CHAPTER I

INTRODUCTION

1.1 Background
Human immunodeficiency virus infection / acquired immunodeficiency
syndrome(HIV/AIDS) is a disease of the human immune system caused by infection
with human immunodeficiency virus (HIV). During the initial infection, a person may
experience a brief period ofinfluenza-like illness. This is typically followed by a
prolonged period without symptoms. As the illness progresses, it interferes more and
more with the immune system, making the person much more likely to get infections,
including opportunistic infections and tumors that do not usually affect people who
have working immune systems.
HIV is transmitted primarily via unprotected sexual intercourse (including anal and
evenoral sex),contaminated blood transfusions, hypodermic needles, and from
mother to child during pregnancy, delivery, or breastfeeding. Some bodily fluids,
such as saliva and tears, do not transmit HIV. Prevention of HIV infection, primarily
through safe sex and needle-exchange programs, is a key strategy to control the
spread of the disease. There is no cure or vaccine; however, antiretroviral
treatment can slow the course of the disease and may lead to a near-normal life
expectancy. While antiretroviral treatment reduces the risk of death and complications
from the disease, these medications are expensive and may be associated with side
effects.
Genetic research indicates that HIV originated in west-central Africa during the
early twentieth century. AIDS was first recognized by the Centers for Disease Control
and Prevention(CDC) in 1981 and its causeHIV infectionwas identified in the
early part of the decade. Since its discovery, AIDS has caused an estimated 36 million
deaths (as of 2012). As of 2012, approximately 35.3 million people are living with
 HIV globally. AIDS is considered a pandemica disease outbreak which is present
over a large area and is actively spreading.
HIV/AIDS has had a great impact on society, both as an illness and as a source
ofdiscrimination. The disease also has significant economic impacts. There are
many misconceptions about HIV/AIDS such as the belief that it can be transmitted by
casual non-sexual contact. The disease has also become subject to many controversies
involving religion. It has attracted international medical and political attention as well
as large-scale funding since it was identified in the 1980s.

1.2 Formulation of the Problem

Formulation of the problem is the formulation is prepared to understand what and how
the problem under study. In accordance with the title of this paper, namely HIV/AIDS,
So, I have several the formulations of the problem are:
1. What is the definition and the different between HIV and AIDS?
2. What is the history of HIV/AIDS?
3. What are the Sign and Symptoms of HIV?
4. Where are the locations of the HIV/AIDS epidemic in this world?
5. How is HIV Transmitted?
6. How prevent the HIV/AIDS?
7. How the spreading of HIV/AIDS Indonesia and the ways to prevent it?
Arms

1.
2. To
 CHAPTER II

DISCUSSION

2.1 The Definition for HIV and AIDS.

AIDS (Acquired immune deficiency syndrome or acquired immunodeficiency
syndrome) is a disease caused by a virus called HIV (Human Immunodeficiency
Virus). The illness alters the immune system, making people much more vulnerable
to infections and diseases. This susceptibility worsens as the disease progresses.
HIV is found in the body fluids of an infected person (semen and vaginal fluids,
blood and breast milk). The virus is passed from one person to another through blood-
to-blood and sexual contact. In addition, infected pregnant women can pass HIV to
their babies during pregnancy, delivering the baby during childbirth, and through
breast feeding.
Both the virus and the disease are often referred to together as HIV/AIDS. People
with HIV have what is called HIV infection. As a result, some will then develop
AIDS. The development of numerous opportunistic infections in an AIDS patient can
ultimately lead to death.
2.2 The History of HIV/AIDS
Scientists identified a type of chimpanzee in West Africa as the source of HIV
infection in humans. They believe that the chimpanzee version of the
immunodeficiency virus (called simian immunodeficiency virus or SIV) most likely
was transmitted to humans and mutated into HIV when humans hunted these
chimpanzees for meat and came into contact with their infected blood. Over decades,
the virus slowly spread across Africa and later into other parts of the world.
The earliest known case of infection with HIV-1 in a human was detected in a
blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of the
Congo. (How he became infected is not known.) Genetic analysis of this blood sample
suggested that HIV-1 may have stemmed from a single virus in the late 1940s or early
1950s.
We know that the virus has existed in the United States since at least the mid- to
late 1970s. From 19791981 rare types of pneumonia, cancer, and other illnesses were
being reported by doctors in Los Angeles and New York among a number of male
patients who had sex with other men. These were conditions not usually found in
people with healthy immune systems.
In 1982 public health officials began to use the term "acquired immunodeficiency
syndrome," or AIDS, to describe the occurrences of opportunistic infections, Kaposi's
sarcoma (a kind of cancer), and Pneumocystis jirovecii pneumonia in previously
healthy people. Formal tracking (surveillance) of AIDS cases began that year in the
United States.
In 1983, scientists discovered the virus that causes AIDS. The virus was at first
named HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy-
associated virus) by an international scientific committee. This name was later
changed to HIV (human immunodeficiency virus).
For many years scientists theorized as to the origins of HIV and how it appeared
in the human population, most believing that HIV originated in other primates. Then
in 1999, an international team of researchers reported that they had discovered the
origins of HIV-1, the predominant strain of HIV in the developed world. A subspecies
of chimpanzees native to west equatorial Africa had been identified as the original
source of the virus. The researchers believe that HIV-1 was introduced into the human
population when hunters became exposed to infected blood
2.3 Signs and symptoms
There are three main stages of HIV infection: acute infection, clinical latency and
AIDS.
a. Acute infection
The initial period following the contraction of HIV is called acute HIV, primary
HIV or acute retroviral syndrome. Many individuals develop an influenza-like
illness or a mononucleosis-like illness 24 weeks post exposure while others have
no significant symptoms. Symptoms occur in 4090% of cases and most commonly
include fever, large tender lymph nodes, throat inflammation, a rash, headache,
and/or sores of the mouth and genitals. Some people also develop opportunistic
infections at this stage such as nausea, vomiting or diarrhea may occur, as may
neurological symptoms of .The duration of the symptoms varies, but is usually one
or two weeks.
Due to their nonspecific character, these symptoms are not often recognized as
signs of HIV infection. Even cases that do get seen by a family doctor or a hospital
are often misdiagnosed as one of the many common infectious diseases with
overlapping symptoms. Thus, it is recommended that HIV be considered in patients
presenting an unexplained fever who may have risk factors for the infection.

b. Clinical latency
The initial symptoms are followed by a stage called clinical latency, asymptomatic
HIV, or chronic HIV. Without treatment, this second stage of the natural history of
HIV infection can last from about three years to over 20 years (on average, about
eight years). While typically there are few or no symptoms at first, near the end of
this stage many people experience fever, weight loss, nausea, vomiting
or diarrhea and muscle pains. Between 50 and 70% of people also
develop persistent generalizedlymphadenopathy, characterized by unexplained,
 non-painful enlargement of more than one group of lymph nodes (other than in the
groin) for over three to six months.

c. Acquired immunodeficiency syndrome/AIDS

Acquired immunodeficiency syndrome (AIDS) is defined in terms of either a
CD4+ T cell or the occurrence of specific diseases in association with an HIV
infection. In the absence of specific treatment, around half of people infected with
HIV develop AIDS within ten years. Opportunistic infections may be caused
by bacteria, viruses, fungi and parasites that are normally controlled by the immune
system.Which infections occur partly depends on what organisms are common in
the person's environment. These infections may affect nearly every organ system.
People with AIDS have an increased risk of developing various viral induced
cancers including Kaposi's sarcoma, Burkitt's lymphoma, primary central nervous
system lymphoma, and cervical cancer. Additionally, people with AIDS frequently
have systemic symptoms such as prolonged fevers,sweats (particularly at
night), swollen lymph nodes, chills, weakness, and weight loss. Diarrhea is another
common symptom present in about 90% of people with AIDS. They can also be
affected by diverse psychiatric and neurological symptoms independent of
opportunistic infections and cancers.

2.4 Transmission
HIV is transmitted by three main routes: sexual contact, exposure to infected body
fluids or tissues, and from mother to child during pregnancy, delivery, or
breastfeeding (known as vertical transmission). There is no risk of acquiring HIV if
exposed to feces, nasal secretions, saliva, sputum, sweat, tears, urine, or vomit unless
these are contaminated with blood. It is possible to be co-infected by more than one
strain of HIVa condition known as HIV super-infection.
a. Sexual

The most frequent mode of transmission of HIV is through sexual contact with an
infected person. The majority of all transmissions worldwide occur
through heterosexual contacts (i.e. sexual contacts between people of the opposite
sex); however, the pattern of transmission varies significantly among countries. In
the United States, as of 2009, most sexual transmission occurred in men who had
sex with men, with this population accounting for 64% of all new cases.
Commercial sex workers (including those in pornography) have an
increased rate of HIV.Rough sex can be a factor associated with an increased risk
of transmission. Sexual assault is also believed to carry an increased risk of HIV
transmission as condoms are rarely worn, physical trauma to the vagina or rectum
is likely, and there may be a greater risk of concurrent sexually transmitted
infections.

b. Body fluids

The second most frequent mode of HIV transmission is via blood and blood
products. HIV is transmitted in about 93% of blood transfusions involving infected
blood. Blood-borne transmission can be through needle-sharing during intravenous
drug use, needle stick injury, transfusion of contaminated blood or blood product,
or medical injections with unsterilized equipment. The risk from sharing a needle
duringdrug injection is between 0.63 and 2.4% per act, with an average of
0.8%. The risk of acquiring HIV from a needle stick from an HIV-infected person
is estimated as 0.3% (about 1 in 333) per act and the risk following mucus
membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. In the
United States intravenous drug users made up 12% of all new cases of HIV in 2009,
and in some areas more than 80% of people who inject drugs are HIV positive.

So, unsafe medical injections play a significant role in HIV spread. People giving
or receivingtattoos, piercings, and scarification are theoretically at risk of infection
 but no confirmed cases have been documented. It is not possible for mosquitoes or
other insects to transmit HIV.

c. Mother-to-child

HIV can be transmitted from mother to child during pregnancy, during delivery, or
through breast milk. This is the third most common way in which HIV is transmitted
globally. In the absence of treatment, the risk of transmission before or during birth
is around 20% and in those who also breastfeed 35%. As of 2008, vertical
transmission accounted for about 90% of cases of HIV in children. With appropriate
treatment the risk of mother-to-child infection can be reduced to about 1%.
Preventive treatment involves the mother taking antiretroviral during pregnancy
and delivery, an elective caesarean section, avoiding breastfeeding, and
administering antiretroviral drugs to the newborn. Many of these measures are
however not available in the developing world. If blood contaminates food
during pre-chewing it may pose a risk of transmission.

2.5 Classifications of HIV infection

The World Health Organization first proposed a definition for AIDS in 1986.
Since then, the WHO classification has been updated and expanded several times, with
the most recent version being published in 2007. The WHO system uses the following
categories:
Primary HIV infection: May be either asymptomatic or associated
with acute retroviral syndrome.
Stage I: HIV infection is asymptomatic with a CD4+ T cell count (also
known as CD4 count) greater than 500 per microlitre of blood. May include generalized
lymph node enlargement.
Stage II: Mild symptoms which may include
minor mucocutaneousmanifestations and recurrent upper respiratory tract infections. A
CD4 count of less than 500/microlitre.
 Stage III: Advanced symptoms which may include
unexplained chronicdiarrhea for longer than a month, severe bacterial infections
including tuberculosis of the lung, and a CD4 count of less than 350/microlitre.
Stage IV or AIDS: severe symptoms which include toxoplasmosis of
the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma.
A CD4 count of less than 200/micolitre.
2.5 Epidemiology
HIV/AIDS is a global pandemic. As of 2012, approximately 35.3 million
people have HIV worldwide with the number of new infections that year being about
2.3 million. This is down from 3.1 million new infections in 2001. Of these approximately
16.8 million are women and 3.4 million are less than 15 years old. It resulted in about
1.6 million deaths in 2012, down from a peak of 2.2 million in 2005.
Sub-Saharan Africa is the region most affected. In 2010, an estimated 68%
(22.9 million) of all HIV cases and 66% of all deaths (1.2 million) occurred in this region.
This means that about 5% of the adult population is infected and it is believed to be the
cause of 10% of all deaths in children. Here in contrast to other regions women compose
nearly 60% of cases. South Africa has the largest population of people with HIV of any
country in the world at 5.9 million.
South & South East Asia is the second most affected; in 2010 this region
contained an estimated 4 million cases or 12% of all people living with HIV resulting in
approximately 250,000 deaths. Approximately 2.4 million of these cases are in India.
In 2008 in the United States approximately 1.2 million people were living with
HIV, resulting in about 17,500 deaths. The US Centers for Disease Control and
Prevention estimated that in 2008 20% of infected Americans were unaware of their
infection. In the United Kingdom as of 2009 there where approximately 86,500 cases
which resulted in 516 deaths. In Canada as of 2008 there were about 65,000 cases causing
53 deaths. Between the first recognition of AIDS in 1981 and 2009 it has led to nearly
30 million deaths. Prevalence is lowest in Middle East and North Africa at 0.1% or
less, East Asia at 0.1% and Western and Central Europe at 0.2%.
2.6 Stigma about HIV/AIDS
 AIDS stigma exists around the world in a variety of ways,
including ostracism, rejection, discrimination and avoidance of HIV infected people;
compulsory HIV testing without prior consent or protection of confidentiality; violence
against HIV infected individuals or people who are perceived to be infected with HIV;
and the quarantine of HIV infected individuals. Stigma-related violence or the fear of
violence prevents many people from seeking HIV testing, returning for their results, or
securing treatment, possibly turning what could be a manageable chronic illness into a
death sentence and perpetuating the spread of HIV.
AIDS stigma has been further divided into the following three categories:
Instrumental AIDS stigmaa reflection of the fear and apprehension
that are likely to be associated with any deadly and transmissible illness.
Symbolic AIDS stigmathe use of HIV/AIDS to express attitudes
toward the social groups or lifestyles perceived to be associated with the disease.
Courtesy AIDS stigmastigmatization of people connected to the
issue of HIV/AIDS or HIV-positive people.[206]
Often, AIDS stigma is expressed in conjunction with one or more other
stigmas, particularly those associated with homosexuality, bisexuality, promiscuity,
prostitution, and intravenous drug use.
In many developed countries, there is an association between AIDS and
homosexuality or bisexuality, and this association is correlated with higher levels of
sexual prejudice, such as anti-homosexual/bisexual attitudes. There is also a perceived
association between AIDS and all male-male sexual behavior, including sex between
uninfected men. However, the dominant mode of spread worldwide for HIV remains
heterosexual transmission.
In 2003, as part of an overall reform of marriage and population legislation, it became
legal for people

2.7 HIV/AIDS in Indonesia

2.7.1 The Cases and Epidemic of HIV/AIDS in Indonesia

 Indonesias first case of HIV was reported in 1987 and between then and 2009,
3,492 people died from the disease. Of the 11,856 cases reported in 2008, 6,962 of them
were people under 30 years of age, including 55 infants under 1 year old. There are a high
number of concentrated cases among Indonesias most at risk including injection drug
users (IDUs), sex workers their partners and clients, homosexual men and infants who
contract the disease through the womb or from being breast fed.

In the last 15 years, HIV/AIDS has become an epidemic in Indonesia. The

highest concentration areas are Papua, Jakarta, East Java, West Java, Bali and Riau and
all are considered to be zones that need immediate attention.

Due to the increasing number of IDUs, the number of new infections has grown
rapidly since 1999. Moreover, a generalized epidemic is already under way in the
provinces of Papua and West Papua, where a population-based survey found an adult-
prevalence rate of 2.4% in 2006.

The epidemic in Indonesia is one of the fastest growing among HIV/AIDS in

Asia. The epidemic of injecting drug use continues to be the primary mode of
transmission, accounting for 59% of HIV infections, and heterosexual transmission
accounted for 41% in 2006. According to the Indonesian Ministry of Health, recent
surveys report that more than 40% of IDUs in Jakarta have tested positive for HIV, and
about 13% tested positive in West Java. Many IDUs sell sex to finance their drug habits.
Yet in 2005, 25% of IDUs in Bandung, Jakarta, and Medan.

The Indonesian archipelago stretches more than 3,000 miles along the
Equator. Cultural practices and levels of urbanization have an impact on the HIV/AIDS
epidemic. For instance, a culture of paid and transactional sex among young men and
women aged 15 to 24 has been a driving factor in Papua. Among 15 to 24 year olds, HIV-
prevalence rates were 3% in 2006, according to the Ministry of Health. Prevalence rates
among sex workers in Papuas major urban areas ranged from 9% in Timika to 16% in
Sorong in 2004.
 Numerous factors put Indonesia in danger of a broader epidemic. Risky sexual
behaviors are common. Only 54.7% of sex workers and 56.5% of men who have sex with
men (MSM) use condomsconsistently, and just 18.5 percent of IDUs consistently use
both sterile needles and condoms, according to Indonesias 2006 report to the United
Nations General Assembly Special Session on HIV/AIDS (UNGASS).

Finally, since 1994 Indonesia established a National AIDS Commission to

focus on preventing the spread of HIV, addressing the needs of people living with
HIV/AIDS, and coordinating government, non-governmental organizations , private
sector, and community activities. The Government of Indonesia signified its continued
commitment to fighting HIV/AIDS in 2005 when it budgeted $13 million to HIV/AIDS
programs, an increase of 40 percent over the amount disbursed in 2004.
2.7.2 The HIV/AIDS Awareness Program

In several provinces across Indonesia, the HIV/AIDS epidemic is among

the fastest growing in Asia. West Papua has the largest population of people living with
the AIDS virus around 50 percent of the countrys total number of cases (despite West
Papua only accounting for 1 percent of Indonesias total population). In 2011 the Papua
AIDS Prevention Commission (KPA) reported a 30 percent growth in the number of
people living with HIV/AIDS in West Papua.

These extremely high rates are exacerbated by the fact that many people are
ignorant of HIV/AIDS and how it is spread. The HIV/AIDS Awareness Program
increases the knowledge and role of the communities in Merauke in preventing the spread
of HIV/AIDS by conducting group discussions and community level training.

The program develops and distributes materials such as posters, leaflets,

video films, calendars and T-shirts as a means of promoting messages on HIV/AIDS so
that people in the community have access to accurate information about the disease. The
program is also using radio and film to spread the message and is developing a network
of volunteers to educate and advocate about HIV/AIDS.
 This program works in cooperation with Church institutions, the local AIDS
Commission (KPAD) and local NGOs working on HIV/AIDS awareness rising in
Merauke. As a result there is growing local government recognition of HIV/AIDS as a
social issue, not just a health problem, and Caritas Australia partner, Yasanto, has been
recognised as a partner of the government in combating HIV/AIDS.

While focusing on awareness rising about HIV-AIDS, Yasantos program also

teaches about related topics such as tuberculosis, sexually transmitted diseases in general,
and reducing alcohol related violence.

Much of BPKM Yasantos work is in isolated villages which have minimal

access to outside knowledge to improve their livelihoods. To meet this need, and because
BPKM Yasanto has some staff with an agriculture background, in 2011 they widened the
program to include workshops on organic gardening. To summarize, the HIV/AIDS
awareness program in the city of Merauke, West Papua, increases peoples knowledge
and awareness about HIV/AIDS in order to help to prevent the spread of the disease.

2.7.3 International Help for HIV/AIDS in Indonesia

In 2007 Australia donated A$100 million to help contain the epidemic in

Indonesia. The aim of the program is to limit the number of people who contract the
disease though education of at risk groups, improve the quality of life for suffers, and
reduce the socioeconomic effects on Indonesia. Australia has been assisting Indonesia to
tackle HIV/AIDS for over 15 years and introduced the first methadone program to a
prison in Asia the program is now in 95 prisons across Indonesia.

America also supports Indonesias National Aids Program, donating US$8

million annually. The program aims to increase awareness of the risks and prevention
methods and will work closely with NGOs and provincial governments to develop
services in areas where the spread is now considered to be an epidemic.
 CHAPTER III

CLOSING

A. CONCLUSION
God almighty, have the power to regulate everything that exists on earth. He
created the universe and everything in it. Likewise with all the events that happen on earth
such as: happiness, sadness of natural disasters, births, deaths, etc. Comes the HIV/AIDS
is one of the major events in the history of human life.
HIV is a virus that lives in the human body, and can cause the onset of AIDS,
which destroys the human immune system, making the body susceptible to disease and I
am will eventually die, it is human nature to always want to feel enjoyment regardless of
the consequences, for example: committed adultery, injection drug us, and soon. We
mankind have known that such actions are strictly prohibited, either according to their
respective religious teachings or rules applicable law. But from some of us still do these
things, for example: homosexuals, bisexuals, pimps, and people who often have multiple
sexual partners and sexual relations outside marriage. And dangerous until now has not
found a cure.
As for the symptoms that we can look at AIDS patients are prolonged fever
accompanied night sweats and cough, with drastic weight loss, etc which will end with
death. Therefore, we should shy away from things that can cause AIDS, through
prevention e.g.: not having sexual relations freely, avoid injections drug use, and soon.
AIDS is an emergency trial or event the punishment of God, which never is
assumed by mankind. However, the weight given trial, the lord almighty. Will always
open the way for his people. So, thing that needed now is the awareness for each people
to always maintain their self to get life with the comfortless and happiness.
B. ADVICE
1) We should always draw closer to God Almighty, and tried to shy away from things that
can cause AIDS.
2) Do not engage in sexual relations outside marriage (adultery), and do not have multiple
sexual partners.
3) For woman who have baby, always check the condition of body to maintain the baby
from the threatening disease.
3) If the treatment by using a syringe, then make sure first that the syringe is sterile or not
and it
4) When doing a blood transfusion, ask through the medical officer to check first the
blood.
5) For young people, stay away from drugs, especially narcotics through a syringe, tattoo
equipment, piercing earrings, and the like that could transmit AIDS, because the tools did
not exist

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http://en.wikipedia.org/wiki/HIV/AIDS_in_Indonesia
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