PREVENTION OF HIV

DR. PAMELA KAITHURU

COUNSELLING PSYCHOLOGIST
 OBJECTIVE
• To create awareness on key HIV
prevention interventions (statistics, basic
facts, emerging issues and interventions)
• Empower staff to influence the
Workplace for achievement of HIV
Prevention and Universal Health
Coverage
 HIV PREVALENCE REMAINS HIGH AND KENYA IS
THE GLOBAL 4TH LARGEST HIV EPIDEMIC (# OF
PLHIV, 2019)
Country Total HIV Prevalence No of PLHIV
Population

South Africa 54 million 11.2% 6.19 m

Nigeria 186 million 3.2% 3.2 m

India 1.2 billion 0.3% 2.1 m

Kenya 42 million 5.9% 1.5 m
 KENYA HIV ESTIMATES - 2020
#KENYAatAIDS2018

4.4% HIV Prevalence 1,401,762

Adults living with HIV (15+)
5.7% 3.1%
106,820
1.5m PLHIV (all ages) Children living with HIV (0-14)

Number of new HIV Infections in 2019 Adolescent and Young People

Adolescents 10-19 years

87,208 PLHIV
42%
41,408 All ages Of adult new
6,150 New infections infections occur
34,597 Adults (15+) among
Young Adults 15-24 years the youth
6,811Children (0-14) 142,161 PLHIV
14,344 New infections
DISTRIBUTION OF HIV PREVALENCE IN KENYA
BY COUNTY, 2020

• No. of PLHV have stabilized at 1.5

million in the last 5yrs. Prevalence=4.4%

• By end of 2019, about 1.11 million

identified and on ART(approx. 400,000
gap). 20% coverage gap (male-41% &
female-25%).

• HIV mortality =21,000 (<15yrs=4,333,

adult male=11,591 adult female=9,392.

• Heterogeneity of HIV burden by

geography and population at County
level. County specific/ tailored
interventions

Source; Kenya 2020 estimates

KENYA’S HIV INCIDENCE CONCENTRATION IN
SEVERAL COUNTIES

HIV Incidence Clusters

1 High Incidence - Incidence equal to or
above 1,000 cases
(Homa Bay, Siaya, Kisumu, Migori, Kiambu,
Kajiado, Mombasa, Kisii, Nairobi, Nakuru,
Uasin Gishu, Kakamega,)

2 Medium Incidence - Incidence equals to

500 to 999 cases
Trans Nzoia, Busia, Nandi, Kilifi, Narok,
Machokos ,Kitui, Turkana, Meru,

3 Low Incidence - Incidence below 500 cases

annually
(Marsabit, Tana River, Kericho, Laikipia,
Bomet, Samburu, Baringo, Elegeyo-Marakwet,
West Pokot, Garissa, Mandera, Wajir, Nyamira,
Makueni, kitui, Kwale, Nyeri, Taita Taveta,
Isiolo, Nyeri, Vihiga, Tharaka- Nithi,Kirinyaga,
Embu, Bungoma, Lamu, Muranga

Source; Kenya 2020 estimates

DISTRIBUTION OF NEW INFECTIONS BY SEX
AND AGE

62
%

42
%
New infections-
41,408

Source: 2020 Estimates

90-90-90 TARGETS – KENYA OVERALL
COVERAGE CASCADE

DHIS2, December 2019

90-90-90 TARGETS – KENYA ADOLESCENT
COVERAGE CASCADE

DHIS2, December 2019

90-90-90 TARGETS – KENYA CHILDREN
COVERAGE CASCADE

DHIS2, December 2019

SUMMARY OF ELIMINATING NEW HIV
INFECTIONS AMONG CHILDREN, 2020
Early Infants Diagnostic (EID)
71,100 first EID tests done
42,422 infants receiving biological test
for HIV within 2 months of birth
Mother-to-Child
Transmission of HIV
(MTCT)
10.8% of children infected with
HIV from MTCT a reduction from
12.4% in 2019
Source; Kenya 2020 estimates
Increase in uptake of ART
among pregnant women living
with HIV
1.7 million estimated no of pregnancies
62,995 women identified (tested
positive + known positives)
59,304 (94%) pregnant women
receiving antiretroviral
medicines (PMTCT)
Modest coverage of syphilis
testing among women attending
antenatal care services at any
visit
63% coverage; with about 1.2 million
women tested for syphilis at ANC
 95–95–95 Total PLHIV 1,555,700

95% of those who are

HIV positive
identified 100,800 551, 300 903,600
Total 1,018,900 [66%] PLHIV on ART

95% of those
identified are on ART
78,700 [81%]
690,300 [73%]
328,600 [55%]
95% of those on ART
are virally 79 % Overall Viral Load Suppression Rates
suppressed

77% among Male 81% among Female

 KEY NCDS PROJECTION
RESULTS
NCD Burden Among HIV Positive
Population

NCD Burden Among HIV Negative

Population

Source: KMoT 2019

NEW HIV INFECTIONS AND TEENAGE
PREGNANCY
• Need for meaningful
engagement of adolescents
and young people.

• Involvement of other
sectors in the response.
example- MoE, Huduma
Centres, labour and social
services etc.
KEY INTERVENTIONS
HIV INTERVENTIONS
• HIV prevention programs/interventions aim to halt
the transmission of HIV
• They are to either protect an individual and their
community, or are rolled out as public health
policies
• Effective HIV prevention needs to take into account
underlying socio-cultural, economic, political, legal
and other contextual factors
• As the complex nature of the global HIV epidemic
has become clear, forms of 'combination prevention'
have largely replaced ABC-type approaches.
AN ENTRY POINT TO PREVENTION, CARE
AND SUPPORT

HIV TESTING
PREVENTION OF MOTHER TO CHILD

This programs offer a range of services for women

living with or at risk of HIV to maintain their health and
stop their infants from acquiring HIV

PMTCT services should be offered before conception,

and throughout pregnancy, labour and breastfeeding

PMTCT services should include Early Infant Diagnosis

at four to six weeks, after birth, testing at 18 months
and/or when breastfeeding ends, and ART initiation as
soon as possible for HIV-exposed infants to prevent
HIV acquisition
 PRE EXPOSURE
PROPHYLAXIS ( PREP)
• A pill taken once daily by HIV negative people
before exposure to HIV infection
• Evidence shows that, when taken consistently and
correctly, PrEP reduces the chances of HIV
infection to near-zero
• Taken for at least 7 days before exposure and at
least 28 days after to reach optimal levels of
protection
• Does not protect against other STIs so needs to be
delivered as part of a comprehensive package of
HIV/STI prevention services
 POST EXPOSURE
PROPHYLAXIS (PEP)
• PEP is an emergency medication for HIV-negative
people that can help prevent infection after exposure to
HIV
• PEP must be started within 72 hours after HIV
exposure and taken for 28 days
• A HIV test is recommended before initiation of PEP
TREATMENT AS PREVENTION
Evidence has now shown that individuals on effective
Antiretroviral treatment (ART) with an undetectable viral
load cannot transmit HIV to others

WHO guidelines now call for ‘test and treat’ strategies –

initiating all people diagnosed with HIV on ART as soon
as possible after diagnosis – as a way to decrease
community viral load and reduce the rate of new HIV
infections

Treatment as Prevention (TasP) will only be effective

alongside the scale up of testing programmes and ART
adherence support
 ALCOHOL & HIV
• Causes disinhibition and reinforces sexual risk
taking
• Triggers immune-suppression and alcohol
induced malnutrition and aggravating progress
to AIDS
• Alcohol causes changes in the cells that makes
them vulnerable to HIV infection
• Interferes with the liver function and ARV
metabolism
 HARM REDUCTION
Programs aim to prevent the spread of HIV and reduce
other harms associated with drug use

Approaches include providing easy access to sterile

needles to reduce infections from needle sharing, and
replacing illegal opiates (such as heroin) with prescribed
medicine such as methadone or buprenorphine under
medical supervision

Stigma and discrimination, the ‘war on drugs’, and lack of

sustainable funding are all preventing roll out of effective
harm reduction programmes
VOLUNTARY MEDICAL MALE CIRCUMSCISION

Voluntary Medical Male Circumcision (VMMC)

reduces female-to-male sexual transmission of
HIV by 60%

The WHO and UNAIDS recommend the

implementation of VMMC programmes in
countries with a high HIV prevalence among the
general population

It is cost-effective and should be included,

alongside behavioral and structural strategies, as
part of a comprehensive HIV prevention plan
WHAT IS STIGMA
A thought/process of
devaluation of one self/or
those associated with a mark
of disgrace attached to one
self

Reducing an individual in the

eyes of others

A mark of shame

Looking down upon PLWHIV

and blaming them for their
plight
WHAT IS DISCRIMINATION
Treating others differently or denying them their
rights because of their HIV status, gender and
color, among others

Unfair and unjust treatment of an individual

based on his/her real or perceived HIV status

It occurs when we separate ‘us’ from ‘them’

Discrimination is actually acted out

 CONDOM USE AS PREVENTION

Male (and female) condoms are the only

FP methods that provide dual protection:
•Protection from pregnancy and
•Protection from transmission of HIV and
other STIs between partners
MENTAL HEALTH

According to WHO this is “a

state of well-being in which
every individual realizes their
own potential, can cope with
normal life stresses, can work
productively, Fruitfully & is
able to make a contribution to
the community.”
WHAT ARE MENTAL DISORDERS

• Mental Disorders are a range of conditions

that affect MOOD, THINKING AND
BEHAVIOUR.
• They are generally characterized by a
combination of perception, behaviour and
abnormal thoughts.
• Examples include: Depression, Anxiety,
Schizophrenia etc.
 TYPES OF MENTAL ILLNESSES

• Anxiety disorders
• Mood disorders
• Psychotic disorders
• Personality disorders
• Developmental disorders
• Eating disorders
• Post traumatic stress disorders
• Impulse control disorders
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 WHO REPORT MAY 2020
Most at risk groups:

Older people Adolescents and People with pre

Frontline health workers young people. existing conditions. Persons in crisis
and conflict
CAUSES OF MENTAL ILLNESS
Your genes and family history
Your life experiences, such as stress or a history of
abuse
Extreme circumstances and disasters
Biological factors such as chemical imbalances in
the brain
Use of alcohol or recreational drugs
Having a serious medical condition like cancer
Having few friends, and feeling lonely or isolated
33
RECOGNITION OF SYMPTOMS
For one to recognize a behaviour as abnormal and
therefore an illness, it has to satisfy this criteria.
1.Distress- to either the person or those around
Deviance- different from how the person is usually
2.Danger- posing either to self or others
3.Dysfunction- at work, family or personal level
4.Cultural in-appropriateness

34
SIGNS AND SYMPTOMS AT THE WORKPLACE

Withdrawal from the team, isolates oneself

Putting things off/missed deadlines
Absent minded
Late to work, accidents
Lack of confidence, unsure of abilities
Low motivation/detached
Inappropriate reactions, strained relationships
Change in appearance
Increased stress levels
35
CORONAVIRUS
• The ongoing pandemic of COVID-19 is a global
challenge which resulted in significant morbidity
and mortality worldwide
• This disease was first detected in China in
December 2019 in Wuhan
• In Kenya the first case was detected in March 2020
• It has also adversely affected the economy and
social integrity
• There is rising concern about the mental health
challenges of the general population, COVID-19
infected patients and affected, close contacts,
elderly, children and health professionals
PREVENTION
CONCLUSION
DIMENSIONS OF WELLNESS