Introduction
Human immunodeficiency virus (HIV) is a virus that alters the human immune system, spread through the body fluids making people much more vulnerable to infection and disease (Okugbe, 2012).
An acronym for acquired immune deficiency syndrome (AIDS), is a specific group of infection and deadly disease resulting from immune suppression caused by a microscopic germ known as human immune deficiency virus (HIV), it renders the body susceptible to fatal attacks by diseases against the body which the body could have normally resisted (WHO, 2007).
AIDS is a late and severe stage of HIV infection as HIV infection progresses, the CD4+ count continues to decrease and the individual is infected with HIV. It affects and kills the CD4 – T cell (a specific type of white blood cells). The CD4 cell in the blood reflects the state of immune system. The effect of HIV is measured by the decline in the number of CD4+ cells. The normal count in the normal adult is between 600 – 1, 200 cells (Ross and Wilson, 2011).
There are two types of HIV, Type 1 and Type 2. Type 1 can be broken down into several subgroups base on location and type 2 which seems to be less easy to transmit. Both are contacted through the exchange of body fluids, and both can cause clinically indistinguishable AIDS, the final life threatening stage of HIV.
According to a 2013 report issued by Joint United Nations Programme on HIV/AIDS, the number of HIV positive people in Africa receiving anti-retroviral treatment in 2012 was over seven times the number receiving treatment in 2005 “with nearly 1 million added in the last year alone”. The number of AIDS related deaths in sub Saharan Africa in 2011 was 33 percent less than the number in 2005. The number of new HIV infections in 2011 was 25% less than the number in 2001. Nigeria has the second largest absolute number of people living with HIV/AIDS in the world at 2.9 million following South Africa estimated at 5.5 million (WHO, 2007). Approximately 3.9% of adult women ages 15 – 49 were the positive as of 2005, HIV prevalence is estimated to be 75%, among Nigeria’s estimated one million sex workers. The Niger Delta region has the second highest HIV prevalence in Nigeria at 5.3%, with the highest prevalence (6.1%) in the North Central region and lowest prevalence is the South-West region (2.6%). However, though not population based, two clinical studies have reported higher HIV prevalence among pregnant women in Niger Delta (Macilwain, 2007).
Conceptual framework
Mark (2012), defines HIV (human immunodeficiency virus) as a virus that causes AIDS. This virus is passed from one person to another through blood to blood contact and sexual contact. According to Almonti (2003), HIV is the cause of the spectrum of disease known as HIV/AIDS. HIV is a retrovirus that primarily infects components of the human immune system such as CD4+ T – cell and microphages and dendritic cells. It indirectly destroys CD4+ T-cells.
According to Luckier (2009), acquired immune deficiency syndrome also called the “slim” disease in some countries is a medical distribution of a combination of illnesses which result from a specific weakness or destruction of the body’s immune systems by strange virus known as HIV. HIV is in type 1 and 2. The HIV weakens the immune system by entering the lymphocytes cell and finally destroys the white blood cells (14 lymphocyte). As more and more lymphocytes are destroyed, the body’s immune system, and the body become weak and inactive to fight infections. Eventually, the person is likely to contact a number of serious diseases which the body cannot resist or fight. Sepkowitz (2001) defined HIV/AIDS as a disease of the human immune system caused by human immunodeficiency virus (HIV). During the initial infection, a person may experience brief period of influenza like illness. This is typically followed by a prolonged period without symptoms. As illness progresses, it interferes more and more with the immune system making the person much more likely to get infections, including opportunistic infections and tumours that do not usually affect people who have working immune system.
Pharries (2011) says that some form of serious discrimination can include being expelled from school, being denied housing, having to pay extra rent and job loss. Persons who have or are perceived to have HIV/AIDS experience discrimination in various aspects of life. In the United States, disability laws prohibit HIV/AIDS discrimination in housing, employment, education and social services. Current research has found that discrimination against people living with HIV is a contributing factor for delayed initiation of HIV treatment. As many as 20 – 40% of Americans do not begin a care regimen within the first 6 month after diagnosis.
Mugaverd (2008) states that when an individual begins treatment late in the progression of HIV (when CD4+ T cells counts are below 500 cells /ul), they have 1.94 times the rest of mortality compared to those whose treatment is initiated when CD4+ T cells are still above 500 cells/ul). Pollini (2011) said that the most common reasons is not seeking treatment and “I did not want to tell anyone I was HIV Positive”, I do not want to think about being HIV positive” and “I was too embarrasses/ ashamed to go”. The presence and perpetuation of HIV stigma prevents many who are able to obtain treatment from feeling comfortable about addressing their health status.
Andrew (2006) Accommodation for HIV/AIDS employee, federal legislation not only prohibits discrimination against handicapped persons, but also requires employers to make reasonable effort to accommodate applicants and employee where obstacles exist that would impede their employment opportunities. In so far as an employee with HIV/AIDS is considered handicapped, an employer must make reasonable accommodation for him or her. In addition, if your company is covered by the Rehabilitation Act and an employee has HIV/AIDS or develop it, you must make reasonable accommodation that permit the employee to continue working in the position.
Mode of transmission/causes of HIV/AIDS
Most commonly, HIV infection is spread through sex with an infected partner. The virus can enter through the lining of the vagina, vulva, penis, rectum or mouth during sex. Although intercourse is the primary risk factor, oral sex transmission is also possible.
To become infected with HIV, infected blood, semen or vaginal secretions must enter the body. A person cannot be infected through ordinary contact, dancing, hand shaking, using the same towel or eating together with someone who has HIV or AIDS. HIV cannot be transmitted through the air, water or via insect bites (Mayo, 2010).
Thomson (2010) opined that HIV can be transmitted from mother to a child during pregnancy, delivery or through breastfeeding. In the absence of treatment, the risk of transmission before birth is around 20% and 30% of HIV cases.
Rose and Wilson (2010) convey that HIV/AIDS is found or located in the body fluid; that is the blood, saliva, tears, vagina secretion and breast milk etc. which can be transmitted when fluid from an infected person enters another person which is the host through direct and indirect contact.
Signs and symptoms of HIV/AIDS
According to WHO (2007), symptoms which occur in 40% of cases and most common include fever, large tender lymph node, throat inflammation, a rash, headache and sore in the mouth and genitals. Some people also develop opportunistic infections at this stage.
According to Grad (2002), the symptoms of HIV/AIDS includes prolonged enlargement of gland in the neck, diarrhoea, persistent skin cancer, weight loss, fatigue, encephalopathy from the brain, candidiasis, cryptocollosis, salomillosis. These are further highlighted in two ways.
Minor signs (Grad, 2002)
- Cough for more than one month
- Itchy skin or cancer
- Candidiasis in the mouth and throat
- Increase in gland in two or more sites.
Major signs (Grad, 2002)
- Fever longer than a month
- Weight loss than ten percent of the weight
- Diarrhoea longer than one month.
- Persistence severe fatigue
Incubation period
According to Luckier (2009), HIV/AIDS is associated with a long term incubation period depending on individual exposure to HIV infection followed by acute fever. In this stage the patient presents with complain of frequent fever, night sweat and malaria. Some individuals with HIV fail to produce antibody which advance clinical AIDS. They will be tested negative yet they have the virus in them. It takes a longer period between seven or more years before most people develop AIDS.
Window period: Lasts between 2 to 12 weeks after infection have occurred in the blood stream (Luckier, 2009).
Acute infection stage: This can take up to three (3) to six (6) months after infection have occurred in the body, the host may be having fever, malaria and diarrhoea but the person will feel normal and healthy if well treated and adequately balanced diet be recommended (Luckier, 2009).
Clinical manifestation stage: In this stage, signs and symptoms of HIV infections has started manifesting which will last from six months to twenty years and above (Luckier, 2009).
Early symptomatic HIV infection: As the virus continue to multiply and destroy immune cells, one may develop mild infections or chronic symptoms such as fever, swollen lymph often one of the first signs of HIV infections, diarrhoea, weight loss, cough and shortness of breath (Luckier, 2009).
Progression to AIDS: If a person receives no treatment for his or her infections, the disease typically progresses to AIDS in about 10 years. By the time the AIDS develops the person immune system has been severely damaged, making him or her susceptible to opportunistic infectious diseases that would not trouble a person with healthy immune system. The signs and symptoms include soaking night sweats, chronic diarrhoea, headache, cough and shortness of breath (Luckier, 2009).
Prevention of HIV/AIDS
WHO (2007), circumcision in sub-Saharan Africa reduce the acquisition of HIV heterosexual men between 28% and 66% over 24 months. Based on these studies, the World Health Organization and UNAIDS both recommended male circumcision as a method of preventing female to male transmission.
Bounce (2002), consistent condom use reduces the risk of HIV transmission by proximately 50% over the long lime.
Means that HIV cannot be transmitted
Okugbe (2012) states that it is very important for people to understand how HIV/AIDS is not spread in ordinary daily life as to understand how it is spread through sex and blood contact. Otherwise as people begin to see AIDS as a serious problem and threat to life, they may panic and reject people living with the HIV infection. They may obstruct them and their families and call for all sorts of repressive measures against them. These reactions include;
- Living in the same house with an infected person
- Playing together.
- Hand shaking and touching each other
- Eating and drinking together
- Hugging and dancing together
- Sharing of water, food and cups
- Being bitten by insects like mosquitoes, lice and others.
The importance of recognizing that normal social contact and daily living experience do not spread the AIDS virus as it is assumed by the layman. Therefore the behavioural attitude and reaction of people towards family members, friends and co-workers who have the virus should be re-addressed. There are grounds for dismissing people for employment, removing children from schools, avoiding friends or relatives and other social activities because of HIV/AIDS (Okugbe, 2012).
References
Alimonti, J. (2003). Mechanism of CD4+ T – Lymphoctye Cell. Death in HIV/AIDS. J. Gen. Virol. 7:61-63.
Grad, B. (2006). Emerging Concept in the Immunopathogenesis of AIDS. Annu. Rev. Med. (20): 471 – 484.
Luckier, B. (2009). Essentials of Community Primary Health Care of HIV/AIDS and Complications. Lagos: College Press.
Mark, C. (2012). Living with HIV/AIDS Patients. Michigan: Scott Press.
Mugaverd, M. (2008). “Improving Engagement in HIV Care: What We Can Do”. Top HIV Med 16(5):156 – 161.
Okugbe, B. (2012). Nigeria People and Culture. Ughelli: Ital Printing Press
Panel on Antiretroviral Guide For Adult and Adolescent (2011). “Guidelines for the Use of Antiretroviral Agent in HIV-1-Infected Adults and Adolescents”. New York: Department of Health and Human Science.
Pharris, K. (2006). Community pattern of Stigma towards Person Living with HIV: A Population Base Latent Analysis From Rural Vietnam. BMC Public Health 705: 314-321
Pollin, A. B. C. (2011). “A Community Base Study of Barriers to HIV Care and Initiation” AIDS Patient’s Care and STDs 14: 601 -609
Ross, A. & Wilson, G. (2010). Anatomy and Physiology in Health and Illness. Livingstone: Elsevier Inc
Sepkowitz, K. (2001). The First 20 Years. N. England Journal of Medicine, (23): 344- 49.
