AIDS_1.doc

Fact files on HIV and AIDS and information on how the NACO functions

Q. What is HIV?

Ans. HIV (Human Immunodeficiency Virus) is the virus that causes AIDS. This virus is passed from one person to another through blood, using shared needles and sexual contact. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Most of these people develop AIDS as a result of HIV infection.

These body fluids have been proven to spread HIV:

• blood

• semen

• vaginal fluid

• breast milk

• other body fluids containing blood.

Other additional body fluids that may transmit the virus that healthcare workers may come into contact with are:

• cerebrospinal fluid surrounding the brain and the spinal cord

• synovial fluid surrounding bone joints

• amniotic fluid surrounding a foetus.

Q. What is AIDS? What causes AIDS?

Ans. AIDS stands for Acquired Immunodeficiency Syndrome. An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC-defined AIDS indicator illnesses. An HIV positive person who has not had any serious illnesses also can receive an AIDS diagnosis on the basis of certain blood tests (CD4+ counts).

A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria (e.g. AIDS indicator illnesses).

Infection with HIV can weaken the immune system to the point that it has difficulty fighting off certain infections. These type of infections are known as "opportunistic" infections because they take the opportunity a weakened immune system gives to cause illness.

Many of the infections that cause problems or may be life-threatening for people with AIDS are usually controlled by a healthy immune system. The immune system of a person with AIDS is weakened to the point that medical intervention may be necessary to prevent or treat serious illness.

Q. Where did HIV come from?

Ans. We do not know. Scientists have different theories about the origin of HIV, but none have been proven. The earliest known case of HIV was from a blood sample collected in 1959 from a man in Kinshasha, Democratic Republic of Congo. (How he became infected is not known.) Genetic analysis of this blood sample suggests that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s.

We do know that the virus existed in the United States since at least the mid to late 1970s. From 1979-1981 rare type of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of gay male patients. 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, and Pneumocystis carinii pneumonia in healthy men. Formal tracking (surveillance) of AIDS cases began that year in the United States.

The cause of AIDS is a virus that scientists isolated in 1983. 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).

The inescapable conclusion of more than 15 years of scientific research is that people, if exposed to HIV through sexual contact or injecting drug use, may become infected with HIV. If they become infected, most of them will eventually develop AIDS.

Q. How long does it take for HIV to cause AIDS?

Ans. Since 1992, scientists have estimated that about half the people with HIV develop AIDS within 10 years after becoming infected. This time varies greatly from person to person and can depend on many factors, including a person's health status and their health-related behaviours.

Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. As with other diseases, early detection offers more options for treatment and preventative healthcare.

Q. Why is the AIDS epidemic considered so serious?

Ans. AIDS affects people primarily when they are most productive and leads to premature death thereby severely affecting the socio-economic structure of whole families, communities and countries. Besides, AIDS is not curable and since HIV is transmitted predominantly through sexual contact, and with sexual practices being essentially a private domain, these issues are difficult to address.

Q. How can I avoid being infected through sex?

Ans. You can avoid HIV infection by abstaining from sex, by having a mutually faithful monogamous sexual relationship with an uninfected partner or by practicing safer sex. Safer sex involves the correct use of a condom during each sexual encounter and also includes non-penetrative sex.

Q. How can children and young people be protected from HIV?

Ans. Children and adolescents have the right to know how to avoid HIV infection before they become sexually active. As some young people will have sex at an early age, they should know about condoms and where they are available. Parents and schools share the responsibility of ensuring that children understand how to avoid HIV infection, and learn the importance of tolerant, compassionate and non-discriminatory attitudes towards people living with HIV/AIDS.

Q. Can injections transmit HIV infection?

Ans. Yes, if the injecting equipment is contaminated with blood containing HIV. Avoid injections unless absolutely necessary. If you must have an injection, make sure the needle and syringe come straight from a sterile package or have been sterilised properly; a needle and syringe that has been cleaned and then boiled for 20 minutes is ready for reuse. Finally, if you inject drugs of whatever kind, never use anyone else's injecting equipment.

Q. What about having a tattoo or your ears pierced?

Ans. Tattooing, ear piercing, acupuncture and some kind of dental work all involve instruments that must be sterile to avoid infection. In general, you should refrain from any procedure if the skin is pierced, unless absolutely necessary.

Q. Is there a treatment for HIV/AIDS?

Ans. All the currently licensed antiretroviral drugs, namely AZT, DDL and DDC, have effects which last only for a limited duration. In addition, these drugs are very expensive and have severe adverse reactions while the virus tends to develop resistance rather quickly with single-drug therapy. The emphasis is now on giving a combination of drugs including newer drugs called protease inhibitors; but this makes treatment even more expensive.

WHO's present policy does not recommend antiviral drugs but instead advocates strengthening of clinical management for HIV- associated opportunistic infections such as tuberculosis and diarrhoea. Better care programmes have been shown to prolong survival and improve the quality of life of people living with HIV/AIDS.

Q. But how can there suddenly be a disease that never existed before?

Ans. If we look at AIDS as a worldwide pandemic, it appears as if it is something new and rather sudden. But if we look at AIDS as a disease and at the virus that causes it, we get a different picture. We find that both the disease and the virus are not new. They were there well before the epidemic occurred. We know that viruses sometimes change. A virus that was once harmless to humans can change and become harmful. This is probably what happened with HIV long before the AIDS epidemic.

What is new is the rapid spread of the virus. Researchers believe that the virus was present in isolated population groups years before the epidemic began. Then the situation changed – people moved more often and traveled more, they settled in big cities and lifestyles changed, including patterns of sexual behaviour. It became easier for HIV to spread through sexual intercourse and contaminated blood. As the virus spread, the disease which was already in existence became a new epidemic.

Q. Is it safe to work with someone infected with HIV?

Ans. Yes. Most workers face no risk of getting the virus while doing their work. The virus is mainly transmitted through the transfer of blood or sexual fluids. Since contact with blood or sexual fluids is not part of most people's work, most workers are safe.

Q. What about working every day in close physical contact with an infected person?

Ans. There are no risks involved. You may share the same telephone with other people in your office or work side by side in a crowded factory with other HIV infected persons, even share the same cup of tea, but this will not expose you to the risk of contracting the infection. Being in contact with dirt and sweat will also not give you the infection.

Q. Who is at risk while at work?

Ans. Those who are likely to come into contact with blood that contains the virus are at risk. These include healthcare workers - doctors, dentists, nurses, laboratory technicians, and a few others. Such workers must take special care against possible contact with infected blood, as for example by using gloves.

Q. If a worker has HIV infection, should he or she be allowed to continue work?

Ans. Workers with HIV infection who are still healthy should be treated in the same way as any other worker. Those with AIDS or AIDS-related illnesses should be treated in the same way as any other worker who is ill. Infection with HIV is not a reason in itself for termination of employment.

Q. Does an employee infected with the virus have to tell the employer about it?

Ans. Anyone infected, or thought to be infected, must be protected from discrimination by employers, co-workers, unions or clients. Employees should not be required to inform their employer about their infection. If correct information and education about AIDS are available to employees, a climate of understanding may develop in the workplace protecting the rights of the HIV-infected person.

Q. Should an employer test a worker for HIV?

Ans. Testing for HIV should not be required of workers. Imagine that you are a worker with HIV infection and are healthy and able to work. As far as your work is concerned, the information about the infection is private. If it is made public, you could be a target for discrimination. If AIDS-related illness makes you unfit for a particular job, you should be treated in the same way as any other employee with a chronic illness. A suitable alternative job can often be arranged by the employer. The employers in different parts of the world are beginning to deal with these problems more humanely. Their associations and workers' unions can be consulted for advice.

Q. What if you are already infected with HIV? Can you still travel?

Ans. If you are already infected, consult your healthcare provider for guidance well before you plan to travel. Some immigration officials insist on an HIV free certificate. Your travel counsellor will advise you.

Q. 'AIDS is mainly a problem of developing countries.' or 'No, AIDS is really a problem of developed countries'. Which of these opinions is more accurate?

Ans. Many people would like to claim that AIDS only affects others - other people or other countries. AIDS breaks the patterns that we associate with major diseases, for example, linking malaria with the tropics or perhaps heart disease with the industrialised world. AIDS affects both developing and industrialised countries, both cold and hot countries. HIV can spread anywhere where people live and have sex.

Q. How do AIDS problems in different countries relate to each other?

Ans. They are related in at least three ways. First, in every country, AIDS is always spread by a virus transmitted through sexual intercourse and through blood. Specific actions by people are therefore required for it to spread in all countries.

Second, AIDS can be prevented in all countries by people if they change their sexual behaviour, by screening blood for transfusion, and by sterilising needles and syringes.

Third, the prevention and control of AIDS bring most countries of the world together in joint action. They have the same basic problems to solve. For example, donated blood must be tested and everyone must benefit from the availability of simple, reliable and cheap blood tests to detect the virus. Only joint international action can make such tests widely available and affordable.

Q. If a person becomes infected with HIV, does that mean he has AIDS?

Ans. No, HIV is an unusual virus because a person can be infected with it for many years and yet appear to be perfectly healthy. But the virus gradually multiplies inside the body and eventually destroys the body's ability to fight off illnesses.

It is still not certain that everyone with HIV infection will get AIDS. It seems likely that most people with HIV will develop serious health problems. But this may be after many years. A person with HIV may not know he is infected but can pass the virus on to other people.

Q. Is it true that male circumcision may provide protection against HIV infection?

Ans. Yes, the interior side of the foreskin has a mucosal surface, which is more susceptible to trauma than the tougher skin of the penile shaft or the glans. The foreskin also contains high levels of HIV target cells such as Langerhan’s cells. Recent study in Chicago has found out that foreskin mucosal tissue has a seven fold greater susceptibility to HIV-1 than cells in cervical tissue under same condition.

Q. Is oral sex unsafe?

Ans. Oral sex (one person kissing, licking or sucking the sexual areas of another person) does carry some risk of infection. If a person sucks the penis of an infected man, for example, infected fluid could get into the mouth. The virus could then get into the blood if you have bleeding gums or tiny sores somewhere in the mouth. The same is true if infected sexual fluids from a woman get into the mouth of her partner. But infection from oral sex alone seems to be very rare.

Q. What about getting AIDS from body fluids like saliva?

Ans. Although small amounts of HIV have been found in body fluids like saliva, faeces, urine and tears, there is no evidence that HIV can spread through these body fluids.

Q. Could I be at risk?

Ans. Unless they know someone who has HIV, many people think this disease can't happen to them. Unfortunately, it can and does happen to all kind of people. By looking at your current and past sexual and drug practices (and your transfusion history), you can get a picture of your risk for HIV. Also you can figure out how you can reduce your future risk for HIV infection.

Q. How can I tell if I have HIV infection?

Ans. The only way to know for sure if you have this virus is by taking a blood test called the "HIV Antibody Test." Some people call it the "HIV Test" or the "AIDS Test," even though this test alone cannot tell you if you have AIDS. The HIV test can tell you if you have the virus and can pass it to others in the ways already described. The test is not a part of your regular blood tests – you have to ask for it by name. It is a very accurate test.

If your test result is "positive," it means you have HIV infection and could benefit from special medical care. Additional tests can tell you how strong your immune system is and whether drug therapy is indicated. Some people stay healthy for a long time with HIV infection, while others develop serious illness and AIDS more rapidly. Scientists do not know why people respond in different ways to HIV infection. If your test is "negative," and you have not had any possible risk for HIV for six months prior to taking the test, it means you do not have HIV infection. You can stay free of HIV by following prevention guidelines.

Q. Should I take the HIV test?

For some people taking the HIV antibody test can be a scary decision. Some people get tested every six months, even if they practice safer sex. No matter what the reasons are, taking the HIV antibody test can be a good idea. Sometimes taking the test is a way to make a new found commitment towards safer practices.

One thing that is important to remember is that getting tested for HIV will not change your HIV status. It just tells you whether or not you have it. With all the new treatments available, finding out your HIV status early on can extend your life.

To find out if you are at risk for HIV, ask yourself the following questions:

• Have you had unprotected vaginal, oral or anal sex (e.g., intercourse without a condom, oral sex without a latex barrier)?

• Have you shared needles to inject street drugs or steroids or to pierce your skin?

• Have you had a sexually transmitted infection (STI) or unwanted pregnancy?

• Have you had a blood transfusion or received blood products before April, 1985?

The counselling that should be provided before and after testing provides a good opportunity to learn more about HIV, discuss your risks and how to avoid infection.

If you are a woman who is planning on getting pregnant, or are currently pregnant, you may want to consider getting tested. There are new treatments to help reduce the transmission of HIV from mother to child.

Q. If I am HIV Positive, what should I do?

Ans. If you have tested positive for HIV, consider the following:

See a healthcare professional for a complete medical check-up for HIV infection and advice on treatment and health maintenance. Make sure you are tested for TB and other STDs. For women, this includes a regular gynaecological exam.

Inform your sexual partner(s) about their possible risk for HIV. Your local health department has a partner notification programme that can assist you.

Protect others from the virus by following the precautions talked about on this page (for example, always using condoms and not sharing needles with others).

Protect yourself from any additional exposure to HIV.

Avoid drug and alcohol use, practice good nutrition, and avoid fatigue and stress.

Seek support from trustworthy friends and family when possible, and consider getting professional counselling.

Find a support group of people who are going through similar experiences.

Do not donate blood, plasma, semen, body organs or other tissue.

Q. Why do people who are infected with HIV eventually die?

Ans. When people are infected with HIV, they do not die of HIV or AIDS. They die due to the effects that the HIV has on the body. With the immune system down, the body becomes susceptible to many infections, from the common cold to cancer. It is actually those particular infections, and the body's inability to fight the infections that cause these people to become so sick, that they eventually die.

Q. How can I tell if I am infected with HIV? What are the symptoms?

Ans. The only way to determine for sure whether you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected with HIV. Many people who are infected with HIV do not have any symptoms at all for many years.

The following may be warning signs of infection with HIV:

• rapid weight loss

• dry cough

• recurring fever or profuse night sweats

• profound and unexplained fatigue

• swollen lymph glands in the armpits, groin, or neck

• diarrhoea that lasts for more than a week

• white spots or unusual blemishes on the tongue, in the mouth, or in the throat

• pneumonia

• red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids

• memory loss, depression and other neurological disorders.

However, no one should assume he is infected if he has any of these symptoms. Each of these symptoms can be related to other illnesses. Again, the only way to determine whether you are infected is to be tested for HIV infection.

Q. How long after a possible exposure should I wait to get tested for HIV?

Ans. The tests commonly used to detect HIV infection actually look for antibodies produced by your body to fight HIV. Most people will develop detectable antibodies within three months after infection, the average being 25 days. In rare cases, it can take upto six months. For this reason, the CDC currently recommends testing six months after the last possible exposure (unprotected vaginal, anal or oral sex or sharing needles). It would be extremely rare to take longer than six months to develop detectable antibodies.

Q. If I test HIV negative, does that mean that my partner is HIV negative also?

Ans. No, your HIV test result reveals only your HIV status. Your negative test result does not tell you whether your partner has HIV or not. HIV is not necessarily transmitted every time there is an exposure. Therefore, your taking an HIV test should not be seen as a method to find out if your partner is infected.

Q. Can I get HIV from anal sex?

Ans. Yes, it is possible for either sex partner to become infected with HIV during anal sex. HIV can be found in the blood, semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus. In general, the person receiving the semen is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, a person who inserts his penis into an infected partner also is at risk because HIV can enter through the urethra (the opening at the tip of the penis) or through small cuts, abrasions or open sores on the penis.

Having unprotected (without a condom) anal sex is considered to be a very risky behaviour. If people choose to have anal sex, they should use a latex condom. Most of the times, condoms work well. However, condoms are more likely to break during anal sex than during vaginal sex. Thus, even with a condom, anal sex can be risky. A person should use a water-based lubricant in addition to the condom to reduce the chances of condom breaking.

Q. Why is injecting drugs a risk for HIV?

Ans. At the start of every intravenous injection, blood is introduced into needles and syringes. HIV can be found in the blood of a person infected with the virus. The reuse of a blood-contaminated needle or syringe by another drug injector (sometimes called "direct syringe sharing") carries a high risk of HIV transmission because infected blood can be injected directly into the bloodstream.

In addition, sharing drug equipment (or "works") can be a risk for spreading HIV. Infected blood can be introduced into drug solutions by:

• using blood-contaminated syringes to prepare drugs

• reusing water

• reusing bottle caps, spoons or other containers ("spoons" and "cookers"

• used to dissolve drugs in water and to heat drug solutions

• reusing small pieces of cotton or cigarette filters ("cottons") used to filter out particles that could block the needle.

"Street sellers" of syringes may repackage used syringes and sell them as sterile syringes. It is important to know that sharing a needle or syringe for any use, including skin popping and injecting steroids, can put one at risk for HIV and other blood-borne infections.

Q. Are patients in a dentist's or doctor's office at risk of getting HIV?

Ans. Although HIV transmission is possible in healthcare settings, it is extremely rare. Medical experts emphasise that the careful practice of infection control procedures, including universal precautions, protects patients as well as healthcare providers from possible HIV infection in medical and dental offices.

In 1990, the CDC reported on an HIV-infected dentist in Florida who apparently infected some of his patients while doing dental work. Studies of viral DNA sequences linked the dentist to six of his patients who were also HIV-infected. The CDC has as yet been unable to establish how the transmission took place.

Further studies of more than 22,000 patients of 63 healthcare providers who were HIV-infected have found no further evidence of transmission from provider to patient in healthcare settings.

Q. Should I be concerned about getting infected with HIV while playing sports?

Ans. There are no documented cases of HIV being transmitted during participation in sports. The very low risk of transmission during sports participation would involve sports with direct body contact in which bleeding might be expected to occur.

If someone is bleeding, his participation in the sport should be interrupted until the wound stops bleeding and is both antiseptically cleaned and securely bandaged. There is no risk of HIV transmission through sports activities where bleeding does not occur.

Q. On viral load tests, what is considered a high viral load and what is considered a low one? What are these tests used for?

Ans. Viral load tests measure how much of the HIV virus is in the bloodstream. They are very new tests and can be very expensive. Insurance companies may or may not cover the cost of the test. A result below 10,000 is considered a low result. A result over 100,000 is considered a high result. The primary use of these tests is to help determine how well a certain antiviral drug is working. If the viral load is high, your physician may consider switching you to another drug therapy. The viral load tests are best used if trends in results are compared over time. If the viral load increases over time, then the drug treatment may need to be changed. If the viral load goes down over time, antiviral treatment may be working for you. So rather than just taking one test, a series of viral load tests gives much more useful information. Of course, antiviral therapy must not be determined by this test alone. Other tests (like CD4 cell counts) are also important indicators as to how well antiviral therapy is working. It is presently not known what a test result between 10,000 and 100,000 means. That's why trends in viral load tests are of much greater value.

Q. Is there a vaccine for HIV?

Ans. Most experts believe that an effective and widely available preventive vaccine for HIV may be our best long term hope to control the global pandemic.

Globally, most people who are carrying the AIDS virus live in countries with very limited budgets for healthcare. This means that in practice, there is little or no money for things like HIV testing, condoms, STI (Sexually Transmitted Infection) treatment and prevention. In settings like this, a vaccine would be very cost-effective.

Developing an effective and safe vaccine has proven to be a difficult challenge. A number of leading researchers are working on this problem, but no one knows when will they succeed.

Q. What is the difference between HIV-1 and HIV-2?

Ans. Two type of HIV are currently recognised: HIV-1 and HIV-2. Worldwide, the predominant virus is HIV-1. Both type of virus are transmitted by sexual contact, through blood, and from mother to child, and they appear to cause clinically indistinguishable AIDS. However, HIV-2 is less easily transmitted, and the period between initial infection and illness is longer in the case of HIV-2.

Q. When was the first AIDS case reported in India?

Ans. The first AIDS case was reported from Chennai, Tamil Nadu in the year 1986.

Q. Why is there so much difference between the reported and estimated number of HIV infections?

Ans. HIV is a chronic infection and may take five to nine years to develop its manifestations in the form of opportunistic infections and other forms of symptoms and signs. During this period, the HIV infected person remains asymptomatic and does not come in contact with hospitals where his/her HIV status can be detected.

Q. What are the common opportunistic infections encountered by HIV/AIDS patients?

Ans. The common opportunistic infections encountered by HIV/AIDS patients are:

• Tuberculosis (Pulmonary and extra-pulmonary)

• Candidiasis

• Pneumocysitis carini

• Toxoplasmosis

• Cryptococcosis

• Cryptosporidial Diarrhoea

• Cytomegolo virus infections

• P. Marneffea infections (a fungus infection in North Eastern part of the country)

HIV-TB.

Testing for Pregnant Women

Q. Can a baby have the HIV test?

Ans. Yes, but it will not necessarily show whether the baby is infected. This is because the test is for HIV antibodies and all babies born to mothers with HIV are born with HIV antibodies. Babies who are not infected lose their antibodies by the time they are about 18 months old. However most babies can be diagnosed as either infected or uninfected by the time they are three months old by using a different test, called a PCR test. The PCR test is more sensitive than the HIV test, and is not used in the standard HIV testing of adults. It looks for the presence of HIV itself, not antibodies.

Q. What are the possible advantages?

Ans. If a pregnant woman has a positive test result there are now drugs that can reduce the risk of her passing HIV on to her baby in the womb or at birth. Delivery by elective Caesarean Section also reduces the risk of a baby becoming infected.

It is usually best for babies to be breast-fed. However, if a mother has HIV, beast-feeding will increase the risk of her baby becoming infected. If a pregnant woman has a negative test result this can be very reassuring.

Q. What are the possible disadvantages?

Ans. Some pregnant women feel that they could not cope with finding out that they have HIV and that they may have put their baby at risk.

A woman who is infected with HIV can still become pregnant and have a baby. Being pregnant will not increase her chances of developing AIDS. But some doctors think that pregnancy will make a woman who already has AIDS more seriously ill.

If a woman's partner is not infected with HIV he is at risk of becoming infected if they have sexual intercourse without a condom. An HIV positive woman also has to consider how she will cope if her baby is infected with HIV. Some doctors think that a woman who has recently been infected, or a woman who has AIDS, is more likely to have an infected baby.

Q. How does a mother transmit HIV to her unborn child?

Ans. An HIV-infected mother can infect the child in her womb through her blood. The baby is more at risk if the mother has been recently infected or is in a later stage of AIDS. Transmission can also occur at the time of birth when the baby is exposed to the mother's blood and to some extent transmission can occur through breast milk..

Q. Are all pregnant women tested?

Ans. Pregnant women are not automatically tested for HIV. In some ante-natal clinics the test is offered and in others women have to ask for it. All pregnant women can have an HIV test. A woman will never be tested without her consent. If a woman is not sure what the arrangements are at her ante-natal clinic, she can ask her doctor or midwife about an HIV test.

Q. What happens when you have the test?

Ans. Before taking an HIV test a woman should be offered the opportunity to talk to someone about the test and what the result will mean. Then the woman can make up her mind whether she wants to be tested or not. If a woman has a test, the clinic will tell her when she can come and get the result. This might be a few days or a week.

The HIV test involves taking a small amount of blood, usually from a person's arm. If you are pregnant when you have the test you will probably not need to give extra blood, as it should be possible for the test to be done at the same time as other blood tests.

The test can be done at any time. But it takes about three months after being infected for a person's blood to have enough antibodies in it for them to show up in the test. For this reason most people are advised to wait at least for three months after their last risk of being infected before they have a test.

When a woman is given the result of her HIV test she should be given the opportunity to talk to someone about it. This is important whether the result says a woman is infected or not.

Q. What happens if a woman has a positive test result?

Ans. When a woman has a positive test result she should be able to plan with a doctor or midwife what happens next and arrange to have follow-up checks. She will be offered special medical care to reduce the risk of her baby being infected.

Some pregnant women with HIV decide to have their baby. Others choose to have a termination. The decision to terminate a pregnancy is very personal and difficult. Someone who has a termination needs time to grieve for the loss of their baby. Someone who is HIV positive also needs to think about how it will affect decisions about pregnancy in the future.

M & E and Research Surveillance

Q. What is HIV Sentinel Surveillance?

Ans. HIV Sentinel Surveillance is an epidemiological tool by which samples of pre-designed size are collected over time, from among the identified risk groups known as sentinel groups. This sample size represents the larger group with similar risk and other characteristics.

Q. What is “Unlinked Anonymity” in HIV Sentinel Surveillance?

Ans. In HIV Sentinel Surveillance, unlinked anonymity means that the blood is primarily collected for some other purpose and the results are not linked to any individual. This methodology is adopted in order to minimise participation bias in the whole procedure.

Q. Is the HIV Sentinel Surveillance clinic based or community based?

Ans. In order to minimise the selection bias of samples, consecutive sampling procedure is adopted and it is ideally a clinic based approach.

Q. What is the usefulness of HIV Sentinel Surveillance?

Ans. HIV Sentinel Surveillance data is used to understand and monitor time trends, know HIV prevalence levels in various risk groups in states/UTs and work out total HIV burden in various sub-populations.

Information, Education and Communication (IEC)

Q. Despite all the publicity regarding the AIDS Awareness Campaign, the awareness about AIDS is very low. Where is all the money going?

Ans. The IEC campaign of NACO is operationalised at two levels: the National level and the State level. The activity has been mostly decentralised to the states and each state society is expected to utilise the funds as per the local requirements. Despite all the talk about funds being available for IEC, the fact is that the funds are quite meagre, considering the size of the country and the magnitude of the problem. Funds amounting to about 10 crore are available for the national campaign, which is operated centrally by NACO.

Q. The message of AIDS advertisements is done crudely with a fear approach. What is the process by which NACO decides its messages for various target audiences?

Ans. The fear approach has been completely done away with in all campaign messages. During the early days of the campaign, this approach was used to a certain extent, but the same has been discontinued for quite some time. NACO has a process by which a committee comprising renowned media personnel come together to decide the content and strategies for all campaigns at the national level. Research, in terms of NFHS and BSS surveys conducted by the Ministry, are used to ascertain knowledge levels in the population. Based on the funds available, appropriate media is used for dissemination of the messages.

Q. AIDS is associated with very high profile funds and personalities. In spite of this, there seems to be no control on the spread of the virus. Why?

Ans. Endorsement by well known personalities gives visibility and acceptance to any product (social and commercial), and is a time tested approach in the field of advertising. Prevention of AIDS is related to behavioural change in individuals who are expected to adopt safer sexual practices. This is an extremely difficult action response that the AIDS campaign expects from the target audience. This process is time consuming, however, we have to work more intensively. Given a limited budget available with NACO, all personalities roped in so far have offered their services for free. Media events that are appropriately located and strategised, are necessary to give visibility to the programme and also enthuse participation from target groups like the youth.

Q. AIDS awareness campaign is concentrated mostly in urban areas whereas the rural belts are left untouched. Why?

Ans. The IEC campaign uses a number of media vehicles to spread the messages in the rural belt also. The bulk of the money is spent on Doordarshan and radio which is accessible by both urban and rural population. As recent surveys have shown, the reach of television has far outstripped the reach of even radio and other media. Apart from the mass media, interpersonnel communication methods are used, which cover urban slums and rural areas.

NGOs

Q. With respect to corruption in the selection of NGOs, how does NACO ensure that bonafide NGOs are given work?

Ans. NACO has a very transparent procedure of inviting NGO proposals. Proposals are invited through newspaper advertisements, which are screened by a Technical Advisory Committee which has members from the NGO community. Blacklisted NGOs are kept out and only those with proven track records are considered. Apart from verification of documents submitted, every NGO is physically verified for nature of work and presence in the target community. The final selection is done by the Executive Committee of the SACS, which is headed by the Secretary (Health).

Q. The number of NGOs is adequate but what about quality of work? How does NACO keep a check on defaulting NGOs?

Ans. NACO has a well laid out monitoring and evaluation system which operates at all stages of NGO functioning. Minimum quality standards are set and necessary capacity building done to ensure compliance. Apart from an internal process of evaluation within the NGO, timely reports are received from them in desired formats. Periodic field visits by SACS officials, in teams that also have NGO workers from other NGOs ensure the veracity of the self reports of NGOs. The NGOs have to provide audited statement of accounts for previous money received to ensure receipt of future installments. Every third year the NGO performance is evaluated by an external agency.

Q. Why is NGO work mostly restricted to Targeted Interventions? Doesn’t it lead to identification of High Risk Groups and further stigmatisation?

Ans. Targeted Intervention is a very important strategy of NACP- II to check the spread of HIV. It is a fact that certain groups of people, known to practice high risk behaviour are more likely to carry the virus than others. Groups like the CSWs, IDU, Truckers, Migrants, etc. are also the most marginalised in the society. These groups do not need half baked interventions where one just tells them about behaviour change. BCC is important but that should be accompanied by services like STD treatment, condom provision, creation of enabling environment etc. All these are essential components of NACO’s TIs.

It is felt that once these groups are approached in the right spirit, they are more likely to come out of their shell and join the mainstream and thereby be less stigmatised.

Q. Many NGOs are harassed for their activities. What does NACO do about it?

Ans. NGOs are normally harassed by police personnel. This is true mostly in states where adequate efforts to sensitise the law and order machinery are not being made. Although NACO has equivocally condemned all such instances of excesses by certain authorities, it is not in a position to become a supercop. NACO on its part has worked out elaborate plans for a sustained advocacy initiative with police personnel at all levels. Efforts are also on to see if relevant provisions of the IPC can be modified in the context of today’s requirements.

Q. What does NACO do about regional disparities in the number of NGOs operating?

Ans. The NGO movement is operating at different levels in different states. While some states have a committed group of NGOs the others have few credible NGOs to talk of. States like Bihar, Uttar Pradesh, Jharkhand etc. have a few NGOs and these organisations by and large are not perceived to be credible. The task is challenging and complex. The process is ongoing. Capacity building of NGOs is one activity that is to be done vigorously. The state governments are also expected to provide an environment that builds trust between the government and the civil society and ensures long term partnerships.

Integrated Counselling and Testing Centre (ICTC)

Q. What is ICTC?

Ans. ICTC stands for Integrated Counselling and Testing Centre.

Q. What is the role of ICTC in the prevention of HIV/AIDS?

Ans. As the HIV problem intensifies, the issues of care and support for affected individuals, and prevention of HIV transmission to those who are not affected, become even more critical. Integrated Counselling and Testing (ICT) is now seen as a key entry point for a range of interventions in HIV prevention and care. It provides people with an opportunity to learn and accept their HIV sero status in a confidential and enabling environment and to cope with the stress arising out of HIV infection. ICT should become an integral part of HIV prevention programmes, as it is a relatively cost-effective intervention in preventing HIV transmission.

The potential benefits of ICT are:

• Earlier access to care and treatment

• Providing factual information about HIV /AIDS and clearing misconceptions

• Reduction of fear and stigma through counselling

• Creating enabling environment for PLHA

• Emotional support

• Better ability to cope with HIV related anxiety

• Improved health status through good nutritional advice

• Motivation to initiate or maintain safer sexual practices and behaviour change

• Prevention of HIV related illness

• Motivation for drug related behaviour

• Safer blood donation

• Motivating HIV infected person to involve spouse/partner for future spread and care.

Q. What is the setup at ICTC?

Ans. ICTC is not a place just for testing a sample for HIV, but much more than that. One of the basic elements involved is a confidential discussion between the client and the trained counsellor and the focus is on emotional and social issues related to possible or actual HIV infection. The aim of the ICTC is to reduce psycho-social stress and provide the client with information & support necessary to make decisions, therefore it needs a private and peaceful setting.

Separate enclosures for male & female clients have been set up to provide confidential environment for encouraging disclosure and providing IPC.

For the effective functioning of the ICTCs, two trained counsellors and one laboratory technician have been provided in each ICTC.

In order to ensure that the result of the HIV test is given on same day to the individual after post-test counselling, Rapid HIV Test Kits have been supplied to these centres or the client is asked to meet the same counsellor for post test counselling on appointed date.

Waiting space, trained Microbiologist/Pathologist, training to staff functionaries of ICTC, two trained counsellors and one laboratory technician have been provided in each ICTC.

In order to ensure that ICTCs provide quality counselling services, stress has been laid on pre-placement in-service training of counsellors & technicians by master trainers & resource persons.

Orientation training is also conducted for these functionaries.

Q. What has been done to make ICTCs user-friendly?

Ans. In order to make the services more user-friendly following efforts are being made:

∙ ICTCs are located in easily accessible areas mostly in OPDs.

∙ Informed consent in local language is taken before HIV testing. Clients are informed about the nature and consequences of HIV test before their consent is taken. It is emphasised that testing should not be forced but left at the will of the client.

∙ Here it is emphasised that counsellors should not be rotated from centre to centre and from one day to another since the rapport between the counsellor and client is very essential.

∙ Adequate supply of condoms is made available in these counselling centres. Individuals attending the ICTC are also made aware about the outlets from which they can get condoms under various schemes.

∙ Counselling is integrated into other services, including STI, antenatal and RCH clinics.

∙ Referral system has been developed in consultation with NGOs, community based organisations, hospitals and PLWA networks.

∙ Counsellors are provided adequate training and ongoing support and supervision to ensure that they give good quality counselling and avoid burnout.

∙ Linkages with NGOs for social support, follow-up counselling and care for those tested sero positive are emphasised.

∙ Innovative ways of scaling up ICT services and making them more accessible and available is the endeavour.

∙ There is an emphasis to make it more client-friendly and service based by augmenting the following services:

∙ Anti retroviral drugs in PPTCT

∙ Anti-tubercular treatment in HIV-TB co-infection

∙ Free treatment of STI & opportunistic infections

∙ Follow up services & networking among patients living with AIDS.

Blood Safety

Q. Is there a National Blood Policy?

Ans. Yes, a National Blood Policy has been formulated and is now being implemented with the mission to ensure easily accessible and adequate supply of safe and quality blood collected from voluntary non-remunerated regular blood donors.

Q. What are the infections for which blood is tested?

Ans. The Drugs & Cosmetics Act provides mandatory testing of blood for five major infections viz. HIV, Hepatitis B, Hepatitis C, Syphilis & Malaria. Every unit of blood is tested for all these infections.

Q. What does the term ‘Service Charge’ means in blood banks?

Ans. No charges for blood as such can be levied by any blood bank. However, the blood that is collected from a donor at no cost, needs to be processed to make it free of infection, to ensure that it has certain minimum quality standards. It also needs to be stored and tested with recipient’s blood before transfusion. Besides all these, establishment costs for the blood bank like infrastructure maintenance, salaries etc. add to the overall costs of providing a safe unit of blood to the patient. Blood banks attempt to recover these costs as service charge from the consumer.

Q. Is there some uniform service charge fixed for a blood unit?

Ans. There are some guidelines developed by the National Blood Transfusion Council and circulated by NACO, on the amount of service charge that can be charged by blood banks functioning in any sector in the country. These guidelines specify that no blood bank will charge more than Rs.500/- for one unit of whole blood. However, since these are mere guidelines and have no legal

Q. NBTC was constituted subsequent to Supreme Court judgment in 1996 with the focus of catering to Nation’s blood security. The prime objective was to phase out professional donors and focus on voluntary donations. How far has this policy been successful and how much voluntary blood is collected in the country?

Ans. Soon after setting up of the National Blood Transfusion Council (NBTC) at the Centre and State Blood Transfusion Councils (SBTCs) in each state/UTs, a complete ban has been imposed on collection of blood from paid donors, with effect from 1st January, 1998. A number of steps were taken by NBTC to keep a strict check on exploitation of the blood users by commercial and private blood banks. SBTCs were provided funds by NBTC to mobilise blood collection through voluntary blood donations. Extensive awareness programmes for donor motivation through Information, Education, Motivation, Recruitment and Retention of voluntary donors was launched. Each state is given an annual target for collection of blood through voluntary sources and this is regularly reviewed by NACO.

Q. Is the blood issued by blood banks safe?

Ans. Yes. As per the National Blood Safety Programme of NACO, it is mandatory on the blood banks to test every unit of blood properly for grouping, cross matching and testing for HIV, Syphilis, Hepatitis B & C and Malaria before it is issued for transfusion. Facilities have been provided by NACO to all the government and charitable blood banks like Red Cross to carry out these tests.

Q. Can one acquire HIV infection if one donates blood?

Ans. No, this is not possible as all materials used for collection of blood are sterile and disposable. Donating blood is a noble gesture. People who are healthy should come forward for donating blood voluntarily.

Q. Who can donate blood?

Ans. Only a healthy person between the age group of 18 – 60 years, weighing 45 kg or more with haemoglobin content of 12.5 gm per 100cc or more can donate blood.

Q. Is there any inspection of blood banks?

Ans. Yes. The blood banks can only function if they are licensed by the Drug Inspectors of the Food and Drug Administration of the respective states. The Drugs & Cosmetics Act provides a legal framework under which the blood banks are inspected and issued a proper license, which is renewed every alternate year. Every blood bank has to prominently display its license for anyone to check.

Care and Support

Q. Do AIDS cases require a separate ward?

Ans. NACO does not support separate ward for AIDS patients. AIDS patients are to be treated at par with the general patients and there should be no discrimination.

Q. If testing has to be done in the hospital, is the consent of the patient required?

Ans. Yes. Whenever HIV test is done, the consent has to be taken. In case of unconscious patients, the consent of the relatives has to be taken.

Q. What is the importance of ICTC in care and support?

Ans. ICTC is an entry point for care and support of HIV/AIDS. Whenever a person feels, he can walk to an ICTC and get himself tested. If tested positive, follow up counselling is suggested at the ICTC for referrals and treatment of HIV/AIDS patients.

Q. Is the government considering to provide anti retroviral therapy for AIDS cases?

Ans. Government as yet is not considering provision of anti retroviral therapy because of its cost. Antenatal therapy is not a cure but can only prolong the life of the patient and the drugs have to be continued for lifetime.

Q. What efforts are being made to integrate HIV/AIDS/STD prevention and control activities into primary healthcare?

Ans. Integration into primary healthcare is a priority because it is necessary for ensuring sustainability. Two examples of an integrated approach are the implementation of HIV/AIDS care and STD prevention and control. For example, a continuum of HIV/AIDS care is being promoted as part of primary healthcare, with linkages to be established between institutional, community and home levels. In the area of STD prevention and control, a syndromic approach to STD diagnosis is most suitable in the developing world as it does not require laboratory tests, and treatment can be given at the first contact with health services. WHO strongly advocates that all primary healthcare workers be trained in the syndromic approach to STD management.

Q. What steps has the Government of India taken to tackle the dual epidemic of HIV-TB?

Ans. Recognising the serious threat posed by HIV-TB co-infection, the Government of India has emphasised the need for strengthening collaboration between TB and AIDS control programmes for better management of HIV-infected patients with TB. An Action Plan for tackling this dual epidemic has been drawn up at the Centre between both the programmes which is initially focussed on the six high prevalence states and is under implementation at the moment by both the National Programmes. Efforts are being made to establish Integrated Counselling & Testing for HIV, diagnosis for TB and Directly Observed Treatment–short course for TB under the same roof to make such services available to the needy patients.

Q. What precautions should be taken while treating HIV and TB at the same time?

Ans. Certain anti-TB medications may affect the levels of anti-HIV medications and vice versa. Hence treatment of both diseases should be under the supervision of an experienced physician, the dosages should be closely monitored and adjusted as needed. If possible, treatment of TB should be completed before starting anti retroviral.

Sexually Transmitted Infections/Reproductive Tract Infections

Q. Why no reduction has been noticed in the prevalence of Sexually Transmitted Infections in India even though the STD Control Programme has been in operation since 1949 ? Which activities are provided under STD Control Programmes?

Ans. Precise data about the prevalence of STIs in India is not available. However, from the limited number of studies conducted among the ‘High Risk Population’ or ‘Hospital Based Studies’, prevalence rate of STIs in India has been quoted to be about five percent. Now, NACO has planned to ascertain the prevalence of STIs and also health seeking behaviour of persons suffering from this group of diseases by undertaking a country wide community based STI Prevalence Survey. STD Control Programme is based on early diagnosis and prompt treatment of STIs and relies on the health seeking behaviour of individuals with STD.

Health seeking behaviour of those suffering from STDs is directly related to the stigma attached to the disease, because of which individuals with STI desire anonymity. As a result, they seek alternate source of medical aid including self-medication and only a small proportion report to public sector medical set-up. Because of this attitude and behaviour of those suffering from STIs, they continue to transmit infection to their multiple sex partners. This is the main obstacle in converting infectious pool into non- infectious. Under the STD Control Programme, the government has established STD clinics in each district hospital, all over the country. The STI drugs are provided free of cost by the Government of India and adequate confidentiality is ensured for those attending these clinics. Such clinics are managed by experts trained to treat STIs. Another major activity of STD Control Programme is Targeted Intervention under which, special facilities are made available easily to commercial sex workers, truckers, migrant workers and other marginalised segments of society. Partner notification, condom promotion and imparting IEC activities through peer-educators are the interventions organised as a part of the programme. STI management through syndromic approach has been now practiced by trained medical officers at peripheral, middle and even at tertiary levels of healthcare where adequate lab facilities are not available.

.Q. What is FHAC?

Ans. FHAC stands for Family Health Awareness Campaign. The campaign is carried out for a period of 15 days once a year. The objectives of the campaign are:

∙ To raise the level of awareness on RTI/STI and HIV/AIDS in rural and slum areas, and other vulnerable groups of the population

∙ To encourage health seeking behaviour in the general population for RTI and STI

∙ To make the people aware about the services available in the public health system for the management of RTI/STI

∙ To facilitate early detection and prompt treatment of RTI and STI by mainstreaming the programme with the infrastructure available under the primary healthcare system

∙ To strengthen the capacity of medical & paramedical professionals working under healthcare system to respond to HIV/AIDS epidemic adequately.

Q. Does the presence of other sexually transmitted diseases (STDs) facilitate HIV transmission?

Ans. Yes, every STD causes some damage to the genital skin and mucous layer, which facilitates the entry of HIV into the body. The most dangerous are:

• Syphilis

• Cancroids

• Genital herpes

• Gonorrhoea.

Q. Why is early treatment of STD important?

Ans. High rates of STD caused by unprotected sexual activity enhance the transmission risk in the general population. Early treatment of STD reduces the risk of spread to other sexual partners and also reduces the risk of contracting HIV from infected partners. Besides, early treatment of STD also prevents infertility and ectopic pregnancies.

Prevention of Parent to Child Transmission (PPTCT)

Q. What is the government’s stand on breast feeding in case of HIV positive mothers?

Ans. Best practice as recommended by UNICEF and supported by NACO is followed. Messages will be consistent with the related programme of RCH. Every effort should be made to promote exclusive breast feeding for upto four months in the case of HIV positive mothers followed by weaning, and complete stoppage of breast feeding at six months in order to restrict transmission through breast feeding. However, such mothers will be informed about the risk of transmission of HIV through breast milk and its consequences, and would be helped for making informed choice regarding infant feeding.

Antiretroviral Therapy

Q. Is the Government of India planning to introduce anti retroviral therapy free of cost in government hospitals? Who will be eligible for the supply of drugs?

Ans. Union Minister for Health & Family Welfare convened a dialogue with the manufacturers of anti retroviral for HIV/AIDS, with a view to examine the feasibility of procuring and delivering ARVs through the public health system. As a result, a Working Group was constituted, chaired by Secretary Health, with the Director General, Health Services and Additional Secretary & Project Director NACO as members, together with CII, FICCI, and representatives of the different manufacturers of anti retroviral. The Working Group has completed its deliberations. If government does proceed to introduce anti retroviral through the public health system, these will be delivered free of cost to the end consumer in government hospitals. While we estimate over people living with HIV/AIDS at the end of the year, we necessarily have to prioritise the beneficiary population which include HIV positive mothers who access the government health system through the Prevention of Parent to Child Transmission clinics, HIV positive children below 15 years of age, and full blown AIDS cases who seek treatment in government hospitals.

Condom Promotion

Q. What is the government’s policy on condoms?

Ans. The government policy has been that condoms are an effective, protective measure to prevent the spread of HIV. The government believes that it is necessary to be focused in the promotion of condoms since a large number of infections occur through unsafe sex. For the general population the dual use of condoms for contraception and disease prevention is emphasised by both National AIDS programme and Reproductive & Child Health programme. For the high risk groups, targeted social marketing and free distribution of condoms is being promoted through NGOs.

Q. How safe are condoms in preventing HIV?

Ans. Consistent and correct use of Latex condoms are fully effective in preventing the spread of HIV through the sexual route.

HIV-TB Co-infection

Q. How does infection with TB affect the HIV/AIDS scenario?

Ans. TB shortens the survival of patients with HIV infection, accelerates the progression of HIV to AIDS as observed by a six- to seven-fold increase in the HIV viral load in TB patients and is the cause of death for one out of every three people with AIDS worldwide. Effective treatment using DOTS not only prolongs the survival of patients living with AIDS, but also improves their quality of life.

Q. What are the clinical features of TB and what type of TB is more commonly seen in HIV positive individuals?

Ans. As the HIV infection progresses, the CD4 lymphocytes decline in number and function. Therefore, the immune system is less able to prevent the growth and spread of the TB bacilli. As a result, disseminated and extra-pulmonary TB disease is more commonly seen in the later stages. Nevertheless, pulmonary TB is still the most common form of TB even in HIV-infected patients. Many studies have shown that pulmonary involvement occurs in 70-90 percent of all HIV/AIDS patients with TB.

Q. How does treatment of TB differ in HIV infected and HIV uninfected individuals?

Ans. In general, anti-TB treatment is the same for HIV-infected and HIV-uninfected TB patients, with the exception of the use of thiacetazone. Thiacetazone causes severe cutaneous reactions that may be fatal and hence should be avoided. Patients who complete treatment show the same clinical, radiographic and microbiological response to short-course treatment irrespective of whether they are HIV positive or negative. Self-administration of treatment is associated with higher case fatality rates. Directly Observed Treatment–short course (DOTS) is therefore even more important for HIV-infected TB patients. Treatment with DOTS for HIV-infected TB patients improves their quality of life, and also has been shown to prolong their life span. DOTS can prevent emergence of MDR -TB and reverse the trend of MDR-TB.