Naulo Ghumti Nepal
ORIENTATION ON HIV,
AIDS AND STIS
Objectives of Presentation
To orient about HIV, AIDS and STIs for Development
of Knowledge, Attitude, and Practice for Prevention
of HIV and STIs.
• To know the basic concept HIV, AIDS & STIs
• To know the History of HIV Infection, situation of HIV in
• To acquire knowledge about mode of Transmission of HIV,
How HIV does not Transmit, Window period.
• To know Pathogenesis, Diagnosis of HIV infection,
General clinical features of AIDS.
• To know Risk Population for HIV infection, Prevention of
• To gain knowledge about Treatment/ curative health
services of HIV infection and AIDS.
• To know the knowledge about STIs, their clinical features,
treatment and Prevention.
HIV AND AIDS
HISTORY OF HIV
• Originated in non-human primates in Sub-Saharan Africa
and was transferred to humans during the late 19th or
early 20th century.
• Two types of HIV exist: HIV-1 and HIV-2.
• The pandemic strain of HIV-1 is closely related to a virus
found in the chimpanzees of the subspecies Pan
troglodytes troglodytes, which lives in the forests of the
Central African nations of Cameroon, Equatoria
Guinea, Gabon, Republic of Congo and Central African
• Most HIV researchers agree that HIV evolved at some
point from the closely related Simian immunodeficiency
virus (SIV), and that SIV or HIV (post mutation) was
transferred from non-human primates to humans in the
• The first confirmed case of AIDS in the United States, a
16-year-old boy from Missouri who died in 1969.
Nepal's first cases of HIV/AIDS were reported in 1988, the
disease has primarily been transmitted by injecting drug
use and unprotected sex.
Mode of HIV Transmission
Only certain fluids—blood,
semen, pre-seminal fluid,
rectal fluids, vaginal fluids,
and breast milk—from an
HIV-infected person can
fluids must come in contact
with a mucous membrane or
damaged tissue or be directly
injected into the bloodstream
1. SEXUAL CONTACT
Anal sex is the highest-
risk sexual behavior
2. From Blood and Blood Products
Sharing needles, syringes
sharing equipment when
transplants that are
contaminated with HIV.
3. Infected Mother to Child (Vertical
• During pregnancy
• During labor and delivery
• Through breastfeeding
HIV Does not Transmit From;
HIV does not survive long outside the human body (such as on
surfaces), and it cannot reproduce. It is not spread by
• Air or water
Insects, including mosquitoes or ticks. Using Common Toilets
Saliva, tears, or sweat, sneezing
Casual contact like shaking hands and sharing dishes.
Using Common Clothes
Stay with Family/Caring of HIV infected
HOW HIV infects human?(Pathogenesis)
HIV destroys certain types of white blood cells, weakening
the body's defenses against infections and cancers.
HIV progressively destroys some types of white blood cells
called CD4+ lymphocytes.
Lymphocytes help defend the body against foreign cells,
infectious organisms, and cancer.
HIV destroys CD4+ lymphocytes, people become
susceptible to attack by many other infectious organisms.
SYMPTOM of HIV Infection
Initially no noticeable symptoms, but within a few weeks,
fever, rashes, swollen lymph nodes, fatigue, and a variety
of less common symptoms may develop.
Symptoms of initial (primary) HIV infection last from a few
days to 1 to 2 weeks.
The symptoms disappear, but lymph nodes often remain
enlarged, felt as small, painless lumps in the neck, under
the arms, or in the groin.
• Time period between initial HIV infection and the
development of a measureable immunological (or
antibody) response to the infection
• During this period, a person infected with HIV
could still have a negative HIV test Result.
• Window period varies from person to person and
can range from as little as 2 weeks to as long as
DIAGNOSIS OF HIV
Getting HIV test is the only way to know if you have HIV.
The Diagnosis of HIV infection is most often based
upon the detection of antibodies to the virus.
Types of Test are
• ANTIBODY TESTS
(ELIZA, RAPID TEST, WESTERN BLOT)
• VIROLOGICAL TEST (HIV antigen test, DNA
PCR(below 18 month), Viral culture)
• Voluntary HIV/AIDS counseling, testing and referral (VCT)
is a major strategy in HIV/AIDS prevention and care.
• VCT allows individuals to learn their HIV status through
• pre- and post-test counseling and HIV test. VCT is client-
initiated, as opposed to provider initiated testing and
VOLUNTARY COUNSELING AND TESTING (VCT)
CONSENT,CONSISTENCY & ACCURACY,
AIDS is the most severe form of HIV infection. HIV infection
is considered to be AIDS when at least one serious
complicating illness develops or the number (count) of
CD4+ lymphocytes decreases substantially.
The number of CD4+ lymphocytes in blood (the CD4 count)
helps determine how well the immune system can protect
the body from infections and how severe the damage done
by the HIV is. Healthy people have a CD4 count of about
800 to 1,300 cells per microliter of blood.
WHO STAGING OF AIDS
Clinical stage 1
• Persistent generalized lymphadenopathy
Clinical stage 2
• Moderate and unexplained weight loss (<10% of presumed or
measured body weight)
• Recurrent respiratory tract infections (such
as sinusitis, bronchitis, otitis media, pharyngitis)
• Herpes zoster
• Recurrent oral ulcerations
• Papular pruritic eruptions
• Angular cheilitis
• Seborrhoeic dermatitis
• Onychomycosis (fungal nail infections)
Clinical stage 3
• Conditions where a presumptive diagnosis can be made on the
basis of clinical signs or simple investigations
• Unexplained chronic diarrhea for longer than one month
• Unexplained persistent fever (intermittent or constant for longer than
• Severe weight loss (>10% of presumed or measured body weight)
• Oral candidiasis
• Oral hairy leukoplakia
• Pulmonary tuberculosis (TB) diagnosed in last two years
• Severe presumed bacterial infections (e.g. pneumonia, empyema,
meningitis, bacteraemia, pyomyositis, bone or joint infection)
• Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis
• Conditions where confirmatory diagnostic testing is necessary
• Unexplained anaemia (< 80 g/l), and or neutropenia (<500/µl) and or
thrombocytopenia (<50 000/ µl) for more than one month
Clinical stage 4
• Conditions where a presumptive diagnosis can be made
on the basis of clinical signs or simple investigations
• HIV wasting syndrome
• Pneumocystis pneumonia
• Recurrent severe or radiological bacterial pneumonia
• Chronic herpes simplex infection (orolabial, genital or anorectal
of more than one month's duration)
• Esophageal candidiasis
• Extrapulmonary tuberculosis
• Kaposi's sarcoma
• Central nervous system toxoplasmosis
• HIV encephalopathy
IS There Treatment of HIV and AIDS?
There no specific vaccination for prevention of HIV and
AIDS. And also there is no any Therapeutic medication for
complete cure of HIV infection and AIDS.
But ART is available
(Anti Retro Viral Therapy) ART is a complex treatment with
multiple medications that, once started, need to be taken
over the long time.
The major role of ART is to Prevent opportunistic Infections
and raise the immune power of body to fight against
various micro organisms, control of HIV replication, balance
the no. of CD4 cells.
Key characteristics of HIV in Nepal
The first HIV was detected in 1988 in Nepal,
since then HIV epidemic has evolved from low to
concentrated among key populations at higher
People who inject drugs
Men who have sex with men
Heterosexual transmission dominant
HIV prevalence in general population is <1%
Clients of sex workers
Male labour migrants
Clients of sex
Injecting drug users.
Men having Sex with
HIV in Nepal
PUBLIC HEALTH ASPECT
Estimated HIV Population Summary
Male living with HIV 26,903
Female living with HIV 13,820
Total PLHIV 40,723
HIV Prevalence (15-49) 0.23 %
New HIV infections 1,408
ART Need 22,760
Mother Needing PMTCT 679
AIDS Deaths 3,362
PREVENTION OF HIV
B- Be faithful
C- Condom use(correct and Consistent)
D- Don’t Share Needle and Syringe.
• Always Use new blades, syringes
• Always use tested bloods
• Proper counseling before conceive baby from HIV
Sexually Transmitted Infections (STI)
Infections (STI) are illnesses that
predominantly transmitted by means
of sexual behavior, including vaginal
intercourse, anal sex and oral sex.
Mode of Transmission
Sexual contact: from one infected person to another
primarily by Sexual contact- Anal, Vaginal or oral
From Mother to child: during Pregnancy and child birth
Occasionally through contaminated fingers, blood and
blood products, organ transplants, contaminated needles
and fomites such as towels, sex toys.
STI increases risk of HIV infection
Estimated annual Incidence WHO: 1999
340 million new cases (syphilis, gonorrhea, chlamydial and
trichomoniasis primarily occurring in men and women aged 15-
Syphilis: 12 million
Gonorrhea: 62 million
Chlamydial infection: 92 million
Trichomoniasis: 173 million
Research by Zeeb (1996) estimated a total of 6,000 to 8,000
annual STIs client in kaski District.
IBBS, 2008 in pokhara 30% of FSW reported at least one
symptom of STIs.
SIGN AND SYMPTOMS OF STIs
• Urethral discharge
• Burning and pain during
• Pain of itch in and around
genitalia, perineum and
• Papules, vesicles,
erosion/ulcers or fleshy growths
in and around genitalia,
perineum and anus/rectum, oral
cavity and occasionally on other
• Swelling in inguinal, anal region
and of scrotum.
abnormal vaginal discharge
Burning and/or increased
frequency of urination
Lower abdominal pain
• Pain, itch, Papules, vesicles,
erosion/ulcers or fleshy
growths in and around
genitalia, perineum and
anus/rectum, oral cavity and
occasionally on other sites.
• Swelling in inguinal, anal
region and of scrotum.
RISK Factors for STIs
Sexual contact with multiple
Sexual contact without using
Sexual contact with causal
Sexual contact with high
possibilities of trauma – anal
sex Other factors
status, drug and
alcohol use etc.
• National Voluntary Counseling and Testing Guideline
• Publication of National Center for AIDS and STI control.
If you Need help ? If you have any
Problems or Query?
Expanded Integrated Health
NAULO GHUMTI NEPAL
(Opposite side of Pokhara Sub-
metropolitan Office Near NCC Bank)
Phone No. : 061538547
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