EPIDEMIOLOGY OF EPIDIOMOGY OF

HIV/AIDS, MODES OF

HIV / AIDS TRAMSMISSION,PROGRES

SION OF HIV week 2
Epidemiology _ refers to the study of patterns of disease occurrence in the population
and factors affecting then.
By epidemiological classification, HIV/AIDS is a pandemic which is an epidemic that
includes all parts of the world.
Epidemic_ is a disease outbreak characterized by a sudden increase in infections
within a short period of time.
Prevalence_ the total number of people infected within a given period of time in a
certain population.
Incidence_ total number of new cases within a given period of time in a certain
populations.
Epidemiology of HIV/AIDS varies from region to region due to various factors
example, human migration, urbanization, civil war, poverty etc
EPIDEMIOLOGY IN UNITED STATES
US as the lowest prevalence of HIV
The population with the highest infection is the homosexual and bisexual men, followed
by injection drug users and drug transfusion recipients
The fasted growing infection rate is the African American which could be due to racism
and social marginalization.

EPIDEMIOLOGY IN ASIA
Asia has most rapidly increasing number of HIV infected people with 3.8 million living
with HIV/AIDS
Commercial sex workers And drug users are two vehicles of HIV in Asia
EPIDEMIOLOGY IN AFRICA.
•Africa has the highest number of HIV infected people
•Women has a higher rate of infection than men unlike in other areas of the world
where HIV affects men and women equally.
•They are twice as likely to become infected with HIV than me of the same ages
•Commercial sex workers are most highly infected groups with atleast 90% of them
being infected.
GLOBAL STATISTICS IN AFRICA CAN BE DIVIDED INTO 2 GROUPS
The sub-Saharan Africa
The southern part of Africa
THE SUB-SAHARAN AFRICA
Hosts nearly 67% of all people living with HIV/AIDS globally
It accounted for 70% of AIDS death in 2008
The number of people living with HIV is 22,000,000
Newly infected in 2008 was 3,800,000
Deaths due to AIDS was 1,5000,000
Women living with HIV is 12000000
Children living with HIV is 8,000,000
THE SOUTHERN PART OF
AFRICA
oThe number of people living with HIV are 2.4 million
oNewly infected in 2008 was 2,900,000
oDeaths due to AIDS was 705,480
oWomen living with HIV was 2.4M
oChildren living with HIV was 243,000
REASONS WHY AFRICA IS
HARDEST HIT BY THE VIRUS
All continents are being infected by HIV but the most affected is Africa. In the
world 10 people are being infected every second.
There are many factors that contribute to this including poverty,
In Kenya 164 people are being infected every day which translates to 60,000
new infections annually. Many factors have contributed to this including
POVERTY : Due to poverty the Africans have been rendered vulnerable to the
virus. It may lead to prostitution which is the main source of infection.
Nutrition will also be a problem to those infected and most victims will not be
able to respond to any attacks.
CONFLICT/DISASTERS : During conflicts displaced populations will be
more vulnerable to such atrocities like rape /defilement
War has led to underdevelopment hen hence to stagnation of economic growth
leading to wide spread poverty. Displaced people are likely to engage in casual and
unprotected sex and in many cases it may hard to reach the affected people with
material and medical help.
WIDE SPREAD IGNORANCE AND ILLETERACY :
Lack of proper information about HIV/AIDS has accelerated the spread of
HIV/AIDS in Africa. The majority may not know the epidemiology of the disease,
how to protect themselves, or how to manage the pandemic. Ignorance may have led
to many new infections because it may lead to believes that having sex with a virgin
may cure HIV/AIDS.
CULTURE :
Some African cultures and myths fuel the spread of HIV/AIDS. Practices like wife
Inheritance polygamy, female genital mutilation, tattooing may spread the virus to
many people.
MISMANAGEMENT OF HEALTH FACILITIES AND RESOURSES:
African countries are known to be corrupt and almost every aspect politicized,
money intended for HIV/AIDS management may diverted into political campaigns
funding
POOR ACCESS TO HEALTH FACILITIES: In many circumstances the rural
population and the urban poor may not have access to heath facilities. This may fuel
the spread of HIV, due to lack of information on personal health and other areas
concerning the pandemic
LARGE POPILATION OF THE YOUTH: Youth form the majority of population in
any African country
For example in Kenya, youth form 60% of the population. They are known
to involve themselves in risky behaviors
They may carry the big load of STDs infections which provide avenues to
contracting HIV/AIDS.
The youth are sexually active because they are getting in reproductive age
and the like experimenting.
They are also daring and willing to take risks
The youth are easily influenced by peers, mass media , current trends and
likely to fall into drug abuse.
EPIDEMIOLOGY IN KENYA
By June 2000, it was estimated that 1.5M people in Kenya had died of HI/AIDS SINCE
the pandemic started in 1980s NASCOP, 2008
 The cumulative number of deaths may rise to 2.6M if no interventions are taken.
The HIV pandemic has been categorized as generalized, meaning that HIV affects all
sectors of population, although HIV prevalence tend to differ according to b gender, age
and location
Various studies have revealed a high HIV prevalence in a number of key affected
groups:
 Sex workers
 Men who have sex with men
 Injecting drug users
 Truck drivers
 Cross boarder mobile populations
By 2011,1.6million people were living with HIV and 1.1 million children
were orphaned by AIDs.
62,000 people died of AIDS related illness in the same year.
Prevalence in women is twice as high as that in men , 8.4% and 5.4%
respectively.
The age group of 15_24 years is most affected 7.4%and the younger women
are more likely to be affected than men of the same age.
HIV prevalence is high in urban than in rural
Most AIDS death occur between the age of 25 and 35 for men and the age of
20 and 30 for women
Dropouts, abortions, SDs and the deadly HIV among youth are a reflection of
these activities
Improved access to treatment is having an impact
The continued rise in the number of people living with HIV reflects combined
effects of high rate of HIV infection and the beneficial impact of ARVs
As of 2008, approximately 4M people in low and middle income countries
were receiving ARVs have long been available, access to treatment has had an
extraordinary impact on HIV related mortality.
In a multi center study in 12 high income countries, the rate of excess
mortality among people living with AIDS in a comparison
With the HIV unaffected population declined by 85% following introduction
of highly active antiretroviral therapy HAART
•ARVs coverage rose from 7% in 2003 to 42% in 2004
Despite the noted progress in reduction in prevalence there exist
challenges that need to be addresses
Unchanging sexual behaviors among majority of Kenyans
Resource constraints both at national and family level
Increasing need for palliative care especially those on the last stage of AIDS
Increasing need for support of orphans
•These challenges cannot be left on government alone thus all sectors of the society
need to contribute. Even though indicators that prevalence rate is on the decline
researchers indicate that infection on certain vulnerable group has either remained
high or increases.

•FOCTORS LEADING TO HIV RISK AMONG THE YOUTH

•Many young people are sexually and involve in high risky behavior including
drug use , alcohol
•Majority does not know there HIV status
•The youth are economically dependent, socially inexperienced ,have poor
knowledge about protection from infection and has less access to heath care
•Social norms and expectations and peer option affect youth behavior
increase health risk
•Young women are at a particular risk due to sex trades, sugar daddies who
entice them with gifts.
•Problem 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 costs 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 can be found in all body fluids. For infection to occure the virus need
High enough concentration
Route of entry
Efficient transmission
FLUIDS THAT TRANSMIT HIV
In order of high concentration of HIV
Blood
Semen
Vaginal fluid
Breast milk
FLUIDS THAT DO NOT TRANSMIT HIV
Saliva
Mucus
Tears
Urine
Sweat
Fesses
HIV IS NOT TRANSIMITTED
VIA
Coughing Public baths
Sneezing Handshakes
Insect bites Work or school contact
Touching, hugging Using telephones
Water food Sharing cups, glasses, utensils

NB Saliva has low quantities of the virus, although not necessarily

transmitted, infections are possible especially when there are sores in the
mouth.
MAJOR MODES OF TRANSMISSION
OF HIV IN ADULTS
Sexual contact
Commercial sex
Casual sex
Marital sex
Men who have sex with other men

Injecting drug users

Injecting drug users
Medical injections or occupational exposure
SEXUAL TRANSIMISSION OF
HIV/AIDS
ANAL SEX
Although there are challenges risk by sexual act , studies consequently
report anal intercourse is a higher risk act than vaginal intercourse which in
turn is more riskier than oral intercourse.
This is why homosexuals remains a group that stands the greatest risk of
infection this is because
the anus does not produce natural lubrication,
it is extremely tight and
has a thin layer
These factors make it prone to wounds, sores, and this break of skin
easily aid the transmission of HIV.
 VAGINAL SEX
The risk of HIV transmission through vaginal sex poses a lesser risk because
of the natural lubrication and more elasticity found in vaginal walls.
ORAL SEX
This os where the genitals come into contact with the mouth. The risk is
considered lower but transmission can still happen especially where the
mouth has small lesion, cuts or wounds.
NB There is a strong relationship between STI and the transmission of HIV.
People that have STI often suffer from sores, lesion on the walls, compromised
immune system, irritation and inflammation of the mucus membrane
BLOOD INFECTION
This can occur through blood transfusion, blood products, accidents, or
contaminated needles.
•Treatment of blood products and donor screening has essentially eliminated
the risk of HIV from contaminated blood products from developed countries
but its spread continues among intravenous drug users who share needles.
•In developing countries, contaminated blood and contaminated needles
remain a major source of HIV transmission
HIV transmission among drug users
For people who inject drugs , risk of transmission per injection from a
contaminated needle has been estimated to be between 0.7% and 0.8%
However studies of contact with improperly discarded needles outside
health care setting suggest that such exposure represent a low risk for HIV
transmission likely due to a low viability of the virus outside the body.
Sharing ancillary injecting equipment example filters or cookers during drug
injection, has been shown to increase the risk of transmission even in the
absence of sharing needles and syringes
OTHER FACTORS INCLUDE
Injecting in unsafe locations
Type of drug used
Frequency of drug injection
People using non injection drugs are also at risk of HIV infection

Drug use can alter sexual behaviors by increasing risk taking

In addition several drugs have been reported to be independent risk factor
for HIV transmission
PASSAGE FROM MOTHER TO
CHILD
13% to 35% of pregnant women infected with HIV/AIDS will pass it to their
babies.
Transmission occurs through:
I. In utero through the placenta
II. During labor and delivery of the baby
III. After delivery mostly through breastfeeding
Breastfeeding accounts for almost 30% to 50% of mother to child transmission
in developing countries
Although transmission can occur at any point during breastfeeding, the first 6
weeks entail the greatest risk, comprising about 67% of total transmission.
The greater cellular composition of colostrum and early milk has been
suggested as a mechanism for high transmission.

The frequency of breast-milk transmission is also increased if the mother’s

CD4+ count is less than 200 cells /ml
The World Health Organization (WHO) recommends that women be
counseled about the risk of HIV transmission through breast feeding.
When replacement feeding is affordable, feasible, acceptable, sustainable, and
safe, avoidance of all breast feeding by HIV-infected mothers is
recommended.
When replacement feeding is not possible, exclusive breast feeding is recommended
and breast feeding should be discontinued as soon as possible.

In some regions and cultures, premastication of solid foods by an adult prior to

feeding of an infant occurs. If the adult is HIV-infected, this practice can result in
infection of the child
OCCUPATION EXPOSURE TO
HIV
The risk of occupational exposure to HIV is most closely related to the activities and
duties of the health care worker.

Additionally, the geographic location and practice setting can also affect the risk of
exposure and the quality of post exposure care.

Accidental infected needle prick to a health care worker; results in 0.03%

transmission.
HIV may be transmitted occupationally to health care workers who
are:
 Exposed to blood and other potentially infectious bodily fluids via
percutaneous injury or
 Splash exposures to mucous membranes or no intact skin.
 Unfamiliar practice environments can put the health care worker at
increased risk of exposure.
PROGRESSION OF HIV
Characteristically, an HIV infection can progress for eight to ten years before
the clinical syndrome AIDS occurs.

The long latent period of the virus has contributed to many of the problems
relating o diagnosis and control. On the hand, not all cases exhibit the long
latent period and abrupt progression to AIDs occurs.
Factors that determine progression of HIV to AIDS
 The age of the individual: The older the person gets, the more various
parts of the body deteriorate and are more prone to infection. The more
advanced the age is, the faster the progression from HIV to AIDs.
•The bodies ability to fight HIV infection: we all have different immune
system in terms of strength and efficacy. This is due to different reasons such
as lifestyle, diet, genetics . The stronger the immune system the lower the
progression of HIV
•Access to health care: these modern times have seen a growth in the care and
management of HIV and AIDS that includes medication nutrition
intervention, psychological intervention and even support groups. The higher
the access to quality heath care, the less the progression of HIV
•Presence of other opportunistic infections such as tuberculosis also increases
progression rate: This is because the body is already trying to fight an already
existing infection present in the body and may not be able to tackle another
infection as effectively as before.
The type of HIV strain: Some of HIV strain are more resistant to drugs and
tis kind make the progression faster than the strain that effectively respond
to drugs

Early testing: The earlier you get to know your status, the earlier you start
your management of HIV and the greater the chances of the body
suppressing the virus which reduces its rate of progression