2. OBJECTIVES
To create awareness of the seriousness of the disease
Ensure that people of Karachi/Sindh are equipped with knowledge and tools to protect themselves
Reduce transmission of HIV and other STI infections through blood and blood products
In case of infection, the patient should be encouraged to seek treatment
Infra Structure and Services on Ground
Provincial Implementation UNIT (PIU)
At I&I Depot, Rafiqui Shaheed Road near JPMC cantt Karachi.
Referral Lab Established for laboratory diagnosis and confirmation of HIV/AIDS Cases & Sexually
Transmitted Infections CHK.
Voluntary Counseling & Testing centers
21 VCT Centers have been Established for screening of HIV/AIDS cases
STIs clinics 46 STIs Clinics have been Established at teaching and DHQ hospitals for management
of STI,s
Establishment of Resource Center With Facilities of Digital Library. For trainees and
projects staff at I. I Depot, Rafique Shaheed Road near JPMC cantt Karachi
PPTCT Centers 03 (Prevention of Parents to Child Transmission)

3. ORIGIN OF HIV
History of HIV/AIDS
HIV came from a similar virus found in chimpanzees - SIV.
HIV probably entered the United States around 1970
CDC in 1981 noticed unusual clusters of Kaposi’s sarcoma in gay men in New
York and San Francisco, which led to the disease to be called GRID (Gay
Related Immune Deficiency).
By 1982 the disease was apparent in heterosexuals and was renamed AIDS
(Acquired Immune Deficiency).

4. Dr Munawar Khan Bcc SACP
2006 History
US National Institutes of Health revealed
the results of two African trials of male
circumcision as an HIV prevention
method with clear evidence that the
intervention reduced HIV
transmission by around 50%.
+ The WHO and other organizations
suggested they would soon begin
promoting male circumcision in areas with
severe HIV epidemics.
Global summary of the AIDS epidemic  2011
34.2 million
30.7 million
16.7 million
3.4 million
2.5 million
2.2 million
330 000
1.7 million
1.5 million
230 000
Number of people
living with HIV
People newly infected
with HIV in 2011
AIDS deaths in 2011
Total
Adults
Women
Children (<15 years)
Total
Adults
Children (<15 years)
Total
Adults
Children (<15 years)
Dr Munawar Khan Bcc SACP
1

5. GLOBAL SITUATION
Every minute, 9 more persons
become
HIV positive
Every minute, 6 persons die of an
AIDS
related illness
Dr Munawar Khan Bcc SACP

6. 28
HIV/AIDS in Pakistan
•Pakistan is going through a transition of the
HIV epidemic; from a low Prevalence state to a
concentrated epidemic.
•Although the estimated prevalence among the
general population is less than 0.1% in the
country,
• Recent surveillance results clearly indicate
that the epidemic is becoming established
among certain high risk groups (HRGs).
Dr Munawar Khan Bcc SACP
SUGGESTIVE HISTORY & RISK
FACTORS
RISK FACTORS/RISK BEHAVIOURS
 People with recent or prior STI’s
 Commercial sex workers & their partners
 Homosexuals
 Travelers to high prevalence areas
 Sexually active injection drug users
 Sexual partners of at risk persons
 Recipients of blood products prior to HIV
screening
 Children born to HIV positive mothers
 People with multiple sexual partners
Dr Munawar Khan Bcc

7. 31
A combination of risk factors is
currently putting Pakistan at serious
risk of further transmission from high
to low risk groups through bridging
populations.
Pakistan’s HIV epidemic
Dr Munawar Khan Bcc
Example of high risk sexual
networks in a population
FSW Male Clients
IDU
General Population
Women
MSW
Dr Munawar Khan Bcc32

8. Dr Munawar Khan Bcc
HISTORY OF HIV IN PAKISTAN
 1986 – An African Sailor Died in Karachi
 1987 – First Pakistani Citizen Diagnosed with
AIDS in Lahore
 1987 – First Husband-Wife-Child transmission of
HIV occurred in Rawalpindi
 1993 – First Breastfed Baby gets AIDS in
Karachi
 2003 First outbreak among Injecting Drug
Users was identified in Larkano
HIV & AIDS in Pakistan
(2nd Quarter 2010)
 Total Estimated Cases = 106000 and 45-50% are
belongs to Sindh and 80% of this are in Karachi.
 Total reported HIV & AIDS cases in the country
are = 7574
 HIV Positive – 7049
 AIDS Cases – 525
Dr Munawar Bcc
35

9. District wise HIV/AIDS Registered Patients in
Sindh till 30th September 2012
District HIV Positive Percentage
AIDS
Positive
Percentage Total
SINDH
Karachi 3714 74.94 67 29.65 3781
Larkana 313 6.32 3 1.33 316
Hyderabad 55 1.11 2 0.88 57
Sukkur 40 0.81 0 0.00 40
Mirpurkhas 11 0.22 1 0.44 12
Dadu 16 0.32 2 0.88 18
Jacobabad 7 0.14 0 0.00 7
Sanghar 79 1.59 0 0.00 79
Sh. Benazirabad Nawabshah 6 0.12 1 0.44 7
Jamshoro 1 0.02 0 0.00 1
Shikarpur 6 0.12 1 0.44 7
Qambar 10 0.20 0 0.00 10
Thatta 9 0.18 1 0.44 10
Matiyari 1 0.02 0 0.00 1
Kashmor 3 0.06 0 0.00 3
Khairpur 4 0.08 0 0.00 4
Tarparkar 1 0.02 0 0.00 1
Ghotiki 4 0.08 0 0.00 4
Badin 5 0.10 0 0.00 5
Naushahroferoz 1 0.02 1 0.44 2
Unknown 377 7.61 136 60.18 513
Sub-Total 4663 94.09 215 95.13 4878
Dr Munawar Khan Bcc SACP
DECEMBER 2011 4th Round
 Sindh is in the concentrated phase of epidemic
among :
 IDU’s = 42%
 Hijra Sex workers =15.45%
Dr Munawar Khan Bcc SACP

10. HIV/AIDS Surveillance
Round-4 results
Dr Munawar Khan Bcc SACP
IDU MSW HSW
Total
FSW
HFS
W
BFSW SFSW KKFSW
Beg
FSW
MFS
W
Karachi
Total Tested 361 353 351 392 131 30 75 96 30 30
Positives 151 20 41 7 6 0 0 1 0 0
% Positives 42 6 12 2 5 0 0 1 0 0
Larkana
Total Tested 363 359 373 378 285 47 19 27 0 0
Positives 68 11 53 7 1 2 2 2 0 0
% Positives 19 3 14 2 0 4 11 7 0 0
Sukkur
Total Tested 334 209 166 178 125 0 33 20 0 0
Positives 58 1 6 1 0 0 1 0 0 0
% Positives 17 0 4 1 0 0 3 0 0 0
Dadu
Total Tested 150 0 0 0 0 0 0 0 0 0
Positives 24 0 0 0 0 0 0 0 0 0
%
Positives
16 0 0 0 0 0 0 0 0 0
 HIV epidemic is still considered ‘low’ or
‘concentrated,’ confined mainly to individuals who
engage in high risk behaviors but less than five
percent,
 An epidemic is considered ‘concentrated’ when less
than one per cent of the general population but more
than five per cent of any ‘high risk’ group are HIV-
positive
 An epidemic is considered ‘generalized’ when more
than one per cent of the general population is HIV-
positive.
Dr Munawar Khan Bcc SACP

11. 3
Basicsabout HIV / AIDS
• What is HIV/AIDS
• How HIV/AIDS can be transmitted
• How HIV/AIDS cannot be transmitted
• People that are especially vulnerable
to HIV/AIDS
4
HIV/AIDS
• H – Human
• I – Immuno Deficiency
• V – Virus
• A – Acquired
• I - Immuno
• D – Deficiency
• S - Syndrome
HIV IS A VIRUS &
IS AN INFECTION
AIDS IS A STAGE &
NOT A DISEASE

12. HIV is short for:
Human Immuno deficiency Virus.
Once infected with HIV, a person is referred to as HIV positive. However, this does not necessarily
mean that (s)he has symptoms or feels sick. An HIV positive person can feel and look healthy for a
long time after first becoming infected.
What is AIDS?
AIDS, or Acquired Immune Deficiency Syndrome, can take many years to develop.
Eventually, the virus kills or impairs more and more cells in the immune system and the
body loses the ability to fight off common infections, such as diarrhea or colds. People with
AIDS can die from diseases that are usually not dangerous for people with healthy immune
systems.
A
I
D
S
Infections in relation to CD4+ cell
count
400
300
200
100
50
Herpes Zoster
Tuberculosis
Oral Candidiasis
Esophageal Candidiasis
Mucocutaneous herpes
PCP
Toxoplasmosis
Cryptococcosis
(Mycobacterium avium complex ) MAC
(Cytomegalovirus) CMV
(Progressive Multifocal Leuko encephalopathy) PML
Cryptosporiodiosis
TimeDr Munawar Khan Bcc SACP
88
From HIV to AIDS
Aids is diagnosed when your CD 4 blood count is at 200 or lower and you have an
opportunistic infection (i.e. Kaposi’s Sarcoma or PCP (This is a set point for medical
diagnosis)
A healthy blood count may range from 800 to 1200 CD4

13. How HIV can be transmitted
Unprotected sexual contact – be it vaginal, oral, or anal - with an infected partner
Sharing unsterilized needles or syringes with an HIV positive person, for example, when
using drugs or in a healthcare setting.
During pregnancy or birth and through breastfeeding from an HIV positive mother to her
baby.
Blood transfusions with infected blood
Major Symptoms
Loss of more than 10% of body weight
Chronic diarrhea
Prolonged fever
People Infected with HIV
 Can look healthy
 Can be unaware of their infection
 Can live long productive lives when their HIV
infection is managed
 Can infect people when they engage in high-risk
behavior
Dr Munawar Khan Bcc SACP
102
Minor Symptoms
Cough for more than a month
Generalised itchy skin rash
Painful group of blisters all over the body
Generalised swollen lymph glands
White curd like patched on tongue/throat

14. How you know?
 You can’t identify a person who carry HIV
and in most cases, he/she himself doesn’t know about it. You can
found out the virus only in HIV tests. A person can carry the virus for
many years, he can be seen, feel and function as usual,.
 Don’t hope from your partner to tell you, that he/she carry the HIV
virus. Because most people living with the virus are feared from
rejection and anger, even though you love each other.
 The responsibility defending your health is only in your hands!
Dr Munawar Khan Bcc SACP
103
HIV/AIDS – MYTHS
There is a cure for HIV/AIDS
Restricted to certain group/ community/country
Sex with virgin can cure AIDS
Is not a major problem in Pakistan
Presence of STD is a pre requisite for HIV infection
HIV/AIDS – THE DIFFICULTIES
Sensitive issue
Non availability of true information/Data
Very low level of awareness/concern
Socio-economically marginalized people are the most vulnerable,
who are difficult to approach
they are unable to access
CONCENTRATION OF VIRUS
Blood, Menstrual Blood – Very High
Vaginal Fluids, Semen, Pre ejaculate Fluid – High
Bone Marrow – High
Saliva – No
Sweat, Tears, urine – No
How HIV can NOT be transmitted
Through air or by coughing and sneezing
Through food or water
Through sweat and tears
By sharing cups, plates, and utensils with an infected person
By touching, hugging and kissing an infected person
By sharing clothes or shaking hands with an infected person
By sharing toilets and bathrooms with an infected person
By living with an infected person

15. By mosquitoes, fleas, or other insects
MODES OF TRANSMISSION
Blood/Blood products, tissues, organs- More than 90%
Sexual Intercourse - 0.1 to 1% (however frequency is high causing high rate of infection)
IDU – 0.5 to 1 %
Parent to child – 30%
HIV Test
Common Method of HIV test is –
Rapid Test
ELISA (common method of HIV test in Pakistan)
Western Blot
PCR
Populations particularly at risk
A person who:
Uses shared/contaminated needles and syringes
Has a sexually transmitted infections(STIs)
Has anal sex with her/his partner(s)
Exchanges sex for money or drugs
Has many sex partners
Leads life separated from spouse due to professional obligations
(e.g., truck drivers, laborers, migrants)
Women and HIV
Social Risk Factors
Illiteracy
Lack of awareness of preventive measures
Biological risk factors
Twice as easy for women to contract HIV from men
Physiology of women (e.g., menstruation, intercourse)
Pregnancy-associated conditions (e.g., anemia, hemorrhage) increase the need for blood
transfusion
Taboo and Stigma
Stigma derives from the association of HIV/AIDS with sex, disease and death, and with behaviours
that may be illegal, forbidden or taboo, such as pre- and extramarital sex, sex work, sex between
men, and injecting drug use.
Stigma builds upon, and reinforces, existing prejudices.
PREVENTION
Take blood from licensed blood bank
Make sure the blood has the stamp of HIV FREE on it
Avoid single unit BT
Avoid sharing needles
Take your own disposable syringe
Safer sex practices
Abstinence
Delay first intercourse

16. Less number of partners
Be faithful to each other
Masturbation
Non penetrative sex
Proper & consistent use of condom
Creating awareness on HIV/AIDS and safe sex
But HIV/AIDS does not discriminate
Everybody is vulnerable. The virus is not restricted to any age group, race, social class, gender, or
religion. In many countries of Asia and the Pacific HIV/AIDS has spread to the general population.
No country is immune to the epidemic
The HIV/AIDS epidemic can spread very quickly
Low HIV prevalence rates in the general population of a country can conceal serious epidemics in
smaller, high-risk groups or in certain areas
The epidemic can quickly cross over from high-risk groups to the general population
Impact of HIV/AIDS
HIV/AIDS has an impact on all bodies responsible for planning and allocation of
resources and education services such as...
 Schools and Universities
 Ministries
 Departments
 Agencies / Organizations
 Policy makers
 Religious and Faith based organizations
What the Community Leaders can and should do
The consequences of inaction
There is hope
Why education is crucial in the fight against HIV/AIDS
Approaches to take Next steps
How to fight HIV/AIDS
Develop appropriate policies
Ensure adequate planning and management
Focus on prevention/awareness
Reduce vulnerability
Introduce or upgrade life skills education
Promote a culture of compassion and care

17. Awareness is the only way
There are no cures or vaccines for HIV/AIDS. Currently awareness/education is the only way to
prevent infection.
Preventive education also means preventing stigma, denial, and discrimination.
HIV/ADS is associated with sex, disease, and death, and with behaviors that may be illegal,
forbidden or taboo, such as pre- and extramarital sex, sex work, sex between men, and injecting
drug use. Awareness will reduce the HIV vulnerability.
 Once a person is infected s/he is always infected
 Medications are available to prolong life but they do
not cure the disease
 Those who are infected are capable of infecting
others without having symptoms or knowing of the
infection
HIV AIDS
Dr Munawar Khan Bcc
106
Watch your self
It is only in your hands
Dr Munawar Khan Bcc S104

18. Challenges
Break the silence on HIV and AIDS
End stigmatization and discrimination of PLWHA
119
Facts about AIDS
 No Curative Treatment available.
 No Vaccine.
BUT IT CAN BE PREVENTED
Dr Munawar Khan BCC SACP
BY
Dr. M. MUNAWAR KHAN
MBBS,DHMS,PGDPA,MAS,MRSH
Behavior Change Communication Coordinator
drkhan256@hotmail.com
pk.linkedin.com/pub/dr-m-munawar-khan-senior-medical-officer/21/a69/79/
www.slideshare.net/munawar256 www.authorstream.com/munawar256
0300-9240816