LECTURE SESSION ONE

INTRODUCTION TO HIV/AIDS, STIS/STDS, PUBLIC HEALTH AND HYGIENE

Lecture Outline
1.1 Introduction
1.2 Learning Outcomes
1.3 Concepts of HIV/AIDS
1.3.1 Meaning of HIV/AIDS
1.3.2 Types of HIV Virus
1.4 Overview of STIs/STDs
1.5 Relationship between HIV/AIDS and STIs
1.6 Role of public health and hygiene in HIV/AIDS issues
1.7 Summary
1.8 Review Activity
1.9 References and Further Reading
1.1 Introduction
VIDEO
Welcome to the first lecture session in HIV/AIDS awareness, prevention and
management. In this session, we shall cover the concepts of HIV/AIDS, STIs/STDs, have
an overviews of STIs/STDs. Additionally, the session will cover the relationship between
HIV/AIDS and STIs and expound on the role of public health and hygiene.
1.2 Learning Outcomes
At the end of this course unit, you should be able to:
1. Explain the concept of HIV/AIDS
2. Identify the various STIs/STDs
3. Explain the relationship between HIV/AIDS and STIs
4. Understand the role of public health and hygiene in HIV/AIDS
issues.

1.3 Concepts of HIV/AIDS

Let us start our discussion by asking ourselves this question.
Question
1: What is the meaning of the initials HIV/AIDs

Great!! I believe that you have responded that HIV stands for Human-Immunodeficiency
Virus, the virus that causes AIDS. AIDS stands for Acquired Immunodeficiency
Syndrome.
The AIDS virus enters the body through the mucus membrane or through broken skin.
Once inside the body, the virus attacks the body defence cells which are mainly the white
blood cells and eventually killing them. White blood cells are a collection of different
kinds of cells that work together to gourd the body against microorganisms.

The virus targets particularly the white blood cells, the T-cells of the body’s immune
system. T-cells are clustered into different categories using protein receptors on their
surface. HIV attacks differential 4 (CD4) clusters of T-cells. Once this happens HIV starts
to reproduce other viruses eventually, destroying other CD4 cells. Normal range of CD4
cells in an adult is about 400-1800 per millilitre of blood volume. If the number falls below
200, the person is said to have developed Immuno-deficiency syndrome (AIDS)

Take Note
AIDS is specifically acquired and not inherited.

You have already looked at the meaning of HIV/AIDs and now let us have an overview
of types of HIV
1.3.1 Types of HIV Virus
Many people see HIV and AIDS as being the same thing, this is not true; HIV
and AIDS are not the same thing and people who get HIV infection do not
automatically develop AIDS.
There are two types of HIV virus:
i. HIV-1 and HIV-2 are types of HIV. HIV-1 and HIV-2 have the same modes
of transmission and are associated with similar opportunistic infections
when a patient’s immune system is compromised.
ii. 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.
iii. Mother to child transmission (MTCT) is common in the case of HIV-1 but
relatively rare with HIV-2.
iv. HIV-1 is more common worldwide. HIV-2 is found predominantly in West
Africa, Angola, and Mozambique.
v. There is large genetic difference between HIV-1 and HIV-2 meaning that
test keyed to one will not reliably detect the other.
HIV is in a family of viruses called retrovirus. Specific test methods are used to detect
and measure certain parts of the virus. For example, a test to detect the core of the
virus called p24 is used to detect early or pediatric infections.
Now you have looked at the meaning and types of HIV/AIDs. You can now have an
overview of common STIs/STDs.
1.4 Overview of STIs/STDs
INSERT IMAGES
The initials STIs/STDs stands for: STIS stands for Sexually Transmitted Infections / STDS
stands for Sexually Transmitted Diseases.
WHO defines STIS as communicable diseases mainly transmitted through sexual
intercourse with an infected person. STIs are also sometimes called sexually transmitted
diseases (STDs). While "STD" is often used interchangeably with "STI," they are not
exactly the same. A "disease" is usually an obvious medical problem with clear signs and
symptoms. "Infection" with an STI may or may not result in disease. This is why many
individuals and organizations working in health are moving toward using the term
"sexually transmitted infection" rather than "sexually transmitted disease." Most people
with STIs do not have any symptoms and therefore often do not know that they can pass
the infection on to their sexual partner(s). In addition to AIDS, there are other types of
STIs/STDs as described below.

1.4.1 Gonorrhoea
Gonorrhoea is a sexually transmitted bacterial infection in adults, and in children
infection is accidental. In women symptoms are mild compared to men. Many women
have no symptoms. Symptoms may include a yellowish or greenish vaginal discharge
and a burning feeling when urinating. Infection occurs in the cervix, urethra, rectum,
anus and throat. In females there is urethritis, endocervicitis and salpingitis which may
be symptomless and later vaginal discharge. Chief manifestations of the infection in
males are purulent urethritis with dysuria (painful urination). Men are far more likely to
notice symptoms than women. Tetracycline and penicillin are among the drugs for
treatment. If left untreated, gonorrhoea can cause Pelvic Inflammatory Disease (PID) and
infertility. All sexually active women should be screened for gonorrhea.
Take Note
It is possible to be infected with gonorrhoea and have no symptoms.

1.4.2 Syphilis
It is a bacterial infection whose causative agent is Treponema Pallidum. It is usually
sexually transmitted, but may also be passed from an infected mother to her unborn child.
The signs and symptoms of syphilis are the same in both men and women. Signs and
Symptoms can be difficult to recognize and may take up to 3 months to show after sexual
contact with an infected person.
Syphilis has three stages. The primary and secondary stages are infectious. The primary
stage appears 4-5 weeks after infection when a primary chancre (a corruption of cancer)
associated with swelling of lymph glands, pyrexia (fever) and malaise appears (Govan et
al, 1985). The chancre is the point at which the bacterium enters the body. The chancre
starts as a reddish papule measuring about 1 cm in diameter which then becomes
ulcerated. It is painless and highly infective. The secondary stage is when the skin
eruption (syphilidae) appears as ulcerations on mucosal surfaces like the vulva in women
and the skin develops a wide variety of popular rashes. The third stage occurs 15-30 years
after the initial infections when there may be nervous system involvement with general
paralysis, (defective muscular control) resulting in irregular and jerky movements.
Cardiovascular involvement may result in aortic aneurysm and impairment or and
destruction of the aortic valve.

Syphilis may be treated with antibiotics like penicillin and tetracyclines. Pregnant women
can pass syphilis to their babies during pregnancy and childbirth, so it is important that
pregnant women get tested for syphilis.

1.4.3 Candidiasis (thrush)

The causative agent is yeast, Candida albicans which is a commensal of the alimentary
canal and the vaginal. Males are infected by females during sexual intercourse and also
from the patient’s own commensal especially the rectum and finger nails. The yeast
generally lives on the skin and is normally kept in check by harmless bacteria. Under
favorable conditions, that is, warm moist environment, the yeast multiplies and can cause
itching, swelling, soreness, and discharge in both men and women. Women may
experience a thick white discharge and pain when passing urine. Men may experience
the same discharge in the penis and difficult pulling back the foreskin. Thrush can be
passed on when having sex with someone who is infected, but also if one wears too tight
nylon or lycra clothes or if one is taking certain antibiotics.
1.4.4 Trichomoniasis
Trichomoniasis is also known as “Trich” and is caused by a parasite (Trichomoniasis
vaginalis) a protozoan organism which is found in vagina in females and the urethra,
prepuce and prostate in males. Often there are no symptoms. When present, symptoms
include local irritation or a burning and itchy sensation in the vulva, urethritis, cervicitis
and a foul smelling vaginal discharge. In males there may be itching and discomfort in
the urethra during urination, urethritis and epididymitis. There may also be some
discharge as well. Transmission normally occurs through oral, anal or vaginal sex with
an infected person. Antibiotics are used for treatment.
1.4.5 Chlamydia
Affect cervix and urethra. It is one of the most common treatable bacterial STIs. Infection
includes trachoma, conjunctivitis, non-gonococcal urethritis and cervicitis. It is caused by
a bacterium that exists in vaginal secretions and semen. Chlamydia trachoma is the most
common found in cervix and urethra in women. The urethra, rectum and eyes can be
infected in both sexes and can cause serious problems later in in life if it is not treated. If
left untreated, it can spread to a woman's upper, internal reproductive organs (ovaries
and fallopian tubes) and cause pelvic inflammatory disease (PID). PID can lead to
infertility, meaning that it may be difficult or impossible to become pregnant.
1.4.6 Chancroid (soft sores)
Chancroid is a genital ulcer caused by an infection due to Haemophilus ducreyi. The
incubation period is a week, and the ulcers are normally multiple. Symptoms may
include genital sores, vaginal discharge, a burning feeling when urinating, and swollen
lymph nodes in the groin. It can be spread by vaginal or anal sex or skin-to-skin contact
with sores. They are painful ulcers which respond to treatment with sulphonamides.
1.4.7 Genital warts
Genital warts are small fleshy growth which may appear anywhere on a man or woman’s
genial area. They are caused by a virus called the Human Papilloma Virus (HPV). Warts
can grow on the genitals, or on different parts of the body, such as the hands. After one
has been infected with the genital wart virus, it usually takes between 1 and 3 months for
warts to appear on one’s genitals, they appear as pinkish/white small lumps or large
cauliflower-shaped lumps on the genital area. Warts can appear around the vulva, the
penis, the scrotum or the anus. They may occur singly or in groups. They may itch, but
are usually painless. Often there no other symptoms and the warts may be difficult to
see. If a woman has warts on her cervix, this may cause light bleeding or, very rarely, an
unusual coloured vaginal discharge.

1.4.8 Genital Herpes

This is caused by the Herpes Simplex Virus (HSV). The virus can affect the mouth, the
genital area, the skin around the anus and the fingers. Once the first outbreak of the
herpes is over, the virus hides away in the nerve fibers, where it remains totally
undetected and causes no symptoms. Symptoms of the first infection usually appear after
26 days after exposure and last two to three weeks. Both men and women may have one
or more symptoms, including an itching or tingling sensation in the genital or anal area,
small fluid-filled blister s and can burst and leave small sores which can be very painful,
pain passing urine if it passes over any of the open sores, flu-like illness, backache,
headache, swollen glands, or fever. In females, there are ulcers and vesicles on the cervix,
vagina, vulva, labia while in males, there are similar effects on the glans, prepuce, penal
shaft and less commonly on the scrotum. In both sexes lesions may be experienced on the
pharynx, thighs, buttocks and perianal area.

Treatment of HSV is by antiviral drugs, Zovirax (acyclovir), Valtrex (valacyclovir), and

Famvir (famciclovir) which can reduce the number of outbreaks if taken daily, and can
shorten outbreaks and make them less severe if taken as soon as symptoms begin. The
affected areas should be kept clean by frequent bathing, and applying barrier creams can
protect against the irritative effects of urine. Pregnant women can pass herpes to their
babies. Systemic spread is possible with people with AIDS.

Having looked at HIV/AIDs and common STIs/STDs, lets us now explain the
relationship that exists between HIV/AIDS and STIs/STDs infection.
1.5 Relationship between HIV/AIDS and STISs/ STDs (INSERT VIDEO)
It is generally accepted that having a STIs/STDs increases in a person's risk of getting
HIV, both for biological and behavioural reasons. STIs/STDs (such as syphilis) enhance
HIV transmission by causing open sores and skin injuries in sex organs through which
the HIV enters. A lot of T-lymphocytes are mobilized to fight the STD infections and
since these are the targets of HIV, a lot of them are destroyed and the person or individual
goes down faster with the HIV. The mode of transmission for the STDs is also the same
as the mode of transmission of HIV. People infected with an STIs/STDs also have
increased concentrations of HIV in their seminal and vaginal fluids, increasing the
possibility of HIV transmission.

1.6 Role of public health and hygiene in HIV/AIDS issues

Public health is the science and art of preventing diseases, prolong life and promoting
health through the organized and informed choices of society /organizations /public and
private, communities and individuals.
Public health can also be defined as the protection and the improvement of health of the
entire populations through community-wide action, primarily by governmental
agencies. Public health work deals with the assessment of health status of the community.
The goals of public health are comparable to those of HIV/AIDS education and they
include:
i. To prevent human disease, injury, and disability.
ii. Protect people from environmental hazards.
iii. Promote behaviors that lead to good physical and mental health.
iv. Educate the public about health; and assure availability of high-quality health
services.
Therefore, public health programs and HIV/AIDS education complement one another.
Most people think of public health workers as physicians and nurses, but a wide variety
of other professionals work in the public health sector including, veterinarians, sanitary
engineers, microbiologists, laboratory technicians, statisticians, economists,
administrators, attorneys, industrial safety and hygiene specialists, psychologists,
sociologists and educators.

Public health workers may engage in activities such as inspecting and licensing
restaurants; conducting rodent and insect control programs and checking the safety of
housing, water, and food supplies. In assuring, overall community health, public health
officials also act as advocates for laws and regulations such as, drug licensing, or product
labelling requirements. Some public health officials are epidemiologists, who use
sophisticated computer and mathematical models to track the incidence of communicable
diseases including HIV/AIDS and to identify new diseases and health trends. Others
conduct state-of-the-art medical research to find new prevention and treatment methods.
Hygiene is defined as the science of dealing with the preservation of health or the practice
or principles of cleanliness. In the public domain, public health officers mainly manage
this practice.

1.7 Summary
This session provided an overview of HIV, AIDS, STIs/STDs, by
giving their meaning, and their relationships. The session also covered
the in-depth review of public health and hygiene in relation to
HIV/AIDS.

1.8 Review Activity

Find out how much you have learned by answering these questions;
1. What is the meaning of HIV, AIDS and CD4?
2. Using suitable examples differentiate between STIs and STDs
3. Briefly explain how STIs increase the risk of HIV acquisition
4. Outline the goals of public health
1.9 References and Further Readings
1. Avert (2019). The science of HIV and AIDS-Overview.
https://www.avert.org/professionals/hiv-science/overview
2. Jonathan Engel. (2015). The Epidemic: A Global History of AIDS.
ISBN: 10: 0061144886
3. International Journal of STD & AIDS. ISSN 1758-1052