1. Aids Education Dr. K. Sivapalan 24-09-071Aids Education

2. Govind Singh In 1996, Govind Singh, aged 25, left his village to find job in Mumbai. He sought pleasure with sex workers as others. In 1999 he began to feel tired and lost weight found himself HIV positive. He returned to his village in 2000. The villagers, including his wife, put him in a cattle shed and allowed to die among the animals. 24-09-07Aids Education2

3. 24-09-07Aids Education3 AIDS posters in Côte d'IvoireCôte d'Ivoire

4. Another Typical Problem Anthony is a 30 year old Kenyan. His wife died of aids 3 years ago. He looked after her. When she died, he had to look after his children but he had to lie in a bed awaiting death. His two children, one of whom is HIV positive, were sent to grandparents. One grandparent in South Africa is looking after 31 of his grandchildren, all aids orphans. 24-09-07Aids Education4

5. Magnitude of the Problem The world is now more than 25 years into AIDS crisis. No vaccine in sight. Few effective and sustainable prevention programs remain the only way out. In spite of several programs to prevent spread since 1980, AIDS epidemic is out of control in many nations of Africa and Asia. 65 million people were infected [in 2003] and 25 million died of AIDS. Worldwide 14,000 people are infected every day, 95 % in developing countries. In Zimbabwe life expectancy is 22 years only. 2 out of 3 of Zimbabweians between 15 and 39 are HIV Positive. 24-09-07Aids Education5

6. Effects of AIDS Persons that are infected with HIV become immune deficient. They get infected by opportunistic infections and die off at early age. AIDS affects more people than it infects. These include the cost of patient care, funerals and care for the orphans left behind. 24-09-07Aids Education6

7. Situation in India India has 4 million commercial sex workers. Prevalence of AIDS among sex workers in Mumbai is 70 %. Each sex worker provides service to 7 clients per night. The second place goes to Tamil Nadu. 24-09-07Aids Education7

8. History. No one knows where the Human Immunodeficiency Virus originated or the conditions led to spread among humans in early 1980s. It may have existed in a latent form for many years or lived in animal host. In late 1970s clues of a strange disease appeared. From analysis of the cases scientists believed that the first HIV case occurred in Africa in 1930s 24-09-07Aids Education8

9. Beginning in US The first documented patient in US came for weight loss with candidiosis in 1980. One week later he was admitted with pneumonia due to pneumocystis carinii. Many more similar patients were identified. All were gay men. First, the doctor realized the defect in the immune system of these patients. This doctor's idea of a new immunosuppressive disease was not accepted by the authorities but insistence made them accept after several years. It was named GRIDS- gay related immunodeficiency syndrome 24-09-07Aids Education9

10. Beginning in US- ctd In 1981 a cluster of a rare cancer [Kaposi's Sarcoma] was reported in New York and San Francisco. Opportunistic pneumonia and other infections killed many patients. These were not gay men. Then suspicion about sexually transmitted virus arose. Initialy named GRIDS- gay related immunodeficiency syndrome- was renamed AIDS. 24-09-07Aids Education10

11. The Virus One virus responsible for AIDS, HIV-1, was identified in 1983 by Dr. Robert Gallo and others in National Cancer Institute, Bethesda, Maryland, USA. At the same time Dr. Luc Montagnier of Pasteur Institute in Paris isolated HIV-2. It is believed that both strains had the same ancestor in Africa. May be the animal with HIV-2 virus bit hunters and initiated transmission to humans. HIV-1 probably crossed over from chimpanzee. 24-09-07Aids Education11

12. Mode of Transmission The current strains are very fragile. They can live only for a few seconds in room temperature, outside the body. So it cannot spread by handshake, kiss, sneeze, mosquito bite, sharing food, cloth etc. The only mode of transmission is through direct transfer with body fluids or sexual contact. Also sharing injection needles, blood transfusions and mother to child transmission through placenta or during birth. 40 % of the babies can get infected in this way. 24-09-07Aids Education12

13. Principles of Prevention Avoid sexual contact with infected person. Use of condoms, abstinence or one to one only sexual partnership. Screen blood before collection. Avoid sharing injecting needle with infected person 24-09-07Aids Education13

14. Incubation and Illness The virus infects lymphocytes and multiplies very fast. Rapid mutation makes development of drugs and vaccine difficult. Normal CD4 cell count should be above 700 per cubic millimeter. When it falls below 500 immune system is seriously handicapped. When below 200, opportunistic infections occur [after about 10 years of infection]. During this period, the individual appears healthy but can infect others. 24-09-07Aids Education14

15. Principles of Treatment Nutrition. Love and tenderness Treat infections Antiviral – to prevent worsening. 24-09-07Aids Education15

16. Initial Contacts The first 40 patients in US were identified by epidemiologists. 19 who lived in Los Angelis were linked through sexual contacts with the other 21 who resided in San Francisco, New York and elsewhere. They had one common quality- very high degree of sexual activity. They had an average of 227 different sex contacts in one year. One had 1560 contacts in the diary. 24-09-07Aids Education16

17. Patient Zero Patient zero was an Air Canada flight attendant. He had sex with eight among the 40. He linked the New York cluster with San Francisco cluster. Eight direct contacts of patient zero infected eight others and they in turn infected ten more. Even after diagnosis of being HIV positive he continued with unprotected sex infecting more. He died in 1984, about 32 years of age. 24-09-07Aids Education17

18. Costly Delays The reports of epidemiologists were ignored by authorities and preventive actions were delayed because of anti-gay stigma, conflicting budget priorities, and bureaucratic inertia. 24-09-07Aids Education18

19. Mode of International Spread Sex tours spread the infection across borders. Sex workers and drug abusers become the nodes of infection. It slowly spreads to occasional sex seeker and goes into the population in big way as epidemic. Many people received blood transfusions and infected by HIV in 80s 5000 hemophiliacs in Japan got HIV by blood imported from US. African American tennis star Arthur Ashe received blood during heart surgery and infected. 24-09-07Aids Education19

20. Urban Beginnings In early eighties almost no one knew about AIDS. Today it is to be found everywhere in the world. The epidemic in every nation passed through three stages; a. beginning among high risk populations in urban centers. b. breaking out from the high risk groups. c. an interiorization era as the epidemic spreads throughout the nation. 24-09-07Aids Education20

21. Illustration of interiorization. Dr. Abraham Verghese was employed in Johnson City, Tennessee in 80s. It is a rural remote location. Local people believed that AIDS was for cities like San Francisco and New York. In 86, Dr V diagnosed AIDS in one patient. The patient had got Pneumocystis carini in far off city and came to be with his family who cared for him. Soon a gay couple came with AIDS. The doctor became known as a person willing to treat AIDS. In four years he had treated 80 patients. He learnt that a gay bar existed in the city. The stigma was very strong and patients came to this doctor because he was a foreigner and did not share the stigma of the local population. Still local population maintained that they did not have the epidemic. The stigma keeps the epidemic under low profile and little is done to prevent it. 24-09-07Aids Education21

22. Magnitude of the Problem In Bangkok, HIV among injecting drug users was 1 % in 87, 24 % in 78, 39% in 99. AIDS orphans amount to 14,000,000 in 2003. by 2010, it is estimated to be 44,000,000. Countries tended to deny presence of AIDS and delayed prevention programs resulting in epidemics. 24-09-07Aids Education22

23. Epidemic's Growth 24-09-07Aids Education23

24. Number of HIV positive in South Africa 24-09-07Aids Education24

25. Number of AIDS Orphans in one Province of south Africa 24-09-07Aids Education25

26. Control by Wealthy Nations. The wealthy nations brought the epidemic under control with very expensive programs. In 1985 the British Prime minister posted a brochure to each and every house on AIDS prevention. 24-09-07Aids Education26

27. Regional statistics for HIV & AIDS, end of 2006 Adults & children 24-09-07Aids Education27 Regionwith HIV/AIDSnewly infected prevalence*Deaths Sub-Saharan Africa24.7 million2.8 million5.9%2.1 million North Africa & Middle East 460,00068,0000.2%36,000 South and South- East Asia 7.8 million860,0000.6%590,000 East Asia750,000100,0000.1%43,000 Oceania81,0007,1000.4%4,000 Latin America1.7 million140,0000.5%65,000 Caribbean250,00027,0001.2%19,000 Eastern Europe & Central Asia 1.7 million270,0000.9%84,000 Western & Central Europe 740,00022,0000.3%12,000 North America1.4 million43,0000.8%18,000 Global Total39.5 million4.3 million1.0%2.9 million

28. Global trends 24-09-07Aids Education28 The number of people living with HIV has risen from around 8 million in 1990 to nearly 40 million today, and is still growing. Around 63% of people living with HIV are in sub-Saharan Africa.

29. Stop Aids Campaign Mounted by gay men in San Francisco where gay men live openly. They organized small group discussions which were perceived as highly credible because they were HIV positive, there language was culturally and linguistically appropriate for the audience. It brought practice of safer sex there. 24-09-07Aids Education29

30. Stop Aids Campaign ctd. This model could not be carried out in other places because gay men were not socially accepted. The US mass media did not support the campaign. AIDS patients were highly stigmatized and they could not be involved in any discussions on AIDS prevention. 24-09-07Aids Education30

31. AIDS Game This was devised in the university of Mexico. The students were given water in a glass and a spoon each. One glass contained heavily salted water. They were asked to pair randomly and exchange three spoons of water. They found after six rounds of random pairing all of them had salt in their glass. This showed the exponential spread of infection. 24-09-07Aids Education31

32. Increase Availability of Condoms Truck stops along main travel routs became the nodes of AIDS. In these areas condoms were laid everywhere for easy access. But in east Africa, truckers pay high price for condomless sex. 24-09-07Aids Education32

33. What can poor developing nations do? Move immediately to mount prevention interventions- safer sex and free condoms. Provide anti-retroviral drugs to HIV positive patients. Start with pregnant to protect unborn babies. Remove the stigma. Address poverty and gender equality ?Isolate HIV positive persons. 24-09-07Aids Education33

34. Use tragic figures- victims 24-09-07Aids Education34

35. Use champions 24-09-07Aids Education35

36. 100 percent condoms- avoid loss of income. 24-09-07Aids Education36

37. Use entertainment education strategies 24-09-07Aids Education37

38. Strategies to use Political and policy makers will Media involvement Use tragic figures- victims. Use champions 100 percent condoms- avoid loss of income. Target unique population Use cultural strategies Overcome stigma Use entertainment education strategies 24-09-07Aids Education38

39. STD/AIDS CONTROL PROGRAMME in Srilanka. Goal/General Objective The objectives of the National STD/AIDS Control Programme (NSACP) are to control and prevent sexually transmitted infections (STI) including human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) and to provide clinical care for those affected with these infections. 24-09-07Aids Education39

40. Specific Objectives To provide care and counseling services for all cases of STD/HIV/AIDS To conduct IEC activities targeting the general public and specific risk groups To establish and maintain an effective surveillance system To promote the use of condoms in the prevention of transmission of STD/HIV infections To establish adequate laboratory facilities at central and provincial levels for the diagnosis of STD/HIV infections To ensure the safety of blood and blood products by mandatory testing for HIV To mobilize public participation through inter sectoral and NGO participation To institute infection control measures including universal precautions in all medical institutions and in the field services To expand the clinical services to PHC institutions by adopting the syndromic approach to management of STDs. 24-09-07Aids Education40

41. Organization The programme is managed by the Director NSACP with the assistance of specialist and grade medical officers. The specialists and senior grade medical officers are responsible for co-ordinating the respective programme areas: HIV care and Counseling, IEC and Condom Promotion, STD/HIV/AIDS Surveillance, STD Care, NGO and Inter sectoral co-ordination, Training and Laboratory Services. 24-09-07Aids Education41

42. The infrastructure Central STD clinic and the office under the line ministry and 21 provincial STD clinics administered by the provincial Health Directorates. The central STD clinic provides STD/HIV clinical services including counseling and health education and also functions as the referral centre for STD/HIV/AIDS. The clinical services are supported by the National Reference Laboratory for STD/HIV. The clinic is served by consultant Venereologists who also function as co-ordinators of programme areas and medical officers trained in STD/HIV/AIDS. 24-09-07Aids Education42

43. Policies Patients with HIV/AIDS should receive the same care as any other patient and should be managed in general wards as far as possible. Voluntary confidential testing with counseling is offered to those who may be at risk of HIV infection. Unlinked anonymous testing methodology is used for surveillance while screening all donor blood for HIV antibodies is mandatory. Pregnant women infected with HIV are offered short course antiretroviral treatment free of charge to prevent mother to child transmission of the virus. 24-09-07Aids Education43

44. Epidemiology By end 2002, a cumulative total of 455 HIV infections among Sri Lankans were reported to the NSACP (since 1987). Of these, 139 were diagnosed as having AIDS and 108 have died. The number of new HIV infections reported in 2002 was 50. In addition 43 (cumulative) foreigners were also detected with HIV infection. 24-09-07Aids Education44

45. Sri Lankan Statistics. Cumul ative HIV cases Cumulative HIV cases by sex Cumul ative AIDS cases Cumul ative AIDS deaths Male: Female ratio of HIV cases MaleFemale 2002455139108 20057434383052071391.4:1 20081029281182 Jaffna3822 24-09-07Aids Education45 UNAIDS estimates 5000 people living with HIV www.aidscontrol.gov.lk

46. Number Reported of HIV Cases from 1987 to thrid quarter 2005 24-09-07Aids Education46

47. Risk in Sri Lanka. Sri Lanka is considered a low prevalence country for HIV/AIDS but at high risk for a potential epidemic : Emerging sexually active youth population (17-19% of the total population of 18.3 million in 2010), Increasing numbers of sex workers (currently - 30,000) An apparent growth in sex work, often associated with military installations and three-wheel drivers, and including young people known to be selling sex in areas such as Kataragama, Anuradhapura, and Ratnapura. Open economy (large industrial zones with an estimated work force consisting of young people of over 100,000) 24-09-07Aids Education47

48. Risks ctd. Migration. Both external and internal Limited Condom Use. Only 3.8 percent of couples use condoms Displacement Due to Civil Conflict and Tsunami. Men Who Have Sex With Men. Beach boys and others Regional Travel. India, Thailand, and Europe Sexually Transmitted Infections Lack of Information for Youth Increasing Average Age of Marriage-multiple sexual partners are more likely. 24-09-07Aids Education48

49. Cultural Strengths Institution of Marriage. Low Sexual Activity Among Youth compared to other countries. Low Numbers of Injection Drug Users Tea Plantation Workers. lived with their families and did not migrate for employment. 24-09-07Aids Education49