sex and who they have sex with. Not everyone's sex life is the same and patterns of sexual behaviour are strongly inuenced JJ II J I J DocDoc I Back Close by social, cultural and psychological factors over which men and women have little control. In most societies, men are generally 12 SZL2111 HIV/AIDs expected to be strong leaders, to be primary providers of their family's food, shelter and defend themselves, their families and societies from aggressors. Virility-the ability to perform sex is almost an essential component of masculinity in almost every so- SODeL JKUAT ciety. Young people are expected to prove their sexual prowess and there is under spread belief that a man's need for sex is beyond control. For men anything that appears to interfere with their sex lives such as appeal to abstinence or use of condoms is a threat to their masculinity. Impelled by these attitudes, men on average report more sexual partners than women. The implication of this are that women are likely to contract HIV but less likely to transmit the virus to other sexual partners while men JJ II J I J DocDoc I Back Close are more likely to contract and transmit the virus. In the long term this means that more women than men will contract HIV. 13 SZL2111 HIV/AIDs Compounding this situation is the fact that many men do not consider sex as a consensual activity. Sex has to take place when man decides and without a condom if he chooses. Wives are often beaten or ejected from their home. If they refuse to submit SODeL JKUAT to their husbands and many women are at risk outside the home if they refuse to submit to their husbands and many women are at risk outside the home. In such instances, women nd it impossible to protect themselves from infection with HIV or other STI's. In prisons or other single sex environments some men rape other men either as a substitute for sex with a woman or to establish power over their victims. In other situations, however, sex between men may be an expression of mutual desire JJ II J I J DocDoc I Back Close or the result of ones desire and other's nancial need. There is need to change men attitudes and subsequent behaviours. Men 14 SZL2111 HIV/AIDs do not protect themselves because male attitudes tell them not to; while women do not protect themselves because men do not SODeL JKUAT allow them to. 1.1.1. Behaviour change could play a greater role in reducing HIV infection If individuals could: 1. Postpone their rst sexual intercourse. 2. Practice safe sexual practices 3. Reduce the number the number of sexual partners 4. Prevent and treat STDs JJ II J I J DocDoc I Back Close 5. Avoid traumatic sexual intercourse 15 SZL2111 HIV/AIDs 6. Make sex a consensual activity, openly discuss sex issues etc. SODeL JKUAT 1.1.2. Safe sex and safer behaviors ˆ Practice abstinence. ˆ Reduce the number of sexual partners to one. ˆ Always use latex condoms with a water-soluble lubricant containing the spermicide nonoxynol 9 and do not reuse condoms. ˆ Do not use cervical caps or diaphragms without using a condom as well. JJ II J I J DocDoc I Back Close ˆ Always use dental dams for oral female genital or anal stimulation. 16 SZL2111 HIV/AIDs ˆ Avoid anal intercourse because this practice may injure SODeL JKUAT tissues. ˆ Avoid manual - anal intercourse (sting). ˆ Do not ingest urine or semen. ˆ Avoid having sex with people who are injecting drug users. ˆ Engage in nonpenetrative sex such as body massage, social kissing (dry), mutual masturbation, fantasy, and sex lms. ˆ If female, avoid pregnancy if you or your sexual partner is HIV seropositive. ˆ Inform prospective sexual partners of your HIV-positive status. JJ II J I J DocDoc I Back Close ˆ Notify previous and present sexual partners if you learn that you are HIV seropositive. 17 SZL2111 HIV/AIDs ˆ If HIV seropositive, do not have unprotected sex with another HIV-seropositive person because cross-infection with another HIV strain can increase the severity of the disease. ˆ Do not share needles, razors, toothbrushes, sex toys, or SODeL JKUAT other blood-contaminated articles. ˆ If HIV seropositive, do not donate blood, plasma, body organs, or sperm 1.2. Role of Gender in HIV/AIDS Transmission Although women are making eorts towards equality with men, a lot of them still do not have control over their lives especially JJ II J I J DocDoc I Back Close their bodies. 18 SZL2111 HIV/AIDs 1.2.1. Cultural, social, biological and economic pressures make women more vulnerable HIV that men. 1. Men still dictate matters regarding sex - for example, when SODeL JKUAT to have sexual intercourse irrespective of whether a woman wants it or not. Also use of condom relies on the man. 2. Girls have been taught to leave decision making on sex matters to males whose needs and demands are expected to dominate. 3. Male predominance often comes with intolerance for predatory and violent sexuality - this carries double standards JJ II J I J DocDoc I Back Close whereby women are blamed or thrown out for indelity whether real or suspected while men are allowed to have 19 SZL2111 HIV/AIDs multiple sexual partners. 4. Biological makeup and reproductive anatomy of the female body makes her to be more vulnerable to contract HIV than men - sex takes place inside the body of the woman SODeL JKUAT and the female genitalia is prone to tears and wear. These tears and wears and/or sores provide entry route for the virus. 5. The female reproductive system is also in direct and longer contact with the male semen deposited during sexual intercourse. If the semen has HIV, then it becomes easier for her to contract the virus. 6. Poverty - failure to respect the human rights of girls in JJ II J I J DocDoc I Back Close terms of equal access to school, training, employment opportunities etc. reinforces their economic dependence on 20 SZL2111 HIV/AIDs men. A woman who is in a stable relationship and is economically dependent on her husband cannot aord to jeopardize his support even when she suspects that he is HIV positive. If she insists on a condom use she is accused of SODeL JKUAT being unfaithful or the man reacts violently. 7. Prostitution-a lot of women go into prostitution as a way of income generating activity. A lot of them end up acquiring HIV/AIDS. For some women, prostitution is a choice while others are forced by circumstances into it to exchange sex for basic necessities of life for themselves and their children. 8. Cultural practices-a number of cultural practices have in- JJ II J I J DocDoc I Back Close creased the vulnerability of women to contracting HIV. These include wife inheritance, polygamy, early marriages 21 SZL2111 HIV/AIDs and resistance to condom use. 9. Social evils - they include rape, sodomy, homosexuality, premarital, extramarital sex, and drug and alcohol abuse. 10. Ignorance - majority of women are poorly educated and SODeL JKUAT lack information on their bodies, HIV/AIDS and other sexually transmitted diseases. They are therefore unable to protect themselves. A vulnerable woman is one who is lacking in power or control over her risk of HIV infection. 1.2.2. Remedy to above problem JJ II J I J DocDoc I Back Close 1. Combating ignorance: (a) improve the access of girls to formal education, 22 SZL2111 HIV/AIDs (b) ensure they have information on their bodies, HIV/AIDS and other STD's, and (c) equip them with skills to say NO to unsafe sex. 2. Provide women friendly services SODeL JKUAT (a) girls and women should have access to appropriate health care and HIV/STD prevention services, (b) make condoms and STD care are available where women don't feel embarrassed. 3. Make female condoms available - female condoms though expensive should be made available. 4. Build safer norms - support organizations advocating against behavioral traditions which have become deadly with the JJ II J I J DocDoc I Back Close advent of HIV/AIDS e.g. genital mutilation, child abuse, rape, sexual coercion. 23 SZL2111 HIV/AIDs 5. Educate boys and men to respect girls and women - this enables them to engage in responsible sexual behavior and to share their responsibility for protecting themselves, their partners and their children from HIV/AIDS and STDs. SODeL JKUAT 6. Reinforce women's economic independence - increase and strengthen existing training opportunities for women, credit programmes, saving schemes and women's cooperatives and link them with AIDS prevention activities. 7. Reduce vulnerability through policy changes - policies from communities to national level must be reshaped if women's vulnerability to HIV is to be reduced. Human rights and legal rights should be improved. JJ II J I J DocDoc I Back Close 24 SZL2111 HIV/AIDs 1.3. Drug/Alcohol Use and Abuse and the Spread of HIV/AIDS A drug can be dened as any substance that aects the function of living cells, used in medicine to diagnose, cure, prevent the SODeL JKUAT occurrence of diseases and disorders, and/or prolong the life of patients with incurable conditions Drug abuse is characterized by taking more than the recommended dose of prescription drugs such as barbiturates (depressants) without medical supervision, or using government-controlled substances such as marijuana, cocaine, heroin, or other illegal substances. Legal substances, such as alcohol and nicotine, are also abused by many people. Abuse of drugs and other substances can lead to physical and JJ II J I J DocDoc I Back Close psychological dependence. Drug abuse can cause a wide variety of adverse physical reactions. Long-term drug use may damage 25 SZL2111 HIV/AIDs the heart, liver, and brain. Drug abusers may suer from malnutrition if they habitually forget to eat, cannot aord to buy food, or eat foods lacking the proper vitamins and minerals. Individuals who abuse injectable drugs risk contracting infections SODeL JKUAT such as hepatitis and HIV from dirty needles or needles shared with other infected abusers. One of the most dangerous eects of illegal drug use is the potential for overdosing that is, taking too large or too strong a dose for the body's systems to handle. A drug overdose may cause an individual to lose consciousness and to breathe inadequately. Without treatment, an individual may die from a drug overdose. Drug addiction is marked by a compulsive craving for a substance. Successful treatment meth- JJ II J I J DocDoc I Back Close ods vary and include psychological counseling, or psychotherapy, and detoxication programs medically supervised programs that 26 SZL2111 HIV/AIDs gradually wean an individual from a drug over a period of days or weeks. Detoxication and psychotherapy are often used together. The illegal use of drugs was once considered a problem unique to residents of poor, urban neighborhoods. Today, how- SODeL JKUAT ever, people from all economic levels, in both cities and suburbs, abuse drugs. Some people use drugs to relieve stress and to forget about their problems. Genetic factors may predispose other individuals to drug addiction. Environmental factors such as peer pressure, especially in young people, and the availability of drugs, also inuence people to abuse drugs. People with alcohol use disorders are more likely to contract HIV than the general population. Similarly people with HIV are more likely to abuse JJ II J I J DocDoc I Back Close alcohol in their life time. In persons already infected, the combination of heavy drinking and HIV has been associated with 27 SZL2111 HIV/AIDs increased medical and psychiatric complications, delay in seeking treatment, poor HIV treatment outcome. People who abuse alcohol are more likely to engage in behaviors that place them at risk of contracting HIV. Heavy alcohol use has been correlated SODeL JKUAT with a high risk sexual behaviors including: ˆ Multiple sex partners ˆ Unprotected intercourse ˆ Sex with high risk partners 1.3.1. Relationship between drug use and HIV ˆ JJ II J I J DocDoc I Back Close Shared needles/syringes for use in drug application can carry HIV and hepatitis viruses. ˆ Drug use is linked with unsafe sexual activity. 28 SZL2111 HIV/AIDs ˆ Infected blood drawn into the needle is infected along with the drug by the next user. ˆ A recent study has shown that HIV can survive in a used syringe for at least 4 weeks. SODeL JKUAT ˆ A lot of people believe that sex and drugs should go together. Drug users might trade sex for drugs. ˆ Others think that sexual activity is more enjoyable when they are using drugs. ˆ Drug use including alcohol increases the chance of not using protection during sex, leads to acquiring/transmitting HIV/AIDS. JJ II J I J DocDoc I Back Close ˆ A lot of drugs interfere with the proper functioning of the antiretroviral drugs. 29 SZL2111 HIV/AIDs ˆ One who is a drug addict might forget to take his ARV therapy - delay in treatment and increment of viral load. A probability of overdose which is fatal SODeL JKUAT ˆ JJ II J I J DocDoc I Back Close 30 SZL2111 HIV/AIDs Revision Questions Exercise 1.  Discuss gender vulnerability of HIV infection in females relative to male counterparts SODeL JKUAT Example . Discuss the eects of stigma and discrimination on the spread of HIV/AIDS Solution : Stigma (attitude) can be dened as a discrediting at- tribute that is used to separate the aected persons or groups apart from the normalized orders, or  an act of identifying, labeling or attributing undesirable qualities targeted towards those who are perceived as being shamefully dierent and deviant from the social ideal . Discrimination (act) is an action or treatment JJ II J I J DocDoc I Back Close based on the stigma, sanction, harassment, scapegoat and violence based on infection or association with HIV/AIDS . 31 SZL2111 HIV/AIDs  Revision questions or guidelines 1. Using appropriate examples discuss the rights of people SODeL JKUAT living with HIV/AIDs at the work place. 2. During Volutary Conselling and Testing explain how the health worker should conduct him/herself to ensure the rights of the person visiting that clinic are observed. 3. Sex education is a right for every youth. Discuss in detail what this entails. 4. Anything else you would like to suggest JJ II J I J DocDoc I Back Close References and Additional Reading Materials 32 SZL2111 HIV/AIDs 1. Maranga R. O, Muy...
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