Vulnerable and High-risk Groups: -Expand knowledge, access, and coverage of vulnerable populations—particularly in large cities—to a package of high impact services, through combined efforts of the government and NGOs. -Implement harm-reduction initiatives for IDUs and safe sex practices for CSWs. -Make effective and affordable STD services available for high-risk groups and the general population.
General Awareness and Behavioral Change: -Undertake behavioral change communications with the following behavioral objectives: (i) use of condoms with non-regular sexual partners; (ii) use of STI treatment services when symptoms are present and knowledge of the link between STIs and HIV; (iii) use of sterile syringes for all injections; (iv) reduction in the number of injections received; (v) voluntary blood donation (particularly among the age group 18 to 30); (vi) use of blood for transfusion only if it has been screened for HIV; and (vii) display of tolerant and caring behaviors towards people living with HIV/AIDS and members of vulnerable populations. -Increase interventions among youth, police, soldiers, and migrant laborers.
Blood and Blood Product Safety: -Ensure mandatory screening of blood and blood products in the public and private sectors for all major blood-borne infections. -Conduct education campaigns to promote voluntary blood donation -Develop Quality Assurance Systems for public and private blood banks to ensure that all blood is properly screened for HIV and Hepatitis B.
Surveillance and Research: -Strengthen and expand the surveillance and monitoring system. -Implement a second-generation HIV surveillance that tracks sero-prevalence and changes in HIV-related behaviors, including the spread of STIs and HIV, sexual attitudes and behaviors, and healthcare-seeking behaviors related to STIs.
Building Management Capacity -Continue to build management capacity within provincial programs and local NGOs to ensure evidence-based program implementation. -Identify gaps in existing programs and continue phased expansion of interventions.
WHAT IS HIV??
“Human Immunodeficiency Virus”
A unique type of virus (a retrovirus)
Invades the helper T cells (CD4 cells) in the body of
the host (defense mechanism of a person)
Threatening a global epidemic.
Preventable, managable but not curable.
WHAT IS AIDS ???
“Acquired Immunodeficiency Syndrome”
HIV is the virus that causes AIDS
Disease limits the body’s ability to fight infection
due to markedly reduced helper T cells.
Patients have a very weak immune system (defense
Patients predisposed to multiple opportunistic
infections leading to death.
Opportunistic infections and malignancies that
rarely occur in the absence of severe
immunodeficiency (eg, Pneumocystis pneumonia,
central nervous system lymphoma).
Persons with positive HIV serology who have ever
had a CD4 lymphocyte count below 200 cells/mcL or
a CD4 lymphocyte percentage below 14% are
considered to have AIDS.
“THE VIRAL GENOME”
Icosahedral (20 sided), enveloped virus of the
lentivirus subfamily of retroviruses.
Retroviruses transcribe RNA to DNA.
Two viral strands of RNA
found in core surrounded by
protein outer coat.
Outer envelope contains a
lipid matrix within which
specific viral glycoproteins are
These knob-like structures
responsible for binding to
Stage 1 - Primary
Short, flu-like illness
- occurs one to six
weeks after infection
Infected person can
infect other people
Stage 2 - Asymptomatic
Lasts for an average of ten years
This stage is free from symptoms
There may be swollen glands
The level of HIV in the blood drops to low
HIV antibodies are detectable in the blood
Stage 3 - Symptomatic
The immune system deteriorates
Opportunistic infections and cancers start to
Stage 4 - HIV AIDS
The immune system
weakens too much as
CD4 cells decrease in
TB & HIV CO-INFECTION
TB is the most common opportunistic infection in HIV and
the first cause of mortality in HIV infected patients (10-
10 million patients co-infected in the world.
Immunosuppression induced by HIV modifies the
clinical presentation of TB :
1. Subnormal clinical and roentgen presentation
2. High rate of MDR/XDR
3. High rate of treatment failure and relapse (5% vs < 1% in HIV)
No name is used
Unique identifying number
Results issued only to test recipient
Blood Detection Tests
immunosorbent assay (ELISA)
Screening test for HIV
Sensitivity > 99.9%
Western blot Confirmatory test
Speicificity > 99.9% (when combined with
HIV rapid antibody test Screening test for HIV
Simple to perform
Absolute CD4 lymphocyte count Predictor of HIV progression
Risk of opportunistic infections and AIDS when
HIV viral load tests Best test for diagnosis of acute HIV infection
Correlates with disease progression and
response to HAART
Urine Western Blot
As sensitive as testing blood
Safe way to screen for HIV
Can cause false positives in certain
people at high risk for HIV
The only FDA approved HIV
As accurate as blood testing
Draws blood-derived fluids
from the gum tissue.
NOT A SALIVA TEST!
HEALTH CARE FOLLOW UP OF HIV
For all HIV-infected individuals:
CD4 counts every 3–6 months
Viral load tests every 3–6 months and 1 month following a change in therapy
INH for those with positive PPD and normal chest radiograph
RPR or VDRL for syphilis
Toxoplasma IgG serology
CMV IgG serology
Influenza vaccine in season
Hepatitis B vaccine for those who are HBsAb-negative
Haemophilus influenzae type b vaccination
Papanicolaou smears every 6 months for women
Five ways to protect yourself?
New shaving/cutting blades
It is the most effective method of not acquiring
Refraining from unprotected sex: oral, anal, or
Refraining from intravenous drug use
A mutually monogamous relationship with a
person who is not infected with HIV
HIV testing before intercourse is necessary to
prove your partner is not infected
Use condoms every time you have
Always use latex or polyurethane
condom (not a natural skin
Always use a latex barrier during
When Using A Condom Remember To:
Make sure the package is
Make sure to check the
package for damages
Do not open the package
with your teeth for risk of
Never use the condom
more than once
Use water-based rather
than oil-based condoms
HIV PREVALENCE IN VARIOUS REGIONS
Source: UNAIDS, AIDS Epidemic Update, December 2004.
Total = 39.4 million
North Africa/Middle East
NEWLY INFECTED CASES OF HIV IN VARIOUS REGIONS
North Africa/Middle East
Source: UNAIDS, AIDS Epidemic Update, December 2004
Total = 4.9 million
WHAT WE CAN DO??
UNAIDS Outcome Framework 2009–2011: nine priority areas
We can reduce sexual transmission of HIV.
We can prevent mothers from dying and babies from becoming infected with
We can ensure that people living with HIV receive treatment.
We can prevent people living with HIV from dying of tuberculosis.
We can protect drug users from becoming infected with HIV.
We can remove punitive laws, policies, practices, stigma and discrimination
block effective responses to AIDS.
We can stop violence against women and girls.
We can empower young people to protect themselves from HIV.
We can enhance social protection for people affected by HIV.