Saturday, 23 October 2010

Readers' queries relating to HIV/AIDS will be answered in this section by a special panel of experts including

vinay kunkarniVinay Kulkarni, a physician specialising in treatment related to HIV/AIDS. He is associated with Prayas Health, a care and support organisation in Pune

padma govindan Eldred Tellis is director of the Sankalp Rehabilitation Trust, Mumbai, and a member of NACO’s Technical Resource Group for programmes related to injecting drug users. He has worked extensively in various parts of India and Asia developing and replicating programmes for IDUs

padma govindan Padma Govindan, founder and co-director of the Shakti Centre, a sexuality advocacy and research non-profit organisation in Chennai

magdalene jeyarathnam Magdalene Jeyarathnam, founder-director, Center for Counselling, Chennai

Click here to send any queries you may have

A technician came to my house to take a blood sample for testing. He didn't wear gloves. When he finished taking blood, he recapped the needle and removed the vial containing the blood sample. He put the capped needles in the briefcase next to the other materials.

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I told him he should ask the company for gloves to wear for his own protection. I also told him he should not recap needles because there is a chance of pricking himself. He said that the company provided gloves but gloves reduced sensitivity and prevented him from finding the vein to put the needle in. He also said that the he had to recap the needle in order to detach the vial.

Is he right? Is it safe to take blood without wearing gloves? Is it possible to find the vein while wearing gloves? Is it not possible to detach the vial without recapping the syringe?

This is not a question of 'right or wrong'. It is about being safe. As a principle it would be safer to use gloves while dealing with needles and blood. But if the source case has no infection there is no need for it to be mandatory. Remember there is little risk of exposure when taking blood samples unless there is any abnormal violent movement by the patient or the technician or others in the room.  

Finding veins with gloves on is a matter of practice and should be encouraged.  

If the needle fitting is lure lock type, it may be sometimes difficult to remove the needle but, still, recapping is not the only solution for that. Statistically, the maximum numbers of injuries occur while recapping, so I would advise avoiding the same.  

One may argue that if done properly taking samples without gloves and recapping the needle are safe so long as no accident happens. But we must remember that accidents occur ‘accidentally’, that is why they are called accidents. So it would be advisable to take precautions.

--- Vinay Kulkarni


I want some information about what to do when it comes to first aid on a child after a hypodermic needle injury. The child is undergoing tests and a course of injections for the injury.

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The protocol for all hypodermic needle injuries is essentially the same. 

Wash the wound with soap and water (in running water). Do not squeeze or suck the wound. Allow the blood to flow naturally if at all there is bleeding. Apply alcohol at the site of the wound. 

Find out if the person on whom the hypodermic needle was used before it was used on the child is HIV-positive or not. If not, then there are little chances of the child being infected. If the person is infected or is very highly likely to be infected (as per symptoms/risk behaviour) then consider post exposure prophylaxis (PEP) of the child. 

The next step is to ascertain the serostatus of the child. This is to exclude already existent infection. If the test is 'positive' that means the child is already infected and needs no PEP. If the tests are negative then:

  • Assess the degree of exposure (was the needle hollow or solid bore used for intravenous purpose, how deep was the wound, how much time elapsed between contact with source case and injury to the child etc).
  • In case of exposure with mild to moderate risk start PEP (routine).
  • In case of severe risk from exposure use extended regimen of PEP. PEP should be administered under medical supervision and after expert advice.
  • Test the child to rule out infection at the end of the ‘window’ period (this is the period of time between a person being infected and the disease showing up in tests)

-- Vinay Kulkarni


Thanks for the advice you gave me earlier. I met a doctor in Hyderabad and he prescribed me Duovir for 28 days. I started the drug within 50 hours of the incident. I am currently taking Duovir and it’s been only 10 days. Because of the drug I have severe acidity even after taking antacids.

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Should I continue with this drug? With the current acidity problem I don’t think I will be able to complete the prescribed course. I have skipped the drug for one day on the eighth day to get relief from the acidity problem. I have got DNA PCR and Elisa test done for HIV and both were negative. Please advise me again now that I am taking the drug and have got the tests done. What are the next steps? I have moved from Hyderabad to my hometown Delhi, where I do not want to visit any doctor.

Please refer to my first reply. As I had said, in my opinion you did not need the medicines in the first place. Secondly, you started them late enough for them not to be very effective. Thirdly you are having severe side effects. You may stop the medication. 

As I wrote previously there is no role for DNA PCR/ELISA at this stage except to prove that you were not already infected when the incident occurred.  

To rule out infection please repeat the ELISA after 12 weeks (minimum) of the incident and then forget about it if the test is negative. Seek medical care if it is positive. Follow the instructions I wrote last time.

--Vinay Kulkarni 


I met a girl in a pub and had sex with her. During intercourse I felt there was something wrong. I found that the condom I was using had burst. I did not ejaculate. What should I do now (it’s been 12 hours) to take immediate action to prevent HIV?

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This is a relatively common issue and thus needs specific detailed answer. It also hints at some misconceptions. 

Generally post-exposure prophylaxis (preventive treatment) is indicated only when the source is known to be HIV infected. So, it is definitely indicated for professional exposures (such as healthcare providers getting exposed to HIV through, say, needle stick injuries when source is known to be HIV infected, or has very high chances of being infected).  

In non-professional sexual exposures like yours, post-exposure prophylaxis is not indicated though there is a fair chance that the casual partner you had sex with could be infected. But you will not know this unless you test and even if the result is negative this could be because you are in the ‘window period’ when the virus does not show up.  

Why is this? Because (1) The status of infection of the source case is not known.

(2) Even a burst condom is going to provide some protection (3) Chances of sexual transmission of HIV when the skin of the penis is not ulcerated or inflamed due to other sexually transmitted infections is relatively very low (say around 1%) even during contacts with a known infected person (4) By now enough time has passed to take any effective prophylaxis (5) Anti-retroviral medicines are potentially toxic drugs and should not to be taken lightly. 

So what can you do now?

  • Do not panic.
  • Get yourself tested after the window period is over (at least 12 weeks). At that time also go in for routine tests. There is no need for doing fancy tests such as p24 antigen, DNA PCR or Western blot. If these tests are done early and if they indicate that you are infected (this also needs to be confirmed), then they have some meaning. However, negative results do not rule out infection. So wait till the window period is over.
  • Do not have unprotected sex with anybody till you find out that you are not infected.

What precautions should you take next time?

  • Condoms break/blast usually for two reasons: they not used properly or are not properly lubricated. Learn to use condoms properly; pay attention to pinching the tip before unrolling on the erect penis.
  • Even if you know how to use a condom properly alcohol and desire to have sex is a deadly combination. You may make mistakes under the influence of alcohol. Avoid it.

Some misconceptions

  • Chances of your infection have nothing to do with you ejaculating or not.

So steps to be taken now:

  • Safe sex till you know that you are not infected.
  • Get tested after 3 months
  • Take care during future encounters.

--Vinay Kulkarni


My father is suffering from HIV/AIDS. He is the family’s only source of income and we are finding it difficult to continue his treatment. Please help us by providing information on free treatment

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Anti-retroviral treatment (ART) is available free of cost, at all government-run ART centres. The cost you mention is perhaps money needed for food, transportation to the ART centre etc. Other people living with HIV/AIDS mostly seek the services of non-government organisations or philanthropists who are willing to give a little money for the extra support. 

Getting in touch with INP+ or positive networks in Belgaum where you live will be useful to you as a family, because they may be giving this support or know of persons who are giving this support. 

More importantly there are many, many people who are able to go to work and lead absolutely productive and qualitative lives because they are taking ART. Which means it is necessary for your father to also take ART if you as a family wish him to continue to work and support you. 

- Magdalene Jeyarathnam


Can I get HIV infection from oral sex in any way if I have not used a condom? Supposing saliva, sweat or fluid has entered, what is the possibility of contracting HIV?

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The four fluids that can carry HIV are: semen and pre-ejaculate fluid, blood, vaginal secretions, and breast milk, and the virus can only be transferred when these four fluids come in contact with each other.  

Saliva does not carry HIV, so ordinarily the virus can’t be transferred from an HIV-positive person to an HIV-negative person through oral sex. However, if the person performing oral sex is HIV-positive, has a cut or sore on the inside or around the mouth, and blood from the cut comes in contact with semen or vaginal fluids, then he or she can transfer the virus to the receiving partner.  

Oral sex is not considered a “high-risk” sexual behaviour for HIV-positive people to engage in, but it’s not risk-free, either. My advice: use a condom or dental dam. When used correctly, barriers are one of the most effective ways of preventing sexually transmitted diseases and infections. It’s better to be safe than sorry. (That goes for all people engaging in any sexual behaviour—straight or gay, HIV-positive or HIV-negative.) 

--Padma Govindan 


Is washing a syringe with water good enough to get rid of HIV?

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No, water is not good enough; bleach solution is the best cleaning agent. To clean needles and syringe with bleach, first flush three times with clean water and then three times with bleach, each time leaving it in the syringe for 30 seconds. Then flush three times again with water. Yet I must admit that even this is not 100% safe.

-- Eldred Tellis 


How many people got HIV in 2008-2009 in Gujarat, India? What is the easy way to get ART?

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The questions are a bit difficult to answer.

Only estimates would be available on how many people got HIV in Gujarat in 2008-2009, and some data from the National Aids Control Organisation (NACO) website (www.nacoonline.org), but they are all estimates. To get precise figures, each person who got infected would have to be tested and then counted. So this statistic is difficult to come by. Also, the best people to provide even the estimates would be the Gujarat State AIDS Society (0/1 Block, New Mental Hospital Complex, Menghaninagar, Ahmedabad-380 016. Tel: 22685210/22680211-13. email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it and This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

The best place to get free ART is a government ART centre. Get registered and, if eligible, you would be put on ART as per the national guidelines. (for ART centres in India see: http://www.nacoonline.org/Living_with_HIVAIDS/Download_ART/)

You could also locate a good HIV physician (both scientific and humane) in your part of the country and approach him/her for treatment. ART medications are freely available almost throughout the country now and the costs also have come down drastically.

---Dr Vinay Kulkarni


I am 41 years old and living with HIV/AIDS since 2003. I am taking ART since two years. My family knows about my HIV status. My earning source is only tailoring work. After drinking, my brother fights with me and discloses my HIV status to the community and my customers. He is always making fun of me to the community. I have refused many times for my HIV identity to be disclosed and shared with the community. But he doesn’t listen and his wife also hurts me. Because of disclosure of my HIV status my customers go away. So I live with tension and HIV.

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Please tell me what I can do for betterment of my condition and to prevent my brother from disclosing my HIV status. 

Looks like your brother and his wife have taken over your right to decide to disclose your HIV status. Remember deciding who you wish to tell and how much you wish to tell is your right.

Have you tried a quiet talk with your brother? Quiet is the key here.

If not, you could try talking to him or get someone he respects a lot to talk to him - like a doctor, religious/community head.

If nothing works is it possible for you to live away from him? I am suggesting this because your brother seems to be more vicious when he is drunk.

Stigma and discrimination is still a huge issue to many people living with HIV. Please do identify some networks of HIV-positive people so you have other people from your community you could talk to.

--Magdalene Jeyarathnam


Why are gay men and transgender women considered more “at risk” than other people? Does being gay automatically mean you’re more at risk for HIV?

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The transmission of HIV occurs through sexual practices, not through sexual orientation or gender identity. No one person is inherently more at risk for HIV than anyone else—gay and transgender people are not born with an increased vulnerability to contracting HIV or any other STD. A monogamous gay couple that uses condoms consistently is far less likely to contract HIV than a straight person with multiple partners who doesn’t practice safe sex. Gay men and transgender women have been identified as being at a greater risk for contracting the virus for a variety of reasons that I’ll go into more detail about below, but it’s very important to remember that stigmatising them on the basis of their risk of becoming HIV-positive (or for any other reason) is both wrong and inaccurate. 

As for why gay men and transgender women have been identified as vulnerable populations, there are a whole host of reasons. One is that, while anal sex can be practised by just about anyone regardless of sexual or gender identity, gay men and transgender women engage in anal sex more frequently. Vaginas and mouths self- lubricate, but anuses do not, so the chance of the skin tearing and bleeding is greater with anal sex than with other sexual practices. And as we know, blood is one of the primary vectors of HIV transmission. (Whether you’re gay, straight, bisexual, or transsexual, it is very important that you use condoms and sufficient lubrication during anal sex to prevent tearing and bleeding.)  

Another thing to bear in mind is that queer and transgender people face a tremendous amount of stigma on the basis of their sexual and gender identity, and the fear of violence and discrimination can prevent sexually marginalised people from getting accurate information about how to practice safe sex or having the confidence to insist on safe sex with their partners. It is very important to understand the complexity of social, behavioural, and political forces at work that lead some populations to being deemed “at risk”.

--Padma Govindan


I know that abstinence is the best way to prevent HIV, but I’ve already had sex before and I plan to continue having sex in the future. How do I prevent HIV infection if I am not going to be abstinent?

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You’re absolutely right in saying that abstinence is the best way to prevent HIV infection (and all other STDs). However, abstinence is not always a realistic course of action, particularly if you are already in a relationship. The best way of preventing the transmission of HIV during sex is by using a condom; when used correctly condoms are 99% effective in preventing STDs, and unlike other forms of contraception, condoms prevent both STDs and pregnancy.  

Condoms, either when placed on a penis or inserted in the anus or vagina, form a physical barrier that prevents sexual partners from exchanging fluids (like blood, semen, or vaginal fluids) during sexual intercourse. There are three different kinds of condoms: latex condoms, polyurethane and lambskin condoms, and female condoms (which are also made of plastic). Latex condoms are the most effective at preventing HIV transmission, but some people have an allergy to latex. You can use female condoms (which can be inserted in the vagina or anus) or polyurethane condoms if you have a latex allergy.  

But how does one use a condom correctly? A couple of things to bear in mind are that condoms are not reusable and that you have to be careful that the condom you’re using doesn’t have any rips or tears in it that could allow fluids to pass through. (This is one reason that you should never “double up” or layer two condoms at once during sex. You may feel safer, but the friction of the two condoms rubbing against each other may cause tearing.) Make sure you store your condoms in a cool, dry place and never use expired condoms. And as far as lubrication goes, oil-based lubricants are fine for polyurethane condoms, but they can break down latex, so make sure you go for a water or silicone-based lube if you’re using a latex condom.   

Another way to prevent HIV transmission if you are planning to be sexually active is monogamy—that is, two people only having sex with each other and no outside sexual partners. If monogamy is something you and your partner can agree on, great! However, if you are not in a steady relationship or you and your partner prefer to remain non-monogamous, the best thing you can do is practice safe sex and use condoms with all of your sexual partners, including your primary partner. There’s always a risk of infection during any kind of sexual encounter, so it is important to be careful and ensure that you and your sexual partners are on the same page. 

--Padma Govindan


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