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

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

When the CD4 cell count is 350cells/cu.mm or below, the person has to be started on Anti-Retroviral Therapy (ART). The person can still lead a healthy life for many years. This treatment is for a lifetime and has to be taken under the guidance of a doctor experienced in the management of HIV/AIDS. Nowadays, it is advocated that patients be started on treatment even if CD4 counts are 500cell/cu.mm or less. /mm 

There are several theories regarding the origin of HIV/AIDS. It is possible that HIV has been around for centuries and may have evolved into a virulent virus only recently. The most likely origin of HIV is that it came from the green African monkey or chimpanzee in whose body the virus existed without causing infection. The infection was transmitted to humankind through possible blood to blood contact and underwent mutation to take its present form. 

HIV/AIDS is transmitted by:

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

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

HIV/AIDS doesn’t spread by mosquito bites. Epidemiologically, the incidence of HIV infection is the highest among the sexually active age group of 15 years to 49 years. However, mosquitoes bite persons of all age groups, and if they were a means of spreading HIV, the incidence of infection would be uniformly high among all age groups. 

HIV or the Human Immunodeficiency Virus is a virus that can survive only inside the body of a human being. HIV does not survive or replicate inside the stomach or intestine of the mosquito, which is another reason to believe that mosquitoes cannot spread HIV. 

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

In the hospital setting, if someone gets pricked with a needle on which HIV infected blood is present, they may be given antiretrovirals for one month to prevent HIV infection. 

 Any kind of unprotected sexual activity (without condom – anal, vaginal or oral sex) that involves direct contact with or exchange of body fluids such as sexual fluids (pre-ejaculatory fluid, semen/seminal fluid, vaginal fluid), blood and menstrual blood can lead to HIV infection if one of the partners is infected with HIV. 

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

Unprotected anal penetrative activity is a high risk for the spread of HIV because condoms tear more easily during anal intercourse unless they are well lubricated. A well-lubricated condom used correctly and consistently, from the time of penetration until the end of the act, provides protection against HIV/AIDS and other Sexually Transmitted Infections (STIs). 

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

1. Penis to mouth 

2. Vagina to mouth 

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

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

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

Oral sex can be safe if there is no direct contact with potentially infected body fluids, i.e., semen, seminal fluid, vaginal fluid, blood, or pus. Condom when used correctly and consistently during oral sexual activity reduces the risk of transmission of HIV infection (penis to mouth contact). 

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

In the AIDS phase, the person’s immune system becomes weak and as a result they develop other infections or show the symptoms of AIDS such as white curd-like mouth ulcers, loss of weight, fever on and off, loose motions for more than a month, different kinds of pneumonia, tuberculosis affecting many parts of the body or brain infections. 

The AIDS phase is the last stage of HIV. Even if a person is in the AIDS phase, by taking antiretroviral therapy for HIV/AIDS, one can live a healthy productive life for a long time, but the medicines have to be taken regularly under the supervision of a qualified medical doctor. 

A person with HIV infection can live a normal and healthy life for a long time, about 8-10 years without showing any signs or symptoms that he/ she is positive. 

AIDS is the last stage of HIV infection where a person starts showing symptoms (i.e., has symptoms and signs of superadded or opportunistic infections). 

Now treatment is available for keeping HIV/AIDS under control in allopathy. When these medicines are taken under the supervision of a doctor, a HIV infected person can live a healthy, productive life for a longer time. 

Yes, a HIV positive woman can have children. A pregnant HIV positive woman has a 60% chance of delivering a HIV negative child even with no medical intervention. But there is a 40% chance of her delivering an HIV positive child without medical intervention. This can now be reduced to less than 5% if the mother is detected to be HIV positive early in the pregnancy and is started on medications to prevent the transmission of HIV infection.This treatment has to be taken during pregnancy, delivery/ labour and while breastfeeding the baby. All the medications for the mother have to be taken under medical supervision only. 

As a general procedure, every pregnant mother has to undergo certain blood tests in the first three months of her pregnancy as advised by her doctor.HIV is one of the tests that the doctor would recommend. The mother is adequately counseled about the test and the test procedure. If the test is confirmed to be HIV positive then, she/her family members are counseled about the importance of preventing the transmission of infection to the baby. 

The prevention of the transmission of Infection happens during three stages in her pregnancy. 

Stage 1: Pregnancy 

The mother is adequately counseled and started on medications after she completes 12-14 weeks of her pregnancy. The duration of her medication depends on her CD4 counts. During this period she needs to follow-up with an HIV/AIDS specialist doctor and should be adherent to medical advice. 

Stage 2: Labour/Delivery: 

The treating doctor decides the mode of delivery (Normal Vaginal Delivery or Elective Cesarean) with the consent of the patient/parents/spouse, and the parents/spouse are also counseled regarding the mode of delivery. It is mandatory for the mother to deliver in the hospital and not at home. During this time, the mother needs to continue her medications. 

Stage 3: Exclusive Breastfeeding (EBF) / Exclusive Replacement Feeding(ERF) 

The mother has to maintain hygiene for herself and her baby while breastfeeding. Breastfeeding should be initiated within an hour of delivery. Exclusive breast feeding should be given to the baby for the first six months. Since the mother is on ART, the risk of transmission through breast feeding is negligible. 

Replacement feeding is only indicated in case of maternal death, severe maternal illness or if the mother has made an individual choice to opt for Exclusive Replacement Feeding provided she can afford it and AFASS(Available, Feasible, Acceptable, Sustainable and Safe) criteria are met. 

 Yes, it is safe to breastfeed the baby provided the mother is on ART. If the mother decides to breastfeed the baby, then the baby should be started on breast milk within an hour of delivery. Exclusive breastfeeding should be continued till 6 months of age for the baby, and at 6 months of age complimentary feeds should be introduced along with continuation of breast feeds till 1 year of age. During this period the mother continues to remain on medications and is advised to be regular with her and the baby’s follow-up. 

In HIV-related situations, mixed feeding (Breast milk+ artificial formula or any other food) for the baby is not recommended and can be fatal to the baby’s health. This is because, formula feeding can inflame the throat passage. Since the breast milk contains the Virus, the Virus can be easily absorbed through the inflamed areas and the baby is at a high risk of getting infected with HIV. 

After birth, the baby is given Nevirapine syrup at birth till 6 weeks of age. At 6 weeks, Nevirapine syrup is stopped and the baby is started on Septran syrup from 6 weeks of age till the baby completes 18 months of age. 

Immunization for the infant will be given as per the immunization schedule 

The first HIV test for the baby is done at 6 weeks through the DNA-PCR method. If the baby is tested to be negative or non-reactive, then the baby is tested at 6 months, 12 months and 18 months through an HIV Antibody test in case of breastfeeding. 

In case the baby is on artificial formula feeding, the first test is done at 6 weeks through DNA-PCR method and finally at the end of 15 months, an antibody blood test is done to confirm the HIV status of the baby. 

At 6 weeks, if the baby is tested to be HIV positive or reactive through DNA-PCR then, we repeat the DNA-PCR immediately to reconfirm the result. If the second test is confirmed to be HIV positive then, the baby is referred to a HIV/AIDS Pediatrician for medical care and support. 

The following need a HIV test:

• Any person who has had unprotected penetrative anal, vaginal or oral sex, pre-maritally or extra-maritally, or
• Any person who has had multiple sexual partners, or
• Any person who has had a blood transfusion where HIV testing on the blood is doubtful or not known, or
• Any person who has used intravenous drugs and has shared needles, or
• Any person who has had a partner with multiple sexual relationships or intravenous drug abuse, or
• Any person who has a partner known to be HIV positive, or
• Any person who has recurrent episodes of illness or fever of unknown cause, and
• Any pregnant woman, who can take measures to prevent her child from getting HIV infection if she knows her HIV status.
• The HIV test is done at three months, six months and one year after any of the above risks for HIV infection. In the event that a person has had multiple risks for HIV, it is advisable to undergo HIV counseling with a HIV test immediately, and to repeat the test after 3 months from the last exposure. If the test is negative or non-reactive for HIV, then the person is recommended to abstain from any kind of sexual contact or exposure to HIV, till his / her HIV status is confirmed through follow-up tests for HIV. 

HIV testing can be done at any good laboratory, or in nursing homes, private hospitals, government hospitals, and district hospitals or in some NGOs like ASHA Foundation. 

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

Presently, free Antiretroviral Treatment is available at selected District Government Hospitals in each State or through Link ART Centers. The State-Wise list of ART centers is available on the NACO website 

(www.nacoonline.org). 

Yes, HIV/ AIDS can be prevented and this can be done by adopting the following measures:

• Knowledge & awareness
• Abstinence before marriage
• Being faithful within marriage
• Correct and consistent condom use
• Safe blood transfusion
• Sterile injection procedures
• Sterile surgical procedures
• Safe dental care.
• Precautions while tattooing, shaving & body piercing
• Abstinence from alcohol/drugs
• Prevention from mother to child transmission

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

Self masturbation does not cause harm to one’s sex life. It does not decrease a person’s sexual desires, nor does it cause any Sexually Transmitted Infection or HIV/AIDS. It does not weaken one’s health, neither does it bring down the sperm count. 

Masturbation brings down a person’s sexual tension, but when a person masturbates often, it may hamper the person’s daily activities. The thought of masturbation often lingers in the mind and the person prefers privacy. This may hamper communication and interaction between family members and friends and affect the individual’s concentration on studies or day to day activities. 

The habit of excessive masturbation can be brought down by diverting one’s mind from it by developing healthy hobbies such as playing energetic outdoor games, jogging, going for long walks, reading good books, etc. One can develop any hobby according to one’s interest, as long as they can divert their mind from the thought of masturbating often.

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

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

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

Precautions to be taken before using a condom:

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

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

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

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

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

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

A HIV positive person can get married provided he/she informs their HIV positive status to the future partner, and the partner is still willing to marry him/her knowing all the facts. The partners should be counseled by the counselor or doctor and then only it is advisable to proceed. 

Post-Exposure Prophylaxis (PEP) involves taking anti-HIV medications as soon as possible after you may have been exposed to HIV to try to reduce the chance of becoming HIV positive. These medications keep HIV from making copies of itself and spreading through your body. 

There are two types of PEP: 

(1) Occupational PEP (sometimes called “PEP”), taken when someone working in a healthcare setting is potentially exposed to material infected with HIV. 

(2) Non-occupational PEP (sometimes called “PEP”), taken when someone is potentially exposed to HIV outside the workplace (e.g., from sexual assault, or during episodes of unprotected sex or needle-sharing injection drug use). 

To be effective, PEP must begin within 72 hours of exposure, before the virus has time to make too many copies of itself in the body. PEP consists of ART medications and should be taken for 28 days. The doctor will determine what treatment is right based on HIV exposure history. PEP is safe but may cause side effects like nausea in some people. These side effects can be treated and are not life threatening. PEP is not 100% effective; it does not guarantee that someone exposed to HIV will not become infected with HIV. 

A HIV test is done soon after the exposure, the person will be asked to return for more HIV testing at 4 to 6 weeks, 3 months, and 6 months after the potential exposure to HIV. 

No. There are many Sexually Transmitted Infections other than HIV. If one has had any kind of sexual exposure, and has reason to believe that they are at risk of contracting a STI, it is recommended that the person consults a Sexologist/Venereal Disease specialist for counseling, testing and treatment.