This slide discusses about epidimiology of HIV its National and international response HIV:- Human Immuno deficiency Virus (retro-virus) HIV attacks body immune system and reduces the count of CD4 cells (T cells) in human body making the person more likely to get life-threating opportunistic infections. AIDS:- Acquired Immune Deficiency Syndrome, is a set of symptoms and illness which develops at the final stage of HIV infection. There is currently no effective cure for HIV. Once people get HIV, they have it for life. But with proper medical care, HIV can be controlled and who get effective treatment can live long, healthy lives and protect their partners. As far back as the late 1800s, HIV may have spread from chimpanzees to humans. Simian immunodeficiency virus (SIV) is a lentivirus (genus of retrovirus) that infect more than 36 different nonhuman primate species in sub-Saharan Africa. In June 1981, the first cases of AIDS reported from Los Angeles in five homosexual men. In Nepal first case detected in 1988.

1. Presentation by :Neeru magar
Epidemiology of Diseases and Health Problems
MPH 2nd sem,SHAS,Pokhara University

2. Contents
• Introduction
• History
• HIV status
• Epidemiological Determinants
• Signs and symptoms
• Prevention
• Treatment
• Diagnosis
• Response
• Reference

3. Introduction
• HIV:- Human Immuno deficiency Virus (retro-virus)
• HIV attacks body immune system and reduces the count of CD4 cells (T cells) in human
body making the person more likely to get life-threating opportunistic infections.
• AIDS:- Acquired Immune Deficiency Syndrome, is a set of symptoms and illness which
develops at the final stage of HIV infection.
• There is currently no effective cure for HIV. Once people get HIV, they have it for life. But
with proper medical care, HIV can be controlled and who get effective treatment can live
long, healthy lives and protect their partners.

4. HISTORY
• As far back as the late 1800s, HIV may have spread from chimpanzees to humans.
• Simian immunodeficiency virus (SIV) is a lentivirus (genus of retrovirus) that infect
more than 36 different nonhuman primate species in sub-Saharan Africa.
• In June 1981, the first cases of AIDS reported from Los Angeles in five homosexual
men.
• In Nepal first case detected in 1988.

6. Global HIV Status
• HIV is still a big global health issue, having taken around 40.4 million lives. Its
transmission persists in all countries, with some witnessing rising new infection
rates after previous declines.
• By the end of 2022, around 39 million people were living with HIV. Two-thirds,
roughly 25.6 million, were in the WHO African Region.
• In 2022, 630 000 [480 000–880 000] people died from HIV-related causes and 1.3
million [1.0–1.7 million] people acquired HIV.

7. • In 2022, targets were 86% diagnosed, 89% on treatment, and 93% with
suppressed viral loads.
• The 2025 goal aims to reach 95% across all these categories.
• Currently, 86% know their status, 76% receive treatment, and 71% have
suppressed viral loads among all people living with HIV.
(WHO)

9. National HIV status

10. Conti………..
HIV Incidence per 1000 = 0.03%
Total AIDS related death= 636 (M-408, F-228)

11. Conti………..

12. Conti………..

13. Conti………..

15. Epidemiological determinants
Agent Factors Host Factors
Agent: HIV
Reservoir of infection: Cases and Carriers
Source of infection:
Greater concentration: Blood, semen and
CSF
Lower concentration: tears, saliva, breast
milk, urine, cervical and vaginal secretions
Age: sexually active persons
Sex: HIV infects people of any sex. Gay,
bisexual and MSMs are at increased risk of
infection.
High-risk groups:
Sex workers, Clients of SW, street children
,IV drug users, transfusion recipients of
blood and blood products, Male sex with
male, transport workers, drivers, Health
workers, labor migrant workers and their
partners worker , uniform service like
Army police

16. • Receiving unsafe injections, blood transfusions and tissue transplantation
• Accidental needle stick injuries among health worker

17. Environmental Factors

18. Natural History

19. Signs and symptoms
• Most people have flu-like symptoms within
2 to 4 weeks after infection. Symptoms may
last for a few days or several weeks.
•Having these symptoms alone doesn’t mean
you have HIV. Other illnesses can cause
similar symptoms.
•Some people have no symptoms at all.
The only way to know if you have HIV is to get
tested. (CDC)

20. Stages of HIV
Acute/Early Stage:(2-4
weeks after exposure):
Chronic/Long-Term stage: This stage can
last for 10 years or longer without
treatment.
Advanced HIV (AIDS):typically
occurs within 10 years but can be
faster or slower in some cases.
• Flu-like illness: fever,
headache fatigue muscles
aches, sore throat, swollen
lymph nodes
• Rash: red, itchy, maculopa
pular rash, often on torso
• Mouth ulcers
• Night sweats
• Nausea, vomiting, diarrhea
• Fever: Recurring or persistent fever
not attributable to other causes.
• Fatigue: Profound tiredness and
weakness.
• Weight Loss: Unexplained and
involuntary weight loss.
• Recurring Infections: Frequent or
severe infections, such as pneumonia
or tuberculosis.
• Night Sweats: Profuse sweating,
particularly at night.
• Diarrhea: Persistent and chronic
diarrhea.
• Skin Issues: Rashes, sores, or lesions
that do not heal easily.
• Opportunistic Infections:
pneumocystis pneumonia
(PCP) and certain cancers
(Kaposi's sarcoma).
• Neurological Issues: Cognitive
problems, memory loss, and
neurological disorders.
• Weight Loss & Wasting: Severe
weight loss and muscle
wasting.
• Mental Health Issues:
Depression, anxiety, and other
mental health concerns.

21. Transmission
Epidemiology of Diseases and Health Problems

22. Diagnosis
• No test can detect virus immediately after infection. There are three types of HIV
tests:-
1. Antibody tests:- Used to detect HIV after exposure of 23 to 90 days. Blood or oral
fluid used for test.
2. Antigen/antibody tests:- Test performed in lab to detect HIV 18 to 45 days after
exposure. There is also a rapid antigen/antibody test available that is done with a
finger stick after exposure 18 to 90 days.
3. Nucleic Acid Tests (NATs):- Used to detect actual virus in the blood. NAT used for
10 to 33 days after exposure.

23. Prevention
• Using condom during sex
• Being tested for HIV and STIs
• Having a voluntary medical male circumcision
• Using harm reduction services for people who inject and use drugs.
• Doctors may suggest medicines and medical devices to help prevent HIV, including : antiretroviral drugs
(ARVs), including oral PrEP and long acting products
• Dapivirine vaginal rings
• Injectable long acting cabotegravir.
• ARVs can also be used to prevent mothers from passing HIV to their children.
• People taking antiretroviral therapy (ART) and who have no evidence of virus in the blood will not pass HIV to
their sexual partners.

24. Treatment
• There is no cure for HIV infection. It is treated with antiretroviral drugs, which stop the virus from
replicating in the body.
• Current antiretroviral therapy (ART) does not cure HIV infection but allows a person’s immune system
to get stronger. This helps them to fight other infections.
• Currently, ART must be taken every day for the rest of a person’s life.
• ART lowers the amount of the virus in a person’s body. This stops symptoms and allows people to live a
full and healthy life.
• People living with HIV who are taking ART and who have no evidence of virus in the blood will not
spread the virus to their sexual partners.
• Pregnant women with HIV should have access to and take ART as soon as possible. This protects the
health of the mother and will help prevent HIV from passing to the fetus before birth, or to the baby
through breast milk.

25. • Antiretroviral drugs given to people without HIV can prevent the disease.
• pre-exposure prophylaxis (PrEP) prevents before, post-exposure
prophylaxis(PEP) after HIV exposure. For high-risk situations, seek clinician
advice before using either.
• Advanced HIV disease remains a persistent problem in the HIV response.
• Newer HIV medicines and short course treatments for opportunistic
infections like cryptococcal meningitis are being developed that may change
the way people take ART and prevention medicines, including access to
injectable formulations, in the future.

26. Control Response
• HIV/AIDS Voluntary Counseling and Testing (VCT)
• Increase the HIV Test (early diagnosis and treatment)
• HIV Surveillance
• Counseling and awareness

27. WHO response
Global strategies by WHO, Global Fund, and UNAIDS align with SDG 3.3 to end HIV by
2030. GHSSs(Global Health Sector Strategies) aim to end AIDS, viral hepatitis B and C,
and STIs by 2030.
• Approach:
Recommend focused actions at country levels, guided by WHO and partners.
Consider past trends, encourage learning, and apply new knowledge and
innovations.
• Focus: Target populations most affected, addressing inequalities.
• Integration: Promote unified health coverage and primary care.
• These strategies aim to create a coordinated and comprehensive approach to
combat HIV, viral hepatitis, and STIs, emphasizing inclusivity, innovation, and
equity in healthcare responses.

28. National response
• 1st National AIDS Prevention and Control Program of Nepal government in 1988.
• In 1992 multi-sector National AIDS Coordinating Committee (NACC)
• National Center for AIDS and STDS Control was established in 2050
• National Policy on HIV/AIDS 1995 (2052 BS)
• National AIDS Council (NAC) in 2002 (intended to set overall policy, advocacy,
provide guidance and direction towards national response to AIDS)
• National Policy on HIV and STIs in 2011
• National HIV Strategic Plan (NHSP) 2016-2021 was launched to achieve ambitious
global goals of 90-90-90 by July 2021.

29. National Policy on HIV and STI, 2011
➢ Vision: Establish Nepal as a society, free of HIV/AIDS and STI
➢ Goal: Ensure the right of Nepalese citizens to live healthy by reducing the HIV
infection rate and its negative impact.
The National Health Sector Strategy Implementation Plan (NHSS-IP 2016-
2021):-
Nepal’s HIV and STI response, recognized as a P1 program by GON, is guided by the
‘National HIV Strategic Plan 2016-2021’, the SDGs, and the National Health Sector
Strategy (2015-2020).
Objectives:
• Fast-Tracking HIV response to achieve ambitious 90-90-90 targets by 2020
• To end the AIDS epidemic as a public health threat by 2030.

30. National HIV Strategic Plan (2016-2021)
Aim: To meeting the global goal of 90-90-90 by 2020.
(i.e. by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people
with diagnosed HIV infection will receive sustained antiretroviral therapy, and, 90% of all
people receiving antiretroviral therapy will have viral suppression.
National Health Sector Strategy (2015-2020)
The commitment by Nepal of both the global “UNAIDS Strategy 2016-2021,” and the
“Sustainable Development Goals” adopted by the UN General Assembly, include commitments
to Fast-Tracking the HIV response to achieve ambitious 90-90-90 targets by 2020 and ending
the AIDS epidemic as a public health threat by 2030.

31. National program guideline 2079/080
Provincial and local AIDS and STI control program guideline 079/080
• 3 Laboratories Center for Excellence lab at provincial level
including above 3 lab 58 provincial ART centers
• 11 local level centers

32. HIV Surveillance
Nepal monitors HIV and STI through various means:
• Case Reporting of HIV and STI: Tracks HIV/STI cases from testing sites and NGOs via
IHMIS/DHIS2 since 2014.
• Integrated Biological and Behavioral Surveillance (IBBS) Survey: Conducts
surveillance among key populations (e.g., drug users, sex workers) to monitor
prevalence and behaviors.
• Drug Resistance Monitoring: Periodically examines HIV drug resistance as per
national guidelines.
• Size Estimation of Key Populations: Regularly estimates sizes of key populations and
plans to update these estimates.

33. • HIV Infection Estimations and Projections: Nepal updates HIV infection
estimates annually using available biological and behavioural data, routine
program data, key population size estimates and other relevant key
information from different studies using AIDS Epidemic Modelling (AEM) and
Spectrum.
• HIV Surveillance: Led by NCASC, in collaboration with various organizations,
for comprehensive surveillance and guideline development, aligning with the
national HIV Strategic Plan (2021-2026).

34. Refrences
• https://www.cdc.gov/hiv/basics/whatishiv.html#:~:text=The%20chimpanzee%20version%20of%20the,
other%20parts%20of%20the%20world.
• https://www.who.int/news-room/fact-sheets/detail/hiv-
aids?gclid=Cj0KCQiAyeWrBhDDARIsAGP1mWTutnFfdKTXOGo9BNzoBMtyBWNBlRemb45pfIkTTL9-
k9aSTWbSF5QaAt2KEALw_wcB
• https://www.who.int/news-room/fact-sheets/detail/hiv-aids
• https://www.cdc.gov/hiv/basics/whatishiv.html
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1179776/
• https://journals.asm.org/doi/10.1128/JVI.79.7.3891-3902.2005
• https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline#year-1994
• https://ncasc.gov.np/uploads/frontend/tabData/638d7cbe6c669.pdf
• https://www.ncasc.gov.np/program-guideline
• https://dohs.gov.np/centers/hivaids-and-sti/
• https://www.hiv.gov/tasp#:~:text=People%20with%20HIV%20who%20take,HIV%2Dnegative%20partn
ers%20through%20sex
• https://www.cdc.gov/hiv/testing/index.html
• afr-rc66-11-en-1011_0.pdf (who.int)

35. THANK YOU!!!!!