Module 1

Unit 2: Epidemiology of HIV

Objectives
At the end of this session, the
participant should be able to:
1.
2.

3.
4.

5.
6.

Describe the history of HIV

Explain the global, regional and national/local
distribution of HIV
Discuss the distribution of HIV by age and sex
Discuss changes in morbidity and mortality due
to HIV/AIDS
define different modes of HIV transmission
Discus factors that facilitate HIV transmissionbiological and social

Historical background

1981 - doctors in US recognized a previously unseen

syndrome (PCP) in homosexual males

Later recognized that they were all immune suppressed

1983/4 - scientist described the cause of the syndrome

as a retrovirus

Lymphadenopathy Associated Virus (LAV)

AIDs Associated Retrovirus (ARV)
Human T-lymphotrophic Virus (HTLV-)

In Kenya the 1st case described in 1984

1986 - HIV accepted as international designation for the

retrovirus in a WHO consultative meeting

Epidemic Update: Global

Picture

Fourth biggest killer in the world

Estimated 40 million living with HIV by

end of 2003

About one-third of PLHA are between

15-24 years

Most people are unaware they are

infected

Young women are more vulnerable

Adults and children estimated to be

living
with HIV/AIDS as of end 2003
Western Europe

Eastern Europe
& Central Asia

520 000 680 1.2 1.8East Asia & Pacific

790 000 1.2
million
000
700 000 1.3
million
North Africa & Middle
Caribbean
South
million
350 000 590 000 470 000East
&
South-East
Asia
730 000
4.6 8.2
Sub-Saharan Africa
million
Latin America
25.0 28.2
Australia
1.3 1.9 million
& New Zealand
million
12 000 18 000
North America

Total: 34 46 million

Global summary of the HIV/AIDS epidemic,

December 2003
Number of people living with HIV/AIDS

People newly infected with HIV in 2003

AIDS deaths in 2003

Total

40 million (34 46 million)

Adults

37 million (31 43 million)

Children under 15 years

2.5 million (2.1 2.9 million)

Total

5 million (4.2 5.8 million)

Adults

4.2 million (3.6 4.8 million)

Children under 15 years

700 000 (590 000 810 000)

Total

3 million (2.5 3.5 million)

Adults

2.5 million (2.1 2.9 million)

Children under 15 years

500 000 (420 000 580 000)

The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available
information. These ranges are more precise than those of previous years, and work is under way to increase even further the precision
of the estimates that will be published mid-2004.

Epidemic Update:
Sub-Saharan Africa

HIV is now the leading cause of death

25.0 28.2 million living with HIV infection by
end of 2003

Estimated 3-3.4 million new HIV infections in 2003

70% found in sub Saharan Africa

10-15% of need ARV

10% (600 million) of worlds population live in sub

Saharan African

By 2010, an estimated 106 million children under

age 15 will have lost one or both parents, with 25
million of this group orphaned due to HIV/AIDS

Updates HIV/AIDS in Kenya

Indicator
National adult prevalence - 15-49
years
Number adults infected

NASCOP 2003
7%
1,100,000

Number children infected

150,000

Number needing ARV

200,000

Impact on Morbidity and

mortality of other infections

People with HIV/AIDS are susceptible to

other infections

Due to lowered immunity

High HIV prevalence increases the pool

of people with suppressed immunity
Any other infectious condition within
such population (e.g.TB) therefore finds
a highly susceptible group of people.

Increase of TB cases in Kenya

NLTP Kenya, TB Casefinding: 1987 - 2001

TB case finding:
73,017 all types
31,307 PTB +

75,000

7-fold increase
since early
nineties
Average annual
increase (5 yrs):
16%
44% of estimated
incidence
50-60% HIV+

70,000

Sm+ PTB

65,000

Sm- PTB

60,000

EPTB

55,000

Relapses

50,000

All TB

45,000
Numbers

40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
'87

'88

'89

'90

'91

'92

'93

'94
Year

'95

'96

'97

'98

'99

'00

'01

HIV Transmission

Modes of Transmission

Biological Factors Affecting Transmission

Socio-economic Factors Facilitating

Transmission

Modes of Transmission

Sexual contact

Parenteral

Blood transfusion of infected blood or blood products

Exposure to infected blood or body fluids- IDU through needlesharing or needle stick accidents
Donated organs

Perinatal

Male-to-female, female-to-male, male-to-male, and female-tofemale

Transplacental, during labour/delivery and breastfeeding

Worldwide, sexual transmission is the predominant mode

HIV cannot be transmitted by casual contact, surface
contact, or from insect bites

Percent infection by transmission

route.
Transmission route
Sexual intercourse
Mother-to-child-transmission

%
70-80
5-10

Blood transfusion

3-5

Injecting drug use

5-10

Health care eg: needle stick

injury

<0.01

Biological factors influencing

HIV transmission

Stage of HIV infection:

Presence of untreated ulcerative STIs

High riskduring primary infection (weeks)

Lower when asymptomatic (several years)
Rises as immune function deteriorates
and viral load increases (months to years)
A major reason for high prevalence in SSA

Gender differences in susceptibility

Socio-economic Factors Facilitating

Transmission

Social Mobility

Stigma and Denial

Denial and silence is the norm

Stigma prevents acknowledgment of problem and careseeking

People in Conflict

Global Economy
HIV/AIDS follows routes of commerce

Context of war and struggle of power spreads AIDS

Cultural Factors

Traditions, beliefs, and practices affect understanding of

health and disease and acceptance of conventional
medical treatment

Socio-economic Factors (contd)

Gender

In many cultures men are expected to have many

sexual relationships

Women suffer gender inequalities

Many women unable to negotiate condom use

Poverty

Lack of information needed to understand and

prevent HIV

Drug Use and Alcohol Consumption

Impaired judgment

Sharing of needles and equipment

Factors not associated with

risk of transmission

Factors not associated with risk of

transmission

insect bites
Saliva
sneezing or coughing
skin contact (e.g. hugging)
shared use of facilities (e.g. toilets)

Summary

HIV has spread worldwide after its

discovery
It is a major cause of morbidity and
mortality in many countries
Many factors contribute to HIV
transmission in a society
Knowledge of these factors can be
used to design control strategies.