u Drugs, Sex and HIV
People can get infected with HIV through sharing needles, cookers, or cottons (works) with someone who is infected. This can happen even when the person passing the works looks clean and healthy.

Some people stopped shooting and/or sharing works many years ago and do not realize that they may have become infected with HIV back when they were still shooting drugs. They also may not realize they can pass it through unprotected sex now.

u Pregnancy and HIV
Treatment during pregnancy can help an HIV-infected woman protect her baby from becoming infected. Without treatment, more than a third of all babies born to HIV-infected women will have the virus and eventually get sick.

Q. What About Getting AIDS From Body Fluids Like Saliva?
Ans. Although small amounts of HIV have been found in body fluids like saliva, feces, urine, and tears, there is no evidence that HIV can spread through these body fluids.

By now, HIV has been the subject of more research than most other diseases in history. Medical science is confident about these basic facts: You can't get HIV or AIDS from touching someone, sharing items such as cups or pencils, or coughing or sneezing. HIV is not spread through routine contact in restaurants, workplaces, or schools.

There has never been any danger of becoming infected with HIV from donating blood. The needles at blood collection sites in the United States are never used twice.

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

Q. What Can I Do To Avoid Getting HIV Infection?
Ans. Six Ways To Reduce Risk

Abstain from vaginal, anal, and oral sex. Many other things feel good and are safe, because no blood, semen, or vaginal secretions get into the body. Safe activities include hugging, cuddling, masturbating, kissing, fantasizing, body-to-body rubbing, and massage.

Use condoms. Unless you're 100% sure your sexual partner is not infected with HIV or other STDs, reduce your risk by using a latex condom (rubber) on the penis from start to finish every time you have anal, vaginal, or oral sex. The female condom can also help protect you. Learn to talk with your partner about condoms and safer sex. Condoms can protect both of you from many STDs.

If you use lubricant, use one that is water-based. Lubricants containing oil (such as Vaseline) might cause latex condoms to break.

If you use spermicidal (birth control) foams and jellies, use them along with condoms, not in place of condoms. The effectiveness of spermicides in preventing HIV is unknown.

If you shoot drugs, seek help. And never share needles.

Avoid mixing alcohol or other drugs with sexual activities-they might cloud your judgment and lead you to engage in unsafe sexual practices.

Q. Is There a Relationship Between HIV and Other STDs?
Ans. The presence of certain STDs increases the risk of getting HIV infection during contact with an HIV-infected person. Certain STDs result in breaks in the skin on or in the anus, vagina, or penis that permit the virus to enter the blood system more easily. See a health care provider for testing and treatment if you think you might have any STD.

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

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

Less than 2% of all people who test for HIV get an "inconclusive result." This means this test cannot determine whether or not they have the virus. Repeat testing is recommended.

Q. Should I Take the HIV Test?
Ans. Recent gains in HIV medical care and treatment have increased the benefit of learning whether you have HIV infection even before symptoms of illness appear. Also, if you are planning a pregnancy, you and your partner may want to know if either of you are infected before conceiving. Before you are tested be sure that counseling is provided, both before and after the test. Consult with a health care provider with experience in HIV care or call your local health department. Many test sites provide free testing and counseling. Ask for more health literature on HIV testing.

Q. If I Am HIV Positive, What Should I Do?
Ans. If you've tested positive for HIV, consider the following:

See a health care professional for a complete medical work-up for HIV infection and advice on treatment and health maintainance. Make sure you are tested for TB and other STDs. For women, this includes a regular gynecological exam.
Inform your sexual partner(s) about their possible risk for HIV. Your local health department has a partner notification program that can assist you.
Protect others from the virus by following the precautions talked about on this page (for example, always using condoms and not sharing needles with others).
Protect yourself from any additional exposure to HIV.
Avoid drug and alcohol use, practice good nutrition, and avoid fatigue and stress.
Seek support from trustworthy friends and family when possible, and consider getting professional counseling.
Find a support group of people who are going through similar experiences.
Do not donate blood, plasma, semen, body organs, or other tissue.

Q. What If a Friend or Associate Has HIV Infection or AIDS?
Ans. A friend or acquaintance will need your support and understanding, just as with any other life-threatening illness. Assurance of your continued friendship is very important. Most importantly, your friend will want to be treated as usual-as a valuable human being. And remember, casual contact-a hug, a handshake, a kiss on the cheek-poses no threat of infection to you.

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

Q. How can I tell if I'm infected with HIV? What are the symptoms?
Ans. The only way to determine for sure whether you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected with HIV. Many people who are infected with HIV do not have any symptoms at all for many years.

The following may be warning signs of infection with HIV:

rapid weight loss

dry cough

recurring fever or profuse night sweats

profound and unexplained fatigue

swollen lymph glands in the armpits, groin, or neck

diarrhea that lasts for more than a week

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

pneumonia

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

memory loss, depression, and other neurological disorders

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

Q.Where can I get tested for HIV infection?
Ans. Many places provide testing for HIV infection. Common testing locations include local health departments, offices of private doctors, hospitals, and sites specifically set up to provide HIV testing.

It is important to seek testing at a place that also provides counseling about HIV and AIDS. Counselors can answer any questions you might have about risky behavior and ways you can protect yourself and others in the future. In addition, they can help you understand the meaning of the test results and describe what AIDS-related resources are available in the local area.

Q. What are rapid HIV tests?
Ans. A rapid test for detecting antibody to HIV is a screening test that produces very quick results, usually in 5 to 30 minutes. In comparison, results from the commonly used HIV antibody-screening test, the EIA (enzyme immunoassay), are not available for 1-2 weeks.

The Food and Drug Administration currently license only one rapid HIV test for use in the United States. The availability of rapid HIV tests may differ from one place to another. The rapid HIV test is considered to be just as accurate as the EIA.

Both the rapid test and the EIA look for the presence of antibodies to HIV. As is true for all screening tests (including the EIA), a reactive rapid HIV test result must be confirmed before a diagnosis of infection can be given.

Q. Are there other tests available?
Ans. The EIA (enzyme immunoassay) is the standard screening test used to detect the presence of antibodies to HIV. The EIA should be used with a confirmatory test such as the Western blot. Tests that detect other signs of HIV are available for special purposes, such as for additional testing of the blood supply and conducting research. Because some tests are expensive or require sophisticated equipment and specialized training, their use is limited. In addition to the EIA, other tests now available include:

Radioimmunoprecipitation assay (RIPA): A confirmatory blood test that may be used when antibody levels are very low or difficult to detect or when Western blot test results are uncertain. An expensive test, the RIPA requires time and expertise to perform.

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.

Dot-blot immunobinding assay: A rapid-screening blood test that is cost-effective and that may become an alternative to conventional EIA and Western blot testing.

Antigen capture assay: Also known as the HIV-1 antigen capture assay. The Food and Drug Administration (FDA) added this blood test as an interim measure in 1996 to HIV-antibody testing to protect the blood supply further until other tests become available to detect early HIV infection before antibodies are fully developed. Because some activity of p24 antigen is unpredictable, this test is not useful for helping people find out if they have HIV.

Polymerase chain reaction (PCR): A specialized blood test that looks for HIV genetic information. Although expensive and labor-intensive, the test can detect the virus even in someone only recently infected. To further protect the blood supply, the FDA has indicated that the development and implementation of tests for HIV genetic material such as PCR is warranted.

Q. How long after a possible exposure should I wait to get tested for HIV?
Ans. The tests commonly used to detect HIV infection actually look for antibodies produced by your body to fight HIV. Most people will develop detectable antibodies within 3 months after infection, the average being 25 days. In rare cases, it can take up to 6 months. For this reason, the CDC currently recommends testing 6 months after the last possible exposure (unprotected vaginal, anal, or oral sex or sharing needles). It would be extremely rare to take longer than 6 months to develop detectable antibodies. It is important, during the 6 months between exposure and the test, to protect yourself and others from further possible exposures to HIV.

Q. If I test HIV negative, does that mean that my partner is HIV negative also?
Ans. No. Your HIV test result reveals only your HIV status. Your negative test result does not tell you whether your partner has HIV.

HIV is not necessarily transmitted every time there is an exposure. Therefore, your taking an HIV test should not be seen as a method to find out if your partner is infected. Testing should never take the place of protecting yourself from HIV infection. If your behaviors are putting you at risk for exposure to HIV, it is important to reduce your risks.

Q. What if I test positive for HIV?
Ans. If you test positive for HIV, the sooner you take steps to protect your health, the better. Early medical treatment and a healthy lifestyle can help you stay well. Prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. There are a number of important steps you can take immediately to protect your health:

See a doctor, even if you do not feel sick. Try to find a doctor who has experience treating HIV. There are now many drugs to treat HIV infection and help you maintain your health. It is never too early to start thinking about treatment possibilities.

Have a TB (tuberculosis) test done. You may be infected with TB and not know it. Undetected TB can cause serious illness, but it can be successfully treated if caught early.

Smoking cigarettes, drinking too much alcohol, or using illegal drugs (such as cocaine) can weaken your immune system. There are programs available that can help you reduce or stop using these substances.

There is much you can do to stay healthy. Learn all that you can about maintaining good health.

Q. How is HIV passed from one person to another?
Ans. HIV transmission can occur when blood, semen (including pre-seminal fluid, or "pre-cum"), vaginal fluid, or breast milk from an infected person enters the body of an uninfected person.

HIV can enter the body through a vein (e.g., injection drug use), the anus or rectum, the vagina, the penis, the mouth, other mucous membranes (e.g., eyes or inside of the nose), or cuts and sores. Intact, healthy skin is an excellent barrier against HIV and other viruses and bacteria.

These are the most common ways that HIV is transmitted from one person to another:

by having sexual intercourse (anal, vaginal, or oral sex) with an HIV-infected person
by sharing needles or injection equipment with an injection drug user who is infected with HIV
from HIV-infected women to babies before or during birth, or through breast-feeding after birth

HIV also can be transmitted through transfusions of infected blood or blood clotting factors. However, since 1985, all donated blood in the United States has been tested for HIV. Therefore, the risk of infection through transfusion of blood or blood products is extremely low. The U.S. blood supply is considered to be among the safest in the world

Some health-care workers have become infected after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood contact with the worker's open cut or through splashes into the worker's eyes or inside their nose. There has been only one instance of patients being infected by an HIV-infected health care worker. This involved HIV transmission from an infected dentist to six patients.

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.

One case suggests that a woman became infected with HIV from her sex partner through exposure to contaminated blood during open-mouth kissing

Q. Can I get HIV from performing oral sex?
Ans. Yes, it is possible for you to become infected with HIV through performing oral sex. There have been a few cases of HIV transmission from performing oral sex on a person infected with HIV. While no one knows exactly what the degree of risk is, evidence suggests that the risk is less than that of unprotected anal or vaginal sex.

Blood, semen, pre-seminal fluid, and vaginal fluid all may contain the virus. Cells in the mucous lining of the mouth may carry HIV into the lymph nodes or the bloodstream. The risk increases

if you have cuts or sores around or in your mouth or throat
if your partner ejaculates in your mouth
if your partner has another sexually transmitted disease (STD).
If you choose to have oral sex, and your partner is male, use a latex condom on the penis
if you or your partner is allergic to latex, plastic (polyurethane) condoms can be used.

Research has shown the effectiveness of latex condoms used on the penis to prevent the transmission of HIV. Condoms are not risk-free, but they greatly reduce your risk of becoming HIV-infected if your partner has the virus. If you choose to have oral sex, and your partner is female,

use a latex barrier (such as a dental dam or a cut-open condom that makes a square) between your mouth and the vagina. Plastic food wrap also can be used as a barrier.

The barrier reduces the risk of blood or vaginal fluids entering your mouth. For more information about latex condoms, female condoms, and plastic (polyurethane) condoms.

Q. Can I get HIV from someone performing oral sex on me?
Ans. Yes, it is possible for you to become infected with HIV through receiving oral sex. If your partner has HIV, blood from their mouth may enter the urethra (the opening at the tip of the penis), the vagina, the anus, or directly into the body through small cuts or open sores. While no one knows exactly what the degree of risk is, evidence suggests that the risk is less than that of unprotected anal or vaginal sex.

If you choose to have oral sex,

use a latex condom on the penis
if you or your partner is allergic to latex, a plastic (polyurethane) condom can be used.

Research has shown the effectiveness of latex condoms used on the penis for preventing the transmission of HIV. Condoms are not risk-free, but they greatly reduce your risk of becoming HIV-infected if your partner has the virus.

If you choose to have oral sex and you are female,

use a latex barrier (such as a cut-open condom that makes a square or a dental dam) between their mouth and the vagina. Plastic food wrap can also be used as a barrier.

The barrier reduces the risk of blood entering the body through the vagina. For more information about latex condoms, female condoms, and plastic (polyurethane) condoms

Q. Can I get HIV from having vaginal sex?
Ans. Yes, it is possible to become infected with HIV through vaginal intercourse. In fact, it is the most common way the virus is transmitted in much of the world. HIV can be found in the blood, semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus. The lining of the vagina can tear and possibly allow HIV to enter the body. Direct absorption of HIV through the mucous membranes that line the vagina also is a possibility.

The male may be at less risk for HIV transmission than the female through vaginal intercourse. However, HIV can enter the body of the male through his urethra (the opening at the tip of the penis) or through small cuts or open sores on the penis.

Risk for HIV infection increases if you or a partner has a sexually transmitted disease (STD).

If you choose to have vaginal intercourse, use a latex condom to help protect both you and your partner from the risk of HIV and other STDs. Studies have shown that latex condoms are very effective, though not perfect, in preventing HIV transmission when used correctly and consistently. If either partner is allergic to latex, plastic (polyurethane) condoms for either the male or female can be used.

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

Having unprotected (without a condom) anal sex is considered to be a very risky 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 consistently and correctly. 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, 98-100 percent of those people who used latex condoms correctly and consistently did not become infected.

Q. Is there a connection between HIV and other sexually transmitted diseases?
Ans. Yes. Having a sexually transmitted disease (STD) can increase a person's risk of becoming infected with HIV, whether the STD causes open sores or breaks in the skin (e.g., syphilis, herpes, chancroid) or does not cause breaks in the skin (e.g., chlamydia, gonorrhea).

If the STD infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even when the STD causes no breaks or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely.

In addition, if an HIV-infected person also is infected with another STD, that person is three to five times more likely than other HIV-infected persons to transmit HIV through sexual contact.

Not having (abstaining from) sexual intercourse is the most effective way to avoid STDs, including HIV. For those who choose to be sexually active, the following HIV prevention activities are highly effective:

Engaging in sex that does not involve vaginal, anal, or oral sex
Having intercourse with only one uninfected partner
Using latex condoms every time you have sex

For more information on latex condoms, the female condom, and plastic (polyurethane) condoms

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

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

using blood-contaminated syringes to prepare drugs
reusing water
reusing bottle caps, spoons, or other containers ("spoons" and "cookers") used to dissolve drugs in water and to heat drug solutions
reusing small pieces of cotton or cigarette filters ("cottons") used to filter out particles that could block the needle.

"Street sellers" of syringes may repackage used syringes and sell them as sterile syringes. For this reason, people who continue to inject drugs should obtain syringes from reliable sources of sterile syringes, such as pharmacies. It is important to know that sharing a needle or syringe for any use, including skin popping and injecting steroids, can put one at risk for HIV and other blood-borne infections.

Q. How can people who use injection drugs reduce their risk for HIV infection?
Ans. The CDC recommends that people who inject drugs should be regularly counseled to

stop using and injecting drugs.
enter and complete substance abuse treatment, including relapse prevention.

For injection drug users who cannot or will not stop injecting drugs, the following steps may be taken to reduce personal and public health risks:

Never reuse or "share" syringes, water, or drug preparation equipment.
Only use syringes obtained from a reliable source (such as pharmacies or needle exchange programs).
Use a new, sterile syringe to prepare and inject drugs.
If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water).
Use a new or disinfected container ("cooker") and a new filter ("cotton") to prepare drugs.
Clean the injection site prior to injection with a new alcohol swab.
Safely dispose of syringes after one use.

If new, sterile syringes and other drug preparation and injection equipment are not available, then previously used equipment should be boiled in water or disinfected with bleach before reuse. Injection drug users and their sex partners also should take precautions, such as using condoms consistently and correctly, to reduce risks of sexual transmission of HIV.

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. CDC recommends 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. You also may call the local health department to find out what sterilization procedures are in place in the local area for these types of establishments.

Q. Are health care workers at risk of getting HIV on the job?
Ans. The risk of health care workers getting HIV on the job is very low, especially if they carefully follow universal precautions (i.e., using protective practices and personal protective equipment to prevent HIV and other blood-borne infections). It is important to remember that casual, everyday contact with an HIV-infected person does not expose health care workers or anyone else to HIV. For health care workers on the job, the main risk of HIV transmission is through accidental injuries from needles and other sharp instruments that may be contaminated with the virus. Even this risk is small, however. Scientists estimate that the risk of infection from a needle jab is less than 1 percent, a figure based on the findings of several studies of health care workers who received punctures from HIV-contaminated needles or were otherwise exposed to HIV-contaminated blood.

Q. Are patients in a dentist's or doctor's office at risk of getting HIV?
Ans. Although HIV transmission is possible in health care settings, it is extremely rare. Medical experts emphasize that the careful practice of infection control procedures, including universal precautions, protects patients as well as health care providers from possible HIV infection in medical and dental offices.

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

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

Q. Should I be concerned about getting infected with HIV while playing sports?
Ans. There are no documented cases of HIV being transmitted during participation in sports. The very low risk of transmission during sports participation would involve sports with direct body contact in which bleeding might be expected to occur.

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

Q. Can I get HIV from casual contact (shaking hands, hugging, using a toilet, drinking from the same glass, or the sneezing and coughing of an infected person)?
Ans. No. HIV is not transmitted by day-to-day contact in the workplace, schools, or social settings. HIV is not transmitted through shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, a drinking fountain, a door knob, dishes, drinking glasses, food, or pets.

A small number of cases of transmission have been reported in which a person became infected with HIV as a result of contact with blood or other body secretions from an HIV-infected person in the household. Although contact with blood and other body substances can occur in households, transmission of HIV is rare in this setting. However, persons infected with HIV and persons providing home care for those who are HIV-infected should be fully educated and trained regarding appropriate infection-control techniques.

HIV is not an airborne or food-borne virus, and it does not live long outside the body. HIV can be found in the blood, semen, or vaginal fluid of an infected person. The three main ways HIV is transmitted are

through having sex (anal, vaginal, or oral) with someone infected with HIV.
through sharing needles and syringes with someone who has HIV.
through exposure (in the case of infants) to HIV before or during birth, or through breast feeding.

Q. Can I get infected with HIV from mosquitoes?
Ans. No. From the start of the HIV epidemic there has been concern about HIV transmission of the virus by biting and bloodsucking insects, such as mosquitoes. However, studies conducted by the CDC and elsewhere have shown no evidence of HIV transmission through mosquitoes or any other insects -- even in areas where there are many cases of AIDS and large populations of mosquitoes. Lack of such outbreaks, despite intense efforts to detect them, supports the conclusion that HIV is not transmitted by insects.

The results of experiments and observations of insect biting behavior indicate that when an insect bites a person, it does not inject its own or a previously bitten person's or animal's blood into the next person bitten. Rather, it injects saliva, which acts as a lubricant so the insect can feed efficiently. Diseases such as yellow fever and malaria are transmitted through the saliva of specific species of mosquitoes. However, HIV lives for only a short time inside an insect and, unlike organisms that are transmitted via insect bites, HIV does not reproduce (and does not survive) in insects. Thus, even if the virus enters a mosquito or another insect, the insect does not become infected and cannot transmit HIV to the next human it bites.

Q. Can a baby have the HIV test?
Ans. Yes, but it will not necessarily show whether the baby is infected. This is because the test is for HIV antibodies and all babies born to mothers with HIV are born with HIV antibodies. Babies who are not infected lose their antibodies by the time they are about 18 months old. However most babies can be diagnosed as either infected or uninfected by the time they are 3 months old by using a different test, called a PCR test. The PCR test is more sensitive than the HIV test, and is not used in the standard HIV testing of adults. The PCR test looks for the presence of HIV itself, not antibodies.

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

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

Q. What are the possible disadvantages?
Ans. Some pregnant women feel that they could not cope with finding out that they have HIV and that they may have put their baby at risk.

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

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

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

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

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

The test can be done at any time. But it takes about 3 months after being infected for a person's blood to have enough antibodies in it for them to show up in the test. For this reason most people are advised to wait at least 3 months after their last risk of being infected before they have a test.

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

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

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

Q. On viral load tests, what is considered a high viral load and what is considered a low one? What are these tests used for?
Ans. Viral load tests measure how much of the HIV virus is in the bloodstream. They are very new tests and can be very expensive. Insurance companies may or may not cover the cost of the test. A result below 10,000 is considered a low result. A result over 100,000 is considered a high result. The primary use of these tests is to help determine how well a certain antiviral drug is working. If the viral load is high, your physician may consider switching you to another drug therapy. The viral load tests are best used if trends in results are compared over time. If the viral load increases over time, then the drug treatment may need to be changed. If the viral load goes down over time, antiviral treatment may be working for you. So rather than just taking 1 test, a series of viral load tests gives much more useful information. Of course, antiviral therapy must not be determined by this test alone. Other tests (like CD4 cell counts) are also important indicators as to how well antiviral therapy is working. It is presently not known what a test result between 10,000 and 100,000 means. That's why trends in viral load tests are of much greater value.

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

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

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

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

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

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

Have you had unprotected vaginal, oral or anal sex (e.g., intercourse without a condom, oral sex without a latex barrier)?
Have you shared needles to inject street drugs or steroids or to pierce your skin?
Have you had a sexually transmitted infection (STI) or unwanted pregnancy?
Have you had a blood transfusion or received blood products before April, 1985?

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

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

Q. Is There a Cure?
Ans. At this time, there is no cure for HIV. HIV is a virus, and medical science has never found a cure for any virus. This has made the search for a cure for HIV very difficult.

Since this is the current reality, it is important that those people who are not infected with HIV stay negative and those living with HIV/AIDS stay healthy. For people infected with HIV, there are more treatments now than ever before. Some of these treatments are for fighting the virus, others are to treat opportunistic infections that may occur if someone's immune system is compromised.

Q. Do Condoms Work?
Ans. Like seatbelts or bike helmets, condoms can't offer 100 percent protection; and sex with condoms can feel different from unprotected sex. The risks associated with not using condoms, such as getting pregnant, getting HIV, sexually transmitted infections (STD's) such as hepatitis and chlamydia, or just having to worry about it, make condoms well worth the hassle.

You've probably heard a lot of old myths about condoms: "They have holes, they're too tight for me, you can't feel anything", etc. Since AIDS, condoms are thinner, stretchier, stronger, and packaged to last longer on the shelf. Each condom is individually tested for holes. As a rule, the thinnest and strongest condoms are made in Japan where they must pass the strictest industrial standards. Before it is packaged, each and every condom is fitted on an underwater, metal rod and zapped with a weak electrical charge. If the electrical charge passes through a hole or weak spot in the condom, it is thrown away. Batches of condoms are randomly selected and filled with a sort of viral soup to test for leaks. If one condom fails the leakage test, the whole lot is discarded.

If you've had sensitivity problems with condoms, try a Japanese brand without spermicide (nonoxynol-9), since this can numb or irritate your skin.

Q. What is the difference betweenHIV-1 and HIV- 2 ?
Ans. Two types of HIV are currently recognized: HIV-1 and HIV-2. Worldwide, the predominant virus is HIV-1. Both types of virus are transmitted by sexual contact, through blood, and from mother to child, and they appear to cause clinically indistinguishable AIDS. However, HIV-2 is less easily transmitted, and the period between intitial infection and illness is longer in the case of HIV2.

Q. How many subtypes do we know about?
Ans. We currently know of at least 10 genetically distinct subtypes of HIV-1 within the major group (group M) containing subtypes A to J. In addition, group O (Outliers) contains a distinct group of very heterogeneous viruses. These subtypes are unevenly distributed throughout the world. For instance, subtype B is mostly found in the Americas, Japan, Australia, the Caribbean and Europe; subtypes A and D predominate in sub-Saharan Africa; subtype C in South Africa and India; and subtype E in Central African Republic, Thailand and other countries of southeast Asia. Subtypes F (Brazil and Romania), G and H (Russia and Central Africa), I (Cyprus), and group O (Cameroon) are of very low prevalence. In Africa, most subtypes are found, although subtype B is less prevalent.

Q. What are the major differences between these subtypes?
Ans. The major difference is their genetic composition; biological differences observed in vitro and/or in vivo may reflect this. It has also been suggested that certain subtypes may be predominantly associated with specific modes of transmission: for example, subtype B with homosexual contact and intravenous drug use (essentially via blood) and subtypes E and C, with heterosexual transmission (via a mucosal route). Laboratory studies undertaken by Dr Max Essex of the Harvard School of Public Health in Boston have demonstrated that subtypes C and E infect and replicate more efficiently than subtype B in Langerhans cells which are present in the vaginal mucosa, cervix and the foreskin of the penis but not on the wall of the rectum. These data suggest that HIV subtypes E and C may have a higher potential for heterosexual transmission than subtype B. However, caution should be exercised in applying in vitro-studies to real-life situations. Other variables which affect the risk of transmission, such as the stage of HIV disease, the frequency of exposure, condom use, and the presence of other sexually transmitted diseases (STDs), must also be taken into consideration before any definite conclusions can be drawn.

Q. Are some subtypes more infectious than others?
Ans. Some recent studies have suggested that subtype E spreads more easily than subtype B. In one study conducted in Thailand (Mastro et al., The Lancet, 22 January 1994), it was found that the transmission rate of subtype E among female commercial sex workers and their clients was higher than that for subtype B found among a general population in North America. In a second study conducted in Thailand (Kunanusont, The Lancet, 29 April 1995), among 185 couples with one partner infected with HIV subtypes E or B, it was found that the probability of both partners in a couple becoming infected was higher for subtype E (69%) than for subtype B (48%). This suggests that subtype E may be more easily transmissible. However, it is important to note that neither study was designed to fully control for multiple variables which may affect the risk of transmission.

Q. How can one protect oneself against the different subtypes?
Ans. The condom and the adoption of safe sex behaviour are still the methods that work best to avoid HIV infection, regardless of subtype.

Q. Is subtype E a new subtype?
Ans. Subtype E is not new. Stored blood samples show that subtype E was already identified at the beginning of the epidemic in Central Africa and as early as 1989 inThailand.

Q. Is subtype E responsible for the rapid spread of HIV in Thailand and is there reason to expect an explosive spread of subtype E in other countries?
Ans. Recent findings on the rapid spread of subtype E in Thailand require further confirmation; and other variables that may affect the risk of transmission need to be studied. The possibility of subtype E virus spreading into other countries cannot be excluded. The prevention strategies advocated by UNAIDS which are currently being applied in countries such as Thailand, are valid in all parts of the world. In the event of subtype E spreading in Europe and other industrialized countries, these prevention strategies do not need to be altered, but simply continued and reinforced. As long as people practise safe sex, there is no need for alarm or panic. While UNAIDS cautions that more research needs to be done before the relative infectivity of subtype E can be established, the programme welcomes the current debate. This debate may serve to remind people that it is imperative that preventive behaviour continue to be promoted as long as the epidemic is not conquered in every part of the world.

Q. Do conventional AIDS tests detect all subtypes?
Ans. Routine AIDS tests, which are currently being used, for blood screening and diagnostic purposes detect virtually all subtypes of the human immunodeficiency virus. (Most companies have modified their assays so that they detect the newly identified HIV-1 group O strains.)

Q. Are more subtypes likely to "appear"?
Ans. 10 subtypes have been identified in the past four years since the techniques to detect subtypes in HIV-1 were introduced in 1992. It is almost certain that new HIV genetic subtypes will be discovered in the future, and that the known subtypes will continue to spread to new areas as the global epidemic continues. For example, two recent articles (Artenstein and Brodine, The Lancet, 4 November 1995) report some cases of persons infected with subtype E in Uruguay and in the United States (apparently from Cambodia and Thailand respectively).

Q. What are the implications of HIV variability for research on treatment and vaccines?
Ans. More research needs to be undertaken. Some HIV subtypes have been observed in the laboratory to have different growth and immunological characteristics; these differences need to be demonstrated in vivo. It is not known whether the genetic variations in subtype E or other subtypes actually make a difference in terms of the risk of transmission, the response to antiviral therapy, or prevention by vaccine. If these genetic variations do make a difference in terms of vaccine effectiveness, this indeed could represent a major obstacle to the development of a widely effective or "global" HIV vaccine. The influenza vaccine has to be periodically modified and updated because of the genetic variations of the influenza virus. The same might need to be done with an HIV vaccine. UNAIDS is supporting a global network for HIV isolation and characterization to monitor the distribution and emergence of new subtypes. The information collected is being used to monitor the dynamics of subtype distributions globally and for vaccine research and evaluation.
 

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

Q. What is "Unlinked Anonymity in HIV Sentinel surveillance?
Ans. In HIV Sentinel surveillance, unlinked anonymity means that the blood is primarily collected for some other purpose and the results are not linked to any individual. This methodology is adopted in order to minimize participation bias in the whole procedure.

Q.Is the HIV sentinel surveillance clinic based or community based?
Ans. In order to minimize the selection bias of samples, consecutive sampling procedure is adopted and it is ideally a clinic based approach.

Q. What is the usefulness of HIV Sentinel surveillance?
Ans. HIV sentinel surveillance data is used to understand and monitor time trends, know HIV prevalence levels in various risk groups in States/UTs and work out total HIV burden in various sub-populations.

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

Q. What is the estimated number of HIV infections in the country?
Ans. The estimated number of HIV infections in the country is 3.97 million.

Q. Why is there so much difference between the reported and estimated number of HIV infections?
Ans. HIV is a chronic infection and may take 5-9 years to develop its manifestations in the form of opportunistic infections and other forms of symptoms and signs. During this period, the HIV infected person remains asymptomatic and does not come in contact with hospitals where his/her HIV status can be detected.

Q. What is the situation of HIV infection in the country?
Ans. According to the Sentinel Surveillance results of 2001, States/UTs can be categorized into three categories.

States like Maharashtra, Tamil Nadu, Manipur, Nagaland, Andhra Pradesh and Karnataka are the worst affected states where the epidemic is progressing fast. The HIV prevalence rate among pregnant mothers in these states is one percent or above.

States like Gujarat, Pondicherry, and Goa have concentrated epidemic in high-risk groups of population. The HIV prevalence rate in these states among high-risk groups (STD clinics attendees/ Intravenous Drug Users (IDUs) is more than five percent but among antenatal mothers is less than one percent.

The remaining States have low-level epidemic with HIV prevalence among high-risk groups less than five percent. 

Q. Despite all the publicity regarding the AIDS Awareness Campaign, the awareness about AIDS is very low. Where is all the money going?
Ans. The IEC Campaign of NACO is operationalized at two levels, the National level and the State level. The activity has been mostly decentralized to the States and each State society is expected to utilize the funds as per the local requirements. Despite all the talk about funds being available for IEC, the fact is that the funds are in fact quite meager, considering the size of the country and the magnitude of the problem. Funds amounting to about 10 crores is available for the National campaign, which is operated centrally by NACO.

Q. The message of AIDS advertisements is done crudely with a fear approach. What is the process by which NACO decides its messages for various target audiences?
Ans. The fear approach has been completely done away with in all campaign messages. During the early days of the campaign, this approach was used to a certain extent, but the same has been discontinued for quite some time. NACO has a process by which a Committee comprising renowned media personnel come together to decide the content and strategies for all campaigns at the National level. Research, in terms of NFHS and BSS surveys conducted in the Ministry, are used to ascertain knowledge levels in the population. Based on the funds available, appropriate media mix is worked out for dissemination of the messages.

Q. AIDS is associated with very high profile funds and personalities. In spite of this, there seems to be no control on the spread of the virus.
Ans. Endorsement by well known personalities gives visibility and acceptance to any product (social and commercial), and is a time tested approach in the field of advertising media. Prevention of AIDS is related to behavioral change in individuals who would be expected to adopt safer sexual practices. This is an extremely difficult action response that the AIDS campaign expects from the target audience. This process is time taking, however we have to work more intensively. Given a limited budget available with NACO, all personalities roped in so far, have offered their services free. Media events that are appropriately located and strategized, are necessary to give visibility to the programme and also enthuse participation from target groups like the youth.

Q. AIDS Awareness campaign is concentrated mostly in urban areas whereas the rural belts are left untouched. Why?
Ans. The IEC Campaign uses a number of media vehicles to spread the messages in the rural belt also. The bulk of the money is spent on Doordarshan and radio which is accessible to both urban and rural population. As recent surveys have shown, the reach of television has far outstripped the reach of even radio and other media. Apart from the mass media, inter-personnel communication methods are used, which cover urban slums and rural areas.

Q. What have been the achievements during the IEC Campaigns being organized over the years?
Ans. Prevention is a very important tool for arresting the spread of the virus. Awareness generation is the key component of prevention activities as knowledge about the nature of the disease is very important, which ultimately brings about behavioral change. According to the data available for the last four or five years, awareness levels amongst rural women in terms of having heard about HIV/AIDS has gone up from 35 percent (NFHS 1998) to 65 percent (BSS 2001). While it would be difficult to quantify how many more infections could have happened if there was no intervention, it can definitely be mentioned that the rate of growth of infections over the last three to four years has shown only a gradual increase.This suggests that the IEC and other delivery components of the NACO programme are on the right track.

NGOs

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

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

Q.Why is NGO work mostly restricted to Targetted Interventions? Doesn’t it lead to identification of High Risk Groups and further stigmatization?
Ans. Targetted Intervention is a very important strategy of NACP II to check the spread of HIV. It is a fact that certain groups of people, known to practice high risk behaviour are more likely to carry the virus than others. Groups like the CSWs, IDU, Truckers, Migrants, etc. are also the most marginalized in the society. These groups do not need half baked interventions where one just tells them about behaviour change. BCC is important but that should be accompanied by services like STD treatment, Condom provision, creation of enabling environment etc. All these are essential components of NACOs TIs.

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

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

Q.What is VCTC?
Ans. VCTC stands for Voluntary Counseling and Testing Center

Q.What is the role of VCTC in the prevention of HIV/AIDS?
Ans. As the HIV problem intensifies, the issues of care and support for affected individuals, and prevention of HIV transmission to those who are not affected, become even more critical. Voluntary counseling and testing (VCT) is now seen as a key entry point for a range of interventions in HIV prevention and care. It provides people with an opportunity to learn and accept their HIV serostatus in a confidential and enabling environment and to cope with the stress arising out of HIV infection. VCT should become an integral part of HIV prevention programs, as it is a relatively cost-effective intervention in preventing HIV transmission.

The potential benefits of VCT are:

Earlier access to care and treatment
Providing factual information about HIV /AIDS and clearing misconcepts
Reduction of fear and stigma through counseling
Creating enabling environment for PLHAs
Emotional Support
Better ability to cope with HIV related anxiety
Improved Health status through good nutritional advice
Motivation to initiate or maintain safer sexual practices and behavior change
Prevention of HIV related illness
Motivation for drug related behaviour
Safer blood donation
Motivating HIV infected person to involve spouse/partner for future spread and care

Q.Where are VCTCs located in India ?
Ans. Keeping in the view the importance of VCT in Prevention and Care of HIV/AIDS, NACO has decided to expand this facility up to district hospitals throughout the country. During the year 2001-2002, State AIDS Control Societies of Six High Prevalence States, namely Tamil Nadu, Maharashtra, Andhra Pradesh, Karnataka, Manipur and Nagaland were asked to establish VCTCs in all Medical College Hospitals and District Hospitals, while other States were advised to cover at least 20-30% of Districts Hospitals, giving priority to those districts which are vulnerable to HIV Infections.

So far more than 540 VCTCs have been established in various states/UTs, which are located in medical college hospital & district hospitals.

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

Separate enclosures for Male & Female clients have been set up to provide confidential environment for encouraging disclosure and providing I.P.C.

For the effective functioning of the VCTCs, two trained counselors and one laboratory technician have been provided in each VCTC.

In order to ensure that the result of the HIV test is given on same day to the individual after post-test counseling, Rapid HIV Test Kits have been supplied to these centers. Or Client is asked to meet the same counselor for post-s test counseling on appointed date.

Waiting space
Trained Microbiologist/Pathologist
Training to staff functionaries of VCTC
For the effective functioning of the VCTCs, two trained counselors and one laboratory technician have been provided in each VCTC.

In order to ensure that VCTCs provide quality Counseling Services, stress has been laid on Pre-placement in-service training of counselors & Technicians by master trainers & resource persons
Orientation training is also conducted for these functionaries.

Q. What has been done to make VCTCs user- friendly?
Ans. In order to make the services more clients friendly following efforts are being made-

VCTCs are located in easily accessible areas mostly in O.P.Ds
Informed consent in local language is taken before HIV testing. Clients are informed about the nature and consequences of HIV test before their consent is taken. It is emphasized that testing should not be forced but left at the will of the client.
Here it is emphasized that counselors should not be rotated from center to center and from one day to another since the rapport between the counselor and client is very essential.
Adequate supply of condoms is made available in these counseling centers. Individuals attending the VCTC are also made aware about the outlets from which they can get condoms under various schemes.
Counseling is integrated into other services, including STI, antenatal and RCH clinics.
Referral system has been developed in consultation with NGOs, community based organizations, hospitals and PLWA networks.
Counselors are provided adequate training and ongoing support and supervision to ensure that they give good quality counseling and avoid burnout.
Linkages with NGOs for social support, follow-up counseling and care for those tested seropositive are emphasized.
Innovative ways of scaling up VCT services and making them more accessible and available is the endeavor.
There is emphasis to make it more clients friendly and service based component by augmenting the following services:
Anti RetroViral drugs in PMTCT
Anti -tubercular treatment in HIV-TB co-infection
Free treatment of STI & opportunistic infections
Follow up services & networking among patients living with AIDS

Q.How do you ensure credibility of reports of the test carried out at VCTC ?
Ans. In order to maintain the quality of the tests being done at VCTCs, the Following measure are adopted
All the sample detected HIV sero positive and 5 percent detected sero negative by VCTCs are sent to reference laboratories for cross checking.

Under External Quality Assurance Programme sera panels are sent to VCTCs by National reference laboratories, which are tested by them & feed back given back to reference laboratories.

Q.What is NACO’s stand for compulsory pre operative HIV testing in private practice and pre employment test in private companies?
Ans. No mandatory HIV testing should be imposed as a precondition for employment or for providing health care services. Testing should be voluntary after obtaining informed consent with pre & post-test counseling

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

To raise the level of awareness on RTI/STI and HIV/AIDS in rural and slum areas, and other vulnerable groups of the population;
To encourage health seeking behavior in the general population for RTI and STI.
To make the people aware about the services available in the public health system for the management of RTI/STI.
To facilitate early detection and prompt treatment of RTI and STI by mainstreaming the programme with the infrastructure available under the primary health care system.
To strengthen the capacity of medical & paramedical professionals working under health care system to respond to HIV/AIDS epidemic adequately. 

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

Q.What is the number of blood banks in the country.
Ans. Presently, there are 1721 licensed blood banks in the country. About 45 percent of them are in the Government sector.

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

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

Q. Is there some uniform service charge fixed for a Blood unit?
Ans. There are some guidelines developed by the National Blood Transfusion Council and circulated by NACO, on the amount of service charges that can be realised by blood banks functioning in any sector in the country. These guidelines specify that no blood bank will charge more than Rs.500/- for one unit of whole blood. However, since these are merely guidelines and have no legal sanction, blood banks have not been following them strictly.

Q. What is the estimated demand of blood in the country and how much is collected. Is there any shortage of blood in the country?
Ans. The estimated demand of blood in the country as calculated on the basis of WHO recommended norm, 7 units of blood per hospital bed, works out to about 6 million units of blood per annum. Presently, 6 million units of blood are being generated in the country, which should be just enough provided there are no wasteful practices in blood transfusion. With the advancement of technology and mushrooming of superspeciality hospitals in cities, the gap between demand and supply is continuously widening. The demand therefore is always on the increase.

Q. NBTC was constituted subsequent to Supreme Court judgment in 1996 with the focus of catering to Nation’s blood security. The prime objective was to phase out professional donors and focus on voluntary donations. How far has this policy been successful and how much voluntary blood is collected in the country?
Ans. Soon after setting up of the National Blood Transfusion Council(NBTC) at the centre and State Blood transfusion Councils in each State/UTs, a complete ban has been imposed on collection of blood from paid donors, with effect from 1st January, 1998. A number of steps were taken by NBTC to keep a strict check on exploiting the blood users by commercial and private blood banks. SBTCs were provided funds by NBTC to mobilise blood collection through voluntary blood donations. Extensive awareness programmes for donor motivation through Information, Education, Motivation, Recruitment and Retention of voluntary donors was launched. Each state is given an annual target for collection of blood through voluntary sources and this is regularly reviewed by NACO. As of now, 45 percent blood is being generated through voluntary donations and the rest are from replacement donors.

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

Q. Can one acquire HIV infection if one donates blood.
Ans. No. This is not possible as all material used for collection of blood are sterile and disposable. Donating blood is a noble gesture, persons who are healthy should come forward for donating blood voluntarily.

Q. Is it beneficial to use blood components?
Ans. Yes. Whole human blood can be separated into different components in blood banks having these facilities. NACO has provided 82 such facilities all over the country. Thus, one unit of blood can benefit 4 to 6 different patients. The components are safer and specific for the disease. Risks associated with transfusion of components is relatively less. At the same time, there is appropriate use of blood if a component instead of whole human blood is transfused.

Q. Why one should donate blood?
Ans. The need of blood for transfusion is great. But the voluntary donors are few. Nobody knows who will require blood when and where. The existence of a good donor base in the community is an insurance for everybody in respect of one’s blood needs. There can be a good donor base in the community provided, each capable and eligible person is prepared to donate blood and it is only the real voluntary blood donor who can ensure safe blood transfusion.

Q. Who can donate blood?
Ans. Only a healthy person between the age group of 18 – 60 years, weighing 45kgs or more with Haemoglobin content of 12.5gms per 100cc or more can donate blood.

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

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

Q. If testing has to be done in the hospital, is the consent of the patient required?
Ans. Yes. Whenever HIV test is done, the consent has to be taken. In case of unconscious patients, the consent of the near relatives has to be taken.

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

Q. Is the government considering to provide anti-retroviral therapy to AIDS cases ?
Ans. Government as yet is not considering provision of anti-retroviral therapy because of its cost. Antenatal theroply and it is not a cure but can only prolong the life of the patient and the drugs have to be continued life long.

Q. What are the common opportunistic infections encountered by HIV/AIDS patients?
Ans. The Common opportunistic infections encountered by HIV/AIDS patients are:

Tuberculosis (Pulmonary and extra-pulmonary).
Candidiasis
Pneumocysitis carini
Toxoplasmosis
Cryptococcosis
Cryptosporidial Diarrhoea
Cytomegolo virus infections
P. Marneffea infections (a fungus infection in North-east part of the country)
HIV-TB

Q. What is the burden of HIV-TB co-infection?
Ans.Over 40 million people worldwide were estimated to be HIV positive by end 2001- including 3.97 million in India. One-third of all People living with HIV/AIDS are co-infected with Mycobacterium tuberculosis. TB is the most common serious opportunistic infection occurring among HIV-positive persons. Of the total number of AIDS cases reported to NACO till 31st March 2002, 56 percent of them had TB.

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

Q. What is the impact of HIV on the epidemiology of TB?
Ans. HIV fuels the TB epidemic. The rate of progression to active TB is 10 to 30 times higher among individuals infected by both TB and HIV than among those infected only with TB. This is because people with HIV infection have suppressed immunity and hence chances of reactivation of dormant TB bacilli is many fold higher in them than among those without HIV. Also, due to low immunity, natural infection may rapidly lead to TB disease. Moreover HIV infection may also contribute to an increase in drug resistance. Increased TB cases in HIV-infected people pose risk of TB transmission to others in the general community.

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

Q. What steps has the Govt. of India taken to tackle this dual epidemic?
Ans. Recognizing the serious threat posed by HIV-TB co-infection, the Government of India has emphasized the need for strengthening collaboration between TB and AIDS control programs for better management of HIV-infected patients with TB. An Action Plan for tackling this dual epidemic has been drawn up at the Center between both the programmes which initially focuses on the six high prevalence States and is under implementation at the moment by both the National Programmes. Efforts are being made to establish Voluntary Counseling & Testing for HIV, diagnosis for TB and Direct Observed Treatment- short course for TB under the same roof to make such services available to the needy patients.

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

Q. What precautions should be taken while treating HIV and TB at the same time?
Ans. Certain anti-TB medications may affect the levels of anti-HIV medications and vice versa. Hence treatment of both diseases should be under the supervision of an experienced physician, the dosages should be closely monitored and adjusted as needed. If possible, treatment of TB should be completed before starting antiretrovirals.

Q. Why no reduction has been noticed in the prevalence of Sexually Transmitted Infections in India even though the STD Control Programme has been in operation since 1949 ? Which activities are provided under STD Control Programmes?
Ans. Precise data about the prevalence of STIs in India is not available. However, from the limited number of studies conducted among the ‘High Risk Population’ or ‘Hospital Based Studies’ prevalence rate of STIs in India has been quoted to be about five percent. Now, NACO has planned to ascertain the prevalence of STIs and also health seeking behaviour of persons suffering from this group of diseases by undertaking a country wide Community Based STI Prevalence Survey. STD Control Programme is based on early diagnosis and prompt treatment of STIs and relies on the health seeking behaviour of individuals with STD.

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

Q. Is there any interrelationship between STDs and HIV infection ?
Ans. Yes, STDs facilitate the HIV transmission either by increasing HIV susceptibility or HIV infectiousness or both. HIV infection also alters the natural history, manifestations and treatment of different STDs.

By treating all STDs at the earliest, HIV transmission can be prevented by 40 to 50%, especially in early epidemic phase.

Q. Is it true that male circumcision may provide protection against HIV infection?
Ans. Yes, the interior side of the foreskin has a mucosal surface, which is more susceptible to trauma than the tougher skin of the penile shaft or the glans. The foreskin also contains high levels of HIV target cells such as Langerhan’s cells. Recent study in Chicago has found out that foreskin mucosal tissue has a 7 fold greater susceptibility to HIV-1 than cells in cervical tissue under same condition. 

Q. What is the risk of transmission of HIV from mothers to babies, and what is the magnitude of the problem in India ?
Ans. The risk of transmission of HIV positive mother to her baby is 30 percent. Taking the overall prevalence as 0.8 percent, for an estimated 27,000,000 million deliveries there will be 2,16,000 mothers, who will be HIV positive. At 30 percent transmission, 64800 babies will be expected to be HIV positive.

Q. What are the goals of the PMTCT programme ?
Ans. The goals are : (1) to reduce HIV prevalence among pregnant women aged 15-49 years to below 3 percent in the six high prevalence states, and to reduce below one percent in other states by 2005; (2) reduce the transmission rate of MTCT of HIV from 30 percent to below 10 percent by 2005.

Q. What steps has the Government of India taken to ensure that all HIV positive pregnant mothers avail the benefits of this programme?
Ans. The Government is in the process of scaling up the PMTCT programme in phases so as to first provide PMTCT services in the high prevalence states, and thereafter the low prevalence states. Training of PMTCT teams from the 81 medical college hospitals has been completed. Training for the 155 district hospitals of the high prevalence states, and the 79 medical colleges of the low prevalence states will be completed by the end of 2002. Infrastructure strengthening and capacity building with the appointment of a counsellor and a laboratory technician is in progress.

Q. What is the Government’s stand on breast feeding in case of HIV positive mothers?
Ans. Best practice as recommended by UNICEF and supported by NACO is practiced. Messages will be consistent with the related programme of RCH. Every effort should be made to promote exclusive breast feeding up to four months in HIV positive mothers followed by weaning, and complete stoppage of breast feeding at 6 months in order to restrict transmission through breast feeding. However, such mothers will be informed about the risk of transmission of HIV through breast milk and its consequences, and would be helped for making informed choice regarding infant feeding.

Q. Is the Government of India planning to introduce Antiretroviral therapy free of cost in Govt. hospitals? Who will be eligible for the supply of drugs?
Ans. Union Minister for Health & Family Welfare convened a dialogue with the manufacturers of anti retrovirals for HIV/AIDS, with a view to examining the feasibility of procuring and delivering ARVs through the public health system. Resultantly, a Working Group was constituted, chaired by Secretary Health, with the Director General Health Services and Additional Secretary & Project Director NACO as Members, together with CII, FICCI, and representatives of the different manufacturers of anti retrovirals. The Working Group has completed its deliberations. If government does proceed to introduce antiretrovirals through the public health system, these will be delivered free of cost to the end consumer, in government hospitals. While we estimate over 4.58 million people living with HIV/ AIDS at end December, 2002, we necessarily have to prioritise the beneficiary population. Accordingly, we have said that HIV positive mothers who access the government health system through the PREVENTION OF PARENT TO CHILD TRANSMISSION clinics, HIV positive children below 15 years of age, and full blown AIDS cases who seek treatment in government hospitals.

Q. How much will this cost and where will the funds be available from?
Ans. The report of the Working Group is being examined. It appears that for 100,000 AIDS patients, the cost of reaching out antiretrovirals would be upwards of Rs. crores (cost of medicines and drugs alone). Additionally, there is the logistics of delivery, the cost of repeated testing and tracking of viral loads. The funds will be sought from domestic budgets and supplemented wherever necessary, from the Global Fund on AIDS, TB and Malaria, and from multilateral and bilateral donors.

Q. Has there been any offer of help from Former President Bill Clinton in combating HIV/AIDS in India?
Ans. President Clinton has negotiated a price reduction for drugs to be supplied to South Africa, countries of Sub Saharan Africa, and from the Caribbean. The Clinton Foundation is willing to extend the benefit of their agreement to other countries. The initiative of the Govt. of India to negotiate lower prices with manufacturers of anti-retrovirals predates the Clinton Foundation initiative. We anticipate that we will succeed in obtaining prices of ARVs lower than those negotiated by the Clinton Foundation, for our people.

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

Q. Recently, some HIV positive persons were quarantined at Mumbai for not taking Yellow Fever vaccination. What are Government Guidelines on Yellow Fever Vaccination for HIV positive persons?
Ans. Public health regulations in India require that all travellers take the Yellow Fever vaccination, should they be travelling to regions where the Yellow fever is endemic. Since the live attenuated vaccine is not recommended for immuno-compromised persons, people living with HIV are advised to take the said vaccine after appropriate advice from the treating physician. HIV positive persons are vulnerable to yellow fever infection. Therefore, in the interest of public health all persons who have not taken yellow fever vaccination, irrespective of their HIV status, have to be quarantined for the required number of days. However when NACO was informed we took all steps needed to make their stay comfortable. Officials from the Maharashtra State AIDS Control Society visited them regularly and took care of their medical and other needs.

Q. Is it true that there is an increase of HIV infection among women in Punjab, Haryana, Chandigarh & Himachal Pradesh.
Ans. The increased number of women cited with HIV could be on account of a number of factors. The increased off take of ante-natal care services leads to higher detection rates of HIV status. But there is a rise in the numbers of women infected by migrant husbands.

Q. There are concerns for young industrial workers infected with HIV and industries should take care of them.
Ans. Business initiatives are coming forward for work place interventions. Tatas, Mahindras, Larsen & Toubro, the Railways, SAIL & ESIC have already commenced several sustainable initiatives to reach out to their work force, and to the populations in their immediate vicinity. CII is co-ordinating acceleration of the business response to HIV. ILO had formulated policies for work place interventions.