The document discusses several key topics related to HIV/AIDS: 1. It describes the natural history and progression of HIV infection from initial infection through asymptomatic stages to AIDS. 2. It explains differences between HIV-1 and HIV-2, modes of transmission, and strategies for prevention. 3. Global statistics on people living with HIV/AIDS are provided, showing high numbers in sub-Saharan Africa and Asia. 4. The impact of AIDS on individuals, families, communities and countries is discussed, including economic impact and the disproportionate effect on women.

1. HIV-AIDS / Cleanliness
Street theatre programmed of the
United theological College
Bangalore

2. The Methods that are used
Folk Songs (interactive)
Issue oriented Skits
Puppet Shows
Question answer time (towards the end with attractive
prizes)

3. Whose theatre?
Theatre of the people

6. Natural History of HIV Infection
HIV can be transmitted during each stage
• Seroconversion
• Infection with HIV, antibodies develop
• Asymptomatic
• No signs of HIV, immune system controls virus
production
• Symptomatic
• Physical signs of HIV infection, some immune
suppression
• AIDS
• Opportunistic infections, end-stage disease

7. Natural History of Untreated HIV Infection
Viral Transmission (2-3 weeks)

Acute Seroconversion Illness (2-3 weeks)

Recovery + Seroconversion (2-4 weeks)

Asymptomatic Phase (~8 years)

Symptomatic Infection  AIDS (1.3 years)

Death

8. HIV-1 and HIV-2
• HIV-1 and HIV-2
– Transmitted through the same routes
– Associated with similar opportunistic
infections
• HIV-1 is more common worldwide.
• HIV-2 is found primarily in West Africa,
Mozambique and Angola.

9. HIV-1 and HIV-2
Differences between HIV-1 & HIV-2
• HIV-2 is less easily transmitted.
• HIV-2 develops more slowly.
• MTCT is relatively rare with HIV-2.

10. Natural History of HIV Infection
Immune suppression
• HIV attacks white blood cells, called
CD4 cells, that protect body from illness.
• Over time, the body’s ability to fight
common infections is lost.
• Opportunistic infections occur.

11. Natural History of HIV Infection
Direct infection of organ systems
– Brain (HIV dementia)
– Gut (wasting)
– Heart (cardiomyopathy)

12. Progression of HIV
Infection
• HIGH viral load (number of copies of HIV in
the blood)
• LOW CD4 count (type of white blood cell)
• Increasing clinical symptoms (such as
opportunistic infections)

13. Progression of HIV Disease
Asymptomatic stage
• Ongoing viral replication
• ‘Set-point’ for viral load
• Gradual decline in CD4 cells
• Antibody tests positive
Symptomatic HIV
• Minor to moderately severe symptoms
AIDS
• Severe immunosuppression associated with OI or
cancers

14. Transmission and Risk factors
Facilitation
• Concurrent STI (esp
ulcerative STI)
• New (incident) HIV
infections
• Presence of AIDS
Protection
• Condom use
• Circumcision (in men)
• Absence of chemokine
receptors (CCR532)
• ART

15. Acute HIV Infection
• Time period from HIV transmission to the
development of antibodies
• Usually present within days to weeks after
initial exposure and subsequent infection
• 40 – 90% of new HIV-1 infections are
associated with symptomatic illness
• Common signs and symptoms: ‘flu-like’ illness,
lymphadenopathy, pharyngitis, oral / genital
ulcers, aseptic meningitis
• Labs: Thrombocytopenia, leukopenia, ALT /
AST
• Duration of symptoms variable; usual 1 – 2
weeks; range few days to >10 weeks

16. Transmission of HIV
HIV is transmitted by
• Direct contact with infected blood
• Sexual contact: oral, anal or vaginal
• Direct contact with semen or vaginal and
cervical secretions
• Mothers infected with HIV to infants
during
pregnancy, delivery and breastfeeding

17.  Coughing,
sneezing
 Insect bites
 Touching, hugging
 Water, food
 Kissing
 Public baths/pools
Transmission of HIV
HIV cannot be transmitted by:
 Toilets
 Handshakes
 Work or school
contact
 Telephones
 Cups, glasses,
plates, or other
utensils

18. Prevention of
HIV Transmission
Public health strategies to prevent HIV
transmission
• Screen all blood and blood products.
• Follow universal precautions.
• Educate in safer sex practises.
• Identify and treat STIs.
• Provide referral for treatment of drug dependence.
• Apply the comprehensive PMTCT approach to prevent

19. GLOBAL SUMMARY OF THE AIDS
EPIDEMIC
DECEMBER 2005
• Number of people living with HIV in 2005
– Total : 40.3 million (36.7–45.3million)
– Adults: 38.0 million (34.5–42.6 million)
– Women: 17.5 million (16.2–19.3 million)
– Children under 15 years: 2.3 million ( 2.1–2.8 million)
• People newly infected with HIV in 2005
– Total : 4.9 million ( 4.3–6.6 million)
– Adults : 4.2 million ( 3.6–5.8 million)
– Children under 15 years : 700 000 (630 000–820 000)
• AIDS deaths in 2005
– Total: 3.1 million (2.8–3.6 million)
– Adults: 2.6 million (2.3–2.9 million)
– Children under 15 years: 570 000 (510 000–670 000)

20. ASIA
HIV and AIDS statistics and features, in
2003 and 2005
Adults &
Children
living
with HIV
Number
of women
living
with HIV
Adults and
children
newly
infected
with HIV
Adult
prevalenc
e (%)
Adult and
child
deaths
due to
AIDS
2005 8.3 million
[5.4–12.0
million]
2.0 million
[1.3–3.0
million]
1.1 million
[600 000–
2.5 million]
0.4
[0.3–0.6]
520 000
[330 000–
780 000]
2003 7.1 million
[4.6–10.4
million]
1.7 million
[1.1–2.5
million]
940 000
[510 000–
2.1 million]
0.4
[0.2–0.5]
420 000
[270 000–
620 000]

25. In INDIA
• Diverse epidemics are underway in India, where an
estimated 5.1 million Indians were living with HIV in 2003
(NACO, 2004a). Although levels of HIV infection
prevalence appear to have stabilized in some states
(such as Tamil Nadu, Andhra Pradesh, Karnataka and
Maharashtra), it is still increasing in at-risk population
groups in several other states. As a result, overall HIV
prevalence has continued to rise. State-wide prevalence
among pregnant women is still very low in the poor and
densely populated northern states of Uttar Pradesh and
Bihar. Even relatively minor increases in HIV
transmission could translate into huge numbers of
people becoming infected in those states, which are
home to one quarter of India’s entire population.
• A significant proportion of new infections is occurring in

26. • India has approximately 10% of the world’s population
and 45% of Asia-Pacific population of people living with
HIV / AIDS.
• It shifts from high-risk groups to bridge population
[people involved with risk behaviour] and then to general
population.
• 89% of the reported cases are occurring in sexually
active and economic productive age group of 15 to 44
years.
• Men account of 77% of AIDS cases and women 23% [a
ratio of 3:1]
• 90% of women with HIV have only ever had one sexual
partner.
• 28% of the rural people and 11% of the urban people

27. Epidemiological analysis of reported AIDS
cases reveals that:
1. In Africa - AIDS is affecting mainly young people in the
sexually active age group. The majority of the HIV
infections (87.7%) are in the age group of 15-44 years.
2. The predominant mode of transmission of infection in
the AIDS patients is through heterosexual contact
(85.7%), followed by Injecting drug use (2.2%),
blood transfusion and blood product infusion (2.6%),
perinatal transmission as 2.7% and others as 6.8%.
3. In the HIV sentinel surveillance, 2003, males account for
73.5% of AIDS cases and females 26.5%. The ratio
being 3:1.
4. The most predominant opportunistic infection among
AIDS patients is tuberculosis, indicating a potential
future high spread of the HIV-TB co-infection.

28. Progress update on the global
response to the AIDS epidemic, 2004
AIDS epidemic continues to expand; vulnerable populations at
greatest risk
• HIV continues to rise in all parts of the world despite the fact that
effective prevention strategies exist. Sub-Saharan Africa remains the
hardest-hit region.
• In Asia, the HIV epidemic remains largely concentrated in injecting
drug users, men who have sex with men, sex workers, clients of sex
workers and their immediate sexual partners. Effective prevention
programming coverage in these populations is inadequate.
• Diverse epidemics are under way in Eastern Europe and Central
Asia. Injecting drug use is the main driving force behind epidemics
across the region.
• In many high-income countries, sex between men plays an
important role in the epidemic. Drug injecting plays a varying role. In
Latin America and the Caribbean, 11 countries have an estimated
national HIV prevalence of 1% or more.

29. Women face greater risk
• African women are being infected at an earlier
age than men.
• Women living with HIV were vastly outnumbered
by men.
• 13 infected women for every 10 infected men—
up from 12 infected women for every 10 infected
men in 2002. The difference between infection
levels is more pronounced in urban areas, with
14 women for every 10 men, than in rural areas,
where 12 women are infected for every 10 men
(Stover, 2004).
• 20 women for every 10 men in South Africa, to

30. Diverse levels and trends
• The factors include poverty and social
instability that result in family disruption, high
levels of other sexually transmitted infections,
the low status of women, sexual violence, and
ineffective leadership during critical periods in
the spread of HIV. An important factor, too, is
high mobility, which is largely linked to migratory
labour systems.
• Human mobility has always been a major
driving force in epidemics of infectious disease.

31. The impact of AIDS on
people and societies
• Women: more vulnerable to HIV than men
• Risk from husbands and lovers
• Violence and the virus
• Impact of HIV on women and girls in the
community and at home
• Globally, the epidemic continues to exact a
devastating toll on individuals and families. In
the hardest-hit countries, it is erasing decades of
health, economic and social progress, reducing
life expectancy by decades, slowing economic
growth, deepening poverty, and contributing to
and exacerbating chronic food shortages.

32. Impact on countries to get worse before
it improves
• More than 40% of countries with generalized
epidemics have yet to evaluate the
socioeconomic impact of AIDS.
• With generalized HIV epidemics, 39% have no
national policy in place to provide essential
support to children orphaned or made vulnerable
by AIDS. In low- and middle-income countries,
less than 3% of all orphans and vulnerable
children receive publicly supported services.
• In sub-Saharan Africa 60% of today’s 15-year-
olds will not reach their 60th birthday.

33. The impact on population and population
structure

35. Women affected more than men
• Face heavy economic, legal, cultural and
social disadvantages which increase their
vulnerability
• Carers, producers and guardians of family
life

36. The impact of AIDS on poverty &
hunger
• AIDS causes the loss of income and production of a household
member. If the infected individual is the sole breadwinner, the impact
is especially severe.
• AIDS creates extraordinary care needs that must be met (usually by
withdrawing other household members from school or work to care
for the sick).
• AIDS causes household expenditures to rise as a result of medical
and related costs, as well as funeral and memorial costs (Food and
Agricultural Organization, 2003a).
• Increasing needs in ‘care economy’
• Impact on agriculture and rural development
• Impact on the health sector
• Impact on public-sector capacity
• Impact on workers and the workplace
• Macroeconomic impact

37. How household response
• Children were sent to relatives, or adults
left to search for employment .
• Women and girls raise and nurture
children, perform domestic labour and take
care of the sick

38. AIDS & orphans: a tragedy unfolding

39. • Strengthening the capacity of families to protect
and care for children Mobilizing community-
based responses
• Preventing mother-to-child transmission
• HIV and young people: High risk, high vulnerability
• The WHO strategy - Treating 3 million by 2005
• Rights and access to AIDS information and
prevention: Stigma and discrimination
• The essential role of people living with AIDS

40. Refugees and HIV

41. Theological Reflection
• Change is possible
• It needs to be facilitated not forced
• It arises from ‘within’, yet can be
influenced from ‘without’.

42. THANK YOU