MNGN 3680 Introduction to Fundamentals of HIV, Part I

1. MNGN 3680Introduction to Fundamentals of HIV, Part I UNAM Faculty HIV Orientation Workshop January & February, 2010

2. Objectives • Identify epidemiological trends of HIV infection around the world and in Namibia • Explain how HIV is transmitted • Identify methods for HIV testing • Recognize common misunderstandings and myths about HIV • Identify global milestones in the history of the HIV pandemic

3. Epidemiology of HIV

4. HIV prevalence (%) in adults in Africa, 2005 2.5

5. Adults and Children Estimated to be Living with HIV/AIDS, end 2005 38.6 million people [33.4‒46.0 million] living with HIV, 2005 http:http://www.unaids.org/en/HIV_data/Epidemiology/epi_slides.asp 2.4

6. Impact of AIDS on life expectancy in five African countries, 1970–2010 70 65 60 Botswana 55 South Africa Life expectancy at birth (years) 50 45 Swaziland 40 35 Zambia 30 Zimbabwe 25 20 1970–1975 1980–1985 1990–1995 2000–2005 1975–1980 1985–1990 1995–2000 2005–2010 Source: United Nations Population Division (2004). World Population Prospects: The 2004 Revision, database. 4.1

7. Why does Africa have such a large number of people living with HIV/AIDS? With Permission, Jeanne Raisler. Durban AIDS Conference, 2001

8. Why does Africa have such a large number of people living with HIV/AIDS? • Migration, transport, and sexual networking • Back and forth migration between rural areas and cities • Work-related, mining industries,,shipping and trucking • War, refugees • Poverty • Lack of access to prevention information • Economic vulnerability and low status of women reduces opportunities to negotiate safer sex • Delayed national and international response • Lack of timely change of societal norms • Biologic factors • High prevalence of ulcerative STIs including HSV • Social behaviour and cultural practices (similar to other continent settings) • Unwillingness to use condoms • Inability to negotiate condom use • Multiple sexual partners • Other unknown factors

9. How Do We Determine the Number of HIV Cases in Namibia?

10. HIV Sentinel Surveys in Namibia • Special surveys done according to WHO standard methodology • Provide estimate of number of cases within Namibia • Performed every 2 years • Anonymous blood testing done on women between ages of 15-49 years attending antenatal clinics

11. HIV Prevalence Rate in Pregnant Women, Biannual Surveys 1992-2004, Namibia Report of the 2004 National HIV Sentinel Survey, Republic of Namibia Ministry of Health and Social Services, page 10.

12. HIV Prevalence in Namibia among ANC attendees by site (2004) Report of the 2004 National HIV Sentinel Survey, Republic of Namibia Ministry of Health and Social Services, page 7.

13. What is the impact of HIV/AIDS on Namibia?

14. What is the impact of HIV/AIDS on Namibia? • Effect on Population • Shortened life expectancy • Population decrease • Increased Number of Orphans • Loss of one or both parents • Children removed from school • Effects on Workforce • Loss of workforce, including skilled workers, e.g. teachers, healthcare professionals • Decreased food production on family farms • Healthcare workers overwhelmed by number of HIV cases; decreased morale

15. Projected reduction in African agricultural labour force due to HIV and AIDS by 2020 Namibia Botswana Zimbabwe Mozambique South Africa Kenya Malawi Uganda UR Tanzania Central African Republic 2020 2000 Côte d’Ivoire Cameroon 0 Projected labor force loss (%) by year 5 10 15 20 25 30 Sources: ILO (2004). HIV/AIDS and work: global estimates, impact and responses 4.8

16. HIV Transmission

17. How is HIV Transmitted? • Contact with infected blood or body fluids, e.g. blood transfusion • Unprotected sexual contact with an infected partner • Through infected vaginal secretions, semen • May be transmitted via oral, vaginal or anal intercourse • Major route of transmission worldwide • Sharing needles • From a mother to baby during pregnancy, delivery or breastfeeding

18. How do you test for HIV Infection?

19. HIV Testing • Health care providers may look at patients and try to guess if they have HIV infection • Only way to identify if an individual is positive is through Voluntary Counseling and Testing for HIV (VCT) • Blood tests that detect HIV antibodies are the most commonly used HIV test • Antibody tests include: Rapid tests, ELISA • Can also detect virus directly with PCR technology, but more expensive and not widely available

20. Interpreting Antibody Test Results • What does a Positive test mean? • Antibodies for HIV were found in the blood, meaning that the person is infected with HIV • ELISA = Highly sensitive test • Rare occasion to get a false positive HIV test • What does a Negative test mean? • That HIV test is actually negative • OR the person may be in a “window period” of HIV infection

21. Window Period • Time from initial infection with HIV until antibodies are detected by a test • Can take anywhere from 2-12 weeks before HIV antibodies are produced in the blood • During this window period, patients can test as false negatives for HIV • Can still pass the virus to others during this period • For this reason it is very important to counsel all HIV negative patients, especially at high risk for HIV infection, to return to the clinic for repeat HIV testing

22. Activity: What do you know about HIV? 1.) STI’s, including HIV, are generally more easily transmitted from men to women than from women to men 2.) One can generally identify a person with HIV infection by looking at him or her 3.) A person can get HIV infection from French or tongue kissing 4.) Once a patient starts ARV treatment, she or he can no longer transmit HIV infection to others 5.) If a woman is HIV-infected then it means the partner is HIV-infected

23. Dispelling Myths About HIV • HIV cannot be transmitted: • By casual contact, e.g. shaking hands • Eating at the same table as someone with HIV • Hugging • Through toilet seats • Insect bites

24. 25 years of AIDS People living with HIV 50 1 First cases of unusual immune deficiency are identified among gay men in USA, and a new deadly disease noticed 9 In 1991-1993, HIV prevalence in young pregnant women in Uganda and in young men in Thailand begins to decrease, the first major downturns in the epidemic in developing countries 45 Million 2 Acquired Immune Deficiency Syndrome (AIDS) is defined for the first time 40 3 The Human Immune Deficiency Virus (HIV) is identified as the cause of AIDS 10 Highly Active Antiretroviral Treatment launched 35 4 In Africa, a heterosexual AIDS epidemic is revealed 11 Scientists develop the first treatment regimen to reduce mother-to-child transmission of HIV 5 The first HIV antibody test becomes available 30 6 Global Network of People living with HIV/AIDS (GNP+) (then International Steering Committee of People Living with HIV/AIDS) founded 11 Children orphaned by AIDS in sub-Saharan Africa 12 UNAIDS is created 25 13 Brazil becomes the first developing country to provide antiretroviral therapy through its public health system 7 The World Health Organisation launches the Global Programme on AIDS 20 8 The first therapy for AIDS – zidovudine, or AZT -- is approved for use in the USA 14 The UN General Assembly Special Session on HIV/AIDS. Global Fund to fight AIDS, Tuberculosis and Malaria launched 15 12 10 15 WHO and UNAIDS launch the "3 x 5" initiative with the goal of reaching 3 million people in developing world with ART by 2005 5 9 1 2 4 6 8 5 13 14 15 16 7 10 3 16 Global Coalition on Women and AIDS launched 0 2005 1980 1985 1990 1995 2000 1.1

25. Key Points • HIV & AIDS is a global crisis • Namibia has been significantly impacted with a high HIV prevalence rate • HIV can be transmitted via infected blood or bodily fluids, sexual contact, contaminated needles, from mother to infant during pregnancy, labour or breastfeeding • The most common form of HIV testing in Namibia is antibody testing • Though many important strides have been made around the world to combat HIV, numbers of those becoming infected and numbers of children becoming orphans continue to rise. HIV prevention is still a key priority for the world