Support the fight against hiv/aids killing many african every seconds

HIV/AIDS IS REAL,AND KILLS SO ,STAY AWAY FROM IT. AM HERE TO TELL THE WORLD THAT HIV/AIDS IS REAL AND IT KILLS,IT DOES NOT GIVE YOU NOTICE BEFORE IT AFFECTS YOU,AM ADVISING ALL PEOPLE IN THE WORLD.BOTH  YOUNG AND OLD TO STAY AWAY FROM UNSAFE SEX AND LIVE LONG. Introduction Human Immunodeficiency Virus-1 (HIV-1) and HIV-2 are lentiviruses. They are retroviruses that contains all their genetic material as two strands of RNA that have to be converted into DNA by viral reverse transcriptase before the virus can replicate. 'Lenti' = slow, reflecting the long period of time before infection becomes symptomatic. HIV-1 and HIV-2 both cause Acquired Immunodeficiency Syndrome (AIDS). HIV-1 has spread rapidly around the world and is much more common than HIV-2. HIV-2 has remained restricted to west Africa, but has also infected significant numbers of people in India. HIV-1 and HIV-2 exhibit many common features: For purposes of simplicity, they will be generically referred to as 'HIV' in these pages. In 1999 at least 33 million people worldwide were living with either HIV infection or AIDS. This is a lot fewer than for other incurable viral infections (e.g. Hepatitis B: 170 million, Hepatitis C: 300 million). But the impact of HIV is far greater in terms of morbidity and mortality. Currently 95% of HIV infections occur in developing countries. No effective vaccines against HIV have yet been produced. In 2000 there were at least 27 different vaccines being tested in clinical trials. HIV is of direct relevance to the practice of dentistry as: Appropriate Cross Infection practices will prevent unnecessary spread of HIV infections in the dental surgery. HIV transmission in the dental surgery is most likely to occur via Inoculation Injuries (needlestick or sharps injuries). HIV positive patients can remain clinically well for many years without knowing that they are infected. Oral lesions are common in AIDS and the first clinical suspicion that a patient may be HIV positive can arise during dental treatment. Most oral lesions (except oral warts) regress with anti-retroviral drugs. Development of further oral lesions may indicate that the drugs are starting to become less effective in controlling HIV. The majority of patients who are HIV positive (some of whom will be undiagnosed) can be safely treated in general dental practice. The Origins of HIV as a Human Infection Recent studies concluded that HIV probably arose as a human infection In western central Africa. In the 1930's. As a consequence of transfer from primates. Probably due to the eating of infected meat from: Chimpanzees (HIV1). Sooty Mangabey monkeys (HIV2). The clinical illness of AIDS in humans would probably have been apparent within a few years, but was not recognized by Western medicine for several reasons including: It was a new illness. Patients can live with HIV infection for several years before AIDS develops. Only small numbers of patients would have been affected in the early years. Life expectancy amongst the affected communities was already low. Little Western medicine was practiced amongst these communities, especially during, and immediately after the 2nd World War. As a consequence, HIV infection spread unrecognized for decades. Two factors in particular allowed HIV to spread rapidly around the world. The post-war boom in global travel as airline travel became accessible to millions of people. Increased sexual promiscuity both amongst heterosexuals, but more importantly amongst homosexual men. The 1960s had seen a relaxation of attitudes to sex outside of marriage. 'Bath houses' were established where homosexual men would go and have sex with many different men over a few hours. Western medicine began to recognise AIDS in the early 1980's as an illness in sexually promiscuous gay men in the U.S.A.. Before the term AIDS was coined, it was initially known as GRID (Gay-Related Immune Deficiency). Some believed that God was punishing homosexuals. One of the first patients to be diagnosed with AIDS was a male homosexual airline pilot who in a short period of time had sex with hundreds of men in a number of cities spread over different continents. With hindsight, it is thought that a Norwegian merchant seaman who visited ports in west Africa was probably the first European to die of AIDS in the 1950s. The Global Spread of HIV Infection Subsequently, it became clear that AIDS was not a disease restricted to homosexual men, and that spread of HIV occurred via three main routes: Sexual contact: Especially when associated with physical abrasions. Receptive anal sex is an extremely high risk behaviour that is not limited to homosexual men: One study in the U.S.A. reported that 23% of single men and 20% of single women had experienced heterosexual anal intercourse at some point in their life. Vaginal heterosexual intercourse is associated with a lower risk of contracting HIV infection. Oral sex is associated with an extremely low risk of HIV infection. The risk of transmission from unprotected receptive oral sex (no condom) is lower than for receptive anal intercourse using a condom. Blood, blood-derived products and organ transplantation: Blood transfusions not screened for HIV. Factor VIII prepared from HIV infected blood caused AIDS in a large number of haemophiliacs prior to anonymous HIV-screening of blood donors. Sharing of needles (contaminated with blood) amongst people who intravenously injected Recreational drugs such as heroin. Performance enhancing drugs (athletes). Organ or tissue transplantation (e.g. kidney or bone marrow) from an HIV-positive donor could result in transmission to the recipient, but this mode of transfer must be considered extremely rare. Maternal-child transmission. Approximately 42% of HIV-infected mothers pass the infection to their children via one of the three following routes: Trans-placental infection in-utero during pregnancy. Infection during vaginal delivery. Infection via breast milk. There have been incidences of HIV transmission from health care workers during therapeutic procedures, but these have been rare. A particularly notorious case involved a dentist in Florida who infected a number of his patients, probably deliberately. In 2001, a doctor and 6 health workers in Libya were accused of deliberately infecting 373 children with HIV. The trial is ongoing. Identification of HIV infection as the cause of AIDS did not take long after the clinical illness was first described in 1981. HIV-1 and HIV-2 were described in 1983 & 1985 respectively. Some influential people still dispute that AIDS is only caused by HIV infection. The most prominent of these is Thabo Mbeke, the President if the Republic of South Africa. President Mbeke's beliefs have had a profound influence on how the AIDS epidemic has been managed in South Africa. By the time that AIDS was recognized, HIV infection had already been spread around the world. Developed countries focused on limiting the spread of HIV infection within their own communities. Governments funded massive safer sex campaigns in the 1980s. By comparison, little attention was given to the emerging HIV pandemic in Africa and other developing countries. Education about safe sex remains limited in many parts of the world where HIV infection is common. For example, 50% of women and 35% of men aged 15-19 years old living in Tanzania in 1999 did not know of ways to protect themselves against HIV/AIDS. The Global Impact of HIV and AIDS The number of people estimated to be living with HIV/AIDS at the end of 1999 was: Sub-Saharan Africa: 23.3 million. South Asia and South-East Asia: 6 million. Latin America: 1.3 million. North America: 920,000. Western Europe: 620,000. Australasia: 12,000. The number of people living with HIV/AIDS is increasing at a dramatic rate. For example, in South Africa about 4.7 million people were HIV positive in 2000, compared to 4.2 million in 1999 (out of a total population of 42 million). Within Sub-Saharan Africa, HIV infection is more prevalent in women and the southern countries (e.g. South Africa, Zimbabwe, Botswana and Namibia). For example, 15-25 year old adults living in Botswana in 1999 34% of women had HIV/AIDS. 16% of men had HIV/AIDS. The statistics that describe the current extent, and likely expansion of the HIV epidemic involve such large numbers that they can become meaningless. To try and address this problem, a team in South Africa applied the statistics to an imaginary South African town of 4000 people and described the impact that HIV would have on this community in 2000 and 2010. Their findings were as follows:   2000 2010 HIV positive 500 1,200 A new case of HIV infection every 5 days 2 days Orphans due to HIV 5 200 HIV infection is mostly spread amongst sexually-active young adults. The consequences of this are devastating on the communities in which they live: This group forms the bulk of the workforce. In some communities the workforce has been decimated with associated economic collapse. A large number of pregnant women are HIV positive: For example, in 2000 24.5% of pregnant women in South Africa were HIV positive. There is a huge impact on the most vulnerable members of these communities (the young and the elderly): Children are being born with HIV contracted from their infected mothers. By 1999 12.1 million children in Sub-Saharan Africa had been orphaned due to HIV. There are fewer young adults to care for the elderly. AIDS is the 4th most common cause of death in the World: It is the most common cause of death in Sub-Saharan Africa. In countries with adult HIV infection prevalences >10% it is predicted that there will be: An average reduction in life expectancy of 17 years by 2010-2015. The full impact of AIDS has yet to be realized. Infection rates are unlikely to drop in the immediate future. Especially in communities who have not adopted safer sex practices despite education campaigns. Although there are drugs that can effectively control HIV infection for many years, delaying the onset of AIDS. These are expensive and available to only a small proportion of patients infected with HIV. The Impact of HIV and AIDS in the United Kingdom Compared to other parts of the world including parts of Europe (prevalence rates are 6 times higher in Spain), the U.K. has had few cases of HIV infection. However, the number of cases is rising as safe sex practices are followed less rigorously. The number of new U.K. cases of HIV infection was 7% higher in 2000 compared to 1999. In the U.K. between 1982 and 1999: 37,875 cases of HIV infection were recorded. 22% of these were a consequence of heterosexual sex. Within the U.K. there is great regional variation in prevalence rates. >70% of all cases have been in London or the surrounding areas. Rates amongst gay men are greater in London than elsewhere in the U.K. Rates amongst intravenous drug abusers are higher in Edinburgh than London. In Leeds between 1982 and 1999: 474 cases of HIV infection were recorded. 25% of these were a consequence of heterosexual sex. 107 went on to develop AIDS, of which 82 had died by 1999. In recent years, there has been an increase in the number of cases of HIV infection contracted via heterosexual sex. Of 2868 new cases of HIV infection recorded in the U.K. in 2000 1315 (45.8%) were transmitted via heterosexual sex. 1096 (38.2%) were transmitted via male homosexual sex. Of the 20 new cases of HIV infection recorded in Leeds in 1999: 13 (65%) were transmitted by heterosexual sex. Although the U.K. has had relatively few cases of HIV infection compared to other parts of the world, it has had a significant social and economic impact: HIV infection has mostly occurred in young adults. HIV infection is associated with considerable social stigma. The health care costs are high. HIV infection cannot be cured. The 3 Stages of HIV Infection 1. Primary HIV Infection The risk of HIV transmission is largely dependent upon direct transfer of infected secretions (e.g. semen) or blood that include high copy numbers of HIV. HIV is much less infective than many other viral infections such as hepatitis B. Genital secretions and blood have the highest HIV copy numbers per ml and pose the greatest risk of transmission. Breast milk also has high HIV copy numbers, and may be a potential source of transmission between mother and child, although the risk is lower compared to that associated with either genital secretions or blood. Cerebrospinal fluid also contains high HIV copy numbers, but is unlikely to be the cause of HIV transmission. Saliva, tears, sweat, urine or faeces have low copy numbers of HIV and pose a low risk of transmission. HIV infection spreads rapidly from the point of inoculation and: Many CD4 positive T-lymphocytes (T-helper cells) are infected. Some macrophages become infected. In the first few weeks there is massive HIV replication that results in: A marked viraemia (e.g. 5000 infectious HIV particles per ml) at which stage: The patient is highly infectious. Antibodies against HIV have yet been formed, so an HIV test would be negative. Dissemination of HIV infection throughout the lymphoid tissue and many other cell types. As many as 250 billion cells may become infected at this time. Within a few weeks a specific immune response against HIV controls the viraemia and copy numbers of HIV drop dramatically. CD4 positive lymphocyte numbers, which have been reduced by HIV viral replication, return to normal. Seroconversion occurs and antibodies against HIV antigens are produced for the first time, and persist thereafter. Although the viraemia ends, HIV is not eliminated from the body. The infectious risk to others diminishes with resolution of the viraemia, but is still present. Clinical symptoms experienced during the primary phase of infection are extremely variable. In many patients this phase is subclinical and they are free of symptoms. Others, perhaps up to 50% experience a Glandular Fever-Like Syndrome. During the acute phase the severity of symptoms varies from patient to patient. There may be little more than a mild flu-like illness. Symptoms may include Sore throat. Fever. Lymphadenopathy (tender, enlarged lymph nodes). General malaise. Headache. Muscle aching. Erythematous rash involving the trunk. Most of the symptoms subside in a few weeks But, lymphadenopathy and general malaise do persist for several months in some patients. A small proportion of patients become clinically immunocompromised at this stage (due to HIV replication killing large numbers of CD4 positive cells) and may present with: Minor infections such as oral or vaginal thrush, or herpes. AIDS-defining opportunistic infections such as oesophageal candidiasis or pneumocystis pneumonia.   2. Post-Seroconversion - Asymptomatic Stage The second phase is entered once a specific immune response against HIV has been mounted and has controlled the initial viraemia. This phase is asymptomatic. The duration of the second phase is usually at least a year and can be over 10 years. The mean length is shorter in Sub-Saharan Africa than in Europe and North America. The reasons for this are not entirely clear, but malnutrition is probably an important factor. A small proportion of patients appear to remain in this asymptomatic stage indefinitely (at least 20 years so far). These fortunate people have been intensively investigated as they may hold the key to finding effective treatments and even a cure for HIV infection. Although the patient is asymptomatic, HIV replication is continuing insidiously The patient is an infection risk to others. The CD4 positive lymphocyte counts drop progressively. The HIV copy number rises progressively.   3. AIDS AIDS is currently defined as an illness characterised by one or more indicator illnesses. The indicator illnesses have changed over the years from those included in the original list formulated by the CDC (Centers for Disease Control). The current list can be found in the British Medical Journal 2001; 322: 1226. AIDS can be diagnosed in the absence of laboratory proof of HIV infection (either the test has not been done or the results are inconclusive) if: Another cause for immune deficiency cannot be identified. Many patients do not know that they are HIV positive until they become clinically immunocompromised and are diagnosed with AIDS. Progression from primary infection to AIDS takes 5-8 years in the majority of HIV positive people living in developed countries. Clinical symptoms are particularly associated with CD4 positive lymphocyte counts below 200/microlitre, and especially below 100 (normal 500-2000). An increase in viral load. The direct effects of HIV infection on cells (such as those in the brain) and immunosuppression due to HIV infection causes a wide range of clinical illnesses including: Opportunistic infections: Fungal infections such as Oesophageal Candidiasis. Viral infections such as disseminated CMV infection. Bacterial infections such as Necrotising Ulcerative Periodontitis. Other infections such as Pneumocystis carinii pneumonia. Neoplasms Particularly Non-Hodgkin's Lymphoma and Kaposi's Sarcoma, both of which are associated with viral infections (EBV and HHV8 respectively). Dementia. The majority of patients with advanced HIV infection have oral lesions. Oral Lesions in HIV infection Oral lesions were recognized in the earliest descriptions of HIV disease. It subsequently became apparent that oral lesions had important relationships to: Immune status. HIV viral load. Progression and stage of HIV disease. For example, oral candidiasis and Hairy Leukoplakia correlate with: Low CD4 counts (a marker of immune suppression) High HIV viral load. The clinical severity of HIV infection. Mucosal lesions are often the earliest clinical indication that a patient has HIV infection. Accordingly, a patient with undiagnosed HIV infection may present to the dental team. Early diagnosis is important in optimising overall management. A wide range of different oral mucosal lesions have been described. A good summary of these remains 'Classification and diagnostic criteria for oral lesions in HIV infection'. Journal of Oral Pathology and Medicine 1993; 22: 289-291. This short paper was distributed in the lecture. Read it. Group 1 lesions that are strongly associated with HIV infection include: Candidiasis Erythmatous candidiasis. Pseudomembranous candidiasis. Hairy Leukoplakia. Kaposi's Sarcoma. Non-Hodgkin's Lymphoma. Periodontal Disease. Linear Gingival Erythema Necrotising (Ulcerative) Gingivitis. Necrotising (Ulcerative) Periodontitis. Also look at HIVdent: (www.HIVDENT.org/main.htm) This is a very good web site aimed at dentists that includes: Brief descriptions of the oral manifestations of HIV infection. Accompanying photographs. Advice about treament planning and provision of dental care. HAART has a major impact on oral lesions due to HIV infection and is considered below. Tobacco smoking is associated with an increase in oral lesions (except Recurrent Oral Aphthous Ulceration). Candidosis and HIV-periodontal disease are likley to be more exagerated in smokers. In contrast to other oro-facial lesions, salivary gland enlargement with associated xerostomia and CD8 positive lymphocyte infiltration is a good prognostic sign: Progression to end-stage AIDS tends to be delayed in these patients.   A patient with AIDS who presented via general dental practice. A. The dentist was concerned about the rapid alveolar bone loss and gingival recession that had not responded to oral hygiene therapy. B. A smooth-surfaced wart was present on the buccal mucosa. C & D. A small purple lesion on the dorsum of the tongue was a Kaposi's sarcoma. More obvious Kaposi's sarcomas involved the hard palate. Abundant Candida was cultured from the saliva. E. Examination of the skin identified further Kaposi's sarcomas. In addition, the patient had been receiving treatment for a number of warts involving the hands, but there had been little response to treatment. Diagnosis of HIV Infection Clinical signs and symptoms may raise the possibility that someone is HIV positive. However, remember that there may be other causes for similar clinical lesions: Glandular Fever-Like Syndromes during seroconversion. Patients may be immunocompromised for other reasons. The history may indicate that the patient belongs to a high risk group for transmission of Blood-borne Viruses including HIV: The relevant questions are considered in the Inoculation Injuries page. However, the diagnosis needs to be confirmed by detection of: HIV antibodies: Only positive following seroconversion. Assays of antibodies raised against HIV form the basis to what has become generically known as an 'AIDS test'. HIV RNA: Assays that estimate of the viral load are: Usually only undertaken when HIV antibodies are present. Important in the determination of: Timing of, and response to treatment. How infective a patient is (low titre, low infection risk). HIV testing should only be undertaken by someone with the appropriate training to counsel the patient. If you see a patient who you suspect may have undiagnosed HIV infection, a prompt referral should be made to an Oral Medicine Unit for further assessment in the near future.   Management of Patients with HIV Infection HIV infection cannot be cured. However, a great deal can be done to support patients with HIV infection and improve their quality of life. In the U.K. services are well-developed, but this is not the case for the majority of patients with HIV infection. HAART The development of HAART (Highly Active Anti-Retroviral Therapy) has had a major impact on the management of AIDS by slowing the progression to AIDS. Of relevance to dentistry: Many oral lesions regress. Although oral warts tend to increase in number and severity. Side effects can include: Dry mouth. Increased melanin pigmentation of oral mucosa - this can be unsightly. Perioral dysaesthesia. HAART can suppress HIV replication for many years allowing the patient to live a relatively normal life free from the symptoms of AIDS. Many systemic lesions regress and others, such as Non-Hodgkin's Lymphoma, are less likely to develop. HPV infections increase and there is an increased risk of cervical cancer in women. Although effective, HAART ultimately fails and HIV replication returns to high levels. Development of new oral lesions is associated with failure of HAART. HAART has only been available for a few years and is evolving all the time as new drugs become available, so the long term benefits and side effects remain unknown. Drugs that suppress HIV in different ways are included together. For example, these include: Reverse transcriptase inhibitors (e.g. AZT) that prevent reverse transcription of HIV RNA. Protease inhibitors that prevent cleavage of newly synthesized HIV proteins. This cleavage is essential for HIV replication. The potential benefits of HAART are considerable, but: It is expensive (unavailable to most patients with HIV around the globe). It can be associated with poor compliance (too many tablets to take every day). The side effects can be severe. HIV resistance is becoming more common. It ultimately fails in most patients. Dental Care of HIV Positive Patients The realization that patients can be HIV positive, yet clinically well, drove the adoption of current cross infection measures used in dental practice in the United Kingdom. The majority of patients who are HIV positive can be treated safely in general dental practice. Have a look at HIVdent. These patients should not be discriminated against. It is unethical to refuse to treat patients soley because they are HIV positive. It is also illogical as some HIV patients: Have not been diagnosed as being HIV positive. Will not declare to you that they are HIV positive. In the dental surgery, the risk of transmission to the dental team is negligible in the absence of Inoculation Injuries. Know what to do if an Inoculation Injury occurs. The dental team form a very important part of the overall team caring for patients who are HIV positive: It is essential that good oral health is established whilst the patient is in the asymptomatic phase prior to development of AIDS. The oral care of patients with AIDS is often more complex: Appropriate referral is then warranted, although it may still be possible to provide dental treatment in the general dental practice after an expert opinion has been obtained. HIV/AIDS IS REAL,ABSTAIN FROM PRE-MARITAL SEX,STAY AWAY AND PRACTICE SAFE SEX,BE FAITHFUL TO YOUR PARTNER ALONE,AND LIVE LONG. Sexually Self-control is better than pre-mature or untimely death: "Remember,the journey of i don't care always ends at the junction of had I know; dont die as a fool while there is a wisdom to guide and protect you to live long and enjoys life and nature". By. Rev.James.

What is HIV and What is AIDS? HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS. AIDS stands for Acquired Immune Deficiency Syndrome. HIV can be transmitted through the blood, sexual fluids, or breast milk of an HIV-infected person. People can get HIV if one of these fluids enters the body and into the bloodstream. The disease can be passed during unprotected sex with a HIV-infected person. An HIV-infected mother can transmit HIV to her infant during pregnancy, delivery or while breastfeeding. People can also become infected with HIV when using injection drugs through sharing needles and other equipment. Over time, infection with HIV can weaken the immune system to the point that the system has difficulty fighting off certain infections. These types of infections are known as opportunistic infections. These infections are usually controlled by a healthy immune system, but they can cause problems or even be life-threatening in someone with AIDS. The immune system of a person with AIDS has weakened to the point that medical intervention may be necessary to prevent or treat serious illness. Why is AIDS Education Important for Young People? The HIV epidemic has been spreading steadily for the past two decades, and now affects every country in the world. Each year, more people die and the number of people living with HIV continues to rise – in spite of the fact that we have developed many proven HIV prevention methods. We now know much more about how HIV is transmitted that we did in the early days of the epidemic, and we know much more about how we can prevent it being transmitted. One of the key means of HIV prevention is education – teaching people about HIV : what it is, what it does, and how people can protect themselves. Over half of the world’s population is now under 25 years old. This age group is more threatened by AIDS than any other; equally it is the group that has more power to fight the epidemic than any other. Education can help to fight HIV, and it must focus on young people. There are two main reasons that AIDS education for young people is important: To prevent them from becoming infected. Young people are often particularly vulnerable to sexually-transmitted HIV, and to HIV infection as a result of drug-use. Young people (15-24 years old) account for half of all new HIV infections worldwide - more than 6,000 become infected with HIV every day 1. More than a third of all people living with HIV or AIDS are under the age of 25, and almost two-thirds of them are women. In many parts of the world, young people in this age-group are at particularly high risk of HIV infection from unprotected sex, sex between men and IV drug-use because of the very high prevalence rates often found amongst people who engage in these behaviours. Young people are also often especially vulnerable to exploitation that may increase their susceptibility to infection. Even if they are not currently engaging in risk behaviours, as they become older, young people may soon be exposed to situations that put them at risk. Indeed, globally, most young people become sexually active in their teens. The fact that they are – or soon will be – at risk of HIV infection makes young people a crucial target for AIDS education. To reduce stigma and discrimination. People who are infected with HIV around the world often suffer terribly from stigma, in that people who are HIV+ are somehow thought to be ‘dirty’, or to have ‘brought it on themselves’ by ‘immoral practises’. They often experience discrimination in terms of housing, medical care, and employment. These experiences, aside from being extremely distressing for HIV+ people, can also have the effect of making people reluctant to be tested for HIV, in case they are found to be HIV+. Stigma and discrimination often starts early – as name-calling amongst children. AIDS education can help to prevent this, halting stigma and discrimination before they have an opportunity to grow. Why is AIDS education for young people an issue? The problem seems to stem from the fact that HIV is often sexually transmitted, or is transmitted via drug use. Any subject that concerns sex between young people or drug use tends to be seen from a moralistic perspective – many adults, particularly those of the religious right – believe that teens need to be prevented from indulging in these high-risk activities. They believe that young people shouldn’t – and don’t need to be – provided with any education about these subjects, other than to be told that they are ‘wrong’, and not to do such things. Unfortunately, however, adults have been trying to stop young people from having sex and taking drugs for many, many years with little success, so this method alone seems unlikely to offer any real relief in the AIDS epidemic. There are other difficulties in talking an exclusively moral approach to HIV education. Firstly, this is what tends to perpetuate stigmatisation of HIV+ people. By teaching young people that indulging in ‘immoral’ sex and drugs will lead to HIV infection, educators imply that anyone who is HIV+ is therefore involved in these ‘immoral’ activities. This stigmatisation tends to make people reluctant to be tested for HIV, and therefore more inclined to remain ignorant of their status – and perhaps go on to infect others. AIDS education shouldn’t ever include a moral judgement – it is one thing to teach young people that promiscuous sex and intravenous drug use are unsafe, another thing to teach them that these things are morally wrong. AIDS education shouldn’t ever include a moral judgement – it is one thing to teach young people that promiscuous sex and intravenous drug use are unsafe, another thing to teach them that these things are morally wrong. Many AIDS educators around the world are disturbed at this growing trend to provide AIDS education from a moralistic perspective, and argue that AIDS education ought to be non-judgemental, teaching what the dangers are and how they can be avoided – without passing moral judgement on those who engage in infection-related behaviours, whether they do so safely or not. The opposing, more conservative viewpoint, however, argues that young people shouldn’t be taught about sexual health and drug-related dangers at all. They feel that teaching them about these things, even teaching about their dangers, may encourage young people to indulge in these risk behaviours. Research suggests that this is not the case at all, and certainly young people themselves tend to be very definite about the fact that they need sex and sexual health education. Unfortunately, curriculum planners tend not to listen to the young people who will be their students. This viewpoint can result in no AIDS education at all being offered. “I did not go to school and learn about the civil war and decide to start a civil war, nor would I have had sex because of a class in school.” - Mark - However, many young people become sexually active long before adults would prefer them to do so, or expect them to do, and teens are not all ‘innocent ‘.Quite simply, if teens are having sex, they need sexual health information. Fortunately, many curriculum planners and legislators have recognised this, and provide young people in many countries with abstinence-plus or comprehensive sex & HIV education. Different approaches to AIDS education for young people Most countries in the world offer teens some sort of sexual health and HIV education in their schools at some stage. AIDS education can also be targeted at young people in non-school environments – through their peers, through the media, and through doctors or their parents. In some countries, individual schools are allowed to determine what AIDS education they will offer. In other countries, this is determined by legislation passed by central government. And in other countries – especially poor ones that are severely affected by HIV – AIDS education is imported by foreign governments, charities and NGOs come in to the country and deliver AIDS education as part of a larger package of HIV prevention work. AIDS education for young people today falls generally into one of two categories - either Abstinence-only or Comprehensive. These are actually types of sex education, rather than AIDS education specifically - AIDS education in many schools comes as a part of a sex education program, if it occurs at all. The type of AIDS education program that is offered usually depends on the attitudes of those who determine the syllabus content – right wing organisations, many Christian organisations, and the family-values lobby tend to prefer Abstinence-only education, while those who feel that preventing young people from becoming infected with HIV is more important than keeping them ignorant about sexual behaviour – prefer comprehensive AIDS education. A report found that over 80% of abstinence-only curricula contained false or misleading information Abstinence-only education teaches students that they must say no to sexual activity until they are married. This approach does not teach students anything about how to protect themselves from STDs or HIV, how pregnancy occurs or how to prevent it, and teaches about homosexuality and masturbation only as far as to say that they are wrong. Those who favour this method of education claim that teaching young people about sex will make them want to try it - thus increasing their risk of contracting HIV, amongst other things. Abstinence-only education is popular in America, especially so now that it has a Republican President. A House of Representatives report at the end of 2004 found that over 80% of abstinence-only curricula contained false or misleading information – something that is worrying now not only for those in America but increasingly for the rest of the world, as America exports its HIV-prevention and Education attitudes to parts of the world with a much higher HIV prevalence. This is particularly worrying in that abstinence-only programmes have been shown not only to fail to reduce the numbers of STD infections and unplanned pregnancies seen in pupils, but recent studies indicate that they might actually be related to an increase in these problems. Comprehensive AIDS education teaches about sexual abstinence until marriage, and teaches that it is one way of protecting yourself from HIV transmission, STDs and unwanted pregnancy. It also teaches that there are other ways of preventing these things, such as condom use. People who favour this approach take the perspective that young people should be taught to remain sexually abstinent until marriage, but that there will always be some who won't - and that they must be provided with the information to enable them to protect themselves. This type of education also teaches not only about the dangers of drug use, but also about methods of HIV-prevention that drug users can employ – the use of clean needles, for example. Abstinence-only and Comprehensive AIDS education have been combined to produce Abstinence-plus education. This type of education focuses on sexual abstinence until marriage as the preferred method of protection, but also provides information about contraception, sexuality and disease prevention. Many abstinence-only campaigners complain that abstinence-plus and comprehensive education are the same thing, although abstinence-plus educators claim that this type of course contains more focus on sexual abstinence until marriage. There has been debate for many years over which form of sex education is most effective in terms of preventing underage sex, unwanted pregnancy and STD and HIV transmission – although most studies seem to show that comprehensive sex and AIDS education is at least as effective as abstinence-only – and probably more so. However, currently the trend in America – and which is being exported to much of the developing world – is towards abstinence-only education. If it is as unsuccessful as studies indicate it to be, then we can expect this morality-induced type of education become responsible for an increase in HIV figures amongst the young, especially in high-prevalence parts of the world to which America has taken its methods. Fifteen percent of Americans believe that schools should teach only about abstinence from sexual intercourse and should not provide information on how to obtain and use condoms and other contraception. Forty-six percent believe that the most appropriate approach is abstinence-plus 2. Almost half of those surveyed felt that the word ‘abstinence’ included not only sexual intercourse, but ‘passionate kissing’ and ‘masturbation’, too. What types of AIDS education can be offered outside schools? Not all young people are fortunate enough to attend school. This might be for one of a variety of reasons – in some countries, it is necessary to pay for schooling. Poor families may be unable to afford to send a child to school, or may be unable to send all their children to school. Sometimes children will be required to work, making them unavailable for school. In other areas, young people may live in areas where a local school is not accessible. In some situations, young people may have been excluded from school for reasons that might be due to the young person’s behaviour, academic or intellectual abilities, or due to discrimination. Some young people play truant, and will have only very limited attendance. The proportion of young people who attend school differs markedly in various parts of the world. Clearly, although AIDS education offered through the school might reach many young people, it will not reach all, and other forms of education are required. One of these is the media. Most young people will, at some time, be exposed to the media – this can include newspapers, television, books, radio – and also traditional media such as street performances or murals. One advantage of media-based AIDS education is that it can target specific groups amongst the population – if the message is to be targeted at young people, then it will be placed in media that are favoured by this audience. Many countries have tried some form of AIDS education advertisements, films, or announcements – a good example of this is the LoveLife campaign in South Africa – an education program ‘by young people, for young people’. LoveLife used eye-catching posters and billboards to tell young people that sex was fun – but that it could be dangerous, too. The campaign also inserted its message into TV soaps that were popular with young people, and used rap and kwaito music to get its message across. There are problems with media-based campaigns, too, however – it is hard to know to what extent the AIDS information has reached young people, and it is difficult to gain continued funding for initiatives whose success is so hard to measure. Another way in which young people receive information about sex and HIV is through their peers. This is something that happens anyway to a great extent -  many young people receive their first information about sexuality from their friends, although this information is often distorted and inaccurate. This type of peer education can be harnessed, though, and used to convey accurate, targeted information. Peer education is, quite simply, the process by which a group is given information by one of their peers who has received training and accurate information. This is a method often used with groups which have been marginalised, and might have cause to distrust information given to them by an authority figure – whereas they will listen to someone who is identifiably a member of their own group. This method of information-provision is often used with such groups as sex workers, the homeless, or drug-users. There is no reason that this method shouldn’t be used with young people, however – and in many parts of the world, it is used. Indeed, it is particularly appropriate for young people who do not attend schools and will not have an opportunity to benefit from an AIDS education curriculum. AIDS education for the future Although the debate continues about how much – if any – AIDS education young people should receive, studies continue to show that being informed about the facts and the dangers of HIV and AIDS enables young people to protect themselves and is a crucial tool in the battle against HIV. There is no cure or vaccine for HIV – prevention is the only way in which we can place any limits on the epidemic. One of the most economical and effective means of HIV prevention is education – involving young people themselves in the HIV prevention effort. On a global level, America’s disposition towards the promotion of abstinence-only education is cause for concern. America’s spending on HIV prevention around the world exceeds that of any other country, and is to be welcomed – as long as it doesn’t use this money to promote its pro-abstinence-only views of AIDS education. Global HIV/AIDS estimates, end of 2006 The latest statistics on the world epidemic of AIDS & HIV were published by UNAIDS/WHO in November 2006, and refer to the end of 2006.                  Groups Estimate Range People living with HIV/AIDS in 2006 39.5 million 34.1-47.1 million Adults living with HIV/AIDS in 2006 37.2 million 32.1-44.5 million Women living with HIV/AIDS in 2006 17.7 million 15.1-20.9 million Children living with HIV/AIDS in 2006 2.3 million 1.7-3.5 million People newly infected with HIV in 2006 4.3 million 3.6-6.6 million Adults newly infected with HIV in 2006 3.8 million 3.2-5.7 million Children newly infected with HIV in 2006 0.53 million 0.41-0.66 million AIDS deaths in 2006 2.9 million 2.5-3.5 million Adult AIDS deaths in 2006 2.6 million 2.2-3.0 million Child AIDS deaths in 2006 0.38 million 0.29-0.50 million More than 25 million people have died of AIDS since 1981. Africa has 12 million AIDS orphans. At the end of 2006, women accounted for 48% of all adults living with HIV worldwide, and for 59% in sub-Saharan Africa. Young people (15-24 years old) account for half of all new HIV infections worldwide - around 6,000 become infected with HIV every day. In developing and transitional countries, 6.8 million people are in immediate need of life-saving AIDS drugs; of these, only 1.65 million are receiving the drugs. Regional statistics for HIV & AIDS, end of 2006 Region Adults & children living with HIV/AIDS Adults & children newly infected Adult prevalence* Deaths of adults & children Sub-Saharan Africa 24.7 million 2.8 million 5.9% 2.1 million North Africa & Middle East 460,000 68,000 0.2% 36,000 South and South-East Asia 7.8 million 860,000 0.6% 590,000 East Asia 750,000 100,000 0.1% 43,000 Oceania 81,000 7,100 0.4% 4,000 Latin America 1.7 million 140,000 0.5% 65,000 Caribbean 250,000 27,000 1.2% 19,000 Eastern Europe & Central Asia 1.7 million 270,000 0.9% 84,000 Western & Central Europe 740,000 22,000 0.3% 12,000 North America 1.4 million 43,000 0.8% 18,000 Global Total 39.5 million 4.3 million 1.0% 2.9 million * Proportion of adults aged 15-49 who were living with HIV/AIDS During 2006 around four million adults and children became infected with HIV (Human Immunodeficiency Virus), the virus that causes AIDS. By the end of the year, an estimated 39.5 million people worldwide were living with HIV/AIDS. The year also saw around three million deaths from AIDS, despite recent improvements in access to antiretroviral treatment. How can HIV transmission be prevented? HIV can be transmitted in three main ways: Sexual transmission Transmission through blood Mother-to-child transmission Wherever there is HIV, all three routes of transmission will take place. However the number of infections resulting from each route will vary greatly between countries and population groups. For each route of transmission there are things that an individual can do to reduce or eliminate risk. There are also interventions that have been proven to work at the community, local and national level. To be successful, an HIV prevention programme must make use of all approaches known to be effective, rather than just implementing one or a few select actions in isolation. Although most of this page looks separately at each transmission route, it should be remembered that many people don’t fit into only one “risk category”. For example, injecting drug users need access to condoms and safer sex counselling as well as help to reduce the risk of transmission through blood. First requirements There are three key things that can be done to help prevent all forms of HIV transmission. First among these is promoting widespread awareness of HIV and how it can be spread. Media campaigns and education in schools are among the best ways to do this. Another essential part of a prevention programme is HIV counselling and testing. People living with HIV are less likely to transmit the virus to others if they know they are infected and if they have received counselling about safer behaviour. In particular, a pregnant woman who has HIV will not be able to benefit from interventions to protect her child unless her infection is diagnosed. Those who discover they are uninfected can also benefit, by receiving counselling about how to remain that way.1, 2 The third key factor is providing antiretroviral treatment. This treatment enables people living with HIV to enjoy longer, healthier lives, and as such it acts as an incentive for people to volunteer for HIV testing. It also brings people into contact with health care workers who can deliver prevention messages and interventions. However, it is important that people understand the limitations of the treatment, and that reduced fear of HIV doesn’t lead to more risky behaviour.3 Sexual transmission What works? Someone can eliminate or reduce their risk of becoming infected with HIV during sex by choosing to: Abstain from sex or delay first sex Be faithful to one partner or have fewer partners Condomise, which means using male or female condoms consistently and correctly There are a number of effective ways to encourage people to adopt safer sexual behaviour, including media campaigns, social marketing, peer education and small group counselling. These activities should be carefully tailored to the needs and circumstances of the people they intend to help. Specific programmes should target key groups such as young people, women, men who have sex with men, injecting drug users and sex workers.4, 5, 6 Comprehensive sex education for young people is an essential part of HIV prevention. This should include training in life skills such as negotiating healthy sexual relationships, as well as accurate and explicit information about how to practise safer sex. Studies have shown that this kind of comprehensive sex education is more effective at preventing sexually transmitted infections than education that focuses solely on teaching abstinence until marriage.7, 8 Numerous studies have shown that condoms, if used consistently and correctly, are highly effective at preventing HIV infection.9 Also there is no evidence that promoting condoms leads to increased sexual activity among young people. Therefore condoms should be made readily and consistently available to all those who need them.10 Another significant intervention is providing treatment for sexually transmitted infections, such as chlamydia and gonorrhoea. This is because such infections, if left untreated, have been found to facilitate HIV transmission during sex.11, 12 A number of studies have found male circumcision to be associated with a lower rate of HIV infection. However, it is not yet clear to what extent this is an effect of circumcision itself, or whether other factors may also play a role, and the World Health Organisation has yet to recommend circumcision for HIV prevention. Further research on this issue is ongoing.13, 14 One group that shouldn’t be overlooked by HIV prevention programmes is those who are already living with the virus. Regular counselling can help HIV positive people to sustain safer sexual behaviour, and so avoid onward transmission.15, 16 What are the obstacles? It is usually not easy for people to sustain changes in sexual behaviour. In particular, young people often have difficulty remaining abstinent, and women in male-dominated societies are frequently unable to negotiate condom use, let alone abstinence. Many couples are compelled to have unprotected sex in order to have children. Others associate condoms with lack of trust or inappropriate sexual experience.17 Some societies find it difficult to discuss sex openly, and some authorities restrict what subjects can be discussed in the classroom, or in public information campaigns, for moral or religious reasons. Particularly contentious issues include premarital sex, condom use and homosexuality, the last of which is illegal or taboo in much of the world. Marginalisation of groups at high risk, such as sex workers and men who have sex with men, can be another hindrance to HIV prevention efforts. Transmission through blood What works? People who share equipment to inject recreational drugs risk becoming infected with HIV from other drug users. Methadone maintenance and other drug treatment programmes are effective ways to help people eliminate this risk by giving up injected drugs altogether. However, there will always be some injecting drug users who are unwilling or unable to end their habit, and these people should be encouraged to minimise the risk of infection by not sharing equipment.18 Needle exchange programmes have been shown to reduce the number of new HIV infections without encouraging drug use. These programmes distribute clean needles and safely dispose of used ones, and also offer related services such as referrals to drug treatment centres and HIV counselling and testing. Needle exchanges are a necessary part of HIV prevention in any community that contains injecting drug users.19 Also important for injecting drug users are community outreach, small group counselling and other activities that encourage safer behaviour and access to available prevention options.20 Transfusion of infected blood or blood products is the most efficient of all ways to transmit HIV. However, the chances of this happening can be greatly reduced by screening all blood supplies for the virus, and by heat-treating blood products where possible. In addition, because screening is not quite 100% accurate, it is sensible to place some restrictions on who is eligible to donate, provided that these are justified by epidemiological evidence, and don’t unnecessarily limit supply or fuel prejudice. Reducing the number of unnecessary transfusions also helps to minimise risk.21, 22 The safety of medical procedures and other activities that involve contact with blood, such as tattooing and circumcision, can be improved by routinely sterilising equipment. An even better option is to dispose of equipment after each use, and this is highly recommended if at all possible. Health care workers themselves run a risk of HIV infection through contact with infected blood. The most effective way for staff to limit this risk is to practise universal precautions, which means acting as though every patient is potentially infected. Universal precautions include washing hands and using protective barriers for direct contact with blood and other body fluids.23 What are the obstacles? Despite the evidence that they do not encourage drug use, some authorities still refuse to support needle exchanges and other programmes to help injecting drug users. Restrictions on pharmacies selling syringes without prescriptions, and on possession of drug paraphernalia, can also hamper HIV prevention programmes by making it harder for drug users to avoid sharing equipment. Many resource-poor countries lack facilities for rigorously screening blood supplies. In addition a lot of countries have difficulty recruiting enough donors, and so have to resort to importing blood or paying their citizens to donate, which is not the best way to ensure safety. In much of the world the safety of medical procedures in general is compromised by lack of resources, and this may put both patients and staff at greater risk of HIV infection. Mother-to-child transmission What works? HIV can be transmitted from a mother to her baby during pregnancy, labour and delivery, and later through breastfeeding. The first step towards reducing the number of babies infected in this way is to prevent HIV infection in women, and to prevent unwanted pregnancies. There are a number of things that can be done to help a pregnant woman with HIV to avoid passing her infection to her child. A course of antiretroviral drugs given to her during pregnancy and labour as well as to her newborn baby can greatly reduce the chances of the child becoming infected. Although the most effective treatment involves a combination of drugs taken over a long period, even a single dose of treatment can cut the transmission rate by half.24 A caesarean section is an operation to deliver a baby through its mother’s abdominal wall, which reduces the baby’s exposure to its mother’s body fluids. This procedure lowers the risk of HIV transmission, but is likely to be recommended only if the mother has a high level of HIV in her blood, and if the benefit to her baby outweighs the risk of the intervention.25, 26 Weighing risks against benefits is also critical when selecting the best feeding option. The World Health Organisation advises mothers with HIV not to breastfeed whenever the use of replacements is acceptable, feasible, affordable, sustainable and safe. However, if safe water is not available then the risk of life-threatening conditions from replacement feeding may be greater than the risk from breastfeeding. An HIV positive mother should be counselled on the risks and benefits of different infant feeding options and should be helped to select the most suitable option for her situation.27 What are the obstacles? In much of the world a lack of drugs and medical facilities limits what can be done to prevent mother-to-child transmission of HIV. Antiretroviral drugs are not widely available in many resource-poor countries, caesarean section is often impractical, and many women lack the resources needed to avoid breastfeeding their babies. HIV-related stigma is another obstacle to preventing mother-to-child transmission. Some women are afraid to attend clinics that distribute antiretroviral drugs, or to feed their babies on formula, in case by doing so they reveal their HIV status. Learn more about Hiv/Aids: http://www.avert.org,  http://www.amfar.org,