Lecture 6: HIV/AIDS Flashcards
Why do HIV/AIDS epidemics differ from country to country or from context to context?
Why do HIV/AIDS epidemics differ from country to country or from context to context?
15% of the world population lives in Africa, but 68% of people living with HIV/AIDS live in Africa and 64% of new infections happen in Africa. New infections happen almost equally amongst the whole population instead of focussing around the key populations like in the rest of the world, e.g. Asia. In Sub-Saharan Africa, the key populations and the relations between them does not hold up. 75% of new infections occur in women between 15 and 19. This phenomenon is caused by concurrent sexual relationships. A concurrent sexual relationship is having many different sexual relationships after each other. If your current partner has 1 or 2 people on the side, the risk of contracting HIV is even higher. Especially as your viral load is much higher after just having contracted HIV. You can then pass it onto someone else more easily. The likelihood of unprotected sex is higher in those concurrent sexual relationships because there is trust. Concurrent sexual relationships in combination with intergenerational sex (the girls have sex with a partner much older than them) is causing girls of this age group to be more likely to be HIV positive. This does not meant that there is not a key contribution of the usual key populations.
What are the key populations for HIV/AIDS?
Key populations are msm (men having (anal) sex with men), trans people, sex workers, people who inject drugs. These key populations are connected, e.g. msm and people who inject drugs are connected because people who inject drugs also sell sex and this sex can also be unprotected sex.
Why are some people who know they have HIV not on treatment?
A sizable group of people know they have HIV, but are not on treatment. This is likely because there is a lot of stigma around HIV and people with a higher risk of contracting HIV like men having sex with men are stigmatised themselves.
Why are children less likely to be on treatment than adults?
Children are less likely to be on treatment than adults. This is again due to stigma and stigma between couples. If a couple knows they are both HIV positive and they discuss it, they are more likely to be on treatment. However, if the woman is tested when she is pregnant (because most women find out they are HIV positive then) and she doesn’t reveal that to her husband, she is likely to drop out from the treatment programme after she has delivered. Because then she does not have an excuse of why she has to go to the hospital every time. To test if a child from a HIV positive mother has HIV, you need to test over time: at 3 months, 6 months, 18 months. Many do not come to the testing at 18 months because by then the mother has dropped out of the programme. In addition, out of fear the child will be positive, some parents will not let them get tested.
Why won’t some men get tested if their partner tests positive?
Men also don’t want to be tested if their partner tests positive, as they fear it will cause tension and arguments in their household. Another big contributing factor is people refusing to go on treatment as prophylaxis as “why would I need treatment if I am not sick”.
If there is treatment available, why do many people still die from HIV?
They do not adhere to treatment, there is resistance, the first treatment does not work anymore and they need a more expansive treatment, there is no access to treatment, etc.
What is HIV combination prevention?
A combination of biomedical, structural and behavioural interventions.
What are the principles of HIV interventions?
Rights based, evidence formed, community owned, a mix of biomedical, behavioural and structural, prioritised on HIV prevention for where it has the most effect, tailor-made, programmatic policy action and synergistically over a period of time.
What does rights based mean?
Rights based: those who are much less likely to have access to prevention and treatment are also part of the intervention.
What does evidence informed mean?
Evidence informed: what is the reality
What does community owned mean?
Community owned: formulate the intervention in a way to help the community figure out the answers
What is an example of a biomedical intervention for HIV?
Medication to lower viral load
What is an example of a structural intervention for HIV?
Stigma reduction, interventions to reduce inequity, laws protecting the rights of people living with HIV, increasing school education, decriminalisation of injectable drugs.
What is an example of a behavioural intervention for HIV?
Stimulation to practice safe sex
Are biomedical, structural and behavioural interventions seperate?
There is a lot of overlap between these types of intervention. E.g. condoms are not really only a biomedical intervention, because a behavioural intervention is needed to make people use the condoms.
