UNIVERSITY OF NAMIBIA

1. UNIVERSITY OF NAMIBIA Contemporary SOCIAL ISSUES

2. UNIVERSITY OF NAMIBIACOURSE: CONTEMPORARY SOCIAL ISSUESDEPARTMENT OF NURSING(USCI3429) • LECTURER: Mr.Shirungu Michael • TEL: 206 3005 • Office no. G132 • E-MAIL: mshirungu@unam.na

3. Announcements • The course consist of 3 components. • HIV, Gender and Ethics • Each will run for 4 weeks • Two tests will be written • See the dates • HIV 23 July - 17 August 2012 • Gender 20 August – 17 September 2012 • Ethics 17 September – 12 October 2012 • Gender and HIV test 19, 20 and 21 September 2012 • Course outline and Reading Materialsavailable on E-Learning and Copy center • Class attendance is compulsory • Two periods per week

4. Objectives • Discuss the origin of HIV/AIDS. • Discuss the historical background of HIV • Explain why HIV knowledge is important • Differentiate between HIV and AIDS • Discuss the modes of transmission • Discuss how HIV cannot be contracted • Discuss how HIV invades the CD4 cell • Explain the types of HIV • Explain window period • Life at University • Cultural and social factors influencing the spread of HIV/AIDS in Namibia

5. Male circumcision • Define male circumcision • Explain the current situation of MC in Namibia • Explain the biological effectiveness of circumcision against HIV” • Explain the additional health benefits of MC for both men and women” • Explain how long does it take to heal after circumcision?” • To explain why must circumcised men still wear condoms?”

6. ARV therapy • Define ARV • Explain how HAART works • Discuss the classes of HIV medication • Explain the clinical and social criteria to start with HIV medication

7. Sexually transmitted diseases • Define Sexual Transmitted Diseases (STDs) • Outline the types of STIs • Name the signs and symptoms of STD’s • Discuss the complications of untreated STIs • Discuss the prevention of STDs • Discuss prevention of STIs infection

8. Stigma and discrimination in HIV and AIDS • Define stigma • Explain the types of stigma • Discuss the drivers of stigma • Explain the impact HIV related stigma to families, communities and society • Discuss the long effect of stigma

9. ORIGIN • Unknown • Speculations • Myths • beliefs

10. HISTORICAL BACKGROUND • Several researchers believe that by 1970’s HIV/AIDS around unnoticed. • First described in 1981 in US (Los Angeles) • Among gay men- Kaposi’s Sarcoma & Pneumocystis Carinii Pneumonia (PCP) • In Central Africa soon afterwards weight loss, diarrhoea in some patients • Luc Montagnet discovered the virus in France in 1984 • WHO collected statistics/prevalence, incidence worldwide • First case in SA in 1982 • 1985 BTS started screening of all donated blood • 1986 first 4 cases in Namibia

11. INTRODUCTION TO HIV AND AIDS • Terrifying, devastating disease • Fear, guilt, hysteria, accusations • Public health concern • Statistics claiming by minute • Global unification • Sub-Saharan hardest hit • Namibia ranking amongst top five • Namibian Government commitment

12. WHY HIV AND AIDS KNOWLEDGE IS SO IMPORTANT • All sectors of the nation affected • Prevention and control measures • Develop coping mechanisms • Mobilize resources to curb the epidemic • National objectives protection (NDPII, Millennium Development Goals, Vision 2030 etc.) • Develop strategies & interventions • Monitoring of the epidemic

13. HIV AND AIDS HIV Stands for; H – Human • I – Immuno-Deficiency • V – Virus AIDS stands for; A – Acquired • I – Immune • D – Deficiency • S – Syndrome • Attacks immune system • Reproductive in the system (bloodstream & bodily fluids)

14. DEFINE HIV The HI Virus • A virus called HIV causes AIDS • HIV stands for the; • Human Immuno-Deficiency Virus • Shape –circular, consists of an inner matrix of protein

15. CONTINUE • Reproductive inside the cell • Only in human cells • Attacks directly defensive cells • CD4 cells & T-helper cells • Attacks immune system • Lead to immuno deficiency • Multiplies in blood • Even cross blood brain barrier & blood cells & causes diseases or infection

16. DEFINITION OF AIDS Stands for; • A - Acquired • I - Immune • D - Deficiency • S - Syndrome • Acquired, not inherited • HIV causes AIDS • Immunity refers to body’s natural defence • Deficiency – how immune system weakens by virus

17. CONTINUE • Syndrome, a medical name for set of collection of signs and symptoms • Opportunistic infections occur • Can be treated, person becomes ill - AIDS • Moves through number of stages 1 – 4 • Until Aids develops

18. HIV TRANSMISSION Through; • Body fluids • Sexual fluids (vaginal & semen) • Blood • Breast milk • Also present in saliva, tears, sweat and urine • Concentration of HIV low infection • Skin a barrier if intact • Broken skin allows penetration of virus

19. EXCHANGE OF BODILY FLUIDS, 3 WAYS • Sexual transmission • 90% of transmission • Unprotected sex • Semen, vaginal fluid • Mucus membrane • Infect other person

20. 2. BLOOD TRANSMISSION • Needle sticks • Skin piercing instruments • Unsterile syringe sharing • Mother to child transmission: 3. Mother to baby • Placenta (unborn baby) • Birth (during birth) • Breast milk (after birth)

21. HIV CANNOT BE TRANSMITTED VIA; • Touch pets • Coughing mosquito • Sneezing baths • Cutlery showers • Glasses other insects • Toilet seats hugging • Swimming pools kissing etc. • clothes

22. HOW HIV INVADES THE CD4 CELLS

23. STEPS • The projections on the virus’s outer layer attach themselves firmly to the outer layer of the CD4 cell. • The cell and the virus now join membranes. • The virus then sheds its outer layer and the genetic material (viral RNA) of the virus enters the CD4 cell • The virus transforms its own RNA into viral DNA so that it can manufacture more viruses. • The viral DNA then fuses with the CD4 cell DNA and makes numerous copies of viral DNA

24. Continue steps • These new viruses become fully functional HIV viruses. 7. In the process of budding they kill the host cell and move out into the blood stream and infect new cells repeating the whole process all over again.

25. HIV TYPES • HIV – 1 (Central, East, Southern Africa, North & South America & other parts of the world (aggressive) • HIV – 2 -West Africa this virus acts slowly, takes longer before symptoms develop THEORIES • Biological warfare instrument (racial aspects) • Witchcraft connected to ancestors • Chimpanzees • African green monkeys

26. 3 TYPES of HIV test (1)ELISA (Enzyme Linked Immunosorbent Assay • Sensitive test simply inexpensive • Can pick up other virus infections • Confirmatory is used to confirm • Also other variations of ELISA test can also be used for confirmation

27. (2) DNA (PCR) test • Polymerase Chain Reaction (PCR) tests, is mainly used in infant. • Since maternal HIV antibodies can pass through the placenta. • Children born to HIV-positive mother may have HIV antibodies up to 18 months. • Therefore, DNA, PCR test, which detect viral RNA or DNA rather maternal antibodies. • In Namibia the test is done at six weeks after birth. (3) WESTERN BLOT • Confirmatory test • More specific • Requires well-trained professionals • Drop of blood from fingerprick • Results in 10-30 minutes

28. (4)RAPID TEST • Clients counseled • Test results in a single visit • Useful in rural areas • If positive, confirmatory test needed • Ethical standard to be applied • Pre and post test counseling pre-requisite

29. POSSIBLE RESULTS Negative results • No contact with HIV • No antibodies yet (though infected) NB: May still contract the HIV infection

30. THE WINDOW PERIOD • HIV test to detect antibodies • 6-12 weeks before body produces antibodies • May test negative – repeat after three months • NB * incubation period – time/infection –first signs of symptoms • There is a difference between the two

31. POSITIVE RESULTS IN ADULTS • Antibodies present • Capable of passing the virus to others • Will remain infectious IN INFANTS • Mother infected with the virus • Antibodies of the child will only be detected at 18 months of age • Baby has 1/3 chance of being infected • Needs further evaluation • If positive at 18 months infected

32. HIV TESTING • Blood test to detect antibodies • Presence of antibodies in blood system means HIV positive • HIV Infection took place • Can infect others • Infection lifelong unless cure is found • Test cannot tell: - • when infected? • who infected you? • how infected? • whether you have Aids? • how long you will live?

33. Topics to be discussed • 1.Life at University • Drivers of the epidemic in Namibia identified by the MOHSS/.Factors influencing the spread of HIV/AIDS in Namibia • 3.Social conditions • 4. Influences from a broader society • 5. Attitudes • 6. Cultural influences • 7. Myths • 8. Behavior change

34. Cont.. • HIV/AIDS intervention strategies at UNAM

35. LIFE AT THE UNIVERSITY OF NAMIBIA • Different ways of coping • *The shy student • *The assertive student • *The exploring student • *The confused student

36. Drivers of the epidemics • Multiple concurrent partnership • Transactional sex • Cross generational sex • Alcohol abuse • Low and inconsistent condom use • Male circumciscion

37. FACTORS INFLUENCING THE SPREAD OF HIV/AIDS IN NAMIBIA • Relationships *Self –concept *Low self esteem *Need for emotional gratification *Fighting Loneliness *Fighting false accusations *Peer pressure *Role models

38. SOCIAL CONDITIONS *Poverty *Alcohol and drugs *Inadequate health and birth control *Rape and sexual violence *Prostitution *Lack of financial assistance for needy people

39. INFLUENCE FROM A BROADER SOCIETY *Pornography and the mass media *Tourism *Rural-urban migration *Lack of friendly entertainment *The sex pool and polygamy

40. ATTITUDES *Influence his/her behavior *Way of feeling about a topic or a person *Attitudes/ condom and gender *Ideas about condoms/myths *Gender attitude

41. CULTURAL INFLUENCES • Influence of culture on HIV/AIDS *Obligatory sex *Marital rape *Widow inheritance *Ceremonial cleansing *Traditional healers

42. MYTHS *Aids can be cured *Nobody dies of Aids *Women who carry condoms are loose women *Condoms has come to destroy relationships *Men should have multiple sexual relationships *A person is bewitched if he/she has Aids

43. BEHAVIOUR CHANGE • *Boys need new values • *Girls need empowerment • * Live with confidence • *Work on a good self-esteem • Communication skills to talk about sex, your dreams for the future, and what you like and dislike

44. HIV/AIDS INTERVENTION STRATEGIES AT UNAM • *Support groups • *Counseling services • *Peer education • *Secrecy of the existence of Aids on the UNAM campus • *Ownership for their sexual behaviour

45. ARV THERAPY DEFENITION

46. DEFINITION ART OR ARV • Antiretroviral Therapy. A treatment that uses antiretroviral medicines to suppress viral replication and improve symptoms of HIV.

47. What is HAART • HAART-Highly active antiretroviral therapy with three or more antiretroviral medication • Once a patient is on HAART, it is a lifetime commitment

48. HOW HAART WORKS • HIV is a type of retrovirus that’s why it requires host cell to replicate • It specifically targets the body’s CD4 cell over time • HAART works to control HIV infection by reducing the ability of the virus to replicate. • Therefore successful HAART therapy include immune reconstitution, an increase in CD4 and a decrease in HIV viral load

49. Classes of HIV Medication • There are three ARV classes mostly available in Namibia • NRTI’s- Nucleoside Reverse Transcriptase • NNRTI’s-Non-Nucleoside Reverse Transcriptase • PI- Protease Inhibitors

50. NRTI’s • Zidovudine – AZT • Lamivudine – 3TC • Stavudine – D4t • Didanosine – DDI • Abacavir – ABC • Emtrivitabine – FTC • Tenofovir – DTF The NRT’s block the( reverse transcriptase), an enzyme required by the virus to make DNA copies of the viral RNA (stage four)