KMC HIV/AIDS Messages By DR Munawar Khan DDO(Curative) EDO Health Karachi


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KMC HIV/AIDS Messages By DR Munawar Khan DDO(Curative) EDO Health Karachi

  1. 1. OBJECTIVESTo create awareness of the seriousness of the diseaseEnsure that people of Karachi/Sindh are equipped with knowledge and tools to protect themselvesReduce transmission of HIV and other STI infections through blood and blood productsIn case of infection, the patient should be encouraged to seek treatmentInfra Structure and Services on GroundProvincial Implementation UNIT (PIU)At I&I Depot, Rafiqui Shaheed Road near JPMC cantt Karachi.Referral Lab Established for laboratory diagnosis and confirmation of HIV/AIDS Cases & SexuallyTransmitted Infections CHK.Voluntary Counseling & Testing centers21 VCT Centers have been Established for screening of HIV/AIDS casesSTIs clinics 46 STIs Clinics have been Established at teaching and DHQ hospitals for managementof STI,sEstablishment of Resource Center With Facilities of Digital Library. For trainees andprojects staff at I. I Depot, Rafique Shaheed Road near JPMC cantt KarachiPPTCT Centers 03 (Prevention of Parents to Child Transmission)
  2. 2. ORIGIN OF HIVHistory of HIV/AIDSHIV came from a similar virus found in chimpanzees - SIV.HIV probably entered the United States around 1970CDC in 1981 noticed unusual clusters of Kaposi’s sarcoma in gay men in NewYork and San Francisco, which led to the disease to be called GRID (GayRelated Immune Deficiency).By 1982 the disease was apparent in heterosexuals and was renamed AIDS(Acquired Immune Deficiency).
  3. 3. Dr Munawar Khan Bcc SACP2006 HistoryUS National Institutes of Health revealedthe results of two African trials of malecircumcision as an HIV preventionmethod with clear evidence that theintervention reduced HIVtransmission by around 50%.+ The WHO and other organizationssuggested they would soon beginpromoting male circumcision in areas withsevere HIV epidemics.Global summary of the AIDS epidemic  201134.2 million30.7 million16.7 million3.4 million2.5 million2.2 million330 0001.7 million1.5 million230 000Number of peopleliving with HIVPeople newly infectedwith HIV in 2011AIDS deaths in 2011TotalAdultsWomenChildren (<15 years)TotalAdultsChildren (<15 years)TotalAdultsChildren (<15 years)Dr Munawar Khan Bcc SACP1
  4. 4. GLOBAL SITUATIONEvery minute, 9 more personsbecomeHIV positiveEvery minute, 6 persons die of anAIDSrelated illnessDr Munawar Khan Bcc SACP
  5. 5. 28HIV/AIDS in Pakistan•Pakistan is going through a transition of theHIV epidemic; from a low Prevalence state to aconcentrated epidemic.•Although the estimated prevalence among thegeneral population is less than 0.1% in thecountry,• Recent surveillance results clearly indicatethat the epidemic is becoming establishedamong certain high risk groups (HRGs).Dr Munawar Khan Bcc SACPSUGGESTIVE HISTORY & RISKFACTORSRISK FACTORS/RISK BEHAVIOURS People with recent or prior STI’s Commercial sex workers & their partners Homosexuals Travelers to high prevalence areas Sexually active injection drug users Sexual partners of at risk persons Recipients of blood products prior to HIVscreening Children born to HIV positive mothers People with multiple sexual partnersDr Munawar Khan Bcc
  6. 6. 31A combination of risk factors iscurrently putting Pakistan at seriousrisk of further transmission from highto low risk groups through bridgingpopulations.Pakistan’s HIV epidemicDr Munawar Khan BccExample of high risk sexualnetworks in a populationFSW Male ClientsIDUGeneral PopulationWomenMSWDr Munawar Khan Bcc32
  7. 7. Dr Munawar Khan BccHISTORY OF HIV IN PAKISTAN 1986 – An African Sailor Died in Karachi 1987 – First Pakistani Citizen Diagnosed withAIDS in Lahore 1987 – First Husband-Wife-Child transmission ofHIV occurred in Rawalpindi 1993 – First Breastfed Baby gets AIDS inKarachi 2003 First outbreak among Injecting DrugUsers was identified in LarkanoHIV & AIDS in Pakistan(2nd Quarter 2010) Total Estimated Cases = 106000 and 45-50% arebelongs to Sindh and 80% of this are in Karachi. Total reported HIV & AIDS cases in the countryare = 7574 HIV Positive – 7049 AIDS Cases – 525Dr Munawar Bcc35
  8. 8. District wise HIV/AIDS Registered Patients inSindh till 30th September 2012District HIV Positive PercentageAIDSPositivePercentage TotalSINDHKarachi 3714 74.94 67 29.65 3781Larkana 313 6.32 3 1.33 316Hyderabad 55 1.11 2 0.88 57Sukkur 40 0.81 0 0.00 40Mirpurkhas 11 0.22 1 0.44 12Dadu 16 0.32 2 0.88 18Jacobabad 7 0.14 0 0.00 7Sanghar 79 1.59 0 0.00 79Sh. Benazirabad Nawabshah 6 0.12 1 0.44 7Jamshoro 1 0.02 0 0.00 1Shikarpur 6 0.12 1 0.44 7Qambar 10 0.20 0 0.00 10Thatta 9 0.18 1 0.44 10Matiyari 1 0.02 0 0.00 1Kashmor 3 0.06 0 0.00 3Khairpur 4 0.08 0 0.00 4Tarparkar 1 0.02 0 0.00 1Ghotiki 4 0.08 0 0.00 4Badin 5 0.10 0 0.00 5Naushahroferoz 1 0.02 1 0.44 2Unknown 377 7.61 136 60.18 513Sub-Total 4663 94.09 215 95.13 4878Dr Munawar Khan Bcc SACPDECEMBER 2011 4th Round Sindh is in the concentrated phase of epidemicamong : IDU’s = 42% Hijra Sex workers =15.45%Dr Munawar Khan Bcc SACP
  9. 9. HIV/AIDS SurveillanceRound-4 resultsDr Munawar Khan Bcc SACPIDU MSW HSWTotalFSWHFSWBFSW SFSW KKFSWBegFSWMFSWKarachiTotal Tested 361 353 351 392 131 30 75 96 30 30Positives 151 20 41 7 6 0 0 1 0 0% Positives 42 6 12 2 5 0 0 1 0 0LarkanaTotal Tested 363 359 373 378 285 47 19 27 0 0Positives 68 11 53 7 1 2 2 2 0 0% Positives 19 3 14 2 0 4 11 7 0 0SukkurTotal Tested 334 209 166 178 125 0 33 20 0 0Positives 58 1 6 1 0 0 1 0 0 0% Positives 17 0 4 1 0 0 3 0 0 0DaduTotal Tested 150 0 0 0 0 0 0 0 0 0Positives 24 0 0 0 0 0 0 0 0 0%Positives16 0 0 0 0 0 0 0 0 0 HIV epidemic is still considered ‘low’ or‘concentrated,’ confined mainly to individuals whoengage in high risk behaviors but less than fivepercent, An epidemic is considered ‘concentrated’ when lessthan one per cent of the general population but morethan five per cent of any ‘high risk’ group are HIV-positive An epidemic is considered ‘generalized’ when morethan one per cent of the general population is HIV-positive.Dr Munawar Khan Bcc SACP
  10. 10. 3Basicsabout HIV / AIDS• What is HIV/AIDS• How HIV/AIDS can be transmitted• How HIV/AIDS cannot be transmitted• People that are especially vulnerableto HIV/AIDS4HIV/AIDS• H – Human• I – Immuno Deficiency• V – Virus• A – Acquired• I - Immuno• D – Deficiency• S - SyndromeHIV IS A VIRUS &IS AN INFECTIONAIDS IS A STAGE &NOT A DISEASE
  11. 11. HIV is short for:Human Immuno deficiency Virus.Once infected with HIV, a person is referred to as HIV positive. However, this does not necessarilymean that (s)he has symptoms or feels sick. An HIV positive person can feel and look healthy for along time after first becoming infected.What is AIDS?AIDS, or Acquired Immune Deficiency Syndrome, can take many years to develop.Eventually, the virus kills or impairs more and more cells in the immune system and thebody loses the ability to fight off common infections, such as diarrhea or colds. People withAIDS can die from diseases that are usually not dangerous for people with healthy immunesystems.AIDSInfections in relation to CD4+ cellcount40030020010050Herpes ZosterTuberculosisOral CandidiasisEsophageal CandidiasisMucocutaneous herpesPCPToxoplasmosisCryptococcosis(Mycobacterium avium complex ) MAC(Cytomegalovirus) CMV(Progressive Multifocal Leuko encephalopathy) PMLCryptosporiodiosisTimeDr Munawar Khan Bcc SACP88From HIV to AIDSAids is diagnosed when your CD 4 blood count is at 200 or lower and you have anopportunistic infection (i.e. Kaposi’s Sarcoma or PCP (This is a set point for medicaldiagnosis)A healthy blood count may range from 800 to 1200 CD4
  12. 12. How HIV can be transmittedUnprotected sexual contact – be it vaginal, oral, or anal - with an infected partnerSharing unsterilized needles or syringes with an HIV positive person, for example, whenusing drugs or in a healthcare setting.During pregnancy or birth and through breastfeeding from an HIV positive mother to herbaby.Blood transfusions with infected bloodMajor SymptomsLoss of more than 10% of body weightChronic diarrheaProlonged feverPeople Infected with HIV Can look healthy Can be unaware of their infection Can live long productive lives when their HIVinfection is managed Can infect people when they engage in high-riskbehaviorDr Munawar Khan Bcc SACP102Minor SymptomsCough for more than a monthGeneralised itchy skin rashPainful group of blisters all over the bodyGeneralised swollen lymph glandsWhite curd like patched on tongue/throat
  13. 13. How you know? You can’t identify a person who carry HIVand in most cases, he/she himself doesn’t know about it. You canfound out the virus only in HIV tests. A person can carry the virus formany years, he can be seen, feel and function as usual,. Don’t hope from your partner to tell you, that he/she carry the HIVvirus. Because most people living with the virus are feared fromrejection and anger, even though you love each other. The responsibility defending your health is only in your hands!Dr Munawar Khan Bcc SACP103HIV/AIDS – MYTHSThere is a cure for HIV/AIDSRestricted to certain group/ community/countrySex with virgin can cure AIDSIs not a major problem in PakistanPresence of STD is a pre requisite for HIV infectionHIV/AIDS – THE DIFFICULTIESSensitive issueNon availability of true information/DataVery low level of awareness/concernSocio-economically marginalized people are the most vulnerable,who are difficult to approachthey are unable to accessCONCENTRATION OF VIRUSBlood, Menstrual Blood – Very HighVaginal Fluids, Semen, Pre ejaculate Fluid – HighBone Marrow – HighSaliva – NoSweat, Tears, urine – NoHow HIV can NOT be transmittedThrough air or by coughing and sneezingThrough food or waterThrough sweat and tearsBy sharing cups, plates, and utensils with an infected personBy touching, hugging and kissing an infected personBy sharing clothes or shaking hands with an infected personBy sharing toilets and bathrooms with an infected personBy living with an infected person
  14. 14. By mosquitoes, fleas, or other insectsMODES OF TRANSMISSIONBlood/Blood products, tissues, organs- More than 90%Sexual Intercourse - 0.1 to 1% (however frequency is high causing high rate of infection)IDU – 0.5 to 1 %Parent to child – 30%HIV TestCommon Method of HIV test is –Rapid TestELISA (common method of HIV test in Pakistan)Western BlotPCRPopulations particularly at riskA person who:Uses shared/contaminated needles and syringesHas a sexually transmitted infections(STIs)Has anal sex with her/his partner(s)Exchanges sex for money or drugsHas many sex partnersLeads life separated from spouse due to professional obligations(e.g., truck drivers, laborers, migrants)Women and HIVSocial Risk FactorsIlliteracyLack of awareness of preventive measuresBiological risk factorsTwice as easy for women to contract HIV from menPhysiology of women (e.g., menstruation, intercourse)Pregnancy-associated conditions (e.g., anemia, hemorrhage) increase the need for bloodtransfusionTaboo and StigmaStigma derives from the association of HIV/AIDS with sex, disease and death, and with behavioursthat may be illegal, forbidden or taboo, such as pre- and extramarital sex, sex work, sex betweenmen, and injecting drug use.Stigma builds upon, and reinforces, existing prejudices.PREVENTIONTake blood from licensed blood bankMake sure the blood has the stamp of HIV FREE on itAvoid single unit BTAvoid sharing needlesTake your own disposable syringeSafer sex practicesAbstinenceDelay first intercourse
  15. 15. Less number of partnersBe faithful to each otherMasturbationNon penetrative sexProper & consistent use of condomCreating awareness on HIV/AIDS and safe sexBut HIV/AIDS does not discriminateEverybody is vulnerable. The virus is not restricted to any age group, race, social class, gender, orreligion. In many countries of Asia and the Pacific HIV/AIDS has spread to the general population.No country is immune to the epidemicThe HIV/AIDS epidemic can spread very quicklyLow HIV prevalence rates in the general population of a country can conceal serious epidemics insmaller, high-risk groups or in certain areasThe epidemic can quickly cross over from high-risk groups to the general populationImpact of HIV/AIDSHIV/AIDS has an impact on all bodies responsible for planning and allocation ofresources and education services such as... Schools and Universities Ministries Departments Agencies / Organizations Policy makers Religious and Faith based organizationsWhat the Community Leaders can and should doThe consequences of inactionThere is hopeWhy education is crucial in the fight against HIV/AIDSApproaches to take Next stepsHow to fight HIV/AIDSDevelop appropriate policiesEnsure adequate planning and managementFocus on prevention/awarenessReduce vulnerabilityIntroduce or upgrade life skills educationPromote a culture of compassion and care
  16. 16. Awareness is the only wayThere are no cures or vaccines for HIV/AIDS. Currently awareness/education is the only way toprevent infection.Preventive education also means preventing stigma, denial, and discrimination.HIV/ADS is associated with sex, disease, and death, and with behaviors that may be illegal,forbidden or taboo, such as pre- and extramarital sex, sex work, sex between men, and injectingdrug use. Awareness will reduce the HIV vulnerability. Once a person is infected s/he is always infected Medications are available to prolong life but they donot cure the disease Those who are infected are capable of infectingothers without having symptoms or knowing of theinfectionHIV AIDSDr Munawar Khan Bcc106Watch your selfIt is only in your handsDr Munawar Khan Bcc S104
  17. 17. ChallengesBreak the silence on HIV and AIDSEnd stigmatization and discrimination of PLWHA119Facts about AIDS No Curative Treatment available. No Vaccine.BUT IT CAN BE PREVENTEDDr Munawar Khan BCC SACPBYDr. M. MUNAWAR KHANMBBS,DHMS,PGDPA,MAS,MRSHBehavior Change Communication