BUCU005 HIVAIDS and DRUG ABUSE PDF

P.O.
Box 342-01000 Thika

Email: info@mku.ac.ke
Web: www.mku.ac.ke
DEPARTMENT OF PUBLIC HEALTH
COURSE CODE: BUCU005
COURSE TITLE: HIV/AIDS AND DRUG

ABUSE
TABLE OF CONTENT
TABLE OF CONTENT ...............................................................................................................................................2
COURSE OUTLINE ....................................................................................................................................................7
CHAPTER 1 .................................................................................................................................................................8
GENERAL INTRODUCTION ...................................................................................................................................8
1.1 PUBLIC HEALTH AND HYGIENE ......................................................................................................8
1.2 CONCEPTS OF HIV, AIDS AND STIS ............................................................................................... 12
1.2.1 HIV: ................................................................................................................................................ 12
1.2.2 AIDS: .............................................................................................................................................. 12
1.2.3 STIS/STDS .................................................................................................................................... 13
1.2.4 RELATIONSHIP BETWEEN HIV/AIDS AND STIS .............................................................. 20
1.3 ORIGIN AND CLASSIFICATION OF HIV/AIDS ........................................................................... 20
1.4 AIDS PROGRESSES AND SIGNS & SYMPTOMS..................................................................................... 27
1.5 CURRENT STATUS OF HIV/AIDS ............................................................................................................ 28
1.5.1 A GLOBAL OVERVIEW ........................................................................................................................ 28
1.5.2 HIV/AIDS IN SUB-SAHARAN AFRICA (SSA) ................................................................................. 29
1.5.3 HIV/AIDS IN KENYA: .......................................................................................................................... 29
REVISION QUESTIONS ..................................................................................................................................... 30
CHAPTER 2 ............................................................................................................................................................... 31
FACTORS FUELING THE SPREAD OF HIV/AIDS ........................................................................................... 31
2.0 INTRODUCTION ............................................................................................................................................... 31
2.1 FACTORS CONTRIBUTING TO HIGH INCIDENCES OF HIV/AIDS ................................................. 31
CHAPTER 3 ............................................................................................................................................................... 37
THE ROLE OF DRUGS IN THE SPREAD OF HIV/AIDS .................................................................................. 37
3.1 INTRODUCTION ............................................................................................................................................... 37

3.1 DEFINITION ................................................................................................................................................... 37
3.2 CLASSIFICATION OF DRUGS .................................................................................................................... 37
3.3 MODES OF DRUG ADMINISTRATION AND ACTION ........................................................................ 40
3.4 DRUG INTERACTIONS ............................................................................................................................... 41
3.5 DRUG ABUSE ................................................................................................................................................. 41
3.5.1 DRUG ABUSE CAN CAUSE A WIDE VARIETY OF ADVERSE PHYSICAL REACTIONS. ...... 42
3.5.2 IMPACT OF DRUG ABUSE .................................................................................................................. 42
3.6 RELATIONSHIP BETWEEN DRUG USE AND HIV/AIDS .................................................................... 42
3.7 THE ROLE OF ALCOHOL IN THE SPREAD OF HI V/AIDS ................................................................ 43
REVISION QUESTIONS .......................................................................................................................................... 43
CHAPTER 4 ............................................................................................................................................................... 45
YOUTH SEXUALITY AND HIV/AIDS ................................................................................................................ 45
4.0 INTRODUCTION ............................................................................................................................................... 45
4.1 DEFINITION ................................................................................................................................................... 45
4.2 HIV/AIDS AND YOUTH ............................................................................................................................. 46
4.3 SEX AND SEXUALITY .................................................................................................................................. 46
4.3.1 SEX ............................................................................................................................................................ 47
4.3.2 SEXUALITY ............................................................................................................................................. 47
4.4 WHY FOCUS ON THE YOUTH .................................................................................................................. 47
4.5 YOUTH’S PROBLEM AND CHALLENGES .............................................................................................. 48
4.6 FACTORS LEADING TO HIGH INCIDENCES OF PREMARITAL ACTIVITY AND HIV

INFECTION IN YOU YOUTH. .......................................................................................................................... 52
CHAPTER 5 ............................................................................................................................................................... 53
ROLE OF GENDER IN HIV/AIDS TRANSMISSION ........................................................................................ 53
5.0 INTRODUCTION ............................................................................................................................................... 53
5.1 FACTOR INFLUENCING GENDER DISPARITY IN HIV/AIDS INFECTION ................................... 53
5.2 REDRESSING GENDER ISSUE IN HIV/AIDS .......................................................................................... 55

CHAPTER 6 ............................................................................................................................................................... 57
GOVERNMENTS POLICIES AND RESPONSES TO HIV/AIDS PANDEMIC .............................................. 57
6.0 INTRODUCTION ............................................................................................................................................... 57
6.1 GLOBAL POLICIES ON HIV/AIDS ........................................................................................................... 57
6.1.1 THE GUIDELINES .................................................................................................................................. 58
6.1.2 HUMAN RIGHTS PRINCIPLE RELEVANT TO HI V/AIDS .......................................................... 58
6.2 INTERNATIONAL RESPONSES TO THE HIV/AIDS PANDEMIC ..................................................... 59
6.2.1 SUCCESSFUL NATIONAL RESPONSES ............................................................................................ 60
6.3 KENYA’S RESPONSE TO THE PANDEMIC ............................................................................................. 64
6.3.1 KENYA NATIONAL AIDS STRATEGIC PLAN (KNASP) 2000 – 2005.......................................... 66
6.3.2 KENYA NATIONAL AIDS STRATEGIC PLAN (KNASP) 2005/6 – 2009/10 ............................... 66
6.3.3 KENYA NATIONAL AIDS STRATEGIC PLAN (KNASP) 2009/10 – 2012/13 ............................. 67
6.4 SOME OF THE STRATEGIES ADOPTED BY THE KENYAN GOVERNMENT TO FIGHT THE
SPREAD OF HIV/AIDS ...................................................................................................................................... 69
CHAPTER 7 ............................................................................................................................................................... 72
TRANSMISSION, PREVENTION AND CONTROL STRATEGIES .................................................................. 72
7.0 INTRODUCTION ............................................................................................................................................... 72
7.1 TREATMENT STRATEGIES ......................................................................................................................... 72
7.1.1 SEXUAL TRANSMISSION .................................................................................................................... 73
7.1.2 MOTHER TO CHILD TRANSMISSION (MTCT)............................................................................... 74
7.1.3 SHARING NEEDLES AND WORKS ................................................................................................... 74
7.1.4 BLOOD AND BLOOD PRODUCTS ..................................................................................................... 74
7.1.5 TATTOOS AND PIERCING .................................................................................................................. 74
7.1.6 NEEDLE STICK INJURIES .................................................................................................................... 74
7.1.7 WAY THROUGH HIV/AIDS CANNOT BE TRANSMITTED ........................................................ 75
7.1.8 WHO ARE AT RISK FOR HIV/AIDS .................................................................................................. 76
7.2 DIAGNOSIS .................................................................................................................................................... 76
7.2.1 THE ELISA TEST .................................................................................................................................... 76

7.2.2 WESTERN BLOT (WB) TEST ................................................................................................................ 77
7.2.3 POLYMERASE CHAIN REACTION (PCR) TESTS ........................................................................... 78
7.2.4 OTHER HIV TESTS ................................................................................................................................ 78
7.2.5 CD4+ CELL COUNT ............................................................................................................................... 79
7.2.6 MEASURING VIRAL LOAD ................................................................................................................ 79
7.3 PREVENTION AND CONTROL STRATEGIES ........................................................................................ 80
7.3.2 PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) ................................ 81
7.3.3 PREVENTION OF TRANSMISSION THROUGH BLOOD AND OTHER BLOOD

PRODUCTS ....................................................................................................................................................... 82
7.3.4 IEC – (INFORMATION EDUCATION AND COMMUNICATION) ................................... 83
7.3.5 VCT ................................................................................................................................................ 84
7.3.6 PPTCT/PMTCT ............................................................................................................................ 84
7.3.7 BLOOD SAFETY .......................................................................................................................... 85
7.3.8 MALE CIRCUMCISION ............................................................................................................. 85
7.3.9 MANAGEMENT OF STI ............................................................................................................. 85
7.3.10 POST EXPOSURE PROPHYLAXIS (PEP) ................................................................................. 85
7.3.11 PRE EXPOSURE PROPHYLAXIS (PREP) ................................................................................ 85
7.3.12 LIFE SKILLS .................................................................................................................................. 85
CHAPTER 8 ............................................................................................................................................................... 89
TREATMENT AND MANAGEMENT OF HIV/AIDS ....................................................................................... 89
8.0 INTRODUCTION ............................................................................................................................................... 89
8.1 TREATMENT .................................................................................................................................................. 90
8.1.1 ANTIRETROVIRAL DRUGS (ARVS) .................................................................................................. 90
4.1.2 TREATMENT OF OPPORTUNISTIC INFECTIONS ................................................................... 93
4.1.3 SUPPORT MECHANISMS .............................................................................................................. 93
8.2 MANAGEMENT STRATEGIES ................................................................................................................... 93
8.2.1 VOLUNTARY COUNSELLING AND TESTING SERVICES (VCT) ............................................... 93
8.2.2 HOME BASED HIV/AIDS CARE ............................................................................................. 99

NUTRITIONAL NEEDS OF PEOPLE LIVING WITH HI V/AIDS ........................................................ 100
REVISION QUESTIONS ................................................................................................................................... 103
CHAPTER 9 ............................................................................................................................................................. 105
IMPACT OF HIV /AIDS ....................................................................................................................................... 105
9.0 INTRODUCTION ............................................................................................................................................. 105
9.1 DEMOGRAPHIC IMPACT ................................................................................................................ 105
9.1.1 IMPACT ON HOUSEHOLDS .................................................................................................. 105
9.1.2 IMPACT ON FAMILY ............................................................................................................... 106
9.2 IMPACT ON INDUSTRY AND THE BUSINESS SECTOR ........................................................... 106
9.3 IMPACT ON AGRICULTURE ........................................................................................................... 106
9.4 IMPACT ON EDUCATION ............................................................................................................... 107
9.5 IMPACT ON THE HEALTH SECTOR ............................................................................................. 107
9.6 IMPACT ON ECONOMIC GROWTH ............................................................................................. 108
REVISION QUESTIONS ................................................................................................................................... 108
SAMPLE EXAMINATION QUESTIONS ............................................................................................................ 109

COURSE OUTLINE
Course Description
General introduction: public health and hygiene, human physiology, sex and sexuality.
History of STDs, History of HIV/AIDS, comparative information on the trends global and
local distribution. Treatment and management: Ant-retroviral drugs and vaccines,
nutrition and home based care. Prevention and control: Abstain, be faithful, condom use,
destigmatise HIV/AIDS (ABCD) method. Pregnancy and AIDS. Social and cultural
practices: religion and AIDS. Behavioural change. VCT services. Drugs abuse and AIDS,
Alcohol and hard drugs. Government policies: global policies of AIDS. Legal rights of
AIDS patients. AIDS impact: family set-up/society, population, agriculture, education,
development and economy and other sectors.
Objectives
By the end of the course, students will be able to:
1. Discuss sexuality and STDs

2. Describe the biology of HIV/AIDS
3. Explain the treatment and management of HIV/AIDS
4. Explain social and cultural practices and they relate to the AIDS pandemic
5. Explain government policies and the impact of AIDS in present society.
Mode of Assessment
CATs 30%
Examination 70%
CHAPTER 1
GENERAL INTRODUCTION
1.0 INTRODUCTION
This section aims at introducing you to public health & hygiene, and HIV/AIDS by
giving their meaning, relationship, origin and classification. The section will also
discuss the relationship between the spread of HIV and Sexually Transmitted Infections
(STIs). The section also brings out the current status of HIV/AIDS At global, African
and Kenyan perspectives. The factors leading to the spread of the virus also form part
of the discussion in the unit.
Objectives
By the end of this section, you should be able to:
 Describe the importance of public health and hygiene in HIV/AIDS issues
 Explain the meaning of HIV/AIDS and their relationship
 Explain the origin and classification of HIV/AIDS
 Explain the relationship between HIV and Sexually Transmitted Infections (STIs)
 Explain the current status in the spread of HIV/AIDS from global, African and
Kenyan perspectives
1.1 PUBLIC HEALTH AND HYGIENE

Public health can be defined as the protection and the improvement of health of the
entire populations through community-wide action, primarily by governmental
agencies. Public health work deals with the assessment of health status of a community.
The goals of public health are comparable to those of HIV/AIDS education and they
include:-
1. To prevent human disease, injury, and disability

2. Protect people from environmental health hazards
3. Promote behaviors that lead to good physical and mental health
4. Educate the public about health; and assure availability of high-quality health
services
Therefore public health programs and HIV/AIDS education compliment one another.
Most people think of public health workers as physicians and nurses, but a wide variety
of other professional work in the public health sector including; veterinarians, sanitary
engineers, microbiologists, laboratory technicians, statisticians, economists,
administrators, attorneys, industrial safety and hygiene specialists, psychologists,
sociologists, and educators.
Public health workers may engage in activities such as inspecting and licensing
restaurants; conducting rodent and insect control programs; and checking the safety of
housing, water, and food supplies. In assuring overall community health, public health
officials also act as advocates for laws and regulations such as drug licensing or product
labeling requirements. Some public health officials are epidemiologists, who use
sophisticated computer and mathematical models to track the incidence of
communicable diseases and to identify new diseases and health trends. Others conduct
state-of-the-art medical research to find new prevention and treatment methods.
Hygiene is defined as the science dealing with the preservation of health or the practice
or principles of cleanliness. In the public domain, public health officers mainly manage
this practice.
Public health programs
Public health programs may include:-
Vaccination:
This is the deliberate process of making the body resistant to a specific disease by using
a vaccine (a suspension or a product of an infectious agent that is used to produce
active immunity). Vaccination programs [protect people against diseases such as
measles, mumps, polio, diphtheria and other childhood infectious diseases. When small
outbreaks of infectious disease threaten to grow into epidemics, public health officials
may initiate new vaccination programs.
Several infectious diseases have been virtually eradicated through immunization. By

1979, a worldwide vaccination program had eliminated smallpox, a viral disease once
responsible for more than 2 million deaths a year (Karlen, 1996). Poliomyelitis,
commonly known as polio, has been virtually eliminated from most developed nations
of the world, and the incidence of tetanus, whooping cough, and diphtheria has been
drastically reduced worldwide through immunization.
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. These
clinics provide prenatal and pediatric care for children who have no regular access to
medical care.
Public health clinics routinely screen for a number of infectious diseases, such as
sexually transmitted infections (STI) and diseases (STD), and may provide free
treatment if patients test positive. Each clinic tracks the incidence of certain
communicable diseases in this area, and reports this information to national and
international public health offices. Public health clinics may also track down past sexual
partners of STD patients, inform them that they may have been infected with an STD,
and urge them to come in to a clinic to be tested.
Disease tracking and epidemiology:
Public health officers are also involved in epidemiology. Threats to public health
concerns change over time and epidemiologists and other officials continuously
evaluate epidemiological trends to determine how best to meet future public health
needs. For example, recent epidemiological reports show that tuberculosis, an infectious
disease believed to be under control just 30 years ago, is now responsible for more
deaths worldwide than any other infectious disease, killing more people per year than
AIDS and malaria combined. This resurgence is due to new drug-resistance strains of
the bacterium that cause tuberculosis. The tuberculosis epidemic, or pandemic, has been
declared a global public health emergency, promoting intensive international public
health efforts to curb its spread.
Epidemiologists and other public health officials attempt to break the chain of disease
transmission by notifying people who may be at risk of contracting an infectious
disease. For example, when epidemiologists learn that a restaurant worker has
infectious hepatitis, they place announcement in local media, such as radio and
newspaper, urging people who ate at the restaurant in recent weeks to be checked for
the disease and to seek treatment so that they will no longer risk infecting others. Public
health officials 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.
Sanitation and pollution control
Disease causing organisms are often transmitted through contaminated drinking water.
The single most effective way to limit water-borne diseases is to ensure that drinking
water is clean and not contaminated by sewage. In many parts of the world, public
health official establish sewage disposal and solid waste disposal systems, and regularly
test water supplies to ensure they are safe.
Many diseases such as hepatitis A and these caused by bacteria are transmitted through
food. When food is not washed or thoroughly cooked, or when food is stored at
temperatures that are hospitable to disease-causing organisms, people who eat the food
are subject to infection. Public health programs establish and enforce laws for safe food
storage and preparation. For example, in most nations, food processing plants
restaurants and grocery stores are legally required to follow strict food-safety
guidelines established by public health officials.
Public health officials also establish and oversee programs to control flies, rodents, and
other animals that spread disease-causing microbes.
Environmental pollution is another preventable cause of disease and disability and in

most countries public health officials address the adverse health effects of air and water
pollution. Public health official may also work in conjunction with pollution control
organizations to establish and enforce pollution limits and advise the general
population when pollution levels exceed safe limits.
Medical research
Another component of public health is scientific and medical research. Cadres of

doctors and scientists work in laboratories to establish new ways to prevent, diagnose,
treat, and cure diseases and disability. They also investigate the safety and effectiveness
of existing pharmaceuticals and treatment programs and test the safety of hundreds of
the products that we use every day, such as new food products, household cleaners,
and nonpolluting forms of gasoline. Scientists and doctors employed by the
government conduct some biomedical research in public health facilities to find better
ways to protect the human health.
Public education campaigns
Many diseases are preventable through health living, and a primary public health goal
is to educate the general public on how to prevent the noninfectious diseases. Public
health campaigns teach people about the value of avoiding smoking, getting treatment
for high blood pressure, avoiding foods high in cholesterol and fat, and maintaining a
healthy body weight. Other campaigns educate the public on ways to prevent birth
defects, such as abstaining from alcohol during pregnancy to prevent fetal alcohol
syndrome.
Health promotion also encourages people to take advantage of early diagnostic tests
that can make the outcome of disease more favorable (Bres, 1986). Regular
mammograms encourage early detection of breast cancer, for instance, increasing the
chances of cure. Detection and proper treatment of high blood pressure reduces the risk
of stroke, the leading cause of permanent disability in older people.
Accidents, particularly automobile accidents, pose a major threat to public health, and
official have undertaken campaigns to reduce the number of automobile accidents by
encouraging seat belt use and discouraging drinking and driving.
1.2 CONCEPTS OF HIV, AIDS AND STIS
1.2.1 HIV:
 HIV stands for Human Immuno-deficiency Virus, the virus that causes AIDS.
The aids virus enters the body through the mucus membrane or through broken
skin.
 Once inside the body, the virus attacks the body defense cells eventually killing
them.
 White blood cells are a collection of different kinds of cells that work together to
gourd the body against micro-organisms.
 The virus targets particularly the white blood cells, the T cells of the body’s
immune system and all the body fluids contain the T cells.
 T- Cells are clustered into different categories using protein receptor on their
surface.
 Differentials within groups of these clusters are identified in numerical order,

based on the protein on their surface.
 HIV attacks differential 4 (CD4) clusters of T-Cells.
 Once this happens HIV starts to reproduce other viruses, eventually destroying
other CD4 cells
 Normal range of CD4 cells in an adult is about 400-1800 per milliter of blood
volume.
 If the no. falls to below 200, the person is said to have developed Immuno-
deficiency syndrome (AIDS).
 The concentration of HIV is high in BLOOD, SEMEN and VARGINAL

SECRETION. The virus reproduces inside the defense cells and other viruses are
released into the blood stream. When a substantial number of defense cells have
been killed, the body lacks protection against common infections. This may take
several years.
1.2.2 AIDS:
This stands for Acquired Immune Deficiency Syndrome. HIV causes AIDS through
progressive destruction of the body defense system. After infection the body defense is
progressively weakened making it liable to get common infections, which are also
recurrent. Due to its inability to defend itself against other infection, the person’s health
deteriorates until death.
1.2.3 STIs/STDs
 Stands for sexually Transmitted Infections/Diseases
 WHO define STIs as communicable diseases mainly transmitted through sexual

intercourse with an infected parson
 They are caused by a no. of micro-organisms
Some common STDS
I. Bacterial Vaginosis - (BV):
 Not strictly an STD as it is not transmitted via sexual intercourse.

However, it can exacerbated by sex and is more frequently found in
sexually active women than those w have never had intercourse.
 It is caused by an imbalance in the normal healthy bacteria found in the

vagina and although it is relatively harmless and may pass unnoticed, it c
sometimes produce an abundance of unpleasant fishy smelling discharge.
 A woman can’t pass BV to a man, but it is important she receives

treatment as BV can occasionally travel up into the uterus and fallopian
tubes and cause a more serious infection.
 Treatment for I consists of applying a cream to the vagina or taking

antibiotics.
II. Balanitis:
 Often referred to as a symptom of infection, and not necessarily an

infection in its o right.
 It is not strictly an STD but more of a consequence of sexual activity. It

only affe men and usually presents itself as an inflammation of the head of
the penis, and is m common in men who are not circumcised.
 It can be caused through poor hygiene, irritation due to condoms and

spermicides, using perfumed toiletries and by having thrush.
 It can be prevented through not using certain toiletries and by washing

under the foreskin.
 Treatment can consist of creams to reduce inflammation and antibiotics if

necessary.
III. Chlamydial Infections:

 The most common treatable bacterial STD. infections include trachoma,
conjunctivitis, non-gonococcal urethritis and cervicitis.
 Chlamydia trachoma is the most common found in cervix and urethra in

women.
 The urethra, rectum and eyes can be infected in both sexes can cause
serious problems later in life if it is not treated.
IV. Crabs or Pubic Lice:
 These are small, crab shaped parasites that live on hair and which draw
blood.
 They live predominantly on pubic hair, but can also be found in hair in
the armpits, on the body and even in facial hair such as eyebrows
 They can live away from the body too, and therefore can be found in
clothes, bedding and towels.
 One can have crabs and not know about it, but after 2 to 3 weeks, one
would expect to experience some itching.
 Crabs are mainly passed on through body contact during sex, but they can
also be passed on through sharing clothes, towels or bedding with an
infected person.
 There is no effective way to prevent infection, though one can protect

others by washing clothes and bedding on a hot wash.
 Lotions impregnated with insecticides can be bought from pharmacies

and applied to the body to kill the parasites
V. Epididymitis
 Refers to inflammation of the epididymis, a tube system above the

testicles where sperms are stored.
 It is not always the result of an STD, but if it is, it is usually due to the
presence of can chlamydial infection or gonorrhoea.
 Symptoms will present themselves in the form of swollen no and painful

testicles and scrotum.
 The best way of preventing it is to use condoms during lure sex, as this is
the most effective way to prevent chiamydial and gonorrhoea
 Treatment usually involves treating the underlying infection with

antibiotics.
VI. Genital herpes:
 This is caused by the Herpes Simplex Virus (HSV). The virus can affect the
mouth, the genital area, the skin around the anus and the fingers.
 Once the first outbreak of herpes is over, the virus hides away in the nerve
fibres, where it remains totally undetected and causes no symptoms.
 Symptoms of the first infection usually appear after 26 days after exposure
and last two to three weeks.
 Both men and women may have one or more symptoms, including an
itching or tingling sensation in the genital or anal area, small fluid-filled
blisters that can lion burst and leave small sores which can be very
painful, pain when passing urine if it passes be over any of the open sores,
flu-like illness, backache, headache, swollen glands or fever. In females,
there are ulcers and vesicles on the cervix, vagina, vulva and labia while
in males, there are similar effects on the glans, prepuce, penal shaft and
less commonly on the scrotum.
 In both sexes lesions may be experienced on the pharynx, thighs buttocks

and perianal area
 Treatment is by antiviral drug, zofirax.
 The affected areas should be kept clean by frequent bathing and applying
barrier creams can protect against the irritative effects of urine.
 Systemic spread is possible in patients with AIDS.
VII. Genital warts:
 They are small fleshy growths which may appear anywhere on a man or
woman’s genital area.
 They are caused by a virus called the Human Papilloma Virus (HPV).
 Warts can grow on the genitals, or on different parts of the body, such as
the hands. After one been infected with the genital wart virus, it usually
takes between 1 and 3 months for warts to appear on one’s genitals, they
appear as pinkish/white small lumps or larger cauliflower-shaped lumps
on the genital area.
 Warts can appear around the vulva, the penis, the scrotum or the anus.
 They may occur singly or in groups.
 They may itch, but are usually painless. Often there are no other
symptoms, and the warts may be difficult to see.
 If a woman has warts on her cervix, this may cause light bleeding or, very
rarely, an unusual coloured vaginal discharge.
VIII. Gonorrhoea:
 It is a sexually transmitted bacterial infection in adults and in children

infection is accidental. In women symptoms are mild compared to men.
 Infection occurs in the cervix, urethra, rectum, anus and throat.
 In females there is urethritis, endocervicitis and salpingitis which may be

symptomless and later vaginal discharge.
 Chief manifestations of the infection in males are purulent urethritis with

dysuria (painful urination).
 Symptoms of infection may appear between 1 and 14 days after exposure

the longer period being in females.
 It is possible to be infected with gonorrhoea and have no symptoms. Men

are far more likely to notice symptoms than women. Tetracycline and
penicillin are among the drugs for treatment.
IX. Gut Infections:
 Two of the most common infections are amoebiasis and giardiasis. They
are protozoan infections, and when they reach one’s gut they can cause
diarrhoea and stomach pains.
 Gut infections can be passed on when having sex with someone who is
infected, especially during activities that involve contact with faeces, such
as rimming and anal sex.
 Infection can be prevented through using condoms, dental dams or latex

gloves.
 Sex toys should be thoroughly cleaned after use and hands washed after
any contact with faeces.
 Anti- diarrhoea treatments should be enough to treat most infections.
X. Molluscum:
 This is a skin disease caused by the Molluscum Contagiosum Virus. It

appears as small bumps on the skin, and can last from a couple of weeks
to a few years.
 Molluscum cause small, pearl-shaped bumps the size of a freckle on the

thighs, buttocks, genitalia and sometimes the face.
 They are passed on through body contact during sex and through skin- to-
skin contact.
 Transmission can be prevented by using condoms, by avoiding skin-to-

skin contact with someone who is infected and by not having sex until
they have been treated.
 In most cases molluscum do not need treatment and will disappear over
time.
XI. Non-Specific Urethritis (NSU):
 It is an inflammation of a man’s urethra. This inflammation can be caused

by several different types of infection, the most common being chiamydial
infection.
 NSU may be experienced months or even in some cases years after

exposure.
 The symptoms of NSU may include pain or a burning sensation when

passing urine, a white/cloudy fluid row from the tip of the penis that may
be more noticeable first thing in the morning, frequent need ted to pass
urine.
 Often there may be no symptoms, but this does not mean that one cannot
r on pass the infection on to sexual partner(s).
XII. Scabies:
 Scabies caused by a parasitic mite can get under the skin and cause
itching.
 The mites are very small and cannot be seen by the naked eye, and many
people do not now they have them.
 They can cause itching, and this can start between 2 to 6 weeks after
infection.
 Signs of infection can be red lines under the skin of the hands, buttocks
and genitals.
 The most common way of becoming infected is through body contact

during sexual intercourse and through sharing towels and clothes with
someone who is infected.
 There is no effective way turn, to prevent one from becoming infected,

though one can prevent others becoming infected y be by washing clothes
and bedding on a hot wash.
 Lotions can be bought from pharmacies and ales applied to the body to
kill off the parasites.
XIII. Syphilis:
 It is a bacterial infection whose caustive agent is Treponema pallidum. It is

usually sexually transmitted, but may also be passed from an infected
mother to her unborn child.
 The signs and symptoms of syphilis are the same in both men and
women.
 They can be difficult to recognize and may take up to 3 months to show

after having sexual contact with an infected roan person.
 Syphilis has three stages.
 The primary and secondary stages are very infectious. 3ins. The primary
stage appears 4-5 weeks after infection when a primary chancre (a
corruption of cancer) associated with swelling of lymph glands, Pyrexia
(fever) and malaise appears (Govan et aL, 1985).
 The chancre is the point at which the bacterium enters the body.
 The chancre begins as a reddish papule measuring about 1cm in diameter

which then becomes ulcerated. It is painless and highly infectve.
 The secondary stage is when the skin eruption (syphilidae) appears as

ulcerations on mucosal surfaces like the vulva in women and the skin
develops a wide variety of papular rashes.
 The third stage occurs 15-30 years after the initial infection when there
may be nervous system involvement with general paralysis of mall the
insane and locomotor ataxia (defective muscular control) resulting in
irregular and jerky movements.
 Cardiovascular involvement may result in aortic aneurysm and
impairment or and destruction of the aortic valve. Syphilis may be treated
with antibiotics like penicillin and kin- tetracyclines
XIV. Candidiasis (Thrush):
 The causative agent is a yeast, Candida albican which a commensal of the

alimentary canal and the vagina.
 Males are infected by females during sexual intercourse and also from the
patient’s own commensals especially the rectum and finger nails.
 The yeast generally lives on the skin and is normally kept in check by
harmless bacteria. Under favourable conditions i.e warm moist
environment, the yeast multiplies and can cause itching, swelling,
soreness and discharge in both men and women.
 Women may experience a thick white discharge and pain when passing
urine.
 Men may experience the same discharge in the penis and difficulty
pulling back the foreskin.
 Thrush can be passed on when having sex with someone who is infected,
but also if one wears too tight nylon or lycra clothes or if one is taking
certain antibiotics
XV. Trichomoniasis:.
 It is also known as “Trich” and is caused by a parasite (TrIchomonas

vaginalis) a protozoan organism which is found in vagina in females and
the urethra, prepuce and prostrate in males.
 Often there are no symptoms.
 When present symptoms local irritation or a burning and itchy sensation

in the vulva, urethritis, cevicitis and a foul smelling vaginal discharge.
 males there may be itching and discomfort in the urethra during

urination, urethritis and epididymitis.
 There may also be some discharge in males as well.
 Transmission normally occurs through oral, anal or vaginal sex with an

infected person. Antibiotics are used for treatment and the infection does
not usually reoccur.
XVI. Chancroid (soft sore):
 It is a genital ulcer caused by a bacterial infection due to Haemophilus

ducreyi.
 The incubation period is week, and the ulcers are normally multiple.
 They are painful ulcers which respond to treatment with sulphonamides.
XVII. Acquired Immunodeficiency Syndrome (AIDS):
 This is a fatal disease that, once symptoms and signs develop, causes
death in less than 2 years (Porth, 1998).
 The virus causing this disease is transmitted mainly through unprotected

sexual intercourse.
 There is no cure or vaccine, although onset of symptoms can be delayed

by the use of antiretroviral drugs.
 Communities must be taught how to prevent AIDS by limiting sexual

activity to one faithful uninfected partner.
 The male and female condoms are an effective method of preventing

AIDS and other sexually transmitted diseases when used consistently for
casual sexual contact.
1.2.4 Relationship between HIV/AIDS and STIs

 STDs enhances HIV transmission (Cohen, 1998) by causing open sores and skin
injuries in sex organs through which the HIV enters.
 A lot of T-lymphocytes are mobilized to fight the STD infections and since these
are the targets of HIV, a lot of them are destroyed and the person or individual
goes down faster with the HIV.
 The mode of transmission for the STDs is also the same as the mode of
transmission of HIV.
1.3 ORIGIN AND CLASSIFICATION OF HIV/AIDS

Wars have been responsible for major changes in sexual lifestyle. By separating families,
wars are responsible for the adulterous and promiscuous behavior of spouses especially
the males who are away and living under stressful conditions. Rape is commonly found
during wars. Prostitution, including child prostitution thrives during wars.
This has been reinforced repeatedly by the many conflicts, which have occurred in
many parts of the world. One of the most important activities, which these wars have
facilitated, has been the increase of prostitution, which in turn has been closely
associated with the spread of sexually transmitted diseases. Prostitution and sexually
transmitted diseases are now known to be closely associated with the spread of AIDS. It
also now appears that these were the very conditions that were needed for the
evolution of the AIDS war to occur. The 1960s brought with them independence in
various African countries. There was large scale migration of school leavers from rural
to urban areas where jobs were easily available then. A new community of urban
workers was thus created and was to become very important in the spread of AIDS
later. They were the perfect targets for tourism, prostitution, including international
prostitution, sexually transmitted diseases and decontrolled sex.
Today, AIDS is the most prominent and catastrophic example of the process of
globalization to Africa in general and Kenya in particular. Sex tourism in Kenya is a
significant component in this global catastrophe.
While globalization has been understood in such economic term as privatization, free
market and removal of subsidies, AIDS epidemic is itself a global health crisis. It offers
both a threat to survival and an opportunity to revive, renovate, revitalize and relocate
our values and ethics of survival.
AIDS was recognized as an entity in 1981 in USA among male homosexuals.
In 1983, the cause of the syndrome was discovered to be a virus, which was given the
title of Human Immune-Deficiency Virus (HIV) because of its role in lowering the
immunity of those infected. This was named as HIV type 1.
In 1986, a second type of virus was discovered in West Africa and was named HIV type
2.
Two types of viruses thus cause AIDS: HIV-1 and HIV-2. The main characteristic is the
long period (6-12 years) they stay in the body of the infected person before the full-
blown condition is developed.
HIV-1 and HIV-2 are thus brothers. They come from a family of other viruses, which are
known as retroviruses. They have a peculiar enzyme, which enables them to change
their genetic or inheritance mechanism, when they get into the human body. When the
viruses get into the body they enter only the cells called T lymphocytes. These are
responsible for the manufacture of immune substances.
Origin of H1V
 When and where the HIV virus first emerged is probably going to remain a
mystery for many years to come.
 While several theories have been put forward, there is no conclusive single
agreement on the origin of HIV/AIDS.
 Some of the mostly acknowledged theories about the origin of HIV include the
following:
- Mysterious origins e.g. the tail of the comet theory
- Religious theories (God’s wrath and witch craft)
- Monkey origin theories (with four theories)
- Conspiracy theories
- The calculation theory
I. Mysterious origin theory
 This theory tries to account for the seemingly mysterious origin of HIV by
locating it out of this world.
 It suggests that viral material was carried in the tail gases of a comet passing
close to the earth and that this material was deposited, subsequently infecting
nearby Sate in people. Although one or two famous astronomers have been
linked to this theory in the popular press, these scientists deny the possibility of
this extraterrestrial phenomena and any personal connection to the theory.
II. Religious theories (God’s wrath and witch craft)
 Certain segments of the population have openly stated that AIDS is God’s wrath
since the Scriptures condemn the homosexual practice in which AIDS was first
observed in the Western world.
 Rather than its being considered a visitation from God, many Africans believe
that AIDS is any caused by another supernatural power - witchcraft and they use
anti-witchcraft rituals and objects to counteract the infection.
Monkey origin theories
 HIV is a lentivirus, and like all viruses of this type, it attacks the immune system.
Lentiviruses are in turn part of a larger group of viruses known as retroviruses.
 The name ‘lentivirus’ literally means ‘slow virus’ because they take such a long
time to produce any adverse effects in the body.
 They have been found in a number of different animals, including cats, sheep,
horses and cattle.
 The most interesting lentivirus in terms of the investigation into the origin of
HIV is the Simian lmmunodeficiency Virus (S IV) that affects monkeys.
 The researchers led by Paul Sharp of Nottingham University and Beatrice Hahn
of the University of Alabama made the discovery during the course of a 10-year
long study into the origins of the virus.
 They claimed that this sample proved that chimpanzees were the source of HIV-
1, and that the virus had at some point crossed species from chimps to humans.
How could HIV have crossed species?
Some of the most common theories about how this ‘zoonosis’ took place, and how SIV
sheep, became HIV in humans include:
- The Oral Polio Vaccine (OPV) theory
- The hunter’s theory
- The Contaminated Needle Theory
- Colonialism theory
i. The Oral Polio Vaccine (OPV) theory
 In his book, The River, the journalist Edward Hooper suggested that HIV could
be traced to the testing of an oral polio vaccine called Chat, given to about a
million people in the Belgian that Congo, Rwanda and Burundi in the late 1950s.
 To be reproduced, live polio vaccine needs strain to be cultivated in living tissue,

and Hooper’s belief is that Chat was grown in kidney cells as taken from local
chimps infected with SlVcpz.
 This, he claims, would have resulted in the contamination of the vaccine with
chimp Sly, and a large number of people subsequently becoming infected with
HIV-1.
ii. The Hunters’ Theory
 The most commonly accepted theory is that of the ‘hunter’. In this theory, SlVcpz
was transferred to humans as a result of chimps being killed and eaten or their
blood getting into cuts or wounds on the hunter. Normally the hunter’s body
would have fought off Sly, but on a few occasions it adapted itself within its new
human host and become HIV-1.
 The fact that there were several different early strains of HIV, each with a slightly
different genetic makeup (the most common of which was HIV-1 group M),
would support this theory: every time it passed from a chimpanzee to a man, it
would have developed in a slightly different way within his body, and thus
produced a slightly different strain.
 An article published in The Lancet in 2004 (Nathan et al., 2004), also shows how
retroviral transfer from primates to hunters is still occurring even today.
 All these infections were believed to have been acquired through the butchering
and consumption of monkey and ape meat.
 Discoveries such as this have lead to calls for an outright ban on bush meat
hunting to prevent simian viruses being passed to humans.
iii. The Contaminated Needle Theory
 This is an extension of the original ‘hunter’ theory. In the 1 950s, the use of
disposable plastic syringes became commonplace around the world as a cheap,
sterile way to administer medicines.
 However, to African healthcare professionals working on inoculation and other

medical programmes, the huge quantities of syringes needed would have been
very costly.
 It is therefore likely that one single syringe would have been used to inject
multiple patients without any sterilisation in between.
 This would rapidly have transferred any viral particles (within a hunter’s blood
for example) from one person to another, creating huge potential for the virus to
mutate and replicate in each new individual it entered, even if the SIV within the
original person infected had not yet converted to HIV
iv. The Colonialism Theory
 It was first proposed in the year 2000, by Jim Moore, an American specialist in
primate behaviour, who published his findings in the journal AIDS Research
and Human Retroviruses.
 During the late 19th and early 20th century, much of Africa was ruled by
colonial forces.
 In areas such as French Equatorial Africa and the Belgian Congo, colonial
rule was particularly harsh and many Africans were forced into labour camps
where sanitation was poor, food was scare and physical demands were
extreme.
 These factors alone would have been sufficient to create poor health in
anyone, so SIV could easily have infiltrated the labour force and taken
advantage of their weakened immune systems to become HIV.
 A stray and perhaps sick chimpanzee with SIV would have made a welcome
extra source of food for the workers.
 Moore also believes that many of the labourers would have been inoculated
with unsterile needles against diseases such as smallpox (to keep them alive
and working), and that many of the camps actively employed prostitutes to
keep the workers happy, creating numerous possibilities for onward
transmission.
 One final factor Moore uses to support his theory, is the fact that the labour
camps were set up around the time that HIV was first believed to have
passed into humans - the early part of the 20th century.
III. Conspiracy theories
 Some say that HIV is a ‘conspiracy’ or that it is ‘man-made with ulterior

motives’.
 Conspiracy administer theorists have blamed German biological warfare all the
way back to the days of Nazi and other dominance in Germany for the escape of
HIV-infecting agents.
 Americans who believe HIV was manufactured as part of a biological warfare

programme,
designed to wipe out large numbers of black and homosexual people.
IV. The calculation theory
 This is the latest theory on the origin of HIV.
 Opponents of the simian-human transmission remain unimpressed by the

evidence in of the monkey theories and argue that viral sequencing of HIV
strains indicate that HIV has been around probably for hundreds of years.
 In 2000 when a team of scientists using computer technology to study the

structure of HIV calculated the rate at which the virus mutates for the HIV viral
sub-bytes to have a common ancestor.
 This process revealed HIV originated around 1930 in rural areas of Central
Africa, where the virus may have been present for many years in isolated
communities.
 The virus probably did not spread because members of these rural communities
had limited contact with people from other areas.
 But in the 1 960s and 1 970s, political upheaval, wars, drought, and famine forced
many people from these rural areas to migrate to cities to find jobs.
 During this time, the incidence of sexually transmitted infections, including HIV
infection, accelerated and quickly spread throughout Africa.
What caused the rapid global spread of the epidemic in the latter half of the 20th
Century?
 There are a number of factors that may have contributed to the sudden global
spread of HIV in the latter half of the twentieth century.
 They include:
a) International travel,
b) The blood industry,
c) Widespread drug use.
Question: How is HIV spread?
HIV/AIDS is transmitted through the following ways:
 Sexual contact with a person infected with the virus.
 From an infected mother to her unborn child in the womb, during birth or soon
after birth.
 Transfusion with infected blood or blood products.
 HIV contaminated cutting and skin piercing instruments e.g. needles, razors,
knives (e.g. during circumcision).
 Occupational exposures like for medical personnel.
 Sharing toothbrushes if one has bleeding gums.
 Deep kissing if one has open wounds in the mouth.
Question: how is HIV not spread?
HIV is not spread through everyday social contact such as:
 Shaking hands
 Living together
 Playing together
 Eating together
 Working together
It is also not spread by:
 Eating and cooking utensils
 Insect e.g. mosquitoes
 Toilet seats
 Coughing and sneezing
1.4 AIDS PROGRESSES AND SIGNS & SYMPTOMS

AIDS progresses through the following stages, which also characterise symptoms:
Asymptomatic stage
During this stage there are no symptoms. The virus can only be detected through
clinical test.
AIDS related complex (ARC) stage
The stage is complex because there are many problems evident at the same time. These
are as follows:
 Weight loss
 High fever
 Night sweat
 Lymphadanapathy (enlargement of the gland)
AIDS related complex are mainly due to the antibodies (B cells) fighting the AIDS virus
and other virus, especially the herpes virus group which normally attacks the body as
soon as the immune system goes down.
The ARC stage is therefore characterized by a win or loses battles between the B cells
and the AIDS virus until finally the body becomes overwhelmed when the few
remaining B cells give up.
AIDS full blown stage
This stage is characterized by frequent opportunistic infections e.g.
 TB
 Fungal infections frequently manifested through the skin and mouth.

 Pneumonia
 Kapsosi sarcoma (cancer of the blood vessels) especially in the mouth region
 The patient is hospitalized on and off with total weight loss and sick looking
Death
During the process from infection to death is 4 – 8 years. Most of the children present
the symptoms within the first two years. This is because their immune system is
immature.
1.5 CURRENT STATUS OF HIV/AIDS
1.5.1 A global overview

HIV has brought about an epidemic far more extensive than what was predicted even a
decade ago. For example UNAIDS and WHO estimated that at the end of 2000, the
number of people living with HIV/AIDS was 36.1 million and is currently at 40 million.
This figure is 50% higher than what WHO’s global programme on AIDS has predicted
on the basis of data available then.
The challenge and the causes of the fast spread of the virus vary from place to place,
depending on among other things, the national response.
However: People of all ages are affected. (Indeed we are all either infected or affected
by HIV/AIDS).rates of new infection in 2000 were 4.7 million adults, 2.3 females and
0.620 million children. About half of all people who contracted AIDS are under the age
25. Over 90% of the children under age 15 who contract HIV are born to mothers with
HIV and get it through, either birth; pregnancy or breastfeeding.
In all parts of the world, except sub Saharan Africa, there are more men infected with
HIV and dying of AIDS than women. Sub-Saharan Africa seems to bear the brunt of the
epidemic. HIV seems to be high in the Black populated areas.
UNAIDS observes that in Africa, there are signs that the HIV incidence (i.e the number
of new infections) may have established in Sub Saharan Africa. Two factors explain this:
 The epidemic in many countries has gone for so long that it has already affected
many people in the sexually active population, leaving a smaller pool of people
still able to acquire the infection
 Some countries have had successful prevention programmes e.g. in Uganda,

which has reduced national infections rates.
Heterosexual transmission is the predominant mode n Africa, while intravenous drug

use (IDU) is predominant in the rest of the world. However, in Australia and New
Zealand, transmission is mainly by having sex with men (MSM).
There are behavioural and social factors as well as biological factors:
1. Behavioural and social factors
 Little, wrong or no use of the condom
 Large proportion of the adult population has multiple sexual partners
 Overlapping ( as opposed to serial ) sexual partners
 Large sexual networks often seen in individuals who move back and forth
between home and far off work places
 Age mixing typically between older men and younger women or girls
2. Biological factors
 High rates of STIs, especially those causing genital ulcers
 Low rate of male circumcision.
1.5.2 HIV/AIDS in Sub-Saharan Africa (SSA)

Note that: SSA has only 10% of the world’s population
 SSA is a home of 70% of adults and 80% of children living with HIV/AIDS in the
world (25.8 M)
 Half of these people live in Eastern Africa
 In W. Africa Nigeria has the largest number at 2.3m
 South Africa has the highest number at 3m
 In countries worst affected by the pandemic, rising sickness and death take place
agaist a backdrop of ;
a) Deteriorating public services
b) Poor employment opportunities
c) Endemic poverty
1.5.3 HIV/AIDS in Kenya:

In discussing HIV/AIDS in Kenya we refer you to: Kenya AIDS Indicator Survey
(KAIS) 2007
 Overall prevalence, 7.1% of adults (aged 15-64 years) were infected with HIV,
representing an estimated 1417000 people.
 Women were more likely to be infected (8.4%) than men (5.4%). In particular,
young women aged 15-24 years were four times more likely to be infected than
young men in the same aged group (5.6% Vs 1.4% respectively)
 There was a wide regional variation in adult HIV prevalence, ranging from
14.9% in Nyanza province to 0.8% in North Eastern province. Other provinces
include Nairobi 8.8%, Coast 8.1%, Rift valley 6.3% Western 5.4%, and Eastern
4.6%.
 An estimated 1027000 adults in rural areas (6.7%) were infected with HIV
compared with an estimated 390000 adults in urban areas (8.4%)
 Uncircumcised men were three times more likely to be infected with HIV than
circumcised men (13.2% Vs 3.9% respectively).
 Women who reported secondary education or more had significantly lower HIV
prevalence(6.2%) than women who reported less education (7.7%- 9.8%)
 80- 90% of infections are in the 15- 49 year age group, while 5-10% occurs in
children less than 5 years old.
 Most AIDS deaths occur between the ages 25-35 years for men and 20-30 years
for women. Thus assuming an incubation period of 9-10 years, it suggests that
most infections occur in the teens and early 20s.
 Thika and Busia are leading with 33% and 34% respectively. Though latest data
shows that Thika is leading with 34%. Mombasa and Nairobi have prevalence at
approximately at approximately 15%.
REVISION QUESTIONS
1. Explain the strategies used by the public health officers to curb the spread of
infectious diseases
2. Discuss various theories expounding on the origin of HIV.
3. Present a brief history on the discovery and spread of HIV/AIDS
4. Account for the rapid global spread of HIV/AIDS in the late 20th century
5. Using suitable examples differentiate between STIs and STDs

CHAPTER 2
FACTORS FUELING THE SPREAD OF HIV/AIDS
2.0 Introduction
This section aims at introducing you to factors fueling the spread of HIV/AIDS. This
section explains African traditional beliefs and practices which may be major factors in
the spread of the virus that causes AIDS. It gives some myths on sexuality and links
them to the rapid spread of HIV/AIDS. The section discusses socio-economic and
cultural factors fueling HIV/AIDS. Finally this section explains political factors
influencing the spread of HIV/AIDS
Objectives
1. Explain African traditional beliefs and practices may be major factors in the
spread of the virus that causes AIDS.
2. Explain myths on sexuality and link them to the rapid spread of HIV/AIDS.
3. Discuss socio-economic and cultural factors fueling HIV/AIDS.
4. Describe political factors influencing the spread of HIV/AIDS.
2.1 FACTORS CONTRIBUTING TO HIGH INCIDENCES OF HIV/AIDS

A. Myths/mysteries surrounding HIV and AIDS
 Its origin that is not clear.
 People still lack the information about HIV/AIDS
 Curse from God
 Witchcraft
 Originated from monkey
 Laboratory mistakes
 Blame on Americans, who might have introduced HIV/AIDS to

Africans sex or controlling population
Some myths which need to be demystified include:-
1) Having multiple sex partners boosts men’s prestige and status among the peers
(not true)
2) Abstinence causes males sexual impotence (not true)
3) For a man infected with HIV/AIDS, sex with a virgin provides a cure (not true)
4) Teaching young people about sex encourages them to practice it (not true –
informed consent/ negotiate for safe sex)
5) Ignorance about sex is a sign of innocence and purity, while too much
knowledge is a sign of immorality (information is power)
6) Condoms have pores thus it is wise to use two or more (not true- effective
protection against HIV, STIs and pregnancy)
7) Knowing your sero-status means an early death (not true – it is the first step in
counseling services, medical intervention, care and support)
8) ARVs provide cure for AIDS. (ARVs helps in restoring immune system, reduce
the viral load and prolong life)
9) People living with HIV/AIDS need not use the condom during sex (re-infection
increase the viral load)
B. Socio-economic and cultural factors fueling HIV/AIDS in Africa
 Premarital sex
- Sex before marriage, involves both fornication and adultery.
- Age at first sexual encounter
- Women aged 14 – 25 majority infected
- Infection in men mostly occur between 25 – 35 while women 20 – 30 years
 Drugs and substance abuse
- Common among youth, especially in institutions of higher learning.
- Individuals have no control over their sexual urge.
- Go for high risk sex.
 Lower status accorded to women especially in Africa
- Inequality in making decision
- In access and control over assets/resources at family, community and national

levels
- Women is obliged/compelled/required to have sex even when she is aware that
her partner is infected
 Extra – marital sex/affairs
- Involves having sex besides the matrimonial spouse.
 Customs and traditions
- African traditional ceremonies – long duration, social gatherings and festivities
- Wife inheritance and widow cleansing especially through sexual performance
- Ritual that encourage sexual activities, related to seasons and events e.g. a man
has to have sex with his wife to mark various stages in farming process i.e.
cultivating, harvesting, newly constructed home e.t.c.
 Cultural practices
- Ear piercing
- Circumcision
- Female genital mutilation
- Tattooing
- Teeth extraction
- Forced marriages
Especially use of shared and unsterilized instruments
 Cultural taboos
- Attributing HIV/AIDS to witchcraft or a from violating some cultural taboos
- A believe that HIV/AIDS doesn’t exist
 Sex for livelihood
- Means commercial sex work, which involves exchange for money – prostitution
- Maybe due to poverty
 Poverty/lack of education and income earning opportunities
- In poor families many children miss out of education
- They marry and start having sex much earlier in life

- Lack education and information on HIV/AIDS
- Lack protective gadgets and adequate information
- Unable to access antiretroviral therapy due to cost of transport and buying other
drugs
- Poverty leads to deprivation which results in poor diet, lack of clean water and
medical care, and support to manage opportunistic infections
- Poverty lead to separation of families – unemployed male are forced to migrate

to urban areas to search for jobs
- Due to unavailability of jobs in urban areas, creates idleness, frustrations forces

many to engage in antisocial activities, loose morals, leisure and unnatural sexual
relation (homosexual) are rampant in urban areas
 Long distance travel
- Especially truck drivers – away from home for a long period of time
- Have sex with commercial sex workers in many top overs
- Their wives are later exposed
 Tourism
- Have sex with local women and men
- Poverty makes men and women flock beaches to seek for money from tourists
 Wars and conflicts
- Separate families encouraging promiscuous sexual behavior of the spouses

especially men
- Women and girls loose male protection and therefore become victims of sexual
harassment, rape and other sexual exploitations
- Women and girls forced trafficked for sexual services (especially to military
camps)
 Unwillingness to establish HIV sero – status
- Utilization of voluntary counseling and testing (VCT) is still low
 Cohabitation
- Trial marriage can be with multiple partners enhancing spread of HIV/AIDS

 Sex for expediency
- A relationship for the purpose of material gain of one kind or another and is
usually with several partners
 Sexual orientation (homosexuality and lesbianism)
- Emerged in urban centre
- Done clandestinely (secretly)
 Resistance to condom use
- Culturally unknown
- New concept in sexual union among men
- Suggests a sign of mistrust and therefore not readily acceptable
 Media and pornography
- Internet and other media readily avail pornography
- Tendency to copy and put into practice
 Lack of recreational facilities
- No space especially in urban centre for playgrounds e.t.c.
- Youths become idle and engage in risk behavior
 Social stigma
- Results to lack of disclosure and continue having unprotected sex
 Polygamy
- Polygamy and extramarital relationship are culturally tolerated
- Polygamy encourages extramarital sex
C. Political factors
- Decreased allocation of resources and commitment to the implementation of

policies that exist
- Most funds – from external donors
- Sustainability – mobilization of locally generated resources

- Most of the well intentioned policies which have been formulated, have not been
fully implemented
- Corruption
REVISION QUESTIONS
1. African traditional beliefs and practices may be major factors in the spread of the
virus that causes AIDS. Discuss giving examples
2. Explain some myths on sexuality and link them to the rapid spread of HIV/AIDS
among the youth.
3. Discuss socio-economic and cultural factors fueling HIV/AIDS in Africa
4. How has political factors influenced the spread of HIV/AIDS in your country?
CHAPTER 3
THE ROLE OF DRUGS IN THE SPREAD OF HIV/AIDS
3.1 INTRODUCTION
This section aims at introducing you to drugs and substance abuse by giving their
meaning, classification, mode of administration, reasons for using drugs, impact and
their relationship with HIV/AIDS.
Objectives:
a) Explain the classification of drugs
b) Explain the modes of administration of drugs
c) Describe the impact of HIV/AIDS
d) Explain the relationship between drugs & HIV/AIDS
3.1 DEFINITION
A drug can be defined as any substance that affects the function of living cells, used in
medicine to diagnose, cure, prevent the occurrence of diseases and disorders, and/or
prolong the life of patients with incurable conditions. Since 1900 the availability of new
and more effective drugs such as antibiotics which fight bacterial infections, and
vaccines which prevent diseases caused by bacteria and viruses, has increased the
average life span of many people. Drugs have vastly improved the quality of life.
Today, drugs have contributed to the eradication of once widespread and sometimes
fatal diseases such as poliomyelitis and smallpox.
3.2 CLASSIFICATION OF DRUGS
Drugs can be classified in many ways (Aldridge, 1998), e.g. by:
1. The way they are dispensed –
- over the counter or
- by prescription
2. The substance from which they are derived
- plant,
- mineral, or
- animal
3. The form they take
- capsule,
- liquid, or
- gas.
4. The way they are administered;
- by mouth,
- injection,
- inhalation, or
- direct application to the skin (absorption).
5. The way they act against diseases or disorders e.g.
- chemotherapeutic drugs attack specific organisms that cause a disease

without harming the host, while
- pharmocodynamic drugs alter the function of bodily systems by

stimulating or depressing normal cell activity in a given system.
6. Its effect on a particular area of the body or a particular condition (most common
way to categorize drugs) e.g.
a) Endocrine drugs - drugs that correct the overproduction or underproduction

of the body’s natural hormones.
b) Anti-infection drugs - include drugs which are classified as antibacterial,

antiviral, or antifungal depending on the type of microorganism they combat.
Anti-infection drugs interfere selectively with the functioning of a
microorganism while leaving the human host unharmed.
c) Cardiovascular drugs - drugs that affect the heart and blood vessels and are
divided into categories according to function. Antihypertensive drugs reduce
blood pressure by dilating blood vessels and reducing the amount of blood
pumped by the heart into the vascular system. Ant-arrhythmic drugs
normalize irregular heartbeats and prevent cardiac malfunction and arrest
d) Drugs that affect the blood - e.g. antianemic drugs, such as certain vitamins or
iron, enhance the formation of red blood cells. Anticoagulants like heparin,
reduce blood-clot formation and ensure free blood flow through major organs
in the body. Thrombolytic drugs dissolve blood clots, which can block blood
vessels and deprive the heart or brain of blood and oxygen, possibly leading
to heart attack or stroke.
e) Central nervous system drugs - Affect the spinal cord and the brain and are
used to treat several neurological (nervous system) and psychiatric problems.
For instance, antiepileptic drugs, antipsychotic drugs (alleviate hallucinations
and other abnormal behaviors), antidepressant drugs (reduce mental
depression). Anti- manic drugs (reduce excessive mood swings in people
with manic- depressive illness), Anti-anxiety drugs, also referred to as
tranquilizers, treat anxiety by decreasing the activity in the anxiety centers of
the brain. Sedative - hypnotic drugs are used both as sedatives to reduce
anxiety and as hypnotics to induce sleep. Sedative-hypnotic drugs act by
reducing brain-cell activity. Stimulatory drugs, on the other hand, increase
neuronal (nerve cell) activity and reduce fatigue and appetite. Analgesic
drugs reduce pain and are generally categorized as narcotics and non-
narcotics. Narcotic analgesics, also known as opioids, include opium and the
natural opium derivatives codeine and morphine; synthetic derivatives of
morphine such as heroin; and synthetic drugs such as meperidine and
propoxyphene hydrochloride. Narcotics relieve pain by acting on specific
structures, called receptors, located on the nerve cells of the spinal cord or
brain. Non-narcotic analgesics such as aspirin, acetaminophen, and ibuprofen
reduce pain by inhibiting the formation of nerve impulses at the site of pain.
Some of these drugs can also reduce fever and inflammation. General
anesthetics, used for surgery or painful procedures, depress brain activity,
causing a loss of sensation throughout the body and unconsciousness. Local
anesthetics are directly applied to or injected in a specific area of the body,
causing a loss of sensation without unconsciousness; they prevent nerves
from transmitting impulses signaling pain.
f) Anticancer drugs - eliminate some cancers or reduce their rapid growth and
spread and are specific to certain cancers.
7. Drugs are also classified by their names. All drugs have three names:
- A chemical name, which describes the exact structure of the drug.
- A generic or proprietary name, which is the official medical name

assigned by regulatory bodies.
- A brand or trade name given by the particular manufacturer that sells the
drug.
3.3 MODES OF DRUG ADMINISTRATION AND ACTION
The effect of a drug on the body depends on a number of processes that the drug
undergoes as it moves through the body. All these processes together are known as
pharmacokinetics (Aldridge, 1998) - literally, - motion of the drug.
 Administered orally - that is, through the mouth. Only drugs that will not be
destroyed by the digestive processes of the stomach or intestines can be given
orally.
 Administered by injection
- into a vein (intravenously), which assures quick distribution through the

bloodstream and a rapid effect;
- under the skin (subcutaneously) into the tissues, which results in localized
action at a particular site as with local anesthetics; or
- Into a muscle (intramuscularly), which enables rapid absorption through

the many blood vessels found in muscles.
- An intramuscular injection may also be given as a depot preparation, in

which the drug is combined with other substances so that it is slowly
released into the blood. Inhaled drugs are designed to act in the nose or
lungs.
 General anesthetics may be given through inhalation.
 Some drugs are administered through drug-filled patches that stick to the skin.
The drug is then slowly released from the patch and enters the body through the
skin.
 Administered topically that is, applied directly to the skin; or rectally absorbed
through an enema (an injection of liquid into the rectum) or a rectal suppository
(a pellet of medication that melts when inserted in the rectum)
N.B From its site of administration, drugs are absorbed into the bloodstream and
distributed throughout the body to various tissues and organs. As the drug is
metabolized, or broken down and used by the body, it goes through chemical changes
that produce metabolites, or altered forms of the drug, most of which have no effect on
the body. Finally, the drug and its metabolites are eliminated from the body.
3.4 DRUG INTERACTIONS
When taken together, drugs can interact with one another and produce desirable or
undesirable results.
 Some drugs have an additive or synergistic effect - that is, they increase the eftect
of other drugs. For example, alcoholic beverages intensify the drowsiness-
producing effect of some sedatives. A drug that displaces, or takes the place of
other drugs present in blood proteins, makes the displaced drugs more active in
the body, increasing their effect.
 Other drugs have a reducing effect that is, they interfere with the action of drugs
already present in the body. For example, antacids prevent antibiotics from being
absorbed by the stomach.
 Some drugs combine with other drugs to create a substance that has no medical
benefit.
In some cases, however, drug interactions can produce desirable results. For instance, it
has been found that using three drugs to fight AIDS is more effective than one drug
used alone.
Some of the reasons for using drugs include:
 Pain relief and treatment
 Control emotion
 Relaxation, tension relief and boredom relief
 Increase sexual performance
 As sedative - to induce sleep.
3.5 DRUG ABUSE

Drug abuse is characterized by
 Taking more than the recommended dose of prescription drugs such as

depressants without medical supervision, or using government-controlled
substances such as marijuana, cocaine, heroin, or other illegal substances.
 Abusing Legal substances, such as alcohol and nicotine,
Abuse of drugs and other substances can lead to physical and psychological
dependence
3.5.1 Drug abuse can cause a wide variety of adverse physical reactions.
 Long-term drug use may damage the heart, liver, and brain.
 Drug abusers may suffer from malnutrition if they habitually forget to eat,
cannot afford to buy food, or eat foods lacking the proper vitamins and minerals.
 Individuals who abuse inject able drugs risk contracting infections such as
hepatitis and HIV from contaminated needles shared with other infected
abusers.
 One of the most dangerous effects of illegal drug use is the potential for
overdosing. A drug overdose may cause an individual to lose consciousness and
to breathe inadequately
 Without treatment, an individual may die
Successful treatment methods vary and include psychological counseling, or

psychotherapy, and detoxification programs which are medically supervised to
gradually wean an individual from a drug over a period of days or weeks.
Detoxification and psychotherapy are often used together.
3.5.2 Impact of drug abuse

 Irresponsible behaviour
 Mental illness
 Addiction
 School dropouts
 Pregnancy
 Increase in crime
 Lack of social interaction
 Abortions
 Spread of HIV and other STDs through casual sex
3.6 RELATIONSHIP BETWEEN DRUG USE AND HIV/AIDS

 Shared needles/syringes for use in drug application can carry HIV and hepatitis
viruses, Infected blood drawn into the needle is injected along with the drug by
the next user
 Drug use is linked with unsafe sexual activity

 A lot of people believe that sex and drugs should go together. Drug users might
trade sex for drugs
 Others claim that sexual activity is more enjoyable when they are using drugs
 Drug use including alcohol increases the chance of not using protection during
sex, leading to acquiring/transmitting HIV/AIDS
 A lot of drugs interfere with the proper functioning of the antiretroviral drugs
 One who is a drug addict might forget to take his ARV therapy — leading to
delay in treatment and increment of viral load
 There may be overdose which could be fatal
3.7 THE ROLE OF ALCOHOL IN THE SPREAD OF HI V/AIDS

 People with alcohol use disorders are more likely to contract HIV than the
general populations as they are more likely to engage in behaviours that place
them at risk of contracting HIV. (NASCOP, 2005; Ndetei, 2004).
 Similarly people with HIV are more likely to abuse alcohol in their life time. In
persons already infected, the combination of heavy drinking and HIV has been
associated with increased medical and psychiatric complications, delay in
seeking treatment and poor HIV treatment outcome.
 Heavy alcohol use has been correlated with a high risk sexual behaviours
including
- Multiple sex partners
- Unprotected sexual intercourse
- Sex with high risk partners
REVISION QUESTIONS
2. Individual behaviour change can drastically reduce HIV/AIDS prevalence. Explain.
Define the term drug and describe how drug abuse may lead to high levels of HIV
3.
infections.
4. Explain how social stigma has led to the spread of HIV/AIDS.
5. Explain why women are at higher risk of acquiring HIV infections than men.
6. List some of the ways in which vulnerability of women to HIV/AIDS can be

reduced
7. Give the correlations between alcohol abuse and HIV infection.
Describe some socio-economic factors that have increased the vulnerability of

8.
individuals to HIV/AIDS.
CHAPTER 4
YOUTH SEXUALITY AND HIV/AIDS
4.0 INTRODUCTION
This section aims at introducing you to youth sexuality and HIV/AIDS. This section
highlights the differences between sex and sexuality and gives reasons why focus is on
the youth. This section explains youths’ problems and challenges. Finally this section
gives factors leading to high incidences of premarital activities and hence HIV infection.
Objectives:
a) Explain HIV/AIDS among the youth.
b) Explain the differences between sexuality and sex.
c) Explain reasons why we focus on the youth.
d) Describe problems and challenges youth face on sexuality and HIVAIDS.
e) Identify factors leading to high incidences of premarital activity and hence

HIV infection.
4.1 DEFINITION
 Terms “youth”, “adolescents” and young people are define variously.
 WHO refers:
- 10 -19 years as adolescents
- 10 – 24 years as youth
 Three terms are often used interchangeably
 Youth constitute 30% of world population (in the start of the 21 st century, it was
1.7 billion and by 2025 it will be 1.8 billion people)
 Size continue to grow across regions, countries, urban and rural areas
 80% of the youth (10 – 24 yaers) live in less developed countries
 Sub – Saharan Africa has 194M.youths – 32% of continent’s total population.

However there are variations in regions:
- West Africa 32% (37M)

- East Africa 32% (75M)
 In Kenya, in 2006 there were 12.2M or 35% of Kenya’s total population
 The number is projected to be 18.3% by 2025
 Kenya is among those countries with the highest number of young people in
Africa
- Others include:-
Algeria 34%
Rwanda 34%
Zambia 34%
Swaziland 34%
4.2 HIV/AIDS AND YOUTH

 Youths comprise an increasing percentage in new HIV infections both in
developing and developed world
 Approximately 40M people are living with HID/AIDS worldwide
 1/3 of these are young people (10 – 24years)
 It is estimated that 6000 youth get infected in a day and one in every 14 seconds,
majority of them young women (UNAID, 2006)
 Among 20 years and over, 60M half (1/2) have been infected with HIV/AIDS
and half of them get infected between the age of 15 – 24 years
4.3 SEX AND SEXUALITY

 Sexuality has for a long time and is still a taboo subject.
 Many parents and religious communities fear if exposed to the youth will
encourage promiscuity among them e.g. resistance shown to the sexual offence
bill of 2006
 When government tried to introduce sex education to schools
 All this is due to lack of understanding of what sexuality is
 Sexuality has been confused with sexual activity
 Sometimes the term ‘sex’ is used ambiguously to refer to being male or female
and other times sexual behavior or reproduction
4.3.1 SEX
 refers to biological attributes (characteristics of a person)
 It is biologically determined state of being female or male
 It is genetically determined at conception
 It is often misused to mean ‘sexual activity or sexual behaviour’
4.3.2 SEXUALITY
 It is a condition of having sex or sexual activity or interest especially when it is
excessive
 It is a lifelong process of acquiring information, forming attitudes, beliefs and

values about identity, relationship and intimacy
4.4 WHY FOCUS ON THE YOUTH

 Sexual behavior is an important force in many people’s lives – so there are
practical reasons for wanting to learn about it. Sexuality with which information
is held by old members of many African societies – (curiosity)
 Continued lack of information has led them to seek it elsewhere (peers, media,
pornography)
 Sexual experimentation
 Early sexual activity (as early as 6 years) – lengthening of the time between
biological readiness and marriage the gap is between 12 – 14 years
 NB// young people 15 – 24 years account for ½ of all new infections worldwide
 In south Africa and Zimbabwe – ½ of all 15years are likely to die of AIDS
 In Kenya – 20% of all reported AIDS patients are young people in the age range
of 15-24years
 Challenge: - young people present the greatest challenge for the prevention of
new HIV infections
 Safeguarding the health and wellbeing of the future generations and their
potential parents
 Young people as “hope of the future” need to be the major beneficiaries of efforts
to prevent and respond to HIV/AIDS
 Youth are every nation’s future – first as an important resource whose capacities
must be tapped for development, and secondly a major potential resource for
economic development, labour force and future leaders.
 10 – 25 youths – form the bulk of the future human resource pool for any country
 Preventing HIV infection among youth could lead to:
- Stem the spread of the pandemic
- Reduce amount of cost of treatment, providing resources that could meet

other needs of the youth
 It is the responsibility of everyone/stakeholders to get involved in the actual

upbringing of youths
- Teachers/teacher trainees – guide
- Parents, family counselors and guardians (appreciate the complexity of the

youth)
- Youth peer educators counselors – right language
- Youth have a responsibility to seek appropriate information
4.5 YOUTH’S PROBLEM AND CHALLENGES

1. Premarital sex
- Incidences of premarital sex have risen in the last few decades
- More young people are engaging in sexual activity
- Early sexual activities
- Studies indicate that adolescents who had initiated early sexual activity, 58.4%
were in age bracket (15 – 19 years)
- By 19years ≈ 97% of the adolescent had this experience
- The effect of early initiation of sex is the substantial lengthening of the time
between biological readiness and marriage
- Sexual experimentation
- Factors which increase sexual activity:
i. Bodily changes
ii. Rising in sex hormones levels

iii. Increased cultural emphasis on sex
iv. Rehearsal for adult sex roles
- Almost 60% have engaged in unprotected sex – means of HIV/AIDS infection
- No condom use and consistent use
- No correct use of condoms
- Age of sexual initiation is lowering to between 8 and 10
- Among those sexually active include
a) Secondary school girls
b) 6% initiated sexual activity > 10 years
c) 36% by age 14 years
 For boys
a) 64% had sex by 18 years
b) 4% married by 18 tears
 Young people should practice safe sex through “ABC”
II. Limited access to health care and service
 Health care and services are not available, accessible, affordable and acceptable
to the youths
 Youths are marginalized in the following ways:
- Lack of resources
- Not willing to access care due to HIV e.g. there is no privacy
- Denial (homeless, chaotic homes, depression, drug & substance

abuse)
- Not to focus on HIV until after school.
- Inaccessibility to services
III. Drug and substance abuse
 Lack of calculation of risks of their behavior due to influence of mind
 Lack of inhibition hence high risk sex.

 Promiscuity, rape and coerced sex is increased with drug and alcohol use.
 Increased addictive psychotropic drugs, alcohol, abusive substances hence

increasea STIs, HIV and AIDS
 Injecting drugs increase HIV infections
IV. Abortion
 Here we are concerned of unhygienic abortions, use of unsafe instruments

resulting to death, infertility, chronic ill-health e.g. HIV and AIDS.
V. Adolescent pregnancy and child bearing.
 Pregnancy and HIV/AIDS are consequences of sexual activity.
 In event, chances of child being infected are high.
 Why high teenage pregnancy
 This is the question of premarital sex.
 Few use condoms hence high risky sex.
 Many engage in premarital sex with lack of information
 This an indication of vulnerability to HIV infections
VI. Sexual abuse and coercion
 Pressure and dangers for young girls are many
 Virgins targeted for sexual assault
 Involve rape, sexual assault, money for sex, sex trafficking, partner violence
 Force is usually characterized by pain, trauma, high chances of HIV
VII. Female genital mutilation(FGM)
 FGM is 28% in African countries as well as Kenya and among Muslim

(including Malasya, Indonesia and Middle East).
 Worldwide 80-110% of Muslim undergoes cut in Africa and world
 Done between age of 4-10 years
 Done by native woman without anaesthetics and in unsanitary conditions.
 Are of three types:

i. Sunna: slit on crotoris or cut on hood. Clitoral hood only is
removed
ii. Excision (clitoridectomy): this is a complete removal of the clitoris

and some inner lips
iii. Infibulations (pharaonic circumcision): named after origin in

Egypt in his regime. This is removal of clitoris, all inner lips
(minora) and part of outer lips (majora). Raw lips of majora are
stitched to cover urethra opening and virginal entrance. This done
until marriage to keep virginity. The concern is when it is done in
unhygienic conditions it increases the chances of infection.
VIII. Male circumcision
 Traditional way of doing it should be discouraged as it predisposes one to

HIV infection.
IX. Sexual education
 It is a lifelong process of acquiring information about sexual behaviour and

forming attitudes, beliefs and values about identity relationships and
intimacy
 It is about developing young people’s skill so that they make informed choice
about their behavior and feel confident and competence about acting on their
choices.
 It is their right but needs help to protect themselves against abuse,

exploitation, unintended pregnancies, STDs and HIV/AIDS
 Education seeks to reduce the risks of potentially negative outcomes from

sexual behavior and enhance the quality of relationship[ by developing
young peoples’ ability to make decisions over their entire infective.
 Subjects covered may include:
i. Physical processes of human reproduction
ii. The working of male and female sex organs
iii. Origin, dissemination and effects of venereal
iv. Family risks and structure
v. Emotional and psychological senses and consequences of sex,

marriage and parenting.
4.6 FACTORS LEADING TO HIGH INCIDENCES OF PREMARITAL ACTIVITY AND
HIV INFECTION IN YOU YOUTH.
 Lack of correct and inadequate information
- Misconceptions on information or skills to refuse sex or negotiate safe sex

practices
- Lack of information and knowledge on infection and transmission and

control of HIV/AIDS
 Culture or conspiracy of silence on sexual matters
- Sexual taboos, myths and silence surrounds sex are all offshoots of
traditional, culture and religious beliefs, attitudes and practices.
- Communication in this area is only through the eyes, feelings, excitements

and movements without talking.
- It is thought to a bedroom personal issue.
 Influence of the media
- Challenges with youth in management of physical and emotional changes.
- It leaves youth to be curious and need to find out about sexual activities
and intimacy from the media- internet, moies, TV, Videos, tape, films.
 Myths surrounding youth sexuality
REVISION QUESTIONS
1. Highlights the differences between sex and sexuality.
2. Explain reasons why the focus of HIV/AIDS is on the youth.
3. Describe the problems and challenges youth face in relation with HIV/AIDS.
4. Discuss factors leading to high incidences of premarital activities among the

youth.
CHAPTER 5
ROLE OF GENDER IN HIV/AIDS TRANSMISSION
5.0 INTRODUCTION
This section aims at introducing you to gender issues in HIV/AIDS. This section
identifies and explains some cultural, social, biological and economic factors that make
women more vulnerable to HIV/AIDS. This section also discusses some ways we can
redress gender issues in HIV/AIDS.
Objectives:
a) Explain cultural, social, biological and economic factors that make women
more vulnerable to HIV/AIDS.
b) Explain ways of redressing gender issues in HIV/AIDS.
5.1 FACTOR INFLUENCING GENDER DISPARITY IN HIV/AIDS INFECTION

Although women are making efforts towards equality with men, a lot of them still do
not have control over their lives. Cultural, social, biological and economic pressures
make women more vulnerable to HIV infection than men.
1. Biological makeup and reproductive anatomy of the female body
Biological makeup and reproductive anatomy of the female body makes her more
vulnerable to contract HIV than men. Sex takes place inside the body of the woman and
the female genitalia is prone to tear and wear. These tears and wears and/or sores
provide entry route for the virus. 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 Changes associated with
female reproduction explain to a larger extent the differential infections.
2. Social cultural functions
 Men dictate matters regarding sex irrespective if a woman wants sex or not in
some societies and countries.
 Male predominance – here male are left with matters about the house (sex) and
they are allowed to have multiple sexual partners.
 Cultural practices – wife inheritance, polygamy, early marriages and resistance
to use of condom are some gender inequalities making women vulnerable to
HIV/AIDS.
 Burden of care is gender based – women e.g. PLWHAs.
 Decreased knowledge endangers women and contract HIV easily
 Social evils/ills – rape, sodomy, homosexuality, premarital sex, extramarital sex

and drug/alcohol abuse
3. Economic factors
 Women depend on men
 Lack of enough capital – sexual working for livelihoods
 Cases of forced marriage for capital
 Old boys/girls provide sex to opposite due to lack of negotiation
 Women have limited access to family resources and security e.g. land for
financial negotiations
 Are not able to meet health needs e.g. drugs for opportunistic infections
 Family property inheritance – some society do not pass them e.g. land to women.
In some societies, when husband dies, relatives of deceased are to be in charge of
property and not wives.
 In such cases that women cannot provide for family, they resort to commercial
sex working.
 Poverty has lead to men abandoning family and resort into drugs/alcohol and in
event contract HIV exposing self and family to HIV.
 Poverty leads women not to question even when asked for sex without condom.
4. Gender – based violence
 May be physical, emotional or sexual abuses
 Manifested in:
- Rape
- Sodomy
- Coerced sex
- Sexual assault
 Although both sex suffer the same, women are more vulnerable
 Is a global issue
 Studies/available evidence shows one in three women have at one time or

another experienced gender – based violence i.e. beating, incest, sodomy, rape
and sexual assaults
 Problem acute in conflict, post conflict and refugee settings where women are
subjected to increased rates of sexual harassment that expose them to HIV/AIDS.
5.2 REDRESSING GENDER ISSUE IN HIV/AIDS

1. Reinforce women’s economic independence
2. Combating ignorance
o Improve the access of girls to education
o Ensure they have information on their bodies, HIV/AIDS and other STDs
o Equip them with skills to say ‘NO’ to unsafe sex
o Cultural believe that ‘NO’ to sex means ‘YES’ and therefore must be forced to
have sex since they in any case will say ‘YES’
3. Provide women friendly services
o Girls and women should have access to appropriate health care and
HIV/STD prevention services
o Make condoms and STDs care available where women don’t feel embarrassed
4. Make female condoms available
o Though expensive, they should be availed
5. Build safer norms
o Support organizations advocating against behavioral traditions which have

become deadly with the advent of HIV/AIDS e.g. genital mutilation, child
abuse, rape, sexual coercion
6. Educate boys and men to respect girls and women

o This enables them to engage in responsible sexual behaviour and to share
their responsibility themselves, their partners and their children from
HIV/AIDS and STDs.
7. Reduce vulnerability through policy changes
o Policies from communities to national level must be reshaped if women’s

vulnerability is to be reduced. Human rights and legal rights should be
improved.
REVISION QUESTIONS
1. Identify and explains cultural, social, biological and economic factors that make
women more vulnerable to HIV/AIDS.
2. Explain how gender issues in HIV/AIDS can redressed

CHAPTER 6
GOVERNMENTS POLICIES AND RESPONSES TO HIV/AIDS PANDEMIC
6.0 INTRODUCTION
This aims to introduce to you the various global policies and responses to HIV/AIDS.
The section gives guidelines on action oriented measures to be employed by
governments in the areas of law, administrative policy and practice that will protect
human rights and achieve HIV related public goals. It also gives principles of human
rights underlying the positive response to the pandemic. This section also explains the
Kenyan response to HIV/AIDS.
Objectives
By the end of this section you should be able to:
a) Explain guidelines on action oriented measures to be employed by governments in

the areas of law, administrative policy and practice that will protect human rights
and achieve HIV related public goals
b) Describe principles of human rights underlying the positive response to the

pandemic
c) Explain international responses to the HIV/AIDS pandemic
d) Discuss successful national responses to HIV/AIDS
e) Describe Kenya’s response to the pandemic
f) Explain some of the strategies adopted by the Kenyan government to fight the
spread of HIV/AIDS
6.1 GLOBAL POLICIES ON HIV/AIDS

 A policy is a program of actions adopted by an individual, group, or
government, or the set of principles on which actions are based.
 The United Nation AIDS (UNAIDS) and United Nation High Commission for
Human Rights (UNHCHR) have set policies to assist states in translating human
rights values into practical observation in the context of HIV/AIDS.
The policies are in two parts

 Guidelines on action oriented measures to be employed by governments in the
areas of law, administrative policy and practice that will protect human rights
and achieve HIV related public goals
 Principles of human rights underlying the positive response to the pandemic
6.1.1 The Guidelines

That there will be:
 National frameworks in response to HIV/AIDS
 Political and financial support (in consultation with communities) in response to

HIV/AIDS
 Address on public health issues related to HIV/AIDS, e.g. tuberculosis out

breaks
 No criminal law violations in the context of HIV/AIDS
 No discrimination/vulnerability to discrimination in both public/private sectors

based on HIV/AIDS
 Availability of qualitative preventive measures and services at an affordable

price
 Education of people affected by HIV/AIDS - about their rights, including free

legal services
 Supportive and enabling environment for women, children and other vulnerable
groups
 Wide spread education through training and media programmes designed to

change stigmatization associated with HIV/AIDS
 Translation of human rights to codes of conduct regarding HIV/AIDS issues
 Guaranteed protection to HIV/AIDS infected people, families and communities
 International cooperation on HI V/AIDS related matters, including knowledge

dissemination, data and experience transfer
6.1.2 Human rights principle relevant to HI V/AIDS

 Countries have an obligation to respect, protect and fulfill all human rights
including HIV/AIDS related human rights (NACC, 2002).
 Human right principles that are most relevant to HIV/AIDS include the right to:
- Non discrimination, equal protection and equality before law
- Life
- The highest attainable standard of physical and mental health.
- Liberty and security of persons
- Freedom of movement
- Seek and enjoy asylum
- Privacy
- Freedom of opinion and expression and the right to freely receive and
impart information
- Freedom of association
- Work
- Marry and found a family
- Equal access to education
- Adequate standards of living
- Social security, assistance and welfare
- Share in scientific advancement and its benefits
- Participate in public and cultural life
- Be free from torture and cruelty, in human or degrading treatment or

punishment
6.2 INTERNATIONAL RESPONSES TO THE HIV/AIDS PANDEMIC

 The epidemic is not out of control everywhere; some 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 significant progress on care and
support for people both infected and affected.
 The initial reaction of many countries to the pandemic was to try to persuade
individuals and selected groups to change their behaviour by providing
information about HIV/AIDS. However,
 Behavior change was later understood to require more than mere information
and the importance of decision-making and negotiation skills, accessibility of
commodities and services, and supportive peer norms became increasingly
apparent.
 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 sexual 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 provide health care and cushion the epidemic’s impact became
increasingly obvious.
 Work on non-discrimination, protection and promotion of human rights, and

against stigmatization brought by HIV/AIDS essential.
 Advancing other social goals such as education, empowerment of women and

human rights protection are important for reducing overall societal vulnerability
to infection, as well as critical in their own right.
6.2.1 Successful national responses

Successful national responses have generally comprised the following features:
 Political will and leadership
- Political will expresses the national commitment and provides overall leadership
to the nation in response to AIDS.
- Effective responses are characterized by political commitment from community

leadership up to a country’s highest political level.
 Societal openness and determination to fight against stigma
- To be effective, programmes need to make HIV visible and the factors leading to
its spread, discussible.
- Programmes need to make people aware of the existence of HIV and how it is
spread, without stigmatizing the behaviours that lead to its transmission.
- 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/AIDS
- Successful prograrimes impart knowledge, counter stigma and discrimination,
create social consensus on safer behaviour, and boost AIDS prevention and care
skills.
 Strategic response
- Powerful national AIDS plan involving a wide range of actors - government, civil
society, the private sector and donors (where appropriate), 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 find out where people in the country are already infected, where
they are most vulnerable, and why.
- Effective strategy development then involves drawing on evidence-based

methods of HIV/AIDS prevention, care and impact alleviation -“best practices”-
recognizing that some of these may be culturally sensitive (e.g. sex education in
schools) or require hard political choices (e.g. needle exchange for injecting drug
users).
- Effective strategies offer both prevention and care. As illness mounts in the
epidemic, so does the need for health care and social support. Care services have
benefits that extend beyond caring for sick individuals. They help convince
others that the threat of HIV is real and they therefore make prevention messages
more credible.
 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 into individual and joint
agendas.
- Only a combined effort will “mainstream” AIDS and establish it firmly 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.
 Community-based responses
- The eventual outcome of the AIDS epidemic is decided within the

community.
- People, not institutions, ultimately decide whether to adapt their sexual,

economic and social behaviour to the threat of HIV infection.
- Responses to HIV are in the first instance local: they imply the
involvement of people in their homes, neighbourhoods and their
workplaces.
- Community members are also indispensable for mobilizing local

commitment and resources for effective action.
- In particular, people living with HIV/AIDS must play a prominent role

and bring their unique experiences and perspective into programmes,
starting from the planning stage.
 Social policy reform to reduce vulnerability
- HIV transmission is associated with specific risk-taking behaviour.
- These behaviours are influenced by personal and societal factors that

determine people’s vulnerability to infection.
- To be effective, risk-reduction programmes must be designed and

implemented in synergy with other programmes, which, in the short and
long term, increase the capacity and autonomy of those people
particularly vulnerable to HIV infection.
- Issues such as gender imbalance and the inability of women to negotiate

when, how and with whom they have sex is a social policy issue.
- The chronic 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
 Long - term and sustained response
- Measurable impact may take four to five years to develop. Therefore, a

long-term approach must be taken, which involves building societal
resistance to HIV
- Begin with the youngest generation, to reinforce of safer attitudes and

behaviour that will gradually fortify a generation against the spread of
AIDS, and in time have a significant impact on incidence.
- To begin with, using existing resources, it makes strategicsense to focus on

important vulnerable populations and geographic areas where rapid HIV
spread takes on the characteristics of an emergency.
 Learning from experience
 The last 26 years of HIV prevention and care have led to the development
of a rich body of experience and expertise.
 Adequate resources
- Reassignment of national priorities must be reflected in a reallocation of

budgets.
- Redirecting to AIDS existing project resources already programmed for

social funds, education and health projects, infrastructure and rural
development is fully justified, as the AIDS epidemic is undermining the
very goals of these other investments.
- Including information on HIV/STDs and life skills in a school curriculum

has only marginal costs, but the resulting decision-making and
negotiation skills may bring about extra benefits such as decline in STDs,
unwanted pregnancies and drug use.
- Similarly, boosting the educational and economic opportunities of young

girls in rural areas not only reduces HIV transmission by providing
alternatives to commercial sex, but also contributes to sustainable rural
development and an improvement in the status of women.
- Even though international financial assistance is not always necessary,

international assistance is crucial in many poor countries with limited
public budgets.
 International support for national responses
- Donor assistance to HIV/AIDS has increased substantially over time.
- It has not kept pace with the spread of the epidemic - or even the most
basic requirements for HIV programmes of the most affected countries
- However, recent indications from donors are encouraging.
- The donor response to the International Partnership Against AIDS in

Africa has also been positive.
- In addition, there is increasing recognition that HIVIAIDS is not only a

major threat to development, but also a threat to peace-building and
human security in Africa.
- Emphasis must be placed on building partnerships between donors and

the most-affected countries. In this way a sense of shared responsibility
can be created both for improving prevention and care as well as for
addressing the formidable, multifaceted development challenges this
epidemic presents.
6.3 KENYA’S RESPONSE TO THE PANDEMIC

Responses are divided into three phases
Phase 1 (1984-1993)
 1st HIV case in Kenya – 1984
 Government didn’t acknowledge presence of HIV and AIDS
 Government remained silent about pandemic
 There were no government supported mechanisms put in place to respond to

the pandemic.
 Government lost valuable time and missed opportunity to deal with the
HIV/AIDS before it would spread
 If it would have sounded alarm measures would have been put in place.
Phase 2 (1994 – 1998)
 Civil society started to pressurize the government to set up mechanisms to deal

with HIV and AIDS.
 NASCOP – National AIDS and STIs control programme was established and
sessional paper No. 4 of 1997 on AIDS in Kenya was developed.
 Paper provided a policy framework and a roadmap within which HIV

prevention and control efforts were to beco-ordinated
 The need for a policy framework was foreseen as a prerequisite to effective

leadership in efforts to combat the epidemic.
Phase 3 (1999-date)
 Started on the 25th Nov. 1999 when the president of Kenya declared HIV/AIDS a
National disaster.
 Was meant to facilitate the mobilization of resources on emergency measures.
 Government put in place the mechanisms to address HIV/AIDS
 National AIDS control council (NACC) was established under legal notice No.
170 of 1999.
 Was put in the office of the president
 Functions included:
- Supervise all HIV/AIDS activities in Kenya
- Mobilize resources
- Formulate and Implement related policies
 Structure were put in place to operationalize the responses from the National
level to the grassroots
 At the grassroots constituency AIDS control committee (CACCs) were

established and mandated to coordinate HIV/AIDS activities within the
constituencies.
 At the District level a technical team was put in place to offer or provide
guidance on the operations of CACCs.
 The framework of operation was articulated through:
- Kenya National AIDS Strategic plan (KNASP) 2000 – 2005
- Kenya National AIDS Strategic plan (KNASP) 2005/6 – 2009/10
- Kenya National AIDS Strategic plan (KNASP) 2009/10 – 2012/13

6.3.1 Kenya National AIDS Strategic plan (KNASP) 2000 – 2005
 Plan sets out a multi-sectoral response to the pandemic as jointly agreed by
stakeholders within government, civil society, private sector and development
partners
 This signified the shift from sectoral response to comprehensive multi-sectoral

approach.
 Planned activities were coordinated under Kenya HIV and AIDS disaster
response project (KHADREP)
 Each ministry within the government had to establish an AIDS control Unit
(ACU) to undertake the mainstreaming of HIV/AIDS activities in all its core
functions.
 In the new structure, constituency AIDS control committees were the focal points
for spear leading the fight against the pandemic at grassroots level
 CACCs were designed to emphasize community- based activities through CBOs,

FBOs and individuals
 According to the strategic plan CACCs were to operate under five components
namely
- Prevention and advocacy
- Treatment, continuum of care and support
- Institutional arrangement, government and coordination
- Monitoring and evaluation (M&E), and research
- Mitigation of socio-economic impact.
6.3.2 Kenya National AIDS Strategic plan (KNASP) 2005/6 – 2009/10

 Drawing the plan was high participatory in which more than 100 other
stakeholders were involved
 Carried the theme “Total War on HIV/AIDS (TOWA)
 This indicated a call on action to operationalize the commitment of Kenya

Government and all stakeholders including development partners and civil
society involved in the fight against HIV/AIDS
 Goal was to reduce the spread of HIV, improve the quality of life the infected
and the affected and mitigate the social economic impact of the pandemic.
 TOWA build on the Kenya HIV/AIDS Disaster Response Project (KHADREP)
which came to an end in Dec. 2005.
 It gave hope to the continued fight against HIV/AIDS.
 Under TOWA the following vulnerable groups were targeted including:
- Sexual workers
- Migrants workers
- People living with disabilities
- Workers in small/medium enterprises
- Micro enterprises
- Informal sector
 Strategic plan estimated that approximately 65000 Kenyan adults and 25000
children became infected with HIV/AIDS related diseases annually.
 Twice the No. of those children died in 1998
 The aim of the plan was to ‘reduce the no. of new infection among the vulnerable
groups and general population by improving in treatment and care of the
infected and affected as well as ensuring access to effective services
 Key priority areas included:
- Prevention of new infections by reducing the no. of new HIV infections in

both vulnerable groups and general public
- Improvement of the quality of life of people infected and affected by HIV

and AIDS by improving treatment and care, protection of the rights and
access to effective services for affected and infected.
- Mitigation of the socio-economic impact of HIV by adapting existing

programs and developing innovative responses to reduce it.
6.3.3 Kenya National AIDS Strategic plan (KNASP) 2009/10 – 2012/13

 The strategic emphasis of this plan is to effectively respond to the evidence base
and provide coordinated, comprehensive, high-quality combination prevention,
treatment and care services, mobilized and strengthened of communities for
‘AIDS competence’ and effective sectoral mainstreaming of HIV.
 It is acknowledged that in order to provide Universal Access to essential services
strategic decisions will be needed to prioritize interventions which realize
maximum efficiency gains and optimal progress towards the expected results.
 Under KNASP III, by 2013, the following four impact results will be achieved:
- Number of new infections reduced by at least 50%
- AIDS- related mortality reduced by 25%
- Reduction in HIV related morbidity and
- Reduce socio-economic impact of HIV and AIDS at household and

community level.
 At the outcome level this strategic plan aims to achieve:
i. Reduce risk behavior among the general, infected, most-at-risk and

vulnerable populations
ii. Proportion of eligible PLWHIV on care and treatment increased and

sustained
iii. Health systems deliver comprehensive HIV services
iv. HIV mainstreamed in sector-specific policies and sector strategies
v. Communities and PLWHIV networks respond to HIV within their local

context;
vi. KNASP III stakeholders aligned and held accountable for results.
 KNASP III will achieve the above impact results and outcome through
implementation of the following four strategies:
- Provision of cost effective prevention, treatment, care and support

services, informed by an engendered rights-based approach, to realize
Universal Access.
- HIV mainstreamed in key sectors through long- term programming

addressing both the root causes and effects of the epidemic
- Targeted, community-based programmes supporting achievement of

Universal Access and social transformation for an AIDS competent society
- All stakeholder coordinated and operating within a nationally – owned

strategy and aligned results framework, grounded in mutual
accountability, gender, equality and human rights
6.4 SOME OF THE STRATEGIES ADOPTED BY THE KENYAN GOVERNMENT TO
FIGHT THE SPREAD OF HIV/AIDS
 Public educational campaigns
- The government through its state owned media has set up sensitization
programmes to try and educate the public on the dangers of the disease
and also advise them to stay healthy.
- This is done through plays; poetry and reality show programs where
HIV/AIDS individuals take the opportunity to air their views and
encourage others to take measures to avoid contracting the virus.
- The government has also increased creating awareness campaigns on

AIDS prevention using billboards, posters, public lectures, pamphlets,
performing
AIDS groups.
- Sensitize people through community barazas where government officials

get the chance to give out the much needed information on the prevention
of AIDS.
 HI V/AIDS seminars and workshops
- Aimed at strengthening prevention activities.
- People are educated and enlightened by professionals on the ways

of contracting the virus and the consequences of the disease.
 Mainstreamed HI V/AIDS lessons in formal education system
- HIV/AIDS has become a core unit that is studied in primary schools,

secondary schools, middle level colleges and universities.
- Students gain knowledge on the mode of transmission, prevention and

control.
- This has helped in the reduction of spread of HIV since most sexually
active Kenyans, the youths are taught about the dangers of casual sexual
behaviour and unprotected sexual relations.
 Destigmatization campaigns
- Done through awareness campaigns and education - programmes to

reduce stigma.
- This has encouraged free talk about AIDS and thus created awareness
amongst Kenyans.
 Provision of treatment to HI V/AIDS patients
- The government plays a role in availing treatment to HIV/AIDS patients.
- It provides free or subsidizes ARV drugs and other health services to

people suffering from HIV/AIDS.
- It has taken the initiative to help prevent mother to child transmission.

HIV positive mothers are given antiretroviral drugs during pregnancy
and at delivery this includes AZT which helps in the reduction of the viral
load.
 Provision of VCT centers
- The government has established and opened VCT centers all over the
country. VCT services are offered free in most government health
facilities.
 Discouragement of detrimental socio-cultural practice
- The government in conjunction with NGO’s is trying to fight socio-

cultural practices that increase the risk of contracting HIV/AIDS.
- It is at the forefront of trying to eradicate practices such as; Female Genital

Mutilation (FGM), unsafe circumcision as is practiced traditionally, wife
inheritance and early marriages.
 Gender advocacy
- The government is also advocating for gender equality and thus is

teaching women on their basic rights and has enacted a sexual abuse bill
to protect women against sexual abuse.
- It has enhanced laws against violence on women and other vulnerable

groups in the society including HIV/AIDS individuals to protect them
from victimization.
 Poverty eradication
- The government has been at the forefront in trying to eradicate poverty.
- It has started constituency development fund through which

constituencies throughout the country receive funds from the central
government and channel them to projects that help elevate the living
standards of the local people by creating income-generating activities.
- It has also allowed formation and operation of NGOs which help people
at the grass root fight poverty.
REVISION QUESTIONS
1. Debt relief for poor countries can be a strategy to fight HIV/AIDS pandemic.
Justify.
2. Discuss some of the common features of effective national responses to

HIV/AIDS pandemic.
3. How does societal openness aid in fighting the spread of HIV/AIDS?
4. List any ten rights of an HIV positive individual.
5. Outline the responses by the Kenyan government to curb HIV/AIDS spread.

CHAPTER 7
TRANSMISSION, PREVENTION AND CONTROL STRATEGIES
7.0 INTRODUCTION
This section aims to introduce you to the transmission of HIV/AIDS and the prevention
and control strategies. This sections deals with various ways on how HIV is transmitted
and various ways through which HIV cannot be transmitted. The section also describes
ways to diagnose HIV/AIDS. This section also gives various prevention and control
strategies.
Objectives
a) Explain way how HIV/AIDS can be transmitted.
b) Explain way how HIV/AIDS cannot be transmitted.
c) Describe how HIV/AIDS can be diagnosed.
d) Discuss prevention and control strategies of HIV/AIDS.
7.1 TREATMENT STRATEGIES

 HIV is a blood – borne virus, in other words, it replicates within your blood cells
but it is also found in other body fluids.
How is HIV transmitted?
 HIV can be transmitted in a number of ways and the risk of transmission

depends on a number of factors.
 The most important factors that will influence the risk of HIV transmission are
the type of body fluids that contain the virus and the entry route of infection.
 Undoubtedly blood contains the highest concentration of HIV virus. For this
reason the risk of acquiring the virus through direct contact with an infected
person’s blood posses a much higher risk of infection than contact with other
body fluids.
 Similarly, the risk of infection is dependent on the route through which the virus
enters the body. For example, if the virus enters directly into the blood stream i.e.
the vein, the risk is much higher than if it enters the body via the digestive tract
e.g. in breast fed babies.
 The most widely recognized ways of acquiring HIV are:

i. Having vaginal, anal or oral sex without a condom with someone who is HIV
positive.
ii. Sharing needles, syringes or other drug infecting equipment with someone who
is infected with HIV.
iii. An HIV positive mother to her baby during pregnancy, delivery or while breast-
feeding.
iv. Blood transfusions, blood products or organ transplant in countries where

screening is not mandatory or common practice.
v. Tattooing or piercing with improperly sterilized equipment
vi. Sharing drug snorting equipment e.g. cocaine straws.
vii. A needle stick injury involving blood tainted with HIV.
7.1.1 Sexual transmission

 On a worldwide basis unprotected sexual intercourse is the main route by which
HIV is transmitted from person to person
 And HIV positive person could pass the virus on another person if they have
vaginal or anal sex without a condom or oral sex without the use of a barrier.
 Some sexual activities appear to be more risky than others, e.g. unprotected anal
intercourse posses a greater risk of transmission than any other sexual activity.
 The tissue inside the anus is much softer than vaginal tissue; it is also less elastic
and less lubricated. Thus this tissue is more prone to tearing during intercourse;
this increases the risk of bleeding and therefore provides more opportunity for
viral transmission.
 The risk of transmission through unprotected vaginal sex is thought to be lower

than oral sex, though still highly significant.
 However, where there is a risk of vaginal tears or sores e.g. in the presence of
sexually transmitted infection, the risk of transmission is increased significantly.
 HIV transmission through oral sex is a much debated subject. However, the virus
is present in blood and semen that means that in theory, this is a possible
transmission route.
 There may be an increased risk if there is ejaculation, bleeding gums or sores

anywhere in the mouth or around lips or, inflammation caused by common
throat infections.
 Sharing of sex toys also carries a risk of HIV transmission. If more than one
person is going to use a vibrator or dildo, it is essential that it is cleaned
thoroughly between users or covered with a fresh condom before each use.
7.1.2 Mother to Child Transmission (MTCT)

 An HIV positive mother can pass the virus to her baby during pregnancy,
delivery or while breast-feeding; this is often referred to as ‘vertical transmission’
7.1.3 Sharing needles and works

 Even spots of blood too small to be seen by human eye can carry enough of the
HIV virus to infect someone
 Using syringes that have previously been used by someone else can easily lead to
infection with HIV
 If a group is sharing the same cup of water to clean out (flush) syringes or other
equipment, there is also a risk that infected blood may be present.
7.1.4 Blood and Blood Products

 In the developed world all donated blood and blood products have been
screened and are therefore considered safe.
 However, it is rare for anything to be 100% foolproof and while stringent

measures are taken and guidelines adhered to, there is still a small possibility
that transmission could occur via this route.
 In developing countries, blood screening is often not common place and there is
risk of one receiving contaminated blood in case of blood transfusion or surgery.
7.1.5 Tattoos and Piercing

 All blood-borne viruses including HIV can be contracted from needles that are
not sterilized properly, if at all.
 This includes needles used for ear and body piercing, acupuncture, tattooing.
 Jewelry used for body and ear piercing should not be shared as this can transmit
the virus
7.1.6 Needle Stick injuries

 Needles are an occupational hazard for medical professionals, but not just
doctors and nurses; it could be laboratory workers or dentists too.
 Some have become infected with HIV as a result of being injured by a needle in
the course of their work.
 Although an area of concern, the risk of contracting virus this way is less than
1%.
 Certain specific factors mean a needle stick injury carries a higher risk e.g.
i. A deep injury
ii. When the source patient has a high viral load
iii. When the sharp instrument is visibly contaminated with blood
iv. When the sharp instrument has been in an artery or vein
 If an injury occurs, bleeding should be encouraged by pressing around the sight

of injury.
 Treatment with anti-HIV drugs as soon as possible after an injury has occurred
can reduce the rate of transmission (often referred to as a post exposure
prophylaxis or PEP)
 There is also a risk of infection from a splash injury. This is when blood splatters
and some enters a person’s eyes. The eyes should be washed out thoroughly
using an eye bath should this happen after which, one may seek medical
attention.
7.1.7 Way through HIV/AIDS cannot be transmitted

HIV cannot be transmitted through:
i. Kissing, touching, hugging or shaking hands
ii. Sharing crockery and cutlery
iii. Coughing or sneezing
iv. Contact with toilet seats
v. Insect or animal bites e.g. mosquitoes, bed-bugs etc.
vi. Swimming pools
vii. Eating food prepared by an infected person
 Although researchers have found HIV in saliva of infected persons, there is no

evidence that the virus is spread through contact with saliva
 Laboratory findings reveal that saliva has natural properties that limit the power
of HIV to infect.
 Studies involving HIV infected people have found no evidence of HIV
transmission through saliva.
 Nobody knows whether “deep kissing” involving exchange of large amount of

saliva, oral intercourse increases the risk of infection.
 No evidence of virus spread through urine, sweat, feces and Tears.
7.1.8 Who are at risk for HIV/AIDS

Drug users who share needles/syringes
i. Homosexual and bisexual men
ii. Person who received blood transfusion or pooled blood products between 1978
to 1995
iii. Sexual worker (promiscuous men and women)
iv. Person having unprotected sex with people of unknown HIV status
v. Having unprotected sex with infected persons
vi. People having sexually transmitted diseases are highly susceptible to HIV
infection during sex with infected persons. Diseases include syphilis, gonorrhea,
genifal herpes, chiamydial infection, herpes zoaster.
A high viral load is an indication of high levels of HIV in body fluids while
undetectable viral load indicates a reduction in levels of HIV in these fluids, but the risk
of transmitting the virus is still present.
NB:
Viral load and CD4 tests should always be carried out at the same time.
7.2 DIAGNOSIS
7.2.1 The ELISA test

 ELISA (Enzyme-Linked Immuno-sorbent Assay) is a screening test that looks for
HIV antibodies in a blood sample taken from a person exposed to HIV risk.
 Some of the blood sample is poured into an HIV antigen-coated vial and a
binding enzyme added. Any antibodies present in the blood migrate to the lining
surface of the vial.
 Excess antigen is flushed out by rinsing, and a chemical which can produce a
color reaction is poured in.
 The color reaction only takes place if there are HIV antibodies present, in which
case the individual is said to be IIIV positive.
 Conversely, if the reaction is not present the person is regarded as being HIV
negative.
 HIV antibodies do not reach detectable levels in the blood for one to three
months.
 This period is known as sero-conversion during which antibody production to

viral proteins take place.
 Window period is the time during which antibody detection using ELISA is
negative.
 In some cases it may take even six months for the antibody levels to get high
enough for detection.
7.2.2 Western blot (WB) test

 Unlike the ELISA test which shows in a general way whether or not there are
HIV antibodies present, the Western Blot test reacts to the presence of specific
elements of the HIV antibodies, the proteins gpl20, gp4l and p24.
 It does this by separating light and heavy chain proteins in an electric field into
their constituent parts.
 These separated proteins are graded by size and placed on the surface of a
specially prepared gel.
 The density of the separated proteins determine, to what level they sink into the
gel layers, with the heaviest sinking lowest.
 Since the molecular weight of each protein is known, they can be identified. Once
identified, the proteins are relocated to nitrocellulose sheets which are cut into
strips to which blood from the ELISA- determined HI V-positive person is
added.
 The strips are washed, and an anti-human antibody enzyme label introduced. A
visible enzyme marker, following this procedure, indicates an HI V-positive
result, thus confirming the EL1SA test.
 This is a method that detects very low viral antigen levels such that one may test
HIV negative by ELISA but test positive through Western blot (V/B).
 Babies born of HIV mothers have antibodies to IITV that were passed on during
pregnancy through the placenta.
 However, these antibodies diminish with time such that by 15 months the child
may test negative.
 Use of Western blot confirms presence of HIV antigen and this rules out whether
babies are positive due to HIV itself or because of maternal antibodies.
7.2.3 Polymerase chain reaction (PCR) tests

 This method is used to detect the presence of the virus itself.
 It involves combining a DNA an1e (taken from the suspected HIV infected
person), some short strands of DNA (primers), four nucleotides (adenosine,
cytosine, guanine and thyrnine), an enzyme, and a buffer solution.
 These items are heated to separate double-stranded DNA into single strands
which when cooled adhere to the single strand primers.
 Reheating allows the enzyme to make new double-stranded DNA using the
ingredients already present.
 The resultant DNA is stretched over repeated similar processing, amplifying the
material over one million times.
 Sequencing of the DNA identifies any HIV isolate present in the strands.
 A draw back to the use of PCR s that samples may be easily contaminated.
7.2.4 Other HIV tests

There are three tests using the ELISA technique relying on a reaction to identify HTV
antibodies. They are:
 EIA (enzyme immunoassay): Where the individual is said to be HI V-positive if

the reagent changes color
 IFA (immuno fluorescence assay): Similar to the above but using a fluorescent
medium
 RIPA (radloimmunoprecipitation): Rather like the ETA and IFA but using a
radioactive medium
 Orasure: Analyses a sample of saliva. While antibodies are only found insmal1
amounts in thè aflvathe infected people, an American Association report says
that the test is 99.9% accurate.
7.2.5 CD4+ Cell Count
 Once a patient is diagnosed positive, the extent of damage to the immune system
is determined by CD4 cell count (T-helper cell count).
 The number of CD4 cells present is direct indicator of the immune system’s
ability to fight off opportunistic infections.
 The test to measure your CD4 count requires a sample of blood to be taken.
 A measurement is made of the number of CD4 cells in a cubic milliliter of blood

and will give an overall picture of the health of the immune system- whether it is
improving or declining.
 The CD4 count of a person who is not infected with HIV may lie anywhere
between 500 and 1200.
 A drop in an HIV positive persons CD4 count usually occurs over a number of
years.
A CD4 count between 500 and 200 indicates that some damage to the immune
system has occurred and a count below 350 or rapid decline is an indication that
one should consider anti-HIV treatment.
 Since your CD4 count will fluctuate in response to infection, stress, smoking,
exercise, the menstrual cycle, the contraceptive pill, the time of day and even
seasons of the year. it is necessary to monitor it over time to identify trends,
7.2.6 Measuring viral load

 Measuring viral load is essential to determine how active the viral replication is.
 If one is taking anti-HIV medication, then it is also a direct indicator of how

successful it is in suppressing viral replication.
 The viral load test requires the collection of a blood sample ‘and estimates the
number of HJV particles in the sample by looking for HIV genes.
 The level of viral load is generally seen as a good indicator of whether to start
anti-HIV treatment.
 Effective anti-HIV treatment will result in a reduction in viral load and one may
even attain an undetectable viral load. This does not mean that the virus is no
longer present, but merely that the sensitivity of the test performed can no longer
detect the virus.
 An undetectable viral load is an indication that both the risk of developing AIDS
and the risk of developing drug resistance has been reduced.
7.3 PREVENTION AND CONTROL STRATEGIES
 Prevention involves tackling the most important modes of transmission i.e.
prevent sexual transmission, mother to child transmission and blood/blood
products transmission.
The ABCD method of prevention
This method has been advocated for, as the best means of preventing and
controlling HIV infections.
A - Abstinence
B - Be faithful
C - Condom
D - Destigmatization
A - Abstaining (Abstinence)
 Refraining from sexual intercourse is the best way to prevent transmission of

HIV.
 Abstinence means not engaging in any sexual activity in which there is direct or
theoretical risk of exposure to blood, semen, and vaginal fluid.
B - Be Faithful
 If two partners are tested negative then they should enter into strictly
monogamous sexual relationship.
 It only works if both partners are known to be uninfected when their sexual
relationship begins; neither partner had sex even one time outside the primary
relationship.
C - Condom use
 Consistence and correct use of latex condoms during intercourse can greatly
reduce the chances of acquiring or transmitting HIV and other STDs.
 Consistent use means using a condom with each act of intercourse.
 Correct use means that you should use a new condom every time you have
sexual intercourse.
i. Never use the same condom

ii. Putting a condom as soon as erection occurs, but before ay contact is made
between the penis and an part of your partner’s body
iii. Leave a space at the tip
iv. Adequate lubrication
v. Withdraw immediately after ejacu1ation
 Condom is not totally safe some of its weaknesses include bursting, leaking and
slipping off inside the women; this exposes both male and female partners to the
AIDS virus.
 Although leaking was not always noticed even after sex, cases of condoms
slipping had become frequent and they reached the attention of the health
officials because sometimes they had to be removed by th doctor.
 Where a condom is used and the stronger the latex the better - it is firmly urged
that a spermicide also be used.
D- Destigmatization
 Stigma - “An act of identifying, labeling or attributing undesirable qualities

targeted towards those who are perceived as being shamefully different and
deviant from social ideal”.
 “An attribute that is significantly discrediting used to set affected persons or

groups apart from the normalized social ideal.
 Remove the stigma such that infected people are not neglected
 Not seen as very bad people
 Irresponsible
 Freely talk about AIDS and create awareness
7.3.2 Prevention of Mother to Child Transmission (PMTCT)

 There are certain factors that may reduce the risk of transmission from
mother to child. These includes:
- Taking anti-HIV therapy during pregnancy and delivery e.g. AZT

which reduces the viral load
- An elected cesarean section instead of normal delivery
- No breast feeding where there is access to safe, adequate milk

substitutes. Breast-feeding should be avoided because the HIV virus is
present in breast milk. Also it is not uncommon for mothers to
experience cracked nipples while breast-feeding, therefore increase the
risk of viral transmission.
- Mothers who are HIV positive should not donate breast milk to breast
milk banks, neither should they express milk to be bottle-fed to their
baby
N.B
- It is known that breast milk contains growth factors that may help the infant’s
gut mature, thus maintaining the integrity of the gut and hindering infections by
virus.
- Alternative feeding may cause contamination leading to inflammation and

damage of the mucosa producing a port of entry for HIV.
- However, exclusive breast-feeding has not given 100% surety of prevention of

transmission.
7.3.3 Prevention of Transmission through Blood and Other Blood Products

 Screening all donated blood especially for transmission
 Careful handling of blood and blood fluids
 Avoidance of sharp injuries- needles, knives, clips, sharp objects in hospital

working situation
 Used needles should be disposed in the right tray
 Never pick up a sharp object without looking
 Use of gloves (heavy duty gloves) when you sense danger
 Avoid skin/mucous membrane contamination
 Equipment should be thoroughly and properly sterilized because:
a) HIV is very sensitive and easily destroyed by boiling for at least 5

minutes
b) Susceptible to a wide range of disinfectants. Suitable disinfectants
- Glutaraldehyde 2% for one hour
- Hypochlorite (JK) 0:2% washing, 10% soak for 30 minutes
- Ethylalcohol 70% - 1 hour

- Isoprcpanol 70% - 1 hour
- Iodine l% -30 minutes
 Drug users: use single use syringe and needles
7.3.4 IEC – (Information Education and Communication)

It is the right of every Kenyan to have comprehensive and accurate information on
various modes of transmission, impact and methods of prevention of pandemic.
Information of safer sex with options of abstinence, masturbation, no-penetration sex

(masturbation, massage, ) and use of condom. Some not in agreement > evil and sinful?
AIDS awareness education in participatory approach should involve:
 Share knowledge and experience
 Expectations and aspirations
 Review their options (advantages and disadvantages)
 Sets information on what people know, do and feel in life reality
 At community level
Information increase use of condom due to myths and misconceptions;
 Have holes and pores
 Men insist in body-body contact not “eating a sweet without removing a

wrapper”
 More than one condom hence slipping of penis
 Female condom is expensive
 It enhances knowledge and communication skills and use of condom without

inhibiting.
 Information on protection of condom and wisely used
 Families to adopt negotiation skills for protection
 Education to seek medical check-ups in use of STI

7.3.5 VCT
 Is voluntary without coercion or persuasion for VCT. Education is of importance
 Confidentiality with client only
 Education – facts around HIV increase knowledge, risks infection and re-
infections.
 Counseling – assesses clients’ personal risk behavior and exposure to HIV

infection and help him or her to explore ways on how to reduce it.
 Pre-test – dialog and explanation by a professional counselor – explain, test and

implications of the results, lead to design by choice
 Post-test – explains test results and how to cope with implications, positive or
negative.
Common barriers to access VCT
 confidentiality – fear that counselor may tell out and fear of positive face –
rejection, divorced, e.t.c.
 Some do not themselves as at risk – is for those others (commercial sex workers,
homosexuals, town dwellers)
 Lack of where to find VCTs in rural areas with low information and
infrastructure.
 Some facilities have stock out of testing kits – donor driven and attached to
corruption.
7.3.6 PPTCT/PMTCT
 Both are parents responsible for MTCT.
 Pregnant mother has 30 – 40% chance > child
 Protect mother from being infected
 If infected, improve mother health and prevent M-C-T
 Increase ANC with increased information about HIV and give AZT and
Nevirapine drugs in pregnancy and in labour
 Avoid prolonged labour and do CS (caesarean section)
 For infected avoid breast feeding and use alternative feeding

7.3.7 Blood safety
 Accounts for 5 – 10 % of HIV infections worldwide
 Increase policy guidelines in protecting and promoting the health of both blood
donors and recipients by establishing efficient, self-sustaining and safe blood
transfusion services
 All donated blood must be screened
7.3.8 Male circumcision

 Fore skin retain vaginal fluid during and after sexual activity
 Therefore male circumcision recommended
7.3.9 Management of STI

 STI enhance HIV infections
 Increase education on recognition of STI symptoms, seek reaction and encourage

use of condom
7.3.10 Post Exposure Prophylaxis (PEP)

 Is a short term ART to reduce the likelihood of HIV infection with 72 hours of
exposure to facilitate interruption of HIV transmission.
 It involves reaction with a combination of 3 ART drugs, which are taken in 28

days.
 For health providers, PEP is given as part of a comprehensive universal

prevention package to infectious hazards at work.
7.3.11 Pre Exposure prophylaxis (PrEP)

 Refers to HIV prevention strategy that would use antiretrovirals (ATVs) to
reduce the risk of HIV infection among HIV-negative people.
 In this intervention individuals would take a single drug or a combination of

drugs before sexual intercourse with the hope that it would lower the risk of
infection.
 The ARV drugs tenofovir disoproxil fumarate (TDF) and a combination of TDF
and emtricitabine (FTC) are currently being tested in clinical trials for use as
PrEP.
7.3.12 Life Skills

- Life skills are psycho-social competencies or abilities that help the individual to
effectively deal with the demands and challenges of everyday life.
- Involves building the self image, know oneself and increase negotiation skills,
apply prevention strategies and improve understanding of socio-cultural factors
in relation to the spread
- There is no definitive list of life skills.
- The list below includes the psychosocial and interpersonal skills generally
considered important.
- The choice of, and emphasis on, different skills will vary according to the topic
and local conditions (e.g., decision-making may feature strongly in HIV/AIDS
prevention whereas conflict management may be more prominent in a peace
education program).
- Though the list suggests these categories are distinct from each other, many skills
are used simultaneously in practice.
- For example, decision-making often involves critical thinking ("what are my
options?") and values clarification ("what is important to me?").
- Ultimately, the interplay between the skills is what produces powerful
behavioural outcomes, especially where this approach is supported by other
strategies such as media, policies and health services.
- These skills involve:-
1. Communication and Interpersonal Skills
Interpersonal communication skills
 Verbal/Nonverbal communication
 Active listening
 Expressing feelings; giving feedback (without blaming) and receiving feedback
Negotiation/refusal skills
 Negotiation and conflict management

 Assertiveness skills
 Refusal skills
Empathy
 Ability to listen and understand another's needs and circumstances and express
that understanding
Cooperation and Teamwork
 Expressing respect for others' contributions and different styles

 Assessing one's own abilities and contributing to the group
Advocacy Skills
 Influencing skills & persuasion
 Networking and motivation skills
2. Decision-Making and Critical Thinking Skills
Decision making / problem solving skills
 Information gathering skills

 Evaluating future consequences of present actions for self and others
 Determining alternative solutions to problems
 Analysis skills regarding the influence of values and attitudes of self and others
on motivation
Critical thinking skills
 Analyzing peer and media influences

 Analyzing attitudes, values, social norms and beliefs and factors affecting these
 Identifying relevant information and information sources
3. Coping and Self-Management Skills
Skills for increasing internal locus of control
 Self esteem/confidence building skills

 Self awareness skills including awareness of rights, influences, values, attitudes,
rights, strengths and weaknesses
 Goal setting skills
 Self evaluation / Self assessment / Self-monitoring skills
Skills for managing feelings
 Anger management
 Dealing with grief and anxiety
 Coping skills for dealing with loss, abuse, trauma
Skills for managing stress
 Time management
 Positive thinking
 Relaxation techniques
Revision Questions
1. Explain various ways on how HIV can be transmitted.
2. Describe various ways through which HIV cannot be transmitted.
3. Describe how to diagnose HIV/AIDS.
4. Identify and explain HIV/AIDS prevention and control strategies.

CHAPTER 8
TREATMENT AND MANAGEMENT OF HIV/AIDS
8.0 INTRODUCTION
This section aims at introducing to treatment and management of HIV/AIDS. The

section highlights various treatment options available for HIV/AIDS. The section also
gives various management strategies for people living with HIV/AIDS
Objectives
By end of this section you should be able to:
a) Explain the various treatment strategies for HIV/AIDS
b) Discuss the management strategies for HIV/AIDS
c) Explain the advantages of home based care
Introduction
 Human Immunodeficiency Virus (HIV) research has made remarkable progress

since the virus was discovered in the early 1 980s (Embretson et al. 1993;
Laurence, 1995, Pantaleo and Fauci, 1995., Safrit and Koup, 1995).
 Preventive efforts have reduced the number of new cases of the disease, and for
people already living with HIV/AIDS; the survival rate is increasing because of
advances in drug therapy.
 However, the majority of those affected by the disease are unable to afford the
latest drug therapies and their lives are still seriously threatened by the disease.
 While no medical treatment cures AIDS, in the relatively short time since the
disease was first recognized, new methods of treating the disease have
developed rapidly.
 Health-care professionals focus on three areas of therapy for people living with
HIV infection or AIDS:
- Antiretroviral therapies that use drugs, nutrition and counselling to

suppress HIV replication
- Medications and other treatments that fight the opportunistic infections

and cancers that commonly accompany HIV infection,
- Support mechanisms that help people deal with the emotional
repercussions as well as the practical considerations of living with a
disabling, potentially fatal disease.
8.1 TREATMENT
8.1.1 Antiretroviral Drugs (ARVs)
 The primary goal of anti-retroviral therapy is to slow down disease progression,

thereby preventing opportunistic infections and an AIDS diagnosis.
 It is through controlling the HIV replication process and subsequent damage to

the immune system that this is achieved (Panteleo and Fauci, 1995).
 The three main classes of drugs developed so far and are used against HIV are:-
- Nucleoside analogues and Non-nucleoside reverse transcriptase inhibitors
- Protease inhibitors
- Entry inhibitors
a) Nucleoside analogues
- These impede the action of reverse transcriptase, the HIV enzyme that
converts the virus’s genetic material into DNA.
- During this conversion process, these drugs incorporate themselves into

the structure of the viral DNA, rendering the DNA useless and preventing
it from instructing the infected cell to make additional HIV.
- The nucleoside analngue known as azidothymidine (AZT), which became

available in 1987, was the first drug approved by the United States Food
and Drug Administration (FDA) to treat AIDS.
- AZT slows HIV replication in the body, permitting an increase in the

number of CD4+ cells, which boosts the immune system.
- AZT also prevents transmission of HIV from an infected mother to her

newborn. Since the introduction of AZT, additional nucleoside analogues
have been developed, including didanosine (sold under the trade name
Videx), zalcitabine (HIVID), stavudine (Zerit), lamivudine (Epivir), and
abacavir (Ziagen). These drugs are not particularly powerful when used
alone, and often their benefits last for only 6 to 12 months.
- But when nucleoside analogues are used in combination with each other,
they provide longer-lasting and more effective results.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- They use a different mechanism to block reverse transcriptase. These

drugs bind directly to reverse transcriptase, preventing the enzyme from
converting RNA to DNA. Three NNRTIs are available: nevirapine
(Viramune), delavirdine Rescriptor), and efavirenz (Sustiva). NNRTIs
work best when used in combination with nucleoside analogues
b) Protease inhibitors
- Target protease, the enzyme vital in the formation of new HIV.
- These drugs block protease, hence defective HIV forms are unable to
infect new cells.
- Protease inhibitors are more powerful than nucleosides and NNRTIs,

producing dramatic decrease in HIV levels in the blood.
- Drugs are taken orally and act against HIV directly.
- As the chemicals produced by the new DNA attempts to make copies of

HIV, the protease inhibitors act against them and prevent them from
working correctly.
- New particles of HIV produced in the presence of protease inhibitors are

immature and non-infections.
- Reduced viral load, in turn, enables CD4+ cell levels to rise.
- The first protease inhibitor, saquinavir (lnvirase), was approved in 1995.
- Since then other protease inhibitors have been approved, including

ritonavir (Norvir), indinavir (Crixivan), nelfinavir (Viracept), and
amprenavir (Agenerase). (MOH, 2001)
c) Entry I Fusion inhibitors
- Latest class of antiretroviral drugs developed.
- They target the first stage of the entry stage of the HIV replication cycle
- This drug is specifically designed to fit between the HIV particle and the
point of the CD4+ cell to which it needs to bind to gain entry and
therefore preventing the HIV from entering the CD4+ cell.
- Best known drug in this class is T-20, which is given as an injection into a
muscular part of the body.
The Limitations of antiretroviral drugs
ARVs have a number of limitations which include
i. Drug resistance.
Benefits are short-lived when a single drug is used alone. This short-term
effectiveness results when HIV mutates, or changes its genetic structure,
becoming resistant to the drug. The genetic material in HIV provides instructions
for the manufacture of critical enzymes needed to replicate the virus. Scientists
have designed current antiretroviral drugs to impede the activity of these
enzymes. The structure of the virus’s enzymes changes if the virus mutates and
the drugs no longer work against the enzymes, making the drugs ineffective
against viral infection and resistance sets in. Since gene mutation occurs during
the course of viral replication, the best way to prevent mutation is to halt
replication. Studies have shown that the most effective treatment to halt HIV
replication employs a combination of three drugs taken together for instance, a
combination of two nucleoside analogues with a protease inhibitor. This
regimen, called triple therapy (also known as Highly Active Antiretroviral
Therapy- (HAART)), maximizes drug potency while reducing the chance for
drug resistance.
ii. Side effects.
Common side effects include nausea, diarrhoea, headache, fatigue, loss of

appetite, skin rushes, pancreatitis, fever, abdominal pain, kidney stones, anemia,
and tingling or numbness in the hands and feet, and Diabetes mellitus,
deposition of fat in the abdomen or back etc
iii. High cost of treatment.
The greatest drawback to triple therapy is its high cost, which is well beyond the
means of people with low incomes or those with limited healthcare facilities. As
a result, the most effective therapies currently available remain beyond the reach
of the majority of HIV-infected people worldwide.
iv. Stigma.
v. Non-adherence to recommended dose and treatment schedule.
4.1.2 Treatment of opportunistic infections
 It very necessary to prevent infections before they begin to avoid

burdening a patient’s already weakened immune system.
 An HIV-infected person must avoid as much as possible exposure to

infectious agents that produce opportunistic infections common in people
with a weakened immune system.
 Doctors try to Doctors usually prescribe more than one drug to forestall
infections.
 For example, for those who have a history of pneumocystic pneumonia

and a CD4 cell count of less than 200 cells per microliter, doctors may
prescribe the antibiotics, sulfamethoxazole and trimethoprim to prevent
further bouts of pneumonia.
4.1.3 Support mechanisms
 There are many challenges faced by people living with HIV and AIDS,
including choosing the best course of treatment, paying for health care,
and providing for the needs of children in the family while ill.
 Other include emotional stress, social stigma, loneliness, anxiety, fear,

anger, and other emotions often require as much attention as the medical
illnesses common to HIV infection.
 Counseling centers and churches should provide individual or group

counseling to help people with HIV infection or AIDS share their feelings,
problems, and coping mechanisms with others.
8.2 MANAGEMENT STRATEGIES
8.2.1 Voluntary Counselling and Testing Services (VCT)
- Counseling is a process that involves listening to people talk about their

problems, and helping them to work out what to do about the problems.
- Counselor guides the counselee in making alternative choices to either

cope or overcome the problem.
- Counselors are people who are trained to help others to understand their
problems, identify and develop solutions, and make their own decisions
about what to do.
- Counseling requires that counselors spend time with the counsellees,

listening to them talk about their problems and fears, helping them to
increase their own self-esteem, and when necessary giving correct and
useful information based on what they need to know at that point in time.
- It is a powerful weapon in the fight against HIV/AIDS since it is

associated with behaviour change that reduces HIV transmission and
serves as a point of entry into care for those testing HIV positive (MOH
and NACC, 2001 a., UNAIDS, 2000., Van de Pierre, 2000.,
- Keya national VCT programme uses four models of service delivery:
 Integrated sites: A VCT centre is usually located within the grounds of

health facilities such as hospitals, health centres or dispensaries. Their
main advantages include easier referral to medical care services and low
start-up costs that allow for rapid scale-up.
 Stand-alone sites: These are not associated with any existing medical
institution and usually have staff fully devoted to VCT. Their main
advantages are that the staff can work full time on VCT services, and they
may have donor funds that facilitate their work.
 Community-based sites: VCT is either integrated into other social services

or implemented as the sole activity of a local community-based
organization (CBO) or a faith-based organization (FBO). There is
widespread scale-up of VCT at the grassroots, given the widespread
distribution of CBOs and FBOs in many countries
 Mobile sites. VCT is provided as an outreach to remote or hard-to-reach

communities where other models of VCT are either not feasible or
unavailable. Most mobile VCT services are offered by standalone or
community-based VCT programmes.
Reasons for testing
 Medical reasons: Pregnancy, STDs, or Legal reasons
 Voluntary testing
HIV testing
i. Pretest counseling
HIV counseling is an effective public health intervention because it promotes the

health of HIV infected persons and plays a role in reducing HIV transmission.
Aims of pretest counseling
- Help to identify risk factors and symptoms that may indicate that the client is
HIV infected.
- Help the client to identify one with whom he/she will share the results with.
- To ensure the client has a full understanding of the implications of the test
and is able to make an informed decision whether to take the test or not
- Ensure informed consent to carry out the test is obtained from the client
- Give the client the opportunity to discuss modes of HIV transmission
- Discuss the implications and support needs that may follow either a positive
or negative test result.
- Consider ways to reduce transmission or contraction of HIV in future.
- Encourage the client to consider and evaluate the impact the result may have
on him/her, emotionally, physically and in relation to his/her lifestyle.
- Reduce the internalized stigma by providing information about HIV in a

neutral environment.
Advantages of testing
They include:
i. Ability to seek early medical intervention which prevents complications of AIDS
ii. Prevention of transmission to others,
iii. Making healthy life style changes; (e.g. eating a balanced diet and regular
exercising).
iv. Understanding the cause of various symptoms.

Disadvantages of a positive test include:
i. Increased fear of illness and death
ii. Fears related to family relations/parenting
iii. Guilt of past relationships and sexual behaviour
iv. Stigma associated with HIV/AIDS
If results are negative benefits include: Increased self confidence by knowing that one
is not HIV positive. However, this self confidence if not well handled may lead to risky
behaviour.
N.B:
- Positive test mean the person is HIV infected except for infants who may carry
the mother’s antibodies and may test positive even when they don’t carry the
HIV.
- There is a period of 3-6 months during which antibodies may not show up in the
blood and test will reveal the person to be negative.
- This is the ‘window period’. Western blot is used to confirm the positive results.
- Because of the window period, tests giving negative results should be repeated
again after 3 and 6 months respectively.
Post test counseling
If the person tests positive, the counselor should explain to him/her that there is a
chance of not developing full blown AIDS through medical intervention by ARVs,
antibiotics and antifungal drugs, good nutrition and reducing stress, and change of
lifestyle through positive living.
If results are negative, then,
- Clarify that the test did not yield positive results but this does not means that
the person does not have the HIV since one may be in the window period.
- Let the person know that there is need to repeat the test after 3 months.
However don’t forget to congratulate the person.
- Discuss methods of reducing the risk of transmission and avoid risky

behaviour.
- Discuss the current risk situations of the patient and help to develop
strategies to increase prevention of transmission.
Role of VCT centers:
i. Enlightening and guiding people on issues relating to HIV/AIDS.
ii. Contributed immensely in the control of HIV/AIDS by offering counseling

services and even treatment.
iii. Offer testing and avail the results to people within short period.
iv. The clients are prepared for both positive and negative results before and after
testing then allowed to know their HIV status.
v. Through counseling, infected people, majority of who have lost hope are with
offered an opportunity for positive living
vi. They reduce the revenge attitude for those innocently infected and may opt to
die with many or commit suicide
vii. They enable the public who include the relatives of the infected to stop him/
stigmatizating those infected to be able to live normal lives knowing that
someone cares for them
viii. They also help the government to keep statistics on the prevalence of the
disease hence policy development or strategic planning.
ix. They enhance peer counselling - which is a more effective tool as it applies peer
pressure.
General reactions to testing HIV positive
 Shock
 Denial
 Anger
 Bargaining
 Fear
 Loneliness
 Self-consciousness
 Depression
 Acceptance
Living positively with HIV/AIDS
The following steps may be taken to cope with the situation:
i) Breath
When one gets overwhelmed, he/she should take three deep breaths. Body
ventilation improves everything from chronic health problems, stress related
disorders to sporting performance. Whether one wants to boost one’s workout, ease
stress or improve one’s health, learning to breathe properly can enhance one’s
quality of life.
ii. Refuse to be a victim by:
- Focusing on positive thoughts like living with HIV and not dying
- Living one day at a time,
- Seeking support not pity.
iii. Educate one’s self about HIV by attending HIV/AIDS seminars, workshops or
any education forum
iv. Physical exercise — exercise regularly to keep muscle tone and reduce stress
v. Keep busy and avoid self pity by concentrating on development but one must be
careful not to overwork
vi. Express one’s self and ask for support by;
- Talking to friends
- Sharing feelings with a partner, friends and family
- Consulting a professional counselor, therapist and clergy
vii. Embrace one’s own spirituality - Faith based organizations have ministers who
support HIV positive people these should be consulted for spiritual support.
viii. Think and act positively in all things.

ix. Seek out people who are honest, trustworthy and supportive.
x. Cry when one needs to let it out, as it creates room for positive feelings
xi. Accept responsibility: Pledge that HIV stops with me. Do not deliberately seek to
infect others. Use condoms to protect others and to avoid re-infection.
xii. Join HIV/AIDS support groups that over group therapy as infected people share
experiences.
xiii. Eat a well balanced diet with lots of proteins and vitamins. Avoid alcohol, drug
and substance abuse
xiv. Attend to opportunistic infections immediately
xv. Have hope about many things. For example that;
- One will live for long
- Their baby will be healthy
- Each sickness will be treated as it comes
- They are loved and accepted for who they are
- Scientists will find a cure
- There is life after death.
8.2.2 Home based HIV/AIDS care
 People living with HIV/AIDS have basic, physical, economic and

psychological needs.
 The needs can be met at familiar home environment and may lead to an
improvement of the quality of life for PLWA’s.
 Home based care establishes an important link between health

professionals and the care givers at home.
 Family, friends and the community must fill the “care gap” at home.
 Home based care simply means the care given to HIV/AIDS patients at
home.
 It means that the things people might do to take care of themselves or the
care given to them by the family and community.
Components of home based care:
 Clinical management; which includes early diagnosis, rational treatment and

planning for follow up care of HIV related illness
 Nursing care; which includes care to promote and maintain good health, hygiene
and nutrition
 Counseling and psycho social care; which includes reducing stress and anxiety,
promoting positive living, and helping individuals to make informed decisions
on HIV testing, plan for the future and behavior change
 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
Advantages of organized home based care
i. It affects the socio economic, psychosocial and medical well being of the patient,
the family, the community and the health care system
ii. It provides comfort of a familiar environment to the PLWA
iii. It is less expensive for families
iv. It helps counteract the myths and mistaken beliefs about HIV/AIDS
v. It encourages people to take steps to prevent infection
vi. It encourages community participation in the care of PLWA’s and thus maintains
community cohesiveness in responding to community members’ needs.
vii. 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.
Nutritional needs of people living with HI V/AIDS
 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 (FAQ, 2002).
 However, HIV/AIDS reduces the household’s ability to produce and buy
food by taking away the adult labour that would otherwise be engaged in
agricultural production or in earning an income.
 At the same time, HIV/AIDS increases health expenditure.
 The capacity of an affected 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 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
Reduced food intake in persons with HIV may be due to painful sores in the mouth and
throat, loss of appetite, or fatigue. The main causes of loss of appetite are infections and
depression. Other causes include side effects of medication such as nausea and
vomiting, and inadequate access to and availability of appealing foods.
Poor nutrient absorption
Poor absorption of nutrients results when HIV damages the small intestine and alters
the healthy bacteria of the digestive system, causing malabsorption of fats and
carbohydrates and frequent episodes of diarrhea. Intestinal infections also cause
diarrhoea, with loss and waste of nutrients.
Increased metabolism
Infections, including HIV itself, lead to increased requirements for energy and protein,
inefficient 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.
HIV/AIDS patient require the following nutrients in a well adjusted diet:

- Vitamins: A good multivitamin should be considered
- Proteins: Sources of protein are red meat, fish, poultry, eggs, nuts, beans, peas
and other pulses.
- Carbohydrates: are required for energy and for the purpose of PLWAs, they may
be categorized into insoluble and soluble dietry fibres.
- Fats: Fats are high in calories (energy). They are needed for many membranes in
the body. Fish, beef, and vegetables all supply fats.
- Vitamins and minerals: Vitamins and minerals are also needed by the immune
system. While our foods contain vitamins and minerals, it is important to
recognize that available data indicate food alone does not supply enough in the
presence of HIV, and that supplementation is very important.
- Water is also very important.
Advantages of good nutrition to PLWA
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:
 Increase resistance to infection and disease and improve the energy supply
 Boost the immune system and therefore reduce the frequency of episode of
morbidity.
 Lessen severity of infection, improve the response to treatment for opportunistic

infections such as TB, and speed the rate of recovery.
 Replace lost micronutrient and provide the body with all essential nutrient
required for good health.
 Preserve muscle mass, slow or stop the loss of lean tissue, prevent weight loss,
and improve body strength and energy.
 Delay the rate of progression of HIV to AIDS and the further advance of AIDS
itself.
 Keep PLWAs alive and able 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.
N.B:
 Studies show that nutrition interventions can positively affect nutrition status
(FAQ, 2002), the immune system and even personal esteem, by maintaining body
weight, improving effectiveness of medication and prolonging life.
 Supplementing micronutrients has been shown to increase life expectancy of

subjects with fewer than 200 CD4 cells per milliliter.
 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 improve immune function (FAQ,
2002)
 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, counselling or education;
- Nutritional education and counselling
- Water and food safety intervention to prevent diarrhoea
- Income-generating activities to enhance food security
- Nutritional supplementation
- Meal designing and planning using locally available foodstuffs
REVISION QUESTIONS
1. 21-year-old college student who has been sexually active for years asks if it’s a
good idea for her to be tested for HIV infection. How would you respond to her
and what recommendation would you give and why?
2. Give an outline of the ABCD of HIV/AIDS prevention and control strategies.

Describe some of the major problems encountered in the prevention and control
of
HIV/AIDS.
3. Discuss the various drugs used to slow down HIV/AIDS progression.
4. Explain the role of nutrition in HIV/AIDS management
5. Explain the role of VCT centres in controlling HIV/AIDS
6. Describe briefly the different types of VCT centres
7. Describe the various responses likely to be encountered in an individual who

tests HIV positive
8. Discuss the benefits of home based care.
9. Give an outline of positive living in HIV/AIDS.
10. Explain vertical transmission of HIV/AIDS and discuss its prevention
11. During a home care visit to a patient who is immune-compromised, you note
spoiled food in the kitchen, dirty dishes, unclean bathroom and the presence of
several cats and dogs. Explain the cause of action you would take.
CHAPTER 9
IMPACT OF HIV /AIDS
9.0 INTRODUCTION
This section aims to introduce to you the impact of HIV/AIDS. This section gives the
impact of HIV/AIDS on demography, agriculture, education, health, industry and the
business, and economic growth.
Objectives
a) Explain the impact of HIV/AIDS on population, agriculture,

education, health, industry and business, and economic growth.
9.1 Demographic impact
- AIDS will continue to affect population growth and other demographic

variables. This is because population growth results from two main
processes - births and deaths.
- It has contributed to reduction of the average life expectancy
9.1.1 Impact on households
- The available evidence shows that AIDS epidemic is having an enormous

effect on households, which include increased medical and health
expenditures, funeral expenses, and decreased income.
- The result is a loss of savings, assets and property in the affected

households.
- This problem is magnified when the infected person is the breadwinner.
- Absenteeism from work due to poor health as the disease progresses

affects household income.
- Affected households are poorer than they would be without HIVIAIDS.

- The vicious cycle of HIV/AIDS and poverty reduces resources to invest in
health and education of children, depleting the country of human capital
in both the present and the next generation.
9.1.2 Impact on family
- HIV/AIDS has increased the number of orphans in Kenya
- These orphans in some cases are taken care of by the older generation,
whose level of income is low, and in other cases are in child-headed
households, which may not be able to provide essential requirements,
including education and health services.
- They do not have the basic material needs that their family would supply
i.e food security, shelter, clothing, schooling, access to health and medical
services (including psychological support services), and parental love and
the feeling of belonging.
9.2 Impact on industry and the business sector
- They form the basis for production and supply of goods and services in an
economy.
- The effect of HIV/AIDS on businesses is transmitted through its effect on

labour.
- The consequences of HI V/AIDS include increased absenteeism,

decreased productivity, and reduced number of employees through death,
loss of accumulated skills and declining morale.
- Businesses with health schemes incur increased medical costs.
- The declining productivity and increasing medical costs result in

declining profits (UNDESAPD, 2004).
9.3 Impact on agriculture
- Agriculture remains the mainstay of Kenya’s economy next to tourism.
- The impact is evident through lower productivity in farming areas due to

illness, absenteeism, death and subsequent loss of farming skills.
- less land under cultivation, less labour - intensive crop production

- These translate into, less crop variety and less livestock production.
Family members’ time is also diverted to care for the sick and attend
funerals, which also contributes to loss of household income and farm
assets.
- The end results are declines in agricultural income and food production
and increased food insecurity.
9.4 Impact on education
- HIV/AIDS impact negatively on the education system.
- The effect of increased morbidity, absenteeism and attrition of teachers,

the reduced number of school-aged children attending school, and poor
performance in the classroom are a combination of factors wreaking havoc
in the education sector and resulting in a decline in the quality of
education.
- Higher costs on the education system
9.5 Impact on the health sector
- HIV/AIDS has increased demand for health services due to the number of
infected persons.
- More health resources and workforce are diverted to HIV/AIDS

treatment, creating shortages for other health care needs.
- Half or more beds in public hospitals are occupied by HIV-infected

patients, creating a big burden on the health sector.
- HIV/AIDS reduces the morale of health workers as patients with AIDS

respond poorly to treatment or die.
- HIV - infected health workers also may have low productivity and morale.
- HIV/AIDS takes about 15% of the resource requirements for the entire
health sector.
- Taking into account resources required for diagnosis and treatment of

STIs and TB, HIV/AIDS consumes about 20% of all health sector
resources.
9.6 Impact on economic growth
- Economic growth is dependent on a sustained increase in productive

capacity and real output resulting in a growing national income.
- The most critical factors that determine economic growth are labour,
capital and technical progress.
- HIV and AIDS slow economic growth by their effect on labour and capital
investment.
- It slows or reverses growth in labour supply as it affects mainly the most

productive members of the population.
- It also reduces the productivity of infected workers.
- Increased medical costs associated with HIV/AIDS reduce the level of

domestic savings and investment that are crucial for capital formation.
- Furthermore, reduced income and increased poverty in the household

imply decreased purchasing power of the household, which translates to
deficient demand for goods and services, hence undermining economic
growth
REVISION QUESTIONS
1. HIV/AIDS results in a vicious cycle of poverty amongst the infected and the
affected. Justify this statement.
2. Discuss the effects of HIV/AIDS pandemic on the household.
3. Discuss how HIV/AIDS has impacted on the following sectors:
a) Education,
b) Agriculture,
c) Health,
d) Industry
4. Discuss the effect of HIV/AIDS on the economy.
5. HIV/AIDS pandemic may lead to destruction and stagnation of growth of all

nations. Discuss.
SAMPLE EXAMINATION QUESTIONS
UNIVERSITY EXAMINATION
EXAMINATION FOR THE BACHELOR IN BUSINESS MANAGEMENT
BUCU005: HIV/AIDS AND DRUG AND SUBSTANCE ABUSE
Instructions
- This paper has two sections A and B

- Answer all questions in Section A
- Answer two questions in section B
SECTION A (30 MARKS)
1. Identify and Discuss factors influencing condom use among the youth (10
marks)
2. In your view, what should be done to ensure that the married couples protect
themselves and their children from HIV/AIDS (10marks)
3. Clearly outline the relationship between drug, substance abuse and HIV and
AIDS (10 marks).
SECTION B (40 MARKS)
4. ‘’The youth are scared of pregnancy more than HIV and AIDS’’ Discuss
(20marks)
5. Discuss the impact of HIV/AIDS on any two of the following sectors (20marks)
I) Education II) Agriculture III) Health
6. Discuss the factors that explain the differential infection rates between men,
women, boys and girls (20marks)
7. Assess the impact of Drugs and Substance Abuse on individual and society
(20marks)
EXAMINATION FOR THE BACHELORS DEGREE
Instructions

1. Identify and discuss factors that contribute o HIV/AIDS- related stigma in

society (10 marks).
2. Women are the most affected by HIV/AIDS pandemic. Discuss the factors for
this gender disparity (10 marks).
3. Discuss five most effective HIV/AIDS prevention and control strategies (10
marks).
4. Myths and mysteries surrounding HIV/AIDS remain one of the factors

contributing to high incidences of the pandemic. Discuss (20mks).
5. Discuss successful National responses to the HIV/AIDS pandemic (20mks).
6. “Drug and substance abuse is related to the spread of HIV/AIDS” Discuss

(20mks).
Instructions

1. “Culture is overwhelmingly responsible for the spread of HIV/AIDS in Kenya”

Discuss. (10marks)
2. Myths and mysteries surrounding HIV/AIDS remain one of the factors

contributing to high incidences of the pandemic. Discuss (10marks).
3. Explain how the rampant spread of HIV could be controlled among married
couples. (10marks)
4. During the Mt Kenya University HIV/Aids awareness week, you tested positive.
Explain the measures you would undertake to ensure that you continue to live
long despite the infection. (20marks)
5. Giving examples to illustrate your points discuss the impact of HIV/Aids on

education and development. (20marks)
6. Discuss any four gender related factors that explain the differential HIV/Aids
infection rates between young men and women in Kenya (20marks).
7. Identify and discuss three ways of managing the spread of HIV/Aids among
drug abusers (20marks).
Instructions
Answer Three Questions
1. Explain the factors responsible for increased vulnerability of women to contracting

HIV/AIDS and show how these can be effectively tacked.
2. Explain the importance of disclosure of one’s status to the control of HIV/AIDS.
3. Giving relevant examples, explain the factors fueling the spread of HIV/AIDS.
4. Recent studies have shown that marriage and regular unions are at more risk of
HIV/AIDS spread. Discuss the statement.
5. a. Describe the components of HIV/AIDS Home Based Care.
b. Explain the advantages and disadvantages of HIV/AIDS Home Based Care.

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P.O.

Box 342-01000 Thika

DEPARTMENT OF PUBLIC HEALTH

COURSE CODE: BUCU005

COURSE TITLE: HIV/AIDS AND DRUG

COURSE OUTLINE ....................................................................................................................................................7

GENERAL INTRODUCTION ...................................................................................................................................8

1.1 PUBLIC HEALTH AND HYGIENE ......................................................................................................8

1.2 CONCEPTS OF HIV, AIDS AND STIS ............................................................................................... 12

1.2.1 HIV: ................................................................................................................................................ 12

1.2.2 AIDS: .............................................................................................................................................. 12

1.2.3 STIS/STDS .................................................................................................................................... 13

1.2.4 RELATIONSHIP BETWEEN HIV/AIDS AND STIS .............................................................. 20

1.3 ORIGIN AND CLASSIFICATION OF HIV/AIDS ........................................................................... 20

1.4 AIDS PROGRESSES AND SIGNS & SYMPTOMS..................................................................................... 27

1.5 CURRENT STATUS OF HIV/AIDS ............................................................................................................ 28

1.5.1 A GLOBAL OVERVIEW ........................................................................................................................ 28

1.5.2 HIV/AIDS IN SUB-SAHARAN AFRICA (SSA) ................................................................................. 29

1.5.3 HIV/AIDS IN KENYA: .......................................................................................................................... 29

REVISION QUESTIONS ..................................................................................................................................... 30

FACTORS FUELING THE SPREAD OF HIV/AIDS ........................................................................................... 31

2.0 INTRODUCTION ............................................................................................................................................... 31

2.1 FACTORS CONTRIBUTING TO HIGH INCIDENCES OF HIV/AIDS ................................................. 31

REVISION QUESTIONS ..................................................................................................................................... 36

THE ROLE OF DRUGS IN THE SPREAD OF HIV/AIDS .................................................................................. 37

3.1 INTRODUCTION ............................................................................................................................................... 37

3.2 CLASSIFICATION OF DRUGS .................................................................................................................... 37

3.3 MODES OF DRUG ADMINISTRATION AND ACTION ........................................................................ 40

3.4 DRUG INTERACTIONS ............................................................................................................................... 41

3.5 DRUG ABUSE ................................................................................................................................................. 41

3.5.2 IMPACT OF DRUG ABUSE .................................................................................................................. 42

3.6 RELATIONSHIP BETWEEN DRUG USE AND HIV/AIDS .................................................................... 42

3.7 THE ROLE OF ALCOHOL IN THE SPREAD OF HI V/AIDS ................................................................ 43

REVISION QUESTIONS .......................................................................................................................................... 43

YOUTH SEXUALITY AND HIV/AIDS ................................................................................................................ 45

4.0 INTRODUCTION ............................................................................................................................................... 45

4.1 DEFINITION ................................................................................................................................................... 45

4.2 HIV/AIDS AND YOUTH ............................................................................................................................. 46

4.3 SEX AND SEXUALITY .................................................................................................................................. 46

4.3.1 SEX ............................................................................................................................................................ 47

4.3.2 SEXUALITY ............................................................................................................................................. 47

4.4 WHY FOCUS ON THE YOUTH .................................................................................................................. 47

4.5 YOUTH’S PROBLEM AND CHALLENGES .............................................................................................. 48

4.6 FACTORS LEADING TO HIGH INCIDENCES OF PREMARITAL ACTIVITY AND HIV

REVISION QUESTIONS .......................................................................................................................................... 52

ROLE OF GENDER IN HIV/AIDS TRANSMISSION ........................................................................................ 53

5.0 INTRODUCTION ............................................................................................................................................... 53

5.1 FACTOR INFLUENCING GENDER DISPARITY IN HIV/AIDS INFECTION ................................... 53

5.2 REDRESSING GENDER ISSUE IN HIV/AIDS .......................................................................................... 55

REVISION QUESTIONS ..................................................................................................................................... 56

GOVERNMENTS POLICIES AND RESPONSES TO HIV/AIDS PANDEMIC .............................................. 57

6.0 INTRODUCTION ............................................................................................................................................... 57

6.1 GLOBAL POLICIES ON HIV/AIDS ........................................................................................................... 57

6.1.1 THE GUIDELINES .................................................................................................................................. 58

6.1.2 HUMAN RIGHTS PRINCIPLE RELEVANT TO HI V/AIDS .......................................................... 58

6.2 INTERNATIONAL RESPONSES TO THE HIV/AIDS PANDEMIC ..................................................... 59

6.2.1 SUCCESSFUL NATIONAL RESPONSES ............................................................................................ 60

6.3 KENYA’S RESPONSE TO THE PANDEMIC ............................................................................................. 64

6.3.1 KENYA NATIONAL AIDS STRATEGIC PLAN (KNASP) 2000 – 2005.......................................... 66

REVISION QUESTIONS ..................................................................................................................................... 71

TRANSMISSION, PREVENTION AND CONTROL STRATEGIES .................................................................. 72

7.0 INTRODUCTION ............................................................................................................................................... 72

7.1 TREATMENT STRATEGIES ......................................................................................................................... 72