**Module 1: Overview of HIV Infection**

+----------------+-----------------------------------------------------+
| **Purpose**    | To provide the participants with the basic terms    |
|                | and concepts related to HIV infection.              |
+----------------+-----------------------------------------------------+
| **P            | None                                                |
| re-requisite** |                                                     |
|                |                                                     |
| **Modules**    |                                                     |
+----------------+-----------------------------------------------------+
| **Module       | 30 minutes                                          |
| Time**         |                                                     |
+----------------+-----------------------------------------------------+
| **Learning     | At the end of this module, participants will be     |
| Objectives**   | able to:                                            |
|                |                                                     |
|                | -   Describe the difference between HIV infection   |
|                |     and AIDS                                        |
|                |                                                     |
|                | -   Discuss the HIV epidemics globally, regionally, |
|                |     and locally in terms of number of people        |
|                |     affected                                        |
|                |                                                     |
|                | -   Define the terms: antibody and antigen          |
|                |                                                     |
|                | -   Explain how "window period" may affect HIV      |
|                |     testing results                                 |
|                |                                                     |
|                | -   Describe the progression of HIV infection       |
+----------------+-----------------------------------------------------+

**Module Overview**

+-----+-------+--------------+---------------------+-------------------+
| **  | **T   | **Activity/\ | **Content**         | **Resources\      |
| Ste | ime** | Method**     |                     | Needed**          |
| p** |       |              |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| **  | 2 min | >            | Module introduction | Slides 1-3        |
| 1** |       | Presentation |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| **  | 25    | >            | HIV/AIDS overview   | Slide 4-19        |
| 2** | min   | Presentation |                     |                   |
+-----+-------+--------------+---------------------+-------------------+
| **  | 3 min | > Q&A        | Summary             | Slide 20          |
| 3** |       |              |                     |                   |
+-----+-------+--------------+---------------------+-------------------+

**Material/Equipment Checklists**

-   PowerPoint slides or transparencies

-   Overhead projector or computer w/LCD projector

-   Prepared Flipchart -- content outline

-   Handout -- WHO Staging System for HIV Infection and Disease in
    Adults and Adolescents

> **Teaching Guide**

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| **Slide         | **Teaching Points**                                 |
| Number**        |                                                     |
+=================+=====================================================+
| ![](m           | For participants [without]{.underline} medical or   |
| edia/image1.gif | laboratory background, keep the presentation simple |
| ){width="0.4479 | and avoid using technical jargons without           |
| 166666666667in" | explaining them first. For participants             |
| height="0.54166 | [with]{.underline} medical or technical background, |
| 66666666666in"} | you may need to provide more in-depth information.  |
| ***TIPS***      |                                                     |
+-----------------+-----------------------------------------------------+
| **1**           | **[Module 1: Overview of HIV                        |
|                 | Infection]{.underline}**                            |
|                 |                                                     |
|                 | DISPLAY this slide before you begin the module.     |
+-----------------+-----------------------------------------------------+
| **2**           | **[Learning Objectives]{.underline}**               |
|                 |                                                     |
|                 | STATE the objectives on the slide.                  |
+-----------------+-----------------------------------------------------+
| **3**           | **[Content Overview]{.underline}**                  |
|                 |                                                     |
|                 | EXPLAIN the topics that will be covered in this     |
|                 | module.                                             |
+-----------------+-----------------------------------------------------+
| **F             | WRITE the content outline on a flipchart prior to   |
| lipchart**![](m | training.                                           |
| edia/image2.wmf |                                                     |
| ){width="0.8423 | REFER to it frequently to orient participants to    |
| 611111111111in" | where they are in the module.                       |
| height="0.84236 |                                                     |
| 11111111111in"} |                                                     |
+-----------------+-----------------------------------------------------+
| **4**           | **[What is HIV?]{.underline}**                      |
|                 |                                                     |
|                 | STATE Many people see HIV and AIDS as being the     |
|                 | same thing, and therefore make the assumption that  |
|                 | someone who is HIV-positive could die tomorrow.     |
|                 | This is not true. It is important to distinguish    |
|                 | between HIV and AIDS.                               |
|                 |                                                     |
|                 | STATE the points on the slide.                      |
|                 |                                                     |
|                 | -   HIV stands for Human Immunodeficiency Virus.    |
|                 |                                                     |
|                 | -   It is the virus that causes AIDS.               |
+-----------------+-----------------------------------------------------+
| **5**           | **[Types of HIV Virus]{.underline}**                |
|                 |                                                     |
|                 | EXPLAIN the two types of HIV virus.                 |
|                 |                                                     |
|                 | ADD the following points:                           |
|                 |                                                     |
|                 | -   Both produce the same patterns of illness. HIV  |
|                 |     2 causes a slower progression of disease than   |
|                 |     HIV 1.                                          |
|                 |                                                     |
|                 | -   It is important for tests to detect the HIV     |
|                 |     subtypes that are present in the region.        |
|                 |     Otherwise, testing may lead to false negative   |
|                 |     results.                                        |
+-----------------+-----------------------------------------------------+
| **6**           | **[Structure of HIV]{.underline}**                  |
|                 |                                                     |
|                 | EXPLAIN the structure of the HIV virus.             |
|                 |                                                     |
|                 | -   Like all viruses, it is made up of 2 main       |
|                 |     elements: the external envelope, and the        |
|                 |     internal core.                                  |
|                 |                                                     |
|                 | -   HIV is a retrovirus.                            |
|                 |                                                     |
|                 | HIGHLIGHT 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.                                         |
+-----------------+-----------------------------------------------------+
| **7**           | **[What is AIDS?]{.underline}**                     |
|                 |                                                     |
|                 | STATE points on the slide.                          |
|                 |                                                     |
|                 | ADD the following points:                           |
|                 |                                                     |
|                 | -   HIV infection leads to a weakened immune        |
|                 |     system. This makes a person with HIV vulnerable |
|                 |     to infections.                                  |
|                 |                                                     |
|                 | -   AIDS results when HIV infection progresses to   |
|                 |     an advanced stage, damaging the immune system   |
|                 |     to a point at which the body can no longer      |
|                 |     fight illness.                                  |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Drugs are available which can treat HIV and     |
|                 |     AIDS.                                           |
|                 |                                                     |
|                 | -   These drugs are called antiretrovirals (ARVs).  |
|                 |     They prevent the virus from replicating and     |
|                 |     slow the progress of the disease.               |
|                 |                                                     |
|                 | -   Currently, there is still no cure for AIDS or a |
|                 |     vaccine that will prevent HIV infection.        |
|                 |                                                     |
|                 | SUMMARIZE by stating AIDS is the final stage of the |
|                 | disease caused by infection with a type of virus    |
|                 | called HIV.                                         |
+-----------------+-----------------------------------------------------+
| **8**           | **[HIV vs. AIDS]{.underline}**                      |
|                 |                                                     |
|                 | DESCRIBE the difference between HIV and AIDS with   |
|                 | the points on the slide.                            |
+-----------------+-----------------------------------------------------+
| ![](m           | Lay counselors may need more information about the  |
| edia/image1.gif | immune system. Consider providing additional        |
| ){width="0.4479 | content to lay counselors.                          |
| 166666666667in" |                                                     |
| height="0.54166 | ## How HIV weakens the immune system                |
| 66666666666in"} |                                                     |
| ***TIPS***      | Our blood contains white and red blood cells.       |
|                 | Normally the white cells fight off and kill any     |
|                 | germs which enter our bodies. They do this by       |
|                 | eating up the germs and by producing chemicals      |
|                 | called antibodies which kill them. In this way our  |
|                 | bodies fight off many different germs and we stay   |
|                 | healthy.                                            |
|                 |                                                     |
|                 | Sometimes we have symptoms of illness when our      |
|                 | white cells are fighting the germs, but usually the |
|                 | white cells win and we get better.                  |
|                 |                                                     |
|                 | HIV weakens the immune system by entering and       |
|                 | destroying our white cells. As more and more white  |
|                 | cells are killed, the body becomes less and less    |
|                 | able to fight off the many different germs which    |
|                 | live around and in our bodies all the time. After   |
|                 | many years the white cells are so damaged that      |
|                 | these germs, which normally do not cause problems,  |
|                 | can cause deadly diseases.                          |
+-----------------+-----------------------------------------------------+
| **9**           | **[How is HIV Transmitted?]{.underline}**           |
|                 |                                                     |
|                 | EXPLAIN the points on the slide.                    |
+-----------------+-----------------------------------------------------+
| **10**          | **[HIV: A Global Pandemic]{.underline}**            |
|                 |                                                     |
|                 | STATE the following:                                |
|                 |                                                     |
|                 | -   This slide provides estimates for the numbers   |
|                 |     of persons living with HIV in different         |
|                 |     continents in 2003. Between 34 and 46 million   |
|                 |     persons live with HIV; most of these in Africa. |
|                 |                                                     |
|                 | -   HIV infection is a worldwide epidemic -- a      |
|                 |     pandemic -- affecting people everywhere.        |
+-----------------+-----------------------------------------------------+
| ![](me          | Customize these two slides with regional and local  |
| dia/image3.wmf) | data about HIV epidemic and impact.                 |
| {width="0.49166 |                                                     |
| 666666666664in" |                                                     |
| heigh           |                                                     |
| t="0.4416666666 |                                                     |
| 6666665in"}***C |                                                     |
| ustomization*** |                                                     |
|                 |                                                     |
| ***Notes***     |                                                     |
|                 |                                                     |
| **11-12**       |                                                     |
+-----------------+-----------------------------------------------------+
| **11**          | **[HIV Epidemic in Sub-Saharan                      |
|                 | Africa]{.underline}**                               |
|                 |                                                     |
|                 | POINT OUT the following on the slide:               |
|                 |                                                     |
|                 | -   The growing number of people living with HIV    |
|                 |     and AIDS                                        |
|                 |                                                     |
|                 | -   The growing trend of HIV prevalence             |
+-----------------+-----------------------------------------------------+
| **12**          | **[HIV Epidemic: Local Facts &                      |
|                 | Impact]{.underline}**                               |
|                 |                                                     |
|                 | EXPLAIN the local HIV infection rate and its impact |
|                 | on local community.                                 |
+-----------------+-----------------------------------------------------+
| **13**          | **[Basic Terms]{.underline}**                       |
|                 |                                                     |
|                 | STATE the definition of antigen and antibody on the |
|                 | slide.                                              |
+-----------------+-----------------------------------------------------+
| **14**          | **[Testing for Viral Infection and Immune           |
|                 | Response]{.underline}**                             |
|                 |                                                     |
|                 | EXPLAIN HIV infection can be measured in terms of:  |
|                 |                                                     |
|                 | -   The amount of virus circulating in the body     |
|                 |     --called the viral load                         |
|                 |                                                     |
|                 | -   The amount of antigen -- p24 antigen --         |
|                 |     circulating in the body                         |
|                 |                                                     |
|                 | -   Proteins or cells that protect the body against |
|                 |     infection -- IgG and IgM antibodies, and CD4    |
|                 |     cells                                           |
+-----------------+-----------------------------------------------------+
| ![](m           | Consider providing additional information about     |
| edia/image1.gif | measuring human response to HIV infection by        |
| ){width="0.4479 | discussing B and T cells when teaching people with  |
| 166666666667in" | a laboratory or medical background.                 |
| height="0.54166 |                                                     |
| 66666666666in"} | T and B cells are types of white blood cells called |
| ***TIPS***      | lymphocytes that provide protection against         |
|                 | infection. B cells are responsible for producing    |
|                 | antibodies. There are three types of T cells.       |
|                 |                                                     |
|                 | -   **Helper T-Cells** (also called CD4+ cells)     |
|                 |     help other cells destroy infective organisms.   |
|                 |                                                     |
|                 | -   **Suppressor T-Cells** (also called CD8+ cells) |
|                 |     suppress the activity of other lymphocytes so   |
|                 |     they don\'t destroy normal tissue.              |
|                 |                                                     |
|                 | -   **Killer T-Cells** (also called cytotoxic T     |
|                 |     lymphocytes, or CTLs, and are another kind of   |
|                 |     or CD8+ cell) recognize and destroy abnormal or |
|                 |     infected cells.                                 |
|                 |                                                     |
|                 | Over a period of time, HIV infects and kills white  |
|                 | blood cells called CD4 lymphocytes or (T cells),    |
|                 | leaving the body unable to fight off certain kinds  |
|                 | of infections.                                      |
+-----------------+-----------------------------------------------------+
| **15**          | **[Evolution of Antibodies]{.underline}**           |
|                 |                                                     |
|                 | DESCRIBE the timeframe by which antibodies are      |
|                 | produced.                                           |
|                 |                                                     |
|                 | STATE Specific antibodies are detected at certain   |
|                 | times over the course of infection                  |
|                 |                                                     |
|                 | POINT to the area of the slide labeled Window       |
|                 | Period.                                             |
|                 |                                                     |
|                 | TRANSITION to providing additional explanation on   |
|                 | the meaning of "window period"                      |
+-----------------+-----------------------------------------------------+
| **16**          | **[Window Period]{.underline}**                     |
|                 |                                                     |
|                 | EXPLAIN window period as the phase when you have    |
|                 | been infected with HIV, but antibody levels are not |
|                 | detectable.                                         |
|                 |                                                     |
|                 | ADD THE FOLLOWING POINTS:                           |
|                 |                                                     |
|                 | -   Seroconversion occurs during the window period. |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   "Seroconversion" is a term used to describe the |
|                 |     change from non-detectable to detectable        |
|                 |     antibody levels. Specimen may test initially    |
|                 |     non-reactive, but change to testing reactive    |
|                 |     after a certain time period.                    |
|                 |                                                     |
|                 | -   Seroconversion occurs generally 3-8 weeks after |
|                 |     the initial infection.                          |
+-----------------+-----------------------------------------------------+
| **17**          | **[Disease Progression]{.underline}**               |
|                 |                                                     |
|                 | STATE the points on the slide.                      |
|                 |                                                     |
|                 | DEFINE viral load as the amount of HIV virus        |
|                 | circulating in the bloodstream.                     |
+-----------------+-----------------------------------------------------+
| **18**          | **[WHO HIV/AIDS Classification                      |
|                 | System]{.underline}**                               |
|                 |                                                     |
|                 | STATE WHO (World Health Organization) marks the     |
|                 | progression of HIV infection with four stages.      |
|                 |                                                     |
|                 | RELATE the clinical course of HIV infection with    |
|                 | WHO's classification system.                        |
|                 |                                                     |
|                 | REFER participants to the handout in their manual   |
|                 | for details of WHO's classification system.         |
|                 |                                                     |
|                 | POINT OUT that testing at any stage allows for      |
|                 | triage towards treatment.                           |
+-----------------+-----------------------------------------------------+
| **19**          | **[Can Disease Progression Be                       |
|                 | Delayed?]{.underline}**                             |
|                 |                                                     |
|                 | STATE the points on the slide.                      |
+-----------------+-----------------------------------------------------+
| **20**          | **[Summary]{.underline}**                           |
|                 |                                                     |
|                 | ASK participants to answer the questions on the     |
|                 | slide.                                              |
|                 |                                                     |
|                 | ANSWER any questions participants may have.         |
+-----------------+-----------------------------------------------------+