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HISTORY OF AIDS
 Up to 1980 “The dominant feature of this first
period was silence, for the human
immunodeficiency virus (HIV) was unknown
and transmission was not accompanied by signs
or symptoms salient enough to be noticed.
HIV had spread to at least five continents (North
America, South America, Europe, Africa and
Australia). During this period of silence, spread
was unchecked by awareness or any preventive
action and approximately 100,000-300,000
persons may have been infected."

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1981-1989
 Kaposi's sarcoma (KS) was a rare form of
relatively benign cancer that tended to occur
in older people. But by March 1981 at least
eight cases of a more aggressive form of KS
had occurred amongst young gay men in
New York

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 At about the same time there was an
increase, in both California and New York,
in the number of cases of a rare lung
infection Pneumocystis Carinii
Pneumonia (PCP)
 In December 1981, it was clear that the
disease affected other population groups,
when the first cases of PCP were reported in
injecting drug users.

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 IN 1982 the disease still did not have a name,
Lancet calling it "gay compromise
syndrome". Others called it GRID (gay-
related immune deficiency), AID (acquired
immunodeficiency disease), "gay cancer" or
"community-acquired immune
dysfunction".
 By 1982 a number of AIDS specific voluntary
organizations had been set up in the USA.
San Francisco AIDS Foundation (SFAF),
AIDS Project Los Angeles (APLA), and Gay
Men's health Crisis (GMHC).
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 In December 1982 a 20-month old child who
had received multiple transfusions of blood
and blood products died from infections
related to AIDS, this case provided clearer
evidence that AIDS was caused by an
infectious agent, and it also caused
additional concerns about the safety of the
blood supply.
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 In May 1983, doctors at the Institute Pasteur in
France reported that they had isolated a new
virus, which they suggested might be the cause
of AIDS. A few months later the virus was
named lymphadenopathy-associated virus
or LAV, patents were applied for, and a sample
of LAV was sent to the National Cancer
Institute.
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INSTITUTE PASTEUR IN FRANCE

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 1984 At the CDC researchers had been continuing to
investigate the cause of AIDS through a study of the
sexual contacts of homosexual men in Los Angeles and
New York. They identified a man as the link between a
number of different cases and they named him
"patient 0(zero)". Darrow was to later change his
original statement, saying that he did not name the
man as patient zero but rather he named him “patient
O”, for “Out of California”
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Gaetan Dugas, "patient zero"

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 On April 23rd, Dr. Robert Gallo of the National
Cancer Institute had isolated the virus which
caused AIDS, that it was named HTLV-III

In May 1986, the International Committee on the

Taxonomy of Viruses ruled that both names
should be dropped and the dispute solved by a
new name, HIV (Human Immunodeficiency
Virus).
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Dr. Robert Gallo of the National
Cancer Institute

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 In September there was dramatic progress in the
provision of medical treatment for AIDS, when
early results of clinical tests showed that a drug
called azidothymidine (AZT) slowed down the
attack of HIV.
 In 1986 HIV and AIDS had also been detected in
India, among sex workers in the southern state of
Tamil Nadu, igniting fears that the disease would
soon spread across the subcontinent.
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 In 1987 By December, 71,751 cases of AIDS
had been reported to the World Health
Organization, with the greatest number
reported by the USA (47,022)

 1988 On December 1st, the first World AIDS

Day took place, with the WHO asking
everyone to "Join the Worldwide Effort
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1990-2000
 1990 In China, 146 people in Yunnan Province
near the Burmese border were found to have HIV
infection due to sharing needles
 In July the CDC reported the possible
transmission of HIV to a patient during a dental
procedure. The dentist had been diagnosed with
AIDS three months before performing the
procedure and the affected patient was na22-year
old Kimberly Bergalis
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 In 1991 Kimberly Bergalis testified to the US
Congress. In what she called her "dying
wish", she asked members of congress to
enact legislation for mandatory HIV
testing of health care workers, to ensure
that: "others don't have to go through
the hell that I have."
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 During the summer 1991 , a third antiretroviral
drug dideoxycytidine (ddC) was authorized by
the FDA for use by patients intolerant of AZT.

 On World AIDS Day, 1st December 1993 ,

Benetton in collaboration with ACT UP Paris
placed a giant condom (22 meters high and 3.5
wide) on the obelisk in Place de la Concorde in
Central Paris in an effort to wake the world to the
reality of the disease
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 At the end of 1993 the estimated number of
AIDS cases worldwide was 2.5 million
 1994 A large European study on mother-to-
child transmission showed that Caesarean
section halved the rate of HIV transmission
Condom use in commercial sex had risen
from 14% in 1989 to 94% in 1993.
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 1995 On 1st December, World AIDS Day,
Nelson Mandela called on all South Africans
to "speak out against the stigma, blame,
shame and denial that have thus far been
associated with this epidemic."

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 1996 The new Joint United Nations
Programme on AIDS (UNAIDS), bringing
together six agencies belonging to or
affiliated with the UN system (WHO,
UNDP, UNICEF, UNFPA, UNESCO and the
World Bank), became operational on
January 1st

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 In June 1996 the FDA approved the drug
Viramune (nevirapine), the first in a new class
of drugs known as non-nucleoside reverse
transcriptase inhibitors
 In May 1997 President Clinton set a target for the
USA to find an AIDS vaccine within ten years,
 1998 In Canada there was an outbreak of HIV
infection amongst injecting drug users in
Vancouver.
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 A study found that the combination of
caesarean delivery and AZT reduced the risk
of HIV transmission from a mother to her
baby to less than 1%.

 1999 In the United States a doctor who

injected his former lover with HIV infected
blood was sentenced to 50 years in prison
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 2000 onwards
 In February, the trial started of Bulgarian health
workers charged in Libya with deliberately
infecting children with HIV. The Bulgarian
medics - five nurses and an anaesthetist - were
detained in 1998 after almost 400 children were
given infected blood at a hospital in Benghazi,
Libya's second largest city. Eight Libyans and a
Palestinian were also charged.
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A Palestinian doctor and two of the five Bulgarian
nurses waiting for the verdict in a court in Tripoli.

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 In 2001 the Indian drug company Cipla
offered to make AIDS drugs available at
reduced prices to the international aid
organization Medecins Sans Frontieres
(MSF). Cipla's offer to produce drugs at a
price less than $1 per day put further
pressure on multinational drug companies
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 In 2002 Ukraine became the first nation in
Europe to have 1% of its adult population
infected with HIV. Botswana became the
first African country to begin providing
antiretroviral treatment through the public
sector

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 AIDS IN INDIA
 India is one of the largest and most populated
countries in the world, with over one billion
inhabitants. Of this number, it's estimated that
around 2.27 million people are currently living
with HIV
 HIV emerged later in India than it did in many
other countries. Infection rates soared
throughout the 1990s, and today the epidemic
affects all sectors of Indian society, not just the
groups such as sex workers and truck drivers
with which it was originally associated.
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 India’s first cases of HIV were diagnosed
among sex workers in Chennai, Tamil Nadu. It
was noted that contact with foreign visitors
had played a role in initial infections among
sex workers
 HIV screening centres were set up across the
country there were calls for visitors to be
screened for HIV
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 In 1987 a National AIDS Control
Programme was launched to co-ordinate
national responses. Its activities covered
surveillance, blood screening, and health
education
 By the end of 1987, out of 52,907 who had
been tested, around 135 people were found to
be HIV positive and 14 had AIDS
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 Most of the initial cases had occurred
through heterosexual sex, but at the end of
the 1980s a rapid spread of HIV was observed
among injecting drug users (IDUs) in
Manipur, Mizoram and Nagaland three
north-eastern states of India bordering
Myanmar (Burma).

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 At the beginning of the 1990s, as infection
rates continued to rise, responses were
strengthened. In 1992 the government set up
NACO (the National AIDS Control
Organisation), to oversee the formulation
of policies, prevention work and control
programmes relating to HIV and AIDS
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 In the 1990, the government launched a
Strategic Plan, the National AIDS Control
Programme (NACP) for HIV prevention.
 In 1999, the second phase of the National
AIDS Control Programme (NACP II) came
into effect with the stated aim of reducing the
spread of HIV through promoting behaviour
change.
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 The prevention of mother-to-child transmission
(PMTCT) programme and the provision of free
antiretroviral treatment were implemented for the
first time.
 The third phase (NACP III) began in 2007, with
the highest priority to reach 80 percent of high-
risk groups including sex workers, men who have
sex with men, and injecting drug users with
targeted interventions.
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 In 2006 UNAIDS estimated that there were 5.6
million people living with HIV in India, which
indicated that there were more people with HIV
in India than in any other country in the world. In
2007, following the first survey of HIV among the
general population, UNAIDS and NACO agreed
on a new estimate – between 2 million and 3.1
million people living with HIV

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EPIDEMIOLOGY

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EPIDEMIOLOGY IN INDIA

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 As of the end of 2005, UNAIDS estimates that
there were 5.7 million people of all ages living
with HIV/AIDS in India. NACO estimates that
there were 5.2 million adults, aged 15-49, at this
same point in time
 HIV/AIDS prevalence among adults in India is
still relatively low, at 0.9%, as estimated by both
UNAIDS and NACO
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 In 2005, five Indian states had high
HIV/AIDS prevalence (>1% in antenatal
clinics) Andhra Pradesh, Karnataka,
Maharashtra, Manipur, and Nagaland, as did
95 districts within states. HIV prevalence of
>10% was found at 34 STD sites

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 Commercial sex work and sex between men
also drive the HIV epidemic in parts of
India. Large-scale population mobility and
migration, primarily through male migrant
labor, further contribute to the spread of
disease.

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 NACO estimates that women accounted for 38% of
India’s adult HIV/AIDS prevalence in 2005.

 Young adults, aged15-29, account for 32% of AIDS

cases reported in India over the course of the
epidemic. Among those aged 15-24, the number of
young women living with HIV/AIDS has been
estimated to be almost twice that of young men.

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Udupi And KMC Manipal
Less than 1% in ANC clinic
22-25 cases are found be HIV positive per month in KMC
Hospital
Mangalore KMC Attawar 10.9(2005) and 6.6 (2006)
Kasturba Medical College
 15.5 ( 1999)
 10.8 (2000)
 24.0 (2001)


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GLOBAL SUMMARY
Number of people living with HIV in 2007
 Total 33.2 million [30.6–36.1 million]
 Adults 30.8 million [28.2–33.6 million]
 Women 15.4 million [13.9–16.6 million]
 Children under 15 years 2.5 million [2.2–2.6
million]
People newly infected with HIV in 2007
 Total 2.5 million [1.8–4.1 million]
 Adults 2.1 million [1.4–3.6 million]
 Children under 15 years 420 000 [350 000–540
000]
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 AIDS deaths in 2007 Total 2.1 million [1.9–2.4
million]
 Adults 1.7 million [1.6–2.1 million]
 Children under 15 years 330 000 [310 000–380 000]


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AIDS AND MENTAL ILLNESS
 AIDS related moderate to severe case of dementia
occurs in approximately 7% of clients newly diagnosed
with HIV and 30% of those with advanced AIDS

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Common Psychiatric Disorders
 Mood Disorders

 Depression Pervasive sadness, apathy, fatigue,

suicidal ideation, hopelessness, changes in
appetite and sleep patterns
 Mania (Bipolar Disorder) Increased energy,
decreased need for sleep, racing thoughts,
grandiosity
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 Psychotic Disorders
Schizophrenia Auditory hallucinations, delusions,
thought disorders
 Anxiety Disorders
Generalized anxiety disorder, Nervousness,
heightened arousal, panic attacks, intrusive
anxiety provoking panic disorder, obsessive-
thoughts, obsessions/rituals, flashbacks
compulsive disorder, posttraumatic stress disorder
Adjustment Disorders Depression and/or anxiety
of less severity and directly related to an
identifiable stressor
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 Personality Disorders Persistent,
maladaptive life behaviors that interfere
with interpersonal relationships
 Sleep Disorders Difficulty initiating
and/or maintaining sleep
 Sexual Functioning Disorders
Diminished libido, difficulty having an
orgasm, difficulty obtaining or maintaining
an erection

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 Constitutional Problems
 Chronic fatigue, chronic lack of energy
 Wasting syndrome, Chronic muscle wasting
 Pain: chronic pain from such conditions as neuropath

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 The prevalence of HIV infection was 36.4%
among female patients reporting
intravenous drug use and 14.5% among their
male counterparts.(David L. Stewart, MD)
 HIV prevalence in mentally disturbed
patients and out patients is 23%.
 Published rates of HIV infection among
psychiatric patients are 3.1% to 23.9%, at
least eight times higher than estimates for
the general population (Cournos and
McKinnon 1997; Rosenberg et al. 2001).
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 In the USA people with severe mental illness are
around 20 times more likely to be infected with HIV
than the general population. In 1997, when the
population HIV prevalence was 0.4%, nearly 8% of
people with SMI were infected.

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Comparison of the prevalence of HIV among
black women in the general population and
black women with severe mental illness after
standardising for age.
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 PREDISPOSING FACTORS- AIDS
 The primary predisposing factors for AIDS in
developed countries are chemical in origin,
such as recreational drugs (cocaine, heroin,
marijuana, alkyl nitrites, methamphetamines),
the chemicals polluting the air, water, and soil,
the chemicals used in food preservation, and
pharmaceutical medications.
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 Secondary predisposing factors are
biological stressors such as semen through
anal intercourses and blood and derivatives
in haemophiliacs and other patients treated
with transfusions. Mental stressors are the
third group of factors that can weaken the
immune system in these countries.

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 Anxiety, depression, and periods of panic,
secondary to social conditions such as
prostitution, drug-addiction, the knowledge
of being "HIV-positive", haemophilia,
homophobia, AIDS-phobia, lack of hope for
a better life, are the main mental stressors

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 Then come the physical pollutants such as
noise, electromagnetic fields, along with
ionizing and non-ionizing radiations. The
excess of fats as well as diets lacking in
certain nutritional needs may constitute a
fifth group of AIDS predisposing factors in
developed countries.

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 In underdeveloped countries, by contrast,
the most important factor debilitating the
immune system is the lack of nutritional
needs, which starts in fetal life and
accompanies people throughout their lives.

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 Secondary factors are biological stressors such
as infections and parasitosis due to poor
sanitation conditions (biological pollution).
Further factors are social and mental stressors
brought on through a lack of hope for a better
life, a hopelessness which also weakens
immune systems in these countries.

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 A fourth level of stressors would be chemical
stressors, but in the poorer countries drugs from
the conventional pharmacopoeia (antibiotics
and anti-parasites) contribute more than
recreational drugs. Industrial chemical and
physical pollution can also be predisposing
factors to AIDS, principally for people living in
the large cities of the underdeveloped countries.
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Common factors
 Sharing of drug needles or syringes
 Sexual contact (including oral, anal or vaginal sex)
with someone who is HIV positive or whose HIV status
is unknown, without the protection of a latex male
condom.
 Having another sexually transmitted disease such as
syphilis, herpes, chlamydial infection, gonorrhoea or
bacterial vaginosis seems to increase the risk of being
infected by HIV during unprotected sexual contact
with an infected partner.
 Babies can be infected by an HIV-positive mother
during pregnancy, birth and breast feeding
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RISK FACTORS AMONG YOUTH
 Alcohol and drug abuse
 Unprotected sex
 Frequent change of sexual partners
 Sex for financial gain, for prestige, for good
grades, to relieve stress,
 Peer pressure
 Casual sex as part of socializing

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RISK FACTORS AMONG WOMEN
a) Inequalities within the family

 The power imbalance can be more difficult for

women to protect themselves from getting
infected with HIV. For example, a woman may
not be able to insist on the use of a condom if
her husband is the one who makes the
decisions.
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b) Violence against women

 Women who are victims of sexual violence

are at a higher risk of being exposed to HIV,
and the lack of condom use and forced
nature of rape means that women are
immediately more vulnerable to HIV
infection
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 c) Illiteracy

 d) Drug abuse

 e) Sex with same gender (lesbians)

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RISK FACTOR AMONG CHILDREN

 Parents who are substance abusers

 HIV infected mothers

 Children of sex workers

 Children with haemophilia

 Children who receives blood

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RESOURCES

 1. UNAIDS, 2006 Report on the Global AIDS Epidemic,

May 2006.
 2 NACO, HIV/AIDS Epidemiological Surveillance &
Estimation Report for the Year 2005, April 2006
 3. CIA, “The World Fact book”, 2006.
 4. UNAIDS India Country Page:
www.unaids.org/en/Regions_Countries/Countries/ind
ia.asp.

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Thank you

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