HIV/AIDS

Definitions HIV - Human Immuno-deficiency Virus

H: Human (only attacks human beings)

I: Immuno-deficiency (lowers immunity)

V: Virus (Germ) HIV infection is when the individual has the virus in the blood but the body’s defense mechanism is still strong and the person may not necessarily have any symptoms and signs (diseases).

 HIV disease is when the body’s defence mechanism is weakened and a person begins to experience some symptoms and signs (diseases) due to infection with HIV but not enough to conclude that it is AIDS.

There are two types of HIV: HIV-1 and HIV-2. The difference between the two is that HIV-1 is more aggressive and has a short incubation period and is common in East, Central and Southern Africa. HIV-2 is less aggressive, has a long incubation period and is common in Western Africa.

AIDS - Acquired Immune Deficiency Syndrome

A: Acquired (something you get)

I: Immune (protection against disease)

D: Deficiency (lack of)

S: Syndrome (a group of different signs and symptoms)

A syndrome is a collection of diseases or signs and symptoms that may occur singly or together. These signs and symptoms are caused by opportunistic infections

Opportunistic infections are infections that take the advantage to attack the body because of low immunity i.e. they take advantage of the person’s weakened immune system.

AIDS is a group of diseases acquired as a result of a weakened defence (immune) system.

HIV prevalence: The proportion of the population who are infected with HIV.

HIV Incidence: The number of new HIV infections occurring within a given population over a specific time period (e.g. in one year).

Epidemiology: the study of the incidence, distribution, and control of diseases and other factors relating to health in a population.

Incubation period: The time between being infected with HIV and beginning to show signs and symptoms of the infection.

Viral load: The amount of HIV a person has in the body.

Window period: The time between infection with HIV and detection of evidence of HIV in the blood through an HIV test

How does HIV Cause AIDS?

HIV is a very small organism that cannot be seen by our naked eyes. Unfortunately, HIV can only survive inside the white blood cells of human beings. These are the very cells that our bodies use to fight off diseases. Therefore, when HIV enters the cells, instead of the white blood cells protecting the body, they will make more copies of the virus. The new viruses will then look for new uninfected white blood cells; and with time, all the cells will be infected. After sometime, there will not be enough white blood cells to protect the body. HIV destroys the immune system and lowers immunity. The process of destruction is slow and HIV infected people gradually progress to AIDS over a period of time. At this level, a person has overwhelming symptoms and signs and meets the WHO clinical case definition for AIDS, which is 2 major, and 1 minor symptom for adults and 2 major and 2 minor symptoms for children. Therefore not all people who have HIV have AIDS. And these days, there are medicines (ARVs), which are given to people to stop HIV from reproducing itself. These medicines are only given out by a qualified health worker

What are the common types of STIs

(i) Gonorrhoea

(ii) Chlamydia

(iii) Syphilis

(iv) Herpes

(v) Cancroids

(vi) Candidiasis (can be transmitted from a woman who has candida – to a man, however, the original infection which is common for women is not usually caused by sexual intercourse)

How Can One Know that they Have an STI?

(Common Signs and Symptoms)

(i) Discharge from the vagina or penis

(ii) Bad smelling fluid coming out of the genitals

(iii) Itching around the private parts

(iv) Pain when passing urine

(v) Lower abdominal pain

(vi) Swellings, wounds, sores, rashes or blisters in and around the genitals.

(vii) Swellings of the skin which covers the testicles

(viii) A discharge from the eyes of a new born baby

Effective management of STIs can reduce the risk of HIV infection. This is because STIs increase the transmission and acquisition of HIV. Awareness of SHRP PIASCY Post Primary Education and Training Complementary Manual 82 the relationship between HIV and STIs is very important for the teacher to help learners seek early treatment. Worldwide, more than 300 million new cases of STIs occur each year, mostly in poor countries, and the global distribution of HIV is similar to that of STIs. Note that STIs are an important cause of ill health, especially in women and children. Early detection and treatment of STI is critical.

The effects and complications of untreated STIs

(i) Swelling in and around the genitals

(ii) Loss of ability to have children (infertility/ barrenness), especially if STIs are not treated

(iii) Pregnancy outside the womb-in the fallopian tube (ectopic pregnancy). Ø Abortions

(iv) Increased chances of cervical cancer

(v) Early breaking of the bag of waters during pregnancy and delivery

(vi) Increased chances of premature birth (the baby coming before it is full term)

How are other STIs similar to HIV?

a) Both are transmitted through having unprotected sex with a person who has it; Anyone who has unprotected sex puts his life in danger of HIV and other STIs

b) A person with an STI has a higher risk of getting or transmitting HIV

c) Both HIV and other STIs can be prevented with the same methods (e.g. abstinence, and delaying sexual intercourse)

d) STIs speed up the multiplication of HIV in the human body, thus leading to AIDS sooner

e) They both carry stigma

f) They can be both passed on from mother to the child What is the difference between other STIs and HIV?

g) Most STIs can be cured if they are properly treated whereas HIV is not curable

What is the difference between other STIs and HIV?

Most STIs can be cured if they are properly treated whereas HIV is not curable

HIV TRANSMISSION: RISK FACTORS FOR ADOLESCENTS

What are the myths and misconception about HIV is transmitted. HIV cannot be transmitted by the following

i. Eating together or sharing food and eating utensils

ii. Shaking hands or hugging

iii. Sitting on the same desk

iv. Sharing a pen

v. A peck on the cheek, hands, or forehead.

vi. Coughing or sneezing or spitting

vii. Being bitten by mosquitoes and other insects

viii. Sharing towels, bed sheets or clothes

ix. Using public latrines or toilets

x. Sharing combs

xi. Sharing bath water

xii. Casual person to person contact at home or school or in social or public places

xiii. Food, air, water

xiv. Shaking hands, touching or hugging

xv. Sharing swimming pools, toilets, etc.

What are other false things said about HIV are:

xvi. Virgins cannot have HIV

xvii. Children whose parents died of AIDS must also have HIV

xviii. People who die of AIDS are immoral

What are the Modes of HIV transmission

HIV is passed on through contact with contaminated bodily fluids, which include blood, semen, vaginal fluids and breast milk. It happens in three main ways;

a) Un-protected sexual intercourse with an HIV infected person. This is the most common mode of HIV transmission, accounting for 75-80% of transmission in Uganda, and makes HIV a Sexually Transmitted Infection (STI).

b) Infected blood and blood products e.g. through the contaminated skin piercing instruments e.g. needles, razor blades, safety pins, knives etc. which accounts for 2-5% of transmission in Uganda.

c) An HIV infected mother to her learner; referred to as mother to learner transmission of HIV (MTCT); also known as vertical transmission. This accounts for 15-25% of HIV infections but is the most common mode of transmission in children under the age of 5.

What are the factors that contribute to the spread of HIV among young people

a) Cultural practices, beliefs and taboos that promote risky behaviours, e.g. parents’ reluctance to discuss reproductive health issues openly with their children, widow inheritance, and the practice of having multiple sexual partners.

b) The tendency to feel that HIV will infect other people, and not you.

c) Economic hardships that lead young girls to adopt practices such as sex for money or other material goods (transactional sex).

d) Infection with Sexually Transmitted Infections (STls)

e) Sex without using a condom with an infected partner or a person whose HIV status you do not know.

f) Urbanisation and migration that move people away from families and communities.

g) Conflict and emergency situations that create vulnerability, especially for women and children, to sexual exploitation.

h) Young people with special needs, such as those with physical and mental disabilities, are more vulnerable to sexual exploitation.

What are the factors that predispose Young People to HIV Infection (Vulnerability of Young People to HIV)

a) Vulnerability results from individual and societal factors that increase the risk of HIV infection. These factors include poverty, unemployment, illiteracy, gender inequities, cultural practices, lack of information and services, and human rights abuses – which greatly increase the vulnerability of some groups, most typically adolescent girls, orphans, and displaced persons.

b) Young people are often more vulnerable because they lack financial independence and are in a stage of life where experimentation is common. The following are examples of how vulnerability can be an issue for young people:

(i) Biological risk factors; it is twice as easy for women to contract HIV from men; due to the large surface area of the female genitalia

(ii) Physiology of women (e.g., menstruation, intercourse)

(iii) Pregnancy-associated conditions (e.g., anaemia, menorrhagia and haemorrhage) increase the need for blood transfusion

(iv) Learner prostitution and financial enticement of young girls by adult men increase girls’ vulnerability to HIV and AIDS in many countries

(v) Orphaned girls can be forced to perform ‘sexual favours’ for their teachers or other adult men in order to stay in school or support their siblings

(vi) Lack of information on sex, STI, and their bodies

(vii) Peer pressure during habit formation

(viii) Poverty

(ix) Stigma and fears attached to HIV that prevent young people from seeking information and get tested for HIV

(x) Cross-generational sex

(xi) Low self-esteem

(xii) Lack of ongoing guidance and counselling in managing relationships and coping with difficult relationships

(xiii) Lack of self-discipline

(xiv) Lack of responsibility to oneself and others

(xv) Use of alcohol and other drugs

(xvi) Lack of access to testing facilities

(xvii) Promoting secrecy about sex among young people u Lack of appropriate life skills to control sexual desires

(xviii) Harmful media images

(xix) Normalisation of HIV (complacency)

How Does One Tell that S/He is Infected with HIV?

(i) This is only possible through HIV Counselling and Testing (HCT). The National HCT policy 2012 clearly articulates that a learner 12 years and above can assent to an HIV test even without the parent/guardians consent.

What is HIV counselling and testing (HCT)?

(ii) Preparing a client for an HIV test

(iii) Testing the client who accepts to take the test

(iv) Giving the client the test results and discussing what they mean

(v) Discussing what the client can do to prolong life and to protect others from HIV

What are the benefits of HIV counselling and testing among young people?

HCT opens doors to:

(i) Medical support: young people identified as having HIV can be initiated on treatment early so as to prolong their life

(ii) Social support e.g. Support from family and friends, faith based organisations etc.

(iii) Promotes disclosure of HIV status

(iv) For sexually active learners, it allows discussion and agreement to protecting each other from HIV infection

(v) If one is HIV negative, it increases determination to remain free of HIV

(vi) If one is HIV positive, it helps in adoption of positive living principles to prolong life:

a) Accepting your HIV status positively.

b) Disclosing your HIV status to your family members.

c) Helping one to abstain from sexual intercourse or negotiate for safer sex practices.

d) Eating enough different foods to improve your health.

e) Continuing to work/ with studies as usual.

f) Stopping or reducing drinking of alcohol and smoking.

g) Going for treatment as soon as you become sick.

h) Doing light exercises to keep your body fit.

i) Joining support groups.

j) Seeking prompt treatment from health facility

Barriers to HCT

k) Stigma attached to HIV infection and disease in the community

l) Ignorance about HCT benefits

m) Myths and misconceptions about HIV infection

n) Lack of HCT facilities

What is HIV-related stigma

(i) Can be described as a process of devaluing people living with or associated with HIV and AIDS. HIV-related stigma refers to a real or perceived negative feeling to a person or a group of persons (in this case the PLHIV) by virtue of his or her HIV positive status.

(ii) It’s a situation where a person is ignored, socially excluded and treated differently from others because of their HIV positive status. AIDS disfigures, so stigma increases as the symptoms of the disease become more visible

Discrimination;

(i) is the unfair, unfavorable and unjust treatment based on bias regarding race, colour, sex, perceived HIV status, disease etc. which is characterized by rejection, isolation, denial, discrediting, devaluing, excluding etc. External or enacted stigma refers to the actual experience of discrimination such as harassment, categorizing, accusation, punishment, blame, exclusion, ridicule, or resentment.

What I need to know about Stigma and Discrimination

a) Out of fear and ignorance, some people think negatively about others because of their race, colour, sex or HIV status. This is called stigma.

b)  hey may then label, reject or treat them differently. This is called discrimination

c)  Discrimination involves unfair treatment and isolation.

d) Sometimes stigma can be self-directed, when you have low self-esteem.

e) Stigma is harmful to affected people and can make them feel sad, rejected and hopeless.

f)  Stigma increases the spread of HIV because it can prevent people from going for testing, treatment, care and support.

Why do some people have Stigma and Discrimination?

a) Some people just don’t know enough; for example they may think when you shake hands with an HIV infected person, you also get infected!

b) Some people just fear, even when there is no reason to fear

What is self-stigma?

a) Self-stigma is when you hate yourself, what you are, your appearance, your condition, your situation etc. A person with HIV may impose negative beliefs and actions on themselves, characterized by

(i) Feeling that others are judging them, so they isolate themselves

(ii)  Believing the negative attitudes, reactions and actions from others.

(iii)  Failing to accept themselves and feeling worthlessness

(iv) Always blaming themselves for their condition

(v) Losing hope and having fear of dying soon

(vi) Having suicidal thoughts

(vii) Developing vengeful feelings: Wanting other people to suffer the same way they are suffering.

What is the difference between stigma and discrimination?

(i) Stigma reflects an attitude

(ii)  Discrimination is an act or behavior

How to address stigma and discrimination in the school community

(i) Create a conducive environment for discussion on issues related to HIV infection u Explore the possible sources of stigma in a school context

(ii)  Identify the challenges that a student faces in trying to cope with stigma

(iii) Support learners to identify ways and means of overcoming stigma u Be a role model, challenge stigma when you observe it.

How to address stigma and discrimination in the school community

(i) Create a conducive environment for discussion on issues related to HIV infection u Explore the possible sources of stigma in a school context

(ii) Identify the challenges that a student faces in trying to cope with stigma

(iii)  Support learners to identify ways and means of overcoming stigma

(iv) Be a role model, challenge stigma when you observe it

What is disclosure?

Disclosure is defined as the act of informing another person or persons of the HIV-positive status of an individual. Disclosure is a process where a learners’ HIV sero- status is revealed to household/family members and other important people in the learners’ life. As teachers, you are expected to provide disclosure support to learners living with or affected by HIV within your setting. Disclosure can also be defined as a situation where information about learners’ HIV sero-status is shared. Sometimes disclosure is not very easy and a learner may go through a long process

What is disclosure counselling?

Disclosure counselling is a confidential conversation between two (or more) people that assists (empowers) one to work through issues related to disclosing one’s HIV status. Why disclosure counselling is necessary:

(i) Enables the adolescent become aware of the possible consequences of disclosure.

(ii) Empowers the adolescent to take the step of sharing his/her status with a trusted person who can provide ongoing psycho-social and other support.

Forms/Levels of disclosure

(i) Non-disclosure: Adolescent is unaware of his/her infection

(ii) Partial disclosure: Partial disclosure: Partial disclosure involves teaching an adolescent about his/her body and how the immune system works before using the actual words “HIV” or “AIDS.” Partial disclosure is useful for building a context in which HIV disclosure can be more meaningful for children.

(iii) Full disclosure: The primary care giver has told the adolescent about his/her HIV status and the medication. It is voluntary.

Benefits to disclosure

Disclosure of HIV status enables an individual to begin dealing with the issue of reducing transmission and obtaining support.

(i) They can access care, support and treatment services more easily

(ii)  They can adopt safer behaviours to protect their family

(iii) It creates a sense of empowerment and control over the virus as the person is able to talk with a friend or counsellor for advice and support

(iv)  The person can feel confident and not have to worry about having to disclose u The learners may be able to influence others to avoid infection

(v)  Openness about HIV status can stop rumors and suspicion

Barriers to disclosure

(i) Fear of stigma and rejection

(ii) Fear of possible conflicts

(iii) Ignorance about HIV infection and disease

(iv) Fear of shame and public opinion

(v) Fear of blame and possible breakdown of relationships

(vi) Fear of breaking confidentiality