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KENYA METHODIST UNIVERSITY

HSCI 225

SEMINAR ON HIV/AIDS

COURSE OUTLINE

Unit 1 FACTS ABOUT HIV/AIDS

Topic 1: The nature of HIV/AID

Topic 2: Common symptoms of HIV/AIDS

Topic 3: Transmission of HIV/AIDS

Topic 4: Prevention of HIV/AIDS Transmission

Topic 5: Understanding stigma and discrimination

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Topic 6: HIV/AIDS and Nutrition

UNIT 11 HIV/AIDS PROFILES

Topic 1 HIV/AIDS situation in Kenya- Statistics and Impact

Topic 2 Global, Regional and National statistics

Topic 3 GOK policies and framework of Action to fight HIV/AIDS

UNIT II1: WORKING WITH PEOPLE LIVING WITH HIV/AIDS

Topic 1: Understanding people living with HIV/AIDS

Topic 2: Principles of Home - based care

Topic 3: Support for orphans and other vulnerable children

UNIT IV SEMINAR PRESENTATIONS ON HIV/AIDS and Business

Sector

Topic 1 Impact mitigation mechanism and strategies: A case of MFIs

in Kenya

Topic 2 HIV/AIDS and Business Sector (Students Group Work)

The GOK Policy framework on HIV/AIDS on Business and Workplace

Impact of HIV/AIDS on Business sector

HIV/AIDS policies and practices of various companies ( At least

Five companies fro various sectors e.g. banking, manufacturing )

Opportunities for students of business studies; Consultancies,

research etc

Recommendations for further studies

Mainstreaming of HIV/AIDS at Work place

Unit 1 FACTS ABOUT HIV/AIDS

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Purpose: To enable you acquire knowledge of basic facts about

HIV/AIDS

Objectives: At the end of this topic you should be able to:-

Give the full meaning of the abbreviation HIV/AIDS

Describe what happens when HIV enters a human body

Describe the response of a human being under attack by

HIV (the progression from HIV to AIDS)

Describe the response of a human being invaded by other

viruses and bacteria

Topic 1: The nature of HIV/AIDS

1 Definition

HIV=

H Human

I Immunodeficiency

V. Virus

AIDS =

A Acquired

I Immune

D Deficiency

S Syndrome

2. Multiplication of the virus in the human host

When the virus enters the human body, it aims for the white blood cells

(the T-cells). The virus is ingested by the host white cell where it attacks

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the nucleus. The infected host cell then begins to manufacture viral

particles. These particles, called virions, are discharged into the body

fluids and the blood. The virions enter other white cells and so continue

to multiply. These white cells continue to manufacture viral particles.

3. Defense response of the individual

The body has a natural way of defending itself from infections. There are

special cells, the white blood cells that attack and kill different kinds of

bacteria or viruses that may enter the body to cause an infection. Some

specialized white blood cells also render the task of killing these

“invaders” easier by secreting chemical substances called antibodies to

neutralize them. The body system under attack by a virus produces

antibodies to neutralize them. The body system under attack by virus

produces antibodies to fight the virus. Some viruses are over-powered,

but HIV continues to multiply in the host cells, and that is why the

disease is incurable. The specialized white cells are known as the T4-

cells. The T4 –cells invaded by the HIV virus eventually succumbs and

dies; as the infection progresses, their numbers decrease, and body

immune systems get weaker. The body cells from then onwards have a

permanent parasite, HIV.

4. The “window period”

The “window period” refers to the period between infection and the

production of anti bodies by the host under attack. During this time, the

viruses are multiplying in the body, but they cannot be detected

because the antibodies are too few in number or are not yet present.

This can range from 6 weeks to 12 weeks. Each bacterium or virus

induces the body to produce a very specific kind of antibody. The HIV

antibodies are specific only to HIV.

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5. Difference between having AIDS and being HIV positive

When a person tests positive for HIV, this means that the person has

been in contact with HIV, and the immune system has produced

antibodies against it. That person is said to have undergone sero-

conversion. Before sero-conversion, he tested negative and after

seroconversion he is HIV-positive. The person usually appears well and

may not be sickly at all, and he is asymptomatic. As the body continues

to fight the HIV infection, the body gets weakened, and eventually

cannot defend itself from any kind of disease.

He begins to show signs of opportunistic infections, like fungal infections

of the skin, mouth and throat, diarrhea, weight loss, pulmonary

tuberculosis, and frequent fever. The person is symptomatic and has

AIDS. The person with AIDS succumbs to all kinds of infections,

infections that people without HIV can deal with easily.

6. Differences in time lapse between infection and manifestation

of AIDS.

There are several factors that influence how soon someone progresses

from HIV infection to AIDS. The genetic make-up of the individual and

the nutritional status has a great influence; as a result, some people

have stronger natural resistance than other.

If the individual is under constant attack from different kinds of germs

and infection, the body will offer less resistance to the virus and will

eventually be over-powered. For example, people living in an

environment with frequent threat of malnutrition, malaria and other

parasites soon wear out their immune systems and may progress to

AIDS faster than people living in a less challenging environment. The

nutritional status of an individual contributes to how the immune system

responds to an infection. A well-nourished person will put up more

resistance to the HIV virus then a poorly nourished person. Because of

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different factors, the time between initial infection and actual

presentation of AIDS can vary between 2 and 10 years.

7. Curable bacterial infections and non-curable viral infections.

A bacterium is much larger than a virus. The genetic material of bacteria

does not control host cell as the HIV virus does. The human body can

completely destroy bacteria, especially with aid of antibiotics. However,

there are no antibiotics which can kill a virus. The current antiretroviral

drugs can only stop a virus from multiplying.

Highlights:

Window period: Long incubation period of HIV infection with no

symptoms and a negative HIV antibody test, but the person harboring

HIV has the capacity to infect another person.

Sero –positive: A person with HIV antibodies, and can be detected

in the laboratory; the person may be asymptomatic, and feels well.

Symptomatic stage: The person with HIV starts showing signs that

the body defense system is getting weak and can be attacked by any

disease, and that is AIDS.

Topic 2: Common symptoms of HIV/AIDS

Objective: You should be able do describe common symptoms of

HIV/AIDS.

AIDS was first called “Slim” in Africa because loss of body weight is one

on the main symptom of AIDS. People with HIV/AIDS have a variety of

symptoms affecting all parts of the body. People without HIV/AIDs can

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have these symptoms too. People may have TB or herpes zoster

(shingles) or chronic diarrhea without having HIV infection, but if they

have HIV infection, these illness and symptoms are likely to become

more frequent or severe.

The World Health Organization (WHO) has described the patterns of

symptoms that help to define AIDS in adults and children (see box

below).Even if some one meets these clinical criteria, they should be

tested for HIV to confirm since TB, cancer, malnutrition and others

conditions can cause similar symptoms.

Common symptoms of HIV/AIDS

General symptoms

General malaise

Loss of weight

Pain

Swollen glands

Swelling of the limbs

Hair loss

Gastrointestinal tract

Diarrhea

Difficulty in swallowing

Poor appetite

Sore mouth

Nausea and vomiting

Abdominal pain

Skin and hair

Itching

Boils

Rashes, ulcerations, wounds

Infections due to bacteria, fungi

and viruses

Diffuse hair loss, thinning of the

hair, early graying (causes of hair

change ranges from nutritional

imbalance to chemotherapy,

infection and HIV itself)

Central nervous system

Headache

Memory loss and confusion

Tingling and numbness of limbs

Convulsions, confusion, coma

Weakness of one side of the body

Anxiety and depression

Chest Genitalia

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Fever TB

Cough Herpes zoster

(shingles)

Chest pain Meningitis

Difficulty in breathing

Discharge

Ulcers

Pain on passing urine

Signs of AIDS in Adults

Major signs

Unexpected 10% weight loss in less than 1 month

Persistent diarrhoea for over 1 month

Fever over 1month

Minor signs

Cough for over 1 month

General Pruritic dermatitis

Recurrent herpes zoster

Candidiasis (thrush) of the mouth

Generalized enlarged lymph nodes

Disseminated progressive herpes simplex

The presence of at least 2 major and 2 minor signs is enough

to diagnose AIDS in Adults

Signs of AIDS in Children

Major signs

Weight loss or abnormally slow growth

Chronic diarrhoea for over 1 month

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Fever over 1 month

Minor signs

Recurrent common infections like otitis media, pharyngitis,

tonsillitis etc

Generalized enlarged lymph nodes

General pruritic dermatitis

Candidiasis (thrush) of the mouth or throat

Cough for over 1 month

Confirmed maternal HIV infection

NB: The presence of at least 2 major and 2 minor signs is

enough to diagnose AIDS in a child in the absence of known

cause of immuno-suppression.

Topic 3: Transmission of HIV/AIDS

Objective: You should be able to describe the various routes of

transmission of HIV.

1. There are 3 modes of transmission of HIV

1. Sexual: Unprotected intercourse (vaginal, oral, anal) with an infected

person. In Kenya, this is the most common mode of transmission

2. Contact with blood or other body fluids: Transfusion of blood

products from an infected person donor; use of contaminated

instruments such as needles, syringes, knives or blades( including

instruments in circumcision of both male and female, skin piercing,

scarification, traditional healing and other traditional practices).

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3. From an infected mother to a child. This will happen in womb,

during labor, at birth or through breastfeeding.

NB HIV is not transmitted through casual contact with another person.

This includes holding hands, hugging, kissing, sharing food and drink or

transmitted by mosquitoes or biting insects. It is important to show

normal care and affection to people living with HIV/AIDS

2. Myths and Misconceptions

Because of lack of knowledge, people have imagined that there are

other routes of transmission. It is important to know these myths so as

to be able to provide the correct information.

Topic 4: Prevention of HIV/AIDS Transmission

4.1: Social Vaccination

Objective: By the end of the topic, you should be able to describe what

is meant by “social vaccination” against HIV/AIDS.

In Africa, sex accounts for about 70% of all the HIV transmission, while

mother-to – child transmission accounts for 20% and contaminated

piercing instruments 10%. Sexual behavior is social activity determined

by the values and norms of a particular society. Individual, family, and

community behavior that prevent the spread of HIV / AIDS should be

identified and promoted, while behavior that increases the risks of

HIV/AIDS should be challenged and stopped. If individuals, families and

society take a collective responsibility of modifying and controlling

sexual behavior, then the battle against HIV/AIDS will be won.

Abstinence and being faithfulness should be promoted

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4. 2: Prevention of mother – to child transmission of HIV and

pediatric AIDS.

Objectives: At the end of this topic, you should be able to:

Describe how transmission of HIV from mother – to child can be

prevented.

Demonstrate an understanding of key issues relevant to mother-to –

child transmission (MTCT) in counseling couples and individuals.

Describe other ways through which children can be infected with

HIV/AIDS.

Explain the guidelines for clinical diagnosis of children living with

HIV/AIDS.

About 20% of all HIV/AIDS cases are due to infection from mother to

child; this occurs through the placenta, from the birth canal at delivery,

or from breast milk. 5 to 10 percent of HIV infected women will pass the

virus to their babies during pregnancy; 10 to 20 percent will pass the

virus during delivery; and 10to 20 percent will pass the virus over the

course of 2 years of breastfeeding. Early knowledge of the mother’s HIV

status and that of the father will enhance the application of timely

preventive measures. Knowing the HIV status of prospective parents

before they decide to procreate will reduce the risk of MTCT. Intrauterine

transmission can be reduced to 2% if antiretroviral drugs are used from

the 14th week of the pregnancy to at least 6 weeks after birth. Ethical

issues surrounding the use of antiretroviral drugs include prohibitive

costs, duration of therapy for the mother (up to 6 weeks only in

developing countries), and continuing or discontinuing breastfeeding.

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Reducing the risk of transmission during labour and delivery can be

achieved by modifying obstetrical practices. Preventing anemia in

pregnancy can reduce the risk of the mother being infected through

blood transfusion. Availing family planning information, including the use

of condoms, can reduce transmission in couples if one partner is already

HIV positive.

Diagnosing pediatrics AIDS:

Antibody HIV testing is not used for diagnosing pediatrics AIDS before 18

months of age; this is because of the presence of maternal antibodies in

the baby.

The diagnosis is based mainly on clinical symptoms before age 18

months or in settings where access to diagnostic tests is limited.

According to WHO guidelines, any child presenting with any 3 of the

following conditions is suspected to have AIDS.

2 or more episodes of pneumonia in the past 2 months

1 or more episodes of persistent diarrhea in the past 2 months

A parent with tuberculosis

Oral candidiasis (thrush)

Enlarged lymph nodes in two or more sites

Weight falling for 2 consecutive months.

Chronic cough and chronic fever are other common symptoms in

children with AIDS.

Pediatric transmission of HIV/AIDS

1. A child cannot be infected with HIV/AIDS even if he /she is sexually

abused.

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False: A child, if abused by a person who is HIV positive, risks being

infected with the virus.

2. Any Child who is HIV positive can infect other children while playing

with them.

False: Ordinary play will not expose other children, but if the child

is injured and s bleeding then there is a risk.

3. A child who is HIV positive should not sleep in the same bed with

other children because sharing beds can infect other children.

True: Its is better for children to sleep in separate beds. Some

children may actually initiate sexual play as early 5 years old. Urine

can contain the virus, although this has not been scientifically

proven as one of the know routes of transmission of HIV/AIDS.

4. If an AIDS parent who has open skin lesions hugs a child there is a

risk of infecting that child.

True: Any contact with body secretions should be avoided. What do

you think of this verse, Leviticus 15:11?

5. An unborn child has a 30% risk of being infected with HIV if the

mother is HIV positive

True: About 30% of HIV positive mothers will infect babies through

the placenta or at birth.

6. All babies born to HIV positive mothers will test positive for the

antibody HIV test.

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False: Some may test positive at birth, but if the mother’s

antibodies did not cross the placenta to reach the baby, then the

baby may test positive.

7. All babies who are born to HIV positive mothers and who test HIV

positive at birth definitely have HIV infection.

False: Only 30% of babies born to HIV positive mothers definitely

have HIV. About 70% are spared. The HIV test conducted at birth is

an antibody test, and the antibodies could have come from the

mother. The child will have HIV infection if the virus entered the

baby have come from the mother. The child will have HIV infection

if the virus entered the baby through the placenta or during labour,

and if the mother decides to breast feed baby. The true state of the

baby at birth can be detected if a direct test for the virus is done,

one that detects virus or viral particles. Unfortunately this is

extremely sophisticated and expensive. Therefore, some babies

who test positive for antibodies at birth may become negative once

the antibodies from the mother are eliminated from the baby’s

blood system and all further contact with the virus removed. To

rule out pediatric HIV, the antibody test must be performed at the

age of 12-18 months.

8. Delivering by caesarean section will reduce the risk of the baby being

infected with the HIV virus from an HIV positive mother.

True: Experience has proved this.

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9. Delivery through the vagina will reduce the risk of HIV infection of the

baby since there is less blood involved.

False: Experience has proved that vaginal delivery increases the

risk, especially if the placenta (bag of water) broke before labour.

10. Boiling the breast milk of an HIV positive mother before giving to

the baby will reduce risks of infection through breast milk.

True: The virus is very sensitive to heat and will be destroyed by it,

but this is a rather difficult and tedious procedure.

11. The only sure way to rule out possibilities of mothers infecting their

children with the HIV virus is by having fathers and mothers test for

HIV when expecting or planning to have a baby.

True: Pre-pregnancy counseling to know HIV status is ideal.

Preventive measures can be taken so that risk of child infection is

greatly reduced.

12. Prolonged breastfeeding for up to 2 years will increase chances of

the baby being infected with the HIV by 10 to 20 percent.

True: Research has proved this

13. A pregnant woman has an added risk of HIV infection if she is

anemic or experiences severe hemorrhage.

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True: Anemia in pregnancy can necessitate blood transfusion.

Blood transfusion is risky even when the blood tests HIV negative

14. Family planning and the use of the condom will reduce the

prevalence of pediatric AIDS

True: No pregnancy, no baby

15. Treatment of an HIV positive mother will not reduce the risk of the

baby being infected.

False: This has been shown to reduce the risk from 2% to 10%

especially in Europe.

16. Wounds on the nipple of a breastfeeding mother will increase the

risk of the child being infected with the HIV virus.

True: This is because blood fluids from the wound will contaminate

the milk.

4.3: Early and effective management of sexually

transmitted infections

Objectives: By the end of this topic, you should be able to:-

Explain the relationship between HIV and sexually-transmitted

infections(STIs)

Describe the different syndromes of STIs

Explain the importance of early diagnosis, treatment and early

referrals of STIs

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List the referral centers for STI management

Explain the four Cs of syndrome management of STIs

Explain the controversies surrounding condom use in HIV / AIDS / STI

management within the Christian milieu

Answer true or false

1. A person can have an STD without any symptom or sign

True: This is particularly true for women. Some STDs may

present symptoms very briefly in their early stages; the symptoms

then disappear, but the infection persists. In men, some STIs (e.g.

Chlamydia) have no symptoms.

2. A Christian wife cannot have an STD

False: If there is infidelity in the couple, one can get an STD

(Hebrew 13:4, Mathew 15:1920)

3. All STDs except HIV can be cured with proper treatment

False: Other viral infections such as herpes cannot be cured.

4. Vaginal discharge in a woman means that she definitely has an

STD

False: It may not be an infection

5. Sex with a virgin will cure an STD of an old man

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False: This is a myth. Sexual activity of any kind cannot cure any

STD

6. The best thing to do if you suspect an STD is to inform your sexual

partner.

False: The first thing to do is to seek treatment and follow it

thoroughly.

7. Only people who have intercourse can contract an STD

False: Infants can contract STIs e.g. syphilis while still in the

womb, or gonorrhea at birth from the birth canal

8. Wife cleansing can expose one to STDs and even HIV

True: A village cleanser cleans the entire village; he is a living

reservoir of STIs in the village

9. It is better to remove the curse from the family when one loses a

husband than to abandon tradition.

False: Christians have no curse. Christ has taken away their

curses in the cross at Calvary” “Cursed is the one who hangs on a

tree” (Galatians 3:13).

10. A married Christian man should use a condom when he suspects

that he has an STD

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True: He should discuss his fears with his wife and the couple

should use a condom

11. It is impossible for an African man to be faithful to one sexual

partner

False: Christ give power to all his children to do the right thing

(John 1:12).

Common sexually transmitted diseases

STI Symptoms and Consequences

STI SYMPTOMS CONSEQUENCES

HIV and AIDS -Symptoms begin several

months to - There is no cure.

years after infection and may include: - You can

give HIV to your

- Persistent tiredness sexual partner or

someone

- Loss of over 10% of body weight with whom

you share a needle.

- Persistent diarrhea -Can be passed from

pregnant

- Persistent fever woman to her unborn

child

Gonorrhea - Symptoms begin 2-21 days after - Damage to

reproductive

infection organs

- Discharge from penis or vagina - Sterility

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- Pain/burning sensation during urination - Blindness in

babies of

or bowel movement infected mothers

- Difficulty urinating

- Lower abdominal pain (pelvic area) - You can give

gonorrhea to

- Most women and some men have your sexual

partner

no symptoms - Heart trouble, blindness,

skin disease, arthritis

Syphilis 1st Stage - Increased risk of ectopic

Symptoms begin 1-12 weeks after pregnancy

Infection - You can give syphilis to

your

- Painless, open sore on the mouth sexual partner

or sex organ

- Sore goes away after 1-5 weeks

2nd Stage

- Symptoms begin 1-6 months after sore - Heart

disease, brain damage,

appears: blindness, death

- Non-itchy rash on the body -Can be passed from

pregnant

- Flu-like symptoms woman to her unborn

child

Herpes Symptoms begin 2-30 days afterThere is no cure for

herpes

Infection

-Painful blister-like lesions on or - Recurring outbreaks of

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around the genitals or in anus or mouth painful

blister occur in 50%

- Flu-like feelings of those who contract

herpes

- Itching and burning around the sex - May be

transmitted to sexual

organs before the blisters appear partner

- Blisters last 1-3 weeks - May be transmitted to a

- Blisters disappear but the individual baby during

childbirth.

still has herpes - May increase the risk of

- Blisters may recur cervical cancer

Chlamydia Symptoms begin 7 - 21 days after - You can give

Chlamydia to

Infection your sexual partner

-Discharge from the sex organs - Damage to

reproductive

- Burning or pain while urinating organs

- Unusual bleeding from the vagina - Sterility

- Pain in the pelvic area - Passed from mother to

child

Most women and some men have no during childbirth

Symptoms

Genital Warts Caused by the human

papillomavirus - Some strains are associated

(HPV) with cervical cancer and

some other genital

cancers

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Small painless fleshy bumps on and these strains may

not

- Inside the genitals and throat. produce visible warts

- Often no visible symptoms

- Can be detected by Pap

smear during gynecologic

exam

- Can be removed by

physical

or chemical means but

virus

cannot be cured and

wards

often reappear.

Hepatitis B Spread by sex, exposure to infected Can develop

chronic liver

Blood and to child during pregnancy disease.

or delivery

- Mild initial symptoms; headache and - Causes

inflammation of liver

fatigue and sometimes leads to

liver

- Later symptoms: dark urine, failure and death

abdominal pain, jaundice

- Often no visible symptoms - No cure

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4.4: Voluntary Counseling and Testing for HIV / AIDS

Objectives: By the end of this, you should be able to:-

Explain what voluntary counseling and testing (VCT) includes

Demonstrate the capacity to conduct pre-and post-test counseling .

Demonstrate the capacity to establish support services for those who

want VCT.

Facts to know:-

It has been shown that when there are benefits to testing for HIV, such

as access to antiretroviral drugs and drugs for treating opportunistic

infections, more people volunteer to know their HIV status. An HIV

positive antibody test means that the person has been in contact with

the HIV virus so that the body has produced enough antibodies to be

detected. Such a person can infect others if the body fluids (semen,

vaginal fluid, breast milk, blood, and blood products) come in contact

with another individual. The HIV positive person can progress to full

blown AIDS in a few years. An individual can be infected with the virus

but may not have produced enough antibodies to be detected in the

laboratory. Though the HIV test is negative, the person could be in the

window period. The test should be repeated in 3 to 6 months. Most

newborns of HIV positive mothers will positive because of passive

immunity (antibodies from the mother) at birth. If such a baby escaped

being infected in the womb and the mother does not breast feed, then

the baby may eventually test negative once the mother’s antibodies are

all eliminated. If the body tests positive persistently at 12-18 months of

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age, then the chances are that the baby was infected in the womb or

during delivery.

Pre-test counseling and post-test counseling help a person make an

informed decision on the option to test or not and help the person cope

with the consequences of a positive or negative HIV test result. A

positive test can be life changing and people generally need support.

Knowledge of centers that conduct VCT is important so that persons

seeking such services can be referred there. It is important to identify

support services for persons testing positive (Church, family, friend’s

community and people living with HIV / AIDS - PLWHA).

It is also very important to maintain confidentiality regarding the HIV

status of a person. The value of support groups for those who have

decided to make their HIV status public should be emphasized.

Counseling process

Note: Pre-test and post-test counseling and an eventual follow-up plan

for both positive and negative outcomes must accompany all HIV

testing.

This topic dwells mostly on pre-test and post-test HIV / AIDS counseling.

The following is a risk assessment guide. This will enable you to assess

the risk of an individual in your community and school so that you can

determine the need for pre-test counseling.

High Risks Behavior for Adults and Teenagers:

Sex with more than one person.

A widow who has just undergone a cleansing ceremony.

A young boy or girl who was a victim of rape (anal, oral, or virginal).

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A group of boys forced a girl to have sex with them on the way from

school.

A husband or wife has just died from TB, meningitis, malaria, or

typhoid.

A man’s first wife or another wife has just died in another town.

Two children in a family died one after the other before they were 5

years old

A wife’s first husband died a year ago

A husband lives in Nairobi or Mombasa and only comes home once in

3 months.

A wife lives in the village and the husband lives in the town; they see

each other once in a month.

A person diagnosed with TB.

A person went for a dance/funeral 6 months ago and awoke the

morning after with a stranger in the bed.

A person who received a blood transfusion in an emergency

operation.

High-risk assessment for children:

A mother died around the time of birth of a child and after a

prolonged illness.

The mother of a child is always ill.

A child is always ill.

A father or mother has chronic cough and has lost weight.

Older siblings have died recently.

A mother died a few months after childbirth; she never recovered

fully after child birth.

A mother has a chronic itching skin condition.

A mother is a widow.

One of the parents is known to have more than one sexual partner.

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A young girl or boy went through group ritual circumcision 2 years

ago.

A young boy or girl recently had the ears pierced.

A child had an accident and received untested blood in a transfusion

to save life.

A young teenager has used injectable drugs.

Hand Out 1: Pre-test counseling session guide

Introduction

Purpose of counseling

1. Establish reasons for wanting test or reasons or referral for testing.

2. Assess the risk of the person requesting pre-test counseling.

3. Discuss the plans after the results: If positive then what, if negative,

then what?

4. Assess the suicidal risk or the risk or intention of infecting others.

5. Discuss notification of partner, family members, employer etc.

6. Discuss the possibility of affiliation to a group of persons who have

volunteered to tests for HIV.

7. Give the client an active choice to go for the tests or not.

8. Provide the client with a referral note to a testing centre, if you do not

do the test yourself.

9. Discuss potential discrimination following outcome of results.

10. Discuss confidentiality.

11. Schedule a pot – test counseling session when the results come

out.

Important guidelines

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Be friendly, considerate and non-judgmental. Follow the key objectives

you intend to discuss. The time between pre-test and post-test

counseling should be minimized so as to reduce anxiety

Hand out 2: Post – test counseling guide

Objectives

1. To assist the client to cope with test results.

2. To assist the client to make future plans.

Presentation process:

1. Read out or give the results to the client

2. Encourage client to share initial feelings (reactions).

3. Clarify the results; explain what the results mean to the client

4. Discuss the implication to the client and to others: Family, friends,

and colleagues at work.

5. Establish follow-up counseling plan, including group counseling and

informing loved ones (spouses).

6. Possibility of access to treatment (ART) and drugs for opportunistic

infections.

7. Establish a follow up action plan:

If positive, discuss how to stay healthy, rest, medication, referrals,

and anti-retroviral drugs.

Prevent spread to others: spouses, children etc

Partner notification (confidentiality)

Affiliation to a care group of PLWHA or other support systems.

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If negative, discuss need for a second test and importance of

reducing or eliminating all high – risk behavior.

Support groups for those who want to make their HIV status

public.

Objective: You should have an increased understanding of group

support for those who would like to know their HIV status.

Facts to know:

People tend to feel more secure in a group, especially with similar

interests or one that is bound together by some common bond. This

could be a same sex group, a women’s church group, widows, guardians

etc. This may help in destigmatization of HIV/AIDS among the members

of school, the church or community. It may easy to start a group of

persons whose past lifestyle exposed them, or their spouses, to the risk

of HIV/AIDS.

Topic 5: Understanding stigma and discrimination:

Fact to know

From the start of the AIDS epidemic, stigma and discrimination have

fuelled the transmission of HIV and have greatly increased the negative

impact associated with the epidemic. HIV – related stigma and

discrimination continue to be manifest in every country and region of

the world, creating major barriers to preventing further infection,

alleviating impact and providing adequate care, support and treatment.

The stigma associated with AIDS has silenced open discussion, both of

its causes and of appropriate responses. Visibility and openness about

AIDS are prerequisites for the successful mobilization of government,

communities and individuals to respond to the epidemic. Concealment

encourages denial that there is a problem and delays urgent action. It

29

causes people living with HIV to be seen as a ‘problem’, rather than as a

solution to containing and managing the epidemic.

Stigmatization associated with AIDS is underpinned by many factors,

including lack of understanding of the illness, misconceptions about how

HIV is transmitted, lack of access to treatment, irresponsible media

reporting on the epidemic, the incurability of AIDS, and prejudice and

fears relating to a number of socially sensitive issues including sexuality,

disease and death, and drug use.

Stigma can lead to discrimination and other violations of human rights

which affect the well-being of people living with HIV in fundamental

ways. In countries all over the world, there are well-documented cases

of people living with HIV being denied the right to health-care, work,

education, and freedom of movement, among others.

Global consensus on the importance of tackling AIDS – related stigma

and discrimination is highlighted by the Declaration of Commitment

adopted by the United Nations General Assembly Special Session on

HIV/AIDS in June 2001. The Declaration states that confronting stigma

and discrimination is a prerequisite for effective prevention and care,

and reaffirms that discrimination on the grounds of one’s HIV status is a

violation of human rights.

Not only is HIV-related discrimination a human rights violation, but it is

also necessary to address such discrimination and stigma in order to

achieve public health goals and overcome the epidemic. Responses to

HIV and AIDS can be placed along a continuum of prevention, care and

treatment, and the negative effects of stigma and discrimination can be

seen on each of these aspects of the response. Ideally, people should be

30

able to seek and receive voluntary and confidential counseling and

testing to identify their HIV status without fear of repercussions.

Those who test HIV – negative should receive available treatment and

care, and prevention counseling to protect others from infection and

themselves from re-infection. People living with HIV and AIDS should be

able to live openly and experience to others, thereby aiding prevention,

care and treatment efforts.

Figure 1: The prevention to care to treatment continuum (Based on

MacNeil and Anderson 1988, Busza 1999)

A stigmatizing social environment poses barriers at all stages of this

cycle by virtue of being, by definition, non-supportive.

HIV –related stigma and discrimination undermine prevention efforts by

making people afraid to find out whether or not they are infected, to

seek out information about how to reduce their risk of exposure to HIV,

and to change their behavior to more safe behavior lest this raise

suspicion about their HIV status. Thus, stigma and discrimination

31

PreventionIdentification of serostatus

Prevetation-to-care continuum

Harm reduction Care and support

undermine the ability of individuals and communities to protect

themselves. The fear of stigma and discrimination also discourages

people living with HIV from disclosing their HIV infection and results from

fear of stigma and discrimination causes people to imagine that they are

not themselves at risk of HIV infection.

The stigma and discrimination associated with HIV and AIDS also mean

that people living with HIV and AIDS are much less likely to receive care

and support. Even those not actually infected but associated with the

infected, such as spouses, children, and caregivers, suffer stigma and

discrimination. This stigma and discrimination needlessly increase the

personal suffering associated with the disease.

The shame associated with AIDS – a manifestation of stigma that has

been described by some writers as ‘internalized’ stigma – may also

prevent people living with HIV from seeking treatment, care and support

and exercising other rights, such as working, attending school, etc. Such

shame can have a powerful psychological influence over how people

with HIV see themselves and adjust to their status, making them

vulnerable to blame, depression and self-imposed isolation.

This may be exacerbated in cases where individuals are members of

particular groups that are already isolated and stigmatized , such as

injecting drug users, men who have sex with men, and sex workers, or

migrants. In settings where medical care is available, stigma may

increase the difficulty of adhering to treatment regimens.

These patterns of non-disclosure and difficulty in seeking treatment,

care and support themselves feed stigma and discrimination, reinforcing

the cycle. This is because stereotypes and fear are perpetuated when

communities often only recognize people living with HIV reinforce the

32

stigmatization of these already-vulnerable individuals. Non-disclosure of

HIV – infection within families often leads to lack of forward planning,

leaving orphans and other bereaved dependents economically deprived

once the bread winner dies and often marginalized, if their association

with AIDS becomes known.

Understanding stigma and discrimination:

Forms and contexts

In order to identify potential solutions to HIV – related stigma and stigma

and discrimination, it is necessary to understand what is meant by these

concepts, to describe how they are manifested, and to analyze the

relationships between them.

What is Stigma?

Stigma has been described as a dynamic process of devaluation that

‘significantly discredits’ an individual in the eyes of others. The qualities

to which stigma adheres can be quite arbitrary – for example, skin

colour, manner of speaking, or sexual preference . Within particular

cultures or settings, certain attributes are seized upon and defined by

others as discreditable or unworthy.

HIV-related stigma is multi-layered, tending to build upon and reinforce

negative connotations through the association of HIV and AIDS with

already-marginalized behavior, fears of outsiders and otherwise

vulnerable groups, such as prisoners and migrants.

Individuals living with HIV are often believed to deserve their HIV-

positive status as a result of having done something ‘wrong’. By

attributing blame to particular individuals and groups that are

33

“different”, others can absolve themselves from acknowledging their

own risk, confronting his problem and caring for those affected.

Images of people living with HIV in the print and visual media may

reinforce blame by using language that suggests that HIV is a ‘woman’s

disease’, a ‘junkie’s disease’, an ‘African disease’, or a ‘gay plague’.

Religious ideas of sin can also help to sustain and reinforce a perception

that HIV infection is a punishment for deviant behavior.

Stigma is expressed in language. Since the beginning of the epidemic,

the powerful metaphors associating HIV with death, guilt and

punishment, crime, horror and ‘otherness’ have compounded and

legitimated stigmatization. This kind of language derives from, and

contributes to, another aspect underpinning blame and distancing:

people’s fear of the outcomes of HIV infection – in particular, the high

fatality rates (especially where treatment is not widely accessible), fear

related to transmission, or fear stemming from witnessing the visible

debilitation of advanced AIDS.

Stigma is deeply rooted, operating within the values of everyday life.

Although images associated with AIDS vary, they are patterned so as to

ensure that AIDS –related stigmas plays into, and reinforces, social

inequalities. These inequalities particularly include those linked to

gender, race and ethnicity, and sexuality. Thus, for example, men and

women are often not dealt with in the same way when infected or

believed to be infected by HIV: a woman is more likely to be blamed

even when the source of her infection is her husband, and infected

woman may be less likely to be accepted by their communities.

34

This process is linked to long-standing gender inequalities underpinned

by ideas about masculinity and femininity that have historically resulted

in women being blamed for transmission of sexually transmitted

infections of all kinds, and have guilt imputed to them our of assumed ‘

Promiscuity’. Similarly, the attribution of blame to homosexual and

transgender people builds on long-standing stigmatization related to

assumptions about their lifestyles and sexual practices. Racial and

ethnic stereotyping also underpins AIDS –related stigma. The epidemic

has been characterized, for example, by racist assumptions about

‘African sexuality’ and perceptions in the developing world of the West’s

‘immoral behavior’. Finally, the vulnerability to HIV of communities living

in poverty has reinforced the existing stigmatization of those people who

are economically marginalized.

Through these associations, stigma is linked to power and domination

throughout society as a whole, creating and reinforcing inequality

whereby some groups are made to feel superior and others devalued.

The association of HIV with already – stigmatized groups and practices

intensifies these pre-existing inequalities, reinforcing the production and

reproduction of inequitable power relations. Pre-existing stigma

compounds HIV-related stigma, not simply because already –

stigmatized groups are further stigmatized through association with HIV,

but also because individuals living with HIV may be assumed to belong

to marginalized groups.

Figure 3: The circle of stigmatization and marginalization

Are seen as responsible

35

Sex workers, injecting drug users, and other marginalized groups

HIV/AIDS

Are seen

Adapted from Parker R. and Aggleton P.(2002)

HIV-related stigmatization, then, is a process by which people living with

HIV are discredited. It may affect both those infected or suspected of

being infected by HIV and those affected by AIDS by association, such as

orphans or the children and families of people living with HIV.

Stigmatization can also occur on another level. People living with HIV

may themselves internalize the negative responses and reaction of

others – a process that can result in what some people have called self-

or ‘internalized’ stigmatization, Self-stigmatization has links to what

some writers have described as ‘felt’, as opposed to enacted’, stigma, in

that it primarily affects an individual’s or affected community’s sense of

pride and worth.

For people living with HIV, this may be manifested in feelings of shame,

self-blame, and worthlessness, which, combined with feelings of being

isolated from society, can lead to depression, self-imposed withdrawal

and even suicidal feelings.

What is discrimination?

36

People living with HIV and AID

When stigma is acted upon, the result is discrimination. Discrimination

consists of actions or omissions that are derived from stigma and

directed towards those individuals who are stigmatized.

Discrimination, as defined by UNAIDS (2000) in the Protocol for

Identification of Discrimination Against People Living with HIV, refers to

any form of arbitrary distinction, exclusion, or restriction affecting a

person, usually but not only by virtue of an inherent personal

characteristic or perceived belonging to a particular group – in the case

of HIV and AIDS, a person’s confirmed or suspected HIV – positive status

– irrespective of whether or not there is any justification for these

measures.

AIDS-related discrimination may occur at various levels. There is

discrimination occurring in family and community settings, which has

been described by some writers as ‘enacted stigma’. This is what

individuals do either deliberately or by omission so as to harm others

and deny to them services or entitlements. Examples of this kind of

discrimination against people living with HIV include: ostracization, such

as the practice of forcing women to return to their kin upon being

diagnosed HIV – positive, following the first signs of illness, or after their

partners have died of AIDS; shunning and avoiding everyday contact;

verbal harassment; physical violence; verbal discrediting and blaming;

gossip; and denial of traditional funeral rites.

Then there is discrimination occurring in institutional settings – in

particular, in work places, health-care services, prisons, educational

institutions and social – welfare settings. Such discrimination crystallizes

enacted stigma in institutional policies and practices that discriminate

against people living with HIV, or indeed in the lack of anti-

discriminatory policies or procedures of redress. Examples of this kind

of discrimination against people living with HIV include the following.

37

Health –care services: Reduced standard of care, denial of access to

care and treatment, HIV testing without consent, breaches of

confidentiality including identifying someone as HIV - positive to

relatives and outside agencies, negative attitudes and degrading

practices by health-care workers.

Workplace: Denial of employment based on HIV – positive status,

compulsory HIV testing, exclusion of HIV – positive individuals from

pension schemes or medical benefits.

Schools: Denial of entry to HIV – affected children, or dismissal of

teachers.

Prisons: Mandatory segregation of HIV – positive individuals,

exclusion form collective activities.

At a national level, discrimination can reflect stigma that has been

officially sanctioned or legitimized through existing laws and policies,

and enacted in practices and procedures. These may result in the

further stigmatization of people living with HIV and, in turn, legitimate

discrimination.

A significant number of countries, for example, have enacted

legislation with a view to restricting the rights of HIV – affected

individuals and groups. These actions include:

The compulsory screening and testing of groups and individuals;

38

The prohibition of people living with HIV from certain occupations and

types of employments;

Isolation, detention and compulsory medical examination, treatment

of infected persons; and

Limitations on international travel and migration including mandatory

HIV testing for those seeking work permits and the deportation of HIV

– positive foreigners.

Discrimination also occurs through omission, such as the absence of, or

failure to implement laws, policies and procedures that offer redress and

safeguard the rights of people.

Topic 6: HIV/AIDS and Nutrition

Facts on HIV/AIDS and Nutrition

The nutritional status of an individual affects his immunity and

consequently his capacity to respond to infection.

A person who is poorly nourished will be a frequent victim of infections.

Unfortunately, this is the case of many children and adults in Africa.

HIV depletes the nutritional status of the individual and the poor

nutritional status quickens the progression from HIV infection to full

blown AIDS. This is because HIV depletes the body of essential nutrients

including micronutrients that are essential in body defense or immunity.

Knowing that good nutrition will help in prolonging the period between

asymptomatic and symptomatic stages of HIV infection, it will be helpful

to go for VCT so as to benefit from nutritional counseling too.

39

The pregnant woman who knows her HIV status will go for antiretroviral

drugs and can reduce the chances of passing the virus to her unborn

child; she can also benefit form breastfeeding counseling, and chose to

breastfeed or not. Some of the options include expressing breast milk

and heating it up to destroy the virus, or using formula milk.

Her husband would also reduce the chances of MTCT if he also chooses

to go for VCT. “Only an untested mother and an untested father will give

their child HIV/AIDS”.

Hand – out: Nutritional Advice

Symptoms Suggested strategy

Fever and loss of

appetite

Drink high – energy, high protein liquids and fruit

juice.

Eat small portions of soft, preferred foods with a

pleasing aroma and texture throughout t the day.

Eat nutritious snacks whenever possible

Drink liquids often.

Sore mouth and throat Avoid citrus fruits tomato, and spicy foods

Avoid very sweet foods

Drink high –energy, high-protein liquids with a

straw

Eat foods at room temperature or cooler

Eat thick smooth foods such as pudding, porridge,

mashed potato, mashed carrots or other non-

acidic vegetables and fruits.

Nausea and vomiting Eat small snacks throughout the day and avoid

large meals

40

Eat crackers, toast and other plain, dry foods.

Avoid food that has a strong aroma

Drink diluted fruit juices, other liquids, and soup

Eat simple boiled foods, such as porridge, potato,

beans.

Loose bowels Eat bananas, mashed fruits, soft rice, porridge

Eat smaller meals more often

Eliminate dairy products to see if they are the

cause.

Decrease high –fat foods.

Don’t eat food with insoluble fibre (roughage)

Drink liquids often.

Fat mal-absorption Eliminate oils, butter, margarine, and foods that

contain or were prepared with them.

Eat only lean meats

Eat fruit and vegetables and other low-fate foods.

Severe Diarrhoea Drink liquids frequently

Drink oral rehydration solution

Drink diluted juices

Eat bananas, mashed fruits, soft rice, and

porridge.

Fatigue, Lethargy Have someone pre-cook foods to avoid energy and

time spent in preparation (care with re-heating).

Eat fresh fruits that do not require preparation

Eat snack foods often through out the day

Drink high energy, high protein liquids.

Set aside time each day for eating.

Adapted from Woods (1999). Taken from HIV/AIDS and nutrition

41

UNIT 11 HIV/AIDS PROFILES

TOPIC 1 HIV/AIDS situation in Kenya- Statistics and Impact

HIV/AIDS pandemic has continued to challenge all other investments in

human capacity development, especially in sub-Saharan Africa. In

Kenya, investment in areas such as education and training, health, and

economic recovery are severely constrained by the spread of HIV/AIDS.

As epidemic matures into the death-phase in Kenya, increased

morbidity, increased expenditure on AIDS related illnesses, high rates of

orphans and eventual death of able bodied and educated young people

deprive the nation off human capital.

The Kenya HIV adult prevalence rate has dropped from 14% as at 2001

to the current 5.1% (2006). This new rate consists of rough averages of

4.0% and 8.3% for rural and urban infections respectively. Across the

board, women are more susceptible to increasing vulnerabilities laced

with poverty. Among higher risk groups, twice as many women than

men are infected.

National HIV prevalence for 2006

Prevalence% Number HIV+

Adults 15-49

Total (range) 5.1

4.6-5.8

943,000

(700,000-1,200,000)

Male 3.5 320,000

Female 6.7 614,000

Urban 8.3 400,000

Rural 4.0 534,000

42

Adults 50+ 55,000

Children 0-14 102,000

Total 1,091,000

Estimated Adult HIV prevalence by province in 2006

Prevalence

Province Number

HIV+

Total Male female

Nairobi 197,000 10.1 8.0 12.3

Central 96,000 4.1 1.7 6.5

Coast 93,000 5.9 5.0 6.9

Eastern 72,000 2.8 1.1 4.4

North

Eastern

9,000 1.4 0.9 1.8

Nyanza 183,000 7.8 6.1 9.6

Rift Valley 171,000 3.8 2.6 4.9

Western 112,000 5.3 4.2 6.4

Total 934,000 5.1 3.5 6.7

Despite the noted progress in reduction in prevalence, there exist

challenges that will need to be addressed. These include unchanging

sexual behavior among majority of Kenyans and resource constrains

both at the national and family levels, increasing need for palliative care

(as majority of those in the last stages of disease are bedridden);

increasing need for support and care of orphans.

Specifically;

1.5M pregnant women need testing to determine their HIV status

68,000 need treatment to prevent mother to child transmission

43

23,000 children need ART and 200,000 need cotrimoxazole

prophylaxis

430,000 adults need ART

2.4M orphans need care and support from their extended families

and communities

These challenges cannot be left to the government alone. All sectors

of the society will need to contribute. The church is a key player in

the next phase of the fight against HIV/AIDS. Even though indications

are that prevalence rate is on the decline, research indicates that

infection among certain vulnerable groups has either remained high

or increased.

The Kenya National AIDS Strategic Plan (KNASP II) identifies injecting

drug users (IDU) to have a prevalence rate of up to 70%1 and CSW

(Commercial Sex Workers) up to 47% in certain geographical areas2).

While Nairobi has prevalence rate of 8%, her informal settlements have

prevalent rate of 15-30%.

Socio-economic impact of HIV/AIDS in Kenya

Impact at Individual level

Impact at family level

Impact at community level

Some of the impact includes

Health

Lifespan

Reduction on production capacity

1 See for example situational analysis by Susan Berckeleg in 2004.

2 See Hot Spots mapping along the Mombasa-Nairobi-Kampla Highway report (November 2005).

44

Increased mortality and morbidity

Understanding the impact of HIV/AIDS using two dimensions

1. Sector review

HIV/AIDS undermines development across all sectors of the economy

Agriculture

Health

Education

2. Poor people and HIV/AIDS

Why are poor people more vulnerable to HIV/AIDS

TOPIC 2 Global, Regional and National statistics

International

AIDS society-

USA

1985 1995 2005

North America 620,000 1.2M 1.9M

South America 140,000 1.1M 1.9M

North Africa 940 260,000 400,000

Sub-Saharan

Africa

700,000 13.3M 22.4M

Asia 220 3M 8.1M

UNAIDS/WHO-May 2006

TOPIC 3 GOK Policies and Framework of Action to fight

HIV/AIDS (including successes and failures)

45

HIV/AIDS spread rapidly in 1990s reaching a prevalence rate of between

20-30% in some areas. The prevalence rate later decline in some areas

but remain stable in other areas

National prevalence in 1994 for instance was 7%. This reduction was

due to a number of factors mainly; Behavior change, Condom use, and

Later age at first sex.

The National Response

1. In 1999, the Gok declared HIV/AIDS a national disaster. This lead to

the establishment of NACC

2. The NACC developed the Kenya Nstional HIV/AIDS strategic plan

2000-05 which set out a multisectoral response to the epidemic

The implementation of this strategic plan realized some achievements

but also faced some obstacles. What are these achievements and

obstacles?

3. Later the Kenya National AIDS strategic plan 2005/6-09/20 was

developed building on the past experiences. What are core principles of

this plan?

UNIT III: Working with People Living with HIV/AIDS

Objectives: You should be able to:

Demonstrate an understanding of the issues of concern for people

living with HIV/AIDS (PLWHA).

46

Demonstrate the capacity to provide assistance to PLWHA at various

stages , from the time of diagnosis to full–blown AIDS.

Describe the principle of “home-based care”

Support for orphans and other vulnerable children

Topic 1: Understanding people living with HIV/AIDS

Facts to know:

Support to an individual after confirmation of HIV status results is

crucial. Support groups are useful for counseling and material benefits to

members. It is important to make lifestyle adjustments so as to prolong

life and reduce opportunistic infections. This includes nutrition, fertility

awareness and education. The following issues need to be addressed:

Management of opportunistic infections

Other treatment options

Home-based care/visit checklist

Succession plan: Writing a will, planning for foster homes for children

Community/school/church/family support

Spiritual Support

Counseling skills (inter-personal communication).

Special groups of PLWHA, include:

Children

Guardians

Singles

Parents (husband, wife)

AIDS orphans (their basic needs).

Facts to know

47

By December 2000, about one out of every five person in Africa were

carrying the HIV virus. We live with it daily and interact with people who

have the virus. When one goes voluntarily for the HIV test, the results

may unveil what many people fear to know. People living with HIV/AIDS

(PLWHA) are those who have chosen to live in the light, knowing their

real HIV situation. The greatest advantage of knowing one’s HIV status is

that necessary lifestyle adjustments can be made to cope with the

condition and actually prolong life.

Topic 2: Principles of home - based care

People with HIV can generally lead healthy lives. Occasionally they will

get sick, but often they can get cared for at home. Sending a family

member to hospital can be a drain on family resources. People with AIDS

can be cared for at home with medical support, sometimes more

effectively than they would be in hospital.

General care

Keep the patient clean and dry in an airy room that receives sunshine

at sunrise and sunset.

Soak soiled linen and clothes in bleach for 20minutes or boil them for

20 minutes; wash and dry in the sun.

If possible, caregivers should wear latex gloves when attending to

patients with open wounds or when changing soiled cloths and

bedding.

If multi-vitamins are available, give daily.

Pain Management

At the beginning, most AIDS patients will respond to mild painkillers like

paracetamol, but as illness progresses, they may need stronger

painkillers to get relief. The caregiver should consult with a trained

health provider who will advise on any change in medication.

48

Fever

Seek help from a health worker to find out the real cause of fever. The

caregiver can sponge the patient with a cool towel and give plenty of

fluids.

Diarrhea

If the patient has frequent liquid stool, this can lead to dehydration.

Soiled linen should be removed and disinfected.

Give plenty of fluids. One can prepare home-made oral fluids: Boiled rice

water, or carrot soup. To prepare oral fluids, boil together 1 litre of

water, half a teaspoon of salt, 2 spoonfuls of sugar; add juice from one

lemon, and give to the patient to drink frequently. The patient should

drink 2-3 litres daily.

Nutritional Advice

Specific conditions will require specific foods. Refer to the section on

nutrition advice on the kind of food to eat when certain AIDS symptoms

present.

Weight loss

The patient should eat a high calorie diet: maize meal, rice, sorghum;

plenty of proteins, groundnuts, milk, meat, fish, fruits and vegetables,

especially green leafy vegetables, half boiled.

Sores and ulcer

Clean with boiled salty water and soap. If gentian violet is available,

apply locally.

If sore is deep, apply granulated sugar twice daily; this will promote

healing after cleaning.

49

If the skin continues to have blisters, refer the sick person to the

nearest trained health provider, preferably the one who has been

seeing the patient.

Oral thrush (thick white coating on the gums, jaws and tongue): Clean

with soda water solution and apply gentian violet if available.

Severe Cough

If there is persistent cough, seek medical attention. If the co ugh is

productive have the patient thrown up the sputum into a tin containing a

disinfectant fluid.

Management of body fluids

Body fluids include urine, blood, faeces, sputum, pus, vomit, menstrual

blood, and after birth. Dispose of them as soon as possible in a pit

latrine. The caregiver should wear gloves when cleansing these

secretions from the patient.

Avoid contact with eyes and open wounds. The caregiver should have

the habit of washing hands with soap and clean water after each contact

or exposure to body fluids.

The kit for home- based care

A care kit should include the following: gloves (disposable gloves or

plastic bags), bar soap, plastic sheets, towels, nail clippers, gentiam

violet, cotton wool, calamine lotion for itching skin, face towels, towels,

petroleum gel, paracetamol for pain relief.

Psychological Care for the PLWHA and the family

It is emotionally very taxing for a family to care for a terminally ill

relative. The caregiver can get burnt out and depressed, especially if the

caregiver is a child. The caregiver will regularly need some time away

50

from this responsibility. School, community and church members will

offer good services if they volunteer relief care.

Depression is common in the PLWHA, and patience (along with tender

loving care) from the caregiver is all that may be needed.

Visits from friends and relatives often cheer the family, although

towards the last days, some PLWHA do not appreciate visits.

Remove mirrors from the bedroom of the PLWHA as depression may

follow the realization of massive weight loss.

Antiretroviral drugs

Follow medical instructions.

Topic 3: Support for orphans and other vulnerable children

Facts to know

Children need different types of support as they grow up:

They have basic human needs such as food, clothes and housing

They need basic human needs such as food, clothes and housing

They need love and emotional support as they grow up

They require healthcare and education

However, orphans may find they do not receive all these things. An

orphan is a child who has lost at least one parent before they are 18

years old. They have no-one to care for them. Even if they do, they

might not feel as loved as the biological children of the adults they live

with. They might not benefit form the same quality of education,

nutrition and healthcare as other children in the household. They may

lose contact with their wider family if they live with neighbors. They may

lose contact with friends in their community if they move away to live

51

with extended family. This means they lose their support networks and

feel insecure. When children lose parents they need emotional support

to help them deal with their grief.

Children orphaned by AIDs are doubly disadvantaged.

They may face discrimination in their community or in the family

they go to live with, either because they are linked with people

with AIDS or because people are suspicious they have HIV

themselves. This can result in emotional difficulties for the orphan

and a lack of support for them from the wider community.

They can be exhausted from caring for their sick parents, both

emotionally and physically

They may have contracted HIV from their mothers and have

specific healthcare needs.

There are a number of options for care to ensure that orphans due to

AIDS do not end up living on the streets. The child could.

Go to live with extended family, either within the community, if

they are financially able to care for another child.

Be looked after by order siblings.

Go into institutional care. This should only be an option where

there is no alternative. In general, orphanages do not meet the

long- term developmental needs of children. They are also

expensive to run

Orphans who live with relatives or neighbors

Orphans require different types of support. Some types of support can

be given by the family that they go to live with. Churches and

development organizations can provide types of support that households

cannot provide. They also have a role in supporting households that take

in orphans. For examples:

52

Psychological support: Families might need help dealing with the

psychological problems that orphan face. The orphans might find it

difficult to settle in new surroundings. They might not be able to cope

with the death of their parents. Families might need advice if the child is

not concentrating at school or is playing truant.

Financial support: Children can be expensive to care for. Families who

take in orphans may need financial support, particularly if the children

are to attend school. This could take the form in income-generating

projects or credit and loans schemes.

Time away: Looking after children can be stressful, particularly if they

are not biological children and have not grown up within the household.

Churches or developmental organizations could provide respite care,

perhaps once a week, in order to give foster parents some time away

from the children or time to carry out activities.

Protection: Some families may take in orphans out of duty to their

relatives and not value them in the way they value their own children.

Children or development organizations could take steps to ensure

orphans are not exploited or abused by their new families or other

members of community.

Ways to reduce the negative impact of resettlements of orphans

Take children to visit the place and people beforehand:

Children may then be less anxious about moving

Allow choice: If children can choose whom they live with, it is less

likely that they will end up living on the streets because they are

happy with their new family. Where appropriate, give children the

option to stay where they are.

53

Share information: Tell children about why they need to move

and about the cause of illness and death in their families.

Enable children to maintain links with their families and

communities

Encourage community support so that the new family is not

burdened. For example, they could reduce school fees or share

food

Support households: If costs of caring for orphans were

reduced, such as schooling, children might be more readily

accepted into new households. This would enable them to stay

with close relatives such as grandparents

Sibling care

As the AIDS epidemic and poverty increases, it becomes more difficult

for extended families and households in the community to take in

orphans. Sibling care may be next best option. Psychologically it is

better for children to stay in their home with their own immediate family

members. Orphans who are sent to live with other families are often

separated form their siblings. Sibling care allows them to grow up in

familiar surroundings and continue attending the same school.

However there are a number of issues that might affect the quality of

that care. By considering these issues, we can think about how we might

support them.

Age of sibling: The sibling carers need to be old enough to take

responsibility for their younger siblings. They need to be able to give

emotional support and financial security. The younger the siblings the

more care they will need. Older siblings may have to leave school or

wait to find employment.

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Financial issues: Older siblings need to find ways of paying for food,

clothes, housing, health care and education. While children may have

worked to supplement their parents’ income, they have to take on the

worry of financial insecurity when their parents die.

Legal issues: Children might not legally be able to be the main carers

for their younger siblings. Adults’ siblings may not legally be able to

adopt their younger siblings. The children might not legally be able to

adopt their younger siblings. The children might not be able to keep

their property when their parents die. Members of the extended family

may come to take property but refuse to look after the orphans.

There are therefore a number of ways in which child-headed

households can be supported.

Regularly spend time listening to children enabling them to

express their views.

Identity people in the community whom the children trust, to

whom they can turn for advice and support.

Ensue health workers make home visits to the children to provide

information about HIV prevention, provide care for children with

HIV and AIDS and to oversee the general health of the children.

Provide technical training for older siblings to enable them find

work easily. This could involve setting up an apprenticeship

scheme with local businesses.

Provide flexible education to enable older siblings to take it in

turns to care for younger siblings, or to work, while still going to

school to school. This could involve evening classes.

Ensure that the children are involved in community activities and

decision –making.

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This is important because child-headed households may become

invisible within communities, either because the parents are no

longer active in community or because stigma means that the

community denies their existence.

Help children protect their rights to property by training them in

their rights and helping them to access legal assistance.

Carry out advocacy work to gain their right for sibling adoption

Preventing child abuse and exploitation

Supporting older carers or orphans

Most people with HIV and AIDS are between the ages of 15 and 49

years. These people usually have children. When they become ill and

die, the burden of care for the children can fall on older members of the

family. In South Africa and Uganda, 40% of children orphaned by AIDs

live with their grandparents. In Zimbabwe it is over this is over 50%. This

option is usually better for the children than alternatives because the

child is able to live in familiar surrounds and maintain some stability. In

many cultures, young people have much respect for their elders. Older

people are therefore in good position to educate and counsel young

people about HIV and AIDS. However, older people experience a number

of disadvantages which can impact their ability to carry out this

important role:

They are more likely to be poor. This means they may not be able

to afford to support the children financially

They are often unable to read and write and may only speak a

local language. This limits their access to information about

prevention.

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While their ability to continue family traditions can provide

stability for the orphans, some of these traditions might involve

practices which encourage the spread of HIV.

Older carers can be supported in the following ways:

Income support through pensions or grants for foster carers,

community credit schemes, income-generating projects, reducing

school fees.

Provision of information about prevention and care using

appropriate methods.

Proving psychosocial support such as opportunities for them to

discuss issues with their peers.

Ensuring their involvement in community activities and decision –

making.

UNIT IV SEMINAR PRESENTATIONS ON HIV/AIDS and Business

Sector

Topic 1 Impact mitigation mechanism and strategies: A case of MFIs

in Kenya

Topic 2 HIV/AIDS and Business Sector (Students Group Work)

The GOK Policy framework on HIV/AIDS on Business and Workplace

Impact of HIV/AIDS on Business sector

HIV/AIDS policies and practices of various companies ( At least

Five companies from various sectors e.g. banking, manufacturing )

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Opportunities for students of business studies; Consultancies,

research etc

Recommendations for further studies

Mainstreaming of HIV/AIDS at Work place.

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