ghjkl

1. HIV-AIDS an alarming
growing global concern
Presented by – Dr. Shobha Yohan
Sr. Programming Co-ordinator (AIDS Desk)
HVS Court, III Floor, #21 Cunningham Road,
Bangalore-560052

2. What is natural history?
The evolution and outcome of the disease
in a typical host
 Helps to predict the progression of HIV
infection (prognosis)
 Helps in therapeutic decision making:
prophylaxis, therapy

3. Impact of Global HIV
 Negative economic impact on countries
 Overwhelmed healthcare systems
 Decreasing life expectancy
 Deteriorating child survival rates
 Increasing numbers of orphans

6. Natural History of HIV Infection
HIV can be transmitted during each stage
 Seroconversion
 Infection with HIV, antibodies develop
 Asymptomatic
 No signs of HIV, immune system controls virus
production
 Symptomatic
 Physical signs of HIV infection, some immune
suppression
 AIDS
 Opportunistic infections, end-stage disease

7. Natural History of Untreated HIV Infection
Viral Transmission (2-3 weeks)

Acute Seroconversion Illness (2-3 weeks)

Recovery + Seroconversion (2-4 weeks)

Asymptomatic Phase (~8 years)

Symptomatic Infection  AIDS (1.3 years)

Death

8. HIV-1 and HIV-2
 HIV-1 and HIV-2
 Transmitted through the same routes
 Associated with similar opportunistic infections
 HIV-1 is more common worldwide.
 HIV-2 is found primarily in West Africa,
Mozambique and Angola.

9. HIV-1 and HIV-2
Differences between HIV-1 & HIV-2
 HIV-2 is less easily transmitted.
 HIV-2 develops more slowly.
 MTCT is relatively rare with HIV-2.

10. Natural History of HIV Infection
Immune suppression
 HIV attacks white blood cells, called CD4
cells, that protect body from illness.
 Over time, the body’s ability to fight
common infections is lost.
 Opportunistic infections occur.

11. Natural History of HIV Infection
Direct infection of organ systems
 Brain (HIV dementia)
 Gut (wasting)
 Heart (cardiomyopathy)

12. Progression of HIV Infection
 HIGH viral load (number of copies of HIV in the
blood)
 LOW CD4 count (type of white blood cell)
 Increasing clinical symptoms (such as
opportunistic infections)

13. Progression of HIV Disease
Asymptomatic stage
 Ongoing viral replication
 ‘Set-point’ for viral load
 Gradual decline in CD4 cells
 Antibody tests positive
Symptomatic HIV
• Minor to moderately severe symptoms
AIDS
• Severe immunosuppression associated with OI or cancers

14. Transmission and Risk factors
Facilitation
 Concurrent STI (esp
ulcerative STI)
 New (incident) HIV
infections
 Presence of AIDS
Protection
 Condom use
 Circumcision (in men)
 Absence of chemokine
receptors (CCR532)
 ART

15. Acute HIV Infection
 Time period from HIV transmission to the
development of antibodies
 Usually present within days to weeks after initial
exposure and subsequent infection
 40 – 90% of new HIV-1 infections are associated
with symptomatic illness
 Common signs and symptoms: ‘flu-like’ illness,
lymphadenopathy, pharyngitis, oral / genital ulcers,
aseptic meningitis
 Labs: Thrombocytopenia, leukopenia, ALT / AST
 Duration of symptoms variable; usual 1 – 2 weeks;
range few days to >10 weeks

16. 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
 Mothers infected with HIV to infants during
pregnancy, delivery and breastfeeding

17.  Coughing, sneezing
 Insect bites
 Touching, hugging
 Water, food
 Kissing
 Public baths/pools
Transmission of HIV
HIV cannot be transmitted by:
 Toilets
 Handshakes
 Work or school
contact
 Telephones
 Cups, glasses,
plates, or other
utensils

18. Prevention of
HIV Transmission
Public health strategies to prevent HIV transmission
 Screen all blood and blood products.
 Follow universal precautions.
 Educate in safer sex practises.
 Identify and treat STIs.
 Provide referral for treatment of drug dependence.
 Apply the comprehensive PMTCT approach to prevent perinatal
transmission of HIV.

19. GLOBAL SUMMARY OF THE AIDS EPIDEMIC
DECEMBER 2005
 Number of people living with HIV in 2005
 Total : 40.3 million (36.7–45.3million)
 Adults: 38.0 million (34.5–42.6 million)
 Women: 17.5 million (16.2–19.3 million)
 Children under 15 years: 2.3 million ( 2.1–2.8 million)
 People newly infected with HIV in 2005
 Total : 4.9 million ( 4.3–6.6 million)
 Adults : 4.2 million ( 3.6–5.8 million)
 Children under 15 years : 700 000 (630 000–820 000)
 AIDS deaths in 2005
 Total: 3.1 million (2.8–3.6 million)
 Adults: 2.6 million (2.3–2.9 million)
 Children under 15 years: 570 000 (510 000–670 000)

20. ASIA
HIV and AIDS statistics and features, in 2003 and 2005
Adults &
Children
living with
HIV
Number of
women
living with
HIV
Adults and
children
newly
infected
with HIV
Adult
prevalence
(%)
Adult and
child
deaths
due to
AIDS
2005 8.3 million
[5.4–12.0
million]
2.0 million
[1.3–3.0
million]
1.1 million
[600 000–
2.5 million]
0.4
[0.3–0.6]
520 000
[330 000–
780 000]
2003 7.1 million
[4.6–10.4
million]
1.7 million
[1.1–2.5
million]
940 000
[510 000–
2.1 million]
0.4
[0.2–0.5]
420 000
[270 000–
620 000]

25. In INDIA
 Diverse epidemics are underway in India, where an estimated
5.1 million Indians were living with HIV in 2003 (NACO, 2004a).
Although levels of HIV infection prevalence appear to have
stabilized in some states (such as Tamil Nadu, Andhra Pradesh,
Karnataka and Maharashtra), it is still increasing in at-risk
population groups in several other states. As a result, overall HIV
prevalence has continued to rise. State-wide prevalence among
pregnant women is still very low in the poor and densely
populated northern states of Uttar Pradesh and Bihar. Even
relatively minor increases in HIV transmission could translate into
huge numbers of people becoming infected in those states,
which are home to one quarter of India’s entire population.
 A significant proportion of new infections is occurring in women
who are married and who have been infected by husbands.

26.  India has approximately 10% of the world’s population and 45%
of Asia-Pacific population of people living with HIV / AIDS.
 It shifts from high-risk groups to bridge population [people
involved with risk behaviour] and then to general population.
 89% of the reported cases are occurring in sexually active and
economic productive age group of 15 to 44 years.
 Men account of 77% of AIDS cases and women 23% [a ratio of
3:1]
 90% of women with HIV have only ever had one sexual partner.
 28% of the rural people and 11% of the urban people have never
heard of AIDS.
 Nearly 60% of HIV / AIDS cases are reported to be infected with
TB
 Source: From know more to no more AIDS [p-16] UNAIDS.

27. Epidemiological analysis of reported AIDS
cases reveals that:
1. In Africa - AIDS is affecting mainly young people in the sexually
active age group. The majority of the HIV infections (87.7%) are
in the age group of 15-44 years.
2. The predominant mode of transmission of infection in the AIDS
patients is through heterosexual contact (85.7%), followed by
Injecting drug use (2.2%), blood transfusion and blood product
infusion (2.6%), perinatal transmission as 2.7% and others as
6.8%.
3. In the HIV sentinel surveillance, 2003, males account for 73.5%
of AIDS cases and females 26.5%. The ratio being 3:1.
4. The most predominant opportunistic infection among AIDS
patients is tuberculosis, indicating a potential future high spread
of the HIV-TB co-infection.

28. Progress update on the global
response to the AIDS epidemic, 2004
AIDS epidemic continues to expand; vulnerable populations at
greatest risk
 HIV continues to rise in all parts of the world despite the fact that
effective prevention strategies exist. Sub-Saharan Africa remains the
hardest-hit region.
 In Asia, the HIV epidemic remains largely concentrated in injecting drug
users, men who have sex with men, sex workers, clients of sex workers
and their immediate sexual partners. Effective prevention programming
coverage in these populations is inadequate.
 Diverse epidemics are under way in Eastern Europe and Central Asia.
Injecting drug use is the main driving force behind epidemics across the
region.
 In many high-income countries, sex between men plays an important
role in the epidemic. Drug injecting plays a varying role. In Latin
America and the Caribbean, 11 countries have an estimated national
HIV prevalence of 1% or more.

29. Women face greater risk
 African women are being infected at an earlier age
than men.
 Women living with HIV were vastly outnumbered by
men.
 13 infected women for every 10 infected men—up
from 12 infected women for every 10 infected men in
2002. The difference between infection levels is
more pronounced in urban areas, with 14 women for
every 10 men, than in rural areas, where 12 women
are infected for every 10 men (Stover, 2004).
 20 women for every 10 men in South Africa, to 45
women for every 10 men in Kenya and Mali.

30. Diverse levels and trends
 The factors include poverty and social instability
that result in family disruption, high levels of other
sexually transmitted infections, the low status of
women, sexual violence, and ineffective leadership
during critical periods in the spread of HIV. An
important factor, too, is high mobility, which is largely
linked to migratory labour systems.
 Human mobility has always been a major driving
force in epidemics of infectious disease.

31. The impact of AIDS on
people and societies
 Women: more vulnerable to HIV than men
 Risk from husbands and lovers
 Violence and the virus
 Impact of HIV on women and girls in the community
and at home
 Globally, the epidemic continues to exact a
devastating toll on individuals and families. In the
hardest-hit countries, it is erasing decades of health,
economic and social progress, reducing life
expectancy by decades, slowing economic growth,
deepening poverty, and contributing to and
exacerbating chronic food shortages.

32. Impact on countries to get worse before it
improves
 More than 40% of countries with generalized
epidemics have yet to evaluate the socioeconomic
impact of AIDS.
 With generalized HIV epidemics, 39% have no
national policy in place to provide essential support
to children orphaned or made vulnerable by AIDS. In
low- and middle-income countries, less than 3% of
all orphans and vulnerable children receive publicly
supported services.
 In sub-Saharan Africa 60% of today’s 15-year-olds
will not reach their 60th birthday.

33. The impact on population and population
structure

35. Women affected more than men
 Face heavy economic, legal, cultural and
social disadvantages which increase their
vulnerability
 Carers, producers and guardians of family life

36. The impact of AIDS on poverty &
hunger
 AIDS causes the loss of income and production of a household
member. If the infected individual is the sole breadwinner, the impact is
especially severe.
 AIDS creates extraordinary care needs that must be met (usually by
withdrawing other household members from school or work to care for
the sick).
 AIDS causes household expenditures to rise as a result of medical and
related costs, as well as funeral and memorial costs (Food and
Agricultural Organization, 2003a).
 Increasing needs in ‘care economy’
 Impact on agriculture and rural development
 Impact on the health sector
 Impact on public-sector capacity
 Impact on workers and the workplace
 Macroeconomic impact

37. How household response
 Children were sent to relatives, or adults left
to search for employment .
 Women and girls raise and nurture children,
perform domestic labour and take care of the
sick

38. AIDS & orphans: a tragedy unfolding

39.  Strengthening the capacity of families to protect and
care for children Mobilizing community-based
responses
 Preventing mother-to-child transmission
 HIV and young people: High risk, high vulnerability
 The WHO strategy - Treating 3 million by 2005
 Rights and access to AIDS information and
prevention: Stigma and discrimination
 The essential role of people living with AIDS

40. Refugees and HIV

41. Theological Reflection
 Change is possible
 It needs to be facilitated not forced
 It arises from ‘within’, yet can be influenced
from ‘without’.

42. THANK YOU