HIV & PEPFAR Flashcards
Lecture outcomes
By the end of this lecture, you should be able to:
* Define what HIV and AIDS mean
* Identify the main risk factors for HIV/AIDS and describe
how they differ across regions and countries
* Understand the drivers of the HIV pandemic
* Describe the main preventive strategies that can be used to
control HIV/AIDS
What is HIV?
- Human Immunodeficiency Virus (HIV), the virus that causes
AIDS - identified as a retrovirus in 1983. - Two serotypes: HIV-1 (most common type) and HIV-2; both are
zoonotic in origin; HIV-1 from chimpanzees and HIV-2 from
sooty mangabeys. - HIV is found in semen, blood, vaginal and anal fluids, and
breast milk - Passed from one person to another when infected blood, semen, or vaginal secretions come in contact
with an uninfected person’s broken skin or mucous membranes. - Infected pregnant women can pass HIV to their baby during pregnancy, delivery and breast-feeding.
- Other: transfusion of blood and blood products, organ transplantation and occupational exposure
- People with HIV have the HIV infection (termed HIV positive).
HIV timeline
What is AIDS?
- AIDS (Acquired Immunodeficiency
Syndrome) - Syndrome – A group of symptoms that
collectively indicate or characterize the
disease. - AIDS characterized by a weakening of
the immune system - the end stage of the
HIV infection - Currently no cure however HIV is now a
manageable chronic health condition
using antiretroviral therapy
What is AIDS?
AIDS defining illnesses
Candidiasis of oesophagus or respiratory tract
Invasive cervical cancer
Cryptosporidial diarrhoea
Cytomegalovirus disease
AIDS dementia/HIV encephalopathy
Kaposi’s sarcoma
Disseminated or pulmonary TB
Pneumocystis pneumonia (PCP)
Toxoplasmosis of brain
Wasting syndrome due to HIV
…. And others
Risk defined as:
“an aspect of personal behaviour or lifestyle, an
environmental exposure or an inborn or inherited
characteristic which on the basis of epidemiological evidence
is known to be associated with health-related condition(s)
considered important to prevent” (Last 2001)
Who is at risk of HIV?
- High risk ‘behaviours’:
- Unprotected anal or vaginal sex with exchange of body
fluids - IV drug use with shared needles/equipment
- Infant of a mother with HIV – during pregnancy, birth and
breast feeding - Having another sexually transmissible infection (STI) e.g.
syphilis, herpes, chlamydia, gonorrhoea - Recipient of blood products (not in Australia anymore)
- Some needle stick activities – tattooing, piercing
- Occupational risk – surgeons, dentists, lab workers
Global summary AIDS epidemic 2022
Regional HIV and AIDS statistics and features 2022
Prevalence of HIV by
region
New infections by population 2020
Sub-Saharan Africa
- 25.6 million people living with HIV/AIDS in Sub-Saharan
Africa - Only 14% of world’s population – but 67% of HIV case
s - Main route of transmission is heterosexual intercourse
- Of the 3600 new HIV infections a day, about 50% of them are
in Sub-Saharan Africa - Every week 4000 adolescent girls and young women aged
15-24 years became infected in 2022: 3100 (77.5%) occurred in
Sub-Saharan Africa
Sub-Saharan Africa - gender
Significant differences between young
women and men:
* Six in seven new HIV infections among
adolescents aged 15–19 years are among
girls.
* Young women aged 15–24 years are twice as
likely to be living with HIV than men.
Vulnerability of young women
- Biological
- More at risk of infection due to vaginal anatomy: more surface area, prone to bruising
particularly in younger women - Social/cultural and economic factors
- Cross generational relationships: impossible to negotiate safe sex with older men
- Transactional sex: in exchange for money or gifts
- Age, economic and social disparity: exploitation
- Many women dependent on their husbands for finances and cultural acceptance
- Interpersonal violence
Drivers of the HIV epidemic
- High levels of stigma and discrimination that:
- Prevent people from accessing preventative services: VCT Voluntary counselling and
testing, buying condoms - Prevent PLHIV from accessing treatment
- Prevent them from risk-reduction measures e.g. condom use, abstinence and correct
condom use - Prevent HIV-infected mothers from accessing prevention of mother to child (PMTCT)
services (e.g. mother will continue to breast feed contrary to health workers advice) - Poverty with wide disparity in wealth: complex relationship: wealthy people
take advantage of poorer people, indulge in more sexual practices and more
sexual partners
Drivers of the HIV epidemic
“social, economic and structural factors that drive the
epidemic”
- Act at various levels and include biological, behavioural, social and
psychological factors - Gender inequality: Low social, economic and cultural status of women:
women cannot ask their husbands to use condoms, cannot refuse sexual
advances, marital rape, cannot leave for financial, cultural reasons - Early sexual debut and early marriages (cannot negotiate for safe sex,
biology not yet mature)
HIV in Australia
- An estimated 28,870 people living with HIV
in Australia in 2022 - 93% of those living with HIV were diagnosed
- Of those known PLHIV receiving ART, 98%
have a suppressed viral load (above WHO
target) - 555 HIV notifications in 2022, a decline from
1,068 in 2013 - Number of infections reduced due to more
people being tested, people starting
antiretroviral treatment early and Preexposure prophylaxis (PrEP) among gay and
bisexual men but also COVID-19 restrictions
Challenges with prevention
- Success is variable by region, country and populations within countries
- Lack of political commitment
- Lack of funding – many countries depend on donor funding
- Key populations left out of prevention strategies
- Marginalisation of key populations and criminalization
- Refusal by some governments to consider key populations at risk and
harm reduction strategies and young people’s sexual and reproductive
needs and rights - Lack of female controlled strategies: have to rely on partners to use
condoms, reduce sexual partners - Lack of systematic prevention implementation
The five prevention pillars for 2025
Good news for HIV!
- Very many interventions in the field of HIV/AIDS
- Social interventions to manage stigma, empowerment issues, education of PLHIV and their
families - Medical advancements/innovations:
- Went from no treatment to antiretroviral therapy
- PREP – pre-exposure prophylaxis
- Latest treatments are long-acting injections
- Possibility of use of long-acting injections for prevention
- Possibility of a cure! https://hivcure.com.au/
Summary
- HIV was identified as a retrovirus in 1983 and there are two serotypes HIV1 and HIV2
- HIV is passed from one person to another during sex, mother to child (during
pregnancy, delivery and breast-feeding), unsafe injecting practices and during blood
transfusion. - AIDS – syndrome characterised by opportunistic infections
- Sub-Saharan Africa has the highest rates of HIV in the world and young women have
higher rates than young men. Most children infected globally live in Sub-Saharan
Africa - Main risk factors differ between regions
- There are several social, environmental, economic, political and historical influences on
the epidemic - Though there have been major advancements in treatment, there is still room for
improvement
