..VIZAG MEDICAL GUIDE..

Q.	What is AIDS?
A.	AIDS stands for Acquired (not inborn, passed from person to person, including from mother to baby); Immune (relating to the body's immune system, which provides protection from disease-causing germs); Deficiency (lack of response by the immune system to germs); Syndrome (a number of signs and symptoms indicating a particular disease or condition). AIDS is caused by a virus, called HIV (human immunodeficiency virus) which attacks and, over time, destroys the body's immune system. A person has AIDS when the virus has done enough damage to the immune system to allow infections and cancers to develop. These infections, cancers etc. make the person ill and lead to his/her death. At present, there is no vaccine or cure for AIDS.
Q.	How do people get infected with HIV?
A.	HIV is transmitted mostly through semen and vaginal fluids during unprotected sex without the use of condoms. Globally, most cases of sexual transmission involve men and women, although in some developed countries homosexual activity remains the primary mode. Besides sexual intercourse, HIV can also be transmitted during drug injection by the sharing of needles contaminated with infected blood; by the transfusion of infected blood or blood products; and from an infected woman to her baby - before birth, during birth of just after delivery. HIV is not spread through ordinary social contact; for example by shaking hands, traveling in the same bus, eating from the same utensils, by hugging or kissing. Mosquitoes and insects do not spread the virus nor is it water-borne or air-borne.
Q.	How many people are affected with HIV?
A.	According to WHO estimates, by end-1996, nearly 30 million people - including over 2.5 million children - had been infected with HIV since the start of the pandemic. Every day, more than 7000 adults and 500 babies are infected. More than 8 million people have developed AIDS.
Q.	Does AIDS also affect our region?
A.	Of the 26.8 million adults with HIV infection - the global estimate in end-1996 - 14 million were in Sub-Saharan Africa and more than 3.5 million in Asia. Our region, that is South-East Asia, is likely to suffer the brunt of the pandemic - being home to over half the world's population. Moreover, HIV/AIDS is now present in every continent and in every region of the world.
Q.	Why is the AIDS epidemic considered so serious?
A.	AIDS affects people primarily when they are most productive and leads to premature death thereby severely affecting the socioeconomic structure of whole families, communities and countries. Besides, AIDS is not curable and since HIV is transmitted predominantly through sexual contact, and with sexual practices being essentially a private domain, these issues are difficult to address.
Q.	How can I avoid being infected through sex?
A.	You can avoid HIV infection by abstaining from sex, by having a mutually faithful monogamous sexual relationship with an uninfected partner or by practicing safer sex. Safer sex involves the correct use of a condom during each sexual encounter and also includes non-penetrative sex.
Q.	Can we assume responsibility in preventing HIV infection?
A.	Both men and women share the responsibility for avoiding behaviour that might lead to HIV infection. Equally, they also share the right to refuse sex and assume responsibility for ensuring safe sex. In many societies, however, men have much more control than women over when, with whom and how they have sex. In such cases, men need to assume greater responsibility for their actions.
Q.	Does the presence of other sexually transmitted diseases (STDs) facilitate HIV transmission?
A.	Yes. Every STD causes some damage to the genital skin and mucous layer, which facilitates the entry of HIV into the body. The most dangerous are: · syphills · chancroid · genital herps · gonorrhoea
Q.	Why is early treatment of STD important?
A.	High rates of STD caused by unprotected sexual activity enhance the transmission risk in the general population. Early treatment of STD reduces the risk of spread of other sexual partners and also reduces the risk of contracting HIV from infected partners. Besides, early treatment of STD also prevents infertility and ectopic pregnancies.
Q.	How can children and young people be protected from HIV?
A.	Children and adolescents have the right to know how to avoid HIV infection before they become sexually active. As some young people will have sex at an early age, they should know about condoms and where they are available. Parents and schools share the responsibility of ensuring that children how to avoid HIV infection, and learn the importance of tolerant, compassionate and no-discriminatory attitudes towards people living with HIV/AIDS.
Q.	How does a mother transmit HIV to her unborn child?
A.	An HIV-infected mother can infect the child in her womb through her blood. The baby is more at risk if the mother has been recently infected or is in a later stage of AIDS. Transmission can also occur at the time of birth when the baby is exposed to the mother's blood and to some extent transmission can occur through breast milk. Transmission from an infected mother to her baby occurs in about 30% of cases.
Q.	Can HIV be transmitted through breast-feeding?
A.	Yes. The virus has been found is breast milk in low concentrations and studies have shown that children of HIV-infected mothers can get HIV infection through breast milk. Breast milk, however, has many substances in it that protect an infant's health and the benefits of breast-feeding for both mother and child are well recognized. The slight risk of an infant becoming infected with HIV through breast-feeding is therefore thought to be outweighed by the benefits of breast-feeding.
Q.	Can blood transfusions transmit HIV infection?
A.	Yes. If the blood contains HIV. In many places blood is now screened for HIV before it is transfused. If you need a transfusion, try to ensure that screened blood is used. You can reduce the chances of needing a blood transfusion by taking ordinary precautions against serious injury - for example, by driving carefully, insisting on wearing a seat belt, and avoiding alcohol.
Q.	Can injection transmit HIV infection?
A.	Yes. If the injecting equipment is contaminated with blood containing HIV. Avoid injections unless absolutely necessary. If you must have an injection, make sure the needle and syringe come straight from a sterile package or have been sterilized properly; a needle and syringe that has been cleaned and then boiled for 20 minutes is ready for reuse. Finally, if you inject drugs, of whatever kind, never use anyone else's injecting equipment.
Q.	What about having a tattoo or your ears pierced?
A.	Tattooing, ear piercing, acupuncture and some kinds of dental work all involve instruments that must be sterile to avoid infection. In general, you should refrain from any procedure where the skin is pierced, unless absolutely necessary.
Q.	How serious is the interaction between HIV and TB in South-East Asia?
A.	Tuberculosis skills nearly 3 million people globally, of whom nearly 50% are Asians. The rapid spread of HIV in the region has further complicated the already serious situation. Not only is TB the commonest life-threatening opportunistic infection among patients living with AIDS, but the incidence of TB has now begun to increase, particularly in areas where HIV seroprevalence is high. Multi-drug resistant TB is also quite common in many areas.
Q.	What efforts are being made to integrate HIV/AIDS/STD prevention and control and activities into primary health care?
A.	Integration into primary health care is a priority because it is necessary for ensuring sustainability. Two examples of an integrated approach are the implementation of HIV/AIDS care and STD prevention and control. For example, a continuum to HIV/AIDS care is being promoted as a part of primary health care, with linkages to be established between institutional, community and home levels. In the area of STD prevention and control, a syndromic approach to STD diagnosis is most suitable in the developing world as it does not require laboratory tests, and treatment can be given at the first contact with health services. WHO strongly advocates that all primary health care workers be trained in the syndromic approach to STD management.
Q.	Is there a vaccine for HIV/AIDS? What is WHO's role in this regard?
A.	While there is currently no vaccine for HIV/AIDS, research is under way. Sixteen candidate vaccines are presently undergoing either phase I or phase II clinical trails in various countries, including Thailand in South-East Asia. These will be followed by field trails in the community to determine efficacy, which is a time consuming process and will take another 3.5 years or more. Hence, a vaccine for general use is unlikely to be available in the near future. WHO's role is to assist in the development, evaluation and availability of vaccines. WHO has helped four countries - Brazil, Rwanda, Thailand and Uganda - to prepare a comprehensive plan for HIV vaccine research including strengthening of national epidemiological, laboratory and socio-behavioural research capabilities.
Q.	Is there a treatment for HIV/AIDS? What is WHO's role in this regard?
A.	While there is currently no vaccine for HIV/AIDS, research is under way. Sixteen candidate vaccines are presently undergoing either phase I or phase II clinical trials in various countries, including Thailand in South-East Asia. These will be followed by field trials in the community to determine efficacy, which is a time consuming process and will take another 3-5 years or more. Hence, a vaccine for general use is unlikely to be available in the near future. WHO's role is to assist in the development, evaluation and availability of vaccines. WHO has helped four countries - Brazil, Rwanda, Thailand and Uganda - to prepare a comprehensive plan for HIV vaccine research including strengthening of national epidemiological, laboratory and socio-behavioural research capabilities.
Q.	Is there a treatment for HIV/AIDS?
A.	All the currently licensed anti-retroviral drugs, namely AZT, ddI and ddC, have effects which last only for a limited duration. In addition, these drugs are very expensive and have severe adverse reactions while the virus tends to develop resistance rather quickly with single-drug therapy. The emphasis is now on giving a combination of drugs including newer drugs called protease inhibitors; but this makes treatment even more expensive. WHO's present policy does not recommend antiviral drugs but instead advocates strengthening of clinical management for HIV - associated opportunistic infections such as tuberculosis and diarrhoea. Better care programmes have been shown to prolong survival and improve the quality of life of people living with HIV/AIDs.
Q.	How should governments share responsibility?
A.	Governments are responsible for ensuring that enough resources are allocated to AIDS prevention and care programmes, that all individuals and groups in society have access to these programmes, and that laws, policies and practices do not discriminate against people living with HIV/AIDS. Governments of developed countries have a moral responsibility to share the AIDS burden of developing countries.
Q.	Do people living with HIV/AIDS have special rights or responsibilities?
A.	Since everyone is entitled to fundamental human rights without discrimination, people living with HIV/AIDS have the same rights as seronegative people to education, employment, health, travel, marriage, procreation, privacy, social security, scientific benefits, asylum, etc. Seronegative and seropositive people share responsibility for avoiding HIV infection/re-infection. But many people, including women, children and teenagers, cannot negotiate safe sex because of their low status in society or luck of personal power. Therefore men, whether knowingly infected or unaware of their HIV status, have a special responsibility of not putting others at risk.
Q.	Where did AIDS come from?
A.	AIDS is caused by a virus called HIV, but where this virus came from is not known. However, as new facts are discovered about viruses like HIV, the question of where HIV first came from is becoming more complicated to answer. Moreover, such questions are no longer relevant and do not help in our efforts to combat this epidemic. What is more important is the fact that HIV is present in all countries and we need to determine how best to prevent the further spread of this deadly virus.
Q.	Where was AIDS first found?
A.	AIDS was first recognized in the United States in 1981. However, it is clear that AIDS cases had occurred in several parts of the world before 1981. Evidence now suggests that the AIDS epidemic began at roughly the same time in several parts of the world, including the U.S.A. and Africa.
Q.	But how can there suddenly be a disease that never existed before?
A.	If we look at AIDS as a worldwide pandemic, it appears as if it is something new and rather sudden. But if we look at AIDS as a disease and at the virus that causes it, we get a different picture. We find that both the disease and the virus are not new. They were there well before the epidemic occurred. We know that viruses sometimes change. A virus that was once harmless to humans can change and become harmful. This is probably what happened with HIV long before the AIDS epidemic. What is new is the rapid spread of the virus. It may be compared with a weed that someone brings home from a distant place. In its original environment the weed survives but does not spread much. However, once it takes root in the new environment, conditions may allow it to grow much better that it did before. It spreads, chokes our other plants, and becomes a nuisance. The spread of HIV is somewhat similar. Researches believe that the virus was present in isolated population groups years before the epidemic began. Then the situation changed; people moved more often and traveled more; they settled in big cities; and lifestyles changed, including patterns of sexual behaviour. It became easier for HIV to spread through sexual intercourse and contaminated blood. As the virus spread, the disease which was already in existence became a new epidemic.
Q.	Are women at equal risk of getting infected with HIV?
A.	Women are in fact more at risk of getting infected because of their increased vulnerability. In addition, their low status within the family and society further heighten their vulnerability to infection. It is therefore most important that every woman has access to information about HIV/AIDS to protect herself.
Q.	Does AIDS affect children?
A.	Yes. Children can be both infected and affected by AIDS. Over 2.5 million children worldwide are now infected with HIV. If HIV continues to spread in countries, there will be a great increase in deaths among infants and children. It is also estimated that by the year 2000, 10 million children will have been orphaned as their parents die of AIDS.
Q.	Who should provide care to HIV/AIDS affected persons?
A.	Everyone in contact with an HIV/AIDS person is a potential care provider. In particular, this includes health care workers at various levels of the health care delivery system, social workers and counsellors, and close family members who are important care providers at home. Care basically involves clinical management, nursing care, counseling and social support.
Q.	What role do NGOs play in AIDS control?
A.	NGOs have an important and very special role to play. The close interpersonal interaction that NGOs have with people in the communities they work in is extremely useful for implementing the behavioural interventions necessary for HIV/AIDS prevention and care. NGOs are also not under the same political constraints are government programmes are. They therefore have greater flexibility and the capacity to accommodate changing programmes and public needs and can innovate and implement new initiatives more easily.
Q.	Is it safe to work with someone infected with HIV?
A.	Yes. Most workers face no risk of getting the virus while doing their work. If they have the virus themselves, they are not a risk to others during the course of their work.
Q.	Why are people safe from HIV infection during work?
A.	As explained already, in adults, the virus is mainly transmitted through the transfer of blood or sexual fluids. Since contact with blood or sexual fluids is not part of most people's work, most workers are safe.
Q.	What about every day in close physical contact with an infected person?
A.	There are no risks involved. You may share the same telephone with other people in your office or work side by side in a crowded factory with other HIV infected persons, even share the same cup of tea, but this will not expose you to the risk of contracting the infection. Being in contact with dirt and sweat will also not give you the infection.
Q.	Who is at risk while at work?
A.	Those who are likely to come into contact with blood that contains the virus are at risk. These include health care workers - doctors, dentists, nurses, laboratory technicians, and a few others. Such workers must take special care against possible contact with infected blood, as for example by using gloves.
Q.	If a worker has HIV infection, should he or she be allowed to continue work?
A.	Workers with HIV infection who are still healthy should be treated in the same way as any other workers. Those with AIDS or AIDS-related illnesses should be treated in the same way as any other worker who is ill. Infection with HIV is not a reason in itself for termination of employment.
Q.	Does an employee infected with the virus have to tell the employer about it?
A.	Anyone infected, or though to be infected, must be protected from discrimination by employers, co-workers, unions or clients. Employees should not be required to inform their employer about their infection. If good information and education about AIDS are available to employees, a climate of understanding ay develop in the workplace protecting the rights of the HIV-infected person.
Q.	Should an employer test a worker for HIV?
A.	Testing for HIV should not be required of workers. Imagine that you are a worker with HIV infection and are healthy and able to work. As far as your work is concerned, the information about the infection is private. If it is made public, you could be a target for discrimination. If AIDS-related illness makes you unfit for a particular job, you should be treated in the same way as any other employees with a chronic illness. A suitable alternative job can often be arranged by the employer.
Q.	Should a traveler or tourist be concerned about AIDS?
A.	Travelers should know about HIV and AIDS because AIDS is a reality throughout the world today. Concern about AIDS, however, should not be an obstacle to travel. Avoiding HIV infection depends mainly on each individual. You can easily protect yourself against HIV infection during your travels by knowing and following some simple rules - the same rules which protect you in your home surroundings.
Q.	Can a traveler become HIV-infected just by casual contact in a foreign country?
A.	No. HIV is not transmitted through casual contact or daily routine activities, either at home or in a foreign country. For example, it is not spread by sitting next to someone who is infected, shaking hands, coughing, or sneezing. HIV is not spread by public transportation, public telephones, restaurants, food, cups, glasses, plates, drinking water, air, toilers, swimming pools or insects.
Q.	How can a traveler get infected with HIV?
A.	In the same way he or she may get infected back home. The virus spreads most frequently through sexual activity, from an infected person to his or her sexual partner. It also spreads through contaminated blood - in transfusions, on needles, or on any other skin-piercing instruments.
Q.	How can the sexual spread of HIV be prevented while traveling?
A.	By following the same precautions as one would follow in one's own country, even in countries which claim they have no AIDS problem. You cannot tell by appearance if someone is infected with the virus; he or she can look healthy. You can avoid HIV infection by refraining from sex of by practicing safer sex. Safer sex involves the correct use of a condom throughout each sexual encounter. Men should use a condom each time from start to finish, and women should make sure that their partner uses one. Remember that vaginal and anal sex can spread AIDS. Oral sex also poses a risk. Finally, remember that the fewer sexual partners you have, the lower your risk of exposure to the virus that causes AIDS.
Q.	What if you are already infected with HIV? Can you still travel?
A.	If you are already infected, consult your health care provider for guidance well before you plan to travel. Some immigration officials insist on an HIV free certificate. Your travel counselor will advise you.
Q.	'AIDS is mainly a problem of developing countries'. 'No, AIDS is really a problem of developed countries'. Which of these opinions is more accurate?
A.	Many people would like to claim that AIDS only affects others - other people or other countries. AIDS breaks the patterns that we associate with major diseases, for example linking malaria with the tropics or perhaps heart disease with the industrialized world. AIDS affects both developing and industrialized countries, both cold and hot countries. HIV can spread anywhere where people live and have sex.
Q.	How do AIDS problems in different countries relate to each other?
A.	They are related in at least three ways. First, in every country, AIDS is always spread by a virus transmitted through sexual intercourse and through blood. Specific actions by people are therefore required for it to spread in all countries. Second, AIDS can be stopped in all countries by people changing their sexual behaviour, by screening blood of transfusion, and by sterilizing needles and syringes. Third, the prevention and control of AIDS bring most countries of the world together in joint action. They have the same basic problems to solve. For example, all must test donated blood and everyone must benefit from the availability of simple, reliable and cheap blood tests to detect the virus. Only joint international action can make such tests widely available and affordable. It is to find these common solutions that the WHO Global Programme on AIDS was established in 1987 and now UNAIDS has been established. Many other groups and organizations are involved as well in what is now a broad partnership between many countries.
Q.	How is the AIDS epidemic being handled by countries?
A.	Every country in the world is being encouraged by the World Health Organization and the United Nations to organized a national AIDS programme (NAP). Almost all countries have developed national AIDS programmes in collaboration with WHO and, are already implementing them. The first step in this process is to establish a broadly represented national AIDS committee with responsibility for coordinating the NAP, its plans and implementation. It is vital to find out how far HIV infection has spread in the country and then to monitor the epidemic as well as the impact of AIDS prevention activities continuously. Healthy workers at all levels must be trained to give proper medical care to AIDS patients and accurate information to the public. · to prevent sexual transmission of the disease - through information and education; · to prevent blood transmission of the disease by making blood safe and ensuring that injection equipment and other skin-piercing instruments are always sterile; and · to prevent mother-to-infant spread of the virus. National programmes must also help provide care and social support to those already infected with HIV, including persons with AIDS, as well as to their families. The UN has been asked by the international community to provide the leadership necessary to shape national efforts into one international strategy for the control of AIDS. This includes attention to health as well as to the socioeconomic and ethical aspects of AIDS. Everyone involved is learning by doing and by evaluating what has been done.
Q.	Where do individuals and communities fir in all of these programmes?
A.	This is a challenge in every emergency and in all crisis situations. AIDS programmes are no exception. Individuals and communities have the power, directly or indirectly, to either spread or to stop HIV infection. They are also at the centre of the local, national, and international policies and programmes, and mould the customs and attitudes on which the various AIDS programmes are built. AIDS prevention and care programmes must be changed. People must be helped to protect themselves and others from HIV. Only then will AIDS programmes succeed in preventing the further spread of the virus.