HIV/AIDS is caused by the human immunodeficiency virus (HIV). The document provides an overview of HIV/AIDS including what it is, how it is transmitted, prevalence rates, and prevention methods. Key points include that there is currently no vaccine for HIV/AIDS, which is a major public health issue globally particularly in sub-Saharan Africa. Prevention methods discussed include safe sex practices, safe blood transfusions, and treating other infections which can increase the risk of HIV transmission.

1. HIV/AIDS: Basic Concept
and Prevention
Dr. Rahat Iqbal Chowdhury
Medical Officer
Civil Surgeon Office, Sylhet.

3. WHAT IS HIV
H-Human
I- Immuno Deficiency
V-Virus
Human Immuno Deficiency Virus

4. What is AIDS
AIDS
A - Acquired
I - Immuno
D - Deficiency
S - Syndrome

5. HIV/AIDS: Basic Concept
Acquired immuno-deficiency syndrome is a
fatal disease caused by the human immuno-
deficiency virus (a retro virus)
Sometimes it is called Slim disease
Termed as modern pandemic
No effective treatment & vaccine is available
To combat HIV/AIDS is a MDG (MDG-6)
Regarded as social & developmental problem

6. A Beautiful and Cute Virus
HIV – 1
HIV - 2

7. HIV Structure

8. History of HIV/AIDS
1981: First case of AIDS identified in Los
Angeles but was named as AIDS in 1984.
1982-85: Rapid spread in western Europe and
Australia.
1983: Virus identified at Pasteur institute but
named HIV in 1986.
1984: Antibody detection test discovered.
1984: First HIV positive in Asia identified.
1985: Blood screening for HIV begins.
1986: First HIV positive in India & Myanmar
1989: First HIV positive case in Bangladesh.

9. Mode of Transmission

10. Injecting drug use
Unprotected heterosexual act
Unprotected penetrative sex between men
Unsafe blood transfusion & injection
Vertical transmission
Modes of HIV Transmission

11. Promiscuity: Through unprotected Sex with
HIV infected
Per-enteral: Through infected Blood/blood
products (tissues and organs transplantation)
Per-enteral: Through contaminated needles,
syringes, medical utensils and other piercing
instruments
Peri-natal: From Mother-to-child (During
pregnancy, delivery & lactation)
Modes of Transmission: 3 ‘P’s

12. Mode of Transmission…
Through sexual intercourse with HIV infected
person Possibility of transmission 75-80%

13. Mode of Transmission..
Sharing needle of infected drug users
Possibility of transmission 5-10%

14. Mode of Transmission..
Transfusion of unscreened infected blood
Possibility of transmission 90%

15. Mode of Transmission..
From infected mother to child
Possibility of transmission 10%

16. Materials Can Transmit HIV
Blood
Semen
Vaginal fluid
Breast milk
Saliva
Sweat
Stool
Urine
Tear

17. HIV in Body Fluids
Semen
11,000 Vaginal
Fluid
7,000
Blood
18,000
Amniotic
Fluid
4,000 Saliva
1
Average number of HIV particles in 1 ml of these body fluids

18. HIV-Infected T-Cell
HIV
Virus
T-Cell
HIV Infected
T-Cell
New HIV
Virus

19. Window Period
This is the period of time after becoming
infected when an HIV test is negative.
90 percent of cases test positive within
three months of exposure.
10 percent of cases test positive within
three to six months of exposure.

20. HIV DOES NOT SPREAD BY -
Social Gathering, hand shaking & hugging
Eating & drinking together (Using same
plate, glass)
Cough & sneezing, bathing together
Using same latrine, same bed
Playing together, attending same class
Work in same office
Insect bite (Mosquito, Fly)

21. I/V drug users
CSWs and their clients
MSM
Truckers
Rickshaw pullers
Migrants (both external & internal)
Women & foetus
Youth of the society
High Risk Groups

22. STI and HIV
STI HIV Transmission
Syphilis +++
Chancroid +++
Chlamydia ++
Gonorrhea ++
Herpes simplex +
Presence of STI can considerably
increase the risk of HIV transmission

23. Magnitude of HIV/AIDS
Global Scenario:
Recognized as an emerging disease in 1980
First AIDS case was detected in USA in 1981
Epidemic occurred in mid 1990s in Africa
1 in 12 African adults is having the disease
Age group 20-40 years is the main victim
About 50% cases are women
Women tend to die at an earlier age

24. Total 33.2 million [30.6 –
36.1million] Adults 30.8 million [28.2 –
33.6million] Women 15.4 million [13.9 –
16.6million] Children under 15
years 2.5 million [2.2 – 2.6
million]Total 2.5 million [1.8 – 4.1
million]
Adults 2.1 million [1.4 – 3.6 million]
Children under 15 years 420 000 [350 000 – 540000]
Total 2.1 million [1.9 – 2.4
million]
Adults 1.7 million [1.6 – 2.1 million]
Children under 15 years 330 000 [310 000 – 380000]
Number of people
living with HIV in 2009
People newly
infected
with HIV in 2009
AIDS deaths
in 2009
Global AIDS Epidemic, December 2009

25. Global Scenario Continued
 More than 60 million peoples are the
victims of HIV/AIDS globally.
 Around 33.2 million people are living with
HIV.
 Over 25 millions have died & about 41
millions are alive.
 Africa is home to 2/3rd of world’s peoples
living with HIV/AIDS.
 Around 4.5 million new infection in 2009.
 Over 7000/day new cases occurred in 2008.

26. Total: 33.2 (30.6 – 36.1) million
Western &
Central Europe
760 000
Middle East & North
Africa
380 000
]
Sub-Saharan Africa
22.5 million
Eastern Europe
& Central Asia
1.6 million
South & South-East
Asia
4.0 million
Oceania
75 000
North America
1.3 million
Latin America
1.6 million
East Asia
800 000
Caribbean
230 000
]
Adults and Children estimated to be
living with HIV

27. Estimated number of Adults and Children
newly infected with HIV
Western &
Central Europe
31 000
Middle East & North
Africa
35 000
Sub-Saharan Africa
1.7 million
Eastern Europe
& Central Asia
150 000
South & South-East
Asia
340 000
Oceania
14 000
North America
46 000
Latin America
100 000
East Asia
92 000
Caribbean
17 000]
Total: 2.5 (1.8 – 4.1) million

28. Projected annual expenditure requirements
for HIV/AIDS care and support by region
Sub-Saharan Africa:
US$3,070M (69.14%)
Total: US$4,440 million
South and Southeast
Asia: US$670M (15.09%)
East Asia, Pacific:
US$80M (1.80%)
Latin America, Caribbean:
US$550M (12.39%)
Eastern Europe, Central
Asia: US$20M (0.45%)
North Africa, Middle East:
US$50M (1.13%)

29. HIV/AIDS : Regional Situation
India : 2.5 million
Myanmar : 2,40,000
Thailand: 6,10,000
Nepal : 70,000

30. Epidemic Trend in Asia
Generalized HIV epidemic:
– Cambodia, parts of India, Myanmar, and Thailand
Concentrated HIV epidemic:
– Parts of China, Indonesia, Malaysia, Nepal and
Vietnam
Low HIV epidemic:
– Bangladesh, Bhutan, Laos, Maldives, Philippines,
– Republic of Korea, Sri Lanka

31. Regional Scenario
1984: First AIDS case was reported in Thailand.
About 8.5 million have been HIV infected & 5
million alive in Asia region.
O.4 millions have died in 2008 in Asia.
1.7 million newly HIV infected in 2008.
20% more new HIV infection in 2008 in East
Asia than in 2001.
HIV prevalence is highest in SEAR.
India is next to South Africa by number of HIV
infected peoples.

32. Regional Scenario Contd..
About 5.5 million peoples are HIV infected in
India.
HIV infection is more common among IDUs
About 50% pregnant women found HIV infected
during ANC in Monipur of India.
Around 3.5% of adult population in Thailand are
HIV infected.
1 in 30 pregnant mothers, 1 in 16 soldiers, 1 in 2
CSWs found HIV infected in Combodia.
0.4% of CSWs, 60% of IDUs and 2.2% pregnant
women found HIV infected in Thailand

33. Bangladesh Context
Bangladesh is a low prevalent but high risk
country
First HIV infection was detected in 1989
Total HIV infected-3241, Total AIDS
patients-1299,Total death-472 (NASP 2013)
According to UNAIDS, it is >13000
370 new HIV infection, 95 newAIDS
patients & 82 deaths in 2013 (NASP 2013)

34. HIV/AIDS in Bangladesh (2013)
Identified Cases : 2013 Total
• HIV+ Cases 370 3241
• AIDS Cases 95 1299
• AIDS Death 82 472
Source: NASP Publication, 1 December 2013

35. HIV Prevalence Rates Over the Rounds
Surveillance
Round
Numbers
Tested
HIV (%)
1st Round 3886 <1% (0.4)
2nd Round 4634 <1% (0.2)
3rd Round 7063 <1% (0.2)
4th Round 7877 <1% (0.3)
5th Round 10445 <1% (0.3)
6th Round 11029 <1% (0.6)

36. Geographic proximity to highly prevalent
neighboring countries like India, Thailand &
Myanmar and air and water routes with the world
High prevalence of STDs
High levels of unprotected sex by CSWs
High rate of needle sharing among IDUs
Limited correct knowledge on HIV/AIDS
Large number of STD cases
Unsafe blood transfusion service
High rate of poverty, illiteracy and ignorance
Factors Making Bangladesh a
High Risk Country

37. Low condom use among the MARP and the
bridging population.
Low level of voluntary blood donation.
External and internal migration.
Subordinate status of women.
Violence against women.
Unequal access to health care services.
Legal laws and human rights.
Factors Making Bangladesh a
High Risk Country

38. Symptoms of AIDS
Major Symptoms:
Loss of weight by more than 10% during last 6 months
Fever (continuous or intermittent) for more than 1 month
Diarrhea for more than 1 month that is not cured by any
medicine
Common Symptoms:
Cough, skin rash (bluish) that does not disappear
White layered thrush in oral cavity and throat
Swelling of body lymph Nodes
Herpes zoster and Herpes simplex infection
Skin infection with itching.

39. A two months old infant born to a mother with AIDS. The child
developed pneumonia and oral candidiasis

40. The child was first seen
at the age of 9 months
for recurrent diarrhoea,
otitis media and failure to
thrive. He was marasmic
and had generalised
lymphadenopathy, and
hepatosplenomegaly.
Chest x-ray showed
evidence of pulmonary
tuberculosis. HIV tests in
mother, baby and the
father were positive.

41. WOMEN ARE ESPECIALLY
VULNERABLE TO HIV/AIDS
Biologically vulnerable
to infection
Sexual exploitation
including trafficking
Inability to refuse sex /
negotiate safer sex
Violence against women
Migration
Poverty

42. Young people and HIV
Sexual experimentation
(40% male adolescents go to CSWs and
80% of them do not use condom)
Many are Drug users
Low awareness level on HIV
prevention
Vulnerability in the workplace
Street children (Forced sex)
Nearly half of new HIV infections occur
to young people below the age of 24

43. Key National Responses of GOB…
 1985: National AIDS Committee(NAC) was
formed.
 Formation of TC of NAC & 2 sub-committees:
Monitoring sub-committee (MSC) & Motivation
cum Publicity sub-Committee (MPSC).
 1987: GOB started AIDS Prevention activities.
 1988: 5 HIV diagnostic laboratory established.
 1989: 3-year Medium Term Plan was formulated.
 1990: HIV Prevention activities were carried out.

44.  1994-1996: UNDP supported the HIV/AIDS
Intervention.
 1997: The National Policy on HIV/AIDS and
STD Related Issues was approved by the
cabinet.
 1997: A five-year National Strategy (1997-
2002) adopted in NAC for effective launching
of HIV/AIDS Interventions.
 1998-2005: Six Behavioral and Serological
Surveillance BSS on HIV and Syphilis was
completed.
Key National Responses of
GOB…

45.  1998:NASP management structure outlined,
activities being carried out by three main
functionaries : the NAC, MOHFW & DGHS.
 1998-2000: UNDP supported Multi-sectoral
AIDS Prevention Project (MAPP).
 2002: Laws on blood safety passed by the
parliament (98 blood screening centers
established; screening HIV, Syphilis,
Malaria, HBV & HCV).
 2004-2010: A National Strategic Plan on
HIV/AIDS formulated & implemented.
Key National Responses of
GOB…

46. NASP has developed
National ART guideline.
National STI management Guideline.
National harm reduction strategy for IDUs.
Safer sex promotion strategy in work place.
Guideline for clinical management.
Safe blood transfusion program.
National Sero & Behavioral Surveillance.
Mutisectoral involvement of NGOs, Donor, Civil society.
Human Rights issues for PLWHA.
Stigma & discrimination prevention.
Contribution of NASP

47. Levels of Prevention of HIV/AIDS
It needs all levels of prevention
Primordial Prevention
Primary Prevention
Secondary Prevention
Tertiary Prevention

48. Primordial Prevention
It includes
 Avoidance of exposure to risk factors
in very early life.
 Health education is the vital strategy.

49. Primary Prevention
It includes
Building and increasing awareness
by health education
Health promotion
Specific protection by vaccination

50. Primary Prevention..
4 ‘S’ should be followed
Safe sex to practice (ABC)
Safe blood to transfuse
Safe injection to use
Safe Pregnancy to ensure

51. Vaccination
 First clinical trial of Phase I of HIV
vaccination took place in 1987 in USA.
 Phase II trial took place in Africa.
 One large scale of Phase III trial is
currently undergoing in Thailand.
 Scientists all over the world are trying
very hard for it.

52. Secondary Prevention
It includes proper management by
Early diagnosis and
Prompt treatment
No cure is possible

53. Diagnosis of HIV/AIDS
Diagnosis is done by:
History
Clinical feature (major & minor) and
Specific laboratory investigations
HIV enzyme immunoassay
Western blot assay, detect HIV
antibodies in serum, plasma, oral fluid,
dried blood spot or urine of patient

54. Treatment
 Antiretrovirals are not a permanent cure,
but it reduces the viral load and extends
the life of people living with HIV.
 UNAIDS declared the lack of treatment
in low and middle income countries is a
global public health emergency.

55. Management of HIV/AIDS
Clinical Stage-1 (Asymptomatic): HIV is not
categorized as AIDS.
Clinical Stage-2 (Mild disease): Includes minor
mucocutaneous manifestations and recurrent
upper respiratory tract infections.
Clinical Stage-3 (Moderate disease): Includes
unexplained chronic diarrhea for longer than a
month, severe bacterial infections and pulmonary
tuberculosis.
Clinical Stage-4 (Severe disease): Includes
toxoplasmosis of the brain, candidiasis of the
esophagus, trachea, bronchi or lungs and Kaposi's
sarcoma; these diseases are indicators of AIDS.

56. General Management Measures
Bed Rest
Ensure adequate nutrition and fluid & electrolyte
balance
Provide proper nursing care and counseling
Maintain personal & oral hygiene
Symptomatic management of fever, pain, itching etc
O2 inhalation SOS
Catheterization SOS
Changing posture & oropharyngeal suctions SOS
Supplementation of vitamins and minerals

57. Management of Opportunistic Infections
Respiratory Infections like
Cough, Bacterial pneumonia, MTB
CMV, Toxoplasmosis, Histoplasmosis
Pneumocystic carinii, Mycobacterium Avium
Complex (MAC)
Gastrointestinal Infections like
Oral candidiasis, Oral Thrush
Oro-esophageal thrush
Diarrhoeal diseases, Parasitic diseases
Bacterial infection: Salmonella, Shigella, Listeria
Toxoplasmosis, Cryptococcosis, MAC ,
Histoplasmosis etc

58. Treatment Regimen
Preferred first-line Regimen
AZT (Zidovudine) + 3 TC (Lamivudine)
+ NVP (Nevirapine)
Alternative first-line Regimen
AZT + 3 TC + EFV (Efavirenz)
Available Regimen
d4T (Stavudine) + 3 TC + NVP/EFV
It does not require any lab monitoring

59. Tertiary Prevention
Disability Limitation: Cannot limit the
disease properly as It is a progressive
disease.
Rehabilitation: It is a social crisis till
today.

60. World AIDS Campaign
Brings diverse global voices on HIV/AIDS
together through a collaborative approach.
Holds world leaders & governments to
account for their promises on AIDS.
Share global actions and awareness on
HIV/AIDS.
“Stop AIDS Keep The Promise” (2006).
Universal Access and Human Rights (2010).

62. Why Leadership?
All our efforts are not delivering at the
speed & scale required.
Promises are not being kept due to
Lack of leadership at all level.
Despite efforts to hold leaders
accountable, progress in halting HIV is
still falling far short of targets.

63. Why Leadership?
 It acts as a vehicle for uniting efforts within a
common global message.
 To maximize national, regional and
international visibility of global campaigning
efforts on AIDS.
 It can promote a wide range of AIDS issues
globally.
 It brings media, governments, businesses
and a range of institutions locally and
globally to embrace common issues on
HIV/AIDS.

64. Message for All
ABCD – 4 Basic rules of HIV Prevention
D-No to drugs
C-Use condom
B- Be faithful /Transfuse safe blood
A- Abstinence

65. Recommendations
Prevention of sexual transmission
Prevention of mother-to child transmission
Prevention of transmission through injecting
drug use, including harm-reduction measures
Ensure safety of blood supply
Prevention of transmission in health facilities
Promote greater access to voluntary HIV
counseling and testing while principles of
confidentiality and consent are followed

66. Integrate HIV prevention and AIDS
treatment into existing healthcare services.
Focus on HIV prevention among young
people
Provide HIV related IEC to enable
individuals to protect themselves from
infection.
Confront and mitigate HIV related stigma
and discrimination.
Prepare for access and use of vaccines and
microbicides
Recommendations

67. Firstly, Formulating the national
HIV/AIDS communication strategy.
Secondly, concentrating on groups
most vulnerable to the infection.
Thirdly, working with the general
population (community mobilization
and community participation).
Fourthly, care and support to those
already infected and affected by
HIV/AIDS (voluntary counseling).
Recommendations

68. Ray of Hopes…
Epidemics of HIV/AIDS is declining
Prevalence of HIV/AIDS has
decreases by 20% in last 20 years
Death rate due to HIV/AIDS has
reduced by 20% by last 5 years
(Report: UNDIDS, 22nd Anniversary,
World AIDS Day, 2010)

69. Ensure Universal access and human rights
in terms of prevention, promotion, health
care, access to opportunities, employment
and social affairs.
Use effective leadership at all levels both
nationally and globally to make Bangladesh
HIV/AIDS free.
Conclusion

70. THANK YOU
Together We Can Protect Our
Country From HIV/AIDS