The document discusses the global HIV/AIDS epidemic and its impact. It notes that as of 2008, there were an estimated 33.4 million people living with HIV/AIDS globally. Women accounted for half of new infections that year. The epidemic disproportionately impacts those in sub-Saharan Africa, where 22.4 million people were estimated to be living with HIV/AIDS in 2008. The epidemic has had vast social and economic impacts, including orphaning millions of children and slowing economic growth.

1. HIV/AIDS Come forward…..Take Leadership…..Stop AIDS Dr Naresh T Chauhan Department of PSM

2. “ HIV/AIDS is one of the biggest challenges to development that we have ever faced. Our response must be Agency-wide. The HIV/AIDS pandemic is not just a health sector issue; it is the business of every officer in every sector in the Agency. […] The design of activities in all sectors should take into account the impact of the HIV/AIDS pandemic on human and institutional capacity in the sector.” USAID Administrator Andrew Nations, 2001

3. Where are we? Feminization of epidemic : in Sub-Saharan Africa women make 60% of HIV positive adults; globally this figure is 50% for the first time India: 95% of new infections in women were among married and monogamous in 2003 Stigma & discrimination: S urveys reveal that majority of respondents do not want to work with people living with HIV/AIDS Lack of treatment : In Africa only 4% of PLWHA have treatment Vast secondary impacts : Orphans, basic social services, instability Curtsey: UNDP

4. Global summary of the AIDS epidemic, 2008 Total 33.4 million [31.1 – 35.8 million] Adults 31.3 million [29.2 – 33.7 million] Women (aged 15 and above) 15.7 million [14.2 – 17.2 million] Children under 15 years 2.1 million [1.2 – 2.9 million] Total 2.7 million [2.4 – 3.0 million] Adults 2.3 million [2.0 – 2.5 million] Children under 15 years 430 000 [240 000 – 610 000] Total 2.0 million [1.7 – 2.4 million] Adults 1.7 million [1.4 – 2.1 million] Children under 15 years 280 000 [150 000 – 410 000] Number of people living with HIV in 2008 People newly infected with HIV in 2008 AIDS-related deaths in 2008

5. Impact on Human development Kills young adults in their most productive years of their lives 40 million orphans by 2010 Poverty spreads and deepens Brake on economic growth Health and education achievements reversed

6. Total: 33.4 million (31.1 – 35.8 million) Western & Central Europe 850 000 [710 000 – 970 000] Middle East & North Africa 310 000 [250 000 – 380 000] Sub-Saharan Africa 22.4 million [20.8 – 24.1 million] Eastern Europe & Central Asia 1.5 million [1.4 – 1.7 million] South & South-East Asia 3.8 million [3.4 – 4.3 million] Oceania 59 000 [51 000 – 68 000] North America 1.4 million [1.2 – 1.6 million] Latin America 2.0 million [1.8 – 2.2 million] East Asia 850 000 [700 000 – 1.0 million] Caribbean 240 000 [220 000 – 260 000] Adults and children estimated to be living with HIV, 2008

7. Western & Central Europe <100 [ <100 – <200] Middle East & North Africa 3300 [1600 – 5300] Sub-Saharan Africa 230 000 [120 000 – 350 000] Eastern Europe & Central Asia 1400 [<500 – 2700] South & South-East Asia 11 000 [4900 – 17 000] Oceania <100 [ <100 – <500] North America <100 [<100 – <200] Latin America 3900 [2100 – 5700] East Asia 1500 [<1000 – 2300] Caribbean 1300 [<1000 – 2100] Estimated deaths of children (<15 years) due to AIDS, 2008 Total: 280 000 (150 000 – 410 000)

8. 0 10 20 30 40 50 60 70 Cambodia Haiti Mozambique Rwanda Côte d'Ivoire Zambia Kenya South Africa Zimbabwe Botswana Life expectancy at birth ( years ) Predicted life expectancy Predicted loss in life expectancy due to HIV/AIDS in children born in 2000 Loss in life expectancy due to HIV/AIDS

10. Over 7400 new HIV infections a day in 2008 More than 97% are in low- and middle-income countries About 1200 are in children under 15 years of age About 6200 are in adults aged 15 years and older, of whom: almost 48% are among women about 40% are among young people (15 – 24)

11. HIV/AIDS Epidemic SEX FEAR SHAME DENIAL ILLNESS DEATH STIGMA DISCRIMINATION Silence and hopelessness

12. 3.97 m. Indians Living with HIV 1998 2002 2003 HIV Prevalence reaches 1% amongst general population in TN, AP & Karnataka Gujarat remained in medium prevalence Gujarat remained in medium prevalence >1% Antenatal women >5 % High risk groups < 5 % High risk groups 1990 1986 1994 2001 2000 First case of HIV detected in Chennai HIV Prevalence reaches over 5% amongst high risk group in Maharahtra & Manip ur HIV Prevalence reaches over 1% amongst women in Maharashtra & Manipur EVOLUTION OF HIV EPIDEMIC– INDIA 1986-2003 High level of HIV among ANC clinic attendants in Maharashtra & TN some sites reporting over 5%

13. Natural History of HIV infection

14. Progress of HIV

15. Development of HIV/AIDS

16. Transmission routes

17. How testing is done?

18. Pre and post test counseling

19. Type of tests

20. Lab diagnosis

21. Lab diagnosis

22. CHALLENGES IN THE BEGINNING Denial Strong feeling about moral values. Blame-Problem due to migrants from UP, Bihar, Orissa, Rajasthan. Rapid industrialization. Longest coast line. Border State. Neighbor of high prevalent State- Maharashtra, with close interaction of population from Gujarat.

23. Active involvement of multitude of partners From Government Municipal Corporations Voluntary Organizations, Community based organizations, Involvement of corporate sector to Implement the targeted interventions and also in other programmes like Blood Safety, STDs, VCTCs, PPTCT, School AIDS Education Programme etc. DOING DIFFERENTLY

24. MEDIAN PREVALENCE OF HIV IN GUJARAT (STD & ANC) SENTINEL SURVEILLANCE

25. Life skills

26. Albert Einstein said “ The world we have made as a result of the level of thinking we have done thus far creates problems that we cannot solve at the same level at which we have created them... We shall require a substantially new manner of thinking if humankind is to survive. .”

27. Don’t EVER give up!