PREVENTION OF HIV/ STD/ AIDS

IN COMMUNITY

Dr. Abe Mathew

Paper Presentation
PRIMARY PREVENTION
• HEALTH PROMOTION
• SPECIFIC PROTECTION
• TESTING AND COUNSELLING

SECONDARY PREVENTION
 HEALTH PROMOTION
(A)HEALTH EDUCATION:
‘ONLY VACCINE’
ROLE OF MEDIA/ RADIO/ ELECTRONIC
MAILING LISTS.
SHOULD COVER:
1. CAUSE, EFFECT, INCURABILITY
2. MODE OF TRANSMISSION
3. A,B,C + ‘HOPE’
4. USAGE OF DISPOSABLE SYRINGES
5. AVOID NEEDLE SHARING
(B) EXAMINATION AND REHABILITATION
OF PROSTITUTES.
(C) CONTROL OF STD’S AND DRUG ABUSE.
Why Mailing lists are more popular?
• Easy to set up
• Setting up is free/ low cost/ no full time staff
• Information goes to individual subscribers.
• Fast and economical

ENCOURAGE HIV POSITIVE PEOPLE TO SPEAK

OUT IN PUBLIC – THEY ARE EFFECTIVE
HEALTH EDUCATORS. CAN MAKE THE
PUBLIC MORE AWARE OF THE PANDEMIC.
 SPECIFIC PROTECTION
1. PROTECTION AGAINST SEXUAL
TRANSMISSION
2. PROTECTION AGAINST SPREAD
THRO’ TRANSFUSION
HIV testing by ELISA.
Discourage donors giving H/O multiple
sex partners.
Carry transfusion only if necessary.
3. PROTECTION AGAINST SPREAD THRO’
SYRINGES
Boil all contaminated linen
Wash hands before and after contact
Gloves, aprons, masks at lab; obstetric and
dental OP; STD clinics/ injection rooms.
Dispose needles into plastic bottle and
incinerated when full.
If pricked – bleed and wash well with soap and
water.
 TESTING AND
COUNSELLING
• TESTING:
SCREENING TESTS:
Sensitive test – ELISA
Confirmatory test - Western Blot –
detects specific antibody to p24 and
gp41.
VIRUS ISOLATION
MANDATORY/ VOLUNTARY
COUNSELING:
Continued dialogue between care provider and
client.
Decision to take test/ cope up with stress/ planning
for future actions.
How does it help?
Express his/ her concern about risks.
Provides information about AIDS.
Follow methods of risk reduction
Enables his/ her capacity to cope with anxiety
Can be referred to a medical institution where
treatment/ supportive services is available.
 Counseling of 2 kinds:
• Pre-Test counseling: • Post test counseling:
To discuss the tests and the Done after subjected to test.
possible impact of If +ve – moral and physical
knowing one’s sero-status support; adopt low risk
Enabled to decide whether to behavior; referred to
take test or not. medical institution/ welfare
agencies.

OTHER MEASURES:
Better nutrition
Prevention, detection and
early treatment of STD’s
Marriage counselling
 SECONDARY PREVENTION
1. HIV CARRIERS:
Informed about long IP.
Educated not to share needles/ syringes/
donate blood
To keep cuts/ bruises covered with plaster.
2. TREATMENT:
(A)DRUGS:
(A)NRTI’s: (B)NNRTI’s:
Zidovudine: 500-600mg (O) Nevirapine: 200mg OD x 2
in 2 or 3 divided doses. weeks; then BD. SE: rash
SE: Anemia. Delaviridine: 400mg TDS.
Didanosine: 12-300mg (O) SE: rash.
BD. SE: PN, hep, (C)PI:
pancreatitis. Saquinavir: 600mg TDS. SE:
Stavudine: 40mg BD(O). SE: GI distress.
same. Ritonavir: 600mg BD or
Zalcitabine: 0.375 – 0.75mg 400mg BD in combination
(O) TDS. SE: PN, with other PI’s. SE: GIT.
aphthous ulcers. Indinavir: 800mg TDS. SE:
Lamivudine: 150mg BD. SE: Kidney stones.
PN, rash Nelfinavir: 750mg TDS. SE:
dairrhoea.
EVOLUTION OF THERAPY:
Monotherapy – resistance.
2 drug combinations: ZDV + 3TC; ZDV + ddl;
Saquinavir and Ritonavir.
Benefits not persistent and resistance.
Triple therapy: one PI (Indinavir) and 2 NRTI’s
(ZDV and 3TC).
PEP:
• AZT (200mg TDS) + 3TC (150mg BD) x 4 weeks
• Advanced AIDS: PI (nelfinavir) added – 750mg
TDS.
• Failed on AZT/3TC; stavudine + ddl used instead.
OPPORTUNISTIC INFECTIONS:
P. carinii pneumonia: <200cells/ul; trimethoprim-
sulphamethoxazole, dapsone.
M. avium: Rifabutin.
M. tuberculosis: 300mg INH daily x 9 months..
Kaposi’s sarcoma: interferon/ chemotherapy/
radiation.
CMV retinitis: ganciclovir
Cryptococcal meningitis: fluconazole.
Esophageal candidiasis: fluconazole/ ketoconazole
HS: acyclovir
• REFERENCES:
Oxford Book on Community health
Principles of Community Medicine (Dr.
Sridhar Rao)
Park and Park