LECTURE FOUR

HIV TRANSMISSION

Expected Learning Outcomes

At the end of this lecture the learner should be able to:
1. To explain factors leading to HIV risk
2. Describe the routes of HIV transmission
3. Discuss the mother to child transmission

How Does Someone Become Infected with HIV?

A person with HIV infection may have a high level of virus certain body fluids
 High levels: Blood, semen, vaginal fluids
 Low levels: tears, saliva, urine
Infection occurs when:
 An infected person’s blood, semen, vaginal fluid contacts an uninfected
person’s blood or mucous membranes
Factors leading to HIV risk among the youth in Kenya
 Many young people are sexually active and involve in risky behaviour
including alcohol, drug use, and challenging of authority.
 Majority of them do not know their HIV status.
 The youth are economically dependent, socially inexperienced, have poor
knowledge about protection from infection and have less access to health
care.
 Social norms and expectations and peer option affect youth behaviour and
increase health risk.
 Young women are a particular risk because of sex trade, sugar daddies who
entice them with gifts, school fees etc.
 Problems of civil unrest, which bring about internally displaced people and
refugees has aggravated the HIV/AIDS long incubation period and lack of
immediate apparent consequences is particularly hard for the youth to grasp.
  Prevention can entail high potential social cost of the youth such as loss of
relationship, loss of trust and loss of per acceptance, which distorts their
sense of vulnerability to HIV/AIDS.
HIV Transmission
HIV is found in all body fluids of infected people. For infection to occur, the virus
needs:
 a high enough concentration
 an entry route
 efficient transmission
HIV can only be transferred through:
 the sex route (70%) of all infections
 the blood route (20%) of all infections
 the mother-to-child route (10%) of all infections
Unprotected penetrative sex:
 Vaginal
 Anal
 oral
Mother to child route during:
 Pregnancy
 Delivery
 Breastfeeding
The blood route:
 Transfusions
 Injections
 Cutting instruments
 Contact with broken skin
 Needle stick injury
  Mucous membrane splash
 Sharing items like razor blade & toothbrush
Factors that increase the likelihood of spread
 The more the virus in a body, the more its likely to spread
 The virus enters a body more easily when sores, wounds or infection are
present
Mother to Child Transmission (MTCT)
MTCT is the predominant mode of transmission of HIV in infants and young
children. This transmission occurs during pregnancy, labour and delivery and,
among breastfed babies, in the post-partum period.
Most likely to occur when viral load is high
In the womb before delivery
 More common in mothers with acquired infection during pregnancy
 Malaria can increase the risk of transmission to baby
During the delivery process - Most common time
Breastfeeding
Factors that increase likelihood of transmission to child
 High virus levels in mother’s blood
 Low CD4 (weakened immune system)
 New HIV infection of mother (since onset of pregnancy)
 Vitamin A deficiency (weakened vaginal mucosa)
 Certain virus characteristics
 Maternal drug use, esp. 1st trimester
 Obstetric factors
Factors that decrease likelihood of transmission to child
 Elective cesarean section (for patients not on ARV treatment)
 HIV treatment (ARV)
 Combination medication
 Antiretroviral drugs to exposed babies
Reasons for Fast spread of HIV
 Ignorance
 False Information
 Inadequate information from parents
 Fear, denial, shame and stigma
 Poverty, malnutrition, poor health care
 Separation of families
 Traditions

SUMMARY
This lecture has centered on factors leading to HIV risk, routes of HIV
transmission as well as an in-depth on mother to child transmission

Further reading
Hardy WD. 2019. Fundamentals of HIV Medicine. Oxford University Press.
ISBN 0190942495, 9780190942496
 Activity

Ms. J.B. is a 28-year-old woman brought to the Emergency Department in

severe breathing problem. A neighbor who brought her to the hospital
reported that he found the door of her apartment was left unlocked. Ms. J.B.
was unconscious lying on a blood-and-sweat-stained mattress in the sitting
room. Her physical examination reveals an emaciated, dehydrated,
unresponsive woman with sores in her mouth and fungal infection on her
groin. She had injection marks on her hands, neck, and feet.

Her laboratory test was positive for HIV and CD4 count was 350 cells/ml.

1. What is the status of disease progression for Ms J.B based on the above
information? (5 marks)
2. Explain the mechanism of HIV in the attack against the immune system
(5 marks)