HIV Lecture Slides

HLTH 102
HIV / AIDS
Source: UN Photo Library

During the first decade of the epidemic, there
was very little to offer someone dying from AIDS.
The best you could hope for was that your family
wouldnt throw you out. You would have been
extremely fortunate to have someone care for you
at the end, either at home or in hospice care.
MICHEL SIDIB
UN AIDS
http://www.unaids.org/sites/default/files/media_asset/MDG6Report_en.pdf
HIV AIDS
1981
HIV AIDS
A brief history
1981-1985 MYSTERY AND CONFUSION
1986-1990 PANIC AND PROTEST
1991-1995 DEATH AND DARKNESS
1996-2000 HOPE AND UNCERTAINTY
2001-2005 COMMITMENT AND MOBILIZATION
2006-2010 SETTING TARGETS FOR UNIVERSAL ACCESS
2011-2015 MEASURING IMPACT

What is HIV?
Source: Wikimedia Commons. http://en.wikipedia.org/wiki/File:HIV-budding-Color.jpg

What is AIDS?
HIV Transmission
Unprotected penetrative (vaginal or anal) and oral sex
Blood transfusion with contaminated blood
Contaminated syringes, needles or other sharp instruments
Infected mother to her child during pregnancy, childbirth and breastfeeding
HIV AIDS
Global Statistics 2015

Global HIV
Proportion of all people aged 15-49 in 2007
Copyright SASI Group (University of Sheffield) and Mark Newman (University of Michigan).
HIV AIDS
Regional Differences 2015
More than two thirds of people with HIV

AIDS, live in Sub-Saharan Africa.
http://www.unaids.org/en/resources/campaigns/HowAIDSchangedeverything/factsheet
HIV AIDS
US$ 20.2 billion was invested in the AIDS response in low-

and middle-income countries.
Domestic resources constituted 57% of the total resources
available for AIDS in LMICs.
Between 2009 and 2014, 84 out of 121 low- and middle
income countries increased their domestic spending on
AIDS.
HIV AIDS
MDGs
01 To have, by 2015, halted and begun to

reverse the spread of HIV/AIDS.
02 To provide special assistance to children orphaned by HIV/AIDS.
03 To encourage the pharmaceutical industry to make essential

drugs more widely available and affordable by all those who need
them in developing countries.
04 To help Africa build its capacity to tackle the spread of the

HIV/AIDS pandemic.
MDG TARGET
Have halted by 2015 and
begun to reverse the
spread of HIV/AIDS.
Source: UN Millennium Declaration Report - 2010

HIV AIDS
HIV Transmission in Canada
55% Men who have sex with men
10% Injection Drug Use
32% heterosexual contact
http://healthycanadians.gc.ca/publications/diseases-conditions-maladies-affections/hiv-aids-estimates-2014-vih-sida-estimations/index-eng.php#a2
HIV prevalence in Canada
0.2% Prevalence
75,000 Canadian living with HIV
10% First Nations of all HIV cases in Canada
http://healthycanadians.gc.ca/publications/diseases-conditions-maladies-affections/hiv-aids-estimates-2014-vih-sida-estimations/index-eng.php#a2
HIGH RISK GROUPS
IV Drug Users
HIGH RISK GROUPS
Sex workers
HIGH RISK GROUPS
MSM
HIV AIDS
Special populations
http://data.unaids.org/pub/Outlook/2010/20100713_outlook_report_web_en.pdf
AIDS kills young people.

AIDS leaves orphans behind.

HIV AIDS
Prevention

HIV Prevention
ABC Strategy
Abstain
Be faithful
Use condoms

https://www.youtube.com/watch?v=L0jQz6jqQS0
HIV PREVENTION
Politics & Moral Values
The New Yorker magazine (Nov 2008)

HIV PREVENTION
Politics & Moral Values
http://www.guardian.co.uk/world/2005/aug/30/usa.aids
HIV PREVENTION
Concurrent partners

The male latex condom is the single, most
efficient, available technology to reduce the
sexual transmission of HIV.
UNAIDS, THE UN POPULATION FUND, AND WHO

HIV AIDS
Condom use
Condom use with last high-risk partner
MEN AND WOMEN AGED 15-24, SELECTED SUB-SAHARAN COUNTRIES 2003/2008

CONDOM USE
MSM
CONDOM USE
Sex workers
HIV AIDS
Sex Workers
http://data.unaids.org/pub/Outlook/2010/20100713_outlook_report_web_en.pdf
HIV PREVENTION
Barriers to condom use
Source: http://www.unfpa.org/public/global/pid/387
HIV Prevention
Barriers to condom use

HIV PREVENTION
Female condom

HIV Knowledge by question
DEVELOPING COUNTRIES 2003/2008
100
Males Females
80
60
(%)
correct
40
20
0
All 5 questions Having Condoms can A healthy Mosquitos do Sharing food
are correct only one prevent HIV looking person not transmit does not
faithful partner can have HIV HIV transmit HIV
can protect
against HIV
QUESTION
Source: UNGASS Country Progress Reports 2008.

HIV PREVENTION
Male circumcision
Reduce the risk of heterosexually acquired HIV among men by

60 percent.
Recommended by the WHO and UNAIDS as an effective

prevention strategy.
HIV PREVENTION
Male circumcision
HIV PREVENTION
IV Drug use
READING
Pisani E. Sex, drugs and HIV let's get rational.
TED2010. Filmed Feb 2010.
HIV AIDS
Testing & Counselling

HIV AIDS
Testing
Detect anti-bodies produced in response to HIV.
Requires 3 to 12-weeks post infection
Confidential HIV test

Results kept confidential in medical records, but not shared without permission.
Anonymous HIV test

The tested person's name is not used in connection with the test. No records
are kept that would link the person to the test.
HIV AIDS
Testing
HIV TESTING
High risk groups

HIV TESTING
High risk groups

HIV AIDS
Treatment

HIV AIDS
Antiretroviral therapy (ART)
Combination therapy (HAART)

3 or 4 medicines at the same time makes it harder for the
virus to adapt and become resistant.
Reduces likelihood of transmitting virus to others.

HIV AIDS
Art & Mother to Child Transmission
(MTCT)
ARTs during pregnancy and

delivery critical
May include replacement

feeding
Possible to reduce transmission

rate to less than 1%

MDG TARGET
Achieve, by 2010, universal access to
treatment for HIV/AIDS for all those who
need it.

HIV AIDS
Treatment access to ART 2015
41% of all adults living with HIV, up from 23% in 2010.

32% of all children living with HIV, up from 14% in 2010.
73% of pregnant women living with HIV had access to
treatment to prevent transmissions.
New HIV infections among children were reduced by
58% from 2000 to 2014.
HIV AIDS
Treatment Adherence
Lower among illicit drug users.
Similar rates of adherence between Africa and High income

countries.
Evidence on the benefit of directly observed treatment

equivocal.

HIV AIDS
Post-exposure prophylaxis for HIV (PEP)

Actions aimed at preventing infection in a person who may have
been exposed to the HIV infection
Provision of a short course (28 days) of antiretroviral drugs may

prevent HIV infections.
HIV AIDS
Post-exposure prophylaxis for HIV (PEP)

TREATMENT
Access: Generics & pharmaceutical companies
http://www.unaids.org/en/KnowledgeCentre/HIVData/mapping_progress.asp
The end of AIDS
HIV infection as a chronic
disease.
Treatment
HIV Vaccine?
HIV TREATMENT
Vaccines
HIV AIDS
Discrimination

Many people living with
HIV/AIDS are the most
stigmatised groups in society.
Stigma and discrimination have a direct
effect on safe sex practices, testing,
treatment seeking, government action
and policies, criminalization, science, and
health care
peoples lives.
Family, job, housing. For many it is
the difference between life or death.
HIV AIDS
Discrimination
HIV AIDS
Discrimination
HIV AIDS
Discrimination
HIV TREATMENT
Access & Politics
Source: http://www.timesonline.co.uk/tol/news/world/africa/article5235539.ece
READINGS
Fighting HIV On the Ground in South Africa
https://www.youtube.com/watch?v=MKIteYoa9ug
HIV AIDS
Counselling

HIV AIDS
Testing & counselling

Advocacy

HIV AIDS
Advocacy
HIV AIDS
Advocacy

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HLTH 102

Source: UN Photo Library

1981-1985 MYSTERY AND CONFUSION

1986-1990 PANIC AND PROTEST

1991-1995 DEATH AND DARKNESS

1996-2000 HOPE AND UNCERTAINTY

2001-2005 COMMITMENT AND MOBILIZATION

2006-2010 SETTING TARGETS FOR UNIVERSAL ACCESS

2011-2015 MEASURING IMPACT

Source: Wikimedia Commons. http://en.wikipedia.org/wiki/File:HIV-budding-Color.jpg

Global Statistics 2015

Regional Differences 2015

More than two thirds of people with HIV

Global Statistics 2015

US$ 20.2 billion was invested in the AIDS response in low-

01 To have, by 2015, halted and begun to

02 To provide special assistance to children orphaned by HIV/AIDS.

03 To encourage the pharmaceutical industry to make essential

04 To help Africa build its capacity to tackle the spread of the

Source: UN Millennium Declaration Report - 2010

Global Statistics 2015

55% Men who have sex with men

10% Injection Drug Use

32% heterosexual contact

75,000 Canadian living with HIV

10% First Nations of all HIV cases in Canada

AIDS kills young people.

AIDS leaves orphans behind.

Source: UN Photo Library

Source: UN Photo Library

Politics & Moral Values

The New Yorker magazine (Nov 2008)

Politics & Moral Values

Source: UN Photo Library

Source: UN Photo Library

Source: UN Millennium Declaration Report - 2010

Barriers to condom use

Source: UN Photo Library

Source: UN Photo Library

Source: UNGASS Country Progress Reports 2008.

Reduce the risk of heterosexually acquired HIV among men by

Recommended by the WHO and UNAIDS as an effective

Testing & Counselling

Requires 3 to 12-weeks post infection

Confidential HIV test

Anonymous HIV test

High risk groups

High risk groups

Source: UN Photo Library

Antiretroviral therapy (ART)

Combination therapy (HAART)

Reduces likelihood of transmitting virus to others.

ARTs during pregnancy and

May include replacement

Possible to reduce transmission

Source: UN Photo Library

Source: UN Millennium Declaration Report - 2010

Treatment access to ART 2015

41% of all adults living with HIV, up from 23% in 2010.

Lower among illicit drug users.

Similar rates of adherence between Africa and High income

Evidence on the benefit of directly observed treatment

Source: UN Photo Library

Post-exposure prophylaxis for HIV (PEP)