BASICS OF HIV AND AIDS
Human Immunodeficiency Virus (HIV) is a virus that affects the immune system. Prolonged virus makes the body susceptible to many other infections and health eventually deteriorates. Acquired Immunodeficiency Virus (AIDS) refers to a set of symptoms and illnesses that occur at the late stage of HIV infection. It is possible that one can have HIV but not AIDS. There is no cure but treatment for HIV and AIDS is available which coupled with healthy lifestyle can prolong longevity. Earlier those infected with HIV would generally develop AIDS early but currently due to advanced treatment and medication people can significantly delay getting AIDS.
What is HIV?
HIV is a virus that attacks the immune system, which provides resistance against toxins and infections. Immune system is the body’s natural defence against diseases. The virus destroys T cells (also known as Helper T cells or CD4 cells), a type of white blood cell in the immune system. T-cells majorly regulate the responses of immune system by directing other cells to perform. They also regulate both innate and adaptive immune responses. HIV destroys CD4 cells which gradually breaks down a person’s immune system. This leaves the person more vulnerable to other infections and viruses around and makes it harder for the body to fight diseases and infections.
What is AIDS?
AIDS is not a virus in isolation, it is a set of symptoms caused by HIV itself. A person with AIDS has a very weak immune system and if untreated for long can be fatal. Although there is currently no cure for HIV but with the right treatment and support, people with HIV can live long and healthy lives. For this it gets important to take correct treatment. Two things which assure correct treatment are, timely uptake of medication and proper adherence. Being diagnosed with HIV, does not mean the person has AIDS. AIDS is diagnosed only when people with HIV infection begin to get severe opportunistic infections (OIs), or their CD4 cell counts fall below a certain level.
Transmission of the virusHIV can be transmitted through:
- Unprotected sex with an HIV infected person;
- HIV infected mother to her baby – during pregnancy, during birth or after delivery through breast milk.
- Transfusion of HIV infected blood or blood products;
- Sharing of needles contaminated with HIV infected blood;
HIV doesn’t spread
The virus doesn’t spread in air, water or through casual contact. The virus cannot be transmitted through sweat, saliva or urine either.
Apart from the above modes of transmission, HIV doesn’t spread by any other way.HIV doesn’t spread through ordinary social contact or sharing physical spaces for example by shaking hands, travelling in the same bus, eating from same utensils, by hugging, contact with saliva, social kissing or mosquito bites.
Precautions against the spread of virusTransmission of HIV can be prevented by undertaking certain precautions:
- Regular, correct and consistent use of condoms: Regular use of condom at every sexual encounter provides protection from transmission of HIV virus as well as unwanted pregnancy and other sexually transmitted infections. A new condom after due check of its expiry date should be used correctly every time before every sexual encounter. They are much less protective if used inconsistently and/or incorrectly.
- Timely testing and treatment for sexually transmitted infections also reduces risk of contracting HIV.
- Used syringe should not be reused: Sharing an already used syringe and needle puts a person at the risk of transmission of HIV virus. The reuse of a HIV infected blood contaminated needle or syringe by another drug injector has some quantity of the HIV infected blood present in the hollow of the needle and the base of the syringe cylinder. Hence the reuse of such needles and syringes carry high risk of HIV transmission or any other blood borne virus when pushed into the blood stream of the next user. The person also becomes susceptible to other infections found in the blood like hepatitis C and hepatitis B etc.
- Proper and just use of Post-Exposure Prophylaxis (PEP): PEP is a regimen where antiretroviral medicines are taken after potential exposure to HIV to prevent from being infected by HIV. PEP should be used as early as possible and definitely within a stipulated time of 72 hours (3 days). On realization that one got needle stick injury from HIV positive person can take PEP after due consultation with the healthcare provider.
- Know your status and that of the partner: It gets imperative to know ones HIV status in order to assure speedy access to treatment and medication. Timely testing and treatment can assure a healthy life. With GoI’s ‘Test and Treat’ Programme in place, a person tested positive for HIV is immediately put on Antiretroviral Therapy (ART) which suppresses the virus and stops the progression of HIV disease.
- Obtaining blood and components from a licensed blood bank: Registered Medical practitioners to procure and transfuse blood/ blood components which has been screened for HIV and other infections to any patient who needs it.
Blood Bank's responsibility: Blood Bank must select only healthy persons from low risk population to donate blood. All donated blood units must be screened for five Transfusion Transmitted Infections (TTI) ie HIV, HBV, HCV, Malaria and Syphilis in accordance to the provisions in the Drugs and Cosmetics Act and Rules thereof.
Clinician's responsibility: Blood or blood components must be prescribed only when actually indicated and transfused only when absolutely necessary. Guidelines for appropriate clinical use of blood/ components must be followed, with proper bedside practices and documentation. Blood and Blood Components should only be sourced from licensed blood banks/ approved blood storage centres.
Recipient's responsibility: Blood and Blood Components should only be sourced from licensed blood banks/ approved blood storage centres and transfused only with a proper medical prescription and supervision of a Registered Medical Practitioner.
HIV infection is not the end of life. People can lead a healthy life for a long time with appropriate medical care. People with HIV who are aware of their status can get HIV treatment (called antiretroviral therapy or ART) and remain healthy for many years. Anti-retroviral therapy (ART) effectively suppresses replication, if taken at the right time. Successful viral suppression restores the immune system and halts onset and progression of disease as well as reduces chances of getting opportunistic infections – this is how ART is aimed to work. Medication thus enhances both quality of life and longevity.
Adherence to ART is Critical
Adherence to ART regimen is therefore very vital in this treatment. Any irregularity in following the prescribed regimen can lead to resistance to HIV drugs, and therefore can weaken or negate its effect.
ART is Accessible to All
ART is now available free to all those who need it. Public health facilities are mandated to ensure that ART is provided to people living with HIV/AIDS (PLHA). Special emphasis is given to the treatment of sero-positive women and infected children.
Q. What is HIV?
Ans. HIV stands for Human Immuno-deficiency Virus. HIV after entering the human body gradually destroys the immune system, i.e. the ability to fight infections/diseases.
Q. What is AIDS?
Ans. AIDS stands for Acquired Immune Deficiency Syndrome. It is the later stage of HIV infection. It is a condition in which a group of symptoms appear as the immune system becomes very weak. It can take around 8-10 years from the time of HIV infection to the stage of AIDS. HIV infected people can lead symptom–free and productive lives for years.
Q. Do all people with HIV have AIDS?
Ans. No. Being diagnosed with HIV does not mean a person will also be diagnosed with AIDS. Healthcare professionals diagnose AIDS only when people with HIV infection begin to get severe opportunistic infections (OIs), or their CD4cell counts fall below a certain level.
Q. How do people get infected with HIV?
Ans.HIV can be transmitted through: Unprotected sex with an HIV infected person; Transfusion of HIV infected blood or blood products; Sharing of needles contaminated with HIV infected blood; and from HIV infected mother to her baby – during pregnancy, during birth or after delivery through breast milk.
Apart from the above modes of transmission, HIV doesn’t spread by any other way, HIV doesn’t spread through ordinary social contact; for example by shaking hands, traveling in the same bus, eating from same utensils, by hugging or social kissing etc.
Q. Where can I get tested for HIV?
Ans.You can get your HIV test done at Integrated Counselling and Testing Center (ICTC) or any other health facility. It’s easy, safe, quick and free of cost. Your HIV status report will be kept confidential. In Andaman & Nicobar Islands there are 13 Health facilities designated as ICTC. Now HIV testing is also done during the outreach activities at field level as Community Based Screening.
Q. Why the HIV/ AIDS epidemic is considered so serious?
Ans.HIV generally affects people at the most productive age, leading to premature death thereby severely affecting the socio-economic structure of whole families, communities and countries. Secondly, HIV infection goes unnoticed in the initial years because it is not symptomatic in the initial phase. Thus, early detection, treatment and management get tough. This is the reason why HIV / AIDS is often called a silent killer. A considerable amount of stigma and discrimination is associated with AIDS, which creates hindrance in prevention as well as care and support efforts. And, because HIV spreads mostly through sexual contact which being very personal and private affair, it becomes difficult to address it.
Q. Can I get HIV from getting a tattoo or through body piercing?
Ans.A risk of HIV transmission does exist if instruments contaminated with blood are either not sterilized or disinfected or are used inappropriately between clients. It is recommended that instruments that are intended to penetrate the skin be used once, then disposed of or thoroughly cleaned and sterilized.
Personal service workers who do tattooing or body piercing should be educated about how HIV is transmitted and take precautions to prevent transmission of HIV and other blood-borne infections in their settings. If you are considering getting a tattoo or having your body pierced, ask staff at the establishment what procedures they use to prevent the spread of HIV and other blood-borne infections, such as hepatitis B virus.
Q. Why is injecting drug use a risk for HIV?
Ans. At the start of every intravenous injecting episode, blood from the vein is drawn in for confirmation and thus blood is introduced into needles and syringes. HIV is present in large quantity in the blood of a person infected with the virus. The reuse of a HIV infected blood -contaminated needle or syringe by another drug injector (sometimes called "direct syringe sharing" has some quantity of the HIV infected blood present in the hollow of the needle and the base of the syringe cylinder. Hence the reuse of such needles and syringes carry high risk of HIV transmission or any other blood borne virus when pushed into the blood stream of the next user.
In addition, using some unsterilised medical equipment can pose a risk of spreading HIV. "Street sellers" of syringes may repackage used unsterilised syringes and sell them as sterile syringes. For this reason, people who continue to inject drugs should obtain syringes from reliable sources of sterile syringes, such as pharmacies and NGOs implementing IDU-Targeted Intervention under NACP. It is important to know that sharing a needle, syringe or any other injecting paraphernalia for any use, including skin-piercing and injecting steroids, can put one at risk for HIV and other blood-borne infections.
Q. Will 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 HIV 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 cause tear of anus and penis thus may allow the HIV 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 behavior. If people choose to have anal sex, they should use a latex condom. Most of the time, 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 the condom breaking.
Q. How effective are latex condoms in preventing HIV?
Ans. Studies have shown that latex condoms are highly effective in preventing HIV transmission when used correct and consistently. These studies looked at uninfected people considered to be at very high risk of infection because they were involved in sexual relationships with HIV-infected people. The studies found that even with repeated sexual contact, majority of those people who used latex condoms correctly and consistently did not become HIV infected.
Q. How can I avoid being infected through sex?
Ans. By abstaining from sex; or By having a mutually faithful monogamous sexual relationship with an uninfected partner; or By practicing safe sex (Safe sex involves the correct use of a condom during each sexual encounter and also includes non-penetrative sex.
Q. I had sex with someone and the condom broke. I think I could be at risk for HIV? What should I do?
Ans. If within 72 hours since the condom broke, you may be able to take medication that could keep you from getting infected with HIV, even if your partner is HIV-positive. Call your doctor or your local health department immediately and ask about Post-Exposure Prophylaxis, or PEP. If it’s been longer than 72 hours, PEP will not protect you from HIV, and you will need to explore HIV testing options. In most cases, you will have to wait at least 6 weeks after a possible exposure before an HIV test can provide accurate results Window Period).
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 an advanced stage of AIDS. Transmission can also occur at the time of birth when the baby is passing through the mother’s genital tract. Transmission can also occur through breast milk.
Q. Can HIV be transmitted through breast-feeding and what can be done?
Ans. Yes. The virus has been found in the breast milk in low concentrations and studies have shown that, 10 to 15% children born to HIV-infected mothers can get HIV infection through breast milk. Breast milk, however, has many substances in it that protect an infant’s health. The benefits of breast-feeding for both mother and child are well recognized and as effective ARV drugs are available, it is now recommended to all HIV positive mothers to continue breastfeed their infant.
Q. How can HIV transmission through blood transfusion be prevented?
Ans. Donor's responsibility: Only healthy persons must enrol as blood donors. Anyone at risk for HIV/ AIDS or already positive for HIV or other TTI should permanently defer himself from donating blood. In case a person at risk donates blood at the blood bank or in a blood donation camp, he can ask the blood bank staff to exclude his unit for transfusion using the provision of "Confidential Unit Exclusion". For details, refer to the Guidelines on Blood Donor Counseling of NACO/NBTC. Blood Bank's responsibility: Blood Bank should select only healthy persons from low risk population to donate blood. All donated blood units must be screened for five Transfusion Transmitted Infections (TTI), ie HIV, HBV, HCV, Malaria and Syphilis in accordance to the provisions in the Drugs and Cosmetics Act and rules thereof. Though the Blood Bank conducts mandatory screening for these five infections, there is a small chance especially among multi-transfused patients of getting blood borne infection due to blood donation during window period. This risk can be minimized through phase out of replacement blood donation and increasing reliance on Repeat Voluntary non-remunerated Blood Donors. NBTC now encourages the use of higher technologies like Fourth Generation ELISA, CLIA and NAT for enhancing the sensitivity of blood screening for donated blood. Adequate stocks of safe tested blood must be available with the blood bank in accordance to requirements. Clinician's responsibility: Blood or blood components must be prescribed only when actually indicated and transfused only when absolutely necessary. Guidelines for appropriate clinical use of blood/ components must be followed, with proper bedside practices and documentation. Blood and Blood Components should only be sourced from licensed blood banks/ approved blood storage centres. Recipient's responsibility: Blood and Blood Components should only be sourced from licensed blood banks/ approved blood storage centres and transfused only with a proper medical prescription and supervision of a Registered Medical Practitioner.
Q. What is the window period?
Ans. The normal HIV blood tests detect the presence of antibodies in human body, which take about 6-12 weeks (upto 6 months in some cases) after infection to form in the body in detectable quantity. This period is called the window period. During this period the HIV status does not show in the test but the person can infect others.
Q. Can I get HIV from kissing on the cheek?
Ans. HIV is not casually transmitted, so kissing on the cheek is very safe. Even if the other person has the virus, your unbroken skin is a good barrier. No one has become infected from such ordinary social contact as dry kisses, hugs, and handshakes.
Q. Can I get HIV from open-mouth kissing?
Ans. Open-mouth kissing is considered a very low-risk activity for the transmission of HIV. However, prolonged open-mouth kissing could damage the mouth or lips and allow HIV to pass from an infected person to a partner and then enter the body through cuts or sores in the mouth. Because of this possible risk, the CDC recommends against open-mouth kissing with an infected partner.
Q. Can I get AIDS from sharing a cup or shaking hands with someone who has HIV or AIDS?
Ans. HIV is found only in body fluids, so you cannot get HIV by shaking someone’s hand or giving them a hug (or by using the same toilet or towel). While HIV is found in saliva, sharing cups or utensils has never been shown to transmit HIV.
Q. Can HIV be transmitted through an insect bite?
Ans. No, Insects cannot transmit HIV. Research has shown that HIV does not replicate or survive well in insects. HIV does not reproduce or live in the mosquito’s saliva. HIV is a fragile virus that does not live outside the human body.
Q. Is there a connection between HIV and other sexually transmitted infection?
Ans. Yes. Sexually Transmitted Infection (STI) can increase a person's risk of becoming infected with HIV five to eight times more. The STI causes ulcers or discharge from genitalia, STI increases the chance of acquiring and transmitting the chance of HIV infection.
If the Sexually Transmitted infection causes irritation or ulcer of the skin, it makes it easier for HIV to enter the body during sexual contact. Even when the STI causes no breaks (discharge) or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmit more easily.
Q. Why is early and complete treatment of STI important?
Ans. A patient with STI is at increased risk (5 to 8 times)of acquiring and transmitting HIV infection. Early diagnosis and treatment of STI helps in curing the STI and reducing the transmission for risk of HIV infection to the sexual partner. Besides, early treatment of STI also prevents infertility and ectopic pregnancies.
Q. What are Sexually Transmitted infections? What are their symptoms in men & women?
Ans. Sexually Transmitted Infections (STI)/ Reproductive Tract Infections (RTI) are defined as any infection that spread primarily through person to person sexual contact and any infection that are located in reproductive tract.
STI symptoms in men
Discharge or pus from the penis Sores, blisters, Rashes or boils on the penis, Lumps on or near the genital area or penis swelling in the genital area, Pain or burning during urination, itching in and around the genital area.
STI symptoms in women
Pain in the lower abdomen, Unusual and foul smelling discharge from the vagina, Lumps on or near the genital area, Pain or burning during the sexual intercourse,Itching in and around the genitals, Sores, blisters, Rashes or boils around the genitals. Women are more susceptible to infections. Correct and Consistent use of condom is the best way to prevent infection and it’s also important to take the full course and only stop medicines when told by doctor only. Get your partner also tested for STIs.
Q. Is there a treatment available for HIV/AIDS?
Ans. While there is no cure, effective Anti-Retroviral Treatment (ART) drugs are available which can prolong the life of an HIV positive person, thus enhance the quality of life as well. Patient has to take life long treatment once initiated on ART. It is freely available at ART centres across India.
Q. Why should young people be concerned about HIV/AIDS?
Ans. The reasons for the important role of young people depend upon several factors:
- A major proportion of HIV infection occurs in young people
- Young people are at a high risk of acquiring sexually transmitted infections, including HIV if they experiment with sex or drug as a part of their growing up.
- Young people can communicate better with other young people than older people can. This means their role as peer educators and motivators cannot be taken by other people.
- Young people have the enthusiasm, energy and idealism that can be harnessed for spreading the message of HIV/AIDS awareness and responsible sexual behaviour.
- Young persons can spread the message not only to their peers and to younger children, but also to their families and the community.
- Young persons can ideally serve as role models for younger children and their peers.
Q. Why is it important to tell people to fight AIDS & not people living with HIV/AIDS?
Ans. This is important because AIDS has produced an unprecedented negative reaction from people.
- It has produced reaction of fear, hostility and prejudice.
- Sometimes people with HIV/AIDS have been evicted from their lodgings and rejected by their family or friends.
- Consequently people with AIDS are afraid to tell others about their condition for fear of victimization
- Reaction such as these are mostly due to ignorance
- Education on how AIDS is transmitted and how people can protect themselves is the most important means of reducing the spread of AIDS.
- Moreover, the facts that HIV is not transmitted through casual and social contacts including sharing of clothes and utensils, eating together, sharing the toilets, playing together, touching, hugging, is reinforced and the fear and stigma associated with HIV can be dispelled.
Q. What support can I give a person who is living with HIV/AIDS?
Ans. It is important that we help a person living with HIV/AIDS to remain strong in the body and mind, as this helps greatly to increase their life expectancy and the quality, by delaying the disease progression.
We can offer support by:
- Joining in the fight against reducing HIV/AIDS related Stigma and discrimination.
- Providing a balanced and nutritious diet
- Ensuring that the person stays active and economically productive
- Accepting the person along with the illness so that he or she maintains a positive self-image by feeling wanted and loved
- Providing the necessary care and affection and support to the family
- Helping neighbours, friends and relatives to understand the nature of the illness and the care and precautions required.
Q. How can we win the war against HIV/AIDS?
Ans. It is important to realize that AIDS is the concern of each one of us as anyone of us is at risk. By sharing and spreading correct facts and positive attitudes we can ensure the safest protective behaviour possible.
We can do this by: Sharing our knowledge and facts about AIDS with all the members of the family Realizing our responsibility to spread the knowledge about AIDS in our community, helping people understand the care and precautions required to avoid the spread of the disease, helping people realize that there is no risk attached to caring for a person with AIDS at home provided that sensible household hygiene measures are taken and by creating an enabling environment for PLHIV at workplace.
Q. Can we assume responsibility in preventing HIV infection?
Ans. Both men and women share the responsibility for avoiding behaviour that might lead to HIV infection. Equally, they also share the right to refuse sex and assume responsibility for ensuring safe sex. In many societies, however, men have much more control than women to over when, with whom and how they have sex. In such cases, men need to assume greater responsibility for their actions.
Q. What is Tuberculosis (TB)?
Ans. Tuberculosis (TB) is an infectious disease caused by a Bacterium, Mycobacterium tuberculosis.
Q. How is tuberculosis caused?
Ans. TB is spread through the air by a person suffering from TB. A single patient can infect 10 or more people in a year if not treated.
Q. What are the symptoms of tuberculosis?
- Cough for two weeks or more, sometimes with blood-streaked sputum
- Fever, especially at night>=2 weeks.
- Weight loss
- Night sweat
Q. What is relation between TUBERCULOSIS AND HIV?
Ans. HIV is the strongest risk factor for tuberculosis among adults. Tuberculosis is the most prominent opportunistic diseases to develop amongst persons infected with HIV. HIV debilitates the immune system increasing the vulnerability to TB and increasing the risk of progression from TB infection to TB disease. People with TB are also susceptible to HIV infection.TB is entirely curable with a full course of treatment, which is freely available up to the Primary Health centres, including ART centres in the country.