HIV AND AIDS DR. GORDON AMBAYO

WHAT IS HIV?? “Human Immunodeficiency Virus” A unique type of virus (a retrovirus) Invades the helper T cells (CD4 cells) in the body of the host (defense mechanism of a person) Has caused a global epidemic. Preventable, manageable but not curable.

WHAT IS AIDS ??? “Acquired Immunodeficiency Syndrome” HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection due to markedly reduced helper T cells. Patients have a very weak immune system (defense mechanism) Patients predisposed to multiple opportunistic infections leading to death.

“The viral genome” Icosahedral (20 sided), enveloped virus of the lentivirus subfamily of retroviruses. Retroviruses transcribe RNA to DNA. Two viral strands of RNA found in core surrounded by protein outer coat. Outer envelope contains a lipid matrix within which specific viral glycoproteins are imbedded. These knob-like structures responsible for binding to target cell.

HIV TRANSMISSION How is HIV virus transmitted? How is it not transmitted?

Through Bodily Fluids Blood products Semen Vaginal fluids

IntraVenous Drug Abuse Sharing Needles Without sterilization Increases the chances of contracting HIV Unsterilized blades

Through Sex Unprotected Intercourse Oral Anal

Mother-to-Baby Before Birth During Birth

Global estimates for adults; 2012 People living with HIV ---35.3 million (32.2–38.8) New HIV infections in 2012 --- 2.3 million [(1.9–2.7) million]. The trend have been declining over the years Deaths due to AIDS in 2012--- 1.6 million [1.4–1.9 million] Source: 2013 UNAIDS reports

Regional estimates for adults; 2012 People living with HIV ---23.5 million [22.1–24.8 million] in sub-Saharan Africa New HIV infections in 2012 ---1.8 million [1.6 million–2 million] in sub-Saharan Africa Deaths due to AIDS in 2012---1.2 million [1.1 million–1.3 million] in sub-Saharan Africa Source: 2013 UNAIDS reports

HIV IN KENYA 101,560 New infects in Kenya in 2014. 21% of new adult infections occur among young women aged 15-24 years. 191,840 children were living with HIV in 2014 63% of men and 80% of women know their HIV status 5.6% of Kenyans are HIV positive. 1.6 million Kenyans are living with HIV

65% 0f new infections occur in 9 out of 47 counties. COUNTY NEW HIV INFECTIONS PEOPLE LIVING WITH HIV IN HIV PREVALENCE (%) Homa Bay 15,003 150000 27.1 Kisumu 12,645 113,000 18.7 Siaya 12,059 100400 17.8 Migori 8,292 68,700 13.4 Kisii 5,975 73,300 4.9 Nakuru 4,326 57,800 5.6 Turkana 3,141 51,200 9.9

65% 0f new infections occur in 9 out of 47 counties. COUNTY NEW HIV INFECTIONS PREVALENCE (%) Nyamira 2.507 16,600 6.9 Bomet 1,965 18,700 3.5

HIV IN KENYA HIV prevalence in Kenya is 5.6% Women infection is 8% Men 4%

POPULATION AT HIGHES RISK Injection drug users 53% Commercial sex workers ( Prostitutes) 27%. Men who have sex with men 18.2%

HIV prevalence among university students Overall prevalence of HIV in six universities- 0.51% Prevalence UON- 0.46% HIV Prevalence by Sex-Males(0.58%) & Females (0.40%) Source :HIV&AIDS Baseline Sero-behavioural Study in Six Universities in Kenya (2009) By IUCEA - Inter-University Council for East Africa EALP & East African Lake Basin Project HIV Prevalence by Year of Study Prevalence (%) 1st year 0.24% 2nd year 0.47% 3rd year 0.81% 4th year 0.75%

Proportion of those abstaining by year of study and sex (source : HIV&AIDS Baseline Sero-behavioural Study in Six Kenyan Universities by EALP/IUCEA 2009)

HIV PREVALENCE BY COUNTY ADULT PREVALENCE (%) ADULT PREVALENCE HOMA BAY 27.1 BUSIA 7.1 KISUMU 18.7 NYAMIRA 6.9 SIAYA 17.8 TAITA TAVETA 6.4 MIGORI 13.4 KWALE 6.2 MOMBASA 11.1 VIHIGA 6 TURKANA 9.9 NAKURU 5.6 KISII 8.9 MAKUENI NAIROBI 8.6 KAKAMEGA TRANS NZOIA 7.2 MURANGA 5.2

HIV PREVALENCE BY COUNTY ADULT HIV PREVALENCE ADULT HIV PREVALENCE THARAKA NITHI 5.1 MACHAKOS 4.7 SAMBURU NYERI 4.4 KAJIADO 5 KIAMBU UASIN GISHU 4.9 KERICHO NAROK BARINGO 4.2 NANDI 4.8 LAIKIPIA 4.1 KITUI KIRINYAGA 4

HIV PREVALENCE BY COUNTY ADULT HIV PREVALENCE NYANDARUA 3.9 GARISA 2.6 ISOLO 3.8 WEST POKOT 2.4 ELGEYO TANA RIVER 2 KILIFI 3.7 MANDERA 1.3 EMBU LAMU BUNGOMA 3.5 MARSABIT 1 BOMET WAJIR 0.2 MERU 3.3

PREVENTION ABC – Abstinence, being faithful and condom use are key to HIV prevention.

Abstinence It is the most effective method of not acquiring HIV/AIDS. Refraining from unprotected sex: oral, anal, or vaginal. Refraining from intravenous drug use

Monogamous relationship A mutually monogamous (only one sex partner) relationship with a person who is not infected with HIV HIV testing before intercourse is necessary to prove your partner is not infected

MULTIPLE SEXUAL PARTNERSHIPS The percentage of Kenyans having multiple sexual partners in the previous 12 months has increased in the last 10 years. Having multiple sexual partners puts one at risk of HIV.

MULTIPLE SEXUAL PARTNERS

MULTIPLE SEXUAL PARTNERSHIPS YEAR % OF MALE CONDOM USE % % OF FEMALE CONDOM USE % 2003 11.6 31.6 1.7 12.2 2008/2009 9.3 37.0 1.2 31.8 2012 14.7 38.8 2.5

MALE CIRCUMCISION Kenya initiated voluntary medical male circumcision in 2008. Since then the program has scaled up from 8,000 in 2008 to 190,000 VMMCs in 2013.

FEMALE SEX WORKERS % REPORTING USE OF CONDOMS IN MOST RECENT SEXUAL INTERCOURSE 86.2 % WHO HAVE RECEIVED hiv TEST IN THE LAST 3 MONTHS 68.0 PERCENTAGE WHO ARE HIV POSITIVE 29.3

MEN WHO HAVE SEX WITH MEN % WHO USED A CONDOM IN THE LAST SEXUAL INTERCOURSE 68.8 % TESTED FOR HIV IN THE LAST 12 MONTHS AND KNOW THEIR RESULTS 74.0 % WHO ARE LIVING WITH HIV 18.2

Impacts of HIV/AIDS Includes the following Individuals and families consequences (increased morbidity, orphans, discrimination, school/college drop outs etc Demographic consequences( increased mortality, reduced fertility and migration Reduced life expectancy Impact of HIV on the workforce (increased absentees) Impacts on the country's economy (poor economic growth)

HIV Transmission Heterosexual risk networks Sexual HIV Transmission HIV Transmission via Blood Heterosexual risk networks Regular sexual partners if HIV+ MSM networks HIV+ MTCT IDU networks medical procedures Other- B/F

HIV Preventive programs Primary Secondary Tertiary

PRIMARY PREVENTION: Five ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles New shaving/cutting blades

Major Types of HIV Preventive Interventions Behavior change interventions Behavior change communication (BCC): multiple media VCT Peer education programs Social/structural programs 100% condom use Economic empowerment of women Harm reduction e.g. access to safe injections Biomedical interventions Anti-retroviral PMTCT HAART Post exposure prophylaxis Treatment of STIs Voluntary Male Medical circumcision Screening donor blood Vaccines? Microbicides?

Effects of HIV preventive programming Reduced stigma and discrimination Increased productivity Reduced morbidity Improve quality of life Improved life expectancy Reduced mortality among others