This document provides information on HIV/AIDS including its epidemiology, transmission, stages, diagnosis, treatment and prevention. It describes HIV/AIDS as a global public health issue and outlines prevention strategies like safe sex practices, antiretroviral treatment, prevention of mother-to-child transmission and harm reduction for intravenous drug users. Statistics on HIV prevalence in Pakistan are presented alongside the national AIDS control program and its strategies to promote awareness, testing and care.
3. DR. ALEINA ALI SHAH
Demonstrator
Community Medicine Department
KGMC
4. OBJECTIVES
• Describe the epidemiological determinants, frequency
and distribution of HIV/AIDS
• Explain the preventive and control measures of HIV/AIDS
• Describe the scope of HIV/AIDS control program
7. STDS
STDs are infections that are
from person to person through
intimate sexual contact.
But this is not the only route of
transmission.
•IV drug
•Congenitally transmitted
STDs are dangerous because they
are easily spread and it is hard to
tell just by looking who has an
8. HIV
Human Immunodeficiency Virus
H = Infects only Human beings
I = Immunodeficiency virus weakens
the immune system and increases the
risk of infection
V = Virus that attacks the body
9. AIDS
Acquired Immune Deficiency Syndrome
•A = Acquired, not inherited
•I = Weakens the Immune system
•D = Creates a Deficiency of CD4+ cells in the immune
system
•S = Syndrome, or a group of illnesses taking place at
the same time
10. AIDS
• When the immune system becomes weakened by HIV, the
illness progresses to AIDS
• Some blood tests, symptoms or certain infections indicate
progression of HIV to AIDS
11.
12. DETERMINANTS OF HIV/AIDS
Studies consistently shows that increased vulnerability to HIV is due to:
• Low income,
• Unemployment,
• Food insecurity and
• Lack of access to education and health care
13. TRANSMISSION OF HIV
HIV is transmitted by
• Direct contact with infected blood
• Sexual contact: oral, anal, or vaginal
• Direct contact with semen or vaginal and
cervical secretions
• HIV-infected mothers to infants during
pregnancy, delivery, or breastfeeding
14. THE STAGES OF HIV
When people with HIV don’t get treatment, they typically progress through three
stages.
But HIV medicine /ARV can slow or prevent progression of the disease.
With the advancements in treatment, progression to Stage 3 is less common today
than in the early days of HIV.
15. People have a large amount of
HIV in
their blood. They are very
contagious.
Some people have flu-like
symptoms. This is the body’s
natural response to infection.
But some people may not feel
sick right away or at all.
If there are flu-like symptoms
and the person thinks that he
may have been exposed to HIV,
seek medical care and ask for a
test to diagnose acute infection.
Only antigen/ antibody tests or
nucleic acid tests (NATs) can
diagnose acute infection.
16. This stage is also called asymptomatic
HIV infection or clinical latency.
HIV is still active but reproduces at very
low levels.
People may not have any symptoms or
get sick during this phase.
Without taking HIV medicine, this
period may last a decade or longer, but
some may progress faster.
People can transmit HIV in this phase.
At the end of this phase, the amount of
HIV in the blood (called viral load) goes
up and the CD4 cell count goes down.
The person may have symptoms as the
virus levels increase in the body, and the
person moves into Stage 3.
People who take HIV medicine as
prescribed may never move into Stage
3.
17. The most severe phase of HIV infection.
People with AIDS have such badly damaged immune systems that they get an increasing number of severe
illnesses, known as opportunistic infections.
People receive an AIDS diagnosis when their CD4 cell count drops below 200 cells/mm, or if they develop
certain opportunistic infections.
People with AIDS can have a high viral load and be very infectious.
Without treatment, people with AIDS typically survive about three years.
https://www.cdc.gov/hiv/basics
18. RISK FACTORS
• having unprotected sex;
• having another sexually transmitted infection such as
syphilis, herpes, chlamydia or gonorrhoea.
• sharing contaminated needles, syringes and other injecting
equipment and drug solutions when injecting drugs;
• receiving unsafe injections, blood transfusions, tissue
transplantation, medical procedures that involve unsterile
cutting or piercing; and
• experiencing accidental needle stick injuries, including
among health workers.
19. DIAGNOSIS
• Serological tests, such as RDTs or enzyme immunoassays (EIAs).
• No single HIV test can provide an HIV-positive diagnosis.
• So should be used in combination.
• HIV infection can be detected with great accuracy, using WHO
prequalified tests within a validated approach.
• Most individuals develop antibodies to HIV within 28 days of infection
and therefore antibodies may not be detectable early, during the so-
called window period.
• It is best practice to also retest all people initially diagnosed as HIV-
positive before they enroll in care and/or treatment to rule out any
potential testing or reporting error.
20. HIV TESTING SERVICE
• HIV testing should be voluntary and the right to decline
testing should be recognized.
•
Mandatory or coerced testing by a health care provider,
authority, or by a partner or family member is not
acceptable as it undermines good public health practice
and infringes on human rights.
•
New technologies to help people test themselves are being
introduced
21. SELF TESTING SERVICE
• HIV self-testing is a process whereby a person who wants
to know his or her HIV status collects a specimen, performs
a test and interprets the test results in private or with
someone they trust.
•
HIV self-testing does not provide a definitive HIV-positive
diagnosis – instead, it is an initial test which requires
further testing by a health worker
22. 5 C’S
• All HIV testing services must follow the 5 Cs principles
recommended by WHO:
•
informed Consent
• Confidentiality
• Counselling
• Correct test results
• Connection (linkage to care, treatment and other
services).
23. TREATMENT
• HIV can be suppressed by combination ART consisting of 3 or
more ARV drugs.
•
ART does not cure HIV infection but suppresses viral
replication within a person's body and allows an individual's
immune system to strengthen and regain the capacity to fight
off infections.
•
WHO recommends to provide lifelong ART to all people living
with HIV, including children, adolescents and adults, pregnant
and breastfeeding women, regardless of clinical status or CD4
cell count.
24.
25. PREVENTION
• Key approached often used in combination include.
• Safe sex
• Testing and counselling for HIV and STIs (for people exposed to risk
factors).
• Testing and counselling, linkages to TB care
• ART: A 2011 trial has confirmed that if an HIV-positive person adheres
to an effective ART regimen, the risk of transmitting the virus to their
uninfected sexual partner can be reduced by 96%.
• Pre exposure prophylaxis
• Post exposure prophylaxis
26. ELIMINATION OF MOTHER-TO-CHILD
TRANSMISSION OF HIV (EMTCT)
• The transmission of HIV from an HIV-positive mother to her
child during pregnancy, labour, delivery or breastfeeding is
called vertical or mother-to-child transmission (MTCT).
• In the absence of any interventions during these stages,
rates of HIV transmission from mother-to-child can be
between 15–45%.
• MTCT can be nearly fully prevented if both the mother and
the baby are provided with ARV drugs as early as possible
in pregnancy and during the period of breastfeeding
27. COUNTRY FACTSHEETS
PAKISTAN 2019
HIV AND AIDS ESTIMATES
Adults and children living with HIV 190 000 [160 000 - 210 000]
Adults aged 15 and over living with HIV 180 000 [160 000 - 200 000]
Women aged 15 and over living with HIV 53 000 [47 000 - 60 000]
Men aged 15 and over living with HIV 130 000 [110 000 - 140 000]
Children aged 0 to 14 living with HIV 6100 [5300 - 6900]
Adult aged 15 to 49 HIV prevalence rate 0.1 [0.1 - 0.2]
Women aged 15 to 49 HIV prevalence rate <0.1 [<0.1 - 0.1]
Men aged 15 to 49 HIV prevalence rate 0.2 [0.2 - 0.2]
HIV prevalence among young women <0.1 [<0.1 - <0.1]
HIV prevalence among young men <0.1 [<0.1 - <0.1]
https://www.unaids.org/
28. HIV remains one of the most serious global health threats of our time. In 2017, 1.8
million people were infected with HIV, and 940,000 died of AIDS-related causes.
Since 2010, deaths related to AIDS have dropped by 35% in the some parts of the
world .
More people are getting treatment than ever before.
By keeping the focus on the needs and rights of key populations, new HIV infections
can be prevented and to ensure those living with AIDS are not left behind.
https://www.pathfinder.org/focus-areas/hiv-aids
29. In the report, UNAIDS urges countries to continue to scale up HIV prevention efforts while continuing to roll out treatment, since many people are still
not being reached.
Young people and adolescents, especially young women and girls, are still being left behind in the AIDS response.
Adolescent girls and young women 15–24 years old are at higher risk of HIV infection globally, accounting for 20% of new HIV infections among
adults globally in 2015, despite accounting for just 11% of the adult population. In sub-Saharan Africa, adolescent girls and young women account for
25% new HIV infections among adults.
Harmful gender norms and inequalities, obstacles to education and sexual and reproductive health services, poverty, food insecurity and violence are
the key drivers of this increased vulnerability.
30. UNAIDS SURVEY REPORT SHOWS
that more than 90% of new HIV infections in central Asia, Europe, North America, the Middle East and North Africa in 2014
were among people from key populations and their sexual partners, including
men who have sex with men,
sex workers and
people who inject drugs.
In sub-Saharan Africa, key populations accounted for more than 20% of new HIV infections. These groups of people are
still not being reached with HIV prevention and treatment services despite having the highest rates of HIV prevalence.
The report urges countries to work closely with partners, particularly civil society, communities and people living with HIV,
to ensure that they know where their epidemics are concentrated and that they have the right services in the right places.
https://www.unaids.org/en/resources/presscentre
31. UNAIDS announces 2 million more people living with HIV on
treatment in 2015, bringing new total to 17 million
New report from UNAIDS shows that the number of people accessing
antiretroviral medicines has more than doubled since 2010
32. end of 2015
GENEVA/NAIROBI, 31 May 2016—An estimated 17
million people were accessing life-saving
antiretroviral medicines at the end of 2015, with an
additional 2 million people gaining access over a
month period.
2016
The announcement, made in a new UNAIDS report
entitled Global AIDS update 2016
34. NATIONAL AIDS CONTROL
PROGRAM(1988)
The program aims to control
HIV/AIDS cases by creating awareness
and promoting blood safety through
strengthening safe blood transfusion services.
• Major components
a) expansion of interventions for vulnerable population
b) prevention of transmission through
• Blood transfusion,
• Improved HIV prevention by the general public through behavior change
communication,
• Targeted intervention for youth, labour, and uniformed personnel.
34
35.
36. PROGRAM
UPDATES
36
Prevalence of disease in the programme area:
< 0.1% among general adult population
Reported cases: 4,000
Estimated cases: 97400
Patients treated through the program: 3983
15 HIV treatment and care centers established
16 VCT centers established
Toll free help line 0800-13536 functional for all type of
guidance and counseling
37. PAKISTAN AT A GLANCE
• Population: 176,940,000 Per capita income: $2,680 Life
expectancy at birth women/men: 66/64 years Infant
mortality rate: 64/1000 live births
Ref: Population Reference Bureau World Population Data Sheet, 2011
• the latest estimate (2017) of people living with HIV
(PLHIV) was 150,000 . In 2018, 21,000 new PLHIV cases
were recorded.
• Ref:UNAIDS Pakistan country profile
38. HIV CASES–PAKISTAN
DISEASE OUTBREAK NEWS 3 JULY 2019
• On 25 April 2019, the local administration in Larkana district was alerted by media
reports of a surge in human immunodeficiency virus (HIV) cases among children in
Ratodero Taluka, Larkana district, Sindh province, Pakistan. A screening camp was
initially established at Taluka’s main hospital. Later, screening was expanded to other
health facilities including selected Rural Health Centers (RHCs) and Basic Health
Units (BHUs). HIV rapid test kits that were initially used were replaced with pre-
qualified WHO test kits.
• From 25 April through 28 June 2019, a total of 30,192 people have been screened
for HIV, of which 876 were found positive. Eighty-two per cent (719/876) of these
were below the age of 15 years. During the screening, several risk factors were
identified, including: unsafe intravenous injections during medical procedures;
unsafe child delivery practices; unsafe practices at blood banks; poorly implemented
infection control programs; and improper collection, storage, segregation and
disposal of hospital waste.
39. PUBLIC HEALTH RESPONSE
• The response to the event has been led by the provincial Department of Health (DOH)
and the Sindh AIDS Control Program (SACP). The response has been supported by
UN partners, the Pakistan Field Epidemiology & Laboratory Training Program
(FELTP), Aga Khan University, and other partners.
• A new HIV/AIDS ART Treatment Center for children has been established at Shaikh
Zaid Children Hospital.
• Unauthorized laboratories, blood banks, and clinics have been closed.
• A mission led by the Federal Ministry of Health (MOH) and WHO, supported by other
UN partners and academia was conducted in the first half of June. The objectives
were to identify sources and chains of transmission of HIV, map the high-risk areas,
and identify gaps in HIV diagnosis, care and treatment.
40. If you have HIV and
an STI, you are more
likely to spread HIV
to your sex
partner(s).
41. Getting treated for an STI other
than HIV does not prevent the
spread of HIV.
42. INTEGRATED BIOLOGICAL AND
BEHAVIORAL SURVEILLANCE (IBBS)
This report provides biological and behavioral information related to HIV infection
among four key populations:
• People who inject drugs (PWID)
• Men who have sex with men (MSM)
• Transgender populations
• Female Sex Workers (FSWs)
Data was collected from 23 sites in Punjab, 6 in Sindh and 2 each in Baluchistan and
KPK.
Integrated Biological and Behavioral Surveillance in Pakistan: Round
5 - 2016-17Publications - Released in 2017
43. PREVENTIVE & CONTROL
MEASURES
• Care for pregnant women with HIV to prevent the transmission of HIV from
mother to child
• Deliver comprehensive care to people living with HIV and their families in the
privacy and comfort of their homes.
• Support key populations—including men who have sex with men, prisoners,
female sex workers, and transgender women—to make sure they can exercise
their rights and receive high quality services free from stigma or judgment
• Promote testing—in communities, facilities, and at hotspots—so people know
their status and can initiate treatment as early as possible.
44. • Strengthen health centers, satellite clinics, and health workers so more people in more
places—especially adolescents and those lost-to-follow-up—have access to the HIV
services they need
• Combine HIV services with contraception and maternal and newborn care,
recognizing the opportunity to meet people’s needs in a single visit
• Challenge restrictive policies and inspire governments to uphold the rights of people
living with HIV, especially key populations, adolescents, and women
45. INTERVENTIONS
• To promote the use of condoms
• Increase demand for services
• Raise the awareness for information on HIV and AIDS
• Create demand/awareness for appropriate STI services
• Interest of policymakers for helping establish more
conducive environment for behavior change
communication (BCC)
• Promote acceptance among communities of BCC services
and the value of information, and education services 45
46. • Increase self-risk assessment
• Increase confidence in condom use
• Increase knowledge about HIV/AIDS, STIs, and VCT and demand for services
• Increase discussion about HIV/AIDS and STIs
• Increase knowledge about standard precautions
• Improve attitudes and behavior among healthcare and other service delivery
workers who interact with PLWA, sex workers, injection drug users, and other
marginalized groups
46
49. REFERENCES :
• K. Park
• Illyas Ansari
• Integrated Biological and Behavioral Surveillance in Pakistan: Round 5 - 2016-17Publications -
Released in 2017
• Report on the global HIV/AIDS epidemic-June 1998
• WHO Consolidated guidelines on HIV testing services, July 2015
• WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV
infection, second edition 2016
• Population Reference Bureau World Population Data Sheet, 2011
• UNAIDS Pakistan country profile
• https://www.unaids.org/en/resources/presscentre
• https://www.pathfinder.org/focus-areas/hiv-aids
• https://www.unaids.org/
Notes de l'éditeur
Behavior change communication (BCC) is the strategic use of communication to promote positive health outcomes, based on proven theories and models of behavior change.
