Please enable JavaScript.
Coggle requires JavaScript to display documents.
HIV Epidemiology + Prevention (i) (Intro (5000 new infections/day (64% in…
HIV Epidemiology + Prevention (i)
Intro
AIDS decreases life expectancy in some countries, mainly Africa (e.g. S Africa)
HIV prevalence increasing as HIV+ve people are living longer
no. of new infections decreasing (still > 1 million/yr - long way to go)
combatting HIV/AIDS was in the millennium development goals
target reached in 2016 (epidemic was halted + reversed)
Sustainable development goals 2015-2030
by 2030 end epidemics of AIDS, TB, malaria, neglected tropical diseases, combat hep, water-borne diseases + other communicable diseases
still a global crisis, mainly in Africa
5000 new infections/day
64% in SSA
400 in under 15s
69% of people living with HIV are in SSA, 70% of HIV deaths in SSA
peak mortality in 2005 - now reducing
stigma stops people coming forward for tx
was once a fatal dx, now a chronic condition (LE on ART almost = HIV -ve)
txable, not curable
Transmission
SEXUAL
90% of the transmission in SSA
risk factors
multiple partners
transactional sex (prostitution)
MSM (prevalence x13 higher than general pop)
co-STIs (esp HSV2 genital herpes)
lake of circumcision in males
circumcision reduces risk of heterosexually acquired HIV infection in meanly approx 60%
Prevention
ABC education (abstinence, be faithful, condoms)
promote safe sex behaviours
delay age of 1st sex (strongly proven to work
reduce no. of partners
condom distribution + social marketing (access to family planning)
male circumcision
MOTHER TO CHILD
25-35% risk
vertical
intrauterine (20%)
peripartum (50%)
early breasting (<2 months - 20%)
late breastfeeding (2-6 months - 10%)
PMTCT
now EMTCT (elimination!)
4 strategies
prevent HIV in women + their partners
prevent unwanted pregnancies
VCT + timely ART for pregnant HIV+ve women
ensure proper + timely HIV care + support women/children living with HIV + their families
until recently WHO advised HIV +ve mothers to avoid breastfeeding if they could afford, prepare + store formulas milk safely
but research shows a combo of exclusive breastfeeding + use of ART significantly reduces the risk of breast-feeding transmission
2009: new recommendations that HIV +ve mothers/infants should take ART throughout the breastfeeding period + until the infant is 12 months
IVDU
prevalence x22 higher
also @ greater risk of sexual transmission
major driver of HIV in E Europe + central Asia
Prevention
harm reduction: needle + syringe exchange programmes
substitution + tx centres: methadone
programmes for vulnerable groups, e.g. prisoners
BLOOD TRANSFUSION
Prevention = screen all blood products + universal precautions
safe injections
blood + body fluid precautions
post-exposure prophylaxis in HCWs (needle stick injury protocols)
Depends on type of epidemic
generalised (e.g. Africa: 1,2,3
concentrated (e.g. E Europe): 4
prevention of transmission = key to HIV control
Impact
on individuals/families/communities
sickness + death
stigma
loss of income, increased poverty
orphans
on health services
increased burden
services stretched
loss of HCWs
on socioeconomic development
loss of productive capacity
burden of caring for affected families + communities
Education
"the social vaccine"
the right message
+ve (frightening people doesn't work)
suited to culture
HIV = chronic
AIDS = txable
info about HIV important but not sufficient
the right method
enablement + empowerment to change behaviour
need to address the social + economic determinants of HIV
fundamental drivers = gender inequality, stigma, discrimination, deprivation, failure to realise + protect human rights