Prevention Of Hiv Std Aids In Community

PREVENTION OF HIV/ STD/ AIDS IN COMMUNITY Dr. Abe Mathew Paper Presentation

PRIMARY PREVENTION • HEALTH PROMOTION • SPECIFIC PROTECTION • TESTING AND COUNSELLING SECONDARY PREVENTION

HEALTH PROMOTION (A)HEALTH EDUCATION: ‘ONLY VACCINE’ ROLE OF MEDIA/ RADIO/ ELECTRONIC MAILING LISTS. SHOULD COVER: 1. CAUSE, EFFECT, INCURABILITY 2. MODE OF TRANSMISSION 3. A,B,C + ‘HOPE’ 4. USAGE OF DISPOSABLE SYRINGES 5. AVOID NEEDLE SHARING (B) EXAMINATION AND REHABILITATION OF PROSTITUTES. (C) CONTROL OF STD’S AND DRUG ABUSE.

Why Mailing lists are more popular? • Easy to set up • Setting up is free/ low cost/ no full time staff • Information goes to individual subscribers. • Fast and economical ENCOURAGE HIV POSITIVE PEOPLE TO SPEAK OUT IN PUBLIC – THEY ARE EFFECTIVE HEALTH EDUCATORS. CAN MAKE THE PUBLIC MORE AWARE OF THE PANDEMIC.

SPECIFIC PROTECTION 1. PROTECTION AGAINST SEXUAL TRANSMISSION 2. PROTECTION AGAINST SPREAD THRO’ TRANSFUSION HIV testing by ELISA. Discourage donors giving H/O multiple sex partners. Carry transfusion only if necessary.

3. PROTECTION AGAINST SPREAD THRO’ SYRINGES Boil all contaminated linen Wash hands before and after contact Gloves, aprons, masks at lab; obstetric and dental OP; STD clinics/ injection rooms. Dispose needles into plastic bottle and incinerated when full. If pricked – bleed and wash well with soap and water.

TESTING AND COUNSELLING • TESTING: SCREENING TESTS: Sensitive test – ELISA Confirmatory test - Western Blot – detects specific antibody to p24 and gp41. VIRUS ISOLATION MANDATORY/ VOLUNTARY

COUNSELING: Continued dialogue between care provider and client. Decision to take test/ cope up with stress/ planning for future actions. How does it help? Express his/ her concern about risks. Provides information about AIDS. Follow methods of risk reduction Enables his/ her capacity to cope with anxiety Can be referred to a medical institution where treatment/ supportive services is available.

Counseling of 2 kinds:

• Pre-Test counseling: To discuss the tests and the possible impact of knowing one’s sero-status Enabled to decide whether to take test or not.

OTHER MEASURES: Better nutrition Prevention, detection and early treatment of STD’s Marriage counselling

• Post test counseling: Done after subjected to test. If +ve – moral and physical support; adopt low risk behavior; referred to medical institution/ welfare agencies.

SECONDARY PREVENTION 1. HIV CARRIERS: Informed about long IP. Educated not to share needles/ syringes/ donate blood To keep cuts/ bruises covered with plaster. 2. TREATMENT: (A)DRUGS:

(A)NRTI’s: Zidovudine: 500-600mg (O) in 2 or 3 divided doses. SE: Anemia. Didanosine: 12-300mg (O) BD. SE: PN, hep, pancreatitis. Stavudine: 40mg BD(O). SE: same. Zalcitabine: 0.375 – 0.75mg (O) TDS. SE: PN, aphthous ulcers. Lamivudine: 150mg BD. SE: PN, rash

(B)NNRTI’s: Nevirapine: 200mg OD x 2 weeks; then BD. SE: rash Delaviridine: 400mg TDS. SE: rash. (C)PI: Saquinavir: 600mg TDS. SE: GI distress. Ritonavir: 600mg BD or 400mg BD in combination with other PI’s. SE: GIT. Indinavir: 800mg TDS. SE: Kidney stones. Nelfinavir: 750mg TDS. SE: dairrhoea.

EVOLUTION OF THERAPY: Monotherapy – resistance. 2 drug combinations: ZDV + 3TC; ZDV + ddl; Saquinavir and Ritonavir. Benefits not persistent and resistance. Triple therapy: one PI (Indinavir) and 2 NRTI’s (ZDV and 3TC). PEP: • AZT (200mg TDS) + 3TC (150mg BD) x 4 weeks • Advanced AIDS: PI (nelfinavir) added – 750mg TDS. • Failed on AZT/3TC; stavudine + ddl used instead.

OPPORTUNISTIC INFECTIONS: P. carinii pneumonia: <200cells/ul; trimethoprimsulphamethoxazole, dapsone. M. avium: Rifabutin. M. tuberculosis: 300mg INH daily x 9 months.. Kaposi’s sarcoma: interferon/ chemotherapy/ radiation. CMV retinitis: ganciclovir Cryptococcal meningitis: fluconazole. Esophageal candidiasis: fluconazole/ ketoconazole HS: acyclovir

• REFERENCES: Oxford Book on Community health Principles of Community Medicine (Dr. Sridhar Rao) Park and Park