Wednesday, 14 March 2012

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

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


Sometimes I realise I've forgotten to take my medicines some hours after they were to be taken. Should I take them right away or should I just take the next dose when it is due?

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It is most important that you set certain reminders for yourself to ensure that this does not happen often. Occasionally it may happen with anybody but remember that this may compromise efficacy of the treatment. If it happens sometimes, it will depend on when you remember that you have missed the dose. If it is a few hours, take the missed dose immediately. If you remember it too close to the next dose then do not take double dose. Just take the next dose as scheduled.

--Vinay Kulkarni


I have done the ELISA test; I have got HIV index value .028. I want to know about index value, is it normal value for human body or early infection value for HIV?

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Index value is an intrinsic issue of the test used to compare test results against controls. As a person who has undergone the test you need not bother about it. The test is interpreted using "cut off" values and as your index is less than that, the interpretation is "Non reactive" or "Negative". If the test was performed after a reasonable window period was over (usually taken as 12 weeks after suspected risky behaviour, then you can relax, knowing that the test is NEGATIVE and there is no need to repeat the test. It DOES NOT indicate early infection.

--Vinay Kulkarni


I have recently been diagnosed as HIV-positive. What food should I eat? I travel a lot.

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Being positive does not necessarily mean restrictions on your travel or food. There are a few things that everyone should follow:

  • Do not drink water from just any source. Whenever possible have clean bottled drinking water. At home use boiled and cooled drinking water.
  • Avoid food that is open and where the cleanliness cannot be guaranteed.
  • Avoid eating exotic meats and mutton.
  • Travellers’ diarrhoea is a common problem so carry capsule Imodium (Loperamide). The dose is two capsules after the first motion and one capsule after every further motion. The maximum is 14 milligrams per day (each capsule is 2 mg). However it is best to consult your doctor if the diarrhoea doesn’t stop after taking the first two capsules.
  • To avoid dehydration and fatigue while on tour, drink adequate quantities of water or oral rehydration solution (available at most chemists).
  • Since fruits are a good source of energy eat fruits whose skin can be peeled off such as banana, orange and mosumbi (sweet lime). Carry chocolates which you can eat if there is no time to have a proper meal.
  • Avoid oily, spicy and fried foods.

--Dr Deodatta Gore


My five-year-old daughter is HIV-positive. Are there any restrictions on her activities? What kind of precautions should she take?

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There is no need to restrict any of her activities. The only precaution that you must take is for everyone to avoid contact with her blood. These children tend to have poor oral hygiene, and dental caries, so visit a dentist once in six months. Keep a milestones and growth chart. General precautions such as good personal hygiene, clean living conditions, clean drinking water and food are basics for the good health of any child.

--Deodatta Gore


I was trying to put the cover back on a needle after injecting a patient and got pricked by it. What should I do? Should I ask for the patient to be tested? Should I start medicine on my own?

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We would like to know more details about the needle stick injury, such as whether the needle was used for an IM or an IV injection, the health of the person who was being given the injection, and for which condition he was being injected. Also the kind of prick you have received – was it a superficial abrasion or a needle stick injury?

Here are the general precautions to take following a needle stick injury:

  • Let the wound bleed on its own if it’s a deep injury. Do not squeeze the injured finger.
  • Wash the wound with lots of soap and water.
  • Apply locally either spirit or ether or anything that contains adequate quantity of alcohol.

Following a needle stick injury, the accident should be discussed with the patient who was being injected, and the need for him to be tested for HIV should be explained. If the patient tests positive for HIV then the question of giving post-exposure prophylaxis (PEP) to the health care worker comes up. If the source is negative no PEP is given.

Most of the books say “Do not panic” following a needle stick injury. But we must be practical. Everyone is afraid of getting HIV following such an accident no matter what the books say. Hence details of the accident should be thoroughly discussed with the health care worker and the future line of management should be decided.

The chances of transmission of HIV through needle stick injury is 0.3% (that is, if 1000 people receive needle stick from a known HIV-positive source then on an average 3 of them will get sero-converted. The chances of sero-conversion can further be minimised by taking post exposure prophylaxsis within one hour of the needle stick injury. This stops the virus from replicating in the body in large numbers and whatever few viral particles have entered the body are taken care of by the body’s immune system.

There are certain general precautions that also need to be followed:

  • If the health care worker has received a needle stick injury from a known HIV positive source he should treat himself as a reactive individual and take the following precautions: Refrain himself from doing any interventional surgery, and abstain from having sex for six months or use a condom.
  • The HCW should test himself for sero-conversion at six weeks, three months and six months. If the test after six months is negative, then we can surely say that the risk of him getting HIV from that particular prick is zero.
  • Here are the few most important tips to prevent needle stick injury:
  • The injection area should not be a crowded place. It has to be an isolated, clean set-up.
  • The needle should never be recapped.
  • The injections should not be administered in a hurry no matter what the OPD load is.
  • A needle and syringe dispenser should be placed within reach so that the needle and syringe can be disposed of immediately.
  • Special care should be taken while injecting children, unconscious patients etc. They are likely to move while injecting which might lead to accidental needle sticks.

There are many technical points that need to be discussed with the health care worker which are not mentioned here. Needle stick should be reported to a higher authority of the institution and a register should be maintained. For private practitioners, the first dose of PEP is always made available at district civil hospitals.

--Deodatta Gore


My wife, 30 years old, is suffering from MDR-TB for one-and-a-half months (total period - seven months running). She has been given the following medicine: Ofloxacin 500 mg x2, Ethionamide 250 x2, Kanamycin-750x1, Clarithromycin-500 x2, PZA-100 x1, Ethambutol-1000 x1. Kindly tell me what better treatment can be given to her.

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The best way to determine treatment is to get a culture and drug sensitivity report and plan treatment accordingly. Having said that, if the sputum or bronchoalveolar lavage is showing no AFB (Acid fast bacilli) now, then the regimen is working. The treatment for MDR-TB is much more prolonged. Consult your physician to decide the duration of treatment. 

--Vinay Kulkarni  


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