Knowing about HIV AIDS

What is HIV ? HIV infection?

Human Immunodeficiency Virus It attacks white blood cells (CD4 cells)

Multiplies Destroys Cd4 cells Decreases body immunity

Leads to AIDS

HUMAN IMMUNODEFICIENCY VIRUS

GHTM

Agent-Types of virus in India

HIV 1
HIV 2 More than 90% is HIV 1 subtype C

Differences between HIV1&HIV-2

HIV-2 infection- longer latent period Lower mother to child transmission rate-HIV-2 Less efficient rates of sexual transmission NNRTI is -not effective for HIV-2

What is AIDS?

Acquired Immunodeficiency Syndrome

Disease limits the bodys ability to fight infection (CD4 count <200 -AIDS manifests) Several Opportunistic infections occur

Death due to complications of these infections

 Who

will get HIV infection? How will you get infected with HIV?

Routes of HIV Transmission

85 out of 100 persons who are HIV+
get infected through unsafe sex in India 84.6 1.8 1.9 4.3 5.6

Sexual Blood and Blood Products Unidentified

IDUs Perinatal

Transmission routes and its efficiency

Efficiency

Sexual intercourse Contaminated needles Mother to child Blood transfusion

.1 to 1% .5 to 1% 30% 90- 95%

Sexual tranmission is the main route of HIV transmission, a person having unprotected sex with many partners. (hetro /homo)

ABC principles for HIV prevention through sexual transmission

Avoid

Sex with a stranger Friendship leading to sexual relationship Premarital sex

Be faithful

To your life partner One partner one life time

Condom use

HIV AIDS

A health problem. Social problem Economic problem a multisector approach Behaviour related - can be prevented No cure

Host factors

Age and sex High risk behaviour STDs Frequency of exposure Mixing pattern immunity

Social and economic factors

Low literacy Urbanization Imprisonment High mobility Migration Drug use Alcohol use

Environmental factors political, cultural

Acceptance of indigeneous sexual practices War & Conflict Limitations on interventions Social un-acceptance of condoms Womens status National policies Norms and practices Culture and ethnic practices Marginalized populations

Every individual..........

Prevention self, family, &community

Protect the rights of those infected

Because..
An HIV infected person is asymptomatic for 7-10 years Does not know his/her own HIV status Is transmitting the infection to others

Current Scenario
Global

The global situation

No of People Living with HIV/ AIDS 33.2 M (Total)
Adult - 30.8 M Women - 15.4 M Children - 2.5 M

Feminisation of the epidemic

~50% 40% - last decade In United States increase 1999 to 2003 women 15 % Men 1%

1981 First HIV infected case in USA -- a disease of males Currently almost half of new HIV infections are being reported in women. Of these < 50% are aware of their infection 84% are in the reproductive age group 9 out of 10 infected women live in a developing country. 0.5 million young people, 2,30,000 women and 30,000 children get infected every year in India.

new infections / yr
2.7M 6800 / day
.37M

Children

Deaths/yr
2M

.27M children

Merging Into India...........

Evolution 1986 to 2002

1986

1990

1994

First case of HIV detected in Chennai

HIV Prevalence reaches over 5% amongst high risk group in Maharashtra and Manipur

1.74 m infected

4.58 m. Indians living with HIV

1998 2001 2002

3.5 m. infected > 1 % antenatal women

4.01 m. infected > 5 % high risk groups

4.58 m. infected < 5 % high risk groups

HIV burden India 2007

2.5 million infected (2M -3.1 M), ( 1 case in 1986 ) the world's third highest caseload after South Africa and Nigeria,
0.34% of adult population infected. ~40% women

Diverse trend in epidemic in India

UP Kerala TN MH Karnataka Manipur 0.07% 0.26% 0.34% 0.69% 0.97% 1.13%

District Categorization for HIV: 2004-07

156 A Category Districts 39 B Category Districts 14 Districts with HIV prevalence > 3% among ANC clinic attendees Evidence of HIV positivity among IDU in Punjab, WB and Orissa Evidence of dual mode of transmission in Manipur & Nagaland.

Categorization of districts based on HIV prev:

Antenatal women and high risk group A >1% among ANC B <1% among ANC , >5% among HRG C <1% among ANC , <5% among HRG,
with hot spots D No hot spots

HIV burden in Kerala 2007

Prevalence : 0.26% ( 2006 : 0.30%) Calculated numbers : 55,167 Prevalence among HRG

IDUs 7.96% Truck drivers 3.6% STD clinic 1.6% MSM 1.20% CSW 0.40%

HIV/ AIDS reported in Kerala (2007)

HIV Estimates

tested HIV positive ~ 10618 Reported 9860

M-56% F -37.5% C- 6.2%

55,167

Children Registered

540

HIV Down the years

1981 -first case detected 1983 Virus isolated 1985 HIV antibody test 1986 -HIV II identified 1990s ARV drugs 2008 Nobel prize to French and German scientists for identifying the virus against HIV and Ca Cervix

Progress of HIV in the body

Entry of virus in the body Window period 6 weeks to 6 months Silent infection No symptoms for 5 to 10 years AIDS Uncontrolled Diarrhoea and fever,unexplained weight loss,general weakness,enlarged lymph nodes,skin infections and opportunistic infections

The Window period

Follows acute infection with HIV, before HIV antibodies can be detected in the patients blood stream.

Patient is highly infectious, despite testing HIV antibody negative, HIV is replicating rapidly in all body compartments.

Typically up to 12 weeks duration but may be shorter in more sensitive HIV antibody assays.

Natural History of Untreated HIV Infection

Infection by HIV Acute Seroconversion Illness Asymptomatic Phase Symptomatic Infection/ AIDS Death

ACUTE (PRIMARY) HIV

GHTM

PRIMARY HIV INFECTION RASH

GHTM

PRIMARY HIV INFECTION : ORAL ULCERS

GHTM

HERPES ZOSTER

GHTM

GHTM

GHTM

KAPOSIS SARCOMA

GHTM

HIV testing

Surveillance epidemiological
Screening (transfusion / transplantation)

Voluntary to know HIV status

Diagnostic clinical management

Testing strategies

Surveillance ELISA by two different antigen preparations

Transfusion safety Single ELISA. Voluntary 3 different ELISA/Rapid/Simple (E/R/S) by three different antigens. Research According to the specific objectives and decided by the researcher

Lab diagnosis during window period

P24 antigen assay (<40%) Viral Culture PCR

Need of Lab diagnosis in window period

Untested blood transfusion Risky heterosexual / homosexual exposure Needle stick injury (contaminated)

National AIDS Control Programme

NACP I - 1992 -1999
(AIDS Awareness & blood safety)

NACP II -1999 2007

(+ Targeted intervention in HRG)

NACP III 2007- 2012

NACP III: Goal

To halt and reverse the epidemic 5 yrs Objectives: Prevention of new infections

saturation of HRG coverage scale up of interventions for General population

Provide care and treatment to more PLWHA Strengthening capacities at district, state and national levels

Services of Kerala State AIDS Control Society

PREVENTION

CARE & SUPPORT

ICTC Jyothis, Pulari STI Clinics Sureksha prevention of HIV among HRG Blood safety PEP IEC

Ushus ART

treatment, counseling. Community Care centre Prathyasha DICDrop in centres for HIV +s, counseling,referrals, recreation, IGPs

Intergrated counseling and Testing centres (ICTC)

ICTC Integrated Counseling

and testing centres

Pre test Counseling Testing with consent Positive Test confirmed -3 type tests Confidentiality maintained Post test conseling Follow up counseling/ family counseling Guidance to services available Screening of all pregnant mothers

ICTC s in Kerala

136 established - All Govt Medical Colleges - Dist /Gen Hospitals, some CHCs., 24X7 PHCs 30 private hospitals 3 Rly stations (TVM, EKM, & TSR) 6 Prisons (Central Prison TVM

STI Clinics

Commonest route sexual Presence of other Sexually transmitted infections increases chances pf HIV transmission Counseling,Diagnosis & treatment for STI Partner testing Condom Promotion

Sureskha projects
Targetted interventions among high risk population

High risk behaviour groups are greatly vulnerable to infection

Risk Group Population

General Population

CSW MSM IDU

General

Population

Bridging Population if they get infected, they may pass on the infection to their clients/partners

Infected clients pass Infection to their spouses

What are the interventions?

aimed at behavioral modification among target groups, from unsafe sexual or injecting practices to protected/ safe sex practices and injecting practices. condom programme STI management (at STI clinics/in house STI clinics) Enabling environment
63 projects in kerala for CSW, MSM, IDU, Truckers. Migrants

Help

Your daily work brings you in contact with some of the HRG, Be accessible to NGOs working on AIDS: understand the nature of their work and identify ways to help each other in working efficiently .NGO outreach workers need your protection Protect peer educators working for vulnerability reduction of high risk groups (e.g. peers distributing condoms)

Telecounselling HIV/AIDS

Phone Number

0484 2237020

CARE, SUPPORT & TREATMENT for the infected

They Need
Medical Nutrition Psychosocial Spiritual Legal

quality life >15 -20 yrs

through
USHUS ART centres & Link ART Centres
Community Care Centres

Prathyasha Drop in centres

Recommendations for Initiating ART in Adults with HIV Infection (WHO)

If CD4 testing available:

WHO Clinical Stage IV disease WHO Clinical Stage I disease with CD4 <200 cells/mm3 WHO Clinical Stage II or III disease with CD4 <350 cells/mm3 WHO Clinical Stage III and IV disease WHO Clinical Stage II disease with ALC <1200/mm3

If CD4 testing NOT available:

Anti Retroviral Treatment Centres (ART)

5 Govt.Medical Colleges, TVPM, ALPY, KTYM, TCR, KZKD DH Palakkad

registered started on ART

9860 5214

3492 continuing on ART

Services at Ushus centres

Free ART drugs (Rs 700/m) Free CD4 testing (~Rs 1500) OI drugs Counseling Referrals

Keep it simple

One pill twice daily if possible

Staffed by HIV positive people One in each district close to the major hospital Sharing of experiences ,promote positive living helps to cope with the infection To establish linkages for PLWHAs with the existing health services, NGOs, CBOs and other welfare and development programmes. To protect and promote the rights of the infected.

Amrita Kripa Sagar , Nedumangad, Trivandrum St Johns Care Centre, Pirapancode, Trivandrum Asha kiran , Pampady Kottayam Snehatheeram Care Centre , Aluva, Ernakulam Institute of palliative Medicine ,Kozhikode Nazereth Care Centre, Palaghat

Community Care centres

VOLUNTARY BLOOD DONATION

Blood is a drug

Should be freely available Should be safe

Possible if we

Voluntarily and regularly donate blood

If u Are able to donate blood

You are in a healthy state of Mind and Body

World AIDS Day

December 1, 1988 as the first World AIDS Day. observed by governments, all depts international organizations and charities around the world.

World AIDS Day- themes

WACs steering Committee

2005 -10 Stop AIDS.

Keep the Promise

Sub themes. Accountability Leadership lead - Empower Deliver Encourage all to acheive commitment to universal access to Prevention ,CS & T of HIV AIDS by 2010

SLOGAN FOR WORLD AIDS DAY 2005-10

THEME for WORLD AIDS DAY 2009--UNIVERSAL ACCESS AND HUMAN RIGHTS Access to Information,Prevention and Testing

KEY MESSAGES

Anybody can get HIV but everyone can prevent it HIV doesnot spread by casual social contact Mosquitoes cannot spread HIV virus Treatment available but not curable Individuals with HIV need our support and understanding Persons living with HIV need love and support from family and friends

LET US JOIN

Lead from the front to control the HIV epidemic

Wishing you all success

THANK YOU