The acronym for Human Immunodeficiency Virus.This virus causes HIV infection and AIDSThe HIV infected person may, or may nothave AIDS.They may, or may not, have signs orsymptoms of illness but are still infectious toothers.

HIV

AIDS

• Acquired immunodeficiency syndrome (AIDS) is a term which applies to the most advanced stages of HIV infection. It is defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers.

• HIV is the infectious stage of the condition, AIDS is the disease phase.

Globally

• Number of people(all ages) living with HIV:• 36.7(34-39.8)million people• Prevalence of HIV among adults:• 0.8%(0.7-0.9%)• Deaths due to HIV:• 1.1million died due to HIV related illnesses

worldwide in 2015

Category NACP-IIIDefinition

A >1%ANC prevalence in any of the sites inThe last 3 years

B<1%ANC prevalence in all the sites duringLast 3 years with >5% prevalence in any HRGsite(STD/FSW/MSM/IDU)

C<1%ANC prevalence in all sites during last 3Years with <5%in all STD clinic attendees orAny HRG,with known hots pots

D<1%ANC prevalence in all sites during last 3Years with <5% in all STD clinic attendees orAny HRG or poor HIV data with noKnown hot spots

Category NACP-III

A 156

B 39

C 296

D 118

NewDistricts 30

Total 609

National AIDS Control Programme

District-wise Scenario of HIV/AIDS

In India

• First cases were seen among commercial sex workers in Chennai in 1986.

GOA• First case in 1987 seen in a foreigner.• 1988- Indian but non Goan• 1989- first case detected in a Goan student

In India

• Approx 86,000 new HIV infections in 2015• Adult HIV prevalence at national level: 0.26%• 0.22%(women) & 0.30%(men)• Goa: 0.40%• PLHA: 21.17lakh• Estimated 61.6 thousand died due to AIDS

related causes

In Goa

• Prevalence in Goa: 0.40%• In 2015: 345 HIV+ cases detected. Including 16

ANC.• Majority of cases from Marmugao, Bardez,

Salcete and Tiswadi.• 80.6% cases in 15-49yrs age group• Sexual route:80-95%• Mother-to-child transmission:4-8%

Routes of Transmission of HIVSexual Contact: Male-to-male

(oral, vaginal or anal) Male-to-female or vice versa

Female-to-female

Blood Exposure: Injecting drug use/needle sharing

Occupational exposure

Transfusion of blood products

Perinatal: Transmission from mother to baby

Breastfeeding

Routes of Transmission of HIVOccupational Transmission

Health care worker/ hospital staff Laboratory workers

Other routesOrgan transplantationArtificial inseminationNeedle-prick

• Infectivity depends on:

• The concentration of HIV in the infected fluid• The QUANTITY of fluid introduced into the

body• The ACCESS of the infected fluid to the T4 cell

• HIV cannot survive outside the human body.

Infection occurs when one comes into contact with body fluids of an infected person.

Semen11,000 Vaginal

Fluid7,000

Blood18,000

Amniotic Fluid4,000 Saliva

1

Average number of HIV particles in 1 ml of these body fluids

Semen11,000 Vaginal

Fluid7,000

Blood18,000

Amniotic Fluid4,000 Saliva

1

HIV is NOT spread by:

Sharing utensils

Pathology

Host cells: CD4 + helper T lymphocytes, B lymphocytes, monocytes and macrophages including specialized macrophages such as Alveolar macrophages in the lungs and Langerhans cells in the dermis. Glial cells and microglia cells. Etc.

Signs and Symptoms

Window Period

This is the period of time after becoming infected when an HIV test is negative.

90 percent of cases test positive within three months of exposure

10 percent of cases test positive within three to six months of exposure

The clinical consequence of HIV infection comprises of a spectrum ranging from an acute syndrome with primary infection to a prolonged asymptomatic stage to adanced disease.

Incubation period: 2 to 10 yrs.• Acute HIV infection• Asymptomatic or Latent

infection• Persistent generalized

lymphadenopathy (PGL)• AIDS related complex• Full blown AIDS (Last

stage)

The Acute HIV Syndrome• Occurs 3-6weeks following the primary HIV

infection.

Second phase-Asymptomatic contact

Initial HIV inf. or after illness of inf.No symptomsLast 2 to 10 yrs.

Third phase-PGL (Persistent Generalized Lymphadenopathy)

Enlargement of lymph nodes.

outside the inguinal areamore than 2 areasmore that 3 months

Fourth phage-AIDS Related Complex

• The patients present with weight loss – of more than 10% of body weight, persistent fever, diarrhea, generalized fatigue and signs of other opportunistic infections may be apparent.

• The opportunistic infections are oral candidiasis, herpes zoster, salmonellosis or Tuberculosis and hairy cell leucoplakia

AIDS

• This is the end stage disease representing the irreversible break down of immune defense mechanisms.

• In addition to the opportunistic infections the patient may develop primary CNS lymphomas and progressive multifocal leukoencephalopathy, dementia and other neurological abnormalities.

• Kaposi sarcoma and Pneumocystis pneumonia are almost always observed in a majority of patients.

Kaposi’s Sarcoma

Candidiasis

Pneumocystis jerovicii

Cryptococcal Meningitis

Tuberculosis

Tests for Diagnosing HIV

Screening Tests: Antibody Tests

Rapid tests

Enzyme linked immunosorbentassays (ELISA)

Confirmatory/Supplemental Tests

2nd/3 rd Rapid /ELISA tests toconfirm 1st HIV test

Western blot

Same blood sample is utilised forperforming the tests for identifyingHIV antibodies

Treatment

• There is no cure for HIV.• Prevention is the only means to stop its

spread.

• Drugs can help slow down the virus and increase life span and quality of life.

Drug Treatment• Treatment consists of a combination of drugs

called highly active anti-retroviral therapy (HAART).

• Treatment is LIFELONG.• Drug classes include: NRTI NNRTI Protease inhibitors Fusion inhibitors Integrase inhibitors CCR5 antagonists

PREVENTION

Educate yourself and others. Know the HIV status of any sexual partner. Use a new condom every time you have sex. Get regular screening tests.Restrict number of sexual Partners.

PREVENTION

Use a clean needle.Be cautious about blood products. Universal safety precautions for healthwokers.Take PEP if exposure is there.Avoid alcohol and drug abuse.Avoid peer pressure.

PREVENTION

• Pregnant women should get themselves tested.

• If HIV+, can start on ART which can decrease chances of transmission to the child

• Avoid breastfeeding if HIV+

PREVENTION

HIV positive individual prevention:Follow safe-sex practices.Tell your sexual partners you have HIV. If your partner is pregnant, tell her you have HIV.Tell others who need to know(doctors).Don't share needles or syringes. Don't donate blood or organs. Don't share razor blades or toothbrushes.If you're pregnant, get medical care right away.

HIV is NOT spread by:

Sharing utensils

AIDS & DISCRIMINATION

Goa’s Response to HIV

• IEC activities for general public and high risk groups.• Blood Safety: voluntary donation, Testing of every unit of

blood for detecting infections for diseases like Hepatitis B & C, Syphilis and Malaria apart from testing for HIV

• Condom promotion: free distribution of condoms• School AIDS education programme

• Toll free AIDS helpline 1097: For information on HIV/ AIDS/ STDs, services available and other related issues an Interactive Voice Record System (IVRS) is available round the clock on all week days and telephone counseling during working hours.

• Integrated Counseling and Testing Centres at:• Goa Medical College, Bambolim • Tuberculosis and Chest Diseases Hospital, St. Inez, Panaji • Hospicio Hospital, Margao• District Hospital, Mapusa• Cottage Hospital, Chicalim • CHCs at Canacona, Curchorem, Pernem and Valpoi • Central Hospital, Tisk Usgao, Ponda-Goa and PHC Candolim. • CD4/ CD8 cell count facility at Goa Medical College (Dept. of

Microbiology), Bambolim for management of HIV/ AIDS patients.

• Sexually Transmitted Diseases/ Infections related services at: • STD clinic, Baina, Vasco • STD clinic, Hospicio Hospital, Margao • STD clinic, District Hospital, Mapusa • Skin and V.D. Dept., Goa Medical College• All Health Centers under Directorate of Health Services• Free drugs for treatment of Opportunistic Infections in HIV/

AIDS patients in District Hospital (Asilo), Mapusa; Hospicio Hospital, Margao; Goa Medical College, Bambolim.

• Prevention of Parent-to-Child Transmission of HIV infection during pregnancy: Programme includes counseling, testing and drug administration at OBG Dept., Goa Medical College, Hospicio Hospital, Margao and District Hospital, Mapusa.

• Early Infant Diagnosis: As early as six weeks babies of HIV positive mothers can be tested to rule out HIV infection in the babies at below mentioned centers.

• Goa Medical College, Bambolim • District Hospital, Mapusa • Hospicio Hospital, Margao • Cottage Hospital, Chicalim• Drop-in Centre for people living with HIV/AIDS at: • Zindagi, F-11, 2nd floor, Pai Building, Behind Uma Petrol

Pump, Mundvel, Vasco-da-Gama, Goa.• Community Care Centres: Free short stay, check-up,

treatment, counseling for People Living with HIV/AIDS at: • EL-Shaddai Community Care Centre, EL-Shaddai House, Socol

Vaddo, Assagao, Bardez.-Goa.• ASRO, Near Holy Cross Church, Cavelossim, Salcete-Goa.

• Antiretroviral Treatment Centre at Goa Medical College (Opp. Paediatric OPD). Free antiretroviral drugs are provided for full blown AIDS cases and Children aged 1-15 year affected with HIV.

• Link ART Centres at: District Hospital, Mapusa and Hospcio Hospital, Margao.

• Provision of free Post Exposure Prophylaxis (PEP) in case of exposure to potentially infectious fluids in Health care workers in Government Institutions.

• Zindagi: a state level network for people living with HIV/ AIDS in Goa. Located at Vasco.

• Caritas Goa• ASRO-Tivim: takes care of children with HIV/AIDS• ASRO-Cavelossim: takes care of adults as well as

children• Home nursing training at Aldona: provides a

certificate course of 1yr.• Centre for responsible tourism.

NGO’s

THANK YOU!