containment - lecture 13 - HIV / AIDS

EXAM; students should be able to discuss what the “combination HIV prevention approach” consists of and on what principles it is based and possible stakeholders to be involved

difference between HIV /AIDS and other infectious diseases

• long time between infection of HIV / AIDS and getting ill / dying (10 years) 

• only 3 months after infection you can test for HIV 

epidemiological data about HIV/AIDS 

• 9 million people currently living on HIV/AIDS not on drugs (ART) → many children get it via their mother, dependence of females in the families. 

• 1.3 million people newly infected in 2024 

• 31.6 million people on ART in 2024 

• 630000 million people died from aids related illnesses in 2023 

sub saharan africa and HIV/AIDS

• 15% of the population live in africa 

• 64% of all PLHIV lives in africa (20.8 million in ESA and 4.8 million in WCA 

• in 2023 for the first time more new HIV infections happened outside of sub saharan africa than i n this continent → how is this possible 

• in Russia and Ukraine more drug injecting (needle sharing) → more HIV/AIDS there now 

important abbreviations

• FSW → female sex worker

• ISW → informal sex worker

• MSM → men having sex with men 

• MSW → male sex worker 

• PWID → people who inject drugs

• TG → transgender 

dynamics of HIV epidemics

• key populations at higher risk of HIV exposure 

• 94% of new infections outside sub-saharan africa within key populations 

• 51% of new infections in sub-saharan africa within key populations. 

• in the picture there should also be a circle for children 

concentrated epidemic

• an HIV epidemic where infection is high in specific subpopulations but remains low in the general population.

discriminatory and punitive HIV related laws in 2024 

• the more policies that do not allow to talk about the marginalized groups (sexuality education, sex workers) → leads to less education more infectious diseases

risk of acquiring HIV (injecting drugs, msm, fsm, tg women)

• injecting needles highest change to get infected → direct contamination into the blood.

  • difference injecting intramuscular or intravenous → intramuscular reduces risk (this is recommended)

  • risk 35times higher than a person not injecting drugs 

• 2nd highest risk group is female sex workers 

  • 30 times higher chance than adult women

• men who have sex with men

  • 28 times higher than adult men 

• transgender women

  • 14 times higher than adult women 

biomedical, behavioural, and structural fators

• in sub Saharan Africa 6/7 new HIV infections amongst age group → 15-19 years (girls)

  • intergenerational sex (old man, young girl)

  • child marriage 

  • concurrent sexual relationships → having multiple partners → puts you at additional risk of having AIDS/HIV

    • this is because the viral load goes up and no time to go down before next sexual partner 

HIV combination prevention

• addresses biomedical, behavioural and structural factors. 

• example structural environment factors→ prison, detention center, sex work sites.

  • structural → political, legal, economic factors

  • structural → physical environment

  • structural → social and cultural

principles HIV combination prevention

• rights based, evidence informed and community owned 

• mix of biomedical, behavioural, and structural interventions 

• prioritized HIV prevention needs of particular individuals and communities to have the greatest sustainable impact on reducing new infections 

• tailor-made to national and local needs and conditions 

• mix of programmatic and policy actions 

• actions planned and managed synergistically over an adequate period of time 

evidence informed versus evidence based

• in public health very hard to do RCTs