Aids

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HIV /AIDS

What is HIV/AIDS?
HIV (Human Immunodeficiency Virus) is a virus that causes AIDS (Acquired
Immunodeficiency Syndrome), a health condition in which a person is affected by a series
of diseases because of poor immunity. HIV by itself is not an illness and does not instantly
lead to AIDS. An HIV-infected person can lead a healthy life for several years before
he/she develops AIDS.

Transmission
A person can get infected with HIV through the following routes
Unprotected sex, Sharing of needles, Unsafe blood, Improperly sterilized hospital tools and
Mother to Child.

Diagnosis
In the early stages of infection, HIV often causes no symptoms and the infection can be
diagnosed only by testing a person's blood. Two tests are available to diagnose HIV
infection - one that looks for the presence of antibodies produced by the body in response
to HIV and the other that looks for the virus itself.

Symptoms
Many people do not develop any symptoms when they first become infected with HIV.
Some people, however, get a flu-like illness within three to six weeks after exposure to the
virus. This illness, called Acute HIV Syndrome, may include fever, headache, tiredness,
nausea, diarrhea and enlarged lymph nodes (organs of the immune system that can be felt
in the neck, armpits and groin).

Treatment
Till today, there is no conclusive treatment to eliminate HIV from the body; however,
timely treatment of opportunistic infections can keep one healthy for many years. The


commonly available treatment for AIDS is the treatment against opportunistic infections.

Life after HIV
The experience of infected people during the last two decades has shown that HIV is not
the "end of the world" and that there is good quality life for several more years. Taking
care of one's health, keeping in mind one's vulnerability to diseases, and a positive attitude
have been found to be very useful.

Prevention
Because there is no effective vaccine and no cure for HIV, the only way to protect oneself
is prevention. People should either avoid having sex with multiple partners or use latex
condoms, during oral, anal, or vaginal sex. Only condoms made of latex should be used,
and whenever necessary only water-based lubricants should be used. People who are
allergic to latex can use polyurethane condoms.

Safe Sex Guide
No risk or very low risk - No reported cases due to these behaviors - Masturbation - mutual
masturbation, Touching - massage, Erotic massage - body rubbing, Kissing, Oral sex on a
man with a condom, Oral sex on a woman with a dental dam, Glyde dam, plastic wrap, or
cut-open condom, Not sharing drug injecting, body piercing instruments, needles, syringes,
Using properly sterilized hospital tools.

Blood Safety
The Human Immunodeficiency Virus (HIV), which causes AIDS, is easily transmitted
through blood transfusions. In fact, the chances that someone who has received a
transfusion with HIV blood will himself or herself become infected are estimated to be
over 90 percent.

Frequently Asked Questions
HIV stands for Human Immunodeficiency Virus. As the name suggests it only causes
disease in humans, which leads to the depletion of white blood cells leading to lowering of
immunity. Once the virus enters the body it lies dormant for many years and hence is


known as a 'slow virus'. Most other viruses for example, those causing measles, mumps,
chicken pox, etc., manifest the disease in 14-21 days after it enters the body. Hence the
incubation period is short (2-3 weeks) whereas in HIV infection it is very long and runs
into years.

What is HIV?
HIV (Human Immunodeficiency Virus) is a virus that causes AIDS (Acquired
Immunodeficiency Syndrome), a health condition in which a person is affected by a series
of diseases because of poor immunity. HIV by itself is not an illness and does not instantly
lead to AIDS. An HIV infected person can lead a healthy life for several years before s/he
develops AIDS.

What is AIDS?
As the name, Acquired Immunodeficiency Syndrome indicates, AIDS is a health condition
that results from the deficiency in the body's immunity following HIV infection. HIV
attacks the human body by breaking down its immune system that is meant to fight
diseases. Over a period of time, the immune system weakens and the body loses its natural
ability to fight diseases. At this stage, various diseases affect the infected person.

Human Immunodeficiency
Virus

TRANSMISSION Français

A person can get infected with HIV through the following routes:

Unprotected sex:


If a person engages in sexual intercourse with an infected person without
using a condom, s/he can get infected. The sexual act can be both vaginal and
anal.

Sharing of needles:

If a person shares the needle or syringe used by/on an infected person, either
for injecting drugs or drawing blood or for any other purpose involving
piercing, s/he can get infected. Instruments used for piercing and tattooing
also carry a small risk of infection.

Unsafe blood:

A person can get the infection, if he/she is given transfusion of infected blood.

Improperly sterilised hospital tools:

If surgical devices like syringes and scalpels, or even certain instruments, used
on an infected person, are used on another person without proper sterilization,
they can transmit the infection.

Parent to Child:

An HIV positive mother can transmit the virus to child during pregnancy or
birth. Breast milk can also act as a transmission-medium.

Theoretically oral sex without condom (on men) or barriers like dental dam,
vaginal dams or plastic wrap (on women) can also transmit the infection.

How is HIV diagnosed?


In the early stages of infection, HIV often causes no symptoms and the
infection can be diagnosed only by testing a person's blood. Two tests are
available to diagnose HIV infection - one that looks for the presence of
antibodies produced by the body in response to HIV and the other that
looks for the virus itself.
Antibodies are proteins produced by the body whenever a disease threatens it. When the
body is infected with HIV, it produces antibodies specific to HIV. The first test, called
ELISA (Enzyme Linked Immunosorbent Assay), looks for such antibodies in blood.
If antibodies are present, the test gives a positive result. A positive test has to be confirmed
by another test called Western Blot or Immunoflouroscent Assay (IFA). All positive tests
by ELISA need not be accurate and hence Western Blot and repeated tests are necessary to
confirm a person's HIV status. A person infected with HIV is termed HIV- positive or
seropositive.
As ELISA requires specialized equipment, blood samples need to be sent to a laboratory
and the result will be available only after several days or weeks. To cut short this waiting
period, RAPID TESTS , that give results in 5 to 30 minutes, are increasingly being used
the world over. The accuracy of rapid tests is stated to be as good as that of ELISA.
Though rapid tests are more expensive, researchers have found them to be more cost
effective in terms of the number of people covered and the time the tests take.

The HIV- antibodies generally do not reach detectable levels in the blood till about three
months after infection. This period, from the time of infection till the blood is tested
positive for antibodies, is called the Window Period . Some times, the antibodies might
take even six months to show up. Even if the tests are negative, during the Window Period,
the amount of virus is very high in an infected person. Hence, if a person is newly infected,
the risk of transmission is higher.

If a person is highly likely to be infected with HIV and yet both the tests are negative, a
doctor may suggest a repetition of the tests after three months or six months when the
antibodies are more likely to have developed.


The second test is called PCR (Polymerase Chain Reaction), which looks for HIV itself in
the blood. This test, which recognizes the presence of the virus' genetic material in the
blood, can detect the virus within a few days of infection.

There are also tests like Radio Immuno Precipitation Assay (RIPA) , a confirmatory blood
test that may be used when antibody levels are difficult to detect or when Western Blot test
results are uncertain. Other available tests are Rapid Latex Agglutination Assay , a
simplified, inexpensive blood test that may prove useful in medically disadvantaged areas
where there is a high prevalence of HIV infection, and p24 Antigen Capture Assay .

Are there any steps to be followed before and after the blood tests?
The process of getting tested for HIV can generate a variety of intense emotional reactions
such as fear, anger and denial. Therefore, psychological counselling is essential to prepare
individuals undergoing testing for the possible consequences. This is called Pre-Test
Counseling and is unavoidable for anybody preparing to take a test.

If the test result is positive, it should not be disclosed without another round of counseling.
This Post-Test Counseling is more crucial because of the enormous stress and the
multitude of emotions that the infected person could undergo on learning his/her HIV
status. A positive test has been linked to increased suicide ideas and attempts and
emotional trauma, both at the time of knowing the positive result and also at the emergence
of AIDS-defining symptoms.

As there is still considerable stigma and discrimination attached to HIV/AIDS, the decision
whether to test or not itself should be preceded by considerable introspection and
assessment of the possible outcome. The person to take test should be aware of the
emotional trauma and the possible consequences a positive test could bring about. For
these reasonse, pre-test counseling is very crucial. With the help of the counselor, the
person taking the test should assess his/her personal setting and prepare himself/herself for
the probable consequences.


On the other hand, one should also be aware of the positive advantages of learning one's
HIV status. If the test turns out to be positive, one can have early access to treatment, take
care of one's health better and plan the future. Early realization of the health condition can
be very useful in a large number of cases. The counselor could help the infected individual
win back his/her confidence and learn how to live a healthy and responsible life. The
individuals should also be prepared how to deal with their relatives, friends, colleagues,
classmates etc. If the test is negative, the person should be advised preventive methods.

What are the early symptoms of HIV infection?

Many people do not develop any symptoms when they first become infected with HIV.
Some people, however, get a flu-like illness within three to six weeks after exposure to the
virus. This illness, called Acute HIV Syndrome, may include fever, headache, tiredness,
nausea, diarrhoea and enlarged lymph nodes (organs of the immune system that can be felt
in the neck, armpits and groin). These symptoms usually disappear within a week to a
month and are often mistaken for another viral infection.

During this period, the quantity of the virus in the body will be high and it spreads to
different parts, particularly the lymphoid tissue. At this stage, the infected person is more
likely to pass on the infection to others. The viral quantity then drops as the body's immune
system launches an orchestrated fight.

More persistent or severe symptoms may not surface for several years, even a decade or
more, after HIV first enters the body in adults, or within two years in children born with
the virus. This period of "asymptomatic" infection varies from individual to individual.
Some people may begin to have symptoms as soon as a few months, while others may be
symptom-free for more than 10 years. However, during the "asymptomatic" period, the
virus will be actively multiplying, infecting, and killing cells of the immune system.

What Happens Inside the Body?
Once HIV enters the human body, it attaches itself to a White Blood Cell (WBC) called


CD4. Also, called T4 cells, they are the main disease fighters of the body. Whenever there
is an infection, CD4 cells lead the infection-fighting army of the body to protect it from
falling sick. Damage of these cells, hence can affect a person's disease-fighting capability
and general health.
After making a foothold on the CD4 cell, the virus injects its RNA into the cell. The RNA
then gets attached to the DNA of the host cell and thus becomes part of the cell's genetic
material. It is a virtual takeover of the cell. Using the cell's division mechanism, the virus
now replicates and churns out hundreds of thousands of its own copies. These cells then
enter the blood stream, get attached to other CD4 cells and continue replicating. As a
result, the number of the virus in the blood rises and that of the CD4 cells declines.
Because of this process, immediately after infection, the viral load of an infected individual
will be very high and the number of CD4, low. But, after a while, the body's immune
system responds vigorously by producing more and more CD4 cells to fight the virus.
Much of the virus gets removed from the blood. To fight the fast-replicating virus, as many
as a billion CD4 cells are produced every day, but the virus too increases on a similar
scale. The battle between the virus and the CD4 cells continues even as the infected person
remains symptom-free.
But after a few years, which can last up to a decade or even more, when the number of the
virus in the body rises to very high levels, the body's immune mechanism finds it difficult
to carry on with the battle. The balance shifts in favour of the virus and the person becomes
more susceptible to various infections. These infections are called Opportunistic Infections
because they swarm the body using the opportunity of its low immunity. At this stage, the
number of CD4 cells per millilitre of blood (called CD4 Count), which ranges between 500
to 1,500 in a healthy individual, falls below 200. The Viral Load, the quantity of the virus
in the blood, will be very high at this stage.
Opportunistic infections are caused by bacteria, virus, fungi and parasites. Some of the
common opportunistic infections that affect HIV positive persons are: Mycobacterium
avium complex (MAC), Tuberculosis (TB), Salmonellosis, Bacillary Angiomatosis (all
caused by bacteria); Cytomegalovirus (CMV), Viral hepatitis, Herpes, Human
papillomavirus (HPV), Progressive multifocal leukoencephalopathy (PML) (caused by
virus); Candidiasis, Cryptococcal meningitis (caused by fungus) and Pneumocystis Carinii


pneumonia (PCP). Toxoplasmosis. Cryptosporidiosis (caused by parasites). HIV positive
persons are also prone to cancers like Kaposi's sarcoma and lymphoma.
The Center for Disease Control (CDC), Atlanta has listed a series of diseases as AIDS-
defining. When these diseases appear, it is a sign that the infected individual has entered
the later stage of HIV infection and has started developing AIDS. The progression of HIV
positive persons into the AIDS stage is highly individual. Some people can reach the AIDS
stage in about five years, while some remain disease free for more than a decade.
Measurement of the viral load and the CD4 count helps a doctor in assessing an infected
person's health condition.

What are the later symptoms of HIV/AIDS?
Lack of energy
Weight loss
Frequent fevers and sweats
A thick, whitish coating of the tongue or mouth (thrush) that is caused by a yeast
infection and sometimes accompanied by a sore throat
Severe or recurring vaginal yeast infections
Chronic pelvic inflammatory disease or severe and frequent infections like herpes
zoster
Periods of extreme and unexplained fatigue that may be combined with headaches,
lightheadedness, and/or dizziness
Rapid loss of more than 10 pounds of weight that is not due to increased physical
exercise or dieting
Bruising more easily than normal
Long-lasting bouts of diarrhoea
Swelling or hardening of glands located in the throat, armpit, or groin
Periods of continued, deep, dry coughing
Increasing shortness of breath
The appearance of discoloured or purplish growths on the skin or inside the mouth
Unexplained bleeding from growths on the skin, from mucous membranes, or from
any opening in the body


Recurring or unusual skin rashes
Severe numbness or pain in the hands or feet, the loss of muscle control and reflex,
paralysis or loss of muscular strength
An altered state of consciousness, personality change, or mental deterioration
Children may grow slowly or fall sick frequently. HIV positive persons are also
found to be more vulnerable to some cancers.

Is there treatment against HIV and AIDS?
Till today, there is no conclusive treatment to eliminate HIV from the body; however,
timely treatment of opportunistic infections can keep one healthy for many years. The
commonly available treatment for AIDS is the treatment against opportunistic infections.
Normally standard treatment regimens, used against such infections in non-HIV patients,
also work well with the HIV-positive persons. If properly treated, almost all the
opportunistic infections can be contained.
However, during the last decade, researchers have developed powerful drugs that check the
replication of the virus at various levels. Called Antiretroviral drugs, they are available in
three classes and under various brands. Taken in combinations (called cocktail or
combination therapy) under specialised medical advice, these drugs drastically reduce the
viral load in blood. However, they do not permanently cure one of HIV. This line of
treatment, called HAART (Highly Active Antiretroviral Therapy) has resulted in a huge
reduction or AIDS-related deaths. Though many positive persons and caregivers have
welcomed these drugs, others have experienced serious side effects. They are also very
expensive and are out of reach for a majority of the infected people. But of late, the prices
have been steeply falling.

The three classes of drugs are:

1. Nucleoside analogue Reverse Transcriptase Inhibitors (NRTIs). NRTIs were the


first antiretroviral drugs to be developed. They inhibit the replication of HIV in the
early stage by inhibiting an enzyme (which is necessary for viral replication) called
Reverse Transcriptase. The drugs include Zidovudine (Retrovir, AZT), Lamivudine
(Epivir, 3TC), Didanosine (Videx, ddI), Zalcitabine (Hivid, ddC), Stavudine (Zerit,
d4T) and Abacavir (Ziagen).
The major reported side effect of Zidovudine is bone marrow suppression, which
causes a decrease in the number of red and white blood cells. The drugs ddI, ddC
and d4T can damage peripheral nerves (peripheral neuropathy), leading to tingling
and burning in the hands and feet. Treatment with ddI can also cause pancreatitis,
and ddC may cause mouth ulcers. Approximately 5 percent of people treated with
Abacavir experience hypersensitivity reactions such as a rash along with fever,
fatigue, nausea, vomiting, diarrhea and abdominal pain. Hypersensitivity reactions
can also occur without a rash. In either case, symptoms usually appear within the
first 6 weeks of treatment and generally disappear when the drug is discontinued. If
a person had a hypersensitivity reaction to Abacavir, he/she should avoid taking the
drug again.
2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). These drugs bind
directly to the enzyme, Reverse Transcriptase. There are three NNRTIs currently
approved for clinical use: Nevirapine (Viramune), Delavirdine (Rescriptor) and
Efavirenz (Sustiva). A major side effect of all NNRTIS is a rash. In addition,
people taking Efavirenz may have side effects such as abnormal dreams,
sleeplessness, dizziness and difficulty concentrating.
3. Protease inhibitors (PIs). PIs interrupt HIV replication at a later stage in its life
cycle by interfering with an enzyme known as HIV protease. This causes HIV
particles in the body to become structurally disorganized and noninfectious. Among
these drugs are Saquinavir (Fortovase), Ritonavir (Norvir), Indinavir (Crixivan),
Nelfinavir (Viracept), Amprenavir (Agenerase) and Lopinavir (Kaletra).

The most common side effects of PIs include nausea, diarrhoea and other digestive tract
problems. They can also cause a significant number of side effects when they interact with
certain other medications. That is because all PIs, to one degree or another, affect an


enzyme system in the liver that is responsible for metabolising a large number of drugs.
Newer side effects have also appeared with the continuing and widespread use of Protease
Inhibitors. These include elevated triglyceride levels and problems with sugar metabolism
that may sometimes progress to diabetes.
There may also be abnormalities in the way fat is metabolised and deposited in the body.
Some people lose much of their total body fat while others gain excess fat on the back
between their shoulders (buffalo hump) or in the stomach (protease paunch). Right now, no
one knows exactly why these abnormalities occur. In fact, it is not even certain whether
these problems are a direct result of treatment with protease inhibitors or due to some other
cause that has yet to be identified. Similar metabolic abnormalities have occurred in people
on antiretroviral therapy that does not include PIs. Although these body changes can be
distressing, the possibility they may occur should not stop one from obtaining treatment for
HIV/AIDS.
In simple combination therapy, some physicians prescribe a combination of RTIs. But in
HAART, which in fact has made a dramatic change in AIDS treatment, a combination of
RTIs and PIs is prescribed.

People respond differently to treatment and maintaining the drug schedule is extremely
important. Indiscriminate treatment results in drug resistance and resurgence of the viral
load. Therefore it should be taken only under expert medical advice.

What about vaccines?
More than a dozen HIV vaccines are currently being tested. As of now, there is no vaccine
to prevent HIV infection.

What is Parent to Child Transmission?
Babies born to mothers infected with HIV may or may not be infected with the virus, but
all carry their mothers' antibodies to HIV for several months after birth. If these babies lack
symptoms, a definitive diagnosis of HIV infection using standard antibody tests cannot be
made until after 15 months of age. By then, the babies are unlikely to still carry their
mothers' antibodies and will have produced their own, if they are infected. New
technologies to detect HIV itself are being used to more accurately determine HIV
infection in infants between ages 3 months and 15 months. A number of blood tests are
being evaluated to determine if they can diagnose HIV infection in babies younger than 3
months.


LIFE AFTER HIV Français

The experience of infected people during the last two decades has shown that HIV is not
the "end of the world" and that there is good quality life for several more years. Taking
care of one's health, keeping in mind one's vulnerability to diseases, and a positive attitude
have been found to be very useful. New drugs and vaccine efforts also offer considerable
hope to infected and affected individuals and their families. Several NGOs/CBOs,
government organisations, public and private institutions offer ongoing support to people
in need.

What should one do if found HIV positive?
Consult a clinician experienced in treating HIV/AIDS.
Protect your sex partner(s) from HIV by following safe-sex guidelines.
Inform sex partner(s) who may also be infected.
Do not share needles.
Get psychological support from a counsellor and/or join a support group for people
with HIV.
Get information and social and legal support from AIDS service organisations.
Don't share your HIV status with people who do not need to know. Only tell people
you can count on for support. Think about whom do you want to share your HIV
status with.
Maintain a strong immune system with a healthy lifestyle and regular medical
examinations.
Consider using antiretroviral therapies that may slow the progress of the infection
in consultation with a qualified physician.

PREVENTION Français


Because there is no effective vaccine and no cure for HIV, the only way to protect
oneself is prevention.
People should either abstain from having sex or use latex condoms, during oral,
anal, or vaginal sex. Only condoms made of latex should be used, and whenever
necessary only water-based lubricants should be used. People who are allergic to
latex can use polyurethane condoms.
Although some laboratory evidence shows that spermicides can kill HIV, there is
no conclusive evidence if it can prevent transmission.
The risk of HIV transmission from a pregnant woman to her baby is significantly
reduced if she takes AZT during pregnancy, labour and delivery, and her baby
takes it for the first six weeks of life. Nevirapine is also found to be useful. But, one
should seek expert medical assistance in such situations. Having a sexually
transmitted disease (STD) can increase manifold a person's chances of getting HIV
through sexual contact. So, it is necessary to treat STD as soon as you suspect
infection

SAFE SEX GUIDE Français

The Risk Chart - Practise Safe Sex

No risk or very low risk - No reported cases due to these behaviours
Masturbation - mutual masturbation
Touching - massage


Erotic massage - body rubbing
Kissing
Oral sex on a man with a condom
Oral sex on a woman with a dental dam, glyde dam, plastic wrap, or cut-open
condom
Not sharing drug injecting, body piercing instruments, needles, syringes
Using properly sterilised hospital tools

Low risk - Rare reported cases due to these behaviours

Deep kissing
Oral sex
Vaginal intercourse with a condom or female condom –
Anal intercourse with a condom (Try not to get semen or blood into the mouth or
on broken skin.)

High risk - Hundreds of thousands of reported cases are associated with the
following.
Vaginal intercourse without a condom
Anal intercourse without a condom
Sharing needles, syringes and other body piercing instruments

BLOOD SAFETY Français

The Human Immunodeficiency Virus (HIV), which causes AIDS, is easily transmitted
through blood transfusions. In fact, the chances that someone who has received a
transfusion with HIV blood will himself or herself become infected are estimated to be
over 90 percent.
Blood transfusions will always carry certain risks, but HIV transmission through blood
transfusion can virtually be prevented. One can do this by setting up and maintaining a safe


blood supply and by using the blood appropriately. One should always ensure that the
blood is screened for the presence of diseases causing viruses, bacteria, or other
microorganisms, or for the presence of anti bodies produced against these agents.
All donated blood must be screened for HIV, as well as for hepatitis B and syphilis (and
hepatitis C where ever possible). In addition, both doctors and patients must be aware that
blood should be used only for necessary transfusion. While it is important to take
necessary precautions, we also must keep in mind that if each individual is to donate blood
once a year voluntarily, the total requirement of blood worldwide would be met.

Transfusion
Is it safe to have blood transfusion?
Blood transfusion saves millions of lives each year, but only if safe blood supply is
guaranteed. Receiving transfused blood has increased the risk to being affected by HIV and
a number of other infections. Diseases such as hepatitis B, hepatitis C and several Sexually
TRansmitetd Diseases (STDs) can also be transmitted through transfusion.

Can I receive my own blood ?
Your own blood is the safest blood for your transfusion needs. A transfusion, after all, is a
transplant of sorts, but instead of a kidney or liver, blood is the tissue a patient receives.
When transfused with your own blood, you are not exposed to infectious disease and you
are the perfect match. Your doctor will also carefully consider the benefits and effects your
blood donations may have on you.

How do I ensure that the blood is actually HIV free?
The process of testing blood to see if it contains infectious agents capable of being
transmitted to those who received the blood is known as screening. Majority of tests detect
the presence of anti bodies to HIV and not the virus itself. Although HIV tests are very
sensitive, there is a window period. This is the period between the onset of infection with
HIV and the appearance of detectable anti bodies to the virus. In the case of most sensitive
HIV tests the window period is about three weeks.


Voluntary Donation of Blood
Who can donate blood?
Every healthy individual with no known infection /disease can donate blood. It should still
be done after having screened yourself. The donor should be in good health and should be
feeling well on the day they donate. He/she should weigh at least 110 lbs. (50 kg) or more,
not on any prescribed medication that may affect the donor or recipient. There should be a
gap of at least 56 days between donations.

How often can I donate blood?
Donating blood over thrice a year is not recommended. Excessive donation results in blood
becoming substandard, for instance lacking in iron. It can also affect the donor's health.

Where can I donate blood?
One can donate blood at any licensed blood bank and blood donation camp.

Why should I donate blood?
The safest type of blood donor is the voluntary, unpaid donor. Such donor gives out of
altruism, and is not under pressure to donate blood. On the whole, such donors are are
more likely to meet the criteria for low risk donors. And they are also more likely to be
willing to donate on a regular basis and at properly spaced intervals. This is important in
maintaining a sufficient stock of blood.

How will it be used?
Blood is often used as a replacement of the quantity given to an individual by a medical
practitioner. In this system, families of people needing a transfusion are asked to donate the
same quantity as that given to their relative and this blood may be used directly, where
compatible, or else put into the general pool.

Is blood donation harmful?
No, if it is at properly spaced intervals and is donated at licensed blood banks/camps it is
not harmful. Many donors have given blood over 50 times, up to four times a year, without
any harm to their health. If you are healthy, you can give blood every 56 days.


Can you get HIV by donating blood?
It is safe to give blood. You cannot contract any diseases through blood donation if the
needle and other clinic materials used to take blood are new, sterile and used only once. If
you are donating at licensed banks, these safety conditions will be definitely adhered to.
The materials used are disposed after one use.

Rational Use
When?
Doctors and other medical staff should be educated to avoid prescribing inappropriate
transfusion. Blood substitutes should be used only when it is appropriate. Simple
alternatives to blood, such as crystalloids or colloids, will not transmit infection and can be
obtained at a fraction of the cost of whole blood.
One of the reasons, which makes blood supply unsafe is shortage. This shortage can be
addressed to a great extent by transfusing blood components instead of whole blood.
Wherever whole blood is not needed, the appropriate component should be used.
The underlying reasons for blood transfusion should be addressed. A condition for which
blood transfusions are often given is chronic anemia, which results from the lack of red
blood cells that carry oxygen to the tissues. Chronic anemia can be caused by malnutrition,
slow loss of blood and infection such as malaria. If the root cause of chronic anemia is
attacked, we can manage the condition. Another condition where blood is often needed is
childbirth-related emergencies. By taking proper care of women before and during
delivery, we can decrease the need for transfusion.

Avoid unnecessary transfusion
Transfusion is not always necessary or appropriate. Avoid using single-unit transfusions.
Transfusion increases the risk of transmitting HIV, especially in places where there is no
adequate screening of blood. Apart from that, it creates an unavoidable shortage in blood
supply. This encourages professional donors to become more active, reducing the safety of
the supply.

Links
Jeevan Blood Bank and Research Centre
Website of the Chennai-based voluntary blood bank. Has information and services, tailored


to Indian needs and conditions. Also has a discussion forum.

Blood Safety in the age of AIDS

HIV/AIDS - FREQUENTLY ASKED QUESTIONS

Question: What is HIV and how does it differ from other viruses which infect human
beings?
Answer: HIV stands for Human Immunodeficiency Virus. As the name suggests it only
causes disease in humans, which leads to the depletion of white blood cells leading to
lowering of immunity. Once the virus enters the body it lies dormant for many years and
hence is known as a 'slow virus'. Most other viruses for example, those causing measles,
mumps, chicken pox, etc., manifest the disease in 14-21 days after it enters the body.
Hence the incubation period is short (2-3 weeks) whereas in HIV infection it is very long
and runs into years.

Question: How does HIV attack the immune system?
Answer: Once HIV enters the body, it gets attached to a type of white blood cell called T
lymphocyte (which is the T cell in the human body's protection against infections). The
RNA (genetic material) of the virus then gets converted to DNA (genetic material) by an
enzyme that the virus produces. This viral DNA then gets incorporated into the DNA of the
human cell (T lymphocyte), and remains there for the lifetime of that cell. This infected
cell now becomes a virus factory producing more viruses (HIV) which bud out of the cell,
attack new T lymphocytes, and destroy them. Over a period of years, the T cell count of
the infected person drops to a critical level and the individual develops many opportunistic


infection and hence is then said to have AIDS.

Question: What is the difference between a person infected with HIV and one who
has AIDS?
Answer: A person living with HIV (medically known as an HIV positive person) is one
who has virus in his/her body. Such a person, remains infected and is presumed infective
for the rest of his/her life. However, s/he will appear to be perfectly normal and healthy
and asymptomatic for many years. An asymptomatic HIV infected person does not have
Acquired Immunodeficiency Syndrome (AIDS). But when an HIV positive person's T
lymphocytes (which are responsible for the immunity) count falls to 200 or less, s/he starts
developing symptoms for eg. cough, fever, diarrhoea, skin lesions, etc. They are due to
opportunistic infections (so called because they develop when the body's immunity
becomes deficient) like TB, Thrush, Pneumonia, Cryptococcal meningitis, etc. All persons
with AIDS are infected with HIV, but not all persons with HIV infection have AIDS.
AIDS is only the end stage of this infection.

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Question: How is HIV transmitted?
Answer: Anyone can become infected with HIV. It is transmitted only through unprotected
penetrative sex (vaginal, anal, oral) with an infected partner, transfusion of infected blood
and blood products, contaminat ed needles and syringes, and from an infected mother to
her baby before, during delivery or through breast milk.


But since the sexual route accounts for almost 80 percent of infections, the prevalence is
much higher in the sexually active age group of 15 years to 40 years. It is not who you are
or where you are, but what you do that puts you at this risk of acquiring the HIV infection
and eventually developing AIDS. Therefore, there are no "risk groups" but only "risk
behaviours".

Question: How is HIV not transmitted?
Answer: HIV cannot spread by casual contact such as touching, holding hands, body contact
in crowded public places, shaking hands, working or playing together, sharing food, vessels
and clothes, eating food cooked by an infected person, light kissing, mosquito and other
insect bites, swimming pools, and toilets.

Question: Do mosquitoes transmit HIV?
Answer: There is no evidence to show that mosquitoes transmit HIV. Epidemiologically,
the incidence of HIV infection is the highest among the sexually active group of 15 years
to 40 years. However, mosquitoes bite persons of all age groups and if they were a means
of spreading HIV, the incidence of infection would be uniformly high and among all age
groups. HIV does not survive or replicate inside the intestine of the mosquito, which is
another reason to believe that mosquitoes cannot spread the HIV infection.

Question: Can HIV spread through kissing?
Answer: Kissing such as on the cheek or lightly on the lips carries no risk of transmitting
HIV. In deep kissing there is a small risk because the saliva of an infected person contains
few virus particles which by itself is not sufficient to cause the infection. But there could
be bleeding gums or ulcers in the mouth and exchange of infected saliva mixed with blood
during kissing could transmit the HIV.


Question: How long can the virus live outside the human body?
Answer: The Human Immunodeficiency Virus is fragile. Once the virus is outside the body
in a dry form, it dies immediately. Even in a wet state, it does not live long when exposed
to heat, detergents, or disinfectants. When stored in blood banks at 4°C, it can live for
about 3 weeks (or longer), or till the white cell disintegrates, but in a frozen state it can
survive for years.

Question: Can I get the HIV infection if I donate blood?
Answer: No. This is not possible as all materials used for collecting blood are sterile. In
fact, persons who are healthy should come forward for voluntary blood donation.

Question: What is the risk of getting HIV by going to a dentist?
Answer: The risk of getting HIV from a dentist is low. However, there have been stray
reports linking the infection with dentists. Wherever there is invasive procedures of skin or
mucous membrane, universal precautions should be practiced.

Question: Is the breast milk of an HIV positive woman infective?
Answer: HIV is known to be present in the breast milk of an infected woman. Hence, there
is a possibility of acquiring the infection via breast milk. However, in a country like India
where infant mortality is very high, the advantages of breast feeding (prevention of other
infections) outweigh the risk of HIV infection through breast milk. Formula feeding should
be advocated on individual cases only after proper counselling.

Question: How would one know if a baby born to an HIV positive woman has the
HIV infection?
Answer: Most children born to HIV positive mothers carry HIV antibodies from the
mother in their blood. These take about fifteen months to disappear. Only after that will an


HIV antibody test show whether the baby is, in fact, infected with the HIV, or not. In less
developed countries, the chance of a baby born to an HIV infected mother being infected is
about 40 percent. But today there are antiretroviral drugs available which can be given to
the pregnant woman and babies to prevent the infection in the babies. As an alternative to
pregnancy, women living with HIV could also be counselled to adopt a baby.

Question: How long does it take for an HIV infected person to develop symptoms?
Answer: This depends on the mode of the HIV transmission and the lifestyle of the HIV
positive person. Majority of persons who are infected through blood transfusion develop
symptoms on an average from 3 years to 5 years. With the other modes of transmission
when the quantum of the virus is low, the person can remain healthy for 8 to 12 years or
longer. If an HIV positive person improves his/her quality of life by adopting safer sex
methods, has good nutrition, regular exercise, regular medical management, emotional
support, does yoga and meditation, avoids stress and regularly treats other illnesses,
continues to be active, and has an optimistic outlook, s/he is likely to live longer

Question: How does an HIV positive person progress to AIDS?
Answer: A few weeks after the virus enters the body, some people have flu-like symptoms
such as fever, body ache, and headache, (every infected person may not experience these).
These symptoms disappear after a while, and then there is a long phase of 3 years to 12
years which is asymptomatic. After that, when the immune system starts failing, AIDS sets
in.

The major and minor signs classified by World Health Organisation are:
Major Signs
Weight loss greater than 10% of body weight.
Fever for longer than one month, intermittent or continous.
Chronic diarrhoea for longer than one month, intermittent or constant.


Minor Signs
Persistent cough for longer than one month.
General itchy dermatitis (skin irritation).
Recurrent herpes zoster (shingles).
Oropharyngeal candidasis (fungus infection in the mouth/throat).
Chronic progressive and disseminated herpes simplex infection.
Generalised lymphadenopathy (swelling of lymp glands).

If a person has two major and two minor signs he is diagnosed as having AIDS. It is
important to note that these symptoms are fairly common in various non-AIDS conditions
also.

Question: How would I know if any of the people I meet everyday is HIV infected?
Answer: You cannot. Individuals may identify their HIV status only by doing an HIV test.

Question: Is there any treatment for HIV/AIDS?
Answer: Almost all opportunistic infections a person with AIDS develops can be treated
with appropriate drugs. Eg. TB, thrush, diarrhoea, pneumonia can all be treated. They can
also be prevented by drugs - chemoprophylaxis. When it comes to treatment of HIV itself,
there are many antiretroviral drugs available. These should be given in combinations of 2
or 3 drugs for lifetime of the patient. These drugs are expensive, have side effects and need
to be monitored using laboratory tests which are very expensive.

Question: What is 'safe sex'?
Answer: Sexual activity which completely eliminates the risk of infection is safe sex. For eg.
1. any sexual activity between two uninfected people is safe. 2. any sexual activity which
does not involve the entry of body fluids such as blood, semen, vaginal fluids, or other
contaminated material into the body is safe

Question: What is 'safer sex'?


Answer: Safer sex is a way of adapting your sex life to minimize the risk of giving or
getting the HIV infection. It includes those sexual practices which reduce the risk of
acquiring or transmitting HIV during sexual activity. Sex can be made safer by using a
condom consistently or by practicing non-penetrative sex.

Question: What can I do to protect myself against getting the HIV infection?
Answer: There is a lot you can do to keep yourself protected from getting the HIV
infection:
- Learn the facts about HIV and AIDS.
- Assess your own risk behaviours (unsafe sex, sharing needles, etc.)
- Postpone, as much as possible, sex until marriage, or else practice safe or safer sex.
- Do not feel shy to talk about your doubts and fears. Get these clarified.
- Verify that any blood product you receive has been screened for HIV.
- Verify that any needles/ syringes or invasive equipment being used on you is sterile.
- If you are going for procedures such as tattooing, ear piercing, or acupuncture, verify that
the equipment to be used on you is sterile.
- Avoid alcohol and drugs as they affect your judgement, and can induce you to take risks
you would not otherwise take, like having unsafe sex, sharing needles, or driving rashly.
- Do not let peer pressure force you into unsafe activities.

Question: What is the role of HIV/AIDS awareness programmes in preventing the
spread of HIV/AIDS?
Answer: The objective of AIDS awareness programmes is to create awareness about the
problem, to give accurate and reliable information about HIV/AIDS, to clear existing
myths and misconceptions, and to provide practical skills that can be implemented at the
individual's level so as to lead to behaviour change that minimize the risk of HIV infection.

Question: How safe are condoms in the prevention of HIV infection?


Answer: Condoms make sex safer when used properly but they are not 100 percent safe.
Safety factors to check on when buying and using condoms are,
- Expiry date of the condom - do not use one which has expired.
- Storage - condoms should be kept away from the heat (for example, from car glove
compartments, direct sunlight), and pressure (for example, sitting on a wallet containing
condoms).
- Making sure that sharp objects do not tear a condom during use.
- Making sure that the air is expelled from the teat of the condom while wearing, so as to
prevent it from bursting during intercourse.

Question: Does the use of a condom reduce sexual pleasure?
Answer: Condoms do not reduce sexual pleasure, as sexual pleasure is a perceived
pleasure. Psychologically, some people perceive a loss of pleasure when using a condom.
Whereas, ribbed condoms, for example, are known to increase sexual pleasure.

Question: Do contraceptives like 'Today', diaphragm, and the pill protect a woman
from getting the HIV infection?
Answer: No, they do not. These contraceptives only prevent a woman from getting
pregnant but do not prevent the potentially infected semen from coming into contact with
the lining of the vagina or cervix. If the HIV or organisms causing STD are present in the
semen, they can still get into a woman's body and infect her.

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Question: What are the different tests to detect HIV?
Answer: There are a number of tests to detect the HIV. Blood tests are done to look for
specific antibodies produced by the HIV. These include,
Screening tests: ELISA (Enzyme Linked Immunosorbent Assay - the most commonly
followed procedure). Spot test or Rapid Test These may give false positive results and
hence should be confirmed.


Confirmatory Tests: Western Blot, the most commonly used procedure. There are other
tests that are done to detect the virus or its protein or genetic material. These are however,
expensive, complicated or may take long and hence, are used only for research and
academic purposes.

Question: Why are consent and confidentiality important during voluntary testing?
Answer: HIV positive persons are discriminated against by family, friends, neighbours,
colleagues, employers, and the society in general. Unless an individual is assured
confidentiality, s/he will not come forward for testing for fear of such discrimination and
stigma. Testing for HIV without consent violates human rights and should not be done.
Only consented testing with pre- and post-test counselling should be encouraged.

Question: How can I know the HIV status of the person I am going to marry?
Answer: Marriages are based on mutual trust. It is important that any concerns about HIV
are communicated to the prospective spouse in a sensitive and sensible manner. The HIV
status of a person cannot be determined without a HIV test. A fully informed voluntary
consent is a pre-requisite before a HIV test can be performed on someone. Please be
prepared to likewise undergo a test should your prospective spouse so requests. In some
states of USA, HIV and VDRL testing are mandated by law as pre-requisite to marriage
registration. In India, there is no such law.

Question: Should premarital HIV testing be done?
Answer: This cannot be made mandatory as it would undermine confidentiality as a pre-
requisite for testing. But if individuals request consented voluntary testing, it should be
encouraged. Unfortunately in India, given the lack of code of conduct in reporting test
results, it may be possible to "purchase" a negative result.


Question: What is ‘window period’?
Answer: The common test for HIV is screening blood for antibodies. The antibodies take 2
to 24 weeks to appear in blood. This is known as the ‘window period.’ During this period,
an infected individual is infective, but the HIV tests for antibodies are negative. Hence, to
be sure, the test should be repeated again 6 months after the last contact or exposure to
HIV.

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