Presentation on HIV/AIDS, public health concern- include cause, symptoms, prevention and appropriate interventions. Also it include the Epidemiological Triangle link between agent, host and environment, Status of the disease in Nepal and in world.

1. HIV/AIDS: A Global
Public Health Issue
By Sachin Bhatt

2. WHAT IS HIV ?
Human
Immuno-deficiency
Virus

3. HIV is the infection of immune system and weakens
people's defense systems against infections and some
types of cancer.
As the virus destroys and weakens the function of
immune cells, infected individuals gradually become
immuno-deficient (no more strong immunity).
Immune function is typically measured by CD4 cell
count. Immunodeficiency results in increased
susceptibility to a wide range of infections and
diseases that people with healthy immune systems
can fight off.
HIV ?

4. Have two types
1. HIV-1, and
2. HIV-2
• HIV-1 accounts for 95% of all infections worldwide.
HIV-2 is mainly seen in a few West African countries
• People infected with HIV-2 are less infectious in the
early stages of the virus than those with HIV-1.
HIV ?

5. Acquired
Immune
Deficiency
Syndrome
WHAT IS AIDS ?

6. • The last stage of HIV infection is AIDS (acquired
immunodeficiency syndrome). People with AIDS have
a low number of CD4+ cells and get infections or
cancers that rarely occur in healthy people. These can
be deadly.
• But having HIV doesn't mean you have AIDS. Even
without treatment, it takes a long time for HIV to
progress to AIDS—usually 10 to 12 years.
• When HIV is diagnosed before it becomes AIDS,
medicines can slow or stop the damage to the immune
system.

7. Through the direct exchange of body fluids from infected
person such as blood, breast milk (very low
concentration), semen and vaginal fluid.
Unprotected (non use of condom) vaginal or anal
intercourse with an infected person is the major mode
of transmission of HIV worldwide.
A mother's infection passing to her child during
pregnancy, birth (vertical transmission) – the risk of HIV
passing from mother to child is approximately 30% if no
preventative measure is used.
Transmission

8. Injection with contaminated needles, which may occur
when Intravenous Drug Users (IDUs) share needles, or
when health care workers are involved in needle prick
accidents (a major cause of HIV among health workers).
Use of contaminated surgical instruments, for example
 During Traditional circumcision (In Muslim and Jews
community).
 During Blood transfusion with infected
instruments.
Contact of a mucous-membrane surface with infected
blood or body fluid, for example with a splashin the eye
(Note that the virus cannot penetrate undamaged
skin.)
Transmission contd…

9. Mosquito bites
Urine or sweat
Public toilets, saunas, showers or swimming pools
Sharing towels, or clothing
Going to school with, socializing or working with HIV-
positive people
Sneezing or coughing
Touching, hugging or dry kissing a person with HIV
How HIV is not transmitted

10. Symptoms
Incubation period (the period from entry of
organism in body and appearance of clinical sign) -
varies from few months to 6 years or more.
Most people who have become recently infected with
HIV will not have any symptoms.
They may, however in Initial stage have a flu-like illness
within a month or two after exposure to the virus, with
fever, headache, tiredness, and enlarged lymph nodes
(glands of the immune system easily felt in the neck and
groin). These symptoms usually disappear within a
week to a month. During this period, people are very
infectious, and HIV is present in large quantities in
blood, semen, and vaginal fluids.

11. Symptoms contd…
A person with AIDS Related Complex stage has illness
caused by damage to the immune system, but without
the opportunistic infections and cancer associated with
AIDS.
They show one or more of the following clinical features:
Unexplained diarrhea for more than a month
Malaise, fatigue, fever for more than a month and
night sweats
Weight loss of more than 10% of the body weight
Lymphadenopathy (lymph node enlargement) and
Splenomegaly (Spleen Swelling)

12. AIDS is the end stage of HIV infection. Death is due to
uncontrolled or untreatable infection.
According to WHO, the infection of HIV has following steps:
• Stage I : HIV infection is asymptomatic and not categorized
as AIDS
• Stage II : includes minor muco-cutaneous signs and
recurrent upper respiratory tract infections
• Stage III : includes unexplained chronic diarrhea for longer
than a month, severe bacterial infections and pulmonary
tuberculosis.
• Stage IV : includes toxoplasmosis of the brain, candidiasis
of the esophagus, trachea, bronchi or lungs and Kaposi's
sarcoma;
These diseases are indicators of AIDS.

13. Fewer sexual Partners
Many other preventive measures can be used but the main
thing is the awareness.
HIV testing and counseling (VCT - voluntary testing and
counseling and HCT – HIV testing and counseling).
Safe Male circumcision.
Reducing needle sharing.
Testing the mother for HIV at their first antenatal
appointment, during their third trimester and after delivery
of their baby and Treatment should be offered if the mother
tests positive.
Preventing of Mother to Child Transmission through using
ART (Anti-Retroviral Therapy) in early stage and treatment
of adults through antiretroviral drugs .
Prevention

14. HIV Awareness and Education regarding.
 Screening before blood transfusion.
 Use of condoms in every sexual act.
 Early diagnosis and treatment of other sexually
transmitted diseases (which increases risk of getting
HIV).
Prevention contd…

15. Treatment as prevention
1. Post-exposure prophylaxis (PEP) - emergency HIV
treatment
Emergency treatment to prevent HIV infection, a series of
antiretroviral drugs taken after potential exposure to HIV.
2. Pre-exposure prophylaxis (PrEP)
HIV treatment (PrEP) can be taken before potential
exposure to HIV.
For example, if one partner in a relationship is HIV + and
the other is HIV -, the negative partner can take PrEP to
protect themselves from HIV transmission.
PrEP is intended for people who don’t have HIV but who
are at high risk of sexually transmitted HIV infection.

16. • IDUs
• Sex workers
• Clients of sex workers (mostly truck drivers)
• Male Labor Migrants (MLM) who go to other
countries for employment
• Male having sex with male (MSM)
Risk Groups

17. In the world, at the end of 2013:-
o35 million people are living with HIV.
o2.5 million new HIV infections each year.
o35 million people have died from AIDS.
o16 million children under 18 have been made orphans.
oSub-Saharan Africa is the most affected region, with 24.7
million people living with HIV in 2013. Also sub-Saharan
Africa accounts for almost 70% of the global total of new
HIV infections.
- WHO, 2014
HIV/AIDS Globally

18. HIV/AIDS Globally contd…

19. First case of HIV infection was identified in 1988.
The epidemic of HIV in Nepal is concentrated among key
populations at higher risk such as People who Inject Drug (PWID),
Men who have Sex with Men (MSM) and Transgender People,
Female Sex Workers (FSW) and Male Labour Migrants.
In Nepal, the epidemic is largely driven by sexual transmission,
which accounts for more than 4 of every 5 HIV infections.
HIV prevalence among adult population has been declining in
slow pace (from 0.49 in 2007 to 0.23 in 2013), however, country
has made significant achievement in reduction of new HIV
infection from 8,039 annually in 2000 to 1,408 in 2013, despite of
high HIV prevalence among certain population groups (PWIDs and
MSM).
HIV/AIDS in Nepal

20. • There are about 3,281 (8% of total estimate) children up to the
age of 14 years that are estimated to be living with HIV in Nepal in
2013, while the adults aged 15 years and above account for 92%.
• By sex, around two-thirds of the infections occurred among males
(66%) and
• the remaining more than one-third (34%) of infections are in
women, out of which around 92.2% are in the reproductive age
group of 15-49 years.