Latest Concepts in Prevention of HIV/AIDS

Dr Ekiria Kikule

History of AIDS
1981 AIDS 1st described as a new clinical entity First identified among MSM Kaposi sarcoma & Pneumocystis pneumonia were the presenting conditions Both conditions common in severe immunosuppression

1st cases highly stigmatized

1983 - Human Immunodeficiency Virus (HIV) identified as the true cause of AIDS

The Human Immunodeficiency Virus

A living structure can multiply Completely parasitic cannot survive on its own No specific antiviral drugs destroy the virus Current drugs only interfere with viral multiplication Cells of the immune system favour HIV multiplication Long latent period ( 5 15 years)

Natural Course of HIV Infection

Openings

in the skin - infected material Contact with mucous membranes sexual Virus invades the lymphoid tissue immune system
Person
AIDS

may remain healthy for a long time

said to occur when signs of disease begin to occur oral thrush; herpes zoster (ekisipi)

Routes of Infection
Unsafe Sex
Hetero and/or homosexual Multiple partners Risky (unprotected)

Vertical Mother-to-child transmission Transfusion infected blood Procedures with infected tools
Circumcision Ear piercing Intravenous drug use

High Risk Groups:

Commercial sex workers Intravenous drug users

Men who have Sex with Men (MSM)

Traditional circumcision (Imbalu)

Basics of HIV diagnosis

Often recognised & diagnosed late
Low CD4 count <200/ml An AIDS illness present

HIV testing to avoid further transmission

For every pregnant woman In blood/organ donation

Diagnosis based on Lab screening tests

Rapid Test (screening) Western Blot - confirmatory

What drives the HIV/AIDS Epidemic?

High risk sex Maternal to Child Transmission (MTCT) HIV Discordance & Disclosure Economic Factors Socio-cultural Factors Stigma and Discrimination Vulnerable Groups/Populations at risk Concurrent STIs

1. High Risk Sex

Multiple partners Non-marital Non- consensual rape, defilement, etc Commercial Transactional

Intergenerational
Alcohol & drug abuse before sex

Sex without testing and/or disclosure

Sex with inconsistent condom use

Why High risk sex ??

There is lack of internalization and personalization of the HIV risk among the population Normalization of HIV/AIDS - now no longer an immediate threat of death or serious illness as before the era of ARVs

2. Mother To Child Transmission (MTCT)

Second commonest means of transmission of HIV in Uganda (40% if no intervention) Intending parents not knowing their status

Viral Load : MTCT occurs at all levels of detectable viral load but especially at delivery Number of women enrolling for Prevention of MTCT is low

MTCT (contd)
80% of pregnant women attend the antenatal clinic at least once but only 30% deliver from health facilities (UDHS 2000) Social cultural factors that deter women from use of PMTCT services include: lack of or limited male involvement, stigma, inadequate health services etc.

3. Blood Transfusion
Transmission of HIV thru infected blood and blood products almost eliminated globally Thorough scrutiny of blood before transfusion

Exclude people from blood donation

Active injection drug users Sexually active men & women Immigrants from high-prevalence areas

PREVENTION
HCT know your status

Abstinence
Being Faithful to one partner

Condom use
Post Exposure Prophylaxis (PEP)

Prevention among positives

Discordance

POST EXPOSURE PROPHYLAXIS

Occupational

exposure to HIV and other blood-borne diseases is unnecessarily common in Uganda. exposure to blood and some other body fluids has the potential to transmit viral infections such as HIV, Hepatitis B and C

Any

When to give P.E.P.

Give If

P.E.P if risk is significant

exposed only to stool, urine vomit, saliva or faeces, do not give Post Exposure Prophylaxis as the risk is low Health Worker to take decision to start P.E.P if risk is significant

Allow

For

HIV only give P.E.P if the Health Worker is HIV negative