The document is an orientation presentation by Sagun Paudel outlining HIV, AIDS, and STIs, focusing on knowledge development for prevention and treatment in Nepal. It covers the transmission modes, clinical features, risk populations, and prevention strategies, as well as the history of HIV in Nepal since its first reported cases in 1988. Key statistics on HIV prevalence and the importance of voluntary counseling and testing are also included.

1. Presented By
SAgun PAudel
Health Assistant
EIHS
Naulo Ghumti Nepal
ORIENTATION ON HIV,
AIDS AND STIS

2. Objectives of Presentation
2
General Objectives
To orient about HIV, AIDS and STIs for Development
of Knowledge, Attitude, and Practice for Prevention
of HIV and STIs.

3. Specific Objectives
• To know the basic concept HIV, AIDS & STIs
• To know the History of HIV Infection, situation of HIV in
Nepal
• To acquire knowledge about mode of Transmission of HIV,
How HIV does not Transmit, Window period.
• To know Pathogenesis, Diagnosis of HIV infection,
General clinical features of AIDS.
• To know Risk Population for HIV infection, Prevention of
HIV infection.
• To gain knowledge about Treatment/ curative health
services of HIV infection and AIDS.
• To know the knowledge about STIs, their clinical features,
treatment and Prevention.
3

4. HIV AND AIDS
HIV
H- HUMAN
I- IMMUNODEFICIENCY
V- VIRUS
AIDS
A- ACQUIRED
I- INMMUNE
D-DEFICIENCY
S- SYNDROME
4

5. HISTORY OF HIV
• Originated in non-human primates in Sub-Saharan Africa
and was transferred to humans during the late 19th or
early 20th century.
• Two types of HIV exist: HIV-1 and HIV-2.
• The pandemic strain of HIV-1 is closely related to a virus
found in the chimpanzees of the subspecies Pan
troglodytes troglodytes, which lives in the forests of the
Central African nations of Cameroon, Equatoria
Guinea, Gabon, Republic of Congo and Central African
Republic.
5

6. • Most HIV researchers agree that HIV evolved at some
point from the closely related Simian immunodeficiency
virus (SIV), and that SIV or HIV (post mutation) was
transferred from non-human primates to humans in the
recent past.
• The first confirmed case of AIDS in the United States, a
16-year-old boy from Missouri who died in 1969.
Nepal's first cases of HIV/AIDS were reported in 1988, the
disease has primarily been transmitted by injecting drug
use and unprotected sex.
6

7. Mode of HIV Transmission
Only certain fluids—blood,
semen, pre-seminal fluid,
rectal fluids, vaginal fluids,
and breast milk—from an
HIV-infected person can
transmit HIV.
fluids must come in contact
with a mucous membrane or
damaged tissue or be directly
injected into the bloodstream
1. SEXUAL CONTACT
Anal sex is the highest-
risk sexual behavior
Vaginal Sex.
70%-80%
7

8. 2. From Blood and Blood Products
Sharing needles, syringes
sharing equipment when
piercing, Tattooing
Receiving blood
transfusions, blood
products, or
organ/tissue
transplants that are
contaminated with HIV.
8

9. 3. Infected Mother to Child (Vertical
Transmission)
• During pregnancy
(5%-10%),
• During labor and delivery
(10%-20%)
• Through breastfeeding
(5%-10%).
9

10. HIV Does not Transmit From;
HIV does not survive long outside the human body (such as on
surfaces), and it cannot reproduce. It is not spread by
• Air or water
Insects, including mosquitoes or ticks. Using Common Toilets
10

11. Saliva, tears, or sweat, sneezing
Casual contact like shaking hands and sharing dishes.
Swimming, Bathing
11

12. Using Common Clothes
Closed-mouth or
“social” kissing
Stay with Family/Caring of HIV infected
Person 12

13. HOW HIV infects human?(Pathogenesis)
HIV destroys certain types of white blood cells, weakening
the body's defenses against infections and cancers.
HIV progressively destroys some types of white blood cells
called CD4+ lymphocytes.
Lymphocytes help defend the body against foreign cells,
infectious organisms, and cancer.
HIV destroys CD4+ lymphocytes, people become
susceptible to attack by many other infectious organisms.
13

14. Life Cycle of the HIV
14

15. SYMPTOM of HIV Infection
Initially no noticeable symptoms, but within a few weeks,
fever, rashes, swollen lymph nodes, fatigue, and a variety
of less common symptoms may develop.
Symptoms of initial (primary) HIV infection last from a few
days to 1 to 2 weeks.
The symptoms disappear, but lymph nodes often remain
enlarged, felt as small, painless lumps in the neck, under
the arms, or in the groin.
15

16. WINDOW PERIOD
• Time period between initial HIV infection and the
development of a measureable immunological (or
antibody) response to the infection
• During this period, a person infected with HIV
could still have a negative HIV test Result.
• Window period varies from person to person and
can range from as little as 2 weeks to as long as
3 months.
16

17. DIAGNOSIS OF HIV
Getting HIV test is the only way to know if you have HIV.
The Diagnosis of HIV infection is most often based
upon the detection of antibodies to the virus.
Types of Test are
• ANTIBODY TESTS
(ELIZA, RAPID TEST, WESTERN BLOT)
• VIROLOGICAL TEST (HIV antigen test, DNA
PCR(below 18 month), Viral culture)
17

18. • Voluntary HIV/AIDS counseling, testing and referral (VCT)
is a major strategy in HIV/AIDS prevention and care.
• VCT allows individuals to learn their HIV status through
• pre- and post-test counseling and HIV test. VCT is client-
initiated, as opposed to provider initiated testing and
counseling (PITC).
VOLUNTARY COUNSELING AND TESTING (VCT)
CONSENT,CONSISTENCY & ACCURACY,
CONFIDENTIALITY, PRIVACY
18

19. AIDS
AIDS is the most severe form of HIV infection. HIV infection
is considered to be AIDS when at least one serious
complicating illness develops or the number (count) of
CD4+ lymphocytes decreases substantially.
CD4 Count:
The number of CD4+ lymphocytes in blood (the CD4 count)
helps determine how well the immune system can protect
the body from infections and how severe the damage done
by the HIV is. Healthy people have a CD4 count of about
800 to 1,300 cells per microliter of blood.
19

20. WHO STAGING OF AIDS
Clinical stage 1
• Asymptomatic
• Persistent generalized lymphadenopathy
Clinical stage 2
• Moderate and unexplained weight loss (<10% of presumed or
measured body weight)
• Recurrent respiratory tract infections (such
as sinusitis, bronchitis, otitis media, pharyngitis)
• Herpes zoster
• Recurrent oral ulcerations
• Papular pruritic eruptions
• Angular cheilitis
• Seborrhoeic dermatitis
• Onychomycosis (fungal nail infections)
20

21. Clinical stage 3
• Conditions where a presumptive diagnosis can be made on the
basis of clinical signs or simple investigations
• Unexplained chronic diarrhea for longer than one month
• Unexplained persistent fever (intermittent or constant for longer than
one month)
• Severe weight loss (>10% of presumed or measured body weight)
• Oral candidiasis
• Oral hairy leukoplakia
• Pulmonary tuberculosis (TB) diagnosed in last two years
• Severe presumed bacterial infections (e.g. pneumonia, empyema,
meningitis, bacteraemia, pyomyositis, bone or joint infection)
• Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis
• Conditions where confirmatory diagnostic testing is necessary
• Unexplained anaemia (< 80 g/l), and or neutropenia (<500/µl) and or
thrombocytopenia (<50 000/ µl) for more than one month
21

22. Clinical stage 4
• Conditions where a presumptive diagnosis can be made
on the basis of clinical signs or simple investigations
• HIV wasting syndrome
• Pneumocystis pneumonia
• Recurrent severe or radiological bacterial pneumonia
• Chronic herpes simplex infection (orolabial, genital or anorectal
of more than one month's duration)
• Esophageal candidiasis
• Extrapulmonary tuberculosis
• Kaposi's sarcoma
• Central nervous system toxoplasmosis
• HIV encephalopathy
22

23. IS There Treatment of HIV and AIDS?
There no specific vaccination for prevention of HIV and
AIDS. And also there is no any Therapeutic medication for
complete cure of HIV infection and AIDS.
But ART is available
(Anti Retro Viral Therapy) ART is a complex treatment with
multiple medications that, once started, need to be taken
over the long time.
The major role of ART is to Prevent opportunistic Infections
and raise the immune power of body to fight against
various micro organisms, control of HIV replication, balance
the no. of CD4 cells.
23

24. Key characteristics of HIV in Nepal
The first HIV was detected in 1988 in Nepal,
since then HIV epidemic has evolved from low to
concentrated among key populations at higher
risk:
People who inject drugs
Sex workers
Men who have sex with men
Heterosexual transmission dominant
HIV prevalence in general population is <1%
 Clients of sex workers
 Male labour migrants
24

25. Risk Population
 Sex Workers
 Clients of sex
workers.
 Injecting drug users.
 Seasonal labor
migrants.
 Housewives
(Spouses).
 Men having Sex with
Men (MSM).
 Trafficked women.
HIV in Nepal
is
characterize
d as
concentrate
d epidemic.
25

26. PUBLIC HEALTH ASPECT
26
High Risk
population
Bridge
population
General
population

27. HIV Prevalence among Adults
(15-49 years)
27

28. Estimated HIV Population Summary
Male living with HIV 26,903
Female living with HIV 13,820
Total PLHIV 40,723
HIV Prevalence (15-49) 0.23 %
New HIV infections 1,408
ART Need 22,760
Mother Needing PMTCT 679
AIDS Deaths 3,362
28

29. Estimated New Infections by Year
9,643
9,474
9,111
8,192
6,628
5,249
4,062
3,334
2,462
1,869
1,516
1,252 1,186 1,031 916 818
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Estimatednumbernewinfections
Years
29

30. 1130
1596
2143
2738
3343
3897
4355
4633 4675
4561
4499
4354
4136
3410
2416
1672
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
EstimatednumberofAIDSDeathsbyYear
Years
ESTIMATEDAIDS RELATED DEATHS BYYEAR
30

31. PREVENTION OF HIV
31
ABCD Strategy
A- Abstinence
B- Be faithful
C- Condom use(correct and Consistent)
D- Don’t Share Needle and Syringe.
• Always Use new blades, syringes
• Always use tested bloods
• Proper counseling before conceive baby from HIV
infected Mother.

32. Sexually Transmitted Infections (STI)
32
Sexually Transmitted
Infections (STI) are illnesses that
predominantly transmitted by means
of sexual behavior, including vaginal
intercourse, anal sex and oral sex.

33. CLASSIFICATION OF STIs
33
Bacterial
 Chancroid (Haemophilus
ducreyi)
 Chlamydia (Chlamydia
trachomatis)
 Gonorrhea (Neisseria
gonorrhoeae)
 Syphilis (Treponema
pallidum)
 Donovanosis
Parasites
• Crab louse pubic lice" (Pthirus pubis)
• Scabies (Sarcoptes scabiei)
Protozoal
Trichomoniasis (Trichomonas
vaginalis)
Viral
 Viral hepatitis (Hepatitis B virus)
 Herpes simplex (Herpes simplex
virus)
 HIV
 HPV
 Molluscum contagiosum

34. Mode of Transmission
34
 Sexual contact: from one infected person to another
primarily by Sexual contact- Anal, Vaginal or oral
 From Mother to child: during Pregnancy and child birth
 Occasionally through contaminated fingers, blood and
blood products, organ transplants, contaminated needles
and fomites such as towels, sex toys.
STI increases risk of HIV infection

35. Epidemiology
35
Estimated annual Incidence WHO: 1999
 340 million new cases (syphilis, gonorrhea, chlamydial and
trichomoniasis primarily occurring in men and women aged 15-
49 years)
 Syphilis: 12 million
 Gonorrhea: 62 million
 Chlamydial infection: 92 million
 Trichomoniasis: 173 million
Research by Zeeb (1996) estimated a total of 6,000 to 8,000
annual STIs client in kaski District.
IBBS, 2008 in pokhara 30% of FSW reported at least one
symptom of STIs.

36. SIGN AND SYMPTOMS OF STIs
36
Male
• Urethral discharge
• Burning and pain during
urination
• Pain of itch in and around
genitalia, perineum and
anus/rectum
• Papules, vesicles,
erosion/ulcers or fleshy growths
in and around genitalia,
perineum and anus/rectum, oral
cavity and occasionally on other
sites.
• Swelling in inguinal, anal region
and of scrotum.

37. 37
Female
 abnormal vaginal discharge
 Burning and/or increased
frequency of urination
 Lower abdominal pain
• Pain, itch, Papules, vesicles,
erosion/ulcers or fleshy
growths in and around
genitalia, perineum and
anus/rectum, oral cavity and
occasionally on other sites.
• Swelling in inguinal, anal
region and of scrotum.

38. RISK Factors for STIs
38
Sexual behaviors
 Sexual contact with multiple
partners
 Sexual contact without using
protective barriers
 Sexual contact with causal
partners
 Sexual contact with high
possibilities of trauma – anal
sex Other factors
 Age, socioeconomic
status, drug and
alcohol use etc.

39. Main STI syndromes
39
• Urethral Discharge Syndrome
• Scrotal swelling Syndrome
• Genital Ulcer Disease Syndrome
• Inguinal Bubo Syndrome
• Vaginal Discharge Syndrome
• Lower Abdominal Pain Syndrome
• Neonatal Conjunctivitis Syndrome

40. Approaches of STIs Diagnosis and
Management
40
• Clinical Treatment
• Etiological Treatment
• Syndromic Treatment
• Enhanced Syndromic
Managenent

41. EDUCATIONAND COUNSELLING
THE 4cs
1. Compliance
- completing all the treatment as prescribed
2. CounselingEducation
- about the disease
- about HIV and AIDS
41

42. 3. Contact tracing
- making sure all sexual partners are encouraged to get
treatment
4. Condoms
- promoting condom use and providing them
- how to avoid catching STI again
42

43. 43
QUESTION /ANSWER

44. References
• National Voluntary Counseling and Testing Guideline
• http://aids.gov/
• http://www.cdc.gov/hiv
• www.google.com
• Publication of National Center for AIDS and STI control.
44

45. If you Need help ? If you have any
Problems or Query?
Contact (office)
Expanded Integrated Health
Service (EIHS)
NAULO GHUMTI NEPAL
Newroad, Pokhara
(Opposite side of Pokhara Sub-
metropolitan Office Near NCC Bank)
Phone No. : 061538547
45
Contact
Sagun Paudel
9856036932
mail4sagun@gmail.com
THANKYOU!!
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