HIV/AIDS is a chronic disease caused by a virus called the human immunodeficiency virus (HIV). One gets HIV infection by indulging in unprotected sexual intercourse with an infected person, through HIV infected blood and blood products, or through the use of unsterilized needles and syringes. A HIV positive pregnant mother can give the infection to her newborn child during the pregnancy itself, during labour or by breastfeeding.

A HIV infected person can be perfectly normal and healthy, and remain asymptomatic for up to 8 to 12 years. AIDS is the last stage of HIV infection and usually manifests with symptoms such as fever, loss of weight, ulcers in the mouth, pneumonia, tuberculosis in parts other than the lung or in many parts of the body, diarrhea for more than one month, or brain fever. In people with AIDS the CD4 cell count (a kind of white blood cell which helps protect the person from infection) will be 200 cells/mm 3 of blood or below. The normal CD4 count is 500-1500 cells/mm

2. HOW DID HIV/AIDS ORIGINATE?

There are several theories regarding the origin of HIV/AIDS. It is possible that HIV has been around for centuries and may have evolved into a virulent virus only recently. However it is of academic interest where the virus originated. More importantly, AIDS is likely to be with us for several decades even if a cure or vaccine is developed, and only immediate preventive measures can stem its further spread.

3. WHAT IS A MALE CONDOM? WHAT IS IT MADE OF? WHAT ARE THE ADVANTAGES OF USING IT? HOW DOES ONE USE IT?

A male condom is a sheath usually made of latex, or of polyurethane. It acts as a barrier by preventing direct exchange of body fluids, such as semen, pre-ejaculatory fluid, vaginal fluid, genital discharge, etc., between sexual partners, thus preventing the spread of HIV infection.

The procedure to use a condom:
•  Check the expiry date before usage.
•  Do not keep the condom in the back pocket or wallet heat makes the latex easy to tear.
•  Do not unroll the condom before putting it on.
•  Keep the condom in the packet till the penis is erect.
•  When the penis is erect, hold the closed tip of the condom to keep out air and allow room for the semen to collect in.
•  Place the condom on the end of the erect penis while holding the tip, and unroll the condom onto the erect penis all the way down to the base (up to the pubic hair). If it does not unroll easily, do not use the condom.
•  During sex, make sure the condom stays in place.
•  Pull out the penis immediately after ejaculation, before it becomes limp.
•  Gently unroll the condom, taking care not to spill any semen.
•  Dispose it promptly and properly by tying it up, wrapping it in paper and throwing it in the garbage or burying it.
•  Do not reuse a condom. Use a fresh condom for every sexual act.
•  Condoms provide almost 100% protection against HIV/AIDS and for a majority of sexually transmitted diseases, if used correctly and consistently, i.e., if a condom is used for every sexual act from the time of penetration till the completion of the act.

Precautions to be taken before using a condom:
•  Store the condom in a cool place away from direct heat and pressure.
•  Make sure that sharp objects do not tear a condom during use.
•  Make sure that the air is expelled from the teat of the condom while wearing it, so as to prevent it from bursting during intercourse.

4. DOES MASTURBATION CAUSE HIV/ AIDS?

Self-masturbation is totally safe. This is a form of stimulating one's own genitals for sexual gratification. It is a physiological phenomenon and brings down the sexual tension of an individual.

Masturbation does not cause harm to one's sex life. It does not decrease a person's sexual desires, nor does it cause any sexually transmitted disease or HIV/AIDS. It does not weaken one's health, neither does it bring down the sperm count.

Mutual masturbation or two people stimulating one another's genitals is safe, only if there is no exchange of HIV infected body fluids such as semen, pre-ejaculatory fluid, vaginal fluid, blood, pus, etc., or HIV infected fluids do not come in contact with fresh open wounds.

Masturbation brings down a person's sexual tension, but when a person masturbates often, it may hamper the person's daily activities. The thought of masturbation often lingers in the mind and the person prefers privacy. This may hamper communication and interaction between family members and friends and affect the individual's concentration on studies. The habit of excessive masturbation can be brought down by diverting one's mind from it by developing healthy hobbies such as playing energetic outdoor games, jogging, going for long walks, reading good books, etc. One can develop any hobby according to one's interest, as long as they can divert their mind from the thought of masturbating often.

5. HOW IS HIV/AIDS TRANSMITTED?

HIV/AIDS is transmitted by:
•  Unprotected sexual intercourse (that is without using a condom) with a HIV infected person.
•  Receiving HIV infected blood or blood products, using unsterilized needles and syringes, or during intravenous drug abuse when sharing needles and syringes with an HIV infected person.
•  From a HIV infected pregnant mother to her baby (transmission by this route can be prevented by counseling the mother about the drugs available, hospitals who will care for her at delivery and infant feeding choices).

HIV/AIDS does not transmit by casual contact such as holding hands, body contact in crowded public places, working together, playing together, hugging, kissing on the cheeks or lightly on the lips, through saliva, sneezing, coughing, through mosquitoes and insect bites, food cooked by an HIV positive person, drinking from the same glass or cup, eating from the same plate, sharing the same telephones, bathrooms, toilets, beds, washing the clothes in the same bucket, and using the same swimming pool.

6. CAN ORAL SEX CAUSE HIV/AIDS?

Oral sex is less risky than penetrative sex. There are two kinds of oral sex:

 i. Penis to mouth
 ii. Vagina to mouth

Penis to mouth:
In this kind of oral sex, if a man is HIV infected then his seminal fluid/semen contains HIV virus. This HIV infected semen comes in contact with the partner's mouth and if she has bleeding gums or swallows it, then there is a chance of her getting infected with HIV.

When a woman is HIV infected, and if she has bleeding gums, this bloodstained saliva can infect the man if he has any cuts/ulcers on his penis.

Vagina to mouth:
When a woman is infected with HIV then her vaginal fluid has a high content of HIV. If her partner's mouth has bleeding gums, cuts, open wounds, or sores, there is a chance of the uninfected person getting HIV infection.

Oral sex can be safe if there is no direct contact with potentially infected body fluids, i.e., semen, seminal fluid, vaginal fluid, blood, or pus. If a condom is used correctly and consistently, in case of penis to mouth contact, there is no risk of spread of HIV.

7. WHY ARE HOMOSEXUALS AT HIGHER RISK OF HIV/AIDS?

Homosexual activity may involve anal penetration of the passive partner by the penis of the other partner. The rectum has a less robust lining than the vagina and is more easily damaged. This provides easy access for HIV from the infected semen to a passive partner or the HIV infected blood from the torn rectal lining of a passive partner can enter the penis through any ulcers or abrasions on the penis of the other partner.

Unprotected anal penetrative activity is a high risk for the spread of HIV because:

 i. Condoms tear more easily during anal intercourse unless they are well lubricated. When one uses a well-lubricated condom correctly and consistently, from the time of penetration until the end of the act, it provides protection against HIV/AIDS and other sexually transmitted diseases.

 ii. Male homosexuals tend to have more number of sexual partners and therefore naturally are at greater risk of picking up the HIV infection.

8. WHAT ARE SAFE SEX PRACTICES?

Any sexual activity between two uninfected people is safe.

Any sexual activity, which doesn't involve the entry of HIV infected blood, semen, or vaginal fluids into the body is safe.

Any sexual activity, which completely eliminates the risk of infection, is safe sex, for example, correct and consistent use of condoms, which eliminates the exchange of possible HIV infected semen, seminal fluid or pre-ejaculatory fluid, or vaginal fluid gives protection against HIV/AIDS and most other STDs.

9. WHO NEEDS TO DO A HIV TEST AND WHEN?

The following need a HIV test:
•  Any person who has had unprotected penetrative anal, vaginal or oral sex, premaritally or extramaritally, or
•  Multiple sexual partners, or
•  Blood transfusion where testing is doubtful or not known, or
•  Intravenous drugs and has shared needles, or
•  Has a partner with multiple sexual relationships or intravenous drug abuse, or •  A partner known to be HIV positive, or
•  Recurrent episodes of illness or fever of unknown cause, and
•  Any pregnant woman, who can take measures to prevent her child from getting HIV infection if she knows her HIV status.

The HIV test is done at three months, six months and one year after any of the above risks for HIV infection. In the event that a person has had multiple risks for HIV, it is advisable to undergo HIV counseling with a HIV test immediately, followed by abstinence or correct and consistent use of condoms from the time of penetration till the end of the sexual act. Getting intoxicated with alcohol or drugs should be strictly avoided, as one would not know if a condom has been used properly in such a state. This person will also need tests three months, six months and one year later.

10. WHERE CAN ONE DO HIV TESTING?

HIV testing can be done at any good laboratory in nursing homes, private hospitals, government hospitals, and district hospitals.

It is important that before one does a HIV test, they go through counseling before the test as it prepares one for the HIV result and further management. Counseling should also be done after the result of the HIV test is known for interpretation of the test result and planning further action.

11. DOES A MOSQUITO BITE SPREAD HIV/AIDS?

HIV/AIDS doesn't spread by mosquito bites. Epidemiologically, the incidence of HIV infection is the highest among the sexually active age group of 15 years to 49 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 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. Mosquitoes suck the blood of the individual they bite, but they do not suck blood from one and inject into another person.

12. IS THERE A CURE FOR HIV/AIDS?

At present there is no cure for HIV/AIDS, but there are medicines in allopathy to keep the disease under control.

13. WHAT IS THE DIFFERENCE BETWEEN HIV AND AIDS?

There are two phases in HIV infection after the virus infects a person. In the first phase, the person infected with HIV is asymptomatic, healthy and active, for 8 to 10 years. Only a blood test will tell if one is HIV positive and at least two to three ELISA tests have to be positive. Such a person is infected and is infective to others.

In the second phase, i.e., AIDS phase, the person's immune system becomes weak and as a result they develop other infections or show the symptoms of AIDS white curd-like mouth ulcers, loss of weight, fever on and off, loose motions for more than a month, different kinds of pneumonia, tuberculosis affecting many parts of the body or brain fever. The AIDS phase is the last stage of HIV. Even if a person is in the AIDS phase, by taking antiretroviral therapy for HIV/AIDS, one can live a healthy productive life for a long time, but the medicines have to be taken regularly under the supervision of a qualified medical doctor.

14. DOES AYURVEDA, SIDDHA OR HOMEOPATHY MEDICINES CURE AIDS?

There is a lot of research going on in all branches of medicine, i.e., ayurveda, siddha, and homeopathy, and medicines are available to boost the immunity. However nothing but allopathic medicine has been proven scientifically to help a person in the AIDS phase of the illness to keep the HIV infection under control. This allopathic treatment has to be taken under the close supervision of an allopathic doctor.

15. HOW LONG CAN A PERSON LIVE WITH HIV/AIDS?

A person with HIV infection can live a normal and healthy life for a long time, say 8-10 years. AIDS is the last stage of HIV infection where a person starts showing symptoms of HIV infection (i.e., has symptoms and signs of superadded or opportunistic infections). Now treatment is available for keeping HIV/AIDS under control in allopathy. When these medicines are taken under the supervision of a doctor, a HIV infected person can live a healthy, productive life for a longer time.

16. CAN TAKING TABLETS SUCH AS MALA-D , OR USING COPPER-T PROTECT AGAINST GETTING HIV/AIDS?

Mala-D is a contraceptive tablet, and the Copper-T an intrauterine device, which is used by women to prevent pregnancy, however they do not provide any protection against HIV/AIDS as there is no barrier to body fluids as in the case of the condom. Condoms provide a barrier for the exchange of body fluids, such as, semen, vaginal fluid/discharge and give almost 100% protection against HIV/AIDS, most STDs, and pregnancy if used correctly and consistently, from the time of penetration till the end of the sexual act.

17. IS THERE TREATMENT FOR HIV/AIDS?

There is treatment for HIV/AIDS by which the viral level in the body is decreased, which in turn allows the immune system to recover. This treatment presently consists of combinations of allopathic drugs taken orally and is to be taken life long under the medical doctor's supervision. Even a single dose should not be skipped.

These drugs prolong the life of a HIV infected person, however, they do not cure HIV/AIDS.

18. CAN A HIV POSITIVE WOMAN HAVE CHILDREN?

Yes, a HIV positive woman can have children. The pregnant HIV positive woman has a 60% chance of delivering a HIV negative child even with no medical intervention. The chance of her delivering a HIV positive child is 40%. This can now be reduced to a 2% chance of delivering a HIV positive child with medical intervention during the last three months of pregnancy, during labor and delivery and by making the right infant feeding choices for the baby.

•  Drugs are available to prevent the child from getting HIV infection from the HIV infected mother and are given to the HIV positive pregnant mother after blood and urine tests during the last three months of pregnancy.
•  The parents are also counseled regarding the type of delivery and its cost, and allowed to make a choice. A planned cesarean operation for the mother about two weeks before the due date is ideal to extract the baby without the baby coming into contact with vaginal secretions and fluids during the course of normal vaginal delivery. This is preferred when afforded, especially when the mother has had no treatment with drugs during pregnancy.
•  The mother is also counseled regarding infant feeding choices. If she can afford to give clean, artificial milk feeds without using a feeding bottle, this is the best option. However, in the absence of clean water and lack of money for formula feeds or animal milk, the mother may give only breast feeds for three months and then wean the baby abruptly to weaning foods and animal milk. The worst option is to give both breast feeds and artificial feeds alternatively at the same time, as mixed feeds irritate and inflame the baby's intestines making it more easy for the HIV present in the mother's milk to infect the baby.

19. CAN A HIV POSITIVE MAN GET MARRIED?

A HIV positive man can get married provided he informs his HIV positive status to his future wife, and she is still willing to marry him knowing all the facts.

A HIV positive man can marry a HIV positive woman, but both need to be counselled before marriage.

20. DO WE GET HIV/AIDS FROM A DENTIST, BARBER, NEEDLES OR SYRINGES?

The risk of getting infected by HIV/AIDS from a dentist, barber, needles or syringes is nil if proper disinfection and sterilization procedures are followed. If the equipment used on an HIV infected person has not been sterilized and is immediately used on an uninfected person, and there contamination of the second person's blood with the sharp infected instrument, then there is a low risk of getting infected with HIV/AIDS.

In the hospital setting, if someone gets pricked with a needle on which HIV infected blood is present, they may be given antiretrovirals for one month to prevent HIV infection. It is difficult to know the HIV status of the person in other settings.