SAS 104: Social Science Perspectives on HIV and AIDS

Required- 3 units

Course Content

Theories of the origin and causes of HIV/ AIDS; HIV transmission modes; HIV prevention and
control; HIV/AIDS patient management and care: home and community based care (HCBC),
ARVs, Prevention of Maternal to Child Transmission (PMCT), contemporary treatment and
management efforts in Kenya; HIV/AIDS and special groups: the youth, the HIV/ AIDS
orphans, commercial sex workers, truckers, drug users, men who have sex with men (MSM),
lesbians; The geography and demography of HIV/AIDS; HIV/AIDS impact on individual,
family, society: social, cultural, economic, political, psychosocial, ethical; Religious response to
HIV/AIDS; Other stakeholders response.

Course Goals/Objectives

1) To prepare students to appreciate and understand that HIV/AIDS is not only a health problem
but also a social, cultural, political and economic problem.

2) To provide students with holistic information about HIV/AIDS, which will enable them to
protect themselves from the disease.

3) To prepare students as resource persons and/or programme managers to provide culturally

appropriate HIV/AIDS intervention and management initiatives in communities.

Learning Outcomes

By the end of the course, the students are expected to:

1. Understand the history and basic facts about HIV/AIDS.

2. Understand facts about HIV prevention and control.

3. Gain knowledge and essential protective measures against HIV infection.

4. Gain in-depth understanding of socio-cultural, economic and political dimensions of HIV and
AIDS infection, prevalence and control.

Teaching Strategy/Methodology
The teaching of the course will be by:

Lectures, Assignments, Class presentations/discussions

Instructional Materials/Equipment’s

1. LCD projectors

2. Chalkboards/whiteboards

3. Resource persons

4. Reference materials Assessment Assignments and Examination

Continuous Assessment Tests

(Individual assignments, Presentations and Term paper) will constitute 30% and end of semester
examination will comprise of 70% of the total mark. The Pass mark shall be 40%.

Course Monitoring and Evaluation

Orientation, Students class attendance lists, Supervision, Students evaluation of course/lecturer at

the end of the course, Students Progress Reports, External examiner’s reports, External and
internal auditor’s reports at the end of every semester of an academic year.

References

1) Marisa Casale and Alan Whiteside (2006). IDRC Working Papers on Globalization, Growth
and Poverty: The Impact of HIV/AIDS on Poverty, Inequality and Economic Growth.
Kwazul Natal: University of Kwazul Natal.

2) AIDS & HIV information from (Newsletter)- Introduction to HIV prevention (ABC,
Condomising, PMTCT, Male Circumcision, Blood Exchange, Syringe, and sex education).
www.avert.org.

3) Carlyne M. Auder, Janeen Burlison, Troy D. Moon, Mohsin Sidor, Alfredo E. Vergara, and
Sten H. Vermund (2009). Sociocultural and epidemiological aspects of of HIV/AIDS in
Mozambique Case.

Notes
Introduction

HIV stands for human immunodeficiency virus, which is the virus that causes HIV infection. The
abbreviation “HIV” can refer to the virus or to HIV infection. AIDS stands for acquired
immunodeficiency syndrome. AIDS is the most advanced stage of HIV infection. HIV attacks
and destroys the infection-fighting CD4 cells (CD4 T lymphocyte) of the immune system. The
loss of CD4 cells makes it difficult for the body to fight off infections, illnesses, and certain
cancers. Without treatment, HIV can gradually destroy the immune system, causing health
decline and the onset of AIDS. With treatment, the immune system can recover.

HIV (human immunodeficiency virus)

HIV (human immunodeficiency virus) sometimes called a retrovirus is a virus that attacks cells
that help the body fight infection (CD4 cells), making a person more vulnerable to other
infections and diseases. It is spread by contact with certain bodily fluids of a person with HIV,
most commonly during unprotected sex (sex without a condom or HIV medicine to prevent or
treat HIV), or through sharing injection drug equipment.

The HIV virus is a fatal, person-to-person infection with no known cure whose final terminal
stage is Acquired Immunodeficiency Syndrome (AIDS). HIV and AIDS are the same disease,
with AIDS being the final stage of the same viral infection right before death.

In the past few years, new medications have been developed that can extend the lifespan of an
infected person by decades. So, HIV has changed from an acute terminal illness to a chronic,
lingering condition requiring medication, monitoring, good nutrition, and care. Be aware
HIV/AIDS remains a fatal disease.

HIV infection has four distinct stages, as defined by the CDC. The stages of HIV disease is
based on clinical history, physical examination, laboratory evidence of immune dysfunction,
signs and symptoms, and infections and malignancies.

 Primary infection (Acute/Recent HIV Infection). The period from infection with HIV
to the development of HIV-specific antibodies is known as primary infection.
  HIV asymptomatic (CDC Category A). After the viral set point is reached, HIV-
positive people enter into a chronic stage in which the immune system cannot eliminate
the virus despite its best efforts.

 HIV symptomatic (CDC Category B). Category B consists of symptomatic

conditions in HIV-infected patients that are not included in the conditions listed in
category C.

 AIDS (CDC Category C). When the CD4+ T-cell level drops below 200
cells/mm3 of blood, the person is said to have AIDS.

Two Types of HIV

There are two significant varieties of the HIV virus. Both of these are spread through sexual
contact, body fluids, or blood-sharing activities. When you hear HIV referred to without
clarification as to the type, HIV-1 is being discussed.

HIV-1 (type 1) is more infectious and the primary cause of infection worldwide.

HIV-2 (type 2) is less common, mainly appearing in West Africa.

Both varieties of the HIV virus are treated the same way in treatment by doctors.

Acquired Immunodeficiency Syndrome (AIDS)

Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV infection. AIDS occurs
when the body’s immune system has been so severely damaged that the individual is highly
vulnerable to diseases, infections, and even infection-related cancers. A person with HIV is
considered to have progressed to AIDS when:

 The number of their CD4 cells falls below 200 cells per cubic millimeter of blood (200
cells/mm3). (In someone with a healthy immune system, CD4 counts are between 500
and 1,600 cells/mm3.) OR

 They develop one or more opportunistic infections regardless of their CD4 count.
Without HIV medicine, people with AIDS typically survive about 3 years. Once someone has a
dangerous opportunistic illness, life expectancy without treatment falls to about 1 year. HIV
medicine can still help people at this stage of HIV infection, and it can even be lifesaving. But
people who start HIV medicine soon after they get HIV experience more benefits—that’s why
HIV testing is so important.

Signs and symptoms

Human immunodeficiency virus (HIV) is an infection that attacks the body’s immune system.
Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of the disease. HIV
targets the body’s white blood cells, weakening the immune system. This makes it easier to get
sick. HIV can be treated and prevented with antiretroviral therapy (ART). Untreated HIV can
progress to AIDS, often after many years.

There are several symptoms of HIV. Not everyone will have the same symptoms. It depends on
the person and what stage of the disease they are in. there are three stages of HIV and some of
the symptoms people may experience.

Stage 1: Acute HIV Infection

Within 2 to 4 weeks after infection with HIV, about two-thirds of people will have a flu-like
illness. This is the body’s natural response to HIV infection. Flu-like symptoms can include:
Fever, Chills, Rash, Night sweats, Muscle aches, Sore throat, Fatigue, Swollen lymph nodes,
Mouth ulcers. These symptoms can last anywhere from a few days to several weeks. But some
people do not have any symptoms at all during this early stage of HIV.

Stage 2: Clinical Latency

In this stage, the virus still multiplies, but at very low levels. People in this stage may not feel
sick or have any symptoms. This stage is also called chronic HIV infection. Without HIV
treatment, people can stay in this stage for 10 or 15 years, but some move through this stage
faster.

If you take HIV medicine exactly as prescribed and get and keep an undetectable viral load, you
can live and long and healthy life and will not transmit HIV to your HIV-negative
partners through sex. But if your viral load is detectable, you can transmit HIV during this stage,
even when you have no symptoms. It’s important to see your health care provider regularly to
get your viral load checked.

Stage 3: AIDS

If you have HIV and you are not on HIV treatment, eventually the virus will weaken your body’s
immune system and you will progress to AIDS (acquired immunodeficiency syndrome). This is
the late stage of HIV infection. Symptoms of AIDS can include: Rapid weight loss, Recurring
fever or profuse night sweats, Extreme and unexplained tiredness, Prolonged swelling of the
lymph glands in the armpits, groin, or neck, Diarrhea that lasts for more than a week, Sores of
the mouth, anus, or genitals, Pneumonia, Red, brown, pink, or purplish blotches on or under the
skin or inside the mouth, nose, or eyelids, Memory loss, depression, and other neurologic
disorders

Each of these symptoms can also be related to other illnesses. The only way to know for sure if
you have HIV is to get tested.

History of HIV Virus

There is a raging controversy about the origin of HIV. Using computer technology to study the
structure of HIV, some scientists have claimed that HIV originated around 1930 in rural areas of
Central Africa, where the virus may have been present for many years in isolated communities.
According to this theory which is contested by African scientists, the virus probably did not
spread because members of these rural communities had limited contact with people from other
areas. But in the 1960s and 1970s, political upheaval, wars, drought, and famine forced many
people from these rural areas to migrate to cities to find jobs. During this time, the incidence of
sexually transmitted infections, including HIV infection, accelerated and quickly spread
throughout Africa. As world travel became more prevalent, HIV infection developed into a
worldwide epidemic.

Studies of stored blood from the United States suggest that HIV infection was well established
there by 1978. Many scientists from Africa have argued that HIV originated from North
America. Beginning in June 1981 reports were published on clusters of gay men (homosexuals)
in New York and California who had been diagnosed with pneumocystic pneumonia or Kaposi’s
sarcoma. These two rare illnesses had previously been observed only in people whose immune
systems had been damaged by drugs or disease. These reports triggered concern that a disease of
the immune systems was spreading quickly in the homosexual community. Initially called
gayrelated immunodeficiency disease (GRID), the new illness soon was identified in population
groups outside the gay community, including users of intravenous drugs, recipients of blood
transfusions, and heterosexual partners of infected people.

In 1982 the name for the new illness was changed to acquired immunodeficiency syndrome, or
AIDS. While the disease was making headlines for the speed with which it was spreading around
the world, the cause of AIDS remained unidentified. Fear of AIDS and ignorance of its causes
resulted in some outlandish theories. Some thought the disease was God’s punishment for
behaviours that they considered immoral. These early theories created a social stigma
surrounding the disease that still lingers. Scientists quickly identified the primary modes of
transmission—sexual contact with an infected person, contact with infected blood products, and
mother-to-child transmission. From these modes of transmission it was clear that the new illness
was spread in a specific manner that matched the profile of a viral infection.

In 1983 French cancer specialist Luc Montagnier and his colleagues isolated what appeared to be
a new human retrovirus from AIDS patients. They named it lymphadenopathy virus (LAV).
Eight months later Gallo and his colleagues isolated the same virus in AIDS patients, naming the
virus HTLV-III. Eventually, scientists agreed to call the infectious agent human
immunodeficiency virus (HIV).

In 1985 a new AIDS-causing virus was discovered in West Africa. Named HIV-2, the new virus
is closely related to the first HIV, but it appears to be less harmful to cells of the immune systems
and reproduces more slowly than HIV-1. Research leading to the development of the ELISA test
was conducted simultaneously by teams led by Gallo in the United States and Montagnier in
France. In 1985 the ELISA test to identify HIV in blood became available, followed by the
development of the Western Blot test. These tests were first employed to screen blood for the
presence of HIV before the blood was used in medical procedures. The tests were later used to
identify HIV-infected people, many of whom did not know they were infected. These diagnostic
tests also helped scientists study the course of HIV infection in populations.

In 1999 some scientists found that HIV spread from chimpanzees to humans on at least three
separate occasions in Central Africa, probably beginning in the 1940s or 1950s. The origin of
HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) is a
complex and ongoing area of research.

The first case of HIV in Kenya was detected in 1984. By the mid-1990s, HIV was one of the
major causes of illness in the country, putting huge demands on the healthcare system as well as
the economy. In 1996, 10.5% of Kenyans were living with HIV, although prevalence has almost
halved since then, standing at 5.9% by 2015. This progress is mainly due to the rapid scaling up
of HIV treatment and care. In 2016, 64% of people living with HIV were on treatment, 51% of
whom were virally suppressed.

Kenya’s HIV epidemic is mainly driven by sexual transmission and is generalized, meaning it
affects all sections of the population including children, young people, adults, women and
men. As of 2015, 660,000 children were recorded as being orphaned by AIDS. However, a
disproportionate number of new infections happen among people from key populations. In 2020,
it was estimated that 30% of new annual HIV infections in Kenya are among these groups.

Geographic location is also a factor, with 65% of all new infections occurring in nine out of the
country’s 47 counties – mainly on the west coast of Kenya. In particular, new HIV infections in
major cities Nairobi and Mombasa increased by more than 50%. As a result, HIV prevalence
ranges from 0.1% in Wajir to 25.4% in Homa Bay.

Theories of the origin and causes of HIV/ AIDS.

theories have been propounded regarding the origin of HIV. The debate still goes on. These
theories are:

Old Human Disease

The first theory is that HIV has been around among mankind for a very long period and has
recently become more virulent. One possibility is that the virus comes from a small and isolated
ethnic group, which had acquired immunity to it, so that it has rarely caused death. When it
spread outside this group, and reached people who had no such immunity, it became a killer
disease. This theory states that diseases common in one part of the world, when carried to
“virgin” territory have often proved a mortal danger to the newly exposed population. European
diseases, such as measles and smallpox, virtually wiped out some North American Indians in the
eighteenth and nineteenth centuries. This theory is important for a key reason. If this was the
origin of the HIV, then the isolated groups’ immunity might enable a vaccine to be developed to
protect the rest of the world. There are few completely isolated people left in the world, mainly
in the rain forests of New Guinea, Amazon, and perhaps Central Africa. In fact, we have in India
the nearly extinct Great Andamanese, a tribe having less than hundred members according to the
2011 census. Since one of the early locations of AIDS was Central Africa, much speculation was
focused on this possibility. By its nature, this is a theory that is very difficult to disprove, but
there is some evidence which argues against it.

Animal Disease

The second theory is that HIV has existed for a long time as an animal disease, and has only
recently managed to infect and trigger off epidemic in humans. There are other examples of
diseases “crossing over” from an animal to mankind, and since a rather similar virus has been
found in a species of monkey, this possibility has received considerable attention. History has
recorded many great human disease epidemics, which have been traced back to infectious
organism carried by animals or insects. It is a fact, that domestic and wild animals can harbor
germs which, when contracted by humans can lead to an infection that in some cases can be
passed on from person to person independent of the original animals source. Source books
written in the 1960s before AIDS, listed eighty-four diseases of major significance to public
health that can be transmitted from animals to humans. Like the malaria parasite, in many cases
the human host is essential to the life- cycle of the infective organism. It can also be that the
human may be an accidental host, contracting the infection from an animal in rare or unusual
circumstances, sometimes with the result that the ensuing disease is more severe in the human
than it was in the original hosts. Since AIDS is a sexually transmitted disease, the theory that it
originated among monkeys has in some cases given rise to the idea that the original transmission
from monkey to human was via sexual relationship. Recent molecular epidemiological data has
indicated that HIV virus has evolved from the Pan troglodytes sub species of the chimpanzees. It
was present in that species for centuries. It does not cause any infection among the chimpanzees.
It is remarkably similar to a virus known as Simian immuno deficiency which is endemic among
monkeys. If the virus was present among the chimps and monkeys, how did it enter the human
beings? The most likely explanation is found in the cultural practices of the people in Central
Africa. Chimpanzees have traditionally served as a source of food to certain people in sub-
Saharan Africa. A person may have been infected with the virus during the process of butchering
the chimps, when he may have had an open wound. The wound may have been contaminated by
Chimp’s blood. Intermittently this type of contact would have occurred throughout the centuries.
In Central Africa the disease must have spread from the infected person to their spouse and if
both of them died then the epidemic would not have spread. If the epidemic had to spread,
certain conditions have to be present. This century provided that ideal condition for the spread of
the disease. These conditions included migration and breaking up of the traditional family
system. Migratory nature of employment brought about increased interaction with sex workers.
Sexual promiscuity of the times added to the spread. Blood transfusion became common. Hence,
contaminated blood could have spread the virus. Contaminated blood was exported from Africa
to other parts of the world. The disease was introduced in United States probably through blood
and it spread to other parts of the globe through migration of people as well as the prevalent
sexual practices of the gays. The gay revolution of 1969 with high risk homosexual practices was
one of the possible settings for the spread of the infection. Similar pattern was seen in other
developed countries as well.

Man-made Virus

The third theory is that of a man-made virus, perhaps from a germ warfare laboratory. Unlike the
first two, this is not a scientific theory posed in terms which are open to experimental
confirmation. Rather it has been propagated like a campaign with different versions picked up
and reported in various news papers and magazines around the world. The other theory is that it
may be due to contaminated or mutated vaccines that were developed against polio virus. There
are no accepted proofs for this theory. According to Renee Sabatier, like all conspiracy theories
AIDS as germ-warfare is impossible to disprove, but it does seem improbable. The first
argument against it is that Genetic Engineering was not sufficiently advanced to develop such a
man made virus at the time HIV first appeared. The AIDS virus must have been in existence
several years before 1980, when wide spread cases of AIDS started to appear in US hospital. If
one accepts the evidence for AIDS cases as early as 1959, it must have been in existence since
the mid 1950s. Virologists are emphatic that even if such a virus could be developed today, the
science of genetic engineering was not sufficiently advanced in the late 1970s, for this to be
possible. The second argument is that a virus like HIV is not the sort of bug a germ warfare
laboratory would wish to develop. There is no point in developing a virus as a weapon unless
one’s own side can be protected against it. The ideal germ warfare organism would be one that
caused disease very quickly that did not spread by itself but only infected those deliberately
infected with it, and for which there was vaccine to be used to protect one’s own side. The HIV
differs from this in every respect. Few if any, virologists take seriously the theory that HIV is the
result of a scientific conspiracy. So far, there is no substantive evidence whatever that this is
where AIDS came from, while there are number of convincing arguments that this origin is
unlikely. Mutation Theory Theories and counter arguments to find the origin of HIV/AIDS are
less important than to understand where HIV/AIDS is going.

The mutation theory

According to this theory, viruses are continually changing and mutating into new strains. It is
possible that a mutation took place in a virus, which produced a new virus with the deadly
properties of HIV. As reported earlier, the first recorded cases for the traces of HIV infection
were from North America (1969), and Zaire (1959). However, it is possible that there were other
cases of HIV/AIDS in other countries of which we have no knowledge. With increased
migration, market economy, liberalization and expansion of global tourism industry, lot of travel
has taken place among people within and outside the country since 1950s. This has increased
interaction among people. Thus, it is easy for disease to cross over from one person/community
to another. It was believed that HIV was a virus that had undergone mutation or it was produced
by recombination of the viral particles. Since the oldest sample was obtained from Africa, it was
postulated that it began in Africa and then spread to rest of the world. This theory was not
accepted. More sensitive tests showed that this theory was not acceptable. With all these theories
to the background, the struggle to find a cure for HIV/AIDS continue globally.

Conspiracy theories of HIV/AIDS

In a new US study, by Laura Bogart of RAND Corporation and Sheryl Thorburn of Oregon State
University, one in seven African Americans surveyed said they believed that AIDS was created
by the Government to control the black population. One in three said they believed that HIV was
produced in a government laboratory, and more than half said there was a cure for HIV/AIDS
that was being withheld from the poor.
Although dismaying, it is not surprising that these conspiracy theories are so prevalent among
black Americans. African Americans have many reasons to mistrust their Government, and the
health profession. There is the history of slavery and post-Civil War Jim Crow laws that
legalised segregation; the discrimination and racist comments, intended and unintended, that
many black Americans endure daily; the persistent disparities in health care and outcomes
between whites and blacks; and, of course, the memory of the infamous 40-year-long “Tuskegee
Study of Untreated Syphilis in the Negro Male”, conducted from 1932–72 by the US Public
Health Service, in which 399 black men with syphilis, most illiterate sharecroppers, were denied
curative treatment so that researchers could follow the progression of the disease.

But while understandable, there is a real risk that these conspiracy theories will frustrate efforts
to halt the epidemic in African American communities, where it is taking a terrible toll. Although
black Americans make up about 12% of the US population, they now account for more than half
of new HIV cases reported in the USA. Of the women diagnosed with HIV/AIDS, more than
70% are African American. And 62% of children born of HIV-infected mothers are African
American.

The findings of the new study indicate that public-health officials working against the spread of
HIV/AIDS need to acknowledge and address the conspiracy theories and mistrust prevalent in
the African American community. After all, it is unlikely that men and women who believe the
government has created HIV will listen to the government's health warnings, come in for testing,
or take recommended treatments.

To reach those at greatest risk, public-health officials need to recruit and train blacker peer
educators and need to craft sex education messages that are culturally suited to black Americans.
And, as Bogart and Thorburn point out, to be effective these messages need not only to
acknowledge that the conspiracy theories exist but also to discuss their roots. As they write: “To
obtain the trust of black communities, government and public health entities need to
acknowledge the origin of conspiracy beliefs openly in the context of historical discrimination.”
Government and health officials, the authors add, must also address the very real discrimination
that continues to exist within the US health-care system. It is also of paramount importance that
black community leaders and black media outlets make challenging these conspiracy theories a
priority.
The Hunter Theory:

It is now generally accepted that HIV is a descendant of a Simian Immunodeficiency Virus (SIV)
because certain strains of SIVs (Simian Immunodeficiency Virus) bear a very close resemblance
to HIV. It is also known that certain viruses can pass between species. Some of the most
common theories, which describes about how the viral transfer between animals and humans
takes place and how SIV became HIV in humans are explained in detail.

This is the most commonly accepted theory because it is said that the Simian Immunodeficiency
Virus (SIV) was transferred to humans as a result of chimps being killed and eaten or their blood
getting into cuts or wounds on the hunter. Simian Immunodeficiency Virus (SIV) on a few
occasions adapted itself within its new human host and become HIV. Every time it passed from a
chimpanzee to a man, it would have developed in a slightly different way within his body, and
thus produced a slightly different strain.

The Oral Polio Vaccine Theory

In this it is said that the virus was transmitted via various medical experiments especially through
the polio vaccines. The oral polio vaccine called Chat was given to millions of people in the
Belgian Congo, Ruanda and Urundi in the late 1950s. Then it was cultivated on kidney cells
taken from the chimps infected with SIV in order to reproduce the vaccine. This is the main
source of contamination, which later affected large number of people with HIV. But it was
rejected as it was proved that only macaque monkey kidney cells, which cannot be infected with
SIV or HIV were used to make Chat. Another reason is that HIV existed in humans before the
vaccine trials were carried out.

The Contaminated Needle Theory

African healthcare professionals were using one single syringe to inject multiple patients without
any sterilization in between. This could have rapidly have transferred infection from one
individual to another resulting in mutation from (Simian Immunodeficiency Virus) SIV to HIV.

The Colonialism Theory

The colonial rule in Africa was particularly harsh and the locals were forced into labor camps
where sanitation was poor and food was scare. Simian Immunodeficiency Virus (SIV) could
easily have infiltrated the labor force and taken advantage of their weakened immune systems.
Laborers were being inoculated with unsterile needles against diseases such as smallpox to keep
them alive and working. Also many of the camps actively employed prostitutes to keep the
workers happy. All these factors may have led to the transmission and development of AIDS as a
disease.

HIV transmission modes

There is still misunderstanding about how HIV is transmitted from one person to another. HIV
is spread through the following:

1. Blood (including menstrual blood)

2. Semen and other male sexual fluids ("pre-cum")
3. Vaginal fluids
4. Breast milk

There are four conditions that must be met for an HIV infection to take place:

1. There must be body fluids in which the virus can thrive. HIV cannot thrive in the open
air or in parts of the body with a high acid content, such as the stomach or bladder.

2. There must be a route of transmission by which the virus enters the body. Primary
routes of transmission include sexual intercourse, shared needles, and mother-to-child
infections.

3. There must be immune cells present near the site of entry. This allows the virus to take
hold once it has entered the body.

4. There must be sufficient amounts of the virus in the body fluids. These amounts,
measured by the viral load, can be high in body fluids like blood and semen and low to non-
existence in tears and saliva.

HIV is not spread through these body fluids:

1. Sweat
2. Tears
3. Saliva (spit)
 4. shaking hands, hugging or kissing
5. coughing or sneezing
6. using a public phone
7. visiting a hospital
8. opening a door
9. sharing food, eating or drinking utensils
10. using drinking fountains
11. using toilets or showers
12. using public swimming pools
13. Getting a mosquito or insect bite.

The spread of HIV can be prevented. There are ways to avoid, or at least, reduce contact with
the bodily fluids that spread HIV (blood, sexual fluids and breast milk). The primary methods of
transmission:

1. Sexual intercourse

HIV can be transmitted through unprotected sexual intercourse—that is, any penetrative sexual
act in which a condom is not used. Anal and vaginal intercourse can transmit the virus from an
HIV-infected man to a woman or to another man, or from an infected woman to a man. The risk
of becoming infected through unprotected sexual intercourse depends on four main factors:

i. the probability that the sex partner is infected,

ii. the type of sex act,
iii. the amount of virus present in the blood or sexual secretions (semen, vaginal or cervical
secretions) of the infected partner, and
iv. The presence of other sexually transmitted diseases and/or genital lesions in either partner.
Age may also be a factor as young girls are physiologically more vulnerable.

All unprotected acts of sexual penetration (anal, vaginal, oral) carry a risk of HIV transmission
because they bring body fluids secreted during sex directly into contact with exposed mucous
membranes (the lining of the rectum, the vagina, the urethra and the mouth).

2. Contaminated blood or blood products, tissues and organs

Blood transfusions save millions of lives each year, but in places where a safe blood supply is
not guaranteed, those receiving transfused blood have an increased risk of being infected with
HIV. In most industrialized countries, the risk of acquiring HIV infection from transfusions is
extremely low. This is due in large part to effective recruitment of regular, volunteer blood
donors; improved donor testing procedures; universal screening of blood and blood products
with highly sensitive and specific tests for the antibody to HIV; and the appropriate use of blood.

3. Contaminated needles, syringes or other piercing instruments

HIV can be transmitted through the use of HIV-contaminated needles or other invasive
instruments. The sharing of syringes and needles by injecting drug users is responsible for the
very rapid rise in HIV infection among these persons in many parts of the world. A risk is also
attached to non-medical procedures if the instruments used are not properly sterilized. Such
procedures include ear- and body-piercing, tattooing, acupuncture, male and female
circumcision, and traditional scarification. The actual risk depends on the local prevalence of
HIV infection.

HIV transmission by means of injection equipment can also occur in health care settings where
syringes, needles and other instruments, such as dental equipment, are not properly sterilized, or
through injury by needles and other sharps.

4. Mother-to-child transmission (MTCT)

Mother-to-child transmission (MTCT) is the overwhelming source of HIV infection in young

children. The virus may be transmitted during pregnancy, labour, delivery or after the child's
birth during breastfeeding. Among infected infants who are not breastfed, most MTCT occurs
around the time of delivery (just before or during labour and delivery). In populations where
breastfeeding is the norm, breastfeeding may account for more than one-third of all cases of
MTCT transmission.

5. Anal Sex

Anal sex is the predominant means of HIV transmission in the United States, occurring at a rate
18 times greater than that of vaginal sex. There are a number of reasons as to why this is, not
least of which is the fact that rectal tissues are more fragile and vulnerable to rupture than
vaginal tissues.

Little micro tears that commonly occur during anal intercourse simply allow more viruses to
enter the body. They also expose the receptive partner's potentially infected blood to the insertive
partner, thereby transmitting to the insertive partner. On top of that, many people who engage in
anal sex will often douche before intercourse, stripping away the layer of mucus that might
impede HIV transmission. The risk is further increased if the insertive partner is uncircumcised,
as microbes beneath the foreskin can increase the shedding (expulsion) of the virus into seminal
fluids.

6. Vaginal Sex

Vaginal sex is the second most common mode of HIV transmission in the United States. In many
parts of the developing world, vaginal sex is the primary mode of transmission, with women
disproportionately affected compared to men. Women are more vulnerable for several reasons:

 The area of exposure within the vagina is greater than that of the penis.

 The vagina and cervix are vulnerable to common infections like bacterial
vaginosis and candidiasis (yeast infection), both of which compromise already delicate
tissues.

 During unprotected sex, the ejaculate can often remain inside the vagina for a prolonged
period of time.

 Vaginal douching prior to sex can strip away protective mucus.

According to a 2018 review in Current HIV/AIDS Reports, women are twice as likely to get HIV
from a male partner during vaginal intercourse as the other way around.

7. Oral Sex

Oral sex is an inefficient way of transmitting HIV, whether it be oral-penile sex ("blowjobs"),
oral-vaginal sex (cunnilingus), or oral-anal sex ("rimming"). The current scientific consensus is
that HIV transmission among those who engage exclusively in oral sex is unlikely. The risk may
not be zero, but most agree that it is edging close to that.
 8. Injecting Drug Use

Injecting drug use is today the third most common mode of transmission in the United States and
is the primary mode of transmission in Russia and Central Asia, where the flow of illegal drugs
remains largely unimpeded. Sharing injecting needles is an extremely effective way of
transmitting HIV, directly inoculating the virus from the blood of one person into that of another.

9. Pregnancy

As with blood transfusions, the risk of mother-to-child HIV infection was high in the early years
of the global pandemic. Today, the risk has dropped dramatically, even in hard-hit parts of
Africa, due to routine HIV screening in pregnant people and the use of antiretroviral drugs to
prevent vertical (mother-to-child) transmission.

When HIV transmission does occur, it usually happens during childbirth with rupture of
membranes, which exposes the baby to HIV-tainted blood and vaginal fluids. Prior to this, HIV
generally does not cross the placenta from mother to child unless there is placental abruption, the
premature rupture of membranes, or a similar problem.

10. Other Possible Causes

There are other, less common causes of HIV transmission and several for which the risk of HIV
is unlikely but possible. These include occupational exposure, dental procedures, body piercings
and tattoos, and shared sex toys.

Occupational Exposure

HIV transmission from needle stick injuries or other occupational exposures can place healthcare
workers at risk. With that said, the risk of HIV from a needle stick injury is less than one in
1,000, while contact with HIV-infected body fluids on intact skin is even lower.

Body Piercings and Tattoos

While theoretically feasible, the risk of HIV from body piercings and tattoos is low due to the
licensing and strict regulation of practitioners within the industry. For its part, the CDC insists
that the risk of HIV transmission is low to negligible. Among unlicensed practitioners who do
 not adhere to industry sterilization and hygiene practices, the risk is potentially higher, although
it is unclear by how much.

Factors that Increase Risk of Transmission

There are a number of factors that can significantly increase the risk of HIV transmission
irrespective of the route of exposure:

i. Unprotected sex: Simply put, using a condom reduces the risk of HIV transmission by
roughly 95%. Not using a condom erases that protective benefit.

ii. High viral load: Every ten-fold increase in viral load—from, say, 1,000 to 10,000 to 100,000
—increases your risk of HIV by two- to three-fold. Taking antiretroviral therapy reduces that
risk.

iii. Multiple partners: Having multiple sex partners increases your opportunity for HIV
exposure. Even if you think a partner is "safe," serosorting (choosing a partner based on their
presumed HIV status) is associated with a three-fold risk of getting an STD.

iv. Substance abuse: Beyond the risk of HIV from shared needles, illicit drugs like crystal
methamphetamine and heroin can impair judgment and increase risk-taking. Even non-
injecting drugs and alcohol can lead to sexual disinhibition and risk-taking.

v. Sexually transmitted diseases: STDs increase the risk of getting and transmitting HIV. With
ulcerative STDs like syphilis, the risk of HIV may increase by as much as a 140-fold in high-
risk MSM populations.

vi. Genital infections: Non-sexually-acquired genital infections carry similar risks of

transmission. Even uncomplicated ones like urethritis are associated with an eightfold
increase in the risk of HIV.

vii. Douching: Some studies have shown that rectal douching in high-risk MSM populations
more than double the risk of HIV from 18% to 44%. The risk of HIV from vaginal douching
is less clear but is known to increase the risk of bacterial vaginitis.

viii. Being a sex worker: The more people one has sexual encounters with, the more likely the
possibility of sexual transmission is.
ix. Where you live: Living in dense urban populations where HIV prevalence rates are high
places you at greater risk compared to rural settings. This is especially true in poorer, ethnic
neighborhoods where access to treatment and preventive services are lacking.

HIV prevention and control

HIV prevention is about knowing the risks and understanding how HIV is transmitted. It is about
taking that extra step to educate yourself about both new and traditional forms of HIV
prevention. To protect yourself, you need to take an honest look at your personal risk factors and
design an individual prevention strategy to minimize the risks.The different tools and techniques
that you can incorporate into your own HIV prevention strategy include;

1. Know the Risks

HIV prevention starts by getting the facts straight—understanding the various modes of
transmission and identifying which activities place you, as an individual, at risk.

2. Take PrEP

HIV pre-exposure prophylaxis (PrEP) is a prevention strategy in which a daily dose of HIV
medications, known as antiretroviral, can reduce your risk of getting HIV by as much as 99%. A
pretude is a newer PrEP option that does not involve taking a daily pill. It is given as an injection
administered every two months to the uninfected partner and has been shown to greatly reduce
infection risk.

3. Get and Stay Undetectable

Undetectable = untransmissible (U=U) is an evidence-based strategy in which people with an

undetectable viral load cannot pass the virus to others. A viral load is a measurement of the
amount of virus in a sample of blood. Undetectable means that no virus was detected in the blood
sample, which is defined as having under 200 copies of HIV per milliliter of blood.

4. Use Condoms

There is no reason to be lax when it comes to condoms. Short of abstinence, internal and external
condoms are still the most reliable means of preventing pregnancy, HIV, and other sexually
transmitted diseases (STDs). No other preventive strategy can do all three. Preventing STDs is
important because they can increase the risk of HIV by compromising delicate vaginal or anal
tissues. This is not only true of STDs like syphilis that cause open sores but also any STD that
causes genital inflammation.

5. Conceive Safely

In nearly half of all couples living with HIV, one partner is HIV-positive and the other is HIV-
negative. With advances in HIV therapy, serodiscordant couples today have a greater opportunity
than ever to conceive—enabling pregnancy while minimizing the risk of transmission to a
partner without HIV. In fact, the combination of PrEP and an undetectable viral load should all
but ensure protection against transmission in serodiscordant relationships.

6. Avoid Mother-to-Child Transmission

The prevention of mother-to-child transmission of HIV involves all stages of pregnancy. Due to
the routine screening of HIV during pregnancy, mother-to-child transmission is uncommon in
the United States. Even so, it still occurs. By placing the mother on antiretroviral therapy early in
the pregnancy, the risk of transmission is extremely low. Even if treatment is started later in the
pregnancy, the overall risk is still less than 2%.

7. Avoid Sharing Needles

The rate of HIV among people who inject drugs is high. Studies suggest that anywhere from
20% to 40% of people are infected due to the shared use of needles or syringes.

8. Prevent HIV After an Exposure

If you believe you have been exposed to HIV, either through condomless sex or other high-risk
activities. Called post-exposure prophylaxis (PEP), the strategy works best if started soon after
exposure to the virus.

9. Choose your sexual partners wisely

In some cases, your chances of contracting or transmitting HIV may increase with the number of
sexual partners you have. Every one of your sexual partners has a sexual history that may
involve other partners. Those partners could have transmitted HIV or other STIs to your current
sexual partner. Monogamous relationships may be safe pairings if you are sexually active. This
means you and your partner will only have sex with each other.

10. Consider intimate activities that don’t involve the exchange of bodily fluids

You only have a chance of contracting HIV if you share bodily fluids with another person. There
are other sexual activities you can engage in that do not involve these exchanges.

11. Test yourself regularly for HIV and other STIs

You can get regular tests for HIV and STIs to stay on top of your health as well as to reduce
transmitting these conditions to others. Getting tested along with a new sexual partner(s) can
ensure that you are not transmitting HIV and STIs to each other when you begin your sexual
relationship.

12. Avoid misusing drugs and alcohol

Misusing alcohol or drugs can impair your decision-making. This can lead you to engage in
certain behaviors that may increase your chances of contracting or transmitting HIV, including
having sex without a barrier method. Avoid situations where you may misuse drugs and alcohol
and find yourself with a higher chance of making poor choices about sexual encounters.

13. risk reduction counseling

Counseling to reduce activities that can increase the risk of HIV transmission to others is
inadequate as a primary strategy for reducing HIV transmission. For persons with HIV, the
impact of consistently taking antiretroviral therapy and maintaining undetectable HIV RNA
levels far exceeds the impact of prevention strategies that rely on behavioral interventions.
Nevertheless, risk reduction counseling for persons with known HIV remains a complementary
piece of a comprehensive prevention strategy.

14. HIV STATUS DISCLOSURE AND PARTNER TESTING

Partner counseling and referral services is a public health service that helps people with HIV
disclose their HIV status to current or former sex or injection drug partners. The public health
system provides a trained counselor who can work with the person newly diagnosed with HIV to
support disclosure to partners, as well as to provide partner notification directly in cases where
the person with newly diagnosed HIV is not able to disclose their HIV status. Partner notification
and testing is important because of the high yield in HIV case finding.

15. SEROSORTING AND SEROPOSITIONING

The practice of serosorting and seropositioning (strategic positioning) and condom serosorting
are self-selected behaviors intended to reduce HIV transmission risk and are referred to as
seroadaptive strategies. Serosorting describes the practice of choosing sex partners based on
concordant HIV status, typically with the practice of selectively using condoms only when sex
occurs with persons of a serodifferent HIV status. Strict serosorting for gay men usually refers to
men having sex only with other men who have the same HIV status as themselves. Position
serosorting (also called strategic positioning or seropositioning) refers to choosing a different
sexual position or practice based on the HIV serostatus of one’s partner—the person with HIV
typically taking the receptive role during unprotected anal sex when their partner does not have
HIV.

16. Voluntary medical male circumcision (VMMC)

Voluntary medical male circumcision (VMMC) is the removal of the foreskin from the penis. It
reduces the chance of a man getting HIV from having sex with a woman by 60%. VMMC is
recommended for adolescents 15 years and older and adult men in 15 priority countries where
there is a high HIV prevalence among the general population. These are: Botswana, Ethiopia,
Kenya, South Sudan, Tanzania, Uganda, Zambia, and Zimbabwe.

HIV/AIDS patient management and care