HIV / AIDS intervention and health systems

levels of ecological framework

• individual and community (risk awareness and prevention)

• health facility based (voluntary counseling, testing, drug treatment, PrEP)

• Human rights (police interventions to prevent violence against women, monitoring and law reform such as discrimination laws)

what HIV interventions seek to achieve

• prevention of new infections among all people , especially women and children in key populations

• increase knowledge of serostatus -detectable antibodies

• increase proportion of PLWHA that are on ArVs

• improve care and quality of life of PLWHA

• address human rights and and structural issues that silently fuel the epidemic

3 intervention types

1. PRep behavioral drug

2. human rights: multi faceted

3. mother to child transmission: drug

who prep drug is indicated for:

• sexually active, HIV negative adults

• sexually active, HIV neg women who report in the past 6 months having a male sex partner also has sex with men or inject drugs

• any HIV uninfected person with an HIV positive sex partner who is considering pregnancy

reduces the risk of getting HIV through sex about 99 percent (when taken as prescribed)

prep PILLS reduce the risk by 74%

prep shots are not recommended for people who inject drugs

established by un: 17 goals set out to be achieved in 2030

environment, society, economy

2020 goal updates:

95-95-95, 10-10-10

UNAIDS prioritized 7 human rights programs for inclusion in AIDS responses

1. hiv related stigma and discrmination in reduction programs

2. hiv related legal services

3. monitoring and reforming laws, policies, regulations

4. rights and legal literacy programs

5. sensitization of lawmakers and law enforcement agents

6. training for health care providers on human rights and medical ethics related to HIV

7. reducing discrimination (gender inequality and violence against women in the context of HIV)

RCT

Randomized Control Trial- the most rigorous way of determining whether a cause and effect relation exists between treatment and outcome

some key features of RCT

• all intervention groups are treated identically except for the experimental treatment (placebo control)

• patients and trialists should remain unaware of which treatment was given until the study is completed (double-blind)

equipose

often cited as an ethical pre requiste of an RCT

theoretical equipose= no prefernce between treatments

zidovudine treatment

AZT, a reverse transcriptase inhibitor

Stigma

•Stigma refers to the negative attitudes and beliefs that society holds about individuals living with HIV. This can manifest as:

•Social Exclusion: People with HIV may be shunned or isolated from their communities.

•Shame and Guilt: Many individuals feel ashamed or guilty about their status due to societal perceptions.

•Internalized Stigma: Those living with HIV may adopt these negative beliefs, affecting their self-esteem and mental health.

Discrimination

•Discrimination is the behavioral aspect that results from stigma. It involves treating people unfairly based on their HIV status, and can include:

•Denial of Services: Individuals may face barriers in healthcare, employment, or housing.

•Legal Discrimination: Some laws may specifically target people with HIV, limiting their rights.

•Violence and Harassment: In extreme cases, individuals may face physical harm or bullying.