EMBU UNIVERSITY

CCS 103F: HIV and AIDS

Lecturer. Jane Nyaga

Course Purpose: To equip the learner with knowledge, skills and attitudes in understanding of
HIV and AIDS and its effects to the society.

Expected Learning Outcomes

By the end of the course unit the learners should be able to

1. Define common terminologies relating to HIV/AIDS

2. Describe the concepts of HIV, AIDS and STIs
3. Explain the modes of HIV transmission
4. Discuss the factors encouraging spread of HIV infection
5. Describe the effects/impact of HIV/AIDS in present society
6. Discuss the measures to prevention of HIV/AIDS

Definition of terms /Introduction of HIV-

HIV - stands for Human immunodeficiency virus, which is the virus that causes HIV infection
- AIDS- The initials stands for Acquired immunodeficiency syndrome. 
- HIV/AIDS virus enters the body through the mucus membrane or a broken skin
- AIDS is the most advanced stage of HIV infection. 
- HIV attacks and destroys the infection-fighting CD4 cells of the immune system.
- PMTCT- Prevention of mother to child transmission of HIV
- PITC- Provider initiated testing and counselling
- VCT- Voluntary testing and counselling
- PEP-Post exposure prophylaxis
- Pre p- Pre exposure prophylaxis
- ART- Antiretroviral therapy
- ARVs- Anti retroviral drugs
Introduction
- HIV stands for Human Immune-deficiency Virus, the virus that causes AIDS.
- AIDS- The initials stands for Acquired immunodeficiency syndrome.
- AIDS virus enters the body through the mucus membrane or through broken skin.
- Once inside the body, the virus attacks the body defense cells eventually killing them.
 - White blood cells are a collection of different kinds of cells that work together to guard
the body against micro-organisms.
- The virus targets particularly the white blood cells, the T cells of the body’s immune
system and all the body fluids contain the T cells.
- T- Cells are clustered into different categories using protein receptor on their surface.
- Differentials within groups of these clusters are identified in numerical order, based on
the protein on their surface.
- HIV attacks differential 4 (CD4) clusters of T-Cells.
- Once this happens HIV starts to reproduce other viruses, eventually destroying other CD4
cells
- Normal range of CD4 cells in an adult is about 400-1800 per milliliter of blood volume.
- If the number falls to below 200, the person is said to have developed Immunodeficiency
syndrome (AIDS).
- NOTE:
- The concentration of HIV is high in BLOOD, SEMEN and VAGINAL SECRETION.
- The virus reproduces inside the defense cells and other viruses are released into the blood
stream.
- When a substantial number of defense cells have been killed, the body lacks protection
against common infections. This may take several years.

NB:
- A person can be infected with HIV and not have AIDS
- HIV does not kill, death results from secondary infections

Historical overview
AIDS was first described in 1981

1981 -Doctors in US recognized an unusual kind of pneumonia called Pneumocystis carinii

pneumonia (PCP) in homosexual males and intravenous drug users, a condition previously
unreported in healthy adults. Pneumocystis pneumonia (PCP) is a serious infection
caused by the fungus Pneumocystis jirovecii. Most people who get PCP have a
medical condition that weakens their immune system, like HIV/AIDS, or take medicines
 (such as corticosteroids) that lower the body's ability to fight germs and sickness. Later
similar infections were soon described in Africa, the Caribbean and Europe.

1982- Doctors realized that the symptoms and related conditions were due to compromised (an
ineffective) immune system.

1982 /4- Scientist described the cause of this acquired immunodeficiency syndrome (AIDS)
as a retrovirus (RNA virus). (Professor Luc Montagnier and others discovered a novel
(strange) pathogen: a retrovirus that invaded CD4 cells that orchestrate cell-mediated
immunity and protect humans from a broad range of viral, mycobacterial, and fungal
pathogens)
1984-The first case was described in Kenya
1986- The term Human Immunodeficiency Virus (HIV) was accepted as international
designation for the retrovirus in a world health organization (WHO) consultative meeting.
- AIDS became an epidemic disease. Most of the young people died
 Screening of blood products where available eliminated transmission transmission but
spread of HIV was not easily stopped.
 Condoms were shown to be effective in preventing sexual transmission of HIV, but it
was not long before those who studied AIDS concluded that male condoms alone would
not be enough in settings in which poverty and gender inequality rendered poor women
especially vulnerable to HIV infection.
 Women in turn transmitted HIV to their unborn children or to breastfeeding infants.
 Poor quality health care – including the reuse of syringes, needles, and other medical
paraphernalia – also contributed to the entrenchment of this new epidemic.
1996 – ARVs (antiretroviral drugs) became available in the world

1997 - ARVs were available in private health sector in Kenya

2003 – ARVs were available in public health sector Kenya

2005- 54,000 Kenyans were on ARVs

THEORIES OF HIV ORIGIN
- When and where the HIV virus first emerged has remained unknown for many years
- However, several theories have been put forward, but none is conclusively agreed on the
origin of HIV/AIDS.

Some of the mostly acknowledged theories about the origin of HIV include the following:

1. Mysterious origin theory

- This theory tries to account for the seemingly mysterious origin of HIV by locating it out of this
world.
- It suggests that viral material was carried in the tail gases of a comet passing close to the earth
and that this material was deposited, subsequently infecting nearby Sate in people. Although one
or two famous astronomers have been linked to this theory in the popular press, these scientists
deny the possibility of extra-terrestrial phenomena and any personal connection to the theory.

2. Religious theories (God’s wrath and witch craft)

- Certain segments of the population have openly stated that AIDS is God’s wrath since the
Scriptures condemn the homosexual practice in which AIDS was first observed in the Western
world.
- Rather than its being considered a visitation from God, many Africans believe that AIDS is
caused by another supernatural power – witchcraft, and they use anti-witchcraft rituals and
objects to counteract the infection.

3. Monkey origin theories

- HIV is a lentivirus, and like all viruses of this type, it attacks the immune system.
- Lentiviruses are in turn part of a larger group of viruses known as retroviruses.
- The name lentivirus literally means „slow virus‟ because they take such a long time to
produce any adverse effects in the body.
- They have been found in a number of different animals, including cats, sheep, horses and
cattle.
 - The most interesting lentivirus in terms of the investigation into the origin of HIV is the
Simian immunodeficiency Virus (S IV) that affects monkeys.
- The researchers led by Paul Sharp of Nottingham University and Beatrice Hahn of the
University of Alabama made the discovery during the course of a 10-year long study into
the origins of the virus.
- They claimed that chimpanzees were the source of HIV-1 and that the virus had at some
point crossed species from chimps to humans.

4. The Oral Polio Vaccine (OPV) theory

The journalist Edward Hooper suggested that HIV could be traced to the testing of an oral polio
vaccine called Chat, given to about a million people by the Belgian in Congo, Rwanda and
Burundi in the late 1950s.
To be reproduced, live polio vaccine needs strain to be cultivated in living tissue, and Hooper‟s
belief is that Chat was grown in kidney cells, taken from local chimps infected with SlV.
This, he claimed, would have resulted in the contamination of the vaccine with chimp SlV, and a
large number of people subsequently becoming infected with HIV.

5. The Hunters‟ Theory

This is the most commonly accepted theory.
In this scenario, simian immunodeficiency virus (SIV) was transferred to humans as a result of
chimpanzee being killed and eaten, or their blood getting into cuts or wounds of people in the
course of hunting.
Normally, the hunter's body would fight off SIV, but on a few occasions the virus adapted itself
within its new human host and became HIV

6. The Contaminated Needle Theory

In the 1950s, the use of disposable plastic syringes became common place around the world as a
cheap, sterile way to administer medicines.
However, to African healthcare professionals working on inoculation and other medical
programmes, the huge quantities of syringes needed would have been very costly.
It is therefore likely that one single syringe would have been used to inject multiple patients
without any sterilisation in between.
This would rapidly have transferred any viral particles from one person to another

7. The Colonialism Theory

It was first proposed in the year 2000, by Jim Moore, an American specialist in primate
behaviour, who published his findings in the journal AIDS Research and Human Retroviruses.
During the late 19th and early 20th century, much of Africa was ruled by colonial forces.
In areas such as French Equatorial Africa and the Belgian Congo, colonial rule was particularly
harsh and many Africans were forced into labour camps where sanitation was poor, food was
scare and physical demands were extreme.
These factors alone would have been sufficient to create poor health in anyone, so SIV could
easily have infiltrated the labour force and taken advantage of their weakened immune systems
to become HIV.
A stray and perhaps sick chimpanzee with SIV would have made a welcome extra source of food
for the workers.
Moore also believes that many of the labourers would have been inoculated with unsterile
needles against diseases such as smallpox (to keep them alive and working), and that many of the
camps actively employed prostitutes to keep the workers happy, creating numerous possibilities
for onward transmission.
One final factor Moore uses to support his theory, is the fact that the labour camps were set up
around the time that HIV was first believed to have passed into humans - the early part of the
20th century.

8. Conspiracy theories
Laura Bogart of RAND (Research And Development) Corporation (created in 1948, is a non-
profit institution in USA which help improve policy and decision making through research and
analysis) and Sheryl Thorburn of Oregon State University, stated that:
i) One in seven African Americans surveyed believed HIV was created by the
Government to control the black population.
ii) One in three said they believed that HIV was produced in government laboratory,
iii) More than half said there was a cure for HIV/AIDS that was being withheld from the
poor.
Therefore, this resulted to mistrust of the Government and the health profession, and believe that
HIV was designed to wipe out large numbers of black and homosexual people.

9. The calculation theory

This is the latest theory on the origin of HIV.
Opponents of the simian-human transmission remain unimpressed by the evidence in of the
monkey theories and argue that viral sequencing of HIV strains indicate that HIV has been
around probably for hundreds of years.
In 2000 when a team of scientists using computer technology to study on the structure of HIV
calculated the rate at which the virus mutates for the HIV viral sub-types to have a common
ancestor.
This process revealed HIV originated around 1930 in rural areas of Central Africa, where the
virus may have been present for many years in isolated communities.
The virus probably did not spread because members of these rural communities had limited
contact with people from other areas.
But in the 1960s and 1 970s, political upheaval, wars, drought, and famine forced many people
from these rural areas to migrate to cities to find jobs.
During this time, the incidence of sexually transmitted infections, including HIV
Infection accelerated and quickly spread throughout Africa.
GLOBAL HIV & AIDS STATISTICS 2016 - 2018

36.9 million [31.1 million to 43.9 million] people globally were living with HIV in 2017.
This are the known cases adding unknown cases may get to 50 million.

Only 21.7 million [19.1 million to 22.6 million] million people are accessing
antiretroviral therapy.

50 million [39.9 million to 100 million] people have become infected with HIV since the start of
the epidemic.

35.4 million [25.0 million to 49.9 million] people have died from AIDS-related illnesses
since the start of the epidemic.

People living with HIV

In 2017, there were 36.9 million [31.1 million to 43.9 million] people living with HIV.

35.1 million [29.6 million to 41.7 million] adults.

1.8 million [1.3 million to 2.4 million] children (<15 years).

75% [55–92%] of all people living with HIV knew their HIV status in 2017.

About 9.4 million people did not know that they were living with HIV.

Number of people who know their status

In 2017, three out of four people living with HIV (75%) knew their status.

Among people who knew their status, four out of five (79%) were accessing
treatment.

And among people accessing treatment, four out of five (81%) were virally
suppressed.
Local distribution ( in Kenya), KAIS (Kenya Aids Indicator Survey) Report 2015 (Nascop,
2015)