HIV

HIV is abbreviation of human.  immunodeficiency virus

Epidemiology study of HIV
Prevalence of HIV global is 38 Millions
Africa is 33 millions which is 60%
Tanzania is 5,1%
        Urban areas are 4.3%
        Rural area are 5.7%
Women are more affected than men
        Weman are 6.2%
         Men are 3.8%
Prevalence of mother to child infection is 20 to 40%
         In Uterine 5 to 10%
        Breastfeeding 5 to 20%
       Delivery 10 to 20%
Modes of HIV Transmission

💠Unprotected sexual contact with an infected partner(s) including Men having sex with men (MSM).
💠In Africa, HIV is predominantly transmitted through heterosexual sex
💠Contact with HIV-infected blood/blood products.
💠Blood transfusion, injection drug use (IDU) through needle-sharing, needle stick
accidents, unsterilized needles.
💠Mother-to-Child transmission (In utero, during delivery and through breast feeding)
💠 Risks of acquiring HIV infection differ depending on the mode of transmission 
💠Needle sharing, blood transfusion and anal intercourse carry the highest risk than other modes.

Factors Influencing HIV Transmission in Tanzania
Factors affecting HIV transmission may be divided into;
                o Socio-economic
            o Socio cultural
         o Behavioural
      o Biological

Socio-Economic Factors

📒 Poverty
📒Children may leave home to work at earlier age
📒Sex work
Loss of community cohesion
• Migration caused by need for employment
📒HIV/AIDS follows routes of commerce, i.e. truck routes
📒 Mines
        Differences in economic opportunities and income for men and women
📒In many places, women’s work pays less than for men

Social & Cultural Factors

Cultural factors
      📒 Traditions, beliefs, and practices
   📒Polygamy
📒 Women inheritance
      📒Widow cleansing
  📒Female genital mutilation
📒 Culture can create barriers that prevent people, and especially women, from taking precautions
📒 Tattooing
📒 Gender inequalities
In some cultures men are expected to have many sexual relationships
Women suffer gender inequalities, often economic and social in nature
📒 Stigma and denial
          Stigma prevents acceptance of the problem and early seeking of care
📒Low awareness
         Lack of information necessary to understand and prevent HIV
        False beliefs about effects of ART
• Conflict and social unrest
📒Civil unrest, especially armed conflict and displacement of people
📒High-risk behaviour of military personnel

Behavioural Factors

📔Multiple sex partners
📔Concurrent sex partnership

Biological Factors

          📔High rates of sexually transmitted infections
   📔 Lack of male circumcision
📔Women’s anatomy makes them more vulnerable
       📔Transfusion of blood from an infected donor

Relationship Between HIV and STIs
📔STIs are a major risk factor for HIV transmission and acquisition
📔 Risk varies based upon type of STI e.g. ulcerative have higher risk of acquisition while the non-ulcerative carry higher risk of transmission
📔STIs increase a person’s vulnerability to HIV in 2 main ways:

=Ulcerative STIs cause open sores in genital area, allowing HIV to pass through open skin
= For all STIs, white blood cells gather at site of infection in order to fight infection and HIV targets these cells
✔HIV also increases vulnerability to STIs:
📒 HIV positive person co-infected with another STI may be more likely to transmit HIV due to increase in HIV viral shedding
📔 A suppressed immune response due to HIV can increase the:
     o Reactivation of genital ulcers
        o Rate of abnormal cell growth
           o Difficulty in curing reactivated or newly acquired genital ulcers
                o Risk of becoming infected with additional STIs

      
Examples of STIs
Ulcerative STIs:
1. Syphilis: Common and frequently asymptomatic
2.Herpes simplex virus type 2 (HSV-2)
3. Other conditions:
              Chancroid
      Lymphogranuloma venereum (LGV)
  Granuloma inguinale

Non-ulcerative STIs/discharge syndromes:
o Gonorrhea
   o Chlamydia
      o Trichomonas
         o Other conditions:
Bacterial vaginosis
Candidiasis

     HIV Transmission in Women
📒Women are biologically more vulnerable to HIV than men because:
📒 Vaginal mucous membrane is more permeable than outside of penis
📒Larger exposed surface area for women
📒Ejaculate stays longer in female genital tract
📒Complicated regulation of vaginal acidity: Lactobacilli are important in creating acidity in the vagina hence protecting infection from HIV and other pathogens
📒 Their population changes with age and when there is a decrease in the lactobacilli
population the woman becomes vulnerable to infections including HIV
📒Lubrication that changes with age: dry vagina is vulnerable to trauma during sexual act and hence adding risk to HIV infection.