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Dibyendu Dutta
Consultant (N.P.P.C.F)
Office of the C.M.O.H. Bankura.
A virus known as the Human
Immuno-Deficiency Virus
It causes disruption of immunity or
body defense mechanism
 HIV vs. AIDS
 Retrovirus->Lentivirus
 Lentivirus->Slow Virus->Takes long
time to develop symptoms
 HIV-1 (8-15 Yrs)
 HIV-2 (20-30 Yrs)
•No
•HIV is a virus and AIDS is the terminal stage of
HIV infection
•All AIDS cases are HIV infected but not all HIV
infected people have AIDS
Affects mostly young adults in prime productive
years
Occurs not randomly, but through risk behaviour
Long period of invisibility : 9–11 years
Prevention is important & cost-effective
Life long but high treatment cost, with no cure
Non-availability of effective HIV preventive vaccine
Associated with high level of social stigma
•Human is the only source as well as
only host
of the infection.
•Infection spread through mixing of
Body Fluid
•Once infected – infected for life
• Age group of 15 – 49 – most vulnerable
 HIV is transmitted through BLOOD,
SEMEN, VAGINAL FLUID, BREAST
MILK
 URINE, SPUTUM, SALIVA, TEARS,
SWEAT etc do not transmit HIV
infection
  
HIV Transmission Risk
Exposure Route HIV Transmission
Blood transfusion - %90 95
Perinatal - %20 40
Sexual intercourse . %0 1 to 10
Vaginal . - . %0 05 0 1
Anal . - . %0 065 0 5
Oral . - . %0 005 0 01
Injecting drugs use . %0 67
Needle stick exposure . %0 3
Mucous membrane . %0 09
, -splash to eye oro nasal
Dynamics of HIV spread
General Population
•Married women
•Babies and Children
•Youth
•Men
High-risk Populations
•Female Sex Workers
•Men who have sex with men
•Injecting drug users
Bridge Populations
• Clients of sex workers
• Partners of IDUs
• Migrant / mobile populations
• Truck drivers
• Population in conflict
 Sharing common toilets
 Touching, Hugging ,Kissing
 Insect Bites
 Coughing, Sneezing
 Sharing Food or Fomites
 Impure water
Weight loss > 10% of body weight
Chronic diarrhoea > 1 month
Prolonged fever > 1 month
Persistent cough > 1 month
Generalised pruritic dermatitis
History of herpes zoster
Oro pharyngeal candidiasis
Generalised lymphadenopathy
Disseminated herpes simplex infection
Exponential viral replication
Widespread systemic dissemination to the brain,
spleen, distant lymph nodes, etc. (5-11 Days)
HIV makes contact with cells located within the genital mucosa
Virus is carried to regional lymph nodes (1-2 Days)
 Dr. Luc Montagnier of Pasteur Institute of Paris-
Cause and routes of transmission of AIDS
 AIDS-Formally recognized as a new Infection on
June5,1981 when Centre for Disease Control
reported 5 LA men developed unexplained
immuno deficiency
 1st
AIDS case-San Fancisco man-recognized on
24th
April’1980
 Patient Zero-A canadian Flight Attendant-
reportedly infected as many as 250 men
 1st
case-among the sex worker in Chennai in 1986
 In the same year one case was reported from
Maharasthra
 1987-NACP launched
 By the end of 1987, 52987 people were tested out
of which 135 were tested positive and 14 were
diagnosed to have AIDS
 In 1992,NACO was set up and it was decided that
SACS will be set up in 25 states and 7 Uts.
Total: 33.2 (30.6 – 36.1)
million
Western &
Central Europe
760 000760 000
[600 000 – 1.1 million][600 000 – 1.1 million]
Middle East & North
Africa
380 000380 000
[270 000 – 500 000][270 000 – 500 000]
Sub-Saharan Africa
22.5 million22.5 million
[20.9 – 24.3 million][20.9 – 24.3 million]
Eastern Europe
& Central Asia
1.6 million1.6 million
[1.2 – 2.1 million][1.2 – 2.1 million]
South & South-East
Asia
4.0 million4.0 million
[3.3 – 5.1 million][3.3 – 5.1 million]
Oceania
75 00075 000
[53 000 – 120 000][53 000 – 120 000]
North America
1.3 million
[480 000 – 1.9 million]
Latin America
1.6 million1.6 million
[1.4 – 1.9 million][1.4 – 1.9 million]
East Asia
800 000800 000
[620 000 – 960 000][620 000 – 960 000]
Caribbean
230 000
[210 000 – 270 000]
Adults and children
Estimated to be living with HIV, 2007
Estimated number of People Living with HIV/AIDS:
2.3 million (1.8—2.9 million) in 2007
Six high prevalence states contribute more than
60% of PLHA
Women constitute 39% and Children 3.8%
Estimated Adult HIV prevalence : 0.34% (0.25%-0.43%);
Males: 0.44%, Females: 0.23%
High
Prevalence
Moderate
Prevalence
Highly
Vulnerable
Vulnerable
States
Tamil Nadu
Andhra
Pradesh
Maharashtra
Karnataka
Nagaland
Manipur
Gujarat
Goa
Pondicherry
Assam
Bihar
Delhi
Himachal Pradesh
Kerala
Madhya Pradesh
Punjab
Rajasthan
Uttar Pradesh
West Bengal
Chhattisgarh
Jharkhand
Orissa
Uttranchal
Arunachal Pradesh
Haryana
Jammu & Kashmir
Meghalaya
Mizoram
Sikkim
Tripura
Andaman &
Nicobar Islands
Chandigarh
Dadra & Nagar
Haveli
Daman & Diu
Lakshadweep
156 A Category Districts
39 B Category Districts
14 Districts with HIV prevalence >
3% among ANC clinic attendees
Evidence of HIV positivity among
IDU in Punjab, WB and Orissa
Evidence of dual mode of
transmission in Manipur & Nagaland.
22
Thank You
Dr. S. Rakshist
Medical Officer
Office of the CMOH Bankura
Basic Services :- ICTC, ICTC- ANC, STD Services & Condom
Promotion, HIV-TB Coordination Programme
Care, Support and Treatment : ART Centers, Link ART
Centers,
Community Care Centers , Drop in Centers
Blood Safety – Supports to Ensure safe Blood transfusion
Sentinel Surveillance – To know the current prevalence and
trend
of HIV infection in the State,
Monitoring & Evaluation - CMIS, Reporting
IEC, BCC - Hot line counseling, Mainstreaming, Youth
affairs, GIPA
Coordination
TI – Targeted Intervention through NGO & CBO
TSU – Technical support Unit
Training – Capacity development of Human resources
Early detection of HIV
Provision of basic information on modes of
transmission and
prevention of HIV/AIDS
Link people with other HIV prevention, care and
treatment
services
Pre-test and Post-test Counseling
Testing for HIV
ARV prophylaxis to mother-baby pairs
Counseling on infant feeding practice
Counseling on family planning
Referral for pre-ART registration and CD4 count
Post-natal follow-up of sero-reactive mothers and their exposed babies
Cotrimoxazole Prophylaxis
EID
Partner counseling
Cross referrals
Whole Blood Finger Prick test
Out Reach Activity
ICTCICTC
STI prevention
& treatment
Community support to
Mainstream HIV/AIDS
Early access to
medical care,
preventive therapy
other OIs and ARV
treatment
MCH services PPTCT
Access to
family planning
Counselling
For BCC &
Psychological support
Peer support from
PLHA Network Spiritual support
Material and financial
assistance
Legal services for
children and family
Access to condoms
Early management of
Opportunistic Infection
 Known as Anti Retroviral Therapy (ART)
 It suppresses HIV replication and reduces
infectivity
 Improvement of clinical condition and quality
of life
 Prolongation of life BUT NO CURE
 Management of opportunistic infection.
(Tuberculosis – commonest)
 Identify eligible persons with HIV/AIDS
requiring ART
 Provide free ARV drugs to eligible persons
with HIV/AIDS life long
 Provide counseling services for drug adherence
 Educate persons on nutrition, hygiene and
prevention
 Referral for specialized services or admission.
 Mechanism to tracking
ART
PPTCT
OI
Access to
condom
TI
Psychosocial
Support Service
CCC
Peer Support
group
STI Services
ICTC
TB / RNTCP
 Common STIs –
Syphillis,Gonorrhoea,Chanchriod,LGV,HIV
 Common presentation – genital ulcer,urethral
and vaginal discharge, swollen lymph node etc
 Screening, Syndromic treatment ,contact
tracing, treatment of partners – need to be done
 STI increases the risk of HIV transmission
 Awareness campaign-through IEC campaign in
local language
 Condom promotion
 Risk reduction, BCC
 Capacity building of the Health care personnel
 Promotion of HIV screening- possibility of
setting up ICTC in PPP mode
 Abstinence from Pre- marital & Extra marital
Sex
 Be faithful to Single Partner
 Condom
THANK YOU

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Sensitisation – hiv aids-NCD-HIV-AIDS_seminar on AIDS

  • 2. A virus known as the Human Immuno-Deficiency Virus It causes disruption of immunity or body defense mechanism
  • 3.  HIV vs. AIDS  Retrovirus->Lentivirus  Lentivirus->Slow Virus->Takes long time to develop symptoms  HIV-1 (8-15 Yrs)  HIV-2 (20-30 Yrs)
  • 4.
  • 5. •No •HIV is a virus and AIDS is the terminal stage of HIV infection •All AIDS cases are HIV infected but not all HIV infected people have AIDS
  • 6. Affects mostly young adults in prime productive years Occurs not randomly, but through risk behaviour Long period of invisibility : 9–11 years Prevention is important & cost-effective Life long but high treatment cost, with no cure Non-availability of effective HIV preventive vaccine Associated with high level of social stigma
  • 7. •Human is the only source as well as only host of the infection. •Infection spread through mixing of Body Fluid •Once infected – infected for life • Age group of 15 – 49 – most vulnerable
  • 8.  HIV is transmitted through BLOOD, SEMEN, VAGINAL FLUID, BREAST MILK  URINE, SPUTUM, SALIVA, TEARS, SWEAT etc do not transmit HIV infection
  • 10.
  • 11. HIV Transmission Risk Exposure Route HIV Transmission Blood transfusion - %90 95 Perinatal - %20 40 Sexual intercourse . %0 1 to 10 Vaginal . - . %0 05 0 1 Anal . - . %0 065 0 5 Oral . - . %0 005 0 01 Injecting drugs use . %0 67 Needle stick exposure . %0 3 Mucous membrane . %0 09 , -splash to eye oro nasal
  • 12. Dynamics of HIV spread General Population •Married women •Babies and Children •Youth •Men High-risk Populations •Female Sex Workers •Men who have sex with men •Injecting drug users Bridge Populations • Clients of sex workers • Partners of IDUs • Migrant / mobile populations • Truck drivers • Population in conflict
  • 13.  Sharing common toilets  Touching, Hugging ,Kissing  Insect Bites  Coughing, Sneezing  Sharing Food or Fomites  Impure water
  • 14. Weight loss > 10% of body weight Chronic diarrhoea > 1 month Prolonged fever > 1 month Persistent cough > 1 month Generalised pruritic dermatitis History of herpes zoster Oro pharyngeal candidiasis Generalised lymphadenopathy Disseminated herpes simplex infection
  • 15. Exponential viral replication Widespread systemic dissemination to the brain, spleen, distant lymph nodes, etc. (5-11 Days) HIV makes contact with cells located within the genital mucosa Virus is carried to regional lymph nodes (1-2 Days)
  • 16.  Dr. Luc Montagnier of Pasteur Institute of Paris- Cause and routes of transmission of AIDS  AIDS-Formally recognized as a new Infection on June5,1981 when Centre for Disease Control reported 5 LA men developed unexplained immuno deficiency  1st AIDS case-San Fancisco man-recognized on 24th April’1980  Patient Zero-A canadian Flight Attendant- reportedly infected as many as 250 men
  • 17.  1st case-among the sex worker in Chennai in 1986  In the same year one case was reported from Maharasthra  1987-NACP launched  By the end of 1987, 52987 people were tested out of which 135 were tested positive and 14 were diagnosed to have AIDS  In 1992,NACO was set up and it was decided that SACS will be set up in 25 states and 7 Uts.
  • 18. Total: 33.2 (30.6 – 36.1) million Western & Central Europe 760 000760 000 [600 000 – 1.1 million][600 000 – 1.1 million] Middle East & North Africa 380 000380 000 [270 000 – 500 000][270 000 – 500 000] Sub-Saharan Africa 22.5 million22.5 million [20.9 – 24.3 million][20.9 – 24.3 million] Eastern Europe & Central Asia 1.6 million1.6 million [1.2 – 2.1 million][1.2 – 2.1 million] South & South-East Asia 4.0 million4.0 million [3.3 – 5.1 million][3.3 – 5.1 million] Oceania 75 00075 000 [53 000 – 120 000][53 000 – 120 000] North America 1.3 million [480 000 – 1.9 million] Latin America 1.6 million1.6 million [1.4 – 1.9 million][1.4 – 1.9 million] East Asia 800 000800 000 [620 000 – 960 000][620 000 – 960 000] Caribbean 230 000 [210 000 – 270 000] Adults and children Estimated to be living with HIV, 2007
  • 19. Estimated number of People Living with HIV/AIDS: 2.3 million (1.8—2.9 million) in 2007 Six high prevalence states contribute more than 60% of PLHA Women constitute 39% and Children 3.8% Estimated Adult HIV prevalence : 0.34% (0.25%-0.43%); Males: 0.44%, Females: 0.23%
  • 20. High Prevalence Moderate Prevalence Highly Vulnerable Vulnerable States Tamil Nadu Andhra Pradesh Maharashtra Karnataka Nagaland Manipur Gujarat Goa Pondicherry Assam Bihar Delhi Himachal Pradesh Kerala Madhya Pradesh Punjab Rajasthan Uttar Pradesh West Bengal Chhattisgarh Jharkhand Orissa Uttranchal Arunachal Pradesh Haryana Jammu & Kashmir Meghalaya Mizoram Sikkim Tripura Andaman & Nicobar Islands Chandigarh Dadra & Nagar Haveli Daman & Diu Lakshadweep
  • 21. 156 A Category Districts 39 B Category Districts 14 Districts with HIV prevalence > 3% among ANC clinic attendees Evidence of HIV positivity among IDU in Punjab, WB and Orissa Evidence of dual mode of transmission in Manipur & Nagaland.
  • 23. Dr. S. Rakshist Medical Officer Office of the CMOH Bankura
  • 24. Basic Services :- ICTC, ICTC- ANC, STD Services & Condom Promotion, HIV-TB Coordination Programme Care, Support and Treatment : ART Centers, Link ART Centers, Community Care Centers , Drop in Centers Blood Safety – Supports to Ensure safe Blood transfusion Sentinel Surveillance – To know the current prevalence and trend of HIV infection in the State, Monitoring & Evaluation - CMIS, Reporting
  • 25. IEC, BCC - Hot line counseling, Mainstreaming, Youth affairs, GIPA Coordination TI – Targeted Intervention through NGO & CBO TSU – Technical support Unit Training – Capacity development of Human resources
  • 26. Early detection of HIV Provision of basic information on modes of transmission and prevention of HIV/AIDS Link people with other HIV prevention, care and treatment services
  • 27. Pre-test and Post-test Counseling Testing for HIV ARV prophylaxis to mother-baby pairs Counseling on infant feeding practice Counseling on family planning Referral for pre-ART registration and CD4 count Post-natal follow-up of sero-reactive mothers and their exposed babies Cotrimoxazole Prophylaxis EID Partner counseling Cross referrals Whole Blood Finger Prick test Out Reach Activity
  • 28. ICTCICTC STI prevention & treatment Community support to Mainstream HIV/AIDS Early access to medical care, preventive therapy other OIs and ARV treatment MCH services PPTCT Access to family planning Counselling For BCC & Psychological support Peer support from PLHA Network Spiritual support Material and financial assistance Legal services for children and family Access to condoms Early management of Opportunistic Infection
  • 29.  Known as Anti Retroviral Therapy (ART)  It suppresses HIV replication and reduces infectivity  Improvement of clinical condition and quality of life  Prolongation of life BUT NO CURE  Management of opportunistic infection. (Tuberculosis – commonest)
  • 30.  Identify eligible persons with HIV/AIDS requiring ART  Provide free ARV drugs to eligible persons with HIV/AIDS life long  Provide counseling services for drug adherence  Educate persons on nutrition, hygiene and prevention  Referral for specialized services or admission.  Mechanism to tracking
  • 32.  Common STIs – Syphillis,Gonorrhoea,Chanchriod,LGV,HIV  Common presentation – genital ulcer,urethral and vaginal discharge, swollen lymph node etc  Screening, Syndromic treatment ,contact tracing, treatment of partners – need to be done  STI increases the risk of HIV transmission
  • 33.  Awareness campaign-through IEC campaign in local language  Condom promotion  Risk reduction, BCC  Capacity building of the Health care personnel  Promotion of HIV screening- possibility of setting up ICTC in PPP mode
  • 34.  Abstinence from Pre- marital & Extra marital Sex  Be faithful to Single Partner  Condom

Editor's Notes

  1. Step 2: Pathogenesis, Progression (Slides 5-11) - 15 minutes Trainer’s Notes: Use the image on the following slide to illustrate the steps involved in the pathogenesis of HIV infection. Ask participants to quickly name the modes of HIV transmission Reader’s Notes: HIV transmitted through sexual activity enters the bloodstream via mucous membranes lining the vagina, rectum and mouth. Macrophages and dendritic cells on the surface of mucous membranes bind virus and shuttle it into the lymph nodes, which contain high concentrations of Helper T cells (CD4+ T cells). Once HIV has entered the body, the immune system initiates anti-HIV antibody and cytotoxic T cell production. However, it can take one to six months for an individual exposed to HIV to produce measurable quantities of antibody. The immune response is weakened as memory T cells (CD4+ CCR5+) are destroyed. HIV enters the body and binds to dendritic cells (orange cells with projections) which carry the virus to CD4+ T cells in lymphoid tissue establishing the infection. Virus replication accelerates producing massive viremia and wide dissemination of virus throughout the body's lymphoid tissues. An immune response against virus causes some protection but a chronic persistent infection is established. The production of cytokines and cell divisions that regulate the immune response for protection also cause HIV replication. There is a rapid turnover of CD4+ T cells that ultimately leads to their destruction and to a change in lymphoid tissues that prevent immune responses.
  2. Six states are categorized as high prevalence states, i.e. Andhra Pradesh, Karnataka, Nagaland, Manipur, Maharashtra and Tamil Nadu, since the HIV prevalence rates among women attending antenatal clinics in these states is 1 percent and above. Gujarat, Pondicherry and Goa are categorized as states with moderate prevalence of HIV, since HIV prevalence rates amongst high risk population (STD Clinic attendees) has been found to be 5 percent or more, but among women attending ante-natal clinics, the HIV prevalence rates are below one percent. All remaining States/Union Territories are categorized as low prevalence States since the prevalence rates amongst high-risk population (STD Clinic attendees) is below 5 percent. However on the basis of vulnerability like migration, size of population and presence of weak health infrastructure, these states are further classified as “Highly vulnerable” and “Vulnerable” States.