HIV/AIDS

Abstain, Be faithful, Condomise

PREPARED BY PREPARED FOR

NAZIFA QARINA DR. SHAIKH ABDUS SALAM
ID: 063 539 045
PBH101
Sec: 7
 What is HIV/AIDS?

Human immunodeficiency virus (HIV) is a lentivirus (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. Infection with HIV occurs by the
transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is
present as both free virus particles and virus within infected immune cells. The four major routes of
transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected
mother to her baby at birth (vertical transmission). Screening of blood products for HIV has largely
eliminated transmission through blood transfusions or infected blood products in the developed world.

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 2006, AIDS killed more than 25 million
AIDS: This refers to persons diagnosed people. HIV infects about 0.6% of the world's population. In 2005
with AIDS, based on the CDC definition in alone, AIDS claimed an estimated 2.4–3.3 million lives, of which
adults and adolescents and children. more than 570,000 were children. A third of these deaths are
occurring in Sub-Saharan Africa, retarding economic growth and
increasing poverty. According to current estimates, HIV is set to
HIV/AIDS: This refers to cases of HIV infect 90 million people in Africa, resulting in a minimum
infection, regardless of whether they have estimate of 18 million orphans. Antiretroviral treatment reduces
progressed to AIDS from the 39 areas (34 both the mortality and the morbidity of HIV infection, but routine
states and 5 U.S. dependent areas) that access to antiretroviral medication is not available in all
have had confidential name-based HIV
countries.
infection reporting long enough to
monitor trends. According to the number HIV infects primarily vital cells in the human immune system
of AIDS cases, these 34 states represent such as helper T cells (to be specific, CD4+ T cells), macrophages,
approximately 66% of the epidemic in the
and dendritic cells. HIV infection leads to low levels of CD4+ T
50 states and the District of Columbia.
cells through three main mechanisms: First, direct viral killing of
infected cells; second, increased rates of apoptosis in infected
cells; and third, killing of infected CD4+ T cells by CD8 cytotoxic
lymphocytes that recognize infected cells. When CD4+ T cell
numbers decline below a critical level, cell-mediated immunity is
lost, and the body becomes progressively more susceptible to opportunistic infections.

Most untreated people infected with HIV-1 eventually develop AIDS. These individuals mostly die from
opportunistic infections or malignancies associated with the progressive failure of the immune system.
HIV progresses to AIDS at a variable rate affected by viral, host, and environmental factors; most will
progress to AIDS within 10 years of HIV infection: some will have progressed much sooner, and some
will take much longer. Treatment with anti-retroviral increases the life expectancy of people infected
with HIV. Even after HIV has progressed to diagnosable AIDS, the average survival time with
antiretroviral therapy was estimated to be more than 5 years as of 2005. Without antiretroviral therapy,
someone who has AIDS typically dies within a year.
Acquired Immunodeficiency Syndrome (AIDS) is caused by the human immunodeficiency virus (HIV),
which destroys the cells in the human body that combat infections. Although recent medical advances
have caused a shift from the mindset of a terminal disease to one of a chronic, manageable condition in
some areas of the world, this new approach brings challenges of its own, as the disease is eventually
fatal (Ferri et. al 1997). HIV has brought about a global epidemic far more extensive than what was
predicted even a decade ago. The issue of HIV/AIDS is not only relevant to medical documentation, but
is complex and highly politically charged, affecting all communities regardless of race, age, or sexual
orientation (Ginsberg 1995). At the end of the year 2000, it was estimated that there were 36.1 million
adults and children living with HIV/AIDS, the vast majority of whom live in the developing world, with
more than twenty-five million living in the continent of Africa ("Global Summary of the HIV/AIDS
Epidemic, 2000" 2001).

Classification: HIV is a member of the genus Lentivirus, part of the family of Retroviridae. Lentiviruses
have many common morphologies and biological properties. Many species are infected by lentiviruses,
which are characteristically responsible for long-duration illnesses with a long incubation period.
Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA viruses. Upon entry of
the target cell, the viral RNA genome is converted to double-stranded DNA by a virally encoded reverse
transcriptase that is present in the virus particle. This viral DNA is then integrated into the cellular DNA
by a virally encoded integrate, along with host cellular co-factors, so that the genome can be
transcribed. After the virus has infected the cell, two pathways are possible: either the virus becomes
latent and the infected cell continues to function or the virus becomes active and replicates, and a large
number of virus particles that can then infect other cells are liberated.

There are two species of HIV known to exist: HIV-1 and HIV-2. HIV-1 is the virus that was initially
discovered and termed both LAV and HTLV-III. It is more virulent, more infective, and is the cause of the
majority of HIV infections globally. The lower infectivity of HIV-2 compared to HIV-1 implies that fewer
of those exposed to HIV-2 will be infected per exposure. Because of its relatively poor capacity for
transmission, HIV-2 is largely confined to West Africa.
HIV/AIDS WORLDWIDE
HIV/AIDS around the world
*Through 1996, an estimated 29.4 million
people worldwide had been infected with UNAIDS and the WHO estimate that AIDS has killed more than 25
HIV, of whom approximately 8.4 million million people since it was first recognized in 1981, making it one
have developed AIDS. of the most destructive pandemics in recorded history. Despite
recent improved access to antiretroviral treatment and care in
*Currently, an estimated 21.8 million
many regions of the world, the AIDS pandemic claimed an
adults and 830,000 children worldwide are
estimated 2.8 million (between 2.4 and 3.3 million) lives in 2005
living with HIV/AIDS.
of which more than half a million (570,000) were children.
*Approximately 42 percent of the 21.8
million adults living with HIV/AIDS In 2007, between 30.6 and 36.1 million people were believed to
worldwide are women; this proportion is live with HIV, and it killed an estimated 2.1 million people that
growing. year, including 330,000 children; there were 2.5 million new
infections.
*An estimated 3.1 million new HIV
infections occurred worldwide during
1996, that is, approximately 8,500
infections each day -- 7,500 in adults and
1,000 in children.

*By the year 2000, an estimated 40 million

people worldwide will be HIV-infected, 90
percent of them in developing countries. The latest statistics of the global HIV and AIDS were published by
UNAIDS in November 2009, and refer to the end of 2008.
*Through 1996, cumulative HIV/AIDS-
associated deaths worldwide numbered Estimate Range
approximately 5 million among adults and
People
1.4 million amongliving with HIV/AIDS in 2008
children. 33.4 million 31.1-35.8 million

*In 1996 Adults living with HIV/AIDS in 2008

alone, HIV/AIDS-associated 31.3 million 29.2-33.7 million
illnesses caused the deaths of
Women living with HIV/AIDS in 2008 15.7 million 14.2-17.2 million
approximately 1.5 million people
worldwide, including
Children an estimated
living with HIV/AIDS in 2008 2.1 million 1.2-2.9 million
350,000 children.
People newly infected with HIV in 2008 2.7 million 2.4-3.0 million
*By the year 2000, an estimated 5 to 10
Children
million children newly
under infected
10 years with
of age will HIV in 2008 0.43 million 0.24-0.61 million
be orphaned worldwide because of the
premature AIDS deaths
deaths in 2008 parents.
of HIV-infected 2.0 million 1.7-2.4 million

Childmore
*Worldwide, AIDS deaths
than in 2008
75 percent of all 0.28 million 0.15-0.41 million
adult HIV infections result from
heterosexual intercourse.

*Mother-to-child (vertical) transmission More than 25 million people have died of AIDS since 1981. Africa
has accounted for more than 90 percent has over 14 million AIDS orphans. At the end of 2008, women
of all HIV infections worldwide in infants accounted for 50% of all adults living with HIV worldwide
and children.
In developing and transitional countries, 9.5 million people are in immediate need of life-saving AIDS
drugs; of these, only 4 million (42%) are receiving the drugs.

The number of people living with HIV has risen from around 8 million in 1990 to 33 million today, and is
still growing. Around 67% of people living with HIV are in sub-Saharan Africa.

Regional statistics for HIV & AIDS, end of 2008

Region Adults & Adults & Adult Deaths of 

children  children  prevalence* adults &
living with newly infected children
HIV/AIDS

Sub-Saharan Africa 22.4 million 1.9 million 5.2% 1.4 million

North Africa & Middle 310,000 35,000 0.2% 20,000

East

South and South-East 3.8 million 280,000 0.3% 270,000

Asia

East Asia 850,000 75,000 <0.1% 59,000

Oceania 59,000 3900 0.3% 2,000

Latin America 2.0 million 170,000 0.6% 77,000

Caribbean 240,000 20,000 1.0% 12,000

Eastern Europe & 1.5 million 110,000 0.7% 87,000

Central Asia

North America 1.4 million 55,000 0.4% 25,000

Western & Central 850,000 30,000 0.3% 13,000

Europe

Global Total 33.4 million 2.7 million 0.8% 2.0 million

* Proportion of adults aged 15-49 who were living with HIV/AIDS

During 2008 more than two and a half million adults and children became infected with HIV (Human
Immunodeficiency Virus), the virus that causes AIDS. By the end of the year, an estimated 33.4 million
people worldwide were living with HIV/AIDS. The year also saw two million deaths from AIDS, despite
recent improvements in access to antiretroviral treatment.
Numbers of people living with, newly infected with, and killed by HIV (1990-2008)

The Source and Reservoir of HIV/AIDS

HIV is a relatively fragile virus. It is not spread by casual contact. It is not easy to "catch"; it must be
acquired. HIV is considered to be a fragile virus when exposed to air and room temperatures. Hepatitis B
(HBV) and hepatitis C (HCV) are both considered "stronger" viruses that can remain infectious for a
longer period of time. When these viruses are outside the human body, much depends on
environmental factors such as heat, cold, exposure to oxygen, etc.). HBV and HCV will be discussed later
in this course. The Chain of Infection provides a model for understanding how any infection is spread.
All of the components below must be present for an infection to occur.
The pathogenic microorganism is the
micro-organism that causes infection such
as bacteria, viruses, fungi and parasites.

The reservoir is the place where micro-

organisms live, such as in humans and
animals, in soils, food, plants, air or water.
The reservoir must meet the needs of the
pathogen in order for the pathogen to
survive and multiply.

The means of escape are how the micro- All of these components together are considered to be the
organism leaves the reservoir. "chain of infection". In the dental care setting, all of these factors
come into play in the spread or the control of infection. There
The method of transmission is how the
are effective strategies of infection control that will prevent
micro-organism moves from place to
place. infection transmission by interrupting one or more links in the
chain of infection.
The means of entry is how the micro-
organism enters the host. There must be Anyone who is infected with HIV can be the HIV source. As
an adequate number of organisms to above, transmission occurs primarily through infected blood,
cause infection.
semen, vaginal secretions or breast milk. Sweat, tears, saliva,
The host susceptibility is the person who urine and feces are not capable of transmitting HIV unless visibly
may become infected. contaminated with blood. In settings such as hospital operating
rooms, other fluids, like cerebrospinal fluid, synovial fluid,
pleural fluid, pericardial fluid and amniotic fluid may be
considered infectious if the source is HIV positive. These fluids
are generally not found outside the hospital setting, so we
consider the most common fluids -- blood, semen, vaginal
secretions and breast milk -- as infectious in the "real world."
Again, outside of the laboratory or medical and dental operation
situations, ONLY blood, semen, vaginal fluids and breast milk are considered to be infectious for HIV.

The youngest victims of HIV/AIDS are those who receive the virus at birth, or shortly after, through
breastfeeding. Testing for young women becomes particularly important because a caesarean section
birth, with no breastfeeding, can dramatically cut down the rate of transmission of the disease to the
children of HIV-positive mothers. When the virus is transmitted parentally, the symptoms of AIDS for
young children are similar to those of adults, although many of these children die before reaching
adolescence. During their life, children with HIV/AIDS often face discrimination within the community
with parents pulling kids out of schools and daycares because they don't want them near children with
HIV.
Acute HIV infection

Main symptoms of acute HIV infection.

The initial infection with HIV generally occurs after transfer of body fluids from an infected person to an
uninfected one. The first stage of infection, the primary, or acute infection, is a period of rapid viral
replication that immediately follows the individual's exposure to HIV leading to an abundance of virus in
the peripheral blood with levels of HIV commonly approaching several million viruses per mL
 Mode of transmission of HIV/AIDS

HIV is transmitted only through the intimate exchange of body fluids, specifically blood, semen, vaginal
fluid, and mother's milk (Dane and Miller 1990). HIV is
sometimes passed perinatally from mother to fetus, or through
breastfeeding (Mulvi-hill 1996). HIV levels in the bloodstream are
Main Known Modes of HIV Transmission
typically highest when a person is first infected and again in the
*Having vaginal or anal sex without a condom late stages of the illness. High-risk behaviors include unprotected
with someone who is infected. anal and vaginal intercourse (without condom) and intravenous
drug use. Before blood screening began in 1986, the virus was
*Having contact with the blood of someone
who has HIV. This could be having a blood also being contracted from transfusions and blood-clotting
transfusion from someone who is infected with agents.
HIV
Three main transmission routes for HIV -1 are there. HIV-2 is
*From a mother who has HIV to her baby: HIV
transmitted less frequently from pregnant mother her child and
can pass to the baby during pregnancy, during
the birth of the baby, or through breast- sexual route than HIV-1. Various modes of transmission of HIV
feeding. Only about one in three babies born to are -
HIV-positive mothers get HIV.
Sexual
*Receiving an injection from an unsterilized
needle that was previously used by someone Most of HIV infections are by unprotected sexual relationship.
with HIV. Transmission occurs when infected secretions of one person
*Heterosexual transmission is the route by come into contact with the genital, oral, or rectal mucous
which most people with AIDS have become membranes of other person. The use of latex condoms reduces
infected with HIV worldwide the risk of sexual transmission of HIV by more than 85%.
Spermicides may increase the transmission rate of HIV. It has
been found that medical circumcision may reduce the risk of
contracting the disease.

Blood or blood product

Transmission through this route is common in intravenous drug users, hemophiliacs and those who
receive blood transfusions and blood products. Health care workers like nurses, doctors, tattooing,
piercings etc. are high risk behavior and can lead to infection by HIV.

Pregnant Mother to Child

The transmission of the HIV from the mother to the child can occur during pregnancy, during childbirth
or through breast milk. The risk of transmission to the child is high in absence of treatment. With
treatment the rate and extent of transmission of the infection in newborn and fetus reduces
dramatically. For prophylaxis antiretroviral drugs are prescribed to infants also.

Other routes
HIV can also be transmitted by saliva, tears and urine of infected individuals but at present no data is
available.

Multiple infections

Unlike some other viruses, infection with HIV does not provide immunity against additional infections,
particularly in the case of more genetically distant viruses. Both inter- and intra-clade multiple infections
have been reported, and even associated with more rapid disease progression. Multiple infections are
divided into two categories depending on the timing of the acquisition of the second strain. Coinfection
refers to two strains that appear to have been acquired at the same time (or too close to distinguish).
Reinfection (or superinfection) is infection with a second strain at a measurable time after the first. Both
forms of dual infection have been reported for HIV in both acute and chronic infection around the
world.

Estimated per-act risk for acquisition

of HIV by exposure route (Note that risk rates may change due to other factors such as commercial sex
exposure, phase of HIV infection, presence or history of genital ulcers, and national income levels.)

Exposure Route Estimated infections

per 10,000 exposures
to an infected source

Blood transfusion 9,000

Childbirth 2,500

Needle-sharing injection drug use 67

Percutaneous needle stick 30

Receptive anal intercourse (2009 and 2010 studies) 170‡ (95% confidence interval 30-890) / 143* (95%
confidence interval 48-285)
Receptive anal intercourse (based on data of a 50
1992 study)*

Insertive anal intercourse for uncircumcised 62a (95% Confidence Interval 7-168)

men(2010 study)*

Insertive anal intercourse for circumcised 11a (95% Confidence Interval 2-24)

men(2010 study)*

Insertive anal intercourse (based on data of a 1992 6.5

study)*

Low-income country female-to-male‡ 38 (95% Confidence Interval 13-110)

Low-income country male-to-female‡ 30 (95% Confidence Interval 14–63)

Receptive penile-vaginal intercourse* 10

Insertive penile-vaginal intercourse* 5

Receptive oral intercourse*§ 1†b

Insertive oral intercourse*§ 0.5†b

*
 assuming no condom use
‡
 Pooled transmission probability estimate
§
 source refers to oral intercourse performed on a man

a
Note that other studies found insufficient evidence that male circumcision
protects against HIV infection or other sexually transmitted infections among men who have sex with men

†
 "best-guess estimate"

b
 Note that potential co-factors, such as oral trauma, sores, inflammation, concomitant sexually transmitted
infections,
ejaculation in the mouth, and systemic immune suppression, may increase HIV transmission rate.
Six common transmission categories are male-to-male sexual contact, injection drug use, male-to-male sexual
contact and injection drug use, high-risk heterosexual (male-female) contact, mother-to-child (perinatal)
transmission, and other (includes blood transfusions and unknown cause).

Following is the distribution of the estimated number of cases of AIDS among adults and adolescents by
transmission category in the 50 states and the District of Columbia. A breakdown by sex is provided where
appropriate.

Transmission Category Estimated # of AIDS Cases, in 2007

Adult and Adult and Total

Adolescent Male Adolescent Female

Male-to-male sexual contact 16,749 - 16,74

9

Injection drug use 3,750 2,260 6,010

Male-to-male sexual contact and injection drug use 1,664 - 1,664

High-risk heterosexual contact* 4,011 7,100 11,11

1

Other** 181 220 401

*Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
** Includes hemophilia, blood transfusion, perinatal exposure, and risk not reported or not identified.

Transmission Category Estimated # of AIDS Cases, Through 2007*

Adult and Adult and Total

Adolescent Male Adolescent Female
Male-to-male sexual contact 487,695 - 487,69
5
Injection drug use 175,704 80,155 255,85
9
Male-to-male sexual contact and injection drug use 71,242 - 71,242

High-risk heterosexual contact** 63,927 112,230 176,15

7
Other*** 12,108 6,158 18,266

*Includes persons with a diagnosis of AIDS from the beginning of the epidemic through 2007.
**Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
*** Includes hemophilia, blood transfusion, perinatal exposure, and risk not reported or not identified.

Who are at “High Risk Group” to get HIV/AIDS

A lot of people all around the world feel that only the persons belonging to the High Risk Group are vulnerable to
the HIV infections which lead to AIDS. But in reality, this is not at all true. Numerous studies all over the world have
proved that a massive number of AIDS patients come from the non-risk group. Here we should differentiate
between the High Risk and no risk group.

The High Risk Group includes those people who are most likely to get infected with HIV. This group includes
peoples like homosexuals, sex workers, drug addicts, people who favors open and unprotected sex and
polygamous persons etc.
According to the UNAIDS and WHO estimations approximately 33.2 million people are infected with HIV all over
the world. Moreover a huge chunk of people are unaware that they are infected with HIV. These people very easily
spread the infection. It has been seen that people who feel that they are not HIV prone can become easy victims of
HIV or AIDS due to the complacence factor. So, irrespective of your risk factor you must be well aware of the
various facets of HIV infection. Then only you can protect yourself from this lethal infection.

Of the estimated number of persons diagnosed with AIDS in the 50 states and the District of Columbia, persons’
ages at time of diagnosis were distributed as follows.

Age (Years) Estimated # of AIDS Cases in 2007 Cumulative Estimated # of AIDS

Cases, Through 2007*

Under 13 28 9,209

Ages 13-14 80 1,169

Ages 15-19 455 6,089

Ages 20-24 1,927 38,175

Ages 25-29 3,380 120,464

Ages 30-34 4,187 201,906

Ages 35-39 5,888 219,601

Ages 40-44 6,813 177,250

Ages 45-49 5,749 112,896

Ages 50-54 3,636 63,408

Ages 55-59 2,040 34,160

Ages 60-64 980 18,249

Ages 65 or older 800 15,853

*Includes persons with a diagnosis of AIDS from the beginning of the epidemic through 2007.

CDC tracks HIV/AIDS information on six racial and ethnic groups: American Indian/Alaska Native; Asian;
Black/African American; Hispanic/Latino; Native Hawaiian/Other Pacific Islander; and White.
Estimated numbers of AIDS cases in the 50 states and the District of Columbia, by race or ethnicity:

Race or Ethnicity Estimated # of AIDS Cases in 2007 Cumulative Estimated # of AIDS

Cases, Through 2007*

American Indian/Alaska Native 158 3,492

Asiana 475 7,511

Black/African American 17,507 426,003

Hispanic/Latinob 6,921 169,138

Native Hawaiian/Other Pacific 76 721

Islander

White 10,407 404,465

*Includes persons with a diagnosis of AIDS from the beginning of the epidemic through 2007.
a
Includes Asian/Pacific Islander legacy cases.
b
Hispanics/Latinos can be of any race.

The distribution of the estimated number of cases of AIDS, among children* in the 50 states and the District of
Columbia, by transmission categories were:

Transmission Category Estimated # of AIDS Cases in 2007 Cumulative Estimated # of AIDS

Cases Through 2007**

Perinatal 24 8,434

Other*** 4 775

*The term "children" refers to persons under age 13 years at the time of diagnosis. 
** Includes persons with a diagnosis of AIDS from the beginning of the epidemic through 2007.
***Includes hemophilia, blood transfusion, and risk not reported or not identified.

Injecting Drug Users (IDU)

HIV epidemics are exploding in places where injection drug use (IDU) is widespread and contaminated
needles are shared multiple times. AIDS is the number one cause of death in IDU populations. More
than 100 epidemics among injecting drug users have been documented globally.
 The size of the network, the degree to which needles and syringes are
shared, and the extent of contact with other injecting drug users influence
the speed and magnitude of the spread of HIV.

 Sizeable populations of injection drug users continue to spread

HIV in Russia, Ukraine and other Central Asian countries, China,
Southeast Asia, and parts of India and Latin America. Recently,
“From the first day I was injecting drug use has been on the rise in some African countries
introduced to heroin, I started as well.
injecting, and very soon I was on
 Injection drug use is associated with other high-risk behaviors,
the downhill road to hell . . . Life
including use of other drugs or alcohol, unprotected sex and sex
became so engaged with the
thought of where to get drugs,
with multiple partners.
where to inject them and where  Injecting drug users are stigmatized, marginalized, and likely face a
to get money for them that I punitive response from law enforcement that only fuels the
forgot I was a human being. epidemic.
Anytime or place I would get the  Those most vulnerable to infection are the regular sex partners of
chance to get a shot, I did, not injecting drug users.
caring whether others have used
the syringe or the needle.”

– Harikumar Singh Men Who Have Sex with Men (MSM)

(HIV positive; former drug addict; Early in the epidemic, HIV/AIDS was strongly associated with men who
independent consultant) have sex with men. In 1981–1982, the first articles appeared in the New
SASO (Social Awareness Service England Journal of Medicine and Morbidity and Mortality Weekly Report
Organization) describing cases of unusual opportunistic infections in homosexual men.

HIV/AIDS has plagued the MSM community for decades; AIDS is now the
number one cause of death in MSM populations. The worst HIV epidemics
among men who have sex with men have occurred in large Western cities
and in some large cities in Latin American and Asian Pacific countries.
Homophobia and the criminalization of homosexuality in some countries have driven men underground,
beyond the reach of most HIV-prevention and health services.

It was estimated that only 9 percent of men who have sex with men have access to prevention
programs. There is a great need for condoms and access to testing and counseling services. Behavior
change programs could promote the regular use of condoms and reduction of sex partners. Stigma and
fear of violence or rejection may inhibit men from seeking testing and counseling services.

Commercial sex workers and child victims of sexual exploitation

 Sex workers are among the groups at highest risk for contracting HIV.

 The nature of their work makes them susceptible to sexually transmitted infections, violence,
irregular or absent condom use and alcohol and substance abuse, all of which increase their risk
of contracting HIV. Sex workers are rarely in a position of power or finance to demand condom
use. 

 Sex work is illegal, hidden and highly stigmatized. It often occurs in dangerous environments
where violence, including gang rape, is common. Without legal protection there is no way to
prosecute violent offenders or enforce payment.

Prisoners

Living in overcrowded and chaotic conditions, prisoners are exposed to HIV/AIDS and other diseases that
are associated with high-risk behaviors, contaminated injecting drug and tattooing paraphernalia, and
violence, rape or consensual sex. They are among the groups least afforded access to proper nutrition
and health services for preventing and treating HIV/AIDS. Their lack of access to condoms and harm
reduction services and lack of knowledge of HIV transmission increase their vulnerability to infection.

Migrant and Mobile Populations

Migration and mobility of people have exacerbated HIV/AIDS

epidemics, although its role in spreading HIV varies widely in the
“Poverty provides the supply that meets degree of documentation. Numerous studies have concluded
the demand for cheap, even free, labor that frequent or long-term travel away from home is linked with
and sexual exploitation that feeds increased prevalence of risky sexual behaviors and increased
corruption – turning solid citizens into infection by HIV.
recruiters and providing incentive for
border guards, customs officials, police, Victims of Human Trafficking
bus drivers, boat captains, employers,
teachers, neighbors and families to look Human trafficking is widely referred to as a modern-day form of
the other way.” slavery. In search of an economic opportunity, poor women and
children, and less often men, may be unwittingly recruited by a
– Sara Friedman trafficker who illegally transports them across internal, national
Global AIDS Program Information Officer, and regional borders. Children are the most vulnerable to
Global Health Council trafficking. Estimates range from 600,000 adults and children to
more than 1 million annually; 80 percent of whom are females.
Victims of trafficking are vulnerable to contracting HIV/AIDS.
How to prevent HIV/AIDS

There's no vaccine to prevent HIV infection and no cure for AIDS. But it's possible to protect yourself and
others from infection. That means educating yourself about HIV and avoiding any behavior that allows
HIV-infected fluids — blood, semen, vaginal secretions and breast milk — into your body.

Taking simple steps to prevent getting or spreading HIV will pay off both for you and for those you love.
An easy way to remember how to prevent getting or spreading HIV through sex is to know your "ABCs."

 A stands for "abstinence" (not having sex of any kind). Abstaining from sexual activities,
including vaginal, anal, or oral sex, is the surest way to avoid HIV.

 B is for "be faithful." Being in a sexual relationship with only one partner who is also faithful to
you can help protect you. This limits your number of sexual partners and the possibility of
infection.

 C is for condoms. Using a male latex condom for all types of sexual contact can greatly lower
your risk of getting HIV during sex. If you or your partner is allergic to latex, use polyurethane
condoms. If your partner can’t or won’t use a condom, you can use a female condom. It may
protect against HIV, but it’s not as good as a male latex condom. “Natural” or “lambskin”
condoms don’t protect against HIV. Be aware that condoms don't provide complete protection
against HIV. The only sure protection is abstinence (not having sex of any kind).
 PEPFAR follows an ABC strategy through "population-specific interventions" that emphasize:

 Abstinence for youth, including the delay of sexual debut and abstinence until marriage

 Being tested for HIV and being faithful in marriage and monogamous relationships

 Correct and consistent use of condoms for those who practice high-risk behaviors.

Those who practice high-risk behaviors include "prostitutes, sexually active discordant couples [in which
one partner is known to have HIV], substance abusers, and others". The PEPFAR definition does not
include the promotion of condoms to young people in general. However, PEPFAR does say that its funds
may be used to support programs that deliver age-appropriate
"ABC information" for young people, provided they are informed
about failure rates of condoms, and provided the programs do
People who do not abstain should do not appear to present abstinence and condom use as equally
everything possible to reduce risk,
viable, alternative choices.
including using condoms.
“condoms, when distributed with educational materials as part
of a comprehensive prevention package, have been shown to
significantly lower sexual risk and activity, both among those
already sexually active and those who are not."  - UNAIDS,
October 2004.”

If you're HIV-negative
the following measures can help keep you from being infected with HIV:

 Educate yourself and others. Make sure you understand what HIV is and how the virus is
transmitted. Just as important, teach your children about HIV.

 Know the HIV status of any sexual partner. Don't engage in unprotected sex unless you're
absolutely certain your partner isn't infected with HIV.

 Use a new latex or polyurethane condom every time you have sex. If you don't know the HIV
status of your partner, use a new latex condom every time you have anal or vaginal sex. Women
can use a female condom. If you're allergic to latex, use a plastic (polyurethane) condom. Avoid
lambskin condoms — they don't protect you from HIV. Use only water-based lubricants, not
petroleum jelly, cold cream or oils. Oil-based lubricants can weaken condoms and cause them to
break. During oral sex use a condom, dental dam — a piece of medical-grade latex — or plastic
wrap. Remember that although condoms can reduce your risk of contracting HIV, they don't
eliminate the risk entirely. Condoms can break or develop small tears, and they may not always
be used properly.
  Consider male circumcision. A large study in 2006 by the National Institutes of Health (NIH)
showed that medically performed circumcision significantly reduced a man's risk of acquiring
HIV through heterosexual intercourse. The study, conducted in Kenya, showed a 53 percent
reduction of HIV infection in circumcised HIV-negative men compared with uncircumcised men
in the study. The outcome was heralded by the NIH as good news not only because it reduced
the number of HIV-infected men, but also because it could lead to fewer infections among
women in areas of the world where HIV is spread primarily through heterosexual intercourse.

 Use a clean needle. If you use a needle to inject drugs, make sure it's sterile, and don't share it.
Take advantage of needle exchange programs in your community and consider seeking help for
your drug use.

 Be cautious about blood products in certain countries.Although the blood supply in the United
States is now well screened, this isn't always the case in other countries. If an emergency
requires that you receive blood or blood products in another country, get tested for HIV as soon
as you return home.

 Get regular screening tests. If you are a woman, have a yearly Pap test. And if you're a man or
woman who has had sex with one or more new partners, be tested annually. Men and women
who engage in anal sex should also have regular tests for anal cancer.

 Don't become complacent. Because potent anti-retroviral medications have reduced the

number of AIDS deaths in the United States, you may think that HIV infection is no longer a
problem. But HIV/AIDS is still a terminal illness for which there is no vaccine and no cure. Right
now, the only way to stay healthy is to protect yourself and others from infection.

If you're HIV-positive
if you've received a diagnosis of HIV/AIDS, the following guidelines can help protect others:

 Follow safe-sex practices. The only foolproof way to protect others from infection is to avoid
practices that expose them to blood, semen or vaginal secretions. Barring that, carefully follow
guidelines for safe sex, including using a new latex condom every time you have vaginal or anal
sex and using a dental dam, condom or piece of plastic wrap during oral sex. If you use sexual
devices, don't share them. It's also important to avoid having unprotected sex with other HIV-
positive people because of the risk of acquiring or passing on a drug-resistant strain of the virus.

 Tell your sexual partners you have HIV. It's important to tell anyone with whom you've had sex
that you're HIV-positive. Your partners need to be tested and to receive medical care if they
have the virus. They also need to know their HIV status so that they don't infect others.
  If your partner is pregnant, tell her you have HIV. Be
Prevent HIV after Exposure
sure to tell any pregnant woman with whom you've had
If you think that the blood or genital fluids sex that you're HIV-positive. She needs to receive
of someone you know or suspect to have treatment to protect her own health and that of her
HIV has entered your body, see a doctor baby.
right away. Some research shows that you
may be able to prevent HIV infection after  Tell others who need to know. Although only you can
exposure if you start taking anti-HIV drugs decide whether to tell friends and family about your
within three days of exposure and illness, you do need to inform your health care providers
continue treatment for 28 days. of your HIV status. This is not just to protect them, but
also to ensure that you get the best possible medical
care.

 Don't share needles or syringes. If you use intravenous drugs, never share your needles and
syringes.

 Don't donate blood or organs. The virus will spread to other people.

 Don't share razor blades or toothbrushes. These items may carry traces of HIV-infected blood.

 If you're pregnant, get medical care right away. If you're HIV-positive, you may pass the
infection to your baby. But if you receive treatment during pregnancy, you can cut your baby's
risk by as much as two-thirds.

Treatments in development

Media reports in 2008 and a publication in the New England Journal of Medicine in 2009 described the
anecdotal case of an HIV-positive patient of a Berlin doctor, Gero Hütter. The patient, who had
both acute myelogenous leukemia (AML) and HIV infection, was said by some to be "functionally cured"
of his HIV following a bone marrow transplant for AML. The bone marrow donor had been selected
as homozygous for a CCR5-Δ32 mutation (which confers resistance to "almost all strains of HIV"). After
600 days without antiretroviral drug treatment, HIV levels in the patient's blood,bone marrow and
bowel were below the limit of detection, although the authors note that the virus is likely present in
other tissues. Researchers cautioned that it would be premature to consider this treatment a possible
cure because of its anecdotal nature, the mortality risk associated with bone marrow transplants and
other concerns.

In 2010, a chemical called BanLec was reported to be a potent inhibitor of HIV replication.. Researchers

at the University of Michigan determined that BanLec bound to the HIV-1 envelope protein gp120,
which is high in sugar content, inhibiting viral entry into human cells. The researchers suggest that such
an inhibitor of HIV infection may find use as a topical treatment, such as a vaginal microbicide, and may
be cheaper to produce than current antiviral topical treatments. BanLec is not FDA approved for the
treatment of HIV-1 infection and it should not be used to treat or prevent HIV-1 infection.
Abacavir - a nucleoside analog reverse transcriptase inhibitors (NARTIs or NRTIs)

WORLD AIDS DAY

World AIDS Day, observed December 1 each year, is dedicated to raising awareness of the AIDS
pandemic caused by the spread of HIV infection. It is common to hold memorials to honor persons who
have died from HIV/AIDS on this day. Government and health officials also observe the event, often with
speeches or forums on the AIDS topics. Since 1995, the President of the United States has made an
official proclamation on World AIDS Day. Governments of other nations have followed suit and issued
similar announcements.

By respecting and protecting ourselves and others we can stop the spread of HIV and end HIV prejudice.
What does Respect & Protect mean to you?

5 things you can do to Respect & Protect:

 Find out the facts about HIV and talk to your friends, family and colleagues about HIV – make
sure they know the reality, not the myths.

 Know your HIV status: get tested if you have put yourself at risk.

What can we do?

Don’t hide; In the middle of our busy lives, our first instinct might be to ignore the problem and hope it
goes away. We can’t do that if we’re going to love those suffering with AIDS as we love ourselves.

You can get involved with the numerous events that are taking place around the world, or choose one of
these ways to help stop AIDS:

 Call the CDC National STD Hotline at 1-800-CDC-INFO (232-4636) in English or español or TTY: 1-
888-232-6348. Health communication specialists are available 24 hours per day and "offer
anonymous, confidential HIV/AIDS information to the American public. They also provide
referrals to appropriate services, including clinics, hospitals, local hotlines, counseling and
testing sites, legal services, health departments, support groups, educational organizations, and
service agencies throughout the United States."

 Use your computer to help "assist fundamental research to discover new drugs, using our
growing knowledge of the structural biology of AIDS." No scientific expertise needed. Through
distributed computing, your idle hard drive does all the work.
 Get tested so that you will know your HIV status and can protect yourself, you sexual partners
and those you love. Act responsibly. Get help if you have trouble doing so.
  Participate in research. A good friend of mine is involved in an HIV vaccine trial. Like her, you
may be able to help scientists and physicians develop new treatments, drugs or vaccines that
fight HIV and AIDS. Also consider the HIV Vaccine Trials Network and the International AIDS
Vaccine Initiative. Remember, you can support research by donating time, money or resources,
in addition to being a study participant.
 Donate time, money, or resources to an HIV/AIDS organization.

We can stop this disease. We have to.