HIV/AIDS Awareness in Sindh Province
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The document provides information about HIV/AIDS in Pakistan, including: 1) It discusses the objectives and infrastructure of the Enhanced Sindh AIDS Control Program, including voluntary counseling and testing centers, STI clinics, and PPTCT centers. 2) It provides a brief history of HIV, noting it originated from chimpanzees and was first identified in the US in 1981. HIV attacks and destroys CD4 cells, eventually causing AIDS. 3) It discusses HIV transmission, noting the major routes are sexual contact, exposure to infected blood or blood products, and from mother to child during pregnancy, birth, or breastfeeding.
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HIV/AIDS Awareness in Sindh Province
- 1. PAKISTAN Presenter Dr. M. MUNAWAR KHAN PROVINCIAL BCC COORDINATOR ENHANCED SINDH AIDS CONTROL PROGRAM What is HIV/AIDS ?
- 4. ENHANCED HIV/AIDS CONTROL PROGRAM SINDH
- 9. African Simean [Green] Chimpanzee
- 11. 1981 History collected by Dr MZ 8 cases of KS among young gay men June 5, 1981: 5 cases of PCP( Pneumocystis Pneumonia ) in gay men Los Angeles, San Francisco and New York, who had developed PCP ... from UCLA (MMWR)
- 12. I n the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Morbidity and Mortality Weekly Report (MMWR) MMWR SEARCH
- 14. Global summary of the AIDS epidemic 2009 33.3 million 30.8 million 15.9 million 2.5 million 2.6 million 2.2 million 370 000 1.8 million 1.6 million 260 000 Number of people living with HIV People newly infected with HIV in 2009 AIDS deaths in 2009 Total Adults Women Children (<15 years) Total Adults Children (<15 years) Total Adults Children (<15 years)
- 20. A combination of risk factors is currently putting Pakistan at serious risk of further transmission from high to low risk groups through bridging populations. Pakistan’s HIV epidemic
- 21. Example of high risk sexual networks in a population FSW Male Clients IDU General Population Women MSW
- 29. AIDS
- 38. THE HIV LIFE CYCLE CONTINUOUS VIRAL REPLICATION LEADING TO IMMUNODEFICIENCY IS THE HALLMARK OF THE DISEASE!!
- 39. The Immune System T Cells (CD4 Cells) = Part of body’s immune system ! CD4 The average person has between 800 & 1500 CD4 cells per cubic millimetre of blood The immune system helps fight diseases Disease CD4 Disease KILLS DISEASE IMMUNE SYSTEM ATTACKS DISEASE
- 41. HIV-Infected T-Cell HIV Virus T-Cell HIV Infected T-Cell New HIV Virus
- 42. VIROLOGY gp 120 & gp 41 have the major role to recognize CD 4 cells thus promoting attachment
- 45. Reverse Transcriptase Inhibitor (red) Protease Inhibitors Viral RNA yellow , DNA blue Attachmen t Entry of the Viral RNA Reverse Transcription Translation: RNA -> Proteins Viral Protease Assembly and Budding Integration of Viral DNA Transcription: Back to RNA
- 53. Press ad Option 1
- 56. ? How can you get HIV? BREAST MILK VAGINAL SECRETIONS BLOOD SEMEN CERVICAL SECRETIONS 2. Through these acts: H INFECTED MOTHER: DURING 1. PREGNANCY 2. BIRTH 3. BREAST FEEDING UNPROTECTED PENETRATIVE INTERCOURSE (HOMOSEXUAL OR HETEROSEXUAL) WITH SOMEONE WHO IS INFECTED 1. INJECTION OR TRANSFUSION OF INFECTED BLOOD / BLOOD PRODUCTS 2. SHARING UNSTERILISED NEEDLES WITH SOMEONE WHO IS INFECTED 1. Through these bodily fluids
- 57. HIV in Body Fluids Semen 11,000 Vaginal Fluid 7,000 Blood 18,000 Amniotic Fluid 4,000 Saliva 1 Average number of HIV particles in 1 ml of these body fluids
- 59. Estimated PPTCT Rates Without intervention During pregnancy 5–10% During labour and delivery About 15% During breastfeeding 5-20% MTCT infection rates = up to 40%
- 61. HIV Infection and Antibody Response Infection Occurs AIDS Symptoms ---Initial Stage---- ---------------Intermediate or Latent Stage-------------- ---Illness Stage--- Flu-like Symptoms Or No Symptoms Symptom-free < ---- ----
- 62. Natural History of HIV Infection
- 64. Infections in relation to CD4 + cell count Herpes Zoster Tuberculosis Oral Candidiasis Esophageal Candidiasis Mucocutaneous herpes Time AIDS 400 300 200 100 50 PCP Toxoplasmosis Cryptococcosis (Mycobacterium avium complex ) MAC (Cytomegalovirus) CMV (Progressive Multifocal Leuko encephalopathy) PML Cryptosporiodiosis
- 73. Press ad Option 3
- 85. HIV DOES NOT SPREAD IN THESE WAYS
- 86. Press ad Option 4
- 89. Questions are Welcomed if ask
- 90. Thank you
Notes de l'éditeur
- -Population: 35 million -23 administrative districts -Multiethnic population -Main Urban Centers: Karachi , Hyderabad, Sukkur & Larkana The port city of Karachi is the largest in Pakistan divided in 18 town and home to more then 10 million people. People from all provinces come here in search of better livelihood -Second largest province in terms of population and third largest in size -Sindh is the home of 5000 year old Indus Valley Civilization.
- Dr. Robert Gallo of the National Cancer Institute had isolated the virus which caused AIDS. Dr. Luc Montagnier Pasteur Institute in Paris The scientific protagonists finally agreed to share credit for the discovery of HIV, and in 1986, both the French and the US names (LAV and HTLV-III) were dropped in favor of the new term human immunodeficiency virus
- Kaposi's Sarcoma (KS) was a rare form of relatively benign cancer that tended to occur in older people. But by March 1981 at least eight cases of a more aggressive form of KS had occurred amongst young gay men in New York.2 At about the same time there was an increase, in both California and New York, in the number of cases of a rare lung infection Pneumocystis carinii pneumonia (PCP)3. In April this increase in PCP was noticed at the Centers for Disease Control (CDC) in Atlanta. A drug technician, Sandra Ford, noticed a high number of requests for the drug pentamine, used in the treatment of PCP. &quot;A doctor was treating a gay man in his 20s who had pneumonia. Two weeks later, he called to ask for a refill of a rare drug that I handled. This was unusual-nobody ever asked for a refill. Patients usually were cured in one 10-day treatment or they died&quot; - Sandra Ford for Newsweek -4 In June, the CDC published a report about the occurrence, without identifiable cause, of PCP in five men in Los Angeles5. This report is sometimes referred to as the &quot;beginning&quot; of AIDS, but it might be more accurate to describe it as the beginning of the general awareness of AIDS in the USA. A few days later, following these reports of PCP and other rare life-threatening opportunistic infections, the CDC formed a Task Force on Kaposi's Sarcoma and Opportunistic Infections (KSOI). 6Around this time a number of theories were developed about the possible cause of these opportunistic infections and cancers. Early theories included, infection with cytomegalovirus, the use of amyl nitrite or butyl nitrate &quot;poppers&quot; and &quot;immune overload&quot;.7 8 9 Because there was so little known about the transmission of what seemed to be a new disease, there was concern about contagion, and whether the disease could by passed on by people who had no apparent signs or symptoms.10 Knowledge about the disease was changing so quickly that certain assumptions made at this time were shown to be unfounded just a few months later. For example, in July 1981 Dr Curran of the CDC was reported as follows: &quot;Dr. Curran said there was no apparent danger to non homosexuals from contagion. 'The best evidence against contagion', he said, 'is that no cases have been reported to date outside the homosexual community or in women'&quot; - The New York Times-11 Just five months later, in December 1981, it was clear that the disease affected other population groups, when the first cases of PCP were reported in injecting drug users.12 At the same time the first case of AIDS was documented in the UK. 13 1982 History The disease still did not have a name, with different groups referring to it in different ways. The CDC generally referred to it by reference to the diseases that were occurring, for example lymphadenopathy (swollen glands), although on some occasions they referred to it as KSOI, the name already given to the CDC task force.14 15 In contrast some still linked the disease to it's initial occurrence in gay men, with the Lancet calling it the 'gay compromise syndrome', whilst at least one newspaper referred to it as GRID (gay-related immune deficiency).16 17 and another newspaper described it as 'gay cancer'.18 The disease was also called 'community-acquired immune dysfunction'.19 In June a report of a group of cases amongst gay men in Southern California, suggested that the disease might be caused by an infectious agent that was sexually transmitted.20 By the beginning of July a total of 452 cases, from 23 states, had been reported to the CDC.21 Later in July the first reports appeared that the disease was occurring in Haitians, as well as haemophiliacs.22 23 By August the disease was being referred to by it's new name of AIDS24. The word AIDS was an abbreviation of Acquired Immune Deficiency Syndrome25. An anagram of AIDS, SIDA was created for use in French and Spanish26. The doctors thought 'AIDS' suitable because people acquired the condition rather than inherited it, because it resulted in a deficiency within the immune system, and because it was a syndrome, with a number of manifestations, rather than a single disease.27 Very little was still known about transmission and public anxiety continued to grow. &quot;It is frightening because no one knows what's causing it, said a 28-year old law student who went to the St. Mark's Clinic in Greenwich Village last week complaining of swollen glands, thought to be one early symptom of the disease. Every week a new theory comes out about how you' re going to spread it.&quot; - The New York Times - 28 By 1982 a number of AIDS specific voluntary organisations had been set up in the USA. They included the San Francisco AIDS Foundation (SFAF), AIDS Project Los Angeles (APLA), and Gay Men's health Crisis (GMHC).29 In November 1982 the first AIDS organisation, the 'Terry Higgins Trust', was formally established in the UK, and by this time a number of AIDS organisations were already producing safer sex advice for gay men.30 31 In December a 20-month old child who had received multiple transfusions of blood and blood products died from infections related to AIDS32. This case provided clearer evidence that AIDS was caused by an infectious agent, and it also caused additional concerns about the safety of the blood supply. Also in December, the CDC reported the first cases of possible mother to child transmission of AIDS.33 By the end of 1982 many more people were taking notice of this new disease, as it was clearer that a much wider group of people was going to be affected. &quot;When it began turning up in children and transfusion recipients, that was a turning point in terms of public perception. Up until then it was entirely a gay epidemic, and it was easy for the average person to say 'So what?' Now everyone could relate.&quot; - Harold Jaffe of the CDC for newsweek -34 It was also becoming clear that AIDS was not a disease that just occurred in the USA. Throughout 1982 there were separate reports of the disease occurring in a number of different countries.35 A report also appeared that a disease previously known as &quot;slim&quot;, was actually an African form of AIDS. 36