NSTP111 – Civic Welfare

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Lesson 2
Common Community Diseases

Learning Outcomes

In this lesson, you are expected to gain the different learning outcomes listed
below:

1. Investigate the different dimensions of different health and

community problems through case studies.

Time Frame: 3 hours

Introduction

Good job! You are now on the second lesson of the third module. In this lesson
you will be learning the different dimensions of development of health in the
community. You will be refreshed with topics such as hygiene, sanitation,
communicable diseases and many more.

Abstraction
Emerging respiratory viruses, including novel coronavirus

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 Viruses continue to emerge and pose challenges to public health  Some

examples of emerging respiratory viruses include:
• 2002: Severe Acute Respiratory Syndrome coronavirus (SARS-CoV)
• 2009: H1N1 influenza
• 2012: Middle East Respiratory Syndrome coronavirus (MERS-CoV)
• 2019: Novel coronavirus (COVID-19)

How do new viruses emerge?

 Human health, animal health and the state of
ecosystems are inextricably linked
 70–80% of emerging and re -emerging infectious
diseases are known to be of zoonotic origin, meaning
they can be transmitted between animals and humans
 Population growth, climate change, increasing
urbanization, and international travel and migration all
increase the risk for emergence and spread of
respiratory pathogens

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What is a coronavirus?
Coronaviruses are a large family of viruses that are known to
cause illness ranging from the common cold to more severe
diseases such as Middle East Respiratory Syndrome (MERS)
and Severe Acute Respiratory Syndrome (SARS)

Where do coronaviruses come from?

 Coronaviruses also cause disease in a
wide variety of animal species
 SARS-CoV was transmitted from civet
cats to humans in China in 2002 and
MERS-CoV from dromedary camels to
humans in Saudi Arabia in 2012
 Several known coronaviruses
are circulating in animals that have not
yet infected humans
 A spillover event is when a virus that is circulating in an animal species is
found to have been transmitted to human(s)
People at risk for infection from a novel
coronavirus
 People in close contact with animals (e.g. live
animal market workers)

 Family members or health care workers who are

caring for a person infected by a new coronavirus

How can I protect myself from infection?

 Wash your hands with soap and water or
alcoholbased hand rub
 Cover your mouth and nose with a medical mask,
tissue, or a sleeve or flexed elbow when coughing
or sneezing

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 Avoid unprotected close contact with anyone developing cold or flu-like

symptoms and seek medical care if you have a fever, cough and
 difficulty breathing
 When visiting live markets, avoid direct unprotected contact with live animals
and surfaces in contact with animals
 Cook your food and especially meat thoroughly

COVID-19
COVID-19, a zoonotic disease, is caused by a
virus known as the Severe Acute Respiratory
Syndrome Coronavirus 2 (SARS-CoV-2)
•This is an enveloped virus with a fragile outer lipid
that makes it susceptible to oxidants, such as soap
and disinfectants
•Size: 65–125nm in diameter

Transmission routes

Can be spread in the environment by talking, sneezing or coughing

as respiratory droplet, physical contact, or aerosol generating
medical procedures.
Detected in stool, gastrointestinal tract, saliva, urine, tears, and
conjunctival secretions (no evidence yet as a source of infection)
Viable in aerosols for 3 hours

Stability of SARS CoV-2

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(COVID-19) at different environmental conditions SURFACES SARS-

CoV-2 was found undetected on surfaces after
 3 hours for paper/ tissue
 2 days for wood, cloth
 4 days for glass, banknotes
 7 days for stainless steel, plastic, mask-inner layer (but not for mask-outer layer)
Stability of SARS‐CoV‐2 at different environmental conditions – TEMPERATURE
AND HUMIDITY
SARS-CoV-2 was undetected at a temperature of:
 22 deg C after 14 days
 37 deg C after 2 days
 56 deg C after 30 mins
 70 deg C after 5 mins
1 percent decrease in relative humidity could increase the number of COVID 19 cases
by 6 percent.
Stability of SARS CoV 2 at different environmental
conditions DISINFECTANTS

“With the exception of a 5 min incubation with hand soap, no infectious virus
could be detected after a 5 min incubation at room temp (22 deg C).”

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Persistence in solid wastes

 Poor solid waste management also
intensifies the risk to
health conditions of garbage
collectors
 Critical work: collecting, separating,
classifying and selling recyclable
waste produced by the population
 Increased risk due to exposure to contaminated wastes
 Safe procedures on waste segregation, collection, treatment and
disposal are essential for proper waste and risk management in all
settings where confirmed, suspect and probable cases are present

Use of face masks and other PPEs

Target users of PPE

• Health care workers

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• Sanitation workers
• Laboratory staff
• Laundry staff
• Handlers of dead bodies
• Admin staff
• Driver
• Patients
• Watchers/guests

Hand hygiene
• Alcohol-based hand rub (60-80%) for 20-30 seconds
• Handwashing with soap and water for 40-60 seconds

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Cleaning
• Removal of dirt to remove pathogens
or significantly reduce their load on
contaminated surfaces
• Use water, soap (or a detergent) and
some form of mechanical action
(brushing or scrubbing)
• From the least soiled (cleanest) to the
most soiled (dirtiest) areas, and from
the higher to lower levels

Disinfection
WHO recommended disinfectants
• Chlorine-based solutions (sodium or calcium
hypochlorite)
 0.1% = 1000 ppm (1:50) –for surfaces  0.5%
= 5000 ppm (1:10)- for blood and body fluids
Contact time: Minimum of 1 minute
• Alcohol (70-90%)
• Hydrogen peroxide > 0.5%
•Spraying, fogging or misting chemical disinfectant to individuals and
environmental surfaces is not recommended

Health care waste management

• All wastes of COVID patients should be
considered infectious
• Proper storage, collection, treatment
and disposal should be implemented
• Full PPE is needed for sanitary workers handling waste
Water supply, sanitation and plumbing

• Water is needed for handwashing, cleaning and disinfection

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• Fecal matters and wastewater should be safely managed with well-

maintained plumbing system
• Water and sanitation safety planning should be used to manage the risks

POLIOVIRUS
Poliomyelitis

• A highly infectious disease, caused by any

of the three serotypes of the poliovirus; Type
1, 2 & 3
• Mainly affects children under 5 years
• Replicates initially in the gastrointestinal
tract and in rare cases in the motor neurons
of the spinal cord
• Replication of the virus results in cell
destruction and paralysis
• Up to 95% of all polio infections are
asymptomatic
Transmission
• The virus is transmitted by
personto-person spread through
the fecaloral route
• Wild polioviruses have a seasonal
pattern of circulation that varies by
geographic area
• Suboptimal hygiene, sanitation and
water quality
contribute to transmission
• Once infected, the virus
will replicate in the intestinal
tract
• Infected persons, with or without
symptoms, will shed the virus in
stools for 3-6 weeks
• Previous natural infection
or vaccination will reduce the
extent and duration of shedding
• The rate of secondary infections in susceptible households is greater than
90%
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Clinical Presentation (Signs and Symptoms)

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Polio Vaccines

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TUBERCULOSIS
• A total of 1.5 million people
died from TB in 2018
(including 251 000 people
with HIV). Worldwide, TB is
one of the top 10 causes of
death and the leading
cause from a
single infectious
agent (above HIV/AIDS).
• In 2018, an estimated 10 million people fell ill with tuberculosis (TB)
worldwide. 5.7 million men, 3.2 million women and 1.1 million children.
There were cases in all countries and age groups. But TB is curable and
preventable.
• In 2018, 1.1 million children fell ill with TB globally, and there were 205
000 child deaths due to TB (including among children with HIV). Child and
adolescent TB is often overlooked by health providers and can be difficult
to diagnose and treat.
• In 2018, the 30 high TB burden countries accounted for 87% of new TB
cases. Eight countries account for two thirds of the total, with India leading

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the count, followed by, China, Indonesia, the Philippines, Pakistan,

Nigeria, Bangladesh and South Africa.
• Multidrug-resistant TB (MDR-TB) remains a public health crisis and a
health security threat. WHO estimates that there were 484 000 new cases
with resistance to rifampicin – the most effective first-line drug, of which
78% had
MDR-TB.
• Globally, TB incidence is falling at about 2% per year. This needs to
accelerate to a 4–5% annual decline to reach the 2020 milestones of the
End TB Strategy.
• An estimated 58 million lives were saved through TB diagnosis and
treatment between 2000 and 2018.
• Ending the TB epidemic by 2030 is among the health targets of the
Sustainable Development Goals.
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often
affect the lungs. Tuberculosis is curable and preventable.
TB is spread from person to person through the air. When people with lung TB
cough, sneeze or spit, they propel the TB germs into the air. A person needs to
inhale only a few of these germs to become infected.
About one-quarter of the
world's population has
latent TB, which means
people have been
infected by TB bacteria
but are not (yet) ill with
the disease and cannot
transmit the disease.
People infected with TB
bacteria have a 5–15%
lifetime risk of falling ill
with TB. Persons with
compromised
immune
systems, such as people living with HIV, malnutrition or diabetes, or people who use
tobacco, have a higher risk of falling ill.
When a person develops active TB disease, the symptoms (such as cough,
fever, night sweats, or weight loss) may be mild for many months. This can lead
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to delays in seeking care, and results in transmission of the bacteria to others.

People with active TB can infect 5–15 other people through close contact over
the course of a year. Without proper treatment, 45% of HIV-negative people with
TB on average and nearly all HIV-positive people with TB will die.

Who is most at risk?

Tuberculosis mostly affects adults in their most productive years. However, all age
groups are at risk. Over 95% of cases and deaths are in developing countries.
People who are infected with HIV are 19 times more likely to develop active TB
(see TB and HIV section below). The risk of active TB is also greater in persons
suffering from other conditions that impair the immune system. People with
undernutrition are 3 times more at risk. There were globally 2.3 million new TB
cases in 2018 that were attributable to undernutrition.
1.1 million children (0–14 years of age) fell ill with TB, and 230 000 children (including
children with HIV associated TB) died from the disease in 2018.
Alcohol use disorder and tobacco smoking increase the risk of TB disease by a
factor of 3.3 and 1.6, respectively. In 2018, 0.83 million new TB cases worldwide
were attributable to alcohol use disorder and 0.86 million were attributable to
smoking.
Global impact of TB
TB occurs in every part of the world. In 2018, the largest number of new TB
cases occurred in the South-East Asian region, with 44% of new cases, followed
by the African region, with 24% of new cases and the Western Pacific with 18%.
In 2018, 87% of new TB cases occurred in the 30 high TB burden countries.
Eight countries accounted for two thirds of the new TB cases: India, China,
Indonesia, Philippines, Pakistan, Nigeria, Bangladesh and South Africa.

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Symptoms and diagnosis

Common symptoms of active lung
TB are cough with sputum and
blood at times, chest pains,
weakness, weight loss, fever and
night sweats. Many countries still
rely on a long-used method called
sputum smear microscopy to
diagnose TB. Trained laboratory
technicians look at sputum samples
under a microscope to see if TB
bacteria are present. Microscopy
detects only half the number of TB
cases and cannot detect drug-resistance.
The use of the rapid test Xpert MTB/RIF® has expanded substantially since
2010, when WHO first recommended its use. The test simultaneously detects
TB and resistance to rifampicin, the most important TB medicine. Diagnosis can
be made within 2 hours and the test is now recommended by WHO as the initial
diagnostic test in all persons with signs and symptoms of TB.
Diagnosing multidrug-resistant and extensively drug-resistant TB (see
Multidrugresistant TB section below) as well as HIV-associated TB can be
complex and expensive. In 2016, 4 new diagnostic tests were recommended by
WHO – a rapid molecular test to detect TB at peripheral health centres where
Xpert MTB/RIF cannot be used, and 3 tests to detect resistance to first- and
second-line TB medicines.
Tuberculosis is particularly difficult to diagnose in children.
Treatment
TB is a treatable and curable disease. Active, drug-susceptible TB disease is
treated with a standard 6-month course of 4 antimicrobial drugs that are provided
with information and support to the patient by a health worker or trained
volunteer.
Without such support, treatment adherence is more difficult.
Between 2000 and 2018, an estimated 58 million lives were saved through TB diagnosis
and treatment.

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TB and HIV
People living with HIV are 19
(15-22) times more likely to
develop active TB disease than
people without HIV.
HIV and TB form a lethal
combination, each speeding the
other's progress. In 2018 about
251 000 people died of
HIVassociated TB. In 2018,
there were an estimated 862
000 new cases of TB amongst
people who were HIV-positive,
72% of whom were living in
Africa.
WHO recommends a
12component
approach of
collaborative TB-HIV activities,
including actions for prevention
and treatment of infection and
disease, to reduce deaths.
Multidrug-resistant TB
Anti-TB medicines have been used for decades and strains that are resistant to
one or more of the medicines have been documented in every country surveyed.
Drug resistance emerges when anti-TB medicines are used inappropriately,
through incorrect prescription by health care providers, poor quality drugs, and
patients stopping treatment prematurely.
Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria
that do not respond to isoniazid and rifampicin, the 2 most powerful first-line anti-
TB drugs. MDR-TB is treatable and curable by using second-line drugs.
However, second-line treatment options are limited and require extensive
chemotherapy (up to 2 years of treatment) with medicines that are expensive
and toxic.
In some cases, more severe drug resistance can develop. Extensively
drugresistant TB (XDR-TB) is a more serious form of MDR-TB caused by
bacteria that do not respond to the most effective second-line anti-TB drugs,
often leaving patients without any further treatment options.
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In 2018, MDR-TB remains a public health crisis and a health security threat.
WHO estimates that there were 484 000 new cases with resistance to rifampicin
– the most effective first-line drug – of which 78% had MDR-TB. The MDR-TB
burden largely falls on 3 countries – India, China and the Russian Federation –
which together account for half of the global cases. About 6.2% of MDR-TB
cases had extensively drug-resistant TB (XDR-TB) in 2018.
Worldwide, only 56% of MDR-TB patients are currently successfully treated. In
2016, WHO approved the use of a short, standardized regimen for MDR-TB
patients who do not have strains that are resistant to second-line TB medicines.
This regimen takes 9–12 months and is much less expensive than the
conventional treatment for MDR-TB, which can take up to 2 years. Patients with
XDR-TB or resistance to second-line anti-TB drugs cannot use this regimen,
however, and need to be put on longer MDR-TB regimens to which 1 of the new
drugs (bedquiline and delamanid) may be added.
In July 2018, the latest evidence on treatment of drug-resistant TB was reviewed
by an independent panel of experts convened by WHO. A rapid communication
on key changes to recommendations for the treatment of drug-resistant TB has
been issued by WHO, to be followed by the release of updated and consolidated
WHO policy guidelines later in the year.
WHO also approved in 2016 a rapid diagnostic test to quickly identify these
patients. Sixty-two countries have started using shorter MDR-TB regimens. By
the end of 2018, 90 countries reported having introduced bedaquiline and 57
countries reported having introduced delamanid, in an effort to improve the
effectiveness of MDR-TB treatment regimens.

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HIV/AIDS
• HIV continues to be a major
global public health issue, having
claimed almost 33 million lives so
far. However, with increasing
access to effective HIV
prevention, diagnosis, treatment
and care, including for
opportunistic infections, HIV
infection has become a
manageable chronic health
condition, enabling people living
with HIV to lead long and healthy lives.
• There were an estimated 38.0 million people living with HIV at the end of
2019.
• As a result of concerted international efforts to respond to HIV, coverage
of services has been steadily increasing. In 2019, 68% of adults and 53%
of children living with HIV globally were receiving lifelong antiretroviral
therapy (ART).
• A great majority (85%) of pregnant and breastfeeding women living with
HIV also received ART, which not only protects their health, but also
ensures prevention of HIV transmission to their newborns.
• However, not everyone is able to access HIV testing, treatment and care.
Notably, the 2018 Super-Fast-Track targets for reducing new pediatric HIV
infections to 40 000 was not achieved. Global targets for 2020 are at risk
of being missed unless rapid action is taken.
• Due to gaps in HIV services, 690 000 people died from HIV-related causes
in 2019 and 1.7 million people were newly infected.
• Key population groups and their sexual partners accounted for over 60%
of all new HIV infections globally among the age group 15-49 years (an
estimated 62%) in 2019. In eastern European and central Asia, Asia and
the Pacific, western and central Europe and north America and Middle East
and north Africa, these groups accounted for over 95% of new HIV
infections in each of these regions.
• WHO defines key populations as people in populations who are at
increased HIV risk in all countries and regions. Key populations include:
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men who have sex with men; people who inject drugs; people in prisons
and other closed settings; sex workers and their clients; and transgender
people.
• In addition, given their life circumstances, a range of other populations may
be particularly vulnerable, and at increased risk of HIV infection, such as
adolescent girls and young women in southern and eastern Africa and
indigenous peoples in some communities.
• Increased HIV vulnerability is often associated with legal and social factors,
which increases exposure to risk situations and creates barriers to
accessing effective, quality and affordable HIV prevention, testing and
treatment services.
• Over two thirds of all people living with HIV live in the WHO African Region
(25.7 million). While HIV is prevalent among the general population in this
region, an increasing number of new infections occur among key
population groups.
• HIV can be diagnosed through rapid diagnostic tests that can provide
sameday results. HIV self-tests are increasingly available and provide an
effective and acceptable alternative way to increase access to people who
are not reached for HIV testing through facility-based services. Rapid test
and selftests have greatly facilitated diagnosis and linkage with treatment
and care.
• There is no cure for HIV infection. However, effective antiretroviral drugs
(ARVs) can control the virus and help prevent onward transmission to other
people.
• At the end of 2019, an estimated 81% of people living with HIV knew their
status. 67% were receiving antiretroviral therapy (ART) and 59% had
achieved suppression of the HIV virus with no risk of infecting others.
• At the end of 2019, 25.4 million people were accessing antiretroviral
therapy.
• Between 2000 and 2019, new HIV infections fell by 39% and HIV-related
deaths fell by 51%, with 15.3 million lives saved due to ART. This
achievement was the result of great efforts by national HIV programs
supported by civil society and international development partners.

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The human immunodeficiency virus

(HIV) targets the immune system and
weakens people's defense against
many infections and some types of
cancer. As the virus destroys and
impairs the function of immune cells,
infected individuals gradually become
immunodeficient. Immune function is
typically measured by CD4 cell count.
Immunodeficiency results in increased
susceptibility to a wide range of infections, cancers and other diseases that
people with healthy immune systems can fight off.
The most advanced stage of HIV infection is acquired immunodeficiency
syndrome (AIDS), which can take many years to develop if not treated,
depending on the individual. AIDS is defined by the development of certain
cancers, infections or other severe long-term clinical manifestations.
Signs and symptoms
The symptoms of HIV vary depending on the stage of
infection. Though people living with HIV tend to be most
infectious in the first few months after being infected, many
are unaware of their status until the later stages. In the first
few weeks after initial infection people may experience no
symptoms or an influenza-like illness including fever,
headache, rash or sore throat.
As the infection progressively weakens the immune system,
they can develop other signs and symptoms, such as swollen
lymph nodes, weight loss, fever, diarrhea and cough. Without
treatment, they could also develop severe illnesses such as
tuberculosis (TB), cryptococcal meningitis, severe bacterial
infections, and cancers such as lymphomas and Kaposi's
sarcoma.

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Transmission
HIV can be transmitted via the
exchange of a variety of body
fluids from infected people, such
as blood, breast milk, semen and
vaginal secretions. HIV can also
be transmitted from a mother to
her child during
pregnancy and delivery.
Individuals cannot
become infected through ordinary
day-to-day contact such as
kissing, hugging, shaking hands,
or sharing personal objects, food
or water.
It is important to note that people with HIV who are taking ART and are virally
suppressed do not transmit HIV to their sexual partners. Early access to ART
and support to remain on treatment is therefore critical not only to improve the
health of people with HIV but also to prevent HIV transmission.
Risk factors
Behaviors and conditions that put individuals at greater risk of contracting HIV include:
• having unprotected anal or vaginal sex;

• having another sexually transmitted infection (STI) such as syphilis, herpes,

chlamydia, gonorrhea and bacterial vaginosis;
• sharing contaminated needles, syringes and other injecting equipment and drug
solutions when injecting drugs;
• receiving unsafe injections, blood transfusions and tissue transplantation, and
medical procedures that involve unsterile cutting or piercing; and
• experiencing accidental needle stick injuries, including among health workers
Diagnosis
HIV can be diagnosed through rapid diagnostic tests that provide same-day
results. This greatly facilitates early diagnosis and linkage with treatment and
care. People can also use HIV self-tests to test themselves. However, no single
test can provide a full HIV diagnosis; confirmatory testing is required, conducted
by a qualified and trained health or community worker at a community center or
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clinic. HIV infection can be detected with great accuracy using WHO prequalified
tests within a nationally approved testing strategy.
Most widely-used HIV diagnostic tests detect antibodies produced by the person
as part of their immune response to fight HIV. In most cases, people develop
antibodies to HIV within 28 days of infection. During this time, people experience
the so-called “window” period – when HIV antibodies haven’t been produced in
high enough levels to be detected by standard tests and when they may have
had no signs of HIV infection, but also when they may transmit HIV to others.
After infection, an individual may transmit HIV transmission to a sexual or drug-
sharing partner or for pregnant women to their infant during pregnancy or the
breastfeeding period.
Following a positive diagnosis, people should be retested before they are
enrolled in treatment and care to rule out any potential testing or reporting error.
Notably, once a person diagnosed with HIV and has started treatment they
should not be retested.
While testing for adolescents and adults has been made simple and efficient,
this is not the case for babies born to HIV-positive mothers. For children less
than 18 months of age, serological testing is not sufficient to identify HIV infection
– virological testing must be provided as early as birth or at 6 weeks of age).
New technologies are now becoming available to perform this test at the point of
care and enable same-day results, which will accelerate appropriate linkage with
treatment and care.

HIV testing services

HIV testing should be voluntary and the right to decline testing should be
recognized. Mandatory or coerced testing by a health care provider or authority,
or by a partner or family member is not acceptable as it undermines good public
health practice and infringes on human rights.
New technologies to help people test themselves are being introduced, with
many countries implementing self-testing as an additional option to encourage
HIV diagnosis. HIV self-testing is a process whereby a person who wants to
know his or her HIV status collects a specimen, performs a test, and interprets
the test results in private or with someone they trust. HIV self-testing does not
provide a definitive HIV-positive diagnosis, but it should be used as an initial test
to be followed by confirmatory testing by a health worker. Many countries are
now using innovative approaches to develop and support HIV self-testing using
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digital platforms and on line support for help with the testing procedure and
linkage to services
The sexual partners and drug-injecting partners of people diagnosed with HIV
infection have an increased probability of also being HIV-positive. WHO
recommends voluntary assisted HIV partner notification services as a simple and
effective way to reach these partners – many of whom are undiagnosed and
unaware of their HIV exposure and may welcome support and an opportunity to
test for HIV. Partner services can be highly acceptable and effective but should
always be provided in a way that respects the choices of the people being offered
these services. It must always be voluntary and support and options provided
to avoid any potential social harms.
All HIV testing services must follow the WHO-recommended principles known as the
“5 Cs”:
• informed Consent
• Confidentiality
• Counselling
• Correct test results
• Connection (linkage to care, treatment and other services).

Prevention
Individuals can reduce the risk of HIV infection by limiting exposure to risk
factors. Key approaches for HIV prevention, which are often used in
combination, are listed below.
Male and female condom use
Correct and consistent use of male and female condoms during vaginal or anal
penetration can protect against the spread of STIs, including HIV. Evidence
shows that male latex condoms when used consistently have an 85% or greater
protective effect against HIV and other STIs.
Testing and counselling for HIV and STIs
Testing for HIV and other STIs is strongly advised for all people exposed to any
of the risk factors. This enables people to learn of their own HIV status and
access necessary prevention and treatment services without delay. WHO also
recommends offering testing for partners or couples. Additionally, WHO
recommends voluntary assisted partner notification approaches, in which people
with HIV receive support to inform their partners either on their own, or with the
help of health care providers. Programs that offer support for testing people in

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social networks can also be an effective and acceptable approach for some
populations.
Testing and counselling, linkages to tuberculosis (TB) care
TB is the most common illness among people living with HIV. Fatal if undetected
or untreated, TB is the leading cause of death among people with HIV,
responsible for nearly 1 in 3 HIV-associated deaths.
Early detection of TB and prompt linkage to TB treatment and ART can prevent
these deaths. TB screening should be offered routinely at HIV care services, and
routine HIV testing should be offered to all patients with presumptive and
diagnosed TB. TB preventive therapy should be offered to all people living with
HIV who do not have active TB. Individuals who are diagnosed with HIV and
active TB should urgently start effective TB treatment (including for multidrug-
resistant TB) and ART.
Voluntary medical male circumcision (VMMC)
Medical male circumcision reduces the risk of heterosexually acquired HIV
infection in men by approximately 50% including in ‘real world’ settings where
scale up occurred alongside the increasing coverage of ART with its secondary
prevention effect. In 2020, WHO updated the 2007 recommendation for VMMC
to continue as an additional prevention intervention among males age 15 years
and older. This is a key intervention of a combination prevention strategy in
settings with high HIV prevalence, particularly countries in eastern and southern
Africa . VMMC also reduces the risk of other sexually transmitted infections. At
the end of 2019, 27 million adolescent boys and men in eastern and southern
Africa had been provided with a package of services. Over 15 million VMMCs
were performed between 2016 and 2019. The service package, includes
education on safer sex and condom use, offer of HIV testing, management of
sexually transmitted infections in including links to treatment as needed, and the
surgical procedure. VMMC is regarded as a good point of contact between men
and adolescent boys and health services, which they often do not seek out; and
other services such as hypertension screening are offered in some settings.

Use of ARVs for prevention

Secondary prevention benefits of ART
Several studies confirmed that if an HIV-positive person is taking ART and is
virally suppressed they do not transmit HIV to their uninfected sexual partners
WHO recommended that all people living with HIV should be offered ART with
the main aim of saving lives and contributing to reducing HIV transmission.
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Pre-exposure prophylaxis (PrEP) for HIV-negative partner

Oral PrEP of HIV is the daily use of ARVs by HIV-negative people to block the
acquisition of HIV. More than 10 randomized controlled studies have
demonstrated the effectiveness of PrEP in reducing HIV transmission among a
range of populations, including serodiscordant heterosexual couples (where one
partner is infected and the other is not), men who have sex with men,
transgender women, high-risk heterosexual couples, and people who inject
drugs.
WHO recommends PrEP as a prevention choice for people at substantial risk of
HIV infection as part of a combination of prevention approaches. WHO has also
expanded these recommendations to HIV-negative women who are pregnant or
breastfeeding. For men who have sex with men “event driven’ PrEP is also an
effective PrEP option. This is taking two pills sex between two and 24 hours in
before sex; then, a third pill 24 hours after the first two pills, and a fourth pill 48
hours after the first two pills. This is often known as the 2+1+1. Long acting
PrEP products including an injection and a vaginal ring show promise and WHO
will continue to review the data on these for future guidance.
Post-exposure prophylaxis for HIV (PEP)
PEP is the use of ARVs within 72 hours of exposure to HIV to prevent infection.
PEP includes counselling, first aid care, HIV testing, and administration of a
28day course of ARV drugs with follow-up care. WHO recommends PEP use for
both occupational and non-occupational exposures, and for adults and children.
Harm reduction for people who inject and use drugs
People who inject drugs can take precautions against becoming infected with
HIV by using sterile injecting equipment (including needles and syringes) for
each injection, and not sharing drug-using equipment and drug solutions.
Treatment of drug dependence, in particular, opioid substitution therapy for
people dependent on opioids, also helps to reduce the risk of HIV transmission
and supports adherence to HIV treatment. A comprehensive package of HIV
prevention and treatment interventions for people who inject drugs includes:
• needle and syringe programs;
• opioid substitution therapy for people dependent on opioids, and other evidence-
based drug dependence treatment;
• HIV testing and counselling;
• HIV treatment and care;
• risk-reduction information and education, and provision of naloxone to prevent
opioid overdose;
• access to condoms; and
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• management of STIs, TB and viral hepatitis.

Elimination of mother-to-child transmission of HIV

The transmission of HIV from an HIV-positive mother to her child during
pregnancy, labor, delivery or breastfeeding is called vertical or mother-to-child
transmission (MTCT). In the absence of any interventions during these stages,
rates of HIV transmission from mother-to-child can be between 15% and 45%.
The risk of MTCT can almost be eliminated if both the mother and her baby are
provided with ARV drugs as early as possible in pregnancy and during the period
of breastfeeding.
WHO recommends lifelong ART for all people living with HIV, regardless of their
CD4 count and the clinical stage of disease; this includes pregnant and
breastfeeding women. In 2019, 85% of the estimated 1.3 million pregnant
women living with HIV globally received ARV drugs to prevent transmission to
their children. A growing number of countries and territories are achieving very
low rates of MTCT, with some formally validated for elimination of MTCT of HIV
as a public health problem (Anguilla, Antigua and Barbuda, Armenia, Belarus,
Bermuda, Cayman Islands, Cuba, Malaysia, Maldives, Montserrat, Saint Kitts
and Nevis, and Thailand). Several countries with a high burden of HIV infection
are also progressing along the path to elimination.

Prevention Methods
A – Abstinence
B – Be Faithful
C – Careful Sex (Consistent and Correct Use of Condom)
D – Don’t inject Drugs / Don’t share needles and Syringes

Treatment
HIV can be suppressed by treatment regimens composed by a combination of
3 or more ARV drugs. Current ART does not cure HIV infection but highly
suppresses viral replication within a person's body and allows an individual's
immune system recovery to strengthen and regain the capacity to fight off
infections.
Since 2016, WHO recommended that all people living with HIV be provided with
lifelong ART, including children, adolescents and adults, and pregnant and
breastfeeding women, regardless of clinical status or CD4 cell count. By the end

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of 2019, 185 countries had already adopted this recommendation, covering 99%
of all people living with HIV globally.
The current HIV treatment guidelines include new ARV options with better
tolerability, higher efficacy, and lower rates of treatment discontinuation when
compared with previous recommended medicines. In 2019, WHO recommends
the use of dolutegravir-based or low-dose efavirenz for first-line therapy. DTG
should also be used in 2nd line therapy, if not used in 1st line and
darunavir/ritonavir is recommended as the anchor drug in third- line or an
alternative option second-line therapy.
By mid-2020, transition to dolutegravir has been implemented in 100 low- and
middle-income countries and is expected to improve the durability of the
treatment and the quality of care for people living with HIV. Despite
improvements, limited options remain for infants and young children. For this
reason, WHO and partners are coordinating efforts to enable a faster and more
effective development and introduction of age-appropriate pediatric formulations
of new ARV drugs.
In addition, 1 in each 3 people living with HIV present to care with advanced
disease, usually with severe clinical symptoms, low CD4 cell counts, and at high
risk of develop serious illness and death. To reduce this risk, WHO recommends
that these individuals receive a “package of care” that includes screening tests
and drug prophylaxis for the most common serious infections that can cause
severe morbidity and death, such as TB and cryptococcal meningitis, in addition
to rapid ART initiation.
Globally, 25.4 million people living with HIV were receiving ART in 2019. This
equates to a global ART coverage rate of 67%. However, more efforts are
needed to scale up treatment, particularly for children and adolescents. Only
53% of children were receiving ART at the end of 2019.
Expanding access to treatment is at the heart of a set of targets for 2020, which aim
to bring the world back on track to end the AIDS epidemic by 2030.

Closure

Congrats! You have finished the second and last lesson for the third module
about health education and promotion against the different diseases that are
rampant in our country. It is now your duty to protect yourself and family
members even your community against these diseases. Now that you known
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about how to protect yourself against diseases, it is now time for you to know the
different techniques to save lives in any eventuality. The nest module will help
you learn basic concepts on First Aid, Basic Life Support and Disaster Risk
Reduction and Management.

References

World Health Organization. (n.d.). Module A: Introduction to Emerging respiratory

viruses, including COVID-19. OpenWHO. Retrieved August 6, 2020, from
https://openwho.org/courses/introduction-
toncov/items/4G8HHcDBaEAkArrbFh84e9
World Health Organization. (2020a). About the Module | Introduction to
Poliomyelitis and the Global Polio.
https://openwho.org/courses/poliointroduction/items/
6c5giCmCLMM2jOKTrs5EdE
World Health Organization. (2020b, July 6). HIV/AIDS.
https://www.who.int/newsroom/fact-sheets/detail/hiv-aids
World Health Organization. (2020, March 24). Tuberculosis.
https://www.who.int/news-room/fact-sheets/detail/tuberculosis

Module Summary
Community health is an important factor to ensure that the economy, peace and
stability will be achieved. In this module you have learned that dangerous drugs
still pose a threat to the people around. It destroys life and family and we should
ensure that there will be no place for illegal drugs in our community.

Likewise, other health concerns such as the COVID-19, tuberculosis,

poliomyelitis and HIV/AIDS are still proliferating in our society despite the efforts
of the government to give health education and treatment to this health
problems.

Module Assessment
With the remaining space or you may use the next page, project your ways to
protect the youth from the illegal drugs and health problems through a poster
and slogan (You may use any methods for poster and slogan to project your
thoughts e.g. pastel, charcoal, digital drawing, etc.)

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