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Module 1 Introduction to HIVAIDS Total Time 120 minutes SESSION

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Module 1 Introduction to HIVAIDS Total Time 120 minutes SESSION

Module 1 Introduction to HIV/AIDS

     Total Time: 120 minutes

SESSION 1 Scope of the HIV/AIDS Pandemic

    Activity/Method Resources Needed Time

    Summary of information on Exercise 1.1 Hope exercise: group 30 minutes local/national/regional discussion

    epidemiology of HIV/AIDS

    If available, HIV prevalence

    among women at local

    prenatal clinics.

SESSION 2 Natural History and Transmission of HIV

    Activity/Method Resources Needed Time

    Prizes, such as sweets or Exercise 1.2 HIV 1, 2, 3 Knowledge 90 minutes condoms (optional), for the interactive game winning team

Also have available the following:

    ? Overheads or PowerPoint slides for this Module (in Presentation Booklet)

    ? Overhead or LCD projector, extra extension cord/lead

    ? Flipchart or whiteboard and markers or blackboard and chalk

    ? Pencil or pen for each participant

    PMTCTGeneric Training Package Trainer Manual Module 11

    Relevant Policies for Inclusion in National Curriculum Session 1

    ? Brief summary of local/national/regional epidemiology of HIV ? If available, a graph illustrating HIV prevalence among pregnant women at

    antenatal clinics (a local variation on Figure 1.2)

    Module 12 Introduction to HIV

SESSION 1 Scope of the HIV/AIDS Pandemic

    Advance Preparation

    For the Hope Exercise (Exercise 1.1), prepare a list of positive responses to

    HIV in your area.

    Total Session Time: 30 minutes

    Trainer Instructions

    Slides 1 and 2

Begin by reviewing the module objectives listed below.

After completing the module, the participant will be able to:

    ? Describe the global and local impact of the epidemic.

    ? Answer basic questions about HIV/AIDS in women, children, and families.

    ? Discuss the natural history of HIV infection.

    ? Present information about HIV transmission.

    Trainer Instructions

    Slides 3, 4 and 5

    Discuss the scope of the global HIV/AIDS pandemic.

    Make These Points

? More than 90% of people living with HIV/AIDS (PLWHA) are in the developing world.

    ? 95% of all HIV-related deaths have been in the developing world, largely among

    young adults.

    PMTCTGeneric Training Package Trainer Manual Module 13

Figure 1.1 Worldwide epidemiology of HIV/AIDS

    Trainer Instructions

    Explain the effects of HIV/AIDS on children.

HIV in children, 2003

    UNAIDS estimates that at the end of 2003:

    ? 40 million people worldwide were living with HIV/AIDS

    ? 2.5 million people with HIV/AIDS were children younger than 15 years old

    ? 90% of the children living with HIV/AIDS were from sub-Saharan Africa

    ? 700,000 children worldwide were newly infected in 2003

    ? 500,000 child deaths are estimated to have occurred from HIV/AIDS during 2003

    Make These Points

? Emphasise the number of new infections using the most recently available data.

    Module 14 Introduction to HIV

New infections, 2003

    According to UNAIDS, about 14,000 new infections occurred each day in 2003. Of these new infections

    ? About 6,000 each day were among persons 15 to 24 years old

    ? Almost 2,000 each day were in children younger than 15 years old

    ? Most of the infections in children younger than 15 years old occurred through mother-

    to-child transmission (MTCT) of HIV.

    Trainer Instructions

Briefly highlight the regional HIV/AIDS data as detailed in Table 1.1. This table also

    appears in the Participant Manual, so you need not discuss the information in detail.

    Table 1.1 Regional HIV/AIDS statistics and features, through 2003

    Adults and Adults and Adult Adult and Child Region Children Living Children Newly Prevalence* Deaths Due to

    with HIV/AIDS Infected with HIV AIDS (%)

    Sub-Saharan 25.028.2 million 3.03.4 million 7.58.5 2.22.4 million Africa

    North Africa and 470,000730,000 43,00067,000 0.20.4 35,00050,000 Middle East

    South and 4.68.2 million 610,0001.1million 0.40.8 330,000590,000 South-East Asia

    East Asia and 700,0001.3 150,000270,000 0.10.1 32,00058,000 Pacific million

    Latin America 1.31.9 million 120,000180,000 0.50.7 49,00070,000 Caribbean 350,000590,000 45,00080,000 1.93.1 30,00050,000 Eastern Europe 1.21.8 million 180,000280,000 0.50.9 23,00037,000 and Central Asia

    Western Europe 520,000680,000 30,00040,000 0.30.3 2,6003,400 North America 790,0001.2 36,00054,000 0.50.7 12,00018,000

    million

    Australia and 12,00018,000 7001,000 0.10.1 <100 New Zealand

    Total 40 million 5 million 1.1 3 million

    (3446 million) (4.25.8 million) (0.91.3) (2.53.5 million) * Percentage of adults age 15 to 49 years living with HIV/AIDS in 2003, using 2003 population data The ranges in this table are based on the best available information. These ranges are more precise than

    in previous years, and work is under way to further improve the precision of the estimates to be published

    in mid-2004.

    PMTCTGeneric Training Package Trainer Manual Module 15

    Trainer Instructions

Explain that to estimate HIV prevalence in the general population, researchers often

    measure HIV prevalence in antenatal clinics.

Figure 1.2 below is a good example of the results of a prevalence study among pregnant

    women, which shows the extent of the South African epidemic.

Figure 1.2 HIV prevalence: pregnant women in South Africa, 19912002

Most of these estimates are based on surveillance systems that focus on pregnant women

    who attend selected antenatal clinics. This method assumes that HIV prevalence among

    pregnant women is a good approximation of prevalence among the adult population (aged

    1549 years). A direct comparison of HIV prevalence among pregnant women at antenatal

    clinics and the adult population in the same community in a number of African communities

    has provided evidence for this method of estimating HIV prevalence.

Module 16 Introduction to HIV

    Trainer Instructions

    Slide 6

    Explain that the impacts of HIV occur at all levels of society from the individual to the family, community and country level. The social and economic consequences are far

    reaching.

    Make These Points

? HIV/AIDS affects every region of the world.

    ? Millions of people are infected with HIV or live in families affected by HIV.

    ? The number of new infections continues to grow.

    ? The HIV/AIDS pandemic contributes to:

    ? Childhood malnutrition

    ? Shortened life span with illness and suffering

    ? Economic loss, personal and countrywide

    ? Weakened family system

    Trainer Instructions

Begin a group discussion about some of the pandemic's global outcomes, based on the

    following information:

Global impact of HIV

    The global impact of the HIV/AIDS pandemic is especially severe in resource-

    constrained settings and results in the following:

    ? Negative impact on countries’ economic development

    ? Overwhelmed healthcare systems

    ? Decreasing life expectancy in many countries

    ? Deteriorating child survival rates

    ? Increasing number of orphans

Effects of the HIV/AIDS pandemic on individuals include the following:

    ? Illness and suffering

    ? Shortened life span

    ? Loss of work and income

    ? Death of family members, grief, poverty, and despair

    ? Barriers to health care related to stigma and discrimination

    ? Deteriorating child health and survival

    ? Weakened integrity and support structure of the family unit

PMTCTGeneric Training Package Trainer Manual Module 17

    Trainer Instructions

    Slides 7, 8 and 9

    Slides 7, 8 and 9 feature national epidemiologic data; review this data with participants.

    Invite the participants to share individual and family outcomes they have witnessed related to the HIV pandemic.

    Trainer Instructions

Lead an interactive discussion based on Exercise 1.1.

    Exercise 1.1 Hope exercise: group discussion Purpose To begin the PMTCT training with a feeling of hope and optimism

    despite the devastation left by decades of HIV. Duration 20 minutes

    Introduction Explain to participants that this activity is intended to introduce hope

    and optimism about the response to HIV/AIDS. Activities Ask participants to share their ideas about positive responses to the

    HIV/AIDS pandemic. Record their responses on the flipchart or board.

    Typical responses include:

    ? Groups in the community that have never worked together before

    have connected with each other to address HIV/AIDS.

    ? Global community has allocated increased funding for healthcare

    systems in the developing world, especially HIV/AIDS care

    systems.

    ? The Ministry of Health in many countries has become a stronger

    advocate for the healthcare needs of people in all sectors of

    society.

    ? Global community has become more attentive to TB because of

    its connection to HIV.

    ? There is increased awareness of safer sex practices that protect

    people from other STIs and HIV.

    If no one identifies PMTCT as a positive response, ask what the

    participants know about preventing transmission from mothers to babies.

    Debriefing Summarise the session by noting the following points:

    ? Much of the progress in HIV treatment and care in developed

    nations relates to HIV-positive people living longer, healthier lives.

    ? Fewer infants are infected from their mothers.

    ? Participants can be part of the progress in PMTCT.

    ? Even though HIV has brought devastation, it also has brought

    positive responses such as bringing together many different kinds

    of people to fight for a common goal.

    ? This PMTCT course begins on a note of hope. Module 18 Introduction to HIV

    Make These Points

? Despite the devastation caused by HIV, there are reasons to be hopeful and

    optimistic.

    Trainer Instructions

    Slides 10, 11 and 12

    Use this part of the session to present an overview of HIV infection and AIDS. For some

    participants, this may be a review.

Discuss the definitions of HIV and AIDS and highlight the differences. Allow time to

    respond to questions.

Overview of HIV and AIDS

    Refer to Pocket Guide.

Definitions of HIV and AIDS

    HIV stands for human immunodeficiency virus, the virus that causes AIDS.

    H: Human

     I: Immunodeficiency

    V: Virus

    ? HIV breaks down the body's defence against infection and diseasethe body's

    immune systemby infecting specific white blood cells, leading to a weakened

    immune system.

    ? When the immune system becomes weak or compromised, the body loses its

    protection against illness.

    ? As time passes, the immune system is unable to fight the HIV infection and the

    person may develop serious and deadly diseases, including other infections and

    some types of cancer.

    When a person is infected with HIV, the person is known as ―HIV-infected.‖

    ―HIV-positive‖ is when person who is HIV-infected has tested positive for HIV.

    AIDS is an acronym for acquired immunodeficiency syndrome and refers to the most advanced stage of HIV infection.

A: Acquired, (not inherited) to differentiate from a genetic or inherited condition that

    causes immune dysfunction

    I: Immuno-, because it attacks the immune system and increases susceptibility to

    infection

    D: Deficiency of certain white blood cells in the immune system S: Syndrome, meaning a group of symptoms or illnesses that result from the HIV infection

PMTCTGeneric Training Package Trainer Manual Module 19

    Make These Points

? Emphasise the differences between HIV and AIDS.

Differences between HIV, HIV infection, and AIDS

    ? HIV is the virus that causes infection.

    ? The person who is HIV-infected may have no signs of illness but can still infect

    others.

    ? Most people who are HIV-infected will develop AIDS after a period of time, which

    may be several months to more than 15 years.

    ? AIDS is a group of serious illnesses and opportunistic infections that develop after

    being infected with HIV for a long period of time.

    ? A diagnosis of AIDS is based on specific clinical criteria and laboratory test results.

(See Appendix 1-A for information about the World Health Organization (WHO) staging

    systems for HIV infection and Disease and Appendix 1-B for the U.S. Centers for

    Disease Control and Prevention (CDC) AIDS Surveillance Case Definitions.)

    Trainer Instructions

    Slides 13 and 14

    Discuss HIV-1 and HIV-2, highlighting the similarities and differences between them.

Types of HIV

    HIV-1 and HIV-2 are types of HIV. Both types are transmitted the same way, and both

    are associated with similar opportunistic infections and AIDS. HIV-1 is more common

    worldwide. HIV-2 is found predominantly in West Africa, Angola, and Mozambique.

Differences between HIV-1 and HIV-2

    HIV-2 is less easily transmitted than is HIV-1, and it is less pathogenic, meaning that

    the period between initial infection and illness is longer. In some areas, a person may

    be infected with both HIV-1 and HIV-2. While HIV-2 can be transmitted from an

    infected mother to her child, this appears to be rare (0% to 5% transmission rate in

    breastfed infants in the absence of any interventions).

A discussion of preventing mother-to-child-transmission (PMTCT) from women who

    are infected with HIV-2 to their infants is included in Module 2, Overview of HIV

    Prevention in Mothers, Infants, and Young Children, Appendix 2-A. Women who are

    infected with both HIV-1 and HIV-2 should follow all PMTCT recommendations for HIV-

    1-infected women.

    Make These Points

? Emphasise the differences between HIV-1 and HIV-2 and be sure that participants

    understand the information.

    Module 110 Introduction to HIV

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