EMERGING ISSUES ON HIV AND

AIDS

Background Information

Kenya is home to one of the world’s harshest HIV and AIDS epidemics.

An estimated 1.5 million people are living with HIV; around 1.2 million children have been orphaned by AIDS; and in 2009 80,000 people died from AIDS-related illnesses.

Kenya’s HIV prevalence peaked during 2000 and, according to the latest figures, has dramatically reduced to around 6.3 percent.

This decline is thought to be partially due to an increase in education and awareness, and high death rates.

Background contd..

Whilst many people in Kenya are still not being reached with HIV prevention and treatment services, access to treatment is increasing.

More than half of adults who need treatment are receiving it, with around 100,000 additional adults on treatment in 2010 than in 2009.

In comparison, the number of children in need of antiretroviral treatment that are receiving it is extremely low.

An estimated 170,000 children are eligible to receive treatment, yet only around 1 in 5 have access to it. This demonstrates Kenya still has a long way to go in providing universal access to HIV treatment, prevention and care.

Access to ARVs and ART

In 2003 only 5 percent of people needing ART were receiving antiretroviral therapy.

In 2006 Kenya’s President announced that antiretroviral drugs would be provided for free in public hospitals and health centres.

In 2007 treatment coverage was low at 42 percent with only 172,000 on treatment.

Nevertheless, by 2009 the number of people receiving antiretroviral therapy had significantly increased to 336,980.

Access to ARVs and ART contd…

However, due to a 2010 change in WHO treatment guidelines, which recommend starting treatment earlier, the proportion of people eligible to receive antiretroviral treatment remained at only 48 percent.

Under the previous guidelines, treatment coverage would have been 65 percent.

By 2010, access to treatment had increased further with 432,621 receiving treatment, around 61 percent of those in need.

Access to ARVs and ART contd…

“Despite an increase in children accessing treatment, the overall coverage for children remains extremely low.”

Around half of those infected with tuberculosis (TB) are co-infected with HIV in Kenya, although this varies widely according to region. Antiretroviral treatment for co-infected individuals has been found to improve patient survival if it is administered as soon as possible after TB treatment.

FACTS ABOUT POST EXPOSURE PROPHYLAXIS

(PEP )

PEP

Post-exposure prophylaxis (PEP) is a special course of HIV treatment that aims to prevent people from becoming infected with HIV.

PEP is prescribed, in some instances, to people who have potentially been exposed to the virus.

The treatment, which can be accessed from clinics and health centers in many parts of the world, can prevent the virus from becoming established in the body of someone who has been exposed.

PEP is particularly important for people who have been sexually assaulted or people who have been exposed to blood through a needle injury or other accident at work

How does PEP work?

Post-exposure prophylaxis is an antiretroviral drug treatment that is started immediately after someone is exposed to HIV.

The aim is to allow a person’s immune system a chance to provide protection against the virus and to prevent HIV from becoming established in someone’s body.

It usually consists of a month long course of two or three different types of the antiretroviral drugs that are also prescribed as treatment for people living with HIV.

Contd…

The World Health Organisation recommends prescribing zidovudine and lamivudine as the preferred regimen, stating that countries are generally advised to use the same regimens as they would for treating HIV.

The British HIV Association recommend a combination of drugs called Truvada (tenofovir and emtricitabine) and Kaletra (lopinavir and ritonavir).

Effectiveness of PEP

The conclusions from both human and animal trials is widely recognized and as a result, a number of countries have produced guidelines suggesting the possible use of post-exposure prophylaxis in both occupational circumstances (for example a health-care worker who has been exposed in a hospital) and non-occupational circumstances (for example a person who has had unprotected sex).

They tend to suggest that, as it is not 100 percent effective, post-exposure prophylaxis should only be used as a very last resort.

Effectiveness contd…

In cases where PEP is used, there are various factors that can affect its effectiveness. Delayed initiation: In order for post-exposure prophylaxis to have

a chance of working, the medication needs to be taken as soon as possible, and within 72 hours of exposure to HIV. Left any longer and it is thought that the effectiveness of the treatment is severely diminished.

Resistant virus: The person who potentially transmitted HIV (the ‘source’) may have a drug-resistant HIV virus, which could make PEP ineffective. 

Adherence: It is very important that a person using PEP takes the treatment exactly as prescribed by their doctor or health worker. The side effects of the medication are a reason why some people find it difficult to adhere to the full 28-day course of treatment properly.

Who can benefit from post-exposure prophylaxis?

People exposed to blood or bodily fluids at work

Victims of rape or sexual assaultPeople potentially exposed through needlesPeople who may have been exposed to HIV

through consensual sexual contact

Risks and side-effects

As with most antiretrovirals, post-exposure prophylaxis can cause side effects such as: Diarrhoea Headaches Nausea / vomiting Fatigue.

Some of these side effects can be quite severe and it is estimated that 1 in 5 people give up the treatment before completion.

There is also the risk that taking PEP may cause a person to develop drug resistance should the patient become infected with HIV and need to be treated with antiretrovirals

Other emerging issues

DiscussionWhat is HIV super-infection?HIV and Gender vulnerabilityHIV and Contraceptives in relation to

increasing vulnerability

FACTS ABOUT VOLUNTARY MEDICAL MALE CIRCUMCISION

(VMMC)

What is VMMC?

VMMC (Voluntary medical adult male circumcision)

A medical intervention that reduces (does not eliminate) risk of HIV infection among sexually active, HIV uninfected men.

Three high-quality scientific studies showing that male circumcision reduces the risk of getting HIV by 60%

Advantages of MC as an addition to existing prevention interventions

Very good safety profile

One time intervention

Most importantly, it works (and saves lives)

Other potential advantages:

Can be delivered through existing health care system (after enhancing capacity)

Likely to be benefits for partners of circumcised men

Other health benefits (reduce other STI and complications of STI)

2007 KAIS: Male circumcision and HIV

Province with the highest HIV prevalence (Nyanza) has the lowest MC level

Province with the second highest HIV prevalence (Nairobi) has second lowest MC level

HIV 3 times more prevalent among uncircumcised men than circumcised

Source: 2007 Kenya AIDS Indicator Survey

Rate of new HIV infection 3 times higher among men not circumcised

0

1

1

2

2

3

3

4

4

5

5

Not circumcised Circumcised

Perc

ent

incid

ent

infe

cti

ons

(%)

\

Source: 2007 Kenya AIDS Indicator Survey

For the avoidance of doubt!

Medical Adult Male Circumcision is and shall remain

VOLUNTARY

FACTS ABOUT BREASTFEEDING

Exclusive breastfeeding

WHO strongly recommends exclusive breastfeeding for

the first six months of life. At six months, other foods should complement breastfeeding for up to two years or more. In addition: Breastfeeding should begin within an hour of

birth; Breastfeeding should be "on demand", as often

as the child wants day and night; and Bottles or pacifiers should be avoided.

Health benefits for infants

Breast milk is the ideal food for newborns and infants. It gives infants all the nutrients they need for healthy development.

It is safe and contains antibodies that help protect infants from common childhood illnesses - such as diarrhoea and pneumonia, the two primary causes of child mortality worldwide.

Breast milk is readily available and affordable, which helps to ensure that infants get adequate sustenance.

Benefits for mothers

Breastfeeding also benefits mothers. The practice when done exclusively is associated with a natural (though not fail-safe) method of birth control (98% of protection in the first 6 months after birth).

It reduces risks of breast and ovarian cancer later in life, helps women return to their pre-pregnancy weight faster, and lowers rates of obesity.

Long-term benefits for children

Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of good health.

Adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as lower rates of overweight, obesity and type-2 diabetes.

There is evidence that people who were breastfed perform better in intelligence tests.

Why not infant formula?

Infant formula does not contain the antibodies found in breast milk. When infant formula is not properly prepared, there are some risks arising from the use of unsafe water and unsterilized equipment or the potential presence of bacteria in powdered formula.

Malnutrition can result from over-diluting formula to "stretch" supplies.

Further, frequent feedings maintain the breast milk supply. If formula is used but becomes unavailable, a return to breastfeeding may not be an option due to diminished breast milk production.

HIV and breastfeeding

An HIV-infected mother can pass the infection to her infant during pregnancy, delivery and through breastfeeding.

Antiretroviral (ARV) drug interventions to either the mother or HIV-exposed infant reduces the risk of transmission of HIV through breastfeeding.

Together, breastfeeding and ARV interventions have the potential to significantly improve infants' chances of surviving while remaining HIV uninfected.

WHO recommends that when HIV-infected mothers breastfeed, they should receive ARVs and follow WHO guidance for breastfeeding and complementary feeding.

Regulating breast-milk substitutes

An international code to regulate the marketing of

breast-milk substitutes was adopted in 1981. It calls for:

All formula labels and information to state the benefits of breastfeeding and the health risks of substitutes;

No promotion of breast-milk substitutes; No free samples of substitutes to be given to

pregnant women, mothers or their families; and No distribution of free or subsidized substitutes

to health workers or facilities.

Support for mothers is essential

Breastfeeding has to be learned and many women encounter difficulties at the beginning. Nipple pain, and fear that there is not enough milk to sustain the baby are common.

Health facilities that support breastfeeding - by making trained breastfeeding counselors available to new mothers - encourage higher rates of the practice.

To provide this support and improve care for mothers and newborns, there are now more than 20 000 "baby-friendly" facilities in 152 countries thanks to a WHO-UNICEF initiative.

Work and breastfeeding

Many mothers who return to work abandon breastfeeding partially or completely because they do not have sufficient time, or a place to breastfeed, express and store their milk.

Mothers need a safe, clean and private place in or near their work to continue breastfeeding.

Enabling conditions at work can help, such as paid maternity leave, part-time work arrangements, facilities for expressing and storing breast milk, and breastfeeding breaks.

The next step: phasing in new foods

To meet the growing needs of babies at six months of age, complementary foods should be introduced as they

continue to

breastfeed. Foods for the baby can be specially prepared or

modified from family meals. WHO notes that: Breastfeeding should not be decreased when starting

complementary feeding; Complementary foods should be given with a spoon or

cup, not in a bottle; Foods should be clean, safe and locally available; and Ample time is needed for young children to learn to eat

solid foods.

ASANTE!!!