Generalities on HIVAIDS

1
Generalities on HIV/AIDS

• Dr. Denis Broun
• UNAIDS Country Coordinator
• 19 April 2007
• Ambassade de France

2
Modes of transmission of HIV

• Sex
• Any unprotected sexual intercourse with an
  infected partner
• Blood through micro or macro transfusion
• Macro transfusion transfusion of contaminated
  blood
• Micro transfusion
• Sharing of needles and syringes among drug users
• Accidental infection with (re) use of non sterile
  equipment injection, razors, tatooing,
  piercing, etc.
• Mother to child
• During pregnancy, birth or breastfeeding

3
How HIV is not transmitted

• HIV transmission never happens in daily
  non-intimate contacts. In particular
• Every day contact at work, at school, at home, in
  public places, in swimming pools, etc.
• Sharing of food, clothes, telephone sets,
  toilets, etc.
• Normal bodily contacts shaking hands, hugging,
  kissing
• Mosquito bites
• HIV transmission requires
• exchange of bodily fluids.

4
In India Sexual Transmission Accounts for most of
HIV Infections

• Modes of HIV transmission
• Sexual
• Unprotected Sex
• Parenteral
• IV drug use
• Blood products
• Nosocomial infection
• Parental to child transmission (PTCT)
• Before birth
• During birth
• After birth during breastfeeding

5
Approaches to preventing blood transmission in
medical settings are well defined

• Ensure Safe Blood Products
• Transfusion Guidelines to avoid unnecessary
  transfusions
• Donor selection criteria
• Voluntary donor pool
• HIV (and other infectious disease) screening.
• Single-use supplies
• Institute Universal Precautions
• Universal precautions policy and procedures
• Adequate funding for supplies for universal
  precautions
• Training of HCP
• Post Exposure Prophylaxis drugs and protocol in
  place

6
Multiple partners at the same time increase risk
of HIV transmission

• Structure of sexual partnerships influences
  transmission
• Concurrent partnerships (partners at the same
  time)
• Serial partnerships
• Researchers have shown that without differences
  in numbers of partners, HIV transmission 10-fold
  greater with concurrent partnerships
• Multiple concurrent sexual partners common in
• Sex workers male and female
• Men who have sex with men on pleasure circuit

7
Epidemic Drivers Reported non-regular partners
by men and women higher in the South
Source 1 NACO BSS 2001 2002, APAC BSS series
1998 to 2004, APSACS-TRU BSS 2003
8
Concurrent Partnerships Globally
Sources Cassell et al, 2005, Epstein, 2005
9
Acute HIV Infection (AHI) STIs Probably Prime
Drivers of HIV Transmission
Source UNAIDS. JID 2005 1911391-1393 Wawer
et al. JID 20051911403-1409
10
ANC (antenatal clinics) Prevalence Points to a
Heterogeneous Epidemic Even in High
Prevalence States

• 87 infections sexually transmitted
• A total of 77 districts with ANC prevalence over
  1 account for 70 of HIV cases in the country
  (2005 ANC data)
• High-prevalence districts appear to cluster
• Coastal Andhra Pradesh
• North Karnataka South Maharashtra
• North-East
• Limited data for the northern states

IDU driven
Sex work driven
Source NACOs Sentinel Surveillance data
Average of ANC urban and rural sites (2005)
11
All Data Suggests that Indias HIV epidemic is
Driven by Sub-populations Most at Risk for HIV
infection.
Source India NACO, 2005
12
Evolution to AIDS

• 7 to 10 years after infection
• Progressive degradation of the immune system
• AIDS is characterized by either
• Specific opportunistic infections
• CD4 count less than 200/microliter
• There is no cure for AIDS
• With antiretroviral treatment, patients can live
  a normal life for several years.