Malaria 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)
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
HIV timeline
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
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?
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
Vulnerability of young 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
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.
Drivers of the HIV 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)
Sub-Saharan Africa
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)
Vulnerability of young women
- Biological
- More at risk of infection due to vaginal anatomy: more surface area, prone to bruising
particularly in younger women
- Poverty with wide disparity in wealth: complex relationship: wealthy people
take advantage of poorer people, indulge in more sexual practices and more
sexual partners
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
Prevention
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
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
What is the difference between HIV and AIDS?
Which countries have the highest
prevalence of HIV?
Which members of a population are most “at risk” of becoming HIV positive?
How are the “at risk” populations for HIV different around the world?
HIV treatment cascade
90-90-90
● In 2016, UNAIDS set a target that by 2020…
● 90% of all people living with HIV are aware of their HIV status,
● 90% of all people who know their status are receiving antiretroviral therapy (ART), and
● 90% of those on ART are virally suppressed
95-95-95
● UNAIDS now aims that by 2030…
● 95% of all people living with HIV are aware of their HIV status,
● 95% of all people who know their status are receiving antiretroviral therapy (ART), and
● 95% of those on ART are virally suppressed
HIV treatment cascade
● Data for these targets is often visualised as a “HIV treatment cascade”
● Vertical bar graphs where
○ the total affected population is the left-hand column
○ the height of the next columns show the proportion of people reached by each step needed to get care and achieve viral suppression
○ the ultimate goal is the right-hand column
Group activity
● What proportion of people who know their status are on ART?
● What proportion of people on ART are virally suppressed?
● Given the data on the chart, what type of program activity would you prioritise in Kenya to get more people
virally suppressed?
Why use cascades?
“The value of calculating the cascade indicators is that they can offer an efficient way to visualize and identify
programmatic gaps in need of intervention in order to achieve the final goal.
Monitoring care cascade indicators over time is a useful way to judge the impact of new or additional efforts to
increase programme impact.”
~ WHO, 2018
Reminder!
We have been discussing HIV treatment
Many programs also focus on HIV prevention
