North South University

A Study on HIV/AIDS

Submitted to Dr. Md Nazrul Islam

Submitted by
Istiak Ahmed 1010118030 Tawfiqul Bari - 1020152030 Shezad Ahmed 0930366030 Syed Golam Shabab - 0930484030 Ferdaus Jahan Nisha - 1020319030

20-Mar-11

A Study on HIV/AIDS
Context
Introduction Sources and reservoir of HIV o o Causes Recognizing the virus The mode of transmission of HIV o o o o o o o o Vaginal sex Anal sex Oral sex Injected drugs Mother to child transmission Blood transfusion and blood products Infection in health-care settings Tattoos and piercing Did HIV come from an SIV HIV structure

The world wide spread of HIV The immune system HIVs target First step in HIV infection The immune system kills only those HIV infected cells which it can recognize From HIV infection to AIDS Diagnosis of HIV infection HIV/Aids Test AIDS Illnesses o o o Illnesses affecting the mouth and intestines Diarrhoea Illnesses affecting the skin Page | 2

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o o Illnesses affecting the lungs Illnesses affecting the brain or nerves

Treatment Advancement in treatment You cannot get HIV / ADS from o o o Touching Hugging and kissing Coughing and sneezing

PREVENTION OF HIV TRANSMISSION AIDS illness Prevention of HIV transmission Global scenario Present situation of HIV/AIDS in Bangladesh Some important High-Risk factors for spread of HIV in Bangladesh Conclusion

Introduction:
Human immunodeficiency virus (HIV) is a lent virus (a member of the retrovirus family) that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. HIV is present as both free virus particles and virus within infected immune cells. HIV infection in humans is considered pandemic by the World Health Organization (WHO). Nevertheless, complacency about HIV may play a key role in HIV risk. From its discovery in 1981 to 2009 AIDS killed more than 30 million people and People living with HIV/AIDS in 2009 is 33.3 million. But only Sub-Saharan Africa has 22.5 million HIV infected people Children is living with HIV/AIDS in 2009 is 2.5 million. An estimated 2.6 million people became newly infected with HIV in 2009. AIDS is now a pandemic.

Source & reservoir of HIV/AIDS:

The origin of AIDS and HIV has puzzled scientists ever since the illness first came to light in the early 1980s. For over twenty years it has been the subject of fierce debate and the cause of countless arguments, with everything from a promiscuous flight attendant to a suspect vaccine programme
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being blamed .The first recognized cases of AIDS occurred in the USA in the early 1980s number of gay men in New York and California suddenly began to develop rare opportunistic infections and cancers that seemed stubbornly resistant to any treatment. At this time, AIDS did not yet have a name, but it quickly became obvious that all the men were suffering from a common syndrome. The discovery of HIV, the Human Immunodeficiency Virus, was made soon after. While some were initially resistant to acknowledge the connection there is now clear evidence to prove that HIV causes AIDS. So, in order to find the source of AIDS, it is necessary to look for the origin of HIV, and find out how, when and where HIV first began to cause disease in humans.

So did HIV come from an SIV?

It is now generally accepted that HIV is a descendant of a Simian Immunodeficiency Virus because certain strains of SIVs bear a very close resemblance to HIV-1 and HIV-2, the two types of HIV. HIV-2 for example corresponds to SIVsm, a strain of the Simian Immunodeficiency Virus found in the sooty mangabey (also known as the White-collared monkey), which is indigenous to western Africa.

HIV's structure:

HIV is of the retrovirus family, and its subfamily is Lentiviruses or slow virus. It is spherical measuring 100-140 nm in diameter HIV contains single stranded RNA and an enzyme Reverse Transcriptase (RT).

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The ability to transcribe DNA from RNA is a unique feature of retro viruses and gives them their name

HIV gains entry to the host cells in CD4 lymphocyte and destroys host immune system:

Causes:
A variety of causes for the severe immune deficiency were suspected including overload of the immune system by repeated exposure to semen or other body fluids, infection with cytomegalovirus, and/or inhalation of amyl nitrate and other commonly used recreational drugs. However the recognition that AIDS also developed in haemophiliacs, injection drug users or partners of bisexual men strongly suggested that the illness was caused by an infection transmitted in blood or body fluids such as semen. About the same time it was found that many of the first patients to develop AIDS in the United States had had sex with other men with the disease and this provided further evidence that AIDS is due to a sexually transmitted infection. Following the recognition that AIDS was affecting homosexual men in large cities in the United States the disease was seen in homosexual men in many other cities such as London, Amsterdam and Sydney. Within a year of the death of the first people with AIDS the homosexual communities in these cities became concerned about how to prevent further cases. Despite arguments from some against giving up newly won freedoms homosexual men started to have fewer sexual partners and to use condoms in the hope that this would stop the spread of the infection suspected to be responsible for AIDS.

Recognising the virus:

In 1983 scientists in Paris reported that they had grown a new virus in the lymph node of a man who had an illness suggestive of early AIDS. In 1984 scientists in Washington, DC, reported that they had grown a virus from the blood or tissues from 48 men who either had AIDS or illnesses recognized to precede AIDS. The American scientists went further and developed a test which could diagnose infection with the virus by detecting antibodies against the virus in the blood of an infected person. A scandal erupted when it was claimed that the virus discovered by the American scientists (which they called Human T-cell Lymphotropic Virus type III or HTLV III) had been stolen from the French scientists (who had called the virus Lymphadenopathy Associated Virus, or LAV).

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By the middle of 1985 the technology required to test blood for antibodies to the virus was widely available and it became possible to diagnose HIV (Human Immono- deficiency Virus) infection. Routine testing of blood and organ donors was quickly introduced. Unfortunately it was too late for very many patients. Approximately 50% to 70% of hemophiliacs had already been infected through the use of contaminated clotting factors and many other patients had been infected when they were given blood transfusions, organ transplants or sperm donations. The ability to diagnose HIV infections by testing for antibodies to HIV also meant that tests could be performed on specimens of blood or tissues which had been stored for other reasons. Antibodies to HIV were also found in samples of blood collected for research in Africa many years earlier. Then when samples of blood which had been collected from homosexual men during trials of a new hepatitis B vaccine in San Francisco, New York, and Amsterdam were tested it was found that very few of the men had HIV infection in 1978 but that almost 30% of them had become infected in 1982.

The mode of transmission of HIV/AIDS:

HIV is a virus that damages human immune cells. It weakens the immune system and, without treatment, leads most infected people to develop AIDS. HIV is found in blood and other body fluids such as semen and vaginal fluids. It cannot live for long outside the body, so to be infected with HIV you need to allow some body fluid from an infected person to get inside your body. The virus can enter the body via contact with the bloodstream or by passing through delicate mucous membranes, such as inside the vagina, rectum or urethra.

How HIV is passed on: Vaginal sex:

HIV is found in the sexual fluids of an infected person. For a man, this means the pre-come and semen fluids that come out of the penis before and during sex. For a woman, it means HIV is in the vaginal fluids which are produced by the vagina to keep it clean and to help make intercourse easier.If a man with HIV has vaginal intercourse without a condom then HIV can pass into the woman's body through the lining of the vagina, cervix and womb. The risk of HIV transmission is increased if the woman has a cut or sore inside or around her vagina; this will make it easier for the virus to enter her bloodstream. Such a cut or sore might not always be visible, and could be so small that the woman wouldn't know about it. If a woman with HIV has sexual intercourse without a condom, HIV could get into the man's body through a sore patch on his penis or by getting into his urethra (the tube that runs down the penis) or the inside of his foreskin (if he has one).Any contact with blood during sex increases the chance of infection. For example, there may be blood in the vagina if intercourse occurs during a woman's period. Some sexually transmitted diseases such as herpes and gonorrhea can also raise the risk of HIV transmission.

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Anal sex:
Receptive anal intercourse (i.e. being the bottom) carries a higher risk of HIV transmission than receptive vaginal intercourse. The lining of the anus is more delicate than the lining of the vagina, so is more likely to be damaged during sex. Any contact with blood during sex increases the risk of infection. If a man takes the insertive (top) position in anal sex with a man or woman who has HIV, then it is too risky for him.

Oral sex:
Oral sex with an infected partner carries a small risk of HIV infection. If a person gives oral sex (licking or sucking the penis) to a man with HIV, then infected fluid could get into their mouth. If the person has bleeding gums or tiny sores or ulcers somewhere in their mouth, there is a risk of HIV entering their bloodstream. The same is true if infected sexual fluids from a woman get into the mouth of her partner.There is also a small risk if a person with HIV gives oral sex when they have bleeding gums or a bleeding wound in their mouth. Saliva does not pose a risk. HIV infection through oral sex alone seems to be very rare, and there are things you can do to protect yourself. For more information visit our Oral sex page.

Injecting drugs:

Injecting drug users are a high-risk group for exposure to HIV. Sharing injecting equipment is a very efficient way to transmit blood-borne viruses such as HIV and Hepatitis C. Sharing needles and works (syringes, spoons, filters and blood-contaminated water) is thought to be three times more likely to transmit HIV than sexual intercourse. Disinfecting equipment between each use can reduce the chance of transmission, but does not eliminate it entirely.

Mother to child transmission:

An infected pregnant woman can pass HIV on to her unborn baby during pregnancy, labor and delivery. HIV can also be transmitted through breastfeeding. If a woman knows she is infected with HIV, there are drugs she can take to greatly reduce the chances of her child becoming infected. For more information, go to our pages about HIV and pregnancy and mother-to-child transmission of HIV.

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Blood transfusions and blood products:
Some people have been infected through a transfusion of infected blood. These days, in developed countries all the blood used for transfusions is tested for HIV. In those countries where the blood is tested, HIV infection through blood transfusions is now extremely rare. In some developing countries, testing systems are not so efficient and transmission through blood transfusions continues to occur.Blood products, such as those used by people with hemophilia, are now heat-treated to make them safe.

Infection in health-care settings:

Hospitals and clinics should take precautions to prevent the spread of blood-borne infections. These measures include using sterile surgical instruments, wearing gloves, and safely disposing of medical waste. In developed countries, HIV transmission in health-care settings is extremely rare. However, cases continue to occur in less-resourced areas where safety procedures are not so well implemented. Health-care workers have on rare occasions become infected with HIV by being stuck with needles containing HIV-infected blood. There have been only a very few documented instances of patients acquiring HIV from an infected health-care worker.

Tattoos / piercing:
Anything that potentially allows another person's blood to get into your bloodstream carries a risk. If the equipment has not been sterilized before having a tattoo or piercing, there could be a significant risk of exposure if the person before was HIV positive.In most developed countries there are hygiene regulations governing tattoo and piercing parlors to ensure all instruments used are sterile. If you are thinking of having a tattoo or piercing, ask staff at the shop what procedures they take to avoid infection.

The worldwide spread of HIV :

It seems likely that HIV first evolved in the African people who hunted and killed apes. Some of these people became infected with SIV through contact with infected monkey blood and in these people SIV evolved into HIV a virus better adapted to infect humans and to be transmitted from person to person. From these people the infection spread to the towns and cities of central Africa. Occasionally the infection was transmitted to people from Europe or America but the epidemic of HIV in the West was not recognised until the infection was introduced into gay communities in New York, San Francisco and Los Angeles. Since then it has spread around the world. In western countries HIV infection is largely a disease of gay men and injecting drug users, while in many third would countries it has spread very widely through the community.

The Immune System - HIV's target:

HIV infects cells of the immune system and AIDS is predominantly a disease due to failure of the immune system. It is not possible to understand how HIV causes AIDS and how AIDS leads to death without a basic understanding of the immune system.
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First steps in HIV Infection :
The first cells to be infected with HIV soon after the virus enters the body, probably are macrophages (1). HIV can replicate within these cells but the amount of virus produced is not large. T helper lymphocytes are attracted to the infected macrophages by the chemicals released from the infected cells (2). While responding to the infected macrophages the T helper lymphocytes become infected by HIV released from the macrophages (3)The T helper lymphocytes produce large amounts of HIV (4) which then infects other T helper lymphocytes, other macrophages or other cells of the macrophage family such as microglia cells in the brain, dendritic cells in the lymph nodes and spleen and similar cells in the gut and skin. These cells of the macrophage family serve as a reservoir of infection releasing virus over the coming years.

The immune system kills only those HIV infected cells which it can recognize:
The process of copying RNA into DNA soon after HIV infects the T helper lymphocyte is a rather inaccurate one and errors are frequently made. This high mutation rate allows HIV to evolve rapidly and this evolution is thought to be a major reason why the immune system has so much difficulty controlling the infection. A T helper lymphocyte which has been infected by HIV produces many different versions of the virus which infected the cell. These new strains of the original virus then infect other T helper lymphocytes. Some strains of the virus are recognized by the immune system, and the cells producing these strains are destroyed by T killer lymphocytes. Other new strains of HIV are not recognized by the immune system and the cells producing these strains are not killed but go on producing more HIV. A persons T killer lymphocytes can recognise a huge variety of different HIV strains and kill the cells producing these strains. However, HIV has an almost unlimited ability to evolve new strains. Eventually many strains of HIV which are not recognized by the immune system evolve. These strains proliferate without control and the amount of virus in the blood gradually rises.

From HIV infection to AIDS:

When a person is first infected with HIV, the virus invades macrophages and T helper lymphocytes and a few other cells which also have [CD4 molecules on their surface. These infected cells produce more HIV which then infects other cells, and over the next few weeks more and more cells become infected, and the amount of virus released into the blood rapidly rises. About four to six weeks after becoming infected, the persons immune system recognises that T helper lymphocytes are producing virus. Over the next few weeks T killer lymphocytes destroy more than 99% of the virus producing cells, and the amount of virus in the blood is rapidly reduced. However, the T killer lymphocytes can
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only recognise as infected those cells which are actively producing virus. Many infected cells are not producing virus, and escape detection to become a reservoir of HIV for the rest of the persons life.

Model for Helper T Cells The destruction of so many infected cells at one time commonly causes a brief illness. The lymph nodes which contain most of the infected T helper lymphocytes become swollen and tender as the virus-producing cells are killed. Other common symptoms include exhaustion, sore throat, headache, fever, and skin rash. The illness is quite similar to glandular fever, another disease also due to a virus which infects lymphocytes. After about a week when most of the virus-producing cells have been killed the person recovers and feels perfectly well again.

Diagnosis of HIV infection:

Finding antibodies to HIV in a persons blood is the usual method of diagnosing HIV infection. This method is used because it is simple, cheap and reliable. It can give an incorrect result (false positive) in the first month of infection when there is a lot of virus in the blood but antibodies have not yet been produced. For someone to be confirmed negative, it is necessary to be tested three months after the first test. Two different methods of detecting antibodies can be used to diagnose HIV infection. A simple and cheap but slightly less reliable test is used first on all blood samples, and a more complicated, expensive and reliable test is used to retest all those blood samples found positive on the first test. The first test method, the ELISA test, will be positive if the blood sample contains antibodies against one or more parts of the virus. It may however also be misleadingly positive if the blood sample contains an antibody against some portion of another organism which is immunologically similar to a part of HIV. The second test method, the Western blot, will show whether there are antibodies to many different parts of HIV. There is lots of information about HIV testing. A person who is infected with HIV has antibodies to several parts of the virus. However a person who has a positive ELISA test, but who does not actually have HIV infection, will have antibodies which cross-react with one or, at most two parts of HIV. When blood samples are tested with the ELISA followed by the Western blot the results are almost 100% accurate. Once a person has developed antibodies against HIV the infection is unable to be eradicated and will be present lifelong. However most people with HIV infection remain well for many years before developing HIV-related illnesses. During these years the amount of HIV in the blood remains relatively constant. However the number of T helper lymphocytes in the blood gradually falls, and eventually gets so low that there are not enough T helper lymphocytes to adequately regulate the other cells of the
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immune system. The infected person starts to develop minor immune deficiency illnesses and gradually progresses to AIDS.

HIV/Aids Test:
Obtain finger stick, whole blood; serum, plasma Store at room temperature Results in 1015 minutes Training not required for laboratory personnel

AIDS Illnesses:
AIDS is the term for the illness affecting a person who has HIV infection and whose immune system is no longer working well enough to provide protection against severe unusual infections. An HIV infected person is said to have AIDS when he or she has suffered one or more of a long list of illnesses, for example Pneumocystis carinii pneumonia, Candida albicans oesophagitis, Toxoplasma gondii encephalitis, etc.

Illnesses affecting the mouth and intestines: Oral hairy leukoplakia (OHL) and gingivitis:

Oral hairy leukoplakia is a thin white line on the edges of the tongue caused by heaping up of normal mucosal cells. It is not usually painful but it may affect taste.

Candida albicans:

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Inflammation of the mouth due to Candida albicans occurs at some time in almost every HIV infected person. It causes a white coating (thrush) which is usually worst on the roof of the mouth and the inside of the cheeks. The mouth is sometimes sore and taste is altered. Severe cases can also affect the oesophagus and cause pain when swallowing. Sometimes Candida albicans causes cracking of the lips at the corners of the mouth as well as thrush in the mouth. Infection due to Candida albicans can be treated with mouth washes, pastilles, gel or pills.

Mouth ulcers:

Large painful ulcers, often half to one centimeter across and almost as deep, can occur in the mouth and oesophagus. They are more common in patients treated with ddC (zalcitabine, Hivid).

Diarrhoea:

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Diarrhea is a common problem for HIV infected patients. It may occur occasionally or may be persistent. It is often associated with bloating, nausea and abdominal pain and may alternate with periods of normal bowel motions or constipation.

Illnesses affecting the skin:

Kaposis sarcoma (KS) is a cancer of blood vessel cells which is caused by a newly discovered virus (Human Herpes Virus 8). It produces firm, non-tender, purple nodules in the skin, which usually do not ulcerate or bleed. Kaposis sarcoma may also occur in the mouth, in lymph glands and in other parts of the body.

Fungal skin infections:

Fungal skin infections are very common in patients with HIV infection and often begin years before any other HIV related illnesses. Most HIV infected patients will at some time have an area of dry, red, scaly skin which is usually about one centimeter in diameter and which gradually enlarges as similar patches appear nearby.

Seborrhea dermatitis:

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Seborrheoic dermatitis is a rash caused by the same fungus as that responsible for dandruff. It causes a greasy, red, scaly rash on the forehead, near the eye-brows and beside the nose. It is easily treated with anti-fungal creams.

Illnesses affecting the lungs: Tuberculosis:

Tuberculosis is an uncommon illness in HIV infected people except for those people who live in third world countries or in the poorest parts of developed countries. However it has been a cause of great concern in some Western countries because it can be easily spread by cough droplets. Some strains of Mycobacterium tuberculosis are resistant to antibiotics and therefore difficult or impossible to treat. Tuberculosis usually affects the lungs or the lymph nodes causing fever, sweats, tiredness and weight-loss.

Pneumonia and Bronchitis:

Pneumonia and bronchitis is an increased risk for patients with HIV infection and they are caused by ordinary sorts of bacteria which often affect elderly people and smokers. These illnesses cause cough, breathlessness, fever, brown sputum and sometimes chest pain and need to be treated with an antibiotic for one or two weeks.

Illnesses affecting the brain or nerves: Toxoplasmosis:

Toxoplasmosis is caused by Toxoplasma gondii, a parasite excreted by cats. Approximately one third of all adults is infected in childhood and carries the infection for the rest of their lives. In HIV
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infected patients with a low T helper lymphocyte count, the infection may reactivate to produce abscesses in the brain. The position of these abscesses in the brain determines how the patient is affected, for example with weakness of one side of the body, or difficulty with speech or balance. The abscesses commonly also cause headaches, fever, nausea and vomiting.

Brain Lymphoma:
Brain lymphoma may produce the same symptoms as toxoplasmosis and it can sometimes be difficult to distinguish between these two illnesses. The CT scan or MRI scan may be helpful in determining which disease is affecting the brain. Testing some of the cerebrospinal fluid (CSF), which surrounds the brain and spinal cord, for the presence of Epstein Barr virus can help to diagnose brain lymphoma. Radiotherapy can provide some short-term benefit but brain lymphoma is usually fatal within a few months.

Cytomegalovirus (CMS) Retinitis:

Cytomegalovirus (CMS) retinitis is a disease which may affect the back of one or both eyes and causes patches of blurred or lost vision which may gradually enlarge to produce complete blindness unless treated. The disease can usually be diagnosed by looking at the back of the eye, and detecting cytomegalovirus in the blood helps to confirm the diagnosis. Cytomegalovirus retinitis can be usually brought under control with intravenous or oral treatment, but eyesight often remains impaired to some degree. Treatment must be continued permanently to prevent the disease reactivating.

Treatment :
Until 1987 the only useful treatment for HIV infected patients were drugs to cue or suppress the unusual secondary infections. These opportunistic infections such as Pneumocystis carinii pneumonia, Candida albicans pharyngitis and oesophagitis, Toxoplasma gondii brain abscesses and Cryptococcus neoformans meningitis could be treated successfully with antibacterial and antifungal drugs. However nothing was available to slow the replication of HIV in the infected person.

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Zidovudine 100mg caps Zidovudine (azidothymidine, AZT), a drug which had been developed as a possible anticancer drug in 1964, was found to be effective against HIV. When given to patients with AIDS, or illnesses which commonly occur shortly before the onset of AIDS, it was found that AZT helped to prevent further opportunistic infections and delay death. Since the variety of other drugs with similar or different mechanisms of action against HIV have been discovered and used as treatments

Advances in Treatment:
The development of antiretroviral therapy has been one of the most dramatic progressions in the history of medicine for reducing HIV related morbidity and mortality
HAART (Highly Active Antiretroviral Therapy ) prescribed to many HIV-positive people,

even before they develop symptoms of AIDS. There is definite progress in the field of opportunistic infections (OI) management

You cannot get HIV / ADS from:

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PREVENTION OF HIV TRANSMISSION:
Abstinence Sex with one partner, Reduce multiple sexual partners Remain faithful to partner Consistent and correct use of condom

Use Condom

Safe blood and blood product transfusion Use disposable or sterilized syringe-needle Use sterilized instrument for all medical surgery Do not share your personal instrument with other (razor, blade, nail cutter etc.) Prevent Parent to Child Transmission (PPTCT)

Global scenario:
According to the latest global estimates from UNAIDS and WHO: There were 33.3 million people living with HIV in 2009, up from 29 million in 2001, the result of continuing new infections, people living longer with HIV, and general population growth. And more than 25 million people have died of AIDS. The global prevalence rate (the percent of people ages 1549 who are infected) has leveled
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since 2000 and was 0.8% in 2008. 2 million people died of AIDS in 2008, up from 1.9 million in 2001, but deaths are now declining due in part to antiretroviral treatment (ART) scale-up. HIV is a leading cause of death worldwide and the number one cause of death in Africa. New HIV infections are believed to have peaked in the late 1990s and declined between 2001 and 2008, from 3.2 million to 2.7 million. The decline is attributable to natural trends in the epidemic and to prevention. Still, there were more than 7,400 new HIV infections per day in 2008. Most new infections are transmitted heterosexually, although risk factors vary. In some countries, men who have sex with men, injecting drug users, and sex workers are at significant risk. Although HIV testing capacity has increased over time, enabling more people to learn their HIV status, the majority of people with HIV are still unaware they are infected. HIV has led to a resurgence of tuberculosis (TB), particularly in Africa, and TB is a leading cause of death for people with HIV worldwide. Women represent half of all people living with HIV worldwide, and more than half (59%) in sub-Saharan Africa. Gender inequalities, differential access to services, and sexual violence increase womens vulnerability to HIV, and women, especially younger women, are biologically more susceptible to HIV. Young people, ages 1524, account for 40% of new HIV infections (among those 15 and over). In sub-Saharan Africa, the HIV prevalence rate among young women is nearly 3 times that of their male counterparts. Globally, there were 2.1 million children living with HIV in 2008, 430,000 new infections among children, and 280,000 AIDS deaths. There are approximately 17.5 million AIDS orphans (children who have lost one or both parents to HIV), most of whom live in sub-Saharan Africa (81%).

Regional HIV and AIDS statistics, 2001 and 2009 Region Adults and children living with HIV Adults and children newly infected with HIV AIDS-related deaths among adults and children
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2001 SUB-SAHARAN AFRICA MIDDLE EAST AND NORTH AFRICA SOUTH AND SOUTH-EAST ASIA EAST ASIA OCEANIA CENTRAL AND SOUTH AMERICA CARIBBEAN EASTERN EUROPE AND CENTRAL ASIA WESTERN AND CENTRAL EUROPE NORTH AMERICA TOTAL 20.3 million 180 000 2009 22.5 million 460 000 2001 2.2 million 36 000 2009 1.8 million 75 000 2001 1.4 million 8300 2009 1.3 million 24 000

3.8 million 350 000 29 000 1.1 million 240 000 760 000

4.1 million 770 000 57 000 1.4 million 240 000 1.4 million

380 000

270 000

230 000

260 000

64 000 4700 99 000 20 000 240 000

82 000 4500 92 000 17 000 130 000

15 000 <1000 53 000 19 000 18 000

36 000 1400 58 000 12 000 76 000

630 000

820 000

31 000

31 000

7300

8500

1.2 million 28.6 million

1.5 million 33.3 million

66 000 3.1 million

70 000 2.6 million

30 000 1.8 million

26 000 1.8 million

Present situation of HIV/AIDS in Bangladesh:

Among the developing countries in Asia, Bangladesh still has a low level HIV epidemic status, where the adult prevalence of HIV infection is estimated to be below 0.1%. However, the overall prevalence of HIV infection among most at-risk populations is increasing with each subsequent round of national HIV serological and behavioral surveillance (from 0.2% in the 2nd round of surveillance to 0.9% in the 7th round of surveillance), mostly due to increased HIV prevalence among
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injecting drug users (IDUs) According to the results from the recent round of surveillance, the HIV epidemic appears to have reached to a concentrated level (7%) among IDUs in Dhaka city, the capital of Bangladesh.

Current scenario of HIV in Bangladesh:

It is estimated that in 2009, 6300 people is living with HIV in Bangladesh. Changes in the incidence rate of HIV infection from 2001 to 2009 is 25% in Bangladesh.
Reported number of PEOPLE RECEIVING ANTIRETROVIRAL THERAPY in 2009 is

353. In order to explore the future course of the HIV epidemic and to develop the most appropriate prevention programs, it is important to monitor the prevalence of HIV-related risk behaviors among high risk groups, the behavior networks within and between the high risk groups and their changes over time, which is the role of behavioral surveillance. In 1998, Bangladesh adopted one of the world's most comprehensive behavioral surveillance systems Updated surveillance has revealed the presence of close sexual networks of IDUs with other high risk groups, especially female sex workers (FSWs). FSWs were, on the other hand, shown to have close sexual links with multiple male client groups, not restricted to IDUs. According to recent rounds of behavioral surveillance, rickshaw pullers in Dhaka city are among the client groups of street and brothel based FSWs. The report shows as many as 50% and 72.8% of the rickshaw pullers having sex with FSWs in the last month and 12 months, respectively, mostly without consistently using a condom. As more than 2 million rickshaws are estimated to be operating nationwide and with 0.3 million in Dhaka city (pulled by more than 0.5 million rickshaw pullers), the HIV-related risk behaviors of the rickshaw pullers may have a substantial impact on the future course of the HIV epidemic in Bangladesh. However, one study conducted by Population Council in 6 areas of Dhaka division including 2 areas of Dhaka city demonstrated only 2.69% of married pullers having sex with FSWs in the last 3 months. In addition, in spite of such a potential importance of this population in the context of the HIV epidemic in Bangladesh, there is little intervention activities toward this population; even the correlates of the HIV-related risk behaviors which are critical for a focused intervention program have never been identified. We therefore decided to conduct a cross-sectional study on the HIVrelated risk behavior of rickshaw pullers of Dhaka city in a specified geographical area to accurately describe the HIV-related risk behavior profile of this population and its correlates using probability samples.

Some important High-Risk factors for spread of HIV in Bangladesh:

Poverty and high population density. Neighboring countries highly affected with HIV/AIDS. Inadequate awareness among general population.
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High External migration & internal migration Unsafe blood transfusion and injection practices High STI among the CSWs Existence of Pre-marital and extra-marital sex2More than 70% of Truckers and rickshaw pullers have regular sex with FSWs HBSWs have around 44 clients/worker/week Brothel-SWs have around 19 (18.8) clients/worker/week 70% of IDUs actively or passively share needles 57% of IDUs visit female sex workers, 10% transgender or Hijra (shemale) Cultural factors (Lack of empowerment of women, especially to negotiate for safer sex) A large number of young people are drug addicted

HIV Surveillance System in Bangladesh:

In 1998, the Government of Bangladesh set up the National HIV Surveillance System. This surveillance system is based on the UNAIDS/WHO Guidelines for Second Generation Surveillance which not only monitors the spread of HIV epidemic serological surveillance but also tracks the risk behaviors that provides warning signs for the spread of HIV epidemic. Till date seven rounds of HIV Surveillance have been conducted.

Improvement of HIV treatment and care countrywide:

According to new data in the 2009 AIDS epidemic update, new HIV infections have been reduced by 17% over the past eight years. Since 2001, when the United Nations Declaration of Commitment on HIV/AIDS was signed, the number of new infections in sub-Saharan Africa is approximately 15% lower, which is about 400,000 fewer infections in 2008. In East Asia new HIV infections declined by nearly 25% and in South and South East Asia by 10% in the same time period. In Eastern Europe, after a dramatic increase in new infections among injecting drug users, the epidemic has leveled off considerably. However, in some countries there are signs that new HIV infections are rising again.

Conclusion: HIV/AIDS is still incurable. Medical science is yet to get the medication against the disease. For the human civilization this disease has been a great damaging factor. To save our future we need to have one idea and that is Prevention is better than cure.

Reference:

http://www.unaids.org/en/
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http://www.bdnasp.net/ http://www.whoban.org/hiv_aids.html http://www.unicef.org/bangladesh/hiv_aids_387.htm http://www.baids.org/ http://www.unaids.org/globalreport/Global_report.htm http://www.globalhealthfacts.org/topic.jsp

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