1) The document discusses the history and epidemiology of the HIV/AIDS epidemic from its earliest known cases in 1981 to modern day. It describes key events like the identification of HIV as the cause and the development of antiretroviral treatments. 2) Surveillance methods for HIV are discussed, including case reporting systems and sentinel surveillance at specific sites. Three types of epidemics - generalized, concentrated, and low-level - are also summarized. 3) Statistics and maps show the current global status of the HIV epidemic, with parts of sub-Saharan Africa most severely affected. Resources for further information are listed.

1. HIV/AIDS
Epidemic

2. Department of error
LR=MMRate*(T50-T15)/l15
lifetime risk of maternal death

3. Communication does not work
denisov@demography.ru
boris-denisov.blogspot.com
or
else

4. Outline
● Major events
● Natural history
● Surveillance Systems
● Different Epidemics

5. Do you recognize these people?

6. Celebrities died of AIDS
● Freddie Mercury (1946–1991) British musician and lead singer of the band
Queen
● Makgatho Mandela (1950–2005) South African attorney; was the son of
former South African president Nelson Mandela
● Arvid Noe (1947–1976) Norwegian sailor famous for being one of the first
humans known to have died from AIDS
● Bill Goldsworthy (1944–1996) Canadian ice hockey player; played in the
National Hockey League for fourteen seasons
● Rudolf Nureyev (1938–1993) Russian ballet dancer; is regarded as one of
the greatest male dancers of the 20th century
● Gia Carangi (1960–1986) American supermodel of the late 1970s and early
1980s.
●

7. Pneumocystis Pneumonia --- Los Angeles
MMWR June 5, 1981 / 30(21);1-3
In the period October 1980-May 1981, 5 young men, all active homosexuals, were
treated for biopsy-confirmed Pneumocystis cariniipneumonia at 3 different hospitals in
Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed
previous or current cytomegalovirus (CMV) infection and candidal mucosal infection.
…
All the above observations suggest the possibility of a cellular-immune dysfunction
related to a common exposure that predisposes individuals to opportunistic infections
such as pneumocystosis and candidiasis. Although the role of CMV infection in the
pathogenesis of pneumocystosis remains unknown, the possibility of P. carinii infection
must be carefully considered in a differential diagnosis for previously healthy
homosexual males with dyspnea and pneumonia.

8. The first reaction

9. further developments
1982 ● introduction of the term AIDS
● an infected woman had been revealed
● a patient infected after a blood transfusion had been revealed
1983 discovery of the human immunodeficiency virus (Nobel prize 2008, Luc
Montagnier, Françoise Barré-Sinoussi), i.e., AIDS identified as being caused
by an HIV
1985 FDA approved first enzyme linked immunosorbant assay (ELISA) test kit to
screen for antibodies to HIV
1987 ● March 19, FDA approved AZT - the first drug approved for the treatment of
AIDS
● FDA revised its strategy for the regulation of condoms by strengthening
its inspection of condom manufacturers and repackers, strengthening its
sampling and testing of domestic and imported condoms in commercial
distribution, and providing guidance on labeling of condoms for the
prevention of AIDS

10. HAART (mid 90s)
general idea = hit hard, hit early
HAART decreases the patient's total burden of
HIV, maintains function of the immune system,
and prevents opportunistic infections that often
lead to death
1991 - HIV+, quit from sports, and got married
1992 - all stars NBA match + Barcelona Olympics
1995 - returned to NBA (unsuccessful)
2002 - no signs of AIDS
a good model to overcome stigma

11. July 16, 2012 FDA Approves First Medication to
Reduce HIV Risk (new use of Truvada)
Currently the FDA recommends pre-exposure prophylactic (PrEP)
considerations for the following high risk groups:
● Gay or bisexual men who have either have had anal sex without a
condom or been diagnosed with an STD in the past 6 months
● Heterosexual men or women who do not regularly use condoms during
sex with partners of unknown HIV status who are substantial risk
● Injection of illicit drugs in the last month with sharing of equipment
● Discordant heterosexual and homosexual partners where one partner is
HIV-positive and the other HIV-negative

12. Natural
history
Scanning electron
micrograph of HIV-1
(in green) budding
from cultured
lymphocyte.
Multiple round
bumps on cell
surface represent
sites of assembly
and budding of
virions.

13. from chimpanzee to human beings
HIV originated in west and central Africa,
jumping from primates to humans. HIV-1 has
evolved from a simian immunodeficiency virus
(SIVcpz) found in the common chimpanzee
subspecies, P. t. troglodytes, native to southern
Cameroon. Kinshasa, in the Democratic Republic
of Congo, has the greatest genetic diversity of
HIV-1 so far discovered, suggesting the virus has
been there longer than anywhere else. HIV-2
crossed species from a different strain of SIV,
found in the sooty mangabey monkeys in
Guinea-Bissau.

14. Location of origin

15. Health v Disease
A generalized graph of
the relationship
between HIV copies
(viral load) and CD4
counts over the average
course of untreated HIV
infection; any particular
individual's disease
course may vary
considerably.

16. Window period
Antibody tests may give false negative (no antibodies were detected
despite the presence of HIV) results during the window period, an
interval of three weeks to six months between the time of HIV
infection and the production of measurable antibodies to HIV
seroconversion.
Seroconversion is the time period during which a specific antibody
develops and becomes detectable in the blood.

17. Containers and transmission
container/carrier transmission
blood blood transfusion, dirty needles, syringes, solutions, etc
sperm and pre-ejaculate various sex
breast milk breast feeding

18. Behavioral risks

19. References for the table

20. Risk groups and vulnerable subpopulations
photo:
Part of the M1/E30 road
(Cork, Ireland — Omsk,
Russia) in Belarus

21. There are two major types of HIV surveillance
● Case reporting system
● Sentinel surveillance system

22. HIV Tests
● The enzyme-linked immunosorbent assay (ELISA) is a test that uses
antibodies and color change to identify a substance (IFA in Russian).
● Western blot (protein immunoblot). The confirmatory HIV test to detect
anti-HIV antibody in a human serum (blood plasma) sample.
● Polymerase chain reaction (PCR), btw invoked by Kary Banks Mullis (in
mid 1980s), known for his AIDS denialism, and climate change denial. It is
used in the window period, to test newborns, and define the exact type of
HIV.

23. Russian case reporting system

24. Urgent report on the person whose blood western
blot reaction revealed HIV antibodies
Address (where report goes) _______________________________
Name (in Russian format: three entries) ________________________________
Sex____________
Date of birth_______
Citizenship_______________________
Place of residence in the USSR_________
Mail address_________________________
Address of job or learnng_______________
Code of contingent____________________
Note: in Code of contingent indicate all relevant codes

25. Result of immunoblot reaction :
Date___________
Type of a test system_____# of series__
Revealed protein and glicoproteid__________________
Institution previously revealed a positive IFA test:
Institution________Address_____________ IFA date: ___________________________
Position, name and signature of a reporter ___________
Phone number _________________ Date "____"______________19__

26. Codes of contingent
100 – USSR citizen, including
101 – Person having sexual contacts with
PLWHA
102 – Drug addict
103 – Homo and bisexual (man)
104 – Person with STD
105 - Promiscuous person
106 – Person being abroad for more than
one month
108 - Donor
109 - Pregnant
110 – Recipient of a blood product
111 – Military servant
112 - Prisoner
113 – Tested due to clinical reasons
114 – Tested anonymously
115 – Having contacts with PLWHA
200 – Foreign citizen, including
201 - Person having sexual contacts with
PLWHA
202 - Drug addict
203 - Homo and bisexual (man)
204 - Person with STD
205 - Promiscuous person
207 – Entering the USSR for more than three
months
209 - Pregnant
210 - Recipient of a blood product
211 - Military servant
212 - Prisoner
213 - Tested due to clinical reasons
214 - Tested anonymously
215 - Having contacts with PLWHA

27. Epidemic strike Russia

28. Sentinel Surveillance
WHO definition is here
Data are collected at sentinel sites
It is the regular, systematic collection, analysis and interpretation of
information for use in tracking and describing changes in the HIV/AIDS
epidemic over time. Second generation surveillance for HIV/AIDS also gathers
information on risk behaviours, using them to warn of or explain changes in
levels of infection.

29. Three Types of Epidemic
● In generalized epidemics where HIV is over one percent in the general population,
surveillance systems concentrate on monitoring HIV infection and risk behaviour in the
general population. This usually includes HIV sentinel surveillance among pregnant
women in antenatal care.
● In concentrated epidemics where HIV is over five percent in any sub-population at higher
risk of infection (such as drug injectors, sex workers, men who have sex with men),
surveillance systems monitor infection in those groups and pay particular attention to
behavioural links between members of those groups and the general population.
Surveillance systems also monitor the general population, especially young people, for
high-risk sexual behaviour that might lead to rapid spread of the virus if it were
introduced and trends in STI.
● In low-level epidemics where relatively little HIV is measured in any group, surveillance
systems focus largely on high-risk behaviours, looking for changes in behaviour which
may foster a rapid spread of infection.

30. Global epidemic
Territory size
shows the
proportion of all
people aged 15-49
with HIV (Human
Immunodeficiency
Virus) worldwide,
living there.
source:
The New
WorldMapper

31. Links to Information
UNAIDS (latest, 2015 report)
Russian Federal Center to Combat AIDS and HIV prevention
HIV in the United States
European Network for HIV/AIDS Surveillance

32. The 'Charlie Sheen effect' really did help HIV awareness
When Sheen announced in November he had been hiding
his HIV-positive status for years, media coverage and
public interest on the star and the topic of HIV exploded.
A study published Monday in JAMA Internal Medicine
shows just how much.
Researchers from San Diego State University's
School of Public Health ran an analysis of media
and Internet searches after Sheen's November 17
announcement. They found that media coverage
of HIV on the day of Sheen's disclosure ranked in
the top 1% compared with the last seven years. It
followed years of declining media coverage of HIV --
from 67 stories per 1,000 in 2004 to 12 stories per
1,000 in 2015.
Celebrities and HIV (CNN)
search also for The 'Angelina effect'
A UK study found referrals to genetic
testing among high-risk English women
rose by 2.5% in the two months after her
announcement [about decision to
undergo a double mastectomy because
she inherited the BRCA1 gene]

33. Recommendations