Ans. HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus is passed from one person to another through blood-to-blood and sexual contact. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Most of these people will develop AIDS as a result of their HIV infection.

Ans. AIDS stands for acquired immunodeficiency syndrome. An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC-defined AIDS indicator illnesses. An HIV-positive person who has not had any serious illnesses also can receive an AIDS diagnosis on the basis of certain blood tests (CD4+ counts).

A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria (e.g., AIDS indicator illnesses).

Infection with HIV can weaken the immune system to the point that it has difficulty fighting off certain infections. These types of infections are known as "opportunistic" infections because they take the opportunity a weakened immune system gives to cause illness.

Many of the infections that cause problems or may be life-threatening for people with AIDS are usually controlled by a healthy immune system. The immune system of a person with AIDS is weakened to the point that medical intervention may be necessary to prevent or treat serious illness.

Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative care.

Ans. We do not know. Scientists have different theories about the origin of HIV, but none have been proven. The earliest known case of HIV was from a blood sample collected in 1959 from a man in Kinshasha, Democratic Republic of Congo. (How he became infected is not known.) Genetic analysis of this blood sample suggests that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s.

We do know that the virus has existed in the United States since at least the mid- to late 1970s. From 1979-1981 rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of gay male patients. These were conditions not usually found in people with healthy immune systems.

In 1982 public health officials began to use the term "acquired immunodeficiency syndrome," or AIDS, to describe the occurrences of opportunistic infections, Kaposi's sarcoma, and Pneumocystis carinii pneumonia in previously healthy men. Formal tracking (surveillance) of AIDS cases began that year in the United States.

The cause of AIDS is a virus that scientists isolated in 1983. The virus was at first named HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy- associated virus) by an international scientific committee. This name was later changed to HIV (human immunodeficiency virus).

Ans. HIV destroys a certain kind of blood cells--CD4+ T cells (helper cells)--which are crucial to the normal function of the human immune system. In fact, loss of these cells in people with HIV is an extremely powerful predictor of the development of AIDS. Studies of thousands of people have revealed that most people infected with HIV carry the virus for years before enough damage is done to the immune system for AIDS to develop. However, recently developed sensitive tests have shown a strong connection between the amount of HIV in the blood and the decline in CD4+ T cell numbers and the development of AIDS. Reducing the amount of virus in the body with anti-HIV drugs can slow this immune destruction.

Ans. No, this is not true. Both HHV-6 and HIV infect the same kind of cells in a person's body. These cells are called CD4+ T cells (helper cells). However, AIDS will not develop in someone who is not infected with HIV. Infection with HHV-6 does not lead to infection with HIV. HHV-6, one of the eight known human herpesviruses, is common throughout the world, with over 90% of adults in many populations being infected. Most people are infected with HHV-6 between the ages of 6 months and 2 years old, soon after they lose their mother's antibodies. HHV-6 is the cause of roseola [ro ZEE o la], a usually mild childhood disease that is also called exanthem subitum [eg ZAN them SUBI tum] or sixth disease. Approximately 30% of all children get roseola, usually before 2 years of age.

Ans. The epidemic of HIV and AIDS has attracted much attention both within and outside the medical and scientific communities. Much of this attention comes from the many social issues--homosexuality, drug use, poverty--related to this disease. Although the scientific evidence is overwhelming and compelling that HIV is the cause of AIDS, the disease process is not yet completely understood.. This incomplete understanding has led some persons to make statements that AIDS is not caused by an infectious agent or is caused by a virus that is not HIV. This is not only misleading, but may have dangerous consequences. Before the discovery of HIV, evidence from epidemiologic studies involving tracing of patients' sex partners and cases occurring in persons receiving transfusions of blood or blood clotting products had clearly indicated that the underlying cause of the condition was an infectious agent. Infection with HV has been the sole common factor shared by AIDS cases throughout the world among homosexual men, transfusion recipients, persons with hemophilia, sex partners of infected persons, children born to infected women, and occupationally exposed health care workers. Recommendations to prevent HIV involve guidance to avoid or modify behaviors that pose a risk of transmitting the virus as well as the use of tests to screen donors of blood and organs.

Ans. Since 1992, scientists have estimated that about half the people with HIV develop AIDS within 10 years after becoming infected. This time varies greatly from person to person and can depend on many factors, including a person's health status and their health-related behaviors.

Ans. HIV is transmitted mostly through semen and vaginal fluids during unprotected sex without the use of condoms. Globally, most cases of sexual transnmission 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 or just after delivery.

Ans. According to UNAIDS estimates, by December-2003, nearly 34-46 million people including over 2.5 million children - had been infected with HIV since the start of the epidemic.

Ans. Of the 31-43 million adults with HIV infection - the global estimate in end-2003 - 25-28.2 million were in Sub-Saharan Africa and more than 9.5 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.

Ans. AIDS affects people primarily when they are most productive and leads to premature death thereby severely affecting the socio-economic 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.

Ans. 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.

Ans. 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.

Ans. 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:

Ans. 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 to 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.

Ans. 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 understand how to avoid HIV infection, and learn the importance of tolerant, compassionate and non-discriminatory attitudes towards people living with HIV/AIDS.

Ans. 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.

Ans. Yes. The virus has been found in 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.

Ans. 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.

Ans. 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 property; 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.

Ans. Tattooing, ear piercing, acupuncture and some kinds of dental work all involve instrunwnts that must be sterile to avoid infection. In general, you should refrain from any procedure where the skin is pierced, unless absolutely necessary.

Ans. Tuberculosis kills 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.

Ans. 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 of HIV/AIDS care is being promoted as 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.

Ans. While there is currently no vaccine for HIV/AIDS, research is under way. many 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.

Ans. 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.

Ans. 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.

Ans. 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, lack of personal power. Therefore, men whether knowingly infected or unaware of their HIV status, have a special responsibility of not putting others at risk.

Ans. 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 eftorts 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.

Ans. AIDS was first recognised 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.

Ans. 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.

Ans. 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.

Ans. 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.

Ans. 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.

Ans. 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 usefid for implementing the behavioural interventions necessary for HIV/AIDS prevention and care. NGOs are also not under the same political constraints as 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.

Ans. 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.

Ans. 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.

Ans. 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.

Ans. 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.

Ans. Workers with HIV infection who are still healthy should be treated in the same way as any other worker. 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.

Ans. Anyone infected, or thought 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 may develop in the workplace protecting the rights of the HIV-infected person.

Ans. 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 particidar job, you should be treated in the same way as any other employee with a chronic illness.A suitable alternative job can often be arranged by the employer.The Employers in different parts of the world are beginning to deal with these problems more humanely. Their associations and workers' unions can be consulted for advice.

Ans. Travellers 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 IIIV infection during your travels by knowing and following some simple rules - the same rules which protect you in your home surroundings.

Ans. 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, toilets, swimming pools or insects.

Ans. 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.

Ans. 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 or 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.

Ans. 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 counsellor will advise you.

Ans. Many people would like to claim that AIDS only affects others - other people or other countries. AIDS break 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.

Ans. 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 for 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.

Ans. No. HIV is an unusual virus because a person can be infected with it for many years and yet appear to be perfectly healthy. But the virus gradually multiplies inside the body and eventually destroys the body's ability to fight off illnesses. It is still not certain that everyone with HIV infection will get AIDS. It seems likely that most people with HIV will develop serious problems with their health. But this may be after many years. A person with HIV may not know they are infected but can pass the virus on to other people.

Ans. Oral sex (one person kissing, licking or sucking the sexual areas of another person) does carry some risk of infection. If a person sucks the penis of an infected man, for example, infected fluid could get into the mouth. The virus could then get into the blood if you have bleeding gums or tiny sores somewhere in the mouth. The same is true if infected sexual fluids from a woman get into the mouth of her partner. But infection from oral sex alone seems to be very rare.

Ans. Unlike many diseases, HIV infection and AIDS are preventable. While it can be disturbing to think about AIDS and consider your risk, getting up-to-date information is the first step toward protecting yourself. An estimated 800,000 to 1.2 million people in the United States are infected with the Human Immunodeficiency Virus (HIV). This virus damages cells in the immmune (defense) system that fight off infections and diseases. As the virus gradually destroys these important cells, the immune system becomes less and less able to protect against illness. Typically, HIV lives in an infected person's body for months or years before any signs of illness appear. AIDS stands for Acquired Immune Dificiency Syndrome. AIDS is the last stage of HIV infection. People with AIDS experience certain life-threatening infections and cancers which make them very sick and can eventually kill them.

Ans. Currently there is no way to get rid of all the virus once a person is infected. However, new medicines can slow the damage that HIV causes to the immune system. Also, doctors are getting better at treating the illnesses that are caused by HIV infection. Many people now consider HIV infection a manageable, long-term illness.

Ans. This virus is spread through the blood, semen, and vaginal discharges of an HIV-infected person. People can get HIV infection when they have contact with these fluids. This can happen by engaging in specific sexual and/or drug use practices. Also, HIV-infected women can pass the virus to their newborns during pregnancy and childbirth. Lastly, some people who received blood products before March 1985 got infected blood. Now all donated blood is being screened for HIV. Many people do not know they have this virus and therefore can unknowingly pass it to others. This is because they usually look and feel fine for many years after HIV infection occurs.

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.

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.

Ans. Six Ways To Reduce Risk

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.

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.

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.

Ans. If you've tested positive for HIV, consider the following:

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.

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.

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.

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.

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.

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:

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.

Ans. No. Your HIV test result reveals only your HIV status. Your negative test result does not tell you whether your partner has 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:

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.

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.

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

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.

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

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.

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.

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.

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

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.

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.

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.

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.

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).

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.

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.

using blood-contaminated syringes to prepare drugs reusing water

Ans. The CDC recommends that people who inject drugs should be regularly counseled to

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:

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.

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.

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.

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.

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.

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

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.

There also is no reason to fear that a mosquito or other insect could transmit HIV from one person to another through HIV-infected blood left on its mouth parts. Several reasons help explain why this is so. First, infected people do not have constantly high levels of HIV in their blood streams. Second, insect mouth parts retain only very small amounts of blood on their surfaces. Finally, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Rather, they fly to a resting place to digest the blood meal.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Ans. The condom and the adoption of safe sex behaviour are still the methods that work best to avoid HIV infection, regardless of 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.

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.

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.)

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).

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.

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.

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.

Ans. In order to minimize the selection bias of samples, consecutive sampling procedure is adopted and it is ideally a clinic based approach.

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.

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

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

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.

Ans. According to the Sentinel Surveillance results of 2001, States/UTs can be categorized into three categories.

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.

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.

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.

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.

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).

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.

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.

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.

Ans. The NGO movement is operating at different levels in different States. While some States have a committed group of NGOs the others have few credible NGOs to talk of. States like Bihar, Uttar Pradesh, Jharkhand etc. have a few NGOs and these organizations by and large are not perceived to be credible. The task is challenging and complex. The process is ongoing. Capacity building of NGOs is one activity that is to be done vigourously. The State Governments are also expected to provide an environment that builds trust between the Govt. and the civil society and ensures long term partnerships.

Ans. VCTC stands for Voluntary Counseling and Testing Center

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.

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.

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.

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

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.

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

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.

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.

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:

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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. Care and Support

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.

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.

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.

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.

Ans. The Common opportunistic infections encountered by HIV/AIDS patients are:

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.

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.

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.

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.

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.

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.

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. Sexually Transmitted Infections

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.

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

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.

Prevention of Mother to Child Transmission (PMTCT)

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.

Prevention of Mother to Child Transmission (PMTCT)

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.

Prevention of Mother to Child Transmission (PMTCT)

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.

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. Antiretroviral Therapy

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.

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. Clinton Foundation

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.

Ans. A memorandum of understanding has been signed between government of India, NACO, ICMR and the IAVI to develop HIV vaccine relevant to the HIV -1 c subtype most prevalent in our country. This is a modified Vaccinia Ankara version developed jointly between Indian Scientists and Therion Biologics USA. The candidate vaccine has been developed an is currently undergoing pre-clinical safety trial. After successful completion of these trials the Phase I clinical trials will be started in India. Research is also on at the Tuberculosis Research Centre, Chennai and the All India Institute of Medical Sciences with technical assistance from department of Bio-technology, Government of India. But these are at the initial stages of development.

Ans. The Govt. policy has been that condoms are an effective protective measure to prevent the spread of HIV. Govt. believes that it is necessary to be focused in the promotion of condoms since a large number of infections occur through unsafe sex. With the general population the dual use of condoms for contraception and disease prevention is emphasized by both National AIDS program& Reproductive &Child Health program. For the high risk groups, targeted social marketing and free distribution of condoms is being promoted through NGOs.

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

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.

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.

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.

Ans. Govt. of India has brought paradigm shift in IEC strategy by making it more holistic and giving equal importance to all four routes of transmission. Emphasis is placed on the ABC approach to AIDS prevention. A - Abstinence translates to efforts to delay sexual initiation among young people; B - Be faithful focuses on remaining faithful after marriage; and C = Condom use promotes safer sex practices and condom use among people who are sexually active. The ABC approach is widely accepted as a model to approach adolescents and young adults where HIV infection has been spreading most rapidly, as the approach is not only flexible but also comprehensive.