Lecture 31 HIV/AIDS

Question 1

Why is HIV/AIDS a problem?

Answer 1

Although the epidemic has lasted many decades, it is still very prevalent in the world (most problematic non communicable disease)

Question 2

How did HIV/AIDS first spread?

Answer 2

It first spread among homosexual men, leading to them becoming advocates to health policies

Question 3

What do we know about HIV?

Answer 3

• There are several modes of transmission, this has helped with facilitating prevention
• There are now cheap and reliable HIV specific screening tests
• We know that HIV/AIDS is caused by HIV
• There are now better treatment options which improves life expectancy for those with AIDS
• There is still not a vaccine
  40 million people have died from the disease

Question 4

What is the rates of HIV/AIDS globally?

Answer 4

Most cases are in sub-Saharan African countries/ low income countries which means access to treatment is low (only 1/3 have access compared to 2/3rds in european countries)

Question 5

How did HIV/AIDS affect the change in life expectancy for countries in Africa

Answer 5

Life expectancy was originally increasing, however due to HIV/AIDS it plummeted by about 10-20 years. With treatment now, life expectancy is increasing again

Question 6

What is the prevalence of new cases and deaths from HIV/AIDs globally?

Answer 6

Deaths from HIV are going down due to better treatment, new infections are going down because we know the modes of transmission and high risk groups, however prevalence is increasing because people are not dying from it

Question 7

What are factors shaping the epidemic?

Answer 7

Nearly 15% of people with HIV don’t know their status, most people living with or at risk of HIV do not have access to HIV prevention, treatment and care, about 95% of affected live in LMICs, to reduce the burden of HIV/AIDS, it is essential to tailor the response and interventions to local circumstances and prevalent risk factors

Question 8

What are recent global trends?

Answer 8

• Heterosexual transmission has become the dominant mode of transmission
• Young people account for a significant and rapidly growing percentage of the population
• Of new infections for people aged 15+, 40% are in the 15-24 age group (mostly female, in sub saharan)
• AIDS related illnesses is the leading cause of death for women of reproductive age worldwide

Question 9

What is the feminization of the HIV epidemic

Answer 9

increasing proportions of new infections are among women primarily due to heterosexual transmission of the infection

Question 10

What proportion of the population affected by HIV/AIDS are female

Answer 10

only around 20% in NZ but in african countries its 70-80%

Question 11

Which age group has the greatest deaths for HIV/AIDS

Answer 11

those aged 15-49 years (mostly females)

Question 12

Who are the high risk groups for unprotected sexual intercourse with an HIV+ person?

Answer 12

Homosexual men, heterosexual people and sex workers

Question 13

What are the high risk groups for sharing un-sterilized injections and needles?

Answer 13

Injecting drug users, those receiving injections with unsterilized needles (generally in low resource settings)

Question 14

Who are most at risk for mother-child transmissions

Answer 14

infants born to or breast fed by untreated HIV+ mothers

Question 15

Who are the high risk groups for blood borne transmissions?

Answer 15

Anyone receiving unscreened blood products or organs (generally in countries with inadequate screening)

Question 16

What are social determinants of the HIV epidemics among women in terms of harmful power dynamics?

Answer 16

• Ability for women to negotiate condom use
• Gender based violence/sexual abuse (women who experience virus are more at risk of HIV)
• Problems with disclosure of HIV status, partner notification and confidentiality
• Stigma and discrimination

Question 17

What are social determinants of the HIV epidemics among women in terms of early school drop out, poverty and financial dependence?

Answer 17

• Lack of education leads to lack of safe/well paid jobs, also lower health literacy leading to problems in accessing healthcare
• Lack of resources leads to women doing things that put them at risk of HIV (sex work,

Question 18

What are social determinants of the HIV epidemics among women in terms of lower access to health services

Answer 18

Women face barriers in accessing HIV prevention, treatment and care
- denied access, need parental consent, low health literacy

Question 19

What is the relationship between human rights and gender inequity

Answer 19

HIV is driven by gender inequity but entrenches gender inequity, leaving women more vulnerable

Question 20

What does the WHO say in terms of human rights, women and HIV/AIDS?

Answer 20

• womens rights to safe sexuality and to autonomy in all decisions relating to sexuality is closely related to economic independence.
• The scope of human rights needs to be extended to economic security or a womens right to safe sex will not be achieved

Question 21

What are interventions for the prevention and control of HIV around gender inequities and harmful social norms?

Answer 21

• Empower women, educate men
• Enable opportunities for education and financial independece
• Change social norms around harmful dynamics, gender based violence, stigma and discrimination
• improve health literacy
• improve access to sexual and reproductive health services

Question 22

What are interventions for the prevention and control of HIV around safer sex?

Answer 22

Media campaigns around wider policy strategies to reduce stigma and discrimination
Educational approaches
Condoms: can promote use, increase availability and reduce cost

Question 23

What are interventions for the prevention and control of HIV around safer products

Answer 23

Screen blood products for HIV, needle and syringe exchange programs for IV drug users, protect against needle stick injuries

Question 24

What are interventions for the prevention and control of HIV around increasing access to healthcare

Answer 24

• voluntary testing and counseling to reduce risk of sexual transmission
• treatment, care and support for HIV+ people
• treatment of STI and provision of family planning services
• Antenatal screening and treatment for HIV to orevent mother-child transmission of HIV

Question 25

What are the details about mother to child transmission

Answer 25

• With no treatment, 1/3rd of children born to women HIV+ will get infected.
• Risk is reduced by screening pregnant mothers and treating HIV+ with retroviral drugs
• Sub saharan africa is home to 91% of pregnant mothers needing treatment

Question 26

Is providing anti-retroviral drugs to pregnant mothers infected with HIV a primary/secondary prevention of AIDS?

Answer 26

For child it is a primary prevention because it prevents the biological onset, for the mother is is a secondary prevention because it reduces disease progression in HIV+ mother

Question 27

What is the HIV/AIDS situation in NZ?

Answer 27

Deaths have come down drastically, however still more people getting infected so prevalence is increasing. 20% were unaware of their HIV status

Question 28

What are lessons we have learnt from the HIV pandemic?

Answer 28

• Surveillance, investigation of risk factors and health promotion were crucial in establishing prevention effors well before the virus was discovered
• Treatment doesn’t replace importance of prevention
• If HIV+ people are unaware of their status, prevention and treatment efforts will be hampered

Question 29

What are three major challenges for the future?

Answer 29

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