AIDS A Case Study of Economic and Social Consequences

Introduction 1Introduction 1 Welcome to the HIV/AIDS module You will be learning about the Human Immunodeficiency Virus (HIV) that causes the Acquired Immunodeficiency Syndrome (AIDS) HIV/AIDS Kaposi’s sarcoma For more information about the authors and reviewers of this module, click hereclick here

What is the Difference between HIV & AIDS? The Human Immunodeficiency Virus (HIV) is a virus which attacks the immune system.HIVimmune system Acquired Immune Deficiency Syndrome (AIDS) is a syndrome which appears in advanced stages of HIV infection.Immune Deficiency The difference between HIV and AIDS is that HIV is a virus, while AIDS is a medical condition. HIV is sometimes referred to as the causative agent, since it is not possible to develop AIDS without an HIV infection, although it is possible to be infected with HIV without developing AIDS.

HIV cannot be transmitted by: Coughing or sneezing Being bitten by an insect Touching or hugging Holding a baby Kissing Going to a public bath/pool Using a public toilet Shaking hands Using telephones Working or going to school with a person who is HIV-infected Drinking water or preparing or eating food Sharing cups, glasses, plates, or other utensils

How is HIV transmitted? Transmission routes: Sexual contact: sexual intercourse (vaginal, oral or anal) Direct contact with HIV- infected body fluids such as semen, cervical and vaginal secretions Maternal-to-child transmission (MTCT): from mothers who are HIV-positive to their infants during pregnancy, labour, delivery, and breast-feeding Blood-to-blood transmission: transfusion or direct contact with HIV-infected blood HIV infection occurs in people of all ages, races and nationalities, the rich and the poor. Now that you know how HIV is transmitted, list 5 groups of people who are particularly at risk of acquiring infection. Answers on the next slide.

AIDS is an incurable disease lurking in the immune system of people in the US. However, in rich countries people live with AIDS, in poor countries they die of it. In Africa AIDS drugs are too expensive.

Epidemiology In 2004: An estimated 39.4 million people were living with HIV 4.9 million people acquired HIV In 2003: AIDS killed 3.1 million people The number of people living with HIV continues to rise in every region, with the steepest increases occurring in East and Central Asia and in Eastern Europe Sub-Saharan Africa remains by far the worst affected region in the world, with 25.4 million people living with HIV in 2004 Just under two-thirds (64%) of all people living with HIV are in sub- Saharan Africa More than three quarters (76%) of all women living with HIV live in sub- Saharan Africa Source: AIDS epidemic update, 2004; Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization AIDS orphans in Zambia

AIDS deaths worldwide = 3 million (2.3 million in Africa) million people estimated to be living with HIV HIV weakens the immune system and the victim can then die from TB, malaria and other diseases

AIDS in the CIS (Confederation of Independent States, the former USSR) The Ukraine has one of the sharpest increases in HIV infections. Cities bordering the Black Sea, where drugs are easy to obtain and where ‘the holiday sex industry’ is booming, have the largest number of cases. In the small town of Nikolaev HIV infection among drug users has increased from 1.7% to 56.5%

Social Consequences Many of the millions of AIDS orphans live without adequate education, healthcare or nutrition Most live with their grandparents and must live with the psychological loss of their parents

Social Consequences Women are more vulnerable to AIDS than men, due to their lower social status and economic dependence on men as well as a lack of education. Those between 15 and 24 are most vulnerable

Social Consequences AIDS is a major cause of maternal death. In 1992 AIDS accounted for 90% of all deaths among urban women of childbearing age in Rwanda. Transmission of AIDS from mother to child within the womb is common

Economic Consequences A generation of workers, teachers and parents have been decimated In some of the most affected countries AIDS victims occupy half the available beds (a strain on medical care)

Economic Consequences The limited pool of skilled workers is being lost Life expectancy is dropping. Botswana’s has dropped from 62 in the 1980s to 37 In hard hit countries up to one quarter of adults are affected by AIDS

Prevention AIDS is the number one killer in Africa. It is the fourth most common cause of death worldwide Many countries have developed education programmes to prevent the spread of AIDS

Strategies to Reduce the Spread of AIDS Sex education in schools. Community education via theater groups, TV, newspaper advertisements, and posters. Free or subsidised condoms to encourage safer sex. Government attempts to tackle prostitution. Free syringes for drug addicts to avoid using infected needles.

Strategies to Reduce the Spread of AID’s (cont’d) Improvements in procedures at blood banks and during blood transfusions. Government attempts to control migration. Allow the sale of low-priced generic AID’s drugs (especially in LEDC’s).

Female Circumcision Worldwide 130 million women have undergone this painful and dangerous practice It is practised in 28 countries across Africa Parts of the female genitalia are removed and some are sewn together It is carried out in unsanitary conditions and without anesthetic, many get infections or die from shock In some cultures uncircumcised girls are seen as unclean

Honour Killings Throughout the world as many as 5000 women and girls a year are murdered by members of their own families. The male family members of the females, who are responsible, go unpunished Kifaya (12) lived in Jordon,she went for a walk without her father’s permission. He beat her to death with a chain for dishonouring the family.

Trafficking in women and children Estimated 4 million women and girls are bought and sold worldwide into marriage, slavery or prostitution Each year at least girls and women enter Thailand from poorer neighbouring countries and end up in the sex trade

Prevention In the absence of a curative treatment or vaccine, prevention of HIV transmission is essential to controlling the epidemic Effective education about HIV transmission and ways to prevent its spread has been considered a “social vaccine” Successful prevention requires collaboration between the health care sector, civil society, many community- based groups and faith-based organizations. Within the healthcare sector, clinicians, social workers, health education specialists, mental health specialists and patients must work together In all settings, especially those that are resource-poor, selection of the most cost-effective interventions is imperative because allocation of resources to one intervention may prevent implementation of other interventions Prevention and Control (1)

Prevention Since sexual contact accounts for most of HIV transmission globally, control measures directed against the spread of this infection must address squarely the issue of sexual promiscuity or excessive sexual activity Advice includes restriction to one partner only, if married. If unmarried, they should abstain or restrict themselves to the person they know best Condom use should be emphasized to those who cannot abstain People must be advised to screen themselves periodically if they expose themselves to more than one partner Prevention and Control (2)