JOMO KENYATTA UNIVERSITY

OF
AGRICULTURE & TECHNOLOGY
JKUAT SODeL

SCHOOL OF OPEN, DISTANCE AND eLEARNING

P.O. Box 62000, 00200
©2013

Nairobi, Kenya
E-mail: elearning@jkuat.ac.ke

TDH 1100: Introduction to HIV/AIDs

JJ II LAST REVISION ON May 10, 2013

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 TDH 1100 Introduction to HIV/AIDs
This presentation is intended to covered within one week.
The notes, examples and exercises should be supple-
mented with a good textbook. Most of the exercises have
solutions/answers appearing elsewhere and accessible by
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clicking the green Exercise tag. To move back to the same

page click the same tag appearing at the end of the solu-
tion/answer.
©2013

Errors and omissions in these notes are entirely the re-

sponsibility of the author who should only be contacted
through the Department of Curricula & Delivery
(SODeL) and suggested corrections may be e-mailed to
elearning@jkuat.ac.ke.
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 TDH 1100 Introduction to HIV/AIDs
LESSON 3
Transmission of HIV

Learning outcomes
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Upon completing this topic, you should be able to understand:

ˆ The modes of HIV transmission
ˆ Pregnancy and HIV/AIDS
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ˆ The relationship between STIs, STDs, FGM and HIV/AIDS

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 TDH 1100 Introduction to HIV/AIDs
3.1. Transmission of HIV
ˆ HIV is present in semen, vaginal/ cervical secretions &
body fluids. It may be present in tears, urine, csf, breast
milk &infected discharges, saliva. HIV is spread when an
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infected individual come into contact with infected body

fluids or cells. How HIV is NOT transmitted.
ˆ There is no evidence to show that HIV can be transmitted
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by:
– casual social contact e.g. shaking hands, hugging
– sneezing or coughing
– shared facilities & equipment e.g. toilets, swimming
pools
JJ II – non wet kissing
J I – sharing food & utensils
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 TDH 1100 Introduction to HIV/AIDs
– insect bites e.g. mosquitoes - HIV only lives for a
short time and does not reproduce in an insect
– Injecting with sterile needles
– Protected sex - If an unbroken latex condom is used,
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there is no risk of HIV transmission. There are myths

saying that ’some very small viruses can pass through
latex’ - this is not true.
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3.1.1. Modes of HIV Transmission

1. Sexual contact - Any unprotected (no condom) penetra-
tive sex whether vaginal, anal or oral can transmit HIV
from infected individual to uninfected sexual partner.
JJ II (a) Heterosexual contact (man &woman) a/c 70%-80%
J I of all HIV transmission.
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 TDH 1100 Introduction to HIV/AIDs
(b) Homosexual contact a/c 5-10%
(c) Oral sex is low risk but oral ulcers, bleeding gums,
genital sores & presence of STIs (gonorrhea, syphilis
& genital ulcers) do increase the risk of hiv transmis-
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sion
(d) Rape, & sodomy victims could get infected if the at-
tacker is HIV+. The victims should seek prompt
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medical attn because early treatment with ARVs can

greatly reduce chances of HIV infection. They will
also require specialized counseling & psychological
/psychiatric care Factors that influence transmission
through sexual contact
JJ II (e) The risk of HIV transmission through sexual contact
J I is influenced by a number of factors:
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 TDH 1100 Introduction to HIV/AIDs
i. level of virus in the body
ii. number of sexual partners
iii. sex – male/female
iv. age
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v. STDs/STIs
vi. Condom use
2. Intravenous Drug Use/ Contaminated Piercing In-
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struments - I.V. drug use is the administration of drugs

of addiction e.g heroin into the blood stream by injecting
into the veins. Most drug users tend to shoot in groups
& often share needles. It therefore becomes very easy for
transmission /infection to occur from one infected group
JJ II member to another. It’s a significant modes in the de-
J I veloped countries accounting for 5-10% of HIV infections.
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 TDH 1100 Introduction to HIV/AIDs
Procedures such as ear piercing & circumcisions when done
with poorly cleaned & unsterile instruments can lead to
HIV transmission.
3. Occupational exposure/ Infection in the health-
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care setting - Occupational exposure is the accidental

exposure of healthcare workers (e.g doctors &nurses) to
body fluids from an infected patient in their care. This
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is most frequently due to needle pricks or cuts with sur-

gical instruments. Infection can also occur due to contact
with infected blood, laboratory samples especially through
broken skin.
4. Mother - to - child transmission (MTCT) - Also
JJ II called Vertical / perinatal transmission & it accounts for
J I 13-40% HIV infections. It’s possible for HIV to be trans-
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 TDH 1100 Introduction to HIV/AIDs
mitted from HIV+ mothers to unborn child. This occurs
in 3 ways:
(a) During pregnancy- The virus crosses from mother’s
blood to child through the placenta. Although there’s
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no exchange of blood between mother & child, re-

searchers believe that the foetus can get HIV through
the placenta i.e through diffusion. It accounts for
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about 35% HIV infections

(b) During birth – Through exposure to mother’s blood &
other secretions. It accounts for 65% HIV infections
(c) After birth- through breast feeding. Breast milk con-
tains minimal quantities of HIV. It accounts for 15%
JJ II HIV infections.
J I Factors that increase chances of MTCT/ Determinants
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 TDH 1100 Introduction to HIV/AIDs
ˆ high level of HIV in mother’s blood & other body fluids
(maternal viral load)
ˆ duration of exposure to maternal secretions during delivery
ˆ inadequate nutrition
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ˆ pre-term delivery- premature babies are more prone to in-

fection because the immune mechanism is still very weak/
immature
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ˆ Maternal immune response- maternal CD4 cell count

ˆ prolonged membrane rupture-increased risk if more than
4hours
ˆ obstetrical procedures- e.g. vacuum assisted delivery
JJ II ˆ unprotected sexual intercourse
J I ˆ presence & amount of virus in the genital tract
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 TDH 1100 Introduction to HIV/AIDs
ˆ Placenta barrier- breaches in barrier leads to mixing of
maternal and foetal cells
ˆ Presence and amount of HIV in genital tracts
Prevention of MTCT (PMTCT)
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ˆ Prevent HIV infection in women i.e. encouraging teenage

girls to delay sexual relationships & discordant couples to
use of condoms.
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ˆ Reduce the number of HIV exposed pregnancies i.e. Women

who are HIV infected can use family planning methods to
prevent pregnancies.
ˆ ART- to infected pregnant women.e.g. AZT (zidovudine/
JJ II azidothymidine- Nov ‘94) is taken in the last week of preg-
J I nancy and nevirapine is given at the onset of labour & to
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 TDH 1100 Introduction to HIV/AIDs
the HIV exposed babies within 3 days after birth
ˆ Preventing malaria - A woman who is infected with both
HIV and malaria has an increased chance of passing HIV to
her baby. Anti-malarial drug treatment during pregnancy
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is therefore an important part of preventing MTCT

ˆ Reducing trauma and shortening exposure of the baby to
the virus during labour and delivery i.e. Modified obstet-
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rical practices which include

– make sure that the mother gives birth within 4 hours
after membrane ruptures (water breaks),
– avoid routine episiotomy,
– avoid prolonged labour,
JJ II – minimum use of vacuum or forceps delivery, and
J I – Electing to use caesarian section.
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 TDH 1100 Introduction to HIV/AIDs
ˆ Appropriate choice of feeding infants i.e. breastfeeding ex-
clusively without any supplements followed by abrupt but
timely weaning or replacement feeding from birth without
any breast milk.
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 TDH 1100 Introduction to HIV/AIDs
3.2. STIs, STDs, FGM and HIV/AIDS
STDs are diseases that are transmittable from an infected person
to another through sexual intercourse. STIs is a term applied to
infections that are transmitted primarily through sexual contact
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be it vaginal, oral, or anal intercourse. They don’t necessarily

involve sexual activity but the organisms that cause STIs enters
mostly through the soft & thin skin that cover the inner surfaces
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i.e. mucus membrane of the vagina, urethra, anus & mouth.

However, in some instances exposure to sores or other types of
skin to skin contact may be insufficient to transmit the infection.

3.2.1. Common examples of STIs/ STDs

JJ II ˆ Syphilis
J I ˆ Gonorrhea
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 TDH 1100 Introduction to HIV/AIDs
ˆ Candidacies
ˆ Hepatitis B & C.
ˆ Chancroids ( genital sores)
ˆ Genital herpes (Herpes Simplex V)
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ˆ Genital warts( Human Papilloma V)

ˆ Bacterial vaginosis.
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ˆ Trichomoniasis

3.2.2. Relationship between HIV & STDs/STIs

STIs/STDs increase the risk of HIV infection by mobilizing a
high population of T cells to fight the STI/STD. Since the T cells
JJ II are the target cells for attack by HIV, such a large population
J I will inevitably provide breeding ground for HIV. STDs/STIs also
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 TDH 1100 Introduction to HIV/AIDs
increase the risk of acquiring or transmitting the virus. Both are
transmitted through sexual contact & to unborn baby during
pregnancy or at birth.

3.2.3. Dangers/ risks of STDs/STIs

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ˆ Increased risks of getting infected with HIV or the risk of

infecting others
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ˆ High incidences of infertility e.g. pelvic inflammatory dis-

ease if untreated result in infertility or tubal pregnancies.
ˆ Future problems with pregnancies & child birth
ˆ Mental disorders & deaths especially in syphilis Treatment
of STDs/STIs
JJ II
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 TDH 1100 Introduction to HIV/AIDs
ment. Any person who has contracted STD/STI & is re-
ceiving treatment should also:
– Receive counseling from a qualified health worker on
how to avoid future infections
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– Take all medicines prescribed exactly according to all

the instructions
– Inform all sexual partners of the need to get examined
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& treated
– Abstain from further risky sexual behaviors
– Use condoms for protection

3.2.4. Why teenagers don’t seek treatment

JJ II ˆ Lack of confidentiality
J I ˆ Hostility of service providers
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 TDH 1100 Introduction to HIV/AIDs
ˆ Stigma attached to STIs/STDs
ˆ Financial constraints for the youth who are unemployed
e.g. anti-fungal drugs( diflunisal pessaries) - clears most
infection and it costs Ksh.1500 per tablet
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ˆ Ignorance of availability of service providers

NB: these concerns could be addressed through training service
providers to be youth friendly & availing information, education
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& communication materials to the youth

3.2.5. FGM (Female Genital Mutilation)

It’s a destructive invasive procedure usually performed on girls
before puberty. It involves surgically removal of part or the
JJ II whole clitoris using razor blades, knives, and scissors. Since the
J I victims are young they are unable to give their informed consent.
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 TDH 1100 Introduction to HIV/AIDs
FGM is forced on approximately 6000girls per day world wide.
Because of poverty & lack of medical facilities the procedure
is frequently done under less hygienic conditions & often with-
out anaesthesia. A person who is not medically trained usually
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circumcises about 20 girls of same age group.

• Types of FGM
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1. Sunna - its most widely practiced in sub-Saharan and

middle east. It involves removal of the tip of the clitoris.
2. Intermediate-it’s where the whole clitoris and adjacent
parts such as labia major and labia minor are removed.
3. Pharoic - it’s the total removal of the clitoris, labia mi-
JJ II nor, labia major and where the two sides of the vulva are
J I drawn together and then fastened leaving a small open-
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 TDH 1100 Introduction to HIV/AIDs
ing for urinating and menstruating. This is especially in
Somalia.
Effects of FGM leads to conditions that favours HIV
survival, they include;
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ˆ An abnormal anatomy with anatomical distortion

ˆ Partial closure of the vagina
ˆ Incomplete healing brought about by infections i.e. acids
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& organisms from urine

ˆ Scar formation which may be excessive
ˆ Urinary tract infection f) Inflammation of the genital area
ˆ Chronic urinary retention - urine is broken down to urea
& uric acid accumulates in joints & causes gout.
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 TDH 1100 Introduction to HIV/AIDs
Revision Questions

Exercise 1.  Enumerate various modes of HIV transmission


Example . HIV testing in VCT involves the following steps:
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Pretest counseling and Post test counseling. Discuss them Briefly

Solution: Pretest counseling - HIV counseling is an effective
public health intervention because it promotes the health of HIV
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infected persons and plays a role in reducing HIV transmission.

Aims of a pretest counseling include; Ensure you have a full un-
derstanding of the implications of the test and are able to make
an informed decision whether to test. Ensure informed consent
(to carry out the test) is gained from you. Give you the op-
JJ II portunity to discuss routes of HIV transmission. Discuss the
J I implications and support needs that may follow either apposi-
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 TDH 1100 Introduction to HIV/AIDs
tive or negative test result. Consider ways to reduce transmis-
sion or contraction of the virus in the future. Encourage you
to consider and evaluate the impact the result may have on you
emotionally, physically and in relation to your lifestyle. Helps
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to identify risk factors and symptoms that may indicate that

the patient is HIV infected. During the pretest counseling the
person thinks of someone to share the results with. To reduce
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the internalized stigma by providing information about HIV in a

neutral environment. Post test counseling - If the person test
positive; Explain to them that there is chance of not developing
full blown AIDS by medical intervention - ARVs, antibiotics and
antifungal, nutrition and reducing stress, and change of lifestyle
JJ II through positive living. If results are negative; Clarify that the
J I test did not yield positive results does not means that the person
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 TDH 1100 Introduction to HIV/AIDs
does not have HIV or has not developed HIV. Let the person
know that there is need to repeat test after 3 months however
don’t forget to congratulate the person. Discusses methods to
reduce risk of transmission and avoiding risky behaviours. Dis-
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cuss the current risk situations of the patient and help to develop
strategies to increase prevention of transmission. 
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References and Additional Reading Materials

1. Maranga R. O, Muya S. M and Ogila K. O (2008) Funda-
mentals of HIV/AIDS Education. Signon Publishers.
2. Barry D. S. (1999) AIDS and HIV in Perspectives. CPU.
ISBN-13: 9780521627665
JJ II 3. Ellison G. Parker M., Camphpbell C (2003) Learning from
J I HIV and AIDS. Cambridge CPU.ISBN-13: 9780521709286.
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 TDH 1100 Introduction to HIV/AIDs
4. Shavitri Ramaiah (2008) HIV/AIDS; Health solutions. Ster-
ling Publishers Ltd. ISBN-9788120733305.
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 TDH 1100 Introduction to HIV/AIDs
Solutions to Exercises
Exercise 1. Having vaginal, anal, or oral sex without a con-
dom with someone who is HIV positive. Sharing needle, sy-
ringes or other drug injecting equipment with someone who is
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infected with HIV. An HIV positive mother to her baby during

pregnancy, delivery or while breastfeeding. Blood transfusions,
blood products or organ transplants in countries where screening
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is not mandatory or common practice. Tattooing and/or pierc-

ing with improperly sterilized equipment. Sharing drug snorting
equipment e.g. cocaine straws. A needle stick injury involving
blood tainted with HIV. Exercise 1

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