Module 4 Lecture 31

Question 1

Factors that shape the HIV epidemic

Answer 1

• AIDS related deaths are decreasing and people are living longer with HIV due to improved treatment and expanded access to treatment and care
• But globally, a high proportion of people with HIV do not know there HIV status, and most people living with or at risk for HIV do not have access to HIV prevention, treatment and care
• HIV/AIDS is really multiple epidemics. Not all communities, regions and populations are affected in the same way
• In order to reduce the burden of HIV/AIDS, it is essential to tailor the response and interventions to local circumstances and prevalent risk factors

Question 2

Major modes of HIV transmission and high risk groups

Answer 2

• Unprotected sexual intercourse with HIV+ person: High risk groups include homosexuals, women and men in heterosexual relationships and sex workers
• Sharing un-sterilised injecting equipment” High risk group is injecting drug users
• Mother to child transmission: High-risk group is infants born to or breast fed by untreated HIV+ mothers
• Blood-borne: High risk group is anyone receiving un-screened blood products, organs or injections with un-sterilised needles

Question 3

Feminisation of the HIV epidemic

Answer 3

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

Question 4

Context of Feminisation

Answer 4

• leading cause of death and disease among women of reproductive age
• Experience of violence is associated with a three fold increased risk of HIV
• Women are likely to face barriers in accessing HIV prevention, treatment and care services
• Women and girls are often the primary caregivers in the family

Question 5

Social Determinants that influence acquisition and treatment of HIV

Answer 5

• Gender inequalities in rules governing sexual relationships, negotiating condom use; sexual abuse/violence
• 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
• Problems with disclosure of HIV status, partner notification and confidentiality

Question 6

Humans rights, women and HIV/AIDS

Answer 6

• Women’s right to safe sexuality and to autonomy in all decisions relating to sexuality is intimately related to economic independence. This right is 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 which results on the one hand from poverty affecting men and women, and on the other hand, from 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 sexuality is not going to be achieved

Question 7

Mother to Child transmission

Answer 7

• Without treatment, about 1/3 of children born to women who are HIV+ will become infected with the virus while in the womb, at birth or through breastfeeding
• The risk is greatly reduced by screening pregnant mothers and treating those who are HIV+ with Anti-Retroviral drugs

Question 8

Data sources commonly used to estimate HIV prevalence in populations

Answer 8

• Surveillance systems in some countries
• Epidemilogical studies
• Surveys in health facilities, especially antenatal clinics

Question 9

Some key sources of bias when generalising from antenatal clinic surveys

Answer 9

• Prevalence among pregnant women may not be similar to prevalence among men, non-pregnant women and children
• Data from urban antenatal clinics will not represent prevalence in remote or rural populations
• Estimates among people attending clinics can defer from those who do not attend clinics

Question 10

Pacific Islands

Answer 10

• 90% of the burden in Pacific Islands is experiences in PNG
• Largely heterosexual transmission
• Relatively high prevalence of other STDs increase the risk of also acquiring HIV
• Other Pacific Island nations: currently have relatively low prevalence of HIV/AIDS, but the high prevalence of other STDs makes HIV a potentially major problem

Question 11

HIV Prevention and Control

Answer 11

• Safer Sex: Media campaigns and strategies, educational approaches, condoms
• Safer products: Screen blood products, needle exchange programme, Protect against needle stick injuries
• Increase access to healthcare: Voluntary testing and counselling, treatment care and support, antenatal screening, treatment of STD infections
• Reduce discrimination of those ‘disabled’ : Wider policy context/legislation