What are the factors influencing HIV
transmission/spreading?
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Some factors that influence HIV transmission
1. Lack of information and services for
adolescent girls
2. Violence against women
3. Lack of treatment and prevention options for
women.
4. Cultural and social expectations for boys
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Some factors that influence HIV transmission …
5. HIV transmission is not a random event
-The spread of the virus is profoundly influenced by
the surrounding social, economic and political
environment.
-Wherever people are struggling against adverse
conditions, such as poverty, discrimination and
illiteracy, they are especially vulnerable
-Efforts to prevent the spread of HIV need to focus
both on individual risk behaviour, and on the broad
structural factors underlying exposure to HIV—so as to
help people control the risks they take and thereby
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protect themselves.
Some factors that influence HIV transmission…
6. Vulnerability, risk and the impact of AIDS coexist in
a vicious circle.
• Vulnerability can be reduced by providing young
people with schooling, supporting protective family
environments and extending access to health and
support services population-wide.
• Addressing vulnerability at the structural level
includes reforming discriminatory laws and policies,
monitoring practices and providing legal protections
for people living with HIV.
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Some factors that influence HIV transmission…
7. Challenges in scaling up antiretroviral treatment.
8. AIDS-related stigma hampers the response and
accelerates transmission. In many countries stigma
and discrimination remain important barriers to
understanding how marginalized groups of society
are coping with the epidemic.
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Some factors that influence HIV transmission…
9. Risk behaviour on the rise
• In South Asia, behavioural information suggests that
conditions are ripe for HIV to spread.
• For example, in Bangladesh, national adult
prevalence is less than 0.1%, but there are significant
levels of risky behaviour.
• Large numbers of men continue to buy sex in greater
proportions than elsewhere in the region.
• Moreover, most of these men do not use condoms in
their commercial sex encounters and female sex
workers report the lowest condom use in the region.
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Some factors that influence HIV transmission…
10. Mobility and the spread of HIV
• Human mobility has always been a major driving
force in epidemics of infectious disease.
• Two recent studies have examined its role in the
spread of HIV.
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• In Yaoundé, Cameroon.
• One study on the relationship between mobility,
sexual behaviour and HIV infection in an urban
population interviewed a representative sample of
1913 men and women in Yaoundé, Cameroon.
• It found HIV prevalence of 7.6% among men who
had been away from home for periods longer than 31
days.
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• Prevalence among those who had been away for less
than 31 days in the year was 3.4%, while prevalence
among those who had not been away from home in
the previous 12 months was 1.4%.
• The association between men’s mobility and HIV was
apparently related to risky sexual behaviour and
remained significant after controlling for other
important variables.
• There was no association between women’s mobility
and HIV infection (Lydié et al., 2004).
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• KwaZulu-Natal, South Africa
• Across Southern Africa, the phenomenon of men
migrating to urban centres in search of work and
leaving their partners and children at home in rural
areas is widespread and has complex historical roots.
• Researchers interested in the role migration plays in
spreading HIV in South Africa studied the pattern of
infection in couples in Hlabisa, a rural district of
KwaZulu-Natal, in which nearly two-thirds of adult
men spent most nights away from home.
• The study confirmed that migration does play an
important role in spreading HIV but revealed a more
complex picture than had been expected, which
challenged some basic assumptions.
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• Looking at discordant couples (that is, couples in
which just one partner is HIV-positive), the study
found that, in nearly 30% of cases, the infected
person was the female partner who stayed home in
the rural area, while her migrant partner was HIVnegative.
• In other words, migration may create vulnerability to
HIV exposure at both ends of the trail, and the virus
may be spread in both directions (Lurie et al., 2003).
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• The association of mobility with HIV infection may
also affect the findings of household surveys.
• Mobile men, who generally have higher levels of HIV
infection, are less likely to be found at home for these
surveys.
• This is especially important in countries with high
levels of mobility or migration, and for surveys with a
high proportion of absentees.
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HIV/AIDS and Conflicts
• Factors in conflicts that may lead to the spread of
HIV
• Armed conflict can increase the likelihood of
exposure to HIV infection in several of the following
ways:
– Population displacement
– Breakdown of traditional sexual norms
– Women and girls become more vulnerable
– Rape as a ‘weapon of war’
– Collapse of health systems
– Increased substance use
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HIV/AIDS and Conflicts…
• For example, in Rwanda, the 1994 genocide is
believed to have contributed to the epidemic
expanding to rural areas, which had previously been
less affected.
• This came about because urban and rural populations
were mixed together in refugee camps in
neighbouring countries.
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HIV/AIDS and Conflicts …
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Challenges of A Pandemic: HIV/AIDS Widows
???
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AIDS and orphans: a tragedy unfolding
???
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AIDS and orphans: a tragedy unfolding …
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AIDS and orphans: a tragedy unfolding
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AIDS and orphans: a tragedy unfolding …
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AIDS and orphans: a tragedy unfolding …
•Mobilizing community-based responses
•Communities are capable of responding effectively to
the plight of orphans and children whose parents are
dying of AIDS?
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The impact of AIDS on people and societies
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The impact on population and population structure
The impact of AIDS on poverty and hunger
Impact on agriculture and rural development
Impact on the supply, demand and quality of education
Impact on the health sector
Impact on public-sector capacity
Impact on workers and the workplace
Macroeconomic impact
Denial of women’s property and inheritance rights
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The impact of AIDS on people and societies
• The impact on population and population structure
• Sub-Saharan Africa has the world’s highest HIV
prevalence and faces the greatest demographic impact.
• In the worst-affected countries of Eastern and
Southern Africa, the probability of a 15-year-old dying
before reaching age 60 has risen dramatically.
• HIV’s impact on adult mortality is greatest on people
in their twenties and thirties, and is proportionately
larger for women than men.
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The impact of AIDS on people and societies
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The impact of AIDS on people and societies
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Reducing HIV transmission
•Forthright national leadership
•Widespread public awareness
•Intensive prevention efforts have enabled entire nations
to reduce HIV transmission.
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Challenges of the ‘Next Agenda’
- UNAIDS, 2004
•The epidemic has placed multiple challenges before
the international community, cutting across every
sector. These challenges include:
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Challenges of the ‘Next Agenda’
- UNAIDS, 2004
•Embedding the message that AIDS is both a global
emergency and a long-term development crisis that
requires an exceptional and sustained response, far
beyond the scale of what we have seen to date.
•Ensuring there is universal recognition that AIDS is
reversing decades of development progress in the
most-affected countries.
•Therefore, strengthening the response to AIDS must
be a central part of development programming and
practice.
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Challenges of the ‘Next Agenda’
- UNAIDS, 2004
•Reorienting situation assessment and early warning
systems to a ‘people focus’ with greater attention to
household impacts.
•Developing new strategies to deal with the
disproportionate impact of the epidemic on women,
girls and orphans, including microcredit, school
support and food assisstance programmes.
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Challenges of the ‘Next Agenda’
- UNAIDS, 2004
•Developing strategies for radical and innovative
approaches to restoring human capacity in the worstaffected countries; for example, massive antiretroviral
therapy programmes
•Developing long-term strategies to replace the shortterm ‘Band-Aid’ approaches which have dominated the
response up until now.
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