Lecture V

TRANSMISSION OF HIV
 HIV is present in semen, vaginal/ cervical secretions & body fluids
 It may be present in tears, urine, central nervous fluids (csf) breast
milk &infected discharges, saliva.
 HIV is spread when an infected individual come into contact with
infected body fluids or cells.
How HIV is NOT transmitted
There is no evidence to show that HIV can be transmitted by:
a) casual social contact e.g. shaking hands, hugging
b) sneezing or coughing
c) shared facilities & equipment e.g. toilets, swimming pools
d) non wet kissing
e) sharing food & utensils
f) insect bites e.g. mosquitoes -HIV only lives for a short time and
does not reproduce in an insect
g) Injecting with sterile needles
h) Protected sex -If an unbroken latex condom is used, there is no
risk of HIV transmission. There are myths saying that 'some very
small viruses can pass through latex' - this is not true.
Modes of HIV Transmission
1. Sexual contact
 Any unprotected (no condom) penetrative sex whether vaginal,
anal or oral can transmit HIV from infected individual to
uninfected sexual partner.
 Heterosexual contact (man &woman) a/c 70%-80% of all HIV
transmission.
 Homosexual contact a/c 5-10%
 Oral sex is low risk but oral ulcers, bleeding gums, genital sores
& presence of STIs (gonorrhea, syphilis & genital ulcers) do
increase the risk of hiv transmission
 Rape, & sodomy victims could get infected if the attacker is
HIV+
 The victims should seek prompt medical attn bcoz early
treatment with ARVs can greatly reduce chances of HIV infection.
 They will also require specialized counseling & psychological
/psychiatric care
Factors that influence transmission through sexual contact
 The risk of HIV transmission through sexual contact is influenced
by a number of factors:
a) level of virus in the body
b) number of sexual partners
c) sex – male/female
d) age
e) STDs/STIs
f) Condom use

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2. Intravenous Drug Use/ Contaminated Piercing Instruments

 I.V. drug use- is the administration of drugs of addiction e.g
heroin into the blood stream by injecting into the veins
 Most drug users tend to shoot in groups & often share needles
 It there4 becomes very easy for transmission /infection to occur
from one infected group member to another
 It’s a significant modes in the developed countries a/c 5-10% of
HIV infections
 Procedures such as ear piercing & circumcisions when done with
poorly cleaned & unsterile instruments can lead to HIV
transmission.

3. Occupational exposure/ Infection in the health-care setting

 Occupational exposure is the accidental exposure of healthcare
workers (e.g doctors &nurses) to body fluids from an infected
patient in their care
 This is most frequently due to needle pricks or cuts with surgical
instruments
 Infection can also occur due to contact with infected blood, lab
samples esp. thro broken skin.
4. Mother -to -child transmission/ MTCT
 Also called Vertical / perinatal transmission & a/c 13-40%
 It’s possible for HIV to be transmitted from HIV+ mothers to
unborn child.
 This occurs in 3 ways:
a) During pregnancy-
 The virus crosses from mother’s blood to child thro
placenta.
 Although there’s no exchange of blood between mother &
child, researchers believe that the foetus can get HIV thro
placenta i.e thro diffusion
 A/c about 35%
b) During birth –
 Thro exposure to mother’s blood & other secretions. A/c
65%
c) After birth- thro breast feeding.
 Breast milk contains minimal quantities of HIV
 A/c 15%
Factors that increase chances of MTCT/ Determinants
a) high level of HIV in mother’s blood & other body fluids (maternal
viral load)
b) duration of exposure to maternal secretions during delivery
c) inadequate nutrition
d) pre-term delivery- premature babies are more prone to infection
bcoz immune mechanism is still very weak/ immature
e) Maternal immune response- low maternal CD4 cell count
f) prolonged membrane rupture-increased risk if more than 4hours

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g) obstetrical procedures- e.g. vacuum assisted delivery

h) unprotected sexual intercourse
i) presence & amount of virus in the genital tract
j) Placenta barrier- breaches in barrier leads to mixing of maternal
and foetal cells
k) Presence and amount of HIV in genital tracts

Prevention of MTCT (PMTCT)

 Prevent HIV infection in women i.e. encouraging teenage girls to
delay sexual relationships & discordant couples to use of condoms.
 Reduce the number of HIV exposed pregnancies i.e. Women who
are HIV infected can use family planning methods to prevent
pregnancies.
 ART- to infected pregnant women.e.g. AZT (zidovudine/
azidothymidine- Nov ‘94) is taken in the last week of pregnancy and
nevirapine is given at the onset of labour& to the HIV exposed
babies within 3 days after birth
 Preventing malaria -A woman who is infected with both HIV and
malaria has an increased chance of passing HIV to her baby. Anti-
malarial drug treatment during pregnancy is therefore an important
part of preventing MTCT
 Reducing trauma and shortening exposure of the baby to the virus
during labour and delivery i.e. Modified obstetrical practices and
the Practices include
a) make sure that the mother gives birth within 4 hours after
membrane ruptures (water breaks),
b) avoid routine episiotomy,
c) avoid prolonged labour,
d) minimum use of vacuum or forceps delivery, and
e) Electing to use caesarian section.
 Appropriate choice of feeding infants i.e. breastfeeding exclusively
without any supplements followed by abrupt but timely weaning or
replacement feeding from birth without any breast milk.

PREVENTION AND CONTROL OF HIV/AIDS

How to prevent the spread of HIV
 Awareness campaigns
 Dealing with practices that can increase the spread of HIV/ AIDS
 Responsible/ legitimate sexual behaviors i.e.
- Abstinence from sex altogether
- Reduce or limit the number of sexual partners
- Stay with one un-infected partner ‘Being faithful’
 Correct use of a new un-used condom every time you have sexual
intercourse
 Going for HIV test or blood screening
 Avoid casual or extramarital sex i.e. chastity
 Avoid sharing un-sterilized needles, toothbrushes razor blades etc.

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 Avoid high risk behavior

 Dress and treat open wound
 Communicating correct information
Common safer sex strategies
 Safer sex is any sexual practices that reduce the risk of transmitting
HIV from one person to another.
a) Total abstinence.
It works well with
 Young people who can manage to delay starting sexual
relationships until they get married
 People who have chosen to remain single
 People who are separated from their regular partners
NB: Saying NO to sex is the most effective safer sex strategies
b) Being faithful to one un-infected partner.
 This works well with
 Neither partner has HIV
 Both partners are faithful to one another all the time
 People wishing to use this strategy should visit the VCT and
remain faithful to one another
 It does not work well with
o Those whose partners are not faithful to one another all the
time
o Those who already have HIV before their relationship
NB: Those wishing to use this strategy should visit the VCT and
remain faithful to one another all the time

Factors that contribute to unfaithfulness

a) Unmotivated partner
b) Financial irresponsibility
c) When the partner has not yet recovered from a past relationship
d) Emotional damage from childhood
e) When the partner is emotionally unavailable
f) Sexual dysfunction- can be explained in 3 ways
i) Sexual addiction and obsession i.e.
o Demanding for sex all the times even if the partner is not in
the mood
o Insisting to engage in humiliating sexual acts e.g. oral sex,
anal sex and unrealistic sexual styles
o Involves addiction to pornography, addiction to masturbation,
visiting topless/ strip bars frequently, rapists etc
ii) Lack of sexual integrity
o When partners don’t honour the sanity of a monogamous
relationship hence leaking their sexual energies to someone
else
o E.g. flirting, or cheating with other people
o Constant staring of other people’s bodies

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o Making sexual comments to your partner’s friend and to

strangers
o Inappropriate touching of other people’s bodies
iii) Sexual performance problems
o Impotence
o Premature ejaculation
o Difficulty in experiencing orgasm
o Lack of grip during sexual intercourse (wide vagina or small
penis)
o Lack of interest in sex
c) Condoms
 Come in two types- Male condoms and female condoms
 Male condoms are more effective than the female ones
 Male condom is a thin sheath latex rubber that is rolled onto
the penis.
 It stops the semen from entering the vagina and also the
vaginal fluids from entering the penis.
 Its 98% effective BUT the 2% is due to mishandling
 Condom use started during the Medieval Roman empire
(100BC)
 1st condom was made from lamb gut- high portions of gull
bladder were reportedly used for fertility regulations
Advantages of using a condom
 Condoms are effective ways of reducing unwanted
pregnancies
 Condoms also help protect one from STDs and HIV
 Man can be able to maintain a longer erection when using a
condom
 Condon use is less messy especially to the woman who
dislikes the wetness, sipping or oozing of semen after sex.
 Condoms also reduce the bad vaginal odor that follows after
sex.
Disadvantages of using a condom
 It can burst, slip or tear during the sexual intercourse
 It can also tear when using sharp objects while tearing the
packet.
 The latex rubber is easily damage or exposure to heat
 If not correctly used it serves no purpose.

Three problems exist in the control and prevention of HIV/AIDS.

i. Prevention and control requires changes in aspect of behavior. It
takes long for people to change their behavioral secrecy that surrounds
sexual behavior and intimate sexual relationship.
ii. A lot of HIV infected people appear healthy and have no symptoms
therefore a lot of people assume that fact that one looks healthy is
negative and by having intercourse the transmission continues.

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iii. Cultural bases on which traditional society depends to enhances

morals have been eroded therefore we have no proper guide. However
some cultural practices are not useful in control, e.g. circumcision,
extraction of teeth and wife inheritance.

Other HIV prevention strategies

Working with Most At Risk population (MARPS) -Works with people
who have a high risk of getting infected with HIV. These include CSWs,
MSMs and IDUs. These groups often have higher infection rates, are a
reservoir for infection and successful initiatives with them is beneficial for
them and society at large.
Pre-Exposure Therapy (Pr EP) - Use of ARVS before exposure to risk a
measure that is meant for those at high risk of infection such as those in
discordant relationships
Post Exposure Therapy (PEP)- People who have been exposed to
infection such as after sexual assault or in health care settings are offered
ARVs within 72 hours in order to prevent infection from setting
Blood safety- This strategy involves the screening of blood before
transfusion, ensuring all blood contaminated objects are properly
disposed of- especially sharp objects as well as sterilising any instruments
that are reused before use on another person
90-90-90 strategy (UNAIDS)- This strategy aims at controlling HIV
Pandemic by achieving the following by 2020:
90% all HIV positive people know there status
90 % of all HIV infected people are on ARVs
90% of all those on ARVs have achieved viral suppression

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