A little description of AIDS regarding Pakistan

1. Acquired Immuno Deficiency Syndrome
(AIDS)

2. Contents
01
Definition, History, HIV to AIDS, Stages
& Phases of HIV
02
How HIV spreads, Prevention,
Treatment, Laboratory assessment &
Screening
03
04 Prevalence & Researches on AIDS
Behavior Models & Intervention
Strategies

3. A life-threatening disease caused by the
Human Immuno Deficiency Virus (HIV). The
virus attacks the body’s immune system and
leaves it vulnerable to infection and immune
system loses its effectiveness, leaving the body
defenseless against bacterial, viral, fungal,
parasitic, cancerous and other opportunistic
diseases.

4. Opportunistic Infections
An opportunistic infection is an infection caused by pathogens
(bacteria, viruses, fungi, or protozoa) that take advantage of an
opportunity not normally available, such as a host with a weakened
immune system. People with weak immune systems include people
living with HIV.HIV-related OIs include
• Pneumonia
• Salmonella infection (diarrhea, nausea, fever, and
headache)
• Candidiasis (thrush) (oral & vaginal fluid thrush/flow)
• Toxoplasmosis (swollen lymph nodes and muscle
aches)

5. History
3 homosexual patients
presenting the clinical signs of
weight loss, fever, mycosis and
pneumonia (Los Angeles)
International
Committee of Virus
Taxonomy adopted the
name HIV
Thailand was the first
country to report a
case of AIDS
Researchers identified a
strain of chimpanzee SIV,
which was nearly
identical to HIV. (South
Africa)
1999198619841980

6. HIV is classified as a
retrovirus because it
works by injecting a copy
of its genetic material in
DNA of T-cell of host.
Healthy human blood
normally contains
approx. 1000 T-cells per
mm3 . HIV
multiplication begin to
HIV to AIDS

7. Stages of HIV
The T-cells concentration falls, and
HIV concentration rises
accompanied by symptoms such as
swollen lymph nodes.
02
Finally, almost all-natural
immunity is lost, and full-
blown AIDS occurs.
04
As T-cells are furthered reduced,
immune function is impaired and
opportunistic infections occur.
03
Soon after the initial HIV infection,
the immune system destroys most
virus, symptoms are mild or non-
existent.
01

10. The symptoms of HIV and AIDS vary, depending on the phase of
infection
Phases
0
1
0
2
030
4

11. Acute HIV Fever
 Headache
 Muscle aches and joint pain
 Rash
 Sore throat and painful mouth sores
 Swollen lymph glands, mainly on
the neck
These are so mild that you may not
notice them.
Chronic HIV
In some people, persistent swelling of
lymph nodes occurs during this stage.
Otherwise, there are no specific signs
and symptoms. HIV remains in the body
and in infected white blood cells. This
stage of HIV infection generally lasts
around 10 years if you're not receiving
antiretroviral therapy. But sometimes,
even with this treatment, it lasts for
decades.

12. Symptomatic HIV
 Fever
 Fatigue
 Swollen lymph nodes — often
one of the first signs of HIV
infection
 Diarrhea
 Weight loss
 Oral yeast infection (thrush)
 Shingles (herpes zoster)
Progression to AIDS
When AIDS occurs, your immune system
has been severely damaged. You'll be more
likely to develop opportunistic infections or
opportunistic cancers. Signs and symptoms
of these infections are:
 Soaking
night sweats
sweats
 Recurring
fever
 Chronic
diarrhea
 Weight loss
 Skin rashes
or bumps
 Persistent
white spots or
unusual
lesions on your
your tongue or
or in your
mouth
 Persistent,
unexplained
fatigue

14. You may become infected if you have vaginal,
anal or oral sex with an infected partner whose
blood, semen or vaginal secretions enter your
body. The virus can enter your body through
mouth sores or small tears that sometimes develop
in the rectum or vagina during sexual activity.In some cases, the virus may be transmitted
through blood transfusions. American
hospitals and blood banks now screen the
blood supply for HIV antibodies, so this risk
is very small.
From Blood Transfusions
By Having sex
By sharing Needles
Sharing contaminated intravenous drug
paraphernalia (needles and syringes) puts you
at high risk of HIV and other infectious
diseases, such as hepatitis.
During pregnancy or delivery
or through breast-feeding
Infected mothers can pass the virus on to
their babies. HIV-positive mothers who
get treatment for the infection during
pregnancy can significantly lower the risk
to their babies.

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16. Use Condom every time you have a
sex.
Consider the drug Truvada.
Tell your sexual partners if you have
HIV.
Use a clean needle.
If you're pregnant, get medical care right
away.
Consider male circumcision.
Preventio
ns

17. The factors that play a role in progression of disease are:
• Lifestyle
• Adherence to medication
• Stress
• Type C coping style
Psychology and the progression of
HIV to AIDS

18. Lifestyle
Researches have indicated that replication of the HIV virus may
be influenced by further exposure to HIV- virus. The following
lifestyles are related with HIV progression:
• Injecting drugs (specifically drugs having immuno-
suppressive effects)
• Unsafe sex.

19. Adherence to medication
• Over the recent years, the life expectancy and quality of life of those
with HIV has improved dramatically (Mocroft et al. 1998). Much of this
has been attributed to the success of highly active antiretroviral therapy
(HAART). But many people who are offered HAART, however do not take
the treatment.
• Cooper et al. (2002) explored people’s beliefs about HAART . They
interviewed 26 gay men about their views about HAART shortly after it
had been recommended by their doctor. The results showed that
concerns about adverse effects of HAART were related to declining
treatment

20. Stress
• Sodroski et al. (1984) suggested that stress or distress may well
increase the replication of the HIV virus, causing a quicker
progression to AIDS. It means that life stress is linked with illness
progression.
• Antoni et al., (2006) conducted a research which addressed the
effectiveness of stress management in slowing down the
progression of HIV. In the similar study, the mechanisms behind
the impact of stress management were explored.

21. In the first part of the study, 130 gay men
who were HIV positive were randomized
to receive either cognitive behavioral
stress management intervention (CBSMI)
and antiretroviral medication adherence
training (MAT) or to receive (MAT) alone.
The men were then followed-up after 9
and 15 months in terms of viral load. The
results showed that men who already
showed a detectable viral load at baseline
(i.e. those with a lot of virus in the blood
already) who received a stress
management showed a reduction in their
viral load over the 15 month period even
when the medication adherence was
controlled for. The authors conclude that
for HIV positive men who already showed
a detectable viral load, stress management
may enhance the beneficial effects of their
In the second part, 25 HIV positive
men were randomized to receive
stress management or a waiting list
control. Urine samples were taken
before and after the intervention
period. The results again showed
that stress management was
effective and that effect was related
to decrease in cortisol and
depressed mood. The authors
conclude that stress management
works by reducing the stress
induced by being ill. With disease
such as HIV.

22. Type C coping style
Research has also explored the link between how people cope with HIV and
the progression of their disease with a focus on type C coping style, which
reflects emotional inexpression and a decreased recognition of needs and
feelings.
Solano et al. (2001,2002) used CD4 cells as a measure of disease status,
assessed baseline coping and followed 200 patients up after 6 and 12 months.
The results showed that type C coping style predicted progression at follow-
up, suggesting that a form of coping that relies upon a lack of emotional
expression may exacerbate the course of HIV disease. However, the results
also showed that very high levels of emotional expression were also
detrimental. The authors conclude that working through emotions rather than
just releasing them may be the most protective coping strategy for people

24. A normal CD4 count is
from 500 to 1,400 cells per
cubic millimeter of blood.
CD4 counts decrease over
time in persons who are not
receiving. At levels below
200 cells per cubic
millimeter, patients become
susceptible to a wide
variety of OIs
(Opportunistic Infections) ,
many of which can be fatal.
Pneumonia, Intestinal tract
infections like diarrhea,
adnominal cramps, fever
Tuberculosis
Fu-like illness & eyes
infections

25. Also called OraQuick
Advance Rapid HIV-1/2
Antibody Test. It was the
first available test that
could provide results in
20 minutes using oral
fluid, a finger-stick
sample of blood, or
plasma.

26. • BioSure HIV Self Test. This test is only
available in certain parts of Europe,
meets European quality standards (has
(has CE marking), and uses blood to
to test for HIV in about 15 minutes.
• Autotest VIH. This test is only available
in certain parts of Europe, meets
European quality standards (has CE
marking), and uses blood from the
fingertip to test for HIV.
• INSTI HIV Self Test. This test launched
in the Netherlands in 2017, meets
European quality standards (has CE
marking), and promises results within
within 60 seconds.

27. • ALT/AST
• BUN/S. Creatinine
• Screening for TB and other
treatable co-infections of
HIV

28. ALT; Alanine aminotransferase (ALT) test measures
the level of ALT in your blood. ALT is an enzyme
made by cells in your liver. It plays a crucial role in
in metabolism, the process that turns food into
energy. ALT is normally found inside liver cells.
However, when your liver is damaged or inflamed,
inflamed, ALT can be released into your
bloodstream. This causes serum ALT levels to rise.
rise.
AST; Aspartate Aminotransferase (AST) is an enzyme
your liver makes. Other organs, like your heart,
kidneys, brain, and muscles, also make smaller
amounts. AST is also called SGOT (serum glutamic-
glutamic-oxaloacetic transaminase). Normally, AST
AST levels in your blood are low. When your liver is
liver is damaged, it puts more AST into your blood,
blood, and your levels rise. A high AST level is a sign
sign of liver damage, but it can also mean you have
have damage to another organ that makes it, like
like your heart or kidneys.

29. BUN; Urea nitrogen is a normal waste
product that your body creates after you
you eat. Blood Urea Nitrogen Test (BUN)
(BUN) or serum BUN test, measures how
how much of the waste product you
have in your blood. If your levels are off
off the normal range, this could mean
that either your kidneys or your liver
may not be working properly.
S. Creatinine; (Serum Creatinine) A
creatinine blood test measures the level
level of creatinine in the blood.
Creatinine is a waste product that forms
forms when creatine, which is found in
in your muscle, breaks down. Creatinine
Creatinine levels in the blood can
provide your doctor with information
about how well your kidneys are

30. Treatment
• There is no such treatment for AIDS, but
certain medications are there to prevent virus
spreading.
• Pre-exposure prophylaxis (or PrEP) are used
by the people who are at very high risk for HIV
take daily medicine to prevent HIV. PrEP can
stop HIV from taking hold and spreading
throughout your body.
• Post-exposure prophylaxis (or PEP) means
taking antiretroviral medicines after being
exposed to HIV to prevent becoming infected.
PEP should be used only in emergency
situations and must be started within 72 hours
after a recent possible exposure to HIV.

31. Antiretroviral
therapy
• Antiretroviral therapy (ART) is the use of HIV medicines to
treat HIV infection. People on ART take a combination of HIV
medicines (called an HIV treatment regimen) every day.
• HIV attacks and destroys the infection-fighting CD4 cells of
the immune system. HIV medicines prevent HIV from
multiplying (making copies of itself), which reduces the
amount of HIV in the body (also called the viral load). Having
less HIV in the body gives the immune system a chance to
recover.
• Even though there is still some HIV in the body, the immune
system is strong enough to fight off infections and certain
HIV-related cancers.

33.  Role of Health Psychologist in the battle
against AIDS
 Educational Programs
 Mass screening & HIV counselling
 Promoting the disclosure of HIV – Positive
Status

34. “Role of Health Psychologist”
Counselling people about being tested for HIV
Helping individuals to modify high-risk behaviors
Helping AIDS patients cope with emotional and
cognitive disturbances
Conducting bereavement therapy for those in the last
stages of the illness, their family and their friends.
Cognitive Behavioral Stress Management Intervention
HAART (Highly Active Antiretroviral Therapy)

35. HAART is a customized combination of different classes of
medications that a physician prescribes based on such factors
as the patient’s viral load (how much virus is in the blood), the
particular strain of the virus, the CD4+ cell count, and other
considerations (e.g., disease symptoms). Because HAART
cannot rid the body of HIV, it must be taken every day for life.
HAART can control viral load, delaying or preventing the
onset of symptoms or progression to AIDS, thereby
prolonging survival in people infected with HIV. HAART has
been in use since 1996 and has changed what was once a fatal
diagnosis into a chronically managed disease.
HAART

36. “Mass Screening & HIV counselling”
Results of all the researches suggest that frequency
of unprotected sex can be dramatically reduced with few
steps:
 Help people to improve their outlook on life.
 Help people to improve their feeling of self-efficacy.
 Help people to improve their sense of personal control.
 Encourage the people to talk more openly about safe

37. “Educational Programs”
 Educational programs and media campaigns are most likely
to be effective when messages are adapted to the target
group.
 People mostly understand the things and follow them if it is
conveyed to them by the person with some culture and
society.
 A study conducted by African-Americans.

42. Relapse
Terminatio
Unaware of the problem-
AIDS
Aware that he/she is
suffering from AIDS and
desire to treat it
Intended to take safety
measures/medication.
Practices doctor’s advice,
vaccination, screening.
Continue his/her
medication, safety

46. Stigm
a
Marginalizatio
n
Povert
y
Discrimi
nation
Violence
Risky
Situation
s &
Behavior
s
Harassme
nt &
Abuse
Poor
Health
Services
, Access
&
Uptake
Poor
Social or
Emotion
al Well-
being
Sickness
Gender Drug UseSexualitySex Work

47. Prevalence
 WHO reported HIV cases among children in Ratodero Taluka,
Larkana district, Sindh province, Pakistan. (3rd July, 2019)
 30,192 people have been screened for HIV,
 876 were found positive.
 82% (719/876) of these were below the age of 15 years.
 Several risk factors were identified; 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.

48. Post-traumatic Stress Disorder and Depression among
Patients Suffering from HIV/AIDS
Ishrat Rizwan
Erum Irshad
Qurtuba University of Sciences & Information
Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
Dec, 2012 Volume VII Number 4

49. Mean age was 34.64.
• HIV positive respondents
scored higher on beck
depression inventory as
compared to HIV negative
respondents.
• HIV positive respondents
scored higher on Clinically
administered PTSD scale as
compared to HIV negative
respondents.

50. A comparative study of Depression an
Anxiety in HIV/AIDS Patients Registered at
Treatment Center in Lahore, Pakistan
T Hafeez*
5th Dec, 2018

54. Aleem Raza Hussain
Syed Muslim Abbas
Qudsia Uzma
Tahira Ezra Reza
July 2013, Volume 63, Issue 7

56. • About healthcare services 45 (32%) of the patients ranking such services extremely beneficial
• 40 (29%) patients considered it to be of no use.
• 55 (39%) patients were either unsure or believed that there was room for improvement and such
services could be better delivered.