Høgskolen i Oslo HIV Human immunodeficency virus Prevention and promotion

Høgskolen i Oslo Three topics 1. What you ought to know about HIV virus 2. Challenges in promotion 3. Challenges in prevention

Høgskolen i Oslo GLOBAL ESTIMATES FOR ADULTS AND CHILDREN END 2004 People living with HIV………………… million (35.9–44.3 million) New HIV infections in …… million (4.3–6.4 million) Deaths due to AIDS in 2004.… million (2.8–3.5 million )

Høgskolen i Oslo

Life-saving drugs for HIV/AIDS l Approximately people in low- and middle-income countries were receiving antiretroviral treatment as of June 2004 (WHO, 2004). l Nine out of every ten people who need antiretroviral treatment—the majority of them in sub-Saharan Africa—are not receiving it. l If this continues five to six million people will die of AIDS in the next two years (UNAIDS, 2004).

Høgskolen i Oslo How HIV is transmitted l Sexual contact, intercourse: Anal, vaginal, very seldom by oral sex l Blood transfusion, sharing needles or piercing wounds that transmit blood from one person to another l From mother to child during pregnancy

Høgskolen i Oslo Some characteristics of the virus l Attacks CD4-lymphocytes l The HIV virus is a retrovirus, so called because of the enzyme Reverse transcriptase: – Makes CD4 cells produce new hiv particles by – making a DNA copy of the viral RNA gene (the reverse of the normal DNA to RNA process) and - inserting this DNA code for virus proteins into human DC4 cell DNA

Høgskolen i Oslo UNAIDS initiative l

Høgskolen i Oslo Women and aids l "Empowering women in this struggle must be our strategy for the future. It is among them that the real heroes of this war are to be found. It is our job to furnish them with hope." l Secretary-General Kofi Annan

Høgskolen i Oslo The vulnerability of women and girls l Women and girls are more susceptible to HIV than men and boys, with studies showing that they can be 2.5 times more likely to be HIV- infected as their male counterparts.

Høgskolen i Oslo Why more vulnerable? l vulnerability is primarily due to –Biological differences in transmission –inadequate knowledge about HIV/AIDS, –insufficient access to HIV prevention services, –inability to negotiate safer sex, and –lack of female-controlled HIV prevention methods like micobicides and femidoms.

Høgskolen i Oslo Some important factors l Sexually transmitted diseases like chlamydia, gonorrea, genital herpes, trichmonas, etc increase the risk of infection l Most of these can be treated if one has access to health care and money for medicines, but not genital herpes which is a lifelong infection and very important for the transmission of HIV, increasing the risk of infection

Høgskolen i Oslo S ociological factors l Women are most often infected by a stable partner l Women are victims of sexual abuse and violence l Sexually transmitted diseases are not beeing treated l Older men with long time risk want young girls as sexual partners –Sex with virgins have been suggested as ”treatment” for HIV infection l Women’s poverty forces them into prostitution or contracting of marriage for the maintenance themselves or children –Of those who are poorest 70% are woman (UN))

Høgskolen i Oslo The Ottawa Charter ”Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment”

Høgskolen i Oslo Challenges in promotion l Poverty means lack of control over ones life, lost possibilities to improve your health, to realize your aspirations, to satisfy your needs. l Poverty is a ”disease” that saps people’s energy, dehumanises them and creates a sense of helplessness and loss of control l 70% of extremely poor people are female, this also affects their children who grow up in poverty and may be permanently damaged due to the lack of nourishment and opportunity

Høgskolen i Oslo Some basic prerequisites and conditions for health l Food l Shelter l Peace l Education - access to information l Income, life skills and opportunities to make choices l Sosial justice l Equity

Høgskolen i Oslo Areas of action l Reduce violence against women l Remove the financial barriers that keep girls out of school l Implement laws to safeguard women’s property and inheritance rights l Improve access to prevention services

Høgskolen i Oslo Challenges in prevention l People have the knowlegde, but it is difficult to do the right thing l ”It doesn’t happens to me.”

Høgskolen i Oslo Some important issues in prevention l Knowledge about factors that increases risk of hiv infection l Increese accessability of condoms and clean syringes l Strengten general health services for drug users l Strengten counselling when testing for HIV l Diagnosing and treating STD l Finding the source of infection

Høgskolen i Oslo Advisory skills l Provide care without creating dependence l Open questions–rather than closed l Active listening l Reflect instead of interpret l Do not prescribe solutions l Use behavioural science theories l Develop communication and advisory skills (the art of giving advice)

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Høgskolen i Oslo The three main issues 1 What you ought to know about hiv 2. Challenges in promotion 3. Challenges in prevention