HIV/AIDS Module for Degree Students

MODULE TITLE: KCAU 001: HIV/AIDS
FOR DEGREE STUDENTS
By Catherine Wangechi Mungai
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Table of Contents
MODULE TITLE: KCAU 001: HIV/AIDS--------------------------------------------------------------ix
COURSE OUTLINE----------------------------------------------------------------------------------------xi
LECTURE ONE: INTRODUCTION TO HIV/AIDS------------------------------------------------1
1.1 Introduction-----------------------------------------------------------------------------------------------1
1.2 Specific Objectives---------------------------------------------------------------------------------------1
1.3 Introduction to Hiv/Aids---------------------------------------------------------------------------------1
1.3.1 Basic Concepts------------------------------------------------------------------------------------------1
1.3.2 The Immune System-----------------------------------------------------------------------------------2
1.3.3The Course of Hiv/Aids--------------------------------------------------------------------------------2
1.3.4 The Stages of Hiv/Aids---Symptoms and Phases of Hiv/Aids-----------------------------------3
1.3.5Myths of Hiv/Aids--------------------------------------------------------------------------------------8
1.3.6 Modes of Transmission--------------------------------------------------------------------------------9
1.3.7 Factors fueling the spread of Hiv/Aids------------------------------------------------------------10
1.4 Activities-------------------------------------------------------------------------------------------------15
1.5 Self Test Questions--------------------------------------------------------------------------------------15
1.6 Summary-------------------------------------------------------------------------------------------------15
1.7 Suggestion for further reading-------------------------------------------------------------------------16
LECTURE TWO: THE IMPACT OF HIV/AIDS TO BUSINESS------------------------------17
2.1 Introduction----------------------------------------------------------------------------------------------17
2.2 Specific Objectives--------------------------------------------------------------------------------------17
2.3 Impact of Hiv/Aids in general-------------------------------------------------------------------------17
2.3.1 Impact on Agriculture--------------------------------------------------------------------------------18
2.3.2 Impact on Health-------------------------------------------------------------------------------------18
2.3.3 Impact on House Holds------------------------------------------------------------------------------19
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2.3.4 Impact on Children-----------------------------------------------------------------------------------19
2.3.5 Impact on Business----------------------------------------------------------------------------------20
2.4 Activities------------------------------------------------------------------------------------------------22
2.5 Self Test Questions------------------------------------------------------------------------------------23
2.6 Summary------------------------------------------------------------------------------------------------23
2.7 Suggestions for further reading----------------------------------------------------------------------23
LECTURE THREE: HIV/AIDS IN THE ACADEMIC COMMUNITY----------------------24
3.1 Introduction---------------------------------------------------------------------------------------------24
3.2 Specific Objectives-------------------------------------------------------------------------------------24
3.3 Causes of Hiv/Aids in the academic community---------------------------------------------------24
3.4 Effects of Hiv/Aids in the Academic community--------------------------------------------------25
3.4.1 Negative Effects--------------------------------------------------------------------------------------25
3.4.2 Positive Effects----------------------------------------------------------------------------------------25
3.5 Barriers to School attendance--------------------------------------------------------------------------26
3.6 Activities-------------------------------------------------------------------------------------------------27
3.7 Self Test Questions-------------------------------------------------------------------------------------28
3.8 Summary-------------------------------------------------------------------------------------------------28
3.9Sugggestion for further reading------------------------------------------------------------------------28
LECTURE FOUR:THE ROLE OF ACADEMICIANS IN FIGHTING HIV/AIDS--------29
4.1 Introduction----------------------------------------------------------------------------------------------29
4.3 General role of academicians in the fight against Hiv/Aids---------------------------------------29
4.4 Activities-------------------------------------------------------------------------------------------------32
4.5 Self Test Questions-----------------------------------------------------------------------------------32
4.6 Summary------------------------------------------------------------------------------------------------32
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LECTURE FIVE: PRACTICAL CASES ABOUT THE CONSEQUENSES OF HIV/AIDS

IN LEADERSHIP--------33
5.1 Introduction---------------------------------------------------------------------------------------------33
5.3 The role of poor leadership in the spread of the pandemic----------------------------------------33
5.3.1 The role of leaders in fighting Hiv/Aids-----------------------------------------------------------33
5.4 Relationship between Hiv/Aids and Leadership----------------------------------------------------34
5.4.1 International Leadership-----------------------------------------------------------------------------34
5.4.2 Local leadership---------------------------------------------------------------------------------------34
5.4.3Religious leadership-----------------------------------------------------------------------------------35
5.4.4Cultural leadership------------------------------------------------------------------------------------36
5.4.5 Family leadership-------------------------------------------------------------------------------------36
5.5 Activities-------------------------------------------------------------------------------------------------37
5.7 Summary-------------------------------------------------------------------------------------------------37
5.8 Suggestion for further reading-------------------------------------------------------------------------37
LECTURE SIX: HOW TO AVOID HIV/AIDS---------------------------------------------------------38
6.1 Introduction----------------------------------------------------------------------------------------------38
6.3 Hiv/Aids prevention in Kenya------------------------------------------------------------------------38
6.3.1 Government policies on Hiv/Aids-----------------------------------------------------------------39
6.3.3 Injecting drug users-----------------------------------------------------------------------------------40
6.3.4 Condom use--------------------------------------------------------------------------------------------40
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6.3.4.1 Facts Opinions and rumors on condom use----------------------------------------------------41
6.3.4.2 Facts about condom use--------------------------------------------------------------------------41
6.3.4.3 Procedure for condom use------------------------------------------------------------------------41
6.3.5 Prevention of Mother to Child Transmission-----------------------------------------------------42
6.3.6 Prevention of STIs------------------------------------------------------------------------------------42
6.3.7 Male Circumcision------------------------------------------------------------------------------------43
6.4 Summary-------------------------------------------------------------------------------------------------44
6.4.1 A general summary on how to avoid Hiv/Aids---------------------------------------------------45
6.5 Activities------------------------------------------------------------------------------------------------48
6.7 Summary-------------------------------------------------------------------------------------------------48
6.8 Suggestion for further reading------------------------------------------------------------------------49
LECTURE SEVEN: STRATEGIES TO MANAGE YOURSELF INCASE YOU ARE THE

PERSON LIVING WITH HIV/AIDS------------------------------------------------------------------50
7.1 Introduction----------------------------------------------------------------------------------------------50
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7.3 Basic monitoring and management of Hiv/Aids----------------------------------------------------50
7.4 What makes a healthy diet for a person living with Hiv/Aids-------------------------------------51
7.5 Habits that improve wellness--------------------------------------------------------------------------53
7.5.1 Personal Hygiene--------------------------------------------------------------------------------------53
7.5.2 Sanitation in communities---------------------------------------------------------------------------53
7.5.3Nutrition---------------------------------------------------------------------------------------------53
7.5.4 Recreation-------------------------------------------------------------------------------------------53
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7.6 Communicable Diseases-----------------------------------------------------------------------------54
7.7 Activities------------------------------------------------------------------------------------------------54
7.8 Self Test Questions------------------------------------------------------------------------------------54
7.9 Summary-------------------------------------------------------------------------------------------------54
7.10 Suggestion for further reading-----------------------------------------------------------------------54
LECTURE EIGHT: LIVING WORKING AND ASSISTING THE PEOPLE LIVING

WITH HIV/AIDS-------------------------------------------------------------------------------------------55
8.1 Introduction---------------------------------------------------------------------------------------------------55
8.2 Specific Objectives------------------------------------------------------------------------------------------55
8.3 Tips on offering your support------------------------------------------------------------------------------55
8.4 Home Based Care-------------------------------------------------------------------------------------------56
8.4.1 Who provides Home Based Care/Their roles ---------------------------------------------------------58
8.4.2 Home Based Care Kits-----------------------------------------------------------------------------------59
8.4.3 Problems with Home Bases Care----------------------------------------------------------------------59

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8.5 Attitudes towards people living with Hiv/Aids---------------------------------------------------------60
8.6 Needs of the people living with Hiv/Aids---------------------------------------------------------------61
8.7 What people with Hiv/Aids can do to stay healthy and live longer---------------------------------62
8.8 Palliative care------------------------------------------------------------------------------------------------64
8.8.1 How definitions for palliative care differ--------------------------------------------------------------64
8.8.2 What is supportive care----------------------------------------------------------------------------------64
8.8.3 What is end of life ----------------------------------------------------------------------------------------65
8.9 Activities---------------------------------------------------------------------------------------------------66
8.11 Summary-------------------------------------------------------------------------------------------------66
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8.12 Suggestions for further reading------------------------------------------------------------------------66
LECTURE NINE: MANAGE YOUR FAMILY TO AVOID HIV/AIDS----------------------67

9.1 Introduction------------------------------------------------------------------------------------------------67
9.2Specific Objectives----------------------------------------------------------------------------------------67
9.3 How can one manage his family to avoid Hiv/Aids-------------------------------------------------67
9.4 Communication information and Hiv/Aids-------------------------------------------------------------68
9.5 Hiv/Aids counselling---------------------------------------------------------------------------------------69
9.5.1 Pre-test counselling--------------------------------------------------------------------------------------69
9.5.2 Testing-----------------------------------------------------------------------------------------------------69
9.5.3 Post test counselling--------------------------------------------------------------------------------------70
9.5.4 Who should receive V.C.T------------------------------------------------------------------------------70
9.5.5 Who should provide VCT--------------------------------------------------------------------------------70
9.5.6 On -going counselling-----------------------------------------------------------------------------------70
9.5.7 Other types of Hiv Tests--------------------------------------------------------------------------------71
9.6 Skills in counselling the infected and the affected--------------------------------------------------71
9.6.1 Counselling Children-------------------------------------------------------------------------------------71
9.6.2 Counselling adults-----------------------------------------------------------------------------------------72
9.7 Effective communication of issues related to Hiv/Aids in the community------------------------72
9.8. Activities-----------------------------------------------------------------------------------------------------73
9.9 Self Test Questions----------------------------------------------------------------------------------------73
9.10 Summary----------------------------------------------------------------------------------------------------74
9.11Suggestion for further reading----------------------------------------------------------------------------74
LECTURE TEN: HAVING A PERSONAL IMPACT IN THE FIGHT AGAINST THE

PANDEMIC/GENDER CONCEPTS IN HIV/AIDS ISSUES---------------------------------------75
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10.1Introduction--------------------------------------------------------------------------------------------------75
10.2 Specific Objectives----------------------------------------------------------------------------------------75
10.3 How can one have a personal impact in the fight against Hiv/Aids-------------------------------75
10.4 Concept of gender in Hiv/Aids---------------------------------------------------------------------------76
10.4.1The role of women in fighting Hiv/Aids--------------------------------------------------------------76
10.4.2The role of men in fighting Hiv/Aids------------------------------------------------------------------76
10.5 Women vulnerability----------------------------------------------------------------------------------77

10.5.1General summary on Women vulnerability-----------------------------------------------------------
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10.6 Groups most affected by Hiv/Aids----------------------------------------------------------------------78
10.6.1Factors contributing the their vulnerability----------------------------------------------------------79
10.7 Stigma and Hiv/Aids-------------------------------------------------------------------------------------79
10.7.1 Negative attitudes directed at people living with Hiv/Aids---------------------------------------79
10.7.2 Direct Effects of stigma-------------------------------------------------------------------------------79
10.7.3 Reasons for stigma-------------------------------------------------------------------------------------79
10.7.4 How to fight stigma by individuals,govts/NGOs--------------------------------------------------80
10.8 Activities----------------------------------------------------------------------------------------------------81
10.9 Self Test Questions----------------------------------------------------------------------------------------81
10.10 Summary-------------------------------------------------------------------------------------------------81
MODULE TITLE: KCAU 001: HIV/AIDS
INTRODUCTION
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Welcome to this module of Hiv/Aids. The purpose of this module is to help you gain new skills
and knowledge on how you can help fight this pandemic. It would not be in order for you to
spend your hard earned resources as well as so many years in school only to end up dying from a
pandemic that together we can help eradicate. Statistics in Kenya indicate that out of every five
people one of them is infected, so count five from where you may be now and consider one of
them as a person living with Hiv/Aids and that there are 1500 new infections every day. Is this
situation the same for your country? We also have to be very open as we study this course. “A
story is shared of a grandma who had been visited by her grandchildren and they were excited
about climbing trees in the village. She called the girls and told them that it was wrong for girls
to climb on top of trees because the boys would see their panties and so the girls removed the
panties and went back to the trees. When grandma came back and was furious with the girls she
was led to under the pillows where the panties were safely hidden and the boys had not seen
them” So if we use shortcuts in discussing Hiv/Aids issues, we may end up in the same position
as this grand ma..How about name tags used for PLWHIV/AIDS…The
Sick,Wagonjwa,Victims,Sufferers etc. I guess we should fight stigma from the word go and
appreciate that this are no lesser human beings just because they are living with Hiv/Aids.
You will also realize that with the knowledge that you will acquire from this unit, you will be
able to identify people among you that could be infected with the virus. My advice is that we
shall not make diagnosis for people. The only sure way that you can tell that a person has HIV is
through a blood test.
The examination will be (70% exams and 30% CAT) 0.5 or as prescribed in
other examination rules.
This is a half module as it is combined with Information Literacy Module.
Main Objectives
By the end of this unit you should be able to
(i)Explain the meaning of Hiv/Aids
(ii)Explain the facts, myths and other practices that promote the spread of Hiv/Aids
(iii)Describe the impact of Hiv/Aids to business and other sectors
(iv)Describe the modes of transmission for Hiv/Aids
(v)Discuss the general role of academicians in fighting Hiv/Aids
(vi)Discuss risk reduction in Leadership

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(vii)Explain ways in which we can avoid getting infected with Hiv/Aids
(viii)Describe management strategies in Hiv/Aids (Self, family and others)
Recommended Readings
Kalipeni E., Craddock S., Oppong J.R. and Ghosh J. eds., (2004): HIV and AIDS in Africa:
Beyond Epidemiology. Blackwell, Oxford.
Kenya Ministry of Health (2004). Challenges facing the Kenyan health workforce in the era of
HIV/AIDS
Kenya National AIDS Control Council (NACC) (2005): Kenya HIV/AIDS Data Booklet.
National AIDS Control Council, Nairobi.
Koch T., (2005) Cartographies of Disease: Maps, Mapping, and Medicine. ESRI Press,
California.
Lee-Smith D. and Lamba D., (1998): Good Governance and Urban Development in Nairobi.
Mazingira Institute, Nairobi.
National AIDS and STI Control Programme (NASCOP)/ Ministry of Health, (2005): AIDS in
Kenya: Trends, Intervention and Impact, 7th ed. NASCOP, Nairobi.
COURSE OUTLINE
Course Code: KCAU 001
Course Title: HIV/AIDS
Main Objective: To impart knowledge to students about the impact of HIV/AIDS in business
performance and how this can be avoided.
Contents:
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1. Introduction to HIV/AIDS
2. The effect of HIV/AIDS to Business
3. HIV/AIDS in the academic community
4. The Role of academicians in fighting against Hiv/Aids
5. Practical cases about the consequences of HIV/AIDS in leadership
6. How to avoid HIV/AIDS
7. Strategies to manage yourself in case you are the victim (Living with HIV/AIDS) and
make a significant contribution to the Economy.
8. Living, working & assisting the victims of HIV/AIDS
9. Manage your Family to avoid Hiv/Aids
10. Having a personal impact on the fight against HIV/AIDS
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LECTURE ONE: INTRODUCTION TO HIV/AIDS
1.1 Introduction
Welcome to the lecture on introduction to Hiv/Aids. We shall begin the study of this lesson by
understanding the meaning of the two concepts.
1.2 Specific Objectives
By the end of this unit you should be able to:

i. Know the meaning of HIV and AIDS
ii. Outline the Stages of HIV/AIDS.
iii. Outline the Symptoms and Phases of HIV Infection
iv. Establish the myths of HIV/AIDS
v. Know the Modes of Transmission of HIV/AIDS
vi Outline the Factors Fueling the Spread of HIV/AIDS
1.3 Introduction to Hiv/Aids
1.3.1 Basic concepts
a)Meaning of HIV
HIV stands for Human Immuno Deficiency Virus that causes AIDS.
A blood test can determine whether a person is infected with HIV but if a person tests positive
for HIV it does not necessarily mean that person has AIDS.
A diagnosis of AIDS is made by a physician according to the CDC AIDS case definition. A
person infected with HIV may receive an AIDS diagnosis after developing one of the CDC
defined AIDS indicator illness.
A person with HIV can also receive an AIDS diagnosis on the basis of certain blood test (CD4
Counts) and may not have experienced any serious illness.
Viral infections occur when viruses attach to and penetrate cells.
Viruses target specific cell types which are identified and distinguished by the protein located on
the surface of the cell. Different cells display different proteins which are attractive to different
viruses. In the case of HIV, T-helper cells and Macrophages are the main cell types targeted by
the virus. T-helper cells and microphages are key players in the human immune system.
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b) Meaning of AIDS
AIDS stands for Acquired Immuno Deficiency Syndrome. Over time infection with HIV can
weaken the immune system to the point that the system has difficult fighting off infections.
These infections are usually controlled by a healthy immune system but they can cause problems
or even be life threatening in someone with AIDS. The immune system of a person with
HIV/AIDS has weakened to the point that medical intervention may be necessary to prevent or
treat serious illnesses.
 AIDS is the disease caused by HIV that is characterized by the weakening of the immune
system which leaves the body ill equipped to fight diseases.
 A person may live with HIV for up to 10 years before developing AIDS.
 The definition of AIDS is determined by a CD4 cell below 200 cells per cubic millimeter
(200mm3).
 AIDS eventually leads to death due to the development of an opportunistic infection (i.e.
Viral, bacterial and fungal infections) or cancers.
 Without treatment AIDS can be rapid within an year of diagnosis.
 There is still no cure or complete remedy for AIDS but the disease can be managed with
antiretroviral treatment (ARVs).
1.3.2 The Immune System

The immune system is the body’s defense mechanism against all kinds of infections (e.g. Viral,
Bacterial or Fungal) foreign bodies (e.g. Pollen allergies) and other factors that cause diseases.
The destruction of the immune system is particularly devastating as it renders the person unable
to fight off infections and other non communicable diseases.
HIV/AIDS initially gained attention in early 1980’s when clusters of young men developed
unusual diseases such as Karposis Sarcoma and Pneumocystis Cavinii Pneumonia which were
unusual for this population.
1.3.3 The Course of HIV/AIDS

HIV binds the T-helper cells (CD4 cells) CD4+ proteins and co-receptors which are located on
the surface of the T-cells. Once the virus attaches to this protein, it can enter the cell.
Once inside, the cell disintegrates, uses the cells own machinery to produce viral protein and re-
assembles.
When the new virus exits the T-helper cell most (but not all) host cells are killed-ruptured as the
virus is released.
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In addition to T-helper cells HIV targets macrophages and T-memory cells. These cells and some
T-helper cells are infected with HIV but not killed. These cells harbor viral particles which use
the cells to generate more viruses that are dispatched to infect other cells in effect becoming
virus producing factories.
NB: Macrophages engulf foreign substances and microbes and are part of the immune systems
first line of defense against infection.
Generally the engulfed substance is destroyed but HIV lodges in the cell and remains dormant
for several years.
T-memory cells ‘remember’ past infections resulting in a more rapid response if a foreign body
such as a virus or bacteria is re-introduced into the body.
This process allows for the “latent” or asymptomatic state of infection which copies of the virus
infect cells but the viral load is at un-detectably low levels.
This asymptomatic state can last for several years.
HIV like other viruses is able to mutate. In particular the proteins on HIV virus and HIV viral
envelope (outside coat) have a high mutation rate and can even mutate over a short time within
an individual. These mutations make it easier for the virus to erode the immune system.
1.3.4 Stages of HIV/AIDS: Symptoms and Phases of HIV Infection

HIV/AIDS is often called the silent epidemic due to its very long incubation period meaning that
a person can be infected for many years without showing any symptoms.
An HIV +ve person may not really know he/she is infected and unknowingly also infect other
people through unprotected sexual intercourse.
Phases of Infection
Although HIV infection can theoretically be divided into different phases, it’s important to note
that HIV infection can not in practice precisely be demarcated into separate and distinct phases
with easily identifiable boundaries.
The health of a HIV +ve person will depend on the health of his/her immune system (on CD4
cell count and viral load in the blood) as well as the exposure to infections and disease in the
environment.
It is not possible to say exactly what symptoms and diseases will be associated with HIV
infection. However HIV infection can theoretically be divided into the following stages / phases.
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 The primary HIV infection phase (window stage, acute, sero-conversion illness).
 The asymptomatic, latent stage, silent phase
 The symptomatic phase and opportunistic diseases.(minor and major)
 AIDs defining conditions (The severe symptomatic phase)
a)Phase I: Primary Phase
The primary phase of HIV infection also called acute, sero-conversion phase begins as soon as
sero-conversion has taken place.
Sero-conversion means the point and time when a persons HIV status converts from being HIV –
ve to HIV +ve.
This also usually coincides with the time when an HIV antibody test will show that a person is
HIV +ve.
Sero-conversion usually occurs 4-8 weeks after an individual has been infected with the HIV
virus. About 30-60% of people affected with HIV develop flu-like symptoms such as:-
 Sore throat
 Headache
 Mild fever
 Fatigue
 Muscle and joint pains
 Swelling of the lymph nodes
 Skin Rashes
 Occasionally (oral) ulcers.
These symptoms usually last from between 1-2 weeks. HIV reproduces quickly in the body and a
person that is infected with HIV is always able to pass HIV to someone else.
However there is always a window period when a person has HIV but test cannot show it.
b) Phase II: The Asymptomatic Phase/ Latent Phase/Silent Phase
In this stage an infected person displays no symptoms. Infected individuals are often not even
aware that they are carrying the HIV virus in this stage and may therefore, unwillingly infect
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others. Even though the infected person may be ignorant of its presence, the virus remains active
in the body during this stage and it continues to damage its immune system.
A +ve HIV antibody test is the only indication of HIV infection during this phase.
HIV infected people can remain healthy for a long time, show no symptoms and carry on their
work in a normal way.
Some people remain HIV positive for many years without any manifestation of clinical disease
while others may deteriorate rapidly, develop AIDS and die within months.
In some cases the only symptom during this phase is swollen nymph nodes.
c) Phase III: The Symptomatic Phase:
Minor Symptoms
In the third phase of infection minor and early symptoms of HIV disease usually begin to
manifest.
This phase usually starts when people with HIV antibodies begin to present with one or more of
the following symptoms:-
 Mild-moderate swelling of the lymph nodes in the neck, armpits and groin.
 Occasional fevers
 Shingles (Herpes zoster)
 Skin rashes and nail infections
 Sores in the mouth that come and go
 Re-current upper respiratory tract infection.
 Weight loss of up to 15% of the person’s usual body weight.
What is shingles?
It’s a viral infection that is caused by the same virus that causes chicken pox. In the days before
the HIV/AIDS pandemic shingles used to be seen only in the older people or in those who had
weakened immune system. Nowadays shingles is very common in people with HIV /AIDS and is
even seen in young people.
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It is one of the 1st symptoms of HIV infection. Shingles affect nerve cells and its characterized by
an extremely painful skin rash or tiny blisters on the face, limbs or body. It can also affect the
eyes causing pain and blurred vision.
Major Symptoms/Opportunistic Infections
Major symptoms and opportunistic diseases begin to appear as the immune system begins to
deteriorate.
At this point the CD4 cell count becomes very low while the viral load becomes very high.
The following symptoms are indication of advanced immune deficiency.
 Oral and vaginal thrush infections which are very persistent and recurrent (Candida)
 Recurrent herpes infections such as cold sores (herpes simplex)
 Recurrent herpes zoster (shingles)
 Bacterial skin infections and skin rashes.
 Fever for more than a month.
 Night sweats
 Persistent diarrhea for more than a month.
 Weight loss of more than 10% of the usual body weight
 Abdominal discomfort, headaches.
 Persistent cough and reactivation of T.B
 Thickened white patches on the side of the tongue.
 Opportunistic diseases of various kinds.
d) Phase IV: Aids Defining Conditions/ The Severe Symptomatic Phase / Full Blown
Stage/Advanced HIV
Only when patients enter the last stage of HIV infection can they be said to have full blown
AIDS.
It usually takes about 18 months for the major symptomatic stage to develop to AIDS.
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In the final stage of AIDS the symptoms of HIV disease become more serious, patients become
infected by relatively rare or unusual organisms that do not respond to antibiotic, the immune
system deteriorates and more persistent and if left untreated opportunistic conditions and cancer
begin to manifest.
The AIDS patient in the final phase is usually plagued by many of the following problems:-
 The AIDS patient is usually very thin and emaciated due to continuous diarrhea, nausea
and vomiting.
 Conditions in the mouth e.g. thrush and sores may become very painful that the patient is
no longer able to eat.
 Women suffer from persistent recurrent vaginal infections and cervical cancer.
 Severe skin infections and ringworms
 Respiratory infections ,persistent cough, chest pain and fever
 Pneumonia
 Herpes zoster which is severe
 Nervous system problem often complaining of pain, numbness or “pins and needles’ in
the hands and feet.
 Neurological abnormalities with symptoms such as memory loss,
 Poor concentration, tremor, headache, confusion, loss of vision and seizures.
 Aids patients may develop infections in the central nervous system or the brain.
 Kaposis Sarcoma or a rare form of skin cancer.
 Cancer of the lymph nodes.
 Tuberculosis
 Sexually Transmitted Diseases
1.3.5 Myths of HIV/AIDS

A myth is a belief which is not true. Also known as misconception.
Some of the misconceptions that exist are:-
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1. Sexual intercourse with a virgin cures AIDS. Sex with a virgin who is not infected will
not cure an HIV infected person but will spread the disease.
2. Sexual intercourse with an animal cures AIDS. No proof that HIV will be cured by sexual
contact with an animal, but this practice may lead to many health risks.
3. HIV antibody testing is not reliable. Antibody testing is an established investigation and
carries more than 90% sensitivity and specificity. This investigation is extremely useful.
4. HIV spreads through casual contact with an HIV infected person. HIV infection cannot
spread through shaking hands, hugging, sharing the toilet; it can’t even be spread through
coughing or sneezing.
5. HIV does not transmit through oral sex. Both of the persons who either receive or insert
orally are at risk of contracting HIV. The risk increases with frequency of oral sex.
6. Only sharing hypodermic needles with patients of HIV will spread infection. Previously
contaminated hypodermic needles can spread HIV. Even some preparations can lead to
HIV spread.
7. HIV can be spread or transmitted by a mosquito bite. Mosquitoes never transfer the blood
from one patient to another but due to their saliva many other infections can occur.
8. Bathing after intercourse will not spread HIV. HIV and AIDS have no relation with the
bathing. HIV can not survive in air.
9. HIV survives at room temperature outside the body for many hours and for weeks if used
in syringes. Hiv cannot survive for long in air
10. HIV infects homosexual men and drug users only. Unnatural practices carry more risk
but HIV is also spread through other ways.
11. An HIV+ lady will not have children. HIV Infected women are fertile but have a higher
risk of miscarriage. Risk of transmission of HIV to the child is also there.
12. HIV will not lead to AIDS as there is a vigorous antibody response to the virus. Even
after antibodies the disease can progress which is evident in various diseases.
13. Few CD4 cells are infected by HIV. Polymerase chain reaction has demonstrated that
large proportion of CD4 cells are infected than what was thought previously.
14. AIDS originated after human male had sexual intercourse with African monkeys. It is
believed that animals have SIV and it can’t mix with HIV
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15. In Africa AIDS is a new name of old diseases. The disease associated with AIDS in
Africa include wasting syndrome, diarrhea and tuberculosis which lead to death of the
individuals but in HIV patients with these infections are due to decreased immunity.
16. HIV is not the cause of AIDS. There are many documented proofs that HIV leads to
AIDs but still some group of scientists are not in favour of this theory.
17. Antiretroviral drugs cause AIDs not HIV. Most of the patients having HIV have not
received any ARV drugs. ARV and ARV therapy increases the mean survival in patients.
18. Drug use and multiple sexual partners lead to AIDS and not HIV. These kinds of
activities had been there for many decades but at that time there was no AIDS.
19. Blood transfusion (HIV +ve) never leads to AIDS, It’s due to underlying diseases. Many
studies have proved that HIV infected blood transfusion will lead to HIV infection
20. HIV does not lead to AIDS as few women are sufferers. As the disease started in gay
males and also it is more prevalent among the IV drug users so women are a bit spared
but there is no distinction by the virus.
21. HIV is not the cause of AIDS as many HIV +ve have not developed AIDS. After HIV
infection it may take more than 10 years to develop AIDS.
1.3.6 Modes of Transmission of HIV/AIDS
a) HIV is spread through the exchange of body fluids, primarily semen, blood and blood
products. The commonest mode of spread is by sexual contact with an infected person. The virus
is present in sexual secretions of infected men and women and gain access to the blood stream of
an infected person by ways of small injuries that may occur as a consequence of sexual
intercourse.
b) HIV is also spread by any sharing of needles or syringes that resulted from direct exposure to
the blood of an infected individual. This method of exposure occurs most commonly among
people abusing interveneous (IV) drugs ie (drugs injected into the veins).
c) HIV transmission through blood transfusion or use of blood clotting factors is now extremely
rare because of extensive screening of the blood supply. HIV is present in fewer than 1 in
450,000 to 600,000 units of blood.
d)HIV can be transmitted from an infected mother to her baby either before or during child birth
or through breast feeding. Although only 25-35% of babies born to HIV infected mothers
become infected, this mode of transmission accounts for 90% all cases of HIV/AIDS in children.
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e)In the health care setting workers have been infected with HIV after being stung with needles
containing HIV infected blood or less frequently, after infected blood contacts the workers open
cut or splashes into a membrane (e.g. eyes or the inside of the nose).
In general infected health care workers pose no risk to their patients. There is also no risk of
contracting HIV infection while donating blood.
The roots of HIV transmission are well known but unfounded fear continues concerning the
potential for transmission by other means, such as casual contact in a household, school, work
place or food service setting. No scientific evidence to support any of these fears has been found.
HIV does not survive well when exposed to the environment.
Additionally HIV is unable to reproduce outside its living host; therefore it does not spread or
maintain infectiousness outside its host.
No cases of HIV transmission through the air by casual contact or even by kissing an infected
individual have been documented.
However practices that increase the likelihood of contact with the blood of an infected individual
such as open-mouth kissing or sharing tooth brushes or razors should be avoided.
1.3.7 Factors Fueling the Spread of HIV/AIDS

a)Social economic status
The relationship between poverty and HIV/AIDS is bidirectional in that poverty is a key factor in
the transmission, and HIV/AIDS can impoverish people in such a way as to intensify the
epidemic itself. Poverty leads to poor nutrition which weakens the immune system making poor
populations more susceptible to infectious diseases such as TB e.t.c
In addition people affected with HIV are likely to fall into poverty due to lack of work and the
high cost of treatment because of their reproductive role and their place in the society; African
women suffer the greatest burden of HIV.
Poverty stricken people focus more on their daily survival than their health which makes them to
engage in risky behaviors including prostitution.
Many young women become sexually involved with numerous friends or clients in exchange of
financial support.
The preference of HIV throughout Africa is consistently higher among prostitutes compared with
the general population.
b) Culture and traditional practices

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Polygamy
In Africa polygamy is a social practice used to ensure continued status and survival of widows
and orphans within an established family structure. In urban settings and other areas where
traditional polygamy is no longer renowned men tend to have many sexual partners and employ
the services of sex workers. Men who have two or more wives were at a high risk of engaging
extra marital sex reinforcing the believe that men are biologically programmed to need sexual
intercourse with many women.
Also putting young girls at risk of contracting HIV is the false believe that men can rid
themselves of HIV/AIDS by engaging in intercourse with a virgin.
As a result of this misconception, many young girls have been raped and subsequently infected
with HIV.
Widow Inheritance
In many African countries, a man’s property including his wife passes to his adult sons or
brothers after his death.
The fate of African widows ranges from disinheritance, deprivation of property to servants of
harmful rituals and practices whereby the widow agrees to marry her husband’s younger brother
to continue as a family, widow inheritance e.t.c
In case of refusal she is expelled and left to care for her children alone. If a man died of AIDS
and had infected his wives the younger brothers will in turn become infected.
However a younger brother may be HIV infected and upon marrying his deceased brother’s wife
he will infect her.
Female Genital Mutilation (FGM)
Commonly called female circumcision involves the partial or complete removal of the external
female genitalia.
This practice carried out in many African and Middle Eastern countries for cultural reasons
leaves behind abdominal scaring.
Female circumcision as a contributing factor to HIV was identified.
Male Circumcision
Data from Africa shows that countries in which fewer than 20% of males are circumcised e.g.
Zimbabwe, Botswana and Zambia experience a high preference of HIV infection whereas in
11
countries in which 80% of men are circumcised e.g. Cameroon, Gabon and Ghana have a lower
preference of HIV infection.
Why uncircumcised men are at high risk of contracting Hiv
 The foreskin contains a high density of angerhans cells (prime target for
sexual HIV transmission) compared with cervical, vaginal or rectal
mucosa.
 Second the foreskin increases the risk for ulcerative STDs which facilitate
the transmission of HIV.
 The susceptibility of the foreskin epithelia to rapture during intercourse

may transmit HIV infection.
 The moisture and temperature under the foreskin may promote micro-
organism survival and lubrication.
 A circumcised penis develops a layer of keratin that minimizes the risk of

HIV transmission.
Dry sex
Dry sex has several meanings.
It may refer to the sexual rubbing and motion of two bodies; whereby no male fluids enter the
vagina, anus or mouth. For the purpose of this article, however, is the drying and / or tightening
of the vagina using various methods of douching and, or application of caustic leaf concoctions,
powders or household detergents to absorb vaginal lubricants. The main purpose of dry sex is to
increase friction during sex enhancing the male’s experience. These practices are destructive and
costly in terms of women health.
The destruction of the vagina’s natural flora facilitates the proliferation of other potential
harmful micro organisms.
The lack of lubrication results in lacerations of the epithelial lining of the vaginal creates a portal
for HIV entry. In addition condoms can break easily due to increased friction exposing the
woman to STD’s. The common methods of dry sex were drinking porridge, the suspension
believed to cause dryness in the vagina, removing vaginal secretion with a cloth and placing
caustic leaves in the vagina.
Drugs and Alcohol Abuse
12
Injection drug use between men and women is by far the most common mode of HIV
transmission; however the significance of intravenous drug abuse tends to be higher than
commonly believed.
Alcohol consumption reduces a person’s ability to make informed choices concerning safer sex
and protection from the HIV infection.
War and Armed Conflicts
Relationship between AIDS and Armed conflict is mutually reinforcing.
Armed conflict destroys economic and social infrastructures resulting in massive internal
displacement of people, loss of livelihood, separation of families, collapse of health and
education services and dramatic increase of instances of rape and prostitution
Labour and Migration
While preference of HIV differs among countries in Africa and within those countries the
infection rates are usually higher in urban areas.
HIV infections in rural areas most of them come from urban sources, and migration has been
determined to be a principal risk factor, change of residence has been found to be associated with
an increased HIV infection. In the rural population and to result in more risky social behaviors
among those who move.
Migration disrupts social constraints on and control of sexual behavior.
The fact that married people travel without their spouses increases their risk for extramarital sex
with commercial sex workers who have much higher rates of HIV infection than the general
adult population.
Military personnel, transport workers, mine workers, construction workers, Agricultural farm
workers, informal traders, domestic workers and refugees are most vulnerable groups.
Men, Culture and HIV/AIDS
Men are influenced by cultural norms regarding manhood, some of which are very negative in
the context of HIV.
For social, cultural and economic reasons men are often in a stronger position in their
relationships with women. This gives them more control in deciding when and where to have
sex, As well as whether or not to use condoms.
Because of their position men can be good advocates for behavioral change and social
responsibilities.
13
Attitudes that encourage multiple sexual partners and risk taking put them and their partners at a
high risk of HIV infection.
Discrimination against or hostility towards men who have sex with men also promote HIV
transmission. Safer sex messages can be difficult to communicate to the community. Talking
about sex and reality of one’s HIV status is often difficult for both men and women. In most
cultures boys and men have more sexual partners than do girls and women. Many cultures and
religions give more freedom to men than to women e.g. in many cultures it is normal and
sometimes encouraged for young men to experiment sex before marriage.
Also in others it is considered acceptable for men including the married men to have sex with
commercial sex workers.
This cultural attitudes lead to HIV infection in both men and women.
14
1.4 Activities
1.Explain the meaning of Hiv/Aids
2.Identify some modes of transmission for Hiv/Aids
1.5 Self-Test Questions

a)Define Hiv/Aids
b)What’s the impact of Hiv/Aids on Households
c)Explain the effects of Hiv/Aids on the immune system
d)What is the role of culture in the spread of Hiv/Aids
e)Outline three misconceptions about Hiv/Aids
1.6 Summary
In this lecture you have learnt that:
1.Hiv and Aids are two very different concepts
2.The battle against the pandemic starts with you and the time for that is now.
15
1.7 Suggestion for further reading
HIV/AIDS
California
16
LECTURE TWO: THE IMPACT OF HIV/AIDS TO BUSINESS
2.1 Introduction
Welcome to the lecture on the impact of Hiv/Aids to Business. This is an interesting topic in the
area of Hiv/Aids since business is a very broad term. It covers all aspects of our lives in terms of
health, education, agriculture children and households.
2.2Specific Objectives
At the end of this lecture you should be able to:

i) Establish the Impact of HIV/AIDS on the agricultural sector
17
ii) Establish the Impact of HIV/AIDS on the health sector
iii) Establish the Impact of HIV/AIDS on the household
iv) Establish the Impact of HIV/AIDS on children
v) Establish the Impact of HIV/AIDS to business
2.3 The Impact of HIV/AIDS in General

Over the past 28 years nearly 30 billion people have died of HIV/AIDS.
HIV/AIDS causes debilitating illness and pre-mature death in people during their primary years
of life and has devastated families and communities.
Further HIV/AIDS has complicated efforts to fight poverty, improve health and promote
development by:-
a) Diminishing a person’s ability to support, work and provide for his/her family. At the same
time treatment and health care cost relating to HIV/AIDS consume household income. The
combined effect of reduced income and increased cost impoverishes individuals and
households.
b) Deepening socioeconomic and gender disparities. Women are at high risk of infections and
have few options in sex related issues; they also have to provide for their children.
c) Children affected by HIV/AIDS are less likely to receive an education as they leave school to
care for ailing parents and younger siblings.
d) Straining the resources of communities. Hospitals, social services, schools and businesses.
Health care workers, teachers and business and government leaders have been lost to
HIV/AIDS. The impact of diminished productivity is fact on National scale.
2.3.1 The Impact of HIV/AIDS on the Agricultural Sector

The impacts of HIV/AIDS on Agrarian system depends on the structure on the farm sector
(especially the small holder sector) the labour intensiveness of the farming system. The adverse
effects of HIV/AIDS on Agricultural and rural development are manifested primarily as loss of
labour supply, on and off farm income and of assets. This can contribute to reduced productivity,
yields and Agricultural outputs.
Factors determining the sensitivity of agriculture to labour loss resulting from AIDS include:-
 The seasonality of demand for labour
 The degree of specialization by sex and age
 The interdependency of labour inputs
18
 Economies of scale in labour
 The substitutability of labour saving technologies.
The combined loss of labour income and assets is likely to decrease food nutrition and food
security, poverty, undermined resilience and reversibility of household coping mechanism
among some household in the long term.
Further the magnitude of the scale of the Eastern and Southern Africa is contributing to a number
of structural changes in the small holder sector including:-
a) Long term changes in farming system as household cultivation shifts from cash crops to
subsistence crops and from labour intensive to labour extensive but often also less
nutritious crops.
This change in cropping pattern is unlikely to reverse itself given the heavy investments
required in terms of labour, cash and time, all of which are in short supply in households
affected by HIV/AIDS.
b) Changes in the age structure and quality of skilled and unskilled agricultural labour. In
view of the growing number of elderly people, children and women who are becoming
responsible for on and off farm tasks previously performed by men.
c) These structural changes in small holder agriculture are likely to contribute to increased
malnutrition and overall decline in the nutritional status of a growing number people with
far reaching consequences for the health and productivity of agricultural labour force.
2.3.2 Impact of HIV/AIDS on the Health Sector

In all heavily affected countries the HIV/AIDS epidemic is adding pressure on the health sector.
As the epidemic matures, the demand for care for those living with HIV rises, as does the toll of
AIDS on health workers.
The direct medical cost of AIDS (excluding antiretroviral therapy) increase. As the HIV
preference of a country rises the strain placed on its hospitals is likely to increase. E.g. In sub-
Saharan Africa, people with HIV related diseases occupy more that ½ of all hospital beds.
HIV positive patients stay in hospital 4 times longer than other patients.
Hospitals are struggling to cope especially in poor African countries where even the spaces
available are often too hard to get. This shortage results in people being admitted only in later
stages when they are wasted by the illness, reducing the high chances of recovery.
Another reason why AIDS is causing an increased demand for health services is because a large
number of health care professionals are also being directly affected by the virus Health care
19
workers are also already scarce in Africa. Although the recent increase in the provision of ARV
which significantly delay the progression from HIV to AIDS has brought hope to many in
Africa.
It has also put increased strain on health care workers; providing ARV (Antiretroviral) treatment
to everyone who needs it, requires more time and training that is currently not available in most
countries.
2.3.3 Impact of HIV/AIDS on Household

The toll of HIV/AIDS on household is very severe. Although no part of the population is
unaffected by HIV, it is often the poorest sectors of society that are most vulnerable to the
epidemic and for our home the consequences are most severe.
In many cases the presence of AIDS causes the households to dissolve as parents die and
children are sent to relatives for care and upbringing.
Much happens before this resolution takes place. AIDS strips families of their assets and income
earners further impoverishing the poor.
1. Household income
2. Basic necessities
3. Food production
4. Health care expenses
5. Funeral costs
2.3.4 Impact of HIV/AIDS on Children

It is hard to over emphasize the trauma and hardship that children affected by HIV/AIDS are
forced to bear. The epidemic not only causes children to lose their parents and guardian but
sometimes their childhood as well.
As parents and family members become ill children take on more responsibility to earn an
income, produce food and core for family members.
It’s harder for these children to access adequate nutrition, basic health care, housing and
clothing.
Fewer families have the money to send their children to school. Usually both parents are HIV
positive, and consequently more children are now being raised by their grandparents or left on
their own in child-headed household.
As projections of the number of AIDS orphans raises some have called for an increase in
institutional care for children.
20
However this solution is not only detrimental to the children but also for society which is ill-
equipped to cope with an influx of young adults who have not been socialized in the community
they are supposed to live in.
The way forward in prevention
1) It is crucial to prevent children from becoming infected with HIV at an early stage as
well as later in life.
2) If efforts are made to prevent adults from becoming infected with HIV and care for those
already infected, then fewer children will be orphans in the future.
2.3.5 The Effect of HIV/AIDS to Business

 Increasingly, businesses are becoming aware of the impact HIV/AIDS will have on their
profitability. In some cases, it is an awareness that is long overdue. In sub-saharan Africa
for example 1 in 12 workers is infected.
 Initially businesses viewed the HIV/AIDS pandemic as a medical issue that concerned
only the so called ‘high risk’ groups.
 Now, however, it has become a much broader threat to communities, businesses and the
economy. Those affected include women, children, agricultural and industrial workers,
technicians and civil servants at all levels.
 Direct costs on business impacts on insurance, retirement funds, health and safety,
medical insurance recruitment costs for new staff, advertising and training, funeral costs
etc.
 Indirect costs include absenteeism, staff churn, loss of skills, loss of tacit knowledge, and
a decline in worker morale. All these add up to loss in productivity and disorganization of
work.
 A typical timeline study of how the pandemic affects a business workforce would follow
this pattern:
0 – 7 years: Workers are outwardly healthy and fully productive: no cost to

company.
7 – 9 years: Illness begins to manifest itself in some workers. Company begins
to incur costs associated with illness.
9 – 10 years: Employees leave or begin to die: Company incurs end of service
costs.
10+ years: Company incurs recruitment, training costs, suffers loss of
efficiency and productivity, as new workers “get up to speed”
The effects on the sectors of the economy are of particular concern because the combined
characteristics of the epidemic adversely affect the economic activity in countries with high
21
prevalence of HIV. The extra burden placed on both households, organizations, firms etc. slowly
but surely undermine domestic economic performance.
 Where a worker might not be HIV+ if one of the family members is, this will almost
certainly impact on the worker. Concerns about the family member, costs to the worker
and hence lower morale, preoccupation with family issues, absenteeism as a result of
having to attend to family members needs etc. impacts on the workers productivity.
o Labour Supply: Workers dying in their most productive years. Younger,

less experienced workers replace experienced workers reducing productivity
which results in decline in international competitiveness.
o Profitability: It increases the cost of production and decreases the productivity of
African workers. These in turn affects the competitive advantage.
 As the epidemic progresses, managers may observe an increase of diseases such as TB,
STIs, skin rashes, diarrhea, etc in the workforce. These increase health care costs and sick
days.
 Some companies have had to resort to hiring highly paid expatriates following the death
of senior managers in cases where suitable replacements are not readily available.
 Absenteeism results in extra work for other healthy employees who have to stand in for
their sick colleagues. So more has to be paid for overtime on overworked and exhausted
workers.
 Stress from overworked workers leads to a decline in both quality and quantity of the
final product.
 Worsening labor relations occur where employees do not feel that their employers are
providing adequate prevention or care services, the relationship may degenerate.
 In some cases workers demand the dismissal of their colleagues on learning of their
colleague’s illness. HIV/AIDS is likely to trigger certain attitudes and behavioral
responses toward colleagues.
 HIV/AIDS can result in significant decline in the demand for some products. Families
spend less on ‘luxury’ goods and direct the money available to products considered as
basic to human needs.
 HIV/AIDS also impacts on national economies for investors seldom invest in countries
with declining economies.
Conclusion
The spread of HIV/AIDS has resulted in the loss of profitability among African
companies. The loss is attributable to increased expenditures on benefits such as health
22
care, sick leave, and death benefits as well as to the additional cost of retraining new
employees.
Revenues have been shown to decline when many workers become infected and their
productivity declines.
There is also decline in morale, labor relations and demand for company’s products, with
the HIV/AIDS experience.
Lost profitability discourages foreign investments.
2.4 Activities
1.Write short notes on the impact of Hiv/Aids to Business
2.Outline five ways in which the education sector is indirectly affected by the pandemic
3.Write some ways in which the agricultural sector would suffer if the elderly people were left to
do farming on their own
23
24
2.5 Self Test Questions
1. Which area according to you has suffered the greatest blow in Hiv/Aids impact. Explain your
reasons for this
2.Give reasons why children must be protected from the impacts of Hiv/Aids
2.6 Summary
In this Lecture you have learnt that
1.All areas have been affected in the area of Hiv/Aids
2. Everyone has a role to play in fighting the pandemic so that the impact is minimized
3.That the impact of Hiv/Aids in different sectors is intertwined

National AIDS and STI Control Programme (NASCOP)/ Ministry of Health, (2005): AIDS in
Kenya: Trends, Intervention and Impact, 7th ed. NASCOP, Nairobi.
LECTURE THREE: HIV/AIDS IN THE ACADEMIC COMMUNITY

3.1 Introduction
25
Welcome to the lecture on the Academic Community. You will enjoy this lecture because it
provides an opportunity for you to start looking at yourself as a very important part of the change
that is required. As members of the group that has benefitted from knowledge and education, you
have the role of helping others who may not have been put on board. An academic community is
a group of people who have benefited from education; they understand what it is, can apply the
knowledge gained, make use of the knowledge positively and benefit others in the society. The
benefits could be ethical and other values such as honesty, respect for others, and fairness and
disseminating information to those who may not have similar knowledge. The members of the
academic community therefore make unique contributions to the communities surrounding them.

i) Outline the causes of HIV/AIDS in the academic community
ii) Outline the Effects of HIV/AIDS in the academic community
iii) Establish the barriers to school attendance
3.3 Causes of HIV/AIDS in the Academic Community

 Ignorance about status/lack of awareness/
 Drug abuse/peer influence/immorality
 Lack of parental guidance/African way of socialization
 Failing to use protection/infidelity
 Stigma/cultural influence/cultural vices like rape and myths
 Technology/role of men and women/lifestyle diseases
3.4 The Effects of HIV/AIDS in the Academic Community
3.4.1 Negative Effects

 Psychological pain-having to bury brains
26
 Living in denial/deaths/stigma/retaliation/reduced life expectancy
 School dropout rates/child labour/orphans/lack of enrollment in schools
 All sectors affected like agriculture, health, education, households and business
 Diversion of resources/reduced productivity/overburdened caregivers
 New infections reported in the medical world/lack of proper medical care
 Moral degradation/separation
3.4.2 Positive Effects

 New researchers joining the field
 Creation of jobs
 Behaviour change/avoidance of hard drugs
 Manufacturing companies
 NGO’s that offer employment
 Infrastructure has improved
The relationship between HIV/AIDS and the education sector is circular. As the epidemic
worsens the education sector is damaged which in turn is likely to increase the incidence of HIV
transmission.
There are numerous ways in which HIV/AIDS can affect the academic community, but equally
there are many ways in which education can help to fight against HIV/AIDS.
The extent to which academic communities like schools and other education institutions are able
to continue functioning will influence how well the society eventually recovers from the
epidemic. A decline in school enrolment is the most visible effect of the epidemic.
This in itself will have an effect on HIV prevention as a good basic education ranks among the
most effective and cost effective means of preventing HIV.
3.5 Barriers to School Attendance

There are numerous barriers to school attendance.
Children may be removed from school to care for their parents/family members.
27
They may themselves be living with HIV.
Many are unable to afford school fees and other expenses.
This is particularly a problem among children who have lost their parents in AIDS, who often
struggle to generate income. Studies have suggested that young people with little or no education
are twice as likely to contract HIV as those who have completed primary education.
In this context the devastating effect that AIDS is having in the academic community especially
school enrollment is of great concern. Studies have indicated some regions that did not enroll in
lower primary schools and colleges. This translates to increased ignorance which is itself a factor
that fuels the spread of the virus.
It is also having a devastating effect on the already inadequate supply of teachers.
Teachers who are affected by HIV are likely to spend long periods of time off work, either
dealing with illness or other side effects of drugs.
Those with sick family members may also take time off to attend funerals or care for the sick or
dying relatives.
When a teacher falls ill the class may be taken on by another teacher, may be combined with
another class, or may be left untaught.
Even when there is sufficient supply of teachers, replacing the lost one can have a significant
impact on students.
The illness or death of teachers is especially devastating in areas where schools depend on only
one or two teachers or just a few teachers.
Students may be psychologically and emotionally affected by the loss of a teacher and this has
been known to impact negatively on their results. Moreover, skilled teachers are not easily
replaced.
Conclusion
Through its impact on the labour force, household and enterprises AIDS has played a significant
role in the reversal of human development more than any other single factor. One aspect of this
28
development reversal has been the damage that the epidemic has done to the economy, which in
turn has made it difficult to respond to the crisis.
One way in which AIDS affects the economy is by reducing the labour supply through increased
mortality and illness. The academic community which plays a significant role in the reversal of
things has not been spared and government policies aimed at arresting the situation before it
blows out of control would come in handy.
3.6 Activities
1.Discuss Three ways in which one becomes a member of the academic community
2.Explain how members of the academic community can be of benefit to other members of the
community
ANSWER a) Through Education, Training, Knowledge,

b) Read paragraph 4
29
a) Differentiate between an academic community and a religious community.
3.8 Summary
1.The members of the academic community have not been spared by Hiv/Aids
2.The effects of Hiv/Aids in the Academic community are both positive and negative
3.What causes Hiv/Aids in the academic community is not unusual, it affects other people
outside the community as well
3.9 Suggestion for further readings

HIV/AIDS
California
30
LECTURE FOUR : THE ROLE OF ACADEMICIANS IN FIGHTING HIV/AIDS
4.1 Introduction
An academician is a member of the academic community who has not only benefited from
education but has also gone further to specialize in a certain field through research. It is
important to mention that those in the academic field have a very big role to play in the fight
against the pandemic since ignorance, education, empowerment and poverty; and the spread of
the virus are all intertwined.

i) Establish the roles of academicians in fighting HIV/AIDS
4.3 General role of academicians
 Education so far has worked as the single most successful approach in dealing with the
pandemic and academicians must take the frontline in all areas, supporting government
policies geared towards fighting the scourge, and initiating new ones,
 Working with NGOS and COUNCILS in this field and also imparting proper values in
their areas of work after training.
 They should also empower others with any information gained in their course of training
especially on behavior change and intervention.
 Academicians should prepare Strategic Plans for the government going beyond the
existing ones based on the Millennium Development Goals, assessing progress at all
levels and writing comprehensive reports on the same, they should also monitor feedback
and raise the alarm where necessary.
31
 Academicians should also strive to bring about change at all levels and in all their areas
of placement. This may include the church, schools, work place etc using their
knowledge to empower others especially where stigma still exists as an impediment. In
such cases, they may organize for
 Workshops and seminars where people benefit from exchanging knowledge and
information.
 The academicians have the noble duty of funding HIV/AIDS related

programmes/projects in areas where funding stands as the only available option in
fighting the scourge. Such funding should be with no strings attached but they can help
write proposals on behalf of ignorant members in situations where donor funding may be
available through such an approach.
 The noble approach touches also on the amount of extra time that has to be put aside to
deal with HIV/AIDS issues.
 They should be willing to venture where others have not reached and initiating
benchmarking and outsourcing approaches. It is important to observe that there are
regions that have been sidelined due to their geographical locations yet such populations
still need to be knowledgeable about the virus.
 Academicians should also be involved with research work in all areas, both in medicine
and vaccines and they should have the final word in the direction that the virus will take.
 Academicians should be role models in behavior change especially among the youth, this
is because the society looks upon those in learning institutions to bring about positive
progress in all dimensions
 Voluntary work has been seen to be a sister approach in the area of HIV /AIDS.
Academicians should go for such initiatives as a leisure gear; working with home based
care givers, sharing knowledge and support and health care workers.
32
 They should also work with programmes that deal with OVC and women in the field of
HIV/AIDS, helping in training and intervening where possible. They should do advocacy
lobbying where necessary especially in gender issues.
 Academicians already in the workplace should campaign for policies that do not only
favor the infected but also the affected.eg medical covers, overtime, easy access to staff
leave and job protection.
 Policies that place travel bans for the infected should be done away with in areas where
academicians are to be found.
 Compulsory testing for interviewees and those seeking promotions and employment
should be on the front pages of the academician’s notepad condemning it at all costs.
 Academicians should also encourage follow up programmes for members of staff who
may be absent from work because of sickness or those who may have been terminated or
retired on medical grounds.
 They should also come up with voluntary support group programmes for infected
colleagues, offering training and support. In the absence of such programmes members of
staff live in denial. Denial ranks very highly as a factor fueling the spread of the virus.
Support groups also help people to come out of their cages and start living positively.
 Academicians in the workplace should work towards community outreach programmes

as part of their CSR. In such cases everyone should be put on board regardless of their
age, gender, political, cultural religious backgrounds and social and economic status.
33
4.4 Activities
1.Distinguish between an academician and a member of the academic community
2.Name a few academicians that you know in your region
3.How is their impact being felt by the people within this region

1. Do you consider yourself an academician? My guess is that you do. Explain the role you can
play in fighting the pandemic.
4.6 Summary
In this lecture have you have learnt that:
1.As an academician, there is so much that you can do to help fight the pandemic
2.That the society expects you to do a lot of research in the pandemic
3.That you do not have to do big things to fight the pandemic, even just reaching out to the
people next to you can go a long way in helping fight the pandemic
4.7 Suggestions for further readings

HIV/AIDS
California
34
LECTURER FIVE: PRACTICAL CASES ABOUT THE CONSEQUENSES OF HIV/AIDS
IN LEADERSHIP
5.1 Introduction
Welcome to the lecture on leadership and Hiv/Aids. A leader is someone who is responsible for
or in control of a group, an organization or even a country. Leadership refers to the position of
being a leader. Leadership resides in everyone and can therefore be encouraged and developed.
There is a close relationship between HIV/AIDS and leadership. The scourge of HIV/AIDS is
greatly undermining development in countries. Leaders are therefore called for greater
commitment and will, in the fight against the pandemic.

i) Establish the Role of poor leadership in the fight against HIV/AIDS
ii) Establish the Role of leaders in fighting HIV/AIDS
iii) Establish the Relationship between HIV/AIDS and leadership
The following are important in dealing with leadership issues in the area of HIV/AIDS
5.3 Role of poor leadership in the spread of HIV/AIDS

 lack of commitment in implementation of policies
 lack of mobilization
 sensitization not well planned
 leaders have not protected the vulnerable populations
 little time is devoted
 lack of proper funding in the area of HIV/AIDS/corruption
5.3.1 Role of leaders in fighting HIV/AIDS

 The leaders should be role models
 They should initiate projects in Hiv/Aids
 The leaders should support existing programmes on HIV/AIDS
 There should be an all rounded leadership approach i.e. political, religious,
organizational, institutional, community and family leaders
 Leaders should look for global partnership in the fight i.e., work together with the G8
nations, participate in the World Aids Day and work with international leaders and bodies
 The leaders should support consolidated systems such as education, testing and
sensitization
35
 Leaders should be involved in research
 Leaders should fight cultures that fuel the spread of HIV/AIDS and strengthen existing
cultures aimed at prevention
5.4 Relationship between HIV/AIDS and leadership
5.4.1 International leadership

Despite HIV/AIDS being a great scourge, the world as not given it the attention it deserves.
Other pandemics such as terrorism, human rights and hunger have received greater attention.
However, there have been significant interventions by the international community:
1. Funding of HIV/AIDs prevention, awareness and testing programmes and provision of

Anti Retro Viral drugs (ARVs) by organizations such as UNAIDS, Clinton Foundation,
Bill and Merida Gates Foundation and others.
2. Low and middle income countries especially in Africa bear the heaviest burden of
HIV/AIDS cases and face the most challenges in delivering prevention and care
programs. African Presidents during the Abuja Declaration on HIV/AIDS, Tuberculosis
and other related infections decided to:
 Consider AIDS as a state of Emergency in the continent

 Strengthen and develop special youth programmes to ensure an AIDS free generation.
 Document and share the successful and positive experiences with a view to sustaining
and scaling them up for wider coverage.
3. Declaration of a World AIDS day (1st December annually)
During this day, AIDS awareness, prevention and management campaigns are held
throughout the world.
4. International leaders openly discussing HIV/AIDs matters and emphasizing the need for
concerted efforts to fight the scourge eg UN Secretary General (Ban Ki Moon) and
former president of South Africa (Nelson Mandela)
International leaders have a moral obligation to ensure that resources are equitably
distributed globally, review terms of trade in order to alleviate poverty in the developing
countries which are more prone to HIV/AIDS. This is because majority of citizens in
these countries cannot afford basic preventive and curative medicines.
5.4.2 Local leadership

Although political will has not always translated into concrete action, local leaders have
contributed positively to the fight against AIDS in the following ways:
 Provision of free ARVs and voluntary testing centers (VCT).
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 Promoting male circumcision
 Legislation - passing laws and establishing policies that help fight HIV/AIDs eg
criminalizing willful infection and national AIDs policy
 Plans are at an advanced stage to build a condoms production factory in Thika by the
government
5.4.3 Religious leadership

HIV/AIDS is a threat to the family life and spiritual wellbeing. It is also a threat to the
growth of the community and human dignity. Every religious community is living with
HIV/AIDS. Religious leaders are in a unique position to alter the course of the pandemic.
They can use the trust and authority they have in their communities to:
 Shape social values
 Promote responsible behavior
 Increase public knowledge and influence opinion
 Hold special prayers, sermons and guided meditations and quotations from sacred and
philosophical texts to support people and give them strength.
 Be tactful and compassionate. Be careful not to offend, exclude or further stigma
 Be accurate and clear. Speak openly and honestly about the transmission of HIV using
scientific facts that are widely available and about treatment and care of those living with
HIV/AIDS.
 Avoid condemnation. Condemnation reinforces fear, denial and indifference. Explore any
personal prejudices and work towards speaking about HIV/AIDS in a non judgmental
way
 Strive not to impose value judgments. Use of words like ‘AIDS victim’ and ‘AIDS
sufferer’ indicate hopelessness and increase stigma while use of phrases like ‘person
living with HIV’ emphasize life and hope.
 Some churches make it mandatory for people to undergo testing before they are wedded.
5.4.4 Cultural leadership

Cultural leaders are an influential voice in the community in that they can promote good
morals and discipline hence indirectly contributing to reduction in spread of HIV/AIDs.
However, the impact created by their interventions is not easy to measure.
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5.4.5 Family leadership
HIV/AIDS affects men and women differently, arising from differential infection rates and
cultural values and norms, including early marriage, stereotypes, gender roles and power
relations that impose a disproportionate burden of care and nurturing on women. On the other
hand, men’s behavior and attitudes drive the HIV/AIDS epidemic. Men have more sexual
partners than women, which mean more opportunity to transmit the virus to others. Men also
tend to decide the circumstances and form of sexual intercourse and exploitative
intergenerational sexual relationships, which are largely fuelled by poverty. Leaders in most
spheres of life are men. Therefore men should also take up the leadership role in families.
They should be role models, stop gender violence and take care of their families. They
should provide for their families, support their wives, and protect their children from harmful
practices such as early marriages.
5.5 Activities
1.Define Leadership
2.What do we mean by poor leadership
2.Who should be considered as leaders in the community
5.6 Self-Test-Questions
1.What is the relationship between Hiv/Aids and Leadership
2.Give yourself leadership ratings. What is your score in an out of 10 scale?
5.7 Summary
1.Leadership resides in everyone and therefore you are a leader that can be depended on in
fighting the pandemic
2.The combined efforts of institutional, religious, family and self leadership are crucial in
fighting the pandemic
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5.8 Suggestions for further reading
HIV/AIDS
LECTURE SIX: HOW TO AVOID HIV/AIDS
6.1 Introduction
Welcome to one of the most interesting lecture in this unit. The prevention of Hiv/Aids is the
most fundamental approach in the fight against the pandemic. There are several concepts to be
understood in this lecture in regard to avoiding getting infected with the virus.

i) Know how to prevent and control HIV/AIDS
ii) Outline and Explain the various HIV/AIDS prevention methods
6.3 HIV Prevention in Kenya

Prevention and Control of HIV/AIDS
Sexual behavior is the most important determination of the spread of HIV and survey shows that
generally men have more sexual partners than women.
As the preference of HIV infection increases in the general population a higher number of people
particularly women become infected. Often these are married women whose husbands have had
unprotected sexual relations outside marriage.
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The mainstream measure aimed at stopping the sexual transmission of HIV such as using
condoms consistently and correctly, sexual abstinence and access to appropriate treatment for
STD’s are not effective by themselves alone, especially in developing countries.
Preventive measures should be implemented in combination with empowerment; so that

everyone is able to control their lives particularly women, and also including them in decision
making in reproductive and sexual matters.
6.3.1 Government Policies on HIV/AIDS Prevention

A principal aim of 2005/2006 to 2009/2010-2011 Kenya National HIV and Strategic -Plan is to
reduce the number of new HIV infections by using new, evidence based approaches to HIV
prevention. The main prevention strategies outlined in the plan include:-
 Increasing availability and access to counseling and testing
 Condom promotion
 Strengthening STD and HIV programme linkages.
 Expanding services to prevent mother to child transmission (PMCT)
 Ensuring more effective and targeted behavior change communication
 Promoting abstinence safe sex and delayed sex debate among young people.
 Improve availability of safe blood supplies.
 Ensure injection safety and expand access to post exposure prophylaxis and universal
precautions.eg use of gloves in all cases
 Ensure mutually supporting prevention and treatment effort
 Encourage empowerment by all means possible including compulsory training at all
levels both in learning institutions and at the work place
 Encourage specific testing for target groups attending government institutions e.g.
those being treated for STIS, pregnant mothers, and those seeking family planning
services. Testing is also compulsory for under 18 year olds being treated for malaria
and T.B
6.3.2 Blood Transfusion Safety

Blood is neither a commercial product nor can it be synthesized artificially.
The responsibility to ensuring its continuous supply rests with the health administrators who
need proper governance, the entire community etc towards regular and non-limited blood
donations. WHOs strategy for safe blood recommends the following integrated strategy for
health nationally.
 Establishment of a well organized blood transfusion which can provide
adequate and timely supply of safe blood for all patients in need.
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 Collection of blood only from voluntary and unpaid blood donors at low
risk of acquiring transmissible infections and stricken donor selection
criteria.
 Testing of all donated blood for transmissible diseases, blood groups and
compatibility.
 Maximum use of donated blood and enable the provision of therapeutic
support for patients with special transfusion requirements.
 Appropriate clinical use of blood and the use of alternatives where
possible to minimize unnecessary transfusion.
 Safe transfusion practices at the bedside.
NB: Unfortunately blood is also a potent vehicle for the transmission of various micro-
organisms. Use of unscreened blood has the potential for infecting recipients with lethal
infections like HIV/AIDS, Hepatitis B and C and many others.
6.3.3. Injecting Drug Users

Several countries have reported significant numbers of people who inject drugs, and also
engaging in Commercial Sex Work. Data shows that HIV positive people who inject drugs are
infecting their sexual partners through hetero-sexual route and subsequently to their children.
Although a major route of HIV transmission, HIV/AIDS among injecting drug users remains a
neglected issue.
Evidence shows that HIV/AIDS epidemic among injecting drug users can be prevented slowed,
stopped and even reversed. How can it be done?
 Information, Education and communication
 Peer counseling and education
 Drug use treatment
 Needle and syringe exchange programme
 Substitution treatment
 HIV testing and counseling
 Access to HIV care, support and antiretroviral treatment (ARVs)
6.3.4. Condom Use

 Persuading people at risk of HIV to use condoms is one of the primary strategies of AIDS
prevention programmes throughout the world.
 It is scientifically undisputed that the transmission of HIV and STDs/STI’s during sexual
intercourse can be prevented when male condoms are used correctly and consistently.
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 The female condom should also protect against HIV/AIDS but more research is needed to
confirm this.
 Most condom programmes target high risk groups such as truck drivers, military personnel
and those at commercial sex establishments
 Such efforts to increase condom use have reduced infection rates in a few notable cases
especially in the 100% condom campaign among sexually active populations in Thailand.
 Consistent sustained use of condoms require behavioral changes, condoms are being used to
encourage behavior change. Increased condom use may be a primary strategy for reducing
the spread of all STI’s and HIV.
 Increasing condom use will require more government, religious as well as a cultural
approval, increased availability of condom, more information, increased skills on negotiating
for condom use, more promotion and better and more focused counseling.
6.3.4.1 Facts, Opinions and rumors on Condom use

 Sex with a condom is not real sex.
 Condoms prevent STI’s and HIV
 Condoms always burst
 Condoms get lost inside a woman.
 Condoms prevent pregnancy
 Condoms are laced with HIV
 Condoms mean you are unfaithful
 Putting condoms on is sensual
 Condoms are only for use with a casual partner
 Female condoms are uncomfortable
 Sex is not pleasurable with a condom
 Lubricated condoms feel good.
 Condoms are embarrassing
 Condoms are too expensive
 Condoms are for sex workers
 Condoms cause irritation and pain
 With condoms you do not feel close to your partner.
 Condoms are unnecessary in a stable relationship.
6.3.4.2 Facts about condom use

 HIV cannot leak through a condom.
 Condoms don’t eliminate sensation although they may change the sensation
 Female condoms come in one size.
 No penis is too big/small for a condom,
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 Almost all condoms are lubricated. If extra lubrication is required use water soluble
lubricant e.g. KY jelly so as not to break the condom.
6.3.4.3 Procedure for using a condom

 Check the expiry date or date of manufacture
 Discuss condom use with your partner.
 Have condom with you
 Have an erection
 Open condom wrapper carefully
 Squeeze air out from the tip of the condom
 Roll condom on erect penis all the way down to the base.
 Have intercourse
 Hugging and fondling
 Ejaculation
 Withdraw penis from partner, holding on to condom at base.
 Be careful not to spill semen
 Remove condom from penis
 Hugging and fondling
 Penis gets soft
 Throw condom away where children cannot find it
 Open another condom.
6.3.5 Prevention of Mother to Child Transmission
Mother to child transmission (MTCT) of HIV is the vertical transmission of HIV from an
infected mother to her infant. Prevention of MTCT aims to reduce this risk of HIV transmission.
A comprehensive approach is needed to prevent HIV transmission in infants.
There are 4 elements to the comprehensive approach to PMTCT include:

 Primary prevention of HIV infection
 Prevention of intended pregnancies in HIV infected women.
 Prevention of HIV transmission from women infected with HIV to their infants.
 Provision of treatment, care and support to HIV infected women, their infants and their
families.
Without interventions the risk of MTCT is high. WHO is supporting comprehensive reproductive
health programs targeting women of child bearing age. This will help protect intended
pregnancies in HIV infected women.
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HIV infected mothers will be encouraged to attend antenatal care clinics for counseling and
testing and receive preventive antiretroviral therapy and adopt safer infant feeding practices.
6.3.6 Prevention of S.T.I’s
STI’s are a major global cause of acute illness, infertility, long-term disability and death among
both men and women but particularly women.
The WHO estimated that 340,000,000 new cases of syphilis, gonorrhea, Chlamydia, etc, have
occurred globally in 1999 in men and women aged 15-49 years.
STI’s enhance the sexual transmission of HIV infection in particular ulcerative STI’s.
The presence of untreated STI can increase the risk of both acquisition and transmission of the
HIV.
STI prevention and control are therefore a potential HIV prevention strategy.
The following are important components of STI control that are adopted by many countries:
 Information education and communication strategies to improve awareness on STI
treatment seeking behavior and promote condom use.
 Integration of STI treatment services into primary health care.
 Improved case management of STI.
 Screening and presumptive
 Targeted interventions to population with high risk behaviors.
 STI surveillance including laboratory surveillance and data management.
NB: WHO is working towards reducing the incident of curable sexually transmitted infection
e.g. syphilis, Gonorrhea, Chlamydia and trychonomiasis by screening and treating those affected
to reduce the incidence of HIV transmission.
6.3.7 Male Circumcision

In light of substantial evidence showing that male circumcision significantly reduces a man risk
of acquiring HIV during hetero sexual intercourse, the Kenyan AIDS/STDS control program has
developed a policy on male circumcision. The aim of the policy is to reduce the number of new
HIV infections in order to help create an AIDS free generation.
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Around 150 thousand male circumcisions per year for 5 years will need to be performed in order
for Kenya to reach its target. In many districts of Kenya circumcision is a cultural process.
Voluntary medical male circumcision programs were therefore concentrated in those districts
which did not hold these cultural practices.
Rates of circumcision increased from 10,000 to 90,000 in just over a year in 2009 which
although substantial, it still remains short of policy aims.
Increasing circumcision among older, sexually active men has been identified as critical if HIV
infection is to be reduced among this group.
6.4 Summary
Prevention involves:-
 Safer sex practices
 Drug use and limiting HIV exposure
 Minimizing HIV exposure from medical exposure.
Complete sexual abstinence as a full prove way to prevent sexually transmitted HIV.
A monogamous sexual relationship between two uninfected individuals also limits the risk of
HIV exposure through sex – as long as both partners are completely faithful.
Experts caution that oil-based lubricants should never be used with latex condoms or the other
latex barrier for this may erode the material and erode the barrier as well. Recommended condom
compatible lubricants are water-based eg KY jelly.
Sexual activities that do not involve contact with blood or other bodily fluids such as hugging
dry or closed mouth kissing and use non shared sex toys are considered safe programs that
distribute clean needles to injecting drug users have helped and lowered the incident of HIV
infection among this people.
HIV has been transmitted through transfusion of contaminated blood and blood components.
However blood banks have added new safe guards to their procedures to ensure that donated
blood does not present an HIV risk. Today the risk of acquiring HIV infection from blood
transfusion is extremely small; people who are scheduling elective surgery can reduce the risk
even further by banking some of their own blood before the surgery.
Dentist, Hygienist and other health care professionals are required to wear protective latex gloves
to avoid the transmission of viral infections such as HIV.
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6.4.1 A General Summary/ HOW TO AVOID HIV/AIDS
a) Abstain from Sex
Any sexual activity that would give you contact with someone’s vaginal fluids, pre-seminal fluid
or semen is the most effective way of getting AIDS through sexual contact. Both pre-cum and
semen can contain high concentrations of HIV.
Scientists have discovered that a protein fragment found in human semen increases the
infectiousness of the HIV virus. More than 80 percent of (HIV) infections are transmitted via
sexual intercourse. And researchers may have discovered at least one reason why. A component
of human semen may facilitate the spread of the virus by targeting immune system cells, in some
cases making the pathogen up to 100,000 times more virulent.
b) Be Monogamous/Faithful
Having one sexual partner who is having sex with you can help prevent AIDS. Both partners
must have been tested and found to be negative for HIV. Retesting is necessary especially in the
window period.
c)Use an Appropriate Condom

This should be a latex or plastic (polyuthane) condom each time you have sex. This should
include oral sex, intercourse and any other sexual acts that give you potential contact with blood;
vaginal fluid, pre-seminal fluid .A new condom must be used all the time.
d)Use Water Based Lubricants

This are recommended than oil based lubricants during sexual activity. Oils can weaken the
condom
e) Avoid Aggressive Sexual Contact
This can cause small tears in the vagina, anus, rectum; such tears give the virus an opening into
the blood stream. Aggressive sex is also more likely to rupture the condom.
f) Do Not Share Needles

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This includes needles with illegal drug use and also the administration in contact with
prescription drugs at home .Do not engage in any activity that puts you into contact with
someone else’s blood.
g) Be Alert when Performing Health Care

A health care worker should follow protocol when dealing with needles or other sharp
instruments, wear gloves, goggles, a mask and other protective gear when anticipating contact
with blood or bodily fluids. Caregivers in the home should also avoid contact with blood or
bodily fluids of anyone who could have hiv/aids.
h) Avoid Sharing Personal Items

Avoid sharing items like toothbrushes and razors as they can contain traces of blood. Do not use
an item if you are not certain it is new or has been used only by you.
i) Seek Reputable Health & Personal Care

Seek reputable professionals for dental work, medical care, surgery, medical testing hair cutting
and tattooing. Your health is vulnerable unless workers use new disposable equipment and
appropriately disinfect their tools.
j). Avoid Breast Milk

Breast milk can contain HIV.You should not allow breast milk to come in contact with the
mucous membranes of your mouth or any open sores.
k). Pregnancy and Birth

If a mother is infected by one of these viruses, it is also possible for a child to contract them
while they are still in the uterus or during childbirth. A child being able to escape the womb of an
infected woman without being infected themselves is a miracle, but to contract it through
breastfeeding afterwards is simply heartbreaking.
l). Avoid Sharing Bodily Fluids

Though kissing is described as safe, always try to avoid any other exchange where foreign
substances are absorbed by the body through bodily fluids.
j). Get Tested, Get your Partner Tested

Don’t assume someone is telling the truth; make sure to get a person tested before having any
sexual contact with him/her. This is extremely important at the beginning of a relationship.
k). Circumcision and HIV

HIV prevalence is higher among uncircumcised men
The foreskin contains a high density of Angerhan cells (prime for sexual HIV target for sexual
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HIV transmission) compared with cervical, vaginal or rectal mucosa.
Second the foreskin increases the risk for ulcerative STDs which facilitate the transmission of
HIV
A circumcised penis develops a layer of keratin that minimizes the risk of HIV transmission etc
l) PMTCT of HIV
Ensuring that programmes reach women in need
WHO HIV/AIDS guidelines for PMTCT and BREASTFEEDING
If the HIV positive mother has access to formula milk, breasting feeding should be avoided all
together. The debate behind bottle milk and child health is very complex.
Formula milk may not be readily available in poor communities
Mothers may not have access to clean and safe water supplies wherewith to prepare the feed.
Mothers may not know how to sterilize bottles
Mothers may not know how to prepare the formula milk (ie what the correct powder-to water
ratio should be)
Mothers may be ignorant of the fact that they should use clean, boiled and cooled water for
formula feeding.
Some mothers may also not know that they will compromise the baby’s health if they add more
water (increase the water in the water-powder ratio in an attempt to save money, or to feed other
children.
m) Post- Exposure Prophylaxes (PEP)
This should be done in events of exposure e.g. rape, accidents etc

The Health Care Givers should have access to (PEP) all the time.
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6.5 Activities
1. Purchase a condom and see whether you can use it as described in the procedure studied in this
lecture.

1.Apart from the ABCS of Hiv/Aids name other ways in which you can avoid getting infected
with the virus
2.Explain why condom use is the most effective way of protecting ourselves from the pandemic
6.7 Summary
In this lecture you have learn that:
Since no vaccine for HIV is available the only way to prevent infection by the virus is to avoid
behaviors that place a person at risk for infection e.g. sharing needles and having unprotected
sex.
Prevention is the key to personal protection against HIV and AIDs. Being aware of behaviors
that increase the risk of infection and taking preventive measures can substantially reduce a
person’s likelihood of becoming infected with HIV.
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50
HIV/AIDS
California
51
LECTURE SEVEN: STRATEGIES TO MANAGE YOURSELF INCASE YOU ARE THE
VICTIM (LIVING WITH HIV/AIDS) AND MAKE A SIGNIFICANT CONTRIBUTION
TO THE ECONOMY
7.1 Introduction
Welcome to the lecture on strategies to manage yourself in case you are the person living with
Hiv/Aids and make a significant contribution to the economy

i) Conduct the basic management and monitoring of HIV infection
ii) Establish What Makes a Healthy/Good Diet for Person Living With HIV?
iii) Know the habits that improve wellness
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7.3 Basic Management and Monitoring Of HIV Infection
Once HIV infection is diagnosed a person has lifelong condition which will go through several
stages and has many consequences. The disease needs to be managed by people with HIV
themselves as well as their health care providers.
An overview of the needs of a person with HIV is as follows: - (Not necessarily in order of
priority)
 Education/information: Learning how to best take care of yourself, staying informed
about the new treatment or approaches.
 Maintaining general health – self care, nutrition
 Financial planning, medical needs, future provision for self and dependants
 Monitoring HIV disease. Regular medical check-ups, monitoring progress.
 Preventing opportunistic diseases by seeking early and immediate interventions.
 Avoiding exposure, alertness to early signs of disease, prophylactic medication.
 Psychological health. Informing others, dealing with stigma, spiritual support, managing
anxiety and depression.
 Sexual and reproductive health information
 Safer sex for partner and self, whether to have a baby, avoiding infection of the baby.
 Antiretroviral treatment (ARV)
 Terminal care: This is the Care and treatment during the final stages of the disease.
 A person with HIV should see a healthcare provider regularly even if you are fairly
well. These regular visits to the health care provider are important because they may lead
to some conditions being detected and treated.
Also it allows your care provider to start preventive treatments in good time. The physical
examination usually include:-
 Checking body weight
 Inspection of palpitation(heart beat)
 Skin, mouth and teeth
 Lymph nodes
 Genitals
 Abdomen
 Respiratory system
 Eyes etc
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7.4 What Makes a Healthy/Good Diet for Person Living With HIV?
It is good for everybody to eat regularly and to have a diet mixed well to make it balanced. This
is even more important for people with HIV. It means eating a variety of food each day including
fruits, vegetables, grains and nuts e.g. Bread, rice, sorghum, maize, cereal, sunflower, pumpkin
seeds etc and diary products e.g. milk, yoghurt, cheese.
The food requirements for people living with HIV are a little different with people without HIV.
The reason is that a person with HIV has got a constant infection which the body is dealing with
and it therefore needs more food and vitamins.
It is important to clean your food and cook it properly.
Meat should be well cooked. Drink only clean water and lots of it.
People living with HIV should avoid the following:
Too much sugar
Sugar encourages the growth of unhealthy fungus e.g. (Candida, thrush) on various areas of the
body. More than 20 teaspoons of sugar per day including sweets) and other foods rich in sugar
reduces the number of fighter cells in your body by ½ (half). This can cause severe health
problems such as severe weight loss, diarrhea, fatigue and outbreaks of infections.
Fried Food
It is very difficult for your stomach to digest fried food. It is even more difficult especially for a
person living with HIV. This can lead to stomach upsets and diarrhea.
Spicy food
Spicy food such as curry, peppers and chilies can irritate your stomach and cause diarrhea. You
can eat such foods but be careful not to eat too much of it.
As well as a balanced diet people living with HIV benefit from additional minerals and vitamins
to help their body fight the HIV virus.
Particularly important ones are Zinc, Selenium, vitamin A, vitamin C and vitamin B12, Vitamin
A- carrots.
Some of these you can get by eating particular foods e.g. Vitamin A- 3-4 carrots per day.
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There are several ways that proper nutrition can help HIV people remain healthy.
Fighting HIV
The ongoing presence of the virus means that the immune system must always be providing the
immune cells and chemicals required to fight it. Since those cells and chemicals are created from
nutrients, a steady supply is a must for the body’s contribution to viral control.
Protecting the body

Any damage to the body caused by HIV AIDS related infections and by the body’s immune
response to the infection must be repaired.
Nutrients are the actual building materials with which the body creates and repairs itself, so there
is an ongoing need for those materials.
Improving quality of life
Good nutrition is a must for feeling well. Optimal levels of nutrients are required for good
energy and overall well being and for the prevention or the management of many symptoms that
nutrient deficiencies can cause e.g. Appetite loss, skin problems or difficult in concentrating,
nerve damage, muscle cramps, depression, anxiety etc
In addition the presence of adequate levels of nutrients may actually prevent and reverse certain
drug side effects. Thus nutrients are an important tool for helping people to feel better and
maintain a higher quality of life.
Managing co-infections
Many HIV + people also have other chronic infections to deal with including hepatitis A and or
hepatitis B.
For people with HIV and hepatitis, co-infection may occur and proper nutrition is required since
the body must handle more than one chronic infection and have a particular need to support the
liver and prevent it from being damaged.
7.5 Habits That Improve Wellness
7.5.1 Personal Hygiene
Include bathing daily, washing and combing hair often, cutting nails, washing hands before
preparing any meals, washing hands after going to the latrine, brushing teeth after each meal and
before going to bed, washing bed sheets and clothing frequently.
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7.5.2 Sanitation in Communities
 Ventilate the house
 Dispose off waste matter properly
 Use a latrine
 Drink clean water
 Sweep and clean house
 Prevent mosquitoes from breeding around the areas of residents etc.
7.5.3 Nutrition
 Eat mixed meals
 Keep insects and pests away from food
 Store food in clean places
 Stop smoking or don’t smoke
 Drink alcohol in moderation or stop if on drugs.
7.5.4 Recreation
 Get adequate exercise
7.6 Communicable Disease
 Get children immunized
 Avoid close contact with other people when you are ill with communicable
infections.
 Seek medical care if you are sick.
7.7 Activities
1.Describe some tips on offering your support to a person living with Hiv/Aids

1.Describe a menu that you would recommend for a person living with Hiv/Aids
2.Explain what sublimation is in Hiv/Aids
7.9 Summary
In this lecture you have learnt
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1.Hiv/Aids care and management is essential for people living with the virus
2.Hiv/Aids does not make anyone a lesser person, with proper care and management, one can
be assured of a complete life.

HIV/AIDS.
57
LECTURE EIGHT: LIVING, WORKING AND ASSISTING THE VICTIMS OF
HIV/AIDS
EMOTIONAL SUPPORT FOR SOMEONE WITH HIV
8.1 Introduction
Welcome to the lecture on how you can live work and assist the people living with Hiv/Aids.
Remember it is your responsibility as well as mine to help people living with Hiv/Aids live a
more meaningful life and work comfortably without stigma and discrimination.
The prospect of being a person who provides support to a friend or a relative with HIV can be
overwhelming but it doesn’t have to be.
Emotional support is crucial to your loved ones psychological and physical health just like it is
for anyone.

i) Offer support to a friend or a relative with HIV?AIDS
ii) How to offer home based care to people living with HIV?AIDS
iii) Establish the Problems Associated With Home Based Care
iv) Know What PLWHAS can do to stay healthy and live longer
v) Know what is supportive care
vi) Know what is the end of life
8.3 Tips on Offering Your Support

 Encourage the person to get involved with his /her own care. People like to feel in charge
of their own affairs, so even if you are offering physical care to a loved one with HIV it is
important to let them know that you want to hear what they have to say.
 Have the person with HIV contribute to household chores. Like everyone else a person
with HIV wants to feel useful and like they are part of a large group with proper
treatment most people l with HIV live long enough to keep up with day to day
responsibilities i.e. for several years.
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 Include the person with HIV in social engagements outside of the household. This may
be difficult if your loved ones becomes bed bound, but it is worth the effort. Just as other
members of the household are involved in events and activities outside the home, make
sure the person with HIV has the opportunity to share in this connections.
 Talk about the disease.
 Create an environment in which the person with HIV feels comfortable, talking about
both physical and emotional aspects of HIV. It is not necessary or even possible for you
to resolve all your loved ones problems and any attempt to do so will likely end up into
frustrations for both of you. Listening though is an important part of caring for someone
with HIV.
 Connect the people with HIV to friends.
 Make an effort to invite friends and family to visit your loved ones as often as possible or
to at least call or write.
 Touch and live casually
 Don’t be afraid to touch a person with HIV.
 Understand how the virus is transmitted and know that casual contact is unlikely to
spread HIV from one person to another.
 Human touch whether it’s a back rubbing, holding hands or a gentle embrace – is a
powerful way to communicate love and understanding
8.4 Home Based Care

Much of the care for people with HIV/AIDS is provided at home by immediate family and
friends as well as by home based care Organizations.
They provide care for people with HIV/AIDS both the infected and the affected people, yet they
rarely get the support that they require as care givers.
It is estimated that up to 90% of illness, care is provided in the home by untrained family and
associates and up to 80% of HIV/AIDs related deaths occur in the home.
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Typically countries with high preference have over stretched health systems, lack of resources
and among the lowest levels of hospitals beds and health workers per person. The massive
epidemic itself contributes to the overburdened health sector.
In Kenya for example 50-60% of public hospitals beds are occupied by HIV patients. There are
relatively few health workers per person in many African countries making the home the likely
location of HIV/AIDS care.
A potential benefit of home based care is that sick people are continually surrounded by people
they love and are familiar with, so they can also receive more flexible and nurturing care. They
will also not be exposed to hospital based infection or disease.
As people with terminal illness spend their final moments at home strengthening the capacity to
be cared for also removes the cost and distress of traveling to and from the hospitals when they
are weakest.
Further more in being cared for at home a person with HIV may be in a more ready position to
work or look after family members for short period of time when they may be well while the
primary care giver works.
The family’s time that would otherwise be used traveling to and from hospital can instead be
spent doing some house work and looking after other family members.
Expenditure on transport and hospital cost will also be reduced.

Despite the potential benefit of home based care, there is little choice as to where someone with
HIV is cared for.
Health facilities may not be able to cope and further more fear of stigma and discrimination from
doctors and nurses towards people living with HIV could deter people from seeking care in a
medical setting.
Although people living with HIV/AIDS can be healthy and strong and live perfectly normal
lives, they can experience a range of HIV/AIDS symptoms that will affect their day to day life
and for which they will need care and assistance. People Living with HIV/AIDS may need
assistance performing simple tasks that most of us would take for granted. This include:-
 Cooking
 Washing
 Feeding
 Going to the toilet
 Purchasing household essentials
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 Cleaning
And other needs not necessarily specific to AIDS but essential in helping a person to live a
relatively stable life.
Monitoring and Recording progress making note of events such as toilet visits, fluids intake and
symptom occurrence are tasks that can be undertaken by family and home based care workers
and volunteers.
These practical measures are in addition to seeing to the persons’ social, psychological and
emotional needs often referred to as psycho-social needs.
8.4.1 Who Provides HIV/AIDS Home Based Care/Their Role

Family members and friends provide the majority of home based care for people with
HIV/AIDS. This burden of care is in most cases assumed by women and the elderly.
Home based care organizations are the other important care providers and consist of trained
health care workers or volunteers linked to a hospital.
NGOs or faith groups also work as caregivers.

These people make visits to people’s homes for 1 or 2 hrs. They may assist with much of the care
provided by family members including household chores and provide and cook food as well as
performing more clinical tasks such as administering pain relief. They may also make referrals
for professional medical help.
They also train existing care givers on how to best ensure safety of the person’s day to day tasks
such as bathing, lifting and bandaging the patient.
In such cases there may be no distinction between the caring activities provided by primary
family care givers and those done by home based care organizations. Maintaining regular contact
with a home based care organizations will also relief a sense of isolation that the ill person and
their family members may be facing. Furthermore this relationship can serve as a gate way to
accessing avenues of psycho-social support during the patients’ illness the death that follows.
Community members’ skills and knowledge should also grow if the home based care program
extends its services into the wider population, educating people both about prevention measures
as well as training them to become community based volunteers.
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8.4.2 Home Based Care Kits
Home based care kits contain the essential items that a care giver needs when caring for someone
with HIV in order to alleviate symptoms, promote hygienic practices, prevent the speed of the
disease, administer ARV drugs and monitor and record progress.
The ideal contents of each kit vary depending on who the kit is designed for clinical or non-
clinical staff as well local needs, resources and guidelines.
Some of the things that a kit may contain are:-
 Mild, pain killers such as aspirin and paracetamols;

 Medication such as antifungal, antibiotics and antihistamines
 Multi-vitamins
 Bandages
 Cotton wool
 Swaps for dressings
 Applying medication to wounds
 Antiseptics soap, disinfectant, disposal and heavy duty gloves.
 Plastic sheets
 Aprons
 Anti diarrhea tablets
 Creams and petroleum jelly
Additionally some items such as rain coats umbrellas, bicycles, steel hard basins, lanterns are
supplied in some home based care kit. Uniforms such as caps, shirts and jeans are also found in
some kits.
8.4.3 Some of the Problems Associated With Home Based Care

Most of the HIV and AIDS home care is carried out by family members who have no contact
with professional help and suffer through lack of support. This means that the infected are
inadequately looked after despite the best effort of their caregivers and families who may face
economic psychological and social difficulties.
While home based care organizations are valued by their patients there are weaknesses on how
some home based care programs are delivered. Care givers workloads may be very heavy and
they are often unable to make frequent home visits or stay with individual patient’s household
for very long.
Any failures of home based care often stem from the shortage of investment in individuals and
organizations that carry out the work. It should also be remembered that home based care
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organizations cannot attend patients round the clock, so there are limitations on what they should
be expected to do.
8.5 Attitudes towards People Living With HIV/AIDS
Stigma and the Family

What happens when the family finds out that one of them has HIV?
 Shock
 Anger
 Disappointment
 Grief
 Worry
 Sorrow
 Fear of caring for them
 Burden
 Fear of infection
 Denial (not accepted)
 Hatred within the family
 Fear of neighbors finding out
 Blaming
 Regrets
Defense Mechanisms
There are various types of reactions and defense mechanism manifested by each individual
when faced with a life threatening situation including HIV. The reactions differ from one
individual to another depending on many factors.
a)Denial:
Refusal to accept the situation “it cannot be me” the test kits are wrong.
b)Anger:
Blaming other people for the situation.
c)Revenge or vengeance
d)Depression:
e)Going into seclusion
f)Negotiation:
Bargaining with God and the community;
Pleading for more time or a change of the status.
g)Sublimation:
Transferring all the energy and attention to another thing work hard to cover work for
the remaining days.
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Many persons indulged in other activities rather than the ones that exposed their life
to danger like drinking alcohol, smoking, prostitution, drugs criminal activities like
rape etc.
h)Acceptance
Coming into terms with the situation regardless of the outcomes. Always manifested
in people living with HIV sharing their status with someone they trust.
8.6 Needs of People with HIV/AIDS

a)Physiological / physical needs.
 Food, water, healthy sex
 Shelter and clothes
 Dedication and hygiene
 Rest.
b)Sociological / Social needs

 Job,
 Dignity
 Identity,
 Acceptance
 Love,
 Friendship
c) Spiritual needs
 Religion,
 Conflict resolution
 Access to spiritual services which include voluntary tasks
d) Emotional needs
 Understanding / Empathy
 Comfort counseling, re-assurance etc.
8.7 What Can PLWHAS Do To Stay Healthy And Live Longer?

There are things that other long-term survivors have done which have helped them to stay
healthy for sometimes (15-20years) and even more after becoming infected with HIV. Keep your
mind, your feelings and emotions healthy.
a)Accept that the virus is in your body
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 Take the attitude that HIV is simply a challenge to be faced and dealt with as best as you
can and not a punishment.
 Focus your attention on the future you want, not on the past.
 If you feel you have a good reason to live with someone, find someone. This is trying to
make the world a better place to live in for yourself and for others.
 Tell at least 1 or 2 people close to you that you are living with HIV (PLWHAS), but first
think about how they may react and how you will respond.
 Join a local support group for PLWHAS
 Talk honestly about the issues, thoughts and feelings you have.
 Talk to the HIV virus in your body and make arrangements with it, close your eyes and
pretend that you can see the virus in front of you, imagine that it has a face and it can
hear what you want to say and it can also make feedback.
 Give it a name. Listen to what it says and reply. Make an agreement with the virus so that
you can both respect one another within certain limits that are acceptable to you. Have
this discussion as often as you feel its necessary.
 Deal with your fears by creating a real plan of reaction in response to the question “What
if it did happen?”
o State what the fear is – Be specific and honest. Ask yourself what is the worst
thing that can happen.
o Think if the worst thing actually happened how you would deal with it. Make a
realistic plan of actions.
 Accept love, support and affections from people around you. If you are in a long-term
relationship you can still stay together, kiss and cuddle, support and care for each other
and have sex with a condom.
b)Keep your body healthy
Eat properly and regularly

A mixture of protein, fruits, vegetables, grains and nuts each day makes up for a good diet
c)Dairy Products
Dairy products like milk, well cooked meat, yoghourt, cheese, cream etc add important minerals
to the body.
Avoid too much sugar, fried food and spicy foods clean your food and cook it properly. Drink
only clean water and lots of it. If possible get the following minerals and vitamins supplements.
 Selenium – 75-200mg
 Zinc
 Vitamin A,C and B12
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d))Avoid too much alcohol and tobacco.
If possible alcohol and tobacco should be avoided as they do not only weigh down the immune
system but they also trigger other conditions like lung cancer and liver cirrhosis
e)Carry on working as normal
Stay active and involve in things you enjoy.

Take time to relax as well to enable your body recover any energy that may have been lost
during the day’s activities.
f)Keep your body warm
This keeps you safe from respiratory related diseases like pneumonia, common colds and flu etc
g)Get treatment for any infection or illness as early as possible.

Early interventions means that the disease does not advance to later stage that may be difficult to
handle.
h)Find out about antiretroviral drugs –
Where can get any and how much they will cost you, consider whether this is an option you
might choose.
i)Abstain from sex
Always use a CD to avoid getting more HIV into your body and also to protect others from
infection.
8.8 PALLIATIVE CARE
This is care that improves the quality of life of patients and their families facing life threatening
illness.
With palliative care attention is given to prevention assessment and treatment of pain and other
symptoms and to the provision of psychological, emotional and spiritual support. Palliative care
is guided by the following principles.
 Focus on quality of life which includes good symptom control
 A whole person approach taking into account the persons past and current situation.
 Care which includes both the person with life threatening illness and those that matter
to the person.
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 A respect for patients autonomy and choice e.g. over place of care, treatment options
etc.
 An emphasis on open and sensitive communication.
8.8.1 There are 4 main ways in which definitions of palliative core may differ:-
 Palliative care is sometimes defined as care that alleviates pain and other symptoms. With
this definition palliative care does not include any other support either to the patient or
their family.
 In 1960’s palliative care was defined as care that was provided for people who were not
receiving any treatment to actively treat their disease. It has since been realized that many
aspects of palliative care are applicable earlier in the course of a disease and that
palliative care can and should be provided alongside disease treatment.
 Palliative care is defined as being for people with a life threatening illness and not usually
defined for people with chronic diseases such as diabetes.
 In 1980’s it was realized that the provision of palliative care for a family could not
exclude the person who mattered most to a person with AIDS.
8.8.2 What is supportive care?
Supportive care is another term like palliative care and has a number of different definitions If
palliative care is a narrow way and is only being about pain and other symptom control then
supportive care may include palliative care as well as a range of other care that could be
provided to support a person with life threatening disease and their family.
Having a number of different definitions of both palliative and supportive care has brought a lot
of confusion not only for health professionals but also for patients.
Many people unsure about what palliative care is and when it should be provided. Palliative
care is in some circumstances part of supportive care and in other circumstances supportive
care is part of palliative care. Sometimes palliative care is given to people who are actually
“dying”
Whatever you call it, the time at the end of life is different for each person and each person has
unique needs for information, for support and for care.
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8.8.3 What is end of life?
End of life care is an important part of palliative care and usually refers to the care of a person
during the last part of their life from the point at which it has become clearly that a person is in a
progressive state of decline.
End of life care is usually a longer period than the time during which someone is considered to
be “dying”.
How do you know that someone is dying? Some people take the view that everyone effectively
starts to die from the day they are born.
The reality of course is that it is never known exactly when someone is going to die from a life
threatening disease.
Some medical organization define some as being terminally ill when it is expected that there is
only a short period of time perhaps a few days or weeks or at most a month before the person is
expected to die.
“You matter because you are you”
You matter to the last moment of your life and we will do all we can not only to help you die
peacefully but to live until you die.
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8.9 Activities
1.How would you offer support to a person living with Hiv/Aids in your neighborhood
2.Why would you encourage a PLWHAIDS to see a health care provider regularly

1.Discuss the physical examination that a doctor may administer on a PLWHAIDS
8.11 Summary
1.It is possible for PLWHIV/AIDS to live their lives with proper care and nutrition
2.We need to monitor the progress of our health in case we are Living with Hiv/Aids
3.That the end of life is an important process in an individual’s life

California.
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LECTURE NINE: MANAGE YOUR FAMILY TO AVOID AIDS
9.1 Introduction
Welcome to the lecture on how to manage our families to avoid getting infected with Hiv/Aids.
Remember our families will blame us for having not told them about the pandemic, yet we had
all the knowledge and information.

i) Know how to manage your family to avoid HIV/AIDS
ii) Know about HIV/AIDS Counseling and testing
iii) Establish the skills required in counseling the infected and the affected
iv) Know the effective communication issues related to HIV/AIDS in the community
9.3 How can one manage his/her family to avoid HIV/AIDS
 Reduce vulnerability/ensure that you take precaution-e.g. Not going out at night, drinking
and driving late in the night, dealing with strangers
 Discuss topics on sex with your family and other avoided areas like rape, dating, incest
etc
 Discussing with friends eg in family groups merry go rounds
 Have all the literature required magazines newspapers or anything that you may come
across that has information on HIV/AIDS
 Make it a parenting approach that when children get to a certain age you start initiating
HIV/AIDS related dialogue
 If parents are already living with the virus they should let the kids know instead of
waiting for them to learn about it from other people. This will encourage them to not only
live positively but also to avoid getting the virus as well
 Parents should also encourage open dialogue with their families; organizing evening
meetings once in a while and deliberately introducing HIV/AIDS topics
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9.4 Communication Information and HIV/AIDS
The following factors are important communication issues for all families willing to
manage HIV/AIDS. The information is a weapon for all the infected and affected.
The battle against HIV/AIDs and its devastating impact is an area of concern for the whole
world. The focus is on preventive education representing an important niche in the worldwide
campaign to arrest and reverse this scourge.
Communication and information can help to fight HIV/AIDS by changing young people. A
number of organizations have undertaken a number of activities with the aim to increase
awareness of HIV/AIDS prevention among young people based on the new possibilities offered
by ICT. An access to comprehensive and reliable youth friendly information in question of
behavioral changes has been promoted.
On the other hand journalists are gaining increased confidence in reporting on the science of
HIV/AIDS and young media professionals are learning to produce better programmes as they
interact positively with the affected people.
In the light of UN General Assembly Special Session (UNGASS) declaration on commitment on

HIV/AIDS and to target to contain the spread of the epidemic awareness raising campaigns
directed to youth supported by non formal education and increased access to information sources
emerge as an essential preventive element and a central pre-condition for reducing the preference
of HIV/AIDS among youths.
Unfortunately, HIV/AIDS infections are still fatal therefore aggressive awareness and prevention
campaigns are constantly needed.
Various activities have been undertaken in the framework of the youth programme in support to
the development of information network linking various youth groups and ensuring effective co-
ordination and backing for its partners engaged in anti- HIV/AIDS efforts. This includes:-
 Providing logistical and financial support for workshops and courses.

 Design and implementation of coherent information and ICT training schemes directed to
disadvantaged youth.
 Creation of youth information centers.
 Content production, design and launching of specific websites on HIV/AIDS prevention.
 Developing information materials and media campaigns.
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9.5 HIV/AIDS Counseling
What is counseling?
Before getting the test, the person and the counselor have a discussion on the HIV test
and the possible implications of knowing ones status are explained.
This way persons consent is informed. He or she has the information needed concerning
the test (pretest) counseling.
After getting the test a person and the health worker have another discussion where test
results are explained and the information on support, referral and encouragement to
reduce the risk behavior is given (post-test counseling).
VCT stands for Voluntary Counseling and Testing

This means that no person can be tested without his/her informed consent.
9.5.1 Pre-Test Counseling
 Pre-test counseling including basic facts about HIV infection and AIDS.
 Meaning of HIV test including the widow period
 Personal risk assessment
 Exploration of potential support from family and friends.
 Exploration of behavior change
 HIV testing procedures at the site.
 Disclosure
9.5.2 Testing
In Kenya a small amount of blood from the client is tested for the HIV antibodies (what the body
produces to fight HIV).
If a blood sample tests positive two times the test the results is pronounced HIV +ve and the
opposite is true.
VCT is for the people who want to know their health status i.e. whether she/he is infected or not
with HIV.
Clients like couples, partners and people joining new relationships can do the test if they wish so.
Anyone aged 18 years and above can use VCT services, however, all those who are below the
age of 18 years and are sexually active, are also considered as mature minor and they can also
use the service.
9.5.3 Post-Test Counseling

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 Maintaining +ve attitudes
 Avoiding additional exposures to the virus and other STI’s
 Taking good care of themselves medically.
 Eating a good diet.
 Joining persons living with HIV/AIDS organization and other social support groups
 Referrals to additional services such as social legal and spiritual.
What is window period?
This is the time between when a person is infected by HIV and the time the HIV antibodies in
the person’s blood can be detected. This period ranges on average between 8-18 weeks after
infection.
9.5.4 Who should receive VCT?
 Anyone serious about behavior change should receive counseling.
 Those with more than one sexual partner.
 Those diagnosed with STD’s or T.B needs counseling
 Anyone who is 18 years and above can request counseling.
 A couple before starting a relationship, before marriage should seek counseling.
 Youth between 15 and 18 can be served if they are mature minors already engaged in risk
behavior (Counselors need to judge carefully)
 Children under 15 should be served only with parental consent and also if it’s of clear
benefit to the child.
9.5.5 Who should provide VCT?
 All VCT providers must be trained in VCT counseling and service delivery.
 VCT counselors should be carefully selected and their duties adjusted so they can
concentrate on VCT services.
 VCT counselor should abide by the code of conduct and ethics.
9.5.6 On – Going Counseling
Ongoing counseling is what you will receive after you have received your test results. The aims
of ongoing counseling are to:
 Help you to manage the impact that HIV has on your own life, and the lives of the people
around you.
 Encourage you to take control of your health and take charge of your life.
 Help you to accept your results and live positively with HIV/AIDS.
 Explore the advantages and disadvantages of telling other people about your status.
 Assist you in tackling your problems provide emotional and psychological support.
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 Help you strengthen your support system. Refer you to community resources.
9.5.7 Other types of HIV tests
a)Diagnostic counseling and testing

There are times when medical care provider might want to know the medical issues affecting an
individual especially after a long time of management that seems not to identify the exact
problems, such a test is referred to as the diagnostic test. In this the government and human right
require that the test should involve consent of the individual which is best attained through
counseling.
b)Mandatory/Compulsory testing
There are some conditions set by various organizations that an individual has to meet before
getting either some benefits or some tasks within the organizations.
Such conditions make the tests to be compulsory or mandatory.
This include:-
 Pre-employment tests
 Tests before being given visa’s to a country.
 Prior to weddings as demanded by religious leaders.
 Testing for PMTCT: The test might include counseling but consent of the person to be
tested is not necessary.
 Routine testing for working people.
c) Tests for children and adults with TB and Malaria
The government has made it compulsory for all children seeking medical help to be
tested for the virus. Adults above 18 years will be tested if they have either malaria or
TB.
9.6 Skills in Counseling the Infected & the Affected
9.6.1Counseling Children
 Establishing counseling relationships with the children and youth
 Helping them tell their stories
 Listening attentively
 Giving them correct and appropriate information
 Helping them identify and build upon their strengths
 Helping them develop positive attitudes towards life.
 Explain what the HIV/AIDS Virus is and how a person can be infected by it
 Explain the symptoms he/she may experience.
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 Explain cultural beliefs practices that can contribute to HIV/AIDS.
 Identify children who are infected with HIV and provide help to them.
 Provide assistance to children affected by HIV/AIDS
 The skills should include activities designed to provide help to the children/youth
 Explain to them the sources of information on HIV/AIDS.
9.6.2Counseling Adults
 Share the thoughts and feelings of the infected/affected.
 Deal with conflicts, fears, and traumas.
 What are the expectations of the affected / infected – establish
 Think about your own feelings fears, conflicts traumas as a counselor in order to be able
to help out.
 Deal with anger, depression and denial
 Explain ways in which HIV/AIDS is transmitted / not transmitted.
 Handle all the misconceptions about HIV/AID e.g. false beliefs, myths etc.
 You must also have ready answers on frequently asked questions on HIV/AIDS
 Explain the concept of HIV and how it differs from AIDS
9.7 Effective communication on issues related to HIV/AIDS in the community

 The basic communication on issues related to HIV/AIDS should revolve around the
meaning and transmission of HIV.
 That for HIV to be transmitted to another person, one of the people must be infected with
HIV, the Virus must be very concentrated in blood. A small amount of blood is enough to
infect someone but much larger amounts of other body fluids would be required.
 The virus must get into the blood stream through an open cut or sore or through contact
with the mucous membranes in the anus and rectum, the genitals, the mouth or the eyes.
 Communication on symptoms and signs is also necessary e.g. weight loss, persistent
fever, headaches, prolonged diarrhea, night sweats, excessive tiredness, dry cough,
swollen lymph nodes in the neck, armpits or groin, dry cough, shortness of breath, skin
rashes, memory loss, confusion, difficult in concentration, sadness or depression,
persistence herpes zoster, persistently painful legs. Others may include haryleukoplakia,
oral lesions, kaposis sarcoma, and candidacies.
 Information on dealing with these infections should be provided.
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 Communication should be geared towards helping people seek help from health
facilities, remain well nourished and free of other diseases and attend counseling take
ARV’s and other medical treatments, etc.
 Those infected should prevent others from getting the virus
 Promotion of open discussion
 Provision of correct information on HIV/AIDS
 Offering support to the affected/infected
9.8Activities
1.Think about ways in which you can help your family avoid getting infected with Hiv/Aids
9.9Self-Test Questions
1.How can we avoid Hiv/Aids in our families
2.What role can you play in your community in communicating information Hiv/Aids issues
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9.10 Summary
1.Hiv/Aids counseling is a very important concept and our families must be equipped with skills
in counselling the affected and the infected
2.Effective communication is essential in the fight against the pandemic
3.Hiv/Aids can best be managed at the family level
9.11 Suggestion for further reading Kenya National AIDS Control Council (NACC) (2005):
Kenya HIV/AIDS Data Booklet. National AIDS Control Council, Nairobi.
California.
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LECTURE TEN: HAVING A PERSONAL IMPACT IN THE WAR AGAINST THE
PANDEMIC /GENDER AND HIV/AIDS
10.1 Introduction
Welcome to the lecture on having a personal impact in the war against the pandemic and the
concept of gender in Hiv/Aids. Everyone should be interested in understanding how they can
help fight the pandemic and the way the pandemic has impacted on their gender.
10.2Specific Objectives
i)Know how one can have a personal impact in the fight against HIV/AIDS
ii)Understand the Concept of gender and HIV/AIDS
iii)Know the groups that are most affected by HIV/AIDS and the factors contributing to the
high vulnerability among these groups
iv)Understand stigma and HIV/AIDS
v) Establish the different roles played by men and women in fighting the Virus
10.3How one can have a personal impact in the fight against HIV/AIDS
 Choosing to do good for the sake of your family eg exercising, eating healthy, medical
checkups, drinking enough water
 Saying no—assertiveness ---to unhealthy lifestyles like alcohol, smoking, sex for leisure,
faithfulness and other temptations
 Change of character, character development—what you do when no-one is watching you
 Workplace campaign
 Other personal safety precautions like travelling during the day, carrying your own
shaving machines, going to clean places e.g. health facilities if you can afford to, cheap is
expensive
 Initiating change in the societies where we live in
 Personal integrity where you choose to preserve your dignity
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10.4 Concept of gender and HIV/AIDS:
10.4.1The Role of Women in Fighting the Virus
 Women are traditionally/naturally caregivers

 They support the sick/orphaned children
 Campaigns against fgm and other risky practices
 Empowerment programmes like kenwa
 Women as agents of change
 Women engaging in practical solutions in curbing the vice such as helping commercial
sex workers and helping them to do more profitable jobs
 Raising funds from international donors and governments, more time money material
talents and abilities are being put into the fight against the scourge
 Training in gender equality, legislative reforms and reinforcement –Njoki Ndung’u
 Prenatal care more than ever before
 International women’s day in the calendar that hails the contributions of women in all
capacities in the fight against hiv/aids
 Use of microbicides where condoms can’t be used and when bearing of kids is needed
 Women fight to have kids even in the face of hiv/aids and the risk involved on their side
10.4.2 Role of Men
 Capacity building through workshops
 Supported sexual act law
 Giving up on polygamy
 Backing equality in gender issues which was unheard of in Africa
 Spent a lot of money buying condoms
 Willing to change lifestyles alcohol, drug abuse-rehabilitating sex for leisure
 Promoters of peace as opposed to armed conflicts, Annan, Ruto
 Labour and migration and men now willing to live with their women in towns
 Reduced multiple sex partners
 Truck drivers/soldiers-health care workers barbers carry your own machine
 Enforcing the rights of people with the virus
 Men and funding for hospital bills
 Refused widow inheritance
 Supported male circumcision
10.5 Women Vulnerability

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The proportion of women living with HIV grows faster in the African countries than in the
developed world. This is basically due to the cultural placement of women in the society where
women have little say in their reproductive health e.g. it is men who dictate when to have sexual
relationships with women. Men dictate family planning methods and whether the woman should
use them or not.
Women have no say when it comes to the use of protective measures in sexual relationships.
Women are blamed in case of HIV/AIDS in the family.
It is no wonder that more women than men live with HIV/AIDS because of their biological make
up. Women may also have more sexual partners than men. They tend to mature earlier than men
and are therefore exposed to HIV/AIDS earlier than their male counterparts.
Widows and children are thrown out after HIV/AIDS related issues. These expose them to other
dangers. Others believe that sex with virgin girls can help alleviate the problem of HIV/AIDS.
Women are traditionally care givers.

 The society has the tendency of marrying of young girls.
 Polygamy is also a contributing factor in the vulnerability of women.
 Practices like female Genital Mutilation also contribute to vulnerability among
women.
 Wife inheritance
 Women are sexually subordinate
 Older men turn to younger girls to sex. They lure them with money. The
misconception they have is that they are free from HIV/AIDS.
 Young girls are also forced to look after siblings or take care of ailing parents.
 There are also biases based on rejection of women, property is taken away from them
and they have to look for survival techniques such as commercial sex work or
prostitution.
 Women are also vulnerable in that majority will get it from men.
 Primitive cultural practices such as violence against women, dry sex, widow
inheritance, polygamy etc should be discouraged by all the stake holders in the fight
against HIV/AIDS.
10.5.1 General Summary on women vulnerability

Men should be encouraged to be at the forefront in the fight because of their position in a society
that puts them at a stronger position in their relationships with women.
80
The migratory culture should be in such a way that married men and women share households
together.
Stable governments devoid of war and conflicts would ensure that societies stick together. Where
there is peace, there is the unlikelihood of the poor effects war on societies.
Male circumcision should be encouraged; circumcised men have a lower risk of getting infected
than their uncircumcised counterparts.
We should also work hard in the fight against drug use and alcohol abuse.
Everyone should also campaign towards the ABC of HIV/AIDS absistence, faithfulness in
marriage, and use of condoms.
The government should expand the PMCTC programme
Improve availability of safe blood supplies etc.
Avoid sharing of blades, needle etc..
10.6 Groups most Affected By HIV/AIDS
Various groups most affected by HIV/AIDS include:

 Truck drivers
 Soldiers
 Health care workers
 Barbers
 Prisoners
 Commercial sex workers
 Children
 Victims of war
 Young girls in marginalized areas
 Military personnel
 Mine workers
 Agricultural farm workers
 Domestic workers
 Refugees
 Informal traders
81
 Constructions workers
 Transport workers
10.6.1 Factors contributing to the high vulnerability among these groups

 Distances away from spouses and many days spent away from partners.
 Labour and migrations where the nature of their work does not encourage partners
to live together e.g. soldiers who live in barracks.
 Health care workers spend a lot of time with HIV/AIDS patients.
 There is also AIDS phobia and lack of knowledge and insufficient skills in
dealing with HIV/AIDS.
 War exposes people to rape, prostitution, poverty and other vices.
 Teachers just like health care workers have to take care of sick children exposing
them to a more direct contact with the victims.
10.7 Stigma and HIV/AIDS

10.7.1 Negative attitudes, abuse and maltreatment directed at PLWHAS e.g.
 Looking at them as weak and a burden,
 Verbal harassment, assault.
 Shunned by family, peers, community
 Poor treatment in health care and education settings.
10.7.2 Direct effects of stigma

 Erosion of rights.
 Psychological damage
 Negative effect on the success HIV testing and treatment.
 It interferes with attempts to fight HIV for the person (internal stigma)
 It deters governments from taking fast effective action against the epidemic.
 Makes people reluctant to access HIV testing treatment and care.
 Women being seen as the source in a male dominated society.
10.7.3 Reasons for stigma

 Negative values associated with the causes that are already stigmatized in many
societies.
 Fear of contagion.
 It is a life threatening disease. People react to it in a strong way.
 Most people become infected through sex which often carries moral baggage.
 Inaccurate information exists about how HIV is transmitted creating irrational
behavior and misperceptions of personal risk.
82
 Fear that with ARVS can’t tell who has and who hasn’t.
 Lack of protective gear, drugs in some clinics and hospitals.
 Also thought to be a result of personal irresponsibility.
 Religious or moral beliefs lead some people to believe that being infected with HIV is
the result of moral fault e.g. promiscuity or deviant sex that deserves to be punished.
 It’s a new disease the fear surrounding the emerging epidemic in the 1980’s is still
fresh in many peoples minds. Little was known about the risk of HIV transmission
which made people scared of those infected due to fear of contagion.
 Powerful images used that reinforce and legitimize stigmatization. This did not only
include the unhealthy body images but also tag images e.g.
 HIV/AIDS as punishment e.g. for immoral behavior.
 HIV as a crime e.g. in relation to innocent and guilty victims. HIV as war e.g. in
which infected people are demonized and feared. HIV as otherness in which the
disease is an affliction of those set apart. HIV as a death channel for those with virus.
10.7.4 How to fight the stigma by Individuals, Govt/ NGOs

 Change of personal attitude towards HIV internal Stigma.
 Increase knowledge, information communication and education on HIV
 Improve health care approach and fight to reduce denial.
 National programs providing universal access to treatment e.g. ARVs
 Programmes that make people find support from health professionals.
 Refusing to accept stigma on individual levels.
 Come up with policies that protect the PLWHAS e.g. Labour laws, health, army
promotions insurance policies.
 Prosecute individuals who infect others intentionally.
 Prioritize health care for PLWHA; universal precautions should be used in all cases.
 Discourage travel and stay restrictions for HIV deportation.
 Enforce the rights of people with HIV
10.8 Activities
1.Identify other groups that may be at risk of getting infected apart from the ones mentioned
83
above

1.Differentiate between stigma and discrimination
10.10 Summary
In this lecture you have learnt that
1. Women are more vulnerable to Hiv/Aids than men
2. There are some groups that are more vulnerable to Hiv/Aids than others
3 Each gender has a role to play in fighting the pandemic
4. We can have a personal impact in fighting the pandemic

California.
SO LETS ALL MANAGE OUR FAMILIES AGAINST THE PANDEMIC AND

THEREFORE HAVE A PERSONAL IMPACT IN ALL OUR AREAS OF
OPERATIONS.THE BATTLE BEGINS WITH YOU.
84
Assignment
i) What is the meaning of HIV and AIDS
ii) Outline the Symptoms and Phases of HIV Infection
iii) What are the Modes of Transmission of HIV/AIDS
iv) Establish the Impact of HIV/AIDS on the agricultural sector
v) Establish the Impact of HIV/AIDS to business
vi) Outline the Effects of HIV/AIDS in the academic community
vii) Establish the roles of academicians in fighting HIV/AIDS
viii) Establish the Role of poor leadership in the fight against HIV/AIDS
ix) Establish the Relationship between HIV/AIDS and leadership
x) Outline and Explain the various HIV/AIDS prevention methods
xi) What Makes a Healthy/Good Diet for a Person Living With HIV?
xii) What is supportive care?
xiii) Establish the different roles played by men and women in fighting the Virus
xiv)What are the groups that are most affected by HIV/AIDS and what are the factors
contributing to the high vulnerability among these groups
85

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HIV/AIDS Module for Degree Students

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MODULE TITLE: KCAU 001: HIV/AIDS

FOR DEGREE STUDENTS

By Catherine Wangechi Mungai

MODULE TITLE: KCAU 001: HIV/AIDS--------------------------------------------------------------ix

LECTURE ONE: INTRODUCTION TO HIV/AIDS------------------------------------------------1

1.2 Specific Objectives---------------------------------------------------------------------------------------1

1.3 Introduction to Hiv/Aids---------------------------------------------------------------------------------1

1.3.1 Basic Concepts------------------------------------------------------------------------------------------1

1.3.2 The Immune System-----------------------------------------------------------------------------------2

1.3.3The Course of Hiv/Aids--------------------------------------------------------------------------------2

1.3.4 The Stages of Hiv/Aids---Symptoms and Phases of Hiv/Aids-----------------------------------3

1.3.6 Modes of Transmission--------------------------------------------------------------------------------9

1.3.7 Factors fueling the spread of Hiv/Aids------------------------------------------------------------10

1.5 Self Test Questions--------------------------------------------------------------------------------------15

1.7 Suggestion for further reading-------------------------------------------------------------------------16

LECTURE TWO: THE IMPACT OF HIV/AIDS TO BUSINESS------------------------------17

2.2 Specific Objectives--------------------------------------------------------------------------------------17

2.3 Impact of Hiv/Aids in general-------------------------------------------------------------------------17

2.3.1 Impact on Agriculture--------------------------------------------------------------------------------18

2.3.2 Impact on Health-------------------------------------------------------------------------------------18

2.3.3 Impact on House Holds------------------------------------------------------------------------------19

2.3.5 Impact on Business----------------------------------------------------------------------------------20

2.5 Self Test Questions------------------------------------------------------------------------------------23

2.7 Suggestions for further reading----------------------------------------------------------------------23

LECTURE THREE: HIV/AIDS IN THE ACADEMIC COMMUNITY----------------------24

3.2 Specific Objectives-------------------------------------------------------------------------------------24

3.3 Causes of Hiv/Aids in the academic community---------------------------------------------------24

3.4 Effects of Hiv/Aids in the Academic community--------------------------------------------------25

3.4.1 Negative Effects--------------------------------------------------------------------------------------25

3.4.2 Positive Effects----------------------------------------------------------------------------------------25

3.5 Barriers to School attendance--------------------------------------------------------------------------26

3.7 Self Test Questions-------------------------------------------------------------------------------------28

3.9Sugggestion for further reading------------------------------------------------------------------------28

LECTURE FOUR:THE ROLE OF ACADEMICIANS IN FIGHTING HIV/AIDS--------29

4.2 Specific Objectives-------------------------------------------------------------------------------------29

4.3 General role of academicians in the fight against Hiv/Aids---------------------------------------29

4.5 Self Test Questions-----------------------------------------------------------------------------------32

LECTURE FIVE: PRACTICAL CASES ABOUT THE CONSEQUENSES OF HIV/AIDS

5.2 Specific Objectives-------------------------------------------------------------------------------------33

5.3 The role of poor leadership in the spread of the pandemic----------------------------------------33

5.3.1 The role of leaders in fighting Hiv/Aids-----------------------------------------------------------33

5.4 Relationship between Hiv/Aids and Leadership----------------------------------------------------34

5.4.1 International Leadership-----------------------------------------------------------------------------34

5.4.2 Local leadership---------------------------------------------------------------------------------------34

5.4.5 Family leadership-------------------------------------------------------------------------------------36

5.6 Self Test Questions-------------------------------------------------------------------------------------37

5.8 Suggestion for further reading-------------------------------------------------------------------------37

LECTURE SIX: HOW TO AVOID HIV/AIDS---------------------------------------------------------38

6.2 Specific Objectives-------------------------------------------------------------------------------------38

6.3 Hiv/Aids prevention in Kenya------------------------------------------------------------------------38

6.3.1 Government policies on Hiv/Aids-----------------------------------------------------------------39

6.3.3 Injecting drug users-----------------------------------------------------------------------------------40

6.3.4 Condom use--------------------------------------------------------------------------------------------40

6.3.4.2 Facts about condom use--------------------------------------------------------------------------41

6.3.4.3 Procedure for condom use------------------------------------------------------------------------41

6.3.5 Prevention of Mother to Child Transmission-----------------------------------------------------42

6.3.6 Prevention of STIs------------------------------------------------------------------------------------42

6.3.7 Male Circumcision------------------------------------------------------------------------------------43

6.4.1 A general summary on how to avoid Hiv/Aids---------------------------------------------------45

6.6 Self Test Questions-------------------------------------------------------------------------------------48

6.8 Suggestion for further reading------------------------------------------------------------------------49

LECTURE SEVEN: STRATEGIES TO MANAGE YOURSELF INCASE YOU ARE THE

7.3 Basic monitoring and management of Hiv/Aids----------------------------------------------------50