HIV/AIDS AND STIs

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HIV/AIDS AND STIs


MODULE COMPETENCE

This module is designed to enable the learner to understand the concepts of HIV/AIDS and STIs.

MODULE OUTCOMES

By the end of this module, you should have gained sufficient skills to:

  1. Define common terms used in HIV/AIDS/STIs.

  2. Appreciate the fundamentals of HIV and AIDS.

  3. Understand the preventive measures of HIV and AIDS.

  4. Describe the management of HIV and AIDS.

  5. Explain Strategic Behavior Change Communication (SBCC).

  6. Understand Home and Community-Based Care (HCBC).

  7. Understand the concepts of STIs.

1. DEFINITION OF TERMS

  • HIV stands for Human Immunodeficiency Virus.

    • It is a Retrovirus.

    • HIV Infection is the state where the virus is in the body (asymptomatic state).

  • AIDS stands for Acquired Immune Deficiency Syndrome.

    • "Acquired" means it is transmissible.

    • "Immune-Deficiency" means it damages the body's defense system.

    • "Syndrome" refers to a group of illnesses.

2. HISTORICAL BACKGROUND OF HIV

  • 1981 – Recognized in homosexual males (USA).

  • 1984 – First case in Kenya described.

  • 1986 – HIV accepted as the international designation (WHO).

  • 1996 – ARVs became available globally.

  • 1997 – ARVs introduced in Kenya (private sector).

  • 1999 – HIV declared a national disaster in Kenya.

  • 2003 – ARVs available in Kenya’s public sector.

3. HIV EPIDEMIC UPDATE (KENYA 2018 – KENPHIA Survey)

  • Prevalence: 4.9% (ages 15-49).

  • Gender disparity:

    • Women: 6.6%

    • Men: 3.1%

  • High-prevalence counties (>9%): Homa Bay, Kisumu, Siaya, Migori, Busia.

  • Lowest prevalence: Samburu, Tana River, Garissa, Wajir, Mandera, Marsabit, Kiambu, West Pokot, Baringo.

4. MOST AT-RISK POPULATIONS

  1. Intravenous Drug Users

  2. Commercial Sex Workers

  3. Men Who Have Sex With Men (MSM)

  4. Vulnerable Groups:

    • Prisoners

    • Transgender persons

    • Children, women, girls

    • Persons with disabilities

  5. Young People & Adolescents

5. VULNERABLE POPULATIONS

  • Widows/widowers

  • Orphans & vulnerable children

  • Street families

  • Young women (15–24 years)

  • Service men/women

  • Refugees & displaced persons

  • Fisherfolk, truckers, alcoholics

6. KEY DETERMINANTS OF HIV PREVALENCE

  • Socio-cultural factors: Stigma, gender inequalities, negative attitudes toward condoms.

  • High-risk sexual behavior: Concurrent partners, transactional sex, intergenerational sex.

  • Biological factors: Male circumcision, STI prevalence.

7. ORIGIN OF HIV

  • Believed to have originated from chimpanzees in West Africa (1930s).

  • Transmitted to humans through hunting (blood transfer).

  • Spread globally by the 1980s.

8. PROPERTIES OF HIV

  • Obligate intracellular parasite (cannot survive outside host).

  • RNA retrovirus (integrates into host DNA).

  • Surface glycoproteins (gp120, gp41) facilitate cell entry.

  • Enzymes:

    • Reverse transcriptase (RNA → DNA).

    • Integrase (inserts viral DNA into host genome).

    • Protease (processes viral proteins).

  • Easily destroyed by heat, disinfectants (e.g., JIK).

9. HOW HIV INFECTS THE BODY

  1. Binding & Entry: gp120 binds to CD4 & co-receptors (CCR5/CXCR4).

  2. Reverse Transcription: Viral RNA → DNA.

  3. Integration: Viral DNA merges with host genome.

  4. Transcription/Translation: Viral proteins synthesized.

  5. Assembly & Budding: New virions released.

10. HIV TYPES

  • HIV-1: Global pandemic.

  • HIV-2: Less transmissible, slower progression (West Africa).

11. TRANSMISSION ROUTES

  • Sexual: Unprotected vaginal/anal/oral sex.

  • Blood: Transfusions, needle-sharing, occupational exposure.

  • Mother-to-Child: Pregnancy, delivery, breastfeeding.

Cannot transmit via:

  • Insect bites, coughing, sharing food, hugging, handshakes.

12. TRANSMISSION RISK BY EXPOSURE

Exposure RouteRisk (%)
Blood transfusion90–95%
Mother-to-child20–40%
Vaginal sex0.1–1%
Anal sex0.5–3%
Needlestick injury0.3%

13. NATURAL HISTORY OF HIV

  1. Infection Stage (asymptomatic).

  2. Acute Seroconversion (flu-like symptoms).

  3. Clinical Latency (8+ years, CD4 >500).

  4. Symptomatic HIV (CD4 <350, recurrent infections).

  5. AIDS (CD4 <200, opportunistic infections).

14. WHO CLINICAL STAGING

Stage 1 (Asymptomatic)

  • Persistent generalized lymphadenopathy (PGL).

Stage 2 (Mild Symptoms)

  • Weight loss (<10%), herpes zoster, recurrent RTIs.

Stage 3 (Moderate Symptoms)

  • Weight loss (>10%), chronic diarrhea, TB, oral candidiasis.

Stage 4 (AIDS-Defining Illnesses)

  • Wasting syndrome, PCP, toxoplasmosis, Kaposi’s sarcoma.

15. OPPORTUNISTIC INFECTIONS (OIs)

  • Bacterial: TB, pneumonia.

  • Fungal: Candidiasis, cryptococcal meningitis.

  • Viral: CMV, HSV.

  • Protozoal: Toxoplasmosis.

16. PREVENTION STRATEGIES

Primary Prevention

  1. ABC Approach:

    • Abstinence

    • Be faithful

    • Condom use

  2. VMMC (Voluntary Medical Male Circumcision).

  3. PMTCT (Prevention of Mother-to-Child Transmission).

  4. PrEP/PEP (Pre-/Post-Exposure Prophylaxis).

Secondary Prevention

  • Early ART initiation.

  • Regular CD4/viral load monitoring.

17. HIV TESTING & COUNSELING (HTC)

  • Rapid Tests: Determine, Unigold, OraQuick.

  • Confirmatory Tests: ELISA, Western Blot.

  • Algorithms: Serial/Parallel testing.

18. MANAGEMENT OF HIV/AIDS

Antiretroviral Therapy (ART)

  • NRTIs: Tenofovir, Lamivudine.

  • NNRTIs: Efavirenz, Nevirapine.

  • Integrase Inhibitors: Dolutegravir.

  • Protease Inhibitors: Lopinavir.

Goal: Viral suppression (undetectable viral load).

19. STIGMA & DISCRIMINATION

  • Effects: Reduced testing, poor adherence, mental health issues.

  • Mitigation: Education, advocacy, legal protections.

20. SOCIAL BEHAVIOR CHANGE COMMUNICATION (SBCC)

  • Goals:

    • Increase condom use.

    • Reduce risky behaviors.

    • Promote VCT/ART adherence.

21. HOME & COMMUNITY-BASED CARE (HCBC)

  • Components: Nursing care, counseling, nutrition support.

  • Benefits: Reduces hospital burden, improves quality of life.

22. SEXUALLY TRANSMITTED INFECTIONS (STIs)

Common STIs

  1. Bacterial: Gonorrhea, Chlamydia, Syphilis.

  2. Viral: HSV, HPV, HIV.

  3. Protozoal: Trichomoniasis.

Syndromic Management

  • Urethral Discharge: Ceftriaxone + Azithromycin.

  • Genital Ulcers: Benzathine Penicillin (Syphilis), Acyclovir (HSV).

  • Vaginal Discharge: Metronidazole (BV), Fluconazole (Candidiasis).

23. PREVENTION OF STIs

  • ABCDE Approach:

    • Abstinence

    • Be faithful

    • Condom use

    • Diagnosis & treatment

    • Education

CONCLUSION

  • HIV/AIDS & STIs remain major public health challenges.

  • Prevention, early diagnosis, and treatment are key.

  • Combating stigma and promoting SBCC are critical.

END.


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