H.I.V.

/
A.I.D.S
DUKKES
R S L A N U D A T A N G S EN D J A J A

DATA DIRI

NAMA

: DR YANUAR T SASTRANEGARA SpOT

PANGKAT/NRP
: MAYOR KES / 528361
JABATAN
: KADUKKES
KESATUAN
: RUMKIT LANUD ATANG SENDJAJA
ALAMAT
: MESS PERWIRA MERDEKA, JL.
TEMPAT LAHIR
: JAKARTA
TANGGAL LAHIR : 29 JANUARI 1976
STATUS NIKAH
: MENIKAH
ANAK
: 2 ORANG

RIWAYAT KEDINASAN
JABATAN

KESATUAN

MASA DINAS

KASUBURKES

MAWING II PASKHAS

2001-2003

PAKES GOL VII

RUSPAU dr ESNAWAN
ANTARIKSA

2003-2004

KAKES

SKADRON UDARA 17

2004-2005

PAMA (DIK)

LANUD HALIM P

2005-2013

KAKLIN BEDAH

RUMKIT LANUD SULTAN

HASANUDIN
RUMKIT LANUD ATANG
SENDJAJA

2013- 2014

KADUKKES

2014

WHAT IS HIV??
Human Immunodeficiency Virus
A unique type of virus (a retrovirus)
Invades the helper T cells (CD4 cells) in the body of

the host (defense mechanism of a person)

Threatening a global epidemic.
Preventable, managable but NOT CURABLE.

OTHER NAMES FOR HIV

Former names of the virus include:

Human T cell lymphotrophic virus (HTLV-III)

Lymphadenopathy associated virus (LAV)

AIDS associated retrovirus (ARV)

WHAT IS AIDS ???

Acquired Immunodeficiency Syndrome
HIV is the virus that causes AIDS
Disease limits the bodys ability to fight infection

due to markedly reduced helper T cells.

Patients have a very weak immune system (defense
mechanism)
Patients predisposed to multiple opportunistic
infections leading to death.

AIDS (definition)
Opportunistic infections and malignancies that

rarely occur in the absence of severe

immunodeficiency (eg, Pneumocystis pneumonia,
central nervous system lymphoma).
Persons with positive HIV serology who have ever
had a CD4 lymphocyte count below 200 cells/mcL or
a CD4 lymphocyte percentage below 14% are
considered to have AIDS.

THE VIRAL GENOME

Icosahedral (20 sided), enveloped virus of the

lentivirus subfamily of retroviruses.

Retroviruses transcribe RNA to DNA.
Two viral strands of RNA
found in core surrounded
by protein outer coat.
Outer envelope contains a
lipid matrix within which
specific viral glycoproteins
are imbedded.
These knob-like structures
responsible for binding to
target cell.

Modes of HIV/AIDS
Transmission

Through Bodily Fluids

Blood products
Semen
Vaginal fluids

IntraVenous Drug Abuse

Sharing Needles

Without sterilization Increases the chances of

contracting HIV

Unsterilized blades

Through Sex
Unprotected Intercourse

Oral
Anal

Mother-to-Baby
Before Birth
During Birth

Myths about transmission

NATURAL COURSE OF
HIV/AIDS

Stage 1 - Primary
Short, flu-like illness

- occurs one to six

weeks after infection
Mild symptoms
Infected person can
infect other people

Stage 2 - Asymptomatic
Lasts for an average of ten years
This stage is free from symptoms
There may be swollen glands
The level of HIV in the blood drops to low

levels
HIV antibodies are detectable in the blood

Stage 3 - Symptomatic

The immune system deteriorates

Opportunistic infections and cancers start to

appear.

Stage 4 - HIV AIDS

The immune system

weakens too much as

CD4 cells decrease in
number.

Opportunistic Infections associated with

AIDS

CD4<500
Bacterial infections
Tuberculosis (TB)
Herpes Simplex
Herpes Zoster
Vaginal candidiasis
Hairy leukoplakia
Kaposis sarcoma

Opportunistic Infections associated with

AIDS
CD4<200
Pneumocystic carinii
Toxoplasmosis
Cryptococcosis
Coccidiodomycosis
Cryptosporiosis
Non hodgkins
lymphoma

CD4 <50
Disseminated mycobacterium avium complex (MAC)
infection
Histoplasmosis
CMV retinitis
CNS lymphoma
Progressive multifocal leukoencephalopathy
HIV dementia

TB & HIV CO-INFECTION

TB is the most common opportunistic infection in HIV and

the first cause of mortality in HIV infected patients (1030%)

10 million patients co-infected in the world.
Immunosuppression induced by HIV modifies the
clinical presentation of TB :
1.
2.
3.

Subnormal clinical and roentgen presentation

High rate of MDR/XDR
High rate of treatment failure and relapse (5% vs < 1% in HIV)

Testing Options for HIV

Anonymous Testing
No name is used
Unique identifying number
Results issued only to test recipient

23659874515
Anonymous

Blood Detection Tests

HIV enzyme-linked
immunosorbent assay (ELISA)

Screening test for HIV

Sensitivity > 99.9%

Western blot

Confirmatory test
Speicificity > 99.9% (when combined with
ELIZA)

HIV rapid antibody test

Screening test for HIV

Simple to perform

Absolute CD4 lymphocyte count

Predictor of HIV progression

Risk of opportunistic infections and AIDS when
<200

HIV viral load tests

Best test for diagnosis of acute HIV infection

Correlates with disease progression and
response to HAART

Urine Testing

Urine Western Blot

As sensitive as testing blood

Safe way to screen for HIV
Can cause false positives in certain
people at high risk for HIV

Oral Testing
Orasure

The only FDA approved HIV

antibody.
As accurate as blood testing
Draws blood-derived fluids
from the gum tissue.
NOT A SALIVA TEST!

Treatment Options

HAART = highly active anti-retroviral treatment

Antiretroviral Drugs (HAART)

Nucleoside Reverse Transcriptase inhibitors

AZT (Zidovudine)
Non-Nucleoside Transcriptase inhibitors
Viramune (Nevirapine)
Protease inhibitors
Norvir (Ritonavir)

EFFECTIVENESS OF HAART IN REDUCING

MORTALITY

HEALTH CARE FOLLOW UP OF HIV

INFECTED PATIENTS
For all HIV-infected individuals:
CD4 counts every 36 months
Viral load tests every 36 months and 1 month following a change in therapy
PPD
INH for those with positive PPD and normal chest radiograph
RPR or VDRL for syphilis
Toxoplasma IgG serology
CMV IgG serology
Pneumococcal vaccine
Influenza vaccine in season
Hepatitis B vaccine for those who are HBsAb-negative
Haemophilus influenzae type b vaccination
Papanicolaou smears every 6 months for women

For HIV-infected individuals with CD4 < 200

cells/mcL:

Pneumocystis jiroveci1 prophylaxis

For HIV-infected individuals with CD4 < 75

cells/mcL:

Mycobacterium avium complex prophylaxis

For HIV-infected individuals with CD4 < 50

cells/mcL:

Consider CMV prophylaxis

PRIMARY PREVENTION:
Five ways to protect yourself?
Abstinence
Monogamous Relationship
Protected Sex
Sterile needles
New shaving/cutting blades

Abstinence

It is the most effective method of not acquiring

HIV/AIDS.
Refraining from unprotected sex: oral, anal, or
vaginal.
Refraining from intravenous drug use

Monogamous relationship
A mutually monogamous (only one sex

partner) relationship with a person who is not

infected with HIV
HIV testing before intercourse is necessary to
prove your partner is not infected

Protected Sex
Use condoms every time you have

sex
Always use latex or polyurethane
condom (not a natural skin
condom)
Always use a latex barrier during
oral sex

When Using A Condom Remember To:

Make sure the package is

not expired
Make sure to check the
package for damages
Do not open the package
with your teeth for risk of
tearing
Never use the condom
more than once
Use water-based rather
than oil-based condoms

Myths and misconceptions

You cannot get HIV if you:
Stand up during sex
Have unprotected oral sex
Have sex for the first time
Have sex with a virgin
Are not gay/bisexual
Do not have sex during a womans period
If you douche/cleanout/pee after sex
Do a little bit of sex and pull out
Already have HIV or AIDS
Do not have an orgasm

Epidemiologi of HIV AIDS

In Indonesia
2012

Network of HIV
Transmission Risk
53%

Customer

Low-risk
man

Women sex
workers

3.4%

50
%

?
Man sex
workers
53%

Injection
drugs

Spouse
Low-risk
women

35%

AIDS Cases by Risk Factor

(In 2011)

What triggered the epidemic of HIV and

AIDS in Indonesia?
+230,000
IDU

+3,1million
Men buy sex

+320,000
Female Sex
Workers

+1.6 million

(2% adult male)

Women who marry man

infected with AIDS
+800,000

Gay,
Transjender man

Male

Female

Infant &
children

Number of HIV Cases

25000
20000
15000
Number of Cases

10000
HIV Cases
AIDS Cases

5000
0

Years

Presentage of HIV AIDS by Age Group

Presentage of AIDS Cases by Age Group in

Indonesia in 2011
50
45
40
35
30
25
45.4
20
30.7

15
10
5
0

9.9
0.9

1.4

<1

1.-4

0.7
5.-14

3.7
15-19

3.1
20-29

Age Group

30-39

40-49

50-59

0.8
60

3.4
unknown

Percentage of HIV-AIDS by Sex

AIDS Cases Number by Occupation

The cumulative number of AIDS cases
by occupation in Indonesia in 1987self-employ ed / own business
3481
2011
housewife

2998

non-professional staff (employ ees)

2882

farmer / rancher / fisherman

1051

unskilled laborers

1002

school / college students

885

sex workers

7 02

civ il

632

conv ict

512

driv er

497

non-medical professionals 247

sailor 236
members of the Armed Forces / Police 166
steward / stewardess / pilot 132
artist / actress / actor 130
medical professionals 97
tourist24
manager / executiv e20
0

500

1000

1500

2000

2500

3000

3500

4000

The Number of AIDS Cases by

Occupation in Indonesia in
2011
housewife

622

non-professional staff (employ ess)

587

self-employ ed/own bussiness

544

farmer / rancher / fisherman

251

unskilled laborers

17 3

school / college students

140

sex workers

123

civ il

105

conv ict

79

driv er

78

non-medical professionals 47
sailor 36
members of the Armed Forces / Police 26
steward / stewardess / pilot 8
artist / actress / actor 4
medical professionals 2
tourist 1
manager / executive 1
0

100

200

300

400

500

600

7 00

Number of AIDS Cases by Province

CASE FATALITY RATE (CFR)

Case Fatality Rate AIDS by Years In
Indonesia, 1987-2011
Percent

Years

Presentage of AIDS Cumulative Cases by Risk Factor a

Periode of 5 years, 1991-1995, 1996-2000, 2001-2005, 20062010

VISION CONTROL OF
HIV/AIDS
CONTROLLING THE SPREAD
OF HIV INFECTION AND STD
AND IMPROVING THE
QUALITY OF PLWHA LIFE

MISSION CONTROL OF HIV /

AIDS
Control the spread of HIV
infection, STDs and HIV &
AIDS impact through
prevention efforts, improve
service quality and reach of
people living with HIV and
communities.

Strategy to Control HIV-AIDS

and STD in Indonesia
1.
2.
3.
4.
5.
6.

Private and civil society

sector empowerment
Promotive, preventive
priority
Financing
Human resource
development and
empowerment
Treatment, investigation
Control management

NATIONAL POLICY
1. Increase advocacy, socialization, and capacity
building.
2. Enhance management capabilities and
professionalism in the control of HIV-AIDS and
STDs.
3. Improve the accessibility and quality control of
HIV-AIDS and STDs.
4. Increase the range of services
5. Priority to community-based program.
6. Improve networks and partnerships and
cooperation.
7. Promote the resources
8. Priority to promotive and preventive.
9. Prioritizing the achievement of MDG's,
national and international commitments.

GENERAL PURPOSE

Improve the control of HIV-AIDS

and STD effectively and
efficiently in order to achieve
public health degree as high.

SPECIAL
PURPOSE
1. Decrease the number of new cases of HIV as
low as possible (long-term target: zero new
infection)
2. Decrease the levels of discrimination as low
as possible (long-term target: zero
discrimination)
3.Reduce AIDS death rates as low as possible
(long-term target: zero AIDS-related
4.Improve the quality of life of people living
with HIV

Sasaran
Activitie
s
Control of
HIV-AIDS

Indicator

Target
2010

1 HIV prevalence in
population aged 15-49
years.
2. Percentage of population
aged 15-24 years who have
comprehensive knowledge
about HIV-AIDS
3. Number of people aged
15 years or older who
received HIV testing and
counseling
4. Percentage of districts /
cities that implement
appropriate guidelines for
the prevention of HIV
transmission
5. Condom use in high-risk
groups
6. PLWHA percentage who
received antiretroviral
treatment
7. Percentage of holding the
Government Hospital
referral services for
PLWHA.

2011

2012

2013

2014

0,2%

<0,5%

<0,5%

<0,5%

<0,5%

65%

75%

85%

90%

95%

300.000

400.00
0

500.000

600.000

700.000

70%

80%

90%

45%(M)
30%(F)
80%

55%(M)
40%(F)
85%

65%(M)
50%(F)
90%

80%

85%

90%

50%
60%

25% (M)
20% (F)
70%

35%(M)
20%(F)
75%

60%
70%

THANK YOU