Punjab AIDS Control Program

7th Floor LDA Plaza, Lahore

Adopted
October 31, 2007

Syed Safdar Raza

A&B Development Consultants

&
Associates
 What is HIV?
 HIV is Human Immunodeficiency Virus, the organism
that causes AIDS. HIV is found in blood and other
body fluids (particularly semen, vaginal secretions
and breast milk) of persons infected with the virus.

 HIV infection affects the immune system. The immune

system is the body’s defence against infections by
micro-organisms that cause disease. The immune
system produces special cells called antibodies to
fight off or kill these micro-organisms. A special
weakness of the immune system is called an
immunodeficiency. Human immunodeficiency virus
(HIV) infects, and eventually destroys, the special
cells in the immune system.
 What is AIDS?
 AIDS (Acquired Immunodeficiency Syndrome) is
a condition caused by advanced HIV infection. It
occurs when a person’s immune system is
weakened due to HIV infection, which limits the
body’s natural ability to fight other infections and
diseases.
 How is HIV transmitted?
The virus can be transmitted in three ways:
1. Sexual transmission
 Through unprotected penetrative sexual intercourse
(oral, vaginal or anal).
2. Through blood and blood products
 Blood transfusion with contaminated blood

 Injecting drug use through contaminated needles and

equipment
 Other means such as tattooing, medical or other
instruments that are contaminated
3. From mother to child
 During pregnancy

 During delivery

 During breastfeeding
 How is HIV not transmitted?
HIV is not transmitted by:

 Shaking hands or hugging;

 Tears, sweat or saliva ;
 Sneezing or coughing ;
 Using other people's cutlery, glasses, plates or bed linen;
 Eating from the same plate;
 Using a toilet ;
 Dogs, cats or insect bites ; and
 Kissing or saliva
 What prevents HIV infection
HIV transmission can be prevented by:

 A: not having sex (abstinence);

 B: being faithful to one uninfected lifelong partner;

 C: consistent condom use;

 N: negotiation skills (empowering men and women to be

able to insist on safe sexual behaviour and/or injecting
practices); and
 What prevents HIV infection
 N: needle exchange programmes
 Blood safety

 Reduction of Sexually Transmitted Infections

 An environment that enables safe sexual and

injecting behaviour
 Information and knowledge on HIV and AIDS, how it
is transmitted and how it is prevented.
 An approach that stimulates responses which are
societal / communal rather than individual.
 Can HIV and AIDS be treated?
 There are at the moment no drugs that can cure HIV and
AIDS. There are, however, drugs that can treat the
infection and prolong life.

 Anti-retroviral drugs (ARVs) are drugs that fight the HIV

virus. The development of the ARVs is very rapid and at
this moment, a combination of three different drugs is given
to people on ARV treatment. This treatment is called Highly
Active Antiretroviral Treatment (HAART). The combination
of drugs needs to be changed regularly to avoid resistance.
A person who has started this treatment has to continue
taking the drugs for life. People can be on treatment when
they have tested HIV positive and have a certain antibody
count. ARVs are now available in Pakistan.
 What are STIs and what is the
relation with HIV?
 Sexually transmitted infections are infections that are
passed from person to person by sexual contact (vaginal,
anal or oral). These infections range from mild, easily
treatable irritations to serious diseases that can cause
infertility and even lead to death.

 The presence of STIs, especially those that have open

sores, increases the risk of acquiring and transmitting HIV
in both men and women.

 Women are more vulnerable for STI and HIV transmission

than men because of their physical characteristics: a larger
surface for exposure, a good breeding ground for infection
inside the body and a higher concentration of HIV in semen
than in vaginal and cervical fluids.
 Vulnerable Groups
In Pakistan the groups that are at a very high risk of HIV
infection are:
 IDUs (Intravenous Drug Users)

 Sex Workers

 MSM (Men having sex with Men)

 Mobile/migrant populations
 Prisoners
 Youth
 Intravenous Drug use and HIV
 Although smoking and inhalation is still the most
common form of drug use in Pakistan, injecting drug
use is increasingly common. HIV transmission
through injection directly into the blood vessel is very
effective and HIV can spread very rapidly among
IDUs, and from them to their sex partners and
children. However, this spread can be prevented or
slowed significantly if interventions are designed
which take into account specific local characteristics
of the IDUs.
 HIV/AIDS and blood safety
 There is a 90-95% chance that someone receiving
blood from an HIV infected donor will become infected
with HIV themselves. Millions of lives are saved each
year through blood transfusions, even in countries
where a safe blood supply is not guaranteed.
However, recipients of blood have an increased risk of
HIV-infection. This risk can be virtually prevented by
a safe blood supply, and by using blood transfusions
appropriately.
 Women and HIV
 Of the estimated 42 million people living with HIV/AIDS in
the world, women now constitute almost half of this number.
In Africa, more women than men are infected, but in
Pakistan, the ratio male-female infection is 7:1.

 This is because in every country the epidemic evolves

differently and also because early in the epidemic more
men than women are likely to be infected. Because of the
particular vulnerability of women, the risk of women
contracting HIV is rising worldwide. More than four-fifths of
all infected women get the virus from their male sex partner,
often by their one partner (their husband). The remainder
become infected from blood transfusions or from injecting
drugs with a contaminated needle.
 Women and HIV
 The risk of becoming infected with HIV during unprotected
vaginal intercourse is as much as 2-4 times higher for women
than men. One major reason for this is that women have a
larger surface area of mucosa (the thin lining of the vagina and
cervix) exposed to their partner’s secretions during sexual
intercourse.
 In many societies, the feminine ideal is characterized by
women’s passivity, ignorance and expectations that they will
defer to men’s sexual needs, while sexual prowess, multiple
partnerships and control over sexual interactions define
masculinity. Women are often powerless to exercise control over
when sex takes place and under what circumstances: they are
constrained to take measures to protect themselves or insist
their partners do so. Between men and women, sexuality and
sexual practices are often not discussed and both lack the
language or experience to start doing so. Discussions about
safer sex and condom use will also bring up the issue of
infidelity.
 Voluntary Counselling and Testing

 Voluntary counselling and testing is the process

whereby a person who has decided to be tested for
HIV is first counselled so that he/she can understand
what the test and the possible result means and then
tested and counselled again when the result is given.
 VCT is Confidential

 Only the client and the counsellor or health worker

involved know that a test was performed and have
access to the results. The information is not to be
given to other health care providers, employers,
insurers, schools or anyone else without the person's
written permission.
 Effective Counselling
Effective counselling requires:

 In depth knowledge about HIV and AIDS and the

transmission routes;
 Self awareness of one's beliefs, values and
assumptions;
 A respectful non-judgemental attitude;
 Active listening, including accurate reflection of issues
and concerns;
 Asking supportive questions that raise important issues;
 Awareness of one's verbal and non-verbal behaviour;
 Providing practical support, advice and information;
 Discussing options for care, prevention and support;
 Effective Counselling
 Encouraging the person counselled and his/her family to
make their own decisions;
 A quiet, private environment; and
 Ensured confidentiality.
 What is stigma and
discrimination?

 Stigma is a social label that alters the way individuals

view themselves and are viewed by others. People who
are stigmatised are usually considered deviant or
shameful and as a result are being avoided and
rejected. Stigma is a process of devaluation of people
living with or associated with HIV/AIDS and of marking
boundaries between ‘normal people’ and ‘outsiders’,
between ‘them’ and ‘us’. Discrimination follows stigma
and is the unfair and unjust treatment of an individual
or group based on real or perceived HIV status.
Our Resposibilities
 To know
 Be vigilant -Always
 Tell others
Tell Others
 How
 Media Campaigns
Strategic Communication
 Science Based –Data-Theory
 Client-Centered –Listen-individualize
 Benefit Oriented-Practical Help
 Service Linked-access/quality-brand – franchise
 Participatory – In planning-implementation –
evaluation
 Multi Channel – media-community – personal
 Technical High quality – marketing/advert,
production, community experties, counselling skills
 Advocacy related- personal/social adv, policy/program
advocacy
Strategic Communication
 Expanding to scale- pilot to region or
national, national to int’l
 Prog sustainability- organizational continuity,
leadership conti, donor conti, outcomes conti
 Result Oriented- knowledge, approval,
behavior, capacity
 Cost effective- cost per person,community
reach, cost by type of intervention
Media Campaigns

 Functions of Media Campaigns

Inform
Familiarize
Provide Understanding
Remind
Spread News
Serve as a ‘providers’ helper’
Reassure/retain users
Personalizing companies/providers
Media Campaigns

 Types of communication media

Individual(1 to 1)
 Peer group

 Home Visits

 Office calls

 Personal letters

 Technical Manuals

 Tutorials

 Self-learning
Media Campaigns
 Types of communication media
Group(2 to 1000)
 Meetings
 Tours
 Exhibits
 Group Discussions
 Street Theatre
 Slide Presentation
 Demonstrations
 Flip Charts/black boards/wall charts
 Dramatic performance
Media Campaigns
 Types of communication media
Mass(1000+)
 Pamphlets Calendars TV
 Posters Newspapers Songs
 Newsletters Novelties Rallies
 Radio Banners Dance
 Cinema Billboards Videos
 Stickers Magazines Theatre
 Stamps/coins Booklets Poems
Media Characteristics
Radio
Advantages Disadvant..
Immediacy No visual
Flexibility Shared attention
Low cost production Fragmentation
Some selectivity Transient nature
Broad reach
High frequency
Media Characteristics
TV
Advantages Disadvant..
Intrusive-sight, sound, motion Expensive
Reach Long lead time
General audience More urban
Impact limited availability
Prestige