Lecture 31. HIV/AIDS

Question 1

HIV/AIDS trends

Answer 1

increase in the burden of disease
> 70% of infected people live in Sub-Saharan Africa
low access to treatment in low and middle income countries
• Most (78%) treated in Western and central Europe and North America
• Only a minority (36%) treated in Western and Central Africa

Question 2

AIDS related death trend

Answer 2

AIDS-related deaths are decreasing and people are living longer
with HIV due to improved treatment and access to treatment/care

Number of new infections decreases

Question 3

Inequality in HIV distribution

Answer 3

• Sub-Saharan Africa has an estimated 1.2 million new infections per year
• Young people account for a significant and rapidly growing percentage of the population and are reaching the age of highest risk for sexual transmission.
-Low-income countries are more susceptible and have less treatment available
-Most people living with or at risk for HIV do not have access to HIV
prevention, treatment, and care

Question 4

Changes in life expectancy in African countries

Answer 4

a significant drop in 1980s
increase since then

Question 5

how many infected people are not aware of their HIV status?

Answer 5

50%

Question 6

how should interventions be tailored

Answer 6

to local circumstances and prevalent risk factors

Question 7

High risk groups for HIV/AIDS

Answer 7

Question 8

What is the dominant mode of transmission now?

Answer 8

heterosexual transmission

Question 9

Trends of disease in Sub-Saharan africa

Answer 9

• Of the new infections among people aged 15 years and older:
- About 39% are among people aged 15-24 years
(majority are female and most live in Sub-Saharan Africa)
- New infections among young women aged (15-24) were 44%
higher than men their age

In Sub-Saharan Africa, about 60% of people living with HIV are women

Question 10

How much of the new infections are in low-middle income countries

Answer 10

-~95% in 2016

Question 11

Feminization of the HIV epidemic

Answer 11

refers to the observation that increasing proportions of new infections are among women, primarily due to heterosexual transmission of the infection.

In Sub-Saharan Africa, about 60% of people living with HIV are women

Question 12

HIV trends in women. Why is the burden among women greater?

Answer 12

• Proportion of HIV+ women has steadily increased (41% in 1997; 51% in 2002)

AIDS-related illnesses is the leading cause of death for women of reproductive age (15-49 years) worldwide

• Experience of violence is associated with a three-fold increased risk of HIV infection

Women are more likely,
• to face barriers in accessing HIV prevention, treatment and care services
• to face barriers to education
• to experience poverty

HIV is not only driven by gender inequity, but it also entrenches gender inequity,
leaving women more vulnerable to its impact

Question 13

Determinant of HIV infection

Answer 13

Gender inequities

Rules governing sexual relationships, negotiating condom use

Sexual abuse/violence

Problems with disclosure of HIV status.

Partner notification and confidentiality (This can prevent getting necessary prevention options, testing for HIV, and treatment)

• Poverty and low social status

– and consequent, limited access to education and reproductive health services

• Social norms, stigma, and discrimination

• that prevent access to prevention efforts and treatment

→ Inequitable distribution in the risks of HIV infection

→ Inequitable distribution of HIV infection (among the low SES groups, women and young people)

Question 14

How are human rights and economic independence related to HIV epidemic in women?

Answer 14

• Women’s rights to safe sex and to autonomy in all decisions relating to sexuality is intimately related to economic independence

• This right is most violated in those places where women exchange sex for survival as a way of life.

• This is not about prostitution but a basic social and economic arrangement between the sexes that results from

– poverty affecting women

– male control over women’s lives in a context of poverty

• Unless and until the scope of human rights is fully extended to economic security, women’s right to safe sex is not going to be achieved i.e., the right not to live in abject poverty in a world of immense riches

Question 15

HIV prevention strategies

Answer 15

Safer Sex

• Media campaigns and wider policy strategies to reduce stigma and discrimination
• Educational approaches re risks: teachers, peers, workplaces, mass media campaigns
• Condoms: promote use (social marketing campaigns), increase availability, reduce cost

Safer products (and related practices)

• Screen blood products for HIV
• Needle and syringe exchange programs for IV drug users
• Protect against needle-stick injuries (health professionals)

Question 16

HIV control strategies

Answer 16

Increase access to Healthcare

• Voluntary testing & counseling to reduce the risk of sexual transmission
• Treatment, care, and support for HIV+ people
• Treatment of sexually transmitted infections, and provision of family planning services
• Antenatal screening and treatment for HIV to prevent Mother-To- Child-Transmission of HIV

Question 17

Without treatment how many kids get infected from HIV + mothers?

Answer 17

⅓ of the kids born to an HIV+ mother will have HIV

Question 18

How can the mother-to-child transmission rate be reduced?

Answer 18

This risk is greatly reduced by screening pregnant mothers and treating those who are HIV+ with AntiRetroviral drugs

Question 19

How many mothers in Sub-Saharan Africa need treatment?

Answer 19

91%

Question 20

In NZ how many current infections are in the MSM population?

Answer 20

– 75% of infections are men who acquired the infection via sex with men

Question 21

What are the problems with HIV in NZ?

Answer 21

in 2008:

– 6.5% of men who have sex with men were infected;

20% were unaware of HIV status.

– Need to encourage condom use to reduce the risk of HIV transmission, and HIV testing to detect infection early

Question 22

Overall HIV trend in NZ

Answer 22

Low prevalence

Question 23

2016 HIV outbreak in Indiana: US response

Answer 23

• Outbreak investigation: Needle-sharing among Injection Drug Users
• “One-stop shop” clinic for prevention advice, testing, and treatment
• Needle & Syringe Exchange program (temporary)
• Public Education

Question 24

2016 HIV outbreak in Indiana: main driver and lessons learnt

Answer 24

County was without an HIV testing center since early 2013 when the sole provider – a Planned Parenthood Clinic - closed

• Surveillance, investigation of risk factors, and health promotion were crucial in establishing prevention efforts well before the virus was discovered.
• Subsequent biomedical & pharmaceutical innovations provided rapid tests for HIV and treatment options that improve quantity (YLL) & quality (YLD) of life.

• But treatment does not replace the importance of prevention.

• As long as most HIV-infected persons are unaware of their infection status, prevention and treatment efforts will be hampered.

Question 25

What are the major challenges for the future?

Answer 25

• Global resources for prevention & care for HIV fall well short of the needs.
• Successful efforts for prevention need to combat stigma and discrimination.
• Inequities in resources and access to health care, make it essential to address the social determinants of health and human rights, especially among women, low SE groups, and young people.

Question 26

What level of prevention of AIDS is treating mothers infected with HIV with antiretroviral drugs?

Answer 26

for the mother-secondary( already infected with HIV, prevent AIDS)

for the child-primary( has not been yet infected, preventing infection)