Community Outbreak: HIV/AIDS

AIDS stands for Acquired immunodeficiency syndrome. AIDS is a communicable disease caused by the virus known as HIV ((human immunodeficiency virus). After the infection, HIV advances in stages, destroying the immune system and advancing to AIDS. HIV does not have a cure; however, the virus is slowed down to prevent it from progressing from one stage to another. The medication for slowing down the progression of HIV/aids is called ART or Antiretroviral therapy (Leonard, 2020). The medication aids people to live healthier lives and have a longer life. The main objective of antiretroviral therapy is to reduce an infected person’s viral load to an undetectable level.

HIV Stages

Acute Infection

It is the earliest stage of the infection. The stage starts within two to four weeks after infection with HIV. At this stage, the infected persons are accompanied by flu-like symptoms like headache, rash, and fever. In this stage, HIV multiplies faster and spreads all over the body, attacking and destroying CD4 cells that fight the infection in the body. During this stage, the HIV level in the bloodstream is high. As a result, there is a significant risk of HIV transmission (Leonard, 2020). The infected person should start taking ART at this stage to slow down the virus advancement from one stage to another.

Chronic Stage

It is also known as clinical or asymptomatic. There is a low level of virus multiplication in this stage compared to the acute infection stage. In this stage, there are no related symptoms. If an infected person does not use ART, the virus progresses to the final stage, which is AIDS. The advancement can take ten years or longer. But in some people, it takes lesser time to advance. However, those taking ART can stay in this stage for decades. In persons taking ART, the viral load is low in their blood. Therefore, they cannot transmit the virus to an infected person through sex (Leonard, 2020). However, the individuals who do not take ART can transmit the virus to another person through sex and other transmittance methods like a blood transfusion.

AIDS

This is the last stage of HIV infection advancement. At this stage, the body cannot protect itself by fighting opportunistic infections due to extreme damage to the immune system. Opportunistic infections are diseases and disease-related cancer that arise in people who have a weak immune system. Opportunistic diseases do not occur in people with high immune systems. At this stage, a person is diagnosed with AIDS, has less than 200cells/mm³ CD4 cell count, and the infected person has opportunistic diseases (Leonard, 2020). They have a high viral load in the blood, and thus they can transmit the virus from one person to another. Without proper treatment, the infected can only survive up to three years.

HIV/AIDS History

From the research, it is believed that HIV originated in West Africa. The virus is believed to come from chimpanzees and gorillas. They are found in western equatorial forests in Africa. These animals have lentivirus in their blood system, similar to HIV. The virus is called the simian immunodeficiency virus (SIV). It is harmless in chimpanzees. In 2009, researchers found that the virus increases the death rate of chimpanzees, which is 10-16 higher than that of uninfected chimpanzees (History of HIV/AIDS n.d.). Hunting, butchering, and eating chimpanzee meat led to the transmission of the virus to human beings. This is believed to be the origin of HIV.

Genetic studies show that the first stain of HIV was known as HIV-1. West This virus emerged from the west and central Africa from 1884 to 1924. The virus spread in the west and central Africa in the 1950s. People were unaware of the virus. In the mid-1960s, the virus evolved from HIV-1 group M to subtype B, spreading from West Africa to Haiti. The spread was caused by the Caribbean returning home from the Democratic Republic of Congo during the colonial period. The subtype B virus acquired exceptional characteristics through genetic recombination. The virus moved from Haiti to the United States in 1970 (History of HIV/AIDS n.d.). However, people were unaware of the virus.

The first case of AIDS was reported On June 5, 1981, by health workers in California. Ten years later, in May 1991, local and state health departments reported 179,136 AIDS from the United States of America. In 1991, AIDS became the second leading cause of death globally among males aged 25-44. It was also the fifth topmost root of death among females aged 15- 44 years in the United States (History of HIV/AIDS n.d.).

By the end of 2000, 40 million were globally infected, where more than 90% were from sub-Saharan Africa, Southeast Asia, Latin America, the Caribbean, and. Additionally, in the 1990s, more than 10 million children were left without parents due to death from HIV/AIDS infections (History of HIV/AIDS n.d.). From the United States, the virus spread to the whole world. The spread of the virus worldwide was facilitated by traveling to Africa, urbanization, drug abuse, and the change of sex partners.

In 2021, according to WHO, approximately 36.3 million people had died, and 37.7 million persons lived with HIV globally. Out of 37.7 million individuals, 16% were unaware they had the virus, while 73% used antiretroviral drugs. In 2018, approximately 770 000 died from HIV /aids (Leonard, 2020).

Epidemiological and Risk Factors for HIV/AIDS

Substance use

Substance use is a problematic pattern of consuming alcohol, methamphetamine, heroin, cocaine, and prescription opioids. These drugs are risk factors for HIV transmission. Most drugs are injected using syringes, needles, and other injection materials. When people share injecting materials, they risk transmitting the virus from an infected person to a negative person. Additionally, drinking alcohol, smoking, inhaling, or ingesting drug substances increases the risk of HIV transmission (Brown et al., 2018). The substances or drugs alter somebody’s judgment and lead to risky sexual conduct such as having multiple partners or unprotected sex. These practices will eventually lead to HIV transmission.

People who have substance use disorder can fasten disease progression due to the impact on the healthy immune system. Also, drugs can adhere to the work of antiretroviral drugs; therefore, HIV advances from one stage to another.

Substances and their HIV Risk.

• Extreme drinking, especially alcohol abuse, is a significant HIV risk factor because it is associated with risky sexual behavior. For the infected, alcohol can damage antiviral treatment outcomes.
• These are classes of painkillers, including both prescription heroin and drugs. Opioids are associated with risky HIV transmission conduct such as needle sharing and risky sex conducts associated with recent HIV outbreaks.
• It is associated with risky sexual conduct that puts the users at greater risk for HIV. It is mainly injected, thus increasing the risk of HIV when the addicts share needles or other injections.
• Crack cocaine. It is a stimulus that can build a cycle where people quickly use their resources and turn to other forms of treatment, including the money or sex trade for drugs, which upsurges the risk of HIV.
• Inhalants such as amyl nitrite, also known as a popper, have long been linked to risky sexual behavior, illicit drug use, and sexually transmitted diseases by gays and lesbians (Brown et al., 2018).

Body fluids

Body fluids are major risk factors for and determinants for HIV/aids. Primary body fluids that risk factors are infected blood, vaginal fluids, breast milk, semen, and rectal fluid or mucus. For transmission to happen, the virus contained in the fluid must contact the bloodstream of uninfected individuals through a mucous film found in the rectum, tip of the penis, vagina, mouth, open soles, or cuts, and through direct injections. The infected person involved must have a detectable viral load in their bodies. Somebody’s fluid may have an undetectable viral load due to HIV drugs, and transmission cannot occur (Brown et al., 2018). Fluids like saliva, tears, urine, and feces do not lead to transmission.

Behavioral Factors

Behaviors like having multiple partners and polygamous sex without protection, such as condoms, are risk factors for HIV. They lead to the transfer of sex fluid from one person to another, thus increasing transmission. Another behavior is the mishandling of needles and sharp objects. When these sharp objects cut an infected person, they become contaminated, and mishandling will lead to transmission from one person to another.

Route of HIV Transmission

Sexual Transmission

Sexual transmission is a common way to spread sexually transmitted infections such as HIV/AIDS. The chances of a person becoming sexually infected depend on unprotected sex with HIV positive partner; therefore, sexual behaviors are connected with the spread of HIV. The virus is contained in fluids such as semen and vaginal fluids. Transmission takes place through the exchange of these fluids.

The chances of getting infected with HIV during specific sexual encounters vary widely and depend on various factors. Male-to-female HIV transmission is highly efficient compared to ‘female-to-male transmission. Women’s first sexual intercourse is associated with a higher risk of infection (van Bilsen et al., 2020). Acceptable anal sex seems to be more dangerous than consensual sex with the apparent impact of homosexuality.

Cases of oral transmission have also been reported, however, this method of transmission is alleged to be less efficient than penile-anal and penile-vaginal sex (van Bilsen et al., 2020). Sexually transmitted HIV transmission also depends heavily on the infection of the infected partner. High viral load in the later stages of the disease is associated with an increased risk of infection.

Mother to child

Without any treatment or care, the chances of an HIV-positive woman passing it on to her baby are high. Before introducing antiretroviral therapy and other preventive measures, the prevalence of transmission was between 14 and 20% in European countries and up to 43% in African countries. Infection transfer occurs during pregnancy, labor and delivery, and breastfeeding. Transmission occurs due to the transfer of genetic material from mother to child. Lack of health intervention rates HIV transmission from an HIV-positive mother to her baby during pregnancy, delivery, childbirth, or breastfeeding ranges from 15% to 45%. Worldwide, an estimated 1.3 million HIV-positive women and girls become pregnant each year (Brown et al., 2018). This shows the possibility of transmissions.

Blood transmission

Blood is the most effective way to transmit HIV infection. The frequency of seroconversion after a transfusion of HIV-positive blood is very high, over 90%. The risk of HIV infection through transfusions has almost been eliminated by using a questionnaire to exclude donors at increased risk of HIV infection and susceptible laboratory tests to detect infected blood donations. 1.5 million people were estimated to contract the infection through blood transfusion, built on 2007-2008 statistics. The first U.S. case of HIV infection transmitted through transfusions reported to the CDC occurred in 2002. In November 2008, a blood test was done in Missouri on a donated, and it was confirmed the donor was HIV-positive. A retrospective study found that the donor had already donated blood In June 2008. The recipient was a kidney transplant patient and was later diagnosed with HIV, and the survey revealed that the patient’s disease was found in donor blood (Brown et al., 2018).

Sharing Sharp Items

Needle cuts or penetration of the sharp body object (such as broken glass, syringe, or scalp) or needles that had been in contact with body tissue, body fluids, or blood before exposure. Needle injections are joint among health employees exposed to infected body fluids (work exposure). It is projected that about 3 million such needles occur worldwide each year and 1 million in Europe, however, most of such accidents are rarely reported. However, the cases of HIV infection after injury are sporadic, but they exist. Additionally, hepatitis B and hepatitis C bacteria can also be transmitted through cuts and injections (Leonard, 2020). The risk of infection depends on whether the person who used the item was infected, the level of viral load in their blood, the type of syringe or needle in question, the amount of blood involved, the time it elapsed after use, and the nature of the injury.

Impact of HIV/AIDS on the Community

Population Structure and Demographics

HIV is still considered a deadly disease that mainly affects people in their reproductive years; this potentially impacts the shape of the population in a country. It is not uncommon for a disease to have such a profound effect on people in society. These demographic effects can be most clearly seen in mortality and life expectancy, which may affect the proportion of men and women, fertility rate, age formation, and overall population growth.

Deaths have increased in developing countries that are particularly affected by HIV / AIDS. HIV causes more deaths than any other infectious disease in the world. There is also evidence that HIV has increased the number of deaths in Asia, the Caribbean, and Africa. Transformation in Sub-Saharan Africa is evident. Before the epidermis, the deaths of people aged 20-49 contributed to 20 %. After the infections, this mortality rate hit 60%. It can be concluded that the additional 40% results from AIDS (Heuveline, 2014).

Before the AIDS epidemic broke out, many developing countries enjoyed a high life expectancy. After the epidemic, the benefit of long life was diminished or deteriorated. Life expectancy in southern Africa has dropped from 60 to 47% over the past 20 years. HIV / AIDS has lowered life expectancy (Heuveline, 2014). The chances of HIV changing the proportion of women to men as most of those affected by HIV are women. Women contribute to half of all adults living with HIV / AIDS worldwide. HIV-positive women are more likely to die earlier than men with AIDS too. This alters the proportion of men and women.

Fertility is usually lower in HIV-positive women than in HIV-negative women. However, fertility rates are expected to decrease with time; Also, most HIV-positive babies born to infected mothers most of them do not reach childbearing age (Heuveline, 2014). The impact of a robust birth rate may reshape the formation of age in the most affected countries.

Studies have shown that HIV impacts overall population growth. Previous research has found that some countries may have a zero or negative growth rate due to HIV. Recent research is still predicting slow growth rates, but it shows that increased access to antiretroviral treatment and lower rates of HIV transmission may reduce the impact.

Governments and the Public Sector

Governments face the same challenges as private companies — sickness and death of employees, reduced productivity, and increased cost. HIV / AIDS poses significant challenges to the governments and public sectors. The disease increases the demands on public services offered by the government. This causes a big challenge because both financial and human resources are comprised at the time. HIV can also eradicate the government’s revenue (tax) base by increasing adult mortality in their early production years; revenue could be significantly reduced as the private sector — the primary source of tax revenue — is affected by the epidemic (Leonard, 2020). When these factors are put together, they influence the way governments to respond to the epidemic; the number of resources available to address HIV / AIDS — including treatment, care, prevention, and social support — and all other aspects of government, including health, justice and education; and government capacity to deliver services.

Health sector

The area most affected by HIV / AIDS is the health of both private and public sectors. AIDS increases the number of people seeking health resources, the cost of patient care, and the need for health workers. People living with HIV / AIDS need many health care services, usually for many years. This growing demand puts pressure on limited health services in many developing countries (Heuveline, 2014). Adding to this is the pressure on health care workers — who are already relatively short in many countries affected by HIV / AIDS — who are also at risk of contracting the disease. As more and more people turn to the Public to help pay for health care after their services run out, governments need to make important choices about their HIV / AIDS response.

Impact on Education

Education is essential to the generation and development of human capital. HIV/AIDS has affected the number of students in school and the supply of teachers in the learning institution. This is most common in Asian and African countries and has affected the overall education systems. The quality of education delivered has also been compromised. According to The Multisectoral Impact of the HIV/AIDS Epidemic – A Primer (n.d.), research has shown that;

• The death toll of HIV-positive children and the removal of orphans and other children affected by the epidemic in schools results in a lower number of children in need of education. In 2016, Swaziland was estimated to have a 30% reduction in the number of students in primary schools per grade.
• In India, 6- to 18-year-olds children live in homes with a sick family member and do other household chores. The children are most likely to drop out of sick and search for jobs to care for their parents’ and siblings’ financial needs. The epidemic has built a population of children with needs (children with HIV/AIDS, orphans, and children caring for relatives living with HIV / AIDS.
• In South Africa, 21% of the teachers in the country between 25-35 years and 13% of 35-44 age were estimated to be affected. In Zambia, illness or care of family members causes more than 60% of teachers to be absent. A study conducted among teachers found that a 5 % increase in absent teachers reduced the average learning benefits by four to 8 % a year.

When teacher resources are declining, there are reports that the number of trained teachers is not enough to fill vacancies in South Africa. The average age and teacher training level are also expected to decrease, so teachers may not be experienced.

Impact on the Private Sector and Firms

HIV /AIDS affects people during their production age. HIV / AIDS can influence the provision. Therefore, the disease can potentially affect labor supply to firms and businesses in the private sector. AIDS-related conditions and the death of workers result from increasing costs, reduced productivity, and altering the working environment. Higher running costs have significant implications for the firms, such as profit and competition results. According to The Multisectoral Impact of the HIV/AIDS Epidemic – A Primer (n.d.), research has shown that:

• HIV / AIDS has increased costs for businesses to absenteeism, poor health of an employee or family member; Higher health care and benefit costs; staff funeral expenses; staff exhaustion due to illness; and additional efforts required to recruit new staff.
• About 10% of South African firms surveyed showed that HIV / AIDS harmed their firms; more than 40% forecast significant adverse effects within the five years following the study.
• In Kenya, a survey of tea sites found that HIV-positive employees produced less productivity per kilogram of tea harvested and consumed more time off than HIV-negative workers.
• The effect of HIV on consumers also affects businesses and markets. Some non-governmental organizations in Africa assessed the potential impacts. They stated that the consumption pattern changes due to changes in the number of people or deaths caused by HIV / AIDS.
• Aside from the implications for the “formal” sector made up of large corporations and businesses, many developing countries have a large “informal” sector of small, self-employed businesses (often accounting for significant GDP shares. Although little research has been done on this. 50% of employment, and 30% of its GDP, show that poor health is closely linked to business closure.

Reporting Protocol of HIV

The community can identify the outbreak of HIV/AIDS through early stages signs such as headache, aching muscles, fatigue, fever, swollen lymph nodes, sore throat, and a red rash that does not cause itching, among others. The person/s should call the toll-free number of HIV equivalence provided by the government or visit the nearest healthcare facilities for testing. Reporting is laboratory-based. The HIV reports are confidential and are protected by regulations or statutes. After a positive test, a follow-up by health professionals can be done (Haddad et al., 2019). The health professional consults the patients or their caregiver addresses, partners, and sex behaviours to develop a prevention strategy. They also administer treatment and diagnosis processes to the patient.

The main Objectives of HIV Surveillance

1. Gather information about people who have tested positive.
2. Ensure that t HIV testing data is accurate and complete.
3. Perform general analysis to keep track of trends and evaluate progress towards leading indicators.
4. Disseminate HIV screening data to enlighten health partners and the general public (Haddad et al., 2019).

HIV Epidemic investigation by the Surveillance team

After HIV-positive results, the surveillance team conducts the investigation to find the root cause and the measures that can be taken to prevent the further spread of the disease. According to Harris, Rabkin, and El-Sadr (2018),  the following is the process of HIV investigation

• Confirm the outbreak

its main objective is to determine the number of reported cases. Essential monitoring data is a valuable tool for making a decision. Ensuring diagnostic tests by laboratory tests is also significant, particularly for new or unusual viruses.

• Outline a case and make a conviction

The surveillance team should obtain a description of the case by identifying conditions with clinical symptoms and epidemiologic data related to the person, time and location. Equivalence can search for more related or additional cases by describing the issue.

• Tabulate data

The data of possible cases are listed and summarized according to time, location and person.

• Control measures

After the source of the HIV, the outbreak is identified and remains a significant threat to community health, appropriate measures are taken as soon as possible. One of the control measures is lockdown and isolation of the place containing the epidermic, closing of strip clubs and bars.

• Build and test a hypothesis

researchers develop a theory consisting of root cause analysis of the outbreak. It involves understanding the virus of the disease and how it is transmitted.

• Plan and do additional lessons

Reliant on the materials available, researchers may test out theories using analytical research, case-control research or retrospective group research.

• Implement the control methods

After the root of the outbreak has been verified, the surveillance team implement long-term control strategies to eliminate current outbreaks and avoid future outbreaks. The control measures are more profound than previous ones, first evaluated to dictate their effectiveness.

• Communication

This is the last stage of the investigation. The surveillance team communicates to their agency, health organizations, and the public about their finding and control measures. HIV outbreak brings about an opportunity for the public to learn about health control and disease prevention.

The benefits of HIV/AIDS Reporting

1. Assessing trends in epidemic patterns, understanding the impact of disease burden on people and health care infrastructure, and better-targeted disease prevention efforts at the community level;
2. Ensuring the transmission of treatment for infected people to reduce infectious diseases and prevent opportunistic infections;
3. Timely identification of cases to disrupt a series of high-level patient interventions such as sexual orientation and behavioural risk-reduction counselling.
4. Identify the required preventive measure.
5. Obtaining funding to prepare for the future of epidemics (Leung et al., 2019).

Community-based education programs

They represent an effective strategy in dealing with the HIV/AIDS epidemic worldwide. Community-based education strategies aim to minimize the spread of HIV to vulnerable people, such as young people and their communities, by culturally appropriate education to influence the behavioural choices of youths and build community social values that promote healthy behaviour. For example, education strategies that train people on transmission methods, diagnoses, care, prevention strategies, and misconceptions related to HIV help promote safe behaviour, promote testing and encourage social support for the people living with HIV/AIDS.

This strategy has been widely used worldwide and has taken different forms. They are used to teach and mobilize community opinion leaders to distribute relevant cultural information on healthy conduct in Zimbabwe, deliver moral lessons and sexual health programs in Tanzania, assimilate HIV/AIDS education into athletics in Tanzania and provide a wide range of HIV education and health amenities through community centres in South Africa. The precise components and characteristics of community-based education strategies have varied broadly. For example, such programs vary in terms of frequency, length, and scope of the curriculum, theoretical basis, the participation of community leaders, behaviours types, attitudes, peer education approaches, and practices that are emphasized on resources used in/out of the training centre, and delivery method (Shamu et al., 2020).

The strategies are grounded on shared values and practices, beliefs and social performances and allow for culturally thoughts about HIV reproductive and sexual well-being. They permit increased and easier access to health care for people at risk or who have been infected with HIV/AIDS by reaching out to persons in their homes, community centres, or schools. Community-based education strategies include counselling and education to endorse HIV awareness. They promote risk-reduction behaviours, HIV testing, appropriate treatment of HIV-positive mothers to avoid mother to child transmission, micronutrient inclusion for lactating and pregnant mothers, and involvements to raise adherence to medication through home visits and care. However, the nature and scope of community-based strategies vary depending on the nature of the epidemic (Shamu et al., 2020). In extreme cases and common epidemics, extraordinary work are needed to unite the whole public. In countries with slow growth and highly epidemic diseases, the emphasis is on reaching those high-risk groups.

Educating children and providing knowledge and skills that may contribute to good choices in life later will protect them as they reach adulthood. Similarly, educating young people on the transmission, prevention strategies and encouraging testing can significantly benefit education investment. This is especially real for women and young girls, who remain the most vulnerable persons.

Governmental Strategy

Government activities may involve research for new prevention programs (such as vaccines and long-acting ingredients for PrEP) to progress the effective and efficient distribution of HIV care, treatment, and prevention. Moreover , the State government supports a wide range of services essential to minimize risky actions and strategies for HIV positive to be kept in HIV care and treatment. The Government provides services such as drug abuse control and other health amenities, transportation, and housing assistance and addresses risks related to HIV transmission or disruption of the ability of HIV- positive people to access HIV suppression. This evidence-based model is reflected in recent scientific evidence’s new integrated HIV / AIDS strategy. The goal of this strategy is to minimize further HIV infections. Across the Government, agencies participate in several different efforts to prevent HIV transmission. The results show that HIV infections are declining in many subgroups and regions where data is available (Leung et al., 2019).

Through the coordination support of the Federal Government Information Service, the Government has launched annual media campaigns on topics of public attention. The central Government funds these campaigns. In 1987 and 1996, an annual media campaign on AIDS was launched, which included the production of TV stations and a variety of similar activities, for example, shows, posters/pamphlets, concerts and press conferences. APIs hold the centre of the campaigns. TV and radio produced over the years are listed in Appendix I and II (Li, Jiang & Zhang 2019). The Government can use these campaigns to spread the information on prevention measures to reach a more extensive public.

Educational activities are designed to convey the message of AIDS to the public. This is different from media campaigns in the direct information delivery rather than radio and Tv. Education needs the use of suitable settings. The internet and hotlines are new channels to promote public awareness on prevention measures like avoiding sharing needles, having fewer partners, use of sex protection, among others. The following are examples of public HIV awareness.

(a) Workplace

(b) Schools – seminars for teachers and students, Inter-school contests, Hotline promotion in universities and colleges.

(c) Youth – through youth concerts and Youth Funding Scheme on AIDS project

(d) Shopping malls – through AIDS Awareness, STD/AIDS Awareness, Red Ribbon Centre promotion, and World AIDS Day campaign.

(e) Roadshows

(f) Public transport – exhibitions in bus, railway, ferry stations, Festivals and carnivals, travel exhibitions, health education carnivals, Flea markets, Sex & AIDS Education expos and Cultural venues.

References

Brown, A. E., Nash, S., Connor, N., Kirwan, P. D., Ogaz, D., Croxford, S., & Delpech, V. C. (2018). Towards elimination of HIV transmission, AIDS and HIV‐related deaths in the U.K. HIV medicine, 19(8), 505-512.

Heuveline, P. (2014). Impact of the HIV epidemic on population and household structure: the dynamics and evidence to date. National Library of Medicine.

History of HIV/AIDS. (n.d.). Canadian Foundation for AIDS RESEARCH.

Leonard, J. (2020). HIV timeline: What are the stages? MedicalNewsToday

The Multisectoral Impact of the HIV/AIDS Epidemic – A Primer. (n.d.). The Henry J. Kaiser Family Foundation.

van Bilsen, W. P., Zimmermann, H. M., Boyd, A., Davidovich, U., & HIV Transmission Elimination Amsterdam Initiative. (2020). Burden of living with HIV among men who have sex with men: a mixed-methods study. The Lancet HIV, 7(12), e835-e843.

Haddad, N., Robert, A., Weeks, A., Popovic, N., Siu, W., & Archibald, C. (2019). HIV: HIV in Canada—Surveillance report, 2018. Canada Communicable Disease Report, 45(12), 304.

Harris, T. G., Rabkin, M., & El-Sadr, W. M. (2018). Achieving the fourth 90: healthy aging for people living with HIV. AIDS (london, England), 32(12), 1563.

Shamu, S., Khupakonke, S., Farirai, T., Slabbert, J., Chidarikire, T., Guloba, G., & Nkhwashu, N. (2020). Knowledge, attitudes and practices of young adults towards HIV prevention: an analysis of baseline data from a community-based HIV prevention intervention study in two high HIV burden districts, South Africa. BMC Public Health, 20(1), 1-10.

Li, G., Jiang, Y., & Zhang, L. (2019). HIV upsurge in China’s students. Science, 364(6442), 711-711.

Leung, H., Shek, D. T., Leung, E., & Shek, E. Y. (2019). Development of contextually-relevant sexuality education: Lessons from a comprehensive review of adolescent sexuality education across cultures. International journal of environmental research and public health, 16(4), 621.