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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 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. 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 JJ II J I J DocDoc I Back Close 1 INTERNATIONAL RESPONSES TO THE HIV/AIDS PANDEMIC 12 1.1 Introduction . . . . . . . . . . . . . . . . . . . . . 1.2 Common Features of Eective National Responses 13 to HIV/AIDS epidemic . . . . . . . . . . . . . . . 16 1.2.1 17 Political Will and Leadership 9 . . . . . . . SZL2111 HIV/AIDs SODeL JKUAT 1.2.2 1.3 Fight against Stigma . . . . . . . . . . . . 18 1.2.3 Strategic Response . . . . . . . . . . . . . 20 1.2.4 Multisectoral and Multilevel Action . . . . 24 1.2.5 Community-based Responses . . . . . . . . 25 1.2.6 Social Policy Reform to Reduce Vulnerability . . . . . . . . . . . . . . . . . . . . . 27 1.2.7 Longer-term and Sustained Response . . . 29 1.2.8 Learning from Experience . . . . . . . . . 31 1.2.9 Adequate Resources . . . . . . . . . . . . 32 International Support for National Responses 1.3.1 JJ II J I J DocDoc I Back Close 1.4 Societal Openness and Determination to Debt Relief . . 35 . . . . . . . . . . . . . . . . . 38 Responses of African Governments to HIV - AIDS epidemic . . . . . . . . . . . . . . . . . . . . . . . 10 42 SZL2111 HIV/AIDs 1.4.1 Formation of institution to coordinate and ght HIV pandemic . . . . . . . . . . . . 1.4.2 Declaring HIV a national disaster . . . . 1.4.3 Some of the strategies adopted by the Kenyan 42 43 Solutions to Exercises . . . . . . . . . . . . . . . . SODeL JKUAT government to ght the spread of HIV/AIDS 44 JJ II J I J DocDoc I Back Close 11 59 SZL2111 HIV/AIDs LESSON 1 INTERNATIONAL RESPONSES TO THE HIV/AIDS PANDEMIC SODeL JKUAT Learning outcomes Upon completing this topic, you should be able to know: ˆ Features of Eective National Responses to HIV/AIDS epidemic ˆ International Support for National Responses ˆ Responses of African Governments to HIV - AIDS epidemic JJ II J I J DocDoc I Back Close ˆ Strategies adopted by the Kenyan government to ght the spread of HIV/AIDS 12 SZL2111 HIV/AIDs 1.1. Introduction AIDS epidemic is a true development crisis that threatens the social and economic fabric, and the political stability, of all nations. The epidemic is not out of control everywhere; some SODeL JKUAT countries and communities have managed to stabilize HIV rates or achieve a turnaround, and some have maintained very low prevalence rates, due to a range of factors that are not yet fully understood. Other communities have made signicant progress on care and support for people both infected and aected. A closer look at individual country responses, and at the corresponding achievements and failures, helps pinpoint some of the factors behind these successes (World Bank 1997, UN 2001). JJ II J I J DocDoc I Back Close The initial reaction of many countries was to try to persuade individuals and selected groups to change their behaviour by 13 SZL2111 HIV/AIDs providing information about HIV/AIDS. Gradually, however, behaviour change was understood to require more than mere information; the importance of decision-making and negotiation skills, accessibility of commodities and services, and supportive SODeL JKUAT peer norms became increasingly apparent. By the mid-1980s, it was well appreciated that individuals do not always control their own risk situations. This led to the development of prevention programmes aimed at enabling particular groups or communities such as sex workers and men who have sex with men to adopt safer behaviour. At the same time, as individuals infected with HIV earlier in the epidemic gradually fell ill and died, challenging family and community structures alike, the need to JJ II J I J DocDoc I Back Close provide health care and cushion the epidemic's impact became increasingly obvious. Simultaneously, the importance of work on 14 SZL2111 HIV/AIDs non-discrimination, protection and promotion of human rights, and against the stigmatization brought by HIV/AIDS, was more widely recognized, including the importance of involving dierent sectors of society (NASCOP 2005). With the mid-1990s, SODeL JKUAT and deepening epidemics in many countries, came a growing realization that HIV/AIDS is also a development challenge. To the extent that people's vulnerability to infection has social and economic roots, often including marginalization, poverty and women's subordinate status, these conditions need to be tackled as a way of making society as a whole less vulnerable to HIV over the long term. Advancing other social goals such as ed- ucation, empowerment of women and human rights protection JJ II J I J DocDoc I Back Close are important for reducing overall societal vulnerability to infection, as well as critical in their own right. At the same time, 15 SZL2111 HIV/AIDs planners need to bear in mind that development projects such as the construction of a major highway or the creation of freetrade zones may exacerbate the epidemic by promoting rapid urbanization, splitting families and depriving individuals of fa- SODeL JKUAT miliar social support systems. These negative eects need to be anticipated and actively countered. 1.2. Common Features of Eective National Responses to HIV/AIDS epidemic Analysis of eective programmes shows that a number of features characterize the responses of communities and countries which have already managed to stabilize or reverse their epi- JJ II J I J DocDoc I Back Close demic trends. This is not to say that there is one ideal expanded response or universal blueprint, but some basic, common prin16 SZL2111 HIV/AIDs ciples of eective response can be identied. It is important for each country to nd locally relevant pathways to a response that are likely to include most, if not all, of the elements summarized below (NASCOP 2005, 2005a). Successful national responses SODeL JKUAT have generally comprised the following features: 1.2.1. Political Will and Leadership Political will expresses the national commitment and provides overall leadership to the nation in response to AIDS. Eective responses are characterized by political commitment from community leadership up to a country's highest political level.Such commitment leads to high-prole advocacy and helps bring in JJ II J I J DocDoc I Back Close all the sectors and players, along with the necessary human and nancial resources. It is also critical for making the hard po17 SZL2111 HIV/AIDs litical choices often involved in adopting intervention methods that really work such as making sex work safer and can lead to helpful policy changes and supportive legislation.Ultimately, the success of a programme is determined by the dedication and SODeL JKUAT eorts of the change agents who are closest to its level of impact. They, however, need to be constantly motivated, supervised and supported by the political leadership 1.2.2. Societal Openness and Determination to Fight against Stigma To be eective, programmes need to make HIV visible and the factors leading to its spread, discussible. Programmes need to JJ II J I J DocDoc I Back Close make people aware of the existence of HIV and how it is spread, without stigmatizing the behaviours that lead to its transmis18 SZL2111 HIV/AIDs sion. They also need to facilitate discussion about an individual or community's own vulnerability, and how to reduce it. This involves dissipating fear and prejudice against people who are already living with HIV or AIDS.Successful programmes impart SODeL JKUAT knowledge, counter stigma and discrimination, create social consensus on safer behaviour, and boost AIDS prevention and care skills. These can be accomplished cost-eectively through mass media campaigns, and through peer/outreach education and lifeskills programmes in schools and workplaces.Programmes such as TASO (Loewenson R, Whiteside A. 1997) in Uganda have demonstrated the enormously positive impact of openness and honesty in facing HIV. Ensuring that counselling and voluntary JJ II J I J DocDoc I Back Close HIV testing are available, so that an individual can nd out her or his HIV status is a further critical ingredient in counteracting 19 SZL2111 HIV/AIDs denial. 1.2.3. Strategic Response A single, powerful national AIDS plan involving a wide range of SODeL JKUAT actors government, civil society, the private sector and (where appropriate) donors is a highly valuable starting point. The development of a country strategy begins with an analysis of the national HIV/AIDS situation, risk behaviours and vulnerability factors, with the resulting data serving to prioritize and focus initial action. It is essential to nd out where people in the country are already infected, where they are most vulnerable, and why. JJ II J I J DocDoc I Back Close Eective strategy development then involves draw- ing on evidence-based methods of HIV/AIDS prevention, care and impact alleviation best practices recognizing that some of 20 SZL2111 HIV/AIDs these may be culturally sensitive (e.g. sex education in schools) or require hard political choices (e.g. jecting drug users). needle exchange for in- At the same time, attention needs to be given to ensuring that the relevant services and commodities SODeL JKUAT such as condoms or STD services are acceptable, aordable and available. Given the resource constraints facing many countries, the development of a strategy will also involve some prioritization. Eective strategies oer both prevention and care. As illness mounts in the epidemic, so does the need for health care and social support. Care services have benets that extend beyond caring for sick individuals. They help convince others that the threat of HIV is real and they therefore make prevention JJ II J I J DocDoc I Back Close messages more credible. Messages and programmes that build compassion and skills in health care settings, communities and 21 SZL2111 HIV/AIDs families are needed right from the start, and combined training for prevention and care helps reduce costs. An important point about programme elements is that they tend to work in synergy. Individual features of eective action can be found in SODeL JKUAT most programmes. The tragedy is that in many countries, action remains sporadic and patchy rather than comprehensive. Boutique projects may provide services for one or two communities, while large areas of the countryside have nothing. Many programmes have yet to become comprehensive in either geographical coverage or content. The national response may focus solely on sex workers, for example; elsewhere, eorts may go into AIDS and life skills education among the young in schools and JJ II J I J DocDoc I Back Close out of schools, but the risks and vulnerability of men who have sex with men are ignored. While human and other resource 22 SZL2111 HIV/AIDs constraints may hamper eorts to scale up, a sound strategic plan based on epidemiological evidence and best practices will at least ensure basic coverage. Strategic planning of national responses is neither easy nor quick. But as the experience of a SODeL JKUAT number of countries has provedfor example, Botswana, Cambodia, China, Côte d'Ivoire, Dominican Republic, Guatemala, Honduras, Malawi, Mozambique, Papua New Guinea, Romania, and the United Republic of Tanzaniait can be done effectively, and the process itself is critical in bringing on board a wide range of actors whose commitment is key to successful outcomes (NASCOP 2005, 2005a). JJ II J I J DocDoc I Back Close 23 SZL2111 HIV/AIDs 1.2.4. Multisectoral and Multilevel Action Successful programmes involve multisectoral and multilevel partnerships between government departments and between government and civil society, with AIDS being routinely factored SODeL JKUAT into individual and joint agendas. Only a combined eort will mainstream AIDS and establish it rmly on the development agenda. Multisectoral and multilevel partnerships make sense for all stakeholders. Government sectors and businesses are affected in multiple ways by a serious epidemic and hence have an important stake in participating in AIDS prevention, care and support at all levels, but especially in ensuring sustained, large-scale programmes. Ministries of Labour for example can JJ II J I J DocDoc I Back Close mandate workplace prevention programmes in the private sector. Ministries of Defence can use their budgets to implement 24 SZL2111 HIV/AIDs programmes for the military, and Ministries of Education for teachers, schoolchildren and their parents. Private rms can contribute in cash and in kind. While Ministries of Health undoubtedly have a critical role to play in responding to the epi- SODeL JKUAT demic, leaving the management of the overall national response to them is unlikely to prove eective in the longer term. NGOs, which are trusted by vulnerable populations, are best positioned to support prevention programmes in collaboration with these communities themselves. The mass media can promote safer behaviour and tolerance through their own channels. 1.2.5. Community-based Responses JJ II J I J DocDoc I Back Close The eventual outcome of the AIDS epidemic is decided within the community. People, not institutions, ultimately decide whether 25 SZL2111 HIV/AIDs to adapt their sexual, economic and social behaviour to the threat of HIV infection. They are the subjects of the response to AIDS, not merely the objects of outside interventions. Therefore, responses to HIV are in the rst instance local: they im- SODeL JKUAT ply the involvement of people where they live in their homes, their neighbourhoods and their workplaces. Community members are also indispensable for mobilizing local commitment and resources for eective action. In particular, people living with HIV/AIDS must play a prominent role and bring their unique experience and perspective into programmes, starting from the planning stage. Community mobilization against HIV/AIDS is taking place successfully all over the world. The activities car- JJ II J I J DocDoc I Back Close ried out in community projects are as diverse as the peoples and cultures that make up these communities. 26 Some are en- SZL2111 HIV/AIDs tirely home-grown and self-sucient, while others have beneted from external advice and funding. Some are based in religious centres, others in medical institutions, and still others in neighbourhoods meeting places. Many concentrate on public SODeL JKUAT education, others on providing care, and still others on prevention and other goals. 1.2.6. Social Policy Reform to Reduce Vulnerability HIV transmission is associated with specic risk-taking behaviours. These behaviours are inuenced by personal and societal factors that determine people's vulnerability to infection. To be eective, risk-reduction programmes must be designed and imple- JJ II J I J DocDoc I Back Close mented in synergy with other programmes, which, in the short and long term, increase the capacity and autonomy of those 27 SZL2111 HIV/AIDs people particularly vulnerable to HIV infection. Therefore, the question is how to address directly the societal forces which determine, more than anything else, vulnerability to HIV/AIDS. Issues such as gender imbalance and the inability of women to SODeL JKUAT negotiate when, how and with whom they have sex is a social policy issue. The chronic and acute poverty of urban households that leads to their eventual breakdown and the migration of children to the street is not an issue that can be easily addressed at a household or community level alone. Addressing the societal forces which determine vulnerability to HIV requires engagement at the policy level and political will and resources. Eective social policy reform is a long-term JJ II J I J DocDoc I Back Close agenda, but even small-scale and incremental steps can send important messages about political commitment to reducing the 28 SZL2111 HIV/AIDs vulnerability of individuals and communities to infection. 1.2.7. Longer-term and Sustained Response Even a comprehensive response to HIV/AIDS does not yield im- SODeL JKUAT mediate results. Measurable impact may take four to ve years to develop. Therefore, a long-term approach must be taken, which involves building societal resistance to HIV. Beginning with t...
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