300 million Indians live below the poverty line and 800 million earn less than $2 a day. About 70 percent of the population is rural, depending upon agriculture and forests for their livelihood. At the same time, India is rapidly urbanizing; by 2020, an estimated 40 percent of Indians will live in cities. Across India, over 90 percent of the workforce is employed in the informal sector, which excludes corporations and the government, and these workers do not have access to legal minimum wages, social security, and decent work conditions Recent figures of HIV/AIDS infections among adults and children in India are estimated at 5.1 million. India has the second largest HIV positive population after South Africa. Without appropriate action and given the risk factors in India (see box below), some predict the infection levels will rise as high as 20 to 25 million by 2010, or equal to the combined population of London, New York and Tokyo. This is the time to act!
On World AIDS Day 2005 both President Bill Clinton and Prime Minister Manmohan Singh addressed these immediate needs. President Clinton said, “when one takes into account the current HIV/AIDS crisis in Africa and the Caribbean, combined with the potential explosion of infections in China, India and eastern Europe and the fact that AIDS kills 8,500 people every day, we must redouble our efforts to reverse the tide.”
Prime Minister Singh reiterated his 2004 message to the nation’s youth:
• “lead by example and lead from the front… be the agent of change that you seek in others"
• “inform your friends and empower them to make safe choices. Act locally to create a global impact!”
• “promise to uphold the dignity of every person living with HIV in our country by love, affection, and social support.”
Facts & Stats - FAQs
1. What is HIV?
HIV stands for 'human immunodeficiency virus'. HIV is a retrovirus that infects cells of the human immune system (mainly CD4 positive T cells and macrophages—key components of the cellular immune system), and destroys or impairs their function. Infection with this virus results in the progressive depletion of the immune system, leading to 'immune deficiency'. The immune system is considered deficient when it can no longer fulfill its role of fighting off infection and diseases. Immunodeficient people are much more vulnerable to a wide range of infections, most of which are very rare among people without immune deficiency. Diseases associated with severe immunodeficiency are known as 'opportunistic infections', because they take advantage of a weakened immune system.
The immune system is considered deficient when it can no longer fulfill its role of fighting off infection and diseases. Immunodeficient people are much more vulnerable to a wide range of infections, most of which are very rare among people without immune deficiency. Diseases associated with severe immunodeficiency are known as 'opportunistic infections', because they take advantage of a weakened immune system.
2. What is AIDS?
AIDS stands for 'acquired immunodeficiency syndrome' and describes the collection of symptoms and infections associated with acquired deficiency of the immune system. Infection with HIV has been established as the underlying cause of AIDS. The level of HIV in the body and the appearance of certain infections are used as indicators that HIV infection has progressed to AIDS (see Question 4).
3. What are the symptoms of HIV?
Most people infected with HIV do not know that they have become infected, because no symptoms develop immediately after the initial infection. Some people have a glandular fever-like illness (with fever, rash, joint pains and enlarged lymph nodes), which can occur at the time of seroconversion. Seroconversion refers to the development of antibodies to HIV and usually takes place between 6 weeks and 3 months after an infection has occurred (see Question 32).
Despite the fact that HIV infection does not cause any initial symptoms, an HIV-infected person is highly infectious and can transmit the virus to another person (see Question 7). The only way to determine whether HIV is present in a person's body is by taking an HIV test (see Question 31). HIV infection causes a gradual depletion and weakening of the immune system. This results in an increased susceptibility of the body to infections and can lead to the development of AIDS (see Question 2 and Question 4).
4. When does a person have AIDS?
The term AIDS applies to the most advanced stages of HIV infection. The majority of people infected with HIV, if not treated, develop signs of AIDS within 8-10 years. AIDS is identified on the basis of certain infections, grouped by the World Health Organization:
· Stage 1 HIV disease is a symptomatic and not categorized as AIDS
· Stage II (includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections)
· Stage III (includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis)
· Stage IV (includes Toxoplasmosis of the brain, Candidiasis of the oesophagus, trachea, bronchi or lungs and Kaposi's Sarcoma) HIV disease are used as indicators of AIDS.
Most of these conditions are opportunistic infections that can be treated easily in healthy people.
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5. How quickly do people infected with HIV develop AIDS?
The length of time can vary widely between individuals. With a healthy lifestyle, the time between infection with HIV and becoming ill with AIDS can be 10–15 years, sometimes longer. Antiretroviral therapy can slow down the progression of AIDS by decreasing viral load in an infected body (see Question 26 and Part 3, Section 12 of Q&A).
6. How can HIV be transmitted?
HIV is transmitted through penetrative (anal or vaginal) and oral sex; blood transfusion; the sharing of contaminated needles in health care settings and through drug injection; and, between mother and infant, during pregnancy, childbirth and breastfeeding.
Sexual transmission
HIV can be transmitted through unprotected penetrative sex. It is difficult to calculate the odds of becoming infected through sexual intercourse, however it is known that the risk of infection through vaginal sex is high. Transmission through anal sex has been reported to be 10 times higher than by vaginal sex. A person with an untreated sexually transmitted infection (STI), particularly involving ulcers or discharge, is, on average, 6-10 times more likely to pass on or acquire HIV during sex.
*Oral sex is regarded as a low-risk sexual activity in terms of HIV transmission. Risk can increase if there are cuts or sores around or in the mouth and if ejaculation occurs in the mouth.
Transmission through sharing of needles and syringes
Re-using or sharing needles or syringes represents a highly efficient way of transmitting HIV. The risk of transmission can be lowered substantially among injecting drug users by using new needles and syringes that are disposable or by properly sterilizing reusable needles/syringes before reuse (see Question 19). Transmission in a health-care setting can be lowered by health-care workers adhering to Universal Precautions (see Question 21).
Mother-to-child transmission (MTCT)
HIV can be transmitted to an infant during pregnancy, labor, delivery and breastfeeding. Generally, there is a 15–30% risk of transmission from mother to child before and during delivery. A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Transmission from mother to child after birth can also occur through breastfeeding (see Question 20).
Transmission through blood transfusion
There is a high risk (greater than 90%) of acquiring HIV through transfusion of infected blood and blood products. However, the implementation of blood safety standards ensures the provision of safe, adequate and good-quality blood and blood products for all patients requiring transfusion. Blood safety includes screening of all donated blood for HIV and other blood-borne pathogens, as well as appropriate donor selection.
7. How would I know if any of the people I meet everyday is HIV infected?
You cannot. Individuals may identify their HIV status only by doing an HIV test.
8. Is there any treatment for HIV/AIDS?
Almost all opportunistic infections a person with AIDS develops can be treated with appropriate drugs. Egg. TB, thrush, diarrhea, pneumonia can all be treated. When it comes to treatment of HIV itself, there are many antiretroviral drugs available. To ensure effective treatment ARTs should be prescribed and administered only by licensed medical practitioners.
9. What can I do to protect myself against getting the HIV infection?
There is a lot you can do to keep yourself protected from getting the HIV infection:
· Learn the facts about HIV and AIDS.
· Assess your own risk behaviors (unsafe sex, sharing needles, etc.)
· Postpone, as much as possible, sex until marriage, or else practice safe or safer sex.
· If you are sexually active be faithful to your partner
· Use condoms
· Do not feel shy to talk about your doubts and fears. Get these clarified.
· Verify that any blood product you receive has been screened for HIV.
· Verify that any needles/ syringes or invasive equipment being used on you is sterile.
· If you are going for procedures such as tattooing, ear piercing, or acupuncture, verify that the equipment to be used on you is sterile.
· Avoid alcohol and drugs as they affect your judgment, and can induce you to take risks you would not otherwise take, like having unsafe sex, sharing needles, or driving rashly.
· Do not let peer pressure force you into unsafe activities
10. What is the role of HIV/AIDS awareness programs in preventing the spread of HIV/AIDS?
The objective of AIDS awareness programs is to create awareness about the problem, to give accurate and reliable information about HIV/AIDS, to clear existing myths and misconceptions, and to provide practical skills that can be implemented at the individual's level so as to lead to behavior change that minimize the risk of HIV infection.
11. How safe are condoms in the prevention of HIV infection?
Condoms make sex safer when used properly but they are not 100 percent safe. Safety factors to check on when buying and using condoms are,
· Expiry date of the condom - do not use one which has expired.
· Storage - condoms should be kept away from the heat (for example, from car glove compartments, direct sunlight), and pressure (for example, sitting on a wallet containing condoms).
· Making sure that sharp objects do not tear a condom during use.
· Making sure that the air is expelled from the teat of the condom while wearing, so as to prevent it from bursting during intercourse
12. Does the use of a condom reduce sexual pleasure?
Condoms do not reduce sexual pleasure, as sexual pleasure is a perceived pleasure. Psychologically, some people perceive a loss of pleasure when using a condom. Whereas, ribbed condoms, for example, are known to increase sexual pleasure.
13. Do contraceptives like 'Today', diaphragm, and the pill protect a woman from getting the HIV infection?
No, they do not. These contraceptives only prevent a woman from getting pregnant but do not prevent the potentially infected semen from coming into contact with the lining of the vagina or cervix. If the HIV or organisms causing STD are present in the semen, they can still get into a woman's body and infect her.
13. What are the different tests to detect HIV?
There are a number of tests to detect the HIV. Blood tests are done to look for specific antibodies produced by the HIV. These include,
· Screening tests: ELISA (Enzyme Linked Immunosorbent Assay - the most commonly followed procedure).
· Spot test or Rapid Test These may give false positive results and hence should be confirmed.
· Confirmatory Tests: Western Blot, the most commonly used procedure.
There are other tests that are done to detect the virus or its protein or genetic material. These are however, expensive, complicated or may take long and hence, are used only for research and academic purposes.
14. Why are consent and confidentiality important during voluntary testing?
HIV positive persons are discriminated against by family, friends, neighbors, colleagues, employers, and the society in general. Unless an individual is assured confidentiality, s/he will not come forward for testing for fear of such discrimination and stigma. Testing for HIV without consent violates human rights and should not be done. Only consented testing with pre- and post-test counseling should be encouraged.
15. How can I know the HIV status of the person I am going to marry?
Marriages are based on mutual trust. It is important that any concerns about HIV are communicated to the prospective spouse in a sensitive and sensible manner. The HIV status of a person cannot be determined without a HIV test. A fully informed voluntary consent is a pre-requisite before a HIV test can be performed on someone. Please be prepared to likewise undergo a test should your prospective spouse so requests. In some states of USA, HIV and VDRL testing are mandated by law as pre-requisite to marriage registration. In India, there is no such law.
16. What is ‘window period’?
The common test for HIV is screening blood for antibodies. The antibodies take 2 to 24 weeks to appear in blood. This is known as the ‘window period.’ During this period, an infected individual is infective, but the HIV tests for antibodies are negative. Hence, to be sure, the test should be repeated again 6 months after the last contact or exposure to HIV.
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Facts & Stats
India is at high risk of a full-blown AIDS epidemic because:
· Considerable portions of the Indian population live in poverty (over 35% of Indians earn less than $1 per day)
· Large numbers of vulnerable groups, including women, sex workers, truck drivers, and intravenous drug users.
· Low levels of literacy (48% of women, 73% of men)
· Significant rural to urban and intrastate migration of male populations
· Culture based stigma related to sex and sexuality, and severe discrimination against HIV+