Basics of HIVAIDS by Melaku

Wollo university
College of Medicine and Health Sciences

Department of Public Health
Course title: HIV/AIDS, SRH (sexual and
reproductive health)) and Life skills
By Melaku Y(PH, MPH in RH)
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Course Delivery
 HIV/AIDS AND SRH
• It will be delivered by Public health department
• Accounts- 50% Time and Mark
 LIFE SKILLS
• It will be delivered by Psychology department
• Accounts -33% Time and Mark
 GENDER AND HEALTH
• It will be delivered by Sociology department
• Accounts-17% Time and Mark
Total 100% with 3 credit hours
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CHAPTER – ONE
HIV/AIDS

OBJECTIVE
At the end of this chapter the students will be able to:
Define HIV and AIDS
Distinguish the differences between HIV and AIDS;
Explain the modes of transmissions and Preventions of
HIV/AIDS;
Describe Risk and Vulnerability factors related to HIV/AIDS
Explain the major impacts of HIV/AIDS at different levels;
Elucidate the importance of HIV testing in the prevention,
treatment, care and other support services;
Contents
• Overview of HIV/AIDS
• Mode of transmission
• Risk and vulnerability
• Common misconception on HIV/AIDS
• HIV Counseling and Testing
• Prevention, Treatment, Care and support
• Basic intervention of HIV/AIDS at community

Acronyms & Abbreviations
ABC--------Abstinence Be faithful and used Condom
AIDS------Acquired Immune Deficiency Syndrome
ART--------Antiretroviral Treatment
HIV---------Human Immunodeficiency Virus
HTP--------Harmful Traditional Practice
PLHIV------People Living with HIV
PMTCT-----Prevention of Mother-to-Child Transmission
SRH--------Sexual and Reproductive Health
STI--------Sexually Transmitted Infection
YFS-------Youth Friendly Service
OI----------opportunistic
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Common terminologies
Antibody: A protein (immunoglobulin) made by the body’s
immune system to recognize and attack foreign substances
Antigen: A substance which is recognized as foreign by the
immune system.
• Antigens can be part of an organism or virus, e.g., envelope,
core (p24).
CD4 receptor: A protein present on the outside of infection-
fighting white blood cells.
• CD4 receptors allow HIV to bind to and enter cells.
Terminologies Cont…
Co-receptor: In addition to binding a CD4 receptor,
HIV must also bind either a CCR5 or CXCR4 co-
receptor protein to get into a cell.
T-lymphocyte: A type of white blood cell that detects
and fights foreign invaders of the body.
Window period: the time period from infection with
HIV until the body produces enough HIV antibodies to
be detected by standard HIV antibody tests.
Terminologies Cont…
HIV/Human Immunodeficiency Virus/; a virus that
weakens the body’s immune system, ultimately causing
AIDS.
Affected persons: Persons whose lives are changed in
any way by HIV and AIDS due to the broader impact of
this epidemic.
AIDS: Acquired Immuno Deficiency Syndrome, a cluster
of medical conditions and the most advanced stage of
HIV infection.
Terminologies Cont …
AIDS patients: Are people whose resistance to
diseases is severely destroyed by HIV, to the extent
that their bodies fail to resist even mild disease and
different manifestations of diseases appear.
ART: The use of HIV medicines to treat HIV
infection is called antiretroviral therapy (ART).

1. Overview of HIV/AIDS
1.1 Introduction
• The successful introduction and spread of HIV in human population has
occurred due to:
 The discovery and widespread use of antibiotics cure for most STIs
Which changes people’s perception about risks of sexual activity.
 The development of hormonal contraceptives hastened the pace of
change in sexual practices, as prevention of pregnancy without barrier
methods.
 Changing Lifestyles allowing for greater social migration and sexual
mixing
 No curable
Introduction Cont…
• HIV/AIDS is one of the most destructive
diseases of human kind has ever faced.
• It brings profound social, economic and public
health consequences.
• It has become one of the world’s most serious
health and development challenges.
• It is a leading cause of death world wide.
1.2 History of HIV/AIDS
• 1981-CDC(USA): unexplained PCP/KS in previously healthy
homosexual men
• 1983:HIV virus was isolated from a patient with lymphadenopathy.
• 1984-HIV virus clearly demonstrated to be the causative agent
• Serologic test started in 1985 (antibody test for HIV infection)
• 1986-human immunodeficiency virus (HIV) accepted as international
designation for the retrovirus in a WHO consultative meeting
• Antiretroviral was first started in 1987, combinations antiretroviral
therapy HAART in 1996 globally.

History of HIV/AIDS …
Ethiopia:
• HIV was first detected in Ethiopia in the stored
sera collected in 1984 and
• The first two AIDS cases were reported in 1986.
• Antiretroviral was first started in Ethiopia in 2003,
free antiretroviral therapy in 2005.

1.3 Basic concepts and facts about HIV/AIDS
HIV stands for human immunodeficiency virus or the
virus that causes AIDS.
H: Human - The virus infects only human beings
I: Immunodeficiency - The virus weakens the immune system
V: Virus – That attacks human body
HIV is the smallest microorganism seen only with
microscope
It can only survives and multiplies in body fluids
Basic concepts and facts Cont..
HIV is a virus that causes infection and affects the
immune system
By killing or damaging cells of the body’s immune
system, HIV slowly destroys the body’s ability to fight
infections and certain cancers,
 Gradually it leads to the developing of opportunistic
infections, at the end develops AIDS.

Basic concepts and facts Cont…
AIDS is acquired immunodeficiency syndrome and refers the
most advanced stage of HIV infection.
A: Acquired (not inherited) to differentiate from a genetic or
inherited condition that causes immune dysfunction.
I: Immuno, because it attacks the immune system and increases
susceptibility of infections
D: Deficiency of certain white blood cells in the immune system
S: Syndrome meaning a group of symptoms or illness that result
from HIV infection.
Basic concepts and facts Cont…
There is a strong link between HIV and AIDS,
but they are not the same.
AIDS is the disease that results from the
breakdown of the immune system by HIV.
It is the final stage of HIV infection, and this is
what causes a person to die.
But HIV infection and AIDS are easily
preventable
Types of HIV
There are 2 main Types of the virus:
A. HIV- 1: is the most common cause of HIV Disease throughout the
world and it has several groups and subtypes;
1. M group (major) which is responsible for most of the infections in
the world and comprises 9 subtypes: A, B, C, D, F, G, H, J and K.
Subtype C is the most common worldwide including Ethiopia.

Cont…
2. O group (outliers): relatively rare viral form originally seen in Cameron

and Gambon and France.
3. N group: reported only in Cameroon
Similarities:
• Transmitted through the same routes
• Associated with similar opportunistic infections
• Hence the impact of both HIV-1 and HIV-2 are the same throughout
this module we call it as HIV.

Differences…
HIV-2:
• Was first identified in Western African countries most
often found in West Central Africa, parts of Europe
and India
• It is less easily transmittable
• Develops more slowly and MTCT is relatively rare.
• Less pathogenic/ less disease causing ability

Cont…
HIV-1:
is more infectious and has a much greater ability to be transmitted
between people and has rapid progression than HIV-2.
Most common in sub-Saharan Africa and throughout the world
Groups M, N, and O
Pandemic dominated by Group M
 Group M comprised of sub types A – J

Characteristics of HIV
• Our body has 3 blood cells: white blood cells, Red
blood cells and platelets
• HIV infects white blood cells (WBC) that express CD4
receptor molecules
• One of these cells are T4-lymphocytes ( T-helper cells)
• It ‘switch on’ the immune system to fight disease
• HIV uses the CD4 receptors and Co-receptors of
WBCs to enter the cells for its replication
Structure of HIV cell
• HIV is
composed of
three main
layers:
Envelope
Viral
Matrix
Core
Steps/life cycle/ of HIV in human body
1. HIV attaches to the CD4 cell and releases RNA & enzymes
2. The enzyme reverse transcriptase makes DNA copy of the viral
RNA.
3. New viral DNA is then integrated using the enzyme integrase
in CD4 cell nucleus.
4. New viral components are then produced using the cell as a
machinery
5. These are assembled together using the enzyme protease.
6. The assembled proteins are released as new viruses and go on
to infect other CD4 cells and continue to reproduce
Mechanism attachment

Steps in life cycle of HIV in the body

1.4 Magnitude and current status
• The world is committed to ending AIDS epidemic on 2030
1. Globally:
• There were approximately 36.7 million [ 30.8 million–42.9
million ] people living with HIV in 2016.
• Worldwide, 1.8 million [1.6 million–2.1 million] people
became newly infected with HIV in 2016.
• 76.1 million [65.2 million–88.0 million] people have become
infected with HIV since the start of the epidemic
Cont …
•Around 53% [39–65%] of all people living with HIV had
access to treatment.
•New HIV infections among children declined by 47% since
2010, from 300,000 [230,000–370,000] in 2010 to 160,000
[100,000–220,000] in 2016.
•AIDS-related deaths have fallen by 48% since the peak in 2005.
•From all pregnant women living with HIV globally received
medicines that prevent transmission to their babies was 77%
(69%-86%) in 2015.
Magnitude and current status …
2. Sub Sahara Africa
• Sub-Saharan Africa alone accounted for about 69%
of all people living with HIV and 70% of all AIDS
deaths
• In 2016, there were 5,000 new infections per day in
Africa.
• Out of these, 64% were in Sub-Saharan Africa,
• About 37% are among 15-24 years old.
Sub Sahara Africa
Figure 1: Eastern and Southern Africa Data

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on HIV and AIDS
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Magnitude and current status …
3. Ethiopia :
• HIV prevalence is relatively low in Ethiopia, with 1.5 percent
of the population age 15-49 HIV positive.
• Women have a higher HIV prevalence 1.9% than men 1.0%.
• peak age 30-34 for women 3.7 % and,
35- 39 for men which is 3.0%
• Marked Urban and rural variation with urban areas showing a
seven fold higher HIV prevalence compared to rural areas
(4.2% versus 0.6%). 2011 EDHS
Ethiopia
• Figure 2: Age and Sex Distribution of HIV Prevalence, EDHS 2011

HIV prevalence among youth
• Overall, less than 1% of Ethiopian youth age 15-24

positive for HIV.
• Three behaviors that correlate with STI/HIV rates are;
the number of sexual partners,
age at first sexual intercourse, and
condom use.
• HIV prevalence is relatively high among young
respondents who report two or more sexual partners
6.7%.
HIV Prevalence and STIs
• A strong link exists between STIs and HIV infections.
• STIs are a co-factor for HIV transmission.
• Management and treatment of STIs can play an important
role in the reduction of HIV transmission.
• Higher percentage of people with STIs 4.7% than of those
with no STIs 2.0%.
• This pattern is observed among both women and men.

1.5. Modes of HIV transmission
1. Natural history of HIV infection:
 It is the progress of a disease process in an individual over
time, in the absence of intervention.
 Natural history of HIV is the course of the viral processes in
the human body without applying any intervention until the
end of the course. The end result of HIV infection is
AIDS Death.

Natural history of HIV infection…
•• Stage
Stage II •• Stage
Stage IIII •• Stage
Stage III
III •• Stage
Stage IV
IV
•• Minor
Minor Symptoms
Symptoms •• Moderate
Moderate
•• Asymptomatic
Asymptomatic •• AIDS
AIDS
Symptoms
Symptoms

Clinical course of HIV infection
 four stages in clinical course of HIV:
Seroconversion: HIV infection develop antibodies.
-Changed from antibody negative into antibody positive
 Asymptomatic: No signs of HIV, immune system
controls virus production
 Symptomatic: Physical signs of HIV infection, some
immune suppression
 AIDS: Opportunistic infections, end-stage disease
Patterns of HIV Progression
1. Rapid Progressor's (5-10%)
• AIDS stage within 1-2Yrs
2. Intermediate Progressor's (80-90%)
• Asymptomatic until 5-8Yrs
3. Slow Progressor's (5-10%)
• Good immune response
• AIDS stage within 10-15Yrs, rare

2. Means of HIV Transmission

Modes of HIV Transmission
Sharing Semen and Sharing Needles Needle Stick

Vaginal Fluids & Syringes Injury
Through Infected Blood During Pregnancy Breast Feeding

or Birth
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Modes of HIV Transmission
• Major body fluids that can transmit HIV:
– Blood and blood products
– Semen
– Vaginal fluid
– Breast Milk
• The virus can only be spread from an infected person if
his or her bodily fluids enter the bloodstream of an
uninfected person
Transmission through sexual relation
1. Unprotected sexual intercourse; and
2. Direct contact with body fluid:
• Unsafe Sex with an infected person is contributor for the
majority of HIV infections.
• HIV is primarily considered a sexually-transmitted infection.
• However, different types of sexual relations have different
degrees of risk for transmitting HIV infection.

Transmission through sexual relation...
Anal sex:
Among sexual practices, anal sex represents the biggest risk of
infection if one of the partners is HIV-infected.
Because of anal mucosa does not produce a natural
lubrication(vagina has natural lubricant), is fragile, and
wounds and bleeds very easily.
The penis can have micro-lesions, which permit the entrance
of the virus into the bloodstream.
Vaginal sex:
 HIV virus can be found in large quantities in semen, and to a
lesser amount in vaginal secretions of infected persons.
 The risk of infection is still high, but less than with anal sex
 Vaginal sex nevertheless represents a serious risk of HIV
infection because the vaginal mucosa can still have micro-lesions
during penetration, it permits the entry of the virus.
 The soft tissue of the foreskin in uncircumcised men seems
to be especially vulnerable to the entry of the HIV virus.
Transmission through sexual relation...
Oral sex
Compared to anal and vaginal sex, oral sex represents the
lesser risk for infection.
Oral sex may have some risk however there are no reports so
far attributable to oral sex.

Transmission through blood and blood products
 HIV can be transmitted through:
1. Receiving infected blood or blood products (infected transfusions) and
transplantation of an infected organ or tissue;
2. The use of contaminated injection (sharing needles, jewelry, IV drugs,
or needles or other sharp objects);
3. Sharing cutting tools (using contaminated skin-piercing instruments,
such as scalpels, needles, razor blades, circumcision instruments); and
4. Contact with broken skin (exposure to blood through cuts or lesions).
Transmission from mother to child
• Majority of (>90%) the source of the HIV infection to
the age < 15yrs children is from the mother.
• MTCT can occur 1. during pregnancy(5-10%),
2. labour and delivery(15-20%), and
3. breastfeeding(10-15%).
• It is however important to note that not all HIV infected
women will automatically transmit the virus to their
child.
Transmission from mother to child…
Risk factors influence on MTCT of HIV
1. Maternal factors:
High viral load
Low CD4 count with advanced disease
Prolonged rupture of membrane
HIV infection during pregnancy/ breast feeding
Mixed feeding
Crackled nipples and breast abscess
Transmission from mother to child…
Risk factors influence MTCT of HIV
2. Infant factors
Prematurity
Oral thrush and ulcer(wound)
Birth order (first twin) in twin pregnancies
Invasive fetal monitoring during labour and delivery
Instrumental delivery
Other ways in which children can get HIV are
–Sexual abuse
–Unsafe injections/injection by local healer
–Blood transfusion from HIV infected blood products
–Wet nursing by untested woman
–Manipulation by local healer
–Feeding children by chewed food by the mother
–Using sharp object contaminated with HIV infected
blood.
Modes HIV transmission…
• Contributing Factors for HIV Transmission in general
1. Behavioral factors:
• Level of awareness
• Multiple casual sexual contact
• Alcohol and drug use
• Condom use
• Health seeking behavior – treatment of STI, HIV
testing
Contributing Factors for HIV …
2. Socio-economic & cultural factors:
–Stigma and denial
–Poverty and mobility
–Cultural practice
–Gender inequality
–Conflict

Contributing Factors for HIV Transmission…
3. Biological factors:
–High viral load
–Viral properties
–Being the receptive partner
–Sex during menstruation
–Uncircumcised male
–Damage to genital skin / mucous membrane
–Having a sexually transmitted infection
HIV is NOT transmitted through
 body fluids like tears, sweat and urine.
Personal contacts: kisses on the mouth, hugging, handshakes.
Social contacts: during the work, in school, cinema,
restaurant.
Air or water: sneezing, coughing, swimming pool, swimming
in the sea.
Contact with common items: pens, toilets, towels, sheets, soap
Insects: mosquito bites or other insects.
Risk and vulnerability
• HIV is a biological entity that is responsive to medical interventions,
but the epidemic has continued to expanded, largely due to the failure
to tackle societal conditions that increases HIV risk and vulnerability.
• Risk is defined as the probability or likelihood that a person may
become infected with HIV.
• Vulnerability results from a range of factors outside the control of the
individual that reduces the ability of individuals and communities
avoid HIV risk.

The behavior related risk factors for the epidemic of HIV in
Ethiopia includes:
• Multiple and concurrent sexual partnership
• Early sexual start and sexual experimentation
• Unsafe sexual practice
• Transactional and intergenerational sex
• Repeated episodes of sexually transmitted infection (STIs)
and low treatment seeking behaviors
• Mobility/migration of population
Vulnerability Factors
Vulnerability factors in Ethiopia in general include:
Biological:
• Sex, age
Life styles
• Lack of parental guidance or support
• Lack of open communication with parents and peers
• Inadequate stress coping skills;
• Abusing the use of social media, availability of internet
pornographic sites, video
• houses which show porn films.
Environmental Factors
• Inadequate life skills building programs
• Lack of youth friendly service and supplies
• Lack of information on service availability
• Inadequate income generation activities
• Lack of counseling services
• In tourist destinations: tourists use students as sex workers through
dealers etc.;
• Availability of big cities, constructions areas, etc.

Vulnerability factor cont…
Societal
• Peer pressure
• Harmful traditional practices like early marriage
• Surrounding environment like bars, “shisha” and ‘chat’ houses, dealers around
university compounds
• Lack of comprehensive knowledge about HIV/AIDS, sexual and reproductive
health;
• Lack of awareness, concrete facts and knowledge related to HIV and other SRH
issues;
Economic
• Inappropriate use of money by students
• Economically/financially weak students who do sexual activity for money

Risk and vulnerability…
Vulnerability also includes;
• Unequal opportunities,
• Social exclusion,
• Unemployment, or uncertain employment and
• Other social, cultural, political, and economic factors that
make a person more susceptible to HIV infection and to
developing AIDS.
• The factors underlying vulnerability may reduce the ability of
individuals and communities to avoid HIV risks.
• Cultural manifestations of denial, AIDS-related stigmas and
discrimination vary from culture to culture.
• Still, in many traditional African cultures, illness is attributed
to spirits and supernatural forces, and these beliefs may be
associated with stigmatizing afflicted persons.
• At the time when those infected really need social support the
most, people living with HIV/AIDS who reveal their status are
often subjugated to victimization and discrimination.

• This happens everywhere starting from their own
homes, within the communities they live in, as well as
at work.
• Consequently, there is a strong culture of silence by
people living with HIV/AIDS because of fear of
rejection and isolation from both close relatives and the
community at large.
• Results hide themselves while engaged in high-risk.
• There is growing local empirical evidence that suggests a
link between substance abuse and HIV infection.
• Alcohol intake increases sexual risk-taking behavior.
• When alcohol or any other illicit drug is consumed in
excessive amounts, it has been found to inhibit a
person’s ability to engage in safer sex practices.

Populations at Higher Risk and vulnerable to HIV Infection
•Sex workers globally risk populations
•In Ethiopia high risk group include,
1. sex workers,
2. Men who have sex with men (Gays)
3. Injecting drug users
4. Uniformed forces(police and armed forces)
5. Prisoners
6. University/collage students,
7. Migrant daily labourers,
8. Long distance drivers and
1. Cultural norms:
• Multiple partner and condom use
• Age at first sexual intercourse
2. Women and young girls:
• Male and females are disproportionately vulnerable to HIV.
 Women's physiological or biological susceptibility – at least 2 to 4
times greater than men’s.

3. Female and males involved in sex work.
More females involved in commercial sex work than males
especially with out condom.
• What Motivate them?
Need for money
Drug or alcohol
coercion.
4. Substance users or abused ( chat, cigarette and drugs)
This leads to : CSW, Transactional/ Forced sex
5. Higher institution students:
 Why higher education students vulnerable to HIV infection include:
• Lack of comprehensive knowledge about HIV/AIDS and sexual
reproductive health issues
• Financial insecurity
• Lack of proper counseling
• Peer pressure
• Absence of discussion with parents before joining university
• Gender-based violence
• Low level of perceived risk of HIV
Common misconception
• I can get HIV by being around people who are HIV positive
• I don’t need to worry about becoming HIV positive , new
drugs well keep me well
• I can get HIV from insect bite
• I am HIV positive , my life is over
• If I am receiving treatment , I can’t spread HIV
• My partner and me HIV positive, there is no any reason for
us to practice safer sex.
Misconception cont…
• Sexual intercourse with a virgin will cure AIDS
• HIV antibody testing is unreliable
• HIV-positive individuals can be detected by their appearance
• HIV cannot be transmitted through oral sex
• HIV can infect only homosexual men and drug users
• An HIV-infected mother cannot have children
• HIV/AIDS can be cured.
• People cannot get HIV from tattoos or body piercing

Origins of common misconception
• Lack of knowledge
• Gender inequality
• Limited access to variety of medias

Correcting misconceptions
• Since individuals who are infected with HIV and AIDS are
often perceived as "other," this reinforces the former
misconception. It can corrected by:
• IEC and BCC at all level of society and community
• Developing curriculum to special and risk group of people
• Empower women and gender equality

1.6. Impacts of AIDS
Demographic Impacts
With the continued AIDS epidemic, the total population of
Ethiopia would be 85 Million by 2014, which is 7 Million
smaller than the projection without AIDS.
It affects maternal mortality ratio, infant mortality ratio,
fertility rate and other demographic variables
AIDS has a big impact on population size, growth and life
expectancy.

Impacts of AIDS…
Childhood deaths:
• The number of children dying from AIDS is increasing and
this negatively affects the outcomes of child survival
programs.

Impacts of AIDS…
Health Care Impacts
Costs of health care
• AIDS is an expensive disease that will require a considerable
amount of resources from the health system.
• This would place a tremendous burden on the public health
care system to provide adequate care for AIDS patients and
still try to meet all the other health needs of the population.

Cont…
• One fifth of all hospital in the country are occupied by AIDS
patients. HIV and
• Tuberculosis complex relation ship
• In the absence of HIV, the number of new TB infections would be
limited to about 0.12% of the adult population. But among
people with both HIV and latent TB infection, 8 percent develop
TB each year

Impacts of AIDS…
Economic Impacts
 AIDS has an impact on the economic development of
Ethiopia in a number of ways.
 The loss of young adults in their most productive years of
life.
 If AIDS is more prevalent among the economically well to
do, the best educated people and with the highest paying
jobs, then the impact could be much larger.

Impacts of AIDS…
The huge expenditures for care of AIDS patient will lead to
reduction in investment
AIDS affects foreign exchange.
It has been estimated that the foreign exchange
requirements for imported drugs could require from 7 to
37 weeks of entire foreign exchange quota if all AIDS
patients received complete drug treatment.

Impacts of AIDS…
So economic impacts are the result of
Loss of workers
Lost work days due to sickness
Lost work days due to funeral leave
Increased health care costs

Impacts of AIDS…
Social Impacts
 Grandparents will have to assume full responsibility for raising children
when parents die.
 Children are more likely to be malnourished, and have fewer
opportunities for education
 Increase in the number of orphans.
 A widow can also be forced to sell sex
 At family level -an increased burden and stress for the extended family.
 At community level and national level there will be an increased burden
on society to provide services for the orphaned children.
1.7. HIV Counseling and testing (HTC)
The Rationale of HTC:
 HT is first step in identifying and linking PLHIV to the treatment cascade
 It provides an important opportunity to reinforce HIV prevention among the
negatives and help them to remain negative by following the none risky
sexual practices.
 To attain universal access of comprehensive HIV/AIDS care and treatment
services
 Identify HIV infected person as early as possible and provide treatment for
those in need
 Identify sero-discordant couples and help prevention of further transmission of
virus.
 Reduce the stigma related to HIV
The five guiding principles of HTC
key principles that apply to all models of HIV testing and counseling and in all
circumstances:
1. People receiving HIV testing and counseling must give informed consent
(verbal consent is sufficient) to be tested and counseled.
 They should be informed of the process for HIV testing and counseling and
their right to decline testing.
2. HIV testing and counseling services are confidential,
 Although confidentiality should be respected, it should not be allowed to
reinforce secrecy, Stigma or shame.
 Counselors should raise, among other issues, whom else the person may wish to
inform and how they would like this to be done.
 Shared confidentiality with partner or family members and trusted others and
with health care providers is often
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The five guiding principles of HTC…
3. HIV testing and counseling services must be accompanied by appropriate and

high-quality pre-test information and post-test counseling.
 Quality assurance mechanisms and supportive supervision and mentoring
systems should be in place to ensure the provision of high quality of counseling.
4. HIV testing and counseling providers should strive to provide high-quality
testing services, and quality assurance mechanisms should be in place to ensure
the provision of Correct test results.
5. Connections to prevention, care and treatment services should include the
provision of effective referral to appropriate follow-up services as indicated,
including long-term prevention and treatment support.

HIV testing and counseling
• There are two types of HIV testing and counseling
mechanisms, these are:
1. Provider initiated HIV testing and counseling (PIHTC)
2. Voluntary HIV testing and counseling (VCT)

Steps of PIHTC
1. Providing basic pretest information on HIV and AIDS in groups
or individually
2. Offering testing for HIV
3. Testing for HIV
4. Declaring HIV test result
5. Providing posttest counseling
6. Linking those who are HIV positive to care and treatment and for
those who are negative provide prevention service packages
The eligible clients for routine HIV testing and
counseling
All pregnant, laboring, postpartum women with
unknown HIV status and their partners
All patients at TB clinics with unknown HIV status
All STI patients with unknown HIV status and their
partners
All family members of index cases
All under five children visiting HF
The eligible clients for routine HIV tes …
Children Orphaned by AIDS and vulnerable children
All family planning clients with unknown HIV status and
their partners
All most at risk populations (marginally at risk
population(MARPS)) and adolescent/youth clients (15-24
years),
 Clients coming with clinical signs and symptoms of
HIV/AIDS visiting health facilities.
Discordant couples
Voluntary HIV testing and counseling (VCT)
Objectives of VCT:
To assist individuals and couples to assess their HIV risk
behaviors, develop a risk reduction plan, and access HIV
testing
To facilitate referral services for the client who needs medical
and psychological support and ability to reduce HIV related
risk taking behaviors to ensure continuity of treatment, care
and other preventive and support services.

VCT benefit for HIV negative individuals
Client learn how stay negative.
 Couple can marry without doubt
 Couple can plan for future pregnancies without
doubt.
 Reduce anxiety about risk behavior
 Testing negative creates powerful motivation to
reduce risk behaviors and remain uninfected.
VCT Benefit for HIV positive person
Good counseling help clients avoid to pass the virus to
anyone else.
Client learn to take better care themselves to lead a longer
healthier life
 Client learn about TB & STD treatment, PMTCT and
family planning
 Client can access medical care and social support early

VCT Guiding principles
Voluntary attendance
Informed consent
Confidentiality
High quality, reliable, affordable prevention and
counseling services
Linkage to prevention, care, and support services
1.8. HIV Prevention, Care, Treatment and
Support program
Priority Areas :
• Community awareness, ownership and support
through targeted social mobilization
• Health sector focused prevention package
• Building the ART pipeline
• Incorporate a focus on quality of prevention,
care and treatment in design of activities
HIV Prevention, Treatment, Care and Support program
A. Primary Prevention
– Social mobilization: IEC/BCC
– ABC rules
– HIV counseling & testing : VCT & PITC
– STI prevention and control
– Infection prevention
– Post exposure prophylaxis
– Prevention of mother to child transmission (PMTCT)
1. Social mobilization: IEC/BCC
Socio-Behavioral Interventions
• encouraging correct and consistent condom use,
• a reduction in the number of sexual partners,
• abstinence and the delaying of sexual initiation among
youth.
• Blood screening
• Encouraging disclosure
For all PLHIV, counsel on safer sex and reducing risk
of transmission
• Even on ART, you can still transmit HIV.
• Be faithful to one partner, or use condoms consistently.
• Practice less risky sexual activities.
• Educate on symptoms of STIs, and necessity to consult for
prompt treatment.
• Dispel myths associated with HIV infection, transmission, and
treatment.
• Advice individuals not to have casual sex
Continue …
2. ABC methods: safer sex practice
• A -Abstinence: 100% effective with ALL STI’s. Everyone has
the right to abstain.
• B- Be faithful:
Trust/Honesty
 Monogamy
Knowledge about sexual history
Still get checked once a year, regardless of
monogamy or not
• C- Condom use: Are only around 97% effective
Condom use
When using a condom you should remember to:
Make sure the package is not expired
Make sure to check the package for damage
Do not open the package with your teeth for risk of
tearing
Never use condom more than once

• After ejaculation, female should hold condom in place
while removing penis from vagina, when using male
condom.
• Female condom should be inserted before penis
touches vagina (can stay up to eight hours before sex).
• After ejaculation, the woman must move away from
partner and take care not to spill semen on vaginal
opening when using female condom.
• Dispose of used condom properly for both.
Condoms
How to use a condom

   

Use a new Place condom on Unroll condom After ejaculation, Throw away
condom for each tip of penis with all the way to hold rim of condom used condom
sex act rolled rim base of penis so it will not slip off, properly
facing away and withdraw penis
from body from vagina while
still erect
• Open package
• Put condom on • If condom does not
carefully. • Move away
before penis unroll easily, it may be Always throw
• Check the expiry or from partner first.
touches vagina. backwards or too old. If away in bin or
• Do not spill
manufacturing date. • If uncircumcised, old, use a new condom. trash can as
• Condoms should be semen on vaginal appropriate.
pull back • Lubricants can be used
opening.
used within 3 years of foreskin. (water-based, not oil-
the manufacturing based) and should be
date. used during anal
intercourse.
3. Prevention of mother to child transmission of HIV
• There are four prongs to eliminate MTCT of HIV infection.
• Prong 1: Primary prevention of HIV infection - focuses on keeping parents-to-be
HIV negative.
• Prong 2: Prevention of unintended pregnancies among women infected with
HIV.
• Prong 3: Prevention of HIV transmission from women infected with HIV to
their infants (child)
 addresses care & treatment for infants born to HIV-positive women and their
mothers during pregnancy, labor and childbirth, and the postpartum period.
• Prong 4: Provision of treatment, care, and support for women infected with HIV,
their infants, and their families.

Continue…
4. Post expose prophylaxis (PEP):

for HIV-negative individuals to reduce their risk of
infection
involves the short-term use of ARVs to prevent
infection in people who have recently been exposed
to HIV
PEP Eg. For health professionals exposed to HIV
infected blood while on work, sexually abused eg.
rape
Continue…
B. Secondary prevention: after infection with HIV
Antiretroviral Therapy (ART)
Opportunistic infection(OI) prophylaxis and
treatment
• ART has reduced HIV-related morbidity and mortality
at all stages of HIV infection and has reduced HIV
transmission
• The daily use of a combination of at least three
antiretroviral drugs by people living with HIV
Continue…
Key ART Treatment Goals:
• The goal of ART is to reduce the number of virus in the
blood and increase the number of CD4 as much as
possible.
• HAART: H=highly, A=active, A=anti, R=retroviral and
T=therapy (treatment)
• It is the use of three or more anti-retroviral drugs for
the treatment of HIV infection
Importance of using combination of 3 ARV drugs?
• sustained viral suppression (low level of virus in
the body).
• Antiretroviral drugs from different drug groups
attack the virus in different ways
• Combinations of anti-HIV drugs may overcome
or delay resistance.
Benefits of HAART
• Prolongs life and improves quality of life
• Significantly decreases morbidity and mortality
• Decreased number of orphans
• Reduces mother-to-child transmission of HIV
• Increased number of people who accept HIV testing and
counselling
• Increased awareness in the community, since more people take
the test
Benefit …
• Decreased stigma surrounding HIV infection
since treatment is now available
• Increased motivation of health workers, since
they feel they can do more for HIV patients
• Less money spent to treat opportunistic
infections and provide palliative care
When to start antiretroviral therapy
ART should be initiated among all individuals with HIV
regardless of WHO clinical stage and at any CD4 cell count
when the following criteria are fulfilled
• HIV positive test result with written documentation
• Ensure that all adherence barriers are addressed
• Any opportunistic infection has been screened and addressed
according to the standard guidelines
• Ensure readiness of patient for ARV therapy

C. Tertiary care
• Chronic HIV Care. What is the Continuum of Care?
• People living with HIV and their families have emotional,
social, physical and spiritual needs that change over time.
• They often must cope with the effects of stigma and
discrimination, poverty, loss, neglect and abandonment.
• The purpose of the Continuum of Care is to address HIV as a
chronic disease and develop systems that provide human,
effective, high-quality comprehensive and continuous care to
PLHIV and their families.
Tertiary care/ chronic care
Purpose of HIV/AIDS care and support programmes
• To reduce morbidity and mortality from HIV/AIDS and
related complications.
• To improve the quality of life of adults and children
living with HIV/AIDS and their families.
• To assure equitable access to diagnosis, medical care,
pharmaceuticals, and supportive care.
• To promote prevention opportunities within care and
support service delivery.
The Continuum of Care has two defining characteristics
1. The Continuum of Care is a network: links coordinates and

consolidates care, treatment, and support services for PLHIV.
 provided in their homes, in the communities where they live,
and in the health facilities.
2. The Continuum of Care is provide group of services
comprehensively to support PLHIV and their families.
To provide both good acute and chronic care and prevention

Elements of Comprehensive Care and Support
Human Rights and Legal

Socioeconomic Support Support e.g.:
e.g.: •PLHA participation
•Material support •Stigma & discrimination
•Economic security reduction
•Food support •Succession planning
PEOPLE AND
FAMILIES AFFECTED
BY HIV/AIDS
Medical & Nursing Psychosocial Support
Care e.g.: e.g.:
•VCT, Family Planning •Counseling
•Preventive therapy •Spiritual support
•OI treatment and HAART •Follow-up counseling
•Palliative care •Community support
Tertiary care...
What is a palliative care?
• It is prevention and relief of suffering, pain and other
problems.
• Components of palliative care:
Community/home based care most cost effective
 pain management
Nutritional support
Psychosocial support
End of life care
Challenges of palliative care
• Late disease presentation,
• Inadequate diagnostic facilities and assessment skills,
• Poor availability of chemotherapy,
• Pricing obstacles and ignorance as well as false beliefs
about its use.
• Limited access to care
• Inadequate medical equipment
Challenges of HIV prevention and control
• Stigma and discrimination
• Access & quality of services
• Lack of diagnostic equipments and supplies
• insufficient Coordination and networking
• Fear to disclose to partner
• Inadequate care and support
• Low uptake and increasing trend in follow up
• Low level of private sectors involvement on ART
What is stigma and discrimination?
Stigma is defined as negative feelings, beliefs, and
behavior directed towards an individual or group due to
a particular characteristic.
According to the UNAIDS definition, discrimination
refers to any form of arbitrary distinction, exclusion, or
restriction of the affecting people because of their
confirmed or suspected HIV positive status. Unfair
treatment.
Stigma and discrimination
HIV and AIDS are complicated with stigma and
discrimination.
Because the virus has historically been surrounded
by mystery (obscurity) and fear
 Individuals affected by HIV and AIDS often
experience rejection by their loved ones, health care
providers, families, and communities
Stigma and discrimination
• Discrimination includes the denial of basic human rights such
as health care, employment, legal services and social welfare
benefits
• Due to stigma and discrimination many people are afraid to
get:
Tested for HIV
To take up HIV prevention and treatment
To disclose their HIV status
Do not participate services about HIV
Where does stigma and discrimination
relating to HIV and AIDS come from?
• At the time when the first cases of HIV were diagnosed, there
was little or no information available on the causes of the
illness, the transmissibility or any effective treatment.
• Stigma and discrimination take on multiple forms, which fall
into four broad categories:
A. physical,
B. social,
C. verbal and
D. institutional.
Consequences
• depression and in some extreme cases even suicide.
• loss of housing,
• employment,
• education, and/or
• access to healthcare.
• fear and denial of HIV less likely to adopt
preventive behavior, test for HIV, disclose their sero
status to others, and access care and treatment.
Strategies for reducing the stigma and
discrimination associated
• Working to dispel myths and information
dissemination
• Providing training
• Working to eliminate existing social stereotypes and
inequalities
• Encouraging greater involvement of people living
with HIV and AIDS in policy formulation
• Providing provisions of visible care in communities
People with special needs and their problems
• People with special needs have either single or multiple functional
disabilities which can create great hindrances in their accessibility in
day-to-day living.
• People with physical disabilities are less likely than their able-bodied
peers to have postsecondary education and are less likely to obtain
meaningful employment.
• Disabilities are “long-term physical, mental, intellectual or sensory
impairments which, in interaction with various attitudinal and
environmental barriers, hinders full and effective participation in the
society”.
People with special needs and their problems
People may have different kinds of disabilities such as:
• physical disability,
• sensory disability,
• intellectual disability,
• mental health and emotional disabilities,

Why to deal HIV/AIDS in people with special needs
1. HIV risk behaviors: due to a number of reasons, including
insufficient access to appropriate HIV prevention and support
services, many persons with disabilities engage in behaviors
which place them at risk of HIV infection, such as:
• Unprotected sex
persons with disabilities who also belong to groups that may
be socially marginalized, such as:
• Men who have sex with men,
• People who inject drugs
Why to deal HIV/AIDS in people with special needs
2. Sexual violence: a large percentage of persons with disabilities
will experience sexual assault or abuse during their lifetime,
3. Lack of Access to HIV education, information and prevention
services:
• Persons with disabilities may also be turned away from HIV
education forums or not be invited by outreach workers,
because of assumptions that they are not sexually active, or do
not engage in other risk behaviors.
1.9. Responses to HIV and AIDS at different level
• A National HIV/AIDS taskforce was established in 1985
• National AIDS Control Program (NACP) was established in 1987
• HIV/AIDS surveillance activities began in 1989
• HIV/AIDS Policy was formulated by MOH and adopted by the
Council of Ministers in 1998.
• The National AIDS Council was established in 2000:
• In June 2002, the National HIV/AIDS Prevention and Control Office
(HAPCO)
• In July 2002 ARV Drugs Supply & Use Policy formulated.
•
1. At a National
Formulating HIV and AIDS policy
Level
• Conducting HIV and AIDS surveillance activities
• Establishing a system and structure
• Formulating ARV Drugs Supply and Use Policy
• Developing Strategic Plan
• Availing ARV drugs
• Having updated data
• Non-discriminatory laws
• Monitoring and evaluating the progress on prevention as well as
treatment.
2. At Community Level
• Establishing voluntary services
• Forming associations of HIV and AIDS
• Establishing different support groups
• Availing legal services
• Providing home-based care
• Availing treatment services
• Availing counseling services
• Availing spiritual services
• Developing awareness creation programs
• Providing linkage services to income generation activities
THANKS

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Wollo university

College of Medicine and Health Sciences

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2. O group (outliers): relatively rare viral form originally seen in Cameron

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Figure 1: Eastern and Southern Africa Data

• Figure 2: Age and Sex Distribution of HIV Prevalence, EDHS 2011

• Overall, less than 1% of Ethiopian youth age 15-24

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Sharing Semen and Sharing Needles Needle Stick

Through Infected Blood During Pregnancy Breast Feeding

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3. HIV testing and counseling services must be accompanied by appropriate and

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How to use a condom

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4. Post expose prophylaxis (PEP):

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1. The Continuum of Care is a network: links coordinates and

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Human Rights and Legal

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