1. WAC 2010 HIV/AIDS information Refresher By: Adham Mousa

2. EPIDEMIC UPDATE Global, Regional and National Perspectives Module 2 Session 2.0

3. GLOBALLY (end of 2007) 33.2 million people living with HIV (PLHIV) 2.5 million children under 15 years of age living with HIV 92.8% are adults 50% are women

4. EVERYDAY 7,400 persons become infected with HIV every day ( new infections globally)

5. Public Health Challenge ONLY 1 out of 10 persons infected with HIV have been tested and know their HIV status

6. Middle East and North Africa (MENA) Region 380,000 PLHIV Low prevalence region 0.3% 2 nd Highest region in growth of new infections ( 300% in the last 5 years) Heterosexual contact is main mode of transmission

7. HIV and AIDS in EGYPT Low prevalence country <0.1% BUT: Existence of risky behaviors Youth have insufficient knowledge about modes of HIV infection and prevention

8. New HIV cases reported in Egypt (1986 – 2007)

9. BASIC HIV TRASMISSION Module 2 Session 2.1

10. Definitions H = Human I = Immunodeficiency V = Virus A = Acquired I = Immuno- D = deficiency S = Syndrom

11. HIV and AIDS HIV is the virus that causes AIDS. HIV is a retrovirus. HIV infects the immune system Antiretroviral (ARV) drugs slow the progression from HIV to AIDS, but they are NOT A CURE. So a person can live with HIV for a long time without symptoms.

12. BODILY FLUIDS that Transmit HIV Blood Seminal fluid Vaginal fluid Breast milk

13. HIV MAIN MODES OF TRANSMISSION

14. Unprotected Sex

15. Blood Transfusions

16. Sharing Needles and Syringes

17. From Mother-to-Child During: Pregnancy Delivery Breastfeeding

18. What Does NOT transmit HIV?

19. Dentists Barbers

20. Swimming Pools Sharing Food Handshakes

21. Non-Sexual Human Contact Insect Bites Sharing Toilets

22. Using Public Transportation

23. Routes That Do Not Transmit HIV Coughing or sneezing Insect bites Touching or hugging Water or food Kissing Public baths Shaking hands Work or school contact Dentists Barbers Using toilets Using telephones, door knobs Swimming pools Sharing cups, glasses, plates and other utensils

24. FACTORS INCREASING HIV TRANSMISSION

25. Vulnerable Populations Social groups at risk of contracting HIV: Children (MTCT, street children, orphans) Youth (sexual contact) Women (biological factors and gender inequalities)

26. Most At Risk Groups “Key Populations” Social groups that expose themselves to the risk of contracting HIV: Injecting drug users (IDUs) Sex workers and their clients Men who have Sex with Men (MSM)

27. BASICS OF HIV PREVENTION There is NO cure for HIV! Good prevention is the only effective way to prevent HIV. Module 2 Session 2.2

28. Prevention of HIV Sexual Transmission Remember the ABCs: A = Abstinence B = Being faithful to one tested faithful partner C = Consistent and correct condom use

29. Prevention of Mother-to-Child Transmission Timely administration of ARVs during pregnancy ( Third Trimester) Cesarean delivery Avoiding breastfeeding

30. Other Modes of Prevention DO NOT share needles/syringes Screen blood for transfusions Follow universal precautions for infection control

31. Importance of HIV Education To prevent new infections To improve the quality of life of PLHIV To reduce stigma and discrimination

32. Voluntary Confidential Counseling and Testing VCCT Module 3 Session 3.2

33. Goals of VCCT To provide anonymous, high quality counseling and testing To help clients to make an informed decision about testing To assist clients to cope effectively with their results To reduce personal risks

34. HIV Counselling and Testing Process by which an individual undergoes counselling enabling him/her to make an informed choice about being tested. Steps: 1.Pre-test counseling 2.HIV testing 3.Post-test counselling 4.Referrals to additional services

35. Benefits of VCCT Positive behavior change and risk reduction Promoting access to care and treatment STI and TB prevention Prevention of MTCT Early management of opportunistic infections Alleviation of anxiety

36. VCCT Centers in Egypt Fixed CentersMobile centers Cairo  Alexandria  Hurghada  Aswan  Luxor  Sharkia  Beni Suef  Kafr El-Shiekh 

37. VCCT Centers in Egypt (cont’d) Assiut  Ismaeillia  South Sinai  Gharbia  Beheira  Fayoum  Minia  Menoufia 

38. HIV and AIDS Hotline Free of charge 0800 700 8000

39. SOCIAL STIGMA AND DISCRIMINATION Module 4 Session 4.1

40. Stigma Social phenomenon With regard to HIV, the idea of perversion and immorality (and also sin) is linked to the fear of death, making HIV a source of culture-related stigma.

41. Self Stigmatization Product of the internalization of shame, blame, hopelessness, guilt and the fear of discrimination associated, in this case, with being HIV positive. Can lead to self-destructive behaviour.

42. Discriminatory Acts Regarding HIV HIV testing without consent Lack of confidentiality of test results Denial of medical and nurse care Being fired from work Social exclusion

43. Causes of HIV Stigma and Discrimination Lack of understanding of the illness Misconceptions about how HIV is transmitted The incurability of HIV and AIDS

44. Impact of Stigma and Discrimination on PLHIV It affects: Prevention of HIV Access to health services, diagnosis, treatment and management of HIV and AIDS Compliance to therapy Fear of being rejected

45. Language of Health Care Providers Stigmatizing LanguageNon-Stigmatizing Language AIDS victimHIV-positive person Slim diseasePerson living with HIV Bad bloodPeople living with HIV AIDS suffererPeople living with HIV AIDS carrierHIV-positive patient AIDS is a death sentencePositive living

46. Opportunistic Infections (OIs) OIs are infections caused by organisms that would not cause a disease in a person with a well-functioning immune system. Ois cause considerable morbidity in PLHIV. In 5% of infected persons, the time between infection and the appearance of the opportunistic infections is more than 10 years.

47. Treatment of Opportunistic Infections Primary prophylaxis or preventive treatment is used to prevent OIs in PLHIV. The CD4 count remains the most reliable indicator for the occurrence of OIs; as the CD4 count declines, the risk of contracting OIs increases. Living a health lifestyle decreases the chances of developing OIs.

48. Disease Progression Even when PLHIV adopt a healthy lifestyle, the development of OIs and other illnesses is inevitable. Co-infections with pathogens such as TB and malaria increase the HIV viral burden and accelerate the disease progression. Obtaining a comprehensive medical history is essential to developing a plan of care.

49. HCV and HIV HCV spreads more easily than HIV through contact with infected blood. HCV exacerbates HIV, probably due to liver damage. Since HCV damages the liver, it can make it harder to take ARVs. HIV and HCV co-infection slows down the rate of increase in CD4 cell counts during HIV treatment.

50. Improving the Quality of Life of PLHIV Adopt a healthy diet Exercise regularly Avoid alcohol and tobacco Avoid stress Avoid all forms of infections See the doctor regularly for early detection of health problem Follow up CD4 count to assess the immune system status