INTRODUCTION TO HIV/AIDS MANAGEMENT IN PUBLIC HEALTH.pdf

INTRODUCTION TO HIV/AIDS MANAGEMENT

1. HIV/AIDS MANAGEMENT IN
PUBLIC HEALTH
INTROCUCTION TO HIV CARE AND
MANAGEMENT
BY
MUTEGEKI ADOLF

2. Introduction to HIV Care and Management
•HIV (Human Immunodeficiency Virus) remains a significant
global health concern, requiring a comprehensive approach
to care and management.
•Effective HIV care involves prevention, early diagnosis,
antiretroviral therapy (ART), monitoring of treatment
adherence, and management of opportunistic infections.
•Proper management helps improve the quality of life for
people living with HIV (PLHIV) and reduces transmission
risks.

3. DEFINITION OF KEY TERMS
•HIV (Human Immunodeficiency Virus)–A virus that attacks the immune
system, specifically CD4 cells (T cells), making individuals more vulnerable to
infections and diseases. If untreated, it can progress to AIDS.
•AIDS (Acquired Immunodeficiency Syndrome)–The advanced stage of HIV
infection, characterized by severe immune system damage and the occurrence
of opportunistic infections or certain cancers.
•CD4 Cells–A type of white blood cell that plays a crucial role in immune
system function. HIV destroys these cells, weakening the body’s defense
against infections.
•Viral Load–The amount of HIV present in a person’s blood. A high viral load
indicates active replication, while an undetectable viral load suggests effective
ART control.

4. •Antiretroviral Therapy (ART)–The use of a combination of antiretroviral
(ARV) drugs to suppress HIV replication, improve immune function, and
prevent disease progression.
•Opportunistic Infections (OIs)–Infections that occur more frequently and
are more severe in individuals with weakened immune systems, such as
tuberculosis (TB), pneumonia, and candidiasis.
•Pre-Exposure Prophylaxis (PrEP)–A preventive strategy where HIV-negative
individuals take ARV medication to reduce their risk of acquiring HIV.
•Post-Exposure Prophylaxis (PEP)–A short-term ART regimen taken within
72 hours after potential exposure to HIV to prevent infection.
•Adherence–The ability of a person living with HIV to take their medication
consistently and correctly as prescribed, which is crucial for treatment
success.

5. •HIV Testing and Counseling (HTC)–The process of providing
individuals with HIV testing services, pre-and post-test
counseling, and linkage to care if needed.
•HIV Drug Resistance (HIVDR)–The ability of HIV to mutate
and become less responsive to antiretroviral drugs, often due
to poor adherence to treatment.
•Harm Reduction–Strategies aimed at reducing the risk of
HIV transmission, especially among key populations such as
people who inject drugs (PWID).

6. •Key Populations–Groups that are at higher risk of HIV
infection, including sex workers, men who have sex with
men (MSM), people who inject drugs (PWID), and
transgender individuals.
•Positive Living–A holistic approach encouraging PLHIV to
maintain healthy lifestyles, adhere to treatment, and
engage in social and emotional well-being activities.
•HIV Cure Research–Scientific efforts aimed at finding a
way to completely eradicate HIV from the body or achieve
long-term remission without the need for ART.

7. History and Origin of HIV
•The history of HIV(Human Immunodeficiency Virus)
is deeply intertwined with the broader history of the
AIDS (Acquired Immunodeficiency Syndrome)
epidemic. The virus's origins and its global spread
have been subjects of extensive study.

8. ORIGIN OF HIV
•The origin of HIV is believed to be traced back to the early 20th century.
•It is believed that HIV originated from a type of simian immunodeficiency
virus (SIV) that existed in certain primates in sub-Saharan Africa.
•There are two main types of HIV:
•HIV-1–This is the most common and widespread strain of HIV. It is believed
to have originated from the transmission of SIV from chimpanzees to
humans, likely through hunting and consumption of chimpanzee meat. This
transmission is known as zoonotic transmissionand is estimated to have
occurred in the early to mid-20th century, particularly between the 1920s
and 1940s.
•HIV-2–This strain is less common and primarily found in West Africa. It is
believed to have come from sooty mangabeymonkeysthrough similar
zoonotic transmission.

9. Early Evidence of HIV (1960s-1970s)
•While the exact time HIV first crossed into humans is not well-documented.
•The first recognized case of HIV infectionwas in a blood sample collected in 1959
from a man in the Congo. Researchers later found that the man had contracted
HIV-1, suggesting that the virus had been circulating in humans for some time
before its recognition.
•HIV may have been present in a relatively low number of cases throughout the
1960s and 1970s, though it did not become a widely recognized problem until the
1980s.
Recognition of AIDS (1980s)
•The first clinical cases of AIDSin the United States were reported in 1981. These
initial cases involved a small number of young gay men in Los Angeles who
developed rare forms of pneumonia and cancer.
•The CDC (Centers for Disease Control and Prevention) began investigating the
phenomenon.
•In 1982, the CDC officially named the disease AIDS(Acquired Immunodeficiency
Syndrome).
•During the early years of the epidemic, the medical community was unclear on
how the disease was transmitted, leading to widespread fear and discrimination.

10. Identification of HIV (1983-1986)
•In 1983, researchers at the Pasteur Institutein Paris, led by Dr. Luc Montagnier,
isolated the virus that caused AIDS. They initially referred to it as
Lymphadenopathy-Associated Virus (LAV).
•In 1984, Dr. Robert Gallofrom the U.S. National Cancer Institute also identified the
virus and dubbed it HTLV-III (Human T-Cell LymphotropicVirus Type III).
•Eventually, the virus was officially named HIVin 1986.
•It was confirmed that HIV attacks the immune system, particularly the CD4 T cells,
which play a crucial role in defending the body against infections.
Global Spread of HIV (1980s-1990s)
•HIV spread globally in the 1980s and 1990s, affecting millions of individuals. The
epidemic heavily impacted communities in sub-Saharan Africa, North America, and
later other parts of the world.
•By the mid-1980s, the World Health Organization (WHO) declared the epidemic a
global health emergency.
•During this time, widespread stigmaand discriminationsurrounding HIV/AIDS
fueled public fear, especially in groups like gay men, intravenous drug users, and
sex workers, who were seen as at higher risk.

11. Advancements in Treatment (1990s-2000s)
•In 1996, the advent of Highly Active Antiretroviral Therapy (HAART)revolutionized HIV
treatment. These medications combine different types of antiretroviral drugs to
suppress viral replication and increase immune function.
•The introduction of HAART allowed individuals living with HIV to live longer, healthier
lives and significantly reduced the number of AIDS-related deaths.
•Over the next two decades, the development of newer ARV drugs further improved
treatment outcomes.
Ongoing Research and Prevention (2000s-Present)
•In recent years, there has been significant progress in the areas of HIV prevention, such
as the development of PrEP(Pre-Exposure Prophylaxis), which significantly reduces the
risk of HIV transmission in high-risk populations.
•Research has continued into finding a curefor HIV, with occasional successes like the
Berlin Patientand London Patient, both of whom underwent stem cell transplants that
led to long-term remission of HIV.
•There has also been a global movement toward ending the HIV epidemic by 2030, with
many countries increasing access to treatment and care, reducing stigma, and focusing
on HIV prevention.

12. WAYS HIV CAN SPREAD
•HIV is primarily spread through contact with certain body fluids
from a person who is infected with the virus.
•These fluids include blood:
Semen,
Vaginal fluids,
Rectal fluids,
Pre-seminal fluids, and
Breast milk.
•HIV transmission can occur in various ways, but the virus does not
spread through casual contact such as hugging, shaking hands, or
sharing food.

13. 1. Sexual Contact
•Unprotected vaginal, anal, or oral sexwith an HIV-positive person is the most
common way HIV is transmitted.
•During sex, if one partner has HIV, the virus can be passed through the
exchange of bodily fluids (semen, vaginal fluids, rectal fluids, etc.).
•Anal sexcarries the highest risk for transmission because the rectal tissues
are more fragile and can easily tear, allowing the virus to enter the
bloodstream.
•Vaginal sexis also a significant mode of transmission, with women being at a
higher risk due to the greater surface area of the vagina and the likelihood of
exposure to semen.
•Oral sexcarries a lower risk of transmission compared to vaginal or anal sex,
but it is still possible, particularly if there are open sores, cuts, or bleeding
gums in the mouth.

14. 2. Sharing Needles or Syringes
•HIV can be transmitted through the sharing of needles, syringes, or other
drug paraphernaliaamong individuals who inject drugs.
•If a needle or syringe has been used by someone with HIV, the virus can
remain on the needle and enter the bloodstream of the next person who uses
it.
3. From Mother to Child (Vertical Transmission)
•During pregnancy, HIV can be transmitted from an infected mother to her
baby. This can occur in utero (while the baby is still in the womb), during
childbirth, or through breastfeeding.
•During delivery: The blood of the mother may mix with the blood of the baby
during cutting of the cord or during instrumental delivery.
•Breastfeedingby an HIV-positive mother can transmit the virus to the infant,
though the use of ART and alternatives like formula feeding can reduce this
risk.

15. 4. Blood Transfusions or Organ Transplants
•HIV can be transmitted through contaminated blood productsor
organ transplantsfrom an HIV-positive donor.
•However, in most countries, blood and organ donations are now
rigorously tested for HIV, greatly reducing this risk.
5. Accidental Needle Sticks
•Healthcare workers or others who handle sharp objects (e.g.,
needles) may be at risk of HIV if they accidentally puncture their skin
with a needle or syringe that has been contaminated with HIV-
infected blood.
•Although the risk is low, the use of universal precautions, including
wearing gloves and proper needle disposal, is crucial to prevent such
incidents.

16. 6. Tattoos, Piercings, and Other Body
Modifications
•HIV can be spreadif tattoo or piercing equipment is not
properly sterilized and comes into contact with infected
blood.
7. Occupational Exposure
•Certain jobs, particularly in healthcare, may involve the risk
of accidental exposure to HIV-infected blood or other bodily
fluids through accidents or injuries.
8. Road Accidents and Injuries

17. Ways HIV Does NOT Spread
•It’s important to clarify that HIV is notspread through:
•Casual Contact–Hugging, shaking hands, or sharing a meal does
not transmit HIV.
•Air or Water–HIV is not spread through the air or water.
•Coughing or Sneezing–HIV cannot be transmitted through
respiratory droplets.
•Insect Bites–Mosquitoes or other insects cannot spread HIV.
•Sharing Toilets or Showers–HIV is not spread through public
restrooms, showers, or swimming pools.
•Kissing–HIV is nottransmitted through closed-mouth or open-
mouth kissing unless there are open sores or bleeding gums.

18. General Strategies to Prevent HIV
HIV prevention requires a comprehensive approachthat
includes:
Behavioral,
Biomedical, and
Structural interventions.

19. 1.Behavioral Strategies
•Abstinence
•Being faithful to one uninfected partner–Reducing
multiple partners lowers HIV exposure.
•Correct and consistent condom use–Using male
or female condomsduring sex prevents HIV and other
STIs.
•HIV education and awareness–Providing information
on how HIV spreads and ways to prevent it.
•Reducing risky behaviors–Avoiding unprotected
sex, casual sex, and sharing needles

20. 2. Biomedical Strategies
•These use medical approaches to prevent HIV transmission.
HIV testing and counseling (HTC)–Early detection helps in prevention
and treatment.
Pre-Exposure Prophylaxis (PrEP)–Daily medication for HIV-negative
people at high risk.
Post-Exposure Prophylaxis (PEP)–Emergency treatment taken within 72
hoursof exposure.
Antiretroviral Therapy (ART) for HIV-positive individuals–Reduces viral
load, making transmission almost impossible ("Undetectable =
Untransmittable" or U=U).
Medical male circumcision–Lowers HIV risk in heterosexual men by
60%.
Prevention of Mother-to-Child Transmission (PMTCT)–HIV-positive
pregnant women take ART to prevent passing HIV to the baby.

21. 3. Structural and Community-Based Strategies
These focus on creating an environment that reduces HIV riskand
supports prevention efforts.
Empowering women and girls–Reducing gender inequality and
sexual violence.
Harm reduction programs–Needle exchange programs and safe
drug use counseling for people who inject drugs
Strengthening healthcare systems–Improving access to HIV
treatment, prevention, and care services.
Enforcing policies to reduce stigma and discrimination–
Encouraging people to seek HIV services without fear.
Community engagement and peer education–Using local
influencers, religious leaders, and youth programs to spread
awareness